Procedures & surgery prices at Dahl Memorial Healthcare Association Inc

Ekalaka, MT · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedurePosted cashPosted gross× Medicare
Application cast elbow finger short arm (29075) $248.60 $248.60 0.9×
Arthrocentesis aspir&/inj interm jt/burs w/o us (20605) $244.20 $244.20 0.8×
Arthrocentesis aspir&/inj major jt/bursa w/o us (20610) $236.50 $236.50 0.8×
Arthrocentesis aspir&/inj small jt/bursa w/o us (20600) $180.40 $180.40 0.6×
Aspirate/Inj Ganglion Cyst (20612) $170.10 $170.10 0.5×
Avulsion nail plate partial/complete simple 1 (11730) $306.60 $306.60 1.5×
Blood Transfusion Service (36430) $954.80 $954.80 2.1×
Closed Tx Nasal Bone Fx W/Mnpj W/O Stabilization (21315) $418.95 $418.95 0.3×
Closed Tx Radial Shaft Fracture W/O Manipulation (25500) $325.24 $325.24 1.3×
Closed tx radial&ulnar shaft fractures w/o man (25560) $573.30 $573.30 2.3×
Closed Tx Ulnar Fracture Prox End W/O Manipulate (24670) $601.97 $601.97 2.4×
Closed tx ulnar shaft fracture w/o manipulation (25530) $538.02 $538.02 2.1×
Clsd tx shoulder dislc w/manipulation w/o anes (23650) $368.24 $368.24 1.5×
Cltx dstl fibular fx lat malls w/manj (27788) $1,159.20 $1,159.20 4.6×
Cltx dstl radial fx/epiphysl sep w/o manj (25600) $519.28 $519.28 2.1×
Cltx dstl rdl fx/epiphysl sep w/manj when perf (25605) $1,406.90 $1,406.90 0.9×
Cltx iphal jt dislc w/manj w/o anes (26770) $787.50 $787.50 3.1×
Cltx metacarpal fx w/o manipulation each bone (26600) $375.95 $375.95 1.5×
Cltx rdl head sublxtj chld nursemaid elbw w/manj (24640) $278.25 $278.25 1.1×
Collect Blood From Catheter Venous Nos (36592) $161.70 $161.70 1.2×
Collection of venous blood by venipuncture (36415) $33.08 $33.08 3.5×
Destruct B9 Lesion 1-14 (17110) $303.45 $303.45 1.5×
Destruction Premalignant Lesion 15/> (17004) $450.45 $450.45 1.1×
Destruction premalignant lesion 1st (17000) $178.50 $178.50 0.9×
Drs&/dbrdmt prtl-thkns burns 1st/sbsq medium (16025) $415.80 $415.80 2.0×
Drs&/dbrdmt prtl-thkns burns 1st/sbsq small (16020) $345.40 $345.40 1.7×
Evacuation of subungual hematoma (11740) $152.25 $152.25 1.1×
Exc b9 les mrgn xcp sk tg t/a/l 0.5 cm/< (11400) $342.30 $342.30 0.5×
Exc Face-Mm B9+Marg 0.5 Cm/< (11440) $383.25 $383.25 0.5×
Exc Face-Mm B9+Marg 0.6-1 Cm (11441) $574.20 $574.20 0.8×
Exc Face-Mm B9+Marg 1.1-2 Cm (11442) $516.60 $516.60 0.7×
Exc H-F-Nk-Sp B9+Marg 0.5/< (11420) $340.20 $340.20 0.2×
Exc H-F-Nk-Sp B9+Marg 1.1-2 (11422) $577.50 $577.50 0.3×
Exc Skin Benig 2.1-3 Cm Trunk,Arm,Leg (11403) $587.40 $587.40 0.8×
Exc Tr-Ext B9+Marg 0.6-1 Cm (11401) $417.90 $417.90 1.0×
Exc Tr-Ext B9+Marg 1.1-2 Cm (11402) $498.30 $498.30 0.7×
Excision of ganglion, wrist (dorsal or volar); primary (25111) $218.30 $218.30 0.1×
I&d abscess simple (10060) $333.90 $333.90 1.6×
Incision & drainage abscess complicated/multiple (10061) $565.95 $565.95 1.4×
Incision & removal foreign body subq tiss simple (10120) $504.90 $504.90 1.2×
Incisional biopsy skin single lesion (11106) $143.55 $143.55 0.2×
Initial Tx 1st Degree Burn Local Tx (16000) $208.95 $208.95 1.0×
Injection single tendon origin/insertion (20551) $261.80 $261.80 0.8×
Injection single/mlt trigger point 1/2 muscles (20552) $157.30 $157.30 0.5×
Injection single/mlt trigger point 3/> muscles (20553) $237.60 $237.60 0.8×
Injection, intralesional; up to and including 7 lesions (11900) $222.20 $222.20 1.1×
Insert Temp Bladder Cath (51702)
range across 2 matching MRF lines		 $155.10–$170.89 $155.10–$170.89 varies
Insert,Non-Indwelling Bladder Catheter (51701) $118.65 $118.65 0.9×
Intmd Rpr Face/Mm 12.6-20 Cm (12055) $653.78 $653.78 1.6×
Intmd Rpr Face/Mm 20.1-30.0 (12056) $756.32 $756.32 1.8×
Intubation endotracheal emergency procedure (31500) $496.13 $496.13 2.1×
