Visits & medical services prices at Good Samaritan Hospital

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

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

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ProcedurePosted cashPosted gross× Medicare
Actigraphy Testing Recording Analysis I&R (95803) $290.40 $484 4.7×
Advncd Care Plan 30 Min (99497) $124.20 $207 1.2×
Airway Inhalation Treatment (94640) $172.80 $288 0.7×
Ambulatory bp mntr w/sw 24 hr+ recording only (93786) $101.40 $169 0.7×
Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) $77.40 $129 5.4×
Application on-body injector (96377) $96.60 $161 1.9×
Assessment of aphasia per hr (96105) $159 $265 1.6×
Behavral qualit analys voice (92524) $148.20 $247 1.4×
Bfb traing w/EMG &/manometry 1st 15 min cntct (90912) $94.20 $157 1.1×
Bfb training ea addl 15 min (90913) $31.20 $52 1.0×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $413.40 $689 1.0×
Canalith repositioning proc (95992) $79.20 $132 1.9×
Cardiac Stress Tst,Tracing Only (93017) $907.80 $1,513 4.0×
Cardiopulmonary resuscitation (92950) $540 $900 2.4×
Cardioversion (92960) $1,008 $1,680 1.4×
Cath Place/Coron Angio, Img Super/Interp,R&L Hrt Cath, L Hrt Ventric (93460) $10,208.40 $17,014 3.0×
Cath Place/Coron Angio, Img Super/Interp,W Left Heart Ventriculography (93458) $9,880.20 $16,467 2.9×
Cbt 1st hour (94644) $160.80 $268 1.1×
Chemo Admin Peritoneal Cavity (96446) $706.80 $1,178 2.0×
Chemo Anti-Neopl Sq/Im (96401) $176.40 $294 2.3×
Chemo Hormon Antineopl Sq/Im (96402) $177.60 $296 2.3×
Chemo Ia Push (96420) $304.20 $507 0.9×
Chemo IV infusion addl hr (96415) $248.40 $414 3.3×
Chemo IV push addl drug (96411) $211.80 $353 2.8×
Chemother Prolong Infuse W/Pump (96416) $495 $825 1.4×
Chemotherapy Into Cns (96450) $478.80 $798 1.4×
Chemotherapy Unspecified (96549) $1,184.40 $1,974 23.9×
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $125.40 $209 1.6×
Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) $671.40 $1,119 1.9×
Chemotx admn IV push tq 1/1st sbst/drug (96409) $349.50 $582.50 1.0×
Chest Wall Manipulation (94668)
range across 2 matching MRF lines		 $187.80–$190.80 $313–$318 varies
Color/duplex Doppler, complete (93975) $837 $1,395 3.3×
Color/duplex Doppler, limited (93976) $482.40 $804 4.4×
Community/Work Reintegration Trainj Ea 15 Min (97537) $72.60 $121 2.3×
Continuous Pulse Ox (94762) $135 $225 1.0×
Coronary Art/Grft Angio S&I (93455) $7,206 $12,010 2.1×
Coronary Artery Angio S&I (93454) $7,873.80 $13,123 2.3×
Cpap Ventilation Cpap Initiation&Mgmt (94660) $326.40 $544 1.4×
Cpt initial (94667) $151.20 $252 1.1×
Critical care first hour (99291) $1,510.80 $2,518 1.7×
Debridement Open Wound 20 Sq Cm< (97597)
range across 8 matching MRF lines		 $122.40–$250.20 $204–$417 varies
Dialysis One Evaluation (90945) $654.90 $1,091.50 1.5×
Dup-scan lxtr art/artl bpgs compl bi study (93925) $418.20 $697 1.7×
Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) $314.40 $524 2.8×
Dup-Scan Xtr Veins Complete Bilateral Study (93970) $965.40 $1,609 3.8×
Dup-scan xtr veins unilateral/limited study (93971) $656.40 $1,094 5.9×
Duplex Scan Artl Infl&Ven O/F Hemo Compl Bi Std (93985) $423.90 $706.50 1.7×
Duplex Scan Artl Infl&Ven O/F Hemo Compl Uni Std (93986) $203.70 $339.50 1.8×
Duplex up extrem art bilat (93930) $401.40 $669 1.6×
Duplex up extrem art unilat/ltd (93931) $252 $420 2.3×
Echo Heart Xthoracic,Limited (93308) $344.40 $574 1.4×
