Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HYDRALAZINE 25 MG TABLET

Facility

$84.60

Service Code	NDC 23155083301
Hospital Charge Code	3700
Hospital Revenue Code	637
Min. Negotiated Rate	$33.25
Max. Negotiated Rate	$76.14
Rate for Payer: Aetna Commercial	$71.91
Rate for Payer: Aetna Medicare	$42.30
Rate for Payer: Aetna New Business (MI Preferred)	$54.99
Rate for Payer: BCBS Complete	$33.84
Rate for Payer: Cash Price	$67.68
Rate for Payer: Cofinity Advantage	$59.22
Rate for Payer: Cofinity Commercial	$72.76
Rate for Payer: Encore Health Key Benefits Commercial	$67.68
Rate for Payer: Healthscope Commercial	$76.14
Rate for Payer: MI Amish Medical Board Commercial	$67.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$71.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$63.45
Rate for Payer: PHP Commercial	$71.91
Rate for Payer: Priority Health SBD	$53.30
Rate for Payer: UHC All Payor (Choice/PPO)	$54.99
Rate for Payer: UHC Core	$44.08
Rate for Payer: UHC Exchange	$33.25

HYDRALAZINE 50 MG TABLET

Facility

$2.47

Service Code	NDC 60687083311
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$2.22
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare	$1.24
Rate for Payer: Aetna New Business (MI Preferred)	$1.61
Rate for Payer: BCBS Complete	$0.99
Rate for Payer: Cash Price	$1.98
Rate for Payer: Cofinity Advantage	$1.73
Rate for Payer: Cofinity Commercial	$2.12
Rate for Payer: Encore Health Key Benefits Commercial	$1.98
Rate for Payer: Healthscope Commercial	$2.22
Rate for Payer: MI Amish Medical Board Commercial	$1.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.85
Rate for Payer: PHP Commercial	$2.10
Rate for Payer: Priority Health SBD	$1.56
Rate for Payer: UHC All Payor (Choice/PPO)	$1.61
Rate for Payer: UHC Core	$1.29
Rate for Payer: UHC Exchange	$0.97

HYDRALAZINE 50 MG TABLET

Facility

$200.45

Service Code	NDC 62584073411
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$78.78
Max. Negotiated Rate	$180.41
Rate for Payer: Aetna Commercial	$170.38
Rate for Payer: Aetna Medicare	$100.22
Rate for Payer: Aetna New Business (MI Preferred)	$130.29
Rate for Payer: BCBS Complete	$80.18
Rate for Payer: Cash Price	$160.36
Rate for Payer: Cofinity Advantage	$140.31
Rate for Payer: Cofinity Commercial	$172.39
Rate for Payer: Encore Health Key Benefits Commercial	$160.36
Rate for Payer: Healthscope Commercial	$180.41
Rate for Payer: MI Amish Medical Board Commercial	$160.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$170.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$150.34
Rate for Payer: PHP Commercial	$170.38
Rate for Payer: Priority Health SBD	$126.28
Rate for Payer: UHC All Payor (Choice/PPO)	$130.29
Rate for Payer: UHC Core	$104.43
Rate for Payer: UHC Exchange	$78.78

HYDRALAZINE 50 MG TABLET

Facility

$244.15

Service Code	NDC 51079007620
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 Advantage	$170.91
Rate for Payer: Cofinity Commercial	$209.97
Rate for Payer: Encore Health Key Benefits Commercial	$195.32
Rate for Payer: Healthscope Commercial	$219.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$207.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$183.11
Rate for Payer: PHP Commercial	$207.53
Rate for Payer: Priority Health SBD	$153.81

HYDRALAZINE 50 MG TABLET

Facility

$2.47

Service Code	NDC 60687083311
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$2.22
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna New Business (MI Preferred)	$1.61
Rate for Payer: Cash Price	$1.98
Rate for Payer: Cofinity Advantage	$1.73
Rate for Payer: Cofinity Commercial	$2.12
Rate for Payer: Encore Health Key Benefits Commercial	$1.98
Rate for Payer: Healthscope Commercial	$2.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.85
Rate for Payer: PHP Commercial	$2.10
Rate for Payer: Priority Health SBD	$1.56

