Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HYDRALAZINE 50 MG TABLET

Facility

$200.45

Service Code	NDC 62584-734-01
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$126.28
Max. Negotiated Rate	$180.40
Rate for Payer: Aetna Commercial	$170.38
Rate for Payer: Aetna New Business (MI Preferred)	$130.29
Rate for Payer: Cash Price	$160.36
Rate for Payer: Cofinity Commercial	$140.32
Rate for Payer: Cofinity Commercial	$172.39
Rate for Payer: Healthscope Commercial	$180.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$170.38
Rate for Payer: PHP Commercial	$170.38
Rate for Payer: Priority Health Cigna Priority Health	$140.32
Rate for Payer: Priority Health SBD	$126.28

HYDRALAZINE 50 MG TABLET

Facility

$98.70

Service Code	NDC 23155-003-01
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$62.18
Max. Negotiated Rate	$88.83
Rate for Payer: Aetna Commercial	$83.90
Rate for Payer: Aetna New Business (MI Preferred)	$64.16
Rate for Payer: Cash Price	$78.96
Rate for Payer: Cofinity Commercial	$69.09
Rate for Payer: Cofinity Commercial	$84.88
Rate for Payer: Healthscope Commercial	$88.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$83.90
Rate for Payer: PHP Commercial	$83.90
Rate for Payer: Priority Health Cigna Priority Health	$69.09
Rate for Payer: Priority Health SBD	$62.18

HYDRALAZINE 50 MG TABLET

Facility

$244.15

Service Code	NDC 51079-076-20
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$153.81
Max. Negotiated Rate	$219.74
Rate for Payer: Aetna Commercial	$207.53
Rate for Payer: Aetna New Business (MI Preferred)	$158.70
Rate for Payer: Cash Price	$195.32
Rate for Payer: Cofinity Commercial	$209.97
Rate for Payer: Cofinity Commercial	$170.90
Rate for Payer: Healthscope Commercial	$219.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$207.53
Rate for Payer: PHP Commercial	$207.53
Rate for Payer: Priority Health Cigna Priority Health	$170.90
Rate for Payer: Priority Health SBD	$153.81

HYDRALAZINE 50 MG TABLET

Facility

$218.55

Service Code	NDC 0904-6442-61
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$137.69
Max. Negotiated Rate	$196.70
Rate for Payer: Aetna Commercial	$185.77
Rate for Payer: Aetna New Business (MI Preferred)	$142.06
Rate for Payer: Cash Price	$174.84
Rate for Payer: Cofinity Commercial	$152.98
Rate for Payer: Cofinity Commercial	$187.95
Rate for Payer: Healthscope Commercial	$196.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$185.77
Rate for Payer: PHP Commercial	$185.77
Rate for Payer: Priority Health Cigna Priority Health	$152.98
Rate for Payer: Priority Health SBD	$137.69

HYDRALAZINE 50 MG TABLET

Facility

$2.45

Service Code	NDC 51079-076-01
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$2.20
Rate for Payer: Aetna Commercial	$2.08
Rate for Payer: Aetna New Business (MI Preferred)	$1.59
Rate for Payer: Cash Price	$1.96
Rate for Payer: Cofinity Commercial	$1.72
Rate for Payer: Cofinity Commercial	$2.11
Rate for Payer: Healthscope Commercial	$2.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.08
Rate for Payer: PHP Commercial	$2.08
Rate for Payer: Priority Health Cigna Priority Health	$1.72
Rate for Payer: Priority Health SBD	$1.54

HYDRALAZINE 50 MG TABLET

Facility

$200.45

Service Code	NDC 62584-734-11
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$126.28
Max. Negotiated Rate	$180.40
Rate for Payer: Aetna Commercial	$170.38
Rate for Payer: Aetna New Business (MI Preferred)	$130.29
Rate for Payer: Cash Price	$160.36
Rate for Payer: Cofinity Commercial	$140.32
Rate for Payer: Cofinity Commercial	$172.39
Rate for Payer: Healthscope Commercial	$180.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$170.38
Rate for Payer: PHP Commercial	$170.38
Rate for Payer: Priority Health Cigna Priority Health	$140.32
Rate for Payer: Priority Health SBD	$126.28

