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Hospital

Sheltering Arms Institute

Richmond, VA · CCN 493036 · Rates published

746 distinct procedures filed
14 distinct payers
12,471 rate rows
2024-06-14 last MRF observed · ⚠ 24 mo old
Data quality

0 of 12,471 rate rows are consumer-grade (0.0%)

12,471 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
per-diem day rate — not a per-procedure price 8,829
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 3,634
exceeds 10× this hospital's gross charge — excluded from medians 8

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 24 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://shelteringarmsinstitute.com/wp-content/uploads/2024/10/Price-Transparency-File-June-2024-SAI.csv
Found on page https://shelteringarmsinstitute.com/patients-and-visitors/fee-schedule/
Discovered viaCMS hospital list
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-05-17
Content fingerprint daa48693af552e2b… · 635,110 bytes · first seen 2026-05-09

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
0201T
CPT 		CT Sacroplasty Bilat 2 Or More Needles 0 — — — nat. median
$8,289
10021
CPT 		US Guide Inj Pseudoaneurysm 0 — — — nat. median
$447
10022
CPT 		Ir Insert Tunneled Cvc With Port > 5 Years 0 — — — nat. median
$462
10060
CPT 		Phy-incision & Drainage Simple Or Single 0 — — — nat. median
$302
10104
CPT 		Court/deposition 1st Hour 0 — — — nat. median
$17
17250
CPT 		Chemical Cauterization Of Wound 0 — — — nat. median
$258
20560
CPT 		Pt Sai Dry Needling Units 0 — — — nat. median
$41
20561
CPT 		Pt Sai Dry Needling 3+ Units 0 — — — nat. median
$50
20600
CPT 		Ir Picc Replacement Without Port/Pump 0 — — — nat. median
$358
22513
CPT 		Ir Kyphoplasty Thoracic 0 — — — nat. median
$8,289
22514
CPT 		Ir Kyphoplasty Lumbar 0 — — — nat. median
$8,289
24220
CPT 		Ir Remove Tunneled Cvad With Port/Pump 0 — — — nat. median
$486
29580
CPT 		Unna Boot 0 — — — nat. median
$222
29581
CPT 		Multilayer Compression Wrap -> Below The Knee 0 — — — nat. median
$253
29584
CPT 		Multilayer Compression Wrap -> Arm 0 — — — nat. median
$218
31500
CPT 		Rt Charge Emergent Intubation -> Yes 0 — — — nat. median
$467
31502
CPT 		Rt Charge Trach Changed 0 — — — nat. median
$325
32555
CPT 		US Thoracentesis 0 — — — nat. median
$1,111
36002
CPT 		Ir Inj Pseudoaneurysm 0 — — — nat. median
$805
36430
CPT 		Transfuse Fresh Frozen Plasma 0 — — — nat. median
$699
36558
CPT 		Ir Insert Tunneled Cvc Without Port > 5 Years 0 — — — nat. median
$3,479
36580
CPT 		Ir Replace Cvc Non Tunneled Without Port/Pump 0 — — — nat. median
$1,816
36581
CPT 		Ir Replace Cvc Tunneled Without Port 0 — — — nat. median
$3,368
36589
CPT 		Ir Remove Tunneled Cvad Without Port/Pump 0 — — — nat. median
$962
36593
CPT 		Ir Declot Imp Vad Cath Thrombolytic 0 — — — nat. median
$423
36598
CPT 		Xr Reposition Cvad With Fluoro 0 — — — nat. median
$381
36600
CPT 		Rt Charge Blood Gas Draw Type -> Arterial 0 — — — nat. median
$134
36901
CPT 		Ir Angiogram Arteriovenous Shunt 0 — — — nat. median
$1,803
37191
CPT 		Ir Place Ivc Filter 0 — — — nat. median
$6,264
38221
CPT 		CT Biopsy Bone Marrow With Bone Marrow Asp 0 — — — nat. median
$1,653
43752
CPT 		Xr Tube Placement Ng Gastric (Stomach) 0 — — — nat. median
$479
43761
CPT 		Xr Tube Reposition Gastric 0 — — — nat. median
$549
47000
CPT 		Ir Biopsy Liver Percutaneous 0 — — — nat. median
$1,798
49083
CPT 		CT Paracentesis 0 — — — nat. median
$1,238
49440
CPT 		Ir Perc Gastrostomy Tube Placement 0 — — — nat. median
$2,173
49446
CPT 		Ir Change G/j Tube Reposition 0 — — — nat. median
$2,185
49450
