Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SODIUM BICARBONATE 650 MG TABLET

Facility

$277.30

Service Code	NDC 77333083110
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$110.92
Max. Negotiated Rate	$249.57
Rate for Payer: Aetna Commercial	$235.71
Rate for Payer: Aetna Medicare	$138.65
Rate for Payer: Aetna New Business (MI Preferred)	$180.25
Rate for Payer: BCBS Complete	$110.92
Rate for Payer: Cash Price	$221.84
Rate for Payer: Cofinity Commercial	$194.11
Rate for Payer: Cofinity Commercial	$238.48
Rate for Payer: Cofinity Medicare Advantage	$194.11
Rate for Payer: Encore Health Key Benefits Commercial	$221.84
Rate for Payer: Healthscope Commercial	$249.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$235.71
Rate for Payer: PHP Commercial	$235.71
Rate for Payer: Priority Health Cigna Priority Health	$180.25
Rate for Payer: Priority Health SBD	$174.70

SODIUM BICARBONATE 650 MG TABLET

Facility

$2.78

Service Code	NDC 77333083125
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$2.36
Rate for Payer: Aetna New Business (MI Preferred)	$1.81
Rate for Payer: Cash Price	$2.22
Rate for Payer: Cofinity Commercial	$1.95
Rate for Payer: Cofinity Commercial	$2.39
Rate for Payer: Cofinity Medicare Advantage	$1.95
Rate for Payer: Encore Health Key Benefits Commercial	$2.22
Rate for Payer: Healthscope Commercial	$2.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.36
Rate for Payer: PHP Commercial	$2.36
Rate for Payer: Priority Health Cigna Priority Health	$1.81
Rate for Payer: Priority Health SBD	$1.75

SODIUM BICARBONATE 650 MG TABLET

Facility

$296.10

Service Code	NDC 77333082710
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$118.44
Max. Negotiated Rate	$266.49
Rate for Payer: Aetna Commercial	$251.69
Rate for Payer: Aetna Medicare	$148.05
Rate for Payer: Aetna New Business (MI Preferred)	$192.47
Rate for Payer: BCBS Complete	$118.44
Rate for Payer: Cash Price	$236.88
Rate for Payer: Cofinity Commercial	$207.27
Rate for Payer: Cofinity Commercial	$254.65
Rate for Payer: Cofinity Medicare Advantage	$207.27
Rate for Payer: Encore Health Key Benefits Commercial	$236.88
Rate for Payer: Healthscope Commercial	$266.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$251.69
Rate for Payer: PHP Commercial	$251.69
Rate for Payer: Priority Health Cigna Priority Health	$192.47
Rate for Payer: Priority Health SBD	$186.54

SODIUM BICARBONATE 650 MG TABLET

Facility

$277.30

Service Code	NDC 77333083110
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$174.70
Max. Negotiated Rate	$249.57
Rate for Payer: Aetna Commercial	$235.71
Rate for Payer: Aetna New Business (MI Preferred)	$180.25
Rate for Payer: Cash Price	$221.84
Rate for Payer: Cofinity Commercial	$194.11
Rate for Payer: Cofinity Commercial	$238.48
Rate for Payer: Cofinity Medicare Advantage	$194.11
Rate for Payer: Encore Health Key Benefits Commercial	$221.84
Rate for Payer: Healthscope Commercial	$249.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$235.71
Rate for Payer: PHP Commercial	$235.71
Rate for Payer: Priority Health Cigna Priority Health	$180.25
Rate for Payer: Priority Health SBD	$174.70

SODIUM BICARBONATE 650 MG TABLET

Facility

$2.97

Service Code	NDC 77333082725
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$2.67
Rate for Payer: Aetna Commercial	$2.52
Rate for Payer: Aetna Medicare	$1.49
Rate for Payer: Aetna New Business (MI Preferred)	$1.93
Rate for Payer: BCBS Complete	$1.19
Rate for Payer: Cash Price	$2.38
Rate for Payer: Cofinity Commercial	$2.08
Rate for Payer: Cofinity Commercial	$2.55
Rate for Payer: Cofinity Medicare Advantage	$2.08
Rate for Payer: Encore Health Key Benefits Commercial	$2.38
Rate for Payer: Healthscope Commercial	$2.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.52
Rate for Payer: PHP Commercial	$2.52
Rate for Payer: Priority Health Cigna Priority Health	$1.93
Rate for Payer: Priority Health SBD	$1.87

