|
TORSEMIDE 20 MG TABLET
|
Facility
IP
|
$139.65
|
|
|
Service Code
|
NDC 50268-756-15
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.17 |
| Max. Negotiated Rate |
$125.68 |
| Rate for Payer: Aetna Commercial |
$118.70
|
| Rate for Payer: BCBS Trust/PPO |
$107.92
|
| Rate for Payer: BCN Commercial |
$107.92
|
| Rate for Payer: Cash Price |
$111.72
|
| Rate for Payer: Cofinity Commercial |
$120.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.72
|
| Rate for Payer: Healthscope Commercial |
$125.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$118.70
|
| Rate for Payer: PHP Commercial |
$118.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.89
|
| Rate for Payer: UHC Core |
$116.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.74
|
|
|
TORSEMIDE 5 MG TABLET
|
Facility
IP
|
$105.75
|
|
|
Service Code
|
NDC 31722-529-01
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$95.18 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: BCBS Trust/PPO |
$81.72
|
| Rate for Payer: BCN Commercial |
$81.72
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.06
|
| Rate for Payer: UHC Core |
$88.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION
|
Facility
IP
|
$87.93
|
|
|
Service Code
|
NDC 0517-9305-01
|
| Hospital Charge Code |
194947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.63 |
| Max. Negotiated Rate |
$79.14 |
| Rate for Payer: Aetna Commercial |
$74.74
|
| Rate for Payer: BCBS Trust/PPO |
$67.95
|
| Rate for Payer: BCN Commercial |
$67.95
|
| Rate for Payer: Cash Price |
$70.34
|
| Rate for Payer: Cofinity Commercial |
$75.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.34
|
| Rate for Payer: Healthscope Commercial |
$79.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.74
|
| Rate for Payer: PHP Commercial |
$74.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.38
|
| Rate for Payer: UHC Core |
$73.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.95
|
|
|
TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION
|
Facility
IP
|
$87.93
|
|
|
Service Code
|
NDC 0517-9305-25
|
| Hospital Charge Code |
194947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.63 |
| Max. Negotiated Rate |
$79.14 |
| Rate for Payer: Aetna Commercial |
$74.74
|
| Rate for Payer: BCBS Trust/PPO |
$67.95
|
| Rate for Payer: BCN Commercial |
$67.95
|
| Rate for Payer: Cash Price |
$70.34
|
| Rate for Payer: Cofinity Commercial |
$75.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.34
|
| Rate for Payer: Healthscope Commercial |
$79.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.74
|
| Rate for Payer: PHP Commercial |
$74.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.38
|
| Rate for Payer: UHC Core |
$73.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.95
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
IP
|
$1.37
|
|
|
Service Code
|
NDC 55154-2541-7
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna Commercial |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$1.06
|
| Rate for Payer: BCN Commercial |
$1.06
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Cofinity Commercial |
$1.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.10
|
| Rate for Payer: Healthscope Commercial |
$1.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.16
|
| Rate for Payer: PHP Commercial |
$1.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.21
|
| Rate for Payer: UHC Core |
$1.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.03
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
IP
|
$103.40
|
|
|
Service Code
|
NDC 57664-377-08
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.06 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: BCBS Trust/PPO |
$79.91
|
| Rate for Payer: BCN Commercial |
$79.91
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.89
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.99
|
| Rate for Payer: UHC Core |
$86.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.55
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
IP
|
$270.25
|
|
|
Service Code
|
NDC 0904-7179-61
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.83 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: BCBS Trust/PPO |
$208.85
|
| Rate for Payer: BCN Commercial |
$208.85
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$232.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Healthscope Commercial |
$243.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.71
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.82
|
| Rate for Payer: UHC Core |
$225.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.69
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
IP
|
$284.35
|
|
|
Service Code
|
NDC 68084-808-01
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.43 |
| Max. Negotiated Rate |
$255.92 |
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: BCBS Trust/PPO |
$219.75
|
| Rate for Payer: BCN Commercial |
$219.75
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$255.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$241.70
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.23
|
| Rate for Payer: UHC Core |
$237.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.26
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
IP
|
$2.85
|
|
|
Service Code
|
NDC 68084-808-11
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$2.20
|
| Rate for Payer: BCN Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.28
