|
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
|
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
|
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
|
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
|
$65.45
|
|
|
Service Code
|
NDC 67777022007
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.22 |
| Max. Negotiated Rate |
$58.91 |
| Rate for Payer: Aetna American Axle |
$42.54
|
| Rate for Payer: Aetna Commercial |
$55.63
|
| Rate for Payer: Aetna Medicare |
$32.73
|
| 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 |
$45.81
|
| Rate for Payer: Cofinity Commercial |
$56.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.36
|
| Rate for Payer: Healthscope Commercial |
$58.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.81
|
| 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
|
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
|
$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
|
$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 |
$12.39
|
| 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
|
$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
|
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
|
$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
|
$65.45
|
|
|
Service Code
|
NDC 67777022007
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$58.91 |
| 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 |
$45.81
|
| Rate for Payer: Cofinity Commercial |
$56.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.36
|
| Rate for Payer: Healthscope Commercial |
$58.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.81
|
| 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
|
|
|
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
|
$597.47
|
|
|
Service Code
|
HCPCS J0475
|
| Hospital Charge Code |
107799
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.13 |
| Max. Negotiated Rate |
$537.72 |
| Rate for Payer: Aetna American Axle |
$388.36
|
| Rate for Payer: Aetna American Axle |
$324.95
|
| Rate for Payer: Aetna Commercial |
$424.93
|
| Rate for Payer: Aetna Commercial |
$507.85
|
| Rate for Payer: Aetna Medicare |
$188.47
|
| Rate for Payer: Aetna Medicare |
$188.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$226.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$226.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$226.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$226.53
|
| Rate for Payer: BCBS Complete |
$101.99
|
| Rate for Payer: BCBS Complete |
$101.99
|
| Rate for Payer: BCBS MAPPO |
$181.22
|
| Rate for Payer: BCBS MAPPO |
$181.22
|
| Rate for Payer: BCN Medicare Advantage |
$181.22
|
| Rate for Payer: BCN Medicare Advantage |
$181.22
|
| Rate for Payer: Cash Price |
$399.94
|
| Rate for Payer: Cash Price |
$477.98
|
| Rate for Payer: Cash Price |
$477.98
|
| Rate for Payer: Cash Price |
$399.94
|
| Rate for Payer: Cofinity Commercial |
$349.94
|
| Rate for Payer: Cofinity Commercial |
$429.93
|
| Rate for Payer: Cofinity Commercial |
$418.23
|
| 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 |
$477.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$181.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$181.22
|
| Rate for Payer: Healthscope Commercial |
$537.72
|
| Rate for Payer: Healthscope Commercial |
$449.93
|
| 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 |
$97.13
|
| Rate for Payer: Mclaren Medicaid |
$97.13
|
| Rate for Payer: Mclaren Medicare |
$181.22
|
| Rate for Payer: Mclaren Medicare |
$181.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$190.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$190.28
|
| Rate for Payer: Meridian Medicaid |
$101.99
|
| Rate for Payer: Meridian Medicaid |
$101.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$507.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.93
|
| Rate for Payer: PACE Medicare |
$172.16
|
| Rate for Payer: PACE Medicare |
$172.16
|
| Rate for Payer: PACE SWMI |
$181.22
|
| Rate for Payer: PACE SWMI |
$181.22
|
| Rate for Payer: PHP Commercial |
$424.93
|
| Rate for Payer: PHP Commercial |
$507.85
|
| Rate for Payer: PHP Medicare Advantage |
$181.22
|
| Rate for Payer: PHP Medicare Advantage |
$181.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.13
|
| 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 Medicare |
$181.22
|
| Rate for Payer: Priority Health Medicare |
$181.22
|
| Rate for Payer: Priority Health SBD |
$314.95
|
| Rate for Payer: Priority Health SBD |
$376.41
|
| Rate for Payer: Railroad Medicare Medicare |
$181.22
|
| Rate for Payer: Railroad Medicare Medicare |
$181.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$510.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$510.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$181.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$181.22
|
| Rate for Payer: UHC Exchange |
$346.33
|
| Rate for Payer: UHC Exchange |
$346.33
|
| Rate for Payer: UHC Medicare Advantage |
$181.22
|
| Rate for Payer: UHC Medicare Advantage |
$181.22
|
| Rate for Payer: UHCCP Medicaid |
$97.13
|
| Rate for Payer: UHCCP Medicaid |
$97.13
|
| Rate for Payer: UMR Bronson Commercial |
$184.97
|
| Rate for Payer: UMR Bronson Commercial |
$221.06
|
| Rate for Payer: VA VA |
$181.22
|
| Rate for Payer: VA VA |
$181.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$448.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.94
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
OP
|
$105.75
|
|
|
Service Code
|
NDC 73320000202
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.13 |
| Max. Negotiated Rate |
$95.17 |
| Rate for Payer: Aetna American Axle |
$68.74
|
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna Medicare |
$52.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: BCBS Complete |
$42.30
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$74.03
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.74
