|
TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$62,778.46
|
|
|
Service Code
|
APR-DRG 0054
|
| Min. Negotiated Rate |
$59,789.01 |
| Max. Negotiated Rate |
$62,778.46 |
| Rate for Payer: BCBS Complete |
$62,778.46
|
| Rate for Payer: Mclaren Medicaid |
$59,789.01
|
| Rate for Payer: Meridian Medicaid |
$62,778.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$59,789.01
|
| Rate for Payer: UHC Medicaid |
$59,789.01
|
| Rate for Payer: UHCCP Medicaid |
$59,789.01
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$11,625.27
|
|
|
Service Code
|
APR-DRG 0051
|
| Min. Negotiated Rate |
$11,071.69 |
| Max. Negotiated Rate |
$11,625.27 |
| Rate for Payer: BCBS Complete |
$11,625.27
|
| Rate for Payer: Mclaren Medicaid |
$11,071.69
|
| Rate for Payer: Meridian Medicaid |
$11,625.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,071.69
|
| Rate for Payer: UHC Medicaid |
$11,071.69
|
| Rate for Payer: UHCCP Medicaid |
$11,071.69
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$50,789.31
|
|
|
Service Code
|
APR-DRG 0053
|
| Min. Negotiated Rate |
$48,370.77 |
| Max. Negotiated Rate |
$50,789.31 |
| Rate for Payer: BCBS Complete |
$50,789.31
|
| Rate for Payer: Mclaren Medicaid |
$48,370.77
|
| Rate for Payer: Meridian Medicaid |
$50,789.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$48,370.77
|
| Rate for Payer: UHC Medicaid |
$48,370.77
|
| Rate for Payer: UHCCP Medicaid |
$48,370.77
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
NDC 51079099101
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.87
|
| Rate for Payer: BCBS Trust/PPO |
$0.84
|
| Rate for Payer: BCN Commercial |
$0.84
|
| 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 Commercial |
$0.87
|
| Rate for Payer: Nomi Health Commercial |
$0.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.77
|
| Rate for Payer: PHP Commercial |
$0.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.71
|
| 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
|
OP
|
$338.40
|
|
|
Service Code
|
NDC 60687079501
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.66 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna Medicare |
$87.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.75
|
| Rate for Payer: BCBS Complete |
$62.64
|
| Rate for Payer: BCBS MAPPO |
$84.60
|
| Rate for Payer: BCBS Trust/PPO |
$278.20
|
| Rate for Payer: BCN Commercial |
$278.20
|
| Rate for Payer: BCN Medicare Advantage |
$84.60
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Mclaren Medicaid |
$59.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.83
|
| Rate for Payer: Meridian Medicaid |
$62.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$93.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Nomi Health Commercial |
$277.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.80
|
| Rate for Payer: PACE Senior Care Partners |
$80.37
|
| Rate for Payer: PACE SWMI |
$84.60
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: PHP Medicare Advantage |
$84.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$294.41
|
| Rate for Payer: Priority Health Medicare |
$85.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.53
|
| Rate for Payer: Railroad Medicare Medicare |
$84.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.79
|
| Rate for Payer: UHC Core |
$282.56
|
| Rate for Payer: UHC Exchange |
$84.60
|
| Rate for Payer: UHC Medicaid |
$59.66
|
| Rate for Payer: UHC Medicare Advantage |
$84.60
|
| Rate for Payer: UHCCP Medicaid |
$59.66
|
| Rate for Payer: VA VA |
$84.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
NDC 60687079501
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$235.53 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: BCBS Trust/PPO |
$279.48
|
| Rate for Payer: BCN Commercial |
$279.48
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Nomi Health Commercial |
$277.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.80
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$294.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.79
|
| Rate for Payer: UHC Core |
$282.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$2.85
|
|
|
Service Code
|
NDC 68084080811
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$2.35
|
| Rate for Payer: BCN Commercial |
$2.35
|
| 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 Commercial |
