|
MAGNESIUM SULFATE 0.5 GRAM/ML (50 %) INJECTION (CODE)
|
Facility
|
OP
|
$40.25
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
163706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$40.25 |
| Rate for Payer: Aetna Commercial |
$36.23
|
| Rate for Payer: Aetna Commercial |
$19.29
|
| Rate for Payer: Aetna Medicare |
$7.93
|
| Rate for Payer: Aetna Medicare |
$14.89
|
| Rate for Payer: ASR ASR |
$39.04
|
| Rate for Payer: ASR ASR |
$20.79
|
| Rate for Payer: BCBS Complete |
$8.57
|
| Rate for Payer: BCBS Complete |
$16.10
|
| Rate for Payer: BCBS Trust/PPO |
$33.19
|
| Rate for Payer: BCBS Trust/PPO |
$17.67
|
| Rate for Payer: BCN Commercial |
$17.67
|
| Rate for Payer: BCN Commercial |
$33.19
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$20.15
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$39.04
|
| Rate for Payer: Healthscope Commercial |
$20.79
|
| Rate for Payer: Healthscope Whirlpool |
$40.25
|
| Rate for Payer: Healthscope Whirlpool |
$21.43
|
| Rate for Payer: Mclaren Commercial |
$36.23
|
| Rate for Payer: Mclaren Commercial |
$19.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.21
|
| Rate for Payer: Nomi Health Commercial |
$17.57
|
| Rate for Payer: Nomi Health Commercial |
$33.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.42
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.42
|
|
|
MAGNESIUM SULFATE 0.5 GRAM/ML (50 %) INJECTION (CODE)
|
Facility
|
IP
|
$21.43
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
163706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$21.43 |
| Rate for Payer: Aetna Commercial |
$19.29
|
| Rate for Payer: Aetna Commercial |
$36.23
|
| Rate for Payer: ASR ASR |
$39.04
|
| Rate for Payer: ASR ASR |
$20.79
|
| Rate for Payer: BCBS Trust/PPO |
$33.05
|
| Rate for Payer: BCBS Trust/PPO |
$17.60
|
| Rate for Payer: BCN Commercial |
$33.05
|
| Rate for Payer: BCN Commercial |
$17.60
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$20.15
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$20.79
|
| Rate for Payer: Healthscope Commercial |
$39.04
|
| Rate for Payer: Healthscope Whirlpool |
$40.25
|
| Rate for Payer: Healthscope Whirlpool |
$21.43
|
| Rate for Payer: Mclaren Commercial |
$36.23
|
| Rate for Payer: Mclaren Commercial |
$19.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.22
|
| Rate for Payer: Nomi Health Commercial |
$33.01
|
| Rate for Payer: Nomi Health Commercial |
$17.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.42
|
|
|
MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$46.26
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
16162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.69 |
| Max. Negotiated Rate |
$46.26 |
| Rate for Payer: Aetna Commercial |
$41.63
|
| Rate for Payer: Aetna Commercial |
$75.51
|
| Rate for Payer: Aetna Commercial |
$44.34
|
| Rate for Payer: ASR ASR |
$81.39
|
| Rate for Payer: ASR ASR |
$44.87
|
| Rate for Payer: ASR ASR |
$47.79
|
| Rate for Payer: BCBS Trust/PPO |
$68.90
|
| Rate for Payer: BCBS Trust/PPO |
$37.98
|
| Rate for Payer: BCBS Trust/PPO |
$40.46
|
| Rate for Payer: BCN Commercial |
$40.46
|
| Rate for Payer: BCN Commercial |
$37.98
|
| Rate for Payer: BCN Commercial |
$68.90
|
| Rate for Payer: Cash Price |
$67.12
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$39.42
|
| Rate for Payer: Cofinity Commercial |
$43.48
|
| Rate for Payer: Cofinity Commercial |
$46.31
|
| Rate for Payer: Cofinity Commercial |
$78.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.42
