|
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
|
$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 SULFATE 0.5 GRAM/ML (50 %) INJECTION (CODE)
|
Facility
|
OP
|
$21.43
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
163706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$21.43 |
| Rate for Payer: Aetna Commercial |
$19.29
|
| Rate for Payer: Aetna Commercial |
$36.23
|
| Rate for Payer: Aetna Medicare |
$10.71
|
| Rate for Payer: Aetna Medicare |
$20.12
|
| Rate for Payer: ASR ASR |
$20.79
|
| Rate for Payer: ASR ASR |
$39.04
|
| Rate for Payer: ASR Commercial |
$39.04
|
| Rate for Payer: ASR Commercial |
$20.79
|
| Rate for Payer: BCBS Complete |
$8.57
|
| Rate for Payer: BCBS Complete |
$16.10
|
| Rate for Payer: BCBS Trust/PPO |
$17.55
|
| Rate for Payer: BCBS Trust/PPO |
$32.96
|
| Rate for Payer: BCN Commercial |
$31.21
|
| Rate for Payer: BCN Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$17.14
|
| 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 |
$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 |
$36.23
|
| 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 |
$17.57
|
| Rate for Payer: Nomi Health Commercial |
$33.01
|
| 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 |
$18.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.27
|
| Rate for Payer: Priority Health Narrow Network |
$28.22
|
| Rate for Payer: Priority Health Narrow Network |
$15.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.86
|
|
|
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 |
$36.23
|
| Rate for Payer: Aetna Commercial |
$19.29
|
| Rate for Payer: ASR ASR |
$20.79
|
| Rate for Payer: ASR ASR |
$39.04
|
| 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 |
$39.04
|
| Rate for Payer: Healthscope Whirlpool |
$20.79
|
| Rate for Payer: Mclaren Commercial |
$19.29
|
| Rate for Payer: Mclaren Commercial |
$36.23
|
| 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: Priority Health Cigna Priority Health |
$13.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.16
|
| 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 |
$71.31
|
| 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 |
$54.53
|
| 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 |
$44.66 |
| Max. Negotiated Rate |
$111.65 |
| Rate for Payer: Aetna Commercial |
$100.48
|
| Rate for Payer: Aetna Commercial |
$41.63
|
| Rate for Payer: Aetna Commercial |
$75.51
|
| Rate for Payer: Aetna Medicare |
$23.13
|
| Rate for Payer: Aetna Medicare |
$41.95
|
| Rate for Payer: Aetna Medicare |
$55.83
|
| 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 |
$81.38
|
| Rate for Payer: ASR Commercial |
$44.87
|
| Rate for Payer: ASR Commercial |
$108.30
|
| 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 |
$91.43
|
| Rate for Payer: BCBS Trust/PPO |
$37.88
|
| Rate for Payer: BCBS Trust/PPO |
$68.71
|
| Rate for Payer: BCN Commercial |
$65.05
|
| Rate for Payer: BCN Commercial |
$86.56
|
| 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 |
$100.48
|
| Rate for Payer: Mclaren Commercial |
$41.63
|
| Rate for Payer: Mclaren Commercial |
$75.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.31
|
| Rate for Payer: Nomi Health Commercial |
$91.55
|
| Rate for Payer: Nomi Health Commercial |
$37.93
|
| Rate for Payer: Nomi Health Commercial |
$68.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.51
|
| Rate for Payer: Priority Health Narrow Network |
$58.81
|
| Rate for Payer: Priority Health Narrow Network |
$78.27
|
| Rate for Payer: Priority Health Narrow Network |
$32.43
|
| 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 |
$22.33 |
| Max. Negotiated Rate |
$55.83 |
| Rate for Payer: Aetna Commercial |
$50.25
|
| Rate for Payer: Aetna Medicare |
$27.91
|
| 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: 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 |
$48.92
|
| Rate for Payer: Priority Health Narrow Network |
$39.14
|
| 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
|
OP
|
$21.83
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$21.83 |
| Rate for Payer: Aetna Commercial |
$19.65
|
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna Medicare |
$12.03
|
| Rate for Payer: Aetna Medicare |
$29.70
|
| Rate for Payer: Aetna Medicare |
$10.91
|
| 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 |
$57.63
|
| Rate for Payer: ASR Commercial |
$23.33
|
| Rate for Payer: ASR Commercial |
$21.18
|
| 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 |
$17.88
