Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SODIUM HYPOCHLORITE 0.125 % SOLUTION

Facility

$66.22

Service Code	NDC 00436067216
Hospital Charge Code	76720
Hospital Revenue Code	637
Min. Negotiated Rate	$41.72
Max. Negotiated Rate	$59.60
Rate for Payer: Aetna Commercial	$56.29
Rate for Payer: Aetna New Business (MI Preferred)	$43.04
Rate for Payer: Cash Price	$52.98
Rate for Payer: Cofinity Advantage	$46.35
Rate for Payer: Cofinity Commercial	$56.95
Rate for Payer: Encore Health Key Benefits Commercial	$52.98
Rate for Payer: Healthscope Commercial	$59.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$49.66
Rate for Payer: PHP Commercial	$56.29
Rate for Payer: Priority Health SBD	$41.72

SODIUM HYPOCHLORITE 0.125 % SOLUTION

Facility

$66.22

Service Code	NDC 00436067216
Hospital Charge Code	76720
Hospital Revenue Code	637
Min. Negotiated Rate	$26.02
Max. Negotiated Rate	$59.60
Rate for Payer: Aetna Commercial	$56.29
Rate for Payer: Aetna Medicare	$33.11
Rate for Payer: Aetna New Business (MI Preferred)	$43.04
Rate for Payer: BCBS Complete	$26.49
Rate for Payer: Cash Price	$52.98
Rate for Payer: Cofinity Advantage	$46.35
Rate for Payer: Cofinity Commercial	$56.95
Rate for Payer: Encore Health Key Benefits Commercial	$52.98
Rate for Payer: Healthscope Commercial	$59.60
Rate for Payer: MI Amish Medical Board Commercial	$52.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$49.66
Rate for Payer: PHP Commercial	$56.29
Rate for Payer: Priority Health SBD	$41.72
Rate for Payer: UHC All Payor (Choice/PPO)	$43.04
Rate for Payer: UHC Core	$34.50
Rate for Payer: UHC Exchange	$26.02

SODIUM HYPOCHLORITE 0.125 % SOLUTION

Facility

$165.19

Service Code	NDC 39328006712
Hospital Charge Code	76720
Hospital Revenue Code	637
Min. Negotiated Rate	$104.07
Max. Negotiated Rate	$148.67
Rate for Payer: Aetna Commercial	$140.41
Rate for Payer: Aetna New Business (MI Preferred)	$107.37
Rate for Payer: Cash Price	$132.15
Rate for Payer: Cofinity Advantage	$115.63
Rate for Payer: Cofinity Commercial	$142.06
Rate for Payer: Encore Health Key Benefits Commercial	$132.15
Rate for Payer: Healthscope Commercial	$148.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$140.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$123.89
Rate for Payer: PHP Commercial	$140.41
Rate for Payer: Priority Health SBD	$104.07

SODIUM HYPOCHLORITE 0.125 % SOLUTION

Facility

$165.19

Service Code	NDC 39328006712
Hospital Charge Code	76720
Hospital Revenue Code	637
Min. Negotiated Rate	$64.92
Max. Negotiated Rate	$148.67
Rate for Payer: Aetna Commercial	$140.41
Rate for Payer: Aetna Medicare	$82.59
Rate for Payer: Aetna New Business (MI Preferred)	$107.37
Rate for Payer: BCBS Complete	$66.08
Rate for Payer: Cash Price	$132.15
Rate for Payer: Cofinity Advantage	$115.63
Rate for Payer: Cofinity Commercial	$142.06
Rate for Payer: Encore Health Key Benefits Commercial	$132.15
Rate for Payer: Healthscope Commercial	$148.67
Rate for Payer: MI Amish Medical Board Commercial	$132.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$140.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$123.89
Rate for Payer: PHP Commercial	$140.41
Rate for Payer: Priority Health SBD	$104.07
Rate for Payer: UHC All Payor (Choice/PPO)	$107.37
Rate for Payer: UHC Core	$86.06
Rate for Payer: UHC Exchange	$64.92

