Updated 01/09/24
Patient Price Information List
Disclaimer: Columbia Memorial Hospital determines its standard charges for patient items and services through the use of a chargemaster system, which is a list of charges for the components of patient care that go into every patient’s bill. These are the baseline rates for items and services provided at the Hospital. The chargemaster is similar in concept to the manufacturer’s suggested retail price (“MSRP”) on a particular product or good. The charges listed provide only a general starting point in determining the potential costs of an individual patient’s care at the Hospital. This list does not reflect the actual out-of-pocket costs that may be paid by a patient for any particular service, it is not binding, and the actual charges for items and services may vary.
Many factors may influence the actual cost of an item or service, including insurance coverage, rates negotiated with payors, and so on. Government payors, such as Medicare and Medicaid for example, do not pay the chargemaster rates, but rather have their own set rates that hospitals are obligated to accept. Commercial insurance payments are based on contract negotiations with payors and may or may not reflect the standard charges. The cost of treatment also may be impacted by variables involved in a patient’s actual care, such as specific equipment or supplies required, the length of time spent in surgery or recovery, additional tests, or any changes in care or unexpected conditions or complications that arise. Moreover, the foregoing list of charges for services only includes charges from the Hospital. It does not reflect the charges for physicians, such as the surgeon, anesthesiologist, radiologist, pathologist, or other physician specialists or providers who may be involved in providing particular services to a patient. These charges are billed separately.
Individuals with questions about their out-of-pocket costs of service and other financial information should contact the hospital or consider contacting their insurers for further information.
Description
Private Room
Private Room
Semi-Private Room
Swing Bed
Private Telemetry
Semi-Private Telemetry
Intensive Care Unit
Description
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus [CPT 76805]
Automated urinalysis test [CPT 81003]
Biopsy of prostate gland [CPT 55700]
Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope [CPT 43239]
Biopsy of the large bowel using an endoscope (colonoscopy) [CPT 45380]
Blood test, basic group of blood chemicals (Calcium, total) [CPT 80048]
Blood test, clotting time [CPT 85610]
Blood test, comprehensive group of blood chemicals [CPT 80053]
Blood test, lipids (cholesterol and triglycerides) [CPT 80061]
Blood test, thyroid stimulating hormone (TSH) [CPT 84443]
CT scan head or brain [CPT 70450]
CT scan of abdomen and pelvis with contrast [CPT 74177]
CT scan pelvis with contrast [CPT 72193]
Cesarean delivery with pre- and post-delivery care [CPT 59510]
Coagulation assessment blood test, plasma or whole blood [CPT 85730]
Complete blood cell count (red cells, white blood cell, platelets), automated test [CPT 85027]
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count [CPT 85025]
Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope [CPT 43235]
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk [CPT 45378]
Diagnostic mammography of both breasts [CPT 77066]
Diagnostic mammography of one breast [CPT 77065]
Family psychotherapy including patient, 50 minutes [CPT 90847]
Family psychotherapy, 50 minutes [CPT 90846]
Initial new patient preventive medicine evaluation age 18-39 years [CPT 99385]
Initial new patient preventive medicine evaluation age 40-64 years [CPT 99386]
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, single level [CPT 64483]
Kidney function blood test panel [CPT 80069]
Liver function blood test panel [CPT 80076]
MRI scan of brain before and after contrast [CPT 70553]
MRI scan of leg joint [CPT 73721]
MRI scan of lower spinal canal [CPT 72148]
New patient outpatient visit, total time 30-44 minutes [CPT 99203]
New patient outpatient visit, total time 45-59 minutes [CPT 99204]
New patient outpatient visit, total time 60-74 minutes [CPT 99205]
Obstetrical pre- and postpartum care and vaginal delivery [CPT 59400]
PSA (prostate specific antigen) measurement, free [CPT 84154]
PSA (prostate specific antigen) measurement, total [CPT 84153]
Psychotherapy, 30 minutes [CPT 90832]
Psychotherapy, 45 minutes [CPT 90834]
Psychotherapy, 60 minutes [CPT 90837]
Removal of 1 or more breast growth, open procedure [CPT 19120]
