Visits & medical services prices at West Holt Memorial Hospital

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

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

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ProcedurePosted cashPosted gross× Medicare
Admn Sarscov2 Vacc 1 Dose (90480) $39 $49 0.9×
Airway Inhalation Treatment (94640)
range across 2 matching MRF lines		 $68–$481 $85–$601 varies
Analyze Neurostim Simple (95971) $125 $156 1.3×
Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) $90 $112 6.3×
Behavral qualit analys voice (92524) $351 $439 3.2×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $774 $967 2.0×
Canalith repositioning proc (95992) $103 $129 2.5×
Cardiac Stress Tst,Tracing Only (93017) $1,216 $1,520 5.4×
Cardiopulmonary resuscitation (92950) $550 $688 2.5×
Cardioversion (92960) $1,330 $1,663 1.9×
Chest Wall Manipulation (94668) $120 $150 0.9×
Chron Care Mgmt Srvc 20 Min (99490) $54 $67 0.5×
Color/duplex Doppler, complete (93975) $1,037 $1,296 4.2×
Color/duplex Doppler, limited (93976) $800 $1,000 7.4×
Continuous Pulse Ox (94762) $446 $557 3.3×
Cpap Ventilation Cpap Initiation&Mgmt (94660) $823 $1,029 3.6×
Cpt initial (94667) $277 $346 2.0×
Critical care first hour (99291) $3,042 $3,803 3.5×
Debridement Open Wound 20 Sq Cm< (97597) $318 $397 1.5×
Dup-scan aorta ivc iliac vascl/bpgs complete (93978) $1,559 $1,949 6.3×
Dup-scan aorta ivc iliac vascl/bpgs uni/lmtd (93979) $827 $1,034 7.6×
Dup-scan lxtr art/artl bpgs compl bi study (93925) $1,076 $1,345 4.3×
Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) $878 $1,097 8.1×
Dup-Scan Xtr Veins Complete Bilateral Study (93970) $1,444 $1,805 5.8×
Dup-scan xtr veins unilateral/limited study (93971) $1,037 $1,296 9.6×
Duplex up extrem art bilat (93930) $1,076 $1,345 4.3×
ECG/monitoring and analysis (93271) $624 $780 6.3×
Echo Heart Xthoracic,Limited (93308)
range across 2 matching MRF lines		 $888–$940 $1,110–$1,175 varies
Echo tthrc r-t 2d w/wo m-mode rest&strs cont ECG (93351) $1,667 $2,084 2.9×
Electrical Stimulation Ea 15 Min (97032) $103 $129 7.0×
Electrocardiogram Tracing (93005)
range across 4 matching MRF lines		 $318–$365 $397–$456 varies
Emergency Dept Visit Level 2 (99282) $319 $399 2.0×
Emergency Dept Visit Level 3 (99283) $509 $636 1.8×
Emergency Dept Visit Level 4 (99284) $740 $925 1.7×
Er level 1 (99281) $188 $235 2.1×
Er level v (99285) $1,165 $1,456 1.9×
Evaluate pt use of inhaler (94664) $197 $246 0.9×
Evaluate Speech Production (92522) $344 $430 3.1×
Evaluate Swallowing Function (92610) $318 $397 3.7×
Evaluation of speech fluency (92521) $419 $524 3.1×
External ECG rec>48hr<7d recording (93242) $477 $596 12.3×
External ECG rec>48hr<7d scanning alys w/report (93243) $877 $1,096 6.3×
External ECG rec>7d<15d recording (93246) $597 $746 15.4×
External ECG rec>7d<15d scanning alys w/report (93247) $998 $1,248 7.2×
External Ecg Scanning Analysis Report (93226) $707 $884 11.5×
Extracranial Bilat Study (93880) $1,559 $1,949 6.3×
Holter monitor recording (93225)
range across 2 matching MRF lines		 $471–$582 $589–$728 varies
Im Adm Intransl/Oral 1 Vaccine (90473) $39 $49 0.5×
Immunization administration (90471) $39 $49 0.5×
Iontophoresis 15 min (97033) $149 $186 7.8×
Irrig Drug Delivery Device (96523) $166 $208 2.7×
IV infusion hydration each additional hour (96361)
range across 2 matching MRF lines		 $109–$125 $136–$156 varies
IV infusion hydration initial 31 min-1 hour (96360) $420 $525 1.9×
IV infusion ther proph addl sequential to 1 hr (96367) $208 $260 2.8×
IV infusion therapy prophylaxis/dx ea hour (96366) $140 $175 2.9×
IV push initial (96374)
range across 2 matching MRF lines		 $91–$236 $114–$295 varies
Lung Function Test (Mbc/Mvv) (94200) $146 $182 2.4×
Lwr Xtr Vasc Stdy Bilat (93924) $1,042 $1,303 4.6×
Mechanical chest wall oscillation per session (94669) $197 $246 0.9×
