|
MAFENIDE 85 MG/G TOPICAL CREAM
|
Facility
|
IP
|
$1,703.50
|
|
|
Service Code
|
NDC 16571072348
|
| Hospital Charge Code |
10478
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$749.54 |
| Max. Negotiated Rate |
$1,533.15 |
| Rate for Payer: Aetna American Axle |
$1,107.28
|
| Rate for Payer: Aetna Commercial |
$1,447.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,107.28
|
| Rate for Payer: Cash Price |
$1,362.80
|
| Rate for Payer: Cofinity Advantage |
$1,192.45
|
| Rate for Payer: Cofinity Commercial |
$1,465.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,362.80
|
| Rate for Payer: Healthscope Commercial |
$1,533.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,192.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,277.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,447.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,277.62
|
| Rate for Payer: PHP Commercial |
$1,447.97
|
| Rate for Payer: Priority Health SBD |
$1,073.20
|
| Rate for Payer: UMR Bronson Commercial |
$749.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,277.62
|
|
|
MAFENIDE 85 MG/G TOPICAL CREAM
|
Facility
|
IP
|
$247.27
|
|
|
Service Code
|
NDC 16571072360
|
| Hospital Charge Code |
10478
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$222.54 |
| Rate for Payer: Aetna American Axle |
$160.73
|
| Rate for Payer: Aetna Commercial |
$210.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.73
|
| Rate for Payer: Cash Price |
$197.82
|
| Rate for Payer: Cofinity Advantage |
$173.09
|
| Rate for Payer: Cofinity Commercial |
$212.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.82
|
| Rate for Payer: Healthscope Commercial |
$222.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.45
|
| Rate for Payer: PHP Commercial |
$210.18
|
| Rate for Payer: Priority Health SBD |
$155.78
|
| Rate for Payer: UMR Bronson Commercial |
$108.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.45
|
|
|
MAFENIDE 85 MG/G TOPICAL CREAM
|
Facility
|
OP
|
$1,703.50
|
|
|
Service Code
|
NDC 16571072348
|
| Hospital Charge Code |
10478
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$630.29 |
| Max. Negotiated Rate |
$1,533.15 |
| Rate for Payer: Aetna American Axle |
$1,107.28
|
| Rate for Payer: Aetna Commercial |
$1,447.97
|
| Rate for Payer: Aetna Medicare |
$851.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,107.28
|
| Rate for Payer: BCBS Complete |
$681.40
|
| Rate for Payer: Cash Price |
$1,362.80
|
| Rate for Payer: Cofinity Advantage |
$1,192.45
|
| Rate for Payer: Cofinity Commercial |
$1,465.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,362.80
|
| Rate for Payer: Healthscope Commercial |
$1,533.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,192.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,277.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,362.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,447.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,277.62
|
| Rate for Payer: PHP Commercial |
$1,447.97
|
| Rate for Payer: Priority Health SBD |
$1,073.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,107.28
|
| Rate for Payer: UHC Core |
$887.52
|
| Rate for Payer: UHC Exchange |
$669.48
|
| Rate for Payer: UMR Bronson Commercial |
$630.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,277.62
|
|
|
MAGIC PERICREAM
|
Facility
|
IP
|
$10.26
|
|
|
Service Code
|
NDC 09900000714
|
| Hospital Charge Code |
150680
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$9.23 |
| Rate for Payer: Aetna American Axle |
$6.67
|
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.67
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Advantage |
$7.18
|
| Rate for Payer: Cofinity Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Healthscope Commercial |
$9.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.70
|
| Rate for Payer: PHP Commercial |
$8.72
|
| Rate for Payer: Priority Health SBD |
$6.46
|
| Rate for Payer: UMR Bronson Commercial |
$4.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.70
|
|
|
MAGIC PERICREAM
|
Facility
|
OP
|
$10.26
|
|
|
Service Code
|
NDC 09900000714
|
| Hospital Charge Code |
150680
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$9.23 |
| Rate for Payer: Aetna American Axle |
$6.67
|
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Aetna Medicare |
$5.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.67
|
| Rate for Payer: BCBS Complete |
$4.10
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Advantage |
$7.18
|
