Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)

Facility

$305.00

Service Code	NDC 09900001915
Hospital Charge Code	300440
Hospital Revenue Code	250
Min. Negotiated Rate	$192.15
Max. Negotiated Rate	$274.50
Rate for Payer: Aetna Commercial	$259.25
Rate for Payer: Aetna New Business (MI Preferred)	$198.25
Rate for Payer: Cash Price	$244.00
Rate for Payer: Cofinity Commercial	$213.50
Rate for Payer: Cofinity Commercial	$262.30
Rate for Payer: Cofinity Medicare Advantage	$213.50
Rate for Payer: Encore Health Key Benefits Commercial	$244.00
Rate for Payer: Healthscope Commercial	$274.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$259.25
Rate for Payer: PHP Commercial	$259.25
Rate for Payer: Priority Health Cigna Priority Health	$198.25
Rate for Payer: Priority Health SBD	$192.15

SODIUM CHLORIDE 5 % EYE DROPS

Facility

$17.49

Service Code	NDC 00536125494
Hospital Charge Code	7332
Hospital Revenue Code	637
Min. Negotiated Rate	$11.02
Max. Negotiated Rate	$15.74
Rate for Payer: Aetna Commercial	$14.87
Rate for Payer: Aetna New Business (MI Preferred)	$11.37
Rate for Payer: Cash Price	$13.99
Rate for Payer: Cofinity Commercial	$12.24
Rate for Payer: Cofinity Commercial	$15.04
Rate for Payer: Cofinity Medicare Advantage	$12.24
Rate for Payer: Encore Health Key Benefits Commercial	$13.99
Rate for Payer: Healthscope Commercial	$15.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.87
Rate for Payer: PHP Commercial	$14.87
Rate for Payer: Priority Health Cigna Priority Health	$11.37
Rate for Payer: Priority Health SBD	$11.02

SODIUM CHLORIDE 5 % EYE DROPS

Facility

$25.18

Service Code	NDC 17478062312
Hospital Charge Code	7332
Hospital Revenue Code	637
Min. Negotiated Rate	$10.07
Max. Negotiated Rate	$22.66
Rate for Payer: Aetna Commercial	$21.40
Rate for Payer: Aetna Medicare	$12.59
Rate for Payer: Aetna New Business (MI Preferred)	$16.37
Rate for Payer: BCBS Complete	$10.07
Rate for Payer: Cash Price	$20.14
Rate for Payer: Cofinity Commercial	$17.63
Rate for Payer: Cofinity Commercial	$21.65
Rate for Payer: Cofinity Medicare Advantage	$17.63
Rate for Payer: Encore Health Key Benefits Commercial	$20.14
Rate for Payer: Healthscope Commercial	$22.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.40
Rate for Payer: PHP Commercial	$21.40
Rate for Payer: Priority Health Cigna Priority Health	$16.37
Rate for Payer: Priority Health SBD	$15.86

SODIUM CHLORIDE 5 % EYE DROPS

Facility

$25.18

Service Code	NDC 17478062312
Hospital Charge Code	7332
Hospital Revenue Code	637
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$22.66
Rate for Payer: Aetna Commercial	$21.40
Rate for Payer: Aetna New Business (MI Preferred)	$16.37
Rate for Payer: Cash Price	$20.14
Rate for Payer: Cofinity Commercial	$17.63
Rate for Payer: Cofinity Commercial	$21.65
Rate for Payer: Cofinity Medicare Advantage	$17.63
Rate for Payer: Encore Health Key Benefits Commercial	$20.14
Rate for Payer: Healthscope Commercial	$22.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.40
Rate for Payer: PHP Commercial	$21.40
Rate for Payer: Priority Health Cigna Priority Health	$16.37
Rate for Payer: Priority Health SBD	$15.86

