|
TRAMADOL 50 MG TABLET
|
Facility
|
OP
|
$136.30
|
|
|
Service Code
|
NDC 55154254104
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.37 |
| 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 |
$54.52
|
| Rate for Payer: BCBS MAPPO |
$34.08
|
| Rate for Payer: BCBS Trust/PPO |
$112.05
|
| Rate for Payer: BCN Commercial |
$105.97
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: Nomi Health Commercial |
$111.77
|
| 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 Cigna Priority Health |
$88.60
|
| Rate for Payer: Priority Health HMO/PPO |
$118.58
|
| Rate for Payer: Priority Health Medicare |
$34.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.32
|
| 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 Dual Complete DSNP |
$34.08
|
| Rate for Payer: UHC Exchange |
$34.08
|
| Rate for Payer: UHC Medicare Advantage |
$34.08
|
| Rate for Payer: VA VA |
$34.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$2.85
|
|
|
Service Code
|
NDC 68084080811
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| 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 Commercial |
$2.42
|
| Rate for Payer: Nomi Health Commercial |
$2.34
|
| Rate for Payer: PHP Commercial |
$2.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.85
|
| Rate for Payer: Priority Health HMO/PPO |
$2.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.91
|
| 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
|
$284.35
|
|
|
Service Code
|
NDC 68084080801
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.53 |
| Max. Negotiated Rate |
$255.92 |
| 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 |
$113.74
|
| Rate for Payer: BCBS MAPPO |
$71.09
|
| Rate for Payer: BCBS Trust/PPO |
$233.76
|
| Rate for Payer: BCN Commercial |
$221.08
|
| 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 |
$255.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| 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 Cigna Priority Health |
$184.83
|
| Rate for Payer: Priority Health HMO/PPO |
$247.38
|
| Rate for Payer: Priority Health Medicare |
$71.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.51
|
| 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 Dual Complete DSNP |
$71.09
|
| Rate for Payer: UHC Exchange |
$71.09
|
| Rate for Payer: UHC Medicare Advantage |
$71.09
|
| Rate for Payer: VA VA |
$71.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.26
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$277.30
|
|
|
Service Code
|
NDC 00904717961
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.24 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna Commercial |
$235.70
|
| Rate for Payer: BCBS Trust/PPO |
$226.36
|
| Rate for Payer: BCN Commercial |
$214.30
|
| 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 |
$207.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.70
|
| Rate for Payer: Nomi Health Commercial |
$227.39
|
| Rate for Payer: PHP Commercial |
$235.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.24
|
| Rate for Payer: Priority Health HMO/PPO |
$241.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$185.79
|
| 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 |
$207.98
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
OP
|
$1.37
|
|
|
Service Code
|
NDC 55154254107
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.33 |
| 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 |
$0.55
|
| Rate for Payer: BCBS MAPPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$1.13
|
| Rate for Payer: BCN Commercial |
$1.07
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.16
|
| Rate for Payer: Nomi Health Commercial |
$1.12
|
| 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 Cigna Priority Health |
$0.89
|
| Rate for Payer: Priority Health HMO/PPO |
$1.19
|
| Rate for Payer: Priority Health Medicare |
$0.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.92
|
| 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 Dual Complete DSNP |
$0.34
|
| Rate for Payer: UHC Exchange |
$0.34
|
| Rate for Payer: UHC Medicare Advantage |
$0.34
|
| 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 |
$0.89 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna Commercial |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$1.12
|
| 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 Commercial |
$1.16
|
| Rate for Payer: Nomi Health Commercial |
$1.12
|
| Rate for Payer: PHP Commercial |
$1.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.89
|
| Rate for Payer: Priority Health HMO/PPO |
$1.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.92
|
| 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
|
$1.02
|
|
|
Service Code
|
NDC 51079099101
