|
LACOSAMIDE 100 MG TABLET
|
Facility
|
IP
|
$4,286.60
|
|
|
Service Code
|
NDC 00131247860
|
| Hospital Charge Code |
96969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,886.10 |
| Max. Negotiated Rate |
$3,857.94 |
| Rate for Payer: Aetna American Axle |
$2,786.29
|
| Rate for Payer: Aetna Commercial |
$3,643.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,786.29
|
| Rate for Payer: Cash Price |
$3,429.28
|
| Rate for Payer: Cofinity Commercial |
$3,000.62
|
| Rate for Payer: Cofinity Commercial |
$3,686.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,000.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,429.28
|
| Rate for Payer: Healthscope Commercial |
$3,857.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,000.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,214.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,643.61
|
| Rate for Payer: PHP Commercial |
$3,643.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,786.29
|
| Rate for Payer: Priority Health SBD |
$2,700.56
|
| Rate for Payer: UMR Bronson Commercial |
$1,886.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,214.95
|
|
|
LACOSAMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$30.17
|
|
|
Service Code
|
NDC 09900000645
|
| Hospital Charge Code |
105482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$27.15 |
| Rate for Payer: Aetna American Axle |
$19.61
|
| Rate for Payer: Aetna Commercial |
$25.64
|
| Rate for Payer: Aetna Medicare |
$15.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.61
|
| Rate for Payer: BCBS Complete |
$12.07
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$21.12
|
| Rate for Payer: Cofinity Commercial |
$25.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.14
|
| Rate for Payer: Healthscope Commercial |
$27.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.64
|
| Rate for Payer: PHP Commercial |
$25.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.61
|
| Rate for Payer: Priority Health SBD |
$19.01
|
| Rate for Payer: UMR Bronson Commercial |
$11.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.63
|
|
|
LACOSAMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$686.20
|
|
|
Service Code
|
NDC 70954048810
|
| Hospital Charge Code |
105482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$301.93 |
| Max. Negotiated Rate |
$617.58 |
| Rate for Payer: Aetna American Axle |
$446.03
|
| Rate for Payer: Aetna Commercial |
$583.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.03
|
| Rate for Payer: Cash Price |
$548.96
|
| Rate for Payer: Cofinity Commercial |
$480.34
|
| Rate for Payer: Cofinity Commercial |
$590.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$480.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.96
|
| Rate for Payer: Healthscope Commercial |
$617.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$480.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$514.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.27
|
| Rate for Payer: PHP Commercial |
$583.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.03
|
| Rate for Payer: Priority Health SBD |
$432.31
|
| Rate for Payer: UMR Bronson Commercial |
$301.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$514.65
|
|
|
LACOSAMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$30.17
|
|
|
Service Code
|
NDC 09900000645
|
| Hospital Charge Code |
105482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$27.15 |
| Rate for Payer: Aetna American Axle |
$19.61
|
| Rate for Payer: Aetna Commercial |
$25.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.61
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$21.12
|
| Rate for Payer: Cofinity Commercial |
$25.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.14
|
| Rate for Payer: Healthscope Commercial |
$27.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.64
|
| Rate for Payer: PHP Commercial |
$25.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.61
|
| Rate for Payer: Priority Health SBD |
$19.01
|
| Rate for Payer: UMR Bronson Commercial |
$13.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.63
|
|
|
LACOSAMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$498.24
|
|
|
Service Code
|
NDC 31722062726
|
| Hospital Charge Code |
105482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.23 |
| Max. Negotiated Rate |
$448.42 |
