Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$23.50

Service Code	NDC 16729018301
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$14.80
Max. Negotiated Rate	$21.15
Rate for Payer: Aetna Commercial	$19.98
Rate for Payer: Aetna New Business (MI Preferred)	$15.28
Rate for Payer: Cash Price	$18.80
Rate for Payer: Cofinity Advantage	$16.45
Rate for Payer: Cofinity Commercial	$20.21
Rate for Payer: Encore Health Key Benefits Commercial	$18.80
Rate for Payer: Healthscope Commercial	$21.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$17.62
Rate for Payer: PHP Commercial	$19.98
Rate for Payer: Priority Health SBD	$14.80

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$198.55

Service Code	NDC 60687059301
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$78.03
Max. Negotiated Rate	$178.69
Rate for Payer: Aetna Commercial	$168.77
Rate for Payer: Aetna Medicare	$99.28
Rate for Payer: Aetna New Business (MI Preferred)	$129.06
Rate for Payer: BCBS Complete	$79.42
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: MI Amish Medical Board Commercial	$158.84
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
Rate for Payer: UHC All Payor (Choice/PPO)	$129.06
Rate for Payer: UHC Core	$103.44
Rate for Payer: UHC Exchange	$78.03

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$49.35

Service Code	NDC 69584036110
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$31.09
Max. Negotiated Rate	$44.41
Rate for Payer: Aetna Commercial	$41.95
Rate for Payer: Aetna New Business (MI Preferred)	$32.08
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: 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

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$23.50

Service Code	NDC 16729018301
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$21.15
Rate for Payer: Aetna Commercial	$19.98
Rate for Payer: Aetna Medicare	$11.75
Rate for Payer: Aetna New Business (MI Preferred)	$15.28
Rate for Payer: BCBS Complete	$9.40
Rate for Payer: Cash Price	$18.80
Rate for Payer: Cofinity Advantage	$16.45
Rate for Payer: Cofinity Commercial	$20.21
Rate for Payer: Encore Health Key Benefits Commercial	$18.80
Rate for Payer: Healthscope Commercial	$21.15
Rate for Payer: MI Amish Medical Board Commercial	$18.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$17.62
Rate for Payer: PHP Commercial	$19.98
Rate for Payer: Priority Health SBD	$14.80
Rate for Payer: UHC All Payor (Choice/PPO)	$15.28
Rate for Payer: UHC Core	$12.24
Rate for Payer: UHC Exchange	$9.24

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$54.05

Service Code	NDC 23155000801
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$21.24
Max. Negotiated Rate	$48.65
Rate for Payer: Aetna Commercial	$45.94
Rate for Payer: Aetna Medicare	$27.02
Rate for Payer: Aetna New Business (MI Preferred)	$35.13
Rate for Payer: BCBS Complete	$21.62
Rate for Payer: Cash Price	$43.24
Rate for Payer: Cofinity Advantage	$37.84
Rate for Payer: Cofinity Commercial	$46.48
Rate for Payer: Encore Health Key Benefits Commercial	$43.24
Rate for Payer: Healthscope Commercial	$48.65
Rate for Payer: MI Amish Medical Board Commercial	$43.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$45.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$40.54
Rate for Payer: PHP Commercial	$45.94
Rate for Payer: Priority Health SBD	$34.05
Rate for Payer: UHC All Payor (Choice/PPO)	$35.13
Rate for Payer: UHC Core	$28.16
Rate for Payer: UHC Exchange	$21.24

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$1.99

Service Code	NDC 60687059311
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$1.79
Rate for Payer: Aetna Commercial	$1.69
Rate for Payer: Aetna Medicare	$1.00
Rate for Payer: Aetna New Business (MI Preferred)	$1.29
Rate for Payer: BCBS Complete	$0.80
Rate for Payer: Cash Price	$1.59
Rate for Payer: Cofinity Advantage	$1.39
Rate for Payer: Cofinity Commercial	$1.71
Rate for Payer: Encore Health Key Benefits Commercial	$1.59
Rate for Payer: Healthscope Commercial	$1.79
Rate for Payer: MI Amish Medical Board Commercial	$1.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.49
Rate for Payer: PHP Commercial	$1.69
Rate for Payer: Priority Health SBD	$1.25
Rate for Payer: UHC All Payor (Choice/PPO)	$1.29
Rate for Payer: UHC Core	$1.04
Rate for Payer: UHC Exchange	$0.78

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$54.05

Service Code	NDC 23155000801
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$34.05
Max. Negotiated Rate	$48.65
Rate for Payer: Aetna Commercial	$45.94
Rate for Payer: Aetna New Business (MI Preferred)	$35.13
Rate for Payer: Cash Price	$43.24
Rate for Payer: Cofinity Advantage	$37.84
Rate for Payer: Cofinity Commercial	$46.48
Rate for Payer: Encore Health Key Benefits Commercial	$43.24
Rate for Payer: Healthscope Commercial	$48.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$45.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$40.54
Rate for Payer: PHP Commercial	$45.94
Rate for Payer: Priority Health SBD	$34.05

