|
LEVOCARNITINE 100 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$448.40
|
|
|
Service Code
|
NDC 54482014801
|
| Hospital Charge Code |
108122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.91 |
| Max. Negotiated Rate |
$403.56 |
| Rate for Payer: Aetna American Axle |
$291.46
|
| Rate for Payer: Aetna Commercial |
$381.14
|
| Rate for Payer: Aetna Medicare |
$224.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.46
|
| Rate for Payer: BCBS Complete |
$179.36
|
| Rate for Payer: Cash Price |
$358.72
|
| Rate for Payer: Cofinity Advantage |
$313.88
|
| Rate for Payer: Cofinity Commercial |
$385.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.72
|
| Rate for Payer: Healthscope Commercial |
$403.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$358.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$336.30
|
| Rate for Payer: PHP Commercial |
$381.14
|
| Rate for Payer: Priority Health SBD |
$282.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.46
|
| Rate for Payer: UHC Core |
$233.62
|
| Rate for Payer: UHC Exchange |
$176.22
|
| Rate for Payer: UMR Bronson Commercial |
$165.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.30
|
|
|
LEVOCARNITINE 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$244.38
|
|
|
Service Code
|
NDC 70954014010
|
| Hospital Charge Code |
108122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.53 |
| Max. Negotiated Rate |
$219.94 |
| Rate for Payer: Aetna American Axle |
$158.85
|
| Rate for Payer: Aetna Commercial |
$207.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.85
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cofinity Advantage |
$171.07
|
| Rate for Payer: Cofinity Commercial |
$210.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.50
|
| Rate for Payer: Healthscope Commercial |
$219.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.28
|
| Rate for Payer: PHP Commercial |
$207.72
|
| Rate for Payer: Priority Health SBD |
$153.96
|
| Rate for Payer: UMR Bronson Commercial |
$107.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.28
|
|
|
LEVOCARNITINE 100 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$244.38
|
|
|
Service Code
|
NDC 70954014010
|
| Hospital Charge Code |
108122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.42 |
| Max. Negotiated Rate |
$219.94 |
| Rate for Payer: Aetna American Axle |
$158.85
|
| Rate for Payer: Aetna Commercial |
$207.72
|
| Rate for Payer: Aetna Medicare |
$122.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.85
|
| Rate for Payer: BCBS Complete |
$97.75
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cofinity Advantage |
$171.07
|
| Rate for Payer: Cofinity Commercial |
$210.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.50
|
| Rate for Payer: Healthscope Commercial |
$219.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.28
|
| Rate for Payer: PHP Commercial |
$207.72
|
| Rate for Payer: Priority Health SBD |
$153.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.85
|
| Rate for Payer: UHC Core |
$127.32
|
| Rate for Payer: UHC Exchange |
$96.04
|
| Rate for Payer: UMR Bronson Commercial |
$90.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.28
|
|
|
LEVOCARNITINE 200 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$100.15
|
|
|
Service Code
|
HCPCS J1955
|
| Hospital Charge Code |
20954
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$90.14 |
| Rate for Payer: Aetna American Axle |
$65.10
|
| Rate for Payer: Aetna American Axle |
$74.03
|
| Rate for Payer: Aetna American Axle |
$60.50
|
| Rate for Payer: Aetna American Axle |
$233.47
|
| Rate for Payer: Aetna Commercial |
$79.12
|
| Rate for Payer: Aetna Commercial |
$96.81
|
| Rate for Payer: Aetna Commercial |
$85.13
|
| Rate for Payer: Aetna Commercial |
$305.31
|
| Rate for Payer: Aetna Medicare |
$46.54
|
| Rate for Payer: Aetna Medicare |
$179.59
|
| Rate for Payer: Aetna Medicare |
$56.95
|
| Rate for Payer: Aetna Medicare |
