Visits & medical services prices at Gordon Memorial Hospital District

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

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

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ProcedureCash priceGross charge× Medicare
Airway inhalation treatment (94640) $54 $54 0.2×
Behavioral and qualitative analysis of voice and resonance (92524) $177 $177 1.6×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $105 $105 0.3×
Canalith Repositioning (95992) $36 $36 0.9×
Cardiopulmonary resuscitation (92950) $1,081 $1,081 4.8×
Chronic care mgmt svcs staff 1st 20 min cal mo (99490) $234 $234 2.2×
Color/duplex Doppler, complete (93975) $226 $226 0.9×
Color/duplex Doppler, limited (93976) $226 $226 2.1×
Cpap initiation and management (94660) $120 $120 0.5×
Cpt initial (94667) $6 $6 0.0×
Critical care (99291) $264 $264 0.3×
Debridement Open Wound 20 Sq Cm< (97597) $405 $405 1.9×
Demo &/or eval,pt use,aerosol device (94664) $900 $900 4.0×
Dup-Scan Aorta Ivc Iliac Vascl/Bpgs Complete (93978) $223 $223 0.9×
Dup-scan aorta ivc iliac vascl/bpgs uni/lmtd (93979) $217 $217 2.0×
Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study (93925) $233 $233 0.9×
Dup-scan lxtr art/artl bpgs uni/lmtd study (93926) $592 $592 5.5×
Dup-Scan Uxtr Art/Artl Bpgs Compl Bi Study (93930) $226 $226 0.9×
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study (93931) $219 $219 2.0×
Dup-scan xtr veins unilateral/limited study (93971) $597.50 $597.50 5.5×
Duplex scan extracranial art compl bi study (93880) $240 $240 1.0×
EKG (93005) $124 $124 2.0×
Er level 1 (99281) $836.50 $836.50 9.6×
Er level ii (99282) $313 $313 2.0×
Er level iii (99283) $857.50 $857.50 3.0×
Er level IV (99284) $863 $863 2.0×
Er level v (99285) $870.50 $870.50 1.4×
Evaluation of speech sound production (92522) $168 $168 1.5×
Evaluation of swallowing function (92610) $835 $835 9.8×
Evaluation with prescription of speech-generating alternative (92607) $194 $194 1.6×
Exam of visual field with limited testing (92081) $78 $78 1.3×
External Ecg Scanning Analysis Report (93226) $21 $21 0.3×
Eye exam w anesth; limited (92019) $39 $39 0.0×
Holter Monitor Recording (93225) $18 $18 0.1×
Imm Admn Sarscov2 Vaccine Single Dose (90480) $32 $32 0.8×
Immuniz admin,intranasal/oral,1 vac/tox (90473) $7.50 $7.50 0.1×
Immunization Admin (90471) $16 $16 0.2×
Immunotherapy, 2+ Injections (95117) $86.50 $86.50 1.8×
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $440 $440 2.0×
Low frequency non-thermal us (97610) $122 $122 0.6×
Manual therapy 15 min (97140) $100.50 $100.50 3.6×
Massage 15 min (97124) $28.50 $28.50 1.0×
Mechanical traction (97012) $36 $36 2.5×
Neg press wnd tx </=50 sq cm (97607) $125 $125 0.3×
Neg press wound tx >50 cm (97608) $142 $142 0.3×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $148 $148 0.7×
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $183 $183 0.4×
Non-Invas Physiologic Std Extremity Art 2 Level (93922) $208 $208 1.5×
Non-Invasive Physiologic Study Extremity 3 Levls (93923) $226 $226 1.0×
Noninvasive Ear/Pulse Oximetry Overnight Monitor (94762) $80 $80 0.6×
Orthotics mgmt & traing initial enctr ea 15 mins (97760) $138 $138 3.0×
Ot eval high complex 60 min (97167) $1,350 $1,350 13.4×
Ot eval low complex 30 min (97165) $221 $221 2.2×
Ot eval mod complex 45 min (97166) $375 $375 3.7×
Ot Orthotics/Prosth Mgmt &/Trainj Sbsq Enctr 15 Min (97763) $1,884 $1,884 37.6×
Ot Prosthetic Training, Each 15 Min (97761) $8,290 $8,290 205.1×
Ot re-eval est plan care (97168) $552 $552 8.1×
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $156 $156 1.2×
Paraffin bath (97018) $135.50 $135.50 22.5×
Phy/qhp op pulm rhb w/mntr (94626) $333 $333 5.4×
Phy/qhp op pulm rhb w/o mntr (94625) $302 $302 4.9×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $20 $20 0.0×
Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) $23 $23 0.5×
Pt Aquatic Therapy/Exercises (97113) $36 $36 1.0×
Pt Electric Current Therapy (97033) $36 $36 1.9×
Pt Electrical Stimulation (97032) $36 $36 2.4×
Pt eval high complex 45 min (97163) $21 $21 0.2×
Pt eval low complex 20 min (97161) $21 $21 0.2×
Pt Gait Training Therapy (97116) $21 $21 0.7×
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $36 $36 1.1×
Pt Physical Therapy Evaluation Mod Complex 30 Mins (97162) $21 $21 0.2×
Pt re-evaluation (97164) $21 $21 0.3×
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $58.50 $58.50 1.8×
Pt Ultrasound Therapy (97035) $36 $36 2.5×
Pt Whirlpool Therapy (97022) $36 $36 2.3×
Remote 30 Day Ecg Rev/Report - Cardiac Event Monitor (93270) $20 $20 0.5×
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $180 $180 0.9×
Rt Chest Wall Manipulation,Subsequent (94668) $95 $95 0.7×
Smoking cessation > 10 min (99407) $175 $175 4.5×
Speech group therapy (92508) $69 $69 2.9×
Speech sound lang comprehen (92523) $192 $192 0.8×
Spirometry (94010) $80 $80 0.4×
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $593.50 $593.50 26.5×
Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes (97130) $225.50 $225.50 10.7×
Ther/Proph/Diag Inj Sc/Im (96372) $165.50 $165.50 2.2×
Therapeutic Activities (97530) $142.50 $142.50 4.1×
Therapeutic phlebotomy (99195) $865 $865 6.3×
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $161 $161 4.1×
Trans Care Mgmt 14 Day Disch (99495) $240 $240 1.7×
Trans Care Mgmt 7 Day Disch (99496) $161 $161 1.2×
Tte W/Doppler Complete - Tte Complete W/ Contrast (93306) $264 $264 0.5×
Tte W/O Doppler Complete - Tte Complete No Doppler No Color (93307) $247 $247 1.0×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $162 $162 2.1×
Tx Swallowing Dysfunction&/Oral Funcj Feeding (92526) $154 $154 1.8×
Unlisted pulmonary service/procedure (94799) $325.50 $325.50 2.4×
Vasc Duplex Extrem Venous,Bilat (93970) $242.50 $242.50 1.0×
Ventilation assist & mgmt inpatient 1st day (94002) $300 $300 0.5×
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $150 $150 0.2×
Vital capacity total (94150) $125 $125 0.9×
Wheelchair Mgmt Ea 15 Min (97542) $36 $36 1.2×