|
LAMIVUDINE 150 MG TABLET
|
Facility
|
OP
|
$1,182.82
|
|
|
Service Code
|
NDC 68180060207
|
| Hospital Charge Code |
15880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$437.64 |
| Max. Negotiated Rate |
$1,064.54 |
| Rate for Payer: Aetna American Axle |
$768.83
|
| Rate for Payer: Aetna Commercial |
$1,005.40
|
| Rate for Payer: Aetna Medicare |
$591.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$768.83
|
| Rate for Payer: BCBS Complete |
$473.13
|
| Rate for Payer: Cash Price |
$946.26
|
| Rate for Payer: Cofinity Commercial |
$1,017.23
|
| Rate for Payer: Cofinity Commercial |
$827.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$827.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$946.26
|
| Rate for Payer: Healthscope Commercial |
$1,064.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$827.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$887.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,005.40
|
| Rate for Payer: PHP Commercial |
$1,005.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$768.83
|
| Rate for Payer: Priority Health SBD |
$745.18
|
| Rate for Payer: UMR Bronson Commercial |
$437.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$887.12
|
|
|
LAMIVUDINE 150 MG TABLET
|
Facility
|
IP
|
$774.34
|
|
|
Service Code
|
NDC 60505325106
|
| Hospital Charge Code |
15880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$340.71 |
| Max. Negotiated Rate |
$696.91 |
| Rate for Payer: Aetna American Axle |
$503.32
|
| Rate for Payer: Aetna Commercial |
$658.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.32
|
| Rate for Payer: Cash Price |
$619.47
|
| Rate for Payer: Cofinity Commercial |
$542.04
|
| Rate for Payer: Cofinity Commercial |
$665.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$542.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$619.47
|
| Rate for Payer: Healthscope Commercial |
$696.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$542.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$580.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$658.19
|
| Rate for Payer: PHP Commercial |
$658.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.32
|
| Rate for Payer: Priority Health SBD |
$487.83
|
| Rate for Payer: UMR Bronson Commercial |
$340.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$580.75
|
|
|
LAMIVUDINE 150 MG TABLET
|
Facility
|
IP
|
$1,182.82
|
|
|
Service Code
|
NDC 68180060207
|
| Hospital Charge Code |
15880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$520.44 |
| Max. Negotiated Rate |
$1,064.54 |
| Rate for Payer: Aetna American Axle |
$768.83
|
| Rate for Payer: Aetna Commercial |
$1,005.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$768.83
|
| Rate for Payer: Cash Price |
$946.26
|
| Rate for Payer: Cofinity Commercial |
$1,017.23
|
| Rate for Payer: Cofinity Commercial |
$827.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$827.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$946.26
|
| Rate for Payer: Healthscope Commercial |
$1,064.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$827.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$887.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,005.40
|
| Rate for Payer: PHP Commercial |
$1,005.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$768.83
|
| Rate for Payer: Priority Health SBD |
$745.18
|
| Rate for Payer: UMR Bronson Commercial |
$520.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$887.12
|
|
|
LAMIVUDINE 150 MG TABLET
|
Facility
|
OP
|
$508.50
|
|
|
Service Code
|
NDC 00904658304
|
| Hospital Charge Code |
15880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.15 |
| Max. Negotiated Rate |
$457.65 |
| Rate for Payer: Aetna American Axle |
$330.52
|
| Rate for Payer: Aetna Commercial |
$432.23
|
| Rate for Payer: Aetna Medicare |
$254.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.52
|
| Rate for Payer: BCBS Complete |
$203.40
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cofinity Commercial |
$355.95
|
| Rate for Payer: Cofinity Commercial |
$437.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$355.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.80
|
| Rate for Payer: Healthscope Commercial |
$457.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$355.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$381.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.23
|
| Rate for Payer: PHP Commercial |
$432.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.52
|
| Rate for Payer: Priority Health SBD |
$320.36
|
| Rate for Payer: UMR Bronson Commercial |
$188.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.38
|
|
|
LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET
|
Facility
|
OP
|
$3,251.86
|
|
|
Service Code
|
NDC 49702020218
|
| Hospital Charge Code |
21810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,203.19 |
| Max. Negotiated Rate |
$2,926.67 |
| Rate for Payer: Aetna American Axle |
$2,113.71
|
| Rate for Payer: Aetna Commercial |
$2,764.08
|
| Rate for Payer: Aetna Medicare |
$1,625.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,113.71
|
| Rate for Payer: BCBS Complete |
$1,300.74
|
| Rate for Payer: Cash Price |
$2,601.49
|
| Rate for Payer: Cofinity Commercial |
$2,276.30
|
| Rate for Payer: Cofinity Commercial |
$2,796.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,276.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,601.49
|
| Rate for Payer: Healthscope Commercial |
$2,926.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,276.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,438.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,764.08
|
| Rate for Payer: PHP Commercial |
$2,764.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,113.71
|
