Procedures & surgery prices at Ellett Memorial Hospital

Appleton City, MO · every code in this section with a posted price and a Medicare benchmark.

199 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) $131.25 $175 0.5×
Application Cast Finger (29086) $120 $160 0.7×
Application Finger Splint Dynamic (29131) $81 $108 1.4×
Application finger splint static (29130)
range across 2 matching MRF lines		 $42–$64.88 $56–$86.50 varies
Application long arm splint shoulder hand (29105)
range across 2 matching MRF lines		 $131.25–$231 $175–$308 varies
Application Short Arm Splint Dynamic (29126) $118.12 $157.50 0.9×
Application short arm splint forearm-hand static (29125)
range across 2 matching MRF lines		 $66–$99.19 $88–$132.25 varies
Application short leg splint calf foot (29515) $136.50 $182 0.8×
Apply long arm cast (29065)
range across 2 matching MRF lines		 $131.25–$217.88 $175–$290.50 varies
Apply Short Leg Cast (29405) $198.75 $265 0.7×
Apply short leg cast (29425) $87 $116 0.3×
Arterial puncture (36600) $107.62 $143.50 0.8×
Arthrocentesis aspir&/inj interm jt/burs w/o us (20605) $87 $116 0.3×
Arthrocentesis aspir&/inj major jt/bursa w/o us (20610)
range across 2 matching MRF lines		 $165.38–$165.75 $220.50–$221 varies
Arthrocentesis aspir&/inj small jt/bursa w/o us (20600) $69 $92 0.2×
Aspirate/Inj Ganglion Cyst (20612) $165.75 $221 0.5×
Avulsion nail plate partial/complete simple 1 (11730) $131.25 $175 0.7×
Biopsy Vulva/Perineum 1 Lesion Spx (56605) $150 $200 0.2×
Bladder Scan (51798) $159.19 $212.25 2.7×
Blood Transfusion Service (36430)
range across 4 matching MRF lines		 $49.50–$1,191.75 $66–$1,589 varies
Bx Cervix (57500) $170.25 $227 0.2×
Bx/exc lymph node open superficial (38500) $414 $552 0.1×
Change Cystostomy Tube Simple (51705) $232.12 $309.50 0.9×
Chemical Cautery Tissue (17250) $116.25 $155 0.6×
Chemodenerv Musc Migraine (64615) $283.50 $378 0.9×
Clear outer ear canal (69200) $211.50 $282 1.6×
Closed Tx Radial Shaft Fracture W/O Manipulation (25500) $521.25 $695 2.1×
Closed Tx Radial&Ulnar Shaft Fractures W/Manj (25565) $521.25 $695 0.3×
Cltx dstl rdl fx/epiphysl sep w/manj when perf (25605)
range across 2 matching MRF lines		 $521.25–$1,404.38 $695–$1,872.50 varies
Collect Blood From Catheter Venous Nos (36592)
range across 2 matching MRF lines		 $106.12–$111.56 $141.50–$148.75 varies
Collection of venous blood by venipuncture (36415)
range across 2 matching MRF lines		 $9.75–$15.38 $13–$20.50 varies
Colonoscopy w/submucosal inj (45381) $702.94 $937.25 0.6×
Colsc Flexible W/Transendoscopic Balloon Dilat (45386) $702.94 $937.25 0.6×
Colsc flx w/removal lesion by hot bx forceps (45384) $702.94 $937.25 0.6×
Control Nasal Hemorrhage Anterior Simple (30901)
range across 2 matching MRF lines		 $82.50–$204.38 $110–$272.50 varies
