Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

TOLVAPTAN 15 MG TABLET

Facility

$2,108.52

Service Code	NDC 67877063533
Hospital Charge Code	97893
Hospital Revenue Code	637
Min. Negotiated Rate	$828.65
Max. Negotiated Rate	$1,897.67
Rate for Payer: Aetna Commercial	$1,792.24
Rate for Payer: Aetna Medicare	$1,054.26
Rate for Payer: Aetna New Business (MI Preferred)	$1,370.54
Rate for Payer: BCBS Complete	$843.41
Rate for Payer: Cash Price	$1,686.82
Rate for Payer: Cofinity Advantage	$1,475.96
Rate for Payer: Cofinity Commercial	$1,813.33
Rate for Payer: Encore Health Key Benefits Commercial	$1,686.82
Rate for Payer: Healthscope Commercial	$1,897.67
Rate for Payer: MI Amish Medical Board Commercial	$1,686.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,792.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,581.39
Rate for Payer: PHP Commercial	$1,792.24
Rate for Payer: Priority Health SBD	$1,328.37
Rate for Payer: UHC All Payor (Choice/PPO)	$1,370.54
Rate for Payer: UHC Core	$1,098.54
Rate for Payer: UHC Exchange	$828.65

TOLVAPTAN 15 MG TABLET

Facility

$206.46

Service Code	NDC 49884076852
Hospital Charge Code	97893
Hospital Revenue Code	637
Min. Negotiated Rate	$130.07
Max. Negotiated Rate	$185.81
Rate for Payer: Aetna Commercial	$175.49
Rate for Payer: Aetna New Business (MI Preferred)	$134.20
Rate for Payer: Cash Price	$165.17
Rate for Payer: Cofinity Advantage	$144.52
Rate for Payer: Cofinity Commercial	$177.56
Rate for Payer: Encore Health Key Benefits Commercial	$165.17
Rate for Payer: Healthscope Commercial	$185.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$175.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$154.84
Rate for Payer: PHP Commercial	$175.49
Rate for Payer: Priority Health SBD	$130.07

TOLVAPTAN 15 MG TABLET

Facility

$19,247.29

Service Code	NDC 59148002050
Hospital Charge Code	97893
Hospital Revenue Code	637
Min. Negotiated Rate	$7,564.18
Max. Negotiated Rate	$17,322.56
Rate for Payer: Aetna Commercial	$16,360.20
Rate for Payer: Aetna Medicare	$9,623.65
Rate for Payer: Aetna New Business (MI Preferred)	$12,510.74
Rate for Payer: BCBS Complete	$7,698.92
Rate for Payer: Cash Price	$15,397.83
Rate for Payer: Cofinity Advantage	$13,473.10
Rate for Payer: Cofinity Commercial	$16,552.67
Rate for Payer: Encore Health Key Benefits Commercial	$15,397.83
Rate for Payer: Healthscope Commercial	$17,322.56
Rate for Payer: MI Amish Medical Board Commercial	$15,397.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16,360.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$14,435.47
Rate for Payer: PHP Commercial	$16,360.20
Rate for Payer: Priority Health SBD	$12,125.79
Rate for Payer: UHC All Payor (Choice/PPO)	$12,510.74
Rate for Payer: UHC Core	$10,027.84
Rate for Payer: UHC Exchange	$7,564.18

TOLVAPTAN 15 MG TABLET

Facility

$2,064.60

Service Code	NDC 49884076854
Hospital Charge Code	97893
Hospital Revenue Code	637
Min. Negotiated Rate	$1,300.70
Max. Negotiated Rate	$1,858.14
Rate for Payer: Aetna Commercial	$1,754.91
Rate for Payer: Aetna New Business (MI Preferred)	$1,341.99
Rate for Payer: Cash Price	$1,651.68
Rate for Payer: Cofinity Advantage	$1,445.22
Rate for Payer: Cofinity Commercial	$1,775.56
Rate for Payer: Encore Health Key Benefits Commercial	$1,651.68
Rate for Payer: Healthscope Commercial	$1,858.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,754.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,548.45
Rate for Payer: PHP Commercial	$1,754.91
Rate for Payer: Priority Health SBD	$1,300.70

