|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$309.70
|
|
|
Service Code
|
NDC 63739-366-10
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.27 |
| Max. Negotiated Rate |
$278.73 |
| Rate for Payer: Aetna American Axle |
$201.30
|
| Rate for Payer: Aetna Commercial |
$263.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.30
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cofinity Commercial |
$216.79
|
| Rate for Payer: Cofinity Commercial |
$266.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.76
|
| Rate for Payer: Healthscope Commercial |
$278.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.24
|
| Rate for Payer: PHP Commercial |
$263.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.79
|
| Rate for Payer: Priority Health SBD |
$195.11
|
| Rate for Payer: UMR Bronson Commercial |
$136.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.28
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$251.75
|
|
|
Service Code
|
NDC 68382-799-01
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.77 |
| Max. Negotiated Rate |
$226.58 |
| Rate for Payer: Aetna American Axle |
$163.64
|
| Rate for Payer: Aetna Commercial |
$213.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.64
|
| Rate for Payer: Cash Price |
$201.40
|
| Rate for Payer: Cofinity Commercial |
$176.22
|
| Rate for Payer: Cofinity Commercial |
$216.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.40
|
| Rate for Payer: Healthscope Commercial |
$226.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.99
|
| Rate for Payer: PHP Commercial |
$213.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.22
|
| Rate for Payer: Priority Health SBD |
$158.60
|
| Rate for Payer: UMR Bronson Commercial |
$110.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.81
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$384.75
|
|
|
Service Code
|
NDC 51079-929-20
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.29 |
| Max. Negotiated Rate |
$346.28 |
| Rate for Payer: Aetna American Axle |
$250.09
|
| Rate for Payer: Aetna Commercial |
$327.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.09
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cofinity Commercial |
$269.32
|
| Rate for Payer: Cofinity Commercial |
$330.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.80
|
| Rate for Payer: Healthscope Commercial |
$346.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$327.04
|
| Rate for Payer: PHP Commercial |
$327.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.32
|
| Rate for Payer: Priority Health SBD |
$242.39
|
| Rate for Payer: UMR Bronson Commercial |
$169.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.56
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$233.70
|
|
|
Service Code
|
NDC 0904-5929-61
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.83 |
| Max. Negotiated Rate |
$210.33 |
| Rate for Payer: Aetna American Axle |
$151.90
|
| Rate for Payer: Aetna Commercial |
$198.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.90
|
| Rate for Payer: Cash Price |
$186.96
|
| Rate for Payer: Cofinity Commercial |
$163.59
|
| Rate for Payer: Cofinity Commercial |
$200.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.96
|
| Rate for Payer: Healthscope Commercial |
$210.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$198.64
|
| Rate for Payer: PHP Commercial |
$198.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.59
|
| Rate for Payer: Priority Health SBD |
$147.23
|
| Rate for Payer: UMR Bronson Commercial |
$102.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.28
|
|
|
LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$16.90
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
155884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$15.21 |
| Rate for Payer: Aetna American Axle |
$10.98
|
| Rate for Payer: Aetna American Axle |
$18.80
|
| Rate for Payer: Aetna American Axle |
$17.32
|
| Rate for Payer: Aetna Commercial |
$24.59
|
| Rate for Payer: Aetna Commercial |
$14.36
|
| Rate for Payer: Aetna Commercial |
$22.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.32
|
| Rate for Payer: Cash Price |
$23.14
|
| Rate for Payer: Cash Price |
$21.32
|
| Rate for Payer: Cash Price |
$13.52
|
| Rate for Payer: Cofinity Commercial |
$11.83
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$18.66
|
| Rate for Payer: Cofinity Commercial |
$14.53
|
| Rate for Payer: Cofinity Commercial |
$22.92
|
| Rate for Payer: Cofinity Commercial |
$24.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.32
|
| Rate for Payer: Healthscope Commercial |
$15.21
|
| Rate for Payer: Healthscope Commercial |
$23.98
|
| Rate for Payer: Healthscope Commercial |
$26.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.65
|
| Rate for Payer: PHP Commercial |
$22.65
|
| Rate for Payer: PHP Commercial |
$24.59
|
| Rate for Payer: PHP Commercial |
$14.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.25
|
| Rate for Payer: Priority Health SBD |
$16.79
