|
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 |
$12.46 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$12.46
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION (DOSE REQUIRED)
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
301014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$12.46
|
| 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: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION (DOSE REQUIRED)
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
301014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| 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: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION (DOSE REQUIRED)
|
Facility
|
OP
|
$63.80
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
301014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$57.42 |
| Rate for Payer: Aetna American Axle |
$41.47
|
| Rate for Payer: Aetna American Axle |
$33.48
|
| Rate for Payer: Aetna American Axle |
$36.39
|
| Rate for Payer: Aetna American Axle |
$38.58
|
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna American Axle |
$40.76
|
| Rate for Payer: Aetna Commercial |
$43.78
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$47.59
|
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: Aetna Commercial |
$50.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.48
|
| Rate for Payer: BCBS Complete |
$20.60
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS Complete |
$25.08
|
| Rate for Payer: BCBS Complete |
$23.74
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Complete |
$25.52
|
| Rate for Payer: BCBS Trust/PPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.22
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$47.48
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cash Price |
$41.21
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$47.48
|
| Rate for Payer: Cash Price |
$41.21
|
| Rate for Payer: Cofinity Commercial |
$53.93
|
| Rate for Payer: Cofinity Commercial |
$36.06
|
| Rate for Payer: Cofinity Commercial |
$44.30
|
| Rate for Payer: Cofinity Commercial |
$39.19
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Cofinity Commercial |
$41.54
|
| Rate for Payer: Cofinity Commercial |
$51.04
|
| Rate for Payer: Cofinity Commercial |
$43.90
|
| Rate for Payer: Cofinity Commercial |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.21
|
| Rate for Payer: Healthscope Commercial |
$50.39
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$53.42
|
| Rate for Payer: Healthscope Commercial |
$46.36
|
| Rate for Payer: Healthscope Commercial |
$56.44
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.78
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: PHP Commercial |
$50.45
|
| Rate for Payer: PHP Commercial |
$43.78
|
| Rate for Payer: PHP Commercial |
$47.59
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.19
|
| Rate for Payer: Priority Health SBD |
$40.19
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$39.51
|
| Rate for Payer: Priority Health SBD |
$35.27
|
| Rate for Payer: Priority Health SBD |
$37.39
|
| Rate for Payer: Priority Health SBD |
$32.45
|
| Rate for Payer: UMR Bronson Commercial |
$23.20
|
| Rate for Payer: UMR Bronson Commercial |
$21.96
|
| Rate for Payer: UMR Bronson Commercial |
$20.72
|
| Rate for Payer: UMR Bronson Commercial |
$19.06
|
| Rate for Payer: UMR Bronson Commercial |
$23.61
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.85
|
|
|
DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION (SD)
|
Facility
|
IP
|
$62.71
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
180608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$56.44 |
| Rate for Payer: Aetna American Axle |
$40.76
|
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.76
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cofinity Commercial |
$43.90
|
| Rate for Payer: Cofinity Commercial |
$53.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.17
|
| Rate for Payer: Healthscope Commercial |
$56.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.30
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.90
|
| Rate for Payer: Priority Health SBD |
$39.51
|
| Rate for Payer: UMR Bronson Commercial |
$27.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.03
|
|
|
DEXTROSE 5 % IN WATER (D5W) IV ADDITIONAL SOLUTION
|
Facility
|
IP
|
$62.71
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
180629
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$56.44 |
| Rate for Payer: Aetna American Axle |
$40.76
|
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.76
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cofinity Commercial |
