|
TOCILIZUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,732.50
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
119446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,186.94 |
| Max. Negotiated Rate |
$6,059.25 |
| Rate for Payer: Aetna Commercial |
$5,722.62
|
| Rate for Payer: Aetna Medicare |
$1,750.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,103.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,103.91
|
| Rate for Payer: BCBS Complete |
$1,246.19
|
| Rate for Payer: BCBS MAPPO |
$1,683.12
|
| Rate for Payer: BCBS Trust/PPO |
$5,534.79
|
| Rate for Payer: BCN Commercial |
$5,534.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,683.12
|
| Rate for Payer: Cash Price |
$5,386.00
|
| Rate for Payer: Cofinity Commercial |
$5,789.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,386.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,683.12
|
| Rate for Payer: Healthscope Commercial |
$6,059.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,049.38
|
| Rate for Payer: Mclaren Medicaid |
$1,186.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,767.28
|
| Rate for Payer: Meridian Medicaid |
$1,246.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,935.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,851.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,722.62
|
| Rate for Payer: Nomi Health Commercial |
$5,520.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,049.38
|
| Rate for Payer: PACE Senior Care Partners |
$1,598.97
|
| Rate for Payer: PACE SWMI |
$1,683.12
|
| Rate for Payer: PHP Commercial |
$5,722.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,683.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,186.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,857.27
|
| Rate for Payer: Priority Health Medicare |
$1,699.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,685.82
|
| Rate for Payer: Railroad Medicare Medicare |
$1,683.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,924.60
|
| Rate for Payer: UHC Core |
$5,621.64
|
| Rate for Payer: UHC Exchange |
$1,683.12
|
| Rate for Payer: UHC Medicaid |
$1,186.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,683.12
|
| Rate for Payer: UHCCP Medicaid |
$1,186.94
|
| Rate for Payer: VA VA |
$1,683.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,049.38
|
|
|
TOCILIZUMAB 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,657.22
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
99452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,153.43 |
| Max. Negotiated Rate |
$1,491.50 |
| Rate for Payer: Aetna Commercial |
$1,408.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,368.70
|
| Rate for Payer: BCN Commercial |
$1,368.70
|
| Rate for Payer: Cash Price |
$1,325.78
|
| Rate for Payer: Cofinity Commercial |
$1,425.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,325.78
|
| Rate for Payer: Healthscope Commercial |
$1,491.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,242.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,408.64
|
| Rate for Payer: Nomi Health Commercial |
$1,358.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,242.91
|
| Rate for Payer: PHP Commercial |
$1,408.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,441.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,153.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,458.35
|
| Rate for Payer: UHC Core |
$1,383.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,242.91
|
|
|
TOCILIZUMAB 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,657.22
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
99452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$292.17 |
| Max. Negotiated Rate |
$1,491.50 |
| Rate for Payer: Aetna Commercial |
$1,408.64
|
| Rate for Payer: Aetna Medicare |
$430.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$517.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$517.88
|
| Rate for Payer: BCBS Complete |
$306.75
|
| Rate for Payer: BCBS MAPPO |
$414.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,362.40
|
| Rate for Payer: BCN Commercial |
$1,362.40
|
| Rate for Payer: BCN Medicare Advantage |
$414.31
|
| Rate for Payer: Cash Price |
$1,325.78
|
| Rate for Payer: Cofinity Commercial |
$1,425.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,325.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$414.31
|
| Rate for Payer: Healthscope Commercial |
$1,491.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,242.91
|
| Rate for Payer: Mclaren Medicaid |
$292.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$435.02
|
| Rate for Payer: Meridian Medicaid |
