Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

vancomycin 500 mg IV Inj [HMC]

Facility

IP

$33.00

Service Code	NDC 72611076110
Hospital Charge Code	3809750
Hospital Revenue Code	250
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$29.70
Rate for Payer: UnitedHealthcare Commercial	$31.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

vancomycin 500 mg IV Inj [HMC]

Facility

IP

$33.00

Service Code	HCPCS J3373
Hospital Charge Code	3809750
Hospital Revenue Code	250
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$29.70
Rate for Payer: Aetna Commercial	$44.25
Rate for Payer: Aetna Commercial	$43.73
Rate for Payer: UnitedHealthcare Commercial	$31.35
Rate for Payer: UnitedHealthcare Commercial	$46.16
Rate for Payer: UnitedHealthcare Commercial	$46.71
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

vancomycin 500 mg IV Inj [HMC]

Facility

OP

$33.00

Service Code	NDC 72611076110
Hospital Charge Code	3809750
Hospital Revenue Code	250
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$31.35
Rate for Payer: Aetna Commercial	$29.70
Rate for Payer: Humana Medicare Advantage	$13.86
Rate for Payer: UnitedHealthcare Commercial	$31.35
Rate for Payer: UnitedHealthcare Medicaid	$13.20
Rate for Payer: WPPA Medicare Advantage	$19.80

vancomycin 500 mg IV Inj [HMC]

Facility

OP

$33.00

Service Code	HCPCS J3373
Hospital Charge Code	3809750
Hospital Revenue Code	250
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$31.35
Rate for Payer: Aetna Commercial	$29.70
Rate for Payer: Aetna Commercial	$44.25
Rate for Payer: Aetna Commercial	$43.73
Rate for Payer: Humana Medicare Advantage	$20.41
Rate for Payer: Humana Medicare Advantage	$13.86
Rate for Payer: Humana Medicare Advantage	$20.65
Rate for Payer: UnitedHealthcare Commercial	$46.16
Rate for Payer: UnitedHealthcare Commercial	$31.35
Rate for Payer: UnitedHealthcare Commercial	$46.71
Rate for Payer: UnitedHealthcare Medicaid	$13.20
Rate for Payer: UnitedHealthcare Medicaid	$19.67
Rate for Payer: UnitedHealthcare Medicaid	$19.44
Rate for Payer: WPPA Medicare Advantage	$29.15
Rate for Payer: WPPA Medicare Advantage	$19.80
Rate for Payer: WPPA Medicare Advantage	$29.50

vancomycin 500 mg Pow

Facility

IP

$33.00

Service Code	HCPCS J3373
Hospital Charge Code	3809750
Hospital Revenue Code	250
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$29.70
Rate for Payer: UnitedHealthcare Commercial	$31.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

vancomycin 500 mg Pow

Facility

OP

$33.00

Service Code	HCPCS J3373
Hospital Charge Code	3809750
Hospital Revenue Code	250
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$31.35
Rate for Payer: Aetna Commercial	$29.70
Rate for Payer: Humana Medicare Advantage	$13.86
Rate for Payer: UnitedHealthcare Commercial	$31.35
Rate for Payer: UnitedHealthcare Medicaid	$13.20
Rate for Payer: WPPA Medicare Advantage	$19.80

vancomycin 50 mg/mL Pow 300 mL [HMC]

Facility

OP

$441.41

Service Code	NDC 65628020810
Hospital Charge Code	3800389
Hospital Revenue Code	250
Min. Negotiated Rate	$176.56
Max. Negotiated Rate	$419.34
Rate for Payer: Aetna Commercial	$397.27
Rate for Payer: Humana Medicare Advantage	$185.39
Rate for Payer: UnitedHealthcare Commercial	$419.34
Rate for Payer: UnitedHealthcare Medicaid	$176.56
Rate for Payer: WPPA Medicare Advantage	$264.85

vancomycin 50 mg/mL Pow 300 mL [HMC]

