Supplies, drugs & other prices at Mary Imogene Bassett Hospital
Cooperstown, NY · every code in this section with a posted price and a Medicare benchmark.
117 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 2d cephal radio image (D0702) | $37.80 | $140 | 0.3× |
| 2d oral/facial photo image (D0703) | $21.60 | $80 | 0.2× |
| Alveoloplasty not w/extracts (D7321) | $153.36 | $568 | 0.1× |
| Alveoloplasty w/extract 1-3 (D7311) | $95.58 | $354 | 0.0× |
| Alveoplasty w/ extraction (D7310) | $102.60 | $380 | 0.1× |
| Alveoplasty w/o extraction (D7320) | $136.89 | $507 | 0.1× |
| Annual alcohol screen 15 min (G0442) | $13.50 | $50 | 0.3× |
| Ant resin-based cmpst crown (D2390) | $99.90 | $370 | 0.1× |
| Apexification/recalc final (D3353) | $151.74 | $562 | 0.2× |
| Apexification/recalc initial (D3351) | $102.33 | $379 | 0.1× |
| Assessment of a patient (D0191) range across 2 matching MRF lines |
$13.50–$61.91 | $50–$229.28 | varies |
| Behavior counsel obesity 15m (G0447) range across 2 matching MRF lines |
$6.48–$29.71 | $24–$110.05 | varies |
| Bitewings - three images (D0273) | $14.85 | $55 | 0.0× |
| Bitewings four images (D0274) | $80.48 | $298.06 | 0.3× |
| Brief alcohol misuse counsel (G0443) | $36.45 | $135 | 0.3× |
| Ca screen;pelvic/breast exam (G0101) | $26.72 | $98.97 | 0.2× |
| Chemo extend iv infus w/pump (G0498) | $81 | $300 | 0.2× |
| Comp periodontal evaluation (D0180) | $43.33 | $160.49 | 0.3× |
| Comprehensve oral evaluation (D0150) | $111.43 | $412.70 | 0.7× |
| Core build-up incl any pins (D2950) | $68.85 | $255 | 0.1× |
| Covid-19 lab test non-cdc (U0002) range across 2 matching MRF lines |
$31.05–$55.08 | $115–$204 | varies |
| Crown full cast base metal (D2791) | $256.50 | $950 | 0.3× |
| Crown porcelain fused base m (D2751) | $260.55 | $965 | 0.3× |
| Crown porcelain w/ h noble m (D2750) | $283.50 | $1,050 | 0.4× |
| Crown porcelain/ceramic (D2740) | $1,132.85 | $4,195.74 | 1.4× |
| Demonstrate use home inr mon (G0248) | $136.57 | $505.81 | 0.8× |
| Dental bitewing single image (D0270) | $8.10 | $30 | 0.1× |
| Dental bitewings two images (D0272) | $55.71 | $206.35 | 0.5× |
| Dental prophylaxis adult (D1110) | $105.24 | $389.77 | 0.6× |
| Depression screen annual (G0444) | $13.50 | $50 | 0.3× |
| Devlopment test interpt&rep (G0451) | $5.76 | $21.34 | 0.0× |
| Diab manage trn per indiv (G0108) range across 2 matching MRF lines |
$21.60–$37.58 | $80–$139.17 | varies |
| Diab manage trn ind/group (G0109) | $9.45 | $35 | 0.6× |
| Direct refer hospital observ (G0379) | $25.05 | $92.78 | 0.0× |
| End thxpy, anterior tooth (D3310) range across 2 matching MRF lines |
$73.98–$186.30 | $274–$690 | varies |
| End thxpy, premolar tooth (D3320) | $990.47 | $3,668.41 | 1.2× |
| Exposure of unerupted tooth (D7280) | $152.55 | $565 | 0.2× |
| Extra oral post radio image (D0705) | $20.25 | $75 | 0.2× |
| Extraction coronal remnants (D7111) | $33.75 | $125 | 0.0× |
| Extraction erupted tooth/exr (D7140) | $204.28 | $756.61 | 0.3× |
| Full mouth debridement (D4355) | $284.76 | $1,054.67 | 0.4× |
| Gingivectomy/plasty 1 to 3 (D4211) | $108 | $400 | 0.0× |
| Gross pulpal debridement (D3221) | $67.50 | $250 | 0.1× |
| Guided tiss regen resorble (D4266) | $228.15 | $845 | 0.1× |
| Hbot, full body chamber, 30m (G0277) | $175.50 | $650 | 1.0× |
| High inten beh couns std 30m (G0445) | $39.62 | $146.74 | 0.3× |
| I&d absc intraoral soft tiss (D7510) | $59.40 | $220 | 0.1× |
| Impact tooth remov comp bony (D7240) | $135 | $500 | 0.2× |
| Impact tooth remov soft tiss (D7220) | $102.60 | $380 | 0.1× |
| Incision/drain abscess intra (D7511) | $108.54 | $402 | 0.1× |
| Intens behave ther cardio dx (G0446) | $58.19 | $215.52 | 1.2× |
| Interim crown (D2799) | $129.60 | $480 | 0.2× |
| Intraor comprehensive series (D0210) | $154.76 | $573.19 | 0.5× |
| Intraoral bite radio image (D0708) | $9.45 | $35 | 0.1× |
| Intraoral comp image capture (D0709) | $39.15 | $145 | 0.4× |
| Intraoral occlus radio image (D0706) | $12.15 | $45 | 0.1× |
| Intraoral occlusal film (D0240) | $10.80 | $40 | 0.1× |
