|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.05
|
|
|
Service Code
|
NDC 72485010701
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.74 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: BCBS Trust/PPO |
$19.86
|
| Rate for Payer: BCN Commercial |
$19.86
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cofinity Commercial |
$20.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: Nomi Health Commercial |
$19.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.04
|
| Rate for Payer: PHP Commercial |
$20.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.16
|
| Rate for Payer: UHC Core |
$20.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.04
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.67
|
|
|
Service Code
|
NDC 25021041510
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.87 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Aetna Commercial |
$21.82
|
| Rate for Payer: BCBS Trust/PPO |
$21.20
|
| Rate for Payer: BCN Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Cofinity Commercial |
$22.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.54
|
| Rate for Payer: Healthscope Commercial |
$23.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.82
|
| Rate for Payer: Nomi Health Commercial |
$21.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.25
|
| Rate for Payer: PHP Commercial |
$21.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.59
|
| Rate for Payer: UHC Core |
$21.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.25
|
|
|
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 |
$2.80 |
| Max. Negotiated Rate |
$14.32 |
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Medicare |
$4.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.97
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$3.98
|
| Rate for Payer: BCBS Trust/PPO |
$13.08
|
| Rate for Payer: BCN Commercial |
$13.08
|
| Rate for Payer: BCN Medicare Advantage |
$3.98
|
| 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: Health Alliance Plan Medicare Advantage |
$3.98
|
| Rate for Payer: Healthscope Commercial |
$14.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.93
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.18
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.52
|
| Rate for Payer: Nomi Health Commercial |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.93
|
| Rate for Payer: PACE Senior Care Partners |
$3.78
|
| Rate for Payer: PACE SWMI |
$3.98
|
| Rate for Payer: PHP Commercial |
$13.52
|
| Rate for Payer: PHP Medicare Advantage |
$3.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.84
|
| Rate for Payer: Priority Health Medicare |
$4.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.07
|
| Rate for Payer: Railroad Medicare Medicare |
$3.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.00
|
| Rate for Payer: UHC Core |
$13.28
|
| Rate for Payer: UHC Exchange |
$3.98
|
| Rate for Payer: UHC Medicaid |
$2.80
|
| Rate for Payer: UHC Medicare Advantage |
$3.98
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$3.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.93
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27.38
|
|
|
Service Code
|
NDC 70860040041
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$24.64 |
| Rate for Payer: Aetna Commercial |
$23.27
|
| Rate for Payer: Aetna Medicare |
$7.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.56
|
| Rate for Payer: BCBS Complete |
$5.07
|
| Rate for Payer: BCBS MAPPO |
$6.84
|
| Rate for Payer: BCBS Trust/PPO |
$22.51
|
| Rate for Payer: BCN Commercial |
$22.51
|
| Rate for Payer: BCN Medicare Advantage |
$6.84
|
| 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: Health Alliance Plan Medicare Advantage |
$6.84
|
| Rate for Payer: Healthscope Commercial |
$24.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.54
|
| Rate for Payer: Mclaren Medicaid |
$4.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.19
|
| Rate for Payer: Meridian Medicaid |
$5.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.27
|
| Rate for Payer: Nomi Health Commercial |
$22.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.54
|
| Rate for Payer: PACE Senior Care Partners |
$6.50
|
| Rate for Payer: PACE SWMI |
$6.84
|
| Rate for Payer: PHP Commercial |
$23.27
|
| Rate for Payer: PHP Medicare Advantage |
