Prices Posted and Effective on 12-23-2020

Geary Community Hospital - Price List for Shoppable Services

Prices Posted and Effective as of 12-23-2020

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.

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Service DescriptionService CodeCash PriceRates
Service DescriptionService CodeCash PriceRates
CT Scan
CT scanCPT 70450$1,853
CT scan of abdomen and pelvis with contrastCPT 74177$4,785
CT scan of pelvis with contrastCPT 72193$1,639
Ct abd & pelvis w/o contrastCPT 74176$4,089
Ct abdomen w/dyeCPT 74160$1,639
Ct abdomen w/o & w/dyeCPT 74170$1,967
Ct abdomen w/o dyeCPT 74150$1,008
Ct angio abdom w/o & w/dyeCPT 74175$1,639
Ct angio abdominal arteriesCPT 75635$1,639
Ct angio lwr extr w/o&w/dyeCPT 73706$1,639
Ct angio upr extrm w/o&w/dyeCPT 73206$1,639
Ct angiograph pelv w/o&w/dyeCPT 72191$1,639
Ct angiography chestCPT 71275$2,798
Ct angiography headCPT 70496$1,639
Ct angiography neckCPT 70498$1,639
Ct chest spine w/dyeCPT 72129$1,639
Ct chest spine w/o & w/dyeCPT 72130$1,967
Ct chest spine w/o dyeCPT 72128$1,008
Ct head/brain w/dyeCPT 70460$1,976
Ct head/brain w/o & w/dyeCPT 70470$2,448
Ct lower extremity w/dyeCPT 73701$1,639
Ct lower extremity w/o dyeCPT 73700$1,008
Ct lumbar spine w/dyeCPT 72132$3,436
Ct lumbar spine w/o & w/dyeCPT 72133$4,123
Ct lumbar spine w/o dyeCPT 72131$1,008
Ct lwr extremity w/o&w/dyeCPT 73702$1,967
Ct maxillofacial w/dyeCPT 70487$2,056
Ct maxillofacial w/o & w/dyeCPT 70488$2,473
Ct maxillofacial w/o dyeCPT 70486$1,846
Ct neck spine w/dyeCPT 72126$3,436
Ct neck spine w/o & w/dyeCPT 72127$4,123
Ct neck spine w/o dyeCPT 72125$2,685
Ct pelvis w/o & w/dyeCPT 72194$1,967
Ct pelvis w/o dyeCPT 72192$1,008
Ct scan for needle biopsyCPT 77012$1,266
Ct sft tsue nck w/o & w/dyeCPT 70492$2,423
Ct soft tissue neck w/dyeCPT 70491$2,016
Ct soft tissue neck w/o dyeCPT 70490$1,671
Ct thorax w/dyeCPT 71260$2,423
Ct thorax w/o & w/dyeCPT 71270$2,907
Ct thorax w/o dyeCPT 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 minCPT 99203$191
New patient office or other outpatient visit, 45 minCPT 99204$292
New patient office or other outpatient visit, 60 minCPT 99205$369
Patient office consultation, 40 min (Not Offered)CPT 99243--
Patient office consultation, 60 min (Not Offered)CPT 99244--
EEG
Sleep studyCPT 95810$4,544
EKG
Electrocardiogram, routine, with interpretation and reportCPT 93000$296
Imaging
Abdomial ultrasound of pregnant uterusCPT 76805$784
Brain imaging (pet)CPT 78608$5,772
Echo exam uterusCPT 76831$1,631
Mammography of both breastsCPT 77066$339
Mammography of one breastCPT 77065$278
Mammography, screening, bilateralCPT 77067$340
Ob us < 14 wks single fetusCPT 76801$784
Ob us detailed sngl fetusCPT 76811$1,631
Ob us follow-up per fetusCPT 76816$784
Ob us limited fetus(s)CPT 76815$784
Pet image w/ct full bodyCPT 78816$5,772
Pet image w/ct skull-thighCPT 78815$5,772
Transvaginal us obstetricCPT 76817$784
Ultrasound breast completeCPT 76641$784
Ultrasound breast limitedCPT 76642$558
Ultrasound of abdomenCPT 76700$784
Ultrasound pelvis through vaginaCPT 76830$784
Us exam pelvic completeCPT 76856$941
Us exam pelvic limitedCPT 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 panelCPT 80074$428
