|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC
|
Facility
|
IP
|
$103,976.26
|
|
|
Service Code
|
MS-DRG 011
|
| Min. Negotiated Rate |
$38,234.63 |
| Max. Negotiated Rate |
$103,976.26 |
| Rate for Payer: Aetna Medicare |
$41,856.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50,308.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50,308.72
|
| Rate for Payer: BCBS MAPPO |
$40,246.98
|
| Rate for Payer: BCBS Trust/PPO |
$103,976.26
|
| Rate for Payer: BCN Medicare Advantage |
$40,246.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40,246.98
|
| Rate for Payer: Mclaren Medicare |
$40,246.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42,259.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46,284.03
|
| Rate for Payer: PACE Medicare |
$38,234.63
|
| Rate for Payer: PACE SWMI |
$40,246.98
|
| Rate for Payer: PHP Medicare Advantage |
$40,246.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73,992.49
|
| Rate for Payer: Priority Health Medicare |
$40,246.98
|
| Rate for Payer: Priority Health Narrow Network |
$59,193.99
|
| Rate for Payer: Railroad Medicare Medicare |
$40,246.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78,654.20
|
| Rate for Payer: UHC Core |
$64,495.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$40,246.98
|
| Rate for Payer: UHC Exchange |
$51,274.25
|
| Rate for Payer: UHC Medicare Advantage |
$41,454.39
|
| Rate for Payer: VA VA |
$40,246.98
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$72,786.15
|
|
|
Service Code
|
MS-DRG 013
|
| Min. Negotiated Rate |
$20,148.01 |
| Max. Negotiated Rate |
$72,786.15 |
| Rate for Payer: Aetna Medicare |
$22,056.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,510.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,510.54
|
| Rate for Payer: BCBS MAPPO |
$21,208.43
|
| Rate for Payer: BCBS Trust/PPO |
$72,786.15
|
| Rate for Payer: BCN Medicare Advantage |
$21,208.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,208.43
|
| Rate for Payer: Mclaren Medicare |
$21,208.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22,268.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,389.69
|
| Rate for Payer: PACE Medicare |
$20,148.01
|
| Rate for Payer: PACE SWMI |
$21,208.43
|
| Rate for Payer: PHP Medicare Advantage |
$21,208.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38,539.58
|
| Rate for Payer: Priority Health Medicare |
$21,208.43
|
| Rate for Payer: Priority Health Narrow Network |
$30,831.66
|
| Rate for Payer: Railroad Medicare Medicare |
$21,208.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40,967.67
|
| Rate for Payer: UHC Core |
$33,592.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$21,208.43
|
| Rate for Payer: UHC Exchange |
$26,706.60
|
| Rate for Payer: UHC Medicare Advantage |
$21,844.68
|
| Rate for Payer: VA VA |
$21,208.43
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES
|
Facility
|
IP
|
$228,030.60
|
|
|
Service Code
|
MS-DRG 004
|
| Min. Negotiated Rate |
$108,101.51 |
| Max. Negotiated Rate |
$228,030.60 |
| Rate for Payer: Aetna Medicare |
$118,342.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142,238.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142,238.82
|
| Rate for Payer: BCBS MAPPO |
$113,791.06
|
| Rate for Payer: BCBS Trust/PPO |
$228,030.60
|
| Rate for Payer: BCN Medicare Advantage |
$113,791.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113,791.06
|
| Rate for Payer: Mclaren Medicare |
$113,791.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119,480.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130,859.72
|
| Rate for Payer: PACE Medicare |
$108,101.51
|
| Rate for Payer: PACE SWMI |
$113,791.06
|
| Rate for Payer: PHP Medicare Advantage |
$113,791.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210,943.82
|
| Rate for Payer: Priority Health Medicare |
$113,791.06
|
| Rate for Payer: Priority Health Narrow Network |
$168,755.06
|
| Rate for Payer: Railroad Medicare Medicare |
$113,791.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224,233.80
|
| Rate for Payer: UHC Core |
$183,867.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$113,791.06
|
| Rate for Payer: UHC Exchange |
$146,176.80
|
| Rate for Payer: UHC Medicare Advantage |
$117,204.79
|
| Rate for Payer: VA VA |
$113,791.06
|
|
|
TRACHEOTOMY TUBE CHANGE PRIOR TO ESTABLISHMENT OF FISTULA TRACT
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 31502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$225.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$271.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$271.40
|
| Rate for Payer: BCBS Complete |
$124.71
|
| Rate for Payer: BCBS MAPPO |
$217.12
|
| Rate for Payer: BCBS Trust/PPO |
$142.11
|
| Rate for Payer: BCN Medicare Advantage |
$217.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.12
|
| Rate for Payer: Mclaren Medicaid |
$118.76
|
| Rate for Payer: Mclaren Medicare |
$217.12
|
| Rate for Payer: Meridian Medicaid |
$124.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$227.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.69
|
| Rate for Payer: PACE Medicare |
$206.26
|
| Rate for Payer: PACE SWMI |
$217.12
|