|
| Rate for Payer: Healthscope Commercial |
$47.79
|
| Rate for Payer: Healthscope Commercial |
$44.87
|
| Rate for Payer: Healthscope Commercial |
$81.39
|
| Rate for Payer: Healthscope Whirlpool |
$49.27
|
| Rate for Payer: Healthscope Whirlpool |
$83.90
|
| Rate for Payer: Healthscope Whirlpool |
$46.26
|
| Rate for Payer: Mclaren Commercial |
$44.34
|
| Rate for Payer: Mclaren Commercial |
$41.63
|
| Rate for Payer: Mclaren Commercial |
$75.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.32
|
| Rate for Payer: Nomi Health Commercial |
$40.40
|
| Rate for Payer: Nomi Health Commercial |
$37.93
|
| Rate for Payer: Nomi Health Commercial |
$68.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.70
|
|
|
MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$46.26
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
16162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$46.26 |
| Rate for Payer: Aetna Commercial |
$41.63
|
| Rate for Payer: Aetna Commercial |
$44.34
|
| Rate for Payer: Aetna Commercial |
$75.51
|
| Rate for Payer: Aetna Medicare |
$18.23
|
| Rate for Payer: Aetna Medicare |
$17.11
|
| Rate for Payer: Aetna Medicare |
$31.04
|
| Rate for Payer: ASR ASR |
$81.39
|
| Rate for Payer: ASR ASR |
$44.87
|
| Rate for Payer: ASR ASR |
$47.79
|
| Rate for Payer: BCBS Complete |
$18.50
|
| Rate for Payer: BCBS Complete |
$33.56
|
| Rate for Payer: BCBS Complete |
$19.71
|
| Rate for Payer: BCBS Trust/PPO |
$38.14
|
| Rate for Payer: BCBS Trust/PPO |
$40.62
|
| Rate for Payer: BCBS Trust/PPO |
$69.18
|
| Rate for Payer: BCN Commercial |
$38.14
|
| Rate for Payer: BCN Commercial |
$40.62
|
| Rate for Payer: BCN Commercial |
$69.18
|
| Rate for Payer: Cash Price |
$39.42
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$39.42
|
| Rate for Payer: Cash Price |
$67.12
|
| Rate for Payer: Cash Price |
$67.12
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cofinity Commercial |
$46.31
|
| Rate for Payer: Cofinity Commercial |
$43.48
|
| Rate for Payer: Cofinity Commercial |
$78.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.42
|
| Rate for Payer: Healthscope Commercial |
$81.39
|
| Rate for Payer: Healthscope Commercial |
$44.87
|
| Rate for Payer: Healthscope Commercial |
$47.79
|
| Rate for Payer: Healthscope Whirlpool |
$49.27
|
| Rate for Payer: Healthscope Whirlpool |
$46.26
|
| Rate for Payer: Healthscope Whirlpool |
$83.90
|
| Rate for Payer: Mclaren Commercial |
$75.51
|
| Rate for Payer: Mclaren Commercial |
$44.34
|
| Rate for Payer: Mclaren Commercial |
$41.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.32
|
| Rate for Payer: Nomi Health Commercial |
$68.80
|
| Rate for Payer: Nomi Health Commercial |
$37.93
|
| Rate for Payer: Nomi Health Commercial |
$40.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.42
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.70
|
|
|
MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$55.83
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117958
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$55.83 |
| Rate for Payer: Aetna Commercial |
$50.24
|
| Rate for Payer: Aetna Medicare |
$20.66
|
| Rate for Payer: ASR ASR |
$54.15
|
| Rate for Payer: BCBS Complete |
$22.33
|
| Rate for Payer: BCBS Trust/PPO |
$46.03
|
| Rate for Payer: BCN Commercial |
$46.03
|
| Rate for Payer: Cash Price |
$44.66
|
| Rate for Payer: Cash Price |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$52.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.66
|
