Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LAMOTRIGINE 100 MG TABLET

Facility

$246.75

Service Code	NDC 51079049920
Hospital Charge Code	13982
Hospital Revenue Code	637
Min. Negotiated Rate	$155.45
Max. Negotiated Rate	$222.07
Rate for Payer: Aetna Commercial	$209.74
Rate for Payer: Aetna New Business (MI Preferred)	$160.39
Rate for Payer: Cash Price	$197.40
Rate for Payer: Cofinity Advantage	$172.72
Rate for Payer: Cofinity Commercial	$212.21
Rate for Payer: Encore Health Key Benefits Commercial	$197.40
Rate for Payer: Healthscope Commercial	$222.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$209.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$185.06
Rate for Payer: PHP Commercial	$209.74
Rate for Payer: Priority Health SBD	$155.45

LAMOTRIGINE 100 MG TABLET

Facility

$277.30

Service Code	NDC 00904700861
Hospital Charge Code	13982
Hospital Revenue Code	637
Min. Negotiated Rate	$108.98
Max. Negotiated Rate	$249.57
Rate for Payer: Aetna Commercial	$235.71
Rate for Payer: Aetna Medicare	$138.65
Rate for Payer: Aetna New Business (MI Preferred)	$180.25
Rate for Payer: BCBS Complete	$110.92
Rate for Payer: Cash Price	$221.84
Rate for Payer: Cofinity Advantage	$194.11
Rate for Payer: Cofinity Commercial	$238.48
Rate for Payer: Encore Health Key Benefits Commercial	$221.84
Rate for Payer: Healthscope Commercial	$249.57
Rate for Payer: MI Amish Medical Board Commercial	$221.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$235.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$207.97
Rate for Payer: PHP Commercial	$235.71
Rate for Payer: Priority Health SBD	$174.70
Rate for Payer: UHC All Payor (Choice/PPO)	$180.25
Rate for Payer: UHC Core	$144.47
Rate for Payer: UHC Exchange	$108.98

LAMOTRIGINE 100 MG TABLET

Facility

$361.90

Service Code	NDC 68084031901
Hospital Charge Code	13982
Hospital Revenue Code	637
Min. Negotiated Rate	$228.00
Max. Negotiated Rate	$325.71
Rate for Payer: Aetna Commercial	$307.62
Rate for Payer: Aetna New Business (MI Preferred)	$235.24
Rate for Payer: Cash Price	$289.52
Rate for Payer: Cofinity Advantage	$253.33
Rate for Payer: Cofinity Commercial	$311.23
Rate for Payer: Encore Health Key Benefits Commercial	$289.52
Rate for Payer: Healthscope Commercial	$325.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$307.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$271.43
Rate for Payer: PHP Commercial	$307.62
Rate for Payer: Priority Health SBD	$228.00

LAMOTRIGINE 100 MG TABLET

Facility

$246.75

Service Code	NDC 51079049920
Hospital Charge Code	13982
Hospital Revenue Code	637
Min. Negotiated Rate	$96.97
Max. Negotiated Rate	$222.07
Rate for Payer: Aetna Commercial	$209.74
Rate for Payer: Aetna Medicare	$123.38
Rate for Payer: Aetna New Business (MI Preferred)	$160.39
Rate for Payer: BCBS Complete	$98.70
Rate for Payer: Cash Price	$197.40
Rate for Payer: Cofinity Advantage	$172.72
Rate for Payer: Cofinity Commercial	$212.21
Rate for Payer: Encore Health Key Benefits Commercial	$197.40
Rate for Payer: Healthscope Commercial	$222.07
Rate for Payer: MI Amish Medical Board Commercial	$197.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$209.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$185.06
Rate for Payer: PHP Commercial	$209.74
Rate for Payer: Priority Health SBD	$155.45
Rate for Payer: UHC All Payor (Choice/PPO)	$160.39
Rate for Payer: UHC Core	$128.56
Rate for Payer: UHC Exchange	$96.97