SODIUM CHLORIDE 5 % EYE DROPS

Facility

$17.49

Service Code	NDC 00536125494
Hospital Charge Code	7332
Hospital Revenue Code	637
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$15.74
Rate for Payer: Aetna Commercial	$14.87
Rate for Payer: Aetna Medicare	$8.74
Rate for Payer: Aetna New Business (MI Preferred)	$11.37
Rate for Payer: BCBS Complete	$7.00
Rate for Payer: Cash Price	$13.99
Rate for Payer: Cofinity Commercial	$12.24
Rate for Payer: Cofinity Commercial	$15.04
Rate for Payer: Cofinity Medicare Advantage	$12.24
Rate for Payer: Encore Health Key Benefits Commercial	$13.99
Rate for Payer: Healthscope Commercial	$15.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.87
Rate for Payer: PHP Commercial	$14.87
Rate for Payer: Priority Health Cigna Priority Health	$11.37
Rate for Payer: Priority Health SBD	$11.02

SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION

Facility

$7.56

Service Code	NDC 00121059530
Hospital Charge Code	15706
Hospital Revenue Code	637
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$6.80
Rate for Payer: Aetna Commercial	$6.43
Rate for Payer: Aetna Medicare	$3.78
Rate for Payer: Aetna New Business (MI Preferred)	$4.91
Rate for Payer: BCBS Complete	$3.02
Rate for Payer: Cash Price	$6.05
Rate for Payer: Cofinity Commercial	$5.29
Rate for Payer: Cofinity Commercial	$6.50
Rate for Payer: Cofinity Medicare Advantage	$5.29
Rate for Payer: Encore Health Key Benefits Commercial	$6.05
Rate for Payer: Healthscope Commercial	$6.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.43
Rate for Payer: PHP Commercial	$6.43
Rate for Payer: Priority Health Cigna Priority Health	$4.91
Rate for Payer: Priority Health SBD	$4.76

SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION

Facility

$19.98

Service Code	NDC 00121119000
Hospital Charge Code	15706
Hospital Revenue Code	637
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$17.98
Rate for Payer: Aetna Commercial	$16.98
Rate for Payer: Aetna Medicare	$9.99
Rate for Payer: Aetna New Business (MI Preferred)	$12.99
Rate for Payer: BCBS Complete	$7.99
Rate for Payer: Cash Price	$15.98
Rate for Payer: Cofinity Commercial	$13.99
Rate for Payer: Cofinity Commercial	$17.18
Rate for Payer: Cofinity Medicare Advantage	$13.99
Rate for Payer: Encore Health Key Benefits Commercial	$15.98
Rate for Payer: Healthscope Commercial	$17.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.98
Rate for Payer: PHP Commercial	$16.98
Rate for Payer: Priority Health Cigna Priority Health	$12.99
Rate for Payer: Priority Health SBD	$12.59

SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION

Facility

$7.56

Service Code	NDC 00121059530
Hospital Charge Code	15706
Hospital Revenue Code	637
Min. Negotiated Rate	$4.76
Max. Negotiated Rate	$6.80
Rate for Payer: Aetna Commercial	$6.43
Rate for Payer: Aetna New Business (MI Preferred)	$4.91
Rate for Payer: Cash Price	$6.05
Rate for Payer: Cofinity Commercial	$5.29
Rate for Payer: Cofinity Commercial	$6.50
Rate for Payer: Cofinity Medicare Advantage	$5.29
Rate for Payer: Encore Health Key Benefits Commercial	$6.05
Rate for Payer: Healthscope Commercial	$6.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.43
Rate for Payer: PHP Commercial	$6.43
Rate for Payer: Priority Health Cigna Priority Health	$4.91
Rate for Payer: Priority Health SBD	$4.76

SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION

Facility

$19.98

Service Code	NDC 00121119000
Hospital Charge Code	15706
Hospital Revenue Code	637
Min. Negotiated Rate	$12.59
Max. Negotiated Rate	$17.98
Rate for Payer: Aetna Commercial	$16.98
Rate for Payer: Aetna New Business (MI Preferred)	$12.99
Rate for Payer: Cash Price	$15.98
Rate for Payer: Cofinity Commercial	$13.99
Rate for Payer: Cofinity Commercial	$17.18
Rate for Payer: Cofinity Medicare Advantage	$13.99
Rate for Payer: Encore Health Key Benefits Commercial	$15.98
Rate for Payer: Healthscope Commercial	$17.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.98
Rate for Payer: PHP Commercial	$16.98
Rate for Payer: Priority Health Cigna Priority Health	$12.99
Rate for Payer: Priority Health SBD	$12.59

SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET

Facility

$4.40

Service Code	NDC 68084076495
Hospital Charge Code	11067
Hospital Revenue Code	637
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$3.96
Rate for Payer: Aetna Commercial	$3.74
Rate for Payer: Aetna Medicare	$2.20
Rate for Payer: Aetna New Business (MI Preferred)	$2.86
Rate for Payer: BCBS Complete	$1.76
Rate for Payer: Cash Price	$3.52
Rate for Payer: Cofinity Commercial	$3.08
Rate for Payer: Cofinity Commercial	$3.78
Rate for Payer: Cofinity Medicare Advantage	$3.08
Rate for Payer: Encore Health Key Benefits Commercial	$3.52
Rate for Payer: Healthscope Commercial	$3.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.74
Rate for Payer: PHP Commercial	$3.74
Rate for Payer: Priority Health Cigna Priority Health	$2.86
Rate for Payer: Priority Health SBD	$2.77

SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET

Facility

$131.91

Service Code	NDC 68084076425
Hospital Charge Code	11067
Hospital Revenue Code	637
Min. Negotiated Rate	$83.10
Max. Negotiated Rate	$118.72
Rate for Payer: Aetna Commercial	$112.12
Rate for Payer: Aetna New Business (MI Preferred)	$85.74
Rate for Payer: Cash Price	$105.53
Rate for Payer: Cofinity Commercial	$113.44
Rate for Payer: Cofinity Commercial	$92.34
Rate for Payer: Cofinity Medicare Advantage	$92.34
Rate for Payer: Encore Health Key Benefits Commercial	$105.53
Rate for Payer: Healthscope Commercial	$118.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.12
Rate for Payer: PHP Commercial	$112.12
Rate for Payer: Priority Health Cigna Priority Health	$85.74
Rate for Payer: Priority Health SBD	$83.10

SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET

Facility

$131.91

Service Code	NDC 68084076425
Hospital Charge Code	11067
Hospital Revenue Code	637
Min. Negotiated Rate	$52.76
Max. Negotiated Rate	$118.72
Rate for Payer: Aetna Commercial	$112.12
Rate for Payer: Aetna Medicare	$65.96
Rate for Payer: Aetna New Business (MI Preferred)	$85.74
Rate for Payer: BCBS Complete	$52.76
Rate for Payer: Cash Price	$105.53
Rate for Payer: Cofinity Commercial	$113.44
Rate for Payer: Cofinity Commercial	$92.34
Rate for Payer: Cofinity Medicare Advantage	$92.34
Rate for Payer: Encore Health Key Benefits Commercial	$105.53
Rate for Payer: Healthscope Commercial	$118.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.12
Rate for Payer: PHP Commercial	$112.12
Rate for Payer: Priority Health Cigna Priority Health	$85.74
Rate for Payer: Priority Health SBD	$83.10

SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET

Facility

$4.40

Service Code	NDC 68084076495
Hospital Charge Code	11067
Hospital Revenue Code	637
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$3.96
Rate for Payer: Aetna Commercial	$3.74
Rate for Payer: Aetna New Business (MI Preferred)	$2.86
Rate for Payer: Cash Price	$3.52
Rate for Payer: Cofinity Commercial	$3.08
Rate for Payer: Cofinity Commercial	$3.78
Rate for Payer: Cofinity Medicare Advantage	$3.08
Rate for Payer: Encore Health Key Benefits Commercial	$3.52
Rate for Payer: Healthscope Commercial	$3.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.74
Rate for Payer: PHP Commercial	$3.74
Rate for Payer: Priority Health Cigna Priority Health	$2.86
Rate for Payer: Priority Health SBD	$2.77

SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET

Facility

$238.45

Service Code	NDC 64980010401
Hospital Charge Code	11067
Hospital Revenue Code	637
Min. Negotiated Rate	$95.38
Max. Negotiated Rate	$214.60
Rate for Payer: Aetna Commercial	$202.68
Rate for Payer: Aetna Medicare	$119.22
Rate for Payer: Aetna New Business (MI Preferred)	$154.99
Rate for Payer: BCBS Complete	$95.38
Rate for Payer: Cash Price	$190.76
Rate for Payer: Cofinity Commercial	$166.92
Rate for Payer: Cofinity Commercial	$205.07
Rate for Payer: Cofinity Medicare Advantage	$166.92
Rate for Payer: Encore Health Key Benefits Commercial	$190.76
Rate for Payer: Healthscope Commercial	$214.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$202.68
Rate for Payer: PHP Commercial	$202.68
Rate for Payer: Priority Health Cigna Priority Health	$154.99
Rate for Payer: Priority Health SBD	$150.22

SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET

Facility

$238.45

Service Code	NDC 64980010401
Hospital Charge Code	11067
Hospital Revenue Code	637
Min. Negotiated Rate	$150.22
Max. Negotiated Rate	$214.60
Rate for Payer: Aetna Commercial	$202.68
Rate for Payer: Aetna New Business (MI Preferred)	$154.99
Rate for Payer: Cash Price	$190.76
Rate for Payer: Cofinity Commercial	$166.92
Rate for Payer: Cofinity Commercial	$205.07
Rate for Payer: Cofinity Medicare Advantage	$166.92
Rate for Payer: Encore Health Key Benefits Commercial	$190.76
Rate for Payer: Healthscope Commercial	$214.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$202.68
Rate for Payer: PHP Commercial	$202.68
Rate for Payer: Priority Health Cigna Priority Health	$154.99
Rate for Payer: Priority Health SBD	$150.22

SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS

Facility

$137.98

Service Code	HCPCS J2916
Hospital Charge Code	24932
Hospital Revenue Code	636
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$124.18
Rate for Payer: Aetna Commercial	$117.28
Rate for Payer: Aetna Medicare	$68.99
Rate for Payer: Aetna New Business (MI Preferred)	$89.69
Rate for Payer: BCBS Complete	$55.19
Rate for Payer: BCBS Trust/PPO	$6.18
Rate for Payer: BCN Commercial	$6.18
Rate for Payer: Cash Price	$110.38
Rate for Payer: Cash Price	$110.38
Rate for Payer: Cofinity Commercial	$118.66
Rate for Payer: Cofinity Commercial	$96.59
Rate for Payer: Cofinity Medicare Advantage	$96.59
Rate for Payer: Encore Health Key Benefits Commercial	$110.38
Rate for Payer: Healthscope Commercial	$124.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$117.28
Rate for Payer: PHP Commercial	$117.28
Rate for Payer: Priority Health Cigna Priority Health	$89.69
Rate for Payer: Priority Health SBD	$86.93

SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS

Facility

$137.98

Service Code	HCPCS J2916
Hospital Charge Code	24932
Hospital Revenue Code	636
Min. Negotiated Rate	$86.93
Max. Negotiated Rate	$124.18
Rate for Payer: Aetna Commercial	$117.28
Rate for Payer: Aetna New Business (MI Preferred)	$89.69
Rate for Payer: Cash Price	$110.38
Rate for Payer: Cofinity Commercial	$118.66
Rate for Payer: Cofinity Commercial	$96.59
Rate for Payer: Cofinity Medicare Advantage	$96.59
Rate for Payer: Encore Health Key Benefits Commercial	$110.38
Rate for Payer: Healthscope Commercial	$124.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$117.28
Rate for Payer: PHP Commercial	$117.28
Rate for Payer: Priority Health Cigna Priority Health	$89.69
Rate for Payer: Priority Health SBD	$86.93

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	$31.46
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 0.125 % 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

$165.19

Service Code	NDC 39328006712
Hospital Charge Code	76720
Hospital Revenue Code	637
Min. Negotiated Rate	$66.08
Max. Negotiated Rate	$148.67
Rate for Payer: Aetna Commercial	$140.41
Rate for Payer: Aetna Medicare	$82.60
Rate for Payer: Aetna New Business (MI Preferred)	$107.37
Rate for Payer: BCBS Complete	$66.08
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 0.25 % 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	$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

$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

Know your out-of-pocket cost for care.

All Charges