|
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
|
IP
|
$3.21
|
|
|
Service Code
|
NDC 60687082611
|
| Hospital Charge Code |
861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna American Axle |
$2.09
|
| Rate for Payer: Aetna Commercial |
$2.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.09
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cofinity Advantage |
$2.25
|
| Rate for Payer: Cofinity Commercial |
$2.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.57
|
| Rate for Payer: Healthscope Commercial |
$2.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.41
|
| Rate for Payer: PHP Commercial |
$2.73
|
| Rate for Payer: Priority Health SBD |
$2.02
|
| Rate for Payer: UMR Bronson Commercial |
$1.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.41
|
|
|
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
|
IP
|
$289.92
|
|
|
Service Code
|
NDC 00904647661
|
| Hospital Charge Code |
861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.56 |
| Max. Negotiated Rate |
$260.93 |
| Rate for Payer: Aetna American Axle |
$188.45
|
| Rate for Payer: Aetna Commercial |
$246.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.45
|
| Rate for Payer: Cash Price |
$231.94
|
| Rate for Payer: Cofinity Advantage |
$202.94
|
| Rate for Payer: Cofinity Commercial |
$249.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.94
|
| Rate for Payer: Healthscope Commercial |
$260.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.44
|
| Rate for Payer: PHP Commercial |
$246.43
|
| Rate for Payer: Priority Health SBD |
$182.65
|
| Rate for Payer: UMR Bronson Commercial |
$127.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.44
|
|
|
BACLOFEN 40,000 MCG/20 ML (2,000 MCG/ML) INTRATHECAL SOLUTION
|
Facility
|
IP
|
$737.06
|
|
|
Service Code
|
HCPCS J0475
|
| Hospital Charge Code |
107800
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$324.31 |
| Max. Negotiated Rate |
$663.35 |
| Rate for Payer: Aetna American Axle |
$479.09
|
| Rate for Payer: Aetna American Axle |
$1,435.75
|
| Rate for Payer: Aetna American Axle |
$613.75
|
| Rate for Payer: Aetna American Axle |
$1,334.49
|
| Rate for Payer: Aetna Commercial |
$802.60
|
| Rate for Payer: Aetna Commercial |
$626.50
|
| Rate for Payer: Aetna Commercial |
$1,745.10
|
| Rate for Payer: Aetna Commercial |
$1,877.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$613.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,435.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,334.49
|
| Rate for Payer: Cash Price |
$1,642.45
|
| Rate for Payer: Cash Price |
$755.38
|
| Rate for Payer: Cash Price |
$1,767.07
|
| Rate for Payer: Cash Price |
$589.65
|
| Rate for Payer: Cofinity Advantage |
$1,546.19
|
| Rate for Payer: Cofinity Advantage |
$1,437.14
|
| Rate for Payer: Cofinity Advantage |
$515.94
|
| Rate for Payer: Cofinity Advantage |
$660.96
|
| Rate for Payer: Cofinity Commercial |
$633.87
|
| Rate for Payer: Cofinity Commercial |
$1,765.63
|
| Rate for Payer: Cofinity Commercial |
$1,899.60
|
| Rate for Payer: Cofinity Commercial |
$812.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,642.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$755.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,767.07
|
| Rate for Payer: Healthscope Commercial |
$1,987.96
|
| Rate for Payer: Healthscope Commercial |
$849.81
|
| Rate for Payer: Healthscope Commercial |
$663.35
|
| Rate for Payer: Healthscope Commercial |
$1,847.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$515.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,437.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,546.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$660.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,656.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$708.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,539.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$802.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,745.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,877.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$708.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,656.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,539.80
|
| Rate for Payer: PHP Commercial |
$1,745.10
|
| Rate for Payer: PHP Commercial |
$626.50
|
| Rate for Payer: PHP Commercial |
$1,877.51
|
| Rate for Payer: PHP Commercial |
$802.60
|
| Rate for Payer: Priority Health SBD |
$594.86
|
| Rate for Payer: Priority Health SBD |
$1,293.43
|
| Rate for Payer: Priority Health SBD |
$464.35
|
| Rate for Payer: Priority Health SBD |
$1,391.57
|
| Rate for Payer: UMR Bronson Commercial |
$971.89
|
| Rate for Payer: UMR Bronson Commercial |
$324.31
|
| Rate for Payer: UMR Bronson Commercial |
$903.35
|
| Rate for Payer: UMR Bronson Commercial |
