|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
OP
|
$181.44
|
|
|
Service Code
|
NDC 69367027102
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.13 |
| Max. Negotiated Rate |
$163.30 |
| Rate for Payer: Aetna American Axle |
$117.94
|
| Rate for Payer: Aetna Commercial |
$154.22
|
| Rate for Payer: Aetna Medicare |
$90.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.94
|
| Rate for Payer: BCBS Complete |
$72.58
|
| Rate for Payer: Cash Price |
$145.15
|
| Rate for Payer: Cofinity Commercial |
$127.01
|
| Rate for Payer: Cofinity Commercial |
$156.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.15
|
| Rate for Payer: Healthscope Commercial |
$163.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.22
|
| Rate for Payer: PHP Commercial |
$154.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.94
|
| Rate for Payer: Priority Health SBD |
$114.31
|
| Rate for Payer: UMR Bronson Commercial |
$67.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.08
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
OP
|
$166.32
|
|
|
Service Code
|
NDC 10006073038
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.54 |
| Max. Negotiated Rate |
$149.69 |
| Rate for Payer: Aetna American Axle |
$108.11
|
| Rate for Payer: Aetna Commercial |
$141.37
|
| Rate for Payer: Aetna Medicare |
$83.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.11
|
| Rate for Payer: BCBS Complete |
$66.53
|
| Rate for Payer: Cash Price |
$133.06
|
| Rate for Payer: Cofinity Commercial |
$116.42
|
| Rate for Payer: Cofinity Commercial |
$143.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.06
|
| Rate for Payer: Healthscope Commercial |
$149.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.37
|
| Rate for Payer: PHP Commercial |
$141.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.11
|
| Rate for Payer: Priority Health SBD |
$104.78
|
| Rate for Payer: UMR Bronson Commercial |
$61.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.74
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
IP
|
$166.32
|
|
|
Service Code
|
NDC 10006073038
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.18 |
| Max. Negotiated Rate |
$149.69 |
| Rate for Payer: Aetna American Axle |
$108.11
|
| Rate for Payer: Aetna Commercial |
$141.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.11
|
| Rate for Payer: Cash Price |
$133.06
|
| Rate for Payer: Cofinity Commercial |
$116.42
|
| Rate for Payer: Cofinity Commercial |
$143.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.06
|
| Rate for Payer: Healthscope Commercial |
$149.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.37
|
| Rate for Payer: PHP Commercial |
$141.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.11
|
| Rate for Payer: Priority Health SBD |
$104.78
|
| Rate for Payer: UMR Bronson Commercial |
$73.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.74
|
|
|
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 Commercial |
$75.46
|
| Rate for Payer: Cofinity Commercial |
$92.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.46
|
| 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: PHP Commercial |
$91.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.07
|
| 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
|
$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 Commercial |
$144.48
|
| Rate for Payer: Cofinity Commercial |
$177.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.48
|
| 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: PHP Commercial |
$175.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.16
|
| 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 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 |
$1.24 |
| 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 |
$34.21
|
| Rate for Payer: Aetna Commercial |
$18.22
|
| 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 |
$1.24
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cofinity Commercial |
$34.62
|
| Rate for Payer: Cofinity Commercial |
$15.01
|
| Rate for Payer: Cofinity Commercial |
$28.18
|
| Rate for Payer: Cofinity Commercial |
$18.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.15
|
| Rate for Payer: Healthscope Commercial |
$36.22
|
| Rate for Payer: Healthscope Commercial |
$19.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.21
|
| Rate for Payer: PHP Commercial |
$18.22
|
| Rate for Payer: PHP Commercial |
$34.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.16
|
| Rate for Payer: Priority Health SBD |
$25.36
|
| Rate for Payer: Priority Health SBD |
$13.51
|
| 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 |
