Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CHLORPROMAZINE 25 MG TABLET

Facility

$437.10

Service Code	NDC 62332073631
Hospital Charge Code	1656
Hospital Revenue Code	637
Min. Negotiated Rate	$171.78
Max. Negotiated Rate	$393.39
Rate for Payer: Aetna Commercial	$371.54
Rate for Payer: Aetna Medicare	$218.55
Rate for Payer: Aetna New Business (MI Preferred)	$284.12
Rate for Payer: BCBS Complete	$174.84
Rate for Payer: Cash Price	$349.68
Rate for Payer: Cofinity Advantage	$305.97
Rate for Payer: Cofinity Commercial	$375.91
Rate for Payer: Encore Health Key Benefits Commercial	$349.68
Rate for Payer: Healthscope Commercial	$393.39
Rate for Payer: MI Amish Medical Board Commercial	$349.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$371.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$327.82
Rate for Payer: PHP Commercial	$371.54
Rate for Payer: Priority Health SBD	$275.37
Rate for Payer: UHC All Payor (Choice/PPO)	$284.12
Rate for Payer: UHC Core	$227.73
Rate for Payer: UHC Exchange	$171.78

CHLORPROMAZINE 25 MG TABLET

Facility

$15.24

Service Code	NDC 51079051901
Hospital Charge Code	1656
Hospital Revenue Code	637
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$13.72
Rate for Payer: Aetna Commercial	$12.95
Rate for Payer: Aetna Medicare	$7.62
Rate for Payer: Aetna New Business (MI Preferred)	$9.91
Rate for Payer: BCBS Complete	$6.10
Rate for Payer: Cash Price	$12.19
Rate for Payer: Cofinity Advantage	$10.67
Rate for Payer: Cofinity Commercial	$13.11
Rate for Payer: Encore Health Key Benefits Commercial	$12.19
Rate for Payer: Healthscope Commercial	$13.72
Rate for Payer: MI Amish Medical Board Commercial	$12.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.43
Rate for Payer: PHP Commercial	$12.95
Rate for Payer: Priority Health SBD	$9.60
Rate for Payer: UHC All Payor (Choice/PPO)	$9.91
Rate for Payer: UHC Core	$7.94
Rate for Payer: UHC Exchange	$5.99

CHLORPROMAZINE 25 MG TABLET

Facility

$1,307.95

Service Code	NDC 00832030100
Hospital Charge Code	1656
Hospital Revenue Code	637
Min. Negotiated Rate	$514.02
Max. Negotiated Rate	$1,177.15
Rate for Payer: Aetna Commercial	$1,111.76
Rate for Payer: Aetna Medicare	$653.98
Rate for Payer: Aetna New Business (MI Preferred)	$850.17
Rate for Payer: BCBS Complete	$523.18
Rate for Payer: Cash Price	$1,046.36
Rate for Payer: Cofinity Advantage	$915.57
Rate for Payer: Cofinity Commercial	$1,124.84
Rate for Payer: Encore Health Key Benefits Commercial	$1,046.36
Rate for Payer: Healthscope Commercial	$1,177.15
Rate for Payer: MI Amish Medical Board Commercial	$1,046.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,111.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$980.96
Rate for Payer: PHP Commercial	$1,111.76
Rate for Payer: Priority Health SBD	$824.01
Rate for Payer: UHC All Payor (Choice/PPO)	$850.17
Rate for Payer: UHC Core	$681.44
Rate for Payer: UHC Exchange	$514.02

CHLORPROMAZINE 25 MG TABLET

Facility

$1,276.87

Service Code	NDC 00904713061
Hospital Charge Code	1656
Hospital Revenue Code	637
Min. Negotiated Rate	$804.43
Max. Negotiated Rate	$1,149.18
Rate for Payer: Aetna Commercial	$1,085.34
Rate for Payer: Aetna New Business (MI Preferred)	$829.97
Rate for Payer: Cash Price	$1,021.50
Rate for Payer: Cofinity Advantage	$893.81
Rate for Payer: Cofinity Commercial	$1,098.11
Rate for Payer: Encore Health Key Benefits Commercial	$1,021.50
Rate for Payer: Healthscope Commercial	$1,149.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,085.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$957.65
Rate for Payer: PHP Commercial	$1,085.34
Rate for Payer: Priority Health SBD	$804.43

