|
TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK
|
Facility
|
OP
|
$25.81
|
|
|
Service Code
|
HCPCS J3291
|
| Hospital Charge Code |
191208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna American Axle |
$16.78
|
| Rate for Payer: Aetna American Axle |
$17.07
|
| Rate for Payer: Aetna American Axle |
$47.15
|
| Rate for Payer: Aetna American Axle |
$17.36
|
| Rate for Payer: Aetna Commercial |
$61.66
|
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: Aetna Commercial |
$21.94
|
| Rate for Payer: Aetna Commercial |
$22.70
|
| Rate for Payer: Aetna Medicare |
$36.27
|
| Rate for Payer: Aetna Medicare |
$13.35
|
| Rate for Payer: Aetna Medicare |
$13.13
|
| Rate for Payer: Aetna Medicare |
$12.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.78
|
| Rate for Payer: BCBS Complete |
$10.50
|
| Rate for Payer: BCBS Complete |
$10.32
|
| Rate for Payer: BCBS Complete |
$10.68
|
| Rate for Payer: BCBS Complete |
$29.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$58.03
|
| Rate for Payer: Cash Price |
$21.36
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cash Price |
$21.36
|
| Rate for Payer: Cash Price |
$58.03
|
| Rate for Payer: Cofinity Advantage |
$50.78
|
| Rate for Payer: Cofinity Advantage |
$18.07
|
| Rate for Payer: Cofinity Advantage |
$18.38
|
| Rate for Payer: Cofinity Advantage |
$18.69
|
| Rate for Payer: Cofinity Commercial |
$22.96
|
| Rate for Payer: Cofinity Commercial |
$62.38
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.36
|
| Rate for Payer: Healthscope Commercial |
$23.23
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: Healthscope Commercial |
$65.29
|
| Rate for Payer: Healthscope Commercial |
$24.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.02
|
| Rate for Payer: PHP Commercial |
$61.66
|
| Rate for Payer: PHP Commercial |
$22.70
|
| Rate for Payer: PHP Commercial |
$21.94
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.11
|
| Rate for Payer: Priority Health SBD |
$16.54
|
| Rate for Payer: Priority Health SBD |
$45.70
|
| Rate for Payer: Priority Health SBD |
$16.82
|
| Rate for Payer: Priority Health SBD |
$16.26
|
| Rate for Payer: Priority Health Tiered Network |
$0.09
|
| Rate for Payer: Priority Health Tiered Network |
$0.09
|
| Rate for Payer: Priority Health Tiered Network |
$0.09
|
| Rate for Payer: Priority Health Tiered Network |
$0.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
| Rate for Payer: UMR Bronson Commercial |
$26.84
|
| Rate for Payer: UMR Bronson Commercial |
$9.88
|
| Rate for Payer: UMR Bronson Commercial |
$9.55
|
| Rate for Payer: UMR Bronson Commercial |
$9.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.41
|
| 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
|
HCPCS J3291
|
| Hospital Charge Code |
191208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$24.03 |
| Rate for Payer: Aetna American Axle |
$17.36
|
| Rate for Payer: Aetna American Axle |
$17.07
|
| Rate for Payer: Aetna American Axle |
$47.15
|
| Rate for Payer: Aetna American Axle |
$16.78
|
| Rate for Payer: Aetna Commercial |
$61.66
|
| Rate for Payer: Aetna Commercial |
$22.70
|
| Rate for Payer: Aetna Commercial |
$21.94
|
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.78
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cash Price |
$58.03
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cash Price |
$21.36
|
| Rate for Payer: Cofinity Advantage |
$18.38
|
| Rate for Payer: Cofinity Advantage |
$18.07
|
| Rate for Payer: Cofinity Advantage |
$18.69
|
| Rate for Payer: Cofinity Advantage |
$50.78
|
| Rate for Payer: Cofinity Commercial |
$22.96
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Cofinity Commercial |
$62.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.01
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: Healthscope Commercial |
$65.29
|
| Rate for Payer: Healthscope Commercial |
$24.03
|
| Rate for Payer: Healthscope Commercial |
$23.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.36
|
| Rate for Payer: PHP Commercial |
$21.94
|
| Rate for Payer: PHP Commercial |
$22.70
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: PHP Commercial |
$61.66
|
| Rate for Payer: Priority Health SBD |
$45.70
|
| Rate for Payer: Priority Health SBD |
$16.26
|
| Rate for Payer: Priority Health SBD |
$16.82
|
| Rate for Payer: Priority Health SBD |
$16.54
|
| Rate for Payer: UMR Bronson Commercial |
$11.55
|
| Rate for Payer: UMR Bronson Commercial |
$11.75
|
| Rate for Payer: UMR Bronson Commercial |
$11.36
|
| Rate for Payer: UMR Bronson Commercial |
$31.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.41
|
|
|
TRANEXAMIC ACID 1000 MG/100 ML NS (IV PREMIX)
|
Facility
|
OP
|
$23.14
|
|
|
Service Code
|
NDC 09900001873
|
| Hospital Charge Code |
301163
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna American Axle |
$15.04
|
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna Medicare |
$11.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: BCBS Complete |
$9.26
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$18.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.36
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: Priority Health SBD |
