|
DEXTROSE 5 % IN WATER (D5W) IV BOLUS FROM BAG
|
Facility
|
OP
|
$9.82
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
500616
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.82 |
| Max. Negotiated Rate |
$9.82 |
| Rate for Payer: BCBS Trust/PPO |
$9.82
|
| Rate for Payer: BCN Commercial |
$9.82
|
|
|
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 |
$4.90 |
| 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 |
$4.90
|
| Rate for Payer: BCN Commercial |
$4.90
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.62
|
| 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: PHP Commercial |
$45.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.94
|
| Rate for Payer: Priority Health SBD |
$33.86
|
| 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 Commercial |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.62
|
| 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: PHP Commercial |
$45.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.94
|
| 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
|
$71.78
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
150701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Aetna American Axle |
$46.66
|
| Rate for Payer: Aetna American Axle |
$36.29
|
| Rate for Payer: Aetna American Axle |
$34.94
|
| Rate for Payer: Aetna Commercial |
$61.01
|
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna Commercial |
$47.46
|
| Rate for Payer: Aetna Medicare |
$27.92
|
| 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) |
$46.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.29
|
| Rate for Payer: BCBS Complete |
$22.33
|
| Rate for Payer: BCBS Complete |
$28.71
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS Trust/PPO |
$4.90
|
| Rate for Payer: BCBS Trust/PPO |
$4.90
|
| Rate for Payer: BCBS Trust/PPO |
$4.90
|
| Rate for Payer: BCN Commercial |
$4.90
|
| Rate for Payer: BCN Commercial |
$4.90
|
| Rate for Payer: BCN Commercial |
$4.90
|
| Rate for Payer: Cash Price |
$44.66
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$44.66
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cofinity Commercial |
$48.01
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Cofinity Commercial |
$39.08
|
| Rate for Payer: Cofinity Commercial |
$50.25
|
| Rate for Payer: Cofinity Commercial |
$61.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.42
|
| Rate for Payer: Healthscope Commercial |
$64.60
|
| Rate for Payer: Healthscope Commercial |
$50.25
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.25
|
| 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: Multiplan/Beech St/PHCS Commercial |
$47.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.01
|
| Rate for Payer: PHP Commercial |
$61.01
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: PHP Commercial |
$47.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.66
|
| Rate for Payer: Priority Health SBD |
$35.17
|
| Rate for Payer: Priority Health SBD |
$45.22
|
| Rate for Payer: Priority Health SBD |
$33.86
|
| 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 |
$40.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.84
|
|
|
DEXTROSE 5% IN WATER INTRAVENOUS SOLUTION (DOSE, ADMIN OVER & INDICATION REQUIRED)
|
Facility
|
OP
|
$60.47
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
301087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$54.42 |
| Rate for Payer: Aetna American Axle |
$39.31
|
| Rate for Payer: Aetna American Axle |
$36.39
|
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna American Axle |
$46.66
|
| Rate for Payer: Aetna American Axle |
$34.94
|
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna American Axle |
$40.76
|
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: Aetna Commercial |
$61.01
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Commercial |
$47.59
|
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna Commercial |
$51.40
|
| Rate for Payer: Aetna Medicare |
$31.36
|
| Rate for Payer: Aetna Medicare |
$33.60
|
| Rate for Payer: Aetna Medicare |
$30.24
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna Medicare |
$28.00
|
| Rate for Payer: Aetna Medicare |
$26.88
|
| Rate for Payer: Aetna Medicare |
$35.89
|
| 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) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Complete |
$24.19
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS Complete |
$28.71
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Complete |
$25.08
|
| Rate for Payer: BCBS Trust/PPO |
$4.90
|
| Rate for Payer: BCBS Trust/PPO |
$4.90
|
| Rate for Payer: BCBS Trust/PPO |
$4.90
|
| Rate for Payer: BCBS Trust/PPO |
$4.90
|
| Rate for Payer: BCBS Trust/PPO |
$4.90
|
| Rate for Payer: BCBS Trust/PPO |
$4.90
|
| Rate for Payer: BCBS Trust/PPO |
$4.90
|
| Rate for Payer: BCN Commercial |
$4.90
|
| Rate for Payer: BCN Commercial |
$4.90
|
| Rate for Payer: BCN Commercial |
$4.90
|
| Rate for Payer: BCN Commercial |
$4.90
|
| Rate for Payer: BCN Commercial |
$4.90
|
| Rate for Payer: BCN Commercial |
$4.90
|
| Rate for Payer: BCN Commercial |
$4.90
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cofinity Commercial |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Cofinity Commercial |
