Supplies, drugs & other prices at Loyola University Medical Center

Maywood, 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.

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ProcedurePosted cashPosted gross× Medicare
Adapt bhv tx prtcl modificaj ea 15 min tech time (0373T) $15.41 $67 0.4×
Adm of soc dtr assess 5-15 m (G0136) $12.65 $55 0.3×
Anatomic guide 3d printed 1st anatomic guide (0561T) $35.65 $155 0.3×
Anatomic Model 3D Printed 1St Compnt Antmc Strux (0559T) $35.65 $155 0.3×
Bdy surf activation mapg pm/cvdfb leads tm f/up (0696T) $996.13 $4,331 24.9×
Bone Strength & Fracture Risk Assessment (0556T) $149.96 $652 0.6×
Ca screen;pelvic/breast exam (G0101) $20.47 $89 0.2×
Cbc without platelet (G0307)
range across 2 matching MRF lines
$19.55–$20.47 $85–$89 varies
Cbc/diffwbc w/o platelet (G0306)
range across 2 matching MRF lines
$23.23–$24.15 $101–$105 varies
Colorectal scrn; hi risk ind (G0105) $852.61 $3,707 0.9×
Computed tomography scan taken for the purpose of biomechanical computed tomography analysis Non-Facility Physician (0558T) $51.52 $224 0.6×
Demonstrate use home inr mon (G0248) $96.37 $419 0.7×
Diab manage trn per indiv (G0108) $36.80 $160 0.7×
Diab manage trn ind/group (G0109) $20.47 $89 1.3×
Direct refer hospital observ (G0379) $252.31 $1,097 0.4×
Ed svc ckd ind per session (G0420) $58.19 $253 0.5×
Ekg tracing for initial prev (G0404) $53.36 $232 1.7×
Elec stim other than wound (G0283) $46.23 $201 3.6×
Elec stim unattend for press (G0281) $43.24 $188 3.7×
Esd endoscopy or colonoscopy (C9779) $1,655.31 $7,197 0.4×
Evac Meibomian Glnds Auto Ht& Intmt Press Uni (0207T) $53.59 $233 0.4×
Fecal microbiota prep instil (G0455)
range across 2 matching MRF lines
$411.24–$443.90 $1,788–$1,930 varies
Followup eval of foot pt lop (G0246) $33.58 $146 0.2×
Glaucoma scrn hgh risk direc (G0118) $22.31 $97 0.6×
Glaucoma scrn hgh risk direc (G0117) $29.90 $130 1.0×
Hbot, full body chamber, 30m (G0277) $215.28 $936 1.5×
Hdr electronic brachytherapy ntrstl/intrcav (0395T) $365.01 $1,587 0.5×
Home sleep test/type 3 porta (G0399) $186.99 $813 0.8×
Hopd mntl hlt, 15-29 min (C7900) $13.80 $60 0.3×
Hopd mntl hlt, 30-60 min (C7901) $34.96 $152 0.3×
Hospital outpt clinic visit (G0463) $123.74 $538 0.9×
Initial foot exam pt lops (G0245) $67.85 $295 0.5×
Initial preventive exam (G0402) $61.41 $267 0.4×
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that… (0216T) $385.48 $1,676 0.4×
Insert palate implants (C9727) $630.43 $2,741 0.4×
Insj/Rplcmt Icds W/Substernal Electrode (0571T)
unusually low: confirm this is the full procedure
$14,707.58 $63,946 0.4×
Instill pharm renal pelvis (C9789) $1,865.76 $8,112 1.4×
Instlj fecal microbiota ssp (0780T) $333.04 $1,448 2.3×
Myocrd Symp Innervaj Img Plnr Qual&Quant W/Spect (0332T) $671.60 $2,920 0.5×
Neuro csf prion prtn qual (0035U) $578.91 $2,517 1.1×
Njx dx/ther paraver fct jt w/us cer/thor 1 lvl (0213T) $385.48 $1,676 0.4×
Njx platelet plasma (0232T)
range across 3 matching MRF lines
$173.88–$540.50 $756–$2,350 varies
Non-ophthalmic fva (C9733) $158.47 $689 0.4×
Obtaining screen pap smear (Q0091) $25.53 $111 0.8×
Onc aml DNA gntyp int tandem dup detcj/nondetcj (0023U) $227.24 $988 0.9×
Oth resp proc, group (G0239) $51.75 $225 1.3×
Oth resp proc, indiv (G0238) $46 $200 1.5×
Perc d-e cor revasc chro sin (C9607)
unusually low: confirm this is the full procedure
$7,003.73 $30,451 0.4×
Perc d-e cor revasc t cabg s (C9604) $6,366.86 $27,682 0.5×
Perc d-e cor stent ather s (C9602)
unusually low: confirm this is the full procedure
$6,869.18 $29,866 0.3×
Perc drug-el cor stent sing (C9600) $6,556.61 $28,507 0.5×
Perq Sacral Augmt Bilat Inj (0201T)
unusually low: confirm this is the full procedure
