Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

acetaminophen 80 mg Chew Tab [HMC]

Facility

IP

$5.29

Service Code	NDC 00904579146
Hospital Charge Code	3807804
Hospital Revenue Code	250
Min. Negotiated Rate	$4.76
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.76
Rate for Payer: UnitedHealthcare Commercial	$5.03
Rate for Payer: WPPA Medicare Advantage	$1,200.00

acetaminophen 80 mg Chew Tab [HMC]

Facility

OP

$5.29

Service Code	NDC 00904579146
Hospital Charge Code	3807804
Hospital Revenue Code	250
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$5.03
Rate for Payer: Aetna Commercial	$4.76
Rate for Payer: Humana Medicare Advantage	$2.22
Rate for Payer: UnitedHealthcare Commercial	$5.03
Rate for Payer: UnitedHealthcare Medicaid	$2.12
Rate for Payer: WPPA Medicare Advantage	$3.17

acetaminophen-codeine 120 mg-12 mg/5 mL Oral Liq 118 mL [HMC]

Facility

OP

$10.57

Service Code	NDC 00121050404
Hospital Charge Code	3808827
Hospital Revenue Code	250
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$10.04
Rate for Payer: Aetna Commercial	$9.51
Rate for Payer: Humana Medicare Advantage	$4.44
Rate for Payer: UnitedHealthcare Commercial	$10.04
Rate for Payer: UnitedHealthcare Medicaid	$4.23
Rate for Payer: WPPA Medicare Advantage	$6.34

acetaminophen-codeine 120 mg-12 mg/5 mL Oral Liq 118 mL [HMC]

Facility

IP

$10.57

Service Code	NDC 00121050404
Hospital Charge Code	3808827
Hospital Revenue Code	250
Min. Negotiated Rate	$9.51
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.51
Rate for Payer: UnitedHealthcare Commercial	$10.04
Rate for Payer: WPPA Medicare Advantage	$1,200.00

acetaminophen-codeine 120 mg-12 mg/5 mL Oral Liq 473 mL [HMC]

Facility

OP

$10.38

Service Code	NDC 50383007916
Hospital Charge Code	3808827
Hospital Revenue Code	250
Min. Negotiated Rate	$4.15
Max. Negotiated Rate	$9.86
Rate for Payer: Aetna Commercial	$9.34
Rate for Payer: Humana Medicare Advantage	$4.36
Rate for Payer: UnitedHealthcare Commercial	$9.86
Rate for Payer: UnitedHealthcare Medicaid	$4.15
Rate for Payer: WPPA Medicare Advantage	$6.23

acetaminophen-codeine 120 mg-12 mg/5 mL Oral Liq 473 mL [HMC]

Facility

IP

$10.38

Service Code	NDC 50383007916
Hospital Charge Code	3808827
Hospital Revenue Code	250
Min. Negotiated Rate	$9.34
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.34
Rate for Payer: UnitedHealthcare Commercial	$9.86
Rate for Payer: WPPA Medicare Advantage	$1,200.00

acetaminophen-codeine 120 mg-12 mg/5 mL Oral Liq 473 mL [HMC]

Facility

OP

$16.57

Service Code	NDC 64950037416
Hospital Charge Code	3808827
Hospital Revenue Code	250
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$15.74
Rate for Payer: Aetna Commercial	$14.91
Rate for Payer: Humana Medicare Advantage	$6.96
Rate for Payer: UnitedHealthcare Commercial	$15.74
Rate for Payer: UnitedHealthcare Medicaid	$6.63
Rate for Payer: WPPA Medicare Advantage	$9.94

acetaminophen-codeine 120 mg-12 mg/5 mL Oral Liq 473 mL [HMC]

Facility

OP

$10.40

Service Code	NDC 00121050416
Hospital Charge Code	3808827
Hospital Revenue Code	250
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$9.88
Rate for Payer: Aetna Commercial	$9.36
Rate for Payer: Humana Medicare Advantage	$4.37
Rate for Payer: UnitedHealthcare Commercial	$9.88
Rate for Payer: UnitedHealthcare Medicaid	$4.16
Rate for Payer: WPPA Medicare Advantage	$6.24

acetaminophen-codeine 120 mg-12 mg/5 mL Oral Liq 473 mL [HMC]

