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