Supplies, drugs & other prices at Lackey Memorial Hospital
Forest, MS · every code in this section with a posted price and a Medicare benchmark.
102 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Admin hepatitis b vaccine (G0010) | $143 | $143 | 3.4× |
| Admin influenza virus vac (G0008) range across 4 matching MRF lines |
$16.10–$79 | $16.10–$79 | varies |
| Admin pneumococcal vaccine (G0009) range across 3 matching MRF lines |
$10.50–$79 | $10.50–$79 | varies |
| Alveoloplasty not w/extracts (D7321) | $631 | $631 | 0.5× |
| Alveoloplasty w/extract 1-3 (D7311) range across 2 matching MRF lines |
$193–$232 | $193–$232 | varies |
| Alveoplasty w/ extraction (D7310) | $221 | $221 | 0.2× |
| Alveoplasty w/o extraction (D7320) | $631 | $631 | 0.5× |
| Amalgam 4 or > surfaces perm (D2161) | $356 | $356 | 0.6× |
| Amalgam one surface permanen (D2140) | $186 | $186 | 0.3× |
| Amalgam three surfaces perma (D2160) | $291 | $291 | 0.5× |
| Amalgam two surfaces permane (D2150) | $242 | $242 | 0.4× |
| Annual alcohol screen 15 min (G0442) range across 2 matching MRF lines |
$32–$48 | $32–$48 | varies |
| Ant resin-based cmpst crown (D2390) | $285 | $285 | 0.5× |
| Behavior counsel obesity 15m (G0447) range across 2 matching MRF lines |
$43.05–$66 | $43.05–$66 | varies |
| Bitewings four images (D0274) | $153 | $153 | 0.7× |
| Brief alcohol misuse counsel (G0443) range across 2 matching MRF lines |
$42–$64 | $42–$64 | varies |
| Ca screen;flexi sigmoidscope (G0104) range across 2 matching MRF lines |
$135–$1,206 | $135–$1,206 | varies |
| Ca screen;pelvic/breast exam (G0101) range across 2 matching MRF lines |
$48.30–$73 | $48.30–$73 | varies |
| Colon ca scrn not hi rsk ind (G0121) range across 4 matching MRF lines |
$464–$1,851 | $464–$1,851 | varies |
| Colorectal scrn; hi risk ind (G0105) range across 4 matching MRF lines |
$443.10–$1,851 | $443.10–$1,851 | varies |
| Covid-19 lab test non-cdc (U0002) range across 3 matching MRF lines |
$80–$223 | $80–$223 | varies |
| Dental prophylaxis adult (D1110) | $208 | $208 | 1.7× |
| Depression screen annual (G0444) range across 4 matching MRF lines |
$16.10–$114 | $16.10–$114 | varies |
| Diab manage trn per indiv (G0108) range across 2 matching MRF lines |
$93.10–$141 | $93.10–$141 | varies |
| Diab manage trn ind/group (G0109) range across 2 matching MRF lines |
$25.90–$39 | $25.90–$39 | varies |
| Direct refer hospital observ (G0379) | $173 | $173 | 0.3× |
| Drug test def 1-7 classes (G0480) range across 3 matching MRF lines |
$140–$212 | $140–$212 | varies |
| Drug test def 15-21 classes (G0482) range across 2 matching MRF lines |
$290–$440 | $290–$440 | varies |
| Drug test def 22+ classes (G0483) range across 2 matching MRF lines |
$423–$572 | $423–$572 | varies |
| Drug test def 8-14 classes (G0481) range across 2 matching MRF lines |
$214–$325 | $214–$325 | varies |
| Ekg tracing for initial prev (G0404) range across 2 matching MRF lines |
$14.70–$23 | $14.70–$23 | varies |
| Elec stim other than wound (G0283) range across 2 matching MRF lines |
$32–$43 | $32–$43 | varies |
| End thxpy, anterior tooth (D3310) | $1,101 | $1,101 | 1.9× |
| End thxpy, molar tooth (D3330) | $1,671 | $1,671 | 2.9× |
| Excision benign lesion>1.25c (D7411) | $1,881 | $1,881 | 1.3× |
| Exposure of unerupted tooth (D7280) | $688 | $688 | 1.2× |
| Extraction coronal remnants (D7111) | $213 | $213 | 0.4× |
| Extraction erupted tooth/exr (D7140) | $203 | $203 | 0.3× |
| Gingivectomy/plasty 1 to 3 (D4211) | $418 | $418 | 0.1× |
| Gingivectomy/plasty rest (D4212) | $2,853 | $2,853 | 1.0× |
| Gross pulpal debridement (D3221) | $467 | $467 | 0.8× |
| Group mnt 2 or more 30 mins (G0271) range across 2 matching MRF lines |
$27.30–$41 | $27.30–$41 | varies |
| I&d absc intraoral soft tiss (D7510) | $356 | $356 | 0.6× |
| I&d abscess extraoral (D7520) range across 3 matching MRF lines |
$669–$1,693 | $669–$1,693 | varies |
| Impact tooth rem bony w/comp (D7241) | $870 | $870 | 1.5× |
| Impact tooth remov comp bony (D7240) | $692 | $692 | 1.2× |
