|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
NDC 10006070028
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.13 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna Commercial |
$217.60
|
| Rate for Payer: Aetna Medicare |
$66.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.00
|
| Rate for Payer: BCBS Complete |
$47.39
|
| Rate for Payer: BCBS MAPPO |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$210.46
|
| Rate for Payer: BCN Commercial |
$210.46
|
| Rate for Payer: BCN Medicare Advantage |
$64.00
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cofinity Commercial |
$220.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.00
|
| Rate for Payer: Healthscope Commercial |
$230.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.00
|
| Rate for Payer: Mclaren Medicaid |
$45.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.20
|
| Rate for Payer: Meridian Medicaid |
$47.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$70.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.60
|
| Rate for Payer: Nomi Health Commercial |
$209.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.00
|
| Rate for Payer: PACE Senior Care Partners |
$60.80
|
| Rate for Payer: PACE SWMI |
$64.00
|
| Rate for Payer: PHP Commercial |
$217.60
|
| Rate for Payer: PHP Medicare Advantage |
$64.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$222.72
|
| Rate for Payer: Priority Health Medicare |
$64.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$178.18
|
| Rate for Payer: Railroad Medicare Medicare |
$64.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.28
|
| Rate for Payer: UHC Core |
$213.76
|
| Rate for Payer: UHC Exchange |
$64.00
|
| Rate for Payer: UHC Medicaid |
$45.13
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: UHCCP Medicaid |
$45.13
|
| Rate for Payer: VA VA |
$64.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.00
|
|
|
MAGNESIUM SULFATE 0.5 GRAM/ML (50 %) INJECTION (CODE)
|
Facility
|
IP
|
$21.44
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
163706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.92 |
| Max. Negotiated Rate |
$19.30 |
| Rate for Payer: Aetna Commercial |
$18.22
|
| Rate for Payer: BCBS Trust/PPO |
$17.71
|
| Rate for Payer: BCN Commercial |
$17.71
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cofinity Commercial |
$18.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.15
|
| Rate for Payer: Healthscope Commercial |
$19.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.22
|
| Rate for Payer: Nomi Health Commercial |
$17.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.08
|
| Rate for Payer: PHP Commercial |
$18.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.87
|
| Rate for Payer: UHC Core |
$17.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.08
|
|
|
MAGNESIUM SULFATE 0.5 GRAM/ML (50 %) INJECTION (CODE)
|
Facility
|
OP
|
$21.44
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
163706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$19.30 |
| Rate for Payer: Aetna Commercial |
$18.22
|
| Rate for Payer: Aetna Medicare |
$5.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.70
|
| Rate for Payer: BCBS Complete |
$3.97
|
| Rate for Payer: BCBS MAPPO |
$5.36
|
| Rate for Payer: BCBS Trust/PPO |
$17.63
|
| Rate for Payer: BCN Commercial |
$17.63
|
| Rate for Payer: BCN Medicare Advantage |
$5.36
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cofinity Commercial |
$18.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.36
|
| Rate for Payer: Healthscope Commercial |
$19.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.08
|
| Rate for Payer: Mclaren Medicaid |
$3.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.63
|
| Rate for Payer: Meridian Medicaid |
$3.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.22
|
| Rate for Payer: Nomi Health Commercial |
$17.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.08
|
| Rate for Payer: PACE Senior Care Partners |
$5.09
|
| Rate for Payer: PACE SWMI |
$5.36
|
| Rate for Payer: PHP Commercial |
$18.22
|
| Rate for Payer: PHP Medicare Advantage |
$5.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.65
|
| Rate for Payer: Priority Health Medicare |
$5.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.92
|
| Rate for Payer: Railroad Medicare Medicare |
$5.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.87
|
| Rate for Payer: UHC Core |
$17.90
|
| Rate for Payer: UHC Exchange |
$5.36
|
| Rate for Payer: UHC Medicaid |
$3.78
|
| Rate for Payer: UHC Medicare Advantage |
$5.36
|
| Rate for Payer: UHCCP Medicaid |
$3.78
|
| Rate for Payer: VA VA |
$5.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.08
|
|
|
MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$49.27
