Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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

DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE

Facility

$66.09

Service Code	NDC 76329330201
Hospital Charge Code	112012
Hospital Revenue Code	250
Min. Negotiated Rate	$26.44
Max. Negotiated Rate	$59.48
Rate for Payer: Aetna Commercial	$56.18
Rate for Payer: Aetna Medicare	$33.04
Rate for Payer: Aetna New Business (MI Preferred)	$42.96
Rate for Payer: BCBS Complete	$26.44
Rate for Payer: Cash Price	$52.87
Rate for Payer: Cofinity Commercial	$46.26
Rate for Payer: Cofinity Commercial	$56.84
Rate for Payer: Cofinity Medicare Advantage	$46.26
Rate for Payer: Encore Health Key Benefits Commercial	$52.87
Rate for Payer: Healthscope Commercial	$59.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.18
Rate for Payer: PHP Commercial	$56.18
Rate for Payer: Priority Health Cigna Priority Health	$42.96
Rate for Payer: Priority Health SBD	$41.64

DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE

Facility

$66.09

Service Code	NDC 76329330201
Hospital Charge Code	112012
Hospital Revenue Code	250
Min. Negotiated Rate	$41.64
Max. Negotiated Rate	$59.48
Rate for Payer: Aetna Commercial	$56.18
Rate for Payer: Aetna New Business (MI Preferred)	$42.96
Rate for Payer: Cash Price	$52.87
Rate for Payer: Cofinity Commercial	$46.26
Rate for Payer: Cofinity Commercial	$56.84
Rate for Payer: Cofinity Medicare Advantage	$46.26
Rate for Payer: Encore Health Key Benefits Commercial	$52.87
Rate for Payer: Healthscope Commercial	$59.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.18
Rate for Payer: PHP Commercial	$56.18
Rate for Payer: Priority Health Cigna Priority Health	$42.96
Rate for Payer: Priority Health SBD	$41.64

DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE

Facility

$71.20

Service Code	NDC 00409490234
Hospital Charge Code	112012
Hospital Revenue Code	250
Min. Negotiated Rate	$44.86
Max. Negotiated Rate	$64.08
Rate for Payer: Aetna Commercial	$60.52
Rate for Payer: Aetna New Business (MI Preferred)	$46.28
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

DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE

Facility

$71.20

Service Code	NDC 00409490234
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

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 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 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

$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 0.2 % 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	$33.60
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

$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 0.45 % 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 0.45 % 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	$33.60
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 0.9 % 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	$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

$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 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	$43.86
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 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 % AND LACTATED RINGERS INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	HCPCS J7121
Hospital Charge Code	9788
Hospital Revenue Code	636
Min. Negotiated Rate	$12.78
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	$12.78
Rate for Payer: BCN Commercial	$12.78
Rate for Payer: Cash Price	$55.94
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	$3.74
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	$3.74
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	$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) FLUSH

Facility

$60.47

Service Code	HCPCS J7060
Hospital Charge Code	161492
Hospital Revenue Code	250
Min. Negotiated Rate	$5.13
Max. Negotiated Rate	$54.42
Rate for Payer: Aetna Commercial	$51.40
Rate for Payer: Aetna Medicare	$30.24
Rate for Payer: Aetna New Business (MI Preferred)	$39.31
Rate for Payer: BCBS Complete	$24.19
Rate for Payer: BCBS Trust/PPO	$5.13
Rate for Payer: BCN Commercial	$5.13
Rate for Payer: Cash Price	$48.38
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

Know your out-of-pocket cost for care.

All Charges