Visits & medical services prices at St. Patrick Hospital
Missoula, MT · every code in this section with a posted price and a Medicare benchmark.
241 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Ablate Heart Dysrhythm Focus (93650) | $11,641.60 | $14,552 | 1.5× |
| Actinotherapy Ultraviolet Light (96900) | $59.20 | $74 | 1.6× |
| Admn Sarscov2 Vacc 1 Dose (90480) | $49.60 | $62 | 1.2× |
| Advncd Care Plan 30 Min (99497) | $122.40 | $153 | 1.2× |
| Airway Inhalation Treatment (94640) | $388 | $485 | 1.7× |
| Anogenital Xm Magnify Child/Suspect Trauma W Img (99170) | $218.40 | $273 | 1.1× |
| Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) range across 2 matching MRF lines |
$28–$39.20 | $35–$49 | varies |
| Assessment of aphasia per hr (96105) | $202.40 | $253 | 2.1× |
| Behavral qualit analys voice (92524) | $224.80 | $281 | 2.1× |
| Bfb traing w/EMG &/manometry 1st 15 min cntct (90912) | $228.80 | $286 | 2.8× |
| Bfb training ea addl 15 min (90913) | $92.80 | $116 | 2.8× |
| Brncdilat rspse spmtry pre&post-brncdilat admn (94060) | $291.20 | $364 | 0.8× |
| Canalith repositioning proc (95992) range across 2 matching MRF lines |
$71.20–$99.20 | $89–$124 | varies |
| Car seat/bed test 60 min (94780) | $128 | $160 | 3.4× |
| Cardiac Stress Tst,Tracing Only (93017) | $538.40 | $673 | 2.4× |
| Cardiopulmonary exercise testing (94621) | $704 | $880 | 1.8× |
| Cardiopulmonary resuscitation (92950) range across 3 matching MRF lines |
$511.20–$587.20 | $639–$734 | varies |
| Cardioversion (92960) range across 2 matching MRF lines |
$431.20–$803.20 | $539–$1,004 | varies |
| Cardioversion elective internal (92961) | $1,016 | $1,270 | 1.5× |
| Cath Place/Coron Angio, Img Super/Interp,R&L Hrt Cath, L Hrt Ventric (93460) | $11,360.80 | $14,201 | 3.4× |
| Cath Place/Coron Angio, Img Super/Interp,W Left Heart Ventriculography (93458) | $11,360.80 | $14,201 | 3.4× |
| Chemo Admin Peritoneal Cavity (96446) | $681.60 | $852 | 2.0× |
| Chemo Anti-Neopl Sq/Im (96401) | $259.20 | $324 | 3.5× |
| Chemo Hormon Antineopl Sq/Im (96402) | $120 | $150 | 1.6× |
| Chemo Ia Push (96420) | $238.40 | $298 | 0.7× |
| Chemo intralesional up to 7 (96405) range across 2 matching MRF lines |
$33.60–$159.20 | $42–$199 | varies |
| Chemo IV infusion addl hr (96415) | $171.20 | $214 | 2.3× |
| Chemo IV push addl drug (96411) | $259.20 | $324 | 3.5× |
| Chemother Prolong Infuse W/Pump (96416) | $664 | $830 | 2.0× |
| Chemotherapy Into Cns (96450) | $635.20 | $794 | 1.9× |
| Chemotherapy Intracavitary (96440) | $665.60 | $832 | 2.0× |
| Chemotherapy Unspecified (96549) | $104.80 | $131 | 2.2× |
| Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) | $120 | $150 | 1.6× |
| Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) | $618.40 | $773 | 1.8× |
| Chemotx admn IV push tq 1/1st sbst/drug (96409) | $485.60 | $607 | 1.4× |
| Chemotx Njx Subarachnd/Intraventr Rsvr 1/Mult (96542) | $328.80 | $411 | 1.0× |
| Chest Wall Manipulation (94668) range across 3 matching MRF lines |
