City of Philadelphia Behavioral Health: disclosed hospital rates

iDirect answer

Based on the published hospital price files, City of Philadelphia Behavioral Health appears in disclosed negotiated rates across 1 hospital and 102 services. This is public hospital price transparency data, not a guaranteed estimate of your bill.

Actual patient responsibility may vary based on your insurance plan, deductible, coinsurance, network status, diagnosis, setting, bundled services, clinical circumstances, and hospital billing practices.

102 prices shown.

Service	Hospital	Code	List price	Cash price	Negotiated range	Allowed (median)
ALTEPLASE TPA 1 MG ML SYRINGE EVD CLEARANCE Inpatient	The Hospital of the University of Pennsylvania	J2997 HCPCS	$255	$255	$43.09 – $255	—
ALTEPLASE TPA 1 MG ML SYRINGE EVD CLEARANCE Outpatient	The Hospital of the University of Pennsylvania	J2997 HCPCS	$255	$255	$44.83 – $255	—
AMINOCAPROIC ACID IVPB 10G 100ML NSS CNR Inpatient	The Hospital of the University of Pennsylvania	J0290 HCPCS	$75.00	$75.00	$12.67 – $75.00	—
AMINOCAPROIC ACID IVPB 10G 100ML NSS CNR Outpatient	The Hospital of the University of Pennsylvania	J0290 HCPCS	$75.00	$75.00	$0.49 – $75.00	—
BUPIVACAINE 0 05 FENTANYL 2 MCG ML EPIDURAL 250 Inpatient	The Hospital of the University of Pennsylvania	102157 CDM	$52.00	$52.00	$8.79 – $52.00	—
BUPIVACAINE 0 05 FENTANYL 2 MCG ML EPIDURAL 250 Outpatient	The Hospital of the University of Pennsylvania	102157 CDM	$52.00	$52.00	$5.82 – $52.00	—
BUPIVACAINE 0 1 EPIDURAL 250ML NSS CNR Inpatient	The Hospital of the University of Pennsylvania	102168 CDM	$33.00	$33.00	$5.58 – $33.00	—
BUPIVACAINE 0 1 EPIDURAL 250ML NSS CNR Outpatient	The Hospital of the University of Pennsylvania	102168 CDM	$33.00	$33.00	$3.70 – $33.00	—
CEFAZOLIN 100 MG ML ANESTHESIA PPMC Inpatient	The Hospital of the University of Pennsylvania	J0690 HCPCS	$2.00	$2.00	$0.34 – $2.00	—
CEFAZOLIN 100 MG ML ANESTHESIA PPMC Outpatient	The Hospital of the University of Pennsylvania	J0690 HCPCS	$2.00	$2.00	$0.22 – $2.00	—
CIDOFOVIR 15 MG ML IV SOLN Inpatient	The Hospital of the University of Pennsylvania	J0740 HCPCS	$533	$533	$90.08 – $533	—
CIDOFOVIR 15 MG ML IV SOLN Outpatient	The Hospital of the University of Pennsylvania	J0740 HCPCS	$533	$533	$93.70 – $1,213	—
CLOG ZAPPER Inpatient	The Hospital of the University of Pennsylvania	100450 CDM	$86.00	$86.00	$14.53 – $86.00	—
CLOG ZAPPER Outpatient	The Hospital of the University of Pennsylvania	100450 CDM	$86.00	$86.00	$9.63 – $86.00	—
CLONIDINE 0 01 MG ML ORAL SUSP ORD Inpatient	The Hospital of the University of Pennsylvania	17306 CDM	$71.00	$71.00	$12.00 – $71.00	—
CLONIDINE 0 01 MG ML ORAL SUSP ORD Outpatient	The Hospital of the University of Pennsylvania	17306 CDM	$71.00	$71.00	$7.95 – $71.00	—
CNR TAC 7 TOP SOLN REPACKAGE PHASE II 5 ML Inpatient	The Hospital of the University of Pennsylvania	99 CDM	$615	$615	$104 – $615	—
CNR TAC 7 TOP SOLN REPACKAGE PHASE II 5 ML Outpatient	The Hospital of the University of Pennsylvania	99 CDM	$615	$615	$68.88 – $615	—
COAPTITE IMPLANT INJECTION Inpatient	The Hospital of the University of Pennsylvania	102005 CDM	$30.00	$30.00	$5.07 – $30.00	—
COAPTITE IMPLANT INJECTION Outpatient	The Hospital of the University of Pennsylvania	102005 CDM	$30.00	$30.00	$3.36 – $30.00	—
DEXAMETHASONE IVPB 10MG 50ML NSS CNR Inpatient	The Hospital of the University of Pennsylvania	J1100 HCPCS	$23.00	$23.00	$3.89 – $23.00	—
DEXAMETHASONE IVPB 10MG 50ML NSS CNR Outpatient	The Hospital of the University of Pennsylvania	J1100 HCPCS	$23.00	$23.00	$0.09 – $23.00	—
DEXAMETHASONE IVPB 12MG 50ML NSS CNR Inpatient	The Hospital of the University of Pennsylvania	J1100 HCPCS	$24.00	$24.00	$4.06 – $24.00	—
DEXAMETHASONE IVPB 12MG 50ML NSS CNR Outpatient	The Hospital of the University of Pennsylvania	J1100 HCPCS	$24.00	$24.00	$0.09 – $24.00	—
DEXAMETHASONE IVPB 8MG 50ML NSS CNR Inpatient	The Hospital of the University of Pennsylvania	J1100 HCPCS	$22.00	$22.00	$3.72 – $22.00	—