Supplies, drugs & other prices at Wynn Hospital
Utica, NY · every code in this section with a posted price and a Medicare benchmark.
275 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 2d tte w or w/o fol w/con,co (C8923) | $1,868.40 | $3,114 | 1.9× |
| 2d tte w or w/o fol w/con,fu (C8924) | $331.20 | $552 | 0.8× |
| Add proc construct new crown (D2971) | $206.40 | $344 | 0.3× |
| Adm tocilizu covid-19 1st (M0249) | $725.40 | $1,209 | 1.3× |
| Admin hepatitis b vaccine (G0010) | $90.60 | $151 | 1.6× |
| Admin influenza virus vac (G0008) | $99 | $165 | 1.7× |
| Admin pneumococcal vaccine (G0009) | $96.60 | $161 | 1.7× |
| Alcohol/subs interv 15-30mn (G0396) | $67.20 | $112 | 1.4× |
| Alveoloplasty not w/extracts (D7321) | $156 | $260 | 0.1× |
| Alveoloplasty w/extract 1-3 (D7311) | $199.20 | $332 | 0.1× |
| Alveolus clsd reduc stblz te (D7771) | $608.40 | $1,014 | 0.1× |
| Alveolus open reduction (D7671) likely a partial charge, not the full procedure |
$608.40 | $1,014 | 0.1× |
| Alveoplasty w/ extraction (D7310) | $128.40 | $214 | 0.1× |
| Alveoplasty w/o extraction (D7320) | $232.80 | $388 | 0.1× |
| Amalgam 4 or > surfaces perm (D2161) | $204 | $340 | 0.3× |
| Amalgam one surface permanen (D2140) | $99 | $165 | 0.1× |
| Amalgam three surfaces perma (D2160) | $161.40 | $269 | 0.2× |
| Amalgam two surfaces permane (D2150) | $129 | $215 | 0.2× |
| Ana crown exp 1-3 per quad (D4231) | $486.60 | $811 | 0.3× |
| Ana crown exp 4 or> per quad (D4230) | $486.60 | $811 | 0.1× |
| Ant resin-based cmpst crown (D2390) | $182.40 | $304 | 0.2× |
| Apexification/recalc final (D3353) | $324.60 | $541 | 0.4× |
| Apexification/recalc initial (D3351) | $244.20 | $407 | 0.3× |
| Apexification/recalc interim (D3352) | $167.40 | $279 | 0.2× |
| Apically positioned flap (D4245) | $370.20 | $617 | 0.2× |
| Apicoectomy - anterior (D3410) | $579 | $965 | 0.7× |
| Auto tissue graft 1st tooth (D4273) | $550.80 | $918 | 0.3× |
| Behavior counsel obesity 15m (G0447) | $39.60 | $66 | 0.3× |
| Bio mtrls to aid soft/os reg (D4265) | $550.80 | $918 | 0.7× |
| Bitewings - three images (D0273) | $52.80 | $88 | 0.2× |
| Bitewings four images (D0274) | $68.40 | $114 | 0.2× |
| Bone replce graft first site (D4263) | $430.80 | $718 | 0.5× |
| Brief alcohol misuse counsel (G0443) | $107.40 | $179 | 0.8× |
| Ca screen;flexi sigmoidscope (G0104) | $3,056.42 | $5,094.03 | 2.6× |
| Ca screen;pelvic/breast exam (G0101) range across 3 matching MRF lines |
$45.60–$55.80 | $76–$93 | varies |
| Canal prep/fitting of dowel (D3950) | $608.40 | $1,014 | 0.8× |
| Chemo extend iv infus w/pump (G0498) | $723.60 | $1,206 | 1.8× |
| Closd rductn splint alveolus (D7670) | $42 | $70 | 0.0× |
| Colon ca scrn not hi rsk ind (G0121) | $3,147.88 | $5,246.47 | 2.7× |
| Colorectal scrn; hi risk ind (G0105) | $3,659.78 | $6,099.64 | 3.2× |
| Complete occlusal adjustment (D9952) | $391.80 | $653 | 0.5× |
| Comprehensve oral evaluation (D0150) | $58.80 | $98 | 0.4× |
| Comt gene analysis c.472g>a variant (0032U) | $1,337.40 | $2,229 | 7.7× |
| Con tissue w pedicle graft (D4276) | $550.80 | $918 | 0.3× |
| Coping (D2975) | $206.40 | $344 | 0.3× |