Removal of cataract with insertion of lens, simple [CPT 66984]
Removal of gallbladder using an endoscope [CPT 47562]
Removal of one knee cartilage using an endoscope [CPT 29881]
Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare [CPT 45385]
Repair of groin hernia patient age 5 years or older [CPT 49505]
Screening mammography of both breasts [CPT 77067]
Shaving of shoulder bone using an endoscope [CPT 29826]
Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes [CPT 97110]
Total Knee or Hip Replacement
Ultrasound of abdomen, complete [CPT 76700]
Ultrasound pelvis through vagina [CPT 76830]
Urinalysis, manual test [CPT 81002]
X-ray of lower and sacral spine, minimum of 4 views [CPT 72110]
Description
Established patient outpatient visit, total time 10-19 minutes [CPT 99212]
Established patient outpatient visit, total time 20-29 minutes [CPT 99213]
Established patient outpatient visit, total time 30-39 minutes [CPT 99214]
Established patient outpatient visit, total time 40-54 minutes [CPT 99215]
Established patient periodic preventive medicine examination age 18-39 years [CPT 99395]
Established patient periodic preventive medicine examination age 40-64 years [CPT 99396]
Established patient periodic preventive medicine examination infant younger than 1 year [CPT 99391]
Established patient periodic preventive medicine examination, age 1 through 4 years [CPT 99392]
Established patient periodic preventive medicine examination, age 12 through 17 years [CPT 99394]
Established patient periodic preventive medicine examination, age 5 through 11 years [CPT 99393]
Established patient periodic preventive medicine examination, age 65 years and older [CPT 99397]
Initial new patient preventive medicine evaluation, age 65 years and older [CPT 99387]
New patient outpatient visit, total time 15-29 minutes [CPT 99202]
Physician telephone patient service, 11-20 minutes of medical discussion [CPT 99442]
Physician telephone patient service, 21-30 minutes of medical discussion [CPT 99443]
Physician telephone patient service, 5-10 minutes of medical discussion [CPT 99441]
Preventive medicine counseling, approximately 60 minutes [CPT 99404]
Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes [CPT 99406]
Description
Amplifed DNA or RNA probe detection of severe acute respiratory syndrome coronavirus 2 (Covid-19) antigen [CPT 87635]
Analysis for antibody to HIV-1 and HIV-2 virus [CPT 86703]
Bacterial blood culture [CPT 87040]
Bacterial colony count, urine [CPT 87086]
Bacterial culture for aerobic isolates [CPT 87077]
Bacterial culture, any other source except urine, blood or stool, aerobic [CPT 87070]
Blood count, hemoglobin [CPT 85018]
Blood creatinine level [CPT 82565]
Blood glucose (sugar) level [CPT 82947]
Blood glucose (sugar) measurement using reagent strip [CPT 82948]
Blood group typing (ABO) [CPT 86900]
Blood pH level [CPT 82800]
Blood typing for Rh (D) antigen [CPT 86901]
Cervicovaginal secretion of placenta protein [CPT 84112]
Creatinine level to test for kidney function or muscle injury [CPT 82570]
Cyanocobalamin (vitamin B-12) level [CPT 82607]
Detection test by immunoassay for identification of organism [CPT 87899]
Detection test by immunoassay technique for Hepatitis B surface antigen [CPT 87340]
Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique [CPT 87591]
Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique [CPT 87491]
Detection test by nucleic acid for clostridium difficile, amplified probe technique [CPT 87493]
Detection test by nucleic acid for human papillomavirus (hpv), high-risk types [CPT 87624]
Detection test by nucleic acid for multiple types influenza virus [CPT 87502]
Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution [CPT 87186]
Ferritin (blood protein) level [CPT 82728]
Flow cytometry technique for DNA or cell analysis, each additional marker [CPT 88185]
Gonadotropin (reproductive hormone) analysis [CPT 84703]
Gonadotropin, chorionic (reproductive hormone) level [CPT 84702]
Hemoglobin A1C level [CPT 83036]
Hepatitis C antibody measurement [CPT 86803]
Identification of organisms by genetic analysis, amplified probe technique [CPT 87150]
Iron binding capacity [CPT 83550]
Iron level [CPT 83540]
Lactate dehydrogenase (enzyme) level [CPT 83615]
Lactic acid level [CPT 83605]
Lipase (fat enzyme) level [CPT 83690]
Magnesium level [CPT 83735]
Measurement C-reactive protein for detection of infection or inflammation, high sensitivity [CPT 86141]
Measurement of bilirubin [CPT 88720]
Microscopic examination for white blood cells with manual cell count [CPT 85007]
Natriuretic peptide (heart and blood vessel protein) level [CPT 83880]
