Supplies, drugs & other prices at Unity Hospital of Rochester
Rochester, NY · every code in this section with a posted price and a Medicare benchmark.
328 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 2019-ncov diagnostic p (U0001) | $123.39 | $154.24 | 3.4× |
| 2d cephalometric image (D0340) | $84 | $105 | 0.8× |
| 2d tee w or w/o fol w/con,in (C8925) range across 2 matching MRF lines |
$1,839.04–$2,240.14 | $2,298.80–$2,800.18 | varies |
| 2d tte w or w/o fol w/con,fu (C8924) | $1,485.38 | $1,856.73 | 3.4× |
| Add proc construct new crown (D2971) | $83.20 | $104 | 0.1× |
| Adm tocilizu covid-19 1st (M0249) | $1,013.10 | $1,266.38 | 1.8× |
| Adm tocilizu covid-19 2nd (M0250) | $1,013.10 | $1,266.38 | 1.8× |
| Admin hepatitis b vaccine (G0010) | $83.37 | $104.21 | 1.4× |
| Admin influenza virus vac (G0008) | $83.37 | $104.21 | 1.4× |
| Admin pneumococcal vaccine (G0009) | $83.37 | $104.21 | 1.4× |
| Alcohol/subs interv 15-30mn (G0396) | $102.21 | $127.76 | 2.2× |
| Alveoloplasty not w/extracts (D7321) | $54.40 | $68 | 0.0× |
| Alveoloplasty w/extract 1-3 (D7311) | $44.80 | $56 | 0.0× |
| Alveolus clsd reduc stblz te (D7771) | $1,778.40 | $2,223 | 0.4× |
| Alveolus open reduction (D7671) likely a partial charge, not the full procedure |
$1,225.60 | $1,532 | 0.2× |
| Alveoplasty w/ extraction (D7310) | $114.40 | $143 | 0.1× |
| Alveoplasty w/o extraction (D7320) | $141.60 | $177 | 0.1× |
| Amalgam 4 or > surfaces perm (D2161) | $224 | $280 | 0.3× |
| Amalgam one surface permanen (D2140) | $87.20 | $109 | 0.1× |
| Amalgam three surfaces perma (D2160) | $179.20 | $224 | 0.2× |
| Amalgam two surfaces permane (D2150) | $108 | $135 | 0.1× |
| Ana crown exp 1-3 per quad (D4231) | $349.60 | $437 | 0.2× |
| Ana crown exp 4 or> per quad (D4230) | $436.80 | $546 | 0.1× |
| Ant resin-based cmpst crown (D2390) | $280.80 | $351 | 0.3× |
| Apexification/recalc final (D3353) | $534.40 | $668 | 0.7× |
| Apexification/recalc initial (D3351) | $253.60 | $317 | 0.3× |
| Apexification/recalc interim (D3352) | $108 | $135 | 0.1× |
| Apically positioned flap (D4245) | $262.40 | $328 | 0.1× |
| Apicoectomy - anterior (D3410) | $588 | $735 | 0.7× |
| Auto tissue graft 1st tooth (D4273) | $644.80 | $806 | 0.3× |
| Bdy surf activation mapg pm/cvdfb leads tm f/up (0696T) | $98.14 | $122.68 | 2.1× |
| Bio mtrls to aid soft/os reg (D4265) | $420.80 | $526 | 0.5× |
| Bitewings - three images (D0273) | $52 | $65 | 0.2× |
| Bitewings four images (D0274) | $59.20 | $74 | 0.2× |
| Blind interatrial shunt ide (C9758) | $24,790.89 | $30,988.61 | 1.2× |
| Ca screen;pelvic/breast exam (G0101) | $277.69 | $347.11 | 2.2× |
| Canal prep/fitting of dowel (D3950) | $110.40 | $138 | 0.1× |
| Catheterize for urine spec (P9612) | $10.82 | $13.53 | 1.2× |
