Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SERTRALINE 50 MG TABLET

Facility

$277.40

Service Code	NDC 00904692561
Hospital Charge Code	11351
Hospital Revenue Code	637
Min. Negotiated Rate	$174.76
Max. Negotiated Rate	$249.66
Rate for Payer: Aetna Commercial	$235.79
Rate for Payer: Aetna New Business (MI Preferred)	$180.31
Rate for Payer: Cash Price	$221.92
Rate for Payer: Cofinity Commercial	$194.18
Rate for Payer: Cofinity Commercial	$238.56
Rate for Payer: Cofinity Medicare Advantage	$194.18
Rate for Payer: Encore Health Key Benefits Commercial	$221.92
Rate for Payer: Healthscope Commercial	$249.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$235.79
Rate for Payer: PHP Commercial	$235.79
Rate for Payer: Priority Health Cigna Priority Health	$180.31
Rate for Payer: Priority Health SBD	$174.76

SERTRALINE 50 MG TABLET

Facility

$304.95

Service Code	NDC 60687024201
Hospital Charge Code	11351
Hospital Revenue Code	637
Min. Negotiated Rate	$121.98
Max. Negotiated Rate	$274.45
Rate for Payer: Aetna Commercial	$259.21
Rate for Payer: Aetna Medicare	$152.47
Rate for Payer: Aetna New Business (MI Preferred)	$198.22
Rate for Payer: BCBS Complete	$121.98
Rate for Payer: Cash Price	$243.96
Rate for Payer: Cofinity Commercial	$213.47
Rate for Payer: Cofinity Commercial	$262.26
Rate for Payer: Cofinity Medicare Advantage	$213.47
Rate for Payer: Encore Health Key Benefits Commercial	$243.96
Rate for Payer: Healthscope Commercial	$274.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$259.21
Rate for Payer: PHP Commercial	$259.21
Rate for Payer: Priority Health Cigna Priority Health	$198.22
Rate for Payer: Priority Health SBD	$192.12

SERTRALINE 50 MG TABLET

Facility

$3.05

Service Code	NDC 60687024211
Hospital Charge Code	11351
Hospital Revenue Code	637
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$2.75
Rate for Payer: Aetna Commercial	$2.59
Rate for Payer: Aetna New Business (MI Preferred)	$1.98
Rate for Payer: Cash Price	$2.44
Rate for Payer: Cofinity Commercial	$2.13
Rate for Payer: Cofinity Commercial	$2.62
Rate for Payer: Cofinity Medicare Advantage	$2.13
Rate for Payer: Encore Health Key Benefits Commercial	$2.44
Rate for Payer: Healthscope Commercial	$2.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.59
Rate for Payer: PHP Commercial	$2.59
Rate for Payer: Priority Health Cigna Priority Health	$1.98
Rate for Payer: Priority Health SBD	$1.92

SERTRALINE 50 MG TABLET

Facility

$3.05

Service Code	NDC 60687024211
Hospital Charge Code	11351
Hospital Revenue Code	637
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$2.75
Rate for Payer: Aetna Commercial	$2.59
Rate for Payer: Aetna Medicare	$1.52
Rate for Payer: Aetna New Business (MI Preferred)	$1.98
Rate for Payer: BCBS Complete	$1.22
Rate for Payer: Cash Price	$2.44
Rate for Payer: Cofinity Commercial	$2.13
Rate for Payer: Cofinity Commercial	$2.62
Rate for Payer: Cofinity Medicare Advantage	$2.13
Rate for Payer: Encore Health Key Benefits Commercial	$2.44
Rate for Payer: Healthscope Commercial	$2.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.59
Rate for Payer: PHP Commercial	$2.59
Rate for Payer: Priority Health Cigna Priority Health	$1.98
Rate for Payer: Priority Health SBD	$1.92

