|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$16,541.52
|
|
|
Service Code
|
MSDRG 822
|
| Min. Negotiated Rate |
$9,903.52 |
| Max. Negotiated Rate |
$16,541.52 |
| Rate for Payer: Aetna Medicare |
$10,424.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,030.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,030.95
|
| Rate for Payer: BCBS MAPPO |
$10,424.76
|
| Rate for Payer: BCN Medicare Advantage |
$10,424.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,424.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,424.76
|
| Rate for Payer: Mclaren Medicare |
$10,424.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,946.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,988.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,467.24
|
| Rate for Payer: PACE Medicare |
$9,903.52
|
| Rate for Payer: PACE SWMI |
$10,424.76
|
| Rate for Payer: PHP Commercial |
$11,467.24
|
| Rate for Payer: PHP Medicare Advantage |
$10,424.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16,541.52
|
| Rate for Payer: Priority Health Medicare |
$10,424.76
|
| Rate for Payer: Priority Health Narrow Network |
$13,233.21
|
| Rate for Payer: Railroad Medicare Medicare |
$10,424.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,424.76
|
| Rate for Payer: UHC Exchange |
$16,158.38
|
| Rate for Payer: UHCCP DNSP |
$10,424.76
|
| Rate for Payer: VA VA |
$10,424.76
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC
|
Facility
|
IP
|
$22,413.48
|
|
|
Service Code
|
MSDRG 841
|
| Min. Negotiated Rate |
$12,827.44 |
| Max. Negotiated Rate |
$22,413.48 |
| Rate for Payer: Aetna Medicare |
$13,502.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,878.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,878.21
|
| Rate for Payer: BCBS MAPPO |
$13,502.57
|
| Rate for Payer: BCN Medicare Advantage |
$13,502.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,502.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,502.57
|
| Rate for Payer: Mclaren Medicare |
$13,502.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,177.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,527.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,852.83
|
| Rate for Payer: PACE Medicare |
$12,827.44
|
| Rate for Payer: PACE SWMI |
$13,502.57
|
| Rate for Payer: PHP Commercial |
$14,852.83
|
| Rate for Payer: PHP Medicare Advantage |
$13,502.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22,413.48
|
| Rate for Payer: Priority Health Medicare |
$13,502.57
|
| Rate for Payer: Priority Health Narrow Network |
$17,930.78
|
| Rate for Payer: Railroad Medicare Medicare |
$13,502.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,502.57
|
| Rate for Payer: UHC Exchange |
$20,928.98
|
| Rate for Payer: UHCCP DNSP |
$13,502.57
|
| Rate for Payer: VA VA |
$13,502.57
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC
|
Facility
|
IP
|
$44,443.64
|
|
|
Service Code
|
MSDRG 840
|
| Min. Negotiated Rate |
$23,797.27 |
| Max. Negotiated Rate |
$44,443.64 |
| Rate for Payer: Aetna Medicare |
$25,049.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,312.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,312.20
|
| Rate for Payer: BCBS MAPPO |
$25,049.76
|
| Rate for Payer: BCN Medicare Advantage |
$25,049.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,049.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$25,049.76
|
| Rate for Payer: Mclaren Medicare |
$25,049.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26,302.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,807.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$27,554.74
|
| Rate for Payer: PACE Medicare |
$23,797.27
|
| Rate for Payer: PACE SWMI |
$25,049.76
|
| Rate for Payer: PHP Commercial |
$27,554.74
|
| Rate for Payer: PHP Medicare Advantage |
$25,049.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$44,443.64
|
| Rate for Payer: Priority Health Medicare |
$25,049.76
|
| Rate for Payer: Priority Health Narrow Network |
$35,554.92
|
| Rate for Payer: Railroad Medicare Medicare |
$25,049.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25,049.76
|
| Rate for Payer: UHC Exchange |
$38,827.13
|
| Rate for Payer: UHCCP DNSP |
$25,049.76
|
| Rate for Payer: VA VA |
$25,049.76
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC
|
Facility
|
IP
|
$31,126.63
|
|
|
Service Code
|
MSDRG 824
|
| Min. Negotiated Rate |
$17,166.11 |
| Max. Negotiated Rate |
$31,126.63 |
| Rate for Payer: Aetna Medicare |
$18,069.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,586.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,586.99
|
| Rate for Payer: BCBS MAPPO |
$18,069.59
|
| Rate for Payer: BCN Medicare Advantage |
