|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.84
|
|
|
Service Code
|
NDC 81284061100
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna Commercial |
$14.26
|
| Rate for Payer: ASR ASR |
$15.36
|
| Rate for Payer: ASR Commercial |
$15.36
|
| Rate for Payer: BCBS Trust/PPO |
$12.91
|
| Rate for Payer: BCN Commercial |
$12.28
|
| Rate for Payer: Cash Price |
$12.67
|
| Rate for Payer: Cofinity Commercial |
$14.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.67
|
| Rate for Payer: Healthscope Commercial |
$15.84
|
| Rate for Payer: Healthscope Whirlpool |
$15.36
|
| Rate for Payer: Mclaren Commercial |
$14.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.46
|
| Rate for Payer: Nomi Health Commercial |
$12.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.94
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.05
|
|
|
Service Code
|
NDC 72485010701
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: Aetna Medicare |
$12.02
|
| Rate for Payer: ASR ASR |
$23.33
|
| Rate for Payer: ASR Commercial |
$23.33
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS Trust/PPO |
$19.69
|
| 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 Commercial |
$20.44
|
| Rate for Payer: Nomi Health Commercial |
$19.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.07
|
| Rate for Payer: Priority Health Narrow Network |
$16.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$22.74
|
|
|
Service Code
|
NDC 47781060191
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$22.74 |
| Rate for Payer: Aetna Commercial |
$20.47
|
| Rate for Payer: Aetna Medicare |
$11.37
|
| Rate for Payer: ASR ASR |
$22.06
|
| Rate for Payer: ASR Commercial |
$22.06
|
| Rate for Payer: BCBS Complete |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$18.62
|
| 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 Commercial |
$19.33
|
| Rate for Payer: Nomi Health Commercial |
$18.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.92
|
| Rate for Payer: Priority Health Narrow Network |
$15.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.01
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.35
|
|
|
Service Code
|
NDC 55150018810
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$16.35 |
| Rate for Payer: Aetna Commercial |
$14.72
|
| Rate for Payer: Aetna Medicare |
$8.18
|
| Rate for Payer: ASR ASR |
$15.86
|
| Rate for Payer: ASR Commercial |
$15.86
|
| Rate for Payer: BCBS Complete |
$6.54
|
| Rate for Payer: BCBS Trust/PPO |
$13.39
|
| 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 Commercial |
$13.90
|
| Rate for Payer: Nomi Health Commercial |
$13.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.33
|
| Rate for Payer: Priority Health Narrow Network |
$11.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.39
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.39
|
|
|
Service Code
|
NDC 61990061100
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.76 |
| Max. Negotiated Rate |
$19.39 |
| Rate for Payer: Aetna Commercial |
$17.45
|
| Rate for Payer: Aetna Medicare |
$9.70
|
| Rate for Payer: ASR ASR |
$18.81
|
| Rate for Payer: ASR Commercial |
$18.81
|
| Rate for Payer: BCBS Complete |
$7.76
|
| Rate for Payer: BCBS Trust/PPO |
$15.88
|
| 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 Commercial |
$16.48
|
| Rate for Payer: Nomi Health Commercial |
$15.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.99
|
| Rate for Payer: Priority Health Narrow Network |
$13.59
|
| 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
|
$62.08
|
|
|
Service Code
|
NDC 67457019710
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.35 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Aetna Commercial |
$55.87
|
| Rate for Payer: ASR ASR |
$60.22
|
| Rate for Payer: ASR Commercial |
$60.22
|
| Rate for Payer: BCBS Trust/PPO |
$50.59
|
| 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 Commercial |
$52.77
|
| Rate for Payer: Nomi Health Commercial |
$50.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.35
|
| 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
|
$15.84
|
|
|
Service Code
|
NDC 81284061110
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna Commercial |
$14.26
|
| Rate for Payer: ASR ASR |
$15.36
|
| Rate for Payer: ASR Commercial |
$15.36
|
| Rate for Payer: BCBS Trust/PPO |
$12.91
|
| Rate for Payer: BCN Commercial |
$12.28
|
| Rate for Payer: Cash Price |
$12.67
|
| Rate for Payer: Cofinity Commercial |
$14.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.67
|
| Rate for Payer: Healthscope Commercial |
$15.84
|
| Rate for Payer: Healthscope Whirlpool |
$15.36
|
| Rate for Payer: Mclaren Commercial |
$14.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.46
|
| Rate for Payer: Nomi Health Commercial |
$12.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.94
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.35
|
|
|
Service Code
|
NDC 55150018810
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$16.35 |
| Rate for Payer: Aetna Commercial |
$14.72
|
| Rate for Payer: ASR ASR |
$15.86
|
| Rate for Payer: ASR Commercial |
$15.86
|
| Rate for Payer: BCBS Trust/PPO |
$13.32
|
| 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 Commercial |
$13.90
|
| Rate for Payer: Nomi Health Commercial |
$13.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.63
|
