Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

CHG X-RAY TRUNK SPINE SCOLIOSIS

Professional

Both

$45.00

Service Code	HCPCS 72069
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$29.25
Rate for Payer: Aetna Medicare	$22.50
Rate for Payer: Aetna Medicare	$30.00
Rate for Payer: BCBS Complete	$24.00
Rate for Payer: BCBS Complete	$18.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Priority Health Cigna Priority Health	$29.25
Rate for Payer: Priority Health Cigna Priority Health	$39.00

CHLORDIAZEPOXIDE 10 MG CAPSULE

Facility

$4.35

Service Code	NDC 51079037501
Hospital Charge Code	1622
Hospital Revenue Code	637
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$4.35
Rate for Payer: Aetna Commercial	$3.92
Rate for Payer: ASR ASR	$4.22
Rate for Payer: ASR Commercial	$4.22
Rate for Payer: BCBS Trust/PPO	$3.54
Rate for Payer: BCN Commercial	$3.37
Rate for Payer: Cash Price	$3.48
Rate for Payer: Cofinity Commercial	$4.09
Rate for Payer: Encore Health Key Benefits Commercial	$3.48
Rate for Payer: Healthscope Commercial	$4.35
Rate for Payer: Healthscope Whirlpool	$4.22
Rate for Payer: Mclaren Commercial	$3.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.70
Rate for Payer: Nomi Health Commercial	$3.57
Rate for Payer: Priority Health Cigna Priority Health	$2.83
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.83

CHLORDIAZEPOXIDE 10 MG CAPSULE

Facility

$4.35

Service Code	NDC 51079037501
Hospital Charge Code	1622
Hospital Revenue Code	637
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$4.35
Rate for Payer: Aetna Commercial	$3.92
Rate for Payer: Aetna Medicare	$2.18
Rate for Payer: ASR ASR	$4.22
Rate for Payer: ASR Commercial	$4.22
Rate for Payer: BCBS Complete	$1.74
Rate for Payer: BCBS Trust/PPO	$3.56
Rate for Payer: BCN Commercial	$3.37
Rate for Payer: Cash Price	$3.48
Rate for Payer: Cofinity Commercial	$4.09
Rate for Payer: Encore Health Key Benefits Commercial	$3.48
Rate for Payer: Healthscope Commercial	$4.35
Rate for Payer: Healthscope Whirlpool	$4.22
Rate for Payer: Mclaren Commercial	$3.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.70
Rate for Payer: Nomi Health Commercial	$3.57
Rate for Payer: Priority Health Cigna Priority Health	$2.83
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3.81
Rate for Payer: Priority Health Narrow Network	$3.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.83

CHLORDIAZEPOXIDE 25 MG CAPSULE

Facility

$354.85

Service Code	NDC 00555015902
Hospital Charge Code	1623
Hospital Revenue Code	637
Min. Negotiated Rate	$141.94
Max. Negotiated Rate	$354.85
Rate for Payer: Aetna Commercial	$319.36
Rate for Payer: Aetna Medicare	$177.42
Rate for Payer: ASR ASR	$344.20
Rate for Payer: ASR Commercial	$344.20
Rate for Payer: BCBS Complete	$141.94
Rate for Payer: BCBS Trust/PPO	$290.59
Rate for Payer: BCN Commercial	$275.12
Rate for Payer: Cash Price	$283.88
Rate for Payer: Cofinity Commercial	$333.56
Rate for Payer: Encore Health Key Benefits Commercial	$283.88
Rate for Payer: Healthscope Commercial	$354.85
Rate for Payer: Healthscope Whirlpool	$344.20
Rate for Payer: Mclaren Commercial	$319.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$301.62
Rate for Payer: Nomi Health Commercial	$290.98
Rate for Payer: Priority Health Cigna Priority Health	$230.65
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$310.92
Rate for Payer: Priority Health Narrow Network	$248.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$312.27