$50.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.10
|
| Rate for Payer: BCBS Complete |
$45.56
|
| Rate for Payer: BCBS Complete |
$40.06
|
| Rate for Payer: BCBS Complete |
$143.68
|
| Rate for Payer: BCBS Complete |
$37.23
|
| Rate for Payer: BCBS Trust/PPO |
$75.43
|
| Rate for Payer: BCBS Trust/PPO |
$75.43
|
| Rate for Payer: BCBS Trust/PPO |
$75.43
|
| Rate for Payer: BCBS Trust/PPO |
$75.43
|
| Rate for Payer: BCN Commercial |
$75.43
|
| Rate for Payer: BCN Commercial |
$75.43
|
| Rate for Payer: BCN Commercial |
$75.43
|
| Rate for Payer: BCN Commercial |
$75.43
|
| Rate for Payer: Cash Price |
$74.46
|
| Rate for Payer: Cash Price |
$287.35
|
| Rate for Payer: Cash Price |
$80.12
|
| Rate for Payer: Cash Price |
$80.12
|
| Rate for Payer: Cash Price |
$91.12
|
| Rate for Payer: Cash Price |
$91.12
|
| Rate for Payer: Cash Price |
$287.35
|
| Rate for Payer: Cash Price |
$74.46
|
| Rate for Payer: Cofinity Advantage |
$65.16
|
| Rate for Payer: Cofinity Advantage |
$70.11
|
| Rate for Payer: Cofinity Advantage |
$79.73
|
| Rate for Payer: Cofinity Advantage |
$251.43
|
| Rate for Payer: Cofinity Commercial |
$308.90
|
| Rate for Payer: Cofinity Commercial |
$80.05
|
| Rate for Payer: Cofinity Commercial |
$97.95
|
| Rate for Payer: Cofinity Commercial |
$86.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.35
|
| Rate for Payer: Healthscope Commercial |
$90.14
|
| Rate for Payer: Healthscope Commercial |
$102.51
|
| Rate for Payer: Healthscope Commercial |
$83.77
|
| Rate for Payer: Healthscope Commercial |
$323.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$287.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.39
|
| Rate for Payer: PHP Commercial |
$79.12
|
| Rate for Payer: PHP Commercial |
$305.31
|
| Rate for Payer: PHP Commercial |
$85.13
|
| Rate for Payer: PHP Commercial |
$96.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23.27
|
| Rate for Payer: Priority Health SBD |
$71.76
|
| Rate for Payer: Priority Health SBD |
$58.64
|
| Rate for Payer: Priority Health SBD |
$226.29
|
| Rate for Payer: Priority Health SBD |
$63.09
|
| Rate for Payer: Priority Health Tiered Network |
$18.62
|
| Rate for Payer: Priority Health Tiered Network |
$18.62
|
| Rate for Payer: Priority Health Tiered Network |
$18.62
|
| Rate for Payer: Priority Health Tiered Network |
$18.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.40
|
| Rate for Payer: UHC Core |
$38.40
|
| Rate for Payer: UHC Core |
$38.40
|
| Rate for Payer: UHC Core |
$38.40
|
| Rate for Payer: UHC Core |
$38.40
|
| Rate for Payer: UHC Exchange |
$38.40
|
| Rate for Payer: UHC Exchange |
$38.40
|
| Rate for Payer: UHC Exchange |
$38.40
|
| Rate for Payer: UHC Exchange |
$38.40
|
| Rate for Payer: UMR Bronson Commercial |
$34.44
|
| Rate for Payer: UMR Bronson Commercial |
$132.90
|
| Rate for Payer: UMR Bronson Commercial |
$37.06
|
| Rate for Payer: UMR Bronson Commercial |
$42.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.39
|
|
|
LEVOCARNITINE 200 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$359.19
|
|
|
Service Code
|
HCPCS J1955
|
| Hospital Charge Code |
20954
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$158.04 |
| Max. Negotiated Rate |
$323.27 |
| Rate for Payer: Aetna American Axle |
$233.47
|
| Rate for Payer: Aetna American Axle |
$74.03
|
| Rate for Payer: Aetna American Axle |
$60.50
|
| Rate for Payer: Aetna American Axle |
$65.10
|
| Rate for Payer: Aetna Commercial |
$79.12
|
| Rate for Payer: Aetna Commercial |
$305.31
|
| Rate for Payer: Aetna Commercial |
$85.13
|
| Rate for Payer: Aetna Commercial |
$96.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.10
|
| Rate for Payer: Cash Price |
$80.12
|
| Rate for Payer: Cash Price |
$74.46
|
| Rate for Payer: Cash Price |
$91.12
|
| Rate for Payer: Cash Price |
$287.35
|
| Rate for Payer: Cofinity Advantage |
$79.73
|
| Rate for Payer: Cofinity Advantage |
$70.11
|
| Rate for Payer: Cofinity Advantage |
$251.43
|
| Rate for Payer: Cofinity Advantage |