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.24 |
| 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 |
$0.41
|
| Rate for Payer: BCBS MAPPO |
$0.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.84
|
| Rate for Payer: BCN Commercial |
$0.79
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.87
|
| Rate for Payer: Nomi Health Commercial |
$0.84
|
| 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 Cigna Priority Health |
$0.66
|
| Rate for Payer: Priority Health HMO/PPO |
$0.89
|
| Rate for Payer: Priority Health Medicare |
$0.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.68
|
| 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 Dual Complete DSNP |
$0.26
|
| Rate for Payer: UHC Exchange |
$0.26
|
| Rate for Payer: UHC Medicare Advantage |
$0.26
|
| Rate for Payer: VA VA |
$0.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.77
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$103.40
|
|
|
Service Code
|
NDC 57664037708
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.21 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: BCBS Trust/PPO |
$84.41
|
| 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 Commercial |
$87.89
|
| Rate for Payer: Nomi Health Commercial |
$84.79
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.21
|
| Rate for Payer: Priority Health HMO/PPO |
$89.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.28
|
| 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
|
$1.02
|
|
|
Service Code
|
NDC 51079099101
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.87
|
| Rate for Payer: BCBS Trust/PPO |
$0.83
|
| 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 Commercial |
$0.87
|
| Rate for Payer: Nomi Health Commercial |
$0.84
|
| Rate for Payer: PHP Commercial |
$0.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.66
|
| Rate for Payer: Priority Health HMO/PPO |
$0.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.68
|
| 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
|
$284.35
|
|
|
Service Code
|
NDC 68084080801
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.83 |
| Max. Negotiated Rate |
$255.92 |
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: BCBS Trust/PPO |
$232.11
|
| 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 Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.83
|
| Rate for Payer: Priority Health HMO/PPO |
$247.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.51
|
| 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
|
|
|
TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK
|
Facility
|
OP
|
$26.70
|
|
|
Service Code
|
NDC 80830232901
|
| Hospital Charge Code |
191208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$24.03 |
| Rate for Payer: Aetna Commercial |
$22.70
|
| Rate for Payer: Aetna Medicare |
$6.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.34
|
| Rate for Payer: BCBS Complete |
$10.68
|
| Rate for Payer: BCBS MAPPO |
$6.68
|
| Rate for Payer: BCBS Trust/PPO |
$21.95
|
| Rate for Payer: BCN Commercial |
$20.76
|
| Rate for Payer: BCN Medicare Advantage |
$6.68
|
| Rate for Payer: Cash Price |
$21.36
|
| Rate for Payer: Cofinity Commercial |
$22.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$24.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.70
|
| Rate for Payer: Nomi Health Commercial |
$21.89
|
| Rate for Payer: PACE Senior Care Partners |
$6.34
|
| Rate for Payer: PACE SWMI |
$6.68
|
| Rate for Payer: PHP Commercial |
$22.70
|
| Rate for Payer: PHP Medicare Advantage |
$6.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.36
|
| Rate for Payer: Priority Health HMO/PPO |
$23.23
|
| Rate for Payer: Priority Health Medicare |
$6.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.89
|
| Rate for Payer: Railroad Medicare Medicare |
$6.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.50
|
| Rate for Payer: UHC Core |
$22.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.68
|
| Rate for Payer: UHC Exchange |
$6.68
|
| Rate for Payer: UHC Medicare Advantage |
$6.68
|
| Rate for Payer: VA VA |
$6.68
|
| 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
|
$26.70
|
|
|
Service Code
|
NDC 80830232901
|
| Hospital Charge Code |
191208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.36 |
| Max. Negotiated Rate |
$24.03 |
| Rate for Payer: Aetna Commercial |
$22.70
|
| Rate for Payer: BCBS Trust/PPO |
$21.80
|
| Rate for Payer: BCN Commercial |
$20.63
|
| Rate for Payer: Cash Price |
$21.36
|
| Rate for Payer: Cofinity Commercial |
$22.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.36
|
| Rate for Payer: Healthscope Commercial |
$24.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.70
|
| Rate for Payer: Nomi Health Commercial |
