Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LACTULOSE 20 GRAM/30 ML ORAL SOLUTION

Facility

$6.63

Service Code	NDC 00121115430
Hospital Charge Code	150919
Hospital Revenue Code	637
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$5.97
Rate for Payer: Aetna Commercial	$5.64
Rate for Payer: Aetna Medicare	$3.31
Rate for Payer: Aetna New Business (MI Preferred)	$4.31
Rate for Payer: BCBS Complete	$2.65
Rate for Payer: Cash Price	$5.30
Rate for Payer: Cofinity Commercial	$4.64
Rate for Payer: Cofinity Commercial	$5.70
Rate for Payer: Cofinity Medicare Advantage	$4.64
Rate for Payer: Encore Health Key Benefits Commercial	$5.30
Rate for Payer: Healthscope Commercial	$5.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.64
Rate for Payer: PHP Commercial	$5.64
Rate for Payer: Priority Health Cigna Priority Health	$4.31
Rate for Payer: Priority Health SBD	$4.18

LACTULOSE 20 GRAM/30 ML ORAL SOLUTION

Facility

$7.20

Service Code	NDC 00121115440
Hospital Charge Code	150919
Hospital Revenue Code	637
Min. Negotiated Rate	$4.54
Max. Negotiated Rate	$6.48
Rate for Payer: Aetna Commercial	$6.12
Rate for Payer: Aetna New Business (MI Preferred)	$4.68
Rate for Payer: Cash Price	$5.76
Rate for Payer: Cofinity Commercial	$5.04
Rate for Payer: Cofinity Commercial	$6.19
Rate for Payer: Cofinity Medicare Advantage	$5.04
Rate for Payer: Encore Health Key Benefits Commercial	$5.76
Rate for Payer: Healthscope Commercial	$6.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.12
Rate for Payer: PHP Commercial	$6.12
Rate for Payer: Priority Health Cigna Priority Health	$4.68
Rate for Payer: Priority Health SBD	$4.54

LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT[S], [EG, SPINAL OR LATERAL RECESS STENOSIS]), SINGLE VERTEBRAL SEGMENT; LUMBAR

Facility

$19,611.80

Service Code	CPT 63047
Hospital Revenue Code	360
Min. Negotiated Rate	$3,734.39
Max. Negotiated Rate	$19,611.80
Rate for Payer: Aetna Medicare	$7,245.83
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,708.92
Rate for Payer: Amish Plain Church Group Commercial	$8,708.92
Rate for Payer: BCBS Complete	$3,921.11
Rate for Payer: BCBS MAPPO	$6,967.14
Rate for Payer: BCN Medicare Advantage	$6,967.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,967.14
Rate for Payer: Mclaren Medicaid	$3,734.39
Rate for Payer: Mclaren Medicare	$6,967.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,315.50
Rate for Payer: Meridian Medicaid	$3,921.11
Rate for Payer: MI Amish Medical Board Commercial	$8,012.21
Rate for Payer: PACE Medicare	$6,618.78
Rate for Payer: PACE SWMI	$6,967.14
Rate for Payer: PHP Medicare Advantage	$6,967.14
Rate for Payer: Priority Health Choice Medicaid	$3,734.39
Rate for Payer: Priority Health Medicare	$6,967.14
Rate for Payer: Railroad Medicare Medicare	$6,967.14
Rate for Payer: UHC All Payor (Choice/PPO)	$19,611.80
Rate for Payer: UHC Dual Complete DSNP	$6,967.14
Rate for Payer: UHC Medicare Advantage	$6,967.14
Rate for Payer: UHCCP Medicaid	$3,922.50
Rate for Payer: VA VA	$6,967.14

LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, PLATE/PADDLE, EPIDURAL

Facility

$58,871.61

Service Code	CPT 63655
Hospital Revenue Code	360
Min. Negotiated Rate	$11,210.05
Max. Negotiated Rate	$58,871.61
Rate for Payer: Aetna Medicare	$21,750.85
Rate for Payer: Allen County Amish Medical Aid Commercial	$26,142.85
Rate for Payer: Amish Plain Church Group Commercial	$26,142.85
Rate for Payer: BCBS Complete	$11,770.56
Rate for Payer: BCBS MAPPO	$20,914.28
Rate for Payer: BCN Medicare Advantage	$20,914.28
Rate for Payer: Health Alliance Plan Medicare Advantage	$20,914.28
Rate for Payer: Mclaren Medicaid	$11,210.05
Rate for Payer: Mclaren Medicare	$20,914.28
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$21,959.99
Rate for Payer: Meridian Medicaid	$11,770.56
Rate for Payer: MI Amish Medical Board Commercial	$24,051.42
Rate for Payer: PACE Medicare	$19,868.57
Rate for Payer: PACE SWMI	$20,914.28
Rate for Payer: PHP Medicare Advantage	$20,914.28
Rate for Payer: Priority Health Choice Medicaid	$11,210.05
Rate for Payer: Priority Health Medicare	$20,914.28
Rate for Payer: Railroad Medicare Medicare	$20,914.28
Rate for Payer: UHC All Payor (Choice/PPO)	$58,871.61
Rate for Payer: UHC Dual Complete DSNP	$20,914.28
Rate for Payer: UHC Medicare Advantage	$20,914.28
Rate for Payer: UHCCP Medicaid	$11,774.74
Rate for Payer: VA VA	$20,914.28

LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC; 1 INTERSPACE, LUMBAR

Facility

$19,611.80

Service Code	CPT 63030
Hospital Revenue Code	360
Min. Negotiated Rate	$3,734.39
Max. Negotiated Rate	$19,611.80
Rate for Payer: Aetna Medicare	$7,245.83
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,708.92
Rate for Payer: Amish Plain Church Group Commercial	$8,708.92
Rate for Payer: BCBS Complete	$3,921.11
Rate for Payer: BCBS MAPPO	$6,967.14
Rate for Payer: BCN Medicare Advantage	$6,967.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,967.14
Rate for Payer: Mclaren Medicaid	$3,734.39
Rate for Payer: Mclaren Medicare	$6,967.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,315.50
Rate for Payer: Meridian Medicaid	$3,921.11
Rate for Payer: MI Amish Medical Board Commercial	$8,012.21
Rate for Payer: PACE Medicare	$6,618.78
Rate for Payer: PACE SWMI	$6,967.14
Rate for Payer: PHP Medicare Advantage	$6,967.14
Rate for Payer: Priority Health Choice Medicaid	$3,734.39
Rate for Payer: Priority Health Medicare	$6,967.14
Rate for Payer: Railroad Medicare Medicare	$6,967.14
Rate for Payer: UHC All Payor (Choice/PPO)	$19,611.80
Rate for Payer: UHC Dual Complete DSNP	$6,967.14
Rate for Payer: UHC Medicare Advantage	$6,967.14
Rate for Payer: UHCCP Medicaid	$3,922.50
Rate for Payer: VA VA	$6,967.14

LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC, REEXPLORATION, SINGLE INTERSPACE; LUMBAR

Facility

$19,611.80

Service Code	CPT 63042
Hospital Revenue Code	360
Min. Negotiated Rate	$3,734.39
Max. Negotiated Rate	$19,611.80
Rate for Payer: Aetna Medicare	$7,245.83
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,708.92
Rate for Payer: Amish Plain Church Group Commercial	$8,708.92
Rate for Payer: BCBS Complete	$3,921.11
Rate for Payer: BCBS MAPPO	$6,967.14
Rate for Payer: BCN Medicare Advantage	$6,967.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,967.14
Rate for Payer: Mclaren Medicaid	$3,734.39
Rate for Payer: Mclaren Medicare	$6,967.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,315.50
Rate for Payer: Meridian Medicaid	$3,921.11
Rate for Payer: MI Amish Medical Board Commercial	$8,012.21
Rate for Payer: PACE Medicare	$6,618.78
Rate for Payer: PACE SWMI	$6,967.14
Rate for Payer: PHP Medicare Advantage	$6,967.14
Rate for Payer: Priority Health Choice Medicaid	$3,734.39
Rate for Payer: Priority Health Medicare	$6,967.14
Rate for Payer: Railroad Medicare Medicare	$6,967.14
Rate for Payer: UHC All Payor (Choice/PPO)	$19,611.80
Rate for Payer: UHC Dual Complete DSNP	$6,967.14
Rate for Payer: UHC Medicare Advantage	$6,967.14
Rate for Payer: UHCCP Medicaid	$3,922.50
Rate for Payer: VA VA	$6,967.14