| Core build-up incl any pins (D2950) | $148.80 | $248 | 0.2× |
| Covid-19 lab test non-cdc (U0002) | $616.20 | $1,027 | 12.0× |
| Crown 3/4 cast base metal (D2781) | $798 | $1,330 | 1.0× |
| Crown 3/4 cast hi noble met (D2780) | $798 | $1,330 | 1.0× |
| Crown 3/4 cast noble metal (D2782) | $798 | $1,330 | 1.0× |
| Crown 3/4 porcelain/ceramic (D2783) | $637.80 | $1,063 | 0.8× |
| Crown 3/4 resin-based compos (D2712) | $550.80 | $918 | 0.7× |
| Crown full cast base metal (D2791) | $945 | $1,575 | 1.2× |
| Crown full cast high noble m (D2790) | $999.60 | $1,666 | 1.2× |
| Crown full cast noble metal (D2792) | $1,013.40 | $1,689 | 1.3× |
| Crown lengthen hard tissue (D4249) | $391.80 | $653 | 0.5× |
| Crown porcelain fused base m (D2751) | $945 | $1,575 | 1.2× |
| Crown porcelain w/ h noble m (D2750) | $1,024.80 | $1,708 | 1.3× |
| Crown porcelain w/ noble met (D2752) | $985.80 | $1,643 | 1.2× |
| Crown porcelain/ceramic (D2740) | $985.80 | $1,643 | 1.2× |
| Crown repair (D2980) | $206.40 | $344 | 0.3× |
| Crown resin w/ base metal (D2721) | $945 | $1,575 | 1.2× |
| Crown resin w/ high noble me (D2720) | $999.60 | $1,666 | 1.2× |
| Crown resin w/ noble metal (D2722) | $945 | $1,575 | 1.2× |
| Crown resin-based indirect (D2710) | $243.60 | $406 | 0.3× |
| Cysto impl 4 or more (C9740) | $34,770.05 | $57,950.09 | 2.9× |
| Dental bitewing single image (D0270) | $28.20 | $47 | 0.3× |
| Dental bitewings two images (D0272) | $41.40 | $69 | 0.4× |
| Dental connector bar (D6920) | $608.40 | $1,014 | 0.8× |
| Dental inlay metalic 1 surf (D2510) | $582.60 | $971 | 0.7× |
| Dental inlay metallic 2 surf (D2520) | $700.20 | $1,167 | 0.9× |
| Dental inlay metl 3/more sur (D2530) | $816 | $1,360 | 1.0× |
| Dental inlay resin 3/mre sur (D2652) | $561 | $935 | 0.7× |
| Dental onlay metallic 2 surf (D2542) | $616.20 | $1,027 | 0.8× |
| Dental onlay metallic 3 surf (D2543) | $945 | $1,575 | 1.2× |
| Dental onlay metl 4/more sur (D2544) | $945 | $1,575 | 1.2× |
| Dental onlay porc 3/more sur (D2630) | $699 | $1,165 | 0.9× |
| Dental onlay porc 4/more sur (D2644) | $875.40 | $1,459 | 1.1× |
| Dental onlay porcelin 2 surf (D2642) | $730.80 | $1,218 | 0.9× |
| Dental onlay porcelin 3 surf (D2643) | $654.60 | $1,091 | 0.8× |
| Dental onlay resin 2 surface (D2662) | $591.60 | $986 | 0.7× |
| Dental onlay resin 3 surface (D2663) | $658.20 | $1,097 | 0.8× |
| Dental onlay resin 4/mre sur (D2664) | $745.80 | $1,243 | 0.9× |
| Dental prophylaxis adult (D1110) | $93 | $155 | 0.6× |
| Dental unspec restorative pr (D2999) | $196.20 | $327 | 0.2× |
| Depression screen annual (G0444) range across 3 matching MRF lines |
$21.60–$60 | $36–$100 | varies |
| Diab manage trn per indiv (G0108) range across 3 matching MRF lines |
$55.20–$136.20 | $92–$227 | varies |
| Diab manage trn ind/group (G0109) range across 4 matching MRF lines |
$39.60–$74.40 | $66–$124 | varies |
| Direct refer hospital observ (G0379) | $343.20 | $572 | 0.5× |
| Each addtnl prefab post (D2957) | $226.80 | $378 | 0.3× |
| Ekg tracing for initial prev (G0404) | $12.60 | $21 | 0.3× |
| End thxpy, anterior tooth (D3310) | $493.80 | $823 | 0.6× |
| End thxpy, molar tooth (D3330) | $789 | $1,315 | 1.0× |