$306.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$476.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$455.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,408.64
|
| Rate for Payer: Nomi Health Commercial |
$1,358.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,242.91
|
| Rate for Payer: PACE Senior Care Partners |
$393.59
|
| Rate for Payer: PACE SWMI |
$414.31
|
| Rate for Payer: PHP Commercial |
$1,408.64
|
| Rate for Payer: PHP Medicare Advantage |
$414.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$292.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,441.78
|
| Rate for Payer: Priority Health Medicare |
$418.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,153.43
|
| Rate for Payer: Railroad Medicare Medicare |
$414.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,458.35
|
| Rate for Payer: UHC Core |
$1,383.78
|
| Rate for Payer: UHC Exchange |
$414.31
|
| Rate for Payer: UHC Medicaid |
$292.17
|
| Rate for Payer: UHC Medicare Advantage |
$414.31
|
| Rate for Payer: UHCCP Medicaid |
$292.17
|
| Rate for Payer: VA VA |
$414.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,242.91
|
|
|
TOLVAPTAN 15 MG TABLET
|
Facility
|
OP
|
$19,247.29
|
|
|
Service Code
|
NDC 59148002050
|
| Hospital Charge Code |
97893
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,393.30 |
| Max. Negotiated Rate |
$17,322.56 |
| Rate for Payer: Aetna Commercial |
$16,360.20
|
| Rate for Payer: Aetna Medicare |
$5,004.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,014.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,014.78
|
| Rate for Payer: BCBS Complete |
$3,562.67
|
| Rate for Payer: BCBS MAPPO |
$4,811.82
|
| Rate for Payer: BCBS Trust/PPO |
$15,823.20
|
| Rate for Payer: BCN Commercial |
$15,823.20
|
| Rate for Payer: BCN Medicare Advantage |
$4,811.82
|
| Rate for Payer: Cash Price |
$15,397.83
|
| Rate for Payer: Cofinity Commercial |
$16,552.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,397.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,811.82
|
| Rate for Payer: Healthscope Commercial |
$17,322.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,435.47
|
| Rate for Payer: Mclaren Medicaid |
$3,393.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,052.41
|
| Rate for Payer: Meridian Medicaid |
$3,562.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,533.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,293.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,360.20
|
| Rate for Payer: Nomi Health Commercial |
$15,782.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,435.47
|
| Rate for Payer: PACE Senior Care Partners |
$4,571.23
|
| Rate for Payer: PACE SWMI |
$4,811.82
|
| Rate for Payer: PHP Commercial |
$16,360.20
|
| Rate for Payer: PHP Medicare Advantage |
$4,811.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,393.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16,745.14
|
| Rate for Payer: Priority Health Medicare |
$4,859.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13,396.11
|
| Rate for Payer: Railroad Medicare Medicare |
$4,811.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,937.62
|
| Rate for Payer: UHC Core |
$16,071.49
|
| Rate for Payer: UHC Exchange |
$4,811.82
|
| Rate for Payer: UHC Medicaid |
$3,393.30
|
| Rate for Payer: UHC Medicare Advantage |
$4,811.82
|
| Rate for Payer: UHCCP Medicaid |
$3,393.30
|
| Rate for Payer: VA VA |
$4,811.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,435.47
|
|
|
TOLVAPTAN 15 MG TABLET
|
Facility
|
IP
|
$2,108.52
|
|
|
Service Code
|
NDC 67877063533
|
| Hospital Charge Code |
97893
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,467.53 |
| Max. Negotiated Rate |
$1,897.67 |
| Rate for Payer: Aetna Commercial |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,741.43
|
| Rate for Payer: BCN Commercial |
$1,741.43
|
| Rate for Payer: Cash Price |
$1,686.82
|
| 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: Lakeland Regional Health Systems Commercial |
$1,581.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,792.24
|
| Rate for Payer: Nomi Health Commercial |
$1,728.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,581.39
|
| Rate for Payer: PHP Commercial |
$1,792.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,834.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,467.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,855.50
|
| Rate for Payer: UHC Core |
$1,760.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,581.39
|
|
|
TOLVAPTAN 15 MG TABLET
|
Facility
|
IP
|
$19,247.29
|
|
|
Service Code
|
NDC 59148002050
|
| Hospital Charge Code |
97893
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13,396.11 |
