|
MAGNESIUM SULFATE 4.06 MEQ/ML (50 %) INJECTION (TPN COMPONENT)
|
Facility
|
OP
|
$227.50
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
180902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Aetna American Axle |
$147.88
|
| Rate for Payer: Aetna Commercial |
$193.38
|
| Rate for Payer: Aetna Medicare |
$113.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.88
|
| Rate for Payer: BCBS Complete |
$91.00
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: Cash Price |
$182.00
|
| 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: MI Amish Medical Board Commercial |
$182.00
|
| 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: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UMR Bronson Commercial |
$84.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.62
|
|
|
MAGNESIUM SULFATE 495 MG/5 GRAM ORAL GRANULES
|
Facility
|
IP
|
$10.90
|
|
|
Service Code
|
NDC 70000002101
|
| Hospital Charge Code |
27322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$9.81 |
| Rate for Payer: Aetna American Axle |
$7.08
|
| Rate for Payer: Aetna Commercial |
$9.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.08
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cofinity Advantage |
$7.63
|
| Rate for Payer: Cofinity Commercial |
$9.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.72
|
| Rate for Payer: Healthscope Commercial |
$9.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.18
|
| Rate for Payer: PHP Commercial |
$9.27
|
| Rate for Payer: Priority Health SBD |
$6.87
|
| Rate for Payer: UMR Bronson Commercial |
$4.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.18
|
|
|
MAGNESIUM SULFATE 495 MG/5 GRAM ORAL GRANULES
|
Facility
|
OP
|
$10.90
|
|
|
Service Code
|
NDC 70000002101
|
| Hospital Charge Code |
27322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$9.81 |
| Rate for Payer: Aetna American Axle |
$7.08
|
| Rate for Payer: Aetna Commercial |
$9.27
|
| Rate for Payer: Aetna Medicare |
$5.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.08
|
| Rate for Payer: BCBS Complete |
$4.36
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cofinity Advantage |
$7.63
|
| Rate for Payer: Cofinity Commercial |
$9.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.72
|
| Rate for Payer: Healthscope Commercial |
$9.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.18
|
| Rate for Payer: PHP Commercial |
$9.27
|
| Rate for Payer: Priority Health SBD |
$6.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.08
|
| Rate for Payer: UHC Core |
$5.68
|
| Rate for Payer: UHC Exchange |
$4.28
|
| Rate for Payer: UMR Bronson Commercial |
$4.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.18
|
|
|
MAGNESIUM SULFATE 4 GRAM/100 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$241.85
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4719
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$217.66 |
| Rate for Payer: Aetna American Axle |
$157.20
|
| Rate for Payer: Aetna American Axle |
$80.85
|
| Rate for Payer: Aetna American Axle |
$98.81
|
| Rate for Payer: Aetna American Axle |
$148.22
|
| Rate for Payer: Aetna American Axle |
$94.32
|
| Rate for Payer: Aetna American Axle |
$305.42
|
| Rate for Payer: Aetna American Axle |
$260.51
|
| Rate for Payer: Aetna Commercial |
$399.40
|
| Rate for Payer: Aetna Commercial |
$105.72
|
| Rate for Payer: Aetna Commercial |
$193.83
|
| Rate for Payer: Aetna Commercial |
$129.22
|
| Rate for Payer: Aetna Commercial |
$205.57
|
| Rate for Payer: Aetna Commercial |
$123.34
|
| Rate for Payer: Aetna Commercial |
$340.66
|
| Rate for Payer: Aetna Medicare |
$62.19
|
| Rate for Payer: Aetna Medicare |
$234.94
|
| Rate for Payer: Aetna Medicare |
$120.92
|
| Rate for Payer: Aetna Medicare |
$200.39
|
| Rate for Payer: Aetna Medicare |
$114.02
|
