Supplies, drugs & other prices at Bellevue Medical Center
Bellevue, NE · every code in this section with a posted price and a Medicare benchmark.
360 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 2d cephalometric image (D0340) | $136.50 | $210 | 1.5× |
| 2d tee w or w/o fol w/con,in (C8925) | $1,238.25 | $1,905 | 1.5× |
| 2d tte w or w/o fol w/con,co (C8923) | $928.20 | $1,428 | 1.1× |
| 2d tte w or w/o fol w/con,fu (C8924) | $508.95 | $783 | 1.4× |
| 3d anat seg imaging preop (C8001) | $243.75 | $375 | 1.8× |
| Ablation b9 thyroid nodule perq laser w/img gdn (0673T) | $2,258.75 | $3,475 | 1.3× |
| Ablation, irreversible electroporation; 1 or more tumors, including fluoroscopic and ultrasound guidance, when… (0601T) range across 2 matching MRF lines |
$2,249.33–$13,845 | $3,460.50–$21,300 | varies |
| Abltj perc cryoabltj img gdn lxtr/perph nerve (0441T) range across 2 matching MRF lines |
$182–$2,876.25 | $280–$4,425 | varies |
| Abltj Perc Cryoabltj Img Gdn Nrv Plex/Trncl Nrv (0442T) | $6,827.60 | $10,504 | 0.7× |
| Adm of soc dtr assess 5-15 m (G0136) range across 2 matching MRF lines |
$13–$62.40 | $20–$96 | varies |
| Admin hepatitis b vaccine (G0010) range across 3 matching MRF lines |
$20.48–$46.80 | $31.50–$72 | varies |
| Admin influenza virus vac (G0008) | $52 | $80 | 1.1× |
| Admin pneumococcal vaccine (G0009) range across 3 matching MRF lines |
$29.25–$58.50 | $45–$90 | varies |
| Alcohol/sub misuse assess (G2011) | $26 | $40 | 0.9× |
| Alcohol/subs interv 15-30mn (G0396) | $50.05 | $77 | 1.3× |
| Alcohol/subs interv >30 min (G0397) | $98.80 | $152 | 0.5× |
| Alveoloplasty not w/extracts (D7321) | $239.20 | $368 | 0.1× |
| Alveoloplasty w/extract 1-3 (D7311) | $239.20 | $368 | 0.1× |
| Alveoplasty w/ extraction (D7310) | $307.45 | $473 | 0.2× |
| Alveoplasty w/o extraction (D7320) | $341.25 | $525 | 0.2× |
| Amalgam 4 or > surfaces perm (D2161) | $182.65 | $281 | 0.3× |
| Amalgam one surface permanen (D2140) | $110.50 | $170 | 0.2× |
| Amalgam three surfaces perma (D2160) range across 2 matching MRF lines |
$156.65–$193.70 | $241–$298 | varies |
| Amalgam two surfaces permane (D2150) | $130 | $200 | 0.2× |
| Annual alcohol screen 15 min (G0442) | $13 | $20 | 0.3× |
| Apexification/recalc initial (D3351) | $272.35 | $419 | 0.4× |
| Apexification/recalc interim (D3352) | $122.20 | $188 | 0.2× |
| Apically positioned flap (D4245) range across 2 matching MRF lines |
$162.50–$520 | $250–$800 | varies |
| Apicoectomy - anterior (D3410) | $429 | $660 | 0.6× |
| Auto tissue graft 1st tooth (D4273) | $585 | $900 | 0.4× |
| Behavior counsel obesity 15m (G0447) range across 3 matching MRF lines |
$38.19–$58.50 | $58.75–$90 | varies |
| Bia whole body composition assessment w/i&r (0358T) | $16.25 | $25 | 0.5× |
| Bio mtrls to aid soft/os reg (D4265) range across 2 matching MRF lines |
$195–$520 | $300–$800 | varies |
| Bitewings - three images (D0273) | $106.66 | $164.09 | 0.4× |
| Bitewings four images (D0274) | $125.54 | $193.14 | 0.5× |
| Blind interatrial shunt ide (C9758) | $16,250 | $25,000 | 0.9× |
| Bone replce graft first site (D4263) | $341.25 | $525 | 0.5× |
| Brief alcohol misuse counsel (G0443) | $43.55 | $67 | 0.4× |
| Ca screen;flexi sigmoidscope (G0104) | $236.15 | $363.30 | 0.2× |
| Ca screen;pelvic/breast exam (G0101) | $48.75 | $75 | 0.5× |
| Canal prep/fitting of dowel (D3950) | $111.80 | $172 | 0.2× |
| Cardiokymography (Q0035) | $21.58 | $33.20 | 0.6× |
| Care manage beh svs 20mins (G0323) | $43.88 | $67.50 | 1.1× |
| Collagen Cross-Linking Cornea&Pachymetry (0402T) | $3,038.10 | $4,674 | 1.2× |
| Colon ca scrn not hi rsk ind (G0121) | $689 | $1,060 | 0.7× |
| Colorectal scrn; hi risk ind (G0105) | $698.23 | $1,074.20 | 0.7× |
| Comp periodontal evaluation (D0180) | $204.75 | $315 | 1.5× |
