Visits & medical services prices at Doctors Memorial Hospital

Bonifay, FL · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Aerosol inhalation pentamidine (94642) $266.85 $593 1.2×
Airway inhalation treatment (94640) $96.30 $214 0.4×
Airway resistance by oscillometry (94728) $214.20 $476 1.6×
Allergy injection single (95115) $61.65 $137 1.3×
Application of a modality to 1 or more areas; contrast baths, each 15 minutes Other Outpatient (97034) $102.15 $227 7.3×
Assessment of aphasia (96105) $219.15 $487 2.3×
Behav assmt w/score & docd/stand instrument (96127) $152.55 $339 3.9×
Behavioral & qualit analysis voice and resonance (92524) $295.20 $656 2.7×
C motor evoked lwr limbs (95929) $1,012.95 $2,251 2.6×
C motor evoked uppr limbs (95928) $1,012.95 $2,251 1.1×
Cardiac stress test (93017) $1,410.75 $3,135 6.3×
Cardiopulmonary exercise testing (94621) $214.20 $476 0.5×
Cardioversion elective external (92960) $299.25 $665 0.4×
Carotid duplex scan; bilat (93880) $486 $1,080 2.0×
Color/duplex Doppler, complete (93975) $839.25 $1,865 3.4×
Continuous inhalation tx, 1st hr (94644) $75.60 $168 0.5×
Cpap/bipap daily (94660) $149.40 $332 0.7×
Cpr (92950) $403.20 $896 1.8×
Cpt initial (94667) $103.50 $230 0.7×
Cpt subsequent (94668) $64.35 $143 0.5×
Critical care first hour (99291) $744.30 $1,654 0.9×
Ctr motr ep std transcrnl motr stim upr&low limb (95939) $1,012.95 $2,251 1.1×
Delivery/birthing room resuscitation (99465) $347.85 $773 0.5×
Developmental tst admin phys/qhp 1st hour (96112) $155.25 $345 1.2×
Duplex ext veins; bilat (93970) $326.25 $725 1.3×
Duplex le art/bpg; bilat (93925) $486.45 $1,081 2.0×
Duplex le art/bpg; unil/limit (93926) $401.40 $892 3.7×
Duplex ue art/bpg; bilat (93930) $486.45 $1,081 2.0×
Duplex ue art/bpg; unil/limit (93931) $401.40 $892 3.7×
Duplex venous ext unilat/lmtd (93971) $246.15 $547 2.3×
ECG up to 48 hrs recording (93225) $275.40 $612 2.0×
EEG awake & asleep (95819) $433.80 $964 1.9×
EEG extended monitoring 61-119 minutes (95813) $1,012.95 $2,251 4.5×
Eeg,Extended Monitoring,41-60 Minutes - Eeg (95812) $1,012.95 $2,251 4.5×
Electrocardiogram (93005) $176.85 $393 2.9×
Emergency department visit high mdm (99285) $411.98 $915.50 0.7×
Emergency department visit low mdm (99283) $171 $380 0.6×
Emergency department visit may not req phys/qhp (99281) $54 $120 0.6×
Emergency department visit moderate mdm (99284) $292.72 $650.50 0.7×
Emergency department visit straightforward mdm (99282) $100.35 $223 0.6×
EMG three extremities (95863) $602.10 $1,338 4.5×
EMG two extremities (95861) $602.10 $1,338 4.3×
Evaluate pt use of inhaler (94664) $144 $320 0.6×
Evaluate speech production (92522) $295.20 $656 2.6×
Evaluation of speech fluency (92521) $295.20 $656 2.2×
External ECG rec>48hr<7d recording (93242) $165.15 $367 4.2×
External ECG rec>7d<15d recording (93246) $165.15 $367 4.2×
Flow volume loop (94375) $214.20 $476 0.9×
Gait training 15 min (97116) $57.15 $127 2.0×
Gas dilut/washout lung vol w/wo distrib vent&vol (94727) $124.65 $277 0.6×
Immunization Admin (90471) $69.30 $154 0.9×
Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant (99460) $152.55 $339 1.1×
Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and… (99463) $152.55 $339 1.1×
Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug (96375) $227.70 $506 4.7×
Injection,Therap/Proph/Diagnost, IV Push, Initial Drug (96374) $227.70 $506 1.0×
Intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction, including test interpretation and… (95024) $46.80 $104 0.8×
IV hydration each add'l hr (96361) $166.50 $370 3.4×
IV infusion hydration initial 31 min-1 hour (96360) $166.50 $370 0.7×
IV infusion ther proph addl sequential to 1 hr (96367) $99.45 $221 1.3×
IV infusion therapy/prophylaxis /dx 1st to 1 hr (96365) $332.10 $738 1.5×
IV tx, each additional hour (96366) $166.50 $370 3.4×
Lwr xtr vasc stdy bilat (93924) $663.30 $1,474 2.9×
Manual therapy ea 15 min (97140) $69.30 $154 2.5×
Massage therapy ea 15 mins (97124) $61.65 $137 2.1×
Maximum voluntary ventilation (94200) $124.20 $276 2.0×
Mechanical chest wall oscillation lung function (94669) $122.85 $273 0.5×
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $19.35 $43 0.6×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $152.55 $339 4.2×
Methacholine challenge (94070) $230.18 $511.50 0.6×
Motion fluoroscopic evaluation of swallowing function by cine or video recording Other Outpatient (92611) $161.10 $358 1.8×
Needle electromyography; larynx (95865) $1,012.95 $2,251 7.3×
Needle EMG lmtd std musc 1 xtr/non-limb uni/bi (95870) $1,012.95 $2,251 7.3×
Needle oculoelectromyography, 1 or more extraocular muscles, 1 or both eyes, with interpretation and report UNSCHEDULED (92265) $1,012.95 $2,251 16.4×
Negative pressure wound therapy dme </= 50 sq cm (97605) $589.05 $1,309 2.8×
Negative pressure wound therapy dme >50 sq cm (97606) $589.05 $1,309 1.4×
Neurobehavioral Status Exam by Psych/Phys (96116) $144.45 $321 0.6×
Neuromuscular junction test (95937) $1,012.95 $2,251 7.5×
Non-invasive physiologic study extremity 3 levels (93923) $530.55 $1,179 2.4×
Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and… (92014) $74.70 $166 0.5×
Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and… (92012) $53.10 $118 0.4×
Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper… (97760) $65.70 $146 1.4×
Ot eval high complex 60 min (97167) $272.25 $605 2.7×
Ot eval low complex 30 min (97165) $148.50 $330 1.5×
Ot eval mod complex 45 min (97166) $210.60 $468 2.1×
Ot group therapy procedures (97150) $49.50 $110 2.7×
Ot mechanical traction (97012) $59.40 $132 4.1×
Ot Prosthetic Training, Each 15 Min (97761) $65.70 $146 1.6×
Ot re-eval est plan care (97168) $61.65 $137 0.9×
Ot Sensory Integrative Techniques Each 15 Minutes (97533) $52.20 $116 0.9×
Ot wheelchair management (97542) $60.30 $134 1.9×
Oxygen uptake, expired gas analysis; including CO2 output, percentage oxygen extracted UNSCHEDULED (94681) $126.45 $281 0.3×
Oxygen uptake, expired gas analysis; rest, indirect (separate procedure) UNSCHEDULED (94690) $57.60 $128 0.9×
Paraffin bath therapy (97018) $36.45 $81 6.1×
Phlebotomy therapeutic (99195) $188.10 $418 1.4×
Professional services for allergen immunotherapy; 2 or more injections (95117) $61.65 $137 1.3×
