Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

budesonide-formoterol 160 mcg-4.5 mcg/inh Inh Aer w/adapter 6 g [HMC]

Facility

OP

$437.33

Service Code	NDC 00186037028
Hospital Charge Code	3800193
Hospital Revenue Code	250
Min. Negotiated Rate	$174.93
Max. Negotiated Rate	$415.46
Rate for Payer: Aetna Commercial	$393.60
Rate for Payer: Humana Medicare Advantage	$183.68
Rate for Payer: UnitedHealthcare Commercial	$415.46
Rate for Payer: UnitedHealthcare Medicaid	$174.93
Rate for Payer: WPPA Medicare Advantage	$262.40

budesonide-formoterol 80 mcg-4.5 mcg/inh Inh Aer w/adapter [HMC]

Facility

IP

$557.29

Service Code	NDC 00186037220
Hospital Charge Code	3800193
Hospital Revenue Code	259
Min. Negotiated Rate	$501.56
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$501.56
Rate for Payer: UnitedHealthcare Commercial	$529.43
Rate for Payer: WPPA Medicare Advantage	$1,200.00

budesonide-formoterol 80 mcg-4.5 mcg/inh Inh Aer w/adapter [HMC]

Facility

OP

$557.29

Service Code	NDC 00186037220
Hospital Charge Code	3800193
Hospital Revenue Code	259
Min. Negotiated Rate	$222.92
Max. Negotiated Rate	$529.43
Rate for Payer: Aetna Commercial	$501.56
Rate for Payer: Humana Medicare Advantage	$234.06
Rate for Payer: UnitedHealthcare Commercial	$529.43
Rate for Payer: UnitedHealthcare Medicaid	$222.92
Rate for Payer: WPPA Medicare Advantage	$334.37

bumetanide 0.25 mg/mL Inj Sol 4 ml [HMC]

Facility

IP

$14.78

Service Code	NDC 00641628410
Hospital Charge Code	3804578
Hospital Revenue Code	250
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$14.04
Rate for Payer: WPPA Medicare Advantage	$1,200.00

bumetanide 0.25 mg/mL Inj Sol 4 ml [HMC]

Facility

OP

$14.78

Service Code	NDC 00641628410
Hospital Charge Code	3804578
Hospital Revenue Code	250
Min. Negotiated Rate	$5.91
Max. Negotiated Rate	$14.04
Rate for Payer: Aetna Commercial	$13.30
Rate for Payer: Humana Medicare Advantage	$6.21
Rate for Payer: UnitedHealthcare Commercial	$14.04
Rate for Payer: UnitedHealthcare Medicaid	$5.91
Rate for Payer: WPPA Medicare Advantage	$8.87

bumetanide 0.25 mg/mL Inj Sol 4 mL [HMC]

Facility

IP

$18.30

Service Code	NDC 65219057004
Hospital Charge Code	3804578
Hospital Revenue Code	250
Min. Negotiated Rate	$16.47
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$16.47
Rate for Payer: UnitedHealthcare Commercial	$17.39
Rate for Payer: WPPA Medicare Advantage	$1,200.00

bumetanide 0.25 mg/mL Inj Sol 4 mL [HMC]

Facility

IP

$15.12

Service Code	NDC 00409141204
Hospital Charge Code	3804578
Hospital Revenue Code	250
Min. Negotiated Rate	$13.61
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$13.61
Rate for Payer: UnitedHealthcare Commercial	$14.36
Rate for Payer: WPPA Medicare Advantage	$1,200.00

bumetanide 0.25 mg/mL Inj Sol 4 mL [HMC]

Facility

IP

$16.24

Service Code	NDC 72205010107
Hospital Charge Code	3804578
Hospital Revenue Code	250
Min. Negotiated Rate	$14.62
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$14.62
Rate for Payer: UnitedHealthcare Commercial	$15.43
Rate for Payer: WPPA Medicare Advantage	$1,200.00

bumetanide 0.25 mg/mL Inj Sol 4 mL [HMC]