Cystourethroscopy (52000)
range across 2 matching MRF lines		 $702.94–$1,364.44 $937.25–$1,819.25 varies
Dbrdmt extensv eczema/infect skn up 10% bdy surf (11000) $66 $88 0.2×
Debride nail 1-5 (11720) $39.75 $53 0.7×
Debride nail 6 or more (11721) $78.75 $105 1.3×
Debridement subcutaneous tissue 20 sq cm/< (11042) $178.50 $238 0.4×
Destruct B9 Lesion 1-14 (17110) $93.75 $125 0.5×
Destruction Benign Lesions 15/> (17111) $75 $100 0.4×
Destruction mal lesion f/e/e/n/l/m 0.6-1.0cm (17281) $174 $232 0.9×
Destruction mal lesion trunk/arm/leg 1.1-2.0cm (17262) $228 $304 1.1×
Destruction malignant lesion f/e/e/n/l/m 0.5cm/< (17280) $165.75 $221 0.8×
Destruction malignant lesion s/n/h/f/g 0.5 cm/> (17270) $128.25 $171 0.6×
Destruction malignant lesion s/n/h/f/g 0.6-1.0cm (17271) $248.25 $331 1.2×
Destruction Premalignant Lesion 15/> (17004) $240 $320 0.6×
Destruction premalignant lesion 1st (17000) $66 $88 0.3×
Diagnostic sigmoidoscopy (45330)
range across 2 matching MRF lines		 $256.31–$393.75 $341.75–$525 varies
Dilat Female Urethra W/Suppository&/Instlj Ini (53660) $165.38 $220.50 1.3×
Dilate Esophagus 1/Mult Pass (43450) $688.12 $917.50 0.8×
Dilate Urethra Stricture (53600) $165.38 $220.50 0.7×
Drainage of hematoma/fluid (10140) $256.50 $342 0.2×
Draw Blood Off Venous Device (36591)
range across 2 matching MRF lines		 $111.56–$119.06 $148.75–$158.75 varies
Drs&/dbrdmt prtl-thkns burns 1st/sbsq medium (16025)
range across 2 matching MRF lines		 $203.25–$379.88 $271–$506.50 varies
Drs&/dbrdmt prtl-thkns burns 1st/sbsq small (16020) $87 $116 0.4×
Dstrj Lesion Penis Simple Electrodesiccation (54055) $213.56 $284.75 0.1×
Egd Balloon Dilation Esophagus <30 Mm Diam (43249) $688.12 $917.50 0.4×
Egd control bleeding any (43255) $688.12 $917.50 0.4×
Egd Flexible Foreign Body Removal (43247) $688.12 $917.50 0.8×
Egd guide wire insertion (43248) $688.12 $917.50 0.8×
Endometrial Biopsy (58100) $236.25 $315 1.2×
Enterosc >2nd prtn w/ileum w/bx single/multiple (44377) $702.94 $937.25 0.4×
Epidural Blood Patch (62273) $646.69 $862.25 0.9×
Esophagogastroduodenoscopy Submucosal Injection (43236) $688.12 $917.50 0.8×
Evacuation of subungual hematoma (11740) $44.25 $59 0.3×
Exc b9 les mrgn xcp sk tg t/a/l 0.5 cm/< (11400) $87 $116 0.1×
Exc b9 lesion mrgn xcp sk tg s/n/h/f/g 2.1-3.0cm (11423) $306 $408 0.2×
Exc F/E/E/N/L Mal+Mrg 0.6-1 (11641) $196.50 $262 0.3×
Exc F/E/E/N/L Mal+Mrg 1.1-2 (11642) $239.25 $319 0.3×
Exc F/E/E/N/L Mal+Mrg 3.1-4 (11644) $732 $976 0.4×
Exc Face-Mm B9+Marg 0.5 Cm/< (11440) $131.25 $175 0.2×
Exc Face-Mm B9+Marg 0.6-1 Cm (11441) $256.50 $342 0.4×
Exc Face-Mm B9+Marg 1.1-2 Cm (11442) $314.25 $419 0.4×
Exc Face-Mm B9+Marg 2.1-3 Cm (11443) $360 $480 0.2×
Exc Face-Mm B9+Marg 3.1-4 Cm (11444) $426 $568 0.3×
Exc H-F-Nk-Sp B9+Marg 0.5/< (11420) $186.75 $249 0.1×