$18,069.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,069.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,069.59
|
| Rate for Payer: Mclaren Medicare |
$18,069.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,973.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,780.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,876.55
|
| Rate for Payer: PACE Medicare |
$17,166.11
|
| Rate for Payer: PACE SWMI |
$18,069.59
|
| Rate for Payer: PHP Commercial |
$19,876.55
|
| Rate for Payer: PHP Medicare Advantage |
$18,069.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$31,126.63
|
| Rate for Payer: Priority Health Medicare |
$18,069.59
|
| Rate for Payer: Priority Health Narrow Network |
$24,901.30
|
| Rate for Payer: Railroad Medicare Medicare |
$18,069.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,069.59
|
| Rate for Payer: UHC Exchange |
$28,007.86
|
| Rate for Payer: UHCCP DNSP |
$18,069.59
|
| Rate for Payer: VA VA |
$18,069.59
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC
|
Facility
|
IP
|
$62,989.65
|
|
|
Service Code
|
MSDRG 823
|
| Min. Negotiated Rate |
$33,032.19 |
| Max. Negotiated Rate |
$62,989.65 |
| Rate for Payer: Aetna Medicare |
$34,770.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43,463.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43,463.41
|
| Rate for Payer: BCBS MAPPO |
$34,770.73
|
| Rate for Payer: BCN Medicare Advantage |
$34,770.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34,770.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$34,770.73
|
| Rate for Payer: Mclaren Medicare |
$34,770.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36,509.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39,986.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$38,247.80
|
| Rate for Payer: PACE Medicare |
$33,032.19
|
| Rate for Payer: PACE SWMI |
$34,770.73
|
| Rate for Payer: PHP Commercial |
$38,247.80
|
| Rate for Payer: PHP Medicare Advantage |
$34,770.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$62,989.65
|
| Rate for Payer: Priority Health Medicare |
$34,770.73
|
| Rate for Payer: Priority Health Narrow Network |
$50,391.72
|
| Rate for Payer: Railroad Medicare Medicare |
$34,770.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$34,770.73
|
| Rate for Payer: UHC Exchange |
$53,894.63
|
| Rate for Payer: UHCCP DNSP |
$34,770.73
|
| Rate for Payer: VA VA |
$34,770.73
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$18,539.14
|
|
|
Service Code
|
MSDRG 825
|
| Min. Negotiated Rate |
$10,898.24 |
| Max. Negotiated Rate |
$18,539.14 |
| Rate for Payer: Aetna Medicare |
$11,471.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,339.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,339.79
|
| Rate for Payer: BCBS MAPPO |
$11,471.83
|
| Rate for Payer: BCN Medicare Advantage |
$11,471.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,471.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,471.83
|
| Rate for Payer: Mclaren Medicare |
$11,471.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,045.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,192.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,619.01
|
| Rate for Payer: PACE Medicare |
$10,898.24
|
| Rate for Payer: PACE SWMI |
$11,471.83
|
| Rate for Payer: PHP Commercial |
$12,619.01
|
| Rate for Payer: PHP Medicare Advantage |
$11,471.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18,539.14
|
| Rate for Payer: Priority Health Medicare |
$11,471.83
|
| Rate for Payer: Priority Health Narrow Network |
$14,831.31
|
| Rate for Payer: Railroad Medicare Medicare |
$11,471.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,471.83
|
| Rate for Payer: UHC Exchange |
$17,781.34
|
| Rate for Payer: UHCCP DNSP |
$11,471.83
|
| Rate for Payer: VA VA |
$11,471.83
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC
|
Facility
|
IP
|
$13,997.43
|
|
|
Service Code
|
MSDRG 842
|
| Min. Negotiated Rate |
$8,579.07 |
| Max. Negotiated Rate |
$13,997.43 |
| Rate for Payer: Aetna Medicare |
$9,030.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,288.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,288.25
|
| Rate for Payer: BCBS MAPPO |
$9,030.60
|
| Rate for Payer: BCN Medicare Advantage |
$9,030.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,030.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,030.60
|
| Rate for Payer: Mclaren Medicare |
$9,030.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,482.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,385.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,933.66
|
| Rate for Payer: PACE Medicare |
$8,579.07
|
| Rate for Payer: PACE SWMI |
$9,030.60
|
| Rate for Payer: PHP Commercial |
