|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
IP
|
$181.44
|
|
|
Service Code
|
NDC 6936727102
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.83 |
| Max. Negotiated Rate |
$163.30 |
| Rate for Payer: Aetna American Axle |
$117.94
|
| Rate for Payer: Aetna Commercial |
$154.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.94
|
| Rate for Payer: Cash Price |
$145.15
|
| Rate for Payer: Cofinity Commercial |
$127.01
|
| Rate for Payer: Cofinity Commercial |
$156.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.15
|
| Rate for Payer: Healthscope Commercial |
$163.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.22
|
| Rate for Payer: PHP Commercial |
$154.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.01
|
| Rate for Payer: Priority Health SBD |
$114.31
|
| Rate for Payer: UMR Bronson Commercial |
$79.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.08
|
|
|
MAGNESIUM SULFATE 0.5 GRAM/ML (50 %) INJECTION (CODE)
|
Facility
|
IP
|
$40.25
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
163706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$36.22 |
| Rate for Payer: Aetna American Axle |
$26.16
|
| Rate for Payer: Aetna American Axle |
$13.94
|
| Rate for Payer: Aetna Commercial |
$34.21
|
| Rate for Payer: Aetna Commercial |
$18.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.94
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cofinity Commercial |
$34.62
|
| Rate for Payer: Cofinity Commercial |
$18.44
|
| Rate for Payer: Cofinity Commercial |
$15.01
|
| Rate for Payer: Cofinity Commercial |
$28.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.20
|
| Rate for Payer: Healthscope Commercial |
$36.22
|
| Rate for Payer: Healthscope Commercial |
$19.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.21
|
| Rate for Payer: PHP Commercial |
$34.21
|
| Rate for Payer: PHP Commercial |
$18.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.01
|
| Rate for Payer: Priority Health SBD |
$13.51
|
| Rate for Payer: Priority Health SBD |
$25.36
|
| Rate for Payer: UMR Bronson Commercial |
$9.43
|
| Rate for Payer: UMR Bronson Commercial |
$17.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.08
|
|
|
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 |
$49.13 |
| Max. Negotiated Rate |
$100.48 |
| Rate for Payer: Aetna American Axle |
$72.57
|
| Rate for Payer: Aetna American Axle |
$30.07
|
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna American Axle |
$54.54
|
| Rate for Payer: Aetna Commercial |
$39.32
|
| Rate for Payer: Aetna Commercial |
$94.90
|
| Rate for Payer: Aetna Commercial |
$71.32
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.54
|
| Rate for Payer: Cash Price |
$67.13
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cash Price |
$37.01
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$39.78
|
| Rate for Payer: Cofinity Commercial |
$58.74
|
| Rate for Payer: Cofinity Commercial |
$72.16
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Cofinity Commercial |
$96.02
|
| Rate for Payer: Cofinity Commercial |
$78.16
|
| Rate for Payer: Cofinity Commercial |
$32.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Healthscope Commercial |
$100.48
|
| Rate for Payer: Healthscope Commercial |
$41.63
|
| Rate for Payer: Healthscope Commercial |
$75.52
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.32
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: PHP Commercial |
$71.32
|
| Rate for Payer: PHP Commercial |
$39.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.74
|
| Rate for Payer: Priority Health SBD |
$52.86
|
| Rate for Payer: Priority Health SBD |
$29.14
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: Priority Health SBD |
$70.34
|
| Rate for Payer: UMR Bronson Commercial |
$49.13
|
| Rate for Payer: UMR Bronson Commercial |
$36.92
|
| Rate for Payer: UMR Bronson Commercial |
$20.35
|
| Rate for Payer: UMR Bronson Commercial |
$21.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.93
|
|
|
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 |
$2.22 |
| Max. Negotiated Rate |
$100.48 |
| Rate for Payer: Aetna American Axle |
$72.57
|
| Rate for Payer: Aetna Commercial |
$94.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.57
|
| Rate for Payer: BCBS Complete |
$44.66
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cofinity Commercial |
$78.16
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$78.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.90
