Visits & medical services prices at Memorial Hospital of Sweetwater County

Rock Springs, WY · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Administration of chemotherapy into fluid-filled space between the tissue that cover the brain and spinal cord (96450) $1,080 $1,080 3.2×
Advance care planning first 30 mins (99497) $310 $310 3.0×
Aerosol inhalation pentamidine (94642) $445 $445 2.0×
Airway inhalation treatment (94640) $146 $146 0.7×
Allergy injection single (95115) $34 $34 0.7×
Appl on-body injector for timed subq injection (96377) $201 $201 4.2×
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes Other Outpatient (97032) $84 $84
Application of a modality to 1 or more areas; iontophoresis, each 15 minutes Other Outpatient (97033) $57 $57
Application of a modality to 1 or more areas; ultrasound, each 15 minutes Other Outpatient (97035) $125 $125
Behav assmt w/score & docd/stand instrument (96127) $18 $18 0.5×
Behavioral & qualit analysis voice and resonance (92524) $359 $359
Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when… (90912) $181 $181
Bioimpedance-derived physiologic cardiovascular analysis (93701) $102 $102 0.8×
Bipap initial day (94660) $867 $867 3.9×
Breathing capacity test (94010) $280 $280 1.3×
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration (94060) $661 $661 1.7×
Cardiovascular stress test (93017) $1,085 $1,085 4.9×
Cardioversion elective external (92960) $2,018 $2,018 3.0×
Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a… (99484) $156 $156 4.1×
Caregiver training 1st 30 min (97550) $145 $145
Caregiver training ea addl 15 (97551) $72 $72
Chemo anti-neopl sq/im (96401) $460 $460 6.3×
Chemo hormon antineopl sq/im (96402) $310 $310 4.2×
Chemo IV infus each addl seq (96417) $452 $452 6.1×
Chemo IV infusion addl hr (96415) $406.50 $406.50 5.5×
Chemo IV push addl drug (96411) $383 $383 5.2×
Chemother prolong infuse w/pump (96416) $1,332 $1,332 3.9×
Chemotherapy administration into the peritoneal cavity via implanted port or catheter (96446) $1,009 $1,009 3.0×
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug (96413) $1,136 $1,136 3.4×
Chemotherapy administration; intravenous, push technique, single or initial substance/drug (96409) $774 $774 2.3×
Chemotherapy injection, subarachnoid or intraventricular via subcutaneous reservoir, single or multiple agents (96542) $620 $620 1.8×
Chest physiotherapy initial (94667) $287 $287 2.1×
Chron care mgmt srvc 20 min (99490) $146 $146 1.4×
Color/duplex Doppler, complete (93975) $2,263 $2,263 9.3×
Color/duplex Doppler, limited (93976) $2,078 $2,078 19.5×
Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or… (97537) $108 $108
Complex chronic care management services for two or more chronic conditions, first 60 minutes of clinical staff time… (99487) $319 $319 1.8×
Comprehensive hearing test (92557) $145 $145 1.1×
Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour (94644) $236 $236 1.7×
Cpr (92950) $1,561 $1,561 7.1×
Critical care ill/injured patient init 30-74 min (99291) $2,930 $2,930 3.5×
Debridement open wound 20 sq cm< (97597) $323.50 $323.50 1.6×
Delivery/birthing room resuscitation (99465) $483 $483 0.7×
Dup-scan artl infl&ven o/f pen vsl compl (93980) $2,047 $2,047 19.2×
Duplex hemodialysis access (93990) $1,544 $1,544 14.5×
Duplex scan artl infl&ven o/f hemo compl bi std (93985) $1,456 $1,456 6.0×
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study Age Under 21 (93978) $2,568 $2,568 10.5×
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study Age Under 21 (93979) $1,961 $1,961 18.4×
Duplex scan of extracranial arteries; complete bilateral study Age Under 21 (93880) $2,059 $2,059 8.4×
Duplex scan of extracranial arteries; unilateral or limited study Age Under 21 (93882) $1,342 $1,342 12.6×
Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study Age… (93970) $2,220 $2,220 9.1×
Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study Age… (93971) $1,029 $1,029 9.6×
Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93925) $2,206 $2,206 9.0×
Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93926) $1,893 $1,893 17.7×
Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93930) $2,419 $2,419 9.9×
Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93931) $1,735 $1,735 16.2×
