|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$10.46
|
|
|
Service Code
|
NDC 00536126328
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna Medicare |
$5.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: BCBS Complete |
$4.18
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Advantage |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.84
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health SBD |
$6.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.80
|
| Rate for Payer: UHC Core |
$5.45
|
| Rate for Payer: UHC Exchange |
$4.11
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$10.23
|
|
|
Service Code
|
NDC 16784011731
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$9.21 |
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Aetna Medicare |
$5.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.65
|
| Rate for Payer: BCBS Complete |
$4.09
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cofinity Advantage |
$7.16
|
| Rate for Payer: Cofinity Commercial |
$8.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.18
|
| Rate for Payer: Healthscope Commercial |
$9.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.67
|
| Rate for Payer: PHP Commercial |
$8.70
|
| Rate for Payer: Priority Health SBD |
$6.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.65
|
| Rate for Payer: UHC Core |
$5.33
|
| Rate for Payer: UHC Exchange |
$4.02
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$9.08
|
|
|
Service Code
|
NDC 70000054701
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$8.17 |
| Rate for Payer: Aetna Commercial |
$7.72
|
| Rate for Payer: Aetna Medicare |
$4.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.90
|
| Rate for Payer: BCBS Complete |
$3.63
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cofinity Advantage |
$6.36
|
| Rate for Payer: Cofinity Commercial |
$7.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.26
|
| Rate for Payer: Healthscope Commercial |
$8.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.81
|
| Rate for Payer: PHP Commercial |
$7.72
|
| Rate for Payer: Priority Health SBD |
$5.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.90
|
| Rate for Payer: UHC Core |
$4.73
|
| Rate for Payer: UHC Exchange |
$3.57
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$10.08
|
|
|
Service Code
|
NDC 61269010556
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$9.07 |
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: Aetna Medicare |
$5.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.55
|
| Rate for Payer: BCBS Complete |
$4.03
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Cofinity Advantage |
$7.06
|
| Rate for Payer: Cofinity Commercial |
$8.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.06
|
| Rate for Payer: Healthscope Commercial |
$9.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.56
|
| Rate for Payer: PHP Commercial |
$8.57
|
| Rate for Payer: Priority Health SBD |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.55
|
| Rate for Payer: UHC Core |
$5.25
|
| Rate for Payer: UHC Exchange |
$3.96
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$10.23
|
|
|
Service Code
|
NDC 16784011731
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$9.21 |
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.65
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cofinity Advantage |
$7.16
|
| Rate for Payer: Cofinity Commercial |
$8.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.18
|
| Rate for Payer: Healthscope Commercial |
$9.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.67
|
| Rate for Payer: PHP Commercial |
$8.70
|
| Rate for Payer: Priority Health SBD |
$6.44
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$10.08
|
|
|
Service Code
|
NDC 61269010556
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$9.07 |
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.55
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Cofinity Advantage |
$7.06
|
| Rate for Payer: Cofinity Commercial |
$8.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.06
|
| Rate for Payer: Healthscope Commercial |
$9.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.56
|
| Rate for Payer: PHP Commercial |
$8.57
|
| Rate for Payer: Priority Health SBD |
$6.35
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$15.80
|
|
|
Service Code
|
NDC 14428000944
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.21 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna Medicare |
$7.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.27
|
| Rate for Payer: BCBS Complete |
$6.32
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cofinity Advantage |
$11.06
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.85
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: Priority Health SBD |
$9.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.27
|
| Rate for Payer: UHC Core |
$8.23
|
