BELLA VISTA HOSPITAL — Hospital Ledger

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
45391	COLONOSCOPY W/ENDOSCOPY ULTR E	$4,000	$4,000	—	—	17
93452	LEFT HEART CATH	$2,300	$2,300	—	—	17
78608	BRAIN IMAGING POSITRON EMI(PET	$2,000	$2,000	—	—	14
78811	PET CT(CHEST,HEAD/NECK) LIMIT	$2,000	$2,000	—	—	15
78812	PET CT SKULL BASE TO MID-THIGH	$2,000	$2,000	—	—	15
78813	PET WHOLE BODY	$2,000	$2,000	—	—	21
78814	PET W CT LOCALIZ IMAGING,LIMIT	$2,000	$2,000	—	—	15
78815	PET W CT SKLL BASE TO MID-THIG	$2,000	$2,000	—	—	17
78816	PET W CT WHOLE BODY	$2,000	$2,000	—	—	17
74485	DILAT NEPRHOST URETER XRAY S/I	$1,900	$1,900	—	—	14
75600	AORTOGRAP THORACIC W/O SERIALO	$1,750	$1,750	—	—	13
75605	AORTOGRAPHY THORACIC BY SERIAL	$1,750	$1,750	—	—	15
75625	AORTOGRAPHY ABDOMINAL BY SERIA	$1,750	$1,750	—	—	17
75630	AORTH. ABDOM PLUS BILAT ILIOFE	$1,750	$1,750	—	—	15
19120	EXC CYST,FIBROADENOMA OTH BENI	$1,700	$1,700	—	—	5
75810	SPLENOPORTOGRAM	$1,700	$1,700	—	—	13
70332	ARTHROGRAM TMJ	$1,400	$1,400	—	—	13
73085	ARTHROGRAM ELBOW	$1,400	$1,400	—	—	13
73115	ARTHROGRAM WRIST	$1,400	$1,400	—	—	13
73525	ARTHROGRAM HIP	$1,400	$1,400	—	—	13
73580	ARTHROGRAM KNEE	$1,400	$1,400	—	—	13
73615	ARTHROGRAM ANKLE	$1,400	$1,400	—	—	13
75705	ANGIOG SPINAL SELECT.EA VESSEL	$1,400	$1,400	—	—	14
75710	ANGIO. EXTREMITY UNILATER	$1,400	$1,400	—	—	16
75716	ANGIO. EXTREMITY BILATERAL	$1,400	$1,400	—	—	16
75726	ANGIOGRAPHY VISCERAL SELECTIVE	$1,400	$1,400	—	—	14
75731	ANGIOGRAPHY ADRENAL UNILAT.	$1,400	$1,400	—	—	14
75733	ANGIOGR. ADRENAL BILATERAL	$1,400	$1,400	—	—	14
75736	ANGIOGR. PELVIC,SELECT./SUPRSE	$1,400	$1,400	—	—	13
75741	ANGIOGRA. PULMONARY UNIL.	$1,400	$1,400	—	—	13
75743	ANGIOG PULMONARY BILATERAL	$1,400	$1,400	—	—	13
75746	ANGIO PULMONAR BY NON-SEL CATH	$1,400	$1,400	—	—	14
75756	ANGIOGRAPHY INTERNAL MAMMARY	$1,400	$1,400	—	—	14
75774	ANGIO SELEC EA ADIT.VES STD EX	$1,400	$1,400	—	—	14
75898	ANGIO. THRU EXIST. CATH.	$1,400	$1,400	—	—	14
77373	STEREO.BODY RADIAT.1 OR MORE	$1,300	$1,300	—	—	4
77301	IMRT PLAN	$1,196	$1,196	—	—	7
78452	MYOCRD PERF SPECT MULT STDY	$954	$954	—	—	17
77047	MRI BREAST BILATERAL W/O CONT	$950	$950	—	—	15
77048	MRI BREAST W & W/O UNI	$950	$950	—	—	15
77049	MRI BREAST W/WO CONT BILAT	$950	$950	—	—	15
55866	LAPAROSCOPY,PROSTATECTOMY RADI	$906	$906	—	—	14
70542	MRI ORBIT,NECK,FACE W CONT.	$850	$850	—	—	16
70543	MRI ORBIT,NECK,FACE W/WO CONTR	$850	$850	—	—	17
70545	MRA HEAD W CONTRAST	$850	$850	—	—	17
70546	MRA HEAD W/WO C	$850	$850	—	—	17
70548	MRA NECK W CONTRAST	$850	$850	—	—	16
70549	MRA NECK W W/O CONTRAST	$850	$850	—	—	15
70552	MRI BRAIN(STEM) W CONTRAST	$850	$850	—	—	18
70553	MRI BRAIN(STEM) W/WO CONTRAST	$850	$850	—	—	17

Showing top 50 of 616 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.