Supplies, drugs & other prices at Stormont Vail Hospital

Topeka, KS · every code in this section with a posted price and a Medicare benchmark.

55 codes. Prices are the hospital's own posted facility charges.

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ProcedureCash priceGross charge× Medicare
2d tte w or w/o fol w/con,fu (C8924) $1,355.57
Colon ca scrn not hi rsk ind (G0121) $3,414.61
Colorectal scrn; hi risk ind (G0105) $3,491.63
Covid-19 lab test non-cdc (U0002) $124.55
Drug test def 1-7 classes (G0480) $124.52
Drug test def 15-21 classes (G0482) $268.69
Drug test def 22+ classes (G0483) $334.23
Drug test def 8-14 classes (G0481) $212.34
Extrnl counterpulse, per tx (G0166) $633.16
Followup eval of foot pt lop (G0246) $374.97
Hbot, full body chamber, 30m (G0277) $891.78
Hepb screen high risk indiv (G0499) $216.38
Home sleep test/type 3 porta (G0399) $808.21
Hospital outpt clinic visit (G0463) $482.47
Insj/Rplcmt Icds W/Substernal Electrode (0571T) $70,552.50
Mra w/cont, chest (C8909) $2,998.69
Mra w/o cont, abd (C8901) $2,617.70
Mra w/o cont, chest (C8910) $2,616.67
Mra w/o cont, pelvis (C8919) $2,315.67
Mra w/o fol w/cont, abd (C8902) $3,774.10
Mra w/o fol w/cont, chest (C8911) $3,774.10
Mra w/o fol w/cont, lwr ext (C8914) $3,523.47
Mra w/o fol w/cont, pelvis (C8920) $3,531
Mri w/cont, breast, bi (C8906) $2,693.87
Mri w/o fol w/cont, breast, (C8908) $6,155.60
Neuro csf detcj prion prtn quakg conf conv qual (0035U) $1,688.30
Njx pltlt plasma w/img harvest/preparation (0232T) $743.90
Onc Merkel Cll Carc Srm Quan (0058U) $1,056.29
Oth resp proc, group (G0239) $103
Oth resp proc, indiv (G0238) $77.55
Perc d-e cor revasc chro sin (C9607) $53,161.07
Perc d-e cor revasc t cabg s (C9604) $65,287.46
Perc d-e cor stent ather s (C9602) $69,034.69
Perc drug-el cor stent sing (C9600) $42,724.15
Perq Sacral Augmt Bilat Inj (0201T) $13,185.42
Perq Sacral Augmt Unilat Inj (0200T) $9,994.44
Perq Tcat Ther Rx Dlvr Ntrac Rx Balo 1 Maj C Art (0913T) $34,115.85
Prostate biopsy, any mthd (G0416) $1,343.44
Rbc DNA hea 35 ag 11 bld grp whl bld cmn allel (0001U) $1,268.56
Revasc intra lithotrip-ather (C9766) $29,002.81
Revasc intra lithotrip-stent (C9765) $30,344.32
Revasc intravasc lithotripsy (C9764) $15,262.53
Revasc lith-sten-ath tib/per (C9775) $65,478.33
Revasc lithotr-ather tib/per (C9774) $30,808.50
Revasc lithotr-stent tib/per (C9773) $25,767.20
Revasc lithotrip tibi/perone (C9772) $20,627.32
Revasc lithotrip-stent-ather (C9767) $45,956.21
Therapeutic procd strg endur (G0237) $80
Trauma respons w/hosp criti (G0390) $14,222.74
Trluml peripheral atherectomy iliac artery ea (0238T) $20,694
Tte w or w/o contr, cont ecg (C8930) $2,907.30
Tte w or w/o fol w/con,stres (C8928) $3,267.75
Tte w or wo fol wcon,doppler (C8929) $3,828.47
Unsched dialysis esrd pt hos (G0257) $2,758.31
Vasc emb/occ w/prs cath (C9797) $31,771.05