Supplies, drugs & other prices at SSM Health DePaul Hospital - St. Louis

Bridgeton, MO · every code in this section with a posted price and a Medicare benchmark.

122 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) $3,660.25 $6,655 4.7×
2d tte w or w/o fol w/con,co (C8923) $1,977.80 $3,596 2.5×
2d tte w or w/o fol w/con,fu (C8924) $1,009.80 $1,836 2.9×
Abltj perc cryoabltj img gdn lxtr/perph nerve (0441T) $3,498 $6,360 1.8×
Abltj perc cryoabltj img gdn nrv plex/trncl nrv (0442T)
unusually low: confirm this is the full procedure
$3,498 $6,360 0.4×
Abltj perc cryoabltj img gdn uxtr/perph nerve (0440T) $3,498 $6,360 1.8×
Adm tocilizu covid-19 1st (M0249) $292.60 $532 0.7×
Admin hepatitis b vaccine (G0010) $83.05 $151 1.8×
Admin influenza virus vac (G0008) $76.45 $139 1.6×
Admin pneumococcal vaccine (G0009) $76.45 $139 1.6×
Bone strength and fracture risk using finite element analysis of functional data and bone-mineral density utilizing… (0555T) $48.40 $88 1.7×
Bone strength and fracture risk using finite element analysis of functional data and bone-mineral density utilizing… (0556T) $439.45 $799 1.8×
Ca screen;pelvic/breast exam (G0101) $33.55 $61 0.3×
Catheterize for urine spec (P9612) $35.75 $65 3.8×
Chemo extend iv infus w/pump (G0498) $724.35 $1,317 2.2×
Computed tomography scan taken for the purpose of biomechanical computed tomography analysis CAT Scan (0558T) $105.05 $191 1.2×
Depression screen annual (G0444) $15.84 $28.80 0.4×
Diab manage trn per indiv (G0108) $112.20 $204 2.0×
Diab manage trn ind/group (G0109) $49.50 $90 3.1×
Direct refer hospital observ (G0379) $437.80 $796 0.7×
Drug test def 1-7 classes (G0480) $275.55 $501 2.4×
Ekg tracing for initial prev (G0404) $56.65 $103 2.0×
Elec stim other than wound (G0283) $97.90 $178 7.7×
Electrophysiologic eval icds w/ss electrode (0577T) $2,501.40 $4,548 2.1×
Endovascular Venous Arterialization Tibl/Prnl Vn (0620T)
likely a partial charge, not the full procedure
$11,420.75 $20,765 0.3×
Ephys eval ccm-d ld 1st impl (0930T) $2,080.65 $3,783 1.7×
Ephys eval ccm-d ld separate (0931T) $2,080.65 $3,783 1.7×
Extraction erupted tooth/exr (D7140) $1,966.80 $3,576 3.0×
Group mnt 2 or more 30 mins (G0271) $35.20 $64 2.1×
Hbot, full body chamber, 30m (G0277) $526.90 $958 3.8×
Hdr electronic brachytherapy ntrstl/intrcav (0395T) $1,340.90 $2,438 1.9×
Home sleep test/type 3 porta (G0399) $935 $1,700 4.3×
Hospital outpt clinic visit (G0463) $124.30 $226 0.9×
Initial preventive exam (G0402) $132.66 $241.20 1.0×
Inj for sacroiliac jt anesth (G0260) $3,217.50 $5,850 4.6×
Insj/Rplc Car Modulj Sys Pls Gen Transvns Eltrd (0408T)
unusually low: confirm this is the full procedure
