Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HYDRALAZINE 25 MG TABLET

Facility

$4.21

Service Code	NDC 51079-075-01
Hospital Charge Code	3700
Hospital Revenue Code	637
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$4.21
Rate for Payer: Aetna Commercial	$3.79
Rate for Payer: ASR ASR	$4.08
Rate for Payer: BCBS Trust/PPO	$3.26
Rate for Payer: BCN Commercial	$3.26
Rate for Payer: Cash Price	$3.37
Rate for Payer: Cofinity Commercial	$3.96
Rate for Payer: Encore Health Key Benefits Commercial	$3.37
Rate for Payer: Healthscope Commercial	$4.21
Rate for Payer: Healthscope Whirlpool	$4.08
Rate for Payer: Mclaren Commercial	$3.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.58
Rate for Payer: Priority Health Cigna Priority Health	$2.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.70

HYDRALAZINE 25 MG TABLET

Facility

$420.65

Service Code	NDC 51079-075-20
Hospital Charge Code	3700
Hospital Revenue Code	637
Min. Negotiated Rate	$294.46
Max. Negotiated Rate	$420.65
Rate for Payer: Aetna Commercial	$378.58
Rate for Payer: ASR ASR	$408.03
Rate for Payer: BCBS Trust/PPO	$326.13
Rate for Payer: BCN Commercial	$326.13
Rate for Payer: Cash Price	$336.52
Rate for Payer: Cofinity Commercial	$395.41
Rate for Payer: Encore Health Key Benefits Commercial	$336.52
Rate for Payer: Healthscope Commercial	$420.65
Rate for Payer: Healthscope Whirlpool	$408.03
Rate for Payer: Mclaren Commercial	$378.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$357.55
Rate for Payer: Priority Health Cigna Priority Health	$294.46
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$370.17

HYDRALAZINE 25 MG TABLET

Facility

$3.74

Service Code	NDC 62584-733-11
Hospital Charge Code	3700
Hospital Revenue Code	637
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$3.74
Rate for Payer: Aetna Commercial	$3.37
Rate for Payer: ASR ASR	$3.63
Rate for Payer: BCBS Trust/PPO	$2.90
Rate for Payer: BCN Commercial	$2.90
Rate for Payer: Cash Price	$2.99
Rate for Payer: Cofinity Commercial	$3.52
Rate for Payer: Encore Health Key Benefits Commercial	$2.99
Rate for Payer: Healthscope Commercial	$3.74
Rate for Payer: Healthscope Whirlpool	$3.63
Rate for Payer: Mclaren Commercial	$3.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.18
Rate for Payer: Priority Health Cigna Priority Health	$2.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.29

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$58.75

Service Code	NDC 63739-128-10
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$41.12
Max. Negotiated Rate	$58.75
Rate for Payer: Aetna Commercial	$52.88
Rate for Payer: ASR ASR	$56.99
Rate for Payer: BCBS Trust/PPO	$45.55
Rate for Payer: BCN Commercial	$45.55
Rate for Payer: Cash Price	$47.00
Rate for Payer: Cofinity Commercial	$55.22
Rate for Payer: Encore Health Key Benefits Commercial	$47.00
Rate for Payer: Healthscope Commercial	$58.75
Rate for Payer: Healthscope Whirlpool	$56.99
Rate for Payer: Mclaren Commercial	$52.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$49.94
Rate for Payer: Priority Health Cigna Priority Health	$41.12
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$51.70

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$298.45

Service Code	NDC 60687-593-01
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$208.92
Max. Negotiated Rate	$298.45
Rate for Payer: Aetna Commercial	$268.60
Rate for Payer: ASR ASR	$289.50
Rate for Payer: BCBS Trust/PPO	$231.39
Rate for Payer: BCN Commercial	$231.39
Rate for Payer: Cash Price	$238.76
Rate for Payer: Cofinity Commercial	$280.54
Rate for Payer: Encore Health Key Benefits Commercial	$238.76
Rate for Payer: Healthscope Commercial	$298.45
Rate for Payer: Healthscope Whirlpool	$289.50
Rate for Payer: Mclaren Commercial	$268.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$253.68
Rate for Payer: Priority Health Cigna Priority Health	$208.92
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$262.64

