|
LEVETIRACETAM 100 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$700.28
|
|
|
Service Code
|
NDC 31722057447
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.10 |
| Max. Negotiated Rate |
$630.25 |
| Rate for Payer: Aetna American Axle |
$455.18
|
| Rate for Payer: Aetna Commercial |
$595.24
|
| Rate for Payer: Aetna Medicare |
$350.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.18
|
| Rate for Payer: BCBS Complete |
$280.11
|
| Rate for Payer: Cash Price |
$560.22
|
| Rate for Payer: Cofinity Commercial |
$490.20
|
| Rate for Payer: Cofinity Commercial |
$602.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$490.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.22
|
| Rate for Payer: Healthscope Commercial |
$630.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$490.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$525.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$595.24
|
| Rate for Payer: PHP Commercial |
$595.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.18
|
| Rate for Payer: Priority Health SBD |
$441.18
|
| Rate for Payer: UMR Bronson Commercial |
$259.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$525.21
|
|
|
LEVETIRACETAM 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$311.24
|
|
|
Service Code
|
NDC 50383024116
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.95 |
| Max. Negotiated Rate |
$280.12 |
| Rate for Payer: Aetna American Axle |
$202.31
|
| Rate for Payer: Aetna Commercial |
$264.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.31
|
| Rate for Payer: Cash Price |
$248.99
|
| Rate for Payer: Cofinity Commercial |
$217.87
|
| Rate for Payer: Cofinity Commercial |
$267.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$217.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.99
|
| Rate for Payer: Healthscope Commercial |
$280.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.55
|
| Rate for Payer: PHP Commercial |
$264.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.31
|
| Rate for Payer: Priority Health SBD |
$196.08
|
| Rate for Payer: UMR Bronson Commercial |
$136.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.43
|
|
|
LEVETIRACETAM 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$255.66
|
|
|
Service Code
|
NDC 65862025047
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.49 |
| Max. Negotiated Rate |
$230.09 |
| Rate for Payer: Aetna American Axle |
$166.18
|
| Rate for Payer: Aetna Commercial |
$217.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.18
|
| Rate for Payer: Cash Price |
$204.53
|
| Rate for Payer: Cofinity Commercial |
$178.96
|
| Rate for Payer: Cofinity Commercial |
$219.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.53
|
| Rate for Payer: Healthscope Commercial |
$230.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.31
|
| Rate for Payer: PHP Commercial |
$217.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.18
|
| Rate for Payer: Priority Health SBD |
$161.07
|
| Rate for Payer: UMR Bronson Commercial |
$112.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.74
|
|
|
LEVETIRACETAM 100 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$255.66
|
|
|
Service Code
|
NDC 65862025047
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.59 |
| Max. Negotiated Rate |
$230.09 |
| Rate for Payer: Aetna American Axle |
$166.18
|
| Rate for Payer: Aetna Commercial |
$217.31
|
| Rate for Payer: Aetna Medicare |
$127.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.18
|
| Rate for Payer: BCBS Complete |
$102.26
|
| Rate for Payer: Cash Price |
$204.53
|
| Rate for Payer: Cofinity Commercial |
$178.96
|
| Rate for Payer: Cofinity Commercial |
$219.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.53
|
| Rate for Payer: Healthscope Commercial |
$230.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.31
|
| Rate for Payer: PHP Commercial |
$217.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.18
|
| Rate for Payer: Priority Health SBD |
$161.07
|
| Rate for Payer: UMR Bronson Commercial |
$94.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.74
|
|
|
LEVETIRACETAM 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$266.78
|
|
|
Service Code
|
NDC 51991065116
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.38 |
| Max. Negotiated Rate |
$240.10 |
| Rate for Payer: Aetna American Axle |
$173.41
|
| Rate for Payer: Aetna Commercial |
$226.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.41
|
| Rate for Payer: Cash Price |
$213.42
|
| Rate for Payer: Cofinity Commercial |
$186.75
|
| Rate for Payer: Cofinity Commercial |
