Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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 Commercial	$115.63
Rate for Payer: Cofinity Commercial	$142.06
Rate for Payer: Cofinity Medicare Advantage	$115.63
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: PHP Commercial	$140.41
Rate for Payer: Priority Health Cigna Priority Health	$107.37
Rate for Payer: Priority Health SBD	$104.07

SODIUM HYPOCHLORITE 0.125 % SOLUTION

Facility

$62.91

Service Code	NDC 00436067216
Hospital Charge Code	76720
Hospital Revenue Code	637
Min. Negotiated Rate	$39.63
Max. Negotiated Rate	$56.62
Rate for Payer: Aetna Commercial	$53.47
Rate for Payer: Aetna New Business (MI Preferred)	$40.89
Rate for Payer: Cash Price	$50.33
Rate for Payer: Cofinity Commercial	$44.04
Rate for Payer: Cofinity Commercial	$54.10
Rate for Payer: Cofinity Medicare Advantage	$44.04
Rate for Payer: Encore Health Key Benefits Commercial	$50.33
Rate for Payer: Healthscope Commercial	$56.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.47
Rate for Payer: PHP Commercial	$53.47
Rate for Payer: Priority Health Cigna Priority Health	$40.89
Rate for Payer: Priority Health SBD	$39.63

SODIUM HYPOCHLORITE 0.125 % SOLUTION

Facility

$62.91

Service Code	NDC 00436067216
Hospital Charge Code	76720
Hospital Revenue Code	637
Min. Negotiated Rate	$25.16
Max. Negotiated Rate	$56.62
Rate for Payer: Aetna Commercial	$53.47
Rate for Payer: Aetna Medicare	$31.45
Rate for Payer: Aetna New Business (MI Preferred)	$40.89
Rate for Payer: BCBS Complete	$25.16
Rate for Payer: Cash Price	$50.33
Rate for Payer: Cofinity Commercial	$44.04
Rate for Payer: Cofinity Commercial	$54.10
Rate for Payer: Cofinity Medicare Advantage	$44.04
Rate for Payer: Encore Health Key Benefits Commercial	$50.33
Rate for Payer: Healthscope Commercial	$56.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.47
Rate for Payer: PHP Commercial	$53.47
Rate for Payer: Priority Health Cigna Priority Health	$40.89
Rate for Payer: Priority Health SBD	$39.63

SODIUM HYPOCHLORITE 0.25 % SOLUTION

Facility

$39.74

Service Code	NDC 39328006325
Hospital Charge Code	15950
Hospital Revenue Code	637
Min. Negotiated Rate	$25.04
Max. Negotiated Rate	$35.77
Rate for Payer: Aetna Commercial	$33.78
Rate for Payer: Aetna New Business (MI Preferred)	$25.83
Rate for Payer: Cash Price	$31.79
Rate for Payer: Cofinity Commercial	$27.82
Rate for Payer: Cofinity Commercial	$34.18
Rate for Payer: Cofinity Medicare Advantage	$27.82
Rate for Payer: Encore Health Key Benefits Commercial	$31.79
Rate for Payer: Healthscope Commercial	$35.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.78
Rate for Payer: PHP Commercial	$33.78
Rate for Payer: Priority Health Cigna Priority Health	$25.83
Rate for Payer: Priority Health SBD	$25.04

SODIUM HYPOCHLORITE 0.25 % SOLUTION

Facility

$12.00

Service Code	NDC 09900001865
Hospital Charge Code	15950
Hospital Revenue Code	637
Min. Negotiated Rate	$4.80
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 Commercial	$10.32
Rate for Payer: Cofinity Commercial	$8.40
Rate for Payer: Cofinity Medicare Advantage	$8.40
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: PHP Commercial	$10.20
Rate for Payer: Priority Health Cigna Priority Health	$7.80
Rate for Payer: Priority Health SBD	$7.56

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 Commercial	$10.32
Rate for Payer: Cofinity Commercial	$8.40
Rate for Payer: Cofinity Medicare Advantage	$8.40
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: PHP Commercial	$10.20
Rate for Payer: Priority Health Cigna Priority Health	$7.80
Rate for Payer: Priority Health SBD	$7.56

