Supplies, drugs & other prices at Vanderbilt University Hospital

Nashville, TN · every code in this section with a posted price and a Medicare benchmark.

243 codes. Prices are the hospital's own posted facility charges.

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ProcedureCash priceGross charge× Medicare
2019-ncov diagnostic p (U0001) $78.30 $145 2.2×
2d tee w or w/o fol w/con,in (C8925) $2,063.34 $3,821 2.7×
2d tte w or w/o fol w/con,co (C8923) $1,409.40 $2,610 1.8×
2d tte w or w/o fol w/con,fu (C8924) $1,131.30 $2,095 3.3×
3d anat seg imaging preop (C8001) $180.90 $335 1.4×
Ablation, malignant breast tumor(s), percutaneous, cryotherapy, including imaging guidance when performed, unilateral (0581T) $3,949.02 $7,313 1.0×
Adm of soc dtr assess 5-15 m (G0136) $28.62 $53 0.8×
Adm tocilizu covid-19 1st (M0249) $521.64 $966 1.2×
Adm tocilizu covid-19 2nd (M0250) $521.64 $966 1.2×
Admin hepatitis b vaccine (G0010) $34.02 $63 0.7×
Admin influenza virus vac (G0008) $34.02 $63 0.7×
Admin pneumococcal vaccine (G0009) $34.02 $63 0.7×
Alcohol/sub misuse assess (G2011) $49.41 $91.50 1.7×
Alcohol/subs interv 15-30mn (G0396) $96.12 $178 2.6×
Alcohol/subs interv >30 min (G0397) $196.83 $364.50 1.1×
Annual alcohol screen 15 min (G0442) $45.90 $85 1.2×
Autolog prp not diab ulcer (G0460) $1,373.76 $2,544 0.7×
Bdy surf activation mapg pm/cvdfb leads tm f/up (0696T) $521.37 $965.50 14.2×
Behavior counsel obesity 15m (G0447) $39.96 $74 0.4×
Bia whole body composition assessment w/i&r (0358T) $59.40 $110 2.1×
Blind cor sinus reducer impl (C9783) $14,422.32 $26,708 1.3×
Blind interatrial shunt ide (C9758) $22,499.64 $41,666 1.3×
Brief alcohol misuse counsel (G0443) $69.66 $129 0.7×
Ca screen;flexi sigmoidscope (G0104) $1,180.98 $2,187 1.3×
Ca screen;pelvic/breast exam (G0101) $83.70 $155 0.8×
Catheterize for urine spec (P9612) $71.82 $133 7.7×
Cbc without platelet (G0307) $48.06 $89 7.4×
Collagen cross-linking of cornea (including removal of the corneal epithelium and intraoperative pachymetry when… (0402T) $2,728.08 $5,052 1.2×
Colon ca scrn not hi rsk ind (G0121) $1,472.58 $2,727 1.6×
Colorectal scrn; hi risk ind (G0105) $1,380.51 $2,556.50 1.5×
Comm hlth intg svs sdoh 60mn (G0019) $106.11 $196.50 1.1×
Compre ful bdy 3d mtn alys (0693T) $240.84 $446 0.7×
Comprehensive audiometry threshold evaluation and speech recognition (0209T, 0211T combined), automated (0212T) $116.64 $216 0.9×
Covid-19 lab test non-cdc (U0002) $82.08 $152 1.6×
Creation of subcutaneous pocket with insertion of implantable interstitial glucose sensor, including system activation… (0446T) $572.18 $1,059.60 0.1×
Demonstrate use home inr mon (G0248) $221.40 $410 1.7×
Depression screen annual (G0444) $43.47 $80.50 1.2×
Dermal filler injection(s) (G0429) $253.80 $470 0.1×
Diab manage trn per indiv (G0108) $89.37 $165.50 1.6×
Diab manage trn ind/group (G0109) $56.70 $105 3.5×
Direct refer hospital observ (G0379) $995.76 $1,844 1.7×
Drug test def 1-7 classes (G0480) $245.70 $455 2.1×
Drug test def 15-21 classes (G0482) $412.56 $764 2.1×
Drug test def 22+ classes (G0483) $536.22 $993 2.2×
Drug test def 8-14 classes (G0481) $321.84 $596 2.1×
Ed svc ckd grp per session (G0421) $68.58 $127 2.5×
