|
LEUPROLIDE ACETATE (6 MONTH) 45 MG INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$34,277.98
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
152942
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.15 |
| Max. Negotiated Rate |
$34,277.98 |
| Rate for Payer: Aetna Commercial |
$30,850.19
|
| Rate for Payer: Aetna Medicare |
$176.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.25
|
| Rate for Payer: ASR ASR |
$33,249.64
|
| Rate for Payer: BCBS Complete |
$96.77
|
| Rate for Payer: BCBS MAPPO |
$176.20
|
| Rate for Payer: BCBS Trust/PPO |
$28,262.20
|
| Rate for Payer: BCN Commercial |
$28,262.20
|
| Rate for Payer: BCN Medicare Advantage |
$176.20
|
| Rate for Payer: Cash Price |
$27,422.39
|
| Rate for Payer: Cash Price |
$27,422.39
|
| Rate for Payer: Cofinity Commercial |
$32,221.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27,422.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.20
|
| Rate for Payer: Healthscope Commercial |
$33,249.64
|
| Rate for Payer: Healthscope Whirlpool |
$34,277.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$176.20
|
| Rate for Payer: Mclaren Commercial |
$30,850.19
|
| Rate for Payer: Mclaren Medicaid |
$176.20
|
| Rate for Payer: Mclaren Medicare |
$176.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.01
|
| Rate for Payer: Meridian Medicaid |
$96.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$193.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29,136.29
|
| Rate for Payer: Nomi Health Commercial |
$28,107.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25,708.49
|
| Rate for Payer: PACE Medicare |
$167.39
|
| Rate for Payer: PACE SWMI |
$176.20
|
| Rate for Payer: PHP Commercial |
$193.82
|
| Rate for Payer: PHP Medicaid |
$94.44
|
| Rate for Payer: PHP Medicare Advantage |
$176.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$177.22
|
| Rate for Payer: Priority Health Medicare |
$176.20
|
| Rate for Payer: Priority Health Narrow Network |
$141.78
|
| Rate for Payer: Railroad Medicare Medicare |
$176.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30,164.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$176.20
|
| Rate for Payer: UHC Exchange |
$273.11
|
| Rate for Payer: UHC Medicaid |
$92.15
|
| Rate for Payer: UHCCP DNSP |
$176.20
|
| Rate for Payer: UHCCP Medicaid |
$92.15
|
| Rate for Payer: VA VA |
$176.20
|
|
|
LEUPROLIDE ACETATE (6 MONTH) 45 MG INTRAMUSCULAR SYRINGE KIT
|
Facility
|
IP
|
$34,277.98
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
152942
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25,708.49 |
| Max. Negotiated Rate |
$34,277.98 |
| Rate for Payer: Aetna Commercial |
$30,850.19
|
| Rate for Payer: ASR ASR |
$33,249.64
|
| Rate for Payer: BCBS Trust/PPO |
$28,149.08
|
| Rate for Payer: BCN Commercial |
$28,149.08
|
| Rate for Payer: Cash Price |
$27,422.39
|
| Rate for Payer: Cofinity Commercial |
$32,221.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27,422.39
|
| Rate for Payer: Healthscope Commercial |
$33,249.64
|
| Rate for Payer: Healthscope Whirlpool |
$34,277.98
|
| Rate for Payer: Mclaren Commercial |
$30,850.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29,136.29
|
| Rate for Payer: Nomi Health Commercial |
$28,107.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25,708.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30,164.63
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
NDC 68084085901
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.12 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: Aetna Commercial |
$338.40
|
| Rate for Payer: Aetna Medicare |
$139.12
|
| Rate for Payer: ASR ASR |
$364.72
|
| Rate for Payer: BCBS Complete |
$150.40
|
| Rate for Payer: BCBS Trust/PPO |
$310.01
|
| Rate for Payer: BCN Commercial |
$310.01
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Commercial |
$353.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.80
|
| Rate for Payer: Healthscope Commercial |
$364.72
|
| Rate for Payer: Healthscope Whirlpool |
$376.00
|
| Rate for Payer: Mclaren Commercial |
$338.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$300.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.60
|
| Rate for Payer: Nomi Health Commercial |
$308.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$329.45
|
| Rate for Payer: Priority Health Narrow Network |
$263.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$330.88
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
OP
|
$343.10
|
|
|
Service Code
|
NDC 904712361
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.95 |
| Max. Negotiated Rate |
$343.10 |
| Rate for Payer: Aetna Commercial |
$308.79
|
| Rate for Payer: Aetna Medicare |
$126.95
|
| Rate for Payer: ASR ASR |
$332.81
|
| Rate for Payer: BCBS Complete |
$137.24
|
