Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION (DOSE REQUIRED)

Facility

$69.92

Service Code	NDC 00338002304
Hospital Charge Code	300135
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: Cofinity Medicare Advantage	$48.94
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: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$45.45
Rate for Payer: Priority Health SBD	$44.05

DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION (DOSE REQUIRED)

Facility

$61.18

Service Code	NDC 00338002302
Hospital Charge Code	300135
Hospital Revenue Code	250
Min. Negotiated Rate	$24.47
Max. Negotiated Rate	$55.06
Rate for Payer: Aetna Commercial	$52.00
Rate for Payer: Aetna Medicare	$30.59
Rate for Payer: Aetna New Business (MI Preferred)	$39.77
Rate for Payer: BCBS Complete	$24.47
Rate for Payer: Cash Price	$48.94
Rate for Payer: Cofinity Commercial	$42.83
Rate for Payer: Cofinity Commercial	$52.61
Rate for Payer: Cofinity Medicare Advantage	$42.83
Rate for Payer: Encore Health Key Benefits Commercial	$48.94
Rate for Payer: Healthscope Commercial	$55.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.00
Rate for Payer: PHP Commercial	$52.00
Rate for Payer: Priority Health Cigna Priority Health	$39.77
Rate for Payer: Priority Health SBD	$38.54

DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION (DOSE REQUIRED)

Facility

$69.92

Service Code	NDC 00338002304
Hospital Charge Code	300135
Hospital Revenue Code	250
Min. Negotiated Rate	$27.97
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: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Cofinity Medicare Advantage	$48.94
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: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$45.45
Rate for Payer: Priority Health SBD	$44.05

DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION (DOSE REQUIRED)

Facility

$61.18

Service Code	NDC 00338002302
Hospital Charge Code	300135
Hospital Revenue Code	250
Min. Negotiated Rate	$38.54
Max. Negotiated Rate	$55.06
Rate for Payer: Aetna Commercial	$52.00
Rate for Payer: Aetna New Business (MI Preferred)	$39.77
Rate for Payer: Cash Price	$48.94
Rate for Payer: Cofinity Commercial	$42.83
Rate for Payer: Cofinity Commercial	$52.61
Rate for Payer: Cofinity Medicare Advantage	$42.83
Rate for Payer: Encore Health Key Benefits Commercial	$48.94
Rate for Payer: Healthscope Commercial	$55.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.00
Rate for Payer: PHP Commercial	$52.00
Rate for Payer: Priority Health Cigna Priority Health	$39.77
Rate for Payer: Priority Health SBD	$38.54

DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION (DOSE REQUIRED)

Facility

$69.92

Service Code	NDC 00338002303
Hospital Charge Code	300135
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: Cofinity Medicare Advantage	$48.94
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: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$45.45
Rate for Payer: Priority Health SBD	$44.05

DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION (DOSE REQUIRED)

Facility

$69.92

Service Code	NDC 00338002303
Hospital Charge Code	300135
Hospital Revenue Code	250
Min. Negotiated Rate	$27.97
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: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Cofinity Medicare Advantage	$48.94
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: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$45.45
Rate for Payer: Priority Health SBD	$44.05

DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION MAXIMUM RATE 250 MR

Facility

$69.92

Service Code	NDC 00338002304
Hospital Charge Code	300148
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: Cofinity Medicare Advantage	$48.94
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: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$45.45
Rate for Payer: Priority Health SBD	$44.05

DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION MAXIMUM RATE 250 MR

Facility

$69.92

Service Code	NDC 00338002304
Hospital Charge Code	300148
Hospital Revenue Code	250
Min. Negotiated Rate	$27.97
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: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Cofinity Medicare Advantage	$48.94
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: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$45.45
Rate for Payer: Priority Health SBD	$44.05

