|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$208.87
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$187.98 |
| Rate for Payer: Aetna American Axle |
$135.77
|
| Rate for Payer: Aetna American Axle |
$127.58
|
| Rate for Payer: Aetna American Axle |
$121.24
|
| Rate for Payer: Aetna Commercial |
$177.54
|
| 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 Medicare |
$104.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.58
|
| Rate for Payer: BCBS Complete |
$78.51
|
| Rate for Payer: BCBS Complete |
$83.55
|
| Rate for Payer: BCBS Complete |
$74.61
|
| Rate for Payer: BCBS Trust/PPO |
$5.32
|
| Rate for Payer: BCBS Trust/PPO |
$5.32
|
| Rate for Payer: BCBS Trust/PPO |
$5.32
|
| Rate for Payer: BCN Commercial |
$5.32
|
| Rate for Payer: BCN Commercial |
$5.32
|
| Rate for Payer: BCN Commercial |
$5.32
|
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cash Price |
$167.10
|
| 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 Commercial |
$146.21
|
| Rate for Payer: Cofinity Commercial |
$179.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.21
|
| 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: Encore Health Key Benefits Commercial |
$167.10
|
| Rate for Payer: Healthscope Commercial |
$187.98
|
| Rate for Payer: Healthscope Commercial |
$176.65
|
| Rate for Payer: Healthscope Commercial |
$167.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.54
|
| Rate for Payer: PHP Commercial |
$177.54
|
| 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 Cigna Priority Health |
$135.77
|
| Rate for Payer: Priority Health SBD |
$123.66
|
| Rate for Payer: Priority Health SBD |
$131.59
|
| Rate for Payer: Priority Health SBD |
$117.51
|
| Rate for Payer: UMR Bronson Commercial |
$77.28
|
| Rate for Payer: UMR Bronson Commercial |
$69.02
|
| Rate for Payer: UMR Bronson Commercial |
$72.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.65
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$186.53
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.07 |
| Max. Negotiated Rate |
$167.88 |
| Rate for Payer: Aetna American Axle |
$121.24
|
| Rate for Payer: Aetna American Axle |
$127.58
|
| Rate for Payer: Aetna American Axle |
$135.77
|
| Rate for Payer: Aetna Commercial |
$166.84
|
| Rate for Payer: Aetna Commercial |
$158.55
|
| Rate for Payer: Aetna Commercial |
$177.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.58
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cofinity Commercial |
$160.42
|
| Rate for Payer: Cofinity Commercial |
$168.80
|
| Rate for Payer: Cofinity Commercial |
$137.40
|
| Rate for Payer: Cofinity Commercial |
$179.63
|
| Rate for Payer: Cofinity Commercial |
$146.21
|
| Rate for Payer: Cofinity Commercial |
$130.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.10
|
| 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: Healthscope Commercial |
$187.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.84
|
| Rate for Payer: PHP Commercial |
$177.54
|
| 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 |
$135.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.24
|
| Rate for Payer: Priority Health SBD |
$131.59
|
| Rate for Payer: Priority Health SBD |
$123.66
|
| Rate for Payer: Priority Health SBD |
$117.51
|
| Rate for Payer: UMR Bronson Commercial |
$82.07
|
| Rate for Payer: UMR Bronson Commercial |
$91.90
|
| Rate for Payer: UMR Bronson Commercial |
$86.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.21
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$186.53
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$167.88 |
| Rate for Payer: Aetna American Axle |
$121.24
|
| 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 |
$5.32
|
| Rate for Payer: BCN Commercial |
$5.32
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$130.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.90
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$69.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.90
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$186.53
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.07 |
| Max. Negotiated Rate |
$167.88 |
| Rate for Payer: Aetna American Axle |
$121.24
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$130.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.90
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$82.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.90
|
|
|
BACITRACIN 500 UNIT/GRAM EYE OINTMENT
|
Facility
|
IP
|
$353.86
|
|
|
Service Code
|
NDC 00574402235
|
| Hospital Charge Code |
852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.70 |
| Max. Negotiated Rate |
