Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET

Facility

$189.00

Service Code	NDC 00904546092
Hospital Charge Code	19483
Hospital Revenue Code	637
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$170.10
Rate for Payer: Aetna Commercial	$160.65
Rate for Payer: Aetna Medicare	$94.50
Rate for Payer: Aetna New Business (MI Preferred)	$122.85
Rate for Payer: BCBS Complete	$75.60
Rate for Payer: Cash Price	$151.20
Rate for Payer: Cofinity Commercial	$132.30
Rate for Payer: Cofinity Commercial	$162.54
Rate for Payer: Cofinity Medicare Advantage	$132.30
Rate for Payer: Encore Health Key Benefits Commercial	$151.20
Rate for Payer: Healthscope Commercial	$170.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$160.65
Rate for Payer: PHP Commercial	$160.65
Rate for Payer: Priority Health Cigna Priority Health	$122.85
Rate for Payer: Priority Health SBD	$119.07

CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET

Facility

$172.00

Service Code	NDC 10006070038
Hospital Charge Code	19483
Hospital Revenue Code	637
Min. Negotiated Rate	$108.36
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna Commercial	$146.20
Rate for Payer: Aetna New Business (MI Preferred)	$111.80
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cofinity Commercial	$120.40
Rate for Payer: Cofinity Commercial	$147.92
Rate for Payer: Cofinity Medicare Advantage	$120.40
Rate for Payer: Encore Health Key Benefits Commercial	$137.60
Rate for Payer: Healthscope Commercial	$154.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$146.20
Rate for Payer: PHP Commercial	$146.20
Rate for Payer: Priority Health Cigna Priority Health	$111.80
Rate for Payer: Priority Health SBD	$108.36

CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET

Facility

$86.94

Service Code	NDC 00536781708
Hospital Charge Code	19483
Hospital Revenue Code	637
Min. Negotiated Rate	$34.78
Max. Negotiated Rate	$78.25
Rate for Payer: Aetna Commercial	$73.90
Rate for Payer: Aetna Medicare	$43.47
Rate for Payer: Aetna New Business (MI Preferred)	$56.51
Rate for Payer: BCBS Complete	$34.78
Rate for Payer: Cash Price	$69.55
Rate for Payer: Cofinity Commercial	$60.86
Rate for Payer: Cofinity Commercial	$74.77
Rate for Payer: Cofinity Medicare Advantage	$60.86
Rate for Payer: Encore Health Key Benefits Commercial	$69.55
Rate for Payer: Healthscope Commercial	$78.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$73.90
Rate for Payer: PHP Commercial	$73.90
Rate for Payer: Priority Health Cigna Priority Health	$56.51
Rate for Payer: Priority Health SBD	$54.77

CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET

Facility

$86.94

Service Code	NDC 00536781708
Hospital Charge Code	19483
Hospital Revenue Code	637
Min. Negotiated Rate	$54.77
Max. Negotiated Rate	$78.25
Rate for Payer: Aetna Commercial	$73.90
Rate for Payer: Aetna New Business (MI Preferred)	$56.51
Rate for Payer: Cash Price	$69.55
Rate for Payer: Cofinity Commercial	$60.86
Rate for Payer: Cofinity Commercial	$74.77
Rate for Payer: Cofinity Medicare Advantage	$60.86
Rate for Payer: Encore Health Key Benefits Commercial	$69.55
Rate for Payer: Healthscope Commercial	$78.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$73.90
Rate for Payer: PHP Commercial	$73.90
Rate for Payer: Priority Health Cigna Priority Health	$56.51
Rate for Payer: Priority Health SBD	$54.77

CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET

Facility

$321.30

Service Code	NDC 00904546072
Hospital Charge Code	19483
Hospital Revenue Code	637
Min. Negotiated Rate	$202.42
Max. Negotiated Rate	$289.17
Rate for Payer: Aetna Commercial	$273.10
Rate for Payer: Aetna New Business (MI Preferred)	$208.84
Rate for Payer: Cash Price	$257.04
Rate for Payer: Cofinity Commercial	$224.91
Rate for Payer: Cofinity Commercial	$276.32
Rate for Payer: Cofinity Medicare Advantage	$224.91
Rate for Payer: Encore Health Key Benefits Commercial	$257.04
Rate for Payer: Healthscope Commercial	$289.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$273.10
Rate for Payer: PHP Commercial	$273.10
Rate for Payer: Priority Health Cigna Priority Health	$208.84
Rate for Payer: Priority Health SBD	$202.42

CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET

Facility

$189.00

Service Code	NDC 00904546092
Hospital Charge Code	19483
Hospital Revenue Code	637
Min. Negotiated Rate	$119.07
Max. Negotiated Rate	$170.10
Rate for Payer: Aetna Commercial	$160.65
Rate for Payer: Aetna New Business (MI Preferred)	$122.85
Rate for Payer: Cash Price	$151.20
Rate for Payer: Cofinity Commercial	$132.30
Rate for Payer: Cofinity Commercial	$162.54
Rate for Payer: Cofinity Medicare Advantage	$132.30
Rate for Payer: Encore Health Key Benefits Commercial	$151.20
Rate for Payer: Healthscope Commercial	$170.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$160.65
Rate for Payer: PHP Commercial	$160.65
Rate for Payer: Priority Health Cigna Priority Health	$122.85
Rate for Payer: Priority Health SBD	$119.07

CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET

Facility

$172.00

Service Code	NDC 10006070038
Hospital Charge Code	19483
Hospital Revenue Code	637
Min. Negotiated Rate	$68.80
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna Commercial	$146.20
Rate for Payer: Aetna Medicare	$86.00
Rate for Payer: Aetna New Business (MI Preferred)	$111.80
Rate for Payer: BCBS Complete	$68.80
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cofinity Commercial	$120.40
Rate for Payer: Cofinity Commercial	$147.92
Rate for Payer: Cofinity Medicare Advantage	$120.40
Rate for Payer: Encore Health Key Benefits Commercial	$137.60
Rate for Payer: Healthscope Commercial	$154.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$146.20
Rate for Payer: PHP Commercial	$146.20
Rate for Payer: Priority Health Cigna Priority Health	$111.80
Rate for Payer: Priority Health SBD	$108.36

CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET

Facility

$321.30

Service Code	NDC 00904546072
Hospital Charge Code	19483
Hospital Revenue Code	637
Min. Negotiated Rate	$128.52
Max. Negotiated Rate	$289.17
Rate for Payer: Aetna Commercial	$273.10
Rate for Payer: Aetna Medicare	$160.65
Rate for Payer: Aetna New Business (MI Preferred)	$208.84
Rate for Payer: BCBS Complete	$128.52
Rate for Payer: Cash Price	$257.04
Rate for Payer: Cofinity Commercial	$224.91
Rate for Payer: Cofinity Commercial	$276.32
Rate for Payer: Cofinity Medicare Advantage	$224.91
Rate for Payer: Encore Health Key Benefits Commercial	$257.04
Rate for Payer: Healthscope Commercial	$289.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$273.10
Rate for Payer: PHP Commercial	$273.10
Rate for Payer: Priority Health Cigna Priority Health	$208.84
Rate for Payer: Priority Health SBD	$202.42

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$565.44

Service Code	NDC 00781208102
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$356.23
Max. Negotiated Rate	$508.90
Rate for Payer: Aetna Commercial	$480.62
Rate for Payer: Aetna New Business (MI Preferred)	$367.54
Rate for Payer: Cash Price	$452.35
Rate for Payer: Cofinity Commercial	$395.81
Rate for Payer: Cofinity Commercial	$486.28
Rate for Payer: Cofinity Medicare Advantage	$395.81
Rate for Payer: Encore Health Key Benefits Commercial	$452.35
Rate for Payer: Healthscope Commercial	$508.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$480.62
Rate for Payer: PHP Commercial	$480.62
Rate for Payer: Priority Health Cigna Priority Health	$367.54
Rate for Payer: Priority Health SBD	$356.23

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$442.70

Service Code	NDC 29033002602
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$278.90
Max. Negotiated Rate	$398.43
Rate for Payer: Aetna Commercial	$376.30
Rate for Payer: Aetna New Business (MI Preferred)	$287.76
Rate for Payer: Cash Price	$354.16
Rate for Payer: Cofinity Commercial	$309.89
Rate for Payer: Cofinity Commercial	$380.72
Rate for Payer: Cofinity Medicare Advantage	$309.89
Rate for Payer: Encore Health Key Benefits Commercial	$354.16
Rate for Payer: Healthscope Commercial	$398.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$376.30
Rate for Payer: PHP Commercial	$376.30
Rate for Payer: Priority Health Cigna Priority Health	$287.76
Rate for Payer: Priority Health SBD	$278.90