$9,933.66
|
| Rate for Payer: PHP Medicare Advantage |
$9,030.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13,881.68
|
| Rate for Payer: Priority Health Medicare |
$9,030.60
|
| Rate for Payer: Priority Health Narrow Network |
$11,105.35
|
| Rate for Payer: Railroad Medicare Medicare |
$9,030.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,030.60
|
| Rate for Payer: UHC Exchange |
$13,997.43
|
| Rate for Payer: UHCCP DNSP |
$9,030.60
|
| Rate for Payer: VA VA |
$9,030.60
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$15,073.32
|
|
|
Service Code
|
APR-DRG 6913
|
| Min. Negotiated Rate |
$13,628.08 |
| Max. Negotiated Rate |
$15,073.32 |
| Rate for Payer: BCBS Complete |
$15,073.32
|
| Rate for Payer: Mclaren Medicaid |
$14,355.54
|
| Rate for Payer: Meridian Medicaid |
$15,073.32
|
| Rate for Payer: PHP Medicaid |
$13,628.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,355.54
|
| Rate for Payer: UHC Medicaid |
$14,355.54
|
| Rate for Payer: UHCCP Medicaid |
$14,355.54
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$20,178.95
|
|
|
Service Code
|
APR-DRG 6914
|
| Min. Negotiated Rate |
$18,244.19 |
| Max. Negotiated Rate |
$20,178.95 |
| Rate for Payer: BCBS Complete |
$20,178.95
|
| Rate for Payer: Mclaren Medicaid |
$19,218.05
|
| Rate for Payer: Meridian Medicaid |
$20,178.95
|
| Rate for Payer: PHP Medicaid |
$18,244.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,218.05
|
| Rate for Payer: UHC Medicaid |
$19,218.05
|
| Rate for Payer: UHCCP Medicaid |
$19,218.05
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$7,804.77
|
|
|
Service Code
|
APR-DRG 6912
|
| Min. Negotiated Rate |
$7,056.45 |
| Max. Negotiated Rate |
$7,804.77 |
| Rate for Payer: BCBS Complete |
$7,804.77
|
| Rate for Payer: Mclaren Medicaid |
$7,433.12
|
| Rate for Payer: Meridian Medicaid |
$7,804.77
|
| Rate for Payer: PHP Medicaid |
$7,056.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,433.12
|
| Rate for Payer: UHC Medicaid |
$7,433.12
|
| Rate for Payer: UHCCP Medicaid |
$7,433.12
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$4,614.64
|
|
|
Service Code
|
APR-DRG 6911
|
| Min. Negotiated Rate |
$4,172.18 |
| Max. Negotiated Rate |
$4,614.64 |
| Rate for Payer: BCBS Complete |
$4,614.64
|
| Rate for Payer: Mclaren Medicaid |
$4,394.89
|
| Rate for Payer: Meridian Medicaid |
$4,614.64
|
| Rate for Payer: PHP Medicaid |
$4,172.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,394.89
|
| Rate for Payer: UHC Medicaid |
$4,394.89
|
| Rate for Payer: UHCCP Medicaid |
$4,394.89
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
OP
|
$17.32
|
|
|
Service Code
|
NDC 71399005101
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna Commercial |
$15.58
|
| Rate for Payer: Aetna Medicare |
$6.41
|
| Rate for Payer: ASR ASR |
$16.80
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: BCBS Trust/PPO |
$14.28
|
| Rate for Payer: BCN Commercial |
$14.28
|
| Rate for Payer: Cash Price |
$13.85
|
| Rate for Payer: Cofinity Commercial |
$16.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.85
|
| Rate for Payer: Healthscope Commercial |
$16.80
|
| Rate for Payer: Healthscope Whirlpool |
$17.32
|
| Rate for Payer: Mclaren Commercial |
$15.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: Nomi Health Commercial |
$14.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15.17
|
| Rate for Payer: Priority Health Narrow Network |
$12.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.24
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
IP
|
$17.32
|
|
|
Service Code
|
NDC 71399788901
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.99 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna Commercial |
$15.58
|
| Rate for Payer: ASR ASR |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$14.22
|
| Rate for Payer: BCN Commercial |
$14.22
|
| Rate for Payer: Cash Price |
$13.85
|
| Rate for Payer: Cofinity Commercial |
$16.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.85
|
| Rate for Payer: Healthscope Commercial |
$16.80
|
| Rate for Payer: Healthscope Whirlpool |
$17.32
|
| Rate for Payer: Mclaren Commercial |
$15.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: Nomi Health Commercial |
$14.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.24
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
IP
|
$17.32
|
|
|
Service Code
|
NDC 71399005101
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.99 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna Commercial |
$15.58
|
| Rate for Payer: ASR ASR |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$14.22
|
| Rate for Payer: BCN Commercial |
$14.22
|
| Rate for Payer: Cash Price |
