Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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	$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	$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	$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 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 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	$55.86
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

$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

$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

$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

$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

$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	$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

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 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 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 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	$1.72
Max. Negotiated Rate	$316.30
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: BCBS Trust/PPO	$1.72
Rate for Payer: BCN Commercial	$1.72
Rate for Payer: Cash Price	$281.16
Rate for Payer: Cash Price	$281.16
Rate for Payer: Cofinity Commercial	$246.02
Rate for Payer: Cofinity Commercial	$302.25
Rate for Payer: Cofinity Medicare Advantage	$246.02
Rate for Payer: Encore Health Key Benefits Commercial	$281.16
Rate for Payer: Healthscope Commercial	$316.30
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	$316.30
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	$246.02
Rate for Payer: Cofinity Commercial	$302.25
Rate for Payer: Cofinity Medicare Advantage	$246.02
Rate for Payer: Encore Health Key Benefits Commercial	$281.16
Rate for Payer: Healthscope Commercial	$316.30
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

$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

Know your out-of-pocket cost for care.

All Charges