|
BACLOFEN 10 MG TABLET
|
Facility
|
OP
|
$408.50
|
|
|
Service Code
|
NDC 63739047910
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.14 |
| Max. Negotiated Rate |
$367.65 |
| Rate for Payer: Aetna American Axle |
$265.52
|
| Rate for Payer: Aetna Commercial |
$347.22
|
| 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 |
$347.22
|
| Rate for Payer: PHP Commercial |
$347.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.52
|
| Rate for Payer: Priority Health SBD |
$257.36
|
| Rate for Payer: UMR Bronson Commercial |
$151.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.38
|
|
|
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 |
$2.30 |
| 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 |
$2.30
|
| 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
|
$105.75
|
|
|
Service Code
|
NDC 73320000202
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.13 |
| Max. Negotiated Rate |
$95.18 |
| 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 |
$74.02
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.02
|
| 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
|
$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
|
$254.40
|
|
|
Service Code
|
NDC 68084085501
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.94 |
| Max. Negotiated Rate |
$228.96 |
| Rate for Payer: Aetna American Axle |
$165.36
|
| Rate for Payer: Aetna Commercial |
$216.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.36
|
| 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 |
$111.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.80
|
|
|
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
|
|
|
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
|
|
|
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 |
$2.30 |
| Rate for Payer: Aetna American Axle |
$1.66
|
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.04
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: 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
|
$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 |
$347.22
|
| 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 |
$347.22
|
| Rate for Payer: PHP Commercial |
$347.22
|
| 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
|
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
|
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 20,000 MCG/20 ML (1,000 MCG/ML) INTRATHECAL SOLUTION
|
Facility
|
IP
|
$1,245.42
|
|
|
Service Code
|
HCPCS J0475
|
| Hospital Charge Code |
160111
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$547.98 |
| Max. Negotiated Rate |
$1,120.88 |
| Rate for Payer: Aetna American Axle |
$809.52
|
| Rate for Payer: Aetna Commercial |
$1,058.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$809.52
|
| Rate for Payer: Cash Price |
$996.34
|
| Rate for Payer: Cofinity Commercial |
$1,071.06
|
| Rate for Payer: Cofinity Commercial |
$871.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$871.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$996.34
|
| Rate for Payer: Healthscope Commercial |
$1,120.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$871.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$934.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,058.61
|
| Rate for Payer: PHP Commercial |
$1,058.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$809.52
|
| Rate for Payer: Priority Health SBD |
$784.61
|
| Rate for Payer: UMR Bronson Commercial |
$547.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$934.06
|
|
|
BACLOFEN 20,000 MCG/20 ML (1,000 MCG/ML) INTRATHECAL SOLUTION
|
Facility
|
OP
|
$1,245.42
|
|
|
Service Code
|
HCPCS J0475
|
| Hospital Charge Code |
160111
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.18 |
| Max. Negotiated Rate |
$1,120.88 |
| Rate for Payer: Aetna American Axle |
$809.52
|
| Rate for Payer: Aetna Commercial |
$1,058.61
|
| Rate for Payer: Aetna Medicare |
$180.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$809.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.30
|
| Rate for Payer: BCBS Complete |
$97.84
|
| Rate for Payer: BCBS MAPPO |
$173.84
|
| Rate for Payer: BCBS Trust/PPO |
$470.72
|
| Rate for Payer: BCN Commercial |
$470.72
|
| Rate for Payer: BCN Medicare Advantage |
$173.84
|
| Rate for Payer: Cash Price |
$996.34
|
| Rate for Payer: Cash Price |
$996.34
|
| Rate for Payer: Cofinity Commercial |
$871.79
|
| Rate for Payer: Cofinity Commercial |
$1,071.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$871.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$996.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.84
|
| Rate for Payer: Healthscope Commercial |
