ST LUKE COMMUNITY HOSPITAL — Hospital Ledger

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
I LAPIPLASTY MINI-INCISION SYS	I LAPIPLASTY MINI-INCISION SYS	$13,464	$10,771	—	—	45
J2997	ACTIVASE 100 MG/100 ML	$10,666	$8,533	—	—	45
J9299	OPDIVO 240 MG/24 ML	$9,072	$7,257	—	—	45
J9301	GAZYVA 25 MG/ML	$7,823	$6,258	—	—	45
J2506	NEULASTA 6 MG/0.6 ML	$7,795	$6,236	—	—	45
C1776	I PROXIMAL FEMORAL NAIL SYSTEM	$7,120	$5,696	—	—	45
I MODULAR EPIPHYSIS SIZE 2 RT	I MODULAR EPIPHYSIS SIZE 2 RT	$7,072	$5,658	—	—	45
C1763	I GENEX BONE GRAFT SUBSTITUTE	$6,982	$5,586	—	—	45
J9271	KEYTRUDA 25 MG/ML	$6,604	$5,283	—	—	45
J3380	ENTYVIO 300 MG	$6,549	$5,239	—	—	45
I FEMORAL STEM 12/14 TAPER -#2	I FEMORAL STEM 12/14 TAPER -#2	$6,138	$4,910	—	—	45
1744	ANESTHESIA HUMERUS REPAIR	$5,016	$4,013	—	—	45
I TIB NAIL 11 TI CANN 360-S	I TIB NAIL 11 TI CANN 360-S	$4,900	$3,920	—	—	45
I NAIL TIB CANN 10TI 345S	I NAIL TIB CANN 10TI 345S	$4,899	$3,919	—	—	45
I GRAFT JACKET NOW 4X4CM	I GRAFT JACKET NOW 4X4CM	$4,650	$3,720	—	—	45
J9354	KADCYLA 100 MG	$4,535	$3,628	—	—	45
I GLENOSPHERE STANDARD RT 38MM	I GLENOSPHERE STANDARD RT 38MM	$4,240	$3,392	—	—	45
49406	MISCELLANEOUS CT SCAN	$4,208	$3,366	—	—	45
43282	LAP PARAESOPH HER RPR W/MESH	$4,192	$3,354	—	—	45
90377	KEDRAB 150 UNITS/ML VIAL 150 UNIT/1 ML	$4,125	$3,300	—	—	45
1214	ANESTH HIP ARTHROPLASTY	$4,104	$3,283	—	—	45
I QUADLINK IMPLANT SYSTEM 10MM	I QUADLINK IMPLANT SYSTEM 10MM	$4,045	$3,236	—	—	45
44204	LAPARO PARTIAL COLECTOMY	$3,882	$3,106	—	—	45
J0717	CIMZIA 400 MG	$3,842	$3,074	—	—	45
I GLENOSPHERE STANDARD 38MM	I GLENOSPHERE STANDARD 38MM	$3,735	$2,988	—	—	45
I STEM MODULAR HUMERAL 12	I STEM MODULAR HUMERAL 12	$3,690	$2,952	—	—	45
I DBL SEMITENDINOSUS TENDON	I DBL SEMITENDINOSUS TENDON	$3,627	$2,902	—	—	45
I PLATE DISTAL RADIUS 2.4 TIVA	I PLATE DISTAL RADIUS 2.4 TIVA	$3,540	$2,832	—	—	45
1402	ANESTH KNEE ARTHROPLASTY	$3,496	$2,797	—	—	45
72197	MRI PELVIS WITH & WITHOUT	$3,464	$2,771	—	—	45
I PLATE 2.4 TI VA 2CLM VLR 6H	I PLATE 2.4 TI VA 2CLM VLR 6H	$3,411	$2,729	—	—	45
Q4125	I GRAFT DECE DERMIS 3.5X3.5CM	$3,410	$2,728	—	—	45
LEVEL 3 VASCULAR PROCEDURES	LEVEL 3 VASCULAR PROCEDURES	$3,365	$2,692	—	—	45
Q4177	FLOWER AMNIOFLO 1.0ML - 10 UN	$3,348	$2,678	—	—	90
1622	ANESTH DX SHOULDER ARTHROSCOPY	$3,344	$2,675	—	—	45
36561	INSERT TUNNELED CV CATH	$3,252	$2,602	—	—	45
I PLATE BONE U-SHAPED L SMALL	I PLATE BONE U-SHAPED L SMALL	$3,069	$2,455	—	—	45
I PLATE CLAVICLE 3.5 LCP 8H LT	I PLATE CLAVICLE 3.5 LCP 8H LT	$3,069	$2,455	—	—	45
70543	MRI ORBIT/FACE/NECK WITH & WIT	$3,065	$2,452	—	—	45
1400	ANESTH KNEE JOINT SURGERY	$3,040	$2,432	—	—	45
J7169	ANDEXXA 200 MG	$3,030	$2,424	—	—	45
73220	MRI UPPER EXT NO JOINT WITH &	$3,008	$2,407	—	—	45
J1437	MONOFERRIC 1000 MG/10 ML	$2,987	$2,389	—	—	45
I CEMENTLESS METAGLENE HA	I CEMENTLESS METAGLENE HA	$2,945	$2,356	—	—	45
AQUAMANTYS DISPOSABLE SUPPLY	AQUAMANTYS DISPOSABLE SUPPLY	$2,931	$2,345	—	—	45
LEVEL 4 GYNECOLOGIC PROCED	LEVEL 4 GYNECOLOGIC PROCED	$2,891	$2,313	—	—	45
74177	CT ABDOMEN & PELVIS WITH	$2,870	$2,296	—	—	90
I HUMERAL PE CUP STANDARD 38	I HUMERAL PE CUP STANDARD 38	$2,796	$2,237	—	—	45
J3262	ACTEMRA 400 MG/20 ML 400 MG/20 ML	$2,795	$2,236	—	—	45
BONE HARVESTOR W/FILTER 6MM	BONE HARVESTOR W/FILTER 6MM	$2,788	$2,231	—	—	45

Showing top 50 of 2,325 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.