| End thxpy, premolar tooth (D3320) | $591.60 | $986 | 0.7× |
| Endo outlet restrict w/tube (C9785) | $17,246.24 | $28,743.73 | 1.3× |
| Endodontic procedure (D3999) | $577.20 | $962 | 0.7× |
| Ev fempop artl revsc tcat plmt IV st grf & clsr (0505T) | $20,019.60 | $33,366 | 1.4× |
| Excision benign lesion compl (D7412) | $259.80 | $433 | 0.1× |
| Excision benign lesion>1.25c (D7411) | $259.80 | $433 | 0.1× |
| Excision malig les complicat (D7415) | $259.80 | $433 | 0.1× |
| Excision malig lesion<=1.25c (D7413) | $259.80 | $433 | 0.1× |
| Excision malig lesion>1.25cm (D7414) | $259.80 | $433 | 0.1× |
| Exposure of unerupted tooth (D7280) | $487.20 | $812 | 0.6× |
| Extensv oral eval prob focus (D0160) | $79.80 | $133 | 0.5× |
| Extraction coronal remnants (D7111) | $70.20 | $117 | 0.1× |
| Extraction erupted tooth/exr (D7140) | $99 | $165 | 0.1× |
| Extraoral 2d project image (D0250) | $60.60 | $101 | 0.6× |
| Fecal blood scrn immunoassay (G0328) | $45 | $75 | 2.5× |
| Fecal microbiota prep instil (G0455) range across 2 matching MRF lines |
$2,120.40–$31,334.40 | $3,534–$52,224 | varies |
| Fixed bilat space maint, man (D1517) | $207 | $345 | 0.3× |
| Fixed bilat space maint, max (D1516) | $207 | $345 | 0.3× |
| Followup eval of foot pt lop (G0246) | $152.40 | $254 | 0.9× |
| Full mouth debridement (D4355) | $92.40 | $154 | 0.1× |
| Gingival flap proc w/ planin (D4240) | $454.20 | $757 | 0.1× |
| Gingivectomy/plasty 1 to 3 (D4211) | $171 | $285 | 0.0× |
| Gingivectomy/plasty 4 or mor (D4210) | $418.80 | $698 | 0.1× |
| Gngvl flap w rootplan 1-3 th (D4241) | $370.20 | $617 | 0.2× |
| Gross pulpal debridement (D3221) | $136.20 | $227 | 0.2× |
| Group train w/o patient (G0543) | $13.20 | $22 | 0.4× |
| Guided tiss regen nonresorb (D4267) | $512.40 | $854 | 0.3× |
| Guided tiss regen resorble (D4266) | $512.40 | $854 | 0.3× |
| Hbot, full body chamber, 30m (G0277) | $383.40 | $639 | 2.2× |
| Hep c screen high risk/other (G0472) | $109.80 | $183 | 2.4× |
| Hepb screen high risk indiv (G0499) | $68.40 | $114 | 2.4× |
| Home sleep test/type 3 porta (G0399) | $637.20 | $1,062 | 2.4× |
| Hopd mntl hlt, 15-29 min (C7900) | $42.60 | $71 | 0.9× |
| Hopd mntl hlt, 30-60 min (C7901) | $97.20 | $162 | 0.8× |
| Hospital outpt clinic visit (G0463) | $108.60 | $181 | 0.7× |
| I&d absc intraoral soft tiss (D7510) | $124.80 | $208 | 0.1× |
| I&d abscess extraoral (D7520) | $171.60 | $286 | 0.2× |
| Ig paraprotein qual imprcip&ms bld/ur w/isotype (0077U) range across 2 matching MRF lines |
$155.40–$677.40 | $259–$1,129 | varies |
| Impact tooth rem bony w/comp (D7241) | $369.60 | $616 | 0.5× |
| Impact tooth remov comp bony (D7240) | $257.40 | $429 | 0.3× |
| Impact tooth remov part bony (D7230) | $354.60 | $591 | 0.4× |
| Impact tooth remov soft tiss (D7220) | $192.60 | $321 | 0.2× |
| Incision/drain abscess extra (D7521) | $373.20 | $622 | 0.4× |
| Incision/drain abscess intra (D7511) | $373.20 | $622 | 0.4× |
| Incomplete endodontic tx (D3332) | $244.20 | $407 | 0.3× |
| Init/sub psych care m 1st 30 (G2214) range across 2 matching MRF lines |
$70.20–$207.60 | $117–$346 | varies |
| Initial foot exam pt lops (G0245) | $253.80 | $423 | 1.5× |
