Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SYRINGE

Facility

$19.41

Service Code	HCPCS J1100
Hospital Charge Code	192063
Hospital Revenue Code	636
Min. Negotiated Rate	$13.59
Max. Negotiated Rate	$19.41
Rate for Payer: Aetna Commercial	$17.47
Rate for Payer: ASR ASR	$18.83
Rate for Payer: BCBS Trust/PPO	$15.05
Rate for Payer: BCN Commercial	$15.05
Rate for Payer: Cash Price	$15.53
Rate for Payer: Cofinity Commercial	$18.25
Rate for Payer: Encore Health Key Benefits Commercial	$15.53
Rate for Payer: Healthscope Commercial	$19.41
Rate for Payer: Healthscope Whirlpool	$18.83
Rate for Payer: Mclaren Commercial	$17.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.50
Rate for Payer: Priority Health Cigna Priority Health	$13.59
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$17.08

DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP

Facility

$7.78

Service Code	NDC 0121-0638-05
Hospital Charge Code	9774
Hospital Revenue Code	637
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$7.78
Rate for Payer: Aetna Commercial	$7.00
Rate for Payer: ASR ASR	$7.55
Rate for Payer: BCBS Trust/PPO	$6.03
Rate for Payer: BCN Commercial	$6.03
Rate for Payer: Cash Price	$6.22
Rate for Payer: Cofinity Commercial	$7.31
Rate for Payer: Encore Health Key Benefits Commercial	$6.22
Rate for Payer: Healthscope Commercial	$7.78
Rate for Payer: Healthscope Whirlpool	$7.55
Rate for Payer: Mclaren Commercial	$7.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6.61
Rate for Payer: Priority Health Cigna Priority Health	$5.45
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$6.85

DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP

Facility

$8.74

Service Code	NDC 0121-1276-00
Hospital Charge Code	9774
Hospital Revenue Code	637
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$8.74
Rate for Payer: Aetna Commercial	$7.87
Rate for Payer: ASR ASR	$8.48
Rate for Payer: BCBS Trust/PPO	$6.78
Rate for Payer: BCN Commercial	$6.78
Rate for Payer: Cash Price	$6.99
Rate for Payer: Cofinity Commercial	$8.22
Rate for Payer: Encore Health Key Benefits Commercial	$6.99
Rate for Payer: Healthscope Commercial	$8.74
Rate for Payer: Healthscope Whirlpool	$8.48
Rate for Payer: Mclaren Commercial	$7.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7.43
Rate for Payer: Priority Health Cigna Priority Health	$6.12
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$7.69

DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP

Facility

$8.74

Service Code	NDC 0121-1276-10
Hospital Charge Code	9774
Hospital Revenue Code	637
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$8.74
Rate for Payer: Aetna Commercial	$7.87
Rate for Payer: ASR ASR	$8.48
Rate for Payer: BCBS Trust/PPO	$6.78
Rate for Payer: BCN Commercial	$6.78
Rate for Payer: Cash Price	$6.99
Rate for Payer: Cofinity Commercial	$8.22
Rate for Payer: Encore Health Key Benefits Commercial	$6.99
Rate for Payer: Healthscope Commercial	$8.74
Rate for Payer: Healthscope Whirlpool	$8.48
Rate for Payer: Mclaren Commercial	$7.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7.43
Rate for Payer: Priority Health Cigna Priority Health	$6.12
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$7.69

DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION

Facility

$61.18

Service Code	NDC 0338-0023-02
Hospital Charge Code	2357
Hospital Revenue Code	250
Min. Negotiated Rate	$42.83
Max. Negotiated Rate	$61.18
Rate for Payer: Aetna Commercial	$55.06
Rate for Payer: ASR ASR	$59.34
Rate for Payer: BCBS Trust/PPO	$47.43
Rate for Payer: BCN Commercial	$47.43
Rate for Payer: Cash Price	$48.94
Rate for Payer: Cofinity Commercial	$57.51
Rate for Payer: Encore Health Key Benefits Commercial	$48.94
Rate for Payer: Healthscope Commercial	$61.18
Rate for Payer: Healthscope Whirlpool	$59.34
Rate for Payer: Mclaren Commercial	$55.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$52.00
Rate for Payer: Priority Health Cigna Priority Health	$42.83
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$53.84

DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION

Facility

$59.81

Service Code	NDC 0264-7520-20
Hospital Charge Code	2357
Hospital Revenue Code	250
Min. Negotiated Rate	$41.87
Max. Negotiated Rate	$59.81
Rate for Payer: Aetna Commercial	$53.83
Rate for Payer: ASR ASR	$58.02
Rate for Payer: BCBS Trust/PPO	$46.37
Rate for Payer: BCN Commercial	$46.37
Rate for Payer: Cash Price	$47.85
Rate for Payer: Cofinity Commercial	$56.22
Rate for Payer: Encore Health Key Benefits Commercial	$47.85
Rate for Payer: Healthscope Commercial	$59.81
Rate for Payer: Healthscope Whirlpool	$58.02
Rate for Payer: Mclaren Commercial	$53.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$50.84
Rate for Payer: Priority Health Cigna Priority Health	$41.87
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$52.63

DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	NDC 0338-0023-04
Hospital Charge Code	2357
Hospital Revenue Code	250
Min. Negotiated Rate	$48.94
Max. Negotiated Rate	$69.92
Rate for Payer: Aetna Commercial	$62.93
Rate for Payer: ASR ASR	$67.82
Rate for Payer: BCBS Trust/PPO	$54.21
Rate for Payer: BCN Commercial	$54.21
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$65.72
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Healthscope Commercial	$69.92
Rate for Payer: Healthscope Whirlpool	$67.82
Rate for Payer: Mclaren Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$48.94
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.53

DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION MAXIMUM RATE 250 MR

Facility

$69.92

Service Code	NDC 0338-0023-04
Hospital Charge Code	300148
Hospital Revenue Code	250
Min. Negotiated Rate	$48.94
Max. Negotiated Rate	$69.92
Rate for Payer: Aetna Commercial	$62.93
Rate for Payer: ASR ASR	$67.82
Rate for Payer: BCBS Trust/PPO	$54.21
Rate for Payer: BCN Commercial	$54.21
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$65.72
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Healthscope Commercial	$69.92
Rate for Payer: Healthscope Whirlpool	$67.82
Rate for Payer: Mclaren Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$48.94
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.53

DEXTROSE 10 % IV BOLUS

Facility

$59.81

Service Code	NDC 0264-7520-20
Hospital Charge Code	400302
Hospital Revenue Code	250
Min. Negotiated Rate	$41.87
Max. Negotiated Rate	$59.81
Rate for Payer: Aetna Commercial	$53.83
Rate for Payer: ASR ASR	$58.02
Rate for Payer: BCBS Trust/PPO	$46.37
Rate for Payer: BCN Commercial	$46.37
Rate for Payer: Cash Price	$47.85
Rate for Payer: Cofinity Commercial	$56.22
Rate for Payer: Encore Health Key Benefits Commercial	$47.85
Rate for Payer: Healthscope Commercial	$59.81
Rate for Payer: Healthscope Whirlpool	$58.02
Rate for Payer: Mclaren Commercial	$53.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$50.84
Rate for Payer: Priority Health Cigna Priority Health	$41.87
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$52.63

DEXTROSE 15 GRAM/32 ML ORAL GEL PACKET

Facility

$42.98

Service Code	NDC 2129200441
Hospital Charge Code	185468
Hospital Revenue Code	637
Min. Negotiated Rate	$30.09
Max. Negotiated Rate	$42.98
Rate for Payer: Aetna Commercial	$38.68
Rate for Payer: ASR ASR	$41.69
Rate for Payer: BCBS Trust/PPO	$33.32
Rate for Payer: BCN Commercial	$33.32
Rate for Payer: Cash Price	$34.38
Rate for Payer: Cofinity Commercial	$40.40
Rate for Payer: Encore Health Key Benefits Commercial	$34.38
Rate for Payer: Healthscope Commercial	$42.98
Rate for Payer: Healthscope Whirlpool	$41.69
Rate for Payer: Mclaren Commercial	$38.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$36.53
Rate for Payer: Priority Health Cigna Priority Health	$30.09
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$37.82

DEXTROSE 25 % IN WATER (D25W) INTRAVENOUS SYRINGE

Facility

$61.10

Service Code	NDC 0409-1775-10
Hospital Charge Code	2361
Hospital Revenue Code	250
Min. Negotiated Rate	$42.77
Max. Negotiated Rate	$61.10
Rate for Payer: Aetna Commercial	$54.99
Rate for Payer: ASR ASR	$59.27
Rate for Payer: BCBS Trust/PPO	$47.37
Rate for Payer: BCN Commercial	$47.37
Rate for Payer: Cash Price	$48.88
Rate for Payer: Cofinity Commercial	$57.43
Rate for Payer: Encore Health Key Benefits Commercial	$48.88
Rate for Payer: Healthscope Commercial	$61.10
Rate for Payer: Healthscope Whirlpool	$59.27
Rate for Payer: Mclaren Commercial	$54.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.94
Rate for Payer: Priority Health Cigna Priority Health	$42.77
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$53.77

DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION

Facility

$95.70

Service Code	NDC 0409-7936-19
Hospital Charge Code	2365
Hospital Revenue Code	250
Min. Negotiated Rate	$66.99
Max. Negotiated Rate	$95.70
Rate for Payer: Aetna Commercial	$86.13
Rate for Payer: ASR ASR	$92.83
Rate for Payer: BCBS Trust/PPO	$74.20
Rate for Payer: BCN Commercial	$74.20
Rate for Payer: Cash Price	$76.56
Rate for Payer: Cofinity Commercial	$89.96
Rate for Payer: Encore Health Key Benefits Commercial	$76.56
Rate for Payer: Healthscope Commercial	$95.70
Rate for Payer: Healthscope Whirlpool	$92.83
Rate for Payer: Mclaren Commercial	$86.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$81.34
Rate for Payer: Priority Health Cigna Priority Health	$66.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$84.22

DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION

Facility

$59.02

Service Code	NDC 0409-6648-02
Hospital Charge Code	2365
Hospital Revenue Code	250
Min. Negotiated Rate	$41.31
Max. Negotiated Rate	$59.02
Rate for Payer: Aetna Commercial	$53.12
Rate for Payer: ASR ASR	$57.25
Rate for Payer: BCBS Trust/PPO	$45.76
Rate for Payer: BCN Commercial	$45.76
Rate for Payer: Cash Price	$47.21
Rate for Payer: Cofinity Commercial	$55.48
Rate for Payer: Encore Health Key Benefits Commercial	$47.22
Rate for Payer: Healthscope Commercial	$59.02
Rate for Payer: Healthscope Whirlpool	$57.25
Rate for Payer: Mclaren Commercial	$53.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$50.17
Rate for Payer: Priority Health Cigna Priority Health	$41.31
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$51.94

DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE

Facility

$43.00

Service Code	NDC 76329-3301-1
Hospital Charge Code	112012
Hospital Revenue Code	250
Min. Negotiated Rate	$30.10
Max. Negotiated Rate	$43.00
Rate for Payer: Aetna Commercial	$38.70
Rate for Payer: ASR ASR	$41.71
Rate for Payer: BCBS Trust/PPO	$33.34
Rate for Payer: BCN Commercial	$33.34
Rate for Payer: Cash Price	$34.40
Rate for Payer: Cofinity Commercial	$40.42
Rate for Payer: Encore Health Key Benefits Commercial	$34.40
Rate for Payer: Healthscope Commercial	$43.00
Rate for Payer: Healthscope Whirlpool	$41.71
Rate for Payer: Mclaren Commercial	$38.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$36.55
Rate for Payer: Priority Health Cigna Priority Health	$30.10
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$37.84

DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE

Facility

$52.60

Service Code	NDC 0409-7517-16
Hospital Charge Code	112012
Hospital Revenue Code	250
Min. Negotiated Rate	$36.82
Max. Negotiated Rate	$52.60
Rate for Payer: Aetna Commercial	$47.34
Rate for Payer: ASR ASR	$51.02
Rate for Payer: BCBS Trust/PPO	$40.78
Rate for Payer: BCN Commercial	$40.78
Rate for Payer: Cash Price	$42.08
Rate for Payer: Cofinity Commercial	$49.44
Rate for Payer: Encore Health Key Benefits Commercial	$42.08
Rate for Payer: Healthscope Commercial	$52.60
Rate for Payer: Healthscope Whirlpool	$51.02
Rate for Payer: Mclaren Commercial	$47.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$44.71
Rate for Payer: Priority Health Cigna Priority Health	$36.82
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$46.29

DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE

Facility

$53.80

Service Code	NDC 0409-4902-34
Hospital Charge Code	112012
Hospital Revenue Code	250
Min. Negotiated Rate	$37.66
Max. Negotiated Rate	$53.80
Rate for Payer: Aetna Commercial	$48.42
Rate for Payer: ASR ASR	$52.19
Rate for Payer: BCBS Trust/PPO	$41.71
Rate for Payer: BCN Commercial	$41.71
Rate for Payer: Cash Price	$43.04
Rate for Payer: Cofinity Commercial	$50.57
Rate for Payer: Encore Health Key Benefits Commercial	$43.04
Rate for Payer: Healthscope Commercial	$53.80
Rate for Payer: Healthscope Whirlpool	$52.19
Rate for Payer: Mclaren Commercial	$48.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$45.73
Rate for Payer: Priority Health Cigna Priority Health	$37.66
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$47.34

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

Facility

$98.68

Service Code	NDC 76329-3301-1
Hospital Charge Code	163718
Hospital Revenue Code	250
Min. Negotiated Rate	$69.08
Max. Negotiated Rate	$98.68
Rate for Payer: Aetna Commercial	$88.81
Rate for Payer: ASR ASR	$95.72
Rate for Payer: BCBS Trust/PPO	$76.51
Rate for Payer: BCN Commercial	$76.51
Rate for Payer: Cash Price	$78.95
Rate for Payer: Cofinity Commercial	$92.76
Rate for Payer: Encore Health Key Benefits Commercial	$78.94
Rate for Payer: Healthscope Commercial	$98.68
Rate for Payer: Healthscope Whirlpool	$95.72
Rate for Payer: Mclaren Commercial	$88.81
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$83.88
Rate for Payer: Priority Health Cigna Priority Health	$69.08
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$86.84

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

Facility

$89.16

Service Code	NDC 0409-7517-16
Hospital Charge Code	163718
Hospital Revenue Code	250
Min. Negotiated Rate	$62.41
Max. Negotiated Rate	$89.16
Rate for Payer: Aetna Commercial	$80.24
Rate for Payer: ASR ASR	$86.49
Rate for Payer: BCBS Trust/PPO	$69.13
Rate for Payer: BCN Commercial	$69.13
Rate for Payer: Cash Price	$71.33
Rate for Payer: Cofinity Commercial	$83.81
Rate for Payer: Encore Health Key Benefits Commercial	$71.33
Rate for Payer: Healthscope Commercial	$89.16
Rate for Payer: Healthscope Whirlpool	$86.49
Rate for Payer: Mclaren Commercial	$80.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$75.79
Rate for Payer: Priority Health Cigna Priority Health	$62.41
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$78.46

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

Facility

$91.19

Service Code	NDC 0409-4902-34
Hospital Charge Code	163718
Hospital Revenue Code	250
Min. Negotiated Rate	$63.83
Max. Negotiated Rate	$91.19
Rate for Payer: Aetna Commercial	$82.07
Rate for Payer: ASR ASR	$88.45
Rate for Payer: BCBS Trust/PPO	$70.70
Rate for Payer: BCN Commercial	$70.70
Rate for Payer: Cash Price	$72.95
Rate for Payer: Cofinity Commercial	$85.72
Rate for Payer: Encore Health Key Benefits Commercial	$72.95
Rate for Payer: Healthscope Commercial	$91.19
Rate for Payer: Healthscope Whirlpool	$88.45
Rate for Payer: Mclaren Commercial	$82.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$77.51
Rate for Payer: Priority Health Cigna Priority Health	$63.83
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$80.25

DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	NDC 0338-0085-04
Hospital Charge Code	9814
Hospital Revenue Code	250
Min. Negotiated Rate	$48.94
Max. Negotiated Rate	$69.92
Rate for Payer: Aetna Commercial	$62.93
Rate for Payer: ASR ASR	$67.82
Rate for Payer: BCBS Trust/PPO	$54.21
Rate for Payer: BCN Commercial	$54.21
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$65.72
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Healthscope Commercial	$69.92
Rate for Payer: Healthscope Whirlpool	$67.82
Rate for Payer: Mclaren Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$48.94
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.53

DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	NDC 0338-0089-04
Hospital Charge Code	9815
Hospital Revenue Code	250
Min. Negotiated Rate	$48.94
Max. Negotiated Rate	$69.92
Rate for Payer: Aetna Commercial	$62.93
Rate for Payer: ASR ASR	$67.82
Rate for Payer: BCBS Trust/PPO	$54.21
Rate for Payer: BCN Commercial	$54.21
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$65.72
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Healthscope Commercial	$69.92
Rate for Payer: Healthscope Whirlpool	$67.82
Rate for Payer: Mclaren Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$48.94
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.53