| Rate for Payer: Aetna American Axle |
$323.86
|
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.86
|
| Rate for Payer: Cash Price |
$398.59
|
| Rate for Payer: Cofinity Commercial |
$348.77
|
| Rate for Payer: Cofinity Commercial |
$428.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$348.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.59
|
| Rate for Payer: Healthscope Commercial |
$448.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$348.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.50
|
| Rate for Payer: PHP Commercial |
$423.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.86
|
| Rate for Payer: Priority Health SBD |
$313.89
|
| Rate for Payer: UMR Bronson Commercial |
$219.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.68
|
|
|
LACOSAMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$686.20
|
|
|
Service Code
|
NDC 70954048810
|
| Hospital Charge Code |
105482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.89 |
| Max. Negotiated Rate |
$617.58 |
| Rate for Payer: Aetna American Axle |
$446.03
|
| Rate for Payer: Aetna Commercial |
$583.27
|
| Rate for Payer: Aetna Medicare |
$343.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.03
|
| Rate for Payer: BCBS Complete |
$274.48
|
| Rate for Payer: Cash Price |
$548.96
|
| Rate for Payer: Cofinity Commercial |
$480.34
|
| Rate for Payer: Cofinity Commercial |
$590.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$480.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.96
|
| Rate for Payer: Healthscope Commercial |
$617.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$480.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$514.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.27
|
| Rate for Payer: PHP Commercial |
$583.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.03
|
| Rate for Payer: Priority Health SBD |
$432.31
|
| Rate for Payer: UMR Bronson Commercial |
$253.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$514.65
|
|
|
LACOSAMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$752.00
|
|
|
Service Code
|
NDC 67877073295
|
| Hospital Charge Code |
105482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$330.88 |
| Max. Negotiated Rate |
$676.80 |
| Rate for Payer: Aetna American Axle |
$488.80
|
| Rate for Payer: Aetna Commercial |
$639.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.80
|
| Rate for Payer: Cash Price |
$601.60
|
| Rate for Payer: Cofinity Commercial |
$526.40
|
| Rate for Payer: Cofinity Commercial |
$646.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$526.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$601.60
|
| Rate for Payer: Healthscope Commercial |
$676.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$526.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$564.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$639.20
|
| Rate for Payer: PHP Commercial |
$639.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$488.80
|
| Rate for Payer: Priority Health SBD |
$473.76
|
| Rate for Payer: UMR Bronson Commercial |
$330.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$564.00
|
|
|
LACOSAMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$498.24
|
|
|
Service Code
|
NDC 31722062726
|
| Hospital Charge Code |
105482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.35 |
| Max. Negotiated Rate |
$448.42 |
| Rate for Payer: Aetna American Axle |
$323.86
|
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Aetna Medicare |
$249.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.86
|
| Rate for Payer: BCBS Complete |
$199.30
|
| Rate for Payer: Cash Price |
$398.59
|
| Rate for Payer: Cofinity Commercial |
$348.77
|
| Rate for Payer: Cofinity Commercial |
$428.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$348.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.59
|
| Rate for Payer: Healthscope Commercial |
$448.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$348.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.50
|
| Rate for Payer: PHP Commercial |
$423.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.86
|
| Rate for Payer: Priority Health SBD |
$313.89
|
| Rate for Payer: UMR Bronson Commercial |
$184.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.68
|
|
|
LACOSAMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$752.00
|
|
|
Service Code
|
NDC 67877073295