$30.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.08
|
|
|
MAGNESIUM SULFATE 0.5 GRAM/ML (50 %) INJECTION (CODE)
|
Facility
|
IP
|
$21.44
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
163706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$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 Commercial |
$34.62
|
| Rate for Payer: Cofinity Commercial |
$28.18
|
| Rate for Payer: Cofinity Commercial |
$15.01
|
| Rate for Payer: Cofinity Commercial |
$18.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.20
|
| Rate for Payer: Healthscope Commercial |
$19.30
|
| Rate for Payer: Healthscope Commercial |
$36.22
|
| 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: Multiplan/Beech St/PHCS Commercial |
$34.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.22
|
| Rate for Payer: PHP Commercial |
$34.21
|
| Rate for Payer: PHP Commercial |
$18.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.16
|
| Rate for Payer: Priority Health SBD |
$13.51
|
| Rate for Payer: Priority Health SBD |
$25.36
|
| Rate for Payer: UMR Bronson Commercial |
$9.43
|
| Rate for Payer: UMR Bronson Commercial |
$17.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$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
|
IP
|
$47.85
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
16162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna American Axle |
$30.07
|
| Rate for Payer: Aetna American Axle |
$72.57
|
| Rate for Payer: Aetna American Axle |
$54.54
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna Commercial |
$71.32
|
| Rate for Payer: Aetna Commercial |
$39.32
|
| Rate for Payer: Aetna Commercial |
$94.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Cash Price |
$37.01
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cash Price |
$67.13
|
| Rate for Payer: Cofinity Commercial |
$78.16
|
| Rate for Payer: Cofinity Commercial |
$72.16
|
| Rate for Payer: Cofinity Commercial |
$58.74
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$32.38
|
| Rate for Payer: Cofinity Commercial |
$39.78
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Cofinity Commercial |
$96.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.01
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Healthscope Commercial |
$100.48
|
| Rate for Payer: Healthscope Commercial |
$41.63
|
| Rate for Payer: Healthscope Commercial |
$75.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: PHP Commercial |
$71.32
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: PHP Commercial |
$39.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.57
|
| Rate for Payer: Priority Health SBD |
$52.86
|
| Rate for Payer: Priority Health SBD |
$70.34
|
| Rate for Payer: Priority Health SBD |
$29.14
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: UMR Bronson Commercial |
$21.05
|
| Rate for Payer: UMR Bronson Commercial |
$36.92
|
| Rate for Payer: UMR Bronson Commercial |
$20.35
|
| Rate for Payer: UMR Bronson Commercial |
$49.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
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 |
$1.24 |
| 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 |
$72.57
|
| Rate for Payer: Aetna American Axle |
$30.07
|
| Rate for Payer: Aetna Commercial |
$71.32
|
| Rate for Payer: Aetna Commercial |
$39.32
|
| Rate for Payer: Aetna Commercial |
$94.90
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna Medicare |
$23.92
|
| Rate for Payer: Aetna Medicare |
$23.13
|
| Rate for Payer: Aetna Medicare |
$55.82
|
| Rate for Payer: Aetna Medicare |
$41.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.07
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: BCBS Complete |
$44.66
|
| Rate for Payer: BCBS Complete |
$33.56
|
| Rate for Payer: BCBS Complete |
$18.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: Cash Price |
$37.01
|
| Rate for Payer: Cash Price |
$67.13
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cash Price |
$37.01
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cash Price |
$67.13
|
| Rate for Payer: Cofinity Commercial |
$72.16
|
| Rate for Payer: Cofinity Commercial |
$39.78
|
| Rate for Payer: Cofinity Commercial |
$78.16
|
| Rate for Payer: Cofinity Commercial |
$96.02
|
| Rate for Payer: Cofinity Commercial |
$32.38
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Cofinity Commercial |
$58.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Healthscope Commercial |
$100.48
|
| Rate for Payer: Healthscope Commercial |
$75.52
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Healthscope Commercial |
$41.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.32
