Supplies, drugs & other prices at Clifton Springs Hospital and Clinic
Clifton Springs, NY · every code in this section with a posted price and a Medicare benchmark.
290 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 2019-ncov diagnostic p (U0001) | $100.26 | $154.24 | 2.8× |
| 2d cephalometric image (D0340) | $68.25 | $105 | 0.6× |
| 2d tee w or w/o fol w/con,in (C8925) | $1,494.22 | $2,298.80 | 1.5× |
| 2d tte w or w/o fol w/con,fu (C8924) | $768.88 | $1,182.90 | 1.8× |
| Add proc construct new crown (D2971) | $67.60 | $104 | 0.1× |
| Adm tocilizu covid-19 1st (M0249) | $823.15 | $1,266.38 | 1.5× |
| Adm tocilizu covid-19 2nd (M0250) | $823.15 | $1,266.38 | 1.5× |
| Admin hepatitis b vaccine (G0010) | $67.74 | $104.21 | 1.2× |
| Admin influenza virus vac (G0008) | $67.74 | $104.21 | 1.2× |
| Admin pneumococcal vaccine (G0009) | $67.74 | $104.21 | 1.2× |
| Alveoloplasty not w/extracts (D7321) | $44.20 | $68 | 0.0× |
| Alveoloplasty w/extract 1-3 (D7311) | $36.40 | $56 | 0.0× |
| Alveolus clsd reduc stblz te (D7771) | $1,444.95 | $2,223 | 0.3× |
| Alveolus open reduction (D7671) likely a partial charge, not the full procedure |
$995.80 | $1,532 | 0.1× |
| Alveoplasty w/ extraction (D7310) | $92.95 | $143 | 0.0× |
| Alveoplasty w/o extraction (D7320) | $115.05 | $177 | 0.1× |
| Amalgam 4 or > surfaces perm (D2161) | $182 | $280 | 0.2× |
| Amalgam one surface permanen (D2140) | $70.85 | $109 | 0.1× |
| Amalgam three surfaces perma (D2160) | $145.60 | $224 | 0.2× |
| Amalgam two surfaces permane (D2150) | $87.75 | $135 | 0.1× |
| Ana crown exp 1-3 per quad (D4231) | $284.05 | $437 | 0.1× |
| Ana crown exp 4 or> per quad (D4230) | $354.90 | $546 | 0.1× |
| Ant resin-based cmpst crown (D2390) | $228.15 | $351 | 0.3× |
| Apexification/recalc final (D3353) | $434.20 | $668 | 0.5× |
| Apexification/recalc initial (D3351) | $206.05 | $317 | 0.3× |
| Apexification/recalc interim (D3352) | $87.75 | $135 | 0.1× |
| Apically positioned flap (D4245) | $213.20 | $328 | 0.1× |
| Apicoectomy - anterior (D3410) | $477.75 | $735 | 0.6× |
| Auto tissue graft 1st tooth (D4273) | $523.90 | $806 | 0.3× |
| Bdy surf activation mapg pm/cvdfb leads tm f/up (0696T) | $79.74 | $122.68 | 1.7× |
| Bio mtrls to aid soft/os reg (D4265) | $341.90 | $526 | 0.4× |
| Bitewings - three images (D0273) | $42.25 | $65 | 0.1× |
| Bitewings four images (D0274) | $48.10 | $74 | 0.2× |
| Ca screen;pelvic/breast exam (G0101) | $208.94 | $321.44 | 1.6× |
| Canal prep/fitting of dowel (D3950) | $89.70 | $138 | 0.1× |
| Catheterize for urine spec (P9612) | $8.79 | $13.53 | 0.9× |
| Closd rductn splint alveolus (D7670) | $1,276.60 | $1,964 | 0.3× |
| Comp periodontal evaluation (D0180) | $40.30 | $62 | 0.2× |
