Visits & medical services prices at Tomah Memorial Hospital
Tomah, WI · every code in this section with a posted price and a Medicare benchmark.
149 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Airway Inhalation Treatment (94640) | $229.14 | $398.50 | 1.1× |
| Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) | $81.36 | $141.50 | 5.7× |
| Application Modality 1/> Areas Infrared (97026) | $81.94 | $142.50 | 12.3× |
| Application on-body injector (96377) | $69.72 | $121.25 | 1.5× |
| Behavral qualit analys voice (92524) | $294.26 | $511.75 | 2.7× |
| Brncdilat rspse spmtry pre&post-brncdilat admn (94060) | $264.93 | $460.75 | 0.7× |
| Canalith repositioning proc (95992) range across 3 matching MRF lines |
$89.41–$217.49 | $155.50–$378.25 | varies |
| Car seat/bed test 60 min (94780) | $127.94 | $222.50 | 3.5× |
| Cardiac Stress Tst,Tracing Only (93017) range across 2 matching MRF lines |
$152.52–$652.34 | $265.25–$1,134.50 | varies |
| Cardiopulmonary resuscitation (92950) range across 2 matching MRF lines |
$414.58–$722.63 | $721–$1,256.75 | varies |
| Cardioversion (92960) range across 2 matching MRF lines |
$461.58–$511.32 | $802.75–$889.25 | varies |
| Care mgmt services behavioral hlth cond 20 mins (99484) | $68.43 | $119 | 1.9× |
| Cbt 1st hour (94644) | $131.82 | $229.25 | 1.0× |
| Chemo Anti-Neopl Sq/Im (96401) | $114.57 | $199.25 | 1.6× |
| Chemo Hormon Antineopl Sq/Im (96402) | $67.71 | $117.75 | 1.0× |
| Chemo IV infusion addl hr (96415) | $116.58 | $202.75 | 1.7× |
| Chemo IV push addl drug (96411) | $68.28 | $118.75 | 1.0× |
| Chemother Prolong Infuse W/Pump (96416) | $315.39 | $548.50 | 1.0× |
| Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) | $147.06 | $255.75 | 2.1× |
| Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) | $480.41 | $835.50 | 1.5× |
| Chemotx admn IV push tq 1/1st sbst/drug (96409) | $157.98 | $274.75 | 0.5× |
| Chest Wall Manipulation (94668) | $58.36 | $101.50 | 0.5× |
| Color/duplex Doppler, complete (93975) range across 2 matching MRF lines |
$295.98–$745.92 | $514.75–$1,297.25 | varies |
| Color/duplex Doppler, limited (93976) range across 2 matching MRF lines |
$170.06–$301.16 | $295.75–$523.75 | varies |
| Community/Work Reintegration Trainj Ea 15 Min (97537) | $35.51 | $61.75 | 1.1× |
| Continuous Pulse Ox (94762) | $138.86 | $241.50 | 1.1× |
| Cpap Ventilation Cpap Initiation&Mgmt (94660) range across 3 matching MRF lines |
$65.41–$126.93 | $113.75–$220.75 | varies |
| Cpt initial (94667) | $88.26 | $153.50 | 0.7× |
| Critical care first hour (99291) | $703.66 | $1,223.75 | 0.9× |
| Debridement Open Wound 20 Sq Cm< (97597) range across 2 matching MRF lines |
$25.59–$61.09 | $44.50–$106.25 | varies |
| Dup-scan aorta ivc iliac vascl/bpgs complete (93978) range across 2 matching MRF lines |
$158.13–$316.25 | $275–$550 | varies |
| Dup-scan lxtr art/artl bpgs compl bi study (93925) range across 2 matching MRF lines |
$480.41–$702.94 | $835.50–$1,222.50 | varies |
| Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) range across 2 matching MRF lines |
$146.34–$480.56 | $254.50–$835.75 | varies |
| Dup-Scan Xtr Veins Complete Bilateral Study (93970) range across 2 matching MRF lines |
$399.34–$1,037.44 | $694.50–$1,804.25 | varies |