|
| 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 |
$94.90
|
| Rate for Payer: PHP Commercial |
$71.32
|
| Rate for Payer: PHP Commercial |
$39.32
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| Rate for Payer: Priority Health SBD |
$70.34
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: Priority Health SBD |
$29.14
|
| Rate for Payer: Priority Health SBD |
$52.86
|
| Rate for Payer: UMR Bronson Commercial |
$41.31
|
| Rate for Payer: UMR Bronson Commercial |
$17.70
|
| Rate for Payer: UMR Bronson Commercial |
$31.05
|
| Rate for Payer: UMR Bronson Commercial |
$17.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.93
|
|
|
MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$87.73
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117958
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| 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 |
$36.29
|
| 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 |
$39.88
|
| Rate for Payer: Aetna Medicare |
$27.92
|
| Rate for Payer: Aetna Medicare |
$43.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.84
|
| Rate for Payer: BCBS Complete |
$31.90
|
| Rate for Payer: BCBS Complete |
$35.09
|
| Rate for Payer: BCBS Complete |
$22.33
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cash Price |
$44.66
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Cash Price |
$44.66
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$68.58
|
| Rate for Payer: Cofinity Commercial |
$39.08
|
| Rate for Payer: Cofinity Commercial |
$48.01
|
| Rate for Payer: Cofinity Commercial |
$55.82
|
| Rate for Payer: Cofinity Commercial |
$61.41
|
| Rate for Payer: Cofinity Commercial |
$75.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$78.96
|
| Rate for Payer: Healthscope Commercial |
$71.78
|
| Rate for Payer: Healthscope Commercial |
$50.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.57
|
| Rate for Payer: PHP Commercial |
$74.57
|
| Rate for Payer: PHP Commercial |
$47.46
|
| Rate for Payer: PHP Commercial |
$67.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.02
|
| Rate for Payer: Priority Health SBD |
$50.24
|
| Rate for Payer: Priority Health SBD |
$55.27
|
| Rate for Payer: Priority Health SBD |
$35.17
|
| Rate for Payer: UMR Bronson Commercial |
$32.46
|
| Rate for Payer: UMR Bronson Commercial |
$20.66
|
| Rate for Payer: UMR Bronson Commercial |
$29.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.80
|
|
|
MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$55.83
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117958
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$50.25 |
| Rate for Payer: Aetna American Axle |
$36.29
|
| Rate for Payer: Aetna American Axle |
$51.84
|
| Rate for Payer: Aetna American Axle |
$57.02
|
| Rate for Payer: Aetna Commercial |
$67.79
|
| Rate for Payer: Aetna Commercial |
$47.46
|
| Rate for Payer: Aetna Commercial |
$74.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.84
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Cash Price |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$48.01
|
| Rate for Payer: Cofinity Commercial |
$68.58
|
| Rate for Payer: Cofinity Commercial |
$55.82
|
| Rate for Payer: Cofinity Commercial |
$75.45
|
| Rate for Payer: Cofinity Commercial |
$61.41
|
| Rate for Payer: Cofinity Commercial |
$39.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.41
|
| 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 |
$63.80
|
| Rate for Payer: Healthscope Commercial |
$71.78
|
| Rate for Payer: Healthscope Commercial |
$50.25
|
| Rate for Payer: Healthscope Commercial |
$78.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.79
|
| Rate for Payer: PHP Commercial |
$74.57
|
| Rate for Payer: PHP Commercial |
$67.79
|
| Rate for Payer: PHP Commercial |
$47.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.29
|
| Rate for Payer: Priority Health SBD |
$55.27
|
| Rate for Payer: Priority Health SBD |
$50.24
|
| Rate for Payer: Priority Health SBD |
$35.17
|
| Rate for Payer: UMR Bronson Commercial |
$24.57
|
| Rate for Payer: UMR Bronson Commercial |
$38.60
|
| Rate for Payer: UMR Bronson Commercial |
$35.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.81
|
|
|
MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$61.19
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.92 |
| Max. Negotiated Rate |
$55.07 |
| Rate for Payer: Aetna American Axle |
$39.77
|
| Rate for Payer: Aetna American Axle |
$33.85
|
| Rate for Payer: Aetna American Axle |
$19.24
|
| Rate for Payer: Aetna American Axle |
$16.63
|
| Rate for Payer: Aetna American Axle |
$15.39
|
