|
MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION
|
Facility
|
OP
|
$15.37
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$13.83 |
| Rate for Payer: Aetna American Axle |
$9.99
|
| Rate for Payer: Aetna American Axle |
$12.44
|
| Rate for Payer: Aetna American Axle |
$18.00
|
| Rate for Payer: Aetna American Axle |
$36.30
|
| Rate for Payer: Aetna American Axle |
$12.96
|
| Rate for Payer: Aetna American Axle |
$15.18
|
| Rate for Payer: Aetna American Axle |
$13.94
|
| Rate for Payer: Aetna Commercial |
$18.22
|
| Rate for Payer: Aetna Commercial |
$47.47
|
| Rate for Payer: Aetna Commercial |
$19.85
|
| Rate for Payer: Aetna Commercial |
$23.54
|
| Rate for Payer: Aetna Commercial |
$16.95
|
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Medicare |
$10.72
|
| Rate for Payer: Aetna Medicare |
$11.68
|
| Rate for Payer: Aetna Medicare |
$9.57
|
| Rate for Payer: Aetna Medicare |
$13.85
|
| Rate for Payer: Aetna Medicare |
$9.97
|
| Rate for Payer: Aetna Medicare |
$7.68
|
| Rate for Payer: Aetna Medicare |
$27.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.00
|
| Rate for Payer: BCBS Complete |
$9.34
|
| Rate for Payer: BCBS Complete |
$7.66
|
| Rate for Payer: BCBS Complete |
$7.98
|
| Rate for Payer: BCBS Complete |
$6.15
|
| Rate for Payer: BCBS Complete |
$22.34
|
| Rate for Payer: BCBS Complete |
$11.08
|
| 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: 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 |
$44.68
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cash Price |
$15.95
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$15.95
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$18.68
|
| Rate for Payer: Cash Price |
$18.68
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$44.68
|
| Rate for Payer: Cofinity Commercial |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$48.03
|
| Rate for Payer: Cofinity Commercial |
$16.34
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$17.15
|
| Rate for Payer: Cofinity Commercial |
$39.10
|
| Rate for Payer: Cofinity Commercial |
$10.76
|
| Rate for Payer: Cofinity Commercial |
$20.08
|
| Rate for Payer: Cofinity Commercial |
$13.96
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Cofinity Commercial |
$19.39
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Cofinity Commercial |
$15.01
|
| Rate for Payer: Cofinity Commercial |
$18.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| 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 |
$22.16
|
| 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 |
$15.95
|
| Rate for Payer: Healthscope Commercial |
$19.30
|
| Rate for Payer: Healthscope Commercial |
$50.26
|
| Rate for Payer: Healthscope Commercial |
$21.02
|
| Rate for Payer: Healthscope Commercial |
$13.83
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Healthscope Commercial |
$17.95
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.96
|
| 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 |
$41.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.95
|
| 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 |
$23.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.47
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: PHP Commercial |
$18.22
|
| Rate for Payer: PHP Commercial |
$47.47
|
| Rate for Payer: PHP Commercial |
$16.95
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: PHP Commercial |
$19.85
|
| Rate for Payer: PHP Commercial |
$23.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.30
|
| Rate for Payer: Priority Health SBD |
$13.51
|
| Rate for Payer: Priority Health SBD |
$14.71
|
| Rate for Payer: Priority Health SBD |
$35.19
|
| Rate for Payer: Priority Health SBD |
$17.45
|
| Rate for Payer: Priority Health SBD |
$12.06
|
| Rate for Payer: Priority Health SBD |
$12.56
|
| Rate for Payer: Priority Health SBD |
$9.68
|
| Rate for Payer: UMR Bronson Commercial |
$8.64
|
| Rate for Payer: UMR Bronson Commercial |
$7.38
|
| Rate for Payer: UMR Bronson Commercial |
$5.69
|
| Rate for Payer: UMR Bronson Commercial |
$7.08
|
| Rate for Payer: UMR Bronson Commercial |
$7.93
|
| Rate for Payer: UMR Bronson Commercial |
$10.25
|
| Rate for Payer: UMR Bronson Commercial |
$20.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.78
|
|
|
MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION
|
Facility
|
IP
|
$15.37
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$13.83 |
| Rate for Payer: Aetna American Axle |
$9.99
|
| Rate for Payer: Aetna American Axle |
$18.00
|
| Rate for Payer: Aetna American Axle |
$15.18
|
| Rate for Payer: Aetna American Axle |
$12.96
|
| Rate for Payer: Aetna American Axle |
$12.44
|
