Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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	$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

$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

$56,630.92

Service Code	CPT 22856
Hospital Revenue Code	360
Min. Negotiated Rate	$7,632.00
Max. Negotiated Rate	$56,630.92
Rate for Payer: Aetna Medicare	$18,738.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$22,522.75
Rate for Payer: Amish Plain Church Group Commercial	$22,522.75
Rate for Payer: BCBS Complete	$10,140.64
Rate for Payer: BCBS MAPPO	$18,018.20
Rate for Payer: BCBS Trust/PPO	$9,930.30
Rate for Payer: BCN Commercial	$9,930.30
Rate for Payer: BCN Medicare Advantage	$18,018.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$18,018.20
Rate for Payer: Mclaren Medicaid	$9,657.76
Rate for Payer: Mclaren Medicare	$18,018.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$18,919.11
Rate for Payer: Meridian Medicaid	$10,140.64
Rate for Payer: MI Amish Medical Board Commercial	$20,720.93
Rate for Payer: Nomi Health Commercial	$37,838.22
Rate for Payer: PACE Medicare	$17,117.29
Rate for Payer: PACE SWMI	$18,018.20
Rate for Payer: PHP Medicare Advantage	$18,018.20
Rate for Payer: Priority Health Choice Medicaid	$9,657.76
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$56,630.92
Rate for Payer: Priority Health Medicare	$18,018.20
Rate for Payer: Priority Health Narrow Network	$45,304.74
Rate for Payer: Railroad Medicare Medicare	$18,018.20
Rate for Payer: UHC All Payor (Choice/PPO)	$50,719.43
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Dual Complete DSNP	$18,018.20
Rate for Payer: UHC Exchange	$8,174.00
Rate for Payer: UHC Medicare Advantage	$18,018.20
Rate for Payer: UHCCP Medicaid	$10,144.25
Rate for Payer: VA VA	$18,018.20

TOTAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY

Facility

$17,966.53

Service Code	CPT 60220
Hospital Revenue Code	360
Min. Negotiated Rate	$755.32
Max. Negotiated Rate	$17,966.53
Rate for Payer: Aetna Medicare	$5,945.05
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,145.49
Rate for Payer: Amish Plain Church Group Commercial	$7,145.49
Rate for Payer: BCBS Complete	$3,217.18
Rate for Payer: BCBS MAPPO	$5,716.39
Rate for Payer: BCBS Trust/PPO	$3,479.23
Rate for Payer: BCN Commercial	$3,479.23
Rate for Payer: BCN Medicare Advantage	$5,716.39
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,716.39
Rate for Payer: Mclaren Medicaid	$3,063.99
Rate for Payer: Mclaren Medicare	$5,716.39
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,002.21
Rate for Payer: Meridian Medicaid	$3,217.18
Rate for Payer: MI Amish Medical Board Commercial	$6,573.85
Rate for Payer: Nomi Health Commercial	$12,004.42
Rate for Payer: PACE Medicare	$5,430.57
Rate for Payer: PACE SWMI	$5,716.39
Rate for Payer: PHP Medicare Advantage	$5,716.39
Rate for Payer: Priority Health Choice Medicaid	$3,063.99
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17,966.53
Rate for Payer: Priority Health Medicare	$5,716.39
Rate for Payer: Priority Health Narrow Network	$14,373.22
Rate for Payer: Railroad Medicare Medicare	$5,716.39
Rate for Payer: UHC All Payor (Choice/PPO)	$755.32
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Dual Complete DSNP	$5,716.39
Rate for Payer: UHC Exchange	$8,174.00
Rate for Payer: UHC Medicare Advantage	$5,716.39
Rate for Payer: UHCCP Medicaid	$3,218.33
Rate for Payer: VA VA	$5,716.39