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$1.99

Service Code	NDC 60687059311
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.79
Rate for Payer: Aetna Commercial	$1.69
Rate for Payer: Aetna New Business (MI Preferred)	$1.29
Rate for Payer: Cash Price	$1.59
Rate for Payer: Cofinity Advantage	$1.39
Rate for Payer: Cofinity Commercial	$1.71
Rate for Payer: Encore Health Key Benefits Commercial	$1.59
Rate for Payer: Healthscope Commercial	$1.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.49
Rate for Payer: PHP Commercial	$1.69
Rate for Payer: Priority Health SBD	$1.25

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$4.61

Service Code	NDC 00406012523
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$4.15
Rate for Payer: Aetna Commercial	$3.92
Rate for Payer: Aetna Medicare	$2.31
Rate for Payer: Aetna New Business (MI Preferred)	$3.00
Rate for Payer: BCBS Complete	$1.84
Rate for Payer: Cash Price	$3.69
Rate for Payer: Cofinity Advantage	$3.23
Rate for Payer: Cofinity Commercial	$3.96
Rate for Payer: Encore Health Key Benefits Commercial	$3.69
Rate for Payer: Healthscope Commercial	$4.15
Rate for Payer: MI Amish Medical Board Commercial	$3.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.46
Rate for Payer: PHP Commercial	$3.92
Rate for Payer: Priority Health SBD	$2.90
Rate for Payer: UHC All Payor (Choice/PPO)	$3.00
Rate for Payer: UHC Core	$2.40
Rate for Payer: UHC Exchange	$1.81

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$10.49

Service Code	NDC 60687041811
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$9.44
Rate for Payer: Aetna Commercial	$8.92
Rate for Payer: Aetna Medicare	$5.25
Rate for Payer: Aetna New Business (MI Preferred)	$6.82
Rate for Payer: BCBS Complete	$4.20
Rate for Payer: Cash Price	$8.39
Rate for Payer: Cofinity Advantage	$7.34
Rate for Payer: Cofinity Commercial	$9.02
Rate for Payer: Encore Health Key Benefits Commercial	$8.39
Rate for Payer: Healthscope Commercial	$9.44
Rate for Payer: MI Amish Medical Board Commercial	$8.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.87
Rate for Payer: PHP Commercial	$8.92
Rate for Payer: Priority Health SBD	$6.61
Rate for Payer: UHC All Payor (Choice/PPO)	$6.82
Rate for Payer: UHC Core	$5.47
Rate for Payer: UHC Exchange	$4.12

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$46.06

Service Code	NDC 00406012562
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$18.10
Max. Negotiated Rate	$41.45
Rate for Payer: Aetna Commercial	$39.15
Rate for Payer: Aetna Medicare	$23.03
Rate for Payer: Aetna New Business (MI Preferred)	$29.94
Rate for Payer: BCBS Complete	$18.42
Rate for Payer: Cash Price	$36.85
Rate for Payer: Cofinity Advantage	$32.24
Rate for Payer: Cofinity Commercial	$39.61
Rate for Payer: Encore Health Key Benefits Commercial	$36.85
Rate for Payer: Healthscope Commercial	$41.45
Rate for Payer: MI Amish Medical Board Commercial	$36.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$34.55
Rate for Payer: PHP Commercial	$39.15
Rate for Payer: Priority Health SBD	$29.02
Rate for Payer: UHC All Payor (Choice/PPO)	$29.94
Rate for Payer: UHC Core	$24.00
Rate for Payer: UHC Exchange	$18.10

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$4.61

Service Code	NDC 00406012523
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$4.15
Rate for Payer: Aetna Commercial	$3.92
Rate for Payer: Aetna New Business (MI Preferred)	$3.00
Rate for Payer: Cash Price	$3.69
Rate for Payer: Cofinity Advantage	$3.23
Rate for Payer: Cofinity Commercial	$3.96
Rate for Payer: Encore Health Key Benefits Commercial	$3.69
Rate for Payer: Healthscope Commercial	$4.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.46
Rate for Payer: PHP Commercial	$3.92
Rate for Payer: Priority Health SBD	$2.90