| Rate for Payer: Healthscope Commercial |
$54.15
|
| Rate for Payer: Healthscope Whirlpool |
$55.83
|
| Rate for Payer: Mclaren Commercial |
$50.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.45
|
| Rate for Payer: Nomi Health Commercial |
$45.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.42
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.13
|
|
|
MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$55.83
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117958
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.87 |
| Max. Negotiated Rate |
$55.83 |
| Rate for Payer: Aetna Commercial |
$50.24
|
| Rate for Payer: ASR ASR |
$54.15
|
| Rate for Payer: BCBS Trust/PPO |
$45.84
|
| Rate for Payer: BCN Commercial |
$45.84
|
| Rate for Payer: Cash Price |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$52.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.66
|
| Rate for Payer: Healthscope Commercial |
$54.15
|
| Rate for Payer: Healthscope Whirlpool |
$55.83
|
| Rate for Payer: Mclaren Commercial |
$50.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.45
|
| Rate for Payer: Nomi Health Commercial |
$45.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.13
|
|
|
MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$21.83
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$21.83 |
| Rate for Payer: Aetna Commercial |
$19.65
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: ASR ASR |
$28.13
|
| Rate for Payer: ASR ASR |
$21.18
|
| Rate for Payer: ASR ASR |
$23.33
|
| Rate for Payer: BCBS Trust/PPO |
$23.81
|
| Rate for Payer: BCBS Trust/PPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$19.75
|
| Rate for Payer: BCN Commercial |
$19.75
|
| Rate for Payer: BCN Commercial |
$17.93
|
| Rate for Payer: BCN Commercial |
$23.81
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Cofinity Commercial |
$22.61
|
| Rate for Payer: Cofinity Commercial |
$27.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$23.33
|
| Rate for Payer: Healthscope Commercial |
$21.18
|
| Rate for Payer: Healthscope Commercial |
$28.13
|
| Rate for Payer: Healthscope Whirlpool |
$24.05
|
| Rate for Payer: Healthscope Whirlpool |
$29.00
|
| Rate for Payer: Healthscope Whirlpool |
$21.83
|
| Rate for Payer: Mclaren Commercial |
$21.64
|
| Rate for Payer: Mclaren Commercial |
$19.65
|
| Rate for Payer: Mclaren Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.56
|
| Rate for Payer: Nomi Health Commercial |
$19.72
|
| Rate for Payer: Nomi Health Commercial |
$17.90
|
| Rate for Payer: Nomi Health Commercial |
$23.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.21
|
|
|
MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$21.83
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$21.83 |
| Rate for Payer: Aetna Commercial |
$19.65
|
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Medicare |
$8.90
|
| Rate for Payer: Aetna Medicare |
$8.08
|
| Rate for Payer: Aetna Medicare |
$10.73
|
| Rate for Payer: ASR ASR |
$28.13
|
| Rate for Payer: ASR ASR |
$21.18
|
| Rate for Payer: ASR ASR |
$23.33
|
| Rate for Payer: BCBS Complete |
$8.73
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS Trust/PPO |
$18.00
|
| Rate for Payer: BCBS Trust/PPO |
$19.83
|
| Rate for Payer: BCBS Trust/PPO |
$23.91
|
| Rate for Payer: BCN Commercial |
$18.00
|
| Rate for Payer: BCN Commercial |
$19.83
|
| Rate for Payer: BCN Commercial |
$23.91
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$22.61
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Cofinity Commercial |
