SANFORD MAYVILLE — Hospital Ledger

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
J2327	Risankizumab-rzaa IV Soln 600 MG/10ML (60 MG/ML)	$11,396	$9,117	—	—	35
J3101	Tenecteplase For IV Soln Kit 50 MG	$7,515	$6,012	—	—	35
J3380	Vedolizumab For IV Solution 300 MG	$6,943	$5,555	—	—	35
J2506	Pegfilgrastim Soln Prefilled Syringe 6 MG/0.6ML	$6,001	$4,801	—	—	35
74174	CTA ABD PELVIS W CONTRAST+WO IF PERFORM	$5,658	$4,526	—	—	35
95811	PSG CPAP BIPAP 4+ PARAMETERS	$5,367	$4,294	—	—	35
66984	SURG 66984 EXTRACAP CATARCT RMVL INSERT IO LENS PROSTH W/O ECP	$5,201	$4,161	—	—	35
66982	SURG 66982 RMVL ECCR IOL INSRT CMPLX	$5,201	$4,161	—	—	35
95810	PSG 4+ PARAMETERS	$4,956	$3,965	—	—	35
72158	MRI L SPINE WO THEN W CONT	$4,905	$3,924	—	—	35
72157	MRI T SPINE WO THEN W CONT	$4,820	$3,856	—	—	35
72156	MRI C SPINE WO THEN W CONT	$4,748	$3,798	—	—	35
72197	MRI PELVIS WO THEN W CONT	$4,730	$3,784	—	—	35
0474T	SURG 0474T INSERT ANT SEG AQUEOUS DRG DEV W/IO RSVR	$4,697	$3,758	—	—	35
70553	MRI BRAIN WO THEN W CONT	$4,663	$3,730	—	—	35
65235	ED 65235 REMV FB EYE INTRAOCULAR	$4,603	$3,682	—	—	35
71552	MRI CHEST WO THEN W CONT	$4,585	$3,668	—	—	35
70543	MRI FACE NECK ORB WO THEN W CONT	$4,570	$3,656	—	—	35
74183	MRI ABDOMEN WO THEN W CONT	$4,543	$3,634	—	—	35
70546	MRA HEAD WO THEN W CONT	$4,504	$3,603	—	—	35
67904	SURG 67904 RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL	$4,477	$3,582	—	—	35
73223	MRI UPPER EXT JT WO THEN W CONT	$4,458	$3,566	—	—	35
73723	MRI LOWER EXT JT WO THEN W CONT	$4,389	$3,511	—	—	35
70549	MRA NECK WO THEN W CONT	$4,346	$3,477	—	—	35
J2426	Paliperidone Palmitate ER Susp Pref Syr 234 MG/1.5ML	$4,300	$3,440	—	—	35
15823	SURG 15823 BLEPHROPL UPPER EXC SKIN	$4,280	$3,424	—	—	35
73220	MRI UPPER EXT WO THEN W CONT	$4,249	$3,399	—	—	35
59409	ED 59409 ED DELIVERY VAGINAL ONLY	$4,173	$3,338	—	—	35
73720	MRI LOWER EXT WO THEN W CONT	$4,131	$3,305	—	—	35
72147	MRI T SPINE W CONTRAST	$3,979	$3,183	—	—	35
26607	ED 26607 CLSD TX MTCRPAL FX WMANIP	$3,955	$3,164	—	—	35
72149	MRI L SPINE W CONTRAST	$3,953	$3,162	—	—	35
72142	MRI C SPINE W CONTRAST	$3,951	$3,161	—	—	35
70552	MRI BRAIN W CONTRAST	$3,861	$3,089	—	—	35
73222	MRI UP EXT JT WCONT	$3,855	$3,084	—	—	35
12037	ED 12037 LYR CLSR OF WND >30.0CM	$3,838	$3,070	—	—	35
52281	CYSTO WDILATATION OFURETHRA	$3,795	$3,036	—	—	35
74178	CT ABD PELVIS WO THEN W CONT	$3,755	$3,004	—	—	35
37609	SURG 37609 LIGATION/BIOPSY TEMPORAL ARTERY	$3,710	$2,968	—	—	35
74170	CT ABDOMEN WO THEN W CONT	$3,673	$2,938	—	—	35
67917	SURG 67917 REPAIR ECTROPION EXTENSIVE	$3,656	$2,925	—	—	35
27603	TX RM 27603 I&D ABSCESS HEMATOMA LEG ANKLE DEEP	$3,650	$2,920	—	—	35
67924	SURG 67924 REPAIR ENTROPION EXTENSIVE	$3,571	$2,857	—	—	35
21337	ED 21337 CLSD TX NOSE FXW WO STABL	$3,443	$2,754	—	—	35
70545	MRA HEAD W CONTRAST	$3,415	$2,732	—	—	35
71550	MRI CHEST WO CONTRAST	$3,312	$2,650	—	—	35
70540	MRI FACE NECK ORB WO CONTRAST	$3,270	$2,616	—	—	35
71270	CT THORAX DIAGNOSTIC WO THEN W CONTRAST	$3,259	$2,607	—	—	35
70488	CT MAXILLOFACIAL WO W CONT	$3,228	$2,582	—	—	35
74175	CTA ABD WCONT +WO IF PERF	$3,211	$2,569	—	—	35

Showing top 50 of 1,646 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.