13 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|
| Ca screen;flexi sigmoidscope (G0104) |
$825.83 |
$1,736.44 |
1.0× |
| Colon ca scrn not hi rsk ind (G0121) |
$825.83 |
$2,500.47 |
1.0× |
| Colorectal scrn; hi risk ind (G0105) |
$825.83 |
$2,109.20 |
1.0× |
| Cysto, litho, vacuum kidney (C9761) |
$8,406.47 |
$15,000 |
1.0× |
| Direct refer hospital observ (G0379) |
$528.85 |
$600 |
1.0× |
| Inj for sacroiliac jt anesth (G0260) |
$626.84 |
$1,823.26 |
1.0× |
| Injection(s), bone substitute material (eg, calcium phosphate) into subchondral bone defect (ie, bone marrow lesion,… (0707T) |
$2,905.62 |
$7,980 |
1.0× |
| Insertion of sinus tarsi implant (0335T) |
$6,443.71 |
$6,833.93 |
1.0× |
| Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections, one leg,… (0263T) |
$3,867.80 |
$7,600 |
1.0× |
| Njx pltlt plasma w/img harvest/preparation (0232T) |
$396.70 |
$2,334.86 |
1.0× |
| Non-ophthalmic fva (C9733) |
$309.81 |
$1,700 |
1.0× |
| Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral… (0627T) |
$11,401.09 |
$16,000 |
1.0× |
| Spine device implant surgery (C9757) |
$11,401.09 |
$10,000 |
1.0× |