| Complete occlusal adjustment (D9952) | $491.40 | $756 | 0.7× |
| Comprehensve oral evaluation (D0150) | $71.50 | $110 | 0.5× |
| Con tissue w pedicle graft (D4276) | $656.50 | $1,010 | 0.4× |
| Cone beam ct capt & interp (D0364) | $341.25 | $525 | 3.1× |
| Cone beam ct interp both jaw (D0367) | $375.70 | $578 | 3.5× |
| Cone beam ct interprete man (D0365) | $237.25 | $365 | 2.2× |
| Cone beam ct interprete max (D0366) | $358.15 | $551 | 3.3× |
| Cone beam ct interprete tmj (D0368) | $375.70 | $578 | 3.5× |
| Core build-up incl any pins (D2950) | $169.65 | $261 | 0.3× |
| Coronectomy (D7251) | $338 | $520 | 0.2× |
| Covid-19 lab test non-cdc (U0002) | $84.50 | $130 | 1.6× |
| Crd hrt trnspl mrna 1283 gen (0087U) | $5,460 | $8,400 | 1.7× |
| Crown 3/4 cast hi noble met (D2780) | $614.25 | $945 | 0.9× |
| Crown full cast base metal (D2791) | $721.50 | $1,110 | 1.1× |
| Crown full cast high noble m (D2790) | $760.50 | $1,170 | 1.1× |
| Crown lengthen hard tissue (D4249) | $586.95 | $903 | 0.9× |
| Crown porcelain fused base m (D2751) | $735.15 | $1,131 | 1.1× |
| Crown porcelain w/ h noble m (D2750) | $789.10 | $1,214 | 1.2× |
| Crown porcelain w/ noble met (D2752) | $752.70 | $1,158 | 1.1× |
| Crown porcelain/ceramic (D2740) | $799.50 | $1,230 | 1.2× |
| Crown resin-based indirect (D2710) | $583.70 | $898 | 0.9× |
| Crtj Subq Insj Impltbl Glucose Sensor Sys Train (0446T) | $162.50 | $250 | 0.0× |
| Dental bitewing single image (D0270) range across 2 matching MRF lines |
$65–$77.15 | $100–$118.69 | varies |
| Dental bitewings two images (D0272) | $106.66 | $164.09 | 1.2× |
| Dental connector bar (D6920) | $682.50 | $1,050 | 1.0× |
| Dental inlay metallic 2 surf (D2520) | $634.40 | $976 | 0.9× |
| Dental inlay metl 3/more sur (D2530) | $731.25 | $1,125 | 1.1× |
| Dental onlay metallic 3 surf (D2543) | $568.75 | $875 | 0.8× |
| Dental onlay metl 4/more sur (D2544) | $591.50 | $910 | 0.9× |
| Dental onlay porcelin 3 surf (D2643) | $588.25 | $905 | 0.9× |
| Dental prophylaxis adult (D1110) | $72.80 | $112 | 0.5× |
| Dental unspec restorative pr (D2999) | $24.05 | $37 | 0.0× |
| Depression screen annual (G0444) range across 2 matching MRF lines |
$35.10–$54.60 | $54–$84 | varies |
| Dermal filler injection(s) (G0429) range across 2 matching MRF lines |
$278.46–$2,172.95 | $428.40–$3,343 | varies |
| Diab manage trn per indiv (G0108) range across 2 matching MRF lines |
$83.98–$143 | $129.20–$220 | varies |
| Diab manage trn ind/group (G0109) range across 2 matching MRF lines |
$19.50–$34.45 | $30–$53 | varies |
| Direct refer hospital observ (G0379) | $798.20 | $1,228 | 1.3× |
| Drug test def 1-7 classes (G0480) range across 34 matching MRF lines |
$39–$478.40 | $60–$736 | varies |
| Drug test def 8-14 classes (G0481) | $117 | $180 | 0.7× |
| Ed svc ckd ind per session (G0420) | $180.90 | $278.30 | 1.6× |
| Ekg tracing for initial prev (G0404) range across 2 matching MRF lines |
$26–$42.25 | $40–$65 | varies |
| Elec stim other than wound (G0283) range across 2 matching MRF lines |
$29.90–$34.13 | $46–$52.50 | varies |
| Electrophysiologic eval ccm-d leads at 1st impl (0930T) | $1,787.50 | $2,750 | 1.4× |
| Electrophysiologic eval ccm-d leads separate (0931T) | $1,787.50 | $2,750 | 1.4× |
| Electrophysiologic Eval Icds W/Ss Electrode (0577T) | $1,723.80 | $2,652 | 1.4× |
| End thxpy, anterior tooth (D3310) | $534.30 | $822 | 0.8× |
| End thxpy, molar tooth (D3330) | $734.50 | $1,130 | 1.1× |
| End thxpy, premolar tooth (D3320) | $551.85 | $849 | 0.8× |
| Endovascular Venous Arterialization Tibl/Prnl Vn (0620T) | $82,075.50 | $126,270 | 1.8× |
| Evac Meibomian Glnds Auto Ht& Intmt Press Uni (0207T) range across 2 matching MRF lines |
$87.75–$600 | $135–$923.07 | varies |
