Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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

Facility

$55.99

Service Code	HCPCS J7050
Hospital Charge Code	301089
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	$39.19
Rate for Payer: Cofinity Commercial	$48.15
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 (SD)

Facility

$58.23

Service Code	HCPCS J7040
Hospital Charge Code	180607
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 New Business (MI Preferred)	$37.85
Rate for Payer: Cash Price	$46.58
Rate for Payer: Cofinity Commercial	$40.76
Rate for Payer: Cofinity Commercial	$50.08
Rate for Payer: Healthscope Commercial	$52.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$49.50
Rate for Payer: PHP Commercial	$49.50
Rate for Payer: Priority Health Cigna Priority Health	$40.76
Rate for Payer: Priority Health SBD	$36.68

SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION

Facility

$69.92

Service Code	NDC 0338-0048-04
Hospital Charge Code	11403
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 0.9 % IRRIGATION SOLUTION

Facility

$63.80

Service Code	NDC 0338-0047-46
Hospital Charge Code	11403
Hospital Revenue Code	250
Min. Negotiated Rate	$40.19
Max. Negotiated Rate	$57.42
Rate for Payer: Aetna Commercial	$54.23
Rate for Payer: Aetna New Business (MI Preferred)	$41.47
Rate for Payer: Cash Price	$51.04
Rate for Payer: Cofinity Commercial	$44.66
Rate for Payer: Cofinity Commercial	$54.87
Rate for Payer: Healthscope Commercial	$57.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$54.23
Rate for Payer: PHP Commercial	$54.23
Rate for Payer: Priority Health Cigna Priority Health	$44.66
Rate for Payer: Priority Health SBD	$40.19

SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION

Facility

$69.92

Service Code	NDC 0338-0048-03
Hospital Charge Code	11403
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 0.9 % IRRIGATION SOLUTION

Facility

$95.70

Service Code	NDC 0338-0047-27
Hospital Charge Code	11403
Hospital Revenue Code	250
Min. Negotiated Rate	$60.29
Max. Negotiated Rate	$86.13
Rate for Payer: Aetna Commercial	$81.34
Rate for Payer: Aetna New Business (MI Preferred)	$62.20
Rate for Payer: Cash Price	$76.56
Rate for Payer: Cofinity Commercial	$66.99
Rate for Payer: Cofinity Commercial	$82.30
Rate for Payer: Healthscope Commercial	$86.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$81.34
Rate for Payer: PHP Commercial	$81.34
Rate for Payer: Priority Health Cigna Priority Health	$66.99
Rate for Payer: Priority Health SBD	$60.29

SODIUM CHLORIDE 0.9 % IV 1000 ML BAG (FOR BOLUS OR FLUSH)

Facility

$69.92

Service Code	HCPCS J7030
Hospital Charge Code	301142
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 % IV ADDITIONAL SOLUTION

Facility

$58.23

Service Code	HCPCS J7040
Hospital Charge Code	180543
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 New Business (MI Preferred)	$37.85
Rate for Payer: Cash Price	$46.58
Rate for Payer: Cofinity Commercial	$40.76
Rate for Payer: Cofinity Commercial	$50.08
Rate for Payer: Healthscope Commercial	$52.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$49.50
Rate for Payer: PHP Commercial	$49.50
Rate for Payer: Priority Health Cigna Priority Health	$40.76
Rate for Payer: Priority Health SBD	$36.68

SODIUM CHLORIDE 0.9 % IV BOLUS

Facility

$67.19

Service Code	HCPCS J7030
Hospital Charge Code	400291
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 New Business (MI Preferred)	$43.67
Rate for Payer: BCBS Complete	$26.88
Rate for Payer: BCBS Trust/PPO	$7.96
Rate for Payer: Cash Price	$53.75
Rate for Payer: Cash Price	$53.75
Rate for Payer: Cofinity Commercial	$57.78
Rate for Payer: Cofinity Commercial	$47.03
Rate for Payer: Healthscope Commercial	$60.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$57.11
Rate for Payer: PHP Commercial	$57.11
Rate for Payer: Priority Health Cigna Priority Health	$47.03
Rate for Payer: Priority Health SBD	$42.33

