Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HYDRALAZINE 50 MG TABLET

Facility

$200.45

Service Code	NDC 62584073411
Hospital Charge Code	3701
Hospital Revenue Code	637
Min. Negotiated Rate	$80.18
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 Commercial	$140.31
Rate for Payer: Cofinity Commercial	$172.39
Rate for Payer: Cofinity Medicare Advantage	$140.31
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: PHP Commercial	$170.38
Rate for Payer: Priority Health Cigna Priority Health	$130.29
Rate for Payer: Priority Health SBD	$126.28

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 Commercial	$170.91
Rate for Payer: Cofinity Commercial	$209.97
Rate for Payer: Cofinity Medicare Advantage	$170.91
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: PHP Commercial	$207.53
Rate for Payer: Priority Health Cigna Priority Health	$158.70
Rate for Payer: Priority Health SBD	$153.81

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$4.38

Service Code	NDC 60687059311
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$3.94
Rate for Payer: Aetna Commercial	$3.72
Rate for Payer: Aetna Medicare	$2.19
Rate for Payer: Aetna New Business (MI Preferred)	$2.85
Rate for Payer: BCBS Complete	$1.75
Rate for Payer: Cash Price	$3.50
Rate for Payer: Cofinity Commercial	$3.07
Rate for Payer: Cofinity Commercial	$3.77
Rate for Payer: Cofinity Medicare Advantage	$3.07
Rate for Payer: Encore Health Key Benefits Commercial	$3.50
Rate for Payer: Healthscope Commercial	$3.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.72
Rate for Payer: PHP Commercial	$3.72
Rate for Payer: Priority Health Cigna Priority Health	$2.85
Rate for Payer: Priority Health SBD	$2.76

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$47.00

Service Code	NDC 23155000801
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$29.61
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna Commercial	$39.95
Rate for Payer: Aetna New Business (MI Preferred)	$30.55
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cofinity Commercial	$32.90
Rate for Payer: Cofinity Commercial	$40.42
Rate for Payer: Cofinity Medicare Advantage	$32.90
Rate for Payer: Encore Health Key Benefits Commercial	$37.60
Rate for Payer: Healthscope Commercial	$42.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.95
Rate for Payer: PHP Commercial	$39.95
Rate for Payer: Priority Health Cigna Priority Health	$30.55
Rate for Payer: Priority Health SBD	$29.61

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$437.10

Service Code	NDC 60687059301
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$174.84
Max. Negotiated Rate	$393.39
Rate for Payer: Aetna Commercial	$371.54
Rate for Payer: Aetna Medicare	$218.55
Rate for Payer: Aetna New Business (MI Preferred)	$284.12
Rate for Payer: BCBS Complete	$174.84
Rate for Payer: Cash Price	$349.68
Rate for Payer: Cofinity Commercial	$305.97
Rate for Payer: Cofinity Commercial	$375.91
Rate for Payer: Cofinity Medicare Advantage	$305.97
Rate for Payer: Encore Health Key Benefits Commercial	$349.68
Rate for Payer: Healthscope Commercial	$393.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$371.54
Rate for Payer: PHP Commercial	$371.54
Rate for Payer: Priority Health Cigna Priority Health	$284.12
Rate for Payer: Priority Health SBD	$275.37

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$91.65

Service Code	NDC 00172208360
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$36.66
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 Commercial	$64.16
Rate for Payer: Cofinity Commercial	$78.82
Rate for Payer: Cofinity Medicare Advantage	$64.16
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: PHP Commercial	$77.90
Rate for Payer: Priority Health Cigna Priority Health	$59.57
Rate for Payer: Priority Health SBD	$57.74

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$23.50

Service Code	NDC 16729018301
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$9.40
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 Commercial	$16.45
Rate for Payer: Cofinity Commercial	$20.21
Rate for Payer: Cofinity Medicare Advantage	$16.45
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: PHP Commercial	$19.98
Rate for Payer: Priority Health Cigna Priority Health	$15.28
Rate for Payer: Priority Health SBD	$14.80

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$437.10

Service Code	NDC 60687059301
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$275.37
Max. Negotiated Rate	$393.39
Rate for Payer: Aetna Commercial	$371.54
Rate for Payer: Aetna New Business (MI Preferred)	$284.12
Rate for Payer: Cash Price	$349.68
Rate for Payer: Cofinity Commercial	$305.97
Rate for Payer: Cofinity Commercial	$375.91
Rate for Payer: Cofinity Medicare Advantage	$305.97
Rate for Payer: Encore Health Key Benefits Commercial	$349.68
Rate for Payer: Healthscope Commercial	$393.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$371.54
Rate for Payer: PHP Commercial	$371.54
Rate for Payer: Priority Health Cigna Priority Health	$284.12
Rate for Payer: Priority Health SBD	$275.37