$65.16
|
| Rate for Payer: Cofinity Commercial |
$308.90
|
| Rate for Payer: Cofinity Commercial |
$86.13
|
| Rate for Payer: Cofinity Commercial |
$97.95
|
| Rate for Payer: Cofinity Commercial |
$80.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.12
|
| Rate for Payer: Healthscope Commercial |
$102.51
|
| Rate for Payer: Healthscope Commercial |
$83.77
|
| Rate for Payer: Healthscope Commercial |
$323.27
|
| Rate for Payer: Healthscope Commercial |
$90.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.11
|
| Rate for Payer: PHP Commercial |
$85.13
|
| Rate for Payer: PHP Commercial |
$305.31
|
| Rate for Payer: PHP Commercial |
$96.81
|
| Rate for Payer: PHP Commercial |
$79.12
|
| Rate for Payer: Priority Health SBD |
$58.64
|
| Rate for Payer: Priority Health SBD |
$63.09
|
| Rate for Payer: Priority Health SBD |
$226.29
|
| Rate for Payer: Priority Health SBD |
$71.76
|
| Rate for Payer: UMR Bronson Commercial |
$50.12
|
| Rate for Payer: UMR Bronson Commercial |
$158.04
|
| Rate for Payer: UMR Bronson Commercial |
$44.07
|
| Rate for Payer: UMR Bronson Commercial |
$40.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.81
|
|
|
LEVOCARNITINE 330 MG TABLET
|
Facility
|
OP
|
$3.50
|
|
|
Service Code
|
NDC 09900000879
|
| Hospital Charge Code |
20952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Aetna American Axle |
$2.27
|
| Rate for Payer: Aetna Commercial |
$2.98
|
| Rate for Payer: Aetna Medicare |
$1.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.27
|
| Rate for Payer: BCBS Complete |
$1.40
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Cofinity Advantage |
$2.45
|
| Rate for Payer: Cofinity Commercial |
$3.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.80
|
| Rate for Payer: Healthscope Commercial |
$3.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.62
|
| Rate for Payer: PHP Commercial |
$2.98
|
| Rate for Payer: Priority Health SBD |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.27
|
| Rate for Payer: UHC Core |
$1.82
|
| Rate for Payer: UHC Exchange |
$1.38
|
| Rate for Payer: UMR Bronson Commercial |
$1.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.62
|
|
|
LEVOCARNITINE 330 MG TABLET
|
Facility
|
IP
|
$341.72
|
|
|
Service Code
|
NDC 70954049210
|
| Hospital Charge Code |
20952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.36 |
| Max. Negotiated Rate |
$307.55 |
| Rate for Payer: Aetna American Axle |
$222.12
|
| Rate for Payer: Aetna Commercial |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.12
|
| Rate for Payer: Cash Price |
$273.38
|
| Rate for Payer: Cofinity Advantage |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$293.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.38
|
| Rate for Payer: Healthscope Commercial |
$307.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$256.29
|
| Rate for Payer: PHP Commercial |
$290.46
|
| Rate for Payer: Priority Health SBD |
$215.28
|
| Rate for Payer: UMR Bronson Commercial |
$150.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.29
|
|
|
LEVOCARNITINE 330 MG TABLET
|
Facility
|
OP
|
$341.72
|
|
|
Service Code
|
NDC 70954049210
|
| Hospital Charge Code |
20952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.44 |
| Max. Negotiated Rate |
$307.55 |
| Rate for Payer: Aetna American Axle |
$222.12
|
| Rate for Payer: Aetna Commercial |
$290.46
|
| Rate for Payer: Aetna Medicare |
$170.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.12
|
| Rate for Payer: BCBS Complete |
$136.69
|
| Rate for Payer: Cash Price |
$273.38
|
| Rate for Payer: Cofinity Advantage |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$293.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.38
|
| Rate for Payer: Healthscope Commercial |
$307.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$256.29
|
| Rate for Payer: PHP Commercial |
$290.46
|
| Rate for Payer: Priority Health SBD |
$215.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.12
|
| Rate for Payer: UHC Core |
