|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$317.30
|
|
|
Service Code
|
NDC 68084053911
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.97 |
| Max. Negotiated Rate |
$317.30 |
| Rate for Payer: Aetna Commercial |
$285.57
|
| Rate for Payer: ASR ASR |
$307.78
|
| Rate for Payer: BCBS Trust/PPO |
$260.57
|
| Rate for Payer: BCN Commercial |
$260.57
|
| Rate for Payer: Cash Price |
$253.84
|
| Rate for Payer: Cofinity Commercial |
$298.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.84
|
| Rate for Payer: Healthscope Commercial |
$307.78
|
| Rate for Payer: Healthscope Whirlpool |
$317.30
|
| Rate for Payer: Mclaren Commercial |
$285.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.70
|
| Rate for Payer: Nomi Health Commercial |
$260.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$279.22
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$317.30
|
|
|
Service Code
|
NDC 68084053911
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.40 |
| Max. Negotiated Rate |
$317.30 |
| Rate for Payer: Aetna Commercial |
$285.57
|
| Rate for Payer: Aetna Medicare |
$117.40
|
| Rate for Payer: ASR ASR |
$307.78
|
| Rate for Payer: BCBS Complete |
$126.92
|
| Rate for Payer: BCBS Trust/PPO |
$261.61
|
| Rate for Payer: BCN Commercial |
$261.61
|
| Rate for Payer: Cash Price |
$253.84
|
| Rate for Payer: Cofinity Commercial |
$298.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.84
|
| Rate for Payer: Healthscope Commercial |
$307.78
|
| Rate for Payer: Healthscope Whirlpool |
$317.30
|
| Rate for Payer: Mclaren Commercial |
$285.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$253.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.70
|
| Rate for Payer: Nomi Health Commercial |
$260.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$278.02
|
| Rate for Payer: Priority Health Narrow Network |
$222.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$279.22
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$143.45
|
|
|
Service Code
|
NDC 50268075615
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.59 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Aetna Commercial |
$129.10
|
| Rate for Payer: ASR ASR |
$139.15
|
| Rate for Payer: BCBS Trust/PPO |
$117.80
|
| Rate for Payer: BCN Commercial |
$117.80
|
| Rate for Payer: Cash Price |
$114.76
|
| Rate for Payer: Cofinity Commercial |
$134.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.76
|
| Rate for Payer: Healthscope Commercial |
$139.15
|
| Rate for Payer: Healthscope Whirlpool |
$143.45
|
| Rate for Payer: Mclaren Commercial |
$129.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.93
|
| Rate for Payer: Nomi Health Commercial |
$117.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.24
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
|
IP
|
$11,853.75
|
|
|
Service Code
|
APR-DRG 8164
|
| Min. Negotiated Rate |
$10,717.21 |
| Max. Negotiated Rate |
$11,853.75 |
| Rate for Payer: BCBS Complete |
$11,853.75
|
| Rate for Payer: Mclaren Medicaid |
$11,289.29
|
| Rate for Payer: Meridian Medicaid |
$11,853.75
|
| Rate for Payer: PHP Medicaid |
$10,717.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,289.29
|
| Rate for Payer: UHC Medicaid |
$11,289.29
|
| Rate for Payer: UHCCP Medicaid |
$11,289.29
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
|
IP
|
$6,941.03
|
|
|
Service Code
|
APR-DRG 8163
|
| Min. Negotiated Rate |
$6,275.52 |
| Max. Negotiated Rate |
$6,941.03 |
| Rate for Payer: BCBS Complete |
$6,941.03
|
| Rate for Payer: Mclaren Medicaid |
$6,610.50
|
| Rate for Payer: Meridian Medicaid |
$6,941.03
|
| Rate for Payer: PHP Medicaid |
$6,275.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,610.50
|
| Rate for Payer: UHC Medicaid |
$6,610.50
|
| Rate for Payer: UHCCP Medicaid |
$6,610.50
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
|
IP
|
$3,159.62
|
|
|
Service Code
|
APR-DRG 8162
|
| Min. Negotiated Rate |
$2,856.67 |
| Max. Negotiated Rate |
$3,159.62 |
| Rate for Payer: BCBS Complete |
$3,159.62
|
| Rate for Payer: Mclaren Medicaid |
$3,009.16
|
| Rate for Payer: Meridian Medicaid |
$3,159.62
|
| Rate for Payer: PHP Medicaid |
$2,856.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,009.16
|
| Rate for Payer: UHC Medicaid |
$3,009.16
|
| Rate for Payer: UHCCP Medicaid |
$3,009.16
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
|
IP
|
$1,961.82
|
|
|
Service Code
|
APR-DRG 8161
|
| Min. Negotiated Rate |
$1,773.72 |
| Max. Negotiated Rate |
$1,961.82 |
| Rate for Payer: BCBS Complete |
$1,961.82
|
| Rate for Payer: Mclaren Medicaid |
$1,868.40
|
| Rate for Payer: Meridian Medicaid |
$1,961.82
|
| Rate for Payer: PHP Medicaid |
$1,773.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,868.40
|
