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.

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ProcedureCash priceGross charge× Medicare
Airway inhalation treatment (94640) $152 $160 0.7×
Analyze neurostim no prog (95970) $65.55 $69 0.5×
Appl on-body injector for timed subq injection (96377) $125.40 $132 2.6×
Assessment of aphasia (96105) $281.20 $296 2.9×
Asstv Technol Assmt Dir Cntct W/Reprt Ea 15 Min (97755) $75.05 $79 2.0×
Behav assmt w/score & docd/stand instrument (96127) $38.95 $41 1.0×
Behavioral and qualitative analysis of voice and resonance (92524) $209 $220 1.9×
Bfb training 1st 15 min (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×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $526.30 $554 1.4×
Canalith Repositioning (95992) $117.80 $124 2.9×
Cardiac Stress Tst,Tracing Only (93017) $1,178.95 $1,241 5.3×
Cardiopulmonary resuscitation (92950) $1,263.50 $1,330 5.6×
Cardioversion (92960) $1,425 $1,500 2.1×
Chemo Hormon Antineopl Sq/Im (96402) $192.85 $203 2.6×
Chemo IV push addl drug (96411) $159.60 $168 2.1×
Chemo Iv Push Sngl Drug (96409) $282.15 $297 0.8×
Chemother, IV infusion, 1 hr (96413) $871.15 $917 2.5×
Chemother, IV infusion, ea add hr (96415) $192.85 $203 2.6×
Chemother,Non-Hormone Anti-Neopl, Sub-Q/Im (96401) $492.10 $518 6.6×
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $165.30 $174 2.2×
Color/duplex Doppler, complete (93975) $906.30 $954 3.7×
Color/duplex Doppler, limited (93976) $553.85 $583 5.1×
Cpap initiation and management (94660) $610.85 $643 2.7×
Cpt initial (94667) $144.40 $152 1.0×
Critical care (99291) $1,406.48 $1,480.50 1.6×
Debridement Open Wound 20 Sq Cm< (97597) $285.48 $300.50 1.4×
Demo &/or eval,pt use,aerosol device (94664) $125.40 $132 0.6×
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) $988 $1,040 4.0×
Dup-scan lxtr art/artl bpgs uni/lmtd study (93926) $775.20 $816 7.1×
Dup-Scan Uxtr Art/Artl Bpgs Compl Bi Study (93930) $1,555.62 $1,637.50 6.3×
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study (93931) $775.20 $816 7.1×
Dup-scan xtr veins unilateral/limited study (93971) $963.30 $1,014 8.9×
Duplex hemodialysis access (93990) $943.35 $993 8.7×
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 extracranial art compl bi study (93880) $1,478.20 $1,556 6.0×
Echo Heart Xthoracic,Limited (93308) $1,375.60 $1,448 5.6×
EKG (93005) $190 $200 3.1×
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×
EMG cranial nerve bilat (95868) $547.20 $576 2.4×
EMG cranial nerve unilat (95867) $409.45 $431 1.8×
EMG four extremities (95864) $1,004.15 $1,057 7.5×
EMG one extremity (95860) $497.80 $524 3.6×
EMG thoracic paraspinal (95869) $374.30 $394 1.7×
EMG three extremities (95863) $899.65 $947 6.7×
EMG two extremities (95861) $703.95 $741 5.1×
Er level 1 (99281) $170.05 $179 1.9×
Er level ii (99282) $271.70 $286 1.7×
Er level iii (99283) $428.45 $451 1.5×
Er level IV (99284) $657.40 $692 1.5×
Er level v (99285) $971.85 $1,023 1.6×
Eval&/Fitg Voice Prostc Dev Suplmnt Oral Speec (92597) $266 $280 3.7×
Evaluation of speech fluency (92521) $175.75 $185 1.3×
Evaluation of speech sound production (92522) $421.80 $444 3.8×
Evaluation of swallowing function (92610) $209 $220 2.5×
