Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$18.36

Service Code	NDC 00121059515
Hospital Charge Code	15706
Hospital Revenue Code	637
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$18.36
Rate for Payer: Aetna Commercial	$16.52
Rate for Payer: ASR ASR	$17.81
Rate for Payer: ASR Commercial	$17.81
Rate for Payer: BCBS Trust/PPO	$14.96
Rate for Payer: BCN Commercial	$14.23
Rate for Payer: Cash Price	$14.69
Rate for Payer: Cofinity Commercial	$17.26
Rate for Payer: Encore Health Key Benefits Commercial	$14.69
Rate for Payer: Healthscope Commercial	$18.36
Rate for Payer: Healthscope Whirlpool	$17.81
Rate for Payer: Mclaren Commercial	$16.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.61
Rate for Payer: Nomi Health Commercial	$15.06
Rate for Payer: Priority Health Cigna Priority Health	$11.93
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.16

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

Facility

$18.36

Service Code	NDC 00121059515
Hospital Charge Code	15706
Hospital Revenue Code	637
Min. Negotiated Rate	$7.34
Max. Negotiated Rate	$18.36
Rate for Payer: Aetna Commercial	$16.52
Rate for Payer: Aetna Medicare	$9.18
Rate for Payer: ASR ASR	$17.81
Rate for Payer: ASR Commercial	$17.81
Rate for Payer: BCBS Complete	$7.34
Rate for Payer: BCBS Trust/PPO	$15.04
Rate for Payer: BCN Commercial	$14.23
Rate for Payer: Cash Price	$14.69
Rate for Payer: Cofinity Commercial	$17.26
Rate for Payer: Encore Health Key Benefits Commercial	$14.69
Rate for Payer: Healthscope Commercial	$18.36
Rate for Payer: Healthscope Whirlpool	$17.81
Rate for Payer: Mclaren Commercial	$16.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.61
Rate for Payer: Nomi Health Commercial	$15.06
Rate for Payer: Priority Health Cigna Priority Health	$11.93
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16.09
Rate for Payer: Priority Health Narrow Network	$12.87
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.16

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

Facility

$238.45

Service Code	NDC 64980010401
Hospital Charge Code	11067
Hospital Revenue Code	637
Min. Negotiated Rate	$154.99
Max. Negotiated Rate	$238.45
Rate for Payer: Aetna Commercial	$214.60
Rate for Payer: ASR ASR	$231.30
Rate for Payer: ASR Commercial	$231.30
Rate for Payer: BCBS Trust/PPO	$194.31
Rate for Payer: BCN Commercial	$184.87
Rate for Payer: Cash Price	$190.76
Rate for Payer: Cofinity Commercial	$224.14
Rate for Payer: Encore Health Key Benefits Commercial	$190.76
Rate for Payer: Healthscope Commercial	$238.45
Rate for Payer: Healthscope Whirlpool	$231.30
Rate for Payer: Mclaren Commercial	$214.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$202.68
Rate for Payer: Nomi Health Commercial	$195.53
Rate for Payer: Priority Health Cigna Priority Health	$154.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$209.84

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

Facility

$238.45

Service Code	NDC 64980010401
Hospital Charge Code	11067
Hospital Revenue Code	637
Min. Negotiated Rate	$95.38
Max. Negotiated Rate	$238.45
Rate for Payer: Aetna Commercial	$214.60
Rate for Payer: Aetna Medicare	$119.22
Rate for Payer: ASR ASR	$231.30
Rate for Payer: ASR Commercial	$231.30
Rate for Payer: BCBS Complete	$95.38
Rate for Payer: BCBS Trust/PPO	$195.27
Rate for Payer: BCN Commercial	$184.87
Rate for Payer: Cash Price	$190.76
Rate for Payer: Cofinity Commercial	$224.14
Rate for Payer: Encore Health Key Benefits Commercial	$190.76
Rate for Payer: Healthscope Commercial	$238.45
Rate for Payer: Healthscope Whirlpool	$231.30
Rate for Payer: Mclaren Commercial	$214.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$202.68
Rate for Payer: Nomi Health Commercial	$195.53
Rate for Payer: Priority Health Cigna Priority Health	$154.99
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$208.93
Rate for Payer: Priority Health Narrow Network	$167.15
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$209.84

