Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION

Facility

$63.80

Service Code	NDC 00338004746
Hospital Charge Code	11403
Hospital Revenue Code	250
Min. Negotiated Rate	$25.52
Max. Negotiated Rate	$57.42
Rate for Payer: Aetna Commercial	$54.23
Rate for Payer: Aetna Medicare	$31.90
Rate for Payer: Aetna New Business (MI Preferred)	$41.47
Rate for Payer: BCBS Complete	$25.52
Rate for Payer: Cash Price	$51.04
Rate for Payer: Cofinity Commercial	$44.66
Rate for Payer: Cofinity Commercial	$54.87
Rate for Payer: Cofinity Medicare Advantage	$44.66
Rate for Payer: Encore Health Key Benefits Commercial	$51.04
Rate for Payer: Healthscope Commercial	$57.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.23
Rate for Payer: PHP Commercial	$54.23
Rate for Payer: Priority Health Cigna Priority Health	$41.47
Rate for Payer: Priority Health SBD	$40.19

SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION

Facility

$63.80

Service Code	NDC 00338004746
Hospital Charge Code	11403
Hospital Revenue Code	250
Min. Negotiated Rate	$40.19
Max. Negotiated Rate	$57.42
Rate for Payer: Aetna Commercial	$54.23
Rate for Payer: Aetna New Business (MI Preferred)	$41.47
Rate for Payer: Cash Price	$51.04
Rate for Payer: Cofinity Commercial	$44.66
Rate for Payer: Cofinity Commercial	$54.87
Rate for Payer: Cofinity Medicare Advantage	$44.66
Rate for Payer: Encore Health Key Benefits Commercial	$51.04
Rate for Payer: Healthscope Commercial	$57.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.23
Rate for Payer: PHP Commercial	$54.23
Rate for Payer: Priority Health Cigna Priority Health	$41.47
Rate for Payer: Priority Health SBD	$40.19

SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION

Facility

$69.92

Service Code	NDC 00338004803
Hospital Charge Code	11403
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 0.9 % IRRIGATION SOLUTION

Facility

$95.70

Service Code	NDC 00338004727
Hospital Charge Code	11403
Hospital Revenue Code	250
Min. Negotiated Rate	$60.29
Max. Negotiated Rate	$86.13
Rate for Payer: Aetna Commercial	$81.34
Rate for Payer: Aetna New Business (MI Preferred)	$62.20
Rate for Payer: Cash Price	$76.56
Rate for Payer: Cofinity Commercial	$66.99
Rate for Payer: Cofinity Commercial	$82.30
Rate for Payer: Cofinity Medicare Advantage	$66.99
Rate for Payer: Encore Health Key Benefits Commercial	$76.56
Rate for Payer: Healthscope Commercial	$86.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.34
Rate for Payer: PHP Commercial	$81.34
Rate for Payer: Priority Health Cigna Priority Health	$62.20
Rate for Payer: Priority Health SBD	$60.29

SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION

Facility

$95.70

Service Code	NDC 00338004727
Hospital Charge Code	11403
Hospital Revenue Code	250
Min. Negotiated Rate	$38.28
Max. Negotiated Rate	$86.13
Rate for Payer: Aetna Commercial	$81.34
Rate for Payer: Aetna Medicare	$47.85
Rate for Payer: Aetna New Business (MI Preferred)	$62.20
Rate for Payer: BCBS Complete	$38.28
Rate for Payer: Cash Price	$76.56
Rate for Payer: Cofinity Commercial	$66.99
Rate for Payer: Cofinity Commercial	$82.30
Rate for Payer: Cofinity Medicare Advantage	$66.99
Rate for Payer: Encore Health Key Benefits Commercial	$76.56
Rate for Payer: Healthscope Commercial	$86.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.34
Rate for Payer: PHP Commercial	$81.34
Rate for Payer: Priority Health Cigna Priority Health	$62.20
Rate for Payer: Priority Health SBD	$60.29

SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION

Facility

$79.75

Service Code	NDC 00338004804
Hospital Charge Code	11403
Hospital Revenue Code	250
Min. Negotiated Rate	$50.24
Max. Negotiated Rate	$71.78
Rate for Payer: Aetna Commercial	$67.79
Rate for Payer: Aetna New Business (MI Preferred)	$51.84
Rate for Payer: Cash Price	$63.80
Rate for Payer: Cofinity Commercial	$55.83
Rate for Payer: Cofinity Commercial	$68.58
Rate for Payer: Cofinity Medicare Advantage	$55.83
Rate for Payer: Encore Health Key Benefits Commercial	$63.80
Rate for Payer: Healthscope Commercial	$71.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.79
Rate for Payer: PHP Commercial	$67.79
Rate for Payer: Priority Health Cigna Priority Health	$51.84
Rate for Payer: Priority Health SBD	$50.24

SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION

Facility

$79.75

Service Code	NDC 00338004804
Hospital Charge Code	11403
Hospital Revenue Code	250
Min. Negotiated Rate	$31.90
Max. Negotiated Rate	$71.78
Rate for Payer: Aetna Commercial	$67.79
Rate for Payer: Aetna Medicare	$39.88
Rate for Payer: Aetna New Business (MI Preferred)	$51.84
Rate for Payer: BCBS Complete	$31.90
Rate for Payer: Cash Price	$63.80
Rate for Payer: Cofinity Commercial	$55.83
Rate for Payer: Cofinity Commercial	$68.58
Rate for Payer: Cofinity Medicare Advantage	$55.83
Rate for Payer: Encore Health Key Benefits Commercial	$63.80
Rate for Payer: Healthscope Commercial	$71.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.79
Rate for Payer: PHP Commercial	$67.79
Rate for Payer: Priority Health Cigna Priority Health	$51.84
Rate for Payer: Priority Health SBD	$50.24

SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION

Facility

$69.92

Service Code	NDC 00338004803
Hospital Charge Code	11403
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 0.9 % IV 1000 ML BAG (FOR BOLUS OR FLUSH)

Facility

$69.92

Service Code	HCPCS J7030
Hospital Charge Code	301142
Hospital Revenue Code	636
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 0.9 % IV 1000 ML BAG (FOR BOLUS OR FLUSH)

Facility

$69.92

Service Code	HCPCS J7030
Hospital Charge Code	301142
Hospital Revenue Code	636
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 0.9 % IV ADDITIONAL SOLUTION

Facility

$58.23

Service Code	HCPCS J7040
Hospital Charge Code	180543
Hospital Revenue Code	636
Min. Negotiated Rate	$23.29
Max. Negotiated Rate	$52.41
Rate for Payer: Aetna Commercial	$49.50
Rate for Payer: Aetna Medicare	$29.11
Rate for Payer: Aetna New Business (MI Preferred)	$37.85
Rate for Payer: BCBS Complete	$23.29
Rate for Payer: Cash Price	$46.58
Rate for Payer: Cofinity Commercial	$40.76
Rate for Payer: Cofinity Commercial	$50.08
Rate for Payer: Cofinity Medicare Advantage	$40.76
Rate for Payer: Encore Health Key Benefits Commercial	$46.58
Rate for Payer: Healthscope Commercial	$52.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$49.50
Rate for Payer: PHP Commercial	$49.50
Rate for Payer: Priority Health Cigna Priority Health	$37.85
Rate for Payer: Priority Health SBD	$36.68

SODIUM CHLORIDE 0.9 % IV ADDITIONAL SOLUTION

Facility

$58.23

Service Code	HCPCS J7040
Hospital Charge Code	180543
Hospital Revenue Code	636
Min. Negotiated Rate	$36.68
Max. Negotiated Rate	$52.41
Rate for Payer: Aetna Commercial	$49.50
Rate for Payer: Aetna New Business (MI Preferred)	$37.85
Rate for Payer: Cash Price	$46.58
Rate for Payer: Cofinity Commercial	$40.76
Rate for Payer: Cofinity Commercial	$50.08
Rate for Payer: Cofinity Medicare Advantage	$40.76
Rate for Payer: Encore Health Key Benefits Commercial	$46.58
Rate for Payer: Healthscope Commercial	$52.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$49.50
Rate for Payer: PHP Commercial	$49.50
Rate for Payer: Priority Health Cigna Priority Health	$37.85
Rate for Payer: Priority Health SBD	$36.68

