Pricing Information

WCDH Pricing Schedule for Common Procedures, Test, Exams, Etc.
Inpatient Procedures DRG/CPT/PCS Average/Estimated Price
Deliveries
Vaginal Delivery without Complications 00560/10E0XZZ $7,500.00
Cesarean Section without Complications 00766/10E00Z1 $23,000.00
Newborns
Normal Newborn 00795/99460/99238 $2,600.00
Orthopedic
Major Joint Replacement (Hip 00470/0SRB039 $62,000.00
Major Joint Replacement (Knee) 00470/0SRC0J9 $60,000.00
Major Joint Replacement (Shoulder) 00470/23472 $55,000.00
General Surgery
Colonoscopy – Diagnostic 45378 $5,200.00
Colonoscopy – Biopsy 45380 $5,500.00
Colonoscopy – Leison Removal 45385 $5,800.00
Upper GI Endoscopy – Diagnostic 43235 $6,800.00
Upper GI Endoscopy – Biopsy 43239 $11,000.00
Removal of Tonsils and Adnoids > 12 42820 $8,500.00
Removal of Tonsils and Adnoids < 12 42821 $11,600.00
Emergency Room – Does not include Lab, Radiology, etc.
Level 1 99281 $240.00
Level 2 99282 $425.00
Level 3 99283 $615.00
Level 4 99284 $1,135.00
Level 5 99285 $1,800.00
Lab & Pathology
Antibody Screen 86850 $102.00
Blood Type and RH 86900/86901 $166.00
Basic Metabolic Panel 80048 $116.00
BNP (Heart Failure) 83880 $184.00
Capillary Collection (Fingerstick or Heelstick) 36416 $11.00
Complet Bood Count 85025 $108.00
Chlamydia/GC–Urine STD screen 87491/87591 $193.00
Comprehensive Metabolic Panel 80053 $145.00
CRP (C- Reative Protein) 86140 $74.00
Crossmatch/per unit 86921 $208.00
EKG 93005 $153.00
Folate 82746 $45.00
FT3 (Free T3) PSPC 84481 $121.00
FT4 (Free T4) 84439 $71.00
Glucose tolerance –1 hour (drink plus 1 glucose) 82950 $100.00
Glucose tolerance–3 hour OB (4 glucose plus drink) 82951/82952 $313.00
Hemoglobin A1C 83036 $93.00
Hemoglobin and Mematocrit 85018/85014 $39.00
HPV (Human Papilloma Virus) 87624 $130.00
H. pylori 86677 $100.00
Influenza A & B by PCR Testing 87502 $143.00
INR–POC (Fingerstick) 85610 $18.00
Lipid Panel (Cholesterol panel) 80061 $159.00
Liver Function Panel 80076 $160.00
Microalbumin/Creat–Urine 82043/82570 $71.00
PAP Smear PSPC 88142 $73.00
Protime w INR 85610 $73.00
Prostate Screening Antigen 84153 $107.00
Sedimentation Rate (also referred to as ESR) 85651 $73.00
Strep A screen–Rapid 87880 $48.00
Thyroid Panel 5 84443/84439 $195.00
Thyroid Stimulating Hormone 84443 $124.00
Urinalysis 81001 $66.00
Urine Culture PSPC (additional fee for ID and Sensitivity testing) 87086 $46.00
Urine Drug Screen 80306 $58.00
Venipuncture 36415 $23.00
Vitamin B12 82607 $44.00
Vitamin D screen 82652 $217.00
Hip X-ray 2-3 views with Pelvis 73502 $565.00
CT Scan Head/Brain without Contrast 70450 $1,540.00
CT Abdomen/Pelvis with Contrast 74177 $3,080.00
CT Abdomen/Pelvis without Contrast 74176 $3,080.00
MRI Brain without Contrast 70551 $2,234.00
MRI Cervical Spine without Contrast 72141 $2,234.00
MRI Lumbar Spine without Contrast 72148 $2,234.00
MRI Upper Extremity Joint without Contrast 73221 $2,234.00
MRI Lower Extremity Joint without Contrast 73721 $2,234.00
Ultrasound OB > 14 weeks 76805 $909.00
Ultrasound Abdomen Complete 76700 $909.00
Mammogram Screening Bilateral 77067 $315.00
Cardiology & Respiratory Therapy
Cardiac Rehab monitored 93798 $190.00
Cardiac Rehab unmonitored 93797 $95.00
Holter Monitor 24 Hour 93225 $170.00
Holter Monitor 48 Hour 93225 $170.00
Event Monitor 93270 $65.00
PADNET 93923 $400.00
Exercise Stress Test 43017 $725.00
Pulmonary Rehab Evaluation per 15 Minutes 94799 $146.00
Pulse Ox Continuous Overnight 94762 $182.00
Spirometry 94010 $218.00
PFT Pre/Post Fitness Evaluation 94620 $291.00
Pulmonary Function Test Pre & Post BD 94060 $500.00
Sleep Study Routine Polysomnagraphy 95810 $2,194.00
Sleep Study Split Night Polysomnagraphy 95811 $2,130.00
Therapies
Physical Therapy – Low Complexity 97161 $110.00
Occupational Therapy – Low Complexity 97166 $117.00
Occupational Therapy – Thereputic Exercise 97110 $46.00
Speech Therapy $160.00
Clinic Visits
Level 1 Established Patient 99211 $42.00
Level 2 Established Patient 99212 $78.00
Level 3 New Patient 99203 $160.00
Level 3 Established Patient 99213 $108.00
Level 4 Established Patient 99214 $175.00
Level 5 Established Patient 99215 $232.00
Well Child Exam New Patient $210.00
Well Child Exam Established Patient $180.00

Emergency Fees

When a patient visits an emergency department, facilities charge an emergency department fee to pay for the patient’s care.  This fee provides for the nurses, staff, equipment and other things the patient needs in the ER as well as the cost of keeping these available 24 hours a day.  The fee does not provide for the doctor or additional tests and treatments. These are billed separately.

Patients who need a higher level of care will be charged a higher facility fee.  A level 1 or 2 emergency department fee might be charged for a very minor or simple condition like a minor viral infection or minor skin rash that requires little to no time in an ER, no tests or treatments and no prescription.  Often these conditions can be best cared for in a primary care location.  A level 4 or 5 emergency department fee may be charged for a medical condition that requires multiple tests and screenings to diagnosis and/or complex care to address.

Codes and prices represent the care, tests and treatments needed by the patient, not the resulting diagnosis.  For example, a patient who has a serious headache might need advance care and screening to rule out stroke or other potentially serious or life threatening conditions and thus be assessed at a level 4 or level 5, even if the resulting diagnosis is minor.  A patient who presents with chest pain might need tests and screenings to rule out a heart attack and receive a level 4 or level 5 bill even if he or she is determined to not be experiencing a heart attack.  The federal Emergency Medical Treatment and Labor Act (EMTALA) forbids staff or providers in a n emergency department from discussing prices or insurance coverage until after a patient has been medically screened by a physician.

While the pricing information posted on this site is a good faith estimate of prices, Wray Hospital & Clinic cannot guarantee the accuracy of these prices.  Prices are based on modeling of a range of patient visits and do not account for any unforeseen complications, additional tests or procedures, medical provider bills and non-hospital related charges.  Any of which may increase the final cost of the services provided.  Prospective patients should understand that a final bill or bills for services rendered may differ substantially from the information provided by this website and Wray Hospital & Clinic shall not be liable for any pricing disparities.