Supplies, drugs & other prices at Dignity Health Mercy Gilbert Medical Center
Gilbert, AZ · every code in this section with a posted price and a Medicare benchmark.
38 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|---|---|---|
| 2d tte w or w/o fol w/con,co (C8923) | $345.39 | $1,404 | 0.4× |
| 2d tte w or w/o fol w/con,fu (C8924) | $302.83 | $1,231 | 0.8× |
| Adm tocilizu covid-19 1st (M0249) | $301.60 | $1,226 | 0.6× |
| Adm tocilizu covid-19 2nd (M0250) | $301.60 | $1,226 | 0.6× |
| Alcohol/subs interv 15-30mn (G0396) | $36.90 | $150 | 0.9× |
| Catheterize for urine spec (P9612) | $7.50 | $30.50 | 0.8× |
| Covid-19 lab test non-cdc (U0002) | $50.43 | $205 | 1.0× |
| Diab manage trn per indiv (G0108) | $93.24 | $379 | 1.7× |
| Diab manage trn ind/group (G0109) | $56.58 | $230 | 3.5× |
| Direct refer hospital observ (G0379) | $773.92 | $3,146 | 1.2× |
| Drug test def 1-7 classes (G0480) | $52.93 | $215.16 | 0.5× |
| Drug test def 15-21 classes (G0482) | $174.83 | $710.66 | 0.9× |
| Drug test def 22+ classes (G0483) | $243.05 | $988 | 1.0× |
| Fern test (Q0114) | $17.72 | $72 | 1.8× |
| Hbot, full body chamber, 30m (G0277) | $292.01 | $1,187 | 2.0× |
| Heart symp image plnr spect (0332T) | $1,439.84 | $5,853 | 1.0× |
| Home sleep test/type 3 porta (G0399) | $439.36 | $1,786 | 1.9× |
| Inj for sacroiliac jt anesth (G0260) | $857.31 | $3,485 | 1.1× |
| Insertion of substernal implantable defibrillator electrode (0572T) | $9,029.93 | $36,707 | 1.0× |
| Insj/Rplcmt Icds W/Substernal Electrode (0571T) | $34,968.17 | $142,147 | 1.0× |
| Mri w/o fol w/cont, breast, (C8908) | $1,511.67 | $6,145 | 4.1× |
| Neuro csf detcj prion prtn quakg conf conv qual (0035U) | $532.34 | $2,163.96 | 1.0× |
| Prolonged iv inf, req pump (C8957) | $330.14 | $1,342 | 1.5× |
| Prostate biopsy, any mthd (G0416) | $377.37 | $1,534 | 1.0× |
| Psa screening (G0103) | $20.67 | $84 | 1.1× |
| Repos prev impl ss impltbl dfb pacing eltrd (0574T) | $4,173.89 | $16,967 | 1.0× |
| Revasc lithotrip-stent-ather (C9767) | $18,821.22 | $76,509 | 1.0× |
| Rmvl Substernal Impltbl Dfb Pulse Generator Only (0580T) | $4,173.89 | $16,967 | 1.0× |
| Rmvl&rplcmt substernal impltbl defibrillator pg (0614T) | $25,059.04 | $101,866 | 1.1× |
| Tcat insj perm 1chmbr ldls pacemaker r atrial (0823T) | $20,710.50 | $84,189 | 1.0× |
| Trauma respons w/hosp criti (G0390) | $3,439.33 | $13,981 | 2.4× |
| Trluml peripheral atherectomy iliac artery ea (0238T) likely a partial charge, not the full procedure |
$5,468.09 | $22,228 | 0.3× |
| Tte w or w/o fol w/con,stres (C8928) | $826.32 | $3,359 | 1.0× |
| Tte w or w/o fol w/cont, com (C8921) | $999.99 | $4,065 | 1.2× |
| Tte w or wo fol wcon,doppler (C8929) | $1,008.36 | $4,099 | 1.2× |
| Unsched dialysis esrd pt hos (G0257) | $565.56 | $2,299 | 0.8× |
| Vasc emb/occ w/prs cath (C9797) | $12,342.81 | $50,174 | 0.6× |
| Wet mounts/ w preparations (Q0111) | $18.45 | $75 | 1.0× |