| Closd rductn splint alveolus (D7670) | $1,571.20 | $1,964 | 0.4× |
| Comp periodontal evaluation (D0180) | $49.60 | $62 | 0.3× |
| Complete occlusal adjustment (D9952) | $252.80 | $316 | 0.3× |
| Comprehensve oral evaluation (D0150) | $52.80 | $66 | 0.3× |
| Con tissue w pedicle graft (D4276) | $754.40 | $943 | 0.4× |
| Cone beam ct both jaws (D0383) | $152.80 | $191 | 1.2× |
| Cone beam ct capt & interp (D0364) | $132 | $165 | 1.0× |
| Cone beam ct capt mandible (D0381) | $152.80 | $191 | 1.2× |
| Cone beam ct capt maxilla (D0382) | $152.80 | $191 | 1.2× |
| Cone beam ct capture limited (D0380) | $132 | $165 | 1.0× |
| Cone beam ct capture tmj (D0384) | $152.80 | $191 | 1.2× |
| Cone beam ct interp both jaw (D0367) | $152.80 | $191 | 1.2× |
| Cone beam ct interprete man (D0365) | $152.80 | $191 | 1.2× |
| Cone beam ct interprete max (D0366) | $152.80 | $191 | 1.2× |
| Cone beam ct interprete tmj (D0368) | $152.80 | $191 | 1.2× |
| Coping (D2975) | $396 | $495 | 0.5× |
| Core build-up incl any pins (D2950) | $162.40 | $203 | 0.2× |
| Coronectomy (D7251) | $300 | $375 | 0.2× |
| Covid-19 lab test non-cdc (U0002) | $176.30 | $220.37 | 3.4× |
| Crown 3/4 cast base metal (D2781) | $874.40 | $1,093 | 1.1× |
| Crown 3/4 cast noble metal (D2782) | $874.40 | $1,093 | 1.1× |
| Crown 3/4 porcelain/ceramic (D2783) | $792 | $990 | 1.0× |
| Crown full cast base metal (D2791) | $961.60 | $1,202 | 1.2× |
| Crown full cast high noble m (D2790) | $1,048.80 | $1,311 | 1.3× |
| Crown full cast noble metal (D2792) | $1,048.80 | $1,311 | 1.3× |
| Crown lengthen hard tissue (D4249) | $349.60 | $437 | 0.4× |
| Crown porc fused to titanium (D2753) | $1,048.80 | $1,311 | 1.3× |
| Crown porcelain fused base m (D2751) | $1,048.80 | $1,311 | 1.3× |
| Crown porcelain w/ h noble m (D2750) | $1,048.80 | $1,311 | 1.3× |
| Crown porcelain w/ noble met (D2752) | $1,048.80 | $1,311 | 1.3× |
| Crown porcelain/ceramic (D2740) | $961.60 | $1,202 | 1.2× |
| Crown repair (D2980) | $112.80 | $141 | 0.1× |
| Crown resin w/ high noble me (D2720) | $897.60 | $1,122 | 1.1× |
| Dental bitewing single image (D0270) | $21.60 | $27 | 0.2× |
| Dental bitewings two images (D0272) | $39.20 | $49 | 0.4× |
| Dental connector bar (D6920) | $137.60 | $172 | 0.2× |
| Dental inlay resin 3/mre sur (D2652) | $607.20 | $759 | 0.8× |
| Dental onlay metallic 2 surf (D2542) | $553.60 | $692 | 0.7× |
| Dental onlay metallic 3 surf (D2543) | $722.40 | $903 | 0.9× |
| Dental onlay metl 4/more sur (D2544) | $722.40 | $903 | 0.9× |
| Dental onlay porc 4/more sur (D2644) | $722.40 | $903 | 0.9× |
| Dental onlay porcelin 2 surf (D2642) | $553.60 | $692 | 0.7× |
| Dental onlay porcelin 3 surf (D2643) | $722.40 | $903 | 0.9× |
| Dental onlay resin 2 surface (D2662) | $542.40 | $678 | 0.7× |
| Dental prophylaxis adult (D1110) | $82.40 | $103 | 0.5× |