SODIUM HYPOCHLORITE 0.25 % SOLUTION

Facility

$12.00

Service Code	NDC 09900001865
Hospital Charge Code	15950
Hospital Revenue Code	637
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna Commercial	$10.20
Rate for Payer: Aetna Medicare	$6.00
Rate for Payer: Aetna New Business (MI Preferred)	$7.80
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cofinity Advantage	$8.40
Rate for Payer: Cofinity Commercial	$10.32
Rate for Payer: Encore Health Key Benefits Commercial	$9.60
Rate for Payer: Healthscope Commercial	$10.80
Rate for Payer: MI Amish Medical Board Commercial	$9.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.00
Rate for Payer: PHP Commercial	$10.20
Rate for Payer: Priority Health SBD	$7.56
Rate for Payer: UHC All Payor (Choice/PPO)	$7.80
Rate for Payer: UHC Core	$6.25
Rate for Payer: UHC Exchange	$4.72

SODIUM HYPOCHLORITE 0.25 % SOLUTION

Facility

$46.36

Service Code	NDC 39328006325
Hospital Charge Code	15950
Hospital Revenue Code	637
Min. Negotiated Rate	$18.22
Max. Negotiated Rate	$41.72
Rate for Payer: Aetna Commercial	$39.41
Rate for Payer: Aetna Medicare	$23.18
Rate for Payer: Aetna New Business (MI Preferred)	$30.13
Rate for Payer: BCBS Complete	$18.54
Rate for Payer: Cash Price	$37.09
Rate for Payer: Cofinity Advantage	$32.45
Rate for Payer: Cofinity Commercial	$39.87
Rate for Payer: Encore Health Key Benefits Commercial	$37.09
Rate for Payer: Healthscope Commercial	$41.72
Rate for Payer: MI Amish Medical Board Commercial	$37.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$34.77
Rate for Payer: PHP Commercial	$39.41
Rate for Payer: Priority Health SBD	$29.21
Rate for Payer: UHC All Payor (Choice/PPO)	$30.13
Rate for Payer: UHC Core	$24.15
Rate for Payer: UHC Exchange	$18.22

SODIUM HYPOCHLORITE 0.25 % SOLUTION

Facility

$46.36

Service Code	NDC 39328006325
Hospital Charge Code	15950
Hospital Revenue Code	637
Min. Negotiated Rate	$29.21
Max. Negotiated Rate	$41.72
Rate for Payer: Aetna Commercial	$39.41
Rate for Payer: Aetna New Business (MI Preferred)	$30.13
Rate for Payer: Cash Price	$37.09
Rate for Payer: Cofinity Advantage	$32.45
Rate for Payer: Cofinity Commercial	$39.87
Rate for Payer: Encore Health Key Benefits Commercial	$37.09
Rate for Payer: Healthscope Commercial	$41.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$34.77
Rate for Payer: PHP Commercial	$39.41
Rate for Payer: Priority Health SBD	$29.21

SODIUM HYPOCHLORITE 0.25 % SOLUTION

Facility

$12.00

Service Code	NDC 09900001865
Hospital Charge Code	15950
Hospital Revenue Code	637
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna Commercial	$10.20
Rate for Payer: Aetna New Business (MI Preferred)	$7.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cofinity Advantage	$8.40
Rate for Payer: Cofinity Commercial	$10.32
Rate for Payer: Encore Health Key Benefits Commercial	$9.60
Rate for Payer: Healthscope Commercial	$10.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.00
Rate for Payer: PHP Commercial	$10.20
Rate for Payer: Priority Health SBD	$7.56

SODIUM HYPOCHLORITE 0.5 % SOLUTION

Facility

$12.00

Service Code	NDC 09900001866
Hospital Charge Code	2110
Hospital Revenue Code	637
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna Commercial	$10.20
Rate for Payer: Aetna New Business (MI Preferred)	$7.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cofinity Advantage	$8.40
Rate for Payer: Cofinity Commercial	$10.32
Rate for Payer: Encore Health Key Benefits Commercial	$9.60
Rate for Payer: Healthscope Commercial	$10.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.00
Rate for Payer: PHP Commercial	$10.20
Rate for Payer: Priority Health SBD	$7.56