|
| Rate for Payer: Priority Health SBD |
$10.65
|
| Rate for Payer: Priority Health SBD |
$18.23
|
| Rate for Payer: UMR Bronson Commercial |
$7.44
|
| Rate for Payer: UMR Bronson Commercial |
$11.73
|
| Rate for Payer: UMR Bronson Commercial |
$12.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.70
|
|
|
LABETALOL 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
10372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna American Axle |
$87.75
|
| Rate for Payer: Aetna American Axle |
$29.82
|
| Rate for Payer: Aetna American Axle |
$54.92
|
| Rate for Payer: Aetna American Axle |
$102.05
|
| Rate for Payer: Aetna American Axle |
$208.00
|
| Rate for Payer: Aetna American Axle |
$27.62
|
| Rate for Payer: Aetna American Axle |
$362.67
|
| Rate for Payer: Aetna American Axle |
$70.85
|
| Rate for Payer: Aetna American Axle |
$150.15
|
| Rate for Payer: Aetna Commercial |
$272.00
|
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Aetna Commercial |
$71.82
|
| Rate for Payer: Aetna Commercial |
$474.27
|
| Rate for Payer: Aetna Commercial |
$92.65
|
| Rate for Payer: Aetna Commercial |
$39.00
|
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Aetna Commercial |
$114.75
|
| Rate for Payer: Aetna Commercial |
$133.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$362.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.05
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$36.70
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Cash Price |
$446.37
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cofinity Commercial |
$32.12
|
| Rate for Payer: Cofinity Commercial |
$72.67
|
| Rate for Payer: Cofinity Commercial |
$76.30
|
| Rate for Payer: Cofinity Commercial |
$93.74
|
| Rate for Payer: Cofinity Commercial |
$116.10
|
| Rate for Payer: Cofinity Commercial |
$94.50
|
| Rate for Payer: Cofinity Commercial |
$479.85
|
| Rate for Payer: Cofinity Commercial |
$390.57
|
| Rate for Payer: Cofinity Commercial |
$109.90
|
| Rate for Payer: Cofinity Commercial |
$135.02
|
| Rate for Payer: Cofinity Commercial |
$161.70
|
| Rate for Payer: Cofinity Commercial |
$198.66
|
| Rate for Payer: Cofinity Commercial |
$224.00
|
| Rate for Payer: Cofinity Commercial |
$275.20
|
| Rate for Payer: Cofinity Commercial |
$39.46
|
| Rate for Payer: Cofinity Commercial |
$59.15
|
| Rate for Payer: Cofinity Commercial |
$29.75
|
| Rate for Payer: Cofinity Commercial |
$36.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$446.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.00
|
| Rate for Payer: Healthscope Commercial |
$141.30
|
| Rate for Payer: Healthscope Commercial |
$76.05
|
| Rate for Payer: Healthscope Commercial |
$288.00
|
| Rate for Payer: Healthscope Commercial |
$502.16
|
| Rate for Payer: Healthscope Commercial |
$207.90
|
| Rate for Payer: Healthscope Commercial |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$98.10
|
| Rate for Payer: Healthscope Commercial |
$41.29
|
| Rate for Payer: Healthscope Commercial |
$121.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$390.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$418.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$196.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$272.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$474.27
|
| Rate for Payer: PHP Commercial |
$474.27
|
| Rate for Payer: PHP Commercial |
$92.65
|
| Rate for Payer: PHP Commercial |
$71.82
|
| Rate for Payer: PHP Commercial |
$114.75
|
| Rate for Payer: PHP Commercial |
$36.12
|
| Rate for Payer: PHP Commercial |
$133.45
|
| Rate for Payer: PHP Commercial |
$196.35
|
| Rate for Payer: PHP Commercial |
$272.00
|
| Rate for Payer: PHP Commercial |
$39.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.30
|
| Rate for Payer: Priority Health SBD |
$98.91
|
| Rate for Payer: Priority Health SBD |
$53.24
|
| Rate for Payer: Priority Health SBD |
$68.67
|
| Rate for Payer: Priority Health SBD |
$201.60
|
| Rate for Payer: Priority Health SBD |
$28.90
|
| Rate for Payer: Priority Health SBD |
$351.51
|
| Rate for Payer: Priority Health SBD |
$145.53
|
| Rate for Payer: Priority Health SBD |
$85.05
|
| Rate for Payer: Priority Health SBD |
$26.78
|
| Rate for Payer: UMR Bronson Commercial |
$245.50
|
| Rate for Payer: UMR Bronson Commercial |
$47.96
|
| Rate for Payer: UMR Bronson Commercial |
$59.40
|
| Rate for Payer: UMR Bronson Commercial |
$69.08
|
| Rate for Payer: UMR Bronson Commercial |
$101.64
|
| Rate for Payer: UMR Bronson Commercial |
$140.80
|
| Rate for Payer: UMR Bronson Commercial |
$18.70
|
| Rate for Payer: UMR Bronson Commercial |
$20.19
|
| Rate for Payer: UMR Bronson Commercial |
$37.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$418.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.38
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
IP
|
$549.22
|
|
|
Service Code
|
NDC 0904-7245-68
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.66 |
| Max. Negotiated Rate |
$494.30 |
