Visits & medical services prices at Jennie M Melham Memorial Medical Center

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

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

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ProcedureCash priceGross charge× Medicare
Airway inhalation treatment (94640) $339.50 $339.50 1.5×
Assessment of aphasia (96105) $300 $300 3.1×
Behavioral and qualitative analysis of voice and resonance (92524) $280 $280 2.6×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $777.79 $777.79 2.0×
Cardiac Stress Tst,Tracing Only (93017) $1,504.65 $1,504.65 6.7×
Cardiopulmonary exercise testing (94621) $522.54 $522.54 1.3×
Cardioversion (92960) $2,458.13 $2,458.13 3.6×
Cbt 1st hour (94644) $336.89 $336.89 2.4×
Chemo Hormon Antineopl Sq/Im (96402) $438.32 $438.32 5.9×
Chemo IV push addl drug (96411) $370 $370 4.9×
Chemo Iv Push Sngl Drug (96409) $560.27 $560.27 1.6×
Chemother, IV infusion, 1 hr (96413) $965.07 $965.07 2.8×
Chemother, IV infusion, ea add hr (96415) $392.60 $392.60 5.3×
Chemother,Non-Hormone Anti-Neopl, Sub-Q/Im (96401) $382.67 $382.67 5.1×
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $478.36 $478.36 6.4×
Color/duplex Doppler, complete (93975) $1,149.89 $1,149.89 4.6×
Cpap initiation and management (94660) $958 $958 4.2×
Cpt initial (94667) $264.32 $264.32 1.9×
Critical care (99291) $2,132.24 $2,132.24 2.5×
Debridement Open Wound 20 Sq Cm< (97597) $147 $147 0.7×
Dup-Scan Aorta Ivc Iliac Vascl/Bpgs Complete (93978) $996.10 $996.10 4.0×
Dup-scan aorta ivc iliac vascl/bpgs uni/lmtd (93979) $612.50 $612.50 5.6×
Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study (93925) $1,430.17 $1,430.17 5.8×
Dup-scan lxtr art/artl bpgs uni/lmtd study (93926) $1,103.85 $1,103.85 10.2×
Dup-Scan Uxtr Art/Artl Bpgs Compl Bi Study (93930) $1,013 $1,013 4.1×
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study (93931) $796 $796 7.3×
Dup-scan xtr veins unilateral/limited study (93971) $1,289.14 $1,289.14 11.9×
Duplex hemodialysis access (93990) $877 $877 8.1×
Duplex scan extracranial art compl bi study (93880) $1,648.80 $1,648.80 6.7×
Echo Heart Xthoracic,Limited (93308) $1,071.44 $1,071.44 4.3×
EEG awake asleep (95819) $1,551.54 $1,551.54 6.9×
EKG (93005) $358.32 $358.32 5.8×
Er level ii (99282) $460 $460 2.9×
Er level iii (99283) $775 $775 2.7×
Er level IV (99284) $1,200 $1,200 2.8×
Er level v (99285) $1,925 $1,925 3.1×
Evaluation of speech fluency (92521) $344.85 $344.85 2.6×
Evaluation of speech sound production (92522) $309.44 $309.44 2.8×
Evaluation of swallowing function (92610) $371.81 $371.81 4.4×
External ECG rec>48hr<7d recording (93242) $473.12 $473.12 12.2×
External ECG rec>7d<15d recording (93246) $455 $455 11.7×
External Ecg Scanning Analysis Report (93226) $871.46 $871.46 14.2×
Holter Monitor Recording (93225) $564.20 $564.20 4.1×
Icd Device Interrogate (93289) $128 $128 3.3×
Immunization Admin (90471) $76.30 $76.30 1.0×
Irrigaj Implntd Venous Access Drug Delivery Syst (96523) $183.12 $183.12 3.0×
IV infusion hydration each additional hour (96361) $324.51 $324.51 6.7×
IV infusion hydration initial 31 min-1 hour (96360) $504.69 $504.69 2.3×
IV infusion, therap/proph/diagnost,add infusion,1st hour (96367) $262.61 $262.61 3.5×
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $576.45 $576.45 2.6×
IV infusion, therap/proph/diagnost,initial,ea add hour (96366) $413.94 $413.94 8.5×
IV push initial (96374) $369.38 $369.38 1.7×
Manual therapy 15 min (97140) $91 $91 3.3×
Massage 15 min (97124) $69 $69 2.3×
Mechanical traction (97012) $73 $73 5.1×
Motion Fluor Eval Swlng Funcj C/V Rec (92611) $505 $505 5.5×
Multiple sleep latency test (95805) $3,505 $3,505 3.9×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $396.26 $396.26 1.9×
