|
MAGNESIUM 2GM IVPB (500MGV)
|
Facility
|
IP
|
$113.78
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
25002435
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.13 |
| Max. Negotiated Rate |
$109.23 |
| Rate for Payer: Aetna Commercial |
$87.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.75
|
| Rate for Payer: Cash Price |
$56.89
|
| Rate for Payer: Cigna Commercial |
$94.44
|
| Rate for Payer: First Health Commercial |
$108.09
|
| Rate for Payer: Humana Commercial |
$96.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.13
|
| Rate for Payer: Ohio Health Group HMO |
$85.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.51
|
| Rate for Payer: PHCS Commercial |
$109.23
|
| Rate for Payer: United Healthcare All Payer |
$100.13
|
|
|
MAGNESIUM 2GM IVPB (500MGV)
|
Facility
|
OP
|
$113.78
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
25002435
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.13 |
| Max. Negotiated Rate |
$109.23 |
| Rate for Payer: Aetna Commercial |
$87.61
|
| Rate for Payer: Anthem Medicaid |
$39.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.75
|
| Rate for Payer: Cash Price |
$56.89
|
| Rate for Payer: Cigna Commercial |
$94.44
|
| Rate for Payer: First Health Commercial |
$108.09
|
| Rate for Payer: Humana Commercial |
$96.71
|
| Rate for Payer: Humana KY Medicaid |
$39.13
|
| Rate for Payer: Kentucky WC Medicaid |
$39.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.13
|
| Rate for Payer: Ohio Health Group HMO |
$85.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.51
|
| Rate for Payer: PHCS Commercial |
$109.23
|
| Rate for Payer: United Healthcare All Payer |
$100.13
|
|
|
MAGNESIUM 4GM/50ML IVPB
|
Facility
|
OP
|
$115.11
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
25003198
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.53 |
| Max. Negotiated Rate |
$110.51 |
| Rate for Payer: Aetna Commercial |
$88.63
|
| Rate for Payer: Anthem Medicaid |
$39.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.79
|
| Rate for Payer: Cash Price |
$57.56
|
| Rate for Payer: Cigna Commercial |
$95.54
|
| Rate for Payer: First Health Commercial |
$109.35
|
| Rate for Payer: Humana Commercial |
$97.84
|
| Rate for Payer: Humana KY Medicaid |
$39.59
|
| Rate for Payer: Kentucky WC Medicaid |
$39.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.30
|
| Rate for Payer: Ohio Health Group HMO |
$86.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.43
|
| Rate for Payer: PHCS Commercial |
$110.51
|
| Rate for Payer: United Healthcare All Payer |
$101.30
|
|
|
MAGNESIUM 4GM/50ML IVPB
|
Facility
|
IP
|
$115.11
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
25003198
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.53 |
| Max. Negotiated Rate |
$110.51 |
| Rate for Payer: Aetna Commercial |
$88.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.79
|
| Rate for Payer: Cash Price |
$57.56
|
| Rate for Payer: Cigna Commercial |
$95.54
|
| Rate for Payer: First Health Commercial |
$109.35
|
| Rate for Payer: Humana Commercial |
$97.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.30
|
| Rate for Payer: Ohio Health Group HMO |
$86.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.43
|
| Rate for Payer: PHCS Commercial |
$110.51
|
| Rate for Payer: United Healthcare All Payer |
$101.30
|
|
|
MAGNESIUM 500MG [10GM/50ML]
|
Facility
|
IP
|
$122.29
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
25003853
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$117.40 |
| Rate for Payer: Aetna Commercial |
$94.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.39
|
| Rate for Payer: Cash Price |
$61.15
|
| Rate for Payer: Cigna Commercial |
$101.50
|
| Rate for Payer: First Health Commercial |
$116.18
|
| Rate for Payer: Humana Commercial |
$103.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.62
|
| Rate for Payer: Ohio Health Group HMO |
$91.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.38
|
| Rate for Payer: PHCS Commercial |
$117.40
|
| Rate for Payer: United Healthcare All Payer |
$107.62
|
|
|
MAGNESIUM 500MG [10GM/50ML]
|
Facility
|
OP
|
$122.29
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
25003853
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$117.40 |
| Rate for Payer: Aetna Commercial |
$94.16
|
| Rate for Payer: Anthem Medicaid |
$42.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.39
|