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
16162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$44.34 |
| Rate for Payer: Aetna Commercial |
$41.88
|
| Rate for Payer: Aetna Medicare |
$12.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.40
|
| Rate for Payer: BCBS Complete |
$9.12
|
| Rate for Payer: BCBS MAPPO |
$12.32
|
| Rate for Payer: BCBS Trust/PPO |
$40.50
|
| Rate for Payer: BCN Commercial |
$40.50
|
| Rate for Payer: BCN Medicare Advantage |
$12.32
|
| Rate for Payer: Cash Price |
$39.42
|
| Rate for Payer: Cofinity Commercial |
$42.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.32
|
| Rate for Payer: Healthscope Commercial |
$44.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.95
|
| Rate for Payer: Mclaren Medicaid |
$8.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.93
|
| Rate for Payer: Meridian Medicaid |
$9.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.88
|
| Rate for Payer: Nomi Health Commercial |
$40.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.95
|
| Rate for Payer: PACE Senior Care Partners |
$11.70
|
| Rate for Payer: PACE SWMI |
$12.32
|
| Rate for Payer: PHP Commercial |
$41.88
|
| Rate for Payer: PHP Medicare Advantage |
$12.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.86
|
| Rate for Payer: Priority Health Medicare |
$12.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.29
|
| Rate for Payer: Railroad Medicare Medicare |
$12.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.36
|
| Rate for Payer: UHC Core |
$41.14
|
| Rate for Payer: UHC Exchange |
$12.32
|
| Rate for Payer: UHC Medicaid |
$8.69
|
| Rate for Payer: UHC Medicare Advantage |
$12.32
|
| Rate for Payer: UHCCP Medicaid |
$8.69
|
| Rate for Payer: VA VA |
$12.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.95
|
|
|
MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$49.27
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
16162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.29 |
| Max. Negotiated Rate |
$44.34 |
| Rate for Payer: Aetna Commercial |
$41.88
|
| Rate for Payer: BCBS Trust/PPO |
$40.69
|
| Rate for Payer: BCN Commercial |
$40.69
|
| Rate for Payer: Cash Price |
$39.42
|
| Rate for Payer: Cofinity Commercial |
$42.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.42
|
| Rate for Payer: Healthscope Commercial |
$44.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.88
|
| Rate for Payer: Nomi Health Commercial |
$40.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.95
|
| Rate for Payer: PHP Commercial |
$41.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.36
|
| Rate for Payer: UHC Core |
$41.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.95
|
|
|
MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$79.75
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117958
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$71.78 |
| Rate for Payer: Aetna Commercial |
$67.79
|
| Rate for Payer: Aetna Medicare |
$20.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.92
|
| Rate for Payer: BCBS Complete |
$14.76
|
| Rate for Payer: BCBS MAPPO |
$19.94
|
| Rate for Payer: BCBS Trust/PPO |
$65.56
|
| Rate for Payer: BCN Commercial |
$65.56
|
| Rate for Payer: BCN Medicare Advantage |
$19.94
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Cofinity Commercial |
$68.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.94
|
| Rate for Payer: Healthscope Commercial |
$71.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.81
|
| Rate for Payer: Mclaren Medicaid |
$14.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.93
|
| Rate for Payer: Meridian Medicaid |
$14.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.79
|
| Rate for Payer: Nomi Health Commercial |
$65.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.81
|
| Rate for Payer: PACE Senior Care Partners |
$18.94
|
| Rate for Payer: PACE SWMI |
$19.94
|
| Rate for Payer: PHP Commercial |
$67.79
|
| Rate for Payer: PHP Medicare Advantage |
$19.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$69.38
|
| Rate for Payer: Priority Health Medicare |
$20.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.51
|
| Rate for Payer: Railroad Medicare Medicare |
$19.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.18
|
| Rate for Payer: UHC Core |
$66.59
|
| Rate for Payer: UHC Exchange |
$19.94
|
| Rate for Payer: UHC Medicaid |
$14.06
|
| Rate for Payer: UHC Medicare Advantage |
$19.94
|
| Rate for Payer: UHCCP Medicaid |
$14.06
|
| Rate for Payer: VA VA |
$19.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.81
|
|
|
MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$79.75
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117958
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.51 |
| Max. Negotiated Rate |
