|
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 Advantage |
$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 Commercial |
$53.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.03
|
| Rate for Payer: PHP Commercial |
$53.30
|
| 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 SOLN BOTTLE
|
Facility
|
OP
|
$53.75
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
150706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$48.38 |
| Rate for Payer: Aetna American Axle |
$34.94
|
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna Medicare |
$26.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.94
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS Trust/PPO |
$5.63
|
| Rate for Payer: BCN Commercial |
$5.63
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Advantage |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$46.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.31
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: Priority Health SBD |
$33.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: UHC Exchange |
$2.89
|
| Rate for Payer: UMR Bronson Commercial |
$19.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
|
|
DEXTROSE 5% IN WATER (D5W) IV SOLN BOTTLE
|
Facility
|
IP
|
$53.75
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
150706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.65 |
| Max. Negotiated Rate |
$48.38 |
| Rate for Payer: Aetna American Axle |
$34.94
|
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.94
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Advantage |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$46.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.31
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: Priority Health SBD |
$33.86
|
| Rate for Payer: UMR Bronson Commercial |
$23.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
|
|
DEXTROSE 5% IN WATER (D5W) IV SOLP NON-PVC BAG
|
Facility
|
OP
|
$55.83
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
150701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$50.25 |
| Rate for Payer: Aetna American Axle |
$36.29
|
| Rate for Payer: Aetna American Axle |
$34.94
|
| Rate for Payer: Aetna American Axle |
$46.66
|
| Rate for Payer: Aetna Commercial |
$47.46
|
| Rate for Payer: Aetna Commercial |
$61.01
|
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna Medicare |
$27.91
|
| Rate for Payer: Aetna Medicare |
$26.88
|
| Rate for Payer: Aetna Medicare |
$35.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.66
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS Complete |
$22.33
|
| Rate for Payer: BCBS Complete |
$28.71
|
| Rate for Payer: BCBS Trust/PPO |
$5.63
|
| Rate for Payer: BCBS Trust/PPO |
$5.63
|
| Rate for Payer: BCBS Trust/PPO |
$5.63
|
| Rate for Payer: BCN Commercial |
$5.63
|
| Rate for Payer: BCN Commercial |
$5.63
|
| Rate for Payer: BCN Commercial |
$5.63
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cash Price |
$44.66
|
| Rate for Payer: Cash Price |
$44.66
|
| Rate for Payer: Cofinity Advantage |
$50.25
|
| Rate for Payer: Cofinity Advantage |
$39.08
|
| Rate for Payer: Cofinity Advantage |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$46.23
|
| Rate for Payer: Cofinity Commercial |
$48.01
|
| Rate for Payer: Cofinity Commercial |
$61.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.66
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Healthscope Commercial |
$50.25
|
| Rate for Payer: Healthscope Commercial |
$64.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.84
|
| Rate for Payer: PHP Commercial |
$47.46
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: PHP Commercial |
$61.01
|
| Rate for Payer: Priority Health SBD |
$33.86
|
| Rate for Payer: Priority Health SBD |
$45.22
|
| Rate for Payer: Priority Health SBD |
$35.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: UHC Exchange |
$2.89
|
| Rate for Payer: UHC Exchange |
$2.89
|
| Rate for Payer: UHC Exchange |
$2.89
|
| Rate for Payer: UMR Bronson Commercial |
$26.56
|
| Rate for Payer: UMR Bronson Commercial |
$19.89
|
| Rate for Payer: UMR Bronson Commercial |
$20.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.84
|
|
|
DEXTROSE 5% IN WATER INTRAVENOUS SOLUTION (DOSE, ADMIN OVER & INDICATION REQUIRED)
|
Facility
|
OP
|
$61.59
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
301087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$55.43 |
| Rate for Payer: Aetna American Axle |
$40.03
|
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna American Axle |
$34.94
|
| Rate for Payer: Aetna American Axle |
$46.66
|
| Rate for Payer: Aetna American Axle |
$40.76
|
| Rate for Payer: Aetna Commercial |
$61.01
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$52.35
|
| Rate for Payer: Aetna Medicare |
$26.88
|
| Rate for Payer: Aetna Medicare |
$30.80
|
| Rate for Payer: Aetna Medicare |
$31.36
|
| Rate for Payer: Aetna Medicare |
$35.89
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: BCBS Complete |
