Supplies, drugs & other prices at Adventist Health Mendocino Coast
Fort Bragg, CA · every code in this section with a posted price and a Medicare benchmark.
164 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 2d tte w or w/o fol w/con,fu (C8924) | $63.36 | $96 | 0.1× |
| Adm of soc dtr assess 5-15 m (G0136) | $32.34 | $49 | 0.7× |
| Admin hepatitis b vaccine (G0010) | $40.92 | $62 | 0.7× |
| Alveoloplasty not w/extracts (D7321) | $236.28 | $358 | 0.1× |
| Alveoplasty w/ extraction (D7310) | $323.40 | $490 | 0.2× |
| Alveoplasty w/o extraction (D7320) | $605.22 | $917 | 0.3× |
| Amalgam 4 or > surfaces perm (D2161) | $356.40 | $540 | 0.4× |
| Amalgam one surface permanen (D2140) | $148.50 | $225 | 0.2× |
| Amalgam three surfaces perma (D2160) | $240.24 | $364 | 0.3× |
| Amalgam two surfaces permane (D2150) | $178.20 | $270 | 0.2× |
| Annual alcohol screen 15 min (G0442) range across 2 matching MRF lines |
$14.52–$29.70 | $22–$45 | varies |
| Ant resin-based cmpst crown (D2390) | $319.44 | $484 | 0.4× |
| Apicoectomy - anterior (D3410) | $884.40 | $1,340 | 1.1× |
| Ascvd rsk mng clin stf pr mo (G0538) | $26.40 | $40 | 0.2× |
| Behavior counsel obesity 15m (G0447) | $53.46 | $81 | 0.4× |
| Bitewings four images (D0274) | $85.80 | $130 | 0.3× |
| Brief alcohol misuse counsel (G0443) range across 2 matching MRF lines |
$48.84–$53.46 | $74–$81 | varies |
| Brief chkin by md/qhp, 11-20 (G2252) range across 2 matching MRF lines |
$40.92–$42.90 | $62–$65 | varies |
| Brief chkin, 5-10, non-e/m (G2251) range across 2 matching MRF lines |
$20.46–$23.76 | $31–$36 | varies |
| Ca screen;flexi sigmoidscope (G0104) | $92.40 | $140 | 0.1× |
| Ca screen;pelvic/breast exam (G0101) range across 2 matching MRF lines |
$43.56–$64.68 | $66–$98 | varies |
| Catheterize for urine spec (P9612) | $15.18 | $23 | 1.6× |
| Chemo extend iv infus w/pump (G0498) | $301.62 | $457 | 0.7× |
| Colon ca scrn not hi rsk ind (G0121) | $293.70 | $445 | 0.2× |
| Colorectal scrn; hi risk ind (G0105) | $293.70 | $445 | 0.2× |
| Complete occlusal adjustment (D9952) | $709.50 | $1,075 | 0.9× |
| Comprehensve oral evaluation (D0150) | $93.06 | $141 | 0.5× |
| Core build-up incl any pins (D2950) | $329.34 | $499 | 0.4× |
| Crown 3/4 cast base metal (D2781) | $673.20 | $1,020 | 0.8× |
| Crown 3/4 porcelain/ceramic (D2783) | $673.20 | $1,020 | 0.8× |
| Crown 3/4 resin-based compos (D2712) | $297 | $450 | 0.4× |
| Crown full cast base metal (D2791) | $1,084.38 | $1,643 | 1.3× |
| Crown full cast noble metal (D2792) | $1,100.22 | $1,667 | 1.3× |
| Crown lengthen hard tissue (D4249) | $947.10 | $1,435 | 1.1× |
| Crown porcelain fused base m (D2751) | $1,084.38 | $1,643 | 1.3× |
| Crown porcelain w/ h noble m (D2750) | $1,310.76 | $1,986 | 1.6× |
| Crown porcelain w/ noble met (D2752) | $1,133.22 | $1,717 | 1.4× |
| Crown porcelain/ceramic (D2740) | $1,201.20 | $1,820 | 1.4× |
| Crown resin w/ base metal (D2721) | $483.78 | $733 | 0.6× |
