|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$11.12
|
|
|
Service Code
|
NDC 51672207502
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$10.01 |
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: Aetna Medicare |
$2.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.48
|
| Rate for Payer: BCBS Complete |
$2.06
|
| Rate for Payer: BCBS MAPPO |
$2.78
|
| Rate for Payer: BCBS Trust/PPO |
$9.14
|
| Rate for Payer: BCN Commercial |
$9.14
|
| Rate for Payer: BCN Medicare Advantage |
$2.78
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$10.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.34
|
| Rate for Payer: Mclaren Medicaid |
$1.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.92
|
| Rate for Payer: Meridian Medicaid |
$2.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: Nomi Health Commercial |
$9.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.34
|
| Rate for Payer: PACE Senior Care Partners |
$2.64
|
| Rate for Payer: PACE SWMI |
$2.78
|
| Rate for Payer: PHP Commercial |
$9.45
|
| Rate for Payer: PHP Medicare Advantage |
$2.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.67
|
| Rate for Payer: Priority Health Medicare |
$2.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.74
|
| Rate for Payer: Railroad Medicare Medicare |
$2.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.79
|
| Rate for Payer: UHC Core |
$9.29
|
| Rate for Payer: UHC Exchange |
$2.78
|
| Rate for Payer: UHC Medicaid |
$1.96
|
| Rate for Payer: UHC Medicare Advantage |
$2.78
|
| Rate for Payer: UHCCP Medicaid |
$1.96
|
| Rate for Payer: VA VA |
$2.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.34
|
|
|
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 |
$2.79 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna Medicare |
$4.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.94
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: BCBS MAPPO |
$3.95
|
| Rate for Payer: BCBS Trust/PPO |
$12.99
|
| Rate for Payer: BCN Commercial |
$12.99
|
| Rate for Payer: BCN Medicare Advantage |
$3.95
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.95
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.85
|
| Rate for Payer: Mclaren Medicaid |
$2.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.15
|
| Rate for Payer: Meridian Medicaid |
$2.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.43
|
| Rate for Payer: Nomi Health Commercial |
$12.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.85
|
| Rate for Payer: PACE Senior Care Partners |
$3.75
|
| Rate for Payer: PACE SWMI |
$3.95
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: PHP Medicare Advantage |
$3.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.75
|
| Rate for Payer: Priority Health Medicare |
$3.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.00
|
| Rate for Payer: Railroad Medicare Medicare |
$3.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.90
|
| Rate for Payer: UHC Core |
$13.19
|
| Rate for Payer: UHC Exchange |
$3.95
|
| Rate for Payer: UHC Medicaid |
$2.79
|
| Rate for Payer: UHC Medicare Advantage |
$3.95
|
| Rate for Payer: UHCCP Medicaid |
$2.79
|
| Rate for Payer: VA VA |
$3.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.85
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
OP
|
$131.60
|
|
|
Service Code
|
NDC 52817032010
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna Medicare |
$34.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.12
|
| Rate for Payer: BCBS Complete |
$24.36
|
| Rate for Payer: BCBS MAPPO |
$32.90
|
| Rate for Payer: BCBS Trust/PPO |
$108.19
|
| Rate for Payer: BCN Commercial |
$108.19
|
| Rate for Payer: BCN Medicare Advantage |
$32.90
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.90
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: Mclaren Medicaid |
$23.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.55
|
| Rate for Payer: Meridian Medicaid |
$24.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Nomi Health Commercial |
$107.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PACE Senior Care Partners |
$31.25
|
| Rate for Payer: PACE SWMI |
$32.90
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: PHP Medicare Advantage |
$32.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$114.49
|
| Rate for Payer: Priority Health Medicare |
$33.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.59
|
| Rate for Payer: Railroad Medicare Medicare |
$32.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.81
|
| Rate for Payer: UHC Core |
$109.89
|
| Rate for Payer: UHC Exchange |
$32.90
|
| Rate for Payer: UHC Medicaid |
$23.20
|
| Rate for Payer: UHC Medicare Advantage |
$32.90
|
| Rate for Payer: UHCCP Medicaid |
$23.20
|
| Rate for Payer: VA VA |
$32.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
OP
|
$389.50
|
|
|
Service Code
|
NDC 58657093101
