Supplies, drugs & other prices at Cibola General Hospital
Grants, NM · every code in this section with a posted price and a Medicare benchmark.
72 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Abltj perc cryoabltj img gdn lxtr/perph nerve (0441T) | $715.15 | $893.94 | 0.4× |
| Abltj Perc Cryoabltj Img Gdn Nrv Plex/Trncl Nrv (0442T) likely a partial charge, not the full procedure |
$715.15 | $893.94 | 0.1× |
| Admin hepatitis b vaccine (G0010) | $28 | $35 | 0.6× |
| Admin influenza virus vac (G0008) range across 3 matching MRF lines |
$28–$63.45 | $35–$79.31 | varies |
| Admin pneumococcal vaccine (G0009) range across 2 matching MRF lines |
$28–$269.45 | $35–$336.81 | varies |
| Alcohol/subs interv 15-30mn (G0396) | $95.58 | $119.48 | 2.6× |
| Amalgam 4 or > surfaces perm (D2161) | $819.06 | $1,023.82 | 1.3× |
| Amalgam one surface permanen (D2140) | $819.06 | $1,023.82 | 1.3× |
| Amalgam three surfaces perma (D2160) | $819.06 | $1,023.82 | 1.3× |
| Amalgam two surfaces permane (D2150) | $819.06 | $1,023.82 | 1.3× |
| Annual alcohol screen 15 min (G0442) | $46.97 | $58.71 | 1.3× |
| Behavior counsel obesity 15m (G0447) | $70.86 | $88.58 | 0.7× |
| Brief alcohol misuse counsel (G0443) | $70.86 | $88.58 | 0.7× |
| Ca screen;flexi sigmoidscope (G0104) | $454.02 | $567.53 | 0.5× |
| Ca screen;pelvic/breast exam (G0101) | $107.12 | $133.90 | 1.1× |
| Catheterize for urine spec (P9612) | $59.33 | $74.16 | 6.4× |
| Colon ca scrn not hi rsk ind (G0121) | $527.36 | $659.20 | 0.6× |
| Colorectal scrn; hi risk ind (G0105) | $524.89 | $656.11 | 0.6× |
| Covid-19 lab test non-cdc (U0002) | $181.28 | $226.60 | 3.5× |
| Crown resin-based indirect (D2710) | $819.06 | $1,023.82 | 1.3× |
| Dental bitewings two images (D0272) | $79.10 | $98.88 | 0.9× |
| Depression screen annual (G0444) | $46.97 | $58.71 | 1.3× |
| Direct refer hospital observ (G0379) | $632.01 | $790.01 | 1.1× |
| Drug test def 1-7 classes (G0480) range across 3 matching MRF lines |
$42.02–$527.36 | $52.53–$659.20 | varies |
| Egd flexible transnasal w/insj intral tube/cath (0654T) | $1,006.10 | $1,257.63 | 0.3× |
| Esw integumentary wound healing initial wound (0512T) range across 2 matching MRF lines |
$135.96–$569.38 | $169.95–$711.73 | varies |
| Extraction erupted tooth/exr (D7140) | $819.06 | $1,023.82 | 1.3× |
| Fecal blood scrn immunoassay (G0328) | $23.07 | $28.84 | 1.3× |
| Followup eval of foot pt lop (G0246) | $100.53 | $125.66 | 0.8× |
| Gingivectomy/plasty rest (D4212) | $819.06 | $1,023.82 | 0.2× |
| Hair analysis (P2031) | $27.19 | $33.99 | 5.5× |
| Hospital outpt clinic visit (G0463) range across 9 matching MRF lines |
$161.50–$407.88 | $201.88–$509.85 | varies |
| I&d absc intraoral soft tiss (D7510) | $819.06 | $1,023.82 | 1.2× |
| Impact tooth remov comp bony (D7240) | $819.06 | $1,023.82 | 1.3× |
| Impact tooth remov soft tiss (D7220) | $819.06 | $1,023.82 | 1.3× |
| Initial foot exam pt lops (G0245) | $175.51 | $219.39 | 1.3× |
| Initial preventive exam (G0402) | $437.54 | $546.93 | 3.3× |
