Geary Community Hospital - Price List for Shoppable Services

Prices Posted and Effective as of 12-23-2020

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Disclaimer: The Hospital determines its standard charges for patient items and services through the use of a chargemaster system, which is a list of charges for the components of patient care that go into every patient’s bill. These are the baseline rates for items and services provided at the Hospital. The chargemaster is similar in concept to the manufacturer’s suggested retail price (“MSRP”) on a particular product or good. The charges listed provide only a general starting point in determining the potential costs of an individual patient’s care at the Hospital. This list does not reflect the actual out-of-pocket costs that may be paid by a patient for any particular service, it is not binding, and the actual charges for items and services may vary. Individuals with questions about their out-of-pocket costs of service and other financial information should contact the hospital or consider contacting their insurers for further information. The cost of treatment also may be impacted by variables involved in a patient’s actual care, such as specific equipment or supplies required, the length of time spent in surgery or recovery, additional tests, or any changes in care or unexpected conditions or complications that arise.

Service Description	Service Code	Cash Price	Rates
CT Scan
CT scan	CPT 70450	$1,853
CT scan of abdomen and pelvis with contrast	CPT 74177	$4,785
CT scan of pelvis with contrast	CPT 72193	$1,639
Ct abd & pelvis w/o contrast	CPT 74176	$4,089
Ct abdomen w/dye	CPT 74160	$1,639
Ct abdomen w/o & w/dye	CPT 74170	$1,967
Ct abdomen w/o dye	CPT 74150	$1,008
Ct angio abdom w/o & w/dye	CPT 74175	$1,639
Ct angio abdominal arteries	CPT 75635	$1,639
Ct angio lwr extr w/o&w/dye	CPT 73706	$1,639
Ct angio upr extrm w/o&w/dye	CPT 73206	$1,639
Ct angiograph pelv w/o&w/dye	CPT 72191	$1,639
Ct angiography chest	CPT 71275	$2,798
Ct angiography head	CPT 70496	$1,639
Ct angiography neck	CPT 70498	$1,639
Ct chest spine w/dye	CPT 72129	$1,639
Ct chest spine w/o & w/dye	CPT 72130	$1,967
Ct chest spine w/o dye	CPT 72128	$1,008
Ct head/brain w/dye	CPT 70460	$1,976
Ct head/brain w/o & w/dye	CPT 70470	$2,448
Ct lower extremity w/dye	CPT 73701	$1,639
Ct lower extremity w/o dye	CPT 73700	$1,008
Ct lumbar spine w/dye	CPT 72132	$3,436
Ct lumbar spine w/o & w/dye	CPT 72133	$4,123
Ct lumbar spine w/o dye	CPT 72131	$1,008
Ct lwr extremity w/o&w/dye	CPT 73702	$1,967
Ct maxillofacial w/dye	CPT 70487	$2,056
Ct maxillofacial w/o & w/dye	CPT 70488	$2,473
Ct maxillofacial w/o dye	CPT 70486	$1,846
Ct neck spine w/dye	CPT 72126	$3,436
Ct neck spine w/o & w/dye	CPT 72127	$4,123
Ct neck spine w/o dye	CPT 72125	$2,685
Ct pelvis w/o & w/dye	CPT 72194	$1,967
Ct pelvis w/o dye	CPT 72192	$1,008
Ct scan for needle biopsy	CPT 77012	$1,266
Ct sft tsue nck w/o & w/dye	CPT 70492	$2,423
Ct soft tissue neck w/dye	CPT 70491	$2,016
Ct soft tissue neck w/o dye	CPT 70490	$1,671
Ct thorax w/dye	CPT 71260	$2,423
Ct thorax w/o & w/dye	CPT 71270	$2,907
Ct thorax w/o dye	CPT 71250	$1,830
Clinic
Initial new patient preventative medicine evaluation (18-3...	CPT 99385	$338