$42.33
|
| Rate for Payer: Cofinity Commercial |
$50.25
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$61.73
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$39.19
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$43.90
|
| Rate for Payer: Cofinity Commercial |
$53.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Healthscope Commercial |
$56.44
|
| Rate for Payer: Healthscope Commercial |
$64.60
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Healthscope Commercial |
$50.39
|
| Rate for Payer: Healthscope Commercial |
$54.42
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| 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: 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 |
$37.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.35
|
| 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 |
$53.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$51.40
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: PHP Commercial |
$47.59
|
| Rate for Payer: PHP Commercial |
$61.01
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.66
|
| Rate for Payer: Priority Health SBD |
$39.51
|
| Rate for Payer: Priority Health SBD |
$38.10
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$45.22
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: Priority Health SBD |
$33.86
|
| Rate for Payer: Priority Health SBD |
$35.27
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: UMR Bronson Commercial |
$26.56
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: UMR Bronson Commercial |
$23.20
|
| Rate for Payer: UMR Bronson Commercial |
$22.37
|
| Rate for Payer: UMR Bronson Commercial |
$20.72
|
| Rate for Payer: UMR Bronson Commercial |
$19.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.84
|
| 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 |
$40.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.35
|
|
|
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 |
$9.82 |
| 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 |
$9.82
|
| Rate for Payer: BCN Commercial |
$9.82
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: 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: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| 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 % IV BOLUS
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
400293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.82 |
| 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 |
$9.82
|
| Rate for Payer: BCN Commercial |
$9.82
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: 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: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| 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 % IV BOLUS
|
Facility
|
OP
|
$55.99
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
400293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$50.39 |
| Rate for Payer: Aetna American Axle |
$36.39
|
| Rate for Payer: Aetna American Axle |
$40.76
|
| Rate for Payer: Aetna American Axle |
$39.31
|
| Rate for Payer: Aetna American Axle |
$34.94
|
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna Commercial |
$47.59
|
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$51.40
|
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: Aetna Medicare |
$30.24
|
| Rate for Payer: Aetna Medicare |
$31.36
|
| Rate for Payer: Aetna Medicare |
$28.00
|
| Rate for Payer: Aetna Medicare |
$26.88
|
| Rate for Payer: Aetna Medicare |
$33.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.31
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS Complete |
$25.08
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Complete |
$24.19
|
| Rate for Payer: BCBS Trust/PPO |
$4.90
|
| Rate for Payer: BCBS Trust/PPO |
$4.90
|
| Rate for Payer: BCBS Trust/PPO |
$4.90
|
| Rate for Payer: BCBS Trust/PPO |
$4.90
|
| Rate for Payer: BCBS Trust/PPO |
$4.90
|
| Rate for Payer: BCN Commercial |
$4.90
|
| Rate for Payer: BCN Commercial |
$4.90
|
| Rate for Payer: BCN Commercial |
$4.90
|
| Rate for Payer: BCN Commercial |
$4.90
|
| Rate for Payer: BCN Commercial |
$4.90
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cofinity Commercial |
$39.19
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$42.33
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| 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 |
$46.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.17
|
| Rate for Payer: Healthscope Commercial |
$56.44
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Healthscope Commercial |
$50.39
|
| Rate for Payer: Healthscope Commercial |
$54.42
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.33
|
| 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 |
$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: Lakeland Regional Health Systems Commercial |
$45.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.69
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: PHP Commercial |
$47.59
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: PHP Commercial |
$51.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.39
