Visits & medical services prices at Providence Medical Center
Wayne, NE · every code in this section with a posted price and a Medicare benchmark.
179 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) | $79.80 | $84 | 1.9× |
| Airway Inhalation Treatment (94640) range across 12 matching MRF lines |
$145.35–$289.75 | $153–$305 | varies |
| Analyze neurostim no prog (95970) | $65.55 | $69 | 0.5× |
| Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) | $41.80 | $44 | 2.9× |
| Application Modality 1/> Areas Infrared (97026) | $19.95 | $21 | 3.0× |
| Application on-body injector (96377) | $125.40 | $132 | 2.6× |
| Assessment of aphasia per hr (96105) range across 2 matching MRF lines |
$228–$334.40 | $240–$352 | varies |
| Behavral qualit analys voice (92524) range across 2 matching MRF lines |
$175.75–$242.25 | $185–$255 | varies |
| Bfb traing w/EMG &/manometry 1st 15 min cntct (90912) | $136.80 | $144 | 1.7× |
| Bfb training ea addl 15 min (90913) | $76 | $80 | 2.3× |
| Biofeedback training any modality (90901) | $64.60 | $68 | 1.6× |
| Brief Emotional/Behav Assmt (96127) | $38.95 | $41 | 1.0× |
| Brncdilat rspse spmtry pre&post-brncdilat admn (94060) range across 6 matching MRF lines |
$86.45–$561.45 | $91–$591 | varies |
| Canalith repositioning proc (95992) | $117.80 | $124 | 2.9× |
| Cardiac Stress Tst,Tracing Only (93017) range across 3 matching MRF lines |
$1,167.55–$1,178.95 | $1,229–$1,241 | varies |
| Cardiopulmonary resuscitation (92950) | $1,263.50 | $1,330 | 5.6× |
| Cardioversion (92960) range across 3 matching MRF lines |
$566.20–$1,461.10 | $596–$1,538 | varies |
| Chemo Anti-Neopl Sq/Im (96401) | $492.10 | $518 | 6.6× |
| Chemo Hormon Antineopl Sq/Im (96402) | $192.85 | $203 | 2.6× |
| Chemo IV infusion addl hr (96415) | $192.85 | $203 | 2.6× |
| Chemo IV push addl drug (96411) | $159.60 | $168 | 2.1× |
| Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) | $165.30 | $174 | 2.2× |
| Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) | $871.15 | $917 | 2.5× |
| Chemotx admn IV push tq 1/1st sbst/drug (96409) | $282.15 | $297 | 0.8× |
| Chest Wall Manipulation (94668) range across 2 matching MRF lines |
$106.40–$268.85 | $112–$283 | varies |
| Color/duplex Doppler, complete (93975) range across 5 matching MRF lines |
$906.30–$999.40 | $954–$1,052 | varies |
| Color/duplex Doppler, limited (93976) | $553.85 | $583 | 5.1× |
| Community/Work Reintegration Trainj Ea 15 Min (97537) | $53.20 | $56 | 1.7× |
| Continuous Pulse Ox (94762) range across 3 matching MRF lines |
$330.60–$374.30 | $348–$394 | varies |
| Cpap Ventilation Cpap Initiation&Mgmt (94660) | $610.85 | $643 | 2.7× |
| Cpt initial (94667) | $144.40 | $152 | 1.0× |
| Critical care first hour (99291) range across 2 matching MRF lines |
$1,258.75–$1,554.20 | $1,325–$1,636 | varies |
| Debridement Open Wound 20 Sq Cm< (97597) range across 2 matching MRF lines |
$133–$437.95 | $140–$461 | varies |
| Developmental tst admin phys/qhp 1st hour (96112) | $393.30 | $414 | 2.9× |
| Dup-scan aorta ivc iliac vascl/bpgs complete (93978) | $1,331.90 | $1,402 | 5.4× |