LAMOTRIGINE 100 MG TABLET

Facility

$246.75

Service Code	NDC 51079049920
Hospital Charge Code	13982
Hospital Revenue Code	637
Min. Negotiated Rate	$98.70
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 Commercial	$172.72
Rate for Payer: Cofinity Commercial	$212.21
Rate for Payer: Cofinity Medicare Advantage	$172.72
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: PHP Commercial	$209.74
Rate for Payer: Priority Health Cigna Priority Health	$160.39
Rate for Payer: Priority Health SBD	$155.45

LAMOTRIGINE 100 MG TABLET

Facility

$2.47

Service Code	NDC 51079049901
Hospital Charge Code	13982
Hospital Revenue Code	637
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$2.22
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare	$1.24
Rate for Payer: Aetna New Business (MI Preferred)	$1.61
Rate for Payer: BCBS Complete	$0.99
Rate for Payer: Cash Price	$1.98
Rate for Payer: Cofinity Commercial	$1.73
Rate for Payer: Cofinity Commercial	$2.12
Rate for Payer: Cofinity Medicare Advantage	$1.73
Rate for Payer: Encore Health Key Benefits Commercial	$1.98
Rate for Payer: Healthscope Commercial	$2.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.10
Rate for Payer: PHP Commercial	$2.10
Rate for Payer: Priority Health Cigna Priority Health	$1.61
Rate for Payer: Priority Health SBD	$1.56

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 Commercial	$172.72
Rate for Payer: Cofinity Commercial	$212.21
Rate for Payer: Cofinity Medicare Advantage	$172.72
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: PHP Commercial	$209.74
Rate for Payer: Priority Health Cigna Priority Health	$160.39
Rate for Payer: Priority Health SBD	$155.45

LAMOTRIGINE 100 MG TABLET

Facility

$385.40

Service Code	NDC 68084031901
Hospital Charge Code	13982
Hospital Revenue Code	637
Min. Negotiated Rate	$242.80
Max. Negotiated Rate	$346.86
Rate for Payer: Aetna Commercial	$327.59
Rate for Payer: Aetna New Business (MI Preferred)	$250.51
Rate for Payer: Cash Price	$308.32
Rate for Payer: Cofinity Commercial	$269.78
Rate for Payer: Cofinity Commercial	$331.44
Rate for Payer: Cofinity Medicare Advantage	$269.78
Rate for Payer: Encore Health Key Benefits Commercial	$308.32
Rate for Payer: Healthscope Commercial	$346.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$327.59
Rate for Payer: PHP Commercial	$327.59
Rate for Payer: Priority Health Cigna Priority Health	$250.51
Rate for Payer: Priority Health SBD	$242.80

LAMOTRIGINE 100 MG TABLET

Facility

$385.40

Service Code	NDC 68084031901
Hospital Charge Code	13982
Hospital Revenue Code	637
Min. Negotiated Rate	$154.16
Max. Negotiated Rate	$346.86
Rate for Payer: Aetna Commercial	$327.59
Rate for Payer: Aetna Medicare	$192.70
Rate for Payer: Aetna New Business (MI Preferred)	$250.51
Rate for Payer: BCBS Complete	$154.16
Rate for Payer: Cash Price	$308.32
Rate for Payer: Cofinity Commercial	$269.78
Rate for Payer: Cofinity Commercial	$331.44
Rate for Payer: Cofinity Medicare Advantage	$269.78
Rate for Payer: Encore Health Key Benefits Commercial	$308.32
Rate for Payer: Healthscope Commercial	$346.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$327.59
Rate for Payer: PHP Commercial	$327.59
Rate for Payer: Priority Health Cigna Priority Health	$250.51
Rate for Payer: Priority Health SBD	$242.80

