Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

PleurX Drainage Bottle 1000ml w/Procedure Pack

Facility

IP

$200.03

Service Code	HCPCS C1729
Hospital Charge Code	3252062
Hospital Revenue Code	278
Min. Negotiated Rate	$180.03
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$180.03
Rate for Payer: UnitedHealthcare Commercial	$190.03
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Plug & Patch Phasix X-Lrg 1.4 x 2 (38mm x 51mm) Synthetic Mesh Inguinal Absorbable

Facility

OP

$1,132.25

Hospital Charge Code	3258840
Hospital Revenue Code	270
Min. Negotiated Rate	$452.90
Max. Negotiated Rate	$1,075.64
Rate for Payer: Aetna Commercial	$1,019.02
Rate for Payer: Humana Medicare Advantage	$475.55
Rate for Payer: UnitedHealthcare Commercial	$1,075.64
Rate for Payer: UnitedHealthcare Medicaid	$452.90
Rate for Payer: WPPA Medicare Advantage	$679.35

Plug & Patch Phasix X-Lrg 1.4 x 2 (38mm x 51mm) Synthetic Mesh Inguinal Absorbable

Facility

IP

$1,132.25

Hospital Charge Code	3258840
Hospital Revenue Code	270
Min. Negotiated Rate	$1,019.02
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,019.02
Rate for Payer: UnitedHealthcare Commercial	$1,075.64
Rate for Payer: WPPA Medicare Advantage	$1,200.00

pneumococcal 13-valent conjugate vaccine - Sus UD [HMC]

Facility

OP

$427.35

Service Code	NDC 00005197102
Hospital Charge Code	3804122
Hospital Revenue Code	250
Min. Negotiated Rate	$170.94
Max. Negotiated Rate	$405.98
Rate for Payer: Aetna Commercial	$384.62
Rate for Payer: Humana Medicare Advantage	$179.49
Rate for Payer: UnitedHealthcare Commercial	$405.98
Rate for Payer: UnitedHealthcare Medicaid	$170.94
Rate for Payer: WPPA Medicare Advantage	$256.41

pneumococcal 13-valent conjugate vaccine - Sus UD [HMC]

Facility

IP

$427.35

Service Code	NDC 00005197102
Hospital Charge Code	3804122
Hospital Revenue Code	250
Min. Negotiated Rate	$384.62
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$384.62
Rate for Payer: UnitedHealthcare Commercial	$405.98
Rate for Payer: WPPA Medicare Advantage	$1,200.00

pneumococcal 20-valent conjugate vaccine Susp [HMC]

Facility

OP

$490.66

Service Code	NDC 00005200010
Hospital Charge Code	3800203
Hospital Revenue Code	250
Min. Negotiated Rate	$196.26
Max. Negotiated Rate	$466.13
Rate for Payer: Aetna Commercial	$441.59
Rate for Payer: Humana Medicare Advantage	$206.08
Rate for Payer: UnitedHealthcare Commercial	$466.13
Rate for Payer: UnitedHealthcare Medicaid	$196.26
Rate for Payer: WPPA Medicare Advantage	$294.40

pneumococcal 20-valent conjugate vaccine Susp [HMC]

Facility

IP

$490.66

Service Code	NDC 00005200010
Hospital Charge Code	3800203
Hospital Revenue Code	250
Min. Negotiated Rate	$441.59
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$441.59
Rate for Payer: UnitedHealthcare Commercial	$466.13
Rate for Payer: WPPA Medicare Advantage	$1,200.00

pneumococcal 23-valent vaccine Inj Sol 2 mL [HMC]

Facility

IP

$1,073.73

Service Code	NDC 00006494300
Hospital Charge Code	3804122
Hospital Revenue Code	250
Min. Negotiated Rate	$966.36
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$966.36
Rate for Payer: UnitedHealthcare Commercial	$1,020.04
Rate for Payer: WPPA Medicare Advantage	$1,200.00

pneumococcal 23-valent vaccine Inj Sol 2 mL [HMC]

Facility

OP

$1,073.73

Service Code	NDC 00006483703
Hospital Charge Code	3804122
Hospital Revenue Code	250
Min. Negotiated Rate	$429.49
Max. Negotiated Rate	$1,020.04
Rate for Payer: Aetna Commercial	$966.36
Rate for Payer: Humana Medicare Advantage	$450.97
Rate for Payer: UnitedHealthcare Commercial	$1,020.04
Rate for Payer: UnitedHealthcare Medicaid	$429.49
Rate for Payer: WPPA Medicare Advantage	$644.24

pneumococcal 23-valent vaccine Inj Sol 2 mL [HMC]

Facility

OP

$671.42

Service Code	NDC 00006473900
Hospital Charge Code	3804122
Hospital Revenue Code	250
Min. Negotiated Rate	$268.57
Max. Negotiated Rate	$637.85
Rate for Payer: Aetna Commercial	$604.28
Rate for Payer: Humana Medicare Advantage	$282.00
Rate for Payer: UnitedHealthcare Commercial	$637.85
Rate for Payer: UnitedHealthcare Medicaid	$268.57
Rate for Payer: WPPA Medicare Advantage	$402.85

pneumococcal 23-valent vaccine Inj Sol 2 mL [HMC]