$2.42
|
| Rate for Payer: Nomi Health Commercial |
$2.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.14
|
| Rate for Payer: PHP Commercial |
$2.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.98
|
| 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
|
OP
|
$1.37
|
|
|
Service Code
|
NDC 55154254107
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna Commercial |
$1.16
|
| Rate for Payer: Aetna Medicare |
$0.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.43
|
| Rate for Payer: BCBS Complete |
$0.25
|
| Rate for Payer: BCBS MAPPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$1.13
|
| Rate for Payer: BCN Commercial |
$1.13
|
| Rate for Payer: BCN Medicare Advantage |
$0.34
|
| 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: Health Alliance Plan Medicare Advantage |
$0.34
|
| Rate for Payer: Healthscope Commercial |
$1.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.03
|
| Rate for Payer: Mclaren Medicaid |
$0.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.36
|
| Rate for Payer: Meridian Medicaid |
$0.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.16
|
| Rate for Payer: Nomi Health Commercial |
$1.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.03
|
| Rate for Payer: PACE Senior Care Partners |
$0.33
|
| Rate for Payer: PACE SWMI |
$0.34
|
| Rate for Payer: PHP Commercial |
$1.16
|
| Rate for Payer: PHP Medicare Advantage |
$0.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.19
|
| Rate for Payer: Priority Health Medicare |
$0.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.95
|
| Rate for Payer: Railroad Medicare Medicare |
$0.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.21
|
| Rate for Payer: UHC Core |
$1.14
|
| Rate for Payer: UHC Exchange |
$0.34
|
| Rate for Payer: UHC Medicaid |
$0.24
|
| Rate for Payer: UHC Medicare Advantage |
$0.34
|
| Rate for Payer: UHCCP Medicaid |
$0.24
|
| Rate for Payer: VA VA |
$0.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.03
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$1.37
|
|
|
Service Code
|
NDC 55154254107
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna Commercial |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$1.13
|
| Rate for Payer: BCN Commercial |
$1.13
|
| 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 Commercial |
$1.16
|
| Rate for Payer: Nomi Health Commercial |
$1.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.03
|
| Rate for Payer: PHP Commercial |
$1.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.95
|
| 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
|
OP
|
$101.05
|
|
|
Service Code
|
NDC 51079099120
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$90.94 |
| Rate for Payer: Aetna Commercial |
$85.89
|
| Rate for Payer: Aetna Medicare |
$26.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.58
|
| Rate for Payer: BCBS Complete |
$18.70
|
| Rate for Payer: BCBS MAPPO |
$25.26
|
| Rate for Payer: BCBS Trust/PPO |
$83.07
|
| Rate for Payer: BCN Commercial |
$83.07
|
| Rate for Payer: BCN Medicare Advantage |
$25.26
|
| 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: Health Alliance Plan Medicare Advantage |
$25.26
|
| Rate for Payer: Healthscope Commercial |
$90.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.79
|
| Rate for Payer: Mclaren Medicaid |
$17.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.53
|
| Rate for Payer: Meridian Medicaid |
$18.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.89
|
| Rate for Payer: Nomi Health Commercial |
$82.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.79
|
| Rate for Payer: PACE Senior Care Partners |
$24.00
|
| Rate for Payer: PACE SWMI |
$25.26
|
| Rate for Payer: PHP Commercial |
$85.89
|
| Rate for Payer: PHP Medicare Advantage |
$25.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$87.91
|
| Rate for Payer: Priority Health Medicare |
$25.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.33
|
| Rate for Payer: Railroad Medicare Medicare |
$25.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.92
|
| Rate for Payer: UHC Core |
$84.38
|
| Rate for Payer: UHC Exchange |
$25.26
|
| Rate for Payer: UHC Medicaid |
$17.82
|
| Rate for Payer: UHC Medicare Advantage |
$25.26
|
| Rate for Payer: UHCCP Medicaid |
$17.82
|
| Rate for Payer: VA VA |