$43.90
|
| Rate for Payer: Cofinity Commercial |
$53.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.17
|
| Rate for Payer: Healthscope Commercial |
$56.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.30
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.90
|
| Rate for Payer: Priority Health SBD |
$39.51
|
| Rate for Payer: UMR Bronson Commercial |
$27.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.03
|
|
|
DEXTROSE 5 % IN WATER (D5W) IV ADDITIONAL SOLUTION
|
Facility
|
OP
|
$80.41
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
180629
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$72.37 |
| Rate for Payer: Aetna American Axle |
$52.27
|
| Rate for Payer: Aetna American Axle |
$37.85
|
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Commercial |
$68.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.27
|
| Rate for Payer: BCBS Complete |
$23.29
|
| Rate for Payer: BCBS Complete |
$32.16
|
| Rate for Payer: BCBS Trust/PPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.22
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cash Price |
$64.33
|
| Rate for Payer: Cash Price |
$64.33
|
| Rate for Payer: Cofinity Commercial |
$56.29
|
| Rate for Payer: Cofinity Commercial |
$40.76
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Cofinity Commercial |
$69.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.58
|
| Rate for Payer: Healthscope Commercial |
$72.37
|
| Rate for Payer: Healthscope Commercial |
$52.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.35
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.29
|
| Rate for Payer: Priority Health SBD |
$50.66
|
| Rate for Payer: Priority Health SBD |
$36.68
|
| Rate for Payer: UMR Bronson Commercial |
$21.55
|
| Rate for Payer: UMR Bronson Commercial |
$29.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.31
|
|
|
DEXTROSE 5% IN WATER (D5W) IV SOLN BOTTLE
|
Facility
|
IP
|
$51.51
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
150706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$46.36 |
| Rate for Payer: Aetna American Axle |
$33.48
|
| Rate for Payer: Aetna Commercial |
$43.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.48
|
| Rate for Payer: Cash Price |
$41.21
|
| Rate for Payer: Cofinity Commercial |
$36.06
|
| Rate for Payer: Cofinity Commercial |
$44.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.21
|
| Rate for Payer: Healthscope Commercial |
$46.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.78
|
| Rate for Payer: PHP Commercial |
$43.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.06
|
| Rate for Payer: Priority Health SBD |
$32.45
|
| Rate for Payer: UMR Bronson Commercial |
$22.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.63
|
|
|
DEXTROSE 5% IN WATER (D5W) IV SOLP NON-PVC BAG
|
Facility
|
OP
|
$63.80
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
150701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$57.42 |
| Rate for Payer: Aetna American Axle |
$41.47
|
| Rate for Payer: Aetna American Axle |
$33.70
|
| Rate for Payer: Aetna American Axle |
$33.48
|
| Rate for Payer: Aetna Commercial |
$43.78
|
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.70
|
| Rate for Payer: BCBS Complete |
$20.74
|
| Rate for Payer: BCBS Complete |
$20.60
|
| Rate for Payer: BCBS Complete |
$25.52
|
| Rate for Payer: BCBS Trust/PPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.22
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$41.47
|
| Rate for Payer: Cash Price |
$41.47
|
| Rate for Payer: Cash Price |
$41.21
|
| Rate for Payer: Cash Price |
$41.21
|
| Rate for Payer: Cofinity Commercial |
$44.58
|
| Rate for Payer: Cofinity Commercial |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$44.30
|
| Rate for Payer: Cofinity Commercial |
$36.06
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Cofinity Commercial |
$36.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.47
|
| Rate for Payer: Healthscope Commercial |
$46.36
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Healthscope Commercial |
$46.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.23
|
| Rate for Payer: PHP Commercial |
$43.78
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: PHP Commercial |
$44.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.06
|
| Rate for Payer: Priority Health SBD |
$32.45
|
| Rate for Payer: Priority Health SBD |
$32.66
|
| Rate for Payer: Priority Health SBD |
$40.19
|
| Rate for Payer: UMR Bronson Commercial |
$19.18
|
| Rate for Payer: UMR Bronson Commercial |
$19.06
|
| Rate for Payer: UMR Bronson Commercial |
$23.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.85
