|
TORSEMIDE 10 MG TABLET
|
Facility
IP
|
$199.75
|
|
|
Service Code
|
NDC 31722-530-01
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.82 |
| Max. Negotiated Rate |
$199.75 |
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: ASR ASR |
$193.76
|
| Rate for Payer: BCBS Trust/PPO |
$154.87
|
| Rate for Payer: BCN Commercial |
$154.87
|
| Rate for Payer: Cash Price |
$159.80
|
| Rate for Payer: Cofinity Commercial |
$187.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.80
|
| Rate for Payer: Healthscope Commercial |
$199.75
|
| Rate for Payer: Healthscope Whirlpool |
$193.76
|
| Rate for Payer: Mclaren Commercial |
$179.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$175.78
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
IP
|
$308.75
|
|
|
Service Code
|
NDC 68084-539-11
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$216.12 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Aetna Commercial |
$277.88
|
| Rate for Payer: ASR ASR |
$299.49
|
| Rate for Payer: BCBS Trust/PPO |
$239.37
|
| Rate for Payer: BCN Commercial |
$239.37
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cofinity Commercial |
$290.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.00
|
| Rate for Payer: Healthscope Commercial |
$308.75
|
| Rate for Payer: Healthscope Whirlpool |
$299.49
|
| Rate for Payer: Mclaren Commercial |
$277.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$262.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.70
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
IP
|
$139.65
|
|
|
Service Code
|
NDC 50268-756-15
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.76 |
| Max. Negotiated Rate |
$139.65 |
| Rate for Payer: Aetna Commercial |
$125.68
|
| Rate for Payer: ASR ASR |
$135.46
|
| Rate for Payer: BCBS Trust/PPO |
$108.27
|
| Rate for Payer: BCN Commercial |
$108.27
|
| Rate for Payer: Cash Price |
$111.72
|
| Rate for Payer: Cofinity Commercial |
$131.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.72
|
| Rate for Payer: Healthscope Commercial |
$139.65
|
| Rate for Payer: Healthscope Whirlpool |
$135.46
|
| Rate for Payer: Mclaren Commercial |
$125.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$118.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.89
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
IP
|
$308.75
|
|
|
Service Code
|
NDC 68084-539-01
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$216.12 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Aetna Commercial |
$277.88
|
| Rate for Payer: ASR ASR |
$299.49
|
| Rate for Payer: BCBS Trust/PPO |
$239.37
|
| Rate for Payer: BCN Commercial |
$239.37
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cofinity Commercial |
$290.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.00
|
| Rate for Payer: Healthscope Commercial |
$308.75
|
| Rate for Payer: Healthscope Whirlpool |
$299.49
|
| Rate for Payer: Mclaren Commercial |
$277.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$262.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.70
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
IP
|
$2.79
|
|
|
Service Code
|
NDC 50268-756-11
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: Aetna Commercial |
$2.51
|
| Rate for Payer: ASR ASR |
$2.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.16
|
| Rate for Payer: BCN Commercial |
$2.16
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$2.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.23
|
| Rate for Payer: Healthscope Commercial |
$2.79
|
| Rate for Payer: Healthscope Whirlpool |
$2.71
|
| Rate for Payer: Mclaren Commercial |
$2.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.46
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
IP
|
$272.65
|
|
|
Service Code
|
NDC 0904-7283-61
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.86 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Aetna Commercial |
$245.38
|
| Rate for Payer: ASR ASR |
$264.47
|
| Rate for Payer: BCBS Trust/PPO |
$211.39
|
| Rate for Payer: BCN Commercial |
$211.39
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$256.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.12
|
| Rate for Payer: Healthscope Commercial |
$272.65
|
| Rate for Payer: Healthscope Whirlpool |
$264.47
|
| Rate for Payer: Mclaren Commercial |
$245.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$231.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.93
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC
|
Facility
IP
|
$51,422.92
|
|
|
Service Code
|
MS-DRG 012
|
| Min. Negotiated Rate |
$33,808.61 |
| Max. Negotiated Rate |
$51,422.92 |
| Rate for Payer: Aetna Medicare |
$35,588.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44,485.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44,485.01
