MADISON VALLEY MEDICAL CENTER (Ennis, MT) prices

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
3000596	paliperidone 819 mg/2.63 mL Sus [MVHO]	$18,785	—	—	—	2
3551752	tenecteplase 50 mg Inj [MVHO]	$12,471	—	—	—	2
3000129	immune globulin 10% IV Soln 400 mL [MVHO]	$12,058	—	—	—	4
3000620	tezepelumab ekko 210 mg/1.91 mL Subcut Soln 1.91 mL [MVHO]	$7,272	—	—	—	2
3000128	immune globulin 10% IV Soln 200 mL [MVHO]	$6,029	—	—	—	4
3000568	paliperidone 234 mg/1.5 mL IM Susp, ER 1.5 mL [MVHO]	$6,027	—	—	—	2
3000488	bevacizumab 25 mg/mL IV Soln 16 mL [MVHO]	$5,738	—	—	—	2
300030	golimumab 50 mg/4 mL IV Soln 4 mL [MVHO]	$3,599	—	—	—	2
3000619	immune globulin 10% IV Soln 200 mL [MVHO]	$2,856	—	—	—	2
3557960	denosumab 60 mg/mL Subcut Soln 1 mL [MVHO]	$2,816	—	—	—	4
4200103	64635 RT A SINGLE LEVEL DESTRUCTION BY NEUROLYTIC AGENT PERF	$2,700	—	—	—	2
4200104	64635 LT A SINGLE LEVEL DESTRUCTION BY NEUROLYTIC AGENT PERF	$2,700	—	—	—	2
3770012	�70553 Under Diagnostic Radiology (Diagnostic Imaging) Procedures of the Head and Neck	$2,695	—	—	—	4
4200050	64633 RT DESTR BY NEUROLYTIC AGENT PARAVERTEBRAL FACET JOINT NERVE(S) WITH IMAGING GUID	$2,695	—	—	—	2
3770024	72158�Under Diagnostic Radiology (Diagnostic Imaging) Procedures of the Spine and Pelvis	$2,692	—	—	—	4
4200035	64493 BILAT INJECTION(S) DIAGNOSTIC OR THERAPEUTIC AGENT PARAVERTEBRAL FACET (ZYGAPOPHYSEAL)	$2,556	—	—	—	5
3000486	abatacept 250 mg IV Inj [MVHO]	$2,426	—	—	—	2
3770009	70549 MRA Neck w/ + w/o Contrast	$2,370	—	—	—	2
3000461	omalizumab 150 mg/mL Subcut Soln 1 mL [MVHO]	$2,308	—	—	—	2
4200027	64483 BILAT INJECTION(S) ANESTHETIC AGENT AND/OR STEROID TRANSFORAMINAL EPIDURAL WITH IMAGING	$2,185	—	—	—	3
3000087	inFLIXimab 100 mg IV Inj (REMICADE) [MVHO]	$2,102	—	—	—	2
3000572	ferumoxytol 30 mg/mL IV Soln 20mL [MVHO]	$2,086	—	—	—	2
3770047	74183 MRI Abdomen w/ + w/o Contrast	$1,994	—	—	—	2
3770040	73720 MRI Lower Extremity w/ + w/o Cnt Left	$1,979	—	—	—	2
3770061	73220 MRI Upper Extremity w/ + w/o Cnt Right	$1,969	—	—	—	2
3770003	70543 MRI Face Neck Orbit w/ + w/o Contrast	$1,936	—	—	—	2
3770055	73723 MRI LE Joint w/ + w/o Contrast Right	$1,852	—	—	—	2
4200053	64635 BILAT DESTR BY NEUROLYTIC AGENT PARAVERTEBRAL FACET JOINT NERVE(S) WITH IMAGING	$1,745	—	—	—	1
3200057	25605 CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PE	$1,663	—	—	—	1
3770004	70544 MRA Brain/Head w/o Contrast	$1,542	—	—	—	2
3000270	immune globulin 10% IV Soln 50 mL [MVHO]	$1,508	—	—	—	4
4200012	27096 BILAT INJECTION PROCEDURE FOR SACROILIAC JOINT ANESTHETIC/STEROID WITH IMAGE GUIDANCE	$1,500	—	—	—	1
3760092	75635 CT Angio Abdomen Aorta + Iliofemoral	$1,497	—	—	—	4
3760097	CT Abd/pelvis w/o Contrast	$1,487	—	—	—	6
3557392	fluticasonesalmeterol 500 mcg50 mcg Inh Powder [MVHO]	$1,477	—	—	—	2
3770027	72195 MRI Pelvis w/o Contrast	$1,475	—	—	—	4
3200071	27818 CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION Pr	$1,466	—	—	—	1
3770031	73218 MRI Upper Extremity w/o Contrast Left	$1,437	—	—	—	4
3770057	73718 MRI Lower Extremity w/o Contrast Right	$1,437	—	—	—	4
3770060	73218 MRI Upper Extremity w/o Contrast Right	$1,437	—	—	—	2
3000487	bevacizumab 25 mg/mL IV Soln 4 mL [MVHO]	$1,435	—	—	—	2
3760099	74178 CT Abdomen and Pelvis w/ + w/o Contrast	$1,389	—	—	—	6
3760103	74178 CT Abdomen and Pelvis w/ + w/o Contrast	$1,389	—	—	—	2
3150004	99291 Critical Care, First Hour	$1,354	—	—	—	1
3557720	DAPTOmycin 500 mg IV Inj [MVHO]	$1,337	—	—	—	6
4200049	64633 LT DESTR BY NEUROLYTIC AGENT PARAVERTEBRAL FACET JOINT NERVE(S) WITH IMAGING GUID	$1,296	—	—	—	2
400083	64493 RT Injection(s), diagnostic or therapeutic agent, para	$1,278	—	—	—	2
3770022	72148 MRI Spine Lumbar w/o Contrast	$1,263	—	—	—	6
3000334	PREMIX esmolol 10 mg/mL IV Soln 250 mL [MVHO]	$1,262	—	—	—	2
3200076	23655 CLSD TX SHOULDER DISLC W/MANIPULATION REQ AN	$1,242	—	—	—	1

Showing top 50 of 833 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.