Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$276.50

Service Code	NDC 50268040015
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$174.19
Max. Negotiated Rate	$248.85
Rate for Payer: Aetna Commercial	$235.03
Rate for Payer: Aetna New Business (MI Preferred)	$179.72
Rate for Payer: Cash Price	$221.20
Rate for Payer: Cofinity Advantage	$193.55
Rate for Payer: Cofinity Commercial	$237.79
Rate for Payer: Encore Health Key Benefits Commercial	$221.20
Rate for Payer: Healthscope Commercial	$248.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$235.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$207.38
Rate for Payer: PHP Commercial	$235.03
Rate for Payer: Priority Health SBD	$174.19

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$175.00

Service Code	NDC 13107002001
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$68.78
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna Commercial	$148.75
Rate for Payer: Aetna Medicare	$87.50
Rate for Payer: Aetna New Business (MI Preferred)	$113.75
Rate for Payer: BCBS Complete	$70.00
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cofinity Advantage	$122.50
Rate for Payer: Cofinity Commercial	$150.50
Rate for Payer: Encore Health Key Benefits Commercial	$140.00
Rate for Payer: Healthscope Commercial	$157.50
Rate for Payer: MI Amish Medical Board Commercial	$140.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$148.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$131.25
Rate for Payer: PHP Commercial	$148.75
Rate for Payer: Priority Health SBD	$110.25
Rate for Payer: UHC All Payor (Choice/PPO)	$113.75
Rate for Payer: UHC Core	$91.17
Rate for Payer: UHC Exchange	$68.78

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$8.82

Service Code	NDC 60687040711
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$5.56
Max. Negotiated Rate	$7.94
Rate for Payer: Aetna Commercial	$7.50
Rate for Payer: Aetna New Business (MI Preferred)	$5.73
Rate for Payer: Cash Price	$7.06
Rate for Payer: Cofinity Advantage	$6.17
Rate for Payer: Cofinity Commercial	$7.59
Rate for Payer: Encore Health Key Benefits Commercial	$7.06
Rate for Payer: Healthscope Commercial	$7.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.62
Rate for Payer: PHP Commercial	$7.50
Rate for Payer: Priority Health SBD	$5.56

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$9.91

Service Code	NDC 00406012423
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$8.92
Rate for Payer: Aetna Commercial	$8.42
Rate for Payer: Aetna Medicare	$4.96
Rate for Payer: Aetna New Business (MI Preferred)	$6.44
Rate for Payer: BCBS Complete	$3.96
Rate for Payer: Cash Price	$7.93
Rate for Payer: Cofinity Advantage	$6.94
Rate for Payer: Cofinity Commercial	$8.52
Rate for Payer: Encore Health Key Benefits Commercial	$7.93
Rate for Payer: Healthscope Commercial	$8.92
Rate for Payer: MI Amish Medical Board Commercial	$7.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.43
Rate for Payer: PHP Commercial	$8.42
Rate for Payer: Priority Health SBD	$6.24
Rate for Payer: UHC All Payor (Choice/PPO)	$6.44
Rate for Payer: UHC Core	$5.16
Rate for Payer: UHC Exchange	$3.89

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$5.53

Service Code	NDC 50268040011
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$4.98
Rate for Payer: Aetna Commercial	$4.70
Rate for Payer: Aetna New Business (MI Preferred)	$3.59
Rate for Payer: Cash Price	$4.42
Rate for Payer: Cofinity Advantage	$3.87
Rate for Payer: Cofinity Commercial	$4.76
Rate for Payer: Encore Health Key Benefits Commercial	$4.42
Rate for Payer: Healthscope Commercial	$4.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.15
Rate for Payer: PHP Commercial	$4.70
Rate for Payer: Priority Health SBD	$3.48

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$990.50

Service Code	NDC 00406012462
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$389.27
Max. Negotiated Rate	$891.45
Rate for Payer: Aetna Commercial	$841.92
Rate for Payer: Aetna Medicare	$495.25
Rate for Payer: Aetna New Business (MI Preferred)	$643.83
Rate for Payer: BCBS Complete	$396.20
Rate for Payer: Cash Price	$792.40
Rate for Payer: Cofinity Advantage	$693.35
Rate for Payer: Cofinity Commercial	$851.83
Rate for Payer: Encore Health Key Benefits Commercial	$792.40
Rate for Payer: Healthscope Commercial	$891.45
Rate for Payer: MI Amish Medical Board Commercial	$792.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$841.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$742.88
Rate for Payer: PHP Commercial	$841.92
Rate for Payer: Priority Health SBD	$624.01
Rate for Payer: UHC All Payor (Choice/PPO)	$643.83
Rate for Payer: UHC Core	$516.05
Rate for Payer: UHC Exchange	$389.27