$229.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.42
|
| Rate for Payer: Healthscope Commercial |
$240.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.76
|
| Rate for Payer: PHP Commercial |
$226.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.41
|
| Rate for Payer: Priority Health SBD |
$168.07
|
| Rate for Payer: UMR Bronson Commercial |
$117.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.08
|
|
|
LEVETIRACETAM 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$4,120.78
|
|
|
Service Code
|
NDC 50474000148
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,813.14 |
| Max. Negotiated Rate |
$3,708.70 |
| Rate for Payer: Aetna American Axle |
$2,678.51
|
| Rate for Payer: Aetna Commercial |
$3,502.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,678.51
|
| Rate for Payer: Cash Price |
$3,296.62
|
| Rate for Payer: Cofinity Commercial |
$2,884.55
|
| Rate for Payer: Cofinity Commercial |
$3,543.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,884.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,296.62
|
| Rate for Payer: Healthscope Commercial |
$3,708.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,884.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,090.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,502.66
|
| Rate for Payer: PHP Commercial |
$3,502.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,678.51
|
| Rate for Payer: Priority Health SBD |
$2,596.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,813.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,090.58
|
|
|
LEVETIRACETAM 100 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$266.78
|
|
|
Service Code
|
NDC 51991065116
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.71 |
| Max. Negotiated Rate |
$240.10 |
| Rate for Payer: Aetna American Axle |
$173.41
|
| Rate for Payer: Aetna Commercial |
$226.76
|
| Rate for Payer: Aetna Medicare |
$133.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.41
|
| Rate for Payer: BCBS Complete |
$106.71
|
| Rate for Payer: Cash Price |
$213.42
|
| Rate for Payer: Cofinity Commercial |
$186.75
|
| Rate for Payer: Cofinity Commercial |
$229.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.42
|
| Rate for Payer: Healthscope Commercial |
$240.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.76
|
| Rate for Payer: PHP Commercial |
$226.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.41
|
| Rate for Payer: Priority Health SBD |
$168.07
|
| Rate for Payer: UMR Bronson Commercial |
$98.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.08
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
IP
|
$258.50
|
|
|
Service Code
|
NDC 63739079510
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.74 |
| Max. Negotiated Rate |
$232.65 |
| Rate for Payer: PHP Commercial |
$219.72
|
| Rate for Payer: Aetna American Axle |
$168.02
|
| Rate for Payer: Aetna Commercial |
$219.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.02
|
| Rate for Payer: Cash Price |
$206.80
|
| Rate for Payer: Cofinity Commercial |
$180.95
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.80
|
| Rate for Payer: Healthscope Commercial |
$232.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.02
|
| Rate for Payer: Priority Health SBD |
$162.86
|
| Rate for Payer: UMR Bronson Commercial |
$113.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.88
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
IP
|
$327.12
|
|
|
Service Code
|
NDC 42385095412
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.93 |
| Max. Negotiated Rate |
$294.41 |
| Rate for Payer: Aetna American Axle |
$212.63
|
| Rate for Payer: Aetna Commercial |
$278.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.63
|
| Rate for Payer: Cash Price |
$261.70
|
| Rate for Payer: Cofinity Commercial |
$228.98
|
| Rate for Payer: Cofinity Commercial |
$281.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$228.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.70
|
| Rate for Payer: Healthscope Commercial |
$294.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.05
|
| Rate for Payer: PHP Commercial |
$278.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.63
|
| Rate for Payer: Priority Health SBD |
$206.09
|
| Rate for Payer: UMR Bronson Commercial |
$143.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.34
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
OP
|
$3.46
|
|
|
Service Code
|
NDC 68084085911
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$3.11 |
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.42
|
| Rate for Payer: Aetna American Axle |
$2.25
|