Ed svc ckd ind per session (G0420) $197.64 $366 1.7×
Egd flexible transnasal w/biopsy single/multiple (0653T) $1,806.03 $3,344.50 1.0×
Egd flexible transnasal w/insj intral tube/cath (0654T) $1,848.15 $3,422.50 0.5×
Ekg tracing for initial prev (G0404) $118.80 $220 4.2×
Elec alys cplx prgrmg iins ptn 4+ parameters (0590T) $191.70 $355 2.1×
Elec alys int nstimj sys vagus nrv w/o prgrmg (0911T) $106.92 $198 1.8×
Elec alys int nstimj sys vagus nrv w/smpl prgrmg (0912T) $158.22 $293 1.7×
Elec alys smpl prgrmg iins ptn 1-3 parameters (0589T) $104.22 $193 1.1×
Elec Alys Smpl Prgrmg Iins Sp/Sac Nrv 1-3 Param (0788T) $162.54 $301 1.7×
Elec stim other than wound (G0283) $85.86 $159 6.8×
Electromagntic tx for ulcers (G0329) $9.72 $18 0.9×
Electronic analysis with complex programming of implanted integrated neurostimulation system (eg, electrode array and… (0789T) $201.96 $374 2.2×
Electrophysiologic eval icds w/ss electrode (0577T) $1,025.46 $1,899 0.9×
Endovascular Venous Arterialization Tibl/Prnl Vn (0620T)
likely a partial charge, not the full procedure
$5,007.42 $9,273 0.1×
Endovenous catheter directed chemical ablation with balloon isolation of incompetent extremity vein, open or… (0524T) $221.94 $411 0.1×
Esd endoscopy or colonoscopy (C9779) $24,264.90 $44,935 6.4×
Esophag muc integ w/eso egd (C9777) $4,960.98 $9,187 1.3×
Ev fempop artl revsc tcat plmt IV st grf & clsr (0505T)
unusually low: confirm this is the full procedure
$3,911.76 $7,244 0.3×
Fecal blood scrn immunoassay (G0328) $28.08 $52 1.6×
Fecal microbiota prep instil (G0455) $396.90 $735 0.4×
Fern test (Q0114) $17.28 $32 1.8×
Followup eval of foot pt lop (G0246) $50.76 $94 0.4×
Fractional abl lsr fenestration first 100 sqcm (0479T) $2,771.55 $5,132.50 3.8×
Glaucoma scrn hgh risk direc (G0118) $31.86 $59 0.9×
Glaucoma scrn hgh risk direc (G0117) $90.18 $167 3.2×
Group behave couns 2-10 (G0473) $33.48 $62 0.9×
Hdr electronic brachytherapy ntrstl/intrcav (0395T) $6,216.48 $11,512 9.1×
High inten beh couns std 30m (G0445) $39.42 $73 0.4×
Histotripsy (ie, non-thermal ablation via acoustic energy delivery) of malignant renal tissue, including imaging… (0888T)
likely a partial charge, not the full procedure
$1,595.16 $2,954 0.1×
Histotripsy mal hepatocellular tiss w/img gdn (0686T)
unusually low: confirm this is the full procedure
$6,802.38 $12,597 0.4×
Hospital outpt clinic visit (G0463) $85.32 $158 0.7×
Impact tooth rem bony w/comp (D7241) $918.54 $1,701 1.4×
Impact tooth remov comp bony (D7240) $166.86 $309 0.3×
Impact tooth remov part bony (D7230) $166.86 $309 0.3×
Init/sub psych care m 1st 30 (G2214) $182.52 $338 1.8×
Initial foot exam pt lops (G0245) $87.48 $162 0.7×
Initial preventive exam (G0402) $145.26 $269 1.1×
Inj for sacroiliac jt anesth (G0260) $1,266.84 $2,346 1.8×
Injection(s), bone substitute material (eg, calcium phosphate) into subchondral bone defect (ie, bone marrow lesion,… (0707T) $540 $1,000 0.2×
Insert drug del implant, >=4 (G0516) $363.42 $673 0.8×
Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space;… (0449T)
unusually low: confirm this is the full procedure
$2,401.38 $4,447 0.5×
Insertion of bioprosthetic valve, open, femoral vein, including duplex ultrasound imaging guidance, when performed,… (0744T) $3,669.84 $6,796 0.7×