$6.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.82
|
| Rate for Payer: Priority Health Medicare |
$6.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.06
|
| Rate for Payer: Railroad Medicare Medicare |
$6.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.09
|
| Rate for Payer: UHC Core |
$22.86
|
| Rate for Payer: UHC Exchange |
$6.84
|
| Rate for Payer: UHC Medicaid |
$4.83
|
| Rate for Payer: UHC Medicare Advantage |
$6.84
|
| Rate for Payer: UHCCP Medicaid |
$4.83
|
| Rate for Payer: VA VA |
$6.84
|
| 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
|
$28.97
|
|
|
Service Code
|
NDC 67457019710
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$26.07 |
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: BCBS Trust/PPO |
$23.93
|
| Rate for Payer: BCN Commercial |
$23.93
|
| 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 Commercial |
$24.62
|
| Rate for Payer: Nomi Health Commercial |
$23.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.73
|
| Rate for Payer: PHP Commercial |
$24.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.16
|
| 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
|
$17.99
|
|
|
Service Code
|
NDC 23155016631
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.52 |
| Max. Negotiated Rate |
$16.19 |
| Rate for Payer: Aetna Commercial |
$15.29
|
| Rate for Payer: BCBS Trust/PPO |
$14.86
|
| Rate for Payer: BCN Commercial |
$14.86
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Cofinity Commercial |
$15.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$16.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.29
|
| Rate for Payer: Nomi Health Commercial |
$14.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.49
|
| Rate for Payer: PHP Commercial |
$15.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.83
|
| Rate for Payer: UHC Core |
$15.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.49
|
|
|
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 |
$5.48 |
| Max. Negotiated Rate |
$27.96 |
| Rate for Payer: Aetna Commercial |
$26.41
|
| Rate for Payer: Aetna Medicare |
$8.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.71
|
| Rate for Payer: BCBS Complete |
$5.75
|
| Rate for Payer: BCBS MAPPO |
$7.77
|
| Rate for Payer: BCBS Trust/PPO |
$25.54
|
| Rate for Payer: BCN Commercial |
$25.54
|
| Rate for Payer: BCN Medicare Advantage |
$7.77
|
| 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: Health Alliance Plan Medicare Advantage |
$7.77
|
| Rate for Payer: Healthscope Commercial |
$27.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.30
|
| Rate for Payer: Mclaren Medicaid |
$5.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.16
|
| Rate for Payer: Meridian Medicaid |
$5.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.41
|
| Rate for Payer: Nomi Health Commercial |
$25.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.30
|
| Rate for Payer: PACE Senior Care Partners |
$7.38
|
| Rate for Payer: PACE SWMI |
$7.77
|
| Rate for Payer: PHP Commercial |
$26.41
|
| Rate for Payer: PHP Medicare Advantage |
$7.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.03
|
| Rate for Payer: Priority Health Medicare |
$7.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.62
|
| Rate for Payer: Railroad Medicare Medicare |
$7.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.34
|
| Rate for Payer: UHC Core |
$25.94
|
| Rate for Payer: UHC Exchange |
$7.77
|
| Rate for Payer: UHC Medicaid |
$5.48
|
| Rate for Payer: UHC Medicare Advantage |
$7.77
|
| Rate for Payer: UHCCP Medicaid |
$5.48
|
| Rate for Payer: VA VA |
$7.77
|
| 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
|
$31.07
|
|
|
Service Code
|
NDC 00517096010
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.62 |
| Max. Negotiated Rate |
$27.96 |
| Rate for Payer: Aetna Commercial |
$26.41
|
| Rate for Payer: BCBS Trust/PPO |
$25.66
|
| Rate for Payer: BCN Commercial |
$25.66
|
| 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 Commercial |
$26.41
|
| Rate for Payer: Nomi Health Commercial |
$25.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.30
|
| Rate for Payer: PHP Commercial |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.62
|
| 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
|
$24.05
|
|
|
Service Code
|
NDC 72485010710
