21784635_1 — Template Non-formulary 1 Ea Vial
Cite this view
HANK Price Transparency. (n.d.). Template Non-Formulary 1 EA Vial (CDM 21784635_1) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/21784635_1?code_type=CDM
“Template Non-Formulary 1 EA Vial (CDM 21784635_1) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/21784635_1?code_type=CDM. Accessed .
“Template Non-Formulary 1 EA Vial (CDM 21784635_1) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/21784635_1?code_type=CDM.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $15,143–$17,459 (25th–75th percentile) across 1 hospital · 5 payers.
“Negotiated” is the hospital’s negotiated facility rate for this CDM 21784635_1 — 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 |
|---|---|---|---|---|---|---|---|
| SYRINGA GENERAL HOSPITAL Outpatient | AETNA-ALL PLANS | AETNA-ALL PLANS | $8,907.81 | $17,815.61 | $16,034.05 | 2026-01-02 | MRF ↗ |
| SYRINGA GENERAL HOSPITAL Outpatient | MULTIPLAN-ALL PLANS | MULTIPLAN-ALL PLANS | $15,143.27 | $17,815.61 | $16,034.05 | 2026-01-02 | MRF ↗ |
| SYRINGA GENERAL HOSPITAL Outpatient | FIRST CHOICE HEALTH - ALL PLANS | FIRST CHOICE HEALTH - ALL PLANS | $16,924.83 | $17,815.61 | $16,034.05 | 2026-01-02 | MRF ↗ |
| SYRINGA GENERAL HOSPITAL Outpatient | BLUE CROSS-ALL PLANS | BLUE CROSS-ALL PLANS | $17,459.30 | $17,815.61 | $16,034.05 | 2026-01-02 | MRF ↗ |
| SYRINGA GENERAL HOSPITAL Outpatient | REGENCE BLUE SHIELD-ALL PLANS | REGENCE BLUE SHIELD-ALL PLANS | $17,815.61 | $17,815.61 | $16,034.05 | 2026-01-02 | MRF ↗ |