TOLVAPTAN 15 MG TABLET

Facility

$19,247.29

Service Code	NDC 59148002050
Hospital Charge Code	97893
Hospital Revenue Code	637
Min. Negotiated Rate	$12,125.79
Max. Negotiated Rate	$17,322.56
Rate for Payer: Aetna Commercial	$16,360.20
Rate for Payer: Aetna New Business (MI Preferred)	$12,510.74
Rate for Payer: Cash Price	$15,397.83
Rate for Payer: Cofinity Advantage	$13,473.10
Rate for Payer: Cofinity Commercial	$16,552.67
Rate for Payer: Encore Health Key Benefits Commercial	$15,397.83
Rate for Payer: Healthscope Commercial	$17,322.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16,360.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$14,435.47
Rate for Payer: PHP Commercial	$16,360.20
Rate for Payer: Priority Health SBD	$12,125.79

TOLVAPTAN 15 MG TABLET

Facility

$206.46

Service Code	NDC 49884076852
Hospital Charge Code	97893
Hospital Revenue Code	637
Min. Negotiated Rate	$81.14
Max. Negotiated Rate	$185.81
Rate for Payer: Aetna Commercial	$175.49
Rate for Payer: Aetna Medicare	$103.23
Rate for Payer: Aetna New Business (MI Preferred)	$134.20
Rate for Payer: BCBS Complete	$82.58
Rate for Payer: Cash Price	$165.17
Rate for Payer: Cofinity Advantage	$144.52
Rate for Payer: Cofinity Commercial	$177.56
Rate for Payer: Encore Health Key Benefits Commercial	$165.17
Rate for Payer: Healthscope Commercial	$185.81
Rate for Payer: MI Amish Medical Board Commercial	$165.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$175.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$154.84
Rate for Payer: PHP Commercial	$175.49
Rate for Payer: Priority Health SBD	$130.07
Rate for Payer: UHC All Payor (Choice/PPO)	$134.20
Rate for Payer: UHC Core	$107.57
Rate for Payer: UHC Exchange	$81.14

TOLVAPTAN 15 MG TABLET

Facility

$2,064.60

Service Code	NDC 49884076854
Hospital Charge Code	97893
Hospital Revenue Code	637
Min. Negotiated Rate	$811.39
Max. Negotiated Rate	$1,858.14
Rate for Payer: Aetna Commercial	$1,754.91
Rate for Payer: Aetna Medicare	$1,032.30
Rate for Payer: Aetna New Business (MI Preferred)	$1,341.99
Rate for Payer: BCBS Complete	$825.84
Rate for Payer: Cash Price	$1,651.68
Rate for Payer: Cofinity Advantage	$1,445.22
Rate for Payer: Cofinity Commercial	$1,775.56
Rate for Payer: Encore Health Key Benefits Commercial	$1,651.68
Rate for Payer: Healthscope Commercial	$1,858.14
Rate for Payer: MI Amish Medical Board Commercial	$1,651.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,754.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,548.45
Rate for Payer: PHP Commercial	$1,754.91
Rate for Payer: Priority Health SBD	$1,300.70
Rate for Payer: UHC All Payor (Choice/PPO)	$1,341.99
Rate for Payer: UHC Core	$1,075.66
Rate for Payer: UHC Exchange	$811.39

TOLVAPTAN 15 MG TABLET

Facility

$2,108.52

Service Code	NDC 67877063533
Hospital Charge Code	97893
Hospital Revenue Code	637
Min. Negotiated Rate	$1,328.37
Max. Negotiated Rate	$1,897.67
Rate for Payer: Aetna Commercial	$1,792.24
Rate for Payer: Aetna New Business (MI Preferred)	$1,370.54
Rate for Payer: Cash Price	$1,686.82
Rate for Payer: Cofinity Advantage	$1,475.96
Rate for Payer: Cofinity Commercial	$1,813.33
Rate for Payer: Encore Health Key Benefits Commercial	$1,686.82
Rate for Payer: Healthscope Commercial	$1,897.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,792.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,581.39
Rate for Payer: PHP Commercial	$1,792.24
Rate for Payer: Priority Health SBD	$1,328.37

TONSIL AND ADENOID PROCEDURES

Facility

$11,714.24

Service Code	APR-DRG 0973
Min. Negotiated Rate	$11,156.42
Max. Negotiated Rate	$11,714.24
Rate for Payer: BCBS Complete	$11,714.24
Rate for Payer: Mclaren Medicaid	$11,156.42
Rate for Payer: Meridian Medicaid	$11,714.24
Rate for Payer: Priority Health Choice Medicaid	$11,156.42
Rate for Payer: UHC Medicaid	$11,156.42
Rate for Payer: UHCCP Medicaid	$11,156.42

