Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CABAZITAXEL 10 MG/ML (FIRST DILUTION) INTRAVENOUS SOLUTION

Facility

$62,272.49

Service Code	HCPCS J9043
Hospital Charge Code	105644
Hospital Revenue Code	636
Min. Negotiated Rate	$39,231.67
Max. Negotiated Rate	$56,045.24
Rate for Payer: Aetna Commercial	$52,931.62
Rate for Payer: Aetna New Business (MI Preferred)	$40,477.12
Rate for Payer: Cash Price	$49,817.99
Rate for Payer: Cofinity Commercial	$43,590.74
Rate for Payer: Cofinity Commercial	$53,554.34
Rate for Payer: Healthscope Commercial	$56,045.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$52,931.62
Rate for Payer: PHP Commercial	$52,931.62
Rate for Payer: Priority Health Cigna Priority Health	$43,590.74
Rate for Payer: Priority Health SBD	$39,231.67

CABAZITAXEL 10 MG/ML (FIRST DILUTION) INTRAVENOUS SOLUTION

Facility

$62,272.49

Service Code	HCPCS J9043
Hospital Charge Code	105644
Hospital Revenue Code	636
Min. Negotiated Rate	$115.12
Max. Negotiated Rate	$56,045.24
Rate for Payer: Aetna Commercial	$52,931.62
Rate for Payer: Aetna Medicare	$218.87
Rate for Payer: Aetna New Business (MI Preferred)	$40,477.12
Rate for Payer: Allen County Amish Medical Aid Commercial	$263.07
Rate for Payer: Amish Plain Church Group Commercial	$263.07
Rate for Payer: BCBS Complete	$120.88
Rate for Payer: BCBS MAPPO	$210.45
Rate for Payer: BCBS Trust/PPO	$623.04
Rate for Payer: BCN Medicare Advantage	$210.45
Rate for Payer: Cash Price	$49,817.99
Rate for Payer: Cash Price	$49,817.99
Rate for Payer: Cofinity Commercial	$53,554.34
Rate for Payer: Cofinity Commercial	$43,590.74
Rate for Payer: Health Alliance Plan Medicare Advantage	$210.45
Rate for Payer: Healthscope Commercial	$56,045.24
Rate for Payer: Mclaren Medicaid	$115.12
Rate for Payer: Mclaren Medicare	$210.45
Rate for Payer: Meridian Medicaid	$120.88
Rate for Payer: Meridian Wellcare - Medicare Advantage	$220.98
Rate for Payer: MI Amish Medical Board Commercial	$242.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$52,931.62
Rate for Payer: PACE Medicare	$199.93
Rate for Payer: PACE SWMI	$210.45
Rate for Payer: PHP Commercial	$52,931.62
Rate for Payer: PHP Medicare Advantage	$210.45
Rate for Payer: Priority Health Choice Medicaid	$115.12
Rate for Payer: Priority Health Cigna Priority Health	$43,590.74
Rate for Payer: Priority Health Medicare	$210.45
Rate for Payer: Priority Health SBD	$39,231.67
Rate for Payer: Railroad Medicare Medicare	$210.45
Rate for Payer: UHC Dual Complete DSNP	$210.45
Rate for Payer: UHC Medicare Advantage	$216.77
Rate for Payer: VA VA	$210.45

CABOTEGRAVIR ER 400 MG/2 ML-RILPIVIRINE ER 600 MG/2ML IM SUSPENSION,ER

Facility

$11,311.36

Service Code	HCPCS J0741
Hospital Charge Code	196075
Hospital Revenue Code	636
Min. Negotiated Rate	$7,126.16
Max. Negotiated Rate	$10,180.22
Rate for Payer: Aetna Commercial	$9,614.66
Rate for Payer: Aetna New Business (MI Preferred)	$7,352.38
Rate for Payer: Cash Price	$9,049.09
Rate for Payer: Cofinity Commercial	$7,917.95
Rate for Payer: Cofinity Commercial	$9,727.77
Rate for Payer: Healthscope Commercial	$10,180.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$9,614.66
Rate for Payer: PHP Commercial	$9,614.66
Rate for Payer: Priority Health Cigna Priority Health	$7,917.95
Rate for Payer: Priority Health SBD	$7,126.16

