Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

nitroglycerin 10 mg/100 mL-D5W IV Sol [HMC]

Facility

IP

$56.87

Service Code	NDC 00338104702
Hospital Charge Code	3809461
Hospital Revenue Code	250
Min. Negotiated Rate	$51.18
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$51.18
Rate for Payer: UnitedHealthcare Commercial	$54.03
Rate for Payer: WPPA Medicare Advantage	$1,200.00

nitroglycerin 20 mg/100 mL-D5W IV Sol [HMC]

Facility

OP

$60.57

Service Code	NDC 00338104902
Hospital Charge Code	3800111
Hospital Revenue Code	250
Min. Negotiated Rate	$24.23
Max. Negotiated Rate	$57.54
Rate for Payer: Aetna Commercial	$54.51
Rate for Payer: Humana Medicare Advantage	$25.44
Rate for Payer: UnitedHealthcare Commercial	$57.54
Rate for Payer: UnitedHealthcare Medicaid	$24.23
Rate for Payer: WPPA Medicare Advantage	$36.34

nitroglycerin 20 mg/100 mL-D5W IV Sol [HMC]

Facility

IP

$60.57

Service Code	NDC 00338104902
Hospital Charge Code	3800111
Hospital Revenue Code	250
Min. Negotiated Rate	$54.51
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$54.51
Rate for Payer: UnitedHealthcare Commercial	$57.54
Rate for Payer: WPPA Medicare Advantage	$1,200.00

nitroglycerin 2% Top Oint [HMC]

Facility

OP

$26.06

Service Code	NDC 00281032608
Hospital Charge Code	3806433
Hospital Revenue Code	250
Min. Negotiated Rate	$10.42
Max. Negotiated Rate	$24.76
Rate for Payer: Aetna Commercial	$23.45
Rate for Payer: Humana Medicare Advantage	$10.95
Rate for Payer: UnitedHealthcare Commercial	$24.76
Rate for Payer: UnitedHealthcare Medicaid	$10.42
Rate for Payer: WPPA Medicare Advantage	$15.64

nitroglycerin 2% Top Oint [HMC]

Facility

IP

$26.06

Service Code	NDC 00281032608
Hospital Charge Code	3806433
Hospital Revenue Code	250
Min. Negotiated Rate	$23.45
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$23.45
Rate for Payer: UnitedHealthcare Commercial	$24.76
Rate for Payer: WPPA Medicare Advantage	$1,200.00

nitroprusside 25 mg/mL IV Sol [HMC]

Facility

IP

$123.77

Service Code	NDC 00409302401
Hospital Charge Code	3806466
Hospital Revenue Code	250
Min. Negotiated Rate	$111.39
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$111.39
Rate for Payer: UnitedHealthcare Commercial	$117.58
Rate for Payer: WPPA Medicare Advantage	$1,200.00

nitroprusside 25 mg/mL IV Sol [HMC]

Facility

IP

$57.50

Service Code	NDC 70069026101
Hospital Charge Code	3806466
Hospital Revenue Code	250
Min. Negotiated Rate	$51.75
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$51.75
Rate for Payer: UnitedHealthcare Commercial	$54.62
Rate for Payer: WPPA Medicare Advantage	$1,200.00

nitroprusside 25 mg/mL IV Sol [HMC]

Facility

OP

$123.77

Service Code	NDC 00409302401
Hospital Charge Code	3806466
Hospital Revenue Code	250
Min. Negotiated Rate	$49.51
Max. Negotiated Rate	$117.58
Rate for Payer: Aetna Commercial	$111.39
Rate for Payer: Humana Medicare Advantage	$51.98
Rate for Payer: UnitedHealthcare Commercial	$117.58
Rate for Payer: UnitedHealthcare Medicaid	$49.51
Rate for Payer: WPPA Medicare Advantage	$74.26

nitroprusside 25 mg/mL IV Sol [HMC]

