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.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × 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, 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) range across 2 matching MRF lines |
$155.50–$157.25 | $155.50–$157.25 | varies |
| Electrophysiologic eval ccm-d leads at 1st impl (0930T) | $3,033 | $3,033 | 2.6× |
| Electrophysiologic eval ccm-d leads 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) range across 2 matching MRF lines |
$62–$180.25 | $62–$180.25 | varies |
| 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× |
| Ire Abltj 1+Tum Organ Perq (0600T) | $25,335.25 | $25,335.25 | 2.5× |
| 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× |
| Ncntc R-T Fluor Wnd Img 1st (0598T) | $750 | $750 | 3.6× |
| Neuro csf prion prtn qual (0035U) | $885 | $885 | 1.6× |
| Njx platelet plasma (0232T) range across 2 matching MRF lines |
$388.25–$716.75 | $388.25–$716.75 | varies |
| Oth resp proc, group (G0239) range across 2 matching MRF lines |
$188.75–$317.75 | $188.75–$317.75 | varies |
| Oth resp proc, indiv (G0238) range across 2 matching MRF lines |
$229.25–$232.25 | $229.25–$232.25 | varies |
| 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) range across 2 matching MRF lines |
$96.50–$230.25 | $96.50–$230.25 | varies |
| 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) range across 2 matching MRF lines |
$106.50–$174 | $106.50–$174 | varies |
| 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) range across 2 matching MRF lines |
$218.75–$223.75 | $218.75–$223.75 | varies |
| Tomosynthesis, mammo (G0279) | $203.75 | $203.75 | 16.1× |
| Trluml Perip Athrc Iliac Art (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× |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.