|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
IP
|
$298.92
|
|
|
Service Code
|
NDC 31722053712
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.52 |
| Max. Negotiated Rate |
$269.03 |
| Rate for Payer: Aetna American Axle |
$194.30
|
| Rate for Payer: Aetna Commercial |
$254.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.30
|
| 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 |
$131.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.19
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
IP
|
$197.40
|
|
|
Service Code
|
NDC 68180011316
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.86 |
| Max. Negotiated Rate |
$177.66 |
| Rate for Payer: Aetna American Axle |
$128.31
|
| Rate for Payer: Aetna Commercial |
$167.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.31
|
| Rate for Payer: Cash Price |
$157.92
|
| Rate for Payer: Cofinity Commercial |
$138.18
|
| Rate for Payer: Cofinity Commercial |
$169.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.92
|
| Rate for Payer: Healthscope Commercial |
$177.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.79
|
| Rate for Payer: PHP Commercial |
$167.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.31
|
| Rate for Payer: Priority Health SBD |
$124.36
|
| Rate for Payer: UMR Bronson Commercial |
$86.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.05
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
OP
|
$2.60
|
|
|
Service Code
|
NDC 51079082101
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna American Axle |
$1.69
|
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: Aetna Medicare |
$1.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.69
|
| Rate for Payer: BCBS Complete |
$1.04
|
| 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 |
$0.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.95
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
IP
|
$361.38
|
|
|
Service Code
|
NDC 71930006315
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.01 |
| Max. Negotiated Rate |
$325.24 |
| Rate for Payer: Aetna American Axle |
$234.90
|
| Rate for Payer: Aetna Commercial |
$307.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.90
|
| Rate for Payer: Cash Price |
$289.10
|
| Rate for Payer: Cofinity Commercial |
$252.97
|
| Rate for Payer: Cofinity Commercial |
$310.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.10
|
| Rate for Payer: Healthscope Commercial |
$325.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.17
|
| Rate for Payer: PHP Commercial |
$307.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.90
|
| Rate for Payer: Priority Health SBD |
$227.67
|
| Rate for Payer: UMR Bronson Commercial |
$159.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.04
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
IP
|
$394.80
|
|
|
Service Code
|
NDC 16571078812
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.71 |
| Max. Negotiated Rate |
$355.32 |
| Rate for Payer: Aetna American Axle |
$256.62
|
| Rate for Payer: Aetna Commercial |
$335.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.62
|
| 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 |
$173.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$296.10
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
IP
|
$238.26
|
|
|
Service Code
|
NDC 42385095512
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.83 |
| Max. Negotiated Rate |
$214.43 |
| Rate for Payer: Aetna American Axle |
$154.87
|
| Rate for Payer: Aetna Commercial |
$202.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.87
|
| Rate for Payer: Cash Price |
$190.61
|
| Rate for Payer: Cofinity Commercial |
$166.78
|
| Rate for Payer: Cofinity Commercial |
$204.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$166.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.61
|
| Rate for Payer: Healthscope Commercial |
$214.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.52
|
| Rate for Payer: PHP Commercial |
$202.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.87
|
| Rate for Payer: Priority Health SBD |
$150.10
|
| Rate for Payer: UMR Bronson Commercial |
$104.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.70
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
NDC 63739041110
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.12 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna American Axle |
