Supplies, drugs & other prices at North Memorial Health - Maple Grove Hospital
Maple Grove, MN · every code in this section with a posted price and a Medicare benchmark.
42 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|---|---|---|
| 2d tee w or w/o fol w/con,in (C8925) | $1,258.48 | $2,388 | 1.5× |
| 2d tte w or w/o fol w/con,fu (C8924) | $514.88 | $977 | 1.4× |
| Admin hepatitis b vaccine (G0010) | $41.11 | $78 | 0.8× |
| Admin influenza virus vac (G0008) | $36.89 | $70 | 0.8× |
| Admin pneumococcal vaccine (G0009) | $35.84 | $68 | 0.7× |
| Chemo extend iv infus w/pump (G0498) | $434.77 | $825 | 1.3× |
| Direct refer hospital observ (G0379) | $656.11 | $1,245 | 1.1× |
| Drug test def 1-7 classes (G0480) | $108.55 | $205.97 | 0.9× |
| Hospital outpt clinic visit (G0463) | $233.46 | $443 | 1.7× |
| Iliac Atherectomy (0238T) | $20,369.60 | $38,652 | 1.1× |
| Inj for sacroiliac jt anesth (G0260) | $1,137.53 | $2,158.50 | 1.5× |
| Jak2 Gene Analysis Trgt Seq Alys Exons 12-15 (0027U) | $338.22 | $641.78 | 2.8× |
| Mra w/cont, abd (C8900) | $933.84 | $1,772 | 2.6× |
| Mra w/cont, lwr ext (C8912) | $933.84 | $1,772 | 2.6× |
| Mra w/cont, pelvis (C8918) | $933.84 | $1,772 | 2.6× |
| Mra w/o cont, pelvis (C8919) | $286.69 | $544 | 1.1× |
| Mra w/o fol w/cont, abd (C8902) | $1,030.28 | $1,955 | 2.8× |
| Mra w/o fol w/cont, chest (C8911) | $1,030.28 | $1,955 | 2.8× |
| Mra w/o fol w/cont, lwr ext (C8914) | $1,030.28 | $1,955 | 2.8× |
| Mra w/o fol w/cont, pelvis (C8920) | $1,030.28 | $1,955 | 2.8× |
| Mra, w/dye, upper extremity (C8934) | $1,074.03 | $2,038 | 2.9× |
| Mra, w/o&w/dye, upper extr (C8936) | $443.21 | $841 | 1.2× |
| Mri w/cont, breast, bi (C8906) | $933.84 | $1,772 | 2.6× |
| Mri w/o fol w/cont, breast, (C8908) | $1,040.82 | $1,975 | 2.8× |
| Oth resp proc, group (G0239) | $73.25 | $139 | 1.9× |
| Perq tcat ther rx dlvr ntrac rx balo 1 maj c art (0913T) unusually low: confirm this is the full procedure |
$5,470.79 | $10,381 | 0.5× |
| Place device/marker, non pro (C9728) | $1,808.66 | $3,432 | 1.2× |
| Prostate biopsy, any mthd (G0416) | $394.20 | $748 | 1.1× |
| Psa screening (G0103) | $28.46 | $54 | 1.5× |
| Revasc intra lithotrip-ather (C9766) | $21,074.73 | $39,990 | 1.1× |
| Revasc intra lithotrip-stent (C9765) | $20,197.80 | $38,326 | 1.1× |
| Revasc intravasc lithotripsy (C9764) | $13,746.79 | $26,085 | 1.1× |
| Revasc lithotrip tibi/perone (C9772) | $13,023.75 | $24,713 | 1.1× |
| Revasc lithotrip-stent-ather (C9767) | $16,030.29 | $30,418 | 0.8× |
| Tee w or w/o fol w/cont,cong (C8926) | $1,029.76 | $1,954 | 1.3× |
| Therapeutic procd strg endur (G0237) | $70.62 | $134 | 2.3× |
| Tomosynthesis, mammo (G0279) | $51.12 | $97 | 4.0× |
| Tpmt nudt15 gene analysis common variants (0034U) | $491.34 | $932.34 | 1.1× |
| Trauma respons w/hosp criti (G0390) | $3,698.49 | $7,018 | 2.6× |
| Tte w or w/o contr, cont ecg (C8930) | $1,162.03 | $2,205 | 1.4× |
| Tte w or w/o fol w/cont, com (C8921) | $1,029.76 | $1,954 | 1.3× |
| Tte w or wo fol wcon,doppler (C8929) | $1,017.11 | $1,930 | 1.2× |