Supplies, drugs & other prices at Concord Hospital – Laconia
Laconia, NH · every code in this section with a posted price and a Medicare benchmark.
133 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) | $727.80 | $2,426 | 0.9× |
| Ablation of benign prostate tissue, transrectal, with high intensity-focused ultrasound (HIFU), including ultrasound… (0950T) likely a partial charge, not the full procedure |
$1,117.80 | $3,726 | 0.1× |
| Admin hepatitis b vaccine (G0010) | $6.60 | $22 | 0.1× |
| Admin influenza virus vac (G0008) | $6.60 | $22 | 0.1× |
| Admin pneumococcal vaccine (G0009) | $8.40 | $28 | 0.2× |
| Alcohol/subs interv 15-30mn (G0396) | $37.50 | $125 | 0.9× |
| Alcohol/subs interv >30 min (G0397) | $75 | $250 | 0.4× |
| Alveoplasty w/ extraction (D7310) | $9.30 | $31 | 0.0× |
| Amalgam 4 or > surfaces perm (D2161) | $45.90 | $153 | 0.1× |
| Amalgam one surface permanen (D2140) | $33.90 | $113 | 0.0× |
| Amalgam three surfaces perma (D2160) | $44.70 | $149 | 0.1× |
| Amalgam two surfaces permane (D2150) | $39 | $130 | 0.1× |
| Annual alcohol screen 15 min (G0442) | $10.80 | $36 | 0.3× |
| Arthro/shoul surg; w/spacer (C9781) | $13,343.40 | $44,478 | 1.0× |
| Behavior counsel obesity 15m (G0447) | $27.90 | $93 | 0.3× |
| Bitewings four images (D0274) | $11.10 | $37 | 0.0× |
| Brief alcohol misuse counsel (G0443) | $24.60 | $82 | 0.2× |
| Brief chkin by md/qhp, 11-20 (G2252) | $31.50 | $105 | 1.1× |
| Ca screen;flexi sigmoidscope (G0104) | $2,763.30 | $9,211 | 2.8× |
| Ca screen;pelvic/breast exam (G0101) | $49.80 | $166 | 0.5× |
| Cardiokymography (Q0035) | $10.80 | $36 | 0.3× |
| Colon ca scrn not hi rsk ind (G0121) | $2,476.20 | $8,254 | 2.5× |
| Colorectal scrn; hi risk ind (G0105) | $2,458.20 | $8,194 | 2.5× |
| Core build-up incl any pins (D2950) | $28.50 | $95 | 0.0× |
| Cysto impl 4 or more (C9740) | $7,620.60 | $25,402 | 0.8× |
| Dental bitewing single image (D0270) | $2.40 | $8 | 0.0× |
| Dental bitewings two images (D0272) | $9.30 | $31 | 0.1× |
| Dental prophylaxis adult (D1110) | $18.60 | $62 | 0.1× |
| Depression screen annual (G0444) | $11.40 | $38 | 0.3× |
| Dermal filler injection(s) (G0429) | $75 | $250 | 0.0× |
| Diab manage trn per indiv (G0108) | $61.20 | $204 | 1.1× |
| Diab manage trn ind/group (G0109) | $24.30 | $81 | 1.5× |
| Direct refer hospital observ (G0379) | $85.20 | $284 | 0.1× |
| Drug test def 1-7 classes (G0480) | $49.50 | $165 | 0.4× |
| Drug test def 15-21 classes (G0482) | $94.05 | $313.50 | 0.5× |
| Drug test def 22+ classes (G0483) | $158.10 | $527 | 0.6× |
| Ed svc ckd grp per session (G0421) | $31.80 | $106 | 1.2× |
| Ed svc ckd ind per session (G0420) | $133.80 | $446 | 1.2× |
| Egd flexible transnasal w/insj intral tube/cath (0654T) | $55.80 | $186 | 0.0× |
| Ekg tracing for initial prev (G0404) | $110.40 | $368 | 3.6× |
| Elec stim other than wound (G0283) | $57.60 | $192 | 4.5× |
| Elec stim unattend for press (G0281) | $11.40 | $38 | 1.0× |
| Electromagntic tx for ulcers (G0329) | $3.90 | $13 | 0.4× |
| Extensv oral eval prob focus (D0160) | $20.70 | $69 | 0.1× |
| Extraction erupted tooth/exr (D7140) | $41.70 | $139 | 0.1× |
