Supplies, drugs & other prices at St. Luke's Wood River Medical Center

Ketchum, ID · every code in this section with a posted price and a Medicare benchmark.

157 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) $3,341 $3,341 4.3×
2d tte w or w/o fol w/con,co (C8923) $3,341 $3,341 4.3×
2d tte w or w/o fol w/con,fu (C8924) $1,470 $1,470 4.3×
3D cntr simula trgt lvr les (0944T) $3,087 $3,087 13.1×
Ablation, benign thyroid nodule(s), percutaneous, laser, including imaging guidance (0673T) $4,347 $4,347 2.7×
Ablation, malignant breast tumor(s), percutaneous, cryotherapy, including imaging guidance when performed, unilateral (0581T) $10,392 $10,392 2.7×
Abltj perc cryoabltj img gdn lxtr/perph nerve (0441T) $5,383 $5,383 2.8×
Abltj perc cryoabltj img gdn nrv plex/trncl nrv (0442T) $13,137 $13,137 1.5×
Abltj perc cryoabltj img gdn uxtr/perph nerve (0440T) $5,383 $5,383 2.8×
Adm tocilizu covid-19 1st (M0249) $1,847 $1,847 4.2×
Adm tocilizu covid-19 2nd (M0250) $1,847 $1,847 4.2×
Admin hepatitis b vaccine (G0010) $65.06 $65.06 1.4×
Admin influenza virus vac (G0008) $65.06 $65.06 1.4×
Admin pneumococcal vaccine (G0009) $65.06 $65.06 1.4×
Alcohol/subs interv 15-30mn (G0396) $7 $7 0.2×
Annual alcohol screen 15 min (G0442) $18 $18 0.5×
Autolog prp not diab ulcer (G0460) $2,988 $2,988 1.5×
Bdy surf activation mapg pm/cvdfb leads tm f/up (0696T) $186 $186 5.0×
Behavior counsel obesity 15m (G0447) $5 $5 0.0×
Brief alcohol misuse counsel (G0443) $5 $5 0.0×
Ca screen;flexi sigmoidscope (G0104) $2,509 $2,509 2.7×
Ca screen;pelvic/breast exam (G0101) $25 $25 0.2×
Cardiac acoustic waveform recording with automated analysis and generation of coronary artery disease risk score… (0716T) $296 $296 5.1×
Catheterize for urine spec (P9612) $70 $70 7.5×
Chemo extend iv infus w/pump (G0498) $1,358 $1,358 4.2×
Colon ca scrn not hi rsk ind (G0121) $2,509 $2,509 2.7×
Colorectal scrn; hi risk ind (G0105) $2,509 $2,509 2.7×
Compre ful bdy cptr mrkrls 3d knmtc&kin mtn alys (0693T) $1,455 $1,455 4.3×
Creation of subcutaneous pocket with insertion of implantable interstitial glucose sensor, including system activation… (0446T) $12,520 $12,520 3.0×
Cysto impl 4 or more (C9740) $12,589 $12,589 1.3×
Cystoscopy prostatic imp 1-3 (C9739) $12,489 $12,489 2.4×
Depression screen annual (G0444) $18 $18 0.5×
Dermal filler injection(s) (G0429) $67 $67 0.0×
Destruction of neurofibroma, extensive (cutaneous, dermal extending into subcutaneous); trunk and extremities,… (0420T) $1,686 $1,686 2.3×
Diab manage trn per indiv (G0108) $133 $133 2.4×
Diab manage trn ind/group (G0109) $38 $38 2.4×
Direct refer hospital observ (G0379) $1,838 $1,838 3.1×
Ed svc ckd ind per session (G0420) $264 $264 2.3×
Eia hiv-1/hiv-2 screen (G0432) $151 $151 7.7×
Ekg tracing for initial prev (G0404) $13 $13 0.5×
Elec stim other than wound (G0283) $31 $31 2.4×
Esd endoscopy or colonoscopy (C9779) $8,663 $8,663 2.3×
Excision of rectal tumor, transanal endoscopic microsurgical approach (ie, TEMS), including muscularis propria (ie,… (0184T) $10,986 $10,986 1.8×
Extrnl counterpulse, per tx (G0166) $515 $515 3.9×
Facility svs dental rehab (G0330) $8,795 $8,795 2.7×
Fecal blood scrn immunoassay (G0328) $139 $139 7.7×
Group behave couns 2-10 (G0473) $2 $2 0.1×
Group mnt 2 or more 30 mins (G0271) $41 $41 2.4×
Hbot, full body chamber, 30m (G0277) $690 $690 5.1×
High inten beh couns std 30m (G0445) $6 $6 0.1×
Home sleep test/type 3 porta (G0399) $743 $743 3.5×
Home sleep test/type 4 porta (G0400) $743 $743 3.5×
