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Charges for Healthcare Services
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Please Note...
When comparing charges with other hospitals or provider practices, it is important to understand that their charges may or may not include both the hospital and the doctor or other provider services. Average charges are estimates; your out-of-pocket expense will depend on your individual insurance coverage (such as co-pays, co-insurance, and deductibles). If you have any questions, please contact our Business Office at 603-747-9220. If you have questions about your insurance policy, please contact your insurance company directly.
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The services you receive from your provider are based on your individual needs and medical conditions. Actual charges will vary based on services delivered and medical condition. Your doctor or provider in order to treat, diagnose, and / or care for individual needs may order additional tests or services not listed in the estimate.
The estimates provided are only related to your hospital bill. Your personal physician or other physicians providing you with services related to your hospital stay or visit will bill you separately. This can include fees related to specialists, anesthesiologists, pathologists, and radiologists.
Independent laboratory and radiology services will also bill you separately for reading and interpreting EKG's, X-rays, EEG's and lab work. If you have questions about those bills, please call the number printed on their statements.
The data was extracted from the most recent calendar year to determine pricing on our most common procedures for both outpatients and inpatients. If the hospital does not perform a service, "N/A" will appear in the pricing range. These estimates of charges are valid between October 1, 2009 and September 30, 2010.
Top Outpatient Procedures
| CPT4 Code | Code Description | Charge |
| 19120 | EXCIS BREAST LESION OPEN | $6650.00 |
| 29826 | ARTHROSCOPY SHOULDER DECOM | $10600.00 |
| 43239 | UPPER GI ENDOSCOPY, BIOPSY | $6200.00 |
| 45378 | DIAGNOSTIC COLONOSCOPY - FACILITY | $2200.00 |
| 45378 | DIAGNOSTIC COLONOSCOPY - PRO FEE | $800.00 |
| 47562 | LAPAROSCOPIC CHOLECYSTECTOMY | $12000.00 |
| 49505 | REPAIR INITIAL INGUINAL HERNIA >=5 YRS OLD | $6200.00 |
| 50590 | LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE | $9700.00 |
| 92506 | SPEECH THERAPY - EVALUATION | $397.00 |
| 92507 | SPEECH THERAPY - RE-EVALUATION | $414.00 |
| 93005 | EKG - TRACING ONLY | $157.00 |
| 93307 | ECHO - W/OUT COLOR OR DOPPLER | $765.00 |
| 93320 | ECHO - DOPPLER | $350.00 |
| 93325 | ECHO - DOPPLER COLOR FLOW MAPPING | $293.00 |
| 95819 | EEG - AWAKE AND ASLEEP | $525.00 |
| 97001 | PHYSICAL THERAPY - EVALUATION | $287.00 |
| 97110 | PHYSICAL THERAPY - THERAPEUTIC EXERCISES | $95.00 |
| 97002 | PHYSICAL THERAPY - RE-EVALUATION | $117.00 |
| 97003 | OCCUPATIONAL THERAPY - EVALUATION | $287.00 |
| 97004 | OCCUPATIONAL THERAPY - RE-EVALUATION | $117.00 |
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Top Outpatient Ancillary Procedures
| CPT4 Code | Code Description | Charge |
| Radiology |
| 59020 | FETAL STRESS TEST - DELIVERY STRESS TEST | $273.00 |
| 59025 | FETAL STRESS TEST - DELIVERY NON-STRESS TEST | $224.00 |
| 70450 | CT BRAIN - W/OUT CONTRAST | $1671.00 |
| 70486 | CT SINUSES-LTD - W/OUT CONTRAST | $1671.00 |
| 70551 | MRI BRAIN - W/OUT CONTRAST | $2610.00 |
| 71020 | CHEST X -RAY (PA - LAT) | $303.00 |
| 72100 | SPINE X-RAY (LUMBAR PA-LAT) | $303.00 |
| 72141 | MRI CERVICAL SPINE- W/OUT CONTRAST | $2451.00 |
| 72193 | CT PELVIS - W/CONTRAST | $2101.00 |
| 73610 | ANKLE X-RAY (3+ Views) | $350.00 |
| 73630 | FOOT X-RAY (3+ views) | $303.00 |
| 74160 | CT ABDOMEN ONLY W/CONTRAST | $2101.00 |
| 76075 | DEXA SCAN (Axial Skeleton) | $891.00 |
| 76645 | ULTRASOUND BREAST | $512.00 |
| 76700 | ABDOMEN COMPLETE | $875.00 |
| 76805 | PREGNANCY US- AFTER 1 TRIMESTER | $608.00 |
| 76815 | PREGNANCY US - AFTER 1ST TRIMESTER - LIMITED | $428.00 |
| 76830 | VAGINAL ULTRASOUND - NON OBGYN (NON PREGNANCY) | $276.00 |
| 76856 | PELVIC ULTRASOUND - NON OBGYN ( NON PREGNANCY) | $345.00 |
| 77057 | SCREENING MAMMOGRAM | $208.00 |
| 93017 | STRESS TEST - CARDIO | $281.00 |
| Laboratory |
| 36415 | ROUTINE VENIPUNCTURE | $18.00 |
| 80048 | BASIC METABOLIC PANEL | $120.00 |
| 80053 | COMPREHEN METABOLIC PANEL | $208.00 |
| 80061 | LIPID PANEL | $121.00 |
| 83036 | GLYCOSYLATED HEMOGLOBIN TEST | $125.00 |
| 84153 | ASSAY OF PSA, TOTAL | $117.00 |
| 84443 | ASSAY THYROID STIM HORMONE (TSH) | $169.00 |
| 85025 | COMPLETE CBC W/AUTO DIFF WBC | $58.00 |
| 85610 | PROTHROMBIN TIME | $54.00 |
| 87086 | URINE CULTURE/COLONY COUNT | $51.00 |
| 88142 | PAP SMEAR THIN/CYTO PATH | $89.00 |
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