$56–$214.40 | $70–$268 | varies |
| Color/duplex Doppler, complete (93975) | $1,310.40 | $1,638 | 5.4× |
| Color/duplex Doppler, limited (93976) | $738.40 | $923 | 6.9× |
| Community/Work Reintegration Trainj Ea 15 Min (97537) | $58.40 | $73 | 1.8× |
| Continuous Pulse Ox (94762) | $163.20 | $204 | 1.2× |
| Coronary Art/Grft Angio S&I (93455) | $10,506.40 | $13,133 | 3.2× |
| Coronary Artery Angio S&I (93454) | $8,791.20 | $10,989 | 2.7× |
| Cpap Ventilation Cpap Initiation&Mgmt (94660) range across 2 matching MRF lines |
$404.80–$655.20 | $506–$819 | varies |
| Cpt initial (94667) | $214.40 | $268 | 1.6× |
| Critical care first hour (99291) range across 2 matching MRF lines |
$527.20–$2,822.40 | $659–$3,528 | varies |
| Debridement Open Wound 20 Sq Cm< (97597) range across 4 matching MRF lines |
$47.20–$144.80 | $59–$181 | varies |
| Dialysis One Evaluation (90945) | $1,357.60 | $1,697 | 3.2× |
| Dup-scan aorta ivc iliac vascl/bpgs complete (93978) | $912 | $1,140 | 3.7× |
| Dup-scan aorta ivc iliac vascl/bpgs uni/lmtd (93979) | $752.80 | $941 | 7.0× |
| Dup-Scan Artl Infl&Ven O/F Pen Vsl Compl (93980) | $478.40 | $598 | 4.5× |
| Dup-scan lxtr art/artl bpgs compl bi study (93925) | $1,281.60 | $1,602 | 5.3× |
| Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) | $958.40 | $1,198 | 9.0× |
| Dup-Scan Xtr Veins Complete Bilateral Study (93970) | $1,153.60 | $1,442 | 4.7× |
| Dup-scan xtr veins unilateral/limited study (93971) | $860.80 | $1,076 | 8.1× |
| Duplex Scan Hemodialysis Access (93990) | $506.40 | $633 | 4.7× |
| Duplex up extrem art bilat (93930) | $738.40 | $923 | 3.0× |
| Duplex up extrem art unilat/ltd (93931) | $699.20 | $874 | 6.5× |
| Echo Congenital Complete (93303) | $1,156 | $1,445 | 2.1× |
| Echo Heart Xthoracic,Limited (93308) | $586.40 | $733 | 2.4× |
| Echo transesophageal (93312) | $1,212 | $1,515 | 2.2× |
| Eeg 41-60 Minutes (95812) | $621.60 | $777 | 2.8× |
| EEG awake and asleep (95819) | $792.80 | $991 | 3.6× |
| EEG awake drowsy (95816) | $797.60 | $997 | 3.6× |
| EEG extended monitoring 61-119 minutes (95813) | $1,024 | $1,280 | 4.6× |
| Eeg Sleep Only (95822) | $735.20 | $919 | 3.3× |
| Eeg W/O Vid Tech Ea Incr 12-26 Hr Cont R-T Mntr (95710) | $1,353.60 | $1,692 | 3.6× |
| EEG wo vid ea 12-26hr unmntr (95708) | $1,353.60 | $1,692 | 3.6× |
| Electrical Stimulation Ea 15 Min (97032) | $48 | $60 | 3.3× |
| Electrocardiogram Tracing (93005) | $153.60 | $192 | 2.5× |
| Electroconvulsive Therapy (90870) | $1,896 | $2,370 | 2.2× |
| Electrophysiology Evaluation (93642) | $2,225.60 | $2,782 | 1.8× |
| Emergency Dept Visit Level 2 (99282) range across 2 matching MRF lines |
$80–$372 | $100–$465 | varies |
| Emergency Dept Visit Level 3 (99283) range across 2 matching MRF lines |
$119.20–$580.80 | $149–$726 | varies |
| Emergency Dept Visit Level 4 (99284) range across 3 matching MRF lines |
$227.20–$1,062.40 | $284–$1,328 | varies |
| Endomyocardial Biopsy (93505) | $2,326.40 | $2,908 | 0.7× |
| Ep & ablate supravent arrhyt (93653) | $24,150.40 | $30,188 | 0.9× |
