PREVOST MEMORIAL HOSPITAL (Donaldsonville, LA) prices

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
700011	ACTIVASE VIAL 100MG 100ML	$19,975	$19,975	—	—	1
700479	TNKase 50 MG KIT 50 mg, 1 each	$13,679	$13,679	—	—	11
700074	CROFAB VIAL VACCINE 2	$11,466	$11,466	—	—	11
Nutritional or Metabolic Disorders without major	Nutritional or Metabolic Disorders without major complications	$6,178	$6,178	—	—	1
350145	CT ABD & PELVIS W/WO CONTRAST	$3,550	$3,550	—	—	1
600901	ANA 12 PLUS REFLEX 1	$3,540	$3,540	—	—	4
350140	CT ABD & PELVIS WITH CONTRAST	$3,050	$3,050	—	—	10
410004	DEBRIDE BONE-FIRST 20CM	$2,500	$2,500	—	—	1
350046	CTA CHEST PE PROTOCAL	$2,450	$2,450	—	—	6
700535	ANAVIP VIAL 1 ea, 1 each	$2,376	$2,376	—	—	11
600789	MUSK ABS	$2,260	$2,260	—	—	2
350094	CT ABDOMEN W/WO CONTRAST	$2,050	$2,050	—	—	4
Diabetes without complications	Diabetes without complications	$1,976	$1,976	—	—	1
350142	CT ABD & PELVIS W/O CONTRAST	$1,800	$1,800	—	—	11
350085	CT LEFT LOWER EXTREMITY W/WO CONTRAST	$1,790	$1,790	—	—	1
350086	CT RIGHT LOWER EXTREMITY W/WO CONTRAST	$1,790	$1,790	—	—	1
700532	KEDRAB 300 UNIT/2 ML VIAL 2 mL, 2 mL	$1,790	$1,790	—	—	11
350042	CT THORAX WITH CONTRAST	$1,790	$1,790	—	—	4
350015	CT HEAD/BRAIN W/WO CONTRAST	$1,790	$1,790	—	—	1
350092	CT ABDOMEN WITH CONTRAST	$1,750	$1,750	—	—	1
350032	CT SOFT TISSUE NECK WITH CONTRAST	$1,670	$1,670	—	—	2
350012	CT HEAD/BRAIN WITH CONTRAST	$1,590	$1,590	—	—	1
350026	CT FACIALS WITH CONTRAST	$1,590	$1,590	—	—	2
350125	CT SINUSES WITH CONTRAST	$1,590	$1,590	—	—	2
410053	DEBRIDE BONE-FIRST 20CM	$1,545	$1,545	—	—	1
350083	CT LEFT LOWER EXTREMITY WITH CONTRAST	$1,480	$1,480	—	—	1
350084	CT RIGHT LOWER EXTREMITY WITH CONTRAST	$1,480	$1,480	—	—	1
350054	CT T-SPINE W/O CONTRAST	$1,400	$1,400	—	—	3
600917	FATTY ACID PROFILE ESSENTIAL	$1,375	$1,375	—	—	2
350060	CT L-SPINE W/O CONTRAST	$1,300	$1,300	—	—	7
320260	CRITICAL CARE FIRST HOUR	$1,200	$1,200	—	—	2
700542	NAYZILAM 5 MG NASAL SPRAY 5 mg, 2 eaches	$1,171	$1,171	—	—	11
350040	CT THORAX W/O CONTRAST	$1,120	$1,120	—	—	8
350030	CT SOFT TISSUE NECK W/O CONTRAST	$1,040	$1,040	—	—	4
600777	ENA+DNA/DS+ANTICH+CENTRO+FA...ENA+DNA/DS+ANTICH+CENTRO+FA...	$1,013	$1,013	—	—	4
350048	CT C-SPINE W/O CONTRAST	$1,000	$1,000	—	—	7
350068	CT PELVIS W/O CONTRAST	$1,000	$1,000	—	—	5
700436	VEKLURY 100 MG VIAL 100 mg, 1 each	$996	$996	—	—	11
350010	CT HEAD/BRAIN W/O CONTRAST	$930	$930	—	—	12
350024	CT FACIALS W/O CONTRAST	$920	$920	—	—	7
350130	CT SINUSES W/O CONTRAST	$920	$920	—	—	7
3201027	BONE SURVEY - METASTATIC SERIES	$918	$918	—	—	1
410002	DEBRIDE SUBQ TISSUE-FIRST 20CM	$900	$900	—	—	6
410005	DEBRIDE SUBQ TISSUE-EACH ADDTL 20CM	$900	$900	—	—	2
410025	APPLICATION OF UNNA BOOT	$900	$900	—	—	1
410027	REMOVAL DEVI TISS;DERM;EPID;FIRST 20CM	$900	$900	—	—	4
410029	ACTIVE WOUND MGMT.NON-SEL DEBRIDEMENT	$900	$900	—	—	4
410047	DEBRIDE SUBQ TISSUE-FIRST 20CM	$900	$900	—	—	4
410049	DEBRIDE SUBQ TISSUE-FIRST 20CM	$900	$900	—	—	1
320256	ER LEVEL V	$800	$800	—	—	9

Showing top 50 of 1,006 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.