Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

cloNIDine 0.1 mg Tab [HMC]

Facility

OP

$5.73

Service Code	NDC 68001023700
Hospital Charge Code	3804883
Hospital Revenue Code	250
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$5.44
Rate for Payer: Aetna Commercial	$5.16
Rate for Payer: Humana Medicare Advantage	$2.41
Rate for Payer: UnitedHealthcare Commercial	$5.44
Rate for Payer: UnitedHealthcare Medicaid	$2.29
Rate for Payer: WPPA Medicare Advantage	$3.44

cloNIDine 0.2 mg/24 hr Transderm ER Film [HMC]

Facility

IP

$60.76

Service Code	NDC 00378087299
Hospital Charge Code	3804012
Hospital Revenue Code	250
Min. Negotiated Rate	$54.68
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$54.68
Rate for Payer: UnitedHealthcare Commercial	$57.72
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cloNIDine 0.2 mg/24 hr Transderm ER Film [HMC]

Facility

OP

$60.76

Service Code	NDC 00591350904
Hospital Charge Code	3804012
Hospital Revenue Code	250
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$57.72
Rate for Payer: Aetna Commercial	$54.68
Rate for Payer: Humana Medicare Advantage	$25.52
Rate for Payer: UnitedHealthcare Commercial	$57.72
Rate for Payer: UnitedHealthcare Medicaid	$24.30
Rate for Payer: WPPA Medicare Advantage	$36.46

cloNIDine 0.2 mg/24 hr Transderm ER Film [HMC]

Facility

OP

$60.83

Service Code	NDC 75907002448
Hospital Charge Code	3804012
Hospital Revenue Code	250
Min. Negotiated Rate	$24.33
Max. Negotiated Rate	$57.79
Rate for Payer: Aetna Commercial	$54.75
Rate for Payer: Humana Medicare Advantage	$25.55
Rate for Payer: UnitedHealthcare Commercial	$57.79
Rate for Payer: UnitedHealthcare Medicaid	$24.33
Rate for Payer: WPPA Medicare Advantage	$36.50

cloNIDine 0.2 mg/24 hr Transderm ER Film [HMC]

Facility

OP

$60.83

Service Code	NDC 00555101016
Hospital Charge Code	3804012
Hospital Revenue Code	250
Min. Negotiated Rate	$24.33
Max. Negotiated Rate	$57.79
Rate for Payer: Aetna Commercial	$54.75
Rate for Payer: Humana Medicare Advantage	$25.55
Rate for Payer: UnitedHealthcare Commercial	$57.79
Rate for Payer: UnitedHealthcare Medicaid	$24.33
Rate for Payer: WPPA Medicare Advantage	$36.50

cloNIDine 0.2 mg/24 hr Transderm ER Film [HMC]

Facility

OP

$60.76

Service Code	NDC 00378087299
Hospital Charge Code	3804012
Hospital Revenue Code	250
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$57.72
Rate for Payer: Aetna Commercial	$54.68
Rate for Payer: Humana Medicare Advantage	$25.52
Rate for Payer: UnitedHealthcare Commercial	$57.72
Rate for Payer: UnitedHealthcare Medicaid	$24.30
Rate for Payer: WPPA Medicare Advantage	$36.46

cloNIDine 0.2 mg/24 hr Transderm ER Film [HMC]

Facility

IP

$60.76

Service Code	NDC 00591350904
Hospital Charge Code	3804012
Hospital Revenue Code	250
Min. Negotiated Rate	$54.68
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$54.68
Rate for Payer: UnitedHealthcare Commercial	$57.72
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cloNIDine 0.2 mg/24 hr Transderm ER Film [HMC]

Facility

IP

$60.83

Service Code	NDC 75907002448
Hospital Charge Code	3804012
Hospital Revenue Code	250
Min. Negotiated Rate	$54.75
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$54.75
Rate for Payer: UnitedHealthcare Commercial	$57.79
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cloNIDine 0.2 mg/24 hr Transderm ER Film [HMC]

