Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

AZTREONAM 2 GRAM SOLUTION FOR INJECTION

Facility

$196.28

Service Code	HCPCS J0457
Hospital Charge Code	9186
Hospital Revenue Code	636
Min. Negotiated Rate	$123.66
Max. Negotiated Rate	$176.65
Rate for Payer: Aetna Commercial	$166.84
Rate for Payer: Aetna Commercial	$158.55
Rate for Payer: Aetna New Business (MI Preferred)	$127.58
Rate for Payer: Aetna New Business (MI Preferred)	$121.24
Rate for Payer: Cash Price	$157.02
Rate for Payer: Cash Price	$149.22
Rate for Payer: Cofinity Commercial	$168.80
Rate for Payer: Cofinity Commercial	$130.57
Rate for Payer: Cofinity Commercial	$160.42
Rate for Payer: Cofinity Commercial	$137.40
Rate for Payer: Cofinity Medicare Advantage	$130.57
Rate for Payer: Cofinity Medicare Advantage	$137.40
Rate for Payer: Encore Health Key Benefits Commercial	$149.22
Rate for Payer: Encore Health Key Benefits Commercial	$157.02
Rate for Payer: Healthscope Commercial	$176.65
Rate for Payer: Healthscope Commercial	$167.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$166.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$158.55
Rate for Payer: PHP Commercial	$158.55
Rate for Payer: PHP Commercial	$166.84
Rate for Payer: Priority Health Cigna Priority Health	$121.24
Rate for Payer: Priority Health Cigna Priority Health	$127.58
Rate for Payer: Priority Health SBD	$123.66
Rate for Payer: Priority Health SBD	$117.51

AZTREONAM 2 GRAM SOLUTION FOR INJECTION

Facility

$186.53

Service Code	HCPCS J0457
Hospital Charge Code	9186
Hospital Revenue Code	636
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$167.88
Rate for Payer: Aetna Commercial	$158.55
Rate for Payer: Aetna Commercial	$166.84
Rate for Payer: Aetna Medicare	$98.14
Rate for Payer: Aetna Medicare	$93.26
Rate for Payer: Aetna New Business (MI Preferred)	$121.24
Rate for Payer: Aetna New Business (MI Preferred)	$127.58
Rate for Payer: BCBS Complete	$78.51
Rate for Payer: BCBS Complete	$74.61
Rate for Payer: BCBS Trust/PPO	$5.57
Rate for Payer: BCBS Trust/PPO	$5.57
Rate for Payer: BCN Commercial	$5.57
Rate for Payer: BCN Commercial	$5.57
Rate for Payer: Cash Price	$157.02
Rate for Payer: Cash Price	$149.22
Rate for Payer: Cash Price	$149.22
Rate for Payer: Cash Price	$157.02
Rate for Payer: Cofinity Commercial	$160.42
Rate for Payer: Cofinity Commercial	$130.57
Rate for Payer: Cofinity Commercial	$137.40
Rate for Payer: Cofinity Commercial	$168.80
Rate for Payer: Cofinity Medicare Advantage	$130.57
Rate for Payer: Cofinity Medicare Advantage	$137.40
Rate for Payer: Encore Health Key Benefits Commercial	$149.22
Rate for Payer: Encore Health Key Benefits Commercial	$157.02
Rate for Payer: Healthscope Commercial	$176.65
Rate for Payer: Healthscope Commercial	$167.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$166.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$158.55
Rate for Payer: PHP Commercial	$166.84
Rate for Payer: PHP Commercial	$158.55
Rate for Payer: Priority Health Cigna Priority Health	$127.58
Rate for Payer: Priority Health Cigna Priority Health	$121.24
Rate for Payer: Priority Health SBD	$123.66
Rate for Payer: Priority Health SBD	$117.51

AZTREONAM 2 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS COMPONENT CUSTOM

Facility

$186.53

Service Code	HCPCS J0457
Hospital Charge Code	301706
Hospital Revenue Code	636
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$167.88
Rate for Payer: Aetna Commercial	$158.55
Rate for Payer: Aetna Medicare	$93.26
Rate for Payer: Aetna New Business (MI Preferred)	$121.24
Rate for Payer: BCBS Complete	$74.61
Rate for Payer: BCBS Trust/PPO	$5.57
Rate for Payer: BCN Commercial	$5.57
Rate for Payer: Cash Price	$149.22
Rate for Payer: Cash Price	$149.22
Rate for Payer: Cofinity Commercial	$130.57
Rate for Payer: Cofinity Commercial	$160.42
Rate for Payer: Cofinity Medicare Advantage	$130.57
Rate for Payer: Encore Health Key Benefits Commercial	$149.22
Rate for Payer: Healthscope Commercial	$167.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$158.55
Rate for Payer: PHP Commercial	$158.55
Rate for Payer: Priority Health Cigna Priority Health	$121.24
Rate for Payer: Priority Health SBD	$117.51