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$5.53

Service Code	NDC 50268040011
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$4.98
Rate for Payer: Aetna Commercial	$4.70
Rate for Payer: Aetna Medicare	$2.77
Rate for Payer: Aetna New Business (MI Preferred)	$3.59
Rate for Payer: BCBS Complete	$2.21
Rate for Payer: Cash Price	$4.42
Rate for Payer: Cofinity Advantage	$3.87
Rate for Payer: Cofinity Commercial	$4.76
Rate for Payer: Encore Health Key Benefits Commercial	$4.42
Rate for Payer: Healthscope Commercial	$4.98
Rate for Payer: MI Amish Medical Board Commercial	$4.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.15
Rate for Payer: PHP Commercial	$4.70
Rate for Payer: Priority Health SBD	$3.48
Rate for Payer: UHC All Payor (Choice/PPO)	$3.59
Rate for Payer: UHC Core	$2.88
Rate for Payer: UHC Exchange	$2.17

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$882.00

Service Code	NDC 60687040701
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$555.66
Max. Negotiated Rate	$793.80
Rate for Payer: Aetna Commercial	$749.70
Rate for Payer: Aetna New Business (MI Preferred)	$573.30
Rate for Payer: Cash Price	$705.60
Rate for Payer: Cofinity Advantage	$617.40
Rate for Payer: Cofinity Commercial	$758.52
Rate for Payer: Encore Health Key Benefits Commercial	$705.60
Rate for Payer: Healthscope Commercial	$793.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$749.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$661.50
Rate for Payer: PHP Commercial	$749.70
Rate for Payer: Priority Health SBD	$555.66

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$276.50

Service Code	NDC 50268040015
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$108.66
Max. Negotiated Rate	$248.85
Rate for Payer: Aetna Commercial	$235.03
Rate for Payer: Aetna Medicare	$138.25
Rate for Payer: Aetna New Business (MI Preferred)	$179.72
Rate for Payer: BCBS Complete	$110.60
Rate for Payer: Cash Price	$221.20
Rate for Payer: Cofinity Advantage	$193.55
Rate for Payer: Cofinity Commercial	$237.79
Rate for Payer: Encore Health Key Benefits Commercial	$221.20
Rate for Payer: Healthscope Commercial	$248.85
Rate for Payer: MI Amish Medical Board Commercial	$221.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$235.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$207.38
Rate for Payer: PHP Commercial	$235.03
Rate for Payer: Priority Health SBD	$174.19
Rate for Payer: UHC All Payor (Choice/PPO)	$179.72
Rate for Payer: UHC Core	$144.06
Rate for Payer: UHC Exchange	$108.66

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$990.50

Service Code	NDC 00406012462
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$624.01
Max. Negotiated Rate	$891.45
Rate for Payer: Aetna Commercial	$841.92
Rate for Payer: Aetna New Business (MI Preferred)	$643.83
Rate for Payer: Cash Price	$792.40
Rate for Payer: Cofinity Advantage	$693.35
Rate for Payer: Cofinity Commercial	$851.83
Rate for Payer: Encore Health Key Benefits Commercial	$792.40
Rate for Payer: Healthscope Commercial	$891.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$841.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$742.88
Rate for Payer: PHP Commercial	$841.92
Rate for Payer: Priority Health SBD	$624.01

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$175.00

Service Code	NDC 13107002001
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$110.25
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna Commercial	$148.75
Rate for Payer: Aetna New Business (MI Preferred)	$113.75
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cofinity Advantage	$122.50
Rate for Payer: Cofinity Commercial	$150.50
Rate for Payer: Encore Health Key Benefits Commercial	$140.00
Rate for Payer: Healthscope Commercial	$157.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$148.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$131.25
Rate for Payer: PHP Commercial	$148.75
Rate for Payer: Priority Health SBD	$110.25

