Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN

Facility

$124.20

Service Code	NDC 00517250210
Hospital Charge Code	1262
Hospital Revenue Code	250
Min. Negotiated Rate	$49.68
Max. Negotiated Rate	$111.78
Rate for Payer: Aetna Commercial	$105.57
Rate for Payer: Aetna Medicare	$62.10
Rate for Payer: Aetna New Business (MI Preferred)	$80.73
Rate for Payer: BCBS Complete	$49.68
Rate for Payer: Cash Price	$99.36
Rate for Payer: Cofinity Commercial	$106.81
Rate for Payer: Cofinity Commercial	$86.94
Rate for Payer: Cofinity Medicare Advantage	$86.94
Rate for Payer: Encore Health Key Benefits Commercial	$99.36
Rate for Payer: Healthscope Commercial	$111.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$105.57
Rate for Payer: PHP Commercial	$105.57
Rate for Payer: Priority Health Cigna Priority Health	$80.73
Rate for Payer: Priority Health SBD	$78.25

CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN

Facility

$124.20

Service Code	NDC 00517250201
Hospital Charge Code	1262
Hospital Revenue Code	250
Min. Negotiated Rate	$78.25
Max. Negotiated Rate	$111.78
Rate for Payer: Aetna Commercial	$105.57
Rate for Payer: Aetna New Business (MI Preferred)	$80.73
Rate for Payer: Cash Price	$99.36
Rate for Payer: Cofinity Commercial	$106.81
Rate for Payer: Cofinity Commercial	$86.94
Rate for Payer: Cofinity Medicare Advantage	$86.94
Rate for Payer: Encore Health Key Benefits Commercial	$99.36
Rate for Payer: Healthscope Commercial	$111.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$105.57
Rate for Payer: PHP Commercial	$105.57
Rate for Payer: Priority Health Cigna Priority Health	$80.73
Rate for Payer: Priority Health SBD	$78.25

CALAMINE 8 %-ZINC OXIDE 8 % LOTION

Facility

$8.50

Service Code	NDC 00904253321
Hospital Charge Code	78879
Hospital Revenue Code	637
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$7.65
Rate for Payer: Aetna Commercial	$7.22
Rate for Payer: Aetna Medicare	$4.25
Rate for Payer: Aetna New Business (MI Preferred)	$5.53
Rate for Payer: BCBS Complete	$3.40
Rate for Payer: Cash Price	$6.80
Rate for Payer: Cofinity Commercial	$5.95
Rate for Payer: Cofinity Commercial	$7.31
Rate for Payer: Cofinity Medicare Advantage	$5.95
Rate for Payer: Encore Health Key Benefits Commercial	$6.80
Rate for Payer: Healthscope Commercial	$7.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.22
Rate for Payer: PHP Commercial	$7.22
Rate for Payer: Priority Health Cigna Priority Health	$5.53
Rate for Payer: Priority Health SBD	$5.36

CALAMINE 8 %-ZINC OXIDE 8 % LOTION

Facility

$14.34

Service Code	NDC 00395041396
Hospital Charge Code	78879
Hospital Revenue Code	637
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$12.91
Rate for Payer: Aetna Commercial	$12.19
Rate for Payer: Aetna Medicare	$7.17
Rate for Payer: Aetna New Business (MI Preferred)	$9.32
Rate for Payer: BCBS Complete	$5.74
Rate for Payer: Cash Price	$11.47
Rate for Payer: Cofinity Commercial	$10.04
Rate for Payer: Cofinity Commercial	$12.33
Rate for Payer: Cofinity Medicare Advantage	$10.04
Rate for Payer: Encore Health Key Benefits Commercial	$11.47
Rate for Payer: Healthscope Commercial	$12.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.19
Rate for Payer: PHP Commercial	$12.19
Rate for Payer: Priority Health Cigna Priority Health	$9.32
Rate for Payer: Priority Health SBD	$9.03

