45 CFR § 180 compliance
F · 50
This hospital published little 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
10,468
Insurances with rates
0
CPT / HCPCS codes
906
Source MRF
Most expensive procedures (gross)
J3101
—
TENECTEPLASE (TNKase) INJ : 50 MG
Gross
$16,524
J3380
—
VEDOLIZUMAB (ENTYVIO) INJ: 300 MG
Gross
$15,502
J1162
—
DIGIBIND (DIGOXIN IMMUNE FAB) : 40 MG
Gross
$12,674
J2505
—
PEGFILGRASTIM (NEULASTA) INJ: 6 MG/0.6ML
Gross
$11,960
J1950
—
LUPRON INJ : 22.5 MG (3 MONTH)
Gross
$10,594
NF-GLATIRAMER (COPAXONE) SQ KIT 20MG/1ML
—
NF-GLATIRAMER (COPAXONE) SQ KIT 20MG/1ML
Gross
$9,754
74174TC
—
CTA ABD/PELVIS
Gross
$9,660
15273
—
SKIN SUB GRAFT T/ARM/LG CHILD 20-29MIN
Gross
$9,193
O/R LITHOTRIPSY
—
O/R LITHOTRIPSY
Gross
$8,085
NF-VANTAS 50 MG(HISTRELIN) SUBQ IMPLANT
—
NF-VANTAS 50 MG(HISTRELIN) SUBQ IMPLANT
Gross
$8,013
74177TC
—
CT ABD/PELVIS WITH IV AND ORAL
Gross
$7,097
74178TC
—
CT ABD/PELVIS W/WO
Gross
$7,097
70543TC
—
MRI ORBIT/FACE/ST NECK W/O W CONTRAST
Gross
$6,806
74176TC
—
CT ABD/PELVIS W/ORAL ONLY
Gross
$6,748
78816TC
—
PET SKULL VERTEX TO TOES
Gross
$6,251
72198TC
—
MRA PELVIS
Gross
$6,170
71550TC
—
MRI CHEST W/O
Gross
$6,109
72156TC
—
MRI C-SPINE W/O W/CONTRAST
Gross
$6,046
72157TC
—
MRI T-SPINE W/O W/CONTRAST
Gross
$6,046
72158TC
—
MRI L-SPINE W/O W/CONTRAST
Gross
$6,046
DARBEPOETIN (ARANESP) : 300 MCG INJ
—
DARBEPOETIN (ARANESP) : 300 MCG INJ
Gross
$5,985
70546
—
MRA HEAD W W/O CONTRAST ANGIO
Gross
$5,833
70492TC
—
CT NECK SOFT TISSUE W/O W/IV CONT (ROUT)
Gross
$5,828
95811
—
CPAP/BIPAP TITRATION
Gross
$5,625
73723TC
—
MRI JOINT LOWER EXT W/O AND W
Gross
$5,575
73720TC
—
DO NOT USE
Gross
$5,575
74181TC
—
MRI ABDOMEN W/O CONTRAST
Gross
$5,568
72195TC
—
MRI PELVIS W0 CONT
Gross
$5,568
74182TC
—
MRI ABDOMEN W CONTRAST
Gross
$5,568
74183TC
—
MRI ABDOMEN W/O W CONTRAST
Gross
$5,568
72197TC
—
MRI SACRUM W/O W CONTRAST
Gross
$5,568
72141TC
—
MRI C-SPINE W/O CONTRAST
Gross
$5,557
72142TC
—
MRI C-SPINE W/CONTRAST
Gross
$5,557
72146TC
—
MRI T-SPINE W/O (ROUTINE)
Gross
$5,557
72147TC
—
MRI T-SPINE W/CONTRAST
Gross
$5,557
72148TC
—
MRI L-SPINE W/O CONT (ROUT)
Gross
$5,557
72149TC
—
MRI L-SPINE W/CONTRAST
Gross
$5,557
70552TC
—
MRI HEAD/BRAIN W/CONTRAST
Gross
$5,557
71555TC
—
MRI BRACHIAL PLEXUS
Gross
$5,557
71551TC
—
MRI CHEST W/CONTRAST
Gross
$5,557
71552TC
—
MRI CHEST W/O W CONTR
Gross
$5,557
70553TC
—
MRI HEAD/BRAIN W/O W/CONTRAST
Gross
$5,544
J1602
—
GOLIMUMAB (SIMPONI ARIA) INJ: 50MG/4ML
Gross
$5,525
78815TC
—
PET SKULL BASE TO MID-THIGH
Gross
$5,424
81162TC
—
.BRCA1 AND BRCA2
Gross
$5,382
J9305
—
PEMETREXED (ALIMTA)INJ: 500 MG VIAL
Gross
$5,260
70551TC
—
MRI BRAIN W/O CONTRAST
Gross
$5,257
70552
—
MRI BRAIN W/CONTRAST
Gross
$5,257
70540TC
—
MRI ORBIT/FACE/ST NECK W/O CONTRAST
Gross
$5,257
70336TC
—
MRI TEMPOROMANDIBULAR JOINT
Gross
$5,257
| Code | Description | Gross | Cash | Min payer | Max payer | # insurers |
|---|---|---|---|---|---|---|
| J3101 | TENECTEPLASE (TNKase) INJ : 50 MG | $16,524 | — | — | — | 0 |
| J3380 | VEDOLIZUMAB (ENTYVIO) INJ: 300 MG | $15,502 | — | — | — | 0 |
| J1162 | DIGIBIND (DIGOXIN IMMUNE FAB) : 40 MG | $12,674 | — | — | — | 0 |
| J2505 | PEGFILGRASTIM (NEULASTA) INJ: 6 MG/0.6ML | $11,960 | — | — | — | 0 |
