|
TOPIRAMATE 200 MG TABLET
|
Facility
|
OP
|
$90.29
|
|
|
Service Code
|
NDC 68084034521
|
| Hospital Charge Code |
18921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.41 |
| Max. Negotiated Rate |
$81.26 |
| Rate for Payer: Aetna American Axle |
$58.69
|
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Medicare |
$45.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.69
|
| Rate for Payer: BCBS Complete |
$36.12
|
| Rate for Payer: Cash Price |
$72.23
|
| Rate for Payer: Cofinity Commercial |
$63.20
|
| Rate for Payer: Cofinity Commercial |
$77.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.23
|
| Rate for Payer: Healthscope Commercial |
$81.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.75
|
| Rate for Payer: PHP Commercial |
$76.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.69
|
| Rate for Payer: Priority Health SBD |
$56.88
|
| Rate for Payer: UMR Bronson Commercial |
$33.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.72
|
|
|
TOPIRAMATE 200 MG TABLET
|
Facility
|
OP
|
$142.41
|
|
|
Service Code
|
NDC 68382014114
|
| Hospital Charge Code |
18921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.69 |
| Max. Negotiated Rate |
$128.17 |
| Rate for Payer: Aetna American Axle |
$92.57
|
| Rate for Payer: Aetna Commercial |
$121.05
|
| Rate for Payer: Aetna Medicare |
$71.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.57
|
| Rate for Payer: BCBS Complete |
$56.96
|
| Rate for Payer: Cash Price |
$113.93
|
| Rate for Payer: Cofinity Commercial |
$122.47
|
| Rate for Payer: Cofinity Commercial |
$99.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.93
|
| Rate for Payer: Healthscope Commercial |
$128.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.05
|
| Rate for Payer: PHP Commercial |
$121.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.57
|
| Rate for Payer: Priority Health SBD |
$89.72
|
| Rate for Payer: UMR Bronson Commercial |
$52.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.81
|
|
|
TOPIRAMATE 200 MG TABLET
|
Facility
|
OP
|
$201.63
|
|
|
Service Code
|
NDC 68462011060
|
| Hospital Charge Code |
18921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$181.47 |
| Rate for Payer: Aetna American Axle |
$131.06
|
| Rate for Payer: Aetna Commercial |
$171.39
|
| Rate for Payer: Aetna Medicare |
$100.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.06
|
| Rate for Payer: BCBS Complete |
$80.65
|
| Rate for Payer: Cash Price |
$161.30
|
| Rate for Payer: Cofinity Commercial |
$141.14
|
| Rate for Payer: Cofinity Commercial |
$173.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$141.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.30
|
| Rate for Payer: Healthscope Commercial |
$181.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.39
|
| Rate for Payer: PHP Commercial |
$171.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.06
|
| Rate for Payer: Priority Health SBD |
$127.03
|
| Rate for Payer: UMR Bronson Commercial |
$74.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.22
|
|
|
TOPIRAMATE 25 MG SPRINKLE CAPSULE
|
Facility
|
IP
|
$354.82
|
|
|
Service Code
|
NDC 68382000514
|
| Hospital Charge Code |
27642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.12 |
| Max. Negotiated Rate |
$319.34 |
| Rate for Payer: Aetna American Axle |
$230.63
|
| Rate for Payer: Aetna Commercial |
$301.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.63
|
| Rate for Payer: Cash Price |
$283.86
|
| Rate for Payer: Cofinity Commercial |
$248.37
|
| Rate for Payer: Cofinity Commercial |
$305.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.86
|
| Rate for Payer: Healthscope Commercial |
$319.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.60
|
| Rate for Payer: PHP Commercial |
$301.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.63
|
| Rate for Payer: Priority Health SBD |
$223.54
|
| Rate for Payer: UMR Bronson Commercial |
$156.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.12
|
|
|
TOPIRAMATE 25 MG SPRINKLE CAPSULE
|
Facility
|
IP
|
$1,577.98
|
|
|
Service Code
|
NDC 50458064565
|
| Hospital Charge Code |
27642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$694.31 |
| Max. Negotiated Rate |
$1,420.18 |
| Rate for Payer: Aetna American Axle |
$1,025.69
|
| Rate for Payer: Aetna Commercial |
$1,341.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,025.69
|
| Rate for Payer: Cash Price |
$1,262.38
|
| Rate for Payer: Cofinity Commercial |
$1,104.59
|
| Rate for Payer: Cofinity Commercial |
$1,357.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,104.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,262.38
|
| Rate for Payer: Healthscope Commercial |
$1,420.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,104.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,183.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,341.28
