HSHS ST CLARE MEMORIAL HOSPITAL

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
C1772	HC PUMP SYNCHROMED INTRATHECAL	$26,221	$17,306	—	—	42
30420	HC RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR	$18,935	$12,497	—	—	50
36566	HC INS DEVICE CV 2 CATH W/PORT	$13,369	$8,824	—	—	50
21501	HC I&D ABSC NECK/THORAX	$13,101	$8,647	—	—	50
54115	HC REMOVAL FOREIGN BODY DEEP PENILE TISSUE	$10,232	$6,753	—	—	50
49321	HC LAPAROSCOPY BIOPSY	$10,210	$6,739	—	—	47
278	GRAFT SOFT TISSUE 4X3CM GRAFIX CORE ALLOGRAFT	$10,152	$6,700	—	—	42
36571	HC INS CATH PERIPH CV W/PORT >5	$10,134	$6,688	—	—	50
36570	HC INS CATH PERIPH CV W/PORT <5	$9,443	$6,232	—	—	50
J2505	HC NEULASTA INJ 6MG	$8,976	$5,924	—	—	49
36565	HC INS DEVICE CV 2 W/O	$8,849	$5,840	—	—	50
36561	HC INSERT TUNEL CV CATH>5YR W/PORT	$8,780	$5,795	—	—	50
36582	HC REPL DEVICE CV TNL W/PORT	$8,389	$5,537	—	—	50
27301	HC I&D ABSC/BURSA THIGH/KNEE	$8,122	$5,361	—	—	50
64489	HC TAP BLOCK BIL BY INFUSION	$7,435	$4,907	—	—	49
36558	HC INSERT TUNNELED CVC > 5 YEARS OLD	$7,407	$4,889	—	—	50
63661	HC RM SPINAL NEUROSTIM ELECTRD	$7,145	$4,716	—	—	50
Q4114	MATRIX WND BOVN COLGN GAG 3CC FLW WND MTRX STER DISP	$6,753	$4,457	—	—	42
19120	HC EXC FIBROADNOMA BREAST-PRV 72HR	$6,701	$4,423	—	—	47
19125	HC EXC LESION BREAST OPEN MARKER-PRV 72HR	$6,701	$4,423	—	—	47
19301	HC MASTECTOMY PARTIAL	$6,701	$4,423	—	—	47
36560	HC INS DEVICE CV W/PORT <5 YRS	$6,591	$4,350	—	—	50
15273	HC APL SKIN SUB TAL>100 INT 100CM	$6,407	$4,229	—	—	50
15120	HC AUTOGRPH F F DG 100SQCM-72 HR	$6,407	$4,229	—	—	47
C1781	HC MESH	$6,365	$4,201	—	—	39
36557	HC INSERT TUNNELED CVC <5 YEARS OLD	$6,250	$4,125	—	—	50
32408	HC CORE NDL BX LUNG/MEDIASTINUM PERQ W IMG	$6,123	$4,041	—	—	50
36563	HC INS PUMP IV INFUSION	$5,991	$3,954	—	—	50
32550	HC INSERT CATH PLEURAL INDWELL W/	$5,843	$3,856	—	—	50
19083	HC BREAST BIOPSY W/IMAG GUIDE ULTRA	$5,726	$3,779	—	—	50
36555	HC INS CATH CV NON-TUNL <5 YRS	$5,508	$3,635	—	—	50
74178	HC CT ABDOMEN/PELVIS W&W/O CONTR	$5,379	$3,550	—	—	50
47531	HC XRAY CHOLANGIOGRAM THRU CATH	$5,370	$3,544	—	—	50
11406	HC EXC B9 LESION >4.0CM	$5,317	$3,509	—	—	47
37616	HC LIGATION JMR ARTERY,CHEST	$5,309	$3,504	—	—	46
74183	HC MRI ABDOMEN W&W/O CON	$5,114	$3,375	—	—	50
78452	HC HT MUSCLE IMAGE SPECT MULTI	$5,099	$3,365	—	—	50
74174	HC CT ANGIO ABD/PELV W & WO CONTRAST	$5,088	$3,358	—	—	50
11426	HC EXC SKIN BENIG >4CM	$5,009	$3,306	—	—	47
11450	HC EXC SKIN SUBQ TISSUE	$5,009	$3,306	—	—	47
62305	HC XR MYELOGRAM >2 REGIONS	$4,970	$3,280	—	—	50
64625	HC ABLATION RF NERVES SI JOINT W/FLUORO OR CT GUID	$4,943	$3,262	—	—	50
C8908	HC MRI BREAST BI W&W/O CON	$4,856	$3,205	—	—	50
64635	HC RADIOFREQ;LUMBO/SACRAL;SINGLE	$4,853	$3,203	—	—	50
99183	HC HYPERBARIC O2 PER SESSION	$4,792	$3,163	—	—	84
36556	HC INS CATH CV NON-TUNL >5 YR	$4,790	$3,161	—	—	50
70336	HC MRI TMJ	$4,709	$3,108	—	—	50
36573	HC INS PER CV CATH W/O PORT W/GUIDANCE 5>	$4,671	$3,083	—	—	50
78451	HC HT MUSCLE IMAGE SPECT SINGLE	$4,656	$3,073	—	—	50
20670	HC REM IMPL WIRE SUPERFIC	$4,644	$3,065	—	—	50

Showing top 50 of 1,725 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.