SEDAN CITY HOSPITAL — Hospital Ledger

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
600126	ALTEPLASE 100 MG	$27,106	$20,330	—	—	0
810922	PROLIA 60 MG/1 ML	$5,450	$4,088	—	—	0
300195	CTA HEAD	$3,250	$2,438	—	—	0
300196	CTA NECK	$3,225	$2,419	—	—	0
300156	CTA CHEST (PE)	$2,586	$1,940	—	—	1
300210	CTA CHEST (DISECTION)	$2,586	$1,940	—	—	1
300205	CTA ABDOMEN/PELVIS WITH	$2,126	$1,594	—	—	0
300157	CT LOWER EXTREMITY W/O CONTRAS	$1,671	$1,253	—	—	0
300159	CT UPPER EXTREMITY W/O CONTRAS	$1,671	$1,253	—	—	0
300118	CT PELVIS & ABDOMEN W/WO CONTR	$1,668	$1,251	—	—	1
300097	CT CHEST/THORAX W/CONTRAST	$1,635	$1,226	—	—	1
630624	MYELOID FISH PANEL	$1,549	$1,162	—	—	0
100005	EMERGENCY ROOM LEVEL V 99285	$1,478	$1,109	—	—	0
600169	INFLECTRA 100 MG VIAL	$1,462	$1,097	—	—	0
300114	CT ABDOMEN W/CONTRAST	$1,431	$1,073	—	—	0
300117	CT PELVIS & ABDOMEN W/CONTRAST	$1,431	$1,073	—	—	1
300096	CT CHEST/THORAX/WO CONTRAST	$1,403	$1,052	—	—	1
300103	CT PELVIS W/O CONTRAST	$1,403	$1,052	—	—	0
300113	CT ABDOMEN W/O CONTRAST	$1,403	$1,052	—	—	1
300116	CT PELVIS & ABDOMEN WO CONTRAS	$1,403	$1,052	—	—	1
300121	CT PELVIS BONY	$1,403	$1,052	—	—	0
300127	CT RENAL STONE PROTOCOL	$1,403	$1,052	—	—	0
300084	CT HEAD/BRAIN W/O CONTRAST	$1,383	$1,037	—	—	1
300094	CT SOFT TISSUE NECK/ W/CONTRAS	$1,351	$1,013	—	—	1
300155	CT FACIAL BONES W/CONTRAST	$1,311	$983	—	—	0
300100	CT THORACIC SPINE W/O CONTRAST	$1,243	$932	—	—	0
300101	CT LUMBAR SPINE W/O CONTRAST	$1,243	$932	—	—	0
300099	CT CERVICAL SPINE W/O CONTRAST	$1,217	$913	—	—	1
550632	AMBU FLEXIBLE VIDEOSCOPE	$1,070	$802	—	—	0
300093	CT SOFT TISSUE NECK W/O CONTR	$1,068	$801	—	—	1
300090	CT FACE WO CONTRAST	$1,061	$796	—	—	0
300126	CT MAXILLO FACIAL SINUSES WO C	$1,061	$796	—	—	0
300087	CT ORBIT SELLA MID/INNER EAR W	$1,040	$780	—	—	0
100004	EMERGENCY ROOM LEVEL IV 99284	$1,001	$751	—	—	1
10005	SEMI PRIVATE - TELEMETRY	$900	$675	—	—	0
400025	NEG PRESS WOUND TX, <50 CM 97	$895	$671	—	—	1
10007	ISOLATION ROOM	$800	$600	—	—	0
400013	DEBRIDE SKIN, INTO SQ 11042	$746	$560	—	—	1
400024	ACTIVE WOUND MGMT, NON SELECTI	$746	$560	—	—	0
400059	DEBRIDE SQ TISSUE @20 SQ CM	$746	$560	—	—	0
400062	SELECTIVE DEBRIDE 20 SQ CM	$746	$560	—	—	1
400063	SELECT DEBRIDE @ADD'L 20 SQ CM	$746	$560	—	—	0
630436	BLOOD TRANSFUSION	$729	$547	—	—	0
810169	PROCRIT 20,000 UNITS/ML INJ	$711	$533	—	—	0
300219	ANNUAL CT LUNG CANCER SCREEN	$644	$483	—	—	1
600174	VENOFER 200 MG/10 ML	$638	$479	—	—	0
10003	SEMI-PRIVATE ROOM	$609	$457	—	—	0
100003	EMERGENCY ROOM LEVEL 111 99283	$595	$446	—	—	1
810915	RETACRIT 2 ML/VIAL	$579	$434	—	—	0
10004	SKILLED SWING-BED ROOM	$567	$425	—	—	0

Showing top 50 of 1,096 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.