Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

TRAMADOL 50 MG TABLET

Facility

$105.75

Service Code	NDC 00093005801
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$66.62
Max. Negotiated Rate	$95.17
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: 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

TRAMADOL 50 MG TABLET

Facility

$1.37

Service Code	NDC 55154254107
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$1.16
Rate for Payer: Aetna Medicare	$0.69
Rate for Payer: Aetna New Business (MI Preferred)	$0.89
Rate for Payer: BCBS Complete	$0.55
Rate for Payer: Cash Price	$1.10
Rate for Payer: Cofinity Advantage	$0.96
Rate for Payer: Cofinity Commercial	$1.18
Rate for Payer: Encore Health Key Benefits Commercial	$1.10
Rate for Payer: Healthscope Commercial	$1.23
Rate for Payer: MI Amish Medical Board Commercial	$1.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.03
Rate for Payer: PHP Commercial	$1.16
Rate for Payer: Priority Health SBD	$0.86
Rate for Payer: UHC All Payor (Choice/PPO)	$0.89
Rate for Payer: UHC Core	$0.71
Rate for Payer: UHC Exchange	$0.54

TRAMADOL 50 MG TABLET

Facility

$1,269.00

Service Code	NDC 65162062711
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$498.72
Max. Negotiated Rate	$1,142.10
Rate for Payer: Aetna Commercial	$1,078.65
Rate for Payer: Aetna Medicare	$634.50
Rate for Payer: Aetna New Business (MI Preferred)	$824.85
Rate for Payer: BCBS Complete	$507.60
Rate for Payer: Cash Price	$1,015.20
Rate for Payer: Cofinity Advantage	$888.30
Rate for Payer: Cofinity Commercial	$1,091.34
Rate for Payer: Encore Health Key Benefits Commercial	$1,015.20
Rate for Payer: Healthscope Commercial	$1,142.10
Rate for Payer: MI Amish Medical Board Commercial	$1,015.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,078.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$951.75
Rate for Payer: PHP Commercial	$1,078.65
Rate for Payer: Priority Health SBD	$799.47
Rate for Payer: UHC All Payor (Choice/PPO)	$824.85
Rate for Payer: UHC Core	$661.15
Rate for Payer: UHC Exchange	$498.72

TRAMADOL 50 MG TABLET

Facility

$136.30

Service Code	NDC 55154254104
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$53.57
Max. Negotiated Rate	$122.67
Rate for Payer: Aetna Commercial	$115.86
Rate for Payer: Aetna Medicare	$68.15
Rate for Payer: Aetna New Business (MI Preferred)	$88.59
Rate for Payer: BCBS Complete	$54.52
Rate for Payer: Cash Price	$109.04
Rate for Payer: Cofinity Advantage	$95.41
Rate for Payer: Cofinity Commercial	$117.22
Rate for Payer: Encore Health Key Benefits Commercial	$109.04
Rate for Payer: Healthscope Commercial	$122.67
Rate for Payer: MI Amish Medical Board Commercial	$109.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$115.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$102.22
Rate for Payer: PHP Commercial	$115.86
Rate for Payer: Priority Health SBD	$85.87
Rate for Payer: UHC All Payor (Choice/PPO)	$88.59
Rate for Payer: UHC Core	$71.01
Rate for Payer: UHC Exchange	$53.57

TRAMADOL 50 MG TABLET

Facility

$101.05

Service Code	NDC 51079099120
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$63.66
Max. Negotiated Rate	$90.94
Rate for Payer: Aetna Commercial	$85.89
Rate for Payer: Aetna New Business (MI Preferred)	$65.68
Rate for Payer: Cash Price	$80.84
Rate for Payer: Cofinity Advantage	$70.73
Rate for Payer: Cofinity Commercial	$86.90
Rate for Payer: Encore Health Key Benefits Commercial	$80.84
Rate for Payer: Healthscope Commercial	$90.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$85.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$75.79
Rate for Payer: PHP Commercial	$85.89
Rate for Payer: Priority Health SBD	$63.66