| Extrnl counterpulse, per tx (G0166) | $126.90 | $423 | 0.9× |
| Fecal microbiota prep instil (G0455) | $84.60 | $282 | 0.1× |
| Fern test (Q0114) | $30.90 | $103 | 3.2× |
| Followup eval of foot pt lop (G0246) | $27.90 | $93 | 0.2× |
| Full mouth debridement (D4355) | $31.50 | $105 | 0.0× |
| Glaucoma scrn hgh risk direc (G0118) | $10.80 | $36 | 0.3× |
| Glaucoma scrn hgh risk direc (G0117) | $27.90 | $93 | 0.9× |
| Group behave couns 2-10 (G0473) | $13.80 | $46 | 0.3× |
| Group mnt 2 or more 30 mins (G0271) | $28.80 | $96 | 1.7× |
| High inten beh couns std 30m (G0445) | $27.90 | $93 | 0.3× |
| Hospital outpt clinic visit (G0463) | $28.80 | $96 | 0.2× |
| I&d absc intraoral soft tiss (D7510) | $41.10 | $137 | 0.1× |
| Iliac Atherectomy (0238T) likely a partial charge, not the full procedure |
$1,092.30 | $3,641 | 0.1× |
| Impact tooth rem bony w/comp (D7241) | $78.90 | $263 | 0.1× |
| Initial foot exam pt lops (G0245) | $55.50 | $185 | 0.4× |
| Initial preventive exam (G0402) | $153 | $510 | 1.1× |
| Insert drug del implant, >=4 (G0516) | $114.90 | $383 | 0.2× |
| Insertion of substernal implantable defibrillator electrode (0572T) likely a partial charge, not the full procedure |
$472.80 | $1,576 | 0.1× |
| Insj/Rplcmt Icds W/Substernal Electrode (0571T) likely a partial charge, not the full procedure |
$472.80 | $1,576 | 0.0× |
| Instlj fecal microbiota ssp (0780T) | $111.60 | $372 | 0.8× |
| Intens behave ther cardio dx (G0446) | $27.90 | $93 | 0.7× |
| Intens cardiac rehab no exer (G0423) | $104.40 | $348 | 0.8× |
| Intens cardiac rehab w/exerc (G0422) | $104.40 | $348 | 0.8× |
| Interrogation device evaluation (in person) of implantable cardioverter-defibrillator system with substernal electrode,… (0576T) | $144 | $480 | 3.6× |
| Intraor comprehensive series (D0210) | $20.40 | $68 | 0.1× |
| Intraoral periapical first (D0220) | $2.40 | $8 | 0.0× |
| Limit oral eval problm focus (D0140) | $15.90 | $53 | 0.1× |
| Limited occlusal adjustment (D9951) | $12.90 | $43 | 0.0× |
| Mnt subs tx for change dx (G0270) | $30.90 | $103 | 1.0× |
| Mra w/cont, chest (C8909) | $1,136.70 | $3,789 | 3.1× |
| Mra w/cont, lwr ext (C8912) | $1,137.60 | $3,792 | 3.1× |
| Mra w/o cont, abd (C8901) | $1,188 | $3,960 | 4.7× |
| Mra w/o cont, lwr ext (C8913) | $1,137.60 | $3,792 | 4.5× |
| Mra w/o fol w/cont, lwr ext (C8914) | $1,137.60 | $3,792 | 3.1× |
| Mra, w/dye, spinal canal (C8931) | $2,200.80 | $7,336 | 5.9× |
| Mra, w/o dye, spinal canal (C8932) | $1,900.20 | $6,334 | 7.5× |
| Mra, w/o&w/dye, spinal canal (C8933) | $2,501.40 | $8,338 | 6.7× |
| Neuro csf prion prtn qual (0035U) | $490.80 | $1,636 | 0.9× |
| Obtaining screen pap smear (Q0091) | $29.85 | $99.50 | 1.0× |
| Occ guard, hard, full arch (D9944) | $38.70 | $129 | 0.1× |
| Occ guard, hard, part arch (D9946) | $38.70 | $129 | 0.1× |
| Occ guard, soft, full arch (D9945) | $38.70 | $129 | 0.1× |
| Open tx iliac spine uni/bil (G0412) likely a partial charge, not the full procedure |
$658.50 | $2,195 | 0.1× |
| Open tx post pelvic fxcture (G0415) | $1,318.80 | $4,396 | 0.4× |
| Oth resp proc, group (G0239) | $40.05 | $133.50 | 1.0× |