| Max. Negotiated Rate |
$17,322.56 |
| Rate for Payer: Aetna Commercial |
$16,360.20
|
| Rate for Payer: BCBS Trust/PPO |
$15,896.34
|
| Rate for Payer: BCN Commercial |
$15,896.34
|
| Rate for Payer: Cash Price |
$15,397.83
|
| 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: Lakeland Regional Health Systems Commercial |
$14,435.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,360.20
|
| Rate for Payer: Nomi Health Commercial |
$15,782.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,435.47
|
| Rate for Payer: PHP Commercial |
$16,360.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16,745.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13,396.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,937.62
|
| Rate for Payer: UHC Core |
$16,071.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,435.47
|
|
|
TOLVAPTAN 15 MG TABLET
|
Facility
|
OP
|
$2,108.52
|
|
|
Service Code
|
NDC 67877063533
|
| Hospital Charge Code |
97893
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$371.73 |
| Max. Negotiated Rate |
$1,897.67 |
| Rate for Payer: Aetna Commercial |
$1,792.24
|
| Rate for Payer: Aetna Medicare |
$548.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$658.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$658.91
|
| Rate for Payer: BCBS Complete |
$390.29
|
| Rate for Payer: BCBS MAPPO |
$527.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,733.41
|
| Rate for Payer: BCN Commercial |
$1,733.41
|
| Rate for Payer: BCN Medicare Advantage |
$527.13
|
| Rate for Payer: Cash Price |
$1,686.82
|
| Rate for Payer: Cofinity Commercial |
$1,813.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,686.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$527.13
|
| Rate for Payer: Healthscope Commercial |
$1,897.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,581.39
|
| Rate for Payer: Mclaren Medicaid |
$371.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$553.49
|
| Rate for Payer: Meridian Medicaid |
$390.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$606.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$579.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,792.24
|
| Rate for Payer: Nomi Health Commercial |
$1,728.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,581.39
|
| Rate for Payer: PACE Senior Care Partners |
$500.77
|
| Rate for Payer: PACE SWMI |
$527.13
|
| Rate for Payer: PHP Commercial |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$527.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$371.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,834.41
|
| Rate for Payer: Priority Health Medicare |
$532.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,467.53
|
| Rate for Payer: Railroad Medicare Medicare |
$527.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,855.50
|
| Rate for Payer: UHC Core |
$1,760.61
|
| Rate for Payer: UHC Exchange |
$527.13
|
| Rate for Payer: UHC Medicaid |
$371.73
|
| Rate for Payer: UHC Medicare Advantage |
$527.13
|
| Rate for Payer: UHCCP Medicaid |
$371.73
|
| Rate for Payer: VA VA |
$527.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,581.39
|
|
|
TONSIL AND ADENOID PROCEDURES
|
Facility
|
IP
|
$4,711.00
|
|
|
Service Code
|
APR-DRG 0971
|
| Min. Negotiated Rate |
$4,486.67 |
| Max. Negotiated Rate |
$4,711.00 |
| Rate for Payer: BCBS Complete |
$4,711.00
|
| Rate for Payer: Mclaren Medicaid |
$4,486.67
|
| Rate for Payer: Meridian Medicaid |
$4,711.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,486.67
|
| Rate for Payer: UHC Medicaid |
$4,486.67
|
| Rate for Payer: UHCCP Medicaid |
$4,486.67
|
|
|
TONSIL AND ADENOID PROCEDURES
|
Facility
|
IP
|
$10,744.49
|
|
|
Service Code
|
APR-DRG 0973
|
| Min. Negotiated Rate |
$10,232.85 |
| Max. Negotiated Rate |
$10,744.49 |
| Rate for Payer: BCBS Complete |
$10,744.49
|
| Rate for Payer: Mclaren Medicaid |
$10,232.85
|
| Rate for Payer: Meridian Medicaid |
$10,744.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,232.85
|
| Rate for Payer: UHC Medicaid |
$10,232.85
|
| Rate for Payer: UHCCP Medicaid |
$10,232.85
|
|
|
TONSIL AND ADENOID PROCEDURES
|
Facility
|
IP
|
$19,119.02
|
|
|
Service Code
|
APR-DRG 0974
|
| Min. Negotiated Rate |
$18,208.59 |
| Max. Negotiated Rate |
$19,119.02 |
| Rate for Payer: BCBS Complete |
$19,119.02
|
| Rate for Payer: Mclaren Medicaid |
$18,208.59
|
| Rate for Payer: Meridian Medicaid |
$19,119.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$18,208.59
|
| Rate for Payer: UHC Medicaid |
$18,208.59
|
| Rate for Payer: UHCCP Medicaid |
$18,208.59
|
|
|
TONSIL AND ADENOID PROCEDURES
|
Facility
|
IP
|
$7,177.19
|
|
|
Service Code
|