TRAMADOL 50 MG TABLET

Facility

$1.37

Service Code	NDC 55154254107
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$1.16
Rate for Payer: Aetna New Business (MI Preferred)	$0.89
Rate for Payer: Cash Price	$1.10
Rate for Payer: Cofinity Advantage	$0.96
Rate for Payer: Cofinity Commercial	$1.18
Rate for Payer: Encore Health Key Benefits Commercial	$1.10
Rate for Payer: Healthscope Commercial	$1.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.03
Rate for Payer: PHP Commercial	$1.16
Rate for Payer: Priority Health SBD	$0.86

TRAMADOL 50 MG TABLET

Facility

$1.02

Service Code	NDC 51079099101
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.92
Rate for Payer: Aetna Commercial	$0.87
Rate for Payer: Aetna New Business (MI Preferred)	$0.66
Rate for Payer: Cash Price	$0.82
Rate for Payer: Cofinity Advantage	$0.71
Rate for Payer: Cofinity Commercial	$0.88
Rate for Payer: Encore Health Key Benefits Commercial	$0.82
Rate for Payer: Healthscope Commercial	$0.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.77
Rate for Payer: PHP Commercial	$0.87
Rate for Payer: Priority Health SBD	$0.64

TRAMADOL 50 MG TABLET

Facility

$505.25

Service Code	NDC 57664037713
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$318.31
Max. Negotiated Rate	$454.73
Rate for Payer: Aetna Commercial	$429.46
Rate for Payer: Aetna New Business (MI Preferred)	$328.41
Rate for Payer: Cash Price	$404.20
Rate for Payer: Cofinity Advantage	$353.68
Rate for Payer: Cofinity Commercial	$434.51
Rate for Payer: Encore Health Key Benefits Commercial	$404.20
Rate for Payer: Healthscope Commercial	$454.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$429.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$378.94
Rate for Payer: PHP Commercial	$429.46
Rate for Payer: Priority Health SBD	$318.31

TRAMADOL 50 MG TABLET

Facility

$136.30

Service Code	NDC 55154254104
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$85.87
Max. Negotiated Rate	$122.67
Rate for Payer: Aetna Commercial	$115.86
Rate for Payer: Aetna New Business (MI Preferred)	$88.59
Rate for Payer: Cash Price	$109.04
Rate for Payer: Cofinity Advantage	$95.41
Rate for Payer: Cofinity Commercial	$117.22
Rate for Payer: Encore Health Key Benefits Commercial	$109.04
Rate for Payer: Healthscope Commercial	$122.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$115.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$102.22
Rate for Payer: PHP Commercial	$115.86
Rate for Payer: Priority Health SBD	$85.87

TRAMADOL 50 MG TABLET

Facility

$505.25

Service Code	NDC 57664037713
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$198.56
Max. Negotiated Rate	$454.73
Rate for Payer: Aetna Commercial	$429.46
Rate for Payer: Aetna Medicare	$252.62
Rate for Payer: Aetna New Business (MI Preferred)	$328.41
Rate for Payer: BCBS Complete	$202.10
Rate for Payer: Cash Price	$404.20
Rate for Payer: Cofinity Advantage	$353.68
Rate for Payer: Cofinity Commercial	$434.51
Rate for Payer: Encore Health Key Benefits Commercial	$404.20
Rate for Payer: Healthscope Commercial	$454.73
Rate for Payer: MI Amish Medical Board Commercial	$404.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$429.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$378.94
Rate for Payer: PHP Commercial	$429.46
Rate for Payer: Priority Health SBD	$318.31
Rate for Payer: UHC All Payor (Choice/PPO)	$328.41
Rate for Payer: UHC Core	$263.24
Rate for Payer: UHC Exchange	$198.56

TRAMADOL 50 MG TABLET

Facility

$3.39

Service Code	NDC 60687079511
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$3.05
Rate for Payer: Aetna Commercial	$2.88
Rate for Payer: Aetna New Business (MI Preferred)	$2.20
Rate for Payer: Cash Price	$2.71
Rate for Payer: Cofinity Advantage	$2.37
Rate for Payer: Cofinity Commercial	$2.92
Rate for Payer: Encore Health Key Benefits Commercial	$2.71
Rate for Payer: Healthscope Commercial	$3.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.54
Rate for Payer: PHP Commercial	$2.88
Rate for Payer: Priority Health SBD	$2.14