|
| Hospital Charge Code |
105482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.24 |
| Max. Negotiated Rate |
$676.80 |
| Rate for Payer: Aetna American Axle |
$488.80
|
| Rate for Payer: Aetna Commercial |
$639.20
|
| Rate for Payer: Aetna Medicare |
$376.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.80
|
| Rate for Payer: BCBS Complete |
$300.80
|
| Rate for Payer: Cash Price |
$601.60
|
| Rate for Payer: Cofinity Commercial |
$526.40
|
| Rate for Payer: Cofinity Commercial |
$646.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$526.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$601.60
|
| Rate for Payer: Healthscope Commercial |
$676.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$526.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$564.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$639.20
|
| Rate for Payer: PHP Commercial |
$639.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$488.80
|
| Rate for Payer: Priority Health SBD |
$473.76
|
| Rate for Payer: UMR Bronson Commercial |
$278.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$564.00
|
|
|
LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$71.74
|
|
|
Service Code
|
HCPCS C9254
|
| Hospital Charge Code |
96972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.57 |
| Max. Negotiated Rate |
$64.57 |
| Rate for Payer: Aetna American Axle |
$46.63
|
| Rate for Payer: Aetna American Axle |
$212.62
|
| Rate for Payer: Aetna American Axle |
$37.14
|
| Rate for Payer: Aetna American Axle |
$48.89
|
| Rate for Payer: Aetna American Axle |
$40.21
|
| Rate for Payer: Aetna Commercial |
$60.98
|
| Rate for Payer: Aetna Commercial |
$48.57
|
| Rate for Payer: Aetna Commercial |
$278.04
|
| Rate for Payer: Aetna Commercial |
$63.93
|
| Rate for Payer: Aetna Commercial |
$52.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.14
|
| Rate for Payer: Cash Price |
$57.39
|
| Rate for Payer: Cash Price |
$60.17
|
| Rate for Payer: Cash Price |
$45.71
|
| Rate for Payer: Cash Price |
$49.49
|
| Rate for Payer: Cash Price |
$261.68
|
| Rate for Payer: Cofinity Commercial |
$52.65
|
| Rate for Payer: Cofinity Commercial |
$228.97
|
| Rate for Payer: Cofinity Commercial |
$61.70
|
| Rate for Payer: Cofinity Commercial |
$50.22
|
| Rate for Payer: Cofinity Commercial |
$43.30
|
| Rate for Payer: Cofinity Commercial |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$49.14
|
| Rate for Payer: Cofinity Commercial |
$53.20
|
| Rate for Payer: Cofinity Commercial |
$281.31
|
| Rate for Payer: Cofinity Commercial |
$64.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$228.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.49
|
| Rate for Payer: Healthscope Commercial |
$51.43
|
| Rate for Payer: Healthscope Commercial |
$64.57
|
| Rate for Payer: Healthscope Commercial |
$55.67
|
| Rate for Payer: Healthscope Commercial |
$67.69
|
| Rate for Payer: Healthscope Commercial |
$294.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.04
|
| Rate for Payer: PHP Commercial |
$278.04
|
| Rate for Payer: PHP Commercial |
$63.93
|
| Rate for Payer: PHP Commercial |
$52.58
|
| Rate for Payer: PHP Commercial |
$60.98
|
| Rate for Payer: PHP Commercial |
$48.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.62
|
| Rate for Payer: Priority Health SBD |
$47.38
|
| Rate for Payer: Priority Health SBD |
$38.97
|
| Rate for Payer: Priority Health SBD |
$36.00
|
| Rate for Payer: Priority Health SBD |
$206.07
|
| Rate for Payer: Priority Health SBD |
$45.20
|
| Rate for Payer: UMR Bronson Commercial |
$143.92
|
| Rate for Payer: UMR Bronson Commercial |
$25.14
|
| Rate for Payer: UMR Bronson Commercial |
$31.57
|
| Rate for Payer: UMR Bronson Commercial |
$33.09
|
| Rate for Payer: UMR Bronson Commercial |
$27.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.80
|
|
|
LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$57.14
|
|
|
Service Code
|
HCPCS C9254
|
| Hospital Charge Code |
96972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$51.43 |
| Rate for Payer: Aetna American Axle |
$37.14
|
| Rate for Payer: Aetna American Axle |
$46.63
|
| Rate for Payer: Aetna American Axle |
$40.21
|
| Rate for Payer: Aetna American Axle |
$212.62
|
| Rate for Payer: Aetna American Axle |
$48.89
|
| Rate for Payer: Aetna Commercial |
$48.57
|
| Rate for Payer: Aetna Commercial |
$278.04
|
