SIOUX CENTER HEALTH — Hospital Ledger

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
C1767	Generator Neurostimulator	$54,675	$53,035	—	—	5
C1767	Generator Neurostimulator	$54,675	$53,035	—	—	7
J2350	Ocrelizumab 300 Mg/10 Ml	$39,824	$38,630	—	—	5
J2350	Ocrelizumab 300 Mg/10 Ml	$39,824	$38,630	—	—	9
C1889	Spacer Shldr Inspace Tiss Sys	$31,350	$30,410	—	—	5
C1889	Spacer Shldr Inspace Tiss Sys	$31,350	$30,410	—	—	8
C1602	Filler Bn Void Cerament Gnta	$21,000	$20,370	—	—	5
C1602	Filler Bn Void Cerament Gnta	$21,000	$20,370	—	—	5
J2327	Risankizumab-Rzaa 600 Mg/10 Ml	$20,264	$19,656	—	—	5
J2327	Risankizumab-Rzaa 600 Mg/10 Ml	$20,264	$19,656	—	—	9
J1930	Lanreotide Acet 120MG/0.5ML Sy	$19,174	$18,599	—	—	5
J1930	Lanreotide Acet 120MG/0.5ML Sy	$19,174	$18,599	—	—	9
J9144	Daratumumab Hyaluronida 1800Mg	$18,479	$17,925	—	—	5
J9144	Daratumumab Hyaluronida 1800Mg	$18,479	$17,925	—	—	9
J3380	Vedolizumab 300 MG Vial	$18,166	$17,622	—	—	5
J3380	Vedolizumab 300 MG Vial	$18,166	$17,622	—	—	7
J2323	Natalizumab 300 MG/15 ML Vial	$16,468	$15,975	—	—	5
J2323	Natalizumab 300 MG/15 ML Vial	$16,468	$15,975	—	—	9
J9228	Ipilimumab 5 MG/ML 10 ML Vial	$16,135	$15,652	—	—	5
J9228	Ipilimumab 5 MG/ML 10 ML Vial	$16,135	$15,652	—	—	8
J9301	Obinutuzumab 1000 MG/40ML Vial	$15,317	$14,858	—	—	5
J9301	Obinutuzumab 1000 MG/40ML Vial	$15,317	$14,858	—	—	9
J2427	Paliper Palm 819Mg/2.625Ml Syr	$14,521	$14,086	—	—	5
J2427	Paliper Palm 819Mg/2.625Ml Syr	$14,521	$14,086	—	—	7
J3101	Tenecteplase 50 Mg/10 Ml Syrng	$14,021	$13,600	—	—	5
J3101	Tenecteplase 50 Mg/10 Ml Syrng	$14,021	$13,600	—	—	9
L8690	Implant Ponto Bhx 4Mm 9Mm Abut	$13,950	$13,532	—	—	5
L8690	Implant Ponto Bhx 4Mm 9Mm Abut	$13,950	$13,532	—	—	7
J1932	Lanreotide Acet 120MG/0.5ML Sy	$11,271	$10,933	—	—	5
J1932	Lanreotide Acet 120MG/0.5ML Sy	$11,271	$10,933	—	—	9
J9271	Pembrolizumab 100 MG/4 ML Vial	$10,666	$10,347	—	—	5
J9271	Pembrolizumab 100 MG/4 ML Vial	$10,666	$10,347	—	—	7
J0517	Benralizumab 30 mg/ml Syringe	$10,000	$9,700	—	—	5
J0517	Benralizumab 30 mg/ml Syringe	$10,000	$9,700	—	—	7
J1950	Leuprolide Acetate 11.25MG Syr	$9,506	$9,221	—	—	5
J1950	Leuprolide Acetate 11.25MG Syr	$9,506	$9,221	—	—	7
J2353	Octreotide (Depot) 20 MG Syr	$8,532	$8,277	—	—	5
J2353	Octreotide (Depot) 20 MG Syr	$8,532	$8,277	—	—	7
J0896	Luspatercept-Aamt 25 Mg Vial	$7,985	$7,746	—	—	5
J0896	Luspatercept-Aamt 25 Mg Vial	$7,985	$7,746	—	—	9
J2356	Tezepelumab-EKKO 210 Mg/1.9 Ml	$7,743	$7,512	—	—	5
J2356	Tezepelumab-EKKO 210 Mg/1.9 Ml	$7,743	$7,512	—	—	7
J0565	Bezlotoxumab 1,000 Mg/40 Ml Vl	$7,649	$7,420	—	—	5
J0565	Bezlotoxumab 1,000 Mg/40 Ml Vl	$7,649	$7,420	—	—	7
C1763	Arthro Bioindctive Implnt 1 Lr	$6,270	$6,082	—	—	5
C1763	Arthro Bioindctive Implnt 1 Lr	$6,270	$6,082	—	—	7
J1561	Immune Glob 10% 40 Gm/400 Ml	$6,202	$6,016	—	—	10
J2426	Paliperidone Palm 234MG/1.5ML	$6,108	$5,925	—	—	5
J2426	Paliperidone Palm 234MG/1.5ML	$6,108	$5,925	—	—	7
78816	PET CT Whole Body Initial	$6,089	$5,906	—	—	5

Showing top 50 of 4,382 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.