HYDROCHLOROTHIAZIDE 25 MG TABLET

Facility

$2.98

Service Code	NDC 60687-593-11
Hospital Charge Code	3720
Hospital Revenue Code	637
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$2.98
Rate for Payer: Aetna Commercial	$2.68
Rate for Payer: ASR ASR	$2.89
Rate for Payer: BCBS Trust/PPO	$2.31
Rate for Payer: BCN Commercial	$2.31
Rate for Payer: Cash Price	$2.39
Rate for Payer: Cofinity Commercial	$2.80
Rate for Payer: Encore Health Key Benefits Commercial	$2.38
Rate for Payer: Healthscope Commercial	$2.98
Rate for Payer: Healthscope Whirlpool	$2.89
Rate for Payer: Mclaren Commercial	$2.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.53
Rate for Payer: Priority Health Cigna Priority Health	$2.09
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2.62

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$7.26

Service Code	NDC 50268-402-11
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$7.26
Rate for Payer: Aetna Commercial	$6.53
Rate for Payer: ASR ASR	$7.04
Rate for Payer: BCBS Trust/PPO	$5.63
Rate for Payer: BCN Commercial	$5.63
Rate for Payer: Cash Price	$5.81
Rate for Payer: Cofinity Commercial	$6.82
Rate for Payer: Encore Health Key Benefits Commercial	$5.81
Rate for Payer: Healthscope Commercial	$7.26
Rate for Payer: Healthscope Whirlpool	$7.04
Rate for Payer: Mclaren Commercial	$6.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6.17
Rate for Payer: Priority Health Cigna Priority Health	$5.08
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$6.39

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$81.03

Service Code	NDC 0406-0125-62
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$56.72
Max. Negotiated Rate	$81.03
Rate for Payer: Aetna Commercial	$72.93
Rate for Payer: ASR ASR	$78.60
Rate for Payer: BCBS Trust/PPO	$62.82
Rate for Payer: BCN Commercial	$62.82
Rate for Payer: Cash Price	$64.82
Rate for Payer: Cofinity Commercial	$76.17
Rate for Payer: Encore Health Key Benefits Commercial	$64.82
Rate for Payer: Healthscope Commercial	$81.03
Rate for Payer: Healthscope Whirlpool	$78.60
Rate for Payer: Mclaren Commercial	$72.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$68.88
Rate for Payer: Priority Health Cigna Priority Health	$56.72
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$71.31

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$363.12

Service Code	NDC 50268-402-15
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$254.18
Max. Negotiated Rate	$363.12
Rate for Payer: Aetna Commercial	$326.81
Rate for Payer: ASR ASR	$352.23
Rate for Payer: BCBS Trust/PPO	$281.53
Rate for Payer: BCN Commercial	$281.53
Rate for Payer: Cash Price	$290.50
Rate for Payer: Cofinity Commercial	$341.33
Rate for Payer: Encore Health Key Benefits Commercial	$290.50
Rate for Payer: Healthscope Commercial	$363.12
Rate for Payer: Healthscope Whirlpool	$352.23
Rate for Payer: Mclaren Commercial	$326.81
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$308.65
Rate for Payer: Priority Health Cigna Priority Health	$254.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$319.55

HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$8.10

Service Code	NDC 0406-0125-23
Hospital Charge Code	28384
Hospital Revenue Code	637
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna Commercial	$7.29
Rate for Payer: ASR ASR	$7.86
Rate for Payer: BCBS Trust/PPO	$6.28
Rate for Payer: BCN Commercial	$6.28
Rate for Payer: Cash Price	$6.48
Rate for Payer: Cofinity Commercial	$7.61
Rate for Payer: Encore Health Key Benefits Commercial	$6.48
Rate for Payer: Healthscope Commercial	$8.10
Rate for Payer: Healthscope Whirlpool	$7.86
Rate for Payer: Mclaren Commercial	$7.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6.88
Rate for Payer: Priority Health Cigna Priority Health	$5.67
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$7.13

