CHEYENNE REGIONAL MEDICAL CENTER

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
J0225	VUTRISIRAN 25 MG/0.5 ML SUBCUTANEOUS SYRINGE	$482,413	$337,689	—	—	5
J0202	ALEMTUZUMAB 12 MG/1.2 ML INTRAVENOUS SOLUTION	$243,806	$170,664	—	—	5
J2351	OCRELIZUMAB 920 MG-HYALURONIDASE-OCSQ 23,000 UNIT/23 ML SUBCUT SOLN	$174,344	$122,041	—	—	5
L8699	HC TAG TBE AORTIC COMPONENT 12MM X 45MM X 15CM	$140,480	$98,336	—	—	5
C1882	HC ICD DEFIB UNIFY CRT CD3231-40Q	$137,992	$96,594	—	—	5
J3590	DEPEMOKIMAB-ULAA 100 MG/ML SUBCUTANEOUS SYRINGE	$130,832	$91,582	—	—	5
J2507	PEGLOTICASE 8 MG/ML INTRAVENOUS SOLUTION	$128,487	$89,941	—	—	5
J9298	NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION	$125,638	$87,947	—	—	5
C1822	PULSE GENERATOR IMPLANTABLE 301328	$122,838	$85,987	—	—	4
A9543	HC NM YTTRUIM 90 ZEV TO 40MCI	$119,876	$83,913	—	—	5
C1721	HC ICD DEFIB FORTIFY DR 2231-40Q	$114,900	$80,430	—	—	5
C1824	HC GENERATR OPTIMIZER SMART MINI CCM	$114,087	$79,861	—	—	5
J9266	PEGASPARGASE 750 UNIT/ML INJECTION SOLUTION	$108,327	$75,829	—	—	5
Q0480	PR DRIVER PNEUMATIC VAD, REP	$107,626	$75,338	—	—	2
C1820	GENERATOR PULSE RESTORE SENSOR SURE SCAN 29408	$106,992	$74,894	—	—	5
J9229	INOTUZUMAB OZOGAMICIN 0.9 MG(0.25 MG/ML INITIAL CONCENTRATION) IV SOLN	$96,756	$67,729	—	—	5
C2624	HC SENSOR CARDIOMEMS PA	$96,719	$67,703	—	—	5
J0638	CANAKINUMAB (PF) 150 MG/ML SUBCUTANEOUS SOLUTION	$89,539	$62,678	—	—	5
J2350	OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION	$86,126	$60,288	—	—	5
J9316	PERTUZUMAB 1,200 MG-TRASTUZUMAB 600 MG-HYALURON-ZZXF/15 ML SUBCUT SOLN	$84,069	$58,848	—	—	5
J9022	ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION	$83,347	$58,343	—	—	5
J9309	POLATUZUMAB VEDOTIN-PIIQ 140 MG INTRAVENOUS SOLUTION	$78,248	$54,774	—	—	5
33249	HC INSRT PACE DEFIB W LEAD	$77,023	$53,916	—	—	5
C1875	HC STENT GRAFT RELAYPRO THORACIC 200MM	$76,808	$53,765	—	—	5
J3241	TEPROTUMUMAB-TRBW 500 MG INTRAVENOUS SOLUTION	$74,256	$51,979	—	—	5
93656	HC TX ATRIAL FIB PULM VEIN ISOL	$68,983	$48,288	—	—	5
J9334	EFGARTIGIMOD ALFA 1008 MG-HYALURON-QVFC 11,200 UNIT/5.6 ML SUBCUT SOLN	$65,879	$46,115	—	—	5
33263	HC REMV REPLC CVD GEN DUAL LEAD	$65,333	$45,733	—	—	5
33270	HC INSERT/REPLACE SUBSEQ DEFIBRILLATOR	$64,170	$44,919	—	—	5
C1767	INTERSTIM INS 16370	$62,955	$44,069	—	—	5
J9144	DARATUMUMAB 1,800 MG-HYALURONIDASE-FIHJ 30,000 UNIT/15 ML SUBCUT SOLN	$60,808	$42,566	—	—	5
33262	HC REMV REPLAC CVD GEN SINGLE LEAD	$60,618	$42,432	—	—	5
J9043	CABAZITAXEL 10 MG/ML (FIRST DILUTION) INTRAVENOUS SOLUTION	$58,908	$41,236	—	—	5
37231	PR REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL	$58,333	$40,833	—	—	4
C1772	PUMP SYNCHROMED II 40MM 16566	$57,953	$40,567	—	—	5
C1722	HC INTICA NEO 7 VR-T DX DF-1 PROMRI	$57,926	$40,548	—	—	5
33264	HC REMV REPLC CVD GEN MULT LEAD	$57,711	$40,398	—	—	5
93654	HC EP & ABLATE VENTRIC TACHY	$57,380	$40,166	—	—	5
C9363	MESH BILAYER WOUND MATRIX SZ 4 X 5 INTEGRA 106616	$55,986	$39,190	—	—	4
A9543	PR Y90 IBRITUMOMAB, RX	$52,935	$37,055	—	—	2
J9042	BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION	$52,237	$36,566	—	—	5
J2327	RISANKIZUMAB-RZAA 60 MG/ML INTRAVENOUS SOLUTION	$51,513	$36,059	—	—	5
C1768	HC EXCLUDER CONFORM AAA TRUNK-IPSILTRL LEG	$51,037	$35,726	—	—	5
93653	HC EP & ABLATE SUPRAVENT ARRHYT	$50,759	$35,531	—	—	5
C9767	HC REVASC LOW EXT LITHOTRIP-STENT-ATHER INCL ANGIOPL	$49,502	$34,651	—	—	5
A9545	PR I131 TOSITUMOMAB, RX	$48,836	$34,186	—	—	2
J9272	DOSTARLIMAB-GXLY 50 MG/ML INTRAVENOUS SOLUTION	$48,670	$34,069	—	—	5
J9271	PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION	$47,720	$33,404	—	—	15
J2329	UBLITUXIMAB-XIIY 25 MG/ML INTRAVENOUS SOLUTION	$46,930	$32,851	—	—	5
C1831	HC STABLE-L INTERBODY 30X28X12	$46,910	$32,837	—	—	5

Showing top 50 of 14,320 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.