SODIUM BICARBONATE 650 MG TABLET

Facility

$2.78

Service Code	NDC 77333083125
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$2.36
Rate for Payer: Aetna Medicare	$1.39
Rate for Payer: Aetna New Business (MI Preferred)	$1.81
Rate for Payer: BCBS Complete	$1.11
Rate for Payer: Cash Price	$2.22
Rate for Payer: Cofinity Commercial	$1.95
Rate for Payer: Cofinity Commercial	$2.39
Rate for Payer: Cofinity Medicare Advantage	$1.95
Rate for Payer: Encore Health Key Benefits Commercial	$2.22
Rate for Payer: Healthscope Commercial	$2.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.36
Rate for Payer: PHP Commercial	$2.36
Rate for Payer: Priority Health Cigna Priority Health	$1.81
Rate for Payer: Priority Health SBD	$1.75

SODIUM BICARBONATE 650 MG TABLET

Facility

$258.50

Service Code	NDC 64980052810
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$232.65
Rate for Payer: Aetna Commercial	$219.72
Rate for Payer: Aetna Medicare	$129.25
Rate for Payer: Aetna New Business (MI Preferred)	$168.03
Rate for Payer: BCBS Complete	$103.40
Rate for Payer: Cash Price	$206.80
Rate for Payer: Cofinity Commercial	$180.95
Rate for Payer: Cofinity Commercial	$222.31
Rate for Payer: Cofinity Medicare Advantage	$180.95
Rate for Payer: Encore Health Key Benefits Commercial	$206.80
Rate for Payer: Healthscope Commercial	$232.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$219.72
Rate for Payer: PHP Commercial	$219.72
Rate for Payer: Priority Health Cigna Priority Health	$168.03
Rate for Payer: Priority Health SBD	$162.85

SODIUM BICARBONATE 650 MG TABLET

Facility

$296.10

Service Code	NDC 77333082710
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$186.54
Max. Negotiated Rate	$266.49
Rate for Payer: Aetna Commercial	$251.69
Rate for Payer: Aetna New Business (MI Preferred)	$192.47
Rate for Payer: Cash Price	$236.88
Rate for Payer: Cofinity Commercial	$207.27
Rate for Payer: Cofinity Commercial	$254.65
Rate for Payer: Cofinity Medicare Advantage	$207.27
Rate for Payer: Encore Health Key Benefits Commercial	$236.88
Rate for Payer: Healthscope Commercial	$266.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$251.69
Rate for Payer: PHP Commercial	$251.69
Rate for Payer: Priority Health Cigna Priority Health	$192.47
Rate for Payer: Priority Health SBD	$186.54

SODIUM BICARBONATE 650 MG TABLET

Facility

$258.50

Service Code	NDC 64980052810
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$162.85
Max. Negotiated Rate	$232.65
Rate for Payer: Aetna Commercial	$219.72
Rate for Payer: Aetna New Business (MI Preferred)	$168.03
Rate for Payer: Cash Price	$206.80
Rate for Payer: Cofinity Commercial	$180.95
Rate for Payer: Cofinity Commercial	$222.31
Rate for Payer: Cofinity Medicare Advantage	$180.95
Rate for Payer: Encore Health Key Benefits Commercial	$206.80
Rate for Payer: Healthscope Commercial	$232.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$219.72
Rate for Payer: PHP Commercial	$219.72
Rate for Payer: Priority Health Cigna Priority Health	$168.03
Rate for Payer: Priority Health SBD	$162.85

SODIUM BICARBONATE 650 MG TABLET

Facility

$2.97

Service Code	NDC 77333082725
Hospital Charge Code	7312
Hospital Revenue Code	637
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$2.67
Rate for Payer: Aetna Commercial	$2.52
Rate for Payer: Aetna New Business (MI Preferred)	$1.93
Rate for Payer: Cash Price	$2.38
Rate for Payer: Cofinity Commercial	$2.08
Rate for Payer: Cofinity Commercial	$2.55
Rate for Payer: Cofinity Medicare Advantage	$2.08
Rate for Payer: Encore Health Key Benefits Commercial	$2.38
Rate for Payer: Healthscope Commercial	$2.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.52
Rate for Payer: PHP Commercial	$2.52
Rate for Payer: Priority Health Cigna Priority Health	$1.93
Rate for Payer: Priority Health SBD	$1.87

SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE

Facility

$72.32

Service Code	NDC 00409663724
Hospital Charge Code	7309
Hospital Revenue Code	250
Min. Negotiated Rate	$45.56
Max. Negotiated Rate	$65.09
Rate for Payer: Aetna Commercial	$61.47
Rate for Payer: Aetna New Business (MI Preferred)	$47.01
Rate for Payer: Cash Price	$57.86
Rate for Payer: Cofinity Commercial	$50.62
Rate for Payer: Cofinity Commercial	$62.20
Rate for Payer: Cofinity Medicare Advantage	$50.62
Rate for Payer: Encore Health Key Benefits Commercial	$57.86
Rate for Payer: Healthscope Commercial	$65.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.47
Rate for Payer: PHP Commercial	$61.47
Rate for Payer: Priority Health Cigna Priority Health	$47.01
Rate for Payer: Priority Health SBD	$45.56

SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE

Facility

$66.75

Service Code	NDC 76329335201
Hospital Charge Code	7309
Hospital Revenue Code	250
Min. Negotiated Rate	$42.05
Max. Negotiated Rate	$60.08
Rate for Payer: Aetna Commercial	$56.74
Rate for Payer: Aetna New Business (MI Preferred)	$43.39
Rate for Payer: Cash Price	$53.40
Rate for Payer: Cofinity Commercial	$46.73
Rate for Payer: Cofinity Commercial	$57.41
Rate for Payer: Cofinity Medicare Advantage	$46.73
Rate for Payer: Encore Health Key Benefits Commercial	$53.40
Rate for Payer: Healthscope Commercial	$60.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.74
Rate for Payer: PHP Commercial	$56.74
Rate for Payer: Priority Health Cigna Priority Health	$43.39
Rate for Payer: Priority Health SBD	$42.05

SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE

Facility

$66.75

Service Code	NDC 76329335201
Hospital Charge Code	7309
Hospital Revenue Code	250
Min. Negotiated Rate	$26.70
Max. Negotiated Rate	$60.08
Rate for Payer: Aetna Commercial	$56.74
Rate for Payer: Aetna Medicare	$33.38
Rate for Payer: Aetna New Business (MI Preferred)	$43.39
Rate for Payer: BCBS Complete	$26.70
Rate for Payer: Cash Price	$53.40
Rate for Payer: Cofinity Commercial	$46.73
Rate for Payer: Cofinity Commercial	$57.41
Rate for Payer: Cofinity Medicare Advantage	$46.73
Rate for Payer: Encore Health Key Benefits Commercial	$53.40
Rate for Payer: Healthscope Commercial	$60.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.74
Rate for Payer: PHP Commercial	$56.74
Rate for Payer: Priority Health Cigna Priority Health	$43.39
Rate for Payer: Priority Health SBD	$42.05

SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE

Facility

$72.32

Service Code	NDC 00409663714
Hospital Charge Code	7309
Hospital Revenue Code	250
Min. Negotiated Rate	$45.56
Max. Negotiated Rate	$65.09
Rate for Payer: Aetna Commercial	$61.47
Rate for Payer: Aetna New Business (MI Preferred)	$47.01
Rate for Payer: Cash Price	$57.86
Rate for Payer: Cofinity Commercial	$50.62
Rate for Payer: Cofinity Commercial	$62.20
Rate for Payer: Cofinity Medicare Advantage	$50.62
Rate for Payer: Encore Health Key Benefits Commercial	$57.86
Rate for Payer: Healthscope Commercial	$65.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.47
Rate for Payer: PHP Commercial	$61.47
Rate for Payer: Priority Health Cigna Priority Health	$47.01
Rate for Payer: Priority Health SBD	$45.56

SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE

Facility

$72.32

Service Code	NDC 00409663724
Hospital Charge Code	7309
Hospital Revenue Code	250
Min. Negotiated Rate	$28.93
Max. Negotiated Rate	$65.09
Rate for Payer: Aetna Commercial	$61.47
Rate for Payer: Aetna Medicare	$36.16
Rate for Payer: Aetna New Business (MI Preferred)	$47.01
Rate for Payer: BCBS Complete	$28.93
Rate for Payer: Cash Price	$57.86
Rate for Payer: Cofinity Commercial	$50.62
Rate for Payer: Cofinity Commercial	$62.20
Rate for Payer: Cofinity Medicare Advantage	$50.62
Rate for Payer: Encore Health Key Benefits Commercial	$57.86
Rate for Payer: Healthscope Commercial	$65.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.47
Rate for Payer: PHP Commercial	$61.47
Rate for Payer: Priority Health Cigna Priority Health	$47.01
Rate for Payer: Priority Health SBD	$45.56

SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE

Facility

$72.32

Service Code	NDC 00409663714
Hospital Charge Code	7309
Hospital Revenue Code	250
Min. Negotiated Rate	$28.93
Max. Negotiated Rate	$65.09
Rate for Payer: Aetna Commercial	$61.47
Rate for Payer: Aetna Medicare	$36.16
Rate for Payer: Aetna New Business (MI Preferred)	$47.01
Rate for Payer: BCBS Complete	$28.93
Rate for Payer: Cash Price	$57.86
Rate for Payer: Cofinity Commercial	$50.62
Rate for Payer: Cofinity Commercial	$62.20
Rate for Payer: Cofinity Medicare Advantage	$50.62
Rate for Payer: Encore Health Key Benefits Commercial	$57.86
Rate for Payer: Healthscope Commercial	$65.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.47
Rate for Payer: PHP Commercial	$61.47
Rate for Payer: Priority Health Cigna Priority Health	$47.01
Rate for Payer: Priority Health SBD	$45.56

SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRINGE (CODE)

Facility

$72.32

Service Code	NDC 00409663724
Hospital Charge Code	163719
Hospital Revenue Code	250
Min. Negotiated Rate	$28.93
Max. Negotiated Rate	$65.09
Rate for Payer: Aetna Commercial	$61.47
Rate for Payer: Aetna Medicare	$36.16
Rate for Payer: Aetna New Business (MI Preferred)	$47.01
Rate for Payer: BCBS Complete	$28.93
Rate for Payer: Cash Price	$57.86
Rate for Payer: Cofinity Commercial	$50.62
Rate for Payer: Cofinity Commercial	$62.20
Rate for Payer: Cofinity Medicare Advantage	$50.62
Rate for Payer: Encore Health Key Benefits Commercial	$57.86
Rate for Payer: Healthscope Commercial	$65.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.47
Rate for Payer: PHP Commercial	$61.47
Rate for Payer: Priority Health Cigna Priority Health	$47.01
Rate for Payer: Priority Health SBD	$45.56

SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRINGE (CODE)

Facility

$72.32

Service Code	NDC 00409663714
Hospital Charge Code	163719
Hospital Revenue Code	250
Min. Negotiated Rate	$45.56
Max. Negotiated Rate	$65.09
Rate for Payer: Aetna Commercial	$61.47
Rate for Payer: Aetna New Business (MI Preferred)	$47.01
Rate for Payer: Cash Price	$57.86
Rate for Payer: Cofinity Commercial	$50.62
Rate for Payer: Cofinity Commercial	$62.20
Rate for Payer: Cofinity Medicare Advantage	$50.62
Rate for Payer: Encore Health Key Benefits Commercial	$57.86
Rate for Payer: Healthscope Commercial	$65.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.47
Rate for Payer: PHP Commercial	$61.47
Rate for Payer: Priority Health Cigna Priority Health	$47.01
Rate for Payer: Priority Health SBD	$45.56

SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRINGE (CODE)

Facility

$66.75

Service Code	NDC 76329335201
Hospital Charge Code	163719
Hospital Revenue Code	250
Min. Negotiated Rate	$26.70
Max. Negotiated Rate	$60.08
Rate for Payer: Aetna Commercial	$56.74
Rate for Payer: Aetna Medicare	$33.38
Rate for Payer: Aetna New Business (MI Preferred)	$43.39
Rate for Payer: BCBS Complete	$26.70
Rate for Payer: Cash Price	$53.40
Rate for Payer: Cofinity Commercial	$46.73
Rate for Payer: Cofinity Commercial	$57.41
Rate for Payer: Cofinity Medicare Advantage	$46.73
Rate for Payer: Encore Health Key Benefits Commercial	$53.40
Rate for Payer: Healthscope Commercial	$60.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.74
Rate for Payer: PHP Commercial	$56.74
Rate for Payer: Priority Health Cigna Priority Health	$43.39
Rate for Payer: Priority Health SBD	$42.05

SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRINGE (CODE)

