SANFORD WORTHINGTON MEDICAL CENTER

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
J2351	Ocrelizumab-Hyaluronidase-ocsq Inj 920-23000 MG-UNIT/23ML	$61,657	$49,326	—	—	10
J9347	Tremelimumab-actl Soln for IV Infusion 300 MG/15ML	$49,671	$39,737	—	—	10
J2350	Ocrelizumab Soln For IV Infusion 300 MG/10ML	$38,913	$31,130	—	—	10
J3357	Ustekinumab Soln Prefilled Syringe 90 MG/ML	$38,816	$31,052	—	—	10
77372	SRS - 1 SESSION	$32,540	$26,032	—	—	10
J9298	Nivolumab-Relatlimab-rmbw 240-80 MG/20ML	$29,570	$23,656	—	—	10
G0339	STEREOTACTIC RAD TRTMT	$23,243	$18,594	—	—	7
J0870	Imetelstat Sodium For IV Soln 188 MG	$20,332	$16,266	—	—	10
J2327	Risankizumab-rzaa IV Soln 600 MG/10ML (60 MG/ML)	$20,216	$16,173	—	—	10
J9144	Daratumumab-Hyaluronidase-fihj Inj 1800-30000 MG-Unit/15ML	$19,388	$15,510	—	—	10
J1930	Lanreotide Acetate Extended Release Inj 120 MG/0.5ML	$19,199	$15,359	—	—	10
J9228	Ipilimumab Soln for IV Infusion 50 MG/10ML (5 MG/ML)	$17,518	$14,014	—	—	10
J3380	Vedolizumab For IV Solution 300 MG	$17,319	$13,855	—	—	10
J9301	Obinutuzumab Soln for IV Infusion 1000 MG/40ML (25 MG/ML)	$16,599	$13,279	—	—	10
J9022	Atezolizumab IV Soln 1200 MG/20ML	$16,508	$13,206	—	—	10
J9223	Lurbinectedin For IV Soln 4 MG	$16,178	$12,942	—	—	10
J9119	Cemiplimab-rwlc IV Soln 350 MG/7ML (50 MG/ML)	$15,568	$12,454	—	—	10
J9311	Rituximab-Hyaluronidase Human Inj 1600-26800 MG-Unit/13.4ML	$15,150	$12,120	—	—	10
J9380	Teclistamab-cqyv Subcutaneous Soln 153 MG/1.7ML (90 MG/ML)	$14,548	$11,638	—	—	10
77373	SRT SBRT - 5 SESSION MAX	$14,181	$11,345	—	—	10
J9306	Pertuzumab Soln for IV Infusion 420 MG/14ML (30 MG/ML)	$13,186	$10,549	—	—	10
J3101	Tenecteplase For IV Soln Kit 50 MG	$12,147	$9,718	—	—	30
J9271	Pembrolizumab IV Soln 100 MG/4ML (25 MG/ML)	$11,480	$9,184	—	—	20
77301	RADIATION THER TRMT PLAN	$11,036	$8,829	—	—	10
G0340	STEROTATC RAD TRTMT SESS	$10,938	$8,750	—	—	7
J0517	Benralizumab Subcutaneous Soln Prefilled Syringe 30 MG/ML	$10,072	$8,057	—	—	10
J9356	Trastuzumab-Hyaluronidase-oysk Inj 600-10000 MG-Unit/5ML	$9,550	$7,640	—	—	10
77295	3-D SIM THERAPY RAD	$9,284	$7,427	—	—	10
J2506	Pegfilgrastim Soln Prefilled Syringe Kit 6 MG/0.6ML	$9,113	$7,291	—	—	10
J1162	Digoxin Immune Fab For Inj 40 MG	$8,948	$7,159	—	—	10
J9295	Necitumumab IV Soln 800 MG/50ML (16 MG/ML)	$8,819	$7,055	—	—	10
J9177	Enfortumab Vedotin-ejfv For IV Soln 30 MG	$8,627	$6,902	—	—	10
J9358	Fam-Trastuzumab Deruxtecan-nxki For IV Soln 100 MG	$8,582	$6,866	—	—	10
J2353	Octreotide Acetate For IM Inj Kit 20 MG	$8,554	$6,843	—	—	10
J9173	Durvalumab Soln for IV Infusion 500 MG/10ML (50 MG/ML)	$8,414	$6,731	—	—	10
78816	PET CT WHOLE BODY	$8,333	$6,666	—	—	10
Q5127	Pegfilgrastim-fpgk Soln Prefilled Syringe 6 MG/0.6ML	$8,270	$6,616	—	—	10
78815	PET CT SKULL BASE TO MID THIGH	$8,153	$6,523	—	—	10
J9354	Ado-Trastuzumab Emtansine For IV Soln 100 MG	$8,021	$6,417	—	—	10
J0896	Luspatercept-aamt For Subcutaneous Inj 25 MG	$7,942	$6,353	—	—	10
77307	TELETHERAPY ISODOSE PLAN COMPLEX INCLUD BASIC DOSIM CAL	$7,719	$6,175	—	—	10
49418	SURG 49418 PLCMNT PERITONEAL CATH TUN W/IMG GUID	$7,683	$6,146	—	—	10
J0565	Bezlotoxumab IV Soln 1000 MG/40ML (25 MG/ML)	$7,636	$6,109	—	—	20
J9317	Sacituzumab Govitecan-hziy For IV Soln 180 MG	$7,555	$6,044	—	—	10
J9043	Cabazitaxel Inj 60 MG/1.5ML (For IV Infusion)	$7,447	$5,958	—	—	10
Q5116	Trastuzumab-qyyp For IV Soln 420 MG	$7,446	$5,957	—	—	20
78608	PET BRAIN METABOLIC EVAL	$7,441	$5,953	—	—	10
J2182	Mepolizumab Subcutaneous Solution Auto-injector 100 MG/ML	$7,415	$5,932	—	—	10
Q5117	Trastuzumab-anns For IV Soln 420 MG	$7,385	$5,908	—	—	10
78814	PET CT LIMITED AREA	$6,962	$5,570	—	—	10

Showing top 50 of 19,023 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.