15 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) |
$27.11 |
$108 |
0.6× |
| Admin influenza virus vac (G0008) |
$27.11 |
$108 |
0.6× |
| Admin pneumococcal vaccine (G0009) |
$27.11 |
$108 |
0.6× |
| Catheterize for urine spec (P9612) |
$49.36 |
$74 |
5.3× |
| Direct refer hospital observ (G0379) |
$362.32 |
$654 |
0.6× |
| Fern test (Q0114) |
$42.37 |
$66 |
4.4× |
| FLT3 (fms-related tyrosine kinase 3) (eg, acute lyeloid leukemia) internal tandem duplication (ITD) variants,… (0046U) |
$1,294.20 |
$1,800 |
3.2× |
| Instlj fecal microbiota ssp rct nma lwr gi trc (0780T) |
$460.78 |
$584 |
3.4× |
| Neuro csf prion prtn qual (0035U) |
$1,166.94 |
$1,623 |
2.2× |
| NPM1 (nucleophosmin) (eg, acute myeloid leukemia) gene analysis, quantitative Other Outpatient (0049U) |
$1,635.72 |
$2,275 |
4.0× |
| Oth resp proc, group (G0239) |
$123.05 |
$214 |
3.2× |
| Oth resp proc, indiv (G0238) |
$39.67 |
$69 |
1.3× |
| Red blood cell antigen typing, DNA, human erythrocyte antigen gene analysis of 35 antigens from 11 blood groups,… (0001U) |
$2,555.28 |
$2,160 |
3.5× |
| Trauma respons w/hosp criti (G0390) |
$1,961.68 |
$3,302.50 |
1.4× |
| Tte w or wo fol wcon,doppler (C8929) |
$2,604.80 |
$3,700 |
3.3× |