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.16
|
| Rate for Payer: Priority Health SBD |
$70.34
|
| Rate for Payer: UMR Bronson Commercial |
$41.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.74
|
|
|
MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$55.83
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117958
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$50.25 |
| Rate for Payer: Aetna American Axle |
$36.29
|
| Rate for Payer: Aetna American Axle |
$51.84
|
| Rate for Payer: Aetna American Axle |
$57.02
|
| Rate for Payer: Aetna Commercial |
$67.79
|
| Rate for Payer: Aetna Commercial |
$47.46
|
| Rate for Payer: Aetna Commercial |
$74.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.84
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Cash Price |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$55.82
|
| Rate for Payer: Cofinity Commercial |
$39.08
|
| Rate for Payer: Cofinity Commercial |
$48.01
|
| Rate for Payer: Cofinity Commercial |
$75.45
|
| Rate for Payer: Cofinity Commercial |
$61.41
|
| Rate for Payer: Cofinity Commercial |
$68.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$71.78
|
| Rate for Payer: Healthscope Commercial |
$50.25
|
| Rate for Payer: Healthscope Commercial |
$78.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.57
|
| Rate for Payer: PHP Commercial |
$67.79
|
| Rate for Payer: PHP Commercial |
$74.57
|
| Rate for Payer: PHP Commercial |
$47.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.41
|
| Rate for Payer: Priority Health SBD |
$55.27
|
| Rate for Payer: Priority Health SBD |
$50.24
|
| Rate for Payer: Priority Health SBD |
$35.17
|
| Rate for Payer: UMR Bronson Commercial |
$35.09
|
| Rate for Payer: UMR Bronson Commercial |
$24.57
|
| Rate for Payer: UMR Bronson Commercial |
$38.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.80
|
|
|
MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$18.03
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$16.23 |
| Rate for Payer: Aetna American Axle |
$11.72
|
| Rate for Payer: Aetna American Axle |
$16.20
|
| Rate for Payer: Aetna American Axle |
$50.41
|
| Rate for Payer: Aetna American Axle |
$39.77
|
| Rate for Payer: Aetna American Axle |
$19.00
|
| Rate for Payer: Aetna American Axle |
$15.39
|
| Rate for Payer: Aetna Commercial |
$21.18
|
| Rate for Payer: Aetna Commercial |
$15.33
|
| Rate for Payer: Aetna Commercial |
$20.13
|
| Rate for Payer: Aetna Commercial |
$24.85
|
| Rate for Payer: Aetna Commercial |
$52.01
|
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.41
|
| Rate for Payer: Cash Price |
$19.94
|
| Rate for Payer: Cash Price |
$48.95
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cash Price |
$23.38
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Commercial |
$12.62
|
| Rate for Payer: Cofinity Commercial |
$20.46
|
| Rate for Payer: Cofinity Commercial |
$42.83
|
| Rate for Payer: Cofinity Commercial |
$16.58
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Cofinity Commercial |
$15.51
|
| Rate for Payer: Cofinity Commercial |
$17.44
|
| Rate for Payer: Cofinity Commercial |
$21.43
|
| Rate for Payer: Cofinity Commercial |
$52.62
|
| Rate for Payer: Cofinity Commercial |
$25.14
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Cofinity Commercial |
$54.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.95
|
| Rate for Payer: Healthscope Commercial |
$21.31
|
| Rate for Payer: Healthscope Commercial |
$22.43
|
| Rate for Payer: Healthscope Commercial |
$16.23
|
| Rate for Payer: Healthscope Commercial |
$69.80
|
| Rate for Payer: Healthscope Commercial |
$55.07
|
| Rate for Payer: Healthscope Commercial |
$26.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.92
|
| Rate for Payer: PHP Commercial |
$65.92
|
| Rate for Payer: PHP Commercial |
$24.85
|
| Rate for Payer: PHP Commercial |
$21.18
|
| Rate for Payer: PHP Commercial |
$20.13
|
| Rate for Payer: PHP Commercial |
$15.33
|
| Rate for Payer: PHP Commercial |
$52.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.28
|
| Rate for Payer: Priority Health SBD |
$18.41
|
| Rate for Payer: Priority Health SBD |
$15.70
|
| Rate for Payer: Priority Health SBD |
$48.86
|
| Rate for Payer: Priority Health SBD |
$38.55
|
| Rate for Payer: Priority Health SBD |
$11.36
|
| Rate for Payer: Priority Health SBD |
$14.92
|
| Rate for Payer: UMR Bronson Commercial |
$34.12
|
| Rate for Payer: UMR Bronson Commercial |
$10.96
|
| Rate for Payer: UMR Bronson Commercial |
$10.42
|
| Rate for Payer: UMR Bronson Commercial |
