Supplies, drugs & other prices at Adventist Health Tehachapi Valley
Tehachapi, CA · every code in this section with a posted price and a Medicare benchmark.
165 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) | $25.92 | $96 | 0.1× |
| Adm of soc dtr assess 5-15 m (G0136) | $13.23 | $49 | 0.3× |
| Admin hepatitis b vaccine (G0010) | $16.74 | $62 | 0.3× |
| Alveoloplasty not w/extracts (D7321) | $96.66 | $358 | 0.0× |
| Alveoplasty w/ extraction (D7310) | $132.30 | $490 | 0.1× |
| Alveoplasty w/o extraction (D7320) | $247.59 | $917 | 0.1× |
| Amalgam 4 or > surfaces perm (D2161) | $145.80 | $540 | 0.2× |
| Amalgam one surface permanen (D2140) | $60.75 | $225 | 0.1× |
| Amalgam three surfaces perma (D2160) | $98.28 | $364 | 0.1× |
| Amalgam two surfaces permane (D2150) | $72.90 | $270 | 0.1× |
| Annual alcohol screen 15 min (G0442) range across 2 matching MRF lines |
$5.94–$12.15 | $22–$45 | varies |
| Ant resin-based cmpst crown (D2390) | $130.68 | $484 | 0.2× |
| Apicoectomy - anterior (D3410) | $361.80 | $1,340 | 0.4× |
| Ascvd rsk mng clin stf pr mo (G0538) | $10.80 | $40 | 0.1× |
| Behavior counsel obesity 15m (G0447) | $21.87 | $81 | 0.2× |
| Bitewings four images (D0274) | $35.10 | $130 | 0.1× |
| Brief alcohol misuse counsel (G0443) range across 2 matching MRF lines |
$19.98–$21.87 | $74–$81 | varies |
| Brief chkin by md/qhp, 11-20 (G2252) range across 2 matching MRF lines |
$16.74–$17.55 | $62–$65 | varies |
| Brief chkin, 5-10, non-e/m (G2251) range across 2 matching MRF lines |
$8.37–$9.72 | $31–$36 | varies |
| Ca screen;flexi sigmoidscope (G0104) | $37.80 | $140 | 0.0× |
| Ca screen;pelvic/breast exam (G0101) range across 2 matching MRF lines |
$17.82–$26.46 | $66–$98 | varies |
| Catheterize for urine spec (P9612) | $111.51 | $413 | 11.9× |
| Colon ca scrn not hi rsk ind (G0121) | $120.15 | $445 | 0.1× |
| Colorectal scrn; hi risk ind (G0105) | $120.15 | $445 | 0.1× |
| Complete occlusal adjustment (D9952) | $290.25 | $1,075 | 0.3× |
| Comprehensve oral evaluation (D0150) | $38.07 | $141 | 0.2× |
| Core build-up incl any pins (D2950) | $134.73 | $499 | 0.2× |
| Crown 3/4 cast base metal (D2781) | $275.40 | $1,020 | 0.3× |
| Crown 3/4 porcelain/ceramic (D2783) | $275.40 | $1,020 | 0.3× |
| Crown 3/4 resin-based compos (D2712) | $121.50 | $450 | 0.1× |
| Crown full cast base metal (D2791) | $443.61 | $1,643 | 0.5× |
| Crown full cast noble metal (D2792) | $450.09 | $1,667 | 0.5× |
| Crown lengthen hard tissue (D4249) | $387.45 | $1,435 | 0.5× |
| Crown porcelain fused base m (D2751) | $443.61 | $1,643 | 0.5× |
| Crown porcelain w/ h noble m (D2750) | $536.22 | $1,986 | 0.6× |
| Crown porcelain w/ noble met (D2752) | $463.59 | $1,717 | 0.6× |
| Crown porcelain/ceramic (D2740) | $491.40 | $1,820 | 0.6× |
| Crown resin w/ base metal (D2721) | $197.91 | $733 | 0.2× |
| Crown resin-based indirect (D2710) | $121.50 | $450 | 0.1× |
| Dental bitewing single image (D0270) | $24.30 | $90 | 0.2× |