| Initial preventive exam (G0402) range across 3 matching MRF lines |
$202.80–$232.80 | $338–$388 | varies |
| Inlay composite/resin one su (D2650) | $421.20 | $702 | 0.5× |
| Inlay composite/resin two su (D2651) | $495 | $825 | 0.6× |
| Inlay porcelain/ceramic 1 su (D2610) | $528 | $880 | 0.7× |
| Inlay porcelain/ceramic 2 su (D2620) | $616.80 | $1,028 | 0.8× |
| Insertion of gastrostomy tube, percutaneous, with magnetic gastropexy, under ultrasound guidance, image documentation… (0647T) | $3,346.80 | $5,578 | 1.4× |
| Intentional replantation (D3470) | $608.40 | $1,014 | 0.8× |
| Interim crown (D2799) | $230.40 | $384 | 0.3× |
| Internal root repair (D3333) | $244.20 | $407 | 0.3× |
| Intraor comprehensive series (D0210) | $128.40 | $214 | 0.4× |
| Intraoral occlusal film (D0240) | $28.80 | $48 | 0.3× |
| Intraoral periapical first (D0220) | $16.20 | $27 | 0.1× |
| Isolation- tooth w rubb dam (D3910) | $60.60 | $101 | 0.1× |
| Jak2 Gene Analysis Trgt Seq Alys Exons 12-15 (0027U) | $898.80 | $1,498 | 7.4× |
| Labial veneer porc indirect (D2962) | $768.60 | $1,281 | 1.0× |
| Labial veneer resin direct (D2960) | $525.60 | $876 | 0.7× |
| Labial veneer resin indirect (D2961) | $579 | $965 | 0.7× |
| Limit oral eval problm focus (D0140) | $47.40 | $79 | 0.3× |
| Limited occlusal adjustment (D9951) | $84 | $140 | 0.1× |
| Liver Dis 10 Assays Serum Algorithm W/Nash (0003M) | $1,173 | $1,955 | 2.3× |
| Localized delivery antimicro (D4381) | $59.40 | $99 | 0.1× |
| Malig tumor > 1.25 cm (D7441) | $473.40 | $789 | 0.1× |
| Mesial/distal wedge proc (D4274) | $550.80 | $918 | 0.7× |
| Mri w/o fol w/cont, breast, (C8908) | $1,009.20 | $1,682 | 2.3× |
| Njx platelet plasma (0232T) | $29,695.01 | $49,491.68 | 53.3× |
| No pt prsnt train initial 30 (G0541) | $53.40 | $89 | 1.5× |
| Non-auto graft 1st tooth (D4275) | $550.80 | $918 | 0.3× |
| Non-surg tx root canal obs (D3331) | $346.20 | $577 | 0.4× |
| Obtaining screen pap smear (Q0091) range across 4 matching MRF lines |
$52.80–$75.60 | $88–$126 | varies |
| Occ guard, hard, full arch (D9944) | $168.60 | $281 | 0.2× |
| Occ guard, hard, part arch (D9946) | $164.40 | $274 | 0.2× |
| Occlusion analysis (D9950) | $160.80 | $268 | 0.2× |
| Open reduc compd alveolus fx (D7770) likely a partial charge, not the full procedure |
$608.40 | $1,014 | 0.1× |
| Oral antral fistula closure (D7260) | $451.20 | $752 | 0.6× |
| Oral/facial photo images (D0350) | $33 | $55 | 0.3× |
| Osseous surg 1 to 3 teeth (D4261) | $550.80 | $918 | 0.1× |
| Osseous surgery 4 or more (D4260) likely a partial charge, not the full procedure |
$756.60 | $1,261 | 0.1× |
| Oth resp proc, group (G0239) | $75.60 | $126 | 1.6× |
| Panoramic image (D0330) | $73.20 | $122 | 0.2× |
| Pathogen test for platelets (P9100) range across 2 matching MRF lines |
$63.60–$106.20 | $106–$177 | varies |
| Pedicle soft tissue graft pr (D4270) | $666 | $1,110 | 0.3× |
| Perc d-e cor revasc chro sin (C9607) unusually low: confirm this is the full procedure |
$9,562.80 | $15,938 | 0.4× |
| Perc d-e cor revasc t cabg s (C9604) | $9,179.40 | $15,299 | 0.6× |
| Perc d-e cor stent ather s (C9602) unusually low: confirm this is the full procedure |