| Intraoral periap radio image (D0707) | $9.45 | $35 | 0.1× |
| Intraoral periapical first (D0220) | $37.14 | $137.57 | 0.3× |
| Limit oral eval problm focus (D0140) | $86.67 | $320.99 | 0.5× |
| Limited occlusal adjustment (D9951) | $46.17 | $171 | 0.1× |
| Mandible graft (D7950) likely a partial charge, not the full procedure |
$1,107 | $4,100 | 0.1× |
| Mri w/cont, breast, uni (C8903) | $927.99 | $3,437 | 4.2× |
| Neuro csf prion prtn qual (0035U) | $175.61 | $650.41 | 0.3× |
| Njx platelet plasma (0232T) range across 2 matching MRF lines |
$125.55–$139.05 | $465–$515 | varies |
| Obtaining screen pap smear (Q0091) | $17.55 | $65 | 0.5× |
| Occ guard, hard, full arch (D9944) | $674.76 | $2,499.10 | 0.8× |
| Occ guard, hard, part arch (D9946) | $147.15 | $545 | 0.2× |
| Occ guard, soft, full arch (D9945) | $147.15 | $545 | 0.2× |
| Oral antral fistula closure (D7260) | $418.50 | $1,550 | 0.5× |
| Oral/facial photo images (D0350) | $37.14 | $137.57 | 0.3× |
| Pano radio image (D0701) | $35.10 | $130 | 0.3× |
| Panoramic image (D0330) | $130 | $481.48 | 0.4× |
| Pathogen test for platelets (P9100) | $22.14 | $82 | 0.3× |
| Periodic oral evaluation (D0120) | $61.91 | $229.28 | 0.4× |
| Periodontal maint procedures (D4910) | $160.95 | $596.12 | 0.2× |
| Periodontal scaling & root (D4341) | $297.14 | $1,100.52 | 0.4× |
| Periodontal scaling 1-3teeth (D4342) | $210.48 | $779.54 | 0.3× |
| Place direct restoration (D2940) range across 2 matching MRF lines |
$31.05–$142.38 | $115–$527.33 | varies |
| Post 1 srfc resinbased cmpst (D2391) | $210.48 | $779.54 | 0.3× |
| Post 2 srfc resinbased cmpst (D2392) | $272.38 | $1,008.81 | 0.3× |
| Post 3 srfc resinbased cmpst (D2393) | $334.28 | $1,238.09 | 0.4× |
| Post >=4srfc resinbase cmpst (D2394) | $396.19 | $1,467.36 | 0.5× |
| Ppps, subseq visit (G0439) | $45.51 | $168.55 | 0.3× |
| Prefab porc/cer crown perm (D2928) | $94.50 | $350 | 0.1× |
| Prefab post/core + crown (D2954) | $390 | $1,444.44 | 0.5× |
| Prefab stnlss steel crown pe (D2931) | $82.35 | $305 | 0.1× |
| Prefab stnlss steel crwn pri (D2930) | $68.85 | $255 | 0.1× |
| Prostate biopsy, any mthd (G0416) | $92.47 | $342.48 | 0.2× |
| Provide inr test mater/equip (G0249) | $40.50 | $150 | 0.2× |
| Pulp cap direct (D3110) | $21.87 | $81 | 0.0× |
| Pulp cap indirect (D3120) | $22.41 | $83 | 0.0× |
| Pulp vitality test (D0460) | $12.15 | $45 | 0.0× |
| Re-cement or re-bond crown (D2920) | $169.62 | $628.22 | 0.2× |
| Rem imp tooth w mucoper flp (D7210) | $70.20 | $260 | 0.0× |
| Rem odontogen cyst > 1.25 cm (D7451) | $275.40 | $1,020 | 0.1× |
| Removal fb skin/areolar tiss (D7530) | $108 | $400 | 0.1× |
| Resin 4/> surf or w incis an (D2335) | $359.05 | $1,329.80 | 0.4× |
| Resin infiltration of lesion (D2990) | $52.65 | $195 | 0.1× |
| Resin one surface-anterior (D2330) | $185.71 | $687.83 | 0.2× |
| Resin three surfaces-anterio (D2332) | $290.95 | $1,077.60 | 0.4× |
| Resin two surfaces-anterior (D2331) | $235.24 | $871.25 | 0.3× |
| Scaling gingiv inflammation (D4346) | $20.25 | $75 | 0.0× |
| Space maintainer fxd unilat (D1510) | $79.65 | $295 | 0.1× |
| Splint extra-coronal (D4323) | $168.75 | $625 | 0.2× |
| Splint intra-coronal (D4322) | $168.75 | $625 | 0.2× |
| Surg rep root res anterior (D3471) | $216 | $800 | 0.3× |
| Surg rep root res molar (D3473) | $283.50 | $1,050 | 0.4× |
| Surg rep root res premolar (D3472) | $249.75 | $925 | 0.3× |
| Tomosynthesis, mammo (G0279) range across 2 matching MRF lines |
$21.60–$38.74 | $80–$143.48 | varies |
| Tooth pin retention (D2951) | $17.55 | $65 | 0.0× |
| Tpmt and Nudt15 Genotype (0034U) | $409.41 | $1,516.34 | 0.9× |
| Trauma respons w/hosp criti (G0390) range across 2 matching MRF lines |
$1,350–$2,025 | $5,000–$7,500 | varies |
| Treatment of complications (D9930) | $45.90 | $170 | 0.1× |
| Trim nail(s) (G0127) | $24.57 | $91 | 0.3× |
| Vert bitewings 7 to 8 images (D0277) | $31.32 | $116 | 0.1× |
| Visit to determ ldct elig (G0296) range across 3 matching MRF lines |
$6.48–$37.85 | $24–$140.20 | varies |
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.