$244.40
|
| Rate for Payer: Aetna Commercial |
$319.60
|
| Rate for Payer: Aetna Medicare |
$188.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.40
|
| Rate for Payer: BCBS Complete |
$150.40
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Commercial |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$323.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$263.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.80
|
| Rate for Payer: Healthscope Commercial |
$338.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.60
|
| Rate for Payer: PHP Commercial |
$319.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.40
|
| Rate for Payer: Priority Health SBD |
$236.88
|
| Rate for Payer: UMR Bronson Commercial |
$139.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.00
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
OP
|
$188.94
|
|
|
Service Code
|
NDC 65862024608
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.91 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Cofinity Commercial |
$162.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.26
|
| Rate for Payer: Aetna American Axle |
$122.81
|
| Rate for Payer: Aetna Commercial |
$160.60
|
| Rate for Payer: Aetna Medicare |
$94.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.81
|
| Rate for Payer: BCBS Complete |
$75.58
|
| Rate for Payer: Cash Price |
$151.15
|
| Rate for Payer: Cofinity Commercial |
$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 |
$69.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.70
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
OP
|
$361.38
|
|
|
Service Code
|
NDC 71930006315
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.71 |
| Max. Negotiated Rate |
$325.24 |
| Rate for Payer: Aetna American Axle |
$234.90
|
| Rate for Payer: Aetna Commercial |
$307.17
|
| Rate for Payer: Aetna Medicare |
$180.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.90
|
| Rate for Payer: BCBS Complete |
$144.55
|
| Rate for Payer: Cash Price |
$289.10
|
| Rate for Payer: Cofinity Commercial |
$252.97
|
| Rate for Payer: Cofinity Commercial |
$310.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.10
|
| Rate for Payer: Healthscope Commercial |
$325.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.17
|
| Rate for Payer: PHP Commercial |
$307.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.90
|
| Rate for Payer: Priority Health SBD |
$227.67
|
| Rate for Payer: UMR Bronson Commercial |
$133.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.04
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
OP
|
$238.26
|
|
|
Service Code
|
NDC 42385095512
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$214.43 |
| Rate for Payer: Aetna American Axle |
$154.87
|
| Rate for Payer: Aetna Commercial |
$202.52
|
| Rate for Payer: Aetna Medicare |
$119.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.87
|
| Rate for Payer: BCBS Complete |
$95.30
|
| Rate for Payer: Cash Price |
$190.61
|
| Rate for Payer: Cofinity Commercial |
$166.78
|
| Rate for Payer: Cofinity Commercial |
$204.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$166.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.61
|
| Rate for Payer: Healthscope Commercial |
$214.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.52
|
| Rate for Payer: PHP Commercial |
$202.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.87
|
| Rate for Payer: Priority Health SBD |
$150.10
|
| Rate for Payer: UMR Bronson Commercial |
$88.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.70
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
OP
|
$197.40
|
|
|
Service Code
|
NDC 68180011316
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.04 |
| Max. Negotiated Rate |
$177.66 |
| Rate for Payer: Aetna American Axle |
$128.31
|
| Rate for Payer: Aetna Commercial |
$167.79
|
| Rate for Payer: Aetna Medicare |
$98.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.31
|
| Rate for Payer: BCBS Complete |
$78.96
|
| Rate for Payer: Cash Price |
$157.92
|
| Rate for Payer: Cofinity Commercial |
$138.18
|
| Rate for Payer: Cofinity Commercial |
$169.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.92
|
| Rate for Payer: Healthscope Commercial |
$177.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.79
|
