Supplies, drugs & other prices at Covenant Health Fort Loudoun
Lenoir City, TN · every code in this section with a posted price and a Medicare benchmark.
63 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) | $379.20 | $1,185 | 0.5× |
| 2d tte w or w/o fol w/con,co (C8923) | $379.20 | $1,185 | 0.5× |
| 2d tte w or w/o fol w/con,fu (C8924) | $251.20 | $785 | 0.8× |
| Admin hepatitis b vaccine (G0010) | $32.96 | $103 | 0.8× |
| Admin influenza virus vac (G0008) | $32.96 | $103 | 0.8× |
| Admin pneumococcal vaccine (G0009) | $32.96 | $103 | 0.8× |
| Devlopment test interpt&rep (G0451) | $44.48 | $139 | 0.5× |
| Drug test def 1-7 classes (G0480) | $58.08 | $181.50 | 0.5× |
| Elec stim other than wound (G0283) | $11.52 | $36 | 0.9× |
| Elisa hiv-1/hiv-2 screen (G0433) | $56.96 | $178 | 3.1× |
| Hbot, full body chamber, 30m (G0277) | $113.28 | $354 | 0.9× |
| Hiv combination assay (G0475) | $56.96 | $178 | 2.4× |
| Home sleep test/type 3 porta (G0399) | $78.40 | $245 | 0.4× |
| Hopd mntl hlt, 15-29 min (C7900) | $65.60 | $205 | 1.9× |
| Hopd mntl hlt, 30-60 min (C7901) | $70.40 | $220 | 0.8× |
| Hopd mntl hlt, grp (C7903) | $48.32 | $151 | 1.4× |
| Hospital outpt clinic visit (G0463) | $72.32 | $226 | 0.6× |
| Inj for sacroiliac jt anesth (G0260) | $332.48 | $1,039 | 0.5× |
| Intens cardiac rehab no exer (G0423) | $84.80 | $265 | 0.7× |
| Intens cardiac rehab w/exerc (G0422) | $84.80 | $265 | 0.7× |
| Mnt subs tx for change dx (G0270) | $13.76 | $43 | 0.4× |
| Mra w/cont, abd (C8900) | $372.48 | $1,164 | 1.2× |
| Mra w/cont, chest (C8909) | $372.48 | $1,164 | 1.2× |
| Mra w/cont, lwr ext (C8912) | $372.48 | $1,164 | 1.2× |
| Mra w/cont, pelvis (C8918) | $568.64 | $1,777 | 1.8× |
| Mra w/o cont, abd (C8901) | $568.64 | $1,777 | 2.6× |
| Mra w/o cont, chest (C8910) | $568.64 | $1,777 | 2.6× |
| Mra w/o cont, lwr ext (C8913) | $372.48 | $1,164 | 1.7× |
| Mra w/o cont, pelvis (C8919) | $568.64 | $1,777 | 2.6× |
| Mra w/o fol w/cont, abd (C8902) | $568.64 | $1,777 | 1.8× |
| Mra w/o fol w/cont, chest (C8911) | $568.64 | $1,777 | 1.8× |
| Mra w/o fol w/cont, lwr ext (C8914) | $568.64 | $1,777 | 1.8× |
| Mra w/o fol w/cont, pelvis (C8920) | $568.64 | $1,777 | 1.8× |
| Mra, w/dye, upper extremity (C8934) | $429.12 | $1,341 | 1.4× |
| Mra, w/o dye, upper extr (C8935) | $429.12 | $1,341 | 2.0× |
| Mra, w/o&w/dye, upper extr (C8936) | $429.12 | $1,341 | 1.4× |
| Mri w/o fol w/cont, breast, (C8908) | $771.52 | $2,411 | 2.4× |
| Mri w/o fol w/cont, brst, un (C8905) | $514.56 | $1,608 | 1.6× |
| Opps service,sched team conf (G0175) | $204.48 | $639 | 0.5× |
| Oth resp proc, group (G0239) | $35.52 | $111 | 1.0× |
| Pathogen test for platelets (P9100) | $33.60 | $105 | 0.6× |
| Perc d-e cor revasc chro sin (C9607) unusually low: confirm this is the full procedure |
$5,918.72 | $18,496 | 0.4× |
| Perc d-e cor revasc t cabg s (C9604) likely a partial charge, not the full procedure |
$2,768.64 | $8,652 | 0.3× |
| Perc d-e cor stent ather s (C9602) unusually low: confirm this is the full procedure |
$5,918.72 | $18,496 | 0.4× |
| Perc drug-el cor stent sing (C9600) likely a partial charge, not the full procedure |
$2,768.64 | $8,652 | 0.3× |
| Place device/marker, non pro (C9728) | $656.64 | $2,052 | 0.5× |
| Prolonged iv inf, req pump (C8957) | $159.68 | $499 | 0.8× |
| Prostate biopsy, any mthd (G0416) | $188.16 | $588 | 0.6× |
| Psa screening (G0103) | $59.20 | $185 | 3.1× |
| Revasc intra lithotrip-ather (C9766) unusually low: confirm this is the full procedure |
$7,302.40 | $22,820 | 0.4× |
| Revasc intra lithotrip-stent (C9765) | $10,953.60 | $34,230 | 0.7× |
| Revasc intravasc lithotripsy (C9764) | $6,850.56 | $21,408 | 0.7× |
| Revasc lith-sten-ath tib/per (C9775) unusually low: confirm this is the full procedure |
$7,302.40 | $22,820 | 0.4× |
| Revasc lithotr-ather tib/per (C9774) unusually low: confirm this is the full procedure |
$7,302.40 | $22,820 | 0.4× |
| Revasc lithotr-stent tib/per (C9773) unusually low: confirm this is the full procedure |
$7,302.40 | $22,820 | 0.4× |
| Revasc lithotrip tibi/perone (C9772) unusually low: confirm this is the full procedure |
$4,567.04 | $14,272 | 0.4× |
| Revasc lithotrip-stent-ather (C9767) unusually low: confirm this is the full procedure |
$7,302.40 | $22,820 | 0.4× |
| Tee w or w/o fol w/cont,cong (C8926) | $379.20 | $1,185 | 0.5× |
| Tomosynthesis, mammo (G0279) | $11.20 | $35 | 0.9× |
| Tte w or w/o contr, cont ecg (C8930) | $430.40 | $1,345 | 0.6× |
| Tte w or wo fol wcon,doppler (C8929) | $399.68 | $1,249 | 0.6× |
| Unsched dialysis esrd pt hos (G0257) | $634.88 | $1,984 | 1.0× |
| Vasc emb/occ w/prs cath (C9797) unusually low: confirm this is the full procedure |
$8,176 | $25,550 | 0.5× |