$318.47 |
| Rate for Payer: Aetna American Axle |
$230.01
|
| Rate for Payer: Aetna Commercial |
$300.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.01
|
| Rate for Payer: Cash Price |
$283.09
|
| Rate for Payer: Cofinity Commercial |
$247.70
|
| Rate for Payer: Cofinity Commercial |
$304.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.09
|
| Rate for Payer: Healthscope Commercial |
$318.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.78
|
| Rate for Payer: PHP Commercial |
$300.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.01
|
| Rate for Payer: Priority Health SBD |
$222.93
|
| Rate for Payer: UMR Bronson Commercial |
$155.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.40
|
|
|
BACITRACIN 500 UNIT/GRAM EYE OINTMENT
|
Facility
|
OP
|
$353.86
|
|
|
Service Code
|
NDC 00574402235
|
| Hospital Charge Code |
852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.93 |
| Max. Negotiated Rate |
$318.47 |
| Rate for Payer: Aetna American Axle |
$230.01
|
| Rate for Payer: Aetna Commercial |
$300.78
|
| Rate for Payer: Aetna Medicare |
$176.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.01
|
| Rate for Payer: BCBS Complete |
$141.54
|
| Rate for Payer: Cash Price |
$283.09
|
| Rate for Payer: Cofinity Commercial |
$247.70
|
| Rate for Payer: Cofinity Commercial |
$304.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.09
|
| Rate for Payer: Healthscope Commercial |
$318.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.78
|
| Rate for Payer: PHP Commercial |
$300.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.01
|
| Rate for Payer: Priority Health SBD |
$222.93
|
| Rate for Payer: UMR Bronson Commercial |
$130.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.40
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$10.23
|
|
|
Service Code
|
NDC 67777022002
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$9.21 |
| Rate for Payer: Aetna American Axle |
$6.65
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$7.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.67
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$3.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.67
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$9.72
|
|
|
Service Code
|
NDC 51672207501
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$8.75 |
| Rate for Payer: Aetna American Axle |
$6.32
|
| Rate for Payer: Aetna Commercial |
$8.26
|
| Rate for Payer: Aetna Medicare |
$4.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.32
|
| Rate for Payer: BCBS Complete |
$3.89
|
| Rate for Payer: Cash Price |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$6.80
|
| Rate for Payer: Cofinity Commercial |
$8.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.78
|
| Rate for Payer: Healthscope Commercial |
$8.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.26
|
| Rate for Payer: PHP Commercial |
$8.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.32
|
| Rate for Payer: Priority Health SBD |
$6.12
|
| Rate for Payer: UMR Bronson Commercial |
$3.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.29
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$65.45
|
|
|
Service Code
|
NDC 67777022007
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.22 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna American Axle |
$42.54
|
| Rate for Payer: Aetna Commercial |
$55.63
|
| Rate for Payer: Aetna Medicare |
$32.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.54
|
| Rate for Payer: BCBS Complete |
$26.18
|
| Rate for Payer: Cash Price |
$52.36
|
| Rate for Payer: Cofinity Commercial |
$45.82
|
| Rate for Payer: Cofinity Commercial |
$56.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.36
|
| Rate for Payer: Healthscope Commercial |
$58.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.63
|
| Rate for Payer: PHP Commercial |
$55.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.54
|
| Rate for Payer: Priority Health SBD |
$41.23
|
| Rate for Payer: UMR Bronson Commercial |
$24.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.09
|
|
|
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 |
$5.85 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna American Axle |
$10.27
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$11.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.85
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$5.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.85
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$65.45
|
|
|
Service Code
|
NDC 67777022007
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna American Axle |