| Impact tooth remov part bony (D7230) | $591 | $591 | 1.0× |
| Impact tooth remov soft tiss (D7220) | $444 | $444 | 0.8× |
| Initial preventive exam (G0402) range across 2 matching MRF lines |
$134–$203 | $134–$203 | varies |
| Interim crown (D2799) range across 2 matching MRF lines |
$1,329–$1,330 | $1,329–$1,330 | varies |
| Intraoral periapical first (D0220) | $64 | $64 | 0.8× |
| Lev 1 hosp type b ed visit (G0380) | $126 | $126 | 1.9× |
| Lev 2 hosp type b ed visit (G0381) | $179 | $179 | 2.1× |
| Lev 3 hosp type b ed visit (G0382) | $294 | $294 | 1.9× |
| Lev 4 hosp type b ed visit (G0383) | $435 | $435 | 1.8× |
| Lev 5 hosp type b ed visit (G0384) | $839 | $839 | 2.3× |
| Limit oral eval problm focus (D0140) | $113 | $113 | 0.9× |
| Mnt subs tx for change dx (G0270) range across 2 matching MRF lines |
$50.40–$76 | $50.40–$76 | varies |
| Obtaining screen pap smear (Q0091) range across 2 matching MRF lines |
$43.40–$66 | $43.40–$66 | varies |
| Part pulp for apexogenesis (D3222) | $250 | $250 | 0.4× |
| Periodontal scaling & root (D4341) | $688 | $688 | 1.2× |
| Place direct restoration (D2940) | $149 | $149 | 0.3× |
| Post 1 srfc resinbased cmpst (D2391) | $245 | $245 | 0.4× |
| Post 2 srfc resinbased cmpst (D2392) | $320 | $320 | 0.5× |
| Post 3 srfc resinbased cmpst (D2393) | $397 | $397 | 0.7× |
| Post >=4srfc resinbase cmpst (D2394) | $486 | $486 | 0.8× |
| Ppps, initial visit (G0438) range across 2 matching MRF lines |
$224–$340 | $224–$340 | varies |
| Ppps, subseq visit (G0439) range across 2 matching MRF lines |
$151–$228 | $151–$228 | varies |
| Prefab stainless steel crown (D2933) | $535 | $535 | 0.9× |
| Prefab steel crown primary (D2934) | $535 | $535 | 0.9× |
| Prefab stnlss steel crown pe (D2931) | $437 | $437 | 0.7× |
| Prefab stnlss steel crwn pri (D2930) | $388 | $388 | 0.7× |
| Prefabricated resin crown (D2932) | $733 | $733 | 1.3× |
| Psa screening (G0103) range across 3 matching MRF lines |
$42–$246 | $42–$246 | varies |
| Pulp cap direct (D3110) | $176 | $176 | 0.3× |
| Pulp cap indirect (D3120) | $144 | $144 | 0.2× |
| Pulpal therapy posterior pri (D3240) | $202 | $202 | 0.3× |
| Rad exc lesion up to 1.25 cm (D7410) | $992 | $992 | 0.7× |
| Rem exostosis any site (D7471) range across 2 matching MRF lines |
$819–$981 | $819–$981 | varies |
| Rem imp tooth w mucoper flp (D7210) | $354 | $354 | 0.3× |
| Rem nonodonto cyst to 1.25cm (D7460) | $538 | $538 | 0.9× |
| Rem odontogen cyst > 1.25 cm (D7451) | $905 | $905 | 0.3× |
| Rem odontogen cyst to 1.25cm (D7450) | $396 | $396 | 0.1× |
| Removal fb skin/areolar tiss (D7530) | $216 | $216 | 0.4× |
| Remove torus mandibularis (D7473) | $819 | $819 | 1.4× |
| Resin 4/> surf or w incis an (D2335) | $386 | $386 | 0.7× |
| Resin one surface-anterior (D2330) | $210 | $210 | 0.4× |
| Resin three surfaces-anterio (D2332) | $325 | $325 | 0.6× |
| Resin two surfaces-anterior (D2331) | $266 | $266 | 0.5× |
| Scr c/v cyto, automated sys (G0147) range across 2 matching MRF lines |
$31–$46 | $31–$46 | varies |
| Scr c/v cyto, autosys, rescr (G0148) range across 2 matching MRF lines |
$36–$56 | $36–$56 | varies |
| Scr c/v cyto,thinlayer,rescr (G0144) range across 2 matching MRF lines |
$46–$70 | $46–$70 | varies |
| Scr c/v cyto,thinlayer,rescr (G0145) range across 2 matching MRF lines |
$57–$87 | $57–$87 | varies |
| Scr c/v cyto,thinlayer,rescr (G0143) range across 2 matching MRF lines |
$44–$67 | $44–$67 | varies |
| Screen cerv/vag thin layer (G0123) range across 2 matching MRF lines |
$48–$73 | $48–$73 | varies |
| Space maintainer fxd unilat (D1510) | $850 | $850 | 1.5× |
| Therapeutic pulpotomy (D3220) | $247 | $247 | 0.4× |
| Tomosynthesis, mammo (G0279) range across 2 matching MRF lines |
$93–$220 | $93–$220 | varies |
| Tooth root removal (D7250) | $374 | $374 | 0.6× |
| Trauma respons w/hosp criti (G0390) | $4,031 | $4,031 | 3.3× |
| Trim nail(s) (G0127) range across 3 matching MRF lines |
$36–$167 | $36–$167 | varies |
| Tte w or wo fol wcon,doppler (C8929) | $2,442 | $2,442 | 3.5× |
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.