|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$5.91
|
|
|
Service Code
|
NDC 09900000148
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Aetna American Axle |
$3.84
|
| Rate for Payer: Aetna Commercial |
$5.02
|
| Rate for Payer: Aetna Medicare |
$2.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.84
|
| Rate for Payer: BCBS Complete |
$2.36
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cofinity Advantage |
$4.14
|
| Rate for Payer: Cofinity Commercial |
$5.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.73
|
| Rate for Payer: Healthscope Commercial |
$5.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.43
|
| Rate for Payer: PHP Commercial |
$5.02
|
| Rate for Payer: Priority Health SBD |
$3.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.84
|
| Rate for Payer: UHC Core |
$3.08
|
| Rate for Payer: UHC Exchange |
$2.32
|
| Rate for Payer: UMR Bronson Commercial |
$2.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.43
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$5.91
|
|
|
Service Code
|
NDC 00121043130
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Aetna American Axle |
$3.84
|
| Rate for Payer: Aetna Commercial |
$5.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.84
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cofinity Advantage |
$4.14
|
| Rate for Payer: Cofinity Commercial |
$5.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.73
|
| Rate for Payer: Healthscope Commercial |
$5.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.43
|
| Rate for Payer: PHP Commercial |
$5.02
|
| Rate for Payer: Priority Health SBD |
$3.72
|
| Rate for Payer: UMR Bronson Commercial |
$2.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.43
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$5.91
|
|
|
Service Code
|
NDC 00121043130
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Aetna American Axle |
$3.84
|
| Rate for Payer: Aetna Commercial |
$5.02
|
| Rate for Payer: Aetna Medicare |
$2.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.84
|
| Rate for Payer: BCBS Complete |
$2.36
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cofinity Advantage |
$4.14
|
| Rate for Payer: Cofinity Commercial |
$5.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.73
|
| Rate for Payer: Healthscope Commercial |
$5.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.43
|
| Rate for Payer: PHP Commercial |
$5.02
|
| Rate for Payer: Priority Health SBD |
$3.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.84
|
| Rate for Payer: UHC Core |
$3.08
|
| Rate for Payer: UHC Exchange |
$2.32
|
| Rate for Payer: UMR Bronson Commercial |
$2.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.43
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$5.91
|
|
|
Service Code
|
NDC 09900000148
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Aetna American Axle |
$3.84
|
| Rate for Payer: Aetna Commercial |
$5.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.84
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cofinity Advantage |
$4.14
|
| Rate for Payer: Cofinity Commercial |
$5.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.73
|
| Rate for Payer: Healthscope Commercial |
$5.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.43
|
| Rate for Payer: PHP Commercial |
$5.02
|
| Rate for Payer: Priority Health SBD |
$3.72
|
| Rate for Payer: UMR Bronson Commercial |
$2.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.43
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
OP
|
$158.40
|
|
|
Service Code
|
NDC 57896063412
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.61 |
| Max. Negotiated Rate |
$142.56 |
| Rate for Payer: Aetna American Axle |
$102.96
|
| Rate for Payer: Aetna Commercial |
$134.64
|
| Rate for Payer: Aetna Medicare |
$79.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.96
|
| Rate for Payer: BCBS Complete |
$63.36
|
| Rate for Payer: Cash Price |
$126.72
|
| Rate for Payer: Cofinity Advantage |
$110.88
|
| Rate for Payer: Cofinity Commercial |
$136.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.72
|
| Rate for Payer: Healthscope Commercial |
$142.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.80
