Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

fluconazole 200 mg/100 mL-NS IV Sol [HMC]

Facility

OP

$42.40

Service Code	HCPCS J1450
Hospital Charge Code	3852110
Hospital Revenue Code	250
Min. Negotiated Rate	$3.59
Max. Negotiated Rate	$40.28
Rate for Payer: Aetna Commercial	$38.16
Rate for Payer: Aetna Commercial	$35.14
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3.59
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3.59
Rate for Payer: Humana Medicare Advantage	$16.40
Rate for Payer: Humana Medicare Advantage	$17.81
Rate for Payer: UnitedHealthcare Commercial	$40.28
Rate for Payer: UnitedHealthcare Commercial	$37.09
Rate for Payer: UnitedHealthcare Medicaid	$4.48
Rate for Payer: UnitedHealthcare Medicaid	$4.48
Rate for Payer: WPPA Medicare Advantage	$23.42
Rate for Payer: WPPA Medicare Advantage	$25.44

fluconazole 200 mg/100 mL-NS IV Sol [HMC]

Facility

IP

$39.04

Service Code	HCPCS J1450
Hospital Charge Code	3852110
Hospital Revenue Code	250
Min. Negotiated Rate	$35.14
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$35.14
Rate for Payer: Aetna Commercial	$38.16
Rate for Payer: UnitedHealthcare Commercial	$37.09
Rate for Payer: UnitedHealthcare Commercial	$40.28
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

fludrocortisone 0.1 mg Tab [HMC]

Facility

OP

$8.16

Service Code	NDC 68084028801
Hospital Charge Code	3805774
Hospital Revenue Code	250
Min. Negotiated Rate	$3.26
Max. Negotiated Rate	$7.75
Rate for Payer: Aetna Commercial	$7.34
Rate for Payer: Humana Medicare Advantage	$3.43
Rate for Payer: UnitedHealthcare Commercial	$7.75
Rate for Payer: UnitedHealthcare Medicaid	$3.26
Rate for Payer: WPPA Medicare Advantage	$4.90

fludrocortisone 0.1 mg Tab [HMC]

Facility

OP

$9.79

Service Code	NDC 50268033015
Hospital Charge Code	3805774
Hospital Revenue Code	250
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$9.30
Rate for Payer: Aetna Commercial	$8.81
Rate for Payer: Humana Medicare Advantage	$4.11
Rate for Payer: UnitedHealthcare Commercial	$9.30
Rate for Payer: UnitedHealthcare Medicaid	$3.92
Rate for Payer: WPPA Medicare Advantage	$5.87

fludrocortisone 0.1 mg Tab [HMC]

Facility

IP

$9.79

Service Code	NDC 50268033015
Hospital Charge Code	3805774
Hospital Revenue Code	250
Min. Negotiated Rate	$8.81
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$8.81
Rate for Payer: UnitedHealthcare Commercial	$9.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

fludrocortisone 0.1 mg Tab [HMC]

Facility

IP

$8.16

Service Code	NDC 68084028801
Hospital Charge Code	3805774
Hospital Revenue Code	250
Min. Negotiated Rate	$7.34
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$7.34
Rate for Payer: UnitedHealthcare Commercial	$7.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

flumazenil 0.1 mg/mL IV Sol 5 mL [HMC]

Facility

IP

$45.51

Service Code	NDC 36000014810
Hospital Charge Code	3808729
Hospital Revenue Code	250
Min. Negotiated Rate	$40.96
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$40.96
Rate for Payer: UnitedHealthcare Commercial	$43.23
Rate for Payer: WPPA Medicare Advantage	$1,200.00

flumazenil 0.1 mg/mL IV Sol 5 mL [HMC]

Facility

OP

$44.38

Service Code	NDC 00143978410
Hospital Charge Code	3808729
Hospital Revenue Code	250
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$42.16
Rate for Payer: Aetna Commercial	$39.94
Rate for Payer: Humana Medicare Advantage	$18.64
Rate for Payer: UnitedHealthcare Commercial	$42.16
Rate for Payer: UnitedHealthcare Medicaid	$17.75
Rate for Payer: WPPA Medicare Advantage	$26.63

flumazenil 0.1 mg/mL IV Sol 5 mL [HMC]