AZTREONAM 2 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS COMPONENT CUSTOM

Facility

$186.53

Service Code	HCPCS J0457
Hospital Charge Code	301706
Hospital Revenue Code	636
Min. Negotiated Rate	$117.51
Max. Negotiated Rate	$167.88
Rate for Payer: Aetna Commercial	$158.55
Rate for Payer: Aetna New Business (MI Preferred)	$121.24
Rate for Payer: Cash Price	$149.22
Rate for Payer: Cofinity Commercial	$130.57
Rate for Payer: Cofinity Commercial	$160.42
Rate for Payer: Cofinity Medicare Advantage	$130.57
Rate for Payer: Encore Health Key Benefits Commercial	$149.22
Rate for Payer: Healthscope Commercial	$167.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$158.55
Rate for Payer: PHP Commercial	$158.55
Rate for Payer: Priority Health Cigna Priority Health	$121.24
Rate for Payer: Priority Health SBD	$117.51

BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT

Facility

$10.08

Service Code	NDC 61269010556
Hospital Charge Code	13818
Hospital Revenue Code	637
Min. Negotiated Rate	$4.03
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 Commercial	$7.06
Rate for Payer: Cofinity Commercial	$8.67
Rate for Payer: Cofinity Medicare Advantage	$7.06
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: PHP Commercial	$8.57
Rate for Payer: Priority Health Cigna Priority Health	$6.55
Rate for Payer: Priority Health SBD	$6.35

BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT

Facility

$10.92

Service Code	NDC 70000054701
Hospital Charge Code	13818
Hospital Revenue Code	637
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$9.83
Rate for Payer: Aetna Commercial	$9.28
Rate for Payer: Aetna New Business (MI Preferred)	$7.10
Rate for Payer: Cash Price	$8.74
Rate for Payer: Cofinity Commercial	$7.64
Rate for Payer: Cofinity Commercial	$9.39
Rate for Payer: Cofinity Medicare Advantage	$7.64
Rate for Payer: Encore Health Key Benefits Commercial	$8.74
Rate for Payer: Healthscope Commercial	$9.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.28
Rate for Payer: PHP Commercial	$9.28
Rate for Payer: Priority Health Cigna Priority Health	$7.10
Rate for Payer: Priority Health SBD	$6.88

BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT

Facility

$10.92

Service Code	NDC 70000054701
Hospital Charge Code	13818
Hospital Revenue Code	637
Min. Negotiated Rate	$4.37
Max. Negotiated Rate	$9.83
Rate for Payer: Aetna Commercial	$9.28
Rate for Payer: Aetna Medicare	$5.46
Rate for Payer: Aetna New Business (MI Preferred)	$7.10
Rate for Payer: BCBS Complete	$4.37
Rate for Payer: Cash Price	$8.74
Rate for Payer: Cofinity Commercial	$7.64
Rate for Payer: Cofinity Commercial	$9.39
Rate for Payer: Cofinity Medicare Advantage	$7.64
Rate for Payer: Encore Health Key Benefits Commercial	$8.74
Rate for Payer: Healthscope Commercial	$9.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.28
Rate for Payer: PHP Commercial	$9.28
Rate for Payer: Priority Health Cigna Priority Health	$7.10
Rate for Payer: Priority Health SBD	$6.88

BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT

Facility

$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 Commercial	$7.06
Rate for Payer: Cofinity Commercial	$8.67
Rate for Payer: Cofinity Medicare Advantage	$7.06
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: PHP Commercial	$8.57
Rate for Payer: Priority Health Cigna Priority Health	$6.55
Rate for Payer: Priority Health SBD	$6.35

BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT

Facility

$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 Commercial	$7.32
Rate for Payer: Cofinity Commercial	$9.00
Rate for Payer: Cofinity Medicare Advantage	$7.32
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: PHP Commercial	$8.89
Rate for Payer: Priority Health Cigna Priority Health	$6.80
Rate for Payer: Priority Health SBD	$6.59

BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT

Facility

$15.80

Service Code	NDC 14428000944
Hospital Charge Code	13818
Hospital Revenue Code	637
Min. Negotiated Rate	$6.32
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 Commercial	$11.06
Rate for Payer: Cofinity Commercial	$13.59
Rate for Payer: Cofinity Medicare Advantage	$11.06
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: PHP Commercial	$13.43
Rate for Payer: Priority Health Cigna Priority Health	$10.27
Rate for Payer: Priority Health SBD	$9.95

BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT

Facility

$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 Commercial	$7.16
Rate for Payer: Cofinity Commercial	$8.80
Rate for Payer: Cofinity Medicare Advantage	$7.16
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: PHP Commercial	$8.70
Rate for Payer: Priority Health Cigna Priority Health	$6.65
Rate for Payer: Priority Health SBD	$6.44

BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT

Facility

$10.23

Service Code	NDC 16784011731
Hospital Charge Code	13818
Hospital Revenue Code	637
Min. Negotiated Rate	$4.09
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 Commercial	$7.16
Rate for Payer: Cofinity Commercial	$8.80
Rate for Payer: Cofinity Medicare Advantage	$7.16
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: PHP Commercial	$8.70
Rate for Payer: Priority Health Cigna Priority Health	$6.65
Rate for Payer: Priority Health SBD	$6.44

BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT

Facility

$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 Commercial	$11.06
Rate for Payer: Cofinity Commercial	$13.59
Rate for Payer: Cofinity Medicare Advantage	$11.06
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: PHP Commercial	$13.43
Rate for Payer: Priority Health Cigna Priority Health	$10.27
Rate for Payer: Priority Health SBD	$9.95

BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT

Facility

$10.46

Service Code	NDC 00536126328
Hospital Charge Code	13818
Hospital Revenue Code	637
Min. Negotiated Rate	$4.18
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 Commercial	$7.32
Rate for Payer: Cofinity Commercial	$9.00
Rate for Payer: Cofinity Medicare Advantage	$7.32
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: PHP Commercial	$8.89
Rate for Payer: Priority Health Cigna Priority Health	$6.80
Rate for Payer: Priority Health SBD	$6.59

BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT IN PACKET

Facility

$1.27

Service Code	NDC 53329008987
Hospital Charge Code	113171
Hospital Revenue Code	637
Min. Negotiated Rate	$0.51
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 Commercial	$0.89
Rate for Payer: Cofinity Commercial	$1.09
Rate for Payer: Cofinity Medicare Advantage	$0.89
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: PHP Commercial	$1.08
Rate for Payer: Priority Health Cigna Priority Health	$0.83
Rate for Payer: Priority Health SBD	$0.80

BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT IN PACKET

Facility

$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 Commercial	$0.89
Rate for Payer: Cofinity Commercial	$1.09
Rate for Payer: Cofinity Medicare Advantage	$0.89
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: PHP Commercial	$1.08
Rate for Payer: Priority Health Cigna Priority Health	$0.83
Rate for Payer: Priority Health SBD	$0.80

BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT IN PACKET

Facility

$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 Commercial	$0.89
Rate for Payer: Cofinity Commercial	$1.09
Rate for Payer: Cofinity Medicare Advantage	$0.89
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: PHP Commercial	$1.08
Rate for Payer: Priority Health Cigna Priority Health	$0.83
Rate for Payer: Priority Health SBD	$0.80

BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT IN PACKET

Facility

$1.27

Service Code	NDC 53329008986
Hospital Charge Code	113171
Hospital Revenue Code	637
Min. Negotiated Rate	$0.51
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 Commercial	$0.89
Rate for Payer: Cofinity Commercial	$1.09
Rate for Payer: Cofinity Medicare Advantage	$0.89
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: PHP Commercial	$1.08
Rate for Payer: Priority Health Cigna Priority Health	$0.83
Rate for Payer: Priority Health SBD	$0.80

BACLOFEN 10 MG TABLET

Facility

$2.55

Service Code	NDC 60687050311
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$2.30
Rate for Payer: Aetna Commercial	$2.17
Rate for Payer: Aetna New Business (MI Preferred)	$1.66
Rate for Payer: Cash Price	$2.04
Rate for Payer: Cofinity Commercial	$1.78
Rate for Payer: Cofinity Commercial	$2.19
Rate for Payer: Cofinity Medicare Advantage	$1.78
Rate for Payer: Encore Health Key Benefits Commercial	$2.04
Rate for Payer: Healthscope Commercial	$2.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.17
Rate for Payer: PHP Commercial	$2.17
Rate for Payer: Priority Health Cigna Priority Health	$1.66
Rate for Payer: Priority Health SBD	$1.61

BACLOFEN 10 MG TABLET

Facility

$406.60

Service Code	NDC 60687081501
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$256.16
Max. Negotiated Rate	$365.94
Rate for Payer: Aetna Commercial	$345.61
Rate for Payer: Aetna New Business (MI Preferred)	$264.29
Rate for Payer: Cash Price	$325.28
Rate for Payer: Cofinity Commercial	$284.62
Rate for Payer: Cofinity Commercial	$349.68
Rate for Payer: Cofinity Medicare Advantage	$284.62
Rate for Payer: Encore Health Key Benefits Commercial	$325.28
Rate for Payer: Healthscope Commercial	$365.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$345.61
Rate for Payer: PHP Commercial	$345.61
Rate for Payer: Priority Health Cigna Priority Health	$264.29
Rate for Payer: Priority Health SBD	$256.16