Exc H-F-Nk-Sp B9+Marg 0.6-1 (11421) $240 $320 0.3×
Exc H-F-Nk-Sp B9+Marg 1.1-2 (11422) $131.25 $175 0.1×
Exc lesion tendon sheath/capsule w/synvct toe ea (28092) $645 $860 0.4×
Exc Skin Benig 2.1-3 Cm Trunk,Arm,Leg (11403) $289.50 $386 0.4×
Exc Skin Benig 3.1-4 Cm Remaindr Body (11424) $318.75 $425 0.2×
Exc Skin Benig >4 Cm Trunk,Arm,Leg (11406) $426 $568 0.3×
Exc Skin Malig 2.1-3 Cm Remaindr Body (11623) $463.50 $618 0.3×
Exc Skin Malig >4 Cm Remaindr Body (11626) $562.50 $750 0.2×
Exc Skin Malig >4 Cm Trunk,Arm,Leg (11606) $261 $348 0.2×
Exc Tr-Ext B9+Marg 0.6-1 Cm (11401) $131.25 $175 0.3×
Exc Tr-Ext B9+Marg 1.1-2 Cm (11402) $131.25 $175 0.2×
Exc Tr-Ext B9+Marg 3.1-4 Cm (11404) $376.50 $502 0.2×
Excise, Malign Lesion w/Margins, Trunk, Arms, or Legs; Excised diam 2.1 to 3.0 cm Charge (11603) $426 $568 0.6×
Excision Mal Lesion Trunk/Arm/Leg 0.5 Cm/< (11600) $342.75 $457 0.5×
Excision Mal Lesion Trunk/Arm/Leg 0.6-1.0 Cm (11601) $152.25 $203 0.2×
Excision mal lesion trunk/arm/leg 1.1-2.0 cm (11602) $174 $232 0.4×
Excision Mal Lesion Trunk/Arm/Leg 3.1-4.0 Cm (11604) $218.25 $291 0.3×
Excision malignant lesion f/e/e/n/l 0.5 cm/< (11640) $356.25 $475 0.5×
Excision Malignant Lesion F/E/E/N/L 2.1-3.0 Cm (11643) $261 $348 0.2×
Excision Malignant Lesion S/N/H/F/G 0.5 Cm/< (11620) $294 $392 0.2×
Excision Malignant Lesion S/N/H/F/G 0.6-1.0 Cm (11621) $348 $464 0.5×
Excision malignant lesion s/n/h/f/g 1.1-2.0 cm (11622) $426 $568 0.6×
Excision Malignant Lesion S/N/H/F/G 3.1-4.0 Cm (11624) $513 $684 0.3×
Excision of ganglion, wrist (dorsal or volar); primary (25111) $840 $1,120 0.5×
I&d abscess simple (10060) $131.25 $175 0.7×
I&d pilonidal cyst simple (10080) $231.75 $309 0.3×
Ileoscopy Thru Stoma Dx W/Collj Spec When Prfmd (44380) $702.94 $937.25 0.8×
Image Cath Fluid Colxn Visc (49405)
range across 2 matching MRF lines		 $1,429.88–$1,430.25 $1,906.50–$1,907 varies
Incise external hemorrhoid (46083) $376.50 $502 1.5×
Incision & drainage abscess complicated/multiple (10061) $152.25 $203 0.4×
Incision & removal foreign body subq tiss simple (10120) $231.75 $309 0.6×
Initial Tx 1st Degree Burn Local Tx (16000) $99.75 $133 0.5×
Inj W/Fluor Eval Cv Device (36598) $164.25 $219 0.8×
Injection 1 tendon sheath/ligament aponeurosis (20550) $109.50 $146 0.4×
Injection aa&/strd axillary nerve w/img gdn (64417) $646.69 $862.25 0.7×
Injection anesthetic agent suprascapular nerve (64418) $646.69 $862.25 0.9×
Injection single tendon origin/insertion (20551) $87 $116 0.3×
Injection single/mlt trigger point 1/2 muscles (20552)
range across 2 matching MRF lines		 $66–$279 $88–$372 varies
Injection single/mlt trigger point 3/> muscles (20553) $87 $116 0.3×
Injection, anesthetic agent; brachial plexus, single (64415) $646.69 $862.25 0.7×
