Supplies, drugs & other prices at Intermountain Health Platte Valley Hospital

Brighton, CO · every code in this section with a posted price and a Medicare benchmark.

41 codes. Prices are the hospital's own posted facility charges.

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ProcedureCash priceGross charge× Medicare
Adm tocilizu covid-19 1st (M0249) $1,756.95
Admin hepatitis b vaccine (G0010) $21.17
Catheterize for urine spec (P9612) $159.70
Covid-19 lab test non-cdc (U0002) $167.72
Direct refer hospital observ (G0379) $1,564.35
Drug test def 1-7 classes (G0480) $410.65
Drug test def 15-21 classes (G0482) $478.85
Drug test def 22+ classes (G0483) $862.95
Drug test def 8-14 classes (G0481) $411.08
Eia hiv-1/hiv-2 screen (G0432) $194.84
Elisa hiv-1/hiv-2 screen (G0433) $58.45
Evasc ven artlz tibl/prnl vn (0620T) $100,101.45
Hbot, full body chamber, 30m (G0277) $921.80
Heart symp image plnr (0331T) $4,073.10
Hep c screen high risk/other (G0472) $167.60
Hepb screen high risk indiv (G0499) $126.06
Hospital outpt clinic visit (G0463) $415.10
Neuro csf prion prtn qual (0035U) $596.30
Pathogen test for platelets (P9100) $123.28
Perc d-e cor revasc chro sin (C9607) $31,508.72
Perq sac agmntj bi w/wo balo/mchnl dev 2/> ndls (0201T) $21,947.60
Perq sac agmntj uni w/wo balo/mchnl dev 1/> ndl (0200T) $20,993.35
Perq tcat ther rx dlvr ntrac rx balo 1 maj c art (0913T) $17,104.55
Prostate biopsy, any mthd (G0416) $954.29
Psa screening (G0103) $69.05
Revasc intra lithotrip-ather (C9766) $49,026.05
Revasc intra lithotrip-stent (C9765) $51,505.08
Revasc intravasc lithotripsy (C9764) $28,782
Revasc lithotr-ather tib/per (C9774) $46,778.35
Revasc lithotr-stent tib/per (C9773) $44,979.20
Revasc lithotrip tibi/perone (C9772) $30,296.85
Revasc lithotrip-stent-ather (C9767) $52,126.85
Scr c/v cyto,thinlayer,rescr (G0145) $117.22
Screen cerv/vag thin layer (G0123) $89.65
Trauma respons w/hosp criti (G0390) $7,861.70
Trluml perip athrc abd aorta (0236T) $40,910.30
Trluml perip athrc brchiocph (0237T) $35,574.20
Trluml perip athrc iliac art (0238T) $45,797.15
Trluml perip athrc renal art (0234T) $40,910.30
Unsched dialysis esrd pt hos (G0257) $1,799.55
Visit to determ ldct elig (G0296) $216.50