Supplies, drugs & other prices at Monument Health Custer Hospital
Custer, SD · every code in this section with a posted price and a Medicare benchmark.
57 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Abltj perc cryoabltj img gdn lxtr/perph nerve (0441T) range across 2 matching MRF lines |
$1,065.60–$1,440 | $1,332–$1,800 | varies |
| Adm of soc dtr assess 5-15 m (G0136) | $46.40 | $58 | 1.2× |
| Annual alcohol screen 15 min (G0442) | $76 | $95 | 2.0× |
| Arthro/shoul surg; w/spacer (C9781) | $16,920.80 | $21,151 | 1.3× |
| Behavior counsel obesity 15m (G0447) range across 2 matching MRF lines |
$71.20–$106.40 | $89–$133 | varies |
| Brief alcohol misuse counsel (G0443) | $118.40 | $148 | 1.1× |
| Ca screen;pelvic/breast exam (G0101) range across 2 matching MRF lines |
$101.60–$104.80 | $127–$131 | varies |
| Chemo extend iv infus w/pump (G0498) | $817.60 | $1,022 | 2.4× |
| Colon ca scrn not hi rsk ind (G0121) | $1,212.80 | $1,516 | 1.3× |
| Colorectal scrn; hi risk ind (G0105) | $949.60 | $1,187 | 1.0× |
| Depression screen annual (G0444) | $39.20 | $49 | 1.0× |
| Diab manage trn per indiv (G0108) | $90.40 | $113 | 1.6× |
| Diab manage trn ind/group (G0109) | $34.40 | $43 | 2.1× |
| Direct refer hospital observ (G0379) | $502.40 | $628 | 0.8× |
| Ed svc ckd grp per session (G0421) | $64 | $80 | 2.3× |
| Ed svc ckd ind per session (G0420) | $268 | $335 | 2.4× |
| Ekg tracing for initial prev (G0404) | $43.20 | $54 | 1.5× |
| Esd endoscopy or colonoscopy (C9779) | $4,576 | $5,720 | 1.2× |
| Group behave couns 2-10 (G0473) range across 2 matching MRF lines |
$33.60–$108 | $42–$135 | varies |
| High inten beh couns std 30m (G0445) | $118.40 | $148 | 1.1× |
| Home sleep test/type 4 porta (G0400) | $740 | $925 | 3.4× |
| Hospital outpt clinic visit (G0463) range across 2 matching MRF lines |
$163.20–$188.80 | $204–$236 | varies |
| Initial foot exam pt lops (G0245) | $175.20 | $219 | 1.3× |
| Initial preventive exam (G0402) range across 2 matching MRF lines |
$270.40–$452.80 | $338–$566 | varies |
| Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that… (0216T) | $2,253.60 | $2,817 | 2.5× |
| Intens behave ther cardio dx (G0446) | $50.40 | $63 | 1.3× |
| Mnt subs tx for change dx (G0270) | $92.80 | $116 | 2.9× |
| Njx dx/ther paraver fct jt w/us cer/thor 1 lvl (0213T) | $1,268 | $1,585 | 1.4× |
| Obtaining screen pap smear (Q0091) range across 2 matching MRF lines |
$78.40–$118.40 | $98–$148 | varies |
| Oth resp proc, group (G0239) | $138.40 | $173 | 3.6× |
| Oth resp proc, indiv (G0238) | $118.40 | $148 | 4.0× |
| Perc d-e cor revasc t cabg s (C9604) | $24,683.20 | $30,854 | 2.1× |
| Perc d-e cor stent ather s (C9602) | $33,860 | $42,325 | 1.8× |
| Perc drug-el cor stent sing (C9600) | $21,104 | $26,380 | 1.8× |
| Pne flu hepb cov home admin (M0201) | $72.80 | $91 | 2.0× |
| Ppps, initial visit (G0438) | $452.80 | $566 | 2.6× |
| Ppps, subseq visit (G0439) | $375.20 | $469 | 2.7× |
| Revasc intra lithotrip-ather (C9766) | $14,191.20 | $17,739 | 0.8× |
| Revasc intra lithotrip-stent (C9765) | $14,901.60 | $18,627 | 0.8× |
| Revasc intravasc lithotripsy (C9764) | $14,191.20 | $17,739 | 1.2× |
| Revasc lith-sten-ath tib/per (C9775) | $40,547.20 | $50,684 | 2.2× |
| Revasc lithotr-ather tib/per (C9774) | $40,547.20 | $50,684 | 2.2× |
| Revasc lithotr-stent tib/per (C9773) | $40,547.20 | $50,684 | 2.2× |
| Revasc lithotrip tibi/perone (C9772) | $25,359.20 | $31,699 | 2.2× |
| Revasc lithotrip-stent-ather (C9767) | $40,192 | $50,240 | 2.1× |
| Routine footcare pt w lops (G0247) | $492 | $615 | 2.4× |
| Tcat Rmvl/Debulk Icar Mass Suction Device Perq (0644T) | $13,956 | $17,445 | 2.4× |
| Therapeutic procd strg endur (G0237) | $100 | $125 | 3.4× |
| Trauma respons w/hosp criti (G0390) range across 6 matching MRF lines |
$2,959.20–$5,258.40 | $3,699–$6,573 | varies |
| Trgt gen seq alys sld orgn neo DNA 324 genes (0037U) | $2,884 | $3,605 | 0.8× |
| Trim nail(s) (G0127) range across 2 matching MRF lines |
$54.40–$87.20 | $68–$109 | varies |
| Trluml Perip Athrc Iliac Art (0238T) | $42,414.40 | $53,018 | 2.3× |
| Trnscut elect modlation pain reproces ea tx sess (0278T) | $221.60 | $277 | 1.7× |
| Unsched dialysis esrd pt hos (G0257) | $532 | $665 | 0.8× |
| Visit esketamine 56m or less (G2082) | $1,608.80 | $2,011 | 1.5× |
| Visit esketamine, > 56m (G2083) | $2,350.40 | $2,938 | 1.4× |
| Visit to determ ldct elig (G0296) | $216.80 | $271 | 2.1× |
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.