Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

TORSEMIDE 10 MG TABLET

Facility

$199.75

Service Code	NDC 23155087201
Hospital Charge Code	18292
Hospital Revenue Code	637
Min. Negotiated Rate	$125.84
Max. Negotiated Rate	$179.78
Rate for Payer: Aetna Commercial	$169.79
Rate for Payer: Aetna New Business (MI Preferred)	$129.84
Rate for Payer: Cash Price	$159.80
Rate for Payer: Cofinity Commercial	$139.82
Rate for Payer: Cofinity Commercial	$171.78
Rate for Payer: Cofinity Medicare Advantage	$139.82
Rate for Payer: Encore Health Key Benefits Commercial	$159.80
Rate for Payer: Healthscope Commercial	$179.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$169.79
Rate for Payer: PHP Commercial	$169.79
Rate for Payer: Priority Health Cigna Priority Health	$129.84
Rate for Payer: Priority Health SBD	$125.84

TORSEMIDE 10 MG TABLET

Facility

$345.45

Service Code	NDC 31722053001
Hospital Charge Code	18292
Hospital Revenue Code	637
Min. Negotiated Rate	$138.18
Max. Negotiated Rate	$310.90
Rate for Payer: Aetna Commercial	$293.63
Rate for Payer: Aetna Medicare	$172.72
Rate for Payer: Aetna New Business (MI Preferred)	$224.54
Rate for Payer: BCBS Complete	$138.18
Rate for Payer: Cash Price	$276.36
Rate for Payer: Cofinity Commercial	$241.81
Rate for Payer: Cofinity Commercial	$297.09
Rate for Payer: Cofinity Medicare Advantage	$241.81
Rate for Payer: Encore Health Key Benefits Commercial	$276.36
Rate for Payer: Healthscope Commercial	$310.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$293.63
Rate for Payer: PHP Commercial	$293.63
Rate for Payer: Priority Health Cigna Priority Health	$224.54
Rate for Payer: Priority Health SBD	$217.63

TORSEMIDE 10 MG TABLET

Facility

$104.50

Service Code	NDC 50268075515
Hospital Charge Code	18292
Hospital Revenue Code	637
Min. Negotiated Rate	$65.83
Max. Negotiated Rate	$94.05
Rate for Payer: Aetna Commercial	$88.83
Rate for Payer: Aetna New Business (MI Preferred)	$67.92
Rate for Payer: Cash Price	$83.60
Rate for Payer: Cofinity Commercial	$73.15
Rate for Payer: Cofinity Commercial	$89.87
Rate for Payer: Cofinity Medicare Advantage	$73.15
Rate for Payer: Encore Health Key Benefits Commercial	$83.60
Rate for Payer: Healthscope Commercial	$94.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$88.83
Rate for Payer: PHP Commercial	$88.83
Rate for Payer: Priority Health Cigna Priority Health	$67.92
Rate for Payer: Priority Health SBD	$65.83

TORSEMIDE 10 MG TABLET

Facility

$104.50

Service Code	NDC 50268075515
Hospital Charge Code	18292
Hospital Revenue Code	637
Min. Negotiated Rate	$41.80
Max. Negotiated Rate	$94.05
Rate for Payer: Aetna Commercial	$88.83
Rate for Payer: Aetna Medicare	$52.25
Rate for Payer: Aetna New Business (MI Preferred)	$67.92
Rate for Payer: BCBS Complete	$41.80
Rate for Payer: Cash Price	$83.60
Rate for Payer: Cofinity Commercial	$73.15
Rate for Payer: Cofinity Commercial	$89.87
Rate for Payer: Cofinity Medicare Advantage	$73.15
Rate for Payer: Encore Health Key Benefits Commercial	$83.60
Rate for Payer: Healthscope Commercial	$94.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$88.83
Rate for Payer: PHP Commercial	$88.83
Rate for Payer: Priority Health Cigna Priority Health	$67.92
Rate for Payer: Priority Health SBD	$65.83