$25.08
|
| Rate for Payer: BCBS Complete |
$24.64
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Complete |
$28.71
|
| Rate for Payer: BCBS Trust/PPO |
$5.63
|
| Rate for Payer: BCBS Trust/PPO |
$5.63
|
| Rate for Payer: BCBS Trust/PPO |
$5.63
|
| Rate for Payer: BCBS Trust/PPO |
$5.63
|
| Rate for Payer: BCBS Trust/PPO |
$5.63
|
| Rate for Payer: BCBS Trust/PPO |
$5.63
|
| Rate for Payer: BCN Commercial |
$5.63
|
| Rate for Payer: BCN Commercial |
$5.63
|
| Rate for Payer: BCN Commercial |
$5.63
|
| Rate for Payer: BCN Commercial |
$5.63
|
| Rate for Payer: BCN Commercial |
$5.63
|
| Rate for Payer: BCN Commercial |
$5.63
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cash Price |
$49.27
|
| Rate for Payer: Cash Price |
$49.27
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Advantage |
$47.03
|
| Rate for Payer: Cofinity Advantage |
$43.90
|
| Rate for Payer: Cofinity Advantage |
$50.25
|
| Rate for Payer: Cofinity Advantage |
$37.62
|
| Rate for Payer: Cofinity Advantage |
$43.11
|
| Rate for Payer: Cofinity Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$46.23
|
| Rate for Payer: Cofinity Commercial |
$52.97
|
| Rate for Payer: Cofinity Commercial |
$53.93
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$61.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Healthscope Commercial |
$56.44
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$64.60
|
| Rate for Payer: Healthscope Commercial |
$55.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.03
|
| Rate for Payer: PHP Commercial |
$52.35
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$61.01
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$33.86
|
| Rate for Payer: Priority Health SBD |
$38.80
|
| Rate for Payer: Priority Health SBD |
$45.22
|
| Rate for Payer: Priority Health SBD |
$39.51
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: UHC Exchange |
$2.89
|
| Rate for Payer: UHC Exchange |
$2.89
|
| Rate for Payer: UHC Exchange |
$2.89
|
| Rate for Payer: UHC Exchange |
$2.89
|
| Rate for Payer: UHC Exchange |
$2.89
|
| Rate for Payer: UHC Exchange |
$2.89
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: UMR Bronson Commercial |
$22.79
|
| Rate for Payer: UMR Bronson Commercial |
$19.89
|
| Rate for Payer: UMR Bronson Commercial |
$26.56
|
| Rate for Payer: UMR Bronson Commercial |
$23.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.19
|
|
|
DEXTROSE 5% IN WATER INTRAVENOUS SOLUTION (DOSE, ADMIN OVER & INDICATION REQUIRED)
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
301087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| 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 |
$9.52
|
| Rate for Payer: BCN Commercial |
$9.52
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.85
|
| Rate for Payer: UHC Core |
$4.85
|
| Rate for Payer: UHC Exchange |
$4.85
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
DEXTROSE 5 % IV BOLUS
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
400293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna American Axle |
$34.94
|
| Rate for Payer: Aetna American Axle |
$40.03
|
| Rate for Payer: Aetna American Axle |
$40.76
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna Commercial |
$52.35
|
| Rate for Payer: Aetna Medicare |
$31.36
|
| Rate for Payer: Aetna Medicare |
$30.80
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna Medicare |
$26.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.76
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS Complete |
$24.64
|
| Rate for Payer: BCBS Complete |
$25.08
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Trust/PPO |
$5.63
|
| Rate for Payer: BCBS Trust/PPO |
$5.63
|
| Rate for Payer: BCBS Trust/PPO |
$5.63
|
| Rate for Payer: BCBS Trust/PPO |
$5.63
|
| Rate for Payer: BCN Commercial |
$5.63
|
| Rate for Payer: BCN Commercial |
$5.63
|
| Rate for Payer: BCN Commercial |
$5.63
|
| Rate for Payer: BCN Commercial |
$5.63
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cash Price |
$49.27
|
| Rate for Payer: Cash Price |
$49.27
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Advantage |
$47.03
|
| Rate for Payer: Cofinity Advantage |
$43.90
|
| Rate for Payer: Cofinity Advantage |
$43.11
|
| Rate for Payer: Cofinity Advantage |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$52.97
|
| Rate for Payer: Cofinity Commercial |
$53.93
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$46.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$56.44
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Healthscope Commercial |
$55.43
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.62
|
| 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 |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$52.35
|
| Rate for Payer: Priority Health SBD |
$39.51
|
| Rate for Payer: Priority Health SBD |
$33.86
|
| Rate for Payer: Priority Health SBD |
$38.80
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: UHC Exchange |