Ag detect nos ia multCPT 87449$107
Alpha-1-antitrypsin totalCPT 82103$120
Alpha-fetoprotein serumCPT 82105$150
Assay alkaline phosphataseCPT 84075$46
Assay blood carbon dioxideCPT 82374$43
Assay glucose blood quantCPT 82947$35
Assay of amylaseCPT 82150$58
Assay of blood/uric acidCPT 84550$40
Assay of calciumCPT 82310$46
Assay of ck (cpk)CPT 82550$58
Assay of creatinineCPT 82565$46
Assay of digoxin totalCPT 80162$119
Assay of estradiolCPT 82670$251
Assay of ferritinCPT 82728$221
Assay of folic acid serumCPT 82746$132
Assay of free thyroxineCPT 84439$192
Assay of igeCPT 82785$148
Assay of insulinCPT 83525$102
Assay of ironCPT 83540$58
Assay of lactic acidCPT 83605$104
Assay of leadCPT 83655$108
Assay of lipaseCPT 83690$149
Assay of lipoproteinCPT 83718$73
Assay of lipoprotein(a)CPT 83695$128
Assay of magnesiumCPT 83735$143
Assay of natriuretic peptideCPT 83880$353
Assay of prealbuminCPT 84134$131
Assay of protein otherCPT 84157$36
Assay of protein urineCPT 84156$33
Assay of serum potassiumCPT 84132$42
Assay of thyroid (t3 or t4)CPT 84479$58
Assay of total thyroxineCPT 84436$61
Assay of transferrinCPT 84466$114
Assay of triglyceridesCPT 84478$51
Assay of troponin quantCPT 84484$202
Assay of urea nitrogenCPT 84520$35
Assay of urine potassiumCPT 84133$42
Assay of urine/uric acidCPT 84560$45
Assay of vancomycinCPT 80202$121
Assay triiodothyronine (t3)CPT 84480$127
Automated diff wbc countCPT 85004$58
Automated leukocyte countCPT 85048$22
Automated platelet countCPT 85049$40
Automated reticulocyte countCPT 85045$87
Basic metabolic panelCPT 80048$233
Bilirubin directCPT 82248$45
Bilirubin totalCPT 82247$45
Blood test, clotting timeCPT 85610$129
Blood test, comprehensive group of blood chemicalsCPT 80053$296
Blood test, lipidsCPT 80061$202
Blood test, thyroid stimulating hormone (TSH)CPT 84443$236
Blood typing serologic rh(d)CPT 86901$75
C diff amplified probeCPT 87493$335
C-reactive proteinCPT 86140$116
COVID-19, AMPLIFIED PROBE TECHNIQUECPT 87635$235
Carcinoembryonic antigenCPT 82378$170
Chlamydia cultureCPT 87110$176
Chorionic gonadotropin assayCPT 84703$133
Chorionic gonadotropin testCPT 84702$269
Clostridium ag iaCPT 87324$107
Coagulation assessment blood testCPT 85730$159
Complete blood cell count (CBC), automatedCPT 85027$116
Complete blood cell count (CBC), with differential white b...CPT 85025$172
Coombs test directCPT 86880$48
Creatinine clearance testCPT 82575$85
Cytomegalovirus ag iaCPT 87332$107
Cytopath smear other sourceCPT 88161$103
Dipropylacetic acid freeCPT 80165$121
Drug screen quantalcoholsCPT 80320$163
Drug test prsmv chem anlyzrCPT 80307$310
Drug test prsmv instrmntCPT 80306$154
Electrolyte panelCPT 80051$63
Fibrin degradation quantCPT 85379$186
Free assay (ft-3)CPT 84481$152
Fungi identification yeastCPT 87106$92
General health panelCPT 80050$346
Glucose testCPT 82950$42
Glycosylated hemoglobin testCPT 83036$132
Gtt-added samplesCPT 82952$35
H pylori (c-13) breathCPT 83013$606
H pylori drug adminCPT 83014$239
HematocritCPT 85014$64
HemoglobinCPT 85018$70
Hepatitis b dna amp probeCPT 87516$315
Hepatitis c ab testCPT 86803$128
Hepatitis c probe&rvrs trnscCPT 87521$315
Hiv-1 probe&reverse trnscrpjCPT 87535$315
Hpylori stool iaCPT 87338$129
