Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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

$987.00

Service Code	NDC 57664037718
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$394.80
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 Commercial	$690.90
Rate for Payer: Cofinity Commercial	$848.82
Rate for Payer: Cofinity Medicare Advantage	$690.90
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: PHP Commercial	$838.95
Rate for Payer: Priority Health Cigna Priority Health	$641.55
Rate for Payer: Priority Health SBD	$621.81

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

$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

$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

$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

TRAMADOL 50 MG TABLET

Facility

$3.06

Service Code	NDC 60687079511
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$2.75
Rate for Payer: Aetna Commercial	$2.60
Rate for Payer: Aetna Medicare	$1.53
Rate for Payer: Aetna New Business (MI Preferred)	$1.99
Rate for Payer: BCBS Complete	$1.22
Rate for Payer: Cash Price	$2.45
Rate for Payer: Cofinity Commercial	$2.14
Rate for Payer: Cofinity Commercial	$2.63
Rate for Payer: Cofinity Medicare Advantage	$2.14
Rate for Payer: Encore Health Key Benefits Commercial	$2.45
Rate for Payer: Healthscope Commercial	$2.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.60
Rate for Payer: PHP Commercial	$2.60
Rate for Payer: Priority Health Cigna Priority Health	$1.99
Rate for Payer: Priority Health SBD	$1.93

TRAMADOL 50 MG TABLET

Facility

$505.25

Service Code	NDC 57664037713
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$202.10
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 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

$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 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

$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

$305.50

Service Code	NDC 60687079501
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$192.47
Max. Negotiated Rate	$274.95
Rate for Payer: Aetna Commercial	$259.68
Rate for Payer: Aetna New Business (MI Preferred)	$198.57
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

$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

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 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

$3.06

Service Code	NDC 60687079511
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$2.75
Rate for Payer: Aetna Commercial	$2.60
Rate for Payer: Aetna New Business (MI Preferred)	$1.99
Rate for Payer: Cash Price	$2.45
Rate for Payer: Cofinity Commercial	$2.14
Rate for Payer: Cofinity Commercial	$2.63
Rate for Payer: Cofinity Medicare Advantage	$2.14
Rate for Payer: Encore Health Key Benefits Commercial	$2.45
Rate for Payer: Healthscope Commercial	$2.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.60
Rate for Payer: PHP Commercial	$2.60
Rate for Payer: Priority Health Cigna Priority Health	$1.99
Rate for Payer: Priority Health SBD	$1.93

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 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

$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 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

$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 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

TRAMADOL 50 MG TABLET

Facility

$1.02

Service Code	NDC 51079099101
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$0.41
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 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

$1.37

Service Code	NDC 55154254107
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$0.55
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 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

$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 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

TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK

Facility

$26.70

Service Code	NDC 80830232902
Hospital Charge Code	191208
Hospital Revenue Code	250
Min. Negotiated Rate	$10.68
Max. Negotiated Rate	$24.03
Rate for Payer: Aetna Commercial	$22.70
Rate for Payer: Aetna Medicare	$13.35
Rate for Payer: Aetna New Business (MI Preferred)	$17.36
Rate for Payer: BCBS Complete	$10.68
Rate for Payer: Cash Price	$21.36
Rate for Payer: Cofinity Commercial	$18.69
Rate for Payer: Cofinity Commercial	$22.96
Rate for Payer: Cofinity Medicare Advantage	$18.69
Rate for Payer: Encore Health Key Benefits Commercial	$21.36
Rate for Payer: Healthscope Commercial	$24.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.70
Rate for Payer: PHP Commercial	$22.70
Rate for Payer: Priority Health Cigna Priority Health	$17.36
Rate for Payer: Priority Health SBD	$16.82

TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK

Facility

$26.70

Service Code	NDC 80830232901
Hospital Charge Code	191208
Hospital Revenue Code	250
Min. Negotiated Rate	$16.82
Max. Negotiated Rate	$24.03
Rate for Payer: Aetna Commercial	$22.70
Rate for Payer: Aetna New Business (MI Preferred)	$17.36
Rate for Payer: Cash Price	$21.36
Rate for Payer: Cofinity Commercial	$18.69
Rate for Payer: Cofinity Commercial	$22.96
Rate for Payer: Cofinity Medicare Advantage	$18.69
Rate for Payer: Encore Health Key Benefits Commercial	$21.36
Rate for Payer: Healthscope Commercial	$24.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.70
Rate for Payer: PHP Commercial	$22.70
Rate for Payer: Priority Health Cigna Priority Health	$17.36
Rate for Payer: Priority Health SBD	$16.82

TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK

Facility

$26.70

Service Code	NDC 80830232901
Hospital Charge Code	191208
Hospital Revenue Code	250
Min. Negotiated Rate	$10.68
Max. Negotiated Rate	$24.03
Rate for Payer: Aetna Commercial	$22.70
Rate for Payer: Aetna Medicare	$13.35
Rate for Payer: Aetna New Business (MI Preferred)	$17.36
Rate for Payer: BCBS Complete	$10.68
Rate for Payer: Cash Price	$21.36
Rate for Payer: Cofinity Commercial	$18.69
Rate for Payer: Cofinity Commercial	$22.96
Rate for Payer: Cofinity Medicare Advantage	$18.69
Rate for Payer: Encore Health Key Benefits Commercial	$21.36
Rate for Payer: Healthscope Commercial	$24.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.70
Rate for Payer: PHP Commercial	$22.70
Rate for Payer: Priority Health Cigna Priority Health	$17.36
Rate for Payer: Priority Health SBD	$16.82

TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK

Facility

$26.70

Service Code	NDC 80830232902
Hospital Charge Code	191208
Hospital Revenue Code	250
Min. Negotiated Rate	$16.82
Max. Negotiated Rate	$24.03
Rate for Payer: Aetna Commercial	$22.70
Rate for Payer: Aetna New Business (MI Preferred)	$17.36
Rate for Payer: Cash Price	$21.36
Rate for Payer: Cofinity Commercial	$18.69
Rate for Payer: Cofinity Commercial	$22.96
Rate for Payer: Cofinity Medicare Advantage	$18.69
Rate for Payer: Encore Health Key Benefits Commercial	$21.36
Rate for Payer: Healthscope Commercial	$24.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.70
Rate for Payer: PHP Commercial	$22.70
Rate for Payer: Priority Health Cigna Priority Health	$17.36
Rate for Payer: Priority Health SBD	$16.82

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION

Facility

$24.05

Service Code	NDC 72485010710
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 Commercial	$16.84
Rate for Payer: Cofinity Commercial	$20.68
Rate for Payer: Cofinity Medicare Advantage	$16.84
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: PHP Commercial	$20.44
Rate for Payer: Priority Health Cigna Priority Health	$15.63
Rate for Payer: Priority Health SBD	$15.15

Know your out-of-pocket cost for care.

All Charges