|
MAGNESIUM SULFATE 40 GM/1000ML IV SOLN [129654]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
00409672909
|
|
Hospital Revenue Code
|
278
|
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
MAGNESIUM SULFATE 40 GRAMS/1000 ML PREMI
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
41654290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$0.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.68
|
| Rate for Payer: SOMOS Essential |
$0.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.11
|
|
|
MAGNESIUM SULFATE 40 GRAMS/1000 ML PREMI
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
41654290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
|
|
MAGNESIUM SULFATE 40 GRAMS/1000 ML PREMI
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
41644290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
|
|
MAGNESIUM SULFATE 40 GRAMS/1000 ML PREMI
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
41644290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$0.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.68
|
| Rate for Payer: SOMOS Essential |
$0.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.11
|
|
|
MAGNESIUM SULFATE 4 GM/100ML IV SOLN [129652]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
63323010600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
|
|
MAGNESIUM SULFATE 4 GM/100ML IV SOLN [129652]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
63323010601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
|
|
MAGNESIUM SULFATE 4 GM/100ML IV SOLN [129652]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
63323010601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: EmblemHealth Commercial |
$0.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
|
|
MAGNESIUM SULFATE 4 GM/100ML IV SOLN [129652]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
47335099202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
|
|
MAGNESIUM SULFATE 4 GM/100ML IV SOLN [129652]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
47335099202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$0.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.04
|
| Rate for Payer: EmblemHealth Commercial |
$0.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.08
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
|
|
MAGNESIUM SULFATE 4 GM/100ML IV SOLN [129652]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
63323010600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: EmblemHealth Commercial |
$0.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
|
|
MAGNESIUM SULFATE 4 GRAMS/100 ML PREMIX
|
Facility
|
IP
|
$1.59
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
41644291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.80
|
|
|
MAGNESIUM SULFATE 4 GRAMS/100 ML PREMIX
|
Facility
|
IP
|
$1.59
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
41654291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.80
|
|
|
MAGNESIUM SULFATE 4 GRAMS/100 ML PREMIX
|
Facility
|
OP
|
$1.59
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
41644291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$0.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.91
|
| Rate for Payer: Group Health Inc Commercial |
$0.80
|
| Rate for Payer: Group Health Inc Medicare |
$0.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.68
|
| Rate for Payer: SOMOS Essential |
$0.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.03
|
|
|
MAGNESIUM SULFATE 4 GRAMS/100 ML PREMIX
|
Facility
|
OP
|
$1.59
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
41654291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$0.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.91
|
| Rate for Payer: Group Health Inc Commercial |
$0.80
|
| Rate for Payer: Group Health Inc Medicare |
$0.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.68
|
| Rate for Payer: SOMOS Essential |
$0.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.03
|
|
|
MAGNESIUM SULFATE 50% 20ML INJ
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
41658452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.04
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.68
|
| Rate for Payer: SOMOS Essential |
$0.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
|
|
MAGNESIUM SULFATE 50% 20ML INJ
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
41648452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.04
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.68
|
| Rate for Payer: SOMOS Essential |
$0.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
|
|
MAGNESIUM SULFATE 50% 20ML INJ
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
41648452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
|
|
MAGNESIUM SULFATE 50% 20ML INJ
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
41658452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
|
|
MAGNESIUM SULFATE 50 % IJ SOLN [4720]
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
63323064220
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$0.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.37
|
| Rate for Payer: Group Health Inc Commercial |
$0.27
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.35
|
|
|
MAGNESIUM SULFATE 50 % IJ SOLN [4720]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
00409216877
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$0.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.16
|
|
|
MAGNESIUM SULFATE 50 % IJ SOLN [4720]
|
Facility
|
OP
|
$1.19
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
63323006403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$0.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.81
|
| Rate for Payer: Group Health Inc Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Medicare |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.78
|
|
|
MAGNESIUM SULFATE 50 % IJ SOLN [4720]
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
63323006443
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$0.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.49
|
| Rate for Payer: Group Health Inc Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Medicare |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.47
|
|
|
MAGNESIUM SULFATE 50 % IJ SOLN [4720]
|
Facility
|
OP
|
$3.67
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
00409175410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$2.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.50
|
| Rate for Payer: Group Health Inc Commercial |
$1.84
|
| Rate for Payer: Group Health Inc Medicare |
$1.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.39
|
|
|
MAGNESIUM SULFATE 50 % IJ SOLN [4720]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
63323006411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$0.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.18
|
| Rate for Payer: Group Health Inc Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.17
|
|
