45 CFR § 180 compliance
D · 65
This hospital published part 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
1,577
Insurances with rates
3
CPT / HCPCS codes
1,562
Source MRF
Most expensive procedures (gross)
J2351
$46,442
ocrelizumab- hyaluronidase 920 mg-23,000 units/23 mL [SAMC]
Gross
$61,923
J3357
$29,832
ustekinumab 90 mg/mL SQ [SAMC]
Gross
$39,776
J2350
$20,625
ocrelizumab 300 mg/10 mL [SAMC]
Gross
$27,500
J2329
$11,063
ublituximab 150 mg/6 mL Sol
Gross
$14,750
J2337
$10,278
risankizumab rzaa 60 mg/mL Sol
Gross
$13,705
J2997
$9,900
alteplase 100 mg IV Inj [SAMC]
Gross
$13,201
J3380
$9,566
vedolizumab 300 mg Inj [SAMC]
Gross
$12,755
J2323
$9,191
natalizumab 300 mg/15 mL Con [SAMC]
Gross
$12,255
Q5111
$8,141
pegfilgrastim cbqv 6 mg/0.6 mL [SAMC]
Gross
$10,855
J3101
$7,603
tenecteplase 50 mg IV Inj [SAMC]
Gross
$10,138
J2506
$7,290
pegfilgrastim 6 mg/0.6 mL OnPro Inj [SAMC]
Gross
$9,720
J0717
$5,634
certolizumab 400 mg Kit [SAMC]
Gross
$7,512
J1449
$5,265
eflapegrastim xnst 13.2 mg/0.6 mL [SAMC]
Gross
$7,020
Q5130
$5,250
pegfilgrastim pbbk 6 mg/0.6 mL Sol
Gross
$7,000
Q5120
$4,946
pegfilgrastim bmez 6 mg/0.6 mL Sol [SAMC]
Gross
$6,595
Q5122
$4,946
pegfilgrastim apgf 6 mg/0.6 mL SubQ Inj [SAMC]
Gross
$6,594
70471
$4,883
CT Angio Head/Neck w/ Contrast
Gross
$6,510
J0565
$4,788
bezlotoxumab 25 mg/mL Sol [SAMC]
Gross
$6,384
74174
$4,749
CT Angio Abdomen and Pelvis
Gross
$6,332
74178
$4,607
CT Abdomen and Pelvis w/ + w/o Contrast
Gross
$6,142
72157
$4,148
MRI Spine Thoracic w/ + w/o Contrast
Gross
$5,530
74177
$4,098
CT Abdomen and Pelvis w/ Contrast
Gross
$5,464
J1437
$4,091
ferric derisomaltose 100 mg/mL [SAMC]
Gross
$5,455
95811
$3,915
POLYSOMNOGRAPHY CPAP
Gross
$5,220
72156
$3,904
MRI Spine Cervical w/ + w/o Contrast
Gross
$5,205
78452
$3,716
NM Myocardial SPECT Rest and Stress
Gross
$4,955
74183
$3,677
MRI Abdomen w/ + w/o Contrast
Gross
$4,902
72158
$3,671
MRI Spine Lumbar w/ + w/o Contrast
Gross
$4,894
70553
$3,667
MRI Brain w/ w/o Contrast
Gross
$4,889
J0897
$3,626
denosumab 120 mg/1.7 mL [SAMC]
Gross
$4,834
95810
$3,575
POLYSOMNOGRAPHY
Gross
$4,766
72142
$3,560
MRI Spine Cervical w/ Contrast
Gross
$4,746
J1306
$3,529
inclisiran 284 mg/1.5 mL Sol
Gross
$4,705
74185
$3,506
MRA Abdomen w/ + w/o Contrast
Gross
$4,674
74176
$3,452
CT Abdomen and Pelvis w/o Contrast
Gross
$4,602
70543
$3,324
MRI Face Neck Orbit w/ + w/o Contrast
Gross
$4,432
70546
$3,319
MRA Brain/Head w/ + w/o Contrast
Gross
$4,425
71552
$3,319
MRI Chest w/ + w/o Contrast
Gross
$4,425
71551
$3,265
MRI Chest w/ Contrast
Gross
$4,353
72197
$3,265
MRI Pelvis w/ + w/o Contrast
Gross
$4,353
74181
$3,191
MRI Abdomen w/o Contrast
Gross
$4,254
J3111
$3,155
romosozumab 105 mg/1.17 mL Sol
Gross
$4,206
74182
$3,134
MRI Abdomen w/ Contrast
Gross
$4,178
71275
$3,107
CT Angio Chest
Gross
$4,143
72141
$3,074
MRI Spine Cervical w/o Contrast
Gross
$4,099
72148
$3,074
MRI Spine Lumbar w/o Contrast
Gross
$4,099
78451
$3,071
NM Myocardial SPECT Single Study
Gross
$4,095
70552
$3,070
MRI Brain w/ Contrast
Gross
$4,093
71550
$3,070
MRI Chest w/o Contrast
Gross
$4,093
72147
$3,070
MRI Spine Thoracic w/ Contrast
Gross
$4,093
| Code | Description | Gross | Cash | Min payer | Max payer | # insurers |
|---|---|---|---|---|---|---|
| J2351 | ocrelizumab- hyaluronidase 920 mg-23,000 units/23 mL [SAMC] | $61,923 | $46,442 | — | — | 0 |
| J3357 | ustekinumab 90 mg/mL SQ [SAMC] | $39,776 | $29,832 | — | — | 0 |
| J2350 | ocrelizumab 300 mg/10 mL [SAMC] | $27,500 | $20,625 | — | — | 0 |