Facility

OP

$371.51

Service Code	NDC 65628001610
Hospital Charge Code	3800389
Hospital Revenue Code	250
Min. Negotiated Rate	$148.60
Max. Negotiated Rate	$352.93
Rate for Payer: Aetna Commercial	$334.36
Rate for Payer: Humana Medicare Advantage	$156.03
Rate for Payer: UnitedHealthcare Commercial	$352.93
Rate for Payer: UnitedHealthcare Medicaid	$148.60
Rate for Payer: WPPA Medicare Advantage	$222.91

vancomycin 50 mg/mL Pow 300 mL [HMC]

Facility

IP

$371.51

Service Code	NDC 65628001610
Hospital Charge Code	3800389
Hospital Revenue Code	250
Min. Negotiated Rate	$334.36
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$334.36
Rate for Payer: UnitedHealthcare Commercial	$352.93
Rate for Payer: WPPA Medicare Advantage	$1,200.00

vancomycin 50 mg/mL Pow 300 mL [HMC]

Facility

IP

$1,118.47

Service Code	NDC 62559083003
Hospital Charge Code	3800389
Hospital Revenue Code	250
Min. Negotiated Rate	$1,006.62
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$1,006.62
Rate for Payer: UnitedHealthcare Commercial	$1,062.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

vancomycin 50 mg/mL Pow 300 mL [HMC]

Facility

IP

$248.39

Service Code	NDC 65628020110
Hospital Charge Code	3800389
Hospital Revenue Code	250
Min. Negotiated Rate	$223.55
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$223.55
Rate for Payer: UnitedHealthcare Commercial	$235.97
Rate for Payer: WPPA Medicare Advantage	$1,200.00

vancomycin 50 mg/mL Pow 300 mL [HMC]

Facility

OP

$248.39

Service Code	NDC 65628020110
Hospital Charge Code	3800389
Hospital Revenue Code	250
Min. Negotiated Rate	$99.36
Max. Negotiated Rate	$235.97
Rate for Payer: Aetna Commercial	$223.55
Rate for Payer: Humana Medicare Advantage	$104.32
Rate for Payer: UnitedHealthcare Commercial	$235.97
Rate for Payer: UnitedHealthcare Medicaid	$99.36
Rate for Payer: WPPA Medicare Advantage	$149.03

vancomycin 50 mg/mL Pow 300 mL [HMC]

Facility

OP

$1,118.47

Service Code	NDC 62559083003
Hospital Charge Code	3800389
Hospital Revenue Code	250
Min. Negotiated Rate	$447.39
Max. Negotiated Rate	$1,062.55
Rate for Payer: Aetna Commercial	$1,006.62
Rate for Payer: Humana Medicare Advantage	$469.76
Rate for Payer: UnitedHealthcare Commercial	$1,062.55
Rate for Payer: UnitedHealthcare Medicaid	$447.39
Rate for Payer: WPPA Medicare Advantage	$671.08

vancomycin 50 mg/mL Pow 300 mL [HMC]

Facility

IP

$441.41

Service Code	NDC 65628020810
Hospital Charge Code	3800389
Hospital Revenue Code	250
Min. Negotiated Rate	$397.27
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$397.27
Rate for Payer: UnitedHealthcare Commercial	$419.34
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Vancomycin Level Trough

Facility

OP

$197.00

Service Code	HCPCS 80202
Hospital Charge Code	3552722
Hospital Revenue Code	300
Min. Negotiated Rate	$13.54
Max. Negotiated Rate	$187.15
Rate for Payer: Aetna Commercial	$177.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$58.96
Rate for Payer: Humana Medicare Advantage	$82.74
Rate for Payer: UnitedHealthcare Commercial	$187.15
Rate for Payer: UnitedHealthcare Medicaid	$13.54
Rate for Payer: WPPA Medicare Advantage	$118.20

Vancomycin Level Trough

Facility

IP

$197.00

Service Code	HCPCS 80202
Hospital Charge Code	3552722
Hospital Revenue Code	300
Min. Negotiated Rate	$177.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$177.30
Rate for Payer: UnitedHealthcare Commercial	$187.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Varicella Titer

