Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LACOSAMIDE 200 MG TABLET

Facility

$4,235.32

Service Code	NDC 00131248035
Hospital Charge Code	96971
Hospital Revenue Code	637
Min. Negotiated Rate	$1,664.48
Max. Negotiated Rate	$3,811.79
Rate for Payer: Aetna Commercial	$3,600.02
Rate for Payer: Aetna Medicare	$2,117.66
Rate for Payer: Aetna New Business (MI Preferred)	$2,752.96
Rate for Payer: BCBS Complete	$1,694.13
Rate for Payer: Cash Price	$3,388.26
Rate for Payer: Cofinity Advantage	$2,964.72
Rate for Payer: Cofinity Commercial	$3,642.38
Rate for Payer: Encore Health Key Benefits Commercial	$3,388.26
Rate for Payer: Healthscope Commercial	$3,811.79
Rate for Payer: MI Amish Medical Board Commercial	$3,388.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,600.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,176.49
Rate for Payer: PHP Commercial	$3,600.02
Rate for Payer: Priority Health SBD	$2,668.25
Rate for Payer: UHC All Payor (Choice/PPO)	$2,752.96
Rate for Payer: UHC Core	$2,206.60
Rate for Payer: UHC Exchange	$1,664.48

LACOSAMIDE 200 MG TABLET

Facility

$262.20

Service Code	NDC 62332017460
Hospital Charge Code	96971
Hospital Revenue Code	637
Min. Negotiated Rate	$103.04
Max. Negotiated Rate	$235.98
Rate for Payer: Aetna Commercial	$222.87
Rate for Payer: Aetna Medicare	$131.10
Rate for Payer: Aetna New Business (MI Preferred)	$170.43
Rate for Payer: BCBS Complete	$104.88
Rate for Payer: Cash Price	$209.76
Rate for Payer: Cofinity Advantage	$183.54
Rate for Payer: Cofinity Commercial	$225.49
Rate for Payer: Encore Health Key Benefits Commercial	$209.76
Rate for Payer: Healthscope Commercial	$235.98
Rate for Payer: MI Amish Medical Board Commercial	$209.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$222.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$196.65
Rate for Payer: PHP Commercial	$222.87
Rate for Payer: Priority Health SBD	$165.19
Rate for Payer: UHC All Payor (Choice/PPO)	$170.43
Rate for Payer: UHC Core	$136.61
Rate for Payer: UHC Exchange	$103.04

LACOSAMIDE 200 MG TABLET

Facility

$508.16

Service Code	NDC 00904724768
Hospital Charge Code	96971
Hospital Revenue Code	637
Min. Negotiated Rate	$320.14
Max. Negotiated Rate	$457.34
Rate for Payer: Aetna Commercial	$431.94
Rate for Payer: Aetna New Business (MI Preferred)	$330.30
Rate for Payer: Cash Price	$406.53
Rate for Payer: Cofinity Advantage	$355.71
Rate for Payer: Cofinity Commercial	$437.02
Rate for Payer: Encore Health Key Benefits Commercial	$406.53
Rate for Payer: Healthscope Commercial	$457.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$431.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$381.12
Rate for Payer: PHP Commercial	$431.94
Rate for Payer: Priority Health SBD	$320.14

LACOSAMIDE 200 MG TABLET

Facility

$4,235.32

Service Code	NDC 00131248035
Hospital Charge Code	96971
Hospital Revenue Code	637
Min. Negotiated Rate	$2,668.25
Max. Negotiated Rate	$3,811.79
Rate for Payer: Aetna Commercial	$3,600.02
Rate for Payer: Aetna New Business (MI Preferred)	$2,752.96
Rate for Payer: Cash Price	$3,388.26
Rate for Payer: Cofinity Advantage	$2,964.72
Rate for Payer: Cofinity Commercial	$3,642.38
Rate for Payer: Encore Health Key Benefits Commercial	$3,388.26
Rate for Payer: Healthscope Commercial	$3,811.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,600.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,176.49
Rate for Payer: PHP Commercial	$3,600.02
Rate for Payer: Priority Health SBD	$2,668.25

