Procedures & surgery prices at West Holt Memorial Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Abd paracentesis w/imaging (49083) $1,990 $2,488 2.1×
Ablate inf turbinate submuc (30802) $2,685 $3,356 1.7×
Acne Surgery (10040) $164 $205 0.8×
Anoscopy diagnostic (46600) $249 $311 1.8×
Application cast elbow finger short arm (29075) $195 $244 0.7×
Application Cast Hand & Lower Forearm Gauntlet (29085) $167 $209 1.0×
Application cast shoulder hand long arm (29065) $234 $292.50 0.8×
Application Finger Splint Dynamic (29131) $186 $233 3.0×
Application finger splint static (29130) $164 $205 1.2×
Application long arm splint shoulder hand (29105) $274 $343 1.6×
Application long leg splint thigh ankle/toes (29505) $152 $190.50 0.9×
Application Short Arm Splint Dynamic (29126) $274 $342 2.0×
Application short arm splint forearm-hand static (29125) $230 $288 1.7×
Application short leg splint calf foot (29515) $194 $242 1.1×
Apply short leg cast (29405) $195 $244 0.7×
Arterial puncture (36600) $83 $103.50 0.6×
Arthrocentesis aspir&/inj interm jt/burs w/o us (20605) $291 $364 0.9×
Arthrocentesis aspir&/inj interm jt/burs w/us (20606) $611 $764 0.8×
Arthrocentesis aspir&/inj major jt/bursa w/o us (20610) $363 $454 1.1×
Arthrocentesis aspir&/inj small jt/bursa w/o us (20600) $266 $333 0.8×
Avulsion nail plate partial/complete simple 1 (11730) $191 $238.50 0.9×
Biopsy of uterus lining (58100) $310 $388 1.5×
Bladder Scan (51798) $68 $85 1.1×
Blood transfusion service (36430) $898 $1,123 2.0×
Bx/exc lymph node needle superficial (38505) $1,559 $1,949 0.9×
Change Cystostomy Tube Simple (51705) $284 $355 1.1×
Chemical Cautery Tissue (17250) $138 $173 0.7×
Chemodenerv 1 extremity 1-4 (64642) $650 $812 0.9×
Chemodenerv Musc Migraine (64615) $629 $786 2.0×
Chemodenerv Musc Neck Dyston (64616) $466 $582 1.5×
Chemodenervation of eccrine glands; both axillae (64650) $207 $259 0.6×
Chemodnrvtj Musc Musc Innervated Facial Nrv Unil (64612) $466 $582 1.5×
Chest tube placement (32551) $982 $1,227.50 0.6×
Chg Collect Blood From Catheter Venous Nos (36592) $136 $170 1.0×
Closed Rx Humeral Supracondylar Fx (24530) $781 $976 3.0×
Closed Rx Trauma Hip Disloc,Anesth (27252) $1,422 $1,777 0.9×
Closed treatment of tarsometatarsal joint dislocation; without anesthesia (28600) $348 $435 1.4×
Closed tx ankle dislocation w/o anesthesia (27840) $656 $820 2.6×
Closed tx metatarsal fracture w/o manipulation (28470) $494 $618 1.9×
Closed tx radial head/neck fx w/o manipulation (24650) $416 $520 1.6×
Closed tx ulnar fracture prox end w/o manipulate (24670) $619 $774 2.4×
Closed tx ulnar shaft fracture w/o manipulation (25530) $390 $488 1.5×