$71.78 |
| Rate for Payer: Aetna Commercial |
$67.79
|
| Rate for Payer: BCBS Trust/PPO |
$65.87
|
| Rate for Payer: BCN Commercial |
$65.87
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Cofinity Commercial |
$68.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.80
|
| Rate for Payer: Healthscope Commercial |
$71.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.79
|
| Rate for Payer: Nomi Health Commercial |
$65.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.81
|
| Rate for Payer: PHP Commercial |
$67.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$69.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.18
|
| Rate for Payer: UHC Core |
$66.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.81
|
|
|
MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.18 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Aetna Commercial |
$24.65
|
| Rate for Payer: Aetna Commercial |
$20.13
|
| Rate for Payer: Aetna Commercial |
$16.67
|
| Rate for Payer: Aetna Commercial |
$44.26
|
| Rate for Payer: BCBS Trust/PPO |
$23.95
|
| Rate for Payer: BCBS Trust/PPO |
$43.00
|
| Rate for Payer: BCBS Trust/PPO |
$19.56
|
| Rate for Payer: BCBS Trust/PPO |
$16.20
|
| Rate for Payer: BCN Commercial |
$23.95
|
| Rate for Payer: BCN Commercial |
$16.20
|
| Rate for Payer: BCN Commercial |
$43.00
|
| Rate for Payer: BCN Commercial |
$19.56
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$41.66
|
| Rate for Payer: Cash Price |
$15.69
|
| Rate for Payer: Cofinity Commercial |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$44.78
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.66
|
| Rate for Payer: Healthscope Commercial |
$46.86
|
| Rate for Payer: Healthscope Commercial |
$21.31
|
| Rate for Payer: Healthscope Commercial |
$26.10
|
| Rate for Payer: Healthscope Commercial |
$17.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.26
|
| Rate for Payer: Nomi Health Commercial |
$16.08
|
| Rate for Payer: Nomi Health Commercial |
$19.42
|
| Rate for Payer: Nomi Health Commercial |
$42.70
|
| Rate for Payer: Nomi Health Commercial |
$23.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.05
|
| Rate for Payer: PHP Commercial |
$44.26
|
| Rate for Payer: PHP Commercial |
$16.67
|
| Rate for Payer: PHP Commercial |
$20.13
|
| Rate for Payer: PHP Commercial |
$24.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$45.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.52
|
| Rate for Payer: UHC Core |
$24.21
|
| Rate for Payer: UHC Core |
$43.48
|
| Rate for Payer: UHC Core |
$19.77
|
| Rate for Payer: UHC Core |
$16.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.75
|
|
|
MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$19.61
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$17.65 |
| Rate for Payer: Aetna Commercial |
$16.67
|
| Rate for Payer: Aetna Commercial |
$24.65
|
| Rate for Payer: Aetna Commercial |
$44.26
|
| Rate for Payer: Aetna Commercial |
$20.13
|
| Rate for Payer: Aetna Medicare |
$6.16
|
| Rate for Payer: Aetna Medicare |
$5.10
|
| Rate for Payer: Aetna Medicare |
$7.54
|
| Rate for Payer: Aetna Medicare |
$13.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.13
|
| Rate for Payer: BCBS Complete |
$9.64
|
| Rate for Payer: BCBS Complete |
$4.38
|
| Rate for Payer: BCBS Complete |
$3.63
|
| Rate for Payer: BCBS Complete |
$5.37
|
| Rate for Payer: BCBS MAPPO |
$4.90
|
| Rate for Payer: BCBS MAPPO |
$5.92
|
| Rate for Payer: BCBS MAPPO |
$13.02
|
| Rate for Payer: BCBS MAPPO |
$7.25
|
| Rate for Payer: BCBS Trust/PPO |
$23.84
|
| Rate for Payer: BCBS Trust/PPO |
$16.12
|
| Rate for Payer: BCBS Trust/PPO |
$42.81
|
| Rate for Payer: BCBS Trust/PPO |
$19.47
|
| Rate for Payer: BCN Commercial |
$23.84
|
| Rate for Payer: BCN Commercial |
$42.81
|
| Rate for Payer: BCN Commercial |
$19.47
|
| Rate for Payer: BCN Commercial |
$16.12
|
| Rate for Payer: BCN Medicare Advantage |
$7.25
|
| Rate for Payer: BCN Medicare Advantage |
$5.92
|
| Rate for Payer: BCN Medicare Advantage |
$13.02
|
| Rate for Payer: BCN Medicare Advantage |
$4.90
|
| Rate for Payer: Cash Price |
$41.66
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$15.69
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Cofinity Commercial |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Cofinity Commercial |
$44.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.25
|
| Rate for Payer: Healthscope Commercial |
$17.65
|
| Rate for Payer: Healthscope Commercial |
$46.86
|
| Rate for Payer: Healthscope Commercial |
$26.10
|
| Rate for Payer: Healthscope Commercial |
$21.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.71
|
| Rate for Payer: Mclaren Medicaid |
$5.11
|
| Rate for Payer: Mclaren Medicaid |
$4.17
|
| Rate for Payer: Mclaren Medicaid |
