Supplies, drugs & other prices at Kaleida Health
Buffalo, NY · every code in this section with a posted price and a Medicare benchmark.
260 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) | $232 | $232 | 2.1× |
| Adapt bhv tx prtcl modificaj ea 15 min tech time (0373T) | $90 | $90 | 1.9× |
| Add proc construct new crown (D2971) | $510 | $510 | 0.6× |
| Adm of soc dtr assess 5-15 m (G0136) | $105 | $105 | 2.2× |
| Alveoloplasty not w/extracts (D7321) | $840 | $840 | 0.4× |
| Alveoloplasty w/extract 1-3 (D7311) | $513 | $513 | 0.3× |
| Alveolus clsd reduc stblz te (D7771) | $1,443 | $1,443 | 0.3× |
| Alveolus open reduction (D7671) likely a partial charge, not the full procedure |
$698 | $698 | 0.1× |
| Alveoplasty w/ extraction (D7310) | $513 | $513 | 0.3× |
| Alveoplasty w/o extraction (D7320) | $840 | $840 | 0.4× |
| Amalgam 4 or > surfaces perm (D2161) | $425 | $425 | 0.5× |
| Amalgam one surface permanen (D2140) | $224 | $224 | 0.3× |
| Amalgam three surfaces perma (D2160) | $349 | $349 | 0.4× |
| Amalgam two surfaces permane (D2150) | $294 | $294 | 0.4× |
| Ana crown exp 1-3 per quad (D4231) | $1,027 | $1,027 | 0.5× |
| Ana crown exp 4 or> per quad (D4230) | $1,370 | $1,370 | 0.3× |
| Anatomic guide 3d printed 1st anatomic guide (0561T) | $197 | $197 | 1.2× |
| Anatomic Model 3D Printed 1St Compnt Antmc Strux (0559T) | $197 | $197 | 1.2× |
| Ant resin-based cmpst crown (D2390) | $828 | $828 | 1.0× |
| Apexification/recalc final (D3353) | $862 | $862 | 1.1× |
| Apexification/recalc initial (D3351) | $630 | $630 | 0.8× |
| Apexification/recalc interim (D3352) | $461 | $461 | 0.6× |
| Apically positioned flap (D4245) | $1,563 | $1,563 | 0.8× |
| Apicoectomy - anterior (D3410) | $1,162 | $1,162 | 1.4× |
| Auto tissue graft 1st tooth (D4273) | $1,992 | $1,992 | 1.0× |
| Bhv id suprt assmt ea 15 min (0362T) | $90 | $90 | 1.9× |
| Bio mtrls to aid soft/os reg (D4265) | $789 | $789 | 1.0× |
| Bitewings - three images (D0273) | $105 | $105 | 0.4× |
| Bitewings four images (D0274) | $140 | $140 | 0.5× |
| Bone replce graft first site (D4263) | $1,253 | $1,253 | 1.6× |
| Ca screen;flexi sigmoidscope (G0104) | $1,042 | $1,042 | 0.9× |
| Ca screen;pelvic/breast exam (G0101) | $348 | $348 | 2.7× |
| Canal prep/fitting of dowel (D3950) | $448 | $448 | 0.6× |
| Closd rductn splint alveolus (D7670) | $2,605 | $2,605 | 0.6× |
| Commissure splint (D5987) | $651 | $651 | 0.8× |
| Comp periodontal evaluation (D0180) | $165 | $165 | 1.0× |
| Complete occlusal adjustment (D9952) | $1,245 | $1,245 | 1.5× |
| Comprehensve oral evaluation (D0150) | $146 | $146 | 0.9× |
| Computed tomography scan taken for the purpose of biomechanical computed tomography analysis Non-Facility Physician (0558T) | $211 | $211 | 1.9× |
| Con tissue w pedicle graft (D4276) | $2,058 | $2,058 | 1.1× |