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.42
|
| Rate for Payer: PHP Commercial |
$2.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.51
|
| Rate for Payer: UHC Core |
$2.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.14
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
IP
|
$136.30
|
|
|
Service Code
|
NDC 55154-2541-4
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.13 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: BCBS Trust/PPO |
$105.33
|
| Rate for Payer: BCN Commercial |
$105.33
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.86
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.94
|
| Rate for Payer: UHC Core |
$113.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
IP
|
$1.02
|
|
|
Service Code
|
NDC 51079-991-01
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.87
|
| Rate for Payer: BCBS Trust/PPO |
$0.79
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$0.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.82
|
| Rate for Payer: Healthscope Commercial |
$0.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.87
|
| Rate for Payer: PHP Commercial |
$0.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.90
|
| Rate for Payer: UHC Core |
$0.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.77
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
IP
|
$101.05
|
|
|
Service Code
|
NDC 51079-991-20
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.63 |
| Max. Negotiated Rate |
$90.94 |
| Rate for Payer: Aetna Commercial |
$85.89
|
| Rate for Payer: BCBS Trust/PPO |
$78.09
|
| Rate for Payer: BCN Commercial |
$78.09
|
| Rate for Payer: Cash Price |
$80.84
|
| Rate for Payer: Cofinity Commercial |
$86.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.84
|
| Rate for Payer: Healthscope Commercial |
$90.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.89
|
| Rate for Payer: PHP Commercial |
$85.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.92
|
| Rate for Payer: UHC Core |
$84.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.79
|
|
|
TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK
|
Facility
IP
|
$36.49
|
|
|
Service Code
|
NDC 51754-0108-3
|
| Hospital Charge Code |
191208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.26 |
| Max. Negotiated Rate |
$32.84 |
| Rate for Payer: Aetna Commercial |
$31.02
|
| Rate for Payer: BCBS Trust/PPO |
$28.20
|
| Rate for Payer: BCN Commercial |
$28.20
|
| Rate for Payer: Cash Price |
$29.19
|
| Rate for Payer: Cofinity Commercial |
$31.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.19
|
| Rate for Payer: Healthscope Commercial |
$32.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.02
|
| Rate for Payer: PHP Commercial |
$31.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.11
|
| Rate for Payer: UHC Core |
$30.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.37
|
|
|
TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK
|
Facility
IP
|
$36.49
|
|
|
Service Code
|
NDC 51754-0108-1
|
| Hospital Charge Code |
191208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.26 |
| Max. Negotiated Rate |
$32.84 |
| Rate for Payer: Aetna Commercial |
$31.02
|
| Rate for Payer: BCBS Trust/PPO |
$28.20
|
| Rate for Payer: BCN Commercial |
$28.20
|
| Rate for Payer: Cash Price |
$29.19
|
| Rate for Payer: Cofinity Commercial |
$31.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.19
|
| Rate for Payer: Healthscope Commercial |
$32.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.02
|
| Rate for Payer: PHP Commercial |
$31.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.11
|
| Rate for Payer: UHC Core |
$30.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.37
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$25.90
|
|
|
Service Code
|
NDC 60505-6169-0
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$20.02
|
| Rate for Payer: BCN Commercial |
$20.02
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.02
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.42
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$43.17
|
|
|
Service Code
|
NDC 23155-166-41
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.33 |
| Max. Negotiated Rate |
$38.85 |
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.99
|
| Rate for Payer: Aetna Commercial |
$36.69
|
| Rate for Payer: BCBS Trust/PPO |
$33.36
|
| Rate for Payer: BCN Commercial |
$33.36
|
| Rate for Payer: Cash Price |
$34.54
|
| Rate for Payer: Cofinity Commercial |
$37.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.54
|
| Rate for Payer: Healthscope Commercial |
$38.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.69
|
| Rate for Payer: PHP Commercial |
$36.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.33
|
| Rate for Payer: UHC Core |
$36.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.38
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$28.97
|
|
|
Service Code
|
NDC 67457-197-10
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$26.07 |
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: BCBS Trust/PPO |
$22.39
|
| Rate for Payer: BCN Commercial |
$22.39
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$24.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Healthscope Commercial |
$26.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.62
|
| Rate for Payer: PHP Commercial |
$24.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.49
|
| Rate for Payer: UHC Core |
$24.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.73
