Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET

Facility

$235.00

Service Code	NDC 0223-1760-01
Hospital Charge Code	94158
Hospital Revenue Code	637
Min. Negotiated Rate	$148.05
Max. Negotiated Rate	$211.50
Rate for Payer: Aetna Commercial	$199.75
Rate for Payer: Aetna New Business (MI Preferred)	$152.75
Rate for Payer: Cash Price	$188.00
Rate for Payer: Cofinity Commercial	$164.50
Rate for Payer: Cofinity Commercial	$202.10
Rate for Payer: Healthscope Commercial	$211.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$199.75
Rate for Payer: PHP Commercial	$199.75
Rate for Payer: Priority Health Cigna Priority Health	$164.50
Rate for Payer: Priority Health SBD	$148.05

SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET

Facility

$397.15

Service Code	NDC 77333-844-10
Hospital Charge Code	94158
Hospital Revenue Code	637
Min. Negotiated Rate	$250.20
Max. Negotiated Rate	$357.44
Rate for Payer: Aetna Commercial	$337.58
Rate for Payer: Aetna New Business (MI Preferred)	$258.15
Rate for Payer: Cash Price	$317.72
Rate for Payer: Cofinity Commercial	$278.00
Rate for Payer: Cofinity Commercial	$341.55
Rate for Payer: Healthscope Commercial	$357.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$337.58
Rate for Payer: PHP Commercial	$337.58
Rate for Payer: Priority Health Cigna Priority Health	$278.00
Rate for Payer: Priority Health SBD	$250.20

SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET

Facility

$3.98

Service Code	NDC 77333-844-25
Hospital Charge Code	94158
Hospital Revenue Code	637
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$3.58
Rate for Payer: Aetna Commercial	$3.38
Rate for Payer: Aetna New Business (MI Preferred)	$2.59
Rate for Payer: Cash Price	$3.18
Rate for Payer: Cofinity Commercial	$2.79
Rate for Payer: Cofinity Commercial	$3.42
Rate for Payer: Healthscope Commercial	$3.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.38
Rate for Payer: PHP Commercial	$3.38
Rate for Payer: Priority Health Cigna Priority Health	$2.79
Rate for Payer: Priority Health SBD	$2.51

SODIUM CHLORIDE 3 % FOR NEBULIZATION

Facility

$2.70

Service Code	NDC 487900360
Hospital Charge Code	7327
Hospital Revenue Code	637
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$2.43
Rate for Payer: Aetna Commercial	$2.30
Rate for Payer: Aetna New Business (MI Preferred)	$1.76
Rate for Payer: Cash Price	$2.16
Rate for Payer: Cofinity Commercial	$1.89
Rate for Payer: Cofinity Commercial	$2.32
Rate for Payer: Healthscope Commercial	$2.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.30
Rate for Payer: PHP Commercial	$2.30
Rate for Payer: Priority Health Cigna Priority Health	$1.89
Rate for Payer: Priority Health SBD	$1.70

SODIUM CHLORIDE 3 % FOR NEBULIZATION

Facility

$2.89

Service Code	NDC 7620402260
Hospital Charge Code	7327
Hospital Revenue Code	637
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna Commercial	$2.46
Rate for Payer: Aetna New Business (MI Preferred)	$1.88
Rate for Payer: Cash Price	$2.31
Rate for Payer: Cofinity Commercial	$2.02
Rate for Payer: Cofinity Commercial	$2.49
Rate for Payer: Healthscope Commercial	$2.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.46
Rate for Payer: PHP Commercial	$2.46
Rate for Payer: Priority Health Cigna Priority Health	$2.02
Rate for Payer: Priority Health SBD	$1.82

SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION

Facility

$69.92

Service Code	NDC 0338-0054-03
Hospital Charge Code	7321
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 4 MEQ/ML INTRAVENOUS SOLUTION

Facility

$156.00

Service Code	NDC 63323-093-01
Hospital Charge Code	7322
Hospital Revenue Code	250
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna Commercial	$132.60
Rate for Payer: Aetna New Business (MI Preferred)	$101.40
Rate for Payer: Cash Price	$124.80
Rate for Payer: Cofinity Commercial	$109.20
Rate for Payer: Cofinity Commercial	$134.16
Rate for Payer: Healthscope Commercial	$140.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$132.60
Rate for Payer: PHP Commercial	$132.60
Rate for Payer: Priority Health Cigna Priority Health	$109.20
Rate for Payer: Priority Health SBD	$98.28

SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION

Facility

$103.50

Service Code	NDC 63323-187-30
Hospital Charge Code	7322
Hospital Revenue Code	250
Min. Negotiated Rate	$65.20
Max. Negotiated Rate	$93.15
Rate for Payer: Aetna Commercial	$87.98
Rate for Payer: Aetna New Business (MI Preferred)	$67.28
Rate for Payer: Cash Price	$82.80
Rate for Payer: Cofinity Commercial	$72.45
Rate for Payer: Cofinity Commercial	$89.01
Rate for Payer: Healthscope Commercial	$93.15
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$87.98
Rate for Payer: PHP Commercial	$87.98
Rate for Payer: Priority Health Cigna Priority Health	$72.45
Rate for Payer: Priority Health SBD	$65.20

SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION

Facility

$72.50

Service Code	NDC 0409-1141-12
Hospital Charge Code	7322
Hospital Revenue Code	250
Min. Negotiated Rate	$45.68
Max. Negotiated Rate	$65.25
Rate for Payer: Aetna Commercial	$61.62
Rate for Payer: Aetna New Business (MI Preferred)	$47.12
Rate for Payer: Cash Price	$58.00
Rate for Payer: Cofinity Commercial	$50.75
Rate for Payer: Cofinity Commercial	$62.35
Rate for Payer: Healthscope Commercial	$65.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$61.62
Rate for Payer: PHP Commercial	$61.62
Rate for Payer: Priority Health Cigna Priority Health	$50.75
Rate for Payer: Priority Health SBD	$45.68

SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION

Facility

$72.50

Service Code	NDC 0409-1141-02
Hospital Charge Code	7322
Hospital Revenue Code	250
Min. Negotiated Rate	$45.68
Max. Negotiated Rate	$65.25
Rate for Payer: Aetna Commercial	$61.62
Rate for Payer: Aetna New Business (MI Preferred)	$47.12
Rate for Payer: Cash Price	$58.00
Rate for Payer: Cofinity Commercial	$50.75
Rate for Payer: Cofinity Commercial	$62.35
Rate for Payer: Healthscope Commercial	$65.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$61.62
Rate for Payer: PHP Commercial	$61.62
Rate for Payer: Priority Health Cigna Priority Health	$50.75
Rate for Payer: Priority Health SBD	$45.68

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

Facility

$72.50

Service Code	NDC 9900-0019-15
Hospital Charge Code	300440
Hospital Revenue Code	250
Min. Negotiated Rate	$45.68
Max. Negotiated Rate	$65.25
Rate for Payer: Aetna Commercial	$61.62
Rate for Payer: Aetna New Business (MI Preferred)	$47.12
Rate for Payer: Cash Price	$58.00
Rate for Payer: Cofinity Commercial	$50.75
Rate for Payer: Cofinity Commercial	$62.35
Rate for Payer: Healthscope Commercial	$65.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$61.62
Rate for Payer: PHP Commercial	$61.62
Rate for Payer: Priority Health Cigna Priority Health	$50.75
Rate for Payer: Priority Health SBD	$45.68

SODIUM CHLORIDE 5 % EYE DROPS

Facility

$25.18

Service Code	NDC 17478-623-12
Hospital Charge Code	7332
Hospital Revenue Code	637
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$22.66
Rate for Payer: Aetna Commercial	$21.40
Rate for Payer: Aetna New Business (MI Preferred)	$16.37
Rate for Payer: Cash Price	$20.14
Rate for Payer: Cofinity Commercial	$17.63
Rate for Payer: Cofinity Commercial	$21.65
Rate for Payer: Healthscope Commercial	$22.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.40
Rate for Payer: PHP Commercial	$21.40
Rate for Payer: Priority Health Cigna Priority Health	$17.63
Rate for Payer: Priority Health SBD	$15.86

SODIUM CHLORIDE 5 % EYE DROPS

Facility

$17.01

Service Code	NDC 0536-1254-94
Hospital Charge Code	7332
Hospital Revenue Code	637
Min. Negotiated Rate	$10.72
Max. Negotiated Rate	$15.31
Rate for Payer: Aetna Commercial	$14.46
Rate for Payer: Aetna New Business (MI Preferred)	$11.06
Rate for Payer: Cash Price	$13.61
Rate for Payer: Cofinity Commercial	$11.91
Rate for Payer: Cofinity Commercial	$14.63
Rate for Payer: Healthscope Commercial	$15.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.46
Rate for Payer: PHP Commercial	$14.46
Rate for Payer: Priority Health Cigna Priority Health	$11.91
Rate for Payer: Priority Health SBD	$10.72

