SAINT ALPHONSUS MEDICAL CENTER ONTARIO

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
PX-274L6110001	HC Prosthetic Molded Socket Below Elbow Muenster/Northwestern Suspension Type Rest Non-Mm Supply	$3,092	$2,010	—	—	276
PX-30086891001	HC Autologous Blood/Component Collection Processing Storage Intra Postoperative Salvage	$1,794	$1,166	—	—	352
PX-274L0464001	HC Tlso Triplanar Control Modular Rigid Four Plastic Shells Prefabricated Restricted Non-Mm Supply	$1,366	$888	—	—	276
PX-274L3766001	HC Orthosis Elbow/Wrist/Hand/Finger Nontorsion Joints Custom Fabricated Restricted Non-Mm Supply	$1,135	$738	—	—	275
PX-274L3765001	HC Orthosis Elbow/Wrist/Hand/Finger Rigid Without Joints Custom Fabricated Restricted Non-Mm Supply	$1,072	$697	—	—	275
PX-274L0639001	HC Lso Sagittal-Coronal Cntrl Rigid Shell/Panel Custom Fabricated Restricted Non-Mm Supply	$1,033	$671	—	—	275
PX-260C8957001	HC IV Infusion Therapy/Diagnosis Initiation Prolonged Infusion	$1,011	$657	—	—	353
PX-26096365001	HC IV Infusion Therapy/Prophylaxis/Diagnosis Initial Up to 1 Hour	$931	$605	—	—	353
PX-26096360001	HC Hydration IV Infusion Initial 31minutes - 1 Hour	$868	$564	—	—	353
PX-274L3905001	HC Orthosis Wrist/Hand 1 or More Nontorsion Joints Custom Fabricated Restricted Non-Mm Supply	$829	$539	—	—	276
PX-30182525017	HC Mayo Copper	$822	$534	—	—	353
PX-30183519041	HC Warde Radioimmunoassay Melanocyte Stimulation Hormone Alpha Quantitative	$739	$480	—	—	353
PX-30183519036	HC Warde Radioimmunoassay Acetylcholine Binding Antibody Quantitative	$739	$480	—	—	353
PX-30182139004	HC Warde Amino Acids 6 or More Urine Quantitative Each Specimen	$736	$478	—	—	285
PX-30182139008	HC External Amino Acids 6 or More Quantitative Each Specimen	$736	$478	—	—	285
PX-30182139003	HC Warde Amino Acids 6 or More Quantitative Each Specimen	$736	$478	—	—	285
PX-3010003M001	HC Warde Liver Disease Ten Biochemical Assays Serum (Nash)	$712	$463	—	—	353
PX-274L3763001	HC Ewho Rigid Without Joints Custom Fabricated Restricted Non-Mm Supply	$618	$402	—	—	276
PX-30081381002	HC Warde Hla Class I Typing High Resolution One Allele/Allele Group Each	$580	$377	—	—	285
PX-30182731001	HC Fetal Fibronectin	$580	$377	—	—	353
PX-26096374001	HC Injection Therapeutic/Prophylactic/Diagnostic IV Push Single/Initial Substance/Drug	$571	$371	—	—	353
PX-30183520055	HC Warde Anti-Purkinje Cell Cytoplasmic Ab Quantitative	$545	$354	—	—	353
PX-30183520071	HC Warde Interleukin-2 Receptor Soluble Quantitative	$545	$354	—	—	353
PX-30183520169	HC Warde Immunoassay Tsh Receptor Antibody Quantitative	$545	$354	—	—	214
PX-274L1832001	HC Orthosis Knee Adjustable Joints Rigid Custom Prefabricated Restricted Non-Mm Supply	$535	$348	—	—	276
PX-30183520264	HC Arup Immunoassay Vascular Endothelial Growth Factor Quantitative	$527	$343	—	—	353
PX-26096369001	HC Subcutaneous Infusion Therapy/Prophylaxis Initial > 1 Hour	$484	$315	—	—	353
PX-3000001U001	HC RBC Antigen Typing Dna Hea Gene Analysis 35 Antigens Whole Blood Reference	$476	$309	—	—	353
PX-30183519103	HC Warde Radioimmunoassay Progesterone Free Quantitative	$473	$307	—	—	353
PX-274L3915001	HC Who W/Nontorsion Joints/Elastic Bands/Turnbuckles Prefabricated Restricted Non-Mm Supply	$444	$289	—	—	275
PX-30182107004	HC External Afp-L3 Frac Isoform & Tot Afp	$419	$272	—	—	353
PX-30180307014	HC Warde 1820000 Drug Test(S) Presumptive Any Class Instrument Chemistry Analyzers	$416	$270	—	—	353
PX-30180307126	HC External Drug Test(S) Presumptive Any Class Inst Chem Analyzer Drug Screen Panel 19 Umb Cord	$416	$270	—	—	353
PX-30180307013	HC Warde Drug Test(S) Presumptive Any Class Instrument Chemistry Analyzers Umbilical Cord Tissue	$416	$270	—	—	353
PX-30180307002	HC Warde 1841040 Drug Test(S) Presumptive Any Class Instrument Chemistry Analyzers	$416	$270	—	—	353
PX-30180307021	HC Warde 1800410 Drug Test(S) Presumptive Any Class Instrument Chemistry Analyzers	$416	$270	—	—	353
PX-30180307017	HC External Drug Test(S) Presumptive Any Class Instrument Chemistry Analyzers Umbilical Cord Tissue	$416	$270	—	—	353
PX-30180307022	HC Warde Drug Test(S) Presumptive Any Class Instrument Chemistry Analyzers Pain Management	$416	$270	—	—	353
PX-30182542054	HC Warde 3800268 Leukotriene E4 Urine	$411	$267	—	—	285
PX-30182542067	HC Warde Leukotriene E4 Urine 24 Hour	$411	$267	—	—	285
PX-30180307028	HC Warde Drug Test(S) Presumptive Any Class Instrument Chem Analyzers Urine Drug Scrn 10c W Cnfm	$404	$263	—	—	353
PX-30180307003	HC Warde Drug Test(S) Presumptive Any Class Instrument Chemistry Analyzers	$404	$263	—	—	353
PX-30180307027	HC Warde Drug Test(S) Presumptive Any Class Instrument Chem Analyzers Urine Drug Scrn 9c W Cnfm	$404	$263	—	—	353
PX-30180307070	HC Warde Drug Test(S) Presumptive Any Class Instrument Chem Analyzer Drug Screen Ghb Urine	$404	$263	—	—	353
PX-30180074002	HC Warde Acute Hepatitis Panel	$402	$261	—	—	353
PX-30081383003	HC Warde Hla Class II Typing High Resolution One Allele/Allele Group Each	$401	$261	—	—	344
PX-30183516051	HC Warde Tysabri Antibodies Multi Step Qualitative/Semiquantitative	$394	$256	—	—	353
PX-30086870001	HC Antibody ID RBC Panel	$388	$252	—	—	352
PX-30086870002	HC Antibody ID RBC Panel Reference	$388	$252	—	—	352
PX-30086902005	HC Blood Typing Ag Donor 4 Antigens Reference	$383	$249	—	—	353

Showing top 50 of 620 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.