Visits & medical services prices at Froedtert Holy Family Memorial Hospital
Manitowoc, WI · every code in this section with a posted price and a Medicare benchmark.
173 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) | $36.85 | $67 | 0.9× |
| Airway Inhalation Treatment (94640) | $104.50 | $190 | 0.5× |
| Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) | $60.50 | $110 | 4.2× |
| Application Modality 1/> Areas Diathermy (97024) | $20.35 | $37 | 2.8× |
| Application on-body injector (96377) | $73.70 | $134 | 1.6× |
| Assessment of aphasia per hr (96105) | $198.55 | $361 | 2.0× |
| Behavral qualit analys voice (92524) range across 5 matching MRF lines |
$50.05–$191.95 | $91–$349 | varies |
| Brncdilat rspse spmtry pre&post-brncdilat admn (94060) range across 2 matching MRF lines |
$538.45–$540.10 | $979–$982 | varies |
| Canalith repositioning proc (95992) | $119.90 | $218 | 2.9× |
| Cardiac Stress Tst,Tracing Only (93017) | $579.15 | $1,053 | 2.8× |
| Cardiopulmonary resuscitation (92950) | $1,249.60 | $2,272 | 5.9× |
| Cardioversion (92960) | $1,214.40 | $2,208 | 1.9× |
| Caregiver Training Strategies&Tq Ea Addl 15 Min (97551) | $74.80 | $136 | 2.9× |
| Cath Place/Coron Angio, Img Super/Interp,R&L Hrt Cath, L Hrt Ventric (93460) | $8,800 | $16,000 | 2.8× |
| Cath Place/Coron Angio, Img Super/Interp,W Left Heart Ventriculography (93458) | $8,800 | $16,000 | 2.8× |
| Cbt 1st hour (94644) | $185.90 | $338 | 1.4× |
| Chemo Anti-Neopl Sq/Im (96401) | $178.75 | $325 | 2.5× |
| Chemo Hormon Antineopl Sq/Im (96402) | $133.65 | $243 | 1.9× |
| Chemo IV infusion addl hr (96415) | $138.05 | $251 | 2.0× |
| Chemo IV push addl drug (96411) | $133.10 | $242 | 1.9× |
| Chemother Prolong Infuse W/Pump (96416) | $728.20 | $1,324 | 2.3× |
| Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) | $152.35 | $277 | 2.2× |
| Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) | $664.95 | $1,209 | 2.1× |
| Chemotx admn IV push tq 1/1st sbst/drug (96409) | $437.80 | $796 | 1.4× |
| Chest Wall Manipulation (94668) range across 7 matching MRF lines |
$113.85–$169.13 | $207–$307.50 | varies |
| Color/duplex Doppler, complete (93975) | $658.35 | $1,197 | 2.8× |
| Color/duplex Doppler, limited (93976) | $481.80 | $876 | 4.7× |
| Continuous Pulse Ox (94762) | $202.40 | $368 | 1.6× |
| Coronary Art/Grft Angio S&I (93455) | $6,245.25 | $11,355 | 2.0× |
| Coronary Artery Angio S&I (93454) | $6,266.15 | $11,393 | 2.0× |
| Cpap Ventilation Cpap Initiation&Mgmt (94660) | $247.50 | $450 | 1.2× |
| Cpt initial (94667) range across 7 matching MRF lines |
$94.60–$140.53 | $172–$255.50 | varies |
| Critical care first hour (99291) | $2,021.25 | $3,675 | 2.5× |
| Debridement Open Wound 20 Sq Cm< (97597) | $242.55 | $441 | 1.2× |
| Dup-scan aorta ivc iliac vascl/bpgs complete (93978) | $689.15 | $1,253 | 3.0× |
| Dup-scan aorta ivc iliac vascl/bpgs uni/lmtd (93979) | $215.60 | $392 | 2.1× |
| Dup-scan lxtr art/artl bpgs compl bi study (93925) | $749.10 | $1,362 | 3.2× |
| Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) | $312.95 | $569 | 3.1× |
| Dup-Scan Xtr Veins Complete Bilateral Study (93970) | $820.05 | $1,491 | 3.5× |
| Dup-scan xtr veins unilateral/limited study (93971) | $475.20 | $864 | 4.7× |
