Procedures & surgery prices at Roger Mills Memorial Hospital

Cheyenne, OK · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Abd paracentesis w/imaging (49083) $819 $1,092 0.9×
Abdom Paracentesis Dx/Ther W/O Imaging Guidance (49082) $421.50 $562 0.5×
Adding Walker Previously Applied Cast (29440) $58.50 $78 0.4×
Amputation Finger/Thumb (26951) $874.50 $1,166 0.3×
Appl Mlt-Layer Venous Wound Compress Below Knee (29581) $421.12 $561.50 2.7×
Application cast elbow finger short arm (29075) $172.50 $230 0.6×
Application finger splint static (29130) $84 $112 0.7×
Application long arm splint shoulder hand (29105) $219.75 $293 1.4×
Application short arm splint forearm-hand static (29125) $84 $112 0.7×
Application short leg splint calf foot (29515) $143.25 $191 0.9×
Apply short leg cast (29405) $189 $252 0.7×
Apply short leg cast (29425) $87.75 $117 0.3×
Arterial puncture (36600) $58.50 $78 0.5×
Arthrocentesis aspir&/inj interm jt/burs w/o us (20605) $186.75 $249 0.6×
Arthrocentesis aspir&/inj major jt/bursa w/o us (20610) $127.50 $170 0.4×
Arthrocentesis aspir&/inj major jt/bursa w/us (20611) $455.25 $607 1.5×
Arthrocentesis aspir&/inj small jt/bursa w/o us (20600) $111 $148 0.4×
Avulsion nail plate partial/complete simple 1 (11730) $124.50 $166 0.6×
Biopsy Bone Trocar/Needle Superficial (20220) $414 $552 0.3×
Biopsy Breast Open Incisional (19101) $255 $340 0.1×
Biopsy of nail unit (11755) $94.50 $126 0.1×
Blood transfusion service (36430) $590.62 $787.50 1.4×
Chg Collect Blood From Catheter Venous Nos (36592) $151.50 $202 1.2×
Closed Rx Med Malleolus Fx (27760) $348.75 $465 1.5×
Closed Rx Rad/Ulna Shaft Fx,Manip (25565) $592.50 $790 0.4×
Closed Rx Radial Shaft Fx (25500) $273.75 $365 1.2×
Closed Rx Tibial Plateau Fx (27530) $414 $552 1.7×
Closed Rx Trimalleolar Fx (27816) $374.25 $499 1.6×
Closed Treat Vert Body Fract (22310) $313.50 $418 1.3×
Closed treatment of talus fracture; without manipulation (28430) $317.25 $423 1.3×
Closed treatment of ulnar shaft fracture; with manipulation (25535) $553.50 $738 2.3×
Closed Treatment Ulnar Styloid Fracture (25650) $319.50 $426 1.3×
Closed tx ankle dislocation w/o anesthesia (27840) $336.75 $449 1.4×
Closed Tx Bimalleolar Ankle Fracture W/O Manip (27808) $312.38 $416.50 1.3×
Closed tx calcaneal fracture w/o manipulation (28400) $345.75 $461 1.5×
Closed tx metatarsal fracture w/o manipulation (28470) $262.50 $350 1.1×
Closed tx patellar dislocation w/anesthesia (27562) $313.50 $418 1.3×
Closed tx patellar dislocation w/o anesthesia (27560) $396.75 $529 1.7×
Closed tx patellar fracture w/o manipulation (27520) $338.25 $451 1.4×
Closed tx radial head/neck fx w/o manipulation (24650) $256.50 $342 1.1×
Closed tx scapular fracture w/o manipulation (23570) $299.25 $399 1.3×
Closed tx ulnar fracture prox end w/o manipulate (24670) $287.25 $383 1.2×
Closed tx ulnar shaft fracture w/o manipulation (25530) $251.62 $335.50 1.1×