| Rate for Payer: Cash Price |
$61.15
|
| Rate for Payer: Cigna Commercial |
$101.50
|
| Rate for Payer: First Health Commercial |
$116.18
|
| Rate for Payer: Humana Commercial |
$103.95
|
| Rate for Payer: Humana KY Medicaid |
$42.06
|
| Rate for Payer: Kentucky WC Medicaid |
$42.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.62
|
| Rate for Payer: Ohio Health Group HMO |
$91.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.38
|
| Rate for Payer: PHCS Commercial |
$117.40
|
| Rate for Payer: United Healthcare All Payer |
$107.62
|
|
|
MAGNESIUM - BLOOD
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 83735
|
| Hospital Charge Code |
30000449
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: Aetna Commercial |
$51.59
|
| Rate for Payer: Anthem Medicaid |
$6.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.70
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$55.61
|
| Rate for Payer: First Health Commercial |
$63.65
|
| Rate for Payer: Humana Commercial |
$56.95
|
| Rate for Payer: Humana KY Medicaid |
$6.70
|
| Rate for Payer: Humana Medicare Advantage |
$6.70
|
| Rate for Payer: Kentucky WC Medicaid |
$6.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.96
|
| Rate for Payer: Ohio Health Group HMO |
$50.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.23
|
| Rate for Payer: PHCS Commercial |
$64.32
|
| Rate for Payer: United Healthcare All Payer |
$58.96
|
|
|
MAGNESIUM - BLOOD
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 83735
|
| Hospital Charge Code |
30000449
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$40.20 |
| Rate for Payer: Aetna Commercial |
$13.48
|
| Rate for Payer: Ambetter Exchange |
$6.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$6.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$6.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.04
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$6.00
|
| Rate for Payer: Healthspan PPO |
$6.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$6.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.70
|
| Rate for Payer: Multiplan PHCS |
$40.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8.71
|
| Rate for Payer: UHCCP Medicaid |
$23.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.70
|
|
|
MAGNESIUM - BLOOD
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 83735
|
| Hospital Charge Code |
30000449
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.10 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: Aetna Commercial |
$51.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.80
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$55.61
|
| Rate for Payer: First Health Commercial |
$63.65
|
| Rate for Payer: Humana Commercial |
$56.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.96
|
| Rate for Payer: Ohio Health Group HMO |
$50.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.23
|
| Rate for Payer: PHCS Commercial |
$64.32
|
| Rate for Payer: United Healthcare All Payer |
$58.96
|
|
|
MAGNESIUM CITRATE 10 OZ 10OZ
|
Facility
|
IP
|
$10.96
|
|
|
Service Code
|
NDC 869016638
|
| Hospital Charge Code |
25000938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$10.52 |
| Rate for Payer: Aetna Commercial |
$8.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.55
|
| Rate for Payer: Cash Price |
$5.48
|
| Rate for Payer: Cigna Commercial |
$9.10
|
| Rate for Payer: First Health Commercial |
$10.41
|
| Rate for Payer: Humana Commercial |
$9.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.64
|
| Rate for Payer: Ohio Health Group HMO |
$8.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.56
|
| Rate for Payer: PHCS Commercial |
$10.52
|
| Rate for Payer: United Healthcare All Payer |
$9.64
|
|
|
MAGNESIUM CITRATE 10 OZ 10OZ
|
Facility
|
OP
|
$10.96
|
|
|
Service Code
|
NDC 869016638
|
| Hospital Charge Code |
25000938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$10.52 |
| Rate for Payer: Aetna Commercial |
$8.44
|
| Rate for Payer: Anthem Medicaid |
$3.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.55
|
| Rate for Payer: Cash Price |
$5.48
|
| Rate for Payer: Cigna Commercial |
$9.10
|
| Rate for Payer: First Health Commercial |
$10.41
|
| Rate for Payer: Humana Commercial |
$9.32
|
| Rate for Payer: Humana KY Medicaid |
$3.77
|
| Rate for Payer: Kentucky WC Medicaid |
$3.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.64
|
| Rate for Payer: Ohio Health Group HMO |
