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	$33.21
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 Commercial	$58.12
Rate for Payer: Cofinity Commercial	$71.41
Rate for Payer: Cofinity Medicare Advantage	$58.12
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: PHP Commercial	$70.58
Rate for Payer: Priority Health Cigna Priority Health	$53.97
Rate for Payer: Priority Health SBD	$52.31

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 Commercial	$58.12
Rate for Payer: Cofinity Commercial	$71.41
Rate for Payer: Cofinity Medicare Advantage	$58.12
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: PHP Commercial	$70.58
Rate for Payer: Priority Health Cigna Priority Health	$53.97
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 Commercial	$470.43
Rate for Payer: Cofinity Commercial	$577.95
Rate for Payer: Cofinity Medicare Advantage	$470.43
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: PHP Commercial	$571.23
Rate for Payer: Priority Health Cigna Priority Health	$436.83
Rate for Payer: Priority Health SBD	$423.39

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	$268.82
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 Commercial	$470.43
Rate for Payer: Cofinity Commercial	$577.95
Rate for Payer: Cofinity Medicare Advantage	$470.43
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: PHP Commercial	$571.23
Rate for Payer: Priority Health Cigna Priority Health	$436.83
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	$140.58
Max. Negotiated Rate	$316.31
Rate for Payer: Aetna Commercial	$298.73
Rate for Payer: Aetna Medicare	$175.72
Rate for Payer: Aetna New Business (MI Preferred)	$228.44
Rate for Payer: BCBS Complete	$140.58
Rate for Payer: Cash Price	$281.16
Rate for Payer: Cofinity Commercial	$246.01
Rate for Payer: Cofinity Commercial	$302.25
Rate for Payer: Cofinity Medicare Advantage	$246.01
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: PHP Commercial	$298.73
Rate for Payer: Priority Health Cigna Priority Health	$228.44
Rate for Payer: Priority Health SBD	$221.41

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 Commercial	$246.01
Rate for Payer: Cofinity Commercial	$302.25
Rate for Payer: Cofinity Medicare Advantage	$246.01
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: PHP Commercial	$298.73
Rate for Payer: Priority Health Cigna Priority Health	$228.44
Rate for Payer: Priority Health SBD	$221.41

SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET

Facility

$978.25

Service Code	NDC 00310111030
Hospital Charge Code	188049
Hospital Revenue Code	637
Min. Negotiated Rate	$616.30
Max. Negotiated Rate	$880.42
Rate for Payer: Aetna Commercial	$831.51
Rate for Payer: Aetna New Business (MI Preferred)	$635.86
Rate for Payer: Cash Price	$782.60
Rate for Payer: Cofinity Commercial	$684.77
Rate for Payer: Cofinity Commercial	$841.29
Rate for Payer: Cofinity Medicare Advantage	$684.77
Rate for Payer: Encore Health Key Benefits Commercial	$782.60
Rate for Payer: Healthscope Commercial	$880.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$831.51
Rate for Payer: PHP Commercial	$831.51
Rate for Payer: Priority Health Cigna Priority Health	$635.86
Rate for Payer: Priority Health SBD	$616.30

SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET

Facility

$32.61

Service Code	NDC 00310111001
Hospital Charge Code	188049
Hospital Revenue Code	637
Min. Negotiated Rate	$13.04
Max. Negotiated Rate	$29.35
Rate for Payer: Aetna Commercial	$27.72
Rate for Payer: Aetna Medicare	$16.30
Rate for Payer: Aetna New Business (MI Preferred)	$21.20
Rate for Payer: BCBS Complete	$13.04
Rate for Payer: Cash Price	$26.09
Rate for Payer: Cofinity Commercial	$22.83
Rate for Payer: Cofinity Commercial	$28.04
Rate for Payer: Cofinity Medicare Advantage	$22.83
Rate for Payer: Encore Health Key Benefits Commercial	$26.09
Rate for Payer: Healthscope Commercial	$29.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.72
Rate for Payer: PHP Commercial	$27.72
Rate for Payer: Priority Health Cigna Priority Health	$21.20
Rate for Payer: Priority Health SBD	$20.54

SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET

Facility

$978.25

Service Code	NDC 00310111030
Hospital Charge Code	188049
Hospital Revenue Code	637
Min. Negotiated Rate	$391.30
Max. Negotiated Rate	$880.42
Rate for Payer: Aetna Commercial	$831.51
Rate for Payer: Aetna Medicare	$489.12
Rate for Payer: Aetna New Business (MI Preferred)	$635.86
Rate for Payer: BCBS Complete	$391.30
Rate for Payer: Cash Price	$782.60
Rate for Payer: Cofinity Commercial	$684.77
Rate for Payer: Cofinity Commercial	$841.29
Rate for Payer: Cofinity Medicare Advantage	$684.77
Rate for Payer: Encore Health Key Benefits Commercial	$782.60
Rate for Payer: Healthscope Commercial	$880.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$831.51
Rate for Payer: PHP Commercial	$831.51
Rate for Payer: Priority Health Cigna Priority Health	$635.86
Rate for Payer: Priority Health SBD	$616.30

SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET

Facility

$32.61

Service Code	NDC 00310111001
Hospital Charge Code	188049
Hospital Revenue Code	637
Min. Negotiated Rate	$20.54
Max. Negotiated Rate	$29.35
Rate for Payer: Aetna Commercial	$27.72
Rate for Payer: Aetna New Business (MI Preferred)	$21.20
Rate for Payer: Cash Price	$26.09
Rate for Payer: Cofinity Commercial	$22.83
Rate for Payer: Cofinity Commercial	$28.04
Rate for Payer: Cofinity Medicare Advantage	$22.83
Rate for Payer: Encore Health Key Benefits Commercial	$26.09
Rate for Payer: Healthscope Commercial	$29.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.72
Rate for Payer: PHP Commercial	$27.72
Rate for Payer: Priority Health Cigna Priority Health	$21.20
Rate for Payer: Priority Health SBD	$20.54

SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET

Facility

$358.69

Service Code	NDC 00310110539
Hospital Charge Code	188048
Hospital Revenue Code	637
Min. Negotiated Rate	$143.48
Max. Negotiated Rate	$322.82
Rate for Payer: Aetna Commercial	$304.89
Rate for Payer: Aetna Medicare	$179.34
Rate for Payer: Aetna New Business (MI Preferred)	$233.15
Rate for Payer: BCBS Complete	$143.48
Rate for Payer: Cash Price	$286.95
Rate for Payer: Cofinity Commercial	$251.08
Rate for Payer: Cofinity Commercial	$308.47
Rate for Payer: Cofinity Medicare Advantage	$251.08
Rate for Payer: Encore Health Key Benefits Commercial	$286.95
Rate for Payer: Healthscope Commercial	$322.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$304.89
Rate for Payer: PHP Commercial	$304.89
Rate for Payer: Priority Health Cigna Priority Health	$233.15
Rate for Payer: Priority Health SBD	$225.97

SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET

Facility

$32.61

Service Code	NDC 00310110501
Hospital Charge Code	188048
Hospital Revenue Code	637
Min. Negotiated Rate	$20.54
Max. Negotiated Rate	$29.35
Rate for Payer: Aetna Commercial	$27.72
Rate for Payer: Aetna New Business (MI Preferred)	$21.20
Rate for Payer: Cash Price	$26.09
Rate for Payer: Cofinity Commercial	$22.83
Rate for Payer: Cofinity Commercial	$28.04
Rate for Payer: Cofinity Medicare Advantage	$22.83
Rate for Payer: Encore Health Key Benefits Commercial	$26.09
Rate for Payer: Healthscope Commercial	$29.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.72
Rate for Payer: PHP Commercial	$27.72
Rate for Payer: Priority Health Cigna Priority Health	$21.20
Rate for Payer: Priority Health SBD	$20.54

SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET

Facility

$358.69

Service Code	NDC 00310110539
Hospital Charge Code	188048
Hospital Revenue Code	637
Min. Negotiated Rate	$225.97
Max. Negotiated Rate	$322.82
Rate for Payer: Aetna Commercial	$304.89
Rate for Payer: Aetna New Business (MI Preferred)	$233.15
Rate for Payer: Cash Price	$286.95
Rate for Payer: Cofinity Commercial	$251.08
Rate for Payer: Cofinity Commercial	$308.47
Rate for Payer: Cofinity Medicare Advantage	$251.08
Rate for Payer: Encore Health Key Benefits Commercial	$286.95
Rate for Payer: Healthscope Commercial	$322.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$304.89
Rate for Payer: PHP Commercial	$304.89
Rate for Payer: Priority Health Cigna Priority Health	$233.15
Rate for Payer: Priority Health SBD	$225.97

SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET

Facility

$32.61

Service Code	NDC 00310110501
Hospital Charge Code	188048
Hospital Revenue Code	637
Min. Negotiated Rate	$13.04
Max. Negotiated Rate	$29.35
Rate for Payer: Aetna Commercial	$27.72
Rate for Payer: Aetna Medicare	$16.30
Rate for Payer: Aetna New Business (MI Preferred)	$21.20
Rate for Payer: BCBS Complete	$13.04
Rate for Payer: Cash Price	$26.09
Rate for Payer: Cofinity Commercial	$22.83
Rate for Payer: Cofinity Commercial	$28.04
Rate for Payer: Cofinity Medicare Advantage	$22.83
Rate for Payer: Encore Health Key Benefits Commercial	$26.09
Rate for Payer: Healthscope Commercial	$29.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.72
Rate for Payer: PHP Commercial	$27.72
Rate for Payer: Priority Health Cigna Priority Health	$21.20
Rate for Payer: Priority Health SBD	$20.54

SORBITOL 70 % SOLUTION

Facility

$29.76

Service Code	NDC 00802391316
Hospital Charge Code	7413
Hospital Revenue Code	637
Min. Negotiated Rate	$11.90
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 Commercial	$20.83
Rate for Payer: Cofinity Commercial	$25.59
Rate for Payer: Cofinity Medicare Advantage	$20.83
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: PHP Commercial	$25.30
Rate for Payer: Priority Health Cigna Priority Health	$19.34
Rate for Payer: Priority Health SBD	$18.75

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 Commercial	$20.83
Rate for Payer: Cofinity Commercial	$25.59
Rate for Payer: Cofinity Medicare Advantage	$20.83
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: PHP Commercial	$25.30
Rate for Payer: Priority Health Cigna Priority Health	$19.34
Rate for Payer: Priority Health SBD	$18.75

SORBITOL 70 % SOLUTION

Facility

$10.51

Service Code	NDC 57896043516
Hospital Charge Code	7413
Hospital Revenue Code	637
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$9.46
Rate for Payer: Aetna Commercial	$8.93
Rate for Payer: Aetna Medicare	$5.25
Rate for Payer: Aetna New Business (MI Preferred)	$6.83
Rate for Payer: BCBS Complete	$4.20
Rate for Payer: Cash Price	$8.41
Rate for Payer: Cofinity Commercial	$7.36
Rate for Payer: Cofinity Commercial	$9.04
Rate for Payer: Cofinity Medicare Advantage	$7.36
Rate for Payer: Encore Health Key Benefits Commercial	$8.41
Rate for Payer: Healthscope Commercial	$9.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.93
Rate for Payer: PHP Commercial	$8.93
Rate for Payer: Priority Health Cigna Priority Health	$6.83
Rate for Payer: Priority Health SBD	$6.62

SORBITOL 70 % SOLUTION

Facility

$10.51

Service Code	NDC 57896043516
Hospital Charge Code	7413
Hospital Revenue Code	637
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$9.46
Rate for Payer: Aetna Commercial	$8.93
Rate for Payer: Aetna New Business (MI Preferred)	$6.83
Rate for Payer: Cash Price	$8.41
Rate for Payer: Cofinity Commercial	$7.36
Rate for Payer: Cofinity Commercial	$9.04
Rate for Payer: Cofinity Medicare Advantage	$7.36
Rate for Payer: Encore Health Key Benefits Commercial	$8.41
Rate for Payer: Healthscope Commercial	$9.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.93
Rate for Payer: PHP Commercial	$8.93
Rate for Payer: Priority Health Cigna Priority Health	$6.83
Rate for Payer: Priority Health SBD	$6.62

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 Commercial	$31.86
Rate for Payer: Cofinity Commercial	$39.14
Rate for Payer: Cofinity Medicare Advantage	$31.86
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: PHP Commercial	$38.68
Rate for Payer: Priority Health Cigna Priority Health	$29.58
Rate for Payer: Priority Health SBD	$28.67

SORBITOL 70 % SOLUTION

Facility

$45.51

Service Code	NDC 46287050001
Hospital Charge Code	7413
Hospital Revenue Code	637
Min. Negotiated Rate	$18.20
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 Commercial	$31.86
Rate for Payer: Cofinity Commercial	$39.14
Rate for Payer: Cofinity Medicare Advantage	$31.86
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: PHP Commercial	$38.68
Rate for Payer: Priority Health Cigna Priority Health	$29.58
Rate for Payer: Priority Health SBD	$28.67

