|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
IP
|
$17.32
|
|
|
Service Code
|
NDC 71399788901
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: ASR ASR |
$16.80
|
| Rate for Payer: ASR Commercial |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$14.11
|
| Rate for Payer: BCN Commercial |
$13.43
|
| Rate for Payer: Cash Price |
$13.85
|
| Rate for Payer: Cofinity Commercial |
$16.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Whirlpool |
$16.80
|
| Rate for Payer: Mclaren Commercial |
$15.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: Nomi Health Commercial |
$14.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.26
|
| 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 |
$11.26 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: ASR ASR |
$16.80
|
| Rate for Payer: ASR Commercial |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$14.11
|
| Rate for Payer: BCN Commercial |
$13.43
|
| Rate for Payer: Cash Price |
$13.85
|
| Rate for Payer: Cofinity Commercial |
$16.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Whirlpool |
$16.80
|
| Rate for Payer: Mclaren Commercial |
$15.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: Nomi Health Commercial |
$14.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.24
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
OP
|
$17.32
|
|
|
Service Code
|
NDC 71399005101
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: Aetna Medicare |
$8.66
|
| Rate for Payer: ASR ASR |
$16.80
|
| Rate for Payer: ASR Commercial |
$16.80
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: BCBS Trust/PPO |
$14.18
|
| Rate for Payer: BCN Commercial |
$13.43
|
| Rate for Payer: Cash Price |
$13.85
|
| Rate for Payer: Cofinity Commercial |
$16.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Whirlpool |
$16.80
|
| Rate for Payer: Mclaren Commercial |
$15.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: Nomi Health Commercial |
$14.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.18
|
| 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
|
OP
|
$0.70
|
|
|
Service Code
|
NDC 09900000340
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Aetna Commercial |
$0.63
|
| Rate for Payer: Aetna Medicare |
$0.35
|
| Rate for Payer: ASR ASR |
$0.68
|
| Rate for Payer: ASR Commercial |
$0.68
|
| Rate for Payer: BCBS Complete |
$0.28
|
| Rate for Payer: BCBS Trust/PPO |
$0.57
|
| Rate for Payer: BCN Commercial |
$0.54
|
| 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 |
$0.70
|
| Rate for Payer: Healthscope Whirlpool |
$0.68
|
| Rate for Payer: Mclaren Commercial |
$0.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.60
|
| Rate for Payer: Nomi Health Commercial |
$0.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.61
|
| Rate for Payer: Priority Health Narrow Network |
$0.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.62
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$10.50
|
|
|
Service Code
|
NDC 00904078816
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: ASR ASR |
$10.18
|
| Rate for Payer: ASR Commercial |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$8.56
|
| Rate for Payer: BCN Commercial |
$8.14
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cofinity Commercial |
$9.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.40
|
| Rate for Payer: Healthscope Commercial |
$10.50
|
| Rate for Payer: Healthscope Whirlpool |
$10.18
|
| Rate for Payer: Mclaren Commercial |
$9.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.92
|
| Rate for Payer: Nomi Health Commercial |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.24
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$10.50
|
|
|
Service Code
|
NDC 00904078816
