CHRISTUS MOTHER FRANCES HOSPITAL- JACKSONVILLE

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
A4719	""Y SET"" TUBING	—	—	—	—	26
96381	1 ADMN RSV MONOC ANTB IM NJX	—	—	$24	$184	26
G9773	1 BOD TEMP >=35.5	—	—	—	—	21
4559F	1 BODYTEMP >=35.5CW/IN 30MIN	—	—	$2,050	$8,200	26
A4206	1 CC STERILE SYRINGE&NEEDLE	—	—	—	—	26
G9873	1 EM CORE SESSION	—	—	$324	$478	21
G9247	1 MED VISIT IN 24MO	—	—	—	—	21
G9354	1 OR NO CT SINUS W/IN 90D DX	—	—	—	—	21
S8490	100 INSULIN SYRINGES	—	—	—	—	25
3120F	12-LEAD ECG PERFORMED	—	—	$2,050	$8,200	26
G9414	1DOSE MENIG VAC BTWN 11 & 13	—	—	—	—	21
444T	1ST PLMT DRUG ELUT OC INS	—	—	$224	$252	19
99492	1ST PSYC COLLAB CARE MGMT	—	—	$2,407	$2,407	26
99494	1ST/SBSQ PSYC COLLAB CARE	—	—	—	—	26
A4207	2 CC STERILE SYRINGE&NEEDLE	—	—	—	—	26
G9877	2 EM CORE MS MO 10-12 NO WL	—	—	$324	$478	21
G9879	2 EM CORE MS MO 10-12 WL	—	—	$324	$478	21
G9876	2 EM CORE MS MO 7-9 NO WL	—	—	$324	$478	21
G9878	2 EM CORE MS MO 7-9 WL	—	—	$324	$478	21
G9882	2 EM ONGOING MS MO 13-15 WL	—	—	$324	$478	21
G9883	2 EM ONGOING MS MO 16-18 WL	—	—	$324	$478	21
G9884	2 EM ONGOING MS MO 19-21 WL	—	—	$324	$478	21
G9885	2 EM ONGOING MS MO 22-24 WL	—	—	$324	$478	21
4145F	2+ ANTI-HYPRTNSV AGENTS TKN	—	—	$2,050	$8,200	26
G0032	2+ ANTIPSY SCHIZ	—	—	—	—	21
G0033	2+ BENZO SEIZ	—	—	—	—	21
A4213	20+ CC SYRINGE ONLY	—	—	—	—	26
U0001	2019-NCOV DIAGNOSTIC P	—	—	$21.55	$158	25
D0702	2D CEPHAL RADIO IMAGE	—	—	—	—	26
D0340	2D CEPHALOMETRIC IMAGE	—	—	—	—	26
D0703	2D ORAL/FACIAL PHOTO IMAGE	—	—	—	—	26
C8925	2D TEE W OR W/O FOL W/CON,IN	—	—	$416	$3,132	26
C8923	2D TTE W OR W/O FOL W/CON,CO	—	—	$416	$3,132	26
90650	2VHPV VACCINE 3 DOSE IM	—	—	$218	$312	24
A4208	3 CC STERILE SYRINGE&NEEDLE	—	—	—	—	26
G9226	3 COMP FOOT EXAM COMPLETED	—	—	—	—	21
77295	3-D RADIOTHERAPY PLAN	—	—	$1,446	$6,971	26
D0801	3D DENTAL SCAN DIRECT	—	—	—	—	26
D0802	3D DENTAL SCAN INDIRECT	—	—	—	—	26
93319	3D ECHO IMG CGEN CAR ANOMAL	—	—	$55.91	$640	24
D0803	3D FACIAL SCAN DIRECT	—	—	—	—	26
D0804	3D FACIAL SCAN INDIRECT	—	—	—	—	26
D0396	3D PRINT OF 3D SURFACE SCAN	—	—	—	—	21
76377	3D RENDER W/INTRP POSTPROCES	—	—	$73.57	$1,402	24
694T	3D VOL IMG&RCNSTJ BRST/AX	—	—	$73.57	$106	24
944T	3D contour simulation of target liver lesion(s) and margin(s) for image-guided percutaneous microwav	—	—	$309	$425	26
4165F	3D-CRT/IMRT RECEIVED	—	—	$2,050	$8,200	26
C8001	3d anatomical segmentation imaging for preoperative planning, data preparation and transmission, obt	—	—	$204	$293	26
G9874	4 EM CORE SESSIONS	—	—	$324	$478	21
G9676	40-75Y W/TYPE 1/2 W/LDL-C RS	—	—	—	—	21

Showing top 50 of 18,292 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.