| Cone beam ct capt mandible (D0381) | $134 | $134 | 1.0× |
| Cone beam ct capt maxilla (D0382) | $134 | $134 | 1.0× |
| Cone beam ct capture limited (D0380) | $613 | $613 | 4.7× |
| Coping (D2975) | $25 | $25 | 0.0× |
| Core build-up incl any pins (D2950) | $504 | $504 | 0.6× |
| Crown 3/4 cast base metal (D2781) | $1,857 | $1,857 | 2.3× |
| Crown 3/4 cast hi noble met (D2780) | $1,953 | $1,953 | 2.4× |
| Crown 3/4 cast noble metal (D2782) | $1,896 | $1,896 | 2.3× |
| Crown 3/4 porcelain/ceramic (D2783) | $2,058 | $2,058 | 2.6× |
| Crown full cast base metal (D2791) | $1,755 | $1,755 | 2.2× |
| Crown full cast high noble m (D2790) | $1,966 | $1,966 | 2.4× |
| Crown full cast noble metal (D2792) | $1,867 | $1,867 | 2.3× |
| Crown lengthen hard tissue (D4249) | $1,370 | $1,370 | 1.7× |
| Crown porcelain fused base m (D2751) | $1,839 | $1,839 | 2.3× |
| Crown porcelain w/ h noble m (D2750) | $1,998 | $1,998 | 2.5× |
| Crown porcelain w/ noble met (D2752) | $1,901 | $1,901 | 2.4× |
| Crown porcelain/ceramic (D2740) | $1,992 | $1,992 | 2.5× |
| Crown repair (D2980) | $497 | $497 | 0.6× |
| Crown resin w/ base metal (D2721) | $1,782 | $1,782 | 2.2× |
| Crown resin w/ high noble me (D2720) | $1,912 | $1,912 | 2.4× |
| Crown resin w/ noble metal (D2722) | $1,857 | $1,857 | 2.3× |
| Crown resin-based indirect (D2710) | $1,539 | $1,539 | 1.9× |
| Crtj Subq Insj Impltbl Glucose Sensor Sys Train (0446T) unusually low: confirm this is the full procedure |
$1,796 | $1,796 | 0.3× |
| CT breast w/3d rendering bi with contrast (0637T) | $1,268 | $1,268 | 2.9× |
| CT breast w/3d rendering bi without contrast (0636T) | $793 | $793 | 2.7× |
| CT breast w/3d rendering uni with contrast (0634T) | $615 | $615 | 2.8× |
| CT breast w/3d rendering uni without contrast (0633T) | $376 | $376 | 2.9× |
| CT brst w/3d rendering bi wo cntrst flwd cntrst (0638T) | $1,268 | $1,268 | 2.9× |
| CT brst w/3d rendering uni wo cntrst flwd cntrst (0635T) | $615 | $615 | 2.8× |
| Dental bitewing single image (D0270) | $49 | $49 | 0.5× |
| Dental bitewings two images (D0272) | $82 | $82 | 0.8× |
| Dental connector bar (D6920) | $1,862 | $1,862 | 2.3× |
| Dental gold foil one surface (D2410) | $1,065 | $1,065 | 1.3× |
| Dental gold foil three surfa (D2430) | $1,396 | $1,396 | 1.7× |
| Dental gold foil two surface (D2420) | $1,203 | $1,203 | 1.5× |
| Dental inlay metalic 1 surf (D2510) | $1,419 | $1,419 | 1.8× |
| Dental inlay metallic 2 surf (D2520) | $1,607 | $1,607 | 2.0× |
| Dental inlay metl 3/more sur (D2530) | $1,809 | $1,809 | 2.2× |
| Dental inlay resin 3/mre sur (D2652) | $1,651 | $1,651 | 2.0× |
| Dental onlay metallic 2 surf (D2542) | $1,737 | $1,737 | 2.2× |
| Dental onlay metallic 3 surf (D2543) | $1,831 | $1,831 | 2.3× |
| Dental onlay metl 4/more sur (D2544) | $1,930 | $1,930 | 2.4× |