$178.04
|
| Rate for Payer: UHC Exchange |
$134.30
|
| Rate for Payer: UMR Bronson Commercial |
$126.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.29
|
|
|
LEVOCARNITINE 330 MG TABLET
|
Facility
|
IP
|
$517.54
|
|
|
Service Code
|
NDC 54482014407
|
| Hospital Charge Code |
20952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$227.72 |
| Max. Negotiated Rate |
$465.79 |
| Rate for Payer: Aetna American Axle |
$336.40
|
| Rate for Payer: Aetna Commercial |
$439.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.40
|
| Rate for Payer: Cash Price |
$414.03
|
| Rate for Payer: Cofinity Advantage |
$362.28
|
| Rate for Payer: Cofinity Commercial |
$445.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.03
|
| Rate for Payer: Healthscope Commercial |
$465.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$362.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$388.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.15
|
| Rate for Payer: PHP Commercial |
$439.91
|
| Rate for Payer: Priority Health SBD |
$326.05
|
| Rate for Payer: UMR Bronson Commercial |
$227.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$388.15
|
|
|
LEVOCARNITINE 330 MG TABLET
|
Facility
|
OP
|
$342.58
|
|
|
Service Code
|
NDC 50383017290
|
| Hospital Charge Code |
20952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$308.32 |
| Rate for Payer: Aetna American Axle |
$222.68
|
| Rate for Payer: Aetna Commercial |
$291.19
|
| Rate for Payer: Aetna Medicare |
$171.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.68
|
| Rate for Payer: BCBS Complete |
$137.03
|
| Rate for Payer: Cash Price |
$274.06
|
| Rate for Payer: Cofinity Advantage |
$239.81
|
| Rate for Payer: Cofinity Commercial |
$294.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.06
|
| Rate for Payer: Healthscope Commercial |
$308.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$256.94
|
| Rate for Payer: PHP Commercial |
$291.19
|
| Rate for Payer: Priority Health SBD |
$215.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.68
|
| Rate for Payer: UHC Core |
$178.48
|
| Rate for Payer: UHC Exchange |
$134.63
|
| Rate for Payer: UMR Bronson Commercial |
$126.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.94
|
|
|
LEVOCARNITINE 330 MG TABLET
|
Facility
|
IP
|
$3.50
|
|
|
Service Code
|
NDC 09900000879
|
| Hospital Charge Code |
20952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Aetna American Axle |
$2.27
|
| Rate for Payer: Aetna Commercial |
$2.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.27
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Cofinity Advantage |
$2.45
|
| Rate for Payer: Cofinity Commercial |
$3.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.80
|
| Rate for Payer: Healthscope Commercial |
$3.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.62
|
| Rate for Payer: PHP Commercial |
$2.98
|
| Rate for Payer: Priority Health SBD |
$2.21
|
| Rate for Payer: UMR Bronson Commercial |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.62
|
|
|
LEVOCARNITINE 330 MG TABLET
|
Facility
|
OP
|
$517.54
|
|
|
Service Code
|
NDC 54482014407
|
| Hospital Charge Code |
20952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.49 |
| Max. Negotiated Rate |
$465.79 |
| Rate for Payer: Aetna American Axle |
$336.40
|
| Rate for Payer: Aetna Commercial |
$439.91
|
| Rate for Payer: Aetna Medicare |
$258.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.40
|
| Rate for Payer: BCBS Complete |
$207.02
|
| Rate for Payer: Cash Price |
$414.03
|
| Rate for Payer: Cofinity Advantage |
$362.28
|
| Rate for Payer: Cofinity Commercial |
$445.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.03
|
| Rate for Payer: Healthscope Commercial |
$465.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$362.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$388.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$414.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.15
|