| Rate for Payer: Aetna Medicare |
$72.56
|
| Rate for Payer: Aetna Medicare |
$76.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.51
|
| Rate for Payer: BCBS Complete |
$58.04
|
| Rate for Payer: BCBS Complete |
$187.95
|
| Rate for Payer: BCBS Complete |
$91.21
|
| Rate for Payer: BCBS Complete |
$96.74
|
| Rate for Payer: BCBS Complete |
$160.31
|
| Rate for Payer: BCBS Complete |
$49.75
|
| Rate for Payer: BCBS Complete |
$60.81
|
| 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: Cash Price |
$121.62
|
| Rate for Payer: Cash Price |
$375.90
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cash Price |
$193.48
|
| Rate for Payer: Cash Price |
$182.42
|
| Rate for Payer: Cash Price |
$182.42
|
| Rate for Payer: Cash Price |
$320.62
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cash Price |
$375.90
|
| Rate for Payer: Cash Price |
$116.09
|
| Rate for Payer: Cash Price |
$320.62
|
| Rate for Payer: Cash Price |
$193.48
|
| Rate for Payer: Cash Price |
$116.09
|
| Rate for Payer: Cash Price |
$121.62
|
| Rate for Payer: Cofinity Advantage |
$159.62
|
| Rate for Payer: Cofinity Advantage |
$106.41
|
| Rate for Payer: Cofinity Advantage |
$101.58
|
| Rate for Payer: Cofinity Advantage |
$87.07
|
| Rate for Payer: Cofinity Advantage |
$169.29
|
| Rate for Payer: Cofinity Advantage |
$280.55
|
| Rate for Payer: Cofinity Advantage |
$328.92
|
| Rate for Payer: Cofinity Commercial |
$207.99
|
| Rate for Payer: Cofinity Commercial |
$344.67
|
| Rate for Payer: Cofinity Commercial |
$404.10
|
| Rate for Payer: Cofinity Commercial |
$106.97
|
| Rate for Payer: Cofinity Commercial |
$124.79
|
| Rate for Payer: Cofinity Commercial |
$130.74
|
| Rate for Payer: Cofinity Commercial |
$196.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.90
|
| Rate for Payer: Healthscope Commercial |
$205.23
|
| Rate for Payer: Healthscope Commercial |
$360.70
|
| Rate for Payer: Healthscope Commercial |
$422.89
|
| Rate for Payer: Healthscope Commercial |
$217.66
|
| Rate for Payer: Healthscope Commercial |
$130.60
|
| Rate for Payer: Healthscope Commercial |
$111.94
|
| Rate for Payer: Healthscope Commercial |
$136.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$328.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$375.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$182.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.28
|
| Rate for Payer: PHP Commercial |
$193.83
|
| Rate for Payer: PHP Commercial |
$129.22
|
| Rate for Payer: PHP Commercial |
$105.72
|
| Rate for Payer: PHP Commercial |
$123.34
|
| Rate for Payer: PHP Commercial |
$205.57
|
| Rate for Payer: PHP Commercial |
$340.66
|
| Rate for Payer: PHP Commercial |
$399.40
|
| Rate for Payer: Priority Health SBD |
$252.49
|
| Rate for Payer: Priority Health SBD |
$95.77
|
| Rate for Payer: Priority Health SBD |
$152.37
|
| Rate for Payer: Priority Health SBD |
$296.02
|
| Rate for Payer: Priority Health SBD |
$91.42
|
| Rate for Payer: Priority Health SBD |
$78.36
|
| Rate for Payer: Priority Health SBD |
$143.66
|
| 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 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 |
$56.25
|
| Rate for Payer: UMR Bronson Commercial |
$84.37
|
| Rate for Payer: UMR Bronson Commercial |
$53.69
|
| Rate for Payer: UMR Bronson Commercial |
$46.02
|
| Rate for Payer: UMR Bronson Commercial |
$173.86
|
| Rate for Payer: UMR Bronson Commercial |
$148.29
|
| Rate for Payer: UMR Bronson Commercial |
$89.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.02
|
|
|
MAGNESIUM SULFATE 4 GRAM/100 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$241.85
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4719
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.41 |
| Max. Negotiated Rate |
$217.66 |
| Rate for Payer: Aetna American Axle |
$157.20
|
