Visits & medical services prices at Ascension St. Vincent Randolph

Winchester, IN · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedurePosted cashPosted gross× Medicare
Admn Sarscov2 Vacc 1 Dose (90480)
range across 31 matching MRF lines		 $100.20–$108 $167–$180 varies
Aep Hearing Status Deter Broadband Stimuli I&R (92651) $445.80 $743 2.0×
Aep neurodiagnostic i&r (92653) $1,003.20 $1,672 4.4×
Aep threshold estimation mlt frequencies i&r (92652) $1,003.20 $1,672 4.4×
Airway Inhalation Treatment (94640)
range across 2 matching MRF lines		 $141.60–$210.60 $236–$351 varies
Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) $106.80 $178 7.4×
Application Modality 1/> Areas Infrared (97026) $78 $130 11.7×
Application on-body injector (96377) $371.40 $619 7.5×
Assessment of aphasia per hr (96105) $321 $535 3.3×
Behavral qualit analys voice (92524) $151.80 $253 1.4×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $834.60 $1,391 2.1×
Canalith repositioning proc (95992) $86.40 $144 2.1×
Car seat/bed test 60 min (94780) $233.40 $389 5.9×
Cardiac Stress Tst,Tracing Only (93017) $1,102.80 $1,838 4.8×
Cardiopulmonary resuscitation (92950) $1,444.80 $2,408 6.3×
Cardioversion (92960)
range across 2 matching MRF lines		 $2,557.80–$2,649 $4,263–$4,415 varies
Cbt 1st hour (94644) $153 $255 1.1×
Chemo Anti-Neopl Sq/Im (96401) $512.40 $854 6.7×
Chemo Hormon Antineopl Sq/Im (96402) $512.40 $854 6.7×
Chemo IV infusion addl hr (96415) $312 $520 4.1×
Chemo IV push addl drug (96411) $443.40 $739 5.8×
Chemother Prolong Infuse W/Pump (96416) $1,091.40 $1,819 3.1×
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $622.80 $1,038 8.2×
Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) $1,244.40 $2,074 3.6×
Chemotx admn IV push tq 1/1st sbst/drug (96409) $557.40 $929 1.6×
Chest Wall Manipulation (94668) $149.40 $249 1.1×
Color/duplex Doppler, complete (93975) $2,724.60 $4,541 10.8×
Color/duplex Doppler, limited (93976) $1,279.80 $2,133 11.6×
Community/Work Reintegration Trainj Ea 15 Min (97537) $86.40 $144 2.7×
Cont gluc mntr physician/qhp provided equiptment (95250) $524.40 $874 3.7×
Continuous Pulse Ox (94762) $576.60 $961 4.2×
Cpap Ventilation Cpap Initiation&Mgmt (94660) $141.60 $236 0.6×
Cpt initial (94667) $141.60 $236 1.0×
Critical care first hour (99291) $3,202.80 $5,338 3.7×
Debridement Open Wound 20 Sq Cm< (97597)
range across 3 matching MRF lines		 $255–$422.40 $425–$704 varies
Dup-scan aorta ivc iliac vascl/bpgs complete (93978) $1,102.20 $1,837 4.4×
Dup-scan aorta ivc iliac vascl/bpgs uni/lmtd (93979) $1,270.80 $2,118 11.5×
Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) $1,148.40 $1,914 10.4×
Dup-Scan Xtr Veins Complete Bilateral Study (93970) $1,944 $3,240 7.7×
Dup-scan xtr veins unilateral/limited study (93971) $1,314.60 $2,191 11.9×
Duplex up extrem art bilat (93930) $1,662.60 $2,771 6.6×
Echo Congenital Complete (93303) $1,719.60 $2,866 3.0×
Echo Heart Xthoracic,Limited (93308) $925.20 $1,542 3.7×
EEG awake drowsy (95816) $1,058.40 $1,764 4.6×
EEG cont rec w/video by tech min 8 channels (95700) $631.20 $1,052 2.8×
Eeg W/O Vid Tech Ea Incr 12-26 Hr Cont R-T Mntr (95710) $3,587.40 $5,979 9.1×
Electrical Stimulation Ea 15 Min (97032) $106.80 $178 7.3×
