|
LACOSAMIDE 100 MG TABLET
|
Facility
|
OP
|
$465.76
|
|
|
Service Code
|
NDC 60687068757
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.33 |
| Max. Negotiated Rate |
$419.18 |
| Rate for Payer: Aetna American Axle |
$302.74
|
| Rate for Payer: Aetna Commercial |
$395.90
|
| Rate for Payer: Aetna Medicare |
$232.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.74
|
| Rate for Payer: BCBS Complete |
$186.30
|
| Rate for Payer: Cash Price |
$372.61
|
| Rate for Payer: Cofinity Advantage |
$326.03
|
| Rate for Payer: Cofinity Commercial |
$400.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.61
|
| Rate for Payer: Healthscope Commercial |
$419.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$326.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.32
|
| Rate for Payer: PHP Commercial |
$395.90
|
| Rate for Payer: Priority Health SBD |
$293.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$302.74
|
| Rate for Payer: UHC Core |
$242.66
|
| Rate for Payer: UHC Exchange |
$183.04
|
| Rate for Payer: UMR Bronson Commercial |
$172.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.32
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
OP
|
$4,398.05
|
|
|
Service Code
|
NDC 00131247860
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,627.28 |
| Max. Negotiated Rate |
$3,958.24 |
| Rate for Payer: Aetna American Axle |
$2,858.73
|
| Rate for Payer: Aetna Commercial |
$3,738.34
|
| Rate for Payer: Aetna Medicare |
$2,199.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,858.73
|
| Rate for Payer: BCBS Complete |
$1,759.22
|
| Rate for Payer: Cash Price |
$3,518.44
|
| Rate for Payer: Cofinity Advantage |
$3,078.64
|
| Rate for Payer: Cofinity Commercial |
$3,782.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,518.44
|
| Rate for Payer: Healthscope Commercial |
$3,958.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,078.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,298.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,518.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,738.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,298.54
|
| Rate for Payer: PHP Commercial |
$3,738.34
|
| Rate for Payer: Priority Health SBD |
$2,770.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,858.73
|
| Rate for Payer: UHC Core |
$2,291.38
|
| Rate for Payer: UHC Exchange |
$1,728.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,627.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,298.54
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
IP
|
$3,997.78
|
|
|
Service Code
|
NDC 00131247835
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,759.02 |
| Max. Negotiated Rate |
$3,598.00 |
| Rate for Payer: Aetna American Axle |
$2,598.56
|
| Rate for Payer: Aetna Commercial |
$3,398.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,598.56
|
| Rate for Payer: Cash Price |
$3,198.22
|
| Rate for Payer: Cofinity Advantage |
$2,798.45
|
| Rate for Payer: Cofinity Commercial |
$3,438.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,198.22
|
| Rate for Payer: Healthscope Commercial |
$3,598.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,798.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,998.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,398.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,998.34
|
| Rate for Payer: PHP Commercial |
$3,398.11
|
| Rate for Payer: Priority Health SBD |
$2,518.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,759.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,998.34
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
OP
|
$549.22
|
|
|
Service Code
|
NDC 00904724568
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.21 |
| Max. Negotiated Rate |
$494.30 |
| Rate for Payer: Aetna American Axle |
$356.99
|
| Rate for Payer: Aetna Commercial |
$466.84
|
| Rate for Payer: Aetna Medicare |
$274.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.99
|
| Rate for Payer: BCBS Complete |
$219.69
|
| Rate for Payer: Cash Price |
$439.38
|
| Rate for Payer: Cofinity Advantage |
$384.45
|
| Rate for Payer: Cofinity Commercial |
$472.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.38
|
| Rate for Payer: Healthscope Commercial |
$494.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$439.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.92
|
| Rate for Payer: PHP Commercial |
$466.84
|
