|
LAMIVUDINE 150 MG TABLET
|
Facility
|
IP
|
$774.34
|
|
|
Service Code
|
NDC 60505325106
|
| Hospital Charge Code |
15880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$340.71 |
| Max. Negotiated Rate |
$696.91 |
| Rate for Payer: Aetna American Axle |
$503.32
|
| Rate for Payer: Aetna Commercial |
$658.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.32
|
| Rate for Payer: Cash Price |
$619.47
|
| Rate for Payer: Cofinity Advantage |
$542.04
|
| Rate for Payer: Cofinity Commercial |
$665.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$619.47
|
| Rate for Payer: Healthscope Commercial |
$696.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$542.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$580.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$658.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$580.75
|
| Rate for Payer: PHP Commercial |
$658.19
|
| Rate for Payer: Priority Health SBD |
$487.83
|
| Rate for Payer: UMR Bronson Commercial |
$340.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$580.75
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$361.90
|
|
|
Service Code
|
NDC 68084031901
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna American Axle |
$235.24
|
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna Medicare |
$180.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.24
|
| Rate for Payer: BCBS Complete |
$144.76
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Advantage |
$253.33
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$289.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.43
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health SBD |
$228.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.24
|
| Rate for Payer: UHC Core |
$188.55
|
| Rate for Payer: UHC Exchange |
$142.23
|
| Rate for Payer: UMR Bronson Commercial |
$133.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.43
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$152.75
|
|
|
Service Code
|
NDC 51672413101
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.21 |
| Max. Negotiated Rate |
$137.47 |
| Rate for Payer: Aetna American Axle |
$99.29
|
| Rate for Payer: Aetna Commercial |
$129.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.29
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cofinity Advantage |
$106.92
|
| Rate for Payer: Cofinity Commercial |
$131.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.20
|
| Rate for Payer: Healthscope Commercial |
$137.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.56
|
| Rate for Payer: PHP Commercial |
$129.84
|
| Rate for Payer: Priority Health SBD |
$96.23
|
| Rate for Payer: UMR Bronson Commercial |
$67.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.56
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$361.90
|
|
|
Service Code
|
NDC 68084031911
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.24 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna American Axle |
$235.24
|
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.24
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Advantage |
$253.33
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.43
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health SBD |
$228.00
|
| Rate for Payer: UMR Bronson Commercial |
$159.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.43
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$2.47
|
|
|
Service Code
|
NDC 51079049901
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna American Axle |
$1.61
|
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna Medicare |
$1.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.61
|
| Rate for Payer: BCBS Complete |
$0.99
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Advantage |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.85
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: Priority Health SBD |
$1.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.61
|
| Rate for Payer: UHC Core |
$1.29
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UMR Bronson Commercial |
$0.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.85
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$152.75
|
|
|
Service Code
|
NDC 51672413101
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.52 |
| Max. Negotiated Rate |
$137.47 |
| Rate for Payer: Aetna American Axle |
$99.29
|
| Rate for Payer: Aetna Commercial |
$129.84
|
| Rate for Payer: Aetna Medicare |
$76.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.29
|
| Rate for Payer: BCBS Complete |
$61.10
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cofinity Advantage |
$106.92
|
| Rate for Payer: Cofinity Commercial |
$131.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.20
|
| Rate for Payer: Healthscope Commercial |
$137.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.56
|
| Rate for Payer: PHP Commercial |
$129.84
|
| Rate for Payer: Priority Health SBD |
$96.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.29
|
| Rate for Payer: UHC Core |
$79.58
|
| Rate for Payer: UHC Exchange |
$60.03
|
| Rate for Payer: UMR Bronson Commercial |
$56.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.56
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$204.25
|
|
|
Service Code
|
NDC 68382000801
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.87 |
| Max. Negotiated Rate |
$183.82 |
| Rate for Payer: Aetna American Axle |
$132.76
|
| Rate for Payer: Aetna Commercial |
$173.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.76
|
| Rate for Payer: Cash Price |
$163.40
|
