17 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|
| Admin influenza virus vac (G0008) |
$47.70 |
$159 |
1.1× |
| Admin pneumococcal vaccine (G0009) |
$40.50 |
$135 |
1.0× |
| Direct refer hospital observ (G0379) |
$199.35 |
$664.50 |
0.4× |
| Drug test def 1-7 classes (G0480) |
$111 |
$370 |
1.0× |
| Drug test def 8-14 classes (G0481) |
$99 |
$330 |
0.6× |
| Elec stim other than wound (G0283) |
$31.20 |
$104 |
2.5× |
| Home sleep test/type 3 porta (G0399) |
$109.95 |
$366.50 |
0.6× |
| Hospital outpt clinic visit (G0463) |
$141.08 |
$470.25 |
1.2× |
| Perc d-e cor revasc t cabg s (C9604) |
$8,947.35 |
$29,824.50 |
0.9× |
| Prostate biopsy, any mthd (G0416) |
$212.70 |
$709 |
0.7× |
| Psa screening (G0103) |
$94.20 |
$314 |
4.9× |
| Real-time fluorescence wound imaging with clinical darkness, to identify location of bacterial wound pathogens and… (0598T) |
$189.15 |
$630.50 |
1.0× |
| Revasc intra lithotrip-ather (C9766) |
$29,999.70 |
$99,999 |
1.8× |
| Revasc intra lithotrip-stent (C9765) |
$29,999.70 |
$99,999 |
1.8× |
| Revasc lithotrip-stent-ather (C9767) |
$29,999.70 |
$99,999 |
1.8× |
| Therapeutic procd strg endur (G0237) |
$44.10 |
$147 |
1.7× |
| Tomosynthesis, mammo (G0279) |
$27 |
$90 |
2.1× |