CPT 		Ir Replace Gastro/Cecostomy Tube Perc 0 — — — nat. median
$1,167
49451
CPT 		Xr Tube Replace D Or J With Fluoro With Cnt 0 — — — nat. median
$1,179
49452
CPT 		Ir Replace Gastro/Jejuno Tube Perc 0 — — — nat. median
$1,222
49460
CPT 		Xr Tube Remove Obst With Fluoro With Cnt 0 — — — nat. median
$1,099
49465
CPT 		Ir Inj Fluoro Exam G/Colon Tube 0 — — — nat. median
$370
50693
CPT 		Ir Ureteral Stent Left Perc Place Existing Si 0 — — — nat. median
$4,063
51102
CPT 		Ir Asp Bladder Supra Cath 0 — — — nat. median
$2,391
51705
CPT 		Ir Change Cystostomy Tube Simple 0 — — — nat. median
$346
62270
CPT 		Ir Spinal Puncture Lumbar Diagnostic 0 — — — nat. median
$834
62305
CPT 		Xr Myelogram 2 Or More Regions With Inject 0 — — — nat. median
$1,388
64483
CPT 		Ir Inj Foramin Epidural Lumbar Anes/Ster Single 0 — — — nat. median
$1,318
64484
CPT 		Ir Inj Foramin Epidural Lumbar Anes/Ster Additional 0 — — — nat. median
$869
64550
CPT 		Tens - Application 0 — — — nat. median
$101
0001U
CPT 		Hea Phenotype 0 — — — nat. median
$720

Other procedures at this hospital

Browse this hospital's 746 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
0201T CPT CT Sacroplasty Bilat 2 Or More Needles 0 0 $10,310.00 $10,310.00 — — — 2024-06-14
10021 CPT US Guide Inj Pseudoaneurysm 0 0 $1,781.00 $1,781.00 — — — 2024-06-14
10022 CPT Ir Insert Tunneled Cvc With Port > 5 Years 0 0 $1,419.00 $1,419.00 — — — 2024-06-14
10060 CPT Phy-incision & Drainage Simple Or Single 0 0 $313.00 $313.00 — — — 2024-06-14
10104 CPT Court/deposition 1st Hour 0 0 $624.00 $624.00 — — — 2024-06-14
17250 CPT Chemical Cauterization Of Wound 0 0 $212.00 $212.00 — — — 2024-06-14
20560 CPT Pt Sai Dry Needling Units 0 0 $80.00 $80.00 — — — 2024-06-14
20561 CPT Pt Sai Dry Needling 3+ Units 0 0 $120.00 $120.00 — — — 2024-06-14
20600 CPT Ir Picc Replacement Without Port/Pump 0 0 $1,798.00 $1,798.00 — — — 2024-06-14
22513 CPT Ir Kyphoplasty Thoracic 0 0 $20,772.00 $20,772.00 — — — 2024-06-14
22514 CPT Ir Kyphoplasty Lumbar 0 0 $18,698.00 $18,698.00 — — — 2024-06-14
24220 CPT Ir Remove Tunneled Cvad With Port/Pump 0 0 $1,522.00 $1,522.00 — — — 2024-06-14
29580 CPT Unna Boot 0 0 $162.00 $162.00 — — — 2024-06-14
29581 CPT Multilayer Compression Wrap -> Below The Knee 0 0 $225.00 $225.00 — — — 2024-06-14
29584 CPT Multilayer Compression Wrap -> Arm 0 0 $209.00 $209.00 — — — 2024-06-14
31500 CPT Rt Charge Emergent Intubation -> Yes 0 0 $1,118.00 $1,118.00 — — — 2024-06-14
31502 CPT Rt Charge Trach Changed 0 0 $93.00 $93.00 — — — 2024-06-14
32555 CPT US Thoracentesis 0 0 $1,940.00 $1,940.00 — — — 2024-06-14
36002 CPT Ir Inj Pseudoaneurysm 0 0 $1,781.00 $1,781.00 — — — 2024-06-14
36430 CPT Transfuse Fresh Frozen Plasma 0 0 $1,248.00 $1,248.00 — — — 2024-06-14
36558 CPT Ir Insert Tunneled Cvc Without Port > 5 Years 0 0 $1,875.00 $1,875.00 — — — 2024-06-14
36580 CPT Ir Replace Cvc Non Tunneled Without Port/Pump 0 0 $2,340.00 $2,340.00 — — — 2024-06-14
36581 CPT Ir Replace Cvc Tunneled Without Port 0 0 $2,342.00 $2,342.00 — — — 2024-06-14
36589 CPT Ir Remove Tunneled Cvad Without Port/Pump 0 0 $693.00 $693.00 — — — 2024-06-14
36593 CPT Ir Declot Imp Vad Cath Thrombolytic 0 0 $547.00 $547.00 — — — 2024-06-14
36598 CPT Xr Reposition Cvad With Fluoro 0 0 $294.00 $294.00 — — — 2024-06-14
36600 CPT Rt Charge Blood Gas Draw Type -> Arterial 0 0 $32.00 $32.00 — — — 2024-06-14
36901 CPT Ir Angiogram Arteriovenous Shunt 0 0 $2,273.00 $2,273.00 — — — 2024-06-14
37191 CPT Ir Place Ivc Filter 0 0 $8,315.00 $8,315.00 — — — 2024-06-14
38221 CPT CT Biopsy Bone Marrow With Bone Marrow Asp 0 0 $681.00 $681.00 — — — 2024-06-14
