Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

SODIUM BORATE-BORIC ACID-SODIUM CHLORIDE-WATER EYE WASH SOLN

Facility

$48.14

Service Code	NDC 536122497
Hospital Charge Code	165406
Hospital Revenue Code	637
Min. Negotiated Rate	$36.11
Max. Negotiated Rate	$48.14
Rate for Payer: Aetna Commercial	$43.33
Rate for Payer: ASR ASR	$46.70
Rate for Payer: BCBS Trust/PPO	$39.54
Rate for Payer: BCN Commercial	$39.54
Rate for Payer: Cash Price	$38.52
Rate for Payer: Cofinity Commercial	$45.26
Rate for Payer: Encore Health Key Benefits Commercial	$38.52
Rate for Payer: Healthscope Commercial	$46.70
Rate for Payer: Healthscope Whirlpool	$48.14
Rate for Payer: Mclaren Commercial	$43.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.92
Rate for Payer: Nomi Health Commercial	$39.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$36.11
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$42.37

SODIUM BORATE-BORIC ACID-SODIUM CHLORIDE-WATER EYE WASH SOLN

Facility

$51.84

Service Code	NDC 10119000252
Hospital Charge Code	165406
Hospital Revenue Code	637
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$51.84
Rate for Payer: Aetna Commercial	$46.66
Rate for Payer: Aetna Medicare	$19.18
Rate for Payer: ASR ASR	$50.28
Rate for Payer: BCBS Complete	$20.74
Rate for Payer: BCBS Trust/PPO	$42.74
Rate for Payer: BCN Commercial	$42.74
Rate for Payer: Cash Price	$41.47
Rate for Payer: Cofinity Commercial	$48.73
Rate for Payer: Encore Health Key Benefits Commercial	$41.47
Rate for Payer: Healthscope Commercial	$50.28
Rate for Payer: Healthscope Whirlpool	$51.84
Rate for Payer: Mclaren Commercial	$46.66
Rate for Payer: MI Amish Medical Board Commercial	$41.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.06
Rate for Payer: Nomi Health Commercial	$42.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$38.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$45.42
Rate for Payer: Priority Health Narrow Network	$36.34
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$45.62

SODIUM BORATE-BORIC ACID-SODIUM CHLORIDE-WATER EYE WASH SOLN

Facility

$51.84

Service Code	NDC 10119000738
Hospital Charge Code	165406
Hospital Revenue Code	637
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$51.84
Rate for Payer: Aetna Commercial	$46.66
Rate for Payer: Aetna Medicare	$19.18
Rate for Payer: ASR ASR	$50.28
Rate for Payer: BCBS Complete	$20.74
Rate for Payer: BCBS Trust/PPO	$42.74
Rate for Payer: BCN Commercial	$42.74
Rate for Payer: Cash Price	$41.47
Rate for Payer: Cofinity Commercial	$48.73
Rate for Payer: Encore Health Key Benefits Commercial	$41.47
Rate for Payer: Healthscope Commercial	$50.28
Rate for Payer: Healthscope Whirlpool	$51.84
Rate for Payer: Mclaren Commercial	$46.66
Rate for Payer: MI Amish Medical Board Commercial	$41.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.06
Rate for Payer: Nomi Health Commercial	$42.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$38.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$45.42
Rate for Payer: Priority Health Narrow Network	$36.34
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$45.62

SODIUM BORATE-BORIC ACID-SODIUM CHLORIDE-WATER EYE WASH SOLN

Facility

$51.84

Service Code	NDC 10119000738
Hospital Charge Code	165406
Hospital Revenue Code	637
Min. Negotiated Rate	$38.88
Max. Negotiated Rate	$51.84
Rate for Payer: Aetna Commercial	$46.66
Rate for Payer: ASR ASR	$50.28
Rate for Payer: BCBS Trust/PPO	$42.57
Rate for Payer: BCN Commercial	$42.57
Rate for Payer: Cash Price	$41.47
Rate for Payer: Cofinity Commercial	$48.73
Rate for Payer: Encore Health Key Benefits Commercial	$41.47
Rate for Payer: Healthscope Commercial	$50.28
Rate for Payer: Healthscope Whirlpool	$51.84
Rate for Payer: Mclaren Commercial	$46.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.06
Rate for Payer: Nomi Health Commercial	$42.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$38.88
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$45.62

