PHILLIPS COUNTY HOSPITAL — Hospital Ledger

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
J2997	ALTEPLASE IVINJ 100MG ACTIVASE KIT	$14,053	$12,648	—	—	0
J3101	TENECTEPLASE INJ 50MG TNKase	$11,278	$10,150	—	—	0
J2505	PEGFILGRASTIM INJ 6MG/0.6ML UDENCYA	$7,495	$6,746	—	—	0
J0840	CROTALIDAE POLYVALENT 1GM CROFAB	$5,198	$4,678	—	—	0
J2506	PEGFILGRASTIM INJ 6MG NEULASTA	$4,946	$4,451	—	—	0
J1569	IV GAMMAGARD 10% INF 30GM/300ML IVIV GAM	$4,905	$4,415	—	—	0
72159	MRA SPINAL CANAL WITH OR W/O CONTRAST	$3,931	$3,538	—	—	0
J0897	DENOSUMAB INJ 60MG PROLIA	$3,675	$3,308	—	—	0
Q5108	PEGFILGRASTIM-jmdb SQ INJ 6MG/0.6ML FULP	$3,675	$3,308	—	—	0
J2357	OMALIZUMAB INJ 150MG/1ML XOLAIR	$3,675	$3,308	—	—	0
74178	CT ABD/PEL W & W/O CONTRA	$3,449	$3,104	—	—	0
J7168	PROTHROMBIN COMPLEX 1000U RANGE KCENTRA	$3,417	$3,075	—	—	0
71551	MRI CHEST WITH CONTRAST	$3,246	$2,921	—	—	0
70553	MRI BRAIN W/O CON FOLLOWED BY CON	$3,226	$2,903	—	—	0
J1602	GOLIMUMAB IV SOL 50MG/4ML	$3,191	$2,872	—	—	0
71552	MRI CHEST W/O CON FOLLOWED BY CON	$3,119	$2,807	—	—	0
70546	MRA HEAD W/O CON FOLLOWED BY CON	$3,116	$2,804	—	—	0
70545	MRA HEAD WITH CONTRAST	$3,057	$2,751	—	—	0
72158	MRI LUMBAR SPINE W/O CON FOLLOWED BY CON	$3,000	$2,700	—	—	0
70549	MRA NECK W/O CON FOLLOWED BY CON	$2,999	$2,699	—	—	0
72197	MRI PELVIS W/O CON FOLLOWED BY CON	$2,986	$2,687	—	—	0
74183	MRI ABDOMEN W/O CON FOLLOWED BY CONTRAST	$2,961	$2,665	—	—	0
70543	MRI ORBIT FACE NECK W/O CON FLWD BY CON	$2,940	$2,646	—	—	0
73223	MRI UPR EXTREM ANY JOINT W/O C FLWD BY C	$2,938	$2,644	—	—	0
72157	MRI THORACIC SPINE W/O CON FOLWD BY CON	$2,936	$2,642	—	—	0
72156	MRI CERVICAL SPINE W/O CON FLWD BY CON	$2,888	$2,599	—	—	0
73723	MRI LWR EXTRM ANY JOINT W/O C FLWD BY C	$2,791	$2,512	—	—	0
73220	MRI UPR EXTREM OTR JOINT W/O C FLWD BY C	$2,788	$2,509	—	—	0
74177	CT IVP KIDNEYS-URETERS-BLADDER	$2,780	$2,502	—	—	0
73720	MRI LWR EXTREM OTR JOINT W/O C FLWD BY C	$2,767	$2,490	—	—	0
81432	HEREDITARY BREAST/GYN CANCER PNL BRGYPso	$2,615	$2,354	—	—	11
71555	MRA CHEST WITH OR W/O CONTRAST	$2,600	$2,340	—	—	0
74175	CT ABD PEL ANGIOGRAM W CON	$2,596	$2,336	—	—	0
27562	CLOSED TX PATELLAR DISLOC, W/ ANESTHESIA	$2,500	$2,250	—	—	1
27818	CLOSED TX TRIMALLEOLAR ANKLE W/MAN	$2,498	$2,248	—	—	1
73225	MRA UPPER EXTREMITY W OR W/O CONTRAST	$2,478	$2,230	—	—	0
72198	MRA PELVIS WITH OR W/O CONTRAST	$2,452	$2,207	—	—	0
74185	MRA ABDOMEN WITH OR W/O CONTRAST	$2,419	$2,177	—	—	0
74170	CT ABDOMEN WO AND W CONTRAST	$2,417	$2,175	—	—	0
27560	CLOSED TX PATELLAR DISLOC, WO ANESTHESIA	$2,365	$2,129	—	—	1
73725	MRA LOWER EXTREMITY WITH OR W/O CONTRAST	$2,323	$2,091	—	—	0
70548	MRA NECK WITH CONTRAST	$2,301	$2,071	—	—	0
71270	CT CHEST-THORAX W/O+W CON	$2,300	$2,070	—	—	0
72196	MRI PELVIS WITH CONTRAST	$2,269	$2,042	—	—	0
73219	MRI UPR EXTREM OTHER THAN JOINT W CON	$2,258	$2,032	—	—	0
71275	CT CHEST ANGIOGRAM W CONTRAST	$2,225	$2,003	—	—	0
70542	MRI ORBIT FACE NECK WITH CONTRAST	$2,214	$1,993	—	—	0
26951	FINGER/THUMB AMPUTATION W/DIR CLOSUR	$2,205	$1,985	—	—	1
71260	CT CHEST-THORAX W CONTRAS	$2,196	$1,976	—	—	0
72147	MRI THORACIC SPINE WITH CONTRACT	$2,192	$1,973	—	—	0

Showing top 50 of 1,264 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.