SUMMERS COUNTY ARH HOSPITAL — Hospital Ledger

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
J3101	TNKASE 50MG INJ	$35,210	$21,126	—	—	17
A2025	MIRO3D 100 CM3/CM3	$30,557	$18,334	—	—	16
J7336	QUTENZA 8% TOPICAL 4 PATCHES	$23,699	$14,219	—	—	17
90377	KEDRAB 1500UNIT/10ML	$22,799	$13,679	—	—	17
J0840	CROFAB 1 EA	$18,122	$10,873	—	—	17
LITHOTRIPSY UNILAT 1ST 10 MIN	LITHOTRIPSY UNILAT 1ST 10 MIN	$14,505	$8,703	—	—	16
OB SURGERY LEVEL 3 1ST 30 MINS	OB SURGERY LEVEL 3 1ST 30 MINS	$11,475	$6,885	—	—	16
Q4197	PURAPLY XT 4.91X4.91(25)/SQCM	$11,305	$6,783	—	—	16
J3032	VYEPTI 100MG/1ML VIAL	$11,136	$6,682	—	—	17
Q4101	APLIGRAF DISK KIT 44 SQ CM	$8,479	$5,087	—	—	16
74178	CT ABD+PELVIS W+WO CONTRAST	$8,247	$4,948	—	—	16
74174	CT ANG ABD+PLVS W OR WO CNTRS	$8,070	$4,842	—	—	16
Q4133	GRAFIX PL PRIME 12 SQ CM/SQCM	$8,047	$4,828	—	—	16
Q4159	AFFINITY 2.25 SQ CM/SQCM	$7,648	$4,589	—	—	16
72156	MR C-SPINE W/WO CONTRAST	$7,614	$4,568	—	—	16
72157	MR THORACIC W/WO CONTRAST	$7,614	$4,568	—	—	16
70553	MR HEAD W/WO CONTRAST	$7,204	$4,322	—	—	16
74177	CT ABD+PELVIS W/CONTRAST	$7,079	$4,247	—	—	16
73702	CT LOW EXTREMITY W+WO CON BIL	$6,992	$4,195	—	—	16
73721	MR LOW EXT JNT WO CON BIL	$6,778	$4,067	—	—	16
J0897	PROLIA 60MG/ML INJECTION	$6,578	$3,947	—	—	17
72158	MR LUMBAR SPINE W/WO CONTRAST	$6,258	$3,755	—	—	16
59409	VAG DELIVERY	$5,641	$3,385	—	—	17
J1439	INJECTAFER 750MG/15ML VIAL	$5,517	$3,310	—	—	17
73720	MR LOW EXT NON JNT W+WO CON LT	$5,462	$3,277	—	—	16
73723	MR LOW EXT JNT W+WO CON LT	$5,462	$3,277	—	—	16
74176	CT ABD+PELVIS WO CONTRAST	$5,385	$3,231	—	—	16
19083	US BX BREAST 1ST LES LT	$5,353	$3,212	—	—	17
71552	MR CHEST W/WO CONTRAST	$5,342	$3,205	—	—	16
72146	MR THORACIC W/O CONTRAST	$5,342	$3,205	—	—	16
72148	MR LUMBAR SPINE W/O CONTRAST	$5,089	$3,053	—	—	16
J3111	EVENITY 105MG SYRINGE	$5,071	$3,043	—	—	17
70540	MR ORBIT/FACE/NECK WO CNTRST	$5,017	$3,010	—	—	16
70551	MR HEAD W/O CONTRAST	$5,017	$3,010	—	—	16
71550	MR CHEST W/O CONTRAST	$5,017	$3,010	—	—	16
72197	MR PELVIS W/WO CONTRAST	$5,017	$3,010	—	—	16
73220	MR UP EXT NON JNT W+WO CON LT	$5,017	$3,010	—	—	16
73223	MR UP EXT JNT W+WO CON LT	$5,017	$3,010	—	—	16
73700	CT LOW EXTREMITY WO CON BIL	$4,877	$2,926	—	—	16
71270	CT CHEST W/WO CONTRAST	$4,833	$2,900	—	—	16
72141	MR C-SPINE W/O CONTRAST	$4,778	$2,867	—	—	16
72195	MR PELVIS W/O CONTRAST	$4,778	$2,867	—	—	16
73221	MR UP EXT JNT WO CON LT	$4,778	$2,867	—	—	16
73719	MR LOW EXT NON JNT W CON RT	$4,778	$2,867	—	—	16
21320	CLS TX NASAL BONE FX W/STAB	$4,726	$2,836	—	—	17
71275	CT ANG CHST W OR WO CONTR	$4,489	$2,693	—	—	16
72130	CT THORACIC SPINE W/WO CONTRST	$4,489	$2,693	—	—	16
72133	CT LUMBAR SPINE W/WO CONTRAST	$4,489	$2,693	—	—	16
72194	CT PELVIS W/WO CONTRAST	$4,489	$2,693	—	—	16
26775	CLS TX FNGR DSL W/MAN W/AN F6	$4,242	$2,545	—	—	17

Showing top 50 of 1,201 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.