|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$2.71
|
|
|
Service Code
|
NDC 60687045011
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$2.44 |
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.76
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cofinity Advantage |
$1.90
|
| Rate for Payer: Cofinity Commercial |
$2.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$2.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.03
|
| Rate for Payer: PHP Commercial |
$2.30
|
| Rate for Payer: Priority Health SBD |
$1.71
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$434.75
|
|
|
Service Code
|
NDC 70377006112
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.89 |
| Max. Negotiated Rate |
$391.27 |
| Rate for Payer: Aetna Commercial |
$369.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.59
|
| Rate for Payer: Cash Price |
$347.80
|
| Rate for Payer: Cofinity Advantage |
$304.32
|
| Rate for Payer: Cofinity Commercial |
$373.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.80
|
| Rate for Payer: Healthscope Commercial |
$391.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$326.06
|
| Rate for Payer: PHP Commercial |
$369.54
|
| Rate for Payer: Priority Health SBD |
$273.89
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$270.24
|
|
|
Service Code
|
NDC 60687045001
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna Commercial |
$229.70
|
| Rate for Payer: Aetna Medicare |
$135.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.66
|
| Rate for Payer: BCBS Complete |
$108.10
|
| Rate for Payer: Cash Price |
$216.19
|
| Rate for Payer: Cofinity Advantage |
$189.17
|
| Rate for Payer: Cofinity Commercial |
$232.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.19
|
| Rate for Payer: Healthscope Commercial |
$243.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.68
|
| Rate for Payer: PHP Commercial |
$229.70
|
| Rate for Payer: Priority Health SBD |
$170.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.66
|
| Rate for Payer: UHC Core |
$140.80
|
| Rate for Payer: UHC Exchange |
$106.20
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$290.70
|
|
|
Service Code
|
NDC 00904711061
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.14 |
| Max. Negotiated Rate |
$261.63 |
| Rate for Payer: Aetna Commercial |
$247.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.96
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cofinity Advantage |
$203.49
|
| Rate for Payer: Cofinity Commercial |
$250.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.56
|
| Rate for Payer: Healthscope Commercial |
$261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.03
|
| Rate for Payer: PHP Commercial |
$247.09
|
| Rate for Payer: Priority Health SBD |
$183.14
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$3.85
|
|
|
Service Code
|
NDC 51079092901
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.50
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cofinity Advantage |
$2.69
|
| Rate for Payer: Cofinity Commercial |
$3.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.08
|
| Rate for Payer: Healthscope Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.89
|
| Rate for Payer: PHP Commercial |
$3.27
|
| Rate for Payer: Priority Health SBD |
$2.43
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$2,079.75
|
|
|
Service Code
|
NDC 70377006113
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$817.34 |
| Max. Negotiated Rate |
$1,871.78 |
| Rate for Payer: Aetna Commercial |
$1,767.79
|
| Rate for Payer: Aetna Medicare |
$1,039.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,351.84
|
| Rate for Payer: BCBS Complete |
$831.90
|
| Rate for Payer: Cash Price |
$1,663.80
|
| Rate for Payer: Cofinity Advantage |
$1,455.83
|
| Rate for Payer: Cofinity Commercial |
$1,788.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,663.80
|
| Rate for Payer: Healthscope Commercial |
