DAHL MEMORIAL HEALTHCARE ASSOCIATION INC

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
71260	CT CHEST ABDOMEN W CONTRAST	$3,686	$3,686	—	—	3
74178	CT ABDOMEN PELVIS W WO CONTRAST	$3,528	$3,528	—	—	3
75635	CTA AORTA ILIAC RUNOFF	$3,308	$3,308	—	—	3
74177	CT ABDOMEN PELVIS W CONTRAST	$3,218	$3,218	—	—	3
72191	CTA PELVIS	$3,087	$3,087	—	—	3
70492	CT SOFT TISSUE NECK W WO CONTRAST	$2,908	$2,908	—	—	3
74174	CTA ABDOMEN AND PELVIS GENERAL	$2,906	$2,906	—	—	3
70480	CT ORBITS IAC + W CONTRAST	$2,575	$2,575	—	—	3
72127	CT C SPINE W WO CONTRAST	$2,536	$2,536	—	—	3
70488	CT FACIAL BONES W WO CONTRAST	$2,536	$2,536	—	—	3
72133	CT L SPINE W WO CONTRAST	$2,536	$2,536	—	—	3
73702	CT LOWER EXT LT W WO CONTRAST	$2,536	$2,536	—	—	3
72130	CT T SPINE W WO CONTRAST	$2,536	$2,536	—	—	3
72126	CT C SPINE W CONTRAST	$2,521	$2,521	—	—	3
71270	CT CHEST ABDOMEN W WO CONTRAST	$2,521	$2,521	—	—	3
70496	CTA HEAD CIRCLE OF WILLIS	$2,431	$2,431	—	—	3
A0427	AMBULANCE BASE - ALS	$2,413	$2,413	—	—	3
71275	CTA CHEST GENERAL	$2,378	$2,378	—	—	3
74176	CT ABDOMEN PELVIS WO CONTRAST	$2,370	$2,370	—	—	3
70498	CTA CAROTID ARTERIES	$2,305	$2,305	—	—	3
70470	CT HEAD W WO CONTRAST	$2,205	$2,205	—	—	3
73202	CT UPPER EXT LT W WO CONTRAST	$2,205	$2,205	—	—	3
74175	CTA ABDOMEN GENERAL	$2,157	$2,157	—	—	3
72125	CT C SPINE WO CONTRAST	$2,100	$2,100	—	—	3
86870	RBC ANTIBODY IDENTIFICATION	$2,042	$2,042	—	—	6
74170	CT ABDOMEN W WO CONTRAST	$1,906	$1,906	—	—	3
72132	CT L SPINE W CONTRAST	$1,874	$1,874	—	—	3
70491	CT SOFT TISSUE NECK W CONTRAST	$1,874	$1,874	—	—	3
72129	CT T SPINE W CONTRAST	$1,874	$1,874	—	—	3
72128	CT T SPINE WO CONTRAST	$1,792	$1,792	—	—	3
72131	CT L SPINE WO CONTRAST	$1,764	$1,764	—	—	3
73701	CT LOWER EXT LT W CONTRAST	$1,764	$1,764	—	—	3
72194	CT PELVIS W WO CONTRAST	$1,764	$1,764	—	—	3
73201	CT UPPER EXT LT W CONTRAST	$1,764	$1,764	—	—	3
74160	CT ABDOMEN W CONTRAST	$1,740	$1,740	—	—	3
72193	CT PELVIS W CONTRAST	$1,726	$1,726	—	—	3
70460	CT HEAD W CONTRAST	$1,654	$1,654	—	—	3
70490	CT SOFT TISSUE NECK WO CONTRAST	$1,654	$1,654	—	—	3
73706	CTA LOWER EXT LT	$1,621	$1,621	—	—	3
73206	CTA UPPER EXT LT	$1,621	$1,621	—	—	3
70487	CT FACIAL BONES W CONTRAST	$1,604	$1,604	—	—	3
72192	CT PELVIS WO CONTRAST	$1,580	$1,580	—	—	3
73700	CT LOWER EXT LT WO CONTRAST	$1,544	$1,544	—	—	3
73200	CT UPPER EXT LT WO CONTRAST	$1,487	$1,487	—	—	3
70450	CT HEAD WO CONTRAST	$1,478	$1,478	—	—	3
25605	FX TRTMNT DISTAL RADIAL W/ MANIPUL	$1,407	$1,407	—	—	3
70486	CT FACIAL BONES WO CONTRAST	$1,404	$1,404	—	—	3
74150	CT ABDOMEN WO CONTRAST	$1,395	$1,395	—	—	3
71250	CT CHEST ABDOMEN WO CONTRAST	$1,375	$1,375	—	—	3
77078	CT BONE DENSITY	$1,323	$1,323	—	—	3

Showing top 50 of 818 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.