|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$39.06
|
|
|
Service Code
|
NDC 24208029005
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna Commercial |
$33.20
|
| Rate for Payer: Aetna Medicare |
$10.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.21
|
| Rate for Payer: BCBS Complete |
$15.62
|
| Rate for Payer: BCBS MAPPO |
$9.76
|
| Rate for Payer: BCBS Trust/PPO |
$32.11
|
| Rate for Payer: BCN Commercial |
$30.37
|
| Rate for Payer: BCN Medicare Advantage |
$9.76
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cofinity Commercial |
$33.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.76
|
| Rate for Payer: Healthscope Commercial |
$35.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.20
|
| Rate for Payer: Nomi Health Commercial |
$32.03
|
| Rate for Payer: PACE Senior Care Partners |
$9.28
|
| Rate for Payer: PACE SWMI |
$9.76
|
| Rate for Payer: PHP Commercial |
$33.20
|
| Rate for Payer: PHP Medicare Advantage |
$9.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.39
|
| Rate for Payer: Priority Health HMO/PPO |
$33.98
|
| Rate for Payer: Priority Health Medicare |
$9.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.17
|
| Rate for Payer: Railroad Medicare Medicare |
$9.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.37
|
| Rate for Payer: UHC Core |
$32.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.76
|
| Rate for Payer: UHC Exchange |
$9.76
|
| Rate for Payer: UHC Medicare Advantage |
$9.76
|
| Rate for Payer: VA VA |
$9.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.30
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$39.06
|
|
|
Service Code
|
NDC 24208029005
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.39 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna Commercial |
$33.20
|
| Rate for Payer: BCBS Trust/PPO |
$31.88
|
| Rate for Payer: BCN Commercial |
$30.19
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cofinity Commercial |
$33.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.25
|
| Rate for Payer: Healthscope Commercial |
$35.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.20
|
| Rate for Payer: Nomi Health Commercial |
$32.03
|
| Rate for Payer: PHP Commercial |
$33.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.39
|
| Rate for Payer: Priority Health HMO/PPO |
$33.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.37
|
| Rate for Payer: UHC Core |
$32.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.30
|
|
|
TOBRAMYCIN 40 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$10.97
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
7994
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$9.87 |
| Rate for Payer: Aetna Commercial |
$9.32
|
| Rate for Payer: Aetna Commercial |
$15.93
|
| Rate for Payer: Aetna Commercial |
$9.52
|
| Rate for Payer: Aetna Medicare |
$4.87
|
| Rate for Payer: Aetna Medicare |
$2.85
|
| Rate for Payer: Aetna Medicare |
$2.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.86
|
| Rate for Payer: BCBS Complete |
$4.48
|
| Rate for Payer: BCBS Complete |
$4.39
|
| Rate for Payer: BCBS Complete |
$7.50
|
| Rate for Payer: BCBS MAPPO |
$4.68
|
| Rate for Payer: BCBS MAPPO |
$2.74
|
| Rate for Payer: BCBS MAPPO |
$2.80
|
| Rate for Payer: BCBS Trust/PPO |
$9.21
|
| Rate for Payer: BCBS Trust/PPO |
$9.02
|
| Rate for Payer: BCBS Trust/PPO |
$15.41
|
| Rate for Payer: BCN Commercial |
$8.71
|
| Rate for Payer: BCN Commercial |
$14.57
|
| Rate for Payer: BCN Commercial |
$8.53
|
| Rate for Payer: BCN Medicare Advantage |
$2.74
|
| Rate for Payer: BCN Medicare Advantage |
$2.80
|
| Rate for Payer: BCN Medicare Advantage |
$4.68
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cash Price |
$14.99
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Cofinity Commercial |
$9.43
|
| Rate for Payer: Cofinity Commercial |
$9.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$10.08
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Commercial |
$16.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.32
|
| Rate for Payer: Nomi Health Commercial |
$15.37
|
| Rate for Payer: Nomi Health Commercial |
$9.00
|
| Rate for Payer: Nomi Health Commercial |
$9.18
|
| Rate for Payer: PACE Senior Care Partners |
$4.45
|
| Rate for Payer: PACE Senior Care Partners |
$2.61
|
| Rate for Payer: PACE Senior Care Partners |
$2.66
|
| Rate for Payer: PACE SWMI |
$2.80
|
| Rate for Payer: PACE SWMI |
$2.74
|
| Rate for Payer: PACE SWMI |
$4.68
|
| Rate for Payer: PHP Commercial |
$15.93
|
| Rate for Payer: PHP Commercial |
$9.52
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: PHP Medicare Advantage |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$4.68
|
