Supplies, drugs & other prices at North Sunflower Medical Center
Ruleville, MS · every code in this section with a posted price and a Medicare benchmark.
85 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Admin influenza virus vac (G0008) | $5 | $10 | 0.1× |
| Admin pneumococcal vaccine (G0009) | $5 | $10 | 0.1× |
| Alveoloplasty not w/extracts (D7321) | $142.50 | $285 | 0.1× |
| Alveoloplasty w/extract 1-3 (D7311) range across 2 matching MRF lines |
$90–$135 | $180–$270 | varies |
| Alveolus open reduction (D7671) range across 2 matching MRF lines |
$1,100–$1,650 | $2,200–$3,300 | varies |
| Alveoplasty w/ extraction (D7310) range across 2 matching MRF lines |
$105–$157.50 | $210–$315 | varies |
| Alveoplasty w/o extraction (D7320) range across 2 matching MRF lines |
$167.50–$252.50 | $335–$505 | varies |
| Ant resin-based cmpst crown (D2390) | $187.50 | $375 | 0.3× |
| Apicoectomy - anterior (D3410) range across 2 matching MRF lines |
$262.50–$525 | $525–$1,050 | varies |
| Ca screen;pelvic/breast exam (G0101) | $32.50 | $65 | 0.4× |
| Colon ca scrn not hi rsk ind (G0121) | $550 | $1,100 | 0.7× |
| Colorectal scrn; hi risk ind (G0105) | $550 | $1,100 | 0.7× |
| Comprehensve oral evaluation (D0150) range across 2 matching MRF lines |
$27.50–$37.50 | $55–$75 | varies |
| Coronectomy (D7251) range across 2 matching MRF lines |
$260–$390 | $520–$780 | varies |
| Covid-19 lab test non-cdc (U0002) | $50 | $100 | 1.0× |
| Crown porcelain w/ h noble m (D2750) | $687.50 | $1,375 | 1.2× |
| Crown porcelain/ceramic (D2740) | $25 | $50 | 0.0× |
| Dental prophylaxis adult (D1110) range across 2 matching MRF lines |
$37.50–$50 | $75–$100 | varies |
| Direct refer hospital observ (G0379) | $75 | $150 | 0.1× |
| Elec stim unattend for press (G0281) | $62.50 | $125 | 5.3× |
| Electromagntic tx for ulcers (G0329) | $62.50 | $125 | 5.8× |
| Elisa hiv-1/hiv-2 screen (G0433) | $20 | $40 | 1.1× |
| End thxpy, anterior tooth (D3310) range across 2 matching MRF lines |
$350–$400 | $700–$800 | varies |
| End thxpy, molar tooth (D3330) | $525 | $1,050 | 0.9× |
| Excision benign lesion>1.25c (D7411) range across 3 matching MRF lines |
$370–$500 | $740–$1,000 | varies |
| Exposure of unerupted tooth (D7280) range across 2 matching MRF lines |
$225–$337.50 | $450–$675 | varies |
| Extraction erupted tooth/exr (D7140) range across 2 matching MRF lines |
$110–$450 | $220–$900 | varies |
| Full mouth debridement (D4355) range across 2 matching MRF lines |
$100–$200 | $200–$400 | varies |
| Gingivectomy/plasty 1 to 3 (D4211) | $150 | $300 | 0.1× |
| Gingivectomy/plasty 4 or mor (D4210) range across 2 matching MRF lines |
$300–$356.25 | $600–$712.50 | varies |
| Guided tiss regen resorble (D4266) | $265 | $530 | 0.2× |
| Hospital outpt clinic visit (G0463) range across 2 matching MRF lines |
$85–$112.50 | $170–$225 | varies |
| I&d absc intraoral soft tiss (D7510) range across 3 matching MRF lines |
$100–$131.25 | $200–$262.50 | varies |
| I&d abscess extraoral (D7520) range across 3 matching MRF lines |
$375–$750 | $750–$1,500 | varies |
| Impact tooth rem bony w/comp (D7241) | $275 | $550 | 0.5× |
| Impact tooth remov comp bony (D7240) range across 2 matching MRF lines |
$225–$232.50 | $450–$465 | varies |
| Impact tooth remov part bony (D7230) range across 2 matching MRF lines |
$200–$202.50 | $400–$405 | varies |
| Impact tooth remov soft tiss (D7220) range across 2 matching MRF lines |
$150–$153.75 | $300–$307.50 | varies |
| Initial preventive exam (G0402) range across 3 matching MRF lines |
$87.50–$157.50 | $175–$315 | varies |
| Limit oral eval problm focus (D0140) range across 3 matching MRF lines |
$22.50–$42.50 | $45–$85 | varies |
