Supplies, drugs & other prices at SSM Health St. Anthony Hospital - Midwest

Midwest City, OK · every code in this section with a posted price and a Medicare benchmark.

63 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) $2,315.53 $4,210.05 3.1×
2d tte w or w/o fol w/con,fu (C8924) $812.52 $1,477.30 2.4×
Adm tocilizu covid-19 1st (M0249) $668.80 $1,216 1.6×
Admin hepatitis b vaccine (G0010) $177.92 $323.50 4.0×
Admin influenza virus vac (G0008) $203.36 $369.75 4.5×
Admin pneumococcal vaccine (G0009) $123.75 $225 2.7×
Ca screen;pelvic/breast exam (G0101) $31.28 $56.88 0.3×
Chemo extend iv infus w/pump (G0498) $388.02 $705.50 1.2×
Covid-19 lab test non-cdc (U0002) $62.42 $113.50 1.2×
Diab manage trn per indiv (G0108) $133.70 $243.10 2.4×
Direct refer hospital observ (G0379) $955.30 $1,736.90 1.7×
Elec stim other than wound (G0283) $151 $274.55 11.9×
Ev fempop artl revsc tcat plmt IV st grf & clsr (0505T) $11,689.84 $21,254.25 1.1×
Hbot, full body chamber, 30m (G0277) $1,223.45 $2,224.45 9.2×
Hospital outpt clinic visit (G0463) $154.28 $280.50 1.2×
Insertion perm ccm-d system pulse generator only (0916T) $38,572.02 $70,130.95 1.8×
Insj Perm Ccm-D Sys 1 Transvns Lead Only (0917T) $14,221.82 $25,857.85 1.8×
Insj Perm Ccm-D Sys Dual Transvns Leads Only (0918T) $14,221.82 $25,857.85 1.8×
Insj perm ccm-d sys pg&dual transvns eltrds/lds (0915T) $55,095.34 $100,173.35 1.8×
Insj/Rplc Car Modulj Sys Pls Gen Transvns Eltrd (0408T) $20,278.28 $36,869.60 0.7×
Insj/Rplc Car Modulj Sys Ventr Electrode Only (0411T) $9,697.82 $17,632.40 1.2×
Insj/Rplc Cardiac Modulj Sys Atr Electrode Only (0410T) $9,697.82 $17,632.40 1.2×
Insj/Rplc Cardiac Modulj Sys Pls Generator Only (0409T) $20,278.28 $36,869.60 0.9×
Interro Device Evaluation Cardiac Modulj System (0418T) $49.09 $89.25 1.4×
Mnt subs tx for change dx (G0270) $55.05 $100.09 1.7×
Mri w/o fol w/cont, breast, (C8908) $3,833.97 $6,970.85 11.4×
Obtaining screen pap smear (Q0091) $37.22 $67.68 1.3×
Perc d-e cor revasc chro sin (C9607) $19,992.17 $36,349.40 1.1×
Perc d-e cor revasc t cabg s (C9604) $21,004.78 $38,190.50 1.9×
Perc d-e cor stent ather s (C9602) $37,853.94 $68,825.35 2.1×
Perc drug-el cor stent sing (C9600) $21,004.78 $38,190.50 1.9×
Perq Tcat Ther Rx Dlvr Ntrac Rx Balo 1 Maj C Art (0913T) $9,797.40 $17,813.45 0.9×
Prgrmg Device Evaluation Cardiac Modulj System (0417T) $49.09 $89.25 1.4×
Prolonged iv inf, req pump (C8957) $1,319.75 $2,399.55 6.5×
Psa screening (G0103) $311.71 $566.75 16.1×
Reloc Skin Pocket Cardiac Modulj Pulse Generator (0416T) $2,035.96 $3,701.75 1.0×
Relocation skin pocket implanted ccm-d pg (0925T) $3,143.47 $5,715.40 1.6×
Removal Cardiac Modulj Sys Pls Generator Only (0412T) $4,093.43 $7,442.60 1.1×
Removal Cardiac Modulj Sys Transvenous Electrode (0413T) $4,093.43 $7,442.60 1.1×
Removal perm ccm-d system pulse generator only (0919T) $6,253.75 $11,370.45 1.7×
Repos Cardiac Modulj Transvenous Electrode (0415T) $642.34 $1,167.90 1.1×
Repositioning prev impl ccm-d transvns eltrd/ld (0924T) $1,062.63 $1,932.05 1.8×
Revasc intra lithotrip-ather (C9766) $11,689.84 $21,254.25 0.7×
Revasc intra lithotrip-stent (C9765) $11,689.84 $21,254.25 0.7×
Revasc intravasc lithotripsy (C9764) $5,769.88 $10,490.70 0.5×
Revasc lith-sten-ath tib/per (C9775) $18,697.66 $33,995.75 1.1×
Revasc lithotr-ather tib/per (C9774) $18,697.66 $33,995.75 1.1×
Revasc lithotr-stent tib/per (C9773) $18,697.66 $33,995.75 1.1×
Revasc lithotrip tibi/perone (C9772) $11,689.84 $21,254.25 1.1×
Revasc lithotrip-stent-ather (C9767) $18,697.66 $33,995.75 1.1×
Rmvl & Rpl Cardiac Modulj Sys Pls Generator Only (0414T) $20,278.28 $36,869.60 0.9×
Rmvl Perm Ccm-D Sys 1 Transvns Dfb Lead Only (0921T) $6,253.75 $11,370.45 1.7×
Rmvl perm ccm-d sys 1 transvns pacing lead only (0920T) $6,253.75 $11,370.45 1.7×
Rmvl Perm Ccm-D Sys Dual Transvns Leads Only (0922T) $6,253.75 $11,370.45 1.7×
Rmvl&Rplcmt Permanent Ccm-D Pulse Generator Only (0923T) $38,572.02 $70,130.95 1.8×
Tcat insj perm 1chmbr ldls pacemaker r atrial (0823T) $28,728.81 $52,234.20 1.6×
Tcat Insj Perm Dual Chamber Ldls Pm Compl Sys (0795T) $21,705.56 $39,464.65 1.2×
Trluml Perip Athrc Renal Art (0234T) $12,343.87 $22,443.40 1.1×
Trluml peripheral atherectomy iliac artery ea (0238T) $16,235.34 $29,518.80 0.9×
Tte w or w/o fol w/con,stres (C8928) $1,887.76 $3,432.30 2.5×
Tte w or wo fol wcon,doppler (C8929) $2,418.84 $4,397.90 3.2×
Unsched dialysis esrd pt hos (G0257) $1,782.58 $3,241.05 2.7×
Visit to determ ldct elig (G0296) $58.21 $105.84 0.6×