|
| Rate for Payer: Priority Health SBD |
$35.27
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$39.51
|
| Rate for Payer: Priority Health SBD |
$33.86
|
| Rate for Payer: Priority Health SBD |
$38.10
|
| Rate for Payer: UMR Bronson Commercial |
$19.89
|
| Rate for Payer: UMR Bronson Commercial |
$22.37
|
| Rate for Payer: UMR Bronson Commercial |
$20.72
|
| Rate for Payer: UMR Bronson Commercial |
$23.20
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.99
|
| 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 |
$45.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
|
|
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: Cofinity Medicare Advantage |
$48.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: 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: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| 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 |
$34.94
|
| Rate for Payer: Aetna American Axle |
$36.39
|
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna American Axle |
$39.31
|
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: Aetna Commercial |
$47.59
|
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$51.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.39
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$53.93
|
| Rate for Payer: Cofinity Commercial |
$43.90
|
| Rate for Payer: Cofinity Commercial |
$42.33
|
| Rate for Payer: Cofinity Commercial |
$39.19
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Cofinity Commercial |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| 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 |
$48.38
|
| Rate for Payer: Healthscope Commercial |
$50.39
|
| Rate for Payer: Healthscope Commercial |
$56.44
|
| Rate for Payer: Healthscope Commercial |
$54.42
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| 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 |
$42.33
|
| 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: Lakeland Regional Health Systems Commercial |
$45.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.40
|
| 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 |
$45.69
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$51.40
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: PHP Commercial |
$47.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.94
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$38.10
|
| Rate for Payer: Priority Health SBD |
$35.27
|
| Rate for Payer: Priority Health SBD |
$33.86
|
| Rate for Payer: Priority Health SBD |
$39.51
|
| Rate for Payer: UMR Bronson Commercial |
$23.65
|
| Rate for Payer: UMR Bronson Commercial |
$24.64
|
| Rate for Payer: UMR Bronson Commercial |
$27.59
|
| Rate for Payer: UMR Bronson Commercial |
$29.56
|
| Rate for Payer: UMR Bronson Commercial |
$26.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.35
|
| 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 |
$47.03
|
|
|
DEXTROSE 5%-LACTATED RINGERS IV BOLUS FROM BAG
|
Facility
|
OP
|
$12.20
|
|
|
Service Code
|
HCPCS J7121
|
| Hospital Charge Code |
500632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$12.20 |
| Rate for Payer: BCBS Trust/PPO |
$12.20
|
| Rate for Payer: BCN Commercial |
$12.20
|
|
|
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 Commercial |
$75.94
|
| Rate for Payer: Cofinity Commercial |
$93.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.94
|
| 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: PHP Commercial |
$92.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.51
|
| Rate for Payer: Priority Health SBD |
$68.34
|
| 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
|
$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 Commercial |
$75.94
|
| Rate for Payer: Cofinity Commercial |
$93.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.94
|
| 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: PHP Commercial |
$92.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.51
|
| 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
|
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 Commercial |
$119.71
|
| Rate for Payer: Cofinity Commercial |
$97.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.44
|
| 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: PHP Commercial |
$118.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.48
|
| 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 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 Commercial |
$119.71
|
| Rate for Payer: Cofinity Commercial |
$97.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.44
|
| 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: PHP Commercial |
$118.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.48
|
| Rate for Payer: Priority Health SBD |
$87.70
|
| 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
|
$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 Commercial |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$94.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.11
|
| 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: PHP Commercial |
$93.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.60
|