DEXTROSE 10 % IV BOLUS

Facility

$63.80

Service Code	NDC 00264752020
Hospital Charge Code	400302
Hospital Revenue Code	250
Min. Negotiated Rate	$40.19
Max. Negotiated Rate	$57.42
Rate for Payer: Aetna Commercial	$54.23
Rate for Payer: Aetna New Business (MI Preferred)	$41.47
Rate for Payer: Cash Price	$51.04
Rate for Payer: Cofinity Commercial	$44.66
Rate for Payer: Cofinity Commercial	$54.87
Rate for Payer: Cofinity Medicare Advantage	$44.66
Rate for Payer: Encore Health Key Benefits Commercial	$51.04
Rate for Payer: Healthscope Commercial	$57.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.23
Rate for Payer: PHP Commercial	$54.23
Rate for Payer: Priority Health Cigna Priority Health	$41.47
Rate for Payer: Priority Health SBD	$40.19

DEXTROSE 10 % IV BOLUS

Facility

$63.80

Service Code	NDC 00264752020
Hospital Charge Code	400302
Hospital Revenue Code	250
Min. Negotiated Rate	$25.52
Max. Negotiated Rate	$57.42
Rate for Payer: Aetna Commercial	$54.23
Rate for Payer: Aetna Medicare	$31.90
Rate for Payer: Aetna New Business (MI Preferred)	$41.47
Rate for Payer: BCBS Complete	$25.52
Rate for Payer: Cash Price	$51.04
Rate for Payer: Cofinity Commercial	$44.66
Rate for Payer: Cofinity Commercial	$54.87
Rate for Payer: Cofinity Medicare Advantage	$44.66
Rate for Payer: Encore Health Key Benefits Commercial	$51.04
Rate for Payer: Healthscope Commercial	$57.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.23
Rate for Payer: PHP Commercial	$54.23
Rate for Payer: Priority Health Cigna Priority Health	$41.47
Rate for Payer: Priority Health SBD	$40.19

DEXTROSE 2.45 GRAM-SOD CITRATE 2.2 GRAM-CITRIC AC 730 MG/100 ML SOLN

Facility

$79.75

Service Code	NDC 00942064104
Hospital Charge Code	167293
Hospital Revenue Code	250
Min. Negotiated Rate	$31.90
Max. Negotiated Rate	$71.78
Rate for Payer: Aetna Commercial	$67.79
Rate for Payer: Aetna Medicare	$39.88
Rate for Payer: Aetna New Business (MI Preferred)	$51.84
Rate for Payer: BCBS Complete	$31.90
Rate for Payer: Cash Price	$63.80
Rate for Payer: Cofinity Commercial	$55.82
Rate for Payer: Cofinity Commercial	$68.58
Rate for Payer: Cofinity Medicare Advantage	$55.82
Rate for Payer: Encore Health Key Benefits Commercial	$63.80
Rate for Payer: Healthscope Commercial	$71.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.79
Rate for Payer: PHP Commercial	$67.79
Rate for Payer: Priority Health Cigna Priority Health	$51.84
Rate for Payer: Priority Health SBD	$50.24

DEXTROSE 2.45 GRAM-SOD CITRATE 2.2 GRAM-CITRIC AC 730 MG/100 ML SOLN

Facility

$79.75

Service Code	NDC 00942064104
Hospital Charge Code	167293
Hospital Revenue Code	250
Min. Negotiated Rate	$50.24
Max. Negotiated Rate	$71.78
Rate for Payer: Aetna Commercial	$67.79
Rate for Payer: Aetna New Business (MI Preferred)	$51.84
Rate for Payer: Cash Price	$63.80
Rate for Payer: Cofinity Commercial	$55.82
Rate for Payer: Cofinity Commercial	$68.58
Rate for Payer: Cofinity Medicare Advantage	$55.82
Rate for Payer: Encore Health Key Benefits Commercial	$63.80
Rate for Payer: Healthscope Commercial	$71.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.79
Rate for Payer: PHP Commercial	$67.79
Rate for Payer: Priority Health Cigna Priority Health	$51.84
Rate for Payer: Priority Health SBD	$50.24