Pap test, automated thin layer preparation; automated system and manual rescreening [CPT 88175]
Pathology examination of tissue using a microscope, intermediate complexity [CPT 88305]
Psa screening [HCPCS G0103]
Red blood cell concentration measurement [CPT 85014]
Red blood cell sedimentation rate, to detect inflammation, non-automated [CPT 85651]
Screening test for compatible blood unit, using reagent serum [CPT 86902]
Screening test for mononucleosis (mono) [CPT 86308]
Semen analysis for sperm presence [CPT 89321]
Sex hormone binding globulin (protein) level [CPT 84270]
Special stained specimen slides to examine tissue, each additional procedure [CPT 88341]
Testing for presence of drug, read by instrument assisted observation [CPT 80306]
Thyroxine (thyroid chemical), free [CPT 84439]
Troponin (protein) analysis, quantitative [CPT 84484]
Urine pregnancy test [CPT 81025]
Vitamin D-3 level [CPT 82306]
Description
Behavior counsel obesity 15m [HCPCS G0447]
Description
Medical nutrition therapy re-assessment and intervention, each 15 minutes [CPT 97803]
Medical nutrition therapy, assessment and intervention, each 15 minutes [CPT 97802]
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session [CPT 93798]
Psychotherapy performed with evaluation and management visit, 30 minutes [CPT 90833]
Vaccine for diphtheria, tetanus toxoids, acellular pertussis (whooping cough), and polio for injection into muscle, patient 4 through 6 years of age [CPT 90696]
Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes [CPT 97113]
Description
Diab manage trn per indiv [HCPCS G0108]
Diab manage trn ind/group [HCPCS G0109]
Foot longitud/metatarsal sup [HCPCS L3020]
Group behave couns 2-10 [HCPCS G0473]
Health behavior assessment, or re-assessment [CPT 96156]
Health behavior intervention, individual, face-to-face; each additional 15 minutes [CPT 96159]
Health behavior intervention, individual, face-to-face; initial 30 minutes [CPT 96158]
Ppps, initial visit [HCPCS G0438]
Ppps, subseq visit [HCPCS G0439]
Description
Injection of different drug or substance into a vein for therapy, diagnosis, or prevention [CPT 96375]
Description
Evaluation of occupational therapy, typically 30 minutes [CPT 97165]
Evaluation of occupational therapy, typically 45 minutes [CPT 97166]
Evaluation of physical therapy, typically 20 minutes [CPT 97161]
Evaluation of physical therapy, typically 30 minutes [CPT 97162]
Manual (physical) therapy techniques to 1 or more regions, each 15 minutes [CPT 97140]
Re-evaluation of physical therapy, typically 20 minutes [CPT 97164]
Self-care or home management training, each 15 minutes [CPT 97535]
Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes [CPT 97530]
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes [CPT 97112]
Treatment of speech, language, voice, communication, and/or hearing processing disorder [CPT 92507]
Walking training to 1 or more areas, each 15 minutes [CPT 97116]
Description
Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device [CPT 94664]
Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration [CPT 94060]
Routine electrocardiogram (EKG) with tracing using at least 12 leads [CPT 93005]
Description
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen [CPT 94640]
Description
Banding of hemorrhoids using a flexible endoscope (colonoscope) [CPT 45398]
Biopsy of breast accessed through the skin with ultrasound guidance, first lesion [CPT 19083]
Destruction of up to 14 skin growths [CPT 17110]
Ear piercing [CPT 69090]
Fetal non-stress test [CPT 59025]
Fine needle aspiration of first lesion using ultrasound guidance [CPT 10005]
Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope, each additional implant [CPT 52442]
Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope, single implant [CPT 52441]
Insertion of needle into vein for collection of blood sample [CPT 36415]
Placement of intra-uterine device (IUD) for pregnancy prevention [CPT 58300]
Removal of 2 to 4 thickened skin growths [CPT 11056]
Removal of intra-uterine device (IUD) for pregnancy prevention [CPT 58301]
Removal of more than 4 thickened skin growths [CPT 11057]
Removal of nail [CPT 11750]
Removal of single thickened skin growth [CPT 11055]
Removal of skin tags [CPT 11201]
Removal of sperm duct [CPT 55250]
Removal of up to and including 15 skin tags [CPT 11200]
Repair of incisional or abdominal hernia, initial or primary, not trapped [CPT 49560]
Repair of inside OR outside knee joint cartilage (meniscus) using an endoscope (arthroscopy) [CPT 29882]
Repair of knee joint, lower or upper part of joint, inside and outside area [CPT 27447]
Replacement of thigh bone and hip joint prosthesis [CPT 27130]