SODIUM BORATE-BORIC ACID-SODIUM CHLORIDE-WATER EYE WASH SOLN

Facility

$51.84

Service Code	NDC 10119000252
Hospital Charge Code	165406
Hospital Revenue Code	637
Min. Negotiated Rate	$38.88
Max. Negotiated Rate	$51.84
Rate for Payer: Aetna Commercial	$46.66
Rate for Payer: ASR ASR	$50.28
Rate for Payer: BCBS Trust/PPO	$42.57
Rate for Payer: BCN Commercial	$42.57
Rate for Payer: Cash Price	$41.47
Rate for Payer: Cofinity Commercial	$48.73
Rate for Payer: Encore Health Key Benefits Commercial	$41.47
Rate for Payer: Healthscope Commercial	$50.28
Rate for Payer: Healthscope Whirlpool	$51.84
Rate for Payer: Mclaren Commercial	$46.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.06
Rate for Payer: Nomi Health Commercial	$42.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$38.88
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$45.62

SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	NDC 338004304
Hospital Charge Code	7318
Hospital Revenue Code	250
Min. Negotiated Rate	$25.87
Max. Negotiated Rate	$69.92
Rate for Payer: Aetna Commercial	$62.93
Rate for Payer: Aetna Medicare	$25.87
Rate for Payer: ASR ASR	$67.82
Rate for Payer: BCBS Complete	$27.97
Rate for Payer: BCBS Trust/PPO	$57.65
Rate for Payer: BCN Commercial	$57.65
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$65.72
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Healthscope Commercial	$67.82
Rate for Payer: Healthscope Whirlpool	$69.92
Rate for Payer: Mclaren 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: Nomi Health Commercial	$57.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$52.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$61.26
Rate for Payer: Priority Health Narrow Network	$49.01
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.53

SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	NDC 338004304
Hospital Charge Code	7318
Hospital Revenue Code	250
Min. Negotiated Rate	$52.44
Max. Negotiated Rate	$69.92
Rate for Payer: Aetna Commercial	$62.93
Rate for Payer: ASR ASR	$67.82
Rate for Payer: BCBS Trust/PPO	$57.42
Rate for Payer: BCN Commercial	$57.42
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$65.72
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Healthscope Commercial	$67.82
Rate for Payer: Healthscope Whirlpool	$69.92
Rate for Payer: Mclaren Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.43
Rate for Payer: Nomi Health Commercial	$57.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$52.44
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.53

SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL

Facility

$6.48

Service Code	NDC 45802035758
Hospital Charge Code	29676
Hospital Revenue Code	637
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$6.48
Rate for Payer: Aetna Commercial	$5.83
Rate for Payer: ASR ASR	$6.29
Rate for Payer: BCBS Trust/PPO	$5.32
Rate for Payer: BCN Commercial	$5.32
Rate for Payer: Cash Price	$5.18
Rate for Payer: Cofinity Commercial	$6.09
Rate for Payer: Encore Health Key Benefits Commercial	$5.18
Rate for Payer: Healthscope Commercial	$6.29
Rate for Payer: Healthscope Whirlpool	$6.48
Rate for Payer: Mclaren Commercial	$5.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.51
Rate for Payer: Nomi Health Commercial	$5.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.86
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5.70

SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL

Facility

$6.60

Service Code	NDC 536250676
Hospital Charge Code	29676
Hospital Revenue Code	637
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$6.60
Rate for Payer: Aetna Commercial	$5.94
Rate for Payer: ASR ASR	$6.40
Rate for Payer: BCBS Trust/PPO	$5.42
Rate for Payer: BCN Commercial	$5.42
Rate for Payer: Cash Price	$5.28
Rate for Payer: Cofinity Commercial	$6.20
Rate for Payer: Encore Health Key Benefits Commercial	$5.28
Rate for Payer: Healthscope Commercial	$6.40
Rate for Payer: Healthscope Whirlpool	$6.60
Rate for Payer: Mclaren Commercial	$5.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.61
Rate for Payer: Nomi Health Commercial	$5.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5.81

SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL

Facility

$6.07

Service Code	NDC 904386575
Hospital Charge Code	29676
Hospital Revenue Code	637
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$6.07
Rate for Payer: Aetna Commercial	$5.46
Rate for Payer: ASR ASR	$5.89
Rate for Payer: BCBS Trust/PPO	$4.99
Rate for Payer: BCN Commercial	$4.99
Rate for Payer: Cash Price	$4.86
Rate for Payer: Cofinity Commercial	$5.71
Rate for Payer: Encore Health Key Benefits Commercial	$4.86
Rate for Payer: Healthscope Commercial	$5.89
Rate for Payer: Healthscope Whirlpool	$6.07
Rate for Payer: Mclaren Commercial	$5.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.16
Rate for Payer: Nomi Health Commercial	$4.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.55
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5.34

SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL

Facility

$6.48

Service Code	NDC 45802035758
Hospital Charge Code	29676
Hospital Revenue Code	637
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$6.48
Rate for Payer: Aetna Commercial	$5.83
Rate for Payer: Aetna Medicare	$2.40
Rate for Payer: ASR ASR	$6.29
Rate for Payer: BCBS Complete	$2.59
Rate for Payer: BCBS Trust/PPO	$5.34
Rate for Payer: BCN Commercial	$5.34
Rate for Payer: Cash Price	$5.18
Rate for Payer: Cofinity Commercial	$6.09
Rate for Payer: Encore Health Key Benefits Commercial	$5.18
Rate for Payer: Healthscope Commercial	$6.29
Rate for Payer: Healthscope Whirlpool	$6.48
Rate for Payer: Mclaren Commercial	$5.83
Rate for Payer: MI Amish Medical Board Commercial	$5.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.51
Rate for Payer: Nomi Health Commercial	$5.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$5.68
Rate for Payer: Priority Health Narrow Network	$4.54
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5.70

SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL

Facility

$6.07

Service Code	NDC 904386575
Hospital Charge Code	29676
Hospital Revenue Code	637
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$6.07
Rate for Payer: Aetna Commercial	$5.46
Rate for Payer: Aetna Medicare	$2.25
Rate for Payer: ASR ASR	$5.89
Rate for Payer: BCBS Complete	$2.43
Rate for Payer: BCBS Trust/PPO	$5.01
Rate for Payer: BCN Commercial	$5.01
Rate for Payer: Cash Price	$4.86
Rate for Payer: Cofinity Commercial	$5.71
Rate for Payer: Encore Health Key Benefits Commercial	$4.86
Rate for Payer: Healthscope Commercial	$5.89
Rate for Payer: Healthscope Whirlpool	$6.07
Rate for Payer: Mclaren Commercial	$5.46
Rate for Payer: MI Amish Medical Board Commercial	$4.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.16
Rate for Payer: Nomi Health Commercial	$4.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$5.32
Rate for Payer: Priority Health Narrow Network	$4.26
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5.34

SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL

Facility

$6.60

Service Code	NDC 536250676
Hospital Charge Code	29676
Hospital Revenue Code	637
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$6.60
Rate for Payer: Aetna Commercial	$5.94
Rate for Payer: Aetna Medicare	$2.44
Rate for Payer: ASR ASR	$6.40
Rate for Payer: BCBS Complete	$2.64
Rate for Payer: BCBS Trust/PPO	$5.44
Rate for Payer: BCN Commercial	$5.44
Rate for Payer: Cash Price	$5.28
Rate for Payer: Cofinity Commercial	$6.20
Rate for Payer: Encore Health Key Benefits Commercial	$5.28
Rate for Payer: Healthscope Commercial	$6.40
Rate for Payer: Healthscope Whirlpool	$6.60
Rate for Payer: Mclaren Commercial	$5.94
Rate for Payer: MI Amish Medical Board Commercial	$5.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.61
Rate for Payer: Nomi Health Commercial	$5.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$5.78
Rate for Payer: Priority Health Narrow Network	$4.63
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5.81

SODIUM CHLORIDE 0.9 % FLUSH SOLUTION 100 ML BAG

Facility

$53.75

Service Code	HCPCS J7040
Hospital Charge Code	300165
Hospital Revenue Code	636
Min. Negotiated Rate	$40.31
Max. Negotiated Rate	$53.75
Rate for Payer: Aetna Commercial	$48.37
Rate for Payer: ASR ASR	$52.14
Rate for Payer: BCBS Trust/PPO	$44.14
Rate for Payer: BCN Commercial	$44.14
Rate for Payer: Cash Price	$43.00
Rate for Payer: Cofinity Commercial	$50.52
Rate for Payer: Encore Health Key Benefits Commercial	$43.00
Rate for Payer: Healthscope Commercial	$52.14
Rate for Payer: Healthscope Whirlpool	$53.75
Rate for Payer: Mclaren Commercial	$48.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$45.69
Rate for Payer: Nomi Health Commercial	$44.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$40.31
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$47.30