| Dup-scan lxtr art/artl bpgs compl bi study (93925) range across 2 matching MRF lines |
$944.30–$1,031.70 | $994–$1,086 | varies |
| Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) range across 3 matching MRF lines |
$765.70–$775.20 | $806–$816 | varies |
| Dup-Scan Xtr Veins Complete Bilateral Study (93970) range across 6 matching MRF lines |
$1,133.35–$1,539 | $1,193–$1,620 | varies |
| Dup-scan xtr veins unilateral/limited study (93971) | $963.30 | $1,014 | 8.9× |
| Duplex Scan Artl Infl&Ven O/F Hemo Compl Bi Std (93985) | $2,030.15 | $2,137 | 8.2× |
| Duplex Scan Artl Infl&Ven O/F Hemo Compl Uni Std (93986) | $946.20 | $996 | 8.7× |
| Duplex Scan Hemodialysis Access (93990) | $943.35 | $993 | 8.7× |
| Duplex up extrem art bilat (93930) range across 2 matching MRF lines |
$1,500.05–$1,611.20 | $1,579–$1,696 | varies |
| Duplex up extrem art unilat/ltd (93931) range across 3 matching MRF lines |
$775.20–$930.05 | $816–$979 | varies |
| Echo Heart Xthoracic,Limited (93308) | $1,375.60 | $1,448 | 5.6× |
| Echo tthrc r-t 2d w/wo m-mode rest&strs cont ECG (93351) | $3,222.40 | $3,392 | 5.7× |
| Elec Alys Implt Cplx Cn Npgt Prgrmg (95977) | $184.30 | $194 | 1.9× |
| Elec Alys Implt Smpl Cn Npgt Prgrmg (95976) | $137.75 | $145 | 3.6× |
| Electrical Stimulation Ea 15 Min (97032) | $48.45 | $51 | 3.3× |
| Electrocardiogram Tracing (93005) | $190 | $200 | 3.1× |
| Emergency Dept Visit Level 2 (99282) range across 3 matching MRF lines |
$231.80–$304 | $244–$320 | varies |
| Emergency Dept Visit Level 3 (99283) range across 3 matching MRF lines |
$345.80–$455.05 | $364–$479 | varies |
| Emergency Dept Visit Level 4 (99284) range across 3 matching MRF lines |
$643.15–$862.60 | $677–$908 | varies |
| Emg 3 Extremities (95863) | $899.65 | $947 | 6.7× |
| Emg 4 Extremities (95864) | $1,004.15 | $1,057 | 7.5× |
| Er level 1 (99281) range across 3 matching MRF lines |
$118.75–$170.05 | $125–$179 | varies |
| Er level v (99285) range across 3 matching MRF lines |
$968.05–$1,270.15 | $1,019–$1,337 | varies |
| Evaluate pt use of inhaler (94664) range across 4 matching MRF lines |
$95–$181.93 | $100–$191.50 | varies |
| Evaluate Speech Production (92522) | $421.80 | $444 | 3.8× |
| Evaluate Swallowing Function (92610) range across 4 matching MRF lines |
$200.45–$225.15 | $211–$237 | varies |
| Evaluation of speech fluency (92521) | $175.75 | $185 | 1.3× |
| Evoked Auditory Test,Limited (92587) | $76 | $80 | 0.3× |
| External ECG rec>48hr<7d recording (93242) | $147.25 | $155 | 3.8× |
| External ECG rec>48hr<7d scanning alys w/report (93243) | $2,748.35 | $2,893 | 19.9× |
| External ECG rec>7d<15d recording (93246) | $147.25 | $155 | 3.8× |
| External ECG rec>7d<15d scanning alys w/report (93247) | $2,861.40 | $3,012 | 20.7× |
| External Ecg Scanning Analysis Report (93226) range across 2 matching MRF lines |
$256.50–$453.15 | $270–$477 | varies |
| Extracranial Bilat Study (93880) range across 3 matching MRF lines |
$1,461.10–$1,522.85 | $1,538–$1,603 | varies |
| Extracranial Uni/Ltd Study (93882) | $787.55 | $829 | 7.3× |