| Rate for Payer: PHP Commercial |
$167.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.31
|
| Rate for Payer: Priority Health SBD |
$124.36
|
| Rate for Payer: UMR Bronson Commercial |
$73.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.05
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
NDC 63739041110
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.44 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna American Axle |
$244.40
|
| Rate for Payer: Aetna Commercial |
$319.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.40
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Commercial |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$323.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$263.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.80
|
| Rate for Payer: Healthscope Commercial |
$338.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.60
|
| Rate for Payer: PHP Commercial |
$319.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.40
|
| Rate for Payer: Priority Health SBD |
$236.88
|
| Rate for Payer: UMR Bronson Commercial |
$165.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.00
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
IP
|
$259.35
|
|
|
Service Code
|
NDC 51079082120
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.11 |
| Max. Negotiated Rate |
$233.42 |
| Rate for Payer: PHP Commercial |
$220.45
|
| Rate for Payer: Aetna American Axle |
$168.58
|
| Rate for Payer: Aetna Commercial |
$220.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.58
|
| Rate for Payer: Cash Price |
$207.48
|
| Rate for Payer: Cofinity Commercial |
$181.54
|
| Rate for Payer: Cofinity Commercial |
$223.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.48
|
| Rate for Payer: Healthscope Commercial |
$233.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.58
|
| Rate for Payer: Priority Health SBD |
$163.39
|
| Rate for Payer: UMR Bronson Commercial |
$114.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.51
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
OP
|
$259.35
|
|
|
Service Code
|
NDC 51079082120
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.96 |
| Max. Negotiated Rate |
$233.42 |
| Rate for Payer: Aetna American Axle |
$168.58
|
| Rate for Payer: Aetna Commercial |
$220.45
|
| Rate for Payer: Aetna Medicare |
$129.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.58
|
| Rate for Payer: BCBS Complete |
$103.74
|
| Rate for Payer: Cash Price |
$207.48
|
| Rate for Payer: Cofinity Commercial |
$181.54
|
| Rate for Payer: Cofinity Commercial |
$223.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.48
|
| Rate for Payer: Healthscope Commercial |
$233.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.45
|
| Rate for Payer: PHP Commercial |
$220.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.58
|
| Rate for Payer: Priority Health SBD |
$163.39
|
| Rate for Payer: UMR Bronson Commercial |
$95.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.51
|
|
|
LEVETIRACETAM ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$221.16
|
|
|
Service Code
|
NDC 68180011707
|
| Hospital Charge Code |
93834
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.83 |
| Max. Negotiated Rate |
$199.04 |
| Rate for Payer: Aetna American Axle |
$143.75
|
| Rate for Payer: Aetna Commercial |
$187.99
|
| Rate for Payer: Aetna Medicare |
$110.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.75
|
| Rate for Payer: BCBS Complete |
$88.46
|
| Rate for Payer: Cash Price |
$176.93
|
| Rate for Payer: Cofinity Commercial |
$154.81
|
| Rate for Payer: Cofinity Commercial |
$190.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.93
|
| Rate for Payer: Healthscope Commercial |
$199.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.99
|
| Rate for Payer: PHP Commercial |
$187.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.75
|
| Rate for Payer: Priority Health SBD |
$139.33
|
| Rate for Payer: UMR Bronson Commercial |
$81.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.87
|
|
|
LEVETIRACETAM ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$221.16
|
|
|
Service Code
|
NDC 68180011707
|
| Hospital Charge Code |
93834
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.31 |
| Max. Negotiated Rate |
$199.04 |
| Rate for Payer: Aetna American Axle |
$143.75
|
| Rate for Payer: Aetna Commercial |