| Dental saliography (D0310) | $175.20 | $219 | 0.6× |
| Dental tmj arthrogram incl i (D0320) | $544.80 | $681 | 1.8× |
| Diab manage trn per indiv (G0108) | $196.70 | $245.88 | 3.5× |
| Diab manage trn ind/group (G0109) range across 2 matching MRF lines |
$54.27–$794.18 | $67.84–$992.72 | varies |
| Digital sub 2 or more images (D0394) | $277.60 | $347 | 2.6× |
| Direct refer hospital observ (G0379) | $1,485.90 | $1,857.38 | 2.0× |
| Dist space maint, fixed unil (D1575) | $177.60 | $222 | 0.2× |
| Drug test def 1-7 classes (G0480) | $230.13 | $287.66 | 2.0× |
| Drug test def 15-21 classes (G0482) | $717 | $896.25 | 3.6× |
| Drug test def 22+ classes (G0483) | $890.81 | $1,113.51 | 3.6× |
| Drug test def 8-14 classes (G0481) | $564.94 | $706.17 | 3.6× |
| Each addtnl prefab post (D2957) | $94.40 | $118 | 0.1× |
| Ekg tracing for initial prev (G0404) | $80.36 | $100.45 | 2.2× |
| Elec alys cplx prgrmg iins ptn 4+ parameters (0590T) | $388.48 | $485.60 | 3.3× |
| Elec alys smpl prgrmg iins ptn 1-3 parameters (0589T) | $388.48 | $485.60 | 3.3× |
| Elec stim other than wound (G0283) | $50.10 | $62.62 | 3.9× |
| Elec stim unattend for press (G0281) | $50.10 | $62.62 | 4.3× |
| End thxpy, anterior tooth (D3310) | $460 | $575 | 0.6× |
| End thxpy, molar tooth (D3330) | $780 | $975 | 1.0× |
| End thxpy, premolar tooth (D3320) | $620 | $775 | 0.8× |
| Ev Catheter Dir Chem Abltj Incmptnt Xtr Vein (0524T) | $7,123.60 | $8,904.50 | 1.8× |
| Excision benign lesion compl (D7412) | $869.60 | $1,087 | 0.4× |
| Excision benign lesion>1.25c (D7411) | $457.60 | $572 | 0.2× |
| Excision malig lesion<=1.25c (D7413) | $704.80 | $881 | 0.4× |
| Excision malig lesion>1.25cm (D7414) | $1,068.80 | $1,336 | 0.6× |
| Exposure of unerupted tooth (D7280) | $329.60 | $412 | 0.4× |
| Extensv oral eval prob focus (D0160) | $120 | $150 | 0.7× |
| Extraction coronal remnants (D7111) | $80.80 | $101 | 0.1× |
| Extraction erupted tooth/exr (D7140) range across 2 matching MRF lines |
$156.80–$2,050.99 | $196–$2,563.74 | varies |
| Extraoral 2d project image (D0250) | $31.20 | $39 | 0.3× |
| Extraoral posterior image (D0251) | $29.60 | $37 | 0.3× |
| Fecal blood scrn immunoassay (G0328) | $70.86 | $88.57 | 3.9× |
| Fern test (Q0114) | $35.14 | $43.92 | 3.6× |
| Fixed bilat space maint, man (D1517) | $289.60 | $362 | 0.4× |
| Fixed bilat space maint, max (D1516) | $289.60 | $362 | 0.4× |
| Full mouth debridement (D4355) | $84.80 | $106 | 0.1× |
| Fusion 2 or more 3d images (D0395) | $309.60 | $387 | 2.9× |
| Gingival flap proc w/ planin (D4240) | $349.60 | $437 | 0.1× |
| Gingivectomy/plasty 1 to 3 (D4211) | $157.60 | $197 | 0.0× |
| Gingivectomy/plasty 4 or mor (D4210) | $349.60 | $437 | 0.1× |
| Gingivectomy/plasty rest (D4212) | $157.60 | $197 | 0.0× |