| Rate for Payer: PHP Medicare Advantage |
$217.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$683.51
|
| Rate for Payer: Priority Health Medicare |
$217.12
|
| Rate for Payer: Priority Health Narrow Network |
$546.81
|
| Rate for Payer: Railroad Medicare Medicare |
$217.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.46
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.12
|
| Rate for Payer: UHC Exchange |
$34.05
|
| Rate for Payer: UHC Medicare Advantage |
$223.63
|
| Rate for Payer: VA VA |
$217.12
|
|
|
TRAMADOL 25 MG CUSTOM TAB
|
Facility
|
IP
|
$1.39
|
|
|
Service Code
|
NDC 9900-0003-13
|
| Hospital Charge Code |
155124
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Aetna American Axle |
$0.90
|
| Rate for Payer: Aetna Commercial |
$1.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.90
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cofinity Commercial |
$0.97
|
| Rate for Payer: Cofinity Commercial |
$1.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.11
|
| Rate for Payer: Healthscope Commercial |
$1.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.18
|
| Rate for Payer: PHP Commercial |
$1.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.97
|
| Rate for Payer: Priority Health SBD |
$0.88
|
| Rate for Payer: UMR Bronson Commercial |
$0.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.04
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$284.35
|
|
|
Service Code
|
NDC 68084-808-01
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.11 |
| Max. Negotiated Rate |
$255.92 |
| Rate for Payer: Aetna American Axle |
$184.83
|
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.83
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$199.04
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$199.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$241.70
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.04
|
| Rate for Payer: Priority Health SBD |
$179.14
|
| Rate for Payer: UMR Bronson Commercial |
$125.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.26
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$101.05
|
|
|
Service Code
|
NDC 51079-991-20
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.46 |
| Max. Negotiated Rate |
$90.94 |
| Rate for Payer: Aetna American Axle |
$65.68
|
| Rate for Payer: Aetna Commercial |
$85.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.68
|
| Rate for Payer: Cash Price |
$80.84
|
| Rate for Payer: Cofinity Commercial |
$70.74
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$70.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.89
|
| Rate for Payer: PHP Commercial |
$85.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.74
|
| Rate for Payer: Priority Health SBD |
$63.66
|
| Rate for Payer: UMR Bronson Commercial |
$44.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.79
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$270.25
|
|
|
Service Code
|
NDC 0904-7179-61
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.91 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna American Axle |
$175.66
|
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.66
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$189.18
|
| Rate for Payer: Cofinity Commercial |
$232.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Healthscope Commercial |
$243.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.71
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.18
|
| Rate for Payer: Priority Health SBD |
$170.26
|
| Rate for Payer: UMR Bronson Commercial |
$118.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.69
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$237.35
|
|
|
Service Code
|
NDC 65162-627-10
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.43 |
| Max. Negotiated Rate |
$213.62 |
| Rate for Payer: Aetna American Axle |
$154.28
|
| Rate for Payer: Aetna Commercial |
$201.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.28
|
| Rate for Payer: Cash Price |
$189.88
|
| Rate for Payer: Cofinity Commercial |
$166.14
|
| Rate for Payer: Cofinity Commercial |
$204.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.88
|
| Rate for Payer: Healthscope Commercial |
$213.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.75
|
| Rate for Payer: PHP Commercial |
$201.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.14
|
| Rate for Payer: Priority Health SBD |
$149.53
|
| Rate for Payer: UMR Bronson Commercial |
$104.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.01
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$136.30
|
|
|
Service Code
|
NDC 55154-2541-4
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.97 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna American Axle |
$88.60
|
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.60
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Cofinity Commercial |
$95.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.86
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.41
|
| Rate for Payer: Priority Health SBD |
$85.87
|
| Rate for Payer: UMR Bronson Commercial |
$59.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
NDC 51079-991-01