$187.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.75
|
| Rate for Payer: Cash Price |
$176.93
|
| Rate for Payer: Cofinity Commercial |
$154.81
|
| Rate for Payer: Cofinity Commercial |
$190.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.93
|
| Rate for Payer: Healthscope Commercial |
$199.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.99
|
| Rate for Payer: PHP Commercial |
$187.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.75
|
| Rate for Payer: Priority Health SBD |
$139.33
|
| Rate for Payer: UMR Bronson Commercial |
$97.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.87
|
|
|
LEVOBUNOLOL 0.5 % EYE DROPS
|
Facility
|
OP
|
$16.38
|
|
|
Service Code
|
NDC 24208050505
|
| Hospital Charge Code |
10394
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$14.74 |
| Rate for Payer: Aetna American Axle |
$10.65
|
| Rate for Payer: Aetna Commercial |
$13.92
|
| Rate for Payer: Aetna Medicare |
$8.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.65
|
| Rate for Payer: BCBS Complete |
$6.55
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$14.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.10
|
| Rate for Payer: Healthscope Commercial |
$14.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.92
|
| Rate for Payer: PHP Commercial |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.65
|
| Rate for Payer: Priority Health SBD |
$10.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.28
|
|
|
LEVOBUNOLOL 0.5 % EYE DROPS
|
Facility
|
IP
|
$16.38
|
|
|
Service Code
|
NDC 24208050505
|
| Hospital Charge Code |
10394
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$14.74 |
| Rate for Payer: Aetna American Axle |
$10.65
|
| Rate for Payer: Aetna Commercial |
$13.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.65
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$14.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.10
|
| Rate for Payer: Healthscope Commercial |
$14.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.92
|
| Rate for Payer: PHP Commercial |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.65
|
| Rate for Payer: Priority Health SBD |
$10.32
|
| Rate for Payer: UMR Bronson Commercial |
$7.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.28
|
|
|
LEVOCARNITINE 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$278.01
|
|
|
Service Code
|
NDC 70954014010
|
| Hospital Charge Code |
108122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.32 |
| Max. Negotiated Rate |
$250.21 |
| Rate for Payer: Aetna American Axle |
$180.71
|
| Rate for Payer: Aetna Commercial |
$236.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.71
|
| Rate for Payer: Cash Price |
$222.41
|
| Rate for Payer: Cofinity Commercial |
$194.61
|
| Rate for Payer: Cofinity Commercial |
$239.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.41
|
| Rate for Payer: Healthscope Commercial |
$250.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.31
|
| Rate for Payer: PHP Commercial |
$236.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.71
|
| Rate for Payer: Priority Health SBD |
$175.15
|
| Rate for Payer: UMR Bronson Commercial |
$122.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.51
|
|
|
LEVOCARNITINE 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$448.40
|
|
|
Service Code
|
NDC 54482014801
|
| Hospital Charge Code |
108122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.30 |
| Max. Negotiated Rate |
$403.56 |
| Rate for Payer: Aetna American Axle |
$291.46
|
| Rate for Payer: Aetna Commercial |
$381.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.46
|
| Rate for Payer: Cash Price |
$358.72
|
| Rate for Payer: Cofinity Commercial |
$313.88
|
| Rate for Payer: Cofinity Commercial |
$385.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$313.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.72
|
| Rate for Payer: Healthscope Commercial |
$403.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.14
|
| Rate for Payer: PHP Commercial |
$381.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.46
|
| Rate for Payer: Priority Health SBD |
$282.49
|
| Rate for Payer: UMR Bronson Commercial |
$197.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.30
|
|
|
LEVOCARNITINE 100 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$448.40
|
|
|
Service Code
|