$415.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,539.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,656.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$708.17
|
|
|
BACLOFEN 40,000 MCG/20 ML (2,000 MCG/ML) INTRATHECAL SOLUTION
|
Facility
|
OP
|
$2,208.84
|
|
|
Service Code
|
HCPCS J0475
|
| Hospital Charge Code |
107800
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.12 |
| Max. Negotiated Rate |
$1,987.96 |
| Rate for Payer: Aetna American Axle |
$1,435.75
|
| Rate for Payer: Aetna American Axle |
$613.75
|
| Rate for Payer: Aetna American Axle |
$479.09
|
| Rate for Payer: Aetna American Axle |
$1,334.49
|
| Rate for Payer: Aetna Commercial |
$1,877.51
|
| Rate for Payer: Aetna Commercial |
$802.60
|
| Rate for Payer: Aetna Commercial |
$1,745.10
|
| Rate for Payer: Aetna Commercial |
$626.50
|
| Rate for Payer: Aetna Medicare |
$185.17
|
| Rate for Payer: Aetna Medicare |
$185.17
|
| Rate for Payer: Aetna Medicare |
$185.17
|
| Rate for Payer: Aetna Medicare |
$185.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,334.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,435.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$613.75
|
| 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: 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: 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 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 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: 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 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: BCN Medicare Advantage |
$178.05
|
| Rate for Payer: BCN Medicare Advantage |
$178.05
|
| Rate for Payer: Cash Price |
$589.65
|
| Rate for Payer: Cash Price |
$1,767.07
|
| Rate for Payer: Cash Price |
$1,642.45
|
| Rate for Payer: Cash Price |
$755.38
|
| Rate for Payer: Cash Price |
$1,767.07
|
| Rate for Payer: Cash Price |
$589.65
|
| Rate for Payer: Cash Price |
$755.38
|
| Rate for Payer: Cash Price |
$1,642.45
|
| Rate for Payer: Cofinity Advantage |
$515.94
|
| Rate for Payer: Cofinity Advantage |
$1,437.14
|
| Rate for Payer: Cofinity Advantage |
$660.96
|
| Rate for Payer: Cofinity Advantage |
$1,546.19
|
| Rate for Payer: Cofinity Commercial |
$812.04
|
| Rate for Payer: Cofinity Commercial |
$1,899.60
|
| Rate for Payer: Cofinity Commercial |
$633.87
|
| Rate for Payer: Cofinity Commercial |
$1,765.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$755.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,642.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,767.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.05
|
| 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 |
$1,987.96
|
| Rate for Payer: Healthscope Commercial |
$663.35
|
| Rate for Payer: Healthscope Commercial |
$849.81
|
| Rate for Payer: Healthscope Commercial |
$1,847.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$660.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,437.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$515.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,546.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$708.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,656.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,539.80
|
| Rate for Payer: Mclaren Medicaid |
$178.05
|
| Rate for Payer: Mclaren Medicaid |
$178.05
|
| 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: 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 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: 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: 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: Molina Medicare/Medicaid |
$195.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$195.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,877.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$802.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,745.10
|
| Rate for Payer: Nomi Health Commercial |
$534.15
|
| Rate for Payer: Nomi Health Commercial |
$534.15
|
| Rate for Payer: Nomi Health Commercial |
$534.15
|
| Rate for Payer: Nomi Health Commercial |
$534.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,539.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,656.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$708.17
|
| Rate for Payer: PACE Medicare |
$169.15
|
| Rate for Payer: PACE Medicare |
$169.15
|
| 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: PACE SWMI |
$178.05
|
| Rate for Payer: PACE SWMI |
$178.05
|
| Rate for Payer: PHP Commercial |
$1,877.51
|
| Rate for Payer: PHP Commercial |
$802.60
|
| Rate for Payer: PHP Commercial |
$1,745.10
|
| Rate for Payer: PHP Commercial |
$626.50
|
| Rate for Payer: PHP Medicare Advantage |
$178.05
|
| Rate for Payer: PHP Medicare Advantage |
$178.05
|
| 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 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 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 Medicare |
$178.05
|
| Rate for Payer: Priority Health Medicare |