| Duplex Scan Hemodialysis Access (93990) | $720.50 | $1,310 | 7.1× |
| Duplex up extrem art bilat (93930) | $1,201.75 | $2,185 | 5.2× |
| Duplex up extrem art unilat/ltd (93931) | $378.95 | $689 | 3.7× |
| ECG/monitoring and analysis (93271) | $673.75 | $1,225 | 7.3× |
| Echo Heart Xthoracic,Limited (93308) | $501.60 | $912 | 2.2× |
| Echo transesophag montr cardiac pump functj (93318) | $678.43 | $1,233.50 | 1.3× |
| Echo transesophageal (93312) | $1,046.65 | $1,903 | 2.0× |
| Eeg 41-60 Minutes (95812) | $513.15 | $933 | 2.4× |
| EEG awake drowsy (95816) | $466.40 | $848 | 2.2× |
| EEG extended monitoring 61-119 minutes (95813) | $440 | $800 | 2.1× |
| Electrical Stimulation Ea 15 Min (97032) | $70.95 | $129 | 4.8× |
| Electrocardiogram Tracing (93005) | $110 | $200 | 1.9× |
| Emergency Dept Visit Level 2 (99282) | $288.75 | $525 | 1.9× |
| Emergency Dept Visit Level 3 (99283) | $605 | $1,100 | 2.3× |
| Emergency Dept Visit Level 4 (99284) range across 2 matching MRF lines |
$601.15–$990 | $1,093–$1,800 | varies |
| Endomyocardial Biopsy (93505) | $2,249.50 | $4,090 | 0.7× |
| Er level 1 (99281) range across 2 matching MRF lines |
$115.50–$206.25 | $210–$375 | varies |
| Er level v (99285) range across 2 matching MRF lines |
$616–$1,375 | $1,120–$2,500 | varies |
| Evaluate pt use of inhaler (94664) | $121.55 | $221 | 0.6× |
| Evaluate Speech Production (92522) range across 5 matching MRF lines |
$75.35–$300.85 | $137–$547 | varies |
| Evaluate Swallowing Function (92610) range across 6 matching MRF lines |
$80.30–$382.25 | $146–$695 | varies |
| Evaluation of speech fluency (92521) range across 5 matching MRF lines |
$174.35–$568.15 | $317–$1,033 | varies |
| Exhaled Air Analysis O2 (94680) | $275.55 | $501 | 2.2× |
| External ECG rec>48hr<7d recording (93242) | $232.10 | $422 | 6.4× |
| External ECG rec>48hr<7d scanning alys w/report (93243) | $334.95 | $609 | 2.6× |
| External ECG rec>7d<15d recording (93246) | $232.10 | $422 | 6.4× |
| External ECG rec>7d<15d scanning alys w/report (93247) | $334.95 | $609 | 2.6× |
| Extracranial Bilat Study (93880) | $768.35 | $1,397 | 3.3× |
| Extracranial Uni/Ltd Study (93882) | $306.35 | $557 | 3.0× |
| Gastroesophag Reflx Test W/Intrluml Imped Eltrd (91037) | $425.15 | $773 | 2.0× |
| Gi tract capsule endoscopy (91110) | $1,076.35 | $1,957 | 1.2× |
| Heart catheterization, both sides, with coronary and bypass graft angiography (93461) | $11,044.55 | $20,081 | 3.5× |
| Holter monitor recording (93225) | $357.50 | $650 | 2.8× |
| Icd Device Interrogate (93289) | $215.05 | $391 | 5.9× |
| Icd Device Progr Eval Mult (93284) | $337.70 | $614 | 9.3× |
| Ilr Device Eval Progr (93285) | $70.95 | $129 | 2.0× |
| Ilr Device Interrogate (93291) | $40.15 | $73 | 1.4× |
| Immunization administration (90471) | $45.65 | $83 | 0.7× |
| Insert/Place Heart Catheter (93503) | $2,163.70 | $3,934 | 1.4× |
| Iontophoresis 15 min (97033) | $76.45 | $139 | 4.0× |
| Irrig Drug Delivery Device (96523) | $123.75 | $225 | 2.2× |
| IV infusion hydration each additional hour (96361) | $96.25 | $175 | 2.1× |
| IV infusion hydration initial 31 min-1 hour (96360) | $356.40 | $648 | 1.7× |
| IV infusion ther proph addl sequential to 1 hr (96367) | $126.50 | $230 | 1.8× |
| IV infusion therapy prophylaxis/dx ea hour (96366) | $88 | $160 | 1.9× |