$2.89
|
| Rate for Payer: UHC Exchange |
$2.89
|
| Rate for Payer: UHC Exchange |
$2.89
|
| Rate for Payer: UHC Exchange |
$2.89
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: UMR Bronson Commercial |
$19.89
|
| Rate for Payer: UMR Bronson Commercial |
$22.79
|
| Rate for Payer: UMR Bronson Commercial |
$23.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
DEXTROSE 5 % IV BOLUS
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
400293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| 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 |
$9.52
|
| Rate for Payer: BCN Commercial |
$9.52
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.85
|
| Rate for Payer: UHC Core |
$4.85
|
| Rate for Payer: UHC Exchange |
$4.85
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
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 Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: 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 Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
DEXTROSE 5 % IV BOLUS
|
Facility
|
IP
|
$62.71
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
400293
|
|
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 American Axle |
$40.03
|
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna American Axle |
$34.94
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna Commercial |
$52.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.94
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$49.27
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cofinity Advantage |
$43.11
|
| Rate for Payer: Cofinity Advantage |
$37.62
|
| Rate for Payer: Cofinity Advantage |
$43.90
|
| Rate for Payer: Cofinity Advantage |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$53.93
|
| Rate for Payer: Cofinity Commercial |
$46.23
|
| Rate for Payer: Cofinity Commercial |
$52.97
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.27
|
| Rate for Payer: Healthscope Commercial |
$55.43
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$56.44
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.31
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: PHP Commercial |
$52.35
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$33.86
|
| Rate for Payer: Priority Health SBD |
$39.51
|
| Rate for Payer: Priority Health SBD |
$38.80
|
| Rate for Payer: UMR Bronson Commercial |
$27.10
|
| Rate for Payer: UMR Bronson Commercial |
$27.59
|
| Rate for Payer: UMR Bronson Commercial |
$23.65
|
| Rate for Payer: UMR Bronson Commercial |
$29.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$110.16
|
|
|
Service Code
|
NDC 00338071906
|
| Hospital Charge Code |
2367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$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 Medicare |
$55.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.60
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: Cash Price |
$88.13
|
| Rate for Payer: Cofinity Advantage |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$94.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.13
|
| Rate for Payer: Healthscope Commercial |
$99.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.62
|
| Rate for Payer: PHP Commercial |
$93.64
|
| Rate for Payer: Priority Health SBD |
$69.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.60
|
| Rate for Payer: UHC Core |
$57.39
|
| Rate for Payer: UHC Exchange |
$43.29
|
| Rate for Payer: UMR Bronson Commercial |
$40.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.62
|
|
|
DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$139.20
|
|
|
Service Code
|
NDC 00338978901
|
| Hospital Charge Code |
2367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$125.28 |
| Rate for Payer: Aetna American Axle |
$90.48
|
| Rate for Payer: Aetna Commercial |
$118.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.48
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cofinity Advantage |
$97.44
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.36
|
| Rate for Payer: Healthscope Commercial |
$125.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.40
|
| Rate for Payer: PHP Commercial |
$118.32
|
| Rate for Payer: Priority Health SBD |
$87.70
|
| Rate for Payer: UMR Bronson Commercial |
$61.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
|
|
DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$139.20
|
|
|
Service Code
|
NDC 00338978904
|
| Hospital Charge Code |
2367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.50 |
| Max. Negotiated Rate |
$125.28 |
| Rate for Payer: Aetna American Axle |
$90.48
|
| Rate for Payer: Aetna Commercial |
$118.32
|
| Rate for Payer: Aetna Medicare |
$69.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.48
|
| Rate for Payer: BCBS Complete |
$55.68
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cofinity Advantage |
$97.44
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.36
|
| Rate for Payer: Healthscope Commercial |
$125.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.40