CHLORPROMAZINE 25 MG TABLET

Facility

$1,307.95

Service Code	NDC 00832030100
Hospital Charge Code	1656
Hospital Revenue Code	637
Min. Negotiated Rate	$824.01
Max. Negotiated Rate	$1,177.15
Rate for Payer: Aetna Commercial	$1,111.76
Rate for Payer: Aetna New Business (MI Preferred)	$850.17
Rate for Payer: Cash Price	$1,046.36
Rate for Payer: Cofinity Advantage	$915.57
Rate for Payer: Cofinity Commercial	$1,124.84
Rate for Payer: Encore Health Key Benefits Commercial	$1,046.36
Rate for Payer: Healthscope Commercial	$1,177.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,111.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$980.96
Rate for Payer: PHP Commercial	$1,111.76
Rate for Payer: Priority Health SBD	$824.01

CHLORPROMAZINE 25 MG TABLET

Facility

$15.24

Service Code	NDC 51079051901
Hospital Charge Code	1656
Hospital Revenue Code	637
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$13.72
Rate for Payer: Aetna Commercial	$12.95
Rate for Payer: Aetna New Business (MI Preferred)	$9.91
Rate for Payer: Cash Price	$12.19
Rate for Payer: Cofinity Advantage	$10.67
Rate for Payer: Cofinity Commercial	$13.11
Rate for Payer: Encore Health Key Benefits Commercial	$12.19
Rate for Payer: Healthscope Commercial	$13.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.43
Rate for Payer: PHP Commercial	$12.95
Rate for Payer: Priority Health SBD	$9.60

CHLORPROMAZINE 25 MG TABLET

Facility

$1,523.29

Service Code	NDC 51079051920
Hospital Charge Code	1656
Hospital Revenue Code	637
Min. Negotiated Rate	$959.67
Max. Negotiated Rate	$1,370.96
Rate for Payer: Aetna Commercial	$1,294.80
Rate for Payer: Aetna New Business (MI Preferred)	$990.14
Rate for Payer: Cash Price	$1,218.63
Rate for Payer: Cofinity Advantage	$1,066.30
Rate for Payer: Cofinity Commercial	$1,310.03
Rate for Payer: Encore Health Key Benefits Commercial	$1,218.63
Rate for Payer: Healthscope Commercial	$1,370.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,294.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,142.47
Rate for Payer: PHP Commercial	$1,294.80
Rate for Payer: Priority Health SBD	$959.67

CHLORPROMAZINE 25 MG TABLET

Facility

$1,523.29

Service Code	NDC 51079051920
Hospital Charge Code	1656
Hospital Revenue Code	637
Min. Negotiated Rate	$598.65
Max. Negotiated Rate	$1,370.96
Rate for Payer: Aetna Commercial	$1,294.80
Rate for Payer: Aetna Medicare	$761.64
Rate for Payer: Aetna New Business (MI Preferred)	$990.14
Rate for Payer: BCBS Complete	$609.32
Rate for Payer: Cash Price	$1,218.63
Rate for Payer: Cofinity Advantage	$1,066.30
Rate for Payer: Cofinity Commercial	$1,310.03
Rate for Payer: Encore Health Key Benefits Commercial	$1,218.63
Rate for Payer: Healthscope Commercial	$1,370.96
Rate for Payer: MI Amish Medical Board Commercial	$1,218.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,294.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,142.47
Rate for Payer: PHP Commercial	$1,294.80
Rate for Payer: Priority Health SBD	$959.67
Rate for Payer: UHC All Payor (Choice/PPO)	$990.14
Rate for Payer: UHC Core	$793.63
Rate for Payer: UHC Exchange	$598.65

CHLORTHALIDONE 25 MG TABLET

Facility

$225.94

Service Code	NDC 60687031725
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$142.34
Max. Negotiated Rate	$203.35
Rate for Payer: Aetna Commercial	$192.05
Rate for Payer: Aetna New Business (MI Preferred)	$146.86
Rate for Payer: Cash Price	$180.75
Rate for Payer: Cofinity Advantage	$158.16
Rate for Payer: Cofinity Commercial	$194.31
Rate for Payer: Encore Health Key Benefits Commercial	$180.75
Rate for Payer: Healthscope Commercial	$203.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$192.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$169.46
Rate for Payer: PHP Commercial	$192.05
Rate for Payer: Priority Health SBD	$142.34

CHLORTHALIDONE 25 MG TABLET

Facility

$9.37

Service Code	NDC 51079005801
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$5.90
Max. Negotiated Rate	$8.43
Rate for Payer: Aetna Commercial	$7.96
Rate for Payer: Aetna New Business (MI Preferred)	$6.09
Rate for Payer: Cash Price	$7.50
Rate for Payer: Cofinity Advantage	$6.56
Rate for Payer: Cofinity Commercial	$8.06
Rate for Payer: Encore Health Key Benefits Commercial	$7.50
Rate for Payer: Healthscope Commercial	$8.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.03
Rate for Payer: PHP Commercial	$7.96
Rate for Payer: Priority Health SBD	$5.90

