Visits & medical services prices at Fort Memorial Hospital
Fort Atkinson, WI · every code in this section with a posted price and a Medicare benchmark.
166 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Admn Sarscov2 Vacc 1 Dose (90480) | $19.20 | $60 | 0.5× |
| Airway Inhalation Treatment (94640) range across 12 matching MRF lines |
$47.68–$56.96 | $149–$178 | varies |
| Analyze neurostim complex (95972) | $134.40 | $420 | 1.4× |
| Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) | $48 | $150 | 3.3× |
| Application Modality 1/> Areas Infrared (97026) | $41.92 | $131 | 6.3× |
| Assessment of aphasia per hr (96105) | $128 | $400 | 1.3× |
| Behavral qualit analys voice (92524) | $160 | $500 | 1.5× |
| Bfb traing w/EMG &/manometry 1st 15 min cntct (90912) range across 4 matching MRF lines |
$116.48–$175.36 | $364–$548 | varies |
| Bfb training ea addl 15 min (90913) range across 4 matching MRF lines |
$55.68–$80 | $174–$250 | varies |
| Biofeedback training any modality (90901) range across 3 matching MRF lines |
$59.52–$78.72 | $186–$246 | varies |
| Brncdilat rspse spmtry pre&post-brncdilat admn (94060) | $113.92 | $356 | 0.3× |
| Canalith repositioning proc (95992) | $68.80 | $215 | 1.7× |
| Cardiac Stress Tst,Tracing Only (93017) range across 5 matching MRF lines |
$320.96–$513.60 | $1,003–$1,605 | varies |
| Cardiopulmonary resuscitation (92950) range across 4 matching MRF lines |
$342.72–$525.12 | $1,071–$1,641 | varies |
| Cardioversion (92960) range across 3 matching MRF lines |
$471.04–$844.80 | $1,472–$2,640 | varies |
| Cbt 1st hour (94644) | $101.12 | $316 | 0.8× |
| Chemo intralesional up to 7 (96405) | $56.96 | $178 | 0.8× |
| Chest Wall Manipulation (94668) | $54.72 | $171 | 0.4× |
| Chron Care Mgmt Srvc 20 Min (99490) | $78.40 | $245 | 0.8× |
| Color/duplex Doppler, limited (93976) | $243.52 | $761 | 2.4× |
| Community/Work Reintegration Trainj Ea 15 Min (97537) range across 11 matching MRF lines |
$35.52–$64 | $111–$200 | varies |
| Complex chronic care mgmt svc 1st 60 min cal mo (99487) | $78.40 | $245 | 0.4× |
| Cont gluc mntr physician/qhp provided equiptment (95250) | $109.12 | $341 | 0.8× |
| Cont Gluc Mntr Pt Prov Eqp (95249) | $53.12 | $166 | 0.9× |
| Continuous Pulse Ox (94762) range across 3 matching MRF lines |
$78.40–$82.24 | $245–$257 | varies |
| Cpap Ventilation Cpap Initiation&Mgmt (94660) range across 3 matching MRF lines |
$193.28–$305.92 | $604–$956 | varies |
| Cpt initial (94667) | $68.80 | $215 | 0.5× |
| Critical care first hour (99291) | $611.84 | $1,912 | 0.7× |
| Debridement Open Wound 20 Sq Cm< (97597) range across 5 matching MRF lines |
$331.84–$418.88 | $1,037–$1,309 | varies |
| Dup-scan lxtr art/artl bpgs compl bi study (93925) range across 2 matching MRF lines |
$553.60–$561.92 | $1,730–$1,756 | varies |
| Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) range across 7 matching MRF lines |
$352–$357.44 | $1,100–$1,117 | varies |
| Dup-Scan Xtr Veins Complete Bilateral Study (93970) | $617.28 | $1,929 | 2.6× |
| Dup-scan xtr veins unilateral/limited study (93971) | $324.80 | $1,015 | 3.1× |
| Duplex up extrem art bilat (93930) | $418.88 | $1,309 | 1.8× |
| Duplex up extrem art unilat/ltd (93931) | $418.88 | $1,309 | 4.1× |
| Ear and throat examination (92502) | $1,166.40 | $3,645 | 2.2× |
| ECG/monitoring and analysis (93271) | $80 | $250 | 0.9× |
| Echo Heart Xthoracic,Limited (93308) range across 3 matching MRF lines |
$584.64–$604.80 | $1,827–$1,890 | varies |
| Echo transesophageal (93312) | $1,169.28 | $3,654 | 2.2× |
| Eeg 41-60 Minutes (95812) | $182.72 | $571 | 0.9× |
| EEG awake and asleep (95819) range across 2 matching MRF lines |