CALAMINE 8 %-ZINC OXIDE 8 % LOTION

Facility

$8.50

Service Code	NDC 00904253321
Hospital Charge Code	78879
Hospital Revenue Code	637
Min. Negotiated Rate	$5.36
Max. Negotiated Rate	$7.65
Rate for Payer: Aetna Commercial	$7.22
Rate for Payer: Aetna New Business (MI Preferred)	$5.53
Rate for Payer: Cash Price	$6.80
Rate for Payer: Cofinity Commercial	$5.95
Rate for Payer: Cofinity Commercial	$7.31
Rate for Payer: Cofinity Medicare Advantage	$5.95
Rate for Payer: Encore Health Key Benefits Commercial	$6.80
Rate for Payer: Healthscope Commercial	$7.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.22
Rate for Payer: PHP Commercial	$7.22
Rate for Payer: Priority Health Cigna Priority Health	$5.53
Rate for Payer: Priority Health SBD	$5.36

CALAMINE 8 %-ZINC OXIDE 8 % LOTION

Facility

$14.34

Service Code	NDC 00395041396
Hospital Charge Code	78879
Hospital Revenue Code	637
Min. Negotiated Rate	$9.03
Max. Negotiated Rate	$12.91
Rate for Payer: Aetna Commercial	$12.19
Rate for Payer: Aetna New Business (MI Preferred)	$9.32
Rate for Payer: Cash Price	$11.47
Rate for Payer: Cofinity Commercial	$10.04
Rate for Payer: Cofinity Commercial	$12.33
Rate for Payer: Cofinity Medicare Advantage	$10.04
Rate for Payer: Encore Health Key Benefits Commercial	$11.47
Rate for Payer: Healthscope Commercial	$12.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.19
Rate for Payer: PHP Commercial	$12.19
Rate for Payer: Priority Health Cigna Priority Health	$9.32
Rate for Payer: Priority Health SBD	$9.03

CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION

Facility

$2,365.92

Service Code	HCPCS J0630
Hospital Charge Code	9347
Hospital Revenue Code	636
Min. Negotiated Rate	$259.94
Max. Negotiated Rate	$2,129.33
Rate for Payer: Aetna Commercial	$2,011.03
Rate for Payer: Aetna Commercial	$2,176.99
Rate for Payer: Aetna Commercial	$1,935.14
Rate for Payer: Aetna Medicare	$504.37
Rate for Payer: Aetna Medicare	$504.37
Rate for Payer: Aetna Medicare	$504.37
Rate for Payer: Aetna New Business (MI Preferred)	$1,537.85
Rate for Payer: Aetna New Business (MI Preferred)	$1,479.82
Rate for Payer: Aetna New Business (MI Preferred)	$1,664.75
Rate for Payer: Allen County Amish Medical Aid Commercial	$606.21
Rate for Payer: Allen County Amish Medical Aid Commercial	$606.21
Rate for Payer: Allen County Amish Medical Aid Commercial	$606.21
Rate for Payer: Amish Plain Church Group Commercial	$606.21
Rate for Payer: Amish Plain Church Group Commercial	$606.21
Rate for Payer: Amish Plain Church Group Commercial	$606.21
Rate for Payer: BCBS Complete	$272.94
Rate for Payer: BCBS Complete	$272.94
Rate for Payer: BCBS Complete	$272.94
Rate for Payer: BCBS MAPPO	$484.97
Rate for Payer: BCBS MAPPO	$484.97
Rate for Payer: BCBS MAPPO	$484.97
Rate for Payer: BCN Medicare Advantage	$484.97
Rate for Payer: BCN Medicare Advantage	$484.97
Rate for Payer: BCN Medicare Advantage	$484.97
Rate for Payer: Cash Price	$1,892.74
Rate for Payer: Cash Price	$1,892.74
Rate for Payer: Cash Price	$1,821.31
Rate for Payer: Cash Price	$1,821.31
Rate for Payer: Cash Price	$2,048.93
Rate for Payer: Cash Price	$2,048.93
Rate for Payer: Cofinity Commercial	$1,957.91
Rate for Payer: Cofinity Commercial	$1,593.65
Rate for Payer: Cofinity Commercial	$2,202.60
Rate for Payer: Cofinity Commercial	$1,792.81
Rate for Payer: Cofinity Commercial	$1,656.14
Rate for Payer: Cofinity Commercial	$2,034.69
Rate for Payer: Cofinity Medicare Advantage	$1,656.14
Rate for Payer: Cofinity Medicare Advantage	$1,593.65
Rate for Payer: Cofinity Medicare Advantage	$1,792.81
Rate for Payer: Encore Health Key Benefits Commercial	$1,821.31
Rate for Payer: Encore Health Key Benefits Commercial	$1,892.74
Rate for Payer: Encore Health Key Benefits Commercial	$2,048.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$484.97
Rate for Payer: Health Alliance Plan Medicare Advantage	$484.97
Rate for Payer: Health Alliance Plan Medicare Advantage	$484.97
Rate for Payer: Healthscope Commercial	$2,305.04
Rate for Payer: Healthscope Commercial	$2,048.98
Rate for Payer: Healthscope Commercial	$2,129.33
Rate for Payer: Mclaren Medicaid	$259.94
Rate for Payer: Mclaren Medicaid	$259.94
Rate for Payer: Mclaren Medicaid	$259.94
Rate for Payer: Mclaren Medicare	$484.97
Rate for Payer: Mclaren Medicare	$484.97
Rate for Payer: Mclaren Medicare	$484.97
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$509.22
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$509.22
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$509.22
Rate for Payer: Meridian Medicaid	$272.94
Rate for Payer: Meridian Medicaid	$272.94
Rate for Payer: Meridian Medicaid	$272.94
Rate for Payer: MI Amish Medical Board Commercial	$557.72
Rate for Payer: MI Amish Medical Board Commercial	$557.72
Rate for Payer: MI Amish Medical Board Commercial	$557.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,935.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,011.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,176.99
Rate for Payer: PACE Medicare	$460.72
Rate for Payer: PACE Medicare	$460.72
Rate for Payer: PACE Medicare	$460.72
Rate for Payer: PACE SWMI	$484.97
Rate for Payer: PACE SWMI	$484.97
Rate for Payer: PACE SWMI	$484.97
Rate for Payer: PHP Commercial	$1,935.14
Rate for Payer: PHP Commercial	$2,176.99
Rate for Payer: PHP Commercial	$2,011.03
Rate for Payer: PHP Medicare Advantage	$484.97
Rate for Payer: PHP Medicare Advantage	$484.97
Rate for Payer: PHP Medicare Advantage	$484.97
Rate for Payer: Priority Health Choice Medicaid	$259.94
Rate for Payer: Priority Health Choice Medicaid	$259.94
Rate for Payer: Priority Health Choice Medicaid	$259.94
Rate for Payer: Priority Health Cigna Priority Health	$1,664.75
Rate for Payer: Priority Health Cigna Priority Health	$1,537.85
Rate for Payer: Priority Health Cigna Priority Health	$1,479.82
Rate for Payer: Priority Health Medicare	$484.97
Rate for Payer: Priority Health Medicare	$484.97
Rate for Payer: Priority Health Medicare	$484.97
Rate for Payer: Priority Health SBD	$1,434.28
Rate for Payer: Priority Health SBD	$1,613.53
Rate for Payer: Priority Health SBD	$1,490.53
Rate for Payer: Railroad Medicare Medicare	$484.97
Rate for Payer: Railroad Medicare Medicare	$484.97
Rate for Payer: Railroad Medicare Medicare	$484.97
Rate for Payer: UHC All Payor (Choice/PPO)	$1,365.14
Rate for Payer: UHC All Payor (Choice/PPO)	$1,365.14
Rate for Payer: UHC All Payor (Choice/PPO)	$1,365.14
Rate for Payer: UHC Dual Complete DSNP	$484.97
Rate for Payer: UHC Dual Complete DSNP	$484.97
Rate for Payer: UHC Dual Complete DSNP	$484.97
Rate for Payer: UHC Medicare Advantage	$484.97
Rate for Payer: UHC Medicare Advantage	$484.97
Rate for Payer: UHC Medicare Advantage	$484.97
Rate for Payer: UHCCP Medicaid	$273.04
Rate for Payer: UHCCP Medicaid	$273.04
Rate for Payer: UHCCP Medicaid	$273.04
Rate for Payer: VA VA	$484.97
Rate for Payer: VA VA	$484.97
Rate for Payer: VA VA	$484.97

CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION

Facility

$2,365.92

Service Code	HCPCS J0630
Hospital Charge Code	9347
Hospital Revenue Code	636
Min. Negotiated Rate	$1,490.53
Max. Negotiated Rate	$2,129.33
Rate for Payer: Aetna Commercial	$2,011.03
Rate for Payer: Aetna Commercial	$1,935.14
Rate for Payer: Aetna Commercial	$2,176.99
Rate for Payer: Aetna New Business (MI Preferred)	$1,537.85
Rate for Payer: Aetna New Business (MI Preferred)	$1,479.82
Rate for Payer: Aetna New Business (MI Preferred)	$1,664.75
Rate for Payer: Cash Price	$1,821.31
Rate for Payer: Cash Price	$2,048.93
Rate for Payer: Cash Price	$1,892.74
Rate for Payer: Cofinity Commercial	$1,593.65
Rate for Payer: Cofinity Commercial	$1,957.91
Rate for Payer: Cofinity Commercial	$1,656.14
Rate for Payer: Cofinity Commercial	$2,034.69
Rate for Payer: Cofinity Commercial	$1,792.81
Rate for Payer: Cofinity Commercial	$2,202.60
Rate for Payer: Cofinity Medicare Advantage	$1,593.65
Rate for Payer: Cofinity Medicare Advantage	$1,792.81
Rate for Payer: Cofinity Medicare Advantage	$1,656.14
Rate for Payer: Encore Health Key Benefits Commercial	$1,821.31
Rate for Payer: Encore Health Key Benefits Commercial	$1,892.74
Rate for Payer: Encore Health Key Benefits Commercial	$2,048.93
Rate for Payer: Healthscope Commercial	$2,048.98
Rate for Payer: Healthscope Commercial	$2,129.33
Rate for Payer: Healthscope Commercial	$2,305.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,935.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,011.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,176.99
Rate for Payer: PHP Commercial	$2,011.03
Rate for Payer: PHP Commercial	$2,176.99
Rate for Payer: PHP Commercial	$1,935.14
Rate for Payer: Priority Health Cigna Priority Health	$1,664.75
Rate for Payer: Priority Health Cigna Priority Health	$1,537.85
Rate for Payer: Priority Health Cigna Priority Health	$1,479.82
Rate for Payer: Priority Health SBD	$1,613.53
Rate for Payer: Priority Health SBD	$1,490.53
Rate for Payer: Priority Health SBD	$1,434.28

CALCITRIOL 0.25 MCG CAPSULE

Facility

$137.09

Service Code	NDC 00054000713
Hospital Charge Code	9350
Hospital Revenue Code	637
Min. Negotiated Rate	$54.84
Max. Negotiated Rate	$123.38
Rate for Payer: Aetna Commercial	$116.53
Rate for Payer: Aetna Medicare	$68.55
Rate for Payer: Aetna New Business (MI Preferred)	$89.11
Rate for Payer: BCBS Complete	$54.84
Rate for Payer: Cash Price	$109.67
Rate for Payer: Cofinity Commercial	$117.90
Rate for Payer: Cofinity Commercial	$95.96
Rate for Payer: Cofinity Medicare Advantage	$95.96
Rate for Payer: Encore Health Key Benefits Commercial	$109.67
Rate for Payer: Healthscope Commercial	$123.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$116.53
Rate for Payer: PHP Commercial	$116.53
Rate for Payer: Priority Health Cigna Priority Health	$89.11
Rate for Payer: Priority Health SBD	$86.37