NDC 54482014801
|
| Hospital Charge Code |
108122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.91 |
| Max. Negotiated Rate |
$403.56 |
| Rate for Payer: Aetna American Axle |
$291.46
|
| Rate for Payer: Aetna Commercial |
$381.14
|
| Rate for Payer: Aetna Medicare |
$224.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.46
|
| Rate for Payer: BCBS Complete |
$179.36
|
| Rate for Payer: Cash Price |
$358.72
|
| Rate for Payer: Cofinity Commercial |
$313.88
|
| Rate for Payer: Cofinity Commercial |
$385.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$313.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.72
|
| Rate for Payer: Healthscope Commercial |
$403.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.14
|
| Rate for Payer: PHP Commercial |
$381.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.46
|
| Rate for Payer: Priority Health SBD |
$282.49
|
| Rate for Payer: UMR Bronson Commercial |
$165.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.30
|
|
|
LEVOCARNITINE 100 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$278.01
|
|
|
Service Code
|
NDC 70954014010
|
| Hospital Charge Code |
108122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.86 |
| Max. Negotiated Rate |
$250.21 |
| Rate for Payer: Aetna American Axle |
$180.71
|
| Rate for Payer: Aetna Commercial |
$236.31
|
| Rate for Payer: Aetna Medicare |
$139.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.71
|
| Rate for Payer: BCBS Complete |
$111.20
|
| Rate for Payer: Cash Price |
$222.41
|
| Rate for Payer: Cofinity Commercial |
$194.61
|
| Rate for Payer: Cofinity Commercial |
$239.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.41
|
| Rate for Payer: Healthscope Commercial |
$250.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.31
|
| Rate for Payer: PHP Commercial |
$236.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.71
|
| Rate for Payer: Priority Health SBD |
$175.15
|
| Rate for Payer: UMR Bronson Commercial |
$102.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.51
|
|
|
LEVOCARNITINE 200 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$89.23
|
|
|
Service Code
|
HCPCS J1955
|
| Hospital Charge Code |
20954
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$80.31 |
| Rate for Payer: Priority Health Narrow Network |
$20.45
|
| Rate for Payer: Priority Health Narrow Network |
$20.45
|
| Rate for Payer: Priority Health SBD |
$71.76
|
| Rate for Payer: Priority Health SBD |
$226.29
|
| Rate for Payer: Priority Health SBD |
$56.21
|
| Rate for Payer: Priority Health SBD |
$63.09
|
| Rate for Payer: UMR Bronson Commercial |
$42.14
|
| Rate for Payer: UMR Bronson Commercial |
$33.02
|
| Rate for Payer: UMR Bronson Commercial |
$132.90
|
| Rate for Payer: UMR Bronson Commercial |
$37.06
|
| Rate for Payer: Aetna American Axle |
$58.00
|
| Rate for Payer: Aetna American Axle |
$233.47
|
| Rate for Payer: Aetna American Axle |
$74.04
|
| Rate for Payer: Aetna American Axle |
$65.10
|
| Rate for Payer: Aetna Commercial |
$75.85
|
| Rate for Payer: Aetna Commercial |
$96.82
|
| Rate for Payer: Aetna Commercial |
$305.31
|
| Rate for Payer: Aetna Commercial |
$85.13
|
| Rate for Payer: Aetna Medicare |
$50.08
|
| Rate for Payer: Aetna Medicare |
$44.62
|
| Rate for Payer: Aetna Medicare |
$56.95
|
| Rate for Payer: Aetna Medicare |
$179.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.04
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS Complete |
$45.56
|
| Rate for Payer: BCBS Complete |
$143.68
|
| Rate for Payer: BCBS Complete |
$40.06
|
| Rate for Payer: BCBS Trust/PPO |
$74.73
|
| Rate for Payer: BCBS Trust/PPO |
$74.73
|
| Rate for Payer: BCBS Trust/PPO |
$74.73
|
| Rate for Payer: BCBS Trust/PPO |
$74.73
|
| Rate for Payer: BCN Commercial |
$74.73
|
| Rate for Payer: BCN Commercial |
$74.73
|
| Rate for Payer: BCN Commercial |
$74.73
|
| Rate for Payer: BCN Commercial |
$74.73
|
| Rate for Payer: Cash Price |
$91.12
|
| Rate for Payer: Cash Price |
$287.35
|
| Rate for Payer: Cash Price |
$71.38
|
| Rate for Payer: Cash Price |
$80.12
|
| Rate for Payer: Cash Price |
$71.38
|
| Rate for Payer: Cash Price |
$80.12
|
| Rate for Payer: Cash Price |
$91.12
|
| Rate for Payer: Cash Price |
$287.35
|
| Rate for Payer: Cofinity Commercial |
$308.90
|
| Rate for Payer: Cofinity Commercial |
$86.13
|
| Rate for Payer: Cofinity Commercial |
