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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ProcedurePosted cashPosted gross× 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×
Adjt tis trns/reargmt f/c/c/m/n/a/g/h/f 10sqcm/< (14040) $1,606 $2,007 0.7×
Anoscopy diagnostic (46600) $249 $311 1.8×
Application cast elbow finger short arm (29075) $195 $244 0.7×
Application Finger Splint Dynamic (29131) $186 $233 3.0×
Application finger splint static (29130)
range across 3 matching MRF lines		 $46–$164 $58–$205 varies
Application long arm splint shoulder hand (29105)
range across 3 matching MRF lines		 $152–$314 $190–$393 varies
Application Long Leg Splint (29505)
range across 2 matching MRF lines		 $138–$166 $173–$208 varies
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)
range across 2 matching MRF lines		 $118–$270 $147–$337 varies
Apply hand/wrist cast (29085) $167 $209 1.0×
Apply long arm cast (29065)
range across 2 matching MRF lines		 $230–$238 $287–$298 varies
Apply Short Leg Cast (29405) $195 $244 0.7×
Arterial puncture (36600)
range across 2 matching MRF lines		 $46–$120 $57–$150 varies
Arthrocentesis aspir&/inj interm jt/burs w/o us (20605)
range across 3 matching MRF lines		 $206–$291 $258–$364 varies
Arthrocentesis aspir&/inj interm jt/burs w/us (20606) $611 $764 0.8×
Arthrocentesis aspir&/inj major jt/bursa w/o us (20610)
range across 4 matching MRF lines		 $210–$363 $262–$454 varies
Arthrocentesis aspir&/inj small jt/bursa w/o us (20600)
range across 3 matching MRF lines		 $205–$266 $256–$333 varies
Aspirate pleura w/ imaging (32555) $1,990 $2,488 3.1×
Aspirate Pleura W/O Imaging (32554) $715 $894 1.1×
Avulsion nail plate partial/complete simple 1 (11730)
range across 2 matching MRF lines		 $153–$229 $191–$286 varies
Bladder Scan (51798) $68 $85 1.1×
Blood Transfusion Service (36430)
range across 3 matching MRF lines		 $503–$1,198 $629–$1,498 varies
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 Eccrine Glands (64650) $207 $259 0.6×
Chemodenerv Musc Migraine (64615) $629 $786 2.0×
Chemodenerv musc neck dyston (64616) $466 $582 1.5×
Chemodnrvtj Musc Musc Innervated Facial Nrv Unil (64612) $466 $582 1.5×
Chest tube placement (32551)
range across 2 matching MRF lines		 $542–$1,422 $678–$1,777 varies
Cl Tx Tib Shft Fx W Manip (27752) $1,747 $2,184 1.0×
Clear outer ear canal (69200) $181 $226 1.3×
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 tarsometatarsal dislocation w/o anes (28600) $348 $435 1.4×
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)
range across 2 matching MRF lines		 $578–$678 $722–$847 varies
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 hip dislocation traumatic req anesthesia (27252) $1,422 $1,777 0.9×
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 Sprcndylr/Transcndylr Humeral Fx W/WO Manj (24530) $781 $976 3.0×
Collect Blood From Catheter Venous Nos (36592) $136 $170 1.0×
Collection of venous blood by venipuncture (36415) $36 $45 3.9×
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)
range across 2 matching MRF lines		 $254–$266 $318–$332 varies
Create Eardrum Opening (69433)
range across 2 matching MRF lines		 $886–$1,768 $1,107–$2,210 varies
Cryotherapy Co2 Slush Liquid N2 Acne (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)
range across 4 matching MRF lines		 $4,770–$8,683 $5,962–$10,854 varies
Destruct B9 Lesion 1-14 (17110) $194 $243 0.9×
Destruction Benign Lesions 15/> (17111) $224 $280 1.1×
Destruction Premalignant Lesion 15/> (17004) $354 $442 0.8×
Destruction premalignant lesion 1st (17000) $186 $232 0.9×
Drainage of hematoma/fluid (10140) $236 $295 0.1×
Draw Blood Off Venous Device (36591) $133 $166 1.0×
Drg Absc Cst Hmtma Vestibule Mouth Smpl (40800) $621 $776 0.8×
Drs&/dbrdmt prtl-thkns burns 1st/sbsq small (16020)
range across 2 matching MRF lines		 $259–$312 $324–$390 varies
Dstrj lesion anus simple surg excision (46922) $2,477 $3,096 0.9×
