|
LEVETIRACETAM 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$311.24
|
|
|
Service Code
|
NDC 50383024116
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.95 |
| Max. Negotiated Rate |
$280.12 |
| Rate for Payer: Aetna American Axle |
$202.31
|
| Rate for Payer: Aetna Commercial |
$264.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.31
|
| Rate for Payer: Cash Price |
$248.99
|
| Rate for Payer: Cofinity Advantage |
$217.87
|
| Rate for Payer: Cofinity Commercial |
$267.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.99
|
| Rate for Payer: Healthscope Commercial |
$280.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.43
|
| Rate for Payer: PHP Commercial |
$264.55
|
| Rate for Payer: Priority Health SBD |
$196.08
|
| Rate for Payer: UMR Bronson Commercial |
$136.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.43
|
|
|
LEVETIRACETAM 100 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$255.66
|
|
|
Service Code
|
NDC 65862025047
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.59 |
| Max. Negotiated Rate |
$230.09 |
| Rate for Payer: Aetna American Axle |
$166.18
|
| Rate for Payer: Aetna Commercial |
$217.31
|
| Rate for Payer: Aetna Medicare |
$127.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.18
|
| Rate for Payer: BCBS Complete |
$102.26
|
| Rate for Payer: Cash Price |
$204.53
|
| Rate for Payer: Cofinity Advantage |
$178.96
|
| Rate for Payer: Cofinity Commercial |
$219.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.53
|
| Rate for Payer: Healthscope Commercial |
$230.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.75
|
| Rate for Payer: PHP Commercial |
$217.31
|
| Rate for Payer: Priority Health SBD |
$161.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.18
|
| Rate for Payer: UHC Core |
$133.20
|
| Rate for Payer: UHC Exchange |
$100.47
|
| Rate for Payer: UMR Bronson Commercial |
$94.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.75
|
|
|
LEVETIRACETAM 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$4,227.49
|
|
|
Service Code
|
NDC 50474000148
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,860.10 |
| Max. Negotiated Rate |
$3,804.74 |
| Rate for Payer: Aetna American Axle |
$2,747.87
|
| Rate for Payer: Aetna Commercial |
$3,593.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,747.87
|
| Rate for Payer: Cash Price |
$3,381.99
|
| Rate for Payer: Cofinity Advantage |
$2,959.24
|
| Rate for Payer: Cofinity Commercial |
$3,635.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,381.99
|
| Rate for Payer: Healthscope Commercial |
$3,804.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,959.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,170.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,593.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,170.62
|
| Rate for Payer: PHP Commercial |
$3,593.37
|
| Rate for Payer: Priority Health SBD |
$2,663.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,860.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,170.62
|
|
|
LEVETIRACETAM 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$655.82
|
|
|
Service Code
|
NDC 31722057447
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$288.56 |
| Max. Negotiated Rate |
$590.24 |
| Rate for Payer: Aetna American Axle |
$426.28
|
| Rate for Payer: Aetna Commercial |
$557.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$426.28
|
| Rate for Payer: Cash Price |
$524.66
|
| Rate for Payer: Cofinity Advantage |
$459.07
|
| Rate for Payer: Cofinity Commercial |
$564.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$524.66
|
| Rate for Payer: Healthscope Commercial |
$590.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$459.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$491.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$557.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$491.87
|
| Rate for Payer: PHP Commercial |
$557.45
|
| Rate for Payer: Priority Health SBD |
$413.17
|
| Rate for Payer: UMR Bronson Commercial |
$288.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$491.87
|
|
|
LEVETIRACETAM 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$422.39
|
|
|
Service Code
|
NDC 00121079916
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.85 |
| Max. Negotiated Rate |
$380.15 |
| Rate for Payer: Aetna American Axle |
$274.55
|
| Rate for Payer: Aetna Commercial |
$359.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.55
|