| J1950 | LUPRON INJ : 22.5 MG (3 MONTH) | $10,594 | — | — | — | 0 |
| NF-GLATIRAMER (COPAXONE) SQ KIT 20MG/1ML | NF-GLATIRAMER (COPAXONE) SQ KIT 20MG/1ML | $9,754 | — | — | — | 0 |
| 74174TC | CTA ABD/PELVIS | $9,660 | — | — | — | 0 |
| 15273 | SKIN SUB GRAFT T/ARM/LG CHILD 20-29MIN | $9,193 | — | — | — | 0 |
| O/R LITHOTRIPSY | O/R LITHOTRIPSY | $8,085 | — | — | — | 0 |
| NF-VANTAS 50 MG(HISTRELIN) SUBQ IMPLANT | NF-VANTAS 50 MG(HISTRELIN) SUBQ IMPLANT | $8,013 | — | — | — | 0 |
| 74177TC | CT ABD/PELVIS WITH IV AND ORAL | $7,097 | — | — | — | 0 |
| 74178TC | CT ABD/PELVIS W/WO | $7,097 | — | — | — | 0 |
| 70543TC | MRI ORBIT/FACE/ST NECK W/O W CONTRAST | $6,806 | — | — | — | 0 |
| 74176TC | CT ABD/PELVIS W/ORAL ONLY | $6,748 | — | — | — | 0 |
| 78816TC | PET SKULL VERTEX TO TOES | $6,251 | — | — | — | 0 |
| 72198TC | MRA PELVIS | $6,170 | — | — | — | 0 |
| 71550TC | MRI CHEST W/O | $6,109 | — | — | — | 0 |
| 72156TC | MRI C-SPINE W/O W/CONTRAST | $6,046 | — | — | — | 0 |
| 72157TC | MRI T-SPINE W/O W/CONTRAST | $6,046 | — | — | — | 0 |
| 72158TC | MRI L-SPINE W/O W/CONTRAST | $6,046 | — | — | — | 0 |
| DARBEPOETIN (ARANESP) : 300 MCG INJ | DARBEPOETIN (ARANESP) : 300 MCG INJ | $5,985 | — | — | — | 0 |
| 70546 | MRA HEAD W W/O CONTRAST ANGIO | $5,833 | — | — | — | 0 |
| 70492TC | CT NECK SOFT TISSUE W/O W/IV CONT (ROUT) | $5,828 | — | — | — | 0 |
| 95811 | CPAP/BIPAP TITRATION | $5,625 | — | — | — | 0 |
| 73723TC | MRI JOINT LOWER EXT W/O AND W | $5,575 | — | — | — | 0 |
| 73720TC | DO NOT USE | $5,575 | — | — | — | 0 |
| 74181TC | MRI ABDOMEN W/O CONTRAST | $5,568 | — | — | — | 0 |
| 72195TC | MRI PELVIS W0 CONT | $5,568 | — | — | — | 0 |
| 74182TC | MRI ABDOMEN W CONTRAST | $5,568 | — | — | — | 0 |
| 74183TC | MRI ABDOMEN W/O W CONTRAST | $5,568 | — | — | — | 0 |
| 72197TC | MRI SACRUM W/O W CONTRAST | $5,568 | — | — | — | 0 |
| 72141TC | MRI C-SPINE W/O CONTRAST | $5,557 | — | — | — | 0 |
| 72142TC | MRI C-SPINE W/CONTRAST | $5,557 | — | — | — | 0 |
| 72146TC | MRI T-SPINE W/O (ROUTINE) | $5,557 | — | — | — | 0 |
| 72147TC | MRI T-SPINE W/CONTRAST | $5,557 | — | — | — | 0 |
| 72148TC | MRI L-SPINE W/O CONT (ROUT) | $5,557 | — | — | — | 0 |
| 72149TC | MRI L-SPINE W/CONTRAST | $5,557 | — | — | — | 0 |
| 70552TC | MRI HEAD/BRAIN W/CONTRAST | $5,557 | — | — | — | 0 |
| 71555TC | MRI BRACHIAL PLEXUS | $5,557 | — | — | — | 0 |
| 71551TC | MRI CHEST W/CONTRAST | $5,557 | — | — | — | 0 |
| 71552TC | MRI CHEST W/O W CONTR | $5,557 | — | — | — | 0 |
| 70553TC | MRI HEAD/BRAIN W/O W/CONTRAST | $5,544 | — | — | — | 0 |
| J1602 | GOLIMUMAB (SIMPONI ARIA) INJ: 50MG/4ML | $5,525 | — | — | — | 0 |
| 78815TC | PET SKULL BASE TO MID-THIGH | $5,424 | — | — | — | 0 |
| 81162TC | .BRCA1 AND BRCA2 | $5,382 | — | — | — | 0 |
| J9305 | PEMETREXED (ALIMTA)INJ: 500 MG VIAL | $5,260 | — | — | — | 0 |
| 70551TC | MRI BRAIN W/O CONTRAST | $5,257 | — | — | — | 0 |
| 70552 | MRI BRAIN W/CONTRAST | $5,257 | — | — | — | 0 |
| 70540TC | MRI ORBIT/FACE/ST NECK W/O CONTRAST | $5,257 | — | — | — | 0 |
| 70336TC | MRI TEMPOROMANDIBULAR JOINT | $5,257 | — | — | — | 0 |
Showing top 50 of 10,468 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.