BRYN MAWR REHABILITATION HOSPITAL Hospital

Legal name: MAIN LINE HOSPITALS, INC.

MALVERN, PA 193553311 (484) 596-5400 283X00000X

Published Procedure Prices

Procedure	CPT	Cash Price	Insurance Range
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION - CHILLED [502033]	00038	$22	N/A
MULTIVIT-MINERALS-IRON 8 MG-FOLIC AC 400 MCG-VIT K 10 MCG CHEW TABLET [176218]	00054	$0	N/A
Hc Mri Cad	01590	$53	N/A
WHITE PETROLATUM TOPICAL JELLY [28809]	05212	$14	N/A
LIDOCAINE-EPINEPHRINE-TETRACAINE 4 %-0.05 TO 0.18 %-0.5 % WRAPPER [502020]	05446	$41	N/A
BICARBONATE DIALYSIS SOLN K 4 MEQ-CA 3 MEQ-MG 1 MEQ/L [408128796]	08021	$237	N/A
Hc Mr Angio Abdomen W/Contrst	08900	$2,175	N/A
Hc Mr Angio Abdomen W/O Contrst	08901	$1,624	N/A
Hc Mr Angio Abd W/Wo Contrast	08902	$2,620	N/A
Hc Mri Of The Breast Uni W/Contr	08903	$1,872	N/A
Hc Mri Of The Breast Uni W/O Cont	08904	$1,356	N/A
Hc Mri Of The Breast Uni W/Wo Con	08905	$2,162	N/A
Hc Mri Breast Bi W/Contr	08906	$2,808	N/A
Hc Mri Breast Bi W/O Contr	08907	$1,937	N/A
Hc Mri Breast Bi W/Wo Contr	08908	$3,228	N/A
Hc Mr Angio Chest W/Contrst	08909	$2,170	N/A
Hc Mr Angio Chest W/O Contrst	08910	$1,622	N/A
Hc Mr Angio Chest W/Wo Contrst	08911	$2,615	N/A
Hc Mr Angio Lwr Ext W/Contrst	08912	$2,170	N/A
Hc Mr Angio Lwr Ext W/O Contrst	08913	$1,622	N/A
Hc Mr Angio Lwr Ext W/Wo Contrast	08914	$2,615	N/A
Hc Mr Angio Pelvis W/Contrst	08918	$2,175	N/A
Hc Mr Angio Pelvis W/O Contrst	08919	$1,624	N/A
Hc Mr Angio Pelvis W/Wo Contrast	08920	$2,620	N/A
Hc Mr Angio Spinal Canal W/Contrst	08931	$2,890	N/A
Hc Mr Angio Spinal Canal Wo/Contrst	08932	$2,890	N/A
Hc Mr Angio Spinal Canal W/Wo Contrst	08933	$3,178	N/A
Hc Mr Angio Up Extrem W/Contrast	08934	$3,269	N/A
Hc Mr Angio Up Extrem Wo/Contrast	08935	$3,269	N/A
Hc Mr Angio Up Extrem W/Wo Contrast	08936	$3,269	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.