| Rate for Payer: Cash Price |
$337.91
|
| Rate for Payer: Cofinity Advantage |
$295.67
|
| Rate for Payer: Cofinity Commercial |
$363.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.91
|
| Rate for Payer: Healthscope Commercial |
$380.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.79
|
| Rate for Payer: PHP Commercial |
$359.03
|
| Rate for Payer: Priority Health SBD |
$266.11
|
| Rate for Payer: UMR Bronson Commercial |
$185.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.79
|
|
|
LEVETIRACETAM 100 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$422.39
|
|
|
Service Code
|
NDC 00121079916
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.28 |
| Max. Negotiated Rate |
$380.15 |
| Rate for Payer: Aetna American Axle |
$274.55
|
| Rate for Payer: Aetna Commercial |
$359.03
|
| Rate for Payer: Aetna Medicare |
$211.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.55
|
| Rate for Payer: BCBS Complete |
$168.96
|
| Rate for Payer: Cash Price |
$337.91
|
| Rate for Payer: Cofinity Advantage |
$295.67
|
| Rate for Payer: Cofinity Commercial |
$363.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.91
|
| Rate for Payer: Healthscope Commercial |
$380.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$337.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.79
|
| Rate for Payer: PHP Commercial |
$359.03
|
| Rate for Payer: Priority Health SBD |
$266.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.55
|
| Rate for Payer: UHC Core |
$220.07
|
| Rate for Payer: UHC Exchange |
$166.00
|
| Rate for Payer: UMR Bronson Commercial |
$156.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.79
|
|
|
LEVETIRACETAM 100 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$655.82
|
|
|
Service Code
|
NDC 31722057447
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$242.65 |
| Max. Negotiated Rate |
$590.24 |
| Rate for Payer: Aetna American Axle |
$426.28
|
| Rate for Payer: Aetna Commercial |
$557.45
|
| Rate for Payer: Aetna Medicare |
$327.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$426.28
|
| Rate for Payer: BCBS Complete |
$262.33
|
| Rate for Payer: Cash Price |
$524.66
|
| Rate for Payer: Cofinity Advantage |
$459.07
|
| Rate for Payer: Cofinity Commercial |
$564.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$524.66
|
| Rate for Payer: Healthscope Commercial |
$590.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$459.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$491.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$524.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$557.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$491.87
|
| Rate for Payer: PHP Commercial |
$557.45
|
| Rate for Payer: Priority Health SBD |
$413.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.28
|
| Rate for Payer: UHC Core |
$341.68
|
| Rate for Payer: UHC Exchange |
$257.74
|
| Rate for Payer: UMR Bronson Commercial |
$242.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$491.87
|
|
|
LEVETIRACETAM 100 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$4,227.49
|
|
|
Service Code
|
NDC 50474000148
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,564.17 |
| Max. Negotiated Rate |
$3,804.74 |
| Rate for Payer: Aetna American Axle |
$2,747.87
|
| Rate for Payer: Aetna Commercial |
$3,593.37
|
| Rate for Payer: Aetna Medicare |
$2,113.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,747.87
|
| Rate for Payer: BCBS Complete |
$1,691.00
|
| Rate for Payer: Cash Price |
$3,381.99
|
| Rate for Payer: Cofinity Advantage |
$2,959.24
|
| Rate for Payer: Cofinity Commercial |
$3,635.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,381.99
|
| Rate for Payer: Healthscope Commercial |
$3,804.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,959.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,170.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,381.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,593.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,170.62
|
| Rate for Payer: PHP Commercial |
$3,593.37
|
| Rate for Payer: Priority Health SBD |
$2,663.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,747.87
|
| Rate for Payer: UHC Core |
$2,202.52
|
| Rate for Payer: UHC Exchange |
$1,661.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,564.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,170.62
|
|
|
LEVETIRACETAM 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$255.66
|
|
|
