|
LOVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$67.68
|
|
|
Service Code
|
NDC 68180-467-07
|
| Hospital Charge Code |
10469
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$60.91 |
| Rate for Payer: Aetna Commercial |
$57.53
|
| Rate for Payer: BCBS Trust/PPO |
$52.30
|
| Rate for Payer: BCN Commercial |
$52.30
|
| Rate for Payer: Cash Price |
$54.14
|
| Rate for Payer: Cofinity Commercial |
$58.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.14
|
| Rate for Payer: Healthscope Commercial |
$60.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.53
|
| Rate for Payer: PHP Commercial |
$57.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.56
|
| Rate for Payer: UHC Core |
$56.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.76
|
|
|
LOXAPINE SUCCINATE 25 MG CAPSULE
|
Facility
|
IP
|
$486.24
|
|
|
Service Code
|
NDC 0378-7025-01
|
| Hospital Charge Code |
4600
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$296.56 |
| Max. Negotiated Rate |
$437.62 |
| Rate for Payer: Aetna Commercial |
$413.30
|
| Rate for Payer: BCBS Trust/PPO |
$375.77
|
| Rate for Payer: BCN Commercial |
$375.77
|
| Rate for Payer: Cash Price |
$388.99
|
| Rate for Payer: Cofinity Commercial |
$418.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.99
|
| Rate for Payer: Healthscope Commercial |
$437.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$413.30
|
| Rate for Payer: PHP Commercial |
$413.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$340.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$423.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$296.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.89
|
| Rate for Payer: UHC Core |
$406.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.68
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
IP
|
$1,276.95
|
|
|
Service Code
|
NDC 64764-080-60
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$778.81 |
| Max. Negotiated Rate |
$1,149.26 |
| Rate for Payer: Aetna Commercial |
$1,085.41
|
| Rate for Payer: BCBS Trust/PPO |
$986.83
|
| Rate for Payer: BCN Commercial |
$986.83
|
| Rate for Payer: Cash Price |
$1,021.56
|
| Rate for Payer: Cofinity Commercial |
$1,098.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.56
|
| Rate for Payer: Healthscope Commercial |
$1,149.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$957.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,085.41
|
| Rate for Payer: PHP Commercial |
$1,085.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$893.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,110.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$778.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,123.72
|
| Rate for Payer: UHC Core |
$1,066.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$957.71
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$8.76
|
|
|
Service Code
|
NDC 57896-649-16
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.34 |
| Max. Negotiated Rate |
$7.88 |
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: BCBS Trust/PPO |
$6.77
|
| Rate for Payer: BCN Commercial |
$6.77
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Cofinity Commercial |
$7.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.01
|
| Rate for Payer: Healthscope Commercial |
$7.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.45
|
| Rate for Payer: PHP Commercial |
$7.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.71
|
| Rate for Payer: UHC Core |
$7.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.57
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 9900-0003-40
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Aetna Commercial |
$0.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.55
|
| Rate for Payer: BCN Commercial |
$0.55
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cofinity Commercial |
$0.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.57
|
| Rate for Payer: Healthscope Commercial |
$0.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.60
|
| Rate for Payer: PHP Commercial |
$0.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.62
|
| Rate for Payer: UHC Core |
$0.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.53
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$10.51
|
|
|
Service Code
|
NDC 0904-0788-16
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$9.46 |
| Rate for Payer: Aetna Commercial |
$8.93
|
| Rate for Payer: BCBS Trust/PPO |
$8.12
|
| Rate for Payer: BCN Commercial |
$8.12
|
| Rate for Payer: Cash Price |
$8.41
|
| Rate for Payer: Cofinity Commercial |
$9.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.41
|
| Rate for Payer: Healthscope Commercial |
$9.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.93
|
| Rate for Payer: PHP Commercial |
$8.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.25
|
| Rate for Payer: UHC Core |
$8.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.88
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$8.64
|
|
|
Service Code
|
NDC 60687-429-76
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.27 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: BCBS Trust/PPO |
$6.68
|
| Rate for Payer: BCN Commercial |
$6.68
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.91
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.34
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.60
|
| Rate for Payer: UHC Core |
$7.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.48
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$8.64
|
|
|
Service Code
|
NDC 60687-429-45
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.27 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: BCBS Trust/PPO |
$6.68
|
| Rate for Payer: BCN Commercial |
$6.68
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.91
