Supplies, drugs & other prices at Mary Rutan Health
Bellefontaine, OH · every code in this section with a posted price and a Medicare benchmark.
23 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 2d tee w or w/o fol w/con,in (C8925) | $2,680 | $3,350 | 3.5× |
| Admin influenza virus vac (G0008) | $20.80 | $26 | 0.5× |
| Autolog prp not diab ulcer (G0460) | $4,848 | $6,060 | 2.4× |
| Diab manage trn per indiv (G0108) | $136 | $170 | 2.4× |
| Drug test def 1-7 classes (G0480) | $173.60 | $217 | 1.5× |
| Hbot, full body chamber, 30m (G0277) | $344.80 | $431 | 2.5× |
| Home sleep test/type 3 porta (G0399) | $847.20 | $1,059 | 4.0× |
| Hospital outpt clinic visit (G0463) range across 12 matching MRF lines |
$55.20–$169.60 | $69–$212 | varies |
| Liver Dis 10 Assays Serum Algorithm W/Nash (0003M) | $604 | $755 | 1.2× |
| Oth resp proc, group (G0239) | $213.60 | $267 | 5.8× |
| Prostate biopsy, any mthd (G0416) | $580.80 | $726 | 1.6× |
| Psa screening (G0103) range across 5 matching MRF lines |
$9.60–$71.20 | $12–$89 | varies |
| Revasc intra lithotrip-ather (C9766) | $22,250.40 | $27,813 | 1.2× |
| Revasc intra lithotrip-stent (C9765) | $22,250.40 | $27,813 | 1.2× |
| Revasc intravasc lithotripsy (C9764) | $14,111.20 | $17,639 | 1.2× |
| Revasc lith-sten-ath tib/per (C9775) | $25,400.80 | $31,751 | 1.4× |
| Revasc lithotr-ather tib/per (C9774) | $25,175.20 | $31,469 | 1.4× |
| Revasc lithotr-stent tib/per (C9773) | $25,400.80 | $31,751 | 1.4× |
| Revasc lithotrip tibi/perone (C9772) | $24,735.20 | $30,919 | 2.2× |
| Revasc lithotrip-stent-ather (C9767) | $22,250.40 | $27,813 | 1.2× |
| Trim nail(s) (G0127) | $166.40 | $208 | 2.9× |
| Tte w or w/o fol w/con,stres (C8928) | $2,680 | $3,350 | 3.5× |
| Tte w or wo fol wcon,doppler (C8929) | $2,680 | $3,350 | 3.5× |
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.