Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

pancrelipase 24,000 units-76,000 units-120,000 units Cap [HMC]

Facility

IP

$29.30

Service Code	NDC 00032122407
Hospital Charge Code	3800432
Hospital Revenue Code	250
Min. Negotiated Rate	$26.37
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$26.37
Rate for Payer: UnitedHealthcare Commercial	$27.84
Rate for Payer: WPPA Medicare Advantage	$1,200.00

pancrelipase 24,000 units-76,000 units-120,000 units Cap [HMC]

Facility

OP

$29.30

Service Code	NDC 00032122407
Hospital Charge Code	3800432
Hospital Revenue Code	250
Min. Negotiated Rate	$11.72
Max. Negotiated Rate	$27.84
Rate for Payer: Aetna Commercial	$26.37
Rate for Payer: Humana Medicare Advantage	$12.31
Rate for Payer: UnitedHealthcare Commercial	$27.84
Rate for Payer: UnitedHealthcare Medicaid	$11.72
Rate for Payer: WPPA Medicare Advantage	$17.58

pancrelipase 24,000 units-76,000 units-120,000 units Cap [HMC]

Facility

IP

$29.70

Service Code	NDC 00032122401
Hospital Charge Code	3800432
Hospital Revenue Code	250
Min. Negotiated Rate	$26.73
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$26.73
Rate for Payer: UnitedHealthcare Commercial	$28.21
Rate for Payer: WPPA Medicare Advantage	$1,200.00

pancrelipase 24,000 units-76,000 units-120,000 units Cap [HMC]

Facility

OP

$25.41

Service Code	NDC 00032263601
Hospital Charge Code	3800432
Hospital Revenue Code	250
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$24.14
Rate for Payer: Aetna Commercial	$22.87
Rate for Payer: Humana Medicare Advantage	$10.67
Rate for Payer: UnitedHealthcare Commercial	$24.14
Rate for Payer: UnitedHealthcare Medicaid	$10.16
Rate for Payer: WPPA Medicare Advantage	$15.25

pancrelipase 24,000 units-76,000 units-120,000 units Cap [HMC]

Facility

IP

$25.41

Service Code	NDC 00032263601
Hospital Charge Code	3800432
Hospital Revenue Code	250
Min. Negotiated Rate	$22.87
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$22.87
Rate for Payer: UnitedHealthcare Commercial	$24.14
Rate for Payer: WPPA Medicare Advantage	$1,200.00

pancrelipase 24,000 units-76,000 units-120,000 units Cap [HMC]

Facility

OP

$29.70

Service Code	NDC 00032122401
Hospital Charge Code	3800432
Hospital Revenue Code	250
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$28.21
Rate for Payer: Aetna Commercial	$26.73
Rate for Payer: Humana Medicare Advantage	$12.47
Rate for Payer: UnitedHealthcare Commercial	$28.21
Rate for Payer: UnitedHealthcare Medicaid	$11.88
Rate for Payer: WPPA Medicare Advantage	$17.82

pantoprazole 20 mg Oral EC Tab [HMC]

Facility

IP

$16.40

Service Code	NDC 60687058501
Hospital Charge Code	3800414
Hospital Revenue Code	250
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$14.76
Rate for Payer: UnitedHealthcare Commercial	$15.58
Rate for Payer: WPPA Medicare Advantage	$1,200.00

pantoprazole 20 mg Oral EC Tab [HMC]

Facility

OP

$5.99

Service Code	NDC 00904745861
Hospital Charge Code	3800414
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$5.69
Rate for Payer: Aetna Commercial	$5.39
Rate for Payer: Humana Medicare Advantage	$2.52
Rate for Payer: UnitedHealthcare Commercial	$5.69
Rate for Payer: UnitedHealthcare Medicaid	$2.40
Rate for Payer: WPPA Medicare Advantage	$3.59

pantoprazole 20 mg Oral EC Tab [HMC]

Facility

IP

$16.40

Service Code	NDC 68084064301
Hospital Charge Code	3800414
Hospital Revenue Code	250
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$14.76
Rate for Payer: UnitedHealthcare Commercial	$15.58
Rate for Payer: WPPA Medicare Advantage	$1,200.00

pantoprazole 20 mg Oral EC Tab [HMC]

