Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

carbidopa-levodopa 25 mg-250 mg Tab [HMC]

Facility

IP

$7.84

Service Code	NDC 68084009401
Hospital Charge Code	3804651
Hospital Revenue Code	250
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$7.06
Rate for Payer: UnitedHealthcare Commercial	$7.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

carbidopa-levodopa 50 mg-200 mg ER Tab [HMC]

Facility

IP

$10.22

Service Code	NDC 51079092320
Hospital Charge Code	3808109
Hospital Revenue Code	250
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.20
Rate for Payer: UnitedHealthcare Commercial	$9.71
Rate for Payer: WPPA Medicare Advantage	$1,200.00

carbidopa-levodopa 50 mg-200 mg ER Tab [HMC]

Facility

OP

$10.22

Service Code	NDC 51079092320
Hospital Charge Code	3808109
Hospital Revenue Code	250
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$9.71
Rate for Payer: Aetna Commercial	$9.20
Rate for Payer: Humana Medicare Advantage	$4.29
Rate for Payer: UnitedHealthcare Commercial	$9.71
Rate for Payer: UnitedHealthcare Medicaid	$4.09
Rate for Payer: WPPA Medicare Advantage	$6.13

carbidopa-levodopa 50 mg-200 mg ER Tab [HMC]

Facility

IP

$9.75

Service Code	NDC 68084028201
Hospital Charge Code	3808109
Hospital Revenue Code	250
Min. Negotiated Rate	$8.78
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$8.78
Rate for Payer: UnitedHealthcare Commercial	$9.26
Rate for Payer: WPPA Medicare Advantage	$1,200.00

carbidopa-levodopa 50 mg-200 mg ER Tab [HMC]

Facility

IP

$10.42

Service Code	NDC 50228046101
Hospital Charge Code	3808109
Hospital Revenue Code	250
Min. Negotiated Rate	$9.38
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.38
Rate for Payer: UnitedHealthcare Commercial	$9.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

carbidopa-levodopa 50 mg-200 mg ER Tab [HMC]

Facility

OP

$10.42

Service Code	NDC 50228046101
Hospital Charge Code	3808109
Hospital Revenue Code	250
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna Commercial	$9.38
Rate for Payer: Humana Medicare Advantage	$4.38
Rate for Payer: UnitedHealthcare Commercial	$9.90
Rate for Payer: UnitedHealthcare Medicaid	$4.17
Rate for Payer: WPPA Medicare Advantage	$6.25

carbidopa-levodopa 50 mg-200 mg ER Tab [HMC]

Facility

OP

$9.75

Service Code	NDC 68084028201
Hospital Charge Code	3808109
Hospital Revenue Code	250
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$9.26
Rate for Payer: Aetna Commercial	$8.78
Rate for Payer: Humana Medicare Advantage	$4.09
Rate for Payer: UnitedHealthcare Commercial	$9.26
Rate for Payer: UnitedHealthcare Medicaid	$3.90
Rate for Payer: WPPA Medicare Advantage	$5.85

CARBOplatin 10 mg/mL IV Sol [HMC]

Facility

OP

$119.18

Service Code	HCPCS J9045
Hospital Charge Code	3851330
Hospital Revenue Code	250
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$113.22
Rate for Payer: Aetna Commercial	$107.26
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$4.78
Rate for Payer: Humana Medicare Advantage	$50.06
Rate for Payer: UnitedHealthcare Commercial	$113.22
Rate for Payer: UnitedHealthcare Medicaid	$2.93
Rate for Payer: WPPA Medicare Advantage	$71.51

CARBOplatin 10 mg/mL IV Sol [HMC]

Facility

IP

$119.18

Service Code	HCPCS J9045
Hospital Charge Code	3851330
Hospital Revenue Code	250
Min. Negotiated Rate	$107.26
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$107.26
Rate for Payer: UnitedHealthcare Commercial	$113.22
Rate for Payer: WPPA Medicare Advantage	$1,200.00

carboprost 250 mcg/mL Inj Sol [HMC]

Facility

IP

$506.00

Service Code	NDC 81298501003
Hospital Charge Code	3800550
Hospital Revenue Code	250
Min. Negotiated Rate	$455.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$455.40
Rate for Payer: UnitedHealthcare Commercial	$480.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

carboprost 250 mcg/mL Inj Sol [HMC]

