Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

docusate-senna 50 mg-8.6 mg Tab [HMC]

Facility

IP

$5.07

Service Code	NDC 69618006501
Hospital Charge Code	3803712
Hospital Revenue Code	250
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: UnitedHealthcare Commercial	$4.82
Rate for Payer: WPPA Medicare Advantage	$1,200.00

docusate-senna 50 mg-8.6 mg Tab [HMC]

Facility

OP

$5.33

Service Code	NDC 68084005001
Hospital Charge Code	3803712
Hospital Revenue Code	250
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$5.06
Rate for Payer: Aetna Commercial	$4.80
Rate for Payer: Humana Medicare Advantage	$2.24
Rate for Payer: UnitedHealthcare Commercial	$5.06
Rate for Payer: UnitedHealthcare Medicaid	$2.13
Rate for Payer: WPPA Medicare Advantage	$3.20

docusate sodium 100 mg Cap [HMC]

Facility

IP

$5.18

Service Code	NDC 00904718361
Hospital Charge Code	3805104
Hospital Revenue Code	250
Min. Negotiated Rate	$4.66
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.66
Rate for Payer: UnitedHealthcare Commercial	$4.92
Rate for Payer: WPPA Medicare Advantage	$1,200.00

docusate sodium 100 mg Cap [HMC]

Facility

OP

$5.18

Service Code	NDC 00904718361
Hospital Charge Code	3805104
Hospital Revenue Code	250
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$4.92
Rate for Payer: Aetna Commercial	$4.66
Rate for Payer: Humana Medicare Advantage	$2.18
Rate for Payer: UnitedHealthcare Commercial	$4.92
Rate for Payer: UnitedHealthcare Medicaid	$2.07
Rate for Payer: WPPA Medicare Advantage	$3.11

docusate sodium 100 mg Cap [HMC]

Facility

OP

$5.11

Service Code	NDC 46122045178
Hospital Charge Code	3805104
Hospital Revenue Code	250
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$4.85
Rate for Payer: Aetna Commercial	$4.60
Rate for Payer: Humana Medicare Advantage	$2.15
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: UnitedHealthcare Medicaid	$2.04
Rate for Payer: WPPA Medicare Advantage	$3.07

docusate sodium 100 mg Cap [HMC]

Facility

IP

$5.14

Service Code	NDC 63739047802
Hospital Charge Code	3805104
Hospital Revenue Code	250
Min. Negotiated Rate	$4.63
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.63
Rate for Payer: UnitedHealthcare Commercial	$4.88
Rate for Payer: WPPA Medicare Advantage	$1,200.00

docusate sodium 100 mg Cap [HMC]

Facility

OP

$5.14

Service Code	NDC 63739047802
Hospital Charge Code	3805104
Hospital Revenue Code	250
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$4.88
Rate for Payer: Aetna Commercial	$4.63
Rate for Payer: Humana Medicare Advantage	$2.16
Rate for Payer: UnitedHealthcare Commercial	$4.88
Rate for Payer: UnitedHealthcare Medicaid	$2.06
Rate for Payer: WPPA Medicare Advantage	$3.08

docusate sodium 100 mg Cap [HMC]

Facility

IP

$5.11

Service Code	NDC 46122045178
Hospital Charge Code	3805104
Hospital Revenue Code	250
Min. Negotiated Rate	$4.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.60
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

docusate sodium 100 mg Cap [HMC]

Facility

OP

$5.65

Service Code	NDC 60687012901
Hospital Charge Code	3805104
Hospital Revenue Code	250
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$5.37
Rate for Payer: Aetna Commercial	$5.08
Rate for Payer: Humana Medicare Advantage	$2.37
Rate for Payer: UnitedHealthcare Commercial	$5.37
Rate for Payer: UnitedHealthcare Medicaid	$2.26
Rate for Payer: WPPA Medicare Advantage	$3.39

docusate sodium 100 mg Cap [HMC]

Facility

IP

$5.65

Service Code	NDC 60687012901
Hospital Charge Code	3805104
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	$5.37
Rate for Payer: WPPA Medicare Advantage	$1,200.00

docusate sodium 150 mg/15 mL Oral Liq [HMC]

Facility

OP

$96.24

Service Code	NDC 00121054410
Hospital Charge Code	3800040
Hospital Revenue Code	250
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$91.43
Rate for Payer: Aetna Commercial	$86.62
Rate for Payer: Humana Medicare Advantage	$40.42
Rate for Payer: UnitedHealthcare Commercial	$91.43
Rate for Payer: UnitedHealthcare Medicaid	$38.50
Rate for Payer: WPPA Medicare Advantage	$57.74

docusate sodium 150 mg/15 mL Oral Liq [HMC]

Facility

IP

$18.34

Service Code	NDC 24385046843
Hospital Charge Code	3800040
Hospital Revenue Code	250
Min. Negotiated Rate	$16.51
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$16.51
Rate for Payer: UnitedHealthcare Commercial	$17.42
Rate for Payer: WPPA Medicare Advantage	$1,200.00

docusate sodium 150 mg/15 mL Oral Liq [HMC]

