Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HH POUCH 2.5" CTF HOLL8331 EA

Facility

$6.36

Service Code	HCPCS A5056
Hospital Charge Code	27000597
Hospital Revenue Code	270
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$5.72
Rate for Payer: Aetna Commercial	$5.41
Rate for Payer: Aetna New Business (MI Preferred)	$4.13
Rate for Payer: Cash Price	$5.09
Rate for Payer: Cofinity Commercial	$4.45
Rate for Payer: Cofinity Commercial	$5.47
Rate for Payer: Cofinity Medicare Advantage	$4.45
Rate for Payer: Encore Health Key Benefits Commercial	$5.09
Rate for Payer: Healthscope Commercial	$5.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.41
Rate for Payer: PHP Commercial	$5.41
Rate for Payer: Priority Health Cigna Priority Health	$4.13
Rate for Payer: Priority Health SBD	$4.01

HH POUCH 2.5" CTF HOLL8331 EA

Facility

$6.36

Service Code	HCPCS A5056
Hospital Charge Code	27000597
Hospital Revenue Code	270
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$5.72
Rate for Payer: Aetna Commercial	$5.41
Rate for Payer: Aetna Medicare	$3.18
Rate for Payer: Aetna New Business (MI Preferred)	$4.13
Rate for Payer: BCBS Complete	$2.54
Rate for Payer: Cash Price	$5.09
Rate for Payer: Cofinity Commercial	$4.45
Rate for Payer: Cofinity Commercial	$5.47
Rate for Payer: Cofinity Medicare Advantage	$4.45
Rate for Payer: Encore Health Key Benefits Commercial	$5.09
Rate for Payer: Healthscope Commercial	$5.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.41
Rate for Payer: PHP Commercial	$5.41
Rate for Payer: Priority Health Cigna Priority Health	$4.13
Rate for Payer: Priority Health SBD	$4.01

HONEY 100 % TOPICAL PASTE

Facility

$47.90

Service Code	NDC 09958003361
Hospital Charge Code	166117
Hospital Revenue Code	637
Min. Negotiated Rate	$30.18
Max. Negotiated Rate	$43.11
Rate for Payer: Aetna Commercial	$40.72
Rate for Payer: Aetna New Business (MI Preferred)	$31.14
Rate for Payer: Cash Price	$38.32
Rate for Payer: Cofinity Commercial	$33.53
Rate for Payer: Cofinity Commercial	$41.19
Rate for Payer: Cofinity Medicare Advantage	$33.53
Rate for Payer: Encore Health Key Benefits Commercial	$38.32
Rate for Payer: Healthscope Commercial	$43.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.72
Rate for Payer: PHP Commercial	$40.72
Rate for Payer: Priority Health Cigna Priority Health	$31.14
Rate for Payer: Priority Health SBD	$30.18

HONEY 100 % TOPICAL PASTE

Facility

$47.90

Service Code	NDC 09958003360
Hospital Charge Code	166117
Hospital Revenue Code	637
Min. Negotiated Rate	$19.16
Max. Negotiated Rate	$43.11
Rate for Payer: Aetna Commercial	$40.72
Rate for Payer: Aetna Medicare	$23.95
Rate for Payer: Aetna New Business (MI Preferred)	$31.14
Rate for Payer: BCBS Complete	$19.16
Rate for Payer: Cash Price	$38.32
Rate for Payer: Cofinity Commercial	$33.53
Rate for Payer: Cofinity Commercial	$41.19
Rate for Payer: Cofinity Medicare Advantage	$33.53
Rate for Payer: Encore Health Key Benefits Commercial	$38.32
Rate for Payer: Healthscope Commercial	$43.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.72
Rate for Payer: PHP Commercial	$40.72
Rate for Payer: Priority Health Cigna Priority Health	$31.14
Rate for Payer: Priority Health SBD	$30.18

