|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$8.64
|
|
|
Service Code
|
NDC 00121043130
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: BCBS Trust/PPO |
$7.05
|
| Rate for Payer: BCN Commercial |
$6.68
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.91
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: Nomi Health Commercial |
$7.08
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.62
|
| Rate for Payer: Priority Health HMO/PPO |
$7.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.60
|
| Rate for Payer: UHC Core |
$7.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.48
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$8.79
|
|
|
Service Code
|
NDC 60687042945
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$7.91 |
| Rate for Payer: Aetna Commercial |
$7.47
|
| Rate for Payer: BCBS Trust/PPO |
$7.18
|
| Rate for Payer: BCN Commercial |
$6.79
|
| Rate for Payer: Cash Price |
$7.03
|
| Rate for Payer: Cofinity Commercial |
$7.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.03
|
| Rate for Payer: Healthscope Commercial |
$7.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.47
|
| Rate for Payer: Nomi Health Commercial |
$7.21
|
| Rate for Payer: PHP Commercial |
$7.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.71
|
| Rate for Payer: Priority Health HMO/PPO |
$7.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.74
|
| Rate for Payer: UHC Core |
$7.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.59
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$8.79
|
|
|
Service Code
|
NDC 60687042945
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$7.91 |
| Rate for Payer: Aetna Commercial |
$7.47
|
| Rate for Payer: Aetna Medicare |
$2.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.75
|
| Rate for Payer: BCBS Complete |
$3.52
|
| Rate for Payer: BCBS MAPPO |
$2.20
|
| Rate for Payer: BCBS Trust/PPO |
$7.23
|
| Rate for Payer: BCN Commercial |
$6.83
|
| Rate for Payer: BCN Medicare Advantage |
$2.20
|
| Rate for Payer: Cash Price |
$7.03
|
| Rate for Payer: Cofinity Commercial |
$7.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.20
|
| Rate for Payer: Healthscope Commercial |
$7.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.47
|
| Rate for Payer: Nomi Health Commercial |
$7.21
|
| Rate for Payer: PACE Senior Care Partners |
$2.09
|
| Rate for Payer: PACE SWMI |
$2.20
|
| Rate for Payer: PHP Commercial |
$7.47
|
| Rate for Payer: PHP Medicare Advantage |
$2.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.71
|
| Rate for Payer: Priority Health HMO/PPO |
$7.65
|
| Rate for Payer: Priority Health Medicare |
$2.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.89
|
| Rate for Payer: Railroad Medicare Medicare |
$2.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.74
|
| Rate for Payer: UHC Core |
$7.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.20
|
| Rate for Payer: UHC Exchange |
$2.20
|
| Rate for Payer: UHC Medicare Advantage |
$2.20
|
| Rate for Payer: VA VA |
$2.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.59
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 09900000340
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Aetna Commercial |
$0.60
|
| Rate for Payer: Aetna Medicare |
$0.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.22
|
| Rate for Payer: BCBS Complete |
$0.28
|
| Rate for Payer: BCBS MAPPO |
$0.18
|
| Rate for Payer: BCBS Trust/PPO |
$0.58
|
| Rate for Payer: BCN Commercial |
$0.55
|
| Rate for Payer: BCN Medicare Advantage |
$0.18
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cofinity Commercial |
$0.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.18
|
| Rate for Payer: Healthscope Commercial |
$0.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.60
|
| Rate for Payer: Nomi Health Commercial |
$0.58
|
| Rate for Payer: PACE Senior Care Partners |
$0.17
|
| Rate for Payer: PACE SWMI |
$0.18
|
| Rate for Payer: PHP Commercial |
$0.60
|
| Rate for Payer: PHP Medicare Advantage |
$0.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.46
|
| Rate for Payer: Priority Health HMO/PPO |
$0.62
|
| Rate for Payer: Priority Health Medicare |
$0.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.48
|
| Rate for Payer: Railroad Medicare Medicare |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.62
|
| Rate for Payer: UHC Core |
$0.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Medicare Advantage |
$0.18
|
| Rate for Payer: VA VA |
$0.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.53