$13.85
|
| Rate for Payer: Cofinity Commercial |
$16.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.85
|
| Rate for Payer: Healthscope Commercial |
$16.80
|
| Rate for Payer: Healthscope Whirlpool |
$17.32
|
| Rate for Payer: Mclaren Commercial |
$15.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: Nomi Health Commercial |
$14.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.24
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
OP
|
$17.32
|
|
|
Service Code
|
NDC 71399788901
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna Commercial |
$15.58
|
| Rate for Payer: Aetna Medicare |
$6.41
|
| Rate for Payer: ASR ASR |
$16.80
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: BCBS Trust/PPO |
$14.28
|
| Rate for Payer: BCN Commercial |
$14.28
|
| Rate for Payer: Cash Price |
$13.85
|
| Rate for Payer: Cofinity Commercial |
$16.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.85
|
| Rate for Payer: Healthscope Commercial |
$16.80
|
| Rate for Payer: Healthscope Whirlpool |
$17.32
|
| Rate for Payer: Mclaren Commercial |
$15.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: Nomi Health Commercial |
$14.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15.17
|
| Rate for Payer: Priority Health Narrow Network |
$12.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.24
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 9900000340
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Aetna Commercial |
$0.63
|
| Rate for Payer: ASR ASR |
$0.68
|
| Rate for Payer: BCBS Trust/PPO |
$0.58
|
| Rate for Payer: BCN Commercial |
$0.58
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cofinity Commercial |
$0.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.56
|
| Rate for Payer: Healthscope Commercial |
$0.68
|
| Rate for Payer: Healthscope Whirlpool |
$0.71
|
| Rate for Payer: Mclaren Commercial |
$0.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.60
|
| Rate for Payer: Nomi Health Commercial |
$0.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.62
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
NDC 904078816
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna Commercial |
$12.60
|
| Rate for Payer: ASR ASR |
$13.58
|
| Rate for Payer: BCBS Trust/PPO |
$11.50
|
| Rate for Payer: BCN Commercial |
$11.50
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Healthscope Commercial |
$13.58
|
| Rate for Payer: Healthscope Whirlpool |
$14.00
|
| Rate for Payer: Mclaren Commercial |
$12.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.90
|
| Rate for Payer: Nomi Health Commercial |
$11.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.32
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
NDC 904078816
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna Commercial |
$12.60
|
| Rate for Payer: Aetna Medicare |
$5.18
|
| Rate for Payer: ASR ASR |
$13.58
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Trust/PPO |
$11.54
|
| Rate for Payer: BCN Commercial |
$11.54
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Healthscope Commercial |
$13.58
|
| Rate for Payer: Healthscope Whirlpool |
$14.00
|
| Rate for Payer: Mclaren Commercial |
$12.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.90
|
| Rate for Payer: Nomi Health Commercial |
$11.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12.27
|
| Rate for Payer: Priority Health Narrow Network |
$9.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.32
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 9900000340
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Aetna Commercial |
$0.63
|
| Rate for Payer: Aetna Medicare |
$0.26
|
| Rate for Payer: ASR ASR |
$0.68
|
| Rate for Payer: BCBS Complete |
$0.28
|
| Rate for Payer: BCBS Trust/PPO |
$0.58
|
| Rate for Payer: BCN Commercial |
$0.58
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cofinity Commercial |
$0.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.56
|
| Rate for Payer: Healthscope Commercial |
$0.68
|
| Rate for Payer: Healthscope Whirlpool |
$0.71
|
| Rate for Payer: Mclaren Commercial |
$0.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.60
|
| Rate for Payer: Nomi Health Commercial |
$0.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.62
|
| Rate for Payer: Priority Health Narrow Network |
$0.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.62
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
OP
|
$107.80
|
|
|
Service Code
|
NDC 64980033901
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.89 |
| Max. Negotiated Rate |
$107.80 |
| Rate for Payer: Aetna Commercial |
$97.02
|
| Rate for Payer: Aetna Medicare |
$39.89
|
| Rate for Payer: ASR ASR |
$104.57
|
| Rate for Payer: BCBS Complete |