| Rate for Payer: Cofinity Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Healthscope Commercial |
$9.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.70
|
| Rate for Payer: PHP Commercial |
$8.72
|
| Rate for Payer: Priority Health SBD |
$6.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.67
|
| Rate for Payer: UHC Core |
$5.35
|
| Rate for Payer: UHC Exchange |
$4.03
|
| Rate for Payer: UMR Bronson Commercial |
$3.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.70
|
|
|
MAGIC PERICREAM WITH NYSTATIN
|
Facility
|
OP
|
$10.26
|
|
|
Service Code
|
NDC 09900000715
|
| Hospital Charge Code |
150679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$9.23 |
| Rate for Payer: Aetna American Axle |
$6.67
|
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Aetna Medicare |
$5.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.67
|
| Rate for Payer: BCBS Complete |
$4.10
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Advantage |
$7.18
|
| Rate for Payer: Cofinity Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Healthscope Commercial |
$9.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.70
|
| Rate for Payer: PHP Commercial |
$8.72
|
| Rate for Payer: Priority Health SBD |
$6.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.67
|
| Rate for Payer: UHC Core |
$5.35
|
| Rate for Payer: UHC Exchange |
$4.03
|
| Rate for Payer: UMR Bronson Commercial |
$3.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.70
|
|
|
MAGIC PERICREAM WITH NYSTATIN
|
Facility
|
IP
|
$10.26
|
|
|
Service Code
|
NDC 09900000715
|
| Hospital Charge Code |
150679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$9.23 |
| Rate for Payer: Aetna American Axle |
$6.67
|
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.67
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Advantage |
$7.18
|
| Rate for Payer: Cofinity Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Healthscope Commercial |
$9.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.70
|
| Rate for Payer: PHP Commercial |
$8.72
|
| Rate for Payer: Priority Health SBD |
$6.46
|
| Rate for Payer: UMR Bronson Commercial |
$4.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.70
|
|
|
MAGNESIUM 200 MG (AS MAGNESIUM OXIDE) TABLET
|
Facility
|
IP
|
$98.70
|
|
|
Service Code
|
NDC 00179803612
|
| Hospital Charge Code |
184339
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.43 |
| Max. Negotiated Rate |
$88.83 |
| Rate for Payer: Aetna American Axle |
$64.16
|
| Rate for Payer: Aetna Commercial |
$83.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.16
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Cofinity Advantage |
$69.09
|
| Rate for Payer: Cofinity Commercial |
$84.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.96
|
| Rate for Payer: Healthscope Commercial |
$88.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.03
|
| Rate for Payer: PHP Commercial |
$83.89
|
| Rate for Payer: Priority Health SBD |
$62.18
|
| Rate for Payer: UMR Bronson Commercial |
$43.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.03
|
|
|
MAGNESIUM 200 MG (AS MAGNESIUM OXIDE) TABLET
|
Facility
|
OP
|
$98.70
|
|
|
Service Code
|
NDC 00179803612
|
| Hospital Charge Code |
184339
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$88.83 |
| Rate for Payer: Aetna American Axle |
$64.16
|
| Rate for Payer: Aetna Commercial |
$83.89
|
| Rate for Payer: Aetna Medicare |
$49.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.16
|
| Rate for Payer: BCBS Complete |
$39.48
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Cofinity Advantage |
$69.09
|
| Rate for Payer: Cofinity Commercial |
$84.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.96
|
| Rate for Payer: Healthscope Commercial |
$88.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.03
|
| Rate for Payer: PHP Commercial |
$83.89
|
| Rate for Payer: Priority Health SBD |
$62.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.16
|
| Rate for Payer: UHC Core |
$51.42
|
| Rate for Payer: UHC Exchange |
$38.79
|
| Rate for Payer: UMR Bronson Commercial |
$36.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.03
|
|
|
MAGNESIUM 64 MG (MAGNESIUM CHLORIDE) TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$112.80
|
|
|
Service Code
|
NDC 68585000575
|
| Hospital Charge Code |
118625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.74 |
| Max. Negotiated Rate |
$101.52 |
| Rate for Payer: Aetna American Axle |
$73.32
|
| Rate for Payer: Aetna Commercial |
$95.88
|
| Rate for Payer: Aetna Medicare |
$56.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.32