|
|
|
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 |
$12.46 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$12.46
|
| 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: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
DEXTROSE 5% IN WATER INTRAVENOUS SOLUTION (DOSE, ADMIN OVER & INDICATION REQUIRED)
|
Facility
|
OP
|
$43.87
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
301087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$39.48 |
| Rate for Payer: Aetna American Axle |
$28.52
|
| Rate for Payer: Aetna American Axle |
$38.58
|
| Rate for Payer: Aetna American Axle |
$41.47
|
| Rate for Payer: Aetna American Axle |
$36.39
|
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna American Axle |
$40.76
|
| Rate for Payer: Aetna American Axle |
$33.48
|
| Rate for Payer: Aetna Commercial |
$50.45
|
| Rate for Payer: Aetna Commercial |
$37.29
|
| Rate for Payer: Aetna Commercial |
$43.78
|
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: Aetna Commercial |
$47.59
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.76
|
| Rate for Payer: BCBS Complete |
$23.74
|
| Rate for Payer: BCBS Complete |
$25.08
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Complete |
$20.60
|
| Rate for Payer: BCBS Complete |
$17.55
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS Complete |
$25.52
|
| Rate for Payer: BCBS Trust/PPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.22
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$47.48
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cash Price |
$41.21
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$41.21
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cash Price |
$47.48
|
| Rate for Payer: Cofinity Commercial |
$39.19
|
| Rate for Payer: Cofinity Commercial |
$36.06
|
| Rate for Payer: Cofinity Commercial |
$44.30
|
| Rate for Payer: Cofinity Commercial |
$53.93
|
| Rate for Payer: Cofinity Commercial |
$43.90
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Cofinity Commercial |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$37.73
|
| Rate for Payer: Cofinity Commercial |
$30.71
|
| Rate for Payer: Cofinity Commercial |
$41.54
|
| Rate for Payer: Cofinity Commercial |
$51.04
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.17
|
| Rate for Payer: Healthscope Commercial |
$50.39
|
| Rate for Payer: Healthscope Commercial |
$53.42
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$39.48
|
| Rate for Payer: Healthscope Commercial |
$56.44
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Healthscope Commercial |
$46.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.78
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: PHP Commercial |
$37.29
|
| Rate for Payer: PHP Commercial |
$50.45
|
| Rate for Payer: PHP Commercial |
$43.78
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: PHP Commercial |
$47.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health SBD |
$40.19
|
| Rate for Payer: Priority Health SBD |
$32.45
|
| Rate for Payer: Priority Health SBD |
$37.39
|
| Rate for Payer: Priority Health SBD |
$27.64
|
| Rate for Payer: Priority Health SBD |
$39.51
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$35.27
|
| Rate for Payer: UMR Bronson Commercial |
$16.23
|
| Rate for Payer: UMR Bronson Commercial |
$23.20
|
| Rate for Payer: UMR Bronson Commercial |
$23.61
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: UMR Bronson Commercial |
$20.72
|
| Rate for Payer: UMR Bronson Commercial |
$19.06
|
| Rate for Payer: UMR Bronson Commercial |
$21.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.99
|
|
|
DEXTROSE 5 % IV BOLUS
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
400293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| 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: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
DEXTROSE 5 % IV BOLUS
|
Facility
|
IP
|
$51.51
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
400293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$46.36 |
| Rate for Payer: Aetna American Axle |
$33.48
|
| Rate for Payer: Aetna American Axle |
$36.39
|
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna American Axle |
$38.58
|
| Rate for Payer: Aetna American Axle |
$40.76
|
| Rate for Payer: Aetna Commercial |
$43.78
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$47.59
|
| Rate for Payer: Aetna Commercial |
$50.45
|
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.58
|
| Rate for Payer: Cash Price |
$47.48
|
| Rate for Payer: Cash Price |
$41.21
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$39.19
