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Executive ProtocolsThe Greenbrier Clinic Comprehensive Health Programs are listed below and are age oriented. These protocols can also be tailored to the patient's executive needs. Discounts for these protocols will be determined upon the number of executives per company, per year. These protocols are used, however insurance may be billed, or we can discount if cash basis only.
UNDER 40 YEARS OF AGE PROTOCOL The recommended protocol used for the Greenbrier Clinic Comprehensive Health Programs for a patient under 40 years of age. CPT
| PROTOCOL
| MALE
| FEMALE
| | 99386/99396
| Preventative Exam | $381.00
| $381.00
| | 99213
| Level III Exam
| $121.00 | $121.00
| | 94010
| Spirometry
| $119.00
| $119.00
| | 92567
| Audiogram, Orthorater, Tonometry
| $42.00
| $42.00
| | 93000
| EKG
| $128.00 | $128.00
| | 97802
| Nutrition Consultation
| $139.00
| $139.00
| | 86141
| C- Reactive Protein
| $84.00
| $84.00
| | 82950
| 2 Hr Glucose
| $61.00
| $61.00
| | 80061
| Lipid Profile
| $90.00
| $90.00
| | 36415
| Venipuncture
| $14.00
| $14.00
| | 85025
| CBC, Diff, Platelets
| $43.00
| $43.00
| | 84443
| TSH
| $101.00
| $101.00
| | 82274
| Stool Occult Blood
| $40.00
| $40.00
| | 84466
| Transferrin
| $53.00
| $53.00 | | 83540
| Iron
| $36.00
| $36.00
| | 80053
| Comp. Metabolic Panel
| $170.00
| $170.00
| | 85651
| Sedimentation Rate
| $23.00 | $23.00
| | 88142
| PAP Smear
| N/A | $87.00
| | 76092
| Mammogram
| N/A | $275.00 | | 81003
| Urinalysis
| $29.00
| $29.00
| | 71020
| Chest, PA and Lateral
| $134.00 | $134.00
| | Total | | $1,808.00 | $2,170.00 | Listed below are examples of studies outside of the Protocol 45378 Colonoscopy $1,488.00
45378 Facility Fee (Room Usage) $1,104.00
93015 Stress Test $458.00
76497 CT Cardiac Calcium Scoring $433.00
93224 Holter Monitor $458.00
71259 CT of Lungs w/o dye $750.00
71260 CT of Lungs w/dye $1,198.00
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40 - 49 YEARS OF AGE PROTOCOL The recommended protocol used for the Greenbrier Clinic Comprehensive Health Programs for patients 40 to 49 years of age.
| CPT | PROTOCOL | MALE | FEMALE | | 99386/99396
| Preventative Exam
| $381.00
| $381.00
| | 99213
| Level III Exam | $121.00
| $121.00 | | 94010
| Spirometry | $119.00
| $119.00
| | 92567
| Audiogram, Orthorater, Tonometry
| $42.00
| $42.00
| | 93000
| EKG
| $128.00
| $128.00 | | 97802
| Nutrition Consultation
| $139.00 | $139.00 | | 86141
| C- Reactive Protein | $84.00 | $84.00 | | 82950
| 2 Hr Glucose
| $61.00 | $61.00 | | 80061 | Lipid Profile | $90.00 | $90.00 | | 36415
| Venipuncture | $14.00 | $14.00 | | 85025
| CBC, Diff, Platelets | $43.00 | $43.00 | | 84443 | TSH | $101.00 | $101.00 | | 82270
| Stool Occult Blood | $40.00
| $40.00 | | 84466
| Transferrin
| $53.00 | $53.00 | | 83540 | Iron | $36.00 | $36.00 | | 85651 | Sedimentation Rate | $23.00 | $23.00 | | 80053 | Comp. Metabolic Panel | $170.00 | $170.00 | | 84153 | PSA
| $126.00 | N/A | | 88142
| PAP Smear
| $87.00 | N/A | | 76092 | Mammogram
| $275.00 | N/A | | 76075 | Bone Mineral Density | $417.00 | $417.00 | | 76497
| Cardiac Calcium Scoring
| $433.00 | $433.00 | | 81003 | Urinalysis
| $23.00 | $23.00 | | 71020
| Chest, PA and Lateral
| $134.00 | $134.00 | | TOTAL
| | $2,778.00 | $3,014.00
| Listed below are examples of studies outside of the Protocol 45378 Colonoscopy $1,488.00
45378 Facility Fee (Room Usage) $1,104.00
93015 Stress Test $458.00
93224 Holter Monitor $458.00
71259 CT of Lungs w/o dye $750.00
71260 CT of Lungs w/dye $1,198.00
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50 YEARS OR OLDER PROTOCOL The recommended protocol used for the Greenbrier Clinic Comprehensive Health Programs for patients 50 years or older. | CPT | PROTOCOL | MALE | FEMALE | | 99386/99396
| Preventative Exam
| $381.00 | $381.00 | | 99213 | Level III Exam | $121.00 | $121.00 | | 94010
| Spirometry
| $119.00 | $119.00 | | 92567 | Audiogram, Orthorater, Tonometry | $42.00 | $42.00 | | 93000
| EKG | $128.00 | $128.00 | | 97802 | Nutrition Consultation | $139.00 | $139.00 | | 86141 | C- Reactive Protein | $84.00 | $84.00 | | 82950 | 2 Hr Glucose
| $61.00 | $61.00 | | 80061 | Lipid Profile | $90.00 | $90.00 | | 36415 | Venipuncture | $14.00 | $14.00 | | 85025 | CBC, Diff, Platelets | $43.00 | $43.00 | | 84443
| TSH | $101.00 | $101.00
| | 82270 | Stool Occult Blood | $40.00 | $40.00 | | 84466
| Transferrin | $53.00 | $53.00
| | 83540 | Iron | $36.00 | $36.00 | | 85651
| Sedimentation Rate | $23.00
| $23.00
| | 80053
| Comp. Metabolic Panel
| $170.00
| $170.00 | | 84153
| PSA | $126.00 | N.A | | 88142 | PAP Smear
| N/A | $87.00 | | 76092
| Mammogram
| N/A | $275.00 | | 76700 | Abdominal Ultrasound Complete | $463.00 | $463.00 | | 76075 | Bone Mineral Density | $417.00 | $417.00 | | 45378
| Colonoscopy
| $1,488.00
| $1,488.00 | | 45378 | Facility Fee (Room Usage)
| $1,104.00
| $1,104.00 | | 76497
| Cardiac Calcium Scoring
| $433.00 | $433.00 | | 81003 | Urinalysis
| $23.00 | $23.00 | | 71020
| Chest, PA and Lateral
| $134.00 | $134.00 | | TOTAL
|
| $5,833.00 | $6,069
| Listed below are examples of studies outside of the Protocol 93015 Stress Test $458.00
93224 Holter Monitor $458.00
71259 CT of Lungs w/o dye $750.00
71260 CT of Lungs w/dye $1,198.00
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