$1,120.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$871.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$934.06
|
| Rate for Payer: Mclaren Medicaid |
$93.18
|
| 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 Medicaid |
$97.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,058.61
|
| Rate for Payer: Nomi Health Commercial |
$521.52
|
| Rate for Payer: PACE Medicare |
$165.15
|
| Rate for Payer: PACE SWMI |
$173.84
|
| Rate for Payer: PHP Commercial |
$1,058.61
|
| Rate for Payer: PHP Medicare Advantage |
$173.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$809.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$502.46
|
| Rate for Payer: Priority Health Medicare |
$173.84
|
| Rate for Payer: Priority Health Narrow Network |
$401.97
|
| Rate for Payer: Priority Health SBD |
$784.61
|
| Rate for Payer: Railroad Medicare Medicare |
$173.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$489.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.84
|
| Rate for Payer: UHC Exchange |
$332.23
|
| Rate for Payer: UHC Medicare Advantage |
$173.84
|
| Rate for Payer: UHCCP Medicaid |
$93.18
|
| Rate for Payer: UMR Bronson Commercial |
$460.81
|
| Rate for Payer: VA VA |
$173.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$934.06
|
|
|
BACLOFEN 2,000 MCG/ML INTRATHECAL SOLUTION
|
Facility
|
OP
|
$3,497.02
|
|
|
Service Code
|
HCPCS J0475
|
| Hospital Charge Code |
9208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.18 |
| Max. Negotiated Rate |
$3,147.32 |
| Rate for Payer: Aetna American Axle |
$2,273.06
|
| Rate for Payer: Aetna Commercial |
$2,972.47
|
| Rate for Payer: Aetna Medicare |
$180.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,273.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.30
|
| Rate for Payer: BCBS Complete |
$97.84
|
| Rate for Payer: BCBS MAPPO |
$173.84
|
| Rate for Payer: BCBS Trust/PPO |
$470.72
|
| Rate for Payer: BCN Commercial |
$470.72
|
| Rate for Payer: BCN Medicare Advantage |
$173.84
|
| Rate for Payer: Cash Price |
$2,797.62
|
| Rate for Payer: Cash Price |
$2,797.62
|
| Rate for Payer: Cofinity Commercial |
$3,007.44
|
| Rate for Payer: Cofinity Commercial |
$2,447.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,447.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,797.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.84
|
| Rate for Payer: Healthscope Commercial |
$3,147.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,447.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,622.76
|
| Rate for Payer: Mclaren Medicaid |
$93.18
|
| 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 Medicaid |
$97.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,972.47
|
| Rate for Payer: Nomi Health Commercial |
$521.52
|
| Rate for Payer: PACE Medicare |
$165.15
|
| Rate for Payer: PACE SWMI |
$173.84
|
| Rate for Payer: PHP Commercial |
$2,972.47
|
| Rate for Payer: PHP Medicare Advantage |
$173.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,273.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$502.46
|
| Rate for Payer: Priority Health Medicare |
$173.84
|
| Rate for Payer: Priority Health Narrow Network |
$401.97
|
| Rate for Payer: Priority Health SBD |
$2,203.12
|
| Rate for Payer: Railroad Medicare Medicare |
$173.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$489.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.84
|
| Rate for Payer: UHC Exchange |
$332.23
|
| Rate for Payer: UHC Medicare Advantage |
$173.84
|
| Rate for Payer: UHCCP Medicaid |
$93.18
|
| Rate for Payer: UMR Bronson Commercial |
$1,293.90
|
| Rate for Payer: VA VA |
$173.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,622.76
|
|
|
BACLOFEN 2,000 MCG/ML INTRATHECAL SOLUTION
|
Facility
|
IP
|
$3,497.02
|
|
|
Service Code
|
HCPCS J0475
|
| Hospital Charge Code |
9208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,538.69 |
| Max. Negotiated Rate |
$3,147.32 |
| Rate for Payer: Aetna American Axle |
$2,273.06
|
| Rate for Payer: Aetna Commercial |
$2,972.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,273.06
|
| Rate for Payer: Cash Price |
$2,797.62
|
| Rate for Payer: Cofinity Commercial |
$2,447.91
|
| Rate for Payer: Cofinity Commercial |
$3,007.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,447.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,797.62
|
| Rate for Payer: Healthscope Commercial |
$3,147.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,447.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,622.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,972.47
|
| Rate for Payer: PHP Commercial |
$2,972.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,273.06
|
| Rate for Payer: Priority Health SBD |
$2,203.12