| Rate for Payer: PHP Medicare Advantage |
$2.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.28
|
| Rate for Payer: Priority Health HMO/PPO |
$16.30
|
| Rate for Payer: Priority Health HMO/PPO |
$9.54
|
| Rate for Payer: Priority Health HMO/PPO |
$9.74
|
| Rate for Payer: Priority Health Medicare |
$2.77
|
| Rate for Payer: Priority Health Medicare |
$4.73
|
| Rate for Payer: Priority Health Medicare |
$2.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.35
|
| Rate for Payer: Railroad Medicare Medicare |
$2.80
|
| Rate for Payer: Railroad Medicare Medicare |
$4.68
|
| Rate for Payer: Railroad Medicare Medicare |
$2.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.65
|
| Rate for Payer: UHC Core |
$15.65
|
| Rate for Payer: UHC Core |
$9.35
|
| Rate for Payer: UHC Core |
$9.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.80
|
| Rate for Payer: UHC Exchange |
$2.80
|
| Rate for Payer: UHC Exchange |
$2.74
|
| Rate for Payer: UHC Exchange |
$4.68
|
| Rate for Payer: UHC Medicare Advantage |
$2.74
|
| Rate for Payer: UHC Medicare Advantage |
$2.80
|
| Rate for Payer: UHC Medicare Advantage |
$4.68
|
| Rate for Payer: VA VA |
$2.80
|
| Rate for Payer: VA VA |
$4.68
|
| Rate for Payer: VA VA |
$2.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.40
|
|
|
TOBRAMYCIN 40 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$10.97
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
7994
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$9.87 |
| Rate for Payer: Aetna Commercial |
$9.32
|
| Rate for Payer: Aetna Commercial |
$9.52
|
| Rate for Payer: Aetna Commercial |
$15.93
|
| Rate for Payer: BCBS Trust/PPO |
$9.14
|
| Rate for Payer: BCBS Trust/PPO |
$8.95
|
| Rate for Payer: BCBS Trust/PPO |
$15.30
|
| Rate for Payer: BCN Commercial |
$8.66
|
| Rate for Payer: BCN Commercial |
$8.48
|
| Rate for Payer: BCN Commercial |
$14.48
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$14.99
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Cofinity Commercial |
$9.63
|
| Rate for Payer: Cofinity Commercial |
$9.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$10.08
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Commercial |
$16.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.93
|
| Rate for Payer: Nomi Health Commercial |
$9.00
|
| Rate for Payer: Nomi Health Commercial |
$9.18
|
| Rate for Payer: Nomi Health Commercial |
$15.37
|
| Rate for Payer: PHP Commercial |
$9.52
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: PHP Commercial |
$15.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.28
|
| Rate for Payer: Priority Health HMO/PPO |
$16.30
|
| Rate for Payer: Priority Health HMO/PPO |
$9.74
|
| Rate for Payer: Priority Health HMO/PPO |
$9.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.65
|
| Rate for Payer: UHC Core |
$9.16
|
| Rate for Payer: UHC Core |
$15.65
|
| Rate for Payer: UHC Core |
$9.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.40
|
|
|
TOCILIZUMAB 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$4,143.08
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
119445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,693.00 |
| Max. Negotiated Rate |
$3,728.77 |
| Rate for Payer: Aetna Commercial |
$3,521.62
|
| Rate for Payer: BCBS Trust/PPO |
$3,382.00
|
| Rate for Payer: BCN Commercial |
$3,201.77
|
| Rate for Payer: Cash Price |
$3,314.46
|
| Rate for Payer: Cofinity Commercial |
$3,563.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,314.46
|
| Rate for Payer: Healthscope Commercial |
$3,728.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,107.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,521.62
|
| Rate for Payer: Nomi Health Commercial |
$3,397.33
|
| Rate for Payer: PHP Commercial |
$3,521.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,693.00
|
| Rate for Payer: Priority Health HMO/PPO |
$3,604.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,775.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,645.91
|
| Rate for Payer: UHC Core |
$3,459.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,107.31
|
|
|
TOCILIZUMAB 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$4,143.08
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
119445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$3,728.77 |
| Rate for Payer: Aetna Commercial |
$3,521.62
|
| Rate for Payer: Aetna Medicare |
$1,077.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,294.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,294.71
|
| Rate for Payer: BCBS Complete |
$4.53
|
| Rate for Payer: BCBS MAPPO |
$1,035.77
|
| Rate for Payer: BCBS Trust/PPO |
$3,406.03
|
| Rate for Payer: BCN Commercial |
