Supplies, drugs & other prices at ProHealth Oconomowoc Memorial Hospital

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

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

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ProcedurePosted cashPosted gross× Medicare
2d tee w or w/o fol w/con,in (C8925) $2,002.55 $3,641 2.6×
2d tte w or w/o fol w/con,fu (C8924) $1,331 $2,420 3.8×
Admin hepatitis b vaccine (G0010) $85.25 $155 1.8×
Admin influenza virus vac (G0008) $34.65 $63 0.7×
Admin pneumococcal vaccine (G0009) $36.85 $67 0.8×
Chemo extend iv infus w/pump (G0498) $634.15 $1,153 1.9×
Covid-19 lab test non-cdc (U0002) $157.30 $286 3.1×
Deoxyribonucleic acid (DNA) antibody, double stranded, high avidity 13,999 or fewer assigned members (0039U) $47.85 $87 3.5×
Diab manage trn per indiv (G0108) $128.15 $233 2.3×
Diab manage trn ind/group (G0109) $64.90 $118 4.0×
Direct refer hospital observ (G0379) $362.45 $659 0.6×
Drug test def 1-7 classes (G0480) $225.50 $410 2.0×
Drug test def 15-21 classes (G0482) $495 $900 2.5×
Drug test def 22+ classes (G0483) $650.65 $1,183 2.6×
Drug test def 8-14 classes (G0481) $475.20 $864 3.0×
Drug test def simple all cl (G0659) $227.15 $413 3.7×
Elec Alys Cplx Prgrmg Iins Sp/Sac Nrv 4+Param (0789T) $180.40 $328 1.9×
Elec Alys Smpl Prgrmg Iins Sp/Sac Nrv 1-3 Param (0788T) $164.45 $299 1.7×
Elec stim other than wound (G0283) $65.45 $119 5.2×
Extrnl counterpulse, per tx (G0166) $278.30 $506 2.1×
Group train w/o patient (G0543) $19.80 $36 0.7×
Hbot, full body chamber, 30m (G0277) $843.70 $1,534 6.2×
Home sleep test/type 2 porta (G0398) $614.35 $1,117 2.9×
Home sleep test/type 3 porta (G0399) $948.75 $1,725 4.4×
Interrog dev eval iims ip (0529T) $128.70 $234 3.5×
Interrog Dev Eval Wrls Car Stimulator in Person (0521T) $92.95 $169 3.2×
Neuro csf prion prtn qual (0035U) $697.40 $1,268 1.3×
No pt prsnt train initial 30 (G0541) $92.95 $169 3.2×
Onc thyr 10 microrna seq +/- rslt mod hi rsk mal (0018U) $9,015.05 $16,391 3.0×
Pemivibart infusion (M0224) $792 $1,440 1.8×
Prgrmg dev eval iims ip (0528T) $128.70 $234 3.5×
Prgrmg dev eval ldls pm single car chamber ip (0826T) $63.25 $115 1.7×
Prgrmg device eval wrls car stimulator in person (0522T) $128.70 $234 3.5×
Quan MRI alys brain with diagnostic MRI (0866T) $433.40 $788 1.8×
Tomosynthesis, mammo (G0279) $69.30 $126 5.5×
Trauma respons w/hosp criti (G0390) $4,550.70 $8,274 3.4×
Tte w or w/o contr, cont ecg (C8930) $2,673 $4,860 3.4×
Tte w or wo fol wcon,doppler (C8929) $2,673 $4,860 3.4×
Unsched dialysis esrd pt hos (G0257) $1,236.95 $2,249 1.8×
Visit to determ ldct elig (G0296) $56.65 $103 0.6×