Supplies, drugs & other prices at Community Hospital, LLC
Oklahoma City, OK · every code in this section with a posted price and a Medicare benchmark.
523 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Cash price | Gross charge | × Medicare |
|---|---|---|---|
| 2019-ncov diagnostic p (U0001) | $107.76 | — | 3.0× |
| 2d cephal radio image (D0702) | $251.10 | — | 3.0× |
| 2d cephalometric image (D0340) | $251.10 | — | 3.0× |
| 2d oral/facial photo image (D0703) | $251.10 | — | 3.0× |
| 2d tee w or w/o fol w/con,in (C8925) | $2,261.85 | — | 3.0× |
| 2d tte w or w/o fol w/con,co (C8923) | $2,261.85 | — | 3.0× |
| 2d tte w or w/o fol w/con,fu (C8924) | $1,006.62 | — | 3.0× |
| 3d anat seg imaging preop (C8001) | $371.25 | — | 3.0× |
| 3d bn img algor drvd fr mri (G0566) | $371.25 | — | 3.0× |
| Add proc construct new crown (D2971) | $1,865.31 | — | 3.0× |
| Adm of soc dtr assess 5-15 m (G0136) | $108.12 | — | 3.0× |
| Adm tocilizu covid-19 1st (M0249) | $1,272.27 | — | 3.0× |
| Adm tocilizu covid-19 2nd (M0250) | $1,272.27 | — | 3.0× |
| Admin hepatitis b vaccine (G0010) | $135.12 | — | 3.0× |
| Admin influenza virus vac (G0008) | $135.12 | — | 3.0× |
| Admin pneumococcal vaccine (G0009) | $135.12 | — | 3.0× |
| Adv prim care mgmt lvl 1 (G0556) | $108.12 | — | 3.0× |
| Adv prim care mgmt lvl 2 (G0557) | $108.12 | — | 3.0× |
| Adv prim care mgmt lvl 3 (G0558) | $293.13 | — | 3.0× |
| Alcohol/sub misuse assess (G2011) | $83.46 | — | 3.0× |
| Alcohol/subs interv 15-30mn (G0396) | $108.12 | — | 3.0× |
| Alcohol/subs interv >30 min (G0397) | $512.13 | — | 3.0× |
| Alveoloplasty not w/extracts (D7321) | $4,476.81 | — | 3.0× |
| Alveoloplasty w/extract 1-3 (D7311) | $4,476.81 | — | 3.0× |
| Alveolus clsd reduc stblz te (D7771) | $9,566.13 | — | 3.0× |
| Alveolus open reduction (D7671) | $17,080.53 | — | 3.0× |
| Alveoplasty w/ extraction (D7310) | $4,476.81 | — | 3.0× |
| Alveoplasty w/o extraction (D7320) | $4,476.81 | — | 3.0× |
| Amalgam 4 or > surfaces perm (D2161) | $1,865.31 | — | 3.0× |
| Amalgam one surface permanen (D2140) | $1,865.31 | — | 3.0× |
| Amalgam three surfaces perma (D2160) | $1,865.31 | — | 3.0× |
| Amalgam two surfaces permane (D2150) | $1,865.31 | — | 3.0× |
| Ana crown exp 1-3 per quad (D4231) | $4,476.81 | — | 3.0× |
| Ana crown exp 4 or> per quad (D4230) | $9,566.13 | — | 3.0× |
| Annual alcohol screen 15 min (G0442) | $108.12 | — | 3.0× |
| Ant resin-based cmpst crown (D2390) | $1,865.31 | — | 3.0× |
| Apexification/recalc final (D3353) | $1,865.31 | — | 3.0× |
| Apexification/recalc initial (D3351) | $1,865.31 | — | 3.0× |
| Apexification/recalc interim (D3352) | $1,865.31 | — | 3.0× |
| Apically positioned flap (D4245) | $4,476.81 | — | 3.0× |
| Apicoectomy - anterior (D3410) | $1,865.31 | — | 3.0× |
| Arthro/shoul surg; w/spacer (C9781) | $37,043.58 | — | 3.0× |
| Ascvd rsk mng clin stf pr mo (G0538) | $293.13 | — | 3.0× |
| Assessment of a patient (D0191) | $384.15 | — | 3.0× |
| Auto tissue graft 1st tooth (D4273) | $4,476.81 | — | 3.0× |
| Autolog prp not diab ulcer (G0460) | $5,953.20 | — | 3.0× |
| Behavior counsel obesity 15m (G0447) | $293.13 | — | 3.0× |
| Bio mtrls to aid soft/os reg (D4265) | $1,865.31 | — | 3.0× |
| Biological materials (D3431) | $1,865.31 | — | 3.0× |
| Bitewings - three images (D0273) | $688.44 | — | 3.0× |
| Bitewings four images (D0274) | $688.44 | — | 3.0× |
| Blind cor sinus reducer impl (C9783) | $33,308.55 | — | 3.0× |
| Blind interatrial shunt ide (C9758) | $49,423.86 | — | 3.0× |
| Blind myocar trpl bon marrow (C9782) | $49,423.86 | — | 3.0× |
| Blind/nonblind trans atrial (C9792) | $27,536.79 | — | 3.0× |
| Blinded conv. tx mdd clin tr (G2000) | $1,076.67 | — | 3.0× |
| Blood mucoprotein (P2038) | $14.85 | — | 3.0× |
| Blood thymol turbidity (P2033) | $14.85 | — | 3.0× |
| Bone graft peri per tooth (D3428) | $1,865.31 | — | 3.0× |
| Bone replce graft first site (D4263) | $1,865.31 | — | 3.0× |
| Brief alcohol misuse counsel (G0443) | $293.13 | — | 3.0× |
