Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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

Facility

$189.00

Service Code	NDC 57896076315
Hospital Charge Code	9385
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 Advantage	$132.30
Rate for Payer: Cofinity Commercial	$162.54
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: Opus (Opus Packaging Group) HMA	$141.75
Rate for Payer: PHP Commercial	$160.65
Rate for Payer: Priority Health SBD	$119.07

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

Facility

$141.75

Service Code	NDC 70000003401
Hospital Charge Code	9385
Hospital Revenue Code	637
Min. Negotiated Rate	$89.30
Max. Negotiated Rate	$127.58
Rate for Payer: Aetna Commercial	$120.49
Rate for Payer: Aetna New Business (MI Preferred)	$92.14
Rate for Payer: Cash Price	$113.40
Rate for Payer: Cofinity Advantage	$99.22
Rate for Payer: Cofinity Commercial	$121.91
Rate for Payer: Encore Health Key Benefits Commercial	$113.40
Rate for Payer: Healthscope Commercial	$127.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$120.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$106.31
Rate for Payer: PHP Commercial	$120.49
Rate for Payer: Priority Health SBD	$89.30

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

Facility

$189.00

Service Code	NDC 57896076315
Hospital Charge Code	9385
Hospital Revenue Code	637
Min. Negotiated Rate	$74.28
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 Advantage	$132.30
Rate for Payer: Cofinity Commercial	$162.54
Rate for Payer: Encore Health Key Benefits Commercial	$151.20
Rate for Payer: Healthscope Commercial	$170.10
Rate for Payer: MI Amish Medical Board Commercial	$151.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$160.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$141.75
Rate for Payer: PHP Commercial	$160.65
Rate for Payer: Priority Health SBD	$119.07
Rate for Payer: UHC All Payor (Choice/PPO)	$122.85
Rate for Payer: UHC Core	$98.47
Rate for Payer: UHC Exchange	$74.28

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

Facility

$693.00

Service Code	NDC 66553000401
Hospital Charge Code	9385
Hospital Revenue Code	637
Min. Negotiated Rate	$272.35
Max. Negotiated Rate	$623.70
Rate for Payer: Aetna Commercial	$589.05
Rate for Payer: Aetna Medicare	$346.50
Rate for Payer: Aetna New Business (MI Preferred)	$450.45
Rate for Payer: BCBS Complete	$277.20
Rate for Payer: Cash Price	$554.40
Rate for Payer: Cofinity Advantage	$485.10
Rate for Payer: Cofinity Commercial	$595.98
Rate for Payer: Encore Health Key Benefits Commercial	$554.40
Rate for Payer: Healthscope Commercial	$623.70
Rate for Payer: MI Amish Medical Board Commercial	$554.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$589.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$519.75
Rate for Payer: PHP Commercial	$589.05
Rate for Payer: Priority Health SBD	$436.59
Rate for Payer: UHC All Payor (Choice/PPO)	$450.45
Rate for Payer: UHC Core	$361.05
Rate for Payer: UHC Exchange	$272.35

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

Facility

$141.75

Service Code	NDC 70000003401
Hospital Charge Code	9385
Hospital Revenue Code	637
Min. Negotiated Rate	$55.71
Max. Negotiated Rate	$127.58
Rate for Payer: Aetna Commercial	$120.49
Rate for Payer: Aetna Medicare	$70.88
Rate for Payer: Aetna New Business (MI Preferred)	$92.14
Rate for Payer: BCBS Complete	$56.70
Rate for Payer: Cash Price	$113.40
Rate for Payer: Cofinity Advantage	$99.22
Rate for Payer: Cofinity Commercial	$121.91
Rate for Payer: Encore Health Key Benefits Commercial	$113.40
Rate for Payer: Healthscope Commercial	$127.58
Rate for Payer: MI Amish Medical Board Commercial	$113.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$120.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$106.31
Rate for Payer: PHP Commercial	$120.49
Rate for Payer: Priority Health SBD	$89.30
Rate for Payer: UHC All Payor (Choice/PPO)	$92.14
Rate for Payer: UHC Core	$73.85
Rate for Payer: UHC Exchange	$55.71