Facility

IP

$218.00

Service Code	HCPCS 86787
Hospital Charge Code	3552201
Hospital Revenue Code	300
Min. Negotiated Rate	$196.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$196.20
Rate for Payer: UnitedHealthcare Commercial	$207.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Varicella Titer

Facility

OP

$218.00

Service Code	HCPCS 86787
Hospital Charge Code	3552201
Hospital Revenue Code	300
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$207.10
Rate for Payer: Aetna Commercial	$196.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$66.20
Rate for Payer: Humana Medicare Advantage	$91.56
Rate for Payer: UnitedHealthcare Commercial	$207.10
Rate for Payer: UnitedHealthcare Medicaid	$10.95
Rate for Payer: WPPA Medicare Advantage	$130.80

Varicella Zoster Virus Ab (IgG) QST

Facility

IP

$218.00

Service Code	HCPCS 86787
Hospital Charge Code	3552201
Hospital Revenue Code	300
Min. Negotiated Rate	$196.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$196.20
Rate for Payer: UnitedHealthcare Commercial	$207.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Varicella Zoster Virus Ab (IgG) QST

Facility

OP

$218.00

Service Code	HCPCS 86787
Hospital Charge Code	3552201
Hospital Revenue Code	300
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$207.10
Rate for Payer: Aetna Commercial	$196.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$66.20
Rate for Payer: Humana Medicare Advantage	$91.56
Rate for Payer: UnitedHealthcare Commercial	$207.10
Rate for Payer: UnitedHealthcare Medicaid	$10.95
Rate for Payer: WPPA Medicare Advantage	$130.80

Varicella Zoster Virus PCR QST Bill only

Facility

IP

$347.00

Service Code	HCPCS 87798
Hospital Charge Code	3556812
Hospital Revenue Code	300
Min. Negotiated Rate	$312.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$312.30
Rate for Payer: UnitedHealthcare Commercial	$329.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Varicella Zoster Virus PCR QST Bill only

Facility

OP

$347.00

Service Code	HCPCS 87798
Hospital Charge Code	3556812
Hospital Revenue Code	300
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$329.65
Rate for Payer: Aetna Commercial	$312.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$185.64
Rate for Payer: Humana Medicare Advantage	$145.74
Rate for Payer: UnitedHealthcare Commercial	$329.65
Rate for Payer: UnitedHealthcare Medicaid	$35.09
Rate for Payer: WPPA Medicare Advantage	$208.20

Vascular Graft Gore-Tex Stretch 7mm ID 40cm Length Non-Heparin Stnd Wall

Facility

IP

$1,598.00

Hospital Charge Code	3259650
Hospital Revenue Code	270
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,518.10
Rate for Payer: Aetna Commercial	$1,438.20
Rate for Payer: UnitedHealthcare Commercial	$1,518.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Vascular Graft Gore-Tex Stretch 7mm ID 40cm Length Non-Heparin Stnd Wall

Facility

OP

$1,598.00

Hospital Charge Code	3259650
Hospital Revenue Code	270
Min. Negotiated Rate	$639.20
Max. Negotiated Rate	$1,518.10
Rate for Payer: Aetna Commercial	$1,438.20
Rate for Payer: Humana Medicare Advantage	$671.16
Rate for Payer: UnitedHealthcare Commercial	$1,518.10
Rate for Payer: UnitedHealthcare Medicaid	$639.20
Rate for Payer: WPPA Medicare Advantage	$958.80

Vaseline Gauze 3 X 9

Facility

OP

$2.50

Hospital Charge Code	3254252
Hospital Revenue Code	270
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.38
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: Humana Medicare Advantage	$1.05
Rate for Payer: UnitedHealthcare Commercial	$2.38
Rate for Payer: UnitedHealthcare Medicaid	$1.00
Rate for Payer: WPPA Medicare Advantage	$1.50

<<
<
501
502
503
504
505
506
507
508
509
510
>
>>