Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

bupivacaine-EPINEPHrine 0.25%-1:200,000 PF Inj Sol 50 mL [HMC]

Facility

IP

$50.64

Service Code	NDC 63323046157
Hospital Charge Code	3801810
Hospital Revenue Code	250
Min. Negotiated Rate	$45.58
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$45.58
Rate for Payer: UnitedHealthcare Commercial	$48.11
Rate for Payer: WPPA Medicare Advantage	$1,200.00

bupivacaine-EPINEPHrine 0.25%-1:200,000 PF Inj Sol 50 mL [HMC]

Facility

OP

$49.35

Service Code	NDC 00409381201
Hospital Charge Code	3801810
Hospital Revenue Code	250
Min. Negotiated Rate	$19.74
Max. Negotiated Rate	$46.88
Rate for Payer: Aetna Commercial	$44.41
Rate for Payer: Humana Medicare Advantage	$20.73
Rate for Payer: UnitedHealthcare Commercial	$46.88
Rate for Payer: UnitedHealthcare Medicaid	$19.74
Rate for Payer: WPPA Medicare Advantage	$29.61

bupivacaine-EPINEPHrine 0.25%-1:200,000 PF Inj Sol 50 mL [HMC]

Facility

OP

$50.64

Service Code	NDC 63323046157
Hospital Charge Code	3801810
Hospital Revenue Code	250
Min. Negotiated Rate	$20.26
Max. Negotiated Rate	$48.11
Rate for Payer: Aetna Commercial	$45.58
Rate for Payer: Humana Medicare Advantage	$21.27
Rate for Payer: UnitedHealthcare Commercial	$48.11
Rate for Payer: UnitedHealthcare Medicaid	$20.26
Rate for Payer: WPPA Medicare Advantage	$30.38

bupivacaine-EPINEPHrine 0.25%-1:200,000 PF Inj Sol 50 mL [HMC]

Facility

IP

$20.00

Service Code	NDC 63323046101
Hospital Charge Code	3801810
Hospital Revenue Code	250
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$18.00
Rate for Payer: UnitedHealthcare Commercial	$19.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

bupivacaine-EPINEPHrine 0.25%-1:200,000 PF Inj Sol 50 mL [HMC]

Facility

IP

$49.35

Service Code	NDC 00409381201
Hospital Charge Code	3801810
Hospital Revenue Code	250
Min. Negotiated Rate	$44.41
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$44.41
Rate for Payer: UnitedHealthcare Commercial	$46.88
Rate for Payer: WPPA Medicare Advantage	$1,200.00

bupivacaine-EPINEPHrine 0.25%-1:200,000 PF Inj Sol 50 mL [HMC]

Facility

OP

$20.00

Service Code	NDC 63323046101
Hospital Charge Code	3801810
Hospital Revenue Code	250
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$18.00
Rate for Payer: Humana Medicare Advantage	$8.40
Rate for Payer: UnitedHealthcare Commercial	$19.00
Rate for Payer: UnitedHealthcare Medicaid	$8.00
Rate for Payer: WPPA Medicare Advantage	$12.00

bupivacaine-epinephrine 0.5%-1:200,000 MDV Inj 50 mL [HMC]

Facility

IP

$59.22

Service Code	NDC 00409175550
Hospital Charge Code	3801810
Hospital Revenue Code	250
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$53.30
Rate for Payer: UnitedHealthcare Commercial	$56.26
Rate for Payer: WPPA Medicare Advantage	$1,200.00

bupivacaine-epinephrine 0.5%-1:200,000 MDV Inj 50 mL [HMC]

Facility

IP

$59.22

Service Code	NDC 00409658101
Hospital Charge Code	3801810
Hospital Revenue Code	250
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$53.30
Rate for Payer: UnitedHealthcare Commercial	$56.26
Rate for Payer: WPPA Medicare Advantage	$1,200.00

bupivacaine-epinephrine 0.5%-1:200,000 MDV Inj 50 mL [HMC]

