Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

tranexamic acid 100 mg/mL IV Sol [HMC]

Facility

IP

$57.43

Service Code	NDC 61990061102
Hospital Charge Code	3800315
Hospital Revenue Code	250
Min. Negotiated Rate	$51.69
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$51.69
Rate for Payer: UnitedHealthcare Commercial	$54.56
Rate for Payer: WPPA Medicare Advantage	$1,200.00

tranexamic acid 100 mg/mL IV Sol [HMC]

Facility

OP

$46.10

Service Code	NDC 70860040010
Hospital Charge Code	3800315
Hospital Revenue Code	250
Min. Negotiated Rate	$18.44
Max. Negotiated Rate	$43.80
Rate for Payer: Aetna Commercial	$41.49
Rate for Payer: Humana Medicare Advantage	$19.36
Rate for Payer: UnitedHealthcare Commercial	$43.80
Rate for Payer: UnitedHealthcare Medicaid	$18.44
Rate for Payer: WPPA Medicare Advantage	$27.66

tranexamic acid 100 mg/mL IV Sol [HMC]

Facility

IP

$46.10

Service Code	NDC 70860040010
Hospital Charge Code	3800315
Hospital Revenue Code	250
Min. Negotiated Rate	$41.49
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$41.49
Rate for Payer: UnitedHealthcare Commercial	$43.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

tranexamic acid 100 mg/mL IV Sol [HMC]

Facility

IP

$110.00

Service Code	NDC 55150018810
Hospital Charge Code	3800315
Hospital Revenue Code	250
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$99.00
Rate for Payer: UnitedHealthcare Commercial	$104.50
Rate for Payer: WPPA Medicare Advantage	$1,200.00

tranexamic acid 100 mg/mL IV Sol [HMC]

Facility

IP

$41.60

Service Code	NDC 25021041510
Hospital Charge Code	3800315
Hospital Revenue Code	250
Min. Negotiated Rate	$37.44
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$37.44
Rate for Payer: UnitedHealthcare Commercial	$39.52
Rate for Payer: WPPA Medicare Advantage	$1,200.00

tranexamic acid 650 mg Tab [HMC]

Facility

OP

$18.15

Service Code	NDC 50268077213
Hospital Charge Code	3800521
Hospital Revenue Code	250
Min. Negotiated Rate	$7.26
Max. Negotiated Rate	$17.24
Rate for Payer: Aetna Commercial	$16.34
Rate for Payer: Humana Medicare Advantage	$7.62
Rate for Payer: UnitedHealthcare Commercial	$17.24
Rate for Payer: UnitedHealthcare Medicaid	$7.26
Rate for Payer: WPPA Medicare Advantage	$10.89

tranexamic acid 650 mg Tab [HMC]

Facility

OP

$18.04

Service Code	NDC 69918030130
Hospital Charge Code	3800521
Hospital Revenue Code	250
Min. Negotiated Rate	$7.22
Max. Negotiated Rate	$17.14
Rate for Payer: Aetna Commercial	$16.24
Rate for Payer: Humana Medicare Advantage	$7.58
Rate for Payer: UnitedHealthcare Commercial	$17.14
Rate for Payer: UnitedHealthcare Medicaid	$7.22
Rate for Payer: WPPA Medicare Advantage	$10.82

tranexamic acid 650 mg Tab [HMC]

Facility

IP

$18.04

Service Code	NDC 69918030130
Hospital Charge Code	3800521
Hospital Revenue Code	250
Min. Negotiated Rate	$16.24
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$16.24
Rate for Payer: UnitedHealthcare Commercial	$17.14
Rate for Payer: WPPA Medicare Advantage	$1,200.00

tranexamic acid 650 mg Tab [HMC]

Facility

IP

$18.15

Service Code	NDC 50268077213
Hospital Charge Code	3800521
Hospital Revenue Code	250
Min. Negotiated Rate	$16.34
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$16.34
Rate for Payer: UnitedHealthcare Commercial	$17.24
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Transferrin

Facility

IP

$255.00

Service Code	HCPCS 84466
Hospital Charge Code	3551864
Hospital Revenue Code	300
Min. Negotiated Rate	$229.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$229.50
Rate for Payer: UnitedHealthcare Commercial	$242.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Transferrin

