45 CFR § 180 compliance
F · 50
This hospital published little 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
1,366
Insurances with rates
7
CPT / HCPCS codes
9
Source MRF
Most expensive procedures (gross)
4200618
—
LEUPROLIDE (LUPRON DEPOT) 30MG INJ
Gross
$7,556
4200616
—
LEUPROLIDE (LUPRON DEPOT) 11.25MG
Gross
$6,860
4200617
—
LEUPROLIDE (LUPRON DEPOT) 15MG INJ
Gross
$2,519
138
$2,325
Inpatient Room and Board
Gross
$2,514
4200142
—
BOTULINUM TOXIN A (BOTOX) 200 UNITS
Gross
$1,674
4200619
—
LEUPROLIDE (LUPRON DEPOT) 7.5MG INJ
Gross
$1,260
4200141
—
BOTULINUM TOXIN A (BOTOX) 100 UNITS
Gross
$661
4200375
—
EPINEPHRINE (EPIPEN) 0.3MG INJ
Gross
$588
4200374
—
EPINEPHRINE (EPI-PEN JR) 0.15MG INJ
Gross
$587
4201014
—
SOMATROPIN (HUMATROPE) 5MG INJ
Gross
$568
4200432
—
FLUTIC/SALME (ADVAIR DISKUS) 500/50
Gross
$457
4200434
—
FLUTIC/SALME (ADVAIR HFA) 230/21 IN
Gross
$456
4200431
—
FLUTIC/SALME (ADVAIR DISKUS) 250/50
Gross
$348
4200433
—
FLUTIC/SALME (ADVAIR HFA) 115/21 IN
Gross
$347
4200440
—
FLUTICASONE (FLOVENT HFA) 220MCG IN
Gross
$342
4200146
—
BUDESO/FORMO (SYMBICORT) 160/4.5 IN
Gross
$320
1800127
—
COVID TESTING CHILD
Gross
$300
4200122
—
BENZYL ALCOHOL (ULESFIA) 5% LOT
Gross
$297
4200012
—
ACYCLOVIR (ZOVIRAX) 5% OINT
Gross
$296
4201063
—
TRETINOIN (RETIN-A) 0.05% GEL
Gross
$281
4200147
—
BUDESO/FORMO (SYMBICORT) 80/4.5 INH
Gross
$280
4200430
—
FLUTIC/SALME (ADVAIR DISKUS) 100/50
Gross
$280
4200435
—
FLUTIC/SALME (ADVAIR HFA) 45/21 INH
Gross
$279
4200288
—
DIAZEPAM (DIASTAT) 20MG RECTAL GEL
Gross
$257
4200286
—
DIAZEPAM (DIASTAT) 10MG RECTAL GEL
Gross
$251
4200570
—
INSULIN LISPRO (HUMALOG) 100 U/ML
Gross
$246
4201058
—
TRETINOIN (RETIN-A MICRO) 0.1% GEL
Gross
$246
4200464
—
GLUCAGON (GLUCAGEN HYPOKIT) 1MG INJ
Gross
$245
4200569
—
INSULIN GLARGINE (LANTUS) 100U/ML
Gross
$241
4201057
—
TRETINOIN (RETIN-A MICRO) 0.04% GEL
Gross
$225
4200439
—
FLUTICASONE (FLOVENT HFA) 110MCG IN
Gross
$221
4200287
—
DIAZEPAM (DIASTAT) 2.5MG RECTAL GEL
Gross
$220
4200437
—
FLUTICASONE (FLOVENT DISKUS) 250MCG
Gross
$220
4200686
—
MALATHION (OVIDE) 0.5% LOT
Gross
$213
4200148
—
BUDESONIDE (PULMICORT FLEX) 180MCG
Gross
$208
4200114
—
BECLOMETHASONE (QVAR) 80MCG INH
Gross
$203
4200756
—
MOMETASONE (ASMANEX HFA) 200MCG INH
Gross
$203
90791
$156
Psychiatric Diagnosic Evaluation
Gross
$200
4201046
—
TOBRAMYCIN/DEXA (TOBRADEX) OPH OINT
Gross
$197
4200528
—
HPV VACCINE (GARDASIL 9)
Gross
$194
4201044
—
TOBRAMYCIN (TOBREX) 0.3% OPHT OIN
Gross
$194
4201019
—
SPINOSAD (NATROBA) 0.9% SUS
Gross
$193
4200209
—
CIPRO/DEXAMETH (CIPRODEX) OTIC
Gross
$186
4200733
—
METRONIDAZOLE (METROGEL) 1% GEL
Gross
$182
1600027
—
XR LUMBOSACRAL SPINE -COMPLETE W BEND
Gross
$175
4200758
—
MOMETASONE (ASMANEX) 220MCG INH
Gross
$173
4200755
—
MOMETASONE (ASMANEX HFA) 100MCG INH
Gross
$172
4200734
—
METRONIDAZOLE (METROLOTION) 0.75%
Gross
$171
4200441
—
FLUTICASONE (FLOVENT HFA) 44MCG INH
Gross
$165
4200436
—
FLUTICASONE (FLOVENT DISKUS) 100MCG
Gross
$165
| Code | Description | Gross | Cash | Min payer | Max payer | # insurers |
|---|---|---|---|---|---|---|
| 4200618 | LEUPROLIDE (LUPRON DEPOT) 30MG INJ | $7,556 | — | — | — | 0 |
| 4200616 | LEUPROLIDE (LUPRON DEPOT) 11.25MG | $6,860 | — | — | — | 0 |
| 4200617 | LEUPROLIDE (LUPRON DEPOT) 15MG INJ | $2,519 | — | — | — | 0 |
| 138 | Inpatient Room and Board | $2,514 | $2,325 | — | — | 8 |
