Visits & medical services prices at Lafayette Hospital and Clinics

Darlington, WI · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedurePosted cashPosted gross× Medicare
Airway Inhalation Treatment (94640) $87.20 $109 0.4×
Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) $65.60 $82 4.6×
Assessment of aphasia per hr (96105) $348 $435 3.6×
Behavral qualit analys voice (92524) $608.80 $761 5.6×
Bfb traing w/EMG &/manometry 1st 15 min cntct (90912) $282.40 $353 3.4×
Bfb training ea addl 15 min (90913) $130.40 $163 4.0×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $304.80 $381 0.8×
Cardiac Stress Tst,Tracing Only (93017) $348 $435 1.7×
Cardiopulmonary resuscitation (92950) $652.80 $816 3.1×
Cardioversion (92960) $1,044 $1,305 1.6×
Cbt 1st hour (94644) $173.60 $217 1.3×
Chemo Hormon Antineopl Sq/Im (96402) $217.60 $272 3.1×
Chest Wall Manipulation (94668) $87.20 $109 0.7×
Color/duplex Doppler, complete (93975) $1,044 $1,305 4.5×
Color/duplex Doppler, limited (93976) $869.60 $1,087 8.6×
Conditioning Play Audiometry (92582) $87.20 $109 0.7×
Continuous Pulse Ox (94762) $271.20 $339 2.2×
Cpap Ventilation Cpap Initiation&Mgmt (94660)
range across 2 matching MRF lines		 $173.60–$260.80 $217–$326 varies
Cpt initial (94667) $130.40 $163 1.0×
Critical care first hour (99291) $1,479.20 $1,849 1.8×
Debridement Open Wound 20 Sq Cm< (97597) $370.40 $463 1.9×
Dup-scan aorta ivc iliac vascl/bpgs complete (93978) $869.60 $1,087 3.8×
Dup-scan lxtr art/artl bpgs compl bi study (93925) $869.60 $1,087 3.8×
Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) $844.80 $1,056 8.3×
Dup-Scan Xtr Veins Complete Bilateral Study (93970) $1,056 $1,320 4.6×
Dup-scan xtr veins unilateral/limited study (93971) $676 $845 6.7×
Duplex up extrem art bilat (93930) $869.60 $1,087 3.8×
Duplex up extrem art unilat/ltd (93931) $676 $845 6.7×
Echo Congenital Complete (93303) $869.60 $1,087 1.6×
Echo Heart Xthoracic,Limited (93308) $485.60 $607 2.1×
Electrical Stimulation Ea 15 Min (97032) $130.40 $163 8.9×
Electrocardiogram Tracing (93005) $173.60 $217 3.0×
Emergency Dept Visit Level 2 (99282) $281.60 $352 1.9×
Emergency Dept Visit Level 3 (99283) $434.40 $543 1.6×
Emergency Dept Visit Level 4 (99284) $868.80 $1,086 2.1×
Er level 1 (99281) $195.20 $244 2.4×
Er level v (99285) $1,391.20 $1,739 2.4×
Evaluate pt use of inhaler (94664) $43.20 $54 0.2×
Evaluate Speech Production (92522) $521.60 $652 4.7×
Evaluate Swallowing Function (92610) $869.60 $1,087 10.2×
Evaluation of speech fluency (92521) $398.40 $498 3.0×
External ECG rec>48hr<7d recording (93242) $348 $435 9.6×
External ECG rec>7d<15d recording (93246) $348 $435 9.6×
External Ecg Scanning Analysis Report (93226) $340.80 $426 5.9×
Extracranial Bilat Study (93880) $1,056 $1,320 4.6×
Extracranial Uni/Ltd Study (93882) $556.80 $696 5.5×
Holter monitor recording (93225) $299.20 $374 2.3×
Icd device progr eval dual (93283) $337.60 $422 9.3×
Immunization administration (90471)
range across 6 matching MRF lines		 $42.44–$43.20 $53.05–$54 varies
Iontophoresis 15 min (97033) $130.40 $163 6.8×
Irrig Drug Delivery Device (96523) $173.60 $217 3.0×
IV infusion hydration each additional hour (96361) $260.80 $326 5.7×
IV infusion hydration initial 31 min-1 hour (96360) $521.60 $652 2.5×
IV infusion ther proph addl sequential to 1 hr (96367) $348.80 $436 5.0×
IV infusion therapy prophylaxis/dx ea hour (96366) $260.80 $326 5.7×
IV push initial (96374) $260.80 $326 1.3×
Lung Function Test (Mbc/Mvv) (94200) $130.40 $163 2.3×
Lwr Xtr Vasc Stdy Bilat (93924) $869.60 $1,087 4.1×
Mechanical chest wall oscillation per session (94669) $108.80 $136 0.5×
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $43.20 $54 1.4×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $43.20 $54 1.2×
Methacholine challenge (94070) $683.20 $854 1.9×