APR-DRG 0972
|
| Min. Negotiated Rate |
$6,835.42 |
| Max. Negotiated Rate |
$7,177.19 |
| Rate for Payer: BCBS Complete |
$7,177.19
|
| Rate for Payer: Mclaren Medicaid |
$6,835.42
|
| Rate for Payer: Meridian Medicaid |
$7,177.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,835.42
|
| Rate for Payer: UHC Medicaid |
$6,835.42
|
| Rate for Payer: UHCCP Medicaid |
$6,835.42
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
IP
|
$379.05
|
|
|
Service Code
|
NDC 00904692961
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$263.82 |
| Max. Negotiated Rate |
$341.14 |
| Rate for Payer: Aetna Commercial |
$322.19
|
| Rate for Payer: BCBS Trust/PPO |
$313.06
|
| Rate for Payer: BCN Commercial |
$313.06
|
| Rate for Payer: Cash Price |
$303.24
|
| Rate for Payer: Cofinity Commercial |
$325.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.24
|
| Rate for Payer: Healthscope Commercial |
$341.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.19
|
| Rate for Payer: Nomi Health Commercial |
$310.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.29
|
| Rate for Payer: PHP Commercial |
$322.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$329.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$263.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$333.56
|
| Rate for Payer: UHC Core |
$316.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.29
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
IP
|
$417.05
|
|
|
Service Code
|
NDC 68084034401
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$290.27 |
| Max. Negotiated Rate |
$375.35 |
| Rate for Payer: Aetna Commercial |
$354.49
|
| Rate for Payer: BCBS Trust/PPO |
$344.44
|
| Rate for Payer: BCN Commercial |
$344.44
|
| Rate for Payer: Cash Price |
$333.64
|
| 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: Lakeland Regional Health Systems Commercial |
$312.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.49
|
| Rate for Payer: Nomi Health Commercial |
$341.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.79
|
| Rate for Payer: PHP Commercial |
$354.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$362.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$290.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$367.00
|
| Rate for Payer: UHC Core |
$348.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.79
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
OP
|
$111.39
|
|
|
Service Code
|
NDC 68382014014
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.64 |
| Max. Negotiated Rate |
$100.25 |
| Rate for Payer: Aetna Commercial |
$94.68
|
| Rate for Payer: Aetna Medicare |
$28.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.81
|
| Rate for Payer: BCBS Complete |
$20.62
|
| Rate for Payer: BCBS MAPPO |
$27.85
|
| Rate for Payer: BCBS Trust/PPO |
$91.57
|
| Rate for Payer: BCN Commercial |
$91.57
|
| Rate for Payer: BCN Medicare Advantage |
$27.85
|
| Rate for Payer: Cash Price |
$89.11
|
| Rate for Payer: Cofinity Commercial |
$95.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.85
|
| Rate for Payer: Healthscope Commercial |
$100.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.54
|
| Rate for Payer: Mclaren Medicaid |
$19.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.24
|
| Rate for Payer: Meridian Medicaid |
$20.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.68
|
| Rate for Payer: Nomi Health Commercial |
$91.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.54
|
| Rate for Payer: PACE Senior Care Partners |
$26.46
|
| Rate for Payer: PACE SWMI |
$27.85
|
| Rate for Payer: PHP Commercial |
$94.68
|
| Rate for Payer: PHP Medicare Advantage |
$27.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.91
|
| Rate for Payer: Priority Health Medicare |
$28.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.53
|
| Rate for Payer: Railroad Medicare Medicare |
$27.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.02
|
| Rate for Payer: UHC Core |
$93.01
|
| Rate for Payer: UHC Exchange |
$27.85
|
| Rate for Payer: UHC Medicaid |
$19.64
|
| Rate for Payer: UHC Medicare Advantage |
$27.85
|
| Rate for Payer: UHCCP Medicaid |
$19.64
|
| Rate for Payer: VA VA |
$27.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.54
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
IP
|
$111.39
|
|
|
Service Code
|
NDC 68382014014
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.53 |
| Max. Negotiated Rate |
$100.25 |
| Rate for Payer: Aetna Commercial |
$94.68
|
| Rate for Payer: BCBS Trust/PPO |
$92.00
|
| Rate for Payer: BCN Commercial |
$92.00
|
| Rate for Payer: Cash Price |
$89.11
|
| Rate for Payer: Cofinity Commercial |