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Aetna Medicare |
$1.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.25
|
| Rate for Payer: BCBS Complete |
$1.38
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Healthscope Commercial |
$3.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.25
|
| Rate for Payer: Priority Health SBD |
$2.18
|
| Rate for Payer: UMR Bronson Commercial |
$1.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.60
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
OP
|
$258.50
|
|
|
Service Code
|
NDC 63739079510
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.64 |
| Max. Negotiated Rate |
$232.65 |
| Rate for Payer: Aetna American Axle |
$168.02
|
| Rate for Payer: Aetna Commercial |
$219.72
|
| Rate for Payer: Aetna Medicare |
$129.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.02
|
| Rate for Payer: BCBS Complete |
$103.40
|
| Rate for Payer: Cash Price |
$206.80
|
| Rate for Payer: Cofinity Commercial |
$180.95
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.80
|
| Rate for Payer: Healthscope Commercial |
$232.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.72
|
| Rate for Payer: PHP Commercial |
$219.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.02
|
| Rate for Payer: Priority Health SBD |
$162.86
|
| Rate for Payer: UMR Bronson Commercial |
$95.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.88
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
OP
|
$291.40
|
|
|
Service Code
|
NDC 00904712361
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.82 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna American Axle |
$189.41
|
| Rate for Payer: Aetna Commercial |
$247.69
|
| Rate for Payer: Aetna Medicare |
$145.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.41
|
| Rate for Payer: BCBS Complete |
$116.56
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cofinity Commercial |
$203.98
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.12
|
| Rate for Payer: Healthscope Commercial |
$262.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.69
|
| Rate for Payer: PHP Commercial |
$247.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.41
|
| Rate for Payer: Priority Health SBD |
$183.58
|
| Rate for Payer: UMR Bronson Commercial |
$107.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.55
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
OP
|
$224.20
|
|
|
Service Code
|
NDC 51079082020
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.95 |
| Max. Negotiated Rate |
$201.78 |
| Rate for Payer: Aetna American Axle |
$145.73
|
| Rate for Payer: Aetna Commercial |
$190.57
|
| Rate for Payer: Aetna Medicare |
$112.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.73
|
| Rate for Payer: BCBS Complete |
$89.68
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Cofinity Commercial |
$156.94
|
| Rate for Payer: Cofinity Commercial |
$192.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.36
|
| Rate for Payer: Healthscope Commercial |
$201.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.57
|
| Rate for Payer: PHP Commercial |
$190.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.73
|
| Rate for Payer: Priority Health SBD |
$141.25
|
| Rate for Payer: UMR Bronson Commercial |
$82.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.15
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
IP
|
$3.46
|
|
|
Service Code
|
NDC 68084085911
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$3.11 |
| Rate for Payer: Aetna American Axle |
$2.25
|
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.25
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Healthscope Commercial |
$3.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.25
|
| Rate for Payer: Priority Health SBD |
$2.18
|
| Rate for Payer: UMR Bronson Commercial |
$1.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.60
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
IP
|
$345.45
|
|
|
Service Code
|
NDC 68084085901
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.00 |
| Max. Negotiated Rate |
$310.90 |
| Rate for Payer: Aetna American Axle |
$224.54
|
| Rate for Payer: Aetna Commercial |
$293.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.54
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$241.82
|
| Rate for Payer: Cofinity Commercial |
$297.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$241.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.36
|
| Rate for Payer: Healthscope Commercial |
$310.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.63
|
| Rate for Payer: PHP Commercial |