| Complete occlusal adjustment (D9952) | $205.40 | $316 | 0.3× |
| Comprehensve oral evaluation (D0150) | $42.90 | $66 | 0.3× |
| Con tissue w pedicle graft (D4276) | $612.95 | $943 | 0.3× |
| Cone beam ct both jaws (D0383) | $124.80 | $192 | 1.0× |
| Cone beam ct capt & interp (D0364) | $107.25 | $165 | 0.8× |
| Cone beam ct capt mandible (D0381) | $124.80 | $192 | 1.0× |
| Cone beam ct capt maxilla (D0382) | $124.15 | $191 | 1.0× |
| Cone beam ct capture limited (D0380) | $107.25 | $165 | 0.8× |
| Cone beam ct capture tmj (D0384) | $124.80 | $192 | 1.0× |
| Cone beam ct interp both jaw (D0367) | $124.15 | $191 | 1.0× |
| Cone beam ct interprete man (D0365) | $124.15 | $191 | 1.0× |
| Cone beam ct interprete max (D0366) | $124.15 | $191 | 1.0× |
| Cone beam ct interprete tmj (D0368) | $124.15 | $191 | 1.0× |
| Coping (D2975) | $321.75 | $495 | 0.4× |
| Core build-up incl any pins (D2950) | $131.95 | $203 | 0.2× |
| Coronectomy (D7251) | $243.75 | $375 | 0.1× |
| Covid-19 lab test non-cdc (U0002) | $143.24 | $220.37 | 2.8× |
| Crown 3/4 cast base metal (D2781) | $710.45 | $1,093 | 0.9× |
| Crown 3/4 cast noble metal (D2782) | $710.45 | $1,093 | 0.9× |
| Crown 3/4 porcelain/ceramic (D2783) | $643.50 | $990 | 0.8× |
| Crown full cast base metal (D2791) | $781.30 | $1,202 | 1.0× |
| Crown full cast high noble m (D2790) | $852.15 | $1,311 | 1.1× |
| Crown full cast noble metal (D2792) | $852.15 | $1,311 | 1.1× |
| Crown lengthen hard tissue (D4249) | $284.05 | $437 | 0.4× |
| Crown porc fused to titanium (D2753) | $852.15 | $1,311 | 1.1× |
| Crown porcelain fused base m (D2751) | $852.15 | $1,311 | 1.1× |
| Crown porcelain w/ h noble m (D2750) | $852.15 | $1,311 | 1.1× |
| Crown porcelain w/ noble met (D2752) | $852.15 | $1,311 | 1.1× |
| Crown porcelain/ceramic (D2740) | $781.30 | $1,202 | 1.0× |
| Crown repair (D2980) | $91.65 | $141 | 0.1× |
| Crown resin w/ high noble me (D2720) | $729.30 | $1,122 | 0.9× |
| Dental bitewing single image (D0270) | $17.55 | $27 | 0.2× |
| Dental bitewings two images (D0272) | $31.85 | $49 | 0.3× |
| Dental connector bar (D6920) | $111.80 | $172 | 0.1× |
| Dental inlay resin 3/mre sur (D2652) | $493.35 | $759 | 0.6× |
| Dental onlay metallic 2 surf (D2542) | $449.80 | $692 | 0.6× |
| Dental onlay metallic 3 surf (D2543) | $586.95 | $903 | 0.7× |
| Dental onlay metl 4/more sur (D2544) | $586.95 | $903 | 0.7× |
| Dental onlay porc 4/more sur (D2644) | $586.95 | $903 | 0.7× |
| Dental onlay porcelin 2 surf (D2642) | $449.80 | $692 | 0.6× |
| Dental onlay porcelin 3 surf (D2643) | $586.95 | $903 | 0.7× |
| Dental onlay resin 2 surface (D2662) | $440.70 | $678 | 0.5× |
| Dental prophylaxis adult (D1110) | $66.95 | $103 | 0.4× |
| Dental saliography (D0310) | $142.35 | $219 | 0.5× |