$95.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.11
|
| Rate for Payer: Healthscope Commercial |
$100.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.68
|
| Rate for Payer: Nomi Health Commercial |
$91.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.54
|
| Rate for Payer: PHP Commercial |
$94.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.02
|
| Rate for Payer: UHC Core |
$93.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.54
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
OP
|
$417.05
|
|
|
Service Code
|
NDC 68084034411
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.53 |
| Max. Negotiated Rate |
$375.35 |
| Rate for Payer: Aetna Commercial |
$354.49
|
| Rate for Payer: Aetna Medicare |
$108.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.33
|
| Rate for Payer: BCBS Complete |
$77.20
|
| Rate for Payer: BCBS MAPPO |
$104.26
|
| Rate for Payer: BCBS Trust/PPO |
$342.86
|
| Rate for Payer: BCN Commercial |
$342.86
|
| Rate for Payer: BCN Medicare Advantage |
$104.26
|
| Rate for Payer: Cash Price |
$333.64
|
| Rate for Payer: Cofinity Commercial |
$358.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.26
|
| Rate for Payer: Healthscope Commercial |
$375.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.79
|
| Rate for Payer: Mclaren Medicaid |
$73.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.48
|
| Rate for Payer: Meridian Medicaid |
$77.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.49
|
| Rate for Payer: Nomi Health Commercial |
$341.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.79
|
| Rate for Payer: PACE Senior Care Partners |
$99.05
|
| Rate for Payer: PACE SWMI |
$104.26
|
| Rate for Payer: PHP Commercial |
$354.49
|
| Rate for Payer: PHP Medicare Advantage |
$104.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$362.83
|
| Rate for Payer: Priority Health Medicare |
$105.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$290.27
|
| Rate for Payer: Railroad Medicare Medicare |
$104.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$367.00
|
| Rate for Payer: UHC Core |
$348.24
|
| Rate for Payer: UHC Exchange |
$104.26
|
| Rate for Payer: UHC Medicaid |
$73.53
|
| Rate for Payer: UHC Medicare Advantage |
$104.26
|
| Rate for Payer: UHCCP Medicaid |
$73.53
|
| Rate for Payer: VA VA |
$104.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.79
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
OP
|
$417.05
|
|
|
Service Code
|
NDC 68084034401
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.53 |
| Max. Negotiated Rate |
$375.35 |
| Rate for Payer: Aetna Commercial |
$354.49
|
| Rate for Payer: Aetna Medicare |
$108.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.33
|
| Rate for Payer: BCBS Complete |
$77.20
|
| Rate for Payer: BCBS MAPPO |
$104.26
|
| Rate for Payer: BCBS Trust/PPO |
$342.86
|
| Rate for Payer: BCN Commercial |
$342.86
|
| Rate for Payer: BCN Medicare Advantage |
$104.26
|
| Rate for Payer: Cash Price |
$333.64
|
| Rate for Payer: Cofinity Commercial |
$358.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.26
|
| Rate for Payer: Healthscope Commercial |
$375.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.79
|
| Rate for Payer: Mclaren Medicaid |
$73.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.48
|
| Rate for Payer: Meridian Medicaid |
$77.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.49
|
| Rate for Payer: Nomi Health Commercial |
$341.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.79
|
| Rate for Payer: PACE Senior Care Partners |
$99.05
|
| Rate for Payer: PACE SWMI |
$104.26
|
| Rate for Payer: PHP Commercial |
$354.49
|
| Rate for Payer: PHP Medicare Advantage |
$104.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$362.83
|
| Rate for Payer: Priority Health Medicare |
$105.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$290.27
|
| Rate for Payer: Railroad Medicare Medicare |
$104.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$367.00
|
| Rate for Payer: UHC Core |
$348.24
|
| Rate for Payer: UHC Exchange |
$104.26
|
| Rate for Payer: UHC Medicaid |
$73.53
|
| Rate for Payer: UHC Medicare Advantage |
$104.26
|
| Rate for Payer: UHCCP Medicaid |
$73.53
|
| Rate for Payer: VA VA |
$104.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.79
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
IP
|
$417.05
|
|
|
Service Code
|
NDC 68084034411
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$290.27 |
| Max. Negotiated Rate |
$375.35 |
| Rate for Payer: Aetna Commercial |
$354.49
|
| Rate for Payer: BCBS Trust/PPO |
$344.44
|
| Rate for Payer: BCN Commercial |
$344.44
|
| Rate for Payer: Cash Price |