SODIUM CHLORIDE 0.9 % IV BOLUS

Facility

$55.99

Service Code	HCPCS J7050
Hospital Charge Code	400291
Hospital Revenue Code	636
Min. Negotiated Rate	$35.27
Max. Negotiated Rate	$50.39
Rate for Payer: Aetna Commercial	$47.59
Rate for Payer: Aetna New Business (MI Preferred)	$36.39
Rate for Payer: Cash Price	$44.79
Rate for Payer: Cofinity Commercial	$39.19
Rate for Payer: Cofinity Commercial	$48.15
Rate for Payer: Cofinity Medicare Advantage	$39.19
Rate for Payer: Encore Health Key Benefits Commercial	$44.79
Rate for Payer: Healthscope Commercial	$50.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$47.59
Rate for Payer: PHP Commercial	$47.59
Rate for Payer: Priority Health Cigna Priority Health	$36.39
Rate for Payer: Priority Health SBD	$35.27

SODIUM CHLORIDE 0.9 % IV BOLUS

Facility

$67.19

Service Code	HCPCS J7030
Hospital Charge Code	400291
Hospital Revenue Code	636
Min. Negotiated Rate	$42.33
Max. Negotiated Rate	$60.47
Rate for Payer: Aetna Commercial	$57.11
Rate for Payer: Aetna Commercial	$59.43
Rate for Payer: Aetna New Business (MI Preferred)	$43.67
Rate for Payer: Aetna New Business (MI Preferred)	$45.45
Rate for Payer: Cash Price	$53.75
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$47.03
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Cofinity Commercial	$57.78
Rate for Payer: Cofinity Medicare Advantage	$48.94
Rate for Payer: Cofinity Medicare Advantage	$47.03
Rate for Payer: Encore Health Key Benefits Commercial	$53.75
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Healthscope Commercial	$60.47
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$57.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.43
Rate for Payer: PHP Commercial	$57.11
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$45.45
Rate for Payer: Priority Health Cigna Priority Health	$43.67
Rate for Payer: Priority Health SBD	$44.05
Rate for Payer: Priority Health SBD	$42.33

SODIUM CHLORIDE 0.9 % IV BOLUS

Facility

$58.23

Service Code	HCPCS J7040
Hospital Charge Code	400291
Hospital Revenue Code	636
Min. Negotiated Rate	$36.68
Max. Negotiated Rate	$52.41
Rate for Payer: Aetna Commercial	$49.50
Rate for Payer: Aetna New Business (MI Preferred)	$37.85
Rate for Payer: Cash Price	$46.58
Rate for Payer: Cofinity Commercial	$40.76
Rate for Payer: Cofinity Commercial	$50.08
Rate for Payer: Cofinity Medicare Advantage	$40.76
Rate for Payer: Encore Health Key Benefits Commercial	$46.58
Rate for Payer: Healthscope Commercial	$52.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$49.50
Rate for Payer: PHP Commercial	$49.50
Rate for Payer: Priority Health Cigna Priority Health	$37.85
Rate for Payer: Priority Health SBD	$36.68

SODIUM CHLORIDE 0.9 % IV BOLUS

Facility

$69.92

Service Code	HCPCS J7030
Hospital Charge Code	400291
Hospital Revenue Code	636
Min. Negotiated Rate	$27.97
Max. Negotiated Rate	$62.93
Rate for Payer: Aetna Commercial	$59.43
Rate for Payer: Aetna Commercial	$57.11
Rate for Payer: Aetna Medicare	$33.59
Rate for Payer: Aetna Medicare	$34.96
Rate for Payer: Aetna New Business (MI Preferred)	$45.45
Rate for Payer: Aetna New Business (MI Preferred)	$43.67
Rate for Payer: BCBS Complete	$27.97
Rate for Payer: BCBS Complete	$26.88
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cash Price	$53.75
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Cofinity Commercial	$47.03
Rate for Payer: Cofinity Commercial	$57.78
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Cofinity Medicare Advantage	$47.03
Rate for Payer: Cofinity Medicare Advantage	$48.94
Rate for Payer: Encore Health Key Benefits Commercial	$53.75
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Healthscope Commercial	$60.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$57.11
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: PHP Commercial	$57.11
Rate for Payer: Priority Health Cigna Priority Health	$43.67
Rate for Payer: Priority Health Cigna Priority Health	$45.45
Rate for Payer: Priority Health SBD	$42.33
Rate for Payer: Priority Health SBD	$44.05