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$530.25

Service Code	NDC 904682661
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$208.39
Max. Negotiated Rate	$477.23
Rate for Payer: Aetna Commercial	$450.71
Rate for Payer: Aetna Medicare	$265.12
Rate for Payer: Aetna New Business (MI Preferred)	$344.66
Rate for Payer: BCBS Complete	$212.10
Rate for Payer: Cash Price	$424.20
Rate for Payer: Cofinity Advantage	$371.18
Rate for Payer: Cofinity Commercial	$456.01
Rate for Payer: Encore Health Key Benefits Commercial	$424.20
Rate for Payer: Healthscope Commercial	$477.23
Rate for Payer: MI Amish Medical Board Commercial	$424.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$450.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$397.69
Rate for Payer: PHP Commercial	$450.71
Rate for Payer: Priority Health SBD	$334.06
Rate for Payer: UHC All Payor (Choice/PPO)	$344.66
Rate for Payer: UHC Core	$276.26
Rate for Payer: UHC Exchange	$208.39

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$8.82

Service Code	NDC 60687040711
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$7.94
Rate for Payer: Aetna Commercial	$7.50
Rate for Payer: Aetna Medicare	$4.41
Rate for Payer: Aetna New Business (MI Preferred)	$5.73
Rate for Payer: BCBS Complete	$3.53
Rate for Payer: Cash Price	$7.06
Rate for Payer: Cofinity Advantage	$6.17
Rate for Payer: Cofinity Commercial	$7.59
Rate for Payer: Encore Health Key Benefits Commercial	$7.06
Rate for Payer: Healthscope Commercial	$7.94
Rate for Payer: MI Amish Medical Board Commercial	$7.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.62
Rate for Payer: PHP Commercial	$7.50
Rate for Payer: Priority Health SBD	$5.56
Rate for Payer: UHC All Payor (Choice/PPO)	$5.73
Rate for Payer: UHC Core	$4.60
Rate for Payer: UHC Exchange	$3.47

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$530.25

Service Code	NDC 00904682661
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$334.06
Max. Negotiated Rate	$477.23
Rate for Payer: Aetna Commercial	$450.71
Rate for Payer: Aetna New Business (MI Preferred)	$344.66
Rate for Payer: Cash Price	$424.20
Rate for Payer: Cofinity Advantage	$371.18
Rate for Payer: Cofinity Commercial	$456.01
Rate for Payer: Encore Health Key Benefits Commercial	$424.20
Rate for Payer: Healthscope Commercial	$477.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$450.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$397.69
Rate for Payer: PHP Commercial	$450.71
Rate for Payer: Priority Health SBD	$334.06

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$882.00

Service Code	NDC 60687040701
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$346.63
Max. Negotiated Rate	$793.80
Rate for Payer: Aetna Commercial	$749.70
Rate for Payer: Aetna Medicare	$441.00
Rate for Payer: Aetna New Business (MI Preferred)	$573.30
Rate for Payer: BCBS Complete	$352.80
Rate for Payer: Cash Price	$705.60
Rate for Payer: Cofinity Advantage	$617.40
Rate for Payer: Cofinity Commercial	$758.52
Rate for Payer: Encore Health Key Benefits Commercial	$705.60
Rate for Payer: Healthscope Commercial	$793.80
Rate for Payer: MI Amish Medical Board Commercial	$705.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$749.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$661.50
Rate for Payer: PHP Commercial	$749.70
Rate for Payer: Priority Health SBD	$555.66
Rate for Payer: UHC All Payor (Choice/PPO)	$573.30
Rate for Payer: UHC Core	$459.52
Rate for Payer: UHC Exchange	$346.63

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$9.91

Service Code	NDC 00406012423
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$8.92
Rate for Payer: Aetna Commercial	$8.42
Rate for Payer: Aetna New Business (MI Preferred)	$6.44
Rate for Payer: Cash Price	$7.93
Rate for Payer: Cofinity Advantage	$6.94
Rate for Payer: Cofinity Commercial	$8.52
Rate for Payer: Encore Health Key Benefits Commercial	$7.93
Rate for Payer: Healthscope Commercial	$8.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.43
Rate for Payer: PHP Commercial	$8.42
Rate for Payer: Priority Health SBD	$6.24