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.67 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Aetna Commercial |
$331.07
|
| Rate for Payer: Aetna Medicare |
$101.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.72
|
| Rate for Payer: BCBS Complete |
$72.10
|
| Rate for Payer: BCBS MAPPO |
$97.38
|
| Rate for Payer: BCBS Trust/PPO |
$320.21
|
| Rate for Payer: BCN Commercial |
$320.21
|
| Rate for Payer: BCN Medicare Advantage |
$97.38
|
| Rate for Payer: Cash Price |
$311.60
|
| Rate for Payer: Cofinity Commercial |
$334.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.38
|
| Rate for Payer: Healthscope Commercial |
$350.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.12
|
| Rate for Payer: Mclaren Medicaid |
$68.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.24
|
| Rate for Payer: Meridian Medicaid |
$72.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$107.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.07
|
| Rate for Payer: Nomi Health Commercial |
$319.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.12
|
| Rate for Payer: PACE Senior Care Partners |
$92.51
|
| Rate for Payer: PACE SWMI |
$97.38
|
| Rate for Payer: PHP Commercial |
$331.07
|
| Rate for Payer: PHP Medicare Advantage |
$97.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$338.87
|
| Rate for Payer: Priority Health Medicare |
$98.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$271.09
|
| Rate for Payer: Railroad Medicare Medicare |
$97.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.76
|
| Rate for Payer: UHC Core |
$325.23
|
| Rate for Payer: UHC Exchange |
$97.38
|
| Rate for Payer: UHC Medicaid |
$68.67
|
| Rate for Payer: UHC Medicare Advantage |
$97.38
|
| Rate for Payer: UHCCP Medicaid |
$68.67
|
| Rate for Payer: VA VA |
$97.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.12
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
OP
|
$3.90
|
|
|
Service Code
|
NDC 58657093110
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Aetna Medicare |
$1.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.22
|
| Rate for Payer: BCBS Complete |
$0.72
|
| Rate for Payer: BCBS MAPPO |
$0.98
|
| Rate for Payer: BCBS Trust/PPO |
$3.21
|
| Rate for Payer: BCN Commercial |
$3.21
|
| Rate for Payer: BCN Medicare Advantage |
$0.98
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$3.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.98
|
| Rate for Payer: Healthscope Commercial |
$3.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.92
|
| Rate for Payer: Mclaren Medicaid |
$0.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.02
|
| Rate for Payer: Meridian Medicaid |
$0.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.31
|
| Rate for Payer: Nomi Health Commercial |
$3.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.92
|
| Rate for Payer: PACE Senior Care Partners |
$0.93
|
| Rate for Payer: PACE SWMI |
$0.98
|
| Rate for Payer: PHP Commercial |
$3.31
|
| Rate for Payer: PHP Medicare Advantage |
$0.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.39
|
| Rate for Payer: Priority Health Medicare |
$0.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.71
|
| Rate for Payer: Railroad Medicare Medicare |
$0.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.43
|
| Rate for Payer: UHC Core |
$3.26
|
| Rate for Payer: UHC Exchange |
$0.98
|
| Rate for Payer: UHC Medicaid |
$0.69
|
| Rate for Payer: UHC Medicare Advantage |
$0.98
|
| Rate for Payer: UHCCP Medicaid |
$0.69
|
| Rate for Payer: VA VA |
$0.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.92
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
IP
|
$3.90
|
|
|
Service Code
|
NDC 58657093110
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: BCBS Trust/PPO |
$3.22
|
| Rate for Payer: BCN Commercial |
$3.22
|
| Rate for Payer: Cash Price |
$3.12
|
| 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: Lakeland Regional Health Systems Commercial |
$2.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.31
|
| Rate for Payer: Nomi Health Commercial |
$3.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.92
|
| Rate for Payer: PHP Commercial |
$3.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.43
|
| Rate for Payer: UHC Core |
$3.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.92
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
IP
|
$131.60
|
|
|
Service Code
|
NDC 52817032010
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.59 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: BCBS Trust/PPO |
$108.69
|
| Rate for Payer: BCN Commercial |
$108.69
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Nomi Health Commercial |
$107.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$114.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.81
|
| Rate for Payer: UHC Core |
$109.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
OP
|