|
| Rate for Payer: BCBS Complete |
$45.12
|
| Rate for Payer: Cash Price |
$90.24
|
| Rate for Payer: Cofinity Advantage |
$78.96
|
| Rate for Payer: Cofinity Commercial |
$97.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.24
|
| Rate for Payer: Healthscope Commercial |
$101.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.60
|
| Rate for Payer: PHP Commercial |
$95.88
|
| Rate for Payer: Priority Health SBD |
$71.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.32
|
| Rate for Payer: UHC Core |
$58.77
|
| Rate for Payer: UHC Exchange |
$44.33
|
| Rate for Payer: UMR Bronson Commercial |
$41.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.60
|
|
|
MAGNESIUM 64 MG (MAGNESIUM CHLORIDE) TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$124.08
|
|
|
Service Code
|
NDC 10006070013
|
| Hospital Charge Code |
118625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.91 |
| Max. Negotiated Rate |
$111.67 |
| Rate for Payer: Aetna American Axle |
$80.65
|
| Rate for Payer: Aetna Commercial |
$105.47
|
| Rate for Payer: Aetna Medicare |
$62.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.65
|
| Rate for Payer: BCBS Complete |
$49.63
|
| Rate for Payer: Cash Price |
$99.26
|
| Rate for Payer: Cofinity Advantage |
$86.86
|
| Rate for Payer: Cofinity Commercial |
$106.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.26
|
| Rate for Payer: Healthscope Commercial |
$111.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.06
|
| Rate for Payer: PHP Commercial |
$105.47
|
| Rate for Payer: Priority Health SBD |
$78.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.65
|
| Rate for Payer: UHC Core |
$64.65
|
| Rate for Payer: UHC Exchange |
$48.76
|
| Rate for Payer: UMR Bronson Commercial |
$45.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.06
|
|
|
MAGNESIUM 64 MG (MAGNESIUM CHLORIDE) TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$124.08
|
|
|
Service Code
|
NDC 10006070013
|
| Hospital Charge Code |
118625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$111.67 |
| Rate for Payer: Aetna American Axle |
$80.65
|
| Rate for Payer: Aetna Commercial |
$105.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.65
|
| Rate for Payer: Cash Price |
$99.26
|
| Rate for Payer: Cofinity Advantage |
$86.86
|
| Rate for Payer: Cofinity Commercial |
$106.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.26
|
| Rate for Payer: Healthscope Commercial |
$111.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.06
|
| Rate for Payer: PHP Commercial |
$105.47
|
| Rate for Payer: Priority Health SBD |
$78.17
|
| Rate for Payer: UMR Bronson Commercial |
$54.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.06
|
|
|
MAGNESIUM 64 MG (MAGNESIUM CHLORIDE) TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$112.80
|
|
|
Service Code
|
NDC 68585000575
|
| Hospital Charge Code |
118625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.63 |
| Max. Negotiated Rate |
$101.52 |
| Rate for Payer: Aetna American Axle |
$73.32
|
| Rate for Payer: Aetna Commercial |
$95.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.32
|
| Rate for Payer: Cash Price |
$90.24
|
| Rate for Payer: Cofinity Advantage |
$78.96
|
| Rate for Payer: Cofinity Commercial |
$97.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.24
|
| Rate for Payer: Healthscope Commercial |
$101.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.60
|
| Rate for Payer: PHP Commercial |
$95.88
|
| Rate for Payer: Priority Health SBD |
$71.06
|
| Rate for Payer: UMR Bronson Commercial |
$49.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.60
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
IP
|
$8.88
|
|
|
Service Code
|
NDC 70000065901
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$7.99 |
| Rate for Payer: Aetna American Axle |
$5.77
|
| Rate for Payer: Aetna Commercial |
$7.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.77
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cofinity Advantage |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$7.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$7.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.66
|
| Rate for Payer: PHP Commercial |
$7.55
|
| Rate for Payer: Priority Health SBD |
$5.59
|
| Rate for Payer: UMR Bronson Commercial |
$3.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.66
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
OP
|
$8.88
|
|
|
Service Code
|
NDC 70000065901
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$7.99 |