$182.72–$190.08 | $571–$594 | varies |
| EEG awake drowsy (95816) range across 2 matching MRF lines |
$182.72–$190.08 | $571–$594 | varies |
| EEG extended monitoring 61-119 minutes (95813) | $182.72 | $571 | 0.9× |
| Eeg Sleep Only (95822) range across 2 matching MRF lines |
$182.72–$190.08 | $571–$594 | varies |
| Electrical Stimulation Ea 15 Min (97032) | $43.20 | $135 | 2.9× |
| Electrocardiogram Tracing (93005) range across 6 matching MRF lines |
$79.36–$81.92 | $248–$256 | varies |
| Emergency Dept Visit Level 2 (99282) | $142.72 | $446 | 0.9× |
| Emergency Dept Visit Level 3 (99283) | $246.72 | $771 | 0.9× |
| Emergency Dept Visit Level 4 (99284) | $398.08 | $1,244 | 1.0× |
| Er level 1 (99281) | $139.20 | $435 | 1.7× |
| Er level v (99285) | $490.24 | $1,532 | 0.8× |
| Eval aud funcj cand/po surg implt dev 1st hr (92626) | $44.16 | $138 | 0.3× |
| Evaluate Speech Production (92522) | $129.60 | $405 | 1.2× |
| Evaluate Swallowing Function (92610) | $184 | $575 | 2.2× |
| Evaluation of speech fluency (92521) | $93.76 | $293 | 0.7× |
| External ECG rec>48hr<7d recording (93242) | $69.12 | $216 | 1.9× |
| External ECG rec>48hr<7d scanning alys w/report (93243) | $240 | $750 | 1.8× |
| External ECG rec>7d<15d recording (93246) | $160 | $500 | 4.3× |
| External ECG rec>7d<15d scanning alys w/report (93247) | $246.40 | $770 | 1.9× |
| External Ecg Scanning Analysis Report (93226) | $224 | $700 | 3.8× |
| Extracranial Bilat Study (93880) | $568.32 | $1,776 | 2.4× |
| Eye exam w anesth; limited (92019) | $2,120.32 | $6,626 | 0.9× |
| Flexible endoscopic eval swallow c/v rec (92612) | $141.76 | $443 | 0.7× |
| Gastroesophag reflx test w/telemtry ph eltrd (91035) | $1,203.84 | $3,762 | 1.4× |
| Group Therapeutic Procedures (97150) range across 4 matching MRF lines |
$2.24–$62.08 | $7–$194 | varies |
| Holter monitor recording (93225) | $199.04 | $622 | 1.5× |
| Icd Device Interrogate (93289) | $80.96 | $253 | 2.2× |
| Icd device progr eval dual (93283) range across 2 matching MRF lines |
$41.60–$80.96 | $130–$253 | varies |
| Icd Device Progr Eval Mult (93284) range across 2 matching MRF lines |
$43.20–$80.96 | $135–$253 | varies |
| Icm Device Eval (93290) | $80.96 | $253 | 2.2× |
| Ilr Device Eval Progr (93285) range across 2 matching MRF lines |
$35.20–$80.96 | $110–$253 | varies |
| Ilr Device Interrogate (93291) | $80.96 | $253 | 2.8× |
| Img Retina Detcj/Mntr Ds Rem Phys/Qhp I&R Uni/Bi (92228) | $9.60 | $30 | 0.3× |
| Immunization administration (90471) range across 4 matching MRF lines |
$17.92–$52.48 | $56–$164 | varies |
| Insert/Place Heart Catheter (93503) | $140.48 | $439 | 0.1× |
| Iontophoresis 15 min (97033) | $48 | $150 | 2.5× |
| Irrig Drug Delivery Device (96523) range across 4 matching MRF lines |
$17.92–$97.28 | $56–$304 | varies |
| IV infusion hydration each additional hour (96361) range across 5 matching MRF lines |
$56.64–$114.24 | $177–$357 | varies |
| IV infusion hydration initial 31 min-1 hour (96360) range across 5 matching MRF lines |
$145.28–$294.72 | $454–$921 | varies |
| IV infusion ther proph addl sequential to 1 hr (96367) range across 5 matching MRF lines |
$45.76–$91.52 | $143–$286 | varies |
| IV infusion therapy prophylaxis/dx ea hour (96366) range across 5 matching MRF lines |
$61.44–$113.92 | $192–$356 | varies |
| IV push initial (96374) range across 5 matching MRF lines |
$37.44–$75.20 | $117–$235 | varies |
| Low frequency non-thermal us (97610) | $175.04 | $547 | 0.9× |
| Lung Function Test (Mbc/Mvv) (94200) | $55.04 | $172 | 0.9× |
| Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) range across 5 matching MRF lines |
