Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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

$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

$195.13

Service Code	NDC 50268040115
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$122.93
Max. Negotiated Rate	$175.62
Rate for Payer: Aetna Commercial	$165.86
Rate for Payer: Aetna New Business (MI Preferred)	$126.83
Rate for Payer: Cash Price	$156.10
Rate for Payer: Cofinity Commercial	$136.59
Rate for Payer: Cofinity Commercial	$167.81
Rate for Payer: Cofinity Medicare Advantage	$136.59
Rate for Payer: Encore Health Key Benefits Commercial	$156.10
Rate for Payer: Healthscope Commercial	$175.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$165.86
Rate for Payer: PHP Commercial	$165.86
Rate for Payer: Priority Health Cigna Priority Health	$126.83
Rate for Payer: Priority Health SBD	$122.93

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

$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

$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

$3.91

Service Code	NDC 50268040111
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$3.52
Rate for Payer: Aetna Commercial	$3.32
Rate for Payer: Aetna Medicare	$1.96
Rate for Payer: Aetna New Business (MI Preferred)	$2.54
Rate for Payer: BCBS Complete	$1.56
Rate for Payer: Cash Price	$3.13
Rate for Payer: Cofinity Commercial	$2.74
Rate for Payer: Cofinity Commercial	$3.36
Rate for Payer: Cofinity Medicare Advantage	$2.74
Rate for Payer: Encore Health Key Benefits Commercial	$3.13
Rate for Payer: Healthscope Commercial	$3.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.32
Rate for Payer: PHP Commercial	$3.32
Rate for Payer: Priority Health Cigna Priority Health	$2.54
Rate for Payer: Priority Health SBD	$2.46

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$195.13

Service Code	NDC 50268040115
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$78.05
Max. Negotiated Rate	$175.62
Rate for Payer: Aetna Commercial	$165.86
Rate for Payer: Aetna Medicare	$97.56
Rate for Payer: Aetna New Business (MI Preferred)	$126.83
Rate for Payer: BCBS Complete	$78.05
Rate for Payer: Cash Price	$156.10
Rate for Payer: Cofinity Commercial	$136.59
Rate for Payer: Cofinity Commercial	$167.81
Rate for Payer: Cofinity Medicare Advantage	$136.59
Rate for Payer: Encore Health Key Benefits Commercial	$156.10
Rate for Payer: Healthscope Commercial	$175.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$165.86
Rate for Payer: PHP Commercial	$165.86
Rate for Payer: Priority Health Cigna Priority Health	$126.83
Rate for Payer: Priority Health SBD	$122.93

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

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION

Facility

$21.04

Service Code	NDC 00121231640
Hospital Charge Code	37848
Hospital Revenue Code	637
Min. Negotiated Rate	$8.42
Max. Negotiated Rate	$18.94
Rate for Payer: Aetna Commercial	$17.88
Rate for Payer: Aetna Medicare	$10.52
Rate for Payer: Aetna New Business (MI Preferred)	$13.68
Rate for Payer: BCBS Complete	$8.42
Rate for Payer: Cash Price	$16.83
Rate for Payer: Cofinity Commercial	$14.73
Rate for Payer: Cofinity Commercial	$18.09
Rate for Payer: Cofinity Medicare Advantage	$14.73
Rate for Payer: Encore Health Key Benefits Commercial	$16.83
Rate for Payer: Healthscope Commercial	$18.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.88
Rate for Payer: PHP Commercial	$17.88
Rate for Payer: Priority Health Cigna Priority Health	$13.68
Rate for Payer: Priority Health SBD	$13.26

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION

Facility

$15.45

Service Code	NDC 66689002350
Hospital Charge Code	37848
Hospital Revenue Code	637
Min. Negotiated Rate	$9.73
Max. Negotiated Rate	$13.90
Rate for Payer: Aetna Commercial	$13.13
Rate for Payer: Aetna New Business (MI Preferred)	$10.04
Rate for Payer: Cash Price	$12.36
Rate for Payer: Cofinity Commercial	$10.81
Rate for Payer: Cofinity Commercial	$13.29
Rate for Payer: Cofinity Medicare Advantage	$10.81
Rate for Payer: Encore Health Key Benefits Commercial	$12.36
Rate for Payer: Healthscope Commercial	$13.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.13
Rate for Payer: PHP Commercial	$13.13
Rate for Payer: Priority Health Cigna Priority Health	$10.04
Rate for Payer: Priority Health SBD	$9.73

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION

Facility

$21.04

Service Code	NDC 00121231640
Hospital Charge Code	37848
Hospital Revenue Code	637
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$18.94
Rate for Payer: Aetna Commercial	$17.88
Rate for Payer: Aetna New Business (MI Preferred)	$13.68
Rate for Payer: Cash Price	$16.83
Rate for Payer: Cofinity Commercial	$14.73
Rate for Payer: Cofinity Commercial	$18.09
Rate for Payer: Cofinity Medicare Advantage	$14.73
Rate for Payer: Encore Health Key Benefits Commercial	$16.83
Rate for Payer: Healthscope Commercial	$18.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.88
Rate for Payer: PHP Commercial	$17.88
Rate for Payer: Priority Health Cigna Priority Health	$13.68
Rate for Payer: Priority Health SBD	$13.26