$3,221.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,035.77
|
| Rate for Payer: Cash Price |
$3,314.46
|
| Rate for Payer: Cash Price |
$3,314.46
|
| Rate for Payer: Cofinity Commercial |
$3,563.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,314.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,035.77
|
| Rate for Payer: Healthscope Commercial |
$3,728.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,107.31
|
| Rate for Payer: Mclaren Medicaid |
$4.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,087.56
|
| Rate for Payer: Meridian Medicaid |
$4.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,191.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,521.62
|
| Rate for Payer: Nomi Health Commercial |
$3,397.33
|
| Rate for Payer: PACE Senior Care Partners |
$983.98
|
| Rate for Payer: PACE SWMI |
$1,035.77
|
| Rate for Payer: PHP Commercial |
$3,521.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,035.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,693.00
|
| Rate for Payer: Priority Health HMO/PPO |
$3,604.48
|
| Rate for Payer: Priority Health Medicare |
$1,046.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,775.86
|
| Rate for Payer: Railroad Medicare Medicare |
$1,035.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,645.91
|
| Rate for Payer: UHC Core |
$3,459.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,035.77
|
| Rate for Payer: UHC Exchange |
$1,035.77
|
| Rate for Payer: UHC Medicare Advantage |
$1,035.77
|
| Rate for Payer: UHCCP Medicaid |
$4.32
|
| Rate for Payer: VA VA |
$1,035.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,107.31
|
|
|
TOCILIZUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,732.50
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
119446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,376.12 |
| Max. Negotiated Rate |
$6,059.25 |
| Rate for Payer: Aetna Commercial |
$5,722.62
|
| Rate for Payer: BCBS Trust/PPO |
$5,495.74
|
| Rate for Payer: BCN Commercial |
$5,202.88
|
| 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: Healthscope Commercial |
$6,059.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,049.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,722.62
|
| Rate for Payer: Nomi Health Commercial |
$5,520.65
|
| Rate for Payer: PHP Commercial |
$5,722.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,376.12
|
| Rate for Payer: Priority Health HMO/PPO |
$5,857.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,510.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,924.60
|
| Rate for Payer: UHC Core |
$5,621.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,049.38
|
|
|
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 |
$4.32 |
| 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 |
$4.53
|
| Rate for Payer: BCBS MAPPO |
$1,683.12
|
| Rate for Payer: BCBS Trust/PPO |
$5,534.79
|
| Rate for Payer: BCN Commercial |
$5,234.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,683.12
|
| Rate for Payer: Cash Price |
$5,386.00
|
| 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 |
$4.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,767.28
|
| Rate for Payer: Meridian Medicaid |
$4.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,935.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,722.62
|
| Rate for Payer: Nomi Health Commercial |
$5,520.65
|
| 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 |
$4.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,376.12
|
| Rate for Payer: Priority Health HMO/PPO |
$5,857.28
|
| Rate for Payer: Priority Health Medicare |
$1,699.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,510.78
|
| 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 Dual Complete DSNP |
$1,683.12
|
| Rate for Payer: UHC Exchange |
$1,683.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,683.12
|
| Rate for Payer: UHCCP Medicaid |
$4.32
|
| 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
|
OP
|
$1,657.22
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
99452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.32 |
| 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 |
$4.53
|
| Rate for Payer: BCBS MAPPO |
$414.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,362.40
|
| Rate for Payer: BCN Commercial |
$1,288.49
|
| Rate for Payer: BCN Medicare Advantage |
$414.30
|
| Rate for Payer: Cash Price |
$1,325.78
|
| 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 |
$414.30
|
| Rate for Payer: Healthscope Commercial |
$1,491.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,242.92
|
| Rate for Payer: Mclaren Medicaid |
$4.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$435.02
|
| Rate for Payer: Meridian Medicaid |