|
| Rate for Payer: PHP Commercial |
$1,341.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.69
|
| Rate for Payer: Priority Health SBD |
$994.13
|
| Rate for Payer: UMR Bronson Commercial |
$694.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,183.48
|
|
|
TOPIRAMATE 25 MG SPRINKLE CAPSULE
|
Facility
|
OP
|
$1,577.98
|
|
|
Service Code
|
NDC 50458064565
|
| Hospital Charge Code |
27642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$583.85 |
| Max. Negotiated Rate |
$1,420.18 |
| Rate for Payer: Aetna American Axle |
$1,025.69
|
| Rate for Payer: Aetna Commercial |
$1,341.28
|
| Rate for Payer: Aetna Medicare |
$788.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,025.69
|
| Rate for Payer: BCBS Complete |
$631.19
|
| Rate for Payer: Cash Price |
$1,262.38
|
| Rate for Payer: Cofinity Commercial |
$1,104.59
|
| Rate for Payer: Cofinity Commercial |
$1,357.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,104.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,262.38
|
| Rate for Payer: Healthscope Commercial |
$1,420.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,104.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,183.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,341.28
|
| Rate for Payer: PHP Commercial |
$1,341.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.69
|
| Rate for Payer: Priority Health SBD |
$994.13
|
| Rate for Payer: UMR Bronson Commercial |
$583.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,183.48
|
|
|
TOPIRAMATE 25 MG SPRINKLE CAPSULE
|
Facility
|
OP
|
$354.82
|
|
|
Service Code
|
NDC 68382000514
|
| Hospital Charge Code |
27642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.28 |
| Max. Negotiated Rate |
$319.34 |
| Rate for Payer: Aetna American Axle |
$230.63
|
| Rate for Payer: Aetna Commercial |
$301.60
|
| Rate for Payer: Aetna Medicare |
$177.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.63
|
| Rate for Payer: BCBS Complete |
$141.93
|
| Rate for Payer: Cash Price |
$283.86
|
| Rate for Payer: Cofinity Commercial |
$248.37
|
| Rate for Payer: Cofinity Commercial |
$305.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.86
|
| Rate for Payer: Healthscope Commercial |
$319.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.60
|
| Rate for Payer: PHP Commercial |
$301.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.63
|
| Rate for Payer: Priority Health SBD |
$223.54
|
| Rate for Payer: UMR Bronson Commercial |
$131.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.12
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
OP
|
$215.65
|
|
|
Service Code
|
NDC 68084034201
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.79 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna American Axle |
$140.17
|
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna Medicare |
$107.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: BCBS Complete |
$86.26
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.17
|
| Rate for Payer: Priority Health SBD |
$135.86
|
| Rate for Payer: UMR Bronson Commercial |
$79.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$57.81
|
|
|
Service Code
|
NDC 68382013814
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$52.03 |
| Rate for Payer: Aetna American Axle |
$37.58
|
| Rate for Payer: Aetna Commercial |
$49.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.58
|
| Rate for Payer: Cash Price |
$46.25
|
| Rate for Payer: Cofinity Commercial |
$40.47
|
| Rate for Payer: Cofinity Commercial |
$49.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.25
|
| Rate for Payer: Healthscope Commercial |
$52.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.14
|
| Rate for Payer: PHP Commercial |
$49.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.58
|
| Rate for Payer: Priority Health SBD |
$36.42
|
| Rate for Payer: UMR Bronson Commercial |
$25.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.36
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$1,380.18
|
|
|
Service Code
|
NDC 50458063965
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$607.28 |
| Max. Negotiated Rate |
$1,242.16 |
| Rate for Payer: Aetna American Axle |
$897.12
|
| Rate for Payer: Aetna Commercial |
$1,173.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$897.12
|
| Rate for Payer: Cash Price |
$1,104.14
|
| Rate for Payer: Cofinity Commercial |
$1,186.95
|
| Rate for Payer: Cofinity Commercial |
$966.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$966.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.14
|
| Rate for Payer: Healthscope Commercial |
$1,242.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$966.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,035.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.15