$27.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$28.13
|
| Rate for Payer: Healthscope Commercial |
$21.18
|
| Rate for Payer: Healthscope Commercial |
$23.33
|
| Rate for Payer: Healthscope Whirlpool |
$24.05
|
| Rate for Payer: Healthscope Whirlpool |
$21.83
|
| Rate for Payer: Healthscope Whirlpool |
$29.00
|
| Rate for Payer: Mclaren Commercial |
$26.10
|
| Rate for Payer: Mclaren Commercial |
$21.64
|
| Rate for Payer: Mclaren Commercial |
$19.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.56
|
| Rate for Payer: Nomi Health Commercial |
$23.78
|
| Rate for Payer: Nomi Health Commercial |
$17.90
|
| Rate for Payer: Nomi Health Commercial |
$19.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.42
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.21
|
|
|
MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION
|
Facility
|
IP
|
$15.52
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.64 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Aetna Commercial |
$13.96
|
| Rate for Payer: Aetna Commercial |
$21.01
|
| Rate for Payer: Aetna Commercial |
$19.29
|
| Rate for Payer: ASR ASR |
$22.64
|
| Rate for Payer: ASR ASR |
$15.05
|
| Rate for Payer: ASR ASR |
$20.79
|
| Rate for Payer: BCBS Trust/PPO |
$19.17
|
| Rate for Payer: BCBS Trust/PPO |
$12.74
|
| Rate for Payer: BCBS Trust/PPO |
$17.60
|
| Rate for Payer: BCN Commercial |
$17.60
|
| Rate for Payer: BCN Commercial |
$12.74
|
| Rate for Payer: BCN Commercial |
$19.17
|
| Rate for Payer: Cash Price |
$18.68
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$14.58
|
| Rate for Payer: Cofinity Commercial |
$20.15
|
| Rate for Payer: Cofinity Commercial |
$21.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$20.79
|
| Rate for Payer: Healthscope Commercial |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$22.64
|
| Rate for Payer: Healthscope Whirlpool |
$21.43
|
| Rate for Payer: Healthscope Whirlpool |
$23.34
|
| Rate for Payer: Healthscope Whirlpool |
$15.52
|
| Rate for Payer: Mclaren Commercial |
$19.29
|
| Rate for Payer: Mclaren Commercial |
$13.96
|
| Rate for Payer: Mclaren Commercial |
$21.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.19
|
| Rate for Payer: Nomi Health Commercial |
$17.57
|
| Rate for Payer: Nomi Health Commercial |
$12.72
|
| Rate for Payer: Nomi Health Commercial |
$19.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.65
|
|
|
MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION
|
Facility
|
OP
|
$15.52
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Aetna Commercial |
$13.96
|
| Rate for Payer: Aetna Commercial |
$19.29
|
| Rate for Payer: Aetna Commercial |
$21.01
|
| Rate for Payer: Aetna Medicare |
$7.93
|
| Rate for Payer: Aetna Medicare |
$5.74
|
| Rate for Payer: Aetna Medicare |
$8.64
|
| Rate for Payer: ASR ASR |
$22.64
|
| Rate for Payer: ASR ASR |
$15.05
|
| Rate for Payer: ASR ASR |
$20.79
|
| Rate for Payer: BCBS Complete |
$6.21
|
| Rate for Payer: BCBS Complete |
$9.34
|
| Rate for Payer: BCBS Complete |
$8.57
|
| Rate for Payer: BCBS Trust/PPO |
$12.79
|
| Rate for Payer: BCBS Trust/PPO |
$17.67
|
| Rate for Payer: BCBS Trust/PPO |
$19.25
|
| Rate for Payer: BCN Commercial |
$12.79
|
| Rate for Payer: BCN Commercial |
$17.67
|
| Rate for Payer: BCN Commercial |
$19.25
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cash Price |
$18.68
|
| Rate for Payer: Cash Price |
$18.68
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cofinity Commercial |
$20.15
