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Medicine Lodge Memorial Hospital

Kansas · 1,500 published self-pay prices, from $34.20 to $36,708.

These items are published without a standard CPT or HCPCS code, so they cannot be reliably matched against the same service at another hospital. They are shown exactly as this facility published them, and are excluded from every median, average and comparison elsewhere on this site.

Showing the 300 lowest-priced of 1,500 published items.

ItemCash priceSetting
15G ARROW EZ-10 NEEDLE SET$333Outpatient
20G X1 NEEDLE PORT-A-CATH GRIPPER$34.30Outpatient
3% SODIUM CHLORIDE INJ 500ML$36.00Outpatient
3D radiographic procedure$478Outpatient
4-0 ETHILON 691$48.40Outpatient
4.0 MONOCRYL$74.30Outpatient
Acne surgery$145Outpatient
ACTICOAT SILVER 4X8$110Outpatient
ACTIDOSE 50 GM LIQUID$50.74Outpatient
Acute hepatitis panel$193Outpatient
ACYCLOVIR 1,000 MG/20 ML VIAL$344Outpatient
ADH (antidiuretic hormone) level$162Outpatient
Adrenocorticotropic hormone (ACTH) level$149Outpatient
ADULT HIGH VELOCITY THEROPY NASAL CANNULA$54.10Outpatient
ALCOHOL AND/OR DRUG SCREENING; LABORATORY ANALYSIS OF SPECIMENS FOR PRESENCE OF ALCOHOL AND/OR DRUGS$75.00Outpatient
Alcohols levels$84.88Outpatient
Alcohols levels, 1 or 2$149Outpatient
Aldolase (enzyme) level$45.00Outpatient
Aldosterone hormone level$155Outpatient
Alkaloids levels$91.00Outpatient
Alpha-1-antitrypsin (protein) blood test, total$70.30Outpatient
Alpha-fetoprotein (AFP) level, serum$61.87Outpatient
AMBULANCE SERVICE, BASIC LIFE SUPPORT, EMERGENCY TRANSPORT (BLS-EMERGENCY)$580Outpatient
Amino acid level, 2 to 5 amino acids, quantitative, each specimen$257Outpatient
Amino acid level, 6 or more amino acids, quantitative, each specimen$743Outpatient
Ammonia level$69.13Outpatient
Amplifed DNA or RNA probe detection of severe acute respiratory syndrome coronavirus 2 (Covid-19) antigen$135Outpatient
Amputation of both lower leg bones leaving wound$800Outpatient
Amputation of finger or thumb with direct closure$831Outpatient
Amputation of finger or thumb with tissue flap$520Outpatient
Amputation of thigh through thigh bone$950Outpatient
Amputation of toe at joint between forefoot and toes$770Outpatient
Analgesics levels, 1 or 2$57.29Outpatient
Analysis for antibody (IgM) to West Nile virus$73.53Outpatient
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)$42.49Outpatient
Analysis for antibody to Ehrlichia (bacteria transmitted by ticks)$60.40Outpatient
Analysis for antibody to Epstein-Barr virus (mononucleosis virus), nuclear antigen$79.79Outpatient
Analysis for antibody to Epstein-Barr virus (mononucleosis virus), viral capsid$115Outpatient
Analysis for antibody to fungus$132Outpatient
Analysis for antibody to Haemophilus influenza (respiratory bacteria)$88.50Outpatient
Analysis for antibody to Herpes simplex virus, type 1$113Outpatient
Analysis for antibody to Herpes simplex virus, type 2$147Outpatient
Analysis for antibody to Legionella (waterborne bacteria)$87.33Outpatient
Analysis for antibody to Leptospira$69.83Outpatient
Analysis for antibody to mumps virus$90.93Outpatient
Analysis for antibody to protozoa (parasite)$46.79Outpatient
Analysis for antibody to Rubella (German measles virus)$56.00Outpatient
Analysis for antibody to Rubeola (measles virus)$81.75Outpatient
Analysis for antibody to varicella-zoster virus (chicken pox)$79.70Outpatient
Analysis for antibody to virus$99.00Outpatient
Analysis for antibody to West Nile virus$73.53Outpatient
Analysis for antibody, Treponema pallidum$74.35Outpatient
Analysis for detection of tumor marker$104Outpatient
Analysis of substance using immunoassay technique, multiple step method$61.75Outpatient
Analysis test by nucleic acid for Hepatitis C virus$582Outpatient
Analysis using chemiluminescent technique (light and chemical )reaction$137Outpatient