SODIUM CHLORIDE 0.9 % IV BOLUS

Facility

$58.23

Service Code	HCPCS J7040
Hospital Charge Code	400291
Hospital Revenue Code	636
Min. Negotiated Rate	$23.29
Max. Negotiated Rate	$52.41
Rate for Payer: Aetna Commercial	$49.50
Rate for Payer: Aetna Medicare	$29.11
Rate for Payer: Aetna New Business (MI Preferred)	$37.85
Rate for Payer: BCBS Complete	$23.29
Rate for Payer: Cash Price	$46.58
Rate for Payer: Cofinity Commercial	$40.76
Rate for Payer: Cofinity Commercial	$50.08
Rate for Payer: Cofinity Medicare Advantage	$40.76
Rate for Payer: Encore Health Key Benefits Commercial	$46.58
Rate for Payer: Healthscope Commercial	$52.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$49.50
Rate for Payer: PHP Commercial	$49.50
Rate for Payer: Priority Health Cigna Priority Health	$37.85
Rate for Payer: Priority Health SBD	$36.68

SODIUM CHLORIDE 0.9 % IV BOLUS

Facility

$55.99

Service Code	HCPCS J7050
Hospital Charge Code	400291
Hospital Revenue Code	636
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$50.39
Rate for Payer: Aetna Commercial	$47.59
Rate for Payer: Aetna Medicare	$28.00
Rate for Payer: Aetna New Business (MI Preferred)	$36.39
Rate for Payer: BCBS Complete	$22.40
Rate for Payer: Cash Price	$44.79
Rate for Payer: Cofinity Commercial	$39.19
Rate for Payer: Cofinity Commercial	$48.15
Rate for Payer: Cofinity Medicare Advantage	$39.19
Rate for Payer: Encore Health Key Benefits Commercial	$44.79
Rate for Payer: Healthscope Commercial	$50.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$47.59
Rate for Payer: PHP Commercial	$47.59
Rate for Payer: Priority Health Cigna Priority Health	$36.39
Rate for Payer: Priority Health SBD	$35.27

SODIUM CHLORIDE 0.9 % IV BOLUS (CODE)

Facility

$69.92

Service Code	HCPCS J7030
Hospital Charge Code	163716
Hospital Revenue Code	636
Min. Negotiated Rate	$27.97
Max. Negotiated Rate	$62.93
Rate for Payer: Aetna Commercial	$59.43
Rate for Payer: Aetna Commercial	$57.11
Rate for Payer: Aetna Medicare	$33.59
Rate for Payer: Aetna Medicare	$34.96
Rate for Payer: Aetna New Business (MI Preferred)	$45.45
Rate for Payer: Aetna New Business (MI Preferred)	$43.67
Rate for Payer: BCBS Complete	$27.97
Rate for Payer: BCBS Complete	$26.88
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cash Price	$53.75
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Cofinity Commercial	$47.03
Rate for Payer: Cofinity Commercial	$57.78
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Cofinity Medicare Advantage	$47.03
Rate for Payer: Cofinity Medicare Advantage	$48.94
Rate for Payer: Encore Health Key Benefits Commercial	$53.75
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Healthscope Commercial	$60.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$57.11
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: PHP Commercial	$57.11
Rate for Payer: Priority Health Cigna Priority Health	$43.67
Rate for Payer: Priority Health Cigna Priority Health	$45.45
Rate for Payer: Priority Health SBD	$42.33
Rate for Payer: Priority Health SBD	$44.05

SODIUM CHLORIDE 0.9 % IV BOLUS (CODE)

Facility

$58.23

Service Code	HCPCS J7040
Hospital Charge Code	163716
Hospital Revenue Code	636
Min. Negotiated Rate	$36.68
Max. Negotiated Rate	$52.41
Rate for Payer: Aetna Commercial	$49.50
Rate for Payer: Aetna New Business (MI Preferred)	$37.85
Rate for Payer: Cash Price	$46.58
Rate for Payer: Cofinity Commercial	$40.76
Rate for Payer: Cofinity Commercial	$50.08
Rate for Payer: Cofinity Medicare Advantage	$40.76
Rate for Payer: Encore Health Key Benefits Commercial	$46.58
Rate for Payer: Healthscope Commercial	$52.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$49.50
Rate for Payer: PHP Commercial	$49.50
Rate for Payer: Priority Health Cigna Priority Health	$37.85
Rate for Payer: Priority Health SBD	$36.68

SODIUM CHLORIDE 0.9 % IV BOLUS (CODE)