Evaluation with prescription of speech-generating alternative (92607) $237.50 $250 1.9×
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) $354.82 $373.50 5.8×
Flow volume loop (94375) $157.70 $166 0.7×
Group Therapeutic Procedures (97150) $57 $60 3.2×
Holter Monitor Recording (93225) $284.05 $299 2.1×
Icd Device Interrogate (93289) $140.60 $148 3.6×
Imm Admn Sarscov2 Vaccine Single Dose (90480) $79.80 $84 1.9×
Immunization Admin (90471) $83.12 $87.50 1.1×
Immunotherapy, 2+ Injections (95117) $40.85 $43 0.8×
Irrigaj Implntd Venous Access Drug Delivery Syst (96523) $152 $160 2.5×
IV infusion hydration each additional hour (96361) $92.62 $97.50 1.9×
IV infusion hydration initial 31 min-1 hour (96360) $303.05 $319 1.4×
IV infusion, therap/proph/diagnost,add infusion,1st hour (96367) $201.40 $212 2.7×
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $454.10 $478 2.1×
IV infusion, therap/proph/diagnost,initial,ea add hour (96366) $142.50 $150 2.9×
IV push initial (96374) $290.70 $306 1.3×
Maintenance of spinal canal or brain drug infusion pump (95990) $262.20 $276 0.8×
Manual therapy 15 min (97140) $86.45 $91 3.1×
Massage 15 min (97124) $94.05 $99 3.2×
Mechanical chest wall oscillation (94669) $807.50 $850 3.6×
Mechanical traction (97012) $60.80 $64 4.2×
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 Fluor Eval Swlng Funcj C/V Rec (92611) $302.58 $318.50 3.3×
Multiple sleep latency test (95805) $1,690.05 $1,779 1.9×
Nasopharyngoscopy (92511) $159.60 $168 0.8×
Needle electromyography hemidiaphragm (95866) $546.25 $575 4.1×
Needle electromyography larynx (95865) $596.60 $628 4.3×
Needle EMG lmtd std musc 1 xtr/non-limb uni/bi (95870) $379.05 $399 2.7×
Needle EMG w/1 fiber electrode quan meas jitter (95872) $803.70 $846 3.6×
Neg press wnd tx </=50 sq cm (97607) $261.25 $275 0.6×
Neg press wound tx >50 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 13/> studies (95913) $1,235.95 $1,301 3.2×
Nerve Conduction Studies 3-4 Studies (95908) $423.70 $446 1.9×
Nerve Conduction Studies 9-10 Studies (95911) $963.30 $1,014 2.5×
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; 5-6 studies (95909) $611.80 $644 2.7×
Nerve conduction studies; 7-8 studies (95910) $805.60 $848 2.1×
Neuromuscular junction test (95937) $330.60 $348 2.5×
Non-Invas Physiologic Std Extremity Art 2 Level (93922) $672.60 $708 4.9×
Noninvasive Ear/Pulse Oximetry Overnight Monitor (94762) $374.30 $394 2.8×
Orthotics mgmt & traing initial enctr ea 15 mins (97760) $143.45 $151 3.1×
Ot Community/Work Reintegration Trainj Ea 15 Min (97537) $53.20 $56 1.7×
Ot Contrast Bath Ea 15 Min (97034) $58.90 $62 4.2×
Ot eval high complex 60 min (97167) $278.35 $293 2.8×
Ot eval low complex 30 min (97165) $278.35 $293 2.8×
Ot eval mod complex 45 min (97166) $278.35 $293 2.8×
Ot Orthotics/Prosth Mgmt &/Trainj Sbsq Enctr 15 Min (97763) $145.35 $153 2.9×
Ot Prosthetic Training, Each 15 Min (97761) $86.45 $91 2.1×
Ot Range Motion Measure,Each Extrem (95851) $24.70 $26 0.9×
Ot re-eval est plan care (97168) $189.05 $199 2.8×
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×
Paraffin bath (97018) $40.85 $43 6.8×
Peripheral arterial disease rehab per session (93668) $171 $180 2.8×
