Hospital 393031 prices — Hospital Ledger

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
L5701	REPLACE SOCKET ABOVE KNEE	$7,445	$5,584	—	—	4
L5649	ISCH CONTAINMT/NARROW M-I SO	$6,317	$4,738	—	—	4
81408	MOPATH PROCEDURE LEVEL 9	$6,180	$4,635	—	—	4
L2036	KAFO PLAS DOUB FREE KNEE MOL	$5,885	$4,414	—	—	4
L0486	TLSO RIGID LINED CUST FAB TWO	$5,846	$4,385	—	—	4
L0484	TLSO RIGID PLASTIC CUST FAB	$5,495	$4,121	—	—	4
750	PEG TUBE PLACEMENT	$5,405	$4,054	—	—	4
72156	MRI SPINE CERVICAL W/ + W/O CO	$4,821	$3,616	—	—	4
72158	MRI SPINE LUMBAR W/ + W/O CONT	$4,821	$3,616	—	—	4
49440	G TUBE INSERTION W/GUIDANCE	$4,673	$3,505	—	—	4
L4631	AFO, WALKING BOOT, CUSTOM	$4,669	$3,502	—	—	4
L0464	TLSO 4MOD SACRO-SCAP PRE	$4,405	$3,304	—	—	4
L5651	AK FLEX INNER SICKET EXT FRA	$4,003	$3,002	—	—	4
70553	MRI BRAIN W/ + W/O CONTRAST	$3,995	$2,996	—	—	4
77301	RADIATION IMR PLAN	$3,787	$2,840	—	—	4
L2020	KAFO DBL SOLID STIRRUP BAND/	$3,702	$2,777	—	—	4
72149	MRI SPINE LUMBAR W/ CONTRAST	$3,685	$2,764	—	—	4
99283	EMERGENCY ROOM-MODERATE	$3,653	$2,740	—	—	4
L0637	LSO SAG-CORONAL PANEL PREFAB	$3,521	$2,641	—	—	4
L0650	LSO SC R ANT/POS PNL PRE OTS	$3,521	$2,641	—	—	4
74170	CT ABDOMEN W/ + W/O CONTRAST	$3,359	$2,519	—	—	4
71275	CT ANGIOGRAPHY CHEST W/ CONTRA	$3,358	$2,519	—	—	4
71270	CT THORAX W/ + W/O CONTRAST	$3,260	$2,445	—	—	4
70551	MRI BRAIN W/O CONTRAST	$3,214	$2,411	—	—	4
72146	MRI SPINE THORACIC W/O CONTRAS	$3,181	$2,386	—	—	4
72148	MRI SPINE LUMBAR W/O CONTRAST	$3,181	$2,386	—	—	4
72141	MRI SPINE CERVICAL W/O CONTRAS	$3,162	$2,372	—	—	4
49083	US GUIDED PARACENTESIS	$3,108	$2,331	—	—	4
L0640	LSO S/C SHELL/PANEL CUSTOM	$3,101	$2,326	—	—	4
70470	CT HEAD OR BRAIN W/ + W/O CONT	$3,093	$2,320	—	—	4
L0631	LSO SAG-CORO RIGID FRAME PREFB	$3,043	$2,282	—	—	4
L0648	LSO SAG R AN/POS PNL PRE OTS	$3,043	$2,282	—	—	4
L0460	TLSO 2MOD SYMPHSIS-STERN PRE	$2,975	$2,231	—	—	4
L1945	AFO MOLDED PLAS RIG ANT TIB	$2,972	$2,229	—	—	4
L0456	TLSO FLEX PREFAB	$2,947	$2,210	—	—	4
L0457	TLSO FLEX TRNK SJ-SS PRE OTS	$2,947	$2,210	—	—	4
610	MRI CHEST W/ CONTRAST	$2,943	$2,207	—	—	4
L1686	HO POST-OP HIP ABDUCTION PREFB	$2,921	$2,191	—	—	4
74177	CT ABDOMEN/PELVIS W/ CONTRAST	$2,846	$2,135	—	—	4
L3904	WHFO ELECTRIC CUSTOM FITTED	$2,812	$2,109	—	—	4
72193	CT PELVIS W/ CONTRAST	$2,811	$2,108	—	—	4
72194	CT PELVIS W/ + W/O CONTRAST	$2,811	$2,108	—	—	4
74160	CT ABDOMEN W/ CONTRAST	$2,778	$2,084	—	—	4
72125	CT SPINE CERVICAL W/O CONTRAST	$2,743	$2,057	—	—	4
72128	CT SPINE THORACIC W/O CONTRAST	$2,742	$2,057	—	—	4
73222	MRI UPPER EXTREM W CONTRAST	$2,723	$2,042	—	—	4
73722	MRI LOWER EXTREM JNT W CONTRAS	$2,723	$2,042	—	—	4
71250	CT THORAX W/O CONTRAST	$2,708	$2,031	—	—	4
L3905	WHO W/NONTORSION JNT(S) CF	$2,674	$2,006	—	—	4
L1843	KO SINGLE UPRIGHT CUSTOM FIT	$2,659	$1,994	—	—	4

Showing top 50 of 1,516 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.