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$69.12

Service Code	NDC 0406-0123-62
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$48.38
Max. Negotiated Rate	$69.12
Rate for Payer: Aetna Commercial	$62.21
Rate for Payer: ASR ASR	$67.05
Rate for Payer: BCBS Trust/PPO	$53.59
Rate for Payer: BCN Commercial	$53.59
Rate for Payer: Cash Price	$55.30
Rate for Payer: Cofinity Commercial	$64.97
Rate for Payer: Encore Health Key Benefits Commercial	$55.30
Rate for Payer: Healthscope Commercial	$69.12
Rate for Payer: Healthscope Whirlpool	$67.05
Rate for Payer: Mclaren Commercial	$62.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$58.75
Rate for Payer: Priority Health Cigna Priority Health	$48.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$60.83

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$3.80

Service Code	NDC 50268-401-11
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$3.80
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: ASR ASR	$3.69
Rate for Payer: BCBS Trust/PPO	$2.95
Rate for Payer: BCN Commercial	$2.95
Rate for Payer: Cash Price	$3.04
Rate for Payer: Cofinity Commercial	$3.57
Rate for Payer: Encore Health Key Benefits Commercial	$3.04
Rate for Payer: Healthscope Commercial	$3.80
Rate for Payer: Healthscope Whirlpool	$3.69
Rate for Payer: Mclaren Commercial	$3.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.23
Rate for Payer: Priority Health Cigna Priority Health	$2.66
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.34

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$6.91

Service Code	NDC 0406-0123-23
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$6.91
Rate for Payer: Aetna Commercial	$6.22
Rate for Payer: ASR ASR	$6.70
Rate for Payer: BCBS Trust/PPO	$5.36
Rate for Payer: BCN Commercial	$5.36
Rate for Payer: Cash Price	$5.53
Rate for Payer: Cofinity Commercial	$6.50
Rate for Payer: Encore Health Key Benefits Commercial	$5.53
Rate for Payer: Healthscope Commercial	$6.91
Rate for Payer: Healthscope Whirlpool	$6.70
Rate for Payer: Mclaren Commercial	$6.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5.87
Rate for Payer: Priority Health Cigna Priority Health	$4.84
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$6.08

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$1,627.50

Service Code	NDC 0406-0123-05
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$1,139.25
Max. Negotiated Rate	$1,627.50
Rate for Payer: Aetna Commercial	$1,464.75
Rate for Payer: ASR ASR	$1,578.68
Rate for Payer: BCBS Trust/PPO	$1,261.80
Rate for Payer: BCN Commercial	$1,261.80
Rate for Payer: Cash Price	$1,302.00
Rate for Payer: Cofinity Commercial	$1,529.85
Rate for Payer: Encore Health Key Benefits Commercial	$1,302.00
Rate for Payer: Healthscope Commercial	$1,627.50
Rate for Payer: Healthscope Whirlpool	$1,578.68
Rate for Payer: Mclaren Commercial	$1,464.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,383.38
Rate for Payer: Priority Health Cigna Priority Health	$1,139.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,432.20

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$189.88

Service Code	NDC 50268-401-15
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$132.92
Max. Negotiated Rate	$189.88
Rate for Payer: Aetna Commercial	$170.89
Rate for Payer: ASR ASR	$184.18
Rate for Payer: BCBS Trust/PPO	$147.21
Rate for Payer: BCN Commercial	$147.21
Rate for Payer: Cash Price	$151.90
Rate for Payer: Cofinity Commercial	$178.49
Rate for Payer: Encore Health Key Benefits Commercial	$151.90
Rate for Payer: Healthscope Commercial	$189.88
Rate for Payer: Healthscope Whirlpool	$184.18
Rate for Payer: Mclaren Commercial	$170.89
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$161.40
Rate for Payer: Priority Health Cigna Priority Health	$132.92
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$167.09