| Rate for Payer: PHP Commercial |
$439.91
|
| Rate for Payer: Priority Health SBD |
$326.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.40
|
| Rate for Payer: UHC Core |
$269.64
|
| Rate for Payer: UHC Exchange |
$203.39
|
| Rate for Payer: UMR Bronson Commercial |
$191.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$388.15
|
|
|
LEVOCARNITINE 330 MG TABLET
|
Facility
|
IP
|
$342.58
|
|
|
Service Code
|
NDC 50383017290
|
| Hospital Charge Code |
20952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.74 |
| Max. Negotiated Rate |
$308.32 |
| Rate for Payer: Aetna American Axle |
$222.68
|
| Rate for Payer: Aetna Commercial |
$291.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.68
|
| Rate for Payer: Cash Price |
$274.06
|
| Rate for Payer: Cofinity Advantage |
$239.81
|
| Rate for Payer: Cofinity Commercial |
$294.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.06
|
| Rate for Payer: Healthscope Commercial |
$308.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$256.94
|
| Rate for Payer: PHP Commercial |
$291.19
|
| Rate for Payer: Priority Health SBD |
$215.83
|
| Rate for Payer: UMR Bronson Commercial |
$150.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.94
|
|
|
LEVOCARNITINE SD 20 MG/ML IV
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS J1955
|
| Hospital Charge Code |
157117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$75.43 |
| Rate for Payer: Aetna American Axle |
$42.25
|
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna Medicare |
$32.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.25
|
| Rate for Payer: BCBS Complete |
$26.00
|
| Rate for Payer: BCBS Trust/PPO |
$75.43
|
| Rate for Payer: BCN Commercial |
$75.43
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Advantage |
$45.50
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.75
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23.27
|
| Rate for Payer: Priority Health SBD |
$40.95
|
| Rate for Payer: Priority Health Tiered Network |
$18.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.40
|
| Rate for Payer: UHC Core |
$38.40
|
| Rate for Payer: UHC Exchange |
$38.40
|
| Rate for Payer: UMR Bronson Commercial |
$24.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.75
|
|
|
LEVOCARNITINE SD 20 MG/ML IV
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS J1955
|
| Hospital Charge Code |
157117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna American Axle |
$42.25
|
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.25
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Advantage |
$45.50
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.75
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: Priority Health SBD |
$40.95
|
| Rate for Payer: UMR Bronson Commercial |
$28.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.75
|
|
|
LEVOFLOXACIN 250 MG/10 ML ORAL SOLUTION
|
Facility
|
OP
|
$1,681.92
|
|
|
Service Code
|
NDC 00527194868
|
| Hospital Charge Code |
39970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$622.31 |
| Max. Negotiated Rate |
$1,513.73 |
| Rate for Payer: Aetna American Axle |
$1,093.25
|
| Rate for Payer: Aetna Commercial |
$1,429.63
|
| Rate for Payer: Aetna Medicare |
$840.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,093.25
|
| Rate for Payer: BCBS Complete |
$672.77
|
| Rate for Payer: Cash Price |
$1,345.54
|
| Rate for Payer: Cofinity Advantage |
$1,177.34
|
| Rate for Payer: Cofinity Commercial |
$1,446.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,345.54
|
| Rate for Payer: Healthscope Commercial |
$1,513.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,177.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,261.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,345.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,429.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,261.44
|
| Rate for Payer: PHP Commercial |
$1,429.63
|
| Rate for Payer: Priority Health SBD |