CHLORTHALIDONE 25 MG TABLET

Facility

$225.94

Service Code	NDC 60687031725
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$88.79
Max. Negotiated Rate	$203.35
Rate for Payer: Aetna Commercial	$192.05
Rate for Payer: Aetna Medicare	$112.97
Rate for Payer: Aetna New Business (MI Preferred)	$146.86
Rate for Payer: BCBS Complete	$90.38
Rate for Payer: Cash Price	$180.75
Rate for Payer: Cofinity Advantage	$158.16
Rate for Payer: Cofinity Commercial	$194.31
Rate for Payer: Encore Health Key Benefits Commercial	$180.75
Rate for Payer: Healthscope Commercial	$203.35
Rate for Payer: MI Amish Medical Board Commercial	$180.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$192.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$169.46
Rate for Payer: PHP Commercial	$192.05
Rate for Payer: Priority Health SBD	$142.34
Rate for Payer: UHC All Payor (Choice/PPO)	$146.86
Rate for Payer: UHC Core	$117.71
Rate for Payer: UHC Exchange	$88.79

CHLORTHALIDONE 25 MG TABLET

Facility

$7.54

Service Code	NDC 60687031795
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$6.79
Rate for Payer: Aetna Commercial	$6.41
Rate for Payer: Aetna Medicare	$3.77
Rate for Payer: Aetna New Business (MI Preferred)	$4.90
Rate for Payer: BCBS Complete	$3.02
Rate for Payer: Cash Price	$6.03
Rate for Payer: Cofinity Advantage	$5.28
Rate for Payer: Cofinity Commercial	$6.48
Rate for Payer: Encore Health Key Benefits Commercial	$6.03
Rate for Payer: Healthscope Commercial	$6.79
Rate for Payer: MI Amish Medical Board Commercial	$6.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.66
Rate for Payer: PHP Commercial	$6.41
Rate for Payer: Priority Health SBD	$4.75
Rate for Payer: UHC All Payor (Choice/PPO)	$4.90
Rate for Payer: UHC Core	$3.93
Rate for Payer: UHC Exchange	$2.96

CHLORTHALIDONE 25 MG TABLET

Facility

$936.96

Service Code	NDC 51079005820
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$590.28
Max. Negotiated Rate	$843.26
Rate for Payer: Aetna Commercial	$796.42
Rate for Payer: Aetna New Business (MI Preferred)	$609.02
Rate for Payer: Cash Price	$749.57
Rate for Payer: Cofinity Advantage	$655.87
Rate for Payer: Cofinity Commercial	$805.79
Rate for Payer: Encore Health Key Benefits Commercial	$749.57
Rate for Payer: Healthscope Commercial	$843.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$796.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$702.72
Rate for Payer: PHP Commercial	$796.42
Rate for Payer: Priority Health SBD	$590.28

CHLORTHALIDONE 25 MG TABLET

Facility

$9.37

Service Code	NDC 51079005801
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$8.43
Rate for Payer: Aetna Commercial	$7.96
Rate for Payer: Aetna Medicare	$4.68
Rate for Payer: Aetna New Business (MI Preferred)	$6.09
Rate for Payer: BCBS Complete	$3.75
Rate for Payer: Cash Price	$7.50
Rate for Payer: Cofinity Advantage	$6.56
Rate for Payer: Cofinity Commercial	$8.06
Rate for Payer: Encore Health Key Benefits Commercial	$7.50
Rate for Payer: Healthscope Commercial	$8.43
Rate for Payer: MI Amish Medical Board Commercial	$7.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.03
Rate for Payer: PHP Commercial	$7.96
Rate for Payer: Priority Health SBD	$5.90
Rate for Payer: UHC All Payor (Choice/PPO)	$6.09
Rate for Payer: UHC Core	$4.88
Rate for Payer: UHC Exchange	$3.68

CHLORTHALIDONE 25 MG TABLET

Facility

$205.35

Service Code	NDC 00904690004
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$129.37
Max. Negotiated Rate	$184.81
Rate for Payer: Aetna Commercial	$174.55
Rate for Payer: Aetna New Business (MI Preferred)	$133.48
Rate for Payer: Cash Price	$164.28
Rate for Payer: Cofinity Advantage	$143.75
Rate for Payer: Cofinity Commercial	$176.60
Rate for Payer: Encore Health Key Benefits Commercial	$164.28
Rate for Payer: Healthscope Commercial	$184.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$174.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$154.01
Rate for Payer: PHP Commercial	$174.55
Rate for Payer: Priority Health SBD	$129.37

