Supplies, drugs & other prices at Phelps Health Hospital
Rolla, MO · every code in this section with a posted price and a Medicare benchmark.
74 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) | $3,714.74 | $5,306.77 | 4.7× |
| 2d tte w or w/o fol w/con,fu (C8924) | $1,523.42 | $2,176.31 | 4.4× |
| Admin hepatitis b vaccine (G0010) | $42 | $60 | 0.9× |
| Admin influenza virus vac (G0008) | $42 | $60 | 0.9× |
| Admin pneumococcal vaccine (G0009) | $33.42 | $47.74 | 0.7× |
| Behavior counsel obesity 15m (G0447) | $119.33 | $170.47 | 1.2× |
| Ca screen;flexi sigmoidscope (G0104) | $1,664.67 | $2,378.10 | 1.8× |
| Ca screen;pelvic/breast exam (G0101) | $74.33 | $106.19 | 0.7× |
| Colon ca scrn not hi rsk ind (G0121) | $1,776.05 | $2,537.21 | 1.9× |
| Colorectal scrn; hi risk ind (G0105) | $2,203.40 | $3,147.71 | 2.4× |
| Comt gene (0032U) | $948.49 | $1,354.99 | 5.4× |
| Core build-up incl any pins (D2950) | $291.45 | $416.36 | 0.5× |
| Crown porcelain/ceramic (D2740) | $2,222.86 | $3,175.51 | 3.4× |
| Cysto impl 4 or more (C9740) | $4,791.77 | $6,845.39 | 0.5× |
| Cystoscopy prostatic imp 1-3 (C9739) | $4,791.77 | $6,845.39 | 0.9× |
| Depression screen annual (G0444) | $46.70 | $66.71 | 1.2× |
| Diab manage trn per indiv (G0108) | $135.38 | $193.40 | 2.4× |
| Diab manage trn ind/group (G0109) | $67.08 | $95.82 | 4.2× |
| Direct refer hospital observ (G0379) | $1,012.72 | $1,446.74 | 1.7× |
| Drug test def 1-7 classes (G0480) | $296.75 | $423.92 | 2.6× |
| Drug test def 15-21 classes (G0482) | $225.89 | $322.70 | 1.1× |
| Drug test def 22+ classes (G0483) | $350.88 | $501.26 | 1.4× |
| Drug test def 8-14 classes (G0481) | $117 | $167.15 | 0.7× |
| Ekg tracing for initial prev (G0404) | $38.71 | $55.30 | 1.3× |
| Elec stim other than wound (G0283) | $129.56 | $185.08 | 10.2× |
| Extraction erupted tooth/exr (D7140) | $2,222.86 | $3,175.51 | 3.4× |
| Fecal blood scrn immunoassay (G0328) | $64.06 | $91.51 | 3.5× |
| Fern test (Q0114) | $114.74 | $163.91 | 11.8× |
| Group mnt 2 or more 30 mins (G0271) | $39.82 | $56.89 | 2.3× |
| Home sleep test/type 3 porta (G0399) | $1,347.26 | $1,924.66 | 6.2× |
| Hospital outpt clinic visit (G0463) | $319.33 | $456.18 | 2.4× |
| Ig paraprotein qual bld/ur (0077U) | $377.70 | $539.57 | 8.7× |
| Infectious disease (bacterial and fungal), organism identification, blood culture, using rRNA FISH, 6 or more organism… (0086U) | $301.50 | $430.72 | 1.5× |
| Initial preventive exam (G0402) | $184.91 | $264.16 | 1.4× |
| Inj for sacroiliac jt anesth (G0260) | $1,278.77 | $1,826.82 | 1.8× |
| Intraoral periapical first (D0220) | $8,187.70 | $11,696.71 | 93.9× |
| Mnt subs tx for change dx (G0270) | $46.90 | $67 | 1.5× |