Initial new patient preventative medicine evaluation (40-6...	CPT 99386	$298
New patient office or other outpatient visit, 30 min	CPT 99203	$191
New patient office or other outpatient visit, 45 min	CPT 99204	$292
New patient office or other outpatient visit, 60 min	CPT 99205	$369
Patient office consultation, 40 min (Not Offered)	CPT 99243	-	-
Patient office consultation, 60 min (Not Offered)	CPT 99244	-	-
EEG
Sleep study	CPT 95810	$4,544
EKG
Electrocardiogram, routine, with interpretation and report	CPT 93000	$296
Imaging
Abdomial ultrasound of pregnant uterus	CPT 76805	$784
Brain imaging (pet)	CPT 78608	$5,772
Echo exam uterus	CPT 76831	$1,631
Mammography of both breasts	CPT 77066	$339
Mammography of one breast	CPT 77065	$278
Mammography, screening, bilateral	CPT 77067	$340
Ob us < 14 wks single fetus	CPT 76801	$784
Ob us detailed sngl fetus	CPT 76811	$1,631
Ob us follow-up per fetus	CPT 76816	$784
Ob us limited fetus(s)	CPT 76815	$784
Pet image w/ct full body	CPT 78816	$5,772
Pet image w/ct skull-thigh	CPT 78815	$5,772
Transvaginal us obstetric	CPT 76817	$784
Ultrasound breast complete	CPT 76641	$784
Ultrasound breast limited	CPT 76642	$558
Ultrasound of abdomen	CPT 76700	$784
Ultrasound pelvis through vagina	CPT 76830	$784
Us exam pelvic complete	CPT 76856	$941
Us exam pelvic limited	CPT 76857	$784
Inpatient Procedures
Cardiac valve or cardiothoracic procedure with cardiac cat... (Not Offered)	DRG 216	-	-
Cervical spinal fusion without CC or MCC (Not Offered)	DRG 473	-	-
Major joint replacement or reattachment of lower extremity...	DRG 470	$51,224
Spinal fusion except cervical without MCC (Not Offered)	DRG 460	-	-
Uterine and adnexa procedures for non-malignancy without C...	DRG 743	$34,084
Laboratory
Acute hepatitis panel	CPT 80074	$428
Ag detect nos ia mult	CPT 87449	$107
Alpha-1-antitrypsin total	CPT 82103	$120
Alpha-fetoprotein serum	CPT 82105	$150
Assay alkaline phosphatase	CPT 84075	$46
Assay blood carbon dioxide	CPT 82374	$43
Assay glucose blood quant	CPT 82947	$35
Assay of amylase	CPT 82150	$58
Assay of blood/uric acid	CPT 84550	$40
Assay of calcium	CPT 82310	$46
Assay of ck (cpk)	CPT 82550	$58
Assay of creatinine	CPT 82565	$46
Assay of digoxin total	CPT 80162	$119
Assay of estradiol	CPT 82670	$251
Assay of ferritin	CPT 82728	$221
Assay of folic acid serum	CPT 82746	$132
Assay of free thyroxine	CPT 84439	$192
Assay of ige	CPT 82785	$148
Assay of insulin	CPT 83525	$102
Assay of iron	CPT 83540	$58
Assay of lactic acid	CPT 83605	$104
Assay of lead	CPT 83655	$108
Assay of lipase	CPT 83690	$149
Assay of lipoprotein	CPT 83718	$73
Assay of lipoprotein(a)	CPT 83695	$128
Assay of magnesium	CPT 83735	$143
Assay of natriuretic peptide	CPT 83880	$353
Assay of prealbumin	CPT 84134	$131
Assay of protein other	CPT 84157	$36
Assay of protein urine	CPT 84156	$33
Assay of serum potassium	CPT 84132	$42
Assay of thyroid (t3 or t4)	CPT 84479	$58
Assay of total thyroxine	CPT 84436	$61
Assay of transferrin	CPT 84466	$114
Assay of triglycerides	CPT 84478	$51
Assay of troponin quant	CPT 84484	$202
Assay of urea nitrogen	CPT 84520	$35
Assay of urine potassium	CPT 84133	$42
Assay of urine/uric acid	CPT 84560	$45
Assay of vancomycin	CPT 80202	$121
Assay triiodothyronine (t3)	CPT 84480	$127
Automated diff wbc count	CPT 85004	$58
Automated leukocyte count	CPT 85048	$22