$9,730.20 | $16,217 | 0.4× |
| Perc drug-el cor stent sing (C9600) range across 2 matching MRF lines |
$11,004–$45,396.39 | $18,340–$75,660.65 | varies |
| Periodic oral evaluation (D0120) | $53.40 | $89 | 0.3× |
| Periodontal maint procedures (D4910) | $94.80 | $158 | 0.1× |
| Periodontal scaling & root (D4341) | $151.80 | $253 | 0.2× |
| Periodontal scaling 1-3teeth (D4342) | $117 | $195 | 0.1× |
| Perq tcat ther rx dlvr ntrac rx balo 1 maj c art (0913T) | $13,111.20 | $21,852 | 0.9× |
| Place direct restoration (D2940) | $60.60 | $101 | 0.1× |
| Post 1 srfc resinbased cmpst (D2391) | $99 | $165 | 0.1× |
| Post 2 srfc resinbased cmpst (D2392) | $132 | $220 | 0.2× |
| Post 3 srfc resinbased cmpst (D2393) | $161.40 | $269 | 0.2× |
| Post >=4srfc resinbase cmpst (D2394) | $194.40 | $324 | 0.2× |
| Post and core cast + crown (D2952) | $354 | $590 | 0.4× |
| Ppps, initial visit (G0438) | $202.20 | $337 | 1.2× |
| Ppps, subseq visit (G0439) range across 2 matching MRF lines |
$159.60–$164.40 | $266–$274 | varies |
| Prefab post/core + crown (D2954) | $240.60 | $401 | 0.3× |
| Prefab steel crown primary (D2934) | $223.80 | $373 | 0.3× |
| Prefab stnlss steel crown pe (D2931) | $158.40 | $264 | 0.2× |
| Prefab stnlss steel crwn pri (D2930) | $228.60 | $381 | 0.3× |
| Prefabricated resin crown (D2932) | $283.20 | $472 | 0.4× |
| Primary closure sinus perf (D7261) | $575.40 | $959 | 0.7× |
| Prostate biopsy, any mthd (G0416) | $1,263 | $2,105 | 2.8× |
| Psa screening (G0103) | $79.80 | $133 | 4.1× |
| Pulp cap direct (D3110) | $45.60 | $76 | 0.1× |
| Pulp cap indirect (D3120) | $42 | $70 | 0.1× |
| Pulp vitality test (D0460) | $46.80 | $78 | 0.1× |
| Pulpal therapy anterior prim (D3230) | $71.40 | $119 | 0.1× |
| Pulpal therapy posterior pri (D3240) | $488.40 | $814 | 0.6× |
| Rad exc lesion up to 1.25 cm (D7410) | $264.60 | $441 | 0.1× |
| Rbc DNA hea 35 ag 11 bld grp whl bld cmn allel (0001U) | $615 | $1,025 | 0.9× |
| Re-cement or re-bond crown (D2920) | $65.40 | $109 | 0.1× |
| Re-eval,est pt,problem focus (D0170) | $79.80 | $133 | 0.5× |
| Recement cast or prefab post (D2915) | $230.40 | $384 | 0.3× |
| Recement inlay onlay or part (D2910) | $60.60 | $101 | 0.1× |
| Rem exostosis any site (D7471) | $373.20 | $622 | 0.1× |
| Rem imp tooth w mucoper flp (D7210) | $167.40 | $279 | 0.1× |
| Rem nonodonto cyst > 1.25 cm (D7461) | $373.20 | $622 | 0.5× |
| Rem nonodonto cyst to 1.25cm (D7460) | $373.20 | $622 | 0.5× |
| Rem odontogen cyst > 1.25 cm (D7451) | $373.20 | $622 | 0.1× |
| Rem odontogen cyst to 1.25cm (D7450) | $373.20 | $622 | 0.1× |
| Removal fb skin/areolar tiss (D7530) | $373.20 | $622 | 0.5× |
| Removal of fb reaction (D7540) | $373.20 | $622 | 0.5× |
| Removal of sloughed off bone (D7550) | $373.20 | $622 | 0.5× |
| Removal of torus palatinus (D7472) | $373.20 | $622 | 0.5× |
| Remove torus mandibularis (D7473) | $397.20 | $662 | 0.5× |
| Remove unilat space maintain (D1520) | $242.40 | $404 | 0.3× |
| Resin 4/> surf or w incis an (D2335) | $194.40 | $324 | 0.2× |
| Resin one surface-anterior (D2330) range across 2 matching MRF lines |
$99–$198 | $165–$330 | varies |