| Gngvl flap w rootplan 1-3 th (D4241) | $262.40 | $328 | 0.1× |
| Gross pulpal debridement (D3221) | $80 | $100 | 0.1× |
| Guided tiss regen resorble (D4266) | $279.20 | $349 | 0.1× |
| Hbot, full body chamber, 30m (G0277) | $440.68 | $550.85 | 2.6× |
| Hep c screen high risk/other (G0472) | $167.22 | $209.03 | 3.6× |
| Hepb screen high risk indiv (G0499) | $125.91 | $157.39 | 4.5× |
| Home sleep test/type 3 porta (G0399) | $517.84 | $647.30 | 1.9× |
| I&d absc intraoral soft tiss (D7510) | $148 | $185 | 0.2× |
| I&d abscess extraoral (D7520) | $814.40 | $1,018 | 0.9× |
| Ig paraprotein qual imprcip&ms bld/ur w/isotype (0077U) | $142.11 | $177.64 | 3.3× |
| Impact tooth rem bony w/comp (D7241) | $358.40 | $448 | 0.4× |
| Impact tooth remov comp bony (D7240) | $336 | $420 | 0.4× |
| Impact tooth remov part bony (D7230) | $278.40 | $348 | 0.3× |
| Impact tooth remov soft tiss (D7220) | $259.20 | $324 | 0.3× |
| Incision/drain abscess extra (D7521) | $895.20 | $1,119 | 1.0× |
| Incision/drain abscess intra (D7511) | $148 | $185 | 0.2× |
| Incomplete endodontic tx (D3332) | $366.40 | $458 | 0.5× |
| Init/sub psych care m 1st 30 (G2214) | $76.85 | $96.06 | 0.6× |
| Initial preventive exam (G0402) | $497.14 | $621.43 | 3.0× |
| Inj for sacroiliac jt anesth (G0260) | $914.90 | $1,143.63 | 1.0× |
| Inlay composite/resin one su (D2650) | $162.40 | $203 | 0.2× |
| Inlay porcelain/ceramic 2 su (D2620) | $553.60 | $692 | 0.7× |
| Inlay repair (D2981) | $112.80 | $141 | 0.1× |
| Insj/Rplc Car Modulj Sys Pls Gen Transvns Eltrd (0408T) unusually low: confirm this is the full procedure |
$19,368.92 | $24,211.15 | 0.5× |
| Insj/Rplc Car Modulj Sys Ventr Electrode Only (0411T) | $7,453.78 | $9,317.23 | 0.7× |
| Insj/Rplc Cardiac Modulj Sys Atr Electrode Only (0410T) | $7,453.78 | $9,317.23 | 0.7× |
| Insj/Rplc Cardiac Modulj Sys Pls Generator Only (0409T) | $19,368.92 | $24,211.15 | 0.7× |
| Insj/Rplcmt Icds W/Substernal Electrode (0571T) | $24,229.73 | $30,287.16 | 0.6× |
| Intentional replantation (D3470) | $477.60 | $597 | 0.6× |
| Interim crown (D2799) | $219.20 | $274 | 0.3× |
| Internal root repair (D3333) | $136.80 | $171 | 0.2× |
| Interro Device Evaluation Cardiac Modulj System (0418T) | $121.47 | $151.84 | 2.6× |
| Intraor comprehensive series (D0210) | $119.20 | $149 | 0.4× |
| Intraoral occlusal film (D0240) | $25.60 | $32 | 0.2× |
| Intraoral periapical first (D0220) | $24 | $30 | 0.2× |
| Isolation- tooth w rubb dam (D3910) | $145.60 | $182 | 0.2× |
| Labial veneer porc indirect (D2962) | $1,075.20 | $1,344 | 1.3× |
| Labial veneer resin direct (D2960) | $280 | $350 | 0.3× |
| Labial veneer resin indirect (D2961) | $928.80 | $1,161 | 1.2× |
| Limit oral eval problm focus (D0140) | $49.60 | $62 | 0.3× |
| Limited occlusal adjustment (D9951) | $37.60 | $47 | 0.0× |