Clsd tx shoulder dislc w/manipulation w/o anes (23650) $628 $784.50 2.5×
Cltx dstl fibular fx lat malls w/o manj (27786) $507 $634 2.0×
Cltx Dstl Phlngl Fx Fngr/Thmb W/O Manj Ea (26750) $406 $508 1.6×
Cltx dstl radial fx/epiphysl sep w/o manj (25600) $547 $684 2.1×
Cltx dstl rdl fx/epiphysl sep w/manj when perf (25605) $998 $1,248 0.6×
Cltx fx phlx/phlg oth/thn grt toe w/o manj (28510) $262 $328 1.0×
Cltx iphal jt dislc w/manj w/o anes (26770) $574 $718 2.2×
Cltx metacarpal fx w/o manipulation each bone (26600) $377 $471 1.5×
Cltx phlngl fx prox/middle px/f/t w/o manj ea (26720) $624 $780 2.4×
Cltx prox fibula/shft fx w/o manj (27780) $487 $609 1.9×
Cltx tibial shaft fx w/manj w/wo skel tracj (27752) $1,747 $2,184 1.0×
Colposcopy,Entire Vagina,W/Biopsy(S) (57421) $711 $889 0.7×
Control Nasal Hemorrhage Anterior Complex (30903) $279 $349 2.0×
Control Nasal Hemorrhage Anterior Simple (30901) $260 $325 1.9×
Cryotherapy of skin (17340) $89 $111 1.5×
Dbrdmt extensv eczema/infect skn up 10% bdy surf (11000) $391 $489 0.9×
Debride nail 1-5 (11720) $101 $126 1.6×
Debride nail 6 or more (11721) $106 $133 1.7×
Debridement subcutaneous tissue 20 sq cm/< (11042) $272 $340 0.6×
Declot vascular device (36593) $300 $375 0.9×
Decompression; median nerve at the carpal tunnel, percutaneous, with intracarpal tunnel balloon dilation, including… (64728) $6,726.50 $8,408 3.3×
Destruc Benign/Premal,15+ Lesions (17004) $354 $442 0.8×
Destruction benign lesions 15 or more (17111) $224 $280 1.1×
Destruction Benign Lesions Up To 14 (17110) $194 $243 0.9×
Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic ves (54056) $158 $198 0.8×
Destruction premalignant lesion 1st (17000) $186 $232 0.9×
Drain Mouth Absc/Cyst/Hematoma,Simpl (40800) $621 $776 0.8×
Drainage of hematoma/fluid (10140) $236 $295 0.1×
Draw blood off venous device (36591) $133 $166 1.0×
Drs&/dbrdmt prtl-thkns burns 1st/sbsq small (16020) $285.50 $357 1.4×
Dstrj lesion anus simple surg excision (46922) $2,477 $3,096 0.9×
Evacuation of subungual hematoma (11740) $97.50 $121.50 0.7×
Exc arm/elbow les sc < 3 cm (24075) $776 $970 0.5×
Exc b9 lesion mrgn xcp sk tg s/n/h/f/g 2.1-3.0cm (11423) $1,196.50 $1,495.50 0.7×
Exc b9 lesion mrgn xcp sk tg s/n/h/f/g 3.1-4.0cm (11424) $439 $549 0.3×
Exc Face-Mm B9+Marg 0.5 Cm/< (11440) $453 $566 0.6×
Exc Face-Mm B9+Marg 2.1-3 Cm (11443) $1,422 $1,777 0.8×
Exc forearm les sc < 3 cm (25075) $764 $955 0.4×
Exc hand les sc < 1.5 cm (26115) $2,195 $2,744 1.3×
Exc Skin Benig 0.6-1 Cm Remaindr Body (11421) $545 $681.50 0.7×
Exc Skin Benig 0.6-1 Cm Trunk,Arm,Leg (11401) $298 $373 0.7×
Exc Skin Benig 1.1-2 Cm Trunk,Arm,Leg (11402) $297 $371 0.4×
Exc Skin Benig 2.1-3 Cm Trunk,Arm,Leg (11403) $471 $589 0.6×