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

Facility

$188.00

Service Code	NDC 10006070038
Hospital Charge Code	19483
Hospital Revenue Code	637
Min. Negotiated Rate	$73.88
Max. Negotiated Rate	$169.20
Rate for Payer: Aetna Commercial	$159.80
Rate for Payer: Aetna Medicare	$94.00
Rate for Payer: Aetna New Business (MI Preferred)	$122.20
Rate for Payer: BCBS Complete	$75.20
Rate for Payer: Cash Price	$150.40
Rate for Payer: Cofinity Advantage	$131.60
Rate for Payer: Cofinity Commercial	$161.68
Rate for Payer: Encore Health Key Benefits Commercial	$150.40
Rate for Payer: Healthscope Commercial	$169.20
Rate for Payer: MI Amish Medical Board Commercial	$150.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$159.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$141.00
Rate for Payer: PHP Commercial	$159.80
Rate for Payer: Priority Health SBD	$118.44
Rate for Payer: UHC All Payor (Choice/PPO)	$122.20
Rate for Payer: UHC Core	$97.95
Rate for Payer: UHC Exchange	$73.88

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

Facility

$340.20

Service Code	NDC 00904546072
Hospital Charge Code	19483
Hospital Revenue Code	637
Min. Negotiated Rate	$214.33
Max. Negotiated Rate	$306.18
Rate for Payer: Aetna Commercial	$289.17
Rate for Payer: Aetna New Business (MI Preferred)	$221.13
Rate for Payer: Cash Price	$272.16
Rate for Payer: Cofinity Advantage	$238.14
Rate for Payer: Cofinity Commercial	$292.57
Rate for Payer: Encore Health Key Benefits Commercial	$272.16
Rate for Payer: Healthscope Commercial	$306.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$289.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$255.15
Rate for Payer: PHP Commercial	$289.17
Rate for Payer: Priority Health SBD	$214.33

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	$74.28
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 Advantage	$132.30
Rate for Payer: Cofinity Commercial	$162.54
Rate for Payer: Encore Health Key Benefits Commercial	$151.20
Rate for Payer: Healthscope Commercial	$170.10
Rate for Payer: MI Amish Medical Board Commercial	$151.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$160.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$141.75
Rate for Payer: PHP Commercial	$160.65
Rate for Payer: Priority Health SBD	$119.07
Rate for Payer: UHC All Payor (Choice/PPO)	$122.85
Rate for Payer: UHC Core	$98.47
Rate for Payer: UHC Exchange	$74.28

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

Facility

$340.20

Service Code	NDC 00904546072
Hospital Charge Code	19483
Hospital Revenue Code	637
Min. Negotiated Rate	$133.70
Max. Negotiated Rate	$306.18
Rate for Payer: Aetna Commercial	$289.17
Rate for Payer: Aetna Medicare	$170.10
Rate for Payer: Aetna New Business (MI Preferred)	$221.13
Rate for Payer: BCBS Complete	$136.08
Rate for Payer: Cash Price	$272.16
Rate for Payer: Cofinity Advantage	$238.14
Rate for Payer: Cofinity Commercial	$292.57
Rate for Payer: Encore Health Key Benefits Commercial	$272.16
Rate for Payer: Healthscope Commercial	$306.18
Rate for Payer: MI Amish Medical Board Commercial	$272.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$289.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$255.15
Rate for Payer: PHP Commercial	$289.17
Rate for Payer: Priority Health SBD	$214.33
Rate for Payer: UHC All Payor (Choice/PPO)	$221.13
Rate for Payer: UHC Core	$177.24
Rate for Payer: UHC Exchange	$133.70