$3.46
|
| Rate for Payer: Mclaren Medicaid |
$9.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.15
|
| Rate for Payer: Meridian Medicaid |
$3.63
|
| Rate for Payer: Meridian Medicaid |
$5.37
|
| Rate for Payer: Meridian Medicaid |
$9.64
|
| Rate for Payer: Meridian Medicaid |
$4.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.26
|
| Rate for Payer: Nomi Health Commercial |
$23.78
|
| Rate for Payer: Nomi Health Commercial |
$16.08
|
| Rate for Payer: Nomi Health Commercial |
$19.42
|
| Rate for Payer: Nomi Health Commercial |
$42.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.71
|
| Rate for Payer: PACE Senior Care Partners |
$6.89
|
| Rate for Payer: PACE Senior Care Partners |
$12.37
|
| Rate for Payer: PACE Senior Care Partners |
$4.66
|
| Rate for Payer: PACE Senior Care Partners |
$5.62
|
| Rate for Payer: PACE SWMI |
$4.90
|
| Rate for Payer: PACE SWMI |
$13.02
|
| Rate for Payer: PACE SWMI |
$5.92
|
| Rate for Payer: PACE SWMI |
$7.25
|
| Rate for Payer: PHP Commercial |
$16.67
|
| Rate for Payer: PHP Commercial |
$20.13
|
| Rate for Payer: PHP Commercial |
$24.65
|
| Rate for Payer: PHP Commercial |
$44.26
|
| Rate for Payer: PHP Medicare Advantage |
$4.90
|
| Rate for Payer: PHP Medicare Advantage |
$13.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.92
|
| Rate for Payer: PHP Medicare Advantage |
$7.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$45.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.06
|
| Rate for Payer: Priority Health Medicare |
$5.98
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health Medicare |
$7.32
|
| Rate for Payer: Priority Health Medicare |
$13.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.65
|
| Rate for Payer: Railroad Medicare Medicare |
$7.25
|
| Rate for Payer: Railroad Medicare Medicare |
$4.90
|
| Rate for Payer: Railroad Medicare Medicare |
$13.02
|
| Rate for Payer: Railroad Medicare Medicare |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.82
|
| Rate for Payer: UHC Core |
$16.37
|
| Rate for Payer: UHC Core |
$24.21
|
| Rate for Payer: UHC Core |
$19.77
|
| Rate for Payer: UHC Core |
$43.48
|
| Rate for Payer: UHC Exchange |
$7.25
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Exchange |
$13.02
|
| Rate for Payer: UHC Exchange |
$4.90
|
| Rate for Payer: UHC Medicaid |
$3.46
|
| Rate for Payer: UHC Medicaid |
$4.17
|
| Rate for Payer: UHC Medicaid |
$5.11
|
| Rate for Payer: UHC Medicaid |
$9.18
|
| Rate for Payer: UHC Medicare Advantage |
$5.92
|
| Rate for Payer: UHC Medicare Advantage |
$4.90
|
| Rate for Payer: UHC Medicare Advantage |
$13.02
|
| Rate for Payer: UHC Medicare Advantage |
$7.25
|
| Rate for Payer: UHCCP Medicaid |
$5.11
|
| Rate for Payer: UHCCP Medicaid |
$9.18
|
| Rate for Payer: UHCCP Medicaid |
$4.17
|
| Rate for Payer: UHCCP Medicaid |
$3.46
|
| Rate for Payer: VA VA |
$4.90
|
| Rate for Payer: VA VA |
$13.02
|
| Rate for Payer: VA VA |
$7.25
|
| Rate for Payer: VA VA |
$5.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.05
|
|
|
MAGNESIUM SULFATE 4.06 MEQ/ML (50 %) INJECTION (TPN COMPONENT)
|
Facility
|
OP
|
$227.50
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
180902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.11 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Aetna Commercial |
$193.38
|
| Rate for Payer: Aetna Medicare |
$59.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.09
|
| Rate for Payer: BCBS Complete |
$42.11
|
| Rate for Payer: BCBS MAPPO |
$56.88
|
| Rate for Payer: BCBS Trust/PPO |
$187.03
|
| Rate for Payer: BCN Commercial |
$187.03
|
| Rate for Payer: BCN Medicare Advantage |
$56.88
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cofinity Commercial |
$195.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.88
|
| Rate for Payer: Healthscope Commercial |
$204.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.62
|
| Rate for Payer: Mclaren Medicaid |
$40.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.72
|
| Rate for Payer: Meridian Medicaid |
$42.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.38
|
| Rate for Payer: Nomi Health Commercial |
$186.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.62
|
| Rate for Payer: PACE Senior Care Partners |
$54.03
|
| Rate for Payer: PACE SWMI |
$56.88
|
| Rate for Payer: PHP Commercial |
$193.38
|
| Rate for Payer: PHP Medicare Advantage |
$56.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$197.93
|
| Rate for Payer: Priority Health Medicare |
$57.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.34
|
| Rate for Payer: Railroad Medicare Medicare |
$56.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.20
|
| Rate for Payer: UHC Core |
$189.96
|
| Rate for Payer: UHC Exchange |
$56.88
|
| Rate for Payer: UHC Medicaid |