|
| Rate for Payer: BCBS Trust/PPO |
$19.69
|
| Rate for Payer: BCBS Trust/PPO |
$48.65
|
| Rate for Payer: BCN Commercial |
$46.06
|
| Rate for Payer: BCN Commercial |
$16.92
|
| 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 |
$19.65
|
| Rate for Payer: Mclaren Commercial |
$21.64
|
| Rate for Payer: Mclaren Commercial |
$53.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.50
|
| Rate for Payer: Nomi Health Commercial |
$17.90
|
| Rate for Payer: Nomi Health Commercial |
$19.72
|
| Rate for Payer: Nomi Health Commercial |
$48.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.06
|
| Rate for Payer: Priority Health Narrow Network |
$41.65
|
| Rate for Payer: Priority Health Narrow Network |
$15.30
|
| Rate for Payer: Priority Health Narrow Network |
$16.86
|
| 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 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 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 |
$6.21 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Aetna Commercial |
$13.97
|
| Rate for Payer: Aetna Commercial |
$19.29
|
| Rate for Payer: Aetna Commercial |
$21.01
|
| Rate for Payer: Aetna Medicare |
$10.71
|
| Rate for Payer: Aetna Medicare |
$11.67
|
| Rate for Payer: Aetna Medicare |
$7.76
|
| 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 |
$22.64
|
| Rate for Payer: ASR Commercial |
$20.79
|
| Rate for Payer: ASR Commercial |
$15.05
|
| 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 |
$12.71
|
| Rate for Payer: BCBS Trust/PPO |
$17.55
|
| Rate for Payer: BCBS Trust/PPO |
$19.11
|
| Rate for Payer: BCN Commercial |
$18.10
|
| Rate for Payer: BCN Commercial |
$12.03
|
| 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 |
$13.97
|
| Rate for Payer: Mclaren Commercial |
$19.29
|
| 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 |
$13.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.84
|
| Rate for Payer: Nomi Health Commercial |
$12.73
|
| Rate for Payer: Nomi Health Commercial |
$17.57
|
| Rate for Payer: Nomi Health Commercial |
$19.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.45
|
| Rate for Payer: Priority Health Narrow Network |
$16.36
|
| Rate for Payer: Priority Health Narrow Network |
$10.88
|
| Rate for Payer: Priority Health Narrow Network |
$15.02
|
| 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 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 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
|
|
|
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 |
$44.66 |
| Max. Negotiated Rate |
$111.65 |
| Rate for Payer: Aetna Commercial |
$100.48
|
| Rate for Payer: Aetna Medicare |
$55.83
|
| 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: 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 |
$97.83
|
| Rate for Payer: Priority Health Narrow Network |
$78.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.25
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$105.09
|
|
|
Service Code
|
NDC 00990771513
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$68.31 |
| Max. Negotiated Rate |
$105.09 |
| Rate for Payer: Aetna Commercial |
$94.58
|
| Rate for Payer: ASR ASR |
$101.94
|
| Rate for Payer: ASR Commercial |
$101.94
|
| Rate for Payer: BCBS Trust/PPO |
$85.64
|
| Rate for Payer: BCN Commercial |
$81.48
|
| Rate for Payer: Cash Price |
$84.07
|
| Rate for Payer: Cofinity Commercial |
$98.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.07
|
| Rate for Payer: Healthscope Commercial |
$105.09
|
| Rate for Payer: Healthscope Whirlpool |
$101.94
|
| Rate for Payer: Mclaren Commercial |
$94.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.33
|
| Rate for Payer: Nomi Health Commercial |
$86.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.48
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$94.92
|
|
|
Service Code
|
NDC 00990771502
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.70 |
| Max. Negotiated Rate |
$94.92 |
| Rate for Payer: Aetna Commercial |
$85.43
|
| Rate for Payer: ASR ASR |
$92.07
|
| Rate for Payer: ASR Commercial |
$92.07
|
| Rate for Payer: BCBS Trust/PPO |
$77.35
|
| Rate for Payer: BCN Commercial |
$73.59
|
| Rate for Payer: Cash Price |
$75.94
|
| Rate for Payer: Cofinity Commercial |
$89.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.94
|
| Rate for Payer: Healthscope Commercial |
$94.92
|
| Rate for Payer: Healthscope Whirlpool |
$92.07
|
| Rate for Payer: Mclaren Commercial |
$85.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.68