$43.12
|
| Rate for Payer: BCBS Trust/PPO |
$88.88
|
| Rate for Payer: BCN Commercial |
$88.88
|
| Rate for Payer: Cash Price |
$86.24
|
| Rate for Payer: Cofinity Commercial |
$101.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.24
|
| Rate for Payer: Healthscope Commercial |
$104.57
|
| Rate for Payer: Healthscope Whirlpool |
$107.80
|
| Rate for Payer: Mclaren Commercial |
$97.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.63
|
| Rate for Payer: Nomi Health Commercial |
$88.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$94.45
|
| Rate for Payer: Priority Health Narrow Network |
$75.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.86
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
OP
|
$1.08
|
|
|
Service Code
|
NDC 64980033990
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna Commercial |
$0.97
|
| Rate for Payer: Aetna Medicare |
$0.40
|
| Rate for Payer: ASR ASR |
$1.05
|
| Rate for Payer: BCBS Complete |
$0.43
|
| Rate for Payer: BCBS Trust/PPO |
$0.89
|
| Rate for Payer: BCN Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cofinity Commercial |
$1.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.86
|
| Rate for Payer: Healthscope Commercial |
$1.05
|
| Rate for Payer: Healthscope Whirlpool |
$1.08
|
| Rate for Payer: Mclaren Commercial |
$0.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.92
|
| Rate for Payer: Nomi Health Commercial |
$0.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.94
|
| Rate for Payer: Priority Health Narrow Network |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.95
|
|
|
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 |
$80.85 |
| Max. Negotiated Rate |
$107.80 |
| Rate for Payer: Aetna Commercial |
$97.02
|
| Rate for Payer: ASR ASR |
$104.57
|
| Rate for Payer: BCBS Trust/PPO |
$88.53
|
| Rate for Payer: BCN Commercial |
$88.53
|
| Rate for Payer: Cash Price |
$86.24
|
| Rate for Payer: Cofinity Commercial |
$101.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.24
|
| Rate for Payer: Healthscope Commercial |
$104.57
|
| Rate for Payer: Healthscope Whirlpool |
$107.80
|
| Rate for Payer: Mclaren Commercial |
$97.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.63
|
| Rate for Payer: Nomi Health Commercial |
$88.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.86
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
IP
|
$1.08
|
|
|
Service Code
|
NDC 64980033990
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna Commercial |
$0.97
|
| Rate for Payer: ASR ASR |
$1.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.89
|
| Rate for Payer: BCN Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cofinity Commercial |
$1.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.86
|
| Rate for Payer: Healthscope Commercial |
$1.05
|
| Rate for Payer: Healthscope Whirlpool |
$1.08
|
| Rate for Payer: Mclaren Commercial |
$0.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.92
|
| Rate for Payer: Nomi Health Commercial |
$0.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.95
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
NDC 10006070028
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.72 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: Aetna Medicare |
$94.72
|
| Rate for Payer: ASR ASR |
$248.32
|
| Rate for Payer: BCBS Complete |
$102.40
|
| Rate for Payer: BCBS Trust/PPO |
$211.07
|
| Rate for Payer: BCN Commercial |
$211.07
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cofinity Commercial |
$240.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.80
|
| Rate for Payer: Healthscope Commercial |
$248.32
|
| Rate for Payer: Healthscope Whirlpool |
$256.00
|
| Rate for Payer: Mclaren Commercial |
$230.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.60
|
| Rate for Payer: Nomi Health Commercial |
$209.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$224.31
|
| Rate for Payer: Priority Health Narrow Network |
$179.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.28
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
NDC 10006070028
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: ASR ASR |
$248.32
|
| Rate for Payer: BCBS Trust/PPO |
$210.23
|
| Rate for Payer: BCN Commercial |
$210.23
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cofinity Commercial |
$240.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.80
|
| Rate for Payer: Healthscope Commercial |
$248.32
|
| Rate for Payer: Healthscope Whirlpool |
$256.00
|
| Rate for Payer: Mclaren Commercial |
$230.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.60
|
| Rate for Payer: Nomi Health Commercial |
$209.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.28
|
|