Automated platelet count	CPT 85049	$40
Automated reticulocyte count	CPT 85045	$87
Basic metabolic panel	CPT 80048	$233
Bilirubin direct	CPT 82248	$45
Bilirubin total	CPT 82247	$45
Blood test, clotting time	CPT 85610	$129
Blood test, comprehensive group of blood chemicals	CPT 80053	$296
Blood test, lipids	CPT 80061	$202
Blood test, thyroid stimulating hormone (TSH)	CPT 84443	$236
Blood typing serologic rh(d)	CPT 86901	$75
C diff amplified probe	CPT 87493	$335
C-reactive protein	CPT 86140	$116
COVID-19, AMPLIFIED PROBE TECHNIQUE	CPT 87635	$235
Carcinoembryonic antigen	CPT 82378	$170
Chlamydia culture	CPT 87110	$176
Chorionic gonadotropin assay	CPT 84703	$133
Chorionic gonadotropin test	CPT 84702	$269
Clostridium ag ia	CPT 87324	$107
Coagulation assessment blood test	CPT 85730	$159
Complete blood cell count (CBC), automated	CPT 85027	$116
Complete blood cell count (CBC), with differential white b...	CPT 85025	$172
Coombs test direct	CPT 86880	$48
Creatinine clearance test	CPT 82575	$85
Cytomegalovirus ag ia	CPT 87332	$107
Cytopath smear other source	CPT 88161	$103
Dipropylacetic acid free	CPT 80165	$121
Drug screen quantalcohols	CPT 80320	$163
Drug test prsmv chem anlyzr	CPT 80307	$310
Drug test prsmv instrmnt	CPT 80306	$154
Electrolyte panel	CPT 80051	$63
Fibrin degradation quant	CPT 85379	$186
Free assay (ft-3)	CPT 84481	$152
Fungi identification yeast	CPT 87106	$92
General health panel	CPT 80050	$346
Glucose test	CPT 82950	$42
Glycosylated hemoglobin test	CPT 83036	$132
Gtt-added samples	CPT 82952	$35
H pylori (c-13) breath	CPT 83013	$606
H pylori drug admin	CPT 83014	$239
Hematocrit	CPT 85014	$64
Hemoglobin	CPT 85018	$70
Hepatitis b dna amp probe	CPT 87516	$315
Hepatitis c ab test	CPT 86803	$128
Hepatitis c probe&rvrs trnsc	CPT 87521	$315
Hiv-1 probe&reverse trnscrpj	CPT 87535	$315
Hpylori stool ia	CPT 87338	$129
Hsv dna amp probe	CPT 87529	$315
Immunoassay tumor ca 125	CPT 86304	$187
Immunoassay tumor ca 15-3	CPT 86300	$187
Immunoassay tumor ca 19-9	CPT 86301	$187
Iron binding test	CPT 83550	$78
Kidney function panel test	CPT 80069	$78
Liver function blood test	CPT 80076	$313
Microscopic exam of urine	CPT 81015	$27
Obstetric blood test panel	CPT 80055	$430
Occult bld feces 1-3 tests	CPT 82272	$38
Occult blood feces	CPT 82270	$39
Other source albumin quan ea	CPT 82042	$70
Ova and parasites smears	CPT 87177	$80
Pinworm exam	CPT 87172	$38
Psa screening	HCPCS G0103	$173
Resp virus 12-25 targets	CPT 87633	$1,250
Resp virus 3-5 targets	CPT 87631	$427
Resp virus 6-11 targets	CPT 87632	$654
Rheumatoid factor test qual	CPT 86430	$55
Routine venipuncture	CPT 36415	$30
Strep a ag ia	CPT 87430	$151
Strep b dna amp probe	CPT 87653	$105
Syphilis test non-trep qual	CPT 86592	$38
Syphilis test non-trep quant	CPT 86593	$39
Tb test cell immun measure	CPT 86480	$557
Total prostate-specific antigen (PSA) test	CPT 84153	$165
Total prostate-specific antigen (PSA) test	CPT 84154	$165
Transferase (ast) (sgot)	CPT 84450	$46
Ur albumin quantitative	CPT 82043	$52
Urinalysis	CPT 81005	$19
Urinalysis test	CPT 81002	$20
Urinalysis test	CPT 81003	$20
Urinalysis test using microscope	CPT 81001	$98
Urinalysis test using microscope (Not Offered)	CPT 81000	-	-
Urine culture/colony count	CPT 87086	$197
Urine pregnancy test	CPT 81025	$77