$14,612.40 $26,568 0.5×
Insj/Rplc Cardiac Modulj Sys Atr Electrode Only (0410T) $6,024.70 $10,954 0.7×
Insj/Rplc Cardiac Modulj Sys Pls Generator Only (0409T) $17,028 $30,960 0.8×
Intens cardiac rehab no exer (G0423) $111.10 $202 0.9×
Intens cardiac rehab w/exerc (G0422) $111.10 $202 0.9×
Interro Device Evaluation Cardiac Modulj System (0418T) $44 $80 1.2×
Mnt subs tx for change dx (G0270) $37.95 $69 1.2×
Mra w/cont, abd (C8900) $1,410.75 $2,565 4.0×
Mra w/cont, chest (C8909) $1,149.50 $2,090 3.3×
Mra w/cont, lwr ext (C8912) $1,619.75 $2,945 4.6×
Mra w/cont, pelvis (C8918) $1,280.40 $2,328 3.7×
Mra w/o cont, abd (C8901) $1,045 $1,900 4.4×
Mra w/o cont, chest (C8910) $1,045 $1,900 4.4×
Mra w/o cont, lwr ext (C8913) $1,410.75 $2,565 5.9×
Mra w/o cont, pelvis (C8919) $1,045 $1,900 4.4×
Mra w/o fol w/cont, abd (C8902) $1,828.75 $3,325 5.2×
Mra w/o fol w/cont, chest (C8911) $1,828.75 $3,325 5.2×
Mra w/o fol w/cont, lwr ext (C8914) $2,090 $3,800 6.0×
Mra w/o fol w/cont, pelvis (C8920) $1,358.50 $2,470 3.9×
Mra, w/dye, upper extremity (C8934) $1,619.75 $2,945 4.6×
Mra, w/o dye, upper extr (C8935) $1,410.75 $2,565 5.9×
Mra, w/o&w/dye, upper extr (C8936) $1,828.75 $3,325 5.2×
Mri w/cont, breast, bi (C8906) $1,619.75 $2,945 4.6×
Mri w/cont, breast, uni (C8903) $836 $1,520 4.8×
Mri w/o fol w/cont, breast, (C8908) $2,071.85 $3,767 5.9×
Mri w/o fol w/cont, brst, un (C8905) $888.25 $1,615 2.5×
Neuro csf detcj prion prtn quakg conf conv qual (0035U) $479.60 $872 0.9×
Njx pltlt plasma w/img harvest/preparation (0232T) $320.10 $582 0.7×
Obtaining screen pap smear (Q0091) $28.71 $52.20 1.0×
Oth resp proc, group (G0239) $154 $280 4.1×
Oth resp proc, indiv (G0238) $87.45 $159 3.0×
Perc d-e cor revasc chro sin (C9607) $13,677.40 $24,868 0.7×
Perc d-e cor revasc t cabg s (C9604) $11,072.05 $20,131 1.0×
Perc d-e cor stent ather s (C9602) $12,375 $22,500 0.7×
Perc drug-el cor stent sing (C9600) $8,467.25 $15,395 0.7×
Perq Sacral Augmt Bilat Inj (0201T) $6,329.40 $11,508 0.9×
Perq Sacral Augmt Unilat Inj (0200T) $6,329.40 $11,508 0.9×
Perq Tcat Ther Rx Dlvr Ntrac Rx Balo 1 Maj C Art (0913T) $12,223.75 $22,225 1.1×
Place device/marker, non pro (C9728) $2,783.55 $5,061 2.0×
Prgrmg Device Evaluation Cardiac Modulj System (0417T) $44 $80 1.2×
Prolonged iv inf, req pump (C8957) $947.10 $1,722 4.4×
Prostate biopsy, any mthd (G0416) $911.35 $1,657 2.5×
Psa screening (G0103) $62.70 $114 3.2×
Pulp cap direct (D3110) $3,075.05 $5,591 4.7×
Rbc DNA hea 35 ag 11 bld grp whl bld cmn allel (0001U) $395.45 $719 0.5×
Reloc Skin Pocket Cardiac Modulj Pulse Generator (0416T) $2,200 $4,000 1.1×
Relocation skin pocket implanted ccm-d pg (0925T) $3,135 $5,700 1.5×
