The Hospital of the University of Pennsylvania — price list
← Hospital overviewVerified from The Hospital of the University of Pennsylvania’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.
63 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 | — | |
| CEFAZOLIN 100 MG ML ANESTHESIA PPMC Inpatient | J0690 HCPCS | $2.00 | $2.00 | $0.34 – $2.00 | — | |
| CEFAZOLIN 100 MG ML ANESTHESIA PPMC Outpatient | J0690 HCPCS | $2.00 | $2.00 | $0.22 – $2.00 | — | |
| 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 | — | |
| CLOG ZAPPER Inpatient | 100450 CDM | $86.00 | $86.00 | $14.53 – $86.00 | — | |
| CLOG ZAPPER Outpatient | 100450 CDM | $86.00 | $86.00 | $9.63 – $86.00 | — | |
| CLONIDINE 0 01 MG ML ORAL SUSP ORD Inpatient | 17306 CDM | $71.00 | $71.00 | $12.00 – $71.00 | — | |
| CLONIDINE 0 01 MG ML ORAL SUSP ORD Outpatient | 17306 CDM | $71.00 | $71.00 | $7.95 – $71.00 | — | |
| CNR TAC 7 TOP SOLN REPACKAGE PHASE II 5 ML Inpatient | 99 CDM | $615 | $615 | $104 – $615 | — | |
| CNR TAC 7 TOP SOLN REPACKAGE PHASE II 5 ML Outpatient | 99 CDM | $615 | $615 | $68.88 – $615 | — | |
| COAPTITE IMPLANT INJECTION Inpatient | 102005 CDM | $30.00 | $30.00 | $5.07 – $30.00 | — | |
| COAPTITE IMPLANT INJECTION Outpatient | 102005 CDM | $30.00 | $30.00 | $3.36 – $30.00 | — | |
| ENDOSCOPIC INK Inpatient | 101922 CDM | $30.00 | $30.00 | $5.07 – $30.00 | — | |
| ENDOSCOPIC INK Outpatient | 101922 CDM | $30.00 | $30.00 | $3.36 – $30.00 | — | |
| 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 | $15.39 – $170 | — | |
| HYDROCODONE BIT HOMATROP MBR 5 1 5 MG 5ML PO SOLN Inpatient | 102125 CDM | $3.00 | $3.00 | $0.51 – $3.00 | — | |
| KETAMINE HCL 10 MG ML INJECTION SOLN WRAPPER Inpatient | 102001 CDM | $150 | $150 | $25.35 – $150 | — | |
| KETAMINE HCL 10 MG ML INJECTION SOLN WRAPPER Outpatient | 102001 CDM | $150 | $150 | $16.80 – $150 | — | |
| LIDOCAINE 4 TETRACAINE 0 5 TOP GEL ORD PPMC Inpatient | 101301 CDM | $65.00 | $65.00 | $10.98 – $65.00 | — | |
| LIDOCAINE 4 TETRACAINE 0 5 TOP GEL ORD PPMC Outpatient | 101301 CDM | $65.00 | $65.00 | $7.28 – $65.00 | — | |
| LIDOCAINE HCL 4 EX SOLN Inpatient | 102002 CDM | $2.00 | $2.00 | $0.34 – $2.00 | — | |
| LIDOCAINE HCL 4 EX SOLN Outpatient | 102002 CDM | $2.00 | $2.00 | $0.22 – $2.00 | — | |
| LOPERAMIDE HCL 1 MG 7 5ML PO SUSP WRAPPER Inpatient | 101747 CDM | $1.00 | $1.00 | $0.17 – $1.00 | — | |
| LOPERAMIDE HCL 1 MG 7 5ML PO SUSP WRAPPER Outpatient | 101747 CDM | $1.00 | $1.00 | $0.11 – $1.00 | — | |
| MAGIC MOUTHWASH CUSTOM MIXTURE Inpatient | 100817 CDM | $1.00 | $1.00 | $0.17 – $1.00 | — | |
| MAGIC MOUTHWASH CUSTOM MIXTURE Outpatient | 100817 CDM | $1.00 | $1.00 | $0.11 – $1.00 | — | |
| MISOPROSTOL 25 MCG PO SPLIT TABLET Inpatient | 101228 CDM | $5.00 | $5.00 | $0.84 – $5.00 | — |