| 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
|
$19.39
|
|
|
Service Code
|
NDC 61990061102
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$19.39 |
| Rate for Payer: Aetna Commercial |
$17.45
|
| Rate for Payer: ASR ASR |
$18.81
|
| Rate for Payer: ASR Commercial |
$18.81
|
| Rate for Payer: BCBS Trust/PPO |
$15.80
|
| 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 Commercial |
$16.48
|
| Rate for Payer: Nomi Health Commercial |
$15.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.60
|
| 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 72485010710
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: ASR ASR |
$23.33
|
| Rate for Payer: ASR Commercial |
$23.33
|
| Rate for Payer: BCBS Trust/PPO |
$19.60
|
| 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 Commercial |
$20.44
|
| Rate for Payer: Nomi Health Commercial |
$19.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15.84
|
|
|
Service Code
|
NDC 81284061210
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna Commercial |
$14.26
|
| Rate for Payer: Aetna Medicare |
$7.92
|
| Rate for Payer: ASR ASR |
$15.36
|
| Rate for Payer: ASR Commercial |
$15.36
|
| Rate for Payer: BCBS Complete |
$6.34
|
| Rate for Payer: BCBS Trust/PPO |
$12.97
|
| Rate for Payer: BCN Commercial |
$12.28
|
| Rate for Payer: Cash Price |
$12.67
|
| Rate for Payer: Cofinity Commercial |
$14.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.67
|
| Rate for Payer: Healthscope Commercial |
$15.84
|
| Rate for Payer: Healthscope Whirlpool |
$15.36
|
| Rate for Payer: Mclaren Commercial |
$14.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.46
|
| Rate for Payer: Nomi Health Commercial |
$12.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.88
|
| Rate for Payer: Priority Health Narrow Network |
$11.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.94
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.99
|
|
|
Service Code
|
NDC 39822100001
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$23.99 |
| Rate for Payer: Aetna Commercial |
$21.59
|
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: ASR ASR |
$23.27
|
| Rate for Payer: ASR Commercial |
$23.27
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS Trust/PPO |
$19.65
|
| 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 Commercial |
$20.39
|
| Rate for Payer: Nomi Health Commercial |
$19.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.02
|
| Rate for Payer: Priority Health Narrow Network |
$16.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.11
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15.84
|
|
|
Service Code
|
NDC 81284061100
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna Commercial |
$14.26
|
| Rate for Payer: Aetna Medicare |
$7.92
|
| Rate for Payer: ASR ASR |
$15.36
|
| Rate for Payer: ASR Commercial |
$15.36
|
| Rate for Payer: BCBS Complete |
$6.34
|
| Rate for Payer: BCBS Trust/PPO |
$12.97
|
| Rate for Payer: BCN Commercial |
$12.28
|
| Rate for Payer: Cash Price |
$12.67
|
| Rate for Payer: Cofinity Commercial |
$14.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.67
|
| Rate for Payer: Healthscope Commercial |
$15.84
|
| Rate for Payer: Healthscope Whirlpool |
$15.36
|
| Rate for Payer: Mclaren Commercial |
$14.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.46
|
| Rate for Payer: Nomi Health Commercial |
$12.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.88
|
| Rate for Payer: Priority Health Narrow Network |
$11.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.94
|
|
|
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 |
$14.78 |
| Max. Negotiated Rate |
$22.74 |
| Rate for Payer: Aetna Commercial |
$20.47
|
| Rate for Payer: ASR ASR |
$22.06
|
| Rate for Payer: ASR Commercial |
$22.06
|
| Rate for Payer: BCBS Trust/PPO |
$18.53
|
| 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 Commercial |
$19.33
|
| Rate for Payer: Nomi Health Commercial |
$18.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.78
|
| 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 00517096001
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.18 |
| Max. Negotiated Rate |
$51.04 |
| Rate for Payer: Aetna Commercial |
$45.94
|
| Rate for Payer: ASR ASR |
$49.51
|
| Rate for Payer: ASR Commercial |
$49.51
|
| Rate for Payer: BCBS Trust/PPO |
$41.59
|
| 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 Commercial |
$43.38
|
| Rate for Payer: Nomi Health Commercial |
$41.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.92
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$22.74
|
|
|
Service Code
|
NDC 47781060122
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$22.74 |
| Rate for Payer: Aetna Commercial |
$20.47
|
| Rate for Payer: Aetna Medicare |
$11.37
|
| Rate for Payer: ASR ASR |
$22.06
|
| Rate for Payer: ASR Commercial |
$22.06
|
| Rate for Payer: BCBS Complete |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$18.62
|
| 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 Commercial |
$19.33
|
| Rate for Payer: Nomi Health Commercial |
$18.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.92
|
| Rate for Payer: Priority Health Narrow Network |
$15.94
|
| 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
|
$23.99
|
|
|
Service Code
|
NDC 39822100001
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.59 |