Facility

IP

$1,073.73

Service Code	NDC 00006483703
Hospital Charge Code	3804122
Hospital Revenue Code	250
Min. Negotiated Rate	$966.36
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$966.36
Rate for Payer: UnitedHealthcare Commercial	$1,020.04
Rate for Payer: WPPA Medicare Advantage	$1,200.00

pneumococcal 23-valent vaccine Inj Sol 2 mL [HMC]

Facility

OP

$1,073.73

Service Code	NDC 00006494300
Hospital Charge Code	3804122
Hospital Revenue Code	250
Min. Negotiated Rate	$429.49
Max. Negotiated Rate	$1,020.04
Rate for Payer: Aetna Commercial	$966.36
Rate for Payer: Humana Medicare Advantage	$450.97
Rate for Payer: UnitedHealthcare Commercial	$1,020.04
Rate for Payer: UnitedHealthcare Medicaid	$429.49
Rate for Payer: WPPA Medicare Advantage	$644.24

pneumococcal 23-valent vaccine Inj Sol 2 mL [HMC]

Facility

IP

$671.42

Service Code	NDC 00006473900
Hospital Charge Code	3804122
Hospital Revenue Code	250
Min. Negotiated Rate	$604.28
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$604.28
Rate for Payer: UnitedHealthcare Commercial	$637.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Pneumothorax Catheter 9fr X 2cm PFTE

Facility

OP

$715.50

Hospital Charge Code	3252121
Hospital Revenue Code	270
Min. Negotiated Rate	$286.20
Max. Negotiated Rate	$679.73
Rate for Payer: Aetna Commercial	$643.95
Rate for Payer: Humana Medicare Advantage	$300.51
Rate for Payer: UnitedHealthcare Commercial	$679.73
Rate for Payer: UnitedHealthcare Medicaid	$286.20
Rate for Payer: WPPA Medicare Advantage	$429.30

Pneumothorax Catheter 9fr X 2cm PFTE

Facility

IP

$715.50

Hospital Charge Code	3252121
Hospital Revenue Code	270
Min. Negotiated Rate	$643.95
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$643.95
Rate for Payer: UnitedHealthcare Commercial	$679.73
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Pneumothorax Kit

Facility

OP

$789.75

Hospital Charge Code	3252120
Hospital Revenue Code	270
Min. Negotiated Rate	$315.90
Max. Negotiated Rate	$750.26
Rate for Payer: Aetna Commercial	$710.77
Rate for Payer: Humana Medicare Advantage	$331.69
Rate for Payer: UnitedHealthcare Commercial	$750.26
Rate for Payer: UnitedHealthcare Medicaid	$315.90
Rate for Payer: WPPA Medicare Advantage	$473.85

Pneumothorax Kit

Facility

IP

$789.75

Hospital Charge Code	3252120
Hospital Revenue Code	270
Min. Negotiated Rate	$710.77
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$710.77
Rate for Payer: UnitedHealthcare Commercial	$750.26
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PNEUMOTHORAX WITH CC

Facility

IP

$4,257.18

Service Code	MSDRG 200
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,257.18
Rate for Payer: UnitedHealthcare Medicaid	$4,257.18
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PNEUMOTHORAX WITH MCC

Facility

IP

$6,798.78

Service Code	MSDRG 199
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,798.78
Rate for Payer: UnitedHealthcare Medicaid	$6,798.78
Rate for Payer: WPPA Medicare Advantage	$1,200.00

PNEUMOTHORAX WITHOUT CC/MCC

Facility

IP

$2,763.99

Service Code	MSDRG 201
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,763.99
Rate for Payer: UnitedHealthcare Medicaid	$2,763.99
Rate for Payer: WPPA Medicare Advantage	$1,200.00

POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC

Facility

IP

$5,019.66

Service Code	MSDRG 917
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,019.66
Rate for Payer: UnitedHealthcare Medicaid	$5,019.66
Rate for Payer: WPPA Medicare Advantage	$1,200.00

POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC

Facility

IP

$2,414.52

Service Code	MSDRG 918
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,414.52
Rate for Payer: UnitedHealthcare Medicaid	$2,414.52
Rate for Payer: WPPA Medicare Advantage	$1,200.00

polycarbophil 625 mg Tab [HMC]

Facility

IP

$5.33

Service Code	NDC 00536430608
Hospital Charge Code	3805377
Hospital Revenue Code	250
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.80
Rate for Payer: UnitedHealthcare Commercial	$5.06
Rate for Payer: WPPA Medicare Advantage	$1,200.00

polycarbophil 625 mg Tab [HMC]

Facility

IP

$5.37

Service Code	NDC 00005250033
Hospital Charge Code	3805377
Hospital Revenue Code	250
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.83
Rate for Payer: UnitedHealthcare Commercial	$5.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

polycarbophil 625 mg Tab [HMC]

Facility

OP

$5.37

Service Code	NDC 00005250033
Hospital Charge Code	3805377
Hospital Revenue Code	250
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$5.10
Rate for Payer: Aetna Commercial	$4.83
Rate for Payer: Humana Medicare Advantage	$2.26
Rate for Payer: UnitedHealthcare Commercial	$5.10
Rate for Payer: UnitedHealthcare Medicaid	$2.15
Rate for Payer: WPPA Medicare Advantage	$3.22

<<
<
395
396
397
398
399
400
401
402
403
404
>
>>