Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE

Facility

$60.75

Service Code	NDC 76329-3352-1
Hospital Charge Code	7309
Hospital Revenue Code	250
Min. Negotiated Rate	$38.27
Max. Negotiated Rate	$54.68
Rate for Payer: Aetna Commercial	$51.64
Rate for Payer: Aetna New Business (MI Preferred)	$39.49
Rate for Payer: Cash Price	$48.60
Rate for Payer: Cofinity Commercial	$52.24
Rate for Payer: Cofinity Commercial	$42.52
Rate for Payer: Healthscope Commercial	$54.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.64
Rate for Payer: PHP Commercial	$51.64
Rate for Payer: Priority Health Cigna Priority Health	$42.52
Rate for Payer: Priority Health SBD	$38.27

SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE

Facility

$59.63

Service Code	NDC 0409-6637-14
Hospital Charge Code	7309
Hospital Revenue Code	250
Min. Negotiated Rate	$37.57
Max. Negotiated Rate	$53.67
Rate for Payer: Aetna Commercial	$50.69
Rate for Payer: Aetna New Business (MI Preferred)	$38.76
Rate for Payer: Cash Price	$47.70
Rate for Payer: Cofinity Commercial	$41.74
Rate for Payer: Cofinity Commercial	$51.28
Rate for Payer: Healthscope Commercial	$53.67
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$50.69
Rate for Payer: PHP Commercial	$50.69
Rate for Payer: Priority Health Cigna Priority Health	$41.74
Rate for Payer: Priority Health SBD	$37.57

SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE

Facility

$59.63

Service Code	NDC 0409-6637-24
Hospital Charge Code	7309
Hospital Revenue Code	250
Min. Negotiated Rate	$37.57
Max. Negotiated Rate	$53.67
Rate for Payer: Aetna Commercial	$50.69
Rate for Payer: Aetna New Business (MI Preferred)	$38.76
Rate for Payer: Cash Price	$47.70
Rate for Payer: Cofinity Commercial	$41.74
Rate for Payer: Cofinity Commercial	$51.28
Rate for Payer: Healthscope Commercial	$53.67
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$50.69
Rate for Payer: PHP Commercial	$50.69
Rate for Payer: Priority Health Cigna Priority Health	$41.74
Rate for Payer: Priority Health SBD	$37.57

SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRINGE (CODE)

Facility

$59.63

Service Code	NDC 0409-6637-14
Hospital Charge Code	163719
Hospital Revenue Code	250
Min. Negotiated Rate	$37.57
Max. Negotiated Rate	$53.67
Rate for Payer: Aetna Commercial	$50.69
Rate for Payer: Aetna New Business (MI Preferred)	$38.76
Rate for Payer: Cash Price	$47.70
Rate for Payer: Cofinity Commercial	$41.74
Rate for Payer: Cofinity Commercial	$51.28
Rate for Payer: Healthscope Commercial	$53.67
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$50.69
Rate for Payer: PHP Commercial	$50.69
Rate for Payer: Priority Health Cigna Priority Health	$41.74
Rate for Payer: Priority Health SBD	$37.57

SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRINGE (CODE)

Facility

$40.28

Service Code	NDC 0409-6637-34
Hospital Charge Code	163719
Hospital Revenue Code	250
Min. Negotiated Rate	$25.38
Max. Negotiated Rate	$36.25
Rate for Payer: Aetna Commercial	$34.24
Rate for Payer: Aetna New Business (MI Preferred)	$26.18
Rate for Payer: Cash Price	$32.22
Rate for Payer: Cofinity Commercial	$28.20
Rate for Payer: Cofinity Commercial	$34.64
Rate for Payer: Healthscope Commercial	$36.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$34.24
Rate for Payer: PHP Commercial	$34.24
Rate for Payer: Priority Health Cigna Priority Health	$28.20
Rate for Payer: Priority Health SBD	$25.38

SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRINGE (CODE)