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Cofinity Commercial |
$53.93
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$43.90
|
| Rate for Payer: Cofinity Commercial |
$51.04
|
| Rate for Payer: Cofinity Commercial |
$41.54
|
| Rate for Payer: Cofinity Commercial |
$44.30
|
| Rate for Payer: Cofinity Commercial |
$36.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.17
|
| Rate for Payer: Healthscope Commercial |
$46.36
|
| Rate for Payer: Healthscope Commercial |
$56.44
|
| Rate for Payer: Healthscope Commercial |
$50.39
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$53.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.59
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$47.59
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: PHP Commercial |
$50.45
|
| Rate for Payer: PHP Commercial |
$43.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health SBD |
$32.45
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$37.39
|
| Rate for Payer: Priority Health SBD |
$39.51
|
| Rate for Payer: Priority Health SBD |
$35.27
|
| Rate for Payer: UMR Bronson Commercial |
$26.11
|
| Rate for Payer: UMR Bronson Commercial |
$27.59
|
| Rate for Payer: UMR Bronson Commercial |
$24.64
|
| Rate for Payer: UMR Bronson Commercial |
$29.56
|
| Rate for Payer: UMR Bronson Commercial |
$22.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$110.16
|
|
|
Service Code
|
NDC 0338-0719-06
|
| Hospital Charge Code |
2367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.47 |
| Max. Negotiated Rate |
$99.14 |
| Rate for Payer: Aetna American Axle |
$71.60
|
| 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 Commercial |
$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: Kalamazoo County Sherrif's Dept Commercial |
$77.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.64
|
| Rate for Payer: PHP Commercial |
$93.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.11
|
| Rate for Payer: Priority Health SBD |
$69.40
|
| Rate for Payer: UMR Bronson Commercial |
$48.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.62
|
|
|
DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$108.48
|
|
|
Service Code
|
NDC 0264-7387-50
|
| Hospital Charge Code |
2367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.73 |
| Max. Negotiated Rate |
$97.63 |
| Rate for Payer: Aetna American Axle |
$70.51
|
| Rate for Payer: Aetna Commercial |
$92.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.51
|
| Rate for Payer: Cash Price |
$86.78
|
| Rate for Payer: Cofinity Commercial |
$75.94
|
| Rate for Payer: Cofinity Commercial |
$93.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.78
|
| Rate for Payer: Healthscope Commercial |
$97.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.21
|
| Rate for Payer: PHP Commercial |
$92.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.94
|
| Rate for Payer: Priority Health SBD |
$68.34
|
| Rate for Payer: UMR Bronson Commercial |
$47.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.36
|
|
|
DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$110.16
|
|
|
Service Code
|
NDC 0338-0719-06
|
| Hospital Charge Code |
2367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.76 |
| Max. Negotiated Rate |
$99.14 |
| Rate for Payer: Aetna American Axle |
$71.60
|
| Rate for Payer: Aetna Commercial |
$93.64
|
| 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 Commercial |
$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: Kalamazoo County Sherrif's Dept Commercial |
$77.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.64
|
| Rate for Payer: PHP Commercial |
$93.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.11
|
| Rate for Payer: Priority Health SBD |
$69.40
|
| Rate for Payer: UMR Bronson Commercial |
$40.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.62
|
|
|
DEXTROSE-DEXTRIN-MALTOSE 24 GRAM/31 GRAM ORAL GEL
|
Facility
|
IP
|
$22.05
|
|
|
Service Code
|
NDC 187074633
|
| Hospital Charge Code |
166415
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$19.84 |
| Rate for Payer: Aetna American Axle |
$14.33
|
| Rate for Payer: Aetna Commercial |
$18.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.33
|
| Rate for Payer: Cash Price |
$17.64
|
| Rate for Payer: Cofinity Commercial |
$15.44
|
| Rate for Payer: Cofinity Commercial |
$18.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.64
|
| Rate for Payer: Healthscope Commercial |
$19.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.74
|
| Rate for Payer: PHP Commercial |
$18.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.44
|
| Rate for Payer: Priority Health SBD |
$13.89
|
| Rate for Payer: UMR Bronson Commercial |