LAMOTRIGINE 100 MG TABLET

Facility

$361.90

Service Code	NDC 68084031911
Hospital Charge Code	13982
Hospital Revenue Code	637
Min. Negotiated Rate	$142.23
Max. Negotiated Rate	$325.71
Rate for Payer: Aetna Commercial	$307.62
Rate for Payer: Aetna Medicare	$180.95
Rate for Payer: Aetna New Business (MI Preferred)	$235.24
Rate for Payer: BCBS Complete	$144.76
Rate for Payer: Cash Price	$289.52
Rate for Payer: Cofinity Advantage	$253.33
Rate for Payer: Cofinity Commercial	$311.23
Rate for Payer: Encore Health Key Benefits Commercial	$289.52
Rate for Payer: Healthscope Commercial	$325.71
Rate for Payer: MI Amish Medical Board Commercial	$289.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$307.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$271.43
Rate for Payer: PHP Commercial	$307.62
Rate for Payer: Priority Health SBD	$228.00
Rate for Payer: UHC All Payor (Choice/PPO)	$235.24
Rate for Payer: UHC Core	$188.55
Rate for Payer: UHC Exchange	$142.23

LAMOTRIGINE 100 MG TABLET

Facility

$277.30

Service Code	NDC 00904700861
Hospital Charge Code	13982
Hospital Revenue Code	637
Min. Negotiated Rate	$174.70
Max. Negotiated Rate	$249.57
Rate for Payer: Aetna Commercial	$235.71
Rate for Payer: Aetna New Business (MI Preferred)	$180.25
Rate for Payer: Cash Price	$221.84
Rate for Payer: Cofinity Advantage	$194.11
Rate for Payer: Cofinity Commercial	$238.48
Rate for Payer: Encore Health Key Benefits Commercial	$221.84
Rate for Payer: Healthscope Commercial	$249.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$235.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$207.97
Rate for Payer: PHP Commercial	$235.71
Rate for Payer: Priority Health SBD	$174.70

LAMOTRIGINE 100 MG TABLET

Facility

$361.90

Service Code	NDC 68084031901
Hospital Charge Code	13982
Hospital Revenue Code	637
Min. Negotiated Rate	$142.23
Max. Negotiated Rate	$325.71
Rate for Payer: Aetna Commercial	$307.62
Rate for Payer: Aetna Medicare	$180.95
Rate for Payer: Aetna New Business (MI Preferred)	$235.24
Rate for Payer: BCBS Complete	$144.76
Rate for Payer: Cash Price	$289.52
Rate for Payer: Cofinity Advantage	$253.33
Rate for Payer: Cofinity Commercial	$311.23
Rate for Payer: Encore Health Key Benefits Commercial	$289.52
Rate for Payer: Healthscope Commercial	$325.71
Rate for Payer: MI Amish Medical Board Commercial	$289.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$307.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$271.43
Rate for Payer: PHP Commercial	$307.62
Rate for Payer: Priority Health SBD	$228.00
Rate for Payer: UHC All Payor (Choice/PPO)	$235.24
Rate for Payer: UHC Core	$188.55
Rate for Payer: UHC Exchange	$142.23

LAMOTRIGINE 100 MG TABLET

Facility

$361.90

Service Code	NDC 68084031911
Hospital Charge Code	13982
Hospital Revenue Code	637
Min. Negotiated Rate	$228.00
Max. Negotiated Rate	$325.71
Rate for Payer: Aetna Commercial	$307.62
Rate for Payer: Aetna New Business (MI Preferred)	$235.24
Rate for Payer: Cash Price	$289.52
Rate for Payer: Cofinity Advantage	$253.33
Rate for Payer: Cofinity Commercial	$311.23
Rate for Payer: Encore Health Key Benefits Commercial	$289.52
Rate for Payer: Healthscope Commercial	$325.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$307.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$271.43
Rate for Payer: PHP Commercial	$307.62
Rate for Payer: Priority Health SBD	$228.00

