FRIEND COMMUNITY HEALTHCARE SYSTEM

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
J3101	Tnkase Kit 50 Mg	$20,519	$12,311	—	—	8
J2505	Neulasta [6Mg]	$17,329	$10,397	—	—	8
Q5120	Ziextenzo [6 Mg/0.6 Ml]	$11,777	$7,066	—	—	8
11426	Ed Exc H-F-Nk-Sp B9+Marg >4 Cm	$7,396	$4,438	—	—	8
11626	Ed Exc S/N/H/F/G Mal+Mrg >4 Cm	$7,396	$4,438	—	—	8
11646	Ed Exc F/E/E/N/L Mal+Mrg >4 Cm	$7,396	$4,438	—	—	8
11772	Ed Remove Pilonidal Cyst Compl	$7,396	$4,438	—	—	8
78608	Pet Ct Metabloc Evaluation	$7,107	$4,264	—	—	8
78816	Pet Ct Whole Body	$6,891	$4,135	—	—	8
78815	Pet Ct Skull Base Mid Thigh	$6,647	$3,988	—	—	8
J2426	Paliperidone Palmitate 234Mg/1.5Ml Syrin	$6,525	$3,915	—	—	8
Q5108	Fulphila [6 Mg/0.6 Ml]	$6,263	$3,758	—	—	8
Independent Living Room Per Month	Independent Living Room Per Month	$5,750	$3,450	—	—	8
95810	Sleep Study W/O Positive Airflow	$5,709	$3,425	—	—	9
J0881	Darbepoetin Alfa Single [200 Mcg/1 Ml]	$5,573	$3,344	—	—	8
74178TC	Ct Abdomen Pelvis W And Wo Contrast	$5,337	$3,202	—	—	9
74182TC	Mri Abdomen W Contrast	$5,224	$3,135	—	—	8
J1439	Ferric Carboxymaltose Inj [750 Mg/15 Ml]	$5,205	$3,123	—	—	8
74181TC	Mri Abdomen Wo Contrast	$5,174	$3,105	—	—	8
74183TC	Mri Abdomen W And Wo Contrast	$5,174	$3,105	—	—	8
74177TC	Ct Abdomen Pelvis W Contrast	$4,962	$2,977	—	—	10
J7325	Synvisc One Syringe 48 Mg	$4,931	$2,958	—	—	8
Or Schedule B 151-165 Min	Or Schedule B 151-165 Min	$4,839	$2,904	—	—	3
Or Schedule B 136-150 Min	Or Schedule B 136-150 Min	$4,632	$2,779	—	—	3
95811	Sleep Study- Split Night	$4,598	$2,759	—	—	9
J0585	Botulinum Toxin-A [200 Units]	$4,565	$2,739	—	—	8
11044	Debridement-Bone-First 20 Sq Cm	$4,534	$2,720	—	—	8
Or Schedule B 121-135 Min	Or Schedule B 121-135 Min	$4,425	$2,655	—	—	3
74176TC	Ct Abdomen Pelvis Wo Contrast	$4,351	$2,611	—	—	9
10121	Ed Remove Foreign Body	$4,220	$2,532	—	—	8
10140	Ed Drainage Of Hematoma/Fluid	$4,220	$2,532	—	—	8
11406	Ed Exc Tr-Ext B9+Marg >4.0 Cm	$4,220	$2,532	—	—	8
11423	Ed Exc H-F-Nk-Sp B9+Marg 2.1-3	$4,220	$2,532	—	—	8
11443	Exc Face-Mm B9+Marg 2.1-3 Cm	$4,220	$2,532	—	—	8
11606	Ed Exc Tr-Ext Mal+Marg >4 Cm	$4,220	$2,532	—	—	8
11643	Ed Exc F/E/E/N/L Mal+Mrg 2.1-3	$4,220	$2,532	—	—	8
Or Schedule B 106-120 Min	Or Schedule B 106-120 Min	$4,218	$2,531	—	—	3
J2700	Oxacillin Inj [10 Gm]	$4,205	$2,523	—	—	8
71552TC	Mri Chest W And Wo Contrast	$4,188	$2,513	—	—	8
J2997	Alteplase Iv Soln [ 50Mg ]	$4,130	$2,478	—	—	8
72157TC	Mri Thoracic Spine W And Wo Contrast	$4,122	$2,473	—	—	8
72156TC	Mri Cervical Spine W And Wo Contrast	$4,095	$2,457	—	—	8
70553TC	Mri Brain W And Wo Contrast	$4,042	$2,425	—	—	8
Mri Face Neck Orbits W And Wo Contrast	Mri Face Neck Orbits W And Wo Contrast	$4,025	$2,415	—	—	8
Or Schedule B 91-105 Min	Or Schedule B 91-105 Min	$4,011	$2,407	—	—	3
70546TC	Mra Angiography Head W And Wo Contrast	$3,992	$2,395	—	—	8
72158TC	Mri Lumbar Spine W And Wo Contrast	$3,951	$2,371	—	—	8
72197TC	Mri Pelvis W And Wo Contrast	$3,859	$2,316	—	—	9
Or Schedule B 76-90 Min	Or Schedule B 76-90 Min	$3,804	$2,283	—	—	3
J3111	Romosozumab-Aqqg [105Mg/1.17Ml]Syr 105Mg	$3,745	$2,247	—	—	8

Showing top 50 of 1,676 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.