43752 CPT Xr Tube Placement Ng Gastric (Stomach) 0 0 $620.00 $620.00 — — — 2024-06-14
43761 CPT Xr Tube Reposition Gastric 0 0 $2,413.00 $2,413.00 — — — 2024-06-14
47000 CPT Ir Biopsy Liver Percutaneous 0 0 $2,754.00 $2,754.00 — — — 2024-06-14
49083 CPT CT Paracentesis 0 0 $2,562.00 $2,562.00 — — — 2024-06-14
49440 CPT Ir Perc Gastrostomy Tube Placement 0 0 $2,156.00 $2,156.00 — — — 2024-06-14
49446 CPT Ir Change G/j Tube Reposition 0 0 $2,445.00 $2,445.00 — — — 2024-06-14
49450 CPT Ir Replace Gastro/Cecostomy Tube Perc 0 0 $1,749.00 $1,749.00 — — — 2024-06-14
49451 CPT Xr Tube Replace D Or J With Fluoro With Cnt 0 0 $1,910.00 $1,910.00 — — — 2024-06-14
49452 CPT Ir Replace Gastro/Jejuno Tube Perc 0 0 $2,364.00 $2,364.00 — — — 2024-06-14
49460 CPT Xr Tube Remove Obst With Fluoro With Cnt 0 0 $1,938.00 $1,938.00 — — — 2024-06-14
49465 CPT Ir Inj Fluoro Exam G/Colon Tube 0 0 $431.00 $431.00 — — — 2024-06-14
50693 CPT Ir Ureteral Stent Left Perc Place Existing Si 0 0 $5,552.00 $5,552.00 — — — 2024-06-14
51102 CPT Ir Asp Bladder Supra Cath 0 0 $3,940.00 $3,940.00 — — — 2024-06-14
51705 CPT Ir Change Cystostomy Tube Simple 0 0 $424.00 $424.00 — — — 2024-06-14
62270 CPT Ir Spinal Puncture Lumbar Diagnostic 0 0 $3,517.00 $3,517.00 — — — 2024-06-14
62305 CPT Xr Myelogram 2 Or More Regions With Inject 0 0 $6,505.00 $6,505.00 — — — 2024-06-14
64483 CPT Ir Inj Foramin Epidural Lumbar Anes/Ster Single 0 0 $1,103.00 $1,103.00 — — — 2024-06-14
64484 CPT Ir Inj Foramin Epidural Lumbar Anes/Ster Additional 0 0 $1,173.00 $1,173.00 — — — 2024-06-14
64550 CPT Tens - Application 0 0 $51.00 $51.00 — — — 2024-06-14
64644 CPT Chemoden 1 Extrem 5+ Musc 64644 0 0 $435.00 $435.00 — — — 2024-06-14
70030 CPT Xr Foreign Body Eye 0 0 $457.00 $457.00 — — — 2024-06-14
70100 CPT Xr Mandible Less Than 4 Views 0 0 $832.00 $832.00 — — — 2024-06-14
70110 CPT Xr Mandible Complete 4+ Views 0 0 $1,138.00 $1,138.00 — — — 2024-06-14
70130 CPT Xr Mastoids Complete 3+ Views 0 0 $733.00 $733.00 — — — 2024-06-14
70140 CPT Xr Facial Bones 1-2 Views 0 0 $229.00 $229.00 — — — 2024-06-14
70150 CPT Xr Facial Bones 3+ Views 0 0 $990.00 $990.00 — — — 2024-06-14
70160 CPT Xr Nasal Bones 0 0 $104.00 $104.00 — — — 2024-06-14
70200 CPT Xr Orbits Complete 4+ Views 0 0 $624.00 $624.00 — — — 2024-06-14
70210 CPT Xr Sinuses Paranasal 1-2 Views 0 0 $936.00 $936.00 — — — 2024-06-14
70220 CPT Xr Sinuses Paranasal 3+ Views 0 0 $1,240.00 $1,240.00 — — — 2024-06-14
70250 CPT Xr Skull 1-3 Views 0 0 $880.00 $880.00 — — — 2024-06-14
70260 CPT Xr Skull Complete 4+ Views 0 0 $1,040.00 $1,040.00 — — — 2024-06-14
70330 CPT Xr Tmj Open And Closed Bilateral 0 0 $1,041.00 $1,041.00 — — — 2024-06-14
70355 CPT Xr Panorex 0 0 $400.00 $400.00 — — — 2024-06-14
70360 CPT Xr Neck Soft Tissue 0 0 $946.00 $946.00 — — — 2024-06-14
70450 CPT CT Brain/Head Without Contrast 0 0 $3,312.00 $3,312.00 — — — 2024-06-14
70460 CPT CT Brain/Head With Contrast 0 0 $3,445.00 $3,445.00 — — — 2024-06-14
70470 CPT CT Brain/Head With + Without Contrast 0 0 $4,409.00 $4,409.00 — — — 2024-06-14
70480 CPT CT Orbits Sella Without Contrast 0 0 $2,347.00 $2,347.00 — — — 2024-06-14
70481 CPT CT Orbits Sella With Contrast 0 0 $2,678.00 $2,678.00 — — — 2024-06-14
70482 CPT CT Coronal Temperal Bone With And Without Cont 0 0 $2,917.00 $2,917.00 — — — 2024-06-14
70486 CPT CT Maxillofacial Without Contrast 0 0 $3,656.00 $3,656.00 — — — 2024-06-14
70487 CPT CT Maxillofacial With Contrast 0 0 $2,680.00 $2,680.00 — — — 2024-06-14
70488 CPT CT Mandible With And Without Contrast 0 0 $2,917.00 $2,917.00 — — — 2024-06-14