Non-Invas Physiologic Std Extremity Art 2 Level (93922) $621.52 $621.52 4.5×
Non-Invasive Physiologic Study Extremity 3 Levls (93923) $863 $863 3.8×
Noninvasive Ear/Pulse Oximetry Overnight Monitor (94762) $542.59 $542.59 4.1×
Orthotics mgmt & traing initial enctr ea 15 mins (97760) $84 $84 1.8×
Ot Community/Work Reintegration Trainj Ea 15 Min (97537) $84 $84 2.6×
Ot eval high complex 60 min (97167) $287 $287 2.9×
Ot eval low complex 30 min (97165) $225.66 $225.66 2.2×
Ot eval mod complex 45 min (97166) $262.25 $262.25 2.6×
Ot Prosthetic Training, Each 15 Min (97761) $71.50 $71.50 1.8×
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $399.74 $399.74 3.0×
Outpatient cardiac rehab w/o cont ECG monitor (93797) $171.60 $171.60 1.3×
Paraffin bath (97018) $44 $44 7.3×
Percutaneous tests w/allergenic extracts (95004) $14 $14 0.0×
Plethysmography (94726) $731.02 $731.02 1.9×
Pm device eval in person (93288) $103 $103 2.7×
Pm device progr eval dual (93280) $128.16 $128.16 3.3×
Pm device progr eval multi (93281) $112 $112 2.9×
Pm device progr eval sngl (93279) $96.90 $96.90 2.5×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $5,027.59 $5,027.59 5.6×
Prgrmg Eval Implantable Dfb - Cardiac Device Clinic Icd Biv Chamber (93284) $153.79 $153.79 4.0×
Programming of dual lead implantable defibrillator system (93283) $155.20 $155.20 4.0×
Programming of single lead implantable defibrillator system (93282) $138 $138 3.6×
Pt Electrical Stimulation (97032) $86 $86 5.9×
Pt eval high complex 45 min (97163) $291.88 $291.88 3.0×
Pt eval low complex 20 min (97161) $207.95 $207.95 2.1×
Pt Gait Training Therapy (97116) $130.68 $130.68 4.5×
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $175.41 $175.41 5.4×
Pt Physical Therapy Evaluation Mod Complex 30 Mins (97162) $243.85 $243.85 2.5×
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $141.73 $141.73 4.4×
Pt Ultrasound Therapy (97035) $62 $62 4.3×
Pt Whirlpool Therapy (97022) $85 $85 5.4×
Pulmonary stress testing (94618) $436.21 $436.21 3.2×
Remote 30 Day Ecg Rev/Report - Cardiac Event Monitor (93270) $446 $446 11.5×
Rt Chest Wall Manipulation,Subsequent (94668) $307.42 $307.42 2.2×
Sensory Integration Ea 15 Min (97533) $84 $84 1.4×
Sleep study unattended (95806) $429 $429 1.9×
Speech group therapy (92508) $130 $130 5.4×
Speech sound lang comprehen (92523) $428.82 $428.82 1.9×
Spirometry (94010) $355.47 $355.47 1.6×
Standardized Cognitive Performance Testing (96125) $300 $300 2.9×
Stress echo (93350) $1,976.85 $1,976.85 3.5×
Test for allergy using allergenic extract injected into skin (95024) $16 $16 0.3×
Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes (97130) $60 $60 2.9×
Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) $255.15 $255.15 2.5×
Ther/Proph/Diag Inj Sc/Im (96372) $205.60 $205.60 2.8×
Therapeutic Activities (97530) $201.92 $201.92 5.8×
Therapeutic phlebotomy (99195) $279.51 $279.51 2.0×
Tte W/Doppler Complete - Tte Complete W/ Contrast (93306) $2,593.98 $2,593.98 4.6×
Tte W/O Doppler Complete - Tte Complete No Doppler No Color (93307) $1,027 $1,027 4.1×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $323.25 $323.25 4.2×
Tx Swallowing Dysfunction&/Oral Funcj Feeding (92526) $333.10 $333.10 4.0×
Tx/Pro/Dx Inj New Drug Addon (96375) $332.66 $332.66 6.8×
Unlisted pulmonary service/procedure (94799) $121 $121 0.9×
Vasc Duplex Extrem Venous,Bilat (93970) $1,580.11 $1,580.11 6.4×
Vasc Duplex Scan Extracranial,Limited (93882) $893 $893 8.2×
Vasc Non-Invasive Lower Extrem Art Stress/Rest, Complete,Bilateral (93924) $736 $736 3.3×
Ventilation assist & mgmt inpatient 1st day (94002) $1,635.54 $1,635.54 2.5×
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $2,131.46 $2,131.46 3.3×
Vital capacity total (94150) $34 $34 0.3×
Wheelchair Mgmt Ea 15 Min (97542) $84 $84 2.7×