| Mra w/o cont, abd (C8901) | $2,179.61 | $3,113.73 | 9.1× |
| Mri w/o fol w/cont, breast, (C8908) | $7,359.35 | $10,513.36 | 21.1× |
| Mri w/o fol w/cont, brst, un (C8905) | $3,679.68 | $5,256.68 | 10.5× |
| Njx pltlt plasma w/img harvest/preparation (0232T) | $453.12 | $647.32 | 1.0× |
| Obtaining screen pap smear (Q0091) | $36.02 | $51.45 | 1.2× |
| Oth resp proc, group (G0239) | $802.94 | $1,147.06 | 21.5× |
| Pelvic ring fracture uni/bil (G0413) | $10,119.21 | $14,456.02 | 1.4× |
| Perc d-e cor revasc t cabg s (C9604) | $9,338.66 | $13,340.94 | 0.8× |
| Perc d-e cor stent ather s (C9602) likely a partial charge, not the full procedure |
$5,349.79 | $7,642.55 | 0.3× |
| Perc drug-el cor stent sing (C9600) unusually low: confirm this is the full procedure |
$5,464 | $7,805.72 | 0.5× |
| Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral… (0627T) | $19,554.75 | $27,935.36 | 1.5× |
| Post 1 srfc resinbased cmpst (D2391) | $2,262.08 | $3,231.54 | 3.5× |
| Post 3 srfc resinbased cmpst (D2393) | $1,094.24 | $1,563.20 | 1.7× |
| Ppps, initial visit (G0438) | $349.08 | $498.68 | 2.0× |
| Ppps, subseq visit (G0439) | $232.16 | $331.66 | 1.7× |
| Prefab stnlss steel crown pe (D2931) | $679.11 | $970.16 | 1.0× |
| Prefab stnlss steel crwn pri (D2930) | $2,222.86 | $3,175.51 | 3.4× |
| Psa screening (G0103) | $238.50 | $340.72 | 12.4× |
| Quan CT tiss charac i&r w/cncrnt CT exam (0722T) | $982.24 | $1,403.20 | 1.5× |
| Quan CT tiss charac w/o CT (0721T) | $982.24 | $1,403.20 | 1.5× |
| Rem imp tooth w mucoper flp (D7210) | $5,471.22 | $7,816.03 | 3.5× |
| Remove unilat space maintain (D1520) | $12,313.83 | $17,591.19 | 19.0× |
| Resin 4/> surf or w incis an (D2335) | $1,094.24 | $1,563.20 | 1.7× |
| Resin one surface-anterior (D2330) | $2,222.86 | $3,175.51 | 3.4× |
| Revasc intra lithotrip-stent (C9765) | $33,741.27 | $48,201.81 | 1.8× |
| Revasc lithotr-stent tib/per (C9773) | $10,332.77 | $14,761.10 | 0.6× |
| Spine device implant surgery (C9757) | $10,367.04 | $14,810.06 | 0.8× |
| Tee w or w/o fol w/cont,cong (C8926) | $2,226.48 | $3,180.68 | 2.8× |
| Therapeutic pulpotomy (D3220) | $2,222.86 | $3,175.51 | 3.4× |
| Tomosynthesis, mammo (G0279) | $67.32 | $96.16 | 5.3× |
| Trim nail(s) (G0127) | $43.88 | $62.68 | 0.7× |
| Tte w or w/o fol w/con,stres (C8928) | $2,707.64 | $3,868.06 | 3.4× |
| Tte w or w/o fol w/cont, com (C8921) | $3,177.97 | $4,539.96 | 4.0× |
| Tte w or w/o fol w/cont, f/u (C8922) | $3,106.12 | $4,437.32 | 4.0× |
| Tte w or wo fol wcon,doppler (C8929) | $3,950.54 | $5,643.64 | 5.0× |
| Unsched dialysis esrd pt hos (G0257) | $2,697.85 | $3,854.08 | 3.9× |
| Visit to determ ldct elig (G0296) | $109.38 | $156.25 | 1.1× |