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

Facility

$137.97

Service Code	HCPCS J2916
Hospital Charge Code	24932
Hospital Revenue Code	636
Min. Negotiated Rate	$89.68
Max. Negotiated Rate	$137.97
Rate for Payer: Aetna Commercial	$124.17
Rate for Payer: ASR ASR	$133.83
Rate for Payer: ASR Commercial	$133.83
Rate for Payer: BCBS Trust/PPO	$112.43
Rate for Payer: BCN Commercial	$106.97
Rate for Payer: Cash Price	$110.38
Rate for Payer: Cofinity Commercial	$129.69
Rate for Payer: Encore Health Key Benefits Commercial	$110.38
Rate for Payer: Healthscope Commercial	$137.97
Rate for Payer: Healthscope Whirlpool	$133.83
Rate for Payer: Mclaren Commercial	$124.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$117.27
Rate for Payer: Nomi Health Commercial	$113.14
Rate for Payer: Priority Health Cigna Priority Health	$89.68
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$121.41

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

Facility

$137.97

Service Code	HCPCS J2916
Hospital Charge Code	24932
Hospital Revenue Code	636
Min. Negotiated Rate	$55.19
Max. Negotiated Rate	$137.97
Rate for Payer: Aetna Commercial	$124.17
Rate for Payer: Aetna Medicare	$68.98
Rate for Payer: ASR ASR	$133.83
Rate for Payer: ASR Commercial	$133.83
Rate for Payer: BCBS Complete	$55.19
Rate for Payer: BCBS Trust/PPO	$112.98
Rate for Payer: BCN Commercial	$106.97
Rate for Payer: Cash Price	$110.38
Rate for Payer: Cofinity Commercial	$129.69
Rate for Payer: Encore Health Key Benefits Commercial	$110.38
Rate for Payer: Healthscope Commercial	$137.97
Rate for Payer: Healthscope Whirlpool	$133.83
Rate for Payer: Mclaren Commercial	$124.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$117.27
Rate for Payer: Nomi Health Commercial	$113.14
Rate for Payer: Priority Health Cigna Priority Health	$89.68
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$120.89
Rate for Payer: Priority Health Narrow Network	$96.72
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$121.41

SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE

Facility

$149.22

Service Code	NDC 08065183055
Hospital Charge Code	28913
Hospital Revenue Code	250
Min. Negotiated Rate	$59.69
Max. Negotiated Rate	$149.22
Rate for Payer: Aetna Commercial	$134.30
Rate for Payer: Aetna Medicare	$74.61
Rate for Payer: ASR ASR	$144.74
Rate for Payer: ASR Commercial	$144.74
Rate for Payer: BCBS Complete	$59.69
Rate for Payer: BCBS Trust/PPO	$122.20
Rate for Payer: BCN Commercial	$115.69
Rate for Payer: Cash Price	$119.38
Rate for Payer: Cofinity Commercial	$140.27
Rate for Payer: Encore Health Key Benefits Commercial	$119.38
Rate for Payer: Healthscope Commercial	$149.22
Rate for Payer: Healthscope Whirlpool	$144.74
Rate for Payer: Mclaren Commercial	$134.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$126.84
Rate for Payer: Nomi Health Commercial	$122.36
Rate for Payer: Priority Health Cigna Priority Health	$96.99
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$130.75
Rate for Payer: Priority Health Narrow Network	$104.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$131.31

SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE

Facility

$149.22

Service Code	NDC 08065183055
Hospital Charge Code	28913
Hospital Revenue Code	250
Min. Negotiated Rate	$96.99
Max. Negotiated Rate	$149.22
Rate for Payer: Aetna Commercial	$134.30
Rate for Payer: ASR ASR	$144.74
Rate for Payer: ASR Commercial	$144.74
Rate for Payer: BCBS Trust/PPO	$121.60
Rate for Payer: BCN Commercial	$115.69
Rate for Payer: Cash Price	$119.38
Rate for Payer: Cofinity Commercial	$140.27
Rate for Payer: Encore Health Key Benefits Commercial	$119.38
Rate for Payer: Healthscope Commercial	$149.22
Rate for Payer: Healthscope Whirlpool	$144.74
Rate for Payer: Mclaren Commercial	$134.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$126.84
Rate for Payer: Nomi Health Commercial	$122.36
Rate for Payer: Priority Health Cigna Priority Health	$96.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$131.31

SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION

Facility

$49.66

Service Code	NDC 72485010501
Hospital Charge Code	18908
Hospital Revenue Code	250
Min. Negotiated Rate	$32.28
Max. Negotiated Rate	$49.66
Rate for Payer: Aetna Commercial	$44.69
Rate for Payer: ASR ASR	$48.17
Rate for Payer: ASR Commercial	$48.17
Rate for Payer: BCBS Trust/PPO	$40.47
Rate for Payer: BCN Commercial	$38.50
Rate for Payer: Cash Price	$39.73
Rate for Payer: Cofinity Commercial	$46.68
Rate for Payer: Encore Health Key Benefits Commercial	$39.73
Rate for Payer: Healthscope Commercial	$49.66
Rate for Payer: Healthscope Whirlpool	$48.17
Rate for Payer: Mclaren Commercial	$44.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$42.21
Rate for Payer: Nomi Health Commercial	$40.72
Rate for Payer: Priority Health Cigna Priority Health	$32.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$43.70

SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION

Facility

$49.66

Service Code	NDC 72485010501
Hospital Charge Code	18908
Hospital Revenue Code	250
Min. Negotiated Rate	$19.86
Max. Negotiated Rate	$49.66
Rate for Payer: Aetna Commercial	$44.69
Rate for Payer: Aetna Medicare	$24.83
Rate for Payer: ASR ASR	$48.17
Rate for Payer: ASR Commercial	$48.17
Rate for Payer: BCBS Complete	$19.86
Rate for Payer: BCBS Trust/PPO	$40.67
Rate for Payer: BCN Commercial	$38.50
Rate for Payer: Cash Price	$39.73
Rate for Payer: Cofinity Commercial	$46.68
Rate for Payer: Encore Health Key Benefits Commercial	$39.73
Rate for Payer: Healthscope Commercial	$49.66
Rate for Payer: Healthscope Whirlpool	$48.17
Rate for Payer: Mclaren Commercial	$44.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$42.21
Rate for Payer: Nomi Health Commercial	$40.72
Rate for Payer: Priority Health Cigna Priority Health	$32.28
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$43.51
Rate for Payer: Priority Health Narrow Network	$34.81
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$43.70

SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION

Facility

$45.92

Service Code	NDC 70436002880
Hospital Charge Code	18908
Hospital Revenue Code	250
Min. Negotiated Rate	$18.37
Max. Negotiated Rate	$45.92
Rate for Payer: Aetna Commercial	$41.33
Rate for Payer: Aetna Medicare	$22.96
Rate for Payer: ASR ASR	$44.54
Rate for Payer: ASR Commercial	$44.54
Rate for Payer: BCBS Complete	$18.37
Rate for Payer: BCBS Trust/PPO	$37.60
Rate for Payer: BCN Commercial	$35.60
Rate for Payer: Cash Price	$36.74
Rate for Payer: Cofinity Commercial	$43.16
Rate for Payer: Encore Health Key Benefits Commercial	$36.74
Rate for Payer: Healthscope Commercial	$45.92
Rate for Payer: Healthscope Whirlpool	$44.54
Rate for Payer: Mclaren Commercial	$41.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.03
Rate for Payer: Nomi Health Commercial	$37.65
Rate for Payer: Priority Health Cigna Priority Health	$29.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$40.24
Rate for Payer: Priority Health Narrow Network	$32.19
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$40.41

SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION

Facility

$264.12

Service Code	NDC 14789001202
Hospital Charge Code	18908
Hospital Revenue Code	250
Min. Negotiated Rate	$105.65
Max. Negotiated Rate	$264.12
Rate for Payer: Aetna Commercial	$237.71
Rate for Payer: Aetna Medicare	$132.06
Rate for Payer: ASR ASR	$256.20
Rate for Payer: ASR Commercial	$256.20
Rate for Payer: BCBS Complete	$105.65
Rate for Payer: BCBS Trust/PPO	$216.29
Rate for Payer: BCN Commercial	$204.77
Rate for Payer: Cash Price	$211.30
Rate for Payer: Cofinity Commercial	$248.27
Rate for Payer: Encore Health Key Benefits Commercial	$211.30
Rate for Payer: Healthscope Commercial	$264.12
Rate for Payer: Healthscope Whirlpool	$256.20
Rate for Payer: Mclaren Commercial	$237.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$224.50
Rate for Payer: Nomi Health Commercial	$216.58
Rate for Payer: Priority Health Cigna Priority Health	$171.68
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$231.42
Rate for Payer: Priority Health Narrow Network	$185.15
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$232.43

SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION

Facility

$45.92

Service Code	NDC 70436002880
Hospital Charge Code	18908
Hospital Revenue Code	250
Min. Negotiated Rate	$29.85
Max. Negotiated Rate	$45.92
Rate for Payer: Aetna Commercial	$41.33
Rate for Payer: ASR ASR	$44.54
Rate for Payer: ASR Commercial	$44.54
Rate for Payer: BCBS Trust/PPO	$37.42
Rate for Payer: BCN Commercial	$35.60
Rate for Payer: Cash Price	$36.74
Rate for Payer: Cofinity Commercial	$43.16
Rate for Payer: Encore Health Key Benefits Commercial	$36.74
Rate for Payer: Healthscope Commercial	$45.92
Rate for Payer: Healthscope Whirlpool	$44.54
Rate for Payer: Mclaren Commercial	$41.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.03
Rate for Payer: Nomi Health Commercial	$37.65
Rate for Payer: Priority Health Cigna Priority Health	$29.85
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$40.41

SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION

Facility

$62.43

Service Code	NDC 42571026575
Hospital Charge Code	18908
Hospital Revenue Code	250
Min. Negotiated Rate	$40.58
Max. Negotiated Rate	$62.43
Rate for Payer: Aetna Commercial	$56.19
Rate for Payer: ASR ASR	$60.56
Rate for Payer: ASR Commercial	$60.56
Rate for Payer: BCBS Trust/PPO	$50.87
Rate for Payer: BCN Commercial	$48.40
Rate for Payer: Cash Price	$49.95
Rate for Payer: Cofinity Commercial	$58.68
Rate for Payer: Encore Health Key Benefits Commercial	$49.94
Rate for Payer: Healthscope Commercial	$62.43
Rate for Payer: Healthscope Whirlpool	$60.56
Rate for Payer: Mclaren Commercial	$56.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.07
Rate for Payer: Nomi Health Commercial	$51.19
Rate for Payer: Priority Health Cigna Priority Health	$40.58
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$54.94

SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION

Facility

$77.07

Service Code	NDC 71839012001
Hospital Charge Code	18908
Hospital Revenue Code	250
Min. Negotiated Rate	$50.10
Max. Negotiated Rate	$77.07
Rate for Payer: Aetna Commercial	$69.36
Rate for Payer: ASR ASR	$74.76
Rate for Payer: ASR Commercial	$74.76
Rate for Payer: BCBS Trust/PPO	$62.80
Rate for Payer: BCN Commercial	$59.75
Rate for Payer: Cash Price	$61.66
Rate for Payer: Cofinity Commercial	$72.45
Rate for Payer: Encore Health Key Benefits Commercial	$61.66
Rate for Payer: Healthscope Commercial	$77.07
Rate for Payer: Healthscope Whirlpool	$74.76
Rate for Payer: Mclaren Commercial	$69.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.51
Rate for Payer: Nomi Health Commercial	$63.20
Rate for Payer: Priority Health Cigna Priority Health	$50.10
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$67.82

SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION

Facility

$62.43

Service Code	NDC 42571026575
Hospital Charge Code	18908
Hospital Revenue Code	250
Min. Negotiated Rate	$24.97
Max. Negotiated Rate	$62.43
Rate for Payer: Aetna Commercial	$56.19
Rate for Payer: Aetna Medicare	$31.21
Rate for Payer: ASR ASR	$60.56
Rate for Payer: ASR Commercial	$60.56
Rate for Payer: BCBS Complete	$24.97
Rate for Payer: BCBS Trust/PPO	$51.12
Rate for Payer: BCN Commercial	$48.40
Rate for Payer: Cash Price	$49.95
Rate for Payer: Cofinity Commercial	$58.68
Rate for Payer: Encore Health Key Benefits Commercial	$49.94
Rate for Payer: Healthscope Commercial	$62.43
Rate for Payer: Healthscope Whirlpool	$60.56
Rate for Payer: Mclaren Commercial	$56.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.07
Rate for Payer: Nomi Health Commercial	$51.19
Rate for Payer: Priority Health Cigna Priority Health	$40.58
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$54.70
Rate for Payer: Priority Health Narrow Network	$43.76
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$54.94

SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION

Facility

$77.07

Service Code	NDC 71839012001
Hospital Charge Code	18908
Hospital Revenue Code	250
Min. Negotiated Rate	$30.83
Max. Negotiated Rate	$77.07
Rate for Payer: Aetna Commercial	$69.36
Rate for Payer: Aetna Medicare	$38.53
Rate for Payer: ASR ASR	$74.76
Rate for Payer: ASR Commercial	$74.76
Rate for Payer: BCBS Complete	$30.83
Rate for Payer: BCBS Trust/PPO	$63.11
Rate for Payer: BCN Commercial	$59.75
Rate for Payer: Cash Price	$61.66
Rate for Payer: Cofinity Commercial	$72.45
Rate for Payer: Encore Health Key Benefits Commercial	$61.66
Rate for Payer: Healthscope Commercial	$77.07
Rate for Payer: Healthscope Whirlpool	$74.76
Rate for Payer: Mclaren Commercial	$69.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.51
Rate for Payer: Nomi Health Commercial	$63.20
Rate for Payer: Priority Health Cigna Priority Health	$50.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$67.53
Rate for Payer: Priority Health Narrow Network	$54.03
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$67.82

SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION

Facility

$264.12

Service Code	NDC 14789001202
Hospital Charge Code	18908
Hospital Revenue Code	250
Min. Negotiated Rate	$171.68
Max. Negotiated Rate	$264.12
Rate for Payer: Aetna Commercial	$237.71
Rate for Payer: ASR ASR	$256.20
Rate for Payer: ASR Commercial	$256.20
Rate for Payer: BCBS Trust/PPO	$215.23
Rate for Payer: BCN Commercial	$204.77
Rate for Payer: Cash Price	$211.30
Rate for Payer: Cofinity Commercial	$248.27
Rate for Payer: Encore Health Key Benefits Commercial	$211.30
Rate for Payer: Healthscope Commercial	$264.12
Rate for Payer: Healthscope Whirlpool	$256.20
Rate for Payer: Mclaren Commercial	$237.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$224.50
Rate for Payer: Nomi Health Commercial	$216.58
Rate for Payer: Priority Health Cigna Priority Health	$171.68
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$232.43