| Rate for Payer: Aetna American Axle |
$16.59
|
| Rate for Payer: Aetna American Axle |
$18.76
|
| Rate for Payer: Aetna American Axle |
$50.41
|
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Aetna Commercial |
$52.01
|
| Rate for Payer: Aetna Commercial |
$21.75
|
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: Aetna Commercial |
$21.70
|
| Rate for Payer: Aetna Commercial |
$20.13
|
| Rate for Payer: Aetna Commercial |
$44.26
|
| Rate for Payer: Aetna Commercial |
$25.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.63
|
| 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) |
$39.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.24
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$48.95
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$20.47
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$41.66
|
| Rate for Payer: Cofinity Commercial |
$24.82
|
| Rate for Payer: Cofinity Commercial |
$16.58
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$17.91
|
| Rate for Payer: Cofinity Commercial |
$17.87
|
| Rate for Payer: Cofinity Commercial |
$21.96
|
| Rate for Payer: Cofinity Commercial |
$22.01
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$36.45
|
| Rate for Payer: Cofinity Commercial |
$44.78
|
| Rate for Payer: Cofinity Commercial |
$42.83
|
| Rate for Payer: Cofinity Commercial |
$52.62
|
| Rate for Payer: Cofinity Commercial |
$54.28
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.47
|
| Rate for Payer: Healthscope Commercial |
$21.31
|
| Rate for Payer: Healthscope Commercial |
$69.80
|
| Rate for Payer: Healthscope Commercial |
$55.07
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Healthscope Commercial |
$46.86
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: Healthscope Commercial |
$23.03
|
| Rate for Payer: Healthscope Commercial |
$22.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.75
|
| Rate for Payer: PHP Commercial |
$52.01
|
| Rate for Payer: PHP Commercial |
$21.75
|
| Rate for Payer: PHP Commercial |
$44.26
|
| 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 |
$25.16
|
| Rate for Payer: PHP Commercial |
$21.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.63
|
| Rate for Payer: Priority Health SBD |
$16.12
|
| Rate for Payer: Priority Health SBD |
$16.08
|
| Rate for Payer: Priority Health SBD |
$14.92
|
| Rate for Payer: Priority Health SBD |
$18.18
|
| Rate for Payer: Priority Health SBD |
$32.80
|
| Rate for Payer: Priority Health SBD |
$18.65
|
| Rate for Payer: Priority Health SBD |
$48.86
|
| Rate for Payer: Priority Health SBD |
$38.55
|
| Rate for Payer: UMR Bronson Commercial |
$11.26
|
| Rate for Payer: UMR Bronson Commercial |
$12.70
|
| Rate for Payer: UMR Bronson Commercial |
$22.91
|
| Rate for Payer: UMR Bronson Commercial |
$26.92
|
| Rate for Payer: UMR Bronson Commercial |
$11.23
|
| Rate for Payer: UMR Bronson Commercial |
$34.12
|
| Rate for Payer: UMR Bronson Commercial |
$13.02
|
| Rate for Payer: UMR Bronson Commercial |
$10.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.20
|
|
|
MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$77.55
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna American Axle |
$50.41
|
| Rate for Payer: Aetna American Axle |
$39.77
|
| Rate for Payer: Aetna American Axle |
$19.24
|
| Rate for Payer: Aetna American Axle |
$18.76
|
| Rate for Payer: Aetna American Axle |
$33.85
|
| Rate for Payer: Aetna American Axle |
$15.39
|
| Rate for Payer: Aetna American Axle |
$16.63
|
| Rate for Payer: Aetna American Axle |
$16.59
|
| Rate for Payer: Aetna Commercial |
$21.75
|
| Rate for Payer: Aetna Commercial |
$20.13
|
| Rate for Payer: Aetna Commercial |
$21.70
|
| Rate for Payer: Aetna Commercial |
$25.16
|
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: Aetna Commercial |
$44.26
|
| Rate for Payer: Aetna Commercial |
$52.01
|
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Aetna Medicare |
$14.43
|
| Rate for Payer: Aetna Medicare |
$12.76
|
| Rate for Payer: Aetna Medicare |
$30.60
|
| Rate for Payer: Aetna Medicare |
$12.80
|
| Rate for Payer: Aetna Medicare |
$38.78
|
| Rate for Payer: Aetna Medicare |
$14.80
|
| Rate for Payer: Aetna Medicare |
$11.84
|
| Rate for Payer: Aetna Medicare |
$26.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.24
|
| Rate for Payer: BCBS Complete |
$31.02
|
| Rate for Payer: BCBS Complete |
$20.83
|
| Rate for Payer: BCBS Complete |
$11.54
|
| Rate for Payer: BCBS Complete |
$10.21
|
| Rate for Payer: BCBS Complete |
$9.47
|
| Rate for Payer: BCBS Complete |
$10.24
|
| Rate for Payer: BCBS Complete |
$24.48
|
| Rate for Payer: BCBS Complete |
