|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
OP
|
$21.74
|
|
|
Service Code
|
NDC 68382077230
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$19.57 |
| Rate for Payer: Aetna Commercial |
$18.48
|
| Rate for Payer: Aetna Medicare |
$5.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.79
|
| Rate for Payer: BCBS Complete |
$4.02
|
| Rate for Payer: BCBS MAPPO |
$5.43
|
| Rate for Payer: BCBS Trust/PPO |
$17.87
|
| Rate for Payer: BCN Commercial |
$17.87
|
| Rate for Payer: BCN Medicare Advantage |
$5.43
|
| Rate for Payer: Cash Price |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$18.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.43
|
| Rate for Payer: Healthscope Commercial |
$19.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.30
|
| Rate for Payer: Mclaren Medicaid |
$3.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.71
|
| Rate for Payer: Meridian Medicaid |
$4.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.48
|
| Rate for Payer: Nomi Health Commercial |
$17.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.30
|
| Rate for Payer: PACE Senior Care Partners |
$5.16
|
| Rate for Payer: PACE SWMI |
$5.43
|
| Rate for Payer: PHP Commercial |
$18.48
|
| Rate for Payer: PHP Medicare Advantage |
$5.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.91
|
| Rate for Payer: Priority Health Medicare |
$5.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.13
|
| Rate for Payer: UHC Core |
$18.15
|
| Rate for Payer: UHC Exchange |
$5.43
|
| Rate for Payer: UHC Medicaid |
$3.83
|
| Rate for Payer: UHC Medicare Advantage |
$5.43
|
| Rate for Payer: UHCCP Medicaid |
$3.83
|
| Rate for Payer: VA VA |
$5.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.30
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
OP
|
$3,104.67
|
|
|
Service Code
|
NDC 00378698288
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$547.35 |
| Max. Negotiated Rate |
$2,794.20 |
| Rate for Payer: Aetna Commercial |
$2,638.97
|
| Rate for Payer: Aetna Medicare |
$807.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$970.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$970.21
|
| Rate for Payer: BCBS Complete |
$574.67
|
| Rate for Payer: BCBS MAPPO |
$776.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,552.35
|
| Rate for Payer: BCN Commercial |
$2,552.35
|
| Rate for Payer: BCN Medicare Advantage |
$776.17
|
| Rate for Payer: Cash Price |
$2,483.74
|
| Rate for Payer: Cofinity Commercial |
$2,670.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,483.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$776.17
|
| Rate for Payer: Healthscope Commercial |
$2,794.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,328.50
|
| Rate for Payer: Mclaren Medicaid |
$547.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$814.98
|
| Rate for Payer: Meridian Medicaid |
$574.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$892.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$853.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,638.97
|
| Rate for Payer: Nomi Health Commercial |
$2,545.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,328.50
|
| Rate for Payer: PACE Senior Care Partners |
$737.36
|
| Rate for Payer: PACE SWMI |
$776.17
|
| Rate for Payer: PHP Commercial |
$2,638.97
|
| Rate for Payer: PHP Medicare Advantage |
$776.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$547.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,701.06
|
| Rate for Payer: Priority Health Medicare |
$783.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,160.85
|
| Rate for Payer: Railroad Medicare Medicare |
$776.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,732.11
|
| Rate for Payer: UHC Core |
$2,592.40
|
| Rate for Payer: UHC Exchange |
$776.17
|
| Rate for Payer: UHC Medicaid |
$547.35
|
| Rate for Payer: UHC Medicare Advantage |
$776.17
|
| Rate for Payer: UHCCP Medicaid |
$547.35
|
| Rate for Payer: VA VA |
$776.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,328.50
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$21.74
|
|
|
Service Code
|
NDC 68382077230
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$19.57 |
| Rate for Payer: Aetna Commercial |
$18.48
|
| Rate for Payer: BCBS Trust/PPO |
$17.96
|
| Rate for Payer: BCN Commercial |
$17.96
|
| Rate for Payer: Cash Price |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$18.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.39
|
| Rate for Payer: Healthscope Commercial |
$19.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.48
|
| Rate for Payer: Nomi Health Commercial |
$17.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.30
|
| Rate for Payer: PHP Commercial |
$18.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.13
|
| Rate for Payer: UHC Core |
