AURORA MEDICAL CTR MANITOWOC COUNTY

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
C1767	1067995 - GENERATOR NRSTM	$50,666	$25,333	—	—	17
C9765	REVASC INTRAVASC LITHO/STNT	$24,840	$12,420	—	—	17
77301	RADIOTHERAPY DOSE PLAN IMRT	$24,310	$12,155	—	—	17
64628	TRML DSTRJ IOS BVN 1ST 2 L/S	$20,290	$10,145	—	—	17
58580	RFA UTERINE FIBROID W/US	$12,680	$6,340	—	—	17
77295	SIMULATION TREATMENT PLAN 3D	$10,600	$5,300	—	—	17
74178	CT ABDOMEN & PELVIS W/WO DYE	$9,220	$4,610	—	—	17
C1776	3030320 - STEM HUM 6 SHLDR ID STRL LF	$9,056	$4,528	—	—	17
77470	SPECIAL TREATMENT PROCEDURE	$8,560	$4,280	—	—	17
37700	LIGATON LONG SAPHENOUS VEIN	$8,510	$4,255	—	—	17
A9572	RRX IN111 OCTREOTIDE PER DOSE	$8,330	$4,165	—	—	17
A9569	RRX TC-99M EXAMETAZINE AUTOLOGOUS WBC'S PER DOSE	$8,300	$4,150	—	—	17
78492	MYOCRD IMG PET MLT RST&STRS	$8,120	$4,060	—	—	17
78815	NM PET CT SKULL/THIGH	$8,120	$4,060	—	—	17
78816	NM PET CT WHOLE BODY	$8,120	$4,060	—	—	17
78608	NM BRAIN METABOLIC EVAL	$8,120	$4,060	—	—	17
78814	NM PET CT LIMITED	$8,120	$4,060	—	—	17
27307	TENOTOMY HAMSTRING > 1 TENDON	$7,570	$3,785	—	—	17
23405	TENOTOMY SHOULDER	$7,540	$3,770	—	—	17
24357	TENOTOMY ELBOW	$7,540	$3,770	—	—	17
60660	THYROID RF ABLAT SNGL LOBE	$7,100	$3,550	—	—	17
C1874	1197267 - STENT ESPH OD23 MM ODSEC28 MM L10.5 CM L78 CM L7 CM OD18.5	$7,049	$3,525	—	—	17
81456	SARCOMA TARGETED GENE PANEL	$7,010	$3,505	—	—	18
49418	INSERT INTRAPERITONEAL CATH TUNNEL	$6,980	$3,490	—	—	17
0638T	CT BREAST W/3D BI WWO DYE	$6,910	$3,455	—	—	17
37609	TEMPORAL ARTERY LIGATION OR BIOPSY	$6,770	$3,385	—	—	17
95811	POLYSOMNOGRAPHY W CPAP/BIPAP	$6,770	$3,385	—	—	17
95810	POLYSOMNOGRAPHY 4/> PAREMETERS	$6,770	$3,385	—	—	17
70549	MRA NECK W/WO DYE	$6,530	$3,265	—	—	17
70553	MR BRAIN W/WO DYE	$6,530	$3,265	—	—	17
70546	MRA HEAD W/WO DYE	$6,530	$3,265	—	—	17
73225	MRA UPPER EXTREM W/WO DYE	$6,530	$3,265	—	—	17
72157	MR T SPINE W/WO DYE	$6,530	$3,265	—	—	17
73720	MR LOWER EXTREM W/WO DYE	$6,530	$3,265	—	—	17
71552	MR CHEST W/WO DYE	$6,530	$3,265	—	—	17
72197	MR PELVIS W/WO DYE	$6,530	$3,265	—	—	17
70543	MR ORBIT/FACE/NECK W/WO DYE	$6,530	$3,265	—	—	17
72156	MR C SPINE W/WO DYE	$6,530	$3,265	—	—	17
74183	MR ABDOMEN W/WO DYE	$6,530	$3,265	—	—	17
73723	MR LOWER EXTREM JOINT W/WO DYE	$6,530	$3,265	—	—	17
72158	MR L SPINE W/WO DYE	$6,530	$3,265	—	—	17
73725	MRA LOWER EXT WWO CNTRST	$6,530	$3,265	—	—	17
73223	MR UPPER EXTREM JOINT W/WO DYE	$6,530	$3,265	—	—	17
74185	MRA ABDOMEN W/WO CONTRAST	$6,530	$3,265	—	—	17
73220	MR UPPER EXTREM W/WO DYE	$6,530	$3,265	—	—	17
77049	MR BREAST W/WO W/CAD CONTRAST BILAT	$6,490	$3,245	—	—	17
57410	PELVIC EXAM UNDER ANESTHESIA	$6,470	$3,235	—	—	17
78452	NM MYO PERF SPECT MULTIPLE	$6,440	$3,220	—	—	17
A9570	RRX IN-111 WBC PER STUDY	$6,420	$3,210	—	—	17
0683	TRAUMA W/O CRITICAL CARE	$6,370	$3,185	—	—	17

Showing top 50 of 11,920 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.