DEXTROSE 40 % ORAL GEL

Facility

$15.02

Service Code	NDC 00574007030
Hospital Charge Code	27466
Hospital Revenue Code	637
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$13.52
Rate for Payer: Aetna Commercial	$12.77
Rate for Payer: Aetna New Business (MI Preferred)	$9.76
Rate for Payer: Cash Price	$12.02
Rate for Payer: Cofinity Commercial	$10.51
Rate for Payer: Cofinity Commercial	$12.92
Rate for Payer: Cofinity Medicare Advantage	$10.51
Rate for Payer: Encore Health Key Benefits Commercial	$12.02
Rate for Payer: Healthscope Commercial	$13.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.77
Rate for Payer: PHP Commercial	$12.77
Rate for Payer: Priority Health Cigna Priority Health	$9.76
Rate for Payer: Priority Health SBD	$9.46

DEXTROSE 40 % ORAL GEL

Facility

$15.02

Service Code	NDC 00574006930
Hospital Charge Code	27466
Hospital Revenue Code	637
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$13.52
Rate for Payer: Aetna Commercial	$12.77
Rate for Payer: Aetna New Business (MI Preferred)	$9.76
Rate for Payer: Cash Price	$12.02
Rate for Payer: Cofinity Commercial	$10.51
Rate for Payer: Cofinity Commercial	$12.92
Rate for Payer: Cofinity Medicare Advantage	$10.51
Rate for Payer: Encore Health Key Benefits Commercial	$12.02
Rate for Payer: Healthscope Commercial	$13.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.77
Rate for Payer: PHP Commercial	$12.77
Rate for Payer: Priority Health Cigna Priority Health	$9.76
Rate for Payer: Priority Health SBD	$9.46

DEXTROSE 40 % ORAL GEL

Facility

$15.02

Service Code	NDC 00574007030
Hospital Charge Code	27466
Hospital Revenue Code	637
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$13.52
Rate for Payer: Aetna Commercial	$12.77
Rate for Payer: Aetna Medicare	$7.51
Rate for Payer: Aetna New Business (MI Preferred)	$9.76
Rate for Payer: BCBS Complete	$6.01
Rate for Payer: Cash Price	$12.02
Rate for Payer: Cofinity Commercial	$10.51
Rate for Payer: Cofinity Commercial	$12.92
Rate for Payer: Cofinity Medicare Advantage	$10.51
Rate for Payer: Encore Health Key Benefits Commercial	$12.02
Rate for Payer: Healthscope Commercial	$13.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.77
Rate for Payer: PHP Commercial	$12.77
Rate for Payer: Priority Health Cigna Priority Health	$9.76
Rate for Payer: Priority Health SBD	$9.46

DEXTROSE 40 % ORAL GEL

Facility

$15.19

Service Code	NDC 00574006915
Hospital Charge Code	27466
Hospital Revenue Code	637
Min. Negotiated Rate	$9.57
Max. Negotiated Rate	$13.67
Rate for Payer: Aetna Commercial	$12.91
Rate for Payer: Aetna New Business (MI Preferred)	$9.87
Rate for Payer: Cash Price	$12.15
Rate for Payer: Cofinity Commercial	$10.63
Rate for Payer: Cofinity Commercial	$13.06
Rate for Payer: Cofinity Medicare Advantage	$10.63
Rate for Payer: Encore Health Key Benefits Commercial	$12.15
Rate for Payer: Healthscope Commercial	$13.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.91
Rate for Payer: PHP Commercial	$12.91
Rate for Payer: Priority Health Cigna Priority Health	$9.87
Rate for Payer: Priority Health SBD	$9.57

DEXTROSE 40 % ORAL GEL

Facility

$2.81

Service Code	NDC 09900001911
Hospital Charge Code	27466
Hospital Revenue Code	637
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$2.53
Rate for Payer: Aetna Commercial	$2.39
Rate for Payer: Aetna Medicare	$1.40
Rate for Payer: Aetna New Business (MI Preferred)	$1.83
Rate for Payer: BCBS Complete	$1.12
Rate for Payer: Cash Price	$2.25
Rate for Payer: Cofinity Commercial	$1.97
Rate for Payer: Cofinity Commercial	$2.42
Rate for Payer: Cofinity Medicare Advantage	$1.97
Rate for Payer: Encore Health Key Benefits Commercial	$2.25
Rate for Payer: Healthscope Commercial	$2.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.39
Rate for Payer: PHP Commercial	$2.39
Rate for Payer: Priority Health Cigna Priority Health	$1.83
Rate for Payer: Priority Health SBD	$1.77

