MERCY HOSPITAL STODDARD — Hospital Ledger

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
RX-244996	EFGARTIGIMOD ALFA 1008 MG-HYALURON-QVFC 11,200 UNIT/5.6 ML SUBCUT SOLN	$60,344	$39,223	—	—	90
093	OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC	$48,536	$31,548	—	—	79
CASE-36593	Declot Thrombolytic of Vad	$47,302	$30,747	—	—	63
RX-231925	LUSPATERCEPT-AAMT 75 MG SUBCUTANEOUS SOLUTION\|RX AMT DISCARD/NOT ADMIN TO PT	$45,365	$29,487	—	—	90
RX-191027	CABAZITAXEL 10 MG/ML (FIRST DILUTION) INTRAVENOUS SOLUTION	$42,527	$27,643	—	—	89
RX-218713	ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION	$42,206	$27,434	—	—	90
RX-227274	CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION\|RX AMT DISCARD/NOT ADMIN TO PT	$39,775	$25,854	—	—	90
RX-233531	DARATUMUMAB 1,800 MG-HYALURONIDASE-FIHJ 30,000 UNIT/15 ML SUBCUT SOLN	$39,657	$25,777	—	—	90
643	ENDOCRINE DISORDERS WITH MCC	$34,199	$22,230	—	—	79
RX-194025	IPILIMUMAB 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION	$33,302	$21,646	—	—	90
177	RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC	$32,315	$21,005	—	—	79
RX-207710	OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION	$32,310	$21,001	—	—	90
640	MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC	$31,449	$20,442	—	—	79
RX-233784	LURBINECTEDIN 4 MG INTRAVENOUS SOLUTION	$30,425	$19,776	—	—	89
605	TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC	$29,806	$19,374	—	—	79
RX-229308	ATEZOLIZUMAB 840 MG/14 ML (60 MG/ML) INTRAVENOUS SOLUTION\|RX AMT DISCARD/NOT ADMIN TO PT	$29,536	$19,198	—	—	90
RX-224645	NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION	$29,214	$18,989	—	—	90
178	RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC	$28,678	$18,641	—	—	79
RX-209334	RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION\|RX AMT DISCARD/NOT ADMIN TO PT	$27,588	$17,932	—	—	89
RX-179915	PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION	$27,187	$17,671	—	—	90
RX-79826	ALTEPLASE 100 MG INTRAVENOUS SOLUTION	$26,401	$17,161	—	—	90
RX-213469	OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE	$25,934	$16,857	—	—	90
RX-200555	PERTUZUMAB 420 MG/14 ML (30 MG/ML) INTRAVENOUS SOLUTION	$25,589	$16,633	—	—	90
372	MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC	$25,421	$16,524	—	—	79
555	SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC	$25,023	$16,265	—	—	79
RX-254199	TENECTEPLASE 25 MG INTRAVENOUS SOLUTION	$24,892	$16,180	—	—	89
RX-225219	TENECTEPLASE 50 MG INTRAVENOUS SOLUTION	$24,892	$16,180	—	—	89
RX-243179	MIRVETUXIMAB SORAVTANSINE-GYNX 5 MG/ML INTRAVENOUS SOLUTION	$24,886	$16,176	—	—	89
280	ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC	$23,757	$15,442	—	—	79
439	DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC	$23,137	$15,039	—	—	79
391	ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC	$23,061	$14,990	—	—	79
RX-213967	IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION	$22,594	$14,686	—	—	356
RX-212708	PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION\|RX AMT DISCARD/NOT ADMIN TO PT	$22,116	$14,376	—	—	90
309	CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC	$21,906	$14,239	—	—	77
948	SIGNS AND SYMPTOMS WITHOUT MCC	$21,575	$14,024	—	—	79
861	SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS,MODERATE	$21,575	—	—	—	1
862	POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC	$21,398	$13,909	—	—	79
463	KIDNEY AND URINARY TRACT INFECTIONS,MAJOR	$20,994	—	—	—	1
871	SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC	$20,944	$13,613	—	—	79
371	MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC	$20,599	$13,389	—	—	79
189	PULMONARY EDEMA AND RESPIRATORY FAILURE	$20,165	$13,107	—	—	79
312	SYNCOPE AND COLLAPSE	$19,614	$12,749	—	—	79
179	RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC	$19,389	$12,603	—	—	79
RX-83055	PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE	$19,254	$12,515	—	—	90
RX-212539	PEGFILGRASTIM 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUTANEOUS INJECTOR	$19,254	$12,515	—	—	90
466	MALFUNCTION, REACTION, COMPLICATION OF GENITOURINARY DEVICE OR PROCEDURE,MAJOR	$19,118	—	—	—	1
698	OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC	$19,118	$12,427	—	—	79
202	BRONCHITIS AND ASTHMA WITH CC/MCC	$18,981	$12,338	—	—	79
308	CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC	$18,976	$12,334	—	—	79
194	SIMPLE PNEUMONIA AND PLEURISY WITH CC	$18,041	$11,727	—	—	79

Showing top 50 of 2,646 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.