| Oth resp proc, indiv (G0238) | $36.90 | $123 | 1.2× |
| Pattern erg w/i&r (0509T) | $24.60 | $82 | 0.1× |
| Pelvic ring fracture uni/bil (G0413) likely a partial charge, not the full procedure |
$991.50 | $3,305 | 0.1× |
| Pelvic ring fx treat int fix (G0414) likely a partial charge, not the full procedure |
$923.70 | $3,079 | 0.1× |
| Periodic oral evaluation (D0120) | $10.50 | $35 | 0.1× |
| Perq tcat ther rx dlvr ntrac rx balo 1 maj c art (0913T) likely a partial charge, not the full procedure |
$621 | $2,070 | 0.1× |
| Pild/placebo control clin tr (G0276) likely a partial charge, not the full procedure |
$452.10 | $1,507 | 0.1× |
| Place direct restoration (D2940) | $19.20 | $64 | 0.0× |
| Post 1 srfc resinbased cmpst (D2391) | $33.90 | $113 | 0.0× |
| Post 2 srfc resinbased cmpst (D2392) | $39 | $130 | 0.1× |
| Post 3 srfc resinbased cmpst (D2393) | $44.70 | $149 | 0.1× |
| Post >=4srfc resinbase cmpst (D2394) | $45.90 | $153 | 0.1× |
| Ppps, initial visit (G0438) | $139.80 | $466 | 0.8× |
| Ppps, subseq visit (G0439) | $85.80 | $286 | 0.6× |
| Prgrmg dev eval ldls pm single car chamber ip (0826T) | $52.80 | $176 | 1.3× |
| Programming device evaluation (in person) of implantable cardioverter-defibrillator system with substernal electrode,… (0575T) | $167.85 | $559.50 | 4.2× |
| Prostate biopsy, any mthd (G0416) | $121.65 | $405.50 | 0.3× |
| Psa screening (G0103) | $67.50 | $225 | 3.5× |
| Pulp cap direct (D3110) | $6.30 | $21 | 0.0× |
| Pulp cap indirect (D3120) | $7.80 | $26 | 0.0× |
| Re-cement or re-bond crown (D2920) | $6.60 | $22 | 0.0× |
| Rem imp tooth w mucoper flp (D7210) | $43.80 | $146 | 0.0× |
| Removal of substernal implantable defibrillator electrode (0573T) | $341.40 | $1,138 | 0.1× |
| Remove drug implant (G0517) | $132.30 | $441 | 0.3× |
| Remove w insert drug implant (G0518) | $223.80 | $746 | 0.5× |
| Repos prev impl ss impltbl dfb pacing eltrd (0574T) | $409.20 | $1,364 | 0.1× |
| Resin 4/> surf or w incis an (D2335) | $45.60 | $152 | 0.1× |
| Resin one surface-anterior (D2330) | $31.50 | $105 | 0.0× |
| Resin three surfaces-anterio (D2332) | $42.30 | $141 | 0.1× |
| Resin two surfaces-anterior (D2331) | $34.80 | $116 | 0.1× |
| Rmvl Substernal Impltbl Dfb Pulse Generator Only (0580T) | $341.40 | $1,138 | 0.1× |
| Routine footcare pt w lops (G0247) | $31.80 | $106 | 0.1× |
| Scr c/v cyto,thinlayer,rescr (G0145) | $17.40 | $58 | 0.7× |
| Single energy x-ray study (G0130) | $13.20 | $44 | 0.1× |
| Tcat Rmvl/Debulk Icar Mass Suction Device Perq (0644T) likely a partial charge, not the full procedure |
$530.10 | $1,767 | 0.1× |
| Therapeutic procd strg endur (G0237) | $36.90 | $123 | 1.2× |
| Tomosynthesis, mammo (G0279) | $37.80 | $126 | 3.0× |
| Tooth root removal (D7250) | $52.20 | $174 | 0.1× |
| Trim nail(s) (G0127) | $10.80 | $36 | 0.2× |
| Trluml periph athrc w/rs&i brchiocphl ea vsl (0237T) likely a partial charge, not the full procedure |
$644.70 | $2,149 | 0.1× |
| Tte w or w/o contr, cont ecg (C8930) | $1,162.80 | $3,876 | 1.4× |
| Tte w or wo fol wcon,doppler (C8929) | $1,134 | $3,780 | 1.4× |
| Visit to determ ldct elig (G0296) | $32.25 | $107.50 | 0.3× |