Facility

$59.63

Service Code	NDC 0409-6637-24
Hospital Charge Code	163719
Hospital Revenue Code	250
Min. Negotiated Rate	$37.57
Max. Negotiated Rate	$53.67
Rate for Payer: Aetna Commercial	$50.69
Rate for Payer: Aetna New Business (MI Preferred)	$38.76
Rate for Payer: Cash Price	$47.70
Rate for Payer: Cofinity Commercial	$41.74
Rate for Payer: Cofinity Commercial	$51.28
Rate for Payer: Healthscope Commercial	$53.67
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$50.69
Rate for Payer: PHP Commercial	$50.69
Rate for Payer: Priority Health Cigna Priority Health	$41.74
Rate for Payer: Priority Health SBD	$37.57

SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRINGE (CODE)

Facility

$60.75

Service Code	NDC 76329-3352-1
Hospital Charge Code	163719
Hospital Revenue Code	250
Min. Negotiated Rate	$38.27
Max. Negotiated Rate	$54.68
Rate for Payer: Aetna Commercial	$51.64
Rate for Payer: Aetna New Business (MI Preferred)	$39.49
Rate for Payer: Cash Price	$48.60
Rate for Payer: Cofinity Commercial	$42.52
Rate for Payer: Cofinity Commercial	$52.24
Rate for Payer: Healthscope Commercial	$54.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.64
Rate for Payer: PHP Commercial	$51.64
Rate for Payer: Priority Health Cigna Priority Health	$42.52
Rate for Payer: Priority Health SBD	$38.27

SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	NDC 0338-0043-04
Hospital Charge Code	7318
Hospital Revenue Code	250
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 Commercial	$48.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.43
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$48.94
Rate for Payer: Priority Health SBD	$44.05

SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	NDC 0338-0043-04
Hospital Charge Code	7318
Hospital Revenue Code	250
Min. Negotiated Rate	$27.97
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: BCBS Complete	$27.97
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.43
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$48.94
Rate for Payer: Priority Health SBD	$44.05

SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION (DOSE, ADMIN OVER & INDICATION REQUIRED)

Facility

$69.92

Service Code	NDC 0338-0043-04
Hospital Charge Code	301088
Hospital Revenue Code	250
Min. Negotiated Rate	$27.97
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: BCBS Complete	$27.97
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.43
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$48.94
Rate for Payer: Priority Health SBD	$44.05

SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL

Facility

$5.28

Service Code	NDC 0904-3865-75
Hospital Charge Code	29676
Hospital Revenue Code	637
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$4.75
Rate for Payer: Aetna Commercial	$4.49
Rate for Payer: Aetna New Business (MI Preferred)	$3.43
Rate for Payer: Cash Price	$4.22
Rate for Payer: Cofinity Commercial	$3.70
Rate for Payer: Cofinity Commercial	$4.54
Rate for Payer: Healthscope Commercial	$4.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4.49
Rate for Payer: PHP Commercial	$4.49
Rate for Payer: Priority Health Cigna Priority Health	$3.70
Rate for Payer: Priority Health SBD	$3.33

SODIUM CHLORIDE 0.9 % FLUSH SOLUTION 100 ML BAG

Facility

$62.71

Service Code	HCPCS J7040
Hospital Charge Code	300165
Hospital Revenue Code	636
Min. Negotiated Rate	$39.51
Max. Negotiated Rate	$56.44
Rate for Payer: Aetna Commercial	$53.30
Rate for Payer: Aetna New Business (MI Preferred)	$40.76
Rate for Payer: Cash Price	$50.17
Rate for Payer: Cofinity Commercial	$43.90
Rate for Payer: Cofinity Commercial	$53.93
Rate for Payer: Healthscope Commercial	$56.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$53.30
Rate for Payer: PHP Commercial	$53.30
Rate for Payer: Priority Health Cigna Priority Health	$43.90
Rate for Payer: Priority Health SBD	$39.51