$42.54
|
| Rate for Payer: Aetna Commercial |
$55.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.54
|
| Rate for Payer: Cash Price |
$52.36
|
| Rate for Payer: Cofinity Commercial |
$45.82
|
| Rate for Payer: Cofinity Commercial |
$56.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.36
|
| Rate for Payer: Healthscope Commercial |
$58.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.63
|
| Rate for Payer: PHP Commercial |
$55.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.54
|
| Rate for Payer: Priority Health SBD |
$41.23
|
| Rate for Payer: UMR Bronson Commercial |
$28.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.09
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$63.97
|
|
|
Service Code
|
NDC 16784011761
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$57.57 |
| Rate for Payer: Aetna American Axle |
$41.58
|
| Rate for Payer: Aetna Commercial |
$54.37
|
| Rate for Payer: Aetna Medicare |
$31.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.58
|
| Rate for Payer: BCBS Complete |
$25.59
|
| Rate for Payer: Cash Price |
$51.18
|
| Rate for Payer: Cofinity Commercial |
$44.78
|
| Rate for Payer: Cofinity Commercial |
$55.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.18
|
| Rate for Payer: Healthscope Commercial |
$57.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.37
|
| Rate for Payer: PHP Commercial |
$54.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.58
|
| Rate for Payer: Priority Health SBD |
$40.30
|
| Rate for Payer: UMR Bronson Commercial |
$23.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.98
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$10.23
|
|
|
Service Code
|
NDC 51672207502
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$9.21 |
| Rate for Payer: Aetna American Axle |
$6.65
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$7.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.67
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$3.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.67
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$10.23
|
|
|
Service Code
|
NDC 51672207502
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$9.21 |
| Rate for Payer: Aetna American Axle |
$6.65
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$7.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.67
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$4.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.67
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$13.23
|
|
|
Service Code
|
NDC 14428000888
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna American Axle |
$8.60
|
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$9.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UMR Bronson Commercial |
$5.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$13.23
|
|
|
Service Code
|
NDC 14428000888
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna American Axle |
$8.60
|
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna Medicare |
$6.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: BCBS Complete |
$5.29
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$9.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UMR Bronson Commercial |
$4.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$63.97
|
|
|
Service Code
|
NDC 16784011761
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$57.57 |
| Rate for Payer: Aetna American Axle |
$41.58
|
| Rate for Payer: Aetna Commercial |
$54.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.58
|
| Rate for Payer: Cash Price |
$51.18
|
| Rate for Payer: Cofinity Commercial |
$44.78
|
| Rate for Payer: Cofinity Commercial |
$55.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.18
|
| Rate for Payer: Healthscope Commercial |
$57.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.37
|
| Rate for Payer: PHP Commercial |
$54.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.58
|
| Rate for Payer: Priority Health SBD |
$40.30
|
| Rate for Payer: UMR Bronson Commercial |
$28.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.98
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$24.79
|
|
|
Service Code
|
NDC 16784011751
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$22.31 |
| Rate for Payer: Aetna American Axle |
$16.11
|
| Rate for Payer: Aetna Commercial |
$21.07
|
| Rate for Payer: Aetna Medicare |
$12.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.11
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$17.35
|
| Rate for Payer: Cofinity Commercial |
$21.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.83
|