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

Facility

$90.72

Service Code	NDC 00536781708
Hospital Charge Code	19483
Hospital Revenue Code	637
Min. Negotiated Rate	$57.15
Max. Negotiated Rate	$81.65
Rate for Payer: Aetna Commercial	$77.11
Rate for Payer: Aetna New Business (MI Preferred)	$58.97
Rate for Payer: Cash Price	$72.58
Rate for Payer: Cofinity Advantage	$63.50
Rate for Payer: Cofinity Commercial	$78.02
Rate for Payer: Encore Health Key Benefits Commercial	$72.58
Rate for Payer: Healthscope Commercial	$81.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$77.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$68.04
Rate for Payer: PHP Commercial	$77.11
Rate for Payer: Priority Health SBD	$57.15

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

Facility

$188.00

Service Code	NDC 10006070038
Hospital Charge Code	19483
Hospital Revenue Code	637
Min. Negotiated Rate	$118.44
Max. Negotiated Rate	$169.20
Rate for Payer: Aetna Commercial	$159.80
Rate for Payer: Aetna New Business (MI Preferred)	$122.20
Rate for Payer: Cash Price	$150.40
Rate for Payer: Cofinity Advantage	$131.60
Rate for Payer: Cofinity Commercial	$161.68
Rate for Payer: Encore Health Key Benefits Commercial	$150.40
Rate for Payer: Healthscope Commercial	$169.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$159.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$141.00
Rate for Payer: PHP Commercial	$159.80
Rate for Payer: Priority Health SBD	$118.44

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 Advantage	$132.30
Rate for Payer: Cofinity Commercial	$162.54
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: Opus (Opus Packaging Group) HMA	$141.75
Rate for Payer: PHP Commercial	$160.65
Rate for Payer: Priority Health SBD	$119.07

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

Facility

$90.72

Service Code	NDC 00536781708
Hospital Charge Code	19483
Hospital Revenue Code	637
Min. Negotiated Rate	$35.65
Max. Negotiated Rate	$81.65
Rate for Payer: Aetna Commercial	$77.11
Rate for Payer: Aetna Medicare	$45.36
Rate for Payer: Aetna New Business (MI Preferred)	$58.97
Rate for Payer: BCBS Complete	$36.29
Rate for Payer: Cash Price	$72.58
Rate for Payer: Cofinity Advantage	$63.50
Rate for Payer: Cofinity Commercial	$78.02
Rate for Payer: Encore Health Key Benefits Commercial	$72.58
Rate for Payer: Healthscope Commercial	$81.65
Rate for Payer: MI Amish Medical Board Commercial	$72.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$77.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$68.04
Rate for Payer: PHP Commercial	$77.11
Rate for Payer: Priority Health SBD	$57.15
Rate for Payer: UHC All Payor (Choice/PPO)	$58.97
Rate for Payer: UHC Core	$47.27
Rate for Payer: UHC Exchange	$35.65

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)	$287.75
Rate for Payer: Cash Price	$354.16
Rate for Payer: Cofinity Advantage	$309.89
Rate for Payer: Cofinity Commercial	$380.72
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: Opus (Opus Packaging Group) HMA	$332.02
Rate for Payer: PHP Commercial	$376.30
Rate for Payer: Priority Health SBD	$278.90

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	$222.22
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 Advantage	$395.81
Rate for Payer: Cofinity Commercial	$486.28
Rate for Payer: Encore Health Key Benefits Commercial	$452.35
Rate for Payer: Healthscope Commercial	$508.90
Rate for Payer: MI Amish Medical Board Commercial	$452.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$480.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$424.08
Rate for Payer: PHP Commercial	$480.62
Rate for Payer: Priority Health SBD	$356.23
Rate for Payer: UHC All Payor (Choice/PPO)	$367.54
Rate for Payer: UHC Core	$294.59
Rate for Payer: UHC Exchange	$222.22

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 Advantage	$352.46
Rate for Payer: Cofinity Commercial	$433.03
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: Opus (Opus Packaging Group) HMA	$377.64
Rate for Payer: PHP Commercial	$427.99
Rate for Payer: Priority Health SBD	$317.22