TONSIL AND ADENOID PROCEDURES

Facility

$20,844.61

Service Code	APR-DRG 0974
Min. Negotiated Rate	$19,852.01
Max. Negotiated Rate	$20,844.61
Rate for Payer: BCBS Complete	$20,844.61
Rate for Payer: Mclaren Medicaid	$19,852.01
Rate for Payer: Meridian Medicaid	$20,844.61
Rate for Payer: Priority Health Choice Medicaid	$19,852.01
Rate for Payer: UHC Medicaid	$19,852.01
Rate for Payer: UHCCP Medicaid	$19,852.01

TONSIL AND ADENOID PROCEDURES

Facility

$5,136.19

Service Code	APR-DRG 0971
Min. Negotiated Rate	$4,891.61
Max. Negotiated Rate	$5,136.19
Rate for Payer: BCBS Complete	$5,136.19
Rate for Payer: Mclaren Medicaid	$4,891.61
Rate for Payer: Meridian Medicaid	$5,136.19
Rate for Payer: Priority Health Choice Medicaid	$4,891.61
Rate for Payer: UHC Medicaid	$4,891.61
Rate for Payer: UHCCP Medicaid	$4,891.61

TONSIL AND ADENOID PROCEDURES

Facility

$7,824.97

Service Code	APR-DRG 0972
Min. Negotiated Rate	$7,452.35
Max. Negotiated Rate	$7,824.97
Rate for Payer: BCBS Complete	$7,824.97
Rate for Payer: Mclaren Medicaid	$7,452.35
Rate for Payer: Meridian Medicaid	$7,824.97
Rate for Payer: Priority Health Choice Medicaid	$7,452.35
Rate for Payer: UHC Medicaid	$7,452.35
Rate for Payer: UHCCP Medicaid	$7,452.35

TONSILLECTOMY AND ADENOIDECTOMY; AGE 12 OR OVER

Facility

$10,683.35

Service Code	CPT 42821
Hospital Revenue Code	360
Min. Negotiated Rate	$1,390.76
Max. Negotiated Rate	$10,683.35
Rate for Payer: Aetna Medicare	$3,435.68
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,129.43
Rate for Payer: Amish Plain Church Group Commercial	$4,129.43
Rate for Payer: BCBS Complete	$1,814.30
Rate for Payer: BCBS MAPPO	$3,303.54
Rate for Payer: BCBS Trust/PPO	$1,390.76
Rate for Payer: BCN Commercial	$1,390.76
Rate for Payer: BCN Medicare Advantage	$3,303.54
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,303.54
Rate for Payer: Mclaren Medicaid	$1,727.75
Rate for Payer: Mclaren Medicare	$3,303.54
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,468.72
Rate for Payer: Meridian Medicaid	$3,468.72
Rate for Payer: MI Amish Medical Board Commercial	$3,799.07
Rate for Payer: Molina Medicare/Medicaid	$3,633.89
Rate for Payer: Nomi Health Commercial	$9,910.62
Rate for Payer: PACE Medicare	$3,138.36
Rate for Payer: PACE SWMI	$3,303.54
Rate for Payer: PHP Medicare Advantage	$3,303.54
Rate for Payer: Priority Health Choice Medicaid	$1,727.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$10,683.35
Rate for Payer: Priority Health Medicare	$3,303.54
Rate for Payer: Priority Health Tiered Network	$8,546.68
Rate for Payer: Railroad Medicare Medicare	$3,303.54
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$3,303.54
Rate for Payer: UHC Medicaid	$1,727.75
Rate for Payer: UHCCP Medicaid	$1,727.75
Rate for Payer: VA VA	$3,303.54