| Dental tmj arthrogram incl i (D0320) | $442.65 | $681 | 1.5× |
| Diab manage trn per indiv (G0108) | $159.82 | $245.87 | 2.9× |
| Diab manage trn ind/group (G0109) | $44.10 | $67.84 | 2.8× |
| Digital sub 2 or more images (D0394) | $225.55 | $347 | 2.1× |
| Direct refer hospital observ (G0379) | $1,014.20 | $1,560.31 | 1.4× |
| Dist space maint, fixed unil (D1575) | $144.30 | $222 | 0.2× |
| Drug test def 1-7 classes (G0480) | $186.98 | $287.66 | 1.6× |
| Drug test def 15-21 classes (G0482) | $582.56 | $896.25 | 2.9× |
| Drug test def 22+ classes (G0483) | $723.78 | $1,113.51 | 2.9× |
| Drug test def 8-14 classes (G0481) | $459.01 | $706.17 | 2.9× |
| Each addtnl prefab post (D2957) | $76.70 | $118 | 0.1× |
| Ekg tracing for initial prev (G0404) | $65.29 | $100.45 | 1.8× |
| Elec stim other than wound (G0283) | $40.70 | $62.62 | 3.2× |
| Elec stim unattend for press (G0281) | $40.70 | $62.62 | 3.5× |
| End thxpy, anterior tooth (D3310) | $373.75 | $575 | 0.5× |
| End thxpy, molar tooth (D3330) | $633.75 | $975 | 0.8× |
| End thxpy, premolar tooth (D3320) | $503.75 | $775 | 0.6× |
| Excision benign lesion compl (D7412) | $706.55 | $1,087 | 0.4× |
| Excision benign lesion>1.25c (D7411) | $371.80 | $572 | 0.2× |
| Excision malig lesion<=1.25c (D7413) | $572.65 | $881 | 0.3× |
| Excision malig lesion>1.25cm (D7414) | $868.40 | $1,336 | 0.4× |
| Exposure of unerupted tooth (D7280) | $267.80 | $412 | 0.3× |
| Extensv oral eval prob focus (D0160) | $97.50 | $150 | 0.6× |
| Extraction coronal remnants (D7111) | $65.65 | $101 | 0.1× |
| Extraction erupted tooth/exr (D7140) range across 2 matching MRF lines |
$127.40–$1,666.43 | $196–$2,563.74 | varies |
| Extraoral 2d project image (D0250) | $25.35 | $39 | 0.2× |
| Extraoral posterior image (D0251) | $24.05 | $37 | 0.2× |
| Fecal blood scrn immunoassay (G0328) | $57.57 | $88.57 | 3.2× |
| Fern test (Q0114) | $28.55 | $43.92 | 2.9× |
| Fixed bilat space maint, man (D1517) | $235.30 | $362 | 0.3× |
| Fixed bilat space maint, max (D1516) | $235.30 | $362 | 0.3× |
| Full mouth debridement (D4355) | $68.90 | $106 | 0.1× |
| Fusion 2 or more 3d images (D0395) | $251.55 | $387 | 2.3× |
| Gingival flap proc w/ planin (D4240) | $284.05 | $437 | 0.1× |
| Gingivectomy/plasty 1 to 3 (D4211) | $128.05 | $197 | 0.0× |
| Gingivectomy/plasty 4 or mor (D4210) | $284.05 | $437 | 0.1× |
| Gingivectomy/plasty rest (D4212) | $128.05 | $197 | 0.0× |
| Gngvl flap w rootplan 1-3 th (D4241) | $213.20 | $328 | 0.1× |
| Gross pulpal debridement (D3221) | $65 | $100 | 0.1× |
| Guided tiss regen resorble (D4266) | $226.85 | $349 | 0.1× |
| Hbot, full body chamber, 30m (G0277) | $312.32 | $480.49 | 1.8× |
| Hep c screen high risk/other (G0472) | $135.87 | $209.03 | 2.9× |
