|
DEXTROSE 5 % AND LACTATED RINGERS INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7121
|
| Hospital Charge Code |
9788
|
|
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 Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
|
|
DEXTROSE 5% IN WATER (D5W) FLUSH
|
Facility
|
IP
|
$61.59
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
161492
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$55.43 |
| Rate for Payer: Aetna Commercial |
$52.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.03
|
| Rate for Payer: Cash Price |
$49.27
|
| Rate for Payer: Cofinity Advantage |
$43.11
|
| Rate for Payer: Cofinity Commercial |
$52.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.27
|
| Rate for Payer: Healthscope Commercial |
$55.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.19
|
| Rate for Payer: PHP Commercial |
$52.35
|
| Rate for Payer: Priority Health SBD |
$38.80
|
|
|
DEXTROSE 5% IN WATER (D5W) FLUSH
|
Facility
|
OP
|
$61.59
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
161492
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$55.43 |
| Rate for Payer: Aetna Commercial |
$52.35
|
| Rate for Payer: Aetna Medicare |
$30.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.03
|
| Rate for Payer: BCBS Complete |
$24.64
|
| Rate for Payer: BCBS Trust/PPO |
$4.36
|
| Rate for Payer: BCN Commercial |
$4.36
|
| Rate for Payer: Cash Price |
$49.27
|
| Rate for Payer: Cash Price |
$49.27
|
| Rate for Payer: Cofinity Advantage |
$43.11
|
| Rate for Payer: Cofinity Commercial |
$52.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.27
|
| Rate for Payer: Healthscope Commercial |
$55.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.19
|
| Rate for Payer: PHP Commercial |
$52.35
|
| Rate for Payer: Priority Health SBD |
$38.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.03
|
| Rate for Payer: UHC Core |
$32.09
|
| Rate for Payer: UHC Exchange |
$24.20
|
|
|
DEXTROSE 5% IN WATER (D5W) FLUSH
|
Facility
|
OP
|
$4.15
|
|
|
Service Code
|
NDC 9900002008
|
| Hospital Charge Code |
161492
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Aetna Medicare |
$2.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.70
|
| Rate for Payer: BCBS Complete |
$1.66
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Cofinity Advantage |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$3.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.32
|
| Rate for Payer: Healthscope Commercial |
$3.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.11
|
| Rate for Payer: PHP Commercial |
$3.53
|
| Rate for Payer: Priority Health SBD |
$2.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.70
|
| Rate for Payer: UHC Core |
$2.16
|
| Rate for Payer: UHC Exchange |
$1.63
|
|
|
DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$172.75
|
|
|
Service Code
|
NDC 00338914730
|
| Hospital Charge Code |
116171
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.83 |
| Max. Negotiated Rate |
$155.47 |
| Rate for Payer: Aetna Commercial |
$146.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.29
|
| Rate for Payer: Cash Price |
$138.20
|
| Rate for Payer: Cofinity Advantage |
$120.92
|
| Rate for Payer: Cofinity Commercial |
$148.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.20
|
| Rate for Payer: Healthscope Commercial |
$155.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.56
|
| Rate for Payer: PHP Commercial |
$146.84
|
| Rate for Payer: Priority Health SBD |
$108.83
|
|
|
DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$172.75
|
|
|
Service Code
|
NDC 00338914730
|
| Hospital Charge Code |
116171
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$67.89 |
| Max. Negotiated Rate |
$155.47 |
| Rate for Payer: Aetna Commercial |
$146.84
|
| Rate for Payer: Aetna Medicare |
$86.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.29
|
| Rate for Payer: BCBS Complete |
$69.10
|
| Rate for Payer: Cash Price |
$138.20
|
| Rate for Payer: Cofinity Advantage |
$120.92
|
| Rate for Payer: Cofinity Commercial |
$148.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.20
|
| Rate for Payer: Healthscope Commercial |
$155.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.56
|
| Rate for Payer: PHP Commercial |
$146.84
|
| Rate for Payer: Priority Health SBD |
$108.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.29
|
| Rate for Payer: UHC Core |
$90.00
|
| Rate for Payer: UHC Exchange |
$67.89
|
|
|
DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
2364
|
|
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 Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
|
|
DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
2364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna Medicare |
$29.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Complete |
$23.29
|
| Rate for Payer: BCBS Trust/PPO |
$4.36
|
| Rate for Payer: BCBS Trust/PPO |
$4.36
|
| Rate for Payer: BCN Commercial |
$4.36
|
| Rate for Payer: BCN Commercial |
$4.36
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Advantage |
