Mt. Graham Regional Medical Center prices

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
J0202	CAMPATH INJ 1 MG	$37,267	$26,087	—	—	7
J2997	ALTEPLASE INJ 1 MG	$17,626	$12,338	—	—	7
C9364	15 X 20 PERMACOL *S	$16,500	$11,550	—	—	7
C1764	IMPLANT LOOP *S	$11,000	$7,700	—	—	7
J0600	CALC DISODIUM EDETATE INJ 1000	$10,796	$7,557	—	—	7
0441T	ABLATION RADIOFREQUENCY NERVE	$9,603	$6,722	—	—	7
J9355	TRASTUZUMAB INJ 10 MG	$9,168	$6,417	—	—	7
36832	AV FISTULA REVISION, OPEN	$9,154	$6,408	—	—	7
J0716	CENTRUROIDES IMMUNE 120 MG	$8,868	$6,207	—	—	7
J2353	OCTREOTIDE DEPOT INJ 1 MG	$8,187	$5,731	—	—	7
25690	LUNATE DISLOCATION W/MANIP	$8,138	$5,697	—	—	7
J0717	CERTOLIZUMAB PEGOL INJ 1 MG	$8,114	$5,680	—	—	7
A9572	NM RADIOPHARM IN-111	$7,918	$5,543	—	—	7
33210	IV PACER INSERTION	$7,798	$5,459	—	—	7
63650	PERC IMP NEUROSTIM	$7,614	$5,330	—	—	7
26615	OPEN TREATMENT METACARPAL FRAC	$7,582	$5,307	—	—	7
J1950	LEUPROLIDE ACETATE INJ 3.75 MG	$7,372	$5,160	—	—	7
J1162	DIGOXIN IMMUNE FAB 1 VIAL	$7,125	$4,988	—	—	7
26607	CL TX MC FX W MANIP/FIXAT	$7,004	$4,903	—	—	7
57200	COLPORRHAPHY	$6,821	$4,775	—	—	7
J9305	PEMETREXED INJ 10 MG	$6,790	$4,753	—	—	7
25260	FLEXOR TENDON REPAIR	$6,608	$4,626	—	—	7
90375	RABIES IMMUNE GLOBULIN 10 ML	$6,507	$4,555	—	—	7
J0840	CROFAB INJ 1 GM	$6,421	$4,495	—	—	7
J3535	BECLOMETHASONE AQ NASAL INH:25	$6,337	$4,436	—	—	7
49418	INSERT TUN IP CATH PERC	$6,189	$4,332	—	—	7
38999	CATHETER INSERTION BONE MARROW	$6,161	$4,313	—	—	7
J9033	BENDAMUSTINE INJ 1 MG	$5,969	$4,178	—	—	7
20694	REM EXT FIX SYS W ANESTH	$5,600	$3,920	—	—	7
27552	KNEE DISLOCATION W/ANESTHESIA	$5,557	$3,890	—	—	7
20680	REMOVAL OF IMPLANT DEEP	$5,545	$3,882	—	—	7
78816	PET TUMOR IMAGING, FULL BODY	$5,488	$1,905	—	—	7
78608	PET/CT BRAIN IMAGING, METABOLI	$5,433	$1,905	—	—	7
11772	EXC PILONIDAL CYST,COMPL	$5,337	$3,736	—	—	7
78609	PET/CT BRAIN IMAGE, PERFUSION	$5,297	$3,708	—	—	7
11770	REMOVE PILONIDAL LESION,SIMPLE	$5,282	$3,697	—	—	7
78815	PET TUMOR IMAGE, SKULL-THIGH	$5,250	$1,905	—	—	7
A4642	NM RADIOPHARM I-111 PENTREOTID	$5,155	$3,609	—	—	7
42182	REPAIR PALATE LAC >2CM	$5,021	$3,515	—	—	7
36557	INSERT TUNNEL CV CATH <5	$4,967	$3,477	—	—	7
78814	PET/CT TUMOR IMAGING, LIMITED	$4,966	$1,905	—	—	7
51040	INCISION/DRAINAGE OF BLADDER	$4,895	$3,427	—	—	7
78466	NM PYP INFARCT AVID	$4,869	$486	—	—	7
11771	EXC PILONIDAL CYST ,EXTENS	$4,857	$3,400	—	—	7
95782	POLYSOMNOGRAPHY <6	$4,836	$3,385	—	—	7
26410	REPAIR HAND TENDON	$4,827	$3,379	—	—	7
36558	INSERT TUNNEL CV CATH >5	$4,796	$3,357	—	—	7
26350	REP FLXR TENDON WO GRAFT	$4,701	$3,291	—	—	7
26765	OPEN TX DISTAL PHALAN FX EA	$4,688	$3,282	—	—	7
26020	DRAIN TENDON SHEATH EA	$4,620	$3,234	—	—	7

Showing top 50 of 2,285 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.