Supplies, drugs & other prices at Elliot Hospital
Manchester, NH · every code in this section with a posted price and a Medicare benchmark.
67 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) | $1,651.31 | $4,463 | 2.0× |
| 2d tte w or w/o fol w/con,fu (C8924) | $1,270.58 | $3,434 | 3.4× |
| Adm of soc dtr assess 5-15 m (G0136) | $21.46 | $58 | 0.5× |
| Admin hepatitis b vaccine (G0010) | $63.27 | $171 | 1.3× |
| Admin influenza virus vac (G0008) | $48.84 | $132 | 1.0× |
| Admin pneumococcal vaccine (G0009) | $63.27 | $171 | 1.3× |
| Ca screen;flexi sigmoidscope (G0104) | $957.93 | $2,589 | 1.0× |
| Ca screen;pelvic/breast exam (G0101) | $35.52 | $96 | 0.3× |
| Chemo extend iv infus w/pump (G0498) | $307.47 | $831 | 0.9× |
| Colon ca scrn not hi rsk ind (G0121) | $1,756.39 | $4,747 | 1.8× |
| Colorectal scrn; hi risk ind (G0105) | $1,597.29 | $4,317 | 1.6× |
| Depression screen annual (G0444) | $54.76 | $148 | 1.4× |
| Diab manage trn per indiv (G0108) | $57.54 | $155.50 | 1.0× |
| Diab manage trn ind/group (G0109) | $32.56 | $88 | 2.0× |
| Direct refer hospital observ (G0379) | $130.61 | $353 | 0.2× |
| Drug test def 1-7 classes (G0480) | $110.63 | $299 | 1.0× |
| Drug test def 8-14 classes (G0481) | $129.87 | $351 | 0.8× |
| Ekg tracing for initial prev (G0404) | $52.17 | $141 | 1.7× |
| Elec stim other than wound (G0283) | $48.10 | $130 | 3.8× |
| Hbot, full body chamber, 30m (G0277) | $468.79 | $1,267 | 3.2× |
| Hiv combination assay (G0475) | $96.57 | $261 | 4.0× |
| Hospital outpt clinic visit (G0463) | $56.24 | $152 | 0.4× |
| Hpv combo assay ca screen (G0476) | $118.40 | $320 | 3.4× |
| Initial preventive exam (G0402) | $54.39 | $147 | 0.4× |
| Ire Ablation 1+Tumors per Organ W/Img Gdn Perq (0600T) likely a partial charge, not the full procedure |
$2,948.53 | $7,969 | 0.3× |
| Mnt subs tx for change dx (G0270) | $20.35 | $55 | 0.6× |
| Mra w/o cont, chest (C8910) | $2,363.93 | $6,389 | 9.3× |
| Mra w/o fol w/cont, abd (C8902) | $2,494.54 | $6,742 | 6.7× |
| Mra w/o fol w/cont, chest (C8911) | $2,363.93 | $6,389 | 6.3× |
| Mra w/o fol w/cont, pelvis (C8920) | $2,386.13 | $6,449 | 6.4× |
| Mra, w/o dye, spinal canal (C8932) | $1,362.71 | $3,683 | 5.3× |
| Mra, w/o&w/dye, upper extr (C8936) | $2,154.51 | $5,823 | 5.8× |
| Mri w/o fol w/cont, breast, (C8908) | $2,831.24 | $7,652 | 7.6× |
| Mri w/o fol w/cont, brst, un (C8905) | $1,415.62 | $3,826 | 3.8× |
| Nav srv peer sup 60 min pr m (G0140) | $35.89 | $97 | 0.3× |
| Neuro csf prion prtn qual (0035U) | $145.78 | $394 | 0.3× |
| Njx pltlt plasma w/img harvest/preparation (0232T) | $845.82 | $2,286 | 1.8× |
| Obtaining screen pap smear (Q0091) | $71.41 | $193 | 2.3× |
| Oth resp proc, group (G0239) | $101.01 | $273 | 2.5× |
| Oth resp proc, indiv (G0238) | $82.51 | $223 | 2.7× |
| Pathogen test for platelets (P9100) | $55.50 | $150 | 0.9× |
| Perc d-e cor revasc chro sin (C9607) likely a partial charge, not the full procedure |
$4,948.75 | $13,375 | 0.3× |
| Perc d-e cor revasc t cabg s (C9604) unusually low: confirm this is the full procedure |
$5,384.24 | $14,552 | 0.4× |
| Perc d-e cor stent ather s (C9602) unusually low: confirm this is the full procedure |
$7,912.45 | $21,385 | 0.4× |
| Perc drug-el cor stent sing (C9600) unusually low: confirm this is the full procedure |
$5,384.24 | $14,552 | 0.4× |
| Perq Sacral Augmt Bilat Inj (0201T) | $4,346.02 | $11,746 | 0.6× |
| Perq Sacral Augmt Unilat Inj (0200T) unusually low: confirm this is the full procedure |
$3,747.36 | $10,128 | 0.5× |
| Pin service 60m per month (G0023) | $35.89 | $97 | 0.3× |
| Prolonged iv inf, req pump (C8957) | $339.29 | $917 | 1.5× |
| Prostate biopsy, any mthd (G0416) | $181.30 | $490 | 0.5× |
| Psa screening (G0103) | $85.10 | $230 | 4.4× |
| Rbc DNA hea 35 ag 11 bld grp whl bld cmn allel (0001U) | $354.09 | $957 | 0.5× |
| Revasc intra lithotrip-stent (C9765) unusually low: confirm this is the full procedure |
$8,084.50 | $21,850 | 0.4× |
| Revasc intravasc lithotripsy (C9764) | $8,084.50 | $21,850 | 0.7× |
| Revasc lithotrip-stent-ather (C9767) unusually low: confirm this is the full procedure |
$8,084.50 | $21,850 | 0.4× |
| Scr c/v cyto,thinlayer,rescr (G0145) | $206.46 | $558 | 7.8× |
| Screen cerv/vag thin layer (G0123) | $136.16 | $368 | 6.7× |
| Therapeutic procd strg endur (G0237) | $82.51 | $223 | 2.7× |
| Tomosynthesis, mammo (G0279) | $63.27 | $171 | 5.0× |
| Trauma respons w/hosp criti (G0390) | $3,566.80 | $9,640 | 2.5× |
| Trgt gen seq alys sld orgn neo DNA 324 genes (0037U) | $4,548.41 | $12,293 | 1.3× |
| Trim nail(s) (G0127) | $35.52 | $96 | 0.6× |
| Tte w or w/o contr, cont ecg (C8930) | $1,670.92 | $4,516 | 2.0× |
| Tte w or w/o fol w/cont, com (C8921) | $1,098.16 | $2,968 | 1.3× |
| Tte w or wo fol wcon,doppler (C8929) | $1,250.97 | $3,381 | 1.5× |
| Unsched dialysis esrd pt hos (G0257) | $863.58 | $2,334 | 1.2× |
| Visit to determ ldct elig (G0296) | $35.89 | $97 | 0.3× |