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$47.00

Service Code	NDC 23155000801
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$18.80
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna Commercial	$39.95
Rate for Payer: Aetna Medicare	$23.50
Rate for Payer: Aetna New Business (MI Preferred)	$30.55
Rate for Payer: BCBS Complete	$18.80
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cofinity Commercial	$32.90
Rate for Payer: Cofinity Commercial	$40.42
Rate for Payer: Cofinity Medicare Advantage	$32.90
Rate for Payer: Encore Health Key Benefits Commercial	$37.60
Rate for Payer: Healthscope Commercial	$42.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.95
Rate for Payer: PHP Commercial	$39.95
Rate for Payer: Priority Health Cigna Priority Health	$30.55
Rate for Payer: Priority Health SBD	$29.61

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 Commercial	$16.45
Rate for Payer: Cofinity Commercial	$20.21
Rate for Payer: Cofinity Medicare Advantage	$16.45
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: PHP Commercial	$19.98
Rate for Payer: Priority Health Cigna Priority Health	$15.28
Rate for Payer: Priority Health SBD	$14.80

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 Commercial	$64.16
Rate for Payer: Cofinity Commercial	$78.82
Rate for Payer: Cofinity Medicare Advantage	$64.16
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: PHP Commercial	$77.90
Rate for Payer: Priority Health Cigna Priority Health	$59.57
Rate for Payer: Priority Health SBD	$57.74

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$4.38

Service Code	NDC 60687059311
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$2.76
Max. Negotiated Rate	$3.94
Rate for Payer: Aetna Commercial	$3.72
Rate for Payer: Aetna New Business (MI Preferred)	$2.85
Rate for Payer: Cash Price	$3.50
Rate for Payer: Cofinity Commercial	$3.07
Rate for Payer: Cofinity Commercial	$3.77
Rate for Payer: Cofinity Medicare Advantage	$3.07
Rate for Payer: Encore Health Key Benefits Commercial	$3.50
Rate for Payer: Healthscope Commercial	$3.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.72
Rate for Payer: PHP Commercial	$3.72
Rate for Payer: Priority Health Cigna Priority Health	$2.85
Rate for Payer: Priority Health SBD	$2.76

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$80.33

Service Code	NDC 00406012562
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$32.13
Max. Negotiated Rate	$72.30
Rate for Payer: Aetna Commercial	$68.28
Rate for Payer: Aetna Medicare	$40.16
Rate for Payer: Aetna New Business (MI Preferred)	$52.21
Rate for Payer: BCBS Complete	$32.13
Rate for Payer: Cash Price	$64.26
Rate for Payer: Cofinity Commercial	$56.23
Rate for Payer: Cofinity Commercial	$69.08
Rate for Payer: Cofinity Medicare Advantage	$56.23
Rate for Payer: Encore Health Key Benefits Commercial	$64.26
Rate for Payer: Healthscope Commercial	$72.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$68.28
Rate for Payer: PHP Commercial	$68.28
Rate for Payer: Priority Health Cigna Priority Health	$52.21
Rate for Payer: Priority Health SBD	$50.61

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$8.04

Service Code	NDC 00406012523
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$7.24
Rate for Payer: Aetna Commercial	$6.83
Rate for Payer: Aetna Medicare	$4.02
Rate for Payer: Aetna New Business (MI Preferred)	$5.23
Rate for Payer: BCBS Complete	$3.22
Rate for Payer: Cash Price	$6.43
Rate for Payer: Cofinity Commercial	$5.63
Rate for Payer: Cofinity Commercial	$6.91
Rate for Payer: Cofinity Medicare Advantage	$5.63
Rate for Payer: Encore Health Key Benefits Commercial	$6.43
Rate for Payer: Healthscope Commercial	$7.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.83
Rate for Payer: PHP Commercial	$6.83
Rate for Payer: Priority Health Cigna Priority Health	$5.23
Rate for Payer: Priority Health SBD	$5.07

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$80.33

Service Code	NDC 00406012562
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$50.61
Max. Negotiated Rate	$72.30
Rate for Payer: Aetna Commercial	$68.28
Rate for Payer: Aetna New Business (MI Preferred)	$52.21
Rate for Payer: Cash Price	$64.26
Rate for Payer: Cofinity Commercial	$56.23
Rate for Payer: Cofinity Commercial	$69.08
Rate for Payer: Cofinity Medicare Advantage	$56.23
Rate for Payer: Encore Health Key Benefits Commercial	$64.26
Rate for Payer: Healthscope Commercial	$72.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$68.28
Rate for Payer: PHP Commercial	$68.28
Rate for Payer: Priority Health Cigna Priority Health	$52.21
Rate for Payer: Priority Health SBD	$50.61

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 Commercial	$480.20
Rate for Payer: Cofinity Commercial	$589.96
Rate for Payer: Cofinity Medicare Advantage	$480.20
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: PHP Commercial	$583.10
Rate for Payer: Priority Health Cigna Priority Health	$445.90
Rate for Payer: Priority Health SBD	$432.18