| Rate for Payer: Priority Health SBD |
$346.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.99
|
| Rate for Payer: UHC Core |
$286.14
|
| Rate for Payer: UHC Exchange |
$215.84
|
| Rate for Payer: UMR Bronson Commercial |
$203.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.92
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
OP
|
$3,997.78
|
|
|
Service Code
|
NDC 00131247835
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,479.18 |
| Max. Negotiated Rate |
$3,598.00 |
| Rate for Payer: Aetna American Axle |
$2,598.56
|
| Rate for Payer: Aetna Commercial |
$3,398.11
|
| Rate for Payer: Aetna Medicare |
$1,998.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,598.56
|
| Rate for Payer: BCBS Complete |
$1,599.11
|
| Rate for Payer: Cash Price |
$3,198.22
|
| Rate for Payer: Cofinity Advantage |
$2,798.45
|
| Rate for Payer: Cofinity Commercial |
$3,438.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,198.22
|
| Rate for Payer: Healthscope Commercial |
$3,598.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,798.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,998.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,198.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,398.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,998.34
|
| Rate for Payer: PHP Commercial |
$3,398.11
|
| Rate for Payer: Priority Health SBD |
$2,518.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,598.56
|
| Rate for Payer: UHC Core |
$2,082.84
|
| Rate for Payer: UHC Exchange |
$1,571.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,479.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,998.34
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
OP
|
$7.77
|
|
|
Service Code
|
NDC 60687068711
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$6.99 |
| Rate for Payer: Aetna American Axle |
$5.05
|
| Rate for Payer: Aetna Commercial |
$6.60
|
| Rate for Payer: Aetna Medicare |
$3.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.05
|
| Rate for Payer: BCBS Complete |
$3.11
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Cofinity Advantage |
$5.44
|
| Rate for Payer: Cofinity Commercial |
$6.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$6.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.83
|
| Rate for Payer: PHP Commercial |
$6.60
|
| Rate for Payer: Priority Health SBD |
$4.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.05
|
| Rate for Payer: UHC Core |
$4.05
|
| Rate for Payer: UHC Exchange |
$3.05
|
| Rate for Payer: UMR Bronson Commercial |
$2.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.83
|
|
|
LACOSAMIDE 100 MG TABLET
|
Facility
|
IP
|
$465.76
|
|
|
Service Code
|
NDC 60687068757
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.93 |
| Max. Negotiated Rate |
$419.18 |
| Rate for Payer: Aetna American Axle |
$302.74
|
| Rate for Payer: Aetna Commercial |
$395.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.74
|
| Rate for Payer: Cash Price |
$372.61
|
| Rate for Payer: Cofinity Advantage |
$326.03
|
| Rate for Payer: Cofinity Commercial |
$400.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.61
|
| Rate for Payer: Healthscope Commercial |
$419.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$326.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.32
|
| Rate for Payer: PHP Commercial |
$395.90
|
| Rate for Payer: Priority Health SBD |
$293.43
|
| Rate for Payer: UMR Bronson Commercial |
$204.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.32
|
|
|
LACOSAMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$752.00
|
|
|
Service Code
|
NDC 59651001602
|
| 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 Advantage |
$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 Commercial |
$639.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$564.00
|
| Rate for Payer: PHP Commercial |
$639.20
|
| 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
|
OP
|
$752.00
|
|
|
Service Code
|
NDC 59651001602
|
| Hospital Charge Code |
105482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.24 |
| Max. Negotiated Rate |
$676.80 |
| Rate for Payer: Aetna American Axle |
$488.80
|
| Rate for Payer: Aetna Commercial |
$639.20
|
| Rate for Payer: Aetna Medicare |
$376.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.80
|
| Rate for Payer: BCBS Complete |
$300.80
|
| Rate for Payer: Cash Price |
$601.60
