Supplies, drugs & other prices at Lost Rivers Medical Center
Arco, ID · every code in this section with a posted price and a Medicare benchmark.
39 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|---|---|---|
| 2019-ncov diagnostic p (U0001) | $125 | $128 | 3.5× |
| 2d tte w or w/o fol w/con,co (C8923) | $2,200 | $2,750 | 2.8× |
| Adm of soc dtr assess 5-15 m (G0136) | $30.40 | $38 | 0.8× |
| Admin hepatitis b vaccine (G0010) | $22.40 | $28 | 0.5× |
| Admin influenza virus vac (G0008) | $26 | $32.50 | 0.6× |
| Admin pneumococcal vaccine (G0009) | $26 | $32.50 | 0.6× |
| Annual alcohol screen 15 min (G0442) | $28 | $35 | 0.8× |
| Ca screen;flexi sigmoidscope (G0104) | $2,008.80 | $2,511 | 2.2× |
| Ca screen;pelvic/breast exam (G0101) | $61.60 | $77 | 0.6× |
| Catheterize for urine spec (P9612) | $56 | $70 | 6.0× |
| Colon ca scrn not hi rsk ind (G0121) | $1,544.40 | $1,930.50 | 1.7× |
| Colorectal scrn; hi risk ind (G0105) | $1,559.20 | $1,949 | 1.7× |
| Covid-19 lab test non-cdc (U0002) | $150 | $153 | 2.9× |
| Depression screen annual (G0444) | $28 | $35 | 0.8× |
| Drug test def 1-7 classes (G0480) | $140.04 | $175.05 | 1.2× |
| Drug test def 15-21 classes (G0482) | $691.20 | $864 | 3.5× |
| Drug test def 22+ classes (G0483) | $896 | $1,120 | 3.6× |
| Drug test def 8-14 classes (G0481) | $512.80 | $641 | 3.3× |
| Drug test def simple all cl (G0659) | $330.40 | $413 | 5.3× |
| Ekg tracing for initial prev (G0404) | $73.60 | $92 | 2.6× |
| Elec stim other than wound (G0283) | $42.40 | $53 | 3.3× |
| Followup eval of foot pt lop (G0246) | $64.80 | $81 | 0.5× |
| Hep c screen high risk/other (G0472) | $192 | $240 | 4.1× |
| Hiv combination assay (G0475) | $125.60 | $157 | 5.2× |
| Hpv combo assay ca screen (G0476) | $194.40 | $243 | 5.5× |
| Initial foot exam pt lops (G0245) | $109.60 | $137 | 0.8× |
| Initial preventive exam (G0402) | $260 | $325 | 2.0× |
| Obtaining screen pap smear (Q0091) | $67.20 | $84 | 2.4× |
| Place direct restoration (D2940) | $45.60 | $57 | 0.1× |
| Ppps, initial visit (G0438) | $284.80 | $356 | 1.6× |
| Ppps, subseq visit (G0439) | $188 | $235 | 1.4× |
| Psa screening (G0103) | $113.60 | $142 | 5.9× |
| Routine footcare pt w lops (G0247) | $138.40 | $173 | 0.7× |
| Screen cerv/vag thin layer (G0123) | $146.40 | $183 | 7.2× |
| Trauma respons w/hosp criti (G0390) | $1,276 | $1,595 | 1.0× |
| Trim nail(s) (G0127) | $39.20 | $49 | 0.7× |
| Tte w or wo fol wcon,doppler (C8929) | $2,840 | $3,550 | 3.7× |
| Visit esketamine 56m or less (G2082) | $1,861.60 | $2,327 | 1.8× |
| Visit to determ ldct elig (G0296) | $44.80 | $56 | 0.4× |