TORSEMIDE 20 MG TABLET

Facility

$280.32

Service Code	NDC 50111091701
Hospital Charge Code	18293
Hospital Revenue Code	637
Min. Negotiated Rate	$176.60
Max. Negotiated Rate	$252.29
Rate for Payer: Aetna Commercial	$238.27
Rate for Payer: Aetna New Business (MI Preferred)	$182.21
Rate for Payer: Cash Price	$224.26
Rate for Payer: Cofinity Commercial	$196.22
Rate for Payer: Cofinity Commercial	$241.08
Rate for Payer: Cofinity Medicare Advantage	$196.22
Rate for Payer: Encore Health Key Benefits Commercial	$224.26
Rate for Payer: Healthscope Commercial	$252.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$238.27
Rate for Payer: PHP Commercial	$238.27
Rate for Payer: Priority Health Cigna Priority Health	$182.21
Rate for Payer: Priority Health SBD	$176.60

TORSEMIDE 20 MG TABLET

Facility

$2.87

Service Code	NDC 50268075611
Hospital Charge Code	18293
Hospital Revenue Code	637
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$2.58
Rate for Payer: Aetna Commercial	$2.44
Rate for Payer: Aetna Medicare	$1.44
Rate for Payer: Aetna New Business (MI Preferred)	$1.87
Rate for Payer: BCBS Complete	$1.15
Rate for Payer: Cash Price	$2.30
Rate for Payer: Cofinity Commercial	$2.01
Rate for Payer: Cofinity Commercial	$2.47
Rate for Payer: Cofinity Medicare Advantage	$2.01
Rate for Payer: Encore Health Key Benefits Commercial	$2.30
Rate for Payer: Healthscope Commercial	$2.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.44
Rate for Payer: PHP Commercial	$2.44
Rate for Payer: Priority Health Cigna Priority Health	$1.87
Rate for Payer: Priority Health SBD	$1.81

TORSEMIDE 20 MG TABLET

Facility

$280.32

Service Code	NDC 50111091701
Hospital Charge Code	18293
Hospital Revenue Code	637
Min. Negotiated Rate	$112.13
Max. Negotiated Rate	$252.29
Rate for Payer: Aetna Commercial	$238.27
Rate for Payer: Aetna Medicare	$140.16
Rate for Payer: Aetna New Business (MI Preferred)	$182.21
Rate for Payer: BCBS Complete	$112.13
Rate for Payer: Cash Price	$224.26
Rate for Payer: Cofinity Commercial	$196.22
Rate for Payer: Cofinity Commercial	$241.08
Rate for Payer: Cofinity Medicare Advantage	$196.22
Rate for Payer: Encore Health Key Benefits Commercial	$224.26
Rate for Payer: Healthscope Commercial	$252.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$238.27
Rate for Payer: PHP Commercial	$238.27
Rate for Payer: Priority Health Cigna Priority Health	$182.21
Rate for Payer: Priority Health SBD	$176.60

TORSEMIDE 20 MG TABLET

Facility

$143.45

Service Code	NDC 50268075615
Hospital Charge Code	18293
Hospital Revenue Code	637
Min. Negotiated Rate	$90.37
Max. Negotiated Rate	$129.10
Rate for Payer: Aetna Commercial	$121.93
Rate for Payer: Aetna New Business (MI Preferred)	$93.24
Rate for Payer: Cash Price	$114.76
Rate for Payer: Cofinity Commercial	$100.42
Rate for Payer: Cofinity Commercial	$123.37
Rate for Payer: Cofinity Medicare Advantage	$100.42
Rate for Payer: Encore Health Key Benefits Commercial	$114.76
Rate for Payer: Healthscope Commercial	$129.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$121.93
Rate for Payer: PHP Commercial	$121.93
Rate for Payer: Priority Health Cigna Priority Health	$93.24
Rate for Payer: Priority Health SBD	$90.37