$293.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.54
|
| Rate for Payer: Priority Health SBD |
$217.63
|
| Rate for Payer: UMR Bronson Commercial |
$152.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.09
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
IP
|
$224.20
|
|
|
Service Code
|
NDC 51079082020
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.65 |
| Max. Negotiated Rate |
$201.78 |
| Rate for Payer: Aetna American Axle |
$145.73
|
| Rate for Payer: Aetna Commercial |
$190.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.73
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Cofinity Commercial |
$156.94
|
| Rate for Payer: Cofinity Commercial |
$192.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.36
|
| Rate for Payer: Healthscope Commercial |
$201.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.57
|
| Rate for Payer: PHP Commercial |
$190.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.73
|
| Rate for Payer: Priority Health SBD |
$141.25
|
| Rate for Payer: UMR Bronson Commercial |
$98.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.15
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
OP
|
$345.45
|
|
|
Service Code
|
NDC 68084085901
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.82 |
| Max. Negotiated Rate |
$310.90 |
| Rate for Payer: Aetna American Axle |
$224.54
|
| Rate for Payer: Aetna Commercial |
$293.63
|
| Rate for Payer: Aetna Medicare |
$172.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.54
|
| Rate for Payer: BCBS Complete |
$138.18
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$241.82
|
| Rate for Payer: Cofinity Commercial |
$297.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$241.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.36
|
| Rate for Payer: Healthscope Commercial |
$310.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.63
|
| Rate for Payer: PHP Commercial |
$293.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.54
|
| Rate for Payer: Priority Health SBD |
$217.63
|
| Rate for Payer: UMR Bronson Commercial |
$127.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.09
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
OP
|
$327.12
|
|
|
Service Code
|
NDC 42385095412
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.03 |
| Max. Negotiated Rate |
$294.41 |
| Rate for Payer: Aetna American Axle |
$212.63
|
| Rate for Payer: Aetna Commercial |
$278.05
|
| Rate for Payer: Aetna Medicare |
$163.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.63
|
| Rate for Payer: BCBS Complete |
$130.85
|
| Rate for Payer: Cash Price |
$261.70
|
| Rate for Payer: Cofinity Commercial |
$228.98
|
| Rate for Payer: Cofinity Commercial |
$281.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$228.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.70
|
| Rate for Payer: Healthscope Commercial |
$294.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.05
|
| Rate for Payer: PHP Commercial |
$278.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.63
|
| Rate for Payer: Priority Health SBD |
$206.09
|
| Rate for Payer: UMR Bronson Commercial |
$121.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.34
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
IP
|
$291.40
|
|
|
Service Code
|
NDC 00904712361
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.22 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna American Axle |
$189.41
|
| Rate for Payer: Aetna Commercial |
$247.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.41
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cofinity Commercial |
$203.98
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.12
|
| Rate for Payer: Healthscope Commercial |
$262.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.69
|
| Rate for Payer: PHP Commercial |
$247.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.41
|
| Rate for Payer: Priority Health SBD |
$183.58
|
| Rate for Payer: UMR Bronson Commercial |
$128.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.55
|
|
|
LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.51
|
|
|
Service Code
|
HCPCS J1953
|
| Hospital Charge Code |
77195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$13.96 |
| Rate for Payer: Aetna American Axle |
$10.08
|
| Rate for Payer: Aetna American Axle |
$11.45
|
| Rate for Payer: Aetna American Axle |
$9.33
|
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna American Axle |
$13.40
|
| Rate for Payer: Aetna American Axle |
$11.78
|
| Rate for Payer: Aetna American Axle |
$146.41
|
| Rate for Payer: Aetna American Axle |
$16.11
|
| Rate for Payer: Aetna American Axle |
