Supplies, drugs & other prices at UCHealth Memorial Hospital Central

Colorado Springs, CO · every code in this section with a posted price and a Medicare benchmark.

119 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) $2,277 $5,060 2.8×
2d tte w or w/o fol w/con,fu (C8924) $1,262.70 $2,806 3.4×
Admin hepatitis b vaccine (G0010) $65.25 $145 1.3×
Admin influenza virus vac (G0008) $65.25 $145 1.3×
Admin pneumococcal vaccine (G0009) $65.25 $145 1.3×
Blind interatrial shunt ide (C9758) $24,965.10 $55,478 1.4×
Blind/nonblind trans atrial (C9792) $13,222.80 $29,384 1.3×
Ca screen;flexi sigmoidscope (G0104) $826.65 $1,837 0.8×
Catheterize for urine spec (P9612) $22.05 $49 2.4×
Chemo extend iv infus w/pump (G0498) $666.45 $1,481 1.9×
Colon ca scrn not hi rsk ind (G0121) $1,667.70 $3,706 1.7×
Colorectal scrn; hi risk ind (G0105) $1,667.70 $3,706 1.7×
Covid-19 lab test non-cdc (U0002) $45 $100 0.9×
Direct refer hospital observ (G0379) $889.65 $1,977 1.4×
Drug test def 1-7 classes (G0480) $203.10 $451.32 1.8×
Drug test def 8-14 classes (G0481) $30.34 $67.42 0.2×
Electrocardiogram, algorithmically generated 12-lead ECG from a reduced-lead ECG; tracing only (0904T) $247.50 $550 4.0×
Electronic analysis of implanted integrated neurostimulation system, vagus nerve; with simple programming by physician… (0912T) $103.95 $231 1.0×
Electronic analysis of implanted integrated neurostimulation system, vagus nerve; without programming by physician or… (0911T) $81 $180 1.3×
Endo outlet restrict w/tube (C9785) $14,250.60 $31,668 1.3×
Ephys eval ccm-d ld 1st impl (0930T) $303.75 $675 0.2×
Ephys eval ccm-d ld separate (0931T) $303.75 $675 0.2×
Esd endoscopy or colonoscopy (C9779) $4,687.20 $10,416 1.2×
Esophagogastroduodenoscopy, flexible, transoral, with volume adjustment of intragastric bariatric balloon (0813T) $1,172.70 $2,606 1.2×
Ev fempop artl revsc tcat plmt IV st grf & clsr (0505T) $21,366 $47,480 1.8×
Fecal microbiota prep instil (G0455) $1,579.50 $3,510 1.6×
Fern test (Q0114) $76.95 $171 7.9×
FLT3 (fms-related tyrosine kinase 3) (eg, acute lyeloid leukemia) internal tandem duplication (ITD) variants,… (0046U) $3,003.75 $6,675 7.4×
Hbot, full body chamber, 30m (G0277) $678.60 $1,508 4.7×
Hep c screen high risk/other (G0472) $112.50 $250 2.4×
High dose rate electronic brachytherapy, interstitial or intracavitary treatment, per fraction, includes basic… (0395T) $1,766.70 $3,926 2.4×
Hiv combination assay (G0475) $80.10 $178 3.3×
Home sleep test/type 3 porta (G0399) $1,048.50 $2,330 4.6×
Hospital outpt clinic visit (G0463) $218.70 $486 1.6×
Ig paraprotein qual imprcip&ms bld/ur w/isotype (0077U) $232.90 $517.54 5.4×
Inj for sacroiliac jt anesth (G0260) $935.55 $2,079 1.3×
Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming,… (0517T) $14,197.05 $31,549 1.3×
Insj wcs lv compl sys (0515T) $35,102.70 $78,006 1.5×
Insj wcs lv eltrd only (0516T) $14,197.05 $31,549 1.3×
Interrog dev eval impl ccm-d system in person (0927T) $253.80 $564 6.4×
JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) gene analysis, targeted sequence analysis exons 12-15 Other… (0027U) $641.22 $1,424.93 5.3×
Lev 1 hosp type b ed visit (G0380) $149.40 $332 1.9×
Lev 2 hosp type b ed visit (G0381) $163.12 $362.50 1.7×
Lev 3 hosp type b ed visit (G0382) $271.35 $603 1.5×
Lev 4 hosp type b ed visit (G0383) $415.58 $923.50 1.5×
Lev 5 hosp type b ed visit (G0384) $565.42 $1,256.50 1.3×
Liver disease, ten biochemical assays (ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT, haptoglobin,… (0003M) $766.59 $1,703.53 1.5×
Mra w/cont, abd (C8900) $1,588.50 $3,530 4.3×
Mra w/cont, chest (C8909) $2,309.85 $5,133 6.3×
Mra w/o cont, abd (C8901) $1,340.10 $2,978 5.3×
Mra w/o cont, chest (C8910) $1,946.70 $4,326 7.7×
Mra w/o cont, lwr ext (C8913) $1,930.05 $4,289 7.7×
Mra w/o cont, pelvis (C8919) $1,237.05 $2,749 4.9×
Mra w/o fol w/cont, abd (C8902) $1,684.80 $3,744 4.6×
Mra w/o fol w/cont, chest (C8911) $2,440.35 $5,423 6.6×
Mra w/o fol w/cont, lwr ext (C8914) $3,024 $6,720 8.2×
Mra w/o fol w/cont, pelvis (C8920) $1,787.40 $3,972 4.9×
Mra, w/o dye, upper extr (C8935) $1,237.05 $2,749 4.9×
Mra, w/o&w/dye, upper extr (C8936) $1,821.60 $4,048 4.9×
Mri w/o fol w/cont, breast, (C8908) $1,285.20 $2,856 3.5×
Mri w/o fol w/cont, brst, un (C8905) $1,115.55 $2,479 3.0×
Neuro csf prion prtn qual (0035U) $721.50 $1,603.32 1.3×
Njx pltlt plasma w/img harvest/preparation (0232T) $849.15 $1,887 1.8×
Oncology (Merkel cell-carcinoma), detection of antibodies to the Merkel cell polyoma virus oncoprotein (small T… (0058U) $616.21 $1,369.35 1.9×
Open implantation of integrated neurostimulation system, vagus nerve, including analysis and programming, when performed (0908T) $57,571.65 $127,937 1.8×
Opto-acoustic imaging, breast, unilateral, including axilla when performed, real-time with image documentation,… (0857T) $142.20 $316 1.3×
Oth resp proc, group (G0239) $324.90 $722 8.2×
Oth resp proc, indiv (G0238) $63.90 $142 2.1×
Perc d-e cor revasc chro sin (C9607) $15,574.05 $34,609 0.8×
Perc d-e cor revasc t cabg s (C9604) $20,234.70 $44,966 1.7×
Perc d-e cor stent ather s (C9602) $21,323.70 $47,386 1.1×
Perc drug-el cor stent sing (C9600) $15,452.10 $34,338 1.3×
Perq sac agmntj bi w/wo balo/mchnl dev 2/> ndls (0201T) $6,240.15 $13,867 0.8×
Perq tcat ther rx dlvr ntrac rx balo 1 maj c art (0913T) $7,735.50 $17,190 0.6×
Pinworm examinations (Q0113) $75.15 $167 17.6×
Place device/marker, non pro (C9728) $1,856.25 $4,125 1.3×
Programming device eval impl ccm-d sys in person (0926T) $314.10 $698 8.0×
Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of… (0826T) $48.60 $108 1.2×
Prolonged iv inf, req pump (C8957) $733.95 $1,631 3.3×
Prostate biopsy, any mthd (G0416) $621.90 $1,382 1.6×
Psa screening (G0103) $70.20 $156 3.6×
QTc interval derived by augmentative algorithmic analysis of input from an external, patient-activated mobile ECG device (0902T) $609.75 $1,355 4.3×
Quan mr alys tis compj wo MRI same sess mlt orgn (0697T) $1,288.80 $2,864 1.3×