| Rate for Payer: UHC Exchange |
$6.21
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$9.08
|
|
|
Service Code
|
NDC 70000054701
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$8.17 |
| Rate for Payer: Aetna Commercial |
$7.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.90
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cofinity Advantage |
$6.36
|
| Rate for Payer: Cofinity Commercial |
$7.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.26
|
| Rate for Payer: Healthscope Commercial |
$8.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.81
|
| Rate for Payer: PHP Commercial |
$7.72
|
| Rate for Payer: Priority Health SBD |
$5.72
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$15.80
|
|
|
Service Code
|
NDC 14428000944
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.27
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cofinity Advantage |
$11.06
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.85
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: Priority Health SBD |
$9.95
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$10.46
|
|
|
Service Code
|
NDC 00536126328
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Advantage |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.84
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health SBD |
$6.59
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT IN PACKET
|
Facility
|
OP
|
$1.27
|
|
|
Service Code
|
NDC 53329008986
|
| Hospital Charge Code |
113171
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna Commercial |
$1.08
|
| Rate for Payer: Aetna Medicare |
$0.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.83
|
| Rate for Payer: BCBS Complete |
$0.51
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cofinity Advantage |
$0.89
|
| Rate for Payer: Cofinity Commercial |
$1.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.02
|
| Rate for Payer: Healthscope Commercial |
$1.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.95
|
| Rate for Payer: PHP Commercial |
$1.08
|
| Rate for Payer: Priority Health SBD |
$0.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.83
|
| Rate for Payer: UHC Core |
$0.66
|
| Rate for Payer: UHC Exchange |
$0.50
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT IN PACKET
|
Facility
|
OP
|
$1.27
|
|
|
Service Code
|
NDC 53329008987
|
| Hospital Charge Code |
113171
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna Commercial |
$1.08
|
| Rate for Payer: Aetna Medicare |
$0.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.83
|
| Rate for Payer: BCBS Complete |
$0.51
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cofinity Advantage |
$0.89
|
| Rate for Payer: Cofinity Commercial |
$1.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.02
|
| Rate for Payer: Healthscope Commercial |
$1.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.95
|
| Rate for Payer: PHP Commercial |
$1.08
|
| Rate for Payer: Priority Health SBD |
$0.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.83
|
| Rate for Payer: UHC Core |
$0.66
|
| Rate for Payer: UHC Exchange |
$0.50
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT IN PACKET
|
Facility
|
IP
|
$1.27
|
|
|
Service Code
|
NDC 53329008986
|
| Hospital Charge Code |
113171
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna Commercial |
$1.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.83
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cofinity Advantage |
$0.89
|
| Rate for Payer: Cofinity Commercial |
$1.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.02
|
| Rate for Payer: Healthscope Commercial |
$1.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.95
|
| Rate for Payer: PHP Commercial |
$1.08
|
| Rate for Payer: Priority Health SBD |
$0.80
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT IN PACKET
|
Facility
|
IP
|
$2.17
|
|
|
Service Code
|
NDC 00904702367
|
| Hospital Charge Code |
113171
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.41
|
| Rate for Payer: Cash Price |
$1.74
|
| Rate for Payer: Cofinity Advantage |
$1.52
|
| Rate for Payer: Cofinity Commercial |
$1.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.74
|
| Rate for Payer: Healthscope Commercial |
$1.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.63
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health SBD |
$1.37
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT IN PACKET
|
Facility
|
IP
|
$1.27
|
|
|
Service Code
|
NDC 53329008987
|
| Hospital Charge Code |
113171
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna Commercial |
$1.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.83
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cofinity Advantage |
$0.89
|
| Rate for Payer: Cofinity Commercial |
$1.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.02
|
| Rate for Payer: Healthscope Commercial |
$1.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.95
|