| Hepb screen high risk indiv (G0499) | $102.30 | $157.39 | 3.6× |
| I&d absc intraoral soft tiss (D7510) | $120.25 | $185 | 0.1× |
| I&d abscess extraoral (D7520) | $661.70 | $1,018 | 0.7× |
| Ig paraprotein qual imprcip&ms bld/ur w/isotype (0077U) | $115.47 | $177.64 | 2.7× |
| Impact tooth rem bony w/comp (D7241) | $291.20 | $448 | 0.4× |
| Impact tooth remov comp bony (D7240) | $273 | $420 | 0.3× |
| Impact tooth remov part bony (D7230) | $226.20 | $348 | 0.3× |
| Impact tooth remov soft tiss (D7220) | $210.60 | $324 | 0.3× |
| Incision/drain abscess extra (D7521) | $727.35 | $1,119 | 0.8× |
| Incision/drain abscess intra (D7511) | $120.25 | $185 | 0.1× |
| Incomplete endodontic tx (D3332) | $297.70 | $458 | 0.4× |
| Init/sub psych care m 1st 30 (G2214) | $62.44 | $96.06 | 0.5× |
| Initial preventive exam (G0402) | $403.93 | $621.43 | 2.4× |
| Inlay composite/resin one su (D2650) | $131.95 | $203 | 0.2× |
| Inlay porcelain/ceramic 2 su (D2620) | $449.80 | $692 | 0.6× |
| Inlay repair (D2981) | $91.65 | $141 | 0.1× |
| Intentional replantation (D3470) | $388.05 | $597 | 0.5× |
| Interim crown (D2799) | $178.10 | $274 | 0.2× |
| Internal root repair (D3333) | $111.15 | $171 | 0.1× |
| Intraor comprehensive series (D0210) | $96.85 | $149 | 0.3× |
| Intraoral occlusal film (D0240) | $20.80 | $32 | 0.2× |
| Intraoral periapical first (D0220) | $19.50 | $30 | 0.2× |
| Isolation- tooth w rubb dam (D3910) | $118.30 | $182 | 0.1× |
| Jak2 Gene Analysis Trgt Seq Alys Exons 12-15 (0027U) | $1,057.01 | $1,626.17 | 8.7× |
| Labial veneer porc indirect (D2962) | $873.60 | $1,344 | 1.1× |
| Labial veneer resin direct (D2960) | $227.50 | $350 | 0.3× |
| Labial veneer resin indirect (D2961) | $754.65 | $1,161 | 0.9× |
| Limit oral eval problm focus (D0140) | $40.30 | $62 | 0.2× |
| Limited occlusal adjustment (D9951) | $30.55 | $47 | 0.0× |
| Liver Dis 10 Assays Serum Algorithm W/Nash (0003M) | $1,047.89 | $1,612.14 | 2.1× |
| Localized delivery antimicro (D4381) | $53.95 | $83 | 0.1× |
| Mandible graft (D7950) likely a partial charge, not the full procedure |
$1,901.90 | $2,926 | 0.3× |
| Mesial/distal wedge proc (D4274) | $163.15 | $251 | 0.2× |
| Mra, w/dye, spinal canal (C8931) | $729.05 | $1,121.62 | 1.7× |
| Mra, w/o dye, spinal canal (C8932) | $539.88 | $830.59 | 1.8× |
| Mra, w/o&w/dye, spinal canal (C8933) | $729.05 | $1,121.62 | 1.7× |
| Neuro csf prion prtn qual (0035U) | $617.40 | $949.84 | 1.1× |
| Nfct ds bact&fng org id bld cul rrna fish 6+trgt (0086U) | $314.07 | $483.18 | 1.6× |
| Non-auto graft 1st tooth (D4275) | $482.95 | $743 | 0.2× |
| Non-surg tx root canal obs (D3331) | $124.15 | $191 | 0.2× |
| Obtaining screen pap smear (Q0091) | $45.80 | $70.46 | 1.3× |
