Supplies, drugs & other prices at Loyola Gottlieb Memorial Hospital
Melrose Park, IL · every code in this section with a posted price and a Medicare benchmark.
93 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Adapt bhv tx prtcl modificaj ea 15 min tech time (0373T) | $12.73 | $67 | 0.3× |
| Adm of soc dtr assess 5-15 m (G0136) | $10.45 | $55 | 0.3× |
| Anatomic guide 3d printed 1st anatomic guide (0561T) | $29.45 | $155 | 0.2× |
| Anatomic Model 3D Printed 1St Compnt Antmc Strux (0559T) | $29.45 | $155 | 0.2× |
| Bdy surf activation mapg pm/cvdfb leads tm f/up (0696T) | $822.89 | $4,331 | 20.6× |
| Bone Strength & Fracture Risk Assessment (0556T) | $123.88 | $652 | 0.5× |
| Ca screen;pelvic/breast exam (G0101) | $16.91 | $89 | 0.2× |
| Cbc without platelet (G0307) range across 2 matching MRF lines |
$16.15–$16.91 | $85–$89 | varies |
| Cbc/diffwbc w/o platelet (G0306) range across 2 matching MRF lines |
$19.19–$19.95 | $101–$105 | varies |
| Colorectal scrn; hi risk ind (G0105) | $704.33 | $3,707 | 0.7× |
| Computed tomography scan taken for the purpose of biomechanical computed tomography analysis Non-Facility Physician (0558T) | $42.56 | $224 | 0.5× |
| Demonstrate use home inr mon (G0248) | $79.61 | $419 | 0.6× |
| Diab manage trn per indiv (G0108) | $30.40 | $160 | 0.5× |
| Diab manage trn ind/group (G0109) | $16.91 | $89 | 1.1× |
| Direct refer hospital observ (G0379) | $208.43 | $1,097 | 0.3× |
| Ed svc ckd ind per session (G0420) | $48.07 | $253 | 0.4× |
| Ekg tracing for initial prev (G0404) | $44.08 | $232 | 1.4× |
| Elec stim other than wound (G0283) | $38.19 | $201 | 3.0× |
| Elec stim unattend for press (G0281) | $35.72 | $188 | 3.1× |
| Esd endoscopy or colonoscopy (C9779) | $1,367.43 | $7,197 | 0.3× |
| Evac Meibomian Glnds Auto Ht& Intmt Press Uni (0207T) | $44.27 | $233 | 0.3× |
| Fecal microbiota prep instil (G0455) range across 2 matching MRF lines |
$339.72–$366.70 | $1,788–$1,930 | varies |
| Followup eval of foot pt lop (G0246) | $27.74 | $146 | 0.2× |
| Glaucoma scrn hgh risk direc (G0118) | $18.43 | $97 | 0.5× |
| Glaucoma scrn hgh risk direc (G0117) | $24.70 | $130 | 0.8× |
| Hbot, full body chamber, 30m (G0277) | $177.84 | $936 | 1.2× |
| Hdr electronic brachytherapy ntrstl/intrcav (0395T) | $301.53 | $1,587 | 0.4× |
| Home sleep test/type 3 porta (G0399) | $154.47 | $813 | 0.7× |
| Hopd mntl hlt, 15-29 min (C7900) | $11.40 | $60 | 0.3× |
| Hopd mntl hlt, 30-60 min (C7901) | $28.88 | $152 | 0.3× |
| Hospital outpt clinic visit (G0463) | $102.22 | $538 | 0.7× |
| Initial foot exam pt lops (G0245) | $56.05 | $295 | 0.4× |
| Initial preventive exam (G0402) | $50.73 | $267 | 0.4× |
| Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that… (0216T) | $318.44 | $1,676 | 0.3× |
| Insert palate implants (C9727) | $520.79 | $2,741 | 0.3× |
| Insj/Rplcmt Icds W/Substernal Electrode (0571T) unusually low: confirm this is the full procedure |
$12,149.74 | $63,946 | 0.4× |
| Instill pharm renal pelvis (C9789) | $1,541.28 | $8,112 | 1.2× |
| Instlj fecal microbiota ssp (0780T) | $275.12 | $1,448 | 1.9× |
| Myocrd Symp Innervaj Img Plnr Qual&Quant W/Spect (0332T) | $554.80 | $2,920 | 0.4× |
| Neuro csf prion prtn qual (0035U) | $478.23 | $2,517 | 0.9× |
| Njx dx/ther paraver fct jt w/us cer/thor 1 lvl (0213T) | $318.44 | $1,676 | 0.3× |
| Njx platelet plasma (0232T) range across 3 matching MRF lines |
$143.64–$446.50 | $756–$2,350 | varies |
| Non-ophthalmic fva (C9733) | $130.91 | $689 | 0.4× |
| Obtaining screen pap smear (Q0091) | $21.09 | $111 | 0.7× |
| Onc aml DNA gntyp int tandem dup detcj/nondetcj (0023U) | $187.72 | $988 | 0.8× |
| Oth resp proc, group (G0239) | $42.75 | $225 | 1.1× |
| Oth resp proc, indiv (G0238) | $38 | $200 | 1.2× |
| Perc d-e cor revasc chro sin (C9607) likely a partial charge, not the full procedure |
$5,785.69 | $30,451 | 0.3× |
| Perc d-e cor revasc t cabg s (C9604) unusually low: confirm this is the full procedure |
$5,259.58 | $27,682 | 0.4× |
| Perc d-e cor stent ather s (C9602) likely a partial charge, not the full procedure |
$5,674.54 | $29,866 | 0.3× |
| Perc drug-el cor stent sing (C9600) unusually low: confirm this is the full procedure |
$5,416.33 | $28,507 | 0.4× |
