Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

buPROPion 150 mg/24 hours ER Tab [HMC]

Facility

OP

$11.68

Service Code	NDC 00904708461
Hospital Charge Code	3800035
Hospital Revenue Code	250
Min. Negotiated Rate	$4.67
Max. Negotiated Rate	$11.10
Rate for Payer: Aetna Commercial	$10.51
Rate for Payer: Humana Medicare Advantage	$4.91
Rate for Payer: UnitedHealthcare Commercial	$11.10
Rate for Payer: UnitedHealthcare Medicaid	$4.67
Rate for Payer: WPPA Medicare Advantage	$7.01

buPROPion 150 mg/24 hours ER Tab [HMC]

Facility

IP

$18.05

Service Code	NDC 16729044310
Hospital Charge Code	3800035
Hospital Revenue Code	250
Min. Negotiated Rate	$16.25
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$16.25
Rate for Payer: UnitedHealthcare Commercial	$17.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

buPROPion 150 mg/24 hours ER Tab [HMC]

Facility

OP

$19.32

Service Code	NDC 68180031906
Hospital Charge Code	3800035
Hospital Revenue Code	250
Min. Negotiated Rate	$7.73
Max. Negotiated Rate	$18.35
Rate for Payer: Aetna Commercial	$17.39
Rate for Payer: Humana Medicare Advantage	$8.11
Rate for Payer: UnitedHealthcare Commercial	$18.35
Rate for Payer: UnitedHealthcare Medicaid	$7.73
Rate for Payer: WPPA Medicare Advantage	$11.59

buPROPion 150 mg/24 hours ER Tab [HMC]

Facility

OP

$19.32

Service Code	NDC 10370010103
Hospital Charge Code	3800035
Hospital Revenue Code	250
Min. Negotiated Rate	$7.73
Max. Negotiated Rate	$18.35
Rate for Payer: Aetna Commercial	$17.39
Rate for Payer: Humana Medicare Advantage	$8.11
Rate for Payer: UnitedHealthcare Commercial	$18.35
Rate for Payer: UnitedHealthcare Medicaid	$7.73
Rate for Payer: WPPA Medicare Advantage	$11.59

buPROPion 150 mg/24 hours ER Tab [HMC]

Facility

IP

$9.74

Service Code	NDC 00904708404
Hospital Charge Code	3800035
Hospital Revenue Code	250
Min. Negotiated Rate	$8.77
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$8.77
Rate for Payer: UnitedHealthcare Commercial	$9.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

buPROPion 150 mg/24 hours ER Tab [HMC]

Facility

IP

$19.32

Service Code	NDC 10370010103
Hospital Charge Code	3800035
Hospital Revenue Code	250
Min. Negotiated Rate	$17.39
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$17.39
Rate for Payer: UnitedHealthcare Commercial	$18.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

buPROPion 150 mg/24 hours ER Tab [HMC]

Facility

IP

$19.32

Service Code	NDC 68180031906
Hospital Charge Code	3800035
Hospital Revenue Code	250
Min. Negotiated Rate	$17.39
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$17.39
Rate for Payer: UnitedHealthcare Commercial	$18.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

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

buPROPion 150 mg/24 hours ER Tab [HMC]

Facility

OP

$18.05

Service Code	NDC 16729044310
Hospital Charge Code	3800035
Hospital Revenue Code	250
Min. Negotiated Rate	$7.22
Max. Negotiated Rate	$17.15
Rate for Payer: Aetna Commercial	$16.25
Rate for Payer: Humana Medicare Advantage	$7.58
Rate for Payer: UnitedHealthcare Commercial	$17.15
Rate for Payer: UnitedHealthcare Medicaid	$7.22
Rate for Payer: WPPA Medicare Advantage	$10.83

busPIRone 5 mg Tab [HMC]

Facility

OP

$7.31

Service Code	NDC 51079098520
Hospital Charge Code	3805550
Hospital Revenue Code	250
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$6.94
Rate for Payer: Aetna Commercial	$6.58
Rate for Payer: Humana Medicare Advantage	$3.07
Rate for Payer: UnitedHealthcare Commercial	$6.94
Rate for Payer: UnitedHealthcare Medicaid	$2.92
Rate for Payer: WPPA Medicare Advantage	$4.39

busPIRone 5 mg Tab [HMC]

Facility

IP

$7.31

Service Code	NDC 68084002801
Hospital Charge Code	3805550
Hospital Revenue Code	250
Min. Negotiated Rate	$6.58
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.58
Rate for Payer: UnitedHealthcare Commercial	$6.94
Rate for Payer: WPPA Medicare Advantage	$1,200.00

busPIRone 5 mg Tab [HMC]

Facility

IP

$7.31

Service Code	NDC 51079098520
Hospital Charge Code	3805550
Hospital Revenue Code	250
Min. Negotiated Rate	$6.58
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.58
Rate for Payer: UnitedHealthcare Commercial	$6.94
Rate for Payer: WPPA Medicare Advantage	$1,200.00

busPIRone 5 mg Tab [HMC]

Facility

OP

$7.31

Service Code	NDC 68084002801
Hospital Charge Code	3805550
Hospital Revenue Code	250
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$6.94
Rate for Payer: Aetna Commercial	$6.58
Rate for Payer: Humana Medicare Advantage	$3.07
Rate for Payer: UnitedHealthcare Commercial	$6.94
Rate for Payer: UnitedHealthcare Medicaid	$2.92
Rate for Payer: WPPA Medicare Advantage	$4.39

busPIRone 5 mg Tab [HMC]

