Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

ibuprofen 100 mg/5 mL Oral Susp 120mL[HMC]

Facility

OP

$10.42

Service Code	NDC 00904530920
Hospital Charge Code	3808553
Hospital Revenue Code	257
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna Commercial	$9.38
Rate for Payer: Humana Medicare Advantage	$4.38
Rate for Payer: UnitedHealthcare Commercial	$9.90
Rate for Payer: UnitedHealthcare Medicaid	$4.17
Rate for Payer: WPPA Medicare Advantage	$6.25

ibuprofen 100 mg/5 mL Oral Susp 120mL[HMC]

Facility

OP

$10.42

Service Code	NDC 00904530920
Hospital Charge Code	3808553
Hospital Revenue Code	250
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna Commercial	$9.38
Rate for Payer: Humana Medicare Advantage	$4.38
Rate for Payer: UnitedHealthcare Commercial	$9.90
Rate for Payer: UnitedHealthcare Medicaid	$4.17
Rate for Payer: WPPA Medicare Advantage	$6.25

ibuprofen 100 mg/5 mL Oral Susp 120mL[HMC]

Facility

IP

$10.42

Service Code	NDC 00904530920
Hospital Charge Code	3808553
Hospital Revenue Code	250
Min. Negotiated Rate	$9.38
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.38
Rate for Payer: UnitedHealthcare Commercial	$9.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ibuprofen 100 mg/5 mL Oral Susp 120mL[HMC]

Facility

IP

$10.42

Service Code	NDC 00904530920
Hospital Charge Code	3808553
Hospital Revenue Code	257
Min. Negotiated Rate	$9.38
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.38
Rate for Payer: UnitedHealthcare Commercial	$9.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ibuprofen 100 mg/5 mL Oral Susp 473mL [HMC]

Facility

IP

$10.64

Service Code	NDC 59651003247
Hospital Charge Code	3808553
Hospital Revenue Code	257
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.58
Rate for Payer: UnitedHealthcare Commercial	$10.11
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ibuprofen 100 mg/5 mL Oral Susp 473mL [HMC]

Facility

OP

$10.64

Service Code	NDC 59651003247
Hospital Charge Code	3808553
Hospital Revenue Code	257
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$10.11
Rate for Payer: Aetna Commercial	$9.58
Rate for Payer: Humana Medicare Advantage	$4.47
Rate for Payer: UnitedHealthcare Commercial	$10.11
Rate for Payer: UnitedHealthcare Medicaid	$4.26
Rate for Payer: WPPA Medicare Advantage	$6.38

ibuprofen 100 mg/5 mL Oral Susp 473mL [HMC]

Facility

IP

$10.64

Service Code	NDC 59651003247
Hospital Charge Code	3808553
Hospital Revenue Code	250
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.58
Rate for Payer: UnitedHealthcare Commercial	$10.11
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ibuprofen 100 mg/5 mL Oral Susp 473mL [HMC]

Facility

OP

$10.64

Service Code	NDC 59651003247
Hospital Charge Code	3808553
Hospital Revenue Code	250
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$10.11
Rate for Payer: Aetna Commercial	$9.58
Rate for Payer: Humana Medicare Advantage	$4.47
Rate for Payer: UnitedHealthcare Commercial	$10.11
Rate for Payer: UnitedHealthcare Medicaid	$4.26
Rate for Payer: WPPA Medicare Advantage	$6.38

ibuprofen 100 mg/5 mL Oral Susp [HMC]

Facility

IP

$11.87

Service Code	NDC 68094060061
Hospital Charge Code	3808553
Hospital Revenue Code	250
Min. Negotiated Rate	$10.68
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.68
Rate for Payer: UnitedHealthcare Commercial	$11.28
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ibuprofen 100 mg/5 mL Oral Susp [HMC]

Facility

OP

$11.87

Service Code	NDC 68094060062
Hospital Charge Code	3808553
Hospital Revenue Code	250
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$11.28
Rate for Payer: Aetna Commercial	$10.68
Rate for Payer: Humana Medicare Advantage	$4.99
Rate for Payer: UnitedHealthcare Commercial	$11.28
Rate for Payer: UnitedHealthcare Medicaid	$4.75
Rate for Payer: WPPA Medicare Advantage	$7.12

ibuprofen 100 mg/5 mL Oral Susp [HMC]

Facility

IP

$11.74

Service Code	NDC 68094049462
Hospital Charge Code	3808553
Hospital Revenue Code	250
Min. Negotiated Rate	$10.57
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.57
Rate for Payer: UnitedHealthcare Commercial	$11.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ibuprofen 100 mg/5 mL Oral Susp [HMC]

Facility

OP

$11.87

Service Code	NDC 68094060061
Hospital Charge Code	3808553
Hospital Revenue Code	250
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$11.28
Rate for Payer: Aetna Commercial	$10.68
Rate for Payer: Humana Medicare Advantage	$4.99
Rate for Payer: UnitedHealthcare Commercial	$11.28
Rate for Payer: UnitedHealthcare Medicaid	$4.75
Rate for Payer: WPPA Medicare Advantage	$7.12

ibuprofen 100 mg/5 mL Oral Susp [HMC]