HONEY 100 % TOPICAL PASTE

Facility

$47.90

Service Code	NDC 09958003360
Hospital Charge Code	166117
Hospital Revenue Code	637
Min. Negotiated Rate	$30.18
Max. Negotiated Rate	$43.11
Rate for Payer: Aetna Commercial	$40.72
Rate for Payer: Aetna New Business (MI Preferred)	$31.14
Rate for Payer: Cash Price	$38.32
Rate for Payer: Cofinity Commercial	$33.53
Rate for Payer: Cofinity Commercial	$41.19
Rate for Payer: Cofinity Medicare Advantage	$33.53
Rate for Payer: Encore Health Key Benefits Commercial	$38.32
Rate for Payer: Healthscope Commercial	$43.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.72
Rate for Payer: PHP Commercial	$40.72
Rate for Payer: Priority Health Cigna Priority Health	$31.14
Rate for Payer: Priority Health SBD	$30.18

HONEY 100 % TOPICAL PASTE

Facility

$47.90

Service Code	NDC 09958003361
Hospital Charge Code	166117
Hospital Revenue Code	637
Min. Negotiated Rate	$19.16
Max. Negotiated Rate	$43.11
Rate for Payer: Aetna Commercial	$40.72
Rate for Payer: Aetna Medicare	$23.95
Rate for Payer: Aetna New Business (MI Preferred)	$31.14
Rate for Payer: BCBS Complete	$19.16
Rate for Payer: Cash Price	$38.32
Rate for Payer: Cofinity Commercial	$33.53
Rate for Payer: Cofinity Commercial	$41.19
Rate for Payer: Cofinity Medicare Advantage	$33.53
Rate for Payer: Encore Health Key Benefits Commercial	$38.32
Rate for Payer: Healthscope Commercial	$43.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.72
Rate for Payer: PHP Commercial	$40.72
Rate for Payer: Priority Health Cigna Priority Health	$31.14
Rate for Payer: Priority Health SBD	$30.18

HONEY 80 % TOPICAL GEL

Facility

$47.90

Service Code	NDC 09958003471
Hospital Charge Code	164073
Hospital Revenue Code	637
Min. Negotiated Rate	$19.16
Max. Negotiated Rate	$43.11
Rate for Payer: Aetna Commercial	$40.72
Rate for Payer: Aetna Medicare	$23.95
Rate for Payer: Aetna New Business (MI Preferred)	$31.14
Rate for Payer: BCBS Complete	$19.16
Rate for Payer: Cash Price	$38.32
Rate for Payer: Cofinity Commercial	$33.53
Rate for Payer: Cofinity Commercial	$41.19
Rate for Payer: Cofinity Medicare Advantage	$33.53
Rate for Payer: Encore Health Key Benefits Commercial	$38.32
Rate for Payer: Healthscope Commercial	$43.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.72
Rate for Payer: PHP Commercial	$40.72
Rate for Payer: Priority Health Cigna Priority Health	$31.14
Rate for Payer: Priority Health SBD	$30.18

HONEY 80 % TOPICAL GEL

Facility

$47.90

Service Code	NDC 09958003471
Hospital Charge Code	164073
Hospital Revenue Code	637
Min. Negotiated Rate	$30.18
Max. Negotiated Rate	$43.11
Rate for Payer: Aetna Commercial	$40.72
Rate for Payer: Aetna New Business (MI Preferred)	$31.14
Rate for Payer: Cash Price	$38.32
Rate for Payer: Cofinity Commercial	$33.53
Rate for Payer: Cofinity Commercial	$41.19
Rate for Payer: Cofinity Medicare Advantage	$33.53
Rate for Payer: Encore Health Key Benefits Commercial	$38.32
Rate for Payer: Healthscope Commercial	$43.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.72
Rate for Payer: PHP Commercial	$40.72
Rate for Payer: Priority Health Cigna Priority Health	$31.14
Rate for Payer: Priority Health SBD	$30.18

