HOLMES COUNTY HOSPITAL AND CLINICS

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
J3101	TENECTEPLASE 50 MG KIT 1 EACH BOX	$41,818	$16,727	—	—	30
J1162	DIGOXIN IMMUNE FAB 40 MG SOLR 1 EACH VIAL	$25,069	$10,028	—	—	30
J2182	MEPOLIZUMAB 100 MG SOLR 1 EACH VIAL	$18,521	$7,409	—	—	30
J0840	CROTALIDAE POLYVALENT IMMUNE FAB SOLR 1 EACH VIAL	$16,118	$6,447	—	—	30
689	KIDNEY AND URINARY TRACT INFECTIONS WITH MCC	$11,901	$4,760	—	—	22
603	CELLULITIS WITHOUT MAJOR COMPLICATION	$11,448	$4,579	—	—	22
J0875	DALBAVANCIN HCL 500 MG SOLR 1 EACH VIAL	$8,967	$3,587	—	—	30
J1439	FERRIC CARBOXYMALTOSE 750 MG/15ML SOLN 15 ML VIAL	$8,118	$3,247	—	—	30
690	KIDNEY & URINARY TRACT INFECTIONS WITHOUT MCC	$7,100	$2,840	—	—	22
177	RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC	$5,739	$2,296	—	—	22
291	HEART FAILURE AND SHOCK W MCC	$5,709	$2,284	—	—	22
J1451	FOMEPIZOLE 1 GM/ML SOLN 1.5 ML VIAL	$5,175	$2,070	—	—	60
J0630	CALCITONIN 200 UNIT/ML SOLN 2 ML VIAL	$5,040	$2,016	—	—	19
J2407	ORITAVANCIN DIPHOSPHATE 400 MG SOLR 1 EACH VIAL	$4,872	$1,949	—	—	60
59409	59409 VAGINAL DELIVERY	$3,985	$1,594	—	—	24
J0882	DARBEPOETIN ALFA 100 MCG/0.5ML SOSY 0.5 ML SYRINGE	$3,901	$1,560	—	—	48
70553	70553 MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST	$3,804	$1,522	—	—	30
73722	73722 MRI SCAN OF LEG JOINT WITH CONTRAST	$3,745	$1,498	—	—	30
72158	72158 MRI SCAN OF LOWER SPINAL CANAL BEFORE AND AFTER CONTRAST	$3,518	$1,407	—	—	30
72156	72156 MRI SCAN OF UPPER SPINAL CANAL BEFORE AND AFTER CONTRAST	$3,308	$1,323	—	—	30
72157	72157 MRI SCAN OF MIDDLE SPINAL CANAL BEFORE AND AFTER CONTRAST	$3,150	$1,260	—	—	30
72149	72149 MRI SCAN OF LOWER SPINAL CANAL WITH CONTRAST	$2,924	$1,170	—	—	30
70552	MR BRAIN W/CONTRAST LMTD	$2,818	$1,127	—	—	30
15275	15275 APPLICATION OF SKIN SUBSTITUTE GRAFT TO WOUND OF FACE	$2,751	$1,100	—	—	30
J1327	EPTIFIBATIDE 75 MG/100ML SOLN 100 ML VIAL	$2,742	$1,097	—	—	22
J3262	TOCILIZUMAB 80 MG/4ML SOLN 4 ML VIAL	$2,677	$1,071	—	—	30
J0248	REMDESIVIR 100 MG SOLR 1 EACH VIAL	$2,621	$1,048	—	—	30
74183	74183 MRI SCAN OF ABDOMEN BEFORE AND AFTER CONTRAST	$2,601	$1,040	—	—	30
72142	72142 MRI SCAN OF UPPER SPINAL CANAL WITH CONTRAST	$2,544	$1,018	—	—	30
74178	74178 CT SCAN OF ABDOMEN AND PELVIS BEFORE AND AFTER CONTRAST	$2,513	$1,005	—	—	30
43242	43242 ULTRASOUND GUIDED NEEDLE ASPIRATION OR BIOPSY OF ESOPHAGUS	$2,503	$1,001	—	—	30
72147	72147 MRI SCAN OF MIDDLE SPINAL CANAL WITH CONTRAST	$2,467	$987	—	—	30
77047	77047 MRI SCAN OF BOTH BREASTS WITHOUT CONTRAST	$2,449	$980	—	—	30
C8906	MRI W/CONT BREAST BI	$2,449	$980	—	—	24
C8908	MRI W/O FOL W/CONT BREAST	$2,449	$980	—	—	24
74177	74177 CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST	$2,393	$957	—	—	30
70336	70336 MRI SCAN OF JAW JOINT	$2,377	$951	—	—	30
11044	REMOVAL OF BONE	$2,364	$946	—	—	30
38505	38505 NEEDLE BIOPSY OR REMOVAL OF SURFACE LYMPH NODES	$2,364	$946	—	—	30
J1670	TETANUS IMMUNE GLOBULIN 250 UNIT/ML SOSY 1 ML SYRINGE	$2,360	$944	—	—	30
74182	74182 MRI SCAN OF ABDOMEN WITH CONTRAST	$2,300	$920	—	—	30
72148	MRI LUMBAR SPINE W/O DYE	$2,295	$918	—	—	30
73702	73702 CT SCAN OF LEG BEFORE AND AFTER CONTRAST	$2,280	$912	—	—	30
11450	11450 REMOVAL OF SKIN AND TISSUE OF UNDERARMS FOR INFLAMED SWEAT GLANDS WITH	$2,279	$912	—	—	30
70551	70551 MRI SCAN OF BRAIN WITHOUT CONTRAST	$2,275	$910	—	—	30
74176	74176 CT SCAN OF ABDOMEN AND PELVIS WITHOUT CONTRAST	$2,274	$910	—	—	30
J0561	PENICILLIN G BENZATHINE 1200000 UNIT/2ML SUSY 2 ML SYRINGE	$2,241	$896	—	—	60
15273	15273 SKIN SUBSTITUTE GRAFT TO WOUND 100.0 SQ CM OR MORE OF TRUNK	$2,225	$890	—	—	30
15277	15277 SKIN SUBSTITUTE GRAFT TO WOUND 100.0 SQ CM OR MORE OF FACE	$2,225	$890	—	—	30
74181	74181 MRI SCAN OF ABDOMEN WITHOUT CONTRAST	$2,157	$863	—	—	30

Showing top 50 of 2,688 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.