Facility

OP

$52.80

Service Code	NDC 63323046357
Hospital Charge Code	3801810
Hospital Revenue Code	250
Min. Negotiated Rate	$21.12
Max. Negotiated Rate	$50.16
Rate for Payer: Aetna Commercial	$47.52
Rate for Payer: Humana Medicare Advantage	$22.18
Rate for Payer: UnitedHealthcare Commercial	$50.16
Rate for Payer: UnitedHealthcare Medicaid	$21.12
Rate for Payer: WPPA Medicare Advantage	$31.68

bupivacaine-epinephrine 0.5%-1:200,000 MDV Inj 50 mL [HMC]

Facility

IP

$52.80

Service Code	NDC 63323046357
Hospital Charge Code	3801810
Hospital Revenue Code	250
Min. Negotiated Rate	$47.52
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$47.52
Rate for Payer: UnitedHealthcare Commercial	$50.16
Rate for Payer: WPPA Medicare Advantage	$1,200.00

bupivacaine-epinephrine 0.5%-1:200,000 MDV Inj 50 mL [HMC]

Facility

OP

$59.22

Service Code	NDC 00409175550
Hospital Charge Code	3801810
Hospital Revenue Code	250
Min. Negotiated Rate	$23.69
Max. Negotiated Rate	$56.26
Rate for Payer: Aetna Commercial	$53.30
Rate for Payer: Humana Medicare Advantage	$24.87
Rate for Payer: UnitedHealthcare Commercial	$56.26
Rate for Payer: UnitedHealthcare Medicaid	$23.69
Rate for Payer: WPPA Medicare Advantage	$35.53

bupivacaine-epinephrine 0.5%-1:200,000 MDV Inj 50 mL [HMC]

Facility

OP

$59.22

Service Code	NDC 00409658101
Hospital Charge Code	3801810
Hospital Revenue Code	250
Min. Negotiated Rate	$23.69
Max. Negotiated Rate	$56.26
Rate for Payer: Aetna Commercial	$53.30
Rate for Payer: Humana Medicare Advantage	$24.87
Rate for Payer: UnitedHealthcare Commercial	$56.26
Rate for Payer: UnitedHealthcare Medicaid	$23.69
Rate for Payer: WPPA Medicare Advantage	$35.53

bupivacaine-EPINEPHrine 0.5%-1:200,000 PF Inj Sol 10 mL [HMC]

Facility

IP

$38.05

Service Code	NDC 00409812610
Hospital Charge Code	3170500
Hospital Revenue Code	250
Min. Negotiated Rate	$34.24
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$34.24
Rate for Payer: UnitedHealthcare Commercial	$36.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

bupivacaine-EPINEPHrine 0.5%-1:200,000 PF Inj Sol 10 mL [HMC]

Facility

IP

$44.77

Service Code	NDC 63323046217
Hospital Charge Code	3170500
Hospital Revenue Code	250
Min. Negotiated Rate	$40.29
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$40.29
Rate for Payer: UnitedHealthcare Commercial	$42.53
Rate for Payer: WPPA Medicare Advantage	$1,200.00

bupivacaine-EPINEPHrine 0.5%-1:200,000 PF Inj Sol 10 mL [HMC]

Facility

OP

$44.77

Service Code	NDC 63323046217
Hospital Charge Code	3170500
Hospital Revenue Code	250
Min. Negotiated Rate	$17.91
Max. Negotiated Rate	$42.53
Rate for Payer: Aetna Commercial	$40.29
Rate for Payer: Humana Medicare Advantage	$18.80
Rate for Payer: UnitedHealthcare Commercial	$42.53
Rate for Payer: UnitedHealthcare Medicaid	$17.91
Rate for Payer: WPPA Medicare Advantage	$26.86

bupivacaine-EPINEPHrine 0.5%-1:200,000 PF Inj Sol 10 mL [HMC]

Facility

OP

$38.05

Service Code	NDC 00409812610
Hospital Charge Code	3170500
Hospital Revenue Code	250
Min. Negotiated Rate	$15.22
Max. Negotiated Rate	$36.15
Rate for Payer: Aetna Commercial	$34.24
Rate for Payer: Humana Medicare Advantage	$15.98
Rate for Payer: UnitedHealthcare Commercial	$36.15
Rate for Payer: UnitedHealthcare Medicaid	$15.22
Rate for Payer: WPPA Medicare Advantage	$22.83

bupivacaine-fentanyl 0.125%-2 mcg/mL-0.9% 250 mL Sol [HMC]

