Visits & medical services prices at Gundersen Palmer Lutheran Hospital and Clinics

West Union, IA · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedurePosted cashPosted gross× Medicare
Acoustic Reflex Testing (92568) $80.78 $136 2.2×
Admn Sarscov2 Vacc 1 Dose (90480)
range across 2 matching MRF lines
$11.88–$32.08 $20–$54 varies
Aep Hearing Status Deter Broadband Stimuli I&R (92651)
range across 2 matching MRF lines
$97.42–$285.12 $164–$480 varies
Aep neurodiagnostic i&r (92653)
range across 2 matching MRF lines
$95.04–$489.46 $160–$824 varies
Aep threshold estimation mlt frequencies i&r (92652)
range across 2 matching MRF lines
$129.49–$489.46 $218–$824 varies
Airway Inhalation Treatment (94640) $179.98 $303 0.9×
Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) $46.93 $79 3.3×
Application on-body injector (96377) $83.75 $141 1.9×
Assessment of aphasia per hr (96105) $270.27 $455 2.8×
Assessment of tinnitus (92625) $245.92 $414 2.0×
Audiometry Air & Bone (92553) $178.79 $301 1.4×
Auditory Function, 60 Min (92620) $352.24 $593 2.8×
Basic vestibular evaluation (92540) $392.04 $660 1.9×
Behavral qualit analys voice (92524) $167.51 $282 1.5×
Bfb traing w/EMG &/manometry 1st 15 min cntct (90912) $81.97 $138 1.0×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $313.04 $527 0.9×
Caloric vestibular test w/rec bi monothermal (92538) $79.60 $134 0.4×
Caloric Vstblr Test W/Rec (92537) $175.23 $295 1.4×
Canalith repositioning proc (95992) $92.66 $156 2.3×
Car seat/bed test 60 min (94780) $68.31 $115 1.9×
Cardiac Stress Tst,Tracing Only (93017) $620.73 $1,045 3.0×
Cardiopulmonary resuscitation (92950) $434.21 $731 2.1×
Cardioversion (92960) $604.10 $1,017 1.0×
Cervical & Ocular Vemp Testing W/I&R (92519)
range across 2 matching MRF lines
$69.50–$426.49 $117–$718 varies
Cervical Vemp Testing W/I&R (92517)
range across 2 matching MRF lines
$46.93–$237.01 $79–$399 varies
Chemo Anti-Neopl Sq/Im (96401) $97.42 $164 1.4×
Chemo Hormon Antineopl Sq/Im (96402) $102.76 $173 1.5×
Chemo IV infusion addl hr (96415) $179.98 $303 2.6×
Chemo IV push addl drug (96411) $174.64 $294 2.5×
Chemother Prolong Infuse W/Pump (96416) $312.44 $526 1.0×
Chemotherapy Into Cns (96450) $433.03 $729 1.4×
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $206.12 $347 3.0×
Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) $531.04 $894 1.7×
Chemotx admn IV push tq 1/1st sbst/drug (96409) $223.94 $377 0.7×
Chest Wall Manipulation (94668) $109.30 $184 0.9×
Color/duplex Doppler, complete (93975) $219.19 $369 1.0×
Color/duplex Doppler, limited (93976) $265.52 $447 2.6×
Community/Work Reintegration Trainj Ea 15 Min (97537) $61.18 $103 1.9×
Comprehensive Hearing Test (92557) $117.02 $197 0.9×
Conditioning Play Audiometry (92582) $314.23 $529 2.5×
Continuous Pulse Ox (94762) $215.62 $363 1.7×
Cpap Ventilation Cpap Initiation&Mgmt (94660) $271.46 $457 1.3×
Cpt initial (94667) $109.30 $184 0.9×
Critical care first hour (99291) $1,303.24 $2,194 1.6×
Debridement Open Wound 20 Sq Cm< (97597) $136.62 $230 0.7×
Distrt prod evokd otoacoustic emsns comp/dx eval (92588) $174.64 $294 0.5×
Dup-scan aorta ivc iliac vascl/bpgs complete (93978) $349.87 $589 1.5×
Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) $655.78 $1,104 6.5×
Dup-Scan Xtr Veins Complete Bilateral Study (93970) $501.93 $845 2.2×
Dup-scan xtr veins unilateral/limited study (93971) $668.84 $1,126 6.7×
ECG/monitoring and analysis (93271) $289.87 $488 3.2×
Echo Congenital Complete (93303) $473.42 $797 0.9×
Echo Heart Xthoracic,Limited (93308) $399.17 $672 1.7×
Echo tthrc r-t 2d w/wo m-mode rest&strs cont ECG (93351) $1,639.44 $2,760 3.1×
Eeg 41-60 Minutes (95812) $391.45 $659 1.9×
EEG awake and asleep (95819) $593.41 $999 2.9×
EEG awake drowsy (95816) $478.17 $805 2.3×
EEG extended monitoring 61-119 minutes (95813) $434.21 $731 2.1×
Electrical Stimulation Ea 15 Min (97032) $47.52 $80 3.2×