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$601.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$639.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$564.00
|
| Rate for Payer: PHP Commercial |
$639.20
|
| Rate for Payer: Priority Health SBD |
$473.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.80
|
| Rate for Payer: UHC Core |
$391.79
|
| Rate for Payer: UHC Exchange |
$295.54
|
| Rate for Payer: UMR Bronson Commercial |
$278.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$564.00
|
|
|
LACOSAMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$498.24
|
|
|
Service Code
|
NDC 31722062726
|
| Hospital Charge Code |
105482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.35 |
| Max. Negotiated Rate |
$448.42 |
| Rate for Payer: Aetna American Axle |
$323.86
|
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Aetna Medicare |
$249.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.86
|
| Rate for Payer: BCBS Complete |
$199.30
|
| Rate for Payer: Cash Price |
$398.59
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$398.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.68
|
| Rate for Payer: PHP Commercial |
$423.50
|
| Rate for Payer: Priority Health SBD |
$313.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.86
|
| Rate for Payer: UHC Core |
$259.58
|
| Rate for Payer: UHC Exchange |
$195.81
|
| Rate for Payer: UMR Bronson Commercial |
$184.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.68
|
|
|
LACOSAMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$695.60
|
|
|
Service Code
|
NDC 70954048810
|
| Hospital Charge Code |
105482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.37 |
| Max. Negotiated Rate |
$626.04 |
| Rate for Payer: Aetna American Axle |
$452.14
|
| Rate for Payer: Aetna Commercial |
$591.26
|
| Rate for Payer: Aetna Medicare |
$347.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.14
|
| Rate for Payer: BCBS Complete |
$278.24
|
| Rate for Payer: Cash Price |
$556.48
|
| Rate for Payer: Cofinity Advantage |
$486.92
|
| Rate for Payer: Cofinity Commercial |
$598.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$556.48
|
| Rate for Payer: Healthscope Commercial |
$626.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$486.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$521.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$556.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$591.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$521.70
|
| Rate for Payer: PHP Commercial |
$591.26
|
| Rate for Payer: Priority Health SBD |
$438.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$452.14
|
| Rate for Payer: UHC Core |
$362.41
|
| Rate for Payer: UHC Exchange |
$273.37
|
| Rate for Payer: UMR Bronson Commercial |
$257.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$521.70
|
|
|
LACOSAMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$498.24
|
|
|
Service Code
|
NDC 31722062726
|
| 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 Advantage |
$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 Commercial |
$423.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.68
|
| Rate for Payer: PHP Commercial |
$423.50
|
| 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
|
$695.60
|
|
|
Service Code
|
NDC 70954048810
|
| Hospital Charge Code |
105482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$306.06 |
| Max. Negotiated Rate |
$626.04 |
| Rate for Payer: Aetna American Axle |
$452.14
|
| Rate for Payer: Aetna Commercial |
$591.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.14
|
| Rate for Payer: Cash Price |
$556.48
|
| Rate for Payer: Cofinity Advantage |
$486.92
|
| Rate for Payer: Cofinity Commercial |
$598.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$556.48
|
| Rate for Payer: Healthscope Commercial |
$626.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$486.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$521.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$591.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$521.70
|
| Rate for Payer: PHP Commercial |
$591.26
|
| Rate for Payer: Priority Health SBD |
$438.23
|
| Rate for Payer: UMR Bronson Commercial |
$306.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$521.70
|
|
|
LACOSAMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$30.17
|
|
|
Service Code
|
NDC 09900000645
|
| Hospital Charge Code |
105482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$27.15 |
