PEMBINA COUNTY MEMORIAL HOSPITAL

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
143134	Tildrakizumab-asmn Subcutaneous Soln Pref Syringe 100 MG/ML	$26,260	$26,260	—	—	1
148337	Daratumumab-Hyaluronidase-fihj Inj 1800-30000 MG-Unit/15ML	$21,418	$21,418	—	—	1
128449	Vedolizumab For IV Solution 300 MG	$16,599	$16,599	—	—	1
148648	Lurbinectedin For IV Soln 4 MG	$16,365	$16,365	—	—	1
153062	Efgartigimod alfa-fcab IV Soln 400 MG/20ML	$12,819	$12,819	—	—	1
Respiratory infections and inflammations with ma	Respiratory infections and inflammations with major complications	$12,763	$12,763	—	—	1
Heart failure & shock without complications	Heart failure & shock without complications	$10,507	$10,507	—	—	1
130696	Pembrolizumab IV Soln 100 MG/4ML (25 MG/ML)	$10,487	$10,487	—	—	2
4902216	HC LAPAROSCOPIC CHOLECYSTECTOMY	$10,264	$10,264	—	—	2
111065	Panitumumab IV Soln 400 MG/20ML	$9,425	$9,425	—	—	1
24435	Octreotide Acetate For IM Inj Kit 20 MG	$9,127	$9,127	—	—	1
General symptoms of illness such as fever, pain,	General symptoms of illness such as fever, pain, shortness of breath	$8,975	$8,975	—	—	1
139944	Durvalumab Soln for IV Infusion 500 MG/10ML (50 MG/ML)	$8,782	$8,782	—	—	1
109717	Denosumab Inj 120 MG/1.7ML	$6,897	$6,897	—	—	8
149123	Ferric Derisomaltose (One Dose) IV Sol 1000 MG/10ML (Fe Eq)	$6,856	$6,856	—	—	1
145223	Romosozumab-aqqg Inj Soln Prefilled Syringe 105 MG/1.17ML	$6,638	$6,638	—	—	2
4902264	HC RPR INITIAL HERNIA >5 YRS STRANG	$6,583	$6,583	—	—	1
111071	Tocilizumab IV Inj 400 MG/20ML	$6,126	$6,126	—	—	1
Head trauma w coma >1 hr or hemorrhage [Moderate	Head trauma w coma >1 hr or hemorrhage [Moderate Severity]	$5,657	$5,657	—	—	1
125072	Golimumab IV Soln 50 MG/4ML	$4,626	$4,626	—	—	2
111063	Panitumumab IV Soln 100 MG/5ML	$4,256	$4,256	—	—	1
142968	Pegfilgrastim-jmdb Soln Prefilled Syringe 6 MG/0.6ML	$4,167	$4,167	—	—	1
144893	Denosumab Inj Soln Prefilled Syringe 60 MG/ML	$4,135	$4,135	—	—	8
J0897	PR DENOSUMAB INJECTION, 1MG	$3,726	$3,726	—	—	8
111070	Tocilizumab IV Inj 200 MG/10ML	$3,467	$3,467	—	—	1
10392	Leuprolide Acetate For Inj Kit 7.5 MG	$3,465	$3,465	—	—	4
6100002	HC MRI ORBIT/FACE/NECK W/WO DYE	$3,339	$3,339	—	—	2
6100033	HC MRI ABDOMEN W/WO DYE	$3,264	$3,264	—	—	4
6120006	HC MRI C-SPINE W/WO DYE	$3,041	$3,041	—	—	1
6100029	HC MRI LOWER EXT JOINT W/WO DYE	$2,993	$2,993	—	—	2
6110003	HC MRI-BRAIN W/WO DYE	$2,895	$2,895	—	—	7
4900047	HC EXC SKIN BENIG >4CM TRUNK,ARM,LEG	$2,782	$2,782	—	—	1
3520037	HC CT ABD/PELVIS W/O&W CONTRAST	$2,552	$2,552	—	—	4
155974	Semaglutide Soln Pen-inj 0.25 or 0.5 MG/DOSE (2 MG/3ML)	$2,520	$2,520	—	—	4
125094	Ferric Carboxymaltose IV Soln 750 MG/15ML (Fe Equivalent)	$2,439	$2,439	—	—	2
3520036	HC CT ABD/PELVIS W/CONTRAST	$2,234	$2,234	—	—	14
6100024	HC MRI LOWER EXT W/O DYE	$2,199	$2,199	—	—	4
3500005	HC CTA CHEST	$2,066	$2,066	—	—	5
40801	Leuprolide Acetate (6 Month) For Subcutaneous Inj Kit 45 MG	$2,035	$2,035	—	—	4
3500003	HC CTA HEAD	$2,032	$2,032	—	—	8
PC3100060	PC MESH: IMPLANTABLE	$1,943	$1,943	—	—	2
6100031	HC MRI-ABDOMEN W/O DYE	$1,930	$1,930	—	—	1
PC86366	PC MUSK AUTOANTIBODY, S	$1,775	$1,775	—	—	1
6100020	HC MRI-UPPER EXT JOINT W/O DYE	$1,773	$1,773	—	—	7
6100027	HC MRI-LOWER EXT JOINT W/O DYE	$1,773	$1,773	—	—	8
3520002	HC CT THORAX W+WO CONTRAST	$1,750	$1,750	—	—	1
3520005	HC CT PELVIS W/DYE	$1,724	$1,724	—	—	1
6110001	HC MRI-BRAIN/BRAIN STEM	$1,717	$1,717	—	—	3
3510003	HC CT ORBITS/FOSSA/SELLA/IAC	$1,653	$1,653	—	—	2
6120000	HC MRI-C-SPINE W/O DYE	$1,649	$1,649	—	—	6

Showing top 50 of 765 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.