SODIUM HYPOCHLORITE 0.5 % SOLUTION

Facility

$12.00

Service Code	NDC 09900001866
Hospital Charge Code	2110
Hospital Revenue Code	637
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna Commercial	$10.20
Rate for Payer: Aetna Medicare	$6.00
Rate for Payer: Aetna New Business (MI Preferred)	$7.80
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cofinity Advantage	$8.40
Rate for Payer: Cofinity Commercial	$10.32
Rate for Payer: Encore Health Key Benefits Commercial	$9.60
Rate for Payer: Healthscope Commercial	$10.80
Rate for Payer: MI Amish Medical Board Commercial	$9.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.00
Rate for Payer: PHP Commercial	$10.20
Rate for Payer: Priority Health SBD	$7.56
Rate for Payer: UHC All Payor (Choice/PPO)	$7.80
Rate for Payer: UHC Core	$6.25
Rate for Payer: UHC Exchange	$4.72

SODIUM HYPOCHLORITE 0.5 % SOLUTION

Facility

$61.26

Service Code	NDC 39328006250
Hospital Charge Code	2110
Hospital Revenue Code	637
Min. Negotiated Rate	$24.08
Max. Negotiated Rate	$55.13
Rate for Payer: Aetna Commercial	$52.07
Rate for Payer: Aetna Medicare	$30.63
Rate for Payer: Aetna New Business (MI Preferred)	$39.82
Rate for Payer: BCBS Complete	$24.50
Rate for Payer: Cash Price	$49.01
Rate for Payer: Cofinity Advantage	$42.88
Rate for Payer: Cofinity Commercial	$52.68
Rate for Payer: Encore Health Key Benefits Commercial	$49.01
Rate for Payer: Healthscope Commercial	$55.13
Rate for Payer: MI Amish Medical Board Commercial	$49.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$45.95
Rate for Payer: PHP Commercial	$52.07
Rate for Payer: Priority Health SBD	$38.59
Rate for Payer: UHC All Payor (Choice/PPO)	$39.82
Rate for Payer: UHC Core	$31.92
Rate for Payer: UHC Exchange	$24.08

SODIUM HYPOCHLORITE 0.5 % SOLUTION

Facility

$61.26

Service Code	NDC 39328006250
Hospital Charge Code	2110
Hospital Revenue Code	637
Min. Negotiated Rate	$38.59
Max. Negotiated Rate	$55.13
Rate for Payer: Aetna Commercial	$52.07
Rate for Payer: Aetna New Business (MI Preferred)	$39.82
Rate for Payer: Cash Price	$49.01
Rate for Payer: Cofinity Advantage	$42.88
Rate for Payer: Cofinity Commercial	$52.68
Rate for Payer: Encore Health Key Benefits Commercial	$49.01
Rate for Payer: Healthscope Commercial	$55.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$45.95
Rate for Payer: PHP Commercial	$52.07
Rate for Payer: Priority Health SBD	$38.59

SODIUM NITRITE 30 MG/ML INTRAVENOUS SOLUTION

Facility

$351.45

Service Code	NDC 60267031110
Hospital Charge Code	24049
Hospital Revenue Code	250
Min. Negotiated Rate	$138.12
Max. Negotiated Rate	$316.31
Rate for Payer: Aetna Commercial	$298.73
Rate for Payer: Aetna Medicare	$175.72
Rate for Payer: Aetna New Business (MI Preferred)	$228.44
Rate for Payer: BCBS Complete	$140.58
Rate for Payer: Cash Price	$281.16
Rate for Payer: Cofinity Advantage	$246.01
Rate for Payer: Cofinity Commercial	$302.25
Rate for Payer: Encore Health Key Benefits Commercial	$281.16
Rate for Payer: Healthscope Commercial	$316.31
Rate for Payer: MI Amish Medical Board Commercial	$281.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$298.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$263.59
Rate for Payer: PHP Commercial	$298.73
Rate for Payer: Priority Health SBD	$221.41
Rate for Payer: UHC All Payor (Choice/PPO)	$228.44
Rate for Payer: UHC Core	$183.11
Rate for Payer: UHC Exchange	$138.12