Facility

OP

$506.00

Service Code	NDC 81298501003
Hospital Charge Code	3800550
Hospital Revenue Code	250
Min. Negotiated Rate	$202.40
Max. Negotiated Rate	$480.70
Rate for Payer: Aetna Commercial	$455.40
Rate for Payer: Humana Medicare Advantage	$212.52
Rate for Payer: UnitedHealthcare Commercial	$480.70
Rate for Payer: UnitedHealthcare Medicaid	$202.40
Rate for Payer: WPPA Medicare Advantage	$303.60

carboprost 250 mcg/mL Inj Sol [HMC]

Facility

OP

$657.98

Service Code	NDC 00009085608
Hospital Charge Code	3800550
Hospital Revenue Code	250
Min. Negotiated Rate	$263.19
Max. Negotiated Rate	$625.08
Rate for Payer: Aetna Commercial	$592.18
Rate for Payer: Humana Medicare Advantage	$276.35
Rate for Payer: UnitedHealthcare Commercial	$625.08
Rate for Payer: UnitedHealthcare Medicaid	$263.19
Rate for Payer: WPPA Medicare Advantage	$394.79

carboprost 250 mcg/mL Inj Sol [HMC]

Facility

IP

$657.98

Service Code	NDC 00009085608
Hospital Charge Code	3800550
Hospital Revenue Code	250
Min. Negotiated Rate	$592.18
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$592.18
Rate for Payer: UnitedHealthcare Commercial	$625.08
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Carboxyhemoglobin Ven

Facility

OP

$78.00

Service Code	HCPCS 82375
Hospital Charge Code	3552376
Hospital Revenue Code	300
Min. Negotiated Rate	$12.32
Max. Negotiated Rate	$74.10
Rate for Payer: Aetna Commercial	$70.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$45.87
Rate for Payer: Humana Medicare Advantage	$32.76
Rate for Payer: UnitedHealthcare Commercial	$74.10
Rate for Payer: UnitedHealthcare Medicaid	$12.32
Rate for Payer: WPPA Medicare Advantage	$46.80

Carboxyhemoglobin Ven

Facility

IP

$78.00

Service Code	HCPCS 82375
Hospital Charge Code	3552376
Hospital Revenue Code	300
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$70.20
Rate for Payer: UnitedHealthcare Commercial	$74.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Carcinoembryonic Antigen

Facility

OP

$230.00

Service Code	HCPCS 82378
Hospital Charge Code	3550221
Hospital Revenue Code	300
Min. Negotiated Rate	$18.96
Max. Negotiated Rate	$218.50
Rate for Payer: Aetna Commercial	$207.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$70.84
Rate for Payer: Humana Medicare Advantage	$96.60
Rate for Payer: UnitedHealthcare Commercial	$218.50
Rate for Payer: UnitedHealthcare Medicaid	$18.96
Rate for Payer: WPPA Medicare Advantage	$138.00

Carcinoembryonic Antigen

Facility

IP

$230.00

Service Code	HCPCS 82378
Hospital Charge Code	3550221
Hospital Revenue Code	300
Min. Negotiated Rate	$207.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$207.00
Rate for Payer: UnitedHealthcare Commercial	$218.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CARDIAC ARREST, UNEXPLAINED WITH CC

Facility

IP

$2,795.76

Service Code	MSDRG 297
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,795.76
Rate for Payer: UnitedHealthcare Medicaid	$2,795.76
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CARDIAC ARREST, UNEXPLAINED WITH MCC

Facility

IP

$6,862.32

Service Code	MSDRG 296
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,862.32
Rate for Payer: UnitedHealthcare Medicaid	$6,862.32
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC

Facility

IP

$2,001.51

Service Code	MSDRG 298
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,001.51
Rate for Payer: UnitedHealthcare Medicaid	$2,001.51
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC

Facility

IP

$2,859.30

Service Code	MSDRG 309
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,859.30
Rate for Payer: UnitedHealthcare Medicaid	$2,859.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC

Facility

IP

$5,750.37

Service Code	MSDRG 308
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,750.37
Rate for Payer: UnitedHealthcare Medicaid	$5,750.37
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC

Facility

IP

$2,255.67

Service Code	MSDRG 310
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,255.67
Rate for Payer: UnitedHealthcare Medicaid	$2,255.67
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC

Facility

IP

$6,925.86

Service Code	MSDRG 306
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,925.86
Rate for Payer: UnitedHealthcare Medicaid	$6,925.86
Rate for Payer: WPPA Medicare Advantage	$1,200.00

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC

Facility

IP

$4,003.02

Service Code	MSDRG 307
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,003.02
Rate for Payer: UnitedHealthcare Medicaid	$4,003.02
Rate for Payer: WPPA Medicare Advantage	$1,200.00

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