|
| Rate for Payer: Cofinity Commercial |
$14.58
|
| Rate for Payer: Cofinity Commercial |
$21.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$22.64
|
| Rate for Payer: Healthscope Commercial |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$20.79
|
| Rate for Payer: Healthscope Whirlpool |
$21.43
|
| Rate for Payer: Healthscope Whirlpool |
$15.52
|
| Rate for Payer: Healthscope Whirlpool |
$23.34
|
| Rate for Payer: Mclaren Commercial |
$21.01
|
| Rate for Payer: Mclaren Commercial |
$19.29
|
| Rate for Payer: Mclaren Commercial |
$13.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.19
|
| Rate for Payer: Nomi Health Commercial |
$19.14
|
| Rate for Payer: Nomi Health Commercial |
$12.72
|
| Rate for Payer: Nomi Health Commercial |
$17.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.42
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.65
|
|
|
MAGNESIUM SULFATE IN D5W 1 GRAM/100 ML IVPB (CODE)
|
Facility
|
IP
|
$49.27
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
163707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.95 |
| Max. Negotiated Rate |
$49.27 |
| Rate for Payer: Aetna Commercial |
$44.34
|
| Rate for Payer: ASR ASR |
$47.79
|
| Rate for Payer: BCBS Trust/PPO |
$40.46
|
| Rate for Payer: BCN Commercial |
$40.46
|
| Rate for Payer: Cash Price |
$39.42
|
| Rate for Payer: Cofinity Commercial |
$46.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.42
|
| Rate for Payer: Healthscope Commercial |
$47.79
|
| Rate for Payer: Healthscope Whirlpool |
$49.27
|
| Rate for Payer: Mclaren Commercial |
$44.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.88
|
| Rate for Payer: Nomi Health Commercial |
$40.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.36
|
|
|
MAGNESIUM SULFATE IN D5W 1 GRAM/100 ML IVPB (CODE)
|
Facility
|
OP
|
$49.27
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
163707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$49.27 |
| Rate for Payer: Aetna Commercial |
$44.34
|
| Rate for Payer: Aetna Medicare |
$18.23
|
| Rate for Payer: ASR ASR |
$47.79
|
| Rate for Payer: BCBS Complete |
$19.71
|
| Rate for Payer: BCBS Trust/PPO |
$40.62
|
| Rate for Payer: BCN Commercial |
$40.62
|
| Rate for Payer: Cash Price |
$39.42
|
| Rate for Payer: Cash Price |
$39.42
|
| Rate for Payer: Cofinity Commercial |
$46.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.42
|
| Rate for Payer: Healthscope Commercial |
$47.79
|
| Rate for Payer: Healthscope Whirlpool |
$49.27
|
| Rate for Payer: Mclaren Commercial |
$44.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.88
|
| Rate for Payer: Nomi Health Commercial |
$40.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.42
|
| Rate for Payer: Priority Health Narrow Network |
$0.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.36
|
|
|
MAJOR ABDOMINAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$23,436.66
|
|
|
Service Code
|
APR-DRG 1693
|
| Min. Negotiated Rate |
$21,189.55 |
| Max. Negotiated Rate |
$23,436.66 |
| Rate for Payer: BCBS Complete |
$23,436.66
|
| Rate for Payer: Mclaren Medicaid |
$22,320.63
|
| Rate for Payer: Meridian Medicaid |
$23,436.66
|
| Rate for Payer: PHP Medicaid |
$21,189.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,320.63
|
| Rate for Payer: UHC Medicaid |
$22,320.63
|
| Rate for Payer: UHCCP Medicaid |
$22,320.63
|
|
|
MAJOR ABDOMINAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$18,307.60
|
|
|
Service Code
|
APR-DRG 1692
|
| Min. Negotiated Rate |
$16,552.26 |