| Rate for Payer: Aetna American Axle |
$98.81
|
| Rate for Payer: Aetna American Axle |
$305.42
|
| Rate for Payer: Aetna American Axle |
$94.32
|
| Rate for Payer: Aetna American Axle |
$80.85
|
| Rate for Payer: Aetna Commercial |
$105.72
|
| Rate for Payer: Aetna Commercial |
$129.22
|
| Rate for Payer: Aetna Commercial |
$205.57
|
| Rate for Payer: Aetna Commercial |
$399.40
|
| Rate for Payer: Aetna Commercial |
$123.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.42
|
| Rate for Payer: Cash Price |
$121.62
|
| Rate for Payer: Cash Price |
$116.09
|
| Rate for Payer: Cash Price |
$375.90
|
| Rate for Payer: Cash Price |
$193.48
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cofinity Advantage |
$87.07
|
| Rate for Payer: Cofinity Advantage |
$328.92
|
| Rate for Payer: Cofinity Advantage |
$101.58
|
| Rate for Payer: Cofinity Advantage |
$169.29
|
| Rate for Payer: Cofinity Advantage |
$106.41
|
| Rate for Payer: Cofinity Commercial |
$404.10
|
| Rate for Payer: Cofinity Commercial |
$106.97
|
| Rate for Payer: Cofinity Commercial |
$124.79
|
| Rate for Payer: Cofinity Commercial |
$130.74
|
| Rate for Payer: Cofinity Commercial |
$207.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.90
|
| Rate for Payer: Healthscope Commercial |
$111.94
|
| Rate for Payer: Healthscope Commercial |
$130.60
|
| Rate for Payer: Healthscope Commercial |
$136.82
|
| Rate for Payer: Healthscope Commercial |
$217.66
|
| Rate for Payer: Healthscope Commercial |
$422.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$328.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.39
|
| Rate for Payer: PHP Commercial |
$129.22
|
| Rate for Payer: PHP Commercial |
$105.72
|
| Rate for Payer: PHP Commercial |
$205.57
|
| Rate for Payer: PHP Commercial |
$399.40
|
| Rate for Payer: PHP Commercial |
$123.34
|
| Rate for Payer: Priority Health SBD |
$152.37
|
| Rate for Payer: Priority Health SBD |
$296.02
|
| Rate for Payer: Priority Health SBD |
$91.42
|
| Rate for Payer: Priority Health SBD |
$78.36
|
| Rate for Payer: Priority Health SBD |
$95.77
|
| Rate for Payer: UMR Bronson Commercial |
$63.85
|
| Rate for Payer: UMR Bronson Commercial |
$206.75
|
| Rate for Payer: UMR Bronson Commercial |
$66.89
|
| Rate for Payer: UMR Bronson Commercial |
$54.73
|
| Rate for Payer: UMR Bronson Commercial |
$106.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.83
|
|
|
MAGNESIUM SULFATE 4 GRAM/50 ML (8 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$53.44
|
|
|
Service Code
|
NDC 63323010705
|
| Hospital Charge Code |
4721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.77 |
| Max. Negotiated Rate |
$48.10 |
| Rate for Payer: Aetna American Axle |
$34.74
|
| Rate for Payer: Aetna Commercial |
$45.42
|
| Rate for Payer: Aetna Medicare |
$26.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.74
|
| Rate for Payer: BCBS Complete |
$21.38
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cofinity Advantage |
$37.41
|
| Rate for Payer: Cofinity Commercial |
$45.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.75
|
| Rate for Payer: Healthscope Commercial |
$48.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.08
|
| Rate for Payer: PHP Commercial |
$45.42
|
| Rate for Payer: Priority Health SBD |
$33.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.74
|
| Rate for Payer: UHC Core |
$27.84
|
| Rate for Payer: UHC Exchange |
$21.00
|
| Rate for Payer: UMR Bronson Commercial |
$19.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.08
|
|
|
MAGNESIUM SULFATE 4 GRAM/50 ML (8 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$53.44
|
|
|
Service Code
|
NDC 63323010701
|
| Hospital Charge Code |
4721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.77 |
| Max. Negotiated Rate |
$48.10 |
| Rate for Payer: Aetna American Axle |
$34.74
