HOSPITAL COMUNITARIO BUEN SAMARITANO INC

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
72197	MRI PELVIS W/O & W/ CONTRAST	$1,004	$1,004	—	—	20
74183	MRI ABDOMEN W/O & W/ CONTRAST	$1,004	$1,004	—	—	20
73223	MRI UPPER EXT SHOULDER ELBOW WRIST W/&W/O CONTRAST	$1,002	$1,002	—	—	20
73720	MRI LOWER EXTREMITY THIGH LEG FOOT W/&W/O CONTRAST	$1,002	$1,002	—	—	20
73723	MRI LOWER EXTREMITY HIP KNEE ANKLE W/&W/O CONTRAST	$1,002	$1,002	—	—	20
70546	MRA ANGIOGRAPHY HEAD W/O & W CONTRAST	$900	$900	—	—	20
70549	MRA ANGIOGRAPHY NECK W/ & W/O CONTRAST	$900	$900	—	—	20
75635	ANGIOGRAPHY ABD AORTA COMPUTED	$658	$658	—	—	20
70553	MRI BRAIN STEM W/ & W/O CONTRAST	$647	$647	—	—	20
74178	ABDOMEN AND PELVIS W/ WOUT CONTRAST CT SCAN	$578	$578	—	—	20
87799	BK VIRUS QUANTITATIVE PCR URINE / SERUM	$550	$550	—	—	20
70552	MRI BRAIN STEM W/CONTRAST	$545	$545	—	—	20
72196	MRI PELVIS W/ CONTRAST	$543	$543	—	—	20
74182	MRI ABDOMEN W/ CONTRAST	$543	$543	—	—	20
81374	ONE ANTIGEN EQUIVALENT EACH (PATOLOGIA)	$521	$521	—	—	20
71275	CTA CHESTPE PROTOCOL W CONTAST CT	$514	$514	—	—	20
72191	CTA PELVIS WITH CONTRAST CT SCAN	$499	$499	—	—	20
74175	CTA ABDOMEN W/IV CONTRAST	$499	$499	—	—	20
81243	FRAGIL X DNA MENTAL RETARDATION FMR1	$492	$492	—	—	20
70336	MRI TEMPOROMANDIBULAR	$468	$468	—	—	20
70544	MRA / MRV ANGIOGRAPHY HEAD W/O CONTRAST	$468	$468	—	—	20
70547	MRA ANGIOGRAPHY NECK W/O CONTRAST	$468	$468	—	—	20
70551	MRI BRAIN STEM W/O CONTRAST	$468	$468	—	—	20
72195	MRI PELVIS W/O CONTRAST	$466	$466	—	—	20
70545	MRA ANGIOGRAPHY HEAD W/ CONTRAST	$454	$454	—	—	18
70548	MRI ANGIOGRAPHY NECK W/ CONTRAST	$454	$454	—	—	20
81220	CFTR CYSTIC FIBROSIS TRANSMENBRANE COND REGULATOR	$443	$443	—	—	20
74177	ABDOMEN AND PELVIS W CONTRAST CT SCAN	$437	$437	—	—	39
81264	KAPPA IKGK@ GENE REARRANGE DETEDT ABNORMAL	$424	$424	—	—	20
81256	HFE HEREDITARY HEMOCHROMATOSIS DNA	$412	$412	—	—	20
82441	CHLORINATED HYDRACARBONS SCREE	$412	$412	—	—	20
86353	Lymphocyte transformation	$412	$412	—	—	20
86352	CELL FUNCTION ASSAY W/STIM	$396	$396	—	—	20
72127	CERVICAL W AND WO CONTRAST CT SCAN	$370	$370	—	—	20
72130	THORACIC SPINE WT OR WO CONTRAST	$370	$370	—	—	20
72133	LUMBAR WT OR WO CONTRAST CT SCAN	$370	$370	—	—	20
86789	WEST NILE VIRUS AB IGG / IGM	$360	$360	—	—	20
72194	PELVIS WT AND WO CONTRAST CT SCAN	$354	$354	—	—	20
74170	ABDOMEN W AND WO CONTRAST CT SCAN	$354	$354	—	—	20
74176	ABDOMEN AND PELVIS WOUT CONTRAST CT SCAN	$344	$344	—	—	39
86481	ENUMERATION OF GAMMA INTERFERON PRODUCTION	$328	$328	—	—	20
80366	PREGABALIN (LIRICA) QUATITATION OF DRUG	$327	$327	—	—	20
80426	Gonadotropin hormone panel	$320	$320	—	—	20
82017	ACYLCARNITINES QUANTITATIVE	$319	$319	—	—	20
82544	Column chromotograph/isotope M	$310	$310	—	—	20
73202	UPPER EXT WT AND WO CONTRAST CT SCAN	$310	$310	—	—	20
73702	LOWER EXT W AND WO CONTRAST CT SCAN	$310	$310	—	—	20
82016	ACYLCARNITINES QUALITATIVE	$309	$309	—	—	20
84238	NONENDOCRINE RECEPTOR	$309	$309	—	—	20
86305	HUMAN EPIDIDYMIS PROTEIN 4 (HE4)	$309	$309	—	—	20

Showing top 50 of 911 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.