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$530.25

Service Code	NDC 00904682661
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$208.39
Max. Negotiated Rate	$477.23
Rate for Payer: Aetna Commercial	$450.71
Rate for Payer: Aetna Medicare	$265.12
Rate for Payer: Aetna New Business (MI Preferred)	$344.66
Rate for Payer: BCBS Complete	$212.10
Rate for Payer: Cash Price	$424.20
Rate for Payer: Cofinity Advantage	$371.18
Rate for Payer: Cofinity Commercial	$456.01
Rate for Payer: Encore Health Key Benefits Commercial	$424.20
Rate for Payer: Healthscope Commercial	$477.23
Rate for Payer: MI Amish Medical Board Commercial	$424.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$450.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$397.69
Rate for Payer: PHP Commercial	$450.71
Rate for Payer: Priority Health SBD	$334.06
Rate for Payer: UHC All Payor (Choice/PPO)	$344.66
Rate for Payer: UHC Core	$276.26
Rate for Payer: UHC Exchange	$208.39

HYDROCOLLOID DRESSING 5 1/2" X 5 1/2"

Facility

$103.38

Service Code	NDC 68455010723
Hospital Charge Code	111353
Hospital Revenue Code	637
Min. Negotiated Rate	$40.63
Max. Negotiated Rate	$93.04
Rate for Payer: Aetna Commercial	$87.87
Rate for Payer: Aetna Medicare	$51.69
Rate for Payer: Aetna New Business (MI Preferred)	$67.20
Rate for Payer: BCBS Complete	$41.35
Rate for Payer: Cash Price	$82.70
Rate for Payer: Cofinity Advantage	$72.37
Rate for Payer: Cofinity Commercial	$88.91
Rate for Payer: Encore Health Key Benefits Commercial	$82.70
Rate for Payer: Healthscope Commercial	$93.04
Rate for Payer: MI Amish Medical Board Commercial	$82.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$87.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$77.53
Rate for Payer: PHP Commercial	$87.87
Rate for Payer: Priority Health SBD	$65.13
Rate for Payer: UHC All Payor (Choice/PPO)	$67.20
Rate for Payer: UHC Core	$53.86
Rate for Payer: UHC Exchange	$40.63

HYDROCOLLOID DRESSING 5 1/2" X 5 1/2"

Facility

$103.38

Service Code	NDC 68455010723
Hospital Charge Code	111353
Hospital Revenue Code	637
Min. Negotiated Rate	$65.13
Max. Negotiated Rate	$93.04
Rate for Payer: Aetna Commercial	$87.87
Rate for Payer: Aetna New Business (MI Preferred)	$67.20
Rate for Payer: Cash Price	$82.70
Rate for Payer: Cofinity Advantage	$72.37
Rate for Payer: Cofinity Commercial	$88.91
Rate for Payer: Encore Health Key Benefits Commercial	$82.70
Rate for Payer: Healthscope Commercial	$93.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$87.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$77.53
Rate for Payer: PHP Commercial	$87.87
Rate for Payer: Priority Health SBD	$65.13

HYDROCOLLOID DRESSING 6" X 6"

Facility

$108.04

Service Code	NDC 68455010692
Hospital Charge Code	111013
Hospital Revenue Code	637
Min. Negotiated Rate	$42.46
Max. Negotiated Rate	$97.24
Rate for Payer: Aetna Commercial	$91.83
Rate for Payer: Aetna Medicare	$54.02
Rate for Payer: Aetna New Business (MI Preferred)	$70.23
Rate for Payer: BCBS Complete	$43.22
Rate for Payer: Cash Price	$86.43
Rate for Payer: Cofinity Advantage	$75.63
Rate for Payer: Cofinity Commercial	$92.91
Rate for Payer: Encore Health Key Benefits Commercial	$86.43
Rate for Payer: Healthscope Commercial	$97.24
Rate for Payer: MI Amish Medical Board Commercial	$86.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$81.03
Rate for Payer: PHP Commercial	$91.83
Rate for Payer: Priority Health SBD	$68.07
Rate for Payer: UHC All Payor (Choice/PPO)	$70.23
Rate for Payer: UHC Core	$56.29
Rate for Payer: UHC Exchange	$42.46

HYDROCOLLOID DRESSING 6" X 6"

Facility

$108.04

Service Code	NDC 68455010692
Hospital Charge Code	111013
Hospital Revenue Code	637
Min. Negotiated Rate	$68.07
Max. Negotiated Rate	$97.24
Rate for Payer: Aetna Commercial	$91.83
Rate for Payer: Aetna New Business (MI Preferred)	$70.23
Rate for Payer: Cash Price	$86.43
Rate for Payer: Cofinity Advantage	$75.63
Rate for Payer: Cofinity Commercial	$92.91
Rate for Payer: Encore Health Key Benefits Commercial	$86.43
Rate for Payer: Healthscope Commercial	$97.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$81.03
Rate for Payer: PHP Commercial	$91.83
Rate for Payer: Priority Health SBD	$68.07