|
| Rate for Payer: PHP Commercial |
$134.64
|
| Rate for Payer: Priority Health SBD |
$99.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.96
|
| Rate for Payer: UHC Core |
$82.53
|
| Rate for Payer: UHC Exchange |
$62.25
|
| Rate for Payer: UMR Bronson Commercial |
$58.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.80
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
IP
|
$158.40
|
|
|
Service Code
|
NDC 57896063412
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.70 |
| Max. Negotiated Rate |
$142.56 |
| Rate for Payer: Aetna American Axle |
$102.96
|
| Rate for Payer: Aetna Commercial |
$134.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.96
|
| Rate for Payer: Cash Price |
$126.72
|
| Rate for Payer: Cofinity Advantage |
$110.88
|
| Rate for Payer: Cofinity Commercial |
$136.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.72
|
| Rate for Payer: Healthscope Commercial |
$142.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.80
|
| Rate for Payer: PHP Commercial |
$134.64
|
| Rate for Payer: Priority Health SBD |
$99.79
|
| Rate for Payer: UMR Bronson Commercial |
$69.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.80
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
OP
|
$1.08
|
|
|
Service Code
|
NDC 64980033990
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Aetna American Axle |
$0.70
|
| Rate for Payer: Aetna Commercial |
$0.92
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.70
|
| Rate for Payer: BCBS Complete |
$0.43
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cofinity Advantage |
$0.76
|
| Rate for Payer: Cofinity Commercial |
$0.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.86
|
| Rate for Payer: Healthscope Commercial |
$0.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.81
|
| Rate for Payer: PHP Commercial |
$0.92
|
| Rate for Payer: Priority Health SBD |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.70
|
| Rate for Payer: UHC Core |
$0.56
|
| Rate for Payer: UHC Exchange |
$0.42
|
| Rate for Payer: UMR Bronson Commercial |
$0.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.81
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
NDC 69367027102
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.16 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna American Axle |
$122.85
|
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.85
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Advantage |
$132.30
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$170.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.75
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health SBD |
$119.07
|
| Rate for Payer: UMR Bronson Commercial |
$83.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.75
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
NDC 69367027102
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.93 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna American Axle |
$122.85
|
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: Aetna Medicare |
$94.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.85
|
| Rate for Payer: BCBS Complete |
$75.60
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Advantage |
$132.30
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$170.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.75
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health SBD |
$119.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.85
|
| Rate for Payer: UHC Core |
$98.47
|
| Rate for Payer: UHC Exchange |
$74.28
|
| Rate for Payer: UMR Bronson Commercial |
$69.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.75
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
IP
|
$107.80
|
|
|
Service Code
|
NDC 64980033901
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.43 |
| Max. Negotiated Rate |
$97.02 |
| Rate for Payer: Aetna American Axle |
$70.07
|
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.07
|
| Rate for Payer: Cash Price |
$86.24
|
| Rate for Payer: Cofinity Advantage |
$75.46
|
| Rate for Payer: Cofinity Commercial |
$92.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.24
|
| Rate for Payer: Healthscope Commercial |