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION

Facility

$15.45

Service Code	NDC 66689002301
Hospital Charge Code	37848
Hospital Revenue Code	637
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$13.90
Rate for Payer: Aetna Commercial	$13.13
Rate for Payer: Aetna Medicare	$7.72
Rate for Payer: Aetna New Business (MI Preferred)	$10.04
Rate for Payer: BCBS Complete	$6.18
Rate for Payer: Cash Price	$12.36
Rate for Payer: Cofinity Commercial	$10.81
Rate for Payer: Cofinity Commercial	$13.29
Rate for Payer: Cofinity Medicare Advantage	$10.81
Rate for Payer: Encore Health Key Benefits Commercial	$12.36
Rate for Payer: Healthscope Commercial	$13.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.13
Rate for Payer: PHP Commercial	$13.13
Rate for Payer: Priority Health Cigna Priority Health	$10.04
Rate for Payer: Priority Health SBD	$9.73

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION

Facility

$16.38

Service Code	NDC 00121231615
Hospital Charge Code	37848
Hospital Revenue Code	637
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$14.74
Rate for Payer: Aetna Commercial	$13.92
Rate for Payer: Aetna New Business (MI Preferred)	$10.65
Rate for Payer: Cash Price	$13.10
Rate for Payer: Cofinity Commercial	$11.47
Rate for Payer: Cofinity Commercial	$14.09
Rate for Payer: Cofinity Medicare Advantage	$11.47
Rate for Payer: Encore Health Key Benefits Commercial	$13.10
Rate for Payer: Healthscope Commercial	$14.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.92
Rate for Payer: PHP Commercial	$13.92
Rate for Payer: Priority Health Cigna Priority Health	$10.65
Rate for Payer: Priority Health SBD	$10.32

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION

Facility

$15.45

Service Code	NDC 66689002301
Hospital Charge Code	37848
Hospital Revenue Code	637
Min. Negotiated Rate	$9.73
Max. Negotiated Rate	$13.90
Rate for Payer: Aetna Commercial	$13.13
Rate for Payer: Aetna New Business (MI Preferred)	$10.04
Rate for Payer: Cash Price	$12.36
Rate for Payer: Cofinity Commercial	$10.81
Rate for Payer: Cofinity Commercial	$13.29
Rate for Payer: Cofinity Medicare Advantage	$10.81
Rate for Payer: Encore Health Key Benefits Commercial	$12.36
Rate for Payer: Healthscope Commercial	$13.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.13
Rate for Payer: PHP Commercial	$13.13
Rate for Payer: Priority Health Cigna Priority Health	$10.04
Rate for Payer: Priority Health SBD	$9.73

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION

Facility

$15.45

Service Code	NDC 66689002350
Hospital Charge Code	37848
Hospital Revenue Code	637
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$13.90
Rate for Payer: Aetna Commercial	$13.13
Rate for Payer: Aetna Medicare	$7.72
Rate for Payer: Aetna New Business (MI Preferred)	$10.04
Rate for Payer: BCBS Complete	$6.18
Rate for Payer: Cash Price	$12.36
Rate for Payer: Cofinity Commercial	$10.81
Rate for Payer: Cofinity Commercial	$13.29
Rate for Payer: Cofinity Medicare Advantage	$10.81
Rate for Payer: Encore Health Key Benefits Commercial	$12.36
Rate for Payer: Healthscope Commercial	$13.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.13
Rate for Payer: PHP Commercial	$13.13
Rate for Payer: Priority Health Cigna Priority Health	$10.04
Rate for Payer: Priority Health SBD	$9.73

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION

Facility

$28.48

Service Code	NDC 00121477205
Hospital Charge Code	37848
Hospital Revenue Code	637
Min. Negotiated Rate	$17.94
Max. Negotiated Rate	$25.63
Rate for Payer: Aetna Commercial	$24.21
Rate for Payer: Aetna New Business (MI Preferred)	$18.51
Rate for Payer: Cash Price	$22.78
Rate for Payer: Cofinity Commercial	$19.94
Rate for Payer: Cofinity Commercial	$24.49
Rate for Payer: Cofinity Medicare Advantage	$19.94
Rate for Payer: Encore Health Key Benefits Commercial	$22.78
Rate for Payer: Healthscope Commercial	$25.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.21
Rate for Payer: PHP Commercial	$24.21
Rate for Payer: Priority Health Cigna Priority Health	$18.51
Rate for Payer: Priority Health SBD	$17.94