$178.05
|
| Rate for Payer: Priority Health SBD |
$1,293.43
|
| Rate for Payer: Priority Health SBD |
$1,391.57
|
| Rate for Payer: Priority Health SBD |
$594.86
|
| Rate for Payer: Priority Health SBD |
$464.35
|
| Rate for Payer: Priority Health Tiered Network |
$457.26
|
| Rate for Payer: Priority Health Tiered Network |
$457.26
|
| 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: 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 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 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 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 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: 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: UHCCP Medicaid |
$93.12
|
| Rate for Payer: UHCCP Medicaid |
$93.12
|
| Rate for Payer: UMR Bronson Commercial |
$272.71
|
| Rate for Payer: UMR Bronson Commercial |
$817.27
|
| Rate for Payer: UMR Bronson Commercial |
$759.63
|
| Rate for Payer: UMR Bronson Commercial |
$349.37
|
| Rate for Payer: VA VA |
$178.05
|
| Rate for Payer: VA VA |
$178.05
|
| Rate for Payer: VA VA |
$178.05
|
| Rate for Payer: VA VA |
$178.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$708.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,656.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,539.80
|
|
|
BACLOFEN 500 MCG/ML INTRATHECAL SOLUTION
|
Facility
|
IP
|
$838.80
|
|
|
Service Code
|
HCPCS J0475
|
| Hospital Charge Code |
9209
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$369.07 |
| Max. Negotiated Rate |
$754.92 |
| Rate for Payer: Aetna American Axle |
$545.22
|
| Rate for Payer: Aetna American Axle |
$545.27
|
| Rate for Payer: Aetna Commercial |
$712.98
|
| Rate for Payer: Aetna Commercial |
$713.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.27
|
| Rate for Payer: Cash Price |
$671.04
|
| Rate for Payer: Cash Price |
$671.10
|
| Rate for Payer: Cofinity Advantage |
$587.21
|
| Rate for Payer: Cofinity Advantage |
$587.16
|
| Rate for Payer: Cofinity Commercial |
$721.43
|
| Rate for Payer: Cofinity Commercial |
$721.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.10
|
| Rate for Payer: Healthscope Commercial |
$754.92
|
| Rate for Payer: Healthscope Commercial |
$754.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$587.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$587.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$712.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$629.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$629.15
|
| Rate for Payer: PHP Commercial |
$712.98
|
| Rate for Payer: PHP Commercial |
$713.04
|
| Rate for Payer: Priority Health SBD |
$528.49
|
| Rate for Payer: Priority Health SBD |
$528.44
|
| Rate for Payer: UMR Bronson Commercial |
$369.07
|
| Rate for Payer: UMR Bronson Commercial |
$369.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.15
|
|
|
BACLOFEN 500 MCG/ML INTRATHECAL SOLUTION
|
Facility
|
OP
|
$838.87
|
|
|
Service Code
|
HCPCS J0475
|
| Hospital Charge Code |
9209
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.12 |
| Max. Negotiated Rate |
$754.98 |
| Rate for Payer: Aetna American Axle |
$545.27
|
| Rate for Payer: Aetna American Axle |
$545.22
|
| Rate for Payer: Aetna Commercial |
$712.98
|
| Rate for Payer: Aetna Commercial |
$713.04
|
| Rate for Payer: Aetna Medicare |
$185.17
|
| Rate for Payer: Aetna Medicare |
$185.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.27
|
| 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 |
$671.04
|
| Rate for Payer: Cash Price |
$671.10
|
| Rate for Payer: Cash Price |
$671.10
|
| Rate for Payer: Cash Price |
$671.04
|
| Rate for Payer: Cofinity Advantage |
$587.21
|
| Rate for Payer: Cofinity Advantage |
$587.16
|
| Rate for Payer: Cofinity Commercial |
$721.37
|
| Rate for Payer: Cofinity Commercial |
$721.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.10
|
| 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 |
$754.92
|
| Rate for Payer: Healthscope Commercial |
$754.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$587.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$587.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.15
|
| 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 |
$712.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.04
|
| Rate for Payer: Nomi Health Commercial |
$534.15
|
| Rate for Payer: Nomi Health Commercial |
$534.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$629.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$629.10
|
| 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 |
$712.98
|
| Rate for Payer: PHP Commercial |
$713.04
|
| 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 |
$528.44
|
| Rate for Payer: Priority Health SBD |
$528.49
|
| 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 |
$310.36
|
| Rate for Payer: UMR Bronson Commercial |
$310.38
|