Facility

IP

$5.46

Service Code	NDC 00904712261
Hospital Charge Code	3805550
Hospital Revenue Code	250
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.91
Rate for Payer: UnitedHealthcare Commercial	$5.19
Rate for Payer: WPPA Medicare Advantage	$1,200.00

busPIRone 5 mg Tab [HMC]

Facility

OP

$5.46

Service Code	NDC 00904712261
Hospital Charge Code	3805550
Hospital Revenue Code	250
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$5.19
Rate for Payer: Aetna Commercial	$4.91
Rate for Payer: Humana Medicare Advantage	$2.29
Rate for Payer: UnitedHealthcare Commercial	$5.19
Rate for Payer: UnitedHealthcare Medicaid	$2.18
Rate for Payer: WPPA Medicare Advantage	$3.28

butorphanol 2 mg/mL Inj Sol [HMC]

Facility

IP

$35.89

Service Code	HCPCS J0595
Hospital Charge Code	3804959
Hospital Revenue Code	250
Min. Negotiated Rate	$32.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$32.30
Rate for Payer: Aetna Commercial	$32.85
Rate for Payer: UnitedHealthcare Commercial	$34.10
Rate for Payer: UnitedHealthcare Commercial	$34.67
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

butorphanol 2 mg/mL Inj Sol [HMC]

Facility

OP

$35.89

Service Code	HCPCS J0595
Hospital Charge Code	3804959
Hospital Revenue Code	250
Min. Negotiated Rate	$4.61
Max. Negotiated Rate	$34.10
Rate for Payer: Aetna Commercial	$32.30
Rate for Payer: Aetna Commercial	$32.85
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$4.61
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$4.61
Rate for Payer: Humana Medicare Advantage	$15.07
Rate for Payer: Humana Medicare Advantage	$15.33
Rate for Payer: UnitedHealthcare Commercial	$34.10
Rate for Payer: UnitedHealthcare Commercial	$34.67
Rate for Payer: UnitedHealthcare Medicaid	$5.54
Rate for Payer: UnitedHealthcare Medicaid	$5.54
Rate for Payer: WPPA Medicare Advantage	$21.53
Rate for Payer: WPPA Medicare Advantage	$21.90

C1 Esterase Inhibitor, Protein QST

Facility

OP

$140.00

Service Code	HCPCS 86160
Hospital Charge Code	3558660
Hospital Revenue Code	300
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$133.00
Rate for Payer: Aetna Commercial	$126.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$55.68
Rate for Payer: Humana Medicare Advantage	$58.80
Rate for Payer: UnitedHealthcare Commercial	$133.00
Rate for Payer: UnitedHealthcare Medicaid	$12.00
Rate for Payer: WPPA Medicare Advantage	$84.00

C1 Esterase Inhibitor, Protein QST

Facility

IP

$140.00

Service Code	HCPCS 86160
Hospital Charge Code	3558660
Hospital Revenue Code	300
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$126.00
Rate for Payer: UnitedHealthcare Commercial	$133.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

C1 Inhibitor, Functional QST

Facility

OP

$107.00

Service Code	HCPCS 86160
Hospital Charge Code	3556161
Hospital Revenue Code	300
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$101.65
Rate for Payer: Aetna Commercial	$96.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$55.68
Rate for Payer: Humana Medicare Advantage	$44.94
Rate for Payer: UnitedHealthcare Commercial	$101.65
Rate for Payer: UnitedHealthcare Medicaid	$12.00
Rate for Payer: WPPA Medicare Advantage	$64.20

C1 Inhibitor, Functional QST

Facility

IP

$107.00

Service Code	HCPCS 86160
Hospital Charge Code	3556161
Hospital Revenue Code	300
Min. Negotiated Rate	$96.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$96.30
Rate for Payer: UnitedHealthcare Commercial	$101.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

C9290 Injection, bupivacaine liposome, 1 mg

Facility

IP

$789.00

Service Code	HCPCS C9290
Hospital Charge Code	SCCC929000
Hospital Revenue Code	521
Min. Negotiated Rate	$710.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$710.10
Rate for Payer: UnitedHealthcare Commercial	$749.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

C9290 Injection, bupivacaine liposome, 1 mg

Facility

OP

$789.00

Service Code	HCPCS C9290
Hospital Charge Code	SCCC929000
Hospital Revenue Code	521
Min. Negotiated Rate	$315.60
Max. Negotiated Rate	$749.55
Rate for Payer: Aetna Commercial	$710.10
Rate for Payer: Humana Medicare Advantage	$331.38
Rate for Payer: UnitedHealthcare Commercial	$749.55
Rate for Payer: UnitedHealthcare Medicaid	$315.60
Rate for Payer: WPPA Medicare Advantage	$473.40

CA 125 QST

Facility

IP

$89.00

Service Code	HCPCS 86304
Hospital Charge Code	3551757
Hospital Revenue Code	300
Min. Negotiated Rate	$80.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$80.10
Rate for Payer: UnitedHealthcare Commercial	$84.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CA 125 QST

Facility

OP

$89.00

Service Code	HCPCS 86304
Hospital Charge Code	3551757
Hospital Revenue Code	300
Min. Negotiated Rate	$20.81
Max. Negotiated Rate	$84.55
Rate for Payer: Aetna Commercial	$80.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$54.77
Rate for Payer: Humana Medicare Advantage	$37.38
Rate for Payer: UnitedHealthcare Commercial	$84.55
Rate for Payer: UnitedHealthcare Medicaid	$20.81
Rate for Payer: WPPA Medicare Advantage	$53.40

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