| Dup-scan xtr veins unilateral/limited study (93971) range across 2 matching MRF lines |
$256.45–$597.71 | $446–$1,039.50 | varies |
| Duplex up extrem art unilat/ltd (93931) range across 2 matching MRF lines |
$199.38–$702.94 | $346.75–$1,222.50 | varies |
| Echo Congenital Complete (93303) range across 2 matching MRF lines |
$222.96–$490.62 | $387.75–$853.25 | varies |
| Echo Heart Xthoracic,Limited (93308) range across 2 matching MRF lines |
$138.43–$163.30 | $240.75–$284 | varies |
| Echo tthrc r-t 2d w/wo m-mode rest&strs cont ECG (93351) range across 2 matching MRF lines |
$310.21–$507.15 | $539.50–$882 | varies |
| Electrical Stimulation Ea 15 Min (97032) range across 3 matching MRF lines |
$84.67–$115.72 | $147.25–$201.25 | varies |
| Electrocardiogram Tracing (93005) | $156.83 | $272.75 | 2.7× |
| Emergency Dept Visit Level 2 (99282) | $170.78 | $297 | 1.1× |
| Emergency Dept Visit Level 3 (99283) | $252.43 | $439 | 1.0× |
| Emergency Dept Visit Level 4 (99284) | $376.34 | $654.50 | 0.9× |
| Er level 1 (99281) | $103.07 | $179.25 | 1.3× |
| Er level v (99285) | $546.68 | $950.75 | 0.9× |
| Evaluate pt use of inhaler (94664) range across 2 matching MRF lines |
$49.59–$126.93 | $86.25–$220.75 | varies |
| Evaluate Speech Production (92522) | $294.26 | $511.75 | 2.6× |
| Evaluate Swallowing Function (92610) | $294.26 | $511.75 | 3.5× |
| Evaluation of speech fluency (92521) | $294.26 | $511.75 | 2.2× |
| Extracranial Bilat Study (93880) range across 2 matching MRF lines |
$494.36–$687.13 | $859.75–$1,195 | varies |
| F-up/limited tthrc echo congenital car anomaly (93304) | $387.12 | $673.25 | 0.7× |
| Group Therapeutic Procedures (97150) range across 4 matching MRF lines |
$71.16–$286.21 | $123.75–$497.75 | varies |
| Immunization administration (90471) | $51.75 | $90 | 0.7× |
| Inital newborn e/m (99460) | $205.28 | $357 | 1.6× |
| Iontophoresis 15 min (97033) | $96.31 | $167.50 | 5.1× |
| Irrig Drug Delivery Device (96523) | $54.63 | $95 | 1.0× |
| IV infusion hydration each additional hour (96361) | $100.63 | $175 | 2.2× |
| IV infusion hydration initial 31 min-1 hour (96360) | $301.88 | $525 | 1.5× |
| IV infusion ther proph addl sequential to 1 hr (96367) | $175.95 | $306 | 2.5× |
| IV infusion therapy prophylaxis/dx ea hour (96366) | $129.38 | $225 | 2.8× |
| IV push initial (96374) | $186.88 | $325 | 0.9× |
| Low frequency non-thermal us (97610) | $326.46 | $567.75 | 1.7× |
| Lwr Xtr Vasc Stdy Bilat (93924) | $324.73 | $564.75 | 1.5× |
| Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) | $15.96 | $27.75 | 0.5× |
| Medical nutrition assmt&ivntj indiv each 15 mi (97802) | $20.84 | $36.25 | 0.6× |
| Motion Fluoroscopy/Swallow (92611) | $294.26 | $511.75 | 3.2× |
| Multiple Sleep Latency Test (95805) range across 2 matching MRF lines |
$312.08–$1,923.66 | $542.75–$3,345.50 | varies |
| Muscle Test Nonparaspinal (95870) | $142.03 | $247 | 1.1× |
| Nasopharyngoscopy (92511) range across 2 matching MRF lines |
$83.38–$204.13 | $145–$355 | varies |
| Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) range across 2 matching MRF lines |
$463.45–$1,390.49 | $806–$2,418.25 | varies |
| Neg Pressure Wound Therapy Non Dme >50 Sq Cm (97608) | $101.78 | $177 | 0.3× |
| Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) range across 2 matching MRF lines |
$76.19–$101.78 | $132.50–$177 | varies |
| Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) range across 2 matching MRF lines |
$101.63–$162.58 | $176.75–$282.75 | varies |
| Neuromuscular Reeducation (97112) range across 2 matching MRF lines |
$78.78–$122.48 | $137–$213 | varies |
| Newborn resuscitation (99465) range across 2 matching MRF lines |
$387.84–$423.92 | $674.50–$737.25 | varies |
| Oral Function Therapy (92526) | $232.01 | $403.50 | 2.8× |
| Orthc/Prostc Mgmt Sbsq Enc (97763) | $56.49 | $98.25 | 1.1× |
| Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) range across 2 matching MRF lines |
$73.17–$81.94 | $127.25–$142.50 | varies |
| Osteopathic Manipulative Tx 1-2 Body Regions (98925) range across 2 matching MRF lines |
$25.01–$69.14 | $43.50–$120.25 | varies |
| Osteopathic manipulative tx 5-6 body regions (98927) range across 2 matching MRF lines |
$79.06–$112.41 | $137.50–$195.50 | varies |
| Ot Contrast Bath Ea 15 Min (97034) | $44.28 | $77 | 3.2× |
| Ot eval high complexity (97167) | $312.80 | $544 | 3.1× |
| Ot Eval Low Complex (97165) | $186.01 | $323.50 | 1.9× |
| Ot Eval Moderate Complexity (97166) | $264.07 | $459.25 | 2.6× |
| Ot manual therapy 15 min (97140) range across 3 matching MRF lines |
$73.17–$110.11 | $127.25–$191.50 | varies |
| Ot paraffin bath (97018) | $58.36 | $101.50 | 9.7× |
| Ot Prosthetic Training, Each 15 Min (97761) | $81.94 | $142.50 | 2.0× |
| Ot Re-Eval Est Plan Care (97168) | $94.16 | $163.75 | 1.4× |
| Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) | $167.33 | $291 | 1.3× |
| Outpatient Cardiac Rehab W/O Cont Ecg Monitor (93797) | $167.33 | $291 | 1.3× |
| Peripheral arterial disease rehab per session (93668) | $71.30 | $124 | 1.2× |
| Phlebotomy therapeutic (99195) | $235.75 | $410 | 1.8× |
| Phys/qhp svcs op pulm rehab w/cont oximtry mntr (94626) | $158.84 | $276.25 | 2.8× |
| Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) | $158.84 | $276.25 | 2.8× |
| Physical Performance Test (97750) range across 2 matching MRF lines |
$40.68–$106.38 | $70.75–$185 | varies |
| Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) range across 2 matching MRF lines |
$442.75–$1,931.57 | $770–$3,359.25 | varies |
| Principal care management services, for a single high-risk disease, with the following required elements: one complex… (99426) | $100.19 | $174.25 | 1.0× |
| Pt Eval High Complex (97163) | $313.81 | $545.75 | 3.2× |
| Pt eval low complex 20 min (97161) | $182.99 | $318.25 | 1.9× |
| Pt Eval Mod Complex (97162) | $266.23 | $463 | 2.7× |
| Pt gait training 15 min (97116) | $81.94 | $142.50 | 2.8× |
| Pt mechanical traction (97012) | $81.94 | $142.50 | 5.7× |
| Pt Re-Eval Est Plan Care (97164) | $94.88 | $165 | 1.4× |
| Pt ultraviolet (97028) | $70.29 | $122.25 | 8.4× |
| Pulmonary service/procedure (94799) range across 2 matching MRF lines |
$92.86–$97.61 | $161.50–$169.75 | varies |
| Refill/Maint Portable Pump (96521) | $191.19 | $332.50 | 0.9× |
| Refill/Maint Pump/Resvr Syst (96522) | $221.38 | $385 | 1.1× |
| Remote 30 Day Ecg Rev/Report (93270) | $652.34 | $1,134.50 | 18.0× |
| Rhythm Ecg 1-3 Leads Tracing Only W/O I&R (93041) range across 2 matching MRF lines |