Facility

OP

$10.00

Service Code	NDC 65219057001
Hospital Charge Code	3804578
Hospital Revenue Code	250
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna Commercial	$9.00
Rate for Payer: Humana Medicare Advantage	$4.20
Rate for Payer: UnitedHealthcare Commercial	$9.50
Rate for Payer: UnitedHealthcare Medicaid	$4.00
Rate for Payer: WPPA Medicare Advantage	$6.00

bumetanide 0.25 mg/mL Inj Sol 4 mL [HMC]

Facility

OP

$16.24

Service Code	NDC 72205010107
Hospital Charge Code	3804578
Hospital Revenue Code	250
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$15.43
Rate for Payer: Aetna Commercial	$14.62
Rate for Payer: Humana Medicare Advantage	$6.82
Rate for Payer: UnitedHealthcare Commercial	$15.43
Rate for Payer: UnitedHealthcare Medicaid	$6.50
Rate for Payer: WPPA Medicare Advantage	$9.74

bumetanide 0.25 mg/mL Inj Sol 4 mL [HMC]

Facility

OP

$15.46

Service Code	NDC 00641616101
Hospital Charge Code	3804578
Hospital Revenue Code	250
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$14.69
Rate for Payer: Aetna Commercial	$13.91
Rate for Payer: Humana Medicare Advantage	$6.49
Rate for Payer: UnitedHealthcare Commercial	$14.69
Rate for Payer: UnitedHealthcare Medicaid	$6.18
Rate for Payer: WPPA Medicare Advantage	$9.28

bumetanide 0.25 mg/mL Inj Sol 4 mL [HMC]

Facility

OP

$16.58

Service Code	NDC 70860040504
Hospital Charge Code	3804578
Hospital Revenue Code	250
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$15.75
Rate for Payer: Aetna Commercial	$14.92
Rate for Payer: Humana Medicare Advantage	$6.96
Rate for Payer: UnitedHealthcare Commercial	$15.75
Rate for Payer: UnitedHealthcare Medicaid	$6.63
Rate for Payer: WPPA Medicare Advantage	$9.95

bumetanide 0.25 mg/mL Inj Sol 4 mL [HMC]

Facility

IP

$16.58

Service Code	NDC 70860040504
Hospital Charge Code	3804578
Hospital Revenue Code	250
Min. Negotiated Rate	$14.92
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$14.92
Rate for Payer: UnitedHealthcare Commercial	$15.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

bumetanide 0.25 mg/mL Inj Sol 4 mL [HMC]

Facility

OP

$18.30

Service Code	NDC 65219057004
Hospital Charge Code	3804578
Hospital Revenue Code	250
Min. Negotiated Rate	$7.32
Max. Negotiated Rate	$17.39
Rate for Payer: Aetna Commercial	$16.47
Rate for Payer: Humana Medicare Advantage	$7.69
Rate for Payer: UnitedHealthcare Commercial	$17.39
Rate for Payer: UnitedHealthcare Medicaid	$7.32
Rate for Payer: WPPA Medicare Advantage	$10.98

bumetanide 0.25 mg/mL Inj Sol 4 mL [HMC]

Facility

IP

$17.25

Service Code	NDC 00641600810
Hospital Charge Code	3804578
Hospital Revenue Code	250
Min. Negotiated Rate	$15.53
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$15.53
Rate for Payer: UnitedHealthcare Commercial	$16.39
Rate for Payer: WPPA Medicare Advantage	$1,200.00

bumetanide 0.25 mg/mL Inj Sol 4 mL [HMC]

Facility

OP

$15.12

Service Code	NDC 00409141204
Hospital Charge Code	3804578
Hospital Revenue Code	250
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$14.36
Rate for Payer: Aetna Commercial	$13.61
Rate for Payer: Humana Medicare Advantage	$6.35
Rate for Payer: UnitedHealthcare Commercial	$14.36
Rate for Payer: UnitedHealthcare Medicaid	$6.05
Rate for Payer: WPPA Medicare Advantage	$9.07

bumetanide 0.25 mg/mL Inj Sol 4 mL [HMC]