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$91.65

Service Code	NDC 0172-2083-60
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$57.74
Max. Negotiated Rate	$82.48
Rate for Payer: Aetna Commercial	$77.90
Rate for Payer: Aetna New Business (MI Preferred)	$59.57
Rate for Payer: Cash Price	$73.32
Rate for Payer: Cofinity Commercial	$64.16
Rate for Payer: Cofinity Commercial	$78.82
Rate for Payer: Healthscope Commercial	$82.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$77.90
Rate for Payer: PHP Commercial	$77.90
Rate for Payer: Priority Health Cigna Priority Health	$64.16
Rate for Payer: Priority Health SBD	$57.74

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$30.55

Service Code	NDC 16729-183-01
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$19.25
Max. Negotiated Rate	$27.50
Rate for Payer: Aetna Commercial	$25.97
Rate for Payer: Aetna New Business (MI Preferred)	$19.86
Rate for Payer: Cash Price	$24.44
Rate for Payer: Cofinity Commercial	$21.38
Rate for Payer: Cofinity Commercial	$26.27
Rate for Payer: Healthscope Commercial	$27.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$25.97
Rate for Payer: PHP Commercial	$25.97
Rate for Payer: Priority Health Cigna Priority Health	$21.38
Rate for Payer: Priority Health SBD	$19.25

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$2.99

Service Code	NDC 60687-593-11
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$2.69
Rate for Payer: Aetna Commercial	$2.54
Rate for Payer: Aetna New Business (MI Preferred)	$1.94
Rate for Payer: Cash Price	$2.39
Rate for Payer: Cofinity Commercial	$2.09
Rate for Payer: Cofinity Commercial	$2.57
Rate for Payer: Healthscope Commercial	$2.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.54
Rate for Payer: PHP Commercial	$2.54
Rate for Payer: Priority Health Cigna Priority Health	$2.09
Rate for Payer: Priority Health SBD	$1.88

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$58.75

Service Code	NDC 63739-128-10
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$37.01
Max. Negotiated Rate	$52.88
Rate for Payer: Aetna Commercial	$49.94
Rate for Payer: Aetna New Business (MI Preferred)	$38.19
Rate for Payer: Cash Price	$47.00
Rate for Payer: Cofinity Commercial	$41.12
Rate for Payer: Cofinity Commercial	$50.52
Rate for Payer: Healthscope Commercial	$52.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$49.94
Rate for Payer: PHP Commercial	$49.94
Rate for Payer: Priority Health Cigna Priority Health	$41.12
Rate for Payer: Priority Health SBD	$37.01

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$298.45

Service Code	NDC 60687-593-01
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$188.02
Max. Negotiated Rate	$268.60
Rate for Payer: Aetna Commercial	$253.68
Rate for Payer: Aetna New Business (MI Preferred)	$193.99
Rate for Payer: Cash Price	$238.76
Rate for Payer: Cofinity Commercial	$208.92
Rate for Payer: Cofinity Commercial	$256.67
Rate for Payer: Healthscope Commercial	$268.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$253.68
Rate for Payer: PHP Commercial	$253.68
Rate for Payer: Priority Health Cigna Priority Health	$208.92
Rate for Payer: Priority Health SBD	$188.02

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$81.03

Service Code	NDC 0406-0125-62
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$51.05
Max. Negotiated Rate	$72.93
Rate for Payer: Aetna Commercial	$68.88
Rate for Payer: Aetna New Business (MI Preferred)	$52.67
Rate for Payer: Cash Price	$64.82
Rate for Payer: Cofinity Commercial	$56.72
Rate for Payer: Cofinity Commercial	$69.69
Rate for Payer: Healthscope Commercial	$72.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$68.88
Rate for Payer: PHP Commercial	$68.88
Rate for Payer: Priority Health Cigna Priority Health	$56.72
Rate for Payer: Priority Health SBD	$51.05