| Dental bitewings two images (D0272) | $24.30 | $90 | 0.2× |
| Dental prophylaxis adult (D1110) | $47.52 | $176 | 0.3× |
| Dental tomographic survey (D0322) | $121.23 | $449 | 0.9× |
| Dental unspec restorative pr (D2999) | $162.27 | $601 | 0.2× |
| Depression screen annual (G0444) range across 2 matching MRF lines |
$5.94–$12.15 | $22–$45 | varies |
| Diab manage trn per indiv (G0108) | $36.99 | $137 | 0.7× |
| Diab manage trn ind/group (G0109) | $10.80 | $40 | 0.7× |
| Direct refer hospital observ (G0379) | $170.10 | $630 | 0.2× |
| Each addtnl prefab post (D2957) | $68.85 | $255 | 0.1× |
| Elec stim other than wound (G0283) | $21.06 | $78 | 1.7× |
| End thxpy, anterior tooth (D3310) | $317.52 | $1,176 | 0.4× |
| End thxpy, molar tooth (D3330) | $503.55 | $1,865 | 0.6× |
| End thxpy, premolar tooth (D3320) | $388.80 | $1,440 | 0.5× |
| Endodontic procedure (D3999) | $162.27 | $601 | 0.2× |
| Excision benign lesion>1.25c (D7411) | $229.23 | $849 | 0.1× |
| Exposure of unerupted tooth (D7280) | $154.44 | $572 | 0.2× |
| Extensv oral eval prob focus (D0160) | $56.16 | $208 | 0.3× |
| Extraction coronal remnants (D7111) | $38.88 | $144 | 0.0× |
| Extraction erupted tooth/exr (D7140) | $58.05 | $215 | 0.1× |
| Fecal blood scrn immunoassay (G0328) | $24.57 | $91 | 1.4× |
| Followup eval of foot pt lop (G0246) range across 2 matching MRF lines |
$12.96–$26.73 | $48–$99 | varies |
| Full mouth debridement (D4355) | $78.84 | $292 | 0.1× |
| Gingival flap proc w/ planin (D4240) | $340.20 | $1,260 | 0.1× |
| Gingivectomy/plasty 1 to 3 (D4211) | $164.97 | $611 | 0.0× |
| Gingivectomy/plasty 4 or mor (D4210) | $210.87 | $781 | 0.0× |
| Gngvl flap w rootplan 1-3 th (D4241) | $196.56 | $728 | 0.1× |
| Gross pulpal debridement (D3221) | $82.62 | $306 | 0.1× |
| Hep c screen high risk/other (G0472) | $31.32 | $116 | 0.7× |
| High inten beh couns std 30m (G0445) range across 2 matching MRF lines |
$19.71–$21.60 | $73–$80 | varies |
| I&d absc intraoral soft tiss (D7510) | $106.11 | $393 | 0.1× |
| I&d abscess extraoral (D7520) | $479.52 | $1,776 | 0.5× |
| Impact tooth rem bony w/comp (D7241) | $222.48 | $824 | 0.3× |
| Impact tooth remov comp bony (D7240) | $216.81 | $803 | 0.3× |
| Impact tooth remov part bony (D7230) | $185.22 | $686 | 0.2× |
| Impact tooth remov soft tiss (D7220) | $136.89 | $507 | 0.2× |
| Initial foot exam pt lops (G0245) range across 2 matching MRF lines |
$25.92–$43.74 | $96–$162 | varies |
| Initial preventive exam (G0402) range across 2 matching MRF lines |
$86.40–$112.32 | $320–$416 | varies |
| Intens behave ther cardio dx (G0446) range across 2 matching MRF lines |
$19.98–$21.87 | $74–$81 | varies |
| Intentional replantation (D3470) | $172.80 | $640 | 0.2× |
| Intraor comprehensive series (D0210) | $56.97 | $211 | 0.2× |
| Intraoral occlusal film (D0240) | $23.76 | $88 | 0.2× |
| Intraoral periapical first (D0220) | $14.85 | $55 | 0.1× |