ECG monit/reprt up to 48 hrs (93226) $438 $438 7.3×
EEG 41-60 minutes (95812) $294 $294 1.3×
EEG awake & asleep (95819) $1,085.50 $1,085.50 4.9×
EEG awake/drowsy (95816) $1,085.50 $1,085.50 4.9×
EEG coma or sleep only (95822) $1,085.50 $1,085.50 4.9×
EEG extended monitoring 61-119 minutes (95813) $2,097 $2,097 9.5×
EKG 12 lead tracing only (93005) $434 $434 7.2×
Emergency department visit high mdm (99285) $1,661 $1,661 2.7×
Emergency department visit low mdm (99283) $744 $744 2.7×
Emergency department visit may not req phys/qhp (99281) $454 $454 5.3×
Emergency department visit moderate mdm (99284) $1,136 $1,136 2.7×
Emergency department visit straightforward mdm (99282) $715.50 $715.50 4.6×
EMG thoracic paraspinal (95869) $339 $339 1.5×
End tidal co2 mntrng (crbn dxde exp gas dtrmntn by infrared analyzer) (94799) $1,108 $1,108 8.4×
Eval of Oral and Pharyngeal Swallowing - Eval of Oral and Pharyngeal Swallowing Fx Chg (92610) $371 $371
Evaluate pt use of inhaler (94664) $206 $206 0.9×
Evaluation of speech fluency (92521) $419 $419
Evaluation of speech sound production articulate (92522) $342 $342
External ECG rec>48hr<7d recording (93242) $679 $679 17.8×
External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes… (93225) $551 $551 4.1×
Gas dilut/washout lung vol w/wo distrib vent&vol (94727) $252 $252 1.1×
Gastroesophag reflx test w/telemtry ph eltrd (91035) $1,704 $1,704 1.9×
Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus through ileum, with interpretation and… (91110) $2,366 $2,366 2.6×
Immunization administration (90471) $205.50 $205.50 2.8×
Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant (99460) $334 $334 2.5×
Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and… (99463) $388 $388 2.9×
Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health… (99492) $500 $500 4.8×
Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug (96375) $215 $215 4.5×
Injection,Therap/Proph/Diagnost, IV Push, Initial Drug (96374) $368 $368 1.7×
Irrigaj implntd venous access drug delivery syst (96523) $353 $353 5.9×
Ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s) 95875 (95875) $472 $472 3.6×
IV infusion hydration each additional hour (96361) $308.50 $308.50 6.4×
IV infusion hydration initial 31 min-1 hour (96360) $654.50 $654.50 3.0×
IV infusion ther proph addl sequential to 1 hr (96367) $457 $457 6.2×
IV infusion therapy/prophylaxis /dx 1st to 1 hr (96365) $799 $799 3.7×
IV tx, each additional hour (96366) $272 $272 5.7×
Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent (94668) $235 $235 1.7×
Maximum voluntary ventilation (94200) $13 $13 0.2×
Mechanical chest wall oscillation lung function (94669) $287 $287 1.3×
Mechanical traction therapy (97012) $84 $84
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $78 $78
Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes… (97803) $46 $46
Methacholine challenge (94070) $1,174 $1,174 3.1×
Motion fluoroscopic evaluation of swallowing function by cine or video recording Other Outpatient (92611) $402 $402
Multiple sleep latency (95805) $2,898 $2,898 3.3×
Muscle test 3 limbs (95863) $749 $749 5.7×
Muscle test larynx (95865) $541 $541 4.0×
Nasopharyngoscopy (92511) $403 $403 2.0×
Ndl EMG 4 xtr w/wo related paraspinal areas (95864) $879 $879 6.7×
Needle electromyography 2 extremities with or without related paraspinal areas 95861 (95861) $606 $606 4.5×
Needle electromyography cranial nrv muscle uni (95867) $381 $381 1.7×
Needle electromyography hemidiaphragm (95866) $478 $478 3.6×
Needle electromyography using single fiber electrode, with quantitative measurement of jitter, blocking and/or fiber… (95872) $704 $704 3.2×
Needle electromyography; 1 extremity with or without related paraspinal areas (95860) $423 $423 3.1×
Needle EMG lmtd std musc 1 xtr/non-limb uni/bi (95870) $320 $320 2.4×
Needle measurement of electrical activity in muscles on both sides of body (95868) $499 $499 2.3×
Negative pressure wound therapy dme </= 50 sq cm (97605) $393 $393 1.9×
Nerve conduction studies 11-12 studies (95912) $919 $919 2.4×
Nerve conduction studies 13/> studies (95913) $1,007 $1,007 2.6×
Nerve conduction studies 3-4 studies (95908) $429 $429 1.9×
Nerve conduction studies 5-6 studies (95909) $514 $514 2.3×
Nerve conduction studies 7-8 studies (95910) $674 $674 1.8×