| Liver Dis 10 Assays Serum Algorithm W/Nash (0003M) | $1,289.71 | $1,612.14 | 2.6× |
| Localized delivery antimicro (D4381) | $66.40 | $83 | 0.1× |
| Mandible graft (D7950) unusually low: confirm this is the full procedure |
$2,340.80 | $2,926 | 0.3× |
| Mesial/distal wedge proc (D4274) | $200.80 | $251 | 0.2× |
| Mnt subs tx for change dx (G0270) | $121.98 | $152.48 | 3.8× |
| Mra w/cont, abd (C8900) | $1,652.32 | $2,065.40 | 3.8× |
| Mra w/cont, chest (C8909) | $1,652.32 | $2,065.40 | 3.8× |
| Mra w/cont, pelvis (C8918) | $1,652.32 | $2,065.40 | 3.8× |
| Mra w/o cont, abd (C8901) | $1,307.22 | $1,634.02 | 4.4× |
| Mra w/o cont, chest (C8910) | $1,307.22 | $1,634.02 | 4.4× |
| Mra w/o cont, pelvis (C8919) | $1,307.22 | $1,634.02 | 4.4× |
| Mra w/o fol w/cont, abd (C8902) | $1,652.32 | $2,065.40 | 3.8× |
| Mra w/o fol w/cont, lwr ext (C8914) | $1,652.32 | $2,065.40 | 3.8× |
| Mra w/o fol w/cont, pelvis (C8920) | $1,652.32 | $2,065.40 | 3.8× |
| Mri w/cont, breast, bi (C8906) | $1,652.32 | $2,065.40 | 3.8× |
| Mri w/cont, breast, uni (C8903) | $759.40 | $949.25 | 3.5× |
| Mri w/o fol w/cont, breast, (C8908) | $1,652.32 | $2,065.40 | 3.8× |
| Mri w/o fol w/cont, brst, un (C8905) | $1,652.32 | $2,065.40 | 3.8× |
| Neuro csf prion prtn qual (0035U) | $759.87 | $949.84 | 1.4× |
| Nfct ds bact&fng org id bld cul rrna fish 6+trgt (0086U) | $386.54 | $483.18 | 1.9× |
| Njx platelet plasma (0232T) | $891.78 | $1,114.73 | 1.6× |
| Non-auto graft 1st tooth (D4275) | $594.40 | $743 | 0.3× |
| Non-surg tx root canal obs (D3331) | $152.80 | $191 | 0.2× |
| Obtaining screen pap smear (Q0091) | $61.34 | $76.67 | 1.7× |
| Occ guard, hard, full arch (D9944) | $240 | $300 | 0.3× |
| Occ guard, soft, full arch (D9945) | $240 | $300 | 0.3× |
| Occlusion analysis (D9950) | $126.40 | $158 | 0.2× |
| Onc merkel cell carc detcj antb serum reprtd +/- (0059U) | $936.28 | $1,170.35 | 2.9× |
| Onc Merkel Cll Carc Srm Quan (0058U) | $936.28 | $1,170.35 | 2.9× |
| Onlay repair (D2982) | $112.80 | $141 | 0.1× |
| Oral antral fistula closure (D7260) | $1,083.20 | $1,354 | 1.3× |
| Oral/facial photo images (D0350) | $16.80 | $21 | 0.2× |
| Osseous surg 1 to 3 teeth (D4261) | $349.60 | $437 | 0.1× |
| Osseous surgery 4 or more (D4260) likely a partial charge, not the full procedure |
$436.80 | $546 | 0.1× |
| Oth resp proc, group (G0239) | $122.45 | $153.06 | 2.6× |
| Oth resp proc, indiv (G0238) | $122.45 | $153.06 | 3.4× |
| Other tmj images by report (D0321) | $204 | $255 | 1.9× |
| Panoramic image (D0330) | $112 | $140 | 0.4× |
| Part pulp for apexogenesis (D3222) | $80 | $100 | 0.1× |
| Pathogen test for platelets (P9100) | $127.10 | $158.88 | 1.7× |
| Pedicle soft tissue graft pr (D4270) | $565.60 | $707 | 0.3× |
| Pelvic ring fracture uni/bil (G0413) | $12,765.81 | $15,957.26 | 1.4× |
