Supplies, drugs & other prices at FirstHealth Montgomery Memorial Hospital

Troy, NC · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
2019-ncov diagnostic p (U0001) $55.25 $55.25 1.5×
2d tee w or w/o fol w/con,in (C8925) $2,696 $2,696 3.6×
2d tte w or w/o fol w/con,fu (C8924) $1,685.50 $1,685.50 5.1×
Ablation, irreversible electroporation; 1 or more tumors per organ, including imaging guidance, when performed,… (0600T) $25,335.25 $25,335.25 2.5×
Ablation, irreversible electroporation; 1 or more tumors, including fluoroscopic and ultrasound guidance, when… (0601T) $25,335.25 $25,335.25 2.5×
Adm tocilizu covid-19 1st (M0249) $1,324.25 $1,324.25 3.1×
Adm tocilizu covid-19 2nd (M0250) $1,324.25 $1,324.25 3.1×
Admin hepatitis b vaccine (G0010) $47 $47 1.1×
Admin influenza virus vac (G0008) $47 $47 1.1×
Admin pneumococcal vaccine (G0009) $47 $47 1.1×
Chemo extend iv infus w/pump (G0498) $1,096.50 $1,096.50 3.5×
Covid-19 lab test non-cdc (U0002) $82.75 $82.75 1.6×
Diab manage trn per indiv (G0108) $200.50 $200.50 3.6×
Diab manage trn ind/group (G0109) $55.25 $55.25 3.4×
Direct refer hospital observ (G0379) $779 $779 1.4×
Elec stim other than wound (G0283) $156.38 $156.38 12.3×
Ephys eval ccm-d ld 1st impl (0930T) $3,033 $3,033 2.6×
Ephys eval ccm-d ld separate (0931T) $3,033 $3,033 2.6×
Esd endoscopy or colonoscopy (C9779) $9,532 $9,532 2.6×
Hbot, full body chamber, 30m (G0277) $746 $746 5.7×
Hiv combination assay (G0475) $121.12 $121.12 5.0×
Home sleep test/type 3 porta (G0399) $1,280.25 $1,280.25 6.2×
Hospital outpt clinic visit (G0463) $142 $142 1.1×
Inj for sacroiliac jt anesth (G0260) $3,094.25 $3,094.25 4.6×
Insertion perm ccm-d system pulse generator only (0916T) $56,075.25 $56,075.25 2.6×
Insj Perm Ccm-D Sys 1 Transvns Lead Only (0917T) $20,675.25 $20,675.25 2.6×
Insj Perm Ccm-D Sys Dual Transvns Leads Only (0918T) $20,675.25 $20,675.25 2.6×
Insj perm ccm-d sys pg&dual transvns eltrds/lds (0915T) $80,096.75 $80,096.75 2.7×
Insj/Rplc Car Modulj Sys Pls Gen Transvns Eltrd (0408T) $68,590 $68,590 2.3×
Insj/Rplc Cardiac Modulj Sys Pls Generator Only (0409T) $68,590 $68,590 3.2×
Interrog dev eval impl ccm-d system in person (0927T) $93.25 $93.25 2.6×
Mnt subs tx for change dx (G0270) $113.50 $113.50 3.6×
Mra w/cont, abd (C8900) $4,907.75 $4,907.75 14.7×
Mra w/cont, lwr ext (C8912) $9,816 $9,816 29.4×
Mra w/o cont, abd (C8901) $4,423.25 $4,423.25 19.4×
Mra w/o cont, chest (C8910) $3,863.75 $3,863.75 16.9×
Mra w/o cont, lwr ext (C8913) $4,423.25 $4,423.25 19.4×
Mra w/o fol w/cont, abd (C8902) $5,605.25 $5,605.25 16.8×
Mra w/o fol w/cont, chest (C8911) $5,605.25 $5,605.25 16.8×
Mra w/o fol w/cont, lwr ext (C8914) $1,562.25 $1,562.25 4.7×
Mra w/o fol w/cont, pelvis (C8920) $5,605.25 $5,605.25 16.8×
Mra, w/o&w/dye, upper extr (C8936) $5,176.75 $5,176.75 15.5×
Mri w/cont, breast, bi (C8906) $1,027 $1,027 3.1×
Mri w/o fol w/cont, breast, (C8908) $5,605.25 $5,605.25 16.8×
Neuro csf detcj prion prtn quakg conf conv qual (0035U) $885 $885 1.6×
Njx pltlt plasma w/img harvest/preparation (0232T) $552.50 $552.50 1.3×
Oth resp proc, group (G0239) $253.25 $253.25 7.1×