SERTRALINE 50 MG TABLET

Facility

$277.40

Service Code	NDC 00904692561
Hospital Charge Code	11351
Hospital Revenue Code	637
Min. Negotiated Rate	$110.96
Max. Negotiated Rate	$249.66
Rate for Payer: Aetna Commercial	$235.79
Rate for Payer: Aetna Medicare	$138.70
Rate for Payer: Aetna New Business (MI Preferred)	$180.31
Rate for Payer: BCBS Complete	$110.96
Rate for Payer: Cash Price	$221.92
Rate for Payer: Cofinity Commercial	$194.18
Rate for Payer: Cofinity Commercial	$238.56
Rate for Payer: Cofinity Medicare Advantage	$194.18
Rate for Payer: Encore Health Key Benefits Commercial	$221.92
Rate for Payer: Healthscope Commercial	$249.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$235.79
Rate for Payer: PHP Commercial	$235.79
Rate for Payer: Priority Health Cigna Priority Health	$180.31
Rate for Payer: Priority Health SBD	$174.76

SERTRALINE 50 MG TABLET

Facility

$225.60

Service Code	NDC 59762490003
Hospital Charge Code	11351
Hospital Revenue Code	637
Min. Negotiated Rate	$90.24
Max. Negotiated Rate	$203.04
Rate for Payer: Aetna Commercial	$191.76
Rate for Payer: Aetna Medicare	$112.80
Rate for Payer: Aetna New Business (MI Preferred)	$146.64
Rate for Payer: BCBS Complete	$90.24
Rate for Payer: Cash Price	$180.48
Rate for Payer: Cofinity Commercial	$157.92
Rate for Payer: Cofinity Commercial	$194.02
Rate for Payer: Cofinity Medicare Advantage	$157.92
Rate for Payer: Encore Health Key Benefits Commercial	$180.48
Rate for Payer: Healthscope Commercial	$203.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$191.76
Rate for Payer: PHP Commercial	$191.76
Rate for Payer: Priority Health Cigna Priority Health	$146.64
Rate for Payer: Priority Health SBD	$142.13

SERTRALINE 50 MG TABLET

Facility

$225.60

Service Code	NDC 59762490003
Hospital Charge Code	11351
Hospital Revenue Code	637
Min. Negotiated Rate	$142.13
Max. Negotiated Rate	$203.04
Rate for Payer: Aetna Commercial	$191.76
Rate for Payer: Aetna New Business (MI Preferred)	$146.64
Rate for Payer: Cash Price	$180.48
Rate for Payer: Cofinity Commercial	$157.92
Rate for Payer: Cofinity Commercial	$194.02
Rate for Payer: Cofinity Medicare Advantage	$157.92
Rate for Payer: Encore Health Key Benefits Commercial	$180.48
Rate for Payer: Healthscope Commercial	$203.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$191.76
Rate for Payer: PHP Commercial	$191.76
Rate for Payer: Priority Health Cigna Priority Health	$146.64
Rate for Payer: Priority Health SBD	$142.13

SESAMOIDECTOMY, FIRST TOE (SEPARATE PROCEDURE)

Facility

$8,907.47

Service Code	CPT 28315
Hospital Revenue Code	360
Min. Negotiated Rate	$1,696.12
Max. Negotiated Rate	$8,907.47
Rate for Payer: Aetna Medicare	$3,290.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,955.50
Rate for Payer: Amish Plain Church Group Commercial	$3,955.50
Rate for Payer: BCBS Complete	$1,780.92
Rate for Payer: BCBS MAPPO	$3,164.40
Rate for Payer: BCN Medicare Advantage	$3,164.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,164.40
Rate for Payer: Mclaren Medicaid	$1,696.12
Rate for Payer: Mclaren Medicare	$3,164.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,322.62
Rate for Payer: Meridian Medicaid	$1,780.92
Rate for Payer: MI Amish Medical Board Commercial	$3,639.06
Rate for Payer: PACE Medicare	$3,006.18
Rate for Payer: PACE SWMI	$3,164.40
Rate for Payer: PHP Medicare Advantage	$3,164.40
Rate for Payer: Priority Health Choice Medicaid	$1,696.12
Rate for Payer: Priority Health Medicare	$3,164.40
Rate for Payer: Railroad Medicare Medicare	$3,164.40
Rate for Payer: UHC All Payor (Choice/PPO)	$8,907.47
Rate for Payer: UHC Dual Complete DSNP	$3,164.40
Rate for Payer: UHC Medicare Advantage	$3,164.40
Rate for Payer: UHCCP Medicaid	$1,781.56
Rate for Payer: VA VA	$3,164.40

SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET

Facility

$2,928.41

Service Code	NDC 43598047890
Hospital Charge Code	99694
Hospital Revenue Code	637
Min. Negotiated Rate	$1,844.90
Max. Negotiated Rate	$2,635.57
Rate for Payer: Aetna Commercial	$2,489.15
Rate for Payer: Aetna New Business (MI Preferred)	$1,903.47
Rate for Payer: Cash Price	$2,342.73
Rate for Payer: Cofinity Commercial	$2,049.89
Rate for Payer: Cofinity Commercial	$2,518.43
Rate for Payer: Cofinity Medicare Advantage	$2,049.89
Rate for Payer: Encore Health Key Benefits Commercial	$2,342.73
Rate for Payer: Healthscope Commercial	$2,635.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,489.15
Rate for Payer: PHP Commercial	$2,489.15
Rate for Payer: Priority Health Cigna Priority Health	$1,903.47
Rate for Payer: Priority Health SBD	$1,844.90

SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET

Facility

$32.54

Service Code	NDC 43598047801
Hospital Charge Code	99694
Hospital Revenue Code	637
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$29.29
Rate for Payer: Aetna Commercial	$27.66
Rate for Payer: Aetna New Business (MI Preferred)	$21.15
Rate for Payer: Cash Price	$26.03
Rate for Payer: Cofinity Commercial	$22.78
Rate for Payer: Cofinity Commercial	$27.98
Rate for Payer: Cofinity Medicare Advantage	$22.78
Rate for Payer: Encore Health Key Benefits Commercial	$26.03
Rate for Payer: Healthscope Commercial	$29.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.66
Rate for Payer: PHP Commercial	$27.66
Rate for Payer: Priority Health Cigna Priority Health	$21.15
Rate for Payer: Priority Health SBD	$20.50

SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET

Facility

$2,928.41

Service Code	NDC 43598047890
Hospital Charge Code	99694
Hospital Revenue Code	637
Min. Negotiated Rate	$1,171.36
Max. Negotiated Rate	$2,635.57
Rate for Payer: Aetna Commercial	$2,489.15
Rate for Payer: Aetna Medicare	$1,464.20
Rate for Payer: Aetna New Business (MI Preferred)	$1,903.47
Rate for Payer: BCBS Complete	$1,171.36
Rate for Payer: Cash Price	$2,342.73
Rate for Payer: Cofinity Commercial	$2,049.89
Rate for Payer: Cofinity Commercial	$2,518.43
Rate for Payer: Cofinity Medicare Advantage	$2,049.89
Rate for Payer: Encore Health Key Benefits Commercial	$2,342.73
Rate for Payer: Healthscope Commercial	$2,635.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,489.15
Rate for Payer: PHP Commercial	$2,489.15
Rate for Payer: Priority Health Cigna Priority Health	$1,903.47
Rate for Payer: Priority Health SBD	$1,844.90

SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET

Facility

$32.54

Service Code	NDC 43598047801
Hospital Charge Code	99694
Hospital Revenue Code	637
Min. Negotiated Rate	$13.02
Max. Negotiated Rate	$29.29
Rate for Payer: Aetna Commercial	$27.66
Rate for Payer: Aetna Medicare	$16.27
Rate for Payer: Aetna New Business (MI Preferred)	$21.15
Rate for Payer: BCBS Complete	$13.02
Rate for Payer: Cash Price	$26.03
Rate for Payer: Cofinity Commercial	$22.78
Rate for Payer: Cofinity Commercial	$27.98
Rate for Payer: Cofinity Medicare Advantage	$22.78
Rate for Payer: Encore Health Key Benefits Commercial	$26.03
Rate for Payer: Healthscope Commercial	$29.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.66
Rate for Payer: PHP Commercial	$27.66
Rate for Payer: Priority Health Cigna Priority Health	$21.15
Rate for Payer: Priority Health SBD	$20.50

SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET

Facility

$9.07

Service Code	NDC 65862093108
Hospital Charge Code	99695
Hospital Revenue Code	637
Min. Negotiated Rate	$5.71
Max. Negotiated Rate	$8.16
Rate for Payer: Aetna Commercial	$7.71
Rate for Payer: Aetna New Business (MI Preferred)	$5.90
Rate for Payer: Cash Price	$7.26
Rate for Payer: Cofinity Commercial	$6.35
Rate for Payer: Cofinity Commercial	$7.80
Rate for Payer: Cofinity Medicare Advantage	$6.35
Rate for Payer: Encore Health Key Benefits Commercial	$7.26
Rate for Payer: Healthscope Commercial	$8.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.71
Rate for Payer: PHP Commercial	$7.71
Rate for Payer: Priority Health Cigna Priority Health	$5.90
Rate for Payer: Priority Health SBD	$5.71

SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET

Facility

$816.05

Service Code	NDC 65862093190
Hospital Charge Code	99695
Hospital Revenue Code	637
Min. Negotiated Rate	$514.11
Max. Negotiated Rate	$734.45
Rate for Payer: Aetna Commercial	$693.64
Rate for Payer: Aetna New Business (MI Preferred)	$530.43
Rate for Payer: Cash Price	$652.84
Rate for Payer: Cofinity Commercial	$571.24
Rate for Payer: Cofinity Commercial	$701.80
Rate for Payer: Cofinity Medicare Advantage	$571.24
Rate for Payer: Encore Health Key Benefits Commercial	$652.84
Rate for Payer: Healthscope Commercial	$734.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$693.64
Rate for Payer: PHP Commercial	$693.64
Rate for Payer: Priority Health Cigna Priority Health	$530.43
Rate for Payer: Priority Health SBD	$514.11

SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET

Facility

$816.05

Service Code	NDC 65862093190
Hospital Charge Code	99695
Hospital Revenue Code	637
Min. Negotiated Rate	$326.42
Max. Negotiated Rate	$734.45
Rate for Payer: Aetna Commercial	$693.64
Rate for Payer: Aetna Medicare	$408.02
Rate for Payer: Aetna New Business (MI Preferred)	$530.43
Rate for Payer: BCBS Complete	$326.42
Rate for Payer: Cash Price	$652.84
Rate for Payer: Cofinity Commercial	$571.24
Rate for Payer: Cofinity Commercial	$701.80
Rate for Payer: Cofinity Medicare Advantage	$571.24
Rate for Payer: Encore Health Key Benefits Commercial	$652.84
Rate for Payer: Healthscope Commercial	$734.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$693.64
Rate for Payer: PHP Commercial	$693.64
Rate for Payer: Priority Health Cigna Priority Health	$530.43
Rate for Payer: Priority Health SBD	$514.11

SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET

Facility

$9.07

Service Code	NDC 65862093108
Hospital Charge Code	99695
Hospital Revenue Code	637
Min. Negotiated Rate	$3.63
Max. Negotiated Rate	$8.16
Rate for Payer: Aetna Commercial	$7.71
Rate for Payer: Aetna Medicare	$4.54
Rate for Payer: Aetna New Business (MI Preferred)	$5.90
Rate for Payer: BCBS Complete	$3.63
Rate for Payer: Cash Price	$7.26
Rate for Payer: Cofinity Commercial	$6.35
Rate for Payer: Cofinity Commercial	$7.80
Rate for Payer: Cofinity Medicare Advantage	$6.35
Rate for Payer: Encore Health Key Benefits Commercial	$7.26
Rate for Payer: Healthscope Commercial	$8.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.71
Rate for Payer: PHP Commercial	$7.71
Rate for Payer: Priority Health Cigna Priority Health	$5.90
Rate for Payer: Priority Health SBD	$5.71