Varicella zoster ag if	CPT 87290	$120
Vitamin b-12	CPT 82607	$234
Vitamin d 25 hydroxy	CPT 82306	$266
West nile virus antibody	CPT 86789	$129
MRI
MRI Scan	CPT 70553	$4,123
MRI scan of leg joint	CPT 73721	$2,199
MRI scan of lower spinal canal	CPT 72148	$2,097
Magnetic image jaw joint	CPT 70336	$2,097
Mri abdomen w/dye	CPT 74182	$3,436
Mri abdomen w/o & w/dye	CPT 74183	$4,123
Mri abdomen w/o dye	CPT 74181	$2,097
Mri brain stem w/dye	CPT 70552	$3,436
Mri brain stem w/o dye	CPT 70551	$2,748
Mri chest spine w/dye	CPT 72147	$3,436
Mri chest spine w/o & w/dye	CPT 72157	$4,123
Mri chest spine w/o dye	CPT 72146	$2,097
Mri chest w/dye	CPT 71551	$2,516
Mri chest w/o & w/dye	CPT 71552	$3,436
Mri chest w/o dye	CPT 71550	$2,097
Mri joint lwr extr w/o&w/dye	CPT 73723	$3,436
Mri joint of lwr extr w/dye	CPT 73722	$2,749
Mri joint upr extr w/o&w/dye	CPT 73223	$3,436
Mri joint upr extrem w/dye	CPT 73222	$2,767
Mri joint upr extrem w/o dye	CPT 73221	$2,097
Mri lower extremity w/dye	CPT 73719	$2,767
Mri lower extremity w/o dye	CPT 73718	$2,097
Mri lumbar spine w/dye	CPT 72149	$3,436
Mri lumbar spine w/o & w/dye	CPT 72158	$4,123
Mri lwr extremity w/o&w/dye	CPT 73720	$3,436
Mri neck spine w/dye	CPT 72142	$3,436
Mri neck spine w/o & w/dye	CPT 72156	$4,123
Mri neck spine w/o dye	CPT 72141	$2,097
Mri orbt/fac/nck w/o &w/dye	CPT 70543	$4,123
Mri pelvis w/dye	CPT 72196	$3,436
Mri pelvis w/o & w/dye	CPT 72197	$4,123
Mri pelvis w/o dye	CPT 72195	$2,097
Mri upper extremity w/o dye	CPT 73218	$2,097
Mri uppr extremity w/o&w/dye	CPT 73220	$2,338
Nuclear Medicine
Parathyroid planar imaging	CPT 78070	$1,472
Thyroid imaging w/blood flow	CPT 78013	$1,472
Psychiatric
Family psychotherapy, including patient, 50 min (Not Offered)	CPT 90847	-	-
Family psychotherapy, not including patient, 50 min (Not Offered)	CPT 90846	-	-
Group psychotherapy (Not Offered)	CPT 90853	-	-
Psychotherapy, 30 min (Not Offered)	CPT 90832	-	-
Psychotherapy, 45 min (Not Offered)	CPT 90834	-	-
Psychotherapy, 60 min (Not Offered)	CPT 90837	-	-
Radiology
Contrast x-ray bladder	CPT 74430	$1,909
Contrast x-ray of hip	CPT 73525	$1,909
Contrast x-ray of knee joint	CPT 73580	$1,909
Contrast x-ray of shoulder	CPT 73040	$1,145
Contrast x-ray of wrist	CPT 73115	$1,909
Ct bone density axial	CPT 77078	$555
Dxa bone density axial	CPT 77080	$560
Dxa bone density study	CPT 77085	$560
Fluoroscopy <1 hr phys/qhp	CPT 76000	$1,165
Needle localization by xray	CPT 77002	$680
PATELLA BILAT 1-2V	CPT 73560	$399
X-Ray of lower back	CPT 72110	$672
X-ray bile ducts/pancreas	CPT 74300	$719
X-ray exam abdomen 2 views	CPT 74019	$560
X-ray exam abdomen 3+ views	CPT 74021	$672
X-ray exam breastbone 2/>vws	CPT 71120	$399
X-ray exam chest 1 view	CPT 71045	$399
X-ray exam chest 2 views	CPT 71046	$478
X-ray exam chest 3 views	CPT 71047	$574
X-ray exam chest 4+ views	CPT 71048	$689
X-ray exam complete abdomen	CPT 74022	$560
X-ray exam hip uni 2-3 views	CPT 73502	$478
X-ray exam hips bi 2 views	CPT 73521	$560
X-ray exam hips bi 3-4 views	CPT 73522	$672
X-ray exam l-s spine 2/3 vws	CPT 72100	$560
X-ray exam l-s spine bending	CPT 72114	$806
X-ray exam neck spine 2-3 vw	CPT 72040	$478
X-ray exam neck spine 4/5vws	CPT 72050	$560
X-ray exam neck spine 6/>vws	CPT 72052	$672
X-ray exam of ankle	CPT 73600	$319