Facility

IP

$10.40

Service Code	NDC 00121050416
Hospital Charge Code	3808827
Hospital Revenue Code	250
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.36
Rate for Payer: UnitedHealthcare Commercial	$9.88
Rate for Payer: WPPA Medicare Advantage	$1,200.00

acetaminophen-codeine 120 mg-12 mg/5 mL Oral Liq 473 mL [HMC]

Facility

IP

$16.57

Service Code	NDC 64950037416
Hospital Charge Code	3808827
Hospital Revenue Code	250
Min. Negotiated Rate	$14.91
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$14.91
Rate for Payer: UnitedHealthcare Commercial	$15.74
Rate for Payer: WPPA Medicare Advantage	$1,200.00

acetaminophen-codeine 300 mg-30 mg Tab [HMC]

Facility

IP

$6.08

Service Code	NDC 00093015001
Hospital Charge Code	3809587
Hospital Revenue Code	250
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.47
Rate for Payer: UnitedHealthcare Commercial	$5.78
Rate for Payer: WPPA Medicare Advantage	$1,200.00

acetaminophen-codeine 300 mg-30 mg Tab [HMC]

Facility

IP

$7.74

Service Code	NDC 00406048462
Hospital Charge Code	3809587
Hospital Revenue Code	250
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.97
Rate for Payer: UnitedHealthcare Commercial	$7.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

acetaminophen-codeine 300 mg-30 mg Tab [HMC]

Facility

OP

$7.74

Service Code	NDC 00406048462
Hospital Charge Code	3809587
Hospital Revenue Code	250
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$7.35
Rate for Payer: Aetna Commercial	$6.97
Rate for Payer: Humana Medicare Advantage	$3.25
Rate for Payer: UnitedHealthcare Commercial	$7.35
Rate for Payer: UnitedHealthcare Medicaid	$3.10
Rate for Payer: WPPA Medicare Advantage	$4.64

acetaminophen-codeine 300 mg-30 mg Tab [HMC]

Facility

OP

$6.08

Service Code	NDC 00093015001
Hospital Charge Code	3809587
Hospital Revenue Code	250
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$5.78
Rate for Payer: Aetna Commercial	$5.47
Rate for Payer: Humana Medicare Advantage	$2.55
Rate for Payer: UnitedHealthcare Commercial	$5.78
Rate for Payer: UnitedHealthcare Medicaid	$2.43
Rate for Payer: WPPA Medicare Advantage	$3.65

acetaminophen-HYDROcodone 325 mg-10 mg Tab [HMC]

Facility

IP

$18.63

Service Code	NDC 00406012562
Hospital Charge Code	3806356
Hospital Revenue Code	250
Min. Negotiated Rate	$16.77
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$16.77
Rate for Payer: UnitedHealthcare Commercial	$17.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

acetaminophen-HYDROcodone 325 mg-10 mg Tab [HMC]

Facility

OP

$18.30

Service Code	NDC 60687041801
Hospital Charge Code	3806356
Hospital Revenue Code	250
Min. Negotiated Rate	$7.32
Max. Negotiated Rate	$17.39
Rate for Payer: Aetna Commercial	$16.47
Rate for Payer: Humana Medicare Advantage	$7.69
Rate for Payer: UnitedHealthcare Commercial	$17.39
Rate for Payer: UnitedHealthcare Medicaid	$7.32
Rate for Payer: WPPA Medicare Advantage	$10.98

acetaminophen-HYDROcodone 325 mg-10 mg Tab [HMC]