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$5.04

Service Code	NDC 68084047911
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$4.54
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare	$2.52
Rate for Payer: Aetna New Business (MI Preferred)	$3.28
Rate for Payer: BCBS Complete	$2.02
Rate for Payer: Cash Price	$4.03
Rate for Payer: Cofinity Commercial	$3.53
Rate for Payer: Cofinity Commercial	$4.33
Rate for Payer: Cofinity Medicare Advantage	$3.53
Rate for Payer: Encore Health Key Benefits Commercial	$4.03
Rate for Payer: Healthscope Commercial	$4.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.28
Rate for Payer: PHP Commercial	$4.28
Rate for Payer: Priority Health Cigna Priority Health	$3.28
Rate for Payer: Priority Health SBD	$3.18

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$442.70

Service Code	NDC 23155053102
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$177.08
Max. Negotiated Rate	$398.43
Rate for Payer: Aetna Commercial	$376.30
Rate for Payer: Aetna Medicare	$221.35
Rate for Payer: Aetna New Business (MI Preferred)	$287.76
Rate for Payer: BCBS Complete	$177.08
Rate for Payer: Cash Price	$354.16
Rate for Payer: Cofinity Commercial	$309.89
Rate for Payer: Cofinity Commercial	$380.72
Rate for Payer: Cofinity Medicare Advantage	$309.89
Rate for Payer: Encore Health Key Benefits Commercial	$354.16
Rate for Payer: Healthscope Commercial	$398.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$376.30
Rate for Payer: PHP Commercial	$376.30
Rate for Payer: Priority Health Cigna Priority Health	$287.76
Rate for Payer: Priority Health SBD	$278.90

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$626.88

Service Code	NDC 62135019122
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$394.93
Max. Negotiated Rate	$564.19
Rate for Payer: Aetna Commercial	$532.85
Rate for Payer: Aetna New Business (MI Preferred)	$407.47
Rate for Payer: Cash Price	$501.50
Rate for Payer: Cofinity Commercial	$438.82
Rate for Payer: Cofinity Commercial	$539.12
Rate for Payer: Cofinity Medicare Advantage	$438.82
Rate for Payer: Encore Health Key Benefits Commercial	$501.50
Rate for Payer: Healthscope Commercial	$564.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$532.85
Rate for Payer: PHP Commercial	$532.85
Rate for Payer: Priority Health Cigna Priority Health	$407.47
Rate for Payer: Priority Health SBD	$394.93

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$507.84

Service Code	NDC 00054008826
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$203.14
Max. Negotiated Rate	$457.06
Rate for Payer: Aetna Commercial	$431.66
Rate for Payer: Aetna Medicare	$253.92
Rate for Payer: Aetna New Business (MI Preferred)	$330.10
Rate for Payer: BCBS Complete	$203.14
Rate for Payer: Cash Price	$406.27
Rate for Payer: Cofinity Commercial	$355.49
Rate for Payer: Cofinity Commercial	$436.74
Rate for Payer: Cofinity Medicare Advantage	$355.49
Rate for Payer: Encore Health Key Benefits Commercial	$406.27
Rate for Payer: Healthscope Commercial	$457.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$431.66
Rate for Payer: PHP Commercial	$431.66
Rate for Payer: Priority Health Cigna Priority Health	$330.10
Rate for Payer: Priority Health SBD	$319.94

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$445.44

Service Code	NDC 00904711961
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$178.18
Max. Negotiated Rate	$400.90
Rate for Payer: Aetna Commercial	$378.62
Rate for Payer: Aetna Medicare	$222.72
Rate for Payer: Aetna New Business (MI Preferred)	$289.54
Rate for Payer: BCBS Complete	$178.18
Rate for Payer: Cash Price	$356.35
Rate for Payer: Cofinity Commercial	$311.81
Rate for Payer: Cofinity Commercial	$383.08
Rate for Payer: Cofinity Medicare Advantage	$311.81
Rate for Payer: Encore Health Key Benefits Commercial	$356.35
Rate for Payer: Healthscope Commercial	$400.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$378.62
Rate for Payer: PHP Commercial	$378.62
Rate for Payer: Priority Health Cigna Priority Health	$289.54
Rate for Payer: Priority Health SBD	$280.63