| J2329 | ublituximab 150 mg/6 mL Sol | $14,750 | $11,063 | — | — | 0 |
| J2337 | risankizumab rzaa 60 mg/mL Sol | $13,705 | $10,278 | — | — | 0 |
| J2997 | alteplase 100 mg IV Inj [SAMC] | $13,201 | $9,900 | — | — | 0 |
| J3380 | vedolizumab 300 mg Inj [SAMC] | $12,755 | $9,566 | — | — | 0 |
| J2323 | natalizumab 300 mg/15 mL Con [SAMC] | $12,255 | $9,191 | — | — | 0 |
| Q5111 | pegfilgrastim cbqv 6 mg/0.6 mL [SAMC] | $10,855 | $8,141 | — | — | 0 |
| J3101 | tenecteplase 50 mg IV Inj [SAMC] | $10,138 | $7,603 | — | — | 0 |
| J2506 | pegfilgrastim 6 mg/0.6 mL OnPro Inj [SAMC] | $9,720 | $7,290 | — | — | 0 |
| J0717 | certolizumab 400 mg Kit [SAMC] | $7,512 | $5,634 | — | — | 0 |
| J1449 | eflapegrastim xnst 13.2 mg/0.6 mL [SAMC] | $7,020 | $5,265 | — | — | 0 |
| Q5130 | pegfilgrastim pbbk 6 mg/0.6 mL Sol | $7,000 | $5,250 | — | — | 0 |
| Q5120 | pegfilgrastim bmez 6 mg/0.6 mL Sol [SAMC] | $6,595 | $4,946 | — | — | 0 |
| Q5122 | pegfilgrastim apgf 6 mg/0.6 mL SubQ Inj [SAMC] | $6,594 | $4,946 | — | — | 0 |
| 70471 | CT Angio Head/Neck w/ Contrast | $6,510 | $4,883 | — | — | 0 |
| J0565 | bezlotoxumab 25 mg/mL Sol [SAMC] | $6,384 | $4,788 | — | — | 0 |
| 74174 | CT Angio Abdomen and Pelvis | $6,332 | $4,749 | — | — | 0 |
| 74178 | CT Abdomen and Pelvis w/ + w/o Contrast | $6,142 | $4,607 | — | — | 0 |
| 72157 | MRI Spine Thoracic w/ + w/o Contrast | $5,530 | $4,148 | — | — | 0 |
| 74177 | CT Abdomen and Pelvis w/ Contrast | $5,464 | $4,098 | — | — | 0 |
| J1437 | ferric derisomaltose 100 mg/mL [SAMC] | $5,455 | $4,091 | — | — | 0 |
| 95811 | POLYSOMNOGRAPHY CPAP | $5,220 | $3,915 | — | — | 0 |
| 72156 | MRI Spine Cervical w/ + w/o Contrast | $5,205 | $3,904 | — | — | 0 |
| 78452 | NM Myocardial SPECT Rest and Stress | $4,955 | $3,716 | — | — | 0 |
| 74183 | MRI Abdomen w/ + w/o Contrast | $4,902 | $3,677 | — | — | 0 |
| 72158 | MRI Spine Lumbar w/ + w/o Contrast | $4,894 | $3,671 | — | — | 0 |
| 70553 | MRI Brain w/ w/o Contrast | $4,889 | $3,667 | — | — | 0 |
| J0897 | denosumab 120 mg/1.7 mL [SAMC] | $4,834 | $3,626 | — | — | 0 |
| 95810 | POLYSOMNOGRAPHY | $4,766 | $3,575 | — | — | 0 |
| 72142 | MRI Spine Cervical w/ Contrast | $4,746 | $3,560 | — | — | 0 |
| J1306 | inclisiran 284 mg/1.5 mL Sol | $4,705 | $3,529 | — | — | 0 |
| 74185 | MRA Abdomen w/ + w/o Contrast | $4,674 | $3,506 | — | — | 0 |
| 74176 | CT Abdomen and Pelvis w/o Contrast | $4,602 | $3,452 | — | — | 0 |
| 70543 | MRI Face Neck Orbit w/ + w/o Contrast | $4,432 | $3,324 | — | — | 0 |
| 70546 | MRA Brain/Head w/ + w/o Contrast | $4,425 | $3,319 | — | — | 0 |
| 71552 | MRI Chest w/ + w/o Contrast | $4,425 | $3,319 | — | — | 0 |
| 71551 | MRI Chest w/ Contrast | $4,353 | $3,265 | — | — | 0 |
| 72197 | MRI Pelvis w/ + w/o Contrast | $4,353 | $3,265 | — | — | 0 |
| 74181 | MRI Abdomen w/o Contrast | $4,254 | $3,191 | — | — | 0 |
| J3111 | romosozumab 105 mg/1.17 mL Sol | $4,206 | $3,155 | — | — | 0 |
| 74182 | MRI Abdomen w/ Contrast | $4,178 | $3,134 | — | — | 0 |
| 71275 | CT Angio Chest | $4,143 | $3,107 | — | — | 0 |
| 72141 | MRI Spine Cervical w/o Contrast | $4,099 | $3,074 | — | — | 0 |
| 72148 | MRI Spine Lumbar w/o Contrast | $4,099 | $3,074 | — | — | 0 |
| 78451 | NM Myocardial SPECT Single Study | $4,095 | $3,071 | — | — | 0 |
| 70552 | MRI Brain w/ Contrast | $4,093 | $3,070 | — | — | 0 |
| 71550 | MRI Chest w/o Contrast | $4,093 | $3,070 | — | — | 0 |
| 72147 | MRI Spine Thoracic w/ Contrast | $4,093 | $3,070 | — | — | 0 |
Showing top 50 of 1,577 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.