Supplies, drugs & other prices at T.J. Samson Community Hospital
Glasgow, KY · every code in this section with a posted price and a Medicare benchmark.
55 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|---|---|---|
| 2d tee w or w/o fol w/con,in (C8925) | $833.30 | $1,282 | 1.1× |
| 2d tte w or w/o fol w/con,co (C8923) | $833.30 | $1,282 | 1.1× |
| 2d tte w or w/o fol w/con,fu (C8924) | $538.85 | $829 | 1.6× |
| Adm of soc dtr assess 5-15 m (G0136) | $30.55 | $47 | 0.9× |
| Admin hepatitis b vaccine (G0010) | $57.52 | $88.50 | 1.3× |
| Admin influenza virus vac (G0008) | $57.52 | $88.50 | 1.3× |
| Admin pneumococcal vaccine (G0009) | $57.52 | $88.50 | 1.3× |
| Behavior counsel obesity 15m (G0447) | $76.70 | $118 | 0.8× |
| Ca screen;flexi sigmoidscope (G0104) | $99.45 | $153 | 0.1× |
| Ca screen;pelvic/breast exam (G0101) | $61.75 | $95 | 0.6× |
| Catheterize for urine spec (P9612) | $14.95 | $23 | 1.6× |
| Chemo extend iv infus w/pump (G0498) | $351 | $540 | 1.1× |
| Colon ca scrn not hi rsk ind (G0121) | $568.75 | $875 | 0.6× |
| Colorectal scrn; hi risk ind (G0105) | $568.75 | $875 | 0.6× |
| Comm hlth intg svs sdoh 60mn (G0019) | $91.65 | $141 | 1.0× |
| Depression screen annual (G0444) | $28.60 | $44 | 0.8× |
| Diab manage trn per indiv (G0108) | $86.45 | $133 | 1.5× |
| Direct refer hospital observ (G0379) | $637.65 | $981 | 1.1× |
| Drug test def 1-7 classes (G0480) | $209.95 | $323 | 1.8× |
| Drug test def 22+ classes (G0483) | $403 | $620 | 1.6× |
| Elec stim other than wound (G0283) | $24.05 | $37 | 1.9× |
| Fern test (Q0114) | $16.25 | $25 | 1.7× |
| Hbot, full body chamber, 30m (G0277) | $264.55 | $407 | 2.0× |
| Home sleep test/type 3 porta (G0399) | $302.25 | $465 | 1.5× |
| Hospital outpt clinic visit (G0463) | $141.70 | $218 | 1.1× |
| Initial preventive exam (G0402) | $211.25 | $325 | 1.7× |
| Injection(s), bone substitute material (eg, calcium phosphate) into subchondral bone defect (ie, bone marrow lesion,… (0707T) | $1,204.45 | $1,853 | 0.4× |
| Liver dis 10 assays w/nash (0003M) | $818.35 | $1,259 | 1.6× |
| Mra w/cont, abd (C8900) | $1,652.30 | $2,542 | 5.0× |
| Mra w/o fol w/cont, abd (C8902) | $1,621.75 | $2,495 | 4.9× |
| Mra w/o fol w/cont, chest (C8911) | $1,417.33 | $2,180.50 | 4.3× |
| Mra w/o fol w/cont, lwr ext (C8914) | $2,478.45 | $3,813 | 7.5× |
| Mra, w/o dye, upper extr (C8935) | $381.22 | $586.50 | 1.7× |
| Mra, w/o&w/dye, upper extr (C8936) | $1,417.65 | $2,181 | 4.3× |
| Obtaining screen pap smear (Q0091) | $32.50 | $50 | 1.2× |
| Oth resp proc, group (G0239) | $40.95 | $63 | 1.2× |
| Perc d-e cor revasc chro sin (C9607) | $19,477.90 | $29,966 | 1.1× |
| Perc d-e cor revasc t cabg s (C9604) | $12,266.15 | $18,871 | 1.1× |
| Perc d-e cor stent ather s (C9602) | $19,477.90 | $29,966 | 1.1× |
| Perc drug-el cor stent sing (C9600) | $12,266.15 | $18,871 | 1.1× |
| Pin service 60m per month (G0023) | $93.28 | $143.50 | 1.0× |
| Potassium hydroxide preps (Q0112) | $9.75 | $15 | 1.7× |
| Ppps, initial visit (G0438) | $269.75 | $415 | 1.5× |
| Ppps, subseq visit (G0439) | $211.25 | $325 | 1.5× |
| Prostate biopsy, any mthd (G0416) | $585 | $900 | 1.7× |
| Psa screening (G0103) | $45.50 | $70 | 2.4× |
| Revasc intravasc lithotripsy (C9764) | $12,266.15 | $18,871 | 1.1× |
| Tomosynthesis, mammo (G0279) | $48.10 | $74 | 3.8× |
| Trim nail(s) (G0127) | $39 | $60 | 0.7× |
| Trluml peripheral atherectomy iliac artery ea (0238T) | $19,477.90 | $29,966 | 1.1× |
| Tte w or w/o contr, cont ecg (C8930) | $833.30 | $1,282 | 1.1× |
| Tte w or wo fol wcon,doppler (C8929) | $942.50 | $1,450 | 1.3× |
| Unsched dialysis esrd pt hos (G0257) | $729.30 | $1,122 | 1.1× |
| Visit to determ ldct elig (G0296) | $46.80 | $72 | 0.5× |
| Wet mounts/ w preparations (Q0111) | $64.35 | $99 | 3.5× |