LACOSAMIDE 200 MG TABLET

Facility

$4,659.34

Service Code	NDC 00131248060
Hospital Charge Code	96971
Hospital Revenue Code	637
Min. Negotiated Rate	$2,935.38
Max. Negotiated Rate	$4,193.41
Rate for Payer: Aetna Commercial	$3,960.44
Rate for Payer: Aetna New Business (MI Preferred)	$3,028.57
Rate for Payer: Cash Price	$3,727.47
Rate for Payer: Cofinity Advantage	$3,261.54
Rate for Payer: Cofinity Commercial	$4,007.03
Rate for Payer: Encore Health Key Benefits Commercial	$3,727.47
Rate for Payer: Healthscope Commercial	$4,193.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,960.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,494.51
Rate for Payer: PHP Commercial	$3,960.44
Rate for Payer: Priority Health SBD	$2,935.38

LACOSAMIDE 200 MG TABLET

Facility

$4,659.34

Service Code	NDC 00131248060
Hospital Charge Code	96971
Hospital Revenue Code	637
Min. Negotiated Rate	$1,831.12
Max. Negotiated Rate	$4,193.41
Rate for Payer: Aetna Commercial	$3,960.44
Rate for Payer: Aetna Medicare	$2,329.67
Rate for Payer: Aetna New Business (MI Preferred)	$3,028.57
Rate for Payer: BCBS Complete	$1,863.74
Rate for Payer: Cash Price	$3,727.47
Rate for Payer: Cofinity Advantage	$3,261.54
Rate for Payer: Cofinity Commercial	$4,007.03
Rate for Payer: Encore Health Key Benefits Commercial	$3,727.47
Rate for Payer: Healthscope Commercial	$4,193.41
Rate for Payer: MI Amish Medical Board Commercial	$3,727.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,960.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,494.51
Rate for Payer: PHP Commercial	$3,960.44
Rate for Payer: Priority Health SBD	$2,935.38
Rate for Payer: UHC All Payor (Choice/PPO)	$3,028.57
Rate for Payer: UHC Core	$2,427.52
Rate for Payer: UHC Exchange	$1,831.12

LACOSAMIDE 200 MG TABLET

Facility

$262.20

Service Code	NDC 62332017460
Hospital Charge Code	96971
Hospital Revenue Code	637
Min. Negotiated Rate	$165.19
Max. Negotiated Rate	$235.98
Rate for Payer: Aetna Commercial	$222.87
Rate for Payer: Aetna New Business (MI Preferred)	$170.43
Rate for Payer: Cash Price	$209.76
Rate for Payer: Cofinity Advantage	$183.54
Rate for Payer: Cofinity Commercial	$225.49
Rate for Payer: Encore Health Key Benefits Commercial	$209.76
Rate for Payer: Healthscope Commercial	$235.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$222.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$196.65
Rate for Payer: PHP Commercial	$222.87
Rate for Payer: Priority Health SBD	$165.19

LACOSAMIDE 200 MG TABLET

Facility

$508.16

Service Code	NDC 00904724768
Hospital Charge Code	96971
Hospital Revenue Code	637
Min. Negotiated Rate	$199.71
Max. Negotiated Rate	$457.34
Rate for Payer: Aetna Commercial	$431.94
Rate for Payer: Aetna Medicare	$254.08
Rate for Payer: Aetna New Business (MI Preferred)	$330.30
Rate for Payer: BCBS Complete	$203.26
Rate for Payer: Cash Price	$406.53
Rate for Payer: Cofinity Advantage	$355.71
Rate for Payer: Cofinity Commercial	$437.02
Rate for Payer: Encore Health Key Benefits Commercial	$406.53
Rate for Payer: Healthscope Commercial	$457.34
Rate for Payer: MI Amish Medical Board Commercial	$406.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$431.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$381.12
Rate for Payer: PHP Commercial	$431.94
Rate for Payer: Priority Health SBD	$320.14
Rate for Payer: UHC All Payor (Choice/PPO)	$330.30
Rate for Payer: UHC Core	$264.75
Rate for Payer: UHC Exchange	$199.71

LACOSAMIDE 50 MG TABLET

Facility

$2,557.22

Service Code	NDC 00131247735
Hospital Charge Code	96968
Hospital Revenue Code	637
Min. Negotiated Rate	$1,611.05
Max. Negotiated Rate	$2,301.50
Rate for Payer: Aetna Commercial	$2,173.64
Rate for Payer: Aetna New Business (MI Preferred)	$1,662.19
Rate for Payer: Cash Price	$2,045.78
Rate for Payer: Cofinity Advantage	$1,790.05
Rate for Payer: Cofinity Commercial	$2,199.21
Rate for Payer: Encore Health Key Benefits Commercial	$2,045.78
Rate for Payer: Healthscope Commercial	$2,301.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,173.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,917.91
Rate for Payer: PHP Commercial	$2,173.64
Rate for Payer: Priority Health SBD	$1,611.05