70491 CPT CT Neck And Chest With Contrast 0 0 $4,181.00 $4,181.00 — — — 2024-06-14
70496 CPT CT Angio Head/Neck With And Without Contrast 0 0 $3,778.00 $3,778.00 — — — 2024-06-14
70498 CPT CT Angio Neck With And Without Contrast 0 0 $1,676.00 $1,676.00 — — — 2024-06-14
70540 CPT MRI Neck Soft Tissue Only Without Contrast 0 0 $3,962.00 $3,962.00 — — — 2024-06-14
70542 CPT MRI Brachial Plexus With Contrast 0 0 $4,221.00 $4,221.00 — — — 2024-06-14
70543 CPT MRI Face Neck Orbit With + Without Contrast 0 0 $5,140.00 $5,140.00 — — — 2024-06-14
70544 CPT MRA Brain/Head Without Contrast 0 0 $1,740.00 $1,740.00 — — — 2024-06-14
70547 CPT MRA Neck Without Contrast 0 0 $2,281.00 $2,281.00 — — — 2024-06-14
70548 CPT MRA Neck With Contrast 0 0 $1,740.00 $1,740.00 — — — 2024-06-14
70551 CPT MRI Brain Without Contrast 0 0 $4,227.00 $4,227.00 — — — 2024-06-14
70553 CPT MRI Brain With + Without Contrast 0 0 $4,664.00 $4,664.00 — — — 2024-06-14
71045 CPT Xr Chest Apical Lordotic 0 0 $492.00 $492.00 — — — 2024-06-14
71046 CPT Xr Chest 2 Views 0 0 $802.00 $802.00 — — — 2024-06-14
71047 CPT Xr Chest 2 Views With Apical Lordotic 0 0 $802.00 $802.00 — — — 2024-06-14
71048 CPT Xr Chest 4+ Views 0 0 $936.00 $936.00 — — — 2024-06-14
71100 CPT Xr Ribs 2 Views Left 0 0 $160.00 $160.00 — — — 2024-06-14
71101 CPT Xr Ribs 2 Views With Pa Chest Left 0 0 $1,467.00 $1,467.00 — — — 2024-06-14
71110 CPT Xr Ribs 3 Views Bilateral 0 0 $216.00 $216.00 — — — 2024-06-14
71111 CPT Xr Ribs 3 Views With Pa Chest Bilateral 0 0 $812.00 $812.00 — — — 2024-06-14
71120 CPT Xr Sternum 2+ Views 0 0 $820.00 $820.00 — — — 2024-06-14
71130 CPT Xr Sternoclavicular Joint(s) 3+ Views 0 0 $936.00 $936.00 — — — 2024-06-14
71250 CPT CT Thorax Without Contrast 0 0 $951.00 $951.00 — — — 2024-06-14
71260 CPT CT Thorax With Contrast 0 0 $4,103.00 $4,103.00 — — — 2024-06-14
71275 CPT CT Angio Chest With And Without Contrast 0 0 $2,384.00 $2,384.00 — — — 2024-06-14
72020 CPT Xr Spine Lumbar 1 View 0 0 $812.00 $812.00 — — — 2024-06-14
72040 CPT Xr Spine Cervical 1 View 0 0 $1,160.00 $1,160.00 — — — 2024-06-14
72050 CPT Xr Spine Cervical 4 Or 5 Views 0 0 $1,733.00 $1,733.00 — — — 2024-06-14
72052 CPT Xr Spine Cervical 6+ Views 0 0 $1,411.00 $1,411.00 — — — 2024-06-14
72070 CPT Xr Spine Thoracic 2 Views 0 0 $1,348.00 $1,348.00 — — — 2024-06-14
72072 CPT Xr Spine Thoracic 3 Views 0 0 $864.00 $864.00 — — — 2024-06-14
72074 CPT Xr Spine Thoracic 4+ Views 0 0 $181.00 $181.00 — — — 2024-06-14
72080 CPT Xr Spine Thoracolumbar Junction 2+ Views (sfmc) 0 0 $534.00 $534.00 — — — 2024-06-14
72082 CPT Xr Spine Thoracolumbar 2 Views 0 0 $175.00 $175.00 — — — 2024-06-14
72100 CPT Xr Spine Lumbosacral 2 Or 3 Views 0 0 $1,554.00 $1,554.00 — — — 2024-06-14
72110 CPT Xr Spine Lumbosacral 4+ Views 0 0 $1,650.00 $1,650.00 — — — 2024-06-14
72114 CPT Xr Spine Lumbosacral With Bending 6+ Views 0 0 $889.00 $889.00 — — — 2024-06-14
72120 CPT Xr Spine Lumbosacral 4+ View With Flex/Ext 0 0 $1,650.00 $1,650.00 — — — 2024-06-14
72125 CPT CT Spine Cervical Without Contrast 0 0 $3,787.00 $3,787.00 — — — 2024-06-14
72126 CPT CT Spine Cervical With Contrast 0 0 $3,548.00 $3,548.00 — — — 2024-06-14
72128 CPT CT Spine Thoracic Without Contrast 0 0 $951.00 $951.00 — — — 2024-06-14
72129 CPT CT Spine Thoracic With Contrast 0 0 $3,548.00 $3,548.00 — — — 2024-06-14
72131 CPT CT Spine Lumbar Without Contrast 0 0 $3,751.00 $3,751.00 — — — 2024-06-14
72132 CPT CT Spine Lumbar With Contrast 0 0 $1,136.00 $1,136.00 — — — 2024-06-14
72133 CPT CT Spine Lumbar With + Without Contrast 0 0 $1,459.00 $1,459.00 — — — 2024-06-14
