|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 67777000860
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$10.17
|
|
|
Service Code
|
NDC 51672207501
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$9.15 |
| Rate for Payer: Aetna American Axle |
$6.61
|
| Rate for Payer: Aetna Commercial |
$8.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.61
|
| Rate for Payer: Cash Price |
$8.14
|
| Rate for Payer: Cofinity Advantage |
$7.12
|
| Rate for Payer: Cofinity Commercial |
$8.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.14
|
| Rate for Payer: Healthscope Commercial |
$9.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.63
|
| Rate for Payer: PHP Commercial |
$8.64
|
| Rate for Payer: Priority Health SBD |
$6.41
|
| Rate for Payer: UMR Bronson Commercial |
$4.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.63
|
|
|
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC
|
Facility
|
IP
|
$45,118.46
|
|
|
Service Code
|
MSDRG 519
|
| Min. Negotiated Rate |
$16,454.01 |
| Max. Negotiated Rate |
$45,118.46 |
| Rate for Payer: Aetna Medicare |
$18,012.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,650.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,650.01
|
| Rate for Payer: BCBS MAPPO |
$17,320.01
|
| Rate for Payer: BCBS Trust/PPO |
$45,118.46
|
| Rate for Payer: BCN Commercial |
$45,118.46
|
| Rate for Payer: BCN Medicare Advantage |
$17,320.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,320.01
|
| Rate for Payer: Mclaren Medicare |
$17,320.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,186.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,918.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,052.01
|
| Rate for Payer: Nomi Health Commercial |
$25,802.58
|
| Rate for Payer: PACE Medicare |
$16,454.01
|
| Rate for Payer: PACE SWMI |
$17,320.01
|
| Rate for Payer: PHP Medicare Advantage |
$17,320.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$32,247.50
|
| Rate for Payer: Priority Health Medicare |
$17,320.01
|
| Rate for Payer: Priority Health Tiered Network |
$25,798.00
|
| Rate for Payer: Railroad Medicare Medicare |
$17,320.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,603.26
|
| Rate for Payer: UHC Core |
$27,276.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,320.01
|
| Rate for Payer: UHC Exchange |
$22,276.23
|
| Rate for Payer: VA VA |
$17,320.01
|
|
|
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR
|
Facility
|
IP
|
$65,201.62
|
|
|
Service Code
|
MSDRG 518
|
| Min. Negotiated Rate |
$30,254.52 |
| Max. Negotiated Rate |
$65,201.62 |
| Rate for Payer: Aetna Medicare |
$33,120.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39,808.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39,808.57
|
| Rate for Payer: BCBS MAPPO |
$31,846.86
|
| Rate for Payer: BCBS Trust/PPO |
$65,201.62
|
| Rate for Payer: BCN Commercial |
$65,201.62
|
| Rate for Payer: BCN Medicare Advantage |
$31,846.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31,846.86
|
| Rate for Payer: Mclaren Medicare |
$31,846.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33,439.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36,623.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$35,031.55
|
| Rate for Payer: Nomi Health Commercial |
$48,211.17
|
| Rate for Payer: PACE Medicare |
$30,254.52
|
| Rate for Payer: PACE SWMI |
$31,846.86
|
| Rate for Payer: PHP Medicare Advantage |
$31,846.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$60,253.27
|
| Rate for Payer: Priority Health Medicare |
$31,846.86
|
| Rate for Payer: Priority Health Tiered Network |
$48,202.61
|
| Rate for Payer: Railroad Medicare Medicare |
$31,846.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60,917.99
|
| Rate for Payer: UHC Core |
$50,965.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31,846.86
|
| Rate for Payer: UHC Exchange |
$41,622.31
|
| Rate for Payer: VA VA |
$31,846.86
|
|
|
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$35,774.14
|
|
|
Service Code
|
MSDRG 520
|
| Min. Negotiated Rate |
$12,431.70 |
| Max. Negotiated Rate |
$35,774.14 |
| Rate for Payer: Aetna Medicare |
$13,609.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,357.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,357.50
|
| Rate for Payer: BCBS MAPPO |
$13,086.00
|
| Rate for Payer: BCBS Trust/PPO |
$35,774.14
|
| Rate for Payer: BCN Commercial |
$35,774.14
|
| Rate for Payer: BCN Medicare Advantage |
$13,086.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,086.00
|
| Rate for Payer: Mclaren Medicare |
$13,086.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,740.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,048.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,394.60
|
| Rate for Payer: Nomi Health Commercial |