LACOSAMIDE 50 MG TABLET

Facility

$2,813.19

Service Code	NDC 00131247760
Hospital Charge Code	96968
Hospital Revenue Code	637
Min. Negotiated Rate	$1,772.31
Max. Negotiated Rate	$2,531.87
Rate for Payer: Aetna Commercial	$2,391.21
Rate for Payer: Aetna New Business (MI Preferred)	$1,828.57
Rate for Payer: Cash Price	$2,250.55
Rate for Payer: Cofinity Advantage	$1,969.23
Rate for Payer: Cofinity Commercial	$2,419.34
Rate for Payer: Encore Health Key Benefits Commercial	$2,250.55
Rate for Payer: Healthscope Commercial	$2,531.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,391.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,109.89
Rate for Payer: PHP Commercial	$2,391.21
Rate for Payer: Priority Health SBD	$1,772.31

LACOSAMIDE 50 MG TABLET

Facility

$2,557.22

Service Code	NDC 00131247735
Hospital Charge Code	96968
Hospital Revenue Code	637
Min. Negotiated Rate	$1,004.99
Max. Negotiated Rate	$2,301.50
Rate for Payer: Aetna Commercial	$2,173.64
Rate for Payer: Aetna Medicare	$1,278.61
Rate for Payer: Aetna New Business (MI Preferred)	$1,662.19
Rate for Payer: BCBS Complete	$1,022.89
Rate for Payer: Cash Price	$2,045.78
Rate for Payer: Cofinity Advantage	$1,790.05
Rate for Payer: Cofinity Commercial	$2,199.21
Rate for Payer: Encore Health Key Benefits Commercial	$2,045.78
Rate for Payer: Healthscope Commercial	$2,301.50
Rate for Payer: MI Amish Medical Board Commercial	$2,045.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,173.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,917.91
Rate for Payer: PHP Commercial	$2,173.64
Rate for Payer: Priority Health SBD	$1,611.05
Rate for Payer: UHC All Payor (Choice/PPO)	$1,662.19
Rate for Payer: UHC Core	$1,332.31
Rate for Payer: UHC Exchange	$1,004.99

LACOSAMIDE 50 MG TABLET

Facility

$2,813.19

Service Code	NDC 00131247760
Hospital Charge Code	96968
Hospital Revenue Code	637
Min. Negotiated Rate	$1,105.58
Max. Negotiated Rate	$2,531.87
Rate for Payer: Aetna Commercial	$2,391.21
Rate for Payer: Aetna Medicare	$1,406.60
Rate for Payer: Aetna New Business (MI Preferred)	$1,828.57
Rate for Payer: BCBS Complete	$1,125.28
Rate for Payer: Cash Price	$2,250.55
Rate for Payer: Cofinity Advantage	$1,969.23
Rate for Payer: Cofinity Commercial	$2,419.34
Rate for Payer: Encore Health Key Benefits Commercial	$2,250.55
Rate for Payer: Healthscope Commercial	$2,531.87
Rate for Payer: MI Amish Medical Board Commercial	$2,250.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,391.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,109.89
Rate for Payer: PHP Commercial	$2,391.21
Rate for Payer: Priority Health SBD	$1,772.31
Rate for Payer: UHC All Payor (Choice/PPO)	$1,828.57
Rate for Payer: UHC Core	$1,465.67
Rate for Payer: UHC Exchange	$1,105.58

LACTASE 9,000 UNIT TABLET

Facility

$46.47

Service Code	NDC 00904590887
Hospital Charge Code	109044
Hospital Revenue Code	637
Min. Negotiated Rate	$18.26
Max. Negotiated Rate	$41.82
Rate for Payer: Aetna Commercial	$39.50
Rate for Payer: Aetna Medicare	$23.23
Rate for Payer: Aetna New Business (MI Preferred)	$30.21
Rate for Payer: BCBS Complete	$18.59
Rate for Payer: Cash Price	$37.18
Rate for Payer: Cofinity Advantage	$32.53
Rate for Payer: Cofinity Commercial	$39.96
Rate for Payer: Encore Health Key Benefits Commercial	$37.18
Rate for Payer: Healthscope Commercial	$41.82
Rate for Payer: MI Amish Medical Board Commercial	$37.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$34.85
Rate for Payer: PHP Commercial	$39.50
Rate for Payer: Priority Health SBD	$29.28
Rate for Payer: UHC All Payor (Choice/PPO)	$30.21
Rate for Payer: UHC Core	$24.21
Rate for Payer: UHC Exchange	$18.26