| Evacuation meibomian glands using heat bilateral (0563T) range across 2 matching MRF lines |
$87.75–$1,300 | $135–$2,000 | varies |
| Excision benign lesion>1.25c (D7411) range across 2 matching MRF lines |
$71.50–$786.50 | $110–$1,210 | varies |
| Excision of rectal tumor, transanal endoscopic microsurgical approach (ie, TEMS), including muscularis propria (ie,… (0184T) likely a partial charge, not the full procedure |
$1,722.50 | $2,650 | 0.3× |
| Exposure of unerupted tooth (D7280) | $308.10 | $474 | 0.5× |
| Extensv oral eval prob focus (D0160) | $123.50 | $190 | 0.9× |
| Extraction coronal remnants (D7111) | $96.85 | $149 | 0.1× |
| Extraction erupted tooth/exr (D7140) | $145.60 | $224 | 0.2× |
| Extrnl counterpulse, per tx (G0166) range across 2 matching MRF lines |
$162.50–$289.38 | $250–$445.20 | varies |
| Facial moulage sectional (D5911) | $1,365 | $2,100 | 2.0× |
| Fecal blood scrn immunoassay (G0328) range across 2 matching MRF lines |
$29.25–$78 | $45–$120 | varies |
| Fecal microbiota prep instil (G0455) | $160.42 | $246.80 | 0.2× |
| Fern test (Q0114) range across 2 matching MRF lines |
$10.27–$19.50 | $15.80–$30 | varies |
| Followup eval of foot pt lop (G0246) | $60.06 | $92.40 | 0.4× |
| Fractional abl lsr fenestration first 100 sqcm (0479T) range across 2 matching MRF lines |
$308.75–$936 | $475–$1,440 | varies |
| Full mouth debridement (D4355) | $139.10 | $214 | 0.2× |
| Gingivectomy/plasty 1 to 3 (D4211) range across 2 matching MRF lines |
$48.75–$156.65 | $75–$241 | varies |
| Gingivectomy/plasty 4 or mor (D4210) | $406.25 | $625 | 0.1× |
| Gross pulpal debridement (D3221) | $123.50 | $190 | 0.2× |
| Group behave couns 2-10 (G0473) range across 2 matching MRF lines |
$18.36–$70.20 | $28.25–$108 | varies |
| Group train w/o patient (G0543) | $48.75 | $75 | 1.6× |
| Guided tiss regen nonresorb (D4267) range across 2 matching MRF lines |
$91–$477.75 | $140–$735 | varies |
| Guided tiss regen resorble (D4266) | $341.25 | $525 | 0.2× |
| Hbot, full body chamber, 30m (G0277) range across 2 matching MRF lines |
$72.35–$1,530.75 | $111.30–$2,355 | varies |
| Hdr electronic brachytherapy ntrstl/intrcav (0395T) | $908.05 | $1,397 | 1.3× |
| Home sleep test/type 2 porta (G0398) | $133.32 | $205.10 | 0.6× |
| Home sleep test/type 3 porta (G0399) | $103.74 | $159.60 | 0.5× |
| Home sleep test/type 4 porta (G0400) | $133.32 | $205.10 | 0.6× |
| I&d absc intraoral soft tiss (D7510) range across 2 matching MRF lines |
$71.50–$336.05 | $110–$517 | varies |
| I&d abscess extraoral (D7520) | $848.25 | $1,305 | 1.2× |
| Ig paraprotein qual imprcip&ms bld/ur w/isotype (0077U) range across 2 matching MRF lines |
$94.90–$325 | $146–$500 | varies |
| Impact tooth rem bony w/comp (D7241) | $466.05 | $717 | 0.7× |
| Impact tooth remov comp bony (D7240) | $444.60 | $684 | 0.7× |
| Impact tooth remov part bony (D7230) | $367.25 | $565 | 0.5× |
| Impact tooth remov soft tiss (D7220) | $268.45 | $413 | 0.4× |
| Incision/drain abscess intra (D7511) range across 2 matching MRF lines |
$71.50–$682.50 | $110–$1,050 | varies |
| Initial foot exam pt lops (G0245) | $105.82 | $162.80 | 0.8× |
| Initial preventive exam (G0402) | $224.90 | $346 | 1.6× |
| Inj for sacroiliac jt anesth (G0260) range across 2 matching MRF lines |
$601.97–$2,660.13 | $926.10–$4,092.50 | varies |
| Injection posterior chamber eye medication (0699T) | $3,333.20 | $5,128 | 1.4× |
| Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that… (0216T) | $464.10 | $714 | 0.5× |
| Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, into the… (0253T) | $1,643.46 | $2,528.40 | 0.4× |
| Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space;… (0449T) | $2,931.96 | $4,510.70 | 0.5× |
