SANFORD WHEATON MEDICAL CENTER

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
J2350	Ocrelizumab Soln For IV Infusion 300 MG/10ML	$25,521	$20,417	—	—	36
J1930	Lanreotide Acetate Extended Release Inj 120 MG/0.5ML	$12,952	$10,362	—	—	36
J3380	Vedolizumab For IV Solution 300 MG	$11,778	$9,422	—	—	36
J1932	Lanreotide Acetate Extended Release Inj 120 MG/0.5ML	$9,750	$7,800	—	—	36
J3101	Tenecteplase For IV Soln Kit 50 MG	$8,545	$6,836	—	—	108
0360	APPENDECTOMY OPEN	$8,438	$6,750	—	—	36
Q5127	Pegfilgrastim-fpgk Soln Prefilled Syringe 6 MG/0.6ML	$6,216	$4,973	—	—	36
J0896	Luspatercept-aamt For Subcutaneous Inj 25 MG	$5,728	$4,582	—	—	36
95811	PSG CPAP BIPAP 4+ PARAMETERS	$5,403	$4,322	—	—	37
78452	NM MYOCARDIAL SPECT MULT STDY	$5,126	$4,101	—	—	37
70543	MRI FACE NECK ORB WO THEN W CONT	$5,096	$4,077	—	—	37
74174	CTA ABD PELVIS W CONTRAST+WO IF PERFORM	$4,981	$3,985	—	—	37
73223	MRI UPPER EXT JT WO THEN W CONT	$4,942	$3,954	—	—	37
J2506	Pegfilgrastim Soln Prefilled Syringe 6 MG/0.6ML	$4,900	$3,920	—	—	36
95810	PSG 4+ PARAMETERS	$4,884	$3,907	—	—	37
72158	MRI L SPINE WO THEN W CONT	$4,813	$3,850	—	—	37
71552	MRI CHEST WO THEN W CONT	$4,810	$3,848	—	—	37
72156	MRI C SPINE WO THEN W CONT	$4,800	$3,840	—	—	37
72157	MRI T SPINE WO THEN W CONT	$4,775	$3,820	—	—	37
65235	ED 65235 REMV FB EYE INTRAOCULAR	$4,691	$3,753	—	—	37
70549	MRA NECK WO THEN W CONT	$4,633	$3,706	—	—	37
70553	MRI BRAIN WO THEN W CONT	$4,631	$3,705	—	—	37
74183	MRI ABDOMEN WO THEN W CONT	$4,631	$3,705	—	—	37
73720	MRI LOWER EXT WO THEN W CONT	$4,578	$3,662	—	—	37
73220	MRI UPPER EXT WO THEN W CONT	$4,525	$3,620	—	—	37
72196	MRI PELVIS W CONTRAST	$4,461	$3,569	—	—	37
70542	MRI FACE NECK ORB W CONTRAST	$4,442	$3,554	—	—	37
J0897	Denosumab Inj 120 MG/1.7ML	$4,395	$3,516	—	—	36
73723	MRI LOWER EXT JT WO THEN W CONT	$4,383	$3,506	—	—	37
J1944	Aripiprazole Lauroxil IM ER Susp Prefilled Syr 882 MG/3.2ML	$4,380	$3,504	—	—	36
Q5119	Rituximab-pvvr IV Soln 500 MG/50ML (10 MG/ML)	$4,276	$3,421	—	—	36
72197	MRI PELVIS WO THEN W CONT	$4,271	$3,417	—	—	37
59409	ED 59409 ED DELIVERY VAGINAL ONLY	$4,173	$3,338	—	—	37
73222	MRI UP EXT JT WCONT	$4,125	$3,300	—	—	37
J3111	Romosozumab-aqqg Inj Soln Prefilled Syringe 105 MG/1.17ML	$4,114	$3,291	—	—	72
72147	MRI T SPINE W CONTRAST	$4,094	$3,275	—	—	37
J3590	Idarucizumab IV Soln 2.5 GM/50ML	$4,080	$3,264	—	—	36
74182	MRI ABDOMEN W CONTRAST	$4,060	$3,248	—	—	37
70552	MRI BRAIN W CONTRAST	$4,011	$3,209	—	—	37
26607	ED 26607 CLSD TX MTCRPAL FX WMANIP	$3,992	$3,194	—	—	37
74178	CT ABD PELVIS WO THEN W CONT	$3,978	$3,182	—	—	37
12037	ED 12037 LYR CLSR OF WND >30.0CM	$3,875	$3,100	—	—	37
72142	MRI C SPINE W CONTRAST	$3,865	$3,092	—	—	37
70471	CTA HEAD NECK W CONTRAST AND NONCONTRAST IMG POST PROC	$3,825	$3,060	—	—	36
70545	MRA HEAD W CONTRAST	$3,797	$3,038	—	—	37
72149	MRI L SPINE W CONTRAST	$3,795	$3,036	—	—	37
71551	MRI CHEST W CONTRAST	$3,788	$3,030	—	—	37
A0434	SCT GRND TRANSPORT	$3,767	$3,014	—	—	36
J2426	Paliperidone Palmitate ER Susp Pref Syr 156 MG/ML	$3,752	$3,001	—	—	36
70540	MRI FACE NECK ORB WO CONTRAST	$3,744	$2,995	—	—	37

Showing top 50 of 7,484 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.