SIERRA VISTA HOSPITAL (T Or C, NM) prices

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
J3101	TENECTEPLASE 50 MG INTRAVENOUS KIT [VIST]	$10,156	$7,617	—	—	18
74178	CT ABDOMEN W + W O + PELVIS W CONTRAST	$7,739	$5,804	—	—	10
VIST LEXISCAN (10 PK)	VIST LEXISCAN (10 PK)	$7,606	$5,704	—	—	14
74177	CT ABDOMEN AND PELVIS W CONTRAST	$6,907	$5,180	—	—	10
74176	CT ABDOMEN AND PELVIS W O CONTRAST	$6,016	$4,512	—	—	18
90377	AMB RABIES IMMUNE GLOBULIN HUMAN CHARGE -> RABIES IMMUNE GLOBULIN HUMAN	$5,932	$4,449	—	—	8
FULL TRAUMA TEAM ACTIVATION FEE TECHFEE	FULL TRAUMA TEAM ACTIVATION FEE TECHFEE	$5,800	$4,350	—	—	14
72197	MRI PELVIS W + W O CONTRAST	$5,780	$4,335	—	—	10
74174	CT ANGIO ABDOMEN AND PELVIS	$5,744	$4,308	—	—	18
72157	MRI SPINE THORACIC W + W O CONTRAST	$5,568	$4,176	—	—	10
72158	MRI SPINE LUMBAR W + W O CONTRAST	$5,215	$3,911	—	—	10
78816	PET CT WHOLE BODY	$4,934	$3,701	—	—	18
G0390-811 PREACTIVATION TRAUMA RESPONSE	G0390-811 PREACTIVATION TRAUMA RESPONSE	$4,800	$3,600	—	—	14
G0390-911 PREACTIVATION TRAUMA RESPONSE	G0390-911 PREACTIVATION TRAUMA RESPONSE	$4,800	$3,600	—	—	14
PARTIAL TRAUMA TEAM ACTIVATION. TECH FEE	PARTIAL TRAUMA TEAM ACTIVATION. TECH FEE	$4,800	$3,600	—	—	14
78815	PET CT SKULL BASE TO MIDTHIGH	$4,764	$3,573	—	—	18
73723	MRI KNEE W + W O CONTRAST LEFT	$4,603	$3,452	—	—	10
72156	MRI SPINE CERVICAL W + W O CONTRAST	$4,575	$3,431	—	—	10
70553	MRI PITUITARY W + W O CONTRAST	$4,410	$3,308	—	—	10
73701	CT LOWER EXTREMITY W CONTRAST BILAT	$4,306	$3,229	—	—	10
72146	MRI SPINE THORACIC W O CONTRAST	$4,195	$3,146	—	—	18
73720	MRI LOWER EXTREMITY W O CONTRAST LEFT	$4,182	$3,136	—	—	18
78452	NM MYOCARDIAL SPECT REST AND STRESS	$4,094	$3,071	—	—	18
MRI SPINE CERVICAL W + W O CONTRAST	MRI SPINE CERVICAL W + W O CONTRAST	$3,961	$2,971	—	—	8
MRI SPINE CERVICAL W + W O CONTRAST	MRI SPINE CERVICAL W + W O CONTRAST	$3,961	$2,971	—	—	6
J0840	ANTIVENIN (CROTALIDAE OVINE) POLYVALENT CROFAB IV INJ [VIST]	$3,914	$2,936	—	—	18
74183	MRI ABDOMEN W + W O CONTRAST	$3,907	$2,930	—	—	10
95811	95811 PRO POLYSOMNOGRAPHY W CPAP CHARGE	$3,900	$2,925	—	—	18
71275	CT ANGIO CHEST	$3,898	$2,924	—	—	18
71270	CT CHEST W + W O CONTRAST	$3,880	$2,910	—	—	10
72195	MRI PELVIS W O CONTRAST	$3,856	$2,892	—	—	18
74170	CT ABDOMEN W + W O CONTRAST	$3,850	$2,887	—	—	10
72141	MRI SPINE CERVICAL W O CONTRAST	$3,764	$2,823	—	—	18
74181	MRI ABDOMEN W O CONTRAST	$3,710	$2,783	—	—	18
72148	MRI SPINE LUMBAR W O CONTRAST	$3,682	$2,762	—	—	18
73721	MRI ANKLE W O CONTRAST LEFT	$3,643	$2,732	—	—	18
73700	CT LOWER EXTREMITY W O CONTRAST BILAT	$3,636	$2,727	—	—	18
74175	CT ANGIO ABDOMEN	$3,563	$2,672	—	—	18
95810	95810 PRO POLYSOMNOGRAPHY CHARGE	$3,507	$2,630	—	—	18
59409	59409 VAGINAL DELIVERY W W O EPOSIOTOMY OR FORCEPS	$3,438	$2,579	—	—	18
72129	CT SPINE THORACIC W CONTRAST	$3,426	$2,569	—	—	10
72128	CT SPINE THORACIC W O CONTRAST	$3,425	$2,568	—	—	18
72132	CT SPINE LUMBAR W CONTRAST	$3,397	$2,548	—	—	10
73221	MRI UPPER EXTREMITY W O CONTRAST LEFT	$3,365	$2,524	—	—	18
73220	MRI UPPER EXTREMITY W + W O CNT LEFT	$3,300	$2,475	—	—	10
72125	CT SPINE CERVICAL W O CONTRAST	$3,292	$2,469	—	—	18
70543	MRI FACE NECK ORBIT W + W O CONTRAST	$3,280	$2,460	—	—	10
13132	13132-FACE NECK HAND FEET GENITAL 2.6-7.5 CM	$3,276	$2,457	—	—	18
C8908	MRI BREAST W O CONTRAST BILATERAL	$3,261	$2,446	—	—	18
72131	CT SPINE LUMBAR W O CONTRAST	$3,244	$2,433	—	—	18

Showing top 50 of 1,425 priced procedures, sorted by gross charge.

Data straight from this hospital's federally-mandated machine-readable file (45 CFR § 180). The compliance grade reflects how completely the hospital published the six required data elements, not the quality of care.