ADVANCED DALLAS HOSPITAL & CLINICS LLC

DALLAS, TX 752313802 (214) 221-6000 273Y00000X

Published Procedure Prices

Procedure	CPT	Cash Price	Insurance Range
NASAL/SINUS ENDOSCOPY, DIAGNOSTIC	31233	$6,500	N/A
XRAY RIB 2 VIEWS	71100	$180	N/A
XRAY CERVICAL SPINE 4+ VIEWS	72050	$265	N/A
RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; 2 OR 3 VIEW	72100	$195	N/A
RADIOLOGIC EXAMINATION, SACRUM AND COCCYX, MINIMUM	72220	$161	N/A
XRAY SHOULDER 2+ VIEWS	73030	$170	N/A
XRAY HUMERUS 2+ VIEWS	73060	$157	N/A
XRAY ELBOW 3+ VIEWS	73080	$161	N/A
XRAY HAND 3+ VIEWS	73130	$183	N/A
RADIOLOGIC EXAMINATION, HIP, UNILATERAL, WITH PELV	73502	$234	N/A
RADIOLOGIC EXAMINATION, KNEE; 1 OR 2 VIEWS	73560	$167	N/A
RADIOLOGIC EXAMINATION; TIBIA AND FIBULA, 2 VIEWS	73590	$156	N/A
RADIOLOGIC EXAMINATION, ANKLE; COMPLETE	73610	$178	N/A
RADIOLOGIC EXAMINATION, FOOT; COMPLETE, MINIMUM	73630	$167	N/A
XRAY TOES 2+ VIEWS	73660	$143	N/A
RADIOLOGIC EXAMINATION, ABDOMEN; 1 VIEW	74018	$48	N/A
RADIOLOGIC EXAMINATION, ABDOMEN; 2 VIEWS	74019	$182	N/A
ULTRASOUND, ABDOMINAL, REAL TIME WITH IMAGE DOCUME	76700	$567	N/A
ULTRASOUND, RETROPERITONEAL (EG, RENAL, AORTA, NOD	76775	$299	N/A
US PELVIC EXAM LIMITED	76857	$246	N/A
SCREENING DITIAL BREAST TOMOSYNTHESIS, BILATERAL; INTERPRETATION	77063	$720	N/A
GENERATOR NEUROSTIMULATOR	82412	$84,000	N/A
PURE TONE AUDIOMETRY	92552	$3,000	N/A
ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME	93306	$950	N/A
DUPLEX SCAN OF LOWER EXTREMITY ARTERIES OR ARTERIA	93925	$1,156	N/A
DUPLEX SCAN OF LOWER EXTREMITY ARTERIES OR ARTERIAL	93926	$648	N/A
DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES	93971	$578	N/A
NEUROSTIMULATION SYSTEMS GENERATOR; RECHARGEABLE	97715	$120,000	N/A

Prices shown are published rates from hospital chargemaster files and insurer rate data. Your actual cost depends on your insurance plan, deductible status, and services rendered.