Supplies, drugs & other prices at Saint Mary's Hospital

Waterbury, CT · every code in this section with a posted price and a Medicare benchmark.

48 codes. Prices are the hospital's own posted facility charges.

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ProcedureCash priceGross charge× Medicare
2d tee w or w/o fol w/con,in (C8925) $1,686.30 $3,066 1.8×
2d tte w or w/o fol w/con,fu (C8924) $1,172.05 $2,131 2.8×
Admin hepatitis b vaccine (G0010) $92.40 $168 1.6×
Admin influenza virus vac (G0008) $93.50 $170 1.7×
Admin pneumococcal vaccine (G0009) $90.75 $165 1.6×
Ca screen;flexi sigmoidscope (G0104) $2,320.45 2.1×
Chemo extend iv infus w/pump (G0498) $562.10 $1,022 1.4×
Colon ca scrn not hi rsk ind (G0121) $2,318.90 2.1×
Colorectal scrn; hi risk ind (G0105) $2,953.21 2.6×
Cysto impl 4 or more (C9740) $17,808.19 1.6×
Direct refer hospital observ (G0379) $1,786.40 2.5×
Elec stim other than wound (G0283) $75.90 $138 6.0×
Facility svs dental rehab (G0330) $14,740.55 3.7×
Fecal blood scrn immunoassay (G0328) $29.70 $54 1.6×
Hbot, full body chamber, 30m (G0277) $1,798.50 10.9×
Hep c screen high risk/other (G0472) $563.75 12.2×
Hepb screen high risk indiv (G0499) $47.58 $86.50 1.7×
Hiv combination assay (G0475) $502.15 20.9×
Home sleep test/type 3 porta (G0399) $330 $600 1.3×
Hospital outpt clinic visit (G0463) $240.90 1.5×
Ig paraprotein qual bld/ur (0077U) $65.45 $119 1.5×
Inj for sacroiliac jt anesth (G0260) $2,791.46 3.3×
Mra w/o fol w/cont, abd (C8902) $2,574 $4,680 6.2×
Mra w/o fol w/cont, chest (C8911) $722.15 $1,313 1.7×
Mra w/o fol w/cont, pelvis (C8920) $2,547.05 $4,631 6.1×
Mri w/o fol w/cont, breast, (C8908) $3,377 $6,140 8.1×
Oth resp proc, group (G0239) $55.55 $101 1.2×
Oth resp proc, indiv (G0238) $460.35 13.3×
Pathogen test for platelets (P9100) $122.10 $222 1.7×
Perc d-e cor revasc chro sin (C9607) $35,420 $64,400 1.6×
Perc d-e cor revasc t cabg s (C9604) $22,369.60 $40,672 1.6×
Perc drug-el cor stent sing (C9600) $21,619.40 $39,308 1.6×
Perq Sacral Augmt Bilat Inj (0201T) $14,091.55 $25,621 1.6×
Perq Tcat Ther Rx Dlvr Ntrac Rx Balo 1 Maj C Art (0913T) $22,834.90 $41,518 1.6×
Ppps, subseq visit (G0439) $40.70 $74 0.3×
Psa screening (G0103) $82.50 $150 4.3×
Rbc DNA hea 35 ag 11 bld grp whl bld cmn allel (0001U) $445.50 $810 0.6×
Revasc intra lithotrip-ather (C9766) $37,911.50 $68,930 1.7×
Revasc intra lithotrip-stent (C9765) $37,911.50 $68,930 1.7×
Revasc intravasc lithotripsy (C9764) $21,385.10 $38,882 1.5×
Screen pap by tech w md supv (P3000) $44.55 $81 2.4×
Tcat Insj Perm Dual Chamber Ldls Pm Compl Sys (0795T) $38,659.50 $70,290 1.7×
Tcat rmvl&rplcmt perm 2chmbr ldls pm 2chmbr sys (0801T) $38,659.50 $70,290 1.7×
Therapeutic procd strg endur (G0237) $49.50 $90 1.4×
Tomosynthesis, mammo (G0279) $221.65 $403 17.5×
Trauma respons w/hosp criti (G0390) $3,319.80 $6,036 2.1×
Tte w or wo fol wcon,doppler (C8929) $2,009.70 $3,654 2.1×
Unsched dialysis esrd pt hos (G0257) $1,062.05 $1,931 1.3×