25 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) |
$78.75 |
$105 |
1.7× |
| Admin pneumococcal vaccine (G0009) |
$78.75 |
$105 |
1.7× |
| Colon ca scrn not hi rsk ind (G0121) |
$825 |
$1,100 |
0.9× |
| Colorectal scrn; hi risk ind (G0105) |
$866.25 |
$1,155 |
0.9× |
| Diab manage trn per indiv (G0108) |
$110.25 |
$147 |
2.0× |
| Diab manage trn ind/group (G0109) |
$39.75 |
$53 |
2.5× |
| Direct refer hospital observ (G0379) |
$87 |
$116 |
0.1× |
| Drug test def 1-7 classes (G0480) |
$120.75 |
$161 |
1.1× |
| Drug test def 8-14 classes (G0481) |
$128.25 |
$171 |
0.8× |
| Ekg tracing for initial prev (G0404) |
$1,575 |
$2,100 |
54.2× |
| Elec stim other than wound (G0283) |
$30 |
$40 |
2.4× |
| Fecal blood scrn immunoassay (G0328) |
$42.75 |
$57 |
2.4× |
| Fecal microbiota prep instil (G0455) |
$146.25 |
$195 |
0.2× |
| Group mnt 2 or more 30 mins (G0271) |
$36 |
$48 |
2.1× |
| Home sleep test/type 3 porta (G0399) |
$236.25 |
$315 |
1.1× |
| Inj for sacroiliac jt anesth (G0260) |
$984.75 |
$1,313 |
1.4× |
| Mnt subs tx for change dx (G0270) |
$51.75 |
$69 |
1.6× |
| Njx pltlt plasma w/img harvest/preparation (0232T) |
$626.25 |
$835 |
1.4× |
| Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral… (0627T) |
$19,687.50 |
$26,250 |
1.5× |
| Perq Sacral Augmt Bilat Inj (0201T) |
$5,906.25 |
$7,875 |
0.8× |
| Perq Sacral Augmt Unilat Inj (0200T) |
$5,906.25 |
$7,875 |
0.8× |
| Prolonged iv inf, req pump (C8957) |
$225 |
$300 |
1.1× |
| Psa screening (G0103) |
$86.25 |
$115 |
4.5× |
| Tomosynthesis, mammo (G0279) |
$75 |
$100 |
5.9× |
| Tte w or wo fol wcon,doppler (C8929) |
$1,125 |
$1,500 |
1.4× |