|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$1,269.00
|
|
|
Service Code
|
NDC 65162062711
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$799.47 |
| Max. Negotiated Rate |
$1,142.10 |
| Rate for Payer: Aetna Commercial |
$1,078.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$824.85
|
| 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: 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
|
|
|
TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK
|
Facility
|
IP
|
$26.70
|
|
|
Service Code
|
HCPCS J3291
|
| Hospital Charge Code |
191208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.82 |
| Max. Negotiated Rate |
$24.03 |
| Rate for Payer: Aetna Commercial |
$22.70
|
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.07
|
| Rate for Payer: Cash Price |
$21.36
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cofinity Advantage |
$18.38
|
| Rate for Payer: Cofinity Advantage |
$18.69
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Cofinity Commercial |
$22.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.01
|
| Rate for Payer: Healthscope Commercial |
$24.03
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.02
|
| Rate for Payer: PHP Commercial |
$22.70
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: Priority Health SBD |
$16.82
|
| Rate for Payer: Priority Health SBD |
$16.54
|
|
|
TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK
|
Facility
|
OP
|
$26.70
|
|
|
Service Code
|
HCPCS J3291
|
| Hospital Charge Code |
191208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$24.03 |
| Rate for Payer: Aetna Commercial |
$22.70
|
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: Aetna Medicare |
$13.13
|
| Rate for Payer: Aetna Medicare |
$13.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.36
|
| Rate for Payer: BCBS Complete |
$10.50
|
| Rate for Payer: BCBS Complete |
$10.68
|
| Rate for Payer: BCBS Trust/PPO |
$0.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.20
|
| Rate for Payer: BCN Commercial |
$0.20
|
| Rate for Payer: BCN Commercial |
$0.20
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cash Price |
$21.36
|
| Rate for Payer: Cash Price |
$21.36
|
| Rate for Payer: Cofinity Advantage |
$18.38
|
| Rate for Payer: Cofinity Advantage |
$18.69
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Cofinity Commercial |
$22.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.36
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: Healthscope Commercial |
$24.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.02
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: PHP Commercial |
$22.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.11
|
| Rate for Payer: Priority Health SBD |
$16.82
|
| Rate for Payer: Priority Health SBD |
$16.54
|
| Rate for Payer: Priority Health Tiered Network |
$0.09
|
| Rate for Payer: Priority Health Tiered Network |
$0.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.05
|
|
|
Service Code
|
NDC 72485010701
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: Aetna Medicare |
$12.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.63
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cofinity Advantage |
$16.84
|
| Rate for Payer: Cofinity Commercial |
$20.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.04
|
| Rate for Payer: PHP Commercial |
$20.44
|
| Rate for Payer: Priority Health SBD |
$15.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.63
|
| Rate for Payer: UHC Core |
$12.53
|
| Rate for Payer: UHC Exchange |
$9.45
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.43
|
|
|
Service Code
|
NDC 83634040141
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: Aetna Medicare |
$9.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.98
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Advantage |
$12.90
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$16.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.82
|
| Rate for Payer: PHP Commercial |
$15.67
|
| Rate for Payer: Priority Health SBD |
$11.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.98
|
| Rate for Payer: UHC Core |
$9.60
|
| Rate for Payer: UHC Exchange |
$7.24
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$38.59
|
|
|
Service Code
|
NDC 63323056310
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.17 |
| Max. Negotiated Rate |
$34.73 |
| Rate for Payer: Aetna Commercial |
$32.80
|
| Rate for Payer: Aetna Medicare |
$19.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.08
|
| Rate for Payer: BCBS Complete |
$15.44
|
| Rate for Payer: Cash Price |
$30.87
|
| Rate for Payer: Cofinity Advantage |
$27.01
|
| Rate for Payer: Cofinity Commercial |
$33.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.87
|
| Rate for Payer: Healthscope Commercial |
$34.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.94
|
| Rate for Payer: PHP Commercial |
$32.80
|
| Rate for Payer: Priority Health SBD |
$24.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.08
|
| Rate for Payer: UHC Core |
$20.11
|
| Rate for Payer: UHC Exchange |
$15.17
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$38.59
|
|
|
Service Code
|
NDC 63323056310
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$34.73 |
| Rate for Payer: Aetna Commercial |
$32.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.08
|
| Rate for Payer: Cash Price |
$30.87
|
| Rate for Payer: Cofinity Advantage |
$27.01
|
| Rate for Payer: Cofinity Commercial |
$33.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.87
|
| Rate for Payer: Healthscope Commercial |
$34.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.94
|
| Rate for Payer: PHP Commercial |
$32.80
|
| Rate for Payer: Priority Health SBD |
$24.31
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.91
|
|
|
Service Code
|
NDC 55150018810
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.02 |
| Max. Negotiated Rate |
$14.32 |