$7.93
|
| Rate for Payer: UMR Bronson Commercial |
$26.92
|
| Rate for Payer: UMR Bronson Commercial |
$12.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.16
|
|
|
MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$29.23
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$26.31 |
| Rate for Payer: Aetna American Axle |
$19.00
|
| Rate for Payer: Aetna American Axle |
$39.77
|
| Rate for Payer: Aetna American Axle |
$15.39
|
| Rate for Payer: Aetna Commercial |
$20.13
|
| Rate for Payer: Aetna Commercial |
$24.85
|
| Rate for Payer: Aetna Commercial |
$52.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.00
|
| Rate for Payer: BCBS Complete |
$9.47
|
| Rate for Payer: BCBS Complete |
$24.48
|
| Rate for Payer: BCBS Complete |
$11.69
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: Cash Price |
$23.38
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$48.95
|
| Rate for Payer: Cash Price |
$48.95
|
| Rate for Payer: Cash Price |
$23.38
|
| Rate for Payer: Cofinity Commercial |
$42.83
|
| Rate for Payer: Cofinity Commercial |
$16.58
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Cofinity Commercial |
$20.46
|
| Rate for Payer: Cofinity Commercial |
$25.14
|
| Rate for Payer: Cofinity Commercial |
$52.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.38
|
| Rate for Payer: Healthscope Commercial |
$26.31
|
| Rate for Payer: Healthscope Commercial |
$55.07
|
| Rate for Payer: Healthscope Commercial |
$21.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.13
|
| Rate for Payer: PHP Commercial |
$20.13
|
| Rate for Payer: PHP Commercial |
$24.85
|
| Rate for Payer: PHP Commercial |
$52.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.58
|
| Rate for Payer: Priority Health SBD |
$38.55
|
| Rate for Payer: Priority Health SBD |
$18.41
|
| Rate for Payer: Priority Health SBD |
$14.92
|
| Rate for Payer: UMR Bronson Commercial |
$8.76
|
| Rate for Payer: UMR Bronson Commercial |
$10.82
|
| Rate for Payer: UMR Bronson Commercial |
$22.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.89
|
|
|
MAGNESIUM SULFATE 4.06 MEQ/ML (50 %) INJECTION (TPN COMPONENT)
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
180902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.92 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Aetna American Axle |
$60.45
|
| Rate for Payer: Aetna Commercial |
$79.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.45
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cofinity Commercial |
$65.10
|
| Rate for Payer: Cofinity Commercial |
$79.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.40
|
| Rate for Payer: Healthscope Commercial |
$83.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.05
|
| Rate for Payer: PHP Commercial |
$79.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.10
|
| Rate for Payer: Priority Health SBD |
$58.59
|
| Rate for Payer: UMR Bronson Commercial |
$40.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.75
|
|
|
MAGNESIUM SULFATE 495 MG/5 GRAM ORAL GRANULES
|
Facility
|
IP
|
$5.45
|
|
|
Service Code
|
NDC 8770140238
|
| Hospital Charge Code |
27322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$4.90 |
| Rate for Payer: Aetna American Axle |
$3.54
|
| Rate for Payer: Aetna Commercial |
$4.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.54
|
| Rate for Payer: Cash Price |
$4.36
|
| Rate for Payer: Cofinity Commercial |
$3.82
|
| Rate for Payer: Cofinity Commercial |
$4.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.36
|
| Rate for Payer: Healthscope Commercial |
$4.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.63
|
| Rate for Payer: PHP Commercial |
$4.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.82
|
| Rate for Payer: Priority Health SBD |
$3.43
|
| Rate for Payer: UMR Bronson Commercial |
$2.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.09
|
|
|
MAGNESIUM SULFATE 495 MG/5 GRAM ORAL GRANULES
|
Facility
|
IP
|
$10.90
|
|
|
Service Code
|
NDC 70000-0021-1
|
| Hospital Charge Code |
27322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$9.81 |
| Rate for Payer: Aetna American Axle |
$7.08
|
| Rate for Payer: Aetna Commercial |
$9.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.08
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cofinity Commercial |
$7.63
|
| Rate for Payer: Cofinity Commercial |
$9.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.72
|
| Rate for Payer: Healthscope Commercial |
$9.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.26
