Visits & medical services prices at Antelope Memorial Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Acoustic reflex testing (92568) $126
Advance care planning first 30 mins (99497) $179
Airway inhalation treatment (94640) $256
Behavioral and qualitative analysis of voice and resonance (92524) $481
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $515
Canalith Repositioning (95992) $137
Car seat/bed test 60 min (94780) $131
Cardiac Stress Tst,Tracing Only (93017) $1,718
Cardiopulmonary exercise testing (94621) $1,944
Cardiopulmonary resuscitation (92950) $728
Cardioversion (92960) $1,338.50
Cbt 1st hour (94644) $332
Chemo Hormon Antineopl Sq/Im (96402) $293
Chemo IV push addl drug (96411) $484
Chemo Iv Push Sngl Drug (96409) $677
Chemother, IV infusion, 1 hr (96413) $877
Chemother, IV infusion, ea add hr (96415) $529
Chemother,Non-Hormone Anti-Neopl, Sub-Q/Im (96401) $293
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $702
Color/duplex Doppler, complete (93975) $1,623
Color/duplex Doppler, limited (93976) $987
Comprehensive Hearing Test (92557) $336
Continuous Glucose Monitoring (95250) $531
Cpap initiation and management (94660) $1,141
Cpt initial (94667) $252
Critical care (99291) $611
Debridement Open Wound 20 Sq Cm< (97597) $421.50
Demo &/or eval,pt use,aerosol device (94664) $227
Dup-Scan Aorta Ivc Iliac Vascl/Bpgs Complete (93978) $1,541
Dup-scan aorta ivc iliac vascl/bpgs uni/lmtd (93979) $1,151
Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study (93925) $1,894
Dup-scan lxtr art/artl bpgs uni/lmtd study (93926) $1,374
Dup-Scan Uxtr Art/Artl Bpgs Compl Bi Study (93930) $1,504
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study (93931) $1,355
Dup-scan xtr veins unilateral/limited study (93971) $1,374
Duplex hemodialysis access (93990) $930
Duplex scan extracranial art compl bi study (93880) $2,086
Echo Heart Xthoracic,Limited (93308) $752
EEG awake asleep (95819) $2,031
Eeg Extended Monitoring 61-119 Minutes (95813) $1,959
EKG (93005) $251
EKG rhythm strip (93041) $320
Electroencephalogram Extend Monitoring 41-60 Min (95812) $1,296
EMG four extremities (95864) $499
EMG one extremity (95860) $242
EMG two extremities (95861) $345
Er level 1 (99281) $300
Er level ii (99282) $530
Er level iii (99283) $875
Er level IV (99284) $1,280
Er level v (99285) $2,055
Evaluation of speech fluency (92521) $458
Evaluation of speech sound production (92522) $481
Evaluation of swallowing function (92610) $498
External ECG rec>48hr<7d recording (93242) $702
External ECG rec>48hr<7d scanning alys w/report (93243) $1,168
External ECG rec>7d<15d recording (93246) $705
External ECG rec>7d<15d scanning alys w/report (93247) $1,168
External Ecg Scanning Analysis Report (93226) $1,274
Flow volume loop (94375) $172.50
Holter Monitor Recording (93225) $701
Imm Admn Sarscov2 Vaccine Single Dose (90480) $22
Immunization Admin (90471) $130
Immunotherapy, 2+ Injections (95117) $26
Inital newborn e/m (99460) $201
Irrigaj Implntd Venous Access Drug Delivery Syst (96523) $53
IV infusion hydration each additional hour (96361) $146
IV infusion hydration initial 31 min-1 hour (96360) $550
IV infusion, therap/proph/diagnost,add infusion,1st hour (96367) $431
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $601
IV infusion, therap/proph/diagnost,initial,ea add hour (96366) $243
IV push initial (96374) $315
Manual therapy 15 min (97140) $158
Massage 15 min (97124) $119
Mechanical chest wall oscillation (94669) $354
Mechanical traction (97012) $103
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $59
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $82
Motion Fluor Eval Swlng Funcj C/V Rec (92611) $728
Motor &/sens nrv cndj preconf eltrd array limb (95905) $387
Multiple sleep latency test (95805) $3,579
Neg press wnd tx </=50 sq cm (97607) $443