Echo transesophageal (93312) $1,678.80 $2,798 2.9×
Echo tthrc r-t 2d w/wo m-mode rest&strs cont ECG (93351) $1,543.20 $2,572 2.7×
Eeg 41-60 Minutes (95812) $426.60 $711 1.9×
EEG awake and asleep (95819) $445.80 $743 2.0×
EEG awake drowsy (95816) $445.80 $743 2.0×
EEG cerebral death evaluation (95824) $589.80 $983 1.5×
EEG cont rec w/video by tech min 8 channels (95700) $400.80 $668 1.8×
EEG extended monitoring 61-119 minutes (95813) $490.20 $817 2.1×
Eeg Sleep Only (95822)
range across 2 matching MRF lines		 $498.60–$538.20 $831–$897 varies
Electrical Stimulation Ea 15 Min (97032) $88.80 $148 6.0×
Electrocardiogram Tracing (93005) $196.80 $328 3.2×
Electroconvulsive Therapy (90870) $307.80 $513 0.3×
Electrophysiology Evaluation (93642) $2,384.40 $3,974 1.9×
Emergency Dept Visit Level 2 (99282) $340.20 $567 2.1×
Emergency Dept Visit Level 3 (99283) $627.60 $1,046 2.2×
Emergency Dept Visit Level 4 (99284) $874.80 $1,458 2.0×
Er level 1 (99281) $153 $255 1.7×
Er level v (99285) $1,404 $2,340 2.2×
Evaluate pt use of inhaler (94664) $148.20 $247 0.6×
Evaluate Speech Production (92522) $195.60 $326 1.7×
Evaluate Swallowing Function (92610) $202.80 $338 2.4×
Evaluation of speech fluency (92521) $148.20 $247 1.1×
Evoked Auditory Test,Limited (92587) $468 $780 2.0×
External ECG rec>48hr<7d recording (93242) $74.40 $124 1.9×
External ECG rec>7d<15d recording (93246) $91.20 $152 2.3×
External Ecg Scanning Analysis Report (93226) $394.80 $658 6.3×
Extracranial Bilat Study (93880)
range across 2 matching MRF lines		 $807 $23–$1,345 3.2×
Extracranial Uni/Ltd Study (93882) $192.30 $320.50 1.7×
Gi tract capsule endoscopy (91110) $1,817.40 $3,029 1.9×
Group Therapeutic Procedures (97150) $76.20 $127 4.2×
Heart catheterization, both sides, with coronary and bypass graft angiography (93461) $10,208.40 $17,014 3.0×
Holter monitor recording (93225) $279 $465 2.0×
Icd device progr eval dual (93283) $37.80 $63 1.0×
Icd Device Progr Eval Mult (93284) $37.80 $63 1.0×
Ilr Device Eval Progr (93285) $44.40 $74 1.1×
Ilr Device Interrogate (93291) $68.40 $114 2.2×
Immunization administration (90471) $42.60 $71 0.6×
Insert/Place Heart Catheter (93503) $6,285 $10,475 3.8×
Iontophoresis 15 min (97033) $97.20 $162 5.1×
Irrig Drug Delivery Device (96523) $168 $280 2.7×
IV infusion hydration each additional hour (96361) $96.60 $161 1.9×
IV infusion hydration initial 31 min-1 hour (96360) $290.40 $484 1.3×
IV infusion ther proph addl sequential to 1 hr (96367) $109.80 $183 1.4×
IV infusion therapy prophylaxis/dx ea hour (96366) $119.40 $199 2.4×
IV push initial (96374) $164.40 $274 0.7×
L Hrt Art/Grft Angio (93459) $10,237.20 $17,062 3.0×
Laryngeal Function Studies (92520) $148.20 $247 1.1×
Lwr Xtr Vasc Stdy Bilat (93924) $910.20 $1,517 4.0×
Mechanical chest wall oscillation per session (94669) $127.20 $212 0.5×
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $27 $45 0.9×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $33 $55 0.9×
Methacholine challenge (94070) $566.40 $944 1.4×
Motility study esophagus (91010) $1,468.80 $2,448 3.7×
Motion Fluoroscopy/Swallow (92611) $150.60 $251 1.6×
Multiple Sleep Latency Test (95805) $1,406.40 $2,344 1.5×
Muscle Test 2 Limbs (95861) $215.70 $359.50 1.5×
Muscle Test One Limb (95860) $187.80 $313 1.3×
Nasopharyngoscopy (92511) $247.20 $412 1.2×
Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) $249.60 $416 0.6×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605)