$11.84
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: Cash Price |
$20.47
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$20.47
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cash Price |
$41.66
|
| Rate for Payer: Cash Price |
$41.66
|
| Rate for Payer: Cash Price |
$48.95
|
| Rate for Payer: Cash Price |
$48.95
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$44.78
|
| Rate for Payer: Cofinity Commercial |
$36.45
|
| Rate for Payer: Cofinity Commercial |
$16.58
|
| Rate for Payer: Cofinity Commercial |
$21.96
|
| Rate for Payer: Cofinity Commercial |
$54.28
|
| Rate for Payer: Cofinity Commercial |
$24.82
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$17.91
|
| Rate for Payer: Cofinity Commercial |
$17.87
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Cofinity Commercial |
$22.01
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$52.62
|
| Rate for Payer: Cofinity Commercial |
$42.83
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.28
|
| 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 |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Healthscope Commercial |
$23.03
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: Healthscope Commercial |
$55.07
|
| 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 |
$22.98
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: PHP Commercial |
$44.26
|
| Rate for Payer: PHP Commercial |
$21.70
|
| Rate for Payer: PHP Commercial |
$65.92
|
| Rate for Payer: PHP Commercial |
$25.16
|
| Rate for Payer: PHP Commercial |
$20.13
|
| Rate for Payer: PHP Commercial |
$21.75
|
| Rate for Payer: PHP Commercial |
$52.01
|
| Rate for Payer: PHP Commercial |
$24.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.77
|
| Rate for Payer: Priority Health SBD |
$14.92
|
| Rate for Payer: Priority Health SBD |
$48.86
|
| Rate for Payer: Priority Health SBD |
$18.18
|
| Rate for Payer: Priority Health SBD |
$18.65
|
| Rate for Payer: Priority Health SBD |
$16.08
|
| Rate for Payer: Priority Health SBD |
$16.12
|
| Rate for Payer: Priority Health SBD |
$38.55
|
| Rate for Payer: Priority Health SBD |
$32.80
|
| Rate for Payer: UMR Bronson Commercial |
$22.64
|
| Rate for Payer: UMR Bronson Commercial |
$28.69
|
| Rate for Payer: UMR Bronson Commercial |
$19.27
|
| Rate for Payer: UMR Bronson Commercial |
$10.95
|
| Rate for Payer: UMR Bronson Commercial |
$10.68
|
| Rate for Payer: UMR Bronson Commercial |
$9.45
|
| Rate for Payer: UMR Bronson Commercial |
$8.76
|
| Rate for Payer: UMR Bronson Commercial |
$9.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.76
|
|
|
MAGNESIUM SULFATE 4.06 MEQ/ML (50 %) INJECTION (TPN COMPONENT)
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
180902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.28 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna American Axle |
$72.80
|
| Rate for Payer: Aetna Commercial |
$95.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.80
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$96.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.60
|
| Rate for Payer: Healthscope Commercial |
$100.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.20
|
| Rate for Payer: PHP Commercial |
$95.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health SBD |
$70.56
|
| Rate for Payer: UMR Bronson Commercial |
$49.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.00
|
|
|
MAGNESIUM SULFATE 4.06 MEQ/ML (50 %) INJECTION (TPN COMPONENT)
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
180902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna American Axle |
$72.80
|
| Rate for Payer: Aetna Commercial |
$95.20
|
| Rate for Payer: Aetna Medicare |
$56.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.80
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$96.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.60
|
| Rate for Payer: Healthscope Commercial |
$100.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.20
|
| Rate for Payer: PHP Commercial |
$95.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health SBD |
$70.56
|
| Rate for Payer: UMR Bronson Commercial |
$41.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.00
|
|
|
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 |
$9.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.08
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cofinity Commercial |
$7.63
|
| Rate for Payer: Cofinity Commercial |
$9.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.63
|
| 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 |
$9.26
|
| Rate for Payer: PHP Commercial |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.08