72141 CPT MRI Spine Cervical Without Contrast 0 0 $4,227.00 $4,227.00 — — — 2024-06-14
72142 CPT MRI Spine Cervical With Contrast 0 0 $3,524.00 $3,524.00 — — — 2024-06-14
72146 CPT MRI Spine Thoracic Without Contrast 0 0 $4,227.00 $4,227.00 — — — 2024-06-14
72148 CPT MRI Spine Lumbar Without Contrast 0 0 $4,300.00 $4,300.00 — — — 2024-06-14
72149 CPT MRI Spine Lumbar With Contrast 0 0 $3,524.00 $3,524.00 — — — 2024-06-14
72156 CPT MRI Spine Cervical With + Without Contrast 0 0 $2,990.00 $2,990.00 — — — 2024-06-14
72157 CPT MRI Spine Thoracic With + Without Contrast 0 0 $4,664.00 $4,664.00 — — — 2024-06-14
72158 CPT MRI Spine Lumbar With + Without Contrast 0 0 $2,990.00 $2,990.00 — — — 2024-06-14
72170 CPT Xr Pelvis 1 Or 2 Views 0 0 $750.00 $750.00 — — — 2024-06-14
72190 CPT Xr Pelvis Complete 3+ Views 0 0 $745.00 $745.00 — — — 2024-06-14
72191 CPT CT Angio Pelvis With And Without Contrast 0 0 $3,609.00 $3,609.00 — — — 2024-06-14
72192 CPT CT Pelvis Without Contrast 0 0 $2,629.00 $2,629.00 — — — 2024-06-14
72193 CPT CT Pelvis With Contrast 0 0 $2,998.00 $2,998.00 — — — 2024-06-14
72194 CPT CT Pelvis With + Without Contrast 0 0 $3,522.00 $3,522.00 — — — 2024-06-14
72195 CPT MRI Pelvic Floor Study 0 0 $5,130.00 $5,130.00 — — — 2024-06-14
72196 CPT MRI Pelvis Bone With Contrast 0 0 $5,300.00 $5,300.00 — — — 2024-06-14
72197 CPT MRI Pelvis Bone With + Without Contrast 0 0 $5,491.00 $5,491.00 — — — 2024-06-14
72198 CPT MRA Pelvis Without Contrast 0 0 $2,247.00 $2,247.00 — — — 2024-06-14
72200 CPT Xr Sacroiliac Joints 1 Or 2 Views 0 0 $1,043.00 $1,043.00 — — — 2024-06-14
72202 CPT Xr Sacroiliac Joints 3+ Views 0 0 $1,352.00 $1,352.00 — — — 2024-06-14
72220 CPT Xr Sacrum/Coccyx 2+ Views 0 0 $1,258.00 $1,258.00 — — — 2024-06-14
73000 CPT Xr Clavicle Left 0 0 $1,220.00 $1,220.00 — — — 2024-06-14
73010 CPT Xr Scapula Left 0 0 $1,075.00 $1,075.00 — — — 2024-06-14
73020 CPT Xr Shoulder 1 View Left 0 0 $695.00 $695.00 — — — 2024-06-14
73030 CPT Xr Shoulder Complete 2+ Views Left 0 0 $1,358.00 $1,358.00 — — — 2024-06-14
73050 CPT Xr Ac Joints Bilateral 0 0 $1,152.00 $1,152.00 — — — 2024-06-14
73060 CPT Xr Humerus Left 0 0 $743.00 $743.00 — — — 2024-06-14
73070 CPT Xr Elbow 1-2 Views Left 0 0 $417.00 $417.00 — — — 2024-06-14
73080 CPT Xr Elbow Complete 3+ Views Left 0 0 $1,208.00 $1,208.00 — — — 2024-06-14
73090 CPT Xr Forearm 2 Views Left 0 0 $667.00 $667.00 — — — 2024-06-14
73100 CPT Xr Wrist 1-2 Views Left 0 0 $814.00 $814.00 — — — 2024-06-14
73110 CPT Xr Wrist Complete 3+ Views Left 0 0 $1,159.00 $1,159.00 — — — 2024-06-14
73120 CPT Xr Hand 1-2 Views Left 0 0 $714.00 $714.00 — — — 2024-06-14
73130 CPT Xr Hand Complete 3+ Views Left 0 0 $1,259.00 $1,259.00 — — — 2024-06-14
73140 CPT Xr Fingers 2+ Views Left 0 0 $824.00 $824.00 — — — 2024-06-14
73200 CPT CT Upper Extremity Without Contrast Left 0 0 $3,355.00 $3,355.00 — — — 2024-06-14
73201 CPT CT Elbow With Contrast Left 0 0 $2,678.00 $2,678.00 — — — 2024-06-14
73202 CPT CT Elbow Left With And Without Contrast 0 0 $2,917.00 $2,917.00 — — — 2024-06-14
73218 CPT MRI Radius/Ulna Left Without Contrast 0 0 $3,962.00 $3,962.00 — — — 2024-06-14
73219 CPT MRI Humerus Left With Contrast 0 0 $3,962.00 $3,962.00 — — — 2024-06-14
73220 CPT MRI Forearm With + Without Contrast Left 0 0 $5,140.00 $5,140.00 — — — 2024-06-14
73221 CPT MRI Elbow Without Contrast Left 0 0 $3,288.00 $3,288.00 — — — 2024-06-14
73222 CPT MRI Shoulder With Contrast Right 0 0 $4,390.00 $4,390.00 — — — 2024-06-14
73225 CPT MRA Upper Extremity With Contrast Left 0 0 $3,490.00 $3,490.00 — — — 2024-06-14
73501 CPT Xr Hip Left 1 View 0 0 $356.00 $356.00 — — — 2024-06-14