HYDRALAZINE 50 MG TABLET

Facility

$200.45

Service Code	NDC 62584073401
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$78.78
Max. Negotiated Rate	$180.41
Rate for Payer: Aetna Commercial	$170.38
Rate for Payer: Aetna Medicare	$100.22
Rate for Payer: Aetna New Business (MI Preferred)	$130.29
Rate for Payer: BCBS Complete	$80.18
Rate for Payer: Cash Price	$160.36
Rate for Payer: Cofinity Advantage	$140.31
Rate for Payer: Cofinity Commercial	$172.39
Rate for Payer: Encore Health Key Benefits Commercial	$160.36
Rate for Payer: Healthscope Commercial	$180.41
Rate for Payer: MI Amish Medical Board Commercial	$160.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$170.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$150.34
Rate for Payer: PHP Commercial	$170.38
Rate for Payer: Priority Health SBD	$126.28
Rate for Payer: UHC All Payor (Choice/PPO)	$130.29
Rate for Payer: UHC Core	$104.43
Rate for Payer: UHC Exchange	$78.78

HYDRALAZINE 50 MG TABLET

Facility

$247.00

Service Code	NDC 60687083301
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$97.07
Max. Negotiated Rate	$222.30
Rate for Payer: Aetna Commercial	$209.95
Rate for Payer: Aetna Medicare	$123.50
Rate for Payer: Aetna New Business (MI Preferred)	$160.55
Rate for Payer: BCBS Complete	$98.80
Rate for Payer: Cash Price	$197.60
Rate for Payer: Cofinity Advantage	$172.90
Rate for Payer: Cofinity Commercial	$212.42
Rate for Payer: Encore Health Key Benefits Commercial	$197.60
Rate for Payer: Healthscope Commercial	$222.30
Rate for Payer: MI Amish Medical Board Commercial	$197.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$209.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$185.25
Rate for Payer: PHP Commercial	$209.95
Rate for Payer: Priority Health SBD	$155.61
Rate for Payer: UHC All Payor (Choice/PPO)	$160.55
Rate for Payer: UHC Core	$128.69
Rate for Payer: UHC Exchange	$97.07

HYDRALAZINE 50 MG TABLET

Facility

$244.15

Service Code	NDC 51079007620
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$95.95
Max. Negotiated Rate	$219.74
Rate for Payer: Aetna Commercial	$207.53
Rate for Payer: Aetna Medicare	$122.08
Rate for Payer: Aetna New Business (MI Preferred)	$158.70
Rate for Payer: BCBS Complete	$97.66
Rate for Payer: Cash Price	$195.32
Rate for Payer: Cofinity Advantage	$170.91
Rate for Payer: Cofinity Commercial	$209.97
Rate for Payer: Encore Health Key Benefits Commercial	$195.32
Rate for Payer: Healthscope Commercial	$219.74
Rate for Payer: MI Amish Medical Board Commercial	$195.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$207.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$183.11
Rate for Payer: PHP Commercial	$207.53
Rate for Payer: Priority Health SBD	$153.81
Rate for Payer: UHC All Payor (Choice/PPO)	$158.70
Rate for Payer: UHC Core	$127.20
Rate for Payer: UHC Exchange	$95.95

HYDRALAZINE 50 MG TABLET

Facility

$2.45

Service Code	NDC 51079007601
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$2.21
Rate for Payer: Aetna Commercial	$2.08
Rate for Payer: Aetna Medicare	$1.23
Rate for Payer: Aetna New Business (MI Preferred)	$1.59
Rate for Payer: BCBS Complete	$0.98
Rate for Payer: Cash Price	$1.96
Rate for Payer: Cofinity Advantage	$1.72
Rate for Payer: Cofinity Commercial	$2.11
Rate for Payer: Encore Health Key Benefits Commercial	$1.96
Rate for Payer: Healthscope Commercial	$2.21
Rate for Payer: MI Amish Medical Board Commercial	$1.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.84
Rate for Payer: PHP Commercial	$2.08
Rate for Payer: Priority Health SBD	$1.54
Rate for Payer: UHC All Payor (Choice/PPO)	$1.59
Rate for Payer: UHC Core	$1.28
Rate for Payer: UHC Exchange	$0.96