| Rate for Payer: Aetna Commercial |
$63.93
|
| Rate for Payer: Aetna Commercial |
$52.58
|
| Rate for Payer: Aetna Commercial |
$60.98
|
| Rate for Payer: Aetna Medicare |
$30.93
|
| Rate for Payer: Aetna Medicare |
$35.87
|
| Rate for Payer: Aetna Medicare |
$28.57
|
| Rate for Payer: Aetna Medicare |
$163.55
|
| Rate for Payer: Aetna Medicare |
$37.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.21
|
| Rate for Payer: BCBS Complete |
$22.86
|
| Rate for Payer: BCBS Complete |
$130.84
|
| Rate for Payer: BCBS Complete |
$28.70
|
| Rate for Payer: BCBS Complete |
$30.08
|
| Rate for Payer: BCBS Complete |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: Cash Price |
$45.71
|
| Rate for Payer: Cash Price |
$49.49
|
| Rate for Payer: Cash Price |
$261.68
|
| Rate for Payer: Cash Price |
$45.71
|
| Rate for Payer: Cash Price |
$261.68
|
| Rate for Payer: Cash Price |
$49.49
|
| Rate for Payer: Cash Price |
$60.17
|
| Rate for Payer: Cash Price |
$60.17
|
| Rate for Payer: Cash Price |
$57.39
|
| Rate for Payer: Cash Price |
$57.39
|
| Rate for Payer: Cofinity Commercial |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$64.68
|
| Rate for Payer: Cofinity Commercial |
$228.97
|
| Rate for Payer: Cofinity Commercial |
$53.20
|
| Rate for Payer: Cofinity Commercial |
$43.30
|
| Rate for Payer: Cofinity Commercial |
$52.65
|
| Rate for Payer: Cofinity Commercial |
$61.70
|
| Rate for Payer: Cofinity Commercial |
$50.22
|
| Rate for Payer: Cofinity Commercial |
$49.14
|
| Rate for Payer: Cofinity Commercial |
$281.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$228.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.39
|
| Rate for Payer: Healthscope Commercial |
$64.57
|
| Rate for Payer: Healthscope Commercial |
$294.39
|
| Rate for Payer: Healthscope Commercial |
$51.43
|
| Rate for Payer: Healthscope Commercial |
$55.67
|
| Rate for Payer: Healthscope Commercial |
$67.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.04
|
| Rate for Payer: PHP Commercial |
$63.93
|
| Rate for Payer: PHP Commercial |
$60.98
|
| Rate for Payer: PHP Commercial |
$48.57
|
| Rate for Payer: PHP Commercial |
$278.04
|
| Rate for Payer: PHP Commercial |
$52.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.14
|
| Rate for Payer: Priority Health SBD |
$36.00
|
| Rate for Payer: Priority Health SBD |
$47.38
|
| Rate for Payer: Priority Health SBD |
$45.20
|
| Rate for Payer: Priority Health SBD |
$206.07
|
| Rate for Payer: Priority Health SBD |
$38.97
|
| Rate for Payer: UMR Bronson Commercial |
$121.03
|
| Rate for Payer: UMR Bronson Commercial |
$22.89
|
| Rate for Payer: UMR Bronson Commercial |
$21.14
|
| Rate for Payer: UMR Bronson Commercial |
$26.54
|
| Rate for Payer: UMR Bronson Commercial |
$27.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.32
|
|
|
LACOSAMIDE 200 MG TABLET
|
Facility
|
IP
|
$671.78
|
|
|
Service Code
|
NDC 60687069857
|
| Hospital Charge Code |
96971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$295.58 |
| Max. Negotiated Rate |
$604.60 |
| Rate for Payer: Aetna American Axle |
$436.66
|
| Rate for Payer: Aetna Commercial |
$571.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.66
|
| Rate for Payer: Cash Price |
$537.42
|
| Rate for Payer: Cofinity Commercial |
$470.25
|
| Rate for Payer: Cofinity Commercial |
$577.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$470.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.42
|
| Rate for Payer: Healthscope Commercial |
$604.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$470.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$503.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$571.01
|
| Rate for Payer: PHP Commercial |
$571.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.66
|
| Rate for Payer: Priority Health SBD |
$423.22
|
| Rate for Payer: UMR Bronson Commercial |
$295.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$503.84
|
|
|
LACOSAMIDE 200 MG TABLET
|
Facility
|
OP
|
$501.50
|
|
|
Service Code
|
NDC 00904724768
|
| Hospital Charge Code |
96971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.56 |
| Max. Negotiated Rate |
$451.35 |
| Rate for Payer: Aetna American Axle |
$325.98
|
| Rate for Payer: Aetna Commercial |
$426.28
|
| Rate for Payer: Aetna Medicare |
$250.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.98
|
| Rate for Payer: BCBS Complete |