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$111.70

Service Code	NDC 63323017005
Hospital Charge Code	7351
Hospital Revenue Code	250
Min. Negotiated Rate	$72.61
Max. Negotiated Rate	$111.70
Rate for Payer: Aetna Commercial	$100.53
Rate for Payer: ASR ASR	$108.35
Rate for Payer: ASR Commercial	$108.35
Rate for Payer: BCBS Trust/PPO	$91.02
Rate for Payer: BCN Commercial	$86.60
Rate for Payer: Cash Price	$89.36
Rate for Payer: Cofinity Commercial	$105.00
Rate for Payer: Encore Health Key Benefits Commercial	$89.36
Rate for Payer: Healthscope Commercial	$111.70
Rate for Payer: Healthscope Whirlpool	$108.35
Rate for Payer: Mclaren Commercial	$100.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$94.94
Rate for Payer: Nomi Health Commercial	$91.59
Rate for Payer: Priority Health Cigna Priority Health	$72.61
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$98.30

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$315.38

Service Code	NDC 63323088101
Hospital Charge Code	7351
Hospital Revenue Code	250
Min. Negotiated Rate	$126.15
Max. Negotiated Rate	$315.38
Rate for Payer: Aetna Commercial	$283.84
Rate for Payer: Aetna Medicare	$157.69
Rate for Payer: ASR ASR	$305.92
Rate for Payer: ASR Commercial	$305.92
Rate for Payer: BCBS Complete	$126.15
Rate for Payer: BCBS Trust/PPO	$258.26
Rate for Payer: BCN Commercial	$244.51
Rate for Payer: Cash Price	$252.30
Rate for Payer: Cofinity Commercial	$296.46
Rate for Payer: Encore Health Key Benefits Commercial	$252.30
Rate for Payer: Healthscope Commercial	$315.38
Rate for Payer: Healthscope Whirlpool	$305.92
Rate for Payer: Mclaren Commercial	$283.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$268.07
Rate for Payer: Nomi Health Commercial	$258.61
Rate for Payer: Priority Health Cigna Priority Health	$205.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$276.34
Rate for Payer: Priority Health Narrow Network	$221.08
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$277.53

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$246.43

Service Code	NDC 00409739172
Hospital Charge Code	7351
Hospital Revenue Code	250
Min. Negotiated Rate	$160.18
Max. Negotiated Rate	$246.43
Rate for Payer: Aetna Commercial	$221.79
Rate for Payer: ASR ASR	$239.04
Rate for Payer: ASR Commercial	$239.04
Rate for Payer: BCBS Trust/PPO	$200.82
Rate for Payer: BCN Commercial	$191.06
Rate for Payer: Cash Price	$197.14
Rate for Payer: Cofinity Commercial	$231.64
Rate for Payer: Encore Health Key Benefits Commercial	$197.14
Rate for Payer: Healthscope Commercial	$246.43
Rate for Payer: Healthscope Whirlpool	$239.04
Rate for Payer: Mclaren Commercial	$221.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$209.47
Rate for Payer: Nomi Health Commercial	$202.07
Rate for Payer: Priority Health Cigna Priority Health	$160.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$216.86