|
| Rate for Payer: BCBS MAPPO |
$35,588.01
|
| Rate for Payer: BCN Medicare Advantage |
$35,588.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35,588.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$35,588.01
|
| Rate for Payer: Mclaren Medicare |
$35,588.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37,367.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40,926.21
|
| Rate for Payer: PACE Medicare |
$33,808.61
|
| Rate for Payer: PACE SWMI |
$35,588.01
|
| Rate for Payer: PHP Commercial |
$39,146.81
|
| Rate for Payer: PHP Medicare Advantage |
$35,588.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51,422.92
|
| Rate for Payer: Priority Health Medicare |
$35,588.01
|
| Rate for Payer: Priority Health Narrow Network |
$41,138.34
|
| Rate for Payer: Railroad Medicare Medicare |
$35,588.01
|
| Rate for Payer: UHC Medicare Advantage |
$36,655.65
|
| Rate for Payer: VA VA |
$35,588.01
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC
|
Facility
IP
|
$66,206.89
|
|
|
Service Code
|
MS-DRG 011
|
| Min. Negotiated Rate |
$43,069.40 |
| Max. Negotiated Rate |
$66,206.89 |
| Rate for Payer: Aetna Medicare |
$45,336.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56,670.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56,670.26
|
| Rate for Payer: BCBS MAPPO |
$45,336.21
|
| Rate for Payer: BCN Medicare Advantage |
$45,336.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45,336.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$45,336.21
|
| Rate for Payer: Mclaren Medicare |
$45,336.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$47,603.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52,136.64
|
| Rate for Payer: PACE Medicare |
$43,069.40
|
| Rate for Payer: PACE SWMI |
$45,336.21
|
| Rate for Payer: PHP Commercial |
$49,869.83
|
| Rate for Payer: PHP Medicare Advantage |
$45,336.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66,206.89
|
| Rate for Payer: Priority Health Medicare |
$45,336.21
|
| Rate for Payer: Priority Health Narrow Network |
$52,965.51
|
| Rate for Payer: Railroad Medicare Medicare |
$45,336.21
|
| Rate for Payer: UHC Medicare Advantage |
$46,696.30
|
| Rate for Payer: VA VA |
$45,336.21
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC
|
Facility
IP
|
$34,484.39
|
|
|
Service Code
|
MS-DRG 013
|
| Min. Negotiated Rate |
$23,198.18 |
| Max. Negotiated Rate |
$34,484.39 |
| Rate for Payer: Aetna Medicare |
$24,419.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,523.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,523.92
|
| Rate for Payer: BCBS MAPPO |
$24,419.14
|
| Rate for Payer: BCN Medicare Advantage |
$24,419.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,419.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$24,419.14
|
| Rate for Payer: Mclaren Medicare |
$24,419.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25,640.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,082.01
|
| Rate for Payer: PACE Medicare |
$23,198.18
|
| Rate for Payer: PACE SWMI |
$24,419.14
|
| Rate for Payer: PHP Commercial |
$26,861.05
|
| Rate for Payer: PHP Medicare Advantage |
$24,419.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,484.39
|
| Rate for Payer: Priority Health Medicare |
$24,419.14
|
| Rate for Payer: Priority Health Narrow Network |
$27,587.51
|
| Rate for Payer: Railroad Medicare Medicare |
$24,419.14
|
| Rate for Payer: UHC Medicare Advantage |
$25,151.71
|
| Rate for Payer: VA VA |
$24,419.14
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES
|
Facility
IP
|
$188,748.00
|
|
|
Service Code
|
MS-DRG 004
|
| Min. Negotiated Rate |
$119,830.13 |
| Max. Negotiated Rate |
$188,748.00 |
| Rate for Payer: Aetna Medicare |
$126,136.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157,671.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157,671.22
|
| Rate for Payer: BCBS MAPPO |
$126,136.98
|
| Rate for Payer: BCN Medicare Advantage |
$126,136.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126,136.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$126,136.98
|
| Rate for Payer: Mclaren Medicare |
$126,136.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$132,443.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145,057.53
|
| Rate for Payer: PACE Medicare |
$119,830.13
|
| Rate for Payer: PACE SWMI |
$126,136.98
|
| Rate for Payer: PHP Commercial |
$138,750.68
|
| Rate for Payer: PHP Medicare Advantage |
$126,136.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$188,748.00
|
| Rate for Payer: Priority Health Medicare |
$126,136.98
|
| Rate for Payer: Priority Health Narrow Network |
$150,998.40
|
| Rate for Payer: Railroad Medicare Medicare |
$126,136.98
|
| Rate for Payer: UHC Medicare Advantage |
$129,921.09
|