$18.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.30
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$19.22
|
|
|
Service Code
|
NDC 70069042101
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$17.30 |
| Rate for Payer: Aetna Commercial |
$16.34
|
| Rate for Payer: BCBS Trust/PPO |
$15.87
|
| Rate for Payer: BCN Commercial |
$15.87
|
| Rate for Payer: Cash Price |
$15.38
|
| Rate for Payer: Cofinity Commercial |
$16.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.38
|
| Rate for Payer: Healthscope Commercial |
$17.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.34
|
| Rate for Payer: Nomi Health Commercial |
$15.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.41
|
| Rate for Payer: PHP Commercial |
$16.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.91
|
| Rate for Payer: UHC Core |
$16.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.41
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$26.28
|
|
|
Service Code
|
NDC 61314054701
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$23.65 |
| Rate for Payer: Aetna Commercial |
$22.34
|
| Rate for Payer: BCBS Trust/PPO |
$21.70
|
| Rate for Payer: BCN Commercial |
$21.70
|
| Rate for Payer: Cash Price |
$21.02
|
| Rate for Payer: Cofinity Commercial |
$22.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.02
|
| Rate for Payer: Healthscope Commercial |
$23.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.34
|
| Rate for Payer: Nomi Health Commercial |
$21.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.71
|
| Rate for Payer: PHP Commercial |
$22.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.13
|
| Rate for Payer: UHC Core |
$21.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.71
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
OP
|
$19.22
|
|
|
Service Code
|
NDC 70069042101
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$17.30 |
| Rate for Payer: Aetna Commercial |
$16.34
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.01
|
| Rate for Payer: BCBS Complete |
$3.56
|
| Rate for Payer: BCBS MAPPO |
$4.80
|
| Rate for Payer: BCBS Trust/PPO |
$15.80
|
| Rate for Payer: BCN Commercial |
$15.80
|
| Rate for Payer: BCN Medicare Advantage |
$4.80
|
| Rate for Payer: Cash Price |
$15.38
|
| Rate for Payer: Cofinity Commercial |
$16.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.80
|
| Rate for Payer: Healthscope Commercial |
$17.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.41
|
| Rate for Payer: Mclaren Medicaid |
$3.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.05
|
| Rate for Payer: Meridian Medicaid |
$3.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.34
|
| Rate for Payer: Nomi Health Commercial |
$15.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.41
|
| Rate for Payer: PACE Senior Care Partners |
$4.56
|
| Rate for Payer: PACE SWMI |
$4.80
|
| Rate for Payer: PHP Commercial |
$16.34
|
| Rate for Payer: PHP Medicare Advantage |
$4.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.72
|
| Rate for Payer: Priority Health Medicare |
$4.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.38
|
| Rate for Payer: Railroad Medicare Medicare |
$4.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.91
|
| Rate for Payer: UHC Core |
$16.05
|
| Rate for Payer: UHC Exchange |
$4.80
|
| Rate for Payer: UHC Medicaid |
$3.39
|
| Rate for Payer: UHC Medicare Advantage |
$4.80
|
| Rate for Payer: UHCCP Medicaid |
$3.39
|
| Rate for Payer: VA VA |
$4.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.41
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
OP
|
$26.28
|
|
|
Service Code
|
NDC 61314054701
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$23.65 |
| Rate for Payer: Aetna Commercial |
$22.34
|
| Rate for Payer: Aetna Medicare |
$6.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.21
|
| Rate for Payer: BCBS Complete |
$4.86
|
| Rate for Payer: BCBS MAPPO |
$6.57
|
| Rate for Payer: BCBS Trust/PPO |
$21.60
|
| Rate for Payer: BCN Commercial |
$21.60
|
| Rate for Payer: BCN Medicare Advantage |
$6.57
|
| Rate for Payer: Cash Price |
$21.02
|
| Rate for Payer: Cofinity Commercial |
$22.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.57
|
| Rate for Payer: Healthscope Commercial |
$23.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.71
|
| Rate for Payer: Mclaren Medicaid |
$4.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.90
|
| Rate for Payer: Meridian Medicaid |
$4.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.34
|
| Rate for Payer: Nomi Health Commercial |
$21.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.71
|
| Rate for Payer: PACE Senior Care Partners |
$6.24
|
| Rate for Payer: PACE SWMI |
$6.57
|
| Rate for Payer: PHP Commercial |
$22.34
|