HUMAN PROTHROMBIN CMPLX CONCENTRATE (PCC)-LANS 1,000 UNIT IV SOLUTION

Facility

$6,970.60

Service Code	HCPCS J7165
Hospital Charge Code	204902
Hospital Revenue Code	636
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$6,273.54
Rate for Payer: Aetna Commercial	$5,925.01
Rate for Payer: Aetna Medicare	$1.61
Rate for Payer: Aetna New Business (MI Preferred)	$4,530.89
Rate for Payer: Allen County Amish Medical Aid Commercial	$1.94
Rate for Payer: Amish Plain Church Group Commercial	$1.94
Rate for Payer: BCBS Complete	$0.87
Rate for Payer: BCBS MAPPO	$1.55
Rate for Payer: BCN Medicare Advantage	$1.55
Rate for Payer: Cash Price	$5,576.48
Rate for Payer: Cash Price	$5,576.48
Rate for Payer: Cofinity Commercial	$5,994.72
Rate for Payer: Cofinity Commercial	$4,879.42
Rate for Payer: Cofinity Medicare Advantage	$4,879.42
Rate for Payer: Encore Health Key Benefits Commercial	$5,576.48
Rate for Payer: Health Alliance Plan Medicare Advantage	$1.55
Rate for Payer: Healthscope Commercial	$6,273.54
Rate for Payer: Mclaren Medicaid	$0.83
Rate for Payer: Mclaren Medicare	$1.55
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1.63
Rate for Payer: Meridian Medicaid	$0.87
Rate for Payer: MI Amish Medical Board Commercial	$1.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,925.01
Rate for Payer: PACE Medicare	$1.47
Rate for Payer: PACE SWMI	$1.55
Rate for Payer: PHP Commercial	$5,925.01
Rate for Payer: PHP Medicare Advantage	$1.55
Rate for Payer: Priority Health Choice Medicaid	$0.83
Rate for Payer: Priority Health Cigna Priority Health	$4,530.89
Rate for Payer: Priority Health Medicare	$1.55
Rate for Payer: Priority Health SBD	$4,391.48
Rate for Payer: Railroad Medicare Medicare	$1.55
Rate for Payer: UHC All Payor (Choice/PPO)	$4.36
Rate for Payer: UHC Dual Complete DSNP	$1.55
Rate for Payer: UHC Medicare Advantage	$1.55
Rate for Payer: UHCCP Medicaid	$0.87
Rate for Payer: VA VA	$1.55

HUMAN PROTHROMBIN CMPLX CONCENTRATE (PCC)-LANS 1,000 UNIT IV SOLUTION

Facility

$6,970.60

Service Code	HCPCS J7165
Hospital Charge Code	204902
Hospital Revenue Code	636
Min. Negotiated Rate	$4,391.48
Max. Negotiated Rate	$6,273.54
Rate for Payer: Aetna Commercial	$5,925.01
Rate for Payer: Aetna New Business (MI Preferred)	$4,530.89
Rate for Payer: Cash Price	$5,576.48
Rate for Payer: Cofinity Commercial	$4,879.42
Rate for Payer: Cofinity Commercial	$5,994.72
Rate for Payer: Cofinity Medicare Advantage	$4,879.42
Rate for Payer: Encore Health Key Benefits Commercial	$5,576.48
Rate for Payer: Healthscope Commercial	$6,273.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,925.01
Rate for Payer: PHP Commercial	$5,925.01
Rate for Payer: Priority Health Cigna Priority Health	$4,530.89
Rate for Payer: Priority Health SBD	$4,391.48