| Perq Sacral Augmt Bilat Inj (0201T) unusually low: confirm this is the full procedure |
$2,718.90 | $14,310 | 0.3× |
| Perq Sacral Augmt Unilat Inj (0200T) unusually low: confirm this is the full procedure |
$2,718.90 | $14,310 | 0.3× |
| Perq tcat ther rx dlvr ntrac rx balo 1 maj c art (0913T) likely a partial charge, not the full procedure |
$2,166.76 | $11,404 | 0.2× |
| Place device/marker, non pro (C9728) | $362.90 | $1,910 | 0.2× |
| Ppps, initial visit (G0438) | $12.35 | $65 | 0.1× |
| Ppps, subseq visit (G0439) | $12.35 | $65 | 0.1× |
| Prgrmg dev eval ldls pm single car chamber ip (0826T) | $41.04 | $216 | 1.0× |
| Prgrmg dev eval ldls pm sys 2chmbr in person (0804T) | $176.51 | $929 | 4.4× |
| Prgrmg dev eval scrms phys/qhp remote (0650T) | $19.19 | $101 | 0.5× |
| Prolonged iv inf, req pump (C8957) | $94.62 | $498 | 0.4× |
| Prostate biopsy, any mthd (G0416) | $133.95 | $705 | 0.3× |
| Provide inr test mater/equip (G0249) | $49.21 | $259 | 0.3× |
| Rem interrog dev eval ss ld icds < 90d tech (0579T) | $17.48 | $92 | 0.4× |
| Revasc intra lithotrip-ather (C9766) unusually low: confirm this is the full procedure |
$6,357.59 | $33,461 | 0.3× |
| Revasc intra lithotrip-stent (C9765) unusually low: confirm this is the full procedure |
$6,357.59 | $33,461 | 0.3× |
| Revasc intravasc lithotripsy (C9764) unusually low: confirm this is the full procedure |
$3,976.13 | $20,927 | 0.3× |
| Revasc lith-sten-ath tib/per (C9775) unusually low: confirm this is the full procedure |
$6,357.59 | $33,461 | 0.3× |
| Revasc lithotr-ather tib/per (C9774) unusually low: confirm this is the full procedure |
$6,357.59 | $33,461 | 0.3× |
| Revasc lithotr-stent tib/per (C9773) unusually low: confirm this is the full procedure |
$6,357.59 | $33,461 | 0.3× |
| Revasc lithotrip tibi/perone (C9772) unusually low: confirm this is the full procedure |
$3,976.13 | $20,927 | 0.3× |
| Revasc lithotrip-stent-ather (C9767) unusually low: confirm this is the full procedure |
$6,357.59 | $33,461 | 0.3× |
| Routine footcare pt w lops (G0247) | $68.78 | $362 | 0.3× |
| Screen pap by tech w md supv (P3000) | $19.76 | $104 | 1.1× |
| Tcat insj perm 1chmbr ldls pacemaker r atrial (0823T) unusually low: confirm this is the full procedure |
$7,247.17 | $38,143 | 0.4× |
| Tcat insj perm 2chmbr ldls pm r ventr pm compnt (0797T) unusually low: confirm this is the full procedure |
$7,247.17 | $38,143 | 0.4× |
| Tcat Insj Perm Dual Chamber Ldls Pm Compl Sys (0795T) unusually low: confirm this is the full procedure |
$7,247.17 | $38,143 | 0.4× |
| Tcat Rmvl/Debulk Icar Mass Suction Device Perq (0644T) unusually low: confirm this is the full procedure |
$2,166.76 | $11,404 | 0.4× |
| Tear film imaging unilateral or bilateral w/i&r (0330T) | $14.06 | $74 | 0.4× |
| Therapeutic procd strg endur (G0237) | $35.72 | $188 | 1.2× |
| Transcatheter Renal Sympath Denervation Bilat (0339T) unusually low: confirm this is the full procedure |
$2,000.51 | $10,529 | 0.3× |
| Transcatheter renal sympath denervation unilat (0338T) unusually low: confirm this is the full procedure |
$2,000.51 | $10,529 | 0.3× |
| Trauma respons w/hosp criti (G0390) range across 2 matching MRF lines |
$1,838.63–$1,966.88 | $9,677–$10,352 | varies |
| Trim nail(s) (G0127) | $21.85 | $115 | 0.3× |
| Trluml perip athrc abd aorta (0236T) unusually low: confirm this is the full procedure |
$4,399.26 | $23,154 | 0.4× |
| Trluml Perip Athrc Brchiocph (0237T) unusually low: confirm this is the full procedure |
$4,399.26 | $23,154 | 0.4× |
| Trluml Perip Athrc Iliac Art (0238T) likely a partial charge, not the full procedure |
$4,208.12 | $22,148 | 0.2× |
| Trluml Peripheral Atherectomy Renal Artery Ea (0234T) unusually low: confirm this is the full procedure |
$3,825.27 | $20,133 | 0.3× |
| Vasc emb/occ w/prs cath (C9797) unusually low: confirm this is the full procedure |
$6,602.88 | $34,752 | 0.3× |
| Visit esketamine 56m or less (G2082) | $247.19 | $1,301 | 0.2× |
| Visit esketamine, > 56m (G2083) | $361.19 | $1,901 | 0.2× |
| Visit to determ ldct elig (G0296) | $29.07 | $153 | 0.3× |
| Wet mounts/ w preparations (Q0111) | $6.08 | $32 | 0.3× |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.