Supplies, drugs & other prices at Bon Secours St. Mary's Hospital
Richmond, VA · every code in this section with a posted price and a Medicare benchmark.
56 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) | $1,759.20 | $2,932 | 2.2× |
| 2d tte w or w/o fol w/con,co (C8923) | $1,284 | $2,140 | 1.6× |
| Ablation, benign thyroid nodule(s), percutaneous, laser, including imaging guidance (0673T) | $3,144.60 | $5,241 | 1.9× |
| Admin influenza virus vac (G0008) | $25.20 | $42 | 0.5× |
| Admin pneumococcal vaccine (G0009) | $38.40 | $64 | 0.8× |
| Alcohol/subs interv 15-30mn (G0396) | $61.80 | $103 | 1.6× |
| Alveolus clsd reduc stblz te (D7771) | $6,087.60 | $10,146 | 1.8× |
| Behavior counsel obesity 15m (G0447) | $61.80 | $103 | 0.6× |
| Ca screen;flexi sigmoidscope (G0104) | $3,405.22 | $5,675.38 | 3.6× |
| Ca screen;pelvic/breast exam (G0101) | $35.40 | $59 | 0.3× |
| Catheterize for urine spec (P9612) | $17.40 | $29 | 1.9× |
| Colon ca scrn not hi rsk ind (G0121) | $3,666 | $6,110 | 3.9× |
| Colorectal scrn; hi risk ind (G0105) | $3,649.20 | $6,082 | 3.9× |
| Drug test def 1-7 classes (G0480) | $370.50 | $617.50 | 3.2× |
| Egd flexible transnasal w/biopsy single/multiple (0653T) | $3,771.24 | $6,285.40 | 2.0× |
| Elec stim other than wound (G0283) | $100.20 | $167 | 7.9× |
| Extraction erupted tooth/exr (D7140) | $15,023.40 | $25,039 | 23.2× |
| Facility svs dental rehab (G0330) | $14,738.78 | $24,564.63 | 4.4× |
| Fecal blood scrn immunoassay (G0328) | $60 | $100 | 3.3× |
| Hepb screen high risk indiv (G0499) | $93 | $155 | 3.3× |
| Home sleep test/type 3 porta (G0399) | $718.80 | $1,198 | 3.3× |
| Home sleep test/type 4 porta (G0400) | $583.20 | $972 | 2.7× |
| Iliac Atherectomy (0238T) | $14,567.40 | $24,279 | 0.8× |
| Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming,… (0517T) | $19,779.60 | $32,966 | 1.9× |
| Intens behave ther cardio dx (G0446) | $20.40 | $34 | 0.5× |
| Mra w/cont, abd (C8900) | $1,587.60 | $2,646 | 4.5× |
| Mra w/cont, chest (C8909) | $3,246.60 | $5,411 | 9.3× |
| Mra w/cont, lwr ext (C8912) | $1,762.20 | $2,937 | 5.0× |
| Mra w/o cont, abd (C8901) | $1,997.40 | $3,329 | 8.3× |
| Mra w/o cont, chest (C8910) | $1,098.60 | $1,831 | 4.6× |
| Mra w/o fol w/cont, abd (C8902) | $1,587.60 | $2,646 | 4.5× |
| Mra w/o fol w/cont, lwr ext (C8914) | $2,346 | $3,910 | 6.7× |
| Mri w/o fol w/cont, breast, (C8908) | $3,868.80 | $6,448 | 11.1× |
| Perc d-e cor revasc chro sin (C9607) | $21,685.80 | $36,143 | 1.2× |
| Perc d-e cor revasc t cabg s (C9604) | $21,633.60 | $36,056 | 1.9× |
| Perc d-e cor stent ather s (C9602) | $21,276 | $35,460 | 1.2× |
| Perc drug-el cor stent sing (C9600) | $17,020.80 | $28,368 | 1.5× |
| Perq Sacral Augmt Bilat Inj (0201T) | $6,913.20 | $11,522 | 0.9× |
| Psa screening (G0103) | $102 | $170 | 5.3× |
| Revasc intra lithotrip-ather (C9766) | $35,886.60 | $59,811 | 2.0× |
| Revasc intra lithotrip-stent (C9765) | $35,886.60 | $59,811 | 2.0× |
| Revasc intravasc lithotripsy (C9764) | $11,950.20 | $19,917 | 1.0× |
| Revasc lith-sten-ath tib/per (C9775) | $35,886.60 | $59,811 | 2.0× |
| Revasc lithotr-ather tib/per (C9774) | $35,886.60 | $59,811 | 2.0× |
| Revasc lithotr-stent tib/per (C9773) | $35,886.60 | $59,811 | 2.0× |
| Revasc lithotrip-stent-ather (C9767) | $35,886.60 | $59,811 | 2.0× |
| Tcat Insj Perm Dual Chamber Ldls Pm Compl Sys (0795T) | $36,044.40 | $60,074 | 1.9× |
| Tcat Rmvl/Debulk Icar Mass Suction Device Perq (0644T) | $10,776 | $17,960 | 1.9× |
| Tomosynthesis, mammo (G0279) | $237.60 | $396 | 18.7× |
| Tooth reimplantation (D7270) | $1,665 | $2,775 | 2.6× |
| Trgt gen seq alys sld orgn neo DNA 324 genes (0037U) | $11,576.40 | $19,294 | 3.3× |
| Tte w or w/o fol w/cont, com (C8921) | $529.80 | $883 | 0.7× |
| Tte w or wo fol wcon,doppler (C8929) | $2,967.60 | $4,946 | 3.8× |
| Unsched dialysis esrd pt hos (G0257) | $1,338 | $2,230 | 1.9× |
| Vasc emb/occ w/prs cath (C9797) | $33,155.40 | $55,259 | 1.8× |
| Visit to determ ldct elig (G0296) | $58.20 | $97 | 0.6× |