LAMOTRIGINE 100 MG TABLET

Facility

$253.80

Service Code	NDC 00904700861
Hospital Charge Code	13982
Hospital Revenue Code	637
Min. Negotiated Rate	$159.89
Max. Negotiated Rate	$228.42
Rate for Payer: Aetna Commercial	$215.73
Rate for Payer: Aetna New Business (MI Preferred)	$164.97
Rate for Payer: Cash Price	$203.04
Rate for Payer: Cofinity Commercial	$177.66
Rate for Payer: Cofinity Commercial	$218.27
Rate for Payer: Cofinity Medicare Advantage	$177.66
Rate for Payer: Encore Health Key Benefits Commercial	$203.04
Rate for Payer: Healthscope Commercial	$228.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$215.73
Rate for Payer: PHP Commercial	$215.73
Rate for Payer: Priority Health Cigna Priority Health	$164.97
Rate for Payer: Priority Health SBD	$159.89

LAMOTRIGINE 100 MG TABLET

Facility

$253.80

Service Code	NDC 00904700861
Hospital Charge Code	13982
Hospital Revenue Code	637
Min. Negotiated Rate	$101.52
Max. Negotiated Rate	$228.42
Rate for Payer: Aetna Commercial	$215.73
Rate for Payer: Aetna Medicare	$126.90
Rate for Payer: Aetna New Business (MI Preferred)	$164.97
Rate for Payer: BCBS Complete	$101.52
Rate for Payer: Cash Price	$203.04
Rate for Payer: Cofinity Commercial	$177.66
Rate for Payer: Cofinity Commercial	$218.27
Rate for Payer: Cofinity Medicare Advantage	$177.66
Rate for Payer: Encore Health Key Benefits Commercial	$203.04
Rate for Payer: Healthscope Commercial	$228.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$215.73
Rate for Payer: PHP Commercial	$215.73
Rate for Payer: Priority Health Cigna Priority Health	$164.97
Rate for Payer: Priority Health SBD	$159.89

LAMOTRIGINE 100 MG TABLET

Facility

$2.47

Service Code	NDC 51079049901
Hospital Charge Code	13982
Hospital Revenue Code	637
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$2.22
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna New Business (MI Preferred)	$1.61
Rate for Payer: Cash Price	$1.98
Rate for Payer: Cofinity Commercial	$1.73
Rate for Payer: Cofinity Commercial	$2.12
Rate for Payer: Cofinity Medicare Advantage	$1.73
Rate for Payer: Encore Health Key Benefits Commercial	$1.98
Rate for Payer: Healthscope Commercial	$2.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.10
Rate for Payer: PHP Commercial	$2.10
Rate for Payer: Priority Health Cigna Priority Health	$1.61
Rate for Payer: Priority Health SBD	$1.56

LAMOTRIGINE 100 MG TABLET

Facility

$385.40

Service Code	NDC 68084031911
Hospital Charge Code	13982
Hospital Revenue Code	637
Min. Negotiated Rate	$242.80
Max. Negotiated Rate	$346.86
Rate for Payer: Aetna Commercial	$327.59
Rate for Payer: Aetna New Business (MI Preferred)	$250.51
Rate for Payer: Cash Price	$308.32
Rate for Payer: Cofinity Commercial	$269.78
Rate for Payer: Cofinity Commercial	$331.44
Rate for Payer: Cofinity Medicare Advantage	$269.78
Rate for Payer: Encore Health Key Benefits Commercial	$308.32
Rate for Payer: Healthscope Commercial	$346.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$327.59
Rate for Payer: PHP Commercial	$327.59
Rate for Payer: Priority Health Cigna Priority Health	$250.51
Rate for Payer: Priority Health SBD	$242.80