Clsd tx clavicular fracture w/o manipulation (23500) $251.25 $335 1.1×
Clsd tx shoulder dislc w/manipulation req anes (23655) $457.50 $610 0.3×
Clsd tx shoulder dislc w/manipulation w/o anes (23650) $303.75 $405 1.3×
Cltx Carpo/Metacarpal Dislocation Thumb W/Manj (26641) $393 $524 1.7×
Cltx dstl fibular fx lat malls w/o manj (27786) $336 $448 1.4×
Cltx dstl phlngl fx fngr/thmb w/manj ea (26755) $324 $432 1.4×
Cltx Dstl Phlngl Fx Fngr/Thmb W/O Manj Ea (26750) $231.38 $308.50 1.0×
Cltx dstl radial fx/epiphysl sep w/o manj (25600) $314.62 $419.50 1.3×
Cltx dstl rdl fx/epiphysl sep w/manj when perf (25605) $611.25 $815 0.4×
Cltx fx grt toe phlx/phlg w/o manj (28490) $165 $220 0.7×
Cltx fx w8 brg artclr prtn dstl tibia w/o manj (27824) $374.25 $499 1.6×
Cltx iphal jt dislc w/manj w/o anes (26770) $264 $352 1.1×
Cltx metacarpal fx w/o manipulation each bone (26600) $247.50 $330 1.0×
Cltx metacarpophalangeal dislc w/manj w/o anes (26700) $338.25 $451 1.4×
Cltx phlngl fx prox/middle px/f/t w/o manj ea (26720) $172.50 $230 0.7×
Cltx rdl head sublxtj chld nursemaid elbw w/manj (24640) $268.12 $357.50 1.1×
Complex Drainage, Wound (10180) $184.50 $246 0.1×
Control Nasal Hemorrhage Anterior Simple (30901) $219.75 $293 1.7×
Cystotomy, with insertion of ureteral catheter or stent (separate procedure) (51045) $637.50 $850 0.3×
Dbrdmt extensv eczema/infect skn up 10% bdy surf (11000) $45 $60 0.1×
Debride nail 1-5 (11720) $123 $164 2.2×
Debride nail 6 or more (11721) $143.25 $191 2.5×
Debridement subcutaneous tissue 20 sq cm/< (11042) $309.75 $413 0.8×
Declot vascular device (36593) $336.75 $449 1.1×
Destruction Benign Lesions Up To 14 (17110) $48 $64 0.2×
Destruction premalignant lesion 1st (17000) $102 $136 0.5×
Destruction vaginal lesions simple (57061) $130.50 $174 0.0×
Drainage of gum lesion (41800) $312 $416 2.4×
Drainage of hematoma/fluid (10140) $736.50 $982 0.5×
Draw blood off venous device (36591) $151.50 $202 1.2×
Drs&/dbrdmt prtl-thkns burns 1st/sbsq large (16030) $363 $484 0.9×
Drs&/dbrdmt prtl-thkns burns 1st/sbsq medium (16025) $348 $464 1.8×
Drs&/dbrdmt prtl-thkns burns 1st/sbsq small (16020) $163.12 $217.50 0.8×
Exc b9 lesion mrgn xcp sk tg s/n/h/f/g 2.1-3.0cm (11423) $209.25 $279 0.1×
Exc b9 lesion mrgn xcp sk tg s/n/h/f/g 3.1-4.0cm (11424) $206.25 $275 0.1×
Exc Face-Mm B9+Marg 0.5 Cm/< (11440) $84.75 $113 0.1×
Exc Skin Benig 0.6-1 Cm Remaindr Body (11421) $110.25 $147 0.2×
Exc Skin Benig 0.6-1 Cm Trunk,Arm,Leg (11401) $246 $328 0.6×
Exc Skin Benig 1.1-2 Cm Trunk,Arm,Leg (11402) $130.50 $174 0.2×
Exc Skin Benig 2.1-3 Cm Trunk,Arm,Leg (11403) $154.50 $206 0.2×
Exc Skin Benig >4 Cm Trunk,Arm,Leg (11406) $349.12 $465.50 0.2×
Exc Skin Malig 2.1-3 Cm Face,Facial (11643) $292.50 $390 0.2×
Exc tr-ext b9+marg 0.5 cm or less (11400) $225 $300 0.3×
Excision Mal Lesion Trunk/Arm/Leg 0.6-1.0 Cm (11601) $438.75 $585 0.6×
Excision mal lesion trunk/arm/leg 1.1-2.0 cm (11602) $174.75 $233 0.4×