| Rate for Payer: Aetna American Axle |
$19.61
|
| Rate for Payer: Aetna Commercial |
$25.64
|
| Rate for Payer: Aetna Medicare |
$15.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.61
|
| Rate for Payer: BCBS Complete |
$12.07
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cofinity Advantage |
$21.12
|
| Rate for Payer: Cofinity Commercial |
$25.95
|
| 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: MI Amish Medical Board Commercial |
$24.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.63
|
| Rate for Payer: PHP Commercial |
$25.64
|
| Rate for Payer: Priority Health SBD |
$19.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.61
|
| Rate for Payer: UHC Core |
$15.72
|
| Rate for Payer: UHC Exchange |
$11.86
|
| Rate for Payer: UMR Bronson Commercial |
$11.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.63
|
|
|
LACOSAMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$752.00
|
|
|
Service Code
|
NDC 67877073295
|
| 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 Advantage |
$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 Commercial |
$639.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$564.00
|
| Rate for Payer: PHP Commercial |
$639.20
|
| 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
|
OP
|
$752.00
|
|
|
Service Code
|
NDC 67877073295
|
| Hospital Charge Code |
105482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.24 |
| Max. Negotiated Rate |
$676.80 |
| Rate for Payer: Aetna American Axle |
$488.80
|
| Rate for Payer: Aetna Commercial |
$639.20
|
| Rate for Payer: Aetna Medicare |
$376.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.80
|
| Rate for Payer: BCBS Complete |
$300.80
|
| Rate for Payer: Cash Price |
$601.60
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$601.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$639.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$564.00
|
| Rate for Payer: PHP Commercial |
$639.20
|
| Rate for Payer: Priority Health SBD |
$473.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.80
|
| Rate for Payer: UHC Core |
$391.79
|
| Rate for Payer: UHC Exchange |
$295.54
|
| Rate for Payer: UMR Bronson Commercial |
$278.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$564.00
|
|
|
LACOSAMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$30.17
|
|
|
Service Code
|
NDC 09900000645
|
| 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 Advantage |
$21.12
|
| Rate for Payer: Cofinity Commercial |
$25.95
|
| 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 Commercial |
$25.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.63
|
| Rate for Payer: PHP Commercial |
$25.64
|
| 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 200 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$57.14
|
|
|
Service Code
|
HCPCS C9254
|
| Hospital Charge Code |
96972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.14 |
| Max. Negotiated Rate |
$51.43 |
| Rate for Payer: Aetna American Axle |
$37.14
|
| Rate for Payer: Aetna American Axle |
$28.98
|
| Rate for Payer: Aetna American Axle |
$42.12
|
| Rate for Payer: Aetna American Axle |
$26.27
|
| Rate for Payer: Aetna American Axle |
$218.15
|
| Rate for Payer: Aetna Commercial |
$285.28
|
| Rate for Payer: Aetna Commercial |
$37.90
|
| Rate for Payer: Aetna Commercial |
$48.57
|
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: Aetna Commercial |
$34.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.12
|
| Rate for Payer: Cash Price |
$35.67
|
| Rate for Payer: Cash Price |
$32.33
|
| Rate for Payer: Cash Price |
$51.84
|
| Rate for Payer: Cash Price |
$45.71
|
| Rate for Payer: Cash Price |
$268.50
|
| Rate for Payer: Cofinity Advantage |
$234.93
|
| Rate for Payer: Cofinity Advantage |
$45.36
|
| Rate for Payer: Cofinity Advantage |
$28.29
|
| Rate for Payer: Cofinity Advantage |
$40.00
|
| Rate for Payer: Cofinity Advantage |
$31.21
|
| Rate for Payer: Cofinity Commercial |
$55.73
|
| Rate for Payer: Cofinity Commercial |
$288.63
|
| Rate for Payer: Cofinity Commercial |
$34.75
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$49.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.84
|
| Rate for Payer: Healthscope Commercial |
$302.06
|
| Rate for Payer: Healthscope Commercial |
$36.37
|
| Rate for Payer: Healthscope Commercial |
$40.13
|
| Rate for Payer: Healthscope Commercial |
$51.43
|