$25.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.79
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
OP
|
$284.35
|
|
|
Service Code
|
NDC 68084080801
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.13 |
| Max. Negotiated Rate |
$255.91 |
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: Aetna Medicare |
$73.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.86
|
| Rate for Payer: BCBS Complete |
$52.63
|
| Rate for Payer: BCBS MAPPO |
$71.09
|
| Rate for Payer: BCBS Trust/PPO |
$233.76
|
| Rate for Payer: BCN Commercial |
$233.76
|
| Rate for Payer: BCN Medicare Advantage |
$71.09
|
| 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: Health Alliance Plan Medicare Advantage |
$71.09
|
| Rate for Payer: Healthscope Commercial |
$255.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.26
|
| Rate for Payer: Mclaren Medicaid |
$50.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.64
|
| Rate for Payer: Meridian Medicaid |
$52.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.26
|
| Rate for Payer: PACE Senior Care Partners |
$67.53
|
| Rate for Payer: PACE SWMI |
$71.09
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: PHP Medicare Advantage |
$71.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$247.38
|
| Rate for Payer: Priority Health Medicare |
$71.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.91
|
| Rate for Payer: Railroad Medicare Medicare |
$71.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.23
|
| Rate for Payer: UHC Core |
$237.43
|
| Rate for Payer: UHC Exchange |
$71.09
|
| Rate for Payer: UHC Medicaid |
$50.13
|
| Rate for Payer: UHC Medicare Advantage |
$71.09
|
| Rate for Payer: UHCCP Medicaid |
$50.13
|
| Rate for Payer: VA VA |
$71.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.26
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
NDC 51079099101
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.87
|
| Rate for Payer: Aetna Medicare |
$0.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.32
|
| Rate for Payer: BCBS Complete |
$0.19
|
| Rate for Payer: BCBS MAPPO |
$0.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.84
|
| Rate for Payer: BCN Commercial |
$0.84
|
| Rate for Payer: BCN Medicare Advantage |
$0.26
|
| 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: Health Alliance Plan Medicare Advantage |
$0.26
|
| Rate for Payer: Healthscope Commercial |
$0.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.77
|
| Rate for Payer: Mclaren Medicaid |
$0.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.27
|
| Rate for Payer: Meridian Medicaid |
$0.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.87
|
| Rate for Payer: Nomi Health Commercial |
$0.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.77
|
| Rate for Payer: PACE Senior Care Partners |
$0.24
|
| Rate for Payer: PACE SWMI |
$0.26
|
| Rate for Payer: PHP Commercial |
$0.87
|
| Rate for Payer: PHP Medicare Advantage |
$0.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.89
|
| Rate for Payer: Priority Health Medicare |
$0.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.71
|
| Rate for Payer: Railroad Medicare Medicare |
$0.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.90
|
| Rate for Payer: UHC Core |
$0.85
|
| Rate for Payer: UHC Exchange |
$0.26
|
| Rate for Payer: UHC Medicaid |
$0.18
|
| Rate for Payer: UHC Medicare Advantage |
$0.26
|
| Rate for Payer: UHCCP Medicaid |
$0.18
|
| Rate for Payer: VA VA |
$0.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.77
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
OP
|
$277.30
|
|
|
Service Code
|
NDC 00904717961
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.89 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna Commercial |
$235.71
|
| Rate for Payer: Aetna Medicare |
$72.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.66
|
| Rate for Payer: BCBS Complete |
$51.33
|
| Rate for Payer: BCBS MAPPO |
$69.33
|
| Rate for Payer: BCBS Trust/PPO |
$227.97
|
| Rate for Payer: BCN Commercial |
$227.97
|
| Rate for Payer: BCN Medicare Advantage |
$69.33
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Commercial |
$238.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.33
|
| Rate for Payer: Healthscope Commercial |
$249.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.97
|
