Supplies, drugs & other prices at Carle Health Pekin Hospital

Pekin, IL · every code in this section with a posted price and a Medicare benchmark.

86 codes. Prices are the hospital's own posted facility charges.

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ProcedurePosted cashPosted gross× Medicare
2d tee w or w/o fol w/con,in (C8925) $3,129 $3,129 3.7×
2d tte w or w/o fol w/con,co (C8923) $3,066 $3,066 3.6×
2d tte w or w/o fol w/con,fu (C8924) $2,006 $2,006 5.4×
Adm tocilizu covid-19 1st (M0249) $882 $882 1.9×
Adm tocilizu covid-19 2nd (M0250) $882 $882 1.9×
Admin hepatitis b vaccine (G0010) $168 $168 3.3×
Admin influenza virus vac (G0008) $91 $91 1.8×
Admin pneumococcal vaccine (G0009) $91 $91 1.8×
Antibody treponema pallidum total & rpr ia qual (0064U) $142 $142 4.5×
Catheterize for urine spec (P9612) $179 $179 19.2×
Complex simulation w/pet-ct (G0562) $914 $914 0.4×
Crtj Subq Insj Impltbl Glucose Sensor Sys Train (0446T) $21,253 $21,253 4.8×
Diab manage trn per indiv (G0108) $215 $215 3.9×
Diab manage trn ind/group (G0109) $131 $131 8.2×
Direct refer hospital observ (G0379) $1,334 $1,334 2.1×
Drug test def 1-7 classes (G0480) $481 $481 4.2×
Drug test def 15-21 classes (G0482)
range across 2 matching MRF lines		 $693–$939 $693–$939 varies
Drug test def 22+ classes (G0483) $1,167 $1,167 4.7×
Drug test def 8-14 classes (G0481)
range across 2 matching MRF lines		 $525–$626 $525–$626 varies
Drug test def simple all cl (G0659) $294 $294 4.7×
Group train w/o patient (G0543) $139 $139 4.5×
Hbot, full body chamber, 30m (G0277) $840 $840 5.7×
Hepb screen high risk indiv (G0499) $221 $221 7.8×
Home sleep test/type 3 porta (G0399) $966 $966 4.2×
Hospital outpt clinic visit (G0463)
range across 25 matching MRF lines		 $142–$2,583 $142–$2,583 varies
Hpv combo assay ca screen (G0476) $504 $504 14.4×
Ig paraprotein qual imprcip&ms bld/ur w/isotype (0077U) $174 $174 4.0×
Inj for sacroiliac jt anesth (G0260) $929 $929 1.2×
Insertion perm ccm-d system pulse generator only (0916T) $73,700 $73,700 3.1×
Insj perm ccm-d sys 1 transvns lead only (0917T) $27,174 $27,174 3.1×
Insj Perm Ccm-D Sys Dual Transvns Leads Only (0918T) $27,174 $27,174 3.1×
Insj perm ccm-d sys pg&dual transvns eltrds/lds (0915T) $105,273 $105,273 3.1×
Insj/Rplc Car Modulj Sys Pls Gen Transvns Eltrd (0408T) $120,509 $120,509 3.6×
Insj/Rplcmt Icds W/Substernal Electrode (0571T) $100,989 $100,989 3.0×
Instlj fecal microbiota ssp (0780T) $410 $410 2.9×
Jak2 Gene Analysis Trgt Seq Alys Exons 12-15 (0027U) $651 $651 5.3×
Mra w/o cont, chest (C8910) $903 $903 3.5×
Mra w/o fol w/cont, chest (C8911) $6,846 $6,846 18.3×
Mra w/o fol w/cont, pelvis (C8920) $1,817 $1,817 4.9×
Mra, w/dye, upper extremity (C8934) $3,276 $3,276 8.8×
Mra, w/o dye, upper extr (C8935) $4,169 $4,169 16.3×
Mra, w/o&w/dye, upper extr (C8936) $3,276 $3,276 8.8×
Mri w/o fol w/cont, breast, (C8908)