CABOTEGRAVIR ER 600 MG/3 ML-RILPIVIRINE ER 900 MG/3ML IM SUSPENSION,ER

Facility

$16,967.03

Service Code	HCPCS J0741
Hospital Charge Code	196915
Hospital Revenue Code	636
Min. Negotiated Rate	$10,689.23
Max. Negotiated Rate	$15,270.33
Rate for Payer: Aetna Commercial	$14,421.98
Rate for Payer: Aetna New Business (MI Preferred)	$11,028.57
Rate for Payer: Cash Price	$13,573.62
Rate for Payer: Cofinity Commercial	$11,876.92
Rate for Payer: Cofinity Commercial	$14,591.65
Rate for Payer: Healthscope Commercial	$15,270.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14,421.98
Rate for Payer: PHP Commercial	$14,421.98
Rate for Payer: Priority Health Cigna Priority Health	$11,876.92
Rate for Payer: Priority Health SBD	$10,689.23

CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) MAINTENANCE INTRAVENOUS SOLUTION

Facility

$44.78

Service Code	HCPCS J0706
Hospital Charge Code	77412
Hospital Revenue Code	636
Min. Negotiated Rate	$28.21
Max. Negotiated Rate	$40.30
Rate for Payer: Aetna Commercial	$38.06
Rate for Payer: Aetna Commercial	$40.86
Rate for Payer: Aetna New Business (MI Preferred)	$29.11
Rate for Payer: Aetna New Business (MI Preferred)	$31.25
Rate for Payer: Cash Price	$35.82
Rate for Payer: Cash Price	$38.46
Rate for Payer: Cofinity Commercial	$38.51
Rate for Payer: Cofinity Commercial	$31.35
Rate for Payer: Cofinity Commercial	$41.34
Rate for Payer: Cofinity Commercial	$33.65
Rate for Payer: Healthscope Commercial	$43.26
Rate for Payer: Healthscope Commercial	$40.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$38.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$40.86
Rate for Payer: PHP Commercial	$38.06
Rate for Payer: PHP Commercial	$40.86
Rate for Payer: Priority Health Cigna Priority Health	$33.65
Rate for Payer: Priority Health Cigna Priority Health	$31.35
Rate for Payer: Priority Health SBD	$28.21
Rate for Payer: Priority Health SBD	$30.28

CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) MAINTENANCE ORAL SOLUTION

Facility

$37.76

Service Code	HCPCS J0706
Hospital Charge Code	77411
Hospital Revenue Code	636
Min. Negotiated Rate	$23.79
Max. Negotiated Rate	$33.98
Rate for Payer: Aetna Commercial	$32.10
Rate for Payer: Aetna New Business (MI Preferred)	$24.54
Rate for Payer: Cash Price	$30.21
Rate for Payer: Cofinity Commercial	$26.43
Rate for Payer: Cofinity Commercial	$32.47
Rate for Payer: Healthscope Commercial	$33.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$32.10
Rate for Payer: PHP Commercial	$32.10
Rate for Payer: Priority Health Cigna Priority Health	$26.43
Rate for Payer: Priority Health SBD	$23.79

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

Facility

$108.02

Service Code	NDC 0517-2502-01
Hospital Charge Code	1262
Hospital Revenue Code	250
Min. Negotiated Rate	$68.05
Max. Negotiated Rate	$97.22
Rate for Payer: Aetna Commercial	$91.82
Rate for Payer: Aetna New Business (MI Preferred)	$70.21
Rate for Payer: Cash Price	$86.42
Rate for Payer: Cofinity Commercial	$75.61
Rate for Payer: Cofinity Commercial	$92.90
Rate for Payer: Healthscope Commercial	$97.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$91.82
Rate for Payer: PHP Commercial	$91.82
Rate for Payer: Priority Health Cigna Priority Health	$75.61
Rate for Payer: Priority Health SBD	$68.05

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

Facility

$108.02

Service Code	NDC 0517-2502-10
Hospital Charge Code	1262
Hospital Revenue Code	250
Min. Negotiated Rate	$68.05
Max. Negotiated Rate	$97.22
Rate for Payer: Aetna Commercial	$91.82
Rate for Payer: Aetna New Business (MI Preferred)	$70.21
Rate for Payer: Cash Price	$86.42
Rate for Payer: Cofinity Commercial	$75.61
Rate for Payer: Cofinity Commercial	$92.90
Rate for Payer: Healthscope Commercial	$97.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$91.82
Rate for Payer: PHP Commercial	$91.82
Rate for Payer: Priority Health Cigna Priority Health	$75.61
Rate for Payer: Priority Health SBD	$68.05