| Occ guard, hard, full arch (D9944) | $195 | $300 | 0.2× |
| Occ guard, soft, full arch (D9945) | $195 | $300 | 0.2× |
| Occlusion analysis (D9950) | $102.70 | $158 | 0.1× |
| Onc merkel cell carc detcj antb serum reprtd +/- (0059U) | $760.73 | $1,170.35 | 2.4× |
| Onc Merkel Cll Carc Srm Quan (0058U) | $760.73 | $1,170.35 | 2.4× |
| Onlay repair (D2982) | $91.65 | $141 | 0.1× |
| Oral antral fistula closure (D7260) | $880.10 | $1,354 | 1.1× |
| Oral/facial photo images (D0350) | $13.65 | $21 | 0.1× |
| Osseous surg 1 to 3 teeth (D4261) | $284.05 | $437 | 0.1× |
| Osseous surgery 4 or more (D4260) likely a partial charge, not the full procedure |
$354.90 | $546 | 0.0× |
| Oth resp proc, group (G0239) | $86.78 | $133.51 | 1.9× |
| Oth resp proc, indiv (G0238) | $86.78 | $133.51 | 2.4× |
| Other tmj images by report (D0321) | $165.75 | $255 | 1.5× |
| Panoramic image (D0330) | $91 | $140 | 0.3× |
| Part pulp for apexogenesis (D3222) | $65 | $100 | 0.1× |
| Pathogen test for platelets (P9100) | $103.27 | $158.88 | 1.4× |
| Pedicle soft tissue graft pr (D4270) | $459.55 | $707 | 0.2× |
| Pelvic ring fracture uni/bil (G0413) | $10,372.22 | $15,957.26 | 1.1× |
| Periodic oral evaluation (D0120) | $29.25 | $45 | 0.2× |
| Periodontal maint procedures (D4910) | $82.55 | $127 | 0.1× |
| Periodontal scaling & root (D4341) | $151.45 | $233 | 0.2× |
| Periodontal scaling 1-3teeth (D4342) | $65.65 | $101 | 0.1× |
| Place device/marker, non pro (C9728) | $3,245.38 | $4,992.90 | 1.9× |
| Place direct restoration (D2940) | $82.55 | $127 | 0.1× |
| Place intra-socket bio dress (D7922) | $112.45 | $173 | 0.1× |
| Post 1 srfc resinbased cmpst (D2391) | $115.05 | $177 | 0.1× |
| Post 2 srfc resinbased cmpst (D2392) | $138.45 | $213 | 0.2× |
| Post 3 srfc resinbased cmpst (D2393) | $184.60 | $284 | 0.2× |
| Post >=4srfc resinbase cmpst (D2394) | $210.60 | $324 | 0.3× |
| Post and core cast + crown (D2952) | $197.60 | $304 | 0.2× |
| Potassium hydroxide preps (Q0112) | $17.08 | $26.28 | 2.9× |
| Pre 3d mdl w/ccta and/or mri (C9793) | $2,209.21 | $3,398.79 | 2.1× |
| Prefab porc/cer crown perm (D2928) | $227.50 | $350 | 0.3× |
| Prefab porc/ceram crown pri (D2929) | $158.60 | $244 | 0.2× |
| Prefab post/core + crown (D2954) | $153.40 | $236 | 0.2× |
| Prefab stainless steel crown (D2933) | $158.60 | $244 | 0.2× |
| Prefab stnlss steel crown pe (D2931) | $155.35 | $239 | 0.2× |
| Prefab stnlss steel crwn pri (D2930) | $143.65 | $221 | 0.2× |
| Prefabricated resin crown (D2932) | $202.15 | $311 | 0.3× |
| Primary closure sinus perf (D7261) | $607.10 | $934 | 0.8× |
| Prostate biopsy, any mthd (G0416) | $595.91 | $916.79 | 1.3× |
| Psa screening (G0103) | $66.59 | $102.44 | 3.4× |