73502 CPT Xr Hip Left 2-3 Views 0 0 $1,023.00 $1,023.00 — — — 2024-06-14
73503 CPT Xr Hip Left 4+ Views 0 0 $1,300.00 $1,300.00 — — — 2024-06-14
73521 CPT Xr Hips Bilateral With Or Without Pelvis 2 Views 0 0 $1,519.00 $1,519.00 — — — 2024-06-14
73522 CPT Xr Hips Bil With Or Without Pelvis 3-4 Views 0 0 $1,700.00 $1,700.00 — — — 2024-06-14
73551 CPT Xr Femur Left 1 View 0 0 $815.00 $815.00 — — — 2024-06-14
73552 CPT Xr Femur Left 2 Views 0 0 $1,128.00 $1,128.00 — — — 2024-06-14
73560 CPT Xr Knee 1 Or 2 Views Left 0 0 $587.00 $587.00 — — — 2024-06-14
73562 CPT Xr Knee 3 Views Left 0 0 $1,259.00 $1,259.00 — — — 2024-06-14
73564 CPT Xr Knee Complete 4+ Views Left 0 0 $1,361.00 $1,361.00 — — — 2024-06-14
73565 CPT Xr Knee 1 View Standing Ap Bilateral 0 0 $457.00 $457.00 — — — 2024-06-14
73590 CPT Xr Tibia/Fibula Left 2 Views 0 0 $1,185.00 $1,185.00 — — — 2024-06-14
73600 CPT Xr Ankle 2 Views Left 0 0 $770.00 $770.00 — — — 2024-06-14
73610 CPT Xr Ankle Complete 3+ Views Left 0 0 $1,057.00 $1,057.00 — — — 2024-06-14
73620 CPT Xr Toes 2 + Views Left 0 0 $542.00 $542.00 — — — 2024-06-14
73630 CPT Xr Foot Complete 3+ Views Left 0 0 $1,057.00 $1,057.00 — — — 2024-06-14
73650 CPT Xr Calcaneous 1 View Left 0 0 $792.00 $792.00 — — — 2024-06-14
73660 CPT Xr Toes 2nd Digit Left 0 0 $508.00 $508.00 — — — 2024-06-14
73700 CPT CT Ankle Without Contrast Left 0 0 $2,347.00 $2,347.00 — — — 2024-06-14
73701 CPT CT Femur Left With Contrast 0 0 $2,678.00 $2,678.00 — — — 2024-06-14
73702 CPT CT Femur Left With And Without Contrast 0 0 $2,917.00 $2,917.00 — — — 2024-06-14
73718 CPT MRI Foot Without Contrast Left 0 0 $5,130.00 $5,130.00 — — — 2024-06-14
73719 CPT MRI Femur Left With Contrast 0 0 $4,221.00 $4,221.00 — — — 2024-06-14
73720 CPT MRI Femur Left With + Without Contrast 0 0 $5,140.00 $5,140.00 — — — 2024-06-14
73721 CPT MRI Ankle Without Contrast Left 0 0 $4,227.00 $4,227.00 — — — 2024-06-14
73722 CPT MRI Lower Extremity Joint Left With Cont 0 0 $3,962.00 $3,962.00 — — — 2024-06-14
73723 CPT MRI Ankle With + Without Contrast Left 0 0 $5,661.00 $5,661.00 — — — 2024-06-14
74018 CPT Xr Abdomen Kub - 1 View 0 0 $891.00 $891.00 — — — 2024-06-14
74019 CPT Xr Abdomen Decubitus Bilateral 0 0 $575.00 $575.00 — — — 2024-06-14
74020 CPT Xr Abdomen Kub Min 2 Views Portable 0 0 $1,374.00 $1,374.00 — — — 2024-06-14
74022 CPT Xr Abdomen Kub + upright/Lt Decub Xray 0 0 $1,160.00 $1,160.00 — — — 2024-06-14
74150 CPT CT Abdomen Without Contrast 0 0 $2,748.00 $2,748.00 — — — 2024-06-14
74160 CPT CT Abdomen With Contrast + Pelvis With And Without Contrast 0 0 $3,085.00 $3,085.00 — — — 2024-06-14
74170 CPT CT Abdomen With + Without Contrast 0 0 $3,842.00 $3,842.00 — — — 2024-06-14
74174 CPT CT Angio Abdomen And Pelvis W+without Contrast 0 0 $5,935.00 $5,935.00 — — — 2024-06-14
74175 CPT CT Angio Abdomen With Contrast 0 0 $3,943.00 $3,943.00 — — — 2024-06-14
74176 CPT CT Abdomen And Pelvis Without Contrast 0 0 $3,547.00 $3,547.00 — — — 2024-06-14
74177 CPT CT Abdomen And Pelvis With Contrast 0 0 $5,356.00 $5,356.00 — — — 2024-06-14
74181 CPT MRI Abdomen And Pelvis Without Contrast (mrmc) 0 0 $4,227.00 $4,227.00 — — — 2024-06-14
74183 CPT MRI Abdomen With + Without Contrast 0 0 $4,054.00 $4,054.00 — — — 2024-06-14
74220 CPT Xr Barium Swallow Esophogram 0 0 $1,941.00 $1,941.00 — — — 2024-06-14
74230 CPT Xr Swallowing Function With Speech 0 0 $338.00 $338.00 — — — 2024-06-14
74240 CPT Xr Upper Gi 0 0 $1,034.00 $1,034.00 — — — 2024-06-14
74241 CPT Xr Upper Gi + Kub 0 0 $3,303.00 $3,303.00 — — — 2024-06-14
74245 CPT Xr Upper Gi Single Contrast With Small Bowel 0 0 $4,286.00 $4,286.00 — — — 2024-06-14
