Visits & medical services prices at Ascension NE Wisconsin - St. Elizabeth Campus

Appleton, WI · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedurePosted cashPosted gross× Medicare
Ablate Heart Dysrhythm Focus (93650) $11,532.24 $20,232 1.5×
Advncd Care Plan 30 Min (99497) $168.72 $296 1.7×
Aep Hearing Status Deter Broadband Stimuli I&R (92651) $482.79 $847 2.3×
Aep neurodiagnostic i&r (92653) $418.95 $735 2.0×
Aep threshold estimation mlt frequencies i&r (92652) $418.95 $735 2.0×
Airway Inhalation Treatment (94640) $165.30 $290 0.8×
Airway resistance by oscillometry (94728) $215.46 $378 1.7×
Analyze neurostim complex (95972) $525.54 $922 5.6×
Analyze neurostim no prog (95970) $217.17 $381 1.7×
Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) $62.70 $110 4.4×
Application on-body injector (96377) $117.42 $206 2.6×
Arrhythmia Induction (93618) $7,643.13 $13,409 6.4×
Assessment of aphasia per hr (96105) $246.81 $433 2.5×
Behavral qualit analys voice (92524) $186.96 $328 1.7×
Bfb traing w/EMG &/manometry 1st 15 min cntct (90912) $139.08 $244 1.7×
Bfb training ea addl 15 min (90913) $69.54 $122 2.1×
Biofeedback training any modality (90901) $127.68 $224 3.1×
Bis Xtracell Fluid Analysis (93702) $233.13 $409 1.8×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $354.54 $622 1.0×
Bundle of his recording (93600) $11,175.42 $19,606 1.5×
C motor evoked uppr limbs (95928) $1,093.26 $1,918 1.3×
C motor evoked upr&lwr limbs (95939) $1,650.72 $2,896 2.0×
Canalith repositioning proc (95992) $84.36 $148 2.1×
Car seat/bed test 60 min (94780) $94.62 $166 2.6×
Cardiac Stress Tst,Tracing Only (93017) $501.60 $880 2.4×
Cardiopulmonary resuscitation (92950)
range across 2 matching MRF lines
$1,288.20–$1,299.60 $2,260–$2,280 varies
Cardioversion (92960)
range across 2 matching MRF lines
$1,136.01–$1,190.16 $1,993–$2,088 varies
Cardioversion elective internal (92961) $1,170.78 $2,054 1.8×
Caregiver Training Strategies&Tq Ea Addl 15 Min (97551) $41.04 $72 1.6×
Cath Place/Coron Angio, Img Super/Interp,R&L Hrt Cath, L Hrt Ventric (93460) $10,947.99 $19,207 3.4×
Cath Place/Coron Angio, Img Super/Interp,W Left Heart Ventriculography (93458) $10,947.99 $19,207 3.4×
Cbt 1st hour (94644) $228 $400 1.7×
Chemo Anti-Neopl Sq/Im (96401) $331.17 $581 4.7×
Chemo Hormon Antineopl Sq/Im (96402) $139.65 $245 2.0×
Chemo Ia Push (96420) $486.21 $853 1.5×
Chemo IV infusion addl hr (96415) $153.33 $269 2.2×
Chemo IV push addl drug (96411) $287.85 $505 4.1×
Chemother Prolong Infuse W/Pump (96416) $672.03 $1,179 2.1×
Chemotherapy Into Cns (96450)
range across 2 matching MRF lines
$566.58–$661.77 $994–$1,161 varies
Chemotx Admn Ia Nfs >8 Hr Prtble Impltbl Pmp (96425) $566.01 $993 1.7×
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $298.11 $523 4.2×
Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) $672.03 $1,179 2.1×
Chemotx admn IV push tq 1/1st sbst/drug (96409) $507.30 $890 1.6×
Chest Wall Manipulation (94668) $57 $100 0.4×
Color/duplex Doppler, complete (93975) $1,078.44 $1,892 4.6×
Color/duplex Doppler, limited (93976) $718.77 $1,261 7.0×
Community/Work Reintegration Trainj Ea 15 Min (97537) $78.09 $137 2.4×
Continuous Pulse Ox (94762) $192.66 $338 1.5×