| Rate for Payer: VA VA |
$178.05
|
| Rate for Payer: VA VA |
$178.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.10
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
OP
|
$333.84
|
|
|
Service Code
|
NDC 50268010515
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.52 |
| Max. Negotiated Rate |
$300.46 |
| Rate for Payer: Aetna American Axle |
$217.00
|
| Rate for Payer: Aetna Commercial |
$283.76
|
| Rate for Payer: Aetna Medicare |
$166.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.00
|
| Rate for Payer: BCBS Complete |
$133.54
|
| Rate for Payer: Cash Price |
$267.07
|
| Rate for Payer: Cofinity Advantage |
$233.69
|
| Rate for Payer: Cofinity Commercial |
$287.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.07
|
| Rate for Payer: Healthscope Commercial |
$300.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$267.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.38
|
| Rate for Payer: PHP Commercial |
$283.76
|
| Rate for Payer: Priority Health SBD |
$210.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.00
|
| Rate for Payer: UHC Core |
$173.93
|
| Rate for Payer: UHC Exchange |
$131.20
|
| Rate for Payer: UMR Bronson Commercial |
$123.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.38
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
IP
|
$401.76
|
|
|
Service Code
|
NDC 71930006612
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.77 |
| Max. Negotiated Rate |
$361.58 |
| Rate for Payer: Aetna American Axle |
$261.14
|
| Rate for Payer: Aetna Commercial |
$341.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.14
|
| Rate for Payer: Cash Price |
$321.41
|
| Rate for Payer: Cofinity Advantage |
$281.23
|
| Rate for Payer: Cofinity Commercial |
$345.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.41
|
| Rate for Payer: Healthscope Commercial |
$361.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.32
|
| Rate for Payer: PHP Commercial |
$341.50
|
| Rate for Payer: Priority Health SBD |
$253.11
|
| Rate for Payer: UMR Bronson Commercial |
$176.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.32
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
OP
|
$401.76
|
|
|
Service Code
|
NDC 71930006612
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.65 |
| Max. Negotiated Rate |
$361.58 |
| Rate for Payer: Aetna American Axle |
$261.14
|
| Rate for Payer: Aetna Commercial |
$341.50
|
| Rate for Payer: Aetna Medicare |
$200.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.14
|
| Rate for Payer: BCBS Complete |
$160.70
|
| Rate for Payer: Cash Price |
$321.41
|
| Rate for Payer: Cofinity Advantage |
$281.23
|
| Rate for Payer: Cofinity Commercial |
$345.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.41
|
| Rate for Payer: Healthscope Commercial |
$361.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.32
|
| Rate for Payer: PHP Commercial |
$341.50
|
| Rate for Payer: Priority Health SBD |
$253.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.14
|
| Rate for Payer: UHC Core |
$209.32
|
| Rate for Payer: UHC Exchange |
$157.89
|
| Rate for Payer: UMR Bronson Commercial |
$148.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.32
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
OP
|
$6.68
|
|
|
Service Code
|
NDC 50268010511
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Aetna American Axle |
$4.34
|
| Rate for Payer: Aetna Commercial |
$5.68
|
| Rate for Payer: Aetna Medicare |
$3.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.34
|
| Rate for Payer: BCBS Complete |
$2.67
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cofinity Advantage |
$4.68
|
| Rate for Payer: Cofinity Commercial |
$5.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.34
|
| Rate for Payer: Healthscope Commercial |
$6.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.01
|
| Rate for Payer: PHP Commercial |
$5.68
|
| Rate for Payer: Priority Health SBD |
$4.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.34
|
| Rate for Payer: UHC Core |
$3.48
|
| Rate for Payer: UHC Exchange |
$2.63
|
| Rate for Payer: UMR Bronson Commercial |
$2.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.01
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
OP
|
$162.15
|
|
|
Service Code
|
NDC 72888000901
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna American Axle |
$105.40
|
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Aetna Medicare |
$81.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.40
|
| Rate for Payer: BCBS Complete |
$64.86
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Advantage |
$113.50
|
| Rate for Payer: Cofinity Commercial |
$139.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.72
|
| Rate for Payer: Healthscope Commercial |
$145.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.61
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: Priority Health SBD |
$102.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.40