| Rate for Payer: Aetna American Axle |
$13.94
|
| Rate for Payer: Aetna American Axle |
$36.30
|
| Rate for Payer: Aetna Commercial |
$23.54
|
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Commercial |
$18.22
|
| Rate for Payer: Aetna Commercial |
$19.85
|
| Rate for Payer: Aetna Commercial |
$47.47
|
| Rate for Payer: Aetna Commercial |
$16.95
|
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.18
|
| 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) |
$13.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.00
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$15.95
|
| Rate for Payer: Cash Price |
$18.68
|
| Rate for Payer: Cash Price |
$44.68
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Cofinity Commercial |
$10.76
|
| Rate for Payer: Cofinity Commercial |
$18.44
|
| Rate for Payer: Cofinity Commercial |
$15.01
|
| Rate for Payer: Cofinity Commercial |
$13.96
|
| Rate for Payer: Cofinity Commercial |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Cofinity Commercial |
$17.15
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$16.34
|
| Rate for Payer: Cofinity Commercial |
$20.08
|
| Rate for Payer: Cofinity Commercial |
$19.39
|
| Rate for Payer: Cofinity Commercial |
$39.10
|
| Rate for Payer: Cofinity Commercial |
$48.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Healthscope Commercial |
$50.26
|
| Rate for Payer: Healthscope Commercial |
$21.02
|
| Rate for Payer: Healthscope Commercial |
$17.95
|
| Rate for Payer: Healthscope Commercial |
$19.30
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Healthscope Commercial |
$13.83
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.53
|
| 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 |
$14.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.54
|
| Rate for Payer: PHP Commercial |
$19.85
|
| Rate for Payer: PHP Commercial |
$16.95
|
| Rate for Payer: PHP Commercial |
$18.22
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: PHP Commercial |
$47.47
|
| Rate for Payer: PHP Commercial |
$23.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.18
|
| Rate for Payer: Priority Health SBD |
$12.56
|
| Rate for Payer: Priority Health SBD |
$12.06
|
| Rate for Payer: Priority Health SBD |
$9.68
|
| Rate for Payer: Priority Health SBD |
$35.19
|
| Rate for Payer: Priority Health SBD |
$17.45
|
| Rate for Payer: Priority Health SBD |
$14.71
|
| Rate for Payer: Priority Health SBD |
$13.51
|
| Rate for Payer: UMR Bronson Commercial |
$9.43
|
| Rate for Payer: UMR Bronson Commercial |
$24.57
|
| Rate for Payer: UMR Bronson Commercial |
$10.27
|
| Rate for Payer: UMR Bronson Commercial |
$12.19
|
| Rate for Payer: UMR Bronson Commercial |
$6.76
|
| Rate for Payer: UMR Bronson Commercial |
$8.77
|
| Rate for Payer: UMR Bronson Commercial |
$8.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.96
|
| 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 |
$11.53
|
|
|
MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SYRINGE
|
Facility
|
IP
|
$239.17
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
112145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.23 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna American Axle |
$155.46
|
| Rate for Payer: Aetna Commercial |
$203.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.46
|
| Rate for Payer: Cash Price |
$191.34
|
| Rate for Payer: Cofinity Commercial |
$167.42
|
| Rate for Payer: Cofinity Commercial |
$205.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.34
|
| Rate for Payer: Healthscope Commercial |
$215.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.29
|
| Rate for Payer: PHP Commercial |
$203.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.46
|
| Rate for Payer: Priority Health SBD |
$150.68
|
| Rate for Payer: UMR Bronson Commercial |
$105.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.38
|
|
|
MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SYRINGE
|
Facility
|
OP
|
$239.17
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
112145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna American Axle |
$155.46
|
| Rate for Payer: Aetna Commercial |
$203.29
|
| Rate for Payer: Aetna Medicare |
$119.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.46
|
| Rate for Payer: BCBS Complete |
$95.67
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: Cash Price |
$191.34
|
| Rate for Payer: Cash Price |
$191.34
|
| Rate for Payer: Cofinity Commercial |
$167.42
|
| Rate for Payer: Cofinity Commercial |
$205.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.34
|
| Rate for Payer: Healthscope Commercial |
$215.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.29