Facility

IP

$43.40

Service Code	NDC 00143968410
Hospital Charge Code	3808729
Hospital Revenue Code	250
Min. Negotiated Rate	$39.06
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$39.06
Rate for Payer: UnitedHealthcare Commercial	$41.23
Rate for Payer: WPPA Medicare Advantage	$1,200.00

flumazenil 0.1 mg/mL IV Sol 5 mL [HMC]

Facility

OP

$43.40

Service Code	NDC 00143968410
Hospital Charge Code	3808729
Hospital Revenue Code	250
Min. Negotiated Rate	$17.36
Max. Negotiated Rate	$41.23
Rate for Payer: Aetna Commercial	$39.06
Rate for Payer: Humana Medicare Advantage	$18.23
Rate for Payer: UnitedHealthcare Commercial	$41.23
Rate for Payer: UnitedHealthcare Medicaid	$17.36
Rate for Payer: WPPA Medicare Advantage	$26.04

flumazenil 0.1 mg/mL IV Sol 5 mL [HMC]

Facility

IP

$44.38

Service Code	NDC 00143978410
Hospital Charge Code	3808729
Hospital Revenue Code	250
Min. Negotiated Rate	$39.94
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$39.94
Rate for Payer: UnitedHealthcare Commercial	$42.16
Rate for Payer: WPPA Medicare Advantage	$1,200.00

flumazenil 0.1 mg/mL IV Sol 5 mL [HMC]

Facility

OP

$45.51

Service Code	NDC 36000014810
Hospital Charge Code	3808729
Hospital Revenue Code	250
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$43.23
Rate for Payer: Aetna Commercial	$40.96
Rate for Payer: Humana Medicare Advantage	$19.11
Rate for Payer: UnitedHealthcare Commercial	$43.23
Rate for Payer: UnitedHealthcare Medicaid	$18.20
Rate for Payer: WPPA Medicare Advantage	$27.31

flumazenil 0.1 mg/mL IV Sol [HMC]

Facility

IP

$159.83

Service Code	NDC 00781300392
Hospital Charge Code	3808729
Hospital Revenue Code	250
Min. Negotiated Rate	$143.85
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$143.85
Rate for Payer: UnitedHealthcare Commercial	$151.84
Rate for Payer: WPPA Medicare Advantage	$1,200.00

flumazenil 0.1 mg/mL IV Sol [HMC]

Facility

OP

$159.83

Service Code	NDC 00781300392
Hospital Charge Code	3808729
Hospital Revenue Code	250
Min. Negotiated Rate	$63.93
Max. Negotiated Rate	$151.84
Rate for Payer: Aetna Commercial	$143.85
Rate for Payer: Humana Medicare Advantage	$67.13
Rate for Payer: UnitedHealthcare Commercial	$151.84
Rate for Payer: UnitedHealthcare Medicaid	$63.93
Rate for Payer: WPPA Medicare Advantage	$95.90

fluocinonide Top 0.05% Crm [HMC]

Facility

IP

$142.99

Service Code	NDC 51672125302
Hospital Charge Code	3801935
Hospital Revenue Code	250
Min. Negotiated Rate	$128.69
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$128.69
Rate for Payer: UnitedHealthcare Commercial	$135.84
Rate for Payer: WPPA Medicare Advantage	$1,200.00

fluocinonide Top 0.05% Crm [HMC]

Facility

OP

$142.99

Service Code	NDC 51672125302
Hospital Charge Code	3801935
Hospital Revenue Code	250
Min. Negotiated Rate	$57.20
Max. Negotiated Rate	$135.84
Rate for Payer: Aetna Commercial	$128.69
Rate for Payer: Humana Medicare Advantage	$60.06
Rate for Payer: UnitedHealthcare Commercial	$135.84
Rate for Payer: UnitedHealthcare Medicaid	$57.20
Rate for Payer: WPPA Medicare Advantage	$85.79

fluocinonide Top 0.05% Oint [HMC]

