Visits & medical services prices at Ellett Memorial Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Airway inhalation treatment (94640) $60.09 $80.12 0.3×
Ambulatory Bp Analysis (93788) $132.19 $176.25 1.0×
Ambulatory Bp Recording (93786) $158.62 $211.50 1.2×
Assessment of aphasia (96105) $168.56 $224.75 1.7×
Behavioral and qualitative analysis of voice and resonance (92524) $137.44 $183.25 1.3×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $438.19 $584.25 1.2×
Cardiac Stress Tst,Tracing Only (93017) $600.94 $801.25 2.8×
Cardiopulmonary resuscitation (92950) $434.62 $579.50 2.0×
Cardioversion (92960) $1,044.28 $1,392.38 1.6×
Color/duplex Doppler, complete (93975) $294.38 $392.50 1.2×
Color/duplex Doppler, limited (93976) $98.06 $130.75 0.9×
Comprehensive Hearing Test (92557) $69 $92 0.5×
Computerized Ophthalmic Imaging Optic Nerve (92133) $48.75 $65 0.8×
Conditioning Play Audiometry (92582) $86.25 $115 0.7×
Cpap initiation and management (94660) $637.50 $850 2.9×
Cpt initial (94667) $187.50 $250 1.4×
Cptrized oph dx img pst segment uni/bi retina (92134) $53.25 $71 0.9×
Critical care (99291) $472.88 $630.50 0.6×
Debridement Open Wound 20 Sq Cm< (97597) $153 $204 0.8×
Demo &/or eval,pt use,aerosol device (94664) $92.81 $123.75 0.4×
Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study (93925) $101.16 $134.88 0.4×
Dup-scan lxtr art/artl bpgs uni/lmtd study (93926) $70.41 $93.88 0.7×
Dup-Scan Uxtr Art/Artl Bpgs Compl Bi Study (93930) $81.56 $108.75 0.3×
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study (93931) $55.50 $74 0.5×
Dup-scan xtr veins unilateral/limited study (93971) $77.62 $103.50 0.7×
Duplex scan extracranial art compl bi study (93880) $104.91 $139.88 0.4×
Echo Heart Xthoracic,Limited (93308) $102.75 $137 0.4×
EEG awake asleep (95819) $716.25 $955 3.3×
EEG awake drowsy (95816) $398.06 $530.75 1.8×
EEG cerebral death evaluation (95824) $690.38 $920.50 1.8×
EKG (93005) $118.97 $158.62 2.0×
EKG rhythm strip (93041) $129.94 $173.25 2.2×
Electroconvulsive Therapy (90870) $1,196.62 $1,595.50 1.4×
Ep Ephys Eval Pacg Cvdfb Prgrmg/Reprgrmg Parameters (93642) $1,884.75 $2,513 1.5×
Er level 1 (99281) $100.41 $133.88 1.2×
Er level ii (99282) $173.25 $231 1.1×
Er level iii (99283) $357.38 $476.50 1.3×
Er level IV (99284) $549.19 $732.25 1.3×
Er level v (99285) $712.03 $949.38 1.2×
Evaluation of speech fluency (92521) $251.25 $335 1.9×
Evaluation of speech sound production (92522) $145.12 $193.50 1.3×
Evaluation of swallowing function (92610) $133.12 $177.50 1.6×
External Ecg Scanning Analysis Report (93226) $54.19 $72.25 0.9×
Eye exam, new patient,comprehesv (92004) $108.75 $145 0.8×
Flexible Endoscopic Eval Swallow C/V Rec (92612) $278.06 $370.75 1.4×
Gonioscopy (92020) $44.25 $59 0.3×
Group Therapeutic Procedures (97150) $28.78 $38.38 1.6×
Holter Monitor Recording (93225) $295.31 $393.75 2.2×
Immunization Admin (90471) $28.69 $38.25 0.4×
Immunotherapy, 2+ Injections (95117) $35.25 $47 0.8×
Inhlj Brncl Challenge Tstg W/Histamine/Methachol (95070) $541.69 $722.25 1.4×