CALCITRIOL 0.25 MCG CAPSULE

Facility

$3.23

Service Code	NDC 60687034511
Hospital Charge Code	9350
Hospital Revenue Code	637
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$2.91
Rate for Payer: Aetna Commercial	$2.75
Rate for Payer: Aetna New Business (MI Preferred)	$2.10
Rate for Payer: Cash Price	$2.58
Rate for Payer: Cofinity Commercial	$2.26
Rate for Payer: Cofinity Commercial	$2.78
Rate for Payer: Cofinity Medicare Advantage	$2.26
Rate for Payer: Encore Health Key Benefits Commercial	$2.58
Rate for Payer: Healthscope Commercial	$2.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.75
Rate for Payer: PHP Commercial	$2.75
Rate for Payer: Priority Health Cigna Priority Health	$2.10
Rate for Payer: Priority Health SBD	$2.03

CALCITRIOL 0.25 MCG CAPSULE

Facility

$137.09

Service Code	NDC 00054000713
Hospital Charge Code	9350
Hospital Revenue Code	637
Min. Negotiated Rate	$86.37
Max. Negotiated Rate	$123.38
Rate for Payer: Aetna Commercial	$116.53
Rate for Payer: Aetna New Business (MI Preferred)	$89.11
Rate for Payer: Cash Price	$109.67
Rate for Payer: Cofinity Commercial	$117.90
Rate for Payer: Cofinity Commercial	$95.96
Rate for Payer: Cofinity Medicare Advantage	$95.96
Rate for Payer: Encore Health Key Benefits Commercial	$109.67
Rate for Payer: Healthscope Commercial	$123.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$116.53
Rate for Payer: PHP Commercial	$116.53
Rate for Payer: Priority Health Cigna Priority Health	$89.11
Rate for Payer: Priority Health SBD	$86.37

CALCITRIOL 0.25 MCG CAPSULE

Facility

$3.23

Service Code	NDC 60687034511
Hospital Charge Code	9350
Hospital Revenue Code	637
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$2.91
Rate for Payer: Aetna Commercial	$2.75
Rate for Payer: Aetna Medicare	$1.61
Rate for Payer: Aetna New Business (MI Preferred)	$2.10
Rate for Payer: BCBS Complete	$1.29
Rate for Payer: Cash Price	$2.58
Rate for Payer: Cofinity Commercial	$2.26
Rate for Payer: Cofinity Commercial	$2.78
Rate for Payer: Cofinity Medicare Advantage	$2.26
Rate for Payer: Encore Health Key Benefits Commercial	$2.58
Rate for Payer: Healthscope Commercial	$2.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.75
Rate for Payer: PHP Commercial	$2.75
Rate for Payer: Priority Health Cigna Priority Health	$2.10
Rate for Payer: Priority Health SBD	$2.03

CALCITRIOL 0.25 MCG CAPSULE

Facility

$63.84

Service Code	NDC 23155066203
Hospital Charge Code	9350
Hospital Revenue Code	637
Min. Negotiated Rate	$40.22
Max. Negotiated Rate	$57.46
Rate for Payer: Aetna Commercial	$54.26
Rate for Payer: Aetna New Business (MI Preferred)	$41.50
Rate for Payer: Cash Price	$51.07
Rate for Payer: Cofinity Commercial	$44.69
Rate for Payer: Cofinity Commercial	$54.90
Rate for Payer: Cofinity Medicare Advantage	$44.69
Rate for Payer: Encore Health Key Benefits Commercial	$51.07
Rate for Payer: Healthscope Commercial	$57.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.26
Rate for Payer: PHP Commercial	$54.26
Rate for Payer: Priority Health Cigna Priority Health	$41.50
Rate for Payer: Priority Health SBD	$40.22