74249 CPT Xr Upper Gi Double Contrast With Small Bowel 0 0 $4,290.00 $4,290.00 — — — 2024-06-14
74340 CPT Xr Feeding Tube Placement Long 0 0 $429.00 $429.00 — — — 2024-06-14
74420 CPT Xr Retrograde Pyelogram Bilateral 0 0 $2,598.00 $2,598.00 — — — 2024-06-14
74430 CPT Xr Cystogram 0 0 $678.00 $678.00 — — — 2024-06-14
74455 CPT Xr Voiding Urethrocystography 0 0 $1,252.00 $1,252.00 — — — 2024-06-14
75557 CPT MRI Cardiac Morph Fnct Without Cnt 0 0 $4,384.00 $4,384.00 — — — 2024-06-14
75635 CPT CT Angio Abdomen Aorta + Iliofemoral 0 0 $3,424.00 $3,424.00 — — — 2024-06-14
75984 CPT Ir Change Uret Tube Via Ileal Conduit (mrmc) 0 0 $890.00 $890.00 — — — 2024-06-14
75989 CPT Ir Cholecystostomy Percutaneous Si 0 0 $1,675.00 $1,675.00 — — — 2024-06-14
76000 CPT Ir Fluoroscopy < 1 Hour 0 0 $1,122.00 $1,122.00 — — — 2024-06-14
76498 CPT MRI Whole Body With + Without Contrast 0 0 $5,410.00 $5,410.00 — — — 2024-06-14
76536 CPT US Head/Neck Soft Tissue 0 0 $1,906.00 $1,906.00 — — — 2024-06-14
76604 CPT US Chest 0 0 $1,906.00 $1,906.00 — — — 2024-06-14
76642 CPT US Breast Limited Bilateral 0 0 $874.00 $874.00 — — — 2024-06-14
76700 CPT US Abdomen Complete 0 0 $3,007.00 $3,007.00 — — — 2024-06-14
76705 CPT Ir Ultrasound Abdomen Limited 0 0 $1,429.00 $1,429.00 — — — 2024-06-14
76770 CPT US Aorta/Retroperitoneal Complete 0 0 $2,637.00 $2,637.00 — — — 2024-06-14
76775 CPT US Urinary Bladder Limited 0 0 $1,120.00 $1,120.00 — — — 2024-06-14
76776 CPT US Kidney Transplant 0 0 $1,040.00 $1,040.00 — — — 2024-06-14
76801 CPT US Pregnant Uts < 14 Weeks Sngl 0 0 $1,952.00 $1,952.00 — — — 2024-06-14
76830 CPT US Transvaginal Non-OB 0 0 $2,797.00 $2,797.00 — — — 2024-06-14
76856 CPT US Pelvis Comp w/Transvag If Indicated 0 0 $2,797.00 $2,797.00 — — — 2024-06-14
76857 CPT US Pelvis Ltd w/Transvag If Indicated 0 0 $413.00 $413.00 — — — 2024-06-14
76870 CPT US Scrotum/Testicles 0 0 $1,673.00 $1,673.00 — — — 2024-06-14
76872 CPT US Prostate Transrectal 0 0 $300.00 $300.00 — — — 2024-06-14
76881 CPT US Ankle Left 0 0 $1,906.00 $1,906.00 — — — 2024-06-14
76882 CPT US Breast Axilla Left 0 0 $332.00 $332.00 — — — 2024-06-14
76937 CPT Ir Ultrasound Guided Vascular Access 0 0 $109.00 $109.00 — — — 2024-06-14
76942 CPT Ir Ultrasound Guided Needle Placement 0 0 $1,264.00 $1,264.00 — — — 2024-06-14
76978 CPT US Aortic W/contrast 0 0 $1,587.00 $1,587.00 — — — 2024-06-14
76999 CPT Ir Unlisted Ultrasound Procedure 0 0 $474.00 $474.00 — — — 2024-06-14
77001 CPT Xr Placement Cvad With Fluoro 0 0 $312.00 $312.00 — — — 2024-06-14
77002 CPT Ir Inj/Asp/Arthro Large Joint/Bursa 0 0 $968.00 $968.00 — — — 2024-06-14
77003 CPT Ir Inj Spine Fluoro Guided 0 0 $1,112.00 $1,112.00 — — — 2024-06-14
77012 CPT CT Biopsy Bone Deep 0 0 $1,302.00 $1,302.00 — — — 2024-06-14
77014 CPT CT Guided Therapy Plan/Placement 0 0 $437.00 $437.00 — — — 2024-06-14
77047 CPT MRI Breast Without Contrast Bilateral 0 0 $3,828.00 $3,828.00 — — — 2024-06-14
77071 CPT Xr Ankle Stress Left Without Contra Joint 0 0 $750.00 $750.00 — — — 2024-06-14
77072 CPT Xr Bone Age Extended 0 0 $508.00 $508.00 — — — 2024-06-14
77073 CPT Xr Lower Extremity Leg Length Evaluation 0 0 $682.00 $682.00 — — — 2024-06-14
77074 CPT Xr Bone Survey Limited 0 0 $1,160.00 $1,160.00 — — — 2024-06-14
77075 CPT Xr Bone Survey Complete 0 0 $1,273.00 $1,273.00 — — — 2024-06-14
77077 CPT Xr Joint Survey Hand/Wrist Single View 2+ Joints 0 0 $508.00 $508.00 — — — 2024-06-14
77280 CPT Simulation Field Setting - Simple 0 0 $1,470.00 $1,470.00 — — — 2024-06-14