HUMAN PROTHROMBIN COMPLEX CONCENTRATE (PCC)-LANS 500 UNIT IV SOLUTION

Facility

$3,753.41

Service Code	HCPCS J7165
Hospital Charge Code	204903
Hospital Revenue Code	636
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$3,378.07
Rate for Payer: Aetna Commercial	$3,190.40
Rate for Payer: Aetna Medicare	$1.61
Rate for Payer: Aetna New Business (MI Preferred)	$2,439.72
Rate for Payer: Allen County Amish Medical Aid Commercial	$1.94
Rate for Payer: Amish Plain Church Group Commercial	$1.94
Rate for Payer: BCBS Complete	$0.87
Rate for Payer: BCBS MAPPO	$1.55
Rate for Payer: BCN Medicare Advantage	$1.55
Rate for Payer: Cash Price	$3,002.73
Rate for Payer: Cash Price	$3,002.73
Rate for Payer: Cofinity Commercial	$3,227.93
Rate for Payer: Cofinity Commercial	$2,627.39
Rate for Payer: Cofinity Medicare Advantage	$2,627.39
Rate for Payer: Encore Health Key Benefits Commercial	$3,002.73
Rate for Payer: Health Alliance Plan Medicare Advantage	$1.55
Rate for Payer: Healthscope Commercial	$3,378.07
Rate for Payer: Mclaren Medicaid	$0.83
Rate for Payer: Mclaren Medicare	$1.55
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1.63
Rate for Payer: Meridian Medicaid	$0.87
Rate for Payer: MI Amish Medical Board Commercial	$1.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,190.40
Rate for Payer: PACE Medicare	$1.47
Rate for Payer: PACE SWMI	$1.55
Rate for Payer: PHP Commercial	$3,190.40
Rate for Payer: PHP Medicare Advantage	$1.55
Rate for Payer: Priority Health Choice Medicaid	$0.83
Rate for Payer: Priority Health Cigna Priority Health	$2,439.72
Rate for Payer: Priority Health Medicare	$1.55
Rate for Payer: Priority Health SBD	$2,364.65
Rate for Payer: Railroad Medicare Medicare	$1.55
Rate for Payer: UHC All Payor (Choice/PPO)	$4.36
Rate for Payer: UHC Dual Complete DSNP	$1.55
Rate for Payer: UHC Medicare Advantage	$1.55
Rate for Payer: UHCCP Medicaid	$0.87
Rate for Payer: VA VA	$1.55

HUMAN PROTHROMBIN COMPLEX CONCENTRATE (PCC)-LANS 500 UNIT IV SOLUTION

Facility

$3,753.41

Service Code	HCPCS J7165
Hospital Charge Code	204903
Hospital Revenue Code	636
Min. Negotiated Rate	$2,364.65
Max. Negotiated Rate	$3,378.07
Rate for Payer: Aetna Commercial	$3,190.40
Rate for Payer: Aetna New Business (MI Preferred)	$2,439.72
Rate for Payer: Cash Price	$3,002.73
Rate for Payer: Cofinity Commercial	$2,627.39
Rate for Payer: Cofinity Commercial	$3,227.93
Rate for Payer: Cofinity Medicare Advantage	$2,627.39
Rate for Payer: Encore Health Key Benefits Commercial	$3,002.73
Rate for Payer: Healthscope Commercial	$3,378.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,190.40
Rate for Payer: PHP Commercial	$3,190.40
Rate for Payer: Priority Health Cigna Priority Health	$2,439.72
Rate for Payer: Priority Health SBD	$2,364.65

HUM PROTHROMBIN CPLX (PCC) 4FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION

Facility

$4.93

Service Code	HCPCS J7168
Hospital Charge Code	170850
Hospital Revenue Code	636
Min. Negotiated Rate	$3.11
Max. Negotiated Rate	$4.44
Rate for Payer: Aetna Commercial	$4.19
Rate for Payer: Aetna New Business (MI Preferred)	$3.20
Rate for Payer: Cash Price	$3.94
Rate for Payer: Cofinity Commercial	$3.45
Rate for Payer: Cofinity Commercial	$4.24
Rate for Payer: Cofinity Medicare Advantage	$3.45
Rate for Payer: Encore Health Key Benefits Commercial	$3.94
Rate for Payer: Healthscope Commercial	$4.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.19
Rate for Payer: PHP Commercial	$4.19
Rate for Payer: Priority Health Cigna Priority Health	$3.20
Rate for Payer: Priority Health SBD	$3.11

HUM PROTHROMBIN CPLX (PCC) 4FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION