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.74 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: BCBS Trust/PPO |
$19.86
|
| Rate for Payer: BCN Commercial |
$19.86
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cofinity Commercial |
$20.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: Nomi Health Commercial |
$19.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.04
|
| Rate for Payer: PHP Commercial |
$20.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.16
|
| Rate for Payer: UHC Core |
$20.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.04
|
|
|
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 |
$4.24 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: Aetna Medicare |
$6.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.52
|
| Rate for Payer: BCBS Complete |
$4.45
|
| Rate for Payer: BCBS MAPPO |
$6.01
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: BCN Medicare Advantage |
$6.01
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cofinity Commercial |
$20.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.01
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.04
|
| Rate for Payer: Mclaren Medicaid |
$4.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.31
|
| Rate for Payer: Meridian Medicaid |
$4.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: Nomi Health Commercial |
$19.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.04
|
| Rate for Payer: PACE Senior Care Partners |
$5.71
|
| Rate for Payer: PACE SWMI |
$6.01
|
| Rate for Payer: PHP Commercial |
$20.44
|
| Rate for Payer: PHP Medicare Advantage |
$6.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.92
|
| Rate for Payer: Priority Health Medicare |
$6.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.74
|
| Rate for Payer: Railroad Medicare Medicare |
$6.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.16
|
| Rate for Payer: UHC Core |
$20.08
|
| Rate for Payer: UHC Exchange |
$6.01
|
| Rate for Payer: UHC Medicaid |
$4.24
|
| Rate for Payer: UHC Medicare Advantage |
$6.01
|
| Rate for Payer: UHCCP Medicaid |
$4.24
|
| Rate for Payer: VA VA |
$6.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.04
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15.69
|
|
|
Service Code
|
NDC 81284061200
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$14.12 |
| Rate for Payer: Aetna Commercial |
$13.34
|
| Rate for Payer: Aetna Medicare |
$4.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.90
|
| Rate for Payer: BCBS Complete |
$2.90
|
| Rate for Payer: BCBS MAPPO |
$3.92
|
| Rate for Payer: BCBS Trust/PPO |
$12.90
|
| Rate for Payer: BCN Commercial |
$12.90
|
| Rate for Payer: BCN Medicare Advantage |
$3.92
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Cofinity Commercial |
$13.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.92
|
| Rate for Payer: Healthscope Commercial |
$14.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.77
|
| Rate for Payer: Mclaren Medicaid |
$2.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.12
|
| Rate for Payer: Meridian Medicaid |
$2.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.34
|
| Rate for Payer: Nomi Health Commercial |
$12.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.77
|
| Rate for Payer: PACE Senior Care Partners |
$3.73
|
| Rate for Payer: PACE SWMI |
$3.92
|
| Rate for Payer: PHP Commercial |
$13.34
|
| Rate for Payer: PHP Medicare Advantage |
$3.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.65
|
| Rate for Payer: Priority Health Medicare |
$3.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.92
|
| Rate for Payer: Railroad Medicare Medicare |
$3.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.81
|
| Rate for Payer: UHC Core |
$13.10
|
| Rate for Payer: UHC Exchange |
$3.92
|
| Rate for Payer: UHC Medicaid |
$2.77
|
| Rate for Payer: UHC Medicare Advantage |
$3.92
|
| Rate for Payer: UHCCP Medicaid |
$2.77
|
| Rate for Payer: VA VA |
$3.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.77
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17.99
|
|
|
Service Code
|
NDC 23155016631
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$16.19 |
| Rate for Payer: Aetna Commercial |
$15.29
|
| Rate for Payer: Aetna Medicare |
$4.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.62
|
| Rate for Payer: BCBS Complete |
$3.33
|
| Rate for Payer: BCBS MAPPO |