$97.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.85
|
| Rate for Payer: PHP Commercial |
$91.63
|
| Rate for Payer: Priority Health SBD |
$67.91
|
| Rate for Payer: UMR Bronson Commercial |
$47.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.85
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
IP
|
$173.88
|
|
|
Service Code
|
NDC 10006073038
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.51 |
| Max. Negotiated Rate |
$156.49 |
| Rate for Payer: Aetna American Axle |
$113.02
|
| Rate for Payer: Aetna Commercial |
$147.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.02
|
| Rate for Payer: Cash Price |
$139.10
|
| Rate for Payer: Cofinity Advantage |
$121.72
|
| Rate for Payer: Cofinity Commercial |
$149.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.10
|
| Rate for Payer: Healthscope Commercial |
$156.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.41
|
| Rate for Payer: PHP Commercial |
$147.80
|
| Rate for Payer: Priority Health SBD |
$109.54
|
| Rate for Payer: UMR Bronson Commercial |
$76.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.41
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
OP
|
$173.88
|
|
|
Service Code
|
NDC 10006073038
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$156.49 |
| Rate for Payer: Aetna American Axle |
$113.02
|
| Rate for Payer: Aetna Commercial |
$147.80
|
| Rate for Payer: Aetna Medicare |
$86.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.02
|
| Rate for Payer: BCBS Complete |
$69.55
|
| Rate for Payer: Cash Price |
$139.10
|
| Rate for Payer: Cofinity Advantage |
$121.72
|
| Rate for Payer: Cofinity Commercial |
$149.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.10
|
| Rate for Payer: Healthscope Commercial |
$156.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.41
|
| Rate for Payer: PHP Commercial |
$147.80
|
| Rate for Payer: Priority Health SBD |
$109.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.02
|
| Rate for Payer: UHC Core |
$90.59
|
| Rate for Payer: UHC Exchange |
$68.33
|
| Rate for Payer: UMR Bronson Commercial |
$64.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.41
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
IP
|
$1.08
|
|
|
Service Code
|
NDC 64980033990
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Aetna American Axle |
$0.70
|
| Rate for Payer: Aetna Commercial |
$0.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.70
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cofinity Advantage |
$0.76
|
| Rate for Payer: Cofinity Commercial |
$0.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.86
|
| Rate for Payer: Healthscope Commercial |
$0.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.81
|
| Rate for Payer: PHP Commercial |
$0.92
|
| Rate for Payer: Priority Health SBD |
$0.68
|
| Rate for Payer: UMR Bronson Commercial |
$0.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.81
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
OP
|
$107.80
|
|
|
Service Code
|
NDC 64980033901
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.89 |
| Max. Negotiated Rate |
$97.02 |
| Rate for Payer: Aetna American Axle |
$70.07
|
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Aetna Medicare |
$53.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.07
|
| Rate for Payer: BCBS Complete |
$43.12
|
| Rate for Payer: Cash Price |
$86.24
|
| Rate for Payer: Cofinity Advantage |
$75.46
|
| Rate for Payer: Cofinity Commercial |
$92.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.24
|
| Rate for Payer: Healthscope Commercial |
$97.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.85
|
| Rate for Payer: PHP Commercial |
$91.63
|
| Rate for Payer: Priority Health SBD |
$67.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.07
|
| Rate for Payer: UHC Core |
$56.16
|
| Rate for Payer: UHC Exchange |
$42.37
|
| Rate for Payer: UMR Bronson Commercial |
$39.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.85
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
IP
|
$206.40
|
|
|
Service Code
|
NDC 64980033912
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.82 |
| Max. Negotiated Rate |
$185.76 |
| Rate for Payer: Aetna American Axle |
$134.16
|
