Supplies, drugs & other prices at Pike County Memorial Hospital
Louisiana, MO · every code in this section with a posted price and a Medicare benchmark.
18 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) | $30.40 | $38 | 0.6× |
| Admin pneumococcal vaccine (G0009) | $30.40 | $38 | 0.6× |
| Ca screen;pelvic/breast exam (G0101) | $104 | $130 | 1.0× |
| Colon ca scrn not hi rsk ind (G0121) | $398.40 | $498 | 0.4× |
| Colorectal scrn; hi risk ind (G0105) | $398.40 | $498 | 0.4× |
| Drug test def 1-7 classes (G0480) | $1,026.40 | $1,283 | 9.0× |
| Drug test def 8-14 classes (G0481) | $2,200 | $2,750 | 14.0× |
| Elec stim other than wound (G0283) | $48 | $60 | 3.8× |
| Fecal blood scrn immunoassay (G0328) | $20 | $25 | 1.1× |
| Initial preventive exam (G0402) | $120 | $150 | 0.9× |
| Obtaining screen pap smear (Q0091) | $50.40 | $63 | 1.7× |
| Ppps, initial visit (G0438) | $104 | $130 | 0.6× |
| Ppps, subseq visit (G0439) | $104 | $130 | 0.8× |
| Psa screening (G0103) | $77.60 | $97 | 4.0× |
| Tomosynthesis, mammo (G0279) | $64 | $80 | 5.0× |
| Trauma respons w/hosp criti (G0390) | $100 | $125 | 0.1× |
| Trim nail(s) (G0127) | $210.40 | $263 | 3.6× |
| Tte w or wo fol wcon,doppler (C8929) | $1,920 | $2,400 | 2.4× |