Oth resp proc, indiv (G0238) $230.75 $230.75 8.3×
Pathogen test for platelets (P9100) $162.25 $162.25 2.9×
Perc d-e cor revasc chro sin (C9607) $31,031.75 $31,031.75 1.8×
Perc d-e cor revasc t cabg s (C9604) $26,843.75 $26,843.75 2.4×
Perc d-e cor stent ather s (C9602) $33,750 $33,750 1.9×
Perc drug-el cor stent sing (C9600) $27,500 $27,500 2.5×
Perq Sacral Augmt Bilat Inj (0201T) $18,752.25 $18,752.25 2.7×
Perq Sacral Augmt Unilat Inj (0200T) $18,752.25 $18,752.25 2.7×
Perq Tcat Ther Rx Dlvr Ntrac Rx Balo 1 Maj C Art (0913T) $14,243.50 $14,243.50 1.3×
Place device/marker, non pro (C9728) $1,596.25 $1,596.25 1.2×
Programming device eval impl ccm-d sys in person (0926T) $93.25 $93.25 2.6×
Prolonged iv inf, req pump (C8957) $639 $639 3.1×
Psa screening (G0103) $163.38 $163.38 8.5×
Real-time fluorescence wound imaging with clinical darkness, to identify location of bacterial wound pathogens and… (0598T) $750 $750 3.6×
Relocation skin pocket implanted ccm-d pg (0925T) $4,569.75 $4,569.75 2.3×
Remote interrog dev eval ccm-d sys <90d tech (0929T) $93.25 $93.25 2.6×
Removal perm ccm-d system pulse generator only (0919T) $9,091.75 $9,091.75 2.5×
Repositioning prev impl ccm-d transvns eltrd/ld (0924T) $1,544.50 $1,544.50 2.6×
Revasc intra lithotrip-ather (C9766) $29,583.25 $29,583.25 1.7×
Revasc intra lithotrip-stent (C9765) $38,500 $38,500 2.2×
Revasc intravasc lithotripsy (C9764) $21,129.75 $21,129.75 1.9×
Revasc lithotrip-stent-ather (C9767) $47,591.25 $47,591.25 2.7×
Rmvl Perm Ccm-D Sys 1 Transvns Dfb Lead Only (0921T) $9,091.75 $9,091.75 2.5×
Rmvl perm ccm-d sys 1 transvns pacing lead only (0920T) $9,091.75 $9,091.75 2.5×
Rmvl Perm Ccm-D Sys Dual Transvns Leads Only (0922T) $9,091.75 $9,091.75 2.5×
Rmvl&Rplcmt Permanent Ccm-D Pulse Generator Only (0923T) $56,075.25 $56,075.25 2.6×
Screen cerv/vag thin layer (G0123) $140.25 $140.25 6.9×
Tcat insj perm 1chmbr ldls pacemaker r atrial (0823T) $51,225 $51,225 2.8×
Tcat insj perm 2chmbr ldls pm r atr pm compnt (0796T) $51,225 $51,225 2.8×
Tcat insj perm 2chmbr ldls pm r ventr pm compnt (0797T) $51,225 $51,225 2.8×
Tcat Insj Perm Dual Chamber Ldls Pm Compl Sys (0795T) $51,225 $51,225 2.8×
Tcat rmvl perm 1chmbr ldls pacemaker r atrial (0824T) $8,379 $8,379 2.8×
Tcat rmvl perm 2chmbr ldls pm r atr pm compnt (0799T) $8,379 $8,379 2.8×
Tcat rmvl perm 2chmbr ldls pm r ventr pm compnt (0800T) $8,379 $8,379 2.8×
Tcat rmvl perm dual chamber ldls pm compl sys (0798T) $8,379 $8,379 2.8×
Tcat rmvl&rplcmt perm 1chmbr ldls pm r atrial (0825T) $51,225 $51,225 2.8×
Tcat rmvl&rplcmt perm 2chmbr ldls pm 2chmbr sys (0801T) $51,225 $51,225 2.8×
Tcat rmvl&rplcmt perm 2chmbr ldls pm r atr cmpnt (0802T) $51,225 $51,225 2.8×
Tcat rmvl&rplcmt prm 2chmbr ldls pm r vntr cmpnt (0803T) $51,225 $51,225 2.8×
Therapeutic procd strg endur (G0237) $221.25 $221.25 8.0×
Tomosynthesis, mammo (G0279) $203.75 $203.75 16.1×
Trluml peripheral atherectomy iliac artery ea (0238T) $25,125.75 $25,125.75 1.4×
Tte w or w/o fol w/con,stres (C8928) $4,443.50 $4,443.50 5.9×
Tte w or wo fol wcon,doppler (C8929) $3,030.50 $3,030.50 4.0×
Unsched dialysis esrd pt hos (G0257) $2,024 $2,024 3.1×