CHRISTUS GOOD SHEPHERD MEDICAL CENTER

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
A4719	""Y SET"" TUBING	—	—	$4	$4	32
96381	1 ADMN RSV MONOC ANTB IM NJX	—	—	$10	$53	32
G9773	1 BOD TEMP >=35.5	—	—	$0.01	$0.01	27
4559F	1 BODYTEMP >=35.5CW/IN 30MIN	—	—	$0.01	$4,099	32
A4206	1 CC STERILE SYRINGE&NEEDLE	—	—	$0.28	$0.28	32
G9873	1 EM CORE SESSION	—	—	$25.55	$766	27
G9247	1 MED VISIT IN 24MO	—	—	$0.01	$0.01	27
G9354	1 OR NO CT SINUS W/IN 90D DX	—	—	$0.01	$0.01	27
S8490	100 INSULIN SYRINGES	—	—	$24.77	$24.77	32
3120F	12-LEAD ECG PERFORMED	—	—	$0.01	$4,099	32
G9414	1DOSE MENIG VAC BTWN 11 & 13	—	—	$0.01	$0.01	27
99223	1ST HOSP IP/OBS HIGH 75	—	—	$153	$8,201	32
99222	1ST HOSP IP/OBS MODERATE 55	—	—	$104	$8,201	32
99221	1ST HOSP IP/OBS SF/LOW 40	—	—	$77.17	$8,201	32
99306	1ST NF CARE HIGH MDM 50	—	—	$128	$128	32
99305	1ST NF CARE MODERATE MDM 35	—	—	$99.58	$99.58	32
99304	1ST NF CARE SF/LOW MDM 25	—	—	$68.86	$68.86	32
444T	1ST PLMT DRUG ELUT OC INS	—	—	$179	$404	25
99492	1ST PSYC COLLAB CARE MGMT	—	—	$83.92	$177	43
99494	1ST/SBSQ PSYC COLLAB CARE	—	—	$32.76	$32.76	32
A4207	2 CC STERILE SYRINGE&NEEDLE	—	—	$0.15	$0.15	32
G9877	2 EM CORE MS MO 10-12 NO WL	—	—	$51.1	$766	27
G9879	2 EM CORE MS MO 10-12 WL	—	—	$67.89	$766	27
G9876	2 EM CORE MS MO 7-9 NO WL	—	—	$51.1	$766	27
G9878	2 EM CORE MS MO 7-9 WL	—	—	$67.89	$766	27
G9882	2 EM ONGOING MS MO 13-15 WL	—	—	$37.96	$766	27
G9883	2 EM ONGOING MS MO 16-18 WL	—	—	$37.96	$766	27
G9884	2 EM ONGOING MS MO 19-21 WL	—	—	$38.69	$766	27
G9885	2 EM ONGOING MS MO 22-24 WL	—	—	$38.69	$766	27
4145F	2+ ANTI-HYPRTNSV AGENTS TKN	—	—	$0.01	$4,099	32
G0032	2+ ANTIPSY SCHIZ	—	—	—	—	27
G0033	2+ BENZO SEIZ	—	—	—	—	27
A4213	20+ CC SYRINGE ONLY	—	—	$0.56	$0.56	32
U0001	2019-NCOV DIAGNOSTIC P	—	—	$21.55	$309	43
D0702	2D CEPHAL RADIO IMAGE	—	—	$79.89	$168	43
D0340	2D CEPHALOMETRIC IMAGE	—	—	$79.89	$168	43
D0703	2D ORAL/FACIAL PHOTO IMAGE	—	—	$79.89	$168	43
90650	2VHPV VACCINE 3 DOSE IM	—	—	$177	$866	30
A4208	3 CC STERILE SYRINGE&NEEDLE	—	—	$0.28	$0.28	32
G9226	3 COMP FOOT EXAM COMPLETED	—	—	$0.01	$0.01	27
77295	3-D RADIOTHERAPY PLAN	—	—	$437	$2,613	43
D0801	3D DENTAL SCAN DIRECT	—	—	$18.1	$18.1	32
D0802	3D DENTAL SCAN INDIRECT	—	—	$18.1	$18.1	32
D0803	3D FACIAL SCAN DIRECT	—	—	$14.62	$14.62	32
D0804	3D FACIAL SCAN INDIRECT	—	—	$14.62	$14.62	32
D0396	3D PRINT OF 3D SURFACE SCAN	—	—	—	—	27
694T	3D VOL IMG&RCNSTJ BRST/AX	—	—	$40.44	$231	30
944T	3D contour simulation of target liver lesion(s) and margin(s) for image-guided percutaneous microwav	—	—	$219	$1,003	43
4165F	3D-CRT/IMRT RECEIVED	—	—	$0.01	$4,099	32
C8001	3d anatomical segmentation imaging for preoperative planning, data preparation and transmission, obt	—	—	$79.89	$642	43

Showing top 50 of 17,447 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.