WEST CARROLL MEMORIAL HOSPITAL

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
J3101	TENECTEPLASE INJ [50 MG]	$20,375	—	—	—	3
J3489	ZOLEDRONIC ACID 'PREMIX' IVPB 5MG/100ML	$2,210	—	—	—	1
43213	EGD W/DILATION VIA DIL	$2,178	—	—	—	7
43235	EGD	$2,178	—	—	—	1
43239	EGD W/BIOPSY	$2,178	—	—	—	8
43453	EGD W/DILATION VIA SAV	$2,178	—	—	—	1
45378	COLONOSCOPY DIAGNOSTIC	$2,178	—	—	—	9
45380	COLONOSCOPY W/ BIOPSY	$2,178	—	—	—	5
45385	COLONOSCOPY W/REMOVAL	$2,178	—	—	—	11
74178	CT ABD/PELVIS W WO CONTRAST P	$1,815	—	—	—	6
G0105	COLONOSCOPY SCREENING HIGH RISK	$1,815	—	—	—	3
G0121	COLONOSCOPY SCREENING LOW RISK	$1,815	—	—	—	5
11042	DEBRIDE SUBQ/TISSUE 1ST	$1,725	—	—	—	3
71275	CT ANGIOGRAM CHEST PE STUDY P	$1,362	—	—	—	10
74176	CT ABD/PELVIS WO CONTRAST P	$1,271	—	—	—	23
74177	CT ABD/PELVIS WITH CONTRAST P	$1,271	—	—	—	24
70470	CT HEAD W WO CONTRAST P	$1,263	—	—	—	6
72194	CT PELVIS W WO CONTRAST P	$1,263	—	—	—	2
74170	CT ABDOMEN W WO CONTRAST P	$1,263	—	—	—	3
D5213	MAX PARTIAL DENTURE(CA	$1,200	—	—	—	1
D5214	MAND PARTIAL DENTURE(C	$1,200	—	—	—	1
72193	CT PELVIS WITH CONTRAST P	$1,172	—	—	—	3
70481	CT ORBIT WITH CONTRAST P	$1,126	—	—	—	1
73201	CT UPPER EXT WITH CONTRAST LEFT P	$1,126	—	—	—	4
D5110	COMPLETE DENTURE (MAX)	$1,100	—	—	—	1
D5120	COMPLETE DENTURE (MAND	$1,100	—	—	—	1
49450	GASTROSTOMY TUBE REPLA	$1,089	—	—	—	2
72132	CT L SPINE WITH CONTRAST P	$1,089	—	—	—	1
74160	CT ABDOMEN W CONTRAST P	$1,053	—	—	—	3
70490	CT ST NECK WO CONTRAST P	$1,035	—	—	—	4
70491	CT ST NECK WITH CONTRAST P	$1,035	—	—	—	8
71260	CT CHEST WITH CONTRAST P	$1,035	—	—	—	17
J1165	PHENYTOIN INJ 100MG/2ML	$1,035	—	—	—	2
36430	BLOOD ADMINISTRATION	$1,002	—	—	—	10
72192	CT PELVIS WO CONTRAST P	$990	—	—	—	6
73701	CT LOWER EXT W CONTRAST LEFT P	$990	—	—	—	8
70487	CT FACIAL BONES W/CONTRAST P	$944	—	—	—	1
72125	CT C SPINE WO CONTRAST P	$944	—	—	—	19
72128	CT T SPINE WO CONTRAST P	$944	—	—	—	11
72131	CT L SPINE WO CONTRAST P	$944	—	—	—	14
73200	CT UPPER EXT WO CONTRAST LEFT P	$944	—	—	—	6
74150	CT ABDOMEN WO CONTRAST P	$944	—	—	—	3
97602	WOUND CARE	$923	—	—	—	10
11402	EXCISION BN LESION 1.1-2	$908	—	—	—	1
70450	CT HEAD WO CONTRAST P	$900	—	—	—	23
J3535	FLUTICASONE HFA MDI 110MCG	$855	—	—	—	2
70486	CT FACIAL BONES WO CONTRAST P	$854	—	—	—	13
73700	CT LOWER EXT WO CONTRAST LEFT P	$854	—	—	—	4
D5212	MAND PARTIAL DENTURE	$850	—	—	—	4
93970	US VENOUS LOWER BILATERAL P	$825	—	—	—	12

Showing top 50 of 537 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.