BOB WILSON MEMORIAL HOSPITAL

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
J9228	IPILIMUMAB 5 MG/ML INJECTION (SO)	$119,455	$47,782	—	—	12
J9269	TAGRAXOFUSP-ERZS 1,000 MCG/ML INTRAVENOUS SOLUTION	$108,194	$43,278	—	—	6
J2507	PEGLOTICASE 8 MG/ML INTRAVENOUS SOLUTION	$100,211	$40,084	—	—	12
J3357	USTEKINUMAB 90 MG/ML SUBCUTANEOUS SYRINGE	$97,450	$38,980	—	—	6
J9281	MITOMYCIN 40 MG X 2 INTRA-PYELOCALYCEAL KIT	$82,845	$33,138	—	—	5
C2616	YTTRIUM-90 BRACHYTX SRC NON-STRANDED	$79,875	$31,950	—	—	6
A9543	Y-90 ZEVALIN	$70,810	$28,324	—	—	5
J2350	OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION	$69,000	$27,600	—	—	6
33276	HC INSERT PHRENIC NERVE STIM SYS W/ IMAGING GDNCE	$67,856	$27,142	—	—	5
33287	HC RMVL & REPLCMNT PHRENIC NERVE STIM PULSE GEN	$67,856	$27,142	—	—	5
J7311	FLUOCINOLONE 0.59 MG INTRAVITREAL IMPLANT	$66,588	$26,635	—	—	6
J9266	PEGASPARGASE 750 UNIT/ML INJECTION SOLUTION	$65,105	$26,042	—	—	5
J3245	TILDRAKIZUMAB-ASMN 100 MG/ML SUBCUTANEOUS SYRINGE	$60,331	$24,132	—	—	6
J3241	TEPROTUMUMAB-TRBW 500 MG INTRAVENOUS SOLUTION	$55,721	$22,288	—	—	6
J9298	NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION	$50,864	$20,345	—	—	6
J9307	PRALATREXATE 40 MG/2 ML (20 MG/ML) INTRAVENOUS SOLUTION	$47,513	$19,005	—	—	6
J0896	LUSPATERCEPT-AAMT 75 MG SUBCUTANEOUS SOLUTION	$40,697	$16,279	—	—	6
J9042	BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION	$39,557	$15,823	—	—	6
J9043	CABAZITAXEL 10 MG/ML (FIRST DILUTION) INTRAVENOUS SOLUTION	$37,846	$15,138	—	—	5
J9022	ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION	$37,121	$14,848	—	—	6
J2329	UBLITUXIMAB-XIIY 25 MG/ML INTRAVENOUS SOLUTION	$36,654	$14,662	—	—	6
J1640	HEMIN 350 MG INTRAVENOUS POWDER FOR SOLUTION	$36,447	$14,579	—	—	12
J9119	CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION	$34,993	$13,997	—	—	5
A9604	SAMARIUM-153 LEXIDRONAM	$34,493	$13,797	—	—	5
J2327	RISANKIZUMAB-RZAA 60 MG/ML INTRAVENOUS SOLUTION	$34,321	$13,728	—	—	5
J9203	GEMTUZUMAB OZOGAMICIN 4.5 MG (1 MG/ML INITIAL CONCENTRATION) IV SOLN	$34,126	$13,650	—	—	6
J9144	DARATUMUMAB 1,800 MG-HYALURONIDASE-FIHJ 30,000 UNIT/15 ML SUBCUT SOLN	$33,926	$13,570	—	—	6
J1932	LANREOTIDE 120 MG/0.5 ML SUBCUTANEOUS SYRINGE	$31,124	$12,450	—	—	6
J3380	VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION	$30,333	$12,133	—	—	6
0620T	HC REVASC VENOUS TIB/PER ARTERIALIZATION	$29,831	$11,932	—	—	5
C9047	CAPLACIZUMAB-YHDP 11 MG INJECTION KIT	$28,847	$11,539	—	—	6
J9301	OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION	$28,846	$11,539	—	—	6
J2323	NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION	$28,733	$11,493	—	—	6
J0475	BACLOFEN 2,000 MCG/ML INTRATHECAL SOLUTION	$28,354	$11,342	—	—	23
J9223	LURBINECTEDIN 4 MG INTRAVENOUS SOLUTION	$27,825	$11,130	—	—	5
J0180	AGALSIDASE BETA 35 MG INTRAVENOUS SOLUTION	$26,092	$10,437	—	—	6
J1930	LANREOTIDE 90 MG/0.3 ML SUBCUTANEOUS SYRINGE	$25,988	$10,395	—	—	12
33277	HC INSERT PHRENIC NERVE STIM TRANSVEN SENSING LEAD	$25,919	$10,368	—	—	5
33288	HC RMVL & REPLCMNT PHRENIC NERVE STIM TRANSVEN LEAD(S)	$25,919	$10,368	—	—	5
92972	HC CORONARY LITHOTRIPSY	$25,852	$10,341	—	—	5
J9308	RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION	$24,994	$9,998	—	—	12
J1459	IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION	$24,632	$9,853	—	—	48
J9273	TISOTUMAB VEDOTIN-TFTV 40 MG INTRAVENOUS SOLUTION	$23,097	$9,239	—	—	5
J9311	RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN	$23,018	$9,207	—	—	6
J9306	PERTUZUMAB 420 MG/14 ML (30 MG/ML) INTRAVENOUS SOLUTION	$22,844	$9,138	—	—	6
J1300	ECULIZUMAB 300 MG/30 ML INTRAVENOUS SOLUTION	$22,830	$9,132	—	—	6
J2506	PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE	$22,463	$8,985	—	—	6
J1303	RAVULIZUMAB-CWVZ 100 MG/ML INTRAVENOUS SOLUTION	$22,414	$8,966	—	—	12
J0850	CYTOMEGALOVIRUS IMMUNE GLOBULIN 50 MG/ML INTRAVENOUS SOLUTION	$22,221	$8,888	—	—	6
J9354	ADO-TRASTUZUMAB EMTANSINE 160 MG INTRAVENOUS SOLUTION	$21,794	$8,718	—	—	6

Showing top 50 of 9,074 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.