LACTASE 9,000 UNIT TABLET

Facility

$46.47

Service Code	NDC 00904590887
Hospital Charge Code	109044
Hospital Revenue Code	637
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$41.82
Rate for Payer: Aetna Commercial	$39.50
Rate for Payer: Aetna New Business (MI Preferred)	$30.21
Rate for Payer: Cash Price	$37.18
Rate for Payer: Cofinity Advantage	$32.53
Rate for Payer: Cofinity Commercial	$39.96
Rate for Payer: Encore Health Key Benefits Commercial	$37.18
Rate for Payer: Healthscope Commercial	$41.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$34.85
Rate for Payer: PHP Commercial	$39.50
Rate for Payer: Priority Health SBD	$29.28

LACTASE 9,000 UNIT TABLET

Facility

$119.70

Service Code	NDC 00450091060
Hospital Charge Code	109044
Hospital Revenue Code	637
Min. Negotiated Rate	$47.04
Max. Negotiated Rate	$107.73
Rate for Payer: Aetna Commercial	$101.75
Rate for Payer: Aetna Medicare	$59.85
Rate for Payer: Aetna New Business (MI Preferred)	$77.81
Rate for Payer: BCBS Complete	$47.88
Rate for Payer: Cash Price	$95.76
Rate for Payer: Cofinity Advantage	$83.79
Rate for Payer: Cofinity Commercial	$102.94
Rate for Payer: Encore Health Key Benefits Commercial	$95.76
Rate for Payer: Healthscope Commercial	$107.73
Rate for Payer: MI Amish Medical Board Commercial	$95.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$101.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$89.78
Rate for Payer: PHP Commercial	$101.75
Rate for Payer: Priority Health SBD	$75.41
Rate for Payer: UHC All Payor (Choice/PPO)	$77.81
Rate for Payer: UHC Core	$62.36
Rate for Payer: UHC Exchange	$47.04

LACTASE 9,000 UNIT TABLET

Facility

$119.70

Service Code	NDC 00450091060
Hospital Charge Code	109044
Hospital Revenue Code	637
Min. Negotiated Rate	$75.41
Max. Negotiated Rate	$107.73
Rate for Payer: Aetna Commercial	$101.75
Rate for Payer: Aetna New Business (MI Preferred)	$77.81
Rate for Payer: Cash Price	$95.76
Rate for Payer: Cofinity Advantage	$83.79
Rate for Payer: Cofinity Commercial	$102.94
Rate for Payer: Encore Health Key Benefits Commercial	$95.76
Rate for Payer: Healthscope Commercial	$107.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$101.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$89.78
Rate for Payer: PHP Commercial	$101.75
Rate for Payer: Priority Health SBD	$75.41

LACTATED RINGERS EYE BOLUS

Facility

$69.92

Service Code	HCPCS J7120
Hospital Charge Code	300324
Hospital Revenue Code	636
Min. Negotiated Rate	$3.93
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	$5.96
Rate for Payer: BCN Commercial	$5.96
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Advantage	$48.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: MI Amish Medical Board Commercial	$55.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$52.44
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: Priority Health SBD	$44.05
Rate for Payer: UHC All Payor (Choice/PPO)	$3.93
Rate for Payer: UHC Core	$3.93
Rate for Payer: UHC Exchange	$3.93

LACTATED RINGERS EYE BOLUS

Facility

$69.92

Service Code	HCPCS J7120
Hospital Charge Code	300324
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 Advantage	$48.94
Rate for Payer: Cofinity Commercial	$60.13
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: Opus (Opus Packaging Group) HMA	$52.44
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: Priority Health SBD	$44.05

LACTATED RINGERS INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	HCPCS J7120
Hospital Charge Code	4318
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 Advantage	$48.94
Rate for Payer: Cofinity Commercial	$60.13
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: Opus (Opus Packaging Group) HMA	$52.44
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: Priority Health SBD	$44.05

