22 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|
| Admin hepatitis b vaccine (G0010) |
$25.20 |
$36 |
0.6× |
| Admin influenza virus vac (G0008) |
$45.15 |
$64.50 |
1.1× |
| Admin pneumococcal vaccine (G0009) |
$45.15 |
$64.50 |
1.1× |
| Ca screen;flexi sigmoidscope (G0104) |
$261.80 |
$374 |
0.3× |
| Ca screen;pelvic/breast exam (G0101) |
$57.40 |
$82 |
0.6× |
| Colon ca scrn not hi rsk ind (G0121) |
$588 |
$840 |
0.7× |
| Colorectal scrn; hi risk ind (G0105) |
$586.60 |
$838 |
0.7× |
| Covid-19 lab test non-cdc (U0002) |
$79.80 |
$114 |
1.6× |
| Direct refer hospital observ (G0379) |
$1,159.20 |
$1,656 |
2.1× |
| Drug test def 1-7 classes (G0480) |
$171.85 |
$245.50 |
1.5× |
| Elec stim other than wound (G0283) |
$35.70 |
$51 |
2.8× |
| Fecal blood scrn immunoassay (G0328) |
$30.80 |
$44 |
1.7× |
| Hepb screen high risk indiv (G0499) |
$51.80 |
$74 |
1.8× |
| Initial preventive exam (G0402) |
$248.50 |
$355 |
2.1× |
| Liver disease, ten biochemical assays (ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT, haptoglobin,… (0002M) |
$368.90 |
$527 |
0.7× |
| Obtaining screen pap smear (Q0091) |
$65.80 |
$94 |
2.5× |
Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral… (0627T)
likely a partial charge, not the full procedure |
$1,756.30 |
$2,509 |
0.2× |
| Ppps, initial visit (G0438) |
$256.20 |
$366 |
1.5× |
| Ppps, subseq visit (G0439) |
$172.20 |
$246 |
1.3× |
| Psa screening (G0103) |
$51.80 |
$74 |
2.7× |
| Therapeutic procd strg endur (G0237) |
$92.40 |
$132 |
3.5× |
| Wet mounts/ w preparations (Q0111) |
$23.80 |
$34 |
1.3× |