$4.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$476.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,408.64
|
| Rate for Payer: Nomi Health Commercial |
$1,358.92
|
| Rate for Payer: PACE Senior Care Partners |
$393.59
|
| Rate for Payer: PACE SWMI |
$414.30
|
| Rate for Payer: PHP Commercial |
$1,408.64
|
| Rate for Payer: PHP Medicare Advantage |
$414.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.19
|
| Rate for Payer: Priority Health HMO/PPO |
$1,441.78
|
| Rate for Payer: Priority Health Medicare |
$418.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,110.34
|
| Rate for Payer: Railroad Medicare Medicare |
$414.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,458.35
|
| Rate for Payer: UHC Core |
$1,383.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$414.30
|
| Rate for Payer: UHC Exchange |
$414.30
|
| Rate for Payer: UHC Medicare Advantage |
$414.30
|
| Rate for Payer: UHCCP Medicaid |
$4.32
|
| Rate for Payer: VA VA |
$414.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,242.92
|
|
|
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 |
$1,077.19 |
| Max. Negotiated Rate |
$1,491.50 |
| Rate for Payer: Aetna Commercial |
$1,408.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,352.79
|
| Rate for Payer: BCN Commercial |
$1,280.70
|
| 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 |
$1,242.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,408.64
|
| Rate for Payer: Nomi Health Commercial |
$1,358.92
|
| Rate for Payer: PHP Commercial |
$1,408.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.19
|
| Rate for Payer: Priority Health HMO/PPO |
$1,441.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,110.34
|
| 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 |
$1,242.92
|
|
|
TOLVAPTAN 15 MG TABLET
|
Facility
|
OP
|
$19,247.29
|
|
|
Service Code
|
NDC 59148002050
|
| Hospital Charge Code |
97893
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,571.23 |
| 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 |
$7,698.92
|
| Rate for Payer: BCBS MAPPO |
$4,811.82
|
| Rate for Payer: BCBS Trust/PPO |
$15,823.20
|
| Rate for Payer: BCN Commercial |
$14,964.77
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,052.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,533.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,360.20
|
| Rate for Payer: Nomi Health Commercial |
$15,782.78
|
| 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 Cigna Priority Health |
$12,510.74
|
| Rate for Payer: Priority Health HMO/PPO |
$16,745.14
|
| Rate for Payer: Priority Health Medicare |
$4,859.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12,895.68
|
| 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 Dual Complete DSNP |
$4,811.82
|
| Rate for Payer: UHC Exchange |
$4,811.82
|
| Rate for Payer: UHC Medicare Advantage |
$4,811.82
|
| 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
|
$2,012.99
|
|
|
Service Code
|
NDC 67877063533
|
| Hospital Charge Code |
97893
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,308.44 |
| Max. Negotiated Rate |
$1,811.69 |
| Rate for Payer: Aetna Commercial |
$1,711.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,643.20
|
| Rate for Payer: BCN Commercial |
$1,555.64
|
| Rate for Payer: Cash Price |
$1,610.39
|
| Rate for Payer: Cofinity Commercial |
$1,731.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,610.39
|
| Rate for Payer: Healthscope Commercial |
$1,811.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,509.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,711.04
|
| Rate for Payer: Nomi Health Commercial |
$1,650.65
|
| Rate for Payer: PHP Commercial |
$1,711.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,308.44
|
| Rate for Payer: Priority Health HMO/PPO |
$1,751.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,348.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,771.43
|
| Rate for Payer: UHC Core |
$1,680.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,509.74
|
|
|
TOLVAPTAN 15 MG TABLET
|
Facility
|
IP
|
$19,247.29
|
|
|
Service Code
|
NDC 59148002050
|
| Hospital Charge Code |
97893
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12,510.74 |
| Max. Negotiated Rate |
$17,322.56 |
| Rate for Payer: Aetna Commercial |
$16,360.20
|
| Rate for Payer: BCBS Trust/PPO |
$15,711.56
|
| Rate for Payer: BCN Commercial |
$14,874.31
|
| 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: PHP Commercial |
$16,360.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,510.74
|
| Rate for Payer: Priority Health HMO/PPO |
$16,745.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12,895.68
|
| 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
|
$2,012.99