| IV push initial (96374) | $187 | $340 | 0.9× |
| L Hrt Art/Grft Angio (93459) | $8,800 | $16,000 | 2.8× |
| Low frequency non-thermal us (97610) | $250.80 | $456 | 1.3× |
| Lwr Xtr Vasc Stdy Bilat (93924) | $530.75 | $965 | 2.5× |
| Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) | $89.10 | $162 | 2.8× |
| Medical nutrition assmt&ivntj indiv each 15 mi (97802) | $53.90 | $98 | 1.5× |
| Motion Fluoroscopy/Swallow (92611) range across 8 matching MRF lines |
$121.55–$777.15 | $221–$1,413 | varies |
| Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) | $499.40 | $908 | 1.3× |
| Neg Pressure Wound Therapy Non Dme >50 Sq Cm (97608) | $614.35 | $1,117 | 1.6× |
| Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) | $299.20 | $544 | 1.5× |
| Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) | $614.35 | $1,117 | 1.6× |
| Neuromuscular Reeducation (97112) | $80.85 | $147 | 2.5× |
| Oral Function Therapy (92526) range across 6 matching MRF lines |
$169.95–$983.95 | $309–$1,789 | varies |
| Orthc/Prostc Mgmt Sbsq Enc (97763) | $139.70 | $254 | 2.8× |
| Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) | $135.85 | $247 | 2.9× |
| Osteopathic Manipulative Tx 1-2 Body Regions (98925) | $41.80 | $76 | 2.0× |
| Ot eval high complexity (97167) | $294.25 | $535 | 2.9× |
| Ot Eval Low Complex (97165) | $184.80 | $336 | 1.8× |
| Ot Eval Moderate Complexity (97166) | $198.55 | $361 | 2.0× |
| Ot manual therapy 15 min (97140) | $85.80 | $156 | 3.1× |
| Ot paraffin bath (97018) | $31.90 | $58 | 5.3× |
| Ot Prosthetic Training, Each 15 Min (97761) | $62.70 | $114 | 1.6× |
| Ot Re-Eval Est Plan Care (97168) | $113.30 | $206 | 1.7× |
| Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) | $169.95 | $309 | 1.4× |
| Outpatient Cardiac Rehab W/O Cont Ecg Monitor (93797) | $176 | $320 | 1.4× |
| Penile Vascular Study,Ltd or F/U (93981) | $158.95 | $289 | 1.6× |
| Pentamidine Aersl Inhalation Pneumocystis/Proph (94642) | $269.50 | $490 | 1.3× |
| Peripheral arterial disease rehab per session (93668) | $126.50 | $230 | 2.2× |
| Perq Trluml C Angioplasty 1 Maj C Art&/Branches (92920) | $6,146.80 | $11,176 | 1.1× |
| Perq Trluml Revsc Chrnc Tot Occls 1 C Art Antgrd (92943) | $13,887.50 | $25,250 | 1.2× |
| Phlebotomy therapeutic (99195) | $151.25 | $275 | 1.2× |
| Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) | $171.60 | $312 | 3.0× |
| Physical Performance Test (97750) | $112.75 | $205 | 3.3× |
| Plethysmography (94726) | $480.15 | $873 | 1.3× |
| Pm device eval in person (93288) | $151.80 | $276 | 4.2× |
| Pm/Icd Remote Tech Serv (93296) | $82.50 | $150 | 2.3× |
| Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) | $3,052.50 | $5,550 | 3.6× |
| Prgrmng Dev Eval Implantable in Persn 1 Ld Dfb (93282) | $240.35 | $437 | 6.6× |
| Prq Card Angio/Athrect 1 Art (92924) | $7,943.10 | $14,442 | 0.7× |
| Prq Card Stent W/Angio 1 Vsl (92928) | $6,457.55 | $11,741 | 0.6× |
| Prq Card Stent/Ath/Angio (92933) | $19,000.30 | $34,546 | 1.1× |
| Prq Revasc Byp Graft 1 Vsl (92937) | $6,457.55 | $11,741 | 0.6× |
| Pt Eval High Complex (97163) | $264.55 | $481 | 2.7× |
| Pt eval low complex 20 min (97161) | $172.15 | $313 | 1.8× |
| Pt Eval Mod Complex (97162) | $206.25 | $375 | 2.1× |