$9.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.54
|
|
|
DEXTROSE-GRAM-SOD CITRATE-GRAM-CITRIC AC FLUSH SOLUTION
|
Facility
|
IP
|
$0.70
|
|
|
Service Code
|
NDC 9900-0009-32
|
| Hospital Charge Code |
300358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Aetna American Axle |
$0.46
|
| Rate for Payer: Aetna Commercial |
$0.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.46
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cofinity Commercial |
$0.49
|
| Rate for Payer: Cofinity Commercial |
$0.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.56
|
| Rate for Payer: Healthscope Commercial |
$0.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.60
|
| Rate for Payer: PHP Commercial |
$0.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.49
|
| Rate for Payer: Priority Health SBD |
$0.44
|
| Rate for Payer: UMR Bronson Commercial |
$0.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.53
|
|
|
DIABETES WITH CC
|
Facility
|
IP
|
$13,719.45
|
|
|
Service Code
|
MS-DRG 638
|
| Min. Negotiated Rate |
$7,071.01 |
| Max. Negotiated Rate |
$13,719.45 |
| Rate for Payer: Aetna Medicare |
$7,740.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,303.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,303.96
|
| Rate for Payer: BCBS MAPPO |
$7,443.17
|
| Rate for Payer: BCBS Trust/PPO |
$13,134.93
|
| Rate for Payer: BCN Medicare Advantage |
$7,443.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,443.17
|
| Rate for Payer: Mclaren Medicare |
$7,443.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,815.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,559.65
|
| Rate for Payer: PACE Medicare |
$7,071.01
|
| Rate for Payer: PACE SWMI |
$7,443.17
|
| Rate for Payer: PHP Medicare Advantage |
$7,443.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,906.32
|
| Rate for Payer: Priority Health Medicare |
$7,443.17
|
| Rate for Payer: Priority Health Narrow Network |
$10,325.06
|
| Rate for Payer: Railroad Medicare Medicare |
$7,443.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,719.45
|
| Rate for Payer: UHC Core |
$11,249.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,443.17
|
| Rate for Payer: UHC Exchange |
$8,943.63
|
| Rate for Payer: UHC Medicare Advantage |
$7,666.47
|
| Rate for Payer: VA VA |
$7,443.17
|
|
|
DIABETES WITH MCC
|
Facility
|
IP
|
$22,107.62
|
|
|
Service Code
|
MS-DRG 637
|
| Min. Negotiated Rate |
$11,096.67 |
| Max. Negotiated Rate |
$22,107.62 |
| Rate for Payer: Aetna Medicare |
$12,147.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,600.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,600.89
|
| Rate for Payer: BCBS MAPPO |
$11,680.71
|
| Rate for Payer: BCBS Trust/PPO |
$20,892.25
|
| Rate for Payer: BCN Medicare Advantage |
$11,680.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,680.71
|
| Rate for Payer: Mclaren Medicare |
$11,680.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,264.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,432.82
|
| Rate for Payer: PACE Medicare |
$11,096.67
|
| Rate for Payer: PACE SWMI |
$11,680.71
|
| Rate for Payer: PHP Medicare Advantage |
$11,680.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,797.34
|
| Rate for Payer: Priority Health Medicare |
$11,680.71
|
| Rate for Payer: Priority Health Narrow Network |
$16,637.87
|
| Rate for Payer: Railroad Medicare Medicare |
$11,680.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,107.62
|
| Rate for Payer: UHC Core |
$18,127.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,680.71
|
| Rate for Payer: UHC Exchange |
$14,411.84
|
| Rate for Payer: UHC Medicare Advantage |
$12,031.13
|
| Rate for Payer: VA VA |
$11,680.71
|
|
|
DIABETES WITHOUT CC/MCC
|
Facility
|
IP
|
$10,627.05
|
|
|
Service Code
|
MS-DRG 639
|
| Min. Negotiated Rate |
$5,043.89 |
| Max. Negotiated Rate |
$10,627.05 |
| Rate for Payer: Aetna Medicare |
$5,521.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,636.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,636.70
|
| Rate for Payer: BCBS MAPPO |
$5,309.36
|
| Rate for Payer: BCBS Trust/PPO |
$10,627.05
|
| Rate for Payer: BCN Medicare Advantage |
$5,309.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,309.36
|
| Rate for Payer: Mclaren Medicare |
$5,309.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,574.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,105.76
|
| Rate for Payer: PACE Medicare |
$5,043.89
|
| Rate for Payer: PACE SWMI |
$5,309.36
|
| Rate for Payer: PHP Medicare Advantage |
$5,309.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,932.83
|
| Rate for Payer: Priority Health Medicare |
$5,309.36
|