Facility

IP

$97.58

Service Code	NDC 70092110537
Hospital Charge Code	3802280
Hospital Revenue Code	250
Min. Negotiated Rate	$87.82
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$87.82
Rate for Payer: UnitedHealthcare Commercial	$92.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

bupivacaine-fentanyl 0.125%-2 mcg/mL-0.9% 250 mL Sol [HMC]

Facility

OP

$97.58

Service Code	NDC 70092110537
Hospital Charge Code	3802280
Hospital Revenue Code	250
Min. Negotiated Rate	$39.03
Max. Negotiated Rate	$92.70
Rate for Payer: Aetna Commercial	$87.82
Rate for Payer: Humana Medicare Advantage	$40.98
Rate for Payer: UnitedHealthcare Commercial	$92.70
Rate for Payer: UnitedHealthcare Medicaid	$39.03
Rate for Payer: WPPA Medicare Advantage	$58.55

bupivacaine liposome 1.3% (13.3 mg/mL) Sus [HMC]

Facility

OP

$586.99

Service Code	HCPCS C9290
Hospital Charge Code	3800430
Hospital Revenue Code	250
Min. Negotiated Rate	$234.80
Max. Negotiated Rate	$557.64
Rate for Payer: Aetna Commercial	$528.29
Rate for Payer: Humana Medicare Advantage	$246.54
Rate for Payer: UnitedHealthcare Commercial	$557.64
Rate for Payer: UnitedHealthcare Medicaid	$234.80
Rate for Payer: WPPA Medicare Advantage	$352.19

bupivacaine liposome 1.3% (13.3 mg/mL) Sus [HMC]

Facility

IP

$586.99

Service Code	HCPCS C9290
Hospital Charge Code	3800430
Hospital Revenue Code	250
Min. Negotiated Rate	$528.29
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$528.29
Rate for Payer: UnitedHealthcare Commercial	$557.64
Rate for Payer: WPPA Medicare Advantage	$1,200.00

buprenorphine-naloxone 8 mg-2 mg Film [HMC]

Facility

OP

$45.20

Service Code	HCPCS J0574
Hospital Charge Code	3800361
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$42.94
Rate for Payer: Aetna Commercial	$40.68
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$10.42
Rate for Payer: Humana Medicare Advantage	$18.98
Rate for Payer: UnitedHealthcare Commercial	$42.94
Rate for Payer: UnitedHealthcare Medicaid	$2.40
Rate for Payer: WPPA Medicare Advantage	$27.12

buprenorphine-naloxone 8 mg-2 mg Film [HMC]

Facility

IP

$45.20

Service Code	HCPCS J0574
Hospital Charge Code	3800361
Hospital Revenue Code	250
Min. Negotiated Rate	$40.68
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$40.68
Rate for Payer: UnitedHealthcare Commercial	$42.94
Rate for Payer: WPPA Medicare Advantage	$1,200.00

buPROPion 150 mg/24 hours ER Tab [HMC]

Facility

OP

$10.76

Service Code	NDC 00904750561
Hospital Charge Code	3800035
Hospital Revenue Code	250
Min. Negotiated Rate	$4.30
Max. Negotiated Rate	$10.22
Rate for Payer: Aetna Commercial	$9.68
Rate for Payer: Humana Medicare Advantage	$4.52
Rate for Payer: UnitedHealthcare Commercial	$10.22
Rate for Payer: UnitedHealthcare Medicaid	$4.30
Rate for Payer: WPPA Medicare Advantage	$6.46

buPROPion 150 mg/24 hours ER Tab [HMC]

Facility

OP

$9.74

Service Code	NDC 00904708404
Hospital Charge Code	3800035
Hospital Revenue Code	250
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$9.25
Rate for Payer: Aetna Commercial	$8.77
Rate for Payer: Humana Medicare Advantage	$4.09
Rate for Payer: UnitedHealthcare Commercial	$9.25
Rate for Payer: UnitedHealthcare Medicaid	$3.90
Rate for Payer: WPPA Medicare Advantage	$5.84

buPROPion 150 mg/24 hours ER Tab [HMC]

Facility

IP

$11.68

Service Code	NDC 00904708461
Hospital Charge Code	3800035
Hospital Revenue Code	250
Min. Negotiated Rate	$10.51
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.51
Rate for Payer: UnitedHealthcare Commercial	$11.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

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