Facility

$72.32

Service Code	NDC 00409663724
Hospital Charge Code	163719
Hospital Revenue Code	250
Min. Negotiated Rate	$45.56
Max. Negotiated Rate	$65.09
Rate for Payer: Aetna Commercial	$61.47
Rate for Payer: Aetna New Business (MI Preferred)	$47.01
Rate for Payer: Cash Price	$57.86
Rate for Payer: Cofinity Commercial	$50.62
Rate for Payer: Cofinity Commercial	$62.20
Rate for Payer: Cofinity Medicare Advantage	$50.62
Rate for Payer: Encore Health Key Benefits Commercial	$57.86
Rate for Payer: Healthscope Commercial	$65.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.47
Rate for Payer: PHP Commercial	$61.47
Rate for Payer: Priority Health Cigna Priority Health	$47.01
Rate for Payer: Priority Health SBD	$45.56

SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRINGE (CODE)

Facility

$66.75

Service Code	NDC 76329335201
Hospital Charge Code	163719
Hospital Revenue Code	250
Min. Negotiated Rate	$42.05
Max. Negotiated Rate	$60.08
Rate for Payer: Aetna Commercial	$56.74
Rate for Payer: Aetna New Business (MI Preferred)	$43.39
Rate for Payer: Cash Price	$53.40
Rate for Payer: Cofinity Commercial	$46.73
Rate for Payer: Cofinity Commercial	$57.41
Rate for Payer: Cofinity Medicare Advantage	$46.73
Rate for Payer: Encore Health Key Benefits Commercial	$53.40
Rate for Payer: Healthscope Commercial	$60.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.74
Rate for Payer: PHP Commercial	$56.74
Rate for Payer: Priority Health Cigna Priority Health	$43.39
Rate for Payer: Priority Health SBD	$42.05

SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRINGE (CODE)

Facility

$72.32

Service Code	NDC 00409663714
Hospital Charge Code	163719
Hospital Revenue Code	250
Min. Negotiated Rate	$28.93
Max. Negotiated Rate	$65.09
Rate for Payer: Aetna Commercial	$61.47
Rate for Payer: Aetna Medicare	$36.16
Rate for Payer: Aetna New Business (MI Preferred)	$47.01
Rate for Payer: BCBS Complete	$28.93
Rate for Payer: Cash Price	$57.86
Rate for Payer: Cofinity Commercial	$50.62
Rate for Payer: Cofinity Commercial	$62.20
Rate for Payer: Cofinity Medicare Advantage	$50.62
Rate for Payer: Encore Health Key Benefits Commercial	$57.86
Rate for Payer: Healthscope Commercial	$65.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.47
Rate for Payer: PHP Commercial	$61.47
Rate for Payer: Priority Health Cigna Priority Health	$47.01
Rate for Payer: Priority Health SBD	$45.56

SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	NDC 00338004304
Hospital Charge Code	7318
Hospital Revenue Code	250
Min. Negotiated Rate	$27.97
Max. Negotiated Rate	$62.93
Rate for Payer: Aetna Commercial	$59.43
Rate for Payer: Aetna Medicare	$34.96
Rate for Payer: Aetna New Business (MI Preferred)	$45.45
Rate for Payer: BCBS Complete	$27.97
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Cofinity Medicare Advantage	$48.94
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.43
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$45.45
Rate for Payer: Priority Health SBD	$44.05

SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	NDC 00338004304
Hospital Charge Code	7318
Hospital Revenue Code	250
Min. Negotiated Rate	$44.05
Max. Negotiated Rate	$62.93
Rate for Payer: Aetna Commercial	$59.43
Rate for Payer: Aetna New Business (MI Preferred)	$45.45
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Cofinity Medicare Advantage	$48.94
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.43
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$45.45
Rate for Payer: Priority Health SBD	$44.05

SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION (DOSE, ADMIN OVER & INDICATION REQUIRED)

Facility

$69.92

Service Code	NDC 00338004304
Hospital Charge Code	301088
Hospital Revenue Code	250
Min. Negotiated Rate	$27.97
Max. Negotiated Rate	$62.93
Rate for Payer: Aetna Commercial	$59.43
Rate for Payer: Aetna Medicare	$34.96
Rate for Payer: Aetna New Business (MI Preferred)	$45.45
Rate for Payer: BCBS Complete	$27.97
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Cofinity Medicare Advantage	$48.94
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.43
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$45.45
Rate for Payer: Priority Health SBD	$44.05

Know your out-of-pocket cost for care.

All Charges