Facility

IP

$60.83

Service Code	NDC 00555101016
Hospital Charge Code	3804012
Hospital Revenue Code	250
Min. Negotiated Rate	$54.75
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$54.75
Rate for Payer: UnitedHealthcare Commercial	$57.79
Rate for Payer: WPPA Medicare Advantage	$1,200.00

clopidogrel 75 mg Tab [HMC]

Facility

IP

$22.03

Service Code	NDC 68084053601
Hospital Charge Code	3802242
Hospital Revenue Code	250
Min. Negotiated Rate	$19.83
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$19.83
Rate for Payer: UnitedHealthcare Commercial	$20.93
Rate for Payer: WPPA Medicare Advantage	$1,200.00

clopidogrel 75 mg Tab [HMC]

Facility

OP

$22.03

Service Code	NDC 68084053601
Hospital Charge Code	3802242
Hospital Revenue Code	250
Min. Negotiated Rate	$8.81
Max. Negotiated Rate	$20.93
Rate for Payer: Aetna Commercial	$19.83
Rate for Payer: Humana Medicare Advantage	$9.25
Rate for Payer: UnitedHealthcare Commercial	$20.93
Rate for Payer: UnitedHealthcare Medicaid	$8.81
Rate for Payer: WPPA Medicare Advantage	$13.22

clopidogrel 75 mg Tab [HMC]

Facility

IP

$22.03

Service Code	NDC 68084060901
Hospital Charge Code	3802242
Hospital Revenue Code	250
Min. Negotiated Rate	$19.83
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$19.83
Rate for Payer: UnitedHealthcare Commercial	$20.93
Rate for Payer: WPPA Medicare Advantage	$1,200.00

clopidogrel 75 mg Tab [HMC]

Facility

OP

$22.03

Service Code	NDC 68084060901
Hospital Charge Code	3802242
Hospital Revenue Code	250
Min. Negotiated Rate	$8.81
Max. Negotiated Rate	$20.93
Rate for Payer: Aetna Commercial	$19.83
Rate for Payer: Humana Medicare Advantage	$9.25
Rate for Payer: UnitedHealthcare Commercial	$20.93
Rate for Payer: UnitedHealthcare Medicaid	$8.81
Rate for Payer: WPPA Medicare Advantage	$13.22

clopidogrel 75 mg Tab [HMC]

Facility

OP

$18.09

Service Code	NDC 00904629461
Hospital Charge Code	3802242
Hospital Revenue Code	250
Min. Negotiated Rate	$7.24
Max. Negotiated Rate	$17.19
Rate for Payer: Aetna Commercial	$16.28
Rate for Payer: Humana Medicare Advantage	$7.60
Rate for Payer: UnitedHealthcare Commercial	$17.19
Rate for Payer: UnitedHealthcare Medicaid	$7.24
Rate for Payer: WPPA Medicare Advantage	$10.85

clopidogrel 75 mg Tab [HMC]

Facility

IP

$18.09

Service Code	NDC 00904629461
Hospital Charge Code	3802242
Hospital Revenue Code	250
Min. Negotiated Rate	$16.28
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$16.28
Rate for Payer: UnitedHealthcare Commercial	$17.19
Rate for Payer: WPPA Medicare Advantage	$1,200.00

clopidogrel 75 mg Tab [HMC]

Facility

OP

$22.40

Service Code	NDC 55111019690
Hospital Charge Code	3802242
Hospital Revenue Code	250
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$21.28
Rate for Payer: Aetna Commercial	$20.16
Rate for Payer: Humana Medicare Advantage	$9.41
Rate for Payer: UnitedHealthcare Commercial	$21.28
Rate for Payer: UnitedHealthcare Medicaid	$8.96
Rate for Payer: WPPA Medicare Advantage	$13.44

clopidogrel 75 mg Tab [HMC]

