Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

DEXTROSE 50% IN WATER (D50W) IV SYRINGE (CODE)

Facility

$98.23

Service Code	NDC 76329330101
Hospital Charge Code	163718
Hospital Revenue Code	250
Min. Negotiated Rate	$39.29
Max. Negotiated Rate	$88.41
Rate for Payer: Aetna Commercial	$83.50
Rate for Payer: Aetna Medicare	$49.12
Rate for Payer: Aetna New Business (MI Preferred)	$63.85
Rate for Payer: BCBS Complete	$39.29
Rate for Payer: Cash Price	$78.58
Rate for Payer: Cofinity Commercial	$68.76
Rate for Payer: Cofinity Commercial	$84.48
Rate for Payer: Cofinity Medicare Advantage	$68.76
Rate for Payer: Encore Health Key Benefits Commercial	$78.58
Rate for Payer: Healthscope Commercial	$88.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.50
Rate for Payer: PHP Commercial	$83.50
Rate for Payer: Priority Health Cigna Priority Health	$63.85
Rate for Payer: Priority Health SBD	$61.88

DEXTROSE 50% IN WATER (D50W) IV SYRINGE (CODE)

Facility

$98.23

Service Code	NDC 76329330101
Hospital Charge Code	163718
Hospital Revenue Code	250
Min. Negotiated Rate	$61.88
Max. Negotiated Rate	$88.41
Rate for Payer: Aetna Commercial	$83.50
Rate for Payer: Aetna New Business (MI Preferred)	$63.85
Rate for Payer: Cash Price	$78.58
Rate for Payer: Cofinity Commercial	$68.76
Rate for Payer: Cofinity Commercial	$84.48
Rate for Payer: Cofinity Medicare Advantage	$68.76
Rate for Payer: Encore Health Key Benefits Commercial	$78.58
Rate for Payer: Healthscope Commercial	$88.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.50
Rate for Payer: PHP Commercial	$83.50
Rate for Payer: Priority Health Cigna Priority Health	$63.85
Rate for Payer: Priority Health SBD	$61.88

DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS SOLUTION

Facility

$67.19

Service Code	NDC 00338007703
Hospital Charge Code	9812
Hospital Revenue Code	250
Min. Negotiated Rate	$26.88
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: Cash Price	$53.75
Rate for Payer: Cofinity Commercial	$47.03
Rate for Payer: Cofinity Commercial	$57.78
Rate for Payer: Cofinity Medicare Advantage	$47.03
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: PHP Commercial	$57.11
Rate for Payer: Priority Health Cigna Priority Health	$43.67
Rate for Payer: Priority Health SBD	$42.33

DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	NDC 00338007704
Hospital Charge Code	9812
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 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS SOLUTION

Facility

$67.19

Service Code	NDC 00338007703
Hospital Charge Code	9812
Hospital Revenue Code	250
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 Commercial	$47.03
Rate for Payer: Cofinity Commercial	$57.78
Rate for Payer: Cofinity Medicare Advantage	$47.03
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: PHP Commercial	$57.11
Rate for Payer: Priority Health Cigna Priority Health	$43.67
Rate for Payer: Priority Health SBD	$42.33

DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	NDC 00338007704
Hospital Charge Code	9812
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 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	NDC 00338008504
Hospital Charge Code	9814
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 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION

Facility

$67.19

Service Code	NDC 00338008503
Hospital Charge Code	9814
Hospital Revenue Code	250
Min. Negotiated Rate	$26.88
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: Cash Price	$53.75
Rate for Payer: Cofinity Commercial	$47.03
Rate for Payer: Cofinity Commercial	$57.78
Rate for Payer: Cofinity Medicare Advantage	$47.03
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: PHP Commercial	$57.11
Rate for Payer: Priority Health Cigna Priority Health	$43.67
Rate for Payer: Priority Health SBD	$42.33

DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	NDC 00338008504
Hospital Charge Code	9814
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 5 % AND 0.9 % SODIUM CHLORIDE 1.5X MAINTENANCE

Facility

$69.92

Service Code	NDC 00338008904
Hospital Charge Code	300210
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 5 % AND 0.9 % SODIUM CHLORIDE 1.5X MAINTENANCE

