45 CFR § 180 compliance
D · 65
This hospital published part of what § 180 requires.
●Machine-readable file published: assessment threshold met
●Gross / standard charges: assessment threshold met
●Discounted cash price: assessment threshold met
○Payer-specific negotiated rates: below assessment threshold
○Min / max negotiated charges: below assessment threshold
●Free, public, no login required: assessment threshold met
Procedures listed
942
Insurances with rates
1
CPT / HCPCS codes
925
Most expensive procedures (gross)
G2083
$1,410
ESKETAMINE PST ADMN OBS >56MG
Gross
$3,812
10114
$1,147
R&B - PRIVATE (1 BED)
Gross
$3,100
BEDHOLD
$1,147
ROOM & BOARD - BED HOLD
Gross
$3,100
G2082
$1,102
ESKETAMINE PST ADMN OBS <=56MG
Gross
$2,978
ESK84
$926
ESKETAMINE HCL 84 MG SPRAY KIT
Gross
$2,503
ESK56
$617
ESKETAMINE HCL 56 MG SPRAY KIT
Gross
$1,668
H0019
$578
RESIDENTIAL TREATMENT
Gross
$1,562
90867
$392
TMS INIT W/CORT MAP & MTR THLD
Gross
$1,059
99255
$357
INPT CONSULT 80 MINS
Gross
$965
90869
$338
TMS SUB MTR THLD REDET DEL/MGT
Gross
$914
73564
$329
XR KNEE LT 4V
Gross
$889
99306
$324
INIT RESI CARE HIGH (50 MIN +)
Gross
$875
99223
$324
INIT IP CARE - HIGH (75 MIN +)
Gross
$875
99205
$324
NEW PT, OP EVAL HIGH (60 MN +)
Gross
$875
72190
$310
XR PELVIS MIN 3V
Gross
$838
24520
$284
FLUPHENAZINE HCL 2.5 MG/ ML VIAL
Gross
$768
74019
$284
XR ABDOMEN MIN 2V
Gross
$767
70150
$275
XR FACIAL BONES MIN 3V
Gross
$744
71110
$274
XR RIBS BI 3V
Gross
$742
73562
$274
XR KNEE LT 3V
Gross
$741
73080
$268
XR ELBOW LT MIN 3V
Gross
$726
99310
$259
SUBSEQ RES CARE HIGH (45 MN +)
Gross
$700
99215
$259
ESTAB PT, OP VISIT (40 MIN +)
Gross
$700
73630
$255
XR FOOT LT MIN 3V
Gross
$689
99254
$252
INPT CONSULT 60 MINS
Gross
$680
90868
$251
TMS SUBSEQUENT DEL/MGT
Gross
$679
90792
$242
PSYCH EVAL W/MEDICAL & SOC HX
Gross
$653
99222
$241
INIT IP CARE - MOD (55-74 MIN)
Gross
$650
99204
$241
NEW PT, OP EVAL MOD (35-59 MN)
Gross
$650
71100
$237
XR RIBS 2V
Gross
$640
99305
$231
INIT RESI CARE MOD (34-49 MIN)
Gross
$625
73560
$227
XR KNEE LT 2V
Gross
$612
99233
$222
SUBSEQ IP CARE, HIGH (50 MN +)
Gross
$600
25266
$222
EPINEPHRINE 0.3 MG/ 0.3 ML AUTO.INJCT
Gross
$600
73120
$218
XR HAND LT 2V
Gross
$588
90791
$216
PSYCH EVL WO MD SVC (16-90 MN)
Gross
$585
73100
$214
XR WRIST LT 2V
Gross
$578
99236
$211
IP W/ADMIT+DC HIGH (85 MIN +)
Gross
$570
27358
$210
COVID VAC 25- 26 (12UP)(MOD)/ PF 50 MCG/ 0.5 ML SYRINGE
Gross
$567
99316
$186
RESI DISCHARGE DAY MGT >30 MIN
Gross
$504
99253
$185
INPT CONSULT 45 MINS
Gross
$500
99214
$178
ESTAB PT OP VISIT (30-39 MIN)
Gross
$480
99309
$178
SUBSEQ RES CARE MOD (30-44 MN)
Gross
$480
26016
$177
ESTRADIOL VALERATE 10 MG/ ML VIAL
Gross
$478
97165
$162
OT EVAL LOW COMPLEX 30 MIN
Gross
$439
97166
$162
OT EVAL MOD COMPLEX 45 MIN
Gross
$439
90837
$159
IND PSYCHOTHERAPY (>= 53 MIN)
Gross
$429
87522
$157
HEP C QUANT
Gross
$423
80074
$156
ACUTE HEPATITIS PANEL
Gross
$421
99234
$155
IP W/ADMIT+DC LOW (45-69 MIN)
Gross
$420
| Code | Description | Gross | Cash | Min payer | Max payer | # insurers |
|---|---|---|---|---|---|---|
| G2083 | ESKETAMINE PST ADMN OBS >56MG | $3,812 | $1,410 | — | — | 0 |
| 10114 | R&B - PRIVATE (1 BED) | $3,100 | $1,147 | — | — | 1 |