| Rate for Payer: Priority Health SBD |
$2,048.67
|
| Rate for Payer: UMR Bronson Commercial |
$1,203.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,438.89
|
|
|
LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET
|
Facility
|
IP
|
$248.26
|
|
|
Service Code
|
NDC 31722050660
|
| Hospital Charge Code |
21810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.23 |
| Max. Negotiated Rate |
$223.43 |
| Rate for Payer: Aetna American Axle |
$161.37
|
| Rate for Payer: Aetna Commercial |
$211.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.37
|
| Rate for Payer: Cash Price |
$198.61
|
| Rate for Payer: Cofinity Commercial |
$173.78
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.61
|
| Rate for Payer: Healthscope Commercial |
$223.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.02
|
| Rate for Payer: PHP Commercial |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.37
|
| Rate for Payer: Priority Health SBD |
$156.40
|
| Rate for Payer: UMR Bronson Commercial |
$109.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.19
|
|
|
LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET
|
Facility
|
IP
|
$3,251.86
|
|
|
Service Code
|
NDC 49702020218
|
| Hospital Charge Code |
21810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,430.82 |
| Max. Negotiated Rate |
$2,926.67 |
| Rate for Payer: Aetna American Axle |
$2,113.71
|
| Rate for Payer: Aetna Commercial |
$2,764.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,113.71
|
| Rate for Payer: Cash Price |
$2,601.49
|
| Rate for Payer: Cofinity Commercial |
$2,276.30
|
| Rate for Payer: Cofinity Commercial |
$2,796.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,276.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,601.49
|
| Rate for Payer: Healthscope Commercial |
$2,926.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,276.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,438.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,764.08
|
| Rate for Payer: PHP Commercial |
$2,764.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,113.71
|
| Rate for Payer: Priority Health SBD |
$2,048.67
|
| Rate for Payer: UMR Bronson Commercial |
$1,430.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,438.89
|
|
|
LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET
|
Facility
|
OP
|
$248.26
|
|
|
Service Code
|
NDC 31722050660
|
| Hospital Charge Code |
21810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.86 |
| Max. Negotiated Rate |
$223.43 |
| Rate for Payer: Aetna American Axle |
$161.37
|
| Rate for Payer: Aetna Commercial |
$211.02
|
| Rate for Payer: Aetna Medicare |
$124.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.37
|
| Rate for Payer: BCBS Complete |
$99.30
|
| Rate for Payer: Cash Price |
$198.61
|
| Rate for Payer: Cofinity Commercial |
$173.78
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.61
|
| Rate for Payer: Healthscope Commercial |
$223.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.02
|
| Rate for Payer: PHP Commercial |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.37
|
| Rate for Payer: Priority Health SBD |
$156.40
|
| Rate for Payer: UMR Bronson Commercial |
$91.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.19
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$152.75
|
|
|
Service Code
|
NDC 51672413101
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.52 |
| Max. Negotiated Rate |
$137.47 |
| Rate for Payer: Aetna American Axle |
$99.29
|
| Rate for Payer: Aetna Commercial |
$129.84
|
| Rate for Payer: Aetna Medicare |
$76.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.29
|
| Rate for Payer: BCBS Complete |
$61.10
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cofinity Commercial |
$106.92
|
| Rate for Payer: Cofinity Commercial |
$131.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$106.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.20
|
| Rate for Payer: Healthscope Commercial |
$137.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.84
|
| Rate for Payer: PHP Commercial |
$129.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.29
|
| Rate for Payer: Priority Health SBD |
$96.23
|
| Rate for Payer: UMR Bronson Commercial |
$56.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.56
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$2.47
|
|
|
Service Code
|
NDC 51079049901
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna American Axle |
$1.61
|
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna Medicare |
$1.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.61
|
| Rate for Payer: BCBS Complete |
$0.99
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.61
|
| Rate for Payer: Priority Health SBD |
$1.56
|
| Rate for Payer: UMR Bronson Commercial |
$0.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.85
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$2.47
|
|
|
Service Code
|
NDC 51079049901
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna American Axle |
$1.61
|
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.61
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.61
|
| Rate for Payer: Priority Health SBD |
$1.56
|
| Rate for Payer: UMR Bronson Commercial |
$1.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.85
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$152.75
|
|
|
Service Code
|
NDC 51672413101
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.21 |
| Max. Negotiated Rate |
$137.47 |
| Rate for Payer: Aetna American Axle |
$99.29
|
| Rate for Payer: Aetna Commercial |
$129.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.29
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cofinity Commercial |
$106.92
|
| Rate for Payer: Cofinity Commercial |