LAMOTRIGINE 150 MG TABLET

Facility

$391.40

Service Code	NDC 60687069301
Hospital Charge Code	14266
Hospital Revenue Code	637
Min. Negotiated Rate	$153.82
Max. Negotiated Rate	$352.26
Rate for Payer: Aetna Commercial	$332.69
Rate for Payer: Aetna Medicare	$195.70
Rate for Payer: Aetna New Business (MI Preferred)	$254.41
Rate for Payer: BCBS Complete	$156.56
Rate for Payer: Cash Price	$313.12
Rate for Payer: Cofinity Advantage	$273.98
Rate for Payer: Cofinity Commercial	$336.60
Rate for Payer: Encore Health Key Benefits Commercial	$313.12
Rate for Payer: Healthscope Commercial	$352.26
Rate for Payer: MI Amish Medical Board Commercial	$313.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$332.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$293.55
Rate for Payer: PHP Commercial	$332.69
Rate for Payer: Priority Health SBD	$246.58
Rate for Payer: UHC All Payor (Choice/PPO)	$254.41
Rate for Payer: UHC Core	$203.92
Rate for Payer: UHC Exchange	$153.82

LAMOTRIGINE 150 MG TABLET

Facility

$115.62

Service Code	NDC 13668004860
Hospital Charge Code	14266
Hospital Revenue Code	637
Min. Negotiated Rate	$45.44
Max. Negotiated Rate	$104.06
Rate for Payer: Aetna Commercial	$98.28
Rate for Payer: Aetna Medicare	$57.81
Rate for Payer: Aetna New Business (MI Preferred)	$75.15
Rate for Payer: BCBS Complete	$46.25
Rate for Payer: Cash Price	$92.50
Rate for Payer: Cofinity Advantage	$80.93
Rate for Payer: Cofinity Commercial	$99.43
Rate for Payer: Encore Health Key Benefits Commercial	$92.50
Rate for Payer: Healthscope Commercial	$104.06
Rate for Payer: MI Amish Medical Board Commercial	$92.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$98.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$86.72
Rate for Payer: PHP Commercial	$98.28
Rate for Payer: Priority Health SBD	$72.84
Rate for Payer: UHC All Payor (Choice/PPO)	$75.15
Rate for Payer: UHC Core	$60.24
Rate for Payer: UHC Exchange	$45.44

LAMOTRIGINE 150 MG TABLET

Facility

$115.62

Service Code	NDC 51672413204
Hospital Charge Code	14266
Hospital Revenue Code	637
Min. Negotiated Rate	$72.84
Max. Negotiated Rate	$104.06
Rate for Payer: Aetna Commercial	$98.28
Rate for Payer: Aetna New Business (MI Preferred)	$75.15
Rate for Payer: Cash Price	$92.50
Rate for Payer: Cofinity Advantage	$80.93
Rate for Payer: Cofinity Commercial	$99.43
Rate for Payer: Encore Health Key Benefits Commercial	$92.50
Rate for Payer: Healthscope Commercial	$104.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$98.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$86.72
Rate for Payer: PHP Commercial	$98.28
Rate for Payer: Priority Health SBD	$72.84

LAMOTRIGINE 150 MG TABLET

Facility

$3.92

Service Code	NDC 60687069311
Hospital Charge Code	14266
Hospital Revenue Code	637
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$3.53
Rate for Payer: Aetna Commercial	$3.33
Rate for Payer: Aetna Medicare	$1.96
Rate for Payer: Aetna New Business (MI Preferred)	$2.55
Rate for Payer: BCBS Complete	$1.57
Rate for Payer: Cash Price	$3.14
Rate for Payer: Cofinity Advantage	$2.74
Rate for Payer: Cofinity Commercial	$3.37
Rate for Payer: Encore Health Key Benefits Commercial	$3.14
Rate for Payer: Healthscope Commercial	$3.53
Rate for Payer: MI Amish Medical Board Commercial	$3.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.94
Rate for Payer: PHP Commercial	$3.33
Rate for Payer: Priority Health SBD	$2.47
Rate for Payer: UHC All Payor (Choice/PPO)	$2.55
Rate for Payer: UHC Core	$2.04
Rate for Payer: UHC Exchange	$1.54