| Insertion or replacement of percutaneous electrode array, sacral, with integrated neurostimulator, including imaging… (0786T) | $20,296.25 | $31,225 | 1.8× |
| Insertion or replacement of percutaneous electrode array, spinal, with integrated neurostimulator, including imaging… (0784T) | $20,296.25 | $31,225 | 1.8× |
| Insertion perm ccm-d system pulse generator only (0916T) | $32,825 | $50,500 | 1.4× |
| Insj perm ccm-d sys 1 transvns lead only (0917T) | $12,103 | $18,620 | 1.4× |
| Insj Perm Ccm-D Sys Dual Transvns Leads Only (0918T) | $12,103 | $18,620 | 1.4× |
| Insj perm ccm-d sys pg&dual transvns eltrds/lds (0915T) | $46,884.50 | $72,130 | 1.4× |
| Insj/Rplc Car Modulj Sys Pls Gen Transvns Eltrd (0408T) range across 2 matching MRF lines |
$50,145.55 | $2,105–$77,147 | 1.5× |
| Insj/Rplcmt Icds W/Substernal Electrode (0571T) | $49,010 | $75,400 | 1.5× |
| Instill pharm renal pelvis (C9789) | $380.25 | $585 | 0.3× |
| Intens behave ther cardio dx (G0446) | $41.99 | $64.60 | 1.1× |
| Interim crown (D2799) | $333.45 | $513 | 0.5× |
| Interrogation Dev Eval Icds W/Ss Eltrd In Person (0576T) | $29.25 | $45 | 0.8× |
| Intraor comprehensive series (D0210) | $99.45 | $153 | 0.4× |
| Intraoral occlusal film (D0240) | $26 | $40 | 0.3× |
| Intraoral periapical first (D0220) | $25.35 | $39 | 0.3× |
| Ire Abltj 1+Tum Organ Perq (0600T) | $13,845 | $21,300 | 1.3× |
| Labial veneer porc indirect (D2962) | $637 | $980 | 0.9× |
| Labial veneer resin direct (D2960) | $523.90 | $806 | 0.8× |
| Limit oral eval problm focus (D0140) | $57.62 | $88.64 | 0.4× |
| Limited occlusal adjustment (D9951) | $71.50 | $110 | 0.1× |
| Liver Dis 10 Assays Serum Algorithm W/Nash (0003M) | $980.85 | $1,509 | 1.9× |
| Lymphovenous bypass, including robotic assistance, when performed, per extremity (1019T) unusually low: confirm this is the full procedure |
$2,180.75 | $3,355 | 0.3× |
| Mandible graft (D7950) range across 2 matching MRF lines |
$71.50–$1,023.75 | $110–$1,575 | varies |
| Mesial/distal wedge proc (D4274) | $334.75 | $515 | 0.5× |
| Mra w/cont, abd (C8900) | $1,081.60 | $1,664 | 3.0× |
| Mra w/cont, lwr ext (C8912) | $1,952.60 | $3,004 | 5.4× |
| Mra w/o cont, abd (C8901) | $993.85 | $1,529 | 4.0× |
| Mra w/o cont, lwr ext (C8913) | $993.85 | $1,529 | 4.0× |
| Mra w/o cont, pelvis (C8919) | $1,121.25 | $1,725 | 4.5× |
| Mra w/o fol w/cont, abd (C8902) | $1,430 | $2,200 | 3.9× |
| Mra w/o fol w/cont, chest (C8911) | $1,430 | $2,200 | 3.9× |
| Mra w/o fol w/cont, lwr ext (C8914) | $1,430 | $2,200 | 3.9× |
| Mra w/o fol w/cont, pelvis (C8920) | $1,527.50 | $2,350 | 4.2× |
| Mra, w/dye, spinal canal (C8931) | $2,275 | $3,500 | 6.3× |
| Mra, w/o dye, spinal canal (C8932) | $1,950 | $3,000 | 7.9× |
| Mra, w/o&w/dye, spinal canal (C8933) | $2,275 | $3,500 | 6.3× |
| Mri w/cont, breast, bi (C8906) | $572.65 | $881 | 1.6× |
| Mri w/o fol w/cont, breast, (C8908) range across 2 matching MRF lines |
$1,690–$1,951.95 | $2,600–$3,003 | varies |
| Mri w/o fol w/cont, brst, un (C8905) range across 2 matching MRF lines |
$1,137.50–$1,952.60 | $1,750–$3,004 | varies |
| Neuro csf prion prtn qual (0035U) | $1,054.95 | $1,623 | 2.0× |
| Njx dx/ther paraver fct jt w/us cer/thor 1 lvl (0213T) | $511.88 | $787.50 | 0.6× |
| Njx platelet plasma (0232T) range across 3 matching MRF lines |
$325–$650 | $500–$1,000 | varies |
| No pt prsnt train initial 30 (G0541) | $48.75 | $75 | 1.6× |
| Obtaining screen pap smear (Q0091) range across 2 matching MRF lines |
$34.45–$65 | $53–$100 | varies |
| Occ guard, hard, full arch (D9944) | $375.05 | $577 | 0.6× |
| Occ guard, hard, part arch (D9946) | $360.75 | $555 | 0.5× |
| Occ guard, soft, full arch (D9945) | $375.05 | $577 | 0.6× |
| Ocular blood flow measure (0198T) range across 2 matching MRF lines |
$65–$136.50 | $100–$210 | varies |
| Off base opioid tx 70min (G2086) | $638.14 | $981.75 | 3.5× |