CALCITRIOL 0.25 MCG CAPSULE

Facility

$322.56

Service Code	NDC 60687034501
Hospital Charge Code	9350
Hospital Revenue Code	637
Min. Negotiated Rate	$129.02
Max. Negotiated Rate	$290.30
Rate for Payer: Aetna Commercial	$274.18
Rate for Payer: Aetna Medicare	$161.28
Rate for Payer: Aetna New Business (MI Preferred)	$209.66
Rate for Payer: BCBS Complete	$129.02
Rate for Payer: Cash Price	$258.05
Rate for Payer: Cofinity Commercial	$225.79
Rate for Payer: Cofinity Commercial	$277.40
Rate for Payer: Cofinity Medicare Advantage	$225.79
Rate for Payer: Encore Health Key Benefits Commercial	$258.05
Rate for Payer: Healthscope Commercial	$290.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$274.18
Rate for Payer: PHP Commercial	$274.18
Rate for Payer: Priority Health Cigna Priority Health	$209.66
Rate for Payer: Priority Health SBD	$203.21

CALCITRIOL 0.25 MCG CAPSULE

Facility

$322.56

Service Code	NDC 60687034501
Hospital Charge Code	9350
Hospital Revenue Code	637
Min. Negotiated Rate	$203.21
Max. Negotiated Rate	$290.30
Rate for Payer: Aetna Commercial	$274.18
Rate for Payer: Aetna New Business (MI Preferred)	$209.66
Rate for Payer: Cash Price	$258.05
Rate for Payer: Cofinity Commercial	$225.79
Rate for Payer: Cofinity Commercial	$277.40
Rate for Payer: Cofinity Medicare Advantage	$225.79
Rate for Payer: Encore Health Key Benefits Commercial	$258.05
Rate for Payer: Healthscope Commercial	$290.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$274.18
Rate for Payer: PHP Commercial	$274.18
Rate for Payer: Priority Health Cigna Priority Health	$209.66
Rate for Payer: Priority Health SBD	$203.21

CALCITRIOL 0.25 MCG CAPSULE

Facility

$63.84

Service Code	NDC 23155066203
Hospital Charge Code	9350
Hospital Revenue Code	637
Min. Negotiated Rate	$25.54
Max. Negotiated Rate	$57.46
Rate for Payer: Aetna Commercial	$54.26
Rate for Payer: Aetna Medicare	$31.92
Rate for Payer: Aetna New Business (MI Preferred)	$41.50
Rate for Payer: BCBS Complete	$25.54
Rate for Payer: Cash Price	$51.07
Rate for Payer: Cofinity Commercial	$44.69
Rate for Payer: Cofinity Commercial	$54.90
Rate for Payer: Cofinity Medicare Advantage	$44.69
Rate for Payer: Encore Health Key Benefits Commercial	$51.07
Rate for Payer: Healthscope Commercial	$57.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.26
Rate for Payer: PHP Commercial	$54.26
Rate for Payer: Priority Health Cigna Priority Health	$41.50
Rate for Payer: Priority Health SBD	$40.22

CALCITRIOL 0.25 MCG CAPSULE

Facility

$422.40

Service Code	NDC 00054000725
Hospital Charge Code	9350
Hospital Revenue Code	637
Min. Negotiated Rate	$168.96
Max. Negotiated Rate	$380.16
Rate for Payer: Aetna Commercial	$359.04
Rate for Payer: Aetna Medicare	$211.20
Rate for Payer: Aetna New Business (MI Preferred)	$274.56
Rate for Payer: BCBS Complete	$168.96
Rate for Payer: Cash Price	$337.92
Rate for Payer: Cofinity Commercial	$295.68
Rate for Payer: Cofinity Commercial	$363.26
Rate for Payer: Cofinity Medicare Advantage	$295.68
Rate for Payer: Encore Health Key Benefits Commercial	$337.92
Rate for Payer: Healthscope Commercial	$380.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$359.04
Rate for Payer: PHP Commercial	$359.04
Rate for Payer: Priority Health Cigna Priority Health	$274.56
Rate for Payer: Priority Health SBD	$266.11