$26.56–$28.48 | $83–$89 | varies |
| Medical nutrition assmt&ivntj indiv each 15 mi (97802) range across 4 matching MRF lines |
$24.64–$28.48 | $77–$89 | varies |
| Methacholine challenge (94070) range across 2 matching MRF lines |
$188.48–$204.48 | $589–$639 | varies |
| Motility study esophagus (91010) | $467.84 | $1,462 | 1.3× |
| Motion Fluoroscopy/Swallow (92611) | $224 | $700 | 2.4× |
| Nasopharyngoscopy (92511) | $183.04 | $572 | 0.9× |
| Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) range across 2 matching MRF lines |
$339.84–$344.96 | $1,062–$1,078 | varies |
| Neg Pressure Wound Therapy Non Dme >50 Sq Cm (97608) | $344.96 | $1,078 | 0.9× |
| Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) range across 4 matching MRF lines |
$183.68–$260.80 | $574–$815 | varies |
| Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) range across 4 matching MRF lines |
$198.08–$339.84 | $619–$1,062 | varies |
| Neurobehavioral Status Exam (96116) range across 2 matching MRF lines |
$92.48–$220.80 | $289–$690 | varies |
| Neuromuscular Reeducation (97112) range across 4 matching MRF lines |
$61.44–$74.56 | $192–$233 | varies |
| Oral Function Therapy (92526) | $145.60 | $455 | 1.7× |
| Oral Speech Device Eval (92597) | $82.88 | $259 | 1.2× |
| Orthc/Prostc Mgmt Sbsq Enc (97763) | $64 | $200 | 1.3× |
| Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) | $64 | $200 | 1.4× |
| Ot eval high complexity (97167) | $160 | $500 | 1.6× |
| Ot Eval Low Complex (97165) | $112 | $350 | 1.1× |
| Ot Eval Moderate Complexity (97166) | $136 | $425 | 1.4× |
| Ot manual therapy 15 min (97140) | $52.80 | $165 | 1.9× |
| Ot paraffin bath (97018) | $24 | $75 | 4.0× |
| Ot Prosthetic Training, Each 15 Min (97761) range across 5 matching MRF lines |
$72–$95.68 | $225–$299 | varies |
| Ot Re-Eval Est Plan Care (97168) | $72 | $225 | 1.1× |
| Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) range across 3 matching MRF lines |
$69.44–$163.52 | $217–$511 | varies |
| Outpatient Cardiac Rehab W/O Cont Ecg Monitor (93797) | $65.60 | $205 | 0.5× |
| Peripheral arterial disease rehab per session (93668) | $76.80 | $240 | 1.3× |
| Phlebotomy therapeutic (99195) | $44.16 | $138 | 0.3× |
| Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) range across 3 matching MRF lines |
$56.64–$160.32 | $177–$501 | varies |
| Physical Performance Test (97750) range across 12 matching MRF lines |
$34.88–$120 | $109–$375 | varies |
| Plethysmography (94726) | $98.88 | $309 | 0.3× |
| Pm device eval in person (93288) range across 2 matching MRF lines |
$15.68–$29.76 | $49–$93 | varies |
| Pm device progr eval dual (93280) range across 2 matching MRF lines |
$43.20–$75.84 | $135–$237 | varies |
| Pm device progr eval multi (93281) range across 2 matching MRF lines |
$44.80–$138.56 | $140–$433 | varies |
| Pm Device Progr Eval Sngl (93279) range across 2 matching MRF lines |
$35.20–$60.80 | $110–$190 | varies |
| Pm/Icd Remote Tech Serv (93296) range across 3 matching MRF lines |
$80.96–$164.80 | $253–$515 | varies |
| Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) | $1,834.88 | $5,734 | 2.2× |
| Prgrmng Dev Eval Implantable in Persn 1 Ld Dfb (93282) range across 2 matching MRF lines |
$40–$80.96 | $125–$253 | varies |
| Pt Eval High Complex (97163) range across 2 matching MRF lines |
$153.60–$168.32 | $480–$526 | varies |
| Pt eval low complex 20 min (97161) | $112 | $350 | 1.1× |
| Pt Eval Mod Complex (97162) | $124.80 | $390 | 1.3× |
| Pt gait training 15 min (97116) | $56 | $175 | 1.9× |
| Pt mechanical traction (97012) | $12.80 | $40 | 0.9× |