Androstenedione (hormone) level$150Outpatient
ANES CRNA ANESTHESIA ADMIN I$70.00Outpatient
ANES CRNA ANESTHESIA ADMIN I (1500)$70.00Outpatient
Anesthesia for access to central vein$70.00Outpatient
Anesthesia for exam of colon using an endoscope$70.00Outpatient
Anesthesia for other procedure on esophagus, stomach, or upper small bowel using an endoscope$70.00Outpatient
Anesthesia for other procedure on large bowel using an endoscope$70.00Outpatient
Anesthesia for other procedure on male genitals$70.00Outpatient
Anesthesia for other procedure on skin of arms, legs, and front body$70.00Outpatient
Anesthesia for other procedure on skin, muscles, or nerves of head, neck, and upper back$70.00Outpatient
Anesthesia for other repair of lower abdomen hernia (1 year or older)$70.00Outpatient
Anesthesia for procedure on small and large bowel using an endoscope$70.00Outpatient
Anesthesia for repair of abdominal wall hernia$70.00Outpatient
ANGIOCATH$102Outpatient
Angiotensin l - converting enzyme (ACE) level$69.13Outpatient
ANKLE BRACE LACE UP MED$95.00Outpatient
ANKLE BRACE LACE-UP SM$95.00Outpatient
ANKLE BRACE UNIVERSAL$58.60Outpatient
ANKLE CONTROL ORTHOSIS, STIRRUP STYLE, RIGID, INCLUDES ANY TYPE INTERFACE (E.G., PNEUMATIC, GEL), PREFABRICATED, OFF-THE-SHELF$70.00Outpatient
ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, RIGID, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT$300Outpatient
ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, SEMI-RIGID, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT$704Outpatient
ANNUAL WELLNESS VISIT, INCLUDES A PERSONALIZED PREVENTION PLAN OF SERVICE (PPS), SUBSEQUENT VISIT$100Outpatient
ANNUAL WELLNESS VISIT; INCLUDES A PERSONALIZED PREVENTION PLAN OF SERVICE (PPS), INITIAL VISIT$100Outpatient
Antibody identification test for white blood cell antibodies$61.76Outpatient
Antineutrophil cytoplasmic antibody titer$51.61Outpatient
Antithrombin III antigen (clotting inhibitor) activity$58.31Outpatient
Antithrombin III antigen (clotting inhibitor) level$190Outpatient
Apolipoprotein level$101Outpatient
APPL SURFACE NEUROSTIMULATOR$368Outpatient
Application of blood vessel compression device$50.20Outpatient
Application of chemical to stop tissue regrowth in wound$49.86Outpatient
Application of elbow to finger cast$119Outpatient
Application of electrical stimulation$54.50Outpatient
Application of electrical stimulation with therapist present, each 15 minutes$45.00Outpatient
Application of finger cast$53.00Outpatient
Application of hand and lower forearm cast$76.00Outpatient
Application of hot and cold baths, each 15 minutes$47.50Outpatient
Application of hot wax bath$55.90Outpatient
Application of long leg cast from thigh to toe$295Outpatient
Application of long leg splint from thigh to ankle or toe$101Outpatient
Application of lower and upper arm splint$118Outpatient
Application of mechanical traction$80.20Outpatient
Application of medication using electrical current, each 15 minutes$55.90Outpatient
Application of moveable or hinged forearm to hand splint$290Outpatient
Application of nonmoveable finger splint$75.00Both
Application of nonmoveable forearm to hand splint$78.00Outpatient
Application of short leg cast$127Outpatient
Application of short leg splint from calf to foot$65.79Both
Application of shoulder to hand cast$132Outpatient
Application of skin substitute graft to wound of trunk, arms, or legs, 25.0 sq cm or less of wound 100.0 sq cm or less$750Outpatient
Application of ultrasound, each 15 minutes$65.70Outpatient
Application of vein wound compression bandages on lower leg, ankle, and foot$38.36Outpatient
Application of vein wound compression bandages on upper arm, forearm, hand, and fingers$370Outpatient
Application of walking cast covering below knee to toe$154Outpatient