$200.60
|
| Rate for Payer: Cash Price |
$401.20
|
| Rate for Payer: Cofinity Commercial |
$351.05
|
| Rate for Payer: Cofinity Commercial |
$431.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$351.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.20
|
| Rate for Payer: Healthscope Commercial |
$451.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$351.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$376.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$426.28
|
| Rate for Payer: PHP Commercial |
$426.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.98
|
| Rate for Payer: Priority Health SBD |
$315.94
|
| Rate for Payer: UMR Bronson Commercial |
$185.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$376.12
|
|
|
LACOSAMIDE 200 MG TABLET
|
Facility
|
OP
|
$671.78
|
|
|
Service Code
|
NDC 60687069857
|
| Hospital Charge Code |
96971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.56 |
| Max. Negotiated Rate |
$604.60 |
| Rate for Payer: Aetna American Axle |
$436.66
|
| Rate for Payer: Aetna Commercial |
$571.01
|
| Rate for Payer: Aetna Medicare |
$335.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.66
|
| Rate for Payer: BCBS Complete |
$268.71
|
| Rate for Payer: Cash Price |
$537.42
|
| Rate for Payer: Cofinity Commercial |
$470.25
|
| Rate for Payer: Cofinity Commercial |
$577.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$470.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.42
|
| Rate for Payer: Healthscope Commercial |
$604.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$470.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$503.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$571.01
|
| Rate for Payer: PHP Commercial |
$571.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.66
|
| Rate for Payer: Priority Health SBD |
$423.22
|
| Rate for Payer: UMR Bronson Commercial |
$248.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$503.84
|
|
|
LACOSAMIDE 200 MG TABLET
|
Facility
|
IP
|
$11.20
|
|
|
Service Code
|
NDC 60687069811
|
| Hospital Charge Code |
96971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$10.08 |
| Rate for Payer: Aetna American Axle |
$7.28
|
| Rate for Payer: Aetna Commercial |
$9.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.28
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cofinity Commercial |
$7.84
|
| Rate for Payer: Cofinity Commercial |
$9.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.96
|
| Rate for Payer: Healthscope Commercial |
$10.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.52
|
| Rate for Payer: PHP Commercial |
$9.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.28
|
| Rate for Payer: Priority Health SBD |
$7.06
|
| Rate for Payer: UMR Bronson Commercial |
$4.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.40
|
|
|
LACOSAMIDE 200 MG TABLET
|
Facility
|
OP
|
$4,127.87
|
|
|
Service Code
|
NDC 00131248035
|
| Hospital Charge Code |
96971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,527.31 |
| Max. Negotiated Rate |
$3,715.08 |
| Rate for Payer: Aetna American Axle |
$2,683.12
|
| Rate for Payer: Aetna Commercial |
$3,508.69
|
| Rate for Payer: Aetna Medicare |
$2,063.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,683.12
|
| Rate for Payer: BCBS Complete |
$1,651.15
|
| Rate for Payer: Cash Price |
$3,302.30
|
| Rate for Payer: Cofinity Commercial |
$2,889.51
|
| Rate for Payer: Cofinity Commercial |
$3,549.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,889.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,302.30
|
| Rate for Payer: Healthscope Commercial |
$3,715.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,889.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,095.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,508.69
|
| Rate for Payer: PHP Commercial |
$3,508.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,683.12
|
| Rate for Payer: Priority Health SBD |
$2,600.56
|
| Rate for Payer: UMR Bronson Commercial |
$1,527.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,095.90
|
|
|
LACOSAMIDE 200 MG TABLET
|
Facility
|
OP
|
$11.20
|
|
|
Service Code
|
NDC 60687069811
|
| Hospital Charge Code |
96971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$10.08 |
| Rate for Payer: Aetna American Axle |
$7.28
|
| Rate for Payer: Aetna Commercial |
$9.52
|
