Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

cyanocobalamin 1000 mcg/mL Inj Sol [HMC]

Facility

IP

$21.06

Service Code	HCPCS J3420
Hospital Charge Code	3801179
Hospital Revenue Code	250
Min. Negotiated Rate	$18.95
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$18.95
Rate for Payer: Aetna Commercial	$40.46
Rate for Payer: Aetna Commercial	$30.89
Rate for Payer: Aetna Commercial	$33.52
Rate for Payer: UnitedHealthcare Commercial	$32.60
Rate for Payer: UnitedHealthcare Commercial	$42.71
Rate for Payer: UnitedHealthcare Commercial	$20.01
Rate for Payer: UnitedHealthcare Commercial	$35.39
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cyanocobalamin 1000 mcg/mL Inj Sol [HMC]

Facility

OP

$37.25

Service Code	NDC 70069000510
Hospital Charge Code	3801179
Hospital Revenue Code	250
Min. Negotiated Rate	$14.90
Max. Negotiated Rate	$35.39
Rate for Payer: Aetna Commercial	$33.52
Rate for Payer: Humana Medicare Advantage	$15.64
Rate for Payer: UnitedHealthcare Commercial	$35.39
Rate for Payer: UnitedHealthcare Medicaid	$14.90
Rate for Payer: WPPA Medicare Advantage	$22.35

cyanocobalamin 1000 mcg Tab [HMC]

Facility

IP

$5.64

Service Code	NDC 77333093810
Hospital Charge Code	3805543
Hospital Revenue Code	250
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.08
Rate for Payer: UnitedHealthcare Commercial	$5.36
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cyanocobalamin 1000 mcg Tab [HMC]

Facility

IP

$6.07

Service Code	NDC 50268085515
Hospital Charge Code	3805543
Hospital Revenue Code	250
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.46
Rate for Payer: UnitedHealthcare Commercial	$5.77
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cyanocobalamin 1000 mcg Tab [HMC]

Facility

OP

$5.64

Service Code	NDC 77333093810
Hospital Charge Code	3805543
Hospital Revenue Code	250
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$5.36
Rate for Payer: Aetna Commercial	$5.08
Rate for Payer: Humana Medicare Advantage	$2.37
Rate for Payer: UnitedHealthcare Commercial	$5.36
Rate for Payer: UnitedHealthcare Medicaid	$2.26
Rate for Payer: WPPA Medicare Advantage	$3.38

cyanocobalamin 1000 mcg Tab [HMC]

Facility

OP

$5.64

Service Code	NDC 20555000600
Hospital Charge Code	3805543
Hospital Revenue Code	250
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$5.36
Rate for Payer: Aetna Commercial	$5.08
Rate for Payer: Humana Medicare Advantage	$2.37
Rate for Payer: UnitedHealthcare Commercial	$5.36
Rate for Payer: UnitedHealthcare Medicaid	$2.26
Rate for Payer: WPPA Medicare Advantage	$3.38

cyanocobalamin 1000 mcg Tab [HMC]

Facility

OP

$6.07

Service Code	NDC 50268085515
Hospital Charge Code	3805543
Hospital Revenue Code	250
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$5.77
Rate for Payer: Aetna Commercial	$5.46
Rate for Payer: Humana Medicare Advantage	$2.55
Rate for Payer: UnitedHealthcare Commercial	$5.77
Rate for Payer: UnitedHealthcare Medicaid	$2.43
Rate for Payer: WPPA Medicare Advantage	$3.64

cyanocobalamin 1000 mcg Tab [HMC]

Facility

IP

$5.64

Service Code	NDC 20555000600
Hospital Charge Code	3805543
Hospital Revenue Code	250
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.08
Rate for Payer: UnitedHealthcare Commercial	$5.36
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cyanocobalamin 5000 mcg Tab [HMC]

Facility

IP

$6.00

Service Code	NDC 74312537950
Hospital Charge Code	3800047
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: UnitedHealthcare Commercial	$5.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cyanocobalamin 5000 mcg Tab [HMC]

Facility

OP

$6.00

Service Code	NDC 74312537950
Hospital Charge Code	3800047
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$5.70
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Humana Medicare Advantage	$2.52
Rate for Payer: UnitedHealthcare Commercial	$5.70
Rate for Payer: UnitedHealthcare Medicaid	$2.40
Rate for Payer: WPPA Medicare Advantage	$3.60

cyclobenzaprine 10 mg Tab [HMC]

Facility

OP

$5.78

Service Code	NDC 00904740161
Hospital Charge Code	3805153
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$5.49
Rate for Payer: Aetna Commercial	$5.20
Rate for Payer: Humana Medicare Advantage	$2.43
Rate for Payer: UnitedHealthcare Commercial	$5.49
Rate for Payer: UnitedHealthcare Medicaid	$2.31
Rate for Payer: WPPA Medicare Advantage	$3.47

cyclobenzaprine 10 mg Tab [HMC]

Facility

OP

$5.64

Service Code	NDC 60687055801
Hospital Charge Code	3805153
Hospital Revenue Code	250
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$5.36
Rate for Payer: Aetna Commercial	$5.08
Rate for Payer: Humana Medicare Advantage	$2.37
Rate for Payer: UnitedHealthcare Commercial	$5.36
Rate for Payer: UnitedHealthcare Medicaid	$2.26
Rate for Payer: WPPA Medicare Advantage	$3.38

cyclobenzaprine 10 mg Tab [HMC]