SODIUM CHLORIDE 0.9 % IV BOLUS

Facility

$55.99

Service Code	HCPCS J7050
Hospital Charge Code	400291
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	$39.19
Rate for Payer: Cofinity Commercial	$48.15
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 % IV BOLUS

Facility

$58.23

Service Code	HCPCS J7040
Hospital Charge Code	400291
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	$47.59
Rate for Payer: Aetna New Business (MI Preferred)	$36.39
Rate for Payer: Aetna New Business (MI Preferred)	$37.85
Rate for Payer: Cash Price	$44.79
Rate for Payer: Cash Price	$46.58
Rate for Payer: Cofinity Commercial	$40.76
Rate for Payer: Cofinity Commercial	$39.19
Rate for Payer: Cofinity Commercial	$48.15
Rate for Payer: Cofinity Commercial	$50.08
Rate for Payer: Healthscope Commercial	$50.39
Rate for Payer: Healthscope Commercial	$52.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$47.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$49.50
Rate for Payer: PHP Commercial	$49.50
Rate for Payer: PHP Commercial	$47.59
Rate for Payer: Priority Health Cigna Priority Health	$39.19
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

SODIUM CHLORIDE 0.9 % IV BOLUS

Facility

$69.92

Service Code	HCPCS J7030
Hospital Charge Code	400291
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	$48.94
Rate for Payer: Cofinity Commercial	$60.13
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	$59.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$57.11
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	$42.33
Rate for Payer: Priority Health SBD	$44.05

SODIUM CHLORIDE 0.9 % IV BOLUS (CODE)

Facility

$67.19

Service Code	HCPCS J7030
Hospital Charge Code	163716
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)	$45.45
Rate for Payer: Aetna New Business (MI Preferred)	$43.67
Rate for Payer: Cash Price	$53.75
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$47.03
Rate for Payer: Cofinity Commercial	$57.78
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Cofinity Commercial	$60.13
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	$59.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$57.11
Rate for Payer: PHP Commercial	$57.11
Rate for Payer: PHP Commercial	$59.43
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 SBD	$42.33
Rate for Payer: Priority Health SBD	$44.05

SODIUM CHLORIDE 0.9 % IV BOLUS (CODE)

Facility

$55.99

Service Code	HCPCS J7050
Hospital Charge Code	163716
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	$39.19
Rate for Payer: Cofinity Commercial	$48.15
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 % IV BOLUS (CODE)

Facility

$58.23

Service Code	HCPCS J7040
Hospital Charge Code	163716
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	$47.59
Rate for Payer: Aetna New Business (MI Preferred)	$37.85
Rate for Payer: Aetna New Business (MI Preferred)	$36.39
Rate for Payer: Cash Price	$46.58
Rate for Payer: Cash Price	$44.79
Rate for Payer: Cofinity Commercial	$50.08
Rate for Payer: Cofinity Commercial	$39.19
Rate for Payer: Cofinity Commercial	$48.15
Rate for Payer: Cofinity Commercial	$40.76
Rate for Payer: Healthscope Commercial	$50.39
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	$47.59
Rate for Payer: PHP Commercial	$47.59
Rate for Payer: PHP Commercial	$49.50
Rate for Payer: Priority Health Cigna Priority Health	$39.19
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

SODIUM CHLORIDE 0.9 % IV - DKA

Facility

$69.92

Service Code	HCPCS J7030
Hospital Charge Code	161519
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 % IV INFUSION (CODE)

Facility

$58.23

Service Code	HCPCS J7040
Hospital Charge Code	163715
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	$47.59
Rate for Payer: Aetna New Business (MI Preferred)	$37.85
Rate for Payer: Aetna New Business (MI Preferred)	$36.39
Rate for Payer: Cash Price	$44.79
Rate for Payer: Cash Price	$46.58
Rate for Payer: Cofinity Commercial	$48.15
Rate for Payer: Cofinity Commercial	$39.19
Rate for Payer: Cofinity Commercial	$40.76
Rate for Payer: Cofinity Commercial	$50.08
Rate for Payer: Healthscope Commercial	$50.39
Rate for Payer: Healthscope Commercial	$52.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$47.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$49.50
Rate for Payer: PHP Commercial	$49.50
Rate for Payer: PHP Commercial	$47.59
Rate for Payer: Priority Health Cigna Priority Health	$39.19
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