| Crown resin-based indirect (D2710) | $297 | $450 | 0.4× |
| Dental bitewing single image (D0270) | $59.40 | $90 | 0.5× |
| Dental bitewings two images (D0272) | $59.40 | $90 | 0.5× |
| Dental prophylaxis adult (D1110) | $116.16 | $176 | 0.7× |
| Dental tomographic survey (D0322) | $296.34 | $449 | 2.2× |
| Dental unspec restorative pr (D2999) | $396.66 | $601 | 0.5× |
| Depression screen annual (G0444) range across 2 matching MRF lines |
$14.52–$29.70 | $22–$45 | varies |
| Diab manage trn per indiv (G0108) | $90.42 | $137 | 1.6× |
| Diab manage trn ind/group (G0109) | $26.40 | $40 | 1.6× |
| Each addtnl prefab post (D2957) | $168.30 | $255 | 0.2× |
| Elec stim other than wound (G0283) | $51.48 | $78 | 4.1× |
| End thxpy, anterior tooth (D3310) | $776.16 | $1,176 | 0.9× |
| End thxpy, molar tooth (D3330) | $1,230.90 | $1,865 | 1.5× |
| End thxpy, premolar tooth (D3320) | $950.40 | $1,440 | 1.1× |
| Endodontic procedure (D3999) | $396.66 | $601 | 0.5× |
| Excision benign lesion>1.25c (D7411) | $560.34 | $849 | 0.3× |
| Exposure of unerupted tooth (D7280) | $377.52 | $572 | 0.5× |
| Extensv oral eval prob focus (D0160) | $137.28 | $208 | 0.8× |
| Extraction coronal remnants (D7111) | $95.04 | $144 | 0.1× |
| Extraction erupted tooth/exr (D7140) | $141.90 | $215 | 0.2× |
| Fecal blood scrn immunoassay (G0328) | $58.08 | $88 | 3.2× |
| Followup eval of foot pt lop (G0246) range across 2 matching MRF lines |
$31.68–$65.34 | $48–$99 | varies |
| Full mouth debridement (D4355) | $192.72 | $292 | 0.2× |
| Gingival flap proc w/ planin (D4240) | $831.60 | $1,260 | 0.2× |
| Gingivectomy/plasty 1 to 3 (D4211) | $403.26 | $611 | 0.1× |
| Gingivectomy/plasty 4 or mor (D4210) | $515.46 | $781 | 0.1× |
| Gngvl flap w rootplan 1-3 th (D4241) | $480.48 | $728 | 0.2× |
| Gross pulpal debridement (D3221) | $201.96 | $306 | 0.2× |
| Hep c screen high risk/other (G0472) | $76.56 | $116 | 1.7× |
| High inten beh couns std 30m (G0445) range across 2 matching MRF lines |
$48.18–$52.80 | $73–$80 | varies |
| I&d absc intraoral soft tiss (D7510) | $259.38 | $393 | 0.3× |
| I&d abscess extraoral (D7520) | $1,172.16 | $1,776 | 1.3× |
| Impact tooth rem bony w/comp (D7241) | $543.84 | $824 | 0.7× |
| Impact tooth remov comp bony (D7240) | $529.98 | $803 | 0.6× |
| Impact tooth remov part bony (D7230) | $452.76 | $686 | 0.5× |
| Impact tooth remov soft tiss (D7220) | $334.62 | $507 | 0.4× |
| Initial foot exam pt lops (G0245) range across 2 matching MRF lines |
$63.36–$106.92 | $96–$162 | varies |
| Initial preventive exam (G0402) range across 2 matching MRF lines |
$211.20–$274.56 | $320–$416 | varies |
| Intens behave ther cardio dx (G0446) range across 2 matching MRF lines |
$48.84–$53.46 | $74–$81 | varies |
| Intentional replantation (D3470) | $422.40 | $640 | 0.5× |
| Intraor comprehensive series (D0210) | $139.26 | $211 | 0.5× |
| Intraoral occlusal film (D0240) | $58.08 | $88 | 0.5× |