| Obtaining screen pap smear (Q0091) range across 2 matching MRF lines |
$25–$87.50 | $50–$175 | varies |
| Oral antral fistula closure (D7260) range across 2 matching MRF lines |
$750–$1,095 | $1,500–$2,190 | varies |
| Osseous surg 1 to 3 teeth (D4261) range across 2 matching MRF lines |
$325–$800 | $650–$1,600 | varies |
| Osseous surgery 4 or more (D4260) likely a partial charge, not the full procedure |
$622.50 | $1,245 | 0.1× |
| Panoramic image (D0330) | $50 | $100 | 0.2× |
| Periodic oral evaluation (D0120) | $22.50 | $45 | 0.2× |
| Periodontal scaling & root (D4341) | $100 | $200 | 0.2× |
| Periodontal scaling 1-3teeth (D4342) range across 2 matching MRF lines |
$62.50–$125 | $125–$250 | varies |
| Post 1 srfc resinbased cmpst (D2391) | $107.50 | $215 | 0.2× |
| Post 2 srfc resinbased cmpst (D2392) range across 2 matching MRF lines |
$130–$825 | $260–$1,650 | varies |
| Post 3 srfc resinbased cmpst (D2393) | $175 | $350 | 0.3× |
| Post >=4srfc resinbase cmpst (D2394) | $212.50 | $425 | 0.4× |
| Ppps, initial visit (G0438) range across 2 matching MRF lines |
$87.50–$160 | $175–$320 | varies |
| Ppps, subseq visit (G0439) range across 2 matching MRF lines |
$87.50–$107.50 | $175–$215 | varies |
| Prefab stainless steel crown (D2933) | $170 | $340 | 0.3× |
| Prefab stnlss steel crwn pri (D2930) | $135 | $270 | 0.2× |
| Prefabricated resin crown (D2932) | $135 | $270 | 0.2× |
| Primary closure sinus perf (D7261) | $100 | $200 | 0.2× |
| Psa screening (G0103) | $36.50 | $73 | 1.9× |
| Rad exc lesion up to 1.25 cm (D7410) | $175 | $350 | 0.1× |
| Rem exostosis any site (D7471) range across 3 matching MRF lines |
$250–$468.75 | $500–$937.50 | varies |
| Rem imp tooth w mucoper flp (D7210) range across 3 matching MRF lines |
$116.25–$1,710 | $232.50–$3,420 | varies |
| Rem nonodonto cyst > 1.25 cm (D7461) | $400 | $800 | 0.7× |
| Rem nonodonto cyst to 1.25cm (D7460) | $325 | $650 | 0.6× |
| Rem odontogen cyst > 1.25 cm (D7451) | $425 | $850 | 0.1× |
| Rem odontogen cyst to 1.25cm (D7450) range across 2 matching MRF lines |
$325–$442.50 | $650–$885 | varies |
| Removal fb skin/areolar tiss (D7530) range across 3 matching MRF lines |
$172.50–$300 | $345–$600 | varies |
| Removal of fb reaction (D7540) | $212.50 | $425 | 0.4× |
| Removal of sloughed off bone (D7550) range across 2 matching MRF lines |
$125–$200 | $250–$400 | varies |
| Removal of torus palatinus (D7472) range across 2 matching MRF lines |
$25–$350 | $50–$700 | varies |
| Remove torus mandibularis (D7473) range across 3 matching MRF lines |
$50–$562.50 | $100–$1,125 | varies |
| Resin 4/> surf or w incis an (D2335) | $170 | $340 | 0.3× |
| Resin one surface-anterior (D2330) | $92.50 | $185 | 0.2× |
| Resin three surfaces-anterio (D2332) | $142.50 | $285 | 0.3× |
| Resin two surfaces-anterior (D2331) | $117.50 | $235 | 0.2× |
| Retrograde filling (D3430) | $131.25 | $262.50 | 0.2× |
| Root surgery molar (D3425) | $517.50 | $1,035 | 0.9× |
| Space maintainer fxd unilat (D1510) | $850 | $1,700 | 1.5× |
| Therapeutic pulpotomy (D3220) | $85 | $170 | 0.2× |
| Tomosynthesis, mammo (G0279) | $50 | $100 | 3.9× |
| Tooth reimplantation (D7270) range across 2 matching MRF lines |
$175–$250 | $350–$500 | varies |
| Tooth root removal (D7250) range across 3 matching MRF lines |
$127.50–$450 | $255–$900 | varies |
| Tooth splitting (D3920) | $150 | $300 | 0.3× |
| Vestibuloplasty exten graft (D7350) range across 2 matching MRF lines |
$2,250–$2,750 | $4,500–$5,500 | varies |
| Vestibuloplasty ridge extens (D7340) likely a partial charge, not the full procedure |
$855.41 | $1,710.82 | 0.2× |
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.