DELTA MEMORIAL HOSPITAL — Hospital Ledger

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
J3101	TENECTEPLASE (TNKASE) INJ [50 MG]	$20,435	$16,348	—	—	7
J0840	CROTALIDAE POLYVALENT IMM FAB (OVINE) IN	$16,632	$13,306	—	—	6
23800	ARTHRODESIS GLENOHUM JNT	$16,537	$13,229	—	—	11
J0585	ONABOTULINUMTOXIN-A (BOTOX) 200U INJ	$13,314	$10,651	—	—	7
J0881	ARANESP (DARBEPOETIN ALFA) INJ 500MCG/ML	$10,852	$8,682	—	—	7
J7300	PARAGARD (INTRAUTERINE) 313.4 MG IUD	$10,763	$8,610	—	—	7
36516	BB ABSORPTION LIFESHARE	$10,400	$8,320	—	—	7
15273	WCC SKN SUB GRAFT TRK/ARM/LG CHILD	$9,152	$7,322	—	—	7
15274	WCC SKN SUB GRAFT TRK/ARM/LG CHLD ADD ON	$9,152	$7,322	—	—	6
35207	RPR BLOOD VES DIR HA/FING	$7,447	$5,958	—	—	13
36558	INSRT CNTRL VNS CATH	$7,447	$5,958	—	—	13
36556	INSERT NON TUNNEL CENTRAL VENOUS DEVICE	$7,447	$5,958	—	—	7
36555	INS CENTRAL LINE	$7,447	$5,958	—	—	7
36556	INSERT NON-TUNNEL CV CATH	$7,447	$5,958	—	—	7
36581	REPLACE TUNNELED CV CATH	$7,447	$5,958	—	—	7
36558	INSERTION TUNNELED CENTRAL VENOUS CATH	$7,447	$5,958	—	—	7
26952	AMP FINGER WITH FLAP	$7,442	$5,953	—	—	13
27087	REMOVAL FOREIGN BODY PELVIS/HIP DEEP	$7,442	$5,953	—	—	7
59409	VAGINAL DELIVERY IN THE ER	$7,069	$5,655	—	—	7
59414	DELIVERY PLACENTA ONLY	$7,069	$5,655	—	—	13
59612	VAGINAL DELIV AFTR PREV C	$7,069	$5,655	—	—	7
J1437	MONOFERRIC (FERRIC DERISOMALTOSE) 10ML	$7,053	$5,642	—	—	7
J0885	PROCRIT INJ [40,000 UNT/ML]	$6,866	$5,493	—	—	7
59510	CLNC CESAREAN DELIVERY	$6,534	$5,227	—	—	5
24201	REM FOREIGN BODY UPPER ARM/ELBOW DEEP	$6,458	$5,167	—	—	7
27086	REMOVAL FOREIGN BODY PELVIS/HIP SUBQ	$6,458	$5,167	—	—	7
23333	REMOVAL FOREIGN BODY OF SHOULDER DEEP	$6,458	$5,167	—	—	7
46230	EXC EXT HEM TAG/MULT PAP	$6,424	$5,139	—	—	7
59400	CLNC OB CARE (VAGINAL DELIVERY)	$5,916	$4,733	—	—	5
43632	PF REMOVAL OF STOMACH PARTIAL	$5,790	$4,632	—	—	5
81162	BCRA PANEL PLUS (SEQ AND DUP)	$5,756	$4,605	—	—	7
12037	REP INT SC/TR/EXT>30CM	$5,535	$4,428	—	—	7
43633	PF GASTRECTOMY WITH ROUX-EN-Y	$5,471	$4,377	—	—	5
51102	DRAIN BL WITH SUPRAPUBIC CATH INSERT	$5,339	$4,271	—	—	7
J0875	DALBAVANCIN (DALVANCE) 500MG INJ	$5,327	$4,262	—	—	7
44150	PF COLECTOMY, TOTAL ABDOMINAL	$5,307	$4,246	—	—	5
J0897	PROLIA (DENOSUMAB) INJ. 60MG/ML	$4,767	$3,813	—	—	7
54150	CIRCUMCISION NEWBORN	$4,637	$3,710	—	—	7
15271	WCC SKN SUB GRAFT TRK/ARM/LG	$4,573	$3,658	—	—	7
15272	WCC SKN SUB GRAFT TRK/ARM/LG ADD ON	$4,573	$3,658	—	—	6
15275	WCC SKN SUB GRAFT FACE/NK/H/F/G	$4,573	$3,658	—	—	7
15276	WCC SKN SUB GRAFT FACE/NK/H/F/G ADD ON	$4,573	$3,658	—	—	6
15277	WCC SKN SUB GRAFT FACE/NK/H/F/G CHILD	$4,573	$3,658	—	—	7
15278	WCC SKN SUB GRAFT FCE/NK/H/F/G CHILD ADD	$4,573	$3,658	—	—	6
64625	PAIN MGMT RF ABLT NRV NRVTG SI JT	$4,494	$3,595	—	—	7
64633	PAIN MGMT DESTRCT NEURO AGNT PARVRTEBRAL	$4,494	$3,595	—	—	7
64635	PAIN MGMT DESTRCT NEURO AGNT PARAVRTEBRA	$4,494	$3,595	—	—	7
72285	PAIN MGMT DISKOGRAPHY CERV THOR SUPER IN	$4,494	$3,595	—	—	6
72295	PAIN MGMT DISKOGRAPHY LUMBAR SUPER IN	$4,494	$3,595	—	—	6
44204	PF LAP PARTIAL COLECTOMY	$4,358	$3,487	—	—	5

Showing top 50 of 1,887 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.