|
| Rate for Payer: Aetna Commercial |
$45.42
|
| Rate for Payer: Aetna Medicare |
$26.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.74
|
| Rate for Payer: BCBS Complete |
$21.38
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cofinity Advantage |
$37.41
|
| Rate for Payer: Cofinity Commercial |
$45.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.75
|
| Rate for Payer: Healthscope Commercial |
$48.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.08
|
| Rate for Payer: PHP Commercial |
$45.42
|
| Rate for Payer: Priority Health SBD |
$33.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.74
|
| Rate for Payer: UHC Core |
$27.84
|
| Rate for Payer: UHC Exchange |
$21.00
|
| Rate for Payer: UMR Bronson Commercial |
$19.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.08
|
|
|
MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION
|
Facility
|
OP
|
$19.14
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna American Axle |
$12.44
|
| Rate for Payer: Aetna American Axle |
$13.94
|
| Rate for Payer: Aetna American Axle |
$18.00
|
| Rate for Payer: Aetna American Axle |
$15.18
|
| Rate for Payer: Aetna American Axle |
$11.60
|
| Rate for Payer: Aetna American Axle |
$9.99
|
| Rate for Payer: Aetna American Axle |
$36.30
|
| Rate for Payer: Aetna American Axle |
$26.32
|
| Rate for Payer: Aetna American Axle |
$23.29
|
| Rate for Payer: Aetna Commercial |
$19.85
|
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna Commercial |
$18.22
|
| Rate for Payer: Aetna Commercial |
$23.55
|
| Rate for Payer: Aetna Commercial |
$30.46
|
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna Commercial |
$47.47
|
| Rate for Payer: Aetna Medicare |
$9.57
|
| Rate for Payer: Aetna Medicare |
$8.92
|
| Rate for Payer: Aetna Medicare |
$17.91
|
| Rate for Payer: Aetna Medicare |
$7.68
|
| Rate for Payer: Aetna Medicare |
$27.93
|
| Rate for Payer: Aetna Medicare |
$11.68
|
| Rate for Payer: Aetna Medicare |
$10.72
|
| Rate for Payer: Aetna Medicare |
$20.25
|
| Rate for Payer: Aetna Medicare |
$13.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.94
|
| Rate for Payer: BCBS Complete |
$7.14
|
| Rate for Payer: BCBS Complete |
$7.66
|
| Rate for Payer: BCBS Complete |
$11.08
|
| Rate for Payer: BCBS Complete |
$8.58
|
| Rate for Payer: BCBS Complete |
$14.33
|
| Rate for Payer: BCBS Complete |
$9.34
|
| Rate for Payer: BCBS Complete |
$22.34
|
| Rate for Payer: BCBS Complete |
$16.20
|
| Rate for Payer: BCBS Complete |
$6.15
|
| 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: 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: BCN Commercial |
$1.30
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$14.27
|
| Rate for Payer: Cash Price |
$28.66
|
| Rate for Payer: Cash Price |
$18.68
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$28.66
|
| Rate for Payer: Cash Price |
$44.68
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$18.68
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$44.68
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$14.27
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cofinity Advantage |
$12.49
|
| Rate for Payer: Cofinity Advantage |
$13.40
|
| Rate for Payer: Cofinity Advantage |
$10.76
|
| Rate for Payer: Cofinity Advantage |
$15.01
|
| Rate for Payer: Cofinity Advantage |
$16.34
|
| Rate for Payer: Cofinity Advantage |
$19.39
|
| Rate for Payer: Cofinity Advantage |
$25.08
|
| Rate for Payer: Cofinity Advantage |
$28.35
|
| Rate for Payer: Cofinity Advantage |
$39.09
|
| Rate for Payer: Cofinity Commercial |
$15.34
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Cofinity Commercial |
$30.81
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$20.08
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Cofinity Commercial |
$48.03
|
| Rate for Payer: Cofinity Commercial |