Irrigaj Implntd Venous Access Drug Delivery Syst (96523) $75.28 $100.38 1.3×
IV infusion hydration each additional hour (96361) $169.31 $225.75 3.6×
IV infusion hydration initial 31 min-1 hour (96360) $330.56 $440.75 1.6×
IV infusion, therap/proph/diagnost,add infusion,1st hour (96367) $255.84 $341.12 3.5×
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $282.38 $376.50 1.3×
IV infusion, therap/proph/diagnost,initial,ea add hour (96366) $195.84 $261.12 4.2×
IV push initial (96374) $184.59 $246.12 0.9×
Manual therapy 15 min (97140) $73.31 $97.75 2.6×
Massage 15 min (97124) $46.88 $62.50 1.6×
Maximum voluntary ventilation (94200) $113.25 $151 1.9×
Mechanical traction (97012) $25.22 $33.62 1.8×
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $37.88 $50.50 1.2×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $35.16 $46.88 1.0×
Methacholine challenge (94070) $455.25 $607 1.2×
Mnt Group Ea 30 Min (97804) $22.12 $29.50 1.3×
Motion Fluor Eval Swlng Funcj C/V Rec (92611) $286.12 $381.50 3.1×
Multiple sleep latency test (95805) $1,170.19 $1,560.25 1.4×
Nerve Conduction Studies 3-4 Studies (95908) $198.75 $265 0.9×
Nerve Conduction Studies 9-10 Studies (95911) $378.75 $505 1.0×
Nerve conduction studies; 1-2 studies (95907) $160.50 $214 0.7×
Nerve conduction studies; 11-12 studies (95912) $442.50 $590 1.2×
Nerve conduction studies; 5-6 studies (95909) $240 $320 1.1×
Nerve conduction studies; 7-8 studies (95910) $315 $420 0.8×
New patient problem focused exam of visual system (92002) $61.50 $82 0.5×
Non-Invas Physiologic Std Extremity Art 2 Level (93922) $44.81 $59.75 0.3×
Non-Invasive Physiologic Study Extremity 3 Levls (93923) $79.41 $105.88 0.4×
Noninvasive Ear/Pulse Oximetry Overnight Monitor (94762) $215.81 $287.75 1.7×
Ophth medical xm&eval comprhnsv estab pt 1/> (92014) $90.75 $121 0.7×
Ophth medical xm&eval intermediate estab pt (92012) $64.50 $86 0.5×
Ophthalmic biometry (92136) $136.50 $182 1.0×
Opscpy extnd rta drawing & scl deprsn i&r uni/bi (92201) $33.75 $45 0.6×
Orthotics mgmt & traing initial enctr ea 15 mins (97760) $71.62 $95.50 1.6×
Osteopathic manipulative tx 1-2 body regions (98925) $44.25 $59 2.0×
Osteopathic manipulative tx 3-4 body regions (98926) $66 $88 3.1×
Ot Community/Work Reintegration Trainj Ea 15 Min (97537) $51.56 $68.75 1.6×
Ot Contrast Bath Ea 15 Min (97034) $40.50 $54 2.9×
Ot eval high complex 60 min (97167) $139.69 $186.25 1.4×
Ot eval low complex 30 min (97165) $143.06 $190.75 1.4×
Ot eval mod complex 45 min (97166) $260.62 $347.50 2.6×
Ot Orthotics/Prosth Mgmt &/Trainj Sbsq Enctr 15 Min (97763) $78.94 $105.25 1.6×
Ot Prosthetic Training, Each 15 Min (97761) $73.03 $97.38 1.8×
Ot Range Motion Measure,Each Extrem (95851) $30.38 $40.50 1.2×
Ot re-eval est plan care (97168) $94.88 $126.50 1.4×
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $274.31 $365.75 2.1×
Paraffin bath (97018) $13.50 $18 2.2×
Plethysmography (94726) $347.44 $463.25 0.9×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $281.25 $375 0.3×
Polysom Any Age Sleep Stage 1-3 Addl Param Attnd (95808) $1,194.94 $1,593.25 1.4×
Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) $18 $24 0.4×
Psytx crisis initial 60 min (90839) $203.25 $271 1.1×
Pt Aquatic Therapy/Exercises (97113) $60.19 $80.25 1.6×
Pt Electric Current Therapy (97033) $40.59 $54.12 2.1×
Pt Electrical Stimulation (97032) $24.38 $32.50 1.7×
Pt eval high complex 45 min (97163) $129.75 $173 1.3×
Pt eval low complex 20 min (97161) $143.06 $190.75 1.5×
Pt Gait Training Therapy (97116) $122.06 $162.75 4.2×
Pt Infrared Therapy (97026) $21.84 $29.12 3.3×
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $54 $72 1.6×
Pt Physical Performance Test (97750) $57.94 $77.25 1.7×
Pt Physical Therapy Evaluation Mod Complex 30 Mins (97162) $129.75 $173 1.3×
Pt re-evaluation (97164) $87.56 $116.75 1.3×
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $77.53 $103.38 2.4×
Pt Ultrasound Therapy (97035) $35.91 $47.88 2.5×
Pt Whirlpool Therapy (97022) $29.06 $38.75 1.9×
Pulmonary stress testing (94618) $120.75 $161 0.9×
Pure Tone Audiometry, Air (92552) $53.25 $71 0.4×
Remote 30 Day Ecg Rev/Report - Cardiac Event Monitor (93270) $183.75 $245 4.9×
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $375 $500 1.9×
Rom meas&reprt hand w/wo comparison normal sid (95852) $27.56 $36.75 1.3×
Rt Chest Wall Manipulation,Subsequent (94668) $150 $200 1.1×
Sensory Integration Ea 15 Min (97533) $53.06 $70.75 0.9×
Sleep study unattended (95806) $159.38 $212.50 0.7×
Smoking cessation > 10 min (99407) $71.62 $95.50 1.9×
Speech Audiometry Threshold (92555) $46.31 $61.75 0.8×
Speech Audiometry, Complete (92556) $69.75 $93 1.2×
Speech group therapy (92508) $35.44 $47.25 1.5×
Speech sound lang comprehen (92523) $302.81 $403.75 1.3×
Spirometry (94010) $218.81 $291.75 1.0×
Tensilon test (95857) $61.31 $81.75 0.3×
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $61.69 $82.25 2.8×
Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes (97130) $60.19 $80.25 2.9×
Ther/Proph/Diag Inj Sc/Im (96372) $71.72 $95.62 1.0×
Therapeutic Activities (97530) $115.31 $153.75 3.3×
Therapeutic phlebotomy (99195) $296.62 $395.50 2.2×
Transtelephonic Rhythm Strip Pacemaker Eval (93293) $104.44 $139.25 2.8×
Tte W/Doppler Complete - Tte Complete W/ Contrast (93306) $1,013.25 $1,351 1.9×
Tte W/O Doppler Complete - Tte Complete No Doppler No Color (93307) $175.50 $234 0.7×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $121.50 $162 1.6×
Tx Swallowing Dysfunction&/Oral Funcj Feeding (92526) $133.12 $177.50 1.6×
Tx/Pro/Dx Inj New Drug Addon (96375) $113.53 $151.38 2.4×
Vasc Duplex Extrem Venous,Bilat (93970) $119.81 $159.75 0.5×
Vasc Duplex Scan Extracranial,Limited (93882) $72 $96 0.7×
Vasc Non-Invasive Lower Extrem Art Stress/Rest, Complete,Bilateral (93924) $61.41 $81.88 0.3×
Vasopneumatic device (97016) $24.56 $32.75 2.0×
Ventilation assist & mgmt inpatient 1st day (94002) $183.75 $245 0.3×
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $131.25 $175 0.2×
Vital capacity total (94150) $74.81 $99.75 0.6×
Wheelchair Mgmt Ea 15 Min (97542) $51.94 $69.25 1.7×
Xtrnl Pt Activated Ecg Rec Dwnld 30 Days (93271) $282.75 $377 3.0×