Visits & medical services prices at Summit Healthcare Regional Medical Center

Show Low, AZ · every code in this section with a posted price and a Medicare benchmark.

219 codes. Prices are the hospital's own posted facility charges.

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ProcedureCash priceGross charge× Medicare
1St psychiatric collab care mgmt 1st 70 mins (99492) $230.46
Airway inhalation treatment (94640) $379.71
Appl on-body injector for timed subq injection (96377) $250.85
Assessment of aphasia (96105) $359.73
Asstv Technol Assmt Dir Cntct W/Reprt Ea 15 Min (97755) $131.78
Behavioral and qualitative analysis of voice and resonance (92524) $435.84
Bfb training 1st 15 min (90912) $125.88
Bfb training ea addl 15 min (90913) $83.90
Biofeedback training any modality (90901) $149.34
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $585.28
Canalith Repositioning (95992) $167.30
Car seat/bed test 60 min (94780) $126.18
Cardiac Stress Tst,Tracing Only (93017) $2,281.78
Cardiopulmonary resuscitation (92950) $1,837.47
Cardioversion (92960) $2,458.21
Cath Cath Place/Coronary Angio, Img Super/Interp, Bypass Angio (93455) $12,165.87
Cath Cath Place/Coronary Angio, Img Super/Interp,W Right Heart Cath (93456) $12,165.87
Cath Place/Coron Angio, Img Super/Interp, Bypass Angio,W L Hrt Ventric (93459) $12,165.87
Cath Place/Coron Angio, Img Super/Interp,W Left Heart Ventriculography (93458) $20,564.50
Cbt 1st hour (94644) $427.28
Chemo Admin Peritoneal Cavity (96446) $725.50
Chemo Hormon Antineopl Sq/Im (96402) $438.48
Chemo IV push addl drug (96411) $433.68
Chemo Iv Push Sngl Drug (96409) $479.32
Chemo prolong 8+ hrs infuse w/pump (96416) $988.48
Chemother, IV infusion, 1 hr (96413) $1,195.01
Chemother, IV infusion, ea add hr (96415) $265.56
Chemother,Non-Hormone Anti-Neopl, Sub-Q/Im (96401) $593.40
Chemotherapy, unspecified procedure (96549) $106.27
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $573
Color/duplex Doppler, complete (93975) $2,305.32
Color/duplex Doppler, limited (93976) $1,957.04
Cont Gluc Monitoring Patient Provided Equipment (95249) $206.58
Coronary artery angio s&i (93454) $13,844.63
Cpap initiation and management (94660) $1,095.58
Cpt initial (94667) $257.57
Critical care (99291) $4,543.94
Debridement Open Wound 20 Sq Cm< (97597) $570.14
Demo &/or eval,pt use,aerosol device (94664) $268.60
Dialysis other/than hemodialysis 1 phys/qhp eval (90945) $2,125.68
Dup-Scan Aorta Ivc Iliac Vascl/Bpgs Complete (93978) $740.12
Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study (93925) $3,419.30
Dup-scan lxtr art/artl bpgs uni/lmtd study (93926) $882.78
Dup-Scan Uxtr Art/Artl Bpgs Compl Bi Study (93930) $1,804.23
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study (93931) $1,179.64
Dup-scan xtr veins unilateral/limited study (93971) $2,104.92
Duplex hemodialysis access (93990) $521.36
Duplex scan extracranial art compl bi study (93880) $2,718.68
Echo Heart Xthoracic,Limited (93308) $729.70
Echo transesophageal (93312) $2,764.58
Echo Transthoracic - Congenital Tte Complete (93303) $1,828.99
EEG awake drowsy (95816) $987.62
EKG (93005) $449.16
EMG cranial nerve bilat (95868) $428.06
EMG cranial nerve unilat (95867) $349.34
EMG four extremities (95864) $753.79
EMG one extremity (95860) $433.76
EMG thoracic paraspinal (95869) $230.04
EMG three extremities (95863) $636.38
EMG two extremities (95861) $333.37
Er level 1 (99281) $472.60
Er level ii (99282) $972.13
Er level iii (99283) $1,213.41
Er level IV (99284) $1,899.31
Er level v (99285) $2,815.62
Eval&/Fitg Voice Prostc Dev Suplmnt Oral Speec (92597) $378.45
Evaluation of speech fluency (92521) $430.79
Evaluation of speech sound production (92522) $353.12
Evaluation of swallowing function (92610) $337.93
Evaluation with prescription of speech-generating alternative (92607) $687.40