Service Code
|
NDC 65862025047
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.49 |
| Max. Negotiated Rate |
$230.09 |
| Rate for Payer: Aetna American Axle |
$166.18
|
| Rate for Payer: Aetna Commercial |
$217.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.18
|
| Rate for Payer: Cash Price |
$204.53
|
| Rate for Payer: Cofinity Advantage |
$178.96
|
| Rate for Payer: Cofinity Commercial |
$219.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.53
|
| Rate for Payer: Healthscope Commercial |
$230.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.75
|
| Rate for Payer: PHP Commercial |
$217.31
|
| Rate for Payer: Priority Health SBD |
$161.07
|
| Rate for Payer: UMR Bronson Commercial |
$112.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.75
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
IP
|
$3.76
|
|
|
Service Code
|
NDC 68084085911
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna American Axle |
$2.44
|
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.44
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: Cofinity Advantage |
$2.63
|
| Rate for Payer: Cofinity Commercial |
$3.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.01
|
| Rate for Payer: Healthscope Commercial |
$3.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.82
|
| Rate for Payer: PHP Commercial |
$3.20
|
| Rate for Payer: Priority Health SBD |
$2.37
|
| Rate for Payer: UMR Bronson Commercial |
$1.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.82
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
OP
|
$3.76
|
|
|
Service Code
|
NDC 68084085911
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna American Axle |
$2.44
|
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: Aetna Medicare |
$1.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.44
|
| Rate for Payer: BCBS Complete |
$1.50
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: Cofinity Advantage |
$2.63
|
| Rate for Payer: Cofinity Commercial |
$3.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.01
|
| Rate for Payer: Healthscope Commercial |
$3.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.82
|
| Rate for Payer: PHP Commercial |
$3.20
|
| Rate for Payer: Priority Health SBD |
$2.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.44
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.48
|
| Rate for Payer: UMR Bronson Commercial |
$1.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.82
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
IP
|
$258.50
|
|
|
Service Code
|
NDC 63739079510
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.74 |
| Max. Negotiated Rate |
$232.65 |
| Rate for Payer: Aetna American Axle |
$168.03
|
| Rate for Payer: Aetna Commercial |
$219.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.03
|
| Rate for Payer: Cash Price |
$206.80
|
| Rate for Payer: Cofinity Advantage |
$180.95
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.80
|
| Rate for Payer: Healthscope Commercial |
$232.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.88
|
| Rate for Payer: PHP Commercial |
$219.72
|
| Rate for Payer: Priority Health SBD |
$162.85
|
| Rate for Payer: UMR Bronson Commercial |
$113.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.88
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
NDC 68084085901
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.12 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna American Axle |
$244.40
|
| Rate for Payer: Aetna Commercial |
$319.60
|
| Rate for Payer: Aetna Medicare |
$188.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.40
|
| Rate for Payer: BCBS Complete |
$150.40
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Advantage |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.80
|
| Rate for Payer: Healthscope Commercial |
$338.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$300.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.00
|
| Rate for Payer: PHP Commercial |
$319.60
|
| Rate for Payer: Priority Health SBD |
$236.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.40
|
| Rate for Payer: UHC Core |
$195.90
|
| Rate for Payer: UHC Exchange |
$147.77
|
| Rate for Payer: UMR Bronson Commercial |
$139.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.00
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
OP
|
$258.50
|
|
|
Service Code
|
NDC 63739079510
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.64 |
| Max. Negotiated Rate |
