45 CFR § 180 compliance
B · 85
This hospital published most of what § 180 requires.
●Machine-readable file published
●Gross / standard charges
●Discounted cash price
●Payer-specific negotiated rates
○Min / max negotiated charges
●Free, public, no login required
Procedures listed
6,846
Insurances with rates
24
CPT / HCPCS codes
82
Source MRF
Most expensive procedures (gross)
1903792
$100,382
00003-2328-22 - Ipilimumab (Yerovy) 200 mg/40 mL Sol [SJMH]
Gross
$200,764
1903828
$81,916
75987-0080-10 - Pegloticase (Krystexxa) 8 mg/mL Injection Solution {SJMH}
Gross
$163,831
1903894
$68,226
00310-4500-12 - Durvalumab (Imfinzi) 120 mg/2.4 mL Vial [SJMH]
Gross
$136,452
1904104
$52,629
50242-0105-01 - Polatuzumab Vedotin (Polivy) 140 mg Vial [SJMH]
Gross
$105,258
1903856
$49,250
47335-0177-95 - tildrakizumab 100 mg/mL Sol
Gross
$98,500
1904155
$46,266
00003-7125-11 - Nivolumab-Relatlimab rmbw (Opdualag) 240 mg-80 mg/20 mL Sol [SJMH]
Gross
$92,532
1903349
$43,629
00310-0720-10 - fulvestrant 50 mg/mL IM Inj [SJMH]
Gross
$87,257
1903789
$40,396
00024-5824-11 - Cabazitaxel (Jevtana) 60 mg/1.5 mL Sol [SJMH]
Gross
$80,791
11009819
$40,365
MESH PHASIX ST 25X30
Gross
$80,730
1903841
$38,155
69794-0304-01 - Burosumab (Crysvita) 30 mg/1 mL Vial [SJMH]
Gross
$76,311
1903585
$35,042
00074-3473-03 - leuprolide 45 mg/6 months [SJMH]
Gross
$70,084
1904050
$33,342
00173-0898-03 - dostarlimab-gxly (Jemperli) 500 mg/10 mL vial [SJMH]
Gross
$66,685
1904008
$32,634
51144-0050-01 - Brentuximab Vedotin (Adcetris) 50 mg Vial [SJMH]
Gross
$65,268
1903819
$31,042
50242-0917-01 - Atezolizumab (Tecentriq) 1200 mg/20 mL Inj Sol [SJMH]
Gross
$62,083
1904021
$29,406
61755-0008-01 - Cemiplimab-rwlc (Libtayo) 350 mg/7 mL Vial [SJMH]
Gross
$58,811
1904053
$28,686
15054-1120-04 - lanreotide 120 mg/0.5 mL Sol
Gross
$57,372
42747-0203-01 - burosumab twza 20 mg/mL Sol
$27,510
42747-0203-01 - burosumab twza 20 mg/mL Sol
Gross
$55,020
1903903
$27,356
57894-0503-01 - Daratumumab-Hyaluronidase 1800 mg-30,000 units/15 mL Vial [SJMH[
Gross
$54,712
69097-0870-67 - lanreotide 120 mg/0.5 mL SoL [SJ
$26,678
69097-0870-67 - lanreotide 120 mg/0.5 mL SoL [SJMH]
Gross
$53,356
1903840
$25,437
69794-0203-01 - Burosumab (Crysvita) 20 mg/1 mL Vial [SJMH]
Gross
$50,874
1903788
$25,096
00003-2327-11 - Ipilimumab (Yervoy) 50 mg/10 mL Sol [SJMH]
Gross
$50,191
50242-0176-01 - tenecteplase 50 mg Pow
$24,892
50242-0176-01 - tenecteplase 50 mg Pow
Gross
$49,784
1904157
$24,892
50242-0014-03 - Tenecteplase (TNKase) 25 mg Vial [SJMH]
Gross
$49,784