| Rate for Payer: PHP Commercial |
$1.08
|
| Rate for Payer: Priority Health SBD |
$0.80
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT IN PACKET
|
Facility
|
OP
|
$2.17
|
|
|
Service Code
|
NDC 00904702367
|
| Hospital Charge Code |
113171
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna Medicare |
$1.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.41
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: Cash Price |
$1.74
|
| Rate for Payer: Cofinity Advantage |
$1.52
|
| Rate for Payer: Cofinity Commercial |
$1.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.74
|
| Rate for Payer: Healthscope Commercial |
$1.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.63
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health SBD |
$1.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.41
|
| Rate for Payer: UHC Core |
$1.13
|
| Rate for Payer: UHC Exchange |
$0.85
|
|
|
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC
|
Facility
|
IP
|
$38,473.39
|
|
|
Service Code
|
MSDRG 519
|
| Min. Negotiated Rate |
$15,235.15 |
| Max. Negotiated Rate |
$38,473.39 |
| Rate for Payer: Aetna Medicare |
$16,678.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,046.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,046.25
|
| Rate for Payer: BCBS MAPPO |
$16,037.00
|
| Rate for Payer: BCBS Trust/PPO |
$38,473.39
|
| Rate for Payer: BCN Commercial |
$38,473.39
|
| Rate for Payer: BCN Medicare Advantage |
$16,037.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,037.00
|
| Rate for Payer: Mclaren Medicare |
$16,037.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,838.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,442.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,640.70
|
| Rate for Payer: Nomi Health Commercial |
$25,802.58
|
| Rate for Payer: PACE Medicare |
$15,235.15
|
| Rate for Payer: PACE SWMI |
$16,037.00
|
| Rate for Payer: PHP Medicare Advantage |
$16,037.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$32,247.50
|
| Rate for Payer: Priority Health Medicare |
$16,037.00
|
| Rate for Payer: Priority Health Tiered Network |
$25,798.00
|
| Rate for Payer: Railroad Medicare Medicare |
$16,037.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,603.26
|
| Rate for Payer: UHC Core |
$27,276.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,037.00
|
| Rate for Payer: UHC Exchange |
$22,276.23
|
| Rate for Payer: VA VA |
$16,037.00
|
|
|
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR
|
Facility
|
IP
|
$60,917.99
|
|
|
Service Code
|
MSDRG 518
|
| Min. Negotiated Rate |
$27,988.62 |
| Max. Negotiated Rate |
$60,917.99 |
| Rate for Payer: Aetna Medicare |
$30,640.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36,827.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36,827.14
|
| Rate for Payer: BCBS MAPPO |
$29,461.71
|
| Rate for Payer: BCBS Trust/PPO |
$55,598.68
|
| Rate for Payer: BCN Commercial |
$55,598.68
|
| Rate for Payer: BCN Medicare Advantage |
$29,461.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29,461.71
|
| Rate for Payer: Mclaren Medicare |
$29,461.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30,934.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33,880.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$32,407.88
|
| Rate for Payer: Nomi Health Commercial |
$48,211.17
|
| Rate for Payer: PACE Medicare |
$27,988.62
|
| Rate for Payer: PACE SWMI |
$29,461.71
|
| Rate for Payer: PHP Medicare Advantage |
$29,461.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$60,253.27
|
| Rate for Payer: Priority Health Medicare |
$29,461.71
|
| Rate for Payer: Priority Health Tiered Network |
$48,202.61
|
| Rate for Payer: Railroad Medicare Medicare |
$29,461.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60,917.99
|
| Rate for Payer: UHC Core |
$50,965.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29,461.71
|
| Rate for Payer: UHC Exchange |
$41,622.31
|
| Rate for Payer: VA VA |
$29,461.71
|
|
|
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$30,505.31
|
|
|
Service Code
|
MSDRG 520
|
| Min. Negotiated Rate |
$11,517.99 |
| Max. Negotiated Rate |
$30,505.31 |
| Rate for Payer: Aetna Medicare |
$12,609.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,155.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,155.25
|
| Rate for Payer: BCBS MAPPO |
$12,124.20
|
| Rate for Payer: BCBS Trust/PPO |
$30,505.31
|
| Rate for Payer: BCN Commercial |
$30,505.31
|
| Rate for Payer: BCN Medicare Advantage |
$12,124.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,124.20
|
| Rate for Payer: Mclaren Medicare |
$12,124.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,730.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,942.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,336.62
|
| Rate for Payer: Nomi Health Commercial |
$19,271.31
|
| Rate for Payer: PACE Medicare |
$11,517.99
|
| Rate for Payer: PACE SWMI |
$12,124.20