LACTATED RINGERS INTRAVENOUS SOLUTION

Facility

$87.40

Service Code	HCPCS J7120
Hospital Charge Code	4318
Hospital Revenue Code	636
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$78.66
Rate for Payer: Aetna Commercial	$74.29
Rate for Payer: Aetna Commercial	$59.43
Rate for Payer: Aetna Medicare	$34.96
Rate for Payer: Aetna Medicare	$43.70
Rate for Payer: Aetna New Business (MI Preferred)	$56.81
Rate for Payer: Aetna New Business (MI Preferred)	$45.45
Rate for Payer: BCBS Complete	$34.96
Rate for Payer: BCBS Complete	$27.97
Rate for Payer: BCBS Trust/PPO	$5.96
Rate for Payer: BCBS Trust/PPO	$5.96
Rate for Payer: BCN Commercial	$5.96
Rate for Payer: BCN Commercial	$5.96
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cash Price	$69.92
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cash Price	$69.92
Rate for Payer: Cofinity Advantage	$61.18
Rate for Payer: Cofinity Advantage	$48.94
Rate for Payer: Cofinity Commercial	$75.16
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Encore Health Key Benefits Commercial	$69.92
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Healthscope Commercial	$78.66
Rate for Payer: MI Amish Medical Board Commercial	$69.92
Rate for Payer: MI Amish Medical Board Commercial	$55.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$52.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$65.55
Rate for Payer: PHP Commercial	$74.29
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: Priority Health SBD	$55.06
Rate for Payer: Priority Health SBD	$44.05
Rate for Payer: UHC All Payor (Choice/PPO)	$3.93
Rate for Payer: UHC All Payor (Choice/PPO)	$3.93
Rate for Payer: UHC Core	$3.93
Rate for Payer: UHC Core	$3.93
Rate for Payer: UHC Exchange	$3.93
Rate for Payer: UHC Exchange	$3.93

LACTATED RINGERS IRRIGATION SOLUTION

Facility

$705.00

Service Code	NDC 00338013729
Hospital Charge Code	4319
Hospital Revenue Code	250
Min. Negotiated Rate	$444.15
Max. Negotiated Rate	$634.50
Rate for Payer: Aetna Commercial	$599.25
Rate for Payer: Aetna New Business (MI Preferred)	$458.25
Rate for Payer: Cash Price	$564.00
Rate for Payer: Cofinity Advantage	$493.50
Rate for Payer: Cofinity Commercial	$606.30
Rate for Payer: Encore Health Key Benefits Commercial	$564.00
Rate for Payer: Healthscope Commercial	$634.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$599.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$528.75
Rate for Payer: PHP Commercial	$599.25
Rate for Payer: Priority Health SBD	$444.15

LACTATED RINGERS IRRIGATION SOLUTION

Facility

$705.00

Service Code	NDC 00338013729
Hospital Charge Code	4319
Hospital Revenue Code	250
Min. Negotiated Rate	$277.06
Max. Negotiated Rate	$634.50
Rate for Payer: Aetna Commercial	$599.25
Rate for Payer: Aetna Medicare	$352.50
Rate for Payer: Aetna New Business (MI Preferred)	$458.25
Rate for Payer: BCBS Complete	$282.00
Rate for Payer: Cash Price	$564.00
Rate for Payer: Cofinity Advantage	$493.50
Rate for Payer: Cofinity Commercial	$606.30
Rate for Payer: Encore Health Key Benefits Commercial	$564.00
Rate for Payer: Healthscope Commercial	$634.50
Rate for Payer: MI Amish Medical Board Commercial	$564.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$599.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$528.75
Rate for Payer: PHP Commercial	$599.25
Rate for Payer: Priority Health SBD	$444.15
Rate for Payer: UHC All Payor (Choice/PPO)	$458.25
Rate for Payer: UHC Core	$367.31
Rate for Payer: UHC Exchange	$277.06