| Rate for Payer: Healthscope Commercial |
$22.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.07
|
| Rate for Payer: PHP Commercial |
$21.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.11
|
| Rate for Payer: Priority Health SBD |
$15.62
|
| Rate for Payer: UMR Bronson Commercial |
$9.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.59
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$9.72
|
|
|
Service Code
|
NDC 51672207501
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$8.75 |
| Rate for Payer: Aetna American Axle |
$6.32
|
| Rate for Payer: Aetna Commercial |
$8.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.32
|
| Rate for Payer: Cash Price |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$6.80
|
| Rate for Payer: Cofinity Commercial |
$8.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.78
|
| Rate for Payer: Healthscope Commercial |
$8.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.26
|
| Rate for Payer: PHP Commercial |
$8.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.32
|
| Rate for Payer: Priority Health SBD |
$6.12
|
| Rate for Payer: UMR Bronson Commercial |
$4.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.29
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$10.23
|
|
|
Service Code
|
NDC 67777022002
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$9.21 |
| Rate for Payer: Aetna American Axle |
$6.65
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$7.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.67
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$4.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.67
|
|
|
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 |
$6.95 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna American Axle |
$10.27
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$11.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.85
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$6.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.85
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$24.79
|
|
|
Service Code
|
NDC 16784011751
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$22.31 |
| Rate for Payer: Aetna American Axle |
$16.11
|
| Rate for Payer: Aetna Commercial |
$21.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.11
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$17.35
|
| Rate for Payer: Cofinity Commercial |
$21.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.83
|
| Rate for Payer: Healthscope Commercial |
$22.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.07
|
| Rate for Payer: PHP Commercial |
$21.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.11
|
| Rate for Payer: Priority Health SBD |
$15.62
|
| Rate for Payer: UMR Bronson Commercial |
$10.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.59
|
|
|
BACLOFEN 10,000 MCG/20 ML (500 MCG/ML) INTRATHECAL SOLUTION
|
Facility
|
IP
|
$499.92
|
|
|
Service Code
|
HCPCS J0475
|
| Hospital Charge Code |
107799
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$219.96 |
| Max. Negotiated Rate |
$449.93 |
| Rate for Payer: Aetna American Axle |
$324.95
|
| Rate for Payer: Aetna American Axle |
$388.36
|
| Rate for Payer: Aetna Commercial |
$424.93
|
| Rate for Payer: Aetna Commercial |
$507.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.36
|
| Rate for Payer: Cash Price |
$399.94
|
| Rate for Payer: Cash Price |
$477.98
|
| Rate for Payer: Cofinity Commercial |
$513.82
|
| Rate for Payer: Cofinity Commercial |
$418.23
|
| Rate for Payer: Cofinity Commercial |
$349.94
|
| Rate for Payer: Cofinity Commercial |
$429.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$418.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.98
|
| Rate for Payer: Healthscope Commercial |
$449.93
|
| Rate for Payer: Healthscope Commercial |
$537.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$418.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$507.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.93
|
| Rate for Payer: PHP Commercial |
$507.85
|
| Rate for Payer: PHP Commercial |
$424.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.36
|
| Rate for Payer: Priority Health SBD |
$314.95
|
| Rate for Payer: Priority Health SBD |
$376.41
|
| Rate for Payer: UMR Bronson Commercial |
$219.96
|
| Rate for Payer: UMR Bronson Commercial |
$262.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$448.10
|
|
|
BACLOFEN 10,000 MCG/20 ML (500 MCG/ML) INTRATHECAL SOLUTION
|
Facility
|
OP
|
$499.92
|
|
|
Service Code
|
HCPCS J0475
|
| Hospital Charge Code |
107799
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.18 |