HYDROCORTISONE 10 MG TABLET

Facility

$709.92

Service Code	NDC 00904718861
Hospital Charge Code	3733
Hospital Revenue Code	637
Min. Negotiated Rate	$279.00
Max. Negotiated Rate	$638.93
Rate for Payer: Aetna Commercial	$603.43
Rate for Payer: Aetna Medicare	$354.96
Rate for Payer: Aetna New Business (MI Preferred)	$461.45
Rate for Payer: BCBS Complete	$283.97
Rate for Payer: Cash Price	$567.94
Rate for Payer: Cofinity Advantage	$496.94
Rate for Payer: Cofinity Commercial	$610.53
Rate for Payer: Encore Health Key Benefits Commercial	$567.94
Rate for Payer: Healthscope Commercial	$638.93
Rate for Payer: MI Amish Medical Board Commercial	$567.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$603.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$532.44
Rate for Payer: PHP Commercial	$603.43
Rate for Payer: Priority Health SBD	$447.25
Rate for Payer: UHC All Payor (Choice/PPO)	$461.45
Rate for Payer: UHC Core	$369.87
Rate for Payer: UHC Exchange	$279.00

HYDROCORTISONE 10 MG TABLET

Facility

$794.40

Service Code	NDC 00009003101
Hospital Charge Code	3733
Hospital Revenue Code	637
Min. Negotiated Rate	$312.20
Max. Negotiated Rate	$714.96
Rate for Payer: Aetna Commercial	$675.24
Rate for Payer: Aetna Medicare	$397.20
Rate for Payer: Aetna New Business (MI Preferred)	$516.36
Rate for Payer: BCBS Complete	$317.76
Rate for Payer: Cash Price	$635.52
Rate for Payer: Cofinity Advantage	$556.08
Rate for Payer: Cofinity Commercial	$683.18
Rate for Payer: Encore Health Key Benefits Commercial	$635.52
Rate for Payer: Healthscope Commercial	$714.96
Rate for Payer: MI Amish Medical Board Commercial	$635.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$675.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$595.80
Rate for Payer: PHP Commercial	$675.24
Rate for Payer: Priority Health SBD	$500.47
Rate for Payer: UHC All Payor (Choice/PPO)	$516.36
Rate for Payer: UHC Core	$413.88
Rate for Payer: UHC Exchange	$312.20

HYDROCORTISONE 10 MG TABLET

Facility

$780.96

Service Code	NDC 60687058201
Hospital Charge Code	3733
Hospital Revenue Code	637
Min. Negotiated Rate	$306.92
Max. Negotiated Rate	$702.86
Rate for Payer: Aetna Commercial	$663.82
Rate for Payer: Aetna Medicare	$390.48
Rate for Payer: Aetna New Business (MI Preferred)	$507.62
Rate for Payer: BCBS Complete	$312.38
Rate for Payer: Cash Price	$624.77
Rate for Payer: Cofinity Advantage	$546.67
Rate for Payer: Cofinity Commercial	$671.63
Rate for Payer: Encore Health Key Benefits Commercial	$624.77
Rate for Payer: Healthscope Commercial	$702.86
Rate for Payer: MI Amish Medical Board Commercial	$624.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$663.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$585.72
Rate for Payer: PHP Commercial	$663.82
Rate for Payer: Priority Health SBD	$492.00
Rate for Payer: UHC All Payor (Choice/PPO)	$507.62
Rate for Payer: UHC Core	$406.88
Rate for Payer: UHC Exchange	$306.92

HYDROCORTISONE 10 MG TABLET

Facility

$230.85

Service Code	NDC 00115169701
Hospital Charge Code	3733
Hospital Revenue Code	637
Min. Negotiated Rate	$145.44
Max. Negotiated Rate	$207.76
Rate for Payer: Aetna Commercial	$196.22
Rate for Payer: Aetna New Business (MI Preferred)	$150.05
Rate for Payer: Cash Price	$184.68
Rate for Payer: Cofinity Advantage	$161.59
Rate for Payer: Cofinity Commercial	$198.53
Rate for Payer: Encore Health Key Benefits Commercial	$184.68
Rate for Payer: Healthscope Commercial	$207.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$196.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$173.14
Rate for Payer: PHP Commercial	$196.22
Rate for Payer: Priority Health SBD	$145.44

Know your out-of-pocket cost for care.

All Charges