Facility

$58.23

Service Code	HCPCS J7040
Hospital Charge Code	163716
Hospital Revenue Code	636
Min. Negotiated Rate	$23.29
Max. Negotiated Rate	$52.41
Rate for Payer: Aetna Commercial	$49.50
Rate for Payer: Aetna Medicare	$29.11
Rate for Payer: Aetna New Business (MI Preferred)	$37.85
Rate for Payer: BCBS Complete	$23.29
Rate for Payer: Cash Price	$46.58
Rate for Payer: Cofinity Commercial	$40.76
Rate for Payer: Cofinity Commercial	$50.08
Rate for Payer: Cofinity Medicare Advantage	$40.76
Rate for Payer: Encore Health Key Benefits Commercial	$46.58
Rate for Payer: Healthscope Commercial	$52.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$49.50
Rate for Payer: PHP Commercial	$49.50
Rate for Payer: Priority Health Cigna Priority Health	$37.85
Rate for Payer: Priority Health SBD	$36.68

SODIUM CHLORIDE 0.9 % IV BOLUS (CODE)

Facility

$69.92

Service Code	HCPCS J7030
Hospital Charge Code	163716
Hospital Revenue Code	636
Min. Negotiated Rate	$44.05
Max. Negotiated Rate	$62.93
Rate for Payer: Aetna Commercial	$59.43
Rate for Payer: Aetna Commercial	$57.11
Rate for Payer: Aetna New Business (MI Preferred)	$43.67
Rate for Payer: Aetna New Business (MI Preferred)	$45.45
Rate for Payer: Cash Price	$53.75
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Cofinity Commercial	$47.03
Rate for Payer: Cofinity Commercial	$57.78
Rate for Payer: Cofinity Medicare Advantage	$47.03
Rate for Payer: Cofinity Medicare Advantage	$48.94
Rate for Payer: Encore Health Key Benefits Commercial	$53.75
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Healthscope Commercial	$60.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$57.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.43
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: PHP Commercial	$57.11
Rate for Payer: Priority Health Cigna Priority Health	$43.67
Rate for Payer: Priority Health Cigna Priority Health	$45.45
Rate for Payer: Priority Health SBD	$42.33
Rate for Payer: Priority Health SBD	$44.05

SODIUM CHLORIDE 0.9 % IV BOLUS (CODE)

Facility

$55.99

Service Code	HCPCS J7050
Hospital Charge Code	163716
Hospital Revenue Code	636
Min. Negotiated Rate	$35.27
Max. Negotiated Rate	$50.39
Rate for Payer: Aetna Commercial	$47.59
Rate for Payer: Aetna New Business (MI Preferred)	$36.39
Rate for Payer: Cash Price	$44.79
Rate for Payer: Cofinity Commercial	$39.19
Rate for Payer: Cofinity Commercial	$48.15
Rate for Payer: Cofinity Medicare Advantage	$39.19
Rate for Payer: Encore Health Key Benefits Commercial	$44.79
Rate for Payer: Healthscope Commercial	$50.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$47.59
Rate for Payer: PHP Commercial	$47.59
Rate for Payer: Priority Health Cigna Priority Health	$36.39
Rate for Payer: Priority Health SBD	$35.27

SODIUM CHLORIDE 0.9 % IV BOLUS (CODE)

Facility

$55.99

Service Code	HCPCS J7050
Hospital Charge Code	163716
Hospital Revenue Code	636
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$50.39
Rate for Payer: Aetna Commercial	$47.59
Rate for Payer: Aetna Medicare	$28.00
Rate for Payer: Aetna New Business (MI Preferred)	$36.39
Rate for Payer: BCBS Complete	$22.40
Rate for Payer: Cash Price	$44.79
Rate for Payer: Cofinity Commercial	$39.19
Rate for Payer: Cofinity Commercial	$48.15
Rate for Payer: Cofinity Medicare Advantage	$39.19
Rate for Payer: Encore Health Key Benefits Commercial	$44.79
Rate for Payer: Healthscope Commercial	$50.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$47.59
Rate for Payer: PHP Commercial	$47.59
Rate for Payer: Priority Health Cigna Priority Health	$36.39
Rate for Payer: Priority Health SBD	$35.27

SODIUM CHLORIDE 0.9 % IV - DKA

Facility

$69.92

Service Code	HCPCS J7030
Hospital Charge Code	161519
Hospital Revenue Code	636
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