|
TOCILIZUMAB-AAZG 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,994.02
|
|
|
Service Code
|
HCPCS Q5135
|
| Hospital Charge Code |
206928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,317.37 |
| Max. Negotiated Rate |
$2,694.62 |
| Rate for Payer: Aetna American Axle |
$1,946.11
|
| Rate for Payer: Aetna Commercial |
$2,544.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,946.11
|
| Rate for Payer: Cash Price |
$2,395.22
|
| Rate for Payer: Cofinity Advantage |
$2,095.81
|
| Rate for Payer: Cofinity Commercial |
$2,574.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,395.22
|
| Rate for Payer: Healthscope Commercial |
$2,694.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,095.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,245.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,544.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,245.51
|
| Rate for Payer: PHP Commercial |
$2,544.92
|
| Rate for Payer: Priority Health SBD |
$1,886.23
|
| Rate for Payer: UMR Bronson Commercial |
$1,317.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,245.51
|
|
|
TOCILIZUMAB-AAZG 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,994.02
|
|
|
Service Code
|
HCPCS Q5135
|
| Hospital Charge Code |
206928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$2,694.62 |
| Rate for Payer: Aetna American Axle |
$1,946.11
|
| Rate for Payer: Aetna Commercial |
$2,544.92
|
| Rate for Payer: Aetna Medicare |
$4.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,946.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.55
|
| Rate for Payer: BCBS Complete |
$2.44
|
| Rate for Payer: BCBS MAPPO |
$4.44
|
| Rate for Payer: BCBS Trust/PPO |
$12.95
|
| Rate for Payer: BCN Commercial |
$12.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.44
|
| Rate for Payer: Cash Price |
$2,395.22
|
| Rate for Payer: Cash Price |
$2,395.22
|
| Rate for Payer: Cofinity Advantage |
$2,095.81
|
| Rate for Payer: Cofinity Commercial |
$2,574.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,395.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.44
|
| Rate for Payer: Healthscope Commercial |
$2,694.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,095.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,245.51
|
| Rate for Payer: Mclaren Medicaid |
$4.44
|
| Rate for Payer: Mclaren Medicare |
$4.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.66
|
| Rate for Payer: Meridian Medicaid |
$4.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,544.92
|
| Rate for Payer: Nomi Health Commercial |
$13.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,245.51
|
| Rate for Payer: PACE Medicare |
$4.22
|
| Rate for Payer: PACE SWMI |
$4.44
|
| Rate for Payer: PHP Commercial |
$2,544.92
|
| Rate for Payer: PHP Medicare Advantage |
$4.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.93
|
| Rate for Payer: Priority Health Medicare |
$4.44
|
| Rate for Payer: Priority Health SBD |
$1,886.23
|
| Rate for Payer: Priority Health Tiered Network |
$11.14
|
| Rate for Payer: Railroad Medicare Medicare |
$4.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.91
|
| Rate for Payer: UHC Core |
$6.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.44
|
| Rate for Payer: UHC Exchange |
$6.91
|
| Rate for Payer: UHC Medicaid |
$2.32
|
| Rate for Payer: UHCCP Medicaid |
$2.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,107.79
|
| Rate for Payer: VA VA |
$4.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,245.51
|
|
|
TOCILIZUMAB-AAZG 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,988.04
|
|
|
Service Code
|
HCPCS Q5135
|
| Hospital Charge Code |
206929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$5,389.24 |
| Rate for Payer: Aetna American Axle |
$3,892.23
|
| Rate for Payer: Aetna Commercial |
$5,089.83
|
| Rate for Payer: Aetna Medicare |
$4.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,892.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.55
|
| Rate for Payer: BCBS Complete |
$2.44
|
| Rate for Payer: BCBS MAPPO |
$4.44
|
| Rate for Payer: BCBS Trust/PPO |
$12.95
|
| Rate for Payer: BCN Commercial |
$12.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.44
|
| Rate for Payer: Cash Price |
$4,790.43
|
| Rate for Payer: Cash Price |
$4,790.43
|
| Rate for Payer: Cofinity Advantage |
$4,191.63
|
| Rate for Payer: Cofinity Commercial |
$5,149.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,790.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.44
|
| Rate for Payer: Healthscope Commercial |
$5,389.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,191.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,491.03
|
| Rate for Payer: Mclaren Medicaid |
$4.44
|
| Rate for Payer: Mclaren Medicare |
$4.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.66
|
| Rate for Payer: Meridian Medicaid |
$4.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,089.83
|
| Rate for Payer: Nomi Health Commercial |
$13.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,491.03
|