Coronary Art/Grft Angio S&I (93455) $10,947.99 $19,207 3.4×
Coronary Artery Angio S&I (93454) $10,947.99 $19,207 3.4×
Cpap Ventilation Cpap Initiation&Mgmt (94660)
range across 2 matching MRF lines
$57–$489.06 $100–$858 varies
Cpt initial (94667) $57 $100 0.4×
Critical care first hour (99291) $1,386.24 $2,432 1.7×
Ctr Motor Ep Std Transcrnl Motor Stimj Lwr Limbs (95929) $407.55 $715 1.1×
Debridement Open Wound 20 Sq Cm< (97597) $265.05 $465 1.3×
Dialysis One Evaluation (90945)
range across 4 matching MRF lines
$536.94–$759.81 $942–$1,333 varies
Dup-scan aorta ivc iliac vascl/bpgs complete (93978) $782.61 $1,373 3.3×
Dup-scan aorta ivc iliac vascl/bpgs uni/lmtd (93979) $522.12 $916 5.1×
Dup-scan lxtr art/artl bpgs compl bi study (93925) $1,072.17 $1,881 4.6×
Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) $714.78 $1,254 7.0×
Dup-Scan Xtr Veins Complete Bilateral Study (93970) $1,094.40 $1,920 4.7×
Dup-scan xtr veins unilateral/limited study (93971) $729.60 $1,280 7.1×
Duplex Scan Artl Infl&Ven O/F Hemo Compl Bi Std (93985) $1,046.52 $1,836 4.5×
Duplex Scan Artl Infl&Ven O/F Hemo Compl Uni Std (93986) $524.40 $920 5.1×
Duplex Scan Hemodialysis Access (93990) $740.43 $1,299 7.2×
Duplex up extrem art bilat (93930) $1,072.17 $1,881 4.6×
Duplex up extrem art unilat/ltd (93931) $714.78 $1,254 7.0×
Echo Congenital Complete (93303) $876.09 $1,537 1.6×
Echo Heart Xthoracic,Limited (93308) $938.22 $1,646 4.0×
Echo r-t 2d w/probe placement only (93313) $808.83 $1,419 1.5×
Echo transesophag montr cardiac pump functj (93318) $1,668.96 $2,928 3.1×
Echo transesophageal (93312) $1,668.96 $2,928 3.1×
Echo tthrc r-t 2d w/wo m-mode rest&strs cont ECG (93351) $940.50 $1,650 1.8×
Eeg 41-60 Minutes (95812) $737.01 $1,293 3.5×
EEG awake and asleep (95819) $765.51 $1,343 3.6×
EEG awake drowsy (95816) $669.18 $1,174 3.2×
EEG extended monitoring 61-119 minutes (95813) $758.67 $1,331 3.6×
EEG w/o vid 2-12hr cont mntr (95707) $528.96 $928 2.5×
Eeg W/O Vid Tech Ea Incr 12-26 Hr Cont R-T Mntr (95710) $1,012.32 $1,776 2.8×
Elec Alys Implt Smpl Cn Npgt Prgrmg (95976) $72.39 $127 2.0×
Electrical Stimulation Ea 15 Min (97032) $43.32 $76 2.9×
Electrocardiogram Tracing (93005) $144.21 $253 2.5×
Emergency Dept Visit Level 2 (99282)
range across 2 matching MRF lines
$100.32–$461.13 $176–$809 varies
Emergency Dept Visit Level 3 (99283)
range across 2 matching MRF lines
$150.48–$790.02 $264–$1,386 varies
Emergency Dept Visit Level 4 (99284)
range across 2 matching MRF lines
$281.01–$1,252.29 $493–$2,197 varies
Emg 4 Extremities (95864) $360.81 $633 2.9×
Ep & ablate supravent arrhyt (93653) $34,628.07 $60,751 1.4×
Ep & ablate ventric tachy (93654) $35,910.57 $63,001 1.4×
Ep Compre Electrophysiologic Arrhythmia Induction (93620) $11,175.42 $19,606 1.5×
Ep Compre Electrophysiologic W/O Arrhyt Induction (93619) $11,175.42 $19,606 1.5×
Er level 1 (99281)
range across 2 matching MRF lines
$53.58–$263.34 $94–$462 varies
Er level v (99285)
range across 3 matching MRF lines
$413.25–$1,957.38 $725–$3,434 varies
Esophageal Capsule Endoscopy (91111) $1,239.18 $2,174 1.4×
Esophgl funcj g-esop rflx impd eltrd prolng (91038) $768.36 $1,348 2.1×
Evaluate pt use of inhaler (94664) $215.46 $378 1.0×
