Supplies, drugs & other prices at Portneuf Medical Center
Pocatello, ID · every code in this section with a posted price and a Medicare benchmark.
81 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) | $3,311.40 | $5,519 | 4.3× |
| 2d tte w or w/o fol w/con,fu (C8924) | $1,116.36 | $1,860.60 | 3.2× |
| Adm tocilizu covid-19 1st (M0249) | $1,020.60 | $1,701 | 2.3× |
| Adm tocilizu covid-19 2nd (M0250) | $1,020.60 | $1,701 | 2.3× |
| Admin hepatitis b vaccine (G0010) | $94.20 | $157 | 2.0× |
| Admin influenza virus vac (G0008) | $75.60 | $126 | 1.6× |
| Admin pneumococcal vaccine (G0009) | $176.40 | $294 | 3.8× |
| Ca screen;flexi sigmoidscope (G0104) | $1,743 | $2,905 | 1.9× |
| Colon ca scrn not hi rsk ind (G0121) | $3,164.46 | $5,274.10 | 3.4× |
| Colorectal scrn; hi risk ind (G0105) | $2,434.20 | $4,057 | 2.6× |
| Covid-19 lab test non-cdc (U0002) | $108 | $180 | 2.1× |
| Diab manage trn per indiv (G0108) | $79.20 | $132 | 1.4× |
| Diab manage trn ind/group (G0109) | $61.20 | $102 | 3.8× |
| Direct refer hospital observ (G0379) | $1,586.40 | $2,644 | 2.7× |
| Drug test def 1-7 classes (G0480) | $358.80 | $598 | 3.1× |
| Drug test def 15-21 classes (G0482) | $451.80 | $753 | 2.3× |
| Drug test def 22+ classes (G0483) | $480.60 | $801 | 1.9× |
| Drug test def 8-14 classes (G0481) | $471.60 | $786 | 3.0× |
| Elec stim other than wound (G0283) | $72 | $120 | 5.7× |
| Fern test (Q0114) | $54 | $90 | 5.5× |
| Hbot, full body chamber, 30m (G0277) | $890.25 | $1,483.75 | 6.5× |
| Home sleep test/type 3 porta (G0399) | $423 | $705 | 2.0× |
| Inj for sacroiliac jt anesth (G0260) | $1,701 | $2,835 | 2.4× |
| Insj/Rplc Car Modulj Sys Pls Gen Transvns Eltrd (0408T) | $68,727 | $114,545 | 2.2× |
| Insj/Rplc Car Modulj Sys Ventr Electrode Only (0411T) | $17,490.60 | $29,151 | 2.1× |
| Insj/Rplc Cardiac Modulj Sys Atr Electrode Only (0410T) | $17,490.60 | $29,151 | 2.1× |
| Insj/Rplc Cardiac Modulj Sys Pls Generator Only (0409T) | $48,891 | $81,485 | 2.2× |
| Interro Device Evaluation Cardiac Modulj System (0418T) | $76.20 | $127 | 2.1× |
| Mra w/cont, abd (C8900) | $2,638.80 | $4,398 | 7.7× |
| Mra w/cont, chest (C8909) | $6,095.40 | $10,159 | 17.7× |
| Mra w/cont, lwr ext (C8912) | $1,500 | $2,500 | 4.4× |
| Mra w/cont, pelvis (C8918) | $2,638.80 | $4,398 | 7.7× |
| Mra w/o cont, chest (C8910) | $5,257.80 | $8,763 | 22.3× |
| Mra w/o cont, lwr ext (C8913) | $2,648.40 | $4,414 | 11.2× |
| Mra w/o fol w/cont, abd (C8902) | $3,602.40 | $6,004 | 10.5× |
| Mra w/o fol w/cont, chest (C8911) | $4,906.86 | $8,178.10 | 14.2× |
| Mra w/o fol w/cont, lwr ext (C8914) | $1,838.40 | $3,064 | 5.3× |
| Mra w/o fol w/cont, pelvis (C8920) | $1,038 | $1,730 | 3.0× |
| Mra, w/dye, upper extremity (C8934) | $1,881.60 | $3,136 | 5.5× |
| Mra, w/o&w/dye, upper extr (C8936) | $1,038 | $1,730 | 3.0× |
| Mri w/cont, breast, bi (C8906) | $4,500.60 | $7,501 | 13.1× |