| Pt Re-Eval Est Plan Care (97164) | $80 | $250 | 1.2× |
| Pulm function test by gas (94727) | $138.56 | $433 | 0.6× |
| Pulmonary Stress Testing (94618) | $136.32 | $426 | 1.0× |
| Refill/Maint Pump/Resvr Syst (96522) | $173.76 | $543 | 0.8× |
| Rem Interrog Scrms <30 D Phys/Qhp (93298) | $80.96 | $253 | 2.2× |
| Rem mntr physiol param 1st set up pt educaj eqp (99453) | $128.64 | $402 | 1.0× |
| Remote 30 Day Ecg Rev/Report (93270) range across 3 matching MRF lines |
$30.72–$224.64 | $96–$702 | varies |
| Remote 30 Day Ecg Tech Supp (93229) | $276.80 | $865 | 0.7× |
| Respiratory flow volume loop (94375) | $262.72 | $821 | 1.2× |
| Rhythm Ecg 1-3 Leads Tracing Only W/O I&R (93041) range across 4 matching MRF lines |
$30.08–$102.40 | $94–$320 | varies |
| Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) range across 4 matching MRF lines |
$87.68–$120.64 | $274–$377 | varies |
| Rx sp-genratj augmnt&comunicaj dev 1st hr (92607) range across 2 matching MRF lines |
$114.88–$227.20 | $359–$710 | varies |
| Rx Sp-Genratj Augmnt&Comunicaj Dev Ea 30 Min (92608) range across 2 matching MRF lines |
$24.96–$49.28 | $78–$154 | varies |
| Self Care Mngment Training (97535) | $56 | $175 | 1.7× |
| Sleep study attended (95807) range across 2 matching MRF lines |
$751.68–$902.08 | $2,349–$2,819 | varies |
| Sleep study unattended (95806) | $453.76 | $1,418 | 2.1× |
| Slp Stdy Unatnd W/Hrt Rate/O2 Sat/Resp/Slp Time (95800) | $138.56 | $433 | 0.6× |
| Speech sound lang comprehen (92523) | $208 | $650 | 0.9× |
| Spirometry (94010) range across 2 matching MRF lines |
$68.48–$70.40 | $214–$220 | varies |
| Standardized Cognitive Performance Testing (96125) range across 2 matching MRF lines |
$144–$158.40 | $450–$495 | varies |
| Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129) | $48 | $150 | 2.1× |
| Ther Ivntj Ea Addl 15 Min (97130) | $44.80 | $140 | 2.1× |
| Ther Px 1/> Areas Each 15 Min Aqua Ther W/Xerss (97113) | $56 | $175 | 1.5× |
| Ther Px 1/> Areas Each 15 Minutes Massage (97124) range across 3 matching MRF lines |
$47.04–$58.56 | $147–$183 | varies |
| Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) | $109.76 | $343 | 1.1× |
| Ther/Proph/Diag Inj Sc/Im (96372) range across 9 matching MRF lines |
$35.52–$77.12 | $111–$241 | varies |
| Ther/Proph/Diag Iv Inf Init (96365) range across 7 matching MRF lines |
$159.68–$293.76 | $499–$918 | varies |
| Therapeutic Activities (97530) | $60.80 | $190 | 1.7× |
| Tilt table test with heart rhythm and blood pressure monitoring (93660) | $299.52 | $936 | 0.8× |
| Transtelephonic Rhythm Strip Pacemaker Eval (93293) | $91.20 | $285 | 2.5× |
| Tte w/doppler, complete (93306) range across 3 matching MRF lines |
$974.40–$1,533.44 | $3,045–$4,792 | varies |
| Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) | $128 | $400 | 1.7× |
| Tx Speech Language Voice Commj Auditry 2/>Indiv (92508) | $55.68 | $174 | 2.3× |
| Tx/Pro/Dx Inj New Drug Addon (96375) range across 6 matching MRF lines |
$37.12–$77.12 | $116–$241 | varies |
| Upr/L Xtremity Art 2 Levels (93922) range across 4 matching MRF lines |
$89.60–$176.32 | $280–$551 | varies |
| Upr/Lxtr Art Stdy 3+ Lvls (93923) range across 9 matching MRF lines |
$169.60–$781.76 | $530–$2,443 | varies |
| Vent Mgmt Inpat Init Day (94002) | $346.24 | $1,082 | 0.6× |
| Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) range across 2 matching MRF lines |
$193.28–$214.40 | $604–$670 | varies |
| Wheelchair Mgmt Ea 15 Min (97542) | $104 | $325 | 3.3× |
| Whirlpool Therapy (97022) range across 3 matching MRF lines |
$35.20–$48.32 | $110–$151 | varies |
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.