$4.50
|
| Rate for Payer: BCBS Trust/PPO |
$14.79
|
| Rate for Payer: BCN Commercial |
$14.79
|
| Rate for Payer: BCN Medicare Advantage |
$4.50
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Cofinity Commercial |
$15.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$16.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.49
|
| Rate for Payer: Mclaren Medicaid |
$3.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.72
|
| Rate for Payer: Meridian Medicaid |
$3.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.29
|
| Rate for Payer: Nomi Health Commercial |
$14.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.49
|
| Rate for Payer: PACE Senior Care Partners |
$4.27
|
| Rate for Payer: PACE SWMI |
$4.50
|
| Rate for Payer: PHP Commercial |
$15.29
|
| Rate for Payer: PHP Medicare Advantage |
$4.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.65
|
| Rate for Payer: Priority Health Medicare |
$4.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.52
|
| Rate for Payer: Railroad Medicare Medicare |
$4.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.83
|
| Rate for Payer: UHC Core |
$15.02
|
| Rate for Payer: UHC Exchange |
$4.50
|
| Rate for Payer: UHC Medicaid |
$3.17
|
| Rate for Payer: UHC Medicare Advantage |
$4.50
|
| Rate for Payer: UHCCP Medicaid |
$3.17
|
| Rate for Payer: VA VA |
$4.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.49
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.39
|
|
|
Service Code
|
NDC 61990061100
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$17.45 |
| Rate for Payer: Aetna Commercial |
$16.48
|
| Rate for Payer: Aetna Medicare |
$5.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.06
|
| Rate for Payer: BCBS Complete |
$3.59
|
| Rate for Payer: BCBS MAPPO |
$4.85
|
| Rate for Payer: BCBS Trust/PPO |
$15.94
|
| Rate for Payer: BCN Commercial |
$15.94
|
| Rate for Payer: BCN Medicare Advantage |
$4.85
|
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Cofinity Commercial |
$16.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.85
|
| Rate for Payer: Healthscope Commercial |
$17.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.54
|
| Rate for Payer: Mclaren Medicaid |
$3.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.09
|
| Rate for Payer: Meridian Medicaid |
$3.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.48
|
| Rate for Payer: Nomi Health Commercial |
$15.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.54
|
| Rate for Payer: PACE Senior Care Partners |
$4.61
|
| Rate for Payer: PACE SWMI |
$4.85
|
| Rate for Payer: PHP Commercial |
$16.48
|
| Rate for Payer: PHP Medicare Advantage |
$4.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.87
|
| Rate for Payer: Priority Health Medicare |
$4.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.50
|
| Rate for Payer: Railroad Medicare Medicare |
$4.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.06
|
| Rate for Payer: UHC Core |
$16.19
|
| Rate for Payer: UHC Exchange |
$4.85
|
| Rate for Payer: UHC Medicaid |
$3.42
|
| Rate for Payer: UHC Medicare Advantage |
$4.85
|
| Rate for Payer: UHCCP Medicaid |
$3.42
|
| Rate for Payer: VA VA |
$4.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.54
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17.99
|
|
|
Service Code
|
NDC 23155016641
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$16.19 |
| Rate for Payer: Aetna Commercial |
$15.29
|
| Rate for Payer: Aetna Medicare |
$4.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.62
|
| Rate for Payer: BCBS Complete |
$3.33
|
| Rate for Payer: BCBS MAPPO |
$4.50
|
| Rate for Payer: BCBS Trust/PPO |
$14.79
|
| Rate for Payer: BCN Commercial |
$14.79
|
| Rate for Payer: BCN Medicare Advantage |
$4.50
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Cofinity Commercial |
$15.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$16.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.49
|
| Rate for Payer: Mclaren Medicaid |
$3.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.72
|
| Rate for Payer: Meridian Medicaid |
$3.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.29
|
| Rate for Payer: Nomi Health Commercial |
$14.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.49
|
| Rate for Payer: PACE Senior Care Partners |
$4.27
|
| Rate for Payer: PACE SWMI |
$4.50