| Off base opioid tx, 60 m (G2087) | $572 | $880 | 3.1× |
| Onc merkel cell carc detcj antb serum reprtd +/- (0059U) | $646.10 | $994 | 2.0× |
| Onc Merkel Cll Carc Srm Quan (0058U) | $646.10 | $994 | 2.0× |
| Open tx iliac spine uni/bil (G0412) likely a partial charge, not the full procedure |
$1,241.50 | $1,910 | 0.2× |
| Open tx post pelvic fxcture (G0415) | $2,981.16 | $4,586.40 | 0.9× |
| Oral antral fistula closure (D7260) | $1,079.65 | $1,661 | 1.6× |
| Oral/facial photo images (D0350) | $51.35 | $79 | 0.6× |
| Osseous surg 1 to 3 teeth (D4261) | $364 | $560 | 0.1× |
| Osseous surgery 4 or more (D4260) likely a partial charge, not the full procedure |
$676 | $1,040 | 0.1× |
| Oth resp proc, group (G0239) range across 2 matching MRF lines |
$117–$445.90 | $180–$686 | varies |
| Oth resp proc, indiv (G0238) | $97.50 | $150 | 3.2× |
| Panoramic image (D0330) range across 2 matching MRF lines |
$91–$130 | $140–$200 | varies |
| Pattern erg w/i&r (0509T) range across 2 matching MRF lines |
$35.10–$91 | $54–$140 | varies |
| Pedicle soft tissue graft pr (D4270) | $481 | $740 | 0.3× |
| Pelvic ring fracture uni/bil (G0413) unusually low: confirm this is the full procedure |
$2,606.50 | $4,010 | 0.3× |
| Pelvic ring fx treat int fix (G0414) likely a partial charge, not the full procedure |
$2,081.63 | $3,202.50 | 0.3× |
| Pemivibart infusion (M0224) | $503.75 | $775 | 1.1× |
| Perc d-e cor revasc chro sin (C9607) | $11,665.55 | $17,947 | 0.6× |
| Perc d-e cor revasc t cabg s (C9604) | $11,665.55 | $17,947 | 1.0× |
| Perc d-e cor stent ather s (C9602) | $11,665.55 | $17,947 | 0.6× |
| Perc drug-el cor stent sing (C9600) | $11,665.55 | $17,947 | 1.0× |
| Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without… (0274T) unusually low: confirm this is the full procedure |
$2,795 | $4,300 | 0.4× |
| Periodic oral evaluation (D0120) | $53.30 | $82 | 0.4× |
| Periodontal maint procedures (D4910) | $104.65 | $161 | 0.2× |
| Periodontal scaling & root (D4341) | $220.35 | $339 | 0.3× |
| Periodontal scaling 1-3teeth (D4342) | $114.40 | $176 | 0.2× |
| Perq njx algc cell &/prdct uni/bi fluor lmbr 1st (0627T) | $19,724.25 | $30,345 | 1.5× |
| Perq njx algc cell&/prdct uni/bi CT lmbr 1st (0629T) | $19,724.25 | $30,345 | 1.5× |
| Perq Sacral Augmt Bilat Inj (0201T) range across 2 matching MRF lines |
$1,660.75–$8,199.10 | $2,555–$12,614 | varies |
| Perq Sacral Augmt Unilat Inj (0200T) range across 3 matching MRF lines |
$1,080.50–$5,465.85 | $1,662.30–$8,409 | varies |
| Perq tcat ther rx dlvr ntrac rx balo 1 maj c art (0913T) | $8,339.50 | $12,830 | 0.7× |
| Pild/placebo control clin tr (G0276) likely a partial charge, not the full procedure |
$632.71 | $973.40 | 0.1× |
| Pin service 60m per month (G0023) | $169 | $260 | 1.6× |
| Place device/marker, non pro (C9728) | $2,085.85 | $3,209 | 1.5× |
| Place direct restoration (D2940) | $70.85 | $109 | 0.1× |
| Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone… (0219T) likely a partial charge, not the full procedure |
$2,980.25 | $4,585 | 0.2× |
| Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone… (0220T) likely a partial charge, not the full procedure |
$2,980.25 | $4,585 | 0.2× |
| Post 1 srfc resinbased cmpst (D2391) | $130 | $200 | 0.2× |
| Post 2 srfc resinbased cmpst (D2392) | $165.10 | $254 | 0.2× |
| Post 3 srfc resinbased cmpst (D2393) | $191.75 | $295 | 0.3× |
| Post >=4srfc resinbase cmpst (D2394) | $202.80 | $312 | 0.3× |
| Post and core cast + crown (D2952) | $258.70 | $398 | 0.4× |
| Potassium hydroxide preps (Q0112) range across 2 matching MRF lines |
$10.40–$12.29 | $16–$18.90 | varies |
| Ppps, initial visit (G0438) | $256.75 | $395 | 1.5× |
| Ppps, subseq visit (G0439) | $178.75 | $275 | 1.3× |