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

Facility

$19.31

Service Code	NDC 121119000
Hospital Charge Code	15706
Hospital Revenue Code	637
Min. Negotiated Rate	$12.17
Max. Negotiated Rate	$17.38
Rate for Payer: Aetna Commercial	$16.41
Rate for Payer: Aetna New Business (MI Preferred)	$12.55
Rate for Payer: Cash Price	$15.45
Rate for Payer: Cofinity Commercial	$13.52
Rate for Payer: Cofinity Commercial	$16.61
Rate for Payer: Healthscope Commercial	$17.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.41
Rate for Payer: PHP Commercial	$16.41
Rate for Payer: Priority Health Cigna Priority Health	$13.52
Rate for Payer: Priority Health SBD	$12.17

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

Facility

$7.56

Service Code	NDC 121059530
Hospital Charge Code	15706
Hospital Revenue Code	637
Min. Negotiated Rate	$4.76
Max. Negotiated Rate	$6.80
Rate for Payer: Aetna Commercial	$6.43
Rate for Payer: Aetna New Business (MI Preferred)	$4.91
Rate for Payer: Cash Price	$6.05
Rate for Payer: Cofinity Commercial	$5.29
Rate for Payer: Cofinity Commercial	$6.50
Rate for Payer: Healthscope Commercial	$6.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6.43
Rate for Payer: PHP Commercial	$6.43
Rate for Payer: Priority Health Cigna Priority Health	$5.29
Rate for Payer: Priority Health SBD	$4.76

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

Facility

$232.75

Service Code	NDC 6498010401
Hospital Charge Code	11067
Hospital Revenue Code	637
Min. Negotiated Rate	$146.63
Max. Negotiated Rate	$209.48
Rate for Payer: Aetna Commercial	$197.84
Rate for Payer: Aetna New Business (MI Preferred)	$151.29
Rate for Payer: Cash Price	$186.20
Rate for Payer: Cofinity Commercial	$162.92
Rate for Payer: Cofinity Commercial	$200.16
Rate for Payer: Healthscope Commercial	$209.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$197.84
Rate for Payer: PHP Commercial	$197.84
Rate for Payer: Priority Health Cigna Priority Health	$162.92
Rate for Payer: Priority Health SBD	$146.63

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

Facility

$131.91

Service Code	NDC 6808476425
Hospital Charge Code	11067
Hospital Revenue Code	637
Min. Negotiated Rate	$52.76
Max. Negotiated Rate	$118.72
Rate for Payer: Aetna Commercial	$112.12
Rate for Payer: Aetna New Business (MI Preferred)	$85.74
Rate for Payer: BCBS Complete	$52.76
Rate for Payer: Cash Price	$105.53
Rate for Payer: Cofinity Commercial	$113.44
Rate for Payer: Cofinity Commercial	$92.34
Rate for Payer: Healthscope Commercial	$118.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$112.12
Rate for Payer: PHP Commercial	$112.12
Rate for Payer: Priority Health Cigna Priority Health	$92.34
Rate for Payer: Priority Health SBD	$83.10

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

Facility

$4.40

Service Code	NDC 6808476495
Hospital Charge Code	11067
Hospital Revenue Code	637
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$3.96
Rate for Payer: Aetna Commercial	$3.74
Rate for Payer: Aetna New Business (MI Preferred)	$2.86
Rate for Payer: BCBS Complete	$1.76
Rate for Payer: Cash Price	$3.52
Rate for Payer: Cofinity Commercial	$3.08
Rate for Payer: Cofinity Commercial	$3.78
Rate for Payer: Healthscope Commercial	$3.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.74
Rate for Payer: PHP Commercial	$3.74
Rate for Payer: Priority Health Cigna Priority Health	$3.08
Rate for Payer: Priority Health SBD	$2.77

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

Facility

$131.91

Service Code	NDC 6808476425
Hospital Charge Code	11067
Hospital Revenue Code	637
Min. Negotiated Rate	$83.10
Max. Negotiated Rate	$118.72
Rate for Payer: Aetna Commercial	$112.12
Rate for Payer: Aetna New Business (MI Preferred)	$85.74
Rate for Payer: Cash Price	$105.53
Rate for Payer: Cofinity Commercial	$113.44
Rate for Payer: Cofinity Commercial	$92.34
Rate for Payer: Healthscope Commercial	$118.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$112.12
Rate for Payer: PHP Commercial	$112.12
Rate for Payer: Priority Health Cigna Priority Health	$92.34
Rate for Payer: Priority Health SBD	$83.10