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$1,048.25

Service Code	NDC 60687041801
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$411.96
Max. Negotiated Rate	$943.42
Rate for Payer: Aetna Commercial	$891.01
Rate for Payer: Aetna Medicare	$524.12
Rate for Payer: Aetna New Business (MI Preferred)	$681.36
Rate for Payer: BCBS Complete	$419.30
Rate for Payer: Cash Price	$838.60
Rate for Payer: Cofinity Advantage	$733.77
Rate for Payer: Cofinity Commercial	$901.50
Rate for Payer: Encore Health Key Benefits Commercial	$838.60
Rate for Payer: Healthscope Commercial	$943.42
Rate for Payer: MI Amish Medical Board Commercial	$838.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$891.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$786.19
Rate for Payer: PHP Commercial	$891.01
Rate for Payer: Priority Health SBD	$660.40
Rate for Payer: UHC All Payor (Choice/PPO)	$681.36
Rate for Payer: UHC Core	$546.14
Rate for Payer: UHC Exchange	$411.96

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$10.49

Service Code	NDC 60687041811
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$6.61
Max. Negotiated Rate	$9.44
Rate for Payer: Aetna Commercial	$8.92
Rate for Payer: Aetna New Business (MI Preferred)	$6.82
Rate for Payer: Cash Price	$8.39
Rate for Payer: Cofinity Advantage	$7.34
Rate for Payer: Cofinity Commercial	$9.02
Rate for Payer: Encore Health Key Benefits Commercial	$8.39
Rate for Payer: Healthscope Commercial	$9.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.87
Rate for Payer: PHP Commercial	$8.92
Rate for Payer: Priority Health SBD	$6.61

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$4.61

Service Code	NDC 406012523
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$4.15
Rate for Payer: Aetna Commercial	$3.92
Rate for Payer: Aetna Medicare	$2.31
Rate for Payer: Aetna New Business (MI Preferred)	$3.00
Rate for Payer: BCBS Complete	$1.84
Rate for Payer: Cash Price	$3.69
Rate for Payer: Cofinity Advantage	$3.23
Rate for Payer: Cofinity Commercial	$3.96
Rate for Payer: Encore Health Key Benefits Commercial	$3.69
Rate for Payer: Healthscope Commercial	$4.15
Rate for Payer: MI Amish Medical Board Commercial	$3.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.46
Rate for Payer: PHP Commercial	$3.92
Rate for Payer: Priority Health SBD	$2.90
Rate for Payer: UHC All Payor (Choice/PPO)	$3.00
Rate for Payer: UHC Core	$2.40
Rate for Payer: UHC Exchange	$1.81

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$1,048.25

Service Code	NDC 60687041801
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$660.40
Max. Negotiated Rate	$943.42
Rate for Payer: Aetna Commercial	$891.01
Rate for Payer: Aetna New Business (MI Preferred)	$681.36
Rate for Payer: Cash Price	$838.60
Rate for Payer: Cofinity Advantage	$733.77
Rate for Payer: Cofinity Commercial	$901.50
Rate for Payer: Encore Health Key Benefits Commercial	$838.60
Rate for Payer: Healthscope Commercial	$943.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$891.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$786.19
Rate for Payer: PHP Commercial	$891.01
Rate for Payer: Priority Health SBD	$660.40

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$686.00

Service Code	NDC 00904682561
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 Advantage	$480.20
Rate for Payer: Cofinity Commercial	$589.96
Rate for Payer: Encore Health Key Benefits Commercial	$548.80
Rate for Payer: Healthscope Commercial	$617.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$583.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$514.50
Rate for Payer: PHP Commercial	$583.10
Rate for Payer: Priority Health SBD	$432.18

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$686.00

Service Code	NDC 00904682561
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$269.60
Max. Negotiated Rate	$617.40
Rate for Payer: Aetna Commercial	$583.10
Rate for Payer: Aetna Medicare	$343.00
Rate for Payer: Aetna New Business (MI Preferred)	$445.90
Rate for Payer: BCBS Complete	$274.40
Rate for Payer: Cash Price	$548.80
Rate for Payer: Cofinity Advantage	$480.20
Rate for Payer: Cofinity Commercial	$589.96
Rate for Payer: Encore Health Key Benefits Commercial	$548.80
Rate for Payer: Healthscope Commercial	$617.40
Rate for Payer: MI Amish Medical Board Commercial	$548.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$583.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$514.50
Rate for Payer: PHP Commercial	$583.10
Rate for Payer: Priority Health SBD	$432.18
Rate for Payer: UHC All Payor (Choice/PPO)	$445.90
Rate for Payer: UHC Core	$357.41
Rate for Payer: UHC Exchange	$269.60

