Supplies, drugs & other prices at Sentara Halifax Regional Hospital
South Boston, VA · every code in this section with a posted price and a Medicare benchmark.
107 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) | $2,000 | $4,000 | 2.6× |
| 2d tte w or w/o fol w/con,fu (C8924) | $1,510 | $3,020 | 4.4× |
| Adm of soc dtr assess 5-15 m (G0136) | $32 | $64 | 0.9× |
| Adm tocilizu covid-19 1st (M0249) | $225 | $450 | 0.5× |
| Adm tocilizu covid-19 2nd (M0250) | $225 | $450 | 0.5× |
| Admin hepatitis b vaccine (G0010) | $43.50 | $87 | 0.9× |
| Admin influenza virus vac (G0008) | $43.50 | $87 | 0.9× |
| Admin pneumococcal vaccine (G0009) | $43.50 | $87 | 0.9× |
| Alcohol/subs interv 15-30mn (G0396) | $41 | $82 | 1.1× |
| Annual alcohol screen 15 min (G0442) | $42.50 | $85 | 1.2× |
| Behavior counsel obesity 15m (G0447) | $37 | $74 | 0.4× |
| Blind cor sinus reducer impl (C9783) | $17,668 | $35,336 | 1.6× |
| Blind interatrial shunt ide (C9758) | $33,236.50 | $66,473 | 2.0× |
| Ca screen;flexi sigmoidscope (G0104) | $1,110 | $2,220 | 1.2× |
| Ca screen;pelvic/breast exam (G0101) | $141 | $282 | 1.4× |
| Catheterize for urine spec (P9612) | $12.25 | $24.50 | 1.3× |
| Chemo extend iv infus w/pump (G0498) | $802.50 | $1,605 | 2.5× |
| Depression screen annual (G0444) | $22 | $44 | 0.6× |
| Diab manage trn per indiv (G0108) | $78 | $156 | 1.4× |
| Diab manage trn ind/group (G0109) | $29 | $58 | 1.8× |
| Direct refer hospital observ (G0379) | $279.50 | $559 | 0.5× |
| Drug test def 1-7 classes (G0480) | $29.50 | $55.50 | 0.3× |
| Ekg tracing for initial prev (G0404) | $75.50 | $151 | 2.7× |
| Elec stim other than wound (G0283) | $71.50 | $143 | 5.6× |
| Ev fempop artl revsc tcat plmt IV st grf & clsr (0505T) | $18,412 | $36,824 | 1.6× |
| Extraction erupted tooth/exr (D7140) | $1,006 | $2,012 | 1.6× |
| Fecal blood scrn immunoassay (G0328) | $104.75 | $209.50 | 5.8× |
| Fern test (Q0114) | $31 | $62 | 3.2× |
| Followup eval of foot pt lop (G0246) | $199 | $398 | 1.5× |
| Group mnt 2 or more 30 mins (G0271) | $63.50 | $127 | 3.7× |
| Hbot, full body chamber, 30m (G0277) | $736 | $1,472 | 5.4× |
| High inten beh couns std 30m (G0445) | $90 | $180 | 0.9× |
| Hiv combination assay (G0475) | $47.50 | $95 | 2.0× |
| Home sleep test/type 3 porta (G0399) | $176 | $352 | 0.8× |
| Hospital outpt clinic visit (G0463) | $302 | $604 | 2.3× |
| Iliac Atherectomy (0238T) | $21,405 | $42,810 | 1.2× |
| Initial foot exam pt lops (G0245) | $177 | $354 | 1.4× |
| Initial preventive exam (G0402) | $265.50 | $531 | 2.0× |
| Inj for sacroiliac jt anesth (G0260) | $999.50 | $1,999 | 1.4× |
| Insertion wrls car stimulator lv pacg compl sys (0515T) | $55,699.50 | $111,399 | 2.5× |
| Insj Wcs Lv Eltrd Only (0516T) | $18,749.50 | $37,499 | 1.8× |
| Intens cardiac rehab no exer (G0423) | $160 | $320 | 1.3× |
| Intens cardiac rehab w/exerc (G0422) | $160 | $320 | 1.3× |
| Mnt subs tx for change dx (G0270) | $63.50 | $127 | 2.0× |
| Mra w/cont, abd (C8900) | $2,182.50 | $4,365 | 6.4× |
| Mra w/cont, chest (C8909) | $1,665 | $3,330 | 4.9× |
| Mra w/cont, lwr ext (C8912) | $2,161.50 | $4,323 | 6.3× |
| Mra w/cont, pelvis (C8918) | $2,058.50 | $4,117 | 6.0× |
| Mra w/o cont, abd (C8901) | $1,899 | $3,798 | 8.1× |
| Mra w/o cont, chest (C8910) | $1,447.50 | $2,895 | 6.2× |
| Mra w/o cont, pelvis (C8919) | $1,880.50 | $3,761 | 8.0× |
| Mra w/o fol w/cont, abd (C8902) | $2,511 | $5,022 | 7.3× |
| Mra w/o fol w/cont, chest (C8911) | $1,695 | $3,390 | 4.9× |