Facility

OP

$57.50

Service Code	NDC 70069026101
Hospital Charge Code	3806466
Hospital Revenue Code	250
Min. Negotiated Rate	$23.00
Max. Negotiated Rate	$54.62
Rate for Payer: Aetna Commercial	$51.75
Rate for Payer: Humana Medicare Advantage	$24.15
Rate for Payer: UnitedHealthcare Commercial	$54.62
Rate for Payer: UnitedHealthcare Medicaid	$23.00
Rate for Payer: WPPA Medicare Advantage	$34.50

nitroprusside 25 mg/mL IV Sol [HMC]

Facility

IP

$57.50

Service Code	NDC 70436002880
Hospital Charge Code	3806466
Hospital Revenue Code	250
Min. Negotiated Rate	$51.75
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$51.75
Rate for Payer: UnitedHealthcare Commercial	$54.62
Rate for Payer: WPPA Medicare Advantage	$1,200.00

nitroprusside 25 mg/mL IV Sol [HMC]

Facility

IP

$505.46

Service Code	NDC 71839012001
Hospital Charge Code	3806466
Hospital Revenue Code	250
Min. Negotiated Rate	$454.91
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$454.91
Rate for Payer: UnitedHealthcare Commercial	$480.19
Rate for Payer: WPPA Medicare Advantage	$1,200.00

nitroprusside 25 mg/mL IV Sol [HMC]

Facility

OP

$57.50

Service Code	NDC 70436002880
Hospital Charge Code	3806466
Hospital Revenue Code	250
Min. Negotiated Rate	$23.00
Max. Negotiated Rate	$54.62
Rate for Payer: Aetna Commercial	$51.75
Rate for Payer: Humana Medicare Advantage	$24.15
Rate for Payer: UnitedHealthcare Commercial	$54.62
Rate for Payer: UnitedHealthcare Medicaid	$23.00
Rate for Payer: WPPA Medicare Advantage	$34.50

nitroprusside 25 mg/mL IV Sol [HMC]

Facility

OP

$505.46

Service Code	NDC 71839012001
Hospital Charge Code	3806466
Hospital Revenue Code	250
Min. Negotiated Rate	$202.18
Max. Negotiated Rate	$480.19
Rate for Payer: Aetna Commercial	$454.91
Rate for Payer: Humana Medicare Advantage	$212.29
Rate for Payer: UnitedHealthcare Commercial	$480.19
Rate for Payer: UnitedHealthcare Medicaid	$202.18
Rate for Payer: WPPA Medicare Advantage	$303.28

NM Bone Imaging Limited

Facility

IP

$1,182.00

Service Code	HCPCS 78300 TC
Hospital Charge Code	3720108
Hospital Revenue Code	341
Min. Negotiated Rate	$1,063.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,063.80
Rate for Payer: UnitedHealthcare Commercial	$1,122.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

NM Bone Imaging Limited

Facility

OP

$1,182.00

Service Code	HCPCS 78300 TC
Hospital Charge Code	3720108
Hospital Revenue Code	341
Min. Negotiated Rate	$218.05
Max. Negotiated Rate	$1,122.90
Rate for Payer: Aetna Commercial	$1,063.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$343.80
Rate for Payer: Humana Medicare Advantage	$496.44
Rate for Payer: UnitedHealthcare Commercial	$1,122.90
Rate for Payer: UnitedHealthcare Medicaid	$218.05
Rate for Payer: WPPA Medicare Advantage	$709.20

NM Bone Imaging Multiple Areas

Facility

IP

$1,182.00

Service Code	HCPCS 78305 TC
Hospital Charge Code	3720116
Hospital Revenue Code	341
Min. Negotiated Rate	$1,063.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,063.80
Rate for Payer: UnitedHealthcare Commercial	$1,122.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

