Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION

Facility

$83.03

Service Code	NDC 46287000660
Hospital Charge Code	27999
Hospital Revenue Code	637
Min. Negotiated Rate	$32.63
Max. Negotiated Rate	$74.73
Rate for Payer: Aetna Commercial	$70.58
Rate for Payer: Aetna Medicare	$41.52
Rate for Payer: Aetna New Business (MI Preferred)	$53.97
Rate for Payer: BCBS Complete	$33.21
Rate for Payer: Cash Price	$66.42
Rate for Payer: Cofinity Advantage	$58.12
Rate for Payer: Cofinity Commercial	$71.41
Rate for Payer: Encore Health Key Benefits Commercial	$66.42
Rate for Payer: Healthscope Commercial	$74.73
Rate for Payer: MI Amish Medical Board Commercial	$66.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$70.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$62.27
Rate for Payer: PHP Commercial	$70.58
Rate for Payer: Priority Health SBD	$52.31
Rate for Payer: UHC All Payor (Choice/PPO)	$53.97
Rate for Payer: UHC Core	$43.26
Rate for Payer: UHC Exchange	$32.63

SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION

Facility

$672.04

Service Code	NDC 46287000601
Hospital Charge Code	27999
Hospital Revenue Code	637
Min. Negotiated Rate	$264.11
Max. Negotiated Rate	$604.84
Rate for Payer: Aetna Commercial	$571.23
Rate for Payer: Aetna Medicare	$336.02
Rate for Payer: Aetna New Business (MI Preferred)	$436.83
Rate for Payer: BCBS Complete	$268.82
Rate for Payer: Cash Price	$537.63
Rate for Payer: Cofinity Advantage	$470.43
Rate for Payer: Cofinity Commercial	$577.95
Rate for Payer: Encore Health Key Benefits Commercial	$537.63
Rate for Payer: Healthscope Commercial	$604.84
Rate for Payer: MI Amish Medical Board Commercial	$537.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$571.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$504.03
Rate for Payer: PHP Commercial	$571.23
Rate for Payer: Priority Health SBD	$423.39
Rate for Payer: UHC All Payor (Choice/PPO)	$436.83
Rate for Payer: UHC Core	$350.13
Rate for Payer: UHC Exchange	$264.11

SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION

Facility

$83.03

Service Code	NDC 46287000660
Hospital Charge Code	27999
Hospital Revenue Code	637
Min. Negotiated Rate	$52.31
Max. Negotiated Rate	$74.73
Rate for Payer: Aetna Commercial	$70.58
Rate for Payer: Aetna New Business (MI Preferred)	$53.97
Rate for Payer: Cash Price	$66.42
Rate for Payer: Cofinity Advantage	$58.12
Rate for Payer: Cofinity Commercial	$71.41
Rate for Payer: Encore Health Key Benefits Commercial	$66.42
Rate for Payer: Healthscope Commercial	$74.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$70.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$62.27
Rate for Payer: PHP Commercial	$70.58
Rate for Payer: Priority Health SBD	$52.31

SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION

Facility

$672.04

Service Code	NDC 46287000601
Hospital Charge Code	27999
Hospital Revenue Code	637
Min. Negotiated Rate	$423.39
Max. Negotiated Rate	$604.84
Rate for Payer: Aetna Commercial	$571.23
Rate for Payer: Aetna New Business (MI Preferred)	$436.83
Rate for Payer: Cash Price	$537.63
Rate for Payer: Cofinity Advantage	$470.43
Rate for Payer: Cofinity Commercial	$577.95
Rate for Payer: Encore Health Key Benefits Commercial	$537.63
Rate for Payer: Healthscope Commercial	$604.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$571.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$504.03
Rate for Payer: PHP Commercial	$571.23
Rate for Payer: Priority Health SBD	$423.39

SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION

Facility

$351.45

Service Code	HCPCS J0209
Hospital Charge Code	7364
Hospital Revenue Code	636
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$316.31
Rate for Payer: Aetna Commercial	$298.73
Rate for Payer: Aetna Medicare	$0.92
Rate for Payer: Aetna New Business (MI Preferred)	$228.44
Rate for Payer: Allen County Amish Medical Aid Commercial	$1.10
Rate for Payer: Amish Plain Church Group Commercial	$1.10
Rate for Payer: BCBS Complete	$0.48
Rate for Payer: BCBS MAPPO	$0.88
Rate for Payer: BCBS Trust/PPO	$1.53
Rate for Payer: BCN Commercial	$1.53
Rate for Payer: BCN Medicare Advantage	$0.88
Rate for Payer: Cash Price	$281.16
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: Health Alliance Plan Medicare Advantage	$0.88
Rate for Payer: Healthscope Commercial	$316.31
Rate for Payer: Mclaren Medicaid	$0.46
Rate for Payer: Mclaren Medicare	$0.88
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.92
Rate for Payer: Meridian Medicaid	$0.92
Rate for Payer: MI Amish Medical Board Commercial	$1.01
Rate for Payer: Molina Medicare/Medicaid	$0.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$298.73
Rate for Payer: Nomi Health Commercial	$2.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$263.59
Rate for Payer: PACE Medicare	$0.84
Rate for Payer: PACE SWMI	$0.88
Rate for Payer: PHP Commercial	$298.73
Rate for Payer: PHP Medicare Advantage	$0.88
Rate for Payer: Priority Health Choice Medicaid	$0.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$2.77
Rate for Payer: Priority Health Medicare	$0.88
Rate for Payer: Priority Health SBD	$221.41
Rate for Payer: Priority Health Tiered Network	$2.22
Rate for Payer: Railroad Medicare Medicare	$0.88
Rate for Payer: UHC All Payor (Choice/PPO)	$1.45
Rate for Payer: UHC Core	$1.45
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$0.88
Rate for Payer: UHC Exchange	$1.45
Rate for Payer: UHC Medicaid	$0.46
Rate for Payer: UHCCP Medicaid	$0.46
Rate for Payer: VA VA	$0.88

SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION

Facility

$351.45

Service Code	HCPCS J0209
Hospital Charge Code	7364
Hospital Revenue Code	636
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 ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET

Facility

$1,313.02

Service Code	NDC 00310111030
Hospital Charge Code	188049
Hospital Revenue Code	637
Min. Negotiated Rate	$516.02
Max. Negotiated Rate	$1,181.72
Rate for Payer: Aetna Commercial	$1,116.07
Rate for Payer: Aetna Medicare	$656.51
Rate for Payer: Aetna New Business (MI Preferred)	$853.46
Rate for Payer: BCBS Complete	$525.21
Rate for Payer: Cash Price	$1,050.42
Rate for Payer: Cofinity Advantage	$919.11
Rate for Payer: Cofinity Commercial	$1,129.20
Rate for Payer: Encore Health Key Benefits Commercial	$1,050.42
Rate for Payer: Healthscope Commercial	$1,181.72
Rate for Payer: MI Amish Medical Board Commercial	$1,050.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,116.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$984.76
Rate for Payer: PHP Commercial	$1,116.07
Rate for Payer: Priority Health SBD	$827.20
Rate for Payer: UHC All Payor (Choice/PPO)	$853.46
Rate for Payer: UHC Core	$684.08
Rate for Payer: UHC Exchange	$516.02

SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET

Facility

$1,313.02

Service Code	NDC 00310111030
Hospital Charge Code	188049
Hospital Revenue Code	637
Min. Negotiated Rate	$827.20
Max. Negotiated Rate	$1,181.72
Rate for Payer: Aetna Commercial	$1,116.07
Rate for Payer: Aetna New Business (MI Preferred)	$853.46
Rate for Payer: Cash Price	$1,050.42
Rate for Payer: Cofinity Advantage	$919.11
Rate for Payer: Cofinity Commercial	$1,129.20
Rate for Payer: Encore Health Key Benefits Commercial	$1,050.42
Rate for Payer: Healthscope Commercial	$1,181.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,116.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$984.76
Rate for Payer: PHP Commercial	$1,116.07
Rate for Payer: Priority Health SBD	$827.20

SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET

Facility

$43.77

Service Code	NDC 00310111001
Hospital Charge Code	188049
Hospital Revenue Code	637
Min. Negotiated Rate	$17.20
Max. Negotiated Rate	$39.39
Rate for Payer: Aetna Commercial	$37.20
Rate for Payer: Aetna Medicare	$21.89
Rate for Payer: Aetna New Business (MI Preferred)	$28.45
Rate for Payer: BCBS Complete	$17.51
Rate for Payer: Cash Price	$35.02
Rate for Payer: Cofinity Advantage	$30.64
Rate for Payer: Cofinity Commercial	$37.64
Rate for Payer: Encore Health Key Benefits Commercial	$35.02
Rate for Payer: Healthscope Commercial	$39.39
Rate for Payer: MI Amish Medical Board Commercial	$35.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$32.83
Rate for Payer: PHP Commercial	$37.20
Rate for Payer: Priority Health SBD	$27.58
Rate for Payer: UHC All Payor (Choice/PPO)	$28.45
Rate for Payer: UHC Core	$22.80
Rate for Payer: UHC Exchange	$17.20

SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET

Facility

$43.77

Service Code	NDC 00310111001
Hospital Charge Code	188049
Hospital Revenue Code	637
Min. Negotiated Rate	$27.58
Max. Negotiated Rate	$39.39
Rate for Payer: Aetna Commercial	$37.20
Rate for Payer: Aetna New Business (MI Preferred)	$28.45
Rate for Payer: Cash Price	$35.02
Rate for Payer: Cofinity Advantage	$30.64
Rate for Payer: Cofinity Commercial	$37.64
Rate for Payer: Encore Health Key Benefits Commercial	$35.02
Rate for Payer: Healthscope Commercial	$39.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$32.83
Rate for Payer: PHP Commercial	$37.20
Rate for Payer: Priority Health SBD	$27.58

SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET

Facility

$43.77

Service Code	NDC 00310110501
Hospital Charge Code	188048
Hospital Revenue Code	637
Min. Negotiated Rate	$17.20
Max. Negotiated Rate	$39.39
Rate for Payer: Aetna Commercial	$37.20
Rate for Payer: Aetna Medicare	$21.89
Rate for Payer: Aetna New Business (MI Preferred)	$28.45
Rate for Payer: BCBS Complete	$17.51
Rate for Payer: Cash Price	$35.02
Rate for Payer: Cofinity Advantage	$30.64
Rate for Payer: Cofinity Commercial	$37.64
Rate for Payer: Encore Health Key Benefits Commercial	$35.02
Rate for Payer: Healthscope Commercial	$39.39
Rate for Payer: MI Amish Medical Board Commercial	$35.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$32.83
Rate for Payer: PHP Commercial	$37.20
Rate for Payer: Priority Health SBD	$27.58
Rate for Payer: UHC All Payor (Choice/PPO)	$28.45
Rate for Payer: UHC Core	$22.80
Rate for Payer: UHC Exchange	$17.20

SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET

Facility

$481.40

Service Code	NDC 00310110539
Hospital Charge Code	188048
Hospital Revenue Code	637
Min. Negotiated Rate	$189.19
Max. Negotiated Rate	$433.26
Rate for Payer: Aetna Commercial	$409.19
Rate for Payer: Aetna Medicare	$240.70
Rate for Payer: Aetna New Business (MI Preferred)	$312.91
Rate for Payer: BCBS Complete	$192.56
Rate for Payer: Cash Price	$385.12
Rate for Payer: Cofinity Advantage	$336.98
Rate for Payer: Cofinity Commercial	$414.00
Rate for Payer: Encore Health Key Benefits Commercial	$385.12
Rate for Payer: Healthscope Commercial	$433.26
Rate for Payer: MI Amish Medical Board Commercial	$385.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$409.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$361.05
Rate for Payer: PHP Commercial	$409.19
Rate for Payer: Priority Health SBD	$303.28
Rate for Payer: UHC All Payor (Choice/PPO)	$312.91
Rate for Payer: UHC Core	$250.81
Rate for Payer: UHC Exchange	$189.19

SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET

Facility

$481.40

Service Code	NDC 00310110539
Hospital Charge Code	188048
Hospital Revenue Code	637
Min. Negotiated Rate	$303.28
Max. Negotiated Rate	$433.26
Rate for Payer: Aetna Commercial	$409.19
Rate for Payer: Aetna New Business (MI Preferred)	$312.91
Rate for Payer: Cash Price	$385.12
Rate for Payer: Cofinity Advantage	$336.98
Rate for Payer: Cofinity Commercial	$414.00
Rate for Payer: Encore Health Key Benefits Commercial	$385.12
Rate for Payer: Healthscope Commercial	$433.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$409.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$361.05
Rate for Payer: PHP Commercial	$409.19
Rate for Payer: Priority Health SBD	$303.28

SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET

Facility

$43.77

Service Code	NDC 00310110501
Hospital Charge Code	188048
Hospital Revenue Code	637
Min. Negotiated Rate	$27.58
Max. Negotiated Rate	$39.39
Rate for Payer: Aetna Commercial	$37.20
Rate for Payer: Aetna New Business (MI Preferred)	$28.45
Rate for Payer: Cash Price	$35.02
Rate for Payer: Cofinity Advantage	$30.64
Rate for Payer: Cofinity Commercial	$37.64
Rate for Payer: Encore Health Key Benefits Commercial	$35.02
Rate for Payer: Healthscope Commercial	$39.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$32.83
Rate for Payer: PHP Commercial	$37.20
Rate for Payer: Priority Health SBD	$27.58

SOFT TISSUE PROCEDURES WITH CC

Facility

$32,019.80

Service Code	MSDRG 501
Min. Negotiated Rate	$13,384.29
Max. Negotiated Rate	$32,019.80
Rate for Payer: Aetna Medicare	$14,652.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$17,610.91
Rate for Payer: Amish Plain Church Group Commercial	$17,610.91
Rate for Payer: BCBS MAPPO	$14,088.73
Rate for Payer: BCBS Trust/PPO	$32,019.80
Rate for Payer: BCN Commercial	$32,019.80
Rate for Payer: BCN Medicare Advantage	$14,088.73
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,088.73
Rate for Payer: Mclaren Medicare	$14,088.73
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$14,793.17
Rate for Payer: MI Amish Medical Board Commercial	$16,202.04
Rate for Payer: Molina Medicare/Medicaid	$15,497.60
Rate for Payer: Nomi Health Commercial	$22,550.49
Rate for Payer: PACE Medicare	$13,384.29
Rate for Payer: PACE SWMI	$14,088.73
Rate for Payer: PHP Medicare Advantage	$14,088.73
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$28,183.11
Rate for Payer: Priority Health Medicare	$14,088.73
Rate for Payer: Priority Health Tiered Network	$22,546.49
Rate for Payer: Railroad Medicare Medicare	$14,088.73
Rate for Payer: UHC All Payor (Choice/PPO)	$28,494.03
Rate for Payer: UHC Core	$23,838.84
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$14,088.73
Rate for Payer: UHC Exchange	$19,468.59
Rate for Payer: VA VA	$14,088.73

SOFT TISSUE PROCEDURES WITH MCC

Facility

$77,597.52

Service Code	MSDRG 500
Min. Negotiated Rate	$23,785.44
Max. Negotiated Rate	$77,597.52
Rate for Payer: Aetna Medicare	$26,038.79
Rate for Payer: Allen County Amish Medical Aid Commercial	$31,296.62
Rate for Payer: Amish Plain Church Group Commercial	$31,296.62
Rate for Payer: BCBS MAPPO	$25,037.30
Rate for Payer: BCBS Trust/PPO	$77,597.52
Rate for Payer: BCN Commercial	$77,597.52
Rate for Payer: BCN Medicare Advantage	$25,037.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$25,037.30
Rate for Payer: Mclaren Medicare	$25,037.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$26,289.17
Rate for Payer: MI Amish Medical Board Commercial	$28,792.90
Rate for Payer: Molina Medicare/Medicaid	$27,541.03
Rate for Payer: Nomi Health Commercial	$40,825.92
Rate for Payer: PACE Medicare	$23,785.44
Rate for Payer: PACE SWMI	$25,037.30
Rate for Payer: PHP Medicare Advantage	$25,037.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$51,023.35
Rate for Payer: Priority Health Medicare	$25,037.30
Rate for Payer: Priority Health Tiered Network	$40,818.67
Rate for Payer: Railroad Medicare Medicare	$25,037.30
Rate for Payer: UHC All Payor (Choice/PPO)	$51,586.24
Rate for Payer: UHC Core	$43,158.38
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$25,037.30
Rate for Payer: UHC Exchange	$35,246.38
Rate for Payer: VA VA	$25,037.30