Electrocardiogram Tracing (93005) $325.80 $543 5.2×
Emergency Dept Visit Level 2 (99282) $277.80 $463 1.7×
Emergency Dept Visit Level 3 (99283) $816.60 $1,361 2.8×
Emergency Dept Visit Level 4 (99284) $1,674 $2,790 3.8×
Er level 1 (99281) $132.60 $221 1.5×
Er level v (99285) $2,304 $3,840 3.7×
Evaluate pt use of inhaler (94664) $178.20 $297 0.8×
Evaluate Speech Production (92522) $147.60 $246 1.3×
Evaluate Swallowing Function (92610) $322.20 $537 3.8×
Evaluation of speech fluency (92521) $181.20 $302 1.4×
Exercise test for bronchospasm (94617) $303.60 $506 2.2×
External ECG rec>48hr<7d recording (93242) $571.80 $953 14.5×
External ECG rec>7d<15d recording (93246) $1,143.60 $1,906 28.9×
External Ecg Scanning Analysis Report (93226)
range across 2 matching MRF lines		 $549.60–$1,099.20 $916–$1,832 varies
Extracranial Bilat Study (93880) $1,435.80 $2,393 5.7×
Extracranial Uni/Ltd Study (93882) $987 $1,645 8.9×
Group Therapeutic Procedures (97150) $111 $185 6.2×
Holter monitor recording (93225)
range across 2 matching MRF lines		 $610.80–$1,221.60 $1,018–$2,036 varies
Immunization administration (90471)
range across 4 matching MRF lines		 $108–$119.40 $180–$199 varies
Intracranial Complete Study (93886) $1,528.20 $2,547 6.1×
Iontophoresis 15 min (97033) $123.60 $206 6.5×
Irrig Drug Delivery Device (96523) $290.40 $484 4.7×
IV infusion hydration each additional hour (96361) $129 $215 2.6×
IV infusion hydration initial 31 min-1 hour (96360) $514.20 $857 2.3×
IV infusion ther proph addl sequential to 1 hr (96367) $162 $270 2.1×
IV infusion therapy prophylaxis/dx ea hour (96366) $162 $270 3.3×
IV push initial (96374) $318 $530 1.4×
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $34.20 $57 1.1×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $34.20 $57 0.9×
Medical nutrition therapy grp2/ indiv ea 30 mi (97804) $54.60 $91 3.2×
Methacholine challenge (94070) $1,087.80 $1,813 2.8×
Motion Fluoroscopy/Swallow (92611) $408.60 $681 4.5×
Multiple Sleep Latency Test (95805) $3,732.60 $6,221 4.1×
Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) $276 $460 0.6×
Neg Pressure Wound Therapy Non Dme >50 Sq Cm (97608) $210 $350 0.5×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $271.80 $453 1.3×
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $210 $350 0.5×
Neuromuscular Reeducation (97112) $86.40 $144 2.6×
Newborn resuscitation (99465) $676.20 $1,127 1.0×
Nitric oxide expired gas determination (95012) $135.60 $226 3.4×
Oral Function Therapy (92526) $232.20 $387 2.8×
Oral Speech Device Eval (92597) $354 $590 5.0×
Orthc/Prostc Mgmt Sbsq Enc (97763) $106.80 $178 2.1×
Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) $109.80 $183 2.4×
Ot Contrast Bath Ea 15 Min (97034) $80.40 $134 5.7×
Ot eval high complexity (97167) $285.60 $476 2.8×
Ot Eval Low Complex (97165) $191.40 $319 1.9×
Ot Eval Moderate Complexity (97166) $236.40 $394 2.4×
Ot manual therapy 15 min (97140) $99.60 $166 3.6×
Ot paraffin bath (97018) $114.60 $191 19.1×
Ot Prosthetic Training, Each 15 Min (97761) $103.80 $173 2.6×
Ot Re-Eval Est Plan Care (97168) $174 $290 2.5×
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $249 $415 1.8×
Outpatient Cardiac Rehab W/O Cont Ecg Monitor (93797) $270.60 $451 2.0×