Nerve conduction studies 9-10 studies (95911) $809 $809 2.1×
Non-invasive physiologic study extremity 3 levels (93923) $669 $669 3.0×
Noninvasive ear/pulse oximetry overnight monitor (94762) $555 $555 4.2×
Nonphysician qualified health care professional online digital assessment and management, for an established patient,… (98972) $51 $51
Occupational therapy eval high complex 60 mins (97167) $358 $358
Occupational therapy eval low complex 30 mins (97165) $172 $172
Occupational therapy eval mod complex 45 mins (97166) $245 $245
Oral function therapy (92526) $333 $333
Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper… (97760) $137 $137
Osteopath manj 1-2 regions (98925) $111 $111 5.0×
Osteopath manj 3-4 regions (98926) $162 $162 7.3×
Osteopath manj 9-10 regions (98929) $305 $305 13.8×
Osteopathic manipulative tx 5-6 body regions (98927) $210 $210 9.5×
Osteopathic manipulative tx 7-8 body regions (98928) $255 $255 11.6×
Ot manual therapy ea 15 min (97140) $106 $106
Ot neuromuscular re-education (97112) $119 $119
Ot paraffin bath (97018) $42 $42
Ot re-evaluation (97168) $245 $245
OT Therapeutic Activities Charges (97530) $125 $125
Outpatient cardiac rehab w/cont ECG monitoring (93798) $328 $328 2.5×
Peripheral vascular rehab (93668) $74.50 $74.50 1.2×
Phlebotomy therapeutic (99195) $494 $494 3.6×
Phy/qhp op pulm rhb w/o mntr (94625) $152 $152 2.5×
Physical therapy evaluation high complex 45 mins (97163) $358 $358
Physical therapy evaluation low complex 20 mins (97161) $172 $172
Physical therapy evaluation mod complex 30 mins (97162) $245 $245
Polysom 6/>yrs sleep w/cpap 4/> addl param attnd (95811) $6,870 $6,870 7.8×
Prepj& allergen immunotherapy 1/mlt antigen (95165) $53 $53 1.1×
Professional services for allergen immunotherapy; 2 or more injections (95117) $38 $38 0.8×
Psychiatric diagnostic evaluation (90791) $13 $13 0.1×
Psytx crisis initial 60 min (90839) $508 $508 2.8×
Pt gait training 15 min (97116) $101 $101
Pt physical performance test (97750) $167 $167
Pt re-evaluation (97164) $245 $245
Pulm funct tst plethysmograp (94726) $317 $317 0.8×
Pulmonary stress testing (94618) $265 $265 1.9×
Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain… (95990) $547 $547 1.6×
Rem mntr physiol param 1st dev supply ea 30 d (99454) $218 $218 5.7×
Rem mntr physiol param 1st set up pt educaj eqp (99453) $67 $67 0.5×
Remote 30 day ECG rev/report (93270) $48 $48 1.3×
Respiratory flow volume loop (94375) $1,174 $1,174 5.3×
Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation,… (97535) $125 $125
Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands,… (97533) $104 $104
Sleep study unattended (95806) $494 $494 2.2×
Speech sound lang comprehen (92523) $705 $705
Stress tte only (93350) $1,804 $1,804 3.2×
Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care… (99493) $500 $500 4.8×
Telephone assmt&mgmt svc nqhp est pt 11-20 min (98967) $98 $98
Telephone assmt&mgmt svc nqhp est pt 21-30 min (98968) $143 $143
Telephone assmt&mgmt svc nqhp est pt 5-10 min (98966) $51 $51
Temp transcutaneous pacing (92953) $1,095 $1,095 1.6×
Test for hearing various pitches using earphone (92552) $121 $121 0.9×
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $282 $282
Ther ivntj cog funcj cntct ea addl 15 minutes (97130) $72 $72
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement… (97124) $97 $97
Therapeutic prophylactic/dx injection subq/im (96372) $211 $211 2.9×
Therapeutic services for the use of speech-generating device, including programming and modification Other Outpatient (92609) $410 $410
Tobacco use cessation intensive >10 minutes (99407) $139 $139 3.6×
Tobacco use cessation intermediate 3-10 minutes (99406) $58 $58 1.5×
Trans care mgmt 14 day disch (99495) $610 $610 4.5×
Trans care mgmt 7 day disch (99496) $805 $805 5.9×
Tte f-up or lmtd (93308) $1,136 $1,136 4.7×
Tte w/doppler complete (93306) $2,885 $2,885 5.2×
Tx of Speech/Lang/Voice/Comm/Auditory Chg (92507) $299 $299
Tympanometry (92567) $61 $61 1.6×
Unlisted allergy/clinical immunologic service or procedure (95199) $177 $177 6.0×
Upr/l xtremity art 2 levels (93922) $554 $554 4.1×
Ventilation ip/obs initial day (94002) $1,662 $1,662 2.6×
Ventilator subsequent day (94003) $1,497 $1,497 2.4×
Wound(s) care non-selective (97602) $181.50 $181.50 0.9×