$21.89
|
| Rate for Payer: PHP Commercial |
$22.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.36
|
| Rate for Payer: Priority Health HMO/PPO |
$23.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.50
|
| Rate for Payer: UHC Core |
$22.29
|
| 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
|
$26.70
|
|
|
Service Code
|
NDC 80830232902
|
| Hospital Charge Code |
191208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.36 |
| Max. Negotiated Rate |
$24.03 |
| Rate for Payer: Aetna Commercial |
$22.70
|
| Rate for Payer: BCBS Trust/PPO |
$21.80
|
| Rate for Payer: BCN Commercial |
$20.63
|
| Rate for Payer: Cash Price |
$21.36
|
| Rate for Payer: Cofinity Commercial |
$22.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.36
|
| Rate for Payer: Healthscope Commercial |
$24.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.70
|
| Rate for Payer: Nomi Health Commercial |
$21.89
|
| Rate for Payer: PHP Commercial |
$22.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.36
|
| Rate for Payer: Priority Health HMO/PPO |
$23.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.50
|
| Rate for Payer: UHC Core |
$22.29
|
| 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
|
OP
|
$32.49
|
|
|
Service Code
|
NDC 51754010803
|
| Hospital Charge Code |
191208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$29.24 |
| Rate for Payer: Aetna Commercial |
$27.62
|
| Rate for Payer: Aetna Medicare |
$8.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.15
|
| Rate for Payer: BCBS Complete |
$13.00
|
| Rate for Payer: BCBS MAPPO |
$8.12
|
| Rate for Payer: BCBS Trust/PPO |
$26.71
|
| Rate for Payer: BCN Commercial |
$25.26
|
| Rate for Payer: BCN Medicare Advantage |
$8.12
|
| Rate for Payer: Cash Price |
$25.99
|
| Rate for Payer: Cofinity Commercial |
$27.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.12
|
| Rate for Payer: Healthscope Commercial |
$29.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.62
|
| Rate for Payer: Nomi Health Commercial |
$26.64
|
| Rate for Payer: PACE Senior Care Partners |
$7.72
|
| Rate for Payer: PACE SWMI |
$8.12
|
| Rate for Payer: PHP Commercial |
$27.62
|
| Rate for Payer: PHP Medicare Advantage |
$8.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.12
|
| Rate for Payer: Priority Health HMO/PPO |
$28.27
|
| Rate for Payer: Priority Health Medicare |
$8.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.77
|
| Rate for Payer: Railroad Medicare Medicare |
$8.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.59
|
| Rate for Payer: UHC Core |
$27.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.12
|
| Rate for Payer: UHC Exchange |
$8.12
|
| Rate for Payer: UHC Medicare Advantage |
$8.12
|
| Rate for Payer: VA VA |
$8.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.37
|
|
|
TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK
|
Facility
|
OP
|
$26.70
|
|
|
Service Code
|
NDC 80830232902
|
| Hospital Charge Code |
191208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$24.03 |
| Rate for Payer: Aetna Commercial |
$22.70
|
| Rate for Payer: Aetna Medicare |
$6.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.34
|
| Rate for Payer: BCBS Complete |
$10.68
|
| Rate for Payer: BCBS MAPPO |
$6.68
|
| Rate for Payer: BCBS Trust/PPO |
$21.95
|
| Rate for Payer: BCN Commercial |
$20.76
|
| Rate for Payer: BCN Medicare Advantage |
$6.68
|
| Rate for Payer: Cash Price |
$21.36
|
| Rate for Payer: Cofinity Commercial |
$22.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$24.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.70
|
| Rate for Payer: Nomi Health Commercial |
$21.89
|
| Rate for Payer: PACE Senior Care Partners |
$6.34
|
| Rate for Payer: PACE SWMI |
$6.68
|
| Rate for Payer: PHP Commercial |
$22.70
|
| Rate for Payer: PHP Medicare Advantage |
$6.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.36
|
| Rate for Payer: Priority Health HMO/PPO |
$23.23
|
| Rate for Payer: Priority Health Medicare |
$6.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.89
|
| Rate for Payer: Railroad Medicare Medicare |
$6.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.50
|
| Rate for Payer: UHC Core |
$22.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.68
|
| Rate for Payer: UHC Exchange |
$6.68
|
| Rate for Payer: UHC Medicare Advantage |
$6.68
|
| Rate for Payer: VA VA |
$6.68
|
| 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
|
OP
|
$32.49
|
|
|
Service Code
|
NDC 51754010801
|
| Hospital Charge Code |
191208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$29.24 |
| Rate for Payer: Aetna Commercial |
$27.62
|
| Rate for Payer: Aetna Medicare |
$8.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.15