| Dental onlay porc 3/more sur (D2630) | $1,823 | $1,823 | 2.3× |
| Dental onlay porc 4/more sur (D2644) | $1,972 | $1,972 | 2.4× |
| Dental onlay porcelin 2 surf (D2642) | $1,888 | $1,888 | 2.3× |
| Dental onlay porcelin 3 surf (D2643) | $1,969 | $1,969 | 2.4× |
| Dental onlay resin 2 surface (D2662) | $1,768 | $1,768 | 2.2× |
| Dental onlay resin 3 surface (D2663) | $1,800 | $1,800 | 2.2× |
| Dental onlay resin 4/mre sur (D2664) | $2,365 | $2,365 | 2.9× |
| Dental prophylaxis adult (D1110) | $165 | $165 | 1.0× |
| Dental saliography (D0310) | $560 | $560 | 1.9× |
| Dental tmj arthrogram incl i (D0320) | $995 | $995 | 3.3× |
| Dental tomographic survey (D0322) | $980 | $980 | 7.5× |
| Dental unspec restorative pr (D2999) range across 4 matching MRF lines |
$212–$525 | $212–$525 | varies |
| Diab manage trn per indiv (G0108) | $180 | $180 | 3.2× |
| Diab manage trn ind/group (G0109) | $90 | $90 | 5.6× |
| Direct refer hospital observ (G0379) | $2,045 | $2,045 | 2.8× |
| Each addtnl prefab post (D2957) | $250 | $250 | 0.3× |
| End thxpy, anterior tooth (D3310) | $1,240 | $1,240 | 1.5× |
| End thxpy, molar tooth (D3330) | $1,823 | $1,823 | 2.3× |
| End thxpy, premolar tooth (D3320) | $1,508 | $1,508 | 1.9× |
| Endodontic endosseous implan (D3460) | $2,380 | $2,380 | 2.9× |
| Endodontic procedure (D3999) | $212 | $212 | 0.3× |
| Excision benign lesion compl (D7412) | $1,255 | $1,255 | 0.6× |
| Excision benign lesion>1.25c (D7411) | $1,083 | $1,083 | 0.6× |
| Excision malig les complicat (D7415) | $1,258 | $1,258 | 0.6× |
| Excision malig lesion<=1.25c (D7413) | $1,130 | $1,130 | 0.6× |
| Excision malig lesion>1.25cm (D7414) | $1,526 | $1,526 | 0.8× |
| Exposure of unerupted tooth (D7280) | $873 | $873 | 1.1× |
| Extensv oral eval prob focus (D0160) | $255 | $255 | 1.5× |
| Extraction coronal remnants (D7111) | $260 | $260 | 0.3× |
| Extraction erupted tooth/exr (D7140) | $266 | $266 | 0.3× |
| Extraoral 2d project image (D0250) | $109 | $109 | 1.0× |
| Extraoral posterior image (D0251) | $86 | $86 | 0.8× |
| Facial moulage complete (D5912) | $453 | $453 | 0.6× |
| Facial moulage sectional (D5911) | $302 | $302 | 0.4× |
| Fixed bilat space maint, man (D1517) | $1,170 | $1,170 | 1.4× |
| Fixed bilat space maint, max (D1516) | $1,170 | $1,170 | 1.4× |
| Full mouth debridement (D4355) | $333 | $333 | 0.4× |
| Gingival flap proc w/ planin (D4240) | $1,408 | $1,408 | 0.3× |
| Gingivectomy/plasty 1 to 3 (D4211) | $482 | $482 | 0.1× |
| Gingivectomy/plasty 4 or mor (D4210) | $1,205 | $1,205 | 0.3× |
| Gngvl flap w rootplan 1-3 th (D4241) | $1,123 | $1,123 | 0.6× |
| Gross pulpal debridement (D3221) | $370 | $370 | 0.5× |
| Group mnt 2 or more 30 mins (G0271) | $30 | $30 | 1.8× |
| Guided tiss regen nonresorb (D4267) | $1,896 | $1,896 | 1.0× |
| Guided tiss regen resorble (D4266) | $1,625 | $1,625 | 0.8× |