| Rate for Payer: Healthscope Commercial |
$58.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$234.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.85
|
| Rate for Payer: PHP Commercial |
$37.90
|
| Rate for Payer: PHP Commercial |
$285.28
|
| Rate for Payer: PHP Commercial |
$48.57
|
| Rate for Payer: PHP Commercial |
$55.08
|
| Rate for Payer: PHP Commercial |
$34.35
|
| Rate for Payer: Priority Health SBD |
$36.00
|
| Rate for Payer: Priority Health SBD |
$40.82
|
| Rate for Payer: Priority Health SBD |
$25.46
|
| Rate for Payer: Priority Health SBD |
$211.44
|
| Rate for Payer: Priority Health SBD |
$28.09
|
| Rate for Payer: UMR Bronson Commercial |
$17.78
|
| Rate for Payer: UMR Bronson Commercial |
$28.51
|
| Rate for Payer: UMR Bronson Commercial |
$19.62
|
| Rate for Payer: UMR Bronson Commercial |
$147.67
|
| Rate for Payer: UMR Bronson Commercial |
$25.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.31
|
|
|
LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$40.41
|
|
|
Service Code
|
HCPCS C9254
|
| Hospital Charge Code |
96972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$36.37 |
| Rate for Payer: Aetna American Axle |
$26.27
|
| Rate for Payer: Aetna American Axle |
$37.14
|
| Rate for Payer: Aetna American Axle |
$28.98
|
| Rate for Payer: Aetna American Axle |
$218.15
|
| Rate for Payer: Aetna American Axle |
$42.12
|
| Rate for Payer: Aetna Commercial |
$37.90
|
| Rate for Payer: Aetna Commercial |
$285.28
|
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: Aetna Commercial |
$34.35
|
| Rate for Payer: Aetna Commercial |
$48.57
|
| Rate for Payer: Aetna Medicare |
$167.81
|
| Rate for Payer: Aetna Medicare |
$28.57
|
| Rate for Payer: Aetna Medicare |
$22.30
|
| Rate for Payer: Aetna Medicare |
$20.20
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.15
|
| Rate for Payer: BCBS Complete |
$16.16
|
| Rate for Payer: BCBS Complete |
$17.84
|
| Rate for Payer: BCBS Complete |
$22.86
|
| Rate for Payer: BCBS Complete |
$25.92
|
| Rate for Payer: BCBS Complete |
$134.25
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCN Commercial |
$1.02
|
| Rate for Payer: BCN Commercial |
$1.02
|
| Rate for Payer: BCN Commercial |
$1.02
|
| Rate for Payer: BCN Commercial |
$1.02
|
| Rate for Payer: BCN Commercial |
$1.02
|
| Rate for Payer: Cash Price |
$32.33
|
| Rate for Payer: Cash Price |
$35.67
|
| Rate for Payer: Cash Price |
$268.50
|
| Rate for Payer: Cash Price |
$268.50
|
| Rate for Payer: Cash Price |
$35.67
|
| Rate for Payer: Cash Price |
$32.33
|
| Rate for Payer: Cash Price |
$51.84
|
| Rate for Payer: Cash Price |
$51.84
|
| Rate for Payer: Cash Price |
$45.71
|
| Rate for Payer: Cash Price |
$45.71
|
| Rate for Payer: Cofinity Advantage |
$234.93
|
| Rate for Payer: Cofinity Advantage |
$28.29
|
| Rate for Payer: Cofinity Advantage |
$45.36
|
| Rate for Payer: Cofinity Advantage |
$40.00
|
| Rate for Payer: Cofinity Advantage |
$31.21
|
| Rate for Payer: Cofinity Commercial |
$34.75
|
| Rate for Payer: Cofinity Commercial |
$49.14
|
| Rate for Payer: Cofinity Commercial |
$55.73
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$288.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.67
|
| Rate for Payer: Healthscope Commercial |
$36.37
|
| Rate for Payer: Healthscope Commercial |
$58.32
|
| Rate for Payer: Healthscope Commercial |
$302.06
|
| Rate for Payer: Healthscope Commercial |
$40.13
|
| Rate for Payer: Healthscope Commercial |
$51.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$234.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$268.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.72
|
| Rate for Payer: PHP Commercial |
$55.08
|
| Rate for Payer: PHP Commercial |
$48.57
|
| Rate for Payer: PHP Commercial |
$285.28
|
| Rate for Payer: PHP Commercial |
$37.90
|
| Rate for Payer: PHP Commercial |
$34.35
|
| Rate for Payer: Priority Health SBD |
$211.44
|
| Rate for Payer: Priority Health SBD |
$40.82
|
| Rate for Payer: Priority Health SBD |
$36.00
|
| Rate for Payer: Priority Health SBD |
$25.46
|
| Rate for Payer: Priority Health SBD |
$28.09
|
| Rate for Payer: UMR Bronson Commercial |
$124.18
|
| Rate for Payer: UMR Bronson Commercial |
$16.50
|
| Rate for Payer: UMR Bronson Commercial |
$14.95
|
| Rate for Payer: UMR Bronson Commercial |
$21.14
|
| Rate for Payer: UMR Bronson Commercial |
$23.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.31
