ANTELOPE MEMORIAL HOSPITAL

CCN 281326

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
4,801
Insurances with rates
0
CPT / HCPCS codes
0
Source MRF

Most expensive procedures (gross)

1620548
—
ALPHA PRIME STIMULATOR
Gross
$30,752
1620578
—
SIDUS STEM FREE ANCHOR
Gross
$12,994
1620556
—
TAILORS PLATE
Gross
$9,750
1620181
—
XCELLERATE
Gross
$8,700
1620857
—
LYOPHILIZED AMNIONTIC MEMBRANE
Gross
$8,700
1650240
—
OR 1-15 MIN D
Gross
$8,541
4000026
—
PET/CT WHOLE BODY
Gross
$8,500
1620698
—
PLATE 30MM
Gross
$8,250
4000025
—
PET/CT BOD SKULL/ THIGH
Gross
$8,250
2010607
—
CT ABD&PELV WITH&WITHOUT CONTRAST
Gross
$8,127
4000024
—
PET/CT LIMTED AREA
Gross
$7,750
1620646
—
OSSEOTI MULTIHOLE
Gross
$7,717
1620583
—
COMP PRIMARY STEM
Gross
$7,590
2074178
—
MRA CAROTID W/WO
Gross
$7,218
1710274
—
VAGINAL DELIV ER
Gross
$7,106
1610139
—
MEMBRANE GRAFT 3X6
Gross
$6,675
2010660
—
CTA ADB & PELVIS
Gross
$6,547
4000002
—
NUCMED SPECT CARD REST&STRESS
Gross
$6,500
1620681
—
V92 BONE MATRIX
Gross
$6,375
2010214
—
VENOGRAM
Gross
$6,315
1620159
—
PSN FEM CR CMT CCR
Gross
$6,113
2310003
—
SLEEP STUDY SPLIT
Gross
$6,050
2010608
—
CT ABD&PELV WITH CONTRAST
Gross
$6,002
2070544
—
MRI ORB FA NE WO/W C
Gross
$5,967
1620357
—
TKL SPDBRG IMP SYS
Gross
$5,914
1620234
—
LAPIDUS PLATE RIGHT
Gross
$5,784
1620642
—
CERT BIOLOXD OPT HD
Gross
$5,753
1627802
—
CYSTO W BOTOX
Gross
$5,685
1650029
—
PERIPHERAL NERVE EVAL
Gross
$5,502
1620777
—
RFA LUMB/SACR 1 JNT
Gross
$5,343
2072157
—
MRI T-SPINE WO/W CON
Gross
$5,294
2310004
—
SLEEP STUDY CONTIN
Gross
$5,214
2072156
—
MRI C-SPINE WO/W CON
Gross
$5,198
2073722
—
MRI-LOEXTJOINW/WOCON
Gross
$5,177
2071552
—
MRI CHEST WO&W
Gross
$5,147
2073220
—
MRI UPP/EXT W/WO CON
Gross
$5,103
2072198
—
MRI PELVIS WITH & WITHOUT CONTRAST
Gross
$5,100
2072158
—
MRI L-SPINE WO/W CON
Gross
$5,077
2010609
—
CT ABD&PELV WO CONT
Gross
$5,052
2074183
—
MRI ABD WO&W
Gross
$5,042
2074179
—
MRA ABDOMEN W/WO
Gross
$4,951
1620648
—
TPRLC 133 T1 PSS
Gross
$4,950
1620658
—
ECHO POR FMRL RPP
Gross
$4,950
4000004
—
NUC MED GATED SPEC EJEC FRAC
Gross
$4,899
2070553
—
MRI BRAIN W0/W CONST
Gross
$4,898
2071551
—
MRI CHEST W/
Gross
$4,886
2072142
—
MRI C-SPINE W CONTRA
Gross
$4,886
2072147
—
MRI T-SPINE W CONTRA
Gross
$4,886
2074182
—
MRI ABD WITH
Gross
$4,886
1628663
—
NERVE PROTECT 7X40
Gross
$4,850
Showing top 50 of 4,801 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.