$1,059.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,093.25
|
| Rate for Payer: UHC Core |
$876.28
|
| Rate for Payer: UHC Exchange |
$660.99
|
| Rate for Payer: UMR Bronson Commercial |
$622.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,261.44
|
|
|
LEVOFLOXACIN 250 MG/10 ML ORAL SOLUTION
|
Facility
|
OP
|
$996.48
|
|
|
Service Code
|
NDC 50383028608
|
| Hospital Charge Code |
39970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$368.70 |
| Max. Negotiated Rate |
$896.83 |
| Rate for Payer: Aetna American Axle |
$647.71
|
| Rate for Payer: Aetna Commercial |
$847.01
|
| Rate for Payer: Aetna Medicare |
$498.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$647.71
|
| Rate for Payer: BCBS Complete |
$398.59
|
| Rate for Payer: Cash Price |
$797.18
|
| Rate for Payer: Cofinity Advantage |
$697.54
|
| Rate for Payer: Cofinity Commercial |
$856.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$797.18
|
| Rate for Payer: Healthscope Commercial |
$896.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$697.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$747.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$797.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$847.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$747.36
|
| Rate for Payer: PHP Commercial |
$847.01
|
| Rate for Payer: Priority Health SBD |
$627.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.71
|
| Rate for Payer: UHC Core |
$519.17
|
| Rate for Payer: UHC Exchange |
$391.62
|
| Rate for Payer: UMR Bronson Commercial |
$368.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$747.36
|
|
|
LEVOFLOXACIN 250 MG/10 ML ORAL SOLUTION
|
Facility
|
OP
|
$2,154.24
|
|
|
Service Code
|
NDC 50383028616
|
| Hospital Charge Code |
39970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$797.07 |
| Max. Negotiated Rate |
$1,938.82 |
| Rate for Payer: Aetna American Axle |
$1,400.26
|
| Rate for Payer: Aetna Commercial |
$1,831.10
|
| Rate for Payer: Aetna Medicare |
$1,077.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,400.26
|
| Rate for Payer: BCBS Complete |
$861.70
|
| Rate for Payer: Cash Price |
$1,723.39
|
| Rate for Payer: Cofinity Advantage |
$1,507.97
|
| Rate for Payer: Cofinity Commercial |
$1,852.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,723.39
|
| Rate for Payer: Healthscope Commercial |
$1,938.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,507.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,615.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,723.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,831.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,615.68
|
| Rate for Payer: PHP Commercial |
$1,831.10
|
| Rate for Payer: Priority Health SBD |
$1,357.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,400.26
|
| Rate for Payer: UHC Core |
$1,122.36
|
| Rate for Payer: UHC Exchange |
$846.62
|
| Rate for Payer: UMR Bronson Commercial |
$797.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,615.68
|
|
|
LEVOFLOXACIN 250 MG/10 ML ORAL SOLUTION
|
Facility
|
IP
|
$852.00
|
|
|
Service Code
|
NDC 00527194866
|
| Hospital Charge Code |
39970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$374.88 |
| Max. Negotiated Rate |
$766.80 |
| Rate for Payer: Aetna American Axle |
$553.80
|
| Rate for Payer: Aetna Commercial |
$724.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.80
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cofinity Advantage |
$596.40
|
| Rate for Payer: Cofinity Commercial |
$732.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$681.60
|
| Rate for Payer: Healthscope Commercial |
$766.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$596.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$639.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$724.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$639.00
|
| Rate for Payer: PHP Commercial |
$724.20
|
| Rate for Payer: Priority Health SBD |
$536.76
|
| Rate for Payer: UMR Bronson Commercial |