| Ca screen;flexi sigmoidscope (G0104) | $2,683.23 | — | 3.0× |
| Ca screen;pelvic/breast exam (G0101) | $293.13 | — | 3.0× |
| Canal prep/fitting of dowel (D3950) | $1,865.31 | — | 3.0× |
| Cardiac mri seg dys strain (C9762) | $1,576.59 | — | 3.0× |
| Cardiac mri seg dys stress (C9763) | $1,576.59 | — | 3.0× |
| Cardiokymography (Q0035) | $107.76 | — | 3.0× |
| Care manage beh svs 20mins (G0323) | $108.12 | — | 3.0× |
| Catheterize for urine spec (P9612) | $28.02 | $170 | 3.0× |
| Cbc without platelet (G0307) | $19.41 | — | 3.0× |
| Cbc/diffwbc w/o platelet (G0306) | $23.31 | — | 3.0× |
| Cephalin floculation test (P2028) | $14.85 | — | 3.0× |
| Chemo extend iv infus w/pump (G0498) | $953.04 | — | 3.0× |
| Closd rductn splint alveolus (D7670) | $9,566.13 | — | 3.0× |
| Colon ca scrn not hi rsk ind (G0121) | $2,683.23 | — | 3.0× |
| Colorectal scrn; hi risk ind (G0105) | $2,683.23 | — | 3.0× |
| Colpopexy, min/inv, ex-perit (C9778) | $14,433.60 | — | 3.0× |
| Comm hlth intg svs sdoh 60mn (G0019) | $293.13 | — | 3.0× |
| Commissure splint (D5987) | $1,865.31 | — | 3.0× |
| Comp periodontal evaluation (D0180) | $384.15 | — | 3.0× |
| Complete occlusal adjustment (D9952) | $1,865.31 | — | 3.0× |
| Complex simulation w/pet-ct (G0562) | $5,508.48 | — | 3.0× |
| Comprehensve oral evaluation (D0150) | $384.15 | — | 3.0× |
| Con tissue w pedicle graft (D4276) | $4,476.81 | — | 3.0× |
| Cone beam ct both jaws (D0383) | $301.65 | — | 3.0× |
| Cone beam ct capt & interp (D0364) | $301.65 | — | 3.0× |
| Cone beam ct capt mandible (D0381) | $301.65 | — | 3.0× |
| Cone beam ct capt maxilla (D0382) | $301.65 | — | 3.0× |
| Cone beam ct capture limited (D0380) | $301.65 | — | 3.0× |
| Cone beam ct capture tmj (D0384) | $301.65 | — | 3.0× |
| Cone beam ct interp both jaw (D0367) | $301.65 | — | 3.0× |
| Cone beam ct interprete man (D0365) | $301.65 | — | 3.0× |
| Cone beam ct interprete max (D0366) | $301.65 | — | 3.0× |
| Cone beam ct interprete tmj (D0368) | $301.65 | — | 3.0× |
| Congo red blood test (P2029) | $14.85 | — | 3.0× |
| Coping (D2975) | $1,865.31 | — | 3.0× |
| Core build-up incl any pins (D2950) | $1,865.31 | — | 3.0× |
| Coronectomy (D7251) | $4,476.81 | — | 3.0× |
| Covid-19 lab test non-cdc (U0002) | $153.93 | — | 3.0× |
| Crown 3/4 cast base metal (D2781) | $1,865.31 | — | 3.0× |
| Crown 3/4 cast hi noble met (D2780) | $1,865.31 | — | 3.0× |
| Crown 3/4 cast noble metal (D2782) | $1,865.31 | — | 3.0× |
| Crown 3/4 porcelain/ceramic (D2783) | $1,865.31 | — | 3.0× |
| Crown 3/4 resin-based compos (D2712) | $1,865.31 | — | 3.0× |
| Crown full cast base metal (D2791) | $1,865.31 | — | 3.0× |
| Crown full cast high noble m (D2790) | $1,865.31 | — | 3.0× |
| Crown full cast noble metal (D2792) | $1,865.31 | — | 3.0× |
| Crown lengthen hard tissue (D4249) | $1,865.31 | — | 3.0× |
| Crown porc fused to titanium (D2753) | $1,865.31 | — | 3.0× |
| Crown porcelain fused base m (D2751) | $1,865.31 | — | 3.0× |
| Crown porcelain w/ h noble m (D2750) | $1,865.31 | — | 3.0× |
| Crown porcelain w/ noble met (D2752) | $1,865.31 | — | 3.0× |
| Crown porcelain/ceramic (D2740) | $1,865.31 | — | 3.0× |
| Crown repair (D2980) | $1,865.31 | — | 3.0× |
| Crown resin w/ base metal (D2721) | $1,865.31 | — | 3.0× |
| Crown resin w/ high noble me (D2720) | $1,865.31 | — | 3.0× |
| Crown resin w/ noble metal (D2722) | $1,865.31 | — | 3.0× |
| Crown resin-based indirect (D2710) | $1,865.31 | — | 3.0× |
| Crown-titanium (D2794) | $1,865.31 | — | 3.0× |
| Cysto impl 4 or more (C9740) | $27,313.68 | — | 3.0× |
| Cysto, litho, vacuum kidney (C9761) | $27,313.68 | — | 3.0× |
| Cystoscopy prostatic imp 1-3 (C9739) | $15,470.43 | — | 3.0× |
| Decor or submerg erupt tooth (D3921) | $1,865.31 | — | 3.0× |
| Demonstrate use home inr mon (G0248) | $384.15 | — | 3.0× |
| Dental bitewing single image (D0270) | $251.10 | — | 3.0× |
| Dental bitewings two images (D0272) | $251.10 | — | 3.0× |
| Dental connector bar (D6920) | $1,865.31 | — | 3.0× |
| Dental gold foil one surface (D2410) | $1,865.31 | — | 3.0× |