Facility

IP

$115.51

Service Code	NDC 51672126401
Hospital Charge Code	3801935
Hospital Revenue Code	250
Min. Negotiated Rate	$103.96
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$103.96
Rate for Payer: UnitedHealthcare Commercial	$109.73
Rate for Payer: WPPA Medicare Advantage	$1,200.00

fluocinonide Top 0.05% Oint [HMC]

Facility

OP

$115.51

Service Code	NDC 51672126401
Hospital Charge Code	3801935
Hospital Revenue Code	250
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$109.73
Rate for Payer: Aetna Commercial	$103.96
Rate for Payer: Humana Medicare Advantage	$48.51
Rate for Payer: UnitedHealthcare Commercial	$109.73
Rate for Payer: UnitedHealthcare Medicaid	$46.20
Rate for Payer: WPPA Medicare Advantage	$69.31

Fluoroscopic Evaluation of Swallow Function Charge

Facility

OP

$348.00

Service Code	HCPCS 92611 GN
Hospital Charge Code	4052611
Hospital Revenue Code	444
Min. Negotiated Rate	$88.44
Max. Negotiated Rate	$330.60
Rate for Payer: Aetna Commercial	$313.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$178.22
Rate for Payer: Humana Medicare Advantage	$146.16
Rate for Payer: UnitedHealthcare Commercial	$330.60
Rate for Payer: UnitedHealthcare Medicaid	$88.44
Rate for Payer: WPPA Medicare Advantage	$208.80

Fluoroscopic Evaluation of Swallow Function Charge

Facility

IP

$348.00

Service Code	HCPCS 92611 GN
Hospital Charge Code	4052611
Hospital Revenue Code	444
Min. Negotiated Rate	$313.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$313.20
Rate for Payer: UnitedHealthcare Commercial	$330.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Fluoroscopy Navigation-Assisted Surgery

Facility

OP

$210.00

Service Code	HCPCS 77001
Hospital Charge Code	3157001
Hospital Revenue Code	360
Min. Negotiated Rate	$73.38
Max. Negotiated Rate	$199.50
Rate for Payer: Aetna Commercial	$189.00
Rate for Payer: Humana Medicare Advantage	$88.20
Rate for Payer: UnitedHealthcare Commercial	$199.50
Rate for Payer: UnitedHealthcare Medicaid	$73.38
Rate for Payer: WPPA Medicare Advantage	$126.00

Fluoroscopy Navigation-Assisted Surgery

Facility

IP

$210.00

Service Code	HCPCS 77001
Hospital Charge Code	3157001
Hospital Revenue Code	360
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$189.00
Rate for Payer: UnitedHealthcare Commercial	$199.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

fluorouracil 50 mg/mL Sol 50 ml [HMC]

Facility

IP

$55.16

Service Code	HCPCS J9190
Hospital Charge Code	3852211
Hospital Revenue Code	250
Min. Negotiated Rate	$49.64
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$49.64
Rate for Payer: UnitedHealthcare Commercial	$52.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

fluorouracil 50 mg/mL Sol 50 ml [HMC]

Facility

OP

$55.16

Service Code	HCPCS J9190
Hospital Charge Code	3852211
Hospital Revenue Code	250
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$52.40
Rate for Payer: Aetna Commercial	$49.64
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$3.80
Rate for Payer: Humana Medicare Advantage	$23.17
Rate for Payer: UnitedHealthcare Commercial	$52.40
Rate for Payer: UnitedHealthcare Medicaid	$1.94
Rate for Payer: WPPA Medicare Advantage	$33.10

FLUoxetine 10 mg Cap [HMC]

Facility

OP

$12.26

Service Code	NDC 00904578461
Hospital Charge Code	3800543
Hospital Revenue Code	250
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$11.65
Rate for Payer: Aetna Commercial	$11.03
Rate for Payer: Humana Medicare Advantage	$5.15
Rate for Payer: UnitedHealthcare Commercial	$11.65
Rate for Payer: UnitedHealthcare Medicaid	$4.90
Rate for Payer: WPPA Medicare Advantage	$7.36

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