|
| Rate for Payer: PHP Commercial |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.63
|
| Rate for Payer: Priority Health SBD |
$6.87
|
| Rate for Payer: UMR Bronson Commercial |
$4.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.18
|
|
|
MAGNESIUM SULFATE 4 GRAM/100 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$469.88
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4719
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$422.89 |
| Rate for Payer: Aetna American Axle |
$305.42
|
| Rate for Payer: Aetna American Axle |
$98.81
|
| Rate for Payer: Aetna Commercial |
$399.40
|
| Rate for Payer: Aetna Commercial |
$129.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.42
|
| Rate for Payer: BCBS Complete |
$187.95
|
| Rate for Payer: BCBS Complete |
$60.81
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: Cash Price |
$375.90
|
| Rate for Payer: Cash Price |
$375.90
|
| Rate for Payer: Cash Price |
$121.62
|
| Rate for Payer: Cash Price |
$121.62
|
| Rate for Payer: Cofinity Commercial |
$404.10
|
| Rate for Payer: Cofinity Commercial |
$106.41
|
| Rate for Payer: Cofinity Commercial |
$130.74
|
| Rate for Payer: Cofinity Commercial |
$328.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.62
|
| Rate for Payer: Healthscope Commercial |
$136.82
|
| Rate for Payer: Healthscope Commercial |
$422.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$328.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$399.40
|
| Rate for Payer: PHP Commercial |
$129.22
|
| Rate for Payer: PHP Commercial |
$399.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.41
|
| Rate for Payer: Priority Health SBD |
$296.02
|
| Rate for Payer: Priority Health SBD |
$95.77
|
| Rate for Payer: UMR Bronson Commercial |
$56.25
|
| Rate for Payer: UMR Bronson Commercial |
$173.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.41
|
| 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 |
$66.89 |
| Max. Negotiated Rate |
$136.82 |
| Rate for Payer: Aetna American Axle |
$98.81
|
| Rate for Payer: Aetna American Axle |
$80.85
|
| Rate for Payer: Aetna American Axle |
$116.78
|
| Rate for Payer: Aetna American Axle |
$305.42
|
| Rate for Payer: Aetna Commercial |
$399.40
|
| Rate for Payer: Aetna Commercial |
$152.71
|
| Rate for Payer: Aetna Commercial |
$129.22
|
| Rate for Payer: Aetna Commercial |
$105.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.85
|
| Rate for Payer: Cash Price |
$375.90
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cash Price |
$121.62
|
| Rate for Payer: Cash Price |
$143.73
|
| Rate for Payer: Cofinity Commercial |
$87.07
|
| Rate for Payer: Cofinity Commercial |
$125.76
|
| Rate for Payer: Cofinity Commercial |
$106.97
|
| Rate for Payer: Cofinity Commercial |
$154.51
|
| Rate for Payer: Cofinity Commercial |
$106.41
|
| Rate for Payer: Cofinity Commercial |
$130.74
|
| Rate for Payer: Cofinity Commercial |
$404.10
|
| Rate for Payer: Cofinity Commercial |
$328.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.50
|
| Rate for Payer: Healthscope Commercial |
$161.69
|
| Rate for Payer: Healthscope Commercial |
$136.82
|
| Rate for Payer: Healthscope Commercial |
$111.94
|
| Rate for Payer: Healthscope Commercial |
$422.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$328.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$152.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$399.40
|
| Rate for Payer: PHP Commercial |
$152.71
|
| Rate for Payer: PHP Commercial |
$105.72
|
| Rate for Payer: PHP Commercial |
$129.22
|
| Rate for Payer: PHP Commercial |
$399.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.07
|
| Rate for Payer: Priority Health SBD |
$95.77
|
| Rate for Payer: Priority Health SBD |
$296.02
|
| Rate for Payer: Priority Health SBD |
$78.36
|
| Rate for Payer: Priority Health SBD |
$113.19
|
| Rate for Payer: UMR Bronson Commercial |
$79.05
|
| Rate for Payer: UMR Bronson Commercial |
$66.89
|
| Rate for Payer: UMR Bronson Commercial |
$54.73
|
| Rate for Payer: UMR Bronson Commercial |
$206.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.28
|
|
|
MAGNESIUM SULFATE 4 GRAM/50 ML (8 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$53.44
|
|
|
Service Code
|
NDC 63323-107-01
|
| Hospital Charge Code |
4721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.51 |
| Max. Negotiated Rate |
$48.10 |
| Rate for Payer: Aetna American Axle |
$34.74
|
| Rate for Payer: Aetna Commercial |
