Hospital 223029 prices — Hospital Ledger

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
74177	CT ABDOMEN/PELVIS W/ CONTRAST	$7,780	$5,835	—	—	2
L5701	REPLACE SOCKET ABOVE KNEE	$7,445	$5,584	—	—	2
70553	MRI BRAIN W/ + W/O CONTRAST	$6,527	$4,895	—	—	2
72156	MRI SPINE CERVICAL W/ + W/O CO	$6,527	$4,895	—	—	2
72158	MRI SPINE LUMBAR W/ + W/O CONT	$6,527	$4,895	—	—	2
73723	MRI LOWER EXTREM JNT W/+W/O CO	$6,527	$4,895	—	—	2
73223	MRI UPPER EXTREM W/+W/O CONTRA	$6,393	$4,795	—	—	2
74176	CT ABDOMEN/PELVIS W/O CONTRAST	$6,325	$4,744	—	—	2
L5649	ISCH CONTAINMT/NARROW M-I SO	$6,317	$4,738	—	—	2
73720	MRI LOWER EXTREM NON JNT W/+W/	$6,264	$4,698	—	—	2
81408	MOPATH PROCEDURE LEVEL 9	$6,180	$4,635	—	—	2
L2036	KAFO PLAS DOUB FREE KNEE MOL	$5,885	$4,414	—	—	2
L0486	TLSO RIGID LINED CUST FAB TWO	$5,846	$4,385	—	—	2
L0484	TLSO RIGID PLASTIC CUST FAB	$5,495	$4,121	—	—	2
73222	MRI UPPER EXTREM W CONTRAST	$5,436	$4,077	—	—	2
73719	MRI LOWER EXTREM NON JNT W CON	$5,436	$4,077	—	—	2
73722	MRI LOWER EXTREM JNT W CONTRAS	$5,436	$4,077	—	—	2
750	PEG TUBE PLACEMENT	$5,405	$4,054	—	—	2
71275	CT ANGIOGRAPHY CHEST W/ CONTRA	$5,110	$3,833	—	—	2
72149	MRI SPINE LUMBAR W/ CONTRAST	$5,005	$3,754	—	—	2
73202	CT UPPER EXTREM W/+W/O CONTRAS	$4,943	$3,707	—	—	2
71270	CT THORAX W/ + W/O CONTRAST	$4,757	$3,568	—	—	2
49440	G TUBE INSERTION W/GUIDANCE	$4,673	$3,505	—	—	2
L4631	AFO, WALKING BOOT, CUSTOM	$4,669	$3,502	—	—	2
70551	MRI BRAIN W/O CONTRAST	$4,662	$3,497	—	—	2
72141	MRI SPINE CERVICAL W/O CONTRAS	$4,662	$3,497	—	—	2
72146	MRI SPINE THORACIC W/O CONTRAS	$4,662	$3,497	—	—	2
72148	MRI SPINE LUMBAR W/O CONTRAST	$4,662	$3,497	—	—	2
73221	MRI UPPER EXTREM W/O CONTRAST	$4,662	$3,497	—	—	2
73718	MRI LOWER EXTREM NON JNT W/O C	$4,662	$3,497	—	—	2
73721	MRI LOWER EXTREM JNT W/O CONTR	$4,662	$3,497	—	—	2
74170	CT ABDOMEN W/ + W/O CONTRAST	$4,659	$3,494	—	—	2
71260	CT THORAX W/ CONTRAST	$4,574	$3,431	—	—	2
72194	CT PELVIS W/ + W/O CONTRAST	$4,533	$3,400	—	—	2
74160	CT ABDOMEN W/ CONTRAST	$4,507	$3,380	—	—	2
L0464	TLSO 4MOD SACRO-SCAP PRE	$4,405	$3,304	—	—	2
73702	CT LOWER EXTREM W/+W/O CONTRAS	$4,126	$3,095	—	—	2
70470	CT HEAD OR BRAIN W/ + W/O CONT	$4,026	$3,020	—	—	2
L5651	AK FLEX INNER SICKET EXT FRA	$4,003	$3,002	—	—	2
71250	CT THORAX W/O CONTRAST	$3,991	$2,993	—	—	2
72125	CT SPINE CERVICAL W/O CONTRAST	$3,948	$2,961	—	—	2
72128	CT SPINE THORACIC W/O CONTRAST	$3,948	$2,961	—	—	2
72131	CT SPINE LUMBAR W/O CONTRAST	$3,948	$2,961	—	—	2
73701	CT LOWER EXTREM W CONTRAST	$3,948	$2,961	—	—	2
72193	CT PELVIS W/ CONTRAST	$3,854	$2,891	—	—	2
70460	CT HEAD OR BRAIN W/ CONTRAST	$3,827	$2,870	—	—	2
77301	RADIATION IMR PLAN	$3,787	$2,840	—	—	2
L2020	KAFO DBL SOLID STIRRUP BAND/	$3,702	$2,777	—	—	2
99283	EMERGENCY ROOM-MODERATE	$3,653	$2,740	—	—	2
73201	CT UPPER EXTREM W CONTRAST	$3,641	$2,731	—	—	2

Showing top 50 of 1,465 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.