|
| 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 |
$9.26
|
| 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 Commercial |
$7.63
|
| Rate for Payer: Cofinity Commercial |
$9.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.63
|
| 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 |
$9.26
|
| Rate for Payer: PHP Commercial |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.08
|
| Rate for Payer: Priority Health SBD |
$6.87
|
| Rate for Payer: UMR Bronson Commercial |
$4.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.18
|
|
|
MAGNESIUM SULFATE 495 MG/5 GRAM ORAL GRANULES
|
Facility
|
IP
|
$5.45
|
|
|
Service Code
|
NDC 87701040238
|
| Hospital Charge Code |
27322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$4.90 |
| Rate for Payer: Aetna American Axle |
$3.54
|
| Rate for Payer: Aetna Commercial |
$4.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.54
|
| Rate for Payer: Cash Price |
$4.36
|
| Rate for Payer: Cofinity Commercial |
$3.82
|
| Rate for Payer: Cofinity Commercial |
$4.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.36
|
| Rate for Payer: Healthscope Commercial |
$4.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.63
|
| Rate for Payer: PHP Commercial |
$4.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.54
|
| Rate for Payer: Priority Health SBD |
$3.43
|
| Rate for Payer: UMR Bronson Commercial |
$2.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.09
|
|
|
MAGNESIUM SULFATE 495 MG/5 GRAM ORAL GRANULES
|
Facility
|
OP
|
$5.45
|
|
|
Service Code
|
NDC 87701040238
|
| Hospital Charge Code |
27322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$4.90 |
| Rate for Payer: Aetna American Axle |
$3.54
|
| Rate for Payer: Aetna Commercial |
$4.63
|
| Rate for Payer: Aetna Medicare |
$2.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.54
|
| Rate for Payer: BCBS Complete |
$2.18
|
| Rate for Payer: Cash Price |
$4.36
|
| Rate for Payer: Cofinity Commercial |
$3.82
|
| Rate for Payer: Cofinity Commercial |
$4.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.36
|
| Rate for Payer: Healthscope Commercial |
$4.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.63
|
| Rate for Payer: PHP Commercial |
$4.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.54
|
| Rate for Payer: Priority Health SBD |
$3.43
|
| Rate for Payer: UMR Bronson Commercial |
$2.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.09
|
|
|
MAGNESIUM SULFATE 4 GRAM/100 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$124.38
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4719
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$111.94 |
| Rate for Payer: Aetna American Axle |
$80.85
|
| Rate for Payer: Aetna American Axle |
$94.32
|
| Rate for Payer: Aetna American Axle |
$260.51
|
| Rate for Payer: Aetna American Axle |
$305.42
|
| Rate for Payer: Aetna American Axle |
$98.81
|
| Rate for Payer: Aetna American Axle |
$148.22
|
| Rate for Payer: Aetna American Axle |
$130.25
|
| Rate for Payer: Aetna Commercial |
$170.33
|
| Rate for Payer: Aetna Commercial |
$399.40
|
| Rate for Payer: Aetna Commercial |
$193.83
|
| Rate for Payer: Aetna Commercial |
$340.66
|
| Rate for Payer: Aetna Commercial |
$129.22
|
| Rate for Payer: Aetna Commercial |
$105.72
|
| Rate for Payer: Aetna Commercial |
$123.34
|
| Rate for Payer: Aetna Medicare |
$100.20
|
| Rate for Payer: Aetna Medicare |
$114.02
|
| Rate for Payer: Aetna Medicare |
$72.56
|
| Rate for Payer: Aetna Medicare |
$200.39
|
| Rate for Payer: Aetna Medicare |
$76.01
|
| Rate for Payer: Aetna Medicare |
$62.19
|
| Rate for Payer: Aetna Medicare |
$234.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.25
|
| 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) |
$305.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.51
|
| Rate for Payer: BCBS Complete |
$91.21
|
| Rate for Payer: BCBS Complete |
$58.04
|
| Rate for Payer: BCBS Complete |
$60.81
|
| Rate for Payer: BCBS Complete |
$49.75
|
| Rate for Payer: BCBS Complete |
$187.95
|
| Rate for Payer: BCBS Complete |
$160.31
|
| Rate for Payer: BCBS Complete |
$80.16
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: Cash Price |
$375.90
|
| Rate for Payer: Cash Price |
$116.09
|
| Rate for Payer: Cash Price |
$121.62
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cash Price |
$116.09
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cash Price |
$121.62
|
| Rate for Payer: Cash Price |
$160.31
|
| Rate for Payer: Cash Price |
$160.31
|
| 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 |
$320.62
|
| Rate for Payer: Cash Price |