| Dental gold foil three surfa (D2430) | $1,865.31 | — | 3.0× |
| Dental gold foil two surface (D2420) | $1,865.31 | — | 3.0× |
| Dental inlay metalic 1 surf (D2510) | $1,865.31 | — | 3.0× |
| Dental inlay metallic 2 surf (D2520) | $1,865.31 | — | 3.0× |
| Dental inlay metl 3/more sur (D2530) | $1,865.31 | — | 3.0× |
| Dental inlay resin 3/mre sur (D2652) | $1,865.31 | — | 3.0× |
| Dental onlay metallic 2 surf (D2542) | $1,865.31 | — | 3.0× |
| Dental onlay metallic 3 surf (D2543) | $1,865.31 | — | 3.0× |
| Dental onlay metl 4/more sur (D2544) | $1,865.31 | — | 3.0× |
| Dental onlay porc 3/more sur (D2630) | $1,865.31 | — | 3.0× |
| Dental onlay porc 4/more sur (D2644) | $1,865.31 | — | 3.0× |
| Dental onlay porcelin 2 surf (D2642) | $1,865.31 | — | 3.0× |
| Dental onlay porcelin 3 surf (D2643) | $1,865.31 | — | 3.0× |
| Dental onlay resin 2 surface (D2662) | $1,865.31 | — | 3.0× |
| Dental onlay resin 3 surface (D2663) | $1,865.31 | — | 3.0× |
| Dental onlay resin 4/mre sur (D2664) | $1,865.31 | — | 3.0× |
| Dental prophylaxis adult (D1110) | $384.15 | — | 3.0× |
| Dental saliography (D0310) | $688.44 | — | 3.0× |
| Dental tmj arthrogram incl i (D0320) | $688.44 | — | 3.0× |
| Dental tomographic survey (D0322) | $301.65 | — | 3.0× |
| Dental unspec restorative pr (D2999) | $1,865.31 | — | 3.0× |
| Depression screen annual (G0444) | $108.12 | — | 3.0× |
| Dermal filler injection(s) (G0429) | $5,953.20 | — | 3.0× |
| Devlopment test interpt&rep (G0451) | $293.13 | — | 3.0× |
| Digital sub 2 or more images (D0394) | $251.10 | — | 3.0× |
| Direct refer hospital observ (G0379) | $1,718.28 | $525 | 3.0× |
| Dist space maint, fixed unil (D1575) | $1,865.31 | — | 3.0× |
| Drug test def 1-7 classes (G0480) | $343.29 | — | 3.0× |
| Drug test def 15-21 classes (G0482) | $596.22 | — | 3.0× |
| Drug test def 22+ classes (G0483) | $740.76 | — | 3.0× |
| Drug test def 8-14 classes (G0481) | $469.77 | — | 3.0× |
| Drug test def simple all cl (G0659) | $186.42 | — | 3.0× |
| Dstry eye lesn,fdr vssl tech (G0186) | $1,586.91 | — | 3.0× |
| Each addtnl prefab post (D2957) | $1,865.31 | — | 3.0× |
| Eia hiv-1/hiv-2 screen (G0432) | $58.71 | — | 3.0× |
| Ekg tracing for initial prev (G0404) | $83.46 | — | 3.0× |
| Elisa hiv-1/hiv-2 screen (G0433) | $54.87 | — | 3.0× |
| End thxpy, anterior tooth (D3310) | $1,865.31 | — | 3.0× |
| End thxpy, molar tooth (D3330) | $1,865.31 | — | 3.0× |
| End thxpy, premolar tooth (D3320) | $1,865.31 | — | 3.0× |
| Endo defect closure gi tract (C9901) | $30,670.35 | — | 3.0× |
| Endo outlet restrict w/tube (C9785) | $30,670.35 | — | 3.0× |
| Endodontic endosseous implan (D3460) | $1,865.31 | — | 3.0× |
| Endodontic procedure (D3999) | $1,865.31 | — | 3.0× |
| Esd endoscopy or colonoscopy (C9779) | $11,124.24 | — | 3.0× |
| Esophag muc integ w/eso egd (C9777) | $11,124.24 | $26,225 | 3.0× |
| Excision benign lesion compl (D7412) | $4,476.81 | — | 3.0× |
| Excision benign lesion>1.25c (D7411) | $4,476.81 | — | 3.0× |
| Excision malig les complicat (D7415) | $4,476.81 | — | 3.0× |
| Excision malig lesion<=1.25c (D7413) | $4,476.81 | — | 3.0× |
| Excision malig lesion>1.25cm (D7414) | $4,476.81 | — | 3.0× |
| Exposure of unerupted tooth (D7280) | $1,865.31 | — | 3.0× |
| Extensv oral eval prob focus (D0160) | $384.15 | — | 3.0× |
| Extra oral post radio image (D0705) | $251.10 | — | 3.0× |
| Extraction coronal remnants (D7111) | $1,865.31 | — | 3.0× |
| Extraction erupted tooth/exr (D7140) | $1,865.31 | — | 3.0× |
| Extraoral 2d project image (D0250) | $251.10 | — | 3.0× |
| Extraoral posterior image (D0251) | $251.10 | — | 3.0× |
| Extrnl counterpulse, per tx (G0166) | $383.88 | — | 3.0× |
| Facial moulage complete (D5912) | $1,865.31 | — | 3.0× |
| Facial moulage sectional (D5911) | $1,865.31 | — | 3.0× |
| Facility svs dental rehab (G0330) | $9,566.13 | — | 3.0× |
| Fecal blood scrn immunoassay (G0328) | $54.15 | — | 3.0× |
| Fecal microbiota prep instil (G0455) | $2,683.23 | — | 3.0× |