CHLORDIAZEPOXIDE 25 MG CAPSULE

Facility

$354.85

Service Code	NDC 00555015902
Hospital Charge Code	1623
Hospital Revenue Code	637
Min. Negotiated Rate	$230.65
Max. Negotiated Rate	$354.85
Rate for Payer: Aetna Commercial	$319.36
Rate for Payer: ASR ASR	$344.20
Rate for Payer: ASR Commercial	$344.20
Rate for Payer: BCBS Trust/PPO	$289.17
Rate for Payer: BCN Commercial	$275.12
Rate for Payer: Cash Price	$283.88
Rate for Payer: Cofinity Commercial	$333.56
Rate for Payer: Encore Health Key Benefits Commercial	$283.88
Rate for Payer: Healthscope Commercial	$354.85
Rate for Payer: Healthscope Whirlpool	$344.20
Rate for Payer: Mclaren Commercial	$319.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$301.62
Rate for Payer: Nomi Health Commercial	$290.98
Rate for Payer: Priority Health Cigna Priority Health	$230.65
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$312.27

CHLORDIAZEPOXIDE 5 MG CAPSULE

Facility

$406.55

Service Code	NDC 00555015802
Hospital Charge Code	1624
Hospital Revenue Code	637
Min. Negotiated Rate	$162.62
Max. Negotiated Rate	$406.55
Rate for Payer: Aetna Commercial	$365.90
Rate for Payer: Aetna Medicare	$203.28
Rate for Payer: ASR ASR	$394.35
Rate for Payer: ASR Commercial	$394.35
Rate for Payer: BCBS Complete	$162.62
Rate for Payer: BCBS Trust/PPO	$332.92
Rate for Payer: BCN Commercial	$315.20
Rate for Payer: Cash Price	$325.24
Rate for Payer: Cofinity Commercial	$382.16
Rate for Payer: Encore Health Key Benefits Commercial	$325.24
Rate for Payer: Healthscope Commercial	$406.55
Rate for Payer: Healthscope Whirlpool	$394.35
Rate for Payer: Mclaren Commercial	$365.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$345.57
Rate for Payer: Nomi Health Commercial	$333.37
Rate for Payer: Priority Health Cigna Priority Health	$264.26
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$356.22
Rate for Payer: Priority Health Narrow Network	$284.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$357.76

CHLORDIAZEPOXIDE 5 MG CAPSULE

Facility

$406.55

Service Code	NDC 00555015802
Hospital Charge Code	1624
Hospital Revenue Code	637
Min. Negotiated Rate	$264.26
Max. Negotiated Rate	$406.55
Rate for Payer: Aetna Commercial	$365.90
Rate for Payer: ASR ASR	$394.35
Rate for Payer: ASR Commercial	$394.35
Rate for Payer: BCBS Trust/PPO	$331.30
Rate for Payer: BCN Commercial	$315.20
Rate for Payer: Cash Price	$325.24
Rate for Payer: Cofinity Commercial	$382.16
Rate for Payer: Encore Health Key Benefits Commercial	$325.24
Rate for Payer: Healthscope Commercial	$406.55
Rate for Payer: Healthscope Whirlpool	$394.35
Rate for Payer: Mclaren Commercial	$365.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$345.57
Rate for Payer: Nomi Health Commercial	$333.37
Rate for Payer: Priority Health Cigna Priority Health	$264.26
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$357.76

CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION

Facility

$95.95

Service Code	HCPCS J3230
Hospital Charge Code	1649
Hospital Revenue Code	636
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$95.95
Rate for Payer: Aetna Commercial	$86.36
Rate for Payer: Aetna Medicare	$47.98
Rate for Payer: ASR ASR	$93.07
Rate for Payer: ASR Commercial	$93.07
Rate for Payer: BCBS Complete	$38.38
Rate for Payer: BCBS Trust/PPO	$78.57
Rate for Payer: BCN Commercial	$74.39
Rate for Payer: Cash Price	$76.76
Rate for Payer: Cash Price	$76.76
Rate for Payer: Cofinity Commercial	$90.19
Rate for Payer: Encore Health Key Benefits Commercial	$76.76
Rate for Payer: Healthscope Commercial	$95.95
Rate for Payer: Healthscope Whirlpool	$93.07
Rate for Payer: Mclaren Commercial	$86.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.56
Rate for Payer: Nomi Health Commercial	$78.68
Rate for Payer: Priority Health Cigna Priority Health	$62.37
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$30.13
Rate for Payer: Priority Health Narrow Network	$24.10
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$84.44

CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION

Facility

$95.95

Service Code	HCPCS J3230
Hospital Charge Code	1649
Hospital Revenue Code	636
Min. Negotiated Rate	$62.37
Max. Negotiated Rate	$95.95
Rate for Payer: Aetna Commercial	$86.36
Rate for Payer: ASR ASR	$93.07
Rate for Payer: ASR Commercial	$93.07
Rate for Payer: BCBS Trust/PPO	$78.19
Rate for Payer: BCN Commercial	$74.39
Rate for Payer: Cash Price	$76.76
Rate for Payer: Cofinity Commercial	$90.19
Rate for Payer: Encore Health Key Benefits Commercial	$76.76
Rate for Payer: Healthscope Commercial	$95.95
Rate for Payer: Healthscope Whirlpool	$93.07
Rate for Payer: Mclaren Commercial	$86.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.56
Rate for Payer: Nomi Health Commercial	$78.68
Rate for Payer: Priority Health Cigna Priority Health	$62.37
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$84.44

CHLORPROMAZINE 25 MG TABLET

Facility

$1,307.95

Service Code	NDC 00832030100
Hospital Charge Code	1656
Hospital Revenue Code	637
Min. Negotiated Rate	$523.18
Max. Negotiated Rate	$1,307.95
Rate for Payer: Aetna Commercial	$1,177.16
Rate for Payer: Aetna Medicare	$653.98
Rate for Payer: ASR ASR	$1,268.71
Rate for Payer: ASR Commercial	$1,268.71
Rate for Payer: BCBS Complete	$523.18
Rate for Payer: BCBS Trust/PPO	$1,071.08
Rate for Payer: BCN Commercial	$1,014.05
Rate for Payer: Cash Price	$1,046.36
Rate for Payer: Cofinity Commercial	$1,229.47
Rate for Payer: Encore Health Key Benefits Commercial	$1,046.36
Rate for Payer: Healthscope Commercial	$1,307.95
Rate for Payer: Healthscope Whirlpool	$1,268.71
Rate for Payer: Mclaren Commercial	$1,177.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,111.76
Rate for Payer: Nomi Health Commercial	$1,072.52
Rate for Payer: Priority Health Cigna Priority Health	$850.17
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,146.03
Rate for Payer: Priority Health Narrow Network	$916.87
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,151.00

CHLORPROMAZINE 25 MG TABLET

Facility

$1,307.95

Service Code	NDC 00832030100
Hospital Charge Code	1656
Hospital Revenue Code	637
Min. Negotiated Rate	$850.17
Max. Negotiated Rate	$1,307.95
Rate for Payer: Aetna Commercial	$1,177.16
Rate for Payer: ASR ASR	$1,268.71
Rate for Payer: ASR Commercial	$1,268.71
Rate for Payer: BCBS Trust/PPO	$1,065.85
Rate for Payer: BCN Commercial	$1,014.05
Rate for Payer: Cash Price	$1,046.36
Rate for Payer: Cofinity Commercial	$1,229.47
Rate for Payer: Encore Health Key Benefits Commercial	$1,046.36
Rate for Payer: Healthscope Commercial	$1,307.95
Rate for Payer: Healthscope Whirlpool	$1,268.71
Rate for Payer: Mclaren Commercial	$1,177.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,111.76
Rate for Payer: Nomi Health Commercial	$1,072.52
Rate for Payer: Priority Health Cigna Priority Health	$850.17
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,151.00

CHLORTHALIDONE 25 MG TABLET

Facility

$206.06

Service Code	NDC 00904690004
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$133.94
Max. Negotiated Rate	$206.06
Rate for Payer: Aetna Commercial	$185.45
Rate for Payer: ASR ASR	$199.88
Rate for Payer: ASR Commercial	$199.88
Rate for Payer: BCBS Trust/PPO	$167.92
Rate for Payer: BCN Commercial	$159.76
Rate for Payer: Cash Price	$164.85
Rate for Payer: Cofinity Commercial	$193.70
Rate for Payer: Encore Health Key Benefits Commercial	$164.85
Rate for Payer: Healthscope Commercial	$206.06
Rate for Payer: Healthscope Whirlpool	$199.88
Rate for Payer: Mclaren Commercial	$185.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$175.15
Rate for Payer: Nomi Health Commercial	$168.97
Rate for Payer: Priority Health Cigna Priority Health	$133.94
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$181.33