|
| Rate for Payer: Nomi Health Commercial |
$77.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.53
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$98.31
|
|
|
Service Code
|
NDC 00338035703
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$98.31 |
| Rate for Payer: Aetna Commercial |
$88.48
|
| Rate for Payer: ASR ASR |
$95.36
|
| Rate for Payer: ASR Commercial |
$95.36
|
| Rate for Payer: BCBS Trust/PPO |
$80.11
|
| Rate for Payer: BCN Commercial |
$76.22
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cofinity Commercial |
$92.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.65
|
| Rate for Payer: Healthscope Commercial |
$98.31
|
| Rate for Payer: Healthscope Whirlpool |
$95.36
|
| Rate for Payer: Mclaren Commercial |
$88.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.56
|
| Rate for Payer: Nomi Health Commercial |
$80.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.51
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$94.92
|
|
|
Service Code
|
NDC 00990771512
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.70 |
| Max. Negotiated Rate |
$94.92 |
| Rate for Payer: Aetna Commercial |
$85.43
|
| Rate for Payer: ASR ASR |
$92.07
|
| Rate for Payer: ASR Commercial |
$92.07
|
| Rate for Payer: BCBS Trust/PPO |
$77.35
|
| Rate for Payer: BCN Commercial |
$73.59
|
| Rate for Payer: Cash Price |
$75.94
|
| Rate for Payer: Cofinity Commercial |
$89.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.94
|
| Rate for Payer: Healthscope Commercial |
$94.92
|
| Rate for Payer: Healthscope Whirlpool |
$92.07
|
| Rate for Payer: Mclaren Commercial |
$85.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.68
|
| Rate for Payer: Nomi Health Commercial |
$77.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.53
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$94.92
|
|
|
Service Code
|
NDC 00990771512
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.97 |
| Max. Negotiated Rate |
$94.92 |
| Rate for Payer: Aetna Commercial |
$85.43
|
| Rate for Payer: Aetna Medicare |
$47.46
|
| Rate for Payer: ASR ASR |
$92.07
|
| Rate for Payer: ASR Commercial |
$92.07
|
| Rate for Payer: BCBS Complete |
$37.97
|
| Rate for Payer: BCBS Trust/PPO |
$77.73
|
| Rate for Payer: BCN Commercial |
$73.59
|
| Rate for Payer: Cash Price |
$75.94
|
| Rate for Payer: Cofinity Commercial |
$89.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.94
|
| Rate for Payer: Healthscope Commercial |
$94.92
|
| Rate for Payer: Healthscope Whirlpool |
$92.07
|
| Rate for Payer: Mclaren Commercial |
$85.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.68
|
| Rate for Payer: Nomi Health Commercial |
$77.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.17
|
| Rate for Payer: Priority Health Narrow Network |
$66.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.53
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$105.09
|
|
|
Service Code
|
NDC 00990771513
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$105.09 |
| Rate for Payer: Aetna Commercial |
$94.58
|
| Rate for Payer: Aetna Medicare |
$52.55
|
| Rate for Payer: ASR ASR |
$101.94
|
| Rate for Payer: ASR Commercial |
$101.94
|
| Rate for Payer: BCBS Complete |
$42.04
|
| Rate for Payer: BCBS Trust/PPO |
$86.06
|
| Rate for Payer: BCN Commercial |
$81.48
|
| Rate for Payer: Cash Price |
$84.07
|
| Rate for Payer: Cofinity Commercial |
$98.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.07
|
| Rate for Payer: Healthscope Commercial |
$105.09
|
| Rate for Payer: Healthscope Whirlpool |
$101.94
|
| Rate for Payer: Mclaren Commercial |
$94.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.33
|
| Rate for Payer: Nomi Health Commercial |
$86.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.08
|
| Rate for Payer: Priority Health Narrow Network |
$73.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.48
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$98.31
|
|
|
Service Code
|
NDC 00338035703
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$98.31 |
| Rate for Payer: Aetna Commercial |
$88.48
|
| Rate for Payer: Aetna Medicare |
$49.16
|
| Rate for Payer: ASR ASR |
$95.36
|
| Rate for Payer: ASR Commercial |
$95.36
|
| Rate for Payer: BCBS Complete |
$39.32
|
| Rate for Payer: BCBS Trust/PPO |
$80.51
|
| Rate for Payer: BCN Commercial |
$76.22
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cofinity Commercial |
$92.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.65
|
