Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

aspirin 81 mg Chew Tab [HMC]

Facility

IP

$5.30

Service Code	NDC 66553000201
Hospital Charge Code	3804461
Hospital Revenue Code	250
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.77
Rate for Payer: UnitedHealthcare Commercial	$5.04
Rate for Payer: WPPA Medicare Advantage	$1,200.00

aspirin 81 mg Chew Tab [HMC]

Facility

IP

$5.19

Service Code	NDC 63739043402
Hospital Charge Code	3804461
Hospital Revenue Code	250
Min. Negotiated Rate	$4.67
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.67
Rate for Payer: UnitedHealthcare Commercial	$4.93
Rate for Payer: WPPA Medicare Advantage	$1,200.00

aspirin 81 mg Chew Tab [HMC]

Facility

OP

$5.26

Service Code	NDC 00904750930
Hospital Charge Code	3804461
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$4.73
Rate for Payer: Humana Medicare Advantage	$2.21
Rate for Payer: UnitedHealthcare Commercial	$5.00
Rate for Payer: UnitedHealthcare Medicaid	$2.10
Rate for Payer: WPPA Medicare Advantage	$3.16

aspirin 81 mg Chew Tab [HMC]

Facility

OP

$5.19

Service Code	NDC 63739043402
Hospital Charge Code	3804461
Hospital Revenue Code	250
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$4.93
Rate for Payer: Aetna Commercial	$4.67
Rate for Payer: Humana Medicare Advantage	$2.18
Rate for Payer: UnitedHealthcare Commercial	$4.93
Rate for Payer: UnitedHealthcare Medicaid	$2.08
Rate for Payer: WPPA Medicare Advantage	$3.11

aspirin 81 mg Chew Tab [HMC]

Facility

IP

$5.12

Service Code	NDC 00904404073
Hospital Charge Code	3804461
Hospital Revenue Code	250
Min. Negotiated Rate	$4.61
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.61
Rate for Payer: UnitedHealthcare Commercial	$4.86
Rate for Payer: WPPA Medicare Advantage	$1,200.00

aspirin 81 mg Chew Tab [HMC]

Facility

IP

$5.26

Service Code	NDC 00904750930
Hospital Charge Code	3804461
Hospital Revenue Code	250
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.73
Rate for Payer: UnitedHealthcare Commercial	$5.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

aspirin 81 mg Chew Tab [HMC]

Facility

OP

$5.30

Service Code	NDC 66553000201
Hospital Charge Code	3804461
Hospital Revenue Code	250
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$5.04
Rate for Payer: Aetna Commercial	$4.77
Rate for Payer: Humana Medicare Advantage	$2.23
Rate for Payer: UnitedHealthcare Commercial	$5.04
Rate for Payer: UnitedHealthcare Medicaid	$2.12
Rate for Payer: WPPA Medicare Advantage	$3.18

aspirin 81 mg Chew Tab [HMC]

Facility

OP

$5.12

Service Code	NDC 00904404073
Hospital Charge Code	3804461
Hospital Revenue Code	250
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$4.86
Rate for Payer: Aetna Commercial	$4.61
Rate for Payer: Humana Medicare Advantage	$2.15
Rate for Payer: UnitedHealthcare Commercial	$4.86
Rate for Payer: UnitedHealthcare Medicaid	$2.05
Rate for Payer: WPPA Medicare Advantage	$3.07

aspirin 81 mg Oral EC Tab [HMC]

Facility

OP

$5.08

Service Code	NDC 00536123441
Hospital Charge Code	3800208
Hospital Revenue Code	250
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$4.57
Rate for Payer: Humana Medicare Advantage	$2.13
Rate for Payer: UnitedHealthcare Commercial	$4.83
Rate for Payer: UnitedHealthcare Medicaid	$2.03
Rate for Payer: WPPA Medicare Advantage	$3.05

aspirin 81 mg Oral EC Tab [HMC]

Facility

IP

$5.08

Service Code	NDC 00536123441
Hospital Charge Code	3800208
Hospital Revenue Code	250
Min. Negotiated Rate	$4.57
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.57
Rate for Payer: UnitedHealthcare Commercial	$4.83
Rate for Payer: WPPA Medicare Advantage	$1,200.00

aspirin 81 mg Oral EC Tab [HMC]

Facility

OP

$5.12

Service Code	NDC 46122059848
Hospital Charge Code	3800208
Hospital Revenue Code	250
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$4.86
Rate for Payer: Aetna Commercial	$4.61
Rate for Payer: Humana Medicare Advantage	$2.15
Rate for Payer: UnitedHealthcare Commercial	$4.86
Rate for Payer: UnitedHealthcare Medicaid	$2.05
Rate for Payer: WPPA Medicare Advantage	$3.07

aspirin 81 mg Oral EC Tab [HMC]

Facility

IP

$5.41

Service Code	NDC 77333003120
Hospital Charge Code	3800208
Hospital Revenue Code	250
Min. Negotiated Rate	$4.87
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.87
Rate for Payer: UnitedHealthcare Commercial	$5.14
Rate for Payer: WPPA Medicare Advantage	$1,200.00

aspirin 81 mg Oral EC Tab [HMC]

Facility

IP

$5.12

Service Code	NDC 46122059848
Hospital Charge Code	3800208
Hospital Revenue Code	250
Min. Negotiated Rate	$4.61
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.61
Rate for Payer: UnitedHealthcare Commercial	$4.86
Rate for Payer: WPPA Medicare Advantage	$1,200.00

aspirin 81 mg Oral EC Tab [HMC]

