Supplies, drugs & other prices at Jackson Hospital
Montgomery, AL · every code in this section with a posted price and a Medicare benchmark.
53 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,fu (C8924) | $290.32 | $1,528 | 0.9× |
| Admin hepatitis b vaccine (G0010) | $27.55 | $145 | 0.7× |
| Admin influenza virus vac (G0008) | $27.55 | $145 | 0.7× |
| Admin pneumococcal vaccine (G0009) | $28.50 | $150 | 0.7× |
| Ca screen;pelvic/breast exam (G0101) | $12.35 | $65 | 0.1× |
| Catheterize for urine spec (P9612) | $3.23 | $17 | 0.3× |
| Colon ca scrn not hi rsk ind (G0121) | $907.15 | $4,774.49 | 1.1× |
| Colorectal scrn; hi risk ind (G0105) | $1,175.37 | $6,186.16 | 1.4× |
| Cysto, litho, vacuum kidney (C9761) unusually low: confirm this is the full procedure |
$4,236.37 | $22,296.69 | 0.5× |
| Demonstrate use home inr mon (G0248) | $11,735.37 | $61,765.08 | 98.3× |
| Direct refer hospital observ (G0379) | $394.25 | $2,075 | 0.7× |
| Drug test def 1-7 classes (G0480) | $137.18 | $722 | 1.2× |
| Elec stim other than wound (G0283) | $16.82 | $88.50 | 1.3× |
| Hbot, full body chamber, 30m (G0277) | $94.81 | $499 | 0.8× |
| Hiv combination assay (G0475) | $16.53 | $87 | 0.7× |
| Hospital outpt clinic visit (G0463) | $87.59 | $461 | 0.7× |
| Inj for sacroiliac jt anesth (G0260) | $476.14 | $2,506 | 0.8× |
| Mra w/cont, abd (C8900) | $247.95 | $1,305 | 0.8× |
| Mra w/cont, chest (C8909) | $234.46 | $1,234 | 0.7× |
| Mra w/cont, lwr ext (C8912) | $392.44 | $2,065.50 | 1.3× |
| Mra w/cont, pelvis (C8918) | $225.34 | $1,186 | 0.7× |
| Mra w/o cont, abd (C8901) | $255.93 | $1,347 | 1.2× |
| Mra w/o cont, chest (C8910) | $225.34 | $1,186 | 1.1× |
| Mra w/o fol w/cont, abd (C8902) | $225.34 | $1,186 | 0.7× |
| Mra w/o fol w/cont, chest (C8911) | $225.34 | $1,186 | 0.7× |
| Mra w/o fol w/cont, pelvis (C8920) | $270.37 | $1,423 | 0.9× |
| Mra, w/dye, upper extremity (C8934) | $300.96 | $1,584 | 1.0× |
| Mri w/cont, breast, bi (C8906) | $557.08 | $2,932 | 1.8× |
| Mri w/cont, breast, uni (C8903) | $557.08 | $2,932 | 3.5× |
| Mri w/o fol w/cont, brst, un (C8905) | $641.25 | $3,375 | 2.0× |
| Non-ophthalmic fva (C9733) | $151.05 | $795 | 0.5× |
| Obtaining screen pap smear (Q0091) | $2.85 | $15 | 0.1× |
| Perc d-e cor revasc t cabg s (C9604) | $11,221.62 | $59,061.15 | 1.1× |
| Perc drug-el cor stent sing (C9600) | $12,355.31 | $65,027.96 | 1.2× |
| Perq Sacral Augmt Bilat Inj (0201T) | $4,824.10 | $25,390 | 0.7× |
| Perq Sacral Augmt Unilat Inj (0200T) | $4,824.10 | $25,390 | 0.7× |
| Placement of a posterior intrafacet implant(s), unilateral or bi lateral, including imaging and placement of bone… (0219T) | $9,004.94 | $47,394.43 | 0.8× |
| Prostate biopsy, any mthd (G0416) | $1,291.12 | $6,795.38 | 4.0× |
| Psa screening (G0103) | $24.32 | $128 | 1.3× |
| Real-time fluorescence wound imaging with clinical darkness, to identify location of bacterial wound pathogens and… (0598T) | $191.52 | $1,008 | 1.0× |
| Revasc intra lithotrip-ather (C9766) unusually low: confirm this is the full procedure |
$7,339.71 | $38,630.07 | 0.4× |
| Revasc intra lithotrip-stent (C9765) unusually low: confirm this is the full procedure |
$7,188.65 | $37,835 | 0.4× |
| Revasc intravasc lithotripsy (C9764) | $9,138.97 | $48,099.84 | 0.9× |
| Revasc lithotr-ather tib/per (C9774) likely a partial charge, not the full procedure |
$3,428.17 | $18,043 | 0.2× |
| Revasc lithotrip-stent-ather (C9767) | $24,832.72 | $130,698.50 | 1.5× |
| Screen cerv/vag thin layer (G0123) | $19 | $100 | 0.9× |
| Spine device implant surgery (C9757) likely a partial charge, not the full procedure |
$3,453.31 | $18,175.29 | 0.3× |
| Tomosynthesis, mammo (G0279) | $30.40 | $160 | 2.4× |
| Transcatheter Renal Sympath Denervation Bilat (0339T) | $3,250.14 | $17,106 | 0.6× |
| Transcatheter renal sympath denervation unilat (0338T) | $3,250.14 | $17,106 | 0.6× |
| Trluml periph athrc w/rs&i brchiocphl ea vsl (0237T) | $13,635.50 | $71,765.81 | 1.3× |
| Tte w or wo fol wcon,doppler (C8929) | $519.84 | $2,736 | 0.7× |
| Unsched dialysis esrd pt hos (G0257) | $445.55 | $2,345 | 0.7× |