CALAMINE 8 %-ZINC OXIDE 8 % LOTION

Facility

$14.34

Service Code	NDC 0395-0413-96
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: Healthscope Commercial	$12.91
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$12.19
Rate for Payer: PHP Commercial	$12.19
Rate for Payer: Priority Health Cigna Priority Health	$10.04
Rate for Payer: Priority Health SBD	$9.03

CALAMINE 8 %-ZINC OXIDE 8 % LOTION

Facility

$8.50

Service Code	NDC 0904-2533-21
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)	$5.52
Rate for Payer: Cash Price	$6.80
Rate for Payer: Cofinity Commercial	$5.95
Rate for Payer: Cofinity Commercial	$7.31
Rate for Payer: Healthscope Commercial	$7.65
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7.22
Rate for Payer: PHP Commercial	$7.22
Rate for Payer: Priority Health Cigna Priority Health	$5.95
Rate for Payer: Priority Health SBD	$5.36

CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION

Facility

$4,988.29

Service Code	HCPCS J0630
Hospital Charge Code	9347
Hospital Revenue Code	636
Min. Negotiated Rate	$3,142.62
Max. Negotiated Rate	$4,489.46
Rate for Payer: Aetna Commercial	$4,240.05
Rate for Payer: Aetna Commercial	$2,883.23
Rate for Payer: Aetna Commercial	$2,656.08
Rate for Payer: Aetna New Business (MI Preferred)	$2,031.12
Rate for Payer: Aetna New Business (MI Preferred)	$2,204.83
Rate for Payer: Aetna New Business (MI Preferred)	$3,242.39
Rate for Payer: Cash Price	$2,499.84
Rate for Payer: Cash Price	$3,990.63
Rate for Payer: Cash Price	$2,713.63
Rate for Payer: Cofinity Commercial	$2,917.15
Rate for Payer: Cofinity Commercial	$2,187.36
Rate for Payer: Cofinity Commercial	$2,687.33
Rate for Payer: Cofinity Commercial	$2,374.43
Rate for Payer: Cofinity Commercial	$3,491.80
Rate for Payer: Cofinity Commercial	$4,289.93
Rate for Payer: Healthscope Commercial	$2,812.32
Rate for Payer: Healthscope Commercial	$3,052.84
Rate for Payer: Healthscope Commercial	$4,489.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,883.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,656.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,240.05
Rate for Payer: PHP Commercial	$4,240.05
Rate for Payer: PHP Commercial	$2,883.23
Rate for Payer: PHP Commercial	$2,656.08
Rate for Payer: Priority Health Cigna Priority Health	$2,374.43
Rate for Payer: Priority Health Cigna Priority Health	$3,491.80
Rate for Payer: Priority Health Cigna Priority Health	$2,187.36
Rate for Payer: Priority Health SBD	$1,968.62
Rate for Payer: Priority Health SBD	$2,136.99
Rate for Payer: Priority Health SBD	$3,142.62

CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION

Facility

$3,392.04

Service Code	HCPCS J0630
Hospital Charge Code	9347
Hospital Revenue Code	636
Min. Negotiated Rate	$585.02
Max. Negotiated Rate	$3,166.25
Rate for Payer: Aetna Commercial	$2,883.23
Rate for Payer: Aetna Medicare	$1,112.28
Rate for Payer: Aetna New Business (MI Preferred)	$2,204.83
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,336.87
Rate for Payer: Amish Plain Church Group Commercial	$1,336.87
Rate for Payer: BCBS Complete	$614.32
Rate for Payer: BCBS MAPPO	$1,069.50
Rate for Payer: BCBS Trust/PPO	$3,166.25
Rate for Payer: BCN Medicare Advantage	$1,069.50
Rate for Payer: Cash Price	$2,713.63
Rate for Payer: Cash Price	$2,713.63
Rate for Payer: Cofinity Commercial	$2,917.15
Rate for Payer: Cofinity Commercial	$2,374.43
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,069.50
Rate for Payer: Healthscope Commercial	$3,052.84
Rate for Payer: Mclaren Medicaid	$585.02
Rate for Payer: Mclaren Medicare	$1,069.50
Rate for Payer: Meridian Medicaid	$614.32
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,122.97
Rate for Payer: MI Amish Medical Board Commercial	$1,229.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,883.23
Rate for Payer: PACE Medicare	$1,016.02
Rate for Payer: PACE SWMI	$1,069.50
Rate for Payer: PHP Commercial	$2,883.23
Rate for Payer: PHP Medicare Advantage	$1,069.50
Rate for Payer: Priority Health Choice Medicaid	$585.02
Rate for Payer: Priority Health Cigna Priority Health	$2,374.43
Rate for Payer: Priority Health Medicare	$1,069.50
Rate for Payer: Priority Health SBD	$2,136.99
Rate for Payer: Railroad Medicare Medicare	$1,069.50
Rate for Payer: UHC Dual Complete DSNP	$1,069.50
Rate for Payer: UHC Medicare Advantage	$1,101.58
Rate for Payer: VA VA	$1,069.50

CALCITRIOL 0.25 MCG CAPSULE

Facility

$422.40

Service Code	NDC 0054-0007-25
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: Healthscope Commercial	$380.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$359.04
Rate for Payer: PHP Commercial	$359.04
Rate for Payer: Priority Health Cigna Priority Health	$295.68
Rate for Payer: Priority Health SBD	$266.11

CALCITRIOL 0.25 MCG CAPSULE

Facility

$3.07

Service Code	NDC 60687-345-11
Hospital Charge Code	9350
Hospital Revenue Code	637
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$2.76
Rate for Payer: Aetna Commercial	$2.61
Rate for Payer: Aetna New Business (MI Preferred)	$2.00
Rate for Payer: Cash Price	$2.46
Rate for Payer: Cofinity Commercial	$2.15
Rate for Payer: Cofinity Commercial	$2.64
Rate for Payer: Healthscope Commercial	$2.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.61
Rate for Payer: PHP Commercial	$2.61
Rate for Payer: Priority Health Cigna Priority Health	$2.15
Rate for Payer: Priority Health SBD	$1.93

CALCITRIOL 0.25 MCG CAPSULE

Facility

$137.09

Service Code	NDC 0054-0007-13
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: Healthscope Commercial	$123.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$116.53
Rate for Payer: PHP Commercial	$116.53
Rate for Payer: Priority Health Cigna Priority Health	$95.96
Rate for Payer: Priority Health SBD	$86.37

CALCITRIOL 0.25 MCG CAPSULE

Facility

$61.28

Service Code	NDC 23155-662-03
Hospital Charge Code	9350
Hospital Revenue Code	637
Min. Negotiated Rate	$38.61
Max. Negotiated Rate	$55.15
Rate for Payer: Aetna Commercial	$52.09
Rate for Payer: Aetna New Business (MI Preferred)	$39.83
Rate for Payer: Cash Price	$49.02
Rate for Payer: Cofinity Commercial	$42.90
Rate for Payer: Cofinity Commercial	$52.70
Rate for Payer: Healthscope Commercial	$55.15
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$52.09
Rate for Payer: PHP Commercial	$52.09
Rate for Payer: Priority Health Cigna Priority Health	$42.90
Rate for Payer: Priority Health SBD	$38.61

CALCITRIOL 0.25 MCG CAPSULE

Facility

$306.72

Service Code	NDC 60687-345-01
Hospital Charge Code	9350
Hospital Revenue Code	637
Min. Negotiated Rate	$193.23
Max. Negotiated Rate	$276.05
Rate for Payer: Aetna Commercial	$260.71
Rate for Payer: Aetna New Business (MI Preferred)	$199.37
Rate for Payer: Cash Price	$245.38
Rate for Payer: Cofinity Commercial	$214.70
Rate for Payer: Cofinity Commercial	$263.78
Rate for Payer: Healthscope Commercial	$276.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$260.71
Rate for Payer: PHP Commercial	$260.71
Rate for Payer: Priority Health Cigna Priority Health	$214.70
Rate for Payer: Priority Health SBD	$193.23