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$8.64
|
|
|
Service Code
|
NDC 09900000148
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna Medicare |
$2.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.70
|
| Rate for Payer: BCBS Complete |
$3.46
|
| Rate for Payer: BCBS MAPPO |
$2.16
|
| Rate for Payer: BCBS Trust/PPO |
$7.10
|
| Rate for Payer: BCN Commercial |
$6.72
|
| Rate for Payer: BCN Medicare Advantage |
$2.16
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.16
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: Nomi Health Commercial |
$7.08
|
| Rate for Payer: PACE Senior Care Partners |
$2.05
|
| Rate for Payer: PACE SWMI |
$2.16
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: PHP Medicare Advantage |
$2.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.62
|
| Rate for Payer: Priority Health HMO/PPO |
$7.52
|
| Rate for Payer: Priority Health Medicare |
$2.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.79
|
| Rate for Payer: Railroad Medicare Medicare |
$2.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.60
|
| Rate for Payer: UHC Core |
$7.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.16
|
| Rate for Payer: UHC Exchange |
$2.16
|
| Rate for Payer: UHC Medicare Advantage |
$2.16
|
| Rate for Payer: VA VA |
$2.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.48
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 09900000340
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Aetna Commercial |
$0.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.58
|
| Rate for Payer: BCN Commercial |
$0.55
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cofinity Commercial |
$0.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.57
|
| Rate for Payer: Healthscope Commercial |
$0.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.60
|
| Rate for Payer: Nomi Health Commercial |
$0.58
|
| Rate for Payer: PHP Commercial |
$0.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.46
|
| Rate for Payer: Priority Health HMO/PPO |
$0.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.62
|
| Rate for Payer: UHC Core |
$0.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.53
|
|
|
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 |
$60.80 |
| 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 |
$102.40
|
| Rate for Payer: BCBS MAPPO |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$210.46
|
| Rate for Payer: BCN Commercial |
$199.04
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.60
|
| Rate for Payer: Nomi Health Commercial |
$209.92
|
| 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 Cigna Priority Health |
$166.40
|
| Rate for Payer: Priority Health HMO/PPO |
$222.72
|
| Rate for Payer: Priority Health Medicare |
$64.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.52
|
| 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 Dual Complete DSNP |
$64.00
|
| Rate for Payer: UHC Exchange |
$64.00
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$64.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.00
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
NDC 10006070028
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna Commercial |
$217.60
|
| Rate for Payer: BCBS Trust/PPO |
$208.97
|
| Rate for Payer: BCN Commercial |
$197.84
|
| 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: Healthscope Commercial |
$230.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.60
|
| Rate for Payer: Nomi Health Commercial |
$209.92
|
| Rate for Payer: PHP Commercial |
$217.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.40
|
| Rate for Payer: Priority Health HMO/PPO |
$222.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.28
|
| Rate for Payer: UHC Core |
$213.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.00
|
|
|
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 |
$5.09 |
| 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 |
$8.58
|
| Rate for Payer: BCBS MAPPO |
$5.36
|
| Rate for Payer: BCBS Trust/PPO |
$17.63
|
| Rate for Payer: BCN Commercial |
$16.67
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.22
|
| Rate for Payer: Nomi Health Commercial |
$17.58
|
| 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 Cigna Priority Health |
$13.94
|
| Rate for Payer: Priority Health HMO/PPO |
$18.65
|
| Rate for Payer: Priority Health Medicare |
$5.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.36
|
| 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 Dual Complete DSNP |
$5.36
|