| I&d absc intraoral soft tiss (D7510) | $406 | $406 | 0.5× |
| I&d abscess extraoral (D7520) | $654 | $654 | 0.7× |
| Impact tooth rem bony w/comp (D7241) | $1,144 | $1,144 | 1.4× |
| Impact tooth remov comp bony (D7240) | $896 | $896 | 1.1× |
| Impact tooth remov part bony (D7230) | $764 | $764 | 0.9× |
| Impact tooth remov soft tiss (D7220) | $640 | $640 | 0.8× |
| Incision/drain abscess extra (D7521) | $654 | $654 | 0.7× |
| Incision/drain abscess intra (D7511) | $406 | $406 | 0.5× |
| Incomplete endodontic tx (D3332) | $685 | $685 | 0.8× |
| Initial preventive exam (G0402) | $363 | $363 | 2.2× |
| Inlay composite/resin one su (D2650) | $1,495 | $1,495 | 1.9× |
| Inlay composite/resin two su (D2651) | $1,599 | $1,599 | 2.0× |
| Inlay porcelain/ceramic 1 su (D2610) | $1,573 | $1,573 | 1.9× |
| Inlay porcelain/ceramic 2 su (D2620) | $1,727 | $1,727 | 2.1× |
| Intentional replantation (D3470) | $1,472 | $1,472 | 1.8× |
| Interim crown (D2799) range across 2 matching MRF lines |
$321–$685 | $321–$685 | varies |
| Internal root repair (D3333) | $419 | $419 | 0.5× |
| Intraor comprehensive series (D0210) | $243 | $243 | 0.8× |
| Intraoral occlusal film (D0240) | $84 | $84 | 0.8× |
| Intraoral periapical first (D0220) | $50 | $50 | 0.5× |
| Isolation- tooth w rubb dam (D3910) | $346 | $346 | 0.4× |
| Labial veneer porc indirect (D2962) | $1,883 | $1,883 | 2.3× |
| Labial veneer resin direct (D2960) | $1,057 | $1,057 | 1.3× |
| Labial veneer resin indirect (D2961) | $1,617 | $1,617 | 2.0× |
| Limit oral eval problm focus (D0140) | $125 | $125 | 0.8× |
| Limited occlusal adjustment (D9951) | $310 | $310 | 0.4× |
| Localized delivery antimicro (D4381) | $372 | $372 | 0.5× |
| Malig tumor > 1.25 cm (D7441) | $995 | $995 | 0.2× |
| Malig tumor exc to 1.25 cm (D7440) | $995 | $995 | 0.2× |
| Mandible graft (D7950) | $5,816 | $5,816 | 0.8× |
| Mesial/distal wedge proc (D4274) | $1,245 | $1,245 | 1.5× |
| Mnt subs tx for change dx (G0270) | $55 | $55 | 1.7× |
| Myocrd Symp Innervaj Img Plnr Qual&Quant W/Spect (0332T) | $4,439 | $4,439 | 2.7× |
| Nav srv peer sup 60 min pr m (G0140) | $328 | $328 | 2.6× |
| Neuro csf prion prtn qual (0035U) | $849 | $849 | 1.6× |
| Non-auto graft 1st tooth (D4275) | $1,698 | $1,698 | 0.9× |
| Non-ophthalmic fva (C9733) | $767 | $767 | 1.8× |
| Non-surg tx root canal obs (D3331) | $654 | $654 | 0.8× |
| Obtaining screen pap smear (Q0091) range across 2 matching MRF lines |
$61–$77 | $61–$77 | varies |
| Occ guard, hard, full arch (D9944) | $369 | $369 | 0.5× |
| Occ guard, soft, full arch (D9945) | $369 | $369 | 0.5× |
| Occlusion analysis (D9950) | $604 | $604 | 0.7× |
| Open reduc compd alveolus fx (D7770) | $4,574 | $4,574 | 0.6× |
| Oral antral fistula closure (D7260) | $1,235 | $1,235 | 1.5× |
| Oral/facial photo images (D0350) | $140 | $140 | 1.3× |