| Rate for Payer: Aetna Medicare |
$5.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.28
|
| Rate for Payer: BCBS Complete |
$4.48
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cofinity Commercial |
$7.84
|
| Rate for Payer: Cofinity Commercial |
$9.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.96
|
| Rate for Payer: Healthscope Commercial |
$10.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.52
|
| Rate for Payer: PHP Commercial |
$9.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.28
|
| Rate for Payer: Priority Health SBD |
$7.06
|
| Rate for Payer: UMR Bronson Commercial |
$4.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.40
|
|
|
LACOSAMIDE 200 MG TABLET
|
Facility
|
IP
|
$501.50
|
|
|
Service Code
|
NDC 00904724768
|
| Hospital Charge Code |
96971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.66 |
| Max. Negotiated Rate |
$451.35 |
| Rate for Payer: Aetna American Axle |
$325.98
|
| Rate for Payer: Aetna Commercial |
$426.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.98
|
| Rate for Payer: Cash Price |
$401.20
|
| Rate for Payer: Cofinity Commercial |
$351.05
|
| Rate for Payer: Cofinity Commercial |
$431.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$351.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.20
|
| Rate for Payer: Healthscope Commercial |
$451.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$351.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$376.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$426.28
|
| Rate for Payer: PHP Commercial |
$426.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.98
|
| Rate for Payer: Priority Health SBD |
$315.94
|
| Rate for Payer: UMR Bronson Commercial |
$220.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$376.12
|
|
|
LACOSAMIDE 200 MG TABLET
|
Facility
|
IP
|
$4,127.87
|
|
|
Service Code
|
NDC 00131248035
|
| Hospital Charge Code |
96971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,816.26 |
| Max. Negotiated Rate |
$3,715.08 |
| Rate for Payer: Aetna American Axle |
$2,683.12
|
| Rate for Payer: Aetna Commercial |
$3,508.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,683.12
|
| Rate for Payer: Cash Price |
$3,302.30
|
| Rate for Payer: Cofinity Commercial |
$2,889.51
|
| Rate for Payer: Cofinity Commercial |
$3,549.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,889.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,302.30
|
| Rate for Payer: Healthscope Commercial |
$3,715.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,889.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,095.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,508.69
|
| Rate for Payer: PHP Commercial |
$3,508.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,683.12
|
| Rate for Payer: Priority Health SBD |
$2,600.56
|
| Rate for Payer: UMR Bronson Commercial |
$1,816.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,095.90
|
|
|
LACOSAMIDE 50 MG TABLET
|
Facility
|
IP
|
$156.18
|
|
|
Service Code
|
NDC 62332017160
|
| Hospital Charge Code |
96968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.72 |
| Max. Negotiated Rate |
$140.56 |
| Rate for Payer: Aetna American Axle |
$101.52
|
| Rate for Payer: Aetna Commercial |
$132.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.52
|
| Rate for Payer: Cash Price |
$124.94
|
| Rate for Payer: Cofinity Commercial |
$109.33
|
| Rate for Payer: Cofinity Commercial |
$134.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.94
|
| Rate for Payer: Healthscope Commercial |
$140.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.75
|
| Rate for Payer: PHP Commercial |
$132.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.52
|
| Rate for Payer: Priority Health SBD |
$98.39
|
| Rate for Payer: UMR Bronson Commercial |
$68.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.14
|
|
|
LACOSAMIDE 50 MG TABLET
|
Facility
|
OP
|
$156.18
|
|
|
Service Code
|
NDC 62332017160
|
| Hospital Charge Code |
96968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.79 |
| Max. Negotiated Rate |
$140.56 |
| Rate for Payer: Aetna American Axle |
$101.52
|
| Rate for Payer: Aetna Commercial |
$132.75
|
| Rate for Payer: Aetna Medicare |
$78.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.52
|
| Rate for Payer: BCBS Complete |
$62.47
|
| Rate for Payer: Cash Price |
$124.94
|