| Rate for Payer: Aetna American Axle |
$356.99
|
| Rate for Payer: Aetna Commercial |
$466.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.99
|
| Rate for Payer: Cash Price |
$439.38
|
| Rate for Payer: Cofinity Commercial |
$384.45
|
| Rate for Payer: Cofinity Commercial |
$472.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.38
|
| Rate for Payer: Healthscope Commercial |
$494.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$466.84
|
| Rate for Payer: PHP Commercial |
$466.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.45
|
| Rate for Payer: Priority Health SBD |
$346.01
|
| Rate for Payer: UMR Bronson Commercial |
$241.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.92
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
IP
|
$10.57
|
|
|
Service Code
|
NDC 60687-687-11
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$9.51 |
| Rate for Payer: Aetna American Axle |
$6.87
|
| Rate for Payer: Aetna Commercial |
$8.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.87
|
| Rate for Payer: Cash Price |
$8.46
|
| Rate for Payer: Cofinity Commercial |
$7.40
|
| Rate for Payer: Cofinity Commercial |
$9.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.46
|
| Rate for Payer: Healthscope Commercial |
$9.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.98
|
| Rate for Payer: PHP Commercial |
$8.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.40
|
| Rate for Payer: Priority Health SBD |
$6.66
|
| Rate for Payer: UMR Bronson Commercial |
$4.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.93
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
IP
|
$3,801.53
|
|
|
Service Code
|
NDC 0131-2478-35
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,672.67 |
| Max. Negotiated Rate |
$3,421.38 |
| Rate for Payer: Aetna American Axle |
$2,470.99
|
| Rate for Payer: Aetna Commercial |
$3,231.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,470.99
|
| Rate for Payer: Cash Price |
$3,041.22
|
| Rate for Payer: Cofinity Commercial |
$2,661.07
|
| Rate for Payer: Cofinity Commercial |
$3,269.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,041.22
|
| Rate for Payer: Healthscope Commercial |
$3,421.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,661.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,851.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,231.30
|
| Rate for Payer: PHP Commercial |
$3,231.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,661.07
|
| Rate for Payer: Priority Health SBD |
$2,394.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,672.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,851.15
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
IP
|
$4,182.04
|
|
|
Service Code
|
NDC 0131-2478-60
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,840.10 |
| Max. Negotiated Rate |
$3,763.84 |
| Rate for Payer: Aetna American Axle |
$2,718.33
|
| Rate for Payer: Aetna Commercial |
$3,554.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,718.33
|
| Rate for Payer: Cash Price |
$3,345.63
|
| Rate for Payer: Cofinity Commercial |
$2,927.43
|
| Rate for Payer: Cofinity Commercial |
$3,596.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,345.63
|
| Rate for Payer: Healthscope Commercial |
$3,763.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,927.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,136.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,554.73
|
| Rate for Payer: PHP Commercial |
$3,554.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,927.43
|
| Rate for Payer: Priority Health SBD |
$2,634.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,840.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,136.53
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
IP
|
$634.04
|
|
|
Service Code
|
NDC 60687-687-57
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.98 |
| Max. Negotiated Rate |
$570.64 |
| Rate for Payer: Aetna American Axle |
$412.13
|
| Rate for Payer: Aetna Commercial |
$538.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.13
|
| Rate for Payer: Cash Price |
$507.23
|
| Rate for Payer: Cofinity Commercial |
$443.83
|
| Rate for Payer: Cofinity Commercial |
$545.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$507.23
|
| Rate for Payer: Healthscope Commercial |
$570.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$443.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$475.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$538.93
|
| Rate for Payer: PHP Commercial |
$538.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$443.83
|
| Rate for Payer: Priority Health SBD |
$399.45
|
| Rate for Payer: UMR Bronson Commercial |
$278.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$475.53
|
|
|
LACOSAMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$498.24
|
|
|
Service Code
|
NDC 31722-627-26
|
| Hospital Charge Code |
105482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.23 |
| Max. Negotiated Rate |
$448.42 |