Facility

OP

$255.00

Service Code	HCPCS 84466
Hospital Charge Code	3551864
Hospital Revenue Code	300
Min. Negotiated Rate	$12.76
Max. Negotiated Rate	$242.25
Rate for Payer: Aetna Commercial	$229.50
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$77.93
Rate for Payer: Humana Medicare Advantage	$107.10
Rate for Payer: UnitedHealthcare Commercial	$242.25
Rate for Payer: UnitedHealthcare Medicaid	$12.76
Rate for Payer: WPPA Medicare Advantage	$153.00

Transforaminal Epidural Steroid Injection

Facility

IP

$1,614.00

Service Code	HCPCS 64483
Hospital Charge Code	3150751
Hospital Revenue Code	360
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,533.30
Rate for Payer: Aetna Commercial	$1,452.60
Rate for Payer: UnitedHealthcare Commercial	$1,533.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Transforaminal Epidural Steroid Injection

Facility

OP

$1,614.00

Service Code	HCPCS 64483
Hospital Charge Code	3150751
Hospital Revenue Code	360
Min. Negotiated Rate	$295.27
Max. Negotiated Rate	$1,533.30
Rate for Payer: Aetna Commercial	$1,452.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$688.43
Rate for Payer: Humana Medicare Advantage	$677.88
Rate for Payer: UnitedHealthcare Commercial	$1,533.30
Rate for Payer: UnitedHealthcare Medicaid	$295.27
Rate for Payer: WPPA Medicare Advantage	$968.40

TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC

Facility

IP

$3,621.78

Service Code	MSDRG 069
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,621.78
Rate for Payer: UnitedHealthcare Medicaid	$3,621.78
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TRANSURETHRAL PROCEDURES WITH CC

Facility

IP

$5,242.05

Service Code	MSDRG 669
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,242.05
Rate for Payer: UnitedHealthcare Medicaid	$5,242.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TRANSURETHRAL PROCEDURES WITH MCC

Facility

IP

$9,848.70

Service Code	MSDRG 668
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$9,848.70
Rate for Payer: UnitedHealthcare Medicaid	$9,848.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TRANSURETHRAL PROCEDURES WITHOUT CC/MCC

Facility

IP

$3,304.08

Service Code	MSDRG 670
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,304.08
Rate for Payer: UnitedHealthcare Medicaid	$3,304.08
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TRANSURETHRAL PROSTATECTOMY WITH CC/MCC

Facility

IP

$5,273.82

Service Code	MSDRG 713
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,273.82
Rate for Payer: UnitedHealthcare Medicaid	$5,273.82
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC

Facility

IP

$3,717.09

Service Code	MSDRG 714
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$3,717.09
Rate for Payer: UnitedHealthcare Medicaid	$3,717.09
Rate for Payer: WPPA Medicare Advantage	$1,200.00

trastuzumab 440 mg IV kit [HMC]

Facility

IP

$9,599.86

Service Code	HCPCS J9355
Hospital Charge Code	3852125
Hospital Revenue Code	250
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$9,119.87
Rate for Payer: Aetna Commercial	$8,639.87
Rate for Payer: UnitedHealthcare Commercial	$9,119.87
Rate for Payer: WPPA Medicare Advantage	$1,200.00

trastuzumab 440 mg IV kit [HMC]

Facility

OP

$9,599.86

Service Code	HCPCS J9355
Hospital Charge Code	3852125
Hospital Revenue Code	250
Min. Negotiated Rate	$73.48
Max. Negotiated Rate	$9,119.87
Rate for Payer: Aetna Commercial	$8,639.87
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$100.13
Rate for Payer: Humana Medicare Advantage	$4,031.94
Rate for Payer: UnitedHealthcare Commercial	$9,119.87
Rate for Payer: UnitedHealthcare Medicaid	$73.48
Rate for Payer: WPPA Medicare Advantage	$5,759.92

TRAUMATIC INJURY WITH MCC

Facility

IP

$4,956.12

Service Code	MSDRG 913
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,956.12
Rate for Payer: UnitedHealthcare Medicaid	$4,956.12
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TRAUMATIC INJURY WITHOUT MCC

Facility

IP

$2,668.68

Service Code	MSDRG 914
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,668.68
Rate for Payer: UnitedHealthcare Medicaid	$2,668.68
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC

Facility

IP

$5,877.45

Service Code	MSDRG 086
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$5,877.45
Rate for Payer: UnitedHealthcare Medicaid	$5,877.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC

Facility

IP

$6,322.23

Service Code	MSDRG 083
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$6,322.23
Rate for Payer: UnitedHealthcare Medicaid	$6,322.23
Rate for Payer: WPPA Medicare Advantage	$1,200.00

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