$1,871.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,663.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,767.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,559.81
|
| Rate for Payer: PHP Commercial |
$1,767.79
|
| Rate for Payer: Priority Health SBD |
$1,310.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,351.84
|
| Rate for Payer: UHC Core |
$1,083.55
|
| Rate for Payer: UHC Exchange |
$817.34
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$384.75
|
|
|
Service Code
|
NDC 51079092920
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.21 |
| Max. Negotiated Rate |
$346.27 |
| Rate for Payer: Aetna Commercial |
$327.04
|
| Rate for Payer: Aetna Medicare |
$192.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.09
|
| Rate for Payer: BCBS Complete |
$153.90
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cofinity Advantage |
$269.32
|
| Rate for Payer: Cofinity Commercial |
$330.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.80
|
| Rate for Payer: Healthscope Commercial |
$346.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$307.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$288.56
|
| Rate for Payer: PHP Commercial |
$327.04
|
| Rate for Payer: Priority Health SBD |
$242.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.09
|
| Rate for Payer: UHC Core |
$200.45
|
| Rate for Payer: UHC Exchange |
$151.21
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$2.71
|
|
|
Service Code
|
NDC 60687045011
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.44 |
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: Aetna Medicare |
$1.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.76
|
| Rate for Payer: BCBS Complete |
$1.08
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cofinity Advantage |
$1.90
|
| Rate for Payer: Cofinity Commercial |
$2.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$2.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.03
|
| Rate for Payer: PHP Commercial |
$2.30
|
| Rate for Payer: Priority Health SBD |
$1.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.76
|
| Rate for Payer: UHC Core |
$1.41
|
| Rate for Payer: UHC Exchange |
$1.07
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$384.75
|
|
|
Service Code
|
NDC 51079092920
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$242.39 |
| Max. Negotiated Rate |
$346.27 |
| Rate for Payer: Aetna Commercial |
$327.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.09
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cofinity Advantage |
$269.32
|
| Rate for Payer: Cofinity Commercial |
$330.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.80
|
| Rate for Payer: Healthscope Commercial |
$346.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$288.56
|
| Rate for Payer: PHP Commercial |
$327.04
|
| Rate for Payer: Priority Health SBD |
$242.39
|
|
|
LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$16.30
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
155884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$14.67 |
| Rate for Payer: Aetna Commercial |
$13.86
|
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: Aetna Commercial |
$7.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.98
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Advantage |
$20.15
|
| Rate for Payer: Cofinity Advantage |
$11.41
|
| Rate for Payer: Cofinity Advantage |
$6.44
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Cofinity Commercial |
$7.91
|
| Rate for Payer: Cofinity Commercial |
$14.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.04
|
| Rate for Payer: Healthscope Commercial |
$25.91
|
| Rate for Payer: Healthscope Commercial |
$14.67
|
| Rate for Payer: Healthscope Commercial |
$8.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.22
|
| Rate for Payer: PHP Commercial |
$13.86
|
| Rate for Payer: PHP Commercial |
$24.47
|
| Rate for Payer: PHP Commercial |
$7.82
|
| Rate for Payer: Priority Health SBD |
$18.14
|
| Rate for Payer: Priority Health SBD |
$10.27
|
| Rate for Payer: Priority Health SBD |
$5.80
|
|
|
LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$16.30
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
155884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$14.67 |
| Rate for Payer: Aetna Commercial |
$13.86
|
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: Aetna Commercial |
$7.82
|
| Rate for Payer: Aetna Medicare |
$8.15
|
| Rate for Payer: Aetna Medicare |
$14.39
|
| Rate for Payer: Aetna Medicare |
$4.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.98
|
| Rate for Payer: BCBS Complete |
$3.68
|
| Rate for Payer: BCBS Complete |
$6.52
|
| Rate for Payer: BCBS Complete |
$11.52
|
| Rate for Payer: BCBS Trust/PPO |
$0.86
|
| Rate for Payer: BCBS Trust/PPO |
$0.86
|
| Rate for Payer: BCBS Trust/PPO |
$0.86
|
| Rate for Payer: BCN Commercial |
$0.86
|
| Rate for Payer: BCN Commercial |
$0.86
|
| Rate for Payer: BCN Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Advantage |
$20.15
|
| Rate for Payer: Cofinity Advantage |
$11.41
|
| Rate for Payer: Cofinity Advantage |
$6.44
|
| Rate for Payer: Cofinity Commercial |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Cofinity Commercial |
$7.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.04
|
| Rate for Payer: Healthscope Commercial |
$8.28
|
| Rate for Payer: Healthscope Commercial |
$25.91
|
| Rate for Payer: Healthscope Commercial |
$14.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.90
|
| Rate for Payer: PHP Commercial |
$13.86
|
| Rate for Payer: PHP Commercial |
$24.47
|
| Rate for Payer: PHP Commercial |
$7.82
|
| Rate for Payer: Priority Health SBD |
$10.27
|
| Rate for Payer: Priority Health SBD |
$5.80
|
| Rate for Payer: Priority Health SBD |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.58
|
| Rate for Payer: UHC Core |
$0.58
|
| Rate for Payer: UHC Core |
$0.58
|
| Rate for Payer: UHC Core |
$0.58
|
| Rate for Payer: UHC Exchange |
$0.58
|
| Rate for Payer: UHC Exchange |
$0.58
|
| Rate for Payer: UHC Exchange |
$0.58
|
|
|
LABETALOL 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
10372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$272.00
|
| Rate for Payer: Aetna Commercial |
$40.14
|
| Rate for Payer: Aetna Commercial |
$133.45
|
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Aetna Commercial |
$42.08
|
| Rate for Payer: Aetna Commercial |
$59.33
|
| Rate for Payer: Aetna Commercial |
$92.65
|
| Rate for Payer: Aetna Commercial |
$260.55
|
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Aetna Commercial |
$39.10
|
| Rate for Payer: Aetna Medicare |
$34.90
|
| Rate for Payer: Aetna Medicare |
$78.50
|
| Rate for Payer: Aetna Medicare |
$54.50
|
| Rate for Payer: Aetna Medicare |
$160.00
|
| Rate for Payer: Aetna Medicare |
$23.61
|
| Rate for Payer: Aetna Medicare |
$21.25
|
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: Aetna Medicare |
$24.75
|
| Rate for Payer: Aetna Medicare |
$115.50
|
| Rate for Payer: Aetna Medicare |
$153.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.05
|
| Rate for Payer: BCBS Complete |
$27.92
|
| Rate for Payer: BCBS Complete |
$19.80
|
| Rate for Payer: BCBS Complete |
$62.80
|
| Rate for Payer: BCBS Complete |
$43.60
|
| Rate for Payer: BCBS Complete |
$92.40
|
| Rate for Payer: BCBS Complete |
$17.00
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS Complete |
$128.00
|
| Rate for Payer: BCBS Complete |
$18.89
|
| Rate for Payer: BCBS Complete |
$122.61
|
| Rate for Payer: BCBS Trust/PPO |
$0.86
|
| Rate for Payer: BCBS Trust/PPO |
$0.86
|
| Rate for Payer: BCBS Trust/PPO |
$0.86
|
| Rate for Payer: BCBS Trust/PPO |
$0.86
|
| Rate for Payer: BCBS Trust/PPO |
$0.86
|
| Rate for Payer: BCBS Trust/PPO |
$0.86
|
| Rate for Payer: BCBS Trust/PPO |
$0.86
|
| Rate for Payer: BCBS Trust/PPO |
$0.86
|
| Rate for Payer: BCBS Trust/PPO |
$0.86
|
| Rate for Payer: BCBS Trust/PPO |
$0.86
|
| Rate for Payer: BCN Commercial |
$0.86
|
| Rate for Payer: BCN Commercial |
$0.86
|
| Rate for Payer: BCN Commercial |
$0.86
|
| Rate for Payer: BCN Commercial |
$0.86