|
| Rate for Payer: PHP Commercial |
$203.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.46
|
| Rate for Payer: Priority Health SBD |
$150.68
|
| Rate for Payer: UMR Bronson Commercial |
$88.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.38
|
|
|
MAGNESIUM SULFATE BOLUS FROM BAG (OB)
|
Facility
|
OP
|
$1.24
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
151287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
|
|
MAGNESIUM SULFATE IN D5W 1 GRAM/100 ML IVPB (CODE)
|
Facility
|
OP
|
$111.65
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
163707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$100.48 |
| Rate for Payer: Aetna American Axle |
$72.57
|
| Rate for Payer: Aetna Commercial |
$94.90
|
| Rate for Payer: Aetna Medicare |
$55.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.57
|
| Rate for Payer: BCBS Complete |
$44.66
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.24
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cofinity Commercial |
$78.16
|
| Rate for Payer: Cofinity Commercial |
$96.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Healthscope Commercial |
$100.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.90
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.57
|
| Rate for Payer: Priority Health SBD |
$70.34
|
| Rate for Payer: UMR Bronson Commercial |
$41.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.74
|
|
|
MAGNESIUM SULFATE IN D5W 1 GRAM/100 ML IVPB (CODE)
|
Facility
|
IP
|
$111.65
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
163707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.13 |
| Max. Negotiated Rate |
$100.48 |
| Rate for Payer: Aetna American Axle |
$72.57
|
| Rate for Payer: Aetna Commercial |
$94.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.57
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cofinity Commercial |
$78.16
|
| Rate for Payer: Cofinity Commercial |
$96.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Healthscope Commercial |
$100.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.90
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.57
|
| Rate for Payer: Priority Health SBD |
$70.34
|
| Rate for Payer: UMR Bronson Commercial |
$49.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.74
|
|
|
MANGANESE CHLORIDE 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$43.84
|
|
|
Service Code
|
NDC 00409409111
|
| Hospital Charge Code |
4744
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$39.46 |
| Rate for Payer: Aetna American Axle |
$28.50
|
| Rate for Payer: Aetna Commercial |
$37.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.50
|
| Rate for Payer: Cash Price |
$35.07
|
| Rate for Payer: Cofinity Commercial |
$30.69
|
| Rate for Payer: Cofinity Commercial |
$37.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.07
|
| Rate for Payer: Healthscope Commercial |
$39.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.26
|
| Rate for Payer: PHP Commercial |
$37.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.50
|
| Rate for Payer: Priority Health SBD |
$27.62
|
| Rate for Payer: UMR Bronson Commercial |
$19.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.88
|
|
|
MANGANESE CHLORIDE 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$43.84
|
|
|
Service Code
|
NDC 00409409101
|
| Hospital Charge Code |
4744
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$39.46 |
| Rate for Payer: Aetna American Axle |
$28.50
|
| Rate for Payer: Aetna Commercial |
$37.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.50
|
| Rate for Payer: Cash Price |
$35.07
|
| Rate for Payer: Cofinity Commercial |
$30.69
|
| Rate for Payer: Cofinity Commercial |
$37.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.07
|
| Rate for Payer: Healthscope Commercial |
$39.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.26
|
| Rate for Payer: PHP Commercial |
$37.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.50
|
| Rate for Payer: Priority Health SBD |
$27.62
|
| Rate for Payer: UMR Bronson Commercial |
$19.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.88
|
|
|
MANGANESE CHLORIDE 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$43.84
|
|
|
Service Code
|
NDC 00409409101
|
| Hospital Charge Code |
4744
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$39.46 |
| Rate for Payer: Aetna American Axle |
$28.50
|
| Rate for Payer: Aetna Commercial |
$37.26
|
| Rate for Payer: Aetna Medicare |
$21.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.50
|
| Rate for Payer: BCBS Complete |
$17.54
|
| Rate for Payer: Cash Price |
$35.07
|
| Rate for Payer: Cofinity Commercial |
$30.69
|