CALCITRIOL 0.25 MCG CAPSULE

Facility

$422.40

Service Code	NDC 00054000725
Hospital Charge Code	9350
Hospital Revenue Code	637
Min. Negotiated Rate	$266.11
Max. Negotiated Rate	$380.16
Rate for Payer: Aetna Commercial	$359.04
Rate for Payer: Aetna New Business (MI Preferred)	$274.56
Rate for Payer: Cash Price	$337.92
Rate for Payer: Cofinity Commercial	$295.68
Rate for Payer: Cofinity Commercial	$363.26
Rate for Payer: Cofinity Medicare Advantage	$295.68
Rate for Payer: Encore Health Key Benefits Commercial	$337.92
Rate for Payer: Healthscope Commercial	$380.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$359.04
Rate for Payer: PHP Commercial	$359.04
Rate for Payer: Priority Health Cigna Priority Health	$274.56
Rate for Payer: Priority Health SBD	$266.11

CALCITRIOL 0.5 MCG CAPSULE

Facility

$219.45

Service Code	NDC 69452020820
Hospital Charge Code	9351
Hospital Revenue Code	637
Min. Negotiated Rate	$138.25
Max. Negotiated Rate	$197.50
Rate for Payer: Aetna Commercial	$186.53
Rate for Payer: Aetna New Business (MI Preferred)	$142.64
Rate for Payer: Cash Price	$175.56
Rate for Payer: Cofinity Commercial	$153.62
Rate for Payer: Cofinity Commercial	$188.73
Rate for Payer: Cofinity Medicare Advantage	$153.62
Rate for Payer: Encore Health Key Benefits Commercial	$175.56
Rate for Payer: Healthscope Commercial	$197.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$186.53
Rate for Payer: PHP Commercial	$186.53
Rate for Payer: Priority Health Cigna Priority Health	$142.64
Rate for Payer: Priority Health SBD	$138.25

CALCITRIOL 0.5 MCG CAPSULE

Facility

$219.45

Service Code	NDC 69452020820
Hospital Charge Code	9351
Hospital Revenue Code	637
Min. Negotiated Rate	$87.78
Max. Negotiated Rate	$197.50
Rate for Payer: Aetna Commercial	$186.53
Rate for Payer: Aetna Medicare	$109.72
Rate for Payer: Aetna New Business (MI Preferred)	$142.64
Rate for Payer: BCBS Complete	$87.78
Rate for Payer: Cash Price	$175.56
Rate for Payer: Cofinity Commercial	$153.62
Rate for Payer: Cofinity Commercial	$188.73
Rate for Payer: Cofinity Medicare Advantage	$153.62
Rate for Payer: Encore Health Key Benefits Commercial	$175.56
Rate for Payer: Healthscope Commercial	$197.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$186.53
Rate for Payer: PHP Commercial	$186.53
Rate for Payer: Priority Health Cigna Priority Health	$142.64
Rate for Payer: Priority Health SBD	$138.25

CALCITRIOL 0.5 MCG CAPSULE

Facility

$375.25

Service Code	NDC 23155066301
Hospital Charge Code	9351
Hospital Revenue Code	637
Min. Negotiated Rate	$150.10
Max. Negotiated Rate	$337.73
Rate for Payer: Aetna Commercial	$318.96
Rate for Payer: Aetna Medicare	$187.62
Rate for Payer: Aetna New Business (MI Preferred)	$243.91
Rate for Payer: BCBS Complete	$150.10
Rate for Payer: Cash Price	$300.20
Rate for Payer: Cofinity Commercial	$262.68
Rate for Payer: Cofinity Commercial	$322.71
Rate for Payer: Cofinity Medicare Advantage	$262.68
Rate for Payer: Encore Health Key Benefits Commercial	$300.20
Rate for Payer: Healthscope Commercial	$337.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$318.96
Rate for Payer: PHP Commercial	$318.96
Rate for Payer: Priority Health Cigna Priority Health	$243.91
Rate for Payer: Priority Health SBD	$236.41

