Visits & medical services prices at Tri Valley Health System

Cambridge, NE · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Airway inhalation treatment (94640) $174.60 $194 0.8×
Behavioral and qualitative analysis of voice and resonance (92524) $414 $460 3.8×
Biofeedback training any modality (90901) $153 $170 3.7×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $847.80 $942 2.2×
Canalith Repositioning (95992) $137.70 $153 3.4×
Car seat/bed test 60 min (94780) $297 $330 7.7×
Cardiac Stress Tst,Tracing Only (93017) $1,348.20 $1,498 6.0×
Cardiopulmonary resuscitation (92950) $1,319.40 $1,466 5.9×
Cardioversion (92960) $2,613.60 $2,904 3.8×
Cbt 1st hour (94644) $254.70 $283 1.8×
Chemo Hormon Antineopl Sq/Im (96402) $250.20 $278 3.3×
Chemother, IV infusion, 1 hr (96413) $545.40 $606 1.6×
Chemother, IV infusion, ea add hr (96415) $206.55 $229.50 2.8×
Chemother,Non-Hormone Anti-Neopl, Sub-Q/Im (96401) $229.50 $255 3.1×
Color/duplex Doppler, complete (93975) $1,352.70 $1,503 5.5×
Color/duplex Doppler, limited (93976) $945.90 $1,051 8.7×
Cont Gluc Monitoring Patient Provided Equipment (95249) $126.90 $141 2.1×
Continuous Glucose Monitoring (95250) $500.40 $556 3.6×
Cpap initiation and management (94660) $1,054.80 $1,172 4.6×
Cpt initial (94667) $242.10 $269 1.8×
Critical care (99291) $1,264.50 $1,405 1.5×
Debridement Open Wound 20 Sq Cm< (97597) $308.70 $343 1.5×
Demo &/or eval,pt use,aerosol device (94664) $243.90 $271 1.1×
Dup-Scan Aorta Ivc Iliac Vascl/Bpgs Complete (93978) $1,527.30 $1,697 6.2×
Dup-scan aorta ivc iliac vascl/bpgs uni/lmtd (93979) $1,323.90 $1,471 12.2×
Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study (93925) $1,643.40 $1,826 6.6×
Dup-scan lxtr art/artl bpgs uni/lmtd study (93926) $1,237.05 $1,374.50 11.4×
Dup-Scan Uxtr Art/Artl Bpgs Compl Bi Study (93930) $1,643.40 $1,826 6.6×
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study (93931) $1,181.70 $1,313 10.9×
Dup-scan xtr veins unilateral/limited study (93971) $1,379.70 $1,533 12.7×
Duplex hemodialysis access (93990) $1,117.80 $1,242 10.3×
Duplex scan extracranial art compl bi study (93880) $1,848.60 $2,054 7.5×
Echo Heart Xthoracic,Limited (93308) $1,055.70 $1,173 4.3×
Echo Transthoracic - Congenital Tte Complete (93303) $1,628.10 $1,809 2.9×
EKG (93005) $471.60 $524 7.7×
Er level 1 (99281) $174.60 $194 2.0×
Er level ii (99282) $225 $250 1.4×
Er level iii (99283) $299.70 $333 1.1×
Er level IV (99284) $478.80 $532 1.1×
Er level v (99285) $753.30 $837 1.2×
Evaluation of speech fluency (92521) $548.10 $609 4.1×
Evaluation of speech sound production (92522) $395.10 $439 3.5×
Evaluation of swallowing function (92610) $529.20 $588 6.2×
External ECG rec>48hr<7d recording (93242) $594 $660 15.3×
External ECG rec>7d<15d recording (93246) $594 $660 15.3×
Flow volume loop (94375) $375.30 $417 1.7×
Holter Monitor Recording (93225) $559.80 $622 4.1×
Immunization Admin (90471) $22.95 $25.50 0.3×
Immunotherapy, 2+ Injections (95117) $38.91 $43.23 0.8×
Inital newborn e/m (99460) $470.70 $523 3.4×
Initial normal newborn care, same day discharge (99463) $757.80 $842 5.5×
Irrigaj Implntd Venous Access Drug Delivery Syst (96523) $191.25 $212.50 3.1×
IV infusion hydration each additional hour (96361) $405 $450 8.3×
IV infusion hydration initial 31 min-1 hour (96360) $475.20 $528 2.2×
IV infusion, therap/proph/diagnost,add infusion,1st hour (96367) $297.90 $331 4.0×
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $595.80 $662 2.7×
IV infusion, therap/proph/diagnost,initial,ea add hour (96366) $508.50 $565 10.5×
IV push initial (96374) $258.30 $287 1.2×
Manual therapy 15 min (97140) $147.15 $163.50 5.3×
Massage 15 min (97124) $88.20 $98 3.0×
Mechanical chest wall oscillation (94669) $281.25 $312.50 1.2×
Mechanical traction (97012) $106.20 $118 7.4×
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $53.10 $59 1.7×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $40.50 $45 1.1×
Mnt Group Ea 30 Min (97804) $58.50 $65 3.4×
Motion Fluor Eval Swlng Funcj C/V Rec (92611) $700.20 $778 7.7×
Neg press wnd tx </=50 sq cm (97607) $1,124.10 $1,249 2.7×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $614.70 $683 3.0×
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $711.90 $791 1.7×
Newborn resuscitation (99465) $560.70 $623 0.8×
