FRANKLIN COUNTY MEMORIAL HOSPITAL

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
J3101	TENECTEPLASE (TNKase) 50MG INJ	$19,576	$19,576	—	—	6
J0840	CROTALIDAE POLYVALENT INJ	$9,272	$9,272	—	—	6
J1306	LEQVIO (INCLISIRAN) 284MG/1.5ML SYRINGE	$6,515	$6,515	—	—	6
J0875	DALBAVANCIN (DALVANCE) 500MG INJ	$5,800	$5,800	—	—	6
36569	PICC INSERTION AOP	$4,308	$4,308	—	—	6
36569	PICC LINE INSERTION, ACUTE OR SWING	$4,308	$4,308	—	—	6
36580	REPLACE NON-TUN VENOUS CATH , AC/SWING	$4,308	$4,308	—	—	6
21454	EXTERNAL FIXATION, MANDIBLE FRACTURE, OP	$3,961	$3,961	—	—	6
31030	CALDWELL LUC	$3,500	$3,500	—	—	6
26951	AMPUTATION FINGER/THUMB	$2,637	$2,637	—	—	6
49082	PARACENTESIS, FACILITY FEE	$2,478	$2,478	—	—	6
75635	CT BILATERAL LE RNFFS W CONT	$2,415	$2,415	—	—	6
41874	ALVEOPLASTY - HOSPITAL	$2,300	$2,300	—	—	6
40810	EXCISION LESION, MOUTH, W/O REPAIR	$2,300	$2,300	—	—	6
40814	EXCSION LESION, MOUTH W/ REPAIR,COMPLEX	$2,300	$2,300	—	—	6
40812	EXCISION LESION MOUTH, W/ REPAIR, SIMPLE	$1,997	$1,997	—	—	6
41826	EXCISE/REPAIR MOUTH LESION, SIMPLE	$1,997	$1,997	—	—	6
41825	EXICSION BENIGN LIP LESION, .5cm	$1,997	$1,997	—	—	6
21031	REMOVAL MANDIBULAR LINGUAL TORI	$1,997	$1,997	—	—	6
21040	EXCISION CYST MANDIBLE BY ENUCLEATION	$1,997	$1,997	—	—	6
D7740	MANDIBLE, CLOSED REDUCTION	$1,850	$1,850	—	—	6
74170	CT ABDOMEN WWO CONTRAST	$1,825	$1,825	—	—	6
71270	CT CHEST WWO CONTRAST	$1,825	$1,825	—	—	6
70470	CT HEAD WWO CONTRAST	$1,825	$1,825	—	—	6
72194	CT PELVIS WWO CONTRAST	$1,825	$1,825	—	—	6
70492	CT SOFT TISSUE NECK WWO CON	$1,825	$1,825	—	—	6
93307	US ECHO 2-D/MMODE	$1,725	$1,725	—	—	6
93306	US ECHO COMPLETE	$1,725	$1,725	—	—	6
11047	BONE EA ADDL 20 SQ CM	$1,679	$1,679	—	—	6
11044	DEBRID SUBC MUSC BONE	$1,679	$1,679	—	—	6
74178	CT ABD PEL WWO CONTRAST	$1,600	$1,600	—	—	6
74177	CT ABD PEL W CONTRAST	$1,596	$1,596	—	—	6
74160	CT ABDOMEN W CONTRAST	$1,596	$1,596	—	—	6
71260	CT CHEST W CONTRAST	$1,596	$1,596	—	—	6
70460	CT HEAD W CONTRAST	$1,596	$1,596	—	—	6
72193	CT PELVIS W CONTRAST	$1,596	$1,596	—	—	6
70491	CT SOFT TISSUE NECK W CONTR	$1,596	$1,596	—	—	6
73201	CT UPPER EXTREMITY W CONTRAST	$1,596	$1,596	—	—	6
31622	BRONCHOSCOPY	$1,500	$1,500	—	—	6
74175	CT CTA ABDOMEN	$1,495	$1,495	—	—	6
70496	CT CTA BRAIN	$1,495	$1,495	—	—	6
70498	CT CTA CAROTID NECK	$1,495	$1,495	—	—	6
71275	CT CTA CHEST	$1,495	$1,495	—	—	6
J0714	CEFTAZIDIME/AVIBACTAM (AVYCAZ) 2-0.5GM	$1,450	$1,450	—	—	6
10005	FINE NEEDLE ASPIRATION W/ IMAGING	$1,440	$1,440	—	—	6
25605	CLOSED REDUCTION DISTAL RADIUS Fx	$1,436	$1,436	—	—	6
25605	CLOSED REDUCTION DISTAL RADIUS Fx	$1,436	$1,436	—	—	6
D7210	SURGICAL EXTRACTION	$1,400	$1,400	—	—	6
D7250	ROOT TIP EXTRACTION	$1,400	$1,400	—	—	6
D7240	SURGICAL EXTRACTION, FULL BONY	$1,400	$1,400	—	—	6

Showing top 50 of 1,628 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.