SODIUM NITRITE 30 MG/ML INTRAVENOUS SOLUTION

Facility

$351.45

Service Code	NDC 60267031110
Hospital Charge Code	24049
Hospital Revenue Code	250
Min. Negotiated Rate	$221.41
Max. Negotiated Rate	$316.31
Rate for Payer: Aetna Commercial	$298.73
Rate for Payer: Aetna New Business (MI Preferred)	$228.44
Rate for Payer: Cash Price	$281.16
Rate for Payer: Cofinity Advantage	$246.01
Rate for Payer: Cofinity Commercial	$302.25
Rate for Payer: Encore Health Key Benefits Commercial	$281.16
Rate for Payer: Healthscope Commercial	$316.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$298.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$263.59
Rate for Payer: PHP Commercial	$298.73
Rate for Payer: Priority Health SBD	$221.41

SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION

Facility

$47.93

Service Code	NDC 70069026101
Hospital Charge Code	18908
Hospital Revenue Code	250
Min. Negotiated Rate	$18.84
Max. Negotiated Rate	$43.14
Rate for Payer: Aetna Commercial	$40.74
Rate for Payer: Aetna Medicare	$23.96
Rate for Payer: Aetna New Business (MI Preferred)	$31.15
Rate for Payer: BCBS Complete	$19.17
Rate for Payer: Cash Price	$38.34
Rate for Payer: Cofinity Advantage	$33.55
Rate for Payer: Cofinity Commercial	$41.22
Rate for Payer: Encore Health Key Benefits Commercial	$38.34
Rate for Payer: Healthscope Commercial	$43.14
Rate for Payer: MI Amish Medical Board Commercial	$38.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$35.95
Rate for Payer: PHP Commercial	$40.74
Rate for Payer: Priority Health SBD	$30.20
Rate for Payer: UHC All Payor (Choice/PPO)	$31.15
Rate for Payer: UHC Core	$24.97
Rate for Payer: UHC Exchange	$18.84

SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION

Facility

$430.62

Service Code	NDC 25021031002
Hospital Charge Code	18908
Hospital Revenue Code	250
Min. Negotiated Rate	$271.29
Max. Negotiated Rate	$387.56
Rate for Payer: Aetna Commercial	$366.03
Rate for Payer: Aetna New Business (MI Preferred)	$279.90
Rate for Payer: Cash Price	$344.50
Rate for Payer: Cofinity Advantage	$301.43
Rate for Payer: Cofinity Commercial	$370.33
Rate for Payer: Encore Health Key Benefits Commercial	$344.50
Rate for Payer: Healthscope Commercial	$387.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$366.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$322.96
Rate for Payer: PHP Commercial	$366.03
Rate for Payer: Priority Health SBD	$271.29

SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION

Facility

$47.93

Service Code	NDC 70069026101
Hospital Charge Code	18908
Hospital Revenue Code	250
Min. Negotiated Rate	$30.20
Max. Negotiated Rate	$43.14
Rate for Payer: Aetna Commercial	$40.74
Rate for Payer: Aetna New Business (MI Preferred)	$31.15
Rate for Payer: Cash Price	$38.34
Rate for Payer: Cofinity Advantage	$33.55
Rate for Payer: Cofinity Commercial	$41.22
Rate for Payer: Encore Health Key Benefits Commercial	$38.34
Rate for Payer: Healthscope Commercial	$43.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$35.95
Rate for Payer: PHP Commercial	$40.74
Rate for Payer: Priority Health SBD	$30.20

SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION

Facility

$430.62

Service Code	NDC 25021031002
Hospital Charge Code	18908
Hospital Revenue Code	250
Min. Negotiated Rate	$169.23
Max. Negotiated Rate	$387.56
Rate for Payer: Aetna Commercial	$366.03
Rate for Payer: Aetna Medicare	$215.31
Rate for Payer: Aetna New Business (MI Preferred)	$279.90
Rate for Payer: BCBS Complete	$172.25
Rate for Payer: Cash Price	$344.50
Rate for Payer: Cofinity Advantage	$301.43
Rate for Payer: Cofinity Commercial	$370.33
Rate for Payer: Encore Health Key Benefits Commercial	$344.50
Rate for Payer: Healthscope Commercial	$387.56
Rate for Payer: MI Amish Medical Board Commercial	$344.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$366.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$322.96
Rate for Payer: PHP Commercial	$366.03
Rate for Payer: Priority Health SBD	$271.29
Rate for Payer: UHC All Payor (Choice/PPO)	$279.90
Rate for Payer: UHC Core	$224.35
Rate for Payer: UHC Exchange	$169.23

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$286.38

Service Code	NDC 00409739172
Hospital Charge Code	7351
Hospital Revenue Code	250
Min. Negotiated Rate	$112.55
Max. Negotiated Rate	$257.74
Rate for Payer: Aetna Commercial	$243.42
Rate for Payer: Aetna Medicare	$143.19
Rate for Payer: Aetna New Business (MI Preferred)	$186.15
Rate for Payer: BCBS Complete	$114.55
Rate for Payer: Cash Price	$229.10
Rate for Payer: Cofinity Advantage	$200.47
Rate for Payer: Cofinity Commercial	$246.29
Rate for Payer: Encore Health Key Benefits Commercial	$229.10
Rate for Payer: Healthscope Commercial	$257.74
Rate for Payer: MI Amish Medical Board Commercial	$229.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$243.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$214.78
Rate for Payer: PHP Commercial	$243.42
Rate for Payer: Priority Health SBD	$180.42
Rate for Payer: UHC All Payor (Choice/PPO)	$186.15
Rate for Payer: UHC Core	$149.20
Rate for Payer: UHC Exchange	$112.55

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$286.38

Service Code	NDC 00409739172
Hospital Charge Code	7351
Hospital Revenue Code	250
Min. Negotiated Rate	$180.42
Max. Negotiated Rate	$257.74
Rate for Payer: Aetna Commercial	$243.42
Rate for Payer: Aetna New Business (MI Preferred)	$186.15
Rate for Payer: Cash Price	$229.10
Rate for Payer: Cofinity Advantage	$200.47
Rate for Payer: Cofinity Commercial	$246.29
Rate for Payer: Encore Health Key Benefits Commercial	$229.10
Rate for Payer: Healthscope Commercial	$257.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$243.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$214.78
Rate for Payer: PHP Commercial	$243.42
Rate for Payer: Priority Health SBD	$180.42

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$286.38

Service Code	NDC 409739172
Hospital Charge Code	7351
Hospital Revenue Code	250
Min. Negotiated Rate	$112.55
Max. Negotiated Rate	$257.74
Rate for Payer: Aetna Commercial	$243.42
Rate for Payer: Aetna Medicare	$143.19
Rate for Payer: Aetna New Business (MI Preferred)	$186.15
Rate for Payer: BCBS Complete	$114.55
Rate for Payer: Cash Price	$229.10
Rate for Payer: Cofinity Advantage	$200.47
Rate for Payer: Cofinity Commercial	$246.29
Rate for Payer: Encore Health Key Benefits Commercial	$229.10
Rate for Payer: Healthscope Commercial	$257.74
Rate for Payer: MI Amish Medical Board Commercial	$229.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$243.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$214.78
Rate for Payer: PHP Commercial	$243.42
Rate for Payer: Priority Health SBD	$180.42
Rate for Payer: UHC All Payor (Choice/PPO)	$186.15
Rate for Payer: UHC Core	$149.20
Rate for Payer: UHC Exchange	$112.55

