126857_ERX — Revatio 10 Mg/ml Oral Susp
Cite this view
HANK Price Transparency. (n.d.). REVATIO 10 MG/ML ORAL SUSP (CDM 126857_ERX) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/126857_ERX?code_type=CDM
“REVATIO 10 MG/ML ORAL SUSP (CDM 126857_ERX) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/126857_ERX?code_type=CDM. Accessed .
“REVATIO 10 MG/ML ORAL SUSP (CDM 126857_ERX) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/126857_ERX?code_type=CDM.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $10,665–$16,301 (25th–75th percentile) across 1 hospital · 22 payers.
“Negotiated” is the hospital’s negotiated facility rate for this CDM 126857_ERX — the consumer-grade median across the country. It covers the facility charge only; the surgeon’s and anesthesiologist’s fees are billed separately.
Per-month price trends are temporarily unavailable while we rebuild them on quality-filtered rates. The medians, percentiles, and per-hospital rates on this page are the quality-filtered figures.
Hospital rates (per row)
Showing consumer-grade rates only. Flagged / outlier filings (excluded from the medians above) are hidden — tick “Show flagged / outlier rates” to include them.
| Hospital | Payer | Plan | Negotiated rate | Gross | Cash | Observed | Source |
|---|---|---|---|---|---|---|---|
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | SCOTT & WHITE MEDICAID | SCOTT & WHITE MEDICAID | $10,665.26 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | MOLINA MEDICAID | MOLINA MEDICAID | $10,665.26 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | BCBS MEDICAID | BCBS MEDICAID | $10,665.26 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | UHC MCAID | UHC MCAID | $10,665.26 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | COMMUNITY FIRST HEALTH PLAN-ALL PLANS | COMMUNITY FIRST HEALTH PLAN-ALL PLANS | $10,665.26 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | SOONERCARE-ALL PLANS | SOONERCARE-ALL PLANS | $10,665.26 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | CHILDREN MED CENTER HEALTH PLAN - ALL PLANS | CHILDREN MED CENTER HEALTH PLAN - ALL PLANS | $10,665.26 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | COOK CHILDRENS HP-ALL PLANS | COOK CHILDRENS HP-ALL PLANS | $10,665.26 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | DRISCOLL CHILDRENS-ALL PLANS | DRISCOLL CHILDRENS-ALL PLANS | $10,665.26 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | MOLINA COMMERCIAL - ALL OTHER PLANS | MOLINA COMMERCIAL - ALL OTHER PLANS | $10,665.26 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | PARKLAND COMM MEDICAID-ALL PLANS | PARKLAND COMM MEDICAID-ALL PLANS | $10,665.26 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | AMERIGROUP MEDICAID-ALL PLANS | AMERIGROUP MEDICAID-ALL PLANS | $10,665.26 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | AETNA MEDICAID | AETNA MEDICAID | $10,985.22 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | FIRSTCARE HEALTH MCAID | FIRSTCARE HEALTH MCAID | $11,198.52 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | TX CHILDRENS HLTH MCAID-ALL PLANS | TX CHILDRENS HLTH MCAID-ALL PLANS | $11,198.52 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | AETNA COMM FRISCO OP ONLY | AETNA COMM FRISCO OP ONLY | $14,058.75 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | BCBS BAV | BCBS BAV | $14,058.75 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | AETNA COMM - ALL OTHER PLANS | AETNA COMM - ALL OTHER PLANS | $15,755.50 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | UHC COMM - ALL OTHER PLANS | UHC COMM - ALL OTHER PLANS | $15,755.50 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | BCBS HMO | BCBS HMO | $16,482.68 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | TRICARE - ALL PLANS | TRICARE - ALL PLANS | $16,967.46 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | FIRSTCARE HEALTH COMM - ALL OTHER PLANS | FIRSTCARE HEALTH COMM - ALL OTHER PLANS | $16,967.46 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | SCOTT & WHITE COMM- ALL OTHER PLANS | SCOTT & WHITE COMM- ALL OTHER PLANS | $18,179.42 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | HEALTHSCOPE - ALL PLANS | HEALTHSCOPE - ALL PLANS | $18,179.42 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | BCBS PPO AND TRAD - ALL OTHER PLANS | BCBS PPO AND TRAD - ALL OTHER PLANS | $18,906.60 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | CIGNA COMM - ALL PLANS | CIGNA COMM - ALL PLANS | $19,391.38 | $24,239.23 | $24,239.23 | 2026-02-09 | MRF ↗ |