$19,271.31
|
| Rate for Payer: PACE Medicare |
$12,431.70
|
| Rate for Payer: PACE SWMI |
$13,086.00
|
| Rate for Payer: PHP Medicare Advantage |
$13,086.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24,084.86
|
| Rate for Payer: Priority Health Medicare |
$13,086.00
|
| Rate for Payer: Priority Health Tiered Network |
$19,267.89
|
| Rate for Payer: Railroad Medicare Medicare |
$13,086.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,350.57
|
| Rate for Payer: UHC Core |
$20,372.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,086.00
|
| Rate for Payer: UHC Exchange |
$16,637.56
|
| Rate for Payer: VA VA |
$13,086.00
|
|
|
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 Advantage |
$418.23
|
| Rate for Payer: Cofinity Advantage |
$349.94
|
| Rate for Payer: Cofinity Commercial |
$513.82
|
| Rate for Payer: Cofinity Commercial |
$429.93
|
| 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 |
$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: Multiplan/Beech St/PHCS Commercial |
$424.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$507.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$374.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$448.10
|
| Rate for Payer: PHP Commercial |
$424.93
|
| Rate for Payer: PHP Commercial |
$507.85
|
| Rate for Payer: Priority Health SBD |
$376.41
|
| Rate for Payer: Priority Health SBD |
$314.95
|
| 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 |
$93.12 |
| Max. Negotiated Rate |
$588.40 |
| 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 |
$185.17
|
| Rate for Payer: Aetna Medicare |
$185.17
|
| 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 |
$222.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.56
|
| Rate for Payer: BCBS Complete |
$97.79
|
| Rate for Payer: BCBS Complete |
$97.79
|
| Rate for Payer: BCBS MAPPO |
$178.05
|
| Rate for Payer: BCBS MAPPO |
$178.05
|
| Rate for Payer: BCBS Trust/PPO |
$588.40
|
| Rate for Payer: BCBS Trust/PPO |
$588.40
|
| Rate for Payer: BCN Commercial |
$588.40
|
| Rate for Payer: BCN Commercial |
$588.40
|
| Rate for Payer: BCN Medicare Advantage |
$178.05
|
| Rate for Payer: BCN Medicare Advantage |
$178.05
|
| 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 Advantage |
$418.23
|
| Rate for Payer: Cofinity Advantage |
$349.94
|
| Rate for Payer: Cofinity Commercial |
$429.93
|
| Rate for Payer: Cofinity Commercial |
$513.82
|
| 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 |
$178.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.05
|
| 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 |
$178.05
|
| Rate for Payer: Mclaren Medicaid |
$178.05
|
| Rate for Payer: Mclaren Medicare |
$178.05
|
| Rate for Payer: Mclaren Medicare |
$178.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.95
|
| Rate for Payer: Meridian Medicaid |
$186.95
|
| Rate for Payer: Meridian Medicaid |
$186.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$195.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$195.85
|
| 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 |
$534.15
|
| Rate for Payer: Nomi Health Commercial |
$534.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$448.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$374.94
|
| Rate for Payer: PACE Medicare |
$169.15
|
| Rate for Payer: PACE Medicare |
$169.15
|
| Rate for Payer: PACE SWMI |
$178.05
|
| Rate for Payer: PACE SWMI |
$178.05
|
| Rate for Payer: PHP Commercial |
$424.93
|
| Rate for Payer: PHP Commercial |
$507.85
|
| Rate for Payer: PHP Medicare Advantage |
$178.05
|
| Rate for Payer: PHP Medicare Advantage |
$178.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$571.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$571.57
|
| Rate for Payer: Priority Health Medicare |
$178.05
|
| Rate for Payer: Priority Health Medicare |
$178.05
|
| Rate for Payer: Priority Health SBD |
$314.95
|
| Rate for Payer: Priority Health SBD |
$376.41
|
| Rate for Payer: Priority Health Tiered Network |
$457.26
|
| Rate for Payer: Priority Health Tiered Network |
$457.26
|
| Rate for Payer: Railroad Medicare Medicare |
$178.05
|
| Rate for Payer: Railroad Medicare Medicare |
$178.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.43
|
| Rate for Payer: UHC Core |
$299.43
|
| Rate for Payer: UHC Core |
$299.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$178.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$178.05
|
| Rate for Payer: UHC Exchange |
$299.43
|
| Rate for Payer: UHC Exchange |
$299.43
|
| Rate for Payer: UHC Medicaid |
$93.12
|
| Rate for Payer: UHC Medicaid |
$93.12
|
| Rate for Payer: UHCCP Medicaid |
$93.12
|
| Rate for Payer: UHCCP Medicaid |
$93.12
|
| Rate for Payer: UMR Bronson Commercial |
$184.97
|
| Rate for Payer: UMR Bronson Commercial |