| 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 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 Commercial |
$119.71
|
| Rate for Payer: Cofinity Commercial |
$97.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.44
|
| 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: PHP Commercial |
$118.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.48
|
| 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: Cofinity Medicare Advantage |
$77.11
|
| 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 Commercial |
$93.64
|
| Rate for Payer: PHP Commercial |
$93.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.60
|
| 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
|
$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 Commercial |
$119.71
|
| Rate for Payer: Cofinity Commercial |
$97.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.44
|
| 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: PHP Commercial |
$118.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.48
|
| Rate for Payer: Priority Health SBD |
$87.70
|
| Rate for Payer: UMR Bronson Commercial |
$51.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
|
|
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 Commercial |
$0.49
|
| Rate for Payer: Cofinity Commercial |
$0.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.49
|
| 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: PHP Commercial |
$0.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.46
|
| 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: Priority Health SBD |
$0.44
|
| Rate for Payer: UMR Bronson Commercial |
$0.26
|
| 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 Commercial |
$0.49
|
| Rate for Payer: Cofinity Commercial |
$0.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.49
|
| 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: PHP Commercial |
$0.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.53
|
|
|
DIAGNOSTIC BONE MARROW; BIOPSY(IES) AND ASPIRATION(S)
|
Facility
|
OP
|
$8,813.49
|
|
|
Service Code
|
CPT 38222
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$71.45 |
| Max. Negotiated Rate |
$8,813.49 |
| Rate for Payer: Aetna Medicare |
$2,916.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$2,897.37
|
| Rate for Payer: BCN Commercial |
$2,897.37
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Nomi Health Commercial |
$5,888.78
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,813.49
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$7,050.79
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.60
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Exchange |
$71.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,503.04
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
DIALYSATE RFP-401 (K-4/CA-3) SOLUTION
|
Facility
|
IP
|
$208.80
|
|
|
Service Code
|
NDC 09900000034
|
| 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: Cofinity Medicare Advantage |
$146.16
|
| 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 Commercial |
$177.48
|
| Rate for Payer: PHP Commercial |
$177.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.72
|
| 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-401 (K-4/CA-3) SOLUTION
|
Facility
|
OP
|
$208.80
|
|
|
Service Code
|
NDC 09900000034
|
| Hospital Charge Code |
150776
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$77.26 |
| Max. Negotiated Rate |
$187.92 |
| Rate for Payer: Aetna American Axle |
$135.72
|
| Rate for Payer: Aetna Commercial |
$177.48
|
| Rate for Payer: Aetna Medicare |
$104.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.72
|
| Rate for Payer: BCBS Complete |
$83.52
|
| Rate for Payer: Cash Price |
$167.04
|
| Rate for Payer: Cofinity Commercial |
$146.16
|
| Rate for Payer: Cofinity Commercial |
$179.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.16
|
| 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 Commercial |
$177.48
|
| Rate for Payer: PHP Commercial |
$177.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.72
|
| Rate for Payer: Priority Health SBD |
$131.54
|
| Rate for Payer: UMR Bronson Commercial |
$77.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.60
|
|
|
DIALYSATE RFP-402 (K-0/CA-3) SOLUTION
|
Facility
|
OP
|
$208.80
|
|
|
Service Code
|
NDC 09900000035
|
| Hospital Charge Code |
150777
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$77.26 |
| Max. Negotiated Rate |
$187.92 |
| Rate for Payer: Aetna American Axle |
$135.72
|
| Rate for Payer: Aetna Commercial |
$177.48
|
| Rate for Payer: Aetna Medicare |
$104.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.72
|
| Rate for Payer: BCBS Complete |
$83.52
|
| Rate for Payer: Cash Price |
$167.04
|
| Rate for Payer: Cofinity Commercial |
$146.16
|
| Rate for Payer: Cofinity Commercial |
$179.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.16
|
| 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 Commercial |
$177.48
|
| Rate for Payer: PHP Commercial |
$177.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.72
|
| Rate for Payer: Priority Health SBD |
$131.54
|
| Rate for Payer: UMR Bronson Commercial |
$77.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.60
|
|