$131.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$106.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.20
|
| Rate for Payer: Healthscope Commercial |
$137.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.84
|
| Rate for Payer: PHP Commercial |
$129.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.29
|
| Rate for Payer: Priority Health SBD |
$96.23
|
| Rate for Payer: UMR Bronson Commercial |
$67.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.56
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$385.40
|
|
|
Service Code
|
NDC 68084031901
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.58 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna American Axle |
$250.51
|
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.51
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Commercial |
$269.78
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.59
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.51
|
| Rate for Payer: Priority Health SBD |
$242.80
|
| Rate for Payer: UMR Bronson Commercial |
$169.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.05
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$385.40
|
|
|
Service Code
|
NDC 68084031901
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.60 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna American Axle |
$250.51
|
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna Medicare |
$192.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.51
|
| Rate for Payer: BCBS Complete |
$154.16
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Commercial |
$269.78
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.59
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.51
|
| Rate for Payer: Priority Health SBD |
$242.80
|
| Rate for Payer: UMR Bronson Commercial |
$142.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.05
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$246.75
|
|
|
Service Code
|
NDC 51079049920
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.30 |
| Max. Negotiated Rate |
$222.07 |
| Rate for Payer: Aetna American Axle |
$160.39
|
| Rate for Payer: Aetna Commercial |
$209.74
|
| Rate for Payer: Aetna Medicare |
$123.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.39
|
| Rate for Payer: BCBS Complete |
$98.70
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$172.72
|
| Rate for Payer: Cofinity Commercial |
$212.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$222.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.74
|
| Rate for Payer: PHP Commercial |
$209.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.39
|
| Rate for Payer: Priority Health SBD |
$155.45
|
| Rate for Payer: UMR Bronson Commercial |
$91.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.06
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$385.40
|
|
|
Service Code
|
NDC 68084031911
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.60 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna American Axle |
$250.51
|
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna Medicare |
$192.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.51
|
| Rate for Payer: BCBS Complete |
$154.16
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Commercial |
$269.78
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.59
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.51
|
| Rate for Payer: Priority Health SBD |
$242.80
|
| Rate for Payer: UMR Bronson Commercial |
$142.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.05
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$207.10
|
|
|
Service Code
|
NDC 68382000801
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.63 |
| Max. Negotiated Rate |
$186.39 |
| Rate for Payer: Aetna American Axle |
$134.62
|
| Rate for Payer: Aetna Commercial |
$176.03
|
| Rate for Payer: Aetna Medicare |
$103.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.62
|
| Rate for Payer: BCBS Complete |
$82.84
|
| Rate for Payer: Cash Price |
$165.68
|
| Rate for Payer: Cofinity Commercial |
$144.97
|
| Rate for Payer: Cofinity Commercial |
$178.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.68
|
| Rate for Payer: Healthscope Commercial |
$186.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.03
|
| Rate for Payer: PHP Commercial |
$176.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.62
|
| Rate for Payer: Priority Health SBD |
$130.47
|
| Rate for Payer: UMR Bronson Commercial |
$76.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.32
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$207.10
|
|
|
Service Code
|
NDC 68382000801
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.12 |
| Max. Negotiated Rate |
$186.39 |
| Rate for Payer: Aetna American Axle |
$134.62
|
| Rate for Payer: Aetna Commercial |
$176.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.62
|
| Rate for Payer: Cash Price |
$165.68
|
| Rate for Payer: Cofinity Commercial |
$144.97
|
| Rate for Payer: Cofinity Commercial |
$178.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.68
|
| Rate for Payer: Healthscope Commercial |
$186.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.03
|
| Rate for Payer: PHP Commercial |
$176.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.62
|
| Rate for Payer: Priority Health SBD |
$130.47
|
| Rate for Payer: UMR Bronson Commercial |
$91.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.32
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$385.40
|
|
|
Service Code
|
NDC 68084031911
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.58 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna American Axle |
$250.51
|
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.51
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Commercial |
$269.78
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.59