$45.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.74
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cofinity Commercial |
$37.41
|
| Rate for Payer: Cofinity Commercial |
$45.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.75
|
| Rate for Payer: Healthscope Commercial |
$48.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.42
|
| Rate for Payer: PHP Commercial |
$45.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.41
|
| Rate for Payer: Priority Health SBD |
$33.67
|
| Rate for Payer: UMR Bronson Commercial |
$23.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.08
|
|
|
MAGNESIUM SULFATE 4 GRAM/50 ML (8 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$53.44
|
|
|
Service Code
|
NDC 63323-107-05
|
| Hospital Charge Code |
4721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.77 |
| Max. Negotiated Rate |
$48.10 |
| Rate for Payer: Aetna American Axle |
$34.74
|
| Rate for Payer: Aetna Commercial |
$45.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.74
|
| Rate for Payer: BCBS Complete |
$21.38
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cofinity Commercial |
$37.41
|
| Rate for Payer: Cofinity Commercial |
$45.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.75
|
| Rate for Payer: Healthscope Commercial |
$48.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.42
|
| Rate for Payer: PHP Commercial |
$45.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.41
|
| Rate for Payer: Priority Health SBD |
$33.67
|
| Rate for Payer: UMR Bronson Commercial |
$19.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.08
|
|
|
MAGNESIUM SULFATE 4 GRAM/50 ML (8 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$53.44
|
|
|
Service Code
|
NDC 63323-107-05
|
| Hospital Charge Code |
4721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.51 |
| Max. Negotiated Rate |
$48.10 |
| Rate for Payer: Aetna American Axle |
$34.74
|
| Rate for Payer: Aetna Commercial |
$45.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.74
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cofinity Commercial |
$37.41
|
| Rate for Payer: Cofinity Commercial |
$45.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.75
|
| Rate for Payer: Healthscope Commercial |
$48.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.42
|
| Rate for Payer: PHP Commercial |
$45.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.41
|
| Rate for Payer: Priority Health SBD |
$33.67
|
| Rate for Payer: UMR Bronson Commercial |
$23.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.08
|
|
|
MAGNESIUM SULFATE 4 GRAM/50 ML (8 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$53.44
|
|
|
Service Code
|
NDC 63323-107-01
|
| Hospital Charge Code |
4721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.77 |
| Max. Negotiated Rate |
$48.10 |
| Rate for Payer: Aetna American Axle |
$34.74
|
| Rate for Payer: Aetna Commercial |
$45.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.74
|
| Rate for Payer: BCBS Complete |
$21.38
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cofinity Commercial |
$37.41
|
| Rate for Payer: Cofinity Commercial |
$45.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.75
|
| Rate for Payer: Healthscope Commercial |
$48.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.42
|
| Rate for Payer: PHP Commercial |
$45.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.41
|
| Rate for Payer: Priority Health SBD |
$33.67
|
| Rate for Payer: UMR Bronson Commercial |
$19.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.08
|
|
|
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION
|
Facility
|
IP
|
$23.35
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$21.02 |
| Rate for Payer: Aetna American Axle |
$15.18
|
| Rate for Payer: Aetna American Axle |
$9.99
|
| Rate for Payer: Aetna American Axle |
$12.44
|
| Rate for Payer: Aetna American Axle |
$13.94
|
| Rate for Payer: Aetna American Axle |
$18.00
|
| Rate for Payer: Aetna American Axle |
$36.30
|
| Rate for Payer: Aetna American Axle |
$17.89
|
| Rate for Payer: Aetna Commercial |
$23.54
|
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Commercial |
$47.47
|
| Rate for Payer: Aetna Commercial |
$19.85
|
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna Commercial |
$18.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.94
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$18.68
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cash Price |
$44.68
|
| Rate for Payer: Cofinity Commercial |
$39.10
|