SODIUM CHLORIDE 0.9 % FLUSH SOLUTION 100 ML BAG

Facility

$53.75

Service Code	HCPCS J7040
Hospital Charge Code	300165
Hospital Revenue Code	636
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$53.75
Rate for Payer: Aetna Commercial	$48.37
Rate for Payer: Aetna Medicare	$19.89
Rate for Payer: ASR ASR	$52.14
Rate for Payer: BCBS Complete	$21.50
Rate for Payer: BCBS Trust/PPO	$44.32
Rate for Payer: BCN Commercial	$44.32
Rate for Payer: Cash Price	$43.00
Rate for Payer: Cash Price	$43.00
Rate for Payer: Cofinity Commercial	$50.52
Rate for Payer: Encore Health Key Benefits Commercial	$43.00
Rate for Payer: Healthscope Commercial	$52.14
Rate for Payer: Healthscope Whirlpool	$53.75
Rate for Payer: Mclaren Commercial	$48.37
Rate for Payer: MI Amish Medical Board Commercial	$43.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$45.69
Rate for Payer: Nomi Health Commercial	$44.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$40.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$1.33
Rate for Payer: Priority Health Narrow Network	$1.06
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$47.30

SODIUM CHLORIDE 0.9 % FOR NEBULIZATION

Facility

$3.14

Service Code	NDC 378698501
Hospital Charge Code	7325
Hospital Revenue Code	250
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$3.13
Rate for Payer: Aetna Commercial	$2.82
Rate for Payer: ASR ASR	$3.04
Rate for Payer: BCBS Trust/PPO	$2.57
Rate for Payer: BCN Commercial	$2.57
Rate for Payer: Cash Price	$2.51
Rate for Payer: Cofinity Commercial	$2.95
Rate for Payer: Encore Health Key Benefits Commercial	$2.51
Rate for Payer: Healthscope Commercial	$3.04
Rate for Payer: Healthscope Whirlpool	$3.13
Rate for Payer: Mclaren Commercial	$2.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.66
Rate for Payer: Nomi Health Commercial	$2.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.35
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2.76

SODIUM CHLORIDE 0.9 % FOR NEBULIZATION

Facility

$2.75

Service Code	NDC 487930133
Hospital Charge Code	7325
Hospital Revenue Code	250
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$2.75
Rate for Payer: Aetna Commercial	$2.48
Rate for Payer: ASR ASR	$2.67
Rate for Payer: BCBS Trust/PPO	$2.26
Rate for Payer: BCN Commercial	$2.26
Rate for Payer: Cash Price	$2.20
Rate for Payer: Cofinity Commercial	$2.58
Rate for Payer: Encore Health Key Benefits Commercial	$2.20
Rate for Payer: Healthscope Commercial	$2.67
Rate for Payer: Healthscope Whirlpool	$2.75
Rate for Payer: Mclaren Commercial	$2.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.34
Rate for Payer: Nomi Health Commercial	$2.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.06
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2.42

SODIUM CHLORIDE 0.9 % FOR NEBULIZATION

Facility

$3.14

Service Code	NDC 378698501
Hospital Charge Code	7325
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$3.13
Rate for Payer: Aetna Commercial	$2.82
Rate for Payer: Aetna Medicare	$1.16
Rate for Payer: ASR ASR	$3.04
Rate for Payer: BCBS Complete	$1.25
Rate for Payer: BCBS Trust/PPO	$2.58
Rate for Payer: BCN Commercial	$2.58
Rate for Payer: Cash Price	$2.51
Rate for Payer: Cofinity Commercial	$2.95
Rate for Payer: Encore Health Key Benefits Commercial	$2.51
Rate for Payer: Healthscope Commercial	$3.04
Rate for Payer: Healthscope Whirlpool	$3.13
Rate for Payer: Mclaren Commercial	$2.82
Rate for Payer: MI Amish Medical Board Commercial	$2.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.66
Rate for Payer: Nomi Health Commercial	$2.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$2.75
Rate for Payer: Priority Health Narrow Network	$2.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2.76

SODIUM CHLORIDE 0.9 % FOR NEBULIZATION

Facility

$2.75

Service Code	NDC 487930133
Hospital Charge Code	7325
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$2.75
Rate for Payer: Aetna Commercial	$2.48
Rate for Payer: Aetna Medicare	$1.02
Rate for Payer: ASR ASR	$2.67
Rate for Payer: BCBS Complete	$1.10
Rate for Payer: BCBS Trust/PPO	$2.27
Rate for Payer: BCN Commercial	$2.27
Rate for Payer: Cash Price	$2.20
Rate for Payer: Cofinity Commercial	$2.58
Rate for Payer: Encore Health Key Benefits Commercial	$2.20
Rate for Payer: Healthscope Commercial	$2.67
Rate for Payer: Healthscope Whirlpool	$2.75
Rate for Payer: Mclaren Commercial	$2.48
Rate for Payer: MI Amish Medical Board Commercial	$2.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.34
Rate for Payer: Nomi Health Commercial	$2.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.06
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$2.41
Rate for Payer: Priority Health Narrow Network	$1.93
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2.42