| Rate for Payer: Cofinity Commercial |
$37.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.07
|
| Rate for Payer: Healthscope Commercial |
$39.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.26
|
| Rate for Payer: PHP Commercial |
$37.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.50
|
| Rate for Payer: Priority Health SBD |
$27.62
|
| Rate for Payer: UMR Bronson Commercial |
$16.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.88
|
|
|
MANGANESE CHLORIDE 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$43.84
|
|
|
Service Code
|
NDC 00409409111
|
| Hospital Charge Code |
4744
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$39.46 |
| Rate for Payer: Aetna American Axle |
$28.50
|
| Rate for Payer: Aetna Commercial |
$37.26
|
| Rate for Payer: Aetna Medicare |
$21.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.50
|
| Rate for Payer: BCBS Complete |
$17.54
|
| Rate for Payer: Cash Price |
$35.07
|
| Rate for Payer: Cofinity Commercial |
$30.69
|
| Rate for Payer: Cofinity Commercial |
$37.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.07
|
| Rate for Payer: Healthscope Commercial |
$39.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.26
|
| Rate for Payer: PHP Commercial |
$37.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.50
|
| Rate for Payer: Priority Health SBD |
$27.62
|
| Rate for Payer: UMR Bronson Commercial |
$16.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.88
|
|
|
MANIPULATION, ELBOW, UNDER ANESTHESIA
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 24300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$423.60 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,263.77
|
| Rate for Payer: BCN Commercial |
$1,263.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$465.96
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$423.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION OR OTHER FIXATION DEVICES)
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 27570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$148.59 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,787.42
|
| Rate for Payer: BCN Commercial |
$1,787.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.45
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$148.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
MANIPULATION UNDER ANESTHESIA, SHOULDER JOINT, INCLUDING APPLICATION OF FIXATION APPARATUS (DISLOCATION EXCLUDED)
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 23700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$189.57 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,263.77
|
| Rate for Payer: BCN Commercial |
$1,263.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.53
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$189.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
MANIPULATION, WRIST, UNDER ANESTHESIA
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 25259
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$416.65 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,083.23
|
| Rate for Payer: BCN Commercial |
$1,083.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.32
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$416.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$105.09
|
|
|
Service Code
|
NDC 00990771513
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$94.58 |
| Rate for Payer: Aetna American Axle |
$68.31
|
| Rate for Payer: Aetna Commercial |
$89.33
|
| Rate for Payer: Aetna Medicare |
$52.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.31
|
| Rate for Payer: BCBS Complete |
$42.04
|
| Rate for Payer: Cash Price |
$84.07
|
| Rate for Payer: Cofinity Commercial |
$73.56
|
| Rate for Payer: Cofinity Commercial |
$90.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.07
|
| Rate for Payer: Healthscope Commercial |
$94.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.33
|
| Rate for Payer: PHP Commercial |
$89.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.31
|
| Rate for Payer: Priority Health SBD |
$66.21
|
| Rate for Payer: UMR Bronson Commercial |
$38.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.82
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$94.92
|
|
|
Service Code
|
NDC 00338035702
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.12 |
| Max. Negotiated Rate |
$85.43 |
| Rate for Payer: Aetna American Axle |
$61.70
|
| Rate for Payer: Aetna Commercial |
$80.68
|
| Rate for Payer: Aetna Medicare |
$47.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.70
|
| Rate for Payer: BCBS Complete |
$37.97
|
| Rate for Payer: Cash Price |
$75.94
|
| Rate for Payer: Cofinity Commercial |
$66.44
|