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION

Facility

$16.38

Service Code	NDC 00121231615
Hospital Charge Code	37848
Hospital Revenue Code	637
Min. Negotiated Rate	$6.55
Max. Negotiated Rate	$14.74
Rate for Payer: Aetna Commercial	$13.92
Rate for Payer: Aetna Medicare	$8.19
Rate for Payer: Aetna New Business (MI Preferred)	$10.65
Rate for Payer: BCBS Complete	$6.55
Rate for Payer: Cash Price	$13.10
Rate for Payer: Cofinity Commercial	$11.47
Rate for Payer: Cofinity Commercial	$14.09
Rate for Payer: Cofinity Medicare Advantage	$11.47
Rate for Payer: Encore Health Key Benefits Commercial	$13.10
Rate for Payer: Healthscope Commercial	$14.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.92
Rate for Payer: PHP Commercial	$13.92
Rate for Payer: Priority Health Cigna Priority Health	$10.65
Rate for Payer: Priority Health SBD	$10.32

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION

Facility

$28.48

Service Code	NDC 00121477205
Hospital Charge Code	37848
Hospital Revenue Code	637
Min. Negotiated Rate	$11.39
Max. Negotiated Rate	$25.63
Rate for Payer: Aetna Commercial	$24.21
Rate for Payer: Aetna Medicare	$14.24
Rate for Payer: Aetna New Business (MI Preferred)	$18.51
Rate for Payer: BCBS Complete	$11.39
Rate for Payer: Cash Price	$22.78
Rate for Payer: Cofinity Commercial	$19.94
Rate for Payer: Cofinity Commercial	$24.49
Rate for Payer: Cofinity Medicare Advantage	$19.94
Rate for Payer: Encore Health Key Benefits Commercial	$22.78
Rate for Payer: Healthscope Commercial	$25.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.21
Rate for Payer: PHP Commercial	$24.21
Rate for Payer: Priority Health Cigna Priority Health	$18.51
Rate for Payer: Priority Health SBD	$17.94

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$757.75

Service Code	NDC 00406012462
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$303.10
Max. Negotiated Rate	$681.98
Rate for Payer: Aetna Commercial	$644.09
Rate for Payer: Aetna Medicare	$378.88
Rate for Payer: Aetna New Business (MI Preferred)	$492.54
Rate for Payer: BCBS Complete	$303.10
Rate for Payer: Cash Price	$606.20
Rate for Payer: Cofinity Commercial	$530.42
Rate for Payer: Cofinity Commercial	$651.66
Rate for Payer: Cofinity Medicare Advantage	$530.42
Rate for Payer: Encore Health Key Benefits Commercial	$606.20
Rate for Payer: Healthscope Commercial	$681.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$644.09
Rate for Payer: PHP Commercial	$644.09
Rate for Payer: Priority Health Cigna Priority Health	$492.54
Rate for Payer: Priority Health SBD	$477.38

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$7.58

Service Code	NDC 00406012423
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$4.78
Max. Negotiated Rate	$6.82
Rate for Payer: Aetna Commercial	$6.44
Rate for Payer: Aetna New Business (MI Preferred)	$4.93
Rate for Payer: Cash Price	$6.06
Rate for Payer: Cofinity Commercial	$5.31
Rate for Payer: Cofinity Commercial	$6.52
Rate for Payer: Cofinity Medicare Advantage	$5.31
Rate for Payer: Encore Health Key Benefits Commercial	$6.06
Rate for Payer: Healthscope Commercial	$6.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.44
Rate for Payer: PHP Commercial	$6.44
Rate for Payer: Priority Health Cigna Priority Health	$4.93
Rate for Payer: Priority Health SBD	$4.78

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$7.58

Service Code	NDC 00406012423
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$6.82
Rate for Payer: Aetna Commercial	$6.44
Rate for Payer: Aetna Medicare	$3.79
Rate for Payer: Aetna New Business (MI Preferred)	$4.93
Rate for Payer: BCBS Complete	$3.03
Rate for Payer: Cash Price	$6.06
Rate for Payer: Cofinity Commercial	$5.31
Rate for Payer: Cofinity Commercial	$6.52
Rate for Payer: Cofinity Medicare Advantage	$5.31
Rate for Payer: Encore Health Key Benefits Commercial	$6.06
Rate for Payer: Healthscope Commercial	$6.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.44
Rate for Payer: PHP Commercial	$6.44
Rate for Payer: Priority Health Cigna Priority Health	$4.93
Rate for Payer: Priority Health SBD	$4.78

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$4.71

Service Code	NDC 50268040011
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$4.24
Rate for Payer: Aetna Commercial	$4.00
Rate for Payer: Aetna New Business (MI Preferred)	$3.06
Rate for Payer: Cash Price	$3.77
Rate for Payer: Cofinity Commercial	$3.30
Rate for Payer: Cofinity Commercial	$4.05
Rate for Payer: Cofinity Medicare Advantage	$3.30
Rate for Payer: Encore Health Key Benefits Commercial	$3.77
Rate for Payer: Healthscope Commercial	$4.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.00
Rate for Payer: PHP Commercial	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.06
Rate for Payer: Priority Health SBD	$2.97

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 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

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	$70.00
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 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