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$503.52

Service Code	NDC 68084047901
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$317.22
Max. Negotiated Rate	$453.17
Rate for Payer: Aetna Commercial	$427.99
Rate for Payer: Aetna New Business (MI Preferred)	$327.29
Rate for Payer: Cash Price	$402.82
Rate for Payer: Cofinity Commercial	$352.46
Rate for Payer: Cofinity Commercial	$433.03
Rate for Payer: Cofinity Medicare Advantage	$352.46
Rate for Payer: Encore Health Key Benefits Commercial	$402.82
Rate for Payer: Healthscope Commercial	$453.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$427.99
Rate for Payer: PHP Commercial	$427.99
Rate for Payer: Priority Health Cigna Priority Health	$327.29
Rate for Payer: Priority Health SBD	$317.22

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$442.70

Service Code	NDC 23155053102
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$278.90
Max. Negotiated Rate	$398.43
Rate for Payer: Aetna Commercial	$376.30
Rate for Payer: Aetna New Business (MI Preferred)	$287.76
Rate for Payer: Cash Price	$354.16
Rate for Payer: Cofinity Commercial	$309.89
Rate for Payer: Cofinity Commercial	$380.72
Rate for Payer: Cofinity Medicare Advantage	$309.89
Rate for Payer: Encore Health Key Benefits Commercial	$354.16
Rate for Payer: Healthscope Commercial	$398.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$376.30
Rate for Payer: PHP Commercial	$376.30
Rate for Payer: Priority Health Cigna Priority Health	$287.76
Rate for Payer: Priority Health SBD	$278.90

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$626.88

Service Code	NDC 62135019122
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$250.75
Max. Negotiated Rate	$564.19
Rate for Payer: Aetna Commercial	$532.85
Rate for Payer: Aetna Medicare	$313.44
Rate for Payer: Aetna New Business (MI Preferred)	$407.47
Rate for Payer: BCBS Complete	$250.75
Rate for Payer: Cash Price	$501.50
Rate for Payer: Cofinity Commercial	$438.82
Rate for Payer: Cofinity Commercial	$539.12
Rate for Payer: Cofinity Medicare Advantage	$438.82
Rate for Payer: Encore Health Key Benefits Commercial	$501.50
Rate for Payer: Healthscope Commercial	$564.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$532.85
Rate for Payer: PHP Commercial	$532.85
Rate for Payer: Priority Health Cigna Priority Health	$407.47
Rate for Payer: Priority Health SBD	$394.93

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$565.44

Service Code	NDC 00781208102
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$226.18
Max. Negotiated Rate	$508.90
Rate for Payer: Aetna Commercial	$480.62
Rate for Payer: Aetna Medicare	$282.72
Rate for Payer: Aetna New Business (MI Preferred)	$367.54
Rate for Payer: BCBS Complete	$226.18
Rate for Payer: Cash Price	$452.35
Rate for Payer: Cofinity Commercial	$395.81
Rate for Payer: Cofinity Commercial	$486.28
Rate for Payer: Cofinity Medicare Advantage	$395.81
Rate for Payer: Encore Health Key Benefits Commercial	$452.35
Rate for Payer: Healthscope Commercial	$508.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$480.62
Rate for Payer: PHP Commercial	$480.62
Rate for Payer: Priority Health Cigna Priority Health	$367.54
Rate for Payer: Priority Health SBD	$356.23

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$5.04

Service Code	NDC 68084047911
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$4.54
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna New Business (MI Preferred)	$3.28
Rate for Payer: Cash Price	$4.03
Rate for Payer: Cofinity Commercial	$3.53
Rate for Payer: Cofinity Commercial	$4.33
Rate for Payer: Cofinity Medicare Advantage	$3.53
Rate for Payer: Encore Health Key Benefits Commercial	$4.03
Rate for Payer: Healthscope Commercial	$4.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.28
Rate for Payer: PHP Commercial	$4.28
Rate for Payer: Priority Health Cigna Priority Health	$3.28
Rate for Payer: Priority Health SBD	$3.18