SOFT TISSUE PROCEDURES WITHOUT CC/MCC

Facility

$27,012.83

Service Code	MSDRG 502
Min. Negotiated Rate	$10,431.41
Max. Negotiated Rate	$27,012.83
Rate for Payer: Aetna Medicare	$11,419.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,725.54
Rate for Payer: Amish Plain Church Group Commercial	$13,725.54
Rate for Payer: BCBS MAPPO	$10,980.43
Rate for Payer: BCBS Trust/PPO	$27,012.83
Rate for Payer: BCN Commercial	$27,012.83
Rate for Payer: BCN Medicare Advantage	$10,980.43
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,980.43
Rate for Payer: Mclaren Medicare	$10,980.43
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,529.45
Rate for Payer: MI Amish Medical Board Commercial	$12,627.49
Rate for Payer: Molina Medicare/Medicaid	$12,078.47
Rate for Payer: Nomi Health Commercial	$17,362.11
Rate for Payer: PACE Medicare	$10,431.41
Rate for Payer: PACE SWMI	$10,980.43
Rate for Payer: PHP Medicare Advantage	$10,980.43
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$21,698.79
Rate for Payer: Priority Health Medicare	$10,980.43
Rate for Payer: Priority Health Tiered Network	$17,359.03
Rate for Payer: Railroad Medicare Medicare	$10,980.43
Rate for Payer: UHC All Payor (Choice/PPO)	$21,938.17
Rate for Payer: UHC Core	$18,354.04
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,980.43
Rate for Payer: UHC Exchange	$14,989.29
Rate for Payer: VA VA	$10,980.43

SORBITOL 70 % SOLUTION

Facility

$45.51

Service Code	NDC 46287050001
Hospital Charge Code	7413
Hospital Revenue Code	637
Min. Negotiated Rate	$28.67
Max. Negotiated Rate	$40.96
Rate for Payer: Aetna Commercial	$38.68
Rate for Payer: Aetna New Business (MI Preferred)	$29.58
Rate for Payer: Cash Price	$36.41
Rate for Payer: Cofinity Advantage	$31.86
Rate for Payer: Cofinity Commercial	$39.14
Rate for Payer: Encore Health Key Benefits Commercial	$36.41
Rate for Payer: Healthscope Commercial	$40.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$34.13
Rate for Payer: PHP Commercial	$38.68
Rate for Payer: Priority Health SBD	$28.67

SORBITOL 70 % SOLUTION

Facility

$29.76

Service Code	NDC 00802391316
Hospital Charge Code	7413
Hospital Revenue Code	637
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$26.78
Rate for Payer: Aetna Commercial	$25.30
Rate for Payer: Aetna Medicare	$14.88
Rate for Payer: Aetna New Business (MI Preferred)	$19.34
Rate for Payer: BCBS Complete	$11.90
Rate for Payer: Cash Price	$23.81
Rate for Payer: Cofinity Advantage	$20.83
Rate for Payer: Cofinity Commercial	$25.59
Rate for Payer: Encore Health Key Benefits Commercial	$23.81
Rate for Payer: Healthscope Commercial	$26.78
Rate for Payer: MI Amish Medical Board Commercial	$23.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$22.32
Rate for Payer: PHP Commercial	$25.30
Rate for Payer: Priority Health SBD	$18.75
Rate for Payer: UHC All Payor (Choice/PPO)	$19.34
Rate for Payer: UHC Core	$15.50
Rate for Payer: UHC Exchange	$11.70

SORBITOL 70 % SOLUTION

Facility

$45.51

Service Code	NDC 46287050001
Hospital Charge Code	7413
Hospital Revenue Code	637
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$40.96
Rate for Payer: Aetna Commercial	$38.68
Rate for Payer: Aetna Medicare	$22.75
Rate for Payer: Aetna New Business (MI Preferred)	$29.58
Rate for Payer: BCBS Complete	$18.20
Rate for Payer: Cash Price	$36.41
Rate for Payer: Cofinity Advantage	$31.86
Rate for Payer: Cofinity Commercial	$39.14
Rate for Payer: Encore Health Key Benefits Commercial	$36.41
Rate for Payer: Healthscope Commercial	$40.96
Rate for Payer: MI Amish Medical Board Commercial	$36.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$34.13
Rate for Payer: PHP Commercial	$38.68
Rate for Payer: Priority Health SBD	$28.67
Rate for Payer: UHC All Payor (Choice/PPO)	$29.58
Rate for Payer: UHC Core	$23.71
Rate for Payer: UHC Exchange	$17.89

