23 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|
| Admin hepatitis b vaccine (G0010) |
$39.60 |
$79.20 |
0.8× |
| Admin influenza virus vac (G0008) |
$63.60 |
$127.20 |
1.3× |
| Admin pneumococcal vaccine (G0009) |
$63.60 |
$127.20 |
1.3× |
| Catheterize for urine spec (P9612) |
$11.68 |
$127.20 |
1.3× |
| Colon ca scrn not hi rsk ind (G0121) |
$1,169.67 |
$3,366 |
1.3× |
| Colorectal scrn; hi risk ind (G0105) |
$1,169.67 |
$3,366 |
1.3× |
| Direct refer hospital observ (G0379) |
$1,185 |
$2,370 |
2.0× |
| Drug test def 1-7 classes (G0480) |
$94.38 |
$188.75 |
0.8× |
| Drug test def 15-21 classes (G0482) |
$26.50 |
$53 |
0.1× |
| Drug test def 22+ classes (G0483) |
$26.50 |
$53 |
0.1× |
| Drug test def 8-14 classes (G0481) |
$26.50 |
$53 |
0.2× |
| Elec stim other than wound (G0283) |
$46.50 |
$93 |
3.7× |
| Elisa hiv-1/hiv-2 screen (G0433) |
$63.60 |
$127.20 |
3.5× |
| Fecal blood scrn immunoassay (G0328) |
$109.20 |
$218.40 |
6.0× |
| Hospital outpt clinic visit (G0463) |
$402.60 |
$805.20 |
3.0× |
| Inj for sacroiliac jt anesth (G0260) |
$887.83 |
$4,632.30 |
1.2× |
| Injection(s), bone substitute material (eg, calcium phosphate) into subchondral bone defect (ie, bone marrow lesion,… (0707T) |
$4,115.41 |
$12,815.85 |
1.2× |
| Njx pltlt plasma w/img harvest/preparation (0232T) |
$561.87 |
$2,550 |
1.2× |
| Ocular blood flow measure (0198T) |
$316.80 |
$633.60 |
2.4× |
| Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral… (0627T) |
$16,148.04 |
$50,159.28 |
1.3× |
| Posterior vertebral joint(s) arthroplasty (e.g., facet joint(s) replacement) including facetectomy, laminectomy,… (0202T) |
$16,148.04 |
$22,000 |
1.3× |
| Psa screening (G0103) |
$63.60 |
$127.20 |
3.3× |
| Spine device implant surgery (C9757) |
$16,148.04 |
$53,599 |
1.3× |