Motion Fluoroscopy/Swallow (92611) $304.80 $381 3.3×
Multiple Sleep Latency Test (95805) $3,044.80 $3,806 3.7×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $260.80 $326 1.3×
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $173.60 $217 0.4×
Nerve Conduction Studies 11-12 Studies (95912) $1,120 $1,400 3.1×
Nerve conduction studies 13 or more studies (95913) $1,200 $1,500 3.3×
Nerve Conduction Studies 3-4 Studies (95908) $640 $800 3.1×
Nerve conduction studies 5-6 studies (95909) $720 $900 3.4×
Nerve conduction studies 7-8 studies (95910) $800 $1,000 2.2×
Nerve Conduction Studies 9-10 Studies (95911) $1,040 $1,300 2.9×
Neuromuscular Reeducation (97112) $87.20 $109 2.7×
Oral Function Therapy (92526) $173.60 $217 2.1×
Orthc/Prostc Mgmt Sbsq Enc (97763) $98.40 $123 2.0×
Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) $130.40 $163 2.8×
Ot eval high complexity (97167) $283.20 $354 2.8×
Ot Eval Low Complex (97165) $160 $200 1.6×
Ot Eval Moderate Complexity (97166) $225.60 $282 2.2×
Ot manual therapy 15 min (97140) $87.20 $109 3.1×
Ot paraffin bath (97018) $65.60 $82 10.9×
Ot Re-Eval Est Plan Care (97168) $130.40 $163 1.9×
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $217.60 $272 1.7×
Outpatient Cardiac Rehab W/O Cont Ecg Monitor (93797) $164.80 $206 1.3×
Phlebotomy therapeutic (99195) $87.20 $109 0.7×
Phys/qhp svcs op pulm rehab w/cont oximtry mntr (94626) $130.40 $163 2.3×
Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) $104 $130 1.8×
Plethysmography (94726) $348 $435 1.0×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $4,349.60 $5,437 5.2×
Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) $43.20 $54 0.9×
Pt Eval High Complex (97163) $348.80 $436 3.6×
Pt eval low complex 20 min (97161) $260.80 $326 2.7×
Pt Eval Mod Complex (97162) $307.20 $384 3.1×
Pt gait training 15 min (97116) $65.60 $82 2.3×
Pt mechanical traction (97012) $79.20 $99 5.5×
Pt Re-Eval Est Plan Care (97164) $130.40 $163 1.9×
Pulmonary Stress Testing (94618) $187.20 $234 1.4×
Remote 30 Day Ecg Rev/Report (93270) $435.20 $544 12.0×
Rx sp-genratj augmnt&comunicaj dev 1st hr (92607) $1,044 $1,305 8.5×
Rx Sp-Genratj Augmnt&Comunicaj Dev Ea 30 Min (92608) $96 $120 2.0×
Self Care Mngment Training (97535) $102.40 $128 3.2×
Sensory Integration Ea 15 Min (97533) $102.40 $128 1.7×
Speech sound lang comprehen (92523) $435.20 $544 1.9×
Spirometry (94010) $87.20 $109 0.4×
Standardized Cognitive Performance Testing (96125) $243.20 $304 2.4×
Stress Tte Only (93350) $1,080.80 $1,351 2.0×
Temp transcutaneous pacing (92953) $521.60 $652 0.8×
Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129) $196.80 $246 8.8×
Ther Ivntj Ea Addl 15 Min (97130) $173.60 $217 8.3×
Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) $260.80 $326 2.5×
Ther/Proph/Diag Inj Sc/Im (96372)
range across 5 matching MRF lines		 $84.88–$87.20 $106.09–$109 varies
Ther/Proph/Diag Iv Inf Init (96365) $521.60 $652 2.5×
Therapeutic Activities (97530) $102.40 $128 2.9×
Tobacco Use Cessation Intensive >10 Minutes (99407) $130.40 $163 3.6×
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $87.20 $109 2.4×
Tte w/doppler, complete (93306) $1,756.80 $2,196 3.3×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $260.80 $326 3.4×
Tx/Pro/Dx Inj New Drug Addon (96375) $217.60 $272 4.8×
Unlisted ophthalmological service/procedure (92499) $43.20 $54 1.5×
Upr/L Xtremity Art 2 Levels (93922) $435.20 $544 3.4×
Vent Mgmt Inpat Init Day (94002) $656 $820 1.1×
Visual Field Exam Extended (92083) $87.20 $109 0.7×
Visual field xm uni/bi w/interp intermed exam (92082) $65.60 $82 1.1×
Visual reinforcement audiometry (vra) (92579) $130.40 $163 0.6×
Xtrnl Ocular Photog W/I&R Docmt Medical Progre (92285) $39.20 $49 1.1×

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.