4120082 — Telfa Clear 4x5
Cite this view
HANK Price Transparency. (n.d.). TELFA CLEAR 4X5 (OTHER 4120082) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/4120082?code_type=OTHER
“TELFA CLEAR 4X5 (OTHER 4120082) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/4120082?code_type=OTHER. Accessed .
“TELFA CLEAR 4X5 (OTHER 4120082) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/4120082?code_type=OTHER.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $5–$10 (25th–75th percentile) across 2 hospitals · 20 payers.
“Negotiated” is the hospital’s negotiated facility rate for this OTHER 4120082 — 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 |
|---|---|---|---|---|---|---|---|
| Dewitt Hospital & Nursing Home, Inc Outpatient | Municipal Health Plan | Commercial | $3.38 | $8.45 | $8.45 | 2026-05-22 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Municipal Health Plan | Commercial | $3.38 | $8.45 | $8.45 | 2026-05-11 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Aetna Plan | Commercial | $4.23 | $8.45 | $8.45 | 2026-05-22 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Aetna Plan | Commercial | $4.23 | $8.45 | $8.45 | 2026-05-11 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Medicare Plan | Medicare | $5.15 | $8.45 | $8.45 | 2026-05-11 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Vantage Medicare Advantage Plan | Medicare | $5.15 | $8.45 | $8.45 | 2026-05-11 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Uhc Medicare Plan | Medicare | $5.15 | $8.45 | $8.45 | 2026-05-22 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Medicare Plan | Medicare | $5.15 | $8.45 | $8.45 | 2026-05-22 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Vantage Medicare Advantage Plan | Medicare | $5.15 | $8.45 | $8.45 | 2026-05-22 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Bcbs Medicare Advantage Plan | Medicare | $5.15 | $8.45 | $8.45 | 2026-05-11 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Uhc Medicare Plan | Medicare | $5.15 | $8.45 | $8.45 | 2026-05-11 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Bcbs Medicare Advantage Plan | Medicare | $5.15 | $8.45 | $8.45 | 2026-05-22 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Vantage Health Plan | Commercial | $5.92 | $8.45 | $8.45 | 2026-05-22 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Vantage Health Plan | Commercial | $5.92 | $8.45 | $8.45 | 2026-05-11 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Ambetter Plan | Medicare | $6.44 | $8.45 | $8.45 | 2026-05-11 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Ambetter Plan | Medicare | $6.44 | $8.45 | $8.45 | 2026-05-22 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Vaccn Plan | Medicare | $6.67 | $8.45 | $8.45 | 2026-05-11 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Vaccn Plan | Medicare | $6.67 | $8.45 | $8.45 | 2026-05-22 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Qualchoice Plan | Commercial | $7.61 | $8.45 | $8.45 | 2026-05-22 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Qualchoice Plan | Commercial | $7.61 | $8.45 | $8.45 | 2026-05-11 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Bcbs Health Advantage Hmo Plan | Commercial | $8.03 | $8.45 | $8.45 | 2026-05-11 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Bcbs First Source Ppo Plan | Commercial | $8.03 | $8.45 | $8.45 | 2026-05-22 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Bcbs Health Advantage Hmo Plan | Commercial | $8.03 | $8.45 | $8.45 | 2026-05-22 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Bcbs True Blue Ppo Plan | Commercial | $8.03 | $8.45 | $8.45 | 2026-05-22 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Bcbs True Blue Ppo Plan | Commercial | $8.03 | $8.45 | $8.45 | 2026-05-11 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Bcbs First Source Ppo Plan | Commercial | $8.03 | $8.45 | $8.45 | 2026-05-11 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Medicaid Plan | Medicaid | $10.02 | $8.45 | $8.45 | 2026-05-22 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Total Care Plan | Medicaid | $10.02 | $8.45 | $8.45 | 2026-05-11 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Medicaid Plan | Medicaid | $10.02 | $8.45 | $8.45 | 2026-05-11 | MRF ↗ |
| Dewitt Hospital & Nursing Home, Inc Outpatient | Total Care Plan | Medicaid | $10.02 | $8.45 | $8.45 | 2026-05-22 | MRF ↗ |
| FERRY COUNTY MEMORIAL HOSPITAL | Medicare All Plans | — | $3,602.49 | $4,503.11 | — | 2026-05-18 | MRF ↗ |
| FERRY COUNTY MEMORIAL HOSPITAL | Premera All Plans | — | $3,827.64 | $4,503.11 | — | 2026-05-18 | MRF ↗ |
| FERRY COUNTY MEMORIAL HOSPITAL | Regence All Plans | — | $3,827.64 | $4,503.11 | — | 2026-05-18 | MRF ↗ |
| FERRY COUNTY MEMORIAL HOSPITAL | Geha All Plans | — | $4,052.80 | $4,503.11 | — | 2026-05-18 | MRF ↗ |
| FERRY COUNTY MEMORIAL HOSPITAL | Cigna All Plans | — | $4,052.80 | $4,503.11 | — | 2026-05-18 | MRF ↗ |
| FERRY COUNTY MEMORIAL HOSPITAL | United Healthcare All Plans | — | $4,052.80 | $4,503.11 | — | 2026-05-18 | MRF ↗ |
| FERRY COUNTY MEMORIAL HOSPITAL | Aetna All Plans | — | $4,052.80 | $4,503.11 | — | 2026-05-18 | MRF ↗ |
| FERRY COUNTY MEMORIAL HOSPITAL | Kaiser All Plans | — | $4,052.80 | $4,503.11 | — | 2026-05-18 | MRF ↗ |