| Rate for Payer: Mclaren Medicaid |
$48.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.79
|
| Rate for Payer: Meridian Medicaid |
$51.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$76.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.71
|
| Rate for Payer: Nomi Health Commercial |
$227.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.97
|
| Rate for Payer: PACE Senior Care Partners |
$65.86
|
| Rate for Payer: PACE SWMI |
$69.33
|
| Rate for Payer: PHP Commercial |
$235.71
|
| Rate for Payer: PHP Medicare Advantage |
$69.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$241.25
|
| Rate for Payer: Priority Health Medicare |
$70.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.00
|
| Rate for Payer: Railroad Medicare Medicare |
$69.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.02
|
| Rate for Payer: UHC Core |
$231.55
|
| Rate for Payer: UHC Exchange |
$69.33
|
| Rate for Payer: UHC Medicaid |
$48.89
|
| Rate for Payer: UHC Medicare Advantage |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$48.89
|
| Rate for Payer: VA VA |
$69.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.97
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$284.35
|
|
|
Service Code
|
NDC 68084080801
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.91 |
| Max. Negotiated Rate |
$255.91 |
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: BCBS Trust/PPO |
$234.84
|
| Rate for Payer: BCN Commercial |
$234.84
|
| 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 |
$255.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.26
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$247.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.91
|
| 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
|
$101.05
|
|
|
Service Code
|
NDC 51079099120
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.33 |
| Max. Negotiated Rate |
$90.94 |
| Rate for Payer: Aetna Commercial |
$85.89
|
| Rate for Payer: BCBS Trust/PPO |
$83.46
|
| Rate for Payer: BCN Commercial |
$83.46
|
| 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 Commercial |
$85.89
|
| Rate for Payer: Nomi Health Commercial |
$82.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.79
|
| Rate for Payer: PHP Commercial |
$85.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$87.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.33
|
| 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
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$136.30
|
|
|
Service Code
|
NDC 55154254104
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.86 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: BCBS Trust/PPO |
$112.57
|
| Rate for Payer: BCN Commercial |
$112.57
|
| 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 Commercial |
$115.86
|
| Rate for Payer: Nomi Health Commercial |
$111.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.22
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$118.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.86
|
| 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
|
OP
|
$2.85
|
|
|
Service Code
|
NDC 68084080811
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.42
|
| Rate for Payer: Aetna Medicare |
$0.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.89
|
| Rate for Payer: BCBS Complete |
$0.53
|
| Rate for Payer: BCBS MAPPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.34
|
| Rate for Payer: BCN Commercial |
$2.34
|
| Rate for Payer: BCN Medicare Advantage |
$0.71
|
| 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: Health Alliance Plan Medicare Advantage |
$0.71
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.14
|
| Rate for Payer: Mclaren Medicaid |
$0.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.75
|
| Rate for Payer: Meridian Medicaid |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.42
|
| Rate for Payer: Nomi Health Commercial |
$2.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.14
|
| Rate for Payer: PACE Senior Care Partners |
$0.68
|
| Rate for Payer: PACE SWMI |
$0.71
|
| Rate for Payer: PHP Commercial |
$2.42
|
| Rate for Payer: PHP Medicare Advantage |
$0.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.48
|
| Rate for Payer: Priority Health Medicare |
$0.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.98
|
| Rate for Payer: Railroad Medicare Medicare |