$40.11
|
| Rate for Payer: UHC Medicare Advantage |
$56.88
|
| Rate for Payer: UHCCP Medicaid |
$40.11
|
| Rate for Payer: VA VA |
$56.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.62
|
|
|
MAGNESIUM SULFATE 4.06 MEQ/ML (50 %) INJECTION (TPN COMPONENT)
|
Facility
|
IP
|
$227.50
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
180902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$158.34 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Aetna Commercial |
$193.38
|
| Rate for Payer: BCBS Trust/PPO |
$187.89
|
| Rate for Payer: BCN Commercial |
$187.89
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cofinity Commercial |
$195.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.00
|
| Rate for Payer: Healthscope Commercial |
$204.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.38
|
| Rate for Payer: Nomi Health Commercial |
$186.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.62
|
| Rate for Payer: PHP Commercial |
$193.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$197.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.20
|
| Rate for Payer: UHC Core |
$189.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.62
|
|
|
MAGNESIUM SULFATE 4 GRAM/100 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$145.11
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4719
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.58 |
| Max. Negotiated Rate |
$130.60 |
| Rate for Payer: Aetna Commercial |
$123.34
|
| Rate for Payer: Aetna Commercial |
$129.22
|
| Rate for Payer: Aetna Medicare |
$39.53
|
| Rate for Payer: Aetna Medicare |
$37.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.51
|
| Rate for Payer: BCBS Complete |
$26.86
|
| Rate for Payer: BCBS Complete |
$28.14
|
| Rate for Payer: BCBS MAPPO |
$36.28
|
| Rate for Payer: BCBS MAPPO |
$38.01
|
| Rate for Payer: BCBS Trust/PPO |
$119.29
|
| Rate for Payer: BCBS Trust/PPO |
$124.98
|
| Rate for Payer: BCN Commercial |
$124.98
|
| Rate for Payer: BCN Commercial |
$119.29
|
| Rate for Payer: BCN Medicare Advantage |
$38.01
|
| Rate for Payer: BCN Medicare Advantage |
$36.28
|
| Rate for Payer: Cash Price |
$116.09
|
| Rate for Payer: Cash Price |
$121.62
|
| Rate for Payer: Cofinity Commercial |
$124.79
|
| Rate for Payer: Cofinity Commercial |
$130.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.28
|
| Rate for Payer: Healthscope Commercial |
$130.60
|
| Rate for Payer: Healthscope Commercial |
$136.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.02
|
| Rate for Payer: Mclaren Medicaid |
$26.80
|
| Rate for Payer: Mclaren Medicaid |
$25.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.09
|
| Rate for Payer: Meridian Medicaid |
$26.86
|
| Rate for Payer: Meridian Medicaid |
$28.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.34
|
| Rate for Payer: Nomi Health Commercial |
$124.66
|
| Rate for Payer: Nomi Health Commercial |
$118.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.02
|
| Rate for Payer: PACE Senior Care Partners |
$36.10
|
| Rate for Payer: PACE Senior Care Partners |
$34.46
|
| Rate for Payer: PACE SWMI |
$38.01
|
| Rate for Payer: PACE SWMI |
$36.28
|
| Rate for Payer: PHP Commercial |
$123.34
|
| Rate for Payer: PHP Commercial |
$129.22
|
| Rate for Payer: PHP Medicare Advantage |
$36.28
|
| Rate for Payer: PHP Medicare Advantage |
$38.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$132.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$126.25
|
| Rate for Payer: Priority Health Medicare |
$38.39
|
| Rate for Payer: Priority Health Medicare |
$36.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.81
|
| Rate for Payer: Railroad Medicare Medicare |
$36.28
|
| Rate for Payer: Railroad Medicare Medicare |
$38.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.78
|
| Rate for Payer: UHC Core |
$126.94
|
| Rate for Payer: UHC Core |
$121.17
|
| Rate for Payer: UHC Exchange |
$38.01
|
| Rate for Payer: UHC Exchange |
$36.28
|
| Rate for Payer: UHC Medicaid |
$26.80
|
| Rate for Payer: UHC Medicaid |
$25.58
|
| Rate for Payer: UHC Medicare Advantage |
$36.28
|
| Rate for Payer: UHC Medicare Advantage |
$38.01
|
| Rate for Payer: UHCCP Medicaid |
$25.58
|
| Rate for Payer: UHCCP Medicaid |
$26.80
|
| Rate for Payer: VA VA |
$36.28
|
| Rate for Payer: VA VA |
$38.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.83
|
|
|
MAGNESIUM SULFATE 4 GRAM/100 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$145.11
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4719
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$130.60 |
| Rate for Payer: Aetna Commercial |
$123.34
|
| Rate for Payer: Aetna Commercial |
$129.22
|
| Rate for Payer: BCBS Trust/PPO |
$119.85
|
| Rate for Payer: BCBS Trust/PPO |
$125.55
|
| Rate for Payer: BCN Commercial |