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$8.04

Service Code	NDC 00406012523
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$7.24
Rate for Payer: Aetna Commercial	$6.83
Rate for Payer: Aetna New Business (MI Preferred)	$5.23
Rate for Payer: Cash Price	$6.43
Rate for Payer: Cofinity Commercial	$5.63
Rate for Payer: Cofinity Commercial	$6.91
Rate for Payer: Cofinity Medicare Advantage	$5.63
Rate for Payer: Encore Health Key Benefits Commercial	$6.43
Rate for Payer: Healthscope Commercial	$7.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.83
Rate for Payer: PHP Commercial	$6.83
Rate for Payer: Priority Health Cigna Priority Health	$5.23
Rate for Payer: Priority Health SBD	$5.07

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	$274.40
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 Commercial	$480.20
Rate for Payer: Cofinity Commercial	$589.96
Rate for Payer: Cofinity Medicare Advantage	$480.20
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: PHP Commercial	$583.10
Rate for Payer: Priority Health Cigna Priority Health	$445.90
Rate for Payer: Priority Health SBD	$432.18

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$6.37

Service Code	NDC 00406012323
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$5.73
Rate for Payer: Aetna Commercial	$5.41
Rate for Payer: Aetna Medicare	$3.19
Rate for Payer: Aetna New Business (MI Preferred)	$4.14
Rate for Payer: BCBS Complete	$2.55
Rate for Payer: Cash Price	$5.10
Rate for Payer: Cofinity Commercial	$4.46
Rate for Payer: Cofinity Commercial	$5.48
Rate for Payer: Cofinity Medicare Advantage	$4.46
Rate for Payer: Encore Health Key Benefits Commercial	$5.10
Rate for Payer: Healthscope Commercial	$5.73
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	$4.14
Rate for Payer: Priority Health SBD	$4.01

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$862.75

Service Code	NDC 68084089501
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	$741.97
Rate for Payer: Cofinity Medicare Advantage	$603.92
Rate for Payer: Encore Health Key Benefits Commercial	$690.20
Rate for Payer: Healthscope Commercial	$776.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$733.34
Rate for Payer: PHP Commercial	$733.34
Rate for Payer: Priority Health Cigna Priority Health	$560.79
Rate for Payer: Priority Health SBD	$543.53

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$63.70

Service Code	NDC 00406012362
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$40.13
Max. Negotiated Rate	$57.33
Rate for Payer: Aetna Commercial	$54.15
Rate for Payer: Aetna New Business (MI Preferred)	$41.41
Rate for Payer: Cash Price	$50.96
Rate for Payer: Cofinity Commercial	$44.59
Rate for Payer: Cofinity Commercial	$54.78
Rate for Payer: Cofinity Medicare Advantage	$44.59
Rate for Payer: Encore Health Key Benefits Commercial	$50.96
Rate for Payer: Healthscope Commercial	$57.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.15
Rate for Payer: PHP Commercial	$54.15
Rate for Payer: Priority Health Cigna Priority Health	$41.41
Rate for Payer: Priority Health SBD	$40.13

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 Commercial	$6.04
Rate for Payer: Cofinity Commercial	$7.42
Rate for Payer: Cofinity Medicare Advantage	$6.04
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: PHP Commercial	$7.34
Rate for Payer: Priority Health Cigna Priority Health	$5.61
Rate for Payer: Priority Health SBD	$5.44

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$862.75

Service Code	NDC 68084089501
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 Medicare	$431.38
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	$741.97
Rate for Payer: Cofinity Medicare Advantage	$603.92
Rate for Payer: Encore Health Key Benefits Commercial	$690.20
Rate for Payer: Healthscope Commercial	$776.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$733.34
Rate for Payer: PHP Commercial	$733.34
Rate for Payer: Priority Health Cigna Priority Health	$560.79
Rate for Payer: Priority Health SBD	$543.53

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$6.37

Service Code	NDC 00406012323
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$5.73
Rate for Payer: Aetna Commercial	$5.41
Rate for Payer: Aetna New Business (MI Preferred)	$4.14
Rate for Payer: Cash Price	$5.10
Rate for Payer: Cofinity Commercial	$4.46
Rate for Payer: Cofinity Commercial	$5.48
Rate for Payer: Cofinity Medicare Advantage	$4.46
Rate for Payer: Encore Health Key Benefits Commercial	$5.10
Rate for Payer: Healthscope Commercial	$5.73
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	$4.14
Rate for Payer: Priority Health SBD	$4.01

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$175.00

Service Code	NDC 27808003501
Hospital Charge Code	34505
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 Commercial	$122.50
Rate for Payer: Cofinity Commercial	$150.50
Rate for Payer: Cofinity Medicare Advantage	$122.50
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: PHP Commercial	$148.75
Rate for Payer: Priority Health Cigna Priority Health	$113.75
Rate for Payer: Priority Health SBD	$110.25

Know your out-of-pocket cost for care.

All Charges