$0.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.51
|
| Rate for Payer: UHC Core |
$2.38
|
| Rate for Payer: UHC Exchange |
$0.71
|
| Rate for Payer: UHC Medicaid |
$0.50
|
| Rate for Payer: UHC Medicare Advantage |
$0.71
|
| Rate for Payer: UHCCP Medicaid |
$0.50
|
| Rate for Payer: VA VA |
$0.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.14
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
OP
|
$3.39
|
|
|
Service Code
|
NDC 60687079511
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna Commercial |
$2.88
|
| Rate for Payer: Aetna Medicare |
$0.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.06
|
| Rate for Payer: BCBS Complete |
$0.63
|
| Rate for Payer: BCBS MAPPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$2.79
|
| Rate for Payer: BCN Commercial |
$2.79
|
| Rate for Payer: BCN Medicare Advantage |
$0.85
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.85
|
| Rate for Payer: Healthscope Commercial |
$3.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Mclaren Medicaid |
$0.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.89
|
| Rate for Payer: Meridian Medicaid |
$0.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.88
|
| Rate for Payer: Nomi Health Commercial |
$2.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.54
|
| Rate for Payer: PACE Senior Care Partners |
$0.81
|
| Rate for Payer: PACE SWMI |
$0.85
|
| Rate for Payer: PHP Commercial |
$2.88
|
| Rate for Payer: PHP Medicare Advantage |
$0.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.95
|
| Rate for Payer: Priority Health Medicare |
$0.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.36
|
| Rate for Payer: Railroad Medicare Medicare |
$0.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.98
|
| Rate for Payer: UHC Core |
$2.83
|
| Rate for Payer: UHC Exchange |
$0.85
|
| Rate for Payer: UHC Medicaid |
$0.60
|
| Rate for Payer: UHC Medicare Advantage |
$0.85
|
| Rate for Payer: UHCCP Medicaid |
$0.60
|
| Rate for Payer: VA VA |
$0.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
OP
|
$136.30
|
|
|
Service Code
|
NDC 55154254104
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.03 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna Medicare |
$35.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.59
|
| Rate for Payer: BCBS Complete |
$25.23
|
| Rate for Payer: BCBS MAPPO |
$34.08
|
| Rate for Payer: BCBS Trust/PPO |
$112.05
|
| Rate for Payer: BCN Commercial |
$112.05
|
| Rate for Payer: BCN Medicare Advantage |
$34.08
|
| 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: Health Alliance Plan Medicare Advantage |
$34.08
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Mclaren Medicaid |
$24.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.78
|
| Rate for Payer: Meridian Medicaid |
$25.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: Nomi Health Commercial |
$111.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.22
|
| Rate for Payer: PACE Senior Care Partners |
$32.37
|
| Rate for Payer: PACE SWMI |
$34.08
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: PHP Medicare Advantage |
$34.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$118.58
|
| Rate for Payer: Priority Health Medicare |
$34.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.86
|
| Rate for Payer: Railroad Medicare Medicare |
$34.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.94
|
| Rate for Payer: UHC Core |
$113.81
|
| Rate for Payer: UHC Exchange |
$34.08
|
| Rate for Payer: UHC Medicaid |
$24.03
|
| Rate for Payer: UHC Medicare Advantage |
$34.08
|
| Rate for Payer: UHCCP Medicaid |
$24.03
|
| Rate for Payer: VA VA |
$34.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$103.40
|
|
|
Service Code
|
NDC 57664037708
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.97 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: BCBS Trust/PPO |
$85.40
|
| Rate for Payer: BCN Commercial |
$85.40
|
| 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 Commercial |
$87.89
|
| Rate for Payer: Nomi Health Commercial |
$84.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.55
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$89.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.97
|
| 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
|
$3.39
|
|
|
Service Code
|