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$81.03

Service Code	NDC 0406-0125-62
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$32.41
Max. Negotiated Rate	$72.93
Rate for Payer: Aetna Commercial	$68.88
Rate for Payer: Aetna New Business (MI Preferred)	$52.67
Rate for Payer: BCBS Complete	$32.41
Rate for Payer: Cash Price	$64.82
Rate for Payer: Cofinity Commercial	$56.72
Rate for Payer: Cofinity Commercial	$69.69
Rate for Payer: Healthscope Commercial	$72.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$68.88
Rate for Payer: PHP Commercial	$68.88
Rate for Payer: Priority Health Cigna Priority Health	$56.72
Rate for Payer: Priority Health SBD	$51.05

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$686.00

Service Code	NDC 0904-6825-61
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$432.18
Max. Negotiated Rate	$617.40
Rate for Payer: Aetna Commercial	$583.10
Rate for Payer: Aetna New Business (MI Preferred)	$445.90
Rate for Payer: Cash Price	$548.80
Rate for Payer: Cofinity Commercial	$480.20
Rate for Payer: Cofinity Commercial	$589.96
Rate for Payer: Healthscope Commercial	$617.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$583.10
Rate for Payer: PHP Commercial	$583.10
Rate for Payer: Priority Health Cigna Priority Health	$480.20
Rate for Payer: Priority Health SBD	$432.18

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$8.11

Service Code	NDC 0406-0125-23
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$7.30
Rate for Payer: Aetna Commercial	$6.89
Rate for Payer: Aetna New Business (MI Preferred)	$5.27
Rate for Payer: BCBS Complete	$3.24
Rate for Payer: Cash Price	$6.49
Rate for Payer: Cofinity Commercial	$5.68
Rate for Payer: Cofinity Commercial	$6.97
Rate for Payer: Healthscope Commercial	$7.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6.89
Rate for Payer: PHP Commercial	$6.89
Rate for Payer: Priority Health Cigna Priority Health	$5.68
Rate for Payer: Priority Health SBD	$5.11

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$8.11

Service Code	NDC 0406-0125-23
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$7.30
Rate for Payer: Aetna Commercial	$6.89
Rate for Payer: Aetna New Business (MI Preferred)	$5.27
Rate for Payer: Cash Price	$6.49
Rate for Payer: Cofinity Commercial	$5.68
Rate for Payer: Cofinity Commercial	$6.97
Rate for Payer: Healthscope Commercial	$7.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6.89
Rate for Payer: PHP Commercial	$6.89
Rate for Payer: Priority Health Cigna Priority Health	$5.68
Rate for Payer: Priority Health SBD	$5.11

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$189.88

Service Code	NDC 50268-401-15
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$119.62
Max. Negotiated Rate	$170.89
Rate for Payer: Aetna Commercial	$161.40
Rate for Payer: Aetna New Business (MI Preferred)	$123.42
Rate for Payer: Cash Price	$151.90
Rate for Payer: Cofinity Commercial	$132.92
Rate for Payer: Cofinity Commercial	$163.30
Rate for Payer: Healthscope Commercial	$170.89
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$161.40
Rate for Payer: PHP Commercial	$161.40
Rate for Payer: Priority Health Cigna Priority Health	$132.92
Rate for Payer: Priority Health SBD	$119.62

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$3.80

Service Code	NDC 50268-401-11
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$3.42
Rate for Payer: Aetna Commercial	$3.23
Rate for Payer: Aetna New Business (MI Preferred)	$2.47
Rate for Payer: Cash Price	$3.04
Rate for Payer: Cofinity Commercial	$2.66
Rate for Payer: Cofinity Commercial	$3.27
Rate for Payer: Healthscope Commercial	$3.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.23
Rate for Payer: PHP Commercial	$3.23
Rate for Payer: Priority Health Cigna Priority Health	$2.66
Rate for Payer: Priority Health SBD	$2.39

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$8.63

Service Code	NDC 68084-895-11
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$5.44
Max. Negotiated Rate	$7.77
Rate for Payer: Aetna Commercial	$7.34
Rate for Payer: Aetna New Business (MI Preferred)	$5.61
Rate for Payer: Cash Price	$6.90
Rate for Payer: Cofinity Commercial	$6.04
Rate for Payer: Cofinity Commercial	$7.42
Rate for Payer: Healthscope Commercial	$7.77
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7.34
Rate for Payer: PHP Commercial	$7.34
Rate for Payer: Priority Health Cigna Priority Health	$6.04
Rate for Payer: Priority Health SBD	$5.44