| Max. Negotiated Rate |
$18,307.60 |
| Rate for Payer: BCBS Complete |
$18,307.60
|
| Rate for Payer: Mclaren Medicaid |
$17,435.81
|
| Rate for Payer: Meridian Medicaid |
$18,307.60
|
| Rate for Payer: PHP Medicaid |
$16,552.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,435.81
|
| Rate for Payer: UHC Medicaid |
$17,435.81
|
| Rate for Payer: UHCCP Medicaid |
$17,435.81
|
|
|
MAJOR ABDOMINAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$31,125.91
|
|
|
Service Code
|
APR-DRG 1694
|
| Min. Negotiated Rate |
$28,141.55 |
| Max. Negotiated Rate |
$31,125.91 |
| Rate for Payer: BCBS Complete |
$31,125.91
|
| Rate for Payer: Mclaren Medicaid |
$29,643.72
|
| Rate for Payer: Meridian Medicaid |
$31,125.91
|
| Rate for Payer: PHP Medicaid |
$28,141.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$29,643.72
|
| Rate for Payer: UHC Medicaid |
$29,643.72
|
| Rate for Payer: UHCCP Medicaid |
$29,643.72
|
|
|
MAJOR ABDOMINAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$16,314.71
|
|
|
Service Code
|
APR-DRG 1691
|
| Min. Negotiated Rate |
$14,750.45 |
| Max. Negotiated Rate |
$16,314.71 |
| Rate for Payer: BCBS Complete |
$16,314.71
|
| Rate for Payer: Mclaren Medicaid |
$15,537.82
|
| Rate for Payer: Meridian Medicaid |
$16,314.71
|
| Rate for Payer: PHP Medicaid |
$14,750.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,537.82
|
| Rate for Payer: UHC Medicaid |
$15,537.82
|
| Rate for Payer: UHCCP Medicaid |
$15,537.82
|
|
|
MAJOR BILIARY TRACT PROCEDURES
|
Facility
|
IP
|
$12,382.35
|
|
|
Service Code
|
APR-DRG 2612
|
| Min. Negotiated Rate |
$11,195.13 |
| Max. Negotiated Rate |
$12,382.35 |
| Rate for Payer: BCBS Complete |
$12,382.35
|
| Rate for Payer: Mclaren Medicaid |
$11,792.72
|
| Rate for Payer: Meridian Medicaid |
$12,382.35
|
| Rate for Payer: PHP Medicaid |
$11,195.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,792.72
|
| Rate for Payer: UHC Medicaid |
$11,792.72
|
| Rate for Payer: UHCCP Medicaid |
$11,792.72
|
|
|
MAJOR BILIARY TRACT PROCEDURES
|
Facility
|
IP
|
$16,317.44
|
|
|
Service Code
|
APR-DRG 2613
|
| Min. Negotiated Rate |
$14,752.92 |
| Max. Negotiated Rate |
$16,317.44 |
| Rate for Payer: BCBS Complete |
$16,317.44
|
| Rate for Payer: Mclaren Medicaid |
$15,540.42
|
| Rate for Payer: Meridian Medicaid |
$16,317.44
|
| Rate for Payer: PHP Medicaid |
$14,752.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,540.42
|
| Rate for Payer: UHC Medicaid |
$15,540.42
|
| Rate for Payer: UHCCP Medicaid |
$15,540.42
|
|
|
MAJOR BILIARY TRACT PROCEDURES
|
Facility
|
IP
|
$8,473.43
|
|
|
Service Code
|
APR-DRG 2611
|
| Min. Negotiated Rate |
$7,660.99 |
| Max. Negotiated Rate |
$8,473.43 |
| Rate for Payer: BCBS Complete |
$8,473.43
|
| Rate for Payer: Mclaren Medicaid |
$8,069.93
|
| Rate for Payer: Meridian Medicaid |
$8,473.43
|
| Rate for Payer: PHP Medicaid |
$7,660.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,069.93
|
| Rate for Payer: UHC Medicaid |
$8,069.93
|
| Rate for Payer: UHCCP Medicaid |
$8,069.93
|
|
|
MAJOR BILIARY TRACT PROCEDURES
|
Facility
|
IP
|
$27,565.21
|
|
|
Service Code
|
APR-DRG 2614
|
| Min. Negotiated Rate |
$24,922.24 |
| Max. Negotiated Rate |
$27,565.21 |
| Rate for Payer: BCBS Complete |
$27,565.21
|
| Rate for Payer: Mclaren Medicaid |
$26,252.58
|
| Rate for Payer: Meridian Medicaid |
$27,565.21
|
| Rate for Payer: PHP Medicaid |
$24,922.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$26,252.58
|
| Rate for Payer: UHC Medicaid |
$26,252.58
|
| Rate for Payer: UHCCP Medicaid |