| Rate for Payer: PHP Medicare Advantage |
$6.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.86
|
| Rate for Payer: Priority Health Medicare |
$6.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.29
|
| Rate for Payer: Railroad Medicare Medicare |
$6.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.13
|
| Rate for Payer: UHC Core |
$21.94
|
| Rate for Payer: UHC Exchange |
$6.57
|
| Rate for Payer: UHC Medicaid |
$4.63
|
| Rate for Payer: UHC Medicare Advantage |
$6.57
|
| Rate for Payer: UHCCP Medicaid |
$4.63
|
| Rate for Payer: VA VA |
$6.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.71
|
|
|
LEVALBUTEROL CONCENTRATE 1.25 MG/0.5 ML SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$17.45
|
|
|
Service Code
|
HCPCS J7612
|
| Hospital Charge Code |
39278
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$15.71 |
| Rate for Payer: Aetna Commercial |
$14.83
|
| Rate for Payer: BCBS Trust/PPO |
$14.41
|
| Rate for Payer: BCN Commercial |
$14.41
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cofinity Commercial |
$15.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.96
|
| Rate for Payer: Healthscope Commercial |
$15.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.83
|
| Rate for Payer: Nomi Health Commercial |
$14.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.09
|
| Rate for Payer: PHP Commercial |
$14.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.36
|
| Rate for Payer: UHC Core |
$14.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.09
|
|
|
LEVALBUTEROL CONCENTRATE 1.25 MG/0.5 ML SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$17.45
|
|
|
Service Code
|
HCPCS J7612
|
| Hospital Charge Code |
39278
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$15.71 |
| Rate for Payer: Aetna Commercial |
$14.83
|
| Rate for Payer: Aetna Medicare |
$4.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.45
|
| Rate for Payer: BCBS Complete |
$3.23
|
| Rate for Payer: BCBS MAPPO |
$4.36
|
| Rate for Payer: BCBS Trust/PPO |
$14.35
|
| Rate for Payer: BCN Commercial |
$14.35
|
| Rate for Payer: BCN Medicare Advantage |
$4.36
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cofinity Commercial |
$15.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.36
|
| Rate for Payer: Healthscope Commercial |
$15.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.09
|
| Rate for Payer: Mclaren Medicaid |
$3.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.58
|
| Rate for Payer: Meridian Medicaid |
$3.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.83
|
| Rate for Payer: Nomi Health Commercial |
$14.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.09
|
| Rate for Payer: PACE Senior Care Partners |
$4.14
|
| Rate for Payer: PACE SWMI |
$4.36
|
| Rate for Payer: PHP Commercial |
$14.83
|
| Rate for Payer: PHP Medicare Advantage |
$4.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.18
|
| Rate for Payer: Priority Health Medicare |
$4.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.15
|
| Rate for Payer: Railroad Medicare Medicare |
$4.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.36
|
| Rate for Payer: UHC Core |
$14.57
|
| Rate for Payer: UHC Exchange |
$4.36
|
| Rate for Payer: UHC Medicaid |
$3.08
|
| Rate for Payer: UHC Medicare Advantage |
$4.36
|
| Rate for Payer: UHCCP Medicaid |
$3.08
|
| Rate for Payer: VA VA |
$4.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.09
|
|
|
LEVALBUTEROL HFA 45 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$155.35
|
|
|
Service Code
|
NDC 63402051001
|
| Hospital Charge Code |
43472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.39 |
| Max. Negotiated Rate |
$139.81 |
| Rate for Payer: Aetna Commercial |
$132.05
|
| Rate for Payer: Aetna Medicare |
$40.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.55
|
| Rate for Payer: BCBS Complete |
$28.76
|
| Rate for Payer: BCBS MAPPO |
$38.84
|
| Rate for Payer: BCBS Trust/PPO |
$127.71
|
| Rate for Payer: BCN Commercial |
$127.71
|
| Rate for Payer: BCN Medicare Advantage |
$38.84
|
| Rate for Payer: Cash Price |
$124.28
|
| Rate for Payer: Cofinity Commercial |
$133.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.84
|
| Rate for Payer: Healthscope Commercial |
$139.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.51
|
| Rate for Payer: Mclaren Medicaid |
$27.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.78
|
| Rate for Payer: Meridian Medicaid |
$28.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.05
|
| Rate for Payer: Nomi Health Commercial |
$127.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.51
|
| Rate for Payer: PACE Senior Care Partners |
$36.90
|
| Rate for Payer: PACE SWMI |
$38.84
|
| Rate for Payer: PHP Commercial |
$132.05
|
| Rate for Payer: PHP Medicare Advantage |