Facility

$4.93

Service Code	HCPCS J7168
Hospital Charge Code	170850
Hospital Revenue Code	636
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$6.02
Rate for Payer: Aetna Commercial	$4.19
Rate for Payer: Aetna Medicare	$2.23
Rate for Payer: Aetna New Business (MI Preferred)	$3.20
Rate for Payer: Allen County Amish Medical Aid Commercial	$2.67
Rate for Payer: Amish Plain Church Group Commercial	$2.67
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: BCBS MAPPO	$2.14
Rate for Payer: BCN Medicare Advantage	$2.14
Rate for Payer: Cash Price	$3.94
Rate for Payer: Cash Price	$3.94
Rate for Payer: Cofinity Commercial	$4.24
Rate for Payer: Cofinity Commercial	$3.45
Rate for Payer: Cofinity Medicare Advantage	$3.45
Rate for Payer: Encore Health Key Benefits Commercial	$3.94
Rate for Payer: Health Alliance Plan Medicare Advantage	$2.14
Rate for Payer: Healthscope Commercial	$4.44
Rate for Payer: Mclaren Medicaid	$1.15
Rate for Payer: Mclaren Medicare	$2.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2.25
Rate for Payer: Meridian Medicaid	$1.20
Rate for Payer: MI Amish Medical Board Commercial	$2.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.19
Rate for Payer: PACE Medicare	$2.03
Rate for Payer: PACE SWMI	$2.14
Rate for Payer: PHP Commercial	$4.19
Rate for Payer: PHP Medicare Advantage	$2.14
Rate for Payer: Priority Health Choice Medicaid	$1.15
Rate for Payer: Priority Health Cigna Priority Health	$3.20
Rate for Payer: Priority Health Medicare	$2.14
Rate for Payer: Priority Health SBD	$3.11
Rate for Payer: Railroad Medicare Medicare	$2.14
Rate for Payer: UHC All Payor (Choice/PPO)	$6.02
Rate for Payer: UHC Dual Complete DSNP	$2.14
Rate for Payer: UHC Medicare Advantage	$2.14
Rate for Payer: UHCCP Medicaid	$1.20
Rate for Payer: VA VA	$2.14

HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION

Facility

$166.66

Service Code	HCPCS J3473
Hospital Charge Code	76338
Hospital Revenue Code	636
Min. Negotiated Rate	$66.66
Max. Negotiated Rate	$149.99
Rate for Payer: Aetna Commercial	$141.66
Rate for Payer: Aetna Medicare	$83.33
Rate for Payer: Aetna New Business (MI Preferred)	$108.33
Rate for Payer: BCBS Complete	$66.66
Rate for Payer: Cash Price	$133.33
Rate for Payer: Cofinity Commercial	$116.66
Rate for Payer: Cofinity Commercial	$143.33
Rate for Payer: Cofinity Medicare Advantage	$116.66
Rate for Payer: Encore Health Key Benefits Commercial	$133.33
Rate for Payer: Healthscope Commercial	$149.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$141.66
Rate for Payer: PHP Commercial	$141.66
Rate for Payer: Priority Health Cigna Priority Health	$108.33
Rate for Payer: Priority Health SBD	$105.00

HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION

Facility

$166.66

Service Code	HCPCS J3473
Hospital Charge Code	76338
Hospital Revenue Code	636
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$149.99
Rate for Payer: Aetna Commercial	$141.66
Rate for Payer: Aetna New Business (MI Preferred)	$108.33
Rate for Payer: Cash Price	$133.33
Rate for Payer: Cofinity Commercial	$143.33
Rate for Payer: Cofinity Commercial	$116.66
Rate for Payer: Cofinity Medicare Advantage	$116.66
Rate for Payer: Encore Health Key Benefits Commercial	$133.33
Rate for Payer: Healthscope Commercial	$149.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$141.66
Rate for Payer: PHP Commercial	$141.66
Rate for Payer: Priority Health Cigna Priority Health	$108.33
Rate for Payer: Priority Health SBD	$105.00

HYDRALAZINE 100 MG TABLET

Facility

$453.55

Service Code	NDC 00904644361
Hospital Charge Code	3699
Hospital Revenue Code	637
Min. Negotiated Rate	$285.74
Max. Negotiated Rate	$408.19
Rate for Payer: Aetna Commercial	$385.52
Rate for Payer: Aetna New Business (MI Preferred)	$294.81
Rate for Payer: Cash Price	$362.84
Rate for Payer: Cofinity Commercial	$317.49
Rate for Payer: Cofinity Commercial	$390.05
Rate for Payer: Cofinity Medicare Advantage	$317.49
Rate for Payer: Encore Health Key Benefits Commercial	$362.84
Rate for Payer: Healthscope Commercial	$408.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$385.52
Rate for Payer: PHP Commercial	$385.52
Rate for Payer: Priority Health Cigna Priority Health	$294.81
Rate for Payer: Priority Health SBD	$285.74