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $63 $79 2.0×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $105 $131 2.9×
Medical nutrition therapy grp2/ indiv ea 30 mi (97804) $63 $79 3.7×
Motion Fluoroscopy/Swallow (92611) $494 $617 5.4×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $420 $525 2.0×
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $525 $656 1.2×
Neuromuscular Reeducation (97112) $105 $131 3.2×
Oral Function Therapy (92526) $320 $400 3.8×
Oral Speech Device Eval (92597) $269 $336 3.8×
Orthc/Prostc Mgmt Sbsq Enc (97763) $119 $149 2.4×
Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) $119 $149 2.6×
Ot Contrast Bath Ea 15 Min (97034) $70 $87 5.0×
Ot eval high complexity (97167) $361 $451 3.6×
Ot Eval Low Complex (97165) $258 $323 2.6×
Ot Eval Moderate Complexity (97166) $309 $386 3.1×
Ot manual therapy 15 min (97140) $107 $134 3.9×
Ot paraffin bath (97018) $79 $99 13.1×
Ot Prosthetic Training, Each 15 Min (97761) $119 $149 2.9×
Ot Re-Eval Est Plan Care (97168) $161 $201 2.4×
Ot rom hand (95852) $53 $66 2.5×
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $259 $324 1.9×
Outpatient Cardiac Rehab W/O Cont Ecg Monitor (93797) $259 $324 1.9×
Pentamidine Aersl Inhalation Pneumocystis/Proph (94642) $197 $246 0.9×
Percutaneous tests w/allergenic extracts (95004) $6 $8 0.0×
Phlebotomy therapeutic (99195) $277 $346 2.0×
Phys/qhp svcs op pulm rehab w/cont oximtry mntr (94626) $306 $383 5.0×
Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) $231 $289 3.8×
Plethysmography (94726) $867 $1,084 2.2×
Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115)
range across 2 matching MRF lines		 $41–$44 $51–$55 varies
Prof svcs allg immntx x w/prv allgic xtrcs njxs (95117) $46 $57 0.9×
Pt Eval High Complex (97163) $334 $418 3.4×
Pt eval low complex 20 min (97161) $232 $290 2.4×
Pt Eval Mod Complex (97162) $283 $354 2.9×
Pt gait training 15 min (97116) $102 $128 3.5×
Pt mechanical traction (97012) $86 $107 6.0×
Pt Re-Eval Est Plan Care (97164) $131 $164 1.9×
Pulmonary Stress Testing (94618) $519 $649 3.8×
Remote 30 Day Ecg Rev/Report (93270) $333 $416 8.6×
Rom Meas&Reprt Ea Xtr Ex Hand/Ea Trnk Sctj Spi (95851) $71 $89 2.7×
Rx sp-genratj augmnt&comunicaj dev 1st hr (92607) $470 $587 3.8×
Rx Sp-Genratj Augmnt&Comunicaj Dev Ea 30 Min (92608) $205 $256 4.3×
Self Care Mngment Training (97535) $109 $136 3.4×
Sensory Integration Ea 15 Min (97533) $95 $119 1.6×
Slp Stdy Unatnd W/Hrt Rate/O2 Sat/Resp/Slp Time (95800) $528 $660 2.4×
Speech sound lang comprehen (92523) $586 $733 2.6×
Spirometry (94010) $350 $437 1.6×
Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129) $102 $128 4.6×
Ther Ivntj Ea Addl 15 Min (97130)
range across 2 matching MRF lines		 $98–$102 $123–$128 varies
Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) $409 $511 4.0×
Ther/Proph/Diag Inj Sc/Im (96372)
range across 5 matching MRF lines		 $22–$149 $27–$186 varies
Ther/Proph/Diag Iv Inf Init (96365) $414 $517 1.9×
Therapeutic Activities (97530) $109 $136 3.1×
Trans Care Mgmt 14 Day Disch (99495) $356 $445 2.6×
Trans Care Mgmt 7 Day Disch (99496) $485 $606 3.5×
Tte w/doppler, complete (93306)
range across 3 matching MRF lines		 $1,990–$2,206 $2,487–$2,758 varies
Tte W/O Doppler Complete (93307) $1,978 $2,472 8.0×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $304 $380 4.0×
Tx/Pro/Dx Inj New Drug Addon (96375) $178 $223 3.7×
Tympanometry (92567) $62 $78 1.6×
Upr/L Xtremity Art 2 Levels (93922) $663 $829 4.8×
Upr/Lxtr Art Stdy 3+ Lvls (93923) $901 $1,126 4.0×
Vasopneumatic device (97016) $68 $85 5.7×
Vent Mgmt Inpat Init Day (94002) $1,241 $1,551 1.9×
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $857 $1,071 1.3×
Wheelchair Mgmt Ea 15 Min (97542) $97 $121 3.1×
Whirlpool Therapy (97022) $124 $155 7.9×

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.