Pt Aquatic Therapy/Exercises (97113) $49.28 $109.50 1.3×
Pt Community/Work Reintegration Trainj Ea 15 Min (97537) $54.90 $122 1.7×
Pt Debridement Open Wound 20 Sq Cm< (97597) $36.90 $82 0.2×
Pt Electric Current Therapy (97033) $73.80 $164 3.9×
Pt Electrical Stimulation (97032) $82.80 $184 5.6×
Pt eval high complex 45 min (97163) $295.65 $657 3.0×
Pt eval low complex 20 min (97161) $171.45 $381 1.8×
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $62.10 $138 1.9×
Pt Physical Therapy Evaluation Mod Complex 30 Mins (97162) $234 $520 2.4×
Pt re-eval est plan care (97164) $103.05 $229 1.5×
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $66.15 $147 2.0×
Pt Therapeut Actvity Direct Pt Contact Each 15 Min (97530) $59.40 $132 1.7×
Pt Whirlpool Therapy (97022) $89.10 $198 5.7×
Pt-focused hlth risk assmt score doc stnd instrm (96160) $83.70 $186 2.1×
Pulm funct tst plethysmograp (94726) $126.45 $281 0.3×
Pulmonary service/procedure (94799) $68.40 $152 0.5×
Pulmonary stress testing (94618) $155.25 $345 1.1×
Pulse oximetry continuous (94762) $124.65 $277 0.9×
Pure tone audiometry, air only (92552) $152.55 $339 1.1×
Range of motion measurements and report (separate procedure); hand, with or without comparison with normal side Other… (95852) $41.85 $93 2.0×
Rem mntr physiol param 1st dev supply ea 30 d (99454) $119.70 $266 3.1×
Rem mntr physiol param 1st set up pt educaj eqp (99453) $81.45 $181 0.6×
Remote 30 Day Ecg Rev/Report - Cardiac Event Monitor (93270) $110.25 $245 2.8×
Short-latency somatosens ep std upr & low limbs (95938) $1,012.95 $2,251 1.1×
Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording… (95926) $1,012.95 $2,251 4.5×
Slp evaloral pharyngeal swallow function (92610) $263.25 $585 3.1×
Speech sound lang comprehen (92523) $295.20 $656 1.3×
Spirometry (94010) $131.85 $293 0.6×
Spirometry with bronchodilator (94060) $214.20 $476 0.5×
Ssep upper limbs (95925) $1,012.95 $2,251 4.5×
Temp transcutaneous pacing (92953) $454.05 $1,009 0.7×
Test to measure exhaled air for evaluation of lung function during rest and exercise (94680) $68.40 $152 0.5×
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $59.85 $133 2.7×
Ther ivntj cog funcj cntct ea addl 15 minutes (97130) $53.10 $118 2.5×
Therapeutic prophylactic/dx injection subq/im (96372) $73.80 $164 1.0×
Tobacco use cessation intensive >10 minutes (99407) $31.50 $70 0.8×
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $31.50 $70 0.8×
Trans care mgmt 14 day disch (99495) $154.35 $343 1.1×
Trans care mgmt 7 day disch (99496) $197.55 $439 1.4×
Treat swallowing dysfunction (92526) $59.85 $133 0.7×
Tte W/Doppler Complete - Tte Complete (93306) $449.32 $998.50 0.8×
Tx of Speech/Lang/Voice/Comm/Auditory Chg (92507) $59.85 $133 0.8×
Ultrasound therapy ea 15 mins (97035) $52.20 $116 3.6×
Upr/l xtremity art 2 levels (93922) $397.80 $884 2.9×
Vasopneumatic device therapy (97016) $81.45 $181 6.8×
Ventilator initial day (94002) $530.55 $1,179 0.8×
Ventilator subsequent day (94003) $397.80 $884 0.6×
Vital capacity total (94150) $117 $260 0.9×
Wound care non-selective (97602) $388.58 $863.50 1.9×