|
| Rate for Payer: PHP Commercial |
$15.29
|
| Rate for Payer: PHP Medicare Advantage |
$4.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.65
|
| Rate for Payer: Priority Health Medicare |
$4.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.52
|
| Rate for Payer: Railroad Medicare Medicare |
$4.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.83
|
| Rate for Payer: UHC Core |
$15.02
|
| Rate for Payer: UHC Exchange |
$4.50
|
| Rate for Payer: UHC Medicaid |
$3.17
|
| Rate for Payer: UHC Medicare Advantage |
$4.50
|
| Rate for Payer: UHCCP Medicaid |
$3.17
|
| Rate for Payer: VA VA |
$4.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.49
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.21
|
|
|
Service Code
|
NDC 43066000801
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Medicare |
$4.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.69
|
| Rate for Payer: BCBS Complete |
$3.37
|
| Rate for Payer: BCBS MAPPO |
$4.55
|
| Rate for Payer: BCBS Trust/PPO |
$14.97
|
| Rate for Payer: BCN Commercial |
$14.97
|
| Rate for Payer: BCN Medicare Advantage |
$4.55
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.55
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.66
|
| Rate for Payer: Mclaren Medicaid |
$3.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.78
|
| Rate for Payer: Meridian Medicaid |
$3.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.48
|
| Rate for Payer: Nomi Health Commercial |
$14.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.66
|
| Rate for Payer: PACE Senior Care Partners |
$4.32
|
| Rate for Payer: PACE SWMI |
$4.55
|
| Rate for Payer: PHP Commercial |
$15.48
|
| Rate for Payer: PHP Medicare Advantage |
$4.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.84
|
| Rate for Payer: Priority Health Medicare |
$4.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.67
|
| Rate for Payer: Railroad Medicare Medicare |
$4.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.02
|
| Rate for Payer: UHC Core |
$15.21
|
| Rate for Payer: UHC Exchange |
$4.55
|
| Rate for Payer: UHC Medicaid |
$3.21
|
| Rate for Payer: UHC Medicare Advantage |
$4.55
|
| Rate for Payer: UHCCP Medicaid |
$3.21
|
| Rate for Payer: VA VA |
$4.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.66
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.39
|
|
|
Service Code
|
NDC 61990061102
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$17.45 |
| Rate for Payer: Aetna Commercial |
$16.48
|
| Rate for Payer: Aetna Medicare |
$5.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.06
|
| Rate for Payer: BCBS Complete |
$3.59
|
| Rate for Payer: BCBS MAPPO |
$4.85
|
| Rate for Payer: BCBS Trust/PPO |
$15.94
|
| Rate for Payer: BCN Commercial |
$15.94
|
| Rate for Payer: BCN Medicare Advantage |
$4.85
|
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Cofinity Commercial |
$16.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.85
|
| Rate for Payer: Healthscope Commercial |
$17.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.54
|
| Rate for Payer: Mclaren Medicaid |
$3.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.09
|
| Rate for Payer: Meridian Medicaid |
$3.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.48
|
| Rate for Payer: Nomi Health Commercial |
$15.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.54
|
| Rate for Payer: PACE Senior Care Partners |
$4.61
|
| Rate for Payer: PACE SWMI |
$4.85
|
| Rate for Payer: PHP Commercial |
$16.48
|
| Rate for Payer: PHP Medicare Advantage |
$4.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.87
|
| Rate for Payer: Priority Health Medicare |
$4.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.50
|
| Rate for Payer: Railroad Medicare Medicare |
$4.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.06
|
| Rate for Payer: UHC Core |
$16.19
|
| Rate for Payer: UHC Exchange |
$4.85
|
| Rate for Payer: UHC Medicaid |
$3.42
|
| Rate for Payer: UHC Medicare Advantage |
$4.85
|
| Rate for Payer: UHCCP Medicaid |
$3.42
|
| Rate for Payer: VA VA |
$4.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.54
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27.38
|
|
|
Service Code
|
NDC 70860040010
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$24.64 |
| Rate for Payer: Aetna Commercial |
$23.27
|
| Rate for Payer: Aetna Medicare |