$18.44
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Healthscope Commercial |
$16.06
|
| Rate for Payer: Healthscope Commercial |
$13.83
|
| Rate for Payer: Healthscope Commercial |
$50.27
|
| Rate for Payer: Healthscope Commercial |
$19.30
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Healthscope Commercial |
$32.25
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Healthscope Commercial |
$21.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.38
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: PHP Commercial |
$18.22
|
| Rate for Payer: PHP Commercial |
$19.85
|
| Rate for Payer: PHP Commercial |
$47.47
|
| Rate for Payer: PHP Commercial |
$23.55
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: PHP Commercial |
$15.16
|
| Rate for Payer: PHP Commercial |
$30.46
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: Priority Health SBD |
$14.71
|
| Rate for Payer: Priority Health SBD |
$22.57
|
| Rate for Payer: Priority Health SBD |
$11.24
|
| Rate for Payer: Priority Health SBD |
$12.06
|
| Rate for Payer: Priority Health SBD |
$17.45
|
| Rate for Payer: Priority Health SBD |
$35.19
|
| Rate for Payer: Priority Health SBD |
$9.68
|
| Rate for Payer: Priority Health SBD |
$13.51
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| 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 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 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: UHC Exchange |
$0.68
|
| Rate for Payer: UMR Bronson Commercial |
$10.25
|
| Rate for Payer: UMR Bronson Commercial |
$7.08
|
| Rate for Payer: UMR Bronson Commercial |
$8.64
|
| Rate for Payer: UMR Bronson Commercial |
$13.26
|
| Rate for Payer: UMR Bronson Commercial |
$14.98
|
| Rate for Payer: UMR Bronson Commercial |
$20.66
|
| Rate for Payer: UMR Bronson Commercial |
$5.69
|
| Rate for Payer: UMR Bronson Commercial |
$6.60
|
| Rate for Payer: UMR Bronson Commercial |
$7.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.38
|
|
|
MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION
|
Facility
|
IP
|
$55.85
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$50.27 |
| Rate for Payer: Aetna American Axle |
$36.30
|
| Rate for Payer: Aetna American Axle |
$26.32
|
| Rate for Payer: Aetna American Axle |
$9.99
|
| Rate for Payer: Aetna American Axle |
$23.29
|
| Rate for Payer: Aetna American Axle |
$18.00
|
| Rate for Payer: Aetna American Axle |
$15.18
|
| Rate for Payer: Aetna American Axle |
$13.94
|
| Rate for Payer: Aetna American Axle |
$12.44
|
| Rate for Payer: Aetna American Axle |
$11.60
|
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna Commercial |
$23.55
|
| Rate for Payer: Aetna Commercial |
$30.46
|
| Rate for Payer: Aetna Commercial |
$18.22
|
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna Commercial |
$47.47
|
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Commercial |
$19.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.30
|
| Rate for Payer: Cash Price |
$28.66
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$44.68
|
| Rate for Payer: Cash Price |
$18.68
|
| Rate for Payer: Cash Price |
$14.27
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cofinity Advantage |
$13.40
|
| Rate for Payer: Cofinity Advantage |
$15.01
|
| Rate for Payer: Cofinity Advantage |
$16.34
|
| Rate for Payer: Cofinity Advantage |
$12.49
|
| Rate for Payer: Cofinity Advantage |
$39.09
|
| Rate for Payer: Cofinity Advantage |
$25.08
|
| Rate for Payer: Cofinity Advantage |
$19.39
|
| Rate for Payer: Cofinity Advantage |
$28.35
|
| Rate for Payer: Cofinity Advantage |
$10.76
|
| Rate for Payer: Cofinity Commercial |
$30.81
|
| Rate for Payer: Cofinity Commercial |
$15.34
|
| Rate for Payer: Cofinity Commercial |
$20.08
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$48.03