Injection, anesthetic agent; femoral nerve, single (64447) $565.69 $754.25 0.8×
Injection, anesthetic agent; other peripheral nerve or branch (64450)
range across 2 matching MRF lines		 $150–$565.69 $200–$754.25 varies
Injection, intralesional; up to and including 7 lesions (11900) $69 $92 0.3×
Insert Drug Implant Device (11981) $289.50 $386 2.2×
Insert non-tunnel cv cath (36556)
range across 2 matching MRF lines		 $323.81–$1,084.50 $431.75–$1,446 varies
Insert pessary/other device (57160) $138.75 $185 0.7×
Insert Temp Bladder Cath (51702)
range across 2 matching MRF lines		 $114.19–$170.25 $152.25–$227 varies
Insert,Non-Indwelling Bladder Catheter (51701)
range across 2 matching MRF lines		 $82.12–$124.50 $109.50–$166 varies
Intubation endotracheal emergency procedure (31500)
range across 2 matching MRF lines		 $76.88–$485.44 $102.50–$647.25 varies
N Block Inj Plantar Digit (64455) $109.50 $146 0.4×
Njx Cholangio Prq W/Img Gid Rs&I Existing Access (47531)
range across 4 matching MRF lines		 $74.06–$250.50 $98.75–$334 varies
Partical Excision Bone Phalanx Toe (28124) $835.50 $1,114 0.3×
Punch biopsy skin single lesion (11104) $131.25 $175 0.3×
Removal Foreign Body Foot Subcutaneous (28190) $131.25 $175 0.2×
Removal Foreign Body Muscle/Tendon Sheath Simple (20520) $131.25 $175 0.1×
Removal impacted cerumen irrigation/lvg unilat (69209) $80.25 $107 1.4×
Removal Impacted Cerumen Requiring Instrumentation, Unilateral (69210) $40.50 $54 0.7×
Removal implantable contraceptive capsules (11976) $152.25 $203 0.2×
Removal of nail bed (11750) $174 $232 0.4×
Removal skn tags mlt fibrq tags any area upw/15 (11200) $66 $88 0.3×
Remove drug implant device (11982) $152.25 $203 0.3×
Remove Intrauterine Device (58301) $149.25 $199 0.5×
Remove Nasal Foreign Body (30300) $131.25 $175 1.0×
Remove Tendon Sheath Lesion (26160) $9 $12 0.0×
Repair complex eyelid/nose/ear/lip 2.6-7.5 cm (13152) $699 $932 0.9×
Repair complex f/c/c/m/n/ax/g/h/f 1.1-2.5 cm (13131) $475.50 $634 1.2×
Repair complex f/c/c/m/n/ax/g/h/f 2.6-7.5 cm (13132) $802.50 $1,070 2.0×
Repair complex scalp/arm/leg 2.6-7.5 cm (13121) $653.25 $871 1.6×
Repair intermediate f/e/e/n/l&/muc 2.5 cm/< (12051) $401.25 $535 1.0×
Repair intermediate f/e/e/n/l&/muc 2.6-5.0 cm (12052) $442.50 $590 1.1×
Repair intermediate f/e/e/n/l&/muc 5.1-7.5 cm (12053) $261 $348 0.6×
Repair intermediate n/h/f/xtrnl gent 2.5cm/< (12041) $294 $392 0.7×
Repair intermediate n/h/f/xtrnl gent 2.6-7.5 cm (12042) $348 $464 0.9×
Repair intermediate s/a/t/e 2.5 cm/< (12031) $339.75 $453 0.8×
Repair intermediate s/a/t/e 2.6-7.5 cm (12032) $438.75 $585 1.1×
Repair intermediate s/a/t/e 7.6-12.5 cm (12034) $360 $480 0.9×
Replace G-J Tube Perc (49452) $781.50 $1,042 0.9×
Replace g/c tube perc (49450)
range across 2 matching MRF lines		 $139.88–$140.25 $186.50–$187 varies