TRAMADOL 50 MG TABLET

Facility

$284.35

Service Code	NDC 68084080801
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$179.14
Max. Negotiated Rate	$255.91
Rate for Payer: Aetna Commercial	$241.70
Rate for Payer: Aetna New Business (MI Preferred)	$184.83
Rate for Payer: Cash Price	$227.48
Rate for Payer: Cofinity Advantage	$199.04
Rate for Payer: Cofinity Commercial	$244.54
Rate for Payer: Encore Health Key Benefits Commercial	$227.48
Rate for Payer: Healthscope Commercial	$255.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$241.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$213.26
Rate for Payer: PHP Commercial	$241.70
Rate for Payer: Priority Health SBD	$179.14

TRAMADOL 50 MG TABLET

Facility

$3.39

Service Code	NDC 60687079511
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$3.05
Rate for Payer: Aetna Commercial	$2.88
Rate for Payer: Aetna Medicare	$1.70
Rate for Payer: Aetna New Business (MI Preferred)	$2.20
Rate for Payer: BCBS Complete	$1.36
Rate for Payer: Cash Price	$2.71
Rate for Payer: Cofinity Advantage	$2.37
Rate for Payer: Cofinity Commercial	$2.92
Rate for Payer: Encore Health Key Benefits Commercial	$2.71
Rate for Payer: Healthscope Commercial	$3.05
Rate for Payer: MI Amish Medical Board Commercial	$2.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.54
Rate for Payer: PHP Commercial	$2.88
Rate for Payer: Priority Health SBD	$2.14
Rate for Payer: UHC All Payor (Choice/PPO)	$2.20
Rate for Payer: UHC Core	$1.77
Rate for Payer: UHC Exchange	$1.33

TRAMADOL 50 MG TABLET

Facility

$987.00

Service Code	NDC 57664037718
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$387.89
Max. Negotiated Rate	$888.30
Rate for Payer: Aetna Commercial	$838.95
Rate for Payer: Aetna Medicare	$493.50
Rate for Payer: Aetna New Business (MI Preferred)	$641.55
Rate for Payer: BCBS Complete	$394.80
Rate for Payer: Cash Price	$789.60
Rate for Payer: Cofinity Advantage	$690.90
Rate for Payer: Cofinity Commercial	$848.82
Rate for Payer: Encore Health Key Benefits Commercial	$789.60
Rate for Payer: Healthscope Commercial	$888.30
Rate for Payer: MI Amish Medical Board Commercial	$789.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$838.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$740.25
Rate for Payer: PHP Commercial	$838.95
Rate for Payer: Priority Health SBD	$621.81
Rate for Payer: UHC All Payor (Choice/PPO)	$641.55
Rate for Payer: UHC Core	$514.23
Rate for Payer: UHC Exchange	$387.89

TRAMADOL 50 MG TABLET

Facility

$2.85

Service Code	NDC 68084080811
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$2.56
Rate for Payer: Aetna Commercial	$2.42
Rate for Payer: Aetna New Business (MI Preferred)	$1.85
Rate for Payer: Cash Price	$2.28
Rate for Payer: Cofinity Advantage	$2.00
Rate for Payer: Cofinity Commercial	$2.45
Rate for Payer: Encore Health Key Benefits Commercial	$2.28
Rate for Payer: Healthscope Commercial	$2.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.14
Rate for Payer: PHP Commercial	$2.42
Rate for Payer: Priority Health SBD	$1.80