Exc Skin Benig 3.1-4 Cm Trunk,Arm,Leg (11404) $971 $1,214 0.6×
Exc Skin Benig >4 Cm Trunk,Arm,Leg (11406) $971 $1,214 0.6×
Exc Skin Malig 2.1-3 Cm Face,Facial (11643) $971 $1,214 0.6×
Exc Skin Malig >4 Cm Trunk,Arm,Leg (11606) $556 $695 0.3×
Exc tr-ext b9+marg 0.5 cm or less (11400) $471 $589 0.6×
Exc tumor soft tissue abdominal wall subq <3cm (22902) $706 $883 0.4×
Excise pharynx lesion (42808) $2,844 $3,555 0.8×
Excise/repair mouth lesion (40812) $3,096 $3,870 1.9×
Excision Mal Lesion Trunk/Arm/Leg 0.6-1.0 Cm (11601) $471 $589 0.6×
Excision mal lesion trunk/arm/leg 1.1-2.0 cm (11602) $358 $448 0.8×
Excision Mal Lesion Trunk/Arm/Leg 2.1-3.0 Cm (11603) $401 $501 0.5×
Excision Mal Lesion Trunk/Arm/Leg 3.1-4.0 Cm (11604) $439 $549 0.6×
Excision malignant lesion f/e/e/n/l 0.6-1.0 cm (11641) $471 $589 0.6×
Excision malignant lesion f/e/e/n/l 1.1-2.0 cm (11642) $474 $593 0.6×
Excision malignant lesion s/n/h/f/g 0.6-1.0 cm (11621) $341 $426 0.5×
Excision malignant lesion s/n/h/f/g 1.1-2.0 cm (11622) $392 $490 0.5×
Excision Malignant Lesion S/N/H/F/G 2.1-3.0 Cm (11623) $470 $588 0.3×
Excision of benign lesion other than skin tag 0.6-1.0 cm (11441) $619 $774 0.8×
Excision of benign lesion other than skin tag 1.1-2.0 cm (11442) $458 $572.50 0.6×
Excision of lesion other than skin tag 1.1-2.0 cm (11422) $1,196.50 $1,495.50 0.7×
Excision of lesion other than skin tag </= 0.5 cm (11420) $1,196.50 $1,495.50 0.7×
Excision of nail fold toe (11765) $140 $175 0.3×
Excision tumor soft tissue thigh/knee subq <3cm (27327) $1,000 $1,250 0.6×
Fetal non-stress test (59025) $238 $298 1.1×
I&d abscess simple (10060) $258 $323 1.2×
I&d pilonidal cyst simple (10080) $263 $329 0.4×
Inc impltj periph nerve neurostimulator eltrd (64575) $13,464 $16,830 1.2×
Incise finger tendon sheath (26055) $2,130.50 $2,663 1.3×
Incision & drainage abscess complicated/multiple (10061) $458 $572 1.1×
Incision & removal foreign body subq tiss compl (10121) $971 $1,214 0.6×
Incision & removal foreign body subq tiss simple (10120) $402 $503 1.0×
Incision and drainage of bartholin's gland abscess (56420) $394 $493 1.9×
Incision of eardrum (69420) $636 $795 2.6×
Incisional biopsy skin single lesion (11106) $329 $411 0.4×
Initial tx 1st degree burn local tx (16000) $152 $190 0.7×
Inj tendon sheath/ligament (20550) $266 $333 0.8×
Inj,Anes Agent,Brachial Plexus,Single (64415) $864 $1,080 0.9×
Inj,Anes Agent,Femoral Nerve,Single (64447) $852 $1,065 1.2×
Inject Nerv Blck,Ilioingu/Iliohyp (64425) $1,239 $1,549 1.7×
Inject Nerv Blck,Intercost,Multpl (64421) $803 $1,004 0.9×
Inject Nerv Blck,Intercostal,One (64420) $619 $774 0.8×
Inject Tendon Origin/Insert (20551) $266 $333 0.8×