$232.65 |
| Rate for Payer: Aetna American Axle |
$168.03
|
| Rate for Payer: Aetna Commercial |
$219.72
|
| Rate for Payer: Aetna Medicare |
$129.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.03
|
| Rate for Payer: BCBS Complete |
$103.40
|
| Rate for Payer: Cash Price |
$206.80
|
| Rate for Payer: Cofinity Advantage |
$180.95
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.80
|
| Rate for Payer: Healthscope Commercial |
$232.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$206.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.88
|
| Rate for Payer: PHP Commercial |
$219.72
|
| Rate for Payer: Priority Health SBD |
$162.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.03
|
| Rate for Payer: UHC Core |
$134.68
|
| Rate for Payer: UHC Exchange |
$101.59
|
| Rate for Payer: UMR Bronson Commercial |
$95.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.88
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
NDC 68084085901
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.44 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna American Axle |
$244.40
|
| Rate for Payer: Aetna Commercial |
$319.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.40
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Advantage |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.80
|
| Rate for Payer: Healthscope Commercial |
$338.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.00
|
| Rate for Payer: PHP Commercial |
$319.60
|
| Rate for Payer: Priority Health SBD |
$236.88
|
| Rate for Payer: UMR Bronson Commercial |
$165.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.00
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
IP
|
$343.10
|
|
|
Service Code
|
NDC 00904712361
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.96 |
| Max. Negotiated Rate |
$308.79 |
| Rate for Payer: Aetna American Axle |
$223.01
|
| Rate for Payer: Aetna Commercial |
$291.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.01
|
| Rate for Payer: Cash Price |
$274.48
|
| Rate for Payer: Cofinity Advantage |
$240.17
|
| Rate for Payer: Cofinity Commercial |
$295.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.48
|
| Rate for Payer: Healthscope Commercial |
$308.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.32
|
| Rate for Payer: PHP Commercial |
$291.63
|
| Rate for Payer: Priority Health SBD |
$216.15
|
| Rate for Payer: UMR Bronson Commercial |
$150.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.32
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
IP
|
$224.20
|
|
|
Service Code
|
NDC 51079082020
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.65 |
| Max. Negotiated Rate |
$201.78 |
| Rate for Payer: Aetna American Axle |
$145.73
|
| Rate for Payer: Aetna Commercial |
$190.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.73
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Cofinity Advantage |
$156.94
|
| Rate for Payer: Cofinity Commercial |
$192.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.36
|
| Rate for Payer: Healthscope Commercial |
$201.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.15
|
| Rate for Payer: PHP Commercial |
$190.57
|
| Rate for Payer: Priority Health SBD |
$141.25
|
| Rate for Payer: UMR Bronson Commercial |
$98.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.15
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
IP
|
$327.12
|
|
|
Service Code
|
NDC 42385095412
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.93 |
| Max. Negotiated Rate |
$294.41 |
| Rate for Payer: Aetna American Axle |
$212.63
|
| Rate for Payer: Aetna Commercial |
$278.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.63
|
| Rate for Payer: Cash Price |
$261.70
|
| Rate for Payer: Cofinity Advantage |
$228.98
|
| Rate for Payer: Cofinity Commercial |
$281.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.70
|
| Rate for Payer: Healthscope Commercial |
$294.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.34
|
| Rate for Payer: PHP Commercial |
$278.05
|
| Rate for Payer: Priority Health SBD |
$206.09
|
| Rate for Payer: UMR Bronson Commercial |
$143.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.34
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
OP
|
$224.20
|
|
|
Service Code
|
NDC 51079082020
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.95 |
| Max. Negotiated Rate |
$201.78 |
| Rate for Payer: Aetna American Axle |
$145.73
|
| Rate for Payer: Aetna Commercial |
$190.57