| Pulp cap direct (D3110) | $36.40 | $56 | 0.0× |
| Pulp cap indirect (D3120) | $35.10 | $54 | 0.0× |
| Pulp vitality test (D0460) | $24.70 | $38 | 0.0× |
| Pulpal regeneration complete (D3357) | $434.20 | $668 | 0.5× |
| Pulpal regeneration initial (D3355) | $107.90 | $166 | 0.1× |
| Pulpal regeneration interim (D3356) | $87.75 | $135 | 0.1× |
| Pulpal therapy anterior prim (D3230) | $139.75 | $215 | 0.2× |
| Pulpal therapy posterior pri (D3240) | $193.05 | $297 | 0.2× |
| Rad exc lesion up to 1.25 cm (D7410) | $207.35 | $319 | 0.1× |
| Radiation shield (D5984) | $204.10 | $314 | 0.3× |
| Rbc DNA hea 35 ag 11 bld grp whl bld cmn allel (0001U) | $1,695.95 | $2,609.16 | 2.4× |
| Re-cement or re-bond crown (D2920) | $57.20 | $88 | 0.1× |
| Reattach tooth fragment (D2921) | $68.25 | $105 | 0.1× |
| Recement cast or prefab post (D2915) | $48.10 | $74 | 0.1× |
| Recement inlay onlay or part (D2910) | $52.65 | $81 | 0.1× |
| Recement space maint - man (D1552) | $57.20 | $88 | 0.1× |
| Recement space maint - max (D1551) | $57.20 | $88 | 0.1× |
| Recement unilat space maint (D1553) | $51.35 | $79 | 0.1× |
| Rem exostosis any site (D7471) | $371.80 | $572 | 0.1× |
| Rem imp tooth w mucoper flp (D7210) | $182 | $280 | 0.1× |
| Rem odontogen cyst > 1.25 cm (D7451) | $487.50 | $750 | 0.1× |
| Rem odontogen cyst to 1.25cm (D7450) | $349.70 | $538 | 0.1× |
| Removal fb skin/areolar tiss (D7530) | $225.55 | $347 | 0.3× |
| Removal of sloughed off bone (D7550) | $436.15 | $671 | 0.5× |
| Removal of torus palatinus (D7472) | $481 | $740 | 0.6× |
| Remove bilat space main, man (D1527) | $235.30 | $362 | 0.3× |
| Remove bilat space main, max (D1526) | $235.30 | $362 | 0.3× |
| Remove torus mandibularis (D7473) | $415.35 | $639 | 0.5× |
| Remove unilat space maintain (D1520) | $143.65 | $221 | 0.2× |
| Reshaping bone orthognathic (D7940) | $2,944.50 | $4,530 | 3.6× |
| Resin 4/> surf or w incis an (D2335) | $157.30 | $242 | 0.2× |
| Resin infiltration of lesion (D2990) | $40.30 | $62 | 0.0× |
| Resin one surface-anterior (D2330) | $93.60 | $144 | 0.1× |
| Resin three surfaces-anterio (D2332) | $130 | $200 | 0.2× |
| Resin two surfaces-anterior (D2331) | $97.50 | $150 | 0.1× |
| Restorative foundation (D2949) | $176.15 | $271 | 0.2× |
| Retreat root canal anterior (D3346) | $488.15 | $751 | 0.6× |
| Retreat root canal molar (D3348) | $871 | $1,340 | 1.1× |
| Retreat root canal premolar (D3347) | $708.50 | $1,090 | 0.9× |
| Retrograde filling (D3430) | $123.50 | $190 | 0.2× |
| Revasc intra lithotrip-ather (C9766) | $15,147.89 | $23,304.45 | 0.7× |
| Revasc intra lithotrip-stent (C9765) | $15,147.89 | $23,304.45 | 0.7× |
| Revasc intravasc lithotripsy (C9764) | $8,897.16 | $13,687.94 | 0.6× |