Quan mr tis wo MRI 1orgn (0648T) $1,738.80 $3,864 1.8×
Quan us tiss charac i&r w/o dx us same anat (0689T) $151.20 $336 1.6×
Quantitative magnetic resonance image (MRI) analysis of the brain with comparison to prior magnetic resonance (MR)… (0865T) $316.80 $704 1.3×
Quantitative magnetic resonance image (MRI) analysis of the brain with comparison to prior magnetic resonance (MR)… (0866T) $430.20 $956 1.7×
Remote interrog dev eval ccm-d sys <90d tech (0929T) $225 $500 5.7×
Removal and replacement of pulse generator for wireless cardiac stimulator for left ventricular pacing, including… (0519T) $14,197.05 $31,549 1.3×
Removal and replacement of pulse generator for wireless cardiac stimulator for left ventricular pacing, including… (0520T) $35,102.70 $78,006 3.2×
Removal of integrated neurostimulation system, vagus nerve (0910T) $4,151.70 $9,226 1.1×
Removal of pulse generator components of wireless heart stimulator system for pacing of lower left chamber of heart (0518T) $4,995.90 $11,102 1.3×
Replacement of integrated neurostimulation system, vagus nerve, including analysis and programming, when performed (0909T) $57,571.65 $127,937 1.8×
Revasc intra lithotrip-ather (C9766) $15,927.75 $35,395 0.8×
Revasc intra lithotrip-stent (C9765) $15,927.75 $35,395 0.8×
Revasc intravasc lithotripsy (C9764) $9,796.50 $21,770 0.8×
Revasc lithotr-ather tib/per (C9774) $24,504.30 $54,454 1.3×
Revasc lithotrip-stent-ather (C9767) $18,205.65 $40,457 0.9×
Tcat insj perm 1chmbr ldls pacemaker r atrial (0823T) $25,203.15 $56,007 1.2×
Tcat rmvl/debulk icar mass suction device perq (0644T) $7,740 $17,200 1.3×
Tee w or w/o fol w/cont, mon (C8927) $1,161.90 $2,582 1.4×
Therapeutic procd strg endur (G0237) $111.15 $247 3.6×
Therapeutic ultrafiltration (0692T) $870.75 $1,935 0.5×
Transcatheter removal and replacement of permanent single-chamber leadless pacemaker, right atrial, including imaging… (0825T) $25,203.15 $56,007 1.2×
Transcatheter removal of permanent single-chamber leadless pacemaker, right atrial, including imaging guidance (eg,… (0824T) $4,122.90 $9,162 1.2×
Transcatheter renal sympathetic denervation, percutaneous approach including arterial puncture, selective catheter… (0339T) $8,308.35 $18,463 1.4×
Trauma respons w/hosp criti (G0390) $3,483.45 $7,741 2.5×
Trluml perip athrc abd aorta (0236T) $16,241.85 $36,093 1.3×
Trluml perip athrc brchiocph (0237T) $14,523.30 $32,274 1.2×
Trluml perip athrc iliac art (0238T) $23,221.35 $51,603 1.2×
Trluml perip athrc renal art (0234T) $16,241.85 $36,093 1.3×
Trnscth renal symp denrv unl (0338T) $7,912.80 $17,584 1.3×
Tte w or w/o contr, cont ecg (C8930) $2,226.60 $4,948 2.7×
Tte w or w/o fol w/con,stres (C8928) $2,099.25 $4,665 2.5×
Tte w or w/o fol w/cont, com (C8921) $1,450.80 $3,224 1.8×
Tte w or w/o fol w/cont, f/u (C8922) $1,071.90 $2,382 1.3×
Tte w or wo fol wcon,doppler (C8929) $3,623.40 $8,052 4.4×
Unsched dialysis esrd pt hos (G0257) $1,774.80 $3,944 2.5×
Wet mounts/ w preparations (Q0111) $75.15 $167 4.1×