CALCITRIOL 0.5 MCG CAPSULE

Facility

$215.65

Service Code	NDC 69452-208-20
Hospital Charge Code	9351
Hospital Revenue Code	637
Min. Negotiated Rate	$135.86
Max. Negotiated Rate	$194.08
Rate for Payer: Aetna Commercial	$183.30
Rate for Payer: Aetna New Business (MI Preferred)	$140.17
Rate for Payer: Cash Price	$172.52
Rate for Payer: Cofinity Commercial	$150.96
Rate for Payer: Cofinity Commercial	$185.46
Rate for Payer: Healthscope Commercial	$194.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$183.30
Rate for Payer: PHP Commercial	$183.30
Rate for Payer: Priority Health Cigna Priority Health	$150.96
Rate for Payer: Priority Health SBD	$135.86

CALCITRIOL 0.5 MCG CAPSULE

Facility

$682.08

Service Code	NDC 0093-7353-01
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: Healthscope Commercial	$613.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$579.77
Rate for Payer: PHP Commercial	$579.77
Rate for Payer: Priority Health Cigna Priority Health	$477.46
Rate for Payer: Priority Health SBD	$429.71

CALCITRIOL 0.5 MCG CAPSULE

Facility

$375.25

Service Code	NDC 23155-663-01
Hospital Charge Code	9351
Hospital Revenue Code	637
Min. Negotiated Rate	$236.41
Max. Negotiated Rate	$337.72
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	$322.72
Rate for Payer: Healthscope Commercial	$337.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$318.96
Rate for Payer: PHP Commercial	$318.96
Rate for Payer: Priority Health Cigna Priority Health	$262.68
Rate for Payer: Priority Health SBD	$236.41

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$507.84

Service Code	NDC 0054-0088-26
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: Healthscope Commercial	$457.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$431.66
Rate for Payer: PHP Commercial	$431.66
Rate for Payer: Priority Health Cigna Priority Health	$355.49
Rate for Payer: Priority Health SBD	$319.94

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$574.56

Service Code	NDC 68084-479-01
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$361.97
Max. Negotiated Rate	$517.10
Rate for Payer: Aetna Commercial	$488.38
Rate for Payer: Aetna New Business (MI Preferred)	$373.46
Rate for Payer: Cash Price	$459.65
Rate for Payer: Cofinity Commercial	$402.19
Rate for Payer: Cofinity Commercial	$494.12
Rate for Payer: Healthscope Commercial	$517.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$488.38
Rate for Payer: PHP Commercial	$488.38
Rate for Payer: Priority Health Cigna Priority Health	$402.19
Rate for Payer: Priority Health SBD	$361.97

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$626.88

Service Code	NDC 62135-191-22
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: Healthscope Commercial	$564.19
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$532.85
Rate for Payer: PHP Commercial	$532.85
Rate for Payer: Priority Health Cigna Priority Health	$438.82
Rate for Payer: Priority Health SBD	$394.93

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$5.75

Service Code	NDC 68084-479-11
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$5.18
Rate for Payer: Aetna Commercial	$4.89
Rate for Payer: Aetna New Business (MI Preferred)	$3.74
Rate for Payer: Cash Price	$4.60
Rate for Payer: Cofinity Commercial	$4.02
Rate for Payer: Cofinity Commercial	$4.94
Rate for Payer: Healthscope Commercial	$5.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4.89
Rate for Payer: PHP Commercial	$4.89
Rate for Payer: Priority Health Cigna Priority Health	$4.02
Rate for Payer: Priority Health SBD	$3.62

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$468.48

Service Code	NDC 0904-7119-61
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$295.14
Max. Negotiated Rate	$421.63
Rate for Payer: Aetna Commercial	$398.21
Rate for Payer: Aetna New Business (MI Preferred)	$304.51
Rate for Payer: Cash Price	$374.78
Rate for Payer: Cofinity Commercial	$327.94
Rate for Payer: Cofinity Commercial	$402.89
Rate for Payer: Healthscope Commercial	$421.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$398.21
Rate for Payer: PHP Commercial	$398.21
Rate for Payer: Priority Health Cigna Priority Health	$327.94
Rate for Payer: Priority Health SBD	$295.14

Know your out-of-pocket cost for care.

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