|
| Rate for Payer: BCN Commercial |
$0.86
|
| Rate for Payer: BCN Commercial |
$0.86
|
| Rate for Payer: BCN Commercial |
$0.86
|
| Rate for Payer: BCN Commercial |
$0.86
|
| Rate for Payer: BCN Commercial |
$0.86
|
| Rate for Payer: BCN Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$245.22
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$37.78
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$55.84
|
| Rate for Payer: Cash Price |
$55.84
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$245.22
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$37.78
|
| Rate for Payer: Cofinity Advantage |
$224.00
|
| Rate for Payer: Cofinity Advantage |
$33.05
|
| Rate for Payer: Cofinity Advantage |
$48.86
|
| Rate for Payer: Cofinity Advantage |
$214.57
|
| Rate for Payer: Cofinity Advantage |
$76.30
|
| Rate for Payer: Cofinity Advantage |
$161.70
|
| Rate for Payer: Cofinity Advantage |
$109.90
|
| Rate for Payer: Cofinity Advantage |
$32.20
|
| Rate for Payer: Cofinity Advantage |
$29.75
|
| Rate for Payer: Cofinity Advantage |
$34.65
|
| Rate for Payer: Cofinity Commercial |
$36.55
|
| Rate for Payer: Cofinity Commercial |
$275.20
|
| Rate for Payer: Cofinity Commercial |
$198.66
|
| Rate for Payer: Cofinity Commercial |
$39.56
|
| Rate for Payer: Cofinity Commercial |
$42.57
|
| Rate for Payer: Cofinity Commercial |
$60.03
|
| Rate for Payer: Cofinity Commercial |
$93.74
|
| Rate for Payer: Cofinity Commercial |
$135.02
|
| Rate for Payer: Cofinity Commercial |
$263.62
|
| Rate for Payer: Cofinity Commercial |
$40.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.20
|
| Rate for Payer: Healthscope Commercial |
$44.55
|
| Rate for Payer: Healthscope Commercial |
$98.10
|
| Rate for Payer: Healthscope Commercial |
$141.30
|
| Rate for Payer: Healthscope Commercial |
$207.90
|
| Rate for Payer: Healthscope Commercial |
$275.88
|
| Rate for Payer: Healthscope Commercial |
$288.00
|
| Rate for Payer: Healthscope Commercial |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$41.40
|
| Rate for Payer: Healthscope Commercial |
$42.50
|
| Rate for Payer: Healthscope Commercial |
$62.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$256.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$245.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.41
|
| Rate for Payer: PHP Commercial |
$42.08
|
| Rate for Payer: PHP Commercial |
$40.14
|
| Rate for Payer: PHP Commercial |
$196.35
|
| Rate for Payer: PHP Commercial |
$92.65
|
| Rate for Payer: PHP Commercial |
$59.33
|
| Rate for Payer: PHP Commercial |
$272.00
|
| Rate for Payer: PHP Commercial |
$260.55
|
| Rate for Payer: PHP Commercial |
$133.45
|
| Rate for Payer: PHP Commercial |
$36.12
|
| Rate for Payer: PHP Commercial |
$39.10
|
| Rate for Payer: Priority Health SBD |
$26.77
|
| Rate for Payer: Priority Health SBD |
$201.60
|
| Rate for Payer: Priority Health SBD |
$28.98
|
| Rate for Payer: Priority Health SBD |
$193.11
|
| Rate for Payer: Priority Health SBD |
$29.75
|
| Rate for Payer: Priority Health SBD |
$145.53
|
| Rate for Payer: Priority Health SBD |
$98.91
|
| Rate for Payer: Priority Health SBD |
$68.67
|
| Rate for Payer: Priority Health SBD |
$31.18
|
| Rate for Payer: Priority Health SBD |
$43.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.58
|
| Rate for Payer: UHC Core |
$0.58
|
| Rate for Payer: UHC Core |
$0.58
|
| Rate for Payer: UHC Core |
$0.58
|
| Rate for Payer: UHC Core |
$0.58
|
| Rate for Payer: UHC Core |
$0.58
|
| Rate for Payer: UHC Core |
$0.58
|
| Rate for Payer: UHC Core |
$0.58
|
| Rate for Payer: UHC Core |
$0.58
|
| Rate for Payer: UHC Core |
$0.58
|
| Rate for Payer: UHC Core |
$0.58
|
| Rate for Payer: UHC Exchange |
$0.58
|
| Rate for Payer: UHC Exchange |
$0.58
|
| Rate for Payer: UHC Exchange |
$0.58
|
| Rate for Payer: UHC Exchange |
$0.58
|
| Rate for Payer: UHC Exchange |
$0.58
|
| Rate for Payer: UHC Exchange |
$0.58
|
| Rate for Payer: UHC Exchange |
$0.58
|
| Rate for Payer: UHC Exchange |
$0.58
|