| Fern test (Q0114) | $29.22 | — | 3.0× |
| Fixed bilat space maint, man (D1517) | $1,865.31 | — | 3.0× |
| Fixed bilat space maint, max (D1516) | $1,865.31 | — | 3.0× |
| Followup eval of foot pt lop (G0246) | $384.15 | — | 3.0× |
| Full mouth debridement (D4355) | $1,865.31 | — | 3.0× |
| Fusion 2 or more 3d images (D0395) | $251.10 | — | 3.0× |
| Gingival flap proc w/ planin (D4240) | $9,566.13 | — | 3.0× |
| Gingival irrigation per quad (D4921) | $384.15 | — | 3.0× |
| Gingivectomy/plasty 1 to 3 (D4211) | $9,566.13 | — | 3.0× |
| Gingivectomy/plasty 4 or mor (D4210) | $9,566.13 | — | 3.0× |
| Gingivectomy/plasty rest (D4212) | $9,566.13 | — | 3.0× |
| Glaucoma scrn hgh risk direc (G0118) | $107.76 | — | 3.0× |
| Glaucoma scrn hgh risk direc (G0117) | $83.46 | — | 3.0× |
| Gngvl flap w rootplan 1-3 th (D4241) | $4,476.81 | — | 3.0× |
| Gross pulpal debridement (D3221) | $1,865.31 | — | 3.0× |
| Group behave couns 2-10 (G0473) | $108.12 | — | 3.0× |
| Group train w/o patient (G0543) | $83.46 | — | 3.0× |
| Guided tiss regen nonresorb (D4267) | $4,476.81 | — | 3.0× |
| Guided tiss regen resorble (D4266) | $4,476.81 | — | 3.0× |
| Guided tissue regeneration (D3432) | $1,865.31 | — | 3.0× |
| Hair analysis (P2031) | $14.85 | — | 3.0× |
| Hbot, full body chamber, 30m (G0277) | $397.05 | — | 3.0× |
| Hep c screen high risk/other (G0472) | $139.05 | — | 3.0× |
| Hepb screen high risk indiv (G0499) | $84.81 | — | 3.0× |
| High inten beh couns std 30m (G0445) | $293.13 | — | 3.0× |
| Hiv combination assay (G0475) | $72.24 | — | 3.0× |
| Hiv prep counsel, clin staff (G0013) | $108.12 | — | 3.0× |
| Home sleep test/type 2 porta (G0398) | $623.01 | — | 3.0× |
| Home sleep test/type 3 porta (G0399) | $623.01 | — | 3.0× |
| Home sleep test/type 4 porta (G0400) | $623.01 | — | 3.0× |
| Hopd mntl hlt, 15-29 min (C7900) | $108.12 | — | 3.0× |
| Hopd mntl hlt, 30-60 min (C7901) | $293.13 | — | 3.0× |
| Hopd mntl hlt, grp (C7903) | $108.12 | — | 3.0× |
| Hospital outpt clinic visit (G0463) | $384.15 | — | 3.0× |
| Hpv combo assay ca screen (G0476) | $105.27 | — | 3.0× |
| I&d absc intraoral soft tiss (D7510) | $2,043.18 | — | 3.0× |
| I&d abscess extraoral (D7520) | $2,043.18 | — | 3.0× |
| Imp extar knee shck absrb (C8003) | $50,590.50 | — | 3.0× |
| Impact tooth rem bony w/comp (D7241) | $1,865.31 | — | 3.0× |
| Impact tooth remov comp bony (D7240) | $1,865.31 | — | 3.0× |
| Impact tooth remov part bony (D7230) | $1,865.31 | — | 3.0× |
| Impact tooth remov soft tiss (D7220) | $1,865.31 | — | 3.0× |
| Incision/drain abscess extra (D7521) | $2,043.18 | — | 3.0× |
| Incision/drain abscess intra (D7511) | $2,043.18 | — | 3.0× |
| Incomplete endodontic tx (D3332) | $1,865.31 | — | 3.0× |
| Init/sub psych care m 1st 30 (G2214) | $293.13 | — | 3.0× |
| Initial foot exam pt lops (G0245) | $384.15 | — | 3.0× |
| Initial preventive exam (G0402) | $384.15 | — | 3.0× |
| Inj for sacroiliac jt anesth (G0260) | $2,036.70 | — | 3.0× |
| Injection of hiv prep drug (G0012) | $207.75 | — | 3.0× |
| Inlay composite/resin one su (D2650) | $1,865.31 | — | 3.0× |
| Inlay composite/resin two su (D2651) | $1,865.31 | — | 3.0× |
| Inlay porcelain/ceramic 1 su (D2610) | $1,865.31 | — | 3.0× |
| Inlay porcelain/ceramic 2 su (D2620) | $1,865.31 | — | 3.0× |
| Inlay repair (D2981) | $1,865.31 | — | 3.0× |
| Insert cv cath inf & sup app (C9780) | $23,300.58 | — | 3.0× |
| Insert drug del implant, >=4 (G0516) | $1,288.95 | — | 3.0× |
| Insert palate implants (C9727) | $4,476.81 | — | 3.0× |
| Instill pharm renal pelvis (C9789) | $3,531.60 | $5,656 | 3.0× |
| Intens behave ther cardio dx (G0446) | $108.12 | — | 3.0× |
| Intens cardiac rehab no exer (G0423) | $371.94 | — | 3.0× |
| Intens cardiac rehab w/exerc (G0422) | $371.94 | — | 3.0× |
| Intentional replantation (D3470) | $1,865.31 | — | 3.0× |
| Interim crown (D2799) | $1,865.31 | — | 3.0× |
| Internal root repair (D3333) | $1,865.31 | — | 3.0× |
| Intraor comprehensive series (D0210) | $688.44 | — | 3.0× |