| Labial veneer resin direct (D2960) | $334.53 | $1,239 | 0.4× |
| Limit oral eval problm focus (D0140) | $37.26 | $138 | 0.2× |
| Limited occlusal adjustment (D9951) | $55.35 | $205 | 0.1× |
| Mesial/distal wedge proc (D4274) | $253.53 | $939 | 0.3× |
| Mnt subs tx for change dx (G0270) | $35.10 | $130 | 1.1× |
| Neuro csf prion prtn qual (0035U) | $127.40 | $471.87 | 0.2× |
| Njx bone sub matrl into subchondral bone defect (0707T) | $364.50 | $1,350 | 0.1× |
| Njx platelet plasma (0232T) range across 2 matching MRF lines |
$321.03–$914.76 | $1,189–$3,388 | varies |
| Obtaining screen pap smear (Q0091) range across 2 matching MRF lines |
$12.15–$31.05 | $45–$115 | varies |
| Occ guard, hard, full arch (D9944) | $101.25 | $375 | 0.1× |
| Occ guard, soft, full arch (D9945) | $101.25 | $375 | 0.1× |
| Occlusion analysis (D9950) | $97.20 | $360 | 0.1× |
| Onc Merkel Cll Carc Srm Quan (0058U) | $92.17 | $341.38 | 0.3× |
| Oral antral fistula closure (D7260) | $289.44 | $1,072 | 0.3× |
| Osseous surg 1 to 3 teeth (D4261) | $300.78 | $1,114 | 0.1× |
| Osseous surgery 4 or more (D4260) likely a partial charge, not the full procedure |
$559.98 | $2,074 | 0.1× |
| Panoramic image (D0330) | $56.43 | $209 | 0.2× |
| Perc d-e cor revasc chro sin (C9607) likely a partial charge, not the full procedure |
$394.20 | $1,460 | 0.0× |
| Perc d-e cor revasc t cabg s (C9604) likely a partial charge, not the full procedure |
$202.50 | $750 | 0.0× |
| Perc d-e cor stent ather s (C9602) likely a partial charge, not the full procedure |
$321.03 | $1,189 | 0.0× |
| Perc drug-el cor stent sing (C9600) likely a partial charge, not the full procedure |
$334.80 | $1,240 | 0.0× |
| Periodic oral evaluation (D0120) | $25.65 | $95 | 0.1× |
| Periodontal maint procedures (D4910) | $59.13 | $219 | 0.1× |
| Periodontal scaling & root (D4341) | $122.31 | $453 | 0.1× |
| Periodontal scaling 1-3teeth (D4342) | $86.67 | $321 | 0.1× |
| Place device/marker, non pro (C9728) | $1,008.18 | $3,734 | 0.6× |
| Place direct restoration (D2940) | $59.40 | $220 | 0.1× |
| Post 1 srfc resinbased cmpst (D2391) | $85.05 | $315 | 0.1× |
| Post 2 srfc resinbased cmpst (D2392) | $111.24 | $412 | 0.1× |
| Post 3 srfc resinbased cmpst (D2393) | $138.24 | $512 | 0.2× |
| Post >=4srfc resinbase cmpst (D2394) | $169.56 | $628 | 0.2× |
| Post and core cast + crown (D2952) | $450.63 | $1,669 | 0.5× |
| Ppps, initial visit (G0438) | $112.05 | $415 | 0.6× |
| Ppps, subseq visit (G0439) | $88.56 | $328 | 0.6× |
| Prefab post/core + crown (D2954) | $136.35 | $505 | 0.2× |
| Prefab stnlss steel crown pe (D2931) | $162.54 | $602 | 0.2× |
| Prefab stnlss steel crwn pri (D2930) | $114.21 | $423 | 0.1× |
| Prostate biopsy, any mthd (G0416) range across 2 matching MRF lines |
$99.90–$106.92 | $370–$396 | varies |
| Psa screening (G0103) range across 5 matching MRF lines |
$3.43–$59.13 | $12.70–$219 | varies |
| Pulp cap direct (D3110) | $59.40 | $220 | 0.1× |
| Pulp cap indirect (D3120) | $56.43 | $209 | 0.1× |