| Rate for Payer: Aetna Commercial |
$175.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.16
|
| Rate for Payer: Cash Price |
$165.12
|
| Rate for Payer: Cofinity Advantage |
$144.48
|
| Rate for Payer: Cofinity Commercial |
$177.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.12
|
| Rate for Payer: Healthscope Commercial |
$185.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.80
|
| Rate for Payer: PHP Commercial |
$175.44
|
| Rate for Payer: Priority Health SBD |
$130.03
|
| Rate for Payer: UMR Bronson Commercial |
$90.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.80
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
OP
|
$206.40
|
|
|
Service Code
|
NDC 64980033912
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.37 |
| Max. Negotiated Rate |
$185.76 |
| Rate for Payer: Aetna American Axle |
$134.16
|
| Rate for Payer: Aetna Commercial |
$175.44
|
| Rate for Payer: Aetna Medicare |
$103.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.16
|
| Rate for Payer: BCBS Complete |
$82.56
|
| Rate for Payer: Cash Price |
$165.12
|
| Rate for Payer: Cofinity Advantage |
$144.48
|
| Rate for Payer: Cofinity Commercial |
$177.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.12
|
| Rate for Payer: Healthscope Commercial |
$185.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.80
|
| Rate for Payer: PHP Commercial |
$175.44
|
| Rate for Payer: Priority Health SBD |
$130.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.16
|
| Rate for Payer: UHC Core |
$107.53
|
| Rate for Payer: UHC Exchange |
$81.12
|
| Rate for Payer: UMR Bronson Commercial |
$76.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.80
|
|
|
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 |
$0.68 |
| Max. Negotiated Rate |
$19.30 |
| Rate for Payer: Aetna American Axle |
$13.94
|
| Rate for Payer: Aetna American Axle |
$26.16
|
| Rate for Payer: Aetna Commercial |
$18.22
|
| Rate for Payer: Aetna Commercial |
$34.21
|
| Rate for Payer: Aetna Medicare |
$10.72
|
| Rate for Payer: Aetna Medicare |
$20.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.16
|
| Rate for Payer: BCBS Complete |
$16.10
|
| Rate for Payer: BCBS Complete |
$8.58
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cofinity Advantage |
$15.01
|
| Rate for Payer: Cofinity Advantage |
$28.18
|
| Rate for Payer: Cofinity Commercial |
$18.44
|
| Rate for Payer: Cofinity Commercial |
$34.62
|
| 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 |
$19.30
|
| Rate for Payer: Healthscope Commercial |
$36.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.08
|
| Rate for Payer: PHP Commercial |
$18.22
|
| Rate for Payer: PHP Commercial |
$34.21
|
| Rate for Payer: Priority Health SBD |
$13.51
|
| Rate for Payer: Priority Health SBD |
$25.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UMR Bronson Commercial |
$7.93
|
| Rate for Payer: UMR Bronson Commercial |
$14.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.19
|
|
|
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 |
$9.43 |
| Max. Negotiated Rate |
$19.30 |
| Rate for Payer: Aetna American Axle |
$13.94
|
| Rate for Payer: Aetna American Axle |
$26.16
|
| Rate for Payer: Aetna Commercial |
$18.22
|
| Rate for Payer: Aetna Commercial |
$34.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.16
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cofinity Advantage |
$28.18
|
| Rate for Payer: Cofinity Advantage |
$15.01
|
| Rate for Payer: Cofinity Commercial |
$34.62
|
| 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 |
$32.20
|
| Rate for Payer: Healthscope Commercial |
$19.30
|
| Rate for Payer: Healthscope Commercial |
$36.23
|
| 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 |
$16.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.19
|
| Rate for Payer: PHP Commercial |
$18.22
|
| Rate for Payer: PHP Commercial |
$34.21
|
| Rate for Payer: Priority Health SBD |
$25.36
|
| Rate for Payer: Priority Health SBD |
$13.51
|
| 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 |
$16.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.19
|
|
|
MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$83.91
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