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.34
|
| Rate for Payer: Cash Price |
$12.73
|
| Rate for Payer: Cofinity Advantage |
$11.14
|
| Rate for Payer: Cofinity Commercial |
$13.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.73
|
| Rate for Payer: Healthscope Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.93
|
| Rate for Payer: PHP Commercial |
$13.52
|
| Rate for Payer: Priority Health SBD |
$10.02
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$31.07
|
|
|
Service Code
|
NDC 00517096001
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$27.96 |
| Rate for Payer: Aetna Commercial |
$26.41
|
| Rate for Payer: Aetna Medicare |
$15.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.20
|
| Rate for Payer: BCBS Complete |
$12.43
|
| Rate for Payer: Cash Price |
$24.86
|
| Rate for Payer: Cofinity Advantage |
$21.75
|
| Rate for Payer: Cofinity Commercial |
$26.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.86
|
| Rate for Payer: Healthscope Commercial |
$27.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.30
|
| Rate for Payer: PHP Commercial |
$26.41
|
| Rate for Payer: Priority Health SBD |
$19.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.20
|
| Rate for Payer: UHC Core |
$16.19
|
| Rate for Payer: UHC Exchange |
$12.21
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$31.07
|
|
|
Service Code
|
NDC 00517096010
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$27.96 |
| Rate for Payer: Aetna Commercial |
$26.41
|
| Rate for Payer: Aetna Medicare |
$15.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.20
|
| Rate for Payer: BCBS Complete |
$12.43
|
| Rate for Payer: Cash Price |
$24.86
|
| Rate for Payer: Cofinity Advantage |
$21.75
|
| Rate for Payer: Cofinity Commercial |
$26.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.86
|
| Rate for Payer: Healthscope Commercial |
$27.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.30
|
| Rate for Payer: PHP Commercial |
$26.41
|
| Rate for Payer: Priority Health SBD |
$19.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.20
|
| Rate for Payer: UHC Core |
$16.19
|
| Rate for Payer: UHC Exchange |
$12.21
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.05
|
|
|
Service Code
|
NDC 72485010701
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.63
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cofinity Advantage |
$16.84
|
| Rate for Payer: Cofinity Commercial |
$20.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.04
|
| Rate for Payer: PHP Commercial |
$20.44
|
| Rate for Payer: Priority Health SBD |
$15.15
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$27.38
|
|
|
Service Code
|
NDC 70860040710
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$24.64 |
| Rate for Payer: Aetna Commercial |
$23.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.80
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cofinity Advantage |
$19.17
|
| Rate for Payer: Cofinity Commercial |
$23.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.90
|
| Rate for Payer: Healthscope Commercial |
$24.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.54
|
| Rate for Payer: PHP Commercial |
$23.27
|
| Rate for Payer: Priority Health SBD |
$17.25
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.43
|
|
|
Service Code
|
NDC 83634040141
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.98
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Advantage |
$12.90
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.82
|
| Rate for Payer: PHP Commercial |
$15.67
|
| Rate for Payer: Priority Health SBD |
$11.61
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.21
|
|
|
Service Code
|
NDC 43066000801
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.84
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cofinity Advantage |
$12.75
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.66
|
| Rate for Payer: PHP Commercial |
$15.48
|
| Rate for Payer: Priority Health SBD |
$11.47
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.01
|
|
|
Service Code
|
NDC 00013111401
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$20.71 |
| Rate for Payer: Aetna Commercial |
$19.56
|
| Rate for Payer: Aetna Medicare |
$11.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.96
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: Cash Price |
$18.41
|
| Rate for Payer: Cofinity Advantage |
$16.11
|
| Rate for Payer: Cofinity Commercial |
$19.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.41
|
| Rate for Payer: Healthscope Commercial |
$20.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.26
|
| Rate for Payer: PHP Commercial |
$19.56
|
| Rate for Payer: Priority Health SBD |
$14.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.96
|
| Rate for Payer: UHC Core |
$11.99
|
| Rate for Payer: UHC Exchange |
$9.04
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.61
|
|
|
Service Code
|
NDC 60505616901
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$16.75 |
| Rate for Payer: Aetna Commercial |
$15.82
|
| Rate for Payer: Aetna Medicare |
$9.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.10
|
| Rate for Payer: BCBS Complete |
$7.44
|
| Rate for Payer: Cash Price |
$14.89
|
| Rate for Payer: Cofinity Advantage |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$16.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.89
|
| Rate for Payer: Healthscope Commercial |
$16.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.96
|
| Rate for Payer: PHP Commercial |
$15.82
|
| Rate for Payer: Priority Health SBD |
$11.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.10
|
| Rate for Payer: UHC Core |
$9.70
|
| Rate for Payer: UHC Exchange |
$7.31
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27.38
|
|
|
Service Code
|
NDC 70860040710
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$24.64 |
| Rate for Payer: Aetna Commercial |
$23.27
|
| Rate for Payer: Aetna Medicare |