TRAMADOL 50 MG TABLET

Facility

$1.02

Service Code	NDC 51079099101
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.92
Rate for Payer: Aetna Commercial	$0.87
Rate for Payer: Aetna Medicare	$0.51
Rate for Payer: Aetna New Business (MI Preferred)	$0.66
Rate for Payer: BCBS Complete	$0.41
Rate for Payer: Cash Price	$0.82
Rate for Payer: Cofinity Advantage	$0.71
Rate for Payer: Cofinity Commercial	$0.88
Rate for Payer: Encore Health Key Benefits Commercial	$0.82
Rate for Payer: Healthscope Commercial	$0.92
Rate for Payer: MI Amish Medical Board Commercial	$0.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.77
Rate for Payer: PHP Commercial	$0.87
Rate for Payer: Priority Health SBD	$0.64
Rate for Payer: UHC All Payor (Choice/PPO)	$0.66
Rate for Payer: UHC Core	$0.53
Rate for Payer: UHC Exchange	$0.40

TRAMADOL 50 MG TABLET

Facility

$101.05

Service Code	NDC 51079099120
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$39.71
Max. Negotiated Rate	$90.94
Rate for Payer: Aetna Commercial	$85.89
Rate for Payer: Aetna Medicare	$50.52
Rate for Payer: Aetna New Business (MI Preferred)	$65.68
Rate for Payer: BCBS Complete	$40.42
Rate for Payer: Cash Price	$80.84
Rate for Payer: Cofinity Advantage	$70.73
Rate for Payer: Cofinity Commercial	$86.90
Rate for Payer: Encore Health Key Benefits Commercial	$80.84
Rate for Payer: Healthscope Commercial	$90.94
Rate for Payer: MI Amish Medical Board Commercial	$80.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$85.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$75.79
Rate for Payer: PHP Commercial	$85.89
Rate for Payer: Priority Health SBD	$63.66
Rate for Payer: UHC All Payor (Choice/PPO)	$65.68
Rate for Payer: UHC Core	$52.65
Rate for Payer: UHC Exchange	$39.71

TRAMADOL 50 MG TABLET

Facility

$987.00

Service Code	NDC 57664037718
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$621.81
Max. Negotiated Rate	$888.30
Rate for Payer: Aetna Commercial	$838.95
Rate for Payer: Aetna New Business (MI Preferred)	$641.55
Rate for Payer: Cash Price	$789.60
Rate for Payer: Cofinity Advantage	$690.90
Rate for Payer: Cofinity Commercial	$848.82
Rate for Payer: Encore Health Key Benefits Commercial	$789.60
Rate for Payer: Healthscope Commercial	$888.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$838.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$740.25
Rate for Payer: PHP Commercial	$838.95
Rate for Payer: Priority Health SBD	$621.81

TRAMADOL 50 MG TABLET

Facility

$284.35

Service Code	NDC 68084080801
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$255.91
Rate for Payer: Aetna Commercial	$241.70
Rate for Payer: Aetna Medicare	$142.18
Rate for Payer: Aetna New Business (MI Preferred)	$184.83
Rate for Payer: BCBS Complete	$113.74
Rate for Payer: Cash Price	$227.48
Rate for Payer: Cofinity Advantage	$199.04
Rate for Payer: Cofinity Commercial	$244.54
Rate for Payer: Encore Health Key Benefits Commercial	$227.48
Rate for Payer: Healthscope Commercial	$255.91
Rate for Payer: MI Amish Medical Board Commercial	$227.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$241.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$213.26
Rate for Payer: PHP Commercial	$241.70
Rate for Payer: Priority Health SBD	$179.14
Rate for Payer: UHC All Payor (Choice/PPO)	$184.83
Rate for Payer: UHC Core	$148.15
Rate for Payer: UHC Exchange	$111.75

TRAMADOL 50 MG TABLET

Facility

$105.75

Service Code	NDC 00093005801
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$41.56
Max. Negotiated Rate	$95.17
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: 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

TRAMADOL 50 MG TABLET

Facility

$338.40

Service Code	NDC 60687079501
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$213.19
Max. Negotiated Rate	$304.56
Rate for Payer: Aetna Commercial	$287.64
Rate for Payer: Aetna New Business (MI Preferred)	$219.96
Rate for Payer: Cash Price	$270.72
Rate for Payer: Cofinity Advantage	$236.88
Rate for Payer: Cofinity Commercial	$291.02
Rate for Payer: Encore Health Key Benefits Commercial	$270.72
Rate for Payer: Healthscope Commercial	$304.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$287.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$253.80
Rate for Payer: PHP Commercial	$287.64
Rate for Payer: Priority Health SBD	$213.19

