FLAGSTAFF MEDICAL CENTER — Hospital Ledger

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
50010218	Imjudo (tremelimumab-ACTL) 20 mg/mL Inj 15mL	$288,840	$144,420	—	—	6
50010218	Imjudo (tremelimumab-ACTL) 20 mg/mL Inj 15mL	$288,840	$144,420	—	—	11
50010218	Imjudo (tremelimumab-ACTL) 20 mg/mL Inj 15mL	$288,840	$144,420	—	—	9
50300287	Sipuleucel-T >/ 50 million cells / 250mL LR	$253,329	$126,665	—	—	6
50300287	Sipuleucel-T >/ 50 million cells / 250mL LR	$253,329	$126,665	—	—	11
50300287	Sipuleucel-T >/ 50 million cells / 250mL LR	$253,329	$126,665	—	—	9
50010242	Pegloticase (Krystexxa) 8mg/mL Inj	$222,406	$111,203	—	—	6
50010242	Pegloticase (Krystexxa) 8mg/mL Inj	$222,406	$111,203	—	—	11
50010242	Pegloticase (Krystexxa) 8mg/mL Inj	$222,406	$111,203	—	—	9
50010098	Alemtuzumab 10mg/mL Inj 1.2mL dns	$218,168	$109,084	—	—	6
50010098	Alemtuzumab 10mg/mL Inj 1.2mL dns	$218,168	$109,084	—	—	11
50010098	Alemtuzumab 10mg/mL Inj 1.2mL dns	$218,168	$109,084	—	—	9
50010207	Ocrelizumab 300 mg/10 mL Inj	$146,126	$73,063	—	—	6
50010207	Ocrelizumab 300 mg/10 mL Inj	$146,126	$73,063	—	—	11
50010207	Ocrelizumab 300 mg/10 mL Inj	$146,126	$73,063	—	—	9
50010215	Teprotumumab-TRBW (Tepezza) 500 mg Inj	$129,822	$64,911	—	—	6
50010215	Teprotumumab-TRBW (Tepezza) 500 mg Inj	$129,822	$64,911	—	—	11
50010215	Teprotumumab-TRBW (Tepezza) 500 mg Inj	$129,822	$64,911	—	—	9
50010115	Ipilimumab 5mg/mL inj 40mL	$116,041	$58,021	—	—	6
50010115	Ipilimumab 5mg/mL inj 40mL	$116,041	$58,021	—	—	11
50010115	Ipilimumab 5mg/mL inj 40mL	$116,041	$58,021	—	—	9
FMC-9816454	KIT VAL AO SAP3 ULT RSL 20MM	$107,100	$53,550	—	—	6
FMC-9816454	KIT VAL AO SAP3 ULT RSL 20MM	$107,100	$53,550	—	—	12
FMC-9816455	KIT VAL AO SAP3 ULT RSL 23MM	$107,100	$53,550	—	—	6
FMC-9816455	KIT VAL AO SAP3 ULT RSL 23MM	$107,100	$53,550	—	—	12
FMC-9816457	KIT VAL AO SAP3 ULT RSL 29MM	$107,100	$53,550	—	—	6
FMC-9816457	KIT VAL AO SAP3 ULT RSL 29MM	$107,100	$53,550	—	—	12
FMC-9816454	KIT VAL AO SAP3 ULT RSL 20MM	$107,100	$53,550	—	—	8
FMC-9816455	KIT VAL AO SAP3 ULT RSL 23MM	$107,100	$53,550	—	—	8
FMC-9816457	KIT VAL AO SAP3 ULT RSL 29MM	$107,100	$53,550	—	—	8
50300261	Pertuzumab 1200mg-Trastuz 600mg HY-zzxf/ 15mL inj	$103,222	$51,611	—	—	6
50300261	Pertuzumab 1200mg-Trastuz 600mg HY-zzxf/ 15mL inj	$103,222	$51,611	—	—	11
50300261	Pertuzumab 1200mg-Trastuz 600mg HY-zzxf/ 15mL inj	$103,222	$51,611	—	—	9
50010213	Tildrakizumab-asmn 100 mg/mL inj syringe	$99,415	$49,708	—	—	6
50010213	Tildrakizumab-asmn 100 mg/mL inj syringe	$99,415	$49,708	—	—	11
50010213	Tildrakizumab-asmn 100 mg/mL inj syringe	$99,415	$49,708	—	—	9
50300272	Luspatercept-aamt 75 mg Inj	$96,117	$48,058	—	—	6
50300272	Luspatercept-aamt 75 mg Inj	$96,117	$48,058	—	—	11
50300272	Luspatercept-aamt 75 mg Inj	$96,117	$48,058	—	—	9
50300279	mitoMYcin 4 mg/mL ureteral gel Jelmyto 80mg kit	$80,794	$40,397	—	—	6
50300279	mitoMYcin 4 mg/mL ureteral gel Jelmyto 80mg kit	$80,794	$40,397	—	—	11
50300279	mitoMYcin 4 mg/mL ureteral gel Jelmyto 80mg kit	$80,794	$40,397	—	—	9
50010225	Skyrizi (Risankizumab-RZAA) 600mg inj	$76,998	$38,499	—	—	6
50010225	Skyrizi (Risankizumab-RZAA) 600mg inj	$76,998	$38,499	—	—	11
50010225	Skyrizi (Risankizumab-RZAA) 600mg inj	$76,998	$38,499	—	—	9
50251010	Cabotegravir 600mg/3mL-Rilpivirine 900mg/3mL Inj K	$72,415	$36,208	—	—	6
50251010	Cabotegravir 600mg/3mL-Rilpivirine 900mg/3mL Inj K	$72,415	$36,208	—	—	11
50251010	Cabotegravir 600mg/3mL-Rilpivirine 900mg/3mL Inj K	$72,415	$36,208	—	—	9
50010159	Daratumumab/Hyaluronidase-fihj 1800mg-30000 units/	$71,610	$35,805	—	—	6
50010159	Daratumumab/Hyaluronidase-fihj 1800mg-30000 units/	$71,610	$35,805	—	—	11

Showing top 50 of 80,825 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.