HYDRALAZINE 50 MG TABLET

Facility

$247.00

Service Code	NDC 60687083301
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$155.61
Max. Negotiated Rate	$222.30
Rate for Payer: Aetna Commercial	$209.95
Rate for Payer: Aetna New Business (MI Preferred)	$160.55
Rate for Payer: Cash Price	$197.60
Rate for Payer: Cofinity Advantage	$172.90
Rate for Payer: Cofinity Commercial	$212.42
Rate for Payer: Encore Health Key Benefits Commercial	$197.60
Rate for Payer: Healthscope Commercial	$222.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$209.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$185.25
Rate for Payer: PHP Commercial	$209.95
Rate for Payer: Priority Health SBD	$155.61

HYDRALAZINE 50 MG TABLET

Facility

$200.45

Service Code	NDC 62584073411
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$126.28
Max. Negotiated Rate	$180.41
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 Advantage	$140.31
Rate for Payer: Cofinity Commercial	$172.39
Rate for Payer: Encore Health Key Benefits Commercial	$160.36
Rate for Payer: Healthscope Commercial	$180.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$170.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$150.34
Rate for Payer: PHP Commercial	$170.38
Rate for Payer: Priority Health SBD	$126.28

HYDRALAZINE 50 MG TABLET

Facility

$2.45

Service Code	NDC 51079007601
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$2.21
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 Advantage	$1.72
Rate for Payer: Cofinity Commercial	$2.11
Rate for Payer: Encore Health Key Benefits Commercial	$1.96
Rate for Payer: Healthscope Commercial	$2.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.84
Rate for Payer: PHP Commercial	$2.08
Rate for Payer: Priority Health SBD	$1.54

HYDRALAZINE 50 MG TABLET

Facility

$200.45

Service Code	NDC 62584073401
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$126.28
Max. Negotiated Rate	$180.41
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 Advantage	$140.31
Rate for Payer: Cofinity Commercial	$172.39
Rate for Payer: Encore Health Key Benefits Commercial	$160.36
Rate for Payer: Healthscope Commercial	$180.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$170.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$150.34
Rate for Payer: PHP Commercial	$170.38
Rate for Payer: Priority Health SBD	$126.28

HYDRALAZINE 50 MG TABLET

Facility

$218.55

Service Code	NDC 00904644261
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$85.89
Max. Negotiated Rate	$196.69
Rate for Payer: Aetna Commercial	$185.77
Rate for Payer: Aetna Medicare	$109.28
Rate for Payer: Aetna New Business (MI Preferred)	$142.06
Rate for Payer: BCBS Complete	$87.42
Rate for Payer: Cash Price	$174.84
Rate for Payer: Cofinity Advantage	$152.99
Rate for Payer: Cofinity Commercial	$187.95
Rate for Payer: Encore Health Key Benefits Commercial	$174.84
Rate for Payer: Healthscope Commercial	$196.69
Rate for Payer: MI Amish Medical Board Commercial	$174.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$185.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$163.91
Rate for Payer: PHP Commercial	$185.77
Rate for Payer: Priority Health SBD	$137.69
Rate for Payer: UHC All Payor (Choice/PPO)	$142.06
Rate for Payer: UHC Core	$113.86
Rate for Payer: UHC Exchange	$85.89

HYDRALAZINE 50 MG TABLET

Facility

$218.55

Service Code	NDC 00904644261
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$137.69
Max. Negotiated Rate	$196.69
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 Advantage	$152.99
Rate for Payer: Cofinity Commercial	$187.95
Rate for Payer: Encore Health Key Benefits Commercial	$174.84
Rate for Payer: Healthscope Commercial	$196.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$185.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$163.91
Rate for Payer: PHP Commercial	$185.77
Rate for Payer: Priority Health SBD	$137.69