| Intraoral bite radio image (D0708) | $251.10 | — | 3.0× |
| Intraoral comp image capture (D0709) | $251.10 | — | 3.0× |
| Intraoral occlus radio image (D0706) | $251.10 | — | 3.0× |
| Intraoral occlusal film (D0240) | $251.10 | — | 3.0× |
| Intraoral periap radio image (D0707) | $251.10 | — | 3.0× |
| Intraoral periapical first (D0220) | $251.10 | — | 3.0× |
| Intraorifice barrier (D3911) | $1,865.31 | — | 3.0× |
| Intrav inf, toci, first dose (M0237) | $1,272.27 | — | 3.0× |
| Intrav inf, toci, second dos (M0238) | $1,272.27 | — | 3.0× |
| Isolation- tooth w rubb dam (D3910) | $1,865.31 | — | 3.0× |
| Iv cipaglucosidase alfa-atga (G0138) | $1,837.11 | — | 3.0× |
| Labial veneer porc indirect (D2962) | $1,865.31 | — | 3.0× |
| Labial veneer resin direct (D2960) | $1,865.31 | — | 3.0× |
| Labial veneer resin indirect (D2961) | $1,865.31 | — | 3.0× |
| Lev 1 hosp type b ed visit (G0380) | $214.47 | — | 3.0× |
| Lev 2 hosp type b ed visit (G0381) | $268.02 | — | 3.0× |
| Lev 3 hosp type b ed visit (G0382) | $495.96 | — | 3.0× |
| Lev 4 hosp type b ed visit (G0383) | $762.60 | — | 3.0× |
| Lev 5 hosp type b ed visit (G0384) | $1,185.06 | — | 3.0× |
| Limit oral eval problm focus (D0140) | $384.15 | — | 3.0× |
| Limited occlusal adjustment (D9951) | $1,865.31 | — | 3.0× |
| Localized delivery antimicro (D4381) | $1,865.31 | — | 3.0× |
| Malig tumor > 1.25 cm (D7441) | $9,566.13 | — | 3.0× |
| Malig tumor exc to 1.25 cm (D7440) | $9,566.13 | — | 3.0× |
| Mandible graft (D7950) | $17,080.53 | — | 3.0× |
| Max mri capture & interprete (D0369) | $301.65 | — | 3.0× |
| Max mri image capture (D0385) | $301.65 | — | 3.0× |
| Max ultrasound capt & interp (D0370) | $301.65 | — | 3.0× |
| Max ultrasound image capture (D0386) | $301.65 | — | 3.0× |
| Mesial/distal wedge proc (D4274) | $1,865.31 | — | 3.0× |
| Monthly tx for dmht 20mins (G0553) | $384.15 | — | 3.0× |
| Mra w/cont, abd (C8900) | $1,006.62 | — | 3.0× |
| Mra w/cont, chest (C8909) | $1,006.62 | — | 3.0× |
| Mra w/cont, lwr ext (C8912) | $1,006.62 | — | 3.0× |
| Mra w/cont, pelvis (C8918) | $1,006.62 | — | 3.0× |
| Mra w/o cont, abd (C8901) | $688.44 | — | 3.0× |
| Mra w/o cont, chest (C8910) | $688.44 | — | 3.0× |
| Mra w/o cont, lwr ext (C8913) | $688.44 | — | 3.0× |
| Mra w/o cont, pelvis (C8919) | $688.44 | — | 3.0× |
| Mra w/o fol w/cont, abd (C8902) | $1,006.62 | — | 3.0× |
| Mra w/o fol w/cont, chest (C8911) | $1,006.62 | — | 3.0× |
| Mra w/o fol w/cont, lwr ext (C8914) | $1,006.62 | — | 3.0× |
| Mra w/o fol w/cont, pelvis (C8920) | $1,006.62 | — | 3.0× |
| Mra, w/dye, spinal canal (C8931) | $1,006.62 | — | 3.0× |
| Mra, w/dye, upper extremity (C8934) | $1,006.62 | — | 3.0× |
| Mra, w/o dye, spinal canal (C8932) | $688.44 | — | 3.0× |
| Mra, w/o dye, upper extr (C8935) | $688.44 | — | 3.0× |
| Mra, w/o&w/dye, spinal canal (C8933) | $1,006.62 | — | 3.0× |
| Mra, w/o&w/dye, upper extr (C8936) | $1,006.62 | — | 3.0× |
| Mri hyperpolarized xenon129 (C9791) | $3,531.60 | — | 3.0× |
| Mri w/cont, breast, bi (C8906) | $1,006.62 | — | 3.0× |
| Mri w/cont, breast, uni (C8903) | $506.10 | — | 3.0× |
| Mri w/o fol w/cont, breast, (C8908) | $1,006.62 | — | 3.0× |
| Mri w/o fol w/cont, brst, un (C8905) | $1,006.62 | — | 3.0× |
| Nav srv peer sup 60 min pr m (G0140) | $293.13 | — | 3.0× |
| No pt prsnt train initial 30 (G0541) | $83.46 | — | 3.0× |
| Non-auto graft 1st tooth (D4275) | $4,476.81 | — | 3.0× |
| Non-blind interatrial shunt (C9760) | $77,665.26 | — | 3.0× |
| Non-cov proc, clinical trial (G0294) | $107.76 | — | 3.0× |
| Non-cov surg proc,clin trial (G0293) | $107.76 | — | 3.0× |
| Non-ionizing diag proc (D0600) | $1,865.31 | — | 3.0× |
| Non-ophthalmic fva (C9733) | $1,006.62 | — | 3.0× |
| Non-surg tx root canal obs (D3331) | $1,865.31 | — | 3.0× |
| Obtaining screen pap smear (Q0091) | $83.46 | — | 3.0× |
| Occ guard, hard, full arch (D9944) | $1,865.31 | — | 3.0× |
| Occ guard, hard, part arch (D9946) | $1,865.31 | — | 3.0× |
| Occ guard, soft, full arch (D9945) | $1,865.31 | — | 3.0× |
