Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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	$15.70
Max. Negotiated Rate	$35.95
Rate for Payer: Aetna Commercial	$33.96
Rate for Payer: Aetna Medicare	$19.98
Rate for Payer: Aetna New Business (MI Preferred)	$25.97
Rate for Payer: BCBS Complete	$15.98
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: MI Amish Medical Board Commercial	$31.96
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
Rate for Payer: UHC All Payor (Choice/PPO)	$25.97
Rate for Payer: UHC Core	$20.81
Rate for Payer: UHC Exchange	$15.70

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

$35.25

Service Code	NDC 00904582360
Hospital Charge Code	109842
Hospital Revenue Code	637
Min. Negotiated Rate	$22.21
Max. Negotiated Rate	$31.73
Rate for Payer: Aetna Commercial	$29.96
Rate for Payer: Aetna New Business (MI Preferred)	$22.91
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: 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

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

$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

$2.07

Service Code	NDC 50268086311
Hospital Charge Code	109842
Hospital Revenue Code	637
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$1.86
Rate for Payer: Aetna Commercial	$1.76
Rate for Payer: Aetna New Business (MI Preferred)	$1.35
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: 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

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

Facility

$3.53

Service Code	NDC 77333094825
Hospital Charge Code	109842
Hospital Revenue Code	637
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$3.18
Rate for Payer: Aetna Commercial	$3.00
Rate for Payer: Aetna New Business (MI Preferred)	$2.29
Rate for Payer: Cash Price	$2.82
Rate for Payer: Cofinity Advantage	$2.47
Rate for Payer: Cofinity Commercial	$3.04
Rate for Payer: Encore Health Key Benefits Commercial	$2.82
Rate for Payer: Healthscope Commercial	$3.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.65
Rate for Payer: PHP Commercial	$3.00
Rate for Payer: Priority Health SBD	$2.22

CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE

Facility

$159.80

Service Code	NDC 79854009098
Hospital Charge Code	15636
Hospital Revenue Code	637
Min. Negotiated Rate	$62.80
Max. Negotiated Rate	$143.82
Rate for Payer: Aetna Commercial	$135.83
Rate for Payer: Aetna Medicare	$79.90
Rate for Payer: Aetna New Business (MI Preferred)	$103.87
Rate for Payer: BCBS Complete	$63.92
Rate for Payer: Cash Price	$127.84
Rate for Payer: Cofinity Advantage	$111.86
Rate for Payer: Cofinity Commercial	$137.43
Rate for Payer: Encore Health Key Benefits Commercial	$127.84
Rate for Payer: Healthscope Commercial	$143.82
Rate for Payer: MI Amish Medical Board Commercial	$127.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$135.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$119.85
Rate for Payer: PHP Commercial	$135.83
Rate for Payer: Priority Health SBD	$100.67
Rate for Payer: UHC All Payor (Choice/PPO)	$103.87
Rate for Payer: UHC Core	$83.26
Rate for Payer: UHC Exchange	$62.80

CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE

Facility

$108.10

Service Code	NDC 00510509460
Hospital Charge Code	15636
Hospital Revenue Code	637
Min. Negotiated Rate	$42.48
Max. Negotiated Rate	$97.29
Rate for Payer: Aetna Commercial	$91.89
Rate for Payer: Aetna Medicare	$54.05
Rate for Payer: Aetna New Business (MI Preferred)	$70.27
Rate for Payer: BCBS Complete	$43.24
Rate for Payer: Cash Price	$86.48
Rate for Payer: Cofinity Advantage	$75.67
Rate for Payer: Cofinity Commercial	$92.97
Rate for Payer: Encore Health Key Benefits Commercial	$86.48
Rate for Payer: Healthscope Commercial	$97.29
Rate for Payer: MI Amish Medical Board Commercial	$86.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$81.08
Rate for Payer: PHP Commercial	$91.89
Rate for Payer: Priority Health SBD	$68.10
Rate for Payer: UHC All Payor (Choice/PPO)	$70.27
Rate for Payer: UHC Core	$56.32
Rate for Payer: UHC Exchange	$42.48

CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE

Facility

$108.10

Service Code	NDC 00510509460
Hospital Charge Code	15636
Hospital Revenue Code	637
Min. Negotiated Rate	$68.10
Max. Negotiated Rate	$97.29
Rate for Payer: Aetna Commercial	$91.89
Rate for Payer: Aetna New Business (MI Preferred)	$70.27
Rate for Payer: Cash Price	$86.48
Rate for Payer: Cofinity Advantage	$75.67
Rate for Payer: Cofinity Commercial	$92.97
Rate for Payer: Encore Health Key Benefits Commercial	$86.48
Rate for Payer: Healthscope Commercial	$97.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$81.08
Rate for Payer: PHP Commercial	$91.89
Rate for Payer: Priority Health SBD	$68.10

CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE

Facility

$2.56

Service Code	NDC 50268086811
Hospital Charge Code	15636
Hospital Revenue Code	637
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$2.30
Rate for Payer: Aetna Commercial	$2.18
Rate for Payer: Aetna New Business (MI Preferred)	$1.66
Rate for Payer: Cash Price	$2.05
Rate for Payer: Cofinity Advantage	$1.79
Rate for Payer: Cofinity Commercial	$2.20
Rate for Payer: Encore Health Key Benefits Commercial	$2.05
Rate for Payer: Healthscope Commercial	$2.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.92
Rate for Payer: PHP Commercial	$2.18
Rate for Payer: Priority Health SBD	$1.61

CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE

Facility

$61.10

Service Code	NDC 80681013100
Hospital Charge Code	15636
Hospital Revenue Code	637
Min. Negotiated Rate	$24.01
Max. Negotiated Rate	$54.99
Rate for Payer: Aetna Commercial	$51.94
Rate for Payer: Aetna Medicare	$30.55
Rate for Payer: Aetna New Business (MI Preferred)	$39.72
Rate for Payer: BCBS Complete	$24.44
Rate for Payer: Cash Price	$48.88
Rate for Payer: Cofinity Advantage	$42.77
Rate for Payer: Cofinity Commercial	$52.55
Rate for Payer: Encore Health Key Benefits Commercial	$48.88
Rate for Payer: Healthscope Commercial	$54.99
Rate for Payer: MI Amish Medical Board Commercial	$48.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$45.83
Rate for Payer: PHP Commercial	$51.94
Rate for Payer: Priority Health SBD	$38.49
Rate for Payer: UHC All Payor (Choice/PPO)	$39.72
Rate for Payer: UHC Core	$31.83
Rate for Payer: UHC Exchange	$24.01

CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE

Facility

$2.56

Service Code	NDC 50268086811
Hospital Charge Code	15636
Hospital Revenue Code	637
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$2.30
Rate for Payer: Aetna Commercial	$2.18
Rate for Payer: Aetna Medicare	$1.28
Rate for Payer: Aetna New Business (MI Preferred)	$1.66
Rate for Payer: BCBS Complete	$1.02
Rate for Payer: Cash Price	$2.05
Rate for Payer: Cofinity Advantage	$1.79
Rate for Payer: Cofinity Commercial	$2.20
Rate for Payer: Encore Health Key Benefits Commercial	$2.05
Rate for Payer: Healthscope Commercial	$2.30
Rate for Payer: MI Amish Medical Board Commercial	$2.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.92
Rate for Payer: PHP Commercial	$2.18
Rate for Payer: Priority Health SBD	$1.61
Rate for Payer: UHC All Payor (Choice/PPO)	$1.66
Rate for Payer: UHC Core	$1.33
Rate for Payer: UHC Exchange	$1.01

CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE

Facility

$127.78

Service Code	NDC 50268086815
Hospital Charge Code	15636
Hospital Revenue Code	637
Min. Negotiated Rate	$50.22
Max. Negotiated Rate	$115.00
Rate for Payer: Aetna Commercial	$108.61
Rate for Payer: Aetna Medicare	$63.89
Rate for Payer: Aetna New Business (MI Preferred)	$83.06
Rate for Payer: BCBS Complete	$51.11
Rate for Payer: Cash Price	$102.22
Rate for Payer: Cofinity Advantage	$89.45
Rate for Payer: Cofinity Commercial	$109.89
Rate for Payer: Encore Health Key Benefits Commercial	$102.22
Rate for Payer: Healthscope Commercial	$115.00
Rate for Payer: MI Amish Medical Board Commercial	$102.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$108.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$95.83
Rate for Payer: PHP Commercial	$108.61
Rate for Payer: Priority Health SBD	$80.50
Rate for Payer: UHC All Payor (Choice/PPO)	$83.06
Rate for Payer: UHC Core	$66.57
Rate for Payer: UHC Exchange	$50.22

CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE

Facility

$127.78

Service Code	NDC 50268086815
Hospital Charge Code	15636
Hospital Revenue Code	637
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$115.00
Rate for Payer: Aetna Commercial	$108.61
Rate for Payer: Aetna New Business (MI Preferred)	$83.06
Rate for Payer: Cash Price	$102.22
Rate for Payer: Cofinity Advantage	$89.45
Rate for Payer: Cofinity Commercial	$109.89
Rate for Payer: Encore Health Key Benefits Commercial	$102.22
Rate for Payer: Healthscope Commercial	$115.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$108.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$95.83
Rate for Payer: PHP Commercial	$108.61
Rate for Payer: Priority Health SBD	$80.50

CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE

Facility

$61.10

Service Code	NDC 80681013100
Hospital Charge Code	15636
Hospital Revenue Code	637
Min. Negotiated Rate	$38.49
Max. Negotiated Rate	$54.99
Rate for Payer: Aetna Commercial	$51.94
Rate for Payer: Aetna New Business (MI Preferred)	$39.72
Rate for Payer: Cash Price	$48.88
Rate for Payer: Cofinity Advantage	$42.77
Rate for Payer: Cofinity Commercial	$52.55
Rate for Payer: Encore Health Key Benefits Commercial	$48.88
Rate for Payer: Healthscope Commercial	$54.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$45.83
Rate for Payer: PHP Commercial	$51.94
Rate for Payer: Priority Health SBD	$38.49

CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE

Facility

$159.80

Service Code	NDC 79854009098
Hospital Charge Code	15636
Hospital Revenue Code	637
Min. Negotiated Rate	$100.67
Max. Negotiated Rate	$143.82
Rate for Payer: Aetna Commercial	$135.83
Rate for Payer: Aetna New Business (MI Preferred)	$103.87
Rate for Payer: Cash Price	$127.84
Rate for Payer: Cofinity Advantage	$111.86
Rate for Payer: Cofinity Commercial	$137.43
Rate for Payer: Encore Health Key Benefits Commercial	$127.84
Rate for Payer: Healthscope Commercial	$143.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$135.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$119.85
Rate for Payer: PHP Commercial	$135.83
Rate for Payer: Priority Health SBD	$100.67

CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET

Facility

$39.95

Service Code	NDC 80681016900
Hospital Charge Code	82639
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) 25 MCG (1,000 UNIT) TABLET

Facility

$212.80

Service Code	NDC 48433010401
Hospital Charge Code	82639
Hospital Revenue Code	637
Min. Negotiated Rate	$83.63
Max. Negotiated Rate	$191.52
Rate for Payer: Aetna Commercial	$180.88
Rate for Payer: Aetna Medicare	$106.40
Rate for Payer: Aetna New Business (MI Preferred)	$138.32
Rate for Payer: BCBS Complete	$85.12
Rate for Payer: Cash Price	$170.24
Rate for Payer: Cofinity Advantage	$148.96
Rate for Payer: Cofinity Commercial	$183.01
Rate for Payer: Encore Health Key Benefits Commercial	$170.24
Rate for Payer: Healthscope Commercial	$191.52
Rate for Payer: MI Amish Medical Board Commercial	$170.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$180.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$159.60
Rate for Payer: PHP Commercial	$180.88
Rate for Payer: Priority Health SBD	$134.06
Rate for Payer: UHC All Payor (Choice/PPO)	$138.32
Rate for Payer: UHC Core	$110.87
Rate for Payer: UHC Exchange	$83.63

CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET

Facility

$35.96

Service Code	NDC 80681016800
Hospital Charge Code	82639
Hospital Revenue Code	637
Min. Negotiated Rate	$22.65
Max. Negotiated Rate	$32.36
Rate for Payer: Aetna Commercial	$30.57
Rate for Payer: Aetna New Business (MI Preferred)	$23.37
Rate for Payer: Cash Price	$28.77
Rate for Payer: Cofinity Advantage	$25.17
Rate for Payer: Cofinity Commercial	$30.93
Rate for Payer: Encore Health Key Benefits Commercial	$28.77
Rate for Payer: Healthscope Commercial	$32.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$26.97
Rate for Payer: PHP Commercial	$30.57
Rate for Payer: Priority Health SBD	$22.65

CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET

Facility

$91.65

Service Code	NDC 20555003300
Hospital Charge Code	82639
Hospital Revenue Code	637
Min. Negotiated Rate	$36.02
Max. Negotiated Rate	$82.48
Rate for Payer: Aetna Commercial	$77.90
Rate for Payer: Aetna Medicare	$45.83
Rate for Payer: Aetna New Business (MI Preferred)	$59.57
Rate for Payer: BCBS Complete	$36.66
Rate for Payer: Cash Price	$73.32
Rate for Payer: Cofinity Advantage	$64.16
Rate for Payer: Cofinity Commercial	$78.82
Rate for Payer: Encore Health Key Benefits Commercial	$73.32
Rate for Payer: Healthscope Commercial	$82.48
Rate for Payer: MI Amish Medical Board Commercial	$73.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$77.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$68.74
Rate for Payer: PHP Commercial	$77.90
Rate for Payer: Priority Health SBD	$57.74
Rate for Payer: UHC All Payor (Choice/PPO)	$59.57
Rate for Payer: UHC Core	$47.75
Rate for Payer: UHC Exchange	$36.02

CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET

Facility

$39.95

Service Code	NDC 80681016900
Hospital Charge Code	82639
Hospital Revenue Code	637
Min. Negotiated Rate	$15.70
Max. Negotiated Rate	$35.95
Rate for Payer: Aetna Commercial	$33.96
Rate for Payer: Aetna Medicare	$19.98
Rate for Payer: Aetna New Business (MI Preferred)	$25.97
Rate for Payer: BCBS Complete	$15.98
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: MI Amish Medical Board Commercial	$31.96
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
Rate for Payer: UHC All Payor (Choice/PPO)	$25.97
Rate for Payer: UHC Core	$20.81
Rate for Payer: UHC Exchange	$15.70

CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET

Facility

$91.65

Service Code	NDC 20555003300
Hospital Charge Code	82639
Hospital Revenue Code	637
Min. Negotiated Rate	$57.74
Max. Negotiated Rate	$82.48
Rate for Payer: Aetna Commercial	$77.90
Rate for Payer: Aetna New Business (MI Preferred)	$59.57
Rate for Payer: Cash Price	$73.32
Rate for Payer: Cofinity Advantage	$64.16
Rate for Payer: Cofinity Commercial	$78.82
Rate for Payer: Encore Health Key Benefits Commercial	$73.32
Rate for Payer: Healthscope Commercial	$82.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$77.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$68.74
Rate for Payer: PHP Commercial	$77.90
Rate for Payer: Priority Health SBD	$57.74

CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET

Facility

$35.96

Service Code	NDC 80681016800
Hospital Charge Code	82639
Hospital Revenue Code	637
Min. Negotiated Rate	$14.13
Max. Negotiated Rate	$32.36
Rate for Payer: Aetna Commercial	$30.57
Rate for Payer: Aetna Medicare	$17.98
Rate for Payer: Aetna New Business (MI Preferred)	$23.37
Rate for Payer: BCBS Complete	$14.38
Rate for Payer: Cash Price	$28.77
Rate for Payer: Cofinity Advantage	$25.17
Rate for Payer: Cofinity Commercial	$30.93
Rate for Payer: Encore Health Key Benefits Commercial	$28.77
Rate for Payer: Healthscope Commercial	$32.36
Rate for Payer: MI Amish Medical Board Commercial	$28.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$26.97
Rate for Payer: PHP Commercial	$30.57
Rate for Payer: Priority Health SBD	$22.65
Rate for Payer: UHC All Payor (Choice/PPO)	$23.37
Rate for Payer: UHC Core	$18.74
Rate for Payer: UHC Exchange	$14.13

CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET

Facility

$212.80

Service Code	NDC 48433010401
Hospital Charge Code	82639
Hospital Revenue Code	637
Min. Negotiated Rate	$134.06
Max. Negotiated Rate	$191.52
Rate for Payer: Aetna Commercial	$180.88
Rate for Payer: Aetna New Business (MI Preferred)	$138.32
Rate for Payer: Cash Price	$170.24
Rate for Payer: Cofinity Advantage	$148.96
Rate for Payer: Cofinity Commercial	$183.01
Rate for Payer: Encore Health Key Benefits Commercial	$170.24
Rate for Payer: Healthscope Commercial	$191.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$180.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$159.60
Rate for Payer: PHP Commercial	$180.88
Rate for Payer: Priority Health SBD	$134.06

Know your out-of-pocket cost for care.

All Charges