| 4200142 | BOTULINUM TOXIN A (BOTOX) 200 UNITS | $1,674 | — | — | — | 0 |
| 4200619 | LEUPROLIDE (LUPRON DEPOT) 7.5MG INJ | $1,260 | — | — | — | 0 |
| 4200141 | BOTULINUM TOXIN A (BOTOX) 100 UNITS | $661 | — | — | — | 0 |
| 4200375 | EPINEPHRINE (EPIPEN) 0.3MG INJ | $588 | — | — | — | 0 |
| 4200374 | EPINEPHRINE (EPI-PEN JR) 0.15MG INJ | $587 | — | — | — | 0 |
| 4201014 | SOMATROPIN (HUMATROPE) 5MG INJ | $568 | — | — | — | 0 |
| 4200432 | FLUTIC/SALME (ADVAIR DISKUS) 500/50 | $457 | — | — | — | 0 |
| 4200434 | FLUTIC/SALME (ADVAIR HFA) 230/21 IN | $456 | — | — | — | 0 |
| 4200431 | FLUTIC/SALME (ADVAIR DISKUS) 250/50 | $348 | — | — | — | 0 |
| 4200433 | FLUTIC/SALME (ADVAIR HFA) 115/21 IN | $347 | — | — | — | 0 |
| 4200440 | FLUTICASONE (FLOVENT HFA) 220MCG IN | $342 | — | — | — | 0 |
| 4200146 | BUDESO/FORMO (SYMBICORT) 160/4.5 IN | $320 | — | — | — | 0 |
| 1800127 | COVID TESTING CHILD | $300 | — | — | — | 0 |
| 4200122 | BENZYL ALCOHOL (ULESFIA) 5% LOT | $297 | — | — | — | 0 |
| 4200012 | ACYCLOVIR (ZOVIRAX) 5% OINT | $296 | — | — | — | 0 |
| 4201063 | TRETINOIN (RETIN-A) 0.05% GEL | $281 | — | — | — | 0 |
| 4200147 | BUDESO/FORMO (SYMBICORT) 80/4.5 INH | $280 | — | — | — | 0 |
| 4200430 | FLUTIC/SALME (ADVAIR DISKUS) 100/50 | $280 | — | — | — | 0 |
| 4200435 | FLUTIC/SALME (ADVAIR HFA) 45/21 INH | $279 | — | — | — | 0 |
| 4200288 | DIAZEPAM (DIASTAT) 20MG RECTAL GEL | $257 | — | — | — | 0 |
| 4200286 | DIAZEPAM (DIASTAT) 10MG RECTAL GEL | $251 | — | — | — | 0 |
| 4200570 | INSULIN LISPRO (HUMALOG) 100 U/ML | $246 | — | — | — | 0 |
| 4201058 | TRETINOIN (RETIN-A MICRO) 0.1% GEL | $246 | — | — | — | 0 |
| 4200464 | GLUCAGON (GLUCAGEN HYPOKIT) 1MG INJ | $245 | — | — | — | 0 |
| 4200569 | INSULIN GLARGINE (LANTUS) 100U/ML | $241 | — | — | — | 0 |
| 4201057 | TRETINOIN (RETIN-A MICRO) 0.04% GEL | $225 | — | — | — | 0 |
| 4200439 | FLUTICASONE (FLOVENT HFA) 110MCG IN | $221 | — | — | — | 0 |
| 4200287 | DIAZEPAM (DIASTAT) 2.5MG RECTAL GEL | $220 | — | — | — | 0 |
| 4200437 | FLUTICASONE (FLOVENT DISKUS) 250MCG | $220 | — | — | — | 0 |
| 4200686 | MALATHION (OVIDE) 0.5% LOT | $213 | — | — | — | 0 |
| 4200148 | BUDESONIDE (PULMICORT FLEX) 180MCG | $208 | — | — | — | 0 |
| 4200114 | BECLOMETHASONE (QVAR) 80MCG INH | $203 | — | — | — | 0 |
| 4200756 | MOMETASONE (ASMANEX HFA) 200MCG INH | $203 | — | — | — | 0 |
| 90791 | Psychiatric Diagnosic Evaluation | $200 | $156 | — | — | 8 |
| 4201046 | TOBRAMYCIN/DEXA (TOBRADEX) OPH OINT | $197 | — | — | — | 0 |
| 4200528 | HPV VACCINE (GARDASIL 9) | $194 | — | — | — | 0 |
| 4201044 | TOBRAMYCIN (TOBREX) 0.3% OPHT OIN | $194 | — | — | — | 0 |
| 4201019 | SPINOSAD (NATROBA) 0.9% SUS | $193 | — | — | — | 0 |
| 4200209 | CIPRO/DEXAMETH (CIPRODEX) OTIC | $186 | — | — | — | 0 |
| 4200733 | METRONIDAZOLE (METROGEL) 1% GEL | $182 | — | — | — | 0 |
| 1600027 | XR LUMBOSACRAL SPINE -COMPLETE W BEND | $175 | — | — | — | 0 |
| 4200758 | MOMETASONE (ASMANEX) 220MCG INH | $173 | — | — | — | 0 |
| 4200755 | MOMETASONE (ASMANEX HFA) 100MCG INH | $172 | — | — | — | 0 |
| 4200734 | METRONIDAZOLE (METROLOTION) 0.75% | $171 | — | — | — | 0 |
| 4200441 | FLUTICASONE (FLOVENT HFA) 44MCG INH | $165 | — | — | — | 0 |
| 4200436 | FLUTICASONE (FLOVENT DISKUS) 100MCG | $165 | — | — | — | 0 |
Showing top 50 of 1,366 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.