DEXTROSE 5 % AND LACTATED RINGERS INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	HCPCS J7121
Hospital Charge Code	9788
Hospital Revenue Code	636
Min. Negotiated Rate	$48.94
Max. Negotiated Rate	$69.92
Rate for Payer: Aetna Commercial	$62.93
Rate for Payer: ASR ASR	$67.82
Rate for Payer: BCBS Trust/PPO	$54.21
Rate for Payer: BCN Commercial	$54.21
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$65.72
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Healthscope Commercial	$69.92
Rate for Payer: Healthscope Whirlpool	$67.82
Rate for Payer: Mclaren Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$48.94
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.53

DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS PIGGYBACK

Facility

$179.66

Service Code	NDC 0338-0551-11
Hospital Charge Code	116171
Hospital Revenue Code	250
Min. Negotiated Rate	$125.76
Max. Negotiated Rate	$179.66
Rate for Payer: Aetna Commercial	$161.69
Rate for Payer: ASR ASR	$174.27
Rate for Payer: BCBS Trust/PPO	$139.29
Rate for Payer: BCN Commercial	$139.29
Rate for Payer: Cash Price	$143.73
Rate for Payer: Cofinity Commercial	$168.88
Rate for Payer: Encore Health Key Benefits Commercial	$143.73
Rate for Payer: Healthscope Commercial	$179.66
Rate for Payer: Healthscope Whirlpool	$174.27
Rate for Payer: Mclaren Commercial	$161.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$152.71
Rate for Payer: Priority Health Cigna Priority Health	$125.76
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$158.10

DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION

Facility

$63.80

Service Code	HCPCS J7060
Hospital Charge Code	2364
Hospital Revenue Code	636
Min. Negotiated Rate	$44.66
Max. Negotiated Rate	$63.80
Rate for Payer: Aetna Commercial	$57.42
Rate for Payer: Aetna Commercial	$48.38
Rate for Payer: Aetna Commercial	$50.39
Rate for Payer: ASR ASR	$52.14
Rate for Payer: ASR ASR	$54.31
Rate for Payer: ASR ASR	$61.89
Rate for Payer: BCBS Trust/PPO	$41.67
Rate for Payer: BCBS Trust/PPO	$43.41
Rate for Payer: BCBS Trust/PPO	$49.46
Rate for Payer: BCN Commercial	$49.46
Rate for Payer: BCN Commercial	$43.41
Rate for Payer: BCN Commercial	$41.67
Rate for Payer: Cash Price	$44.79
Rate for Payer: Cash Price	$51.04
Rate for Payer: Cash Price	$43.00
Rate for Payer: Cofinity Commercial	$50.52
Rate for Payer: Cofinity Commercial	$59.97
Rate for Payer: Cofinity Commercial	$52.63
Rate for Payer: Encore Health Key Benefits Commercial	$43.00
Rate for Payer: Encore Health Key Benefits Commercial	$51.04
Rate for Payer: Encore Health Key Benefits Commercial	$44.79
Rate for Payer: Healthscope Commercial	$55.99
Rate for Payer: Healthscope Commercial	$63.80
Rate for Payer: Healthscope Commercial	$53.75
Rate for Payer: Healthscope Whirlpool	$54.31
Rate for Payer: Healthscope Whirlpool	$61.89
Rate for Payer: Healthscope Whirlpool	$52.14
Rate for Payer: Mclaren Commercial	$50.39
Rate for Payer: Mclaren Commercial	$48.38
Rate for Payer: Mclaren Commercial	$57.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$47.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$45.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$54.23
Rate for Payer: Priority Health Cigna Priority Health	$39.19
Rate for Payer: Priority Health Cigna Priority Health	$37.62
Rate for Payer: Priority Health Cigna Priority Health	$44.66
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$47.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$56.14
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$49.27

DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	HCPCS J7070
Hospital Charge Code	2364
Hospital Revenue Code	636
Min. Negotiated Rate	$48.94
Max. Negotiated Rate	$69.92
Rate for Payer: Aetna Commercial	$62.93
Rate for Payer: ASR ASR	$67.82
Rate for Payer: BCBS Trust/PPO	$54.21
Rate for Payer: BCN Commercial	$54.21
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$65.72
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Healthscope Commercial	$69.92
Rate for Payer: Healthscope Whirlpool	$67.82
Rate for Payer: Mclaren Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$48.94
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.53

Know your out-of-pocket cost for care.

All Charges