SANFORD JACKSON MEDICAL CENTER

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
J3357	Ustekinumab Soln Prefilled Syringe 90 MG/ML	$45,012	$36,009	—	—	42
J1628	Guselkumab IV Soln 200 MG/20ML (10 MG/ML)	$29,059	$23,247	—	—	41
J2356	Tezepelumab-ekko Subcutaneous Soln Pref Syr 210 MG/1.91ML	$13,953	$11,162	—	—	41
J3101	Tenecteplase For IV Soln Kit 50 MG	$13,766	$11,013	—	—	82
J3380	Vedolizumab For IV Solution 300 MG	$11,801	$9,441	—	—	41
J0717	Certolizumab Pegol Prefilled Syringe Kit 200 MG/ML	$11,598	$9,279	—	—	82
J1932	Lanreotide Acetate Extended Release Inj 120 MG/0.5ML	$11,591	$9,273	—	—	41
J9144	Daratumumab-Hyaluronidase-fihj Inj 1800-30000 MG-Unit/15ML	$10,394	$8,315	—	—	41
J0517	Benralizumab Subcutaneous Soln Prefilled Syringe 30 MG/ML	$10,013	$8,011	—	—	41
J2506	Pegfilgrastim Soln Prefilled Syringe 6 MG/0.6ML	$9,917	$7,933	—	—	41
36475	SURG 36475 ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN	$9,498	$7,598	—	—	42
66984	SURG 66984 EXTRACAP CATARCT RMVL INSERT IO LENS PROSTH W/O ECP	$8,955	$7,164	—	—	42
J2353	Octreotide Acetate For IM Inj Kit 20 MG	$7,918	$6,334	—	—	41
J0565	Bezlotoxumab IV Soln 1000 MG/40ML (25 MG/ML)	$7,636	$6,109	—	—	41
A9582	I123 IOBENGUANE PER STUDY DOSE UP TO 15 MCI	$7,041	$5,633	—	—	41
J1306	Inclisiran Sodium Subcutaneous Soln Pref Syr 284 MG/1.5ML	$6,575	$5,260	—	—	41
74178	CT ABD PELVIS WO THEN W CONT	$6,481	$5,185	—	—	42
36476	SURG 36476 ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS	$6,122	$4,898	—	—	41
74174	CTA ABD PELVIS W CONTRAST+WO IF PERFORM	$6,098	$4,878	—	—	42
95811	SLEEP STUDY SPLT NGHT 95811	$6,074	$4,859	—	—	42
72156	MRI C SPINE WO THEN W CONT	$5,988	$4,790	—	—	42
70543	MRI FACE NECK ORB WO THEN W CONT	$5,938	$4,750	—	—	42
74177	CT ABD PELVIS W CONTRAST	$5,787	$4,630	—	—	42
11426	TX RM 11426 EXC BNGN LSN SCALP NECK HANDS FEET GENITAL >4.0CM	$5,751	$4,601	—	—	42
95810	PSG 4+ PARAMETERS	$5,747	$4,598	—	—	42
78452	NM MYOCARDIAL SPECT MULT STDY	$5,657	$4,526	—	—	42
57410	SURG 57410 PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL	$5,634	$4,507	—	—	42
72157	MRI T SPINE WO THEN W CONT	$5,614	$4,491	—	—	42
72158	MRI L SPINE WO THEN W CONT	$5,610	$4,488	—	—	42
J2426	Paliperidone Palmitate ER Susp Pref Syr 234 MG/1.5ML	$5,445	$4,356	—	—	41
70553	MRI BRAIN WO THEN W CONT	$5,395	$4,316	—	—	42
72197	MRI PELVIS WO THEN W CONT	$5,378	$4,302	—	—	42
74183	MRI ABDOMEN WO THEN W CONT	$5,352	$4,282	—	—	42
J0401	Aripiprazole IM For ER Susp Prefilled Syringe 400 MG	$5,339	$4,271	—	—	41
73223	MRI UPPER EXT JT WO THEN W CONT	$5,306	$4,245	—	—	42
73720	MRI LOWER EXT WO THEN W CONT	$5,217	$4,174	—	—	42
73220	MRI UPPER EXT WO THEN W CONT	$5,154	$4,123	—	—	42
72196	MRI PELVIS W CONTRAST	$5,105	$4,084	—	—	42
J3111	Romosozumab-aqqg Inj Soln Prefilled Syringe 105 MG/1.17ML	$5,057	$4,046	—	—	82
73723	MRI LOWER EXT JT WO THEN W CONT	$5,004	$4,003	—	—	42
70549	MRA NECK WO THEN W CONT	$4,946	$3,957	—	—	42
38500	SURG 38500 SURG BX LYMPH NODES(S) SUPERFICIAL OPEN	$4,799	$3,839	—	—	42
0750	COLON POLYP BX	$4,734	$3,787	—	—	41
73222	MRI UP EXT JT WCONT	$4,698	$3,758	—	—	42
90375	Rabies Immune Globulin (Human) Inj 1500 Unt/5ML (300 Unt/ML)	$4,643	$3,714	—	—	82
74176	CT ABD PELVIS WO CONTRAST	$4,606	$3,685	—	—	42
70552	MRI BRAIN W CONTRAST	$4,474	$3,579	—	—	42
0689	TRAUMA ACTIVATION FULL	$4,469	$3,575	—	—	41
G0390	TRAUMA ACTIVATION FULL W CCARE	$4,469	$3,575	—	—	42
70540	MRI FACE NECK ORB WO CONTRAST	$4,363	$3,490	—	—	42

Showing top 50 of 7,602 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.