$374.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$639.00
|
|
|
LEVOFLOXACIN 250 MG/10 ML ORAL SOLUTION
|
Facility
|
IP
|
$996.48
|
|
|
Service Code
|
NDC 50383028608
|
| Hospital Charge Code |
39970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$438.45 |
| Max. Negotiated Rate |
$896.83 |
| Rate for Payer: Aetna American Axle |
$647.71
|
| Rate for Payer: Aetna Commercial |
$847.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$647.71
|
| Rate for Payer: Cash Price |
$797.18
|
| Rate for Payer: Cofinity Advantage |
$697.54
|
| Rate for Payer: Cofinity Commercial |
$856.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$797.18
|
| Rate for Payer: Healthscope Commercial |
$896.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$697.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$747.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$847.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$747.36
|
| Rate for Payer: PHP Commercial |
$847.01
|
| Rate for Payer: Priority Health SBD |
$627.78
|
| Rate for Payer: UMR Bronson Commercial |
$438.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$747.36
|
|
|
LEVOFLOXACIN 250 MG/10 ML ORAL SOLUTION
|
Facility
|
IP
|
$1,681.92
|
|
|
Service Code
|
NDC 00527194868
|
| Hospital Charge Code |
39970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$740.04 |
| Max. Negotiated Rate |
$1,513.73 |
| Rate for Payer: Aetna American Axle |
$1,093.25
|
| Rate for Payer: Aetna Commercial |
$1,429.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,093.25
|
| Rate for Payer: Cash Price |
$1,345.54
|
| Rate for Payer: Cofinity Advantage |
$1,177.34
|
| Rate for Payer: Cofinity Commercial |
$1,446.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,345.54
|
| Rate for Payer: Healthscope Commercial |
$1,513.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,177.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,261.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,429.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,261.44
|
| Rate for Payer: PHP Commercial |
$1,429.63
|
| Rate for Payer: Priority Health SBD |
$1,059.61
|
| Rate for Payer: UMR Bronson Commercial |
$740.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,261.44
|
|
|
LEVOFLOXACIN 250 MG/10 ML ORAL SOLUTION
|
Facility
|
OP
|
$852.00
|
|
|
Service Code
|
NDC 00527194866
|
| Hospital Charge Code |
39970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$315.24 |
| Max. Negotiated Rate |
$766.80 |
| Rate for Payer: Aetna American Axle |
$553.80
|
| Rate for Payer: Aetna Commercial |
$724.20
|
| Rate for Payer: Aetna Medicare |
$426.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.80
|
| Rate for Payer: BCBS Complete |
$340.80
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cofinity Advantage |
$596.40
|
| Rate for Payer: Cofinity Commercial |
$732.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$681.60
|
| Rate for Payer: Healthscope Commercial |
$766.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$596.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$639.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$681.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$724.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$639.00
|
| Rate for Payer: PHP Commercial |
$724.20
|
| Rate for Payer: Priority Health SBD |
$536.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$553.80
|
| Rate for Payer: UHC Core |
$443.89
|
| Rate for Payer: UHC Exchange |
$334.84
|
| Rate for Payer: UMR Bronson Commercial |
$315.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$639.00
|
|
|
LEVOFLOXACIN 250 MG/10 ML ORAL SOLUTION
|
Facility
|
IP
|
$2,154.24
|
|
|
Service Code
|
NDC 50383028616
|
| Hospital Charge Code |
39970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$947.87 |
| Max. Negotiated Rate |
$1,938.82 |
| Rate for Payer: Aetna American Axle |
$1,400.26
|
| Rate for Payer: Aetna Commercial |