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna American Axle |
$0.66
|
| Rate for Payer: Aetna Commercial |
$0.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.66
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$0.71
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$0.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.87
|
| Rate for Payer: PHP Commercial |
$0.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.71
|
| Rate for Payer: Priority Health SBD |
$0.64
|
| Rate for Payer: UMR Bronson Commercial |
$0.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.77
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$2.85
|
|
|
Service Code
|
NDC 68084-808-11
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna American Axle |
$1.85
|
| Rate for Payer: Aetna Commercial |
$2.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.85
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.42
|
| Rate for Payer: PHP Commercial |
$2.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.00
|
| Rate for Payer: Priority Health SBD |
$1.80
|
| Rate for Payer: UMR Bronson Commercial |
$1.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.14
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$775.50
|
|
|
Service Code
|
NDC 65162-627-50
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$341.22 |
| Max. Negotiated Rate |
$697.95 |
| Rate for Payer: Aetna American Axle |
$504.08
|
| Rate for Payer: Aetna Commercial |
$659.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.08
|
| Rate for Payer: Cash Price |
$620.40
|
| Rate for Payer: Cofinity Commercial |
$542.85
|
| Rate for Payer: Cofinity Commercial |
$666.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.40
|
| Rate for Payer: Healthscope Commercial |
$697.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$542.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$581.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$659.18
|
| Rate for Payer: PHP Commercial |
$659.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.85
|
| Rate for Payer: Priority Health SBD |
$488.56
|
| Rate for Payer: UMR Bronson Commercial |
$341.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.62
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$1.37
|
|
|
Service Code
|
NDC 55154-2541-7
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna American Axle |
$0.89
|
| Rate for Payer: Aetna Commercial |
$1.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.89
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Cofinity Commercial |
$0.96
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$0.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.16
|
| Rate for Payer: PHP Commercial |
$1.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.96
|
| Rate for Payer: Priority Health SBD |
$0.86
|
| Rate for Payer: UMR Bronson Commercial |
$0.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.03
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$103.40
|
|
|
Service Code
|
NDC 57664-377-08
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna American Axle |
$67.21
|
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.21
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Commercial |
$72.38
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$72.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.89
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.38
|
| Rate for Payer: Priority Health SBD |
$65.14
|
| Rate for Payer: UMR Bronson Commercial |
$45.50
|
| 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
|
IP
|
$36.49
|
|
|
Service Code
|
NDC 51754-0108-1
|
| Hospital Charge Code |
191208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$32.84 |
| Rate for Payer: Aetna American Axle |
$23.72
|
| Rate for Payer: Aetna Commercial |
$31.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.72
|
| Rate for Payer: Cash Price |
$29.19
|
| Rate for Payer: Cofinity Commercial |
$25.54
|
| Rate for Payer: Cofinity Commercial |
$31.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.19
|
| Rate for Payer: Healthscope Commercial |
$32.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.02
|
| Rate for Payer: PHP Commercial |
$31.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.54
|
| Rate for Payer: Priority Health SBD |
$22.99
|
| Rate for Payer: UMR Bronson Commercial |
$16.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.37
|
|
|
TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK
|
Facility
|
IP
|
$36.49
|
|
|
Service Code
|
NDC 51754-0108-3
|
| Hospital Charge Code |
191208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$32.84 |
| Rate for Payer: Aetna American Axle |
$23.72
|
| Rate for Payer: Aetna Commercial |
$31.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.72
|
| Rate for Payer: Cash Price |
$29.19
|
| Rate for Payer: Cofinity Commercial |
$25.54
|
| Rate for Payer: Cofinity Commercial |
$31.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.19
|
| Rate for Payer: Healthscope Commercial |
$32.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.02
|
| Rate for Payer: PHP Commercial |
$31.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.54
|
| Rate for Payer: Priority Health SBD |