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: Aetna Medicare |
$5.25
|
| Rate for Payer: ASR ASR |
$10.18
|
| Rate for Payer: ASR Commercial |
$10.18
|
| Rate for Payer: BCBS Complete |
$4.20
|
| Rate for Payer: BCBS Trust/PPO |
$8.60
|
| Rate for Payer: BCN Commercial |
$8.14
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cofinity Commercial |
$9.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.40
|
| Rate for Payer: Healthscope Commercial |
$10.50
|
| Rate for Payer: Healthscope Whirlpool |
$10.18
|
| Rate for Payer: Mclaren Commercial |
$9.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.92
|
| Rate for Payer: Nomi Health Commercial |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.20
|
| Rate for Payer: Priority Health Narrow Network |
$7.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.24
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$0.70
|
|
|
Service Code
|
NDC 09900000340
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Aetna Commercial |
$0.63
|
| Rate for Payer: ASR ASR |
$0.68
|
| Rate for Payer: ASR Commercial |
$0.68
|
| Rate for Payer: BCBS Trust/PPO |
$0.57
|
| Rate for Payer: BCN Commercial |
$0.54
|
| 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 |
$0.70
|
| Rate for Payer: Healthscope Whirlpool |
$0.68
|
| Rate for Payer: Mclaren Commercial |
$0.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.60
|
| Rate for Payer: Nomi Health Commercial |
$0.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.62
|
|
|
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 |
$166.40 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: ASR ASR |
$248.32
|
| Rate for Payer: ASR Commercial |
$248.32
|
| Rate for Payer: BCBS Trust/PPO |
$208.61
|
| Rate for Payer: BCN Commercial |
$198.48
|
| 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 |
$256.00
|
| Rate for Payer: Healthscope Whirlpool |
$248.32
|
| 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: Priority Health Cigna Priority Health |
$166.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.28
|
|
|
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 |
$0.70 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna Commercial |
$0.97
|
| Rate for Payer: ASR ASR |
$1.05
|
| Rate for Payer: ASR Commercial |
$1.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.88
|
| Rate for Payer: BCN Commercial |
$0.84
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cofinity Commercial |
$1.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.86
|
| Rate for Payer: Healthscope Commercial |
$1.08
|
| Rate for Payer: Healthscope Whirlpool |
$1.05
|
| Rate for Payer: Mclaren Commercial |
$0.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.92
|
| Rate for Payer: Nomi Health Commercial |
$0.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.95
|
|
|
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 |
$43.12 |
| Max. Negotiated Rate |
$107.80 |
| Rate for Payer: Aetna Commercial |
$97.02
|
| Rate for Payer: Aetna Medicare |
$53.90
|
| Rate for Payer: ASR ASR |
$104.57
|
| Rate for Payer: ASR Commercial |
$104.57
|
| Rate for Payer: BCBS Complete |
$43.12
|
| Rate for Payer: BCBS Trust/PPO |
$88.28
|
| Rate for Payer: BCN Commercial |
$83.58
|
| 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 |
$107.80
|
| Rate for Payer: Healthscope Whirlpool |
$104.57
|
| 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: Priority Health Cigna Priority Health |
$70.07
|
| Rate for Payer: 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
|
IP
|
$107.80
|
|
|
Service Code
|
NDC 64980033901
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.07 |
| Max. Negotiated Rate |
$107.80 |
| Rate for Payer: Aetna Commercial |
$97.02
|
| Rate for Payer: ASR ASR |
$104.57
|