|
| Rate for Payer: Aetna Medicare |
$112.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.73
|
| Rate for Payer: BCBS Complete |
$89.68
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Cofinity Advantage |
$156.94
|
| Rate for Payer: Cofinity Commercial |
$192.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.36
|
| Rate for Payer: Healthscope Commercial |
$201.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$179.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.15
|
| Rate for Payer: PHP Commercial |
$190.57
|
| Rate for Payer: Priority Health SBD |
$141.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.73
|
| Rate for Payer: UHC Core |
$116.81
|
| Rate for Payer: UHC Exchange |
$88.11
|
| Rate for Payer: UMR Bronson Commercial |
$82.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.15
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
OP
|
$343.10
|
|
|
Service Code
|
NDC 00904712361
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.95 |
| Max. Negotiated Rate |
$308.79 |
| Rate for Payer: Aetna American Axle |
$223.01
|
| Rate for Payer: Aetna Commercial |
$291.63
|
| Rate for Payer: Aetna Medicare |
$171.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.01
|
| Rate for Payer: BCBS Complete |
$137.24
|
| Rate for Payer: Cash Price |
$274.48
|
| Rate for Payer: Cofinity Advantage |
$240.17
|
| Rate for Payer: Cofinity Commercial |
$295.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.48
|
| Rate for Payer: Healthscope Commercial |
$308.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.32
|
| Rate for Payer: PHP Commercial |
$291.63
|
| Rate for Payer: Priority Health SBD |
$216.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.01
|
| Rate for Payer: UHC Core |
$178.76
|
| Rate for Payer: UHC Exchange |
$134.84
|
| Rate for Payer: UMR Bronson Commercial |
$126.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.32
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
OP
|
$327.12
|
|
|
Service Code
|
NDC 42385095412
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.03 |
| Max. Negotiated Rate |
$294.41 |
| Rate for Payer: Aetna American Axle |
$212.63
|
| Rate for Payer: Aetna Commercial |
$278.05
|
| Rate for Payer: Aetna Medicare |
$163.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.63
|
| Rate for Payer: BCBS Complete |
$130.85
|
| Rate for Payer: Cash Price |
$261.70
|
| Rate for Payer: Cofinity Advantage |
$228.98
|
| Rate for Payer: Cofinity Commercial |
$281.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.70
|
| Rate for Payer: Healthscope Commercial |
$294.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$261.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.34
|
| Rate for Payer: PHP Commercial |
$278.05
|
| Rate for Payer: Priority Health SBD |
$206.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.63
|
| Rate for Payer: UHC Core |
$170.43
|
| Rate for Payer: UHC Exchange |
$128.56
|
| Rate for Payer: UMR Bronson Commercial |
$121.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.34
|
|
|
LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15.95
|
|
|
Service Code
|
HCPCS J1953
|
| Hospital Charge Code |
77195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$14.36 |
| Rate for Payer: Aetna American Axle |
$10.37
|
| Rate for Payer: Aetna American Axle |
$11.45
|
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna American Axle |
$12.03
|
| Rate for Payer: Aetna American Axle |
$10.08
|
| Rate for Payer: Aetna American Axle |
$9.33
|
| Rate for Payer: Aetna American Axle |
$16.11
|
| Rate for Payer: Aetna American Axle |
$150.22
|
| Rate for Payer: Aetna American Axle |
$13.10
|
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Commercial |
$13.18
|
| Rate for Payer: Aetna Commercial |
$13.56
|
| Rate for Payer: Aetna Commercial |
$12.21
|
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Commercial |
$16.76
|
| Rate for Payer: Aetna Commercial |
$17.14
|
| Rate for Payer: Aetna Commercial |
$196.44
|
| Rate for Payer: Aetna Commercial |
$21.07
|
| Rate for Payer: Aetna Medicare |
$7.97
|
| Rate for Payer: Aetna Medicare |
$7.75
|
| Rate for Payer: Aetna Medicare |
$10.08
|
| Rate for Payer: Aetna Medicare |
$7.18
|
| Rate for Payer: Aetna Medicare |
$12.39
|
| Rate for Payer: Aetna Medicare |
$9.25
|
| Rate for Payer: Aetna Medicare |
$8.81
|
| Rate for Payer: Aetna Medicare |
$115.56
|
| Rate for Payer: Aetna Medicare |
$9.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.45