$119.85
|
| Rate for Payer: BCN Commercial |
$125.55
|
| Rate for Payer: Cash Price |
$116.09
|
| Rate for Payer: Cash Price |
$121.62
|
| Rate for Payer: Cofinity Commercial |
$130.74
|
| Rate for Payer: Cofinity Commercial |
$124.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.09
|
| Rate for Payer: Healthscope Commercial |
$130.60
|
| Rate for Payer: Healthscope Commercial |
$136.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.22
|
| Rate for Payer: Nomi Health Commercial |
$118.99
|
| Rate for Payer: Nomi Health Commercial |
$124.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.02
|
| Rate for Payer: PHP Commercial |
$129.22
|
| Rate for Payer: PHP Commercial |
$123.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$132.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$126.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.78
|
| Rate for Payer: UHC Core |
$121.17
|
| Rate for Payer: UHC Core |
$126.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.02
|
|
|
MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION
|
Facility
|
IP
|
$21.44
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.92 |
| Max. Negotiated Rate |
$19.30 |
| Rate for Payer: Aetna Commercial |
$18.22
|
| Rate for Payer: Aetna Commercial |
$13.86
|
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: BCBS Trust/PPO |
$17.71
|
| Rate for Payer: BCBS Trust/PPO |
$18.38
|
| Rate for Payer: BCBS Trust/PPO |
$13.46
|
| Rate for Payer: BCBS Trust/PPO |
$12.69
|
| Rate for Payer: BCN Commercial |
$17.71
|
| Rate for Payer: BCN Commercial |
$12.69
|
| Rate for Payer: BCN Commercial |
$18.38
|
| Rate for Payer: BCN Commercial |
$13.46
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$18.44
|
| Rate for Payer: Cofinity Commercial |
$14.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Healthscope Commercial |
$14.67
|
| Rate for Payer: Healthscope Commercial |
$19.30
|
| Rate for Payer: Healthscope Commercial |
$13.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.91
|
| Rate for Payer: Nomi Health Commercial |
$12.60
|
| Rate for Payer: Nomi Health Commercial |
$13.37
|
| Rate for Payer: Nomi Health Commercial |
$18.25
|
| Rate for Payer: Nomi Health Commercial |
$17.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.69
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: PHP Commercial |
$13.86
|
| Rate for Payer: PHP Commercial |
$18.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.87
|
| Rate for Payer: UHC Core |
$17.90
|
| Rate for Payer: UHC Core |
$18.58
|
| Rate for Payer: UHC Core |
$13.61
|
| Rate for Payer: UHC Core |
$12.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.08
|
|
|
MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION
|
Facility
|
OP
|
$15.37
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$13.83 |
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna Commercial |
$18.22
|
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: Aetna Commercial |
$13.86
|
| Rate for Payer: Aetna Medicare |
$4.24
|
| Rate for Payer: Aetna Medicare |
$4.00
|
| Rate for Payer: Aetna Medicare |
$5.57
|
| Rate for Payer: Aetna Medicare |
$5.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.80
|
| Rate for Payer: BCBS Complete |
$4.12
|
| Rate for Payer: BCBS Complete |
$3.02
|
| Rate for Payer: BCBS Complete |
$2.84
|
| Rate for Payer: BCBS Complete |
$3.97
|
| Rate for Payer: BCBS MAPPO |
$3.84
|
| Rate for Payer: BCBS MAPPO |
$4.08
|
| Rate for Payer: BCBS MAPPO |
$5.56
|
| Rate for Payer: BCBS MAPPO |
$5.36
|
| Rate for Payer: BCBS Trust/PPO |
$17.63
|
| Rate for Payer: BCBS Trust/PPO |
$12.64
|
| Rate for Payer: BCBS Trust/PPO |
$18.29
|
| Rate for Payer: BCBS Trust/PPO |
$13.40
|
| Rate for Payer: BCN Commercial |
$17.63
|
| Rate for Payer: BCN Commercial |
$18.29
|
| Rate for Payer: BCN Commercial |
$13.40
|
| Rate for Payer: BCN Commercial |
$12.64
|
| Rate for Payer: BCN Medicare Advantage |
$5.36
|
| Rate for Payer: BCN Medicare Advantage |
$4.08
|
| Rate for Payer: BCN Medicare Advantage |
$5.56
|
| Rate for Payer: BCN Medicare Advantage |
$3.84
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cofinity Commercial |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$18.44
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.36
|
| Rate for Payer: Healthscope Commercial |
$13.83
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Healthscope Commercial |
$19.30
|
| Rate for Payer: Healthscope Commercial |
$14.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.53
|
| Rate for Payer: Mclaren Medicaid |
$3.78
|
| Rate for Payer: Mclaren Medicaid |
$2.87
|
| Rate for Payer: Mclaren Medicaid |
$2.71
|
| Rate for Payer: Mclaren Medicaid |
$3.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.03
|