DEXTROSE 40 % ORAL GEL

Facility

$15.02

Service Code	NDC 00574006930
Hospital Charge Code	27466
Hospital Revenue Code	637
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$13.52
Rate for Payer: Aetna Commercial	$12.77
Rate for Payer: Aetna Medicare	$7.51
Rate for Payer: Aetna New Business (MI Preferred)	$9.76
Rate for Payer: BCBS Complete	$6.01
Rate for Payer: Cash Price	$12.02
Rate for Payer: Cofinity Commercial	$10.51
Rate for Payer: Cofinity Commercial	$12.92
Rate for Payer: Cofinity Medicare Advantage	$10.51
Rate for Payer: Encore Health Key Benefits Commercial	$12.02
Rate for Payer: Healthscope Commercial	$13.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.77
Rate for Payer: PHP Commercial	$12.77
Rate for Payer: Priority Health Cigna Priority Health	$9.76
Rate for Payer: Priority Health SBD	$9.46

DEXTROSE 40 % ORAL GEL

Facility

$2.81

Service Code	NDC 09900001911
Hospital Charge Code	27466
Hospital Revenue Code	637
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$2.53
Rate for Payer: Aetna Commercial	$2.39
Rate for Payer: Aetna New Business (MI Preferred)	$1.83
Rate for Payer: Cash Price	$2.25
Rate for Payer: Cofinity Commercial	$1.97
Rate for Payer: Cofinity Commercial	$2.42
Rate for Payer: Cofinity Medicare Advantage	$1.97
Rate for Payer: Encore Health Key Benefits Commercial	$2.25
Rate for Payer: Healthscope Commercial	$2.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.39
Rate for Payer: PHP Commercial	$2.39
Rate for Payer: Priority Health Cigna Priority Health	$1.83
Rate for Payer: Priority Health SBD	$1.77

DEXTROSE 40 % ORAL GEL

Facility

$15.19

Service Code	NDC 00574006915
Hospital Charge Code	27466
Hospital Revenue Code	637
Min. Negotiated Rate	$6.08
Max. Negotiated Rate	$13.67
Rate for Payer: Aetna Commercial	$12.91
Rate for Payer: Aetna Medicare	$7.60
Rate for Payer: Aetna New Business (MI Preferred)	$9.87
Rate for Payer: BCBS Complete	$6.08
Rate for Payer: Cash Price	$12.15
Rate for Payer: Cofinity Commercial	$10.63
Rate for Payer: Cofinity Commercial	$13.06
Rate for Payer: Cofinity Medicare Advantage	$10.63
Rate for Payer: Encore Health Key Benefits Commercial	$12.15
Rate for Payer: Healthscope Commercial	$13.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.91
Rate for Payer: PHP Commercial	$12.91
Rate for Payer: Priority Health Cigna Priority Health	$9.87
Rate for Payer: Priority Health SBD	$9.57

DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION

Facility

$66.99

Service Code	NDC 00409664816
Hospital Charge Code	2365
Hospital Revenue Code	250
Min. Negotiated Rate	$42.20
Max. Negotiated Rate	$60.29
Rate for Payer: Aetna Commercial	$56.94
Rate for Payer: Aetna New Business (MI Preferred)	$43.54
Rate for Payer: Cash Price	$53.59
Rate for Payer: Cofinity Commercial	$46.89
Rate for Payer: Cofinity Commercial	$57.61
Rate for Payer: Cofinity Medicare Advantage	$46.89
Rate for Payer: Encore Health Key Benefits Commercial	$53.59
Rate for Payer: Healthscope Commercial	$60.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.94
Rate for Payer: PHP Commercial	$56.94
Rate for Payer: Priority Health Cigna Priority Health	$43.54
Rate for Payer: Priority Health SBD	$42.20

DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION

Facility

$66.99

Service Code	NDC 00409664802
Hospital Charge Code	2365
Hospital Revenue Code	250
Min. Negotiated Rate	$26.80
Max. Negotiated Rate	$60.29
Rate for Payer: Aetna Commercial	$56.94
Rate for Payer: Aetna Medicare	$33.50
Rate for Payer: Aetna New Business (MI Preferred)	$43.54
Rate for Payer: BCBS Complete	$26.80
Rate for Payer: Cash Price	$53.59
Rate for Payer: Cofinity Commercial	$46.89
Rate for Payer: Cofinity Commercial	$57.61
Rate for Payer: Cofinity Medicare Advantage	$46.89
Rate for Payer: Encore Health Key Benefits Commercial	$53.59
Rate for Payer: Healthscope Commercial	$60.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.94
Rate for Payer: PHP Commercial	$56.94
Rate for Payer: Priority Health Cigna Priority Health	$43.54
Rate for Payer: Priority Health SBD	$42.20

DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION

Facility

$66.99

Service Code	NDC 00409664816
Hospital Charge Code	2365
Hospital Revenue Code	250
Min. Negotiated Rate	$26.80
Max. Negotiated Rate	$60.29
Rate for Payer: Aetna Commercial	$56.94
Rate for Payer: Aetna Medicare	$33.50
Rate for Payer: Aetna New Business (MI Preferred)	$43.54
Rate for Payer: BCBS Complete	$26.80
Rate for Payer: Cash Price	$53.59
Rate for Payer: Cofinity Commercial	$46.89
Rate for Payer: Cofinity Commercial	$57.61
Rate for Payer: Cofinity Medicare Advantage	$46.89
Rate for Payer: Encore Health Key Benefits Commercial	$53.59
Rate for Payer: Healthscope Commercial	$60.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.94
Rate for Payer: PHP Commercial	$56.94
Rate for Payer: Priority Health Cigna Priority Health	$43.54
Rate for Payer: Priority Health SBD	$42.20

DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION

Facility

$66.99

Service Code	NDC 00409664802
Hospital Charge Code	2365
Hospital Revenue Code	250
Min. Negotiated Rate	$42.20
Max. Negotiated Rate	$60.29
Rate for Payer: Aetna Commercial	$56.94
Rate for Payer: Aetna New Business (MI Preferred)	$43.54
Rate for Payer: Cash Price	$53.59
Rate for Payer: Cofinity Commercial	$46.89
Rate for Payer: Cofinity Commercial	$57.61
Rate for Payer: Cofinity Medicare Advantage	$46.89
Rate for Payer: Encore Health Key Benefits Commercial	$53.59
Rate for Payer: Healthscope Commercial	$60.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.94
Rate for Payer: PHP Commercial	$56.94
Rate for Payer: Priority Health Cigna Priority Health	$43.54
Rate for Payer: Priority Health SBD	$42.20

DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE

Facility

$71.20

Service Code	NDC 00409490264
Hospital Charge Code	112012
Hospital Revenue Code	250
Min. Negotiated Rate	$28.48
Max. Negotiated Rate	$64.08
Rate for Payer: Aetna Commercial	$60.52
Rate for Payer: Aetna Medicare	$35.60
Rate for Payer: Aetna New Business (MI Preferred)	$46.28
Rate for Payer: BCBS Complete	$28.48
Rate for Payer: Cash Price	$56.96
Rate for Payer: Cofinity Commercial	$49.84
Rate for Payer: Cofinity Commercial	$61.23
Rate for Payer: Cofinity Medicare Advantage	$49.84
Rate for Payer: Encore Health Key Benefits Commercial	$56.96
Rate for Payer: Healthscope Commercial	$64.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.52
Rate for Payer: PHP Commercial	$60.52
Rate for Payer: Priority Health Cigna Priority Health	$46.28
Rate for Payer: Priority Health SBD	$44.86

Know your out-of-pocket cost for care.

All Charges