Facility

IP

$5.99

Service Code	NDC 00904745861
Hospital Charge Code	3800414
Hospital Revenue Code	250
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.39
Rate for Payer: UnitedHealthcare Commercial	$5.69
Rate for Payer: WPPA Medicare Advantage	$1,200.00

pantoprazole 20 mg Oral EC Tab [HMC]

Facility

IP

$16.40

Service Code	NDC 60687072501
Hospital Charge Code	3800414
Hospital Revenue Code	250
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$14.76
Rate for Payer: UnitedHealthcare Commercial	$15.58
Rate for Payer: WPPA Medicare Advantage	$1,200.00

pantoprazole 20 mg Oral EC Tab [HMC]

Facility

OP

$16.40

Service Code	NDC 60687072501
Hospital Charge Code	3800414
Hospital Revenue Code	250
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$15.58
Rate for Payer: Aetna Commercial	$14.76
Rate for Payer: Humana Medicare Advantage	$6.89
Rate for Payer: UnitedHealthcare Commercial	$15.58
Rate for Payer: UnitedHealthcare Medicaid	$6.56
Rate for Payer: WPPA Medicare Advantage	$9.84

pantoprazole 20 mg Oral EC Tab [HMC]

Facility

OP

$16.40

Service Code	NDC 60687058501
Hospital Charge Code	3800414
Hospital Revenue Code	250
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$15.58
Rate for Payer: Aetna Commercial	$14.76
Rate for Payer: Humana Medicare Advantage	$6.89
Rate for Payer: UnitedHealthcare Commercial	$15.58
Rate for Payer: UnitedHealthcare Medicaid	$6.56
Rate for Payer: WPPA Medicare Advantage	$9.84

pantoprazole 20 mg Oral EC Tab [HMC]

Facility

OP

$16.40

Service Code	NDC 68084064301
Hospital Charge Code	3800414
Hospital Revenue Code	250
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$15.58
Rate for Payer: Aetna Commercial	$14.76
Rate for Payer: Humana Medicare Advantage	$6.89
Rate for Payer: UnitedHealthcare Commercial	$15.58
Rate for Payer: UnitedHealthcare Medicaid	$6.56
Rate for Payer: WPPA Medicare Advantage	$9.84

pantoprazole 40 mg IV Inj [HMC]

Facility

IP

$35.40

Service Code	HCPCS J2470
Hospital Charge Code	3808652
Hospital Revenue Code	250
Min. Negotiated Rate	$31.86
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$31.86
Rate for Payer: Aetna Commercial	$29.54
Rate for Payer: Aetna Commercial	$31.05
Rate for Payer: Aetna Commercial	$37.08
Rate for Payer: Aetna Commercial	$39.60
Rate for Payer: UnitedHealthcare Commercial	$32.77
Rate for Payer: UnitedHealthcare Commercial	$31.18
Rate for Payer: UnitedHealthcare Commercial	$33.63
Rate for Payer: UnitedHealthcare Commercial	$41.80
Rate for Payer: UnitedHealthcare Commercial	$39.14
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
Rate for Payer: WPPA Medicare Advantage	$1,200.00

pantoprazole 40 mg IV Inj [HMC]

Facility

OP

$44.00

Service Code	HCPCS J2470
Hospital Charge Code	3808652
Hospital Revenue Code	250
Min. Negotiated Rate	$6.16
Max. Negotiated Rate	$41.80
Rate for Payer: Aetna Commercial	$39.60
Rate for Payer: Aetna Commercial	$31.86
Rate for Payer: Aetna Commercial	$31.05
Rate for Payer: Aetna Commercial	$37.08
Rate for Payer: Aetna Commercial	$29.54
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$6.16
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$6.16
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$6.16
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$6.16
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$6.16
Rate for Payer: Humana Medicare Advantage	$13.78
Rate for Payer: Humana Medicare Advantage	$14.49
Rate for Payer: Humana Medicare Advantage	$17.30
Rate for Payer: Humana Medicare Advantage	$18.48
Rate for Payer: Humana Medicare Advantage	$14.87
Rate for Payer: UnitedHealthcare Commercial	$33.63
Rate for Payer: UnitedHealthcare Commercial	$32.77
Rate for Payer: UnitedHealthcare Commercial	$41.80
Rate for Payer: UnitedHealthcare Commercial	$31.18
Rate for Payer: UnitedHealthcare Commercial	$39.14
Rate for Payer: UnitedHealthcare Medicaid	$14.16
Rate for Payer: UnitedHealthcare Medicaid	$13.13
Rate for Payer: UnitedHealthcare Medicaid	$13.80
Rate for Payer: UnitedHealthcare Medicaid	$16.48
Rate for Payer: UnitedHealthcare Medicaid	$17.60
Rate for Payer: WPPA Medicare Advantage	$24.72
Rate for Payer: WPPA Medicare Advantage	$20.70
Rate for Payer: WPPA Medicare Advantage	$19.69
Rate for Payer: WPPA Medicare Advantage	$26.40
Rate for Payer: WPPA Medicare Advantage	$21.24