Facility

OP

$18.63

Service Code	NDC 00406012562
Hospital Charge Code	3806356
Hospital Revenue Code	250
Min. Negotiated Rate	$7.45
Max. Negotiated Rate	$17.70
Rate for Payer: Aetna Commercial	$16.77
Rate for Payer: Humana Medicare Advantage	$7.82
Rate for Payer: UnitedHealthcare Commercial	$17.70
Rate for Payer: UnitedHealthcare Medicaid	$7.45
Rate for Payer: WPPA Medicare Advantage	$11.18

acetaminophen-HYDROcodone 325 mg-10 mg Tab [HMC]

Facility

IP

$19.70

Service Code	NDC 50268040815
Hospital Charge Code	3806356
Hospital Revenue Code	250
Min. Negotiated Rate	$17.73
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$17.73
Rate for Payer: UnitedHealthcare Commercial	$18.71
Rate for Payer: WPPA Medicare Advantage	$1,200.00

acetaminophen-HYDROcodone 325 mg-10 mg Tab [HMC]

Facility

IP

$18.30

Service Code	NDC 60687041801
Hospital Charge Code	3806356
Hospital Revenue Code	250
Min. Negotiated Rate	$16.47
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$16.47
Rate for Payer: UnitedHealthcare Commercial	$17.39
Rate for Payer: WPPA Medicare Advantage	$1,200.00

acetaminophen-HYDROcodone 325 mg-10 mg Tab [HMC]

Facility

OP

$19.70

Service Code	NDC 50268040815
Hospital Charge Code	3806356
Hospital Revenue Code	250
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$18.71
Rate for Payer: Aetna Commercial	$17.73
Rate for Payer: Humana Medicare Advantage	$8.27
Rate for Payer: UnitedHealthcare Commercial	$18.71
Rate for Payer: UnitedHealthcare Medicaid	$7.88
Rate for Payer: WPPA Medicare Advantage	$11.82

acetaminophen-HYDROcodone 325 mg-5 mg Tab [HMC]

Facility

IP

$7.06

Service Code	NDC 68084089509
Hospital Charge Code	3802248
Hospital Revenue Code	250
Min. Negotiated Rate	$6.35
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.35
Rate for Payer: UnitedHealthcare Commercial	$6.71
Rate for Payer: WPPA Medicare Advantage	$1,200.00

acetaminophen-HYDROcodone 325 mg-5 mg Tab [HMC]

Facility

OP

$6.20

Service Code	NDC 68084036801
Hospital Charge Code	3802248
Hospital Revenue Code	250
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$5.89
Rate for Payer: Aetna Commercial	$5.58
Rate for Payer: Humana Medicare Advantage	$2.60
Rate for Payer: UnitedHealthcare Commercial	$5.89
Rate for Payer: UnitedHealthcare Medicaid	$2.48
Rate for Payer: WPPA Medicare Advantage	$3.72

acetaminophen-HYDROcodone 325 mg-5 mg Tab [HMC]

Facility

OP

$7.39

Service Code	NDC 00406012362
Hospital Charge Code	3802248
Hospital Revenue Code	250
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$7.02
Rate for Payer: Aetna Commercial	$6.65
Rate for Payer: Humana Medicare Advantage	$3.10
Rate for Payer: UnitedHealthcare Commercial	$7.02
Rate for Payer: UnitedHealthcare Medicaid	$2.96
Rate for Payer: WPPA Medicare Advantage	$4.43

acetaminophen-HYDROcodone 325 mg-5 mg Tab [HMC]

Facility

IP

$6.20

Service Code	NDC 68084036801
Hospital Charge Code	3802248
Hospital Revenue Code	250
Min. Negotiated Rate	$5.58
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.58
Rate for Payer: UnitedHealthcare Commercial	$5.89
Rate for Payer: WPPA Medicare Advantage	$1,200.00

acetaminophen-HYDROcodone 325 mg-5 mg Tab [HMC]

Facility

IP

$6.22

Service Code	NDC 00904682461
Hospital Charge Code	3802248
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.60
Rate for Payer: UnitedHealthcare Commercial	$5.91
Rate for Payer: WPPA Medicare Advantage	$1,200.00

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