$40.76
|
| Rate for Payer: Cofinity Advantage |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.58
|
| Rate for Payer: Healthscope Commercial |
$52.41
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: Priority Health SBD |
$36.68
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: UHC Exchange |
$2.89
|
| Rate for Payer: UHC Exchange |
$2.89
|
|
|
DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
2364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$7.36
|
| Rate for Payer: BCN Commercial |
$7.36
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope 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: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.85
|
| Rate for Payer: UHC Core |
$4.85
|
| Rate for Payer: UHC Exchange |
$4.85
|
|
|
DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$58.23
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
2364
|
|
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 |
$57.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Advantage |
$40.76
|
| Rate for Payer: Cofinity Advantage |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.58
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$52.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health SBD |
$36.68
|
| Rate for Payer: Priority Health SBD |
$42.33
|
|
|
DEXTROSE 5 % IN WATER (D5W) IV ADDITIONAL SOLUTION
|
Facility
|
OP
|
$58.23
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
180629
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$52.41 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Medicare |
$29.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.85
|
| Rate for Payer: BCBS Complete |
$23.29
|
| Rate for Payer: BCBS Trust/PPO |
$4.36
|
| Rate for Payer: BCN Commercial |
$4.36
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cofinity Advantage |
$40.76
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.58
|
| Rate for Payer: Healthscope Commercial |
$52.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.67
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: Priority Health SBD |
$36.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: UHC Exchange |
$2.89
|
|
|
DEXTROSE 5 % IN WATER (D5W) IV ADDITIONAL SOLUTION
|
Facility
|
IP
|
$58.23
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
180629
|
|
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 Advantage |
$40.76
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.58
|
| Rate for Payer: Healthscope Commercial |
$52.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.67
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: Priority Health SBD |
$36.68
|
|
|
DEXTROSE 5% IN WATER INTRAVENOUS SOLUTION (DOSE, ADMIN OVER & INDICATION REQUIRED)
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
301087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Medicare |
$29.11
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.85
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Complete |
$23.29
|
| Rate for Payer: BCBS Trust/PPO |
$4.36
|
| Rate for Payer: BCBS Trust/PPO |
$4.36
|
| Rate for Payer: BCN Commercial |
$4.36
|
| Rate for Payer: BCN Commercial |
$4.36
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Advantage |
$47.03
|
| Rate for Payer: Cofinity Advantage |
$40.76
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$52.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$36.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: UHC Exchange |
$2.89
|
| Rate for Payer: UHC Exchange |
$2.89
|
|
|
DEXTROSE 5% IN WATER INTRAVENOUS SOLUTION (DOSE, ADMIN OVER & INDICATION REQUIRED)
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
301087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$7.36
|
| Rate for Payer: BCN Commercial |
$7.36
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope 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: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.85
|
| Rate for Payer: UHC Core |
$4.85
|
| Rate for Payer: UHC Exchange |
$4.85
|
|
|
DEXTROSE 5 % IV BOLUS
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
400293
|
|
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 New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Advantage |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health SBD |
$42.33
|
|
|
DEXTROSE 5 % IV BOLUS
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
400293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$7.36
|
| Rate for Payer: BCN Commercial |
$7.36
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope 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: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.85
|
| Rate for Payer: UHC Core |
$4.85
|
| Rate for Payer: UHC Exchange |
$4.85
|
|
|
DEXTROSE 5 % IV BOLUS
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
400293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Trust/PPO |
$4.36
|
| Rate for Payer: BCN Commercial |
$4.36
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Advantage |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: UHC Exchange |
