Supplies, drugs & other prices at Othello Community Hospital
Othello, WA · every code in this section with a posted price and a Medicare benchmark.
44 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|---|---|---|
| Adm tocilizu covid-19 1st (M0249) | $498.38 | $664.50 | 1.0× |
| Amalgam one surface permanen (D2140) | $54.56 | $72.75 | 0.1× |
| Amalgam three surfaces perma (D2160) | $54.56 | $72.75 | 0.1× |
| Amalgam two surfaces permane (D2150) | $54.56 | $72.75 | 0.1× |
| Covid-19 lab test non-cdc (U0002) | $192 | $256 | 3.7× |
| Crown porcelain w/ h noble m (D2750) | $54.56 | $72.75 | 0.1× |
| Crown porcelain/ceramic (D2740) | $54.56 | $72.75 | 0.1× |
| Direct refer hospital observ (G0379) | $396.23 | $528.30 | 0.6× |
| Elec stim other than wound (G0283) | $168.66 | $224.88 | 13.3× |
| End thxpy, premolar tooth (D3320) | $54.56 | $72.75 | 0.1× |
| Extraction coronal remnants (D7111) | $54.56 | $72.75 | 0.1× |
| Extraction erupted tooth/exr (D7140) | $54.56 | $72.75 | 0.1× |
| Gingivectomy/plasty 1 to 3 (D4211) | $54.56 | $72.75 | 0.0× |
| Gingivectomy/plasty 4 or mor (D4210) | $54.56 | $72.75 | 0.0× |
| Hospital outpt clinic visit (G0463) | $273 | $364 | 1.8× |
| I&d absc intraoral soft tiss (D7510) | $54.56 | $72.75 | 0.1× |
| Impact tooth rem bony w/comp (D7241) | $54.56 | $72.75 | 0.1× |
| Impact tooth remov comp bony (D7240) | $54.56 | $72.75 | 0.1× |
| Impact tooth remov part bony (D7230) | $54.56 | $72.75 | 0.1× |
| Limited occlusal adjustment (D9951) | $54.56 | $72.75 | 0.1× |
| Periodontal scaling & root (D4341) | $54.56 | $72.75 | 0.1× |
| Post 1 srfc resinbased cmpst (D2391) | $54.56 | $72.75 | 0.1× |
| Post 2 srfc resinbased cmpst (D2392) | $54.56 | $72.75 | 0.1× |
| Post 3 srfc resinbased cmpst (D2393) | $54.56 | $72.75 | 0.1× |
| Prefab porc/ceram crown pri (D2929) | $54.56 | $72.75 | 0.1× |
| Prefab post/core + crown (D2954) | $54.56 | $72.75 | 0.1× |
| Prefab stainless steel crown (D2933) | $54.56 | $72.75 | 0.1× |
| Prefab steel crown primary (D2934) | $54.56 | $72.75 | 0.1× |
| Prefab stnlss steel crown pe (D2931) | $54.56 | $72.75 | 0.1× |
| Prefab stnlss steel crwn pri (D2930) | $54.56 | $72.75 | 0.1× |
| Prefabricated resin crown (D2932) | $54.56 | $72.75 | 0.1× |
| Psa screening (G0103) | $162 | $216 | 8.4× |
| Pulp cap direct (D3110) | $54.56 | $72.75 | 0.1× |
| Pulp cap indirect (D3120) | $54.56 | $72.75 | 0.1× |
| Pulpal therapy anterior prim (D3230) | $54.56 | $72.75 | 0.1× |
| Re-cement or re-bond crown (D2920) | $54.56 | $72.75 | 0.1× |
| Rem imp tooth w mucoper flp (D7210) | $54.56 | $72.75 | 0.0× |
| Resin 4/> surf or w incis an (D2335) | $54.56 | $72.75 | 0.1× |
| Resin one surface-anterior (D2330) | $54.56 | $72.75 | 0.1× |
| Resin three surfaces-anterio (D2332) | $54.56 | $72.75 | 0.1× |
| Resin two surfaces-anterior (D2331) | $54.56 | $72.75 | 0.1× |
| Space maintainer fxd unilat (D1510) | $54.56 | $72.75 | 0.1× |
| Therapeutic pulpotomy (D3220) | $54.56 | $72.75 | 0.1× |
| Tomosynthesis, mammo (G0279) | $86.06 | $114.75 | 6.8× |