| Perc d-e cor revasc chro sin (C9607) | $27,734.70 | $34,668.38 | 1.2× |
| Perc d-e cor revasc t cabg s (C9604) | $21,741.66 | $27,177.08 | 1.5× |
| Perc drug-el cor stent sing (C9600) | $21,741.66 | $27,177.08 | 1.5× |
| Percutaneous implantation or replacement of integrated single device neurostimulation system including electrode array… (0587T) likely a partial charge, not the full procedure |
$1,515.42 | $1,894.28 | 0.2× |
| Periodic oral evaluation (D0120) | $36 | $45 | 0.2× |
| Periodontal maint procedures (D4910) | $101.60 | $127 | 0.1× |
| Periodontal scaling & root (D4341) | $186.40 | $233 | 0.2× |
| Periodontal scaling 1-3teeth (D4342) | $80.80 | $101 | 0.1× |
| Perq Sacral Augmt Bilat Inj (0201T) | $15,663.61 | $19,579.51 | 1.7× |
| Perq Sacral Augmt Unilat Inj (0200T) | $15,663.61 | $19,579.51 | 1.7× |
| Perq tcat ther rx dlvr ntrac rx balo 1 maj c art (0913T) | $9,823.40 | $12,279.25 | 0.7× |
| Place device/marker, non pro (C9728) | $3,994.32 | $4,992.90 | 2.3× |
| Place direct restoration (D2940) | $101.60 | $127 | 0.1× |
| Place intra-socket bio dress (D7922) | $138.40 | $173 | 0.2× |
| Post 1 srfc resinbased cmpst (D2391) | $141.60 | $177 | 0.2× |
| Post 2 srfc resinbased cmpst (D2392) | $170.40 | $213 | 0.2× |
| Post 3 srfc resinbased cmpst (D2393) | $227.20 | $284 | 0.3× |
| Post >=4srfc resinbase cmpst (D2394) | $259.20 | $324 | 0.3× |
| Post and core cast + crown (D2952) | $240.80 | $301 | 0.3× |
| Potassium hydroxide preps (Q0112) | $21.02 | $26.28 | 3.6× |
| Pre 3d mdl w/ccta and/or mri (C9793) | $2,719.03 | $3,398.79 | 2.5× |
| Prefab porc/cer crown perm (D2928) | $288 | $360 | 0.4× |
| Prefab porc/ceram crown pri (D2929) | $195.20 | $244 | 0.2× |
| Prefab post/core + crown (D2954) | $188.80 | $236 | 0.2× |
| Prefab stainless steel crown (D2933) | $195.20 | $244 | 0.2× |
| Prefab stnlss steel crown pe (D2931) | $191.20 | $239 | 0.2× |
| Prefab stnlss steel crwn pri (D2930) | $176.80 | $221 | 0.2× |
| Prefabricated resin crown (D2932) | $248.80 | $311 | 0.3× |
| Prgrmg Device Evaluation Cardiac Modulj System (0417T) | $121.47 | $151.84 | 2.6× |
| Primary closure sinus perf (D7261) | $747.20 | $934 | 0.9× |
| Prostate biopsy, any mthd (G0416) | $733.43 | $916.79 | 1.6× |
| Psa screening (G0103) | $81.95 | $102.44 | 4.2× |
| Pulp cap direct (D3110) | $44.80 | $56 | 0.1× |
| Pulp cap indirect (D3120) | $43.20 | $54 | 0.1× |
| Pulp vitality test (D0460) | $30.40 | $38 | 0.0× |
| Pulpal regeneration complete (D3357) | $534.40 | $668 | 0.7× |
| Pulpal regeneration initial (D3355) | $132.80 | $166 | 0.2× |
| Pulpal regeneration interim (D3356) | $108 | $135 | 0.1× |
| Pulpal therapy anterior prim (D3230) | $172 | $215 | 0.2× |
| Pulpal therapy posterior pri (D3240) | $237.60 | $297 | 0.3× |
| Rad exc lesion up to 1.25 cm (D7410) | $255.20 | $319 | 0.1× |
