99090561-2215105 — 72694-0954-01 - Pegaspargase 3,750 IntlUnit(s) / 5
Cite this view
HANK Price Transparency. (n.d.). 72694-0954-01 - pegaspargase 3,750 IntlUnit(s) / 5 (OTHER 99090561-2215105) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/99090561-2215105?code_type=OTHER
“72694-0954-01 - pegaspargase 3,750 IntlUnit(s) / 5 (OTHER 99090561-2215105) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/99090561-2215105?code_type=OTHER. Accessed .
“72694-0954-01 - pegaspargase 3,750 IntlUnit(s) / 5 (OTHER 99090561-2215105) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/99090561-2215105?code_type=OTHER.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $193,511–$298,628 (25th–75th percentile) across 2 hospitals · 26 payers.
“Negotiated” is the hospital’s negotiated facility rate for this OTHER 99090561-2215105 — 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 |
|---|---|---|---|---|---|---|---|
| NORTHWEST HEALTH-LA PORTE Outpatient | Aetna | Node Aetna Mcr Adv | $89,373.62 | $343,744.71 | $113,435.75 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Outpatient | Aetna | Node Aetna Mcr Adv | $89,373.62 | $343,744.71 | $92,811.07 | 2026-05-27 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Outpatient | Self Pay | Self Pay | $92,811.07 | $343,744.71 | $92,811.07 | 2026-05-27 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Outpatient | Lutheran | Lutheran Preferred | $92,811.07 | $343,744.71 | $113,435.75 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Outpatient | Lutheran | Lutheran Preferred | $92,811.07 | $343,744.71 | $92,811.07 | 2026-05-27 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Outpatient | Self Pay | Self Pay | $113,435.75 | $343,744.71 | $113,435.75 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Inpatient | Medpartners | Lutheran Preferred Chs Employees | $115,154.48 | $343,744.71 | $189,059.59 | 2026-05-27 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Outpatient | Physicians Health Plan | Php Options | $142,000.94 | $343,744.71 | $92,811.07 | 2026-05-27 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Outpatient | Php | Php Options | $142,000.94 | $343,744.71 | $113,435.75 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Inpatient | Lutheran Preferred Medpartners | Lutheran Preferred Chs Employees | $143,685.29 | $343,744.71 | $185,622.14 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Outpatient | Alpha Baking | Alpha Baking | $154,685.12 | $343,744.71 | $92,811.07 | 2026-05-27 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Outpatient | Alpha Baking | Alpha Baking | $154,685.12 | $343,744.71 | $113,435.75 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Inpatient | Self Pay | Self Pay | $185,622.14 | $343,744.71 | $185,622.14 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Inpatient | Self Pay | Self Pay | $189,059.59 | $343,744.71 | $189,059.59 | 2026-05-27 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Outpatient | Php | Php Freedom Network | $206,865.57 | $343,744.71 | $92,811.07 | 2026-05-27 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Outpatient | Php Freedom Network | Php Freedom Network | $206,865.57 | $343,744.71 | $113,435.75 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Inpatient | Encore | Encore Combined Ppo | $223,434.06 | $343,744.71 | $185,622.14 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Inpatient | Encore | Encore Combined Ppo | $223,434.06 | $343,744.71 | $189,059.59 | 2026-05-27 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Outpatient | United Healthcare | Uhc Apa | $239,590.06 | $343,744.71 | $113,435.75 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Outpatient | One Call | One Call Care Diagnostics Wc | $240,621.30 | $343,744.71 | $92,811.07 | 2026-05-27 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Outpatient | One Call | One Call | $240,621.30 | $343,744.71 | $113,435.75 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Inpatient | County Of Laporte | County Of Laporte | $240,621.30 | $343,744.71 | $185,622.14 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Outpatient | One Call | One Call Work Comp | $240,621.30 | $343,744.71 | $113,435.75 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Outpatient | Uhc Apa | Uhc Apa | $240,965.04 | $343,744.71 | $92,811.07 | 2026-05-27 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Outpatient | United Healthcare | Uhc Core | $241,996.28 | $343,744.71 | $113,435.75 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Outpatient | United Healthcare | Uhc Core | $243,371.25 | $343,744.71 | $92,811.07 | 2026-05-27 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Outpatient | Cigna | Cigna All | $255,402.32 | $343,744.71 | $113,435.75 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Inpatient | Prime Health Services Auto | Prime Health Services Auto | $257,808.53 | $343,744.71 | $185,622.14 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Inpatient | Prime Health Services | Prime Health Services | $257,808.53 | $343,744.71 | $185,622.14 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Inpatient | Aetna | Aetna All | $267,089.64 | $343,744.71 | $185,622.14 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Outpatient | Aetna | Aetna | $274,652.02 | $343,744.71 | $113,435.75 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Outpatient | Ihn | Ihn | $274,995.77 | $343,744.71 | $113,435.75 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Outpatient | Multiplan Inc | Multiplan Complementary | $274,995.77 | $343,744.71 | $92,811.07 | 2026-05-27 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Outpatient | Aetna | Aetna All | $280,839.43 | $343,744.71 | $92,811.07 | 2026-05-27 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Inpatient | Aetna | Aetna Nap | $284,276.88 | $343,744.71 | $185,622.14 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Inpatient | Cigna All | Cigna All | $285,308.11 | $343,744.71 | $189,059.59 | 2026-05-27 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Inpatient | Encore | Encore Market Share | $292,183.00 | $343,744.71 | $185,622.14 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Inpatient | Multiplan Inc | Multiplan Complementary | $292,183.00 | $343,744.71 | $189,059.59 | 2026-05-27 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Inpatient | Coventry First Health | Coventry First Health | $297,339.17 | $343,744.71 | $189,059.59 | 2026-05-27 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Inpatient | Aetna | Aetna Nap | $297,339.17 | $343,744.71 | $189,059.59 | 2026-05-27 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Inpatient | Encore | Encore | $299,057.90 | $343,744.71 | $189,059.59 | 2026-05-27 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Inpatient | Community Health Alliance | Cha | $299,057.90 | $343,744.71 | $185,622.14 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Inpatient | Lutheran Network | Lutheran Preferred Choice | $302,495.34 | $343,744.71 | $189,059.59 | 2026-05-27 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Inpatient | Sagamore Health Network | Sagamore | $302,495.34 | $343,744.71 | $189,059.59 | 2026-05-27 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Inpatient | Lutheran Network | Lutheran Preferred Choice | $302,495.34 | $343,744.71 | $185,622.14 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Inpatient | Sagamore Health Network | Sagamore | $302,495.34 | $343,744.71 | $185,622.14 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Inpatient | Hfn Workers Compensation | Hfn Work Comp | $309,370.24 | $343,744.71 | $185,622.14 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Inpatient | Multiplan | Multiplan | $309,370.24 | $343,744.71 | $185,622.14 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Inpatient | Encore | Encore | $309,370.24 | $343,744.71 | $185,622.14 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Inpatient | Chandler Group | Preferred Plan Inc | $309,370.24 | $343,744.71 | $185,622.14 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH-LA PORTE Inpatient | Phcs | Phcs | $309,370.24 | $343,744.71 | $185,622.14 | 2026-05-09 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Inpatient | Multiplan Inc | Multiplan Primary | $309,370.24 | $343,744.71 | $189,059.59 | 2026-05-27 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Inpatient | Community Health Alliance | Community Health Alliance | $309,370.24 | $343,744.71 | $189,059.59 | 2026-05-27 | MRF ↗ |
| NORTHWEST HEALTH - STARKE Inpatient | Ppom | Cofinity | $323,120.03 | $343,744.71 | $189,059.59 | 2026-05-27 | MRF ↗ |