$8.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.56
|
| Rate for Payer: PHCS Commercial |
$10.52
|
| Rate for Payer: United Healthcare All Payer |
$9.64
|
|
|
MAGNESIUM SULF 0.5GM[50% 5GM
|
Facility
|
OP
|
$78.17
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
25002437
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.45 |
| Max. Negotiated Rate |
$75.04 |
| Rate for Payer: Aetna Commercial |
$60.19
|
| Rate for Payer: Anthem Medicaid |
$26.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.97
|
| Rate for Payer: Cash Price |
$39.08
|
| Rate for Payer: Cigna Commercial |
$64.88
|
| Rate for Payer: First Health Commercial |
$74.26
|
| Rate for Payer: Humana Commercial |
$66.44
|
| Rate for Payer: Humana KY Medicaid |
$26.88
|
| Rate for Payer: Kentucky WC Medicaid |
$27.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.79
|
| Rate for Payer: Ohio Health Group HMO |
$58.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.94
|
| Rate for Payer: PHCS Commercial |
$75.04
|
| Rate for Payer: United Healthcare All Payer |
$68.79
|
|
|
MAGNESIUM SULF 0.5GM[50% 5GM
|
Facility
|
IP
|
$78.17
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
25002437
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.45 |
| Max. Negotiated Rate |
$75.04 |
| Rate for Payer: Aetna Commercial |
$60.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.97
|
| Rate for Payer: Cash Price |
$39.08
|
| Rate for Payer: Cigna Commercial |
$64.88
|
| Rate for Payer: First Health Commercial |
$74.26
|
| Rate for Payer: Humana Commercial |
$66.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.79
|
| Rate for Payer: Ohio Health Group HMO |
$58.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.94
|
| Rate for Payer: PHCS Commercial |
$75.04
|
| Rate for Payer: United Healthcare All Payer |
$68.79
|
|
|
MAGNESIUM SULF 6 GM/D5W 100ML
|
Facility
|
IP
|
$112.68
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
25002441
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$108.17 |
| Rate for Payer: Aetna Commercial |
$86.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.89
|
| Rate for Payer: Cash Price |
$56.34
|
| Rate for Payer: Cigna Commercial |
$93.52
|
| Rate for Payer: First Health Commercial |
$107.05
|
| Rate for Payer: Humana Commercial |
$95.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.16
|
| Rate for Payer: Ohio Health Group HMO |
$84.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.75
|
| Rate for Payer: PHCS Commercial |
$108.17
|
| Rate for Payer: United Healthcare All Payer |
$99.16
|
|
|
MAGNESIUM SULF 6 GM/D5W 100ML
|
Facility
|
OP
|
$112.68
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
25002441
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$108.17 |
| Rate for Payer: Aetna Commercial |
$86.76
|
| Rate for Payer: Anthem Medicaid |
$38.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.89
|
| Rate for Payer: Cash Price |
$56.34
|
| Rate for Payer: Cigna Commercial |
$93.52
|
| Rate for Payer: First Health Commercial |
$107.05
|
| Rate for Payer: Humana Commercial |
$95.78
|
| Rate for Payer: Humana KY Medicaid |
$38.75
|
| Rate for Payer: Kentucky WC Medicaid |
$39.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.16
|
| Rate for Payer: Ohio Health Group HMO |
$84.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.75
|
| Rate for Payer: PHCS Commercial |
$108.17
|
| Rate for Payer: United Healthcare All Payer |
$99.16
|
|
|
MAGNESIUM SULFATE 1GM/2ML VIAL
|
Facility
|
OP
|
$77.58
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
25002438
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.27 |
| Max. Negotiated Rate |
$74.48 |
| Rate for Payer: Aetna Commercial |
$59.74
|
| Rate for Payer: Aetna Commercial |
$60.27
|
| Rate for Payer: Anthem Medicaid |
$26.68
|
| Rate for Payer: Anthem Medicaid |
$26.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.05
|
| Rate for Payer: Cash Price |
$38.79
|
| Rate for Payer: Cash Price |
$39.13
|
| Rate for Payer: Cigna Commercial |
$64.96
|
| Rate for Payer: Cigna Commercial |
$64.39
|
| Rate for Payer: First Health Commercial |
$74.36
|
| Rate for Payer: First Health Commercial |
$73.70
|
| Rate for Payer: Humana Commercial |
$65.94
|
| Rate for Payer: Humana Commercial |
$66.53
|
| Rate for Payer: Humana KY Medicaid |
$26.68
|
| Rate for Payer: Humana KY Medicaid |
$26.92
|
| Rate for Payer: Kentucky WC Medicaid |