| Mra w/o fol w/cont, lwr ext (C8914) | $3,208 | $6,416 | 9.4× |
| Mra w/o fol w/cont, pelvis (C8920) | $2,486 | $4,972 | 7.2× |
| Mra, w/o&w/dye, spinal canal (C8933) | $2,007 | $4,014 | 5.8× |
| Mra, w/o&w/dye, upper extr (C8936) | $2,007 | $4,014 | 5.8× |
| Mri w/cont, breast, bi (C8906) | $2,790 | $5,580 | 8.1× |
| Mri w/cont, breast, uni (C8903) | $2,464.50 | $4,929 | 14.3× |
| Mri w/o fol w/cont, breast, (C8908) | $3,027.50 | $6,055 | 8.8× |
| Mri w/o fol w/cont, brst, un (C8905) | $2,711 | $5,422 | 7.9× |
| Neuro csf prion prtn qual (0035U) | $316 | $632 | 0.6× |
| Obtaining screen pap smear (Q0091) | $36 | $72 | 1.3× |
| Off base opioid tx 70min (G2086) | $182.50 | $365 | 1.0× |
| Off base opioid tx, 60 m (G2087) | $182.50 | $365 | 1.0× |
| Onc thyr 10 microrna seq +/- rslt mod hi rsk mal (0018U) | $1,007.50 | $2,015 | 0.3× |
| Oth resp proc, group (G0239) | $71.50 | $143 | 1.9× |
| Oth resp proc, indiv (G0238) | $87.50 | $175 | 3.1× |
| Pathogen test for platelets (P9100) | $50 | $100 | 0.9× |
| Pelvic ring fracture uni/bil (G0413) | $4,203 | $8,406 | 0.6× |
| Perc d-e cor revasc chro sin (C9607) | $13,103 | $26,206 | 0.7× |
| Perc d-e cor revasc t cabg s (C9604) | $15,248.50 | $30,497 | 1.3× |
| Perc d-e cor stent ather s (C9602) | $15,248.50 | $30,497 | 0.8× |
| Perc drug-el cor stent sing (C9600) | $15,248.50 | $30,497 | 1.3× |
| Perq Sacral Augmt Bilat Inj (0201T) | $6,054 | $12,108 | 0.8× |
| Perq Sacral Augmt Unilat Inj (0200T) | $6,054 | $12,108 | 0.8× |
| Pin service 60m per month (G0023) | $99 | $198 | 1.0× |
| Place device/marker, non pro (C9728) | $4,519.50 | $9,039 | 3.3× |
| Potassium hydroxide preps (Q0112) | $16.50 | $33 | 2.8× |
| Ppps, initial visit (G0438) | $519.50 | $1,039 | 3.0× |
| Ppps, subseq visit (G0439) | $348 | $696 | 2.5× |
| Prolonged iv inf, req pump (C8957) | $1,238 | $2,476 | 5.9× |
| Prostate biopsy, any mthd (G0416) | $438.25 | $876.50 | 1.2× |
| Psa screening (G0103) | $121.50 | $243 | 6.3× |
| Rem imp tooth w mucoper flp (D7210) | $1,006 | $2,012 | 0.7× |
| Revasc intra lithotrip-ather (C9766) | $17,479 | $34,958 | 1.0× |
| Revasc intra lithotrip-stent (C9765) | $17,479 | $34,958 | 1.0× |
| Revasc intravasc lithotripsy (C9764) | $8,739.50 | $17,479 | 0.8× |
| Revasc lith-sten-ath tib/per (C9775) | $40,676.50 | $81,353 | 2.3× |
| Revasc lithotr-ather tib/per (C9774) | $40,676.50 | $81,353 | 2.3× |
| Revasc lithotr-stent tib/per (C9773) | $40,676.50 | $81,353 | 2.3× |
| Revasc lithotrip tibi/perone (C9772) | $25,431 | $50,862 | 2.2× |
| Revasc lithotrip-stent-ather (C9767) | $28,118.50 | $56,237 | 1.6× |
| Routine footcare pt w lops (G0247) | $166.50 | $333 | 0.8× |
| Scr c/v cyto,thinlayer,rescr (G0145) | $32.50 | $65 | 1.2× |
| Screen cerv/vag thin layer (G0123) | $94.50 | $189 | 4.7× |
| Screen pap by tech w md supv (P3000) | $61 | $122 | 3.3× |
| Therapeutic procd strg endur (G0237) | $106.50 | $213 | 3.7× |
| Tomosynthesis, mammo (G0279) | $42.50 | $85 | 3.3× |
| Trgt gen seq alys sld orgn neo DNA 324 genes (0037U) | $1,757.50 | $3,515 | 0.5× |
| Trim nail(s) (G0127) | $103 | $206 | 1.8× |
| Trluml periph athrc w/rs&i brchiocphl ea vsl (0237T) | $18,240.50 | $36,481 | 1.6× |
| Trluml Peripheral Atherectomy Renal Artery Ea (0234T) | $15,690 | $31,380 | 1.4× |
| Tte w or w/o fol w/con,stres (C8928) | $1,875 | $3,750 | 2.4× |
| Tte w or wo fol wcon,doppler (C8929) | $1,805 | $3,610 | 2.3× |
| Unsched dialysis esrd pt hos (G0257) | $1,462 | $2,924 | 2.2× |
| Wet mounts/ w preparations (Q0111) | $35 | $70 | 1.9× |