SODIUM CHLORIDE 0.9 % IV INFUSION (CODE)

Facility

$69.92

Service Code	HCPCS J7030
Hospital Charge Code	163715
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)	$45.45
Rate for Payer: Aetna New Business (MI Preferred)	$43.67
Rate for Payer: Cash Price	$53.75
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Cofinity Commercial	$47.03
Rate for Payer: Cofinity Commercial	$57.78
Rate for Payer: Cofinity Commercial	$60.13
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	$59.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$57.11
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 % IV INFUSION (CODE)

Facility

$55.99

Service Code	HCPCS J7050
Hospital Charge Code	163715
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	$39.19
Rate for Payer: Cofinity Commercial	$48.15
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 % IV NON PVC BAG

Facility

$67.19

Service Code	HCPCS J7040
Hospital Charge Code	150715
Hospital Revenue Code	636
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$60.47
Rate for Payer: Aetna Commercial	$57.11
Rate for Payer: Aetna Commercial	$74.29
Rate for Payer: Aetna New Business (MI Preferred)	$56.81
Rate for Payer: Aetna New Business (MI Preferred)	$43.67
Rate for Payer: BCBS Complete	$34.96
Rate for Payer: BCBS Complete	$26.88
Rate for Payer: BCBS Trust/PPO	$3.98
Rate for Payer: BCBS Trust/PPO	$3.98
Rate for Payer: Cash Price	$53.75
Rate for Payer: Cash Price	$69.92
Rate for Payer: Cash Price	$53.75
Rate for Payer: Cash Price	$69.92
Rate for Payer: Cofinity Commercial	$61.18
Rate for Payer: Cofinity Commercial	$47.03
Rate for Payer: Cofinity Commercial	$57.78
Rate for Payer: Cofinity Commercial	$75.16
Rate for Payer: Healthscope Commercial	$60.47
Rate for Payer: Healthscope Commercial	$78.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$74.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$57.11
Rate for Payer: PHP Commercial	$74.29
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	$61.18
Rate for Payer: Priority Health SBD	$42.33
Rate for Payer: Priority Health SBD	$55.06

SODIUM CHLORIDE 0.9 % IV NON PVC BAG

Facility

$55.83

Service Code	HCPCS J7040
Hospital Charge Code	150715
Hospital Revenue Code	636
Min. Negotiated Rate	$35.17
Max. Negotiated Rate	$50.25
Rate for Payer: Aetna Commercial	$47.46
Rate for Payer: Aetna Commercial	$57.11
Rate for Payer: Aetna Commercial	$74.29
Rate for Payer: Aetna New Business (MI Preferred)	$43.67
Rate for Payer: Aetna New Business (MI Preferred)	$36.29
Rate for Payer: Aetna New Business (MI Preferred)	$56.81
Rate for Payer: Cash Price	$53.75
Rate for Payer: Cash Price	$44.66
Rate for Payer: Cash Price	$69.92
Rate for Payer: Cofinity Commercial	$39.08
Rate for Payer: Cofinity Commercial	$48.01
Rate for Payer: Cofinity Commercial	$47.03
Rate for Payer: Cofinity Commercial	$57.78
Rate for Payer: Cofinity Commercial	$61.18
Rate for Payer: Cofinity Commercial	$75.16
Rate for Payer: Healthscope Commercial	$60.47
Rate for Payer: Healthscope Commercial	$78.66
Rate for Payer: Healthscope Commercial	$50.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$47.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$57.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$74.29
Rate for Payer: PHP Commercial	$57.11
Rate for Payer: PHP Commercial	$47.46
Rate for Payer: PHP Commercial	$74.29
Rate for Payer: Priority Health Cigna Priority Health	$47.03
Rate for Payer: Priority Health Cigna Priority Health	$61.18
Rate for Payer: Priority Health Cigna Priority Health	$39.08
Rate for Payer: Priority Health SBD	$35.17
Rate for Payer: Priority Health SBD	$42.33
Rate for Payer: Priority Health SBD	$55.06