| Rate for Payer: UHC Exchange |
$0.58
|
| Rate for Payer: UHC Exchange |
$0.58
|
|
|
LABETALOL 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$47.22
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
10372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Cofinity Advantage |
$33.05
|
| Rate for Payer: Aetna Commercial |
$40.14
|
| Rate for Payer: Aetna Commercial |
$39.10
|
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Aetna Commercial |
$260.55
|
| Rate for Payer: Aetna Commercial |
$133.45
|
| Rate for Payer: Aetna Commercial |
$92.65
|
| Rate for Payer: Aetna Commercial |
$272.00
|
| Rate for Payer: Aetna Commercial |
$59.33
|
| Rate for Payer: Aetna Commercial |
$42.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.24
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$245.22
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$37.78
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$55.84
|
| Rate for Payer: Cofinity Advantage |
$29.75
|
| Rate for Payer: Cofinity Advantage |
$48.86
|
| Rate for Payer: Cofinity Advantage |
$214.57
|
| Rate for Payer: Cofinity Advantage |
$224.00
|
| Rate for Payer: Cofinity Advantage |
$34.65
|
| Rate for Payer: Cofinity Advantage |
$161.70
|
| Rate for Payer: Cofinity Advantage |
$109.90
|
| Rate for Payer: Cofinity Advantage |
$76.30
|
| Rate for Payer: Cofinity Advantage |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$39.56
|
| Rate for Payer: Cofinity Commercial |
$275.20
|
| Rate for Payer: Cofinity Commercial |
$263.62
|
| Rate for Payer: Cofinity Commercial |
$36.55
|
| Rate for Payer: Cofinity Commercial |
$198.66
|
| Rate for Payer: Cofinity Commercial |
$93.74
|
| Rate for Payer: Cofinity Commercial |
$135.02
|
| Rate for Payer: Cofinity Commercial |
$40.61
|
| Rate for Payer: Cofinity Commercial |
$42.57
|
| Rate for Payer: Cofinity Commercial |
$60.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.22
|
| Rate for Payer: Healthscope Commercial |
$98.10
|
| Rate for Payer: Healthscope Commercial |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$41.40
|
| Rate for Payer: Healthscope Commercial |
$44.55
|
| Rate for Payer: Healthscope Commercial |
$288.00
|
| Rate for Payer: Healthscope Commercial |
$207.90
|
| Rate for Payer: Healthscope Commercial |
$275.88
|
| Rate for Payer: Healthscope Commercial |
$62.82
|
| Rate for Payer: Healthscope Commercial |
$42.50
|
| Rate for Payer: Healthscope Commercial |
$141.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.35
|
| Rate for Payer: PHP Commercial |
$39.10
|
| Rate for Payer: PHP Commercial |
$196.35
|
| Rate for Payer: PHP Commercial |
$42.08
|
| Rate for Payer: PHP Commercial |
$36.12
|
| Rate for Payer: PHP Commercial |
$133.45
|
| Rate for Payer: PHP Commercial |
$92.65
|
| Rate for Payer: PHP Commercial |
$40.14
|
| Rate for Payer: PHP Commercial |
$272.00
|
| Rate for Payer: PHP Commercial |
$260.55
|
| Rate for Payer: PHP Commercial |
$59.33
|
| Rate for Payer: Priority Health SBD |
$98.91
|
| Rate for Payer: Priority Health SBD |
$145.53
|
| Rate for Payer: Priority Health SBD |
$193.11
|
| Rate for Payer: Priority Health SBD |
$201.60
|
| Rate for Payer: Priority Health SBD |
$31.18
|
| Rate for Payer: Priority Health SBD |
$43.97
|
| Rate for Payer: Priority Health SBD |
$28.98
|
| Rate for Payer: Priority Health SBD |
$26.77
|
| Rate for Payer: Priority Health SBD |
$68.67
|
| Rate for Payer: Priority Health SBD |
$29.75
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
OP
|
$7.77
|
|
|
Service Code
|
NDC 60687068711
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$6.99 |
| Rate for Payer: Aetna Commercial |
$6.60
|
| Rate for Payer: Aetna Medicare |
$3.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.05
|
| Rate for Payer: BCBS Complete |
$3.11
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Cofinity Advantage |
$5.44
|
| Rate for Payer: Cofinity Commercial |
$6.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$6.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.83