$7.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.56
|
| Rate for Payer: BCBS Complete |
$5.07
|
| Rate for Payer: BCBS MAPPO |
$6.84
|
| Rate for Payer: BCBS Trust/PPO |
$22.51
|
| Rate for Payer: BCN Commercial |
$22.51
|
| Rate for Payer: BCN Medicare Advantage |
$6.84
|
| 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: Health Alliance Plan Medicare Advantage |
$6.84
|
| Rate for Payer: Healthscope Commercial |
$24.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.54
|
| Rate for Payer: Mclaren Medicaid |
$4.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.19
|
| Rate for Payer: Meridian Medicaid |
$5.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.27
|
| Rate for Payer: Nomi Health Commercial |
$22.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.54
|
| Rate for Payer: PACE Senior Care Partners |
$6.50
|
| Rate for Payer: PACE SWMI |
$6.84
|
| Rate for Payer: PHP Commercial |
$23.27
|
| Rate for Payer: PHP Medicare Advantage |
$6.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.82
|
| Rate for Payer: Priority Health Medicare |
$6.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.06
|
| Rate for Payer: Railroad Medicare Medicare |
$6.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.09
|
| Rate for Payer: UHC Core |
$22.86
|
| Rate for Payer: UHC Exchange |
$6.84
|
| Rate for Payer: UHC Medicaid |
$4.83
|
| Rate for Payer: UHC Medicare Advantage |
$6.84
|
| Rate for Payer: UHCCP Medicaid |
$4.83
|
| Rate for Payer: VA VA |
$6.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.54
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) NEBULIZED SOLUTION CUSTOM
|
Facility
|
OP
|
$27.38
|
|
|
Service Code
|
NDC 70860040010
|
| Hospital Charge Code |
301846
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$24.64 |
| Rate for Payer: Aetna Commercial |
$23.27
|
| Rate for Payer: Aetna Medicare |
$7.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.56
|
| Rate for Payer: BCBS Complete |
$5.07
|
| Rate for Payer: BCBS MAPPO |
$6.84
|
| Rate for Payer: BCBS Trust/PPO |
$22.51
|
| Rate for Payer: BCN Commercial |
$22.51
|
| Rate for Payer: BCN Medicare Advantage |
$6.84
|
| 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: Health Alliance Plan Medicare Advantage |
$6.84
|
| Rate for Payer: Healthscope Commercial |
$24.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.54
|
| Rate for Payer: Mclaren Medicaid |
$4.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.19
|
| Rate for Payer: Meridian Medicaid |
$5.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.27
|
| Rate for Payer: Nomi Health Commercial |
$22.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.54
|
| Rate for Payer: PACE Senior Care Partners |
$6.50
|
| Rate for Payer: PACE SWMI |
$6.84
|
| Rate for Payer: PHP Commercial |
$23.27
|
| Rate for Payer: PHP Medicare Advantage |
$6.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.82
|
| Rate for Payer: Priority Health Medicare |
$6.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.06
|
| Rate for Payer: Railroad Medicare Medicare |
$6.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.09
|
| Rate for Payer: UHC Core |
$22.86
|
| Rate for Payer: UHC Exchange |
$6.84
|
| Rate for Payer: UHC Medicaid |
$4.83
|
| Rate for Payer: UHC Medicare Advantage |
$6.84
|
| Rate for Payer: UHCCP Medicaid |
$4.83
|
| Rate for Payer: VA VA |
$6.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.54
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) NEBULIZED SOLUTION CUSTOM
|
Facility
|
IP
|
$27.38
|
|
|
Service Code
|
NDC 70860040010
|
| Hospital Charge Code |
301846
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.06 |
| Max. Negotiated Rate |
$24.64 |
| Rate for Payer: Aetna Commercial |
$23.27
|
| Rate for Payer: BCBS Trust/PPO |
$22.61
|
| Rate for Payer: BCN Commercial |
$22.61
|
| 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 Commercial |
$23.27
|
| Rate for Payer: Nomi Health Commercial |
$22.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.54
|
| Rate for Payer: PHP Commercial |
$23.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.06
|
| 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) SOLUTION CUSTOM
|
Facility
|
OP
|
$17.99
|
|
|
Service Code
|
NDC 23155016641
|
| Hospital Charge Code |
300870
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$16.19 |