Facility

$69.92

Service Code	NDC 00338008904
Hospital Charge Code	300210
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 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	NDC 00338008904
Hospital Charge Code	9815
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 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	NDC 00338008904
Hospital Charge Code	9815
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 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION

Facility

$87.73

Service Code	NDC 00338008903
Hospital Charge Code	9815
Hospital Revenue Code	250
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$78.96
Rate for Payer: Aetna Commercial	$74.57
Rate for Payer: Aetna Medicare	$43.87
Rate for Payer: Aetna New Business (MI Preferred)	$57.02
Rate for Payer: BCBS Complete	$35.09
Rate for Payer: Cash Price	$70.18
Rate for Payer: Cofinity Commercial	$61.41
Rate for Payer: Cofinity Commercial	$75.45
Rate for Payer: Cofinity Medicare Advantage	$61.41
Rate for Payer: Encore Health Key Benefits Commercial	$70.18
Rate for Payer: Healthscope Commercial	$78.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.57
Rate for Payer: PHP Commercial	$74.57
Rate for Payer: Priority Health Cigna Priority Health	$57.02
Rate for Payer: Priority Health SBD	$55.27

DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION

Facility

$87.73

Service Code	NDC 00338008903
Hospital Charge Code	9815
Hospital Revenue Code	250
Min. Negotiated Rate	$55.27
Max. Negotiated Rate	$78.96
Rate for Payer: Aetna Commercial	$74.57
Rate for Payer: Aetna New Business (MI Preferred)	$57.02
Rate for Payer: Cash Price	$70.18
Rate for Payer: Cofinity Commercial	$61.41
Rate for Payer: Cofinity Commercial	$75.45
Rate for Payer: Cofinity Medicare Advantage	$61.41
Rate for Payer: Encore Health Key Benefits Commercial	$70.18
Rate for Payer: Healthscope Commercial	$78.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.57
Rate for Payer: PHP Commercial	$74.57
Rate for Payer: Priority Health Cigna Priority Health	$57.02
Rate for Payer: Priority Health SBD	$55.27

DEXTROSE 5 % AND LACTATED RINGERS INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	HCPCS J7121
Hospital Charge Code	9788
Hospital Revenue Code	636
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 5 % AND LACTATED RINGERS INTRAVENOUS SOLUTION

Facility

$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 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 5% IN WATER (D5W) FLUSH

Facility

$4.15

Service Code	NDC 09900002008
Hospital Charge Code	161492
Hospital Revenue Code	250
Min. Negotiated Rate	$1.66
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 Commercial	$2.90
Rate for Payer: Cofinity Commercial	$3.57
Rate for Payer: Cofinity Medicare Advantage	$2.90
Rate for Payer: Encore Health Key Benefits Commercial	$3.32
Rate for Payer: Healthscope Commercial	$3.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.53
Rate for Payer: PHP Commercial	$3.53
Rate for Payer: Priority Health Cigna Priority Health	$2.70
Rate for Payer: Priority Health SBD	$2.61

DEXTROSE 5% IN WATER (D5W) FLUSH

Facility

$60.47

Service Code	HCPCS J7060
Hospital Charge Code	161492
Hospital Revenue Code	250
Min. Negotiated Rate	$24.19
Max. Negotiated Rate	$54.42
Rate for Payer: Aetna Commercial	$51.40
Rate for Payer: Aetna Medicare	$30.23
Rate for Payer: Aetna New Business (MI Preferred)	$39.31
Rate for Payer: BCBS Complete	$24.19
Rate for Payer: Cash Price	$48.38
Rate for Payer: Cofinity Commercial	$42.33
Rate for Payer: Cofinity Commercial	$52.00
Rate for Payer: Cofinity Medicare Advantage	$42.33
Rate for Payer: Encore Health Key Benefits Commercial	$48.38
Rate for Payer: Healthscope Commercial	$54.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.40
Rate for Payer: PHP Commercial	$51.40
Rate for Payer: Priority Health Cigna Priority Health	$39.31
Rate for Payer: Priority Health SBD	$38.10