|
| Rate for Payer: PHP Commercial |
$6.60
|
| Rate for Payer: Priority Health SBD |
$4.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.05
|
| Rate for Payer: UHC Core |
$4.05
|
| Rate for Payer: UHC Exchange |
$3.05
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
OP
|
$4,398.05
|
|
|
Service Code
|
NDC 00131247860
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,728.43 |
| Max. Negotiated Rate |
$3,958.24 |
| Rate for Payer: Aetna Commercial |
$3,738.34
|
| Rate for Payer: Aetna Medicare |
$2,199.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,858.73
|
| Rate for Payer: BCBS Complete |
$1,759.22
|
| Rate for Payer: Cash Price |
$3,518.44
|
| Rate for Payer: Cofinity Advantage |
$3,078.64
|
| Rate for Payer: Cofinity Commercial |
$3,782.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,518.44
|
| Rate for Payer: Healthscope Commercial |
$3,958.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,518.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,738.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,298.54
|
| Rate for Payer: PHP Commercial |
$3,738.34
|
| Rate for Payer: Priority Health SBD |
$2,770.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,858.73
|
| Rate for Payer: UHC Core |
$2,291.38
|
| Rate for Payer: UHC Exchange |
$1,728.43
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
IP
|
$4,398.05
|
|
|
Service Code
|
NDC 00131247860
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,770.77 |
| Max. Negotiated Rate |
$3,958.24 |
| Rate for Payer: Aetna Commercial |
$3,738.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,858.73
|
| Rate for Payer: Cash Price |
$3,518.44
|
| Rate for Payer: Cofinity Advantage |
$3,078.64
|
| Rate for Payer: Cofinity Commercial |
$3,782.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,518.44
|
| Rate for Payer: Healthscope Commercial |
$3,958.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,738.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,298.54
|
| Rate for Payer: PHP Commercial |
$3,738.34
|
| Rate for Payer: Priority Health SBD |
$2,770.77
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
IP
|
$549.22
|
|
|
Service Code
|
NDC 00904724568
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$346.01 |
| Max. Negotiated Rate |
$494.30 |
| Rate for Payer: Aetna Commercial |
$466.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.99
|
| Rate for Payer: Cash Price |
$439.38
|
| Rate for Payer: Cofinity Advantage |
$384.45
|
| Rate for Payer: Cofinity Commercial |
$472.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.38
|
| Rate for Payer: Healthscope Commercial |
$494.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.92
|
| Rate for Payer: PHP Commercial |
$466.84
|
| Rate for Payer: Priority Health SBD |
$346.01
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
OP
|
$549.22
|
|
|
Service Code
|
NDC 00904724568
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$215.84 |
| Max. Negotiated Rate |
$494.30 |
| Rate for Payer: Aetna Commercial |
$466.84
|
| Rate for Payer: Aetna Medicare |
$274.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.99
|
| Rate for Payer: BCBS Complete |
$219.69
|
| Rate for Payer: Cash Price |
$439.38
|
| Rate for Payer: Cofinity Advantage |
$384.45
|
| Rate for Payer: Cofinity Commercial |
$472.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.38
|
| Rate for Payer: Healthscope Commercial |
$494.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$439.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.92
|
| Rate for Payer: PHP Commercial |
$466.84
|
| Rate for Payer: Priority Health SBD |
$346.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.99
|
| Rate for Payer: UHC Core |
$286.14
|
| Rate for Payer: UHC Exchange |
$215.84
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
IP
|
$7.77
|
|
|
Service Code
|
NDC 60687068711
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$6.99 |
| Rate for Payer: Aetna Commercial |