|
| Rate for Payer: BCBS Complete |
$13.00
|
| Rate for Payer: BCBS MAPPO |
$8.12
|
| Rate for Payer: BCBS Trust/PPO |
$26.71
|
| Rate for Payer: BCN Commercial |
$25.26
|
| Rate for Payer: BCN Medicare Advantage |
$8.12
|
| Rate for Payer: Cash Price |
$25.99
|
| Rate for Payer: Cofinity Commercial |
$27.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.12
|
| Rate for Payer: Healthscope Commercial |
$29.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.62
|
| Rate for Payer: Nomi Health Commercial |
$26.64
|
| Rate for Payer: PACE Senior Care Partners |
$7.72
|
| Rate for Payer: PACE SWMI |
$8.12
|
| Rate for Payer: PHP Commercial |
$27.62
|
| Rate for Payer: PHP Medicare Advantage |
$8.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.12
|
| Rate for Payer: Priority Health HMO/PPO |
$28.27
|
| Rate for Payer: Priority Health Medicare |
$8.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.77
|
| Rate for Payer: Railroad Medicare Medicare |
$8.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.59
|
| Rate for Payer: UHC Core |
$27.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.12
|
| Rate for Payer: UHC Exchange |
$8.12
|
| Rate for Payer: UHC Medicare Advantage |
$8.12
|
| Rate for Payer: VA VA |
$8.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.37
|
|
|
TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK
|
Facility
|
IP
|
$32.49
|
|
|
Service Code
|
NDC 51754010803
|
| Hospital Charge Code |
191208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$29.24 |
| Rate for Payer: Aetna Commercial |
$27.62
|
| Rate for Payer: BCBS Trust/PPO |
$26.52
|
| Rate for Payer: BCN Commercial |
$25.11
|
| Rate for Payer: Cash Price |
$25.99
|
| Rate for Payer: Cofinity Commercial |
$27.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.99
|
| Rate for Payer: Healthscope Commercial |
$29.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.62
|
| Rate for Payer: Nomi Health Commercial |
$26.64
|
| Rate for Payer: PHP Commercial |
$27.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.12
|
| Rate for Payer: Priority Health HMO/PPO |
$28.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.59
|
| Rate for Payer: UHC Core |
$27.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.37
|
|
|
TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK
|
Facility
|
IP
|
$32.49
|
|
|
Service Code
|
NDC 51754010801
|
| Hospital Charge Code |
191208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$29.24 |
| Rate for Payer: Aetna Commercial |
$27.62
|
| Rate for Payer: BCBS Trust/PPO |
$26.52
|
| Rate for Payer: BCN Commercial |
$25.11
|
| Rate for Payer: Cash Price |
$25.99
|
| Rate for Payer: Cofinity Commercial |
$27.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.99
|
| Rate for Payer: Healthscope Commercial |
$29.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.62
|
| Rate for Payer: Nomi Health Commercial |
$26.64
|
| Rate for Payer: PHP Commercial |
$27.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.12
|
| Rate for Payer: Priority Health HMO/PPO |
$28.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.59
|
| Rate for Payer: UHC Core |
$27.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.37
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.88
|
|
|
Service Code
|
NDC 23155016631
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$15.19 |
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: BCBS Trust/PPO |
$13.78
|
| Rate for Payer: BCN Commercial |
$13.04
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cofinity Commercial |
$14.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Healthscope Commercial |
$15.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.35
|
| Rate for Payer: Nomi Health Commercial |
$13.84
|
| Rate for Payer: PHP Commercial |
$14.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.97
|
| Rate for Payer: Priority Health HMO/PPO |
$14.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.85
|
| Rate for Payer: UHC Core |
$14.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.66
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.88
|
|
|
Service Code
|
NDC 23155016631
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$15.19 |
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Aetna Medicare |
$4.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.28
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: BCBS MAPPO |
$4.22
|
| Rate for Payer: BCBS Trust/PPO |
$13.88
|
| Rate for Payer: BCN Commercial |
$13.12
|
| Rate for Payer: BCN Medicare Advantage |
$4.22
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cofinity Commercial |
$14.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.22
|