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$31.07
|
|
|
Service Code
|
NDC 0517-0960-01
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$27.96 |
| Rate for Payer: Aetna Commercial |
$26.41
|
| Rate for Payer: BCBS Trust/PPO |
$24.01
|
| Rate for Payer: BCN Commercial |
$24.01
|
| Rate for Payer: Cash Price |
$24.86
|
| Rate for Payer: Cofinity Commercial |
$26.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.86
|
| Rate for Payer: Healthscope Commercial |
$27.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.41
|
| Rate for Payer: PHP Commercial |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.34
|
| Rate for Payer: UHC Core |
$25.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.30
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$23.99
|
|
|
Service Code
|
NDC 39822-1000-1
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$21.59 |
| Rate for Payer: Aetna Commercial |
$20.39
|
| Rate for Payer: BCBS Trust/PPO |
$18.54
|
| Rate for Payer: BCN Commercial |
$18.54
|
| Rate for Payer: Cash Price |
$19.19
|
| Rate for Payer: Cofinity Commercial |
$20.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.19
|
| Rate for Payer: Healthscope Commercial |
$21.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.39
|
| Rate for Payer: PHP Commercial |
$20.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.11
|
| Rate for Payer: UHC Core |
$20.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.99
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$43.17
|
|
|
Service Code
|
NDC 23155-166-31
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.33 |
| Max. Negotiated Rate |
$38.85 |
| Rate for Payer: Aetna Commercial |
$36.69
|
| Rate for Payer: BCBS Trust/PPO |
$33.36
|
| Rate for Payer: BCN Commercial |
$33.36
|
| Rate for Payer: Cash Price |
$34.54
|
| Rate for Payer: Cofinity Commercial |
$37.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.54
|
| Rate for Payer: Healthscope Commercial |
$38.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.69
|
| Rate for Payer: PHP Commercial |
$36.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.99
|
| Rate for Payer: UHC Core |
$36.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.38
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$15.91
|
|
|
Service Code
|
NDC 55150-188-10
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$14.32 |
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: BCBS Trust/PPO |
$12.30
|
| Rate for Payer: BCN Commercial |
$12.30
|
| Rate for Payer: Cash Price |
$12.73
|
| Rate for Payer: Cofinity Commercial |
$13.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.73
|
| Rate for Payer: Healthscope Commercial |
$14.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.52
|
| Rate for Payer: PHP Commercial |
$13.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.00
|
| Rate for Payer: UHC Core |
$13.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.93
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$28.97
|
|
|
Service Code
|
NDC 67457-197-00
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$26.07 |
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: BCBS Trust/PPO |
$22.39
|
| Rate for Payer: BCN Commercial |
$22.39
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$24.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Healthscope Commercial |
$26.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.62
|
| Rate for Payer: PHP Commercial |
$24.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.49
|
| Rate for Payer: UHC Core |
$24.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.73
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$27.38
|
|
|
Service Code
|
NDC 70860-400-10
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$24.64 |
| Rate for Payer: Aetna Commercial |
$23.27
|
| Rate for Payer: BCBS Trust/PPO |
$21.16
|
| Rate for Payer: BCN Commercial |
$21.16
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cofinity Commercial |
$23.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.90
|
| Rate for Payer: Healthscope Commercial |
$24.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.27
|
| Rate for Payer: PHP Commercial |
$23.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.09
|
| Rate for Payer: UHC Core |
$22.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.54
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$22.20
|
|
|
Service Code
|
NDC 43066-008-10
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: BCBS Trust/PPO |
$17.16
|
| Rate for Payer: BCN Commercial |
$17.16
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.87
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.54
|
| Rate for Payer: UHC Core |
$18.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$31.07
|
|
|
Service Code
|
NDC 0517-0960-10
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$27.96 |
| Rate for Payer: Aetna Commercial |
$26.41
|
| Rate for Payer: BCBS Trust/PPO |
$24.01
|
| Rate for Payer: BCN Commercial |
$24.01
|
| Rate for Payer: Cash Price |
$24.86
|
| Rate for Payer: Cofinity Commercial |
$26.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.86
|
| Rate for Payer: Healthscope Commercial |
$27.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.41
|
| Rate for Payer: PHP Commercial |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.34
|
| Rate for Payer: UHC Core |
$25.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.30
|
|