CHLORTHALIDONE 25 MG TABLET

Facility

$8.69

Service Code	NDC 51079005801
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$8.69
Rate for Payer: Aetna Commercial	$7.82
Rate for Payer: Aetna Medicare	$4.34
Rate for Payer: ASR ASR	$8.43
Rate for Payer: ASR Commercial	$8.43
Rate for Payer: BCBS Complete	$3.48
Rate for Payer: BCBS Trust/PPO	$7.12
Rate for Payer: BCN Commercial	$6.74
Rate for Payer: Cash Price	$6.95
Rate for Payer: Cofinity Commercial	$8.17
Rate for Payer: Encore Health Key Benefits Commercial	$6.95
Rate for Payer: Healthscope Commercial	$8.69
Rate for Payer: Healthscope Whirlpool	$8.43
Rate for Payer: Mclaren Commercial	$7.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.39
Rate for Payer: Nomi Health Commercial	$7.13
Rate for Payer: Priority Health Cigna Priority Health	$5.65
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7.61
Rate for Payer: Priority Health Narrow Network	$6.09
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$7.65

CHLORTHALIDONE 25 MG TABLET

Facility

$168.96

Service Code	NDC 50268016715
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$67.58
Max. Negotiated Rate	$168.96
Rate for Payer: Aetna Commercial	$152.06
Rate for Payer: Aetna Medicare	$84.48
Rate for Payer: ASR ASR	$163.89
Rate for Payer: ASR Commercial	$163.89
Rate for Payer: BCBS Complete	$67.58
Rate for Payer: BCBS Trust/PPO	$138.36
Rate for Payer: BCN Commercial	$130.99
Rate for Payer: Cash Price	$135.17
Rate for Payer: Cofinity Commercial	$158.82
Rate for Payer: Encore Health Key Benefits Commercial	$135.17
Rate for Payer: Healthscope Commercial	$168.96
Rate for Payer: Healthscope Whirlpool	$163.89
Rate for Payer: Mclaren Commercial	$152.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$143.62
Rate for Payer: Nomi Health Commercial	$138.55
Rate for Payer: Priority Health Cigna Priority Health	$109.82
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$148.04
Rate for Payer: Priority Health Narrow Network	$118.44
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$148.68

CHLORTHALIDONE 25 MG TABLET

Facility

$3.38

Service Code	NDC 50268016711
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare	$1.69
Rate for Payer: ASR ASR	$3.28
Rate for Payer: ASR Commercial	$3.28
Rate for Payer: BCBS Complete	$1.35
Rate for Payer: BCBS Trust/PPO	$2.77
Rate for Payer: BCN Commercial	$2.62
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cofinity Commercial	$3.18
Rate for Payer: Encore Health Key Benefits Commercial	$2.70
Rate for Payer: Healthscope Commercial	$3.38
Rate for Payer: Healthscope Whirlpool	$3.28
Rate for Payer: Mclaren Commercial	$3.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.87
Rate for Payer: Nomi Health Commercial	$2.77
Rate for Payer: Priority Health Cigna Priority Health	$2.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2.96
Rate for Payer: Priority Health Narrow Network	$2.37
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2.97

CHLORTHALIDONE 25 MG TABLET

Facility

$8.69

Service Code	NDC 51079005801
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$8.69
Rate for Payer: Aetna Commercial	$7.82
Rate for Payer: ASR ASR	$8.43
Rate for Payer: ASR Commercial	$8.43
Rate for Payer: BCBS Trust/PPO	$7.08
Rate for Payer: BCN Commercial	$6.74
Rate for Payer: Cash Price	$6.95
Rate for Payer: Cofinity Commercial	$8.17
Rate for Payer: Encore Health Key Benefits Commercial	$6.95
Rate for Payer: Healthscope Commercial	$8.69
Rate for Payer: Healthscope Whirlpool	$8.43
Rate for Payer: Mclaren Commercial	$7.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.39
Rate for Payer: Nomi Health Commercial	$7.13
Rate for Payer: Priority Health Cigna Priority Health	$5.65
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$7.65

CHLORTHALIDONE 25 MG TABLET

Facility

$168.96

Service Code	NDC 50268016715
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$109.82
Max. Negotiated Rate	$168.96
Rate for Payer: Aetna Commercial	$152.06
Rate for Payer: ASR ASR	$163.89
Rate for Payer: ASR Commercial	$163.89
Rate for Payer: BCBS Trust/PPO	$137.69
Rate for Payer: BCN Commercial	$130.99
Rate for Payer: Cash Price	$135.17
Rate for Payer: Cofinity Commercial	$158.82
Rate for Payer: Encore Health Key Benefits Commercial	$135.17
Rate for Payer: Healthscope Commercial	$168.96
Rate for Payer: Healthscope Whirlpool	$163.89
Rate for Payer: Mclaren Commercial	$152.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$143.62
Rate for Payer: Nomi Health Commercial	$138.55
Rate for Payer: Priority Health Cigna Priority Health	$109.82
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$148.68