$138.65
|
|
|
Service Code
|
NDC 00172409660
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna Medicare |
$36.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.33
|
| Rate for Payer: BCBS Complete |
$25.66
|
| Rate for Payer: BCBS MAPPO |
$34.66
|
| Rate for Payer: BCBS Trust/PPO |
$113.98
|
| Rate for Payer: BCN Commercial |
$113.98
|
| Rate for Payer: BCN Medicare Advantage |
$34.66
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.66
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Mclaren Medicaid |
$24.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.40
|
| Rate for Payer: Meridian Medicaid |
$25.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Nomi Health Commercial |
$113.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: PACE Senior Care Partners |
$32.93
|
| Rate for Payer: PACE SWMI |
$34.66
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: PHP Medicare Advantage |
$34.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$120.63
|
| Rate for Payer: Priority Health Medicare |
$35.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.50
|
| Rate for Payer: Railroad Medicare Medicare |
$34.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.01
|
| Rate for Payer: UHC Core |
$115.77
|
| Rate for Payer: UHC Exchange |
$34.66
|
| Rate for Payer: UHC Medicaid |
$24.44
|
| Rate for Payer: UHC Medicare Advantage |
$34.66
|
| Rate for Payer: UHCCP Medicaid |
$24.44
|
| Rate for Payer: VA VA |
$34.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
IP
|
$353.40
|
|
|
Service Code
|
NDC 00904647561
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.97 |
| Max. Negotiated Rate |
$318.06 |
| Rate for Payer: Aetna Commercial |
$300.39
|
| Rate for Payer: BCBS Trust/PPO |
$291.87
|
| Rate for Payer: BCN Commercial |
$291.87
|
| Rate for Payer: Cash Price |
$282.72
|
| Rate for Payer: Cofinity Commercial |
$303.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.72
|
| Rate for Payer: Healthscope Commercial |
$318.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.39
|
| Rate for Payer: Nomi Health Commercial |
$289.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.05
|
| Rate for Payer: PHP Commercial |
$300.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$307.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.99
|
| Rate for Payer: UHC Core |
$295.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.05
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
IP
|
$389.50
|
|
|
Service Code
|
NDC 58657093101
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.09 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Aetna Commercial |
$331.07
|
| Rate for Payer: BCBS Trust/PPO |
$321.69
|
| Rate for Payer: BCN Commercial |
$321.69
|
| Rate for Payer: Cash Price |
$311.60
|
| 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: Lakeland Regional Health Systems Commercial |
$292.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.07
|
| Rate for Payer: Nomi Health Commercial |
$319.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.12
|
| Rate for Payer: PHP Commercial |
$331.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$338.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$271.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.76
|
| Rate for Payer: UHC Core |
$325.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.12
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
IP
|
$138.65
|
|
|
Service Code
|
NDC 00172409660
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.50 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: BCBS Trust/PPO |
$114.51
|
| Rate for Payer: BCN Commercial |
$114.51
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Nomi Health Commercial |
$113.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$120.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.01
|
| Rate for Payer: UHC Core |
$115.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
OP
|
$353.40
|
|
|
Service Code
|
NDC 00904647561
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$318.06 |
| Rate for Payer: Aetna Commercial |
$300.39
|
| Rate for Payer: Aetna Medicare |
$91.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$110.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$110.44
|
| Rate for Payer: BCBS Complete |
$65.41
|
| Rate for Payer: BCBS MAPPO |
$88.35
|
| Rate for Payer: BCBS Trust/PPO |
$290.53
|
| Rate for Payer: BCN Commercial |
$290.53
|
| Rate for Payer: BCN Medicare Advantage |
$88.35
|
| Rate for Payer: Cash Price |
$282.72
|
| Rate for Payer: Cofinity Commercial |
$303.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.35
|
| Rate for Payer: Healthscope Commercial |
$318.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.05
|
| Rate for Payer: Mclaren Medicaid |
$62.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.77
|
| Rate for Payer: Meridian Medicaid |