16162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$75.52 |
| Rate for Payer: Aetna American Axle |
$54.54
|
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna American Axle |
$32.03
|
| Rate for Payer: Aetna American Axle |
$43.18
|
| Rate for Payer: Aetna Commercial |
$71.32
|
| Rate for Payer: Aetna Commercial |
$56.47
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna Commercial |
$41.88
|
| Rate for Payer: Aetna Medicare |
$33.22
|
| Rate for Payer: Aetna Medicare |
$24.64
|
| Rate for Payer: Aetna Medicare |
$41.95
|
| Rate for Payer: Aetna Medicare |
$23.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.18
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: BCBS Complete |
$19.71
|
| Rate for Payer: BCBS Complete |
$26.57
|
| Rate for Payer: BCBS Complete |
$33.56
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: Cash Price |
$53.14
|
| Rate for Payer: Cash Price |
$67.13
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cash Price |
$67.13
|
| Rate for Payer: Cash Price |
$53.14
|
| Rate for Payer: Cash Price |
$39.42
|
| Rate for Payer: Cash Price |
$39.42
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Advantage |
$58.74
|
| Rate for Payer: Cofinity Advantage |
$46.50
|
| Rate for Payer: Cofinity Advantage |
$34.49
|
| Rate for Payer: Cofinity Advantage |
$33.49
|
| Rate for Payer: Cofinity Commercial |
$42.37
|
| Rate for Payer: Cofinity Commercial |
$57.13
|
| Rate for Payer: Cofinity Commercial |
$72.16
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$59.79
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Healthscope Commercial |
$44.34
|
| Rate for Payer: Healthscope Commercial |
$75.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.93
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: PHP Commercial |
$56.47
|
| Rate for Payer: PHP Commercial |
$71.32
|
| Rate for Payer: PHP Commercial |
$41.88
|
| Rate for Payer: Priority Health SBD |
$41.85
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: Priority Health SBD |
$31.04
|
| Rate for Payer: Priority Health SBD |
$52.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UMR Bronson Commercial |
$31.05
|
| Rate for Payer: UMR Bronson Commercial |
$17.70
|
| Rate for Payer: UMR Bronson Commercial |
$18.23
|
| Rate for Payer: UMR Bronson Commercial |
$24.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.93
|
|
|
MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$66.43
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
16162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.23 |
| Max. Negotiated Rate |
$59.79 |
| Rate for Payer: Aetna American Axle |
$43.18
|
| Rate for Payer: Aetna American Axle |
$32.03
|
| Rate for Payer: Aetna American Axle |
$54.54
|
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$71.32
|
| Rate for Payer: Aetna Commercial |
$56.47
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna Commercial |
$41.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cash Price |
$67.13
|
| Rate for Payer: Cash Price |
$39.42
|
| Rate for Payer: Cash Price |
$53.14
|
| Rate for Payer: Cofinity Advantage |
$34.49
|
| Rate for Payer: Cofinity Advantage |
$33.49
|
| Rate for Payer: Cofinity Advantage |
$46.50
|
| Rate for Payer: Cofinity Advantage |
$58.74
|
| Rate for Payer: Cofinity Commercial |
$57.13
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Cofinity Commercial |
$42.37
|
| Rate for Payer: Cofinity Commercial |
$72.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.42
|
| Rate for Payer: Healthscope Commercial |
$44.34
|
| Rate for Payer: Healthscope Commercial |
$75.52
|
| Rate for Payer: Healthscope Commercial |
$59.79
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.89
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: PHP Commercial |
$56.47
|
| Rate for Payer: PHP Commercial |
$41.88
|
| Rate for Payer: PHP Commercial |
$71.32
|
| Rate for Payer: Priority Health SBD |
$52.86
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: Priority Health SBD |
$41.85
|
| Rate for Payer: Priority Health SBD |
$31.04
|
| Rate for Payer: UMR Bronson Commercial |
$21.68
|
| Rate for Payer: UMR Bronson Commercial |
$29.23
|
| Rate for Payer: UMR Bronson Commercial |