| Rate for Payer: Healthscope Commercial |
$98.31
|
| Rate for Payer: Healthscope Whirlpool |
$95.36
|
| Rate for Payer: Mclaren Commercial |
$88.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.56
|
| Rate for Payer: Nomi Health Commercial |
$80.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.14
|
| Rate for Payer: Priority Health Narrow Network |
$68.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.51
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$94.92
|
|
|
Service Code
|
NDC 00990771502
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.97 |
| Max. Negotiated Rate |
$94.92 |
| Rate for Payer: Aetna Commercial |
$85.43
|
| Rate for Payer: Aetna Medicare |
$47.46
|
| Rate for Payer: ASR ASR |
$92.07
|
| Rate for Payer: ASR Commercial |
$92.07
|
| Rate for Payer: BCBS Complete |
$37.97
|
| Rate for Payer: BCBS Trust/PPO |
$77.73
|
| Rate for Payer: BCN Commercial |
$73.59
|
| Rate for Payer: Cash Price |
$75.94
|
| Rate for Payer: Cofinity Commercial |
$89.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.94
|
| Rate for Payer: Healthscope Commercial |
$94.92
|
| Rate for Payer: Healthscope Whirlpool |
$92.07
|
| Rate for Payer: Mclaren Commercial |
$85.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.68
|
| Rate for Payer: Nomi Health Commercial |
$77.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.17
|
| Rate for Payer: Priority Health Narrow Network |
$66.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.53
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$380.95
|
|
|
Service Code
|
NDC 00904651761
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.38 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Aetna Commercial |
$342.86
|
| Rate for Payer: Aetna Medicare |
$190.47
|
| Rate for Payer: ASR ASR |
$369.52
|
| Rate for Payer: ASR Commercial |
$369.52
|
| Rate for Payer: BCBS Complete |
$152.38
|
| Rate for Payer: BCBS Trust/PPO |
$311.96
|
| Rate for Payer: BCN Commercial |
$295.35
|
| Rate for Payer: Cash Price |
$304.76
|
| Rate for Payer: Cofinity Commercial |
$358.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.76
|
| Rate for Payer: Healthscope Commercial |
$380.95
|
| Rate for Payer: Healthscope Whirlpool |
$369.52
|
| Rate for Payer: Mclaren Commercial |
$342.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.81
|
| Rate for Payer: Nomi Health Commercial |
$312.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$333.79
|
| Rate for Payer: Priority Health Narrow Network |
$267.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.24
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$380.95
|
|
|
Service Code
|
NDC 00904651761
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$247.62 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Aetna Commercial |
$342.86
|
| Rate for Payer: ASR ASR |
$369.52
|
| Rate for Payer: ASR Commercial |
$369.52
|
| Rate for Payer: BCBS Trust/PPO |
$310.44
|
| Rate for Payer: BCN Commercial |
$295.35
|
| Rate for Payer: Cash Price |
$304.76
|
| Rate for Payer: Cofinity Commercial |
$358.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.76
|
| Rate for Payer: Healthscope Commercial |
$380.95
|
| Rate for Payer: Healthscope Whirlpool |
$369.52
|
| Rate for Payer: Mclaren Commercial |
$342.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.81
|
| Rate for Payer: Nomi Health Commercial |
$312.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.24
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
OP
|
$140.64
|
|
|
Service Code
|
NDC 50268052315
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.26 |
| Max. Negotiated Rate |
$140.64 |
| Rate for Payer: Aetna Commercial |
$126.58
|
| Rate for Payer: Aetna Medicare |
$70.32
|
| Rate for Payer: ASR ASR |
$136.42
|
| Rate for Payer: ASR Commercial |
$136.42
|
| Rate for Payer: BCBS Complete |
$56.26
|
| Rate for Payer: BCBS Trust/PPO |
$115.17
|
| Rate for Payer: BCN Commercial |
$109.04
|
| Rate for Payer: Cash Price |
$112.51
|
| Rate for Payer: Cofinity Commercial |
$132.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.51
|
| Rate for Payer: Healthscope Commercial |
$140.64
|
| Rate for Payer: Healthscope Whirlpool |
$136.42
|
| Rate for Payer: Mclaren Commercial |
$126.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.54
|
| Rate for Payer: Nomi Health Commercial |
$115.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.23
|
| Rate for Payer: Priority Health Narrow Network |
$98.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.76
|
|