Facility

IP

$11.87

Service Code	NDC 68094060062
Hospital Charge Code	3808553
Hospital Revenue Code	250
Min. Negotiated Rate	$10.68
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.68
Rate for Payer: UnitedHealthcare Commercial	$11.28
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ibuprofen 100 mg/5 mL Oral Susp [HMC]

Facility

OP

$11.88

Service Code	NDC 00121091700
Hospital Charge Code	3808553
Hospital Revenue Code	250
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$11.29
Rate for Payer: Aetna Commercial	$10.69
Rate for Payer: Humana Medicare Advantage	$4.99
Rate for Payer: UnitedHealthcare Commercial	$11.29
Rate for Payer: UnitedHealthcare Medicaid	$4.75
Rate for Payer: WPPA Medicare Advantage	$7.13

ibuprofen 100 mg/5 mL Oral Susp [HMC]

Facility

IP

$11.88

Service Code	NDC 00121091700
Hospital Charge Code	3808553
Hospital Revenue Code	250
Min. Negotiated Rate	$10.69
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.69
Rate for Payer: UnitedHealthcare Commercial	$11.29
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ibuprofen 100 mg/5 mL Oral Susp [HMC]

Facility

OP

$11.74

Service Code	NDC 68094049462
Hospital Charge Code	3808553
Hospital Revenue Code	250
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$11.15
Rate for Payer: Aetna Commercial	$10.57
Rate for Payer: Humana Medicare Advantage	$4.93
Rate for Payer: UnitedHealthcare Commercial	$11.15
Rate for Payer: UnitedHealthcare Medicaid	$4.70
Rate for Payer: WPPA Medicare Advantage	$7.04

ibuprofen 400 mg Tab [HMC]

Facility

IP

$5.78

Service Code	NDC 60687044601
Hospital Charge Code	3805799
Hospital Revenue Code	250
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.20
Rate for Payer: UnitedHealthcare Commercial	$5.49
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ibuprofen 400 mg Tab [HMC]

Facility

OP

$6.10

Service Code	NDC 67877031901
Hospital Charge Code	3805799
Hospital Revenue Code	250
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$5.79
Rate for Payer: Aetna Commercial	$5.49
Rate for Payer: Humana Medicare Advantage	$2.56
Rate for Payer: UnitedHealthcare Commercial	$5.79
Rate for Payer: UnitedHealthcare Medicaid	$2.44
Rate for Payer: WPPA Medicare Advantage	$3.66

ibuprofen 400 mg Tab [HMC]

Facility

IP

$5.65

Service Code	NDC 00904585361
Hospital Charge Code	3805799
Hospital Revenue Code	250
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.08
Rate for Payer: UnitedHealthcare Commercial	$5.37
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ibuprofen 400 mg Tab [HMC]

Facility

IP

$6.10

Service Code	NDC 67877031901
Hospital Charge Code	3805799
Hospital Revenue Code	250
Min. Negotiated Rate	$5.49
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.49
Rate for Payer: UnitedHealthcare Commercial	$5.79
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ibuprofen 400 mg Tab [HMC]

Facility

OP

$5.78

Service Code	NDC 60687044601
Hospital Charge Code	3805799
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$5.49
Rate for Payer: Aetna Commercial	$5.20
Rate for Payer: Humana Medicare Advantage	$2.43
Rate for Payer: UnitedHealthcare Commercial	$5.49
Rate for Payer: UnitedHealthcare Medicaid	$2.31
Rate for Payer: WPPA Medicare Advantage	$3.47

ibuprofen 400 mg Tab [HMC]

Facility

OP

$5.65

Service Code	NDC 00904585361
Hospital Charge Code	3805799
Hospital Revenue Code	250
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$5.37
Rate for Payer: Aetna Commercial	$5.08
Rate for Payer: Humana Medicare Advantage	$2.37
Rate for Payer: UnitedHealthcare Commercial	$5.37
Rate for Payer: UnitedHealthcare Medicaid	$2.26
Rate for Payer: WPPA Medicare Advantage	$3.39

ibuprofen 40 mg/mL Oral Susp [HMC]

Facility

IP

$25.92

Service Code	NDC 45802005705
Hospital Charge Code	3802195
Hospital Revenue Code	250
Min. Negotiated Rate	$23.33
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$23.33
Rate for Payer: UnitedHealthcare Commercial	$24.62
Rate for Payer: WPPA Medicare Advantage	$1,200.00

ibuprofen 40 mg/mL Oral Susp [HMC]

Facility

OP

$25.92

Service Code	NDC 45802005705
Hospital Charge Code	3802195
Hospital Revenue Code	250
Min. Negotiated Rate	$10.37
Max. Negotiated Rate	$24.62
Rate for Payer: Aetna Commercial	$23.33
Rate for Payer: Humana Medicare Advantage	$10.89
Rate for Payer: UnitedHealthcare Commercial	$24.62
Rate for Payer: UnitedHealthcare Medicaid	$10.37
Rate for Payer: WPPA Medicare Advantage	$15.55

ibuprofen 40 mg/mL Oral Susp [HMC]

Facility

OP

$22.11

Service Code	NDC 24385055010
Hospital Charge Code	3802195
Hospital Revenue Code	250
Min. Negotiated Rate	$8.84
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$19.90
Rate for Payer: Humana Medicare Advantage	$9.29
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid	$8.84
Rate for Payer: WPPA Medicare Advantage	$13.27

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