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BON SECOURS MARYVIEW MEDICAL CENTER

Hospital

3636 HIGH STREET

PORTSMOUTH, VA, 23707

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Procedure Prices at BON SECOURS MARYVIEW MEDICAL CENTER

ROUTINE VENIPUNCTURE

CPT 36415

$2.7

CBC WITH AUTO DIFF

CPT 85025

$6.99

COMPREHEN METABOLIC PANEL

CPT 80053

$9.5

Chest X-Ray (1 view)

CPT 71045

$11.2

EKG Tracing

CPT 93005

$11.2

Mechanical Traction

CPT 97012

$14.7

Chest X-Ray (2 views)

CPT 71046

$20.65

Thoracic Spine X-Ray

CPT 72072

$26.25

Therapeutic Exercises

CPT 97110

$30.43

Therapeutic Activities

CPT 97530

$38.39

Screening Mammogram (bilateral)

CPT 77067

$49.59

Abdominal Ultrasound — Limited

CPT 76705

$73.85

Diagnostic Mammogram (unilateral)

CPT 77065

$90.18

ESTAB PT LEVEL III

CPT 99213

$92.78

Echocardiogram

CPT 93307

$102.55

CT Chest

CPT 71250

$102.76

Abdominal Ultrasound

CPT 76700

$102.76

Retroperitoneal Ultrasound

CPT 76770

$102.76

OB Ultrasound

CPT 76805

$102.76

Diagnostic Mammogram (bilateral)

CPT 77066

$111.65

PSYCH TX 60 MIN W/PT

CPT 90837

$126.29

Echocardiogram w/ Doppler

CPT 93306

$157.15

INJ(S) ANES/STER EPI LUMB SNG W IMA-PBB

CPT 64483

$167.65

ER Visit — Low-Moderate Complexity

CPT 99283

$170.85

ER Visit — Moderate Complexity

CPT 99284

$215.85

MRI Brain w/o Contrast

CPT 70551

$217.19

MRI Joint of Lower Extremity

CPT 73721

$217.19

ER Visit — High Complexity

CPT 99285

$300.81

MRI Brain w/ Contrast

CPT 70553

$347.59

CT Abdomen & Pelvis

CPT 74177

$347.59

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Prices sourced from federally mandated hospital price transparency files. Cash prices reflect self-pay discounted rates. Negotiated rates vary by insurance plan. Data may not reflect current pricing — always confirm with the hospital before scheduling.