Evaluate Speech Production (92522) $180.69 $317 1.6×
Evaluate Swallowing Function (92610) $132.24 $232 1.6×
Evaluation of speech fluency (92521) $226.86 $398 1.7×
External Ecg Scanning Analysis Report (93226) $420.66 $738 7.3×
Extracranial Bilat Study (93880) $836.19 $1,467 3.6×
Extracranial Uni/Ltd Study (93882) $571.14 $1,002 5.6×
F-up/limited tthrc echo congenital car anomaly (93304) $1,483.71 $2,603 2.8×
Funcjal Cort&Subcort Mapg Phys/Qhp Attnd Init Hr (95961) $1,304.16 $2,288 1.6×
Gastroesophag reflx test w/telemtry ph eltrd (91035) $1,899.24 $3,332 2.3×
Group Therapeutic Procedures (97150) $45.03 $79 2.5×
Heart catheterization, both sides, with coronary and bypass graft angiography (93461) $10,947.99 $19,207 3.4×
Hemodialysis Procedure W/ Phys/Qhp Evaluation (90935) $801.99 $1,407 1.2×
High altitude simulation test (94452) $131.67 $231 1.0×
High Altitude Simulatj W/Phys I&R W/O2 Titration (94453) $131.67 $231 1.0×
Holter monitor recording (93225) $467.40 $820 3.6×
Icd Device Progr Eval Mult (93284) $123.12 $216 3.4×
Immunization administration (90471) $70.11 $123 1.0×
Insert/Place Heart Catheter (93503) $2,391.15 $4,195 1.6×
Intra-atrial pacing (93610) $9,350.85 $16,405 1.2×
Intra-atrial recording (93602) $11,922.12 $20,916 1.6×
Intracranial Complete Study (93886) $986.67 $1,731 4.2×
Iontophoresis 15 min (97033) $62.70 $110 3.3×
Irrig Drug Delivery Device (96523) $75.81 $133 1.3×
IV infusion hydration each additional hour (96361) $78.09 $137 1.7×
IV infusion hydration initial 31 min-1 hour (96360) $275.31 $483 1.3×
IV infusion ther proph addl sequential to 1 hr (96367) $123.12 $216 1.7×
IV infusion therapy prophylaxis/dx ea hour (96366) $84.93 $149 1.9×
IV push initial (96374) $120.27 $211 0.6×
L Hrt Art/Grft Angio (93459) $10,947.99 $19,207 3.4×
Lung Function Test (Mbc/Mvv) (94200) $160.74 $282 2.8×
Lwr Xtr Vasc Stdy Bilat (93924) $1,243.74 $2,182 5.9×
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $43.89 $77 1.4×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $51.30 $90 1.4×
Medical nutrition therapy grp2/ indiv ea 30 mi (97804) $34.20 $60 2.0×
Methacholine challenge (94070) $490.77 $861 1.3×
Motility study esophagus (91010) $555.18 $974 1.5×
Motion Fluoroscopy/Swallow (92611) $198.36 $348 2.2×
Muscle Test 2 Limbs (95861) $259.35 $455 2.0×
Muscle Test Nonparaspinal (95870) $181.83 $319 1.4×
Nasopharyngoscopy (92511) $282.72 $496 1.4×
Needle Electromyography Cranial Nrv Muscle Bi (95868) $245.67 $431 1.2×
Needle Electromyography Cranial Nrv Muscle Uni (95867) $198.36 $348 0.9×
Needle electromyography larynx (95865) $181.83 $319 1.4×
Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) $363.66 $638 0.9×
Neg Pressure Wound Therapy Non Dme >50 Sq Cm (97608) $369.36 $648 0.9×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $144.78 $254 0.7×
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $238.26 $418 0.6×
Neuromuscular Junct Tstg Ea Nrv Any 1 Meth (95937) $155.61 $273 1.2×
Neuromuscular Reeducation (97112) $69.54 $122 2.1×
Newborn resuscitation (99465) $457.71 $803 0.7×
Oral Function Therapy (92526) $178.98 $314 2.1×
Oral Speech Device Eval (92597) $80.37 $141 1.1×
Orthc/Prostc Mgmt Sbsq Enc (97763) $78.09 $137 1.6×
Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) $75.81 $133 1.6×
Ot eval high complexity (97167) $230.28 $404 2.3×
Ot Eval Low Complex (97165) $153.33 $269 1.5×
Ot Eval Moderate Complexity (97166) $184.68 $324 1.8×
Ot manual therapy 15 min (97140) $74.10 $130 2.7×
Ot paraffin bath (97018) $21.09 $37 3.5×
Ot Prosthetic Training, Each 15 Min (97761) $103.74 $182 2.6×
Ot Re-Eval Est Plan Care (97168) $93.48 $164 1.4×
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $272.46 $478 2.2×
Outpatient Cardiac Rehab W/O Cont Ecg Monitor (93797) $256.50 $450 2.0×
Peripheral arterial disease rehab per session (93668) $95.76 $168 1.7×
Perq Trluml C Angioplasty 1 Maj C Art&/Branches (92920) $12,017.88 $21,084 2.2×
Perq Trluml Revsc Chrnc Tot Occls 1 C Art Antgrd (92943) $23,213.82 $40,726 2.1×
Phlebotomy therapeutic (99195) $372.78 $654 2.9×
Phys/qhp svcs op pulm rehab w/cont oximtry mntr (94626) $283.86 $498 4.9×
Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) $266.76 $468 4.6×
Physical Performance Test (97750) $64.41 $113 1.9×
Plethysmography (94726) $120.84 $212 0.3×
Pm device progr eval dual (93280) $57 $100 1.6×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $3,853.77 $6,761 4.6×
Polysom <6 yrs 4/> paramtrs (95782) $1,874.73 $3,289 2.2×
Polysom <6 Yrs Sleep W/Cpap/Bilvl Vent 4/> Param (95783) $1,874.73 $3,289 2.2×
Principal care management services, for a single high-risk disease, with the following required elements: one complex… (99426) $169.86 $298 1.7×
Prq Card Angio/Athrect 1 Art (92924) $12,060.06 $21,158 1.1×
Prq Card Stent W/Angio 1 Vsl (92928) $23,213.82 $40,726 2.1×
Prq Card Stent/Ath/Angio (92933) $35,795.43 $62,799 2.0×
Prq Revasc Byp Graft 1 Vsl (92937) $23,213.82 $40,726 2.1×
Psych diag eval w/med srvcs (90792) $454.86 $798 2.6×
Psychiatric diagnostic evaluation (90791)
range across 6 matching MRF lines
$119.13–$837.90 $209–$1,470 varies
Psytx Crisis Initial 60 Min (90839) $738.72 $1,296 4.2×
Pt Asstv Technol Assmt Dir Cntct W/Reprt Ea 15 Min (97755) $111.15 $195 2.9×
Pt Eval High Complex (97163) $215.46 $378 2.2×
Pt eval low complex 20 min (97161) $153.33 $269 1.6×
Pt Eval Mod Complex (97162) $184.11 $323 1.9×
Pt gait training 15 min (97116) $59.85 $105 2.1×
Pt group caregiver training (97552) $34.77 $61 1.6×
Pt mechanical traction (97012) $35.91 $63 2.5×
Pt Re-Eval Est Plan Care (97164) $88.35 $155 1.3×
Pt ultraviolet (97028) $52.44 $92 6.3×
Pulm function test by gas (94727) $163.02 $286 0.8×
Pulmonary Stress Testing (94618) $141.36 $248 1.1×
R Hrt Art/Grft Angio (93457) $10,947.99 $19,207 3.4×
R hrt coronary artery angio (93456) $10,947.99 $19,207 3.4×
R&L Hrt Cath Chd Img Cath Trgt Zon Abnl Nt Connj (93597) $4,522.38 $7,934 1.4×
R&L Hrt Cath Chd Img Cath Trgt Zone Nml Nt Connj (93596) $4,522.38 $7,934 1.4×
R&L Hrt Cath W/Ventriclgrphy (93453) $10,947.99 $19,207 3.4×
Rapid Desensitization Procedure Each Hour (95180) $481.08 $844 1.1×
Refill/Maint Portable Pump (96521) $339.15 $595 1.6×
Refill/Maint Pump/Resvr Syst (96522) $302.10 $530 1.4×
Remote 30 Day Ecg Rev/Report (93270) $197.79 $347 5.4×
Respiratory flow volume loop (94375) $308.37 $541 1.5×
Rhythm Ecg 1-3 Leads Tracing Only W/O I&R (93041) $181.83 $319 3.1×
Right Heart Cath (93451) $10,947.99 $19,207 3.4×
