Supplies, drugs & other prices at Sentara Albemarle Medical Center
Elizabeth City, NC · every code in this section with a posted price and a Medicare benchmark.
105 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) | $1,379 | $2,758 | 1.8× |
| 2d tte w or w/o fol w/con,fu (C8924) | $1,059.50 | $2,119 | 3.2× |
| Adm of soc dtr assess 5-15 m (G0136) | $35 | $70 | 1.0× |
| Adm tocilizu covid-19 1st (M0249) | $225 | $450 | 0.5× |
| Adm tocilizu covid-19 2nd (M0250) | $225 | $450 | 0.5× |
| Admin hepatitis b vaccine (G0010) | $47.50 | $95 | 1.1× |
| Admin influenza virus vac (G0008) | $58.50 | $117 | 1.3× |
| Admin pneumococcal vaccine (G0009) | $58.50 | $117 | 1.3× |
| Alcohol/subs interv 15-30mn (G0396) | $36 | $72 | 1.0× |
| Annual alcohol screen 15 min (G0442) | $40.50 | $81 | 1.1× |
| Behavior counsel obesity 15m (G0447) | $40.50 | $81 | 0.4× |
| Blind cor sinus reducer impl (C9783) | $14,042 | $28,084 | 1.3× |
| Blind interatrial shunt ide (C9758) | $30,378 | $60,756 | 1.9× |
| Ca screen;flexi sigmoidscope (G0104) | $1,110 | $2,220 | 1.2× |
| Ca screen;pelvic/breast exam (G0101) | $124 | $248 | 1.3× |
| Catheterize for urine spec (P9612) | $15.50 | $31 | 1.7× |
| Depression screen annual (G0444) | $24 | $48 | 0.7× |
| Diab manage trn per indiv (G0108) | $44 | $88 | 0.8× |
| Diab manage trn ind/group (G0109) | $30 | $60 | 1.9× |
| Direct refer hospital observ (G0379) | $360.50 | $721 | 0.6× |
| Drug test def 1-7 classes (G0480) | $29.50 | $55.50 | 0.3× |
| Ekg tracing for initial prev (G0404) | $75.50 | $151 | 2.7× |
| Elec stim other than wound (G0283) | $81.50 | $163 | 6.4× |
| Ev fempop artl revsc tcat plmt IV st grf & clsr (0505T) | $16,828 | $33,656 | 1.5× |
| Extraction erupted tooth/exr (D7140) | $1,106.50 | $2,213 | 1.8× |
| Fecal blood scrn immunoassay (G0328) | $81.25 | $162.50 | 4.5× |
| Fern test (Q0114) | $25 | $50 | 2.6× |
| Followup eval of foot pt lop (G0246) | $175 | $350 | 1.4× |
| Group mnt 2 or more 30 mins (G0271) | $48.50 | $97 | 2.8× |
| Hbot, full body chamber, 30m (G0277) | $426 | $852 | 3.2× |
| High inten beh couns std 30m (G0445) | $99 | $198 | 1.0× |
| Hiv combination assay (G0475) | $34.50 | $69 | 1.4× |
| Hospital outpt clinic visit (G0463) | $209 | $418 | 1.6× |
| Initial foot exam pt lops (G0245) | $155.50 | $311 | 1.2× |
| Initial preventive exam (G0402) | $233.50 | $467 | 1.8× |
| Inj for sacroiliac jt anesth (G0260) | $1,033.50 | $2,067 | 1.5× |
| Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming,… (0516T) | $14,337 | $28,674 | 1.4× |
| Insertion wrls car stimulator lv pacg compl sys (0515T) | $42,592 | $85,184 | 2.0× |
| Intens cardiac rehab no exer (G0423) | $140.50 | $281 | 1.1× |
| Intens cardiac rehab w/exerc (G0422) | $140.50 | $281 | 1.1× |
| Mnt subs tx for change dx (G0270) | $48.50 | $97 | 1.5× |
| Mra w/cont, abd (C8900) | $1,540.50 | $3,081 | 4.6× |
| Mra w/cont, chest (C8909) | $1,692 | $3,384 | 5.1× |
| Mra w/cont, lwr ext (C8912) | $2,765 | $5,530 | 8.3× |
| Mra w/cont, pelvis (C8918) | $2,633.50 | $5,267 | 7.9× |
| Mra w/o cont, abd (C8901) | $1,480.50 | $2,961 | 6.5× |
| Mra w/o cont, chest (C8910) | $1,495.50 | $2,991 | 6.6× |
| Mra w/o cont, pelvis (C8919) | $2,405.50 | $4,811 | 10.5× |
| Mra w/o fol w/cont, abd (C8902) | $1,797 | $3,594 | 5.4× |
| Mra w/o fol w/cont, chest (C8911) | $1,851 | $3,702 | 5.6× |
| Mra w/o fol w/cont, lwr ext (C8914) | $3,179.50 | $6,359 | 9.5× |
| Mra w/o fol w/cont, pelvis (C8920) | $3,179.50 | $6,359 | 9.5× |