Insertion of sinus tarsi implant (0335T)
likely a partial charge, not the full procedure
$1,407.24 $2,606 0.2×
Insertion of substernal implantable defibrillator electrode (0572T) $6,516.18 $12,067 0.8×
Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming,… (0516T)
likely a partial charge, not the full procedure
$914.22 $1,693 0.1×
Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming,… (0517T)
likely a partial charge, not the full procedure
$819.72 $1,518 0.1×
Insertion or replacement of intracardiac ischemia monitoring system, including testing of the lead and monitor, initial… (0526T)
likely a partial charge, not the full procedure
$436.32 $808 0.1×
Insertion or replacement of percutaneous electrode array, sacral, with integrated neurostimulator, including imaging… (0786T)
likely a partial charge, not the full procedure
$2,202.12 $4,078 0.2×
Insertion or replacement of percutaneous electrode array, spinal, with integrated neurostimulator, including imaging… (0784T)
likely a partial charge, not the full procedure
$2,866.86 $5,309 0.3×
Insertion wrls car stimulator lv pacg compl sys (0515T)
likely a partial charge, not the full procedure
$436.32 $808 0.0×
Insertion/replacement complete iims (0525T)
likely a partial charge, not the full procedure
$2,046.06 $3,789 0.1×
Insertion/replacement iims implantable mntr only (0527T)
likely a partial charge, not the full procedure
$223.02 $413 0.0×
Insj ant sgm drg dev trab mw w/o res&ctrc rmvl1+ (0671T)
likely a partial charge, not the full procedure
$675 $1,250 0.1×
Insj ocular telescope prosth (0308T)
likely a partial charge, not the full procedure
$3,039.66 $5,629 0.2×
Insj/Rplcmt Icds W/Substernal Electrode (0571T) $39,607.92 $73,348 1.3×
Intens behave ther cardio dx (G0446) $69.66 $129 1.9×
Intens cardiac rehab no exer (G0423) $274.86 $509 2.2×
Intens cardiac rehab w/exerc (G0422) $274.86 $509 2.2×
Interrog dev eval iims ip (0529T) $184.14 $341 5.0×
Interrog dev eval wcs ip (0521T) $184.14 $341 6.5×
Interrogation dev eval icds w/ss eltrd in person (0576T) $126.36 $234 3.4×
Lev 1 hosp type b ed visit (G0380) $244.08 $452 3.3×
Lev 2 hosp type b ed visit (G0381) $423.36 $784 4.6×
Lev 3 hosp type b ed visit (G0382) $826.20 $1,530 4.9×
Lev 4 hosp type b ed visit (G0383) $1,330.56 $2,464 5.1×
Lev 5 hosp type b ed visit (G0384) $1,954.26 $3,619 4.8×
Liver dis 10 assays w/nash (0003M) $1,040.58 $1,927 2.1×
Mra w/cont, abd (C8900) $921.24 $1,706 2.7×
Mra w/cont, chest (C8909) $922.32 $1,708 2.7×
Mra w/cont, lwr ext (C8912) $166.32 $308 0.5×
Mra w/cont, pelvis (C8918) $922.32 $1,708 2.7×
Mra w/o cont, abd (C8901) $164.70 $305 0.7×
Mra w/o cont, chest (C8910) $768.96 $1,424 3.3×
Mra w/o cont, lwr ext (C8913) $922.32 $1,708 3.9×
Mra w/o cont, pelvis (C8919) $164.70 $305 0.7×
Mra w/o fol w/cont, abd (C8902) $768.96 $1,424 2.2×
Mra w/o fol w/cont, chest (C8911) $165.78 $307 0.5×
Mra w/o fol w/cont, lwr ext (C8914) $768.42 $1,423 2.2×
Mra w/o fol w/cont, pelvis (C8920) $922.32 $1,708 2.7×
Mra, w/dye, spinal canal (C8931) $1,028.70 $1,905 3.0×
Mra, w/o dye, spinal canal (C8932) $164.16 $304 0.7×
Mra, w/o&w/dye, spinal canal (C8933) $874.26 $1,619 2.6×
Mri w/o fol w/cont, breast, (C8908) $1,396.98 $2,587 4.1×