| Rate for Payer: Cofinity Commercial |
$81.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.94
|
| Rate for Payer: Healthscope Commercial |
$85.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.68
|
| Rate for Payer: PHP Commercial |
$80.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.70
|
| Rate for Payer: Priority Health SBD |
$59.80
|
| Rate for Payer: UMR Bronson Commercial |
$35.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.19
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$94.92
|
|
|
Service Code
|
NDC 00338035702
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.76 |
| Max. Negotiated Rate |
$85.43 |
| Rate for Payer: Aetna American Axle |
$61.70
|
| Rate for Payer: Aetna Commercial |
$80.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.70
|
| Rate for Payer: Cash Price |
$75.94
|
| Rate for Payer: Cofinity Commercial |
$66.44
|
| Rate for Payer: Cofinity Commercial |
$81.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.94
|
| Rate for Payer: Healthscope Commercial |
$85.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.68
|
| Rate for Payer: PHP Commercial |
$80.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.70
|
| Rate for Payer: Priority Health SBD |
$59.80
|
| Rate for Payer: UMR Bronson Commercial |
$41.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.19
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$105.09
|
|
|
Service Code
|
NDC 00990771503
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$94.58 |
| Rate for Payer: Aetna American Axle |
$68.31
|
| Rate for Payer: Aetna Commercial |
$89.33
|
| Rate for Payer: Aetna Medicare |
$52.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.31
|
| Rate for Payer: BCBS Complete |
$42.04
|
| Rate for Payer: Cash Price |
$84.07
|
| Rate for Payer: Cofinity Commercial |
$73.56
|
| Rate for Payer: Cofinity Commercial |
$90.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.07
|
| Rate for Payer: Healthscope Commercial |
$94.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.33
|
| Rate for Payer: PHP Commercial |
$89.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.31
|
| Rate for Payer: Priority Health SBD |
$66.21
|
| Rate for Payer: UMR Bronson Commercial |
$38.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.82
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$234.32
|
|
|
Service Code
|
NDC 00264757810
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$86.70 |
| Max. Negotiated Rate |
$210.89 |
| Rate for Payer: Aetna American Axle |
$152.31
|
| Rate for Payer: Aetna Commercial |
$199.17
|
| Rate for Payer: Aetna Medicare |
$117.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.31
|
| Rate for Payer: BCBS Complete |
$93.73
|
| Rate for Payer: Cash Price |
$187.46
|
| Rate for Payer: Cofinity Commercial |
$164.02
|
| Rate for Payer: Cofinity Commercial |
$201.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.46
|
| Rate for Payer: Healthscope Commercial |
$210.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.17
|
| Rate for Payer: PHP Commercial |
$199.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.31
|
| Rate for Payer: Priority Health SBD |
$147.62
|
| Rate for Payer: UMR Bronson Commercial |
$86.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.74
|
|
|
MANNITOL 25 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$90.12
|
|
|
Service Code
|
HCPCS J2150
|
| Hospital Charge Code |
4750
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.65 |
| Max. Negotiated Rate |
$81.11 |
| Rate for Payer: Aetna American Axle |
$58.58
|
| Rate for Payer: Aetna American Axle |
$39.77
|
| Rate for Payer: Aetna Commercial |
$52.00
|
| Rate for Payer: Aetna Commercial |
$76.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.58
|
| Rate for Payer: Cash Price |
$48.94
|
| Rate for Payer: Cash Price |
$72.10
|
| Rate for Payer: Cofinity Commercial |
$77.50
|
| Rate for Payer: Cofinity Commercial |
$63.08
|
| Rate for Payer: Cofinity Commercial |
$52.61
|
| Rate for Payer: Cofinity Commercial |
$42.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.10
|
| Rate for Payer: Healthscope Commercial |
$55.06
|
| Rate for Payer: Healthscope Commercial |
$81.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.60
|
| Rate for Payer: PHP Commercial |
$76.60
|
| Rate for Payer: PHP Commercial |
$52.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.58
|
| Rate for Payer: Priority Health SBD |
$56.78
|
| Rate for Payer: Priority Health SBD |
$38.54
|
| Rate for Payer: UMR Bronson Commercial |
$26.92
|
| Rate for Payer: UMR Bronson Commercial |
$39.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.59
|
|
|