CHLORTHALIDONE 25 MG TABLET

Facility

$305.50

Service Code	NDC 43598071901
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$198.58
Max. Negotiated Rate	$305.50
Rate for Payer: Aetna Commercial	$274.95
Rate for Payer: ASR ASR	$296.34
Rate for Payer: ASR Commercial	$296.34
Rate for Payer: BCBS Trust/PPO	$248.95
Rate for Payer: BCN Commercial	$236.85
Rate for Payer: Cash Price	$244.40
Rate for Payer: Cofinity Commercial	$287.17
Rate for Payer: Encore Health Key Benefits Commercial	$244.40
Rate for Payer: Healthscope Commercial	$305.50
Rate for Payer: Healthscope Whirlpool	$296.34
Rate for Payer: Mclaren Commercial	$274.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$259.68
Rate for Payer: Nomi Health Commercial	$250.51
Rate for Payer: Priority Health Cigna Priority Health	$198.58
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$268.84

CHLORTHALIDONE 25 MG TABLET

Facility

$206.06

Service Code	NDC 00904690004
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$82.42
Max. Negotiated Rate	$206.06
Rate for Payer: Aetna Commercial	$185.45
Rate for Payer: Aetna Medicare	$103.03
Rate for Payer: ASR ASR	$199.88
Rate for Payer: ASR Commercial	$199.88
Rate for Payer: BCBS Complete	$82.42
Rate for Payer: BCBS Trust/PPO	$168.74
Rate for Payer: BCN Commercial	$159.76
Rate for Payer: Cash Price	$164.85
Rate for Payer: Cofinity Commercial	$193.70
Rate for Payer: Encore Health Key Benefits Commercial	$164.85
Rate for Payer: Healthscope Commercial	$206.06
Rate for Payer: Healthscope Whirlpool	$199.88
Rate for Payer: Mclaren Commercial	$185.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$175.15
Rate for Payer: Nomi Health Commercial	$168.97
Rate for Payer: Priority Health Cigna Priority Health	$133.94
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$180.55
Rate for Payer: Priority Health Narrow Network	$144.45
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$181.33

CHLORTHALIDONE 25 MG TABLET

Facility

$305.50

Service Code	NDC 43598071901
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$122.20
Max. Negotiated Rate	$305.50
Rate for Payer: Aetna Commercial	$274.95
Rate for Payer: Aetna Medicare	$152.75
Rate for Payer: ASR ASR	$296.34
Rate for Payer: ASR Commercial	$296.34
Rate for Payer: BCBS Complete	$122.20
Rate for Payer: BCBS Trust/PPO	$250.17
Rate for Payer: BCN Commercial	$236.85
Rate for Payer: Cash Price	$244.40
Rate for Payer: Cofinity Commercial	$287.17
Rate for Payer: Encore Health Key Benefits Commercial	$244.40
Rate for Payer: Healthscope Commercial	$305.50
Rate for Payer: Healthscope Whirlpool	$296.34
Rate for Payer: Mclaren Commercial	$274.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$259.68
Rate for Payer: Nomi Health Commercial	$250.51
Rate for Payer: Priority Health Cigna Priority Health	$198.58
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$267.68
Rate for Payer: Priority Health Narrow Network	$214.16
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$268.84

CHLORTHALIDONE 25 MG TABLET

Facility

$213.75

Service Code	NDC 57664064888
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$138.94
Max. Negotiated Rate	$213.75
Rate for Payer: Aetna Commercial	$192.38
Rate for Payer: ASR ASR	$207.34
Rate for Payer: ASR Commercial	$207.34
Rate for Payer: BCBS Trust/PPO	$174.18
Rate for Payer: BCN Commercial	$165.72
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cofinity Commercial	$200.92
Rate for Payer: Encore Health Key Benefits Commercial	$171.00
Rate for Payer: Healthscope Commercial	$213.75
Rate for Payer: Healthscope Whirlpool	$207.34
Rate for Payer: Mclaren Commercial	$192.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$181.69
Rate for Payer: Nomi Health Commercial	$175.28
Rate for Payer: Priority Health Cigna Priority Health	$138.94
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$188.10