| Radiation shield (D5984) | $251.20 | $314 | 0.3× |
| Rbc DNA hea 35 ag 11 bld grp whl bld cmn allel (0001U) | $2,087.33 | $2,609.16 | 2.9× |
| Re-cement or re-bond crown (D2920) | $70.40 | $88 | 0.1× |
| Reattach tooth fragment (D2921) | $84 | $105 | 0.1× |
| Recement cast or prefab post (D2915) | $59.20 | $74 | 0.1× |
| Recement inlay onlay or part (D2910) | $64.80 | $81 | 0.1× |
| Recement space maint - man (D1552) | $70.40 | $88 | 0.1× |
| Recement space maint - max (D1551) | $70.40 | $88 | 0.1× |
| Recement unilat space maint (D1553) | $63.20 | $79 | 0.1× |
| Reloc Skin Pocket Cardiac Modulj Pulse Generator (0416T) | $2,829.64 | $3,537.05 | 1.1× |
| Rem exostosis any site (D7471) | $457.60 | $572 | 0.1× |
| Rem imp tooth w mucoper flp (D7210) | $224 | $280 | 0.1× |
| Rem odontogen cyst > 1.25 cm (D7451) | $600 | $750 | 0.1× |
| Rem odontogen cyst to 1.25cm (D7450) | $430.40 | $538 | 0.1× |
| Removal fb skin/areolar tiss (D7530) | $277.60 | $347 | 0.3× |
| Removal of sloughed off bone (D7550) | $536.80 | $671 | 0.7× |
| Removal of torus palatinus (D7472) | $592 | $740 | 0.7× |
| Remove bilat space main, man (D1527) | $289.60 | $362 | 0.4× |
| Remove bilat space main, max (D1526) | $289.60 | $362 | 0.4× |
| Remove torus mandibularis (D7473) | $511.20 | $639 | 0.6× |
| Remove unilat space maintain (D1520) | $176.80 | $221 | 0.2× |
| Repos Cardiac Modulj Transvenous Electrode (0415T) | $1,672.78 | $2,090.98 | 2.1× |
| Reshaping bone orthognathic (D7940) | $3,624 | $4,530 | 4.5× |
| Resin 4/> surf or w incis an (D2335) | $193.60 | $242 | 0.2× |
| Resin infiltration of lesion (D2990) | $49.60 | $62 | 0.1× |
| Resin one surface-anterior (D2330) | $115.20 | $144 | 0.1× |
| Resin three surfaces-anterio (D2332) | $160 | $200 | 0.2× |
| Resin two surfaces-anterior (D2331) | $120 | $150 | 0.1× |
| Restorative foundation (D2949) | $216.80 | $271 | 0.3× |
| Retreat root canal anterior (D3346) | $600.80 | $751 | 0.7× |
| Retreat root canal molar (D3348) | $1,072 | $1,340 | 1.3× |
| Retreat root canal premolar (D3347) | $872 | $1,090 | 1.1× |
| Retrograde filling (D3430) | $152 | $190 | 0.2× |
| Revasc intra lithotrip-ather (C9766) | $18,643.56 | $23,304.45 | 0.8× |
| Revasc intra lithotrip-stent (C9765) | $18,643.56 | $23,304.45 | 0.8× |
| Revasc intravasc lithotripsy (C9764) | $10,950.35 | $13,687.94 | 0.8× |
| Revasc lith-sten-ath tib/per (C9775) | $24,480.21 | $30,600.26 | 1.1× |
| Revasc lithotr-ather tib/per (C9774) | $24,480.21 | $30,600.26 | 1.1× |
| Revasc lithotr-stent tib/per (C9773) | $24,480.21 | $30,600.26 | 1.1× |
| Revasc lithotrip tibi/perone (C9772) | $18,643.56 | $23,304.45 | 1.3× |
| Revasc lithotrip-stent-ather (C9767) | $24,480.21 | $30,600.26 | 1.1× |
