Supplies, drugs & other prices at Susan B Allen Memorial Hospital
El Dorado, KS · every code in this section with a posted price and a Medicare benchmark.
23 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|---|---|---|
| Admin hepatitis b vaccine (G0010) | $39.65 | $61 | 0.9× |
| Admin influenza virus vac (G0008) | $38.02 | $58.50 | 0.9× |
| Admin pneumococcal vaccine (G0009) | $39.65 | $61 | 0.9× |
| Colon ca scrn not hi rsk ind (G0121) | $2,139.80 | $3,292 | 2.5× |
| Colorectal scrn; hi risk ind (G0105) | $1,782.95 | $2,743 | 2.1× |
| Covid-19 lab test non-cdc (U0002) | $81.25 | $125 | 1.6× |
| Direct refer hospital observ (G0379) | $172.90 | $266 | 0.3× |
| Drug test def 1-7 classes (G0480) | $82.55 | $127 | 0.7× |
| Elec stim other than wound (G0283) | $59.80 | $92 | 4.7× |
| Hepb screen high risk indiv (G0499) | $39 | $60 | 1.4× |
| Home sleep test/type 3 porta (G0399) | $325 | $500 | 1.6× |
| Hospital outpt clinic visit (G0463) | $82.22 | $126.50 | 0.7× |
| Inj for sacroiliac jt anesth (G0260) | $464.10 | $714 | 0.7× |
| Mra w/o fol w/cont, abd (C8902) | $1,253.85 | $1,929 | 3.9× |
| Mra w/o fol w/cont, chest (C8911) | $1,253.85 | $1,929 | 3.9× |
| Mra w/o fol w/cont, lwr ext (C8914) | $1,253.85 | $1,929 | 3.9× |
| Mri w/o fol w/cont, breast, (C8908) | $1,914.90 | $2,946 | 6.0× |
| Mri w/o fol w/cont, brst, un (C8905) | $1,253.85 | $1,929 | 3.9× |
| Opps service,sched team conf (G0175) | $477.75 | $735 | 1.2× |
| Prolonged iv inf, req pump (C8957) | $923 | $1,420 | 4.7× |
| Psa screening (G0103) | $43.55 | $67 | 2.3× |
| Screen pap by tech w md supv (P3000) | $34.45 | $53 | 1.9× |
| Tomosynthesis, mammo (G0279) | $18.85 | $29 | 1.5× |