|
|
|
Service Code
|
NDC 67877063533
|
| Hospital Charge Code |
97893
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$478.09 |
| Max. Negotiated Rate |
$1,811.69 |
| Rate for Payer: Aetna Commercial |
$1,711.04
|
| Rate for Payer: Aetna Medicare |
$523.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$629.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$629.06
|
| Rate for Payer: BCBS Complete |
$805.20
|
| Rate for Payer: BCBS MAPPO |
$503.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,654.88
|
| Rate for Payer: BCN Commercial |
$1,565.10
|
| Rate for Payer: BCN Medicare Advantage |
$503.25
|
| Rate for Payer: Cash Price |
$1,610.39
|
| Rate for Payer: Cofinity Commercial |
$1,731.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,610.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$503.25
|
| Rate for Payer: Healthscope Commercial |
$1,811.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,509.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$528.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$578.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,711.04
|
| Rate for Payer: Nomi Health Commercial |
$1,650.65
|
| Rate for Payer: PACE Senior Care Partners |
$478.09
|
| Rate for Payer: PACE SWMI |
$503.25
|
| Rate for Payer: PHP Commercial |
$1,711.04
|
| Rate for Payer: PHP Medicare Advantage |
$503.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,308.44
|
| Rate for Payer: Priority Health HMO/PPO |
$1,751.30
|
| Rate for Payer: Priority Health Medicare |
$508.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,348.70
|
| Rate for Payer: Railroad Medicare Medicare |
$503.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,771.43
|
| Rate for Payer: UHC Core |
$1,680.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$503.25
|
| Rate for Payer: UHC Exchange |
$503.25
|
| Rate for Payer: UHC Medicare Advantage |
$503.25
|
| Rate for Payer: VA VA |
$503.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,509.74
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
IP
|
$382.85
|
|
|
Service Code
|
NDC 68084034411
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.85 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: BCBS Trust/PPO |
$312.52
|
| Rate for Payer: BCN Commercial |
$295.87
|
| Rate for Payer: Cash Price |
$306.28
|
| Rate for Payer: Cofinity Commercial |
$329.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.28
|
| Rate for Payer: Healthscope Commercial |
$344.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.42
|
| Rate for Payer: Nomi Health Commercial |
$313.94
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.85
|
| Rate for Payer: Priority Health HMO/PPO |
$333.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.91
|
| Rate for Payer: UHC Core |
$319.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.14
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
OP
|
$101.52
|
|
|
Service Code
|
NDC 68382014014
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna Medicare |
$26.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.72
|
| Rate for Payer: BCBS Complete |
$40.61
|
| Rate for Payer: BCBS MAPPO |
$25.38
|
| Rate for Payer: BCBS Trust/PPO |
$83.46
|
| Rate for Payer: BCN Commercial |
$78.93
|
| Rate for Payer: BCN Medicare Advantage |
$25.38
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.38
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: Nomi Health Commercial |
$83.25
|
| Rate for Payer: PACE Senior Care Partners |
$24.11
|
| Rate for Payer: PACE SWMI |
$25.38
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: PHP Medicare Advantage |
$25.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.99
|
| Rate for Payer: Priority Health HMO/PPO |
$88.32
|
| Rate for Payer: Priority Health Medicare |
$25.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.02
|
| Rate for Payer: Railroad Medicare Medicare |
$25.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.34
|
| Rate for Payer: UHC Core |
$84.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.38
|
| Rate for Payer: UHC Exchange |
$25.38
|
| Rate for Payer: UHC Medicare Advantage |
$25.38
|
| Rate for Payer: VA VA |
$25.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.14
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
IP
|
$101.52
|
|
|
Service Code
|
NDC 68382014014
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.99 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: BCBS Trust/PPO |
$82.87
|
| Rate for Payer: BCN Commercial |
$78.45
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: Nomi Health Commercial |
$83.25
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.99
|
| Rate for Payer: Priority Health HMO/PPO |