|
| Rate for Payer: PHP Commercial |
$118.32
|
| Rate for Payer: Priority Health SBD |
$87.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.48
|
| Rate for Payer: UHC Core |
$72.52
|
| Rate for Payer: UHC Exchange |
$54.71
|
| Rate for Payer: UMR Bronson Commercial |
$51.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
|
|
DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$108.48
|
|
|
Service Code
|
NDC 00264738750
|
| Hospital Charge Code |
2367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.14 |
| Max. Negotiated Rate |
$97.63 |
| Rate for Payer: Aetna American Axle |
$70.51
|
| Rate for Payer: Aetna Commercial |
$92.21
|
| Rate for Payer: Aetna Medicare |
$54.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.51
|
| Rate for Payer: BCBS Complete |
$43.39
|
| Rate for Payer: Cash Price |
$86.78
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$86.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.36
|
| Rate for Payer: PHP Commercial |
$92.21
|
| Rate for Payer: Priority Health SBD |
$68.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.51
|
| Rate for Payer: UHC Core |
$56.52
|
| Rate for Payer: UHC Exchange |
$42.63
|
| Rate for Payer: UMR Bronson Commercial |
$40.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.36
|
|
|
DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$139.20
|
|
|
Service Code
|
NDC 00338978904
|
| Hospital Charge Code |
2367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$125.28 |
| Rate for Payer: Aetna American Axle |
$90.48
|
| Rate for Payer: Aetna Commercial |
$118.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.48
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cofinity Advantage |
$97.44
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.36
|
| Rate for Payer: Healthscope Commercial |
$125.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.40
|
| Rate for Payer: PHP Commercial |
$118.32
|
| Rate for Payer: Priority Health SBD |
$87.70
|
| Rate for Payer: UMR Bronson Commercial |
$61.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
|
|
DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$110.16
|
|
|
Service Code
|
NDC 00338071906
|
| Hospital Charge Code |
2367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$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 Advantage |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$94.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.13
|
| Rate for Payer: Healthscope Commercial |
$99.14
|
| Rate for Payer: 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 Commercial |
$93.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.62
|
| Rate for Payer: PHP Commercial |
$93.64
|
| Rate for Payer: Priority Health SBD |
$69.40
|
| Rate for Payer: UMR Bronson Commercial |
$48.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.62
|
|
|
DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$110.16
|
|
|
Service Code
|
NDC 338071906
|
| 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 Medicare |
$55.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.60
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: Cash Price |
$88.13
|
| Rate for Payer: Cofinity Advantage |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$94.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.13
|
| Rate for Payer: Healthscope Commercial |
$99.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.62
|
| Rate for Payer: PHP Commercial |
$93.64
|
| Rate for Payer: Priority Health SBD |
$69.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.60
|
| Rate for Payer: UHC Core |
$57.39
|
| Rate for Payer: UHC Exchange |
$43.29
|
| Rate for Payer: UMR Bronson Commercial |
$40.76
|
| 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 00264738750
|
| 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 Advantage |
$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 Commercial |
$92.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.36
|
| Rate for Payer: PHP Commercial |
$92.21
|
| 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
|
$139.20
|
|
|
Service Code
|
NDC 00338978901
|
| Hospital Charge Code |
2367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.50 |
| Max. Negotiated Rate |
$125.28 |
| Rate for Payer: Aetna American Axle |
$90.48
|
| Rate for Payer: Aetna Commercial |
$118.32
|
| Rate for Payer: Aetna Medicare |
$69.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.48
|
| Rate for Payer: BCBS Complete |
$55.68
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cofinity Advantage |
$97.44
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.36
|
| Rate for Payer: Healthscope Commercial |
$125.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.40
|
| Rate for Payer: PHP Commercial |
$118.32
|
| Rate for Payer: Priority Health SBD |
$87.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.48
|
| Rate for Payer: UHC Core |
$72.52
|
| Rate for Payer: UHC Exchange |
$54.71
|
| Rate for Payer: UMR Bronson Commercial |