| Group Therapeutic Procedures (97150) range across 4 matching MRF lines |
$57–$64.60 | $60–$68 | varies |
| Holter monitor recording (93225) range across 2 matching MRF lines |
$229.90–$338.20 | $242–$356 | varies |
| Icd Device Interrogate (93289) | $140.60 | $148 | 3.6× |
| Icd device progr eval dual (93283) | $190.95 | $201 | 4.9× |
| Icd Device Progr Eval Mult (93284) | $204.25 | $215 | 5.3× |
| Immunization administration (90471) range across 2 matching MRF lines |
$74.10–$92.15 | $78–$97 | varies |
| Iontophoresis 15 min (97033) | $64.60 | $68 | 3.4× |
| Irrig Drug Delivery Device (96523) | $152 | $160 | 2.5× |
| IV infusion hydration each additional hour (96361) range across 2 matching MRF lines |
$90.25–$95 | $95–$100 | varies |
| IV infusion hydration initial 31 min-1 hour (96360) range across 3 matching MRF lines |
$303.05–$312.55 | $319–$329 | varies |
| IV infusion ther proph addl sequential to 1 hr (96367) range across 2 matching MRF lines |
$196.65–$206.15 | $207–$217 | varies |
| IV infusion therapy prophylaxis/dx ea hour (96366) range across 2 matching MRF lines |
$139.65–$145.35 | $147–$153 | varies |
| IV push initial (96374) range across 3 matching MRF lines |
$288.80–$304.95 | $304–$321 | varies |
| Lwr Xtr Vasc Stdy Bilat (93924) range across 2 matching MRF lines |
$850.25–$1,239.75 | $895–$1,305 | varies |
| Mechanical chest wall oscillation per session (94669) range across 3 matching MRF lines |
$798–$832.20 | $840–$876 | varies |
| Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) | $91.20 | $96 | 2.9× |
| Medical nutrition assmt&ivntj indiv each 15 mi (97802) | $68.40 | $72 | 1.9× |
| Motion Fluoroscopy/Swallow (92611) range across 2 matching MRF lines |
$239.40–$365.75 | $252–$385 | varies |
| Multiple Sleep Latency Test (95805) | $1,690.05 | $1,779 | 1.9× |
| Muscle Test 2 Limbs (95861) | $703.95 | $741 | 5.1× |
| Muscle Test Hemidiaphragm (95866) | $546.25 | $575 | 4.1× |
| Muscle Test Nonparaspinal (95870) | $379.05 | $399 | 2.7× |
| Muscle Test One Limb (95860) | $497.80 | $524 | 3.6× |
| Nasopharyngoscopy (92511) | $159.60 | $168 | 0.8× |
| Needle Electromyography Cranial Nrv Muscle Bi (95868) | $547.20 | $576 | 2.4× |
| Needle Electromyography Cranial Nrv Muscle Uni (95867) | $409.45 | $431 | 1.8× |
| Needle electromyography larynx (95865) | $596.60 | $628 | 4.3× |
| Needle Emg Thrc Paraspi Musc Excluding T1/T12 (95869) | $374.30 | $394 | 1.7× |
| Needle EMG w/1 fiber electrode quan meas jitter (95872) | $803.70 | $846 | 3.6× |
| Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) | $261.25 | $275 | 0.6× |
| Neg Pressure Wound Therapy Non Dme >50 Sq Cm (97608) | $291.65 | $307 | 0.7× |
| Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) | $503.50 | $530 | 2.4× |
| Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) | $342.95 | $361 | 0.8× |
| Nerve Conduction Studies 1-2 Studies (95907) | $287.85 | $303 | 1.3× |
| Nerve Conduction Studies 11-12 Studies (95912) | $1,069.70 | $1,126 | 2.8× |
| Nerve conduction studies 13 or more studies (95913) | $1,235.95 | $1,301 | 3.2× |