range across 8 matching MRF lines		 $213–$225.90 $355–$376.50 varies
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606)
range across 9 matching MRF lines		 $275.40–$306.60 $459–$511 varies
Nerve Conduction Studies 1-2 Studies (95907) $275.40 $459 1.2×
Nerve Conduction Studies 11-12 Studies (95912) $1,660.20 $2,767 4.2×
Nerve conduction studies 13 or more studies (95913) $1,900.20 $3,167 4.8×
Nerve Conduction Studies 3-4 Studies (95908) $479.40 $799 2.1×
Nerve conduction studies 5-6 studies (95909) $720 $1,200 3.2×
Nerve conduction studies 7-8 studies (95910) $958.80 $1,598 2.4×
Nerve Conduction Studies 9-10 Studies (95911) $1,198.80 $1,998 3.0×
Neuromuscular Reeducation (97112) $88.80 $148 2.7×
Nitric oxide expired gas determination (95012) $60 $100 1.5×
Nrpsyc tst eval phys/qhp 1st (96132) $249.60 $416 0.6×
Oral Function Therapy (92526) $163.20 $272 1.9×
Oral Speech Device Eval (92597) $252 $420 3.5×
Orthc/Prostc Mgmt Sbsq Enc (97763) $60.60 $101 1.2×
Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) $88.20 $147 1.9×
Ot eval high complexity (97167) $238.20 $397 2.4×
Ot Eval Low Complex (97165) $176.40 $294 1.8×
Ot Eval Moderate Complexity (97166) $231.60 $386 2.3×
Ot manual therapy 15 min (97140) $93.60 $156 3.4×
Ot paraffin bath (97018) $57.60 $96 9.6×
Ot Prosthetic Training, Each 15 Min (97761) $79.20 $132 2.0×
Ot Re-Eval Est Plan Care (97168) $85.20 $142 1.2×
Ot rom hand (95852) $32.40 $54 1.5×
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798)
range across 2 matching MRF lines		 $138.90–$139.20 $231.50–$232 varies
Outpatient Cardiac Rehab W/O Cont Ecg Monitor (93797)
range across 2 matching MRF lines		 $222–$235.80 $370–$393 varies
Pentamidine Aersl Inhalation Pneumocystis/Proph (94642) $157.80 $263 0.7×
Peripheral arterial disease rehab per session (93668)
range across 2 matching MRF lines		 $90.60–$91.20 $151–$152 varies
Perq Tcat Plmt Ntrac St 2+Les 2+St 2+C Segments (92930) $14,046.60 $23,411 0.7×
Perq Trluml C Angioplasty 1 Maj C Art&/Branches (92920) $7,575 $12,625 1.3×
Perq Trluml Revsc Chrnc Tot Occls 1 C Art Antgrd (92943)
range across 5 matching MRF lines		 $9,783.60–$12,883.20 $16,306–$21,472 varies
Phlebotomy therapeutic (99195) $139.80 $233 1.0×
Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) $198.60 $331 3.2×
Physical Performance Test (97750) $59.40 $99 1.8×
Plethysmography (94726) $226.80 $378 0.6×
Pm device progr eval dual (93280) $44.40 $74 1.1×
Pm device progr eval multi (93281)
range across 2 matching MRF lines		 $37.80–$144 $63–$240 varies
Pm Device Progr Eval Sngl (93279) $40.80 $68 1.0×
Pm/Icd Remote Tech Serv (93296) $55.80 $93 1.4×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $2,828.70 $4,714.50 3.1×
Prgrmng Dev Eval Implantable in Persn 1 Ld Dfb (93282) $39.60 $66 1.0×
Prq Card Angio/Athrect 1 Art (92924) $7,990.20 $13,317 0.7×
Prq Card Stent W/Angio 1 Vsl (92928) $14,181.60 $23,636 1.2×
Prq Card Stent/Ath/Angio (92933) $12,780.60 $21,301 0.7×
Prq Revasc Byp Graft 1 Vsl (92937) $8,383.20 $13,972 0.7×
Prq trl rvs ch occ ant&rtrgr (92945) $8,845.80 $14,743 0.7×
Psych diag eval w/med srvcs (90792) $135 $225 0.7×
Psychiatric diagnostic evaluation (90791) $135 $225 0.7×
Pt Eval High Complex (97163) $239.40 $399 2.4×
Pt eval low complex 20 min (97161) $176.40 $294 1.8×
Pt Eval Mod Complex (97162) $216.60 $361 2.2×
Pt gait training 15 min (97116) $77.40 $129 2.7×
Pt mechanical traction (97012) $74.40 $124 5.2×