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) $2,627.70 $2,766 2.9×
Prgrmg Eval Implantable Dfb - Cardiac Device Clinic Icd Biv Chamber (93284) $204.25 $215 5.3×
Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) $34.20 $36 0.7×
Programming of dual lead implantable defibrillator system (93283) $190.95 $201 4.9×
Programming of single lead implantable defibrillator system (93282) $153.90 $162 4.0×
Pt Aquatic Therapy/Exercises (97113) $119.70 $126 3.2×
Pt Electric Current Therapy (97033) $64.60 $68 3.4×
Pt Electrical Stimulation (97032) $48.45 $51 3.3×
Pt eval high complex 45 min (97163) $258.40 $272 2.6×
Pt eval low complex 20 min (97161) $258.40 $272 2.6×
Pt Gait Training Therapy (97116) $94.05 $99 3.2×
Pt Infrared Therapy (97026) $19.95 $21 3.0×
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $108.30 $114 3.3×
Pt Physical Performance Test (97750) $114.95 $121 3.4×
Pt Physical Therapy Evaluation Mod Complex 30 Mins (97162) $258.40 $272 2.6×
Pt re-evaluation (97164) $174.80 $184 2.6×
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $105.45 $111 3.3×
Pt Ultrasound Therapy (97035) $41.80 $44 2.9×
Pt Whirlpool Therapy (97022) $73.62 $77.50 4.7×
Pulm function test by gas (94727) $366.70 $386 1.6×
Pulmonary stress testing (94618) $455.05 $479 3.3×
Remote 30 Day Ecg Rev/Report - Cardiac Event Monitor (93270) $235.12 $247.50 6.1×
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $242.25 $255 1.2×
Rom meas&reprt hand w/wo comparison normal sid (95852) $57 $60 2.7×
Rt Chest Wall Manipulation,Subsequent (94668) $187.62 $197.50 1.4×
Rx Sp-Genratj Augmnt&Comunicaj Dev Ea 30 Min (92608) $133 $140 2.8×
Sensory Integration Ea 15 Min (97533) $79.80 $84 1.3×
Slp Stdy Unatnd W/Hrt Rate/O2 Sat/Resp/Slp Time (95800) $317.30 $334 1.4×
Smoking cessation > 10 min (99407) $81.70 $86 2.1×
Speech sound lang comprehen (92523) $543.40 $572 2.4×
Spirometry (94010) $246.05 $259 1.1×
Standardized Cognitive Performance Testing (96125) $364.80 $384 3.5×
Stress Tte Complete (93351) $3,222.40 $3,392 5.7×
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $80.28 $84.50 3.6×
Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes (97130) $72.20 $76 3.4×
Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) $166.25 $175 1.6×
Ther/Proph/Diag Inj Sc/Im (96372) $142.50 $150 1.9×
Therapeutic Activities (97530) $96.90 $102 2.8×
Therapeutic phlebotomy (99195) $295.45 $311 2.1×
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $37.05 $39 1.0×
Tte W/Doppler Complete - Tte Complete W/ Contrast (93306) $2,771.15 $2,917 4.9×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $228 $240 3.0×
Tx Swallowing Dysfunction&/Oral Funcj Feeding (92526) $211.85 $223 2.5×
Tx/Pro/Dx Inj New Drug Addon (96375) $123.50 $130 2.5×
Tympanometry (92567) $113.05 $119 2.9×
Unlisted pulmonary service/procedure (94799) $148.20 $156 1.1×
Vasc Duplex Extrem Venous,Bilat (93970) $1,448.75 $1,525 5.8×
Vasc Duplex Scan Extracranial,Limited (93882) $787.55 $829 7.3×
Vasc Non-Invasive Lower Extrem Art Stress/Rest, Complete,Bilateral (93924) $1,045 $1,100 4.7×
Vasopneumatic device (97016) $35.15 $37 2.9×
Vital capacity total (94150) $75.05 $79 0.6×
Wheelchair Mgmt Ea 15 Min (97542) $61.75 $65 2.0×