SEVELAMER CARBONATE 800 MG TABLET

Facility

$8.49

Service Code	NDC 68094003459
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$7.64
Rate for Payer: Aetna Commercial	$7.22
Rate for Payer: Aetna Medicare	$4.25
Rate for Payer: Aetna New Business (MI Preferred)	$5.52
Rate for Payer: BCBS Complete	$3.40
Rate for Payer: Cash Price	$6.79
Rate for Payer: Cofinity Commercial	$5.94
Rate for Payer: Cofinity Commercial	$7.30
Rate for Payer: Cofinity Medicare Advantage	$5.94
Rate for Payer: Encore Health Key Benefits Commercial	$6.79
Rate for Payer: Healthscope Commercial	$7.64
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	$5.52
Rate for Payer: Priority Health SBD	$5.35

SEVELAMER CARBONATE 800 MG TABLET

Facility

$2,051.57

Service Code	NDC 00955105027
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$1,292.49
Max. Negotiated Rate	$1,846.41
Rate for Payer: Aetna Commercial	$1,743.83
Rate for Payer: Aetna New Business (MI Preferred)	$1,333.52
Rate for Payer: Cash Price	$1,641.26
Rate for Payer: Cofinity Commercial	$1,436.10
Rate for Payer: Cofinity Commercial	$1,764.35
Rate for Payer: Cofinity Medicare Advantage	$1,436.10
Rate for Payer: Encore Health Key Benefits Commercial	$1,641.26
Rate for Payer: Healthscope Commercial	$1,846.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,743.83
Rate for Payer: PHP Commercial	$1,743.83
Rate for Payer: Priority Health Cigna Priority Health	$1,333.52
Rate for Payer: Priority Health SBD	$1,292.49

SEVELAMER CARBONATE 800 MG TABLET

Facility

$10.56

Service Code	NDC 60687032811
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna Commercial	$8.98
Rate for Payer: Aetna Medicare	$5.28
Rate for Payer: Aetna New Business (MI Preferred)	$6.86
Rate for Payer: BCBS Complete	$4.22
Rate for Payer: Cash Price	$8.45
Rate for Payer: Cofinity Commercial	$7.39
Rate for Payer: Cofinity Commercial	$9.08
Rate for Payer: Cofinity Medicare Advantage	$7.39
Rate for Payer: Encore Health Key Benefits Commercial	$8.45
Rate for Payer: Healthscope Commercial	$9.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.98
Rate for Payer: PHP Commercial	$8.98
Rate for Payer: Priority Health Cigna Priority Health	$6.86
Rate for Payer: Priority Health SBD	$6.65

SEVELAMER CARBONATE 800 MG TABLET

Facility

$527.62

Service Code	NDC 60687032865
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$211.05
Max. Negotiated Rate	$474.86
Rate for Payer: Aetna Commercial	$448.48
Rate for Payer: Aetna Medicare	$263.81
Rate for Payer: Aetna New Business (MI Preferred)	$342.95
Rate for Payer: BCBS Complete	$211.05
Rate for Payer: Cash Price	$422.10
Rate for Payer: Cofinity Commercial	$369.33
Rate for Payer: Cofinity Commercial	$453.75
Rate for Payer: Cofinity Medicare Advantage	$369.33
Rate for Payer: Encore Health Key Benefits Commercial	$422.10
Rate for Payer: Healthscope Commercial	$474.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$448.48
Rate for Payer: PHP Commercial	$448.48
Rate for Payer: Priority Health Cigna Priority Health	$342.95
Rate for Payer: Priority Health SBD	$332.40

SEVELAMER CARBONATE 800 MG TABLET

Facility

$8.49

Service Code	NDC 68094003459
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$5.35
Max. Negotiated Rate	$7.64
Rate for Payer: Aetna Commercial	$7.22
Rate for Payer: Aetna New Business (MI Preferred)	$5.52
Rate for Payer: Cash Price	$6.79
Rate for Payer: Cofinity Commercial	$5.94
Rate for Payer: Cofinity Commercial	$7.30
Rate for Payer: Cofinity Medicare Advantage	$5.94
Rate for Payer: Encore Health Key Benefits Commercial	$6.79
Rate for Payer: Healthscope Commercial	$7.64
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	$5.52
Rate for Payer: Priority Health SBD	$5.35