|
| Rate for Payer: PHP Medicare Advantage |
$12,124.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24,084.86
|
| Rate for Payer: Priority Health Medicare |
$12,124.20
|
| Rate for Payer: Priority Health Tiered Network |
$19,267.89
|
| Rate for Payer: Railroad Medicare Medicare |
$12,124.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,350.57
|
| Rate for Payer: UHC Core |
$20,372.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,124.20
|
| Rate for Payer: UHC Exchange |
$16,637.56
|
| Rate for Payer: VA VA |
$12,124.20
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
IP
|
$3.91
|
|
|
Service Code
|
NDC 60687081511
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$3.52 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.54
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Cofinity Advantage |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$3.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.13
|
| Rate for Payer: Healthscope Commercial |
$3.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.93
|
| Rate for Payer: PHP Commercial |
$3.32
|
| Rate for Payer: Priority Health SBD |
$2.46
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
OP
|
$3.91
|
|
|
Service Code
|
NDC 60687081511
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.52 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Aetna Medicare |
$1.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.54
|
| Rate for Payer: BCBS Complete |
$1.56
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Cofinity Advantage |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$3.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.13
|
| Rate for Payer: Healthscope Commercial |
$3.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.93
|
| Rate for Payer: PHP Commercial |
$3.32
|
| Rate for Payer: Priority Health SBD |
$2.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.54
|
| Rate for Payer: UHC Core |
$2.04
|
| Rate for Payer: UHC Exchange |
$1.54
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
OP
|
$3.90
|
|
|
Service Code
|
NDC 58657093110
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Aetna Medicare |
$1.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.54
|
| Rate for Payer: BCBS Complete |
$1.56
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cofinity Advantage |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$3.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.12
|
| Rate for Payer: Healthscope Commercial |
$3.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.92
|
| Rate for Payer: PHP Commercial |
$3.31
|
| Rate for Payer: Priority Health SBD |
$2.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.54
|
| Rate for Payer: UHC Core |
$2.03
|
| Rate for Payer: UHC Exchange |
$1.53
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
IP
|
$96.35
|
|
|
Service Code
|
NDC 72888001001
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.70 |
| Max. Negotiated Rate |
$86.72 |
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.63
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Cofinity Advantage |
$67.44
|
| Rate for Payer: Cofinity Commercial |
$82.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Healthscope Commercial |
$86.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.26
|
| Rate for Payer: PHP Commercial |
$81.90
|
| Rate for Payer: Priority Health SBD |
$60.70
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
OP
|
$389.50
|
|
|
Service Code
|
NDC 58657093101
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.07 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Aetna Commercial |
$331.07
|
| Rate for Payer: Aetna Medicare |
$194.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.18
|
| Rate for Payer: BCBS Complete |
$155.80
|
| Rate for Payer: Cash Price |
$311.60
|
| Rate for Payer: Cofinity Advantage |
$272.65
|
| Rate for Payer: Cofinity Commercial |
$334.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.60
|
| Rate for Payer: Healthscope Commercial |
$350.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$311.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.12
|
| Rate for Payer: PHP Commercial |
$331.07
|
| Rate for Payer: Priority Health SBD |
$245.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.18
|
| Rate for Payer: UHC Core |
$202.93
|
| Rate for Payer: UHC Exchange |
$153.07
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
IP
|
$3.35
|
|
|
Service Code
|
NDC 50268010611
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna Commercial |
$2.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.18
|
| Rate for Payer: Cash Price |
$2.68
|
| Rate for Payer: Cofinity Advantage |
$2.35
|
| Rate for Payer: Cofinity Commercial |
$2.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.68
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.51
|
| Rate for Payer: PHP Commercial |
$2.85
|
| Rate for Payer: Priority Health SBD |
$2.11
|
|