$13.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.80
|
| Rate for Payer: BCBS Complete |
$10.95
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cofinity Advantage |
$19.17
|
| Rate for Payer: Cofinity Commercial |
$23.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.90
|
| Rate for Payer: Healthscope Commercial |
$24.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.54
|
| Rate for Payer: PHP Commercial |
$23.27
|
| Rate for Payer: Priority Health SBD |
$17.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.80
|
| Rate for Payer: UHC Core |
$14.26
|
| Rate for Payer: UHC Exchange |
$10.76
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15.91
|
|
|
Service Code
|
NDC 55150018810
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$14.32 |
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Medicare |
$7.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.34
|
| Rate for Payer: BCBS Complete |
$6.36
|
| Rate for Payer: Cash Price |
$12.73
|
| Rate for Payer: Cofinity Advantage |
$11.14
|
| Rate for Payer: Cofinity Commercial |
$13.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.73
|
| Rate for Payer: Healthscope Commercial |
$14.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.93
|
| Rate for Payer: PHP Commercial |
$13.52
|
| Rate for Payer: Priority Health SBD |
$10.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.34
|
| Rate for Payer: UHC Core |
$8.29
|
| Rate for Payer: UHC Exchange |
$6.25
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.43
|
|
|
Service Code
|
NDC 83634040110
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.98
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Advantage |
$12.90
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.82
|
| Rate for Payer: PHP Commercial |
$15.67
|
| Rate for Payer: Priority Health SBD |
$11.61
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.43
|
|
|
Service Code
|
NDC 83634040110
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: Aetna Medicare |
$9.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.98
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Advantage |
$12.90
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$16.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.82
|
| Rate for Payer: PHP Commercial |
$15.67
|
| Rate for Payer: Priority Health SBD |
$11.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.98
|
| Rate for Payer: UHC Core |
$9.60
|
| Rate for Payer: UHC Exchange |
$7.24
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$38.59
|
|
|
Service Code
|
NDC 63323056301
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.17 |
| Max. Negotiated Rate |
$34.73 |
| Rate for Payer: Aetna Commercial |
$32.80
|
| Rate for Payer: Aetna Medicare |
$19.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.08
|
| Rate for Payer: BCBS Complete |
$15.44
|
| Rate for Payer: Cash Price |
$30.87
|
| Rate for Payer: Cofinity Advantage |
$27.01
|
| Rate for Payer: Cofinity Commercial |
$33.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.87
|
| Rate for Payer: Healthscope Commercial |
$34.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.94
|
| Rate for Payer: PHP Commercial |
$32.80
|
| Rate for Payer: Priority Health SBD |
$24.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.08
|
| Rate for Payer: UHC Core |
$20.11
|
| Rate for Payer: UHC Exchange |
$15.17
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.21
|
|
|
Service Code
|
NDC 43066000810
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.84
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cofinity Advantage |
$12.75
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.66
|
| Rate for Payer: PHP Commercial |
$15.48
|
| Rate for Payer: Priority Health SBD |
$11.47
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.21
|
|
|
Service Code
|
NDC 43066000801
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Medicare |
$9.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.84
|
| Rate for Payer: BCBS Complete |
$7.28
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cofinity Advantage |
$12.75
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.66
|
| Rate for Payer: PHP Commercial |
$15.48
|
| Rate for Payer: Priority Health SBD |
$11.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.84
|
| Rate for Payer: UHC Core |
$9.49
|
| Rate for Payer: UHC Exchange |
$7.16
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$51.85
|
|
|
Service Code
|
NDC 00013111420
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$46.66 |
| Rate for Payer: Aetna Commercial |
$44.07
|
| Rate for Payer: Aetna Medicare |
$25.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.70
|
| Rate for Payer: BCBS Complete |
$20.74
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Cofinity Advantage |
$36.30
|
| Rate for Payer: Cofinity Commercial |
$44.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.48
|
| Rate for Payer: Healthscope Commercial |
$46.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.89
|
| Rate for Payer: PHP Commercial |
$44.07
|
| Rate for Payer: Priority Health SBD |
$32.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.70
|
| Rate for Payer: UHC Core |
$27.01
|
| Rate for Payer: UHC Exchange |
$20.38
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$51.85
|
|
|
Service Code
|
NDC 00013111420
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.67 |
| Max. Negotiated Rate |
$46.66 |
| Rate for Payer: Aetna Commercial |
$44.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.70
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Cofinity Advantage |
$36.30
|
| Rate for Payer: Cofinity Commercial |
$44.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.48
|
| Rate for Payer: Healthscope Commercial |
$46.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.89
|
| Rate for Payer: PHP Commercial |
$44.07
|
| Rate for Payer: Priority Health SBD |
$32.67
|
|