External Ecg Scanning Analysis Report (93226) $1,397.61
Gastroesophag Reflx Test W/Intrluml Imped Eltrd (91037) $732.01
Gastroesophag reflx test w/telemtry ph eltrd (91035) $3,609.34
Group Therapeutic Procedures (97150) $64.07
Hemodialysis (90935) $1,621.31
Holter Monitor Recording (93225) $915.82
Icd Device Interrogate (93289) $401.67
Ilr Device Eval Progr (93285) $212.70
Immunization Admin (90471) $168.22
Inhlj Brncl Challenge Tstg W/Histamine/Methachol (95070) $1,008.92
Interrog dev eval icpms phys/qhp in person (93290) $207.32
Interrog dev eval scrms phys/qhp in person (93291) $160.25
Interrogate subq defib (93261) $148.20
Irrigaj Implntd Venous Access Drug Delivery Syst (96523) $270.36
Ischemic limb exercise test (95875) $348.12
IV infusion hydration each additional hour (96361) $273.35
IV infusion hydration initial 31 min-1 hour (96360) $639.60
IV infusion, therap/proph/diagnost,add infusion,1st hour (96367) $325.45
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $847.96
IV infusion, therap/proph/diagnost,initial,ea add hour (96366) $221.27
IV push initial (96374) $361.74
Manual therapy 15 min (97140) $149.67
Massage 15 min (97124) $114.42
Mechanical chest wall oscillation (94669) $760.18
Mechanical traction (97012) $96.02
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $81.65
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $94.02
Methacholine challenge (94070) $591.12
Mnt Group Ea 30 Min (97804) $51.40
Motility study esophagus (91010) $1,294.54
Motion Fluor Eval Swlng Funcj C/V Rec (92611) $515.21
Multiple sleep latency test (95805) $1,920.52
Nasopharyngoscopy (92511) $458.57
Needle EMG lmtd std musc 1 xtr/non-limb uni/bi (95870) $191.94
Needle EMG w/1 fiber electrode quan meas jitter (95872) $554.73
Neg press wnd tx </=50 sq cm (97607) $1,072.77
Neg press wound tx >50 cm (97608) $1,072.77
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $330.98
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $457.62
Nerve conduction studies 13/> studies (95913) $1,107.34
Nerve Conduction Studies 3-4 Studies (95908) $233.42
Nerve Conduction Studies 9-10 Studies (95911) $416.34
Nerve conduction studies; 1-2 studies (95907) $201.38
Nerve conduction studies; 11-12 studies (95912) $1,073.84
Nerve conduction studies; 5-6 studies (95909) $291.68
Nerve conduction studies; 7-8 studies (95910) $304
Neurobehavioral Status Exam (96116) $244.56
Neuromuscular junction test (95937) $492.45
Newborn resuscitation (99465) $991.41
Non-Invas Physiologic Std Extremity Art 2 Level (93922) $501.19
Non-Invasive Physiologic Study Extremity 3 Levls (93923) $569.20
Noninvasive Ear/Pulse Oximetry Overnight Monitor (94762) $575.64
Nrpsyc tst eval phys/qhp 1st (96132) $282.39
Orthotics mgmt & traing initial enctr ea 15 mins (97760) $133.70
Ot Community/Work Reintegration Trainj Ea 15 Min (97537) $70.47
Ot Contrast Bath Ea 15 Min (97034) $97.92
Ot eval high complex 60 min (97167) $537.20
Ot eval low complex 30 min (97165) $398.58
Ot eval mod complex 45 min (97166) $468.20
Ot Orthotics/Prosth Mgmt &/Trainj Sbsq Enctr 15 Min (97763) $145.20
Ot Prosthetic Training, Each 15 Min (97761) $124.11
Ot Range Motion Measure,Each Extrem (95851) $111.38
Ot re-eval est plan care (97168) $287.44
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $314.35
Outpatient cardiac rehab w/o cont ECG monitor (93797) $329.38
Paraffin bath (97018) $68.54
Phy/qhp op pulm rhb w/o mntr (94625) $304.67
Plethysmography (94726) $182.22
Pm device eval in person (93288) $207.32
Pm device progr eval dual (93280) $210.32
Pm device progr eval multi (93281) $229.54
Pm device progr eval sngl (93279) $189.90
Pm/Icd Remote Tech Serv (93296) $173.71
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $3,239.68
Polysom <6 yrs 4/> paramtrs (95782) $2,862.41
Polysom <6 Yrs Sleep W/Cpap/Bilvl Vent 4/> Param (95783) $2,768.43