| Rate for Payer: Priority Health Narrow Network |
$7,146.26
|
| Rate for Payer: Railroad Medicare Medicare |
$5,309.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,495.62
|
| Rate for Payer: UHC Core |
$7,786.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,309.36
|
| Rate for Payer: UHC Exchange |
$6,190.14
|
| Rate for Payer: UHC Medicare Advantage |
$5,468.64
|
| Rate for Payer: VA VA |
$5,309.36
|
|
|
DIAGNOSTIC BONE MARROW; BIOPSY(IES) AND ASPIRATION(S)
|
Facility
|
OP
|
$7,951.14
|
|
|
Service Code
|
CPT 38222
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$72.69 |
| Max. Negotiated Rate |
$7,951.14 |
| Rate for Payer: Aetna Medicare |
$2,626.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,157.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,157.18
|
| Rate for Payer: BCBS Complete |
$1,450.79
|
| Rate for Payer: BCBS MAPPO |
$2,525.74
|
| Rate for Payer: BCBS Trust/PPO |
$2,762.53
|
| Rate for Payer: BCN Medicare Advantage |
$2,525.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,525.74
|
| Rate for Payer: Mclaren Medicaid |
$1,381.58
|
| Rate for Payer: Mclaren Medicare |
$2,525.74
|
| Rate for Payer: Meridian Medicaid |
$1,450.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,652.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,904.60
|
| Rate for Payer: PACE Medicare |
$2,399.45
|
| Rate for Payer: PACE SWMI |
$2,525.74
|
| Rate for Payer: PHP Medicare Advantage |
$2,525.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,381.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,951.14
|
| Rate for Payer: Priority Health Medicare |
$2,525.74
|
| Rate for Payer: Priority Health Narrow Network |
$6,360.91
|
| Rate for Payer: Railroad Medicare Medicare |
$2,525.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.96
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,525.74
|
| Rate for Payer: UHC Exchange |
$72.69
|
| Rate for Payer: UHC Medicare Advantage |
$2,601.51
|
| Rate for Payer: VA VA |
$2,525.74
|
|
|
DIALYSATE RFP-401 (K-4/CA-3) SOLUTION
|
Facility
|
IP
|
$208.80
|
|
|
Service Code
|
NDC 0990-0000-34
|
| Hospital Charge Code |
150776
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.87 |
| Max. Negotiated Rate |
$187.92 |
| Rate for Payer: Aetna American Axle |
$135.72
|
| Rate for Payer: Aetna Commercial |
$177.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.72
|
| Rate for Payer: Cash Price |
$167.04
|
| Rate for Payer: Cofinity Commercial |
$146.16
|
| Rate for Payer: Cofinity Commercial |
$179.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$187.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.48
|
| Rate for Payer: PHP Commercial |
$177.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.16
|
| Rate for Payer: Priority Health SBD |
$131.54
|
| Rate for Payer: UMR Bronson Commercial |
$91.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.60
|
|
|
DIALYSATE RFP-402 (K-0/CA-3) SOLUTION
|
Facility
|
IP
|
$208.80
|
|
|
Service Code
|
NDC 0990-0000-35
|
| Hospital Charge Code |
150777
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.87 |
| Max. Negotiated Rate |
$187.92 |
| Rate for Payer: Aetna American Axle |
$135.72
|
| Rate for Payer: Aetna Commercial |
$177.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.72
|
| Rate for Payer: Cash Price |
$167.04
|
| Rate for Payer: Cofinity Commercial |
$146.16
|
| Rate for Payer: Cofinity Commercial |
$179.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$187.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.48
|
| Rate for Payer: PHP Commercial |
$177.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.16
|
| Rate for Payer: Priority Health SBD |
$131.54
|
| Rate for Payer: UMR Bronson Commercial |
$91.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.60
|
|
|
DIALYSATE RFP-453 (K-2/CA-0) SOLUTION
|
Facility
|
IP
|
$208.80
|
|
|
Service Code
|
NDC 0990-0000-36
|
| Hospital Charge Code |
150773
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.87 |
| Max. Negotiated Rate |
$187.92 |
| Rate for Payer: Aetna American Axle |
$135.72
|
| Rate for Payer: Aetna Commercial |
$177.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.72
|
| Rate for Payer: Cash Price |
$167.04
|
| Rate for Payer: Cofinity Commercial |
$146.16
|
| Rate for Payer: Cofinity Commercial |
$179.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$187.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.48
|
| Rate for Payer: PHP Commercial |
$177.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.16
|
| Rate for Payer: Priority Health SBD |
$131.54
|
| Rate for Payer: UMR Bronson Commercial |
$91.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.60
|
|