Description
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus [CPT 76801]
Bone and/or joint imaging, whole body [CPT 78306]
Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine) [CPT 77080]
CT scan abdomen before and after contrast [CPT 74170]
CT scan head or brain before and after contrast [CPT 70470]
CT scan of abdomen and pelvis [CPT 74176]
CT scan of abdomen and pelvis before and after contrast [CPT 74178]
CT scan of abdominal blood vessels with contrast [CPT 74175]
CT scan of blood vessel of head with contrast [CPT 70496]
CT scan of blood vessels in chest with contrast [CPT 71275]
CT scan of face [CPT 70486]
CT scan of face with contrast [CPT 70487]
CT scan of lower spine [CPT 72131]
CT scan of middle spine [CPT 72128]
CT scan of neck [CPT 70490]
CT scan of neck blood vessels with contrast [CPT 70498]
CT scan of neck with contrast [CPT 70491]
CT scan of upper spine [CPT 72125]
CT scan pelvis [CPT 72192]
Diagnostic CT scan of chest [CPT 71250]
Diagnostic CT scan of chest with contrast [CPT 71260]
Digital tomography of both breasts [CPT 77062]
Digital tomography of one breast [CPT 77061]
Follow-up or limited ultrasound examination of heart [CPT 93308]
Intensity modulated radiation therapy delivery, complex [CPT 77386]
Intensity modulated radiation therapy delivery, simple [CPT 77385]
Ldct for lung ca screen [HCPCS G0297]
MRA scan of head blood vessels [CPT 70544]
MRI of both breasts [CPT 77047]
MRI of both breasts with and without contrast [CPT 77049]
MRI of one breast with and without contrast [CPT 77048]
MRI scan bones of the eye, face, and/or neck [CPT 70540]
MRI scan bones of the eye, face, and/or neck before and after contrast [CPT 70543]
MRI scan bones of the eye, face, and/or neck with contrast [CPT 70542]
MRI scan brain [CPT 70551]
MRI scan of abdomen [CPT 74181]
MRI scan of abdomen before and after contrast [CPT 74183]
MRI scan of arm [CPT 73218]
MRI scan of arm before and after contrast [CPT 73220]
MRI scan of arm joint [CPT 73221]
MRI scan of arm joint before and after contrast [CPT 73223]
MRI scan of arm joint with contrast [CPT 73222]
MRI scan of arm with contrast [CPT 73219]
MRI scan of brain with contrast [CPT 70552]
MRI scan of chest [CPT 71550]
MRI scan of chest before and after contrast [CPT 71552]
MRI scan of chest with contrast [CPT 71551]
MRI scan of leg [CPT 73718]
MRI scan of leg before and after contrast [CPT 73720]
MRI scan of leg joint before and after contrast [CPT 73723]
MRI scan of leg joint with contrast [CPT 73722]
MRI scan of leg with contrast [CPT 73719]
MRI scan of lower spinal canal before and after contrast [CPT 72158]
MRI scan of lower spinal canal with contrast [CPT 72149]
MRI scan of middle spinal canal [CPT 72146]
MRI scan of middle spinal canal before and after contrast [CPT 72157]
MRI scan of middle spinal canal with contrast [CPT 72147]
MRI scan of pelvis [CPT 72195]
MRI scan of pelvis before and after contrast [CPT 72197]
MRI scan of pelvis with contrast [CPT 72196]
MRI scan of upper spinal canal [CPT 72141]
MRI scan of upper spinal canal before and after contrast [CPT 72156]
MRI scan of upper spinal canal with contrast [CPT 72142]
Nuclear medicine study with CT imaging skull base to mid-thigh [CPT 78815]
Nuclear medicine study with CT imaging whole body [CPT 78816]
Radiation therapy consultation per week [CPT 77336]
Radiation treatment delivery, complex [CPT 77412]
Radiological supervision and interpretation of CT guidance for needle insertion [CPT 77012]
Screening digital tomography of both breasts [CPT 77063]
Ultrasound examination and continuous monitoring of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report [CPT 93351]
Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function [CPT 93306]
Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow [CPT 93976]
Ultrasound of abdomen, limited [CPT 76705]
Ultrasound of head and neck [CPT 76536]
Ultrasound of one breast, complete [CPT 76641]
Ultrasound of pelvis, complete, not pregnancy related [CPT 76856]
Ultrasound of pregnant uterus, 1 or more fetus(es) [CPT 76815]
Ultrasound re-evaluation of pregnant uterus, per fetus [CPT 76816]
Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow [CPT 93975]
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers [CPT 93970]
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers [CPT 93971]
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck [CPT 93880]
Ultrasound study of arteries of both arms and legs, limited [CPT 93922]
X-ray of abdomen, 1 view [CPT 74018]
X-ray of abdomen, 2 views [CPT 74019]
X-ray of ankle, 2 views [CPT 73600]
X-ray of ankle, minimum of 3 views [CPT 73610]
