SANFORD WESTBROOK MEDICAL CENTER

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
J2350	Ocrelizumab Soln For IV Infusion 300 MG/10ML	$35,669	$28,535	—	—	37
J2997	Alteplase For Inj 100 MG	$15,592	$12,474	—	—	37
0360	ABD HYSTERECTOMY	$14,724	$11,779	—	—	37
28485	SURG 28485 OPEN TREAT METATARSAL FX WWO INT EXT FIXN EACH	$11,051	$8,841	—	—	38
28750	SURG 28750 ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT	$10,727	$8,582	—	—	38
J3101	Tenecteplase For IV Soln Kit 50 MG	$10,142	$8,114	—	—	37
J0517	Benralizumab Subcutaneous Soln Prefilled Syringe 30 MG/ML	$9,866	$7,893	—	—	37
36475	SURG 36475 ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN	$9,057	$7,246	—	—	38
28476	SURG 28476 PERQ SKELETAL FIXN METATARSAL FX WMANIP EACH	$8,594	$6,875	—	—	38
20680	SURG 20680 REMVL OF IMPLANT DEEP	$8,352	$6,682	—	—	38
37700	SURG 37700 LIG&DIV LONG SAPH VEIN SAPHFEM JUNCT/INTERRUPTION	$8,153	$6,522	—	—	38
J2353	Octreotide Acetate For IM Inj Kit 20 MG	$8,048	$6,439	—	—	37
37760	SURG 37760 LIGATION PRFRATR VEIN SUBFSCAL RAD INCL SKN GRF 1 LEG	$8,003	$6,402	—	—	38
36558	SURG 36558 HICKMAN GROSHONG	$7,553	$6,042	—	—	38
37785	SURG 37785 LIGATION DIVISION &/OR EXCISION VARICOSE VEIN CLUSTER 1 LEG	$7,123	$5,698	—	—	38
Q5111	Pegfilgrastim-cbqv Soln Prefilled Syringe 6 MG/0.6ML	$6,899	$5,519	—	—	37
J1306	Inclisiran Sodium Subcutaneous Soln Pref Syr 284 MG/1.5ML	$6,854	$5,483	—	—	37
36476	SURG 36476 ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS	$6,632	$5,306	—	—	37
74178	CT ABD PELVIS WO THEN W CONT	$6,577	$5,262	—	—	38
0750	COLON POLYP BX	$6,514	$5,211	—	—	37
28110	SURG 28110 OSTECTOMY PARTIAL EXC 5TH METATARS HEAD (BUNIONETTE) (SEP PROC)	$6,411	$5,129	—	—	38
95811	SLEEP STUDY SPLT NGHT 95811	$6,187	$4,950	—	—	38
78452	NM MYOCARDIAL SPECT MULT STDY	$6,151	$4,921	—	—	38
J9306	Pertuzumab Soln for IV Infusion 420 MG/14ML (30 MG/ML)	$6,124	$4,899	—	—	37
28315	SURG 28315 SESAMOIDECTOMY 1ST TOE (SEP PROC)	$6,075	$4,860	—	—	38
74174	CTA ABD PELVIS W CONTRAST+WO IF PERFORM	$5,975	$4,780	—	—	38
70543	MRI FACE NECK ORB WO THEN W CONT	$5,948	$4,758	—	—	38
72156	MRI C SPINE WO THEN W CONT	$5,901	$4,721	—	—	38
53899	SURG 53899 UNLISTED PROCEDURE URINARY SYSTEM	$5,865	$4,692	—	—	38
74177	CT ABD PELVIS W CONTRAST	$5,820	$4,656	—	—	38
28043	SURG 28043 EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM	$5,607	$4,486	—	—	38
95810	PSG 4+ PARAMETERS	$5,565	$4,452	—	—	38
72158	MRI L SPINE WO THEN W CONT	$5,499	$4,399	—	—	38
72197	MRI PELVIS WO THEN W CONT	$5,489	$4,391	—	—	38
11406	SURG 11406 EXC BENGN SKN LESN INC MARGN NO SKN TAG TRNK ARM LEG DIA > 4.0 C	$5,488	$4,390	—	—	38
74183	MRI ABDOMEN WO THEN W CONT	$5,419	$4,335	—	—	38
72157	MRI T SPINE WO THEN W CONT	$5,403	$4,322	—	—	38
Q5117	Trastuzumab-anns For IV Soln 420 MG	$5,387	$4,309	—	—	37
73223	MRI UPPER EXT JT WO THEN W CONT	$5,257	$4,206	—	—	38
70553	MRI BRAIN WO THEN W CONT	$5,194	$4,155	—	—	38
28285	SURG 28285 CORRECTION HAMMERTOE	$5,159	$4,127	—	—	38
J2182	Mepolizumab For Inj 100 MG	$5,152	$4,121	—	—	37
73720	MRI LOWER EXT WO THEN W CONT	$5,141	$4,113	—	—	38
70492	CT SFT TISUE NECK WWO THEN W	$5,120	$4,096	—	—	38
73723	MRI LOWER EXT JT WO THEN W CONT	$5,110	$4,088	—	—	38
70546	MRA HEAD WO THEN W CONT	$5,083	$4,066	—	—	38
73220	MRI UPPER EXT WO THEN W CONT	$5,078	$4,062	—	—	38
72196	MRI PELVIS W CONTRAST	$5,010	$4,008	—	—	38
28192	ED 28192 REMOVE FB FOOT DEEP	$4,939	$3,951	—	—	38
25999	ED 25999 FOREARM/WRIST UNLSTD PROC	$4,886	$3,909	—	—	38

Showing top 50 of 7,623 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.