| Prefab post/core + crown (D2954) | $214.50 | $330 | 0.3× |
| Prefab stnlss steel crown pe (D2931) | $255.45 | $393 | 0.4× |
| Prefab stnlss steel crwn pri (D2930) | $255.45 | $393 | 0.4× |
| Prefabricated resin crown (D2932) | $226.85 | $349 | 0.3× |
| Prgrmg dev eval ldls pm single car chamber ip (0826T) range across 3 matching MRF lines |
$52–$58.50 | $80–$90 | varies |
| Prgrmg dev eval ldls pm sys 2chmbr in person (0804T) range across 2 matching MRF lines |
$55.90–$91 | $86–$140 | varies |
| Primary closure sinus perf (D7261) | $429 | $660 | 0.6× |
| Programming dev eval icds w/ss eltrd in person (0575T) range across 3 matching MRF lines |
$29.25–$117 | $45–$180 | varies |
| Prolonged iv inf, req pump (C8957) range across 2 matching MRF lines |
$370.50–$1,055.60 | $570–$1,624 | varies |
| Prostate biopsy, any mthd (G0416) range across 2 matching MRF lines |
$420.55–$967.92 | $647–$1,489.10 | varies |
| Psa screening (G0103) range across 2 matching MRF lines |
$48.95–$58.50 | $75.30–$90 | varies |
| Pulp cap direct (D3110) | $55.25 | $85 | 0.1× |
| Pulp cap indirect (D3120) | $45.50 | $70 | 0.1× |
| Pulp vitality test (D0460) | $39 | $60 | 0.1× |
| Quan CT tiss charac i&r w/cncrnt CT exam (0722T) | $1,017.25 | $1,565 | 1.5× |
| Quan mr alys tiss composition w/MRI 1orgn (0649T) | $1,545.05 | $2,377 | 1.6× |
| Quan MRI alys brain w/o diagnostic MRI same sess (0865T) | $396.50 | $610 | 1.6× |
| Quan MRI alys brain with diagnostic MRI (0866T) | $396.50 | $610 | 1.6× |
| Rad exc lesion up to 1.25 cm (D7410) range across 2 matching MRF lines |
$71.50–$497.25 | $110–$765 | varies |
| Radiation shield (D5984) | $1,175.20 | $1,808 | 1.8× |
| Re-cement or re-bond crown (D2920) | $65.65 | $101 | 0.1× |
| Re-eval post-op visit (D0171) | $71.50 | $110 | 0.5× |
| Re-eval,est pt,problem focus (D0170) | $71.50 | $110 | 0.5× |
| Recement inlay onlay or part (D2910) | $63.05 | $97 | 0.1× |
| Relocation pg wcs lv pacg battery component only (0862T) | $2,730 | $4,200 | 1.3× |
| Relocation pg wcs lv pacg transmittr compnt only (0863T) | $2,730 | $4,200 | 1.3× |
| Relocation skin pocket implanted ccm-d pg (0925T) | $2,681.25 | $4,125 | 1.3× |
| Rem exostosis any site (D7471) | $624 | $960 | 0.2× |
| Rem imp tooth w mucoper flp (D7210) | $276.25 | $425 | 0.2× |
| Rem nonodonto cyst > 1.25 cm (D7461) | $1,027.65 | $1,581 | 1.5× |
| Rem nonodonto cyst to 1.25cm (D7460) | $4,095 | $6,300 | 6.1× |
| Rem odontogen cyst > 1.25 cm (D7451) | $1,570.40 | $2,416 | 0.5× |
| Rem odontogen cyst to 1.25cm (D7450) range across 2 matching MRF lines |
$71.50–$851.50 | $110–$1,310 | varies |
| Removal fb skin/areolar tiss (D7530) range across 2 matching MRF lines |
$71.50–$305.50 | $110–$470 | varies |
| Removal iims implt mntr only (0532T) | $828.75 | $1,275 | 0.2× |
| Removal of implantable interstitial glucose sensor from subcutaneous pocket via incision (0447T) range across 2 matching MRF lines |
$65–$130 | $100–$200 | varies |
| Removal of sloughed off bone (D7550) range across 2 matching MRF lines |
$71.50–$1,617.85 | $110–$2,489 | varies |
| Removal of torus palatinus (D7472) | $731.25 | $1,125 | 1.1× |
| Removal perm ccm-d system pulse generator only (0919T) | $5,323.50 | $8,190 | 1.4× |
| Removal pg wcs lv pacing both components (0861T) | $5,850 | $9,000 | 1.5× |
| Removal Ss Dfb Electrode (0573T) range across 2 matching MRF lines |
$494–$5,689.45 | $760–$8,753 | varies |
| Remove torus mandibularis (D7473) | $689 | $1,060 | 1.0× |
| Repositioning prev impl ccm-d transvns eltrd/ld (0924T) | $1,007.50 | $1,550 | 1.5× |
| Resin 4/> surf or w incis an (D2335) | $213.85 | $329 | 0.3× |
| Resin one surface-anterior (D2330) range across 2 matching MRF lines |
$128.05–$275.60 | $197–$424 | varies |
| Resin three surfaces-anterio (D2332) | $182.65 | $281 | 0.3× |