$1,831.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,400.26
|
| Rate for Payer: Cash Price |
$1,723.39
|
| Rate for Payer: Cofinity Advantage |
$1,507.97
|
| Rate for Payer: Cofinity Commercial |
$1,852.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,723.39
|
| Rate for Payer: Healthscope Commercial |
$1,938.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,507.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,615.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,831.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,615.68
|
| Rate for Payer: PHP Commercial |
$1,831.10
|
| Rate for Payer: Priority Health SBD |
$1,357.17
|
| Rate for Payer: UMR Bronson Commercial |
$947.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,615.68
|
|
|
LEVOFLOXACIN 250 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$57.42
|
|
|
Service Code
|
HCPCS J1956
|
| Hospital Charge Code |
112929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.26 |
| Max. Negotiated Rate |
$51.68 |
| Rate for Payer: Aetna American Axle |
$37.32
|
| Rate for Payer: Aetna American Axle |
$55.68
|
| Rate for Payer: Aetna Commercial |
$48.81
|
| Rate for Payer: Aetna Commercial |
$72.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.68
|
| Rate for Payer: Cash Price |
$45.94
|
| Rate for Payer: Cash Price |
$68.53
|
| Rate for Payer: Cofinity Advantage |
$59.96
|
| Rate for Payer: Cofinity Advantage |
$40.19
|
| Rate for Payer: Cofinity Commercial |
$73.67
|
| Rate for Payer: Cofinity Commercial |
$49.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.53
|
| Rate for Payer: Healthscope Commercial |
$51.68
|
| Rate for Payer: Healthscope Commercial |
$77.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.25
|
| Rate for Payer: PHP Commercial |
$48.81
|
| Rate for Payer: PHP Commercial |
$72.81
|
| Rate for Payer: Priority Health SBD |
$53.97
|
| Rate for Payer: Priority Health SBD |
$36.17
|
| Rate for Payer: UMR Bronson Commercial |
$25.26
|
| Rate for Payer: UMR Bronson Commercial |
$37.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.25
|
|
|
LEVOFLOXACIN 250 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$57.42
|
|
|
Service Code
|
HCPCS J1956
|
| Hospital Charge Code |
112929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$51.68 |
| Rate for Payer: Aetna American Axle |
$37.32
|
| Rate for Payer: Aetna American Axle |
$55.68
|
| Rate for Payer: Aetna Commercial |
$48.81
|
| Rate for Payer: Aetna Commercial |
$72.81
|
| Rate for Payer: Aetna Medicare |
$28.71
|
| Rate for Payer: Aetna Medicare |
$42.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.68
|
| Rate for Payer: BCBS Complete |
$34.26
|
| Rate for Payer: BCBS Complete |
$22.97
|
| Rate for Payer: BCBS Trust/PPO |
$7.00
|
| Rate for Payer: BCBS Trust/PPO |
$7.00
|
| Rate for Payer: BCN Commercial |
$7.00
|
| Rate for Payer: BCN Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$45.94
|
| Rate for Payer: Cash Price |
$68.53
|
| Rate for Payer: Cash Price |
$45.94
|
| Rate for Payer: Cash Price |
$68.53
|
| Rate for Payer: Cofinity Advantage |
$40.19
|
| Rate for Payer: Cofinity Advantage |
$59.96
|
| Rate for Payer: Cofinity Commercial |
$49.38
|
| Rate for Payer: Cofinity Commercial |
$73.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.53
|
| Rate for Payer: Healthscope Commercial |
$51.68
|
| Rate for Payer: Healthscope Commercial |
$77.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.06
|
| Rate for Payer: PHP Commercial |
$48.81
|
| Rate for Payer: PHP Commercial |
$72.81
|
| Rate for Payer: Priority Health SBD |
$36.17
|
| Rate for Payer: Priority Health SBD |
$53.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.56
|
| Rate for Payer: UHC Core |
$3.56
|
| Rate for Payer: UHC Core |
$3.56
|
| Rate for Payer: UHC Exchange |
$3.56
|
| Rate for Payer: UHC Exchange |
$3.56
|
| Rate for Payer: UMR Bronson Commercial |
$21.25
|
| Rate for Payer: UMR Bronson Commercial |
$31.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.25
|
|