| Max. Negotiated Rate |
$23.99 |
| Rate for Payer: Aetna Commercial |
$21.59
|
| Rate for Payer: ASR ASR |
$23.27
|
| Rate for Payer: ASR Commercial |
$23.27
|
| Rate for Payer: BCBS Trust/PPO |
$19.55
|
| 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 Commercial |
$20.39
|
| Rate for Payer: Nomi Health Commercial |
$19.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.59
|
| 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
|
$51.04
|
|
|
Service Code
|
NDC 00517096010
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.18 |
| Max. Negotiated Rate |
$51.04 |
| Rate for Payer: Aetna Commercial |
$45.94
|
| Rate for Payer: ASR ASR |
$49.51
|
| Rate for Payer: ASR Commercial |
$49.51
|
| Rate for Payer: BCBS Trust/PPO |
$41.59
|
| 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 Commercial |
$43.38
|
| Rate for Payer: Nomi Health Commercial |
$41.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.18
|
| 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
|
$15.84
|
|
|
Service Code
|
NDC 81284061210
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna Commercial |
$14.26
|
| Rate for Payer: ASR ASR |
$15.36
|
| Rate for Payer: ASR Commercial |
$15.36
|
| Rate for Payer: BCBS Trust/PPO |
$12.91
|
| Rate for Payer: BCN Commercial |
$12.28
|
| Rate for Payer: Cash Price |
$12.67
|
| Rate for Payer: Cofinity Commercial |
$14.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.67
|
| Rate for Payer: Healthscope Commercial |
$15.84
|
| Rate for Payer: Healthscope Whirlpool |
$15.36
|
| Rate for Payer: Mclaren Commercial |
$14.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.46
|
| Rate for Payer: Nomi Health Commercial |
$12.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.94
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.39
|
|
|
Service Code
|
NDC 61990061100
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$19.39 |
| Rate for Payer: Aetna Commercial |
$17.45
|
| Rate for Payer: ASR ASR |
$18.81
|
| Rate for Payer: ASR Commercial |
$18.81
|
| Rate for Payer: BCBS Trust/PPO |
$15.80
|
| 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 Commercial |
$16.48
|
| Rate for Payer: Nomi Health Commercial |
$15.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.06
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$51.04
|
|
|
Service Code
|
NDC 00517096010
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.42 |
| Max. Negotiated Rate |
$51.04 |
| Rate for Payer: Aetna Commercial |
$45.94
|
| Rate for Payer: Aetna Medicare |
$25.52
|
| Rate for Payer: ASR ASR |
$49.51
|
| Rate for Payer: ASR Commercial |
$49.51
|
| Rate for Payer: BCBS Complete |
$20.42
|
| Rate for Payer: BCBS Trust/PPO |
$41.80
|
| 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 Commercial |
$43.38
|
| Rate for Payer: Nomi Health Commercial |
$41.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.72
|
| Rate for Payer: Priority Health Narrow Network |
$35.78
|
| 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
|
$24.05
|
|
|
Service Code
|
NDC 72485010701
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: ASR ASR |
$23.33
|
| Rate for Payer: ASR Commercial |
$23.33
|
| Rate for Payer: BCBS Trust/PPO |
$19.60
|
| 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 Commercial |
$20.44
|
| Rate for Payer: Nomi Health Commercial |
$19.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.05
|
|
|
Service Code
|
NDC 72485010710
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: Aetna Medicare |
$12.02
|
| Rate for Payer: ASR ASR |
$23.33
|
| Rate for Payer: ASR Commercial |
$23.33
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS Trust/PPO |
$19.69
|
| 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 Commercial |
$20.44
|
| Rate for Payer: Nomi Health Commercial |
$19.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.07
|
| Rate for Payer: Priority Health Narrow Network |
$16.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$51.04
|
|
|
Service Code
|
NDC 00517096001
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.42 |
| Max. Negotiated Rate |
$51.04 |
| Rate for Payer: Aetna Commercial |
$45.94
|
| Rate for Payer: Aetna Medicare |
$25.52
|
| Rate for Payer: ASR ASR |
$49.51
|
| Rate for Payer: ASR Commercial |
$49.51
|
| Rate for Payer: BCBS Complete |
$20.42
|
| Rate for Payer: BCBS Trust/PPO |
$41.80
|
| 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 Commercial |
$43.38
|
| Rate for Payer: Nomi Health Commercial |
$41.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.72
|
| Rate for Payer: Priority Health Narrow Network |
$35.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.92
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$62.08
|
|
|
Service Code
|
NDC 67457019700
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Aetna Commercial |
$55.87
|
| Rate for Payer: Aetna Medicare |
$31.04
|
| Rate for Payer: ASR ASR |
$60.22
|
| Rate for Payer: ASR Commercial |
$60.22
|
| Rate for Payer: BCBS Complete |
$24.83
|
| Rate for Payer: BCBS Trust/PPO |
$50.84
|
| 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 Commercial |
$52.77
|
| Rate for Payer: Nomi Health Commercial |
$50.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.39
|
| Rate for Payer: Priority Health Narrow Network |
$43.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.63
|
|
