Supplies, drugs & other prices at Aspirus Lake View Hospital
Two Harbors, MN · every code in this section with a posted price and a Medicare benchmark.
102 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|---|---|---|
| 2d tee w or w/o fol w/con,in (C8925) | $2,264.07 | $2,751 | 2.8× |
| 2d tte w or w/o fol w/con,co (C8923) | $2,169.43 | $2,636 | 2.7× |
| 2d tte w or w/o fol w/con,fu (C8924) | $1,211.46 | $1,472 | 3.4× |
| Admin hepatitis b vaccine (G0010) | $60.90 | $74 | 1.3× |
| Admin influenza virus vac (G0008) | $34.57 | $42 | 0.7× |
| Admin pneumococcal vaccine (G0009) | $34.57 | $42 | 0.7× |
| Assistive algorithmic analysis of acoustic and electrocardiogram recording for detection of cardiac dysfunction (eg,… (0962T) | $138.26 | $168 | 1.0× |
| Ca screen;flexi sigmoidscope (G0104) | $794.20 | $965 | 0.8× |
| Ca screen;pelvic/breast exam (G0101) | $124.68 | $151.50 | 1.2× |
| Catheterize for urine spec (P9612) | $18.11 | $22 | 1.9× |
| Colon ca scrn not hi rsk ind (G0121) | $2,036.10 | $2,474 | 2.1× |
| Colorectal scrn; hi risk ind (G0105) | $2,222.92 | $2,701 | 2.3× |
| Demonstrate use home inr mon (G0248) | $354.71 | $431 | 2.6× |
| Depression screen annual (G0444) | $39.50 | $48 | 1.0× |
| Diab manage trn per indiv (G0108) | $195.05 | $237 | 3.5× |
| Diab manage trn ind/group (G0109) | $55.14 | $67 | 3.4× |
| Direct refer hospital observ (G0379) | $272.41 | $331 | 0.4× |
| Drug test def 1-7 classes (G0480) | $297.93 | $362 | 2.6× |
| Drug test def 15-21 classes (G0482) | $328.38 | $399 | 1.7× |
| Drug test def 22+ classes (G0483) | $643.18 | $781.50 | 2.6× |
| Drug test def 8-14 classes (G0481) | $259.24 | $315 | 1.7× |
| Ekg tracing for initial prev (G0404) | $106.17 | $129 | 3.6× |
| Elec stim other than wound (G0283) | $95.47 | $116 | 7.5× |
| Ephys eval ccm-d ld separate (0931T) | $6,100.90 | $7,413 | 4.9× |
| Esd endoscopy or colonoscopy (C9779) | $5,629.32 | $6,840 | 1.4× |
| Esophag muc integ w/eso egd (C9777) | $4,435.15 | $5,389 | 1.1× |
| Extrnl counterpulse, per tx (G0166) | $2,186.71 | $2,657 | 15.9× |
| Fecal blood scrn immunoassay (G0328) | $108.64 | $132 | 6.0× |
| Hbot, full body chamber, 30m (G0277) | $809.01 | $983 | 5.7× |
| Hep c screen high risk/other (G0472) | $149.79 | $182 | 3.2× |
| Hepb screen high risk indiv (G0499) | $288.05 | $350 | 10.2× |
| Home sleep test/type 3 porta (G0399) | $770.33 | $936 | 3.5× |
| Iliac Atherectomy (0238T) | $14,271.64 | $17,341 | 0.8× |
| Initial foot exam pt lops (G0245) | $111.10 | $135 | 0.8× |
| Initial preventive exam (G0402) | $244.02 | $296.50 | 1.8× |
| Inj for sacroiliac jt anesth (G0260) | $985.13 | $1,197 | 1.4× |
| Insj ant sgm drg dev trab mw w/o res&ctrc rmvl1+ (0671T) | $7,115.66 | $8,646 | 1.3× |
| Interrogation device evaluation (remote), up to 90 days, cardiac contractility modulation system, remote data… (0949T) | $142.38 | $173 | 3.7× |
| Magnetically controlled capsule endoscopy w/i&r (0651T) | $4,074.68 | $4,951 | 4.4× |
| Mnt subs tx for change dx (G0270) | $55.14 | $67 | 1.7× |
| Mra w/cont, abd (C8900) | $3,911.72 | $4,753 | 10.9× |
| Mra w/cont, lwr ext (C8912) | $2,848.40 | $3,461 | 7.9× |
| Mra w/cont, pelvis (C8918) | $656.75 | $798 | 1.8× |
| Mra w/o cont, abd (C8901) | $2,594.10 | $3,152 | 10.5× |
| Mra w/o cont, chest (C8910) | $2,651.71 | $3,222 | 10.8× |
| Mra w/o cont, lwr ext (C8913) | $1,681.39 | $2,043 | 6.8× |
| Mra w/o cont, pelvis (C8919) | $414.79 | $504 | 1.7× |
| Mra w/o fol w/cont, abd (C8902) | $3,586.63 | $4,358 | 10.0× |
| Mra w/o fol w/cont, chest (C8911) | $3,373.48 | $4,099 | 9.4× |
| Mra w/o fol w/cont, lwr ext (C8914) | $3,451.66 | $4,194 | 9.6× |