$26,252.58
|
|
|
MAJOR BLADDER PROCEDURES
|
Facility
|
IP
|
$15,580.67
|
|
|
Service Code
|
APR-DRG 4412
|
| Min. Negotiated Rate |
$14,086.79 |
| Max. Negotiated Rate |
$15,580.67 |
| Rate for Payer: BCBS Complete |
$15,580.67
|
| Rate for Payer: Mclaren Medicaid |
$14,838.73
|
| Rate for Payer: Meridian Medicaid |
$15,580.67
|
| Rate for Payer: PHP Medicaid |
$14,086.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,838.73
|
| Rate for Payer: UHC Medicaid |
$14,838.73
|
| Rate for Payer: UHCCP Medicaid |
$14,838.73
|
|
|
MAJOR BLADDER PROCEDURES
|
Facility
|
IP
|
$34,140.03
|
|
|
Service Code
|
APR-DRG 4414
|
| Min. Negotiated Rate |
$30,866.67 |
| Max. Negotiated Rate |
$34,140.03 |
| Rate for Payer: BCBS Complete |
$34,140.03
|
| Rate for Payer: Mclaren Medicaid |
$32,514.31
|
| Rate for Payer: Meridian Medicaid |
$34,140.03
|
| Rate for Payer: PHP Medicaid |
$30,866.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$32,514.31
|
| Rate for Payer: UHC Medicaid |
$32,514.31
|
| Rate for Payer: UHCCP Medicaid |
$32,514.31
|
|
|
MAJOR BLADDER PROCEDURES
|
Facility
|
IP
|
$20,596.93
|
|
|
Service Code
|
APR-DRG 4413
|
| Min. Negotiated Rate |
$18,622.09 |
| Max. Negotiated Rate |
$20,596.93 |
| Rate for Payer: BCBS Complete |
$20,596.93
|
| Rate for Payer: Mclaren Medicaid |
$19,616.12
|
| Rate for Payer: Meridian Medicaid |
$20,596.93
|
| Rate for Payer: PHP Medicaid |
$18,622.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,616.12
|
| Rate for Payer: UHC Medicaid |
$19,616.12
|
| Rate for Payer: UHCCP Medicaid |
$19,616.12
|
|
|
MAJOR BLADDER PROCEDURES
|
Facility
|
IP
|
$12,283.17
|
|
|
Service Code
|
APR-DRG 4411
|
| Min. Negotiated Rate |
$11,105.46 |
| Max. Negotiated Rate |
$12,283.17 |
| Rate for Payer: BCBS Complete |
$12,283.17
|
| Rate for Payer: Mclaren Medicaid |
$11,698.26
|
| Rate for Payer: Meridian Medicaid |
$12,283.17
|
| Rate for Payer: PHP Medicaid |
$11,105.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,698.26
|
| Rate for Payer: UHC Medicaid |
$11,698.26
|
| Rate for Payer: UHCCP Medicaid |
$11,698.26
|
|
|
MAJOR BLADDER PROCEDURES WITH CC
|
Facility
|
IP
|
$38,459.02
|
|
|
Service Code
|
MSDRG 654
|
| Min. Negotiated Rate |
$20,817.26 |
| Max. Negotiated Rate |
$38,459.02 |
| Rate for Payer: Aetna Medicare |
$21,912.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,391.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,391.12
|
| Rate for Payer: BCBS MAPPO |
$21,912.90
|
| Rate for Payer: BCN Medicare Advantage |
$21,912.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,912.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$21,912.90
|
| Rate for Payer: Mclaren Medicare |
$21,912.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23,008.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,199.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$24,104.19
|
| Rate for Payer: PACE Medicare |
$20,817.26
|
| Rate for Payer: PACE SWMI |
$21,912.90
|
| Rate for Payer: PHP Commercial |
$24,104.19
|
| Rate for Payer: PHP Medicare Advantage |
$21,912.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$38,459.02
|
| Rate for Payer: Priority Health Medicare |
$21,912.90
|
| Rate for Payer: Priority Health Narrow Network |
$30,767.22
|
| Rate for Payer: Railroad Medicare Medicare |
$21,912.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21,912.90
|
| Rate for Payer: UHC Exchange |
$33,965.00
|
| Rate for Payer: UHCCP DNSP |
$21,912.90
|
| Rate for Payer: VA VA |
$21,912.90
|
|
