Supplies, drugs & other prices at West Holt Memorial Hospital
Atkinson, NE · every code in this section with a posted price and a Medicare benchmark.
19 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|---|---|---|
| 2d tte w or w/o fol w/con,fu (C8924) | $1,702 | $2,128 | 4.7× |
| Admin influenza virus vac (G0008) | $38.50 | $48 | 0.8× |
| Admin pneumococcal vaccine (G0009) | $38.50 | $48 | 0.8× |
| Ca screen;pelvic/breast exam (G0101) | $85 | $106 | 0.8× |
| Demonstrate use home inr mon (G0248) | $220 | $275 | 1.6× |
| Direct refer hospital observ (G0379) | $569 | $711 | 0.9× |
| Hepb screen high risk indiv (G0499) | $82 | $102 | 2.9× |
| Initial preventive exam (G0402) | $187 | $234 | 1.4× |
| Jak2 Gene Analysis Trgt Seq Alys Exons 12-15 (0027U) | $357 | $446 | 2.9× |
| Obtaining screen pap smear (Q0091) | $20 | $25 | 0.7× |
| Oth resp proc, indiv (G0238) | $64 | $80 | 2.1× |
| Ppps, initial visit (G0438) | $223 | $279 | 1.3× |
| Ppps, subseq visit (G0439) | $223 | $279 | 1.6× |
| Psa screening (G0103) | $131 | $164 | 6.8× |
| Tomosynthesis, mammo (G0279) | $109 | $136 | 8.6× |
| Trim nail(s) (G0127) | $14 | $18 | 0.2× |
| Tte w or w/o contr, cont ecg (C8930) | $2,145 | $2,681 | 2.6× |
| Tte w or w/o fol w/con,stres (C8928) | $1,806 | $2,257 | 2.2× |
| Tte w or wo fol wcon,doppler (C8929) | $2,752 | $3,440 | 3.4× |