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.51
|
| Rate for Payer: Priority Health SBD |
$242.80
|
| Rate for Payer: UMR Bronson Commercial |
$169.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.05
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$246.75
|
|
|
Service Code
|
NDC 51079049920
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.57 |
| Max. Negotiated Rate |
$222.07 |
| Rate for Payer: Aetna American Axle |
$160.39
|
| Rate for Payer: Aetna Commercial |
$209.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.39
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$172.72
|
| Rate for Payer: Cofinity Commercial |
$212.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$222.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.74
|
| Rate for Payer: PHP Commercial |
$209.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.39
|
| Rate for Payer: Priority Health SBD |
$155.45
|
| Rate for Payer: UMR Bronson Commercial |
$108.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.06
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$253.80
|
|
|
Service Code
|
NDC 00904700861
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.91 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna American Axle |
$164.97
|
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: Aetna Medicare |
$126.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.97
|
| Rate for Payer: BCBS Complete |
$101.52
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Commercial |
$177.66
|
| Rate for Payer: Cofinity Commercial |
$218.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Healthscope Commercial |
$228.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.73
|
| Rate for Payer: PHP Commercial |
$215.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.97
|
| Rate for Payer: Priority Health SBD |
$159.89
|
| Rate for Payer: UMR Bronson Commercial |
$93.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.35
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$253.80
|
|
|
Service Code
|
NDC 00904700861
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.67 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna American Axle |
$164.97
|
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.97
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Commercial |
$177.66
|
| Rate for Payer: Cofinity Commercial |
$218.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Healthscope Commercial |
$228.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.73
|
| Rate for Payer: PHP Commercial |
$215.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.97
|
| Rate for Payer: Priority Health SBD |
$159.89
|
| Rate for Payer: UMR Bronson Commercial |
$111.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.35
|
|
|
LAMOTRIGINE 150 MG TABLET
|
Facility
|
IP
|
$132.81
|
|
|
Service Code
|
NDC 68382000914
|
| Hospital Charge Code |
14266
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.44 |
| Max. Negotiated Rate |
$119.53 |
| Rate for Payer: Aetna American Axle |
$86.33
|
| Rate for Payer: Aetna Commercial |
$112.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.33
|
| Rate for Payer: Cash Price |
$106.25
|
| Rate for Payer: Cofinity Commercial |
$114.22
|
| Rate for Payer: Cofinity Commercial |
$92.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.25
|
| Rate for Payer: Healthscope Commercial |
$119.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.89
|
| Rate for Payer: PHP Commercial |
$112.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.33
|
| Rate for Payer: Priority Health SBD |
$83.67
|
| Rate for Payer: UMR Bronson Commercial |
$58.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.61
|
|
|
LAMOTRIGINE 150 MG TABLET
|
Facility
|
OP
|
$362.90
|
|
|
Service Code
|
NDC 60687069301
|
| Hospital Charge Code |
14266
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.27 |
| Max. Negotiated Rate |
$326.61 |
| Rate for Payer: Aetna American Axle |
$235.88
|
| Rate for Payer: Aetna Commercial |
$308.46
|
| Rate for Payer: Aetna Medicare |
$181.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.88
|
| Rate for Payer: BCBS Complete |
$145.16
|
| Rate for Payer: Cash Price |
$290.32
|
| Rate for Payer: Cofinity Commercial |
$254.03
|
| Rate for Payer: Cofinity Commercial |
$312.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$254.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.32
|
| Rate for Payer: Healthscope Commercial |
$326.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.46
|
| Rate for Payer: PHP Commercial |
$308.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.88
|
| Rate for Payer: Priority Health SBD |
$228.63
|
| Rate for Payer: UMR Bronson Commercial |
$134.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.18
|
|
|
LAMOTRIGINE 150 MG TABLET
|
Facility
|
OP
|
$115.62
|
|
|
Service Code
|
NDC 51672413204
|
| Hospital Charge Code |
14266
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.78 |
| Max. Negotiated Rate |
$104.06 |
| Rate for Payer: Aetna American Axle |
$75.15
|
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Medicare |
$57.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.15
|
| Rate for Payer: BCBS Complete |
$46.25
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cofinity Commercial |
$80.93
|
| Rate for Payer: Cofinity Commercial |
$99.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.50
|
| Rate for Payer: Healthscope Commercial |
$104.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.28
|
| Rate for Payer: PHP Commercial |
$98.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.15
|
| Rate for Payer: Priority Health SBD |
$72.84
|
| Rate for Payer: UMR Bronson Commercial |
$42.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.72
|
|
