Supplies, drugs & other prices at West Tennessee Healthcare Dyersburg Hospital
Dyersburg, TN · every code in this section with a posted price and a Medicare benchmark.
30 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) | $1,075.50 | $3,585 | 1.5× |
| 2d tte w or w/o fol w/con,fu (C8924) | $576.90 | $1,923 | 1.8× |
| Adm tocilizu covid-19 1st (M0249) | $236.10 | $787 | 0.6× |
| Admin hepatitis b vaccine (G0010) | $16.50 | $55 | 0.4× |
| Admin influenza virus vac (G0008) | $16.50 | $55 | 0.4× |
| Admin pneumococcal vaccine (G0009) | $16.50 | $55 | 0.4× |
| Direct refer hospital observ (G0379) | $75.60 | $252 | 0.1× |
| Drug test def 1-7 classes (G0480) | $55.50 | $185 | 0.5× |
| Hbot, full body chamber, 30m (G0277) | $177.90 | $593 | 1.4× |
| Home sleep test/type 3 porta (G0399) | $892.50 | $2,975 | 4.6× |
| Inj for sacroiliac jt anesth (G0260) | $816.90 | $2,723 | 1.3× |
| Oth resp proc, group (G0239) | $62.40 | $208 | 1.8× |
| Oth resp proc, indiv (G0238) | $48.60 | $162 | 1.9× |
| Perq Sacral Augmt Bilat Inj (0201T) unusually low: confirm this is the full procedure |
$3,207.60 | $10,692 | 0.5× |
| Perq Sacral Augmt Unilat Inj (0200T) likely a partial charge, not the full procedure |
$1,604.10 | $5,347 | 0.2× |
| Perq Tcat Ther Rx Dlvr Ntrac Rx Balo 1 Maj C Art (0913T) unusually low: confirm this is the full procedure |
$4,908.60 | $16,362 | 0.5× |
| Prostate biopsy, any mthd (G0416) | $147 | $490 | 0.5× |
| Psa screening (G0103) | $48 | $160 | 2.5× |
| Revasc intra lithotrip-ather (C9766) | $8,676.60 | $28,922 | 0.5× |
| Revasc intra lithotrip-stent (C9765) unusually low: confirm this is the full procedure |
$6,815.70 | $22,719 | 0.4× |
| Revasc intravasc lithotripsy (C9764) | $5,650.80 | $18,836 | 0.5× |
| Revasc lithotrip-stent-ather (C9767) | $9,810.60 | $32,702 | 0.6× |
| Tcat Rmvl/Debulk Icar Mass Suction Device Perq (0644T) | $3,811.80 | $12,706 | 0.7× |
| Therapeutic procd strg endur (G0237) | $49.50 | $165 | 1.9× |
| Tomosynthesis, mammo (G0279) | $105.75 | $352.50 | 8.3× |
| Trgt gen seq alys sld orgn neo DNA 324 genes (0037U) | $1,138.80 | $3,796 | 0.3× |
| Trluml peripheral atherectomy iliac artery ea (0238T) likely a partial charge, not the full procedure |
$3,667.80 | $12,226 | 0.2× |
| Tte w or w/o fol w/con,stres (C8928) | $797.70 | $2,659 | 1.1× |
| Tte w or wo fol wcon,doppler (C8929) | $1,279.50 | $4,265 | 1.8× |
| Unsched dialysis esrd pt hos (G0257) | $372.90 | $1,243 | 0.6× |