SODIUM CHLORIDE 0.9 % IV NON PVC BAG

Facility

$94.92

Service Code	HCPCS J7030
Hospital Charge Code	150715
Hospital Revenue Code	636
Min. Negotiated Rate	$59.80
Max. Negotiated Rate	$85.43
Rate for Payer: Aetna Commercial	$80.68
Rate for Payer: Aetna New Business (MI Preferred)	$61.70
Rate for Payer: Cash Price	$75.94
Rate for Payer: Cofinity Commercial	$66.44
Rate for Payer: Cofinity Commercial	$81.63
Rate for Payer: Healthscope Commercial	$85.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$80.68
Rate for Payer: PHP Commercial	$80.68
Rate for Payer: Priority Health Cigna Priority Health	$66.44
Rate for Payer: Priority Health SBD	$59.80

SODIUM CHLORIDE 0.9 % IV NON PVC BAG

Facility

$43.87

Service Code	HCPCS J7050
Hospital Charge Code	150715
Hospital Revenue Code	636
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$39.48
Rate for Payer: Aetna Commercial	$37.29
Rate for Payer: Aetna New Business (MI Preferred)	$28.52
Rate for Payer: BCBS Complete	$17.55
Rate for Payer: BCBS Trust/PPO	$1.98
Rate for Payer: Cash Price	$35.10
Rate for Payer: Cash Price	$35.10
Rate for Payer: Cofinity Commercial	$30.71
Rate for Payer: Cofinity Commercial	$37.73
Rate for Payer: Healthscope Commercial	$39.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$37.29
Rate for Payer: PHP Commercial	$37.29
Rate for Payer: Priority Health Cigna Priority Health	$30.71
Rate for Payer: Priority Health SBD	$27.64

SODIUM CHLORIDE 0.9 % IV NON PVC BAG

Facility

$43.87

Service Code	HCPCS J7050
Hospital Charge Code	150715
Hospital Revenue Code	636
Min. Negotiated Rate	$27.64
Max. Negotiated Rate	$39.48
Rate for Payer: Aetna Commercial	$37.29
Rate for Payer: Aetna Commercial	$47.46
Rate for Payer: Aetna New Business (MI Preferred)	$36.29
Rate for Payer: Aetna New Business (MI Preferred)	$28.52
Rate for Payer: Cash Price	$44.66
Rate for Payer: Cash Price	$35.10
Rate for Payer: Cofinity Commercial	$48.01
Rate for Payer: Cofinity Commercial	$39.08
Rate for Payer: Cofinity Commercial	$30.71
Rate for Payer: Cofinity Commercial	$37.73
Rate for Payer: Healthscope Commercial	$50.25
Rate for Payer: Healthscope Commercial	$39.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$37.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$47.46
Rate for Payer: PHP Commercial	$37.29
Rate for Payer: PHP Commercial	$47.46
Rate for Payer: Priority Health Cigna Priority Health	$30.71
Rate for Payer: Priority Health Cigna Priority Health	$39.08
Rate for Payer: Priority Health SBD	$27.64
Rate for Payer: Priority Health SBD	$35.17

SODIUM CHLORIDE 0.9 % IV NON PVC BAG

Facility

$94.92

Service Code	HCPCS J7030
Hospital Charge Code	150715
Hospital Revenue Code	636
Min. Negotiated Rate	$7.96
Max. Negotiated Rate	$85.43
Rate for Payer: Aetna Commercial	$80.68
Rate for Payer: Aetna New Business (MI Preferred)	$61.70
Rate for Payer: BCBS Complete	$37.97
Rate for Payer: BCBS Trust/PPO	$7.96
Rate for Payer: Cash Price	$75.94
Rate for Payer: Cash Price	$75.94
Rate for Payer: Cofinity Commercial	$66.44
Rate for Payer: Cofinity Commercial	$81.63
Rate for Payer: Healthscope Commercial	$85.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$80.68
Rate for Payer: PHP Commercial	$80.68
Rate for Payer: Priority Health Cigna Priority Health	$66.44
Rate for Payer: Priority Health SBD	$59.80

Know your out-of-pocket cost for care.

All Charges