ELY - BLOOMENSON COMMUNITY HOSPITAL

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
J2507.01	pegloticase 8 MG/ML Solution 1 mL Vial	$48,367	—	—	—	28
J2350.01	ocrelizumab 300 MG/10ML Solution 10 mL Vial	$33,150	—	—	—	28
J9043.01	cabazitaxel 60 MG/1.5ML Solution 6 mL Vial	$28,293	—	—	—	28
J9173.01	durvalumab 120 MG/2.4ML Solution 2.4 mL Vial	$21,772	—	—	—	28
J9119.01	cemiplimab-rwlc 350 MG/7ML Solution 7 mL Vial	$19,219	—	—	—	28
C1781	PHASIX 25X30CM 1190400	$16,080	—	—	—	22
J2323.01	natalizumab 300 MG/15ML Concentrate 15 mL Vial	$15,227	—	—	—	28
PX96377	Appl on-Body Injector for Timed Subq Injection	$13,093	—	—	—	27
J2506.01	pegfilgrastim 6 MG/0.6ML Prefilled Syringe Kit 0.6 mL Syringe	$13,093	—	—	—	28
J9217.01	leuprolide 22.5 MG Kit 1 Each Box	$12,510	—	—	—	56
J3380.01	vedolizumab 300 MG Recon Soln 1 Each Vial	$12,439	—	—	—	28
Q5111.01	pegfilgrastim-cbqv 6 MG/0.6ML solution prefilled syringe 0.6 mL Syringe	$10,040	—	—	—	28
Q5108.01	pegfilgrastim-jmdb 6 MG/0.6ML solution prefilled syringe 0.6 mL Syringe	$10,040	—	—	—	28
J9271.01	pembrolizumab 100 MG/4ML Solution 4 mL Vial	$9,628	—	—	—	28
Q5115.01	riTUXimab-abbs 500 MG/50ML Solution 50 mL Vial	$8,625	—	—	—	28
J3101.01	tenecteplase 50 MG Kit 1 Each Box	$8,461	—	—	—	84
PX28296F	Correct Bunion,Metatarsal Osteotomy	$8,100	—	—	—	29
J9305.01	PEMEtrexed 500 MG Recon Soln 1 Each Vial	$8,086	—	—	—	28
90375	rabies immune globulin 1500 UNIT/5ML Solution 5 mL Vial	$8,065	—	—	—	28
J7168.01	prothrombin complex concentrate - human 500 units Kit 500 Units Box	$8,007	—	—	—	29
PX36000006	Or Level 6	$7,960	—	—	—	22
J9227.01	isatuximab-irfc 500 MG/25ML Solution 25 mL Vial	$7,876	—	—	—	28
J0565.01	bezlotoxumab 1000 MG/40ML Solution 40 mL Vial	$7,752	—	—	—	28
J2182.01	mepolizumab 100 MG Recon Soln 1 Each Vial	$6,960	—	—	—	28
PX43280F	Lap,Esophagogast Fundoplasty	$6,713	—	—	—	29
120.567	PURAPLYAM XT-COM 4.91X4.91 EXTRA FENESTRATED 24.10 SQCM	$6,562	—	—	—	25
PX36000085	Level 6 Additional Procedure	$6,500	—	—	—	22
PX43281	Lap Paraesophag Hern Repair	$5,950	—	—	—	27
PX36000005	Or Level 5	$5,898	—	—	—	22
J0129.01	abatacept 250 MG Recon Soln 1 Each Vial	$5,663	—	—	—	56
C1713	POLYAXIAL LOCKING PLATE MTP CROSS PLATE LEFT T8	$5,413	—	—	—	23
PX36000084	Level 5 Additional Procedure	$5,300	—	—	—	22
J7325.01	hyaluronate 48 MG/6ML solution prefilled syringe 6 mL Syringe	$5,274	—	—	—	28
PX7214901	MRI L Spine W Contrast Tc	$5,136	—	—	—	29
800000	bendamustine 100 MG/4ML Solution 4 mL Vial	$5,047	—	—	—	28
PX43775	Lap Sleeve Gastrectomy	$5,030	—	—	—	27
J0717.01	certolizumab 2 X 200 MG Kit 1 Each Box	$4,912	—	—	—	28
27800000	PHALINX STERILE LARGE 0 HAMMERTOE SYSTEM 45A01004	$4,759	—	—	—	23
J3262.01	Tocilizumab 400 MG/20ML Solution 20 mL Vial	$4,704	—	—	—	28
J0897.01	denosumab 120 MG/1.7ML Solution 1.7 mL Vial	$4,659	—	—	—	28
PX9581101	Polysomnography W/Cpap	$4,575	—	—	—	29
PX43280P	Lap,Esophagogast Fundoplasty	$4,449	—	—	—	27
J3590.25	sarilumab 200 MG/1.14ML solution prefilled syringe 1.14 mL Syringe	$4,408	—	—	—	22
PX9580501	Multiple Sleep Latency Test	$4,313	—	—	—	29
PX9581001	Polysomnography, 4 or More	$4,313	—	—	—	29
PX7417601	CT Abd & Pelvis W/O Contrast	$4,288	—	—	—	29
PX7417701	CT Abdomen&Pelvis W/Contrast	$4,288	—	—	—	29
PX7213301	CT Lumbar Spine W/O & W/Dye	$4,283	—	—	—	29
PX7417801	CT Abd&Pelv 1+ Section/Regns	$4,226	—	—	—	29
PX7417501	CT Angio Abdom W/O & W/Dye	$4,183	—	—	—	29

Showing top 50 of 2,959 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.