45 CFR § 180 compliance
D · 65
This hospital published part 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
1,298
Insurances with rates
10
CPT / HCPCS codes
224
Source MRF
Most expensive procedures (gross)
| Code | Description | Gross | Cash | Min payer | Max payer | # insurers |
|---|---|---|---|---|---|---|
| TRELEGY ELLIPTA 100/62.5/25MCG 30 DOSE* | TRELEGY ELLIPTA 100/62.5/25MCG 30 DOSE* | $854 | $854 | — | — | 0 |
| TRELEGY ELLIPTA 200/62.5/25MCG 30 DOSE | TRELEGY ELLIPTA 200/62.5/25MCG 30 DOSE | $854 | $854 | — | — | 0 |
| SPIRIVA RESPIMAT 1.25MCG INH 4GM | SPIRIVA RESPIMAT 1.25MCG INH 4GM | $649 | $649 | — | — | 0 |
| SPIRIVA RESPIMAT 2.5MCG INH 4GM | SPIRIVA RESPIMAT 2.5MCG INH 4GM | $649 | $649 | — | — | 0 |
| COMBIVENT RESPIMAT INH 4GM | COMBIVENT RESPIMAT INH 4GM | $639 | $639 | — | — | 0 |
| FLUTIC-SALM(ADVAIR HFA)230-21MCG INH 12G | FLUTIC-SALM(ADVAIR HFA)230-21MCG INH 12G | $625 | $625 | — | — | 0 |
| FLUTIC/SALMET (ADVAIR) 500-50 DISKUS #60 | FLUTIC/SALMET (ADVAIR) 500-50 DISKUS #60 | $607 | $607 | — | — | 0 |
| FLUTICASONE HFA 220 MCG INHALER 12G | FLUTICASONE HFA 220 MCG INHALER 12G | $501 | $501 | — | — | 0 |
| FLUTIC-SALM(ADVAIR HFA)115-21MCG INH 12G | FLUTIC-SALM(ADVAIR HFA)115-21MCG INH 12G | $479 | $479 | — | — | 0 |
| CLOBETASOL(TEMOVATE)0.05% CREAM 60GM | CLOBETASOL(TEMOVATE)0.05% CREAM 60GM | $475 | $475 | — | — | 0 |
| FLUTIC/SALMET(ADVAIR) 250-50 DISKUS #60 | FLUTIC/SALMET(ADVAIR) 250-50 DISKUS #60 | $466 | $466 | — | — | 0 |
| INCRUSE ELLIPTA 62.5MCG INHALER #30* | INCRUSE ELLIPTA 62.5MCG INHALER #30* | $441 | $441 | — | — | 0 |
| RHOPRESSA 0.02% EYE DROP | RHOPRESSA 0.02% EYE DROP | $430 | $430 | — | — | 0 |
| BUDESONIDE-FORMOT 160/4.5MCG INH 10.2GM* | BUDESONIDE-FORMOT 160/4.5MCG INH 10.2GM* | $419 | $419 | — | — | 0 |
| SANTYL OINTMENT 30GM | SANTYL OINTMENT 30GM | $417 | $417 | — | — | 0 |
| J2794 | RISPERIDONE (RISPERDAL CON) 12.5MG SYG | $415 | $415 | — | — | 52 |
| ACYCLOVIR (ZOVIRAX) 5% OINT 15GM | ACYCLOVIR (ZOVIRAX) 5% OINT 15GM | $415 | $415 | — | — | 0 |
| TRELEGY ELLIPTA 100/62.5/25MCG 14 DOSE | TRELEGY ELLIPTA 100/62.5/25MCG 14 DOSE | $407 | $407 | — | — | 0 |
| TRELEGY ELLIPTA 200/62.5/25MCG 14 DOSE | TRELEGY ELLIPTA 200/62.5/25MCG 14 DOSE | $407 | $407 | — | — | 0 |
| 92523 | SLP EVAL SPCH LANG (-52) 92523 | $400 | $400 | — | — | 42 |
| 55705 | BASACA INITIAL SCREEN | $398 | $398 | — | — | 23 |
| ATROVENT HFA 17MCG INHALER 12.9 GM | ATROVENT HFA 17MCG INHALER 12.9 GM | $385 | $385 | — | — | 0 |
| CYCLOSPORINE(RESTASIS) .05% EYE 30X0.4ML | CYCLOSPORINE(RESTASIS) .05% EYE 30X0.4ML | $384 | $384 | — | — | 0 |