| Mri w/o fol w/cont, breast, (C8908) | $5,493 | $9,155 | 15.9× |
| Mri w/o fol w/cont, brst, un (C8905) | $3,535.20 | $5,892 | 10.3× |
| Oth resp proc, group (G0239) | $128.40 | $214 | 3.5× |
| Oth resp proc, indiv (G0238) | $48.60 | $81 | 1.7× |
| Pathogen test for platelets (P9100) | $123 | $205 | 2.1× |
| Perc d-e cor revasc chro sin (C9607) | $23,724.96 | $39,541.60 | 1.3× |
| Perc d-e cor revasc t cabg s (C9604) | $18,768.96 | $31,281.60 | 1.6× |
| Perc d-e cor stent ather s (C9602) | $30,847.32 | $51,412.20 | 1.7× |
| Perc drug-el cor stent sing (C9600) | $26,812.80 | $44,688 | 2.4× |
| Perq Sacral Augmt Bilat Inj (0201T) | $34,511.40 | $57,519 | 4.8× |
| Perq tcat ther rx dlvr ntrac rx balo 1 maj c art (0913T) | $21,229.80 | $35,383 | 1.9× |
| Post-coital mucous exam (Q0115) | $47.40 | $79 | 1.9× |
| Pre 3d mdl w/ccta and/or mri (C9793) | $1,978.80 | $3,298 | 2.3× |
| Prgrmg Device Evaluation Cardiac Modulj System (0417T) | $76.20 | $127 | 2.1× |
| Prostate biopsy, any mthd (G0416) | $581.40 | $969 | 1.6× |
| Psa screening (G0103) | $156 | $260 | 8.1× |
| Rbc DNA hea 35 ag 11 bld grp whl bld cmn allel (0001U) | $1,934.40 | $3,224 | 2.7× |
| Reloc Skin Pocket Cardiac Modulj Pulse Generator (0416T) | $3,699 | $6,165 | 1.8× |
| Removal Cardiac Modulj Sys Pls Generator Only (0412T) | $7,180.80 | $11,968 | 1.9× |
| Removal Cardiac Modulj Sys Transvenous Electrode (0413T) | $7,180.80 | $11,968 | 1.9× |
| Repos Cardiac Modulj Transvenous Electrode (0415T) | $1,240.20 | $2,067 | 2.0× |
| Revasc intra lithotrip-ather (C9766) | $23,503.20 | $39,172 | 1.3× |
| Revasc intra lithotrip-stent (C9765) | $23,503.20 | $39,172 | 1.3× |
| Revasc intravasc lithotripsy (C9764) | $11,601 | $19,335 | 1.0× |
| Revasc lith-sten-ath tib/per (C9775) | $37,593.60 | $62,656 | 2.1× |
| Revasc lithotr-ather tib/per (C9774) | $37,593.60 | $62,656 | 2.1× |
| Revasc lithotr-stent tib/per (C9773) | $37,593.60 | $62,656 | 2.1× |
| Revasc lithotrip tibi/perone (C9772) | $23,503.20 | $39,172 | 2.1× |
| Revasc lithotrip-stent-ather (C9767) | $37,593.60 | $62,656 | 2.1× |
| Rmvl & Rpl Cardiac Modulj Sys Pls Generator Only (0414T) | $48,891 | $81,485 | 2.2× |
| Tcat insj perm 1chmbr ldls pacemaker r atrial (0823T) | $37,075.20 | $61,792 | 1.9× |
| Tcat Rmvl/Debulk Icar Mass Suction Device Perq (0644T) | $11,084.40 | $18,474 | 2.0× |
| Therapeutic procd strg endur (G0237) | $48.60 | $81 | 1.7× |
| Transcatheter Renal Sympath Denervation Bilat (0339T) | $10,467 | $17,445 | 1.9× |
| Transcatheter renal sympath denervation unilat (0338T) | $10,467 | $17,445 | 1.9× |
| Trauma respons w/hosp criti (G0390) | $9,760.74 | $16,267.90 | 7.4× |
| Tte w or wo fol wcon,doppler (C8929) | $2,650.80 | $4,418 | 3.4× |
| Unsched dialysis esrd pt hos (G0257) | $1,892.52 | $3,154.20 | 2.8× |
| Visit to determ ldct elig (G0296) | $83.40 | $139 | 0.8× |
| Wet mounts/ w preparations (Q0111) | $69.60 | $116 | 3.8× |