|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.46
|
|
|
Service Code
|
NDC 00013111401
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Aetna Commercial |
$19.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.25
|
| Rate for Payer: Cash Price |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Cofinity Commercial |
$20.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.77
|
| Rate for Payer: Healthscope Commercial |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.94
|
| Rate for Payer: PHP Commercial |
$19.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.25
|
| Rate for Payer: Priority Health SBD |
$14.78
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.99
|
|
|
Service Code
|
NDC 39822100001
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$21.59 |
| Rate for Payer: Aetna Commercial |
$20.39
|
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.59
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: Cash Price |
$19.19
|
| Rate for Payer: Cofinity Commercial |
$16.79
|
| Rate for Payer: Cofinity Commercial |
$20.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.19
|
| Rate for Payer: Healthscope Commercial |
$21.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.39
|
| Rate for Payer: PHP Commercial |
$20.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.59
|
| Rate for Payer: Priority Health SBD |
$15.11
|
|
|
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 Commercial |
$11.14
|
| Rate for Payer: Cofinity Commercial |
$13.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.14
|
| 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: PHP Commercial |
$13.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.34
|
| Rate for Payer: Priority Health SBD |
$10.02
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$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
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.99
|
|
|
Service Code
|
NDC 39822100001
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.11 |
| Max. Negotiated Rate |
$21.59 |
| Rate for Payer: Aetna Commercial |
$20.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.59
|
| Rate for Payer: Cash Price |
$19.19
|
| Rate for Payer: Cofinity Commercial |
$16.79
|
| Rate for Payer: Cofinity Commercial |
$20.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.19
|
| Rate for Payer: Healthscope Commercial |
$21.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.39
|
| Rate for Payer: PHP Commercial |
$20.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.59
|
| Rate for Payer: Priority Health SBD |
$15.11
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$31.07
|
|
|
Service Code
|
NDC 00517096010
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.57 |
| Max. Negotiated Rate |
$27.96 |
| Rate for Payer: Aetna Commercial |
$26.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.20
|
| Rate for Payer: Cash Price |
$24.86
|
| Rate for Payer: Cofinity Commercial |
$21.75
|
| Rate for Payer: Cofinity Commercial |
$26.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.86
|
| Rate for Payer: Healthscope Commercial |
$27.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.41
|
| Rate for Payer: PHP Commercial |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.20
|
| Rate for Payer: Priority Health SBD |
$19.57
|
|
|
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 |
$6.36 |
| 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 Commercial |
$11.14
|
| Rate for Payer: Cofinity Commercial |
$13.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.14
|
| 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: PHP Commercial |
$13.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.34
|
| 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 00517096010
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.43 |
| 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 Commercial |
$21.75
|
| Rate for Payer: Cofinity Commercial |
$26.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.86
|
| Rate for Payer: Healthscope Commercial |
$27.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.41
|
| Rate for Payer: PHP Commercial |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.20
|
| Rate for Payer: Priority Health SBD |
$19.57
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.43
|
|
|
Service Code
|
NDC 60505616901
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: Aetna Medicare |
$9.22
|
| 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 Commercial |
$12.90
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.90
|
| 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: PHP Commercial |
$15.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.98
|
| Rate for Payer: Priority Health SBD |
$11.61
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.05
|
|
|
Service Code
|
NDC 72485010710
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: Aetna Medicare |
$12.02
|
| 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 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
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.10
|
|
|
Service Code
|
NDC 00013111421
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: Aetna Commercial |
$16.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.42
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$13.37
|
| Rate for Payer: Cofinity Commercial |
$16.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$17.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.24
|
| Rate for Payer: PHP Commercial |
$16.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.42
|
| Rate for Payer: Priority Health SBD |
$12.03
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$38.59
|
|
|
Service Code
|
NDC 63323056301
|
| 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 Commercial |
$27.01
|
| Rate for Payer: Cofinity Commercial |
$33.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.01
|
| 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: PHP Commercial |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.08
|
| Rate for Payer: Priority Health SBD |
$24.31
|
|
|
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 |
$9.62 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: Aetna Medicare |
$12.02
|
| 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 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
|
|
|
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 Commercial |
$27.01
|
| Rate for Payer: Cofinity Commercial |
$33.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.01
|
| 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: PHP Commercial |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.08
|
| Rate for Payer: Priority Health SBD |
$24.31
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.43
|
|
|
Service Code
|
NDC 60505616901
|
| 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 Commercial |
$12.90
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.90
|