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$46.06

Service Code	NDC 406012562
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$18.10
Max. Negotiated Rate	$41.45
Rate for Payer: Aetna Commercial	$39.15
Rate for Payer: Aetna Medicare	$23.03
Rate for Payer: Aetna New Business (MI Preferred)	$29.94
Rate for Payer: BCBS Complete	$18.42
Rate for Payer: Cash Price	$36.85
Rate for Payer: Cofinity Advantage	$32.24
Rate for Payer: Cofinity Commercial	$39.61
Rate for Payer: Encore Health Key Benefits Commercial	$36.85
Rate for Payer: Healthscope Commercial	$41.45
Rate for Payer: MI Amish Medical Board Commercial	$36.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$34.55
Rate for Payer: PHP Commercial	$39.15
Rate for Payer: Priority Health SBD	$29.02
Rate for Payer: UHC All Payor (Choice/PPO)	$29.94
Rate for Payer: UHC Core	$24.00
Rate for Payer: UHC Exchange	$18.10

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$46.06

Service Code	NDC 00406012562
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$29.02
Max. Negotiated Rate	$41.45
Rate for Payer: Aetna Commercial	$39.15
Rate for Payer: Aetna New Business (MI Preferred)	$29.94
Rate for Payer: Cash Price	$36.85
Rate for Payer: Cofinity Advantage	$32.24
Rate for Payer: Cofinity Commercial	$39.61
Rate for Payer: Encore Health Key Benefits Commercial	$36.85
Rate for Payer: Healthscope Commercial	$41.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$34.55
Rate for Payer: PHP Commercial	$39.15
Rate for Payer: Priority Health SBD	$29.02

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$178.50

Service Code	NDC 27808003501
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$112.45
Max. Negotiated Rate	$160.65
Rate for Payer: Aetna Commercial	$151.72
Rate for Payer: Aetna New Business (MI Preferred)	$116.03
Rate for Payer: Cash Price	$142.80
Rate for Payer: Cofinity Advantage	$124.95
Rate for Payer: Cofinity Commercial	$153.51
Rate for Payer: Encore Health Key Benefits Commercial	$142.80
Rate for Payer: Healthscope Commercial	$160.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$151.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$133.88
Rate for Payer: PHP Commercial	$151.72
Rate for Payer: Priority Health SBD	$112.45

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$245.00

Service Code	NDC 42858020101
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 Advantage	$171.50
Rate for Payer: Cofinity Commercial	$210.70
Rate for Payer: Encore Health Key Benefits Commercial	$196.00
Rate for Payer: Healthscope Commercial	$220.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$208.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$183.75
Rate for Payer: PHP Commercial	$208.25
Rate for Payer: Priority Health SBD	$154.35

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$8.63

Service Code	NDC 68084089511
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 Advantage	$6.04
Rate for Payer: Cofinity Commercial	$7.42
Rate for Payer: Encore Health Key Benefits Commercial	$6.90
Rate for Payer: Healthscope Commercial	$7.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.47
Rate for Payer: PHP Commercial	$7.34
Rate for Payer: Priority Health SBD	$5.44

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$178.50

Service Code	NDC 27808003501
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$70.15
Max. Negotiated Rate	$160.65
Rate for Payer: Aetna Commercial	$151.72
Rate for Payer: Aetna Medicare	$89.25
Rate for Payer: Aetna New Business (MI Preferred)	$116.03
Rate for Payer: BCBS Complete	$71.40
Rate for Payer: Cash Price	$142.80
Rate for Payer: Cofinity Advantage	$124.95
Rate for Payer: Cofinity Commercial	$153.51
Rate for Payer: Encore Health Key Benefits Commercial	$142.80
Rate for Payer: Healthscope Commercial	$160.65
Rate for Payer: MI Amish Medical Board Commercial	$142.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$151.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$133.88
Rate for Payer: PHP Commercial	$151.72
Rate for Payer: Priority Health SBD	$112.45
Rate for Payer: UHC All Payor (Choice/PPO)	$116.03
Rate for Payer: UHC Core	$93.00
Rate for Payer: UHC Exchange	$70.15

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$8.63

Service Code	NDC 00406012323
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$7.77
Rate for Payer: Aetna Commercial	$7.34
Rate for Payer: Aetna Medicare	$4.32
Rate for Payer: Aetna New Business (MI Preferred)	$5.61
Rate for Payer: BCBS Complete	$3.45
Rate for Payer: Cash Price	$6.90
Rate for Payer: Cofinity Advantage	$6.04
Rate for Payer: Cofinity Commercial	$7.42
Rate for Payer: Encore Health Key Benefits Commercial	$6.90
Rate for Payer: Healthscope Commercial	$7.77
Rate for Payer: MI Amish Medical Board Commercial	$6.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.47
Rate for Payer: PHP Commercial	$7.34
Rate for Payer: Priority Health SBD	$5.44
Rate for Payer: UHC All Payor (Choice/PPO)	$5.61
Rate for Payer: UHC Core	$4.50
Rate for Payer: UHC Exchange	$3.39

Know your out-of-pocket cost for care.

All Charges