| Rate for Payer: UHC Medicaid |
$1,868.40
|
| Rate for Payer: UHCCP Medicaid |
$1,868.40
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC
|
Facility
|
IP
|
$57,922.78
|
|
|
Service Code
|
MSDRG 012
|
| Min. Negotiated Rate |
$30,509.15 |
| Max. Negotiated Rate |
$57,922.78 |
| Rate for Payer: Aetna Medicare |
$32,114.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40,143.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40,143.62
|
| Rate for Payer: BCBS MAPPO |
$32,114.90
|
| Rate for Payer: BCN Medicare Advantage |
$32,114.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32,114.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$32,114.90
|
| Rate for Payer: Mclaren Medicare |
$32,114.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33,720.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36,932.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$35,326.39
|
| Rate for Payer: PACE Medicare |
$30,509.15
|
| Rate for Payer: PACE SWMI |
$32,114.90
|
| Rate for Payer: PHP Commercial |
$35,326.39
|
| Rate for Payer: PHP Medicare Advantage |
$32,114.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$57,922.78
|
| Rate for Payer: Priority Health Medicare |
$32,114.90
|
| Rate for Payer: Priority Health Narrow Network |
$46,338.22
|
| Rate for Payer: Railroad Medicare Medicare |
$32,114.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$32,114.90
|
| Rate for Payer: UHC Exchange |
$49,778.10
|
| Rate for Payer: UHCCP DNSP |
$32,114.90
|
| Rate for Payer: VA VA |
$32,114.90
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC
|
Facility
|
IP
|
$74,932.79
|
|
|
Service Code
|
MSDRG 011
|
| Min. Negotiated Rate |
$38,979.22 |
| Max. Negotiated Rate |
$74,932.79 |
| Rate for Payer: Aetna Medicare |
$41,030.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51,288.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51,288.45
|
| Rate for Payer: BCBS MAPPO |
$41,030.76
|
| Rate for Payer: BCN Medicare Advantage |
$41,030.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41,030.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$41,030.76
|
| Rate for Payer: Mclaren Medicare |
$41,030.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43,082.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47,185.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$45,133.84
|
| Rate for Payer: PACE Medicare |
$38,979.22
|
| Rate for Payer: PACE SWMI |
$41,030.76
|
| Rate for Payer: PHP Commercial |
$45,133.84
|
| Rate for Payer: PHP Medicare Advantage |
$41,030.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$74,932.79
|
| Rate for Payer: Priority Health Medicare |
$41,030.76
|
| Rate for Payer: Priority Health Narrow Network |
$59,946.23
|
| Rate for Payer: Railroad Medicare Medicare |
$41,030.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41,030.76
|
| Rate for Payer: UHC Exchange |
$63,597.68
|
| Rate for Payer: UHCCP DNSP |
$41,030.76
|
| Rate for Payer: VA VA |
$41,030.76
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$39,592.47
|
|
|
Service Code
|
MSDRG 013
|
| Min. Negotiated Rate |
$21,381.65 |
| Max. Negotiated Rate |
$39,592.47 |
| Rate for Payer: Aetna Medicare |
$22,507.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28,133.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28,133.75
|
| Rate for Payer: BCBS MAPPO |
$22,507.00
|
| Rate for Payer: BCN Medicare Advantage |
$22,507.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,507.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$22,507.00
|
| Rate for Payer: Mclaren Medicare |
$22,507.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23,632.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,883.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$24,757.70
|
| Rate for Payer: PACE Medicare |
$21,381.65
|
| Rate for Payer: PACE SWMI |
$22,507.00
|
| Rate for Payer: PHP Commercial |
$24,757.70
|
| Rate for Payer: PHP Medicare Advantage |
$22,507.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$39,592.47
|
| Rate for Payer: Priority Health Medicare |
$22,507.00
|
| Rate for Payer: Priority Health Narrow Network |
$31,673.98
|
| Rate for Payer: Railroad Medicare Medicare |
$22,507.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22,507.00
|
| Rate for Payer: UHC Exchange |
$34,885.85
|
| Rate for Payer: UHCCP DNSP |
$22,507.00
|
| Rate for Payer: VA VA |
$22,507.00
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES
|
Facility
|
IP
|
$190,301.61
|
|
|
Service Code
|
MSDRG 004
|
| Min. Negotiated Rate |
$96,426.67 |
| Max. Negotiated Rate |
$190,301.61 |
| Rate for Payer: Aetna Medicare |
$101,501.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126,877.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126,877.20
|