LAMOTRIGINE 100 MG TABLET

Facility

$385.40

Service Code	NDC 68084031911
Hospital Charge Code	13982
Hospital Revenue Code	637
Min. Negotiated Rate	$154.16
Max. Negotiated Rate	$346.86
Rate for Payer: Aetna Commercial	$327.59
Rate for Payer: Aetna Medicare	$192.70
Rate for Payer: Aetna New Business (MI Preferred)	$250.51
Rate for Payer: BCBS Complete	$154.16
Rate for Payer: Cash Price	$308.32
Rate for Payer: Cofinity Commercial	$269.78
Rate for Payer: Cofinity Commercial	$331.44
Rate for Payer: Cofinity Medicare Advantage	$269.78
Rate for Payer: Encore Health Key Benefits Commercial	$308.32
Rate for Payer: Healthscope Commercial	$346.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$327.59
Rate for Payer: PHP Commercial	$327.59
Rate for Payer: Priority Health Cigna Priority Health	$250.51
Rate for Payer: Priority Health SBD	$242.80

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 Commercial	$80.93
Rate for Payer: Cofinity Commercial	$99.43
Rate for Payer: Cofinity Medicare Advantage	$80.93
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: PHP Commercial	$98.28
Rate for Payer: Priority Health Cigna Priority Health	$75.15
Rate for Payer: Priority Health SBD	$72.84

LAMOTRIGINE 150 MG TABLET

Facility

$362.90

Service Code	NDC 60687069301
Hospital Charge Code	14266
Hospital Revenue Code	637
Min. Negotiated Rate	$145.16
Max. Negotiated Rate	$326.61
Rate for Payer: Aetna Commercial	$308.46
Rate for Payer: Aetna Medicare	$181.45
Rate for Payer: Aetna New Business (MI Preferred)	$235.88
Rate for Payer: BCBS Complete	$145.16
Rate for Payer: Cash Price	$290.32
Rate for Payer: Cofinity Commercial	$254.03
Rate for Payer: Cofinity Commercial	$312.09
Rate for Payer: Cofinity Medicare Advantage	$254.03
Rate for Payer: Encore Health Key Benefits Commercial	$290.32
Rate for Payer: Healthscope Commercial	$326.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$308.46
Rate for Payer: PHP Commercial	$308.46
Rate for Payer: Priority Health Cigna Priority Health	$235.88
Rate for Payer: Priority Health SBD	$228.63

LAMOTRIGINE 150 MG TABLET

Facility

$362.90

Service Code	NDC 60687069301
Hospital Charge Code	14266
Hospital Revenue Code	637
Min. Negotiated Rate	$228.63
Max. Negotiated Rate	$326.61
Rate for Payer: Aetna Commercial	$308.46
Rate for Payer: Aetna New Business (MI Preferred)	$235.88
Rate for Payer: Cash Price	$290.32
Rate for Payer: Cofinity Commercial	$254.03
Rate for Payer: Cofinity Commercial	$312.09
Rate for Payer: Cofinity Medicare Advantage	$254.03
Rate for Payer: Encore Health Key Benefits Commercial	$290.32
Rate for Payer: Healthscope Commercial	$326.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$308.46
Rate for Payer: PHP Commercial	$308.46
Rate for Payer: Priority Health Cigna Priority Health	$235.88
Rate for Payer: Priority Health SBD	$228.63

LAMOTRIGINE 150 MG TABLET

Facility

$115.62

Service Code	NDC 51672413204
Hospital Charge Code	14266
Hospital Revenue Code	637
Min. Negotiated Rate	$46.25
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 Commercial	$80.93
Rate for Payer: Cofinity Commercial	$99.43
Rate for Payer: Cofinity Medicare Advantage	$80.93
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: PHP Commercial	$98.28
Rate for Payer: Priority Health Cigna Priority Health	$75.15
Rate for Payer: Priority Health SBD	$72.84

LAMOTRIGINE 150 MG TABLET

Facility

$3.63

Service Code	NDC 60687069311
Hospital Charge Code	14266
Hospital Revenue Code	637
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$3.27
Rate for Payer: Aetna Commercial	$3.09
Rate for Payer: Aetna New Business (MI Preferred)	$2.36
Rate for Payer: Cash Price	$2.90
Rate for Payer: Cofinity Commercial	$2.54
Rate for Payer: Cofinity Commercial	$3.12
Rate for Payer: Cofinity Medicare Advantage	$2.54
Rate for Payer: Encore Health Key Benefits Commercial	$2.90
Rate for Payer: Healthscope Commercial	$3.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.09
Rate for Payer: PHP Commercial	$3.09
Rate for Payer: Priority Health Cigna Priority Health	$2.36
Rate for Payer: Priority Health SBD	$2.29