Dstrj Lesion Penis Simple Cryosurgery (54056) $158 $198 0.8×
Endometrial Biopsy (58100) $310 $388 1.5×
Evacuation of subungual hematoma (11740)
range across 2 matching MRF lines		 $90–$105 $112–$131 varies
Exc arm/elbow les sc < 3 cm (24075) $776 $970 0.5×
Exc b9 les mrgn xcp sk tg t/a/l 0.5 cm/< (11400) $471 $589 0.6×
Exc b9 lesion mrgn xcp sk tg s/n/h/f/g 2.1-3.0cm (11423)
range across 2 matching MRF lines		 $971–$1,422 $1,214–$1,777 varies
Exc F/E/E/N/L Mal+Mrg 0.6-1 (11641) $471 $589 0.6×
Exc F/E/E/N/L Mal+Mrg 1.1-2 (11642) $474 $593 0.6×
Exc Face-Mm B9+Marg 0.5 Cm/< (11440) $453 $566 0.6×
Exc Face-Mm B9+Marg 0.6-1 Cm (11441)
range across 3 matching MRF lines		 $471–$619 $589–$774 varies
Exc Face-Mm B9+Marg 1.1-2 Cm (11442)
range across 2 matching MRF lines		 $297–$619 $371–$774 varies
Exc Face-Mm B9+Marg 2.1-3 Cm (11443) $1,422 $1,777 0.8×
Exc H-F-Nk-Sp B9+Marg 0.5/< (11420)
range across 2 matching MRF lines		 $971–$1,422 $1,214–$1,777 varies
Exc H-F-Nk-Sp B9+Marg 0.6-1 (11421)
range across 2 matching MRF lines		 $471–$619 $589–$774 varies
Exc H-F-Nk-Sp B9+Marg 1.1-2 (11422)
range across 2 matching MRF lines		 $971–$1,422 $1,214–$1,777 varies
Exc Hand Les Sc < 1.5 Cm (26115) $2,195 $2,744 1.3×
Exc Skin Benig 2.1-3 Cm Trunk,Arm,Leg (11403) $471 $589 0.6×
Exc Skin Benig 3.1-4 Cm Remaindr Body (11424) $439 $549 0.3×
Exc Skin Benig >4 Cm Trunk,Arm,Leg (11406) $971 $1,214 0.6×
Exc Skin Malig 2.1-3 Cm Remaindr Body (11623) $470 $588 0.3×
Exc Skin Malig >4 Cm Trunk,Arm,Leg (11606) $556 $695 0.3×
Exc Tr-Ext B9+Marg 0.6-1 Cm (11401)
range across 2 matching MRF lines		 $238–$358 $298–$448 varies
Exc Tr-Ext B9+Marg 1.1-2 Cm (11402) $297 $371 0.4×
Exc Tr-Ext B9+Marg 3.1-4 Cm (11404) $971 $1,214 0.6×
Exc tumor soft tissue abdominal wall subq <3cm (22902) $706 $883 0.4×
Exc Tumor Soft Tissue Forearm &/Wrist Subq <3Cm (25075) $764 $955 0.4×
Excis Mouth Mucosa/Sub,Simpl Repair (40812) $3,096 $3,870 1.9×
Excise, Malign Lesion w/Margins, Trunk, Arms, or Legs; Excised diam 2.1 to 3.0 cm Charge (11603) $401 $501 0.5×
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 3.1-4.0 Cm (11604) $439 $549 0.6×
Excision Malignant Lesion F/E/E/N/L 2.1-3.0 Cm (11643) $971 $1,214 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 Pilonidal Cyst/Sinus Extensive (11771) $2,912 $3,640 1.0×
Excision Tumor Soft Tissue Thigh/Knee Subq <3Cm (27327) $1,000 $1,250 0.6×
Excision/destruction lesion pharynx any method (42808) $2,844 $3,555 0.8×
Fetal non-stress test (59025) $238 $298 1.1×
Hemorrhoidectomy, internal, by rubber band ligation(s) (46221) $852 $1,065 0.9×
I&d abscess simple (10060) $258 $323 1.2×
I&d pilonidal cyst simple (10080) $263 $329 0.4×
Incise finger tendon sheath (26055)
range across 2 matching MRF lines		 $1,699–$2,562 $2,124–$3,202 varies
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)
range across 3 matching MRF lines		 $262–$764 $328–$955 varies
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×
Injection 1 tendon sheath/ligament aponeurosis (20550) $266 $333 0.8×
Injection aa&/strd intercostal nrv ea addl lvl (64421) $803 $1,004 0.9×
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 Anes Agent Sphenopalatine Ganglion (64505) $550 $688 1.7×
Injection single tendon origin/insertion (20551) $266 $333 0.8×
Injection single/mlt trigger point 1/2 muscles (20552)
range across 4 matching MRF lines		 $205–$493 $256–$616 varies
Injection single/mlt trigger point 3/> muscles (20553) $666 $832 2.1×
Injection therapeutic carpal tunnel (20526)
range across 2 matching MRF lines		 $310–$621 $388–$776 varies
Injection, anesthetic agent; brachial plexus, single (64415) $864 $1,080 0.9×
Injection, anesthetic agent; femoral nerve, single (64447) $852 $1,065 1.2×
Injection, anesthetic agent; other peripheral nerve or branch (64450) $1,034 $1,292 1.4×
Injection, intralesional; up to and including 7 lesions (11900)