$221.06
|
| Rate for Payer: VA VA |
$178.05
|
| Rate for Payer: VA VA |
$178.05
|
| 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
|
$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 Advantage |
$285.95
|
| Rate for Payer: Cofinity Commercial |
$351.31
|
| 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: MI Amish Medical Board Commercial |
$326.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$306.38
|
| Rate for Payer: PHP Commercial |
$347.23
|
| Rate for Payer: Priority Health SBD |
$257.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.52
|
| Rate for Payer: UHC Core |
$212.83
|
| Rate for Payer: UHC Exchange |
$160.54
|
| 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
|
$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 Advantage |
$74.03
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| 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: Opus (Opus Packaging Group) HMA |
$79.31
|
| Rate for Payer: PHP Commercial |
$89.89
|
| 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
|
OP
|
$138.65
|
|
|
Service Code
|
NDC 00172409660
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.30 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna American Axle |
$90.12
|
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna Medicare |
$69.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Advantage |
$97.06
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health SBD |
$87.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.12
|
| Rate for Payer: UHC Core |
$72.24
|
| Rate for Payer: UHC Exchange |
$54.49
|
| Rate for Payer: UMR Bronson Commercial |
$51.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
IP
|
$353.40
|
|
|
Service Code
|
NDC 00904647561
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.50 |
| Max. Negotiated Rate |
$318.06 |
| Rate for Payer: Aetna American Axle |
$229.71
|
| Rate for Payer: Aetna Commercial |
$300.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.71
|
| Rate for Payer: Cash Price |
$282.72
|
| Rate for Payer: Cofinity Advantage |
$247.38
|
| Rate for Payer: Cofinity Commercial |
$303.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.72
|
| Rate for Payer: Healthscope Commercial |
$318.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.05
|
| Rate for Payer: PHP Commercial |
$300.39
|
| Rate for Payer: Priority Health SBD |
$222.64
|
| Rate for Payer: UMR Bronson Commercial |
$155.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.05
|
|
|
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 Advantage |
$285.95
|
| Rate for Payer: Cofinity Commercial |
$351.31
|
| 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: Opus (Opus Packaging Group) HMA |
$306.38
|
| Rate for Payer: PHP Commercial |
$347.23
|
| 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
|
$138.65
|
|
|
Service Code
|
NDC 00172409660
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.01 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna American Axle |
$90.12
|
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Advantage |
$97.06
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health SBD |
$87.35
|
| Rate for Payer: UMR Bronson Commercial |
$61.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
OP
|
$353.40
|
|
|
Service Code
|
NDC 00904647561
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.76 |
| Max. Negotiated Rate |
$318.06 |
| Rate for Payer: Aetna American Axle |
$229.71
|
| Rate for Payer: Aetna Commercial |
$300.39
|
| Rate for Payer: Aetna Medicare |
$176.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.71
|
| Rate for Payer: BCBS Complete |
$141.36
|
| Rate for Payer: Cash Price |
$282.72
|
| Rate for Payer: Cofinity Advantage |
$247.38
|
| Rate for Payer: Cofinity Commercial |
$303.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.72
|
| Rate for Payer: Healthscope Commercial |
$318.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.05
|
| Rate for Payer: PHP Commercial |
$300.39
|
| Rate for Payer: Priority Health SBD |
$222.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.71
|
| Rate for Payer: UHC Core |
$184.12
|
| Rate for Payer: UHC Exchange |
$138.89
|
| Rate for Payer: UMR Bronson Commercial |
$130.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.05
|
|
|
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 Advantage |
$74.03
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| 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: MI Amish Medical Board Commercial |
$84.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.31
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health SBD |
$66.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.74
|
| Rate for Payer: UHC Core |
$55.10
|
| Rate for Payer: UHC Exchange |