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

Facility

$4.40

Service Code	NDC 6808476495
Hospital Charge Code	11067
Hospital Revenue Code	637
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$3.96
Rate for Payer: Aetna Commercial	$3.74
Rate for Payer: Aetna New Business (MI Preferred)	$2.86
Rate for Payer: Cash Price	$3.52
Rate for Payer: Cofinity Commercial	$3.78
Rate for Payer: Cofinity Commercial	$3.08
Rate for Payer: Healthscope Commercial	$3.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.74
Rate for Payer: PHP Commercial	$3.74
Rate for Payer: Priority Health Cigna Priority Health	$3.08
Rate for Payer: Priority Health SBD	$2.77

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

Facility

$131.61

Service Code	HCPCS J2916
Hospital Charge Code	24932
Hospital Revenue Code	636
Min. Negotiated Rate	$82.91
Max. Negotiated Rate	$118.45
Rate for Payer: Aetna Commercial	$111.87
Rate for Payer: Aetna New Business (MI Preferred)	$85.55
Rate for Payer: Cash Price	$105.29
Rate for Payer: Cofinity Commercial	$113.18
Rate for Payer: Cofinity Commercial	$92.13
Rate for Payer: Healthscope Commercial	$118.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$111.87
Rate for Payer: PHP Commercial	$111.87
Rate for Payer: Priority Health Cigna Priority Health	$92.13
Rate for Payer: Priority Health SBD	$82.91

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

Facility

$131.61

Service Code	HCPCS J2916
Hospital Charge Code	24932
Hospital Revenue Code	636
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$118.45
Rate for Payer: Aetna Commercial	$111.87
Rate for Payer: Aetna New Business (MI Preferred)	$85.55
Rate for Payer: BCBS Complete	$52.64
Rate for Payer: BCBS Trust/PPO	$7.00
Rate for Payer: Cash Price	$105.29
Rate for Payer: Cash Price	$105.29
Rate for Payer: Cofinity Commercial	$113.18
Rate for Payer: Cofinity Commercial	$92.13
Rate for Payer: Healthscope Commercial	$118.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$111.87
Rate for Payer: PHP Commercial	$111.87
Rate for Payer: Priority Health Cigna Priority Health	$92.13
Rate for Payer: Priority Health SBD	$82.91

SODIUM HYPOCHLORITE 0.125 % SOLUTION

Facility

$62.91

Service Code	NDC 0436-0672-16
Hospital Charge Code	76720
Hospital Revenue Code	637
Min. Negotiated Rate	$39.63
Max. Negotiated Rate	$56.62
Rate for Payer: Aetna Commercial	$53.47
Rate for Payer: Aetna New Business (MI Preferred)	$40.89
Rate for Payer: Cash Price	$50.33
Rate for Payer: Cofinity Commercial	$44.04
Rate for Payer: Cofinity Commercial	$54.10
Rate for Payer: Healthscope Commercial	$56.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$53.47
Rate for Payer: PHP Commercial	$53.47
Rate for Payer: Priority Health Cigna Priority Health	$44.04
Rate for Payer: Priority Health SBD	$39.63

SODIUM HYPOCHLORITE 0.125 % SOLUTION

Facility

$180.49

Service Code	NDC 3932806712
Hospital Charge Code	76720
Hospital Revenue Code	637
Min. Negotiated Rate	$113.71
Max. Negotiated Rate	$162.44
Rate for Payer: Aetna Commercial	$153.42
Rate for Payer: Aetna New Business (MI Preferred)	$117.32
Rate for Payer: Cash Price	$144.39
Rate for Payer: Cofinity Commercial	$126.34
Rate for Payer: Cofinity Commercial	$155.22
Rate for Payer: Healthscope Commercial	$162.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$153.42
Rate for Payer: PHP Commercial	$153.42
Rate for Payer: Priority Health Cigna Priority Health	$126.34
Rate for Payer: Priority Health SBD	$113.71

SODIUM HYPOCHLORITE 0.25 % SOLUTION

Facility

$12.00

Service Code	NDC 9900-0018-65
Hospital Charge Code	15950
Hospital Revenue Code	637
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna Commercial	$10.20
Rate for Payer: Aetna New Business (MI Preferred)	$7.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cofinity Commercial	$10.32
Rate for Payer: Cofinity Commercial	$8.40
Rate for Payer: Healthscope Commercial	$10.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.20
Rate for Payer: PHP Commercial	$10.20
Rate for Payer: Priority Health Cigna Priority Health	$8.40
Rate for Payer: Priority Health SBD	$7.56

Know your out-of-pocket cost for care.

All Charges