| Resin two surfaces-anterior (D2331) | $179.16 | $275.63 | 0.3× |
| Retreat root canal molar (D3348) | $931.45 | $1,433 | 1.4× |
| Retreat root canal premolar (D3347) | $752.70 | $1,158 | 1.1× |
| Retrograde filling (D3430) | $170.95 | $263 | 0.3× |
| Revasc intra lithotrip-ather (C9766) | $30,439.50 | $46,830 | 1.6× |
| Revasc intra lithotrip-stent (C9765) range across 2 matching MRF lines |
$15,555.15–$30,439.50 | $23,931–$46,830 | varies |
| Revasc intravasc lithotripsy (C9764) range across 2 matching MRF lines |
$7,677.15–$19,175 | $11,811–$29,500 | varies |
| Revasc lith-sten-ath tib/per (C9775) | $30,439.50 | $46,830 | 1.6× |
| Revasc lithotr-ather tib/per (C9774) | $30,439.50 | $46,830 | 1.6× |
| Revasc lithotr-stent tib/per (C9773) | $30,439.50 | $46,830 | 1.6× |
| Revasc lithotrip tibi/perone (C9772) | $15,555.15 | $23,931 | 1.3× |
| Revasc lithotrip-stent-ather (C9767) | $30,439.50 | $46,830 | 1.6× |
| Revision or removal of neurostimulator electrode array, sacral, with integrated neurostimulator (0787T) | $5,070 | $7,800 | 1.4× |
| Revj/Rmvl Nstim Eltrd Ra Spi W/Integrated Nstim (0785T) | $5,070 | $7,800 | 1.4× |
| Rmvl Car Modulj Tranvns Elt (0413T) range across 2 matching MRF lines |
$962–$5,689.45 | $1,480–$8,753 | varies |
| Rmvl Cardiac Modulj Pls Gen (0412T) range across 2 matching MRF lines |
$357.50–$5,689.45 | $550–$8,753 | varies |
| Rmvl insj impltbl gluc sensor dif anatomic site (0448T) range across 2 matching MRF lines |
$130–$195 | $200–$300 | varies |
| Rmvl perm ccm-d sys 1 transvns dfb lead only (0921T) | $5,323.50 | $8,190 | 1.4× |
| Rmvl perm ccm-d sys 1 transvns pacing lead only (0920T) | $5,323.50 | $8,190 | 1.4× |
| Rmvl perm ccm-d sys dual transvns leads only (0922T) | $5,323.50 | $8,190 | 1.4× |
| Rmvl Substernal Impltbl Dfb Pulse Generator Only (0580T) range across 2 matching MRF lines |
$315.25–$5,689.45 | $485–$8,753 | varies |
| Rmvl&rplcmt permanent ccm-d pulse generator only (0923T) likely a partial charge, not the full procedure |
$5,323.50 | $8,190 | 0.2× |
| Root amputation (D3450) | $341.25 | $525 | 0.5× |
| Root surgery molar (D3425) | $680.55 | $1,047 | 1.0× |
| Root surgery premolar (D3421) | $477.75 | $735 | 0.7× |
| Routine footcare pt w lops (G0247) | $80.54 | $123.90 | 0.4× |
| Scaling gingiv inflammation (D4346) | $48.75 | $75 | 0.1× |
| Screen cerv/vag thin layer (G0123) range across 2 matching MRF lines |
$40.95–$51.22 | $63–$78.80 | varies |
| Screen pap by tech w md supv (P3000) | $66.95 | $103 | 3.6× |
| Semen analysis (G0027) | $15.28 | $23.50 | 2.4× |
| Single energy x-ray study (G0130) | $65.52 | $100.80 | 0.6× |
| Soft tissue graft firsttooth (D4277) range across 2 matching MRF lines |
$507–$2,044.25 | $780–$3,145 | varies |
| Splint extra-coronal (D4323) range across 2 matching MRF lines |
$575.25–$1,073.80 | $885–$1,652 | varies |
| Splint intra-coronal (D4322) range across 2 matching MRF lines |
$357.50–$1,073.80 | $550–$1,652 | varies |
| Surg reduct osseoustuberosit (D7485) likely a partial charge, not the full procedure |
$717.60 | $1,104 | 0.1× |
| Surgical splint (D5988) | $768.66 | $1,182.55 | 1.1× |
| Tcat insj perm 1chmbr ldls pacemaker r atrial (0823T) range across 2 matching MRF lines |
$29,022.50 | $1,135–$44,650 | 1.5× |
| Tcat insj perm 2chmbr ldls pm r atr pm compnt (0796T) likely a partial charge, not the full procedure |
$737.75 | $1,135 | 0.0× |
| Tcat insj perm 2chmbr ldls pm r ventr pm compnt (0797T) likely a partial charge, not the full procedure |
$737.75 | $1,135 | 0.0× |
| Tcat Insj Perm Dual Chamber Ldls Pm Compl Sys (0795T) range across 2 matching MRF lines |
$1,290.25–$29,835 | $1,985–$45,900 | varies |
| Tcat rmvl perm 1chmbr ldls pacemaker r atrial (0824T) range across 2 matching MRF lines |