| Rate for Payer: Aetna American Axle |
$323.86
|
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.86
|
| Rate for Payer: Cash Price |
$398.59
|
| Rate for Payer: Cofinity Commercial |
$348.77
|
| Rate for Payer: Cofinity Commercial |
$428.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.59
|
| Rate for Payer: Healthscope Commercial |
$448.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$348.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$423.50
|
| Rate for Payer: PHP Commercial |
$423.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.77
|
| Rate for Payer: Priority Health SBD |
$313.89
|
| Rate for Payer: UMR Bronson Commercial |
$219.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.68
|
|
|
LACOSAMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$676.80
|
|
|
Service Code
|
NDC 70954-488-10
|
| Hospital Charge Code |
105482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.79 |
| Max. Negotiated Rate |
$609.12 |
| Rate for Payer: Aetna American Axle |
$439.92
|
| Rate for Payer: Aetna Commercial |
$575.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.92
|
| Rate for Payer: Cash Price |
$541.44
|
| Rate for Payer: Cofinity Commercial |
$582.05
|
| Rate for Payer: Cofinity Commercial |
$473.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.44
|
| Rate for Payer: Healthscope Commercial |
$609.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$473.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$507.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$575.28
|
| Rate for Payer: PHP Commercial |
$575.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.76
|
| Rate for Payer: Priority Health SBD |
$426.38
|
| Rate for Payer: UMR Bronson Commercial |
$297.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.60
|
|
|
LACOSAMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$752.00
|
|
|
Service Code
|
NDC 67877-732-95
|
| Hospital Charge Code |
105482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$330.88 |
| Max. Negotiated Rate |
$676.80 |
| Rate for Payer: Aetna American Axle |
$488.80
|
| Rate for Payer: Aetna Commercial |
$639.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.80
|
| Rate for Payer: Cash Price |
$601.60
|
| Rate for Payer: Cofinity Commercial |
$526.40
|
| Rate for Payer: Cofinity Commercial |
$646.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$601.60
|
| Rate for Payer: Healthscope Commercial |
$676.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$526.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$564.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$639.20
|
| Rate for Payer: PHP Commercial |
$639.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$526.40
|
| Rate for Payer: Priority Health SBD |
$473.76
|
| Rate for Payer: UMR Bronson Commercial |
$330.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$564.00
|
|
|
LACOSAMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$30.17
|
|
|
Service Code
|
NDC 9900-0006-45
|
| Hospital Charge Code |
105482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$27.15 |
| Rate for Payer: Aetna American Axle |
$19.61
|
| Rate for Payer: Aetna Commercial |
$25.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.61
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$25.95
|
| Rate for Payer: Cofinity Commercial |
$21.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.14
|
| Rate for Payer: Healthscope Commercial |
$27.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.64
|
| Rate for Payer: PHP Commercial |
$25.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.12
|
| Rate for Payer: Priority Health SBD |
$19.01
|
| Rate for Payer: UMR Bronson Commercial |
$13.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.63
|
|
|
LACOSAMIDE 150 MG TABLET
|
Facility
|
IP
|
$4,026.20
|
|
|
Service Code
|
NDC 0131-2479-35
|
| Hospital Charge Code |
96970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,771.53 |
| Max. Negotiated Rate |
$3,623.58 |
| Rate for Payer: Aetna American Axle |
$2,617.03
|
| Rate for Payer: Aetna Commercial |
$3,422.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,617.03
|
| Rate for Payer: Cash Price |
$3,220.96
|
| Rate for Payer: Cofinity Commercial |
$2,818.34
|
| Rate for Payer: Cofinity Commercial |
$3,462.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,220.96
|
| Rate for Payer: Healthscope Commercial |
$3,623.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,818.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,019.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,422.27
|
| Rate for Payer: PHP Commercial |
$3,422.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,818.34
|
| Rate for Payer: Priority Health SBD |
$2,536.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,771.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,019.65
|
|
|
LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$81.08
|
|
|
Service Code
|
HCPCS C9254
|
| Hospital Charge Code |
96972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.68 |