| Osseous surg 1 to 3 teeth (D4261) | $1,542 | $1,542 | 0.4× |
| Osseous surgery 4 or more (D4260) likely a partial charge, not the full procedure |
$1,933 | $1,933 | 0.3× |
| Other tmj images by report (D0321) | $391 | $391 | 3.6× |
| Panoramic image (D0330) | $204 | $204 | 0.7× |
| Pedicle soft tissue graft pr (D4270) | $1,495 | $1,495 | 0.8× |
| Periodic oral evaluation (D0120) | $86 | $86 | 0.5× |
| Periodontal maint procedures (D4910) | $247 | $247 | 0.3× |
| Periodontal scaling & root (D4341) | $456 | $456 | 0.6× |
| Periodontal scaling 1-3teeth (D4342) | $234 | $234 | 0.3× |
| Pin service 60m per month (G0023) | $328 | $328 | 2.6× |
| Place direct restoration (D2940) | $198 | $198 | 0.2× |
| Post 1 srfc resinbased cmpst (D2391) | $302 | $302 | 0.4× |
| Post 2 srfc resinbased cmpst (D2392) | $398 | $398 | 0.5× |
| Post 3 srfc resinbased cmpst (D2393) | $503 | $503 | 0.6× |
| Post >=4srfc resinbase cmpst (D2394) | $589 | $589 | 0.7× |
| Post and core cast + crown (D2952) | $794 | $794 | 1.0× |
| Ppps, initial visit (G0438) | $617 | $617 | 3.5× |
| Ppps, subseq visit (G0439) | $514 | $514 | 3.7× |
| Prefab post/core + crown (D2954) | $609 | $609 | 0.8× |
| Prefab stainless steel crown (D2933) | $669 | $669 | 0.8× |
| Prefab stnlss steel crown pe (D2931) | $583 | $583 | 0.7× |
| Prefab stnlss steel crwn pri (D2930) | $484 | $484 | 0.6× |
| Prefabricated resin crown (D2932) | $622 | $622 | 0.8× |
| Primary closure sinus perf (D7261) | $1,360 | $1,360 | 1.7× |
| Pulp cap direct (D3110) | $143 | $143 | 0.2× |
| Pulp cap indirect (D3120) | $143 | $143 | 0.2× |
| Pulp vitality test (D0460) | $99 | $99 | 0.1× |
| Pulpal therapy anterior prim (D3230) | $471 | $471 | 0.6× |
| Pulpal therapy posterior pri (D3240) | $537 | $537 | 0.7× |
| Rad exc lesion up to 1.25 cm (D7410) | $708 | $708 | 0.4× |
| Radiation applicator (D5983) | $212 | $212 | 0.3× |
| Radiation cone locator (D5985) | $212 | $212 | 0.3× |
| Radiation shield (D5984) | $212 | $212 | 0.3× |
| Re-cement or re-bond crown (D2920) | $193 | $193 | 0.2× |
| Re-eval,est pt,problem focus (D0170) | $112 | $112 | 0.7× |
| Recement cast or prefab post (D2915) | $193 | $193 | 0.2× |
| Recement inlay onlay or part (D2910) | $193 | $193 | 0.2× |
| Recement space maint - man (D1552) | $126 | $126 | 0.2× |
| Recement space maint - max (D1551) | $126 | $126 | 0.2× |
| Recement unilat space maint (D1553) | $126 | $126 | 0.2× |
| Rem exostosis any site (D7471) | $1,120 | $1,120 | 0.3× |
| Rem imp tooth w mucoper flp (D7210) | $504 | $504 | 0.3× |
| Rem nonodonto cyst > 1.25 cm (D7461) | $1,307 | $1,307 | 1.6× |
| Rem nonodonto cyst to 1.25cm (D7460) | $854 | $854 | 1.1× |
| Rem odontogen cyst > 1.25 cm (D7451) | $1,182 | $1,182 | 0.3× |
| Rem odontogen cyst to 1.25cm (D7450) | $867 | $867 | 0.2× |