$18.57
|
| Rate for Payer: Aetna American Axle |
$48.84
|
| Rate for Payer: Aetna American Axle |
$10.37
|
| Rate for Payer: Aetna Commercial |
$17.52
|
| Rate for Payer: Aetna Commercial |
$191.46
|
| Rate for Payer: Aetna Commercial |
$13.56
|
| Rate for Payer: Aetna Commercial |
$63.87
|
| Rate for Payer: Aetna Commercial |
$16.76
|
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Commercial |
$13.18
|
| Rate for Payer: Aetna Commercial |
$12.21
|
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna Commercial |
$15.41
|
| Rate for Payer: Aetna Commercial |
$21.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.37
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cash Price |
$12.76
|
| Rate for Payer: Cash Price |
$11.49
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cash Price |
$60.11
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cash Price |
$180.20
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Cofinity Commercial |
$157.68
|
| Rate for Payer: Cofinity Commercial |
$12.35
|
| Rate for Payer: Cofinity Commercial |
$13.72
|
| Rate for Payer: Cofinity Commercial |
$13.34
|
| Rate for Payer: Cofinity Commercial |
$10.86
|
| Rate for Payer: Cofinity Commercial |
$11.16
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$12.69
|
| Rate for Payer: Cofinity Commercial |
$15.59
|
| Rate for Payer: Cofinity Commercial |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$10.05
|
| Rate for Payer: Cofinity Commercial |
$17.72
|
| Rate for Payer: Cofinity Commercial |
$14.43
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$64.62
|
| Rate for Payer: Cofinity Commercial |
$52.60
|
| Rate for Payer: Cofinity Commercial |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$21.32
|
| Rate for Payer: Cofinity Commercial |
$17.35
|
| Rate for Payer: Cofinity Commercial |
$24.57
|
| Rate for Payer: Cofinity Commercial |
$193.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.86
|
| Rate for Payer: Healthscope Commercial |
$17.75
|
| Rate for Payer: Healthscope Commercial |
$12.92
|
| Rate for Payer: Healthscope Commercial |
$13.96
|
| Rate for Payer: Healthscope Commercial |
$14.36
|
| Rate for Payer: Healthscope Commercial |
$15.86
|
| Rate for Payer: Healthscope Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$18.55
|
| Rate for Payer: Healthscope Commercial |
$202.72
|
| Rate for Payer: Healthscope Commercial |
$22.31
|
| Rate for Payer: Healthscope Commercial |
$25.71
|
| Rate for Payer: Healthscope Commercial |
$67.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.87
|
| Rate for Payer: PHP Commercial |
$12.21
|
| Rate for Payer: PHP Commercial |
$15.41
|
| Rate for Payer: PHP Commercial |
$21.07
|
| Rate for Payer: PHP Commercial |
$14.98
|
| Rate for Payer: PHP Commercial |
$16.76
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: PHP Commercial |
$17.52
|
| Rate for Payer: PHP Commercial |
$63.87
|
| Rate for Payer: PHP Commercial |
$13.18
|
| Rate for Payer: PHP Commercial |
$13.56
|
| Rate for Payer: PHP Commercial |
$191.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.82
|
| Rate for Payer: Priority Health SBD |
$9.77
|
| Rate for Payer: Priority Health SBD |
$10.05
|
| Rate for Payer: Priority Health SBD |
$18.00
|
| Rate for Payer: Priority Health SBD |
$47.34
|
| Rate for Payer: Priority Health SBD |
$11.42
|
| Rate for Payer: Priority Health SBD |
$12.42
|
| Rate for Payer: Priority Health SBD |
$12.98
|
| Rate for Payer: Priority Health SBD |
$11.10
|
| Rate for Payer: Priority Health SBD |
$15.62
|
| Rate for Payer: Priority Health SBD |
$9.05
|
| Rate for Payer: Priority Health SBD |
$141.91
|
| Rate for Payer: UMR Bronson Commercial |
$10.91
|
| Rate for Payer: UMR Bronson Commercial |
$6.82
|
| Rate for Payer: UMR Bronson Commercial |
$33.06
|
| Rate for Payer: UMR Bronson Commercial |
$99.11
|
| Rate for Payer: UMR Bronson Commercial |
$7.02
|
| Rate for Payer: UMR Bronson Commercial |
$8.68
|
| Rate for Payer: UMR Bronson Commercial |
$12.57
|
| Rate for Payer: UMR Bronson Commercial |
$6.32
|
| Rate for Payer: UMR Bronson Commercial |
$7.75
|
| Rate for Payer: UMR Bronson Commercial |
$9.07
|
| Rate for Payer: UMR Bronson Commercial |
$7.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.79
|
|
|
LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$225.25
|
|
|
Service Code
|
HCPCS J1953
|
| Hospital Charge Code |
77195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$202.72 |
| Rate for Payer: Aetna American Axle |
$146.41
|
| Rate for Payer: Aetna American Axle |
$48.84
|
| Rate for Payer: Aetna American Axle |
$10.37
|