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Cofinity Commercial |
$18.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Healthscope Commercial |
$16.06
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Healthscope Commercial |
$32.25
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Healthscope Commercial |
$13.83
|
| Rate for Payer: Healthscope Commercial |
$19.30
|
| Rate for Payer: Healthscope Commercial |
$50.27
|
| Rate for Payer: Healthscope Commercial |
$21.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.87
|
| Rate for Payer: PHP Commercial |
$15.16
|
| Rate for Payer: PHP Commercial |
$18.22
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: PHP Commercial |
$19.85
|
| Rate for Payer: PHP Commercial |
$23.55
|
| Rate for Payer: PHP Commercial |
$30.46
|
| Rate for Payer: PHP Commercial |
$47.47
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: Priority Health SBD |
$17.45
|
| Rate for Payer: Priority Health SBD |
$14.71
|
| Rate for Payer: Priority Health SBD |
$35.19
|
| Rate for Payer: Priority Health SBD |
$22.57
|
| Rate for Payer: Priority Health SBD |
$11.24
|
| Rate for Payer: Priority Health SBD |
$9.68
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| Rate for Payer: Priority Health SBD |
$12.06
|
| Rate for Payer: Priority Health SBD |
$13.51
|
| Rate for Payer: UMR Bronson Commercial |
$6.76
|
| Rate for Payer: UMR Bronson Commercial |
$8.42
|
| Rate for Payer: UMR Bronson Commercial |
$12.19
|
| Rate for Payer: UMR Bronson Commercial |
$9.43
|
| Rate for Payer: UMR Bronson Commercial |
$15.77
|
| Rate for Payer: UMR Bronson Commercial |
$10.27
|
| Rate for Payer: UMR Bronson Commercial |
$24.57
|
| Rate for Payer: UMR Bronson Commercial |
$7.85
|
| Rate for Payer: UMR Bronson Commercial |
$17.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.89
|
|
|
MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SYRINGE
|
Facility
|
OP
|
$263.07
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
112145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$236.76 |
| Rate for Payer: Aetna American Axle |
$171.00
|
| Rate for Payer: Aetna Commercial |
$223.61
|
| Rate for Payer: Aetna Medicare |
$131.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.00
|
| Rate for Payer: BCBS Complete |
$105.23
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: Cash Price |
$210.46
|
| Rate for Payer: Cash Price |
$210.46
|
| Rate for Payer: Cofinity Advantage |
$184.15
|
| Rate for Payer: Cofinity Commercial |
$226.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.46
|
| Rate for Payer: Healthscope Commercial |
$236.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.30
|
| Rate for Payer: PHP Commercial |
$223.61
|
| Rate for Payer: Priority Health SBD |
$165.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UMR Bronson Commercial |
$97.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.30
|
|
|
MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SYRINGE
|
Facility
|
IP
|
$263.07
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
112145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.75 |
| Max. Negotiated Rate |
$236.76 |
| Rate for Payer: Aetna American Axle |
$171.00
|
| Rate for Payer: Aetna Commercial |
$223.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.00
|
| Rate for Payer: Cash Price |
$210.46
|
| Rate for Payer: Cofinity Advantage |
$184.15
|
| Rate for Payer: Cofinity Commercial |
$226.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.46
|
| Rate for Payer: Healthscope Commercial |
$236.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.30
|
| Rate for Payer: PHP Commercial |
$223.61
|
| Rate for Payer: Priority Health SBD |
$165.73
|
| Rate for Payer: UMR Bronson Commercial |
$115.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.30
|
|
|