| Rate for Payer: PACE Medicare |
$4.22
|
| Rate for Payer: PACE SWMI |
$4.44
|
| Rate for Payer: PHP Commercial |
$5,089.83
|
| Rate for Payer: PHP Medicare Advantage |
$4.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.93
|
| Rate for Payer: Priority Health Medicare |
$4.44
|
| Rate for Payer: Priority Health SBD |
$3,772.47
|
| Rate for Payer: Priority Health Tiered Network |
$11.14
|
| Rate for Payer: Railroad Medicare Medicare |
$4.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.91
|
| Rate for Payer: UHC Core |
$6.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.44
|
| Rate for Payer: UHC Exchange |
$6.91
|
| Rate for Payer: UHC Medicaid |
$2.32
|
| Rate for Payer: UHCCP Medicaid |
$2.32
|
| Rate for Payer: UMR Bronson Commercial |
$2,215.57
|
| Rate for Payer: VA VA |
$4.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,491.03
|
|
|
TOCILIZUMAB-AAZG 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,988.04
|
|
|
Service Code
|
HCPCS Q5135
|
| Hospital Charge Code |
206929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,634.74 |
| Max. Negotiated Rate |
$5,389.24 |
| Rate for Payer: Aetna American Axle |
$3,892.23
|
| Rate for Payer: Aetna Commercial |
$5,089.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,892.23
|
| Rate for Payer: Cash Price |
$4,790.43
|
| Rate for Payer: Cofinity Advantage |
$4,191.63
|
| Rate for Payer: Cofinity Commercial |
$5,149.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,790.43
|
| Rate for Payer: Healthscope Commercial |
$5,389.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,191.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,491.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,089.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,491.03
|
| Rate for Payer: PHP Commercial |
$5,089.83
|
| Rate for Payer: Priority Health SBD |
$3,772.47
|
| Rate for Payer: UMR Bronson Commercial |
$2,634.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,491.03
|
|
|
TOCILIZUMAB-AAZG 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,197.61
|
|
|
Service Code
|
HCPCS Q5135
|
| Hospital Charge Code |
206927
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$1,077.85 |
| Rate for Payer: Aetna American Axle |
$778.45
|
| Rate for Payer: Aetna Commercial |
$1,017.97
|
| Rate for Payer: Aetna Medicare |
$4.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$778.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.55
|
| Rate for Payer: BCBS Complete |
$2.44
|
| Rate for Payer: BCBS MAPPO |
$4.44
|
| Rate for Payer: BCBS Trust/PPO |
$12.95
|
| Rate for Payer: BCN Commercial |
$12.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.44
|
| Rate for Payer: Cash Price |
$958.09
|
| Rate for Payer: Cash Price |
$958.09
|
| Rate for Payer: Cofinity Advantage |
$838.33
|
| Rate for Payer: Cofinity Commercial |
$1,029.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$958.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.44
|
| Rate for Payer: Healthscope Commercial |
$1,077.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$838.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$898.21
|
| Rate for Payer: Mclaren Medicaid |
$4.44
|
| Rate for Payer: Mclaren Medicare |
$4.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.66
|
| Rate for Payer: Meridian Medicaid |
$4.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,017.97
|
| Rate for Payer: Nomi Health Commercial |
$13.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$898.21
|
| Rate for Payer: PACE Medicare |
$4.22
|
| Rate for Payer: PACE SWMI |
$4.44
|
| Rate for Payer: PHP Commercial |
$1,017.97
|
| Rate for Payer: PHP Medicare Advantage |
$4.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.93
|
| Rate for Payer: Priority Health Medicare |
$4.44
|
| Rate for Payer: Priority Health SBD |
$754.49
|
| Rate for Payer: Priority Health Tiered Network |
$11.14
|
| Rate for Payer: Railroad Medicare Medicare |
$4.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.91
|
| Rate for Payer: UHC Core |
$6.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.44
|
| Rate for Payer: UHC Exchange |
$6.91
|
| Rate for Payer: UHC Medicaid |
$2.32
|
| Rate for Payer: UHCCP Medicaid |
$2.32
|
| Rate for Payer: UMR Bronson Commercial |
$443.12
|
| Rate for Payer: VA VA |
$4.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$898.21
|
|
|
TOLVAPTAN 15 MG TABLET
|
Facility
|
IP
|
$2,064.60
|
|
|
Service Code
|
NDC 49884076854
|
| Hospital Charge Code |
97893
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$908.42 |
| Max. Negotiated Rate |
$1,858.14 |
| Rate for Payer: Aetna American Axle |
$1,341.99
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1,445.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,548.45
|
| 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: UMR Bronson Commercial |
$908.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,548.45
|
|
|
TOLVAPTAN 15 MG TABLET
|
Facility
|
IP
|
$19,247.29
|
|
|
Service Code
|
NDC 59148002050
|
| Hospital Charge Code |
97893