| Rate for Payer: Cofinity Commercial |
$20.08
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Cofinity Commercial |
$19.39
|
| Rate for Payer: Cofinity Commercial |
$15.01
|
| Rate for Payer: Cofinity Commercial |
$18.44
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Cofinity Commercial |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$16.34
|
| Rate for Payer: Cofinity Commercial |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$10.76
|
| Rate for Payer: Cofinity Commercial |
$48.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Healthscope Commercial |
$13.83
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Healthscope Commercial |
$19.30
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Healthscope Commercial |
$50.26
|
| Rate for Payer: Healthscope Commercial |
$21.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.40
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: PHP Commercial |
$18.22
|
| Rate for Payer: PHP Commercial |
$19.85
|
| Rate for Payer: PHP Commercial |
$23.40
|
| Rate for Payer: PHP Commercial |
$23.54
|
| Rate for Payer: PHP Commercial |
$47.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.76
|
| Rate for Payer: Priority Health SBD |
$13.51
|
| Rate for Payer: Priority Health SBD |
$9.68
|
| Rate for Payer: Priority Health SBD |
$17.34
|
| Rate for Payer: Priority Health SBD |
$12.06
|
| Rate for Payer: Priority Health SBD |
$35.19
|
| Rate for Payer: Priority Health SBD |
$17.45
|
| Rate for Payer: Priority Health SBD |
$14.71
|
| Rate for Payer: UMR Bronson Commercial |
$10.27
|
| Rate for Payer: UMR Bronson Commercial |
$12.11
|
| Rate for Payer: UMR Bronson Commercial |
$12.19
|
| Rate for Payer: UMR Bronson Commercial |
$9.43
|
| Rate for Payer: UMR Bronson Commercial |
$8.42
|
| Rate for Payer: UMR Bronson Commercial |
$6.76
|
| Rate for Payer: UMR Bronson Commercial |
$24.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.89
|
|
|
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION
|
Facility
|
OP
|
$55.85
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$50.26 |
| Rate for Payer: Aetna American Axle |
$36.30
|
| Rate for Payer: Aetna American Axle |
$15.18
|
| Rate for Payer: Aetna American Axle |
$9.99
|
| Rate for Payer: Aetna American Axle |
$18.00
|
| Rate for Payer: Aetna American Axle |
$13.94
|
| Rate for Payer: Aetna American Axle |
$17.89
|
| Rate for Payer: Aetna Commercial |
$47.47
|
| Rate for Payer: Aetna Commercial |
$23.54
|
| Rate for Payer: Aetna Commercial |
$18.22
|
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna Commercial |
$19.85
|
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.18
|
| Rate for Payer: BCBS Complete |
$6.15
|
| Rate for Payer: BCBS Complete |
$11.08
|
| Rate for Payer: BCBS Complete |
$9.34
|
| Rate for Payer: BCBS Complete |
$8.58
|
| Rate for Payer: BCBS Complete |
$22.34
|
| Rate for Payer: BCBS Complete |
$11.01
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: Cash Price |
$44.68
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$44.68
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$18.68
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$18.68
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cofinity Commercial |
$18.44
|
| Rate for Payer: Cofinity Commercial |
$15.01
|
| Rate for Payer: Cofinity Commercial |
$39.10
|
| Rate for Payer: Cofinity Commercial |
$16.34
|
| Rate for Payer: Cofinity Commercial |
$20.08
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$10.76
|
| Rate for Payer: Cofinity Commercial |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$48.03
|
| Rate for Payer: Cofinity Commercial |
$19.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.68
|
| 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 |
$18.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Healthscope Commercial |
$19.30
|
| Rate for Payer: Healthscope Commercial |
$50.26
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Healthscope Commercial |
$21.02
|
| Rate for Payer: Healthscope Commercial |
$13.83
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.06
|
| Rate for Payer: PHP Commercial |
$23.54
|
| Rate for Payer: PHP Commercial |
$18.22
|
| Rate for Payer: PHP Commercial |
$47.47
|
| Rate for Payer: PHP Commercial |
$23.40
|
| Rate for Payer: PHP Commercial |
$19.85
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.27
|
| Rate for Payer: Priority Health SBD |
$17.45
|
| Rate for Payer: Priority Health SBD |
$17.34
|
| Rate for Payer: Priority Health SBD |