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION (TPN COMPONENT)

Facility

$286.38

Service Code	NDC 09900001920
Hospital Charge Code	301290
Hospital Revenue Code	250
Min. Negotiated Rate	$112.55
Max. Negotiated Rate	$257.74
Rate for Payer: Aetna Commercial	$243.42
Rate for Payer: Aetna Medicare	$143.19
Rate for Payer: Aetna New Business (MI Preferred)	$186.15
Rate for Payer: BCBS Complete	$114.55
Rate for Payer: Cash Price	$229.10
Rate for Payer: Cofinity Advantage	$200.47
Rate for Payer: Cofinity Commercial	$246.29
Rate for Payer: Encore Health Key Benefits Commercial	$229.10
Rate for Payer: Healthscope Commercial	$257.74
Rate for Payer: MI Amish Medical Board Commercial	$229.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$243.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$214.78
Rate for Payer: PHP Commercial	$243.42
Rate for Payer: Priority Health SBD	$180.42
Rate for Payer: UHC All Payor (Choice/PPO)	$186.15
Rate for Payer: UHC Core	$149.20
Rate for Payer: UHC Exchange	$112.55

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION (TPN COMPONENT)

Facility

$286.38

Service Code	NDC 09900001920
Hospital Charge Code	301290
Hospital Revenue Code	250
Min. Negotiated Rate	$180.42
Max. Negotiated Rate	$257.74
Rate for Payer: Aetna Commercial	$243.42
Rate for Payer: Aetna New Business (MI Preferred)	$186.15
Rate for Payer: Cash Price	$229.10
Rate for Payer: Cofinity Advantage	$200.47
Rate for Payer: Cofinity Commercial	$246.29
Rate for Payer: Encore Health Key Benefits Commercial	$229.10
Rate for Payer: Healthscope Commercial	$257.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$243.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$214.78
Rate for Payer: PHP Commercial	$243.42
Rate for Payer: Priority Health SBD	$180.42

SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA

Facility

$34.39

Service Code	NDC 00132020140
Hospital Charge Code	11395
Hospital Revenue Code	637
Min. Negotiated Rate	$13.52
Max. Negotiated Rate	$30.95
Rate for Payer: Aetna Commercial	$29.23
Rate for Payer: Aetna Medicare	$17.20
Rate for Payer: Aetna New Business (MI Preferred)	$22.35
Rate for Payer: BCBS Complete	$13.76
Rate for Payer: Cash Price	$27.51
Rate for Payer: Cofinity Advantage	$24.07
Rate for Payer: Cofinity Commercial	$29.58
Rate for Payer: Encore Health Key Benefits Commercial	$27.51
Rate for Payer: Healthscope Commercial	$30.95
Rate for Payer: MI Amish Medical Board Commercial	$27.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$25.79
Rate for Payer: PHP Commercial	$29.23
Rate for Payer: Priority Health SBD	$21.67
Rate for Payer: UHC All Payor (Choice/PPO)	$22.35
Rate for Payer: UHC Core	$17.92
Rate for Payer: UHC Exchange	$13.52

SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA

Facility

$34.39

Service Code	NDC 00132020140
Hospital Charge Code	11395
Hospital Revenue Code	637
Min. Negotiated Rate	$21.67
Max. Negotiated Rate	$30.95
Rate for Payer: Aetna Commercial	$29.23
Rate for Payer: Aetna New Business (MI Preferred)	$22.35
Rate for Payer: Cash Price	$27.51
Rate for Payer: Cofinity Advantage	$24.07
Rate for Payer: Cofinity Commercial	$29.58
Rate for Payer: Encore Health Key Benefits Commercial	$27.51
Rate for Payer: Healthscope Commercial	$30.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$25.79
Rate for Payer: PHP Commercial	$29.23
Rate for Payer: Priority Health SBD	$21.67

Know your out-of-pocket cost for care.

All Charges