HYDRALAZINE 50 MG TABLET

Facility

$98.70

Service Code	NDC 23155000301
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$38.79
Max. Negotiated Rate	$88.83
Rate for Payer: Aetna Commercial	$83.89
Rate for Payer: Aetna Medicare	$49.35
Rate for Payer: Aetna New Business (MI Preferred)	$64.16
Rate for Payer: BCBS Complete	$39.48
Rate for Payer: Cash Price	$78.96
Rate for Payer: Cofinity Advantage	$69.09
Rate for Payer: Cofinity Commercial	$84.88
Rate for Payer: Encore Health Key Benefits Commercial	$78.96
Rate for Payer: Healthscope Commercial	$88.83
Rate for Payer: MI Amish Medical Board Commercial	$78.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$74.03
Rate for Payer: PHP Commercial	$83.89
Rate for Payer: Priority Health SBD	$62.18
Rate for Payer: UHC All Payor (Choice/PPO)	$64.16
Rate for Payer: UHC Core	$51.42
Rate for Payer: UHC Exchange	$38.79

HYDRALAZINE 50 MG TABLET

Facility

$98.70

Service Code	NDC 23155000301
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$62.18
Max. Negotiated Rate	$88.83
Rate for Payer: Aetna Commercial	$83.89
Rate for Payer: Aetna New Business (MI Preferred)	$64.16
Rate for Payer: Cash Price	$78.96
Rate for Payer: Cofinity Advantage	$69.09
Rate for Payer: Cofinity Commercial	$84.88
Rate for Payer: Encore Health Key Benefits Commercial	$78.96
Rate for Payer: Healthscope Commercial	$88.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$74.03
Rate for Payer: PHP Commercial	$83.89
Rate for Payer: Priority Health SBD	$62.18

HYDROCHLOROTHIAZIDE 12.5 MG TABLET

Facility

$122.20

Service Code	NDC 23155076401
Hospital Charge Code	76988
Hospital Revenue Code	637
Min. Negotiated Rate	$48.02
Max. Negotiated Rate	$109.98
Rate for Payer: Aetna Commercial	$103.87
Rate for Payer: Aetna Medicare	$61.10
Rate for Payer: Aetna New Business (MI Preferred)	$79.43
Rate for Payer: BCBS Complete	$48.88
Rate for Payer: Cash Price	$97.76
Rate for Payer: Cofinity Advantage	$85.54
Rate for Payer: Cofinity Commercial	$105.09
Rate for Payer: Encore Health Key Benefits Commercial	$97.76
Rate for Payer: Healthscope Commercial	$109.98
Rate for Payer: MI Amish Medical Board Commercial	$97.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$103.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$91.65
Rate for Payer: PHP Commercial	$103.87
Rate for Payer: Priority Health SBD	$76.99
Rate for Payer: UHC All Payor (Choice/PPO)	$79.43
Rate for Payer: UHC Core	$63.67
Rate for Payer: UHC Exchange	$48.02

HYDROCHLOROTHIAZIDE 12.5 MG TABLET

Facility

$252.70

Service Code	NDC 00228282011
Hospital Charge Code	76988
Hospital Revenue Code	637
Min. Negotiated Rate	$159.20
Max. Negotiated Rate	$227.43
Rate for Payer: Aetna Commercial	$214.79
Rate for Payer: Aetna New Business (MI Preferred)	$164.25
Rate for Payer: Cash Price	$202.16
Rate for Payer: Cofinity Advantage	$176.89
Rate for Payer: Cofinity Commercial	$217.32
Rate for Payer: Encore Health Key Benefits Commercial	$202.16
Rate for Payer: Healthscope Commercial	$227.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$214.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$189.53
Rate for Payer: PHP Commercial	$214.79
Rate for Payer: Priority Health SBD	$159.20

HYDROCHLOROTHIAZIDE 12.5 MG TABLET

Facility

$252.70

Service Code	NDC 00228282011
Hospital Charge Code	76988
Hospital Revenue Code	637
Min. Negotiated Rate	$99.31
Max. Negotiated Rate	$227.43
Rate for Payer: Aetna Commercial	$214.79
Rate for Payer: Aetna Medicare	$126.35
Rate for Payer: Aetna New Business (MI Preferred)	$164.25
Rate for Payer: BCBS Complete	$101.08
Rate for Payer: Cash Price	$202.16
Rate for Payer: Cofinity Advantage	$176.89
Rate for Payer: Cofinity Commercial	$217.32
Rate for Payer: Encore Health Key Benefits Commercial	$202.16
Rate for Payer: Healthscope Commercial	$227.43
Rate for Payer: MI Amish Medical Board Commercial	$202.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$214.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$189.53
Rate for Payer: PHP Commercial	$214.79
Rate for Payer: Priority Health SBD	$159.20
Rate for Payer: UHC All Payor (Choice/PPO)	$164.25
Rate for Payer: UHC Core	$131.66
Rate for Payer: UHC Exchange	$99.31