range across 2 matching MRF lines		 $184–$238 $230–$297 varies
Insert Bladder Cath Complex (51703)
range across 2 matching MRF lines		 $220–$249 $275–$311 varies
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)
range across 3 matching MRF lines		 $165–$199 $206–$249 varies
Insert tunneled cv cath (36561) $4,758 $5,947 1.5×
Insert,Non-Indwelling Bladder Catheter (51701)
range across 3 matching MRF lines		 $145–$174 $181–$218 varies
Insertion Picc W/Rs&I 5 Yr/> (36573) $2,977 $3,721 1.8×
Intubation endotracheal emergency procedure (31500)
range across 2 matching MRF lines		 $188–$538 $235–$673 varies
Laryngoscopy flexible diagnostic (31575) $434 $542 2.1×
N Block Inj Ilio-Ing/Hypogi (64425) $1,239 $1,549 1.7×
N block inj intercost sng (64420) $619 $774 0.8×
Nasal Endoscopy Dx (31231) $369 $461 1.8×
Nasal/Sinus Ndsc Surg W/Dilation Sphenoid Sinus (31297) $6,009 $7,511 0.8×
Needle Biopsy Lymph Nodes (38505) $1,559 $1,949 0.9×
Nfct ds bct/vir respir DNA/RNA 22 trgt sarscov2 (0202U) $354 $442 0.8×
Njx Anes Trigeminal Nrv Any Div/Branch (64400) $437 $546 1.4×
Occipital Nerve Block (64405) $350 $437 1.1×
Open Implantation Nea Peripheral Nerve (64575) $13,464 $16,830 1.2×
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)
range across 3 matching MRF lines		 $256–$358 $320–$448 varies
Puncture aspiration abscess hematoma bulla/cyst (10160) $259 $324 0.6×
Removal Embedded Foreign Body Eyelid (67938) $627 $784 1.9×
Removal Foreign Body Muscle/Tendon Sheath Simple (20520) $1,422 $1,777 0.8×
Removal impacted cerumen irrigation/lvg unilat (69209)
range across 4 matching MRF lines		 $70–$140 $87–$175 varies
Removal Impacted Cerumen Requiring Instrumentation, Unilateral (69210)
range across 4 matching MRF lines		 $97–$192 $121–$240 varies
Removal of nail bed (11750)
range across 2 matching MRF lines		 $317–$525 $396–$656 varies
Removal skn tags mlt fibrq tags any area upw/15 (11200)
range across 3 matching MRF lines		 $174–$184 $218–$230 varies
Remove drug implant device (11982)
range across 2 matching MRF lines		 $306–$358 $383–$448 varies
Remove foreign body from eye (65205)
range across 2 matching MRF lines		 $102–$120 $128–$150 varies
Remove Intrauterine Device (58301) $220 $275 0.7×
Remove Nasal Foreign Body (30300) $354 $442 2.6×
Remove/Insert Drug Implant (11983)
range across 2 matching MRF lines		 $334–$358 $418–$448 varies
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×
Rpr F/E/E/N/L/M 7.6-12.5 Cm (12015) $395 $494 1.9×
Shave skin lesion 0.5 cm/< (11300) $168 $210 0.4×
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×
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)
range across 2 matching MRF lines		 $371–$392 $464–$490 varies
Simple repair scalp/neck/ax/genit/trunk 2.5cm/< (12001)
range across 2 matching MRF lines		 $361–$362 $451–$452 varies
Simple rpr scalp/neck/ax/genit/trunk 7.6-12.5cm (12004)
range across 2 matching MRF lines		 $378–$405 $472–$506 varies
Skin sub graft trnk/arm/leg (15271) $1,606 $2,007 2.1×
Smpl repair scalp/neck/ax/genit/trunk 2.6-7.5cm (12002)
range across 2 matching MRF lines		 $399–$409 $499–$511 varies
Smpl rpr scalp/neck/ax/genit/trunk 12.6-20.0cm (12005)
range across 2 matching MRF lines		 $444–$481 $555–$601 varies
Strapping elbow or 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×
Surg Nasopharyngoscopy Dilat Eustachian Tube Uni (69705) $5,137 $6,421 0.8×
Tangential biopsy skin single lesion (11102) $223 $279 0.5×
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 Nondystrophic Nails Any Number (11719) $57 $71 0.9×
Unlisted procedure nervous system (64999) $324 $405 1.0×
Vasectomy uni/bi spx w/postop semen exams (55250) $1,834 $2,293 0.8×
Ventilating tube removal requiring general anesthesia (69424) $2,844 $3,555 0.8×
Wedge excision skin nail fold (11765) $140 $175 0.3×
Wound Prep Trk/Arm/Leg (15002) $1,786 $2,233 2.3×

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.