$38.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$135.15
|
| Rate for Payer: Priority Health Medicare |
$39.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.12
|
| Rate for Payer: Railroad Medicare Medicare |
$38.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.71
|
| Rate for Payer: UHC Core |
$129.72
|
| Rate for Payer: UHC Exchange |
$38.84
|
| Rate for Payer: UHC Medicaid |
$27.39
|
| Rate for Payer: UHC Medicare Advantage |
$38.84
|
| Rate for Payer: UHCCP Medicaid |
$27.39
|
| Rate for Payer: VA VA |
$38.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.51
|
|
|
LEVALBUTEROL HFA 45 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$155.35
|
|
|
Service Code
|
NDC 63402051001
|
| Hospital Charge Code |
43472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.12 |
| Max. Negotiated Rate |
$139.81 |
| Rate for Payer: Aetna Commercial |
$132.05
|
| Rate for Payer: BCBS Trust/PPO |
$128.30
|
| Rate for Payer: BCN Commercial |
$128.30
|
| Rate for Payer: Cash Price |
$124.28
|
| Rate for Payer: Cofinity Commercial |
$133.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.28
|
| Rate for Payer: Healthscope Commercial |
$139.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.05
|
| Rate for Payer: Nomi Health Commercial |
$127.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.51
|
| Rate for Payer: PHP Commercial |
$132.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$135.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.71
|
| Rate for Payer: UHC Core |
$129.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.51
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
OP
|
$343.10
|
|
|
Service Code
|
NDC 00904712361
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.49 |
| Max. Negotiated Rate |
$308.79 |
| Rate for Payer: Aetna Commercial |
$291.63
|
| Rate for Payer: Aetna Medicare |
$89.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.22
|
| Rate for Payer: BCBS Complete |
$63.51
|
| Rate for Payer: BCBS MAPPO |
$85.78
|
| Rate for Payer: BCBS Trust/PPO |
$282.06
|
| Rate for Payer: BCN Commercial |
$282.06
|
| Rate for Payer: BCN Medicare Advantage |
$85.78
|
| Rate for Payer: Cash Price |
$274.48
|
| Rate for Payer: Cofinity Commercial |
$295.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.78
|
| Rate for Payer: Healthscope Commercial |
$308.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.32
|
| Rate for Payer: Mclaren Medicaid |
$60.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.06
|
| Rate for Payer: Meridian Medicaid |
$63.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$94.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.63
|
| Rate for Payer: Nomi Health Commercial |
$281.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.32
|
| Rate for Payer: PACE Senior Care Partners |
$81.49
|
| Rate for Payer: PACE SWMI |
$85.78
|
| Rate for Payer: PHP Commercial |
$291.63
|
| Rate for Payer: PHP Medicare Advantage |
$85.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$298.50
|
| Rate for Payer: Priority Health Medicare |
$86.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.80
|
| Rate for Payer: Railroad Medicare Medicare |
$85.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.93
|
| Rate for Payer: UHC Core |
$286.49
|
| Rate for Payer: UHC Exchange |
$85.78
|
| Rate for Payer: UHC Medicaid |
$60.49
|
| Rate for Payer: UHC Medicare Advantage |
$85.78
|
| Rate for Payer: UHCCP Medicaid |
$60.49
|
| Rate for Payer: VA VA |
$85.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.32
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
IP
|
$343.10
|
|
|
Service Code
|
NDC 00904712361
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.80 |
| Max. Negotiated Rate |
$308.79 |
| Rate for Payer: Aetna Commercial |
$291.63
|
| Rate for Payer: BCBS Trust/PPO |
$283.37
|
| Rate for Payer: BCN Commercial |
$283.37
|
| Rate for Payer: Cash Price |
$274.48
|
| Rate for Payer: Cofinity Commercial |
$295.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.48
|
| Rate for Payer: Healthscope Commercial |
$308.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.63
|
| Rate for Payer: Nomi Health Commercial |
$281.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.32
|
| Rate for Payer: PHP Commercial |
$291.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$298.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.93
|
| Rate for Payer: UHC Core |
$286.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.32
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$13.35
|
|
|
Service Code
|
NDC 00904726541
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$12.02 |
| Rate for Payer: Aetna Commercial |
$11.35
|
| Rate for Payer: Aetna Medicare |
$3.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.17
|
