ST JOSEPHS COMMUNITY HOSPITAL WEST BEND

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
J2351	ocrelizumab-hyaluronidase-ocsq 920-23000 mg-unit/23 mL Solution 23 mL Vial	$175,458	$96,502	—	—	11
J9228	ipilimumab 200 MG/40ML Solution 40 mL Vial	$145,601	$80,080	—	—	11
J9269	tagraxofusp-erzs 1000 MCG/ML Solution 1 mL Vial	$138,417	$76,130	—	—	11
J2507	Pegloticase 8 MG/ML Solution 1 mL Vial	$127,605	$70,183	—	—	11
J0202	alemtuzumab 12 MG/1.2ML Solution 1.2 mL Vial	$125,171	$68,844	—	—	11
J1747	spesolimab-sbzo 450 MG/7.5ML Solution 7.5 mL Vial	$118,599	$65,229	—	—	11
J9359	loncastuximab tesirine-lpyl 10 mg/2 mL Recon Soln 1 Each Vial	$113,857	$62,621	—	—	11
J9281	mitoMYcin 80 (2 x 40) MG Recon Soln 1 Each Box	$100,383	$55,211	—	—	11
J9229	inotuzumab ozogamicin 0.25 mg/ml Recon Soln 1 Each Vial	$93,938	$51,666	—	—	11
J2350	ocrelizumab 300 MG/10ML Solution 10 mL Vial	$87,734	$48,254	—	—	11
J0638	canakinumab 150 mg/mL Solution 1 mL Vial	$85,952	$47,274	—	—	11
J9274	Tebentafusp-tebn 100 MCG/0.5ML Solution 0.5 mL Vial	$83,983	$46,191	—	—	11
J9309	polatuzumab vedotin-piiq 20 mg/mL Recon Soln 1 Each Vial	$76,322	$41,977	—	—	22
J3241	teprotumumab-trbw 500 MG Recon Soln 1 Each Vial	$74,432	$40,938	—	—	11
J9334	efgartigimod alfa-hyaluronidase-qvfc 1008-11200 mg-UT/5.6 mL Solution 5.6 mL Vial	$68,386	$37,612	—	—	11
J9026	tarlatamab-dlle 10 MG Recon Soln 1 Each Vial	$63,760	$35,068	—	—	11
J9298	nivolumab-relatlimab-rmbw 240-80 mg/20mL Solution 20 mL Vial	$62,005	$34,103	—	—	11
J1628	guselkumab 200 MG/20ML Solution 20 mL Vial	$61,917	$34,055	—	—	11
J9381	teplizumab-mzwv 2 MG/2ML Solution 2 mL Vial	$59,100	$32,505	—	—	11
J9043	cabazitaxel Solution 1.5 mL Vial	$58,886	$32,387	—	—	11
J1323	elranatamab-bcmm 76 mg/1.9 mL Solution 1.9 mL Vial	$56,444	$31,044	—	—	11
37227	HC REVASC, ENDVASC, FEM, POPLIT ART, W STENT & ATHRECT	$53,268	$29,297	—	—	9
J9271	pembrolizumab 200 mg 200 mg Solution 58 mL Bag	$51,853	$28,519	—	—	22
J0896	luspatercept-aamt 50 mg/mL Recon Soln 1 Each Vial	$51,424	$28,283	—	—	22
J9042	brentuximab 5 mg/mL Recon Soln 1 Each Vial	$50,035	$27,519	—	—	22
J9272	dostarlimab-gxly 500 MG/10ML Solution 10 mL Vial	$48,372	$26,605	—	—	11
37231	HC REVASC, ENDVASC, TIB, PERON ART, INIT VES, W STENT & ATHRECT	$46,364	$25,500	—	—	9
J9022	atezolizumab 1200 MG/20ML Solution 20 mL Vial	$46,147	$25,381	—	—	11
J9024	atezolizumab-hyaluronidase-tqjs 1875-30,000 mg-unit/15 mL Solution 15 mL Vial	$46,147	$25,381	—	—	11
J3055	talquetamab-tgvs 40 MG/ML Solution 1 mL Vial	$45,692	$25,131	—	—	33
C9797	HC VASC EMBO/OCCLUS W/ USE OF PRESS GEN CATH, TUM, ORG ISCHEMIA/INFARCTION	$45,619	$25,090	—	—	9
J9119	cemiplimab-rwlc 350 MG/7ML Solution 7 mL Vial	$44,807	$24,644	—	—	11
C9773	HC REVASC, ENDOVASC, OPEN/PERC, TIB/PERON ART, W/ IVL & TRANSLUM STENC	$44,606	$24,533	—	—	9
J9153	DAUNOrubicin-cytarabine liposomal 44-100 MG Recon Susp 1 Each Vial	$44,162	$24,289	—	—	11
J2327	risankizumab-rzaa 600 MG/10ML Solution 10 mL Vial	$44,094	$24,252	—	—	11
36836	HC PERC ARTVEN FIST CREAT, UPR EXTREM, SGL ACC PERIPH ART&VEIN, IMG GUID	$44,079	$24,243	—	—	9
J9144	daratumumab-hyaluronidase-fihj 1800-30000 mg-UT/15 mL Solution 15 mL Vial	$43,360	$23,848	—	—	11
36906	HC PERC TRANSLUM MECH THROMBECT/INFUS, DIALYS CIRCUIT, PERIPH STENT/PTA	$42,138	$23,176	—	—	9
J0870	imetelstat sodium 188 MG Recon Soln 1 Each Vial	$41,755	$22,965	—	—	11
J7313	fluocinolone acetonide 0.19 MG Implant 1 Each Box	$38,553	$21,204	—	—	11
J3263	toripalimab-tpzi 240 mg/6 mL Solution 6 mL Vial	$38,118	$20,965	—	—	11
J9316	pertuzumab/trastuzumab/hyaluronidase-zzxf 60-60-2000 MG-MG-U/ML Solution 10 mL Vial	$38,052	$20,929	—	—	11
J9299	nivolumab Solution 124 mL Flex Cont	$37,387	$20,563	—	—	11
37225	HC REVASC, ENDVASC, FEM, POPLIT ART, W ATHRECT	$37,096	$20,403	—	—	9
C9047	caplacizumab-yhdp 11 MG Kit 1 Each Box	$36,440	$20,042	—	—	8
J2323	natalizumab 300 MG/15ML Conc 15 mL Vial	$36,295	$19,962	—	—	11
C9772	HC REVASC, ENDOVASC, OPEN/PERC, TIBIAL/PERONEAL ART, W INTRVASC LITHOTRIPSY	$35,409	$19,475	—	—	9
J9301	obinutuzumab 1000 MG/40ML Solution 40 mL Vial	$35,327	$19,430	—	—	11
J3101	tenecteplase 50 mg/10 mL Kit 1 Each Box	$35,273	$19,400	—	—	11
J1930	lanreotide acetate 90 MG/0.3ML Solution 0.3 mL Syringe	$34,469	$18,958	—	—	11

Showing top 50 of 16,676 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.