| Revision or removal of integrated single device neurostimulation system including electrode array and receiver or pulse… (0588T) | $391.83 | $489.79 | 0.1× |
| Rmvl & Rpl Cardiac Modulj Sys Pls Generator Only (0414T) | $19,368.92 | $24,211.15 | 0.7× |
| Rmvl Car Modulj Tranvns Elt (0413T) | $7,765.78 | $9,707.22 | 1.7× |
| Rmvl Cardiac Modulj Pls Gen (0412T) | $7,765.78 | $9,707.22 | 1.7× |
| Root amputation (D3450) | $329.60 | $412 | 0.4× |
| Root surgery molar (D3425) | $814.40 | $1,018 | 1.0× |
| Root surgery premolar (D3421) | $723.20 | $904 | 0.9× |
| Screen cerv/vag thin layer (G0123) | $90.23 | $112.79 | 4.5× |
| Screen pap by tech w md supv (P3000) | $52.86 | $66.08 | 2.9× |
| Soft tissue graft firsttooth (D4277) | $576.80 | $721 | 0.3× |
| Space maintainer fxd unilat (D1510) | $269.60 | $337 | 0.3× |
| Splint extra-coronal (D4323) | $237.60 | $297 | 0.3× |
| Splint intra-coronal (D4322) | $237.60 | $297 | 0.3× |
| Surg exp root surf anterior (D3501) | $143.20 | $179 | 0.2× |
| Surg exp root surf molar (D3503) | $143.20 | $179 | 0.2× |
| Surg exp root surf premolar (D3502) | $143.20 | $179 | 0.2× |
| Surg reduct osseoustuberosit (D7485) likely a partial charge, not the full procedure |
$592 | $740 | 0.1× |
| Surg rep root res anterior (D3471) | $206.40 | $258 | 0.3× |
| Surg rep root res molar (D3473) | $206.40 | $258 | 0.3× |
| Surg rep root res premolar (D3472) | $206.40 | $258 | 0.3× |
| Surgical splint (D5988) | $400 | $500 | 0.5× |
| Tcat Rmvl/Debulk Icar Mass Suction Device Perq (0644T) | $10,649.94 | $13,312.42 | 1.5× |
| Therapeutic procd strg endur (G0237) | $122.45 | $153.06 | 3.4× |
| Therapeutic pulpotomy (D3220) | $88 | $110 | 0.1× |
| Tooth reimplantation (D7270) | $310.40 | $388 | 0.4× |
| Tooth root removal (D7250) | $269.60 | $337 | 0.3× |
| Tooth splitting (D3920) | $329.60 | $412 | 0.4× |
| Tooth transplantation (D7272) | $310.40 | $388 | 0.4× |
| Tpmt and Nudt15 Genotype (0034U) | $1,525.46 | $1,906.82 | 3.3× |
| Trluml Perip Athrc Iliac Art (0238T) range across 2 matching MRF lines |
$25,311.24–$27,734.70 | $31,639.05–$34,668.38 | varies |
| Trtmnt simulation 3d image (D0393) | $258.40 | $323 | 2.4× |
| Tte w or w/o contr, cont ecg (C8930) | $2,240.14 | $2,800.18 | 2.3× |
| Tte w or wo fol wcon,doppler (C8929) | $2,240.14 | $2,800.18 | 2.3× |
| Unsched dialysis esrd pt hos (G0257) | $1,939.30 | $2,424.12 | 2.3× |
| Veneer repair (D2983) | $112.80 | $141 | 0.1× |
| Vert bitewings 7 to 8 images (D0277) | $61.60 | $77 | 0.2× |
| Vestibuloplasty exten graft (D7350) unusually low: confirm this is the full procedure |
$2,219.20 | $2,774 | 0.3× |
| Vestibuloplasty ridge extens (D7340) likely a partial charge, not the full procedure |
$840.80 | $1,051 | 0.1× |
| Visit to determ ldct elig (G0296) | $277.69 | $347.11 | 2.2× |
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.