HYDRALAZINE 100 MG TABLET

Facility

$453.55

Service Code	NDC 00904644361
Hospital Charge Code	3699
Hospital Revenue Code	637
Min. Negotiated Rate	$181.42
Max. Negotiated Rate	$408.19
Rate for Payer: Aetna Commercial	$385.52
Rate for Payer: Aetna Medicare	$226.78
Rate for Payer: Aetna New Business (MI Preferred)	$294.81
Rate for Payer: BCBS Complete	$181.42
Rate for Payer: Cash Price	$362.84
Rate for Payer: Cofinity Commercial	$317.49
Rate for Payer: Cofinity Commercial	$390.05
Rate for Payer: Cofinity Medicare Advantage	$317.49
Rate for Payer: Encore Health Key Benefits Commercial	$362.84
Rate for Payer: Healthscope Commercial	$408.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$385.52
Rate for Payer: PHP Commercial	$385.52
Rate for Payer: Priority Health Cigna Priority Health	$294.81
Rate for Payer: Priority Health SBD	$285.74

HYDRALAZINE 10 MG TABLET

Facility

$392.45

Service Code	NDC 51079007420
Hospital Charge Code	3698
Hospital Revenue Code	637
Min. Negotiated Rate	$247.24
Max. Negotiated Rate	$353.20
Rate for Payer: Aetna Commercial	$333.58
Rate for Payer: Aetna New Business (MI Preferred)	$255.09
Rate for Payer: Cash Price	$313.96
Rate for Payer: Cofinity Commercial	$274.71
Rate for Payer: Cofinity Commercial	$337.51
Rate for Payer: Cofinity Medicare Advantage	$274.71
Rate for Payer: Encore Health Key Benefits Commercial	$313.96
Rate for Payer: Healthscope Commercial	$353.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$333.58
Rate for Payer: PHP Commercial	$333.58
Rate for Payer: Priority Health Cigna Priority Health	$255.09
Rate for Payer: Priority Health SBD	$247.24

HYDRALAZINE 10 MG TABLET

Facility

$345.45

Service Code	NDC 68084044711
Hospital Charge Code	3698
Hospital Revenue Code	637
Min. Negotiated Rate	$138.18
Max. Negotiated Rate	$310.90
Rate for Payer: Aetna Commercial	$293.63
Rate for Payer: Aetna Medicare	$172.72
Rate for Payer: Aetna New Business (MI Preferred)	$224.54
Rate for Payer: BCBS Complete	$138.18
Rate for Payer: Cash Price	$276.36
Rate for Payer: Cofinity Commercial	$241.81
Rate for Payer: Cofinity Commercial	$297.09
Rate for Payer: Cofinity Medicare Advantage	$241.81
Rate for Payer: Encore Health Key Benefits Commercial	$276.36
Rate for Payer: Healthscope Commercial	$310.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$293.63
Rate for Payer: PHP Commercial	$293.63
Rate for Payer: Priority Health Cigna Priority Health	$224.54
Rate for Payer: Priority Health SBD	$217.63

HYDRALAZINE 10 MG TABLET

Facility

$392.45

Service Code	NDC 51079007420
Hospital Charge Code	3698
Hospital Revenue Code	637
Min. Negotiated Rate	$156.98
Max. Negotiated Rate	$353.20
Rate for Payer: Aetna Commercial	$333.58
Rate for Payer: Aetna Medicare	$196.22
Rate for Payer: Aetna New Business (MI Preferred)	$255.09
Rate for Payer: BCBS Complete	$156.98
Rate for Payer: Cash Price	$313.96
Rate for Payer: Cofinity Commercial	$274.71
Rate for Payer: Cofinity Commercial	$337.51
Rate for Payer: Cofinity Medicare Advantage	$274.71
Rate for Payer: Encore Health Key Benefits Commercial	$313.96
Rate for Payer: Healthscope Commercial	$353.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$333.58
Rate for Payer: PHP Commercial	$333.58
Rate for Payer: Priority Health Cigna Priority Health	$255.09
Rate for Payer: Priority Health SBD	$247.24