$88.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.34
|
| Rate for Payer: UHC Core |
$84.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.14
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
NDC 00904692961
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$222.30 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: BCBS Trust/PPO |
$279.17
|
| Rate for Payer: BCN Commercial |
$264.30
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Commercial |
$294.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.60
|
| Rate for Payer: Healthscope Commercial |
$307.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.70
|
| Rate for Payer: Nomi Health Commercial |
$280.44
|
| Rate for Payer: PHP Commercial |
$290.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.30
|
| Rate for Payer: Priority Health HMO/PPO |
$297.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$229.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.96
|
| Rate for Payer: UHC Core |
$285.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.50
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
NDC 00904692961
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.22 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna Medicare |
$88.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.88
|
| Rate for Payer: BCBS Complete |
$136.80
|
| Rate for Payer: BCBS MAPPO |
$85.50
|
| Rate for Payer: BCBS Trust/PPO |
$281.16
|
| Rate for Payer: BCN Commercial |
$265.90
|
| Rate for Payer: BCN Medicare Advantage |
$85.50
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Commercial |
$294.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.50
|
| Rate for Payer: Healthscope Commercial |
$307.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.70
|
| Rate for Payer: Nomi Health Commercial |
$280.44
|
| Rate for Payer: PACE Senior Care Partners |
$81.22
|
| Rate for Payer: PACE SWMI |
$85.50
|
| Rate for Payer: PHP Commercial |
$290.70
|
| Rate for Payer: PHP Medicare Advantage |
$85.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.30
|
| Rate for Payer: Priority Health HMO/PPO |
$297.54
|
| Rate for Payer: Priority Health Medicare |
$86.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$229.14
|
| Rate for Payer: Railroad Medicare Medicare |
$85.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.96
|
| Rate for Payer: UHC Core |
$285.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.50
|
| Rate for Payer: UHC Exchange |
$85.50
|
| Rate for Payer: UHC Medicare Advantage |
$85.50
|
| Rate for Payer: VA VA |
$85.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.50
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
OP
|
$382.85
|
|
|
Service Code
|
NDC 68084034411
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.93 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: Aetna Medicare |
$99.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.64
|
| Rate for Payer: BCBS Complete |
$153.14
|
| Rate for Payer: BCBS MAPPO |
$95.71
|
| Rate for Payer: BCBS Trust/PPO |
$314.74
|
| Rate for Payer: BCN Commercial |
$297.67
|
| Rate for Payer: BCN Medicare Advantage |
$95.71
|
| Rate for Payer: Cash Price |
$306.28
|
| Rate for Payer: Cofinity Commercial |
$329.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.71
|
| Rate for Payer: Healthscope Commercial |
$344.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.42
|
| Rate for Payer: Nomi Health Commercial |
$313.94
|
| Rate for Payer: PACE Senior Care Partners |
$90.93
|
| Rate for Payer: PACE SWMI |
$95.71
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: PHP Medicare Advantage |
$95.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.85
|
| Rate for Payer: Priority Health HMO/PPO |
$333.08
|
| Rate for Payer: Priority Health Medicare |
$96.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.51
|
| Rate for Payer: Railroad Medicare Medicare |
$95.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.91
|
| Rate for Payer: UHC Core |
$319.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.71
|
| Rate for Payer: UHC Exchange |
$95.71
|
| Rate for Payer: UHC Medicare Advantage |
$95.71
|
| Rate for Payer: VA VA |
$95.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.14
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
OP
|
$382.85
|
|
|
Service Code
|
NDC 68084034401
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.93 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: Aetna Medicare |
$99.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.64
|
| Rate for Payer: BCBS Complete |
$153.14
|
| Rate for Payer: BCBS MAPPO |
$95.71
|
| Rate for Payer: BCBS Trust/PPO |
$314.74
|
| Rate for Payer: BCN Commercial |
$297.67
|