| Rate for Payer: UHC Exchange |
$5.36
|
| Rate for Payer: UHC Medicare Advantage |
$5.36
|
| Rate for Payer: VA VA |
$5.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.08
|
|
|
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 |
$13.94 |
| Max. Negotiated Rate |
$19.30 |
| Rate for Payer: Aetna Commercial |
$18.22
|
| Rate for Payer: BCBS Trust/PPO |
$17.50
|
| Rate for Payer: BCN Commercial |
$16.57
|
| 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: PHP Commercial |
$18.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.94
|
| Rate for Payer: Priority Health HMO/PPO |
$18.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.36
|
| 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 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$111.65
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
16162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$100.48 |
| Rate for Payer: Aetna Commercial |
$94.90
|
| Rate for Payer: Aetna Medicare |
$29.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.89
|
| Rate for Payer: BCBS Complete |
$44.66
|
| Rate for Payer: BCBS MAPPO |
$27.91
|
| Rate for Payer: BCBS Trust/PPO |
$91.79
|
| Rate for Payer: BCN Commercial |
$86.81
|
| Rate for Payer: BCN Medicare Advantage |
$27.91
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cofinity Commercial |
$96.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.91
|
| Rate for Payer: Healthscope Commercial |
$100.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.90
|
| Rate for Payer: Nomi Health Commercial |
$91.55
|
| Rate for Payer: PACE Senior Care Partners |
$26.52
|
| Rate for Payer: PACE SWMI |
$27.91
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: PHP Medicare Advantage |
$27.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.57
|
| Rate for Payer: Priority Health HMO/PPO |
$97.14
|
| Rate for Payer: Priority Health Medicare |
$28.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.81
|
| Rate for Payer: Railroad Medicare Medicare |
$27.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.25
|
| Rate for Payer: UHC Core |
$93.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.91
|
| Rate for Payer: UHC Exchange |
$27.91
|
| Rate for Payer: UHC Medicare Advantage |
$27.91
|
| Rate for Payer: VA VA |
$27.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.74
|
|
|
MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$111.65
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
16162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.57 |
| Max. Negotiated Rate |
$100.48 |
| Rate for Payer: Aetna Commercial |
$94.90
|
| Rate for Payer: BCBS Trust/PPO |
$91.14
|
| Rate for Payer: BCN Commercial |
$86.28
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cofinity Commercial |
$96.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Healthscope Commercial |
$100.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.90
|
| Rate for Payer: Nomi Health Commercial |
$91.55
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.57
|
| Rate for Payer: Priority Health HMO/PPO |
$97.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.25
|
| Rate for Payer: UHC Core |
$93.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.74
|
|
|
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 |
$18.94 |
| 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 |
$31.90
|
| Rate for Payer: BCBS MAPPO |
$19.94
|
| Rate for Payer: BCBS Trust/PPO |
$65.56
|
| Rate for Payer: BCN Commercial |
$62.01
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.79
|
| Rate for Payer: Nomi Health Commercial |
$65.39
|
| 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 Cigna Priority Health |
$51.84
|
| Rate for Payer: Priority Health HMO/PPO |
$69.38
|
| Rate for Payer: Priority Health Medicare |
$20.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.43
|
| 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 Dual Complete DSNP |
$19.94
|
| Rate for Payer: UHC Exchange |
$19.94
|
| Rate for Payer: UHC Medicare Advantage |
$19.94
|
| 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 |
$51.84 |
| Max. Negotiated Rate |
$71.78 |
| Rate for Payer: Aetna Commercial |
$67.79
|
| Rate for Payer: BCBS Trust/PPO |
$65.10
|
| Rate for Payer: BCN Commercial |
$61.63
|
| 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: PHP Commercial |
$67.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.84
|
| Rate for Payer: Priority Health HMO/PPO |
$69.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.43
|
| 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