Nav srv peer sup 60 min pr m (G0140) $112.59 $208.50 1.1×
Ncntc nr ifr spectrsc oth/thn pad 1st antmc site (0640T) $484.92 $898 13.2×
Njx dx/ther paraver fct jt w/us cer/thor 1 lvl (0213T) $443.88 $822 0.5×
Njx pltlt plasma w/img harvest/preparation (0232T) $1,319.22 $2,443 3.0×
Noninvasive assessment of blood oxygenation, gas exchange efficiency, and cardiorespiratory status, with physician or… (0893T) $105.30 $195 0.8×
Noninvasive prostate cancer estimation map, derived from augmentative analysis of image-guided fusion biopsy and… (0898T) $273.24 $506 0.3×
Obtaining screen pap smear (Q0091) $30.78 $57 1.1×
Onc merkel cell carc detcj antb serum reprtd +/- (0059U) $2,880.36 $5,334 8.9×
Onc Merkel Cll Carc Srm Quan (0058U) $2,880.36 $5,334 8.9×
Onc thyr DNA&mrna 112 genes fna ndul alg alys (0026U) $3,142.80 $5,820 0.9×
Open insertion or replacement of integrated neurostimulation system for bladder dysfunction including electrode(s) (eg,… (0817T)
likely a partial charge, not the full procedure
$874.80 $1,620 0.0×
Open insj/rplcmt integrated nstimj sys ptn subq (0816T)
likely a partial charge, not the full procedure
$874.80 $1,620 0.0×
Open tx iliac spine uni/bil (G0412)
likely a partial charge, not the full procedure
$1,062.72 $1,968 0.1×
Open tx post pelvic fxcture (G0415) $2,017.44 $3,736 0.6×
Osteotomy, humerus, with insertion of an externally controlled intramedullary lengthening device, including… (0594T)
likely a partial charge, not the full procedure
$1,434.78 $2,657 0.2×
Oth resp proc, group (G0239) $194.94 $361 5.3×
Oth resp proc, indiv (G0238) $117.72 $218 4.1×
Pattern erg w/i&r (0509T) $104.22 $193 0.5×
Pelvic ring fracture uni/bil (G0413) $8,497.44 $15,736 1.2×
Pelvic ring fx treat int fix (G0414)
likely a partial charge, not the full procedure
$1,472.04 $2,726 0.2×
Pemivibart infusion (M0224) $411.48 $762 1.0×
Perc d-e cor revasc chro sin (C9607)
likely a partial charge, not the full procedure
$1,262.52 $2,338 0.1×
Perc d-e cor revasc t cabg s (C9604)
likely a partial charge, not the full procedure
$1,125.90 $2,085 0.1×
Perc d-e cor stent ather s (C9602)
likely a partial charge, not the full procedure
$1,259.82 $2,333 0.1×
Perc drug-el cor stent sing (C9600)
likely a partial charge, not the full procedure
$1,126.44 $2,086 0.1×
Percutaneous implantation or replacement of integrated single device neurostimulation system including electrode array… (0587T)
likely a partial charge, not the full procedure
$550.80 $1,020 0.1×
Percutaneous transcatheter ultrasound ablation of nerves innervating the pulmonary arteries, including right heart… (0632T) $12,607.38 $23,347 0.7×
Perq Tcat Ther Rx Dlvr Ntrac Rx Balo 1 Maj C Art (0913T) $9,866.88 $18,272 0.9×
Pin service 60m per month (G0023) $106.11 $196.50 1.1×
Place device/marker, non pro (C9728) $2,527.20 $4,680 1.9×
Place endorectal app (C9725) $1,004.94 $1,861 1.1×
Placement of a posterior intrafacet implant(s), unilateral or bi lateral, including imaging and placement of bone… (0219T)
unusually low: confirm this is the full procedure
$4,061.88 $7,522 0.3×
Potassium hydroxide preps (Q0112) $6.48 $12 1.1×
Ppps, initial visit (G0438) $360.18 $667 2.1×
Ppps, subseq visit (G0439) $133.92 $248 1.0×
