Supplies, drugs & other prices at Intermountain Health Good Samaritan Hospital
Lafayette, CO · every code in this section with a posted price and a Medicare benchmark.
40 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Adm tocilizu covid-19 1st (M0249) | — | $1,773.85 | — |
| Admin hepatitis b vaccine (G0010) | — | $21.17 | — |
| Catheterize for urine spec (P9612) | — | $74.40 | — |
| Covid-19 lab test non-cdc (U0002) range across 2 matching MRF lines |
— | $164.44–$172.65 | — |
| Direct refer hospital observ (G0379) | — | $1,579.40 | — |
| Drug test def 1-7 classes (G0480) range across 2 matching MRF lines |
— | $360.45–$464.25 | — |
| Drug test def 15-21 classes (G0482) | — | $478.85 | — |
| Drug test def 22+ classes (G0483) | — | $862.95 | — |
| Drug test def 8-14 classes (G0481) range across 2 matching MRF lines |
— | $343.30–$478.85 | — |
| Eia hiv-1/hiv-2 screen (G0432) range across 2 matching MRF lines |
— | $268.14–$309.35 | — |
| Elisa hiv-1/hiv-2 screen (G0433) | — | $309.35 | — |
| Fecal microbiota prep instil (G0455) | — | $7,606.65 | — |
| Heart Symp Image Plnr (0331T) | — | $4,112.25 | — |
| Hep c screen high risk/other (G0472) range across 2 matching MRF lines |
— | $309.33–$535.30 | — |
| Hepb screen high risk indiv (G0499) range across 2 matching MRF lines |
— | $135.67–$157.10 | — |
| Hospital outpt clinic visit (G0463) | — | $419.10 | — |
| Neuro csf prion prtn qual (0035U) | — | $596.30 | — |
| Oth resp proc, group (G0239) | — | $207.50 | — |
| Oth resp proc, indiv (G0238) | — | $207.50 | — |
| Pathogen test for platelets (P9100) range across 2 matching MRF lines |
— | $113.15–$135.80 | — |
| Perc d-e cor revasc chro sin (C9607) | — | $41,207.04 | — |
| Perq Sacral Augmt Bilat Inj (0201T) | — | $22,158.60 | — |
| Perq Sacral Augmt Unilat Inj (0200T) | — | $21,195.20 | — |
| Pet not otherwise specified (G0235) | — | $3,816.40 | — |
| Prostate biopsy, any mthd (G0416) | — | $954.29 | — |
| Psa screening (G0103) | — | $242.30 | — |
| Revasc intra lithotrip-ather (C9766) | — | $49,497.45 | — |
| Revasc intra lithotrip-stent (C9765) | — | $49,497.45 | — |
| Revasc intravasc lithotripsy (C9764) | — | $30,588.15 | — |
| Revasc lithotr-ather tib/per (C9774) | — | $47,228.15 | — |
| Revasc lithotrip tibi/perone (C9772) | — | $31,770.70 | — |
| Scr c/v cyto,thinlayer,rescr (G0145) | — | $117.22 | — |
| Screen cerv/vag thin layer (G0123) | — | $89.65 | — |
| Therapeutic procd strg endur (G0237) | — | $207.50 | — |
| Trauma respons w/hosp criti (G0390) range across 2 matching MRF lines |
— | $9,531.20–$14,099.80 | — |
| Trluml perip athrc abd aorta (0236T) | — | $41,303.65 | — |
| Trluml Perip Athrc Brchiocph (0237T) | — | $35,916.25 | — |
| Trluml Perip Athrc Iliac Art (0238T) | — | $46,237.50 | — |
| Trluml Peripheral Atherectomy Renal Artery Ea (0234T) | — | $41,303.65 | — |
| Unsched dialysis esrd pt hos (G0257) | — | $3,825.95 | — |
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.