Rmvl fb xtrnl eye corneal w/o slit lamp (65220) $252.75 $337 0.6×
Rmvl fb xtrnl eye corneal w/slit lamp (65222) $99.75 $133 0.7×
Rmvl fb xtrnl eye embed scjncl/scleral nonperfor (65210) $108 $144 0.2×
Rmvl tun ctr vad w/subq port/pmp ctr/prph insj (36590) $365.62 $487.50 0.2×
Rmvl Tun Cvc W/O Subq Port/Pmp (36589) $264.38 $352.50 0.4×
Shave skin lesion 0.5 cm/< (11300) $66 $88 0.2×
Shaving Skin Lesion 1 F/E/E/N/L/M Diam 0.5 Cm/< (11310) $109.50 $146 0.5×
Shaving Skin Lesion 1 S/N/H/F/G Diam 0.5 Cm/< (11305) $66 $88 0.3×
Shaving Skin Lesion 1 S/N/H/F/G Diam 0.6-1.0 Cm (11306) $182.25 $243 0.9×
Shaving Skin Lesion 1 S/N/H/F/G Diam 1.1-2.0 Cm (11307) $141 $188 0.7×
Shaving Skin Lesion 1 S/N/H/F/G Diam >2.0 Cm (11308) $168.75 $225 0.4×
Shvg Skin Lesion 1 F/E/E/N/L/M Diam 0.6-1.0 Cm (11311) $109.50 $146 0.5×
Shvg Skin Lesion 1 F/E/E/N/L/M Diam 1.1-2.0 Cm (11312) $153 $204 0.4×
Shvg Skin Lesion 1 Trunk/Arm/Leg Diam 0.6-1.0 Cm (11301) $178.50 $238 0.9×
Shvg Skin Lesion 1 Trunk/Arm/Leg Diam >2.0 Cm (11303) $168.75 $225 0.4×
Shvg Skn Lesion 1 Trunk/Arm/Leg Diam 1.1-2.0 Cm (11302) $136.50 $182 0.7×
Sigmoidoscopy, flexible; with biopsy, single or multiple (45331) $337.50 $450 0.4×
Simple repair f/e/e/n/l/m 2.5cm/< (12011) $109.50 $146 0.5×
Simple repair f/e/e/n/l/m 2.6cm-5.0 cm (12013) $131.25 $175 0.7×
Simple repair scalp/neck/ax/genit/trunk 2.5cm/< (12001) $112.50 $150 0.6×
Simple repair scalp/neck/ax/genit/trunk >30.0cm (12007) $438.75 $585 2.2×
Simple rpr scalp/neck/ax/genit/trunk 7.6-12.5cm (12004) $152.25 $203 0.8×
Smpl repair scalp/neck/ax/genit/trunk 2.6-7.5cm (12002) $131.25 $175 0.7×
Smpl rpr scalp/neck/ax/genit/trunk 12.6-20.0cm (12005) $314.25 $419 0.8×
Spinal puncture lumbar diagnostic (62270) $404.44 $539.25 0.6×
Strapping ankle (29540) $41.25 $55 0.3×
Strapping elbow or wrist (29260) $46.31 $61.75 0.8×
Strapping hand/finger (29280) $46.88 $62.50 0.8×
Strapping Hip (29520) $178.88 $238.50 1.3×
Strapping knee (29530) $46.31 $61.75 0.3×
Strapping shoulder (29240)
range across 2 matching MRF lines		 $46.69–$243.19 $62.25–$324.25 varies
Strapping thorax (29200) $48.38 $64.50 0.3×
Strapping toes (29550) $29.62 $39.50 0.5×
Strapping Unna Boot (29580) $93.75 $125 0.6×
Tangential biopsy skin single lesion (11102) $112.50 $150 0.3×
Tenotomy Percutaneous Toe Single Tendon (28010) $243.75 $325 0.2×
Trim skin lesion (11055) $66 $88 0.3×
Trim skin lesions 2 to 4 (11056) $87 $116 0.4×
Trim skin lesions over 4 (11057) $91.50 $122 0.5×
Trimming Nondystrophic Nails Any Number (11719) $23.25 $31 0.4×
Unlisted Procedure Casting/Strapping (29799) $188.81 $251.75 1.2×
Vasectomy uni/bi spx w/postop semen exams (55250) $835.50 $1,114 0.4×
Wedge excision skin nail fold (11765) $131.25 $175 0.3×

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.