| Rate for Payer: BCN Medicare Advantage |
$95.71
|
| Rate for Payer: Cash Price |
$306.28
|
| Rate for Payer: Cofinity Commercial |
$329.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.71
|
| Rate for Payer: Healthscope Commercial |
$344.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.42
|
| Rate for Payer: Nomi Health Commercial |
$313.94
|
| Rate for Payer: PACE Senior Care Partners |
$90.93
|
| Rate for Payer: PACE SWMI |
$95.71
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: PHP Medicare Advantage |
$95.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.85
|
| Rate for Payer: Priority Health HMO/PPO |
$333.08
|
| Rate for Payer: Priority Health Medicare |
$96.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.51
|
| Rate for Payer: Railroad Medicare Medicare |
$95.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.91
|
| Rate for Payer: UHC Core |
$319.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.71
|
| Rate for Payer: UHC Exchange |
$95.71
|
| Rate for Payer: UHC Medicare Advantage |
$95.71
|
| Rate for Payer: VA VA |
$95.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.14
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
IP
|
$382.85
|
|
|
Service Code
|
NDC 68084034401
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.85 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: BCBS Trust/PPO |
$312.52
|
| Rate for Payer: BCN Commercial |
$295.87
|
| Rate for Payer: Cash Price |
$306.28
|
| Rate for Payer: Cofinity Commercial |
$329.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.28
|
| Rate for Payer: Healthscope Commercial |
$344.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.42
|
| Rate for Payer: Nomi Health Commercial |
$313.94
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.85
|
| Rate for Payer: Priority Health HMO/PPO |
$333.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.91
|
| Rate for Payer: UHC Core |
$319.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.14
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$215.65
|
|
|
Service Code
|
NDC 68084034201
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.17 |
| Max. Negotiated Rate |
$194.08 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: BCBS Trust/PPO |
$176.04
|
| Rate for Payer: BCN Commercial |
$166.65
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Nomi Health Commercial |
$176.83
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.17
|
| Rate for Payer: Priority Health HMO/PPO |
$187.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.77
|
| Rate for Payer: UHC Core |
$180.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
OP
|
$215.65
|
|
|
Service Code
|
NDC 68084034201
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.22 |
| Max. Negotiated Rate |
$194.08 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna Medicare |
$56.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.39
|
| Rate for Payer: BCBS Complete |
$86.26
|
| Rate for Payer: BCBS MAPPO |
$53.91
|
| Rate for Payer: BCBS Trust/PPO |
$177.29
|
| Rate for Payer: BCN Commercial |
$167.67
|
| Rate for Payer: BCN Medicare Advantage |
$53.91
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.91
|
| Rate for Payer: Healthscope Commercial |
$194.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Nomi Health Commercial |
$176.83
|
| Rate for Payer: PACE Senior Care Partners |
$51.22
|
| Rate for Payer: PACE SWMI |
$53.91
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: PHP Medicare Advantage |
$53.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.17
|
| Rate for Payer: Priority Health HMO/PPO |
$187.62
|
| Rate for Payer: Priority Health Medicare |
$54.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.49
|
| Rate for Payer: Railroad Medicare Medicare |
$53.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.77
|
| Rate for Payer: UHC Core |
$180.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.91
|
| Rate for Payer: UHC Exchange |
$53.91
|
| Rate for Payer: UHC Medicare Advantage |
$53.91
|
| Rate for Payer: VA VA |
$53.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$215.65
|
|
|
Service Code
|
NDC 68084034211
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.17 |
| Max. Negotiated Rate |
$194.08 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: BCBS Trust/PPO |
$176.04
|
| Rate for Payer: BCN Commercial |
$166.65
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Nomi Health Commercial |
$176.83
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.17
|
| Rate for Payer: Priority Health HMO/PPO |
$187.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.77
|
| Rate for Payer: UHC Core |
$180.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
