ALICE PECK DAY MEMORIAL HOSPITAL

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
PX-999970553	MRI Brn Brn Stem C-/C+	$7,087	$3,820	—	—	33
PX-999973220	MRI Uxtr Oth/Thn Jt C-/C+	$7,031	$3,790	—	—	33
PX-999973720	MRI Lxtr Oth/Thn Jt C-/C+	$7,031	$3,790	—	—	33
PX-J1950	Leuprolide Acetate, per 3.75 Mg, Inj (Lupron Depot)	$6,370	$3,434	—	—	18
PX-999973723	MRI Any Jt Lxtr C-/C+	$6,188	$3,335	—	—	33
PX-999972156	MRI Spi Canal&Cnts C-/C+ Crv	$5,999	$3,233	—	—	33
PX-999972157	MRI Spi Canal&Cnts C-/C+	$5,999	$3,233	—	—	33
PX-999972158	MRI Spi Canal&Cnts C-/C+ Lmbr	$5,999	$3,233	—	—	33
PX-999972197	MRI Pelvis C-/C+	$5,874	$3,166	—	—	33
PX-999973223	MRI Any Jt Uxtr C-/C+	$5,792	$3,122	—	—	33
PX-999971552	MRI Chest W/O&W Contrast	$5,787	$3,119	—	—	33
PX-999974183	MRI Abd C-/C+	$5,787	$3,119	—	—	33
PX-58553	Hysterectomy	$5,727	$3,087	—	—	33
PX-58563	Hysteroscopy W Endometrial Ablation, Professional	$5,711	$3,078	—	—	33
PX-27134	Revise Hip Joint Replacement	$5,693	$3,069	—	—	33
PX-999970540	MRI Orbit Face &/Neck W/O Contrast	$5,646	$3,043	—	—	33
PX-999970543	MRI Orbit Face&Nck C-/C+	$5,646	$3,043	—	—	33
PX-999945390	Colonoscopy, Flexible, W Endoscopic Mucosal Resection, Technical	$5,532	$2,982	—	—	31
PX-59510	OB Antepartum Care Cesarean Delivery & Postpartum, Professional	$5,507	$2,968	—	—	33
PX-22633	Arthrodesis Combined Technique 1 Interspace Lumbar	$5,307	$2,860	—	—	33
PX-999970548	Mra Nck C+ Matrl	$5,223	$2,815	—	—	33
PX-999970549	Mra Nck C-/C+	$5,223	$2,815	—	—	33
PX-000591516	Dh Heme Seq Panel	$5,222	$2,815	—	—	31
PX-58565	Hysteroscopy W Bilat Tube Occlusion W Permanent Implants, Professional	$5,211	$2,809	—	—	33
PX-59610	Routine OB Care Vag Dlvry & Postpartum After Prev Cesarean, Professional	$5,119	$2,759	—	—	33
PX-999974174	CT Angio Abd&Plvis Cntrst Mtrl W/WO Cntrst Imges	$5,042	$2,718	—	—	33
PX-27132	Total Hip Arthroplasty	$4,973	$2,680	—	—	33
PX-CC00242	Suction Assisted Lipectomy, Professional	$4,940	$4,940	—	—	31
PX-999970546	Mra Head C-/C+	$4,939	$2,662	—	—	33
PX-999970482	CT Orbit Sella/Post Fossa/Ear C-/C+	$4,906	$2,644	—	—	33
PX-61343	Procedure of Skull	$4,884	$2,632	—	—	33
PX-59400	OB Care Incl Antepartum, Vaginal Delivery and Postpartum, Professional	$4,864	$2,622	—	—	33
PX-000591958	Complete Sarcoma Panel	$4,828	$2,602	—	—	31
PX-27487	Revise Knee Joint Replace, All Parts	$4,828	$2,602	—	—	33
PX-44204	Surgery Procedure	$4,705	$2,536	—	—	33
PX-58542	Surgery of Uterus	$4,669	$2,517	—	—	33
PX-58180	Supracervical Abdominal Hysterectomy W/O Removal Tube/Ovary, Professional	$4,651	$2,507	—	—	33
PX-999995782	Polysom <6 Yrs Sleep Stage 4/> Addl Param Attnd, Technical	$4,650	$2,506	—	—	33
PX-999995783	Polysom <6 Yrs Sleep W Cpap/Bilvl Vent 4/> Param, Technical	$4,650	$2,506	—	—	33
PX-58554	Hysterectomy	$4,580	$2,469	—	—	33
PX-27138	Revise Hip Joint Replacement	$4,545	$2,450	—	—	33
PX-63282	Biopsy/Removal Spinal Tumor	$4,516	$2,434	—	—	33
PX-58270	Vaginal Hysterectomy	$4,454	$2,401	—	—	33
PX-27137	Revise Hip Joint Replacement	$4,370	$2,355	—	—	33
PX-22612	Arthrodesis Posterior/Pstlat Technique 1 Interspace Lumbar	$4,367	$2,354	—	—	33
PX-22630	Arthrodesis Posterior Interbody 1 Interspace Lumbar	$4,242	$2,286	—	—	33
PX-22861	Rev W Replacement Total Disc Arthroplasty Ant, One Interspace, Cervical	$4,089	$2,204	—	—	31
PX-999927570	Manipulation Knee Joint Under General Anes, Technical	$4,042	$2,179	—	—	33
PX-Q9992	Buprenorphine Extended-Release (Sublocade), Greater Than 100 Mg, Inj	$4,033	$2,174	—	—	31
PX-27130	Total Hip Arthroplasty	$4,025	$2,169	—	—	33

Showing top 50 of 4,152 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.