| Rate for Payer: ASR Commercial |
$104.57
|
| Rate for Payer: BCBS Trust/PPO |
$87.85
|
| Rate for Payer: BCN Commercial |
$83.58
|
| 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 |
$107.80
|
| Rate for Payer: Healthscope Whirlpool |
$104.57
|
| 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: Priority Health Cigna Priority Health |
$70.07
|
| 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 |
$0.43 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna Commercial |
$0.97
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: ASR ASR |
$1.05
|
| Rate for Payer: ASR Commercial |
$1.05
|
| Rate for Payer: BCBS Complete |
$0.43
|
| Rate for Payer: BCBS Trust/PPO |
$0.88
|
| Rate for Payer: BCN Commercial |
$0.84
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cofinity Commercial |
$1.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.86
|
| Rate for Payer: Healthscope Commercial |
$1.08
|
| Rate for Payer: Healthscope Whirlpool |
$1.05
|
| Rate for Payer: Mclaren Commercial |
$0.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.92
|
| Rate for Payer: Nomi Health Commercial |
$0.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.95
|
| 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
|
OP
|
$256.00
|
|
|
Service Code
|
NDC 10006070028
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.40 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: Aetna Medicare |
$128.00
|
| Rate for Payer: ASR ASR |
$248.32
|
| Rate for Payer: ASR Commercial |
$248.32
|
| Rate for Payer: BCBS Complete |
$102.40
|
| Rate for Payer: BCBS Trust/PPO |
$209.64
|
| Rate for Payer: BCN Commercial |
$198.48
|
| 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 |
$256.00
|
| Rate for Payer: Healthscope Whirlpool |
$248.32
|
| 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: Priority Health Cigna Priority Health |
$166.40
|
| Rate for Payer: 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 SULFATE 0.5 GRAM/ML (50 %) INJECTION (CODE)
|
Facility
|
IP
|
$40.25
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
163706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.16 |
| Max. Negotiated Rate |
$40.25 |
| Rate for Payer: Aetna Commercial |
$36.22
|
| Rate for Payer: Aetna Commercial |
$19.29
|
| Rate for Payer: ASR ASR |
$39.04
|
| Rate for Payer: ASR ASR |
$20.79
|
| Rate for Payer: ASR Commercial |
$20.79
|
| Rate for Payer: ASR Commercial |
$39.04
|
| Rate for Payer: BCBS Trust/PPO |
$17.46
|
| Rate for Payer: BCBS Trust/PPO |
$32.80
|
| Rate for Payer: BCN Commercial |
$31.21
|
| Rate for Payer: BCN Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$20.14
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.20
|
| Rate for Payer: Healthscope Commercial |
$21.43
|
| Rate for Payer: Healthscope Commercial |
$40.25
|
| Rate for Payer: Healthscope Whirlpool |
$20.79
|
| Rate for Payer: Healthscope Whirlpool |
$39.04
|
| Rate for Payer: Mclaren Commercial |
$19.29
|
| Rate for Payer: Mclaren Commercial |
$36.22
|
| 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 |
$33.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.93
|
| 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
|
OP
|
$40.25
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
163706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$40.25 |
| Rate for Payer: Aetna Commercial |
$36.22
|
| Rate for Payer: Aetna Commercial |
$19.29
|
| Rate for Payer: Aetna Medicare |
$10.72
|
| Rate for Payer: Aetna Medicare |
$20.12
|
| Rate for Payer: ASR ASR |
$39.04
|
| Rate for Payer: ASR ASR |
$20.79
|
| Rate for Payer: ASR Commercial |
$20.79
|
| Rate for Payer: ASR Commercial |
$39.04
|
| Rate for Payer: BCBS Complete |
$16.10
|
| Rate for Payer: BCBS Complete |
$8.57
|
| Rate for Payer: BCBS Trust/PPO |