| Intens behave ther cardio dx (G0446) | $70.86 | $88.58 | 1.9× |
| Mra w/cont, abd (C8900) range across 2 matching MRF lines |
$994.57–$2,742.27 | $1,243.21–$3,427.84 | varies |
| Mra w/cont, lwr ext (C8912) range across 4 matching MRF lines |
$994.57–$3,163.34 | $1,243.21–$3,954.17 | varies |
| Mra w/cont, pelvis (C8918) range across 2 matching MRF lines |
$994.57–$3,072.70 | $1,243.21–$3,840.87 | varies |
| Mra w/o cont, abd (C8901) range across 2 matching MRF lines |
$994.57–$3,399 | $1,243.21–$4,248.75 | varies |
| Mra w/o cont, lwr ext (C8913) range across 4 matching MRF lines |
$994.57–$2,409.38 | $1,243.21–$3,011.72 | varies |
| Mra w/o cont, pelvis (C8919) range across 2 matching MRF lines |
$994.57–$2,697.78 | $1,243.21–$3,372.22 | varies |
| Mra w/o fol w/cont, abd (C8902) range across 3 matching MRF lines |
$994.57–$3,399 | $1,243.21–$4,248.75 | varies |
| Mra w/o fol w/cont, lwr ext (C8914) range across 4 matching MRF lines |
$994.57–$4,140.60 | $1,243.21–$5,175.75 | varies |
| Mra w/o fol w/cont, pelvis (C8920) range across 2 matching MRF lines |
$994.57–$3,100.71 | $1,243.21–$3,875.89 | varies |
| Mra, w/o&w/dye, spinal canal (C8933) range across 2 matching MRF lines |
$994.57–$3,673.39 | $1,243.21–$4,591.74 | varies |
| Obtaining screen pap smear (Q0091) | $68.39 | $85.49 | 2.4× |
| Periodontal scaling & root (D4341) | $819.06 | $1,023.82 | 1.3× |
| Post 1 srfc resinbased cmpst (D2391) | $819.06 | $1,023.82 | 1.3× |
| Post 2 srfc resinbased cmpst (D2392) | $819.06 | $1,023.82 | 1.3× |
| Post 3 srfc resinbased cmpst (D2393) | $819.06 | $1,023.82 | 1.3× |
| Post >=4srfc resinbase cmpst (D2394) | $819.06 | $1,023.82 | 1.3× |
| Ppps, initial visit (G0438) | $452.38 | $565.47 | 2.6× |
| Ppps, subseq visit (G0439) | $305.70 | $382.13 | 2.2× |
| Prefab steel crown primary (D2934) | $819.06 | $1,023.82 | 1.3× |
| Prefab stnlss steel crwn pri (D2930) | $819.06 | $1,023.82 | 1.3× |
| Prefabricated resin crown (D2932) | $819.06 | $1,023.82 | 1.3× |
| Psa screening (G0103) range across 2 matching MRF lines |
$77.46–$93.11 | $96.82–$116.39 | varies |
| Re-cement or re-bond crown (D2920) | $79.10 | $98.88 | 0.1× |
| Rem imp tooth w mucoper flp (D7210) | $819.06 | $1,023.82 | 0.5× |
| Rem nonodonto cyst to 1.25cm (D7460) | $819.06 | $1,023.82 | 1.3× |
| Resin 4/> surf or w incis an (D2335) | $819.06 | $1,023.82 | 1.3× |
| Resin one surface-anterior (D2330) | $819.06 | $1,023.82 | 1.3× |
| Resin three surfaces-anterio (D2332) | $819.06 | $1,023.82 | 1.3× |
| Resin two surfaces-anterior (D2331) | $819.06 | $1,023.82 | 1.3× |
| Routine footcare pt w lops (G0247) | $211.77 | $264.71 | 1.1× |
| Space maintainer fxd unilat (D1510) | $819.06 | $1,023.82 | 1.3× |
| Therapeutic pulpotomy (D3220) | $819.06 | $1,023.82 | 1.3× |
| Tomosynthesis, mammo (G0279) range across 14 matching MRF lines |
$45.32–$269.45 | $56.65–$336.81 | varies |
| Tooth root removal (D7250) | $819.06 | $1,023.82 | 1.3× |
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.