|
| Rate for Payer: PHP Commercial |
$1,173.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.12
|
| Rate for Payer: Priority Health SBD |
$869.51
|
| Rate for Payer: UMR Bronson Commercial |
$607.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,035.13
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
OP
|
$57.81
|
|
|
Service Code
|
NDC 68382013814
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.39 |
| Max. Negotiated Rate |
$52.03 |
| Rate for Payer: Aetna American Axle |
$37.58
|
| Rate for Payer: Aetna Commercial |
$49.14
|
| Rate for Payer: Aetna Medicare |
$28.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.58
|
| Rate for Payer: BCBS Complete |
$23.12
|
| Rate for Payer: Cash Price |
$46.25
|
| Rate for Payer: Cofinity Commercial |
$40.47
|
| Rate for Payer: Cofinity Commercial |
$49.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.25
|
| Rate for Payer: Healthscope Commercial |
$52.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.14
|
| Rate for Payer: PHP Commercial |
$49.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.58
|
| Rate for Payer: Priority Health SBD |
$36.42
|
| Rate for Payer: UMR Bronson Commercial |
$21.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.36
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$215.65
|
|
|
Service Code
|
NDC 68084034211
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.89 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna American Axle |
$140.17
|
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.17
|
| Rate for Payer: Priority Health SBD |
$135.86
|
| Rate for Payer: UMR Bronson Commercial |
$94.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
OP
|
$1,380.18
|
|
|
Service Code
|
NDC 50458063965
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$510.67 |
| Max. Negotiated Rate |
$1,242.16 |
| Rate for Payer: Aetna American Axle |
$897.12
|
| Rate for Payer: Aetna Commercial |
$1,173.15
|
| Rate for Payer: Aetna Medicare |
$690.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$897.12
|
| Rate for Payer: BCBS Complete |
$552.07
|
| Rate for Payer: Cash Price |
$1,104.14
|
| Rate for Payer: Cofinity Commercial |
$1,186.95
|
| Rate for Payer: Cofinity Commercial |
$966.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$966.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.14
|
| Rate for Payer: Healthscope Commercial |
$1,242.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$966.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,035.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.15
|
| Rate for Payer: PHP Commercial |
$1,173.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.12
|
| Rate for Payer: Priority Health SBD |
$869.51
|
| Rate for Payer: UMR Bronson Commercial |
$510.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,035.13
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$215.65
|
|
|
Service Code
|
NDC 68084034201
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.89 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna American Axle |
$140.17
|
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.17
|
| Rate for Payer: Priority Health SBD |
$135.86
|
| Rate for Payer: UMR Bronson Commercial |
$94.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
OP
|
$215.65
|
|
|
Service Code
|
NDC 68084034211
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.79 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna American Axle |
$140.17
|
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna Medicare |
$107.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: BCBS Complete |
$86.26
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.17
|
| Rate for Payer: Priority Health SBD |
$135.86
|
| Rate for Payer: UMR Bronson Commercial |
$79.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
TOPOTECAN 4 MG/4 ML (1 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$105.88
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
152057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.18 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna American Axle |
$68.82
|
| Rate for Payer: Aetna American Axle |
$293.84
|
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Commercial |
$384.25
|
| Rate for Payer: Aetna Medicare |
$52.94
|
| Rate for Payer: Aetna Medicare |
$226.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.84
|
| Rate for Payer: BCBS Complete |
$180.82
|
| Rate for Payer: BCBS Complete |
$42.35
|
| Rate for Payer: Cash Price |
$84.70
|
| Rate for Payer: Cash Price |
$361.65
|
| Rate for Payer: Cofinity Commercial |
$91.06
|
| Rate for Payer: Cofinity Commercial |
$74.12
|
| Rate for Payer: Cofinity Commercial |
$316.44
|
| Rate for Payer: Cofinity Commercial |