| Occlusion analysis (D9950) | $1,865.31 | — | 3.0× |
| Off base opioid tx 70min (G2086) | $512.13 | — | 3.0× |
| Off base opioid tx, 60 m (G2087) | $512.13 | — | 3.0× |
| Onlay repair (D2982) | $1,865.31 | — | 3.0× |
| Open reduc compd alveolus fx (D7770) | $17,080.53 | — | 3.0× |
| Open tx iliac spine uni/bil (G0412) | $20,936.43 | — | 3.0× |
| Open tx post pelvic fxcture (G0415) | $9,440.73 | — | 3.0× |
| Opps service,sched team conf (G0175) | $1,203.93 | — | 3.0× |
| Oral antral fistula closure (D7260) | $1,865.31 | — | 3.0× |
| Oral hiv-1/hiv-2 screen (G0435) | $35.94 | — | 3.0× |
| Oral/facial photo images (D0350) | $251.10 | — | 3.0× |
| Osseous surg 1 to 3 teeth (D4261) | $9,566.13 | — | 3.0× |
| Osseous surgery 4 or more (D4260) | $17,080.53 | — | 3.0× |
| Oth resp proc, group (G0239) | $107.76 | — | 3.0× |
| Oth resp proc, indiv (G0238) | $83.46 | — | 3.0× |
| Other tmj images by report (D0321) | $251.10 | — | 3.0× |
| Pano radio image (D0701) | $251.10 | — | 3.0× |
| Panoramic image (D0330) | $688.44 | — | 3.0× |
| Part pulp for apexogenesis (D3222) | $1,865.31 | — | 3.0× |
| Pathogen test for platelets (P9100) | $170.22 | — | 3.0× |
| Pedicle soft tissue graft pr (D4270) | $4,476.81 | — | 3.0× |
| Pef bronch ablt 3d nav ebus (C8005) | $49,423.86 | — | 3.0× |
| Pelvic ring fracture uni/bil (G0413) | $20,936.43 | — | 3.0× |
| Pelvic ring fx treat int fix (G0414) | $20,936.43 | — | 3.0× |
| Pemivibart infusion (M0224) | $1,272.27 | — | 3.0× |
| Perc d-e cor revasc chro sin (C9607) | $52,892.43 | — | 3.0× |
| Perc d-e cor revasc t cabg s (C9604) | $33,308.55 | — | 3.0× |
| Perc d-e cor stent ather s (C9602) | $52,892.43 | — | 3.0× |
| Perc drug-el cor stent sing (C9600) | $33,308.55 | — | 3.0× |
| Periodic oral evaluation (D0120) | $384.15 | — | 3.0× |
| Periodontal maint procedures (D4910) | $1,865.31 | — | 3.0× |
| Periodontal scaling & root (D4341) | $1,865.31 | — | 3.0× |
| Periodontal scaling 1-3teeth (D4342) | $1,865.31 | — | 3.0× |
| Pet not otherwise specified (G0235) | $1,153.47 | — | 3.0× |
| Pild/placebo control clin tr (G0276) | $20,936.43 | — | 3.0× |
| Pin service 60m per month (G0023) | $293.13 | — | 3.0× |
| Pinworm examinations (Q0113) | $12.81 | — | 3.0× |
| Place device/marker, non pro (C9728) | $3,993.63 | — | 3.0× |
| Place direct restoration (D2940) | $1,865.31 | — | 3.0× |
| Place endorectal app (C9725) | $2,683.23 | — | 3.0× |
| Place intra-socket bio dress (D7922) | $1,865.31 | — | 3.0× |
| Pne flu hepb cov home admin (M0201) | $104.07 | — | 3.0× |
| Post 1 srfc resinbased cmpst (D2391) | $1,865.31 | — | 3.0× |
| Post 2 srfc resinbased cmpst (D2392) | $1,865.31 | — | 3.0× |
| Post 3 srfc resinbased cmpst (D2393) | $1,865.31 | — | 3.0× |
| Post >=4srfc resinbase cmpst (D2394) | $1,865.31 | — | 3.0× |
| Post and core cast + crown (D2952) | $1,865.31 | — | 3.0× |
| Post d/c phone follow up (G0544) | $293.13 | — | 3.0× |
| Post op service lvrs min 6 (G0305) | $1,076.67 | — | 3.0× |
| Post-coital mucous exam (Q0115) | $75 | — | 3.0× |
| Potassium hydroxide preps (Q0112) | $17.49 | — | 3.0× |
| Pre 3d mdl w/ccta and/or mri (C9793) | $2,477.73 | — | 3.0× |
| Pre-op service lvrs 1-9 dos (G0304) | $1,076.67 | — | 3.0× |
| Pre-op service lvrs 10-15dos (G0303) | $623.01 | — | 3.0× |
| Pre-op service lvrs complete (G0302) | $1,076.67 | — | 3.0× |
| Prefab porc/cer crown perm (D2928) | $1,865.31 | — | 3.0× |
| Prefab porc/ceram crown pri (D2929) | $1,865.31 | — | 3.0× |
| Prefab post/core + crown (D2954) | $1,865.31 | — | 3.0× |
| Prefab stainless steel crown (D2933) | $1,865.31 | — | 3.0× |
| Prefab steel crown primary (D2934) | $1,865.31 | — | 3.0× |
| Prefab stnlss steel crown pe (D2931) | $1,865.31 | — | 3.0× |
| Prefab stnlss steel crwn pri (D2930) | $1,865.31 | — | 3.0× |
| Prefabricated resin crown (D2932) | $1,865.31 | — | 3.0× |
| Prep skin cell susp, automtd (C8002) | $20,476.44 | — | 3.0× |
| Primary closure sinus perf (D7261) | $1,865.31 | — | 3.0× |
| Prolonged iv inf, req pump (C8957) | $613.71 | — | 3.0× |