| Mra w/o fol w/cont, pelvis (C8920) | $2,595.74 | $3,154 | 7.2× |
| Mri w/o fol w/cont, breast, (C8908) | $4,389.88 | $5,334 | 12.2× |
| Mri w/o fol w/cont, brst, un (C8905) | $6,032.59 | $7,330 | 16.8× |
| Neuro csf prion prtn qual (0035U) | $274.88 | $334 | 0.5× |
| Noninvasive assessment of blood oxygenation, gas exchange efficiency, and cardiorespiratory status, with physician or… (0893T) | $332.49 | $404 | 2.4× |
| Obtaining screen pap smear (Q0091) | $107.82 | $131 | 3.6× |
| Onc Merkel Cll Carc Srm Quan (0058U) | $827.12 | $1,005 | 2.6× |
| Ortho impl mvmt alys pair CT (0946T) | $1,664.11 | $2,022 | 15.4× |
| Oth resp proc, group (G0239) | $160.48 | $195 | 4.2× |
| Oth resp proc, indiv (G0238) | $154.72 | $188 | 5.2× |
| Pathogen test for platelets (P9100) | $87.24 | $106 | 1.4× |
| Perc d-e cor revasc chro sin (C9607) | $15,432.07 | $18,751 | 0.8× |
| Perc d-e cor revasc t cabg s (C9604) | $14,089.76 | $17,120 | 1.2× |
| Perc d-e cor stent ather s (C9602) | $15,432.07 | $18,751 | 0.8× |
| Perc drug-el cor stent sing (C9600) | $19,787.39 | $24,043 | 1.7× |
| Perq Sacral Augmt Bilat Inj (0201T) | $10,770.60 | $13,087 | 1.4× |
| Perq tcat ther rx dlvr ntrac rx balo 1 maj c art (0913T) | $10,691.59 | $12,991 | 0.9× |
| Pne flu hepb cov home admin (M0201) | $57.61 | $70 | 1.5× |
| Potassium hydroxide preps (Q0112) | $33.74 | $41 | 5.8× |
| Ppps, initial visit (G0438) | $245.25 | $298 | 1.4× |
| Ppps, subseq visit (G0439) | $137.44 | $167 | 1.0× |
| Prgrmg Dev Eval Scrms Phys/Qhp Remote (0650T) | $296.28 | $360 | 7.7× |
| Prolonged iv inf, req pump (C8957) | $300.40 | $365 | 1.4× |
| Prostate biopsy, any mthd (G0416) | $1,168.66 | $1,420 | 3.2× |
| Provide inr test mater/equip (G0249) | $319.32 | $388 | 2.3× |
| Psa screening (G0103) | $145.67 | $177 | 7.5× |
| Revasc intra lithotrip-ather (C9766) | $28,556.45 | $34,698 | 1.5× |
| Revasc intra lithotrip-stent (C9765) | $30,504.50 | $37,065 | 1.6× |
| Revasc intravasc lithotripsy (C9764) | $16,197.67 | $19,681.25 | 1.4× |
| Revasc lith-sten-ath tib/per (C9775) | $37,062.16 | $45,033 | 2.0× |
| Revasc lithotr-ather tib/per (C9774) | $18,582.52 | $22,579 | 1.0× |
| Revasc lithotr-stent tib/per (C9773) | $21,836.66 | $26,533 | 1.2× |
| Revasc lithotrip tibi/perone (C9772) | $13,993.47 | $17,003 | 1.2× |
| Revasc lithotrip-stent-ather (C9767) | $42,079.99 | $51,130 | 2.2× |
| Scr c/v cyto,thinlayer,rescr (G0145) | $159.66 | $194 | 6.0× |
| Screen cerv/vag thin layer (G0123) | $123.45 | $150 | 6.1× |
| Spine device implant surgery (C9757) | $7,295.90 | $8,865 | 0.6× |
| Tcat insj perm 1chmbr ldls pacemaker r atrial (0823T) | $16,850.92 | $20,475 | 0.8× |
| Tcat Insj Perm Dual Chamber Ldls Pm Compl Sys (0795T) | $16,077.30 | $19,535 | 0.8× |
| Tcat Rmvl/Debulk Icar Mass Suction Device Perq (0644T) unusually low: confirm this is the full procedure |
$2,815.48 | $3,421 | 0.5× |
| Therapeutic procd strg endur (G0237) | $154.72 | $188 | 5.2× |
| Tomosynthesis, mammo (G0279) | $157.20 | $191 | 12.4× |
| Transcatheter Renal Sympath Denervation Bilat (0339T) | $7,544.44 | $9,167 | 1.3× |
| Transcatheter renal sympath denervation unilat (0338T) | $5,029.35 | $6,111 | 0.9× |
| Trauma respons w/hosp criti (G0390) | $2,623.72 | $3,188 | 1.9× |
| Trim nail(s) (G0127) | $44.44 | $54 | 0.7× |
| Tte w or w/o fol w/con,stres (C8928) | $2,169.43 | $2,636 | 2.7× |
| Tte w or w/o fol w/cont, com (C8921) | $2,139.80 | $2,600 | 2.6× |
| Tte w or w/o fol w/cont, f/u (C8922) | $1,113.52 | $1,353 | 1.4× |
| Tte w or wo fol wcon,doppler (C8929) | $2,529.90 | $3,074 | 3.1× |
| Unsched dialysis esrd pt hos (G0257) | $1,993.31 | $2,422 | 2.8× |
| Visit to determ ldct elig (G0296) | $127.15 | $154.50 | 1.2× |