| Rate for Payer: BCBS Trust/PPO |
$282.89
|
| Rate for Payer: BCN Commercial |
$282.89
|
| Rate for Payer: Cash Price |
$274.48
|
| Rate for Payer: Cofinity Commercial |
$322.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.48
|
| Rate for Payer: Healthscope Commercial |
$332.81
|
| Rate for Payer: Healthscope Whirlpool |
$343.10
|
| Rate for Payer: Mclaren Commercial |
$308.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.63
|
| Rate for Payer: Nomi Health Commercial |
$281.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$300.62
|
| Rate for Payer: Priority Health Narrow Network |
$240.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$301.93
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
IP
|
$3.76
|
|
|
Service Code
|
NDC 68084085911
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: ASR ASR |
$3.65
|
| Rate for Payer: BCBS Trust/PPO |
$3.09
|
| Rate for Payer: BCN Commercial |
$3.09
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: Cofinity Commercial |
$3.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.01
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: Healthscope Whirlpool |
$3.76
|
| Rate for Payer: Mclaren Commercial |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: Nomi Health Commercial |
$3.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.31
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
NDC 68084085901
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$282.00 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: Aetna Commercial |
$338.40
|
| Rate for Payer: ASR ASR |
$364.72
|
| Rate for Payer: BCBS Trust/PPO |
$308.77
|
| Rate for Payer: BCN Commercial |
$308.77
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Commercial |
$353.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.80
|
| Rate for Payer: Healthscope Commercial |
$364.72
|
| Rate for Payer: Healthscope Whirlpool |
$376.00
|
| Rate for Payer: Mclaren Commercial |
$338.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.60
|
| Rate for Payer: Nomi Health Commercial |
$308.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$330.88
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
IP
|
$343.10
|
|
|
Service Code
|
NDC 904712361
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.32 |
| Max. Negotiated Rate |
$343.10 |
| Rate for Payer: Aetna Commercial |
$308.79
|
| Rate for Payer: ASR ASR |
$332.81
|
| Rate for Payer: BCBS Trust/PPO |
$281.75
|
| Rate for Payer: BCN Commercial |
$281.75
|
| Rate for Payer: Cash Price |
$274.48
|
| Rate for Payer: Cofinity Commercial |
$322.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.48
|
| Rate for Payer: Healthscope Commercial |
$332.81
|
| Rate for Payer: Healthscope Whirlpool |
$343.10
|
| Rate for Payer: Mclaren Commercial |
$308.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.63
|
| Rate for Payer: Nomi Health Commercial |
$281.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$301.93
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
OP
|
$3.76
|
|
|
Service Code
|
NDC 68084085911
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Aetna Medicare |
$1.39
|
| Rate for Payer: ASR ASR |
$3.65
|
| Rate for Payer: BCBS Complete |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$3.10
|
| Rate for Payer: BCN Commercial |
$3.10
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: Cofinity Commercial |
$3.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.01
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: Healthscope Whirlpool |
$3.76
|
| Rate for Payer: Mclaren Commercial |
$3.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: Nomi Health Commercial |
$3.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.29
|
| Rate for Payer: Priority Health Narrow Network |
$2.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.31
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$14.74
|
|
|
Service Code
|
NDC 121479950
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$14.74 |
| Rate for Payer: Aetna Commercial |
$13.26
|
| Rate for Payer: Aetna Medicare |
$5.45
|
| Rate for Payer: ASR ASR |
$14.29
|
| Rate for Payer: BCBS Complete |
$5.89
|
| Rate for Payer: BCBS Trust/PPO |
$12.15
|
| Rate for Payer: BCN Commercial |
$12.15
|
| Rate for Payer: Cash Price |
$11.79
|
| Rate for Payer: Cofinity Commercial |
$13.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.79
|
| Rate for Payer: Healthscope Commercial |
$14.29
|
| Rate for Payer: Healthscope Whirlpool |
$14.74
|
| Rate for Payer: Mclaren Commercial |
$13.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.53
|
| Rate for Payer: Nomi Health Commercial |
$12.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12.91
|
| Rate for Payer: Priority Health Narrow Network |
$10.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.97