|
| Rate for Payer: UMR Bronson Commercial |
$1,538.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,622.76
|
|
|
BACLOFEN 20 MG TABLET
|
Facility
|
OP
|
$246.72
|
|
|
Service Code
|
NDC 00904647661
|
| Hospital Charge Code |
861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.29 |
| Max. Negotiated Rate |
$222.05 |
| Rate for Payer: Aetna American Axle |
$160.37
|
| Rate for Payer: Aetna Commercial |
$209.71
|
| Rate for Payer: Aetna Medicare |
$123.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.37
|
| Rate for Payer: BCBS Complete |
$98.69
|
| Rate for Payer: Cash Price |
$197.38
|
| Rate for Payer: Cofinity Commercial |
$172.70
|
| Rate for Payer: Cofinity Commercial |
$212.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.38
|
| Rate for Payer: Healthscope Commercial |
$222.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.71
|
| Rate for Payer: PHP Commercial |
$209.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.37
|
| Rate for Payer: Priority Health SBD |
$155.43
|
| Rate for Payer: UMR Bronson Commercial |
$91.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.04
|
|
|
BACLOFEN 20 MG TABLET
|
Facility
|
OP
|
$230.30
|
|
|
Service Code
|
NDC 00172409760
|
| Hospital Charge Code |
861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.21 |
| Max. Negotiated Rate |
$207.27 |
| Rate for Payer: Aetna American Axle |
$149.70
|
| Rate for Payer: Aetna Commercial |
$195.76
|
| Rate for Payer: Aetna Medicare |
$115.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.70
|
| Rate for Payer: BCBS Complete |
$92.12
|
| Rate for Payer: Cash Price |
$184.24
|
| Rate for Payer: Cofinity Commercial |
$161.21
|
| Rate for Payer: Cofinity Commercial |
$198.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$161.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.24
|
| Rate for Payer: Healthscope Commercial |
$207.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.76
|
| Rate for Payer: PHP Commercial |
$195.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.70
|
| Rate for Payer: Priority Health SBD |
$145.09
|
| Rate for Payer: UMR Bronson Commercial |
$85.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.72
|
|
|
BACLOFEN 20 MG TABLET
|
Facility
|
OP
|
$271.68
|
|
|
Service Code
|
NDC 63739048010
|
| Hospital Charge Code |
861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.52 |
| Max. Negotiated Rate |
$244.51 |
| Rate for Payer: Aetna American Axle |
$176.59
|
| Rate for Payer: Aetna Commercial |
$230.93
|
| Rate for Payer: Aetna Medicare |
$135.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.59
|
| Rate for Payer: BCBS Complete |
$108.67
|
| Rate for Payer: Cash Price |
$217.34
|
| Rate for Payer: Cofinity Commercial |
$190.18
|
| Rate for Payer: Cofinity Commercial |
$233.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.34
|
| Rate for Payer: Healthscope Commercial |
$244.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.93
|
| Rate for Payer: PHP Commercial |
$230.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.59
|
| Rate for Payer: Priority Health SBD |
$171.16
|
| Rate for Payer: UMR Bronson Commercial |
$100.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.76
|
|
|
BACLOFEN 20 MG TABLET
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 68084086811
|
| Hospital Charge Code |
861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Aetna American Axle |
$2.73
|
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.73
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$3.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.36
|
| Rate for Payer: Healthscope Commercial |
$3.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.57
|
| Rate for Payer: PHP Commercial |
$3.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.73
|
| Rate for Payer: Priority Health SBD |
$2.65
|
| Rate for Payer: UMR Bronson Commercial |
$1.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.15
|
|
|
BACLOFEN 20 MG TABLET
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 68084086811
|
| Hospital Charge Code |
861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Aetna American Axle |
$2.73
|
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Aetna Medicare |
$2.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.73
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$3.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.36
|
| Rate for Payer: Healthscope Commercial |
$3.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.57
|
| Rate for Payer: PHP Commercial |
$3.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.73
|
| Rate for Payer: Priority Health SBD |
$2.65
|
| Rate for Payer: UMR Bronson Commercial |