DEXTROSE 5% IN WATER (D5W) FLUSH

Facility

$60.47

Service Code	HCPCS J7060
Hospital Charge Code	161492
Hospital Revenue Code	250
Min. Negotiated Rate	$38.10
Max. Negotiated Rate	$54.42
Rate for Payer: Aetna Commercial	$51.40
Rate for Payer: Aetna New Business (MI Preferred)	$39.31
Rate for Payer: Cash Price	$48.38
Rate for Payer: Cofinity Commercial	$42.33
Rate for Payer: Cofinity Commercial	$52.00
Rate for Payer: Cofinity Medicare Advantage	$42.33
Rate for Payer: Encore Health Key Benefits Commercial	$48.38
Rate for Payer: Healthscope Commercial	$54.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.40
Rate for Payer: PHP Commercial	$51.40
Rate for Payer: Priority Health Cigna Priority Health	$39.31
Rate for Payer: Priority Health SBD	$38.10

DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS PIGGYBACK

Facility

$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 Commercial	$120.92
Rate for Payer: Cofinity Commercial	$148.56
Rate for Payer: Cofinity Medicare Advantage	$120.92
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: PHP Commercial	$146.84
Rate for Payer: Priority Health Cigna Priority Health	$112.29
Rate for Payer: Priority Health SBD	$108.83

DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS PIGGYBACK

Facility

$172.75

Service Code	NDC 00338914730
Hospital Charge Code	116171
Hospital Revenue Code	250
Min. Negotiated Rate	$69.10
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 Commercial	$120.92
Rate for Payer: Cofinity Commercial	$148.56
Rate for Payer: Cofinity Medicare Advantage	$120.92
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: PHP Commercial	$146.84
Rate for Payer: Priority Health Cigna Priority Health	$112.29
Rate for Payer: Priority Health SBD	$108.83

DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION

Facility

$55.99

Service Code	HCPCS J7060
Hospital Charge Code	2364
Hospital Revenue Code	636
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$50.39
Rate for Payer: Aetna Commercial	$47.59
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	$28.00
Rate for Payer: Aetna Medicare	$29.11
Rate for Payer: Aetna New Business (MI Preferred)	$43.67
Rate for Payer: Aetna New Business (MI Preferred)	$36.39
Rate for Payer: Aetna New Business (MI Preferred)	$37.85
Rate for Payer: BCBS Complete	$23.29
Rate for Payer: BCBS Complete	$22.40
Rate for Payer: BCBS Complete	$26.88
Rate for Payer: Cash Price	$53.75
Rate for Payer: Cash Price	$44.79
Rate for Payer: Cash Price	$46.58
Rate for Payer: Cofinity Commercial	$57.78
Rate for Payer: Cofinity Commercial	$48.15
Rate for Payer: Cofinity Commercial	$39.19
Rate for Payer: Cofinity Commercial	$50.08
Rate for Payer: Cofinity Commercial	$40.76
Rate for Payer: Cofinity Commercial	$47.03
Rate for Payer: Cofinity Medicare Advantage	$40.76
Rate for Payer: Cofinity Medicare Advantage	$39.19
Rate for Payer: Cofinity Medicare Advantage	$47.03
Rate for Payer: Encore Health Key Benefits Commercial	$46.58
Rate for Payer: Encore Health Key Benefits Commercial	$53.75
Rate for Payer: Encore Health Key Benefits Commercial	$44.79
Rate for Payer: Healthscope Commercial	$52.41
Rate for Payer: Healthscope Commercial	$50.39
Rate for Payer: Healthscope Commercial	$60.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$49.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$57.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$47.59
Rate for Payer: PHP Commercial	$49.50
Rate for Payer: PHP Commercial	$47.59
Rate for Payer: PHP Commercial	$57.11
Rate for Payer: Priority Health Cigna Priority Health	$36.39
Rate for Payer: Priority Health Cigna Priority Health	$43.67
Rate for Payer: Priority Health Cigna Priority Health	$37.85
Rate for Payer: Priority Health SBD	$42.33
Rate for Payer: Priority Health SBD	$36.68
Rate for Payer: Priority Health SBD	$35.27

DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION

Facility

$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 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 5 % IN WATER (D5W) INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	HCPCS J7070
Hospital Charge Code	2364
Hospital Revenue Code	636
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

Know your out-of-pocket cost for care.

All Charges