22 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|
| Adm of soc dtr assess 5-15 m (G0136) |
$78 |
$78 |
1.7× |
| Ca screen;pelvic/breast exam (G0101) |
$244 |
$244 |
2.0× |
| Demonstrate use home inr mon (G0248) |
$181 |
$181 |
1.1× |
| Diab manage trn per indiv (G0108) |
$160 |
$160 |
2.9× |
| Diab manage trn ind/group (G0109) |
$93.50 |
$93.50 |
5.8× |
| Drug test def 1-7 classes (G0480) |
$23 |
$23 |
0.2× |
| Ekg tracing for initial prev (G0404) |
$42 |
$42 |
1.2× |
| Hepb screen high risk indiv (G0499) |
$61 |
$61 |
2.2× |
| Ig paraprotein qual bld/ur (0077U) |
$111 |
$111 |
2.6× |
| Initial preventive exam (G0402) |
$182 |
$182 |
1.1× |
| Mnt subs tx for change dx (G0270) |
$85 |
$85 |
2.7× |
| Mri w/o fol w/cont, brst, un (C8905) |
$2,000 |
$2,000 |
4.8× |
| Obtaining screen pap smear (Q0091) |
$81 |
$81 |
2.3× |
| Oth resp proc, group (G0239) |
$82 |
$82 |
1.8× |
| Oth resp proc, indiv (G0238) |
$60 |
$60 |
1.7× |
| Pathogen test for platelets (P9100) |
$137 |
$137 |
1.9× |
| Perq Sacral Augmt Bilat Inj (0201T) |
$8,200 |
$8,200 |
0.9× |
| Perq Sacral Augmt Unilat Inj (0200T) |
$8,000 |
$8,000 |
0.9× |
| Provide inr test mater/equip (G0249) |
$361 |
$361 |
2.3× |
| Rbc DNA hea 35 ag 11 bld grp whl bld cmn allel (0001U) |
$1,800 |
$1,800 |
2.5× |
| Therapeutic procd strg endur (G0237) |
$60 |
$60 |
1.7× |
| Visit to determ ldct elig (G0296) |
$173 |
$173 |
1.4× |