| Intraoral periapical first (D0220) | $36.30 | $55 | 0.3× |
| Labial veneer resin direct (D2960) | $817.74 | $1,239 | 1.0× |
| Limit oral eval problm focus (D0140) | $91.08 | $138 | 0.5× |
| Limited occlusal adjustment (D9951) | $135.30 | $205 | 0.2× |
| Mesial/distal wedge proc (D4274) | $619.74 | $939 | 0.7× |
| Mra w/cont, lwr ext (C8912) | $2,383.92 | $3,612 | 5.3× |
| Mra w/o cont, lwr ext (C8913) | $1,928.52 | $2,922 | 6.3× |
| Mra w/o fol w/cont, lwr ext (C8914) | $2,516.58 | $3,813 | 5.6× |
| Mra w/o fol w/cont, pelvis (C8920) | $3,963.30 | $6,005 | 8.8× |
| Njx bone sub matrl into subchondral bone defect (0707T) | $891 | $1,350 | 0.2× |
| Njx platelet plasma (0232T) range across 2 matching MRF lines |
$784.74–$2,236.08 | $1,189–$3,388 | varies |
| Obtaining screen pap smear (Q0091) range across 2 matching MRF lines |
$29.70–$75.90 | $45–$115 | varies |
| Occ guard, hard, full arch (D9944) | $247.50 | $375 | 0.3× |
| Occ guard, soft, full arch (D9945) | $247.50 | $375 | 0.3× |
| Occlusion analysis (D9950) | $237.60 | $360 | 0.3× |
| Onc Merkel Cll Carc Srm Quan (0058U) | $225.31 | $341.38 | 0.7× |
| Oral antral fistula closure (D7260) | $707.52 | $1,072 | 0.9× |
| Osseous surg 1 to 3 teeth (D4261) | $735.24 | $1,114 | 0.2× |
| Osseous surgery 4 or more (D4260) likely a partial charge, not the full procedure |
$1,368.84 | $2,074 | 0.2× |
| Oth resp proc, indiv (G0238) | $110.88 | $168 | 3.0× |
| Panoramic image (D0330) | $137.94 | $209 | 0.4× |
| Perc d-e cor revasc chro sin (C9607) likely a partial charge, not the full procedure |
$963.60 | $1,460 | 0.0× |
| Perc d-e cor revasc t cabg s (C9604) likely a partial charge, not the full procedure |
$495 | $750 | 0.0× |
| Perc d-e cor stent ather s (C9602) likely a partial charge, not the full procedure |
$784.74 | $1,189 | 0.0× |
| Perc drug-el cor stent sing (C9600) likely a partial charge, not the full procedure |
$818.40 | $1,240 | 0.1× |
| Periodic oral evaluation (D0120) | $62.70 | $95 | 0.4× |
| Periodontal maint procedures (D4910) | $144.54 | $219 | 0.2× |
| Periodontal scaling & root (D4341) | $298.98 | $453 | 0.4× |
| Periodontal scaling 1-3teeth (D4342) | $211.86 | $321 | 0.3× |
| Place device/marker, non pro (C9728) | $2,464.44 | $3,734 | 1.4× |
| Place direct restoration (D2940) | $145.20 | $220 | 0.2× |
| Post 1 srfc resinbased cmpst (D2391) | $247.50 | $375 | 0.3× |
| Post 2 srfc resinbased cmpst (D2392) | $227.04 | $344 | 0.3× |
| Post 3 srfc resinbased cmpst (D2393) | $282.48 | $428 | 0.3× |
| Post >=4srfc resinbase cmpst (D2394) | $280.50 | $425 | 0.3× |
| Post and core cast + crown (D2952) | $1,101.54 | $1,669 | 1.3× |
| Ppps, initial visit (G0438) | $273.90 | $415 | 1.6× |
| Ppps, subseq visit (G0439) | $216.48 | $328 | 1.6× |
| Prefab post/core + crown (D2954) | $333.30 | $505 | 0.4× |
| Prefab stnlss steel crown pe (D2931) | $397.32 | $602 | 0.5× |
| Prefab stnlss steel crwn pri (D2930) | $279.18 | $423 | 0.3× |
