Supplies, drugs & other prices at Citizens Memorial Hospital
Bolivar, MO · every code in this section with a posted price and a Medicare benchmark.
57 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Cash price | Gross charge | × Medicare |
|---|---|---|---|
| 2d tee w or w/o fol w/con,in (C8925) | $2,352 | $2,940 | 3.0× |
| 2d tte w or w/o fol w/con,co (C8923) | $1,668.60 | $2,085.75 | 2.1× |
| 2d tte w or w/o fol w/con,fu (C8924) | $1,710.60 | $2,138.25 | 4.9× |
| Admin hepatitis b vaccine (G0010) | $42.30 | $52.88 | 0.9× |
| Admin influenza virus vac (G0008) | $53.80 | $67.25 | 1.1× |
| Admin pneumococcal vaccine (G0009) | $53.80 | $67.25 | 1.1× |
| Ca screen;flexi sigmoidscope (G0104) | $1,640.60 | $2,050.75 | 1.8× |
| Catheterize for urine spec (P9612) | $28.80 | $36 | 3.1× |
| Colon ca scrn not hi rsk ind (G0121) | $1,681.70 | $2,102.12 | 1.8× |
| Colorectal scrn; hi risk ind (G0105) | $1,640.60 | $2,050.75 | 1.8× |
| Cysto impl 4 or more (C9740) | $4,889.80 | $6,112.25 | 0.5× |
| Cystoscopy prostatic imp 1-3 (C9739) | $3,954.90 | $4,943.62 | 0.7× |
| Diab manage trn per indiv (G0108) | $121.20 | $151.50 | 2.2× |
| Diab manage trn ind/group (G0109) | $27.80 | $34.75 | 1.7× |
| Direct refer hospital observ (G0379) | $205.90 | $257.38 | 0.3× |
| Drug test def 1-7 classes (G0480) | $346.50 | $433.12 | 3.0× |
| Drug test def 8-14 classes (G0481) | $98.40 | $123 | 0.6× |
| Elec stim other than wound (G0283) | $104.80 | $131 | 8.3× |
| Group mnt 2 or more 30 mins (G0271) | $24.80 | $31 | 1.5× |
| Hbot, full body chamber, 30m (G0277) | $193.60 | $242 | 1.4× |
| Home sleep test/type 3 porta (G0399) | $708.70 | $885.88 | 3.3× |
| Hospital outpt clinic visit (G0463) | $148 | $185 | 1.1× |
| Hpv combo assay ca screen (G0476) | $162.40 | $203 | 4.6× |
| Inj for sacroiliac jt anesth (G0260) | $1,076.70 | $1,345.88 | 1.5× |
| Mnt subs tx for change dx (G0270) | $42.60 | $53.25 | 1.3× |
| Mra w/cont, abd (C8900) | $2,886.60 | $3,608.25 | 8.3× |
| Mra w/cont, lwr ext (C8912) | $3,397 | $4,246.25 | 9.7× |
| Mra w/o cont, abd (C8901) | $1,969.40 | $2,461.75 | 8.2× |
| Mra w/o cont, lwr ext (C8913) | $659.20 | $824 | 2.8× |
| Mra w/o fol w/cont, abd (C8902) | $3,134.60 | $3,918.25 | 9.0× |
| Mri w/o fol w/cont, breast, (C8908) | $3,929.40 | $4,911.75 | 11.2× |
| Njx dx/ther paraver fct jt w/us cer/thor 1 lvl (0213T) | $430.40 | $538 | 0.5× |
| Njx pltlt plasma w/img harvest/preparation (0232T) | $466.40 | $583 | 1.0× |
| Obtaining screen pap smear (Q0091) | $78.40 | $98 | 2.7× |
| Oth resp proc, indiv (G0238) | $68.30 | $85.38 | 2.4× |
| Perc d-e cor revasc chro sin (C9607) | $22,729.60 | $28,412 | 1.2× |
| Perc d-e cor revasc t cabg s (C9604) | $13,364.80 | $16,706 | 1.2× |
| Perc d-e cor stent ather s (C9602) | $26,700.30 | $33,375.38 | 1.5× |
| Perc drug-el cor stent sing (C9600) | $15,290.20 | $19,112.75 | 1.3× |
| Prostate biopsy, any mthd (G0416) | $683.90 | $854.88 | 1.9× |
| Psa screening (G0103) | $142.70 | $178.38 | 7.4× |
| Rbc DNA hea 35 ag 11 bld grp whl bld cmn allel (0001U) | $494.40 | $618 | 0.7× |
| Revasc intra lithotrip-ather (C9766) | $16,503.20 | $20,629 | 0.9× |
| Revasc intra lithotrip-stent (C9765) | $17,328.40 | $21,660.50 | 0.9× |
| Revasc intravasc lithotripsy (C9764) | $9,081.40 | $11,351.75 | 0.8× |
| Revasc lith-sten-ath tib/per (C9775) | $16,503.20 | $20,629 | 0.9× |
| Revasc lithotr-ather tib/per (C9774) | $16,503.20 | $20,629 | 0.9× |
| Revasc lithotr-stent tib/per (C9773) | $16,503.20 | $20,629 | 0.9× |
| Revasc lithotrip tibi/perone (C9772) | $8,648.80 | $10,811 | 0.7× |
| Revasc lithotrip-stent-ather (C9767) | $16,503.20 | $20,629 | 0.9× |
| Screen pap by tech w md supv (P3000) | $34.20 | $42.75 | 1.8× |
| Therapeutic procd strg endur (G0237) | $311 | $388.75 | 10.7× |
| Tomosynthesis, mammo (G0279) | $126.40 | $158 | 10.0× |
| Trim nail(s) (G0127) | $50.40 | $63 | 0.9× |
| Trluml peripheral atherectomy iliac artery ea (0238T) | $20,560.40 | $25,700.50 | 1.1× |
| Tte w or w/o fol w/con,stres (C8928) | $2,309.80 | $2,887.25 | 2.9× |
| Tte w or wo fol wcon,doppler (C8929) | $2,653.40 | $3,316.75 | 3.4× |