PROCEDURE CHARGES / HOSPITAL may vary depending on circumstances. Prices subject to change. LABORATORY PROCEDURES Basic Metabolic Panel $112.00 80048 Comprehensive Metabolic Panel $140.00 80053 UA Micro $47.00 81015 C-Reactive Protein $73.00 86140 CBC $66.00 85025 Lipid Panel 4 $111.00 80061 Thyroid Stimulating Hormone $129.00 84443 Prothrombin Time $48.00 85610 UA w/o Micro $20.00 81003 LDL $57.00 83721 Urine Culture $74.00 87088 Manual Differential $25.00 85507 Hemogram $62.00 85027 Troponin $165.00 84484 Venipuncture (Lab Draw) $18.00 36415 THERAPY Electrical Stimulation $49.00 97014 Wound Debridement $134.00 97166 Physical Therapy Evaluation Moderate $192.00 97162 Therapeutic Exercise Charge $96.00 97110 Therapeutic Activities Charge $90.00 97530 Neuromuscular Re-education $92.00 97112 Manual Therapy Charge $95.00 97140 PT Gait Training Charges $88.00 97116 Vasopneumatic Devices $58.00 97016 Physical Therapy Evaluation Low $125.00 97162 GVH EMERGENCY DEPARTMENT PROCECURES Level 1 $245.00 99281 Level 2 $328.00 99282 Level 3 $495.00 99283 Level 4 $740.00 99284 Level 5 $1,266.00 99285 Hydration First Hour $362.00 96360 Hydration Additional Hour $150.00 96361 IV Injection Initial $193.00 96374 IV Injection Additional $140.00 96375 IV tx, First Hour $303.00 96365 IV tx, Additional Hour $150.00 96366 ER Laceration Repair Simple $382.00 12001 ER Laceration Repair Complex $844.00 13101 ER I&D Abscess $393.00 10060 Foreign Body Removal $677.00 10120 EKG $227.00 93005 Respiratory Treatment $125.00 94640 IMAGING/RADIOLOGY PROCEDURES CT Exams: CT Single Body Part w/o Contrast $1,353.00 73700 (i.e. knee, shoulder, spine, brain, abdomen) CT Single Body Part w/ Contrast $1,632.00 73701 CT Abdomen/Pelvis w/o Contrast $2,533.00 74176 CT Abdomen/Pelvis w/ Contrast $2,709.00 74177 MRI Exams: MRI Single Body Part w/o Contrast $1,601.00 73721 (i.e. knee, shoulder, spine, brain, abdomen) MRI Single Body Part $1,971.00 73723 w/ and w/o Contrast Ultrasound Exams: Ultrasound Abdomen Complete $608.00 76700 Ultrasound Pelvic $584.00 76856 Ultrasound Abdomen Limited $456.00 76705 Ultrasound Breast $212.00 76642 Ultrasound Transvaginal Scan $332.00 76830 Ultrasound Head & Neck $524.00 76536 X-Ray Exams XR Chest 2 Views $268.00 71020 XR Chest Single View $230.00 71010 XR Lumbar Spine $349.00 72100 XR Foot 3 Views $249.00 73630
PROCEDURE CHARGES / HOSPITAL may vary depending on circumstances. Prices subject to change. PROCEDURES Home Sleep Study $561.00 95800 Colonoscopy $5,743.40 45378 SI Joint Injections $1,180.00 27096 Facet Joint Injections First Level $402.00 64493 Facet Joint Injections Additional Level $402.00 64494 Injection Sacroiliac Joint Charge $1,180.00 27096 Epidural Steroid Injection Cervical. Thorasic $1,510.00 62321 Transforaminal or Selective Nerve Root Block Lumbar $2,135.00 64483 Transforaminal Additional Level $1,060.00 64484 SURGICAL PROCEDURES Please call 970-641-1456 and ask for the Admissions Department to obtain an estimate for surgical procedures. The pricing for all surgical procedures, both inpatient and outpatient, are quoted in a cost range. These procedures vary in price dependent on the surgical provider (surgeon) of the service. These prices do not include your physician s fees. Your surgeon and anesthesiologist will bill you separately. Surgeons use different equipment and implants (hip, knee and other replacement joints made by various manufacturers), and take varying amounts of time to perform the same procedure. The amount of time in the operating room may vary due to many factors, including the patient s health condition or the physician s approach to the particular procedure. Please obtain as much information from your surgeon as possible before calling the hospital to obtain an estimate. WWW.GUNNISONVALLEYHEALTH.ORG 970-641-1456 711 N. TAYLOR STREET GUNNISON, CO 81230