| Prostate biopsy, any mthd (G0416) | $1,034.22 | — | 3.0× |
| Provide inr test mater/equip (G0249) | $384.15 | — | 3.0× |
| Psa screening (G0103) | $57.93 | — | 3.0× |
| Pulp cap direct (D3110) | $1,865.31 | — | 3.0× |
| Pulp cap indirect (D3120) | $1,865.31 | — | 3.0× |
| Pulp vitality test (D0460) | $1,865.31 | — | 3.0× |
| Pulpal regeneration complete (D3357) | $1,865.31 | — | 3.0× |
| Pulpal regeneration initial (D3355) | $1,865.31 | — | 3.0× |
| Pulpal regeneration interim (D3356) | $1,865.31 | — | 3.0× |
| Pulpal therapy anterior prim (D3230) | $1,865.31 | — | 3.0× |
| Pulpal therapy posterior pri (D3240) | $1,865.31 | — | 3.0× |
| Rad exc lesion up to 1.25 cm (D7410) | $4,476.81 | — | 3.0× |
| Radiation applicator (D5983) | $1,865.31 | — | 3.0× |
| Radiation cone locator (D5985) | $1,865.31 | — | 3.0× |
| Radiation shield (D5984) | $1,865.31 | — | 3.0× |
| Re-cement or re-bond crown (D2920) | $1,865.31 | — | 3.0× |
| Re-eval post-op visit (D0171) | $384.15 | — | 3.0× |
| Re-eval,est pt,problem focus (D0170) | $384.15 | — | 3.0× |
| Reattach tooth fragment (D2921) | $1,865.31 | — | 3.0× |
| Recement cast or prefab post (D2915) | $1,865.31 | — | 3.0× |
| Recement inlay onlay or part (D2910) | $1,865.31 | — | 3.0× |
| Recement space maint - man (D1552) | $1,865.31 | — | 3.0× |
| Recement space maint - max (D1551) | $1,865.31 | — | 3.0× |
| Recement unilat space maint (D1553) | $1,865.31 | — | 3.0× |
| Rem exostosis any site (D7471) | $9,566.13 | — | 3.0× |
| Rem imp tooth w mucoper flp (D7210) | $4,476.81 | — | 3.0× |
| Rem nonodonto cyst > 1.25 cm (D7461) | $1,865.31 | — | 3.0× |
| Rem nonodonto cyst to 1.25cm (D7460) | $1,865.31 | — | 3.0× |
| Rem odontogen cyst > 1.25 cm (D7451) | $9,566.13 | — | 3.0× |
| Rem odontogen cyst to 1.25cm (D7450) | $9,566.13 | — | 3.0× |
| Removal fb skin/areolar tiss (D7530) | $1,865.31 | — | 3.0× |
| Removal of fb reaction (D7540) | $1,865.31 | — | 3.0× |
| Removal of sloughed off bone (D7550) | $1,865.31 | — | 3.0× |
| Removal of torus palatinus (D7472) | $1,865.31 | — | 3.0× |
| Remove bilat space main, man (D1527) | $1,865.31 | — | 3.0× |
| Remove bilat space main, max (D1526) | $1,865.31 | — | 3.0× |
| Remove drug implant (G0517) | $1,288.95 | — | 3.0× |
| Remove torus mandibularis (D7473) | $1,865.31 | — | 3.0× |
| Remove unilat space maintain (D1520) | $1,865.31 | — | 3.0× |
| Remove w insert drug implant (G0518) | $1,288.95 | — | 3.0× |
| Replacment pt electronic sys (G0555) | $2,477.73 | — | 3.0× |
| Reshaping bone orthognathic (D7940) | $1,865.31 | — | 3.0× |
| Resin 4/> surf or w incis an (D2335) | $1,865.31 | — | 3.0× |
| Resin infiltration of lesion (D2990) | $1,865.31 | — | 3.0× |
| Resin one surface-anterior (D2330) | $1,865.31 | — | 3.0× |
| Resin three surfaces-anterio (D2332) | $1,865.31 | — | 3.0× |
| Resin two surfaces-anterior (D2331) | $1,865.31 | — | 3.0× |
| Restorative foundation (D2949) | $1,865.31 | — | 3.0× |
| Retreat root canal anterior (D3346) | $1,865.31 | — | 3.0× |
| Retreat root canal molar (D3348) | $1,865.31 | — | 3.0× |
| Retreat root canal premolar (D3347) | $1,865.31 | — | 3.0× |
| Retrograde filling (D3430) | $1,865.31 | — | 3.0× |
| Revasc intra lithotrip-ather (C9766) | $52,892.43 | — | 3.0× |
| Revasc intra lithotrip-stent (C9765) | $52,892.43 | — | 3.0× |
| Revasc intravasc lithotripsy (C9764) | $33,308.55 | — | 3.0× |
| Revasc lith-sten-ath tib/per (C9775) | $52,892.43 | — | 3.0× |
| Revasc lithotr-ather tib/per (C9774) | $52,892.43 | — | 3.0× |
| Revasc lithotr-stent tib/per (C9773) | $52,892.43 | — | 3.0× |
| Revasc lithotrip tibi/perone (C9772) | $33,308.55 | — | 3.0× |
| Revasc lithotrip-stent-ather (C9767) | $52,892.43 | — | 3.0× |
| Risk ascvd tst once pr 12 mo (G0537) | $108.12 | — | 3.0× |
| Root amputation (D3450) | $1,865.31 | — | 3.0× |
| Root surgery molar (D3425) | $1,865.31 | — | 3.0× |
| Root surgery premolar (D3421) | $1,865.31 | — | 3.0× |
| Routine footcare pt w lops (G0247) | $578.88 | — | 3.0× |
