JEFF DAVIS HOSPITAL — Hospital Ledger

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
10535367	Epifix 7x7	$33,906	$11,867	—	—	50
10535363	Epifix 5x6 Sheet	$20,263	$7,092	—	—	50
10535309	Puraply AM 2x4	$17,820	$6,237	—	—	49
10535316	Epicord 3x5	$11,506	$4,027	—	—	48
11857422	EPI EFFECT 3X5 SQ CM	$11,100	$3,885	—	—	48
8669061	15272 APPLY SKIN GRAFT UP TO 100CM EA ADD 25S CHARGE	$10,919	$3,822	—	—	48
8045902	15271 APPL SKIN SUBSTIT GRAFT TRUNK ARMS LEGS CHARGE	$10,790	$3,777	—	—	50
10536105	EPIFIX 4 X 4	$10,676	$3,736	—	—	50
10535322	NUSHIELD 6 X 6	$10,650	$3,728	—	—	48
10535319	Primatrix Meshed 8x8	$10,268	$3,594	—	—	49
9740101	Q4187 GRAFT ST TIS 3X2CM AMNIOCORD PURION	$9,360	$3,276	—	—	48
10813782	74178: CT Abdomen and Pelvis w/ + w/o Contrast AddOn	$8,930	$3,125	—	—	53
9883104	74178 CT Abdomen and Pelvis w/ + w/o Contrast	$8,930	$3,125	—	—	53
2424644	CT Abdomen and Pelvis w/ + w/o Contrast	$8,930	$3,125	—	—	53
10535361	Epifix 3x4 Sheet	$8,442	$2,955	—	—	50
8045886	10140 I & D OF HEMATOMA, SEROMMA OR FLUID CHARGE	$8,380	$2,933	—	—	50
10818542	74177: CT Abdomen and Pelvis w/ Contrast AddOn	$8,298	$2,904	—	—	57
9740099	Q4186 GRAFT ST TIS EPIFIX PURION 4SQ CM	$8,185	$2,865	—	—	50
1168796	MRI Brain w/ + w/o Contrast	$8,081	$2,828	—	—	56
8045890	11044 SUBCUTANEOUS MUSCLE/BONE FIRST 20 SQ CM CHARGE	$7,039	$2,464	—	—	49
9337872	C5273 Skin sub app trunk,arms,legs,total wound>=100sq cm/1st 100 sq cm-Low Cost-WC Charge	$7,039	$2,464	—	—	48
10536106	EPIFIX 3 X 5 GS-5350	$6,867	$2,403	—	—	50
11846012	EPI EFFECT 2X3 SQ CMM	$6,750	$2,363	—	—	48
12256777	EPIEFFECT 2 X 3 LE-5230	$6,750	$2,363	—	—	48
9883102	74177 CT Abdomen and Pelvis w/ Contrast	$6,392	$2,237	—	—	57
2424647	CT Abdomen and Pelvis w/ Contrast	$6,392	$2,237	—	—	57
10813783	74176: CT Abdomen and Pelvis w/o Contrast AddOn	$6,168	$2,159	—	—	60
2424650	CT Abdomen and Pelvis w/o Contrast	$6,168	$2,159	—	—	60
2424863	CT Stone Protocol	$6,168	$2,159	—	—	60
9120645	OR Level 2 BCE	$6,150	$2,153	—	—	48
8584494	TREADMILL MONITOR OR DRUG INDUCED	$6,125	$2,144	—	—	49
10767604	Myocardial Perfusion Rest / Stress	$6,125	$2,144	—	—	52
9929570	Myocardial Viability	$6,082	$2,129	—	—	52
8669077	20240 OPEN SUPERFIC BONE BX CHARGE	$6,038	$2,113	—	—	49
8246314	99204 NP VISIT LEVEL 4	$6,038	$2,113	—	—	49
8963024	CT Chest Abd Pelvis W/ Contrast	$6,025	$2,109	—	—	55
1168730	MRI Abdomen w/ + w/o Contrast	$5,910	$2,069	—	—	53
1169024	MRI Pelvis w/ + w/o Contrast	$5,859	$2,051	—	—	52
10765168	72157 MRI Spine Thoracic w/ + w/o Contrast Rad Charge	$5,806	$2,032	—	—	49
1169062	MRI Spine Thoracic w/ + w/o Contrast	$5,806	$2,032	—	—	49
631287	MRI Spine Lumbar w/o Contrast	$5,698	$1,994	—	—	56
9883258	70553 MRI Brain w/ + w/o Contrast	$5,666	$1,983	—	—	56
9066871	CT Chest PE Protocol	$5,383	$1,884	—	—	57
10535356	MESH SEPRA 6 X 8	$5,382	$1,884	—	—	48
8045914	93922 TCPO2 MONITOR (SINGLE SITE) PVR CHARGE	$5,243	$1,835	—	—	51
1169060	MRI Spine Lumbar w/o Contrast	$5,227	$1,829	—	—	56
8099897	MRI Femur w/ + w/o Contrast Left	$5,093	$1,783	—	—	53
8099939	MRI Tibia/Fibula w/ + w/o Contrast Left	$5,093	$1,783	—	—	53
8099941	MRI Tibia/Fibula w/ + w/o Contrast Right	$5,093	$1,783	—	—	53
8211297	32110 THORCOM CTRL TRAUMTC HEMRRG&/RPR LNG TEAR TechFee	$4,990	$1,747	—	—	49

Showing top 50 of 3,453 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.