LAMOTRIGINE 150 MG TABLET

Facility

$115.62

Service Code	NDC 51672413204
Hospital Charge Code	14266
Hospital Revenue Code	637
Min. Negotiated Rate	$45.44
Max. Negotiated Rate	$104.06
Rate for Payer: Aetna Commercial	$98.28
Rate for Payer: Aetna Medicare	$57.81
Rate for Payer: Aetna New Business (MI Preferred)	$75.15
Rate for Payer: BCBS Complete	$46.25
Rate for Payer: Cash Price	$92.50
Rate for Payer: Cofinity Advantage	$80.93
Rate for Payer: Cofinity Commercial	$99.43
Rate for Payer: Encore Health Key Benefits Commercial	$92.50
Rate for Payer: Healthscope Commercial	$104.06
Rate for Payer: MI Amish Medical Board Commercial	$92.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$98.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$86.72
Rate for Payer: PHP Commercial	$98.28
Rate for Payer: Priority Health SBD	$72.84
Rate for Payer: UHC All Payor (Choice/PPO)	$75.15
Rate for Payer: UHC Core	$60.24
Rate for Payer: UHC Exchange	$45.44

LAMOTRIGINE 150 MG TABLET

Facility

$3.92

Service Code	NDC 60687069311
Hospital Charge Code	14266
Hospital Revenue Code	637
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$3.53
Rate for Payer: Aetna Commercial	$3.33
Rate for Payer: Aetna New Business (MI Preferred)	$2.55
Rate for Payer: Cash Price	$3.14
Rate for Payer: Cofinity Advantage	$2.74
Rate for Payer: Cofinity Commercial	$3.37
Rate for Payer: Encore Health Key Benefits Commercial	$3.14
Rate for Payer: Healthscope Commercial	$3.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.94
Rate for Payer: PHP Commercial	$3.33
Rate for Payer: Priority Health SBD	$2.47

LAMOTRIGINE 150 MG TABLET

Facility

$391.40

Service Code	NDC 60687069301
Hospital Charge Code	14266
Hospital Revenue Code	637
Min. Negotiated Rate	$246.58
Max. Negotiated Rate	$352.26
Rate for Payer: Aetna Commercial	$332.69
Rate for Payer: Aetna New Business (MI Preferred)	$254.41
Rate for Payer: Cash Price	$313.12
Rate for Payer: Cofinity Advantage	$273.98
Rate for Payer: Cofinity Commercial	$336.60
Rate for Payer: Encore Health Key Benefits Commercial	$313.12
Rate for Payer: Healthscope Commercial	$352.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$332.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$293.55
Rate for Payer: PHP Commercial	$332.69
Rate for Payer: Priority Health SBD	$246.58

LAMOTRIGINE 150 MG TABLET

Facility

$115.62

Service Code	NDC 13668004860
Hospital Charge Code	14266
Hospital Revenue Code	637
Min. Negotiated Rate	$72.84
Max. Negotiated Rate	$104.06
Rate for Payer: Aetna Commercial	$98.28
Rate for Payer: Aetna New Business (MI Preferred)	$75.15
Rate for Payer: Cash Price	$92.50
Rate for Payer: Cofinity Advantage	$80.93
Rate for Payer: Cofinity Commercial	$99.43
Rate for Payer: Encore Health Key Benefits Commercial	$92.50
Rate for Payer: Healthscope Commercial	$104.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$98.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$86.72
Rate for Payer: PHP Commercial	$98.28
Rate for Payer: Priority Health SBD	$72.84

LAMOTRIGINE 25 MG TABLET

Facility

$354.85

Service Code	NDC 68084031801
Hospital Charge Code	13981
Hospital Revenue Code	637
Min. Negotiated Rate	$223.56
Max. Negotiated Rate	$319.37
Rate for Payer: Aetna Commercial	$301.62
Rate for Payer: Aetna New Business (MI Preferred)	$230.65
Rate for Payer: Cash Price	$283.88
Rate for Payer: Cofinity Advantage	$248.40
Rate for Payer: Cofinity Commercial	$305.17
Rate for Payer: Encore Health Key Benefits Commercial	$283.88
Rate for Payer: Healthscope Commercial	$319.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$301.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$266.14
Rate for Payer: PHP Commercial	$301.62
Rate for Payer: Priority Health SBD	$223.56