Application of walking cast covering foot, ankle, and lower leg$135Outpatient
Application of whirlpool therapy$44.00Outpatient
ARMBOARD DISP ADULT$176Outpatient
Arsenic level$168Outpatient
Artery puncture collection of blood sample$97.75Both
Ascorbic acid (Vitamin C) level, blood$107Outpatient
Aspiration and/or injection of cyst of tendon$161Outpatient
Aspiration and/or injection of fluid from large joint$85.00Outpatient
Aspiration and/or injection of fluid from medium joint$97.00Outpatient
Aspiration and/or injection of fluid from small joint$94.00Outpatient
Aspiration and/or injection of fluid large joint using ultrasound guidance$170Outpatient
Aspiration of abscess, blood, or cyst$128Outpatient
Aspiration of bladder with insertion of bladder tube to skin$375Outpatient
Aspiration of cyst of breast, first cyst$110Outpatient
Aspiration of fluid collection in testicle and sperm reservoir$206Outpatient
Aspiration of fluid from chest cavity$177Outpatient
Aspiration of fluid from chest cavity using imaging guidance$910Outpatient
Back Brace$362Outpatient
Bacterial blood culture$50.58Outpatient
Bacterial colony count, urine$42.53Outpatient
Bacterial culture for aerobic isolates$47.61Outpatient
Bacterial culture for anaerobic isolates$43.25Outpatient
Bacterial culture, any other source except urine, blood or stool, aerobic$40.00Outpatient
Bacterial culture, any source, except blood, anaerobic$43.69Outpatient
Bacterial urine culture$38.70Outpatient
Balloon dilation of esophagus using a flexible endoscope, less than 3.0 cm$1,251Outpatient
Balloon dilation of esophagus, stomach, and/or upper small bowel using a flexible endoscope, less than 3.0 cm$957Outpatient
Barbiturates levels$137Outpatient
benzocaine Top 20% mucous membrane spray [MLKS]$107Outpatient
Benzodiazepines levels, 1-12$110Outpatient
Beta 2 glycoprotein 1 antibody (autoantibody) measurement$136Outpatient
Beta-2 microglobulin (protein) level$85.81Outpatient
Bill Additional Charges$115Outpatient
BIOCEP INJECTION NEEDLE( ENDOT)$108Outpatient
Biochemical assays for evaluation of chronic Hepatitis C virus infection$312Outpatient
Biopsies of rectum and/or lower large bowel using a rigid endoscope$1,148Outpatient
Biopsy and scraping of cervix using an endoscope$368Outpatient
BIOPSY FORCEPS FENESTRATED ELLIPSOID HOT$34.20Outpatient
BIOPSY FORCEPS SINGLE USE$34.20Outpatient
Biopsy of bladder using an endoscope$1,100Outpatient
Biopsy of bone marrow$194Outpatient
Biopsy of bone using needle or trocar$119Outpatient
Biopsy of esophagus using a flexible endoscope through mouth$130Outpatient
Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope$630Outpatient
Biopsy of large bowel using a flexible endoscope$823Outpatient
Biopsy of lining of uterus$2,010Outpatient
Biopsy of lining of uterus and/or removal of polyp using an endoscope$175Outpatient
Biopsy of lip$104Outpatient
Biopsy of lower large bowel using a flexible endoscope$380Outpatient
Biopsy of muscle$808Outpatient
Biopsy of related skin growth, first growth$51.04Outpatient
Biopsy or removal of deep lymph nodes of underarm$905Outpatient
Biopsy or removal of lymph nodes$695Outpatient
BIPAP MACHINE PER DAY$520Outpatient
Blood gases measurement$88.94Outpatient
Blood glucose (sugar) tolerance test, 3 specimens$63.68Outpatient
Blood osmolality (concentration) measurement$40.19Outpatient
Blood test, basic group of blood chemicals (Calcium, total)$50.41Outpatient
Blood test, clotting time, substitution$97.00Outpatient
Blood test, comprehensive group of blood chemicals$61.54Outpatient
Blood test, lipids (cholesterol and triglycerides)$56.43Outpatient
Blood test, thyroid stimulating hormone (TSH)$57.46Outpatient
Blood typing Rh phenotyping$87.00Outpatient
Blood unit compatibility test, antiglobulin technique$58.11Outpatient
Blood unit compatibility test, immediate spin technique$64.05Outpatient