$14.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.04
|
| Rate for Payer: UHC Core |
$12.06
|
| Rate for Payer: UHC Exchange |
$9.09
|
| Rate for Payer: UMR Bronson Commercial |
$8.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.36
|
|
|
TRANEXAMIC ACID 1000 MG/100 ML NS (IV PREMIX)
|
Facility
|
IP
|
$23.14
|
|
|
Service Code
|
NDC 09900001873
|
| 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 Advantage |
$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 Commercial |
$19.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.36
|
| Rate for Payer: PHP Commercial |
$19.67
|
| 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
|
OP
|
$16.36
|
|
|
Service Code
|
NDC 65145010610
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$14.72 |
| Rate for Payer: Aetna American Axle |
$10.63
|
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: Aetna Medicare |
$8.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.63
|
| Rate for Payer: BCBS Complete |
$6.54
|
| Rate for Payer: Cash Price |
$13.09
|
| Rate for Payer: Cofinity Advantage |
$11.45
|
| Rate for Payer: Cofinity Commercial |
$14.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.09
|
| Rate for Payer: Healthscope Commercial |
$14.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.27
|
| Rate for Payer: PHP Commercial |
$13.91
|
| Rate for Payer: Priority Health SBD |
$10.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.63
|
| Rate for Payer: UHC Core |
$8.52
|
| Rate for Payer: UHC Exchange |
$6.43
|
| Rate for Payer: UMR Bronson Commercial |
$6.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.27
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.69
|
|
|
Service Code
|
NDC 81284061100
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$14.12 |
| Rate for Payer: Aetna American Axle |
$10.20
|
| Rate for Payer: Aetna Commercial |
$13.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.20
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Cofinity Advantage |
$10.98
|
| Rate for Payer: Cofinity Commercial |
$13.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$14.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.77
|
| Rate for Payer: PHP Commercial |
$13.34
|
| Rate for Payer: Priority Health SBD |
$9.88
|
| Rate for Payer: UMR Bronson Commercial |
$6.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.77
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.43
|
|
|
Service Code
|
NDC 83634040110
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Aetna American Axle |
$11.98
|
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.98
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Advantage |
$12.90
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$16.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.82
|
| Rate for Payer: PHP Commercial |
$15.67
|
| Rate for Payer: Priority Health SBD |
$11.61
|
| Rate for Payer: UMR Bronson Commercial |
$8.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.82
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$195.04
|
|
|
Service Code
|
NDC 63323056397
|
| 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 Advantage |
$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 Commercial |
$165.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.28
|
| Rate for Payer: PHP Commercial |
$165.78
|
| 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
|
OP
|
$72.81
|
|
|
Service Code
|
NDC 42192060510
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.94 |
| Max. Negotiated Rate |
$65.53 |
| Rate for Payer: Aetna American Axle |
$47.33
|
| Rate for Payer: Aetna Commercial |
$61.89
|
| Rate for Payer: Aetna Medicare |
$36.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.33
|
| Rate for Payer: BCBS Complete |
$29.12
|
| Rate for Payer: Cash Price |
$58.25
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$58.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.61
|
| Rate for Payer: PHP Commercial |
$61.89
|
| Rate for Payer: Priority Health SBD |
$45.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.33
|
| Rate for Payer: UHC Core |
$37.93
|
| Rate for Payer: UHC Exchange |
$28.61
|
| Rate for Payer: UMR Bronson Commercial |
$26.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.61
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.69
|
|
|
Service Code
|
NDC 81284061200
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$14.12 |
| Rate for Payer: Aetna American Axle |
$10.20
|
| Rate for Payer: Aetna Commercial |
$13.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.20
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Cofinity Advantage |
$10.98
|
| Rate for Payer: Cofinity Commercial |
$13.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$14.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.77
|
| Rate for Payer: PHP Commercial |
$13.34
|
| Rate for Payer: Priority Health SBD |
$9.88
|
| Rate for Payer: UMR Bronson Commercial |
$6.90
|
| 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
|
$28.97
|
|
|
Service Code
|
NDC 67457019700
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$26.07 |
| Rate for Payer: Aetna American Axle |
$18.83
|
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Aetna Medicare |