SODIUM HYPOCHLORITE 0.25 % SOLUTION

Facility

$39.74

Service Code	NDC 39328006325
Hospital Charge Code	15950
Hospital Revenue Code	637
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$35.77
Rate for Payer: Aetna Commercial	$33.78
Rate for Payer: Aetna Medicare	$19.87
Rate for Payer: Aetna New Business (MI Preferred)	$25.83
Rate for Payer: BCBS Complete	$15.90
Rate for Payer: Cash Price	$31.79
Rate for Payer: Cofinity Commercial	$27.82
Rate for Payer: Cofinity Commercial	$34.18
Rate for Payer: Cofinity Medicare Advantage	$27.82
Rate for Payer: Encore Health Key Benefits Commercial	$31.79
Rate for Payer: Healthscope Commercial	$35.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.78
Rate for Payer: PHP Commercial	$33.78
Rate for Payer: Priority Health Cigna Priority Health	$25.83
Rate for Payer: Priority Health SBD	$25.04

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 Commercial	$10.32
Rate for Payer: Cofinity Commercial	$8.40
Rate for Payer: Cofinity Medicare Advantage	$8.40
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: PHP Commercial	$10.20
Rate for Payer: Priority Health Cigna Priority Health	$7.80
Rate for Payer: Priority Health SBD	$7.56

SODIUM HYPOCHLORITE 0.5 % SOLUTION

Facility

$39.74

Service Code	NDC 39328006250
Hospital Charge Code	2110
Hospital Revenue Code	637
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$35.77
Rate for Payer: Aetna Commercial	$33.78
Rate for Payer: Aetna Medicare	$19.87
Rate for Payer: Aetna New Business (MI Preferred)	$25.83
Rate for Payer: BCBS Complete	$15.90
Rate for Payer: Cash Price	$31.79
Rate for Payer: Cofinity Commercial	$27.82
Rate for Payer: Cofinity Commercial	$34.18
Rate for Payer: Cofinity Medicare Advantage	$27.82
Rate for Payer: Encore Health Key Benefits Commercial	$31.79
Rate for Payer: Healthscope Commercial	$35.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.78
Rate for Payer: PHP Commercial	$33.78
Rate for Payer: Priority Health Cigna Priority Health	$25.83
Rate for Payer: Priority Health SBD	$25.04

SODIUM HYPOCHLORITE 0.5 % SOLUTION

Facility

$12.00

Service Code	NDC 09900001866
Hospital Charge Code	2110
Hospital Revenue Code	637
Min. Negotiated Rate	$4.80
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 Commercial	$10.32
Rate for Payer: Cofinity Commercial	$8.40
Rate for Payer: Cofinity Medicare Advantage	$8.40
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: PHP Commercial	$10.20
Rate for Payer: Priority Health Cigna Priority Health	$7.80
Rate for Payer: Priority Health SBD	$7.56

SODIUM HYPOCHLORITE 0.5 % SOLUTION

Facility

$39.74

Service Code	NDC 39328006250
Hospital Charge Code	2110
Hospital Revenue Code	637
Min. Negotiated Rate	$25.04
Max. Negotiated Rate	$35.77
Rate for Payer: Aetna Commercial	$33.78
Rate for Payer: Aetna New Business (MI Preferred)	$25.83
Rate for Payer: Cash Price	$31.79
Rate for Payer: Cofinity Commercial	$27.82
Rate for Payer: Cofinity Commercial	$34.18
Rate for Payer: Cofinity Medicare Advantage	$27.82
Rate for Payer: Encore Health Key Benefits Commercial	$31.79
Rate for Payer: Healthscope Commercial	$35.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.78
Rate for Payer: PHP Commercial	$33.78
Rate for Payer: Priority Health Cigna Priority Health	$25.83
Rate for Payer: Priority Health SBD	$25.04

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	$19.17
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 Commercial	$33.55
Rate for Payer: Cofinity Commercial	$41.22
Rate for Payer: Cofinity Medicare Advantage	$33.55
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: PHP Commercial	$40.74
Rate for Payer: Priority Health Cigna Priority Health	$31.15
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	$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 Commercial	$301.43
Rate for Payer: Cofinity Commercial	$370.33
Rate for Payer: Cofinity Medicare Advantage	$301.43
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: PHP Commercial	$366.03
Rate for Payer: Priority Health Cigna Priority Health	$279.90
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 Commercial	$33.55
Rate for Payer: Cofinity Commercial	$41.22
Rate for Payer: Cofinity Medicare Advantage	$33.55
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: PHP Commercial	$40.74
Rate for Payer: Priority Health Cigna Priority Health	$31.15
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	$172.25
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 Commercial	$301.43
Rate for Payer: Cofinity Commercial	$370.33
Rate for Payer: Cofinity Medicare Advantage	$301.43
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: PHP Commercial	$366.03
Rate for Payer: Priority Health Cigna Priority Health	$279.90
Rate for Payer: Priority Health SBD	$271.29