range across 2 matching MRF lines		 $6,195–$6,405 $6,195–$6,405 varies
Mri w/o fol w/cont, brst, un (C8905) $2,804 $2,804 7.5×
Njx platelet plasma (0232T) $431 $431 0.9×
No pt prsnt train initial 30 (G0541) $75 $75 2.4×
Ortho impl mvmt alys pair CT (0946T) $352 $352 3.1×
Oth resp proc, group (G0239) $268 $268 6.7×
Oth resp proc, indiv (G0238) $173 $173 5.6×
Pathogen test for platelets (P9100) $110 $110 1.7×
Perc d-e cor revasc chro sin (C9607) $30,776 $30,776 1.6×
Perc d-e cor revasc t cabg s (C9604) $36,036 $36,036 2.9×
Perc d-e cor stent ather s (C9602) $30,776 $30,776 1.6×
Perc drug-el cor stent sing (C9600) $36,036 $36,036 2.9×
Perq tcat ther rx dlvr ntrac rx balo 1 maj c art (0913T) $18,722 $18,722 1.5×
Ppps, initial visit (G0438) $389 $389 2.2×
Prostate biopsy, any mthd (G0416)
range across 2 matching MRF lines		 $469–$773 $469–$773 varies
Psa screening (G0103) $265 $265 13.7×
Quan CT tiss charac i&r w/cncrnt CT exam (0722T) $2,142 $2,142 3.1×
Quan CT tiss charac w/o CT (0721T) $2,142 $2,142 3.1×
Relocation skin pocket implanted ccm-d pg (0925T) $6,006 $6,006 2.7×
Removal of implantable interstitial glucose sensor from subcutaneous pocket via incision (0447T) $1,025 $1,025 4.8×
Removal perm ccm-d system pulse generator only (0919T) $11,949 $11,949 3.0×
Repositioning prev impl ccm-d transvns eltrd/ld (0924T) $2,037 $2,037 3.0×
Revasc intra lithotrip-ather (C9766) $43,796 $43,796 2.2×
Revasc intra lithotrip-stent (C9765) $54,999 $54,999 2.8×
Revasc intravasc lithotripsy (C9764)
range across 2 matching MRF lines		 $21,609–$21,630 $21,609–$21,630 varies
Revasc lithotrip tibi/perone (C9772) $37,233 $37,233 3.0×
Rmvl insj impltbl gluc sensor dif anatomic site (0448T) $21,253 $21,253 4.8×
Rmvl perm ccm-d sys 1 transvns dfb lead only (0921T) $11,949 $11,949 3.0×
Rmvl perm ccm-d sys 1 transvns pacing lead only (0920T) $11,949 $11,949 3.0×
Rmvl perm ccm-d sys dual transvns leads only (0922T) $11,949 $11,949 3.0×
Rmvl&rplcmt permanent ccm-d pulse generator only (0923T) $73,700 $73,700 3.1×
Sbrt w/positron emission del (G0563) $452 $452 0.1×
Scr c/v cyto,thinlayer,rescr (G0145) $488 $488 18.4×
Screen cerv/vag thin layer (G0123) $64 $64 3.2×
Syphilis tst non-treponemal antibody ia qual rpr (0065U) $152 $152 8.4×
Tcat implt wrls l atr prs snr l-t l atr prs mntr (0933T) $10,563 $10,563 3.0×
Tcat Rmvl/Debulk Icar Mass Suction Device Perq (0644T) $28,077 $28,077 4.6×
Tomosynthesis, mammo (G0279)
range across 3 matching MRF lines		 $116–$1,187 $116–$1,187 varies
Tpmt and Nudt15 Genotype (0034U) $1,865 $1,865 4.0×
Trauma respons w/hosp criti (G0390) $2,982 $2,982 2.1×
Tte w or w/o contr, cont ecg (C8930) $3,066 $3,066 3.6×
Tte w or w/o fol w/con,stres (C8928) $3,066 $3,066 3.6×
Tte w or wo fol wcon,doppler (C8929) $3,129 $3,129 3.7×
Unsched dialysis esrd pt hos (G0257) $2,226 $2,226 3.0×

A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.