Neg press wound tx >50 cm (97608) $473
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $575
Nerve conduction studies 13/> studies (95913) $4,725
Nerve Conduction Studies 3-4 Studies (95908) $1,244
Nerve Conduction Studies 9-10 Studies (95911) $2,877
Nerve conduction studies; 1-2 studies (95907) $588
Nerve conduction studies; 11-12 studies (95912) $3,654
Nerve conduction studies; 5-6 studies (95909) $1,859
Nerve conduction studies; 7-8 studies (95910) $2,667
Newborn resuscitation (99465) $305
Non-Invas Physiologic Std Extremity Art 2 Level (93922) $856
Noninvasive Ear/Pulse Oximetry Overnight Monitor (94762) $704
Orthotics mgmt & traing initial enctr ea 15 mins (97760) $182
Ot Community/Work Reintegration Trainj Ea 15 Min (97537) $106
Ot eval high complex 60 min (97167) $318
Ot eval low complex 30 min (97165) $252
Ot eval mod complex 45 min (97166) $315
Ot Orthotics/Prosth Mgmt &/Trainj Sbsq Enctr 15 Min (97763) $111
Ot Prosthetic Training, Each 15 Min (97761) $139
Ot re-eval est plan care (97168) $137
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $402
Outpatient cardiac rehab w/o cont ECG monitor (93797) $5
Paraffin bath (97018) $88
Peripheral arterial disease rehab per session (93668) $166
Phy/qhp op pulm rhb w/mntr (94626) $442
Phy/qhp op pulm rhb w/o mntr (94625) $432
Plethysmography (94726) $993
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $6,671
Prepj& allergen immunotherapy 1/mlt antigen (95165) $31
Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) $21
Psycl/Nrpsyc Tst Auto Result (96146) $135
Pt Aquatic Therapy/Exercises (97113) $235
Pt Electric Current Therapy (97033) $208
Pt Electrical Stimulation (97032) $149
Pt eval high complex 45 min (97163) $420
Pt eval low complex 20 min (97161) $315
Pt Gait Training Therapy (97116) $132
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $156
Pt Physical Performance Test (97750) $110
Pt Physical Therapy Evaluation Mod Complex 30 Mins (97162) $315
Pt re-evaluation (97164) $214
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $137
Pt Ultrasound Therapy (97035) $96
Pt Whirlpool Therapy (97022) $130
Pulmonary stress testing (94618) $596
Pure Tone Audiometry Air & Bone (92553) $336
Pure Tone Audiometry, Air (92552) $103
Remote 30 Day Ecg Rev/Report - Cardiac Event Monitor (93270) $453
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $287
Rt Chest Wall Manipulation,Subsequent (94668) $154
Sensory Integration Ea 15 Min (97533) $116
Sleep study unattended (95806) $637
Smoking cessation > 10 min (99407) $95
Speech Audiometry Threshold (92555) $126
Speech Audiometry, Complete (92556) $126
Speech sound lang comprehen (92523) $521
Spirometry (94010) $524
Standardized Cognitive Performance Testing (96125) $418
Stress echo (93350) $2,334
Stress Tte Complete (93351) $182
Temp transcutaneous pacing (92953) $1,746
Ther/Proph/Diag Inj Sc/Im (96372) $212
Therapeutic Activities (97530) $155
Therapeutic phlebotomy (99195) $339
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $61
Tte W/Doppler Complete - Tte Complete W/ Contrast (93306) $1,593
Tte W/O Doppler Complete - Tte Complete No Doppler No Color (93307) $2,693
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $406
Tx Swallowing Dysfunction&/Oral Funcj Feeding (92526) $376
Tx/Pro/Dx Inj New Drug Addon (96375) $510
Tympanometry (92567) $76
Unlisted pulmonary service/procedure (94799) $240
Vasc Duplex Extrem Venous,Bilat (93970) $1,987
Vasc Duplex Scan Extracranial,Limited (93882) $1,163
Vasc Non-Invasive Lower Extrem Art Stress/Rest, Complete,Bilateral (93924) $1,679
Vasopneumatic device (97016) $112
Ventilation assist & mgmt inpatient 1st day (94002) $1,882
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $990
Wheelchair Mgmt Ea 15 Min (97542) $162
Xtrnl Pt Activated Ecg Rec Dwnld 30 Days (93271) $1,035