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$285.80

Service Code	NDC 63323017015
Hospital Charge Code	7351
Hospital Revenue Code	250
Min. Negotiated Rate	$180.05
Max. Negotiated Rate	$257.22
Rate for Payer: Aetna Commercial	$242.93
Rate for Payer: Aetna New Business (MI Preferred)	$185.77
Rate for Payer: Cash Price	$228.64
Rate for Payer: Cofinity Commercial	$200.06
Rate for Payer: Cofinity Commercial	$245.79
Rate for Payer: Cofinity Medicare Advantage	$200.06
Rate for Payer: Encore Health Key Benefits Commercial	$228.64
Rate for Payer: Healthscope Commercial	$257.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$242.93
Rate for Payer: PHP Commercial	$242.93
Rate for Payer: Priority Health Cigna Priority Health	$185.77
Rate for Payer: Priority Health SBD	$180.05

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$285.80

Service Code	NDC 63323017015
Hospital Charge Code	7351
Hospital Revenue Code	250
Min. Negotiated Rate	$114.32
Max. Negotiated Rate	$257.22
Rate for Payer: Aetna Commercial	$242.93
Rate for Payer: Aetna Medicare	$142.90
Rate for Payer: Aetna New Business (MI Preferred)	$185.77
Rate for Payer: BCBS Complete	$114.32
Rate for Payer: Cash Price	$228.64
Rate for Payer: Cofinity Commercial	$200.06
Rate for Payer: Cofinity Commercial	$245.79
Rate for Payer: Cofinity Medicare Advantage	$200.06
Rate for Payer: Encore Health Key Benefits Commercial	$228.64
Rate for Payer: Healthscope Commercial	$257.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$242.93
Rate for Payer: PHP Commercial	$242.93
Rate for Payer: Priority Health Cigna Priority Health	$185.77
Rate for Payer: Priority Health SBD	$180.05

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$111.71

Service Code	NDC 63323017005
Hospital Charge Code	7351
Hospital Revenue Code	250
Min. Negotiated Rate	$70.38
Max. Negotiated Rate	$100.54
Rate for Payer: Aetna Commercial	$94.95
Rate for Payer: Aetna New Business (MI Preferred)	$72.61
Rate for Payer: Cash Price	$89.37
Rate for Payer: Cofinity Commercial	$78.20
Rate for Payer: Cofinity Commercial	$96.07
Rate for Payer: Cofinity Medicare Advantage	$78.20
Rate for Payer: Encore Health Key Benefits Commercial	$89.37
Rate for Payer: Healthscope Commercial	$100.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$94.95
Rate for Payer: PHP Commercial	$94.95
Rate for Payer: Priority Health Cigna Priority Health	$72.61
Rate for Payer: Priority Health SBD	$70.38

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$111.71

Service Code	NDC 63323017005
Hospital Charge Code	7351
Hospital Revenue Code	250
Min. Negotiated Rate	$44.68
Max. Negotiated Rate	$100.54
Rate for Payer: Aetna Commercial	$94.95
Rate for Payer: Aetna Medicare	$55.85
Rate for Payer: Aetna New Business (MI Preferred)	$72.61
Rate for Payer: BCBS Complete	$44.68
Rate for Payer: Cash Price	$89.37
Rate for Payer: Cofinity Commercial	$78.20
Rate for Payer: Cofinity Commercial	$96.07
Rate for Payer: Cofinity Medicare Advantage	$78.20
Rate for Payer: Encore Health Key Benefits Commercial	$89.37
Rate for Payer: Healthscope Commercial	$100.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$94.95
Rate for Payer: PHP Commercial	$94.95
Rate for Payer: Priority Health Cigna Priority Health	$72.61
Rate for Payer: Priority Health SBD	$70.38