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$862.75

Service Code	NDC 68084-895-01
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$603.92
Max. Negotiated Rate	$862.75
Rate for Payer: Aetna Commercial	$776.48
Rate for Payer: ASR ASR	$836.87
Rate for Payer: BCBS Trust/PPO	$668.89
Rate for Payer: BCN Commercial	$668.89
Rate for Payer: Cash Price	$690.20
Rate for Payer: Cofinity Commercial	$810.98
Rate for Payer: Encore Health Key Benefits Commercial	$690.20
Rate for Payer: Healthscope Commercial	$862.75
Rate for Payer: Healthscope Whirlpool	$836.87
Rate for Payer: Mclaren Commercial	$776.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$733.34
Rate for Payer: Priority Health Cigna Priority Health	$603.92
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$759.22

HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$8.63

Service Code	NDC 68084-895-11
Hospital Charge Code	34505
Hospital Revenue Code	637
Min. Negotiated Rate	$6.04
Max. Negotiated Rate	$8.63
Rate for Payer: Aetna Commercial	$7.77
Rate for Payer: ASR ASR	$8.37
Rate for Payer: BCBS Trust/PPO	$6.69
Rate for Payer: BCN Commercial	$6.69
Rate for Payer: Cash Price	$6.90
Rate for Payer: Cofinity Commercial	$8.11
Rate for Payer: Encore Health Key Benefits Commercial	$6.90
Rate for Payer: Healthscope Commercial	$8.63
Rate for Payer: Healthscope Whirlpool	$8.37
Rate for Payer: Mclaren Commercial	$7.77
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7.34
Rate for Payer: Priority Health Cigna Priority Health	$6.04
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$7.59

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

Facility

$15.44

Service Code	NDC 66689-023-01
Hospital Charge Code	37848
Hospital Revenue Code	637
Min. Negotiated Rate	$10.81
Max. Negotiated Rate	$15.44
Rate for Payer: Aetna Commercial	$13.90
Rate for Payer: ASR ASR	$14.98
Rate for Payer: BCBS Trust/PPO	$11.97
Rate for Payer: BCN Commercial	$11.97
Rate for Payer: Cash Price	$12.36
Rate for Payer: Cofinity Commercial	$14.51
Rate for Payer: Encore Health Key Benefits Commercial	$12.35
Rate for Payer: Healthscope Commercial	$15.44
Rate for Payer: Healthscope Whirlpool	$14.98
Rate for Payer: Mclaren Commercial	$13.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.12
Rate for Payer: Priority Health Cigna Priority Health	$10.81
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$13.59

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

Facility

$42.44

Service Code	NDC 0121-0772-04
Hospital Charge Code	37848
Hospital Revenue Code	637
Min. Negotiated Rate	$29.71
Max. Negotiated Rate	$42.44
Rate for Payer: Aetna Commercial	$38.20
Rate for Payer: ASR ASR	$41.17
Rate for Payer: BCBS Trust/PPO	$32.90
Rate for Payer: BCN Commercial	$32.90
Rate for Payer: Cash Price	$33.96
Rate for Payer: Cofinity Commercial	$39.89
Rate for Payer: Encore Health Key Benefits Commercial	$33.95
Rate for Payer: Healthscope Commercial	$42.44
Rate for Payer: Healthscope Whirlpool	$41.17
Rate for Payer: Mclaren Commercial	$38.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$36.07
Rate for Payer: Priority Health Cigna Priority Health	$29.71
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$37.35

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

Facility

$10.12

Service Code	NDC 9900-0006-53
Hospital Charge Code	37848
Hospital Revenue Code	637
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$10.12
Rate for Payer: Aetna Commercial	$9.11
Rate for Payer: ASR ASR	$9.82
Rate for Payer: BCBS Trust/PPO	$7.85
Rate for Payer: BCN Commercial	$7.85
Rate for Payer: Cash Price	$8.10
Rate for Payer: Cofinity Commercial	$9.51
Rate for Payer: Encore Health Key Benefits Commercial	$8.10
Rate for Payer: Healthscope Commercial	$10.12
Rate for Payer: Healthscope Whirlpool	$9.82
Rate for Payer: Mclaren Commercial	$9.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.60
Rate for Payer: Priority Health Cigna Priority Health	$7.08
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$8.91