$14.71
|
| Rate for Payer: Priority Health SBD |
$13.51
|
| Rate for Payer: Priority Health SBD |
$9.68
|
| Rate for Payer: Priority Health SBD |
$35.19
|
| Rate for Payer: UMR Bronson Commercial |
$10.19
|
| Rate for Payer: UMR Bronson Commercial |
$5.69
|
| Rate for Payer: UMR Bronson Commercial |
$7.93
|
| Rate for Payer: UMR Bronson Commercial |
$8.64
|
| Rate for Payer: UMR Bronson Commercial |
$10.25
|
| Rate for Payer: UMR Bronson Commercial |
$20.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.51
|
| 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 |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.89
|
|
|
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SYRINGE
|
Facility
|
OP
|
$197.66
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
112145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$177.89 |
| Rate for Payer: Aetna American Axle |
$128.48
|
| Rate for Payer: Aetna Commercial |
$168.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.48
|
| Rate for Payer: BCBS Complete |
$79.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: Cash Price |
$158.13
|
| Rate for Payer: Cash Price |
$158.13
|
| Rate for Payer: Cofinity Commercial |
$138.36
|
| Rate for Payer: Cofinity Commercial |
$169.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.13
|
| Rate for Payer: Healthscope Commercial |
$177.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.01
|
| Rate for Payer: PHP Commercial |
$168.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.36
|
| Rate for Payer: Priority Health SBD |
$124.53
|
| Rate for Payer: UMR Bronson Commercial |
$73.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.24
|
|
|
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SYRINGE
|
Facility
|
IP
|
$197.66
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
112145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.97 |
| Max. Negotiated Rate |
$177.89 |
| Rate for Payer: Aetna American Axle |
$128.48
|
| Rate for Payer: Aetna Commercial |
$168.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.48
|
| Rate for Payer: Cash Price |
$158.13
|
| Rate for Payer: Cofinity Commercial |
$138.36
|
| Rate for Payer: Cofinity Commercial |
$169.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.13
|
| Rate for Payer: Healthscope Commercial |
$177.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.01
|
| Rate for Payer: PHP Commercial |
$168.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.36
|
| Rate for Payer: Priority Health SBD |
$124.53
|
| Rate for Payer: UMR Bronson Commercial |
$86.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.24
|
|
|
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 |
$49.13 |
| Max. Negotiated Rate |
$100.48 |
| Rate for Payer: Aetna American Axle |
$72.57
|
| Rate for Payer: Aetna Commercial |
$94.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.57
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cofinity Commercial |
$96.02
|
| Rate for Payer: Cofinity Commercial |
$78.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Healthscope Commercial |
$100.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.90
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.16
|
| Rate for Payer: Priority Health SBD |
$70.34
|
| Rate for Payer: UMR Bronson Commercial |
$49.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.74
|
|
|
MAJOR BLADDER PROCEDURES WITH CC
|
Facility
|
IP
|
$66,413.43
|
|
|
Service Code
|
MS-DRG 654
|
| Min. Negotiated Rate |
$20,527.23 |
| Max. Negotiated Rate |
$66,413.43 |
| Rate for Payer: Aetna Medicare |
$22,471.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,009.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,009.51
|
| Rate for Payer: BCBS MAPPO |
$21,607.61
|
| Rate for Payer: BCBS Trust/PPO |
$66,413.43
|
| Rate for Payer: BCN Medicare Advantage |
$21,607.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,607.61
|
| Rate for Payer: Mclaren Medicare |
$21,607.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22,687.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,848.75
|
| Rate for Payer: PACE Medicare |
$20,527.23
|
| Rate for Payer: PACE SWMI |
$21,607.61
|
| Rate for Payer: PHP Medicare Advantage |
$21,607.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39,282.91
|
| Rate for Payer: Priority Health Medicare |
$21,607.61
|
| Rate for Payer: Priority Health Narrow Network |
$31,426.33
|
| Rate for Payer: Railroad Medicare Medicare |
$21,607.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41,757.83