Polysom Any Age Sleep Stage 1-3 Addl Param Attnd (95808) $2,332.59
Positional Nystagmus Test (92542) $275.64
Prgrmg Dev Eval Implantable Subq Lead Dfb System (93260) $163.03
Prgrmg Eval Implantable Dfb - Cardiac Device Clinic Icd Biv Chamber (93284) $363.33
Programming of dual lead implantable defibrillator system (93283) $329.70
Programming of single lead implantable defibrillator system (93282) $271.59
Prq card revasc chronic 1vsl (92943) $24,855.08
Prq Card Stent W/Angio 1 Vsl (92928) $18,111.19
Prq Card Stent/Ath/Angio (92933) $24,855.08
Prq revasc byp graft 1 vsl (92937) $24,855.08
Prq trluml coronary angio/atherect one art/brnch (92924) $25,166.11
Prq trluml coronary angioplasty one art/branch (92920) $18,311.74
Psych diag eval w/med srvcs (90792) $465.71
Psychiatric diagnostic evaluation (90791) $389.70
Psyl/nrpsycl tst phys/qhp 2+ tst 1st 30 min (96136) $64.79
Psytx crisis initial 60 min (90839) $479.47
Pt Aquatic Therapy/Exercises (97113) $181.60
Pt Electric Current Therapy (97033) $81.95
Pt Electrical Stimulation (97032) $61.52
Pt eval high complex 45 min (97163) $538.47
Pt eval low complex 20 min (97161) $400.50
Pt Gait Training Therapy (97116) $143.28
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $233.98
Pt Physical Performance Test (97750) $146.47
Pt Physical Therapy Evaluation Mod Complex 30 Mins (97162) $469.48
Pt re-evaluation (97164) $270.83
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $163.08
Pt Ultrasound Therapy (97035) $200.76
Pulmonary stress testing (94618) $301.46
R & l hrt cath w/njx l ventriculog img s&i (93453) $12,165.87
R & L Hrt Cath Winjx Hrt Art& L Ventr Img (93460) $21,810.96
R hrt art/grft angio (93457) $12,165.87
R& L Hrt Cath W/Injec Hrt Art/Grft& L Vent I (93461) $12,165.87
Refill/Maint Pump/Resvr Syst (96522) $504.54
Refill/maint, portable pump (96521) $450.49
Rem Interrog Scrms <30 D Phys/Qhp (93298) $144.97
Rem mntr physiol param 1st dev supply ea 30 days (99454) $135.65
Rem mntr physiol param 1st set up pt educaj eqp (99453) $433.61
Remote 30 Day Ecg Rev/Report - Cardiac Event Monitor (93270) $368.46
Right heart cath (93451) $7,726.92
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $345.96
Rom meas&reprt hand w/wo comparison normal sid (95852) $98.08
Rt Chest Wall Manipulation,Subsequent (94668) $183.38
Sensory Integration Ea 15 Min (97533) $143.28
Sleep study attended (95807) $1,536.97
Slp Stdy Unatnd W/Hrt Rate/O2 Sat/Resp/Slp Time (95800) $490.84
Speech group therapy (92508) $121.84
Speech sound lang comprehen (92523) $733
Spirometry (94010) $203.78
Spontaneous Nystagmus Test (92541) $492.42
Standardized Cognitive Performance Testing (96125) $1,683.27
Stress echo (93350) $2,726.09
Stress Tte Complete (93351) $1,796.27
Temp transcutaneous pacing (92953) $1,744.65
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $66.65
Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes (97130) $64.63
Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) $447.68
Ther/prop/diag inj/inf proc (96379) $180.88
Ther/Proph/Diag Inj Sc/Im (96372) $373.65
Therapeutic Activities (97530) $200.76
Therapeutic phlebotomy (99195) $560.66
Tte W/Doppler Complete - Tte Complete W/ Contrast (93306) $531.15
Tte W/O Doppler Complete - Tte Complete No Doppler No Color (93307) $2,467.90
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $268.72
Tx Swallowing Dysfunction&/Oral Funcj Feeding (92526) $332.86
Tx/Pro/Dx Inj New Drug Addon (96375) $341.23
Ultraviolet Therapy (97028) $66.63
Unlisted pulmonary service/procedure (94799) $1,200.04
Vasc Duplex Extrem Venous,Bilat (93970) $3,316.44
Vasopneumatic device (97016) $89.62
Ventilation assist & mgmt inpatient 1st day (94002) $4,624.24
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $1,770.18
Wheelchair Mgmt Ea 15 Min (97542) $176.53