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$246.43

Service Code	NDC 00409739172
Hospital Charge Code	7351
Hospital Revenue Code	250
Min. Negotiated Rate	$155.25
Max. Negotiated Rate	$221.79
Rate for Payer: Aetna Commercial	$209.47
Rate for Payer: Aetna New Business (MI Preferred)	$160.18
Rate for Payer: Cash Price	$197.14
Rate for Payer: Cofinity Commercial	$172.50
Rate for Payer: Cofinity Commercial	$211.93
Rate for Payer: Cofinity Medicare Advantage	$172.50
Rate for Payer: Encore Health Key Benefits Commercial	$197.14
Rate for Payer: Healthscope Commercial	$221.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$209.47
Rate for Payer: PHP Commercial	$209.47
Rate for Payer: Priority Health Cigna Priority Health	$160.18
Rate for Payer: Priority Health SBD	$155.25

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$246.43

Service Code	NDC 00409739172
Hospital Charge Code	7351
Hospital Revenue Code	250
Min. Negotiated Rate	$98.57
Max. Negotiated Rate	$221.79
Rate for Payer: Aetna Commercial	$209.47
Rate for Payer: Aetna Medicare	$123.22
Rate for Payer: Aetna New Business (MI Preferred)	$160.18
Rate for Payer: BCBS Complete	$98.57
Rate for Payer: Cash Price	$197.14
Rate for Payer: Cofinity Commercial	$172.50
Rate for Payer: Cofinity Commercial	$211.93
Rate for Payer: Cofinity Medicare Advantage	$172.50
Rate for Payer: Encore Health Key Benefits Commercial	$197.14
Rate for Payer: Healthscope Commercial	$221.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$209.47
Rate for Payer: PHP Commercial	$209.47
Rate for Payer: Priority Health Cigna Priority Health	$160.18
Rate for Payer: Priority Health SBD	$155.25

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

Facility

$246.43

Service Code	NDC 09900001920
Hospital Charge Code	301290
Hospital Revenue Code	250
Min. Negotiated Rate	$155.25
Max. Negotiated Rate	$221.79
Rate for Payer: Aetna Commercial	$209.47
Rate for Payer: Aetna New Business (MI Preferred)	$160.18
Rate for Payer: Cash Price	$197.14
Rate for Payer: Cofinity Commercial	$172.50
Rate for Payer: Cofinity Commercial	$211.93
Rate for Payer: Cofinity Medicare Advantage	$172.50
Rate for Payer: Encore Health Key Benefits Commercial	$197.14
Rate for Payer: Healthscope Commercial	$221.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$209.47
Rate for Payer: PHP Commercial	$209.47
Rate for Payer: Priority Health Cigna Priority Health	$160.18
Rate for Payer: Priority Health SBD	$155.25

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

Facility

$246.43

Service Code	NDC 09900001920
Hospital Charge Code	301290
Hospital Revenue Code	250
Min. Negotiated Rate	$98.57
Max. Negotiated Rate	$221.79
Rate for Payer: Aetna Commercial	$209.47
Rate for Payer: Aetna Medicare	$123.22
Rate for Payer: Aetna New Business (MI Preferred)	$160.18
Rate for Payer: BCBS Complete	$98.57
Rate for Payer: Cash Price	$197.14
Rate for Payer: Cofinity Commercial	$172.50
Rate for Payer: Cofinity Commercial	$211.93
Rate for Payer: Cofinity Medicare Advantage	$172.50
Rate for Payer: Encore Health Key Benefits Commercial	$197.14
Rate for Payer: Healthscope Commercial	$221.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$209.47
Rate for Payer: PHP Commercial	$209.47
Rate for Payer: Priority Health Cigna Priority Health	$160.18
Rate for Payer: Priority Health SBD	$155.25

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 Commercial	$24.07
Rate for Payer: Cofinity Commercial	$29.58
Rate for Payer: Cofinity Medicare Advantage	$24.07
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: PHP Commercial	$29.23
Rate for Payer: Priority Health Cigna Priority Health	$22.35
Rate for Payer: Priority Health SBD	$21.67

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	$13.76
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 Commercial	$24.07
Rate for Payer: Cofinity Commercial	$29.58
Rate for Payer: Cofinity Medicare Advantage	$24.07
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: PHP Commercial	$29.23
Rate for Payer: Priority Health Cigna Priority Health	$22.35
Rate for Payer: Priority Health SBD	$21.67

Know your out-of-pocket cost for care.

All Charges