| Max. Negotiated Rate |
$521.52 |
| Rate for Payer: Aetna American Axle |
$324.95
|
| Rate for Payer: Aetna American Axle |
$388.36
|
| Rate for Payer: Aetna Commercial |
$507.85
|
| Rate for Payer: Aetna Commercial |
$424.93
|
| Rate for Payer: Aetna Medicare |
$180.79
|
| Rate for Payer: Aetna Medicare |
$180.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.30
|
| Rate for Payer: BCBS Complete |
$97.84
|
| Rate for Payer: BCBS Complete |
$97.84
|
| Rate for Payer: BCBS MAPPO |
$173.84
|
| Rate for Payer: BCBS MAPPO |
$173.84
|
| Rate for Payer: BCBS Trust/PPO |
$470.72
|
| Rate for Payer: BCBS Trust/PPO |
$470.72
|
| Rate for Payer: BCN Commercial |
$470.72
|
| Rate for Payer: BCN Commercial |
$470.72
|
| Rate for Payer: BCN Medicare Advantage |
$173.84
|
| Rate for Payer: BCN Medicare Advantage |
$173.84
|
| Rate for Payer: Cash Price |
$477.98
|
| Rate for Payer: Cash Price |
$399.94
|
| Rate for Payer: Cash Price |
$477.98
|
| Rate for Payer: Cash Price |
$399.94
|
| Rate for Payer: Cofinity Commercial |
$418.23
|
| Rate for Payer: Cofinity Commercial |
$349.94
|
| Rate for Payer: Cofinity Commercial |
$429.93
|
| Rate for Payer: Cofinity Commercial |
$513.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$418.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.84
|
| Rate for Payer: Healthscope Commercial |
$449.93
|
| Rate for Payer: Healthscope Commercial |
$537.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$418.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$448.10
|
| Rate for Payer: Mclaren Medicaid |
$93.18
|
| Rate for Payer: Mclaren Medicaid |
$93.18
|
| Rate for Payer: Mclaren Medicare |
$173.84
|
| Rate for Payer: Mclaren Medicare |
$173.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.53
|
| Rate for Payer: Meridian Medicaid |
$97.84
|
| Rate for Payer: Meridian Medicaid |
$97.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$507.85
|
| Rate for Payer: Nomi Health Commercial |
$521.52
|
| Rate for Payer: Nomi Health Commercial |
$521.52
|
| Rate for Payer: PACE Medicare |
$165.15
|
| Rate for Payer: PACE Medicare |
$165.15
|
| Rate for Payer: PACE SWMI |
$173.84
|
| Rate for Payer: PACE SWMI |
$173.84
|
| Rate for Payer: PHP Commercial |
$424.93
|
| Rate for Payer: PHP Commercial |
$507.85
|
| Rate for Payer: PHP Medicare Advantage |
$173.84
|
| Rate for Payer: PHP Medicare Advantage |
$173.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$502.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$502.46
|
| Rate for Payer: Priority Health Medicare |
$173.84
|
| Rate for Payer: Priority Health Medicare |
$173.84
|
| Rate for Payer: Priority Health Narrow Network |
$401.97
|
| Rate for Payer: Priority Health Narrow Network |
$401.97
|
| Rate for Payer: Priority Health SBD |
$314.95
|
| Rate for Payer: Priority Health SBD |
$376.41
|
| Rate for Payer: Railroad Medicare Medicare |
$173.84
|
| Rate for Payer: Railroad Medicare Medicare |
$173.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$489.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$489.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.84
|
| Rate for Payer: UHC Exchange |
$332.23
|
| Rate for Payer: UHC Exchange |
$332.23
|
| Rate for Payer: UHC Medicare Advantage |
$173.84
|
| Rate for Payer: UHC Medicare Advantage |
$173.84
|
| Rate for Payer: UHCCP Medicaid |
$93.18
|
| Rate for Payer: UHCCP Medicaid |
$93.18
|
| Rate for Payer: UMR Bronson Commercial |
$184.97
|
| Rate for Payer: UMR Bronson Commercial |
$221.06
|
| Rate for Payer: VA VA |
$173.84
|
| Rate for Payer: VA VA |
$173.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$448.10
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
OP
|
$341.05
|
|
|
Service Code
|
NDC 00904647561
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.19 |
| Max. Negotiated Rate |
$306.94 |
| Rate for Payer: Aetna American Axle |
$221.68
|
| Rate for Payer: Aetna Commercial |
$289.89
|
| Rate for Payer: Aetna Medicare |
$170.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.68
|
| Rate for Payer: BCBS Complete |
$136.42
|
| Rate for Payer: Cash Price |
$272.84
|
| Rate for Payer: Cofinity Commercial |
$238.74
|
| Rate for Payer: Cofinity Commercial |
$293.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.84
|
| Rate for Payer: Healthscope Commercial |
$306.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.89
|
| Rate for Payer: PHP Commercial |
$289.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.68
|
| Rate for Payer: Priority Health SBD |
$214.86
|
| Rate for Payer: UMR Bronson Commercial |
$126.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.79
|
|