Body fluid cell count with cell identification$52.22Outpatient
BREVI-XL 19G X 14$169Outpatient
BREVI-XL 19GX14 EPIDURAL CATH$169Outpatient
BRIDION 200 MG/2 ML VIAL$379Outpatient
BROVANA 15 MCG/2 ML SOLUTION$37.21Outpatient
Buprenorphine level$57.80Outpatient
C-peptide (protein) level$85.68Outpatient
C02 ADULT CANNULA$36.60Outpatient
Cadmium level$91.70Outpatient
Calcium level, ionized$51.75Outpatient
Cannabinoids levels, natural$58.00Outpatient
CAPVAXIVE 0.5 ML SYRINGE$708Outpatient
Carbamazepine level, total$128Outpatient
Carbohydrate analysis, single qualitative$87.50Outpatient
Carboxyhemoglobin (protein) level$63.60Outpatient
Carcinoembryonic antigen (CEA) protein level$99.18Outpatient
Cardiolipin antibody (tissue antibody) measurement$96.73Outpatient
CAST TAPE 3 BLUE$71.20Outpatient
Catecholamines (organic nitrogen) level$146Outpatient
CATH 12FR/5CC/2WAY$130Outpatient
CATH 16FR/5CC/3WAY$41.50Outpatient
CATH 18FR/5CC/2WAY$99.70Outpatient
CATH 20FR/30CC/3WAY$36.00Outpatient
CATH 20FR/5CC/3WAY$41.50Outpatient
CATH 24FR/30CC/3WAY$134Outpatient
CATH WHISTLE TIP (PAIR)$99.20Outpatient
CATHETER, DRAINAGE$195Outpatient
CATHETER, INFUSION, INSERTED PERIPHERALLY, CENTRALLY OR MIDLINE (OTHER THAN HEMODIALYSIS)$43.90Outpatient
Cell examination of specimen, concentration technique$108Outpatient
Cell examination of specimen, selective cellular enhancement technique$108Outpatient
Ceruloplasmin (protein) level$66.60Outpatient
CERVICAL OR VAGINAL CANCER SCREENING; PELVIC AND CLINICAL BREAST EXAMINATION$107Outpatient
Chemical analysis using chromatography technique$227Outpatient
Chloride level$37.61Outpatient
CHOLANGIOGRAPHY CATH$429Outpatient
Chromosome analysis for genetic defects, analyze 100-300 cells$183Outpatient
Chromosome analysis for genetic defects, analyze 25-99 cells$183Outpatient
Citrate level$126Outpatient
Closed treatment of 2 broken lower leg bones at ankle with manipulation$670Both
Closed treatment of 3 broken lower leg bones at ankle with manipulation$550Outpatient
Closed treatment of broken bone in forefoot or midfoot$285Outpatient
Closed treatment of broken collar bone$1,100Outpatient
Closed treatment of broken end of finger or thumb$148Outpatient
Closed treatment of broken finger or hand at base of finger$821Outpatient
Closed treatment of broken finger or thumb at midportion or part near hand$180Outpatient
Closed treatment of broken finger or thumb at midportion or part near hand with manipulation$1,420Both
Closed treatment of broken forearm (radius) bone at the wrist area on the thumb side of the wrist without manipulation$350Outpatient
Closed treatment of broken forearm bone on small finger side at elbow$260Outpatient
Closed treatment of broken forearm bone on thumb side at elbow$260Outpatient
Closed treatment of broken hand bone$226Outpatient
Closed treatment of broken midpart of both forearm bones$370Outpatient
Closed treatment of broken midpart of forearm bone on small finger side with manipulation$1,634Both
Closed treatment of broken midpart of forearm bone on thumb side$255Outpatient
Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation$485Outpatient
Closed treatment of broken toe with manipulation$300Outpatient
Closed treatment of broken top of upper arm bone$318Outpatient
Closed treatment of dislocated ankle$670Both
Closed treatment of dislocated finger joint with manipulation$222Outpatient
Closed treatment of dislocated finger joint with manipulation under anesthesia$260Outpatient
Closed treatment of dislocated forearm bone on thumb side at elbow with manipulation, child$243Outpatient
Closed treatment of dislocated joint in toe$116Outpatient
Closed treatment of dislocated knee$150Outpatient
Closed treatment of dislocated kneecap$289Both
Closed treatment of dislocated shoulder with manipulation$402Both
Closed treatment of dislocated shoulder with manipulation under anesthesia$425Both