$65.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$97.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.39
|
| Rate for Payer: Nomi Health Commercial |
$289.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.05
|
| Rate for Payer: PACE Senior Care Partners |
$83.93
|
| Rate for Payer: PACE SWMI |
$88.35
|
| Rate for Payer: PHP Commercial |
$300.39
|
| Rate for Payer: PHP Medicare Advantage |
$88.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$307.46
|
| Rate for Payer: Priority Health Medicare |
$89.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.97
|
| Rate for Payer: Railroad Medicare Medicare |
$88.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.99
|
| Rate for Payer: UHC Core |
$295.09
|
| Rate for Payer: UHC Exchange |
$88.35
|
| Rate for Payer: UHC Medicaid |
$62.30
|
| Rate for Payer: UHC Medicare Advantage |
$88.35
|
| Rate for Payer: UHCCP Medicaid |
$62.30
|
| Rate for Payer: VA VA |
$88.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.05
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
OP
|
$333.84
|
|
|
Service Code
|
NDC 50268010515
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.86 |
| Max. Negotiated Rate |
$300.46 |
| Rate for Payer: Aetna Commercial |
$283.76
|
| Rate for Payer: Aetna Medicare |
$86.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.33
|
| Rate for Payer: BCBS Complete |
$61.79
|
| Rate for Payer: BCBS MAPPO |
$83.46
|
| Rate for Payer: BCBS Trust/PPO |
$274.45
|
| Rate for Payer: BCN Commercial |
$274.45
|
| Rate for Payer: BCN Medicare Advantage |
$83.46
|
| Rate for Payer: Cash Price |
$267.07
|
| Rate for Payer: Cofinity Commercial |
$287.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.46
|
| Rate for Payer: Healthscope Commercial |
$300.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.38
|
| Rate for Payer: Mclaren Medicaid |
$58.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.63
|
| Rate for Payer: Meridian Medicaid |
$61.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$91.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.76
|
| Rate for Payer: Nomi Health Commercial |
$273.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.38
|
| Rate for Payer: PACE Senior Care Partners |
$79.29
|
| Rate for Payer: PACE SWMI |
$83.46
|
| Rate for Payer: PHP Commercial |
$283.76
|
| Rate for Payer: PHP Medicare Advantage |
$83.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$290.44
|
| Rate for Payer: Priority Health Medicare |
$84.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.35
|
| Rate for Payer: Railroad Medicare Medicare |
$83.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.78
|
| Rate for Payer: UHC Core |
$278.76
|
| Rate for Payer: UHC Exchange |
$83.46
|
| Rate for Payer: UHC Medicaid |
$58.86
|
| Rate for Payer: UHC Medicare Advantage |
$83.46
|
| Rate for Payer: UHCCP Medicaid |
$58.86
|
| Rate for Payer: VA VA |
$83.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.38
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
IP
|
$6.68
|
|
|
Service Code
|
NDC 50268010511
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Aetna Commercial |
$5.68
|
| Rate for Payer: BCBS Trust/PPO |
$5.52
|
| Rate for Payer: BCN Commercial |
$5.52
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cofinity Commercial |
$5.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.34
|
| Rate for Payer: Healthscope Commercial |
$6.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.68
|
| Rate for Payer: Nomi Health Commercial |
$5.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.01
|
| Rate for Payer: PHP Commercial |
$5.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.88
|
| Rate for Payer: UHC Core |
$5.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.01
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
OP
|
$310.20
|
|
|
Service Code
|
NDC 52817031910
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.69 |
| Max. Negotiated Rate |
$279.18 |
| Rate for Payer: Aetna Commercial |
$263.67
|
| Rate for Payer: Aetna Medicare |
$80.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.94
|
| Rate for Payer: BCBS Complete |
$57.42
|
| Rate for Payer: BCBS MAPPO |
$77.55
|
| Rate for Payer: BCBS Trust/PPO |
$255.02
|
| Rate for Payer: BCN Commercial |
$255.02
|
| Rate for Payer: BCN Medicare Advantage |
$77.55
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cofinity Commercial |
$266.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.55
|
| Rate for Payer: Healthscope Commercial |
$279.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.65
|
| Rate for Payer: Mclaren Medicaid |
$54.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.43
|
| Rate for Payer: Meridian Medicaid |
$57.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$85.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.67
|
| Rate for Payer: Nomi Health Commercial |