CHLORTHALIDONE 25 MG TABLET

Facility

$7.54

Service Code	NDC 60687031795
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$6.79
Rate for Payer: Aetna Commercial	$6.41
Rate for Payer: Aetna New Business (MI Preferred)	$4.90
Rate for Payer: Cash Price	$6.03
Rate for Payer: Cofinity Advantage	$5.28
Rate for Payer: Cofinity Commercial	$6.48
Rate for Payer: Encore Health Key Benefits Commercial	$6.03
Rate for Payer: Healthscope Commercial	$6.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.66
Rate for Payer: PHP Commercial	$6.41
Rate for Payer: Priority Health SBD	$4.75

CHLORTHALIDONE 25 MG TABLET

Facility

$152.75

Service Code	NDC 64980059901
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$60.03
Max. Negotiated Rate	$137.47
Rate for Payer: Aetna Commercial	$129.84
Rate for Payer: Aetna Medicare	$76.38
Rate for Payer: Aetna New Business (MI Preferred)	$99.29
Rate for Payer: BCBS Complete	$61.10
Rate for Payer: Cash Price	$122.20
Rate for Payer: Cofinity Advantage	$106.92
Rate for Payer: Cofinity Commercial	$131.37
Rate for Payer: Encore Health Key Benefits Commercial	$122.20
Rate for Payer: Healthscope Commercial	$137.47
Rate for Payer: MI Amish Medical Board Commercial	$122.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$129.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$114.56
Rate for Payer: PHP Commercial	$129.84
Rate for Payer: Priority Health SBD	$96.23
Rate for Payer: UHC All Payor (Choice/PPO)	$99.29
Rate for Payer: UHC Core	$79.58
Rate for Payer: UHC Exchange	$60.03

CHLORTHALIDONE 25 MG TABLET

Facility

$152.75

Service Code	NDC 64980059901
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$96.23
Max. Negotiated Rate	$137.47
Rate for Payer: Aetna Commercial	$129.84
Rate for Payer: Aetna New Business (MI Preferred)	$99.29
Rate for Payer: Cash Price	$122.20
Rate for Payer: Cofinity Advantage	$106.92
Rate for Payer: Cofinity Commercial	$131.37
Rate for Payer: Encore Health Key Benefits Commercial	$122.20
Rate for Payer: Healthscope Commercial	$137.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$129.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$114.56
Rate for Payer: PHP Commercial	$129.84
Rate for Payer: Priority Health SBD	$96.23

CHLORTHALIDONE 25 MG TABLET

Facility

$205.35

Service Code	NDC 00904690004
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$80.70
Max. Negotiated Rate	$184.81
Rate for Payer: Aetna Commercial	$174.55
Rate for Payer: Aetna Medicare	$102.67
Rate for Payer: Aetna New Business (MI Preferred)	$133.48
Rate for Payer: BCBS Complete	$82.14
Rate for Payer: Cash Price	$164.28
Rate for Payer: Cofinity Advantage	$143.75
Rate for Payer: Cofinity Commercial	$176.60
Rate for Payer: Encore Health Key Benefits Commercial	$164.28
Rate for Payer: Healthscope Commercial	$184.81
Rate for Payer: MI Amish Medical Board Commercial	$164.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$174.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$154.01
Rate for Payer: PHP Commercial	$174.55
Rate for Payer: Priority Health SBD	$129.37
Rate for Payer: UHC All Payor (Choice/PPO)	$133.48
Rate for Payer: UHC Core	$106.99
Rate for Payer: UHC Exchange	$80.70

CHLORTHALIDONE 25 MG TABLET

Facility

$936.96

Service Code	NDC 51079005820
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$368.23
Max. Negotiated Rate	$843.26
Rate for Payer: Aetna Commercial	$796.42
Rate for Payer: Aetna Medicare	$468.48
Rate for Payer: Aetna New Business (MI Preferred)	$609.02
Rate for Payer: BCBS Complete	$374.78
Rate for Payer: Cash Price	$749.57
Rate for Payer: Cofinity Advantage	$655.87
Rate for Payer: Cofinity Commercial	$805.79
Rate for Payer: Encore Health Key Benefits Commercial	$749.57
Rate for Payer: Healthscope Commercial	$843.26
Rate for Payer: MI Amish Medical Board Commercial	$749.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$796.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$702.72
Rate for Payer: PHP Commercial	$796.42
Rate for Payer: Priority Health SBD	$590.28
Rate for Payer: UHC All Payor (Choice/PPO)	$609.02
Rate for Payer: UHC Core	$488.16
Rate for Payer: UHC Exchange	$368.23

CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET

Facility

$2.07

Service Code	NDC 50268086311
Hospital Charge Code	109842
Hospital Revenue Code	637
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.86
Rate for Payer: Aetna Commercial	$1.76
Rate for Payer: Aetna Medicare	$1.03
Rate for Payer: Aetna New Business (MI Preferred)	$1.35
Rate for Payer: BCBS Complete	$0.83
Rate for Payer: Cash Price	$1.66
Rate for Payer: Cofinity Advantage	$1.45
Rate for Payer: Cofinity Commercial	$1.78
Rate for Payer: Encore Health Key Benefits Commercial	$1.66
Rate for Payer: Healthscope Commercial	$1.86
Rate for Payer: MI Amish Medical Board Commercial	$1.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.55
Rate for Payer: PHP Commercial	$1.76
Rate for Payer: Priority Health SBD	$1.30
Rate for Payer: UHC All Payor (Choice/PPO)	$1.35
Rate for Payer: UHC Core	$1.08
Rate for Payer: UHC Exchange	$0.81

CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET

Facility

$103.08

Service Code	NDC 50268086315
Hospital Charge Code	109842
Hospital Revenue Code	637
Min. Negotiated Rate	$64.94
Max. Negotiated Rate	$92.77
Rate for Payer: Aetna Commercial	$87.62
Rate for Payer: Aetna New Business (MI Preferred)	$67.00
Rate for Payer: Cash Price	$82.46
Rate for Payer: Cofinity Advantage	$72.16
Rate for Payer: Cofinity Commercial	$88.65
Rate for Payer: Encore Health Key Benefits Commercial	$82.46
Rate for Payer: Healthscope Commercial	$92.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$87.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$77.31
Rate for Payer: PHP Commercial	$87.62
Rate for Payer: Priority Health SBD	$64.94

CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET

Facility

$39.95

Service Code	NDC 96295012845
Hospital Charge Code	109842
Hospital Revenue Code	637
Min. Negotiated Rate	$25.17
Max. Negotiated Rate	$35.95
Rate for Payer: Aetna Commercial	$33.96
Rate for Payer: Aetna New Business (MI Preferred)	$25.97
Rate for Payer: Cash Price	$31.96
Rate for Payer: Cofinity Advantage	$27.96
Rate for Payer: Cofinity Commercial	$34.36
Rate for Payer: Encore Health Key Benefits Commercial	$31.96
Rate for Payer: Healthscope Commercial	$35.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$29.96
Rate for Payer: PHP Commercial	$33.96
Rate for Payer: Priority Health SBD	$25.17

CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET

Facility

$35.25

Service Code	NDC 00904582360
Hospital Charge Code	109842
Hospital Revenue Code	637
Min. Negotiated Rate	$13.85
Max. Negotiated Rate	$31.73
Rate for Payer: Aetna Commercial	$29.96
Rate for Payer: Aetna Medicare	$17.62
Rate for Payer: Aetna New Business (MI Preferred)	$22.91
Rate for Payer: BCBS Complete	$14.10
Rate for Payer: Cash Price	$28.20
Rate for Payer: Cofinity Advantage	$24.68
Rate for Payer: Cofinity Commercial	$30.32
Rate for Payer: Encore Health Key Benefits Commercial	$28.20
Rate for Payer: Healthscope Commercial	$31.73
Rate for Payer: MI Amish Medical Board Commercial	$28.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$26.44
Rate for Payer: PHP Commercial	$29.96
Rate for Payer: Priority Health SBD	$22.21
Rate for Payer: UHC All Payor (Choice/PPO)	$22.91
Rate for Payer: UHC Core	$18.37
Rate for Payer: UHC Exchange	$13.85

CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET

Facility

$352.50

Service Code	NDC 77333094810
Hospital Charge Code	109842
Hospital Revenue Code	637
Min. Negotiated Rate	$222.07
Max. Negotiated Rate	$317.25
Rate for Payer: Aetna Commercial	$299.62
Rate for Payer: Aetna New Business (MI Preferred)	$229.12
Rate for Payer: Cash Price	$282.00
Rate for Payer: Cofinity Advantage	$246.75
Rate for Payer: Cofinity Commercial	$303.15
Rate for Payer: Encore Health Key Benefits Commercial	$282.00
Rate for Payer: Healthscope Commercial	$317.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$299.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$264.38
Rate for Payer: PHP Commercial	$299.62
Rate for Payer: Priority Health SBD	$222.07

Know your out-of-pocket cost for care.

All Charges