|
| Rate for Payer: BCBS Complete |
$6.20
|
| Rate for Payer: BCBS Complete |
$6.38
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: BCBS Complete |
$7.05
|
| Rate for Payer: BCBS Complete |
$8.06
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS Complete |
$92.44
|
| Rate for Payer: BCBS Complete |
$5.74
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cash Price |
$184.89
|
| Rate for Payer: Cash Price |
$11.49
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cash Price |
$12.76
|
| Rate for Payer: Cash Price |
$11.49
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cash Price |
$12.76
|
| Rate for Payer: Cash Price |
$184.89
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Advantage |
$10.86
|
| Rate for Payer: Cofinity Advantage |
$11.16
|
| Rate for Payer: Cofinity Advantage |
$10.05
|
| Rate for Payer: Cofinity Advantage |
$12.33
|
| Rate for Payer: Cofinity Advantage |
$12.95
|
| Rate for Payer: Cofinity Advantage |
$13.80
|
| Rate for Payer: Cofinity Advantage |
$14.11
|
| Rate for Payer: Cofinity Advantage |
$161.78
|
| Rate for Payer: Cofinity Advantage |
$17.35
|
| Rate for Payer: Cofinity Commercial |
$13.34
|
| Rate for Payer: Cofinity Commercial |
$198.75
|
| Rate for Payer: Cofinity Commercial |
$17.34
|
| Rate for Payer: Cofinity Commercial |
$12.35
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Cofinity Commercial |
$13.72
|
| Rate for Payer: Cofinity Commercial |
$21.32
|
| Rate for Payer: Cofinity Commercial |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.76
|
| Rate for Payer: Healthscope Commercial |
$14.36
|
| Rate for Payer: Healthscope Commercial |
$13.96
|
| Rate for Payer: Healthscope Commercial |
$12.92
|
| Rate for Payer: Healthscope Commercial |
$22.31
|
| Rate for Payer: Healthscope Commercial |
$15.86
|
| Rate for Payer: Healthscope Commercial |
$208.00
|
| Rate for Payer: Healthscope Commercial |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$17.75
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.33
|
| Rate for Payer: PHP Commercial |
$13.56
|
| Rate for Payer: PHP Commercial |
$14.98
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: PHP Commercial |
$21.07
|
| Rate for Payer: PHP Commercial |
$16.76
|
| Rate for Payer: PHP Commercial |
$12.21
|
| Rate for Payer: PHP Commercial |
$13.18
|
| Rate for Payer: PHP Commercial |
$17.14
|
| Rate for Payer: PHP Commercial |
$196.44
|
| Rate for Payer: Priority Health SBD |
$11.65
|
| Rate for Payer: Priority Health SBD |
$12.70
|
| Rate for Payer: Priority Health SBD |
$9.77
|
| Rate for Payer: Priority Health SBD |
$10.05
|
| Rate for Payer: Priority Health SBD |
$12.42
|
| Rate for Payer: Priority Health SBD |
$15.62
|
| Rate for Payer: Priority Health SBD |
$9.05
|
| Rate for Payer: Priority Health SBD |
$11.10
|
| Rate for Payer: Priority Health SBD |
$145.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UMR Bronson Commercial |
$7.30
|
| Rate for Payer: UMR Bronson Commercial |
$5.90
|
| Rate for Payer: UMR Bronson Commercial |
$6.84
|
| Rate for Payer: UMR Bronson Commercial |
$7.46
|
| Rate for Payer: UMR Bronson Commercial |
$85.51
|
| Rate for Payer: UMR Bronson Commercial |
$9.17
|
| Rate for Payer: UMR Bronson Commercial |
$5.31
|
| Rate for Payer: UMR Bronson Commercial |
$5.74
|
| Rate for Payer: UMR Bronson Commercial |
$6.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.63
|
|
|
LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.79
|
|
|
Service Code
|
HCPCS J1953
|
| Hospital Charge Code |
77195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$22.31 |
| Rate for Payer: Aetna American Axle |
$16.11
|
| Rate for Payer: Aetna American Axle |
$150.22
|
| Rate for Payer: Aetna American Axle |
$9.33
|
| Rate for Payer: Aetna American Axle |
$13.10
|
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna American Axle |
$12.03
|
| Rate for Payer: Aetna American Axle |
$11.45
|
| Rate for Payer: Aetna American Axle |
$10.37
|
| Rate for Payer: Aetna American Axle |
$10.08
|
| Rate for Payer: Aetna Commercial |
$196.44
|
| Rate for Payer: Aetna Commercial |
$16.76
|
| Rate for Payer: Aetna Commercial |
$17.14
|
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Commercial |
$13.18
|
| Rate for Payer: Aetna Commercial |
$12.21
|
| Rate for Payer: Aetna Commercial |
$21.07
|
| Rate for Payer: Aetna Commercial |
$13.56
|
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.11
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cash Price |