NDC 60687079511
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna Commercial |
$2.88
|
| Rate for Payer: BCBS Trust/PPO |
$2.80
|
| Rate for Payer: BCN Commercial |
$2.80
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.71
|
| Rate for Payer: Healthscope Commercial |
$3.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.88
|
| Rate for Payer: Nomi Health Commercial |
$2.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.54
|
| Rate for Payer: PHP Commercial |
$2.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.98
|
| Rate for Payer: UHC Core |
$2.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$277.30
|
|
|
Service Code
|
NDC 00904717961
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.00 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna Commercial |
$235.71
|
| Rate for Payer: BCBS Trust/PPO |
$229.02
|
| Rate for Payer: BCN Commercial |
$229.02
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Commercial |
$238.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$249.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.71
|
| Rate for Payer: Nomi Health Commercial |
$227.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.97
|
| Rate for Payer: PHP Commercial |
$235.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$241.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.02
|
| Rate for Payer: UHC Core |
$231.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.97
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
OP
|
$103.40
|
|
|
Service Code
|
NDC 57664037708
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.23 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna Medicare |
$26.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.31
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: BCBS MAPPO |
$25.85
|
| Rate for Payer: BCBS Trust/PPO |
$85.01
|
| Rate for Payer: BCN Commercial |
$85.01
|
| Rate for Payer: BCN Medicare Advantage |
$25.85
|
| 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: Health Alliance Plan Medicare Advantage |
$25.85
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.55
|
| Rate for Payer: Mclaren Medicaid |
$18.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.14
|
| Rate for Payer: Meridian Medicaid |
$19.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.89
|
| Rate for Payer: Nomi Health Commercial |
$84.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.55
|
| Rate for Payer: PACE Senior Care Partners |
$24.56
|
| Rate for Payer: PACE SWMI |
$25.85
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: PHP Medicare Advantage |
$25.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$89.96
|
| Rate for Payer: Priority Health Medicare |
$26.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.97
|
| Rate for Payer: Railroad Medicare Medicare |
$25.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.99
|
| Rate for Payer: UHC Core |
$86.34
|
| Rate for Payer: UHC Exchange |
$25.85
|
| Rate for Payer: UHC Medicaid |
$18.23
|
| Rate for Payer: UHC Medicare Advantage |
$25.85
|
| Rate for Payer: UHCCP Medicaid |
$18.23
|
| Rate for Payer: VA VA |
$25.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.55
|
|
|
TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK
|
Facility
|
OP
|
$25.81
|
|
|
Service Code
|
HCPCS J3291
|
| Hospital Charge Code |
191208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna Commercial |
$21.94
|
| Rate for Payer: Aetna Commercial |
$22.70
|
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: Aetna Medicare |
$6.94
|
| Rate for Payer: Aetna Medicare |
$6.71
|
| Rate for Payer: Aetna Medicare |
$6.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.34
|
| Rate for Payer: BCBS Complete |
$4.86
|
| Rate for Payer: BCBS Complete |
$4.78
|
| Rate for Payer: BCBS Complete |
$4.94
|
| Rate for Payer: BCBS MAPPO |
$6.67
|
| Rate for Payer: BCBS MAPPO |
$6.45
|
| Rate for Payer: BCBS MAPPO |
$6.57
|
| Rate for Payer: BCBS Trust/PPO |
$21.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.59
|
| Rate for Payer: BCBS Trust/PPO |
$21.95
|
| Rate for Payer: BCN Commercial |
$21.59
|
| Rate for Payer: BCN Commercial |
$21.95
|
| Rate for Payer: BCN Commercial |
$21.22
|
| Rate for Payer: BCN Medicare Advantage |
$6.67
|
| Rate for Payer: BCN Medicare Advantage |
$6.57
|
| Rate for Payer: BCN Medicare Advantage |