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602)
range across 3 matching MRF lines
$209.19–$351.69 $367–$617 varies
Rx sp-genratj augmnt&comunicaj dev 1st hr (92607) $153.33 $269 1.3×
Rx Sp-Genratj Augmnt&Comunicaj Dev Ea 30 Min (92608) $76.95 $135 1.6×
Same day nb discharge (99463) $227.43 $399 1.7×
Self Care Mngment Training (97535) $63.84 $112 2.0×
Sensory Integration Ea 15 Min (97533) $70.68 $124 1.2×
Sleep study unattended (95806) $1,810.32 $3,176 8.6×
Slp caregiver training 1st 30 min (97550) $82.65 $145 1.6×
Somatosensory Testing (95938) $1,463.19 $2,567 1.7×
Speech sound lang comprehen (92523) $320.34 $562 1.4×
Spirometry (94010) $203.49 $357 1.0×
Standardized Cognitive Performance Testing (96125) $228.57 $401 2.2×
Stress Tte Only (93350) $808.83 $1,419 1.5×
Surfactant Admin Thru Tube (94610) $376.77 $661 1.8×
Temp transcutaneous pacing (92953) $868.68 $1,524 1.3×
Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129) $52.44 $92 2.3×
Ther Ivntj Ea Addl 15 Min (97130) $26.22 $46 1.2×
Ther Px 1/> Areas Each 15 Min Aqua Ther W/Xerss (97113) $87.21 $153 2.4×
Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) $186.96 $328 1.8×
Ther/Proph/Diag Inj Sc/Im (96372)
range across 2 matching MRF lines
$67.26–$79.23 $118–$139 varies
Ther/Proph/Diag Iv Inf Init (96365) $271.89 $477 1.3×
Therap repetitive tms tx subseq delivery & mng (90868) $507.87 $891 2.4×
Therapeutic Activities (97530) $69.54 $122 2.0×
Tilt table test with heart rhythm and blood pressure monitoring (93660) $1,370.28 $2,404 3.7×
Tobacco Use Cessation Intensive >10 Minutes (99407) $85.50 $150 2.3×
Tobacco Use Cessation Intermediate 3-10 Minutes (99406)
range across 2 matching MRF lines
$29.07–$64.41 $51–$113 varies
Trans Care Mgmt 14 Day Disch (99495)
range across 2 matching MRF lines
$184.11–$334.02 $323–$586 varies
Trans Care Mgmt 7 Day Disch (99496)
range across 2 matching MRF lines
$184.11–$477.09 $323–$837 varies
Transcath Closure of Asd (93580) $32,286.51 $56,643 1.8×
Transcranial Doppler Stdy Intracranial Art Lmtd (93888) $624.15 $1,095 6.1×
Tte w/doppler, complete (93306)
range across 2 matching MRF lines
$1,600.56–$1,723.68 $2,808–$3,024 varies
Tte W/O Doppler Complete (93307) $1,594.86 $2,798 6.8×
Tx atrial fib pulm vein isol (93656) $39,318.03 $68,979 1.5×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $156.18 $274 2.1×
Tx Speech Language Voice Commj Auditry 2/>Indiv (92508) $49.59 $87 2.1×
Tx/Pro/Dx Inj New Drug Addon (96375) $117.42 $206 2.6×
Upr/L Xtremity Art 2 Levels (93922) $369.36 $648 2.8×
Upr/Lxtr Art Stdy 3+ Lvls (93923) $729.03 $1,279 3.4×
Valvuloplasty aortic valve (92986) $7,730.34 $13,562 1.4×
Vasopneumatic device (97016) $41.04 $72 3.4×
Veeg 2-12 hr intmt mntr (95712) $505.59 $887 1.4×
Veeg by tech ea incr 12-26 hr intermittent mntr (95715) $969.57 $1,701 2.7×
Vent Mgmt Inpat Init Day (94002) $684 $1,200 1.1×
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $684 $1,200 1.1×
Visual Evoked Potential Test (95930) $518.70 $910 2.5×
Vital capacity, total (94150) $208.62 $366 1.7×
Wheelchair Mgmt Ea 15 Min (97542) $69.54 $122 2.2×
Whirlpool Therapy (97022) $41.04 $72 2.6×

A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.