20 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|
| Admin influenza virus vac (G0008) |
$27.50 |
$68 |
0.6× |
| Admin pneumococcal vaccine (G0009) |
$52 |
$129 |
1.1× |
| Antibody, Treponema pallidum, total and rapid plasma reagin (RPR), immunoassay, qualitative Other Outpatient (0064U) |
$14 |
$36 |
0.4× |
| Ca screen;pelvic/breast exam (G0101) |
$16 |
$40 |
0.2× |
| Catheterize for urine spec (P9612) |
$3 |
$8 |
0.3× |
| Colon ca scrn not hi rsk ind (G0121) |
$200 |
$500 |
0.2× |
| Depression screen annual (G0444) |
$12 |
$30 |
0.3× |
| Direct refer hospital observ (G0379) |
$84 |
$210 |
0.1× |
| Drug test def 1-7 classes (G0480) |
$69 |
$173 |
0.6× |
| Ekg tracing for initial prev (G0404) |
$8 |
$20 |
0.3× |
| Elec stim other than wound (G0283) |
$14 |
$35 |
1.1× |
| Home sleep test/type 3 porta (G0399) |
$472.50 |
$1,181.50 |
2.2× |
| Hospital outpt clinic visit (G0463) |
$146 |
$365 |
1.1× |
| Initial preventive exam (G0402) |
$70 |
$175 |
0.5× |
| Inj for sacroiliac jt anesth (G0260) |
$510 |
$1,274 |
0.7× |
| Ppps, initial visit (G0438) |
$74 |
$185 |
0.4× |
| Ppps, subseq visit (G0439) |
$54 |
$135 |
0.4× |
| Psa screening (G0103) |
$32 |
$80 |
1.7× |
| Semen analysis (G0027) |
$21 |
$53 |
3.2× |
| Trauma respons w/hosp criti (G0390) |
$1,226 |
$3,065 |
0.9× |