| Psa screening (G0103) range across 3 matching MRF lines |
$48.84–$150.48 | $74–$228 | varies |
| Pulp cap direct (D3110) | $145.20 | $220 | 0.2× |
| Pulp cap indirect (D3120) | $137.94 | $209 | 0.2× |
| Pulp vitality test (D0460) | $34.98 | $53 | 0.0× |
| Pulpal therapy anterior prim (D3230) | $198.66 | $301 | 0.2× |
| Pulpal therapy posterior pri (D3240) | $217.80 | $330 | 0.3× |
| Rad exc lesion up to 1.25 cm (D7410) | $354.42 | $537 | 0.2× |
| Rbc DNA hea 35 ag 11 bld grp whl bld cmn allel (0001U) | $158.40 | $240 | 0.2× |
| Re-cement or re-bond crown (D2920) | $137.94 | $209 | 0.2× |
| Re-eval,est pt,problem focus (D0170) | $90.42 | $137 | 0.5× |
| Recement inlay onlay or part (D2910) | $66 | $100 | 0.1× |
| Rem exostosis any site (D7471) | $850.08 | $1,288 | 0.2× |
| Rem imp tooth w mucoper flp (D7210) | $245.52 | $372 | 0.1× |
| Rem nonodonto cyst > 1.25 cm (D7461) | $477.18 | $723 | 0.6× |
| Rem nonodonto cyst to 1.25cm (D7460) | $354.42 | $537 | 0.4× |
| Removal of sloughed off bone (D7550) | $249.48 | $378 | 0.3× |
| Remove torus mandibularis (D7473) | $953.70 | $1,445 | 1.1× |
| Resin 4/> surf or w incis an (D2335) | $264.66 | $401 | 0.3× |
| Resin one surface-anterior (D2330) | $247.50 | $375 | 0.3× |
| Resin three surfaces-anterio (D2332) | $336.60 | $510 | 0.4× |
| Resin two surfaces-anterior (D2331) | $310.20 | $470 | 0.4× |
| Retreat root canal anterior (D3346) | $1,034.88 | $1,568 | 1.2× |
| Retreat root canal molar (D3348) | $1,506.78 | $2,283 | 1.8× |
| Retreat root canal premolar (D3347) | $1,217.70 | $1,845 | 1.5× |
| Retrograde filling (D3430) | $270.60 | $410 | 0.3× |
| Risk ascvd tst once pr 12 mo (G0537) | $32.34 | $49 | 0.7× |
| Root surgery molar (D3425) | $925.98 | $1,403 | 1.1× |
| Routine footcare pt w lops (G0247) | $142.56 | $216 | 0.6× |
| Space maintainer fxd unilat (D1510) | $355.08 | $538 | 0.4× |
| Surg reduct osseoustuberosit (D7485) likely a partial charge, not the full procedure |
$438.24 | $664 | 0.1× |
| Surgical splint (D5988) | $343.20 | $520 | 0.4× |
| Therapeutic pulpotomy (D3220) | $184.14 | $279 | 0.2× |
| Tomosynthesis, mammo (G0279) range across 2 matching MRF lines |
$46.20–$178.86 | $70–$271 | varies |
| Tooth pin retention (D2951) | $60.06 | $91 | 0.1× |
| Tooth reimplantation (D7270) | $221.76 | $336 | 0.3× |
| Tooth root removal (D7250) | $286.44 | $434 | 0.3× |
| Treatment of complications (D9930) | $55.44 | $84 | 0.1× |
| Trim nail(s) (G0127) range across 2 matching MRF lines |
$34.32–$504.24 | $52–$764 | varies |
| Tte w or wo fol wcon,doppler (C8929) | $176.88 | $268 | 0.2× |
| Vestibuloplasty ridge extens (D7340) likely a partial charge, not the full procedure |
$811.14 | $1,229 | 0.1× |
| Visit to determ ldct elig (G0296) range across 2 matching MRF lines |
$40.92–$73.26 | $62–$111 | varies |
| Wet mounts/ w preparations (Q0111) | $29.70 | $45 | 1.6× |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.