$51.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
|
|
DEXTROSE-DEXTRIN-MALTOSE 24 GRAM/31 GRAM ORAL GEL
|
Facility
|
OP
|
$23.58
|
|
|
Service Code
|
NDC 24208002403
|
| Hospital Charge Code |
166415
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$21.22 |
| Rate for Payer: Aetna American Axle |
$15.33
|
| Rate for Payer: Aetna Commercial |
$20.04
|
| Rate for Payer: Aetna Medicare |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.33
|
| Rate for Payer: BCBS Complete |
$9.43
|
| Rate for Payer: Cash Price |
$18.86
|
| Rate for Payer: Cofinity Advantage |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.86
|
| Rate for Payer: Healthscope Commercial |
$21.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.68
|
| Rate for Payer: PHP Commercial |
$20.04
|
| Rate for Payer: Priority Health SBD |
$14.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.33
|
| Rate for Payer: UHC Core |
$12.29
|
| Rate for Payer: UHC Exchange |
$9.27
|
| Rate for Payer: UMR Bronson Commercial |
$8.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.68
|
|
|
DEXTROSE-DEXTRIN-MALTOSE 24 GRAM/31 GRAM ORAL GEL
|
Facility
|
IP
|
$23.58
|
|
|
Service Code
|
NDC 24208002401
|
| Hospital Charge Code |
166415
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$21.22 |
| Rate for Payer: Aetna American Axle |
$15.33
|
| Rate for Payer: Aetna Commercial |
$20.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.33
|
| Rate for Payer: Cash Price |
$18.86
|
| Rate for Payer: Cofinity Advantage |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.86
|
| Rate for Payer: Healthscope Commercial |
$21.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.68
|
| Rate for Payer: PHP Commercial |
$20.04
|
| Rate for Payer: Priority Health SBD |
$14.86
|
| Rate for Payer: UMR Bronson Commercial |
$10.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.68
|
|
|
DEXTROSE-DEXTRIN-MALTOSE 24 GRAM/31 GRAM ORAL GEL
|
Facility
|
OP
|
$23.58
|
|
|
Service Code
|
NDC 24208002401
|
| Hospital Charge Code |
166415
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$21.22 |
| Rate for Payer: Aetna American Axle |
$15.33
|
| Rate for Payer: Aetna Commercial |
$20.04
|
| Rate for Payer: Aetna Medicare |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.33
|
| Rate for Payer: BCBS Complete |
$9.43
|
| Rate for Payer: Cash Price |
$18.86
|
| Rate for Payer: Cofinity Advantage |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.86
|
| Rate for Payer: Healthscope Commercial |
$21.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.68
|
| Rate for Payer: PHP Commercial |
$20.04
|
| Rate for Payer: Priority Health SBD |
$14.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.33
|
| Rate for Payer: UHC Core |
$12.29
|
| Rate for Payer: UHC Exchange |
$9.27
|
| Rate for Payer: UMR Bronson Commercial |
$8.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.68
|
|
|
DEXTROSE-DEXTRIN-MALTOSE 24 GRAM/31 GRAM ORAL GEL
|
Facility
|
IP
|
$23.58
|
|
|
Service Code
|
NDC 24208002403
|
| Hospital Charge Code |
166415
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$21.22 |
| Rate for Payer: Aetna American Axle |
$15.33
|
| Rate for Payer: Aetna Commercial |
$20.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.33
|
| Rate for Payer: Cash Price |
$18.86
|
| Rate for Payer: Cofinity Advantage |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.86
|
| Rate for Payer: Healthscope Commercial |
$21.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.68
|
| Rate for Payer: PHP Commercial |
$20.04
|
| Rate for Payer: Priority Health SBD |
$14.86
|
| Rate for Payer: UMR Bronson Commercial |
$10.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.68
|
|
|
DEXTROSE-GRAM-SOD CITRATE-GRAM-CITRIC AC FLUSH SOLUTION
|
Facility
|
IP
|
$0.70
|
|
|
Service Code
|
NDC 09900000932
|
| 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 Advantage |
$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 Commercial |
$0.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.53
|
| Rate for Payer: PHP Commercial |
$0.60
|
| 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
|
|
|
DEXTROSE-GRAM-SOD CITRATE-GRAM-CITRIC AC FLUSH SOLUTION
|
Facility
|
OP
|
$0.70
|
|
|
Service Code
|
NDC 09900000932
|
| Hospital Charge Code |
300358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Aetna American Axle |
$0.46
|
| Rate for Payer: Aetna Commercial |
$0.60
|
| Rate for Payer: Aetna Medicare |
$0.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.46
|
| Rate for Payer: BCBS Complete |
$0.28
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$0.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.53
|
| Rate for Payer: PHP Commercial |
$0.60
|
| Rate for Payer: Priority Health SBD |
$0.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.46
|
| Rate for Payer: UHC Core |
$0.36
|
| Rate for Payer: UHC Exchange |
$0.28
|
| Rate for Payer: UMR Bronson Commercial |
$0.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.53
|
|