Hsv dna amp probeCPT 87529$315
Immunoassay tumor ca 125CPT 86304$187
Immunoassay tumor ca 15-3CPT 86300$187
Immunoassay tumor ca 19-9CPT 86301$187
Iron binding testCPT 83550$78
Kidney function panel testCPT 80069$78
Liver function blood testCPT 80076$313
Microscopic exam of urineCPT 81015$27
Obstetric blood test panelCPT 80055$430
Occult bld feces 1-3 testsCPT 82272$38
Occult blood fecesCPT 82270$39
Other source albumin quan eaCPT 82042$70
Ova and parasites smearsCPT 87177$80
Pinworm examCPT 87172$38
Psa screeningHCPCS G0103$173
Resp virus 12-25 targetsCPT 87633$1,250
Resp virus 3-5 targetsCPT 87631$427
Resp virus 6-11 targetsCPT 87632$654
Rheumatoid factor test qualCPT 86430$55
Routine venipunctureCPT 36415$30
Strep a ag iaCPT 87430$151
Strep b dna amp probeCPT 87653$105
Syphilis test non-trep qualCPT 86592$38
Syphilis test non-trep quantCPT 86593$39
Tb test cell immun measureCPT 86480$557
Total prostate-specific antigen (PSA) testCPT 84153$165
Total prostate-specific antigen (PSA) testCPT 84154$165
Transferase (ast) (sgot)CPT 84450$46
Ur albumin quantitativeCPT 82043$52
UrinalysisCPT 81005$19
Urinalysis testCPT 81002$20
Urinalysis testCPT 81003$20
Urinalysis test using microscopeCPT 81001$98
Urinalysis test using microscope (Not Offered)CPT 81000--
Urine culture/colony countCPT 87086$197
Urine pregnancy testCPT 81025$77
Varicella zoster ag ifCPT 87290$120
Vitamin b-12CPT 82607$234
Vitamin d 25 hydroxyCPT 82306$266
West nile virus antibodyCPT 86789$129
MRI
MRI ScanCPT 70553$4,123
MRI scan of leg jointCPT 73721$2,199
MRI scan of lower spinal canalCPT 72148$2,097
Magnetic image jaw jointCPT 70336$2,097
Mri abdomen w/dyeCPT 74182$3,436
Mri abdomen w/o & w/dyeCPT 74183$4,123
Mri abdomen w/o dyeCPT 74181$2,097
Mri brain stem w/dyeCPT 70552$3,436
Mri brain stem w/o dyeCPT 70551$2,748
Mri chest spine w/dyeCPT 72147$3,436
Mri chest spine w/o & w/dyeCPT 72157$4,123
Mri chest spine w/o dyeCPT 72146$2,097
Mri chest w/dyeCPT 71551$2,516
Mri chest w/o & w/dyeCPT 71552$3,436
Mri chest w/o dyeCPT 71550$2,097
Mri joint lwr extr w/o&w/dyeCPT 73723$3,436
Mri joint of lwr extr w/dyeCPT 73722$2,749
Mri joint upr extr w/o&w/dyeCPT 73223$3,436
Mri joint upr extrem w/dyeCPT 73222$2,767
Mri joint upr extrem w/o dyeCPT 73221$2,097
Mri lower extremity w/dyeCPT 73719$2,767
Mri lower extremity w/o dyeCPT 73718$2,097
Mri lumbar spine w/dyeCPT 72149$3,436
Mri lumbar spine w/o & w/dyeCPT 72158$4,123
Mri lwr extremity w/o&w/dyeCPT 73720$3,436
Mri neck spine w/dyeCPT 72142$3,436
Mri neck spine w/o & w/dyeCPT 72156$4,123
Mri neck spine w/o dyeCPT 72141$2,097
Mri orbt/fac/nck w/o &w/dyeCPT 70543$4,123
Mri pelvis w/dyeCPT 72196$3,436
Mri pelvis w/o & w/dyeCPT 72197$4,123
Mri pelvis w/o dyeCPT 72195$2,097
Mri upper extremity w/o dyeCPT 73218$2,097
Mri uppr extremity w/o&w/dyeCPT 73220$2,338
Nuclear Medicine
Parathyroid planar imagingCPT 78070$1,472
Thyroid imaging w/blood flowCPT 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 bladderCPT 74430$1,909
Contrast x-ray of hipCPT 73525$1,909
Contrast x-ray of knee jointCPT 73580$1,909
Contrast x-ray of shoulderCPT 73040$1,145
Contrast x-ray of wristCPT 73115$1,909
Ct bone density axialCPT 77078$555
Dxa bone density axialCPT 77080$560