$388.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$316.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.65
|
| Rate for Payer: Healthscope Commercial |
$406.85
|
| Rate for Payer: Healthscope Commercial |
$95.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$316.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.25
|
| Rate for Payer: PHP Commercial |
$384.25
|
| Rate for Payer: PHP Commercial |
$90.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.84
|
| Rate for Payer: Priority Health SBD |
$284.80
|
| Rate for Payer: Priority Health SBD |
$66.70
|
| Rate for Payer: UMR Bronson Commercial |
$39.18
|
| Rate for Payer: UMR Bronson Commercial |
$167.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.41
|
|
|
TOPOTECAN 4 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$371.16
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
17285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$137.33 |
| Max. Negotiated Rate |
$334.04 |
| Rate for Payer: Aetna American Axle |
$241.25
|
| Rate for Payer: Aetna American Axle |
$3,619.79
|
| Rate for Payer: Aetna Commercial |
$315.49
|
| Rate for Payer: Aetna Commercial |
$4,733.57
|
| Rate for Payer: Aetna Medicare |
$185.58
|
| Rate for Payer: Aetna Medicare |
$2,784.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,619.79
|
| Rate for Payer: BCBS Complete |
$148.46
|
| Rate for Payer: BCBS Complete |
$2,227.56
|
| Rate for Payer: Cash Price |
$296.93
|
| Rate for Payer: Cash Price |
$4,455.13
|
| Rate for Payer: Cofinity Commercial |
$319.20
|
| Rate for Payer: Cofinity Commercial |
$259.81
|
| Rate for Payer: Cofinity Commercial |
$4,789.26
|
| Rate for Payer: Cofinity Commercial |
$3,898.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,898.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,455.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.93
|
| Rate for Payer: Healthscope Commercial |
$334.04
|
| Rate for Payer: Healthscope Commercial |
$5,012.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,898.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,176.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,733.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.49
|
| Rate for Payer: PHP Commercial |
$4,733.57
|
| Rate for Payer: PHP Commercial |
$315.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,619.79
|
| Rate for Payer: Priority Health SBD |
$3,508.41
|
| Rate for Payer: Priority Health SBD |
$233.83
|
| Rate for Payer: UMR Bronson Commercial |
$137.33
|
| Rate for Payer: UMR Bronson Commercial |
$2,060.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,176.68
|
|
|
TOPOTECAN 4 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,568.91
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
17285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,450.32 |
| Max. Negotiated Rate |
$5,012.02 |
| Rate for Payer: Aetna American Axle |
$3,619.79
|
| Rate for Payer: Aetna Commercial |
$4,733.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,619.79
|
| Rate for Payer: Cash Price |
$4,455.13
|
| Rate for Payer: Cofinity Commercial |
$3,898.24
|
| Rate for Payer: Cofinity Commercial |
$4,789.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,898.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,455.13
|
| Rate for Payer: Healthscope Commercial |
$5,012.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,898.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,176.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,733.57
|
| Rate for Payer: PHP Commercial |
$4,733.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,619.79
|
| Rate for Payer: Priority Health SBD |
$3,508.41
|
| Rate for Payer: UMR Bronson Commercial |
$2,450.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,176.68
|
|
|
TORSEMIDE 100 MG TABLET
|
Facility
|
IP
|
$398.05
|
|
|
Service Code
|
NDC 31722053201
|
| Hospital Charge Code |
18294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.14 |
| Max. Negotiated Rate |
$358.25 |
| Rate for Payer: Aetna American Axle |
$258.73
|
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.73
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Commercial |
$278.63
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$358.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.73
|
| Rate for Payer: Priority Health SBD |
$250.77
|
| Rate for Payer: UMR Bronson Commercial |
$175.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.54
|
|
|
TORSEMIDE 100 MG TABLET
|
Facility
|
OP
|
$3.03
|
|
|
Service Code
|
NDC 50268075711
|
| Hospital Charge Code |
18294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Aetna American Axle |
$1.97
|
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna Medicare |
$1.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.97
