AMERICAN FORK HOSPITAL — Hospital Ledger

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
202663	LUTETIUM LU 177 DOTATATE 10 MCI/ML (370 MBQ/ML) INTRAVENOUS SOLUTION	$191,164	$143,373	—	—	27
202663	LUTETIUM LU 177 DOTATATE 10 MCI/ML (370 MBQ/ML) INTRAVENOUS SOLUTION	$191,164	$143,373	—	—	27
2722109771	HC PERCUTANEOUS VENTRICULAR ASSIST DEVICE LVL 71	$155,721	$116,790	—	—	27
2782649771	HC VALVE IMPLANT LVL 71	$155,721	$116,790	—	—	27
2722109771	HC PERCUTANEOUS VENTRICULAR ASSIST DEVICE LVL 71	$155,721	$116,790	—	—	27
2782649771	HC VALVE IMPLANT LVL 71	$155,721	$116,790	—	—	27
216356	LUTETIUM LU-177 VIPIVOTIDE TETRAXETAN 27 MCI/ML (1,000 MBQ/ML) IV SOLN	$155,670	$116,752	—	—	27
216356	LUTETIUM LU-177 VIPIVOTIDE TETRAXETAN 27 MCI/ML (1,000 MBQ/ML) IV SOLN	$155,670	$116,752	—	—	27
2721649601	HC KIT PUMP DEVICE CARDIAC VENTRICULAR SMARTASSIST 5.5 S2	$149,468	$112,101	—	—	27
2721649601	HC KIT PUMP DEVICE CARDIAC VENTRICULAR SMARTASSIST 5.5 S2	$149,468	$112,101	—	—	27
2782649770	HC VALVE IMPLANT LVL 70	$148,305	$111,229	—	—	27
278TRIG470	HC NTAP TRICLIP G4 VLV RPR SYSTM	$148,305	$111,229	—	—	27
2782649770	HC VALVE IMPLANT LVL 70	$148,305	$111,229	—	—	27
278TRIG470	HC NTAP TRICLIP G4 VLV RPR SYSTM	$148,305	$111,229	—	—	27
2721040201	HC BERLIN HEART PUMP REPLACEMENT	$148,265	$111,199	—	—	27
2721649701	HC PUMP BLOOD VAD W/ VALVES	$148,265	$111,199	—	—	27
2721040201	HC BERLIN HEART PUMP REPLACEMENT	$148,265	$111,199	—	—	27
2721649701	HC PUMP BLOOD VAD W/ VALVES	$148,265	$111,199	—	—	27
275C188267	HC ICD BIV/CRT-D LVL 67	$128,112	$96,084	—	—	27
275C188267	HC ICD BIV/CRT-D LVL 67	$128,112	$96,084	—	—	27
278C188966	HC IMPLANTABLE-INSERTABLE DEVICE NOC LVL 66	$122,011	$91,508	—	—	27
2782649766	HC VALVE IMPLANT LVL 66	$122,011	$91,508	—	—	27
278C182366	HC NEUROSTIM GENERATOR/LEAD LVL 66	$122,011	$91,508	—	—	27
278C188966	HC IMPLANTABLE-INSERTABLE DEVICE NOC LVL 66	$122,011	$91,508	—	—	27
2782649766	HC VALVE IMPLANT LVL 66	$122,011	$91,508	—	—	27
278C182366	HC NEUROSTIM GENERATOR/LEAD LVL 66	$122,011	$91,508	—	—	27
4813324901	HC IMPLANT/REPOS DEFIB PULSE GEN W/LEADS SNG/DUAL	$118,744	$89,058	—	—	27
4813324901	HC IMPLANT/REPOS DEFIB PULSE GEN W/LEADS SNG/DUAL	$118,744	$89,058	—	—	27
2782649765	HC VALVE IMPLANT LVL 65	$116,201	$87,151	—	—	27
2782649765	HC VALVE IMPLANT LVL 65	$116,201	$87,151	—	—	27
4813326401	HC REMOVE & REPLAC DEFIB PULSE GEN MULT LEADS	$114,039	$85,529	—	—	27
4813326401	HC REMOVE & REPLAC DEFIB PULSE GEN MULT LEADS	$114,039	$85,529	—	—	27
2782669764	HC VASCULAR STENT GRAFT IMPLANT LVL 64	$110,668	$83,001	—	—	27
2782649764	HC VALVE IMPLANT LVL 64	$110,668	$83,001	—	—	27
2782669764	HC VASCULAR STENT GRAFT IMPLANT LVL 64	$110,668	$83,001	—	—	27
2782649764	HC VALVE IMPLANT LVL 64	$110,668	$83,001	—	—	27
278C188963	HC IMPLANTABLE-INSERTABLE DEVICE NOC LVL 63	$105,398	$79,048	—	—	27
2782649763	HC VALVE IMPLANT LVL 63	$105,398	$79,048	—	—	27
278C188963	HC IMPLANTABLE-INSERTABLE DEVICE NOC LVL 63	$105,398	$79,048	—	—	27
2782649763	HC VALVE IMPLANT LVL 63	$105,398	$79,048	—	—	27
183256	RADIUM RA 223 DICHLOR 1,100 KBQ/ML (30 MICROCURIE/ML) INTRAVENOUS SOLN	$102,893	$77,169	—	—	27
183256	RADIUM RA 223 DICHLOR 1,100 KBQ/ML (30 MICROCURIE/ML) INTRAVENOUS SOLN	$102,893	$77,169	—	—	27
278C187462	HC STENT COATED/COVERED IMPLANT LVL 62	$100,379	$75,284	—	—	27
2782669762	HC VASCULAR STENT GRAFT IMPLANT LVL 62	$100,379	$75,284	—	—	27
278C188962	HC IMPLANTABLE-INSERTABLE DEVICE NOC LVL 62	$100,379	$75,284	—	—	27
278C187462	HC STENT COATED/COVERED IMPLANT LVL 62	$100,379	$75,284	—	—	27
2782669762	HC VASCULAR STENT GRAFT IMPLANT LVL 62	$100,379	$75,284	—	—	27
278C188962	HC IMPLANTABLE-INSERTABLE DEVICE NOC LVL 62	$100,379	$75,284	—	—	27
4813327001	HC INSERT/REPLMNT SUBQ IMPL DEFIB W SBQ ELECTRODE	$98,013	$73,510	—	—	27
4813327001	HC INSERT/REPLMNT SUBQ IMPL DEFIB W SBQ ELECTRODE	$98,013	$73,510	—	—	27

Showing top 50 of 40,397 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.