$375.90
|
| Rate for Payer: Cofinity Commercial |
$101.58
|
| Rate for Payer: Cofinity Commercial |
$404.10
|
| Rate for Payer: Cofinity Commercial |
$159.62
|
| Rate for Payer: Cofinity Commercial |
$87.07
|
| Rate for Payer: Cofinity Commercial |
$130.74
|
| Rate for Payer: Cofinity Commercial |
$328.92
|
| Rate for Payer: Cofinity Commercial |
$106.97
|
| Rate for Payer: Cofinity Commercial |
$196.11
|
| Rate for Payer: Cofinity Commercial |
$106.41
|
| Rate for Payer: Cofinity Commercial |
$344.67
|
| Rate for Payer: Cofinity Commercial |
$280.55
|
| Rate for Payer: Cofinity Commercial |
$124.79
|
| Rate for Payer: Cofinity Commercial |
$140.27
|
| Rate for Payer: Cofinity Commercial |
$172.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$159.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$280.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$106.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$328.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.62
|
| Rate for Payer: Healthscope Commercial |
$180.35
|
| Rate for Payer: Healthscope Commercial |
$422.89
|
| Rate for Payer: Healthscope Commercial |
$205.23
|
| 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 |
$360.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.27
|
| 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 |
$159.62
|
| 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: Lakeland Regional Health Systems Commercial |
$114.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.83
|
| 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 |
$150.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.34
|
| 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 |
$399.40
|
| Rate for Payer: PHP Commercial |
$123.34
|
| Rate for Payer: PHP Commercial |
$170.33
|
| Rate for Payer: PHP Commercial |
$399.40
|
| Rate for Payer: PHP Commercial |
$129.22
|
| Rate for Payer: PHP Commercial |
$105.72
|
| Rate for Payer: PHP Commercial |
$193.83
|
| Rate for Payer: PHP Commercial |
$340.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.42
|
| Rate for Payer: Priority Health SBD |
$126.25
|
| Rate for Payer: Priority Health SBD |
$143.66
|
| Rate for Payer: Priority Health SBD |
$296.02
|
| Rate for Payer: Priority Health SBD |
$252.49
|
| Rate for Payer: Priority Health SBD |
$91.42
|
| Rate for Payer: Priority Health SBD |
$95.77
|
| Rate for Payer: Priority Health SBD |
$78.36
|
| Rate for Payer: UMR Bronson Commercial |
$84.37
|
| Rate for Payer: UMR Bronson Commercial |
$56.25
|
| Rate for Payer: UMR Bronson Commercial |
$46.02
|
| Rate for Payer: UMR Bronson Commercial |
$53.69
|
| Rate for Payer: UMR Bronson Commercial |
$74.14
|
| Rate for Payer: UMR Bronson Commercial |
$148.29
|
| Rate for Payer: UMR Bronson Commercial |
$173.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.28
|
| 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 |
$300.58
|
|
|
MAGNESIUM SULFATE 4 GRAM/100 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$200.39
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4719
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.17 |
| Max. Negotiated Rate |
$180.35 |
| Rate for Payer: Aetna American Axle |
$130.25
|
| Rate for Payer: Aetna American Axle |
$80.85
|
| Rate for Payer: Aetna American Axle |
$94.32
|
| Rate for Payer: Aetna American Axle |
$305.42
|
| Rate for Payer: Aetna American Axle |
$98.81
|
| Rate for Payer: Aetna Commercial |
$170.33
|
| Rate for Payer: Aetna Commercial |
$123.34
|
| Rate for Payer: Aetna Commercial |
$105.72
|
| Rate for Payer: Aetna Commercial |
$399.40
|
| Rate for Payer: Aetna Commercial |
$129.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.25
|
| 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) |
$80.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.32
|
| Rate for Payer: Cash Price |
$160.31
|
| Rate for Payer: Cash Price |
$375.90
|
| Rate for Payer: Cash Price |
$116.09
|
| Rate for Payer: Cash Price |
$121.62
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cofinity Commercial |
$328.92
|
| Rate for Payer: Cofinity Commercial |
$106.97
|
| Rate for Payer: Cofinity Commercial |
$172.34
|
| Rate for Payer: Cofinity Commercial |
$140.27
|
| Rate for Payer: Cofinity Commercial |
$106.41
|
| Rate for Payer: Cofinity Commercial |
$101.58
|
| Rate for Payer: Cofinity Commercial |
$124.79
|
| Rate for Payer: Cofinity Commercial |
$130.74
|
| Rate for Payer: Cofinity Commercial |
$87.07
|
| Rate for Payer: Cofinity Commercial |
$404.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$328.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$106.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.62