TONSILLECTOMY AND ADENOIDECTOMY; YOUNGER THAN AGE 12

Facility

$19,075.37

Service Code	CPT 42820
Hospital Revenue Code	360
Min. Negotiated Rate	$2,062.78
Max. Negotiated Rate	$19,075.37
Rate for Payer: Aetna Medicare	$6,134.48
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,373.18
Rate for Payer: Amish Plain Church Group Commercial	$7,373.18
Rate for Payer: BCBS Complete	$3,239.48
Rate for Payer: BCBS MAPPO	$5,898.54
Rate for Payer: BCBS Trust/PPO	$2,062.78
Rate for Payer: BCN Commercial	$2,062.78
Rate for Payer: BCN Medicare Advantage	$5,898.54
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,898.54
Rate for Payer: Mclaren Medicaid	$3,084.94
Rate for Payer: Mclaren Medicare	$5,898.54
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,193.47
Rate for Payer: Meridian Medicaid	$6,193.47
Rate for Payer: MI Amish Medical Board Commercial	$6,783.32
Rate for Payer: Molina Medicare/Medicaid	$6,488.39
Rate for Payer: Nomi Health Commercial	$17,695.62
Rate for Payer: PACE Medicare	$5,603.61
Rate for Payer: PACE SWMI	$5,898.54
Rate for Payer: PHP Medicare Advantage	$5,898.54
Rate for Payer: Priority Health Choice Medicaid	$3,084.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$19,075.37
Rate for Payer: Priority Health Medicare	$5,898.54
Rate for Payer: Priority Health Tiered Network	$15,260.30
Rate for Payer: Railroad Medicare Medicare	$5,898.54
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$5,898.54
Rate for Payer: UHC Medicaid	$3,084.94
Rate for Payer: UHCCP Medicaid	$3,084.94
Rate for Payer: VA VA	$5,898.54

TONSILLECTOMY, PRIMARY OR SECONDARY; AGE 12 OR OVER

Facility

$10,683.35

Service Code	CPT 42826
Hospital Revenue Code	360
Min. Negotiated Rate	$1,727.75
Max. Negotiated Rate	$10,683.35
Rate for Payer: Aetna Medicare	$3,435.68
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,129.43
Rate for Payer: Amish Plain Church Group Commercial	$4,129.43
Rate for Payer: BCBS Complete	$1,814.30
Rate for Payer: BCBS MAPPO	$3,303.54
Rate for Payer: BCBS Trust/PPO	$2,022.55
Rate for Payer: BCN Commercial	$2,022.55
Rate for Payer: BCN Medicare Advantage	$3,303.54
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,303.54
Rate for Payer: Mclaren Medicaid	$1,727.75
Rate for Payer: Mclaren Medicare	$3,303.54
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,468.72
Rate for Payer: Meridian Medicaid	$3,468.72
Rate for Payer: MI Amish Medical Board Commercial	$3,799.07
Rate for Payer: Molina Medicare/Medicaid	$3,633.89
Rate for Payer: Nomi Health Commercial	$9,910.62
Rate for Payer: PACE Medicare	$3,138.36
Rate for Payer: PACE SWMI	$3,303.54
Rate for Payer: PHP Medicare Advantage	$3,303.54
Rate for Payer: Priority Health Choice Medicaid	$1,727.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$10,683.35
Rate for Payer: Priority Health Medicare	$3,303.54
Rate for Payer: Priority Health Tiered Network	$8,546.68
Rate for Payer: Railroad Medicare Medicare	$3,303.54
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$3,303.54
Rate for Payer: UHC Medicaid	$1,727.75
Rate for Payer: UHCCP Medicaid	$1,727.75
Rate for Payer: VA VA	$3,303.54

TOPIRAMATE 100 MG TABLET

Facility

$417.05

Service Code	NDC 68084034401
Hospital Charge Code	18922
Hospital Revenue Code	637
Min. Negotiated Rate	$262.74
Max. Negotiated Rate	$375.35
Rate for Payer: Aetna Commercial	$354.49
Rate for Payer: Aetna New Business (MI Preferred)	$271.08
Rate for Payer: Cash Price	$333.64
Rate for Payer: Cofinity Advantage	$291.94
Rate for Payer: Cofinity Commercial	$358.66
Rate for Payer: Encore Health Key Benefits Commercial	$333.64
Rate for Payer: Healthscope Commercial	$375.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$354.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$312.79
Rate for Payer: PHP Commercial	$354.49
Rate for Payer: Priority Health SBD	$262.74

TOPIRAMATE 100 MG TABLET

Facility

$417.05

Service Code	NDC 68084034401
Hospital Charge Code	18922
Hospital Revenue Code	637
Min. Negotiated Rate	$163.90
Max. Negotiated Rate	$375.35
Rate for Payer: Aetna Commercial	$354.49
Rate for Payer: Aetna Medicare	$208.53
Rate for Payer: Aetna New Business (MI Preferred)	$271.08
Rate for Payer: BCBS Complete	$166.82
Rate for Payer: Cash Price	$333.64
Rate for Payer: Cofinity Advantage	$291.94
Rate for Payer: Cofinity Commercial	$358.66
Rate for Payer: Encore Health Key Benefits Commercial	$333.64
Rate for Payer: Healthscope Commercial	$375.35
Rate for Payer: MI Amish Medical Board Commercial	$333.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$354.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$312.79
Rate for Payer: PHP Commercial	$354.49
Rate for Payer: Priority Health SBD	$262.74
Rate for Payer: UHC All Payor (Choice/PPO)	$271.08
Rate for Payer: UHC Core	$217.28
Rate for Payer: UHC Exchange	$163.90