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8,468.81 |
| Max. Negotiated Rate |
$17,322.56 |
| Rate for Payer: Aetna American Axle |
$12,510.74
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13,473.10
|
| 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: 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: UMR Bronson Commercial |
$8,468.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,435.47
|
|
|
TOLVAPTAN 15 MG TABLET
|
Facility
|
OP
|
$19,247.29
|
|
|
Service Code
|
NDC 59148002050
|
| Hospital Charge Code |
97893
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7,121.50 |
| Max. Negotiated Rate |
$17,322.56 |
| Rate for Payer: Aetna American Axle |
$12,510.74
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13,473.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,435.47
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$7,121.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,435.47
|
|
|
TOLVAPTAN 15 MG TABLET
|
Facility
|
OP
|
$206.46
|
|
|
Service Code
|
NDC 49884076852
|
| Hospital Charge Code |
97893
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.39 |
| Max. Negotiated Rate |
$185.81 |
| Rate for Payer: Aetna American Axle |
$134.20
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$144.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.84
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$76.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.84
|
|
|
TOLVAPTAN 15 MG TABLET
|
Facility
|
IP
|
$206.46
|
|
|
Service Code
|
NDC 49884076852
|
| Hospital Charge Code |
97893
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.84 |
| Max. Negotiated Rate |
$185.81 |
| Rate for Payer: Aetna American Axle |
$134.20
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$144.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.84
|
| 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: UMR Bronson Commercial |
$90.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.84
|
|
|
TOLVAPTAN 15 MG TABLET
|
Facility
|
OP
|
$2,064.60
|
|
|
Service Code
|
NDC 49884076854
|
| Hospital Charge Code |
97893
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$763.90 |
| Max. Negotiated Rate |
$1,858.14 |
| Rate for Payer: Aetna American Axle |
$1,341.99
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1,445.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,548.45
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$763.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,548.45
|
|
|
TONSIL AND ADENOID PROCEDURES
|
Facility
|
IP
|
$8,262.08
|
|
|
Service Code
|
APR-DRG 0972
|
| Min. Negotiated Rate |
$7,868.65 |
| Max. Negotiated Rate |
$8,262.08 |
| Rate for Payer: BCBS Complete |
$8,262.08
|
| Rate for Payer: Mclaren Medicaid |
$7,868.65
|
| Rate for Payer: Meridian Medicaid |
$8,262.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,868.65
|
| Rate for Payer: UHC Medicaid |
$7,868.65
|
| Rate for Payer: UHCCP Medicaid |
$7,868.65
|
|
|
TONSIL AND ADENOID PROCEDURES
|
Facility
|
IP
|
$12,368.61
|
|
|
Service Code
|
APR-DRG 0973
|
| Min. Negotiated Rate |
$11,779.62 |
| Max. Negotiated Rate |
$12,368.61 |
| Rate for Payer: BCBS Complete |
$12,368.61
|
| Rate for Payer: Mclaren Medicaid |
$11,779.62
|
| Rate for Payer: Meridian Medicaid |
$12,368.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,779.62
|
| Rate for Payer: UHC Medicaid |
$11,779.62
|
| Rate for Payer: UHCCP Medicaid |
$11,779.62
|
|
|
TONSIL AND ADENOID PROCEDURES
|
Facility
|
IP
|
$5,423.11
|
|
|
Service Code
|
APR-DRG 0971
|
| Min. Negotiated Rate |
$5,164.86 |
| Max. Negotiated Rate |
$5,423.11 |
| Rate for Payer: BCBS Complete |
$5,423.11
|
| Rate for Payer: Mclaren Medicaid |
$5,164.86
|
| Rate for Payer: Meridian Medicaid |
$5,423.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,164.86
|
| Rate for Payer: UHC Medicaid |
$5,164.86
|
| Rate for Payer: UHCCP Medicaid |
$5,164.86
|
|
|
TONSIL AND ADENOID PROCEDURES
|
Facility
|
IP
|
$22,009.01
|
|
|
Service Code
|
APR-DRG 0974
|
| Min. Negotiated Rate |
$20,960.96 |
| Max. Negotiated Rate |
$22,009.01 |
| Rate for Payer: BCBS Complete |
$22,009.01
|
| Rate for Payer: Mclaren Medicaid |
$20,960.96
|
| Rate for Payer: Meridian Medicaid |
$22,009.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$20,960.96
|
| Rate for Payer: UHC Medicaid |
$20,960.96
|
| Rate for Payer: UHCCP Medicaid |
$20,960.96
|
|
|
TONSILLECTOMY AND ADENOIDECTOMY; AGE 12 OR OVER
|
Facility
|
OP
|
$10,683.35
|
|
|
Service Code
|
CPT 42821
|
|
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 |
$2,285.60
|
| Rate for Payer: BCN Commercial |
$2,285.60
|
| 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 |
$3,303.54
|
| 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
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 42820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| 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 |
$3,390.01
|
| Rate for Payer: BCN Commercial |
$3,390.01
|
| 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 |
$5,898.54
|
| 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