| Rate for Payer: BCBS Complete |
$2.47
|
| Rate for Payer: BCBS MAPPO |
$3.34
|
| Rate for Payer: BCBS Trust/PPO |
$10.98
|
| Rate for Payer: BCN Commercial |
$10.98
|
| Rate for Payer: BCN Medicare Advantage |
$3.34
|
| Rate for Payer: Cash Price |
$10.68
|
| Rate for Payer: Cofinity Commercial |
$11.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.34
|
| Rate for Payer: Healthscope Commercial |
$12.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.01
|
| Rate for Payer: Mclaren Medicaid |
$2.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.50
|
| Rate for Payer: Meridian Medicaid |
$2.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.35
|
| Rate for Payer: Nomi Health Commercial |
$10.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.01
|
| Rate for Payer: PACE Senior Care Partners |
$3.17
|
| Rate for Payer: PACE SWMI |
$3.34
|
| Rate for Payer: PHP Commercial |
$11.35
|
| Rate for Payer: PHP Medicare Advantage |
$3.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.61
|
| Rate for Payer: Priority Health Medicare |
$3.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.29
|
| Rate for Payer: Railroad Medicare Medicare |
$3.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.75
|
| Rate for Payer: UHC Core |
$11.15
|
| Rate for Payer: UHC Exchange |
$3.34
|
| Rate for Payer: UHC Medicaid |
$2.35
|
| Rate for Payer: UHC Medicare Advantage |
$3.34
|
| Rate for Payer: UHCCP Medicaid |
$2.35
|
| Rate for Payer: VA VA |
$3.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.01
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$13.35
|
|
|
Service Code
|
NDC 00904726541
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$12.02 |
| Rate for Payer: Aetna Commercial |
$11.35
|
| Rate for Payer: BCBS Trust/PPO |
$11.03
|
| Rate for Payer: BCN Commercial |
$11.03
|
| Rate for Payer: Cash Price |
$10.68
|
| Rate for Payer: Cofinity Commercial |
$11.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.68
|
| Rate for Payer: Healthscope Commercial |
$12.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.35
|
| Rate for Payer: Nomi Health Commercial |
$10.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.01
|
| Rate for Payer: PHP Commercial |
$11.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.75
|
| Rate for Payer: UHC Core |
$11.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.01
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$13.35
|
|
|
Service Code
|
NDC 00904726592
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$12.02 |
| Rate for Payer: Aetna Commercial |
$11.35
|
| Rate for Payer: BCBS Trust/PPO |
$11.03
|
| Rate for Payer: BCN Commercial |
$11.03
|
| Rate for Payer: Cash Price |
$10.68
|
| Rate for Payer: Cofinity Commercial |
$11.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.68
|
| Rate for Payer: Healthscope Commercial |
$12.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.35
|
| Rate for Payer: Nomi Health Commercial |
$10.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.01
|
| Rate for Payer: PHP Commercial |
$11.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.75
|
| Rate for Payer: UHC Core |
$11.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.01
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$13.35
|
|
|
Service Code
|
NDC 00904726592
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$12.02 |
| Rate for Payer: Aetna Commercial |
$11.35
|
| Rate for Payer: Aetna Medicare |
$3.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.17
|
| Rate for Payer: BCBS Complete |
$2.47
|
| Rate for Payer: BCBS MAPPO |
$3.34
|
| Rate for Payer: BCBS Trust/PPO |
$10.98
|
| Rate for Payer: BCN Commercial |
$10.98
|
| Rate for Payer: BCN Medicare Advantage |
$3.34
|
| Rate for Payer: Cash Price |
$10.68
|
| Rate for Payer: Cofinity Commercial |
$11.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.34
|
| Rate for Payer: Healthscope Commercial |
$12.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.01
|
| Rate for Payer: Mclaren Medicaid |
$2.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.50
|
| Rate for Payer: Meridian Medicaid |
$2.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.35
|
| Rate for Payer: Nomi Health Commercial |
$10.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.01
|
| Rate for Payer: PACE Senior Care Partners |
$3.17
|
| Rate for Payer: PACE SWMI |
$3.34
|
| Rate for Payer: PHP Commercial |
$11.35
|
| Rate for Payer: PHP Medicare Advantage |
$3.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.61
|
| Rate for Payer: Priority Health Medicare |
$3.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.29
|
| Rate for Payer: Railroad Medicare Medicare |
$3.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.75
|
| Rate for Payer: UHC Core |
$11.15
|