| Ep & ablate ventric tachy (93654) | $24,150.40 | $30,188 | 0.9× |
| Ep Compre Electrophysiologic Arrhythmia Induction (93620) | $11,958.40 | $14,948 | 1.5× |
| Ep Compre Electrophysiologic W/O Arrhyt Induction (93619) | $9,423.20 | $11,779 | 1.2× |
| Er level 1 (99281) range across 2 matching MRF lines |
$40–$252 | $50–$315 | varies |
| Er level v (99285) range across 2 matching MRF lines |
$332.80–$1,407.20 | $416–$1,759 | varies |
| Evaluate pt use of inhaler (94664) | $264 | $330 | 1.2× |
| Evaluate Speech Production (92522) | $224.80 | $281 | 2.0× |
| Evaluate Swallowing Function (92610) | $216 | $270 | 2.5× |
| Evaluation of speech fluency (92521) | $224.80 | $281 | 1.7× |
| Exercise test for bronchospasm (94617) | $273.60 | $342 | 2.0× |
| External ECG rec>48hr<7d recording (93242) | $94.40 | $118 | 2.5× |
| External ECG rec>7d<15d recording (93246) | $140 | $175 | 3.7× |
| External ECG rec>7d<15d scanning alys w/report (93247) | $258.40 | $323 | 1.9× |
| External Ecg Scanning Analysis Report (93226) | $507.20 | $634 | 8.4× |
| Extracranial Bilat Study (93880) | $936 | $1,170 | 3.8× |
| Extracranial Uni/Ltd Study (93882) | $500.80 | $626 | 4.7× |
| F-up/limited tthrc echo congenital car anomaly (93304) | $1,156 | $1,445 | 2.1× |
| Gastroesophag Reflx Test W/Cath Ph Eltrd Plcmt (91034) | $674.40 | $843 | 1.8× |
| Gi tract capsule endoscopy (91110) | $1,932 | $2,415 | 2.1× |
| Group Therapeutic Procedures (97150) | $38.40 | $48 | 2.1× |
| Heart catheterization, both sides, with coronary and bypass graft angiography (93461) | $12,957.60 | $16,197 | 3.9× |
| Hemodialysis Procedure W/ Phys/Qhp Evaluation (90935) range across 2 matching MRF lines |
$1,296–$1,452 | $1,620–$1,815 | varies |
| High altitude simulation test (94452) | $258.40 | $323 | 1.9× |
| High Altitude Simulatj W/Phys I&R W/O2 Titration (94453) | $230.40 | $288 | 1.7× |
| Holter monitor recording (93225) | $458.40 | $573 | 3.4× |
| Immunization administration (90471) range across 4 matching MRF lines |
$17.06–$56 | $21.32–$70 | varies |
| Inhlj Brncl Challenge Tstg W/Histam/Methachol (95070) | $972 | $1,215 | 2.5× |
| Insert/Place Heart Catheter (93503) | $2,808 | $3,510 | 1.7× |
| Intracranial Complete Study (93886) | $636.80 | $796 | 2.6× |
| Iontophoresis 15 min (97033) | $40.80 | $51 | 2.1× |
| Irrig Drug Delivery Device (96523) | $158.40 | $198 | 2.6× |
| IV infusion hydration each additional hour (96361) | $80 | $100 | 1.7× |
| IV infusion hydration initial 31 min-1 hour (96360) | $236 | $295 | 1.1× |
| IV infusion ther proph addl sequential to 1 hr (96367) | $108.80 | $136 | 1.5× |
| IV infusion therapy prophylaxis/dx ea hour (96366) | $80 | $100 | 1.7× |
| IV push initial (96374) | $276.80 | $346 | 1.3× |
| L Hrt Art/Grft Angio (93459) | $12,957.60 | $16,197 | 3.9× |
| Lwr Xtr Vasc Stdy Bilat (93924) | $540 | $675 | 2.4× |
| Mechanical chest wall oscillation per session (94669) | $360 | $450 | 1.6× |
| Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) | $27.20 | $34 | 0.9× |
| Medical nutrition assmt&ivntj indiv each 15 mi (97802) | $36.80 | $46 | 1.0× |
| Methacholine challenge (94070) | $608 | $760 | 1.6× |
| Motility study esophagus (91010) | $939.20 | $1,174 | 2.5× |
| Motion Fluoroscopy/Swallow (92611) | $382.40 | $478 | 4.2× |
| Multiple Sleep Latency Test (95805) | $1,785.60 | $2,232 | 2.0× |
| Muscle Test 2 Limbs (95861) | $164.80 | $206 | 1.2× |
| Nasopharyngoscopy (92511) | $157.60 | $197 | 0.8× |
| Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) range across 2 matching MRF lines |
$286.40–$456 | $358–$570 | varies |
| Neg Pressure Wound Therapy Non Dme >50 Sq Cm (97608) range across 2 matching MRF lines |
$286.40–$479.20 | $358–$599 | varies |
| Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) | $319.20 | $399 | 1.6× |
| Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) range across 3 matching MRF lines |
$159.20–$479.20 | $199–$599 | varies |
| Neuromuscular Reeducation (97112) | $68 | $85 | 2.1× |
| Newborn resuscitation (99465) | $1,467.20 | $1,834 | 2.2× |
| Ophth Medical Xm&Eval Intermediate New Pt (92002) | $166.40 | $208 | 1.2× |
| Oral Function Therapy (92526) | $148.80 | $186 | 1.8× |
| Oral Speech Device Eval (92597) | $153.60 | $192 | 2.2× |
| Orthc/Prostc Mgmt Sbsq Enc (97763) | $55.20 | $69 | 1.1× |
| Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) | $65.60 | $82 | 1.4× |
| Ot eval high complexity (97167) | $187.20 | $234 | 1.9× |
| Ot Eval Low Complex (97165) | $119.20 | $149 | 1.2× |
| Ot Eval Moderate Complexity (97166) | $146.40 | $183 | 1.5× |
| Ot manual therapy 15 min (97140) | $59.20 | $74 | 2.1× |
| Ot paraffin bath (97018) | $37.60 | $47 | 6.3× |
| Ot Prosthetic Training, Each 15 Min (97761) | $60 | $75 | 1.5× |
| Ot Re-Eval Est Plan Care (97168) | $146.40 | $183 | 2.1× |
| Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) | $228.80 | $286 | 1.7× |
| Outpatient Cardiac Rehab W/O Cont Ecg Monitor (93797) | $182.40 | $228 | 1.4× |
| Oxygen Uptake Rest Indirect (94690) | $80 | $100 | 1.3× |
| Penile Vascular Study,Ltd or F/U (93981) | $311.20 | $389 | 2.9× |
| Pentamidine Aersl Inhalation Pneumocystis/Proph (94642) range across 2 matching MRF lines |
$168–$407.20 | $210–$509 | varies |
| Peripheral arterial disease rehab per session (93668) | $153.60 | $192 | 2.5× |
| Perq transcath closure pda (93582) unusually low: confirm this is the full procedure |
$8,593.60 | $10,742 | 0.5× |
| Perq Transcath Cls Aortic (93591) | $36,353.60 | $45,442 | 1.9× |
| Perq Transcath Cls Mitral (93590) | $38,113.60 | $47,642 | 2.0× |
| Perq Trluml C Angioplasty 1 Maj C Art&/Branches (92920) | $8,716.80 | $10,896 | 1.5× |
| Perq Trluml Revsc Chrnc Tot Occls 1 C Art Antgrd (92943) | $12,628.80 | $15,786 | 1.1× |
| Phlebotomy therapeutic (99195) | $154.40 | $193 | 1.1× |
| Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) | $113.60 | $142 | 1.9× |
| Physical Performance Test (97750) | $50.40 | $63 | 1.5× |
| Plethysmography (94726) | $245.60 | $307 | 0.6× |
| Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) range across 2 matching MRF lines |
$1,818.40–$2,143.20 | $2,273–$2,679 | varies |
| Positional nystagmus test (92542) | $31.20 | $39 | 0.2× |
| Prq Card Angio/Athrect 1 Art (92924) | $15,853.60 | $19,817 | 1.3× |
| Prq Card Stent W/Angio 1 Vsl (92928) | $12,628.80 | $15,786 | 1.1× |
| Prq Card Stent/Ath/Angio (92933) | $12,628.80 | $15,786 | 0.7× |
| Prq Revasc Byp Graft 1 Vsl (92937) | $12,628.80 | $15,786 | 1.1× |
| Prq Tcat Clsr Cgen Ventr Septal Dfct W/Implt (93581) | $26,973.60 | $33,717 | 1.4× |
| Psych diag eval w/med srvcs (90792) range across 2 matching MRF lines |
$318.40–$366.40 | $398–$458 | varies |
| Psychiatric diagnostic evaluation (90791) | $192 | $240 | 1.1× |
| Psytx Crisis Initial 60 Min (90839) | $200 | $250 | 1.1× |
| Pt Asstv Technol Assmt Dir Cntct W/Reprt Ea 15 Min (97755) range across 2 matching MRF lines |
$17.60–$75.20 | $22–$94 | varies |
| Pt Eval High Complex (97163) | $187.20 | $234 | 1.9× |
| Pt eval low complex 20 min (97161) | $119.20 | $149 | 1.2× |
| Pt Eval Mod Complex (97162) | $146.40 | $183 | 1.5× |
| Pt gait training 15 min (97116) | $60.80 | $76 | 2.1× |
| Pt mechanical traction (97012) | $39.20 | $49 | 2.7× |
| Pt Re-Eval Est Plan Care (97164) | $146.40 | $183 | 2.2× |
| Pulm function test by gas (94727) | $276.80 | $346 | 1.3× |
| Pulmonary service/procedure (94799) | $319.20 | $399 | 2.4× |
| Pulmonary Stress Testing (94618) | $273.60 | $342 | 2.0× |
| R Hrt Art/Grft Angio (93457) | $16,436 | $20,545 | 5.0× |
| R hrt coronary artery angio (93456) | $14,314.40 | $17,893 | 4.3× |
| R&L Hrt Cath W/Ventriclgrphy (93453) | $7,012 | $8,765 | 2.1× |
| Refill/Maint Portable Pump (96521) | $499.20 | $624 | 2.3× |
| Refill/Maint Pump/Resvr Syst (96522) | $284.80 | $356 | 1.3× |
| Remote 30 Day Ecg Rev/Report (93270) | $296 | $370 | 7.8× |
| Remote therapeutic mntr 1st set-up&pt educaj eqp (98975) | $144.80 | $181 | 1.1× |
| Respiratory flow volume loop (94375) | $506.40 | $633 | 2.3× |
| Rhythm Ecg 1-3 Leads Tracing Only W/O I&R (93041) | $63.20 | $79 | 1.0× |
| Right Heart Cath (93451) | $6,404 | $8,005 | 1.9× |
| Right ventricular recording (93603) | $2,239.20 | $2,799 | 1.8× |
| Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) | $331.20 | $414 | 1.6× |
| Rx sp-genratj augmnt&comunicaj dev 1st hr (92607) | $264.80 | $331 | 2.2× |
| Rx/Physical Eeg Activaj Phys/Qhp Attendance (95954) | $630.40 | $788 | 1.7× |
| Self Care Mngment Training (97535) | $60 | $75 | 1.9× |
| Sensory Integration Ea 15 Min (97533) | $53.60 | $67 | 0.9× |
| Short-latency somatosens ep std upr limbs (95925) | $587.20 | $734 | 2.7× |
| Sleep study attended (95807) | $1,355.20 | $1,694 | 3.6× |
| Sleep study unattended (95806) | $189.60 | $237 | 0.9× |
| Somatosensory Testing (95938) | $700.80 | $876 | 0.8× |
| Speech sound lang comprehen (92523) | $224.80 | $281 | 1.0× |
| Spin/Brain Pump Refil & Main (95991) | $632 | $790 | 2.0× |
| Spirometry (94010) | $164.80 | $206 | 0.7× |