|
$23.68
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$21.31 |
| Rate for Payer: Aetna Commercial |
$20.13
|
| Rate for Payer: Aetna Commercial |
$44.26
|
| Rate for Payer: Aetna Commercial |
$52.01
|
| Rate for Payer: BCBS Trust/PPO |
$42.50
|
| Rate for Payer: BCBS Trust/PPO |
$19.33
|
| Rate for Payer: BCBS Trust/PPO |
$49.95
|
| Rate for Payer: BCN Commercial |
$40.24
|
| Rate for Payer: BCN Commercial |
$18.30
|
| Rate for Payer: BCN Commercial |
$47.29
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$48.95
|
| Rate for Payer: Cash Price |
$41.66
|
| Rate for Payer: Cofinity Commercial |
$52.62
|
| Rate for Payer: Cofinity Commercial |
$44.78
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.95
|
| Rate for Payer: Healthscope Commercial |
$46.86
|
| Rate for Payer: Healthscope Commercial |
$21.31
|
| Rate for Payer: Healthscope Commercial |
$55.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.01
|
| Rate for Payer: Nomi Health Commercial |
$19.42
|
| Rate for Payer: Nomi Health Commercial |
$42.70
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: PHP Commercial |
$44.26
|
| Rate for Payer: PHP Commercial |
$20.13
|
| Rate for Payer: PHP Commercial |
$52.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.85
|
| Rate for Payer: Priority Health HMO/PPO |
$53.24
|
| Rate for Payer: Priority Health HMO/PPO |
$45.30
|
| Rate for Payer: Priority Health HMO/PPO |
$20.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.84
|
| Rate for Payer: UHC Core |
$19.77
|
| Rate for Payer: UHC Core |
$51.09
|
| Rate for Payer: UHC Core |
$43.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.05
|
|
|
MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$23.68
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$21.31 |
| Rate for Payer: Aetna Commercial |
$20.13
|
| Rate for Payer: Aetna Commercial |
$52.01
|
| Rate for Payer: Aetna Commercial |
$44.26
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: Aetna Medicare |
$6.16
|
| Rate for Payer: Aetna Medicare |
$13.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.12
|
| 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 |
$19.12
|
| Rate for Payer: BCBS Complete |
$20.83
|
| Rate for Payer: BCBS Complete |
$9.47
|
| Rate for Payer: BCBS Complete |
$24.48
|
| Rate for Payer: BCBS MAPPO |
$15.30
|
| Rate for Payer: BCBS MAPPO |
$5.92
|
| Rate for Payer: BCBS MAPPO |
$13.02
|
| Rate for Payer: BCBS Trust/PPO |
$42.81
|
| Rate for Payer: BCBS Trust/PPO |
$19.47
|
| Rate for Payer: BCBS Trust/PPO |
$50.30
|
| Rate for Payer: BCN Commercial |
$40.48
|
| Rate for Payer: BCN Commercial |
$47.58
|
| Rate for Payer: BCN Commercial |
$18.41
|
| Rate for Payer: BCN Medicare Advantage |
$5.92
|
| Rate for Payer: BCN Medicare Advantage |
$13.02
|
| Rate for Payer: BCN Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$41.66
|
| Rate for Payer: Cash Price |
$48.95
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$52.62
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Cofinity Commercial |
$44.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.92
|
| Rate for Payer: Healthscope Commercial |
$46.86
|
| Rate for Payer: Healthscope Commercial |
$21.31
|
| Rate for Payer: Healthscope Commercial |
$55.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.76
|
| 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 |
$13.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.13
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: Nomi Health Commercial |
$19.42
|
| Rate for Payer: Nomi Health Commercial |
$42.70
|
| Rate for Payer: PACE Senior Care Partners |
$14.53
|
| Rate for Payer: PACE Senior Care Partners |
$5.62
|
| Rate for Payer: PACE Senior Care Partners |
$12.37
|
| Rate for Payer: PACE SWMI |
$13.02
|
| Rate for Payer: PACE SWMI |
$5.92
|
| Rate for Payer: PACE SWMI |
$15.30
|
| Rate for Payer: PHP Commercial |
$52.01
|
| Rate for Payer: PHP Commercial |
$44.26
|
| Rate for Payer: PHP Commercial |
$20.13
|
| Rate for Payer: PHP Medicare Advantage |
$13.02
|
| Rate for Payer: PHP Medicare Advantage |
$15.30
|
| Rate for Payer: PHP Medicare Advantage |
$5.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.85
|
| Rate for Payer: Priority Health HMO/PPO |
$53.24
|
| Rate for Payer: Priority Health HMO/PPO |
$20.60
|
| Rate for Payer: Priority Health HMO/PPO |
$45.30
|
| Rate for Payer: Priority Health Medicare |
$5.98
|
| Rate for Payer: Priority Health Medicare |
$15.45
|
| Rate for Payer: Priority Health Medicare |