$32.96
|
| Rate for Payer: BCBS Trust/PPO |
$17.55
|
| Rate for Payer: BCN Commercial |
$16.61
|
| Rate for Payer: BCN Commercial |
$31.21
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$20.14
|
| 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 |
$40.25
|
| Rate for Payer: Healthscope Commercial |
$21.43
|
| Rate for Payer: Healthscope Whirlpool |
$39.04
|
| Rate for Payer: Healthscope Whirlpool |
$20.79
|
| Rate for Payer: Mclaren Commercial |
$19.29
|
| Rate for Payer: Mclaren Commercial |
$36.22
|
| 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 |
$33.00
|
| Rate for Payer: Nomi Health Commercial |
$17.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| 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 |
$30.07 |
| Max. Negotiated Rate |
$46.26 |
| Rate for Payer: Aetna Commercial |
$41.63
|
| Rate for Payer: Aetna Commercial |
$100.48
|
| Rate for Payer: Aetna Commercial |
$75.51
|
| Rate for Payer: ASR ASR |
$108.30
|
| Rate for Payer: ASR ASR |
$44.87
|
| Rate for Payer: ASR ASR |
$81.38
|
| Rate for Payer: ASR Commercial |
$44.87
|
| Rate for Payer: ASR Commercial |
$108.30
|
| Rate for Payer: ASR Commercial |
$81.38
|
| Rate for Payer: BCBS Trust/PPO |
$68.37
|
| Rate for Payer: BCBS Trust/PPO |
$90.98
|
| Rate for Payer: BCBS Trust/PPO |
$37.70
|
| Rate for Payer: BCN Commercial |
$86.56
|
| Rate for Payer: BCN Commercial |
$65.05
|
| Rate for Payer: BCN Commercial |
$35.87
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cash Price |
$67.12
|
| Rate for Payer: Cofinity Commercial |
$78.87
|
| Rate for Payer: Cofinity Commercial |
$104.95
|
| Rate for Payer: Cofinity Commercial |
$43.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.12
|
| Rate for Payer: Healthscope Commercial |
$111.65
|
| Rate for Payer: Healthscope Commercial |
$46.26
|
| Rate for Payer: Healthscope Commercial |
$83.90
|
| Rate for Payer: Healthscope Whirlpool |
$44.87
|
| Rate for Payer: Healthscope Whirlpool |
$108.30
|
| Rate for Payer: Healthscope Whirlpool |
$81.38
|
| Rate for Payer: Mclaren Commercial |
$41.63
|
| Rate for Payer: Mclaren Commercial |
$100.48
|
| Rate for Payer: Mclaren Commercial |
$75.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.90
|
| Rate for Payer: Nomi Health Commercial |
$37.93
|
| Rate for Payer: Nomi Health Commercial |
$91.55
|
| Rate for Payer: Nomi Health Commercial |
$68.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.25
|
|
|
MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$111.65
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
16162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$111.65 |
| Rate for Payer: Aetna Commercial |
$100.48
|
| Rate for Payer: Aetna Commercial |
$75.51
|
| Rate for Payer: Aetna Commercial |
$41.63
|
| Rate for Payer: Aetna Medicare |
$41.95
|
| Rate for Payer: Aetna Medicare |
$55.82
|
| Rate for Payer: Aetna Medicare |
$23.13
|
| Rate for Payer: ASR ASR |
$44.87
|
| Rate for Payer: ASR ASR |
$108.30
|
| Rate for Payer: ASR ASR |
$81.38
|
| Rate for Payer: ASR Commercial |
$44.87
|
| Rate for Payer: ASR Commercial |
$108.30
|
| Rate for Payer: ASR Commercial |
$81.38
|
| Rate for Payer: BCBS Complete |
$44.66
|
| Rate for Payer: BCBS Complete |
$18.50
|
| Rate for Payer: BCBS Complete |
$33.56
|
| Rate for Payer: BCBS Trust/PPO |
$68.71
|
| Rate for Payer: BCBS Trust/PPO |
$91.43
|
| Rate for Payer: BCBS Trust/PPO |
$37.88
|
| Rate for Payer: BCN Commercial |
$35.87
|
| Rate for Payer: BCN Commercial |
$65.05
|
| Rate for Payer: BCN Commercial |
$86.56
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$67.12
|
| Rate for Payer: Cash Price |
$67.12
|
| Rate for Payer: Cofinity Commercial |
$78.87
|
| Rate for Payer: Cofinity Commercial |
$104.95
|