|
| Rate for Payer: Healthscope Commercial |
$130.60
|
| Rate for Payer: Healthscope Commercial |
$180.35
|
| Rate for Payer: Healthscope Commercial |
$136.82
|
| Rate for Payer: Healthscope Commercial |
$422.89
|
| Rate for Payer: Healthscope Commercial |
$111.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.27
|
| 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 |
$101.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$328.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.72
|
| Rate for Payer: PHP Commercial |
$105.72
|
| Rate for Payer: PHP Commercial |
$399.40
|
| Rate for Payer: PHP Commercial |
$129.22
|
| Rate for Payer: PHP Commercial |
$170.33
|
| Rate for Payer: PHP Commercial |
$123.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.85
|
| Rate for Payer: Priority Health SBD |
$296.02
|
| Rate for Payer: Priority Health SBD |
$95.77
|
| Rate for Payer: Priority Health SBD |
$91.42
|
| Rate for Payer: Priority Health SBD |
$78.36
|
| Rate for Payer: Priority Health SBD |
$126.25
|
| Rate for Payer: UMR Bronson Commercial |
$54.73
|
| Rate for Payer: UMR Bronson Commercial |
$63.85
|
| Rate for Payer: UMR Bronson Commercial |
$88.17
|
| Rate for Payer: UMR Bronson Commercial |
$206.75
|
| Rate for Payer: UMR Bronson Commercial |
$66.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.28
|
| 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 |
$352.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.29
|
|
|
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 Commercial |
$37.41
|
| Rate for Payer: Cofinity Commercial |
$45.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.75
|
| Rate for Payer: Healthscope Commercial |
$48.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.42
|
| Rate for Payer: PHP Commercial |
$45.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.74
|
| Rate for Payer: Priority Health SBD |
$33.67
|
| Rate for Payer: UMR Bronson Commercial |
$19.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.08
|
|
|
MAGNESIUM SULFATE 4 GRAM/50 ML (8 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$53.44
|
|
|
Service Code
|
NDC 63323010705
|
| Hospital Charge Code |
4721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.51 |
| Max. Negotiated Rate |
$48.10 |
| Rate for Payer: Aetna American Axle |
$34.74
|
| Rate for Payer: Aetna Commercial |
$45.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.74
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cofinity Commercial |
$37.41
|
| Rate for Payer: Cofinity Commercial |
$45.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.75
|
| Rate for Payer: Healthscope Commercial |
$48.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.42
|
| Rate for Payer: PHP Commercial |
$45.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.74
|
| Rate for Payer: Priority Health SBD |
$33.67
|
| Rate for Payer: UMR Bronson Commercial |
$23.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.08
|
|
|
MAGNESIUM SULFATE 4 GRAM/50 ML (8 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$53.44
|
|
|
Service Code
|
NDC 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 Commercial |
$37.41
|
| Rate for Payer: Cofinity Commercial |
$45.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.75
|
| Rate for Payer: Healthscope Commercial |
$48.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.42
|
| Rate for Payer: PHP Commercial |
$45.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.74
|
| Rate for Payer: Priority Health SBD |
$33.67
|
| Rate for Payer: UMR Bronson Commercial |
$19.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.08
|
|
|
MAGNESIUM SULFATE 4 GRAM/50 ML (8 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$53.44
|
|
|
Service Code
|
NDC 63323010701
|
| Hospital Charge Code |
4721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.51 |
| Max. Negotiated Rate |
$48.10 |
| Rate for Payer: Aetna American Axle |
$34.74
|
| Rate for Payer: Aetna Commercial |
$45.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.74
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cofinity Commercial |
$37.41
|
| Rate for Payer: Cofinity Commercial |
$45.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.75
|
| Rate for Payer: Healthscope Commercial |
$48.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.42
|
| Rate for Payer: PHP Commercial |
$45.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.74
|
| Rate for Payer: Priority Health SBD |
$33.67
|
| Rate for Payer: UMR Bronson Commercial |
$23.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.08
|
|