$14.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.83
|
| Rate for Payer: BCBS Complete |
$11.59
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$23.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.73
|
| Rate for Payer: PHP Commercial |
$24.62
|
| Rate for Payer: Priority Health SBD |
$18.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.83
|
| Rate for Payer: UHC Core |
$15.09
|
| Rate for Payer: UHC Exchange |
$11.39
|
| Rate for Payer: UMR Bronson Commercial |
$10.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.73
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$27.38
|
|
|
Service Code
|
NDC 70860040010
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$24.64 |
| Rate for Payer: Aetna American Axle |
$17.80
|
| Rate for Payer: Aetna Commercial |
$23.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.80
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cofinity Advantage |
$19.17
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$19.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.54
|
| Rate for Payer: PHP Commercial |
$23.27
|
| Rate for Payer: Priority Health SBD |
$17.25
|
| Rate for Payer: UMR Bronson Commercial |
$12.05
|
| 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
|
$20.65
|
|
|
Service Code
|
NDC 72485051010
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$18.59 |
| Rate for Payer: Aetna American Axle |
$13.42
|
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna Medicare |
$10.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.42
|
| Rate for Payer: BCBS Complete |
$8.26
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Advantage |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$18.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.49
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: Priority Health SBD |
$13.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.42
|
| Rate for Payer: UHC Core |
$10.76
|
| Rate for Payer: UHC Exchange |
$8.12
|
| Rate for Payer: UMR Bronson Commercial |
$7.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.69
|
|
|
Service Code
|
NDC 81284061110
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$14.12 |
| Rate for Payer: Aetna American Axle |
$10.20
|
| Rate for Payer: Aetna Commercial |
$13.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.20
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Cofinity Advantage |
$10.98
|
| Rate for Payer: Cofinity Commercial |
$13.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$14.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.77
|
| Rate for Payer: PHP Commercial |
$13.34
|
| Rate for Payer: Priority Health SBD |
$9.88
|
| Rate for Payer: UMR Bronson Commercial |
$6.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.77
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.99
|
|
|
Service Code
|
NDC 39822100001
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$21.59 |
| Rate for Payer: Aetna American Axle |
$15.59
|
| Rate for Payer: Aetna Commercial |
$20.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.59
|
| Rate for Payer: Cash Price |
$19.19
|
| Rate for Payer: Cofinity Advantage |
$16.79
|
| Rate for Payer: Cofinity Commercial |
$20.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.19
|
| Rate for Payer: Healthscope Commercial |
$21.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.99
|
| Rate for Payer: PHP Commercial |
$20.39
|
| Rate for Payer: Priority Health SBD |
$15.11
|
| Rate for Payer: UMR Bronson Commercial |
$10.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.99
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.97
|
|
|
Service Code
|
NDC 67457019710
|
| 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 Advantage |
$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 Commercial |
$24.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.73
|
| Rate for Payer: PHP Commercial |
$24.62
|
| 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
|
$22.74
|
|
|
Service Code
|
NDC 47781060191
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$20.47 |
| Rate for Payer: Aetna American Axle |
$14.78
|
| Rate for Payer: Aetna Commercial |
$19.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.78
|
| Rate for Payer: Cash Price |
$18.19
|
| Rate for Payer: Cofinity Advantage |
$15.92
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.19
|
| Rate for Payer: Healthscope Commercial |
$20.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.05
|
| Rate for Payer: PHP Commercial |
$19.33
|
| Rate for Payer: Priority Health SBD |
$14.33
|
| Rate for Payer: UMR Bronson Commercial |
$10.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.05
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.36
|
|
|
Service Code
|
NDC 65145010601
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$14.72 |
| Rate for Payer: Aetna American Axle |
$10.63
|
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.63
|
| Rate for Payer: Cash Price |
$13.09
|
| Rate for Payer: Cofinity Advantage |
$11.45
|
| Rate for Payer: Cofinity Commercial |
$14.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.09
|
| Rate for Payer: Healthscope Commercial |
$14.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.27
|
