Visits & medical services prices at Summit Pacific Medical Center

Elma, WA · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
1St psyc collab care mgmt (99492) $240
Advance care planning first 30 mins (99497) $286
Airway inhalation treatment (94640) $210.50
Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) $76
Assessment of aphasia per hr (96105) $341
Bedside Swallowing Eval (92610) $256
Behavioral and qualitative analysis of voice and resonance (92524) $312
Brief Emotional/Behavioral Assessment (96127) $21
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $245
Canalith Repositioning Procedure (95992) $137
Cardiac Stress Tst,Tracing Only (93017) $587
Cardiopulmonary resuscitation (92950) $1,535
Cardioversion (92960) $879
Care mgmt svc bhvl hlth cond (99484) $87
Caregiver hlth risk assmt score doc stnd instrm (96161) $19
Cbt 1st hour (94644) $1,241
Chemother, IV infusion, 1 hr (96413) $568
Chemother, IV infusion, ea add hr (96415) $125
Chemotx admn IV push tq 1/1st sbst/drug (96409) $422
Chronic care management services 1st 20 min (99490) $128
Color/duplex Doppler, complete (93975) $1,877
Color/duplex Doppler, limited (93976) $1,594
Complex chronic care mgmt svc 1st 60 min cal mo (99487) $142
Cpap/bipap (94660) $191
Cpt initial (94667) $489
Critical care (99291) $2,064
Debridement Open Wound 20 Sq Cm< (97597) $239
Dup-Scan Aorta Ivc Iliac Vascl/Bpgs Complete (93978) $1,875
Dup-scan artl infl&ven o/f pen vsl compl (93980) $1,174
Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study (93925) $1,626
Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) $1,498
Dup-Scan Uxtr Art/Artl Bpgs Compl Bi Study (93930) $1,393
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study (93931) $990
Dup-Scan Xtr Veins Complete Bilateral Study (93970) $1,928
Dup-scan xtr veins unilateral/limited study (93971) $1,178
Duplex scan extracranial art compl bi study (93880) $1,977
Echo Heart Xthoracic,Limited (93308) $614
Echo transesophageal (93312) $3,078
Echo tthrc r-t 2d w/wo m-mode rest&strs cont ECG (93351) $2,725.50
Electrocardiogram Tracing (93005) $63.75
Er level 1 (99281) $276.50
Er level ii (99282) $537.50
Er level iii (99283) $801.50
Er level IV (99284) $1,517
Er level v (99285) $2,239
Eval speech sound production (92522) $327
Evaluate Pt Use Of Inhaler (94664) $65
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with… (92607) $558
Evaluation of speech fluency (92521) $397
External ECG rec>48hr<7d recording (93242) $61
External ECG rec>7d<15d recording (93246) $61
Imm admn sarscov2 vaccine single dose (90480) $44
Immune Admin Oral/Nasal (90473) $23
Immunization Admin (90471) $28.50
Induction of arrhythmia by electrical pacing (93618) $1,267
Inital newborn e/m (99460) $350
Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and… (99463) $300
Interrogate subq defib (93261) $318
Irrig drug delivery device (96523) $277
IV infusion hydration each additional hour (96361) $230
IV infusion hydration initial 31 min-1 hour (96360) $849
IV infusion ther proph addl sequential to 1 hr (96367) $454.50
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $1,027.50
IV infusion, therap/proph/diagnost,initial,ea add hour (96366) $282
IV push ea addl new drug (96375) $334.50
IV push initial (96374) $843.50
Manual therapy 15 min (97140) $107
Massage 15 min (97124) $89
Mechanical traction (97012) $73
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $102
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $111
Motion Fluor Eval Swlng Funcj C/V Rec (92611) $353
Multiple Sleep Latency Test (95805) $2,458
Neg press wound tx >50 cm (97608) $515.50
Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) $441
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $106
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $343
Non-Invas Physiologic Std Extremity Art 2 Level (93922) $592.50
Nonphysician Telephone Assessment 11-20 Min (98967) $72
Nonphysician Telephone Assessment 21-30 Min (98968) $107
Nonphysician Telephone Assessment 5-10 Min (98966) $38
Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) $134
Osteopathic Manipulative Tx 1-2 Body Regions (98925) $87
Osteopathic manipulative tx 3-4 body regions (98926) $133
Osteopathic manipulative tx 5-6 body regions (98927) $174
Ot eval high complex 60 min (97167) $276
Ot eval low complex 30 min (97165) $289
Ot eval mod complex 45 min (97166) $276
Ot Orthotics/Prosth Mgmt &/Trainj Sbsq Enctr 15 Min (97763) $137
Ot re-evaluation (97168) $171
Ot therapeutic activity 15 min (97530) $123
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $322
Outpatient Cardiac Rehab W/O Cont Ecg Monitor (93797) $260
Phlebotomy therapeutic (99195) $720
Pm device eval in person (93288) $194
Pm device progr eval dual (93280) $305
Pm device progr eval multi (93281) $357
Pm device progr eval sngl (93279) $260
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $2,458
Principal care management services, for a single high-risk disease, with the following required elements: one complex… (99426) $142
Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) $44
Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs Njxs (95117) $114
Psych diag eval w/med srvcs (90792) $508
Psychiatric diagnostic evaluation (90791) $360
Psychoanalysis (90845) $296
Psytx crisis initial 60 min (90839) $401
Pt Electrical Stimulation (97032) $82
Pt eval high complex 45 min (97163) $262
Pt eval low complex 20 min (97161) $262
Pt eval mod complex 30 min (97162) $262
Pt gait training 15 min (97116) $102
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $120
Pt re-evaluation (97164) $148
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $124
Pt-focused hlth risk assmt (96160) $19
Pulmonary stress test simple (94618) $70
Pure Tone Audiometry Air Only (92552) $115
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $240
Rt Chest Wall Manipulation,Subsequent (94668) $4,238
Sbsq psyc collab care mgmt (99493) $216
Sleep study unattended (95806) $942
Slp caregiver training 1st 30 min (97550) $111
Smoking cessation > 10 min (99407) $74
Speech sound lang comprehen (92523) $608
Spirometry (94010) $133
Standardized Cognitive Performance Testing (96125) $386
Stress echo (93350) $2,423
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $85
Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes (97130) $83
Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) $360
Therapeutic prophylactic/dx injection subq/im (96372) $279
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $45.50
Trans Care Mgmt 14 Day Disch (99495) $399
Trans Care Mgmt 7 Day Disch (99496) $575
Tte w/doppler, complete (93306) $2,140.50
Tte W/O Doppler Complete - Tte Complete No Doppler No Color (93307) $1,311.50
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $277
Tx Speech Language Voice Commj Auditry 2/>Indiv (92508) $198
Tx Swallowing Dysfunction&/Oral Funcj Feeding (92526) $302
Upr/lxtr art stdy 3+ lvls (93923) $1,330
Vent mgmt inpat init day (94002) $1,880
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $1,324
Vital capacity, total (94150) $181
Wheelchair Mgmt Ea 15 Min (97542) $111