| Ssep lower limbs (95926) | $587.20 | $734 | 2.7× |
| Standardized Cognitive Performance Testing (96125) | $212.80 | $266 | 2.1× |
| Stress Tte Only (93350) | $1,156 | $1,445 | 2.1× |
| Subcutaneous Infusion Each Additional Hour (96370) | $60 | $75 | 1.3× |
| Subcutaneous infusion initial 1 hr w/pump set-up (96369) | $290.40 | $363 | 1.3× |
| Subq Infusion Additional Pump Infusion Site (96371) | $94.40 | $118 | 1.3× |
| Surfactant Admin Thru Tube (94610) | $367.20 | $459 | 1.6× |
| Temp transcutaneous pacing (92953) | $505.60 | $632 | 0.7× |
| Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129) | $41.60 | $52 | 1.9× |
| Ther Ivntj Ea Addl 15 Min (97130) | $40.80 | $51 | 1.9× |
| Ther Px 1/> Areas Each 15 Min Aqua Ther W/Xerss (97113) | $64 | $80 | 1.7× |
| Ther Px 1/> Areas Each 15 Minutes Massage (97124) | $52.80 | $66 | 1.8× |
| Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) | $198.40 | $248 | 1.9× |
| Ther/Prop/Diag Inj/Inf Proc (96379) | $60 | $75 | 1.3× |
| Ther/Proph/Diag Inj Ia (96373) | $470.40 | $588 | 2.2× |
| Ther/Proph/Diag Inj Sc/Im (96372) range across 3 matching MRF lines |
$48–$136.80 | $60–$171 | varies |
| Ther/Proph/Diag Iv Inf Init (96365) | $443.20 | $554 | 2.0× |
| Therapeutic Activities (97530) | $60 | $75 | 1.7× |
| Tilt table test with heart rhythm and blood pressure monitoring (93660) | $1,473.60 | $1,842 | 3.9× |
| Transcath Closure of Asd (93580) | $17,088 | $21,360 | 0.9× |
| Transcranial Doppler Stdy Intracranial Art Lmtd (93888) | $323.20 | $404 | 3.0× |
| Tte w/doppler, complete (93306) | $1,156 | $1,445 | 2.1× |
| Tte W/O Doppler Complete (93307) | $784 | $980 | 3.2× |
| Tx atrial fib pulm vein isol (93656) | $24,150.40 | $30,188 | 0.9× |
| Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) | $131.20 | $164 | 1.7× |
| Tx Speech Language Voice Commj Auditry 2/>Indiv (92508) | $51.20 | $64 | 2.1× |
| Tx/Pro/Dx Inj New Drug Addon (96375) | $108.80 | $136 | 2.3× |
| Unlisted cardiovascular service/procedure (93799) range across 2 matching MRF lines |
$6,969.60–$9,721.60 | $8,712–$12,152 | varies |
| Upr/L Xtremity Art 2 Levels (93922) | $280.80 | $351 | 2.1× |
| Upr/Lxtr Art Stdy 3+ Lvls (93923) | $456 | $570 | 2.1× |
| Valvuloplasty aortic valve (92986) | $8,400 | $10,500 | 1.4× |
| Valvuloplasty mitral valve (92987) | $8,593.60 | $10,742 | 0.7× |
| Veeg 2-12 Hr Cont Mntr (95713) | $1,261.60 | $1,577 | 3.3× |
| Veeg 2-12 hr intmt mntr (95712) | $737.60 | $922 | 1.9× |
| Veeg by tech ea incr 12-26 hr intermittent mntr (95715) | $1,353.60 | $1,692 | 3.6× |
| Veeg Ea 12-26 Hr Unmntr (95714) | $1,353.60 | $1,692 | 3.6× |
| Vent Mgmt Inpat Init Day (94002) | $1,844 | $2,305 | 2.9× |
| Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) | $1,310.40 | $1,638 | 2.1× |
| Visual Evoked Potential Test (95930) | $520.80 | $651 | 2.4× |
| Vital capacity, total (94150) | $276.80 | $346 | 2.1× |
| Wheelchair Mgmt Ea 15 Min (97542) | $57.60 | $72 | 1.9× |
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.