$254.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.65
|
| Rate for Payer: PACE Senior Care Partners |
$73.67
|
| Rate for Payer: PACE SWMI |
$77.55
|
| Rate for Payer: PHP Commercial |
$263.67
|
| Rate for Payer: PHP Medicare Advantage |
$77.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$269.87
|
| Rate for Payer: Priority Health Medicare |
$78.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.90
|
| Rate for Payer: Railroad Medicare Medicare |
$77.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.98
|
| Rate for Payer: UHC Core |
$259.02
|
| Rate for Payer: UHC Exchange |
$77.55
|
| Rate for Payer: UHC Medicaid |
$54.69
|
| Rate for Payer: UHC Medicare Advantage |
$77.55
|
| Rate for Payer: UHCCP Medicaid |
$54.69
|
| Rate for Payer: VA VA |
$77.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.65
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
OP
|
$162.15
|
|
|
Service Code
|
NDC 72888000901
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.59 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Aetna Medicare |
$42.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.67
|
| Rate for Payer: BCBS Complete |
$30.01
|
| Rate for Payer: BCBS MAPPO |
$40.54
|
| Rate for Payer: BCBS Trust/PPO |
$133.30
|
| Rate for Payer: BCN Commercial |
$133.30
|
| Rate for Payer: BCN Medicare Advantage |
$40.54
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Commercial |
$139.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.54
|
| Rate for Payer: Healthscope Commercial |
$145.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.61
|
| Rate for Payer: Mclaren Medicaid |
$28.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.56
|
| Rate for Payer: Meridian Medicaid |
$30.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.83
|
| Rate for Payer: Nomi Health Commercial |
$132.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.61
|
| Rate for Payer: PACE Senior Care Partners |
$38.51
|
| Rate for Payer: PACE SWMI |
$40.54
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: PHP Medicare Advantage |
$40.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$141.07
|
| Rate for Payer: Priority Health Medicare |
$40.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.86
|
| Rate for Payer: Railroad Medicare Medicare |
$40.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.69
|
| Rate for Payer: UHC Core |
$135.40
|
| Rate for Payer: UHC Exchange |
$40.54
|
| Rate for Payer: UHC Medicaid |
$28.59
|
| Rate for Payer: UHC Medicare Advantage |
$40.54
|
| Rate for Payer: UHCCP Medicaid |
$28.59
|
| Rate for Payer: VA VA |
$40.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.61
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
IP
|
$333.84
|
|
|
Service Code
|
NDC 50268010515
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.35 |
| Max. Negotiated Rate |
$300.46 |
| Rate for Payer: Aetna Commercial |
$283.76
|
| Rate for Payer: BCBS Trust/PPO |
$275.72
|
| Rate for Payer: BCN Commercial |
$275.72
|
| Rate for Payer: Cash Price |
$267.07
|
| Rate for Payer: Cofinity Commercial |
$287.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.07
|
| Rate for Payer: Healthscope Commercial |
$300.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.76
|
| Rate for Payer: Nomi Health Commercial |
$273.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.38
|
| Rate for Payer: PHP Commercial |
$283.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$290.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.78
|
| Rate for Payer: UHC Core |
$278.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.38
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
OP
|
$6.68
|
|
|
Service Code
|
NDC 50268010511
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Aetna Commercial |
$5.68
|
| Rate for Payer: Aetna Medicare |
$1.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.09
|
| Rate for Payer: BCBS Complete |
$1.24
|
| Rate for Payer: BCBS MAPPO |
$1.67
|
| Rate for Payer: BCBS Trust/PPO |
$5.49
|
| Rate for Payer: BCN Commercial |
$5.49
|
| Rate for Payer: BCN Medicare Advantage |
$1.67
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cofinity Commercial |
$5.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.67
|
| Rate for Payer: Healthscope Commercial |
$6.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.01
|
| Rate for Payer: Mclaren Medicaid |
$1.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.75
|
| Rate for Payer: Meridian Medicaid |
$1.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.68
|
| Rate for Payer: Nomi Health Commercial |
$5.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.01
|
| Rate for Payer: PACE Senior Care Partners |
$1.59
|
| Rate for Payer: PACE SWMI |
$1.67
|
| Rate for Payer: PHP Commercial |
$5.68
|
| Rate for Payer: PHP Medicare Advantage |
$1.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.81
|