$2.89
|
|
|
DEXTROSE 5 % IV BOLUS
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
400293
|
|
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 Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
|
|
DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$110.16
|
|
|
Service Code
|
NDC 00338071906
|
| Hospital Charge Code |
2367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$99.14 |
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.60
|
| Rate for Payer: Cash Price |
$88.13
|
| Rate for Payer: Cofinity Advantage |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$94.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.13
|
| Rate for Payer: Healthscope Commercial |
$99.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.62
|
| Rate for Payer: PHP Commercial |
$93.64
|
| Rate for Payer: Priority Health SBD |
$69.40
|
|
|
DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$110.16
|
|
|
Service Code
|
NDC 00338071906
|
| Hospital Charge Code |
2367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.29 |
| Max. Negotiated Rate |
$99.14 |
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: Aetna Medicare |
$55.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.60
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: Cash Price |
$88.13
|
| Rate for Payer: Cofinity Advantage |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$94.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.13
|
| Rate for Payer: Healthscope Commercial |
$99.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.62
|
| Rate for Payer: PHP Commercial |
$93.64
|
| Rate for Payer: Priority Health SBD |
$69.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.60
|
| Rate for Payer: UHC Core |
$57.39
|
| Rate for Payer: UHC Exchange |
$43.29
|
|
|
DIABETES
|
Facility
|
IP
|
$6,107.94
|
|
|
Service Code
|
APR-DRG 4203
|
| Min. Negotiated Rate |
$5,817.08 |
| Max. Negotiated Rate |
$6,107.94 |
| Rate for Payer: BCBS Complete |
$6,107.94
|
| Rate for Payer: Mclaren Medicaid |
$5,817.08
|
| Rate for Payer: Meridian Medicaid |
$6,107.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,817.08
|
| Rate for Payer: UHC Medicaid |
$5,817.08
|
| Rate for Payer: UHCCP Medicaid |
$5,817.08
|
|
|
DIABETES
|
Facility
|
IP
|
$4,251.02
|
|
|
Service Code
|
APR-DRG 4202
|
| Min. Negotiated Rate |
$4,048.59 |
| Max. Negotiated Rate |
$4,251.02 |
| Rate for Payer: BCBS Complete |
$4,251.02
|
| Rate for Payer: Mclaren Medicaid |
$4,048.59
|
| Rate for Payer: Meridian Medicaid |
$4,251.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,048.59
|
| Rate for Payer: UHC Medicaid |
$4,048.59
|
| Rate for Payer: UHCCP Medicaid |
$4,048.59
|
|
|
DIABETES
|
Facility
|
IP
|
$9,403.27
|
|
|
Service Code
|
APR-DRG 4204
|
| Min. Negotiated Rate |
$8,955.49 |
| Max. Negotiated Rate |
$9,403.27 |
| Rate for Payer: BCBS Complete |
$9,403.27
|
| Rate for Payer: Mclaren Medicaid |
$8,955.49
|
| Rate for Payer: Meridian Medicaid |
$9,403.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,955.49
|
| Rate for Payer: UHC Medicaid |
$8,955.49
|
| Rate for Payer: UHCCP Medicaid |
$8,955.49
|
|
|
DIABETES
|
Facility
|
IP
|
$3,024.16
|
|
|
Service Code
|
APR-DRG 4201
|
| Min. Negotiated Rate |
$2,880.15 |
| Max. Negotiated Rate |
$3,024.16 |
| Rate for Payer: BCBS Complete |
$3,024.16
|
| Rate for Payer: Mclaren Medicaid |
$2,880.15
|
| Rate for Payer: Meridian Medicaid |
$3,024.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,880.15
|
| Rate for Payer: UHC Medicaid |
$2,880.15
|
| Rate for Payer: UHCCP Medicaid |
$2,880.15
|
|
|
DIABETES WITH CC
|
Facility
|
IP
|
$14,608.06
|
|
|
Service Code
|
MSDRG 638
|
| Min. Negotiated Rate |
$7,129.78 |
| Max. Negotiated Rate |
$14,608.06 |
| Rate for Payer: Aetna Medicare |
$7,805.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,381.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,381.29
|
| Rate for Payer: BCBS MAPPO |
$7,505.03
|
| Rate for Payer: BCBS Trust/PPO |
$12,221.32
|
| Rate for Payer: BCN Commercial |
$12,221.32
|
| Rate for Payer: BCN Medicare Advantage |
$7,505.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,505.03
|
| Rate for Payer: Mclaren Medicare |
$7,505.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,880.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,630.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,255.53
|
| Rate for Payer: Nomi Health Commercial |
$11,560.98
|
| Rate for Payer: PACE Medicare |
$7,129.78
|
| Rate for Payer: PACE SWMI |
$7,505.03
|
| Rate for Payer: PHP Medicare Advantage |
$7,505.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,448.66
|
| Rate for Payer: Priority Health Medicare |
$7,505.03
|
| Rate for Payer: Priority Health Tiered Network |
$11,558.93
|
| Rate for Payer: Railroad Medicare Medicare |
$7,505.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,608.06
|
| Rate for Payer: UHC Core |
$12,221.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,505.03
|
| Rate for Payer: UHC Exchange |
$9,980.98
|
| Rate for Payer: VA VA |
$7,505.03
|
|