| QVAR 80 MCG REDIHALER 10.6GM | QVAR 80 MCG REDIHALER 10.6GM | $383 | $383 | — | — | 0 |
| FLUTIC/SALMET(ADVAIR) 100-50 DISKUS #60 | FLUTIC/SALMET(ADVAIR) 100-50 DISKUS #60 | $378 | $378 | — | — | 0 |
| BUDESONIE-FORMOT 80/4.5 MCG INH 10.2GM* | BUDESONIE-FORMOT 80/4.5 MCG INH 10.2GM* | $369 | $369 | — | — | 0 |
| J1610 | GLUCAGON 1MG EMERGENCY SYRINGE | $353 | $353 | — | — | 38 |
| LIDOCAINE(XYLOCAINE) 2% JELLY 30ML* | LIDOCAINE(XYLOCAINE) 2% JELLY 30ML* | $346 | $346 | — | — | 0 |
| LUMIGAN 0.01% EYE DROP 2.5ML | LUMIGAN 0.01% EYE DROP 2.5ML | $340 | $340 | — | — | 0 |
| METRONIDAZOLE (METROGEL) 0.75% GEL 45GM | METRONIDAZOLE (METROGEL) 0.75% GEL 45GM | $336 | $336 | — | — | 0 |
| 99306 | NH COMP HX EXAM HIGH COMPLEXITY | $333 | $333 | — | — | 14 |
| FLUTICASONE HFA 110 MCG INHALER 12G | FLUTICASONE HFA 110 MCG INHALER 12G | $329 | $329 | — | — | 0 |
| 99236 | ADMIT AND DISCHARGE SAME DAY | $324 | $324 | — | — | 33 |
| SPINOSAD (NATROBA) 0.9% TOPICAL SUSP | SPINOSAD (NATROBA) 0.9% TOPICAL SUSP | $324 | $324 | — | — | 0 |
| TRULICITY 3MG/0.5ML PEN INJ | TRULICITY 3MG/0.5ML PEN INJ | $319 | $319 | — | — | 0 |
| OXCARBAZEPINE (TRILEPTAL) 300MG/5ML SUSP | OXCARBAZEPINE (TRILEPTAL) 300MG/5ML SUSP | $301 | $301 | — | — | 0 |
| DULERA 200MCG/5MCG HFA #60 INH 8.8GM | DULERA 200MCG/5MCG HFA #60 INH 8.8GM | $295 | $295 | — | — | 0 |
| KETOCONAZOLE (NIZORAL) 2% CR 60GM | KETOCONAZOLE (NIZORAL) 2% CR 60GM | $293 | $293 | — | — | 0 |
| QVAR 40 MCG REDIHALER 10.6GM | QVAR 40 MCG REDIHALER 10.6GM | $290 | $290 | — | — | 0 |
| 99310 | NH DETAILED/COMP HX EXAM HIGH COMPLEXITY | $281 | $281 | — | — | 14 |
| CLOBETASOL(TEMOVATE)0.05% OINT 30GM | CLOBETASOL(TEMOVATE)0.05% OINT 30GM | $276 | $276 | — | — | 0 |
| CLOBETASOL (TEMOVATE) 0.05% CREAM 30GM* | CLOBETASOL (TEMOVATE) 0.05% CREAM 30GM* | $273 | $273 | — | — | 0 |
| 99223 | INITIAL VISIT HIGH | $267 | $267 | — | — | 49 |
| EPINEPHRINE(EPIPEN)0.3MG AUTO-INJECTOR | EPINEPHRINE(EPIPEN)0.3MG AUTO-INJECTOR | $264 | $264 | — | — | 0 |
| DESMOPRESSIN (DDAVP)0.1MG/ML NASAL | DESMOPRESSIN (DDAVP)0.1MG/ML NASAL | $263 | $263 | — | — | 0 |
| 87631 | INFLUENZA A/B AND RSV RNA QUAL | $257 | $257 | — | — | 15 |
| FLUTICASONE FUR (ARNUITY)100MCG INH #30* | FLUTICASONE FUR (ARNUITY)100MCG INH #30* | $254 | $254 | — | — | 0 |
| J2997 | CATHFLO ACTIVASE (ALTEPLASE) 2MG VIAL | $250 | $250 | — | — | 38 |
| FLUTICASONE HFA 44 MCG INH 10.6 GM | FLUTICASONE HFA 44 MCG INH 10.6 GM | $250 | $250 | — | — | 0 |
| LOTEPREDNOL(LOTEMAX) 0.5%OPHTH *GEL* 5GM | LOTEPREDNOL(LOTEMAX) 0.5%OPHTH *GEL* 5GM | $248 | $248 | — | — | 0 |
Showing top 50 of 1,298 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.