$21.05
|
| Rate for Payer: UMR Bronson Commercial |
$36.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.93
|
|
|
MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$98.31
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117958
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$88.48 |
| Rate for Payer: Aetna American Axle |
$63.90
|
| 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 |
$83.56
|
| Rate for Payer: Aetna Commercial |
$74.57
|
| Rate for Payer: Aetna Commercial |
$47.46
|
| Rate for Payer: Aetna Commercial |
$67.79
|
| Rate for Payer: Aetna Medicare |
$43.87
|
| Rate for Payer: Aetna Medicare |
$39.88
|
| Rate for Payer: Aetna Medicare |
$49.16
|
| Rate for Payer: Aetna Medicare |
$27.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: BCBS Complete |
$22.33
|
| Rate for Payer: BCBS Complete |
$31.90
|
| Rate for Payer: BCBS Complete |
$35.09
|
| Rate for Payer: BCBS Complete |
$39.32
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$44.66
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Cash Price |
$44.66
|
| Rate for Payer: Cofinity Advantage |
$68.82
|
| Rate for Payer: Cofinity Advantage |
$61.41
|
| Rate for Payer: Cofinity Advantage |
$55.83
|
| Rate for Payer: Cofinity Advantage |
$39.08
|
| Rate for Payer: Cofinity Commercial |
$68.58
|
| Rate for Payer: Cofinity Commercial |
$75.45
|
| Rate for Payer: Cofinity Commercial |
$84.55
|
| Rate for Payer: Cofinity Commercial |
$48.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.66
|
| Rate for Payer: Healthscope Commercial |
$78.96
|
| Rate for Payer: Healthscope Commercial |
$50.25
|
| Rate for Payer: Healthscope Commercial |
$71.78
|
| Rate for Payer: Healthscope Commercial |
$88.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.73
|
| Rate for Payer: PHP Commercial |
$47.46
|
| Rate for Payer: PHP Commercial |
$74.57
|
| Rate for Payer: PHP Commercial |
$83.56
|
| Rate for Payer: PHP Commercial |
$67.79
|
| Rate for Payer: Priority Health SBD |
$55.27
|
| Rate for Payer: Priority Health SBD |
$35.17
|
| Rate for Payer: Priority Health SBD |
$50.24
|
| Rate for Payer: Priority Health SBD |
$61.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UMR Bronson Commercial |
$36.37
|
| Rate for Payer: UMR Bronson Commercial |
$20.66
|
| Rate for Payer: UMR Bronson Commercial |
$29.51
|
| Rate for Payer: UMR Bronson Commercial |
$32.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.73
|
|
|
MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$87.73
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117958
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.60 |
| Max. Negotiated Rate |
$78.96 |
| Rate for Payer: Aetna American Axle |
$57.02
|
| Rate for Payer: Aetna American Axle |
$51.84
|
| Rate for Payer: Aetna American Axle |
$63.90
|
| Rate for Payer: Aetna American Axle |
$36.29
|
| Rate for Payer: Aetna Commercial |
$83.56
|
| Rate for Payer: Aetna Commercial |
$74.57
|
| Rate for Payer: Aetna Commercial |
$47.46
|
| Rate for Payer: Aetna Commercial |
$67.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.29
|
| Rate for Payer: Cash Price |
$44.66
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Advantage |
$55.83
|
| Rate for Payer: Cofinity Advantage |
$39.08
|
| Rate for Payer: Cofinity Advantage |
$61.41
|
| Rate for Payer: Cofinity Advantage |
$68.82
|
| Rate for Payer: Cofinity Commercial |
$75.45
|
| Rate for Payer: Cofinity Commercial |
$48.01
|
| Rate for Payer: Cofinity Commercial |
$68.58
|
| Rate for Payer: Cofinity Commercial |
$84.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.80
|
| Rate for Payer: Healthscope Commercial |
$71.78
|
| Rate for Payer: Healthscope Commercial |
$88.48
|
| Rate for Payer: Healthscope Commercial |
$78.96
|
| Rate for Payer: Healthscope Commercial |
$50.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.82
|
| 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 |
$73.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.87
|
| Rate for Payer: PHP Commercial |
$47.46
|
| Rate for Payer: PHP Commercial |
$74.57
|
| Rate for Payer: PHP Commercial |
$67.79
|
| Rate for Payer: PHP Commercial |
$83.56
|
| Rate for Payer: Priority Health SBD |