$6.45
|
| Rate for Payer: Cash Price |
$21.36
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Cofinity Commercial |
$22.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.45
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: Healthscope Commercial |
$23.23
|
| Rate for Payer: Healthscope Commercial |
$24.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.70
|
| Rate for Payer: Mclaren Medicaid |
$4.55
|
| Rate for Payer: Mclaren Medicaid |
$4.71
|
| Rate for Payer: Mclaren Medicaid |
$4.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.01
|
| Rate for Payer: Meridian Medicaid |
$4.94
|
| Rate for Payer: Meridian Medicaid |
$4.78
|
| Rate for Payer: Meridian Medicaid |
$4.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.32
|
| Rate for Payer: Nomi Health Commercial |
$21.89
|
| Rate for Payer: Nomi Health Commercial |
$21.53
|
| Rate for Payer: Nomi Health Commercial |
$21.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.36
|
| Rate for Payer: PACE Senior Care Partners |
$6.24
|
| Rate for Payer: PACE Senior Care Partners |
$6.13
|
| Rate for Payer: PACE Senior Care Partners |
$6.34
|
| Rate for Payer: PACE SWMI |
$6.67
|
| Rate for Payer: PACE SWMI |
$6.57
|
| Rate for Payer: PACE SWMI |
$6.45
|
| Rate for Payer: PHP Commercial |
$21.94
|
| Rate for Payer: PHP Commercial |
$22.70
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: PHP Medicare Advantage |
$6.57
|
| Rate for Payer: PHP Medicare Advantage |
$6.45
|
| Rate for Payer: PHP Medicare Advantage |
$6.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.23
|
| Rate for Payer: Priority Health Medicare |
$6.74
|
| Rate for Payer: Priority Health Medicare |
$6.63
|
| Rate for Payer: Priority Health Medicare |
$6.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.96
|
| Rate for Payer: Railroad Medicare Medicare |
$6.57
|
| Rate for Payer: Railroad Medicare Medicare |
$6.67
|
| Rate for Payer: Railroad Medicare Medicare |
$6.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.71
|
| Rate for Payer: UHC Core |
$21.55
|
| Rate for Payer: UHC Core |
$22.29
|
| Rate for Payer: UHC Core |
$21.93
|
| Rate for Payer: UHC Exchange |
$6.67
|
| Rate for Payer: UHC Exchange |
$6.57
|
| Rate for Payer: UHC Exchange |
$6.45
|
| Rate for Payer: UHC Medicaid |
$4.55
|
| Rate for Payer: UHC Medicaid |
$4.71
|
| Rate for Payer: UHC Medicaid |
$4.63
|
| Rate for Payer: UHC Medicare Advantage |
$6.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.45
|
| Rate for Payer: UHC Medicare Advantage |
$6.67
|
| Rate for Payer: UHCCP Medicaid |
$4.63
|
| Rate for Payer: UHCCP Medicaid |
$4.55
|
| Rate for Payer: UHCCP Medicaid |
$4.71
|
| Rate for Payer: VA VA |
$6.45
|
| Rate for Payer: VA VA |
$6.67
|
| Rate for Payer: VA VA |
$6.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.02
|
|
|
TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK
|
Facility
|
IP
|
$25.81
|
|
|
Service Code
|
HCPCS J3291
|
| Hospital Charge Code |
191208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna Commercial |
$21.94
|
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: Aetna Commercial |
$22.70
|
| Rate for Payer: BCBS Trust/PPO |
$21.69
|
| Rate for Payer: BCBS Trust/PPO |
$21.32
|
| Rate for Payer: BCBS Trust/PPO |
$22.05
|
| Rate for Payer: BCN Commercial |
$21.69
|
| Rate for Payer: BCN Commercial |
$21.32
|
| Rate for Payer: BCN Commercial |
$22.05
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cash Price |
$21.36
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cofinity Commercial |
$22.96
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.36
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: Healthscope Commercial |
$23.23
|
| Rate for Payer: Healthscope Commercial |
$24.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.70
|
| Rate for Payer: Nomi Health Commercial |
$21.16
|
| Rate for Payer: Nomi Health Commercial |
$21.53
|
| Rate for Payer: Nomi Health Commercial |
$21.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.02
|
| Rate for Payer: PHP Commercial |
$21.94
|
| Rate for Payer: PHP Commercial |
$22.70
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.71
|
| Rate for Payer: UHC Core |
$21.55
|
| Rate for Payer: UHC Core |
$22.29
|
| Rate for Payer: UHC Core |
$21.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.70
|
|