$6.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.05
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Cofinity Advantage |
$5.44
|
| Rate for Payer: Cofinity Commercial |
$6.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$6.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.83
|
| Rate for Payer: PHP Commercial |
$6.60
|
| Rate for Payer: Priority Health SBD |
$4.90
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
IP
|
$465.76
|
|
|
Service Code
|
NDC 60687068757
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$293.43 |
| Max. Negotiated Rate |
$419.18 |
| Rate for Payer: Aetna Commercial |
$395.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.74
|
| Rate for Payer: Cash Price |
$372.61
|
| Rate for Payer: Cofinity Advantage |
$326.03
|
| Rate for Payer: Cofinity Commercial |
$400.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.61
|
| Rate for Payer: Healthscope Commercial |
$419.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.32
|
| Rate for Payer: PHP Commercial |
$395.90
|
| Rate for Payer: Priority Health SBD |
$293.43
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
OP
|
$465.76
|
|
|
Service Code
|
NDC 60687068757
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.04 |
| Max. Negotiated Rate |
$419.18 |
| Rate for Payer: Aetna Commercial |
$395.90
|
| Rate for Payer: Aetna Medicare |
$232.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.74
|
| Rate for Payer: BCBS Complete |
$186.30
|
| Rate for Payer: Cash Price |
$372.61
|
| Rate for Payer: Cofinity Advantage |
$326.03
|
| Rate for Payer: Cofinity Commercial |
$400.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.61
|
| Rate for Payer: Healthscope Commercial |
$419.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.32
|
| Rate for Payer: PHP Commercial |
$395.90
|
| Rate for Payer: Priority Health SBD |
$293.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$302.74
|
| Rate for Payer: UHC Core |
$242.66
|
| Rate for Payer: UHC Exchange |
$183.04
|
|
|
LACOSAMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$1,653.90
|
|
|
Service Code
|
NDC 00131541072
|
| Hospital Charge Code |
105482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,041.96 |
| Max. Negotiated Rate |
$1,488.51 |
| Rate for Payer: Aetna Commercial |
$1,405.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,075.04
|
| Rate for Payer: Cash Price |
$1,323.12
|
| Rate for Payer: Cofinity Advantage |
$1,157.73
|
| Rate for Payer: Cofinity Commercial |
$1,422.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,323.12
|
| Rate for Payer: Healthscope Commercial |
$1,488.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,405.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,240.42
|
| Rate for Payer: PHP Commercial |
$1,405.82
|
| Rate for Payer: Priority Health SBD |
$1,041.96
|
|
|
LACOSAMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$1,653.90
|
|
|
Service Code
|
NDC 00131541072
|
| Hospital Charge Code |
105482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$649.98 |
| Max. Negotiated Rate |
$1,488.51 |
| Rate for Payer: Aetna Commercial |
$1,405.82
|
| Rate for Payer: Aetna Medicare |
$826.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,075.04
|
| Rate for Payer: BCBS Complete |
$661.56
|
| Rate for Payer: Cash Price |
$1,323.12
|
| Rate for Payer: Cofinity Advantage |
$1,157.73
|
| Rate for Payer: Cofinity Commercial |
$1,422.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,323.12
|
| Rate for Payer: Healthscope Commercial |
$1,488.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,323.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,405.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,240.42
|
| Rate for Payer: PHP Commercial |
$1,405.82
|
| Rate for Payer: Priority Health SBD |
$1,041.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,075.04
|
| Rate for Payer: UHC Core |
$861.68
|
| Rate for Payer: UHC Exchange |
$649.98
|
|
|
LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$335.62
|
|
|
Service Code