| Rate for Payer: VA VA |
$126,136.98
|
|
|
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 |
$199.04 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$255.92
|
| Rate for Payer: ASR ASR |
$275.82
|
| Rate for Payer: BCBS Trust/PPO |
$220.46
|
| Rate for Payer: BCN Commercial |
$220.46
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$267.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$284.35
|
| Rate for Payer: Healthscope Whirlpool |
$275.82
|
| Rate for Payer: Mclaren Commercial |
$255.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$241.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.23
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
IP
|
$1.01
|
|
|
Service Code
|
NDC 51079-991-01
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Aetna Commercial |
$0.91
|
| Rate for Payer: ASR ASR |
$0.98
|
| Rate for Payer: BCBS Trust/PPO |
$0.78
|
| Rate for Payer: BCN Commercial |
$0.78
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cofinity Commercial |
$0.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.81
|
| Rate for Payer: Healthscope Commercial |
$1.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.98
|
| Rate for Payer: Mclaren Commercial |
$0.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.89
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
IP
|
$2.84
|
|
|
Service Code
|
NDC 68084-808-11
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Healthscope Commercial |
$2.84
|
| Rate for Payer: Aetna Commercial |
$2.56
|
| Rate for Payer: ASR ASR |
$2.75
|
| Rate for Payer: BCBS Trust/PPO |
$2.20
|
| Rate for Payer: BCN Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.27
|
| Rate for Payer: Healthscope Whirlpool |
$2.75
|
| Rate for Payer: Mclaren Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.50
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$16.35
|
|
|
Service Code
|
NDC 55150-188-10
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$16.35 |
| Rate for Payer: Aetna Commercial |
$14.72
|
| Rate for Payer: ASR ASR |
$15.86
|
| Rate for Payer: BCBS Trust/PPO |
$12.68
|
| Rate for Payer: BCN Commercial |
$12.68
|
| Rate for Payer: Cash Price |
$13.08
|
| Rate for Payer: Cofinity Commercial |
$15.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.08
|
| Rate for Payer: Healthscope Commercial |
$16.35
|
| Rate for Payer: Healthscope Whirlpool |
$15.86
|
| Rate for Payer: Mclaren Commercial |
$14.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.39
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$62.08
|
|
|
Service Code
|
NDC 67457-197-00
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Aetna Commercial |
$55.87
|
| Rate for Payer: ASR ASR |
$60.22
|
| Rate for Payer: BCBS Trust/PPO |
$48.13
|
| Rate for Payer: BCN Commercial |
$48.13
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Cofinity Commercial |
$58.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.66
|
| Rate for Payer: Healthscope Commercial |
$62.08
|
| Rate for Payer: Healthscope Whirlpool |
$60.22
|
| Rate for Payer: Mclaren Commercial |
$55.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.63
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$22.74
|
|
|
Service Code
|
NDC 47781-601-91
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$22.74 |
| Rate for Payer: Aetna Commercial |
$20.47
|
| Rate for Payer: ASR ASR |
$22.06
|
| Rate for Payer: BCBS Trust/PPO |
$17.63
|
| Rate for Payer: BCN Commercial |
$17.63
|
| Rate for Payer: Cash Price |
$18.19
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.19
|
| Rate for Payer: Healthscope Commercial |
$22.74
|
| Rate for Payer: Healthscope Whirlpool |
$22.06
|
| Rate for Payer: Mclaren Commercial |
$20.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.01
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$51.04
|
|
|
Service Code
|
NDC 0517-0960-01
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.73 |
| Max. Negotiated Rate |
$51.04 |
| Rate for Payer: Aetna Commercial |
$45.94
|
| Rate for Payer: ASR ASR |
$49.51
|
| Rate for Payer: BCBS Trust/PPO |
$39.57
|
| Rate for Payer: BCN Commercial |
$39.57
|
| Rate for Payer: Cash Price |
$40.83
|
| Rate for Payer: Cofinity Commercial |
$47.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.83
|
| Rate for Payer: Healthscope Commercial |
$51.04
|
| Rate for Payer: Healthscope Whirlpool |
$49.51
|
| Rate for Payer: Mclaren Commercial |
$45.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.92
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$15.69
|
|
|
Service Code
|
NDC 81284-611-10
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.98 |
| Max. Negotiated Rate |
$15.69 |
| Rate for Payer: Aetna Commercial |
$14.12
|
| Rate for Payer: ASR ASR |
$15.22
|
| Rate for Payer: BCBS Trust/PPO |