MAGNESIUM SULFATE IN D5W 1 GRAM/100 ML IVPB (CODE)
|
Facility
|
IP
|
$49.27
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
163707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$44.34 |
| Rate for Payer: Aetna American Axle |
$32.03
|
| Rate for Payer: Aetna Commercial |
$41.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.03
|
| Rate for Payer: Cash Price |
$39.42
|
| Rate for Payer: Cofinity Advantage |
$34.49
|
| Rate for Payer: Cofinity Commercial |
$42.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.42
|
| Rate for Payer: Healthscope Commercial |
$44.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.95
|
| Rate for Payer: PHP Commercial |
$41.88
|
| Rate for Payer: Priority Health SBD |
$31.04
|
| Rate for Payer: UMR Bronson Commercial |
$21.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.95
|
|
|
MAGNESIUM SULFATE IN D5W 1 GRAM/100 ML IVPB (CODE)
|
Facility
|
OP
|
$49.27
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
163707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$44.34 |
| Rate for Payer: Aetna American Axle |
$32.03
|
| Rate for Payer: Aetna Commercial |
$41.88
|
| Rate for Payer: Aetna Medicare |
$24.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.03
|
| Rate for Payer: BCBS Complete |
$19.71
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: Cash Price |
$39.42
|
| Rate for Payer: Cash Price |
$39.42
|
| Rate for Payer: Cofinity Advantage |
$34.49
|
| Rate for Payer: Cofinity Commercial |
$42.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.42
|
| Rate for Payer: Healthscope Commercial |
$44.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.95
|
| Rate for Payer: PHP Commercial |
$41.88
|
| Rate for Payer: Priority Health SBD |
$31.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UMR Bronson Commercial |
$18.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.95
|
|
|
MAJOR ABDOMINAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$18,122.22
|
|
|
Service Code
|
APR-DRG 1691
|
| Min. Negotiated Rate |
$17,259.26 |
| Max. Negotiated Rate |
$18,122.22 |
| Rate for Payer: BCBS Complete |
$18,122.22
|
| Rate for Payer: Mclaren Medicaid |
$17,259.26
|
| Rate for Payer: Meridian Medicaid |
$18,122.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,259.26
|
| Rate for Payer: UHC Medicaid |
$17,259.26
|
| Rate for Payer: UHCCP Medicaid |
$17,259.26
|
|
|
MAJOR ABDOMINAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$34,574.35
|
|
|
Service Code
|
APR-DRG 1694
|
| Min. Negotiated Rate |
$32,927.95 |
| Max. Negotiated Rate |
$34,574.35 |
| Rate for Payer: BCBS Complete |
$34,574.35
|
| Rate for Payer: Mclaren Medicaid |
$32,927.95
|
| Rate for Payer: Meridian Medicaid |
$34,574.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$32,927.95
|
| Rate for Payer: UHC Medicaid |
$32,927.95
|
| Rate for Payer: UHCCP Medicaid |
$32,927.95
|
|
|
MAJOR ABDOMINAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$26,033.21
|
|
|
Service Code
|
APR-DRG 1693
|
| Min. Negotiated Rate |
$24,793.54 |
| Max. Negotiated Rate |
$26,033.21 |
| Rate for Payer: BCBS Complete |
$26,033.21
|
| Rate for Payer: Mclaren Medicaid |
$24,793.54
|
| Rate for Payer: Meridian Medicaid |
$26,033.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$24,793.54
|
| Rate for Payer: UHC Medicaid |
$24,793.54
|
| Rate for Payer: UHCCP Medicaid |
$24,793.54
|
|
|
MAJOR ABDOMINAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$20,335.89
|
|
|
Service Code
|
APR-DRG 1692
|
| Min. Negotiated Rate |
$19,367.52 |
| Max. Negotiated Rate |
$20,335.89 |
| Rate for Payer: BCBS Complete |
$20,335.89
|
| Rate for Payer: Mclaren Medicaid |
$19,367.52
|
| Rate for Payer: Meridian Medicaid |
$20,335.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,367.52
|
| Rate for Payer: UHC Medicaid |
$19,367.52
|