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$862.75

Service Code	NDC 68084-895-01
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$543.53
Max. Negotiated Rate	$776.48
Rate for Payer: Aetna Commercial	$733.34
Rate for Payer: Aetna New Business (MI Preferred)	$560.79
Rate for Payer: Cash Price	$690.20
Rate for Payer: Cofinity Commercial	$603.92
Rate for Payer: Cofinity Commercial	$741.96
Rate for Payer: Healthscope Commercial	$776.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$733.34
Rate for Payer: PHP Commercial	$733.34
Rate for Payer: Priority Health Cigna Priority Health	$603.92
Rate for Payer: Priority Health SBD	$543.53

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$6.92

Service Code	NDC 0406-0123-23
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$4.36
Max. Negotiated Rate	$6.23
Rate for Payer: Aetna Commercial	$5.88
Rate for Payer: Aetna New Business (MI Preferred)	$4.50
Rate for Payer: Cash Price	$5.54
Rate for Payer: Cofinity Commercial	$4.84
Rate for Payer: Cofinity Commercial	$5.95
Rate for Payer: Healthscope Commercial	$6.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5.88
Rate for Payer: PHP Commercial	$5.88
Rate for Payer: Priority Health Cigna Priority Health	$4.84
Rate for Payer: Priority Health SBD	$4.36

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$245.00

Service Code	NDC 42858-201-01
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$154.35
Max. Negotiated Rate	$220.50
Rate for Payer: Aetna Commercial	$208.25
Rate for Payer: Aetna New Business (MI Preferred)	$159.25
Rate for Payer: Cash Price	$196.00
Rate for Payer: Cofinity Commercial	$171.50
Rate for Payer: Cofinity Commercial	$210.70
Rate for Payer: Healthscope Commercial	$220.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$208.25
Rate for Payer: PHP Commercial	$208.25
Rate for Payer: Priority Health Cigna Priority Health	$171.50
Rate for Payer: Priority Health SBD	$154.35

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$69.13

Service Code	NDC 0406-0123-62
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$43.55
Max. Negotiated Rate	$62.22
Rate for Payer: Aetna Commercial	$58.76
Rate for Payer: Aetna New Business (MI Preferred)	$44.93
Rate for Payer: Cash Price	$55.30
Rate for Payer: Cofinity Commercial	$48.39
Rate for Payer: Cofinity Commercial	$59.45
Rate for Payer: Healthscope Commercial	$62.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$58.76
Rate for Payer: PHP Commercial	$58.76
Rate for Payer: Priority Health Cigna Priority Health	$48.39
Rate for Payer: Priority Health SBD	$43.55

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$862.75

Service Code	NDC 68084-895-01
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$345.10
Max. Negotiated Rate	$776.48
Rate for Payer: Aetna Commercial	$733.34
Rate for Payer: Aetna New Business (MI Preferred)	$560.79
Rate for Payer: BCBS Complete	$345.10
Rate for Payer: Cash Price	$690.20
Rate for Payer: Cofinity Commercial	$603.92
Rate for Payer: Cofinity Commercial	$741.96
Rate for Payer: Healthscope Commercial	$776.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$733.34
Rate for Payer: PHP Commercial	$733.34
Rate for Payer: Priority Health Cigna Priority Health	$603.92
Rate for Payer: Priority Health SBD	$543.53

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION

Facility

$20.75

Service Code	NDC 0121-2316-40
Hospital Charge Code	37848
Hospital Revenue Code	637
Min. Negotiated Rate	$13.07
Max. Negotiated Rate	$18.68
Rate for Payer: Aetna Commercial	$17.64
Rate for Payer: Aetna New Business (MI Preferred)	$13.49
Rate for Payer: Cash Price	$16.60
Rate for Payer: Cofinity Commercial	$14.52
Rate for Payer: Cofinity Commercial	$17.84
Rate for Payer: Healthscope Commercial	$18.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.64
Rate for Payer: PHP Commercial	$17.64
Rate for Payer: Priority Health Cigna Priority Health	$14.52
Rate for Payer: Priority Health SBD	$13.07

Know your out-of-pocket cost for care.

All Charges