Dxa bone density studyCPT 77085$560
Fluoroscopy <1 hr phys/qhpCPT 76000$1,165
Needle localization by xrayCPT 77002$680
PATELLA BILAT 1-2VCPT 73560$399
X-Ray of lower backCPT 72110$672
X-ray bile ducts/pancreasCPT 74300$719
X-ray exam abdomen 2 viewsCPT 74019$560
X-ray exam abdomen 3+ viewsCPT 74021$672
X-ray exam breastbone 2/>vwsCPT 71120$399
X-ray exam chest 1 viewCPT 71045$399
X-ray exam chest 2 viewsCPT 71046$478
X-ray exam chest 3 viewsCPT 71047$574
X-ray exam chest 4+ viewsCPT 71048$689
X-ray exam complete abdomenCPT 74022$560
X-ray exam hip uni 2-3 viewsCPT 73502$478
X-ray exam hips bi 2 viewsCPT 73521$560
X-ray exam hips bi 3-4 viewsCPT 73522$672
X-ray exam l-s spine 2/3 vwsCPT 72100$560
X-ray exam l-s spine bendingCPT 72114$806
X-ray exam neck spine 2-3 vwCPT 72040$478
X-ray exam neck spine 4/5vwsCPT 72050$560
X-ray exam neck spine 6/>vwsCPT 72052$672
X-ray exam of ankleCPT 73600$319
X-ray exam of ankleCPT 73610$399
X-ray exam of collar boneCPT 73000$399
X-ray exam of elbowCPT 73070$319
X-ray exam of elbowCPT 73080$399
X-ray exam of facial bonesCPT 70150$560
X-ray exam of femur 1CPT 73551$399
X-ray exam of femur 2/>CPT 73552$478
X-ray exam of finger(s)CPT 73140$399
X-ray exam of footCPT 73620$319
X-ray exam of footCPT 73630$399
X-ray exam of forearmCPT 73090$399
X-ray exam of handCPT 73120$560
X-ray exam of handCPT 73130$672
X-ray exam of humerusCPT 73060$399
X-ray exam of knee 1 or 2CPT 73560$399
X-ray exam of knee 3CPT 73562$478
X-ray exam of kneesCPT 73565$399
X-ray exam of leg infantCPT 73592$399
X-ray exam of lower legCPT 73590$399
X-ray exam of neckCPT 70360$399
X-ray exam of pelvisCPT 72170$448
X-ray exam of pelvisCPT 72190$560
X-ray exam of shoulderCPT 73030$478
X-ray exam of shoulderCPT 73020$399
X-ray exam of shoulder bladeCPT 73010$560
X-ray exam of toe(s)CPT 73660$399
X-ray exam of wristCPT 73100$319
X-ray exam of wristCPT 73110$399
X-ray exam ribs bil 3 viewsCPT 71110$560
X-ray exam sacrum tailboneCPT 72220$399
X-ray exam thorac spine 2vwsCPT 72070$560
X-ray exam unilat ribs/chestCPT 71101$560
X-ray strenoclavic jt 3/>vwsCPT 71130$478
X-ray urethra/bladderCPT 74455$1,165
X-ray xm colon 1cntrst stdCPT 74270$1,114
X-ray xm esophagus 1cntrstCPT 74220$911
X-ray xm sm int 1cntrst stdCPT 74250$911
X-ray xm swlng funcj c+CPT 74230$911
X-ray xm upr gi trc 1cntrstCPT 74240$911
X-ray xm upr gi trc 2cntrstCPT 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 endoscopeCPT 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 endoscopeCPT 45378$886
Injection(s) of anesthetic into lower spine using imaging ... (Not Offered)CPT 64483--
Injection(s) of therapeutic substanceCPT 62322$1,875
Injection(s) of therapeutic substanceCPT 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 endoscopeCPT 47562$1,546
Removal of one knee cartilage using an endoscopeCPT 29881$2,638
Removal of one or more breast growth, open procedureCPT 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 laserCPT 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 olderCPT 49505$1,350
Shaving of shoulder bone using endoscopeCPT 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 exerciseCPT 97110$59
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