SODIUM CHLORIDE 0.9 % FOR NEBULIZATION

Facility

$3.14

Service Code	NDC 0378-6985-01
Hospital Charge Code	7325
Hospital Revenue Code	250
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.67
Rate for Payer: Aetna New Business (MI Preferred)	$2.04
Rate for Payer: Cash Price	$2.51
Rate for Payer: Cofinity Commercial	$2.20
Rate for Payer: Cofinity Commercial	$2.70
Rate for Payer: Healthscope Commercial	$2.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.67
Rate for Payer: PHP Commercial	$2.67
Rate for Payer: Priority Health Cigna Priority Health	$2.20
Rate for Payer: Priority Health SBD	$1.98

SODIUM CHLORIDE 0.9 % INTRAVENOUS 1.5 MAINTENANCE SOLUTION

Facility

$69.92

Service Code	HCPCS J7030
Hospital Charge Code	180423
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 Commercial	$48.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.43
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$48.94
Rate for Payer: Priority Health SBD	$44.05

SODIUM CHLORIDE 0.9 % INTRAVENOUS 2X MAINTENANCE SOLUTION

Facility

$69.92

Service Code	HCPCS J7030
Hospital Charge Code	300194
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 Commercial	$48.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.43
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$48.94
Rate for Payer: Priority Health SBD	$44.05

SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK

Facility

$41.47

Service Code	NDC 0338-0553-18
Hospital Charge Code	116170
Hospital Revenue Code	250
Min. Negotiated Rate	$26.13
Max. Negotiated Rate	$37.32
Rate for Payer: Aetna Commercial	$35.25
Rate for Payer: Aetna New Business (MI Preferred)	$26.96
Rate for Payer: Cash Price	$33.18
Rate for Payer: Cofinity Commercial	$29.03
Rate for Payer: Cofinity Commercial	$35.66
Rate for Payer: Healthscope Commercial	$37.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$35.25
Rate for Payer: PHP Commercial	$35.25
Rate for Payer: Priority Health Cigna Priority Health	$29.03
Rate for Payer: Priority Health SBD	$26.13

SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK

Facility

$41.47

Service Code	NDC 0338-0553-11
Hospital Charge Code	116170
Hospital Revenue Code	250
Min. Negotiated Rate	$26.13
Max. Negotiated Rate	$37.32
Rate for Payer: Aetna Commercial	$35.25
Rate for Payer: Aetna New Business (MI Preferred)	$26.96
Rate for Payer: Cash Price	$33.18
Rate for Payer: Cofinity Commercial	$29.03
Rate for Payer: Cofinity Commercial	$35.66
Rate for Payer: Healthscope Commercial	$37.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$35.25
Rate for Payer: PHP Commercial	$35.25
Rate for Payer: Priority Health Cigna Priority Health	$29.03
Rate for Payer: Priority Health SBD	$26.13

SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	HCPCS J7030
Hospital Charge Code	27838
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 Commercial	$57.11
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 Commercial	$60.13
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Cofinity Commercial	$57.78
Rate for Payer: Cofinity Commercial	$47.03
Rate for Payer: Healthscope Commercial	$60.47
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$57.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.43
Rate for Payer: PHP Commercial	$57.11
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$47.03
Rate for Payer: Priority Health Cigna Priority Health	$48.94
Rate for Payer: Priority Health SBD	$44.05
Rate for Payer: Priority Health SBD	$42.33

SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION

Facility

$55.99

Service Code	HCPCS J7050
Hospital Charge Code	27838
Hospital Revenue Code	636
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$50.39
Rate for Payer: Aetna Commercial	$47.59
Rate for Payer: Aetna New Business (MI Preferred)	$36.39
Rate for Payer: BCBS Complete	$22.40
Rate for Payer: BCBS Trust/PPO	$1.98
Rate for Payer: Cash Price	$44.79
Rate for Payer: Cash Price	$44.79
Rate for Payer: Cofinity Commercial	$48.15
Rate for Payer: Cofinity Commercial	$39.19
Rate for Payer: Healthscope Commercial	$50.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$47.59
Rate for Payer: PHP Commercial	$47.59
Rate for Payer: Priority Health Cigna Priority Health	$39.19
Rate for Payer: Priority Health SBD	$35.27

SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION

Facility

$55.99

Service Code	HCPCS J7050
Hospital Charge Code	27838
Hospital Revenue Code	636
Min. Negotiated Rate	$35.27
Max. Negotiated Rate	$50.39
Rate for Payer: Aetna Commercial	$47.59
Rate for Payer: Aetna New Business (MI Preferred)	$36.39
Rate for Payer: Cash Price	$44.79
Rate for Payer: Cofinity Commercial	$48.15
Rate for Payer: Cofinity Commercial	$39.19
Rate for Payer: Healthscope Commercial	$50.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$47.59
Rate for Payer: PHP Commercial	$47.59
Rate for Payer: Priority Health Cigna Priority Health	$39.19
Rate for Payer: Priority Health SBD	$35.27

SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION

Facility

$67.19

Service Code	HCPCS J7030
Hospital Charge Code	27838
Hospital Revenue Code	636
Min. Negotiated Rate	$7.96
Max. Negotiated Rate	$60.47
Rate for Payer: Aetna Commercial	$57.11
Rate for Payer: Aetna Commercial	$53.63
Rate for Payer: Aetna Commercial	$59.43
Rate for Payer: Aetna New Business (MI Preferred)	$41.01
Rate for Payer: Aetna New Business (MI Preferred)	$45.45
Rate for Payer: Aetna New Business (MI Preferred)	$43.67
Rate for Payer: BCBS Complete	$25.24
Rate for Payer: BCBS Complete	$27.97
Rate for Payer: BCBS Complete	$26.88
Rate for Payer: BCBS Trust/PPO	$7.96
Rate for Payer: BCBS Trust/PPO	$7.96
Rate for Payer: BCBS Trust/PPO	$7.96
Rate for Payer: Cash Price	$55.94
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	$50.47
Rate for Payer: Cash Price	$50.47
Rate for Payer: Cofinity Commercial	$54.26
Rate for Payer: Cofinity Commercial	$47.03
Rate for Payer: Cofinity Commercial	$57.78
Rate for Payer: Cofinity Commercial	$44.16
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Healthscope Commercial	$60.47
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Healthscope Commercial	$56.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$57.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$53.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.43
Rate for Payer: PHP Commercial	$53.63
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: PHP Commercial	$57.11
Rate for Payer: Priority Health Cigna Priority Health	$47.03
Rate for Payer: Priority Health Cigna Priority Health	$44.16
Rate for Payer: Priority Health Cigna Priority Health	$48.94
Rate for Payer: Priority Health SBD	$42.33
Rate for Payer: Priority Health SBD	$39.75
Rate for Payer: Priority Health SBD	$44.05

SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION

Facility

$58.23

Service Code	HCPCS J7040
Hospital Charge Code	27838
Hospital Revenue Code	636
Min. Negotiated Rate	$36.68
Max. Negotiated Rate	$52.41
Rate for Payer: Aetna Commercial	$49.50
Rate for Payer: Aetna Commercial	$37.96
Rate for Payer: Aetna Commercial	$47.59
Rate for Payer: Aetna Commercial	$53.30
Rate for Payer: Aetna Commercial	$45.69
Rate for Payer: Aetna New Business (MI Preferred)	$36.39
Rate for Payer: Aetna New Business (MI Preferred)	$40.76
Rate for Payer: Aetna New Business (MI Preferred)	$29.03
Rate for Payer: Aetna New Business (MI Preferred)	$34.94
Rate for Payer: Aetna New Business (MI Preferred)	$37.85
Rate for Payer: Cash Price	$35.73
Rate for Payer: Cash Price	$50.17
Rate for Payer: Cash Price	$43.00
Rate for Payer: Cash Price	$44.79
Rate for Payer: Cash Price	$46.58
Rate for Payer: Cofinity Commercial	$53.93
Rate for Payer: Cofinity Commercial	$31.26
Rate for Payer: Cofinity Commercial	$38.41
Rate for Payer: Cofinity Commercial	$37.62
Rate for Payer: Cofinity Commercial	$46.22
Rate for Payer: Cofinity Commercial	$39.19
Rate for Payer: Cofinity Commercial	$48.15
Rate for Payer: Cofinity Commercial	$40.76
Rate for Payer: Cofinity Commercial	$50.08
Rate for Payer: Cofinity Commercial	$43.90
Rate for Payer: Healthscope Commercial	$40.19
Rate for Payer: Healthscope Commercial	$50.39
Rate for Payer: Healthscope Commercial	$48.38
Rate for Payer: Healthscope Commercial	$52.41
Rate for Payer: Healthscope Commercial	$56.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$53.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$49.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$37.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$47.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$45.69
Rate for Payer: PHP Commercial	$37.96
Rate for Payer: PHP Commercial	$47.59
Rate for Payer: PHP Commercial	$45.69
Rate for Payer: PHP Commercial	$49.50
Rate for Payer: PHP Commercial	$53.30
Rate for Payer: Priority Health Cigna Priority Health	$31.26
Rate for Payer: Priority Health Cigna Priority Health	$39.19
Rate for Payer: Priority Health Cigna Priority Health	$37.62
Rate for Payer: Priority Health Cigna Priority Health	$43.90
Rate for Payer: Priority Health Cigna Priority Health	$40.76
Rate for Payer: Priority Health SBD	$36.68
Rate for Payer: Priority Health SBD	$35.27
Rate for Payer: Priority Health SBD	$28.14
Rate for Payer: Priority Health SBD	$33.86
Rate for Payer: Priority Health SBD	$39.51

SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION

Facility

$59.44

Service Code	HCPCS J7040
Hospital Charge Code	27838
Hospital Revenue Code	636
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$53.50
Rate for Payer: Aetna Commercial	$50.52
Rate for Payer: Aetna Commercial	$51.40
Rate for Payer: Aetna Commercial	$49.50
Rate for Payer: Aetna New Business (MI Preferred)	$38.64
Rate for Payer: Aetna New Business (MI Preferred)	$37.85
Rate for Payer: Aetna New Business (MI Preferred)	$39.31
Rate for Payer: BCBS Complete	$23.29
Rate for Payer: BCBS Complete	$23.78
Rate for Payer: BCBS Complete	$24.19
Rate for Payer: BCBS Trust/PPO	$3.98
Rate for Payer: BCBS Trust/PPO	$3.98
Rate for Payer: BCBS Trust/PPO	$3.98
Rate for Payer: Cash Price	$47.55
Rate for Payer: Cash Price	$48.38
Rate for Payer: Cash Price	$48.38
Rate for Payer: Cash Price	$47.55
Rate for Payer: Cash Price	$46.58
Rate for Payer: Cash Price	$46.58
Rate for Payer: Cofinity Commercial	$42.33
Rate for Payer: Cofinity Commercial	$40.76
Rate for Payer: Cofinity Commercial	$50.08
Rate for Payer: Cofinity Commercial	$41.61
Rate for Payer: Cofinity Commercial	$51.12
Rate for Payer: Cofinity Commercial	$52.00
Rate for Payer: Healthscope Commercial	$54.42
Rate for Payer: Healthscope Commercial	$53.50
Rate for Payer: Healthscope Commercial	$52.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$50.52
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$49.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.40
Rate for Payer: PHP Commercial	$50.52
Rate for Payer: PHP Commercial	$49.50
Rate for Payer: PHP Commercial	$51.40
Rate for Payer: Priority Health Cigna Priority Health	$41.61
Rate for Payer: Priority Health Cigna Priority Health	$40.76
Rate for Payer: Priority Health Cigna Priority Health	$42.33
Rate for Payer: Priority Health SBD	$36.68
Rate for Payer: Priority Health SBD	$38.10
Rate for Payer: Priority Health SBD	$37.45

SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION (DOSE, ADMIN OVER AND INDICATION REQUIRED)

Facility

$69.92

Service Code	HCPCS J7030
Hospital Charge Code	301089
Hospital Revenue Code	636
Min. Negotiated Rate	$7.96
Max. Negotiated Rate	$62.93
Rate for Payer: Aetna Commercial	$59.43
Rate for Payer: Aetna Commercial	$53.63
Rate for Payer: Aetna Commercial	$57.11
Rate for Payer: Aetna New Business (MI Preferred)	$43.67
Rate for Payer: Aetna New Business (MI Preferred)	$45.45
Rate for Payer: Aetna New Business (MI Preferred)	$41.01
Rate for Payer: BCBS Complete	$27.97
Rate for Payer: BCBS Complete	$25.24
Rate for Payer: BCBS Complete	$26.88
Rate for Payer: BCBS Trust/PPO	$7.96
Rate for Payer: BCBS Trust/PPO	$7.96
Rate for Payer: BCBS Trust/PPO	$7.96
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cash Price	$50.47
Rate for Payer: Cash Price	$53.75
Rate for Payer: Cash Price	$50.47
Rate for Payer: Cash Price	$53.75
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Cofinity Commercial	$47.03
Rate for Payer: Cofinity Commercial	$57.78
Rate for Payer: Cofinity Commercial	$54.26
Rate for Payer: Cofinity Commercial	$44.16
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Healthscope Commercial	$56.78
Rate for Payer: Healthscope Commercial	$60.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$57.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$53.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.43
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: PHP Commercial	$57.11
Rate for Payer: PHP Commercial	$53.63
Rate for Payer: Priority Health Cigna Priority Health	$48.94
Rate for Payer: Priority Health Cigna Priority Health	$47.03
Rate for Payer: Priority Health Cigna Priority Health	$44.16
Rate for Payer: Priority Health SBD	$42.33
Rate for Payer: Priority Health SBD	$39.75
Rate for Payer: Priority Health SBD	$44.05

SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION (DOSE, ADMIN OVER AND INDICATION REQUIRED)

Facility

$60.47

Service Code	HCPCS J7040
Hospital Charge Code	301089
Hospital Revenue Code	636
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$54.42
Rate for Payer: Aetna Commercial	$51.40
Rate for Payer: Aetna Commercial	$49.50
Rate for Payer: Aetna New Business (MI Preferred)	$39.31
Rate for Payer: Aetna New Business (MI Preferred)	$37.85
Rate for Payer: BCBS Complete	$23.29
Rate for Payer: BCBS Complete	$24.19
Rate for Payer: BCBS Trust/PPO	$3.98
Rate for Payer: BCBS Trust/PPO	$3.98
Rate for Payer: Cash Price	$46.58
Rate for Payer: Cash Price	$48.38
Rate for Payer: Cash Price	$46.58
Rate for Payer: Cash Price	$48.38
Rate for Payer: Cofinity Commercial	$50.08
Rate for Payer: Cofinity Commercial	$52.00
Rate for Payer: Cofinity Commercial	$40.76
Rate for Payer: Cofinity Commercial	$42.33
Rate for Payer: Healthscope Commercial	$54.42
Rate for Payer: Healthscope Commercial	$52.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$49.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.40
Rate for Payer: PHP Commercial	$51.40
Rate for Payer: PHP Commercial	$49.50
Rate for Payer: Priority Health Cigna Priority Health	$42.33
Rate for Payer: Priority Health Cigna Priority Health	$40.76
Rate for Payer: Priority Health SBD	$36.68
Rate for Payer: Priority Health SBD	$38.10

Know your out-of-pocket cost for care.

All Charges