| Rate for Payer: Meridian Medicaid |
$2.84
|
| Rate for Payer: Meridian Medicaid |
$3.97
|
| Rate for Payer: Meridian Medicaid |
$4.12
|
| Rate for Payer: Meridian Medicaid |
$3.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.91
|
| Rate for Payer: Nomi Health Commercial |
$17.58
|
| Rate for Payer: Nomi Health Commercial |
$12.60
|
| Rate for Payer: Nomi Health Commercial |
$13.37
|
| Rate for Payer: Nomi Health Commercial |
$18.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.53
|
| Rate for Payer: PACE Senior Care Partners |
$5.09
|
| Rate for Payer: PACE Senior Care Partners |
$5.28
|
| Rate for Payer: PACE Senior Care Partners |
$3.65
|
| Rate for Payer: PACE Senior Care Partners |
$3.87
|
| Rate for Payer: PACE SWMI |
$3.84
|
| Rate for Payer: PACE SWMI |
$5.56
|
| Rate for Payer: PACE SWMI |
$4.08
|
| Rate for Payer: PACE SWMI |
$5.36
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: PHP Commercial |
$13.86
|
| Rate for Payer: PHP Commercial |
$18.22
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: PHP Medicare Advantage |
$3.84
|
| Rate for Payer: PHP Medicare Advantage |
$5.56
|
| Rate for Payer: PHP Medicare Advantage |
$4.08
|
| Rate for Payer: PHP Medicare Advantage |
$5.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.37
|
| Rate for Payer: Priority Health Medicare |
$4.12
|
| Rate for Payer: Priority Health Medicare |
$3.88
|
| Rate for Payer: Priority Health Medicare |
$5.41
|
| Rate for Payer: Priority Health Medicare |
$5.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.70
|
| Rate for Payer: Railroad Medicare Medicare |
$5.36
|
| Rate for Payer: Railroad Medicare Medicare |
$3.84
|
| Rate for Payer: Railroad Medicare Medicare |
$5.56
|
| Rate for Payer: Railroad Medicare Medicare |
$4.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.58
|
| Rate for Payer: UHC Core |
$12.83
|
| Rate for Payer: UHC Core |
$17.90
|
| Rate for Payer: UHC Core |
$13.61
|
| Rate for Payer: UHC Core |
$18.58
|
| Rate for Payer: UHC Exchange |
$5.36
|
| Rate for Payer: UHC Exchange |
$4.08
|
| Rate for Payer: UHC Exchange |
$5.56
|
| Rate for Payer: UHC Exchange |
$3.84
|
| Rate for Payer: UHC Medicaid |
$2.71
|
| Rate for Payer: UHC Medicaid |
$2.87
|
| Rate for Payer: UHC Medicaid |
$3.78
|
| Rate for Payer: UHC Medicaid |
$3.92
|
| Rate for Payer: UHC Medicare Advantage |
$4.08
|
| Rate for Payer: UHC Medicare Advantage |
$3.84
|
| Rate for Payer: UHC Medicare Advantage |
$5.56
|
| Rate for Payer: UHC Medicare Advantage |
$5.36
|
| Rate for Payer: UHCCP Medicaid |
$3.78
|
| Rate for Payer: UHCCP Medicaid |
$3.92
|
| Rate for Payer: UHCCP Medicaid |
$2.87
|
| Rate for Payer: UHCCP Medicaid |
$2.71
|
| Rate for Payer: VA VA |
$3.84
|
| Rate for Payer: VA VA |
$5.56
|
| Rate for Payer: VA VA |
$5.36
|
| Rate for Payer: VA VA |
$4.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.69
|
|
|
MAGNESIUM SULFATE IN D5W 1 GRAM/100 ML IVPB (CODE)
|
Facility
|
IP
|
$49.27
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
163707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.29 |
| Max. Negotiated Rate |
$44.34 |
| Rate for Payer: Aetna Commercial |
$41.88
|
| Rate for Payer: BCBS Trust/PPO |
$40.69
|
| Rate for Payer: BCN Commercial |
$40.69
|
| Rate for Payer: Cash Price |
$39.42
|
| Rate for Payer: Cofinity Commercial |
$42.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.42
|
| Rate for Payer: Healthscope Commercial |
$44.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.88
|
| Rate for Payer: Nomi Health Commercial |
$40.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.95
|
| Rate for Payer: PHP Commercial |
$41.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.36
|
| Rate for Payer: UHC Core |
$41.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.95
|
|
|
MAGNESIUM SULFATE IN D5W 1 GRAM/100 ML IVPB (CODE)
|
Facility
|
OP
|
$49.27
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
163707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$44.34 |
| Rate for Payer: Aetna Commercial |
$41.88
|
| Rate for Payer: Aetna Medicare |
$12.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.40
|
| Rate for Payer: BCBS Complete |
$9.12
|
| Rate for Payer: BCBS MAPPO |
$12.32
|
| Rate for Payer: BCBS Trust/PPO |
$40.50
|
| Rate for Payer: BCN Commercial |
$40.50
|
| Rate for Payer: BCN Medicare Advantage |
$12.32
|
| Rate for Payer: Cash Price |
$39.42
|
| Rate for Payer: Cofinity Commercial |
$42.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.32
|
| Rate for Payer: Healthscope Commercial |
$44.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.95
|
| Rate for Payer: Mclaren Medicaid |
$8.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.93
|
| Rate for Payer: Meridian Medicaid |
$9.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.88