$333.64
|
| 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: Lakeland Regional Health Systems Commercial |
$312.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.49
|
| Rate for Payer: Nomi Health Commercial |
$341.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.79
|
| Rate for Payer: PHP Commercial |
$354.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$362.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$290.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$367.00
|
| Rate for Payer: UHC Core |
$348.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.79
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
OP
|
$379.05
|
|
|
Service Code
|
NDC 00904692961
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.83 |
| Max. Negotiated Rate |
$341.14 |
| Rate for Payer: Aetna Commercial |
$322.19
|
| Rate for Payer: Aetna Medicare |
$98.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.45
|
| Rate for Payer: BCBS Complete |
$70.16
|
| Rate for Payer: BCBS MAPPO |
$94.76
|
| Rate for Payer: BCBS Trust/PPO |
$311.62
|
| Rate for Payer: BCN Commercial |
$311.62
|
| Rate for Payer: BCN Medicare Advantage |
$94.76
|
| Rate for Payer: Cash Price |
$303.24
|
| Rate for Payer: Cofinity Commercial |
$325.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.76
|
| Rate for Payer: Healthscope Commercial |
$341.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.29
|
| Rate for Payer: Mclaren Medicaid |
$66.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.50
|
| Rate for Payer: Meridian Medicaid |
$70.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.19
|
| Rate for Payer: Nomi Health Commercial |
$310.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.29
|
| Rate for Payer: PACE Senior Care Partners |
$90.02
|
| Rate for Payer: PACE SWMI |
$94.76
|
| Rate for Payer: PHP Commercial |
$322.19
|
| Rate for Payer: PHP Medicare Advantage |
$94.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$329.77
|
| Rate for Payer: Priority Health Medicare |
$95.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$263.82
|
| Rate for Payer: Railroad Medicare Medicare |
$94.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$333.56
|
| Rate for Payer: UHC Core |
$316.51
|
| Rate for Payer: UHC Exchange |
$94.76
|
| Rate for Payer: UHC Medicaid |
$66.83
|
| Rate for Payer: UHC Medicare Advantage |
$94.76
|
| Rate for Payer: UHCCP Medicaid |
$66.83
|
| Rate for Payer: VA VA |
$94.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.29
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$232.75
|
|
|
Service Code
|
NDC 68084034201
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.99 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: BCBS Trust/PPO |
$192.23
|
| Rate for Payer: BCN Commercial |
$192.23
|
| Rate for Payer: Cash Price |
$186.20
|
| 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: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$202.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.82
|
| Rate for Payer: UHC Core |
$194.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$232.75
|
|
|
Service Code
|
NDC 68084034211
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.99 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: BCBS Trust/PPO |
$192.23
|
| Rate for Payer: BCN Commercial |
$192.23
|
| Rate for Payer: Cash Price |
$186.20
|
| 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: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$202.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.82
|
| Rate for Payer: UHC Core |
$194.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$211.85
|
|
|
Service Code
|
NDC 00904692861
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.45 |
| Max. Negotiated Rate |
$190.66 |
| Rate for Payer: Aetna Commercial |
$180.07
|
| Rate for Payer: BCBS Trust/PPO |
$174.97
|
| Rate for Payer: BCN Commercial |
$174.97
|
| Rate for Payer: Cash Price |
$169.48
|
| 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: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: Nomi Health Commercial |
$173.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.89
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$184.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.43
|
| Rate for Payer: UHC Core |
$176.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.89
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
OP
|
$211.85
|
|
|
Service Code
|
NDC 00904692861
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.35 |
| Max. Negotiated Rate |
$190.66 |
| Rate for Payer: Aetna Commercial |
$180.07
|
| Rate for Payer: Aetna Medicare |
$55.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.20