|
| Rate for Payer: UHC Core |
$84.48
|
| Rate for Payer: UHC Exchange |
$63.72
|
| Rate for Payer: UMR Bronson Commercial |
$60.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.61
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
IP
|
$303.60
|
|
|
Service Code
|
NDC 58657093005
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.58 |
| Max. Negotiated Rate |
$273.24 |
| Rate for Payer: Aetna American Axle |
$197.34
|
| Rate for Payer: Aetna Commercial |
$258.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.34
|
| Rate for Payer: Cash Price |
$242.88
|
| Rate for Payer: Cofinity Advantage |
$212.52
|
| Rate for Payer: Cofinity Commercial |
$261.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.88
|
| Rate for Payer: Healthscope Commercial |
$273.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.70
|
| Rate for Payer: PHP Commercial |
$258.06
|
| Rate for Payer: Priority Health SBD |
$191.27
|
| Rate for Payer: UMR Bronson Commercial |
$133.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.70
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
IP
|
$6.08
|
|
|
Service Code
|
NDC 58657093010
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$5.47 |
| Rate for Payer: Aetna American Axle |
$3.95
|
| Rate for Payer: Aetna Commercial |
$5.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.95
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cofinity Advantage |
$4.26
|
| Rate for Payer: Cofinity Commercial |
$5.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.86
|
| Rate for Payer: Healthscope Commercial |
$5.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.56
|
| Rate for Payer: PHP Commercial |
$5.17
|
| Rate for Payer: Priority Health SBD |
$3.83
|
| Rate for Payer: UMR Bronson Commercial |
$2.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.56
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
IP
|
$6.68
|
|
|
Service Code
|
NDC 50268010511
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Aetna American Axle |
$4.34
|
| Rate for Payer: Aetna Commercial |
$5.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.34
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cofinity Advantage |
$4.68
|
| Rate for Payer: Cofinity Commercial |
$5.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.34
|
| Rate for Payer: Healthscope Commercial |
$6.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.01
|
| Rate for Payer: PHP Commercial |
$5.68
|
| Rate for Payer: Priority Health SBD |
$4.21
|
| Rate for Payer: UMR Bronson Commercial |
$2.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.01
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
OP
|
$303.60
|
|
|
Service Code
|
NDC 58657093005
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.33 |
| Max. Negotiated Rate |
$273.24 |
| Rate for Payer: Aetna American Axle |
$197.34
|
| Rate for Payer: Aetna Commercial |
$258.06
|
| Rate for Payer: Aetna Medicare |
$151.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.34
|
| Rate for Payer: BCBS Complete |
$121.44
|
| Rate for Payer: Cash Price |
$242.88
|
| Rate for Payer: Cofinity Advantage |
$212.52
|
| Rate for Payer: Cofinity Commercial |
$261.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.88
|
| Rate for Payer: Healthscope Commercial |
$273.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$242.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.70
|
| Rate for Payer: PHP Commercial |
$258.06
|
| Rate for Payer: Priority Health SBD |
$191.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.34
|
| Rate for Payer: UHC Core |
$158.18
|
| Rate for Payer: UHC Exchange |
$119.31
|
| Rate for Payer: UMR Bronson Commercial |
$112.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.70
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
IP
|
$333.84
|
|
|
Service Code
|
NDC 50268010515
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.89 |
| Max. Negotiated Rate |
$300.46 |
| Rate for Payer: Aetna American Axle |
$217.00
|
| Rate for Payer: Aetna Commercial |
$283.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.00
|
| Rate for Payer: Cash Price |
$267.07
|
| Rate for Payer: Cofinity Advantage |
$233.69
|
| Rate for Payer: Cofinity Commercial |
$287.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.07
|
| Rate for Payer: Healthscope Commercial |
$300.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.38
|
| Rate for Payer: PHP Commercial |
$283.76
|
| Rate for Payer: Priority Health SBD |
$210.32
|
| Rate for Payer: UMR Bronson Commercial |
$146.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.38
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
OP
|
$6.08
|
|
|
Service Code
|
NDC 58657093010
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$5.47 |
| Rate for Payer: Aetna American Axle |
$3.95
|
| Rate for Payer: Aetna Commercial |
$5.17
|
| Rate for Payer: Aetna Medicare |