pantoprazole 40 mg IV Inj [HMC]

Facility

OP

$44.00

Service Code	NDC 71839012210
Hospital Charge Code	3808652
Hospital Revenue Code	250
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$41.80
Rate for Payer: Aetna Commercial	$39.60
Rate for Payer: Humana Medicare Advantage	$18.48
Rate for Payer: UnitedHealthcare Commercial	$41.80
Rate for Payer: UnitedHealthcare Medicaid	$17.60
Rate for Payer: WPPA Medicare Advantage	$26.40

pantoprazole 40 mg IV Inj [HMC]

Facility

IP

$44.00

Service Code	NDC 71839012210
Hospital Charge Code	3808652
Hospital Revenue Code	250
Min. Negotiated Rate	$39.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$39.60
Rate for Payer: UnitedHealthcare Commercial	$41.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

pantoprazole 40 mg Oral EC Tab [HMC]

Facility

IP

$6.35

Service Code	NDC 35573042880
Hospital Charge Code	3803158
Hospital Revenue Code	250
Min. Negotiated Rate	$5.71
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.71
Rate for Payer: UnitedHealthcare Commercial	$6.03
Rate for Payer: WPPA Medicare Advantage	$1,200.00

pantoprazole 40 mg Oral EC Tab [HMC]

Facility

IP

$17.26

Service Code	NDC 00904647461
Hospital Charge Code	3803158
Hospital Revenue Code	250
Min. Negotiated Rate	$15.53
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$15.53
Rate for Payer: UnitedHealthcare Commercial	$16.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

pantoprazole 40 mg Oral EC Tab [HMC]

Facility

OP

$17.26

Service Code	NDC 00904647461
Hospital Charge Code	3803158
Hospital Revenue Code	250
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$16.40
Rate for Payer: Aetna Commercial	$15.53
Rate for Payer: Humana Medicare Advantage	$7.25
Rate for Payer: UnitedHealthcare Commercial	$16.40
Rate for Payer: UnitedHealthcare Medicaid	$6.90
Rate for Payer: WPPA Medicare Advantage	$10.36

pantoprazole 40 mg Oral EC Tab [HMC]

Facility

OP

$6.35

Service Code	NDC 35573042880
Hospital Charge Code	3803158
Hospital Revenue Code	250
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$6.03
Rate for Payer: Aetna Commercial	$5.71
Rate for Payer: Humana Medicare Advantage	$2.67
Rate for Payer: UnitedHealthcare Commercial	$6.03
Rate for Payer: UnitedHealthcare Medicaid	$2.54
Rate for Payer: WPPA Medicare Advantage	$3.81

Pap & HPV, CT/NG 91339 QST PMH

Facility

OP

$249.00

Service Code	HCPCS 87591
Hospital Charge Code	3551732
Hospital Revenue Code	300
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$236.55
Rate for Payer: Aetna Commercial	$224.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$75.32
Rate for Payer: Humana Medicare Advantage	$104.58
Rate for Payer: UnitedHealthcare Commercial	$236.55
Rate for Payer: UnitedHealthcare Medicaid	$35.09
Rate for Payer: WPPA Medicare Advantage	$149.40

Pap & HPV, CT/NG 91339 QST PMH

Facility

IP

$249.00

Service Code	HCPCS 87591
Hospital Charge Code	3551732
Hospital Revenue Code	300
Min. Negotiated Rate	$224.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$224.10
Rate for Payer: UnitedHealthcare Commercial	$236.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Paracentesis

Facility

IP

$2,335.00

Service Code	HCPCS 58940
Hospital Charge Code	3158943
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,218.25
Rate for Payer: Aetna Commercial	$2,101.50
Rate for Payer: UnitedHealthcare Commercial	$2,218.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

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