Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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

$199.75

Service Code	NDC 23155087201
Hospital Charge Code	18292
Hospital Revenue Code	637
Min. Negotiated Rate	$79.90
Max. Negotiated Rate	$179.78
Rate for Payer: Aetna Commercial	$169.79
Rate for Payer: Aetna Medicare	$99.88
Rate for Payer: Aetna New Business (MI Preferred)	$129.84
Rate for Payer: BCBS Complete	$79.90
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

$475.00

Service Code	NDC 50111091601
Hospital Charge Code	18292
Hospital Revenue Code	637
Min. Negotiated Rate	$190.00
Max. Negotiated Rate	$427.50
Rate for Payer: Aetna Commercial	$403.75
Rate for Payer: Aetna Medicare	$237.50
Rate for Payer: Aetna New Business (MI Preferred)	$308.75
Rate for Payer: BCBS Complete	$190.00
Rate for Payer: Cash Price	$380.00
Rate for Payer: Cofinity Commercial	$332.50
Rate for Payer: Cofinity Commercial	$408.50
Rate for Payer: Cofinity Medicare Advantage	$332.50
Rate for Payer: Encore Health Key Benefits Commercial	$380.00
Rate for Payer: Healthscope Commercial	$427.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$403.75
Rate for Payer: PHP Commercial	$403.75
Rate for Payer: Priority Health Cigna Priority Health	$308.75
Rate for Payer: Priority Health SBD	$299.25

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 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

$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

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

$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

$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

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 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

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

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

$2.85

Service Code	NDC 68084080811
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$1.14
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 Commercial	$2.00
Rate for Payer: Cofinity Commercial	$2.45
Rate for Payer: Cofinity Medicare Advantage	$2.00
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: PHP Commercial	$2.42
Rate for Payer: Priority Health Cigna Priority Health	$1.85
Rate for Payer: Priority Health SBD	$1.80

TRAMADOL 50 MG TABLET

Facility

$277.30

Service Code	NDC 00904717961
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$110.92
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 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

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 Commercial	$0.71
Rate for Payer: Cofinity Commercial	$0.88
Rate for Payer: Cofinity Medicare Advantage	$0.71
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: PHP Commercial	$0.87
Rate for Payer: Priority Health Cigna Priority Health	$0.66
Rate for Payer: Priority Health SBD	$0.64

TRAMADOL 50 MG TABLET

Facility

$1,269.00

Service Code	NDC 65162062711
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$507.60
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 Commercial	$1,091.34
Rate for Payer: Cofinity Commercial	$888.30
Rate for Payer: Cofinity Medicare Advantage	$888.30
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: PHP Commercial	$1,078.65
Rate for Payer: Priority Health Cigna Priority Health	$824.85
Rate for Payer: Priority Health SBD	$799.47

TRAMADOL 50 MG TABLET

Facility

$284.35

Service Code	NDC 68084080801
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$113.74
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 Commercial	$199.04
Rate for Payer: Cofinity Commercial	$244.54
Rate for Payer: Cofinity Medicare Advantage	$199.04
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: PHP Commercial	$241.70
Rate for Payer: Priority Health Cigna Priority Health	$184.83
Rate for Payer: Priority Health SBD	$179.14

TRAMADOL 50 MG TABLET

Facility

$136.30

Service Code	NDC 55154254104
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$54.52
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 Commercial	$117.22
Rate for Payer: Cofinity Commercial	$95.41
Rate for Payer: Cofinity Medicare Advantage	$95.41
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: PHP Commercial	$115.86
Rate for Payer: Priority Health Cigna Priority Health	$88.59
Rate for Payer: Priority Health SBD	$85.87

Know your out-of-pocket cost for care.

All Charges