$1,300–$4,751.50 | $2,000–$7,310 | varies |
| Tcat rmvl perm 2chmbr ldls pm r atr pm compnt (0799T) | $1,300 | $2,000 | 0.4× |
| Tcat rmvl perm 2chmbr ldls pm r ventr pm compnt (0800T) | $1,300 | $2,000 | 0.4× |
| Tcat Rmvl Perm Dual Chamber Ldls Pm Compl Sys (0798T) | $2,275 | $3,500 | 0.7× |
| Tcat rmvl&rplcmt perm 1chmbr ldls pm r atrial (0825T) range across 2 matching MRF lines |
$29,022.50 | $1,135–$44,650 | 1.5× |
| Tcat rmvl&rplcmt perm 2chmbr ldls pm 2chmbr sys (0801T) range across 2 matching MRF lines |
$1,290.25–$29,835 | $1,985–$45,900 | varies |
| Tcat rmvl&rplcmt perm 2chmbr ldls pm r atr cmpnt (0802T) likely a partial charge, not the full procedure |
$1,290.25 | $1,985 | 0.1× |
| Tcat rmvl&rplcmt prm 2chmbr ldls pm r vntr cmpnt (0803T) likely a partial charge, not the full procedure |
$1,290.25 | $1,985 | 0.1× |
| Tcat Rmvl/Debulk Icar Mass Suction Device Perq (0644T) | $8,154.25 | $12,545 | 1.4× |
| Tear film imaging unilateral or bilateral w/i&r (0330T) | $48.75 | $75 | 1.3× |
| Tee w or w/o fol w/cont, mon (C8927) range across 2 matching MRF lines |
$1,238.25–$2,112.50 | $1,905–$3,250 | varies |
| Tee w or w/o fol w/cont,cong (C8926) | $1,238.25 | $1,905 | 1.5× |
| Therapeutic procd strg endur (G0237) | $87.75 | $135 | 2.9× |
| Therapeutic pulpotomy (D3220) | $154.05 | $237 | 0.2× |
| Tomosynthesis, mammo (G0279) range across 2 matching MRF lines |
$29.25–$89.25 | $45–$137.30 | varies |
| Tooth pin retention (D2951) | $35.75 | $55 | 0.1× |
| Tooth reimplantation (D7270) | $341.25 | $525 | 0.5× |
| Tooth root removal (D7250) | $193.70 | $298 | 0.3× |
| Tooth transplantation (D7272) | $429 | $660 | 0.6× |
| Transcatheter Renal Sympath Denervation Bilat (0339T) range across 2 matching MRF lines |
$295.75–$8,515 | $455–$13,100 | varies |
| Transcatheter renal sympath denervation unilat (0338T) range across 2 matching MRF lines |
$617.50–$8,515 | $950–$13,100 | varies |
| Transseptal fiberotomy (D7291) | $204.75 | $315 | 0.3× |
| Trauma respons w/hosp criti (G0390) | $2,897.05 | $4,457 | 2.1× |
| Treatment of complications (D9930) | $57.85 | $89 | 0.1× |
| Trgt gen seq alys sld orgn neo DNA 324 genes (0037U) | $2,281.50 | $3,510 | 0.7× |
| Trim nail(s) (G0127) range across 2 matching MRF lines |
$36.21–$42.25 | $55.70–$65 | varies |
| Trluml Perip Athrc Iliac Art (0238T) unusually low: confirm this is the full procedure |
$9,418.50 | $14,490 | 0.5× |
| Trluml Peripheral Atherectomy Renal Artery Ea (0234T) range across 2 matching MRF lines |
$2,210–$16,110.25 | $3,400–$24,785 | varies |
| Tte w or w/o contr, cont ecg (C8930) range across 3 matching MRF lines |
$643.50–$1,238.25 | $990–$1,905 | varies |
| Tte w or w/o fol w/con,stres (C8928) | $1,238.25 | $1,905 | 1.5× |
| Tte w or w/o fol w/cont, com (C8921) | $1,238.25 | $1,905 | 1.5× |
| Tte w or w/o fol w/cont, f/u (C8922) | $1,238.25 | $1,905 | 1.5× |
| Tte w or wo fol wcon,doppler (C8929) range across 2 matching MRF lines |
$702–$1,787.50 | $1,080–$2,750 | varies |
| Unsched dialysis esrd pt hos (G0257) range across 5 matching MRF lines |
$140.60–$1,077.70 | $216.30–$1,658 | varies |
| Vasc emb/occ w/prs cath (C9797) | $28,080 | $43,200 | 1.5× |
| Vestibuloplasty exten graft (D7350) | $3,308.50 | $5,090 | 0.5× |
| Vestibuloplasty ridge extens (D7340) likely a partial charge, not the full procedure |
$1,137.50 | $1,750 | 0.2× |
| Visit esketamine 56m or less (G2082) range across 2 matching MRF lines |
$52–$995.28 | $80–$1,531.20 | varies |
| Visit esketamine, > 56m (G2083) | $1,454.28 | $2,237.35 | 0.9× |
| Visit to determ ldct elig (G0296) | $44.20 | $68 | 0.4× |
| Wet mounts/ w preparations (Q0111) range across 2 matching MRF lines |
$10.27–$28.60 | $15.80–$44 | varies |
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.