| Max. Negotiated Rate |
$72.97 |
| Rate for Payer: Aetna American Axle |
$52.70
|
| Rate for Payer: Aetna American Axle |
$63.23
|
| Rate for Payer: Aetna American Axle |
$207.45
|
| Rate for Payer: Aetna American Axle |
$60.52
|
| Rate for Payer: Aetna Commercial |
$79.14
|
| Rate for Payer: Aetna Commercial |
$68.92
|
| Rate for Payer: Aetna Commercial |
$82.69
|
| Rate for Payer: Aetna Commercial |
$271.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.45
|
| Rate for Payer: Cash Price |
$64.86
|
| Rate for Payer: Cash Price |
$255.32
|
| Rate for Payer: Cash Price |
$74.48
|
| Rate for Payer: Cash Price |
$77.82
|
| Rate for Payer: Cofinity Commercial |
$68.10
|
| Rate for Payer: Cofinity Commercial |
$223.40
|
| Rate for Payer: Cofinity Commercial |
$274.47
|
| Rate for Payer: Cofinity Commercial |
$80.07
|
| Rate for Payer: Cofinity Commercial |
$65.17
|
| Rate for Payer: Cofinity Commercial |
$83.66
|
| Rate for Payer: Cofinity Commercial |
$56.76
|
| Rate for Payer: Cofinity Commercial |
$69.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.32
|
| Rate for Payer: Healthscope Commercial |
$83.79
|
| Rate for Payer: Healthscope Commercial |
$287.24
|
| Rate for Payer: Healthscope Commercial |
$87.55
|
| Rate for Payer: Healthscope Commercial |
$72.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$223.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$271.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.69
|
| Rate for Payer: PHP Commercial |
$68.92
|
| Rate for Payer: PHP Commercial |
$79.14
|
| Rate for Payer: PHP Commercial |
$82.69
|
| Rate for Payer: PHP Commercial |
$271.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.10
|
| Rate for Payer: Priority Health SBD |
$58.65
|
| Rate for Payer: Priority Health SBD |
$61.29
|
| Rate for Payer: Priority Health SBD |
$201.06
|
| Rate for Payer: Priority Health SBD |
$51.08
|
| Rate for Payer: UMR Bronson Commercial |
$40.96
|
| Rate for Payer: UMR Bronson Commercial |
$140.43
|
| Rate for Payer: UMR Bronson Commercial |
$42.80
|
| Rate for Payer: UMR Bronson Commercial |
$35.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.96
|
|
|
LACOSAMIDE 200 MG TABLET
|
Facility
|
IP
|
$508.16
|
|
|
Service Code
|
NDC 0904-7247-68
|
| Hospital Charge Code |
96971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.59 |
| Max. Negotiated Rate |
$457.34 |
| Rate for Payer: Aetna American Axle |
$330.30
|
| Rate for Payer: Aetna Commercial |
$431.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.30
|
| Rate for Payer: Cash Price |
$406.53
|
| Rate for Payer: Cofinity Commercial |
$355.71
|
| Rate for Payer: Cofinity Commercial |
$437.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.53
|
| Rate for Payer: Healthscope Commercial |
$457.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$355.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$381.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$431.94
|
| Rate for Payer: PHP Commercial |
$431.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.71
|
| Rate for Payer: Priority Health SBD |
$320.14
|
| Rate for Payer: UMR Bronson Commercial |
$223.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.12
|
|
|
LACOSAMIDE 200 MG TABLET
|
Facility
|
IP
|
$671.78
|
|
|
Service Code
|
NDC 60687-698-57
|
| Hospital Charge Code |
96971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$295.58 |
| Max. Negotiated Rate |
$604.60 |
| Rate for Payer: Aetna American Axle |
$436.66
|
| Rate for Payer: Aetna Commercial |
$571.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.66
|
| Rate for Payer: Cash Price |
$537.42
|
| Rate for Payer: Cofinity Commercial |
$470.25
|
| Rate for Payer: Cofinity Commercial |
$577.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.42
|
| Rate for Payer: Healthscope Commercial |
$604.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$470.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$503.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$571.01
|
| Rate for Payer: PHP Commercial |
$571.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.25
|
| Rate for Payer: Priority Health SBD |
$423.22
|
| Rate for Payer: UMR Bronson Commercial |
$295.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$503.84
|
|
|
LACOSAMIDE 200 MG TABLET
|
Facility
|
IP
|
$4,027.31
|
|
|
Service Code
|
NDC 0131-2480-35
|
| Hospital Charge Code |
96971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,772.02 |
| Max. Negotiated Rate |
$3,624.58 |
| Rate for Payer: Aetna American Axle |
$2,617.75
|
| Rate for Payer: Aetna Commercial |
$3,423.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,617.75
|
| Rate for Payer: Cash Price |
$3,221.85
|
| Rate for Payer: Cofinity Commercial |
$2,819.12
|
| Rate for Payer: Cofinity Commercial |
$3,463.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,221.85
|
| Rate for Payer: Healthscope Commercial |