77285 CPT Simulation Field Setting - Intermediate 0 0 $1,738.00 $1,738.00 — — — 2024-06-14
77290 CPT Simulation Field Setting - Complex 0 0 $2,309.00 $2,309.00 — — — 2024-06-14
77295 CPT Simulation Field Setting - 3d 0 0 $7,767.00 $7,767.00 — — — 2024-06-14
77300 CPT Basic Dosimetry Calc 0 0 $496.00 $496.00 — — — 2024-06-14
77301 CPT Imrt Planning 0 0 $5,219.00 $5,219.00 — — — 2024-06-14
77306 CPT Isodone Plan - Complex 2d 0 0 $919.00 $919.00 — — — 2024-06-14
77307 CPT Isodone Plan - Simple 2d 0 0 $919.00 $919.00 — — — 2024-06-14
77321 CPT Special Teletherapy Port Plan 0 0 $2,023.00 $2,023.00 — — — 2024-06-14
77331 CPT Special Dosimetry 0 0 $746.00 $746.00 — — — 2024-06-14
77332 CPT Treatment Device - Simple 0 0 $421.00 $421.00 — — — 2024-06-14
77333 CPT Treatment Device - Intermediate 0 0 $524.00 $524.00 — — — 2024-06-14
77334 CPT Treatment Device - Complex 0 0 $1,549.00 $1,549.00 — — — 2024-06-14
77336 CPT Continued Radiation Physics Consult 0 0 $865.00 $865.00 — — — 2024-06-14
77338 CPT Imrt Mlc Devices 0 0 $2,229.00 $2,229.00 — — — 2024-06-14
77385 CPT Imrt - Simplex 0 0 $2,028.00 $2,028.00 — — — 2024-06-14
77386 CPT Imrt - Complex 0 0 $2,236.00 $2,236.00 — — — 2024-06-14
77387 CPT Igrt 0 0 $442.00 $442.00 — — — 2024-06-14
77402 CPT Simple Radiation Treatment Delivery 0 0 $454.00 $454.00 — — — 2024-06-14
77407 CPT Intermediate Treatment Delivery 0 0 $700.00 $700.00 — — — 2024-06-14
77412 CPT Complex Treatment Delivery 0 0 $1,010.00 $1,010.00 — — — 2024-06-14
77417 CPT Therapeutic Radiology Port Films 0 0 $318.00 $318.00 — — — 2024-06-14
78264 CPT Nm Gastric Emptying Study 0 0 $5,412.00 $5,412.00 — — — 2024-06-14
78278 CPT Nm Gastrointestinal Blood Loss Imaging 0 0 $945.00 $945.00 — — — 2024-06-14
78300 CPT Nm Bone Imaging Limited 0 0 $626.00 $626.00 — — — 2024-06-14
78306 CPT Nm Bone Imaging Whole Body 0 0 $4,141.00 $4,141.00 — — — 2024-06-14
78315 CPT Nm Bone Three Phase Study 0 0 $4,780.00 $4,780.00 — — — 2024-06-14
78582 CPT Nm Lung Perfusion Differential Imaging 0 0 $2,352.00 $2,352.00 — — — 2024-06-14
78708 CPT Nm Kidney Imaging Single With Pharm 0 0 $2,282.00 $2,282.00 — — — 2024-06-14
80048 CPT Basic Metabolic Panel 0 0 $64.00 $64.00 — — — 2024-06-14
80051 CPT Electrolyte Panel 0 0 $56.00 $56.00 — — — 2024-06-14
80053 CPT Comprehensive Metabolic Panel 0 0 $79.00 $79.00 — — — 2024-06-14
80061 CPT Lipid Panel (Chol, Trig, Hdl, Ldl, Vldl) 0 0 $83.00 $83.00 — — — 2024-06-14
80069 CPT Renal Function Panel 0 0 $54.00 $54.00 — — — 2024-06-14
80074 CPT Acute Hepatitis Panel 0 0 $337.00 $337.00 — — — 2024-06-14
80076 CPT Hepatic (Liver) Function Panel - LFTs 0 0 $96.00 $96.00 — — — 2024-06-14
80156 CPT Carbamazepine Level 0 0 $135.00 $135.00 — — — 2024-06-14
80157 CPT Carbamazepine Level, Free And Total 0 0 $108.00 $108.00 — — — 2024-06-14
80158 CPT Cyclosporine Level, Trough 0 0 $293.00 $293.00 — — — 2024-06-14
80162 CPT Digoxin Level 0 0 $55.00 $55.00 — — — 2024-06-14
80163 CPT Digoxin Level, Free 0 0 $233.00 $233.00 — — — 2024-06-14
80164 CPT Valproic Acid Level 0 0 $84.00 $84.00 — — — 2024-06-14
80165 CPT Valproic Acid Level, Free 0 0 $44.00 $44.00 — — — 2024-06-14
80170 CPT Gentamicin, Random Level 0 0 $138.00 $138.00 — — — 2024-06-14
80175 CPT Lamotrigine Level 0 0 $94.00 $94.00 — — — 2024-06-14
80177 CPT Levetiracetam Level 0 0 $100.00 $100.00 — — — 2024-06-14
80178 CPT Lithium Level 0 0 $38.00 $38.00 — — — 2024-06-14
80183 CPT Oxcarbazepine Level 0 0 $111.00 $111.00 — — — 2024-06-14
80184 CPT Phenobarbital Level 0 0 $84.00 $84.00 — — — 2024-06-14
0001U CPT Hea Phenotype 0 0 $960.00 $960.00 — — — 2024-06-14
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