$70.10
|
| Rate for Payer: Cofinity Commercial |
$76.74
|
| Rate for Payer: Cofinity Commercial |
$251.43
|
| Rate for Payer: Cofinity Commercial |
$62.46
|
| Rate for Payer: Cofinity Commercial |
$97.95
|
| Rate for Payer: Cofinity Commercial |
$79.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$251.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.12
|
| Rate for Payer: Healthscope Commercial |
$90.14
|
| Rate for Payer: Healthscope Commercial |
$323.27
|
| Rate for Payer: Healthscope Commercial |
$80.31
|
| Rate for Payer: Healthscope Commercial |
$102.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.85
|
| Rate for Payer: PHP Commercial |
$85.13
|
| Rate for Payer: PHP Commercial |
$305.31
|
| Rate for Payer: PHP Commercial |
$75.85
|
| Rate for Payer: PHP Commercial |
$96.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.56
|
| Rate for Payer: Priority Health Narrow Network |
$20.45
|
| Rate for Payer: Priority Health Narrow Network |
$20.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.42
|
|
|
LEVOCARNITINE 200 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$359.19
|
|
|
Service Code
|
HCPCS J1955
|
| Hospital Charge Code |
20954
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$158.04 |
| Max. Negotiated Rate |
$323.27 |
| Rate for Payer: Aetna American Axle |
$233.47
|
| Rate for Payer: Aetna American Axle |
$74.04
|
| Rate for Payer: Aetna American Axle |
$65.10
|
| Rate for Payer: Aetna American Axle |
$58.00
|
| Rate for Payer: Aetna Commercial |
$305.31
|
| Rate for Payer: Aetna Commercial |
$75.85
|
| Rate for Payer: Aetna Commercial |
$96.82
|
| Rate for Payer: Aetna Commercial |
$85.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.47
|
| Rate for Payer: Cash Price |
$91.12
|
| Rate for Payer: Cash Price |
$287.35
|
| Rate for Payer: Cash Price |
$80.12
|
| Rate for Payer: Cash Price |
$71.38
|
| Rate for Payer: Cofinity Commercial |
$70.10
|
| Rate for Payer: Cofinity Commercial |
$76.74
|
| Rate for Payer: Cofinity Commercial |
$62.46
|
| Rate for Payer: Cofinity Commercial |
$251.43
|
| Rate for Payer: Cofinity Commercial |
$79.73
|
| Rate for Payer: Cofinity Commercial |
$97.95
|
| Rate for Payer: Cofinity Commercial |
$308.90
|
| Rate for Payer: Cofinity Commercial |
$86.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$251.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.12
|
| Rate for Payer: Healthscope Commercial |
$323.27
|
| Rate for Payer: Healthscope Commercial |
$90.14
|
| Rate for Payer: Healthscope Commercial |
$102.51
|
| Rate for Payer: Healthscope Commercial |
$80.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.31
|
| Rate for Payer: PHP Commercial |
$305.31
|
| Rate for Payer: PHP Commercial |
$75.85
|
| Rate for Payer: PHP Commercial |
$85.13
|
| Rate for Payer: PHP Commercial |
$96.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.10
|
| Rate for Payer: Priority Health SBD |
$56.21
|
| Rate for Payer: Priority Health SBD |
$63.09
|
| Rate for Payer: Priority Health SBD |
$71.76
|
| Rate for Payer: Priority Health SBD |
$226.29
|
| Rate for Payer: UMR Bronson Commercial |
$158.04
|
| Rate for Payer: UMR Bronson Commercial |
$39.26
|
| Rate for Payer: UMR Bronson Commercial |
$50.12
|
| Rate for Payer: UMR Bronson Commercial |
$44.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.39
|
|
|
LEVOCARNITINE 330 MG TABLET
|
Facility
|
IP
|
$342.58
|
|
|
Service Code
|
NDC 50383017290
|
| Hospital Charge Code |
20952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.74 |
| Max. Negotiated Rate |
$308.32 |
| Rate for Payer: Cofinity Commercial |
$239.81
|
| Rate for Payer: Cofinity Commercial |
$294.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$239.81
|
| Rate for Payer: Aetna American Axle |
$222.68
|
| Rate for Payer: Aetna Commercial |
$291.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.68
|
| Rate for Payer: Cash Price |
$274.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.06
|
| Rate for Payer: Healthscope Commercial |
$308.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.19
|
| Rate for Payer: PHP Commercial |
$291.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.68
|
| Rate for Payer: Priority Health SBD |
$215.83
|
| Rate for Payer: UMR Bronson Commercial |
$150.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.94
|
|
