Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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	$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	$46.72
Rate for Payer: Cofinity Commercial	$57.40
Rate for Payer: Cofinity Medicare Advantage	$46.72
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 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

$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	$46.72
Rate for Payer: Cofinity Commercial	$57.40
Rate for Payer: Cofinity Medicare Advantage	$46.72
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

$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	$46.72
Rate for Payer: Cofinity Commercial	$57.40
Rate for Payer: Cofinity Medicare Advantage	$46.72
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 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	$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	$46.72
Rate for Payer: Cofinity Commercial	$57.40
Rate for Payer: Cofinity Medicare Advantage	$46.72
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	$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	$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 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

SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL

Facility

$5.28

Service Code	NDC 00904386575
Hospital Charge Code	29676
Hospital Revenue Code	637
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$4.75
Rate for Payer: Aetna Commercial	$4.49
Rate for Payer: Aetna Medicare	$2.64
Rate for Payer: Aetna New Business (MI Preferred)	$3.43
Rate for Payer: BCBS Complete	$2.11
Rate for Payer: Cash Price	$4.22
Rate for Payer: Cofinity Commercial	$3.70
Rate for Payer: Cofinity Commercial	$4.54
Rate for Payer: Cofinity Medicare Advantage	$3.70
Rate for Payer: Encore Health Key Benefits Commercial	$4.22
Rate for Payer: Healthscope Commercial	$4.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.49
Rate for Payer: PHP Commercial	$4.49
Rate for Payer: Priority Health Cigna Priority Health	$3.43
Rate for Payer: Priority Health SBD	$3.33

SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL

Facility

$5.28

Service Code	NDC 00904386575
Hospital Charge Code	29676
Hospital Revenue Code	637
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$4.75
Rate for Payer: Aetna Commercial	$4.49
Rate for Payer: Aetna New Business (MI Preferred)	$3.43
Rate for Payer: Cash Price	$4.22
Rate for Payer: Cofinity Commercial	$3.70
Rate for Payer: Cofinity Commercial	$4.54
Rate for Payer: Cofinity Medicare Advantage	$3.70
Rate for Payer: Encore Health Key Benefits Commercial	$4.22
Rate for Payer: Healthscope Commercial	$4.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.49
Rate for Payer: PHP Commercial	$4.49
Rate for Payer: Priority Health Cigna Priority Health	$3.43
Rate for Payer: Priority Health SBD	$3.33

SODIUM CHLORIDE 0.9 % BOLUS FOR AMNIOINFUSION (OB)

Facility

$7.24

Service Code	HCPCS J7030
Hospital Charge Code	158682
Hospital Revenue Code	636
Min. Negotiated Rate	$7.24
Max. Negotiated Rate	$7.24
Rate for Payer: BCBS Trust/PPO	$7.24
Rate for Payer: BCN Commercial	$7.24

SODIUM CHLORIDE 0.9 % FLUSH SOLUTION 100 ML BAG

Facility

$62.71

Service Code	HCPCS J7040
Hospital Charge Code	300165
Hospital Revenue Code	636
Min. Negotiated Rate	$39.51
Max. Negotiated Rate	$56.44
Rate for Payer: Aetna Commercial	$53.30
Rate for Payer: Aetna New Business (MI Preferred)	$40.76
Rate for Payer: Cash Price	$50.17
Rate for Payer: Cofinity Commercial	$43.90
Rate for Payer: Cofinity Commercial	$53.93
Rate for Payer: Cofinity Medicare Advantage	$43.90
Rate for Payer: Encore Health Key Benefits Commercial	$50.17
Rate for Payer: Healthscope Commercial	$56.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.30
Rate for Payer: PHP Commercial	$53.30
Rate for Payer: Priority Health Cigna Priority Health	$40.76
Rate for Payer: Priority Health SBD	$39.51