| Rate for Payer: Aetna Commercial |
$15.29
|
| Rate for Payer: Aetna Medicare |
$4.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.62
|
| Rate for Payer: BCBS Complete |
$3.33
|
| Rate for Payer: BCBS MAPPO |
$4.50
|
| Rate for Payer: BCBS Trust/PPO |
$14.79
|
| Rate for Payer: BCN Commercial |
$14.79
|
| Rate for Payer: BCN Medicare Advantage |
$4.50
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Cofinity Commercial |
$15.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$16.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.49
|
| Rate for Payer: Mclaren Medicaid |
$3.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.72
|
| Rate for Payer: Meridian Medicaid |
$3.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.29
|
| Rate for Payer: Nomi Health Commercial |
$14.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.49
|
| Rate for Payer: PACE Senior Care Partners |
$4.27
|
| Rate for Payer: PACE SWMI |
$4.50
|
| Rate for Payer: PHP Commercial |
$15.29
|
| Rate for Payer: PHP Medicare Advantage |
$4.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.65
|
| Rate for Payer: Priority Health Medicare |
$4.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.52
|
| Rate for Payer: Railroad Medicare Medicare |
$4.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.83
|
| Rate for Payer: UHC Core |
$15.02
|
| Rate for Payer: UHC Exchange |
$4.50
|
| Rate for Payer: UHC Medicaid |
$3.17
|
| Rate for Payer: UHC Medicare Advantage |
$4.50
|
| Rate for Payer: UHCCP Medicaid |
$3.17
|
| Rate for Payer: VA VA |
$4.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.49
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) SOLUTION CUSTOM
|
Facility
|
IP
|
$17.99
|
|
|
Service Code
|
NDC 23155016641
|
| Hospital Charge Code |
300870
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.52 |
| Max. Negotiated Rate |
$16.19 |
| Rate for Payer: Aetna Commercial |
$15.29
|
| Rate for Payer: BCBS Trust/PPO |
$14.86
|
| Rate for Payer: BCN Commercial |
$14.86
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Cofinity Commercial |
$15.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$16.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.29
|
| Rate for Payer: Nomi Health Commercial |
$14.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.49
|
| Rate for Payer: PHP Commercial |
$15.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.83
|
| Rate for Payer: UHC Core |
$15.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.49
|
|
|
TRANSIENT ISCHEMIA
|
Facility
|
IP
|
$4,727.30
|
|
|
Service Code
|
APR-DRG 0472
|
| Min. Negotiated Rate |
$4,502.19 |
| Max. Negotiated Rate |
$4,727.30 |
| Rate for Payer: BCBS Complete |
$4,727.30
|
| Rate for Payer: Mclaren Medicaid |
$4,502.19
|
| Rate for Payer: Meridian Medicaid |
$4,727.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,502.19
|
| Rate for Payer: UHC Medicaid |
$4,502.19
|
| Rate for Payer: UHCCP Medicaid |
$4,502.19
|
|
|
TRANSIENT ISCHEMIA
|
Facility
|
IP
|
$9,464.59
|
|
|
Service Code
|
APR-DRG 0474
|
| Min. Negotiated Rate |
$9,013.90 |
| Max. Negotiated Rate |
$9,464.59 |
| Rate for Payer: BCBS Complete |
$9,464.59
|
| Rate for Payer: Mclaren Medicaid |
$9,013.90
|
| Rate for Payer: Meridian Medicaid |
$9,464.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,013.90
|
| Rate for Payer: UHC Medicaid |
$9,013.90
|
| Rate for Payer: UHCCP Medicaid |
$9,013.90
|
|
|
TRANSIENT ISCHEMIA
|
Facility
|
IP
|
$6,057.68
|
|
|
Service Code
|
APR-DRG 0473
|
| Min. Negotiated Rate |
$5,769.22 |
| Max. Negotiated Rate |
$6,057.68 |
| Rate for Payer: BCBS Complete |
$6,057.68
|
| Rate for Payer: Mclaren Medicaid |
$5,769.22
|
| Rate for Payer: Meridian Medicaid |
$6,057.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,769.22
|
| Rate for Payer: UHC Medicaid |
$5,769.22
|
| Rate for Payer: UHCCP Medicaid |
$5,769.22
|
|
|
TRANSIENT ISCHEMIA
|
Facility
|
IP
|
$3,905.94
|
|
|
Service Code
|
APR-DRG 0471
|
| Min. Negotiated Rate |
$3,719.94 |
| Max. Negotiated Rate |
$3,905.94 |
| Rate for Payer: BCBS Complete |
$3,905.94
|
| Rate for Payer: Mclaren Medicaid |
$3,719.94
|
| Rate for Payer: Meridian Medicaid |
$3,905.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,719.94
|
| Rate for Payer: UHC Medicaid |
$3,719.94
|
| Rate for Payer: UHCCP Medicaid |
$3,719.94
|
|