| Rate for Payer: UHC Exchange |
$3.34
|
| Rate for Payer: UHC Medicaid |
$2.35
|
| Rate for Payer: UHC Medicare Advantage |
$3.34
|
| Rate for Payer: UHCCP Medicaid |
$2.35
|
| Rate for Payer: VA VA |
$3.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.01
|
|
|
LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14.36
|
|
|
Service Code
|
HCPCS J1953
|
| Hospital Charge Code |
77195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$12.92 |
| Rate for Payer: Aetna Commercial |
$12.21
|
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Commercial |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$14.55
|
| Rate for Payer: BCBS Trust/PPO |
$11.86
|
| Rate for Payer: BCBS Trust/PPO |
$16.65
|
| Rate for Payer: BCN Commercial |
$14.55
|
| Rate for Payer: BCN Commercial |
$11.86
|
| Rate for Payer: BCN Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$11.49
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cofinity Commercial |
$17.34
|
| Rate for Payer: Cofinity Commercial |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$12.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.13
|
| Rate for Payer: Healthscope Commercial |
$15.86
|
| Rate for Payer: Healthscope Commercial |
$12.92
|
| Rate for Payer: Healthscope Commercial |
$18.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.14
|
| Rate for Payer: Nomi Health Commercial |
$11.78
|
| Rate for Payer: Nomi Health Commercial |
$14.45
|
| Rate for Payer: Nomi Health Commercial |
$16.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.12
|
| Rate for Payer: PHP Commercial |
$12.21
|
| Rate for Payer: PHP Commercial |
$17.14
|
| Rate for Payer: PHP Commercial |
$14.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.64
|
| Rate for Payer: UHC Core |
$11.99
|
| Rate for Payer: UHC Core |
$16.83
|
| Rate for Payer: UHC Core |
$14.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.21
|
|
|
LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14.36
|
|
|
Service Code
|
HCPCS J1953
|
| Hospital Charge Code |
77195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$12.92 |
| Rate for Payer: Aetna Commercial |
$12.21
|
| Rate for Payer: Aetna Commercial |
$17.14
|
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Medicare |
$5.24
|
| Rate for Payer: Aetna Medicare |
$3.73
|
| Rate for Payer: Aetna Medicare |
$4.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.30
|
| Rate for Payer: BCBS Complete |
$3.26
|
| Rate for Payer: BCBS Complete |
$2.66
|
| Rate for Payer: BCBS Complete |
$3.73
|
| Rate for Payer: BCBS MAPPO |
$5.04
|
| Rate for Payer: BCBS MAPPO |
$3.59
|
| Rate for Payer: BCBS MAPPO |
$4.41
|
| Rate for Payer: BCBS Trust/PPO |
$11.81
|
| Rate for Payer: BCBS Trust/PPO |
$14.49
|
| Rate for Payer: BCBS Trust/PPO |
$16.57
|
| Rate for Payer: BCN Commercial |
$14.49
|
| Rate for Payer: BCN Commercial |
$16.57
|
| Rate for Payer: BCN Commercial |
$11.81
|
| Rate for Payer: BCN Medicare Advantage |
$5.04
|
| Rate for Payer: BCN Medicare Advantage |
$4.41
|
| Rate for Payer: BCN Medicare Advantage |
$3.59
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cash Price |
$11.49
|
| Rate for Payer: Cofinity Commercial |
$12.35
|
| Rate for Payer: Cofinity Commercial |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$17.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.59
|
| Rate for Payer: Healthscope Commercial |
$15.86
|
| Rate for Payer: Healthscope Commercial |
$12.92
|
| Rate for Payer: Healthscope Commercial |
$18.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.21
|
| Rate for Payer: Mclaren Medicaid |
$2.53
|
| Rate for Payer: Mclaren Medicaid |
$3.55
|
| Rate for Payer: Mclaren Medicaid |
$3.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.29
|
| Rate for Payer: Meridian Medicaid |
$3.73
|
| Rate for Payer: Meridian Medicaid |
$2.66
|
| Rate for Payer: Meridian Medicaid |
$3.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.98
|
| Rate for Payer: Nomi Health Commercial |
$16.53
|
| Rate for Payer: Nomi Health Commercial |
$14.45
|
| Rate for Payer: Nomi Health Commercial |
$11.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.77
|
| Rate for Payer: PACE Senior Care Partners |
$4.18
|
| Rate for Payer: PACE Senior Care Partners |
$3.41
|
| Rate for Payer: PACE Senior Care Partners |
$4.79
|
| Rate for Payer: PACE SWMI |
$5.04
|
| Rate for Payer: PACE SWMI |
$4.41
|
| Rate for Payer: PACE SWMI |
$3.59
|
| Rate for Payer: PHP Commercial |
$12.21
|
| Rate for Payer: PHP Commercial |
$17.14
|
| Rate for Payer: PHP Commercial |
$14.98
|
| Rate for Payer: PHP Medicare Advantage |
$4.41
|
| Rate for Payer: PHP Medicare Advantage |
$3.59
|
| Rate for Payer: PHP Medicare Advantage |
$5.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.54
|
| Rate for Payer: Priority Health Medicare |