$61.94
|
| Rate for Payer: Priority Health SBD |
$35.17
|
| Rate for Payer: Priority Health SBD |
$55.27
|
| Rate for Payer: Priority Health SBD |
$50.24
|
| Rate for Payer: UMR Bronson Commercial |
$35.09
|
| Rate for Payer: UMR Bronson Commercial |
$38.60
|
| Rate for Payer: UMR Bronson Commercial |
$24.57
|
| Rate for Payer: UMR Bronson Commercial |
$43.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.73
|
|
|
MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$25.81
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.36 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna American Axle |
$16.78
|
| Rate for Payer: Aetna American Axle |
$18.85
|
| Rate for Payer: Aetna American Axle |
$33.85
|
| Rate for Payer: Aetna American Axle |
$11.72
|
| Rate for Payer: Aetna American Axle |
$15.39
|
| Rate for Payer: Aetna American Axle |
$14.43
|
| Rate for Payer: Aetna American Axle |
$50.41
|
| Rate for Payer: Aetna American Axle |
$18.76
|
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Aetna Commercial |
$44.26
|
| Rate for Payer: Aetna Commercial |
$21.94
|
| Rate for Payer: Aetna Commercial |
$15.33
|
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna Commercial |
$24.65
|
| Rate for Payer: Aetna Commercial |
$20.13
|
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.85
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$41.66
|
| Rate for Payer: Cofinity Advantage |
$54.28
|
| Rate for Payer: Cofinity Advantage |
$15.54
|
| Rate for Payer: Cofinity Advantage |
$18.07
|
| Rate for Payer: Cofinity Advantage |
$16.58
|
| Rate for Payer: Cofinity Advantage |
$12.62
|
| Rate for Payer: Cofinity Advantage |
$20.30
|
| Rate for Payer: Cofinity Advantage |
$36.45
|
| Rate for Payer: Cofinity Advantage |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Cofinity Commercial |
$15.51
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Cofinity Commercial |
$24.82
|
| Rate for Payer: Cofinity Commercial |
$44.78
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| 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 |
$23.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: Healthscope Commercial |
$23.23
|
| Rate for Payer: Healthscope Commercial |
$16.23
|
| Rate for Payer: Healthscope Commercial |
$69.80
|
| Rate for Payer: Healthscope Commercial |
$46.86
|
| Rate for Payer: Healthscope Commercial |
$21.31
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$26.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.16
|
| Rate for Payer: PHP Commercial |
$21.94
|
| Rate for Payer: PHP Commercial |
$24.53
|
| Rate for Payer: PHP Commercial |
$65.92
|
| Rate for Payer: PHP Commercial |
$20.13
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: PHP Commercial |
$15.33
|
| Rate for Payer: PHP Commercial |
$24.65
|
| Rate for Payer: PHP Commercial |
$44.26
|
| Rate for Payer: Priority Health SBD |
$18.27
|
| Rate for Payer: Priority Health SBD |
$32.80
|
| Rate for Payer: Priority Health SBD |
$48.86
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: Priority Health SBD |
$11.36
|
| Rate for Payer: Priority Health SBD |
$14.92
|
| Rate for Payer: Priority Health SBD |
$16.26
|
| Rate for Payer: Priority Health SBD |
$18.18
|
| Rate for Payer: UMR Bronson Commercial |
$7.93
|
| Rate for Payer: UMR Bronson Commercial |
$12.70
|
| Rate for Payer: UMR Bronson Commercial |
$10.42
|
| Rate for Payer: UMR Bronson Commercial |
$34.12
|
| Rate for Payer: UMR Bronson Commercial |
$22.91
|
| Rate for Payer: UMR Bronson Commercial |
$11.36
|
| Rate for Payer: UMR Bronson Commercial |
$9.77
|
| Rate for Payer: UMR Bronson Commercial |
$12.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.05
|
|
|
MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$52.07
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$46.86 |
| Rate for Payer: Aetna American Axle |
$33.85
|
| Rate for Payer: Aetna American Axle |
$18.85
|
| Rate for Payer: Aetna American Axle |
$15.39
|
| Rate for Payer: Aetna American Axle |
$16.78
|
| Rate for Payer: Aetna American Axle |
$18.76
|
| Rate for Payer: Aetna American Axle |
$11.72
|
| Rate for Payer: Aetna American Axle |
$14.43
|
| Rate for Payer: Aetna American Axle |