TRABECTEDIN 1 MG INTRAVENOUS SOLUTION

Facility

$15,481.44

Service Code	HCPCS J9352
Hospital Charge Code	175966
Hospital Revenue Code	636
Min. Negotiated Rate	$194.43
Max. Negotiated Rate	$13,933.30
Rate for Payer: Aetna Commercial	$13,159.22
Rate for Payer: Aetna Medicare	$377.26
Rate for Payer: Aetna New Business (MI Preferred)	$10,062.94
Rate for Payer: Allen County Amish Medical Aid Commercial	$453.44
Rate for Payer: Amish Plain Church Group Commercial	$453.44
Rate for Payer: BCBS Complete	$204.16
Rate for Payer: BCBS MAPPO	$362.75
Rate for Payer: BCBS Trust/PPO	$1,024.88
Rate for Payer: BCN Commercial	$1,024.88
Rate for Payer: BCN Medicare Advantage	$362.75
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	$362.75
Rate for Payer: Healthscope Commercial	$13,933.30
Rate for Payer: Mclaren Medicaid	$194.43
Rate for Payer: Mclaren Medicare	$362.75
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$380.89
Rate for Payer: Meridian Medicaid	$204.16
Rate for Payer: MI Amish Medical Board Commercial	$417.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13,159.22
Rate for Payer: Nomi Health Commercial	$1,088.25
Rate for Payer: PACE Medicare	$344.61
Rate for Payer: PACE SWMI	$362.75
Rate for Payer: PHP Commercial	$13,159.22
Rate for Payer: PHP Medicare Advantage	$362.75
Rate for Payer: Priority Health Choice Medicaid	$194.43
Rate for Payer: Priority Health Cigna Priority Health	$10,062.94
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,044.20
Rate for Payer: Priority Health Medicare	$362.75
Rate for Payer: Priority Health Narrow Network	$835.36
Rate for Payer: Priority Health SBD	$9,753.31
Rate for Payer: Railroad Medicare Medicare	$362.75
Rate for Payer: UHC All Payor (Choice/PPO)	$1,021.10
Rate for Payer: UHC Dual Complete DSNP	$362.75
Rate for Payer: UHC Medicare Advantage	$362.75
Rate for Payer: UHCCP Medicaid	$204.23
Rate for Payer: VA VA	$362.75

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 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 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 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

TRACHEOSTOMY, EMERGENCY PROCEDURE; TRANSTRACHEAL

Facility

$4,561.52

Service Code	CPT 31603
Hospital Revenue Code	360
Min. Negotiated Rate	$341.86
Max. Negotiated Rate	$4,561.52
Rate for Payer: Aetna Medicare	$1,509.38
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,814.16
Rate for Payer: Amish Plain Church Group Commercial	$1,814.16
Rate for Payer: BCBS Complete	$816.81
Rate for Payer: BCBS MAPPO	$1,451.33
Rate for Payer: BCBS Trust/PPO	$501.66
Rate for Payer: BCN Commercial	$501.66
Rate for Payer: BCN Medicare Advantage	$1,451.33
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,451.33
Rate for Payer: Mclaren Medicaid	$777.91
Rate for Payer: Mclaren Medicare	$1,451.33
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,523.90
Rate for Payer: Meridian Medicaid	$816.81
Rate for Payer: MI Amish Medical Board Commercial	$1,669.03
Rate for Payer: Nomi Health Commercial	$3,047.79
Rate for Payer: PACE Medicare	$1,378.76
Rate for Payer: PACE SWMI	$1,451.33
Rate for Payer: PHP Medicare Advantage	$1,451.33
Rate for Payer: Priority Health Choice Medicaid	$777.91
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,561.52
Rate for Payer: Priority Health Medicare	$1,451.33
Rate for Payer: Priority Health Narrow Network	$3,649.22
Rate for Payer: Railroad Medicare Medicare	$1,451.33
Rate for Payer: UHC All Payor (Choice/PPO)	$341.86
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,451.33
Rate for Payer: UHC Exchange	$3,362.00
Rate for Payer: UHC Medicare Advantage	$1,451.33
Rate for Payer: UHCCP Medicaid	$817.10
Rate for Payer: VA VA	$1,451.33

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	$255.92
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	$255.92
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

$284.35

Service Code	NDC 68084080801
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$179.14
Max. Negotiated Rate	$255.92
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	$255.92
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

$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

$105.75

Service Code	NDC 00093005801
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$66.62
Max. Negotiated Rate	$95.18
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	$74.02
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Cofinity Medicare Advantage	$74.02
Rate for Payer: Encore Health Key Benefits Commercial	$84.60
Rate for Payer: Healthscope Commercial	$95.18
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

$105.75

Service Code	NDC 00093005801
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$95.18
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	$74.02
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Cofinity Medicare Advantage	$74.02
Rate for Payer: Encore Health Key Benefits Commercial	$84.60
Rate for Payer: Healthscope Commercial	$95.18
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

$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)	$88.60
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	$88.60
Rate for Payer: Priority Health SBD	$85.87

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)	$88.60
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	$88.60
Rate for Payer: Priority Health SBD	$85.87

TRAMADOL 50 MG TABLET

Facility

$987.00

Service Code	NDC 57664037718
Hospital Charge Code	14632
Hospital Revenue Code	637
Min. Negotiated Rate	$621.81
Max. Negotiated Rate	$888.30
Rate for Payer: Aetna Commercial	$838.95
Rate for Payer: Aetna New Business (MI Preferred)	$641.55
Rate for Payer: Cash Price	$789.60
Rate for Payer: Cofinity 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

$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

$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	$70.74
Rate for Payer: Cofinity Commercial	$86.90
Rate for Payer: Cofinity Medicare Advantage	$70.74
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

$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

Know your out-of-pocket cost for care.

All Charges