21 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|
| Admin influenza virus vac (G0008) |
$17 |
$17 |
0.4× |
| Admin pneumococcal vaccine (G0009) |
$54.82 |
$54.82 |
1.3× |
| Bone strength and fracture risk using finite element analysis of functional data and bone-mineral density utilizing… (0555T) |
$135.20 |
$135.20 |
5.3× |
| Catheterize for urine spec (P9612) |
$80 |
$80 |
8.6× |
| Colon ca scrn not hi rsk ind (G0121) |
$11,628.80 |
$11,628.80 |
14.3× |
| Colorectal scrn; hi risk ind (G0105) |
$11,628.80 |
$11,628.80 |
14.3× |
| Direct refer hospital observ (G0379) |
$250 |
$250 |
0.5× |
| Drug test def 1-7 classes (G0480) |
$203.29 |
$203.29 |
1.8× |
| Drug test def 15-21 classes (G0482) |
$550 |
$550 |
2.8× |
| Drug test def 8-14 classes (G0481) |
$722.72 |
$722.72 |
4.6× |
| Elec stim other than wound (G0283) |
$110.20 |
$110.20 |
8.7× |
| Hospital outpt clinic visit (G0463) |
$75.88 |
$75.88 |
0.7× |
| Inj for sacroiliac jt anesth (G0260) |
$9,100.80 |
$9,100.80 |
14.7× |
| Injection(s), bone substitute material (eg, calcium phosphate) into subchondral bone defect (ie, bone marrow lesion,… (0707T) |
$13,118.94 |
$13,118.94 |
4.6× |
| Njx pltlt plasma w/img harvest/preparation (0232T) |
$6,067.20 |
$6,067.20 |
15.5× |
| Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral… (0627T) |
$75,341 |
$75,341 |
6.7× |
| Perq Sacral Augmt Bilat Inj (0201T) |
$6,067.20 |
$6,067.20 |
1.0× |
| Perq Sacral Augmt Unilat Inj (0200T) |
$69,000 |
$69,000 |
10.9× |
| Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone… (0221T) |
$6,067.20 |
$6,067.20 |
1.0× |
| Psa screening (G0103) |
$202.32 |
$202.32 |
10.5× |
| Spine device implant surgery (C9757) |
$30,724 |
$30,724 |
2.7× |