Non-Invas Physiologic Std Extremity Art 2 Level (93922) $701.10 $779 5.1×
Non-Invasive Physiologic Study Extremity 3 Levls (93923) $1,238.40 $1,376 5.5×
Noninvasive Ear/Pulse Oximetry Overnight Monitor (94762) $578.70 $643 4.3×
Nrpsyc tst eval phys/qhp 1st (96132) $207.90 $231 0.5×
Orthotics mgmt & traing initial enctr ea 15 mins (97760) $153 $170 3.3×
Osteopathic manipulative tx 1-2 body regions (98925) $58.50 $65 2.6×
Osteopathic manipulative tx 3-4 body regions (98926) $81 $90 3.6×
Osteopathic manipulative tx 5-6 body regions (98927) $108 $120 4.8×
Osteopathic manipulative tx 7-8 body regions (98928) $130.50 $145 5.8×
Osteopathic manipulative tx 9-10 body regions (98929) $153 $170 6.8×
Ot Community/Work Reintegration Trainj Ea 15 Min (97537) $99.90 $111 3.1×
Ot Contrast Bath Ea 15 Min (97034) $99.90 $111 7.1×
Ot eval high complex 60 min (97167) $417.60 $464 4.2×
Ot eval low complex 30 min (97165) $353.70 $393 3.5×
Ot eval mod complex 45 min (97166) $387.90 $431 3.9×
Ot Orthotics/Prosth Mgmt &/Trainj Sbsq Enctr 15 Min (97763) $180.90 $201 3.6×
Ot Prosthetic Training, Each 15 Min (97761) $152.10 $169 3.8×
Ot re-eval est plan care (97168) $262.80 $292 3.8×
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $287.10 $319 2.1×
Outpatient cardiac rehab w/o cont ECG monitor (93797) $248.40 $276 1.9×
Paraffin bath (97018) $104.40 $116 17.4×
Pentamidine Aersl Inhalation Pneumocystis/Proph (94642) $318.60 $354 1.4×
Percutaneous tests w/allergenic extracts (95004) $17.10 $19 0.0×
Peripheral arterial disease rehab per session (93668) $287.10 $319 4.7×
Phy/qhp op pulm rhb w/mntr (94626) $538.20 $598 8.8×
Plethysmography (94726) $485.10 $539 1.3×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $5,434.20 $6,038 6.1×
Prepj& allergen immunotherapy 1/mlt antigen (95165) $23.40 $26 0.5×
Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) $27.77 $30.86 0.6×
Pt Aquatic Therapy/Exercises (97113) $112.50 $125 3.0×
Pt Electric Current Therapy (97033) $159.30 $177 8.4×
Pt eval high complex 45 min (97163) $301.50 $335 3.1×
Pt eval low complex 20 min (97161) $235.80 $262 2.4×
Pt Gait Training Therapy (97116) $138.60 $154 4.8×
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $147.60 $164 4.5×
Pt Physical Therapy Evaluation Mod Complex 30 Mins (97162) $268.20 $298 2.7×
Pt re-evaluation (97164) $133.20 $148 2.0×
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $134.10 $149 4.1×
Pt Ultrasound Therapy (97035) $138.15 $153.50 9.6×
Pt Whirlpool Therapy (97022) $134.55 $149.50 8.6×
Pulmonary stress testing (94618) $627.30 $697 4.5×
Remote 30 Day Ecg Rev/Report - Cardiac Event Monitor (93270) $429.30 $477 11.1×
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $399.15 $443.50 1.9×
Rt Chest Wall Manipulation,Subsequent (94668) $220.50 $245 1.6×
Sensory Integration Ea 15 Min (97533) $116.10 $129 1.9×
Sleep study unattended (95806) $716.40 $796 3.2×
Speech sound lang comprehen (92523) $505.80 $562 2.2×
Spirometry (94010) $364.50 $405 1.6×
Stress Tte Complete (93351) $2,208.60 $2,454 3.9×
Test for allergy using allergenic extract injected into skin (95024) $16.20 $18 0.3×
Ther/Proph/Diag Inj Sc/Im (96372) $117 $130 1.6×
Therapeutic Activities (97530) $144.90 $161 4.1×
Therapeutic phlebotomy (99195) $155.70 $173 1.1×
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $76.50 $85 2.0×
Trans Care Mgmt 14 Day Disch (99495) $446.40 $496 3.2×
Trans Care Mgmt 7 Day Disch (99496) $603.90 $671 4.4×
Tte W/Doppler Complete - Tte Complete W/ Contrast (93306) $2,623.50 $2,915 4.6×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $391.95 $435.50 5.1×
Tx Swallowing Dysfunction&/Oral Funcj Feeding (92526) $424.80 $472 5.0×
Tx/Pro/Dx Inj New Drug Addon (96375) $203.40 $226 4.2×
Tympanometry (92567) $95.40 $106 2.5×
Unlisted pulmonary service/procedure (94799) $315 $350 2.4×
Vasc Duplex Extrem Venous,Bilat (93970) $1,798.20 $1,998 7.3×
Vasc Duplex Scan Extracranial,Limited (93882) $1,409.40 $1,566 13.0×
Vasc Non-Invasive Lower Extrem Art Stress/Rest, Complete,Bilateral (93924) $1,238.40 $1,376 5.5×
Vasopneumatic device (97016) $138.60 $154 11.5×
Ventilation assist & mgmt inpatient 1st day (94002) $1,485 $1,650 2.3×
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $1,350 $1,500 2.1×
Vital capacity total (94150) $127.80 $142 1.0×
Wheelchair Mgmt Ea 15 Min (97542) $116.10 $129 3.7×