Supplies, drugs & other prices at Saline Memorial Hospital

Benton, AR · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Adm tocilizu covid-19 1st (M0249) $2,487.28
Adm tocilizu covid-19 2nd (M0250) $2,238.58
Admin influenza virus vac (G0008) $175.76
Admin pneumococcal vaccine (G0009) $175.76
Catheterize for urine spec (P9612) $13.28
Colon ca scrn not hi rsk ind (G0121) $4,811.74
Colorectal scrn; hi risk ind (G0105) $4,998.11
Direct refer hospital observ (G0379) $2,434.23
Egd flexible transnasal w/biopsy single/multiple (0653T) $10,667.40
Fecal microbiota prep instil (G0455) $3,229.86
Group mnt 2 or more 30 mins (G0271) $63.17
Hbot, full body chamber, 30m (G0277) $926.94
Home sleep test/type 2 porta (G0398) $3,289.85
Injection(s), bone substitute material (eg, calcium phosphate) into subchondral bone defect (ie, bone marrow lesion,… (0707T) $45,215.04
Instlj fecal microbiota ssp (0780T) $3,229.86
Liver dis 10 assays w/nash (0003M) $1,901.28
Mnt subs tx for change dx (G0270) $112.77
Mra w/cont, pelvis (C8918) $1,747.74
Mra w/o cont, pelvis (C8919) $1,371.33
Mra w/o fol w/cont, lwr ext (C8914) $5,531.71
Mra w/o fol w/cont, pelvis (C8920) $2,134.09
Mra, w/dye, upper extremity (C8934) $3,639.74
Mra, w/o dye, upper extr (C8935) $2,911.79
Mra, w/o&w/dye, upper extr (C8936) $4,550.06
Perc d-e cor revasc chro sin (C9607) $57,084.80
Perc d-e cor revasc t cabg s (C9604) $37,279.38
Perc d-e cor stent ather s (C9602) $71,126.34
Perc drug-el cor stent sing (C9600) $61,649.20
Prostate biopsy, any mthd (G0416) $1,297.87
Psa screening (G0103) $213.90
Revasc intravasc lithotripsy (C9764) $40,727.53
Tomosynthesis, mammo (G0279) $112.77
Trauma respons w/hosp criti (G0390) $4,490.37
Trluml Perip Athrc Renal Art (0234T) $44,789.33
Trluml peripheral atherectomy iliac artery ea (0238T) $71,126.34
Tte w or wo fol wcon,doppler (C8929) $3,213.18
Unsched dialysis esrd pt hos (G0257) $2,994.70