| Rate for Payer: Cofinity Advantage |
$142.97
|
| Rate for Payer: Cofinity Commercial |
$175.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.40
|
| Rate for Payer: Healthscope Commercial |
$183.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.19
|
| Rate for Payer: PHP Commercial |
$173.61
|
| Rate for Payer: Priority Health SBD |
$128.68
|
| Rate for Payer: UMR Bronson Commercial |
$89.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.19
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$277.30
|
|
|
Service Code
|
NDC 00904700861
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.60 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna American Axle |
$180.25
|
| Rate for Payer: Aetna Commercial |
$235.71
|
| Rate for Payer: Aetna Medicare |
$138.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.25
|
| Rate for Payer: BCBS Complete |
$110.92
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Advantage |
$194.11
|
| Rate for Payer: Cofinity Commercial |
$238.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$249.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.97
|
| Rate for Payer: PHP Commercial |
$235.71
|
| Rate for Payer: Priority Health SBD |
$174.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.25
|
| Rate for Payer: UHC Core |
$144.47
|
| Rate for Payer: UHC Exchange |
$108.98
|
| Rate for Payer: UMR Bronson Commercial |
$102.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.97
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$361.90
|
|
|
Service Code
|
NDC 68084031911
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna American Axle |
$235.24
|
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna Medicare |
$180.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.24
|
| Rate for Payer: BCBS Complete |
$144.76
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Advantage |
$253.33
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$289.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.43
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health SBD |
$228.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.24
|
| Rate for Payer: UHC Core |
$188.55
|
| Rate for Payer: UHC Exchange |
$142.23
|
| Rate for Payer: UMR Bronson Commercial |
$133.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.43
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$246.75
|
|
|
Service Code
|
NDC 51079049920
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.30 |
| Max. Negotiated Rate |
$222.07 |
| Rate for Payer: Aetna American Axle |
$160.39
|
| Rate for Payer: Aetna Commercial |
$209.74
|
| Rate for Payer: Aetna Medicare |
$123.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.39
|
| Rate for Payer: BCBS Complete |
$98.70
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Advantage |
$172.72
|
| Rate for Payer: Cofinity Commercial |
$212.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$222.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.06
|
| Rate for Payer: PHP Commercial |
$209.74
|
| Rate for Payer: Priority Health SBD |
$155.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.39
|
| Rate for Payer: UHC Core |
$128.56
|
| Rate for Payer: UHC Exchange |
$96.97
|
| Rate for Payer: UMR Bronson Commercial |
$91.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.06
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$246.75
|
|
|
Service Code
|
NDC 51079049920
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.57 |
| Max. Negotiated Rate |
$222.07 |
| Rate for Payer: Aetna American Axle |
$160.39
|
| Rate for Payer: Aetna Commercial |
$209.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.39
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Advantage |
$172.72
|
| Rate for Payer: Cofinity Commercial |
$212.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$222.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.06
|
| Rate for Payer: PHP Commercial |
$209.74
|
| Rate for Payer: Priority Health SBD |
$155.45
|
| Rate for Payer: UMR Bronson Commercial |
$108.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.06
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$204.25
|
|
|
Service Code
|
NDC 68382000801
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.57 |
| Max. Negotiated Rate |
$183.82 |
| Rate for Payer: Aetna American Axle |
$132.76
|
| Rate for Payer: Aetna Commercial |
$173.61
|
| Rate for Payer: Aetna Medicare |
$102.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.76
|
| Rate for Payer: BCBS Complete |
$81.70
|
| Rate for Payer: Cash Price |
$163.40
|
| Rate for Payer: Cofinity Advantage |
$142.97
|
| Rate for Payer: Cofinity Commercial |
$175.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.40
|
| Rate for Payer: Healthscope Commercial |
$183.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.19
|
| Rate for Payer: PHP Commercial |
$173.61
|
| Rate for Payer: Priority Health SBD |
$128.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.76
|
| Rate for Payer: UHC Core |
$106.41
|
| Rate for Payer: UHC Exchange |
$80.27
|
| Rate for Payer: UMR Bronson Commercial |
$75.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.19
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$361.90
|
|
|
Service Code
|
NDC 68084031901
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.24 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna American Axle |
$235.24
|
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.24
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Advantage |
$253.33
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.43