Hpv combo assay ca screen (G0476) $270 $270 7.7×
Iliac Atherectomy (0238T) $33,500 $33,500 1.8×
Impact tooth remov comp bony (D7240) $4,585 $4,585 7.2×
Initial foot exam pt lops (G0245) $52 $52 0.4×
Inj for sacroiliac jt anesth (G0260) $1,886 $1,886 2.7×
Injection posterior chamber eye medication (0699T) $5,599 $5,599 2.5×
Injection(s), bone substitute material (eg, calcium phosphate) into subchondral bone defect (ie, bone marrow lesion,… (0707T) $8,372 $8,372 2.6×
Insertion of sinus tarsi implant (0335T) $14,738 $14,738 2.1×
Insertion or replacement of pulse generator only, permanent implantable synchronized diaphragmatic stimulation system… (0680T) $10,592 $10,592 0.6×
Intens behave ther cardio dx (G0446) $5 $5 0.1×
Intens cardiac rehab no exer (G0423) $334 $334 2.6×
Intens cardiac rehab w/exerc (G0422) $334 $334 2.6×
Interrogation device evaluation (in-person) with analysis, review and report by a physician or other qualified health… (0685T) $186 $186 5.0×
Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections, one leg,… (0265T) $12,935 $12,935 3.0×
Laparoscopic removal of diaphragmatic lead(s), permanent implantable synchronized diaphragmatic stimulation system for… (0679T) $8,811 $8,811 0.8×
Mnt subs tx for change dx (G0270) $78 $78 2.5×
Mra w/cont, abd (C8900) $3,763 $3,763 10.9×
Mra w/cont, chest (C8909) $2,263 $2,263 6.6×
Mra w/cont, lwr ext (C8912) $3,763 $3,763 10.9×
Mra w/cont, pelvis (C8918) $3,763 $3,763 10.9×
Mra w/o cont, abd (C8901) $3,087 $3,087 13.1×
Mra w/o cont, chest (C8910) $3,087 $3,087 13.1×
Mra w/o cont, lwr ext (C8913) $3,087 $3,087 13.1×
Mra w/o cont, pelvis (C8919) $3,087 $3,087 13.1×
Mra w/o fol w/cont, abd (C8902) $3,763 $3,763 10.9×
Mra w/o fol w/cont, chest (C8911) $2,263 $2,263 6.6×
Mra w/o fol w/cont, lwr ext (C8914) $3,763 $3,763 10.9×
Mra w/o fol w/cont, pelvis (C8920) $3,763 $3,763 10.9×
Mra, w/dye, spinal canal (C8931) $3,763 $3,763 10.9×
Mra, w/dye, upper extremity (C8934) $3,763 $3,763 10.9×
Mra, w/o dye, spinal canal (C8932) $3,087 $3,087 13.1×
Mra, w/o dye, upper extr (C8935) $3,087 $3,087 13.1×
Mra, w/o&w/dye, spinal canal (C8933) $3,763 $3,763 10.9×
Mra, w/o&w/dye, upper extr (C8936) $2,263 $2,263 6.6×
Mri w/o fol w/cont, breast, (C8908) $2,263 $2,263 6.6×
Mri w/o fol w/cont, brst, un (C8905) $3,763 $3,763 10.9×
N-invs det hrt fail aug echo (0932T) $836 $836 2.8×
Neuro csf prion prtn qual (0035U) $252.25 $252.25 0.5×
Njx pltlt plasma w/img harvest/preparation (0232T) $1,025 $1,025 2.3×
Noninvasive arterial plaque analysis using software processing of data from non-coronary computerized tomography… (0712T) $1,126 $1,126 5.3×
Obtaining screen pap smear (Q0091) $116 $116 4.1×
Oth resp proc, group (G0239) $90 $90 2.4×
Oth resp proc, indiv (G0238) $72 $72 2.5×
Pathogen test for platelets (P9100) $42.30 $42.30 0.7×
Perc d-e cor revasc chro sin (C9607) $33,500 $33,500 1.8×
Perc d-e cor revasc t cabg s (C9604) $28,020 $28,020 2.5×
Perc d-e cor stent ather s (C9602) $33,500 $33,500 1.8×
Perc drug-el cor stent sing (C9600) $28,020 $28,020 2.5×
Periodic oral evaluation (D0120) $361 $361 2.7×
Perq Sacral Augmt Bilat Inj (0201T) $14,738 $14,738 2.1×
Perq Sacral Augmt Unilat Inj (0200T) $14,738 $14,738 2.1×
Perq tcat ther rx dlvr ntrac rx balo 1 maj c art (0913T) $15,720 $15,720 1.4×
Place device/marker, non pro (C9728) $9,659 $9,659 7.1×
Prefab stnlss steel crwn pri (D2930) $4,585 $4,585 7.2×
Prgrmg dev eval ldls pm single car chamber ip (0826T) $104 $104 2.8×