HYDROCHLOROTHIAZIDE 12.5 MG TABLET

Facility

$122.20

Service Code	NDC 23155076401
Hospital Charge Code	76988
Hospital Revenue Code	637
Min. Negotiated Rate	$76.99
Max. Negotiated Rate	$109.98
Rate for Payer: Aetna Commercial	$103.87
Rate for Payer: Aetna New Business (MI Preferred)	$79.43
Rate for Payer: Cash Price	$97.76
Rate for Payer: Cofinity Advantage	$85.54
Rate for Payer: Cofinity Commercial	$105.09
Rate for Payer: Encore Health Key Benefits Commercial	$97.76
Rate for Payer: Healthscope Commercial	$109.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$103.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$91.65
Rate for Payer: PHP Commercial	$103.87
Rate for Payer: Priority Health SBD	$76.99

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$91.65

Service Code	NDC 00172208360
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 Advantage	$64.16
Rate for Payer: Cofinity Commercial	$78.82
Rate for Payer: Encore Health Key Benefits Commercial	$73.32
Rate for Payer: Healthscope Commercial	$82.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$77.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$68.74
Rate for Payer: PHP Commercial	$77.90
Rate for Payer: Priority Health SBD	$57.74

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$49.35

Service Code	NDC 69584036110
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$19.39
Max. Negotiated Rate	$44.41
Rate for Payer: Aetna Commercial	$41.95
Rate for Payer: Aetna Medicare	$24.68
Rate for Payer: Aetna New Business (MI Preferred)	$32.08
Rate for Payer: BCBS Complete	$19.74
Rate for Payer: Cash Price	$39.48
Rate for Payer: Cofinity Advantage	$34.55
Rate for Payer: Cofinity Commercial	$42.44
Rate for Payer: Encore Health Key Benefits Commercial	$39.48
Rate for Payer: Healthscope Commercial	$44.41
Rate for Payer: MI Amish Medical Board Commercial	$39.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$37.01
Rate for Payer: PHP Commercial	$41.95
Rate for Payer: Priority Health SBD	$31.09
Rate for Payer: UHC All Payor (Choice/PPO)	$32.08
Rate for Payer: UHC Core	$25.71
Rate for Payer: UHC Exchange	$19.39

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$198.55

Service Code	NDC 60687059301
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$125.09
Max. Negotiated Rate	$178.69
Rate for Payer: Aetna Commercial	$168.77
Rate for Payer: Aetna New Business (MI Preferred)	$129.06
Rate for Payer: Cash Price	$158.84
Rate for Payer: Cofinity Advantage	$138.99
Rate for Payer: Cofinity Commercial	$170.75
Rate for Payer: Encore Health Key Benefits Commercial	$158.84
Rate for Payer: Healthscope Commercial	$178.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$168.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$148.91
Rate for Payer: PHP Commercial	$168.77
Rate for Payer: Priority Health SBD	$125.09

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$91.65

Service Code	NDC 00172208360
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$36.02
Max. Negotiated Rate	$82.48
Rate for Payer: Aetna Commercial	$77.90
Rate for Payer: Aetna Medicare	$45.83
Rate for Payer: Aetna New Business (MI Preferred)	$59.57
Rate for Payer: BCBS Complete	$36.66
Rate for Payer: Cash Price	$73.32
Rate for Payer: Cofinity Advantage	$64.16
Rate for Payer: Cofinity Commercial	$78.82
Rate for Payer: Encore Health Key Benefits Commercial	$73.32
Rate for Payer: Healthscope Commercial	$82.48
Rate for Payer: MI Amish Medical Board Commercial	$73.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$77.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$68.74
Rate for Payer: PHP Commercial	$77.90
Rate for Payer: Priority Health SBD	$57.74
Rate for Payer: UHC All Payor (Choice/PPO)	$59.57
Rate for Payer: UHC Core	$47.75
Rate for Payer: UHC Exchange	$36.02

Know your out-of-pocket cost for care.

All Charges