$5.09
|
| Rate for Payer: Priority Health Medicare |
$4.45
|
| Rate for Payer: Priority Health Medicare |
$3.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.99
|
| Rate for Payer: Railroad Medicare Medicare |
$4.41
|
| Rate for Payer: Railroad Medicare Medicare |
$5.04
|
| Rate for Payer: Railroad Medicare Medicare |
$3.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.64
|
| Rate for Payer: UHC Core |
$11.99
|
| Rate for Payer: UHC Core |
$16.83
|
| Rate for Payer: UHC Core |
$14.71
|
| Rate for Payer: UHC Exchange |
$5.04
|
| Rate for Payer: UHC Exchange |
$4.41
|
| Rate for Payer: UHC Exchange |
$3.59
|
| Rate for Payer: UHC Medicaid |
$2.53
|
| Rate for Payer: UHC Medicaid |
$3.55
|
| Rate for Payer: UHC Medicaid |
$3.11
|
| Rate for Payer: UHC Medicare Advantage |
$4.41
|
| Rate for Payer: UHC Medicare Advantage |
$3.59
|
| Rate for Payer: UHC Medicare Advantage |
$5.04
|
| Rate for Payer: UHCCP Medicaid |
$3.11
|
| Rate for Payer: UHCCP Medicaid |
$2.53
|
| Rate for Payer: UHCCP Medicaid |
$3.55
|
| Rate for Payer: VA VA |
$3.59
|
| Rate for Payer: VA VA |
$5.04
|
| Rate for Payer: VA VA |
$4.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.12
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
IP
|
$390.10
|
|
|
Service Code
|
NDC 00904712461
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.51 |
| Max. Negotiated Rate |
$351.09 |
| Rate for Payer: Aetna Commercial |
$331.58
|
| Rate for Payer: BCBS Trust/PPO |
$322.18
|
| Rate for Payer: BCN Commercial |
$322.18
|
| Rate for Payer: Cash Price |
$312.08
|
| Rate for Payer: Cofinity Commercial |
$335.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.08
|
| Rate for Payer: Healthscope Commercial |
$351.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.58
|
| Rate for Payer: Nomi Health Commercial |
$319.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.57
|
| Rate for Payer: PHP Commercial |
$331.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$339.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$271.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.29
|
| Rate for Payer: UHC Core |
$325.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.57
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
IP
|
$2.42
|
|
|
Service Code
|
NDC 51079082101
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Aetna Commercial |
$2.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.00
|
| Rate for Payer: BCN Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$2.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Healthscope Commercial |
$2.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.06
|
| Rate for Payer: Nomi Health Commercial |
$1.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.81
|
| Rate for Payer: PHP Commercial |
$2.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.13
|
| Rate for Payer: UHC Core |
$2.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.81
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
IP
|
$241.30
|
|
|
Service Code
|
NDC 51079082120
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.94 |
| Max. Negotiated Rate |
$217.17 |
| Rate for Payer: Aetna Commercial |
$205.10
|
| Rate for Payer: BCBS Trust/PPO |
$199.29
|
| Rate for Payer: BCN Commercial |
$199.29
|
| Rate for Payer: Cash Price |
$193.04
|
| Rate for Payer: Cofinity Commercial |
$207.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.04
|
| Rate for Payer: Healthscope Commercial |
$217.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.10
|
| Rate for Payer: Nomi Health Commercial |
$197.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.97
|
| Rate for Payer: PHP Commercial |
$205.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$209.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.34
|
| Rate for Payer: UHC Core |
$201.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.97
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
OP
|
$2.42
|
|
|
Service Code
|
NDC 51079082101
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Aetna Commercial |
$2.06
|
| Rate for Payer: Aetna Medicare |
$0.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.76
|
| Rate for Payer: BCBS Complete |
$0.45
|
| Rate for Payer: BCBS MAPPO |
$0.61
|
| Rate for Payer: BCBS Trust/PPO |
$1.99
|
| Rate for Payer: BCN Commercial |
$1.99
|
| Rate for Payer: BCN Medicare Advantage |
$0.61
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$2.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.61
|
| Rate for Payer: Healthscope Commercial |
$2.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.81
|
| Rate for Payer: Mclaren Medicaid |
$0.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.64
|
| Rate for Payer: Meridian Medicaid |
$0.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.06