|
| Rate for Payer: Nomi Health Commercial |
$40.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.95
|
| Rate for Payer: PACE Senior Care Partners |
$11.70
|
| Rate for Payer: PACE SWMI |
$12.32
|
| Rate for Payer: PHP Commercial |
$41.88
|
| Rate for Payer: PHP Medicare Advantage |
$12.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.86
|
| Rate for Payer: Priority Health Medicare |
$12.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.29
|
| Rate for Payer: Railroad Medicare Medicare |
$12.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.36
|
| Rate for Payer: UHC Core |
$41.14
|
| Rate for Payer: UHC Exchange |
$12.32
|
| Rate for Payer: UHC Medicaid |
$8.69
|
| Rate for Payer: UHC Medicare Advantage |
$12.32
|
| Rate for Payer: UHCCP Medicaid |
$8.69
|
| Rate for Payer: VA VA |
$12.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.95
|
|
|
MAJOR ABDOMINAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$30,034.40
|
|
|
Service Code
|
APR-DRG 1694
|
| Min. Negotiated Rate |
$28,604.19 |
| Max. Negotiated Rate |
$30,034.40 |
| Rate for Payer: BCBS Complete |
$30,034.40
|
| Rate for Payer: Mclaren Medicaid |
$28,604.19
|
| Rate for Payer: Meridian Medicaid |
$30,034.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$28,604.19
|
| Rate for Payer: UHC Medicaid |
$28,604.19
|
| Rate for Payer: UHCCP Medicaid |
$28,604.19
|
|
|
MAJOR ABDOMINAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$15,742.60
|
|
|
Service Code
|
APR-DRG 1691
|
| Min. Negotiated Rate |
$14,992.95 |
| Max. Negotiated Rate |
$15,742.60 |
| Rate for Payer: BCBS Complete |
$15,742.60
|
| Rate for Payer: Mclaren Medicaid |
$14,992.95
|
| Rate for Payer: Meridian Medicaid |
$15,742.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,992.95
|
| Rate for Payer: UHC Medicaid |
$14,992.95
|
| Rate for Payer: UHCCP Medicaid |
$14,992.95
|
|
|
MAJOR ABDOMINAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$22,614.80
|
|
|
Service Code
|
APR-DRG 1693
|
| Min. Negotiated Rate |
$21,537.91 |
| Max. Negotiated Rate |
$22,614.80 |
| Rate for Payer: BCBS Complete |
$22,614.80
|
| Rate for Payer: Mclaren Medicaid |
$21,537.91
|
| Rate for Payer: Meridian Medicaid |
$22,614.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,537.91
|
| Rate for Payer: UHC Medicaid |
$21,537.91
|
| Rate for Payer: UHCCP Medicaid |
$21,537.91
|
|
|
MAJOR ABDOMINAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$17,665.59
|
|
|
Service Code
|
APR-DRG 1692
|
| Min. Negotiated Rate |
$16,824.38 |
| Max. Negotiated Rate |
$17,665.59 |
| Rate for Payer: BCBS Complete |
$17,665.59
|
| Rate for Payer: Mclaren Medicaid |
$16,824.38
|
| Rate for Payer: Meridian Medicaid |
$17,665.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,824.38
|
| Rate for Payer: UHC Medicaid |
$16,824.38
|
| Rate for Payer: UHCCP Medicaid |
$16,824.38
|
|
|
MAJOR BILIARY TRACT PROCEDURES
|
Facility
|
IP
|
$11,948.14
|
|
|
Service Code
|
APR-DRG 2612
|
| Min. Negotiated Rate |
$11,379.18 |
| Max. Negotiated Rate |
$11,948.14 |
| Rate for Payer: BCBS Complete |
$11,948.14
|
| Rate for Payer: Mclaren Medicaid |
$11,379.18
|
| Rate for Payer: Meridian Medicaid |
$11,948.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,379.18
|
| Rate for Payer: UHC Medicaid |
$11,379.18
|
| Rate for Payer: UHCCP Medicaid |
$11,379.18
|
|
|
MAJOR BILIARY TRACT PROCEDURES
|
Facility
|
IP
|
$8,176.29
|
|
|
Service Code
|
APR-DRG 2611
|
| Min. Negotiated Rate |
$7,786.94 |
| Max. Negotiated Rate |
$8,176.29 |
| Rate for Payer: BCBS Complete |
$8,176.29
|
| Rate for Payer: Mclaren Medicaid |
$7,786.94
|
| Rate for Payer: Meridian Medicaid |
$8,176.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,786.94
|
| Rate for Payer: UHC Medicaid |
$7,786.94
|
| Rate for Payer: UHCCP Medicaid |
$7,786.94
|
|
|
MAJOR BILIARY TRACT PROCEDURES
|
Facility
|
IP
|
$15,745.23
|
|
|
Service Code
|
APR-DRG 2613
|
| Min. Negotiated Rate |
$14,995.45 |
| Max. Negotiated Rate |
$15,745.23 |
| Rate for Payer: BCBS Complete |
$15,745.23
|
| Rate for Payer: Mclaren Medicaid |
$14,995.45
|
| Rate for Payer: Meridian Medicaid |
$15,745.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,995.45
|
| Rate for Payer: UHC Medicaid |
$14,995.45
|
| Rate for Payer: UHCCP Medicaid |
$14,995.45
|
|
|
MAJOR BILIARY TRACT PROCEDURES
|
Facility
|
IP
|
$26,598.56
|
|
|
Service Code
|
APR-DRG 2614
|
| Min. Negotiated Rate |
$25,331.97 |
| Max. Negotiated Rate |
$26,598.56 |
| Rate for Payer: BCBS Complete |
$26,598.56
|
| Rate for Payer: Mclaren Medicaid |
$25,331.97
|
| Rate for Payer: Meridian Medicaid |
$26,598.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$25,331.97
|
| Rate for Payer: UHC Medicaid |
$25,331.97
|
| Rate for Payer: UHCCP Medicaid |
$25,331.97
|
|