X-ray of both knees, standing, front to back view [CPT 73565]
X-ray of chest, 1 view [CPT 71045]
X-ray of chest, 2 views [CPT 71046]
X-ray of collar bone [CPT 73000]
X-ray of elbow, 2 views [CPT 73070]
X-ray of elbow, minimum of 3 views [CPT 73080]
X-ray of foot, 2 views [CPT 73620]
X-ray of foot, minimum of 3 views [CPT 73630]
X-ray of hand, 2 views [CPT 73120]
X-ray of hand, minimum of 3 views [CPT 73130]
X-ray of hip with pelvis, 1 view [CPT 73501]
X-ray of hip with pelvis, 2-3 views [CPT 73502]
X-ray of knee, 1 or 2 views [CPT 73560]
X-ray of knee, 3 views [CPT 73562]
X-ray of knee, 4 or more views [CPT 73564]
X-ray of lower and sacral spine, 2 or 3 views [CPT 72100]
X-ray of pelvis, 1 or 2 views [CPT 72170]
X-ray of pelvis, minimum of 2 views [CPT 72220]
X-ray of pelvis, minimum of 3 views [CPT 72190]
X-ray of shoulder blade [CPT 73010]
X-ray of shoulder, 1 view [CPT 73020]
X-ray of shoulder, minimum of 2 views [CPT 73030]
X-ray of spine of neck, 2 or 3 views [CPT 72040]
X-ray of wrist, 2 views [CPT 73100]
X-ray of wrist, minimum of 3 views [CPT 73110]
Description
Total Shoulder Replacement
How You Can Help
Thank you for choosing Columbia Memorial Hospital for your healthcare needs. As part of our commitment to delivering EXCELLENT service, we want to make understanding and paying your bill as easy as possible. Here are some ways you can help us as we work to make the billing process go smoothly.
• Please give us complete health insurance information.
In addition to your health insurance card, we may ask for a photo ID. If you have been seen at Columbia Memorial Hospital, let us know if your personal information or insurance information has changed since your last visit.
• Please understand and follow the requirements of your health plan.
Be sure to know your benefits, obtain proper authorization for services and submit referral claim forms if necessary. Many insurance plans require patients to pay a co-payment or deductible amount. You are responsible for paying co-payments required by your insurance provider and Columbia Memorial Hospital is responsible for collecting co-payments. Please come to your appointment prepared to make your co-payment.
• Please respond promptly to any requests from your insurance provider.
You may receive multiple bills for your hospital visit, including your family doctor, specialists, physicians to read x-rays, give anesthesia, or do blood work. Insurance benefits are the result of your contract with your insurance company. We are a third-party to those benefits and may need your help with your insurance. If your insurance plan does not pay the bill within 90 days after billing, or your claim is denied, you will receive a statement from Columbia Memorial Hospital indicating the bill is now your responsibility. All bills sent to you are due upon receipt.
Questions about Price and Billing Information
Our goal is for each of our patients and their families to have the best healthcare experience possible. Part of our commitment is to provide you with information that helps you make well informed decisions about your own care.
To ask questions or get more information about a bill for services you've received, please contact our Customer Call Center at 503-338-7530.
If you need more information about the price of a future service, please contact our Price Hotline at 503-338-7530. A CPT code is strongly encouraged when you call. You can obtain the CPT code from the ordering physician.
Financial Assistance
We are pleased to offer financial assistance to patients with limited resources and inadequate medical insurance coverage. Eligibility is determined by total family income/assets. The patient must agree to apply for other assistance available to pay hospital charges (Medicaid, Medicare, private insurance) before being discharged.
Columbia Memorial Hospital's Charity Care Policy
Columbia Memorial Hospital provides high quality care to everyone, regardless of their ability to pay.
Columbia Memorial Hospital's charity care policy includes:
• Substantial charity care guidelines that provide free care for individuals and families who earn less than 200 percent of the federal poverty level.
• Sliding scale fees to provide substantially discounted care for individuals and families who are between 200 and 400 percent of the federal poverty level.
• Hardship policy for those patients who would not otherwise qualify for charity care but have unique circumstances.
In many cases, Columbia Memorial Hospital offers interest free loans for up to one year to assist patients.
For more information, please contact our Customer Call Center at 503-338-7530.