|
| Rate for Payer: Nomi Health Commercial |
$1.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.81
|
| Rate for Payer: PACE Senior Care Partners |
$0.57
|
| Rate for Payer: PACE SWMI |
$0.61
|
| Rate for Payer: PHP Commercial |
$2.06
|
| Rate for Payer: PHP Medicare Advantage |
$0.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.11
|
| Rate for Payer: Priority Health Medicare |
$0.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.68
|
| Rate for Payer: Railroad Medicare Medicare |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.13
|
| Rate for Payer: UHC Core |
$2.02
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UHC Medicaid |
$0.43
|
| Rate for Payer: UHC Medicare Advantage |
$0.61
|
| Rate for Payer: UHCCP Medicaid |
$0.43
|
| Rate for Payer: VA VA |
$0.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.81
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
OP
|
$241.30
|
|
|
Service Code
|
NDC 51079082120
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.54 |
| Max. Negotiated Rate |
$217.17 |
| Rate for Payer: Aetna Commercial |
$205.10
|
| Rate for Payer: Aetna Medicare |
$62.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.41
|
| Rate for Payer: BCBS Complete |
$44.66
|
| Rate for Payer: BCBS MAPPO |
$60.33
|
| Rate for Payer: BCBS Trust/PPO |
$198.37
|
| Rate for Payer: BCN Commercial |
$198.37
|
| Rate for Payer: BCN Medicare Advantage |
$60.33
|
| Rate for Payer: Cash Price |
$193.04
|
| Rate for Payer: Cofinity Commercial |
$207.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.33
|
| Rate for Payer: Healthscope Commercial |
$217.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.97
|
| Rate for Payer: Mclaren Medicaid |
$42.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.34
|
| Rate for Payer: Meridian Medicaid |
$44.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$66.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.10
|
| Rate for Payer: Nomi Health Commercial |
$197.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.97
|
| Rate for Payer: PACE Senior Care Partners |
$57.31
|
| Rate for Payer: PACE SWMI |
$60.33
|
| Rate for Payer: PHP Commercial |
$205.10
|
| Rate for Payer: PHP Medicare Advantage |
$60.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$209.93
|
| Rate for Payer: Priority Health Medicare |
$60.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.94
|
| Rate for Payer: Railroad Medicare Medicare |
$60.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.34
|
| Rate for Payer: UHC Core |
$201.49
|
| Rate for Payer: UHC Exchange |
$60.33
|
| Rate for Payer: UHC Medicaid |
$42.54
|
| Rate for Payer: UHC Medicare Advantage |
$60.33
|
| Rate for Payer: UHCCP Medicaid |
$42.54
|
| Rate for Payer: VA VA |
$60.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.97
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
OP
|
$390.10
|
|
|
Service Code
|
NDC 00904712461
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.77 |
| Max. Negotiated Rate |
$351.09 |
| Rate for Payer: Aetna Commercial |
$331.58
|
| Rate for Payer: Aetna Medicare |
$101.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.91
|
| Rate for Payer: BCBS Complete |
$72.21
|
| Rate for Payer: BCBS MAPPO |
$97.53
|
| Rate for Payer: BCBS Trust/PPO |
$320.70
|
| Rate for Payer: BCN Commercial |
$320.70
|
| Rate for Payer: BCN Medicare Advantage |
$97.53
|
| Rate for Payer: Cash Price |
$312.08
|
| Rate for Payer: Cofinity Commercial |
$335.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.53
|
| Rate for Payer: Healthscope Commercial |
$351.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.57
|
| Rate for Payer: Mclaren Medicaid |
$68.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.40
|
| Rate for Payer: Meridian Medicaid |
$72.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$107.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.58
|
| Rate for Payer: Nomi Health Commercial |
$319.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.57
|
| Rate for Payer: PACE Senior Care Partners |
$92.65
|
| Rate for Payer: PACE SWMI |
$97.53
|
| Rate for Payer: PHP Commercial |
$331.58
|
| Rate for Payer: PHP Medicare Advantage |
$97.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$339.39
|
| Rate for Payer: Priority Health Medicare |
$98.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$271.51
|
| Rate for Payer: Railroad Medicare Medicare |
$97.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.29
|
| Rate for Payer: UHC Core |
$325.73
|
| Rate for Payer: UHC Exchange |
$97.53
|
| Rate for Payer: UHC Medicaid |
$68.77
|
| Rate for Payer: UHC Medicare Advantage |
$97.53
|
| Rate for Payer: UHCCP Medicaid |
$68.77
|
| Rate for Payer: VA VA |
$97.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.57
|
|
