HOSPITAL PAVIA ARECIBO — Hospital Ledger

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
93452	Exam of Left Heart with Catheter Insertion	$1,510	$1,510	$221	$1,350	19
78452	Multiple SPECT Scans of Heart Muscle	$710	$710	$105	$422	23
70553	MRI of Brain With and Without Contrast	$532	$532	$111	$1,300	31
73721	MRI of Leg Joint Without Contrast	$532	$532	$65.96	$650	31
72148	MRI of Lower Spinal Canal Without Contrast	$532	$532	$72.39	$650	31
70551	MRI of Brain Without Contrast	$532	$532	$71.85	$650	31
72141	MRI of Upper Spinal Canal Without Contrast	$532	$532	$72.09	$650	31
70552	MRI of Brain With Contrast	$532	$532	$86.77	$650	30
74182	MRI of Abdomen With Contrast	$532	$532	$84.36	$650	30
72197	MRI of Pelvis With and Without Contrast	$532	$532	$110	$1,300	30
72146	MRI of Middle Spinal Canal Without Contrast	$532	$532	$72.09	$650	31
73718	MRI of Leg Not Including Joint Without Contrast	$532	$532	$65.65	$650	30
72196	MRI of Pelvis With Contrast	$532	$532	$84.36	$650	31
72158	MRI of Lower Spinal Canal With and Without Contrast	$532	$532	$112	$1,300	31
74181	MRI of Abdomen Without Contrast	$532	$532	$70.83	$650	31
73218	MRI of Arm Without Contrast	$532	$532	$66.12	$650	31
73221	MRI of Arm Without Contrast	$532	$532	$66.12	$650	31
72156	MRI of Upper Spinal Canal With and Without Contrast	$532	$532	$111	$1,300	31
73719	MRI of Leg Not Including Joint With Contrast	$532	$532	$78.95	$650	30
70544	MRI of Blood Vessels of Head Without Contrast	$532	$532	$134	$406	11
72149	MRI of Lower Spinal Canal With Contrast	$532	$532	$87	$650	31
72195	MRI of Pelvis Without Contrast	$532	$532	$71.14	$650	31
73720	MRI of Leg Other Than Joint With and Without Contrast	$532	$532	$105	$1,300	31
73723	MRI of Leg Joint With and Without Contrast	$532	$532	$105	$1,300	30
72157	MRI of Middle Spinal Canal With and Without Contrast	$532	$532	$111	$1,300	31
73722	MRI of Leg Joint With Contrast	$532	$532	$78.95	$650	30
70543	MRI of Face or Neck With and Without Contrast	$532	$532	$104	$1,300	30
73222	MRI of Arm With Contrast	$532	$532	$78.95	$650	30
73223	MRI of Arm With and Without Contrast	$532	$532	$105	$1,300	30
70545	MRI of Blood Vessels of Head With Contrast	$532	$532	$162	$325	8
70542	MRI of Face or Neck With Contrast	$532	$532	$78.95	$650	30
70546	MRI of Blood Vessels of Head With and Without Contrast	$375	$375	$223	$406	10
84402	Lab Test - Free Testosterone Level	$366	$366	$24.28	$64	29
47562	Removal of Gallbladder Using Laparoscope	$350	$350	$350	$1,324	11
75716	X-Ray of Arm or Leg Arteries on Both Sides With Catheter Insertion	$300	$300	$53.63	$1,200	18
80076	Lab Test - Liver Function Panel	$257	$257	$7.79	$23.25	29
74177	CAT Scan of Abdomen and Pelvis With Contrast	$255	$255	$83.38	$450	27
84207	Lab Test - Vitamin B-6 Level	$239	$239	$26.79	$150	30
82670	Lab Test - Estradiol Hormone Level	$234	$234	$26.64	$66	30
77066	Diagnostic Mammogram of Both Breasts	$225	$225	$28.77	$121	24
74176	CAT Scan of Abdomen and Pelvis Without Contrast	$225	$225	$62.5	$450	27
74175	CAT Scan of Blood Vessels of Abdomen With Contrast	$225	$225	$82.76	$222	20
74178	CAT Scan of Abdomen and Pelvis With and Without Contrast	$225	$225	$92.05	$265	25
80055	Lab Test - Panel for Pregnant Patients without HIV Testing	$221	$221	$45	$75	26
77067	Screening Mammogram	$200	$200	$19.5	$100	24
85303	Lab Test - Measurement of Protein C Blood Clotting Inhibitor Activity	$199	$199	$13.19	$115	29
85305	Lab Test - Measurement of Total Protein S Blood Clotting Inhibitor Level	$199	$199	$11.06	$126	29
84154	Lab Test - Free Prostate Specific Antigen Level	$192	$192	$17.54	$37.5	29
70450	CAT Scan of Head or Brain Without Contrast	$188	$188	$36.12	$275	31
72193	CAT Scan of Pelvis With Contrast	$188	$188	$56.45	$300	31

Showing top 50 of 252 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.