TRAMADOL 50 MG TABLET

Facility

$277.30

Service Code	NDC 00904717961
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$174.70
Max. Negotiated Rate	$249.57
Rate for Payer: Aetna Commercial	$235.71
Rate for Payer: Aetna New Business (MI Preferred)	$180.25
Rate for Payer: Cash Price	$221.84
Rate for Payer: Cofinity Advantage	$194.11
Rate for Payer: Cofinity Commercial	$238.48
Rate for Payer: Encore Health Key Benefits Commercial	$221.84
Rate for Payer: Healthscope Commercial	$249.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$235.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$207.97
Rate for Payer: PHP Commercial	$235.71
Rate for Payer: Priority Health SBD	$174.70

TRAMADOL 50 MG TABLET

Facility

$277.30

Service Code	NDC 00904717961
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$108.98
Max. Negotiated Rate	$249.57
Rate for Payer: Aetna Commercial	$235.71
Rate for Payer: Aetna Medicare	$138.65
Rate for Payer: Aetna New Business (MI Preferred)	$180.25
Rate for Payer: BCBS Complete	$110.92
Rate for Payer: Cash Price	$221.84
Rate for Payer: Cofinity Advantage	$194.11
Rate for Payer: Cofinity Commercial	$238.48
Rate for Payer: Encore Health Key Benefits Commercial	$221.84
Rate for Payer: Healthscope Commercial	$249.57
Rate for Payer: MI Amish Medical Board Commercial	$221.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$235.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$207.97
Rate for Payer: PHP Commercial	$235.71
Rate for Payer: Priority Health SBD	$174.70
Rate for Payer: UHC All Payor (Choice/PPO)	$180.25
Rate for Payer: UHC Core	$144.47
Rate for Payer: UHC Exchange	$108.98

TRAMADOL 50 MG TABLET

Facility

$338.40

Service Code	NDC 60687079501
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$132.99
Max. Negotiated Rate	$304.56
Rate for Payer: Aetna Commercial	$287.64
Rate for Payer: Aetna Medicare	$169.20
Rate for Payer: Aetna New Business (MI Preferred)	$219.96
Rate for Payer: BCBS Complete	$135.36
Rate for Payer: Cash Price	$270.72
Rate for Payer: Cofinity Advantage	$236.88
Rate for Payer: Cofinity Commercial	$291.02
Rate for Payer: Encore Health Key Benefits Commercial	$270.72
Rate for Payer: Healthscope Commercial	$304.56
Rate for Payer: MI Amish Medical Board Commercial	$270.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$287.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$253.80
Rate for Payer: PHP Commercial	$287.64
Rate for Payer: Priority Health SBD	$213.19
Rate for Payer: UHC All Payor (Choice/PPO)	$219.96
Rate for Payer: UHC Core	$176.31
Rate for Payer: UHC Exchange	$132.99

TRAMADOL 50 MG TABLET

Facility

$2.85

Service Code	NDC 68084080811
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$2.56
Rate for Payer: Aetna Commercial	$2.42
Rate for Payer: Aetna Medicare	$1.43
Rate for Payer: Aetna New Business (MI Preferred)	$1.85
Rate for Payer: BCBS Complete	$1.14
Rate for Payer: Cash Price	$2.28
Rate for Payer: Cofinity Advantage	$2.00
Rate for Payer: Cofinity Commercial	$2.45
Rate for Payer: Encore Health Key Benefits Commercial	$2.28
Rate for Payer: Healthscope Commercial	$2.56
Rate for Payer: MI Amish Medical Board Commercial	$2.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.14
Rate for Payer: PHP Commercial	$2.42
Rate for Payer: Priority Health SBD	$1.80
Rate for Payer: UHC All Payor (Choice/PPO)	$1.85
Rate for Payer: UHC Core	$1.48
Rate for Payer: UHC Exchange	$1.12

Know your out-of-pocket cost for care.

All Charges