TOPIRAMATE 100 MG TABLET

Facility

$417.05

Service Code	NDC 68084034411
Hospital Charge Code	18922
Hospital Revenue Code	637
Min. Negotiated Rate	$163.90
Max. Negotiated Rate	$375.35
Rate for Payer: Aetna Commercial	$354.49
Rate for Payer: Aetna Medicare	$208.53
Rate for Payer: Aetna New Business (MI Preferred)	$271.08
Rate for Payer: BCBS Complete	$166.82
Rate for Payer: Cash Price	$333.64
Rate for Payer: Cofinity Advantage	$291.94
Rate for Payer: Cofinity Commercial	$358.66
Rate for Payer: Encore Health Key Benefits Commercial	$333.64
Rate for Payer: Healthscope Commercial	$375.35
Rate for Payer: MI Amish Medical Board Commercial	$333.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$354.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$312.79
Rate for Payer: PHP Commercial	$354.49
Rate for Payer: Priority Health SBD	$262.74
Rate for Payer: UHC All Payor (Choice/PPO)	$271.08
Rate for Payer: UHC Core	$217.28
Rate for Payer: UHC Exchange	$163.90

TOPIRAMATE 100 MG TABLET

Facility

$417.05

Service Code	NDC 68084034411
Hospital Charge Code	18922
Hospital Revenue Code	637
Min. Negotiated Rate	$262.74
Max. Negotiated Rate	$375.35
Rate for Payer: Aetna Commercial	$354.49
Rate for Payer: Aetna New Business (MI Preferred)	$271.08
Rate for Payer: Cash Price	$333.64
Rate for Payer: Cofinity Advantage	$291.94
Rate for Payer: Cofinity Commercial	$358.66
Rate for Payer: Encore Health Key Benefits Commercial	$333.64
Rate for Payer: Healthscope Commercial	$375.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$354.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$312.79
Rate for Payer: PHP Commercial	$354.49
Rate for Payer: Priority Health SBD	$262.74

TOPIRAMATE 25 MG TABLET

Facility

$232.75

Service Code	NDC 68084034211
Hospital Charge Code	18920
Hospital Revenue Code	637
Min. Negotiated Rate	$91.47
Max. Negotiated Rate	$209.47
Rate for Payer: Aetna Commercial	$197.84
Rate for Payer: Aetna Medicare	$116.38
Rate for Payer: Aetna New Business (MI Preferred)	$151.29
Rate for Payer: BCBS Complete	$93.10
Rate for Payer: Cash Price	$186.20
Rate for Payer: Cofinity Advantage	$162.93
Rate for Payer: Cofinity Commercial	$200.16
Rate for Payer: Encore Health Key Benefits Commercial	$186.20
Rate for Payer: Healthscope Commercial	$209.47
Rate for Payer: MI Amish Medical Board Commercial	$186.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$197.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$174.56
Rate for Payer: PHP Commercial	$197.84
Rate for Payer: Priority Health SBD	$146.63
Rate for Payer: UHC All Payor (Choice/PPO)	$151.29
Rate for Payer: UHC Core	$121.26
Rate for Payer: UHC Exchange	$91.47

TOPIRAMATE 25 MG TABLET

Facility

$211.85

Service Code	NDC 00904692861
Hospital Charge Code	18920
Hospital Revenue Code	637
Min. Negotiated Rate	$83.26
Max. Negotiated Rate	$190.66
Rate for Payer: Aetna Commercial	$180.07
Rate for Payer: Aetna Medicare	$105.92
Rate for Payer: Aetna New Business (MI Preferred)	$137.70
Rate for Payer: BCBS Complete	$84.74
Rate for Payer: Cash Price	$169.48
Rate for Payer: Cofinity Advantage	$148.29
Rate for Payer: Cofinity Commercial	$182.19
Rate for Payer: Encore Health Key Benefits Commercial	$169.48
Rate for Payer: Healthscope Commercial	$190.66
Rate for Payer: MI Amish Medical Board Commercial	$169.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$180.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$158.89
Rate for Payer: PHP Commercial	$180.07
Rate for Payer: Priority Health SBD	$133.47
Rate for Payer: UHC All Payor (Choice/PPO)	$137.70
Rate for Payer: UHC Core	$110.37
Rate for Payer: UHC Exchange	$83.26