$1.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.15
|
|
|
BACLOFEN 20 MG TABLET
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
NDC 68084086801
|
| Hospital Charge Code |
861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna American Axle |
$273.00
|
| Rate for Payer: Aetna Commercial |
$357.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cofinity Commercial |
$294.00
|
| Rate for Payer: Cofinity Commercial |
$361.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.00
|
| Rate for Payer: Healthscope Commercial |
$378.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.00
|
| Rate for Payer: PHP Commercial |
$357.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.00
|
| Rate for Payer: Priority Health SBD |
$264.60
|
| Rate for Payer: UMR Bronson Commercial |
$184.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.00
|
|
|
BACLOFEN 20 MG TABLET
|
Facility
|
IP
|
$246.72
|
|
|
Service Code
|
NDC 00904647661
|
| Hospital Charge Code |
861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.56 |
| Max. Negotiated Rate |
$222.05 |
| Rate for Payer: Aetna American Axle |
$160.37
|
| Rate for Payer: Aetna Commercial |
$209.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.37
|
| Rate for Payer: Cash Price |
$197.38
|
| Rate for Payer: Cofinity Commercial |
$172.70
|
| Rate for Payer: Cofinity Commercial |
$212.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.38
|
| Rate for Payer: Healthscope Commercial |
$222.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.71
|
| Rate for Payer: PHP Commercial |
$209.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.37
|
| Rate for Payer: Priority Health SBD |
$155.43
|
| Rate for Payer: UMR Bronson Commercial |
$108.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.04
|
|
|
BACLOFEN 20 MG TABLET
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
NDC 68084086801
|
| Hospital Charge Code |
861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.40 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna American Axle |
$273.00
|
| Rate for Payer: Aetna Commercial |
$357.00
|
| Rate for Payer: Aetna Medicare |
$210.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.00
|
| Rate for Payer: BCBS Complete |
$168.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cofinity Commercial |
$294.00
|
| Rate for Payer: Cofinity Commercial |
$361.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.00
|
| Rate for Payer: Healthscope Commercial |
$378.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.00
|
| Rate for Payer: PHP Commercial |
$357.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.00
|
| Rate for Payer: Priority Health SBD |
$264.60
|
| Rate for Payer: UMR Bronson Commercial |
$155.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.00
|
|
|
BACLOFEN 20 MG TABLET
|
Facility
|
IP
|
$230.30
|
|
|
Service Code
|
NDC 00172409760
|
| Hospital Charge Code |
861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.33 |
| Max. Negotiated Rate |
$207.27 |
| Rate for Payer: Aetna American Axle |
$149.70
|
| Rate for Payer: Aetna Commercial |
$195.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.70
|
| Rate for Payer: Cash Price |
$184.24
|
| Rate for Payer: Cofinity Commercial |
$161.21
|
| Rate for Payer: Cofinity Commercial |
$198.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$161.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.24
|
| Rate for Payer: Healthscope Commercial |
$207.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.76
|
| Rate for Payer: PHP Commercial |
$195.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.70
|
| Rate for Payer: Priority Health SBD |
$145.09
|
| Rate for Payer: UMR Bronson Commercial |
$101.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.72
|
|
|
BACLOFEN 20 MG TABLET
|
Facility
|
IP
|
$271.68
|
|
|
Service Code
|
NDC 63739048010
|
| Hospital Charge Code |
861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.54 |
| Max. Negotiated Rate |
$244.51 |
| Rate for Payer: Aetna American Axle |
$176.59
|
| Rate for Payer: Aetna Commercial |
$230.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.59
|
| Rate for Payer: Cash Price |
$217.34
|
| Rate for Payer: Cofinity Commercial |
$190.18
|
| Rate for Payer: Cofinity Commercial |
$233.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.34
|
| Rate for Payer: Healthscope Commercial |
$244.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.93
|
| Rate for Payer: PHP Commercial |
$230.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.59
|
| Rate for Payer: Priority Health SBD |
$171.16
|
| Rate for Payer: UMR Bronson Commercial |
$119.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.76
|
|