| Revasc lith-sten-ath tib/per (C9775) | $19,890.17 | $30,600.26 | 0.9× |
| Revasc lithotr-ather tib/per (C9774) | $19,890.17 | $30,600.26 | 0.9× |
| Revasc lithotr-stent tib/per (C9773) | $19,890.17 | $30,600.26 | 0.9× |
| Revasc lithotrip tibi/perone (C9772) | $15,147.89 | $23,304.45 | 1.1× |
| Revasc lithotrip-stent-ather (C9767) | $19,890.17 | $30,600.26 | 0.9× |
| Root amputation (D3450) | $267.80 | $412 | 0.3× |
| Root surgery molar (D3425) | $661.70 | $1,018 | 0.8× |
| Root surgery premolar (D3421) | $587.60 | $904 | 0.7× |
| Screen cerv/vag thin layer (G0123) | $73.31 | $112.79 | 3.6× |
| Screen pap by tech w md supv (P3000) | $42.95 | $66.08 | 2.3× |
| Soft tissue graft firsttooth (D4277) | $468.65 | $721 | 0.2× |
| Space maintainer fxd unilat (D1510) | $219.05 | $337 | 0.3× |
| Splint extra-coronal (D4323) | $198.90 | $306 | 0.2× |
| Splint intra-coronal (D4322) | $198.90 | $306 | 0.2× |
| Surg exp root surf anterior (D3501) | $116.35 | $179 | 0.1× |
| Surg exp root surf molar (D3503) | $116.35 | $179 | 0.1× |
| Surg exp root surf premolar (D3502) | $116.35 | $179 | 0.1× |
| Surg reduct osseoustuberosit (D7485) likely a partial charge, not the full procedure |
$481 | $740 | 0.1× |
| Surg rep root res anterior (D3471) | $232.70 | $358 | 0.3× |
| Surg rep root res molar (D3473) | $167.70 | $258 | 0.2× |
| Surg rep root res premolar (D3472) | $167.70 | $258 | 0.2× |
| Surgical splint (D5988) | $325 | $500 | 0.4× |
| Tcat Rmvl/Debulk Icar Mass Suction Device Perq (0644T) | $8,653.07 | $13,312.42 | 1.2× |
| Therapeutic procd strg endur (G0237) | $86.78 | $133.51 | 2.4× |
| Therapeutic pulpotomy (D3220) | $71.50 | $110 | 0.1× |
| Tomosynthesis, mammo (G0279) | $80.17 | $123.34 | 6.3× |
| Tooth reimplantation (D7270) | $252.20 | $388 | 0.3× |
| Tooth root removal (D7250) | $219.05 | $337 | 0.3× |
| Tooth splitting (D3920) | $267.80 | $412 | 0.3× |
| Tooth transplantation (D7272) | $252.20 | $388 | 0.3× |
| Tpmt and Nudt15 Genotype (0034U) | $1,239.43 | $1,906.82 | 2.7× |
| Trluml Perip Athrc Iliac Art (0238T) | $20,565.38 | $31,639.05 | 0.9× |
| Trtmnt simulation 3d image (D0393) | $209.95 | $323 | 1.9× |
| Tte w or w/o contr, cont ecg (C8930) | $1,320.81 | $2,032.01 | 1.3× |
| Tte w or wo fol wcon,doppler (C8929) | $1,320.81 | $2,032.01 | 1.3× |
| Unsched dialysis esrd pt hos (G0257) | $1,159.66 | $1,784.09 | 1.4× |
| Veneer repair (D2983) | $91.65 | $141 | 0.1× |
| Vert bitewings 7 to 8 images (D0277) | $50.05 | $77 | 0.2× |
| Vestibuloplasty exten graft (D7350) likely a partial charge, not the full procedure |
$1,803.10 | $2,774 | 0.2× |
| Vestibuloplasty ridge extens (D7340) likely a partial charge, not the full procedure |
$683.15 | $1,051 | 0.1× |
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.