| Pulp vitality test (D0460) | $14.31 | $53 | 0.0× |
| Pulpal therapy anterior prim (D3230) | $81.27 | $301 | 0.1× |
| Pulpal therapy posterior pri (D3240) | $89.10 | $330 | 0.1× |
| Quan MRI alys brain w/o diagnostic MRI same sess (0865T) | $212.22 | $786 | 0.7× |
| Quan MRI alys brain with diagnostic MRI (0866T) | $265.41 | $983 | 0.9× |
| Rad exc lesion up to 1.25 cm (D7410) | $144.99 | $537 | 0.1× |
| Rbc DNA hea 35 ag 11 bld grp whl bld cmn allel (0001U) | $64.80 | $240 | 0.1× |
| Re-cement or re-bond crown (D2920) | $56.43 | $209 | 0.1× |
| Re-eval,est pt,problem focus (D0170) | $36.99 | $137 | 0.2× |
| Recement inlay onlay or part (D2910) | $27 | $100 | 0.0× |
| Rem exostosis any site (D7471) | $347.76 | $1,288 | 0.1× |
| Rem imp tooth w mucoper flp (D7210) | $100.44 | $372 | 0.1× |
| Rem nonodonto cyst > 1.25 cm (D7461) | $195.21 | $723 | 0.2× |
| Rem nonodonto cyst to 1.25cm (D7460) | $144.99 | $537 | 0.2× |
| Removal of sloughed off bone (D7550) | $102.06 | $378 | 0.1× |
| Remove torus mandibularis (D7473) | $390.15 | $1,445 | 0.5× |
| Resin 4/> surf or w incis an (D2335) | $134.19 | $497 | 0.2× |
| Resin one surface-anterior (D2330) | $72.09 | $267 | 0.1× |
| Resin three surfaces-anterio (D2332) | $113.13 | $419 | 0.1× |
| Resin two surfaces-anterior (D2331) | $92.88 | $344 | 0.1× |
| Retreat root canal anterior (D3346) | $423.36 | $1,568 | 0.5× |
| Retreat root canal molar (D3348) | $616.41 | $2,283 | 0.7× |
| Retreat root canal premolar (D3347) | $498.15 | $1,845 | 0.6× |
| Retrograde filling (D3430) | $110.70 | $410 | 0.1× |
| Risk ascvd tst once pr 12 mo (G0537) | $13.23 | $49 | 0.3× |
| Root surgery molar (D3425) | $378.81 | $1,403 | 0.5× |
| Routine footcare pt w lops (G0247) | $58.32 | $216 | 0.2× |
| Space maintainer fxd unilat (D1510) | $145.26 | $538 | 0.2× |
| Surg reduct osseoustuberosit (D7485) likely a partial charge, not the full procedure |
$179.28 | $664 | 0.0× |
| Surgical splint (D5988) | $140.40 | $520 | 0.2× |
| Therapeutic pulpotomy (D3220) | $75.33 | $279 | 0.1× |
| Tomosynthesis, mammo (G0279) range across 2 matching MRF lines |
$18.90–$31.32 | $70–$116 | varies |
| Tooth pin retention (D2951) | $24.57 | $91 | 0.0× |
| Tooth reimplantation (D7270) | $90.72 | $336 | 0.1× |
| Tooth root removal (D7250) | $117.18 | $434 | 0.1× |
| Treatment of complications (D9930) | $22.68 | $84 | 0.0× |
| Trim nail(s) (G0127) range across 2 matching MRF lines |
$14.04–$206.28 | $52–$764 | varies |
| Tte w or wo fol wcon,doppler (C8929) | $72.36 | $268 | 0.1× |
| Unsched dialysis esrd pt hos (G0257) | $713.07 | $2,641 | 0.8× |
| Vestibuloplasty ridge extens (D7340) likely a partial charge, not the full procedure |
$331.83 | $1,229 | 0.0× |
| Visit to determ ldct elig (G0296) range across 2 matching MRF lines |
$16.74–$29.97 | $62–$111 | varies |
| Wet mounts/ w preparations (Q0111) | $12.15 | $45 | 0.7× |
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.