MAINEHEALTH FRANKLIN HOSPITAL

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
J9355	TRASTUZUMAB 150 MG/7.15ML IV (WET SOLR VIAL)	$716,655	$716,655	—	—	10
J3357	USTEKINUMAB 90 MG/ML SC SOSY	$88,661	$88,661	—	—	10
J2350	OCRELIZUMAB 300 MG/10ML IV SOLN	$62,777	$62,777	—	—	10
J9026	TARLATAMAB-DLLE 10 MG/4.167ML (WET VIAL SOLR)	$45,658	$45,658	—	—	10
J9306	PERTUZUMAB 420 MG/14ML IV SOLN	$41,488	$41,488	—	—	10
J1950	LEUPROLIDE ACETATE (PED)(3MON) 30 MG IM KIT	$39,531	$39,531	—	—	10
J9217	LEUPROLIDE ACETATE (6 MONTH) 45 MG IM KIT	$39,167	$39,167	—	—	10
J9022	ATEZOLIZUMAB 1200 MG/20ML IV SOLN	$34,221	$34,221	—	—	10
J9203	GEMTUZUMAB OZOGAMICIN 4.5 MG/4.5ML IV (WET SOLR VIAL)	$30,551	$30,551	—	—	10
J1930	LANREOTIDE ACETATE 120 MG/0.5ML SC SOLN	$29,082	$29,082	—	—	10
J3380	VEDOLIZUMAB 300 MG IV SOLR	$28,467	$28,467	—	—	10
J9228	IPILIMUMAB 5 MG/ML IV SOLN (COMBINED)	$26,999	$26,999	—	—	10
J2997	ALTEPLASE 100 MG IV SOLR	$26,765	$26,765	—	—	10
J9301	OBINUTUZUMAB 1000 MG/40ML IV SOLN	$26,195	$26,195	—	—	10
J2323	NATALIZUMAB 300 MG/15ML IV CONC	$25,967	$25,967	—	—	10
J9299	NIVOLUMAB 240 MG/24ML IV SOLN	$23,684	$23,684	—	—	10
0313U	HC ONC PANCREATIC FLUID NGS ANALYS DNA&MRNA SEQ 74	$22,464	$22,464	—	—	10
J9303	PANITUMUMAB 400 MG/20ML IV SOLN	$22,040	$22,040	—	—	10
J2427	PALIPERIDONE PALMITATE ER 546 MG/1.75ML IM SUSY	$21,711	$21,711	—	—	10
27664	HC REPAIR EXTEN LEG TENDN,PRIM,EACH	$21,191	$21,191	—	—	10
63650	HC STIM TRIAL EPID PERC IMP	$20,265	$20,265	—	—	10
J2506	PEGFILGRASTIM 6 MG/0.6ML SC SOSY	$19,520	$19,520	—	—	10
62350	HC EPIDURAL/IT CATHETER PLACEMENT	$18,960	$18,960	—	—	10
J9271	PEMBROLIZUMAB 100 MG/4ML IV SOLN	$17,937	$17,937	—	—	10
33210	HC INS. TEMP. PACER 1 CHAMBER	$17,353	$17,353	—	—	10
J9041	BORTEZOMIB 3.5 MG IJ SOLR	$17,064	$17,064	—	—	10
21453	HC CLX RD MANDIBLE FX+DENTAL FIX	$16,933	$16,933	—	—	10
J2802	ROMIPLOSTIM 500 MCG SC SOLR	$16,746	$16,746	—	—	10
41016	HC XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMENT	$15,342	$15,342	—	—	10
J1162	DIGOXIN IMMUNE FAB 40 MG IV SOLR	$15,128	$15,128	—	—	10
J9204	MOGAMULIZUMAB-KPKC 20 MG/5ML IV SOLN	$14,260	$14,260	—	—	10
57210	HC COLPOPERINEORRHAPHY SUTURE INJ VAGINA&/PERINEU	$13,553	$13,553	—	—	10
J9173	DURVALUMAB 500 MG/10ML IV SOLN	$12,806	$12,806	—	—	10
Q5111	PEGFILGRASTIM-CBQV 6 MG/0.6ML SC SOSY	$12,698	$12,698	—	—	10
47531	HC INJ FOR CHOLNGIOGRM EXIST ACC	$12,267	$12,267	—	—	10
14301	HC ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA, 30.1-60.0 SQ CM	$11,913	$11,913	—	—	10
49000	HC EXPLORATORY LAPAROTOMY	$11,378	$11,378	—	—	9
64595	HC REVISE/REMOVE PERIPH/GASTRIC NEUROSTIM/RECEIVER	$10,907	$10,907	—	—	10
J2426	PALIPERIDONE PALMITATE ER 234 MG/1.5ML IM SUSY	$10,855	$10,855	—	—	10
J9047	CARFILZOMIB 60 MG IV SOLR	$10,758	$10,758	—	—	10
J2182	MEPOLIZUMAB 100 MG SC SOLR	$10,743	$10,743	—	—	10
54435	HC SHUNT CREATION FOR PRIAPISM	$10,679	$10,679	—	—	10
81509	HC FETAL CONGENITAL AASSAY 3 PROTEINS	$10,606	$10,606	—	—	10
52332	HC CYSTO W/INSERT URETERAL STENT	$9,835	$9,835	—	—	10
36558	HC INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>	$9,804	$9,804	—	—	10
27532	HC CLOSED RX TIB PLAT FX+MANIP	$9,684	$9,684	—	—	10
28545	HC CLOSED RX TARSAL DISLOC,ANESTH	$9,574	$9,574	—	—	10
37799	HC LIGATION OF FACIAL ARTERY	$9,531	$9,531	—	—	10
25270	HC PRR TDN/MUSC XTNSR F/ARM&/WRIST PRIM 1 EA TDN	$9,429	$9,429	—	—	10
21337	HC CLOSED RX NASAL SEPTAL FRACTURE	$9,256	$9,256	—	—	10

Showing top 50 of 18,376 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.