| Removal fb skin/areolar tiss (D7530) | $628 | $628 | 0.8× |
| Removal of fb reaction (D7540) | $1,169 | $1,169 | 1.4× |
| Removal of implantable interstitial glucose sensor from subcutaneous pocket via incision (0447T) | $656 | $656 | 2.6× |
| Removal of sloughed off bone (D7550) | $883 | $883 | 1.1× |
| Removal of torus palatinus (D7472) | $1,276 | $1,276 | 1.6× |
| Remove torus mandibularis (D7473) | $1,386 | $1,386 | 1.7× |
| Remove unilat space maintain (D1520) | $804 | $804 | 1.0× |
| Reshaping bone orthognathic (D7940) | $6,715 | $6,715 | 8.3× |
| Resin 4/> surf or w incis an (D2335) | $529 | $529 | 0.7× |
| Resin one surface-anterior (D2330) | $271 | $271 | 0.3× |
| Resin three surfaces-anterio (D2332) | $422 | $422 | 0.5× |
| Resin two surfaces-anterior (D2331) | $341 | $341 | 0.4× |
| Retreat root canal anterior (D3346) | $1,456 | $1,456 | 1.8× |
| Retreat root canal molar (D3348) | $2,006 | $2,006 | 2.5× |
| Retreat root canal premolar (D3347) | $1,643 | $1,643 | 2.0× |
| Retrograde filling (D3430) | $479 | $479 | 0.6× |
| Rmvl insj impltbl gluc sensor dif anatomic site (0448T) unusually low: confirm this is the full procedure |
$1,796 | $1,796 | 0.3× |
| Root amputation (D3450) | $857 | $857 | 1.1× |
| Root surgery molar (D3425) | $1,539 | $1,539 | 1.9× |
| Root surgery premolar (D3421) | $1,307 | $1,307 | 1.6× |
| Space maintainer fxd unilat (D1510) | $604 | $604 | 0.7× |
| Splint extra-coronal (D4323) | $299 | $299 | 0.4× |
| Surg reduct osseoustuberosit (D7485) likely a partial charge, not the full procedure |
$1,143 | $1,143 | 0.2× |
| Surgical revision procedure (D4268) | $1,492 | $1,492 | 1.8× |
| Surgical splint (D5988) | $1,539 | $1,539 | 1.9× |
| Therapeutic pulpotomy (D3220) | $349 | $349 | 0.4× |
| Tmj arthroscopy disc reposit (D7874) | $212 | $212 | 0.1× |
| Tooth pin retention (D2951) | $125 | $125 | 0.2× |
| Tooth reimplantation (D7270) | $982 | $982 | 1.2× |
| Tooth root removal (D7250) | $542 | $542 | 0.7× |
| Tooth splitting (D3920) | $820 | $820 | 1.0× |
| Tooth transplantation (D7272) | $1,229 | $1,229 | 1.5× |
| Transseptal fiberotomy (D7291) | $531 | $531 | 0.7× |
| Treatment of complications (D9930) | $250 | $250 | 0.3× |
| Trim nail(s) (G0127) range across 2 matching MRF lines |
$29–$268 | $29–$268 | varies |
| Unsched dialysis esrd pt hos (G0257) | $2,746 | $2,746 | 3.2× |
| Unscheduled dressing change (D4920) | $190 | $190 | 0.2× |
| Unspecified periodontal proc (D4999) | $212 | $212 | 0.7× |
| Vert bitewings 7 to 8 images (D0277) | $161 | $161 | 0.5× |
| Vestibuloplasty exten graft (D7350) | $3,698 | $3,698 | 0.5× |
| Vestibuloplasty ridge extens (D7340) likely a partial charge, not the full procedure |
$1,680 | $1,680 | 0.2× |
| Visit to determ ldct elig (G0296) | $265 | $265 | 2.1× |
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.