MANNITOL 25 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$61.18
|
|
|
Service Code
|
HCPCS J2150
|
| Hospital Charge Code |
4750
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$55.06 |
| Rate for Payer: Aetna American Axle |
$39.77
|
| Rate for Payer: Aetna American Axle |
$58.58
|
| Rate for Payer: Aetna Commercial |
$76.60
|
| Rate for Payer: Aetna Commercial |
$52.00
|
| Rate for Payer: Aetna Medicare |
$30.59
|
| Rate for Payer: Aetna Medicare |
$45.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.58
|
| Rate for Payer: BCBS Complete |
$36.05
|
| Rate for Payer: BCBS Complete |
$24.47
|
| Rate for Payer: BCBS Trust/PPO |
$7.01
|
| Rate for Payer: BCBS Trust/PPO |
$7.01
|
| Rate for Payer: BCN Commercial |
$7.01
|
| Rate for Payer: BCN Commercial |
$7.01
|
| Rate for Payer: Cash Price |
$72.10
|
| Rate for Payer: Cash Price |
$72.10
|
| Rate for Payer: Cash Price |
$48.94
|
| Rate for Payer: Cash Price |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$77.50
|
| Rate for Payer: Cofinity Commercial |
$42.83
|
| Rate for Payer: Cofinity Commercial |
$63.08
|
| Rate for Payer: Cofinity Commercial |
$52.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.94
|
| Rate for Payer: Healthscope Commercial |
$81.11
|
| Rate for Payer: Healthscope Commercial |
$55.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.60
|
| Rate for Payer: PHP Commercial |
$52.00
|
| Rate for Payer: PHP Commercial |
$76.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.58
|
| Rate for Payer: Priority Health SBD |
$56.78
|
| Rate for Payer: Priority Health SBD |
$38.54
|
| Rate for Payer: UMR Bronson Commercial |
$22.64
|
| Rate for Payer: UMR Bronson Commercial |
$33.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.88
|
|
|
MARSUPIALIZATION OF BARTHOLIN'S GLAND CYST
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 56440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$176.31 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,490.59
|
| Rate for Payer: BCN Commercial |
$2,490.59
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.94
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$176.31
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
MARSUPIALIZATION OF SUBLINGUAL SALIVARY CYST (RANULA)
|
Facility
|
OP
|
$9,986.81
|
|
|
Service Code
|
CPT 42409
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$222.68 |
| Max. Negotiated Rate |
$9,986.81 |
| Rate for Payer: Aetna Medicare |
$3,304.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,464.71
|
| Rate for Payer: BCN Commercial |
$1,464.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Nomi Health Commercial |
$6,672.75
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,986.81
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$7,989.45
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.95
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$222.68
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,703.14
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
OP
|
$11,792.02
|
|
|
Service Code
|
CPT 19300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$415.99 |
| Max. Negotiated Rate |
$11,792.02 |
| Rate for Payer: Aetna Medicare |
$3,901.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,689.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,689.81
|
| Rate for Payer: BCBS Complete |
$2,111.54
|
| Rate for Payer: BCBS MAPPO |
$3,751.85
|
| Rate for Payer: BCBS Trust/PPO |
$5,380.67
|
| Rate for Payer: BCN Commercial |
$5,380.67
|
| Rate for Payer: BCN Medicare Advantage |
$3,751.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,751.85
|
| Rate for Payer: Mclaren Medicaid |
$2,010.99
|
| Rate for Payer: Mclaren Medicare |
$3,751.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,939.44
|
| Rate for Payer: Meridian Medicaid |
$2,111.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,314.63
|
| Rate for Payer: Nomi Health Commercial |
$7,878.88
|
| Rate for Payer: PACE Medicare |
$3,564.26
|
| Rate for Payer: PACE SWMI |
$3,751.85
|
| Rate for Payer: PHP Medicare Advantage |
$3,751.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,010.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,792.02
|
| Rate for Payer: Priority Health Medicare |
$3,751.85
|
| Rate for Payer: Priority Health Narrow Network |
$9,433.62
|
| Rate for Payer: Railroad Medicare Medicare |
$3,751.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$457.59
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,751.85
|
| Rate for Payer: UHC Exchange |
$415.99
|
| Rate for Payer: UHC Medicare Advantage |
$3,751.85
|
| Rate for Payer: UHCCP Medicaid |
$2,010.99
|
| Rate for Payer: VA VA |
$3,751.85
|
|