|
HCPCS C9254
|
| Hospital Charge Code |
96972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$302.06 |
| Rate for Payer: Aetna Commercial |
$285.28
|
| Rate for Payer: Aetna Commercial |
$123.62
|
| Rate for Payer: Aetna Commercial |
$41.54
|
| Rate for Payer: Aetna Commercial |
$37.90
|
| Rate for Payer: Aetna Medicare |
$24.43
|
| Rate for Payer: Aetna Medicare |
$72.72
|
| Rate for Payer: Aetna Medicare |
$167.81
|
| Rate for Payer: Aetna Medicare |
$22.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.77
|
| Rate for Payer: BCBS Complete |
$134.25
|
| Rate for Payer: BCBS Complete |
$58.17
|
| Rate for Payer: BCBS Complete |
$19.55
|
| Rate for Payer: BCBS Complete |
$17.84
|
| Rate for Payer: BCBS Trust/PPO |
$0.79
|
| Rate for Payer: BCBS Trust/PPO |
$0.79
|
| Rate for Payer: BCBS Trust/PPO |
$0.79
|
| Rate for Payer: BCBS Trust/PPO |
$0.79
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: Cash Price |
$268.50
|
| Rate for Payer: Cash Price |
$35.67
|
| Rate for Payer: Cash Price |
$35.67
|
| Rate for Payer: Cash Price |
$39.10
|
| Rate for Payer: Cash Price |
$39.10
|
| Rate for Payer: Cash Price |
$116.34
|
| Rate for Payer: Cash Price |
$116.34
|
| Rate for Payer: Cash Price |
$268.50
|
| Rate for Payer: Cofinity Advantage |
$31.21
|
| Rate for Payer: Cofinity Advantage |
$101.80
|
| Rate for Payer: Cofinity Advantage |
$234.93
|
| Rate for Payer: Cofinity Advantage |
$34.21
|
| Rate for Payer: Cofinity Commercial |
$125.07
|
| Rate for Payer: Cofinity Commercial |
$288.63
|
| Rate for Payer: Cofinity Commercial |
$42.03
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.10
|
| Rate for Payer: Healthscope Commercial |
$43.98
|
| Rate for Payer: Healthscope Commercial |
$130.89
|
| Rate for Payer: Healthscope Commercial |
$302.06
|
| Rate for Payer: Healthscope Commercial |
$40.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$268.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.44
|
| Rate for Payer: PHP Commercial |
$37.90
|
| Rate for Payer: PHP Commercial |
$41.54
|
| Rate for Payer: PHP Commercial |
$285.28
|
| Rate for Payer: PHP Commercial |
$123.62
|
| Rate for Payer: Priority Health SBD |
$30.79
|
| Rate for Payer: Priority Health SBD |
$91.62
|
| Rate for Payer: Priority Health SBD |
$211.44
|
| Rate for Payer: Priority Health SBD |
$28.09
|
|
|
LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$48.87
|
|
|
Service Code
|
HCPCS C9254
|
| Hospital Charge Code |
96972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.79 |
| Max. Negotiated Rate |
$43.98 |
| Rate for Payer: Aetna Commercial |
$41.54
|
| Rate for Payer: Aetna Commercial |
$37.90
|
| Rate for Payer: Aetna Commercial |
$123.62
|
| Rate for Payer: Aetna Commercial |
$285.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.77
|
| Rate for Payer: Cash Price |
$116.34
|
| Rate for Payer: Cash Price |
$268.50
|
| Rate for Payer: Cash Price |
$35.67
|
| Rate for Payer: Cash Price |
$39.10
|
| Rate for Payer: Cofinity Advantage |
$234.93
|
| Rate for Payer: Cofinity Advantage |
$31.21
|
| Rate for Payer: Cofinity Advantage |
$34.21
|
| Rate for Payer: Cofinity Advantage |
$101.80
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$288.63
|
| Rate for Payer: Cofinity Commercial |
$42.03
|
| Rate for Payer: Cofinity Commercial |
$125.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.10
|
| Rate for Payer: Healthscope Commercial |
$130.89
|
| Rate for Payer: Healthscope Commercial |
$40.13
|
| Rate for Payer: Healthscope Commercial |
$302.06
|
| Rate for Payer: Healthscope Commercial |
$43.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.65
|
| Rate for Payer: PHP Commercial |
$285.28
|
| Rate for Payer: PHP Commercial |
$123.62
|
| Rate for Payer: PHP Commercial |
$41.54
|
| Rate for Payer: PHP Commercial |
$37.90
|
| Rate for Payer: Priority Health SBD |
$28.09
|
| Rate for Payer: Priority Health SBD |
$211.44
|
| Rate for Payer: Priority Health SBD |
$30.79
|
| Rate for Payer: Priority Health SBD |
$91.62
|
|