| Rate for Payer: BCBS MAPPO |
$101,501.76
|
| Rate for Payer: BCN Medicare Advantage |
$101,501.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101,501.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$101,501.76
|
| Rate for Payer: Mclaren Medicare |
$101,501.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106,576.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116,727.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$111,651.94
|
| Rate for Payer: PACE Medicare |
$96,426.67
|
| Rate for Payer: PACE SWMI |
$101,501.76
|
| Rate for Payer: PHP Commercial |
$111,651.94
|
| Rate for Payer: PHP Medicare Advantage |
$101,501.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$190,301.61
|
| Rate for Payer: Priority Health Medicare |
$101,501.76
|
| Rate for Payer: Priority Health Narrow Network |
$152,241.29
|
| Rate for Payer: Railroad Medicare Medicare |
$101,501.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101,501.76
|
| Rate for Payer: UHC Exchange |
$157,327.73
|
| Rate for Payer: UHCCP DNSP |
$101,501.76
|
| Rate for Payer: VA VA |
$101,501.76
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$101,368.87
|
|
|
Service Code
|
APR-DRG 0044
|
| Min. Negotiated Rate |
$91,649.59 |
| Max. Negotiated Rate |
$101,368.87 |
| Rate for Payer: BCBS Complete |
$101,368.87
|
| Rate for Payer: Mclaren Medicaid |
$96,541.79
|
| Rate for Payer: Meridian Medicaid |
$101,368.87
|
| Rate for Payer: PHP Medicaid |
$91,649.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$96,541.79
|
| Rate for Payer: UHC Medicaid |
$96,541.79
|
| Rate for Payer: UHCCP Medicaid |
$96,541.79
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$39,380.81
|
|
|
Service Code
|
APR-DRG 0042
|
| Min. Negotiated Rate |
$35,604.97 |
| Max. Negotiated Rate |
$39,380.81 |
| Rate for Payer: BCBS Complete |
$39,380.81
|
| Rate for Payer: Mclaren Medicaid |
$37,505.54
|
| Rate for Payer: Meridian Medicaid |
$39,380.81
|
| Rate for Payer: PHP Medicaid |
$35,604.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$37,505.54
|
| Rate for Payer: UHC Medicaid |
$37,505.54
|
| Rate for Payer: UHCCP Medicaid |
$37,505.54
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$26,401.19
|
|
|
Service Code
|
APR-DRG 0041
|
| Min. Negotiated Rate |
$23,869.84 |
| Max. Negotiated Rate |
$26,401.19 |
| Rate for Payer: BCBS Complete |
$26,401.19
|
| Rate for Payer: Mclaren Medicaid |
$25,143.99
|
| Rate for Payer: Meridian Medicaid |
$26,401.19
|
| Rate for Payer: PHP Medicaid |
$23,869.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$25,143.99
|
| Rate for Payer: UHC Medicaid |
$25,143.99
|
| Rate for Payer: UHCCP Medicaid |
$25,143.99
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$62,769.52
|
|
|
Service Code
|
APR-DRG 0043
|
| Min. Negotiated Rate |
$56,751.16 |
| Max. Negotiated Rate |
$62,769.52 |
| Rate for Payer: BCBS Complete |
$62,769.52
|
| Rate for Payer: Mclaren Medicaid |
$59,780.50
|
| Rate for Payer: Meridian Medicaid |
$62,769.52
|
| Rate for Payer: PHP Medicaid |
$56,751.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$59,780.50
|
| Rate for Payer: UHC Medicaid |
$59,780.50
|
| Rate for Payer: UHCCP Medicaid |
$59,780.50
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$12,047.75
|
|
|
Service Code
|
APR-DRG 0051
|
| Min. Negotiated Rate |
$10,892.61 |
| Max. Negotiated Rate |
$12,047.75 |
| Rate for Payer: BCBS Complete |
$12,047.75
|
| Rate for Payer: Mclaren Medicaid |
$11,474.05
|
| Rate for Payer: Meridian Medicaid |
$12,047.75
|
| Rate for Payer: PHP Medicaid |
$10,892.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,474.05
|
| Rate for Payer: UHC Medicaid |
$11,474.05
|
| Rate for Payer: UHCCP Medicaid |
$11,474.05
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$23,134.76
|
|
|
Service Code
|
APR-DRG 0052
|
| Min. Negotiated Rate |
$20,916.59 |
| Max. Negotiated Rate |
$23,134.76 |
| Rate for Payer: BCBS Complete |
$23,134.76
|
| Rate for Payer: Mclaren Medicaid |
$22,033.11
|
| Rate for Payer: Meridian Medicaid |
$23,134.76
|
| Rate for Payer: PHP Medicaid |
$20,916.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,033.11
|
| Rate for Payer: UHC Medicaid |
$22,033.11
|
| Rate for Payer: UHCCP Medicaid |
$22,033.11
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$52,635.09
|
|
|
Service Code
|
APR-DRG 0053
|
| Min. Negotiated Rate |
$47,588.41 |
| Max. Negotiated Rate |
$52,635.09 |
| Rate for Payer: BCBS Complete |
$52,635.09
|
| Rate for Payer: Mclaren Medicaid |
$50,128.65
|
| Rate for Payer: Meridian Medicaid |
$52,635.09
|
| Rate for Payer: PHP Medicaid |
$47,588.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$50,128.65
|
| Rate for Payer: UHC Medicaid |
$50,128.65
|
| Rate for Payer: UHCCP Medicaid |
$50,128.65