|
| Rate for Payer: UHC Core |
$34,240.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$21,607.61
|
| Rate for Payer: UHC Exchange |
$27,221.70
|
| Rate for Payer: UHC Medicare Advantage |
$22,255.84
|
| Rate for Payer: VA VA |
$21,607.61
|
|
|
MAJOR BLADDER PROCEDURES WITH MCC
|
Facility
|
IP
|
$82,579.05
|
|
|
Service Code
|
MS-DRG 653
|
| Min. Negotiated Rate |
$40,118.26 |
| Max. Negotiated Rate |
$82,579.05 |
| Rate for Payer: Aetna Medicare |
$43,918.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52,787.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52,787.19
|
| Rate for Payer: BCBS MAPPO |
$42,229.75
|
| Rate for Payer: BCBS Trust/PPO |
$66,473.74
|
| Rate for Payer: BCN Medicare Advantage |
$42,229.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42,229.75
|
| Rate for Payer: Mclaren Medicare |
$42,229.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44,341.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48,564.21
|
| Rate for Payer: PACE Medicare |
$40,118.26
|
| Rate for Payer: PACE SWMI |
$42,229.75
|
| Rate for Payer: PHP Medicare Advantage |
$42,229.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77,684.73
|
| Rate for Payer: Priority Health Medicare |
$42,229.75
|
| Rate for Payer: Priority Health Narrow Network |
$62,147.78
|
| Rate for Payer: Railroad Medicare Medicare |
$42,229.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82,579.05
|
| Rate for Payer: UHC Core |
$67,713.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$42,229.75
|
| Rate for Payer: UHC Exchange |
$53,832.84
|
| Rate for Payer: UHC Medicare Advantage |
$43,496.64
|
| Rate for Payer: VA VA |
$42,229.75
|
|
|
MAJOR BLADDER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$59,095.87
|
|
|
Service Code
|
MS-DRG 655
|
| Min. Negotiated Rate |
$15,917.38 |
| Max. Negotiated Rate |
$59,095.87 |
| Rate for Payer: Aetna Medicare |
$17,425.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,943.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,943.92
|
| Rate for Payer: BCBS MAPPO |
$16,755.14
|
| Rate for Payer: BCBS Trust/PPO |
$59,095.87
|
| Rate for Payer: BCN Medicare Advantage |
$16,755.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,755.14
|
| Rate for Payer: Mclaren Medicare |
$16,755.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,592.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,268.41
|
| Rate for Payer: PACE Medicare |
$15,917.38
|
| Rate for Payer: PACE SWMI |
$16,755.14
|
| Rate for Payer: PHP Medicare Advantage |
$16,755.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,246.76
|
| Rate for Payer: Priority Health Medicare |
$16,755.14
|
| Rate for Payer: Priority Health Narrow Network |
$24,197.41
|
| Rate for Payer: Railroad Medicare Medicare |
$16,755.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,152.38
|
| Rate for Payer: UHC Core |
$26,364.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,755.14
|
| Rate for Payer: UHC Exchange |
$20,959.96
|
| Rate for Payer: UHC Medicare Advantage |
$17,257.79
|
| Rate for Payer: VA VA |
$16,755.14
|
|
|
MAJOR CHEST PROCEDURES WITH CC
|
Facility
|
IP
|
$50,986.74
|
|
|
Service Code
|
MS-DRG 164
|
| Min. Negotiated Rate |
$19,157.52 |
| Max. Negotiated Rate |
$50,986.74 |
| Rate for Payer: Aetna Medicare |
$20,972.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,207.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,207.26
|
| Rate for Payer: BCBS MAPPO |
$20,165.81
|
| Rate for Payer: BCBS Trust/PPO |
$50,986.74
|
| Rate for Payer: BCN Medicare Advantage |
$20,165.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,165.81
|
| Rate for Payer: Mclaren Medicare |
$20,165.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21,174.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,190.68
|
| Rate for Payer: PACE Medicare |
$19,157.52
|
| Rate for Payer: PACE SWMI |
$20,165.81
|
| Rate for Payer: PHP Medicare Advantage |
$20,165.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36,598.04
|
| Rate for Payer: Priority Health Medicare |
$20,165.81
|
| Rate for Payer: Priority Health Narrow Network |
$29,278.43
|
| Rate for Payer: Railroad Medicare Medicare |
$20,165.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38,903.80
|
| Rate for Payer: UHC Core |
$31,900.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$20,165.81
|
| Rate for Payer: UHC Exchange |
$25,361.18
|
| Rate for Payer: UHC Medicare Advantage |
$20,770.78
|
| Rate for Payer: VA VA |
$20,165.81
|
|