Prgrmg dev eval ldls pm sys 2chmbr in person (0804T) $104 $104 2.8×
Prgrmg Dev Eval Scrms Phys/Qhp Remote (0650T) $186 $186 5.0×
Programming device evaluation (in-person) with iterative adjustment of the implantable device to test the function of… (0683T) $186 $186 5.0×
Prolonged iv inf, req pump (C8957) $1,159 $1,159 5.5×
Prostate biopsy, any mthd (G0416) $2,745 $2,745 7.8×
Psa screening (G0103) $86 $86 4.5×
Quan mr alys tiss composition w/MRI mlt organs (0698T) $12,166 $12,166 13.2×
Quan us tiss charac i&r w/o dx us same anat (0689T) $365 $365 4.2×
Relocation of pulse generator only, permanent implantable synchronized diaphragmatic stimulation system for… (0681T) $8,735 $8,735 2.5×
Removal of implantable interstitial glucose sensor from subcutaneous pocket via incision (0447T) $69 $69 0.3×
Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and… (0448T) $11,677 $11,677 2.8×
Removal of pulse generator only, permanent implantable synchronized diaphragmatic stimulation system for augmentation… (0682T) $8,735 $8,735 2.5×
Remove w insert drug implant (G0518) $272 $272 0.6×
Revasc intra lithotrip-stent (C9765) $23,450 $23,450 1.3×
Revasc intravasc lithotripsy (C9764) $19,614 $19,614 1.7×
Revasc lithotrip tibi/perone (C9772) $19,614 $19,614 1.7×
Risk ascvd tst once pr 12 mo (G0537) $21 $21 0.6×
Space maintainer fxd unilat (D1510) $4,585 $4,585 7.2×
Spine device implant surgery (C9757) $19,343 $19,343 1.5×
Tcat insj perm 1chmbr ldls pacemaker r atrial (0823T) $20,158 $20,158 1.1×
Tcat insj perm 2chmbr ldls pm r atr pm compnt (0796T) $20,158 $20,158 1.1×
Tcat insj perm 2chmbr ldls pm r ventr pm compnt (0797T) $20,158 $20,158 1.1×
Tcat Insj Perm Dual Chamber Ldls Pm Compl Sys (0795T) $20,158 $20,158 1.1×
Tcat rmvl perm 1chmbr ldls pacemaker r atrial (0824T) $7,280 $7,280 2.3×
Tcat rmvl perm 2chmbr ldls pm r atr pm compnt (0799T) $7,280 $7,280 2.3×
Tcat rmvl perm 2chmbr ldls pm r ventr pm compnt (0800T) $7,280 $7,280 2.3×
Tcat rmvl perm dual chamber ldls pm compl sys (0798T) $7,280 $7,280 2.3×
Tcat rmvl&rplcmt perm 1chmbr ldls pm r atrial (0825T) $20,158 $20,158 1.1×
Tcat rmvl&rplcmt perm 2chmbr ldls pm 2chmbr sys (0801T) $20,158 $20,158 1.1×
Tcat rmvl&rplcmt perm 2chmbr ldls pm r atr cmpnt (0802T) $20,158 $20,158 1.1×
Tcat rmvl&rplcmt prm 2chmbr ldls pm r vntr cmpnt (0803T) $20,158 $20,158 1.1×
Tcat Rmvl/Debulk Icar Mass Suction Device Perq (0644T) $11,004 $11,004 2.0×
Tee w or w/o fol w/cont,cong (C8926) $3,341 $3,341 4.3×
Therapeutic procd strg endur (G0237) $72 $72 2.5×
Therapeutic ultrafiltration (0692T) $4,579 $4,579 3.0×
Transcatheter Renal Sympath Denervation Bilat (0339T) $11,004 $11,004 2.0×
Transcatheter renal sympath denervation unilat (0338T) $11,004 $11,004 2.0×
Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation;… (0236T) $28,020 $28,020 2.5×
Trauma respons w/hosp criti (G0390) $5,756 $5,756 4.4×
Trim nail(s) (G0127) $35 $35 0.6×
Trluml periph athrc w/rs&i brchiocphl ea vsl (0237T) $28,020 $28,020 2.5×
Tte w or w/o contr, cont ecg (C8930) $3,341 $3,341 4.3×
Tte w or w/o fol w/con,stres (C8928) $3,341 $3,341 4.3×
Tte w or w/o fol w/cont, com (C8921) $3,341 $3,341 4.3×
Tte w or w/o fol w/cont, f/u (C8922) $3,341 $3,341 4.3×
Tte w or wo fol wcon,doppler (C8929) $3,341 $3,341 4.3×
Unsched dialysis esrd pt hos (G0257) $1,915 $1,915 2.8×
Visit esketamine 56m or less (G2082) $5,465 $5,465 5.4×
Visit esketamine, > 56m (G2083) $6,890 $6,890 4.3×
Visit to determ ldct elig (G0296) $268 $268 2.7×