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$65,059.95
|
|
|
Service Code
|
APR-DRG 0054
|
| Min. Negotiated Rate |
$58,821.97 |
| Max. Negotiated Rate |
$65,059.95 |
| Rate for Payer: BCBS Complete |
$65,059.95
|
| Rate for Payer: Mclaren Medicaid |
$61,961.85
|
| Rate for Payer: Meridian Medicaid |
$65,059.95
|
| Rate for Payer: PHP Medicaid |
$58,821.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$61,961.85
|
| Rate for Payer: UHC Medicaid |
$61,961.85
|
| Rate for Payer: UHCCP Medicaid |
$61,961.85
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
OP
|
$2.84
|
|
|
Service Code
|
NDC 68084080811
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna Commercial |
$2.56
|
| Rate for Payer: Aetna Medicare |
$1.05
|
| Rate for Payer: ASR ASR |
$2.76
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: BCBS Trust/PPO |
$2.34
|
| Rate for Payer: BCN Commercial |
$2.34
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.28
|
| Rate for Payer: Healthscope Commercial |
$2.76
|
| Rate for Payer: Healthscope Whirlpool |
$2.84
|
| Rate for Payer: Mclaren Commercial |
$2.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.42
|
| Rate for Payer: Nomi Health Commercial |
$2.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.49
|
| Rate for Payer: Priority Health Narrow Network |
$1.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.50
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
OP
|
$1.01
|
|
|
Service Code
|
NDC 51079099101
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Aetna Commercial |
$0.91
|
| Rate for Payer: Aetna Medicare |
$0.37
|
| Rate for Payer: ASR ASR |
$0.98
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.83
|
| Rate for Payer: BCN Commercial |
$0.83
|
| 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 |
$0.98
|
| Rate for Payer: Healthscope Whirlpool |
$1.01
|
| Rate for Payer: Mclaren Commercial |
$0.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.86
|
| Rate for Payer: Nomi Health Commercial |
$0.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.89
|
| Rate for Payer: Priority Health Narrow Network |
$0.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.89
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
OP
|
$284.35
|
|
|
Service Code
|
NDC 68084080801
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.21 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$255.91
|
| Rate for Payer: Aetna Medicare |
$105.21
|
| Rate for Payer: ASR ASR |
$275.82
|
| Rate for Payer: BCBS Complete |
$113.74
|
| Rate for Payer: BCBS Trust/PPO |
$234.45
|
| Rate for Payer: BCN Commercial |
$234.45
|
| 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 |
$275.82
|
| Rate for Payer: Healthscope Whirlpool |
$284.35
|
| Rate for Payer: Mclaren Commercial |
$255.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$249.15
|
| Rate for Payer: Priority Health Narrow Network |
$199.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.23
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$284.35
|
|
|
Service Code
|
NDC 68084080801
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.26 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$255.91
|
| Rate for Payer: ASR ASR |
$275.82
|
| Rate for Payer: BCBS Trust/PPO |
$233.51
|
| Rate for Payer: BCN Commercial |
$233.51
|
| 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 |
$275.82
|
| Rate for Payer: Healthscope Whirlpool |
$284.35
|
| Rate for Payer: Mclaren Commercial |
$255.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.23
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$2.84
|
|
|
Service Code
|
NDC 68084080811
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna Commercial |
$2.56
|
| Rate for Payer: ASR ASR |
$2.76
|
| Rate for Payer: BCBS Trust/PPO |
$2.34
|
| Rate for Payer: BCN Commercial |
$2.34
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.28
|
| Rate for Payer: Healthscope Commercial |
$2.76
|
| Rate for Payer: Healthscope Whirlpool |
$2.84
|
| Rate for Payer: Mclaren Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.42
|
| Rate for Payer: Nomi Health Commercial |
$2.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.50
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$1.01
|
|
|
Service Code
|
NDC 51079099101
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.76 |
| 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 |
$0.83
|
| Rate for Payer: BCN Commercial |
$0.83
|
| 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 |
$0.98
|
| Rate for Payer: Healthscope Whirlpool |
$1.01
|
| Rate for Payer: Mclaren Commercial |
$0.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.86
|
| Rate for Payer: Nomi Health Commercial |
$0.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.89
|
|