| Nerve Conduction Studies 3-4 Studies (95908) | $423.70 | $446 | 1.9× |
| Nerve conduction studies 5-6 studies (95909) | $611.80 | $644 | 2.7× |
| Nerve conduction studies 7-8 studies (95910) | $805.60 | $848 | 2.1× |
| Nerve Conduction Studies 9-10 Studies (95911) | $963.30 | $1,014 | 2.5× |
| Neuromuscular Junct Tstg Ea Nrv Any 1 Meth (95937) | $330.60 | $348 | 2.5× |
| Neuromuscular Reeducation (97112) range across 3 matching MRF lines |
$85.50–$113.05 | $90–$119 | varies |
| Oral Function Therapy (92526) range across 2 matching MRF lines |
$187.15–$236.55 | $197–$249 | varies |
| Oral Speech Device Eval (92597) | $266 | $280 | 3.7× |
| Orthc/Prostc Mgmt Sbsq Enc (97763) range across 2 matching MRF lines |
$143.45–$147.25 | $151–$155 | varies |
| Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) | $143.45 | $151 | 3.1× |
| Ot Contrast Bath Ea 15 Min (97034) | $58.90 | $62 | 4.2× |
| Ot eval high complexity (97167) | $278.35 | $293 | 2.8× |
| Ot Eval Low Complex (97165) | $278.35 | $293 | 2.8× |
| Ot Eval Moderate Complexity (97166) | $278.35 | $293 | 2.8× |
| Ot manual therapy 15 min (97140) range across 5 matching MRF lines |
$85.50–$86.45 | $90–$91 | varies |
| Ot paraffin bath (97018) range across 3 matching MRF lines |
$23.75–$46.55 | $25–$49 | varies |
| Ot Prosthetic Training, Each 15 Min (97761) | $86.45 | $91 | 2.1× |
| Ot Re-Eval Est Plan Care (97168) | $189.05 | $199 | 2.8× |
| Ot rom hand (95852) | $57 | $60 | 2.7× |
| Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) | $206.15 | $217 | 1.5× |
| Outpatient Cardiac Rehab W/O Cont Ecg Monitor (93797) | $118.75 | $125 | 0.9× |
| Peripheral arterial disease rehab per session (93668) | $171 | $180 | 2.8× |
| Phlebotomy therapeutic (99195) | $295.45 | $311 | 2.1× |
| Physical Performance Test (97750) range across 6 matching MRF lines |
$76.95–$114.95 | $81–$121 | varies |
| Pm device eval in person (93288) | $108.30 | $114 | 2.8× |
| Pm device progr eval dual (93280) | $153.90 | $162 | 4.0× |
| Pm device progr eval multi (93281) | $161.50 | $170 | 4.2× |
| Pm Device Progr Eval Sngl (93279) | $129.20 | $136 | 3.3× |
| Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) range across 2 matching MRF lines |
$1,308.15–$3,947.25 | $1,377–$4,155 | varies |
| Prgrmng Dev Eval Implantable in Persn 1 Ld Dfb (93282) | $153.90 | $162 | 4.0× |
| Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) | $34.20 | $36 | 0.7× |
| Prof svcs allg immntx x w/prv allgic xtrcs njxs (95117) | $40.85 | $43 | 0.8× |
| Pt Asstv Technol Assmt Dir Cntct W/Reprt Ea 15 Min (97755) | $75.05 | $79 | 2.0× |
| Pt Eval High Complex (97163) | $258.40 | $272 | 2.6× |
| Pt eval low complex 20 min (97161) | $258.40 | $272 | 2.6× |
| Pt Eval Mod Complex (97162) | $258.40 | $272 | 2.6× |
| Pt gait training 15 min (97116) range across 3 matching MRF lines |
$85.50–$94.05 | $90–$99 | varies |
| Pt mechanical traction (97012) range across 3 matching MRF lines |
$54.15–$60.80 | $57–$64 | varies |
| Pt Re-Eval Est Plan Care (97164) | $174.80 | $184 | 2.6× |
| Pulm function test by gas (94727) range across 3 matching MRF lines |