| Rate for Payer: Aetna American Axle |
$11.78
|
| Rate for Payer: Aetna American Axle |
$18.57
|
| Rate for Payer: Aetna American Axle |
$11.45
|
| Rate for Payer: Aetna American Axle |
$16.11
|
| Rate for Payer: Aetna American Axle |
$9.33
|
| Rate for Payer: Aetna American Axle |
$10.08
|
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna American Axle |
$13.40
|
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna Commercial |
$16.76
|
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Commercial |
$21.07
|
| Rate for Payer: Aetna Commercial |
$12.21
|
| Rate for Payer: Aetna Commercial |
$191.46
|
| Rate for Payer: Aetna Commercial |
$17.52
|
| Rate for Payer: Aetna Commercial |
$63.87
|
| Rate for Payer: Aetna Commercial |
$15.41
|
| Rate for Payer: Aetna Commercial |
$13.18
|
| Rate for Payer: Aetna Commercial |
$13.56
|
| Rate for Payer: Aetna Medicare |
$112.62
|
| Rate for Payer: Aetna Medicare |
$9.06
|
| Rate for Payer: Aetna Medicare |
$7.76
|
| Rate for Payer: Aetna Medicare |
$7.18
|
| Rate for Payer: Aetna Medicare |
$9.86
|
| Rate for Payer: Aetna Medicare |
$10.30
|
| Rate for Payer: Aetna Medicare |
$7.98
|
| Rate for Payer: Aetna Medicare |
$37.57
|
| Rate for Payer: Aetna Medicare |
$14.28
|
| Rate for Payer: Aetna Medicare |
$12.40
|
| Rate for Payer: Aetna Medicare |
$8.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.08
|
| Rate for Payer: BCBS Complete |
$6.38
|
| Rate for Payer: BCBS Complete |
$6.20
|
| Rate for Payer: BCBS Complete |
$30.06
|
| Rate for Payer: BCBS Complete |
$7.25
|
| Rate for Payer: BCBS Complete |
$5.74
|
| Rate for Payer: BCBS Complete |
$90.10
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS Complete |
$11.43
|
| Rate for Payer: BCBS Complete |
$7.05
|
| Rate for Payer: BCBS Complete |
$8.24
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.13
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cash Price |
$12.76
|
| Rate for Payer: Cash Price |
$11.49
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cash Price |
$11.49
|
| Rate for Payer: Cash Price |
$12.76
|
| Rate for Payer: Cash Price |
$60.11
|
| Rate for Payer: Cash Price |
$60.11
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cash Price |
$180.20
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$180.20
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Cofinity Commercial |
$13.34
|
| Rate for Payer: Cofinity Commercial |
$17.35
|
| Rate for Payer: Cofinity Commercial |
$21.32
|
| Rate for Payer: Cofinity Commercial |
$17.72
|
| Rate for Payer: Cofinity Commercial |
$14.43
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$24.57
|
| Rate for Payer: Cofinity Commercial |
$52.60
|
| Rate for Payer: Cofinity Commercial |
$64.62
|
| Rate for Payer: Cofinity Commercial |
$13.72
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$11.16
|
| Rate for Payer: Cofinity Commercial |
$10.86
|
| Rate for Payer: Cofinity Commercial |
$12.35
|
| Rate for Payer: Cofinity Commercial |
$157.68
|
| Rate for Payer: Cofinity Commercial |
$193.72
|
| Rate for Payer: Cofinity Commercial |
$10.05
|
| Rate for Payer: Cofinity Commercial |
$12.69
|
| Rate for Payer: Cofinity Commercial |
$15.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.86
|
| Rate for Payer: Healthscope Commercial |
$17.75
|
| Rate for Payer: Healthscope Commercial |
$15.86
|
| Rate for Payer: Healthscope Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$67.63
|
| Rate for Payer: Healthscope Commercial |
$14.36
|
| Rate for Payer: Healthscope Commercial |
$13.96
|
| Rate for Payer: Healthscope Commercial |
$12.92
|
| Rate for Payer: Healthscope Commercial |
$25.71
|
| Rate for Payer: Healthscope Commercial |
$18.55
|
| Rate for Payer: Healthscope Commercial |
$202.72
|
| Rate for Payer: Healthscope Commercial |
$22.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.76
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: PHP Commercial |
$15.41
|
| Rate for Payer: PHP Commercial |
$63.87
|
| Rate for Payer: PHP Commercial |
$17.52
|
| Rate for Payer: PHP Commercial |
$14.98
|
| Rate for Payer: PHP Commercial |
$191.46
|
| Rate for Payer: PHP Commercial |
$21.07
|
| Rate for Payer: PHP Commercial |
$13.18
|
| Rate for Payer: PHP Commercial |
$12.21
|
| Rate for Payer: PHP Commercial |
$13.56
|
| Rate for Payer: PHP Commercial |
$16.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.37
|
| Rate for Payer: Priority Health SBD |
$11.42
|
| Rate for Payer: Priority Health SBD |
$141.91
|
| Rate for Payer: Priority Health SBD |
$18.00
|
| Rate for Payer: Priority Health SBD |
$12.42
|
| Rate for Payer: Priority Health SBD |
$15.62