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$445.44

Service Code	NDC 00904711961
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$280.63
Max. Negotiated Rate	$400.90
Rate for Payer: Aetna Commercial	$378.62
Rate for Payer: Aetna New Business (MI Preferred)	$289.54
Rate for Payer: Cash Price	$356.35
Rate for Payer: Cofinity Commercial	$311.81
Rate for Payer: Cofinity Commercial	$383.08
Rate for Payer: Cofinity Medicare Advantage	$311.81
Rate for Payer: Encore Health Key Benefits Commercial	$356.35
Rate for Payer: Healthscope Commercial	$400.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$378.62
Rate for Payer: PHP Commercial	$378.62
Rate for Payer: Priority Health Cigna Priority Health	$289.54
Rate for Payer: Priority Health SBD	$280.63

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$507.84

Service Code	NDC 00054008826
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$319.94
Max. Negotiated Rate	$457.06
Rate for Payer: Aetna Commercial	$431.66
Rate for Payer: Aetna New Business (MI Preferred)	$330.10
Rate for Payer: Cash Price	$406.27
Rate for Payer: Cofinity Commercial	$355.49
Rate for Payer: Cofinity Commercial	$436.74
Rate for Payer: Cofinity Medicare Advantage	$355.49
Rate for Payer: Encore Health Key Benefits Commercial	$406.27
Rate for Payer: Healthscope Commercial	$457.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$431.66
Rate for Payer: PHP Commercial	$431.66
Rate for Payer: Priority Health Cigna Priority Health	$330.10
Rate for Payer: Priority Health SBD	$319.94

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$442.70

Service Code	NDC 29033002602
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$177.08
Max. Negotiated Rate	$398.43
Rate for Payer: Aetna Commercial	$376.30
Rate for Payer: Aetna Medicare	$221.35
Rate for Payer: Aetna New Business (MI Preferred)	$287.76
Rate for Payer: BCBS Complete	$177.08
Rate for Payer: Cash Price	$354.16
Rate for Payer: Cofinity Commercial	$309.89
Rate for Payer: Cofinity Commercial	$380.72
Rate for Payer: Cofinity Medicare Advantage	$309.89
Rate for Payer: Encore Health Key Benefits Commercial	$354.16
Rate for Payer: Healthscope Commercial	$398.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$376.30
Rate for Payer: PHP Commercial	$376.30
Rate for Payer: Priority Health Cigna Priority Health	$287.76
Rate for Payer: Priority Health SBD	$278.90

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$503.52

Service Code	NDC 68084047901
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$201.41
Max. Negotiated Rate	$453.17
Rate for Payer: Aetna Commercial	$427.99
Rate for Payer: Aetna Medicare	$251.76
Rate for Payer: Aetna New Business (MI Preferred)	$327.29
Rate for Payer: BCBS Complete	$201.41
Rate for Payer: Cash Price	$402.82
Rate for Payer: Cofinity Commercial	$352.46
Rate for Payer: Cofinity Commercial	$433.03
Rate for Payer: Cofinity Medicare Advantage	$352.46
Rate for Payer: Encore Health Key Benefits Commercial	$402.82
Rate for Payer: Healthscope Commercial	$453.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$427.99
Rate for Payer: PHP Commercial	$427.99
Rate for Payer: Priority Health Cigna Priority Health	$327.29
Rate for Payer: Priority Health SBD	$317.22

CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SOLUTION

Facility

$33.65

Service Code	NDC 00517671001
Hospital Charge Code	108968
Hospital Revenue Code	250
Min. Negotiated Rate	$21.20
Max. Negotiated Rate	$30.28
Rate for Payer: Aetna Commercial	$28.60
Rate for Payer: Aetna New Business (MI Preferred)	$21.87
Rate for Payer: Cash Price	$26.92
Rate for Payer: Cofinity Commercial	$23.56
Rate for Payer: Cofinity Commercial	$28.94
Rate for Payer: Cofinity Medicare Advantage	$23.56
Rate for Payer: Encore Health Key Benefits Commercial	$26.92
Rate for Payer: Healthscope Commercial	$30.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$28.60
Rate for Payer: PHP Commercial	$28.60
Rate for Payer: Priority Health Cigna Priority Health	$21.87
Rate for Payer: Priority Health SBD	$21.20

Know your out-of-pocket cost for care.

All Charges