NELSON COUNTY HEALTH SYSTEM (Mcville, ND) prices

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
J3101	Tenecteplase For IV Soln Kit 50 MG	$15,952	$15,952	—	—	10
J2506	Pegfilgrastim Soln Prefilled Syringe 6 MG/0.6ML	$14,675	$14,675	—	—	5
27828	HC OPEN RX WEIGHTBEAR TIB,FIX TIB/FIB	$10,266	$10,266	—	—	5
Q5108	Pegfilgrastim-jmdb Soln Prefilled Syringe 6 MG/0.6ML	$5,461	$5,461	—	—	5
J0897	Denosumab Inj 120 MG/1.7ML	$4,518	$4,518	—	—	5
71552	HC MRI CHEST WO/W DYE	$3,478	$3,478	—	—	5
77046	HC MRI BREAST W/O CONTRAST UNILATERAL	$3,435	$3,435	—	—	5
11772	HC REMV PILONIDAL LESION COMPLIC	$3,383	$3,383	—	—	5
11771	HC REMV PILONIDAL LESION EXTENS	$3,383	$3,383	—	—	5
11770	HC REMV PILONIDAL LESION SMPL	$3,383	$3,383	—	—	5
Q5110	Filgrastim-aafi Soln Prefilled Syringe 300 MCG/0.5ML	$2,950	$2,950	—	—	10
73720	HC MRI-LOWER EXT W/WO DYE	$2,944	$2,944	—	—	5
74183	HC MRI ABDOMEN W/WO DYE	$2,932	$2,932	—	—	5
72197	HC MRI PELVIS W/WO DYE	$2,925	$2,925	—	—	5
73220	HC MRI-UPPER EXT W/WO DYE	$2,925	$2,925	—	—	5
71551	HC CHEST W/DYE	$2,797	$2,797	—	—	5
23505	HC CLOSED RX CLAVICLE FX,MANIPULATN	$2,785	$2,785	—	—	5
23625	HC CLOSED RX GR TUBER HUM FX,MANIP	$2,785	$2,785	—	—	5
23605	HC CLOSED RX PROX HUMERUS FX,MANIP	$2,785	$2,785	—	—	5
74182	HC MRI ABDOMEN W/DYE	$2,742	$2,742	—	—	5
73723	HC MRI LOWER EXT JOINT W/WO DYE	$2,705	$2,705	—	—	5
73223	HC MRI UPPER EXT JOINT W/WO DYE	$2,701	$2,701	—	—	5
00173088710	Fluticasone-Umeclidinium-Vilanterol AEPB 100-62.5-25 MCG/ACT	$2,690	$2,690	—	—	0
23931	HC DRAIN ARM BURSA	$2,687	$2,687	—	—	5
23930	HC DRAIN ARM LESION	$2,687	$2,687	—	—	5
10180	HC WOUND DRAINAGE,CMPLX	$2,687	$2,687	—	—	5
71550	HC MRI-CHEST WO DYE	$2,554	$2,554	—	—	5
70544	HC MRA HEAD W/O DYE	$2,472	$2,472	—	—	5
70545	HC MRA HEAD W/DYE	$2,451	$2,451	—	—	5
10121	HC REMOVE FOREIGN BODY,CMPLX	$2,418	$2,418	—	—	5
72196	HC MRI-PELVIS	$2,415	$2,415	—	—	5
73719	HC LOWER EXT W/DYE	$2,413	$2,413	—	—	5
73219	HC UPPER EXT WDYE	$2,390	$2,390	—	—	5
70543	HC MRI ORBIT/FACE/NECK W/WO DYE	$2,307	$2,307	—	—	5
72195	HC MRI PELVIS WO DYE	$2,252	$2,252	—	—	5
73722	HC MRI LOWER EXT JOINT W/DYE	$2,236	$2,236	—	—	5
73218	HC MRI UPPER EXT W/O DYE	$2,220	$2,220	—	—	5
73718	HC MRI LOWER EXT W/O DYE	$2,215	$2,215	—	—	5
73222	HC MRI UPPER EXT JOINT W/DYE	$2,212	$2,212	—	—	5
95811	HC POLYSOMNOGRAM;SLEEP STG;4+CPAP	$2,169	$2,169	—	—	5
77048	HC MRI BREAST W&WO CONTRAST W/CAD UNILATERAL	$2,163	$2,163	—	—	5
77049	HC MRI BREAST W&WO CONTRAST W/CAD BILATERAL	$2,153	$2,153	—	—	5
23655	HC CLOSED RX SHLDR DISLOC,ANESTHESIA	$2,119	$2,119	—	—	5
95810	HC POLYSOMNOGRAM;SLEEP STG;4+	$2,007	$2,007	—	—	5
72157	HC MRI T-SPINE W/WO DYE	$1,982	$1,982	—	—	5
72156	HC MRI C-SPINE W/WO DYE	$1,978	$1,978	—	—	5
72158	HC MRI L-SPINE W/WO DYE	$1,962	$1,962	—	—	5
70553	HC MRI-BRAIN W/WO DYE	$1,957	$1,957	—	—	5
74181	HC MRI-ABDOMEN W/O DYE	$1,936	$1,936	—	—	5
70542	HC MRI ORBIT/FACE/NECK W/DYE	$1,926	$1,926	—	—	5

Showing top 50 of 2,907 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.