Pennsylvania Hospital — price list

← Hospital overviewVerified from Pennsylvania Hospital’s published price file

Includes cash prices, list prices, insurance-negotiated rates. Open any row for plan-level negotiated rates. This is public hospital price transparency data, not a guaranteed estimate of your bill.

How to read these columns

List: The hospital’s full undiscounted (gross) charge — rarely what anyone actually pays.
Cash: The discounted self-pay price for paying directly, without insurance.
Negotiated: Rates agreed with insurers; open a row for plan-level detail. Your share depends on your benefits.

These are the hospital’s published reference prices, not a personalized estimate of your bill.

69 prices shown.

Service	Code	List price	Cash price	Negotiated range	Allowed (median)
ALTEPLASE (TPA) 1 MG/ML SYRINGE EVD CLEARANCE Inpatient	J2997 HCPCS	$255	$255	$43.09 – $255	—
ALTEPLASE (TPA) 1 MG/ML SYRINGE EVD CLEARANCE Outpatient	J2997 HCPCS	$255	$255	$44.83 – $255	—
ALTEPLASE (TPA) INJECTION 1MG/ML ORD Inpatient	J2997 HCPCS	$308	$308	$52.05 – $308	—
ALTEPLASE (TPA) INJECTION 1MG/ML ORD Outpatient	J2997 HCPCS	$308	$308	$54.15 – $308	—
ALTEPLASE (TPA) INJECTION 5MG/5ML ORD Inpatient	J2997 HCPCS	$1,372	$1,372	$232 – $1,372	—
ALTEPLASE (TPA) INJECTION 5MG/5ML ORD Outpatient	J2997 HCPCS	$1,372	$1,372	$91.48 – $1,372	—
AMPHOTERICIN B 100 MCG/ML NASAL IRRIGATION ORD Inpatient	J0285 HCPCS	$28.00	$28.00	$4.73 – $28.00	—
AMPHOTERICIN B 100 MCG/ML NASAL IRRIGATION ORD Outpatient	J0285 HCPCS	$28.00	$28.00	$3.78 – $96.37	—
AMPICILLIN IVPB 1G/50ML NSS (CNR) Inpatient	J0290 HCPCS	$31.00	$31.00	$5.24 – $31.00	—
AMPICILLIN IVPB 1G/50ML NSS (CNR) Outpatient	J0290 HCPCS	$31.00	$31.00	$0.49 – $31.00	—
AMPICILLIN IVPB 2G/100ML NSS (CNR) Inpatient	J0290 HCPCS	$56.00	$56.00	$9.46 – $56.00	—
AMPICILLIN IVPB 2G/100ML NSS (CNR) Outpatient	J0290 HCPCS	$56.00	$56.00	$0.49 – $56.00	—
ATROPINE SULFATE 0.4 MG/ML INJECTION SOLN (WRAPPER Inpatient	J0461 HCPCS	$32.00	$32.00	$5.41 – $32.00	—
CEFAZOLIN 100 MG/ML (ANESTHESIA) Inpatient	J0690 HCPCS	$2.00	$2.00	$0.34 – $2.00	—
CEFAZOLIN 100 MG/ML (ANESTHESIA) Outpatient	J0690 HCPCS	$2.00	$2.00	$0.27 – $2.00	—
CEFAZOLIN FORTE 50 MG/ML OPHTH SOLN ORD Inpatient	J0690 HCPCS	$89.00	$89.00	$15.04 – $89.00	—
CEFAZOLIN FORTE 50 MG/ML OPHTH SOLN ORD Outpatient	J0690 HCPCS	$89.00	$89.00	$0.81 – $89.00	—
CEFTAZIDIME 50 MG/ML OPHTH SOLN ORD Inpatient	J0713 HCPCS	$183	$183	$30.93 – $183	—
CEFTAZIDIME 50 MG/ML OPHTH SOLN ORD Outpatient	J0713 HCPCS	$183	$183	$1.47 – $183	—
CIDOFOVIR 15 MG/ML IV SOLN Inpatient	J0740 HCPCS	$533	$533	$90.08 – $533	—
CIDOFOVIR 15 MG/ML IV SOLN Outpatient	J0740 HCPCS	$533	$533	$93.70 – $1,213	—
DEXAMETHASONE 0.25 MG PO SPLIT TABLET Inpatient	J8540 HCPCS	$1.00	$1.00	$0.17 – $1.00	—
DEXAMETHASONE 0.25 MG PO SPLIT TABLET Outpatient	J8540 HCPCS	$1.00	$1.00	$0.01 – $1.00	—
EPOPROSTENOL (FLOLAN) 1.5 MG IN 50 ML INHALATION S Inpatient	J1325 HCPCS	$170	$170	$28.73 – $170	—
EPOPROSTENOL (FLOLAN) 1.5 MG IN 50 ML INHALATION S Outpatient	J1325 HCPCS	$170	$170	$15.65 – $170	—
FENTANYL CITRATE 0.05 MG/ML INJECTION SOLN EPIDURA Inpatient	J3010 HCPCS	$1.00	$1.00	$0.17 – $1.00	—
FENTANYL CITRATE 0.05 MG/ML INJECTION SOLN EPIDURA Outpatient	J3010 HCPCS	$1.00	$1.00	$0.14 – $2.44	—
FENTANYL CITRATE 0.05 MG/ML INJECTION SOLN INTRATH Inpatient	J3010 HCPCS	$1.00	$1.00	$0.17 – $1.00	—
FENTANYL CITRATE 0.05 MG/ML INJECTION SOLN INTRATH Outpatient	J3010 HCPCS	$1.00	$1.00	$0.14 – $2.44	—
FENTANYL PCA 1500 MCG/30ML (CNR) (WRAPPER) Inpatient	J3010 HCPCS	$10.00	$10.00	$1.69 – $10.00	—