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.34
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.60
|
| Rate for Payer: UHC Core |
$7.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.48
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$8.64
|
|
|
Service Code
|
NDC 0121-0431-30
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.27 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: BCBS Trust/PPO |
$6.68
|
| Rate for Payer: BCN Commercial |
$6.68
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.91
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.34
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.60
|
| Rate for Payer: UHC Core |
$7.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.48
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$8.64
|
|
|
Service Code
|
NDC 9900-0001-48
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.27 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: BCBS Trust/PPO |
$6.68
|
| Rate for Payer: BCN Commercial |
$6.68
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.91
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.34
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.60
|
| Rate for Payer: UHC Core |
$7.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.48
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
NDC 1000670028
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.69 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: BCBS Trust/PPO |
$194.75
|
| Rate for Payer: BCN Commercial |
$194.75
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.20
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.76
|
| Rate for Payer: UHC Core |
$210.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.00
|
|
|
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 |
$13.08 |
| Max. Negotiated Rate |
$19.30 |
| Rate for Payer: Aetna Commercial |
$18.22
|
| Rate for Payer: BCBS Trust/PPO |
$16.57
|
| Rate for Payer: BCN Commercial |
$16.57
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cofinity Commercial |
$18.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.15
|
| Rate for Payer: Healthscope Commercial |
$19.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.22
|
| Rate for Payer: PHP Commercial |
$18.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.87
|
| Rate for Payer: UHC Core |
$17.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.08
|
|
|
MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$111.65
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
16162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.10 |
| Max. Negotiated Rate |
$100.48 |
| Rate for Payer: Aetna Commercial |
$94.90
|
| Rate for Payer: BCBS Trust/PPO |
$86.28
|
| Rate for Payer: BCN Commercial |
$86.28
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cofinity Commercial |
$96.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Healthscope Commercial |
$100.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.90
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.25
|
| Rate for Payer: UHC Core |
$93.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.74
|
|
|
MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$79.75
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117958
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.64 |
| Max. Negotiated Rate |
$71.78 |
| Rate for Payer: Aetna Commercial |
$67.79
|
| Rate for Payer: BCBS Trust/PPO |
$61.63
|
| Rate for Payer: BCN Commercial |
$61.63
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Cofinity Commercial |
$68.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.80
|
| Rate for Payer: Healthscope Commercial |
$71.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.79
|
| Rate for Payer: PHP Commercial |
$67.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.18
|
| Rate for Payer: UHC Core |
$66.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.81
|
|
|
MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$23.68
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.44 |
| Max. Negotiated Rate |
$21.31 |
| Rate for Payer: Aetna Commercial |
$20.13
|
| Rate for Payer: Aetna Commercial |
$52.01
|
| Rate for Payer: BCBS Trust/PPO |
$47.29
|
| Rate for Payer: BCBS Trust/PPO |
$18.30
|
| Rate for Payer: BCN Commercial |
$47.29
|
| Rate for Payer: BCN Commercial |
$18.30
|
| Rate for Payer: Cash Price |
$48.95
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Cofinity Commercial |
$52.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Healthscope Commercial |
$55.07
|
| Rate for Payer: Healthscope Commercial |
$21.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.01
|
| Rate for Payer: PHP Commercial |
$20.13
|
| Rate for Payer: PHP Commercial |
$52.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.85
|
| Rate for Payer: UHC Core |
$19.77
|
| Rate for Payer: UHC Core |
$51.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.89
|
|
|
MAGNESIUM SULFATE 4.06 MEQ/ML (50 %) INJECTION (TPN COMPONENT)
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
180902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.72 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Aetna Commercial |
$79.05
|
| Rate for Payer: BCBS Trust/PPO |
$71.87
|
| Rate for Payer: BCN Commercial |
$71.87
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cofinity Commercial |
$79.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.40
|
| Rate for Payer: Healthscope Commercial |
$83.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.05
|
| Rate for Payer: PHP Commercial |
$79.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.84
|
| Rate for Payer: UHC Core |
$77.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.75
|
|
|
MAGNESIUM SULFATE 4 GRAM/100 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$152.02
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4719