|
| Rate for Payer: BCBS Complete |
$39.21
|
| Rate for Payer: BCBS MAPPO |
$52.96
|
| Rate for Payer: BCBS Trust/PPO |
$174.16
|
| Rate for Payer: BCN Commercial |
$174.16
|
| Rate for Payer: BCN Medicare Advantage |
$52.96
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Cofinity Commercial |
$182.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.96
|
| Rate for Payer: Healthscope Commercial |
$190.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: Mclaren Medicaid |
$37.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.61
|
| Rate for Payer: Meridian Medicaid |
$39.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: Nomi Health Commercial |
$173.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.89
|
| Rate for Payer: PACE Senior Care Partners |
$50.31
|
| Rate for Payer: PACE SWMI |
$52.96
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: PHP Medicare Advantage |
$52.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$184.31
|
| Rate for Payer: Priority Health Medicare |
$53.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.45
|
| Rate for Payer: Railroad Medicare Medicare |
$52.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.43
|
| Rate for Payer: UHC Core |
$176.89
|
| Rate for Payer: UHC Exchange |
$52.96
|
| Rate for Payer: UHC Medicaid |
$37.35
|
| Rate for Payer: UHC Medicare Advantage |
$52.96
|
| Rate for Payer: UHCCP Medicaid |
$37.35
|
| Rate for Payer: VA VA |
$52.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.89
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
OP
|
$232.75
|
|
|
Service Code
|
NDC 68084034211
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.03 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: Aetna Medicare |
$60.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.73
|
| Rate for Payer: BCBS Complete |
$43.08
|
| Rate for Payer: BCBS MAPPO |
$58.19
|
| Rate for Payer: BCBS Trust/PPO |
$191.34
|
| Rate for Payer: BCN Commercial |
$191.34
|
| Rate for Payer: BCN Medicare Advantage |
$58.19
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.19
|
| Rate for Payer: Healthscope Commercial |
$209.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Mclaren Medicaid |
$41.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.10
|
| Rate for Payer: Meridian Medicaid |
$43.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: PACE Senior Care Partners |
$55.28
|
| Rate for Payer: PACE SWMI |
$58.19
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: PHP Medicare Advantage |
$58.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$202.49
|
| Rate for Payer: Priority Health Medicare |
$58.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.99
|
| Rate for Payer: Railroad Medicare Medicare |
$58.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.82
|
| Rate for Payer: UHC Core |
$194.35
|
| Rate for Payer: UHC Exchange |
$58.19
|
| Rate for Payer: UHC Medicaid |
$41.03
|
| Rate for Payer: UHC Medicare Advantage |
$58.19
|
| Rate for Payer: UHCCP Medicaid |
$41.03
|
| Rate for Payer: VA VA |
$58.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
OP
|
$232.75
|
|
|
Service Code
|
NDC 68084034201
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.03 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: Aetna Medicare |
$60.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.73
|
| Rate for Payer: BCBS Complete |
$43.08
|
| Rate for Payer: BCBS MAPPO |
$58.19
|
| Rate for Payer: BCBS Trust/PPO |
$191.34
|
| Rate for Payer: BCN Commercial |
$191.34
|
| Rate for Payer: BCN Medicare Advantage |
$58.19
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.19
|
| Rate for Payer: Healthscope Commercial |
$209.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Mclaren Medicaid |
$41.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.10
|
| Rate for Payer: Meridian Medicaid |
$43.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: PACE Senior Care Partners |
$55.28
|
| Rate for Payer: PACE SWMI |
$58.19
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: PHP Medicare Advantage |
$58.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$202.49
|
| Rate for Payer: Priority Health Medicare |
$58.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.99
|
| Rate for Payer: Railroad Medicare Medicare |
$58.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.82
|
| Rate for Payer: UHC Core |
$194.35
|
| Rate for Payer: UHC Exchange |
$58.19
|
| Rate for Payer: UHC Medicaid |
$41.03
|
| Rate for Payer: UHC Medicare Advantage |
$58.19
|
| Rate for Payer: UHCCP Medicaid |
$41.03
|
| Rate for Payer: VA VA |
$58.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