HYDRALAZINE 10 MG TABLET

Facility

$345.45

Service Code	NDC 68084044701
Hospital Charge Code	3698
Hospital Revenue Code	637
Min. Negotiated Rate	$138.18
Max. Negotiated Rate	$310.90
Rate for Payer: Aetna Commercial	$293.63
Rate for Payer: Aetna Medicare	$172.72
Rate for Payer: Aetna New Business (MI Preferred)	$224.54
Rate for Payer: BCBS Complete	$138.18
Rate for Payer: Cash Price	$276.36
Rate for Payer: Cofinity Commercial	$241.81
Rate for Payer: Cofinity Commercial	$297.09
Rate for Payer: Cofinity Medicare Advantage	$241.81
Rate for Payer: Encore Health Key Benefits Commercial	$276.36
Rate for Payer: Healthscope Commercial	$310.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$293.63
Rate for Payer: PHP Commercial	$293.63
Rate for Payer: Priority Health Cigna Priority Health	$224.54
Rate for Payer: Priority Health SBD	$217.63

HYDRALAZINE 10 MG TABLET

Facility

$227.95

Service Code	NDC 00904644061
Hospital Charge Code	3698
Hospital Revenue Code	637
Min. Negotiated Rate	$91.18
Max. Negotiated Rate	$205.16
Rate for Payer: Aetna Commercial	$193.76
Rate for Payer: Aetna Medicare	$113.97
Rate for Payer: Aetna New Business (MI Preferred)	$148.17
Rate for Payer: BCBS Complete	$91.18
Rate for Payer: Cash Price	$182.36
Rate for Payer: Cofinity Commercial	$159.56
Rate for Payer: Cofinity Commercial	$196.04
Rate for Payer: Cofinity Medicare Advantage	$159.56
Rate for Payer: Encore Health Key Benefits Commercial	$182.36
Rate for Payer: Healthscope Commercial	$205.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$193.76
Rate for Payer: PHP Commercial	$193.76
Rate for Payer: Priority Health Cigna Priority Health	$148.17
Rate for Payer: Priority Health SBD	$143.61

HYDRALAZINE 10 MG TABLET

Facility

$345.45

Service Code	NDC 68084044701
Hospital Charge Code	3698
Hospital Revenue Code	637
Min. Negotiated Rate	$217.63
Max. Negotiated Rate	$310.90
Rate for Payer: Aetna Commercial	$293.63
Rate for Payer: Aetna New Business (MI Preferred)	$224.54
Rate for Payer: Cash Price	$276.36
Rate for Payer: Cofinity Commercial	$241.81
Rate for Payer: Cofinity Commercial	$297.09
Rate for Payer: Cofinity Medicare Advantage	$241.81
Rate for Payer: Encore Health Key Benefits Commercial	$276.36
Rate for Payer: Healthscope Commercial	$310.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$293.63
Rate for Payer: PHP Commercial	$293.63
Rate for Payer: Priority Health Cigna Priority Health	$224.54
Rate for Payer: Priority Health SBD	$217.63

HYDRALAZINE 10 MG TABLET

Facility

$227.95

Service Code	NDC 00904644061
Hospital Charge Code	3698
Hospital Revenue Code	637
Min. Negotiated Rate	$143.61
Max. Negotiated Rate	$205.16
Rate for Payer: Aetna Commercial	$193.76
Rate for Payer: Aetna New Business (MI Preferred)	$148.17
Rate for Payer: Cash Price	$182.36
Rate for Payer: Cofinity Commercial	$159.56
Rate for Payer: Cofinity Commercial	$196.04
Rate for Payer: Cofinity Medicare Advantage	$159.56
Rate for Payer: Encore Health Key Benefits Commercial	$182.36
Rate for Payer: Healthscope Commercial	$205.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$193.76
Rate for Payer: PHP Commercial	$193.76
Rate for Payer: Priority Health Cigna Priority Health	$148.17
Rate for Payer: Priority Health SBD	$143.61

Know your out-of-pocket cost for care.

All Charges