$13.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.87
|
| Rate for Payer: Railroad Medicare Medicare |
$13.02
|
| Rate for Payer: Railroad Medicare Medicare |
$15.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.84
|
| Rate for Payer: UHC Core |
$51.09
|
| Rate for Payer: UHC Core |
$43.48
|
| Rate for Payer: UHC Core |
$19.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.02
|
| Rate for Payer: UHC Exchange |
$13.02
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Exchange |
$15.30
|
| Rate for Payer: UHC Medicare Advantage |
$5.92
|
| Rate for Payer: UHC Medicare Advantage |
$13.02
|
| Rate for Payer: UHC Medicare Advantage |
$15.30
|
| Rate for Payer: VA VA |
$13.02
|
| Rate for Payer: VA VA |
$15.30
|
| Rate for Payer: VA VA |
$5.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.89
|
| 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
|
$112.00
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
180902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$95.20
|
| Rate for Payer: Aetna Medicare |
$29.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.00
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS MAPPO |
$28.00
|
| Rate for Payer: BCBS Trust/PPO |
$92.08
|
| Rate for Payer: BCN Commercial |
$87.08
|
| Rate for Payer: BCN Medicare Advantage |
$28.00
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$96.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$100.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.20
|
| Rate for Payer: Nomi Health Commercial |
$91.84
|
| Rate for Payer: PACE Senior Care Partners |
$26.60
|
| Rate for Payer: PACE SWMI |
$28.00
|
| Rate for Payer: PHP Commercial |
$95.20
|
| Rate for Payer: PHP Medicare Advantage |
$28.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health HMO/PPO |
$97.44
|
| Rate for Payer: Priority Health Medicare |
$28.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.04
|
| Rate for Payer: Railroad Medicare Medicare |
$28.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.56
|
| Rate for Payer: UHC Core |
$93.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.00
|
| Rate for Payer: UHC Exchange |
$28.00
|
| Rate for Payer: UHC Medicare Advantage |
$28.00
|
| Rate for Payer: VA VA |
$28.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.00
|
|
|
MAGNESIUM SULFATE 4.06 MEQ/ML (50 %) INJECTION (TPN COMPONENT)
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
180902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$95.20
|
| Rate for Payer: BCBS Trust/PPO |
$91.43
|
| Rate for Payer: BCN Commercial |
$86.55
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$96.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.60
|
| Rate for Payer: Healthscope Commercial |
$100.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.20
|
| Rate for Payer: Nomi Health Commercial |
$91.84
|
| Rate for Payer: PHP Commercial |
$95.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health HMO/PPO |
$97.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.56
|
| Rate for Payer: UHC Core |
$93.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.00
|
|
|
MAGNESIUM SULFATE 4 GRAM/100 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$152.02
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4719
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.10 |
| Max. Negotiated Rate |
$136.82 |
| Rate for Payer: Aetna Commercial |
$129.22
|
| Rate for Payer: Aetna Medicare |
$39.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.51
|
| Rate for Payer: BCBS Complete |
$60.81
|
| Rate for Payer: BCBS MAPPO |
$38.01
|
| Rate for Payer: BCBS Trust/PPO |
$124.98
|
| Rate for Payer: BCN Commercial |
$118.20
|
| Rate for Payer: BCN Medicare Advantage |
$38.01
|
| Rate for Payer: Cash Price |
$121.62
|
| Rate for Payer: Cofinity Commercial |
$130.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.01
|
| Rate for Payer: Healthscope Commercial |
$136.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.22
|
| Rate for Payer: Nomi Health Commercial |
$124.66
|
| Rate for Payer: PACE Senior Care Partners |
$36.10
|
| Rate for Payer: PACE SWMI |
$38.01
|
| Rate for Payer: PHP Commercial |
$129.22
|
| Rate for Payer: PHP Medicare Advantage |
$38.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.81
|
| Rate for Payer: Priority Health HMO/PPO |
$132.26
|
| Rate for Payer: Priority Health Medicare |
$38.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.85
|
| Rate for Payer: Railroad Medicare Medicare |
$38.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.78
