Supplies, drugs & other prices at Frisbie Memorial Hospital
Rochester, NH · every code in this section with a posted price and a Medicare benchmark.
48 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) | $3,665.50 | $3,665.50 | 4.4× |
| 2d tte w or w/o fol w/con,co (C8923) | $3,882 | $3,882 | 4.6× |
| 2d tte w or w/o fol w/con,fu (C8924) | $1,901 | $1,901 | 5.1× |
| Admin hepatitis b vaccine (G0010) | $136.50 | $136.50 | 2.7× |
| Admin influenza virus vac (G0008) | $192.50 | $192.50 | 3.9× |
| Admin pneumococcal vaccine (G0009) | $168 | $168 | 3.4× |
| Alcohol/subs interv 15-30mn (G0396) | $174 | $174 | 4.3× |
| Alcohol/subs interv >30 min (G0397) | $887 | $887 | 4.7× |
| Ca screen;pelvic/breast exam (G0101) | $78.50 | $78.50 | 0.7× |
| Chemo extend iv infus w/pump (G0498) | $1,828 | $1,828 | 5.2× |
| Covid-19 lab test non-cdc (U0002) | $118 | $118 | 2.3× |
| Diab manage trn per indiv (G0108) | $103 | $103 | 1.8× |
| Direct refer hospital observ (G0379) | $4,153 | $4,153 | 6.5× |
| Drug test def 1-7 classes (G0480) | $559 | $559 | 4.9× |
| Drug test def 15-21 classes (G0482) | $1,087 | $1,087 | 5.5× |
| Drug test def 22+ classes (G0483) | $1,528 | $1,528 | 6.2× |
| Drug test def 8-14 classes (G0481) | $856 | $856 | 5.5× |
| Ekg tracing for initial prev (G0404) | $25 | $25 | 0.8× |
| Elec stim other than wound (G0283) | $213 | $213 | 16.8× |
| Elec stim unattend for press (G0281) | $213 | $213 | 18.2× |
| Hbot, full body chamber, 30m (G0277) | $1,163 | $1,163 | 7.9× |
| Hiv combination assay (G0475) | $258 | $258 | 10.7× |
| Home sleep test/type 3 porta (G0399) | $526 | $526 | 2.3× |
| Initial preventive exam (G0402) | $194 | $194 | 1.4× |
| Mra w/cont, abd (C8900) | $3,021 | $3,021 | 8.1× |
| Mra w/cont, chest (C8909) | $3,021 | $3,021 | 8.1× |
| Mra w/cont, pelvis (C8918) | $1,834 | $1,834 | 4.9× |
| Mra w/o cont, abd (C8901) | $2,938 | $2,938 | 11.5× |
| Mra w/o cont, chest (C8910) | $2,938 | $2,938 | 11.5× |
| Mra w/o cont, pelvis (C8919) | $5,270 | $5,270 | 20.7× |
| Mra w/o fol w/cont, abd (C8902) | $6,569 | $6,569 | 17.6× |
| Mra w/o fol w/cont, chest (C8911) | $3,504 | $3,504 | 9.4× |
| Mra w/o fol w/cont, pelvis (C8920) | $5,270 | $5,270 | 14.1× |
| Mra, w/dye, spinal canal (C8931) | $1,834 | $1,834 | 4.9× |
| Mra, w/o dye, spinal canal (C8932) | $1,200 | $1,200 | 4.7× |
| Mra, w/o&w/dye, spinal canal (C8933) | $6,247 | $6,247 | 16.8× |
| Mri w/o fol w/cont, breast, (C8908) | $6,509 | $6,509 | 17.5× |
| Mri w/o fol w/cont, brst, un (C8905) | $2,385 | $2,385 | 6.4× |
| Obtaining screen pap smear (Q0091) | $69 | $69 | 2.2× |
| Pathogen test for platelets (P9100) | $593 | $593 | 9.4× |
| Psa screening (G0103) | $249 | $249 | 12.9× |
| Tee w or w/o fol w/cont,cong (C8926) | $3,950.50 | $3,950.50 | 4.7× |
| Tomosynthesis, mammo (G0279) | $55 | $55 | 4.3× |
| Tte w or w/o contr, cont ecg (C8930) | $3,882 | $3,882 | 4.6× |
| Tte w or w/o fol w/cont, com (C8921) | $3,882 | $3,882 | 4.6× |
| Tte w or w/o fol w/cont, f/u (C8922) | $3,882 | $3,882 | 4.6× |
| Tte w or wo fol wcon,doppler (C8929) | $4,409 | $4,409 | 5.3× |
| Unsched dialysis esrd pt hos (G0257) | $3,165.50 | $3,165.50 | 4.3× |