Removal Cardiac Modulj Sys Pls Generator Only (0412T) $4,422.55 $8,041 1.2×
Removal Cardiac Modulj Sys Transvenous Electrode (0413T) $4,422.55 $8,041 1.2×
Removal perm ccm-d system pulse generator only (0919T) $6,237.55 $11,341 1.7×
Repos Cardiac Modulj Transvenous Electrode (0415T) $694.65 $1,263 1.1×
Repositioning prev impl ccm-d transvns eltrd/ld (0924T) $1,128.60 $2,052 1.8×
Revasc intra lithotrip-ather (C9766) $11,860.20 $21,564 0.6×
Revasc intra lithotrip-stent (C9765) $11,860.20 $21,564 0.6×
Revasc intravasc lithotripsy (C9764) $7,417.30 $13,486 0.6×
Revasc lith-sten-ath tib/per (C9775) $11,860.20 $21,564 0.6×
Revasc lithotr-ather tib/per (C9774) $11,860.20 $21,564 0.6×
Revasc lithotr-stent tib/per (C9773) $12,015.30 $21,846 0.7×
Revasc lithotrip tibi/perone (C9772) $7,417.30 $13,486 0.6×
Revasc lithotrip-stent-ather (C9767) $11,860.20 $21,564 0.6×
Rmvl Perm Ccm-D Sys 1 Transvns Dfb Lead Only (0921T) $6,237.55 $11,341 1.7×
Rmvl perm ccm-d sys 1 transvns pacing lead only (0920T) $6,237.55 $11,341 1.7×
Rmvl Perm Ccm-D Sys Dual Transvns Leads Only (0922T) $6,237.55 $11,341 1.7×
Rmvl&Rplcmt Permanent Ccm-D Pulse Generator Only (0923T)
likely a partial charge, not the full procedure
$4,192.10 $7,622 0.2×
Screen cerv/vag thin layer (G0123) $70.40 $128 3.5×
Screen pap by tech w md supv (P3000) $41.80 $76 2.3×
Sim ang w/prs cath rad emb (C8004) $22,490.60 $40,892 1.9×
Tcat Rmvl/Debulk Icar Mass Suction Device Perq (0644T) $15,678.85 $28,507 2.8×
Tee w or w/o fol w/cont,cong (C8926) $1,995.40 $3,628 2.5×
Therapeutic procd strg endur (G0237) $85.80 $156 3.0×
Therapeutic ultrafiltration (0692T) $539 $980 0.3×
Tooth reimplantation (D7270) $884.40 $1,608 1.4×
Transcatheter Renal Sympath Denervation Bilat (0339T) $13,306.15 $24,193 2.3×
Transcatheter renal sympath denervation unilat (0338T) $6,652.80 $12,096 1.2×
Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation;… (0236T) $16,287.70 $29,614 1.4×
Trauma respons w/hosp criti (G0390) $7,328.75 $13,325 5.5×
Trim nail(s) (G0127) $76.60 $139.28 1.3×
Trluml Perip Athrc Renal Art (0234T) $16,940 $30,800 1.5×
Trluml periph athrc w/rs&i brchiocphl ea vsl (0237T) $17,917.35 $32,577 1.5×
Trluml peripheral atherectomy iliac artery ea (0238T) $19,272 $35,040 1.0×
Tte w or w/o fol w/con,stres (C8928) $3,959.45 $7,199 5.0×
Tte w or wo fol wcon,doppler (C8929) $4,436.85 $8,067 5.7×
Unsched dialysis esrd pt hos (G0257) $1,872.75 $3,405 2.7×
Vasc emb/occ w/prs cath (C9797) $33,075.90 $60,138 1.8×
Visit esketamine 56m or less (G2082) $1,012 $1,840 1.0×
Visit esketamine, > 56m (G2083) $1,478.95 $2,689 0.9×
Visit to determ ldct elig (G0296) $42.37 $77.04 0.4×