|
|
|
LACOSAMIDE 200 MG TABLET
|
Facility
|
OP
|
$4,235.32
|
|
|
Service Code
|
NDC 00131248035
|
| Hospital Charge Code |
96971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,567.07 |
| Max. Negotiated Rate |
$3,811.79 |
| Rate for Payer: Aetna American Axle |
$2,752.96
|
| Rate for Payer: Aetna Commercial |
$3,600.02
|
| Rate for Payer: Aetna Medicare |
$2,117.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,752.96
|
| Rate for Payer: BCBS Complete |
$1,694.13
|
| Rate for Payer: Cash Price |
$3,388.26
|
| Rate for Payer: Cofinity Advantage |
$2,964.72
|
| Rate for Payer: Cofinity Commercial |
$3,642.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,388.26
|
| Rate for Payer: Healthscope Commercial |
$3,811.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,964.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,176.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,388.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,600.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,176.49
|
| Rate for Payer: PHP Commercial |
$3,600.02
|
| Rate for Payer: Priority Health SBD |
$2,668.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,752.96
|
| Rate for Payer: UHC Core |
$2,206.60
|
| Rate for Payer: UHC Exchange |
$1,664.48
|
| Rate for Payer: UMR Bronson Commercial |
$1,567.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,176.49
|
|
|
LACOSAMIDE 200 MG TABLET
|
Facility
|
IP
|
$508.16
|
|
|
Service Code
|
NDC 00904724768
|
| 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 Advantage |
$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 Commercial |
$431.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$381.12
|
| Rate for Payer: PHP Commercial |
$431.94
|
| 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 60687069857
|
| 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 Advantage |
$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 |
$503.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$571.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$503.83
|
| Rate for Payer: PHP Commercial |
$571.01
|
| 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 |
$503.83
|
|
|
LACOSAMIDE 200 MG TABLET
|
Facility
|
IP
|
$11.20
|
|
|
Service Code
|
NDC 60687069811
|
| 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 Advantage |
$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 Commercial |
$9.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.40
|
| Rate for Payer: PHP Commercial |
$9.52
|
| 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 200 MG TABLET
|
Facility
|
OP
|
$11.20
|
|
|
Service Code
|
NDC 60687069811
|
| Hospital Charge Code |
96971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$10.08 |
| Rate for Payer: Aetna American Axle |
$7.28
|
| Rate for Payer: Aetna Commercial |
$9.52
|
| Rate for Payer: Aetna Medicare |
$5.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.28
|
| Rate for Payer: BCBS Complete |
$4.48
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$8.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.40
|
| Rate for Payer: PHP Commercial |
$9.52
|
| Rate for Payer: Priority Health SBD |
$7.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.28
|
| Rate for Payer: UHC Core |
$5.84
|
| Rate for Payer: UHC Exchange |
$4.40
|
| Rate for Payer: UMR Bronson Commercial |
$4.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.40
|
|
|
LACOSAMIDE 200 MG TABLET
|
Facility
|
OP
|
$508.16
|
|
|
Service Code
|
NDC 00904724768
|
| Hospital Charge Code |
96971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.02 |
| Max. Negotiated Rate |
$457.34 |
| Rate for Payer: Aetna American Axle |
$330.30
|
| Rate for Payer: Aetna Commercial |
$431.94
|
| Rate for Payer: Aetna Medicare |
$254.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.30
|
| Rate for Payer: BCBS Complete |
$203.26
|
| Rate for Payer: Cash Price |
$406.53
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$406.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$431.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$381.12
|
| Rate for Payer: PHP Commercial |
$431.94
|
| Rate for Payer: Priority Health SBD |
$320.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.30
|
| Rate for Payer: UHC Core |
$264.75
|
| Rate for Payer: UHC Exchange |
$199.71
|
| Rate for Payer: UMR Bronson Commercial |
$188.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.12
|
|