1904085
$24,726
50242-0070-01 - Obinutuzumab (Gazyva) 25 mg/mL Vial [SJMH]
Gross
$49,451
1903869
$24,528
64764-0300-20 - Vedolizumab (Entyvio) 300 mg Vial [SJMH]
Gross
$49,056
1904133
$24,330
68727-0712-01 - lurbinectedin (ZEPZELCA) 4 mg vial [SJMH]
Gross
$48,660
450332101
$23,395
33210 Tmp Pacemaker
Gross
$46,790
332101
$23,395
Temporary Pacemaker Placement
Gross
$46,790
450332111
$23,395
33211 Insrt Temp Transven Pacing Electr
Gross
$46,790
1901296
$23,361
00074-3683-03 - leuprolide 30 mg/4 months IM Inj, ER [SJMH]
Gross
$46,722
1901394
$22,135
50242-0120-47 - Tenecteplase (TNKase) 50 mg Vial [SJMH]
Gross
$44,270
00002-7678-01 - Ramucirumab (Cyramza) 500 mg Via
$22,070
00002-7678-01 - Ramucirumab (Cyramza) 500 mg Vial [SJMH]
Gross
$44,141
1903796
$22,015
00003-3734-13 - Nivolumab (Opdivo) 240 mg/24 mL Sol [SJMH]
Gross
$44,029
11010560
$20,150
Reverse Total Shoulder Cap Pricing (Arthrex)
Gross
$40,300
1904038
$19,628
61314-0866-01 - Pegfilgrastim-bmez (Ziextenzo) 6 mg/0.6 mL Syringe [SJMH]
Gross
$39,255
1901527
$19,254
55513-0190-01 - pegfilgrastim 6 mg/0.6 mL SubQ Inj [SJMH]
Gross
$38,508
1903833
$19,254
55513-0192-01 - Neulasta OnPro (Pegfilgrastim) 6 mg/0.6 mL Solution [SJMH]
Gross
$38,508
11009486
$19,188
NEXGEN LCCK FEMORAL SIZE F-RT
Gross
$38,376
1903799
$19,010
50242-0145-01 - Pertuzumab (Perjeta) 420 mg/14 mL Sol [SJMH]
Gross
$38,020
1903980
$18,833
55513-0956-01 - Panitumumab (Vectibix) 400 mg/20 mL Vial [SJMH]
Gross
$37,667
2019933
$18,278
Implant MGS Shoulder (CAP)
Gross
$36,556
1901295
$17,521
00074-3346-03 - leuprolide 22.5 mg/3 months IM Inj, ER [SJMH]
Gross
$35,042
00310-1830-30 - benralizumab 30 mg/mL Sol
$17,030
00310-1830-30 - benralizumab 30 mg/mL Sol
Gross
$34,061
11009691
$16,796
NEXGEN LCCK FEMORAL SIZE F-LT
Gross
$33,592
1903807
$16,534
00310-1730-30 - Benralizumab (Fasenra) 30 mg/mL Solution [SJMH]
Gross
$33,068
1903783
$16,346
00006-3026-02 - pembrolizumab 100 mg/4 mL Sol [SJMH]
Gross
$32,691
11010495
$16,120
InSpace Balloon System
Gross
$32,240
11010554
$16,120
InSpace Balloon System-0132
Gross
$32,240
11009437
$15,881
LCCK FEMORAL NEGEN SIZE E-LT
Gross
$31,762
361364821
$15,133
36482 Endoven Ther Chem Adhes 1st
Gross
$30,265
| Code | Description | Gross | Cash | Min payer | Max payer | # insurers |
|---|---|---|---|---|---|---|
| 1903792 | 00003-2328-22 - Ipilimumab (Yerovy) 200 mg/40 mL Sol [SJMH] | $200,764 | $100,382 | — | — | 26 |
| 1903828 | 75987-0080-10 - Pegloticase (Krystexxa) 8 mg/mL Injection Solution {SJMH} | $163,831 | $81,916 | — | — | 26 |