| Rate for Payer: Cofinity Commercial |
$43.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.01
|
| Rate for Payer: Healthscope Commercial |
$83.90
|
| Rate for Payer: Healthscope Commercial |
$46.26
|
| Rate for Payer: Healthscope Commercial |
$111.65
|
| Rate for Payer: Healthscope Whirlpool |
$81.38
|
| Rate for Payer: Healthscope Whirlpool |
$44.87
|
| Rate for Payer: Healthscope Whirlpool |
$108.30
|
| Rate for Payer: Mclaren Commercial |
$41.63
|
| Rate for Payer: Mclaren Commercial |
$75.51
|
| Rate for Payer: Mclaren Commercial |
$100.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.90
|
| Rate for Payer: Nomi Health Commercial |
$91.55
|
| Rate for Payer: Nomi Health Commercial |
$68.80
|
| Rate for Payer: Nomi Health Commercial |
$37.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.83
|
|
|
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 |
$0.41 |
| Max. Negotiated Rate |
$55.83 |
| Rate for Payer: Aetna Commercial |
$50.25
|
| Rate for Payer: Aetna Medicare |
$27.92
|
| Rate for Payer: ASR ASR |
$54.16
|
| Rate for Payer: ASR Commercial |
$54.16
|
| Rate for Payer: BCBS Complete |
$22.33
|
| Rate for Payer: BCBS Trust/PPO |
$45.72
|
| Rate for Payer: BCN Commercial |
$43.28
|
| 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 |
$55.83
|
| Rate for Payer: Healthscope Whirlpool |
$54.16
|
| Rate for Payer: Mclaren Commercial |
$50.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.46
|
| Rate for Payer: Nomi Health Commercial |
$45.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| 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 |
$36.29 |
| Max. Negotiated Rate |
$55.83 |
| Rate for Payer: Aetna Commercial |
$50.25
|
| Rate for Payer: ASR ASR |
$54.16
|
| Rate for Payer: ASR Commercial |
$54.16
|
| Rate for Payer: BCBS Trust/PPO |
$45.50
|
| Rate for Payer: BCN Commercial |
$43.28
|
| 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 |
$55.83
|
| Rate for Payer: Healthscope Whirlpool |
$54.16
|
| Rate for Payer: Mclaren Commercial |
$50.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.46
|
| Rate for Payer: Nomi Health Commercial |
$45.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.13
|
|
|
MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$24.05
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: Aetna Commercial |
$19.65
|
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: ASR ASR |
$21.18
|
| Rate for Payer: ASR ASR |
$23.33
|
| Rate for Payer: ASR ASR |
$57.63
|
| Rate for Payer: ASR Commercial |
$23.33
|
| Rate for Payer: ASR Commercial |
$21.18
|
| Rate for Payer: ASR Commercial |
$57.63
|
| Rate for Payer: BCBS Trust/PPO |
$48.41
|
| Rate for Payer: BCBS Trust/PPO |
$17.79
|
| Rate for Payer: BCBS Trust/PPO |
$19.60
|
| Rate for Payer: BCN Commercial |
$16.92
|
| Rate for Payer: BCN Commercial |
$46.06
|
| Rate for Payer: BCN Commercial |
$18.65
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$47.53
|
| Rate for Payer: Cofinity Commercial |
$55.85
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Cofinity Commercial |
$22.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.53
|
| Rate for Payer: Healthscope Commercial |
$21.83
|
| Rate for Payer: Healthscope Commercial |
$24.05
|
| Rate for Payer: Healthscope Commercial |
$59.41
|
| Rate for Payer: Healthscope Whirlpool |
$23.33
|
| Rate for Payer: Healthscope Whirlpool |
$21.18
|
| Rate for Payer: Healthscope Whirlpool |
$57.63
|
| Rate for Payer: Mclaren Commercial |
$21.64
|
| Rate for Payer: Mclaren Commercial |
$19.65
|
| Rate for Payer: Mclaren Commercial |
$53.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| 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 |
$48.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.28
|