| Rate for Payer: Aetna American Axle |
$5.77
|
| Rate for Payer: Aetna Commercial |
$7.55
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.77
|
| Rate for Payer: BCBS Complete |
$3.55
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cofinity Advantage |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$7.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$7.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.66
|
| Rate for Payer: PHP Commercial |
$7.55
|
| Rate for Payer: Priority Health SBD |
$5.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.77
|
| Rate for Payer: UHC Core |
$4.63
|
| Rate for Payer: UHC Exchange |
$3.49
|
| Rate for Payer: UMR Bronson Commercial |
$3.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.66
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
IP
|
$17.32
|
|
|
Service Code
|
NDC 71399788901
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$15.59 |
| Rate for Payer: Aetna American Axle |
$11.26
|
| Rate for Payer: Aetna Commercial |
$14.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.26
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Cofinity Advantage |
$12.12
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$15.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.99
|
| Rate for Payer: PHP Commercial |
$14.72
|
| Rate for Payer: Priority Health SBD |
$10.91
|
| Rate for Payer: UMR Bronson Commercial |
$7.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.99
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
OP
|
$8.88
|
|
|
Service Code
|
NDC 70000066001
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$7.99 |
| Rate for Payer: Aetna American Axle |
$5.77
|
| Rate for Payer: Aetna Commercial |
$7.55
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.77
|
| Rate for Payer: BCBS Complete |
$3.55
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cofinity Advantage |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$7.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$7.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.66
|
| Rate for Payer: PHP Commercial |
$7.55
|
| Rate for Payer: Priority Health SBD |
$5.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.77
|
| Rate for Payer: UHC Core |
$4.63
|
| Rate for Payer: UHC Exchange |
$3.49
|
| Rate for Payer: UMR Bronson Commercial |
$3.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.66
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
OP
|
$8.88
|
|
|
Service Code
|
NDC 70000066101
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$7.99 |
| Rate for Payer: Aetna American Axle |
$5.77
|
| Rate for Payer: Aetna Commercial |
$7.55
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.77
|
| Rate for Payer: BCBS Complete |
$3.55
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cofinity Advantage |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$7.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$7.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.66
|
| Rate for Payer: PHP Commercial |
$7.55
|
| Rate for Payer: Priority Health SBD |
$5.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.77
|
| Rate for Payer: UHC Core |
$4.63
|
| Rate for Payer: UHC Exchange |
$3.49
|
| Rate for Payer: UMR Bronson Commercial |
$3.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.66
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
IP
|
$8.88
|
|
|
Service Code
|
NDC 70000066101
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$7.99 |
| Rate for Payer: Aetna American Axle |
$5.77
|
| Rate for Payer: Aetna Commercial |
$7.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.77
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cofinity Advantage |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$7.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$7.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.66
|
| Rate for Payer: PHP Commercial |
$7.55
|
| Rate for Payer: Priority Health SBD |
$5.59
|
| Rate for Payer: UMR Bronson Commercial |
$3.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.66
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
IP
|
$8.88
|
|
|
Service Code
|
NDC 70000066001
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$7.99 |
| Rate for Payer: Aetna American Axle |
$5.77
|
| Rate for Payer: Aetna Commercial |
$7.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.77
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cofinity Advantage |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$7.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$7.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.66
