Memorial Hospital
1900 State St
Chester, IL 62233
Critical Access Hospitals
Overview
- CCN141338
Procedures & prices
- MANNITOL INJECTIONJ2150$11cashGross $130 payers
- INJ CEFTAZIDIME PER 500 MGJ0713$11cashGross $140 payers
- PHENYTOIN SODIUM INJECTIONJ1165$12cashGross $150 payers
- Lead wires, pairA4557$13cashGross $160 payers
- CEFOXITIN SODIUM INJECTIONJ0694$14cashGross $180 payers
- PROMETHAZINE HCL 12.5MG ORALQ0169$15cashGross $180 payers
- AMINOPHYLLIN 250 MG INJJ0280$15cashGross $180 payers
- HALOPERIDOL INJECTIONJ1630$15cashGross $180 payers
- DIGOXIN INJECTIONJ1160$15cashGross $190 payers
- HC COOMBS TEST, INDIRECT, QUAL86885$15cashGross $190 payers
| Procedure | Code | Cash↑ | Gross | Negotiated range | Payers |
|---|---|---|---|---|---|
| MANNITOL INJECTION | J2150 | $11 | $13 | — | 0 |
| INJ CEFTAZIDIME PER 500 MG | J0713 | $11 | $14 | — | 0 |
| PHENYTOIN SODIUM INJECTION | J1165 | $12 | $15 | — | 0 |
| Lead wires, pair | A4557 | $13 | $16 | — | 0 |
| CEFOXITIN SODIUM INJECTION | J0694 | $14 | $18 | — | 0 |
| PROMETHAZINE HCL 12.5MG ORAL | Q0169 | $15 | $18 | — | 0 |
| AMINOPHYLLIN 250 MG INJ | J0280 | $15 | $18 | — | 0 |
| HALOPERIDOL INJECTION | J1630 | $15 | $18 | — | 0 |
| DIGOXIN INJECTION | J1160 | $15 | $19 | — | 0 |
| HC COOMBS TEST, INDIRECT, QUAL | 86885 | $15 | $19 | — | 0 |
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