$50.41
|
| Rate for Payer: Aetna Commercial |
$20.13
|
| Rate for Payer: Aetna Commercial |
$15.33
|
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: Aetna Commercial |
$21.94
|
| Rate for Payer: Aetna Commercial |
$24.65
|
| Rate for Payer: Aetna Commercial |
$44.26
|
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna Medicare |
$11.84
|
| Rate for Payer: Aetna Medicare |
$11.10
|
| Rate for Payer: Aetna Medicare |
$26.04
|
| Rate for Payer: Aetna Medicare |
$9.02
|
| Rate for Payer: Aetna Medicare |
$14.43
|
| Rate for Payer: Aetna Medicare |
$12.90
|
| Rate for Payer: Aetna Medicare |
$38.77
|
| Rate for Payer: Aetna Medicare |
$14.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.76
|
| Rate for Payer: BCBS Complete |
$31.02
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS Complete |
$10.32
|
| Rate for Payer: BCBS Complete |
$7.21
|
| Rate for Payer: BCBS Complete |
$9.47
|
| Rate for Payer: BCBS Complete |
$8.88
|
| Rate for Payer: BCBS Complete |
$20.83
|
| Rate for Payer: BCBS Complete |
$11.54
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$41.66
|
| Rate for Payer: Cash Price |
$41.66
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Advantage |
$20.30
|
| Rate for Payer: Cofinity Advantage |
$54.28
|
| Rate for Payer: Cofinity Advantage |
$16.58
|
| Rate for Payer: Cofinity Advantage |
$20.20
|
| Rate for Payer: Cofinity Advantage |
$36.45
|
| Rate for Payer: Cofinity Advantage |
$18.07
|
| Rate for Payer: Cofinity Advantage |
$12.62
|
| Rate for Payer: Cofinity Advantage |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Cofinity Commercial |
$15.51
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Cofinity Commercial |
$44.78
|
| Rate for Payer: Cofinity Commercial |
$24.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.66
|
| Rate for Payer: Healthscope Commercial |
$16.23
|
| Rate for Payer: Healthscope Commercial |
$69.80
|
| Rate for Payer: Healthscope Commercial |
$21.31
|
| Rate for Payer: Healthscope Commercial |
$23.23
|
| Rate for Payer: Healthscope Commercial |
$46.86
|
| Rate for Payer: Healthscope Commercial |
$26.10
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.76
|
| Rate for Payer: PHP Commercial |
$15.33
|
| Rate for Payer: PHP Commercial |
$21.94
|
| Rate for Payer: PHP Commercial |
$24.65
|
| Rate for Payer: PHP Commercial |
$20.13
|
| Rate for Payer: PHP Commercial |
$65.92
|
| Rate for Payer: PHP Commercial |
$44.26
|
| Rate for Payer: PHP Commercial |
$24.53
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: Priority Health SBD |
$48.86
|
| Rate for Payer: Priority Health SBD |
$11.36
|
| Rate for Payer: Priority Health SBD |
$18.27
|
| Rate for Payer: Priority Health SBD |
$32.80
|
| Rate for Payer: Priority Health SBD |
$14.92
|
| Rate for Payer: Priority Health SBD |
$16.26
|
| Rate for Payer: Priority Health SBD |
$18.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UMR Bronson Commercial |
$19.27
|
| Rate for Payer: UMR Bronson Commercial |
$28.69
|
| Rate for Payer: UMR Bronson Commercial |
$10.68
|
| Rate for Payer: UMR Bronson Commercial |
$8.76
|
| Rate for Payer: UMR Bronson Commercial |
$10.73
|
| Rate for Payer: UMR Bronson Commercial |
$6.67
|
| Rate for Payer: UMR Bronson Commercial |
$8.21
|
| Rate for Payer: UMR Bronson Commercial |
$9.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.05
|
|
|
MAGNESIUM SULFATE 4.06 MEQ/ML (50 %) INJECTION (TPN COMPONENT)
|
Facility
|
IP
|
$227.50
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
180902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Aetna American Axle |
$147.88
|
| Rate for Payer: Aetna Commercial |
$193.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.88
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cofinity Advantage |
$159.25
|
| Rate for Payer: Cofinity Commercial |
$195.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.00
|
| Rate for Payer: Healthscope Commercial |
$204.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.62
|
| Rate for Payer: PHP Commercial |
$193.38
|
| Rate for Payer: Priority Health SBD |
$143.32
|
| Rate for Payer: UMR Bronson Commercial |
$100.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.62
|
|