Phlebotomy therapeutic (99195) $380.40 $634 2.7×
Phys/qhp svcs op pulm rehab w/cont oximtry mntr (94626) $227.40 $379 3.6×
Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) $227.40 $379 3.6×
Physical Performance Test (97750) $107.40 $179 3.2×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $4,411.80 $7,353 4.9×
Psychiatric diagnostic evaluation (90791) $141.60 $236 0.8×
Pt Eval High Complex (97163) $285.60 $476 2.9×
Pt eval low complex 20 min (97161) $191.40 $319 2.0×
Pt Eval Mod Complex (97162) $236.40 $394 2.4×
Pt gait training 15 min (97116) $81 $135 2.8×
Pt mechanical traction (97012) $150 $250 10.4×
Pt Re-Eval Est Plan Care (97164) $174 $290 2.6×
Pulm function test by gas (94727) $647.40 $1,079 2.8×
Pulmonary service/procedure (94799) $233.40 $389 1.7×
Pulmonary Stress Testing (94618) $452.40 $754 3.2×
Refill/Maint Portable Pump (96521) $524.40 $874 2.3×
Remote 30 Day Ecg Rev/Report (93270) $903 $1,505 22.9×
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602)
range across 3 matching MRF lines		 $144.60–$237 $241–$395 varies
Rom Meas&Reprt Ea Xtr Ex Hand/Ea Trnk Sctj Spi (95851) $81 $135 3.1×
Self Care Mngment Training (97535) $86.40 $144 2.7×
Sensory Integration Ea 15 Min (97533) $94.80 $158 1.6×
Speech sound lang comprehen (92523) $304.20 $507 1.3×
Spirometry (94010) $339.60 $566 1.5×
Standardized Cognitive Performance Testing (96125) $255 $425 2.5×
Temp transcutaneous pacing (92953)
range across 2 matching MRF lines		 $1,176.60–$1,267.20 $1,961–$2,112 varies
Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129) $91.80 $153 4.1×
Ther Ivntj Ea Addl 15 Min (97130) $79.80 $133 3.8×
Ther Px 1/> Areas Each 15 Min Aqua Ther W/Xerss (97113) $86.40 $144 2.3×
Ther Px 1/> Areas Each 15 Minutes Massage (97124) $98.40 $164 3.3×
Ther/Proph/Diag Inj Sc/Im (96372) $160.20 $267 2.1×
Ther/Proph/Diag Iv Inf Init (96365) $646.20 $1,077 2.9×
Therapeutic Activities (97530) $75.60 $126 2.2×
Tobacco Use Cessation Intensive >10 Minutes (99407) $176.40 $294 4.5×
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $32.40 $54 0.8×
Transcranial Doppler Stdy Intracranial Art Lmtd (93888) $887.40 $1,479 8.0×
Tte w/doppler, complete (93306) $2,893.80 $4,823 5.0×
Tte W/O Doppler Complete (93307) $1,570.20 $2,617 6.2×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507)
range across 8 matching MRF lines		 $69.60–$271.80 $116–$453 varies
Tx Speech Language Voice Commj Auditry 2/>Indiv (92508) $118.20 $197 4.9×
Tx/Pro/Dx Inj New Drug Addon (96375) $222.60 $371 4.5×
Unlisted otorhinolaryngological service (92700) $144 $240 4.7×
Upr/L Xtremity Art 2 Levels (93922) $724.80 $1,208 5.1×
Upr/Lxtr Art Stdy 3+ Lvls (93923) $1,270.80 $2,118 5.6×
Vasopneumatic device (97016) $120.60 $201 10.0×
Veeg 2-12 Hr Cont Mntr (95713) $1,217.40 $2,029 3.1×
Veeg 2-12 hr intmt mntr (95712) $631.20 $1,052 1.6×
Veeg by tech ea incr 12-26 hr intermittent mntr (95715) $1,217.40 $2,029 3.1×
Veeg ea 12-26hr cont mntr (95716) $2,280 $3,800 2.5×
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $1,689 $2,815 2.6×
Wheelchair Mgmt Ea 15 Min (97542) $91.80 $153 3.0×
Whirlpool Therapy (97022) $174.60 $291 11.1×

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.