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	$1.98
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 Advantage	$3.53
Rate for Payer: Cofinity Commercial	$4.33
Rate for Payer: Encore Health Key Benefits Commercial	$4.03
Rate for Payer: Healthscope Commercial	$4.54
Rate for Payer: MI Amish Medical Board Commercial	$4.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.78
Rate for Payer: PHP Commercial	$4.28
Rate for Payer: Priority Health SBD	$3.18
Rate for Payer: UHC All Payor (Choice/PPO)	$3.28
Rate for Payer: UHC Core	$2.63
Rate for Payer: UHC Exchange	$1.98

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	$199.58
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 Advantage	$355.49
Rate for Payer: Cofinity Commercial	$436.74
Rate for Payer: Encore Health Key Benefits Commercial	$406.27
Rate for Payer: Healthscope Commercial	$457.06
Rate for Payer: MI Amish Medical Board Commercial	$406.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$431.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$380.88
Rate for Payer: PHP Commercial	$431.66
Rate for Payer: Priority Health SBD	$319.94
Rate for Payer: UHC All Payor (Choice/PPO)	$330.10
Rate for Payer: UHC Core	$264.58
Rate for Payer: UHC Exchange	$199.58

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	$246.36
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 Advantage	$438.82
Rate for Payer: Cofinity Commercial	$539.12
Rate for Payer: Encore Health Key Benefits Commercial	$501.50
Rate for Payer: Healthscope Commercial	$564.19
Rate for Payer: MI Amish Medical Board Commercial	$501.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$532.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$470.16
Rate for Payer: PHP Commercial	$532.85
Rate for Payer: Priority Health SBD	$394.93
Rate for Payer: UHC All Payor (Choice/PPO)	$407.47
Rate for Payer: UHC Core	$326.60
Rate for Payer: UHC Exchange	$246.36

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 Advantage	$438.82
Rate for Payer: Cofinity Commercial	$539.12
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: Opus (Opus Packaging Group) HMA	$470.16
Rate for Payer: PHP Commercial	$532.85
Rate for Payer: Priority Health SBD	$394.93

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	$173.98
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)	$287.75
Rate for Payer: BCBS Complete	$177.08
Rate for Payer: Cash Price	$354.16
Rate for Payer: Cofinity Advantage	$309.89
Rate for Payer: Cofinity Commercial	$380.72
Rate for Payer: Encore Health Key Benefits Commercial	$354.16
Rate for Payer: Healthscope Commercial	$398.43
Rate for Payer: MI Amish Medical Board Commercial	$354.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$376.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$332.02
Rate for Payer: PHP Commercial	$376.30
Rate for Payer: Priority Health SBD	$278.90
Rate for Payer: UHC All Payor (Choice/PPO)	$287.75
Rate for Payer: UHC Core	$230.65
Rate for Payer: UHC Exchange	$173.98

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)	$287.75
Rate for Payer: Cash Price	$354.16
Rate for Payer: Cofinity Advantage	$309.89
Rate for Payer: Cofinity Commercial	$380.72
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: Opus (Opus Packaging Group) HMA	$332.02
Rate for Payer: PHP Commercial	$376.30
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	$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 Advantage	$3.53
Rate for Payer: Cofinity Commercial	$4.33
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: Opus (Opus Packaging Group) HMA	$3.78
Rate for Payer: PHP Commercial	$4.28
Rate for Payer: Priority Health SBD	$3.18

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 Advantage	$355.49
Rate for Payer: Cofinity Commercial	$436.74
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: Opus (Opus Packaging Group) HMA	$380.88
Rate for Payer: PHP Commercial	$431.66
Rate for Payer: Priority Health SBD	$319.94

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$456.48

Service Code	NDC 00904711961
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$287.58
Max. Negotiated Rate	$410.83
Rate for Payer: Aetna Commercial	$388.01
Rate for Payer: Aetna New Business (MI Preferred)	$296.71
Rate for Payer: Cash Price	$365.18
Rate for Payer: Cofinity Advantage	$319.54
Rate for Payer: Cofinity Commercial	$392.57
Rate for Payer: Encore Health Key Benefits Commercial	$365.18
Rate for Payer: Healthscope Commercial	$410.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$388.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$342.36
Rate for Payer: PHP Commercial	$388.01
Rate for Payer: Priority Health SBD	$287.58

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