Closed treatment of dislocated thumb at wrist with manipulation$350Outpatient
CLOSED TREATMENT OF NASAL BONE FRACTURE WITHOUT MANIPULATION$126Outpatient
Closed treatment of other broken wrist bone$260Outpatient
Closure of abnormal drainage tract from rectum to vagina through vagina or anus$907Outpatient
Closure of surgically created large or small bowel opening$1,070Outpatient
CLOSURE SYSTEM$462Outpatient
Clotting factor V (AcG or proaccelerin) measurement$119Outpatient
Clotting factor X assessment test, diluted$43.40Outpatient
CO2 DETECTOR EASY CAP$44.30Outpatient
CO2 TUBING SET W/FILTER$71.60Outpatient
Coagulation function analysis, agglutination slide, semiquantitative$122Outpatient
Coagulation function measurement, D-dimer; quantitative$84.85Outpatient
Cocaine level$58.00Outpatient
collagenase Top 250 units/g Oint [MLKS]$588Outpatient
Collection of blood sample from central venous tube$70.00Outpatient
Collection of blood sample from implanted device$70.00Both
COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK$788Outpatient
COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK$788Outpatient
COLORECTAL CANCER SCREENING; FECAL OCCULT BLOOD TEST, IMMUNOASSAY, 1-3 SIMULTANEOUS$44.62Outpatient
COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY$788Outpatient
COLOSTOMY IRRIGATION SET$56.50Outpatient
Complete blood cell count (red cells, white blood cell, platelets), automated test$37.32Outpatient
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$40.61Outpatient
Complete ultrasound of abdomen and pelvis artery and vein blood flow$665Outpatient
Complete ultrasound of aorta, vena cava, groin vessels or bypass grafts$665Outpatient
Complete ultrasound scan behind abdominal cavity$283Outpatient
Complete ultrasound scan of abdomen$457Outpatient
Complete ultrasound scan of joint$201Outpatient
Complete ultrasound scan of pelvis$290Outpatient
Complete X-ray of body bones$929Outpatient
Complex control of nose bleed$160Both
Complex drainage of wound infection after surgery$236Outpatient
Complicated drainage of abscess in finger$173Outpatient
Complicated or multiple drainage of skin abscess$247Outpatient
Complicated removal of cyst of tailbone$905Outpatient
Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 1.1-2.5 cm$295Both
Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm$495Outpatient
Complicated repair of wound of scalp, arms, or legs, 2.6-7.5 cm$404Outpatient
COMPUTED TOMOGRAPHIC ANGIOGRAPHY (CTA), HEAD AND NECK, WITH CONTRAST MATERIAL(S), INCLUDING NONCONTRAST IMAGES, WHEN PERFORMED, AND IMAGE POSTPROCESSING$3,250Outpatient
Concentration of specimen for infectious agents$45.35Outpatient
Copper level$65.70Outpatient
Cortisol (hormone) measurement, free$83.79Outpatient
Cortisol (hormone) measurement, total$84.76Outpatient
COUDE BLUNT NERVE BLOCK 20GX8$57.30Outpatient
CPR ELECTRODE ADULT (ZOLL)$215Outpatient
CPR ELECTRODE PEDI (ZOLL)$214Outpatient
Creatine kinase (cardiac enzyme) level, MB fraction only$70.61Outpatient
Creatinine clearance measurement to test for kidney function$45.53Outpatient
Creation of sling around urethra in female to control leakage$1,020Outpatient
Critical care, each additional 30 minutes$205Outpatient
Critical care, first 30-74 minutes$358Outpatient
Crystal identification from tissue or body fluid$97.58Outpatient
CT scan head or brain with contrast$633Outpatient
CT scan head or brain without contrast$633Outpatient
CT scan of abdomen and pelvis before and after contrast$717Outpatient
CT scan of abdomen and pelvis with contrast$779Outpatient
CT scan of abdomen and pelvis without contrast$686Outpatient
CT scan of abdomen before and after contrast$700Outpatient
CT scan of abdomen with contrast$806Outpatient
CT scan of abdomen without contrast$798Outpatient

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