| Rpr intst excl anrect fist (C9796) | $8,008.65 | — | 3.0× |
| Sbrt w/positron emission del (G0563) | $9,179.88 | — | 3.0× |
| Scaling gingiv inflammation (D4346) | $1,865.31 | — | 3.0× |
| Scr c/v cyto, automated sys (G0147) | $55.62 | — | 3.0× |
| Scr c/v cyto, autosys, rescr (G0148) | $95.82 | — | 3.0× |
| Scr c/v cyto,thinlayer,rescr (G0144) | $131.91 | — | 3.0× |
| Scr c/v cyto,thinlayer,rescr (G0145) | $79.47 | — | 3.0× |
| Scr c/v cyto,thinlayer,rescr (G0143) | $81.15 | — | 3.0× |
| Screen cerv/vag thin layer (G0123) | $60.78 | — | 3.0× |
| Screen pap by tech w md supv (P3000) | $55.62 | — | 3.0× |
| Screening hep c detect (G0567) | $105.27 | — | 3.0× |
| Semen analysis (G0027) | $19.50 | — | 3.0× |
| Sialoendoscopy capt & interp (D0371) | $251.10 | — | 3.0× |
| Sim ang w/prs cath rad emb (C8004) | $33,308.55 | — | 3.0× |
| Single energy x-ray study (G0130) | $301.65 | — | 3.0× |
| Soft tissue graft firsttooth (D4277) | $4,476.81 | — | 3.0× |
| Software meas of cardiac vol (G0183) | $251.10 | — | 3.0× |
| Space maintainer fxd unilat (D1510) | $1,865.31 | — | 3.0× |
| Spine device implant surgery (C9757) | $37,043.58 | — | 3.0× |
| Splint extra-coronal (D4323) | $1,865.31 | — | 3.0× |
| Splint intra-coronal (D4322) | $1,865.31 | — | 3.0× |
| Supply of digital device (G0552) | $384.15 | — | 3.0× |
| Surg exp root surf anterior (D3501) | $1,865.31 | — | 3.0× |
| Surg exp root surf molar (D3503) | $1,865.31 | — | 3.0× |
| Surg exp root surf premolar (D3502) | $1,865.31 | — | 3.0× |
| Surg reduct osseoustuberosit (D7485) | $17,080.53 | — | 3.0× |
| Surg rep root res anterior (D3471) | $1,865.31 | — | 3.0× |
| Surg rep root res molar (D3473) | $1,865.31 | — | 3.0× |
| Surg rep root res premolar (D3472) | $1,865.31 | — | 3.0× |
| Surgical revision procedure (D4268) | $1,865.31 | — | 3.0× |
| Surgical splint (D5988) | $1,865.31 | — | 3.0× |
| Tee w or w/o fol w/cont, mon (C8927) | $2,261.85 | — | 3.0× |
| Tee w or w/o fol w/cont,cong (C8926) | $2,261.85 | — | 3.0× |
| Therapeutic procd strg endur (G0237) | $83.46 | — | 3.0× |
| Therapeutic pulpotomy (D3220) | $1,865.31 | — | 3.0× |
| Tmj arthroscopy disc reposit (D7874) | $9,440.73 | — | 3.0× |
| Tooth pin retention (D2951) | $1,865.31 | — | 3.0× |
| Tooth reimplantation (D7270) | $1,865.31 | — | 3.0× |
| Tooth root removal (D7250) | $1,865.31 | — | 3.0× |
| Tooth splitting (D3920) | $1,865.31 | — | 3.0× |
| Tooth transplantation (D7272) | $1,865.31 | — | 3.0× |
| Transseptal fiberotomy (D7291) | $1,865.31 | — | 3.0× |
| Trauma respons w/hosp criti (G0390) | $3,845.85 | — | 3.0× |
| Treatment of complications (D9930) | $1,865.31 | — | 3.0× |
| Trim nail(s) (G0127) | $170.22 | — | 3.0× |
| Trtmnt simulation 3d image (D0393) | $251.10 | — | 3.0× |
| Tte w or w/o contr, cont ecg (C8930) | $2,261.85 | — | 3.0× |
| Tte w or w/o fol w/con,stres (C8928) | $2,261.85 | — | 3.0× |
| Tte w or w/o fol w/cont, com (C8921) | $2,261.85 | — | 3.0× |
| Tte w or w/o fol w/cont, f/u (C8922) | $2,261.85 | — | 3.0× |
| Tte w or wo fol wcon,doppler (C8929) | $2,261.85 | — | 3.0× |
| U/s trtmt, not leiomyomata (C9734) | $37,043.58 | — | 3.0× |
| Unsched dialysis esrd pt hos (G0257) | $1,980.24 | — | 3.0× |
| Unscheduled dressing change (D4920) | $1,865.31 | — | 3.0× |
| Unspecified periodontal proc (D4999) | $683.40 | — | 3.0× |
| Urine specimen collect mult (P9615) | $28.02 | — | 3.0× |
| Vasc emb/occ w/prs cath (C9797) | $52,892.43 | — | 3.0× |
| Ven blood coll snf/hha (G0471) | $34.02 | — | 3.0× |
| Veneer repair (D2983) | $1,865.31 | — | 3.0× |
| Vert bitewings 7 to 8 images (D0277) | $688.44 | — | 3.0× |
| Vestibuloplasty exten graft (D7350) | $17,080.53 | — | 3.0× |
| Vestibuloplasty ridge extens (D7340) | $17,080.53 | — | 3.0× |
| Visit esketamine 56m or less (G2082) | $2,966.76 | — | 3.0× |
| Visit esketamine, > 56m (G2083) | $4,661.25 | — | 3.0× |
| Visit to determ ldct elig (G0296) | $293.13 | — | 3.0× |
| Warfarin respon genetic test (G9143) | $362.16 | — | 3.0× |
| Wet mounts/ w preparations (Q0111) | $55.62 | — | 3.0× |