Facility

IP

$22.40

Service Code	NDC 55111019690
Hospital Charge Code	3802242
Hospital Revenue Code	250
Min. Negotiated Rate	$20.16
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$20.16
Rate for Payer: UnitedHealthcare Commercial	$21.28
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Closed Suction System 14 FR T-Piece 21 Long - In-Line Suction Catheter

Facility

IP

$29.34

Hospital Charge Code	3255695
Hospital Revenue Code	270
Min. Negotiated Rate	$26.41
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$26.41
Rate for Payer: UnitedHealthcare Commercial	$27.87
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Closed Suction System 14 FR T-Piece 21 Long - In-Line Suction Catheter

Facility

OP

$29.34

Hospital Charge Code	3255695
Hospital Revenue Code	270
Min. Negotiated Rate	$11.74
Max. Negotiated Rate	$27.87
Rate for Payer: Aetna Commercial	$26.41
Rate for Payer: Humana Medicare Advantage	$12.32
Rate for Payer: UnitedHealthcare Commercial	$27.87
Rate for Payer: UnitedHealthcare Medicaid	$11.74
Rate for Payer: WPPA Medicare Advantage	$17.60

Clostridium Difficile (GeneXpert)

Facility

OP

$219.00

Service Code	HCPCS 87493
Hospital Charge Code	3550017
Hospital Revenue Code	300
Min. Negotiated Rate	$34.26
Max. Negotiated Rate	$208.05
Rate for Payer: Aetna Commercial	$197.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$75.32
Rate for Payer: Humana Medicare Advantage	$91.98
Rate for Payer: UnitedHealthcare Commercial	$208.05
Rate for Payer: UnitedHealthcare Medicaid	$34.26
Rate for Payer: WPPA Medicare Advantage	$131.40

Clostridium Difficile (GeneXpert)

Facility

IP

$219.00

Service Code	HCPCS 87493
Hospital Charge Code	3550017
Hospital Revenue Code	300
Min. Negotiated Rate	$197.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$197.10
Rate for Payer: UnitedHealthcare Commercial	$208.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Closure Ileostomy

Facility

IP

$5,045.00

Service Code	HCPCS 43880
Hospital Charge Code	3153880
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,792.75
Rate for Payer: Aetna Commercial	$4,540.50
Rate for Payer: UnitedHealthcare Commercial	$4,792.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Closure Ileostomy

Facility

OP

$5,045.00

Service Code	HCPCS 43880
Hospital Charge Code	3153880
Hospital Revenue Code	360
Min. Negotiated Rate	$416.00
Max. Negotiated Rate	$4,792.75
Rate for Payer: Aetna Commercial	$4,540.50
Rate for Payer: Humana Medicare Advantage	$2,118.90
Rate for Payer: UnitedHealthcare Commercial	$4,792.75
Rate for Payer: UnitedHealthcare Medicaid	$416.00
Rate for Payer: WPPA Medicare Advantage	$3,027.00

Closure Tracheostomy

Facility

OP

$1,265.00

Service Code	HCPCS 31820
Hospital Charge Code	3151820
Hospital Revenue Code	360
Min. Negotiated Rate	$531.30
Max. Negotiated Rate	$1,201.75
Rate for Payer: Aetna Commercial	$1,138.50
Rate for Payer: Humana Medicare Advantage	$531.30
Rate for Payer: UnitedHealthcare Commercial	$1,201.75
Rate for Payer: UnitedHealthcare Medicaid	$1,042.99
Rate for Payer: WPPA Medicare Advantage	$759.00

Closure Tracheostomy

Facility

IP

$1,265.00

Service Code	HCPCS 31820
Hospital Charge Code	3151820
Hospital Revenue Code	360
Min. Negotiated Rate	$1,138.50
Max. Negotiated Rate	$1,201.75
Rate for Payer: Aetna Commercial	$1,138.50
Rate for Payer: UnitedHealthcare Commercial	$1,201.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

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