$27.19
|
| Rate for Payer: Kentucky WC Medicaid |
$26.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.88
|
| Rate for Payer: Ohio Health Group HMO |
$58.19
|
| Rate for Payer: Ohio Health Group HMO |
$58.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.01
|
| Rate for Payer: PHCS Commercial |
$75.14
|
| Rate for Payer: PHCS Commercial |
$74.48
|
| Rate for Payer: United Healthcare All Payer |
$68.88
|
| Rate for Payer: United Healthcare All Payer |
$68.27
|
|
|
MAGNESIUM SULFATE 1GM/2ML VIAL
|
Facility
|
IP
|
$77.58
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
25002438
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.27 |
| Max. Negotiated Rate |
$74.48 |
| Rate for Payer: Aetna Commercial |
$59.74
|
| Rate for Payer: Aetna Commercial |
$60.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.05
|
| Rate for Payer: Cash Price |
$38.79
|
| Rate for Payer: Cash Price |
$39.13
|
| Rate for Payer: Cigna Commercial |
$64.39
|
| Rate for Payer: Cigna Commercial |
$64.96
|
| Rate for Payer: First Health Commercial |
$74.36
|
| Rate for Payer: First Health Commercial |
$73.70
|
| Rate for Payer: Humana Commercial |
$66.53
|
| Rate for Payer: Humana Commercial |
$65.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.88
|
| Rate for Payer: Ohio Health Group HMO |
$58.19
|
| Rate for Payer: Ohio Health Group HMO |
$58.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.53
|
| Rate for Payer: PHCS Commercial |
$74.48
|
| Rate for Payer: PHCS Commercial |
$75.14
|
| Rate for Payer: United Healthcare All Payer |
$68.27
|
| Rate for Payer: United Healthcare All Payer |
$68.88
|
|
|
MAGNESIUM SULFATE 4GM/100ML IV
|
Facility
|
IP
|
$79.52
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
25002439
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$76.34 |
| Rate for Payer: Aetna Commercial |
$61.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.03
|
| Rate for Payer: Cash Price |
$39.76
|
| Rate for Payer: Cigna Commercial |
$66.00
|
| Rate for Payer: First Health Commercial |
$75.54
|
| Rate for Payer: Humana Commercial |
$67.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.98
|
| Rate for Payer: Ohio Health Group HMO |
$59.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.87
|
| Rate for Payer: PHCS Commercial |
$76.34
|
| Rate for Payer: United Healthcare All Payer |
$69.98
|
|
|
MAGNESIUM SULFATE 4GM/100ML IV
|
Facility
|
OP
|
$79.52
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
25002439
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$76.34 |
| Rate for Payer: Aetna Commercial |
$61.23
|
| Rate for Payer: Anthem Medicaid |
$27.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.03
|
| Rate for Payer: Cash Price |
$39.76
|
| Rate for Payer: Cigna Commercial |
$66.00
|
| Rate for Payer: First Health Commercial |
$75.54
|
| Rate for Payer: Humana Commercial |
$67.59
|
| Rate for Payer: Humana KY Medicaid |
$27.35
|
| Rate for Payer: Kentucky WC Medicaid |
$27.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.98
|
| Rate for Payer: Ohio Health Group HMO |
$59.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.87
|
| Rate for Payer: PHCS Commercial |
$76.34
|
| Rate for Payer: United Healthcare All Payer |
$69.98
|
|
|
MAGNETIC RESONANCE SPECTRO
|
Facility
|
OP
|
$2,674.00
|
|
|
Service Code
|
HCPCS 76390
|
| Hospital Charge Code |
61000047
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$2,567.04 |
| Rate for Payer: Aetna Commercial |
$2,058.98
|
| Rate for Payer: Anthem Medicaid |
$919.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,085.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$1,337.00
|
| Rate for Payer: Cash Price |
$1,337.00
|
| Rate for Payer: Cigna Commercial |
$2,219.42
|
| Rate for Payer: First Health Commercial |
$2,540.30
|
| Rate for Payer: Humana Commercial |
$2,272.90
|
| Rate for Payer: Humana KY Medicaid |
$919.59
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$928.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,192.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,973.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$938.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,353.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,005.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,326.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,845.06
|
| Rate for Payer: PHCS Commercial |
$2,567.04
|
