MEMORIAL HOSPITAL WEST — Hospital Ledger

45 CFR § 180 compliance

B · 85

This hospital published most of what § 180 requires.

●Machine-readable file published

●Gross / standard charges

●Discounted cash price

●Payer-specific negotiated rates

○Min / max negotiated charges

●Free, public, no login required

Procedures listed

205

Insurances with rates

CPT / HCPCS codes

205

Source MRF

csv ↗

Most expensive procedures (gross)

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
J7298	LEVONORGESTREL IU 52MG 5 YR	$1,907	$1,907	—	—	20
44055	CORRECT BOWEL MALROTATION	$1,589	$1,589	—	—	20
44025	COLOTOMY, EXPLORE/BX/FB REMOVAL	$1,532	$1,532	—	—	20
44020	ENTEROTOMY SM INTESTINE, EXPLORE/BX/FB	$1,511	$1,511	—	—	20
44050	REDUCE VOLV/INTUSS/HERN, LAP	$1,460	$1,460	—	—	20
44021	ENTEROTOMY, SM BOWEL, DECOMPRESS	$1,448	$1,448	—	—	20
J7307	ETONOGESTREL (CONTRACEPTIVE) IMPLANT SYSTEM, IMPLANT/SUPPLY	$1,237	$1,237	—	—	20
J7302	LEVONORGESTREL-RELEASING INTRAUTERINE CONTRACEPTIVE SYSTEM	$1,175	$1,175	—	—	20
58661	LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES	$1,142	$1,142	—	—	20
J7300	INTRAUT COPPER CONTRACEPTIVE	$1,062	$1,062	—	—	20
90378	RSV-IGIM, FOR IM USE, 50MG EACH	$885	$885	—	—	20
S4989	CONTRACEPTIVE INTRAUTERINE DEVICE (E.G. PROGESTACERT IUD)	$880	$880	—	—	20
90734	MCV, SEROGROUPS A, C, Y AND W-135, IM USE	$808	$808	—	—	20
90677	PCV20 VACCINE IM	$770	$770	—	—	20
17004	DESTRUCT BENIGN/PREMALIG LESION; 15 OR >	$706	$706	—	—	20
90732	PNEUMOCOCCAL VACCINE, 23-VALENT, ADULT DOSE SQ/IM USE	$702	$702	—	—	20
90736	ZOSTER (SHINGLES) VACCINE, LIVE, FOR SUBCUTANEOUS INJECTION	$693	$693	—	—	20
25500	CLOSED TREATMENT OF RADIAL SHAFT FX	$654	$654	—	—	20
90670	PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT, FOR IM USE	$557	$557	—	—	20
90723	DTAP, TDS, HEPB, AND IPV, INACTIVATED; FOR IM USE	$537	$537	—	—	20
44015	TUBE/NEEDLE CATH JEJUNOSTOMY	$472	$472	—	—	20
90716	VARICELLA VIRUS VACCINE, LIVE, FOR SUBCUTANEOUS USE	$453	$453	—	—	20
90719	DIPHTHERIA TOXOID, FOR INTRAMUSCULAR USE	$446	$446	—	—	20
J7324	HYALURONAN/DERIVATIVE, ORTHOVISC, INTRA-ARTICULAR INJECT, DS	$435	$435	—	—	20
90710	MMR-VARICELLA VACCINE, LIVE FOR SQ USE(PROQUAD)	$391	$391	—	—	20
99245	OFFICE CONSULT NEW OR ESTAB PT - LEVEL 5	$384	$384	—	—	20
17000	DESTRUCTION OF BENIGN/PREMALIGANT LESIONS; FIRST LESIONS	$367	$367	—	—	20
90651	HPV VACCINE NON VALENT IM	$364	$364	—	—	20
99387	INITIAL PREVENTIVE CARE, NEW PT, =/+ 65Y	$346	$346	—	—	20
90696	DTAP-IPV (KINRIX) CHILDREN 4-6 YRS, FOR IM USE	$340	$340	—	—	20
99397	PERIODIC PREVENTIVE CARE ESTAB PT =/+65Y	$334	$334	—	—	20
99205	OFFICE VISIT - NEW PT, LEVEL 5	$332	$332	—	—	20
90707	MMR VACCINE, LIVE, FOR SQ OR JET INJECTION USE	$318	$318	—	—	20
90698	DTAP, HIB, IPV,(PENTACEL) FOR IM USE	$317	$317	—	—	20
99386	INITIAL PREVENTIVE CARE, NEW PT, 40-64YR	$304	$304	—	—	20
99244	OFFICE CONSULT NEW OR ESTAB PT - LEVEL 4	$304	$304	—	—	20
58301	REMOVE IUD	$290	$290	—	—	20
90715	TDAP VACCINE,(BOOSTRIX) 7 YEARS+, FOR IM USE	$287	$287	—	—	20
G0438	ANNUAL WELLNESS VISIT; INCLUDES A PPS, INITIAL VISIT	$281	$281	—	—	20
G0439	ANNUAL WELLNESS VISIT, INCLUDES A PPS, SUBSEQUENT VISIT	$281	$281	—	—	20
99385	INITIAL PREVENTIVE CARE, NEW PT, 18-39YR	$276	$276	—	—	20
17111	DESTRUCT FLAT WARTS; 15 OR MORE LESIONS	$273	$273	—	—	20
99396	PERIODIC PREVENTIVE CARE ESTAB PT 40-64Y	$264	$264	—	—	20
99243	OFFICE CONSULT NEW OR ESTAB PT - LEVEL 3	$254	$254	—	—	20
99204	OFFICE VISIT - NEW PT, LEVEL 4	$247	$247	—	—	20
58300	INSERT IUD	$240	$240	—	—	20
99215	OFFICE VISIT - ESTABLISHED PT, LEVEL 5	$240	$240	—	—	20
11981	INSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT	$236	$236	—	—	20
11983	REMOVAL W/REINSERT, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT	$234	$234	—	—	20
99350	HOME VISIT, FOR E&M ESTAB PT - LEVEL 4	$234	$234	—	—	20

Showing top 50 of 205 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.