TOPIRAMATE 25 MG TABLET

Facility

$232.75

Service Code	NDC 68084034211
Hospital Charge Code	18920
Hospital Revenue Code	637
Min. Negotiated Rate	$146.63
Max. Negotiated Rate	$209.47
Rate for Payer: Aetna Commercial	$197.84
Rate for Payer: Aetna New Business (MI Preferred)	$151.29
Rate for Payer: Cash Price	$186.20
Rate for Payer: Cofinity Advantage	$162.93
Rate for Payer: Cofinity Commercial	$200.16
Rate for Payer: Encore Health Key Benefits Commercial	$186.20
Rate for Payer: Healthscope Commercial	$209.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$197.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$174.56
Rate for Payer: PHP Commercial	$197.84
Rate for Payer: Priority Health SBD	$146.63

TOPIRAMATE 25 MG TABLET

Facility

$232.75

Service Code	NDC 68084034201
Hospital Charge Code	18920
Hospital Revenue Code	637
Min. Negotiated Rate	$91.47
Max. Negotiated Rate	$209.47
Rate for Payer: Aetna Commercial	$197.84
Rate for Payer: Aetna Medicare	$116.38
Rate for Payer: Aetna New Business (MI Preferred)	$151.29
Rate for Payer: BCBS Complete	$93.10
Rate for Payer: Cash Price	$186.20
Rate for Payer: Cofinity Advantage	$162.93
Rate for Payer: Cofinity Commercial	$200.16
Rate for Payer: Encore Health Key Benefits Commercial	$186.20
Rate for Payer: Healthscope Commercial	$209.47
Rate for Payer: MI Amish Medical Board Commercial	$186.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$197.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$174.56
Rate for Payer: PHP Commercial	$197.84
Rate for Payer: Priority Health SBD	$146.63
Rate for Payer: UHC All Payor (Choice/PPO)	$151.29
Rate for Payer: UHC Core	$121.26
Rate for Payer: UHC Exchange	$91.47

TOPIRAMATE 25 MG TABLET

Facility

$1,421.47

Service Code	NDC 50458063965
Hospital Charge Code	18920
Hospital Revenue Code	637
Min. Negotiated Rate	$558.64
Max. Negotiated Rate	$1,279.32
Rate for Payer: Aetna Commercial	$1,208.25
Rate for Payer: Aetna Medicare	$710.74
Rate for Payer: Aetna New Business (MI Preferred)	$923.96
Rate for Payer: BCBS Complete	$568.59
Rate for Payer: Cash Price	$1,137.18
Rate for Payer: Cofinity Advantage	$995.03
Rate for Payer: Cofinity Commercial	$1,222.46
Rate for Payer: Encore Health Key Benefits Commercial	$1,137.18
Rate for Payer: Healthscope Commercial	$1,279.32
Rate for Payer: MI Amish Medical Board Commercial	$1,137.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,208.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,066.10
Rate for Payer: PHP Commercial	$1,208.25
Rate for Payer: Priority Health SBD	$895.53
Rate for Payer: UHC All Payor (Choice/PPO)	$923.96
Rate for Payer: UHC Core	$740.59
Rate for Payer: UHC Exchange	$558.64

TOPIRAMATE 25 MG TABLET

Facility

$53.58

Service Code	NDC 68382013814
Hospital Charge Code	18920
Hospital Revenue Code	637
Min. Negotiated Rate	$21.06
Max. Negotiated Rate	$48.22
Rate for Payer: Aetna Commercial	$45.54
Rate for Payer: Aetna Medicare	$26.79
Rate for Payer: Aetna New Business (MI Preferred)	$34.83
Rate for Payer: BCBS Complete	$21.43
Rate for Payer: Cash Price	$42.86
Rate for Payer: Cofinity Advantage	$37.51
Rate for Payer: Cofinity Commercial	$46.08
Rate for Payer: Encore Health Key Benefits Commercial	$42.86
Rate for Payer: Healthscope Commercial	$48.22
Rate for Payer: MI Amish Medical Board Commercial	$42.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$45.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$40.19
Rate for Payer: PHP Commercial	$45.54
Rate for Payer: Priority Health SBD	$33.76
Rate for Payer: UHC All Payor (Choice/PPO)	$34.83
Rate for Payer: UHC Core	$27.92
Rate for Payer: UHC Exchange	$21.06

Know your out-of-pocket cost for care.

All Charges