Needle insertion w/o injection 1 or 2 muscles (20560) $17.60 $17.60 0.6×
Needle insertion w/o injection 3 or more muscles (20561) $23.10 $23.10 0.8×
Occipital Nerve Block (64405) $435.60 $435.60 1.4×
Punch biopsy skin single lesion (11104)
range across 2 matching MRF lines		 $108.82–$213 $108.82–$213 varies
Removal impacted cerumen irrigation/lvg unilat (69209) $55 $55 0.9×
Removal of nail bed (11750) $424.20 $424.20 1.0×
Removal skn tags mlt fibrq tags any area upw/15 (11200) $243.60 $243.60 1.2×
Remove drug implant device (11982) $299.25 $299.25 0.7×
Remove Intrauterine Device (58301) $295.05 $295.05 0.9×
Repair complex f/c/c/m/n/ax/g/h/f 1.1-2.5 cm (13131) $503.84 $503.84 1.2×
Repair intermediate f/e/e/n/l&/muc 2.5 cm/< (12051)
range across 2 matching MRF lines		 $464.20–$759.15 $464.20–$759.15 varies
Repair intermediate f/e/e/n/l&/muc 2.6-5.0 cm (12052) $469.70 $469.70 1.1×
Repair intermediate f/e/e/n/l&/muc 5.1-7.5 cm (12053) $475.20 $475.20 1.1×
Repair intermediate f/e/e/n/l&/muc 7.6-12.5 cm (12054) $560.07 $560.07 1.3×
Repair intermediate n/h/f/xtrnl gent 12.6-20 cm (12045) $596.45 $596.45 0.8×
Repair intermediate n/h/f/xtrnl gent 2.5cm/< (12041) $469.70 $469.70 1.1×
Repair intermediate n/h/f/xtrnl gent 2.6-7.5 cm (12042) $470.80 $470.80 1.1×
Repair intermediate n/h/f/xtrnl gent 7.6-12.5cm (12044) $509.36 $509.36 0.7×
Repair Intermediate N/H/F/Xtrnl Gent >30.0 Cm (12047) $997.76 $997.76 0.5×
Repair intermediate s/a/t/e 12.6-20.0cm (12035) $523.69 $523.69 1.3×
Repair intermediate s/a/t/e 2.5 cm/< (12031) $465.30 $465.30 1.1×
Repair intermediate s/a/t/e 2.6-7.5 cm (12032) $463.10 $463.10 1.1×
Repair intermediate s/a/t/e 20.1-30.0 cm (12036) $647.17 $647.17 0.9×
Repair intermediate s/a/t/e 7.6-12.5 cm (12034) $504.90 $504.90 1.2×
Repair intermediate s/a/t/e >30.0 cm (12037) $754.11 $754.11 0.4×
Rpr F/E/E/N/L/M 7.6-12.5 Cm (12015) $481.79 $481.79 2.4×
Rpr Intermediate N/H/F/Xtrnl Gent 20.1-30.0 Cm (12046) $856.64 $856.64 1.1×
Shave skin lesion 0.5 cm/< (11300) $270.90 $270.90 0.7×
Shaving Skin Lesion 1 F/E/E/N/L/M Diam 0.5 Cm/< (11310) $311.85 $311.85 1.5×
Shaving Skin Lesion 1 S/N/H/F/G Diam 0.5 Cm/< (11305) $282.45 $282.45 1.4×
Shaving Skin Lesion 1 S/N/H/F/G Diam 1.1-2.0 Cm (11307) $372.75 $372.75 1.8×
Shvg Skin Lesion 1 F/E/E/N/L/M Diam 1.1-2.0 Cm (11312) $418.95 $418.95 1.0×
Shvg Skin Lesion 1 Trunk/Arm/Leg Diam 0.6-1.0 Cm (11301) $326.55 $326.55 1.6×
Shvg Skn Lesion 1 Trunk/Arm/Leg Diam 1.1-2.0 Cm (11302) $367.50 $367.50 1.8×
Simple repair f/e/e/n/l/m 12.6cm-20.0 cm (12016) $596.45 $596.45 1.4×
Simple repair f/e/e/n/l/m 2.5cm/< (12011) $448.80 $448.80 2.2×
Simple repair f/e/e/n/l/m 2.6cm-5.0 cm (12013) $404.80 $404.80 2.0×
Simple Repair F/E/E/N/L/M 20.1cm-30.0 Cm (12017) $738.68 $738.68 1.8×
Simple repair f/e/e/n/l/m 5.1cm-7.5 cm (12014) $409.03 $409.03 2.0×
Simple repair scalp/neck/ax/genit/trunk 2.5cm/< (12001) $302.50 $302.50 1.5×
Simple repair scalp/neck/ax/genit/trunk >30.0cm (12007) $710.01 $710.01 3.5×
Simple rpr scalp/neck/ax/genit/trunk 7.6-12.5cm (12004) $369.34 $369.34 1.8×
Smpl repair scalp/neck/ax/genit/trunk 2.6-7.5cm (12002) $380.60 $380.60 1.9×
Smpl rpr scalp/neck/ax/genit/trunk 12.6-20.0cm (12005) $502.74 $502.74 1.2×
Smpl rpr scalp/neck/ax/genit/trunk 20.1-30.0cm (12006) $606.38 $606.38 1.5×
Strapping hand/finger (29280) $78.75 $78.75 1.3×
Tangential biopsy skin single lesion (11102) $270.90 $270.90 0.7×
Treat Thumb Dislocation (26641) $375.95 $375.95 1.5×
Trim skin lesion (11055) $191.10 $191.10 0.9×
Trim skin lesions 2 to 4 (11056) $219.45 $219.45 1.1×
Trim skin lesions over 4 (11057) $239.40 $239.40 1.2×
Trimming Nondystrophic Nails Any Number (11719) $77 $77 1.3×

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.