TORSEMIDE 20 MG TABLET

Facility

$143.45

Service Code	NDC 50268075615
Hospital Charge Code	18293
Hospital Revenue Code	637
Min. Negotiated Rate	$57.38
Max. Negotiated Rate	$129.10
Rate for Payer: Aetna Commercial	$121.93
Rate for Payer: Aetna Medicare	$71.72
Rate for Payer: Aetna New Business (MI Preferred)	$93.24
Rate for Payer: BCBS Complete	$57.38
Rate for Payer: Cash Price	$114.76
Rate for Payer: Cofinity Commercial	$100.42
Rate for Payer: Cofinity Commercial	$123.37
Rate for Payer: Cofinity Medicare Advantage	$100.42
Rate for Payer: Encore Health Key Benefits Commercial	$114.76
Rate for Payer: Healthscope Commercial	$129.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$121.93
Rate for Payer: PHP Commercial	$121.93
Rate for Payer: Priority Health Cigna Priority Health	$93.24
Rate for Payer: Priority Health SBD	$90.37

TORSEMIDE 20 MG TABLET

Facility

$2.87

Service Code	NDC 50268075611
Hospital Charge Code	18293
Hospital Revenue Code	637
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$2.58
Rate for Payer: Aetna Commercial	$2.44
Rate for Payer: Aetna New Business (MI Preferred)	$1.87
Rate for Payer: Cash Price	$2.30
Rate for Payer: Cofinity Commercial	$2.01
Rate for Payer: Cofinity Commercial	$2.47
Rate for Payer: Cofinity Medicare Advantage	$2.01
Rate for Payer: Encore Health Key Benefits Commercial	$2.30
Rate for Payer: Healthscope Commercial	$2.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.44
Rate for Payer: PHP Commercial	$2.44
Rate for Payer: Priority Health Cigna Priority Health	$1.87
Rate for Payer: Priority Health SBD	$1.81

TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDING DISCECTOMY WITH END PLATE PREPARATION (INCLUDES OSTEOPHYTECTOMY FOR NERVE ROOT OR SPINAL CORD DECOMPRESSION AND MICRODISSECTION); SINGLE INTERSPACE, CERVICAL

Facility

$50,486.50

Service Code	CPT 22856
Hospital Revenue Code	360
Min. Negotiated Rate	$9,613.40
Max. Negotiated Rate	$50,486.50
Rate for Payer: Aetna Medicare	$18,652.87
Rate for Payer: Allen County Amish Medical Aid Commercial	$22,419.31
Rate for Payer: Amish Plain Church Group Commercial	$22,419.31
Rate for Payer: BCBS Complete	$10,094.07
Rate for Payer: BCBS MAPPO	$17,935.45
Rate for Payer: BCN Medicare Advantage	$17,935.45
Rate for Payer: Health Alliance Plan Medicare Advantage	$17,935.45
Rate for Payer: Mclaren Medicaid	$9,613.40
Rate for Payer: Mclaren Medicare	$17,935.45
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$18,832.22
Rate for Payer: Meridian Medicaid	$10,094.07
Rate for Payer: MI Amish Medical Board Commercial	$20,625.77
Rate for Payer: PACE Medicare	$17,038.68
Rate for Payer: PACE SWMI	$17,935.45
Rate for Payer: PHP Medicare Advantage	$17,935.45
Rate for Payer: Priority Health Choice Medicaid	$9,613.40
Rate for Payer: Priority Health Medicare	$17,935.45
Rate for Payer: Railroad Medicare Medicare	$17,935.45
Rate for Payer: UHC All Payor (Choice/PPO)	$50,486.50
Rate for Payer: UHC Dual Complete DSNP	$17,935.45
Rate for Payer: UHC Medicare Advantage	$17,935.45
Rate for Payer: UHCCP Medicaid	$10,097.66
Rate for Payer: VA VA	$17,935.45

TOTAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY

Facility

$16,017.15

Service Code	CPT 60220
Hospital Revenue Code	360
Min. Negotiated Rate	$3,049.91
Max. Negotiated Rate	$16,017.15
Rate for Payer: Aetna Medicare	$5,917.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,112.66
Rate for Payer: Amish Plain Church Group Commercial	$7,112.66
Rate for Payer: BCBS Complete	$3,202.41
Rate for Payer: BCBS MAPPO	$5,690.13
Rate for Payer: BCN Medicare Advantage	$5,690.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,690.13
Rate for Payer: Mclaren Medicaid	$3,049.91
Rate for Payer: Mclaren Medicare	$5,690.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,974.64
Rate for Payer: Meridian Medicaid	$3,202.41
Rate for Payer: MI Amish Medical Board Commercial	$6,543.65
Rate for Payer: PACE Medicare	$5,405.62
Rate for Payer: PACE SWMI	$5,690.13
Rate for Payer: PHP Medicare Advantage	$5,690.13
Rate for Payer: Priority Health Choice Medicaid	$3,049.91
Rate for Payer: Priority Health Medicare	$5,690.13
Rate for Payer: Railroad Medicare Medicare	$5,690.13
Rate for Payer: UHC All Payor (Choice/PPO)	$16,017.15
Rate for Payer: UHC Dual Complete DSNP	$5,690.13
Rate for Payer: UHC Medicare Advantage	$5,690.13
Rate for Payer: UHCCP Medicaid	$3,203.54
Rate for Payer: VA VA	$5,690.13

TRABECTEDIN 1 MG INTRAVENOUS SOLUTION

Facility

$15,481.44

Service Code	HCPCS J9352
Hospital Charge Code	175966
Hospital Revenue Code	636
Min. Negotiated Rate	$209.61
Max. Negotiated Rate	$13,933.30
Rate for Payer: Aetna Commercial	$13,159.22
Rate for Payer: Aetna Medicare	$406.71
Rate for Payer: Aetna New Business (MI Preferred)	$10,062.94
Rate for Payer: Allen County Amish Medical Aid Commercial	$488.84
Rate for Payer: Amish Plain Church Group Commercial	$488.84
Rate for Payer: BCBS Complete	$220.09
Rate for Payer: BCBS MAPPO	$391.07
Rate for Payer: BCN Medicare Advantage	$391.07
Rate for Payer: Cash Price	$12,385.15
Rate for Payer: Cash Price	$12,385.15
Rate for Payer: Cofinity Commercial	$13,314.04
Rate for Payer: Cofinity Commercial	$10,837.01
Rate for Payer: Cofinity Medicare Advantage	$10,837.01
Rate for Payer: Encore Health Key Benefits Commercial	$12,385.15
Rate for Payer: Health Alliance Plan Medicare Advantage	$391.07
Rate for Payer: Healthscope Commercial	$13,933.30
Rate for Payer: Mclaren Medicaid	$209.61
Rate for Payer: Mclaren Medicare	$391.07
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$410.62
Rate for Payer: Meridian Medicaid	$220.09
Rate for Payer: MI Amish Medical Board Commercial	$449.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13,159.22
Rate for Payer: PACE Medicare	$371.52
Rate for Payer: PACE SWMI	$391.07
Rate for Payer: PHP Commercial	$13,159.22
Rate for Payer: PHP Medicare Advantage	$391.07
Rate for Payer: Priority Health Choice Medicaid	$209.61
Rate for Payer: Priority Health Cigna Priority Health	$10,062.94
Rate for Payer: Priority Health Medicare	$391.07
Rate for Payer: Priority Health SBD	$9,753.31
Rate for Payer: Railroad Medicare Medicare	$391.07
Rate for Payer: UHC All Payor (Choice/PPO)	$1,100.82
Rate for Payer: UHC Dual Complete DSNP	$391.07
Rate for Payer: UHC Medicare Advantage	$391.07
Rate for Payer: UHCCP Medicaid	$220.17
Rate for Payer: VA VA	$391.07

TRABECTEDIN 1 MG INTRAVENOUS SOLUTION

Facility

$15,481.44

Service Code	HCPCS J9352
Hospital Charge Code	175966
Hospital Revenue Code	636
Min. Negotiated Rate	$9,753.31
Max. Negotiated Rate	$13,933.30
Rate for Payer: Aetna Commercial	$13,159.22
Rate for Payer: Aetna New Business (MI Preferred)	$10,062.94
Rate for Payer: Cash Price	$12,385.15
Rate for Payer: Cofinity Commercial	$10,837.01
Rate for Payer: Cofinity Commercial	$13,314.04
Rate for Payer: Cofinity Medicare Advantage	$10,837.01
Rate for Payer: Encore Health Key Benefits Commercial	$12,385.15
Rate for Payer: Healthscope Commercial	$13,933.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13,159.22
Rate for Payer: PHP Commercial	$13,159.22
Rate for Payer: Priority Health Cigna Priority Health	$10,062.94
Rate for Payer: Priority Health SBD	$9,753.31

TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION

Facility

$96.02

Service Code	NDC 00517930501
Hospital Charge Code	194947
Hospital Revenue Code	250
Min. Negotiated Rate	$60.49
Max. Negotiated Rate	$86.42
Rate for Payer: Aetna Commercial	$81.62
Rate for Payer: Aetna New Business (MI Preferred)	$62.41
Rate for Payer: Cash Price	$76.82
Rate for Payer: Cofinity Commercial	$67.21
Rate for Payer: Cofinity Commercial	$82.58
Rate for Payer: Cofinity Medicare Advantage	$67.21
Rate for Payer: Encore Health Key Benefits Commercial	$76.82
Rate for Payer: Healthscope Commercial	$86.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.62
Rate for Payer: PHP Commercial	$81.62
Rate for Payer: Priority Health Cigna Priority Health	$62.41
Rate for Payer: Priority Health SBD	$60.49

TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION

Facility

$96.02

Service Code	NDC 00517930525
Hospital Charge Code	194947
Hospital Revenue Code	250
Min. Negotiated Rate	$38.41
Max. Negotiated Rate	$86.42
Rate for Payer: Aetna Commercial	$81.62
Rate for Payer: Aetna Medicare	$48.01
Rate for Payer: Aetna New Business (MI Preferred)	$62.41
Rate for Payer: BCBS Complete	$38.41
Rate for Payer: Cash Price	$76.82
Rate for Payer: Cofinity Commercial	$67.21
Rate for Payer: Cofinity Commercial	$82.58
Rate for Payer: Cofinity Medicare Advantage	$67.21
Rate for Payer: Encore Health Key Benefits Commercial	$76.82
Rate for Payer: Healthscope Commercial	$86.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.62
Rate for Payer: PHP Commercial	$81.62
Rate for Payer: Priority Health Cigna Priority Health	$62.41
Rate for Payer: Priority Health SBD	$60.49

TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION

Facility

$96.02

Service Code	NDC 00517930501
Hospital Charge Code	194947
Hospital Revenue Code	250
Min. Negotiated Rate	$38.41
Max. Negotiated Rate	$86.42
Rate for Payer: Aetna Commercial	$81.62
Rate for Payer: Aetna Medicare	$48.01
Rate for Payer: Aetna New Business (MI Preferred)	$62.41
Rate for Payer: BCBS Complete	$38.41
Rate for Payer: Cash Price	$76.82
Rate for Payer: Cofinity Commercial	$67.21
Rate for Payer: Cofinity Commercial	$82.58
Rate for Payer: Cofinity Medicare Advantage	$67.21
Rate for Payer: Encore Health Key Benefits Commercial	$76.82
Rate for Payer: Healthscope Commercial	$86.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.62
Rate for Payer: PHP Commercial	$81.62
Rate for Payer: Priority Health Cigna Priority Health	$62.41
Rate for Payer: Priority Health SBD	$60.49

TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION

Facility

$96.02

Service Code	NDC 00517930525
Hospital Charge Code	194947
Hospital Revenue Code	250
Min. Negotiated Rate	$60.49
Max. Negotiated Rate	$86.42
Rate for Payer: Aetna Commercial	$81.62
Rate for Payer: Aetna New Business (MI Preferred)	$62.41
Rate for Payer: Cash Price	$76.82
Rate for Payer: Cofinity Commercial	$67.21
Rate for Payer: Cofinity Commercial	$82.58
Rate for Payer: Cofinity Medicare Advantage	$67.21
Rate for Payer: Encore Health Key Benefits Commercial	$76.82
Rate for Payer: Healthscope Commercial	$86.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.62
Rate for Payer: PHP Commercial	$81.62
Rate for Payer: Priority Health Cigna Priority Health	$62.41
Rate for Payer: Priority Health SBD	$60.49