|
| Rate for Payer: UHC Core |
$126.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.01
|
| Rate for Payer: UHC Exchange |
$38.01
|
| Rate for Payer: UHC Medicare Advantage |
$38.01
|
| Rate for Payer: VA VA |
$38.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.02
|
|
|
MAGNESIUM SULFATE 4 GRAM/100 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$152.02
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4719
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.81 |
| Max. Negotiated Rate |
$136.82 |
| Rate for Payer: Aetna Commercial |
$129.22
|
| Rate for Payer: BCBS Trust/PPO |
$124.09
|
| Rate for Payer: BCN Commercial |
$117.48
|
| Rate for Payer: Cash Price |
$121.62
|
| Rate for Payer: Cofinity Commercial |
$130.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.62
|
| Rate for Payer: Healthscope Commercial |
$136.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.22
|
| Rate for Payer: Nomi Health Commercial |
$124.66
|
| Rate for Payer: PHP Commercial |
$129.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.81
|
| Rate for Payer: Priority Health HMO/PPO |
$132.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.78
|
| Rate for Payer: UHC Core |
$126.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.02
|
|
|
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 |
$3.65 |
| Max. Negotiated Rate |
$13.83 |
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: Aetna Commercial |
$18.22
|
| 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 |
$6.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.80
|
| 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 |
$6.15
|
| Rate for Payer: BCBS Complete |
$6.52
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: BCBS Complete |
$8.58
|
| 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 |
$12.64
|
| Rate for Payer: BCBS Trust/PPO |
$18.29
|
| Rate for Payer: BCBS Trust/PPO |
$13.40
|
| Rate for Payer: BCBS Trust/PPO |
$17.63
|
| Rate for Payer: BCN Commercial |
$11.95
|
| Rate for Payer: BCN Commercial |
$16.67
|
| Rate for Payer: BCN Commercial |
$12.67
|
| Rate for Payer: BCN Commercial |
$17.30
|
| 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: BCN Medicare Advantage |
$5.36
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$18.44
|
| 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 |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| 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 |
$11.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.03
|
| 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 |
$5.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.91
|
| 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 |
$18.22
|
| Rate for Payer: Nomi Health Commercial |
$17.58
|
| Rate for Payer: Nomi Health Commercial |
$18.25
|
| Rate for Payer: Nomi Health Commercial |
$12.60
|
| Rate for Payer: Nomi Health Commercial |
$13.37
|
| Rate for Payer: PACE Senior Care Partners |
$3.65
|
| 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 |
$3.87
|
| Rate for Payer: PACE SWMI |
$4.08
|
| Rate for Payer: PACE SWMI |
$3.84
|
| Rate for Payer: PACE SWMI |
$5.36
|
| Rate for Payer: PACE SWMI |
$5.56
|
| Rate for Payer: PHP Commercial |
$18.22
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: PHP Commercial |
$13.86
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: PHP Medicare Advantage |
$4.08
|
| Rate for Payer: PHP Medicare Advantage |
$3.84
|
| Rate for Payer: PHP Medicare Advantage |
$5.56
|
| Rate for Payer: PHP Medicare Advantage |
$5.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.99
|
| Rate for Payer: Priority Health HMO/PPO |
$14.18
|
| Rate for Payer: Priority Health HMO/PPO |
$19.36
|
| Rate for Payer: Priority Health HMO/PPO |
$18.65
|
| Rate for Payer: Priority Health HMO/PPO |
$13.37
|
| Rate for Payer: Priority Health Medicare |
$5.41
|
| Rate for Payer: Priority Health Medicare |
$3.88
|
| Rate for Payer: Priority Health Medicare |
$4.12
|
| Rate for Payer: Priority Health Medicare |
$5.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.30
|
| Rate for Payer: Railroad Medicare Medicare |
$4.08
|
| 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: UHC All Payor (Choice/PPO) |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC Core |
$12.83
|
| Rate for Payer: UHC Core |
$18.58
|
| Rate for Payer: UHC Core |
$13.61
|
| Rate for Payer: UHC Core |
$17.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.08
|
| Rate for Payer: UHC Exchange |
$5.56
|
| Rate for Payer: UHC Exchange |