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health SBD |
$228.00
|
| Rate for Payer: UMR Bronson Commercial |
$159.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.43
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$277.30
|
|
|
Service Code
|
NDC 00904700861
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.01 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna American Axle |
$180.25
|
| Rate for Payer: Aetna Commercial |
$235.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.25
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Advantage |
$194.11
|
| Rate for Payer: Cofinity Commercial |
$238.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$249.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.97
|
| Rate for Payer: PHP Commercial |
$235.71
|
| Rate for Payer: Priority Health SBD |
$174.70
|
| Rate for Payer: UMR Bronson Commercial |
$122.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.97
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$2.47
|
|
|
Service Code
|
NDC 51079049901
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna American Axle |
$1.61
|
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.61
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Advantage |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.85
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: Priority Health SBD |
$1.56
|
| Rate for Payer: UMR Bronson Commercial |
$1.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.85
|
|
|
LAMOTRIGINE 150 MG TABLET
|
Facility
|
IP
|
$3.92
|
|
|
Service Code
|
NDC 60687069311
|
| Hospital Charge Code |
14266
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$3.53 |
| Rate for Payer: Aetna American Axle |
$2.55
|
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.55
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cofinity Advantage |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$3.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.14
|
| Rate for Payer: Healthscope Commercial |
$3.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.94
|
| Rate for Payer: PHP Commercial |
$3.33
|
| Rate for Payer: Priority Health SBD |
$2.47
|
| Rate for Payer: UMR Bronson Commercial |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.94
|
|
|
LAMOTRIGINE 150 MG TABLET
|
Facility
|
IP
|
$86.01
|
|
|
Service Code
|
NDC 59746024760
|
| Hospital Charge Code |
14266
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.84 |
| Max. Negotiated Rate |
$77.41 |
| Rate for Payer: Aetna American Axle |
$55.91
|
| Rate for Payer: Aetna Commercial |
$73.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.91
|
| Rate for Payer: Cash Price |
$68.81
|
| Rate for Payer: Cofinity Advantage |
$60.21
|
| Rate for Payer: Cofinity Commercial |
$73.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.81
|
| Rate for Payer: Healthscope Commercial |
$77.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.51
|
| Rate for Payer: PHP Commercial |
$73.11
|
| Rate for Payer: Priority Health SBD |
$54.19
|
| Rate for Payer: UMR Bronson Commercial |
$37.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.51
|
|
|
LAMOTRIGINE 150 MG TABLET
|
Facility
|
OP
|
$391.40
|
|
|
Service Code
|
NDC 60687069301
|
| Hospital Charge Code |
14266
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.82 |
| Max. Negotiated Rate |
$352.26 |
| Rate for Payer: Aetna American Axle |
$254.41
|
| Rate for Payer: Aetna Commercial |
$332.69
|
| Rate for Payer: Aetna Medicare |
$195.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.41
|
| Rate for Payer: BCBS Complete |
$156.56
|
| Rate for Payer: Cash Price |
$313.12
|
| Rate for Payer: Cofinity Advantage |
$273.98
|
| Rate for Payer: Cofinity Commercial |
$336.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.12
|
| Rate for Payer: Healthscope Commercial |
$352.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$273.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$293.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$313.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$293.55
|
| Rate for Payer: PHP Commercial |
$332.69
|
| Rate for Payer: Priority Health SBD |
$246.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.41
|
| Rate for Payer: UHC Core |
$203.92
|
| Rate for Payer: UHC Exchange |
$153.82
|
| Rate for Payer: UMR Bronson Commercial |
$144.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$293.55
|
|
|
LAMOTRIGINE 150 MG TABLET
|
Facility
|
IP
|
$134.52
|
|
|
Service Code
|
NDC 68382000914
|
| Hospital Charge Code |
14266
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.19 |
| Max. Negotiated Rate |
$121.07 |
| Rate for Payer: Aetna American Axle |
$87.44
|
| Rate for Payer: Aetna Commercial |
$114.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.44
|
| Rate for Payer: Cash Price |
$107.62
|
| Rate for Payer: Cofinity Advantage |
$94.16
|
| Rate for Payer: Cofinity Commercial |
$115.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.62
|
| Rate for Payer: Healthscope Commercial |
$121.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.89
|
| Rate for Payer: PHP Commercial |
$114.34
|
| Rate for Payer: Priority Health SBD |
$84.75
|
| Rate for Payer: UMR Bronson Commercial |
$59.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.89
|
|
|
LAMOTRIGINE 150 MG TABLET
|
Facility
|
OP
|
$134.52
|
|
|
Service Code
|
NDC 68382000914
|
| Hospital Charge Code |
14266
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.77 |
| Max. Negotiated Rate |
$121.07 |
| Rate for Payer: Aetna American Axle |
$87.44
|