NM Bone Imaging Multiple Areas

Facility

OP

$1,182.00

Service Code	HCPCS 78305 TC
Hospital Charge Code	3720116
Hospital Revenue Code	341
Min. Negotiated Rate	$218.05
Max. Negotiated Rate	$1,122.90
Rate for Payer: Aetna Commercial	$1,063.80
Rate for Payer: Humana Medicare Advantage	$496.44
Rate for Payer: UnitedHealthcare Commercial	$1,122.90
Rate for Payer: UnitedHealthcare Medicaid	$218.05
Rate for Payer: WPPA Medicare Advantage	$709.20

NM Bone Imaging Whole Body

Facility

OP

$1,182.00

Service Code	HCPCS 78306 TC
Hospital Charge Code	3720124
Hospital Revenue Code	341
Min. Negotiated Rate	$218.05
Max. Negotiated Rate	$1,122.90
Rate for Payer: Aetna Commercial	$1,063.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$400.49
Rate for Payer: Humana Medicare Advantage	$496.44
Rate for Payer: UnitedHealthcare Commercial	$1,122.90
Rate for Payer: UnitedHealthcare Medicaid	$218.05
Rate for Payer: WPPA Medicare Advantage	$709.20

NM Bone Imaging Whole Body

Facility

IP

$1,182.00

Service Code	HCPCS 78306 TC
Hospital Charge Code	3720124
Hospital Revenue Code	341
Min. Negotiated Rate	$1,063.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,063.80
Rate for Payer: UnitedHealthcare Commercial	$1,122.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

NM Bone Three Phase Study

Facility

IP

$1,182.00

Service Code	HCPCS 78315 TC
Hospital Charge Code	3720132
Hospital Revenue Code	341
Min. Negotiated Rate	$1,063.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,063.80
Rate for Payer: UnitedHealthcare Commercial	$1,122.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

NM Bone Three Phase Study

Facility

OP

$1,182.00

Service Code	HCPCS 78315 TC
Hospital Charge Code	3720132
Hospital Revenue Code	341
Min. Negotiated Rate	$218.05
Max. Negotiated Rate	$1,122.90
Rate for Payer: Aetna Commercial	$1,063.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$347.52
Rate for Payer: Humana Medicare Advantage	$496.44
Rate for Payer: UnitedHealthcare Commercial	$1,122.90
Rate for Payer: UnitedHealthcare Medicaid	$218.05
Rate for Payer: WPPA Medicare Advantage	$709.20

NM Cardiac MUGA

Facility

IP

$950.00

Service Code	HCPCS 78472 TC
Hospital Charge Code	3720264
Hospital Revenue Code	341
Min. Negotiated Rate	$855.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: UnitedHealthcare Commercial	$902.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

NM Cardiac MUGA

Facility

OP

$950.00

Service Code	HCPCS 78472 TC
Hospital Charge Code	3720264
Hospital Revenue Code	341
Min. Negotiated Rate	$218.05
Max. Negotiated Rate	$902.50
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$507.34
Rate for Payer: Humana Medicare Advantage	$399.00
Rate for Payer: UnitedHealthcare Commercial	$902.50
Rate for Payer: UnitedHealthcare Medicaid	$218.05
Rate for Payer: WPPA Medicare Advantage	$570.00

NM Gastric Emptying Study

Facility

OP

$595.00

Service Code	HCPCS 78264 TC
Hospital Charge Code	3720290
Hospital Revenue Code	341
Min. Negotiated Rate	$218.05
Max. Negotiated Rate	$565.25
Rate for Payer: Aetna Commercial	$535.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$269.47
Rate for Payer: Humana Medicare Advantage	$249.90
Rate for Payer: UnitedHealthcare Commercial	$565.25
Rate for Payer: UnitedHealthcare Medicaid	$218.05
Rate for Payer: WPPA Medicare Advantage	$357.00

NM Gastric Emptying Study

Facility

IP

$595.00

Service Code	HCPCS 78264 TC
Hospital Charge Code	3720290
Hospital Revenue Code	341
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$535.50
Rate for Payer: UnitedHealthcare Commercial	$565.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

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