Electrocardiogram Tracing (93005) $137.81 $232 2.4×
Emergency Dept Visit Level 2 (99282) $238.79 $402 1.6×
Emergency Dept Visit Level 3 (99283) $347.49 $585 1.3×
Emergency Dept Visit Level 4 (99284) $521.53 $878 1.3×
Er level 1 (99281) $111.08 $187 1.4×
Er level v (99285) $901.69 $1,518 1.6×
Evaluate pt use of inhaler (94664) $179.98 $303 0.9×
Evaluate Speech Production (92522) $171.07 $288 1.5×
Evaluate Swallowing Function (92610) $219.78 $370 2.6×
Evaluation of speech fluency (92521) $210.28 $354 1.6×
Evoked Auditory Test,Limited (92587) $62.96 $106 0.3×
External ECG rec>48hr<7d recording (93242) $67.72 $114 1.9×
External ECG rec>7d<15d recording (93246) $67.72 $114 1.9×
External Ecg Scanning Analysis Report (93226) $421.74 $710 7.4×
Extracranial Bilat Study (93880) $793.58 $1,336 3.5×
Filtered Speech Test (92571) $75.44 $127 2.1×
Group Therapeutic Procedures (97150) $43.36 $73 2.4×
Holter monitor recording (93225) $312.44 $526 2.4×
Im Adm Intransl/Oral 1 Vaccine (90473)
range across 2 matching MRF lines
$11.88–$62.96 $20–$106 varies
Immunization administration (90471)
range across 8 matching MRF lines
$11.88–$97.42 $20–$164 varies
Iontophoresis 15 min (97033) $55.84 $94 2.9×
Irrig Drug Delivery Device (96523) $141.97 $239 2.5×
IV infusion hydration each additional hour (96361) $71.87 $121 1.6×
IV infusion hydration initial 31 min-1 hour (96360) $238.79 $402 1.2×
IV infusion ther proph addl sequential to 1 hr (96367) $130.68 $220 1.9×
IV infusion therapy prophylaxis/dx ea hour (96366) $86.72 $146 1.9×
IV push initial (96374) $207.90 $350 1.0×
Mechanical chest wall oscillation per session (94669) $179.98 $303 0.9×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $35.64 $60 1.0×
Medical nutrition therapy grp2/ indiv ea 30 mi (97804) $16.04 $27 0.9×
Motion Fluoroscopy/Swallow (92611) $199.58 $336 2.2×
Multiple Sleep Latency Test (95805) $2,071.87 $3,488 2.5×
Nasopharyngoscopy (92511) $131.87 $222 0.7×
Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) $350.46 $590 0.9×
Neg Pressure Wound Therapy Non Dme >50 Sq Cm (97608) $350.46 $590 0.9×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $160.38 $270 0.8×
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $308.88 $520 0.8×
Neurobehavioral Status Exam (96116) $263.14 $443 1.3×
Neuromuscular Reeducation (97112) $65.34 $110 2.0×
Nitric oxide expired gas determination (95012) $69.50 $117 1.9×
Ocular Vemp Testing W/I&R (92518)
range across 2 matching MRF lines
$46.93–$237.01 $79–$399 varies
Optokinetic Nystagmus Test (92544) $119.39 $201 1.0×
Oral Function Therapy (92526) $218 $367 2.6×
Oral Speech Device Eval (92597) $136.62 $230 1.9×
Orthc/Prostc Mgmt Sbsq Enc (97763) $97.42 $164 1.9×
Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) $91.48 $154 2.0×
Oscillating Tracking Test (92545) $109.89 $185 0.5×
Ot Contrast Bath Ea 15 Min (97034) $35.05 $59 2.5×
Ot eval high complexity (97167) $191.86 $323 1.9×
Ot Eval Low Complex (97165) $132.46 $223 1.3×
Ot Eval Moderate Complexity (97166) $168.10 $283 1.7×
Ot manual therapy 15 min (97140) $58.21 $98 2.1×
Ot paraffin bath (97018) $41.58 $70 6.9×
Ot Prosthetic Training, Each 15 Min (97761) $77.81 $131 1.9×
Ot Re-Eval Est Plan Care (97168) $116.42 $196 1.7×
Ot rom hand (95852) $47.52 $80 2.2×
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $197.21 $332 1.6×
Outpatient Cardiac Rehab W/O Cont Ecg Monitor (93797) $261.36 $440 2.1×
Oxygen Uptake Rest Indirect (94690) $54.05 $91 1.0×
Pentamidine Aersl Inhalation Pneumocystis/Proph (94642) $179.98 $303 0.9×
Peripheral arterial disease rehab per session (93668)
range across 2 matching MRF lines
$68.90–$79.60 $116–$134 varies
Phlebotomy therapeutic (99195) $332.64 $560 2.6×
Phys/qhp svcs op pulm rehab w/cont oximtry mntr (94626) $316.01 $532 5.6×
Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) $316.01 $532 5.6×
Physical Performance Test (97750) $64.75 $109 1.9×