| Rate for Payer: Cofinity Commercial |
$109.33
|
| Rate for Payer: Cofinity Commercial |
$134.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.94
|
| Rate for Payer: Healthscope Commercial |
$140.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.75
|
| Rate for Payer: PHP Commercial |
$132.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.52
|
| Rate for Payer: Priority Health SBD |
$98.39
|
| Rate for Payer: UMR Bronson Commercial |
$57.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.14
|
|
|
LACTASE 9,000 UNIT TABLET
|
Facility
|
IP
|
$75.72
|
|
|
Service Code
|
NDC 00450091032
|
| Hospital Charge Code |
109044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.32 |
| Max. Negotiated Rate |
$68.15 |
| Rate for Payer: Aetna American Axle |
$49.22
|
| Rate for Payer: Aetna Commercial |
$64.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.22
|
| Rate for Payer: Cash Price |
$60.58
|
| Rate for Payer: Cofinity Commercial |
$53.00
|
| Rate for Payer: Cofinity Commercial |
$65.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.58
|
| Rate for Payer: Healthscope Commercial |
$68.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.36
|
| Rate for Payer: PHP Commercial |
$64.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.22
|
| Rate for Payer: Priority Health SBD |
$47.70
|
| Rate for Payer: UMR Bronson Commercial |
$33.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.79
|
|
|
LACTASE 9,000 UNIT TABLET
|
Facility
|
OP
|
$75.72
|
|
|
Service Code
|
NDC 00450091032
|
| Hospital Charge Code |
109044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.02 |
| Max. Negotiated Rate |
$68.15 |
| Rate for Payer: Aetna American Axle |
$49.22
|
| Rate for Payer: Aetna Commercial |
$64.36
|
| Rate for Payer: Aetna Medicare |
$37.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.22
|
| Rate for Payer: BCBS Complete |
$30.29
|
| Rate for Payer: Cash Price |
$60.58
|
| Rate for Payer: Cofinity Commercial |
$53.00
|
| Rate for Payer: Cofinity Commercial |
$65.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.58
|
| Rate for Payer: Healthscope Commercial |
$68.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.36
|
| Rate for Payer: PHP Commercial |
$64.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.22
|
| Rate for Payer: Priority Health SBD |
$47.70
|
| Rate for Payer: UMR Bronson Commercial |
$28.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.79
|
|
|
LACTASE 9,000 UNIT TABLET
|
Facility
|
OP
|
$114.24
|
|
|
Service Code
|
NDC 00450091060
|
| Hospital Charge Code |
109044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.27 |
| Max. Negotiated Rate |
$102.82 |
| Rate for Payer: Aetna American Axle |
$74.26
|
| Rate for Payer: Aetna Commercial |
$97.10
|
| Rate for Payer: Aetna Medicare |
$57.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.26
|
| Rate for Payer: BCBS Complete |
$45.70
|
| Rate for Payer: Cash Price |
$91.39
|
| Rate for Payer: Cofinity Commercial |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$98.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.39
|
| Rate for Payer: Healthscope Commercial |
$102.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.10
|
| Rate for Payer: PHP Commercial |
$97.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.26
|
| Rate for Payer: Priority Health SBD |
$71.97
|
| Rate for Payer: UMR Bronson Commercial |
$42.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.68
|
|
|
LACTASE 9,000 UNIT TABLET
|
Facility
|
IP
|
$114.24
|
|
|
Service Code
|
NDC 00450091060
|
| Hospital Charge Code |
109044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.27 |
| Max. Negotiated Rate |
$102.82 |
| Rate for Payer: Aetna American Axle |
$74.26
|
| Rate for Payer: Aetna Commercial |
$97.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.26
|
| Rate for Payer: Cash Price |
$91.39
|
| Rate for Payer: Cofinity Commercial |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$98.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.39
|
| Rate for Payer: Healthscope Commercial |
$102.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.10
|
| Rate for Payer: PHP Commercial |
$97.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.26
|
| Rate for Payer: Priority Health SBD |
$71.97
|
| Rate for Payer: UMR Bronson Commercial |
$50.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.68
|
|