Excision Mal Lesion Trunk/Arm/Leg 2.1-3.0 Cm (11603) $193.50 $258 0.3×
Excision malignant lesion f/e/e/n/l 0.5 cm/< (11640) $140.25 $187 0.2×
Excision malignant lesion f/e/e/n/l 1.1-2.0 cm (11642) $247.50 $330 0.4×
Excision malignant lesion s/n/h/f/g 1.1-2.0 cm (11622) $197.25 $263 0.3×
Excision of benign lesion other than skin tag 0.6-1.0 cm (11441) $213 $284 0.3×
Excision of benign lesion other than skin tag 1.1-2.0 cm (11442) $159.75 $213 0.2×
Excision of lesion other than skin tag 1.1-2.0 cm (11422) $141.75 $189 0.1×
Excision of lesion other than skin tag </= 0.5 cm (11420) $151.88 $202.50 0.1×
Explore/Treat Interphalangeal Jt,Ea (26080) $2,108.25 $2,811 1.4×
I&D Abscess Peritonsillar (42700) $179.25 $239 0.8×
I&d abscess simple (10060) $217.88 $290.50 1.1×
I&d pilonidal cyst simple (10080) $97.50 $130 0.1×
Incision & drainage abscess complicated/multiple (10061) $432.75 $577 1.1×
Incision & removal foreign body subq tiss simple (10120) $328.88 $438.50 0.8×
Incision and drainage of vulva or perineal abscess (56405) $139.50 $186 0.5×
Incision thrombosed hemorrhoid external (46083) $147.75 $197 0.6×
Initial tx 1st degree burn local tx (16000) $246.75 $329 1.3×
Injection single/mlt trigger point 1/2 muscles (20552) $176.62 $235.50 0.6×
Injection single/mlt trigger point 3/> muscles (20553) $336.75 $449 1.1×
Insert Bladder Cath Complex (51703) $1,264.50 $1,686 10.2×
Insert non-tunnel cv cath (36556) $409.50 $546 0.1×
Insert Temp Bladder Cath (51702) $116.62 $155.50 0.9×
Insert,Non-Indwelling Bladder Catheter (51701) $131.25 $175 1.0×
Intubation endotracheal emergency procedure (31500) $675 $900 3.0×
Placement of needle for intraosseous infusion (36680) $151.50 $202 0.4×
Punch biopsy skin single lesion (11104) $287.25 $383 0.7×
Puncture Aspiration (10160) $126 $168 0.3×
Puncture Aspiration Cyst Breast (19000) $57.75 $77 0.1×
Removal fb intranasal (30300) $99.38 $132.50 0.8×
Removal Foreign Body Deep Thigh/Knee (27372) $573.75 $765 0.2×
Removal foreign body foot deep (28192) $509.25 $679 0.3×
Removal foreign body foot subcutaneous (28190) $414.75 $553 0.6×
Removal Foreign Body Muscle/Tendon Sheath Simple (20520) $272.25 $363 0.2×
Removal foreign body pharynx (42809) $127.50 $170 0.3×
Removal impacted cerumen irrigation/lvg unilat (69209) $127.50 $170 2.2×
Removal Impacted Cerumen Requiring Instrumentation, Unilateral (69210) $84 $112 1.5×
Removal of intrauterine device (iud) (58301) $81 $108 0.3×
Removal of nail bed (11750) $383.62 $511.50 1.0×
Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions (11200) $112.50 $150 0.6×
Remv Ext Canal Foreign Body (69200) $106.12 $141.50 0.8×
Remv F.B.,Eye,Superf Conjunc (65205) $135 $180 1.1×
Repair complex f/c/c/m/n/ax/g/h/f 1.1-2.5 cm (13131) $305.25 $407 0.8×
Repair complex scalp/arm/leg 2.6-7.5 cm (13121) $342.75 $457 0.9×
Repair complex trunk 2.6-7.5 cm (13101) $313.50 $418 0.4×
Repair intermediate f/e/e/n/l&/muc 2.5 cm/< (12051) $306 $408 0.8×