| Pt gait training 15 min (97116) | $73.70 | $134 | 2.5× |
| Pt group caregiver training (97552) | $28.05 | $51 | 1.3× |
| Pt mechanical traction (97012) range across 4 matching MRF lines |
$108.35–$352.55 | $197–$641 | varies |
| Pt Re-Eval Est Plan Care (97164) | $95.15 | $173 | 1.4× |
| Pulmonary service/procedure (94799) range across 7 matching MRF lines |
$61.60–$356.40 | $112–$648 | varies |
| Pulmonary Stress Testing (94618) | $206.80 | $376 | 1.6× |
| R Hrt Art/Grft Angio (93457) | $7,150 | $13,000 | 2.3× |
| R hrt coronary artery angio (93456) | $5,500 | $10,000 | 1.7× |
| R&L Hrt Cath W/Ventriclgrphy (93453) | $6,831.55 | $12,421 | 2.2× |
| Refill/Maint Portable Pump (96521) | $268.95 | $489 | 1.3× |
| Remote 30 Day Ecg Rev/Report (93270) | $121.55 | $221 | 3.3× |
| Rhythm Ecg 1-3 Leads Tracing Only W/O I&R (93041) | $48.40 | $88 | 0.8× |
| Right Heart Cath (93451) | $5,350.95 | $9,729 | 1.7× |
| Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) range across 2 matching MRF lines |
$163.90–$168.85 | $298–$307 | varies |
| Rx sp-genratj augmnt&comunicaj dev 1st hr (92607) | $364.10 | $662 | 3.0× |
| Self Care Mngment Training (97535) | $73.15 | $133 | 2.3× |
| Sensory Integration Ea 15 Min (97533) | $102.30 | $186 | 1.7× |
| Slp caregiver training 1st 30 min (97550) | $149.60 | $272 | 2.8× |
| Slp Stdy Unatnd W/Hrt Rate/O2 Sat/Resp/Slp Time (95800) | $726 | $1,320 | 3.4× |
| Speech sound lang comprehen (92523) range across 6 matching MRF lines |
$133.10–$639.10 | $242–$1,162 | varies |
| Spirometry (94010) range across 3 matching MRF lines |
$288.75–$335.50 | $525–$610 | varies |
| Stress Tte Only (93350) | $1,036.75 | $1,885 | 1.9× |
| Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129) | $44.55 | $81 | 2.0× |
| Ther Ivntj Ea Addl 15 Min (97130) | $43.45 | $79 | 2.1× |
| Ther Px 1/> Areas Each 15 Min Aqua Ther W/Xerss (97113) | $116.60 | $212 | 3.1× |
| Ther/Proph/Diag Inj Sc/Im (96372) | $111.10 | $202 | 1.6× |
| Ther/Proph/Diag Iv Inf Init (96365) | $395.45 | $719 | 1.9× |
| Therapeutic Activities (97530) | $79.20 | $144 | 2.3× |
| Tilt table test with heart rhythm and blood pressure monitoring (93660) | $1,055.45 | $1,919 | 2.9× |
| Tobacco Use Cessation Intensive >10 Minutes (99407) | $34.10 | $62 | 0.9× |
| Tobacco Use Cessation Intermediate 3-10 Minutes (99406) | $34.10 | $62 | 0.9× |
| Transtelephonic Rhythm Strip Pacemaker Eval (93293) | $476.85 | $867 | 13.1× |
| Tte w/doppler, complete (93306) | $1,488.30 | $2,706 | 2.8× |
| Tte W/O Doppler Complete (93307) | $1,210 | $2,200 | 5.2× |
| Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) range across 6 matching MRF lines |
$169.95–$623.15 | $309–$1,133 | varies |
| Tx/Pro/Dx Inj New Drug Addon (96375) | $90.20 | $164 | 2.0× |
| Unlis neurological/neuromuscular dx px (95999) | $196.90 | $358 | 1.6× |
| Upr/L Xtremity Art 2 Levels (93922) | $300.85 | $547 | 2.3× |
| Upr/Lxtr Art Stdy 3+ Lvls (93923) | $358.05 | $651 | 1.7× |
| Vent Mgmt Inpat Init Day (94002) | $614.90 | $1,118 | 1.0× |
| Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) | $444.95 | $809 | 0.7× |
| Wheelchair Mgmt Ea 15 Min (97542) | $100.10 | $182 | 3.2× |
| Whirlpool Therapy (97022) | $70.40 | $128 | 4.5× |
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.