$366.70–$579.50 | $386–$610 | varies |
| Pulmonary service/procedure (94799) | $148.20 | $156 | 1.1× |
| Pulmonary Stress Testing (94618) | $455.05 | $479 | 3.3× |
| Refill&Maintenance Pump Drug Dlvr Spinal/Brain (95990) | $262.20 | $276 | 0.8× |
| Remote 30 Day Ecg Rev/Report (93270) range across 2 matching MRF lines |
$124.45–$345.80 | $131–$364 | varies |
| Respiratory flow volume loop (94375) range across 4 matching MRF lines |
$109.25–$426.55 | $115–$449 | varies |
| Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) | $242.25 | $255 | 1.2× |
| Rom Meas&Reprt Ea Xtr Ex Hand/Ea Trnk Sctj Spi (95851) range across 3 matching MRF lines |
$24.70–$67.45 | $26–$71 | varies |
| Rx sp-genratj augmnt&comunicaj dev 1st hr (92607) | $237.50 | $250 | 1.9× |
| Rx Sp-Genratj Augmnt&Comunicaj Dev Ea 30 Min (92608) | $133 | $140 | 2.8× |
| Self Care Mngment Training (97535) | $105.45 | $111 | 3.3× |
| Sensory Integration Ea 15 Min (97533) range across 4 matching MRF lines |
$79.80–$105.45 | $84–$111 | varies |
| Slp Stdy Unatnd W/Hrt Rate/O2 Sat/Resp/Slp Time (95800) | $317.30 | $334 | 1.4× |
| Speech sound lang comprehen (92523) | $543.40 | $572 | 2.4× |
| Spirometry (94010) range across 4 matching MRF lines |
$236.55–$255.55 | $249–$269 | varies |
| Standardized Cognitive Performance Testing (96125) range across 3 matching MRF lines |
$256.50–$364.80 | $270–$384 | varies |
| Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129) range across 4 matching MRF lines |
$75.05–$85.50 | $79–$90 | varies |
| Ther Ivntj Ea Addl 15 Min (97130) | $72.20 | $76 | 3.4× |
| Ther Px 1/> Areas Each 15 Min Aqua Ther W/Xerss (97113) | $119.70 | $126 | 3.2× |
| Ther Px 1/> Areas Each 15 Minutes Massage (97124) | $94.05 | $99 | 3.2× |
| Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) | $166.25 | $175 | 1.6× |
| Ther/Proph/Diag Inj Sc/Im (96372) | $142.50 | $150 | 1.9× |
| Ther/Proph/Diag Iv Inf Init (96365) range across 3 matching MRF lines |
$288.80–$472.15 | $304–$497 | varies |
| Therapeutic Activities (97530) range across 3 matching MRF lines |
$81.70–$101.65 | $86–$107 | varies |
| Tobacco Use Cessation Intensive >10 Minutes (99407) | $81.70 | $86 | 2.1× |
| Tobacco Use Cessation Intermediate 3-10 Minutes (99406) | $37.05 | $39 | 1.0× |
| Tte w/doppler, complete (93306) | $2,771.15 | $2,917 | 4.9× |
| Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) range across 4 matching MRF lines |
$216.60–$255.55 | $228–$269 | varies |
| Tx/Pro/Dx Inj New Drug Addon (96375) | $123.50 | $130 | 2.5× |
| Tympanometry (92567) | $113.05 | $119 | 2.9× |
| Upr/L Xtremity Art 2 Levels (93922) range across 3 matching MRF lines |
$672.60–$707.75 | $708–$745 | varies |
| Vasopneumatic device (97016) range across 3 matching MRF lines |
$35.15–$39.90 | $37–$42 | varies |
| Vital capacity, total (94150) | $75.05 | $79 | 0.6× |
| Wheelchair Mgmt Ea 15 Min (97542) range across 3 matching MRF lines |
$61.75–$103.55 | $65–$109 | varies |
| Whirlpool Therapy (97022) range across 4 matching MRF lines |
$69.35–$77.90 | $73–$82 | varies |
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.