Injection aa&/strd nerves nrvtg si joint w/img (64451) $918 $1,147 1.3×
Injection aa&/strd sciatic nerve w/img gdn (64445) $673 $841 0.9×
Injection aa&/strd trigeminal nerve each branch (64400) $437 $546 1.4×
Injection anes other peripheral nerve/branch (64450) $1,034 $1,292 1.4×
Injection single/mlt trigger point 1/2 muscles (20552) $493 $616 1.5×
Injection single/mlt trigger point 3/> muscles (20553) $666 $832 2.1×
Injection therapeutic carpal tunnel (20526) $465.50 $582 1.5×
Injection, anesthetic agent; greater occipital nerve (64405) $350 $437 1.1×
Injection, anesthetic agent; sphenopalatine ganglion (64505) $550 $688 1.7×
Injection, intralesional; up to and including 7 lesions (11900) $211 $263.50 1.0×
Insert Bladder Cath Complex (51703) $234.50 $293 1.8×
Insert Drug Implant Device (11981) $270 $337 2.0×
Insert pessary/other device (57160) $184 $230 0.9×
Insert Picc W/O Sub-Q Port <5 Y/O (36568) $1,422 $1,777 0.9×
Insert Temp Bladder Cath (51702) $199 $249 1.4×
Insert tunneled cv cath (36561) $4,758 $5,947 1.5×
Insert,Non-Indwelling Bladder Catheter (51701) $174 $218 1.3×
Insertion Picc W/Rs&I 5 Yr/> (36573) $2,977 $3,721 1.8×
Intubation endotracheal emergency procedure (31500) $363 $454 1.5×
Laryngoscopy Flexible Diagnostic (31575) $434 $542 2.1×
Ligation of hemorrhoid(s) (46221) $852 $1,065 0.9×
Nasal Endoscopy Diagnostic Uni/Bi Spx (31231) $369 $461 1.8×
Nasopharyngoscopy, surgical, with dilation of eustachian tube (ie, balloon dilation); unilateral (69705) $5,137 $6,421 0.8×
Nfct ds bct/vir respir DNA/RNA 22 trgt sarscov2 (0202U) $354 $442 0.8×
Open Tx Distal Phalangeal Fracture Each (26765) $1,080 $1,350 0.3×
Prq impltj neurostimulator eltrd peripheral nrv (64555) $6,009 $7,511 0.9×
Punch biopsy skin single lesion (11104) $256 $320 0.6×
Puncture Aspiration (10160) $259 $324 0.6×
Removal fb intranasal (30300) $354 $442 2.6×
Removal Foreign Body Muscle/Tendon Sheath Simple (20520) $1,422 $1,777 0.8×
Removal impacted cerumen irrigation/lvg unilat (69209) $102.50 $128 1.7×
Removal Impacted Cerumen Requiring Instrumentation, Unilateral (69210) $127.50 $159.50 2.1×
Removal of intrauterine device (iud) (58301) $220 $275 0.7×
Removal of nail bed (11750) $421 $526 1.0×
Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions (11200) $174 $218 0.8×
Remove drug implant device (11982) $332 $415.50 0.7×
Remove Eyelid Foreign Body (67938) $627 $784 1.9×
Remove Pilonidal Cyst Exten (11771) $2,912 $3,640 1.0×
Remv Ext Canal Foreign Body (69200) $181 $226 1.3×
Remv F.B.,Eye,Superf Conjunc (65205) $111 $139 0.8×
Repair complex f/c/c/m/n/ax/g/h/f 2.6-7.5 cm (13132) $1,147 $1,434 2.7×