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$246.43

Service Code	NDC 00409739182
Hospital Charge Code	7351
Hospital Revenue Code	250
Min. Negotiated Rate	$98.57
Max. Negotiated Rate	$246.43
Rate for Payer: Aetna Commercial	$221.79
Rate for Payer: Aetna Medicare	$123.22
Rate for Payer: ASR ASR	$239.04
Rate for Payer: ASR Commercial	$239.04
Rate for Payer: BCBS Complete	$98.57
Rate for Payer: BCBS Trust/PPO	$201.80
Rate for Payer: BCN Commercial	$191.06
Rate for Payer: Cash Price	$197.14
Rate for Payer: Cofinity Commercial	$231.64
Rate for Payer: Encore Health Key Benefits Commercial	$197.14
Rate for Payer: Healthscope Commercial	$246.43
Rate for Payer: Healthscope Whirlpool	$239.04
Rate for Payer: Mclaren Commercial	$221.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$209.47
Rate for Payer: Nomi Health Commercial	$202.07
Rate for Payer: Priority Health Cigna Priority Health	$160.18
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$215.92
Rate for Payer: Priority Health Narrow Network	$172.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$216.86

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$111.70

Service Code	NDC 63323017005
Hospital Charge Code	7351
Hospital Revenue Code	250
Min. Negotiated Rate	$44.68
Max. Negotiated Rate	$111.70
Rate for Payer: Aetna Commercial	$100.53
Rate for Payer: Aetna Medicare	$55.85
Rate for Payer: ASR ASR	$108.35
Rate for Payer: ASR Commercial	$108.35
Rate for Payer: BCBS Complete	$44.68
Rate for Payer: BCBS Trust/PPO	$91.47
Rate for Payer: BCN Commercial	$86.60
Rate for Payer: Cash Price	$89.36
Rate for Payer: Cofinity Commercial	$105.00
Rate for Payer: Encore Health Key Benefits Commercial	$89.36
Rate for Payer: Healthscope Commercial	$111.70
Rate for Payer: Healthscope Whirlpool	$108.35
Rate for Payer: Mclaren Commercial	$100.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$94.94
Rate for Payer: Nomi Health Commercial	$91.59
Rate for Payer: Priority Health Cigna Priority Health	$72.61
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$97.87
Rate for Payer: Priority Health Narrow Network	$78.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$98.30

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$315.38

Service Code	NDC 63323088116
Hospital Charge Code	7351
Hospital Revenue Code	250
Min. Negotiated Rate	$205.00
Max. Negotiated Rate	$315.38
Rate for Payer: Aetna Commercial	$283.84
Rate for Payer: ASR ASR	$305.92
Rate for Payer: ASR Commercial	$305.92
Rate for Payer: BCBS Trust/PPO	$257.00
Rate for Payer: BCN Commercial	$244.51
Rate for Payer: Cash Price	$252.30
Rate for Payer: Cofinity Commercial	$296.46
Rate for Payer: Encore Health Key Benefits Commercial	$252.30
Rate for Payer: Healthscope Commercial	$315.38
Rate for Payer: Healthscope Whirlpool	$305.92
Rate for Payer: Mclaren Commercial	$283.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$268.07
Rate for Payer: Nomi Health Commercial	$258.61
Rate for Payer: Priority Health Cigna Priority Health	$205.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$277.53

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$315.38

Service Code	NDC 63323088101
Hospital Charge Code	7351
Hospital Revenue Code	250
Min. Negotiated Rate	$205.00
Max. Negotiated Rate	$315.38
Rate for Payer: Aetna Commercial	$283.84
Rate for Payer: ASR ASR	$305.92
Rate for Payer: ASR Commercial	$305.92
Rate for Payer: BCBS Trust/PPO	$257.00
Rate for Payer: BCN Commercial	$244.51
Rate for Payer: Cash Price	$252.30
Rate for Payer: Cofinity Commercial	$296.46
Rate for Payer: Encore Health Key Benefits Commercial	$252.30
Rate for Payer: Healthscope Commercial	$315.38
Rate for Payer: Healthscope Whirlpool	$305.92
Rate for Payer: Mclaren Commercial	$283.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$268.07
Rate for Payer: Nomi Health Commercial	$258.61
Rate for Payer: Priority Health Cigna Priority Health	$205.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$277.53

Know your out-of-pocket cost for care.

All Charges