Supplies, drugs & other prices at Tennova Jefferson Memorial Hospital
Jefferson City, TN · every code in this section with a posted price and a Medicare benchmark.
66 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) | $1,237.46 | $5,591.78 | 1.7× |
| 2d tte w or w/o fol w/con,co (C8923) | $923.11 | $4,171.32 | 1.3× |
| 2d tte w or w/o fol w/con,fu (C8924) | $963.77 | $4,355.04 | 3.0× |
| Adm tocilizu covid-19 1st (M0249) | $287.19 | $1,297.73 | 0.7× |
| Adm tocilizu covid-19 2nd (M0250) | $287.19 | $1,297.73 | 0.7× |
| Admin hepatitis b vaccine (G0010) | $40.23 | $181.81 | 0.9× |
| Admin influenza virus vac (G0008) | $56.79 | $256.61 | 1.3× |
| Admin pneumococcal vaccine (G0009) | $89.47 | $404.30 | 2.1× |
| Autolog prp not diab ulcer (G0460) | $1,527.34 | $6,901.67 | 0.8× |
| Ca screen;flexi sigmoidscope (G0104) | $3,317.55 | $14,991.20 | 3.9× |
| Catheterize for urine spec (P9612) | $6.89 | $31.13 | 0.7× |
| Colon ca scrn not hi rsk ind (G0121) | $2,684.08 | $12,128.70 | 3.2× |
| Colorectal scrn; hi risk ind (G0105) | $2,716.53 | $12,275.33 | 3.2× |
| Diab manage trn per indiv (G0108) | $36.54 | $165.12 | 0.7× |
| Diab manage trn ind/group (G0109) | $18.27 | $82.56 | 1.1× |
| Direct refer hospital observ (G0379) | $464.69 | $2,099.84 | 0.9× |
| Eia hiv-1/hiv-2 screen (G0432) | $29.46 | $133.14 | 1.5× |
| Elec stim other than wound (G0283) | $87.40 | $394.96 | 6.9× |
| Elec stim unattend for press (G0281) | $14.90 | $67.34 | 1.3× |
| Elisa hiv-1/hiv-2 screen (G0433) | $53.90 | $243.60 | 2.9× |
| Fecal blood scrn immunoassay (G0328) | $51.45 | $232.51 | 2.9× |
| Group mnt 2 or more 30 mins (G0271) | $19.96 | $90.21 | 1.2× |
| Hbot, full body chamber, 30m (G0277) | $250.66 | $1,132.65 | 2.0× |
| Hep c screen high risk/other (G0472) | $76.92 | $347.57 | 1.7× |
| Hepb screen high risk indiv (G0499) | $185.67 | $838.98 | 6.6× |
| Hiv combination assay (G0475) | $50.97 | $230.32 | 2.1× |
| Hospital outpt clinic visit (G0463) | $152.52 | $689.21 | 1.3× |
| Inj for sacroiliac jt anesth (G0260) | $1,289.80 | $5,828.29 | 2.0× |
| Liver dis 10 assays w/nash (0003M) | $275.01 | $1,242.69 | 0.5× |
| Mnt subs tx for change dx (G0270) | $37.62 | $170 | 1.2× |
| Mra w/cont, abd (C8900) | $760.31 | $3,435.66 | 2.4× |
| Mra w/cont, chest (C8909) | $865.20 | $3,909.62 | 2.7× |
| Mra w/cont, lwr ext (C8912) | $1,176.42 | $5,315.96 | 3.7× |
| Mra w/cont, pelvis (C8918) | $807.53 | $3,649.02 | 2.6× |
| Mra w/o cont, abd (C8901) | $903.47 | $4,082.54 | 4.2× |
| Mra w/o cont, chest (C8910) | $672.45 | $3,038.62 | 3.1× |
| Mra w/o cont, lwr ext (C8913) | $1,078.86 | $4,875.13 | 5.0× |
| Mra w/o cont, pelvis (C8919) | $758.91 | $3,429.32 | 3.5× |
| Mra w/o fol w/cont, abd (C8902) | $1,505.21 | $6,801.67 | 4.8× |
| Mra w/o fol w/cont, chest (C8911) | $1,894.48 | $8,560.70 | 6.0× |
| Mra w/o fol w/cont, lwr ext (C8914) | $2,117.49 | $9,568.41 | 6.7× |
| Mra w/o fol w/cont, pelvis (C8920) | $1,127.07 | $5,092.97 | 3.6× |
| Mra, w/dye, upper extremity (C8934) | $907.51 | $4,100.83 | 2.9× |
| Mra, w/o&w/dye, upper extr (C8936) | $716.81 | $3,239.10 | 2.3× |
| Mri w/cont, breast, bi (C8906) | $1,172.33 | $5,297.46 | 3.7× |
| Mri w/cont, breast, uni (C8903) | $563.06 | $2,544.31 | 3.5× |
| Mri w/o fol w/cont, breast, (C8908) | $1,576.10 | $7,122.01 | 5.0× |
| Mri w/o fol w/cont, brst, un (C8905) | $1,130.96 | $5,110.55 | 3.6× |
| Neuro csf detcj prion prtn quakg conf conv qual (0035U) | $293.47 | $1,326.13 | 0.5× |
| Njx pltlt plasma w/img harvest/preparation (0232T) | $9,176.52 | $41,466.43 | 22.6× |
| Oral hiv-1/hiv-2 screen (G0435) | $24.95 | $112.73 | 2.1× |
| Oth resp proc, group (G0239) | $51.28 | $231.70 | 1.5× |
| Perc d-e cor revasc chro sin (C9607) | $22,129.95 | $99,999.77 | 1.3× |
| Perc d-e cor revasc t cabg s (C9604) | $14,852.08 | $67,112.86 | 1.4× |
| Perc d-e cor stent ather s (C9602) | $22,129.95 | $99,999.77 | 1.3× |
| Perc drug-el cor stent sing (C9600) | $14,019.79 | $63,351.97 | 1.3× |
| Prolonged iv inf, req pump (C8957) | $261.13 | $1,180 | 1.4× |
| Prostate biopsy, any mthd (G0416) | $532.13 | $2,404.57 | 1.6× |
| Psa screening (G0103) | $67.01 | $302.78 | 3.5× |
| Tee w or w/o fol w/cont, mon (C8927) | $770.25 | $3,480.59 | 1.1× |
| Tomosynthesis, mammo (G0279) | $42.32 | $191.25 | 3.3× |
| Trauma respons w/hosp criti (G0390) | $802.46 | $3,626.11 | 0.7× |
| Tte w or w/o contr, cont ecg (C8930) | $1,142.06 | $5,160.67 | 1.6× |
| Tte w or w/o fol w/con,stres (C8928) | $1,142.06 | $5,160.67 | 1.6× |
| Tte w or wo fol wcon,doppler (C8929) | $993.98 | $4,491.56 | 1.4× |
| Unsched dialysis esrd pt hos (G0257) | $2,213.63 | $10,002.83 | 3.6× |