Supplies, drugs & other prices at Pawnee Valley Community Hospital
Larned, KS · every code in this section with a posted price and a Medicare benchmark.
43 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|---|---|---|
| 2d tee w or w/o fol w/con,in (C8925) | $956 | $2,390 | 1.3× |
| 2d tte w or w/o fol w/con,fu (C8924) | $437 | $1,092.50 | 1.4× |
| Admin hepatitis b vaccine (G0010) | $14 | $35 | 0.3× |
| Admin influenza virus vac (G0008) | $36 | $90 | 0.8× |
| Admin pneumococcal vaccine (G0009) | $36 | $90 | 0.8× |
| Ca screen;pelvic/breast exam (G0101) | $14.80 | $37 | 0.2× |
| Colon ca scrn not hi rsk ind (G0121) | $900 | $2,250 | 1.1× |
| Colorectal scrn; hi risk ind (G0105) | $900 | $2,250 | 1.1× |
| Covid-19 lab test non-cdc (U0002) | $56 | $140 | 1.1× |
| Depression screen annual (G0444) | $13.60 | $34 | 0.4× |
| Diab manage trn ind/group (G0109) | $6 | $15 | 0.4× |
| Direct refer hospital observ (G0379) | $156 | $390 | 0.3× |
| Drug test def 1-7 classes (G0480) | $72 | $180 | 0.6× |
| Ekg tracing for initial prev (G0404) | $15.60 | $39 | 0.6× |
| Elec stim other than wound (G0283) | $52 | $130 | 4.1× |
| Ev fempop artl revsc tcat plmt IV st grf & clsr (0505T) | $8,052 | $20,130 | 0.8× |
| Hbot, full body chamber, 30m (G0277) | $1,660 | $4,150 | 13.1× |
| Hospital outpt clinic visit (G0463) | $72 | $180 | 0.6× |
| Inj for sacroiliac jt anesth (G0260) | $484 | $1,210 | 0.7× |
| Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that… (0216T) | $776 | $1,940 | 1.0× |
| Insj/Rplcmt Icds W/Substernal Electrode (0571T) unusually low: confirm this is the full procedure |
$9,200 | $23,000 | 0.3× |
| Mra w/o cont, abd (C8901) | $892 | $2,230 | 4.1× |
| Njx pltlt plasma w/img harvest/preparation (0232T) | $161.20 | $403 | 0.4× |
| Obtaining screen pap smear (Q0091) | $24.40 | $61 | 0.9× |
| Oth resp proc, group (G0239) | $68 | $170 | 2.0× |
| Oth resp proc, indiv (G0238) | $60 | $150 | 2.3× |
| Perc d-e cor revasc chro sin (C9607) unusually low: confirm this is the full procedure |
$6,916.80 | $17,292 | 0.4× |
| Perc d-e cor revasc t cabg s (C9604) | $5,792 | $14,480 | 0.5× |
| Perc d-e cor stent ather s (C9602) unusually low: confirm this is the full procedure |
$5,604 | $14,010 | 0.3× |
| Perc drug-el cor stent sing (C9600) | $8,210.40 | $20,526 | 0.8× |
| Psa screening (G0103) | $55.20 | $138 | 2.9× |
| Revasc intra lithotrip-ather (C9766) | $9,056 | $22,640 | 0.5× |
| Revasc intra lithotrip-stent (C9765) | $8,768 | $21,920 | 0.5× |
| Revasc intravasc lithotripsy (C9764) | $6,520 | $16,300 | 0.6× |
| Revasc lithotrip tibi/perone (C9772) | $8,098.40 | $20,246 | 0.8× |
| Therapeutic procd strg endur (G0237) | $44 | $110 | 1.7× |
| Tomosynthesis, mammo (G0279) | $24 | $60 | 1.9× |
| Transcatheter Renal Sympath Denervation Bilat (0339T) | $8,784 | $21,960 | 1.7× |
| Trauma respons w/hosp criti (G0390) | $1,436 | $3,590 | 1.2× |
| Trim nail(s) (G0127) | $13.20 | $33 | 0.2× |
| Tte w or w/o contr, cont ecg (C8930) | $1,000 | $2,500 | 1.4× |
| Tte w or wo fol wcon,doppler (C8929) | $1,220 | $3,050 | 1.7× |
| Unsched dialysis esrd pt hos (G0257) | $736 | $1,840 | 1.2× |