BROWN COUNTY HOSPITAL — Hospital Ledger

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
4141707	Ustekinumab 90 Mg/1 Ml Inj [Brwn]	$38,246	$28,685	$2,173	$76,492	7
4141759	Paliperidone 1560 Mg/5 Ml Sus [Brwn]	$29,875	$22,406	$2,173	$59,750	7
4141652	Leuprolide 45 Mg/6 Months Kit (Lupron) [Brwn]	$16,687	$12,515	$2,173	$33,374	7
4141823	Risankizumab-rzaa 60 Mg/ml Sol [Brwn]	$15,180	$11,385	$2,173	$30,360	7
4141726	Vedolizumab 300 Mg Pwd [Brwn]	$13,885	$10,414	$2,173	$27,770	7
4141264	Alteplase 100 Mg Iv Inj [Brwn]	$13,201	$9,901	$2,173	$26,402	7
4141742	Pegfilgrastim Jmdb 6 Mg/0.6 Ml [Brwn]	$12,526	$9,395	$2,173	$25,052	7
4140826	Tenecteplase 50 Mg Iv Inj [Brwn]	$12,471	$9,353	$2,173	$24,942	7
4141276	Octreotide 30 Mg Im Inj [Brwn]	$11,496	$8,622	$2,173	$22,992	7
4141671	Certolizumab 400mg/2ml Kit [Brwn]	$10,800	$8,100	$2,173	$21,600	7
4141803	Pembrolizumab 100mg/4ml Sol [Brwn]	$10,005	$7,504	$2,173	$20,010	7
4140274	Digoxin Immune Fab 40 Mg Inj [Brwn]	$8,679	$6,509	$2,173	$17,358	7
4141818	Durvalumab 50 Mg/ml Sol 10ml [Brwn]	$8,457	$6,343	$2,173	$16,914	7
4140738	Rituximab 500 Mg/50 Ml Iv Sol [Brwn]	$8,457	$6,343	$2,173	$16,914	7
4140069	Darbepoetin Alfa 500 Mcg/1 Ml Inj Sol [Brwn]	$8,127	$6,095	$2,173	$16,254	7
4141825	Aripiprazole 1064 Mg/3.9 Ml Sus-inj [Brwn]	$8,061	$6,046	$2,173	$16,122	7
16977	Puraply Am 6x9	$7,722	$5,792	$5,405	$15,444	7
4141696	Paliperidone 819 Mg/2.63 Ml [Brwn]	$7,423	$5,567	$2,173	$14,846	7
16500	Bioinductive Implant W/ Arth Del Med	$7,157	$5,368	$5,010	$14,314	7
16741	Open Bioinductive Implant 1 Large	$7,140	$5,355	$4,998	$14,280	7
4141574	Adalimumab 40 Mg/0.8 Ml Subq Sol [Brwn]	$7,085	$5,314	$2,173	$14,170	7
4141795	Inclisiran 284 Mg/1.5 Ml Sol [Brwn]	$6,825	$5,119	$2,173	$13,650	7
4140233	Antivenin (Crotalidae) Polyvalentpwd [Brwn]	$6,716	$5,037	$2,173	$13,432	7
16756	Perform Humeral Stem Sz 3	$6,440	$4,830	$4,508	$12,880	7
CP17546872100363595	Removal of tonsils and adenoid glands, patient younger than age 12	$6,073	$4,555	$544	$12,146	7
4141738	Leuprolide 45 Mg/6 Months Pwd For Inj (Eligard) [Brwn]	$5,691	$4,268	$2,173	$11,382	7
4141774	Ferric Derisomaltose 100 Mg/ml Sol [Brwn]	$5,490	$4,118	$2,173	$10,980	7
4334178-TC	74178 Ct Abdomen And Pelvis W/ + W/o Contrast: Addon	$5,471	$4,103	$3,830	$10,942	7
4334178	Ct Abdomen And Pelvis W/ + W/o Contrast	$5,471	$4,103	$541	$10,942	7
CP17546872100363847	Removal of one knee cartilage using an endoscope	$5,312	$3,984	$756	$10,624	7
4334174	Ct Angio Abdomen And Pelvis	$5,255	$3,941	$598	$10,510	7
4141767	Docetaxel 20 Mg/ml Sol [Brwn]	$5,112	$3,834	$2,173	$10,224	7
4141727	Immune Globulin 10% (Octagam) Iv Sol 300 Ml [Brwn]	$4,998	$3,749	$2,173	$9,996	7
4141699	Darbepoetin Alfa 300 Mcg/0.6 Ml Inj Sol [Brwn]	$4,876	$3,657	$2,173	$9,752	7
4141668	Golimumab 50 Mg/4 Ml [Brwn]	$4,798	$3,599	$2,173	$9,596	7
4334177-TC	CT scan of abdomen and pelvis with contrast	$4,689	$3,517	$3,282	$9,378	7
4334177	CT scan of abdomen and pelvis with contrast	$4,689	$3,517	$477	$9,378	7
4295811	95811 Polysom 6/> Yrs Cpap 4/> Parm Charge	$4,600	$3,450	$112	$9,200	7
4328452	Nm Myocardial Spect Multiple Studies	$4,595	$3,446	$1	$9,190	7
16752	Tornier Perform Reversed Fullwedge Bp 15 Deg Dia 25mm	$4,480	$3,360	$3,136	$8,960	7
4141755	Ustekinumab 5 Mg/ml Sol [Brwn]	$4,449	$3,337	$2,173	$8,898	7
4140418	Eptifibatide 200 Mg/100 Ml Iv Sol [Brwn]	$4,388	$3,291	$2,173	$8,776	7
16755	Perform Rev Insert Sz 3/4, 39mm Dia, +0	$4,340	$3,255	$3,038	$8,680	7
4141125	Bortezomib 3.5 Mg Iv/sq Inj [Brwn]	$4,328	$3,246	$2,173	$8,656	7
4384183	Mri Abdomen And Pelvis W/ + W/o Contrast	$4,314	$3,236	$648	$8,628	7
4380553	MRI Scan	$4,314	$3,236	$575	$8,628	7
78451	Nm Myocardial Spect Single Study	$4,314	$3,236	$404	$8,628	7
4328451	Nm Myocardial Spect Single Study Eo	$4,314	$3,236	$404	$8,628	7
4295810	Sleep study	$4,300	$3,225	$61	$8,600	7
4141108	Denosumab 60 Mg/1 Ml Sq Inj [Brwn]	$4,287	$3,215	$2,173	$8,574	7

Showing top 50 of 2,227 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.