Pt Re-Eval Est Plan Care (97164) $90.60 $151 1.3×
Pulm function test by gas (94727) $226.80 $378 1.0×
Pulmonary service/procedure (94799) $192.60 $321 1.4×
Pulmonary Stress Testing (94618) $121.80 $203 0.9×
Pure Tone Audiometry Air (92552) $117.60 $196 0.8×
R Hrt Art/Grft Angio (93457) $6,933 $11,555 2.0×
R hrt coronary artery angio (93456) $7,597.80 $12,663 2.2×
R&L Hrt Cath W/Ventriclgrphy (93453) $6,812.40 $11,354 2.0×
Rem interrog icpms <30 d phys/qhp (93297) $75 $125 1.9×
Rem Interrog Scrms <30 D Phys/Qhp (93298) $75 $125 1.9×
Repet tms tx initial w/map/motr threshld/del&m (90867) $273 $455 1.2×
Repet Tms Tx Subseq Motr Threshld W/Deliv & Mngt (90869) $440.40 $734 1.9×
Right Heart Cath (93451) $7,012.20 $11,687 2.0×
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602)
range across 7 matching MRF lines		 $139.80–$148.20 $233–$247 varies
Rom Meas&Reprt Ea Xtr Ex Hand/Ea Trnk Sctj Spi (95851) $45.60 $76 1.8×
Rx sp-genratj augmnt&comunicaj dev 1st hr (92607) $176.40 $294 1.4×
Self Care Mngment Training (97535) $91.20 $152 2.8×
Sensory Integration Ea 15 Min (97533) $31.20 $52 0.5×
Sleep study attended (95807) $949.80 $1,583 2.4×
Sleep study unattended (95806) $460.80 $768 2.0×
Slp Stdy Unatnd W/Hrt Rate/O2 Sat/Resp/Slp Time (95800) $855.60 $1,426 3.7×
Speech sound lang comprehen (92523) $148.20 $247 0.7×
Spirometry (94010) $192.60 $321 0.8×
Standardized Cognitive Performance Testing (96125) $157.20 $262 1.5×
Subcutaneous Infusion Each Additional Hour (96370) $118.20 $197 2.4×
Subcutaneous infusion initial 1 hr w/pump set-up (96369) $171 $285 0.8×
Surfactant Admin Thru Tube (94610) $277.80 $463 1.2×
Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129) $52.20 $87 2.3×
Ther Ivntj Ea Addl 15 Min (97130) $30 $50 1.4×
Ther Px 1/> Areas Each 15 Min Aqua Ther W/Xerss (97113) $94.80 $158 2.6×
Ther Px 1/> Areas Each 15 Minutes Massage (97124) $73.20 $122 2.5×
Ther/Proph/Diag Inj Sc/Im (96372)
range across 2 matching MRF lines		 $93.60–$96.60 $156–$161 varies
Ther/Proph/Diag Iv Inf Init (96365) $355.20 $592 1.6×
Therap repetitive tms tx subseq delivery & mng (90868) $440.40 $734 1.9×
Therapeutic Activities (97530) $90.60 $151 2.6×
Tilt table test with heart rhythm and blood pressure monitoring (93660) $942.60 $1,571 2.4×
Tobacco Use Cessation Intensive >10 Minutes (99407) $49.50 $82.50 1.2×
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $49.50 $82.50 1.2×
Trans Care Mgmt 14 Day Disch (99495) $115.80 $193 0.8×
Trans Care Mgmt 7 Day Disch (99496) $167.40 $279 1.2×
Tte w/doppler, complete (93306) $1,827.60 $3,046 3.2×
Tte W/O Doppler Complete (93307) $946.80 $1,578 3.8×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $148.20 $247 1.9×
Tx Speech Language Voice Commj Auditry 2/>Indiv (92508) $66 $110 2.7×
Tx/Pro/Dx Inj New Drug Addon (96375) $145.80 $243 2.9×
Upr/L Xtremity Art 2 Levels (93922)
range across 3 matching MRF lines		 $694.80 $23–$1,158 4.9×
Upr/Lxtr Art Stdy 3+ Lvls (93923) $772.80 $1,288 3.4×
Vasopneumatic device (97016) $106.20 $177 8.8×
Veeg 2-12 hr unmonitored (95711) $400.80 $668 1.8×
Veeg Ea 12-26 Hr Unmntr (95714) $768.60 $1,281 1.9×
Vent Mgmt Inpat Init Day (94002) $570 $950 0.9×
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $576.60 $961 0.9×
Vital capacity, total (94150) $244.80 $408 1.8×
Wheelchair Mgmt Ea 15 Min (97542) $54 $90 1.7×
Whirlpool Therapy (97022) $74.40 $124 4.7×

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.