$3.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.95
|
| Rate for Payer: BCBS Complete |
$2.43
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cofinity Advantage |
$4.26
|
| Rate for Payer: Cofinity Commercial |
$5.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.86
|
| Rate for Payer: Healthscope Commercial |
$5.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.56
|
| Rate for Payer: PHP Commercial |
$5.17
|
| Rate for Payer: Priority Health SBD |
$3.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.95
|
| Rate for Payer: UHC Core |
$3.17
|
| Rate for Payer: UHC Exchange |
$2.39
|
| Rate for Payer: UMR Bronson Commercial |
$2.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.56
|
|
|
BACLOFEN 5 MG TABLET
|
Facility
|
IP
|
$162.15
|
|
|
Service Code
|
NDC 72888000901
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.35 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna American Axle |
$105.40
|
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.40
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Advantage |
$113.50
|
| Rate for Payer: Cofinity Commercial |
$139.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.72
|
| Rate for Payer: Healthscope Commercial |
$145.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.61
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: Priority Health SBD |
$102.15
|
| Rate for Payer: UMR Bronson Commercial |
$71.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.61
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
IP
|
$9,991.49
|
|
|
Service Code
|
APR-DRG 0491
|
| Min. Negotiated Rate |
$9,515.71 |
| Max. Negotiated Rate |
$9,991.49 |
| Rate for Payer: BCBS Complete |
$9,991.49
|
| Rate for Payer: Mclaren Medicaid |
$9,515.71
|
| Rate for Payer: Meridian Medicaid |
$9,991.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,515.71
|
| Rate for Payer: UHC Medicaid |
$9,515.71
|
| Rate for Payer: UHCCP Medicaid |
$9,515.71
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
IP
|
$10,519.34
|
|
|
Service Code
|
APR-DRG 0492
|
| Min. Negotiated Rate |
$10,018.42 |
| Max. Negotiated Rate |
$10,519.34 |
| Rate for Payer: BCBS Complete |
$10,519.34
|
| Rate for Payer: Mclaren Medicaid |
$10,018.42
|
| Rate for Payer: Meridian Medicaid |
$10,519.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,018.42
|
| Rate for Payer: UHC Medicaid |
$10,018.42
|
| Rate for Payer: UHCCP Medicaid |
$10,018.42
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
IP
|
$19,323.18
|
|
|
Service Code
|
APR-DRG 0494
|
| Min. Negotiated Rate |
$18,403.03 |
| Max. Negotiated Rate |
$19,323.18 |
| Rate for Payer: BCBS Complete |
$19,323.18
|
| Rate for Payer: Mclaren Medicaid |
$18,403.03
|
| Rate for Payer: Meridian Medicaid |
$19,323.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$18,403.03
|
| Rate for Payer: UHC Medicaid |
$18,403.03
|
| Rate for Payer: UHCCP Medicaid |
$18,403.03
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
IP
|
$15,026.59
|
|
|
Service Code
|
APR-DRG 0493
|
| Min. Negotiated Rate |
$14,311.04 |
| Max. Negotiated Rate |
$15,026.59 |
| Rate for Payer: BCBS Complete |
$15,026.59
|
| Rate for Payer: Mclaren Medicaid |
$14,311.04
|
| Rate for Payer: Meridian Medicaid |
$15,026.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,311.04
|
| Rate for Payer: UHC Medicaid |
$14,311.04
|
| Rate for Payer: UHCCP Medicaid |
$14,311.04
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC
|
Facility
|
IP
|
$68,009.85
|
|
|
Service Code
|
MSDRG 095
|
| Min. Negotiated Rate |
$21,053.92 |
| Max. Negotiated Rate |
$68,009.85 |
| Rate for Payer: Aetna Medicare |
$23,048.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,702.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,702.53
|
| Rate for Payer: BCBS MAPPO |
$22,162.02
|
| Rate for Payer: BCBS Trust/PPO |
$68,009.85
|
| Rate for Payer: BCN Commercial |
$68,009.85
|
| Rate for Payer: BCN Medicare Advantage |
$22,162.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,162.02
|
| Rate for Payer: Mclaren Medicare |
$22,162.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23,270.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,486.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$24,378.22
|
| Rate for Payer: Nomi Health Commercial |
$33,271.68
|
| Rate for Payer: PACE Medicare |
$21,053.92
|
| Rate for Payer: PACE SWMI |
$22,162.02
|
| Rate for Payer: PHP Medicare Advantage |
$22,162.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,582.22
|
| Rate for Payer: Priority Health Medicare |
$22,162.02
|
| Rate for Payer: Priority Health Tiered Network |
$33,265.77
|
| Rate for Payer: Railroad Medicare Medicare |
$22,162.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42,040.96
|
| Rate for Payer: UHC Core |
$35,172.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22,162.02
|
| Rate for Payer: UHC Exchange |
$28,724.55
|
| Rate for Payer: VA VA |
$22,162.02
|
|