|
OP
|
$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 |
$3,323.90
|
| Rate for Payer: BCN Commercial |
$3,323.90
|
| 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 |
$3,303.54
|
| 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, PRIMARY OR SECONDARY; YOUNGER THAN AGE 12
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 42825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| 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 |
$3,527.23
|
| Rate for Payer: BCN Commercial |
$3,527.23
|
| 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 |
$5,898.54
|
| 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
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
IP
|
$379.05
|
|
|
Service Code
|
NDC 00904692961
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.78 |
| Max. Negotiated Rate |
$341.14 |
| Rate for Payer: Aetna American Axle |
$246.38
|
| Rate for Payer: Aetna Commercial |
$322.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.38
|
| Rate for Payer: Cash Price |
$303.24
|
| Rate for Payer: Cofinity Advantage |
$265.33
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$265.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.29
|
| Rate for Payer: PHP Commercial |
$322.19
|
| Rate for Payer: Priority Health SBD |
$238.80
|
| Rate for Payer: UMR Bronson Commercial |
$166.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.29
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
IP
|
$153.69
|
|
|
Service Code
|
NDC 68462010960
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.62 |
| Max. Negotiated Rate |
$138.32 |
| Rate for Payer: Aetna American Axle |
$99.90
|
| Rate for Payer: Aetna Commercial |
$130.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.90
|
| Rate for Payer: Cash Price |
$122.95
|
| Rate for Payer: Cofinity Advantage |
$107.58
|
| Rate for Payer: Cofinity Commercial |
$132.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.95
|
| Rate for Payer: Healthscope Commercial |
$138.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.27
|
| Rate for Payer: PHP Commercial |
$130.64
|
| Rate for Payer: Priority Health SBD |
$96.82
|
| Rate for Payer: UMR Bronson Commercial |
$67.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.27
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
OP
|
$417.05
|
|
|
Service Code
|
NDC 68084034401
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$375.35 |
| Rate for Payer: Aetna American Axle |
$271.08
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$291.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.79
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$154.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.79
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
IP
|
$111.39
|
|
|
Service Code
|
NDC 68382014014
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.01 |
| Max. Negotiated Rate |
$100.25 |
| Rate for Payer: Aetna American Axle |
$72.40
|
| Rate for Payer: Aetna Commercial |
$94.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.40
|
| Rate for Payer: Cash Price |
$89.11
|
| Rate for Payer: Cofinity Advantage |
$77.97
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$77.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.54
|
| Rate for Payer: PHP Commercial |
$94.68
|
| Rate for Payer: Priority Health SBD |
$70.18
|
| Rate for Payer: UMR Bronson Commercial |
$49.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.54
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
OP
|
$153.69
|
|
|
Service Code
|
NDC 68462010960
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.87 |
| Max. Negotiated Rate |
$138.32 |
| Rate for Payer: Aetna American Axle |
$99.90
|
| Rate for Payer: Aetna Commercial |
$130.64
|
| Rate for Payer: Aetna Medicare |
$76.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.90
|
| Rate for Payer: BCBS Complete |
$61.48
|
| Rate for Payer: Cash Price |
$122.95
|
| Rate for Payer: Cofinity Advantage |
$107.58
|
| Rate for Payer: Cofinity Commercial |
$132.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.95
|
| Rate for Payer: Healthscope Commercial |
$138.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.27
|
| Rate for Payer: PHP Commercial |
$130.64
|
| Rate for Payer: Priority Health SBD |
$96.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.90
|
| Rate for Payer: UHC Core |
$80.07
|
| Rate for Payer: UHC Exchange |
$60.40
|
| Rate for Payer: UMR Bronson Commercial |
$56.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.27
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
IP
|
$417.05
|
|
|
Service Code
|
NDC 68084034401
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.50 |
| Max. Negotiated Rate |
$375.35 |
| Rate for Payer: Aetna American Axle |
$271.08
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$291.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.79
|
| 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: UMR Bronson Commercial |
$183.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.79
|
|