SOTALOL 80 MG TABLET

Facility

$122.20

Service Code	NDC 60505008000
Hospital Charge Code	11421
Hospital Revenue Code	637
Min. Negotiated Rate	$48.88
Max. Negotiated Rate	$109.98
Rate for Payer: Aetna Commercial	$103.87
Rate for Payer: Aetna Medicare	$61.10
Rate for Payer: Aetna New Business (MI Preferred)	$79.43
Rate for Payer: BCBS Complete	$48.88
Rate for Payer: Cash Price	$97.76
Rate for Payer: Cofinity Commercial	$105.09
Rate for Payer: Cofinity Commercial	$85.54
Rate for Payer: Cofinity Medicare Advantage	$85.54
Rate for Payer: Encore Health Key Benefits Commercial	$97.76
Rate for Payer: Healthscope Commercial	$109.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$103.87
Rate for Payer: PHP Commercial	$103.87
Rate for Payer: Priority Health Cigna Priority Health	$79.43
Rate for Payer: Priority Health SBD	$76.99

SOTALOL 80 MG TABLET

Facility

$444.00

Service Code	NDC 00245001201
Hospital Charge Code	11421
Hospital Revenue Code	637
Min. Negotiated Rate	$279.72
Max. Negotiated Rate	$399.60
Rate for Payer: Aetna Commercial	$377.40
Rate for Payer: Aetna New Business (MI Preferred)	$288.60
Rate for Payer: Cash Price	$355.20
Rate for Payer: Cofinity Commercial	$310.80
Rate for Payer: Cofinity Commercial	$381.84
Rate for Payer: Cofinity Medicare Advantage	$310.80
Rate for Payer: Encore Health Key Benefits Commercial	$355.20
Rate for Payer: Healthscope Commercial	$399.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$377.40
Rate for Payer: PHP Commercial	$377.40
Rate for Payer: Priority Health Cigna Priority Health	$288.60
Rate for Payer: Priority Health SBD	$279.72

SOTALOL 80 MG TABLET

Facility

$4.44

Service Code	NDC 00245001289
Hospital Charge Code	11421
Hospital Revenue Code	637
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.77
Rate for Payer: Aetna Medicare	$2.22
Rate for Payer: Aetna New Business (MI Preferred)	$2.89
Rate for Payer: BCBS Complete	$1.78
Rate for Payer: Cash Price	$3.55
Rate for Payer: Cofinity Commercial	$3.11
Rate for Payer: Cofinity Commercial	$3.82
Rate for Payer: Cofinity Medicare Advantage	$3.11
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: PHP Commercial	$3.77
Rate for Payer: Priority Health Cigna Priority Health	$2.89
Rate for Payer: Priority Health SBD	$2.80

SOTALOL 80 MG TABLET

Facility

$499.68

Service Code	NDC 68084065401
Hospital Charge Code	11421
Hospital Revenue Code	637
Min. Negotiated Rate	$199.87
Max. Negotiated Rate	$449.71
Rate for Payer: Aetna Commercial	$424.73
Rate for Payer: Aetna Medicare	$249.84
Rate for Payer: Aetna New Business (MI Preferred)	$324.79
Rate for Payer: BCBS Complete	$199.87
Rate for Payer: Cash Price	$399.74
Rate for Payer: Cofinity Commercial	$349.78
Rate for Payer: Cofinity Commercial	$429.72
Rate for Payer: Cofinity Medicare Advantage	$349.78
Rate for Payer: Encore Health Key Benefits Commercial	$399.74
Rate for Payer: Healthscope Commercial	$449.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$424.73
Rate for Payer: PHP Commercial	$424.73
Rate for Payer: Priority Health Cigna Priority Health	$324.79
Rate for Payer: Priority Health SBD	$314.80

SOTALOL 80 MG TABLET

Facility

$499.68

Service Code	NDC 68084065401
Hospital Charge Code	11421
Hospital Revenue Code	637
Min. Negotiated Rate	$314.80
Max. Negotiated Rate	$449.71
Rate for Payer: Aetna Commercial	$424.73
Rate for Payer: Aetna New Business (MI Preferred)	$324.79
Rate for Payer: Cash Price	$399.74
Rate for Payer: Cofinity Commercial	$349.78
Rate for Payer: Cofinity Commercial	$429.72
Rate for Payer: Cofinity Medicare Advantage	$349.78
Rate for Payer: Encore Health Key Benefits Commercial	$399.74
Rate for Payer: Healthscope Commercial	$449.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$424.73
Rate for Payer: PHP Commercial	$424.73
Rate for Payer: Priority Health Cigna Priority Health	$324.79
Rate for Payer: Priority Health SBD	$314.80

Know your out-of-pocket cost for care.

All Charges