Plethysmography (94726) $415.21 $699 1.2×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $2,837.54 $4,777 3.4×
Positional nystagmus test (92542) $115.83 $195 0.9×
Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) $22.57 $38 0.5×
Prof svcs allg immntx x w/prv allgic xtrcs njxs (95117) $27.92 $47 0.6×
Psychiatric diagnostic evaluation (90791) $305.91 $515 1.8×
Pt Eval High Complex (97163) $188.89 $318 1.9×
Pt eval low complex 20 min (97161) $129.49 $218 1.3×
Pt Eval Mod Complex (97162) $159.19 $268 1.6×
Pt gait training 15 min (97116) $55.84 $94 1.9×
Pt mechanical traction (97012) $40.99 $69 2.9×
Pt Re-Eval Est Plan Care (97164) $109.30 $184 1.6×
Pulmonary service/procedure (94799)
range across 4 matching MRF lines
$121.18–$136.62 $204–$230 varies
Pulmonary Stress Testing (94618) $162.16 $273 1.3×
Pure Tone Audiometry Air (92552)
range across 4 matching MRF lines
$10.69–$146.72 $18–$247 varies
Qnhp Ol Dig Assmt&Mgmt 11-20 (98971) $26.14 $44 1.1×
Qualified nonphysician health care professional online digital assessment and management, for an established patient,… (98972) $26.14 $44 0.8×
Qualified nonphysician health care professional online digital assessment and management, for an established patient,… (98970) $182.95 $308 14.8×
Remote 30 Day Ecg Rev/Report (93270) $173.45 $292 4.8×
Remote 30 Day Ecg Tech Supp (93229) $275.02 $463 0.8×
Rhythm Ecg 1-3 Leads Tracing Only W/O I&R (93041) $66.53 $112 1.2×
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $159.19 $268 0.8×
Rom Meas&Reprt Ea Xtr Ex Hand/Ea Trnk Sctj Spi (95851) $68.90 $116 2.6×
Rx sp-genratj augmnt&comunicaj dev 1st hr (92607) $239.98 $404 2.0×
Rx Sp-Genratj Augmnt&Comunicaj Dev Ea 30 Min (92608) $96.23 $162 2.0×
Select picture audiometry (92583) $230.47 $388 4.1×
Self Care Mngment Training (97535) $63.56 $107 2.0×
Sensory Integration Ea 15 Min (97533) $95.63 $161 1.6×
Sleep study unattended (95806) $615.38 $1,036 3.0×
Slp Stdy Unatnd W/Hrt Rate/O2 Sat/Resp/Slp Time (95800) $643.90 $1,084 3.1×
Speech Audiometry Complete (92556)
range across 2 matching MRF lines
$50.49–$168.10 $85–$283 varies
Speech audiometry threshold (92555) $107.51 $181 1.9×
Speech sound lang comprehen (92523) $361.15 $608 1.6×
Spirometry (94010) $286.90 $483 1.4×
Spontaneous Nystagmus Test (92541) $166.91 $281 1.3×
Standardized Cognitive Performance Testing (96125) $217.40 $366 2.1×
Stenger Test Speech (92577) $454.41 $765 1.3×
Stenger Test, Pure Tone (92565) $77.22 $130 1.4×
Stress Tte Only (93350) $473.42 $797 0.9×
Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129) $48.11 $81 2.1×
Ther Ivntj Ea Addl 15 Min (97130) $48.11 $81 2.3×
Ther Px 1/> Areas Each 15 Min Aqua Ther W/Xerss (97113) $71.87 $121 1.9×
Ther Px 1/> Areas Each 15 Minutes Massage (97124) $64.75 $109 2.2×
Ther Sp-Genratj Dev Prgrmg&Modificaj (92609)
range across 2 matching MRF lines
$199.58–$201.96 $336–$340 varies
Ther/Proph/Diag Inj Sc/Im (96372) $80.19 $135 1.2×
Ther/Proph/Diag Iv Inf Init (96365) $238.79 $402 1.2×
Therapeutic Activities (97530) $73.06 $123 2.1×
Tobacco Use Cessation Intensive >10 Minutes (99407) $61.18 $103 1.7×
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $60.59 $102 1.7×
Tte w/doppler, complete (93306) $1,307.99 $2,202 2.5×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $147.91 $249 1.9×
Tx Speech Language Voice Commj Auditry 2/>Indiv (92508) $129.49 $218 5.4×
Tx/Pro/Dx Inj New Drug Addon (96375) $86.72 $146 1.9×
Tympanometry (92567) $45.74 $77 1.3×
Upr/L Xtremity Art 2 Levels (93922) $398.57 $671 3.1×
Vent Mgmt Inpat Init Day (94002) $523.31 $881 0.9×
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $523.31 $881 0.9×
Visual reinforcement audiometry (vra) (92579) $216.22 $364 1.0×
Vital capacity, total (94150) $141.37 $238 1.1×
Wheelchair Mgmt Ea 15 Min (97542) $61.78 $104 2.0×

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.