CHLORTHALIDONE 25 MG TABLET

Facility

$213.75

Service Code	NDC 57664064888
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$85.50
Max. Negotiated Rate	$213.75
Rate for Payer: Aetna Commercial	$192.38
Rate for Payer: Aetna Medicare	$106.88
Rate for Payer: ASR ASR	$207.34
Rate for Payer: ASR Commercial	$207.34
Rate for Payer: BCBS Complete	$85.50
Rate for Payer: BCBS Trust/PPO	$175.04
Rate for Payer: BCN Commercial	$165.72
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cofinity Commercial	$200.92
Rate for Payer: Encore Health Key Benefits Commercial	$171.00
Rate for Payer: Healthscope Commercial	$213.75
Rate for Payer: Healthscope Whirlpool	$207.34
Rate for Payer: Mclaren Commercial	$192.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$181.69
Rate for Payer: Nomi Health Commercial	$175.28
Rate for Payer: Priority Health Cigna Priority Health	$138.94
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$187.29
Rate for Payer: Priority Health Narrow Network	$149.84
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$188.10

CHLORTHALIDONE 25 MG TABLET

Facility

$3.38

Service Code	NDC 50268016711
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: ASR ASR	$3.28
Rate for Payer: ASR Commercial	$3.28
Rate for Payer: BCBS Trust/PPO	$2.75
Rate for Payer: BCN Commercial	$2.62
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cofinity Commercial	$3.18
Rate for Payer: Encore Health Key Benefits Commercial	$2.70
Rate for Payer: Healthscope Commercial	$3.38
Rate for Payer: Healthscope Whirlpool	$3.28
Rate for Payer: Mclaren Commercial	$3.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.87
Rate for Payer: Nomi Health Commercial	$2.77
Rate for Payer: Priority Health Cigna Priority Health	$2.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2.97

CHOLECALCIFEROL (VITAMIN D3) 1,250 MCG (50,000 UNIT) CAPSULE

Facility

$333.70

Service Code	NDC 75834002001
Hospital Charge Code	88945
Hospital Revenue Code	637
Min. Negotiated Rate	$133.48
Max. Negotiated Rate	$333.70
Rate for Payer: Aetna Commercial	$300.33
Rate for Payer: Aetna Medicare	$166.85
Rate for Payer: ASR ASR	$323.69
Rate for Payer: ASR Commercial	$323.69
Rate for Payer: BCBS Complete	$133.48
Rate for Payer: BCBS Trust/PPO	$273.27
Rate for Payer: BCN Commercial	$258.72
Rate for Payer: Cash Price	$266.96
Rate for Payer: Cofinity Commercial	$313.68
Rate for Payer: Encore Health Key Benefits Commercial	$266.96
Rate for Payer: Healthscope Commercial	$333.70
Rate for Payer: Healthscope Whirlpool	$323.69
Rate for Payer: Mclaren Commercial	$300.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$283.64
Rate for Payer: Nomi Health Commercial	$273.63
Rate for Payer: Priority Health Cigna Priority Health	$216.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$292.39
Rate for Payer: Priority Health Narrow Network	$233.92
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$293.66

CHOLECALCIFEROL (VITAMIN D3) 1,250 MCG (50,000 UNIT) CAPSULE

Facility

$333.70

Service Code	NDC 75834002001
Hospital Charge Code	88945
Hospital Revenue Code	637
Min. Negotiated Rate	$216.90
Max. Negotiated Rate	$333.70
Rate for Payer: Aetna Commercial	$300.33
Rate for Payer: ASR ASR	$323.69
Rate for Payer: ASR Commercial	$323.69
Rate for Payer: BCBS Trust/PPO	$271.93
Rate for Payer: BCN Commercial	$258.72
Rate for Payer: Cash Price	$266.96
Rate for Payer: Cofinity Commercial	$313.68
Rate for Payer: Encore Health Key Benefits Commercial	$266.96
Rate for Payer: Healthscope Commercial	$333.70
Rate for Payer: Healthscope Whirlpool	$323.69
Rate for Payer: Mclaren Commercial	$300.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$283.64
Rate for Payer: Nomi Health Commercial	$273.63
Rate for Payer: Priority Health Cigna Priority Health	$216.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$293.66

Know your out-of-pocket cost for care.

All Charges