Facility

OP

$5.41

Service Code	NDC 77333003120
Hospital Charge Code	3800208
Hospital Revenue Code	250
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$5.14
Rate for Payer: Aetna Commercial	$4.87
Rate for Payer: Humana Medicare Advantage	$2.27
Rate for Payer: UnitedHealthcare Commercial	$5.14
Rate for Payer: UnitedHealthcare Medicaid	$2.16
Rate for Payer: WPPA Medicare Advantage	$3.25

aspirin-dipyridamole 25 mg-200 mg ERCap [HMC]

Facility

OP

$27.56

Service Code	NDC 00597000160
Hospital Charge Code	3803679
Hospital Revenue Code	250
Min. Negotiated Rate	$11.02
Max. Negotiated Rate	$26.18
Rate for Payer: Aetna Commercial	$24.80
Rate for Payer: Humana Medicare Advantage	$11.58
Rate for Payer: UnitedHealthcare Commercial	$26.18
Rate for Payer: UnitedHealthcare Medicaid	$11.02
Rate for Payer: WPPA Medicare Advantage	$16.54

aspirin-dipyridamole 25 mg-200 mg ERCap [HMC]

Facility

OP

$25.89

Service Code	NDC 68462040560
Hospital Charge Code	3803679
Hospital Revenue Code	250
Min. Negotiated Rate	$10.36
Max. Negotiated Rate	$24.60
Rate for Payer: Aetna Commercial	$23.30
Rate for Payer: Humana Medicare Advantage	$10.87
Rate for Payer: UnitedHealthcare Commercial	$24.60
Rate for Payer: UnitedHealthcare Medicaid	$10.36
Rate for Payer: WPPA Medicare Advantage	$15.53

aspirin-dipyridamole 25 mg-200 mg ERCap [HMC]

Facility

IP

$25.89

Service Code	NDC 68462040560
Hospital Charge Code	3803679
Hospital Revenue Code	250
Min. Negotiated Rate	$23.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$23.30
Rate for Payer: UnitedHealthcare Commercial	$24.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

aspirin-dipyridamole 25 mg-200 mg ERCap [HMC]

Facility

IP

$27.56

Service Code	NDC 00597000160
Hospital Charge Code	3803679
Hospital Revenue Code	250
Min. Negotiated Rate	$24.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$24.80
Rate for Payer: UnitedHealthcare Commercial	$26.18
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Assmt. Care PT W/ Cognitive impairment

Facility

OP

$511.00

Service Code	HCPCS 99483
Hospital Charge Code	3359483
Hospital Revenue Code	761
Min. Negotiated Rate	$204.40
Max. Negotiated Rate	$485.45
Rate for Payer: Aetna Commercial	$459.90
Rate for Payer: Humana Medicare Advantage	$214.62
Rate for Payer: UnitedHealthcare Commercial	$485.45
Rate for Payer: UnitedHealthcare Medicaid	$204.40
Rate for Payer: WPPA Medicare Advantage	$306.60

Assmt. Care PT W/ Cognitive impairment

Facility

IP

$511.00

Service Code	HCPCS 99483
Hospital Charge Code	3359483
Hospital Revenue Code	761
Min. Negotiated Rate	$459.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$459.90
Rate for Payer: UnitedHealthcare Commercial	$485.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

atenolol 25 mg Tab [HMC]

Facility

IP

$7.40

Service Code	NDC 51079075920
Hospital Charge Code	3800166
Hospital Revenue Code	250
Min. Negotiated Rate	$6.66
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.66
Rate for Payer: UnitedHealthcare Commercial	$7.03
Rate for Payer: WPPA Medicare Advantage	$1,200.00

atenolol 25 mg Tab [HMC]

Facility

OP

$5.93

Service Code	NDC 60687060501
Hospital Charge Code	3800166
Hospital Revenue Code	250
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$5.63
Rate for Payer: Aetna Commercial	$5.34
Rate for Payer: Humana Medicare Advantage	$2.49
Rate for Payer: UnitedHealthcare Commercial	$5.63
Rate for Payer: UnitedHealthcare Medicaid	$2.37
Rate for Payer: WPPA Medicare Advantage	$3.56

atenolol 25 mg Tab [HMC]

Facility

IP

$5.71

Service Code	NDC 00904718761
Hospital Charge Code	3800166
Hospital Revenue Code	250
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.14
Rate for Payer: UnitedHealthcare Commercial	$5.42
Rate for Payer: WPPA Medicare Advantage	$1,200.00

atenolol 25 mg Tab [HMC]

Facility

OP

$5.71

Service Code	NDC 00904718761
Hospital Charge Code	3800166
Hospital Revenue Code	250
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$5.42
Rate for Payer: Aetna Commercial	$5.14
Rate for Payer: Humana Medicare Advantage	$2.40
Rate for Payer: UnitedHealthcare Commercial	$5.42
Rate for Payer: UnitedHealthcare Medicaid	$2.28
Rate for Payer: WPPA Medicare Advantage	$3.43

atenolol 25 mg Tab [HMC]

Facility

OP

$7.40

Service Code	NDC 51079075920
Hospital Charge Code	3800166
Hospital Revenue Code	250
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$7.03
Rate for Payer: Aetna Commercial	$6.66
Rate for Payer: Humana Medicare Advantage	$3.11
Rate for Payer: UnitedHealthcare Commercial	$7.03
Rate for Payer: UnitedHealthcare Medicaid	$2.96
Rate for Payer: WPPA Medicare Advantage	$4.44

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