$22.99
|
| Rate for Payer: UMR Bronson Commercial |
$16.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.37
|
|
|
TRANEXAMIC ACID 1000 MG/100 ML NS (IV PREMIX)
|
Facility
|
IP
|
$23.14
|
|
|
Service Code
|
NDC 9900-0018-73
|
| Hospital Charge Code |
301163
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna American Axle |
$15.04
|
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.67
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.20
|
| Rate for Payer: Priority Health SBD |
$14.58
|
| Rate for Payer: UMR Bronson Commercial |
$10.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.36
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.97
|
|
|
Service Code
|
NDC 67457-197-00
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$26.07 |
| Rate for Payer: Aetna American Axle |
$18.83
|
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.83
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$20.28
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$20.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.62
|
| Rate for Payer: PHP Commercial |
$24.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.28
|
| Rate for Payer: Priority Health SBD |
$18.25
|
| Rate for Payer: UMR Bronson Commercial |
$12.75
|
| 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
|
$25.90
|
|
|
Service Code
|
NDC 60505-6169-1
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.02
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.13
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UMR Bronson Commercial |
$11.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.42
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$43.17
|
|
|
Service Code
|
NDC 23155-166-31
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.99 |
| Max. Negotiated Rate |
$38.85 |
| Rate for Payer: Aetna American Axle |
$28.06
|
| Rate for Payer: Aetna Commercial |
$36.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.06
|
| Rate for Payer: Cash Price |
$34.54
|
| Rate for Payer: Cofinity Commercial |
$30.22
|
| Rate for Payer: Cofinity Commercial |
$37.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.54
|
| Rate for Payer: Healthscope Commercial |
$38.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.69
|
| Rate for Payer: PHP Commercial |
$36.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.22
|
| Rate for Payer: Priority Health SBD |
$27.20
|
| Rate for Payer: UMR Bronson Commercial |
$18.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.38
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.97
|
|
|
Service Code
|
NDC 67457-197-10
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$26.07 |
| Rate for Payer: Aetna American Axle |
$18.83
|
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.83
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$20.28
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$20.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.62
|
| Rate for Payer: PHP Commercial |
$24.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.28
|
| Rate for Payer: Priority Health SBD |
$18.25
|
| Rate for Payer: UMR Bronson Commercial |
$12.75
|
| 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
|
$25.90
|
|
|
Service Code
|
NDC 60505-6169-0
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.02
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.13
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UMR Bronson Commercial |
$11.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.42
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$195.04
|
|
|
Service Code
|
NDC 63323-563-97
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna American Axle |
$126.78
|
| Rate for Payer: Aetna Commercial |
$165.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.78
|
| Rate for Payer: Cash Price |
$156.03
|
| Rate for Payer: Cofinity Commercial |
$136.53
|
| Rate for Payer: Cofinity Commercial |
$167.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.03
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.78
|
| Rate for Payer: PHP Commercial |
$165.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.53
|
| Rate for Payer: Priority Health SBD |
$122.88
|
| Rate for Payer: UMR Bronson Commercial |
$85.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.28
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$72.81
|
|
|
Service Code
|
NDC 42192-605-01
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.04 |
| Max. Negotiated Rate |
$65.53 |
| Rate for Payer: Aetna American Axle |
$47.33
|
| Rate for Payer: Aetna Commercial |
$61.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.33
|
| Rate for Payer: Cash Price |
$58.25
|
| Rate for Payer: Cofinity Commercial |
$50.97
|
| Rate for Payer: Cofinity Commercial |
$62.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.25
|
| Rate for Payer: Healthscope Commercial |
$65.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.89
|
| Rate for Payer: PHP Commercial |
$61.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.97
|
| Rate for Payer: Priority Health SBD |
$45.87
|
| Rate for Payer: UMR Bronson Commercial |
$32.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.61
|
|