|
| Rate for Payer: Priority Health SBD |
$11.10
|
| Rate for Payer: Priority Health SBD |
$47.34
|
| Rate for Payer: Priority Health SBD |
$12.98
|
| Rate for Payer: Priority Health SBD |
$10.05
|
| Rate for Payer: Priority Health SBD |
$9.05
|
| Rate for Payer: Priority Health SBD |
$9.77
|
| Rate for Payer: UMR Bronson Commercial |
$83.34
|
| Rate for Payer: UMR Bronson Commercial |
$7.30
|
| Rate for Payer: UMR Bronson Commercial |
$5.90
|
| Rate for Payer: UMR Bronson Commercial |
$27.80
|
| Rate for Payer: UMR Bronson Commercial |
$5.31
|
| Rate for Payer: UMR Bronson Commercial |
$5.74
|
| Rate for Payer: UMR Bronson Commercial |
$10.57
|
| Rate for Payer: UMR Bronson Commercial |
$6.52
|
| Rate for Payer: UMR Bronson Commercial |
$7.63
|
| Rate for Payer: UMR Bronson Commercial |
$6.71
|
| Rate for Payer: UMR Bronson Commercial |
$9.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.22
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
IP
|
$2.60
|
|
|
Service Code
|
NDC 51079082101
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna American Axle |
$1.69
|
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.69
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Healthscope Commercial |
$2.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.21
|
| Rate for Payer: PHP Commercial |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.69
|
| Rate for Payer: Priority Health SBD |
$1.64
|
| Rate for Payer: UMR Bronson Commercial |
$1.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.95
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
OP
|
$394.80
|
|
|
Service Code
|
NDC 16571078812
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.08 |
| Max. Negotiated Rate |
$355.32 |
| Rate for Payer: Aetna American Axle |
$256.62
|
| Rate for Payer: Aetna Commercial |
$335.58
|
| Rate for Payer: Aetna Medicare |
$197.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.62
|
| Rate for Payer: BCBS Complete |
$157.92
|
| Rate for Payer: Cash Price |
$315.84
|
| Rate for Payer: Cofinity Commercial |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$339.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$276.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.84
|
| Rate for Payer: Healthscope Commercial |
$355.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$296.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.58
|
| Rate for Payer: PHP Commercial |
$335.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.62
|
| Rate for Payer: Priority Health SBD |
$248.72
|
| Rate for Payer: UMR Bronson Commercial |
$146.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$296.10
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
OP
|
$298.92
|
|
|
Service Code
|
NDC 31722053712
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.60 |
| Max. Negotiated Rate |
$269.03 |
| Rate for Payer: Aetna American Axle |
$194.30
|
| Rate for Payer: Aetna Commercial |
$254.08
|
| Rate for Payer: Aetna Medicare |
$149.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.30
|
| Rate for Payer: BCBS Complete |
$119.57
|
| Rate for Payer: Cash Price |
$239.14
|
| Rate for Payer: Cofinity Commercial |
$209.24
|
| Rate for Payer: Cofinity Commercial |
$257.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$209.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.14
|
| Rate for Payer: Healthscope Commercial |
$269.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.08
|
| Rate for Payer: PHP Commercial |
$254.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.30
|
| Rate for Payer: Priority Health SBD |
$188.32
|
| Rate for Payer: UMR Bronson Commercial |
$110.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.19
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
IP
|
$188.94
|
|
|
Service Code
|
NDC 65862024608
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.13 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Aetna American Axle |
$122.81
|
| Rate for Payer: Aetna Commercial |
$160.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.81
|
| Rate for Payer: Cash Price |
$151.15
|
| Rate for Payer: Cofinity Commercial |
$132.26
|
| Rate for Payer: Cofinity Commercial |
$162.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.15
|
| Rate for Payer: Healthscope Commercial |
$170.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.60
|
| Rate for Payer: PHP Commercial |
$160.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.81
|
| Rate for Payer: Priority Health SBD |
$119.03
|
| Rate for Payer: UMR Bronson Commercial |
$83.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.70
|
|