Pre 3d mdl w/ccta and/or mri (C9793) $2,277.72 $4,218 2.7×
Prgrmg dev eval icds ss ip (0575T) $132.84 $246 3.6×
Prgrmg dev eval iims ip (0528T) $286.20 $530 7.8×
Prgrmg dev eval ldls pm single car chamber ip (0826T) $226.26 $419 6.2×
Prgrmg dev eval wcs ip (0522T) $241.92 $448 6.6×
Prostate biopsy, any mthd (G0416) $767.61 $1,421.50 2.2×
Psa screening (G0103) $53.46 $99 2.8×
Quan mr alys tis compj wo MRI same sess mlt orgn (0697T) $2,239.11 $4,146.50 2.5×
Quan mr alys tiss composition w/MRI 1orgn (0649T) $853.20 $1,580 0.9×
Quan mr alys tiss composition w/MRI mlt organs (0698T) $2,239.11 $4,146.50 2.5×
Rectal tumor excision, transanal endoscopic microsurgical, full thick (0184T)
likely a partial charge, not the full procedure
$1,287.90 $2,385 0.2×
Relocation of pulse generator for wireless cardiac stimulator for left ventricular pacing, including device… (0863T) $3,479.49 $6,443.50 1.7×
Relocation of pulse generator for wireless cardiac stimulator for left ventricular pacing, including device… (0862T) $3,479.49 $6,443.50 1.7×
Removal and replacement of wireless cardiac stimulator for left ventricular pacing pulse generator component(s)… (0520T)
likely a partial charge, not the full procedure
$1,230.66 $2,279 0.1×
Removal and replacement of wireless cardiac stimulator for left ventricular pacing; pulse generator component(s)… (0519T)
likely a partial charge, not the full procedure
$762.48 $1,412 0.1×
Removal complete iims (0530T) $597.24 $1,106 0.2×
Removal iims electrode only (0531T) $636.12 $1,178 0.2×
Removal iims implt mntr only (0532T) $547.02 $1,013 0.1×
Removal of only pulse generator component(s) (battery and/or transmitter) of wireless cardiac stimulator for left… (0518T) $581.04 $1,076 0.2×
Removal Pg Wcs Lv Pacing Both Components (0861T) $3,875.04 $7,176 1.1×
Remove drug implant (G0517) $560.25 $1,037.50 1.3×
Remove w insert drug implant (G0518) $690.12 $1,278 1.6×
Repos prev impl ss impltbl dfb pacing eltrd (0574T) $2,750.76 $5,094 0.7×
Revasc intra lithotrip-ather (C9766) $19,193.22 $35,543 1.1×
Revasc intra lithotrip-stent (C9765) $19,193.22 $35,543 1.1×
Revasc intravasc lithotripsy (C9764) $13,653.36 $25,284 1.2×
Revasc lith-sten-ath tib/per (C9775) $18,279 $33,850 1.0×
Revasc lithotr-ather tib/per (C9774) $19,193.22 $35,543 1.1×
Revasc lithotr-stent tib/per (C9773) $19,193.22 $35,543 1.1×
Revasc lithotrip tibi/perone (C9772) $13,653.36 $25,284 1.2×
Revasc lithotrip-stent-ather (C9767) $19,193.22 $35,543 1.1×
Revision (eg, augmentation, division of tether), replacement, or removal of thoracolumbar or lumbar vertebral body… (0790T)
likely a partial charge, not the full procedure
$1,453.14 $2,691 0.1×
Revision or removal of integrated neurostimulation system for bladder dysfunction, including analysis, programming, and… (0819T) $693.36 $1,284 0.2×
Revision or removal of integrated single device neurostimulation system including electrode array and receiver or pulse… (0588T) $648 $1,200 0.2×
Revision or removal of neurostimulator electrode array, sacral, with integrated neurostimulator (0787T) $656.64 $1,216 0.2×
Revision or removal of neurostimulator electrode array, spinal, with integrated neurostimulator (0785T) $4,455 $8,250 1.3×