| 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 |
$0.41 |
| Max. Negotiated Rate |
$21.83 |
| Rate for Payer: Aetna Commercial |
$19.65
|
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: Aetna Medicare |
$29.70
|
| Rate for Payer: Aetna Medicare |
$10.92
|
| Rate for Payer: Aetna Medicare |
$12.02
|
| Rate for Payer: ASR ASR |
$23.33
|
| Rate for Payer: ASR ASR |
$21.18
|
| Rate for Payer: ASR ASR |
$57.63
|
| Rate for Payer: ASR Commercial |
$23.33
|
| Rate for Payer: ASR Commercial |
$21.18
|
| Rate for Payer: ASR Commercial |
$57.63
|
| Rate for Payer: BCBS Complete |
$8.73
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS Complete |
$23.76
|
| Rate for Payer: BCBS Trust/PPO |
$48.65
|
| Rate for Payer: BCBS Trust/PPO |
$17.88
|
| Rate for Payer: BCBS Trust/PPO |
$19.69
|
| Rate for Payer: BCN Commercial |
$18.65
|
| Rate for Payer: BCN Commercial |
$46.06
|
| Rate for Payer: BCN Commercial |
$16.92
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cash Price |
$47.53
|
| Rate for Payer: Cash Price |
$47.53
|
| Rate for Payer: Cofinity Commercial |
$55.85
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Cofinity Commercial |
$22.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.53
|
| 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 |
$59.41
|
| Rate for Payer: Healthscope Commercial |
$24.05
|
| Rate for Payer: Healthscope Commercial |
$21.83
|
| Rate for Payer: Healthscope Whirlpool |
$57.63
|
| Rate for Payer: Healthscope Whirlpool |
$23.33
|
| Rate for Payer: Healthscope Whirlpool |
$21.18
|
| Rate for Payer: Mclaren Commercial |
$21.64
|
| Rate for Payer: Mclaren Commercial |
$53.47
|
| Rate for Payer: Mclaren Commercial |
$19.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.56
|
| Rate for Payer: Nomi Health Commercial |
$17.90
|
| Rate for Payer: Nomi Health Commercial |
$48.72
|
| Rate for Payer: Nomi Health Commercial |
$19.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.28
|
|
|
MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION
|
Facility
|
IP
|
$21.43
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$21.43 |
| Rate for Payer: Aetna Commercial |
$19.29
|
| Rate for Payer: Aetna Commercial |
$13.97
|
| Rate for Payer: Aetna Commercial |
$21.01
|
| Rate for Payer: ASR ASR |
$15.05
|
| Rate for Payer: ASR ASR |
$20.79
|
| Rate for Payer: ASR ASR |
$22.64
|
| Rate for Payer: ASR Commercial |
$20.79
|
| Rate for Payer: ASR Commercial |
$15.05
|
| Rate for Payer: ASR Commercial |
$22.64
|
| Rate for Payer: BCBS Trust/PPO |
$19.02
|
| Rate for Payer: BCBS Trust/PPO |
$12.65
|
| Rate for Payer: BCBS Trust/PPO |
$17.46
|
| Rate for Payer: BCN Commercial |
$12.03
|
| Rate for Payer: BCN Commercial |
$18.10
|
| Rate for Payer: BCN Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cash Price |
$18.68
|
| Rate for Payer: Cofinity Commercial |
$21.94
|
| Rate for Payer: Cofinity Commercial |
$14.59
|
| Rate for Payer: Cofinity Commercial |
$20.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.67
|
| Rate for Payer: Healthscope Commercial |
$15.52
|
| Rate for Payer: Healthscope Commercial |
$21.43
|
| Rate for Payer: Healthscope Commercial |
$23.34
|
| Rate for Payer: Healthscope Whirlpool |
$20.79
|
| Rate for Payer: Healthscope Whirlpool |
$15.05
|
| Rate for Payer: Healthscope Whirlpool |
$22.64
|
| Rate for Payer: Mclaren Commercial |
$19.29
|
| Rate for Payer: Mclaren Commercial |
$13.97
|
| Rate for Payer: Mclaren Commercial |
$21.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.19
|
| Rate for Payer: Nomi Health Commercial |
$17.57
|
| Rate for Payer: Nomi Health Commercial |
$12.73
|
| Rate for Payer: Nomi Health Commercial |
$19.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.66
|
|
|