| Rate for Payer: Healthscope Commercial |
$15.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.35
|
| Rate for Payer: Nomi Health Commercial |
$13.84
|
| Rate for Payer: PACE Senior Care Partners |
$4.01
|
| Rate for Payer: PACE SWMI |
$4.22
|
| Rate for Payer: PHP Commercial |
$14.35
|
| Rate for Payer: PHP Medicare Advantage |
$4.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.97
|
| Rate for Payer: Priority Health HMO/PPO |
$14.69
|
| Rate for Payer: Priority Health Medicare |
$4.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.31
|
| Rate for Payer: Railroad Medicare Medicare |
$4.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.85
|
| Rate for Payer: UHC Core |
$14.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.22
|
| Rate for Payer: UHC Exchange |
$4.22
|
| Rate for Payer: UHC Medicare Advantage |
$4.22
|
| Rate for Payer: VA VA |
$4.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.66
|
|
|
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 |
$7.38 |
| 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 |
$12.43
|
| Rate for Payer: BCBS MAPPO |
$7.77
|
| Rate for Payer: BCBS Trust/PPO |
$25.54
|
| Rate for Payer: BCN Commercial |
$24.16
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.41
|
| Rate for Payer: Nomi Health Commercial |
$25.48
|
| 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 Cigna Priority Health |
$20.20
|
| Rate for Payer: Priority Health HMO/PPO |
$27.03
|
| Rate for Payer: Priority Health Medicare |
$7.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.82
|
| 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 Dual Complete DSNP |
$7.77
|
| Rate for Payer: UHC Exchange |
$7.77
|
| Rate for Payer: UHC Medicare Advantage |
$7.77
|
| 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
|
$28.97
|
|
|
Service Code
|
NDC 67457019700
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.83 |
| Max. Negotiated Rate |
$26.07 |
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: BCBS Trust/PPO |
$23.65
|
| 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 Commercial |
$24.62
|
| Rate for Payer: Nomi Health Commercial |
$23.76
|
| Rate for Payer: PHP Commercial |
$24.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.83
|
| Rate for Payer: Priority Health HMO/PPO |
$25.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.41
|
| 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
|
$22.20
|
|
|
Service Code
|
NDC 43066000810
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: BCBS Trust/PPO |
$18.12
|
| 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 Commercial |
$18.87
|
| Rate for Payer: Nomi Health Commercial |
$18.20
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.43
|
| Rate for Payer: Priority Health HMO/PPO |
$19.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.87
|
| 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
|
OP
|
$27.38
|
|
|
Service Code
|
NDC 70860040041
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.50 |
| 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 |
$10.95
|
| Rate for Payer: BCBS MAPPO |
$6.84
|
| Rate for Payer: BCBS Trust/PPO |
$22.51
|
| Rate for Payer: BCN Commercial |
$21.29
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.27
|
| Rate for Payer: Nomi Health Commercial |
$22.45
|
| 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 Cigna Priority Health |
$17.80
|
| Rate for Payer: Priority Health HMO/PPO |
$23.82
|
| Rate for Payer: Priority Health Medicare |
$6.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.34
|
| 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 Dual Complete DSNP |
$6.84
|
| Rate for Payer: UHC Exchange |
$6.84
|
| Rate for Payer: UHC Medicare Advantage |
$6.84
|
| 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
|
OP
|
$19.39
|
|
|
Service Code
|
NDC 61990061100
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.61 |
| 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 |
$7.76
|
| Rate for Payer: BCBS MAPPO |
$4.85
|
| Rate for Payer: BCBS Trust/PPO |
$15.94
|
| Rate for Payer: BCN Commercial |
$15.08
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.48
|
| Rate for Payer: Nomi Health Commercial |
$15.90
|
| 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 Cigna Priority Health |
$12.60
|
| Rate for Payer: Priority Health HMO/PPO |
$16.87
|
| Rate for Payer: Priority Health Medicare |
$4.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.99
|
| 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 Dual Complete DSNP |
$4.85
|
| Rate for Payer: UHC Exchange |
$4.85
|
| Rate for Payer: UHC Medicare Advantage |
$4.85
|
| Rate for Payer: VA VA |
$4.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.54
|
|