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.72 |
| Max. Negotiated Rate |
$136.82 |
| Rate for Payer: Aetna Commercial |
$129.22
|
| Rate for Payer: BCBS Trust/PPO |
$117.48
|
| Rate for Payer: BCN Commercial |
$117.48
|
| Rate for Payer: Cash Price |
$121.62
|
| Rate for Payer: Cofinity Commercial |
$130.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.62
|
| Rate for Payer: Healthscope Commercial |
$136.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.22
|
| Rate for Payer: PHP Commercial |
$129.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.78
|
| Rate for Payer: UHC Core |
$126.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.02
|
|
|
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION
|
Facility
|
IP
|
$16.30
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$14.67 |
| Rate for Payer: Aetna Commercial |
$13.86
|
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna Commercial |
$18.22
|
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: BCBS Trust/PPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$17.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.57
|
| Rate for Payer: BCBS Trust/PPO |
$11.88
|
| Rate for Payer: BCN Commercial |
$17.19
|
| Rate for Payer: BCN Commercial |
$16.57
|
| Rate for Payer: BCN Commercial |
$12.60
|
| Rate for Payer: BCN Commercial |
$11.88
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$18.44
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.04
|
| 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 |
$19.30
|
| Rate for Payer: Healthscope Commercial |
$14.67
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Healthscope Commercial |
$13.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.91
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: PHP Commercial |
$13.86
|
| Rate for Payer: PHP Commercial |
$18.22
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC Core |
$13.61
|
| Rate for Payer: UHC Core |
$18.58
|
| Rate for Payer: UHC Core |
$17.90
|
| Rate for Payer: UHC Core |
$12.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.08
|
|
|
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 |
$68.10 |
| Max. Negotiated Rate |
$100.48 |
| Rate for Payer: Aetna Commercial |
$94.90
|
| Rate for Payer: BCBS Trust/PPO |
$86.28
|
| Rate for Payer: BCN Commercial |
$86.28
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cofinity Commercial |
$96.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Healthscope Commercial |
$100.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.90
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.25
|
| Rate for Payer: UHC Core |
$93.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.74
|
|
|
MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST; BILATERAL
|
Facility
|
OP
|
$264.89
|
|
|
Service Code
|
CPT C8908
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$252.28 |
| Max. Negotiated Rate |
$264.89 |
| Rate for Payer: BCBS Complete |
$264.89
|
| Rate for Payer: Mclaren Medicaid |
$252.28
|
| Rate for Payer: Meridian Medicaid |
$264.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.28
|
|
|
MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION OR OTHER FIXATION DEVICES)
|
Facility
|
OP
|
$1,107.03
|
|
|
Service Code
|
CPT 27570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,054.31 |
| Max. Negotiated Rate |
$1,107.03 |
| Rate for Payer: BCBS Complete |
$1,107.03
|
| Rate for Payer: Mclaren Medicaid |
$1,054.31
|
| Rate for Payer: Meridian Medicaid |
$1,107.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,054.31
|
|
|
MANIPULATION UNDER ANESTHESIA, SHOULDER JOINT, INCLUDING APPLICATION OF FIXATION APPARATUS (DISLOCATION EXCLUDED)
|
Facility
|
OP
|
$1,107.03
|
|
|
Service Code
|
CPT 23700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,054.31 |
| Max. Negotiated Rate |
$1,107.03 |
| Rate for Payer: BCBS Complete |
$1,107.03
|
| Rate for Payer: Mclaren Medicaid |
$1,054.31
|
| Rate for Payer: Meridian Medicaid |
$1,107.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,054.31
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$94.92
|
|
|
Service Code
|
NDC 0338-0357-02
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.89 |
| Max. Negotiated Rate |
$85.43 |
| Rate for Payer: Aetna Commercial |
$80.68
|
| Rate for Payer: BCBS Trust/PPO |
$73.35
|
| Rate for Payer: BCN Commercial |
$73.35
|
| Rate for Payer: Cash Price |
$75.94
|
| Rate for Payer: Cofinity Commercial |
$81.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.94
|
| Rate for Payer: Healthscope Commercial |
$85.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.68
|
| Rate for Payer: PHP Commercial |
$80.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.53
|
| Rate for Payer: UHC Core |
$79.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.19
|
|
|
MARSUPIALIZATION OF BARTHOLIN'S GLAND CYST
|
Facility
|
OP
|
$2,153.41
|
|
|
Service Code
|
CPT 56440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,050.87 |
| Max. Negotiated Rate |
$2,153.41 |
| Rate for Payer: BCBS Complete |
$2,153.41
|
| Rate for Payer: Mclaren Medicaid |
$2,050.87
|
| Rate for Payer: Meridian Medicaid |
$2,153.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,050.87
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$3.23
|
|
|
Service Code
|
NDC 50268-522-11
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: BCBS Trust/PPO |
$2.50
|
| Rate for Payer: BCN Commercial |
$2.50
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$2.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.58
|
| Rate for Payer: Healthscope Commercial |
$2.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.75
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.84
|
| Rate for Payer: UHC Core |
$2.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.42
|
|