| 1903894 | 00310-4500-12 - Durvalumab (Imfinzi) 120 mg/2.4 mL Vial [SJMH] | $136,452 | $68,226 | — | — | 26 |
| 1904104 | 50242-0105-01 - Polatuzumab Vedotin (Polivy) 140 mg Vial [SJMH] | $105,258 | $52,629 | — | — | 24 |
| 1903856 | 47335-0177-95 - tildrakizumab 100 mg/mL Sol | $98,500 | $49,250 | — | — | 25 |
| 1904155 | 00003-7125-11 - Nivolumab-Relatlimab rmbw (Opdualag) 240 mg-80 mg/20 mL Sol [SJMH] | $92,532 | $46,266 | — | — | 24 |
| 1903349 | 00310-0720-10 - fulvestrant 50 mg/mL IM Inj [SJMH] | $87,257 | $43,629 | — | — | 25 |
| 1903789 | 00024-5824-11 - Cabazitaxel (Jevtana) 60 mg/1.5 mL Sol [SJMH] | $80,791 | $40,396 | — | — | 25 |
| 11009819 | MESH PHASIX ST 25X30 | $80,730 | $40,365 | — | — | 18 |
| 1903841 | 69794-0304-01 - Burosumab (Crysvita) 30 mg/1 mL Vial [SJMH] | $76,311 | $38,155 | — | — | 25 |
| 1903585 | 00074-3473-03 - leuprolide 45 mg/6 months [SJMH] | $70,084 | $35,042 | — | — | 25 |
| 1904050 | 00173-0898-03 - dostarlimab-gxly (Jemperli) 500 mg/10 mL vial [SJMH] | $66,685 | $33,342 | — | — | 24 |
| 1904008 | 51144-0050-01 - Brentuximab Vedotin (Adcetris) 50 mg Vial [SJMH] | $65,268 | $32,634 | — | — | 25 |
| 1903819 | 50242-0917-01 - Atezolizumab (Tecentriq) 1200 mg/20 mL Inj Sol [SJMH] | $62,083 | $31,042 | — | — | 26 |
| 1904021 | 61755-0008-01 - Cemiplimab-rwlc (Libtayo) 350 mg/7 mL Vial [SJMH] | $58,811 | $29,406 | — | — | 26 |
| 1904053 | 15054-1120-04 - lanreotide 120 mg/0.5 mL Sol | $57,372 | $28,686 | — | — | 24 |
| 42747-0203-01 - burosumab twza 20 mg/mL Sol | 42747-0203-01 - burosumab twza 20 mg/mL Sol | $55,020 | $27,510 | — | — | 25 |
| 1903903 | 57894-0503-01 - Daratumumab-Hyaluronidase 1800 mg-30,000 units/15 mL Vial [SJMH[ | $54,712 | $27,356 | — | — | 24 |
| 69097-0870-67 - lanreotide 120 mg/0.5 mL SoL [SJ | 69097-0870-67 - lanreotide 120 mg/0.5 mL SoL [SJMH] | $53,356 | $26,678 | — | — | 24 |
| 1903840 | 69794-0203-01 - Burosumab (Crysvita) 20 mg/1 mL Vial [SJMH] | $50,874 | $25,437 | — | — | 25 |
| 1903788 | 00003-2327-11 - Ipilimumab (Yervoy) 50 mg/10 mL Sol [SJMH] | $50,191 | $25,096 | — | — | 26 |
| 50242-0176-01 - tenecteplase 50 mg Pow | 50242-0176-01 - tenecteplase 50 mg Pow | $49,784 | $24,892 | — | — | 27 |
| 1904157 | 50242-0014-03 - Tenecteplase (TNKase) 25 mg Vial [SJMH] | $49,784 | $24,892 | — | — | 27 |
| 1904085 | 50242-0070-01 - Obinutuzumab (Gazyva) 25 mg/mL Vial [SJMH] | $49,451 | $24,726 | — | — | 25 |
| 1903869 | 64764-0300-20 - Vedolizumab (Entyvio) 300 mg Vial [SJMH] | $49,056 | $24,528 | — | — | 25 |