| Rate for Payer: Priority Health Medicare |
$1.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.65
|
| Rate for Payer: Railroad Medicare Medicare |
$1.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.88
|
| Rate for Payer: UHC Core |
$5.58
|
| Rate for Payer: UHC Exchange |
$1.67
|
| Rate for Payer: UHC Medicaid |
$1.18
|
| Rate for Payer: UHC Medicare Advantage |
$1.67
|
| Rate for Payer: UHCCP Medicaid |
$1.18
|
| Rate for Payer: VA VA |
$1.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.01
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
IP
|
$310.20
|
|
|
Service Code
|
NDC 52817031910
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$215.90 |
| Max. Negotiated Rate |
$279.18 |
| Rate for Payer: Aetna Commercial |
$263.67
|
| Rate for Payer: BCBS Trust/PPO |
$256.19
|
| Rate for Payer: BCN Commercial |
$256.19
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cofinity Commercial |
$266.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.16
|
| Rate for Payer: Healthscope Commercial |
$279.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.67
|
| Rate for Payer: Nomi Health Commercial |
$254.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.65
|
| Rate for Payer: PHP Commercial |
$263.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$269.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.98
|
| Rate for Payer: UHC Core |
$259.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.65
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
IP
|
$162.15
|
|
|
Service Code
|
NDC 72888000901
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.86 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: BCBS Trust/PPO |
$133.92
|
| Rate for Payer: BCN Commercial |
$133.92
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Commercial |
$139.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.72
|
| Rate for Payer: Healthscope Commercial |
$145.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.83
|
| Rate for Payer: Nomi Health Commercial |
$132.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.61
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$141.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.69
|
| Rate for Payer: UHC Core |
$135.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.61
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
IP
|
$13,053.45
|
|
|
Service Code
|
APR-DRG 0493
|
| Min. Negotiated Rate |
$12,431.86 |
| Max. Negotiated Rate |
$13,053.45 |
| Rate for Payer: BCBS Complete |
$13,053.45
|
| Rate for Payer: Mclaren Medicaid |
$12,431.86
|
| Rate for Payer: Meridian Medicaid |
$13,053.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,431.86
|
| Rate for Payer: UHC Medicaid |
$12,431.86
|
| Rate for Payer: UHCCP Medicaid |
$12,431.86
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
IP
|
$16,785.86
|
|
|
Service Code
|
APR-DRG 0494
|
| Min. Negotiated Rate |
$15,986.54 |
| Max. Negotiated Rate |
$16,785.86 |
| Rate for Payer: BCBS Complete |
$16,785.86
|
| Rate for Payer: Mclaren Medicaid |
$15,986.54
|
| Rate for Payer: Meridian Medicaid |
$16,785.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,986.54
|
| Rate for Payer: UHC Medicaid |
$15,986.54
|
| Rate for Payer: UHCCP Medicaid |
$15,986.54
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
IP
|
$9,138.05
|
|
|
Service Code
|
APR-DRG 0492
|
| Min. Negotiated Rate |
$8,702.90 |
| Max. Negotiated Rate |
$9,138.05 |
| Rate for Payer: BCBS Complete |
$9,138.05
|
| Rate for Payer: Mclaren Medicaid |
$8,702.90
|
| Rate for Payer: Meridian Medicaid |
$9,138.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,702.90
|
| Rate for Payer: UHC Medicaid |
$8,702.90
|
| Rate for Payer: UHCCP Medicaid |
$8,702.90
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
IP
|
$8,679.52
|
|
|
Service Code
|
APR-DRG 0491
|
| Min. Negotiated Rate |
$8,266.20 |
| Max. Negotiated Rate |
$8,679.52 |
| Rate for Payer: BCBS Complete |
$8,679.52
|
| Rate for Payer: Mclaren Medicaid |
$8,266.20
|
| Rate for Payer: Meridian Medicaid |
$8,679.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,266.20
|
| Rate for Payer: UHC Medicaid |
$8,266.20
|
| Rate for Payer: UHCCP Medicaid |
$8,266.20
|
|
|
B-COMPLEX WITH VITAMIN C TABLET
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
NDC 80681015400
|
| Hospital Charge Code |
807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.01 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: BCBS Trust/PPO |
$122.23
|
| Rate for Payer: BCN Commercial |
$122.23
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.80
|
| Rate for Payer: Nomi Health Commercial |
$121.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.00
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$128.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.24
|
| Rate for Payer: UHC Core |
$123.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