| Rate for Payer: United Healthcare All Payer |
$2,353.12
|
|
|
MAGNETIC RESONANCE SPECTRO
|
Facility
|
IP
|
$2,674.00
|
|
|
Service Code
|
HCPCS 76390
|
| Hospital Charge Code |
61000047
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$802.20 |
| Max. Negotiated Rate |
$2,567.04 |
| Rate for Payer: Aetna Commercial |
$2,058.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,085.72
|
| Rate for Payer: Cash Price |
$1,337.00
|
| Rate for Payer: Cigna Commercial |
$2,219.42
|
| Rate for Payer: First Health Commercial |
$2,540.30
|
| Rate for Payer: Humana Commercial |
$2,272.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,192.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,973.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$802.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,353.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,005.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,326.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,845.06
|
| Rate for Payer: PHCS Commercial |
$2,567.04
|
| Rate for Payer: United Healthcare All Payer |
$2,353.12
|
|
|
MAGNETIC RESONANCE SPECTRO
|
Professional
|
Both
|
$2,674.00
|
|
|
Service Code
|
HCPCS 76390
|
| Hospital Charge Code |
61000047
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.95 |
| Max. Negotiated Rate |
$1,871.80 |
| Rate for Payer: Aetna Commercial |
$702.60
|
| Rate for Payer: Anthem Medicaid |
$351.96
|
| Rate for Payer: Cash Price |
$1,337.00
|
| Rate for Payer: Cash Price |
$1,337.00
|
| Rate for Payer: Cigna Commercial |
$715.05
|
| Rate for Payer: Healthspan PPO |
$472.86
|
| Rate for Payer: Humana Medicaid |
$351.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$359.00
|
| Rate for Payer: Molina Healthcare Passport |
$351.96
|
| Rate for Payer: Multiplan PHCS |
$1,604.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,871.80
|
| Rate for Payer: UHCCP Medicaid |
$935.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$355.48
|
|
|
MAGNETIC RESONANCE SPECTRO(P
|
Professional
|
Both
|
$200.00
|
|
| Hospital Charge Code |
610P0047
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
|
|
MAGNETIC RESONANCE SPECTRO(T
|
Facility
|
OP
|
$2,474.00
|
|
|
Service Code
|
HCPCS 76390
|
| Hospital Charge Code |
610T0047
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$2,375.04 |
| Rate for Payer: Aetna Commercial |
$1,904.98
|
| Rate for Payer: Anthem Medicaid |
$850.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,929.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$1,237.00
|
| Rate for Payer: Cash Price |
$1,237.00
|
| Rate for Payer: Cigna Commercial |
$2,053.42
|
| Rate for Payer: First Health Commercial |
$2,350.30
|
| Rate for Payer: Humana Commercial |
$2,102.90
|
| Rate for Payer: Humana KY Medicaid |
$850.81
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$859.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,028.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,825.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$867.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,177.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,855.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,152.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,707.06
|
| Rate for Payer: PHCS Commercial |
$2,375.04
|
| Rate for Payer: United Healthcare All Payer |
$2,177.12
|
|
|
MAGNETIC RESONANCE SPECTRO(T
|
Facility
|
IP
|
$2,474.00
|
|
|
Service Code
|
HCPCS 76390
|
| Hospital Charge Code |
610T0047
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$742.20 |
| Max. Negotiated Rate |
$2,375.04 |
| Rate for Payer: Aetna Commercial |
$1,904.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,929.72
|
| Rate for Payer: Cash Price |
$1,237.00
|
| Rate for Payer: Cigna Commercial |
$2,053.42
|
| Rate for Payer: First Health Commercial |
$2,350.30
|
| Rate for Payer: Humana Commercial |
$2,102.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,028.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,825.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$742.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,177.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,855.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,152.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,707.06
|
| Rate for Payer: PHCS Commercial |
$2,375.04
|
| Rate for Payer: United Healthcare All Payer |
$2,177.12
|
|