CALCITRIOL 0.5 MCG CAPSULE

Facility

$682.08

Service Code	NDC 00093735301
Hospital Charge Code	9351
Hospital Revenue Code	637
Min. Negotiated Rate	$272.83
Max. Negotiated Rate	$613.87
Rate for Payer: Aetna Commercial	$579.77
Rate for Payer: Aetna Medicare	$341.04
Rate for Payer: Aetna New Business (MI Preferred)	$443.35
Rate for Payer: BCBS Complete	$272.83
Rate for Payer: Cash Price	$545.66
Rate for Payer: Cofinity Commercial	$477.46
Rate for Payer: Cofinity Commercial	$586.59
Rate for Payer: Cofinity Medicare Advantage	$477.46
Rate for Payer: Encore Health Key Benefits Commercial	$545.66
Rate for Payer: Healthscope Commercial	$613.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$579.77
Rate for Payer: PHP Commercial	$579.77
Rate for Payer: Priority Health Cigna Priority Health	$443.35
Rate for Payer: Priority Health SBD	$429.71

CALCITRIOL 0.5 MCG CAPSULE

Facility

$375.25

Service Code	NDC 23155066301
Hospital Charge Code	9351
Hospital Revenue Code	637
Min. Negotiated Rate	$236.41
Max. Negotiated Rate	$337.73
Rate for Payer: Aetna Commercial	$318.96
Rate for Payer: Aetna New Business (MI Preferred)	$243.91
Rate for Payer: Cash Price	$300.20
Rate for Payer: Cofinity Commercial	$262.68
Rate for Payer: Cofinity Commercial	$322.71
Rate for Payer: Cofinity Medicare Advantage	$262.68
Rate for Payer: Encore Health Key Benefits Commercial	$300.20
Rate for Payer: Healthscope Commercial	$337.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$318.96
Rate for Payer: PHP Commercial	$318.96
Rate for Payer: Priority Health Cigna Priority Health	$243.91
Rate for Payer: Priority Health SBD	$236.41

CALCITRIOL 0.5 MCG CAPSULE

Facility

$682.08

Service Code	NDC 00093735301
Hospital Charge Code	9351
Hospital Revenue Code	637
Min. Negotiated Rate	$429.71
Max. Negotiated Rate	$613.87
Rate for Payer: Aetna Commercial	$579.77
Rate for Payer: Aetna New Business (MI Preferred)	$443.35
Rate for Payer: Cash Price	$545.66
Rate for Payer: Cofinity Commercial	$477.46
Rate for Payer: Cofinity Commercial	$586.59
Rate for Payer: Cofinity Medicare Advantage	$477.46
Rate for Payer: Encore Health Key Benefits Commercial	$545.66
Rate for Payer: Healthscope Commercial	$613.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$579.77
Rate for Payer: PHP Commercial	$579.77
Rate for Payer: Priority Health Cigna Priority Health	$443.35
Rate for Payer: Priority Health SBD	$429.71

CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET

Facility

$151.20

Service Code	NDC 00536100715
Hospital Charge Code	9385
Hospital Revenue Code	637
Min. Negotiated Rate	$95.26
Max. Negotiated Rate	$136.08
Rate for Payer: Aetna Commercial	$128.52
Rate for Payer: Aetna New Business (MI Preferred)	$98.28
Rate for Payer: Cash Price	$120.96
Rate for Payer: Cofinity Commercial	$105.84
Rate for Payer: Cofinity Commercial	$130.03
Rate for Payer: Cofinity Medicare Advantage	$105.84
Rate for Payer: Encore Health Key Benefits Commercial	$120.96
Rate for Payer: Healthscope Commercial	$136.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$128.52
Rate for Payer: PHP Commercial	$128.52
Rate for Payer: Priority Health Cigna Priority Health	$98.28
Rate for Payer: Priority Health SBD	$95.26

Know your out-of-pocket cost for care.

All Charges