Supplies, drugs & other prices at Southwell Medical
Adel, GA · every code in this section with a posted price and a Medicare benchmark.
73 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) | $1,569.56 | $3,139.10 | 2.3× |
| 2d tte w or w/o fol w/con,fu (C8924) | $610 | $1,220 | 2.0× |
| Adm tocilizu covid-19 1st (M0249) | $438.50 | $877 | 1.1× |
| Adm tocilizu covid-19 2nd (M0250) | $438.50 | $877 | 1.1× |
| Admin hepatitis b vaccine (G0010) | $12 | $24 | 0.3× |
| Admin influenza virus vac (G0008) | $24.16 | $48.32 | 0.6× |
| Admin pneumococcal vaccine (G0009) | $33.55 | $67.09 | 0.8× |
| Annual alcohol screen 15 min (G0442) | $33.25 | $66.50 | 1.0× |
| Behavior counsel obesity 15m (G0447) | $17.50 | $35 | 0.2× |
| Brief alcohol misuse counsel (G0443) | $76 | $152 | 0.9× |
| Brief chkin by md/qhp, 11-20 (G2252) | $44 | $88 | 1.5× |
| Brief chkin, 5-10, non-e/m (G2251) | $23.50 | $47 | 1.7× |
| Ca screen;flexi sigmoidscope (G0104) | $208 | $416 | 0.3× |
| Ca screen;pelvic/breast exam (G0101) | $51.50 | $103 | 0.6× |
| Catheterize for urine spec (P9612) | $15.44 | $30.88 | 1.7× |
| Depression screen annual (G0444) | $33.25 | $66.50 | 1.0× |
| Diab manage trn per indiv (G0108) | $29.50 | $59 | 0.5× |
| Diab manage trn ind/group (G0109) | $16.75 | $33.50 | 1.0× |
| Direct refer hospital observ (G0379) | $478.59 | $957.18 | 0.9× |
| Drug test def 1-7 classes (G0480) | $124.20 | $248.38 | 1.1× |
| Ed svc ckd grp per session (G0421) | $45 | $90 | 1.6× |
| Ed svc ckd ind per session (G0420) | $192.50 | $385 | 1.7× |
| Elec stim other than wound (G0283) | $37.62 | $75.24 | 3.0× |
| Extraction erupted tooth/exr (D7140) | $261.04 | $522.08 | 0.5× |
| Fern test (Q0114) | $164.40 | $328.79 | 16.9× |
| Followup eval of foot pt lop (G0246) | $64.50 | $129 | 0.6× |
| Hbot, full body chamber, 30m (G0277) | $197.34 | $394.66 | 1.6× |
| High inten beh couns std 30m (G0445) | $47 | $94 | 0.5× |
| Home sleep test/type 3 porta (G0399) | $69.50 | $139 | 0.4× |
| Home sleep test/type 4 porta (G0400) | $304.50 | $609 | 1.6× |
| Initial foot exam pt lops (G0245) | $111.50 | $223 | 1.0× |
| Initial preventive exam (G0402) | $100 | $200 | 0.9× |
| Inj for sacroiliac jt anesth (G0260) | $1,495 | $2,990 | 2.4× |
| Intens behave ther cardio dx (G0446) | $40.50 | $81 | 1.2× |
| Mra w/cont, lwr ext (C8912) | $1,854.49 | $3,708.98 | 6.1× |
| Mra w/cont, pelvis (C8918) | $1,978.50 | $3,957 | 6.5× |
| Mra w/o cont, lwr ext (C8913) | $1,612.36 | $3,224.72 | 7.7× |
| Mra w/o fol w/cont, lwr ext (C8914) | $2,268.65 | $4,537.30 | 7.4× |
| Mra w/o fol w/cont, pelvis (C8920) | $2,033.50 | $4,067 | 6.7× |
| Mri w/cont, breast, bi (C8906) | $941 | $1,882 | 3.1× |
| Mri w/o fol w/cont, breast, (C8908) | $990.15 | $1,980.29 | 3.2× |
| Mri w/o fol w/cont, brst, un (C8905) | $1,201 | $2,402 | 3.9× |
| Neuro csf detcj prion prtn quakg conf conv qual (0035U) | $801 | $1,602 | 1.5× |
| Obtaining screen pap smear (Q0091) | $37 | $74 | 1.5× |
| Onc Merkel Cll Carc Srm Quan (0058U) | $469 | $938 | 1.5× |
| Oth resp proc, indiv (G0238) | $77.22 | $154.44 | 3.0× |
| Pathogen test for platelets (P9100) | $49.50 | $99 | 1.0× |
| Perc d-e cor revasc chro sin (C9607) | $9,884.64 | $19,769.28 | 0.6× |
| Perc d-e cor revasc t cabg s (C9604) | $9,884.64 | $19,769.28 | 1.0× |
| Perc d-e cor stent ather s (C9602) | $19,756.18 | $39,512.34 | 1.2× |
| Perc drug-el cor stent sing (C9600) | $9,884.64 | $19,769.28 | 1.0× |
| Place device/marker, non pro (C9728) | $1,671.52 | $3,343.04 | 1.4× |
| Ppps, initial visit (G0438) | $102.50 | $205 | 0.6× |
| Ppps, subseq visit (G0439) | $75 | $150 | 0.5× |
| Programming device evaluation (remote) of subcutaneous cardiac rhythm monitor system, with iterative adjustment of the… (0650T) | $51 | $102 | 1.6× |
| Prostate biopsy, any mthd (G0416) | $488.50 | $977 | 1.6× |
| Rbc DNA hea 35 ag 11 bld grp whl bld cmn allel (0001U) | $373.50 | $747 | 0.5× |
| Remot img sub by pt, non e/m (G2250) | $17 | $34 | 1.3× |
| Revasc intra lithotrip-ather (C9766) | $11,596.75 | $23,193.50 | 0.7× |
| Revasc intra lithotrip-stent (C9765) | $11,596.75 | $23,193.50 | 0.7× |
| Revasc intravasc lithotripsy (C9764) | $7,253.25 | $14,506.50 | 0.7× |
| Revasc lith-sten-ath tib/per (C9775) | $11,596.75 | $23,193.50 | 0.7× |
| Revasc lithotr-ather tib/per (C9774) | $11,596.75 | $23,193.50 | 0.7× |
| Revasc lithotr-stent tib/per (C9773) | $11,596.75 | $23,193.50 | 0.7× |
| Revasc lithotrip tibi/perone (C9772) | $7,253.25 | $14,506.50 | 0.7× |
| Revasc lithotrip-stent-ather (C9767) | $11,596.75 | $23,193.50 | 0.7× |
| Therapeutic procd strg endur (G0237) | $77.22 | $154.44 | 3.0× |
| Trluml Perip Athrc Renal Art (0234T) | $13,543.50 | $27,087 | 1.3× |
| Trluml periph athrc w/rs&i brchiocphl ea vsl (0237T) | $13,672 | $27,344 | 1.4× |
| Trluml peripheral atherectomy iliac artery ea (0238T) | $14,066.16 | $28,132.32 | 0.9× |
| Unsched dialysis esrd pt hos (G0257) | $405.98 | $811.95 | 0.7× |
| Visit to determ ldct elig (G0296) | $78.25 | $156.50 | 0.9× |
| Xenograft implantation into the articular surface (0737T) | $8,512 | $17,024 | 0.8× |