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	$1.65
Max. Negotiated Rate	$69.92
Rate for Payer: Aetna Commercial	$62.93
Rate for Payer: Aetna Medicare	$25.87
Rate for Payer: ASR ASR	$67.82
Rate for Payer: BCBS Complete	$27.97
Rate for Payer: BCBS Trust/PPO	$57.65
Rate for Payer: BCN Commercial	$57.65
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$65.72
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Healthscope Commercial	$67.82
Rate for Payer: Healthscope Whirlpool	$69.92
Rate for Payer: Mclaren 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: Nomi Health Commercial	$57.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$52.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$2.06
Rate for Payer: Priority Health Narrow Network	$1.65
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.53

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	$52.44
Max. Negotiated Rate	$69.92
Rate for Payer: Aetna Commercial	$62.93
Rate for Payer: ASR ASR	$67.82
Rate for Payer: BCBS Trust/PPO	$57.42
Rate for Payer: BCN Commercial	$57.42
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$65.72
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Healthscope Commercial	$67.82
Rate for Payer: Healthscope Whirlpool	$69.92
Rate for Payer: Mclaren Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.43
Rate for Payer: Nomi Health Commercial	$57.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$52.44
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.53

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	$52.44
Max. Negotiated Rate	$69.92
Rate for Payer: Aetna Commercial	$62.93
Rate for Payer: ASR ASR	$67.82
Rate for Payer: BCBS Trust/PPO	$57.42
Rate for Payer: BCN Commercial	$57.42
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$65.72
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Healthscope Commercial	$67.82
Rate for Payer: Healthscope Whirlpool	$69.92
Rate for Payer: Mclaren Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.43
Rate for Payer: Nomi Health Commercial	$57.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$52.44
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.53

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	$1.65
Max. Negotiated Rate	$69.92
Rate for Payer: Aetna Commercial	$62.93
Rate for Payer: Aetna Medicare	$25.87
Rate for Payer: ASR ASR	$67.82
Rate for Payer: BCBS Complete	$27.97
Rate for Payer: BCBS Trust/PPO	$57.65
Rate for Payer: BCN Commercial	$57.65
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$65.72
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Healthscope Commercial	$67.82
Rate for Payer: Healthscope Whirlpool	$69.92
Rate for Payer: Mclaren 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: Nomi Health Commercial	$57.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$52.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$2.06
Rate for Payer: Priority Health Narrow Network	$1.65
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.53

SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK

Facility

$43.07

Service Code	NDC 338055318
Hospital Charge Code	116170
Hospital Revenue Code	250
Min. Negotiated Rate	$15.93
Max. Negotiated Rate	$43.06
Rate for Payer: Aetna Commercial	$38.76
Rate for Payer: Aetna Medicare	$15.93
Rate for Payer: ASR ASR	$41.77
Rate for Payer: BCBS Complete	$17.23
Rate for Payer: BCBS Trust/PPO	$35.51
Rate for Payer: BCN Commercial	$35.51
Rate for Payer: Cash Price	$34.45
Rate for Payer: Cofinity Commercial	$40.48
Rate for Payer: Encore Health Key Benefits Commercial	$34.45
Rate for Payer: Healthscope Commercial	$41.77
Rate for Payer: Healthscope Whirlpool	$43.06
Rate for Payer: Mclaren Commercial	$38.76
Rate for Payer: MI Amish Medical Board Commercial	$34.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$36.61
Rate for Payer: Nomi Health Commercial	$35.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$32.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$37.73
Rate for Payer: Priority Health Narrow Network	$30.19
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$37.90

SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK

Facility

$43.07

Service Code	NDC 338055318
Hospital Charge Code	116170
Hospital Revenue Code	250
Min. Negotiated Rate	$32.30
Max. Negotiated Rate	$43.06
Rate for Payer: Aetna Commercial	$38.76
Rate for Payer: ASR ASR	$41.77
Rate for Payer: BCBS Trust/PPO	$35.36
Rate for Payer: BCN Commercial	$35.36
Rate for Payer: Cash Price	$34.45
Rate for Payer: Cofinity Commercial	$40.48
Rate for Payer: Encore Health Key Benefits Commercial	$34.45
Rate for Payer: Healthscope Commercial	$41.77
Rate for Payer: Healthscope Whirlpool	$43.06
Rate for Payer: Mclaren Commercial	$38.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$36.61
Rate for Payer: Nomi Health Commercial	$35.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$32.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$37.90

Know your out-of-pocket cost for care.

All Charges