Hospital 203025 prices — Hospital Ledger

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
L5701	REPLACE SOCKET ABOVE KNEE	$7,445	$5,584	—	—	5
L5649	ISCH CONTAINMT/NARROW M-I SO	$6,317	$4,738	—	—	5
81408	MOPATH PROCEDURE LEVEL 9	$6,180	$4,635	—	—	5
L2036	KAFO PLAS DOUB FREE KNEE MOL	$5,885	$4,414	—	—	5
L0486	TLSO RIGID LINED CUST FAB TWO	$5,846	$4,385	—	—	5
L0484	TLSO RIGID PLASTIC CUST FAB	$5,495	$4,121	—	—	5
750	PEG TUBE PLACEMENT	$5,405	$4,054	—	—	5
49440	G TUBE INSERTION W/GUIDANCE	$4,673	$3,505	—	—	5
L4631	AFO ANKLE FOOT OTHO	$4,669	$3,502	—	—	5
L0464	TLSO 4MOD SACRO-SCAP PRE	$4,405	$3,304	—	—	5
L1700	LEG PERTHES ORTH TORONTO TYP	$4,355	$3,266	—	—	5
L5651	AK FLEX INNER SICKET EXT FRA	$4,003	$3,002	—	—	5
333	RADIATION 3D RADIOTHERAPY PLAN	$3,787	$2,840	—	—	5
77301	RADIATION IMR PLAN	$3,787	$2,840	—	—	5
L2020	KAFO DBL SOLID STIRRUP BAND/	$3,702	$2,777	—	—	5
99283	EMERGENCY ROOM-MODERATE	$3,653	$2,740	—	—	5
L1685	POST-OP HIP ABDUCT CUSTOM FA	$3,559	$2,669	—	—	5
L0637	LSO SAG-CORONAL PANEL PREFAB	$3,521	$2,641	—	—	5
L0650	LSO SC R ANT/POS PNL PRE OTS	$3,521	$2,641	—	—	5
250	PONATinib 15 mg Tab	$3,170	$2,377	—	—	5
49083	US GUIDED PARACENTESIS	$3,108	$2,331	—	—	5
L0640	LSO S/C SHELL/PANEL CUSTOM	$3,101	$2,326	—	—	5
L0631	LSO SAG-CORO RIGID FRAME PREFB	$3,043	$2,282	—	—	5
L0648	LSO SAG R AN/POS PNL PRE OTS	$3,043	$2,282	—	—	5
L0460	TLSO 2MOD SYMPHSIS-STERN PRE	$2,975	$2,231	—	—	5
L1945	AFO MOLDED PLAS RIG ANT TIB	$2,972	$2,229	—	—	5
L0456	TLSO FLEX PREFAB	$2,947	$2,210	—	—	5
L0457	TLSO FLEX TRNK SJ-SS PRE OTS	$2,947	$2,210	—	—	5
610	MRI CHEST W/ CONTRAST	$2,943	$2,207	—	—	5
L0462	TLSO 3MOD SACRO-SCAP PRE	$2,925	$2,194	—	—	5
L1686	HO POST-OP HIP ABDUCTION PREFB	$2,921	$2,191	—	—	5
L3900	HINGE EXTENSION/FLEX WRIST/F	$2,857	$2,143	—	—	5
70553	MRI BRAIN W/ + W/O CONTRAST	$2,821	$2,116	—	—	5
72156	MRI SPINE CERVICAL W/ + W/O CO	$2,821	$2,116	—	—	5
72158	MRI SPINE LUMBAR W/ + W/O CONT	$2,821	$2,116	—	—	5
L0639	LSO S/C SHELL/PANEL PREFAB	$2,743	$2,057	—	—	5
73222	MRI UPPER EXTREM W CONTRAST	$2,723	$2,042	—	—	5
73722	MRI LOWER EXTREM JNT W CONTRAS	$2,723	$2,042	—	—	5
384	PLATELETS 1 UNIT	$2,700	$2,025	—	—	5
L3905	WHO W/NONTORSION JNT(S) CF	$2,674	$2,006	—	—	5
L1843	KO SINGLE UPRIGHT CUSTOM FIT	$2,659	$1,994	—	—	5
L1932	AFO RIG ANT TIB PREFAB TCF/=	$2,644	$1,983	—	—	5
L0458	TLSO 2MOD SYMPHIS-XIPHO PRE	$2,643	$1,982	—	—	5
81407	MOPATH PROCEDURE LEVEL 8	$2,616	$1,962	—	—	5
32555	US THORACENTESIS	$2,586	$1,940	—	—	5
72149	MRI SPINE LUMBAR W/ CONTRAST	$2,568	$1,926	—	—	5
L5950	ENDO AK ULTRA-LIGHT MATERIAL	$2,549	$1,912	—	—	5
L1845	KO W/ADJ FLEX/EXT ROTAT CUS	$2,536	$1,902	—	—	5
L1951	AFO SPIRAL PREFABRICATED	$2,489	$1,867	—	—	5
51710	BLADDER TUBE CHANGE	$2,420	$1,815	—	—	5

Showing top 50 of 1,329 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.