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

Facility

$15.44

Service Code	NDC 66689-023-50
Hospital Charge Code	37848
Hospital Revenue Code	637
Min. Negotiated Rate	$10.81
Max. Negotiated Rate	$15.44
Rate for Payer: Aetna Commercial	$13.90
Rate for Payer: ASR ASR	$14.98
Rate for Payer: BCBS Trust/PPO	$11.97
Rate for Payer: BCN Commercial	$11.97
Rate for Payer: Cash Price	$12.36
Rate for Payer: Cofinity Commercial	$14.51
Rate for Payer: Encore Health Key Benefits Commercial	$12.35
Rate for Payer: Healthscope Commercial	$15.44
Rate for Payer: Healthscope Whirlpool	$14.98
Rate for Payer: Mclaren Commercial	$13.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.12
Rate for Payer: Priority Health Cigna Priority Health	$10.81
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$13.59

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$5.70

Service Code	NDC 50268-400-11
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$5.70
Rate for Payer: Aetna Commercial	$5.13
Rate for Payer: ASR ASR	$5.53
Rate for Payer: BCBS Trust/PPO	$4.42
Rate for Payer: BCN Commercial	$4.42
Rate for Payer: Cash Price	$4.56
Rate for Payer: Cofinity Commercial	$5.36
Rate for Payer: Encore Health Key Benefits Commercial	$4.56
Rate for Payer: Healthscope Commercial	$5.70
Rate for Payer: Healthscope Whirlpool	$5.53
Rate for Payer: Mclaren Commercial	$5.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4.84
Rate for Payer: Priority Health Cigna Priority Health	$3.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5.02

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$822.50

Service Code	NDC 0406-0124-62
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$575.75
Max. Negotiated Rate	$822.50
Rate for Payer: Aetna Commercial	$740.25
Rate for Payer: ASR ASR	$797.82
Rate for Payer: BCBS Trust/PPO	$637.68
Rate for Payer: BCN Commercial	$637.68
Rate for Payer: Cash Price	$658.00
Rate for Payer: Cofinity Commercial	$773.15
Rate for Payer: Encore Health Key Benefits Commercial	$658.00
Rate for Payer: Healthscope Commercial	$822.50
Rate for Payer: Healthscope Whirlpool	$797.82
Rate for Payer: Mclaren Commercial	$740.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$699.12
Rate for Payer: Priority Health Cigna Priority Health	$575.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$723.80

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$285.25

Service Code	NDC 50268-400-15
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$199.68
Max. Negotiated Rate	$285.25
Rate for Payer: Aetna Commercial	$256.72
Rate for Payer: ASR ASR	$276.69
Rate for Payer: BCBS Trust/PPO	$221.15
Rate for Payer: BCN Commercial	$221.15
Rate for Payer: Cash Price	$228.20
Rate for Payer: Cofinity Commercial	$268.14
Rate for Payer: Encore Health Key Benefits Commercial	$228.20
Rate for Payer: Healthscope Commercial	$285.25
Rate for Payer: Healthscope Whirlpool	$276.69
Rate for Payer: Mclaren Commercial	$256.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$242.46
Rate for Payer: Priority Health Cigna Priority Health	$199.68
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$251.02

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$8.22

Service Code	NDC 0406-0124-23
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$5.75
Max. Negotiated Rate	$8.22
Rate for Payer: Aetna Commercial	$7.40
Rate for Payer: ASR ASR	$7.97
Rate for Payer: BCBS Trust/PPO	$6.37
Rate for Payer: BCN Commercial	$6.37
Rate for Payer: Cash Price	$6.58
Rate for Payer: Cofinity Commercial	$7.73
Rate for Payer: Encore Health Key Benefits Commercial	$6.58
Rate for Payer: Healthscope Commercial	$8.22
Rate for Payer: Healthscope Whirlpool	$7.97
Rate for Payer: Mclaren Commercial	$7.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6.99
Rate for Payer: Priority Health Cigna Priority Health	$5.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$7.23

Know your out-of-pocket cost for care.

All Charges