$12.16
|
| Rate for Payer: BCN Commercial |
$12.16
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Cofinity Commercial |
$14.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$15.69
|
| Rate for Payer: Healthscope Whirlpool |
$15.22
|
| Rate for Payer: Mclaren Commercial |
$14.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.81
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$23.99
|
|
|
Service Code
|
NDC 39822-1000-1
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.79 |
| Max. Negotiated Rate |
$23.99 |
| Rate for Payer: Aetna Commercial |
$21.59
|
| Rate for Payer: ASR ASR |
$23.27
|
| Rate for Payer: BCBS Trust/PPO |
$18.60
|
| Rate for Payer: BCN Commercial |
$18.60
|
| Rate for Payer: Cash Price |
$19.19
|
| Rate for Payer: Cofinity Commercial |
$22.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.19
|
| Rate for Payer: Healthscope Commercial |
$23.99
|
| Rate for Payer: Healthscope Whirlpool |
$23.27
|
| Rate for Payer: Mclaren Commercial |
$21.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.11
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$19.39
|
|
|
Service Code
|
NDC 61990-0611-2
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$19.39 |
| Rate for Payer: Aetna Commercial |
$17.45
|
| Rate for Payer: ASR ASR |
$18.81
|
| Rate for Payer: BCBS Trust/PPO |
$15.03
|
| Rate for Payer: BCN Commercial |
$15.03
|
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Cofinity Commercial |
$18.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.51
|
| Rate for Payer: Healthscope Commercial |
$19.39
|
| Rate for Payer: Healthscope Whirlpool |
$18.81
|
| Rate for Payer: Mclaren Commercial |
$17.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.06
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$24.05
|
|
|
Service Code
|
NDC 72485-107-10
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.84 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: ASR ASR |
$23.33
|
| Rate for Payer: BCBS Trust/PPO |
$18.65
|
| Rate for Payer: BCN Commercial |
$18.65
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cofinity Commercial |
$22.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$24.05
|
| Rate for Payer: Healthscope Whirlpool |
$23.33
|
| Rate for Payer: Mclaren Commercial |
$21.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$24.05
|
|
|
Service Code
|
NDC 72485-107-01
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.84 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: ASR ASR |
$23.33
|
| Rate for Payer: BCBS Trust/PPO |
$18.65
|
| Rate for Payer: BCN Commercial |
$18.65
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cofinity Commercial |
$22.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$24.05
|
| Rate for Payer: Healthscope Whirlpool |
$23.33
|
| Rate for Payer: Mclaren Commercial |
$21.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$15.69
|
|
|
Service Code
|
NDC 81284-611-00
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.98 |
| Max. Negotiated Rate |
$15.69 |
| Rate for Payer: Aetna Commercial |
$14.12
|
| Rate for Payer: ASR ASR |
$15.22
|
| Rate for Payer: BCBS Trust/PPO |
$12.16
|
| Rate for Payer: BCN Commercial |
$12.16
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Cofinity Commercial |
$14.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$15.69
|
| Rate for Payer: Healthscope Whirlpool |
$15.22
|
| Rate for Payer: Mclaren Commercial |
$14.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.81
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$62.08
|
|
|
Service Code
|
NDC 67457-197-10
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Aetna Commercial |
$55.87
|
| Rate for Payer: ASR ASR |
$60.22
|
| Rate for Payer: BCBS Trust/PPO |
$48.13
|
| Rate for Payer: BCN Commercial |
$48.13
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Cofinity Commercial |
$58.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.66
|
| Rate for Payer: Healthscope Commercial |
$62.08
|
| Rate for Payer: Healthscope Whirlpool |
$60.22
|
| Rate for Payer: Mclaren Commercial |
$55.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.63
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$22.74
|
|
|
Service Code
|
NDC 47781-601-22
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$22.74 |
| Rate for Payer: Aetna Commercial |
$20.47
|
| Rate for Payer: ASR ASR |
$22.06
|
| Rate for Payer: BCBS Trust/PPO |
$17.63
|
| Rate for Payer: BCN Commercial |
$17.63
|
| Rate for Payer: Cash Price |
$18.19
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.19
|
| Rate for Payer: Healthscope Commercial |
$22.74
|
| Rate for Payer: Healthscope Whirlpool |
$22.06
|
| Rate for Payer: Mclaren Commercial |
$20.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.01
|
|