$41.56
|
| Rate for Payer: UMR Bronson Commercial |
$39.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
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 |
$93.12 |
| 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 |
$185.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$809.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.56
|
| Rate for Payer: BCBS Complete |
$97.79
|
| Rate for Payer: BCBS MAPPO |
$178.05
|
| Rate for Payer: BCBS Trust/PPO |
$588.40
|
| Rate for Payer: BCN Commercial |
$588.40
|
| Rate for Payer: BCN Medicare Advantage |
$178.05
|
| Rate for Payer: Cash Price |
$996.34
|
| Rate for Payer: Cash Price |
$996.34
|
| Rate for Payer: Cofinity Advantage |
$871.79
|
| Rate for Payer: Cofinity Commercial |
$1,071.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$996.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.05
|
| 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 |
$934.07
|
| Rate for Payer: Mclaren Medicaid |
$178.05
|
| Rate for Payer: Mclaren Medicare |
$178.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.95
|
| Rate for Payer: Meridian Medicaid |
$186.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$195.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,058.61
|
| Rate for Payer: Nomi Health Commercial |
$534.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$934.07
|
| Rate for Payer: PACE Medicare |
$169.15
|
| Rate for Payer: PACE SWMI |
$178.05
|
| Rate for Payer: PHP Commercial |
$1,058.61
|
| Rate for Payer: PHP Medicare Advantage |
$178.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$571.57
|
| Rate for Payer: Priority Health Medicare |
$178.05
|
| Rate for Payer: Priority Health SBD |
$784.61
|
| Rate for Payer: Priority Health Tiered Network |
$457.26
|
| Rate for Payer: Railroad Medicare Medicare |
$178.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.43
|
| Rate for Payer: UHC Core |
$299.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$178.05
|
| Rate for Payer: UHC Exchange |
$299.43
|
| Rate for Payer: UHC Medicaid |
$93.12
|
| Rate for Payer: UHCCP Medicaid |
$93.12
|
| Rate for Payer: UMR Bronson Commercial |
$460.81
|
| Rate for Payer: VA VA |
$178.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$934.07
|
|
|
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 Advantage |
$871.79
|
| Rate for Payer: Cofinity Commercial |
$1,071.06
|
| 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 |
$934.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,058.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$934.07
|
| Rate for Payer: PHP Commercial |
$1,058.61
|
| 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 |
$934.07
|
|
|
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 |
$93.12 |
| 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 |
$185.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,273.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.56
|
| Rate for Payer: BCBS Complete |
$97.79
|
| Rate for Payer: BCBS MAPPO |
$178.05
|
| Rate for Payer: BCBS Trust/PPO |
$588.40
|
| Rate for Payer: BCN Commercial |
$588.40
|
| Rate for Payer: BCN Medicare Advantage |
$178.05
|
| Rate for Payer: Cash Price |
$2,797.62
|
| Rate for Payer: Cash Price |
$2,797.62
|
| Rate for Payer: Cofinity Advantage |
$2,447.91
|
| Rate for Payer: Cofinity Commercial |
$3,007.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,797.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.05
|
| 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 |
$178.05
|
| Rate for Payer: Mclaren Medicare |
$178.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.95
|
| Rate for Payer: Meridian Medicaid |
$186.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$195.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,972.47
|
| Rate for Payer: Nomi Health Commercial |
$534.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,622.76
|
| Rate for Payer: PACE Medicare |
$169.15
|
| Rate for Payer: PACE SWMI |
$178.05
|
| Rate for Payer: PHP Commercial |
$2,972.47
|
| Rate for Payer: PHP Medicare Advantage |
$178.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$571.57
|
| Rate for Payer: Priority Health Medicare |
$178.05
|
| Rate for Payer: Priority Health SBD |
$2,203.12
|
| Rate for Payer: Priority Health Tiered Network |
$457.26
|
| Rate for Payer: Railroad Medicare Medicare |
$178.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.43
|
| Rate for Payer: UHC Core |
$299.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$178.05
|
| Rate for Payer: UHC Exchange |
$299.43
|
| Rate for Payer: UHC Medicaid |
$93.12
|
| Rate for Payer: UHCCP Medicaid |
$93.12
|
| Rate for Payer: UMR Bronson Commercial |
$1,293.90
|
| Rate for Payer: VA VA |
$178.05
|