GENERAL SURGERY CLINIC PROCEDURE CHARGES / GENERAL SURGERY CLINIC New Patient Office Visit, Level 1 New Patient Office Visit, Level 2 New Patient Office Visit, Level 3 New Patient Office Visit, Level 4 New Patient Office Visit, Level 5 Est Patient Office Visit, Level 1 Est Patient Office Visit, Level 2 Est Patient Office Visit, Level 3 Est Patient Office Visit, Level 4 Est Patient Office Visit, Level 5 Office Consult, Level 2 Office Consult, Level 3 Office Consult, Level 4 ER Level Consult, Level 3 ER Level Consult, Level 4 Excision Benign Lesion Trunk (1.1 CM - 2.0 CM) Excision Benign Lesion Trunk (>4 CM) Excision Benign Lesion Scalp (1.1 CM - 2.0 CM) EGD EGD w/biopsy Laparoscopy, Appendectomy Colonoscopy Colonoscopy w/biopsy Colonoscopy w/snare Anoscopy Laparoscopy, Cholecystectomy Umbilical Hernia Repair Laparoscopy, Inguinal Hernia Repair $160.00 $273.00 $395.00 $606.00 $752.00 $74.00 $161.00 $267.00 $394.00 $527.00 $210.00 $340.00 $480.00 $520.00 $760.00 $1,200.00 $1,300.00 $1,600.00 $1,700.00 $2,200.00 $2,200.00 $1,590.00 99201 99241 99242 99243 99283 99284 11402 11406 11422 43235 43239 44970 45378 45380 45385 46600 47562 49585 49650 WWW.GUNNISONVALLEYHEALTH.ORG 970-641-1456 711 N. TAYLOR STREET GUNNISON, CO 81230
PROCEDURE CHARGES / FAMILY MEDICINE CLINIC New Patient Office Visit, Level I $160.00 New Patient Office Visit, Level II $273.00 New Patient Office Visit, Level III $395.00 New Patient Office Visit, Level IV $606.00 New Patient Office Visit, Level V $752.00 Est Patient Office Visit, Level I $74.00 Est Patient Office Visit, Level II $161.00 Est Patient Office Visit, Level III $267.00 Est Patient Office Visit, Level IV $394.00 Est Patient Office Visit, Level V $527.00 Office Consult, New or Est 15 min Initial Preventative Care, New Pt $280.00 Periodic Preventative Care Ages 1-4 $225.00 Periodic Preventative Care Ages 12-17 $245.00 Periodic Preventative Care Ages 18-39 $250.00 Periodic Preventative Care Ages 40-64 $290.00 Destruction Benign Lesion $285.00 Venipuncture $12.00 Urinalysis $8.00 Pregnancy Test, Urine $20.00 Hemoglobin $14.00 Mononucleosis, Blood $18.00 Influenza Test $40.00 Strep A Test $41.00 Immunization Admin $65.00 Pneumococcal Vaccine $290.00 Flu Vaccine $51.00 EKG (12 Lead) $44.00 Nebulizer Treatment $45.00 99201 99242 99385 99392 99394 99395 99396 17110 36415 81002 81025 86036 86308 86710 87430 90471 90670 90686 93000 94640 WWW.GUNNISONVALLEYHEALTH.ORG 970-642-8413 707 N. IOWA STREET GUNNISON, CO 81230
MOUNTAIN CLINIC PROCEDURE CHARGES / MOUNTAIN CLINIC AIRWAY INHALATION TREATMENT HYDRATION IV INFUSION ADD ON THERAPEUTIC INJECTION INTRAMUSCULAR THERAPEUTIC INJECTION IV PUSH IV PUSH EACH ADDITIONAL BRACE KNEE ER LEVEL I ER LEVEL II ER LEVEL III ER LEVEL IV ER LEVEL V Urgent Care NEW PT-OFFICE VISIT LEVEL 2 Urgent Care NEW PT-OFFICE VISIT LEVEL 3 Urgent Care NEW PT-OFFICE VISIT LEVEL 4 Urgent Care NEW PT-OFFICE VISIT LEVEL 5 ESTABLISHED PT-OFFICE VISIT LEVEL 1 ESTABLISHED PT-OFFICE VISIT LEVEL 2 ESTABLISHED PT-OFFICE VISIT LEVEL 3 ESTABLISHED PT-OFFICE VISIT LEVEL 4 ESTABLISHED PT-OFFICE VISIT LEVEL 5 ARM SLING APPLICATION SHORT LEG SPLINT APPLICATION LONG LEG SPLINT APPLICATION SHORT ARM SPLINT LACERATION REPAIR CLOSED TREATMENT SHOULDER CLOSED TREATMENT COLLES FRACTURE INTERMEDIATE WOUND REPAIR NERVE BLOCK PERIPHERAL REMOVAL FOREIGN BODY EYE THERAPEUTIC IV INFUSION INITIAL HYDRATION IV INFUSION INITIAL $125.00 $61.00 $81.00 $193.00 $81.00 $340.00 $100.00 $150.00 $230.00 $400.00 $500.00 $191.00 $277.00 $419.00 $528.00 $52.00 $112.00 $187.00 $274.00 $369.00 $19.00 $155.00 $320.00 $828.00 $368.00 $547.00 $142.00 $318.00 $195.00 94640 96361 96372 96374 96375 L1832 99281 99282 99283 99284 99285 A4565 29515 29505 29125 12001, 12011, 12002 23650 25605 12032 64417 65205 96365 96360 WWW.GUNNISONVALLEYHEALTH.ORG 970-349-0321 12 SNOWMASS ROAD, AXTEL 100 MT. CRESTED BUTTE, CO 81225