Supplies, drugs & other prices at North Mississippi Medical Center-Pontotoc
Pontotoc, MS · every code in this section with a posted price and a Medicare benchmark.
56 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|---|---|---|
| Admin hepatitis b vaccine (G0010) | $58.05 | $135 | 1.4× |
| Admin influenza virus vac (G0008) | $58.05 | $135 | 1.4× |
| Admin pneumococcal vaccine (G0009) | $58.05 | $135 | 1.4× |
| Chemo extend iv infus w/pump (G0498) | $559 | $1,300 | 2.0× |
| Colon ca scrn not hi rsk ind (G0121) | $966.21 | $2,247 | 1.2× |
| Colorectal scrn; hi risk ind (G0105) | $966.21 | $2,247 | 1.2× |
| Diab manage trn per indiv (G0108) | $59.34 | $138 | 1.1× |
| Direct refer hospital observ (G0379) | $838.93 | $1,951 | 1.6× |
| Drug test def 1-7 classes (G0480) | $67.51 | $157 | 0.6× |
| Drug test def 8-14 classes (G0481) | $83.85 | $195 | 0.5× |
| Eia hiv-1/hiv-2 screen (G0432) | $136.74 | $318 | 7.0× |
| Elec stim other than wound (G0283) | $74.60 | $173.50 | 5.9× |
| Elec stim unattend for press (G0281) | $77.40 | $180 | 6.6× |
| Fecal microbiota prep instil (G0455) | $55.04 | $128 | 0.1× |
| Hbot, full body chamber, 30m (G0277) | $164.69 | $383 | 1.4× |
| Hospital outpt clinic visit (G0463) | $83.85 | $195 | 0.7× |
| Inj for sacroiliac jt anesth (G0260) | $899.34 | $2,091.50 | 1.5× |
| Instlj fecal microbiota ssp (0780T) | $344 | $800 | 3.0× |
| Mra w/cont, abd (C8900) | $1,741.50 | $4,050 | 5.8× |
| Mra w/cont, pelvis (C8918) | $1,565.63 | $3,641 | 5.2× |
| Mra w/o cont, chest (C8910) | $1,537.25 | $3,575 | 7.5× |
| Mra w/o cont, lwr ext (C8913) | $1,470.17 | $3,419 | 7.1× |
| Mra w/o cont, pelvis (C8919) | $1,466.30 | $3,410 | 7.1× |
| Mra w/o fol w/cont, abd (C8902) | $2,241.59 | $5,213 | 7.5× |
| Mra w/o fol w/cont, chest (C8911) | $2,285.88 | $5,316 | 7.6× |
| Mra w/o fol w/cont, pelvis (C8920) | $2,205.47 | $5,129 | 7.3× |
| N-invs det hrt fail aug echo (0932T) | $387 | $900 | 1.5× |
| Ncntc nr ifr spectrsc oth/thn pad 1st antmc site (0640T) | $58.05 | $135 | 1.8× |
| Oth resp proc, group (G0239) | $43.43 | $101 | 1.3× |
| Perc d-e cor revasc chro sin (C9607) | $10,071.03 | $23,421 | 0.6× |
| Perc d-e cor revasc t cabg s (C9604) | $14,585.60 | $33,920 | 1.5× |
| Perc d-e cor stent ather s (C9602) | $14,585.60 | $33,920 | 0.9× |
| Perc drug-el cor stent sing (C9600) | $7,429.54 | $17,278 | 0.7× |
| Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral… (0627T) | $16,598 | $38,600 | 1.5× |
| Perq Sacral Augmt Bilat Inj (0201T) | $4,883.94 | $11,358 | 0.8× |
| Perq Sacral Augmt Unilat Inj (0200T) | $4,691.30 | $10,910 | 0.7× |
| Psa screening (G0103) | $27.09 | $63 | 1.4× |
| Real-time fluorescence wound imaging with clinical darkness, to identify location of bacterial wound pathogens and… (0598T) | $329.81 | $767 | 1.8× |
| Revasc intra lithotrip-ather (C9766) | $12,781.75 | $29,725 | 0.8× |
| Revasc intra lithotrip-stent (C9765) | $12,781.75 | $29,725 | 0.8× |
| Revasc intravasc lithotripsy (C9764) | $6,390.23 | $14,861 | 0.6× |
| Revasc lith-sten-ath tib/per (C9775) | $17,970.56 | $41,792 | 1.1× |
| Revasc lithotr-ather tib/per (C9774) | $17,970.56 | $41,792 | 1.1× |
| Revasc lithotr-stent tib/per (C9773) | $17,970.56 | $41,792 | 1.1× |
| Revasc lithotrip tibi/perone (C9772) | $10,502.32 | $24,424 | 1.1× |
| Revasc lithotrip-stent-ather (C9767) | $20,562.60 | $47,820 | 1.3× |
| Scr c/v cyto,thinlayer,rescr (G0144) | $109.65 | $255 | 2.5× |
| Tcat insj perm 1chmbr ldls pacemaker r atrial (0823T) | $21,780.79 | $50,653 | 1.3× |
| Therapeutic procd strg endur (G0237) | $77.40 | $180 | 3.1× |
| Tomosynthesis, mammo (G0279) | $94.60 | $220 | 7.5× |
| Transcatheter Renal Sympath Denervation Bilat (0339T) | $14,064.44 | $32,708 | 2.9× |
| Transcatheter renal sympath denervation unilat (0338T) | $7,032.65 | $16,355 | 1.4× |
| Trauma respons w/hosp criti (G0390) | $1,894.58 | $4,406 | 1.6× |
| Trim nail(s) (G0127) | $119.97 | $279 | 2.4× |
| Unsched dialysis esrd pt hos (G0257) | $448.92 | $1,044 | 0.8× |
| Visit to determ ldct elig (G0296) | $82.13 | $191 | 0.9× |