LAMOTRIGINE 150 MG TABLET

Facility

$3.63

Service Code	NDC 60687069311
Hospital Charge Code	14266
Hospital Revenue Code	637
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$3.27
Rate for Payer: Aetna Commercial	$3.09
Rate for Payer: Aetna Medicare	$1.81
Rate for Payer: Aetna New Business (MI Preferred)	$2.36
Rate for Payer: BCBS Complete	$1.45
Rate for Payer: Cash Price	$2.90
Rate for Payer: Cofinity Commercial	$2.54
Rate for Payer: Cofinity Commercial	$3.12
Rate for Payer: Cofinity Medicare Advantage	$2.54
Rate for Payer: Encore Health Key Benefits Commercial	$2.90
Rate for Payer: Healthscope Commercial	$3.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.09
Rate for Payer: PHP Commercial	$3.09
Rate for Payer: Priority Health Cigna Priority Health	$2.36
Rate for Payer: Priority Health SBD	$2.29

LAMOTRIGINE 150 MG TABLET

Facility

$117.03

Service Code	NDC 13668004860
Hospital Charge Code	14266
Hospital Revenue Code	637
Min. Negotiated Rate	$46.81
Max. Negotiated Rate	$105.33
Rate for Payer: Aetna Commercial	$99.48
Rate for Payer: Aetna Medicare	$58.52
Rate for Payer: Aetna New Business (MI Preferred)	$76.07
Rate for Payer: BCBS Complete	$46.81
Rate for Payer: Cash Price	$93.62
Rate for Payer: Cofinity Commercial	$100.65
Rate for Payer: Cofinity Commercial	$81.92
Rate for Payer: Cofinity Medicare Advantage	$81.92
Rate for Payer: Encore Health Key Benefits Commercial	$93.62
Rate for Payer: Healthscope Commercial	$105.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$99.48
Rate for Payer: PHP Commercial	$99.48
Rate for Payer: Priority Health Cigna Priority Health	$76.07
Rate for Payer: Priority Health SBD	$73.73

LAMOTRIGINE 150 MG TABLET

Facility

$117.03

Service Code	NDC 13668004860
Hospital Charge Code	14266
Hospital Revenue Code	637
Min. Negotiated Rate	$73.73
Max. Negotiated Rate	$105.33
Rate for Payer: Aetna Commercial	$99.48
Rate for Payer: Aetna New Business (MI Preferred)	$76.07
Rate for Payer: Cash Price	$93.62
Rate for Payer: Cofinity Commercial	$100.65
Rate for Payer: Cofinity Commercial	$81.92
Rate for Payer: Cofinity Medicare Advantage	$81.92
Rate for Payer: Encore Health Key Benefits Commercial	$93.62
Rate for Payer: Healthscope Commercial	$105.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$99.48
Rate for Payer: PHP Commercial	$99.48
Rate for Payer: Priority Health Cigna Priority Health	$76.07
Rate for Payer: Priority Health SBD	$73.73

LAMOTRIGINE 25 MG TABLET

Facility

$3.62

Service Code	NDC 68084031811
Hospital Charge Code	13981
Hospital Revenue Code	637
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$3.26
Rate for Payer: Aetna Commercial	$3.08
Rate for Payer: Aetna Medicare	$1.81
Rate for Payer: Aetna New Business (MI Preferred)	$2.35
Rate for Payer: BCBS Complete	$1.45
Rate for Payer: Cash Price	$2.90
Rate for Payer: Cofinity Commercial	$2.53
Rate for Payer: Cofinity Commercial	$3.11
Rate for Payer: Cofinity Medicare Advantage	$2.53
Rate for Payer: Encore Health Key Benefits Commercial	$2.90
Rate for Payer: Healthscope Commercial	$3.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.08
Rate for Payer: PHP Commercial	$3.08
Rate for Payer: Priority Health Cigna Priority Health	$2.35
Rate for Payer: Priority Health SBD	$2.28

Know your out-of-pocket cost for care.

All Charges