Revj/rmvl integrated nstimj sys ptn subcutaneous (0818T) $693.36 $1,284 0.2×
Rmvl substernal implantable defibrillator eltrd (0573T) $2,750.76 $5,094 0.7×
Rmvl Substernal Impltbl Dfb Pulse Generator Only (0580T) $2,750.76 $5,094 0.7×
Rmvl&rimpltj ant sgm io nbiodgrd rx elut implt (0661T) $1,047.06 $1,939 0.3×
Routine footcare pt w lops (G0247) $54.54 $101 0.3×
Subretinal injection of a pharmacologic agent, including vitrectomy and 1 or more retinotomies (0810T) $3,019.14 $5,591 0.7×
Tcat Implt Wrls L Atr Prs Snr L-T L Atr Prs Mntr (0933T) $13,222.98 $24,487 4.2×
Tcat insj perm 1chmbr ldls pacemaker r atrial (0823T) $13,184.91 $24,416.50 0.7×
Tcat insj perm 2chmbr ldls pm r atr pm compnt (0796T) $13,143.33 $24,339.50 0.7×
Tcat insj perm 2chmbr ldls pm r ventr pm compnt (0797T) $13,143.33 $24,339.50 0.7×
Tcat Insj Perm Dual Chamber Ldls Pm Compl Sys (0795T) $13,852.35 $25,652.50 0.7×
Tcat rmvl perm 1chmbr ldls pacemaker r atrial (0824T) $3,301.02 $6,113 1.1×
Tcat rmvl perm 2chmbr ldls pm r atr pm compnt (0799T) $4,775.22 $8,843 1.5×
Tcat rmvl perm 2chmbr ldls pm r ventr pm compnt (0800T) $4,775.22 $8,843 1.5×
Tcat rmvl perm dual chamber ldls pm compl sys (0798T) $5,536.08 $10,252 1.8×
Tcat rmvl&rplcmt perm 1chmbr ldls pm r atrial (0825T) $16,485.93 $30,529.50 0.9×
Tcat rmvl&rplcmt perm 2chmbr ldls pm 2chmbr sys (0801T) $17,381.25 $32,187.50 0.9×
Tcat rmvl&rplcmt perm 2chmbr ldls pm r atr cmpnt (0802T) $15,911.37 $29,465.50 0.8×
Tcat rmvl&rplcmt prm 2chmbr ldls pm r vntr cmpnt (0803T) $15,911.37 $29,465.50 0.8×
Tcat Rmvl/Debulk Icar Mass Suction Device Perq (0644T) $7,300.26 $13,519 1.3×
Tee w or w/o fol w/cont, mon (C8927) $2,365.74 $4,381 3.1×
Tee w or w/o fol w/cont,cong (C8926) $2,655.18 $4,917 3.5×
Therapeutic procd strg endur (G0237) $112.86 $209 4.0×
Therapeutic ultrafiltration (0692T) $703.89 $1,303.50 0.5×
Tomosynthesis, mammo (G0279) $41.85 $77.50 3.3×
Tpmt Nudt15 Gene Analysis Common Variants (0034U) $352.62 $653 0.8×
Transcatheter Renal Sympath Denervation Bilat (0339T) $5,056.83 $9,364.50 0.9×
Transcatheter renal sympath denervation unilat (0338T) $7,225.74 $13,381 1.3×
Transurethral ablation of malignant prostate tissue by high-energy water vapor thermotherapy, including intraoperative… (0582T)
likely a partial charge, not the full procedure
$2,932.74 $5,431 0.2×
Trauma respons w/hosp criti (G0390) $6,842.34 $12,671 5.2×
Trim nail(s) (G0127) $59.40 $110 1.0×
Trluml peripheral atherectomy iliac artery ea (0238T)
likely a partial charge, not the full procedure
$1,170.72 $2,168 0.1×
Tte w or w/o contr, cont ecg (C8930) $2,730.24 $5,056 3.5×
Tte w or w/o fol w/con,stres (C8928) $1,613.52 $2,988 2.1×
Tte w or w/o fol w/cont, com (C8921) $1,777.68 $3,292 2.3×
Tte w or w/o fol w/cont, f/u (C8922) $1,226.34 $2,271 1.6×
Tte w or wo fol wcon,doppler (C8929) $377.73 $699.50 0.5×
Vertebral body tethering, anterior; 8 or more vertebral segments (0657T) $10,247.58 $18,977 0.6×
Vertebral body tethering, anterior; up to 7 vertebral segments (0656T) $9,284.76 $17,194 0.5×
Visit esketamine 56m or less (G2082) $2,466.72 $4,568 2.4×
Visit esketamine, > 56m (G2083) $3,602.88 $6,672 2.3×
Visit to determ ldct elig (G0296) $112.86 $209 1.1×
Wet mounts/ w preparations (Q0111) $22.14 $41 1.2×