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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| Procedure | Posted cash | Posted gross | × 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 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 Car Modulj Tranvns Elt (0413T) | $4,093.43 | $7,442.60 | 1.1× |
| Rmvl Cardiac Modulj Pls Gen (0412T) | $4,093.43 | $7,442.60 | 1.1× |
| 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 Iliac Art (0238T) | $16,235.34 | $29,518.80 | 0.9× |
| Trluml Peripheral Atherectomy Renal Artery Ea (0234T) | $12,343.87 | $22,443.40 | 1.1× |
| 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) range across 2 matching MRF lines |
$1,658.22–$1,906.93 | $3,014.95–$3,467.15 | varies |
| Visit to determ ldct elig (G0296) | $58.21 | $105.84 | 0.6× |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.