LAMOTRIGINE 25 MG TABLET

Facility

$3.55

Service Code	NDC 68084031811
Hospital Charge Code	13981
Hospital Revenue Code	637
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.19
Rate for Payer: Aetna Commercial	$3.02
Rate for Payer: Aetna Medicare	$1.77
Rate for Payer: Aetna New Business (MI Preferred)	$2.31
Rate for Payer: BCBS Complete	$1.42
Rate for Payer: Cash Price	$2.84
Rate for Payer: Cofinity Advantage	$2.48
Rate for Payer: Cofinity Commercial	$3.05
Rate for Payer: Encore Health Key Benefits Commercial	$2.84
Rate for Payer: Healthscope Commercial	$3.19
Rate for Payer: MI Amish Medical Board Commercial	$2.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.66
Rate for Payer: PHP Commercial	$3.02
Rate for Payer: Priority Health SBD	$2.24
Rate for Payer: UHC All Payor (Choice/PPO)	$2.31
Rate for Payer: UHC Core	$1.85
Rate for Payer: UHC Exchange	$1.40

LAMOTRIGINE 25 MG TABLET

Facility

$321.95

Service Code	NDC 00904700761
Hospital Charge Code	13981
Hospital Revenue Code	637
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$289.75
Rate for Payer: Aetna Commercial	$273.66
Rate for Payer: Aetna Medicare	$160.97
Rate for Payer: Aetna New Business (MI Preferred)	$209.27
Rate for Payer: BCBS Complete	$128.78
Rate for Payer: Cash Price	$257.56
Rate for Payer: Cofinity Advantage	$225.37
Rate for Payer: Cofinity Commercial	$276.88
Rate for Payer: Encore Health Key Benefits Commercial	$257.56
Rate for Payer: Healthscope Commercial	$289.75
Rate for Payer: MI Amish Medical Board Commercial	$257.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$273.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$241.46
Rate for Payer: PHP Commercial	$273.66
Rate for Payer: Priority Health SBD	$202.83
Rate for Payer: UHC All Payor (Choice/PPO)	$209.27
Rate for Payer: UHC Core	$167.74
Rate for Payer: UHC Exchange	$126.53

LAMOTRIGINE 25 MG TABLET

Facility

$131.60

Service Code	NDC 51672413001
Hospital Charge Code	13981
Hospital Revenue Code	637
Min. Negotiated Rate	$51.72
Max. Negotiated Rate	$118.44
Rate for Payer: Aetna Commercial	$111.86
Rate for Payer: Aetna Medicare	$65.80
Rate for Payer: Aetna New Business (MI Preferred)	$85.54
Rate for Payer: BCBS Complete	$52.64
Rate for Payer: Cash Price	$105.28
Rate for Payer: Cofinity Advantage	$92.12
Rate for Payer: Cofinity Commercial	$113.18
Rate for Payer: Encore Health Key Benefits Commercial	$105.28
Rate for Payer: Healthscope Commercial	$118.44
Rate for Payer: MI Amish Medical Board Commercial	$105.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$111.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$98.70
Rate for Payer: PHP Commercial	$111.86
Rate for Payer: Priority Health SBD	$82.91
Rate for Payer: UHC All Payor (Choice/PPO)	$85.54
Rate for Payer: UHC Core	$68.56
Rate for Payer: UHC Exchange	$51.72

LAMOTRIGINE 25 MG TABLET

Facility

$321.95

Service Code	NDC 00904700761
Hospital Charge Code	13981
Hospital Revenue Code	637
Min. Negotiated Rate	$202.83
Max. Negotiated Rate	$289.75
Rate for Payer: Aetna Commercial	$273.66
Rate for Payer: Aetna New Business (MI Preferred)	$209.27
Rate for Payer: Cash Price	$257.56
Rate for Payer: Cofinity Advantage	$225.37
Rate for Payer: Cofinity Commercial	$276.88
Rate for Payer: Encore Health Key Benefits Commercial	$257.56
Rate for Payer: Healthscope Commercial	$289.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$273.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$241.46
Rate for Payer: PHP Commercial	$273.66
Rate for Payer: Priority Health SBD	$202.83