$4.08
|
| Rate for Payer: UHC Exchange |
$3.84
|
| Rate for Payer: UHC Exchange |
$5.36
|
| Rate for Payer: UHC Medicare Advantage |
$5.56
|
| Rate for Payer: UHC Medicare Advantage |
$3.84
|
| Rate for Payer: UHC Medicare Advantage |
$5.36
|
| Rate for Payer: UHC Medicare Advantage |
$4.08
|
| Rate for Payer: VA VA |
$4.08
|
| Rate for Payer: VA VA |
$5.56
|
| Rate for Payer: VA VA |
$5.36
|
| Rate for Payer: VA VA |
$3.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.22
|
| 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 |
$16.08
|
|
|
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 |
$13.94 |
| 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 |
$17.50
|
| Rate for Payer: BCBS Trust/PPO |
$18.16
|
| Rate for Payer: BCBS Trust/PPO |
$13.31
|
| Rate for Payer: BCBS Trust/PPO |
$12.55
|
| Rate for Payer: BCN Commercial |
$16.57
|
| Rate for Payer: BCN Commercial |
$11.88
|
| Rate for Payer: BCN Commercial |
$17.19
|
| Rate for Payer: BCN Commercial |
$12.60
|
| 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: PHP Commercial |
$13.86
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: PHP Commercial |
$18.22
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.94
|
| Rate for Payer: Priority Health HMO/PPO |
$18.65
|
| Rate for Payer: Priority Health HMO/PPO |
$19.36
|
| Rate for Payer: Priority Health HMO/PPO |
$13.37
|
| Rate for Payer: Priority Health HMO/PPO |
$14.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.30
|
| 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 IN D5W 1 GRAM/100 ML IVPB (CODE)
|
Facility
|
IP
|
$111.65
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
163707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.57 |
| Max. Negotiated Rate |
$100.48 |
| Rate for Payer: Aetna Commercial |
$94.90
|
| Rate for Payer: BCBS Trust/PPO |
$91.14
|
| Rate for Payer: BCN Commercial |
$86.28
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cofinity Commercial |
$96.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Healthscope Commercial |
$100.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.90
|
| Rate for Payer: Nomi Health Commercial |
$91.55
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.57
|
| Rate for Payer: Priority Health HMO/PPO |
$97.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.25
|
| Rate for Payer: UHC Core |
$93.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.74
|
|
|
MAGNESIUM SULFATE IN D5W 1 GRAM/100 ML IVPB (CODE)
|
Facility
|
OP
|
$111.65
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
163707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$100.48 |
| Rate for Payer: Aetna Commercial |
$94.90
|
| Rate for Payer: Aetna Medicare |
$29.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.89
|
| Rate for Payer: BCBS Complete |
$44.66
|
| Rate for Payer: BCBS MAPPO |
$27.91
|
| Rate for Payer: BCBS Trust/PPO |
$91.79
|
| Rate for Payer: BCN Commercial |
$86.81
|
| Rate for Payer: BCN Medicare Advantage |
$27.91
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cofinity Commercial |
$96.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.91
|
| Rate for Payer: Healthscope Commercial |
$100.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.90
|
| Rate for Payer: Nomi Health Commercial |
$91.55
|
| Rate for Payer: PACE Senior Care Partners |
$26.52
|
| Rate for Payer: PACE SWMI |
$27.91
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: PHP Medicare Advantage |
$27.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.57
|
| Rate for Payer: Priority Health HMO/PPO |
$97.14
|
| Rate for Payer: Priority Health Medicare |
$28.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.81
|
| Rate for Payer: Railroad Medicare Medicare |
$27.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.25
|
| Rate for Payer: UHC Core |
$93.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.91
|
| Rate for Payer: UHC Exchange |
$27.91
|
| Rate for Payer: UHC Medicare Advantage |
$27.91
|
| Rate for Payer: VA VA |
$27.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.74
|
|
|
MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST; BILATERAL
|
Facility
|
OP
|
$271.13
|
|
|
Service Code
|
CPT C8908
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$258.20 |
| Max. Negotiated Rate |
$271.13 |
| Rate for Payer: BCBS Complete |
$271.13
|
| Rate for Payer: Mclaren Medicaid |
$258.20
|
| Rate for Payer: Meridian Medicaid |
$271.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$258.20
|
| Rate for Payer: UHCCP Medicaid |
$258.20
|
|