BACLOFEN 10 MG TABLET

Facility

$3.17

Service Code	NDC 50268010611
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.85
Rate for Payer: Aetna Commercial	$2.69
Rate for Payer: Aetna New Business (MI Preferred)	$2.06
Rate for Payer: Cash Price	$2.54
Rate for Payer: Cofinity Commercial	$2.22
Rate for Payer: Cofinity Commercial	$2.73
Rate for Payer: Cofinity Medicare Advantage	$2.22
Rate for Payer: Encore Health Key Benefits Commercial	$2.54
Rate for Payer: Healthscope Commercial	$2.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.69
Rate for Payer: PHP Commercial	$2.69
Rate for Payer: Priority Health Cigna Priority Health	$2.06
Rate for Payer: Priority Health SBD	$2.00

BACLOFEN 10 MG TABLET

Facility

$2.55

Service Code	NDC 60687050311
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$2.30
Rate for Payer: Aetna Commercial	$2.17
Rate for Payer: Aetna Medicare	$1.28
Rate for Payer: Aetna New Business (MI Preferred)	$1.66
Rate for Payer: BCBS Complete	$1.02
Rate for Payer: Cash Price	$2.04
Rate for Payer: Cofinity Commercial	$1.78
Rate for Payer: Cofinity Commercial	$2.19
Rate for Payer: Cofinity Medicare Advantage	$1.78
Rate for Payer: Encore Health Key Benefits Commercial	$2.04
Rate for Payer: Healthscope Commercial	$2.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.17
Rate for Payer: PHP Commercial	$2.17
Rate for Payer: Priority Health Cigna Priority Health	$1.66
Rate for Payer: Priority Health SBD	$1.61

BACLOFEN 10 MG TABLET

Facility

$178.60

Service Code	NDC 00172409660
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$112.52
Max. Negotiated Rate	$160.74
Rate for Payer: Aetna Commercial	$151.81
Rate for Payer: Aetna New Business (MI Preferred)	$116.09
Rate for Payer: Cash Price	$142.88
Rate for Payer: Cofinity Commercial	$125.02
Rate for Payer: Cofinity Commercial	$153.60
Rate for Payer: Cofinity Medicare Advantage	$125.02
Rate for Payer: Encore Health Key Benefits Commercial	$142.88
Rate for Payer: Healthscope Commercial	$160.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$151.81
Rate for Payer: PHP Commercial	$151.81
Rate for Payer: Priority Health Cigna Priority Health	$116.09
Rate for Payer: Priority Health SBD	$112.52

BACLOFEN 10 MG TABLET

Facility

$254.88

Service Code	NDC 60687050301
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$101.95
Max. Negotiated Rate	$229.39
Rate for Payer: Aetna Commercial	$216.65
Rate for Payer: Aetna Medicare	$127.44
Rate for Payer: Aetna New Business (MI Preferred)	$165.67
Rate for Payer: BCBS Complete	$101.95
Rate for Payer: Cash Price	$203.90
Rate for Payer: Cofinity Commercial	$178.42
Rate for Payer: Cofinity Commercial	$219.20
Rate for Payer: Cofinity Medicare Advantage	$178.42
Rate for Payer: Encore Health Key Benefits Commercial	$203.90
Rate for Payer: Healthscope Commercial	$229.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$216.65
Rate for Payer: PHP Commercial	$216.65
Rate for Payer: Priority Health Cigna Priority Health	$165.67
Rate for Payer: Priority Health SBD	$160.57

BACLOFEN 10 MG TABLET

Facility

$158.18

Service Code	NDC 50268010615
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$99.65
Max. Negotiated Rate	$142.36
Rate for Payer: Aetna Commercial	$134.45
Rate for Payer: Aetna New Business (MI Preferred)	$102.82
Rate for Payer: Cash Price	$126.54
Rate for Payer: Cofinity Commercial	$110.73
Rate for Payer: Cofinity Commercial	$136.03
Rate for Payer: Cofinity Medicare Advantage	$110.73
Rate for Payer: Encore Health Key Benefits Commercial	$126.54
Rate for Payer: Healthscope Commercial	$142.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.45
Rate for Payer: PHP Commercial	$134.45
Rate for Payer: Priority Health Cigna Priority Health	$102.82
Rate for Payer: Priority Health SBD	$99.65

Know your out-of-pocket cost for care.

All Charges