SODIUM CHLORIDE 0.9 % FLUSH SOLUTION 100 ML BAG

Facility

$62.71

Service Code	HCPCS J7040
Hospital Charge Code	300165
Hospital Revenue Code	636
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$56.44
Rate for Payer: Aetna Commercial	$53.30
Rate for Payer: Aetna Medicare	$31.36
Rate for Payer: Aetna New Business (MI Preferred)	$40.76
Rate for Payer: BCBS Complete	$25.08
Rate for Payer: BCBS Trust/PPO	$3.60
Rate for Payer: BCN Commercial	$3.60
Rate for Payer: Cash Price	$50.17
Rate for Payer: Cash Price	$50.17
Rate for Payer: Cofinity Commercial	$43.90
Rate for Payer: Cofinity Commercial	$53.93
Rate for Payer: Cofinity Medicare Advantage	$43.90
Rate for Payer: Encore Health Key Benefits Commercial	$50.17
Rate for Payer: Healthscope Commercial	$56.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.30
Rate for Payer: PHP Commercial	$53.30
Rate for Payer: Priority Health Cigna Priority Health	$40.76
Rate for Payer: Priority Health SBD	$39.51

SODIUM CHLORIDE 0.9 % FOR AMNIOINFUSION (OB)

Facility

$69.92

Service Code	HCPCS J7030
Hospital Charge Code	158683
Hospital Revenue Code	636
Min. Negotiated Rate	$7.24
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: BCBS Trust/PPO	$7.24
Rate for Payer: BCN Commercial	$7.24
Rate for Payer: Cash Price	$55.94
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 % FOR AMNIOINFUSION (OB)

Facility

$69.92

Service Code	HCPCS J7030
Hospital Charge Code	158683
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 % FOR NEBULIZATION

Facility

$3.14

Service Code	NDC 00378698501
Hospital Charge Code	7325
Hospital Revenue Code	250
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.67
Rate for Payer: Aetna New Business (MI Preferred)	$2.04
Rate for Payer: Cash Price	$2.51
Rate for Payer: Cofinity Commercial	$2.20
Rate for Payer: Cofinity Commercial	$2.70
Rate for Payer: Cofinity Medicare Advantage	$2.20
Rate for Payer: Encore Health Key Benefits Commercial	$2.51
Rate for Payer: Healthscope Commercial	$2.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.67
Rate for Payer: PHP Commercial	$2.67
Rate for Payer: Priority Health Cigna Priority Health	$2.04
Rate for Payer: Priority Health SBD	$1.98

SODIUM CHLORIDE 0.9 % FOR NEBULIZATION

Facility

$3.14

Service Code	NDC 00378698501
Hospital Charge Code	7325
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.67
Rate for Payer: Aetna Medicare	$1.57
Rate for Payer: Aetna New Business (MI Preferred)	$2.04
Rate for Payer: BCBS Complete	$1.26
Rate for Payer: Cash Price	$2.51
Rate for Payer: Cofinity Commercial	$2.20
Rate for Payer: Cofinity Commercial	$2.70
Rate for Payer: Cofinity Medicare Advantage	$2.20
Rate for Payer: Encore Health Key Benefits Commercial	$2.51
Rate for Payer: Healthscope Commercial	$2.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.67
Rate for Payer: PHP Commercial	$2.67
Rate for Payer: Priority Health Cigna Priority Health	$2.04
Rate for Payer: Priority Health SBD	$1.98

SODIUM CHLORIDE 0.9 % INJECTION SOLUTION

Facility

$3.60

Service Code	HCPCS J7040
Hospital Charge Code	41463
Hospital Revenue Code	636
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: BCBS Trust/PPO	$3.60
Rate for Payer: BCN Commercial	$3.60

SODIUM CHLORIDE 0.9 % INTRAVENOUS 1.5 MAINTENANCE SOLUTION

Facility

$69.92

Service Code	HCPCS J7030
Hospital Charge Code	180423
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 % INTRAVENOUS 1.5 MAINTENANCE SOLUTION

Facility

$69.92

Service Code	HCPCS J7030
Hospital Charge Code	180423
Hospital Revenue Code	636
Min. Negotiated Rate	$7.24
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: BCBS Trust/PPO	$7.24
Rate for Payer: BCN Commercial	$7.24
Rate for Payer: Cash Price	$55.94
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