SEVELAMER CARBONATE 800 MG TABLET

Facility

$763.35

Service Code	NDC 68094003464
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$305.34
Max. Negotiated Rate	$687.01
Rate for Payer: Aetna Commercial	$648.85
Rate for Payer: Aetna Medicare	$381.68
Rate for Payer: Aetna New Business (MI Preferred)	$496.18
Rate for Payer: BCBS Complete	$305.34
Rate for Payer: Cash Price	$610.68
Rate for Payer: Cofinity Commercial	$534.35
Rate for Payer: Cofinity Commercial	$656.48
Rate for Payer: Cofinity Medicare Advantage	$534.35
Rate for Payer: Encore Health Key Benefits Commercial	$610.68
Rate for Payer: Healthscope Commercial	$687.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$648.85
Rate for Payer: PHP Commercial	$648.85
Rate for Payer: Priority Health Cigna Priority Health	$496.18
Rate for Payer: Priority Health SBD	$480.91

SEVELAMER CARBONATE 800 MG TABLET

Facility

$527.62

Service Code	NDC 60687032865
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$332.40
Max. Negotiated Rate	$474.86
Rate for Payer: Aetna Commercial	$448.48
Rate for Payer: Aetna New Business (MI Preferred)	$342.95
Rate for Payer: Cash Price	$422.10
Rate for Payer: Cofinity Commercial	$369.33
Rate for Payer: Cofinity Commercial	$453.75
Rate for Payer: Cofinity Medicare Advantage	$369.33
Rate for Payer: Encore Health Key Benefits Commercial	$422.10
Rate for Payer: Healthscope Commercial	$474.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$448.48
Rate for Payer: PHP Commercial	$448.48
Rate for Payer: Priority Health Cigna Priority Health	$342.95
Rate for Payer: Priority Health SBD	$332.40

SEVELAMER CARBONATE 800 MG TABLET

Facility

$5,499.50

Service Code	NDC 58468013001
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$3,464.68
Max. Negotiated Rate	$4,949.55
Rate for Payer: Aetna Commercial	$4,674.57
Rate for Payer: Aetna New Business (MI Preferred)	$3,574.68
Rate for Payer: Cash Price	$4,399.60
Rate for Payer: Cofinity Commercial	$3,849.65
Rate for Payer: Cofinity Commercial	$4,729.57
Rate for Payer: Cofinity Medicare Advantage	$3,849.65
Rate for Payer: Encore Health Key Benefits Commercial	$4,399.60
Rate for Payer: Healthscope Commercial	$4,949.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,674.57
Rate for Payer: PHP Commercial	$4,674.57
Rate for Payer: Priority Health Cigna Priority Health	$3,574.68
Rate for Payer: Priority Health SBD	$3,464.68

SEVELAMER CARBONATE 800 MG TABLET

Facility

$2,051.57

Service Code	NDC 00955105027
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$820.63
Max. Negotiated Rate	$1,846.41
Rate for Payer: Aetna Commercial	$1,743.83
Rate for Payer: Aetna Medicare	$1,025.79
Rate for Payer: Aetna New Business (MI Preferred)	$1,333.52
Rate for Payer: BCBS Complete	$820.63
Rate for Payer: Cash Price	$1,641.26
Rate for Payer: Cofinity Commercial	$1,436.10
Rate for Payer: Cofinity Commercial	$1,764.35
Rate for Payer: Cofinity Medicare Advantage	$1,436.10
Rate for Payer: Encore Health Key Benefits Commercial	$1,641.26
Rate for Payer: Healthscope Commercial	$1,846.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,743.83
Rate for Payer: PHP Commercial	$1,743.83
Rate for Payer: Priority Health Cigna Priority Health	$1,333.52
Rate for Payer: Priority Health SBD	$1,292.49

Know your out-of-pocket cost for care.

All Charges