TRACHEOSTOMY, EMERGENCY PROCEDURE; TRANSTRACHEAL

Facility

$4,066.57

Service Code	CPT 31603
Hospital Revenue Code	360
Min. Negotiated Rate	$774.34
Max. Negotiated Rate	$4,066.57
Rate for Payer: Aetna Medicare	$1,502.45
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,805.83
Rate for Payer: Amish Plain Church Group Commercial	$1,805.83
Rate for Payer: BCBS Complete	$813.05
Rate for Payer: BCBS MAPPO	$1,444.66
Rate for Payer: BCN Medicare Advantage	$1,444.66
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,444.66
Rate for Payer: Mclaren Medicaid	$774.34
Rate for Payer: Mclaren Medicare	$1,444.66
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,516.89
Rate for Payer: Meridian Medicaid	$813.05
Rate for Payer: MI Amish Medical Board Commercial	$1,661.36
Rate for Payer: PACE Medicare	$1,372.43
Rate for Payer: PACE SWMI	$1,444.66
Rate for Payer: PHP Medicare Advantage	$1,444.66
Rate for Payer: Priority Health Choice Medicaid	$774.34
Rate for Payer: Priority Health Medicare	$1,444.66
Rate for Payer: Railroad Medicare Medicare	$1,444.66
Rate for Payer: UHC All Payor (Choice/PPO)	$4,066.57
Rate for Payer: UHC Dual Complete DSNP	$1,444.66
Rate for Payer: UHC Medicare Advantage	$1,444.66
Rate for Payer: UHCCP Medicaid	$813.34
Rate for Payer: VA VA	$1,444.66

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 Commercial	$353.68
Rate for Payer: Cofinity Commercial	$434.51
Rate for Payer: Cofinity Medicare Advantage	$353.68
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: PHP Commercial	$429.46
Rate for Payer: Priority Health Cigna Priority Health	$328.41
Rate for Payer: Priority Health SBD	$318.31

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 Commercial	$0.96
Rate for Payer: Cofinity Commercial	$1.18
Rate for Payer: Cofinity Medicare Advantage	$0.96
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: PHP Commercial	$1.16
Rate for Payer: Priority Health Cigna Priority Health	$0.89
Rate for Payer: Priority Health SBD	$0.86

TRAMADOL 50 MG TABLET

Facility

$105.75

Service Code	NDC 00093005801
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$42.30
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 Commercial	$74.03
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Cofinity Medicare Advantage	$74.03
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: PHP Commercial	$89.89
Rate for Payer: Priority Health Cigna Priority Health	$68.74
Rate for Payer: Priority Health SBD	$66.62

TRAMADOL 50 MG TABLET

Facility

$101.05

Service Code	NDC 51079099120
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$40.42
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 Commercial	$70.73
Rate for Payer: Cofinity Commercial	$86.90
Rate for Payer: Cofinity Medicare Advantage	$70.73
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: PHP Commercial	$85.89
Rate for Payer: Priority Health Cigna Priority Health	$65.68
Rate for Payer: Priority Health SBD	$63.66

TRAMADOL 50 MG TABLET

Facility

$305.50

Service Code	NDC 60687079501
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$122.20
Max. Negotiated Rate	$274.95
Rate for Payer: Aetna Commercial	$259.68
Rate for Payer: Aetna Medicare	$152.75
Rate for Payer: Aetna New Business (MI Preferred)	$198.57
Rate for Payer: BCBS Complete	$122.20
Rate for Payer: Cash Price	$244.40
Rate for Payer: Cofinity Commercial	$213.85
Rate for Payer: Cofinity Commercial	$262.73
Rate for Payer: Cofinity Medicare Advantage	$213.85
Rate for Payer: Encore Health Key Benefits Commercial	$244.40
Rate for Payer: Healthscope Commercial	$274.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$259.68
Rate for Payer: PHP Commercial	$259.68
Rate for Payer: Priority Health Cigna Priority Health	$198.57
Rate for Payer: Priority Health SBD	$192.47

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 Commercial	$194.11
Rate for Payer: Cofinity Commercial	$238.48
Rate for Payer: Cofinity Medicare Advantage	$194.11
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: PHP Commercial	$235.71
Rate for Payer: Priority Health Cigna Priority Health	$180.25
Rate for Payer: Priority Health SBD	$174.70

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