| Rate for Payer: PHP Commercial |
$13.91
|
| Rate for Payer: Priority Health SBD |
$10.31
|
| Rate for Payer: UMR Bronson Commercial |
$7.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.27
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$72.81
|
|
|
Service Code
|
NDC 42192060501
|
| 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 Advantage |
$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 Commercial |
$61.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.61
|
| Rate for Payer: PHP Commercial |
$61.89
|
| 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
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.61
|
|
|
Service Code
|
NDC 60505616901
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$16.75 |
| Rate for Payer: Aetna American Axle |
$12.10
|
| Rate for Payer: Aetna Commercial |
$15.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.10
|
| Rate for Payer: Cash Price |
$14.89
|
| Rate for Payer: Cofinity Advantage |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$16.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.89
|
| Rate for Payer: Healthscope Commercial |
$16.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.96
|
| Rate for Payer: PHP Commercial |
$15.82
|
| Rate for Payer: Priority Health SBD |
$11.72
|
| Rate for Payer: UMR Bronson Commercial |
$8.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.96
|
|
|
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 |
$5.89 |
| Max. Negotiated Rate |
$14.32 |
| Rate for Payer: Aetna American Axle |
$10.34
|
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Medicare |
$7.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.34
|
| Rate for Payer: BCBS Complete |
$6.36
|
| Rate for Payer: Cash Price |
$12.73
|
| Rate for Payer: Cofinity Advantage |
$11.14
|
| Rate for Payer: Cofinity Commercial |
$13.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.73
|
| Rate for Payer: Healthscope Commercial |
$14.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.93
|
| Rate for Payer: PHP Commercial |
$13.52
|
| Rate for Payer: Priority Health SBD |
$10.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.34
|
| Rate for Payer: UHC Core |
$8.29
|
| Rate for Payer: UHC Exchange |
$6.25
|
| Rate for Payer: UMR Bronson Commercial |
$5.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.93
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$72.81
|
|
|
Service Code
|
NDC 42192060510
|
| 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 Advantage |
$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 Commercial |
$61.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.61
|
| Rate for Payer: PHP Commercial |
$61.89
|
| 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
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$38.59
|
|
|
Service Code
|
NDC 63323056310
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$34.73 |
| Rate for Payer: Aetna American Axle |
$25.08
|
| Rate for Payer: Aetna Commercial |
$32.80
|
| Rate for Payer: Aetna Medicare |
$19.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.08
|
| Rate for Payer: BCBS Complete |
$15.44
|
| Rate for Payer: Cash Price |
$30.87
|
| Rate for Payer: Cofinity Advantage |
$27.01
|
| Rate for Payer: Cofinity Commercial |
$33.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.87
|
| Rate for Payer: Healthscope Commercial |
$34.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.94
|
| Rate for Payer: PHP Commercial |
$32.80
|
| Rate for Payer: Priority Health SBD |
$24.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.08
|
| Rate for Payer: UHC Core |
$20.11
|
| Rate for Payer: UHC Exchange |
$15.17
|
| Rate for Payer: UMR Bronson Commercial |
$14.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.94
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.43
|
|
|
Service Code
|
NDC 83634040110
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Aetna American Axle |
$11.98
|
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: Aetna Medicare |
$9.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.98
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Advantage |
$12.90
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$16.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.82
|
| Rate for Payer: PHP Commercial |
$15.67
|
| Rate for Payer: Priority Health SBD |
$11.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.98
|
| Rate for Payer: UHC Core |
$9.60
|
| Rate for Payer: UHC Exchange |
$7.24
|
| Rate for Payer: UMR Bronson Commercial |
$6.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.82
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.65
|
|
|
Service Code
|
NDC 72485051010
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$18.59 |
| Rate for Payer: Aetna American Axle |
$13.42
|
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.42
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Advantage |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$18.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.49
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: Priority Health SBD |
$13.01
|
| Rate for Payer: UMR Bronson Commercial |
$9.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
|