SORBITOL 70 % SOLUTION

Facility

$29.76

Service Code	NDC 00802391316
Hospital Charge Code	7413
Hospital Revenue Code	637
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$26.78
Rate for Payer: Aetna Commercial	$25.30
Rate for Payer: Aetna New Business (MI Preferred)	$19.34
Rate for Payer: Cash Price	$23.81
Rate for Payer: Cofinity Advantage	$20.83
Rate for Payer: Cofinity Commercial	$25.59
Rate for Payer: Encore Health Key Benefits Commercial	$23.81
Rate for Payer: Healthscope Commercial	$26.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$22.32
Rate for Payer: PHP Commercial	$25.30
Rate for Payer: Priority Health SBD	$18.75

SOTALOL 80 MG TABLET

Facility

$487.20

Service Code	NDC 68084065401
Hospital Charge Code	11421
Hospital Revenue Code	637
Min. Negotiated Rate	$191.47
Max. Negotiated Rate	$438.48
Rate for Payer: Aetna Commercial	$414.12
Rate for Payer: Aetna Medicare	$243.60
Rate for Payer: Aetna New Business (MI Preferred)	$316.68
Rate for Payer: BCBS Complete	$194.88
Rate for Payer: Cash Price	$389.76
Rate for Payer: Cofinity Advantage	$341.04
Rate for Payer: Cofinity Commercial	$418.99
Rate for Payer: Encore Health Key Benefits Commercial	$389.76
Rate for Payer: Healthscope Commercial	$438.48
Rate for Payer: MI Amish Medical Board Commercial	$389.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$414.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$365.40
Rate for Payer: PHP Commercial	$414.12
Rate for Payer: Priority Health SBD	$306.94
Rate for Payer: UHC All Payor (Choice/PPO)	$316.68
Rate for Payer: UHC Core	$253.83
Rate for Payer: UHC Exchange	$191.47

SOTALOL 80 MG TABLET

Facility

$487.20

Service Code	NDC 68084065401
Hospital Charge Code	11421
Hospital Revenue Code	637
Min. Negotiated Rate	$306.94
Max. Negotiated Rate	$438.48
Rate for Payer: Aetna Commercial	$414.12
Rate for Payer: Aetna New Business (MI Preferred)	$316.68
Rate for Payer: Cash Price	$389.76
Rate for Payer: Cofinity Advantage	$341.04
Rate for Payer: Cofinity Commercial	$418.99
Rate for Payer: Encore Health Key Benefits Commercial	$389.76
Rate for Payer: Healthscope Commercial	$438.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$414.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$365.40
Rate for Payer: PHP Commercial	$414.12
Rate for Payer: Priority Health SBD	$306.94

SOTALOL 80 MG TABLET

Facility

$4.44

Service Code	NDC 00245001289
Hospital Charge Code	11421
Hospital Revenue Code	637
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.77
Rate for Payer: Aetna New Business (MI Preferred)	$2.89
Rate for Payer: Cash Price	$3.55
Rate for Payer: Cofinity Advantage	$3.11
Rate for Payer: Cofinity Commercial	$3.82
Rate for Payer: Encore Health Key Benefits Commercial	$3.55
Rate for Payer: Healthscope Commercial	$4.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.33
Rate for Payer: PHP Commercial	$3.77
Rate for Payer: Priority Health SBD	$2.80

SOTALOL 80 MG TABLET

Facility

$143.35

Service Code	NDC 60505008000
Hospital Charge Code	11421
Hospital Revenue Code	637
Min. Negotiated Rate	$90.31
Max. Negotiated Rate	$129.01
Rate for Payer: Aetna Commercial	$121.85
Rate for Payer: Aetna New Business (MI Preferred)	$93.18
Rate for Payer: Cash Price	$114.68
Rate for Payer: Cofinity Advantage	$100.34
Rate for Payer: Cofinity Commercial	$123.28
Rate for Payer: Encore Health Key Benefits Commercial	$114.68
Rate for Payer: Healthscope Commercial	$129.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$121.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$107.51
Rate for Payer: PHP Commercial	$121.85
Rate for Payer: Priority Health SBD	$90.31

Know your out-of-pocket cost for care.

All Charges