|
| Rate for Payer: BCBS Complete |
$1.21
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$2.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.97
|
| Rate for Payer: Priority Health SBD |
$1.91
|
| Rate for Payer: UMR Bronson Commercial |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.27
|
|
|
TORSEMIDE 100 MG TABLET
|
Facility
|
OP
|
$398.05
|
|
|
Service Code
|
NDC 31722053201
|
| Hospital Charge Code |
18294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.28 |
| Max. Negotiated Rate |
$358.25 |
| Rate for Payer: Aetna American Axle |
$258.73
|
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna Medicare |
$199.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.73
|
| Rate for Payer: BCBS Complete |
$159.22
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Commercial |
$278.63
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$358.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.73
|
| Rate for Payer: Priority Health SBD |
$250.77
|
| Rate for Payer: UMR Bronson Commercial |
$147.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.54
|
|
|
TORSEMIDE 100 MG TABLET
|
Facility
|
OP
|
$151.05
|
|
|
Service Code
|
NDC 50268075715
|
| Hospital Charge Code |
18294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.89 |
| Max. Negotiated Rate |
$135.94 |
| Rate for Payer: Aetna American Axle |
$98.18
|
| Rate for Payer: Aetna Commercial |
$128.39
|
| Rate for Payer: Aetna Medicare |
$75.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.18
|
| Rate for Payer: BCBS Complete |
$60.42
|
| Rate for Payer: Cash Price |
$120.84
|
| Rate for Payer: Cofinity Commercial |
$105.73
|
| Rate for Payer: Cofinity Commercial |
$129.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.84
|
| Rate for Payer: Healthscope Commercial |
$135.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.39
|
| Rate for Payer: PHP Commercial |
$128.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.18
|
| Rate for Payer: Priority Health SBD |
$95.16
|
| Rate for Payer: UMR Bronson Commercial |
$55.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.29
|
|
|
TORSEMIDE 100 MG TABLET
|
Facility
|
IP
|
$151.05
|
|
|
Service Code
|
NDC 50268075715
|
| Hospital Charge Code |
18294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.46 |
| Max. Negotiated Rate |
$135.94 |
| Rate for Payer: Aetna American Axle |
$98.18
|
| Rate for Payer: Aetna Commercial |
$128.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.18
|
| Rate for Payer: Cash Price |
$120.84
|
| Rate for Payer: Cofinity Commercial |
$105.73
|
| Rate for Payer: Cofinity Commercial |
$129.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.84
|
| Rate for Payer: Healthscope Commercial |
$135.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.39
|
| Rate for Payer: PHP Commercial |
$128.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.18
|
| Rate for Payer: Priority Health SBD |
$95.16
|
| Rate for Payer: UMR Bronson Commercial |
$66.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.29
|
|
|
TORSEMIDE 100 MG TABLET
|
Facility
|
IP
|
$3.03
|
|
|
Service Code
|
NDC 50268075711
|
| Hospital Charge Code |
18294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Aetna American Axle |
$1.97
|
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.97
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$2.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.97
|
| Rate for Payer: Priority Health SBD |
$1.91
|
| Rate for Payer: UMR Bronson Commercial |
$1.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.27
|
|
|
TORSEMIDE 100 MG TABLET
|
Facility
|
OP
|
$868.32
|
|
|
Service Code
|
NDC 50111091801
|
| Hospital Charge Code |
18294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$321.28 |
| Max. Negotiated Rate |
$781.49 |
| Rate for Payer: Aetna American Axle |
$564.41
|
| Rate for Payer: Aetna Commercial |
$738.07
|
| Rate for Payer: Aetna Medicare |
$434.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.41
|
| Rate for Payer: BCBS Complete |
$347.33
|
| Rate for Payer: Cash Price |
$694.66
|
| Rate for Payer: Cofinity Commercial |
$607.82
|
| Rate for Payer: Cofinity Commercial |
$746.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$607.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$694.66
|
| Rate for Payer: Healthscope Commercial |
$781.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$607.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$651.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$738.07
|
| Rate for Payer: PHP Commercial |
$738.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.41
|
| Rate for Payer: Priority Health SBD |
$547.04
|
| Rate for Payer: UMR Bronson Commercial |
$321.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$651.24
|
|