Repair intermediate f/e/e/n/l&/muc 2.6-5.0 cm (12052) $213 $284 0.5×
Repair intermediate n/h/f/xtrnl gent 2.5cm/< (12041) $166.12 $221.50 0.4×
Repair intermediate n/h/f/xtrnl gent 2.6-7.5 cm (12042) $294 $392 0.8×
Repair intermediate n/h/f/xtrnl gent 7.6-12.5cm (12044) $243.75 $325 0.3×
Repair intermediate s/a/t/e 12.6-20.0cm (12035) $348 $464 0.9×
Repair intermediate s/a/t/e 2.5 cm/< (12031) $242.62 $323.50 0.6×
Repair intermediate s/a/t/e 2.6-7.5 cm (12032) $283.12 $377.50 0.7×
Repair intermediate s/a/t/e 20.1-30.0 cm (12036) $261.75 $349 0.4×
Repair intermediate s/a/t/e 7.6-12.5 cm (12034) $274.50 $366 0.7×
Rmvl fb xtrnl eye corneal w/o slit lamp (65220) $127.50 $170 0.3×
Rpr intermediate n/h/f/xtrnl gent 20.1-30.0 cm (12046) $350.25 $467 0.5×
Shaving Skin Lesion 1 F/E/E/N/L/M Diam 0.5 Cm/< (11310) $53.25 $71 0.3×
Shaving Skin Lesion 1 S/N/H/F/G Diam 0.5 Cm/< (11305) $49.50 $66 0.3×
Shaving Skin Lesion 1 S/N/H/F/G Diam >2.0 Cm (11308) $102 $136 0.3×
Shaving skin lesion 1 trunk/arm/leg diam 0.5cm/< (11300) $79.88 $106.50 0.2×
Shvg Skin Lesion 1 F/E/E/N/L/M Diam 0.6-1.0 Cm (11311) $80.25 $107 0.4×
Simple repair f/e/e/n/l/m 2.5cm/< (12011) $192 $256 1.0×
Simple repair f/e/e/n/l/m 2.6cm-5.0 cm (12013) $234 $312 1.2×
Simple repair f/e/e/n/l/m 5.1cm-7.5 cm (12014) $176.25 $235 0.9×
Simple repair f/e/e/n/l/m 7.6cm-12.5 cm (12015) $180 $240 0.9×
Simple repair scalp/neck/ax/genit/trunk 2.5cm/< (12001) $166.88 $222.50 0.9×
Simple rpr scalp/neck/ax/genit/trunk 7.6-12.5cm (12004) $231.38 $308.50 1.2×
Skin splt grft trnk/arm/leg (15100) $781.50 $1,042 0.4×
Skn splt a-grft fac/nck/hf/g (15120) $930 $1,240 0.3×
Smpl repair scalp/neck/ax/genit/trunk 2.6-7.5cm (12002) $199.88 $266.50 1.0×
Smpl rpr scalp/neck/ax/genit/trunk 12.6-20.0cm (12005) $295.50 $394 0.8×
Smpl rpr scalp/neck/ax/genit/trunk 20.1-30.0cm (12006) $217.50 $290 0.6×
Strapping ankle (29540) $172.50 $230 1.1×
Strapping elbow/wrist (29260) $84 $112 1.5×
Strapping knee (29530) $244.50 $326 1.9×
Strapping shoulder (29240) $84 $112 0.7×
Strapping thorax (29200) $42 $56 0.3×
Strapping unna boot (29580) $33.75 $45 0.2×
Thoracentesis needle/cath pleura w/o imaging (32554) $797.62 $1,063.50 1.3×
Tongue to lip surgery (41510) $47.25 $63 0.0×
Treat Fracture Radius & Ulna (25560) $270.75 $361 1.1×
Treat humerus fracture (24500) $378 $504 1.6×
Treat humerus fracture (23600) $336.75 $449 1.4×
Treat thumb fracture (26650) $744 $992 0.2×
Treat Thumb Fx/Disloc,Manip (26645) $494.25 $659 0.3×
Treat wrist bone fracture (25622) $271.12 $361.50 1.1×
Treatment closed elbow dislocation w/o anes (24600) $473.25 $631 2.0×
Treatment of tarsal bone fracture (except talus and calcaneus); without manipulation, each (28450) $299.25 $399 1.3×
Trimming Of Nondystrophic Nails, Any Number (11719) $121.50 $162 2.1×
Tx Superficial Wound Dehiscence Simple Closure (12020) $206.25 $275 0.3×
Venipuncture (36415) $24 $32 2.6×