$12.76
|
| Rate for Payer: Cash Price |
$11.49
|
| Rate for Payer: Cash Price |
$184.89
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cofinity Advantage |
$11.16
|
| Rate for Payer: Cofinity Advantage |
$12.33
|
| Rate for Payer: Cofinity Advantage |
$12.95
|
| Rate for Payer: Cofinity Advantage |
$10.86
|
| Rate for Payer: Cofinity Advantage |
$17.35
|
| Rate for Payer: Cofinity Advantage |
$14.11
|
| Rate for Payer: Cofinity Advantage |
$13.80
|
| Rate for Payer: Cofinity Advantage |
$161.78
|
| Rate for Payer: Cofinity Advantage |
$10.05
|
| Rate for Payer: Cofinity Commercial |
$17.34
|
| Rate for Payer: Cofinity Commercial |
$13.34
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$198.75
|
| Rate for Payer: Cofinity Commercial |
$12.35
|
| Rate for Payer: Cofinity Commercial |
$21.32
|
| Rate for Payer: Cofinity Commercial |
$13.72
|
| Rate for Payer: Cofinity Commercial |
$15.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$208.00
|
| Rate for Payer: Healthscope Commercial |
$13.96
|
| Rate for Payer: Healthscope Commercial |
$14.36
|
| Rate for Payer: Healthscope Commercial |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$17.75
|
| Rate for Payer: Healthscope Commercial |
$12.92
|
| Rate for Payer: Healthscope Commercial |
$15.86
|
| Rate for Payer: Healthscope Commercial |
$22.31
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.12
|
| Rate for Payer: PHP Commercial |
$13.18
|
| Rate for Payer: PHP Commercial |
$14.98
|
| Rate for Payer: PHP Commercial |
$196.44
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: PHP Commercial |
$16.76
|
| Rate for Payer: PHP Commercial |
$17.14
|
| Rate for Payer: PHP Commercial |
$21.07
|
| Rate for Payer: PHP Commercial |
$13.56
|
| Rate for Payer: PHP Commercial |
$12.21
|
| Rate for Payer: Priority Health SBD |
$12.42
|
| Rate for Payer: Priority Health SBD |
$11.65
|
| Rate for Payer: Priority Health SBD |
$15.62
|
| Rate for Payer: Priority Health SBD |
$12.70
|
| Rate for Payer: Priority Health SBD |
$9.77
|
| Rate for Payer: Priority Health SBD |
$9.05
|
| Rate for Payer: Priority Health SBD |
$145.60
|
| Rate for Payer: Priority Health SBD |
$10.05
|
| Rate for Payer: Priority Health SBD |
$11.10
|
| Rate for Payer: UMR Bronson Commercial |
$6.32
|
| Rate for Payer: UMR Bronson Commercial |
$7.02
|
| Rate for Payer: UMR Bronson Commercial |
$8.68
|
| Rate for Payer: UMR Bronson Commercial |
$7.75
|
| Rate for Payer: UMR Bronson Commercial |
$8.87
|
| Rate for Payer: UMR Bronson Commercial |
$8.14
|
| Rate for Payer: UMR Bronson Commercial |
$10.91
|
| Rate for Payer: UMR Bronson Commercial |
$6.82
|
| Rate for Payer: UMR Bronson Commercial |
$101.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.59
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
IP
|
$188.94
|
|
|
Service Code
|
NDC 65862024608
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.13 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Aetna American Axle |
$122.81
|
| Rate for Payer: Aetna Commercial |
$160.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.81
|
| Rate for Payer: Cash Price |
$151.15
|
| Rate for Payer: Cofinity Advantage |
$132.26
|
| Rate for Payer: Cofinity Commercial |
$162.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.15
|
| Rate for Payer: Healthscope Commercial |
$170.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.71
|
| Rate for Payer: PHP Commercial |
$160.60
|
| Rate for Payer: Priority Health SBD |
$119.03
|
| Rate for Payer: UMR Bronson Commercial |
$83.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.71
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
IP
|
$241.30
|
|
|
Service Code
|
NDC 51079082120
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.17 |
| Max. Negotiated Rate |
$217.17 |
| Rate for Payer: Aetna American Axle |
$156.84
|
| Rate for Payer: Aetna Commercial |
$205.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.84
|
| Rate for Payer: Cash Price |
$193.04
|
| Rate for Payer: Cofinity Advantage |
$168.91
|
| Rate for Payer: Cofinity Commercial |
$207.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.04
|
| Rate for Payer: Healthscope Commercial |
$217.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.97
|
| Rate for Payer: PHP Commercial |
$205.10
|
| Rate for Payer: Priority Health SBD |
$152.02
|
| Rate for Payer: UMR Bronson Commercial |
$106.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.97
|
|