$35.79–$55.20 | $62.25–$96 | varies |
| Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) | $155.39 | $270.25 | 0.8× |
| Rom Meas&Reprt Ea Xtr Ex Hand/Ea Trnk Sctj Spi (95851) | $68.28 | $118.75 | 2.6× |
| Rx sp-genratj augmnt&comunicaj dev 1st hr (92607) | $392.01 | $681.75 | 3.2× |
| Rx Sp-Genratj Augmnt&Comunicaj Dev Ea 30 Min (92608) | $195.79 | $340.50 | 4.1× |
| Same day nb discharge (99463) | $205.28 | $357 | 1.6× |
| Self Care Mngment Training (97535) range across 3 matching MRF lines |
$58.65–$122.19 | $102–$212.50 | varies |
| Sensory Integration Ea 15 Min (97533) | $81.94 | $142.50 | 1.3× |
| Sleep study unattended (95806) range across 2 matching MRF lines |
$271.11–$461.29 | $471.50–$802.25 | varies |
| Slp Stdy Unatnd W/Anal (95801) | $229.14 | $398.50 | 4.0× |
| Slp Stdy Unatnd W/Hrt Rate/O2 Sat/Resp/Slp Time (95800) range across 2 matching MRF lines |
$169.63–$467.19 | $295–$812.50 | varies |
| Speech sound lang comprehen (92523) | $294.26 | $511.75 | 1.3× |
| Spirometry (94010) | $100.19 | $174.25 | 0.5× |
| Standardized Cognitive Performance Testing (96125) | $294.26 | $511.75 | 2.9× |
| Stress Tte Only (93350) range across 2 matching MRF lines |
$237.33–$416.01 | $412.75–$723.50 | varies |
| Subcutaneous Infusion Each Additional Hour (96370) | $37.38 | $65 | 0.8× |
| Subcutaneous infusion initial 1 hr w/pump set-up (96369) | $209.88 | $365 | 1.0× |
| Subq Infusion Additional Pump Infusion Site (96371) | $66.13 | $115 | 0.9× |
| Temp transcutaneous pacing (92953) range across 2 matching MRF lines |
$165.46–$336.38 | $287.75–$585 | varies |
| Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129) | $73.17 | $127.25 | 3.3× |
| Ther Ivntj Ea Addl 15 Min (97130) | $71.73 | $124.75 | 3.4× |
| Ther Px 1/> Areas Each 15 Min Aqua Ther W/Xerss (97113) | $90.28 | $157 | 2.4× |
| Ther Px 1/> Areas Each 15 Minutes Massage (97124) | $81.94 | $142.50 | 2.8× |
| Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) | $232.01 | $403.50 | 2.3× |
| Ther/Proph/Diag Inj Ia (96373) | $127.51 | $221.75 | 0.6× |
| Ther/Proph/Diag Inj Sc/Im (96372) | $112.13 | $195 | 1.6× |
| Ther/Proph/Diag Iv Inf Init (96365) | $301.88 | $525 | 1.5× |
| Therapeutic Activities (97530) | $84.67 | $147.25 | 2.4× |
| Tobacco Use Cessation Intermediate 3-10 Minutes (99406) | $33.35 | $58 | 0.9× |
| Tte w/doppler, complete (93306) range across 2 matching MRF lines |
$207.43–$705.24 | $360.75–$1,226.50 | varies |
| Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) | $232.01 | $403.50 | 3.0× |
| Tx/Pro/Dx Inj New Drug Addon (96375) | $106.23 | $184.75 | 2.3× |
| Upr/L Xtremity Art 2 Levels (93922) | $186.73 | $324.75 | 1.4× |
| Upr/Lxtr Art Stdy 3+ Lvls (93923) range across 2 matching MRF lines |
$104.22–$277.44 | $181.25–$482.50 | varies |
| Vasopneumatic device (97016) range across 2 matching MRF lines |
$81.94–$141.02 | $142.50–$245.25 | varies |
| Vent Mgmt Inpat Init Day (94002) | $727.66 | $1,265.50 | 1.2× |
| Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) | $653.92 | $1,137.25 | 1.1× |
| Vital capacity, total (94150) | $98.61 | $171.50 | 0.8× |
| Wheelchair Mgmt Ea 15 Min (97542) | $73.17 | $127.25 | 2.4× |
| Whirlpool Therapy (97022) | $87.54 | $152.25 | 5.6× |
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.