Facility

IP

$10.00

Service Code	NDC 65219057001
Hospital Charge Code	3804578
Hospital Revenue Code	250
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.00
Rate for Payer: UnitedHealthcare Commercial	$9.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

bumetanide 0.25 mg/mL Inj Sol 4 mL [HMC]

Facility

IP

$15.46

Service Code	NDC 00641616101
Hospital Charge Code	3804578
Hospital Revenue Code	250
Min. Negotiated Rate	$13.91
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$13.91
Rate for Payer: UnitedHealthcare Commercial	$14.69
Rate for Payer: WPPA Medicare Advantage	$1,200.00

bumetanide 0.25 mg/mL Inj Sol 4 mL [HMC]

Facility

OP

$17.25

Service Code	NDC 00641600810
Hospital Charge Code	3804578
Hospital Revenue Code	250
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$16.39
Rate for Payer: Aetna Commercial	$15.53
Rate for Payer: Humana Medicare Advantage	$7.25
Rate for Payer: UnitedHealthcare Commercial	$16.39
Rate for Payer: UnitedHealthcare Medicaid	$6.90
Rate for Payer: WPPA Medicare Advantage	$10.35

bumetanide 0.25 mg/mL Sol 10mL [HMC]

Facility

IP

$40.05

Service Code	NDC 00409141210
Hospital Charge Code	3800885
Hospital Revenue Code	250
Min. Negotiated Rate	$36.05
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$36.05
Rate for Payer: UnitedHealthcare Commercial	$38.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

bumetanide 0.25 mg/mL Sol 10mL [HMC]

Facility

IP

$34.82

Service Code	NDC 00641616210
Hospital Charge Code	3800885
Hospital Revenue Code	250
Min. Negotiated Rate	$31.34
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$31.34
Rate for Payer: UnitedHealthcare Commercial	$33.08
Rate for Payer: WPPA Medicare Advantage	$1,200.00

bumetanide 0.25 mg/mL Sol 10mL [HMC]

Facility

OP

$39.67

Service Code	NDC 00641600710
Hospital Charge Code	3800885
Hospital Revenue Code	250
Min. Negotiated Rate	$15.87
Max. Negotiated Rate	$37.69
Rate for Payer: Aetna Commercial	$35.70
Rate for Payer: Humana Medicare Advantage	$16.66
Rate for Payer: UnitedHealthcare Commercial	$37.69
Rate for Payer: UnitedHealthcare Medicaid	$15.87
Rate for Payer: WPPA Medicare Advantage	$23.80

bumetanide 0.25 mg/mL Sol 10mL [HMC]

Facility

OP

$34.82

Service Code	NDC 00641616210
Hospital Charge Code	3800885
Hospital Revenue Code	250
Min. Negotiated Rate	$13.93
Max. Negotiated Rate	$33.08
Rate for Payer: Aetna Commercial	$31.34
Rate for Payer: Humana Medicare Advantage	$14.62
Rate for Payer: UnitedHealthcare Commercial	$33.08
Rate for Payer: UnitedHealthcare Medicaid	$13.93
Rate for Payer: WPPA Medicare Advantage	$20.89

bumetanide 0.25 mg/mL Sol 10mL [HMC]

Facility

OP

$40.05

Service Code	NDC 00409141210
Hospital Charge Code	3800885
Hospital Revenue Code	250
Min. Negotiated Rate	$16.02
Max. Negotiated Rate	$38.05
Rate for Payer: Aetna Commercial	$36.05
Rate for Payer: Humana Medicare Advantage	$16.82
Rate for Payer: UnitedHealthcare Commercial	$38.05
Rate for Payer: UnitedHealthcare Medicaid	$16.02
Rate for Payer: WPPA Medicare Advantage	$24.03

bumetanide 0.25 mg/mL Sol 10mL [HMC]

Facility

IP

$39.67

Service Code	NDC 00641600710
Hospital Charge Code	3800885
Hospital Revenue Code	250
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$35.70
Rate for Payer: UnitedHealthcare Commercial	$37.69
Rate for Payer: WPPA Medicare Advantage	$1,200.00

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