$3,291.30 $14,310 0.4×
Perq Sacral Augmt Unilat Inj (0200T)
unusually low: confirm this is the full procedure
$3,291.30 $14,310 0.4×
Perq tcat ther rx dlvr ntrac rx balo 1 maj c art (0913T)
likely a partial charge, not the full procedure
$2,622.92 $11,404 0.2×
Place device/marker, non pro (C9728) $439.30 $1,910 0.3×
Ppps, initial visit (G0438) $14.95 $65 0.1×
Ppps, subseq visit (G0439) $14.95 $65 0.1×
Prgrmg dev eval ldls pm single car chamber ip (0826T) $49.68 $216 1.2×
Prgrmg dev eval ldls pm sys 2chmbr in person (0804T) $213.67 $929 5.3×
Prgrmg dev eval scrms phys/qhp remote (0650T) $23.23 $101 0.6×
Prolonged iv inf, req pump (C8957) $114.54 $498 0.5×
Prostate biopsy, any mthd (G0416) $162.15 $705 0.4×
Provide inr test mater/equip (G0249) $59.57 $259 0.4×
Rem interrog dev eval ss ld icds < 90d tech (0579T) $21.16 $92 0.5×
Revasc intra lithotrip-ather (C9766)
unusually low: confirm this is the full procedure
$7,696.03 $33,461 0.4×
Revasc intra lithotrip-stent (C9765)
unusually low: confirm this is the full procedure
$7,696.03 $33,461 0.4×
Revasc intravasc lithotripsy (C9764)
unusually low: confirm this is the full procedure
$4,813.21 $20,927 0.4×
Revasc lith-sten-ath tib/per (C9775)
unusually low: confirm this is the full procedure
$7,696.03 $33,461 0.4×
Revasc lithotr-ather tib/per (C9774)
unusually low: confirm this is the full procedure
$7,696.03 $33,461 0.4×
Revasc lithotr-stent tib/per (C9773)
unusually low: confirm this is the full procedure
$7,696.03 $33,461 0.4×
Revasc lithotrip tibi/perone (C9772)
unusually low: confirm this is the full procedure
$4,813.21 $20,927 0.4×
Revasc lithotrip-stent-ather (C9767)
unusually low: confirm this is the full procedure
$7,696.03 $33,461 0.4×
Routine footcare pt w lops (G0247) $83.26 $362 0.4×
Screen pap by tech w md supv (P3000) $23.92 $104 1.3×
Tcat insj perm 1chmbr ldls pacemaker r atrial (0823T)
unusually low: confirm this is the full procedure
$8,772.89 $38,143 0.4×
Tcat insj perm 2chmbr ldls pm r ventr pm compnt (0797T)
unusually low: confirm this is the full procedure
$8,772.89 $38,143 0.4×
Tcat Insj Perm Dual Chamber Ldls Pm Compl Sys (0795T)
unusually low: confirm this is the full procedure
$8,772.89 $38,143 0.4×
Tcat Rmvl/Debulk Icar Mass Suction Device Perq (0644T)
unusually low: confirm this is the full procedure
$2,622.92 $11,404 0.4×
Tear film imaging unilateral or bilateral w/i&r (0330T) $17.02 $74 0.4×
Therapeutic procd strg endur (G0237) $43.24 $188 1.4×
Transcatheter Renal Sympath Denervation Bilat (0339T)
unusually low: confirm this is the full procedure
$2,421.67 $10,529 0.4×
Transcatheter renal sympath denervation unilat (0338T)
unusually low: confirm this is the full procedure
$2,421.67 $10,529 0.4×
Trauma respons w/hosp criti (G0390)
range across 2 matching MRF lines
$2,225.71–$2,380.96 $9,677–$10,352 varies
Trim nail(s) (G0127) $26.45 $115 0.4×
Trluml perip athrc abd aorta (0236T)
unusually low: confirm this is the full procedure
$5,325.42 $23,154 0.4×
Trluml Perip Athrc Brchiocph (0237T)
unusually low: confirm this is the full procedure
$5,325.42 $23,154 0.4×
Trluml Perip Athrc Iliac Art (0238T)
likely a partial charge, not the full procedure
$5,094.04 $22,148 0.3×
Trluml Peripheral Atherectomy Renal Artery Ea (0234T)
unusually low: confirm this is the full procedure
$4,630.59 $20,133 0.4×
Vasc emb/occ w/prs cath (C9797)
unusually low: confirm this is the full procedure
$7,992.96 $34,752 0.4×
Visit esketamine 56m or less (G2082) $299.23 $1,301 0.3×
Visit esketamine, > 56m (G2083) $437.23 $1,901 0.3×
Visit to determ ldct elig (G0296) $35.19 $153 0.3×
Wet mounts/ w preparations (Q0111) $7.36 $32 0.4×

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.