Facility

OP

$18.34

Service Code	NDC 24385046843
Hospital Charge Code	3800040
Hospital Revenue Code	250
Min. Negotiated Rate	$7.34
Max. Negotiated Rate	$17.42
Rate for Payer: Aetna Commercial	$16.51
Rate for Payer: Humana Medicare Advantage	$7.70
Rate for Payer: UnitedHealthcare Commercial	$17.42
Rate for Payer: UnitedHealthcare Medicaid	$7.34
Rate for Payer: WPPA Medicare Advantage	$11.00

docusate sodium 150 mg/15 mL Oral Liq [HMC]

Facility

IP

$96.24

Service Code	NDC 00121054410
Hospital Charge Code	3800040
Hospital Revenue Code	250
Min. Negotiated Rate	$86.62
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$86.62
Rate for Payer: UnitedHealthcare Commercial	$91.43
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Dog Dander (E5) IgE QST

Facility

IP

$27.00

Service Code	HCPCS 86003
Hospital Charge Code	LAB1011
Hospital Revenue Code	300
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$24.30
Rate for Payer: UnitedHealthcare Commercial	$25.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Dog Dander (E5) IgE QST

Facility

OP

$133.00

Service Code	HCPCS 86008
Hospital Charge Code	3558600
Hospital Revenue Code	300
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$126.35
Rate for Payer: Aetna Commercial	$119.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$40.26
Rate for Payer: Humana Medicare Advantage	$55.86
Rate for Payer: UnitedHealthcare Commercial	$126.35
Rate for Payer: UnitedHealthcare Medicaid	$17.93
Rate for Payer: WPPA Medicare Advantage	$79.80

Dog Dander (E5) IgE QST

Facility

OP

$27.00

Service Code	HCPCS 86003
Hospital Charge Code	LAB1011
Hospital Revenue Code	300
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$25.65
Rate for Payer: Aetna Commercial	$24.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$15.51
Rate for Payer: Humana Medicare Advantage	$11.34
Rate for Payer: UnitedHealthcare Commercial	$25.65
Rate for Payer: UnitedHealthcare Medicaid	$5.22
Rate for Payer: WPPA Medicare Advantage	$16.20

Dog Dander (E5) IgE QST

Facility

IP

$133.00

Service Code	HCPCS 86008
Hospital Charge Code	3558600
Hospital Revenue Code	300
Min. Negotiated Rate	$119.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$119.70
Rate for Payer: UnitedHealthcare Commercial	$126.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

donanemab azbt 17.5 mg/mL 20 ml Inj Sol [HMC]

Facility

IP

$94.52

Service Code	HCPCS J0175
Hospital Charge Code	3170014
Hospital Revenue Code	250
Min. Negotiated Rate	$85.07
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$85.07
Rate for Payer: UnitedHealthcare Commercial	$89.79
Rate for Payer: WPPA Medicare Advantage	$1,200.00

donanemab azbt 17.5 mg/mL 20 ml Inj Sol [HMC]

Facility

OP

$94.52

Service Code	HCPCS J0175
Hospital Charge Code	3170014
Hospital Revenue Code	250
Min. Negotiated Rate	$37.81
Max. Negotiated Rate	$89.79
Rate for Payer: Aetna Commercial	$85.07
Rate for Payer: Humana Medicare Advantage	$39.70
Rate for Payer: UnitedHealthcare Commercial	$89.79
Rate for Payer: UnitedHealthcare Medicaid	$37.81
Rate for Payer: WPPA Medicare Advantage	$56.71

donepezil 5 mg Tab [HMC]

Facility

IP

$5.49

Service Code	NDC 00904647761
Hospital Charge Code	3800592
Hospital Revenue Code	250
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: UnitedHealthcare Commercial	$5.22
Rate for Payer: WPPA Medicare Advantage	$1,200.00

donepezil 5 mg Tab [HMC]

Facility

OP

$7.33

Service Code	NDC 60687029201
Hospital Charge Code	3800592
Hospital Revenue Code	250
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$6.96
Rate for Payer: Aetna Commercial	$6.60
Rate for Payer: Humana Medicare Advantage	$3.08
Rate for Payer: UnitedHealthcare Commercial	$6.96
Rate for Payer: UnitedHealthcare Medicaid	$2.93
Rate for Payer: WPPA Medicare Advantage	$4.40

donepezil 5 mg Tab [HMC]

Facility

IP

$7.33

Service Code	NDC 60687029201
Hospital Charge Code	3800592
Hospital Revenue Code	250
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.60
Rate for Payer: UnitedHealthcare Commercial	$6.96
Rate for Payer: WPPA Medicare Advantage	$1,200.00

donepezil 5 mg Tab [HMC]

Facility

OP

$5.49

Service Code	NDC 00904647761
Hospital Charge Code	3800592
Hospital Revenue Code	250
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Humana Medicare Advantage	$2.31
Rate for Payer: UnitedHealthcare Commercial	$5.22
Rate for Payer: UnitedHealthcare Medicaid	$2.20
Rate for Payer: WPPA Medicare Advantage	$3.29

DOPamine 1.6 mg/mL-D5W intravenous solution [HMC]

Facility

IP

$59.69

Service Code	HCPCS J1265
Hospital Charge Code	3808646
Hospital Revenue Code	250
Min. Negotiated Rate	$53.72
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$53.72
Rate for Payer: Aetna Commercial	$55.03
Rate for Payer: UnitedHealthcare Commercial	$56.71
Rate for Payer: UnitedHealthcare Commercial	$58.08
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

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