Facility

IP

$5.64

Service Code	NDC 60687055801
Hospital Charge Code	3805153
Hospital Revenue Code	250
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.08
Rate for Payer: UnitedHealthcare Commercial	$5.36
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cyclobenzaprine 10 mg Tab [HMC]

Facility

IP

$5.28

Service Code	NDC 63739053110
Hospital Charge Code	3805153
Hospital Revenue Code	250
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$5.02
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cyclobenzaprine 10 mg Tab [HMC]

Facility

OP

$5.28

Service Code	NDC 63739053110
Hospital Charge Code	3805153
Hospital Revenue Code	250
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$5.02
Rate for Payer: Aetna Commercial	$4.75
Rate for Payer: Humana Medicare Advantage	$2.22
Rate for Payer: UnitedHealthcare Commercial	$5.02
Rate for Payer: UnitedHealthcare Medicaid	$2.11
Rate for Payer: WPPA Medicare Advantage	$3.17

cyclobenzaprine 10 mg Tab [HMC]

Facility

IP

$5.78

Service Code	NDC 00904740161
Hospital Charge Code	3805153
Hospital Revenue Code	250
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.20
Rate for Payer: UnitedHealthcare Commercial	$5.49
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cyclospora and Isospora Examination QST

Facility

IP

$84.00

Service Code	HCPCS 87015
Hospital Charge Code	3557015
Hospital Revenue Code	300
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$75.60
Rate for Payer: UnitedHealthcare Commercial	$79.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Cyclospora and Isospora Examination QST

Facility

OP

$84.00

Service Code	HCPCS 87015
Hospital Charge Code	3557015
Hospital Revenue Code	300
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$79.80
Rate for Payer: Aetna Commercial	$75.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$35.75
Rate for Payer: Humana Medicare Advantage	$35.28
Rate for Payer: UnitedHealthcare Commercial	$79.80
Rate for Payer: UnitedHealthcare Medicaid	$6.68
Rate for Payer: WPPA Medicare Advantage	$50.40

Cyclosporine A, Trough QST

Facility

OP

$26.00

Service Code	HCPCS 80158
Hospital Charge Code	3550158
Hospital Revenue Code	300
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$71.17
Rate for Payer: Aetna Commercial	$23.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$71.17
Rate for Payer: Humana Medicare Advantage	$10.92
Rate for Payer: UnitedHealthcare Commercial	$24.70
Rate for Payer: UnitedHealthcare Medicaid	$15.34
Rate for Payer: WPPA Medicare Advantage	$15.60

Cyclosporine A, Trough QST

Facility

IP

$26.00

Service Code	HCPCS 80158
Hospital Charge Code	3550158
Hospital Revenue Code	300
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$23.40
Rate for Payer: UnitedHealthcare Commercial	$24.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cycloSPORINE microEmul 100 mg Cap [HMC]

Facility

IP

$25.99

Service Code	HCPCS J7502
Hospital Charge Code	3852215
Hospital Revenue Code	250
Min. Negotiated Rate	$23.39
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$23.39
Rate for Payer: UnitedHealthcare Commercial	$24.69
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cycloSPORINE microEmul 100 mg Cap [HMC]

Facility

OP

$25.99

Service Code	HCPCS J7502
Hospital Charge Code	3852215
Hospital Revenue Code	250
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$24.69
Rate for Payer: Aetna Commercial	$23.39
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$2.92
Rate for Payer: Humana Medicare Advantage	$10.92
Rate for Payer: UnitedHealthcare Commercial	$24.69
Rate for Payer: UnitedHealthcare Medicaid	$10.40
Rate for Payer: WPPA Medicare Advantage	$15.59

cycloSPORINE Ophth 0.05% Emul [HMC]

Facility

IP

$516.79

Service Code	NDC 00378876058
Hospital Charge Code	3807368
Hospital Revenue Code	250
Min. Negotiated Rate	$465.11
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$465.11
Rate for Payer: UnitedHealthcare Commercial	$490.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cycloSPORINE Ophth 0.05% Emul [HMC]

Facility

IP

$542.94

Service Code	NDC 00023916330
Hospital Charge Code	3807368
Hospital Revenue Code	250
Min. Negotiated Rate	$488.65
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$488.65
Rate for Payer: UnitedHealthcare Commercial	$515.79
Rate for Payer: WPPA Medicare Advantage	$1,200.00

cycloSPORINE Ophth 0.05% Emul [HMC]

Facility

OP

$516.79

Service Code	NDC 00378876058
Hospital Charge Code	3807368
Hospital Revenue Code	250
Min. Negotiated Rate	$206.72
Max. Negotiated Rate	$490.95
Rate for Payer: Aetna Commercial	$465.11
Rate for Payer: Humana Medicare Advantage	$217.05
Rate for Payer: UnitedHealthcare Commercial	$490.95
Rate for Payer: UnitedHealthcare Medicaid	$206.72
Rate for Payer: WPPA Medicare Advantage	$310.07

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