|
| Rate for Payer: Priority Health SBD |
$66.62
|
| Rate for Payer: UMR Bronson Commercial |
$39.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
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 |
$170.53
|
| 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
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
OP
|
$2.55
|
|
|
Service Code
|
NDC 68084085511
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna American Axle |
$1.66
|
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Aetna Medicare |
$1.27
|
| 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 |
$2.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$0.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
IP
|
$178.60
|
|
|
Service Code
|
NDC 00172409660
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.58 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna American Axle |
$116.09
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$125.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.95
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$78.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.95
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
IP
|
$2.55
|
|
|
Service Code
|
NDC 68084085511
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna American Axle |
$1.66
|
| 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 |
$2.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
OP
|
$254.40
|
|
|
Service Code
|
NDC 68084085501
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.13 |
| Max. Negotiated Rate |
$228.96 |
| Rate for Payer: Aetna American Axle |
$165.36
|
| Rate for Payer: Aetna Commercial |
$216.24
|
| Rate for Payer: Aetna Medicare |
$127.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.36
|
| Rate for Payer: BCBS Complete |
$101.76
|
| Rate for Payer: Cash Price |
$203.52
|
| Rate for Payer: Cofinity Commercial |
$178.08
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.52
|
| Rate for Payer: Healthscope Commercial |
$228.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.24
|
| Rate for Payer: PHP Commercial |
$216.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.36
|
| Rate for Payer: Priority Health SBD |
$160.27
|
| Rate for Payer: UMR Bronson Commercial |
$94.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.80
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
OP
|
$408.50
|
|
|
Service Code
|
NDC 63739047910
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.15 |
| Max. Negotiated Rate |
$367.65 |
| Rate for Payer: Aetna American Axle |
$265.52
|
| Rate for Payer: Aetna Commercial |
$347.23
|
| Rate for Payer: Aetna Medicare |
$204.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.52
|
| Rate for Payer: BCBS Complete |
$163.40
|
| Rate for Payer: Cash Price |
$326.80
|
| Rate for Payer: Cofinity Commercial |
$285.95
|
| Rate for Payer: Cofinity Commercial |
$351.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$285.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.80
|
| Rate for Payer: Healthscope Commercial |
$367.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.23
|
| Rate for Payer: PHP Commercial |
$347.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.52
|
| Rate for Payer: Priority Health SBD |
$257.36
|
| Rate for Payer: UMR Bronson Commercial |
$151.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.38
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
IP
|
$408.50
|
|
|
Service Code
|
NDC 63739047910
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.74 |
| Max. Negotiated Rate |
$367.65 |
| Rate for Payer: Aetna American Axle |
$265.52
|
| Rate for Payer: Aetna Commercial |
$347.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.52
|
| Rate for Payer: Cash Price |
$326.80
|
| Rate for Payer: Cofinity Commercial |
$285.95
|
| Rate for Payer: Cofinity Commercial |
$351.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$285.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.80
|
| Rate for Payer: Healthscope Commercial |
$367.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.23
|
| Rate for Payer: PHP Commercial |
$347.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.52
|
| Rate for Payer: Priority Health SBD |
$257.36
|
| Rate for Payer: UMR Bronson Commercial |
$179.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.38
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
OP
|
$178.60
|
|
|
Service Code
|
NDC 00172409660
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.08 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna American Axle |
$116.09
|
| Rate for Payer: Aetna Commercial |
$151.81
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.09
|
| Rate for Payer: BCBS Complete |
$71.44
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$125.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.95
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$66.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.95
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
IP
|
$105.75
|
|
|
Service Code
|
NDC 73320000202
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.53 |
| Max. Negotiated Rate |
$95.17 |
| Rate for Payer: Aetna American Axle |
$68.74
|
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$74.03
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.74
|
| Rate for Payer: Priority Health SBD |
$66.62
|
| Rate for Payer: UMR Bronson Commercial |
$46.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
IP
|
$341.05
|
|
|
Service Code
|
NDC 00904647561
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.06 |
| Max. Negotiated Rate |
$306.94 |
| Rate for Payer: Aetna American Axle |
$221.68
|
| Rate for Payer: Aetna Commercial |
$289.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.68
|
| 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 |
$150.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.79
|
|