| Mra, w/o&w/dye, spinal canal (C8933) | $2,567 | $5,134 | 7.7× |
| Mra, w/o&w/dye, upper extr (C8936) | $2,567 | $5,134 | 7.7× |
| Mri w/cont, breast, bi (C8906) | $3,873.50 | $7,747 | 11.6× |
| Mri w/cont, breast, uni (C8903) | $3,467.50 | $6,935 | 20.7× |
| Mri w/o fol w/cont, breast, (C8908) | $4,066.50 | $8,133 | 12.2× |
| Mri w/o fol w/cont, brst, un (C8905) | $3,661.50 | $7,323 | 11.0× |
| Neuro csf detcj prion prtn quakg conf conv qual (0035U) | $316 | $632 | 0.6× |
| Obtaining screen pap smear (Q0091) | $31.50 | $63 | 1.1× |
| Off base opioid tx 70min (G2086) | $160.50 | $321 | 0.9× |
| Off base opioid tx, 60 m (G2087) | $160.50 | $321 | 0.9× |
| Onc thyr 10 microrna seq +/- rslt mod hi rsk mal (0018U) | $1,007.50 | $2,015 | 0.3× |
| Oth resp proc, group (G0239) | $48.50 | $97 | 1.4× |
| Oth resp proc, indiv (G0238) | $45.50 | $91 | 1.6× |
| Pathogen test for platelets (P9100) | $36 | $72 | 0.6× |
| Pelvic ring fracture uni/bil (G0413) | $4,014 | $8,028 | 0.6× |
| Perc d-e cor revasc chro sin (C9607) | $11,976 | $23,952 | 0.7× |
| Perc d-e cor revasc t cabg s (C9604) | $11,976 | $23,952 | 1.1× |
| Perc d-e cor stent ather s (C9602) | $15,633 | $31,266 | 0.9× |
| Perc drug-el cor stent sing (C9600) | $17,964.50 | $35,929 | 1.6× |
| Perq Sacral Augmt Bilat Inj (0201T) | $3,503.50 | $7,007 | 0.5× |
| Perq Sacral Augmt Unilat Inj (0200T) | $3,503.50 | $7,007 | 0.5× |
| Pin service 60m per month (G0023) | $109 | $218 | 1.1× |
| Place device/marker, non pro (C9728) | $2,615 | $5,230 | 2.0× |
| Potassium hydroxide preps (Q0112) | $16.50 | $33 | 2.8× |
| Ppps, initial visit (G0438) | $456.50 | $913 | 2.6× |
| Ppps, subseq visit (G0439) | $306 | $612 | 2.2× |
| Prolonged iv inf, req pump (C8957) | $368 | $736 | 1.8× |
| Prostate biopsy, any mthd (G0416) | $438.25 | $876.50 | 1.3× |
| Psa screening (G0103) | $70.50 | $141 | 3.7× |
| Rem imp tooth w mucoper flp (D7210) | $1,106.50 | $2,213 | 0.7× |
| Revasc intra lithotrip-ather (C9766) | $15,976 | $31,952 | 0.9× |
| Revasc intra lithotrip-stent (C9765) | $15,976 | $31,952 | 0.9× |
| Revasc intravasc lithotripsy (C9764) | $7,988 | $15,976 | 0.7× |
| Revasc lith-sten-ath tib/per (C9775) | $32,329 | $64,658 | 1.8× |
| Revasc lithotr-ather tib/per (C9774) | $32,329 | $64,658 | 1.8× |
| Revasc lithotr-stent tib/per (C9773) | $32,329 | $64,658 | 1.8× |
| Revasc lithotrip tibi/perone (C9772) | $23,244 | $46,488 | 2.1× |
| Revasc lithotrip-stent-ather (C9767) | $25,700 | $51,400 | 1.5× |
| Routine footcare pt w lops (G0247) | $146.50 | $293 | 0.8× |
| Scr c/v cyto,thinlayer,rescr (G0145) | $38.50 | $77 | 1.5× |
| Screen cerv/vag thin layer (G0123) | $59 | $118 | 2.9× |
| Screen pap by tech w md supv (P3000) | $42 | $84 | 2.3× |
| Therapeutic procd strg endur (G0237) | $50.50 | $101 | 1.8× |
| Tomosynthesis, mammo (G0279) | $23.50 | $47 | 1.9× |
| Trgt gen seq alys sld orgn neo DNA 324 genes (0037U) | $1,757.50 | $3,515 | 0.5× |
| Trim nail(s) (G0127) | $89.50 | $179 | 1.6× |
| Trluml Perip Athrc Renal Art (0234T) | $9,080 | $18,160 | 0.8× |
| Trluml periph athrc w/rs&i brchiocphl ea vsl (0237T) | $13,218 | $26,436 | 1.2× |
| Trluml peripheral atherectomy iliac artery ea (0238T) | $10,006.50 | $20,013 | 0.6× |
| Tte w or w/o fol w/con,stres (C8928) | $1,705 | $3,410 | 2.3× |
| Tte w or wo fol wcon,doppler (C8929) | $1,641 | $3,282 | 2.2× |
| Unsched dialysis esrd pt hos (G0257) | $935 | $1,870 | 1.4× |
| Wet mounts/ w preparations (Q0111) | $25.50 | $51 | 1.4× |