Supplies, drugs & other prices at Franklin County Memorial Hospital
Meadville, MS · every code in this section with a posted price and a Medicare benchmark.
52 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|---|---|---|
| Admin influenza virus vac (G0008) | $30 | $30 | 0.7× |
| Admin pneumococcal vaccine (G0009) | $20 | $20 | 0.5× |
| Alveoloplasty w/extract 1-3 (D7311) | $128 | $128 | 0.1× |
| Alveoplasty w/ extraction (D7310) | $145 | $145 | 0.1× |
| Alveoplasty w/o extraction (D7320) | $220 | $220 | 0.2× |
| Comprehensve oral evaluation (D0150) | $80 | $80 | 0.7× |
| Coronectomy (D7251) | $300 | $300 | 0.2× |
| Covid-19 lab test non-cdc (U0002) | $92 | $92 | 1.8× |
| Crown lengthen hard tissue (D4249) | $100 | $100 | 0.2× |
| Direct refer hospital observ (G0379) | $69 | $69 | 0.1× |
| Drug test def 1-7 classes (G0480) | $54 | $54 | 0.5× |
| Elec stim other than wound (G0283) | $26 | $26 | 2.0× |
| End thxpy, anterior tooth (D3310) | $400 | $400 | 0.7× |
| End thxpy, molar tooth (D3330) | $595 | $595 | 1.1× |
| End thxpy, premolar tooth (D3320) | $491 | $491 | 0.9× |
| Excision benign lesion>1.25c (D7411) | $615 | $615 | 0.5× |
| Exposure of unerupted tooth (D7280) | $450 | $450 | 0.8× |
| Extraction erupted tooth/exr (D7140) | $284 | $284 | 0.5× |
| Gingivectomy/plasty 1 to 3 (D4211) | $176 | $176 | 0.1× |
| Guided tiss regen resorble (D4266) | $200 | $200 | 0.1× |
| Hep c screen high risk/other (G0472) | $50 | $50 | 1.1× |
| Hepb screen high risk indiv (G0499) | $40 | $40 | 1.4× |
| I&d absc intraoral soft tiss (D7510) | $164.50 | $164.50 | 0.3× |
| I&d abscess extraoral (D7520) | $670 | $670 | 1.1× |
| Impact tooth rem bony w/comp (D7241) | $490.50 | $490.50 | 0.9× |
| Impact tooth remov comp bony (D7240) | $461.50 | $461.50 | 0.8× |
| Impact tooth remov part bony (D7230) | $439 | $439 | 0.8× |
| Impact tooth remov soft tiss (D7220) | $416.50 | $416.50 | 0.7× |
| Initial preventive exam (G0402) | $115 | $115 | 1.0× |
| Limit oral eval problm focus (D0140) | $65 | $65 | 0.6× |
| Mandible graft (D7950) likely a partial charge, not the full procedure |
$425 | $425 | 0.1× |
| Obtaining screen pap smear (Q0091) | $50 | $50 | 2.0× |
| Oral antral fistula closure (D7260) | $1,127.50 | $1,127.50 | 2.0× |
| Ppps, initial visit (G0438) | $160 | $160 | 0.9× |
| Ppps, subseq visit (G0439) | $150 | $150 | 1.1× |
| Psa screening (G0103) | $104 | $104 | 5.4× |
| Rad exc lesion up to 1.25 cm (D7410) | $400 | $400 | 0.3× |
| Re-eval,est pt,problem focus (D0170) | $100 | $100 | 0.9× |
| Rem exostosis any site (D7471) | $483.50 | $483.50 | 0.2× |
| Rem imp tooth w mucoper flp (D7210) | $707 | $707 | 0.5× |
| Rem nonodonto cyst > 1.25 cm (D7461) | $600 | $600 | 1.1× |
| Rem nonodonto cyst to 1.25cm (D7460) | $400 | $400 | 0.7× |
| Rem odontogen cyst > 1.25 cm (D7451) | $540 | $540 | 0.2× |
| Rem odontogen cyst to 1.25cm (D7450) | $407.50 | $407.50 | 0.1× |
| Removal fb skin/areolar tiss (D7530) | $300 | $300 | 0.5× |
| Removal of sloughed off bone (D7550) | $251.50 | $251.50 | 0.5× |
| Remove torus mandibularis (D7473) | $690 | $690 | 1.2× |
| Tooth reimplantation (D7270) | $450 | $450 | 0.8× |
| Tooth root removal (D7250) | $614 | $614 | 1.1× |
| Trauma respons w/hosp criti (G0390) | $1,000 | $1,000 | 0.9× |
| Trim nail(s) (G0127) | $118 | $118 | 2.3× |
| Visit to determ ldct elig (G0296) | $215 | $215 | 2.5× |