LACTATED RINGERS IV BOLUS

Facility

$69.92

Service Code	HCPCS J7120
Hospital Charge Code	400296
Hospital Revenue Code	636
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$62.93
Rate for Payer: Aetna Commercial	$59.43
Rate for Payer: Aetna Commercial	$57.11
Rate for Payer: Aetna Medicare	$34.96
Rate for Payer: Aetna Medicare	$33.59
Rate for Payer: Aetna New Business (MI Preferred)	$43.67
Rate for Payer: Aetna New Business (MI Preferred)	$45.45
Rate for Payer: BCBS Complete	$27.97
Rate for Payer: BCBS Complete	$26.88
Rate for Payer: BCBS Trust/PPO	$5.96
Rate for Payer: BCBS Trust/PPO	$5.96
Rate for Payer: BCN Commercial	$5.96
Rate for Payer: BCN Commercial	$5.96
Rate for Payer: Cash Price	$53.75
Rate for Payer: Cash Price	$53.75
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Advantage	$47.03
Rate for Payer: Cofinity Advantage	$48.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Cofinity Commercial	$57.78
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Encore Health Key Benefits Commercial	$53.75
Rate for Payer: Healthscope Commercial	$60.47
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: MI Amish Medical Board Commercial	$55.94
Rate for Payer: MI Amish Medical Board Commercial	$53.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$57.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$50.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$52.44
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: PHP Commercial	$57.11
Rate for Payer: Priority Health SBD	$42.33
Rate for Payer: Priority Health SBD	$44.05
Rate for Payer: UHC All Payor (Choice/PPO)	$3.93
Rate for Payer: UHC All Payor (Choice/PPO)	$3.93
Rate for Payer: UHC Core	$3.93
Rate for Payer: UHC Core	$3.93
Rate for Payer: UHC Exchange	$3.93
Rate for Payer: UHC Exchange	$3.93

LACTATED RINGERS IV BOLUS

Facility

$67.19

Service Code	HCPCS J7120
Hospital Charge Code	400296
Hospital Revenue Code	636
Min. Negotiated Rate	$42.33
Max. Negotiated Rate	$60.47
Rate for Payer: Aetna Commercial	$57.11
Rate for Payer: Aetna Commercial	$59.43
Rate for Payer: Aetna New Business (MI Preferred)	$43.67
Rate for Payer: Aetna New Business (MI Preferred)	$45.45
Rate for Payer: Cash Price	$53.75
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Advantage	$47.03
Rate for Payer: Cofinity Advantage	$48.94
Rate for Payer: Cofinity Commercial	$57.78
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Encore Health Key Benefits Commercial	$53.75
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Healthscope Commercial	$60.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$57.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$50.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$52.44
Rate for Payer: PHP Commercial	$57.11
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: Priority Health SBD	$42.33
Rate for Payer: Priority Health SBD	$44.05

LACTATED RINGERS IV -DKA

Facility

$69.92

Service Code	HCPCS J7120
Hospital Charge Code	301462
Hospital Revenue Code	636
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$62.93
Rate for Payer: Aetna Commercial	$59.43
Rate for Payer: Aetna Commercial	$57.11
Rate for Payer: Aetna Medicare	$34.96
Rate for Payer: Aetna Medicare	$33.59
Rate for Payer: Aetna New Business (MI Preferred)	$43.67
Rate for Payer: Aetna New Business (MI Preferred)	$45.45
Rate for Payer: BCBS Complete	$27.97
Rate for Payer: BCBS Complete	$26.88
Rate for Payer: BCBS Trust/PPO	$5.96
Rate for Payer: BCBS Trust/PPO	$5.96
Rate for Payer: BCN Commercial	$5.96
Rate for Payer: BCN Commercial	$5.96
Rate for Payer: Cash Price	$53.75
Rate for Payer: Cash Price	$53.75
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Advantage	$47.03
Rate for Payer: Cofinity Advantage	$48.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Cofinity Commercial	$57.78
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Encore Health Key Benefits Commercial	$53.75
Rate for Payer: Healthscope Commercial	$60.47
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: MI Amish Medical Board Commercial	$55.94
Rate for Payer: MI Amish Medical Board Commercial	$53.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$57.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$50.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$52.44
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: PHP Commercial	$57.11
Rate for Payer: Priority Health SBD	$42.33
Rate for Payer: Priority Health SBD	$44.05
Rate for Payer: UHC All Payor (Choice/PPO)	$3.93
Rate for Payer: UHC All Payor (Choice/PPO)	$3.93
Rate for Payer: UHC Core	$3.93
Rate for Payer: UHC Core	$3.93
Rate for Payer: UHC Exchange	$3.93
Rate for Payer: UHC Exchange	$3.93

Know your out-of-pocket cost for care.

All Charges