X-ray exam of ankle	CPT 73610	$399
X-ray exam of collar bone	CPT 73000	$399
X-ray exam of elbow	CPT 73070	$319
X-ray exam of elbow	CPT 73080	$399
X-ray exam of facial bones	CPT 70150	$560
X-ray exam of femur 1	CPT 73551	$399
X-ray exam of femur 2/>	CPT 73552	$478
X-ray exam of finger(s)	CPT 73140	$399
X-ray exam of foot	CPT 73620	$319
X-ray exam of foot	CPT 73630	$399
X-ray exam of forearm	CPT 73090	$399
X-ray exam of hand	CPT 73120	$560
X-ray exam of hand	CPT 73130	$672
X-ray exam of humerus	CPT 73060	$399
X-ray exam of knee 1 or 2	CPT 73560	$399
X-ray exam of knee 3	CPT 73562	$478
X-ray exam of knees	CPT 73565	$399
X-ray exam of leg infant	CPT 73592	$399
X-ray exam of lower leg	CPT 73590	$399
X-ray exam of neck	CPT 70360	$399
X-ray exam of pelvis	CPT 72170	$448
X-ray exam of pelvis	CPT 72190	$560
X-ray exam of shoulder	CPT 73030	$478
X-ray exam of shoulder	CPT 73020	$399
X-ray exam of shoulder blade	CPT 73010	$560
X-ray exam of toe(s)	CPT 73660	$399
X-ray exam of wrist	CPT 73100	$319
X-ray exam of wrist	CPT 73110	$399
X-ray exam ribs bil 3 views	CPT 71110	$560
X-ray exam sacrum tailbone	CPT 72220	$399
X-ray exam thorac spine 2vws	CPT 72070	$560
X-ray exam unilat ribs/chest	CPT 71101	$560
X-ray strenoclavic jt 3/>vws	CPT 71130	$478
X-ray urethra/bladder	CPT 74455	$1,165
X-ray xm colon 1cntrst std	CPT 74270	$1,114
X-ray xm esophagus 1cntrst	CPT 74220	$911
X-ray xm sm int 1cntrst std	CPT 74250	$911
X-ray xm swlng funcj c+	CPT 74230	$911
X-ray xm upr gi trc 1cntrst	CPT 74240	$911
X-ray xm upr gi trc 2cntrst	CPT 74246	$1,237
Surgical Procedures
Biopsy exam of esophagus, stomach or small bowel using an ...	CPT 43239	$873
Biopsy exam of large bowel using an endoscope	CPT 45380	$1,033
Biopsy of prostate gland (Not Offered)	CPT 55700	-	-
Diagnostic exam of esophagus, stomach or small bowel using...	CPT 43235	$653
Diagnostic exam of large bowel using an endoscope	CPT 45378	$886
Injection(s) of anesthetic into lower spine using imaging ... (Not Offered)	CPT 64483	-	-
Injection(s) of therapeutic substance	CPT 62322	$1,875
Injection(s) of therapeutic substance	CPT 62323	$2,250
Insertion of catheter into left heart for diagnosis (Not Offered)	CPT 93452	-	-
Obstetric care, planned cesarean delivery (Not Offered)	CPT 59510	-	-
Obstetric care, planned vaginal delivery (Not Offered)	CPT 59400	-	-
Obstetric care, planned vaginal delivery (post delivery by... (Not Offered)	CPT 59610	-	-
Removal of cataract with insertion of lens (Not Offered)	CPT 66984	-	-
Removal of gallbladder using an endoscope	CPT 47562	$1,546
Removal of one knee cartilage using an endoscope	CPT 29881	$2,638
Removal of one or more breast growth, open procedure	CPT 19120	$917
Removal of polyps or growths of large bowel using an endos...	CPT 45385	$1,125
Removal of recurring cataract in lens capsule using laser	CPT 66821	$1,520
Removal of tonsils and adenoid glands, patient younger tha...	CPT 42820	$8,442
Repair of groin hernia patient age 5 years or older	CPT 49505	$1,350
Shaving of shoulder bone using endoscope	CPT 29826	$455
Surgical removal of prostate and surrounding lymph nodes u... (Not Offered)	CPT 55866	-	-
Ultrasound examination of lower large bowel using an endos... (Not Offered)	CPT 45391	-	-
Therapy
Physical therapy, therapeutic exercise	CPT 97110	$59