$3,624.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,819.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,020.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,423.21
|
| Rate for Payer: PHP Commercial |
$3,423.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,819.12
|
| Rate for Payer: Priority Health SBD |
$2,537.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,772.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,020.48
|
|
|
LACOSAMIDE 200 MG TABLET
|
Facility
|
IP
|
$11.20
|
|
|
Service Code
|
NDC 60687-698-11
|
| Hospital Charge Code |
96971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$10.08 |
| Rate for Payer: Aetna American Axle |
$7.28
|
| Rate for Payer: Aetna Commercial |
$9.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.28
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cofinity Commercial |
$7.84
|
| Rate for Payer: Cofinity Commercial |
$9.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.96
|
| Rate for Payer: Healthscope Commercial |
$10.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.52
|
| Rate for Payer: PHP Commercial |
$9.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.84
|
| Rate for Payer: Priority Health SBD |
$7.06
|
| Rate for Payer: UMR Bronson Commercial |
$4.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.40
|
|
|
LACOSAMIDE 50 MG TABLET
|
Facility
|
IP
|
$2,431.57
|
|
|
Service Code
|
NDC 0131-2477-35
|
| Hospital Charge Code |
96968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,069.89 |
| Max. Negotiated Rate |
$2,188.41 |
| Rate for Payer: Aetna American Axle |
$1,580.52
|
| Rate for Payer: Aetna Commercial |
$2,066.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,580.52
|
| Rate for Payer: Cash Price |
$1,945.26
|
| Rate for Payer: Cofinity Commercial |
$1,702.10
|
| Rate for Payer: Cofinity Commercial |
$2,091.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,945.26
|
| Rate for Payer: Healthscope Commercial |
$2,188.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,702.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,823.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,066.83
|
| Rate for Payer: PHP Commercial |
$2,066.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,702.10
|
| Rate for Payer: Priority Health SBD |
$1,531.89
|
| Rate for Payer: UMR Bronson Commercial |
$1,069.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,823.68
|
|
|
LACOSAMIDE 50 MG TABLET
|
Facility
|
IP
|
$149.46
|
|
|
Service Code
|
NDC 67877-733-60
|
| Hospital Charge Code |
96968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.76 |
| Max. Negotiated Rate |
$134.51 |
| Rate for Payer: Aetna American Axle |
$97.15
|
| Rate for Payer: Aetna Commercial |
$127.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.15
|
| Rate for Payer: Cash Price |
$119.57
|
| Rate for Payer: Cofinity Commercial |
$104.62
|
| Rate for Payer: Cofinity Commercial |
$128.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.57
|
| Rate for Payer: Healthscope Commercial |
$134.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.04
|
| Rate for Payer: PHP Commercial |
$127.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.62
|
| Rate for Payer: Priority Health SBD |
$94.16
|
| Rate for Payer: UMR Bronson Commercial |
$65.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.10
|
|
|
LACOSAMIDE 50 MG TABLET
|
Facility
|
IP
|
$8.77
|
|
|
Service Code
|
NDC 60687-676-11
|
| Hospital Charge Code |
96968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Aetna American Axle |
$5.70
|
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.70
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cofinity Commercial |
$6.14
|
| Rate for Payer: Cofinity Commercial |
$7.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.02
|
| Rate for Payer: Healthscope Commercial |
$7.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.45
|
| Rate for Payer: PHP Commercial |
$7.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.14
|
| Rate for Payer: Priority Health SBD |
$5.53
|
| Rate for Payer: UMR Bronson Commercial |
$3.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.58
|
|
|
LACOSAMIDE 50 MG TABLET
|
Facility
|
IP
|
$155.04
|
|
|
Service Code
|
NDC 62332-171-60
|
| Hospital Charge Code |
96968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.22 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Aetna American Axle |
$100.78
|
| Rate for Payer: Aetna Commercial |
$131.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.78
|
| Rate for Payer: Cash Price |
$124.03
|
| Rate for Payer: Cofinity Commercial |
$108.53
|
| Rate for Payer: Cofinity Commercial |
$133.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.03
|
| Rate for Payer: Healthscope Commercial |
$139.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.78
|
| Rate for Payer: PHP Commercial |
$131.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.53
|
| Rate for Payer: Priority Health SBD |
$97.68
|
| Rate for Payer: UMR Bronson Commercial |
$68.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.28
|
|