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 |
$0.41 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Aetna Commercial |
$13.97
|
| Rate for Payer: Aetna Commercial |
$21.01
|
| Rate for Payer: Aetna Commercial |
$19.29
|
| Rate for Payer: Aetna Medicare |
$11.67
|
| Rate for Payer: Aetna Medicare |
$7.76
|
| Rate for Payer: Aetna Medicare |
$10.72
|
| Rate for Payer: ASR ASR |
$20.79
|
| Rate for Payer: ASR ASR |
$15.05
|
| Rate for Payer: ASR ASR |
$22.64
|
| Rate for Payer: ASR Commercial |
$20.79
|
| Rate for Payer: ASR Commercial |
$15.05
|
| Rate for Payer: ASR Commercial |
$22.64
|
| Rate for Payer: BCBS Complete |
$6.21
|
| Rate for Payer: BCBS Complete |
$8.57
|
| Rate for Payer: BCBS Complete |
$9.34
|
| Rate for Payer: BCBS Trust/PPO |
$19.11
|
| Rate for Payer: BCBS Trust/PPO |
$12.71
|
| Rate for Payer: BCBS Trust/PPO |
$17.55
|
| Rate for Payer: BCN Commercial |
$16.61
|
| Rate for Payer: BCN Commercial |
$18.10
|
| Rate for Payer: BCN Commercial |
$12.03
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cash Price |
$18.68
|
| Rate for Payer: Cash Price |
$18.68
|
| Rate for Payer: Cofinity Commercial |
$21.94
|
| Rate for Payer: Cofinity Commercial |
$14.59
|
| Rate for Payer: Cofinity Commercial |
$20.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$23.34
|
| Rate for Payer: Healthscope Commercial |
$21.43
|
| Rate for Payer: Healthscope Commercial |
$15.52
|
| Rate for Payer: Healthscope Whirlpool |
$22.64
|
| Rate for Payer: Healthscope Whirlpool |
$20.79
|
| Rate for Payer: Healthscope Whirlpool |
$15.05
|
| Rate for Payer: Mclaren Commercial |
$19.29
|
| Rate for Payer: Mclaren Commercial |
$21.01
|
| Rate for Payer: Mclaren Commercial |
$13.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.19
|
| Rate for Payer: Nomi Health Commercial |
$12.73
|
| Rate for Payer: Nomi Health Commercial |
$19.14
|
| Rate for Payer: Nomi Health Commercial |
$17.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.54
|
|
|
MAGNESIUM SULFATE IN D5W 1 GRAM/100 ML IVPB (CODE)
|
Facility
|
OP
|
$111.65
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
163707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$111.65 |
| Rate for Payer: Aetna Commercial |
$100.48
|
| Rate for Payer: Aetna Medicare |
$55.82
|
| Rate for Payer: ASR ASR |
$108.30
|
| Rate for Payer: ASR Commercial |
$108.30
|
| Rate for Payer: BCBS Complete |
$44.66
|
| Rate for Payer: BCBS Trust/PPO |
$91.43
|
| Rate for Payer: BCN Commercial |
$86.56
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cofinity Commercial |
$104.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Healthscope Commercial |
$111.65
|
| Rate for Payer: Healthscope Whirlpool |
$108.30
|
| Rate for Payer: Mclaren Commercial |
$100.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.90
|
| Rate for Payer: Nomi Health Commercial |
$91.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.51
|
| Rate for Payer: Priority Health Narrow Network |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.25
|
|
|
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 |
$72.57 |
| Max. Negotiated Rate |
$111.65 |
| Rate for Payer: Aetna Commercial |
$100.48
|
| Rate for Payer: ASR ASR |
$108.30
|
| Rate for Payer: ASR Commercial |
$108.30
|
| Rate for Payer: BCBS Trust/PPO |
$90.98
|
| Rate for Payer: BCN Commercial |
$86.56
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cofinity Commercial |
$104.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Healthscope Commercial |
$111.65
|
| Rate for Payer: Healthscope Whirlpool |
$108.30
|
| Rate for Payer: Mclaren Commercial |
$100.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.90
|
| Rate for Payer: Nomi Health Commercial |
$91.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.25
|
|
