AdventHealth Polk — price list
← Hospital overviewVerified from AdventHealth Polk’s published price file
Includes 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.
Showing the first 1,500 prices. Search a procedure or code below to narrow the list.
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.
1,500 prices shown.
| Service | Code | List price | Cash price | Negotiated range | Allowed (median) | |
|---|---|---|---|---|---|---|
| 12 HOUR DECONGESTANT 0.05 % NA SOLN Inpatient & outpatient | 259 RC | $43.50 | — | — | — | |
| 7 DAY VAGINAL 2 % VA CREA Inpatient & outpatient | 259 RC | $58.85 | — | — | — | |
| ACETAMINOPHEN 1000 MG/100 ML IV SOLN Inpatient & outpatient | J0131 HCPCS | $35.44 | — | — | — | |
| ACETAMINOPHEN 1000 MG/100 ML IV SOLN Inpatient & outpatient | J0134 HCPCS | $33.75 | — | — | — | |
| ACETAMINOPHEN 1000 MG/100 ML IV SOLN Inpatient & outpatient | J0137 HCPCS | $52.13 | — | — | — | |
| ACETAMINOPHEN 1000 MG/100 ML IV SOLN Inpatient & outpatient | J0136 HCPCS | $38.13 | — | — | — | |
| ACETAMINOPHEN 160 MG/5ML PO SOLN Inpatient & outpatient | 259 RC | $27.51 | — | — | — | |
| ACETAMINOPHEN 500 MG/50 ML IV SOLN Inpatient & outpatient | J0136 HCPCS | $43.15 | — | — | — | |
| ACETAMINOPHEN 650 MG/20.3ML PO SOLN Inpatient & outpatient | 259 RC | $10.04 | — | — | — | |
| ACETAZOLAMIDE SODIUM 500 MG IJ SOLR Inpatient & outpatient | J1120 HCPCS | $63.21 | — | — | — | |
| ACETIC ACID 3 % SOLN Inpatient & outpatient | 259 RC | $3.47 | — | — | — | |
| ACETYLCYSTEINE 20 % IN SOLN Inpatient & outpatient | 259 RC | $109 | — | — | — | |
| ACETYLCYSTEINE 200 MG/ML IV SOLN Inpatient & outpatient | J0132 HCPCS | $102 | — | — | — | |
| ACTEMRA 200 MG/10ML IV SOLN Inpatient & outpatient | J3262 HCPCS | $511 | — | — | — | |
| ACTEMRA 400 MG/20ML IV SOLN Inpatient & outpatient | J3262 HCPCS | $4,088 | — | — | — | |
| ACTEMRA 80 MG/4ML IV SOLN Inpatient & outpatient | J3262 HCPCS | $511 | — | — | — | |
| ACTIDOSE WITH SORBITOL 25 GM/120ML PO SUSP Inpatient & outpatient | 259 RC | $154 | — | — | — | |
| ACTIDOSE-AQUA 25 GM/120ML PO LIQD Inpatient & outpatient | 259 RC | $154 | — | — | — | |
| ACYCLOVIR SODIUM 50 MG/ML IV SOLN Inpatient & outpatient | J0133 HCPCS | $33.54 | — | — | — | |
| ADACEL 5-2-15.5 LF-MCG/0.5 IM SUSP Inpatient & outpatient | 90715 HCPCS | $365 | — | — | — | |
| ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN Inpatient & outpatient | J0153 HCPCS | $39.02 | — | — | — | |
| ADENOSINE 12 MG/4ML IV SOLN Inpatient & outpatient | J0153 HCPCS | $81.80 | — | — | — | |
| ADENOSINE 6 MG/2ML IV SOLN Inpatient & outpatient | J0153 HCPCS | $40.84 | — | — | — | |
| ADMELOG 100 UNIT/ML IJ SOLN Inpatient & outpatient | J1815 HCPCS | $16.21 | — | — | — | |
| ADRENALIN 0.1 % NA SOLN Inpatient & outpatient | 259 RC | $1,005 | — | — | — | |
| ADRENALIN 1 MG/ML IJ SOLN Inpatient & outpatient | J0171 HCPCS | $18.47 | — | — | — | |
| ADRENALIN 30 MG/30ML IJ SOLN Inpatient & outpatient | J0171 HCPCS | $15.30 | — | — | — | |
| ADRENALIN-NACL 4-0.9 MG/250ML-% IV SOLN Inpatient & outpatient | J3490 HCPCS | $170 | — | — | — | |
| AFLURIA PRESERVATIVE FREE 0.5 ML IM SUSY Inpatient & outpatient | 90656 HCPCS | $126 | — | — | — | |
| AFRIN NODRIP EXTRA MOISTURE 0.05 % NA SOLN Inpatient & outpatient | 259 RC | $117 | — | — | — |