HOSPITAL SAN FRANCISCO — Hospital Ledger

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
84145	Lab Test - Procalcitonin Hormone Level	$500	$500	—	—	0
84402	Lab Test - Free Testosterone Level	$380	$380	$24.28	$170	33
84481	Lab Test - Free T3 Thyroid Hormone Level	$333	$333	$16.15	$115	34
86360	Lab Test - Measurement of CD4 and CD8 White Blood T Cells With Ratio	$333	$333	$39	$123	33
82024	Lab Test - Pituitary Hormone Level	$333	$333	$36.83	$140	32
70553	MRI of Brain With and Without Contrast	$325	$325	$102	$813	35
73721	MRI of Leg Joint Without Contrast	$325	$325	$63.22	$650	35
72148	MRI of Lower Spinal Canal Without Contrast	$325	$325	$60.35	$650	35
70551	MRI of Brain Without Contrast	$325	$325	$62.26	$650	35
72141	MRI of Upper Spinal Canal Without Contrast	$325	$325	$60.62	$650	35
74181	MRI of Abdomen Without Contrast	$325	$325	$87.66	$650	35
72197	MRI of Pelvis With and Without Contrast	$325	$325	$133	$813	31
73719	MRI of Leg Not Including Joint With Contrast	$325	$325	$106	$650	31
73718	MRI of Leg Not Including Joint Without Contrast	$325	$325	$88.85	$650	35
74182	MRI of Abdomen With Contrast	$325	$325	$81.28	$650	31
74183	MRI of Abdomen With and Without Contrast	$325	$325	$133	$813	31
72146	MRI of Middle Spinal Canal Without Contrast	$325	$325	$60.62	$650	35
72196	MRI of Pelvis With Contrast	$325	$325	$108	$650	35
72156	MRI of Upper Spinal Canal With and Without Contrast	$325	$325	$102	$813	35
72158	MRI of Lower Spinal Canal With and Without Contrast	$325	$325	$102	$813	35
70552	MRI of Brain With Contrast	$325	$325	$85.39	$720	35
72195	MRI of Pelvis Without Contrast	$325	$325	$90.67	$650	35
70544	MRI of Blood Vessels of Head Without Contrast	$325	$325	$86.49	$650	33
73720	MRI of Leg Other Than Joint With and Without Contrast	$325	$325	$132	$813	35
72149	MRI of Lower Spinal Canal With Contrast	$325	$325	$85.69	$725	35
72157	MRI of Middle Spinal Canal With and Without Contrast	$325	$325	$102	$813	35
73219	MRI of Arm With Contrast	$325	$325	$106	$650	31
70543	MRI of Face or Neck With and Without Contrast	$325	$325	$129	$813	31
82677	Lab Test - Estriol Hormone Level	$253	$253	$23.06	$65	34
85306	Lab Test - Measurement of Free Protein S Blood Clotting Inhibitor Level	$253	$253	$14.61	$110	33
78452	Multiple SPECT Scans of Heart Muscle	$250	$250	$105	$355	10
84207	Lab Test - Vitamin B-6 Level	$248	$248	$26.79	$150	33
83498	Lab Test - Hydroxyprogestone 17-D Level	$246	$246	$25.91	$100	33
85613	Lab Test - Measurement of Blood Clotting Factor X Using Diluted Russell Viper Venom	$240	$240	$8.33	$75	26
85303	Lab Test - Measurement of Protein C Blood Clotting Inhibitor Activity	$206	$206	$13.19	$130	32
85246	Lab Test - Measurement of Blood Clotting Factor von Willebrand Antigen	$199	$199	$12.53	$150	32
82652	Lab Test - Vitamin D Level	$196	$196	$36.71	$195	32
80061	Lab Test - Cholesterol Panel	$187	$187	$12.77	$60	34
85240	Lab Test - Measurement of Blood Clotting Factor VIII Deficiency	$186	$186	$12.53	$125	33
71275	CAT Scan of Blood Vessels in Chest With Contrast	$175	$175	$80.58	$343	29
73706	CAT Scan of Blood Vessels of Leg With Contrast	$175	$175	$88.47	$330	27
82088	Lab Test - Aldosterone Hormone Level	$166	$166	$36.86	$146	32
74177	CAT Scan of Abdomen and Pelvis With Contrast	$163	$163	$83.47	$450	34
70450	CAT Scan of Head or Brain Without Contrast	$163	$163	$32.55	$325	35
72193	CAT Scan of Pelvis With Contrast	$163	$163	$60.07	$328	35
74176	CAT Scan of Abdomen and Pelvis Without Contrast	$163	$163	$82.85	$450	34
74178	CAT Scan of Abdomen and Pelvis With and Without Contrast	$163	$163	$94.49	$468	34
72125	CAT Scan of Neck Spine Without Contrast	$163	$163	$44.86	$325	35
71250	CAT Scan of Chest Without Contrast	$163	$163	$44.05	$325	35
70486	CAT Scan of Facial Bones Without Contrast	$163	$163	$37.65	$325	35

Showing top 50 of 248 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.