Visits & medical services prices at South Big Horn County Hospital (Three Rivers Health)

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

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

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ProcedureCash priceGross charge× Medicare
Airway inhalation treatment (94640) $108.68 $144.90 0.5×
Application of a modality to 1 or more areas; contrast baths, each 15 minutes Other Outpatient (97034) $34.28 $45.70
Application of a modality to 1 or more areas; iontophoresis, each 15 minutes Other Outpatient (97033) $113.78 $151.70
Application of a modality to 1 or more areas; ultrasound, each 15 minutes Other Outpatient (97035) $79.65 $106.20
Application of a modality to 1 or more areas; vasopneumatic devices Other Outpatient (97016) $95.62 $127.50
Behavioral & qualit analysis voice and resonance (92524) $258.15 $344.20
Cardioversion elective external (92960) $822.45 $1,096.60 1.2×
Chemo anti-neopl sq/im (96401) $179.40 $239.20 2.4×
Chemo hormon antineopl sq/im (96402) $78.07 $104.10 1.1×
Chemo IV infus each addl seq (96417) $157.05 $209.40 2.1×
Chemo IV infusion addl hr (96415) $68.55 $91.40 0.9×
Chemo IV push addl drug (96411) $135.60 $180.80 1.8×
Chemother prolong infuse w/pump (96416) $316.42 $421.90 0.9×
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug (96413) $322.73 $430.30 1.0×
Chemotherapy administration; intravenous, push technique, single or initial substance/drug (96409) $248.70 $331.60 0.7×
Color/duplex Doppler, complete (93975) $350.10 $466.80 1.4×
Color/duplex Doppler, limited (93976) $421.80 $562.40 3.9×
Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or… (97537) $78.53 $104.70
Cpr (92950) $1,038 $1,384 4.7×
Critical care ill/injured patient init 30-74 min (99291) $1,494.98 $1,993.30 1.8×
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study Age Under 21 (93978) $610.05 $813.40 2.5×
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study Age Under 21 (93979) $339.60 $452.80 3.2×
Duplex scan of extracranial arteries; complete bilateral study Age Under 21 (93880) $564 $752 2.3×
Duplex scan of extracranial arteries; unilateral or limited study Age Under 21 (93882) $382.50 $510 3.6×
Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study Age… (93970) $679.42 $905.90 2.8×
Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study Age… (93971) $685.80 $914.40 6.4×
Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93925) $657.22 $876.30 2.7×
Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93926) $397.95 $530.60 3.7×
Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93930) $657.22 $876.30 2.7×
Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93931) $397.95 $530.60 3.7×
Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed,… (93307) $1,240.12 $1,653.50 5.1×
EKG 12 lead tracing only (93005) $212.62 $283.50 3.5×
Emergency department visit high mdm (99285) $1,507.28 $2,009.70 2.5×
Emergency department visit low mdm (99283) $615.79 $821.05 2.2×
Emergency department visit may not req phys/qhp (99281) $236.77 $315.70 2.7×
Emergency department visit moderate mdm (99284) $1,055.25 $1,407 2.5×
Emergency department visit straightforward mdm (99282) $369.30 $492.40 2.4×
Eval of Oral and Pharyngeal Swallowing - Eval of Oral and Pharyngeal Swallowing Fx Chg (92610) $200.85 $267.80
Evaluation of speech fluency (92521) $312.45 $416.60
Evaluation of speech sound production articulate (92522) $262.20 $349.60
External ECG rec>48hr<7d recording (93242) $91.12 $121.50 2.4×
External ECG rec>7d<15d recording (93246) $91.12 $121.50 2.4×
External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data… (93229) $253.35 $337.80 0.7×
Fluidotherapy (97022) $103.57 $138.10
Hot/cold pack (97010) $31.88 $42.50
Im adm intransl/oral 1 vaccine (90473) $39.08 $52.10 0.5×
Immunization administration (90471) $43.65 $58.20 0.6×
Infrared therapy (97026) $60.30 $80.40
Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug (96375) $154.12 $205.50 3.2×
Injection,Therap/Proph/Diagnost, IV Push, Initial Drug (96374) $174.15 $232.20 0.8×
Irrigaj implntd venous access drug delivery syst (96523) $102.38 $136.50 1.7×
IV infusion hydration each additional hour (96361) $93.45 $124.60 2.0×
IV infusion hydration initial 31 min-1 hour (96360) $320.25 $427 1.5×
IV infusion ther proph addl sequential to 1 hr (96367) $160.73 $214.30 2.2×
IV infusion therapy/prophylaxis /dx 1st to 1 hr (96365) $360.98 $481.30 1.7×
IV tx, each additional hour (96366) $128.55 $171.40 2.7×
Lwr xtr vasc stdy bilat (93924) $650.03 $866.70 2.9×
Motion fluoroscopic evaluation of swallowing function by cine or video recording Other Outpatient (92611) $215.92 $287.90
Non-invasive physiologic study extremity 3 levels (93923) $297.38 $396.50 1.3×
Occupational therapy eval high complex 60 mins (97167) $209.62 $279.50
Occupational therapy eval low complex 30 mins (97165) $209.62 $279.50
Occupational therapy eval mod complex 45 mins (97166) $209.62 $279.50
Oral function therapy (92526) $200.10 $266.80
Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper… (97760) $128.62 $171.50
Ot manual therapy ea 15 min (97140) $100.20 $133.60
Ot neuromuscular re-education (97112) $107.02 $142.70
Ot paraffin bath (97018) $87.68 $116.90
OT Therapeutic Activities Charges (97530) $110.40 $147.20
Ot wheelchair management (97542) $74.78 $99.70
Phlebotomy therapeutic (99195) $66.15 $88.20 0.5×
Physical therapy evaluation high complex 45 mins (97163) $209.62 $279.50
Physical therapy evaluation low complex 20 mins (97161) $209.62 $279.50
Physical therapy evaluation mod complex 30 mins (97162) $209.62 $279.50
Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes Other… (97761) $98.02 $130.70
Pt gait training 15 min (97116) $100.20 $133.60
Pt physical performance test (97750) $138.90 $185.20
Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation,… (97535) $101.32 $135.10
Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands,… (97533) $117.22 $156.30
Speech sound lang comprehen (92523) $898.80 $1,198.40
Standardized cognitive performance testing (96125) $243.82 $325.10
Therapeutic procedure(s), group (2 or more individuals) Other Outpatient (97150) $25.65 $34.20
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement… (97124) $87.68 $116.90
Therapeutic prophylactic/dx injection subq/im (96372) $40.58 $54.10 0.6×
Tte f-up or lmtd (93308) $723.60 $964.80 3.0×
Tte w/doppler complete (93306) $1,240.12 $1,653.50 2.2×
Tx of Speech/Lang/Voice/Comm/Auditory Chg (92507) $421.05 $561.40
Upr/l xtremity art 2 levels (93922) $191.32 $255.10 1.4×