LAMOTRIGINE 25 MG TABLET

Facility

$131.60

Service Code	NDC 51672413001
Hospital Charge Code	13981
Hospital Revenue Code	637
Min. Negotiated Rate	$82.91
Max. Negotiated Rate	$118.44
Rate for Payer: Aetna Commercial	$111.86
Rate for Payer: Aetna New Business (MI Preferred)	$85.54
Rate for Payer: Cash Price	$105.28
Rate for Payer: Cofinity Advantage	$92.12
Rate for Payer: Cofinity Commercial	$113.18
Rate for Payer: Encore Health Key Benefits Commercial	$105.28
Rate for Payer: Healthscope Commercial	$118.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$111.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$98.70
Rate for Payer: PHP Commercial	$111.86
Rate for Payer: Priority Health SBD	$82.91

LAMOTRIGINE 25 MG TABLET

Facility

$354.85

Service Code	NDC 68084031801
Hospital Charge Code	13981
Hospital Revenue Code	637
Min. Negotiated Rate	$139.46
Max. Negotiated Rate	$319.37
Rate for Payer: Aetna Commercial	$301.62
Rate for Payer: Aetna Medicare	$177.43
Rate for Payer: Aetna New Business (MI Preferred)	$230.65
Rate for Payer: BCBS Complete	$141.94
Rate for Payer: Cash Price	$283.88
Rate for Payer: Cofinity Advantage	$248.40
Rate for Payer: Cofinity Commercial	$305.17
Rate for Payer: Encore Health Key Benefits Commercial	$283.88
Rate for Payer: Healthscope Commercial	$319.37
Rate for Payer: MI Amish Medical Board Commercial	$283.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$301.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$266.14
Rate for Payer: PHP Commercial	$301.62
Rate for Payer: Priority Health SBD	$223.56
Rate for Payer: UHC All Payor (Choice/PPO)	$230.65
Rate for Payer: UHC Core	$184.88
Rate for Payer: UHC Exchange	$139.46

LAMOTRIGINE 25 MG TABLET

Facility

$3.55

Service Code	NDC 68084031811
Hospital Charge Code	13981
Hospital Revenue Code	637
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$3.19
Rate for Payer: Aetna Commercial	$3.02
Rate for Payer: Aetna New Business (MI Preferred)	$2.31
Rate for Payer: Cash Price	$2.84
Rate for Payer: Cofinity Advantage	$2.48
Rate for Payer: Cofinity Commercial	$3.05
Rate for Payer: Encore Health Key Benefits Commercial	$2.84
Rate for Payer: Healthscope Commercial	$3.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.66
Rate for Payer: PHP Commercial	$3.02
Rate for Payer: Priority Health SBD	$2.24

LANREOTIDE 120 MG/0.5 ML SUBCUTANEOUS SYRINGE

Facility

$44,648.56

Service Code	HCPCS J1930
Hospital Charge Code	87861
Hospital Revenue Code	636
Min. Negotiated Rate	$28,128.59
Max. Negotiated Rate	$40,183.70
Rate for Payer: Aetna Commercial	$37,951.28
Rate for Payer: Aetna New Business (MI Preferred)	$29,021.56
Rate for Payer: Cash Price	$35,718.85
Rate for Payer: Cofinity Advantage	$31,253.99
Rate for Payer: Cofinity Commercial	$38,397.76
Rate for Payer: Encore Health Key Benefits Commercial	$35,718.85
Rate for Payer: Healthscope Commercial	$40,183.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37,951.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$33,486.42
Rate for Payer: PHP Commercial	$37,951.28
Rate for Payer: Priority Health SBD	$28,128.59

Know your out-of-pocket cost for care.

All Charges