Repair intermediate f/e/e/n/l&/muc 2.5 cm/< (12051) $399 $499 0.9×
Repair intermediate n/h/f/xtrnl gent 2.6-7.5 cm (12042) $434 $543 1.0×
Repair intermediate s/a/t/e 2.6-7.5 cm (12032) $400 $500 0.9×
Rmvl w/rinsj non-biodegradable drug dlvr implt (11983) $346 $433 0.7×
Shaving Skin Lesion 1 F/E/E/N/L/M Diam 0.5 Cm/< (11310) $174 $218 0.8×
Shaving Skin Lesion 1 F/E/E/N/L/M Diam >2.0 Cm (11313) $318 $398 0.8×
Shaving Skin Lesion 1 S/N/H/F/G Diam 0.5 Cm/< (11305) $168 $210 0.8×
Shaving Skin Lesion 1 S/N/H/F/G Diam 0.6-1.0 Cm (11306) $186 $233 0.9×
Shaving Skin Lesion 1 S/N/H/F/G Diam 1.1-2.0 Cm (11307) $206 $258 1.0×
Shaving Skin Lesion 1 S/N/H/F/G Diam >2.0 Cm (11308) $266 $333 0.6×
Shaving skin lesion 1 trunk/arm/leg diam 0.5cm/< (11300) $168 $210 0.4×
Shvg Skin Lesion 1 F/E/E/N/L/M Diam 0.6-1.0 Cm (11311) $194 $242 0.9×
Shvg Skin Lesion 1 F/E/E/N/L/M Diam 1.1-2.0 Cm (11312) $280 $350 0.7×
Shvg Skin Lesion 1 Trunk/Arm/Leg Diam 0.6-1.0 Cm (11301) $182 $227 0.9×
Shvg Skin Lesion 1 Trunk/Arm/Leg Diam >2.0 Cm (11303) $269 $336 0.6×
Shvg Skn Lesion 1 Trunk/Arm/Leg Diam 1.1-2.0 Cm (11302) $195 $244 0.9×
Simple repair f/e/e/n/l/m 2.5cm/< (12011) $308 $385 1.5×
Simple repair f/e/e/n/l/m 2.6cm-5.0 cm (12013) $337 $421 1.6×
Simple repair f/e/e/n/l/m 5.1cm-7.5 cm (12014) $381.50 $477 1.8×
Simple repair f/e/e/n/l/m 7.6cm-12.5 cm (12015) $395 $494 1.9×
Simple repair scalp/neck/ax/genit/trunk 2.5cm/< (12001) $361.50 $451.50 1.7×
Simple rpr scalp/neck/ax/genit/trunk 7.6-12.5cm (12004) $391.50 $489 1.9×
Sinus endo w/balloon dil (31297) $6,009 $7,511 0.8×
Skin sub graft trnk/arm/leg (15271) $1,606 $2,007 2.1×
Skin tissue rearrangement (14040) $1,606 $2,007 0.7×
Smpl repair scalp/neck/ax/genit/trunk 2.6-7.5cm (12002) $404 $505 1.9×
Smpl rpr scalp/neck/ax/genit/trunk 12.6-20.0cm (12005) $462.50 $578 1.1×
Strapping elbow/wrist (29260) $186 $233 3.0×
Strapping hand/finger (29280) $182 $227 3.0×
Strapping shoulder (29240) $208 $260 1.5×
Strapping unna boot (29580) $66 $82 0.4×
Tangential biopsy skin single lesion (11102) $223 $279 0.5×
Thoracentesis Needle/Cath Pleura W/Imaging (32555) $1,990 $2,488 3.1×
Thoracentesis needle/cath pleura w/o imaging (32554) $715 $894 1.1×
Trim skin lesion (11055) $138 $173 0.7×
Trim skin lesions 2 to 4 (11056) $137 $171 0.7×
Trim skin lesions over 4 (11057) $111 $139 0.5×
Trimming Of Nondystrophic Nails, Any Number (11719) $57 $71 0.9×
Tympanostomy (69433) $1,327 $1,658.50 2.4×
Unlisted Procedure Nervous System (64999) $324 $405 1.0×
Vasectomy (55250) $1,834 $2,293 0.8×
Venipuncture (36415) $36 $45 3.9×
Ventilating tube removal requiring general anesthesia (69424) $2,844 $3,555 0.8×
Wound prep trk/arm/leg 1st 100 sq cm (15002) $1,786 $2,233 2.3×