| Rate for Payer: UHCCP Medicaid |
$19,367.52
|
|
|
MAJOR BILIARY TRACT PROCEDURES
|
Facility
|
IP
|
$9,412.20
|
|
|
Service Code
|
APR-DRG 2611
|
| Min. Negotiated Rate |
$8,964.00 |
| Max. Negotiated Rate |
$9,412.20 |
| Rate for Payer: BCBS Complete |
$9,412.20
|
| Rate for Payer: Mclaren Medicaid |
$8,964.00
|
| Rate for Payer: Meridian Medicaid |
$9,412.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,964.00
|
| Rate for Payer: UHC Medicaid |
$8,964.00
|
| Rate for Payer: UHCCP Medicaid |
$8,964.00
|
|
|
MAJOR BILIARY TRACT PROCEDURES
|
Facility
|
IP
|
$13,754.19
|
|
|
Service Code
|
APR-DRG 2612
|
| Min. Negotiated Rate |
$13,099.23 |
| Max. Negotiated Rate |
$13,754.19 |
| Rate for Payer: BCBS Complete |
$13,754.19
|
| Rate for Payer: Mclaren Medicaid |
$13,099.23
|
| Rate for Payer: Meridian Medicaid |
$13,754.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,099.23
|
| Rate for Payer: UHC Medicaid |
$13,099.23
|
| Rate for Payer: UHCCP Medicaid |
$13,099.23
|
|
|
MAJOR BILIARY TRACT PROCEDURES
|
Facility
|
IP
|
$18,125.25
|
|
|
Service Code
|
APR-DRG 2613
|
| Min. Negotiated Rate |
$17,262.14 |
| Max. Negotiated Rate |
$18,125.25 |
| Rate for Payer: BCBS Complete |
$18,125.25
|
| Rate for Payer: Mclaren Medicaid |
$17,262.14
|
| Rate for Payer: Meridian Medicaid |
$18,125.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,262.14
|
| Rate for Payer: UHC Medicaid |
$17,262.14
|
| Rate for Payer: UHCCP Medicaid |
$17,262.14
|
|
|
MAJOR BILIARY TRACT PROCEDURES
|
Facility
|
IP
|
$30,619.15
|
|
|
Service Code
|
APR-DRG 2614
|
| Min. Negotiated Rate |
$29,161.10 |
| Max. Negotiated Rate |
$30,619.15 |
| Rate for Payer: BCBS Complete |
$30,619.15
|
| Rate for Payer: Mclaren Medicaid |
$29,161.10
|
| Rate for Payer: Meridian Medicaid |
$30,619.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$29,161.10
|
| Rate for Payer: UHC Medicaid |
$29,161.10
|
| Rate for Payer: UHCCP Medicaid |
$29,161.10
|
|
|
MAJOR BLADDER PROCEDURES
|
Facility
|
IP
|
$13,644.03
|
|
|
Service Code
|
APR-DRG 4411
|
| Min. Negotiated Rate |
$12,994.31 |
| Max. Negotiated Rate |
$13,644.03 |
| Rate for Payer: BCBS Complete |
$13,644.03
|
| Rate for Payer: Mclaren Medicaid |
$12,994.31
|
| Rate for Payer: Meridian Medicaid |
$13,644.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,994.31
|
| Rate for Payer: UHC Medicaid |
$12,994.31
|
| Rate for Payer: UHCCP Medicaid |
$12,994.31
|
|
|
MAJOR BLADDER PROCEDURES
|
Facility
|
IP
|
$22,878.86
|
|
|
Service Code
|
APR-DRG 4413
|
| Min. Negotiated Rate |
$21,789.39 |
| Max. Negotiated Rate |
$22,878.86 |
| Rate for Payer: BCBS Complete |
$22,878.86
|
| Rate for Payer: Mclaren Medicaid |
$21,789.39
|
| Rate for Payer: Meridian Medicaid |
$22,878.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,789.39
|
| Rate for Payer: UHC Medicaid |
$21,789.39
|
| Rate for Payer: UHCCP Medicaid |
$21,789.39
|
|
|
MAJOR BLADDER PROCEDURES
|
Facility
|
IP
|
$17,306.85
|
|
|
Service Code
|
APR-DRG 4412
|
| Min. Negotiated Rate |
$16,482.71 |
| Max. Negotiated Rate |
$17,306.85 |
| Rate for Payer: BCBS Complete |
$17,306.85
|
| Rate for Payer: Mclaren Medicaid |
$16,482.71
|
| Rate for Payer: Meridian Medicaid |
$17,306.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,482.71
|
| Rate for Payer: UHC Medicaid |
$16,482.71
|
| Rate for Payer: UHCCP Medicaid |
$16,482.71
|
|
|
MAJOR BLADDER PROCEDURES
|
Facility
|
IP
|
$37,922.40
|
|
|
Service Code
|
APR-DRG 4414
|
| Min. Negotiated Rate |
$36,116.57 |
| Max. Negotiated Rate |
$37,922.40 |
| Rate for Payer: BCBS Complete |
$37,922.40
|
| Rate for Payer: Mclaren Medicaid |
$36,116.57
|
| Rate for Payer: Meridian Medicaid |
$37,922.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$36,116.57
|
| Rate for Payer: UHC Medicaid |
$36,116.57
|
| Rate for Payer: UHCCP Medicaid |
$36,116.57
|
|