|
| Rate for Payer: PHP Commercial |
$7.55
|
| Rate for Payer: Priority Health SBD |
$5.59
|
| Rate for Payer: UMR Bronson Commercial |
$3.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.66
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
IP
|
$17.32
|
|
|
Service Code
|
NDC 71399005101
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$15.59 |
| Rate for Payer: Aetna American Axle |
$11.26
|
| Rate for Payer: Aetna Commercial |
$14.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.26
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Cofinity Advantage |
$12.12
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$15.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.99
|
| Rate for Payer: PHP Commercial |
$14.72
|
| Rate for Payer: Priority Health SBD |
$10.91
|
| Rate for Payer: UMR Bronson Commercial |
$7.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.99
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
OP
|
$17.32
|
|
|
Service Code
|
NDC 71399005101
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$15.59 |
| Rate for Payer: Aetna American Axle |
$11.26
|
| Rate for Payer: Aetna Commercial |
$14.72
|
| Rate for Payer: Aetna Medicare |
$8.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.26
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Cofinity Advantage |
$12.12
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$15.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.99
|
| Rate for Payer: PHP Commercial |
$14.72
|
| Rate for Payer: Priority Health SBD |
$10.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.26
|
| Rate for Payer: UHC Core |
$9.02
|
| Rate for Payer: UHC Exchange |
$6.81
|
| Rate for Payer: UMR Bronson Commercial |
$6.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.99
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
OP
|
$10.66
|
|
|
Service Code
|
NDC 00904741844
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$9.59 |
| Rate for Payer: Aetna American Axle |
$6.93
|
| Rate for Payer: Aetna Commercial |
$9.06
|
| Rate for Payer: Aetna Medicare |
$5.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.93
|
| Rate for Payer: BCBS Complete |
$4.26
|
| Rate for Payer: Cash Price |
$8.53
|
| Rate for Payer: Cofinity Advantage |
$7.46
|
| Rate for Payer: Cofinity Commercial |
$9.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.53
|
| Rate for Payer: Healthscope Commercial |
$9.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.00
|
| Rate for Payer: PHP Commercial |
$9.06
|
| Rate for Payer: Priority Health SBD |
$6.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.93
|
| Rate for Payer: UHC Core |
$5.55
|
| Rate for Payer: UHC Exchange |
$4.19
|
| Rate for Payer: UMR Bronson Commercial |
$3.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.00
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
IP
|
$10.66
|
|
|
Service Code
|
NDC 00904741844
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$9.59 |
| Rate for Payer: Aetna American Axle |
$6.93
|
| Rate for Payer: Aetna Commercial |
$9.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.93
|
| Rate for Payer: Cash Price |
$8.53
|
| Rate for Payer: Cofinity Advantage |
$7.46
|
| Rate for Payer: Cofinity Commercial |
$9.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.53
|
| Rate for Payer: Healthscope Commercial |
$9.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.00
|
| Rate for Payer: PHP Commercial |
$9.06
|
| Rate for Payer: Priority Health SBD |
$6.72
|
| Rate for Payer: UMR Bronson Commercial |
$4.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.00
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
OP
|
$17.32
|
|
|
Service Code
|
NDC 71399788901
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$15.59 |
| Rate for Payer: Aetna American Axle |
$11.26
|
| Rate for Payer: Aetna Commercial |
$14.72
|
| Rate for Payer: Aetna Medicare |
$8.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.26
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Cofinity Advantage |
$12.12
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$15.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.99
|
| Rate for Payer: PHP Commercial |
$14.72
|
| Rate for Payer: Priority Health SBD |
$10.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.26
|
| Rate for Payer: UHC Core |
$9.02
|
| Rate for Payer: UHC Exchange |
$6.81
|
| Rate for Payer: UMR Bronson Commercial |
$6.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.99
|
|