| BEDHOLD | ROOM & BOARD - BED HOLD | $3,100 | $1,147 | — | — | 0 |
| G2082 | ESKETAMINE PST ADMN OBS <=56MG | $2,978 | $1,102 | — | — | 0 |
| ESK84 | ESKETAMINE HCL 84 MG SPRAY KIT | $2,503 | $926 | — | — | 0 |
| ESK56 | ESKETAMINE HCL 56 MG SPRAY KIT | $1,668 | $617 | — | — | 0 |
| H0019 | RESIDENTIAL TREATMENT | $1,562 | $578 | — | — | 0 |
| 90867 | TMS INIT W/CORT MAP & MTR THLD | $1,059 | $392 | — | — | 0 |
| 99255 | INPT CONSULT 80 MINS | $965 | $357 | — | — | 0 |
| 90869 | TMS SUB MTR THLD REDET DEL/MGT | $914 | $338 | — | — | 0 |
| 73564 | XR KNEE LT 4V | $889 | $329 | — | — | 0 |
| 99306 | INIT RESI CARE HIGH (50 MIN +) | $875 | $324 | — | — | 0 |
| 99223 | INIT IP CARE - HIGH (75 MIN +) | $875 | $324 | — | — | 0 |
| 99205 | NEW PT, OP EVAL HIGH (60 MN +) | $875 | $324 | — | — | 0 |
| 72190 | XR PELVIS MIN 3V | $838 | $310 | — | — | 0 |
| 24520 | FLUPHENAZINE HCL 2.5 MG/ ML VIAL | $768 | $284 | — | — | 0 |
| 74019 | XR ABDOMEN MIN 2V | $767 | $284 | — | — | 0 |
| 70150 | XR FACIAL BONES MIN 3V | $744 | $275 | — | — | 0 |
| 71110 | XR RIBS BI 3V | $742 | $274 | — | — | 0 |
| 73562 | XR KNEE LT 3V | $741 | $274 | — | — | 0 |
| 73080 | XR ELBOW LT MIN 3V | $726 | $268 | — | — | 0 |
| 99310 | SUBSEQ RES CARE HIGH (45 MN +) | $700 | $259 | — | — | 0 |
| 99215 | ESTAB PT, OP VISIT (40 MIN +) | $700 | $259 | — | — | 0 |
| 73630 | XR FOOT LT MIN 3V | $689 | $255 | — | — | 0 |
| 99254 | INPT CONSULT 60 MINS | $680 | $252 | — | — | 0 |
| 90868 | TMS SUBSEQUENT DEL/MGT | $679 | $251 | — | — | 0 |
| 90792 | PSYCH EVAL W/MEDICAL & SOC HX | $653 | $242 | — | — | 0 |
| 99222 | INIT IP CARE - MOD (55-74 MIN) | $650 | $241 | — | — | 0 |
| 99204 | NEW PT, OP EVAL MOD (35-59 MN) | $650 | $241 | — | — | 0 |
| 71100 | XR RIBS 2V | $640 | $237 | — | — | 0 |
| 99305 | INIT RESI CARE MOD (34-49 MIN) | $625 | $231 | — | — | 0 |
| 73560 | XR KNEE LT 2V | $612 | $227 | — | — | 0 |
| 99233 | SUBSEQ IP CARE, HIGH (50 MN +) | $600 | $222 | — | — | 0 |
| 25266 | EPINEPHRINE 0.3 MG/ 0.3 ML AUTO.INJCT | $600 | $222 | — | — | 0 |
| 73120 | XR HAND LT 2V | $588 | $218 | — | — | 0 |
| 90791 | PSYCH EVL WO MD SVC (16-90 MN) | $585 | $216 | — | — | 0 |
| 73100 | XR WRIST LT 2V | $578 | $214 | — | — | 0 |
| 99236 | IP W/ADMIT+DC HIGH (85 MIN +) | $570 | $211 | — | — | 0 |
| 27358 | COVID VAC 25- 26 (12UP)(MOD)/ PF 50 MCG/ 0.5 ML SYRINGE | $567 | $210 | — | — | 0 |
| 99316 | RESI DISCHARGE DAY MGT >30 MIN | $504 | $186 | — | — | 0 |
| 99253 | INPT CONSULT 45 MINS | $500 | $185 | — | — | 0 |
| 99214 | ESTAB PT OP VISIT (30-39 MIN) | $480 | $178 | — | — | 0 |
| 99309 | SUBSEQ RES CARE MOD (30-44 MN) | $480 | $178 | — | — | 0 |
| 26016 | ESTRADIOL VALERATE 10 MG/ ML VIAL | $478 | $177 | — | — | 0 |
| 97165 | OT EVAL LOW COMPLEX 30 MIN | $439 | $162 | — | — | 0 |
| 97166 | OT EVAL MOD COMPLEX 45 MIN | $439 | $162 | — | — | 0 |
| 90837 | IND PSYCHOTHERAPY (>= 53 MIN) | $429 | $159 | — | — | 0 |
| 87522 | HEP C QUANT | $423 | $157 | — | — | 0 |
| 80074 | ACUTE HEPATITIS PANEL | $421 | $156 | — | — | 0 |
| 99234 | IP W/ADMIT+DC LOW (45-69 MIN) | $420 | $155 | — | — | 0 |
Showing top 50 of 942 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.