| Resin three surfaces-anterio (D2332) | $172.80 | $288 | 0.2× |
| Resin two surfaces-anterior (D2331) | $144 | $240 | 0.2× |
| Retreat root canal anterior (D3346) | $520.20 | $867 | 0.6× |
| Retreat root canal molar (D3348) | $831.60 | $1,386 | 1.0× |
| Retreat root canal premolar (D3347) | $709.20 | $1,182 | 0.9× |
| Retrograde filling (D3430) | $101.40 | $169 | 0.1× |
| Revasc intra lithotrip-stent (C9765) | $19,036.20 | $31,727 | 0.8× |
| Revasc lithotrip tibi/perone (C9772) | $19,036.20 | $31,727 | 1.3× |
| Root amputation (D3450) | $608.40 | $1,014 | 0.8× |
| Root surgery molar (D3425) | $608.40 | $1,014 | 0.8× |
| Root surgery premolar (D3421) | $163.20 | $272 | 0.2× |
| Space maintainer fxd unilat (D1510) | $223.20 | $372 | 0.3× |
| Surg reduct osseoustuberosit (D7485) likely a partial charge, not the full procedure |
$373.20 | $622 | 0.1× |
| Surgical revision procedure (D4268) | $550.80 | $918 | 0.7× |
| Surgical splint (D5988) | $14.40 | $24 | 0.0× |
| Tcat Rmvl/Debulk Icar Mass Suction Device Perq (0644T) | $13,263 | $22,105 | 1.9× |
| Tee w or w/o fol w/cont, mon (C8927) | $2,561.40 | $4,269 | 2.6× |
| Tee w or w/o fol w/cont,cong (C8926) | $1,868.40 | $3,114 | 1.9× |
| Therapeutic pulpotomy (D3220) | $168.60 | $281 | 0.2× |
| Tomosynthesis, mammo (G0279) | $63 | $105 | 5.0× |
| Tooth pin retention (D2951) | $30.60 | $51 | 0.0× |
| Tooth reimplantation (D7270) | $146.40 | $244 | 0.2× |
| Tooth root removal (D7250) | $191.40 | $319 | 0.2× |
| Tooth splitting (D3920) | $58.20 | $97 | 0.1× |
| Tooth transplantation (D7272) | $608.40 | $1,014 | 0.8× |
| Transseptal fiberotomy (D7291) | $608.40 | $1,014 | 0.8× |
| Trauma respons w/hosp criti (G0390) | $1,185.60 | $1,976 | 0.7× |
| Treatment of complications (D9930) | $75 | $125 | 0.1× |
| Trim nail(s) (G0127) range across 3 matching MRF lines |
$27–$30.60 | $45–$51 | varies |
| Trluml perip athrc abd aorta (0236T) | $23,500.20 | $39,167 | 1.6× |
| Trluml Perip Athrc Brchiocph (0237T) | $23,500.20 | $39,167 | 1.6× |
| Trluml Perip Athrc Iliac Art (0238T) | $23,500.20 | $39,167 | 1.0× |
| Trluml Peripheral Atherectomy Renal Artery Ea (0234T) | $23,500.20 | $39,167 | 1.6× |
| Tte w or w/o fol w/con,stres (C8928) range across 2 matching MRF lines |
$1,833–$1,944.60 | $3,055–$3,241 | varies |
| Tte w or w/o fol w/cont, com (C8921) | $1,868.40 | $3,114 | 1.9× |
| Tte w or w/o fol w/cont, f/u (C8922) | $1,868.40 | $3,114 | 1.9× |
| Tte w or wo fol wcon,doppler (C8929) | $2,451 | $4,085 | 2.5× |
| Unsched dialysis esrd pt hos (G0257) range across 2 matching MRF lines |
$738–$757.20 | $1,230–$1,262 | varies |
| Unscheduled dressing change (D4920) | $99 | $165 | 0.1× |
| Unspecified periodontal proc (D4999) | $76.80 | $128 | 0.3× |
| Ven blood coll snf/hha (G0471) | $7.80 | $13 | 0.7× |
| Vestibuloplasty exten graft (D7350) likely a partial charge, not the full procedure |
$275.40 | $459 | 0.0× |
| Vestibuloplasty ridge extens (D7340) likely a partial charge, not the full procedure |
$275.40 | $459 | 0.0× |
| Visit to determ ldct elig (G0296) range across 2 matching MRF lines |
$33.60–$39 | $56–$65 | 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.