| 1904133 | 68727-0712-01 - lurbinectedin (ZEPZELCA) 4 mg vial [SJMH] | $48,660 | $24,330 | — | — | 25 |
| 450332101 | 33210 Tmp Pacemaker | $46,790 | $23,395 | — | — | 22 |
| 332101 | Temporary Pacemaker Placement | $46,790 | $23,395 | — | — | 22 |
| 450332111 | 33211 Insrt Temp Transven Pacing Electr | $46,790 | $23,395 | — | — | 22 |
| 1901296 | 00074-3683-03 - leuprolide 30 mg/4 months IM Inj, ER [SJMH] | $46,722 | $23,361 | — | — | 25 |
| 1901394 | 50242-0120-47 - Tenecteplase (TNKase) 50 mg Vial [SJMH] | $44,270 | $22,135 | — | — | 27 |
| 00002-7678-01 - Ramucirumab (Cyramza) 500 mg Via | 00002-7678-01 - Ramucirumab (Cyramza) 500 mg Vial [SJMH] | $44,141 | $22,070 | — | — | 25 |
| 1903796 | 00003-3734-13 - Nivolumab (Opdivo) 240 mg/24 mL Sol [SJMH] | $44,029 | $22,015 | — | — | 27 |
| 11010560 | Reverse Total Shoulder Cap Pricing (Arthrex) | $40,300 | $20,150 | — | — | 18 |
| 1904038 | 61314-0866-01 - Pegfilgrastim-bmez (Ziextenzo) 6 mg/0.6 mL Syringe [SJMH] | $39,255 | $19,628 | — | — | 24 |
| 1901527 | 55513-0190-01 - pegfilgrastim 6 mg/0.6 mL SubQ Inj [SJMH] | $38,508 | $19,254 | — | — | 25 |
| 1903833 | 55513-0192-01 - Neulasta OnPro (Pegfilgrastim) 6 mg/0.6 mL Solution [SJMH] | $38,508 | $19,254 | — | — | 25 |
| 11009486 | NEXGEN LCCK FEMORAL SIZE F-RT | $38,376 | $19,188 | — | — | 18 |
| 1903799 | 50242-0145-01 - Pertuzumab (Perjeta) 420 mg/14 mL Sol [SJMH] | $38,020 | $19,010 | — | — | 25 |
| 1903980 | 55513-0956-01 - Panitumumab (Vectibix) 400 mg/20 mL Vial [SJMH] | $37,667 | $18,833 | — | — | 25 |
| 2019933 | Implant MGS Shoulder (CAP) | $36,556 | $18,278 | — | — | 18 |
| 1901295 | 00074-3346-03 - leuprolide 22.5 mg/3 months IM Inj, ER [SJMH] | $35,042 | $17,521 | — | — | 25 |
| 00310-1830-30 - benralizumab 30 mg/mL Sol | 00310-1830-30 - benralizumab 30 mg/mL Sol | $34,061 | $17,030 | — | — | 26 |
| 11009691 | NEXGEN LCCK FEMORAL SIZE F-LT | $33,592 | $16,796 | — | — | 18 |
| 1903807 | 00310-1730-30 - Benralizumab (Fasenra) 30 mg/mL Solution [SJMH] | $33,068 | $16,534 | — | — | 26 |
| 1903783 | 00006-3026-02 - pembrolizumab 100 mg/4 mL Sol [SJMH] | $32,691 | $16,346 | — | — | 26 |
| 11010495 | InSpace Balloon System | $32,240 | $16,120 | — | — | 18 |
| 11010554 | InSpace Balloon System-0132 | $32,240 | $16,120 | — | — | 18 |
| 11009437 | LCCK FEMORAL NEGEN SIZE E-LT | $31,762 | $15,881 | — | — | 18 |
| 361364821 | 36482 Endoven Ther Chem Adhes 1st | $30,265 | $15,133 | — | — | 25 |
Showing top 50 of 6,846 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.