| 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: PHP Commercial |
$15.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.98
|
| Rate for Payer: Priority Health SBD |
$11.61
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.10
|
|
|
Service Code
|
NDC 00013111420
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: Aetna Commercial |
$16.24
|
| Rate for Payer: Aetna Medicare |
$9.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.42
|
| Rate for Payer: BCBS Complete |
$7.64
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$13.37
|
| Rate for Payer: Cofinity Commercial |
$16.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$17.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.24
|
| Rate for Payer: PHP Commercial |
$16.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.42
|
| Rate for Payer: Priority Health SBD |
$12.03
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.10
|
|
|
Service Code
|
NDC 00013111421
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: Aetna Commercial |
$16.24
|
| Rate for Payer: Aetna Medicare |
$9.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.42
|
| Rate for Payer: BCBS Complete |
$7.64
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$13.37
|
| Rate for Payer: Cofinity Commercial |
$16.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$17.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.24
|
| Rate for Payer: PHP Commercial |
$16.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.42
|
| Rate for Payer: Priority Health SBD |
$12.03
|
|
|
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 |
$15.44 |
| 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 Commercial |
$27.01
|
| Rate for Payer: Cofinity Commercial |
$33.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.01
|
| 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: PHP Commercial |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.08
|
| Rate for Payer: Priority Health SBD |
$24.31
|
|
|
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 |
$12.43 |
| 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 Commercial |
$21.75
|
| Rate for Payer: Cofinity Commercial |
$26.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.86
|
| Rate for Payer: Healthscope Commercial |
$27.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.41
|
| Rate for Payer: PHP Commercial |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.20
|
| Rate for Payer: Priority Health SBD |
$19.57
|
|
|
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 |
$15.44 |
| 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 Commercial |
$27.01
|
| Rate for Payer: Cofinity Commercial |
$33.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.01
|
| 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: PHP Commercial |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.08
|
| Rate for Payer: Priority Health SBD |
$24.31
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) NEBULIZED SOLUTION CUSTOM
|
Facility
|
OP
|
$24.05
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
301846
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: Aetna Medicare |
$12.02
|
| 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 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
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) NEBULIZED SOLUTION CUSTOM
|
Facility
|
IP
|
$24.05
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
301846
|
|
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
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) SOLUTION CUSTOM
|
Facility
|
IP
|
$18.43
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
300870
|
|
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 Commercial |
$20.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.63
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Cofinity Commercial |
$20.68
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$16.59
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: PHP Commercial |
$15.67
|
| Rate for Payer: PHP Commercial |
$20.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.98
|
| Rate for Payer: Priority Health SBD |
$15.15
|
| Rate for Payer: Priority Health SBD |
$11.61
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) SOLUTION CUSTOM
|
Facility
|
OP
|
$24.05
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
300870
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: Aetna Medicare |
$9.22
|
| Rate for Payer: Aetna Medicare |
$12.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.98
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$20.68
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Healthscope Commercial |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: PHP Commercial |
$20.44
|
| Rate for Payer: PHP Commercial |
$15.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.63
|
| Rate for Payer: Priority Health SBD |
$11.61
|
| Rate for Payer: Priority Health SBD |
$15.15
|
|
|
TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S) (EXCEPT LOWER EXTREMITY ARTERY(S) FOR OCCLUSIVE DISEASE, CERVICAL CAROTID, EXTRACRANIAL VERTEBRAL OR INTRATHORACIC CAROTID, INTRACRANIAL, OR CORONARY), OPEN OR PERCUTANEOUS, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION AND INCLUDING ALL ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED; INITIAL ARTERY
|
Facility
|
OP
|
$34,922.52
|
|
|
Service Code
|
CPT 37236
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$467.39 |
| Max. Negotiated Rate |
$34,922.52 |
| Rate for Payer: Aetna Medicare |
$11,555.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,889.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,889.08
|
| Rate for Payer: BCBS Complete |
$6,253.42
|
| Rate for Payer: BCBS MAPPO |
$11,111.26
|
| Rate for Payer: BCBS Trust/PPO |
$6,738.31
|
| Rate for Payer: BCN Commercial |
$6,738.31
|
| Rate for Payer: BCN Medicare Advantage |
$11,111.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,111.26
|
| Rate for Payer: Mclaren Medicaid |
$5,955.64
|
| Rate for Payer: Mclaren Medicare |
$11,111.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,666.82
|
| Rate for Payer: Meridian Medicaid |
$6,253.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,777.95
|
| Rate for Payer: Nomi Health Commercial |
$23,333.65
|
| Rate for Payer: PACE Medicare |
$10,555.70
|
| Rate for Payer: PACE SWMI |
$11,111.26
|
| Rate for Payer: PHP Medicare Advantage |
$11,111.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,955.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,922.52
|
| Rate for Payer: Priority Health Medicare |
$11,111.26
|
| Rate for Payer: Priority Health Narrow Network |
$27,938.02
|
| Rate for Payer: Railroad Medicare Medicare |
$11,111.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$467.39
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,111.26
|
| Rate for Payer: UHC Exchange |
$9,445.00
|
| Rate for Payer: UHC Medicare Advantage |
$11,111.26
|
| Rate for Payer: UHCCP Medicaid |
$6,255.64
|
| Rate for Payer: VA VA |
$11,111.26
|
|