| Rate for Payer: Aetna Commercial |
$114.34
|
| Rate for Payer: Aetna Medicare |
$67.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.44
|
| Rate for Payer: BCBS Complete |
$53.81
|
| Rate for Payer: Cash Price |
$107.62
|
| Rate for Payer: Cofinity Advantage |
$94.16
|
| Rate for Payer: Cofinity Commercial |
$115.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.62
|
| Rate for Payer: Healthscope Commercial |
$121.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.89
|
| Rate for Payer: PHP Commercial |
$114.34
|
| Rate for Payer: Priority Health SBD |
$84.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.44
|
| Rate for Payer: UHC Core |
$70.08
|
| Rate for Payer: UHC Exchange |
$52.87
|
| Rate for Payer: UMR Bronson Commercial |
$49.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.89
|
|
|
LAMOTRIGINE 150 MG TABLET
|
Facility
|
IP
|
$391.40
|
|
|
Service Code
|
NDC 60687069301
|
| Hospital Charge Code |
14266
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.22 |
| Max. Negotiated Rate |
$352.26 |
| Rate for Payer: Aetna American Axle |
$254.41
|
| Rate for Payer: Aetna Commercial |
$332.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.41
|
| Rate for Payer: Cash Price |
$313.12
|
| Rate for Payer: Cofinity Advantage |
$273.98
|
| Rate for Payer: Cofinity Commercial |
$336.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.12
|
| Rate for Payer: Healthscope Commercial |
$352.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$273.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$293.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$293.55
|
| Rate for Payer: PHP Commercial |
$332.69
|
| Rate for Payer: Priority Health SBD |
$246.58
|
| Rate for Payer: UMR Bronson Commercial |
$172.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$293.55
|
|
|
LAMOTRIGINE 150 MG TABLET
|
Facility
|
OP
|
$3.92
|
|
|
Service Code
|
NDC 60687069311
|
| Hospital Charge Code |
14266
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$3.53 |
| Rate for Payer: Aetna American Axle |
$2.55
|
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Aetna Medicare |
$1.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.55
|
| Rate for Payer: BCBS Complete |
$1.57
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cofinity Advantage |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$3.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.14
|
| Rate for Payer: Healthscope Commercial |
$3.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.94
|
| Rate for Payer: PHP Commercial |
$3.33
|
| Rate for Payer: Priority Health SBD |
$2.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.55
|
| Rate for Payer: UHC Core |
$2.04
|
| Rate for Payer: UHC Exchange |
$1.54
|
| Rate for Payer: UMR Bronson Commercial |
$1.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.94
|
|
|
LAMOTRIGINE 150 MG TABLET
|
Facility
|
OP
|
$101.52
|
|
|
Service Code
|
NDC 65862022960
|
| Hospital Charge Code |
14266
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.56 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna American Axle |
$65.99
|
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna Medicare |
$50.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: BCBS Complete |
$40.61
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Advantage |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.14
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health SBD |
$63.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.99
|
| Rate for Payer: UHC Core |
$52.89
|
| Rate for Payer: UHC Exchange |
$39.90
|
| Rate for Payer: UMR Bronson Commercial |
$37.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.14
|
|
|
LAMOTRIGINE 150 MG TABLET
|
Facility
|
OP
|
$115.62
|
|
|
Service Code
|
NDC 51672413204
|
| Hospital Charge Code |
14266
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.78 |
| Max. Negotiated Rate |
$104.06 |
| Rate for Payer: Aetna American Axle |
$75.15
|
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Medicare |
$57.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.15
|
| Rate for Payer: BCBS Complete |
$46.25
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cofinity Advantage |
$80.93
|
| Rate for Payer: Cofinity Commercial |
$99.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.50
|
| Rate for Payer: Healthscope Commercial |
$104.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.72
|
| Rate for Payer: PHP Commercial |
$98.28
|
| Rate for Payer: Priority Health SBD |
$72.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.15
|
| Rate for Payer: UHC Core |
$60.24
|
| Rate for Payer: UHC Exchange |
$45.44
|
| Rate for Payer: UMR Bronson Commercial |
$42.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.72
|
|
|
LAMOTRIGINE 150 MG TABLET
|
Facility
|
IP
|
$115.62
|
|
|
Service Code
|
NDC 51672413204
|
| Hospital Charge Code |
14266
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.87 |
| Max. Negotiated Rate |
$104.06 |
| Rate for Payer: Aetna American Axle |
$75.15
|
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.15
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cofinity Advantage |
$80.93
|
| Rate for Payer: Cofinity Commercial |
$99.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.50
|
| Rate for Payer: Healthscope Commercial |
$104.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.72
|
| Rate for Payer: PHP Commercial |
$98.28
|
| Rate for Payer: Priority Health SBD |
$72.84
|
| Rate for Payer: UMR Bronson Commercial |
$50.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.72
|
|