| 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 Advantage |
$2,447.91
|
| Rate for Payer: Cofinity Commercial |
$3,007.44
|
| 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: Opus (Opus Packaging Group) HMA |
$2,622.76
|
| Rate for Payer: PHP Commercial |
$2,972.47
|
| 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
|
IP
|
$320.64
|
|
|
Service Code
|
NDC 60687082601
|
| Hospital Charge Code |
861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.08 |
| Max. Negotiated Rate |
$288.58 |
| Rate for Payer: Aetna American Axle |
$208.42
|
| Rate for Payer: Aetna Commercial |
$272.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.42
|
| Rate for Payer: Cash Price |
$256.51
|
| Rate for Payer: Cofinity Advantage |
$224.45
|
| Rate for Payer: Cofinity Commercial |
$275.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.51
|
| Rate for Payer: Healthscope Commercial |
$288.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.48
|
| Rate for Payer: PHP Commercial |
$272.54
|
| Rate for Payer: Priority Health SBD |
$202.00
|
| Rate for Payer: UMR Bronson Commercial |
$141.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.48
|
|
|
BACLOFEN 20 MG TABLET
|
Facility
|
IP
|
$183.30
|
|
|
Service Code
|
NDC 00172409760
|
| Hospital Charge Code |
861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.65 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna American Axle |
$119.14
|
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.14
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Advantage |
$128.31
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.47
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: Priority Health SBD |
$115.48
|
| Rate for Payer: UMR Bronson Commercial |
$80.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.47
|
|
|
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 Advantage |
$190.18
|
| Rate for Payer: Cofinity Commercial |
$233.64
|
| 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: MI Amish Medical Board Commercial |
$217.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.76
|
| Rate for Payer: PHP Commercial |
$230.93
|
| Rate for Payer: Priority Health SBD |
$171.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.59
|
| Rate for Payer: UHC Core |
$141.55
|
| Rate for Payer: UHC Exchange |
$106.77
|
| Rate for Payer: UMR Bronson Commercial |
$100.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.76
|
|
|
BACLOFEN 20 MG TABLET
|
Facility
|
OP
|
$183.30
|
|
|
Service Code
|
NDC 00172409760
|
| Hospital Charge Code |
861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.82 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna American Axle |
$119.14
|
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: Aetna Medicare |
$91.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.14
|
| Rate for Payer: BCBS Complete |
$73.32
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Advantage |
$128.31
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.47
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: Priority Health SBD |
$115.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.14
|
| Rate for Payer: UHC Core |
$95.50
|
| Rate for Payer: UHC Exchange |
$72.04
|
| Rate for Payer: UMR Bronson Commercial |
$67.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.47
|
|
|
BACLOFEN 20 MG TABLET
|
Facility
|
OP
|
$320.64
|
|
|
Service Code
|
NDC 60687082601
|
| Hospital Charge Code |
861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.64 |
| Max. Negotiated Rate |
$288.58 |
| Rate for Payer: Aetna American Axle |
$208.42
|
| Rate for Payer: Aetna Commercial |
$272.54
|
| Rate for Payer: Aetna Medicare |
$160.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.42
|
| Rate for Payer: BCBS Complete |
$128.26
|
| Rate for Payer: Cash Price |
$256.51
|
| Rate for Payer: Cofinity Advantage |
$224.45
|
| Rate for Payer: Cofinity Commercial |
$275.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.51
|
| Rate for Payer: Healthscope Commercial |
$288.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$256.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.48
|
| Rate for Payer: PHP Commercial |
$272.54
|
| Rate for Payer: Priority Health SBD |
$202.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.42
|
| Rate for Payer: UHC Core |
$167.05
|
| Rate for Payer: UHC Exchange |
$126.01
|
| Rate for Payer: UMR Bronson Commercial |
$118.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.48
|
|
|
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 Advantage |
$190.18
|
| Rate for Payer: Cofinity Commercial |
$233.64
|
| 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: Opus (Opus Packaging Group) HMA |
$203.76
|
| Rate for Payer: PHP Commercial |
$230.93
|
| 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
|
|