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$14.74
|
|
|
Service Code
|
NDC 121479950
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$14.74 |
| Rate for Payer: Aetna Commercial |
$13.26
|
| Rate for Payer: ASR ASR |
$14.29
|
| Rate for Payer: BCBS Trust/PPO |
$12.10
|
| Rate for Payer: BCN Commercial |
$12.10
|
| Rate for Payer: Cash Price |
$11.79
|
| Rate for Payer: Cofinity Commercial |
$13.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.79
|
| Rate for Payer: Healthscope Commercial |
$14.29
|
| Rate for Payer: Healthscope Whirlpool |
$14.74
|
| Rate for Payer: Mclaren Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.53
|
| Rate for Payer: Nomi Health Commercial |
$12.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.97
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$15.53
|
|
|
Service Code
|
NDC 50268047011
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$15.53 |
| Rate for Payer: Aetna Commercial |
$13.98
|
| Rate for Payer: Aetna Medicare |
$5.75
|
| Rate for Payer: ASR ASR |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.21
|
| Rate for Payer: BCBS Trust/PPO |
$12.80
|
| Rate for Payer: BCN Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Cofinity Commercial |
$14.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.42
|
| Rate for Payer: Healthscope Commercial |
$15.06
|
| Rate for Payer: Healthscope Whirlpool |
$15.53
|
| Rate for Payer: Mclaren Commercial |
$13.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.20
|
| Rate for Payer: Nomi Health Commercial |
$12.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.61
|
| Rate for Payer: Priority Health Narrow Network |
$10.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.66
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$13.34
|
|
|
Service Code
|
NDC 904726541
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$13.34 |
| Rate for Payer: Aetna Commercial |
$12.01
|
| Rate for Payer: ASR ASR |
$12.94
|
| Rate for Payer: BCBS Trust/PPO |
$10.96
|
| Rate for Payer: BCN Commercial |
$10.96
|
| Rate for Payer: Cash Price |
$10.68
|
| Rate for Payer: Cofinity Commercial |
$12.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.68
|
| Rate for Payer: Healthscope Commercial |
$12.94
|
| Rate for Payer: Healthscope Whirlpool |
$13.34
|
| Rate for Payer: Mclaren Commercial |
$12.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.34
|
| Rate for Payer: Nomi Health Commercial |
$10.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.74
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$13.34
|
|
|
Service Code
|
NDC 904726592
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$13.34 |
| Rate for Payer: Aetna Commercial |
$12.01
|
| Rate for Payer: ASR ASR |
$12.94
|
| Rate for Payer: BCBS Trust/PPO |
$10.96
|
| Rate for Payer: BCN Commercial |
$10.96
|
| Rate for Payer: Cash Price |
$10.68
|
| Rate for Payer: Cofinity Commercial |
$12.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.68
|
| Rate for Payer: Healthscope Commercial |
$12.94
|
| Rate for Payer: Healthscope Whirlpool |
$13.34
|
| Rate for Payer: Mclaren Commercial |
$12.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.34
|
| Rate for Payer: Nomi Health Commercial |
$10.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.74
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$13.34
|
|
|
Service Code
|
NDC 904726592
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$13.34 |
| Rate for Payer: Aetna Commercial |
$12.01
|
| Rate for Payer: Aetna Medicare |
$4.94
|
| Rate for Payer: ASR ASR |
$12.94
|
| Rate for Payer: BCBS Complete |
$5.34
|
| Rate for Payer: BCBS Trust/PPO |
$11.00
|
| Rate for Payer: BCN Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$10.68
|
| Rate for Payer: Cofinity Commercial |
$12.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.68
|
| Rate for Payer: Healthscope Commercial |
$12.94
|
| Rate for Payer: Healthscope Whirlpool |
$13.34
|
| Rate for Payer: Mclaren Commercial |
$12.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.34
|
| Rate for Payer: Nomi Health Commercial |
$10.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.69
|
| Rate for Payer: Priority Health Narrow Network |
$9.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.74
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$22.94
|
|
|
Service Code
|
NDC 121479905
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.49 |
| Max. Negotiated Rate |
$22.94 |
| Rate for Payer: Aetna Commercial |
$20.65
|
| Rate for Payer: Aetna Medicare |
$8.49
|
| Rate for Payer: ASR ASR |
$22.25
|
| Rate for Payer: BCBS Complete |
$9.18
|
| Rate for Payer: BCBS Trust/PPO |
$18.92
|
| Rate for Payer: BCN Commercial |
$18.92
|
| Rate for Payer: Cash Price |
$18.35
|
| Rate for Payer: Cofinity Commercial |
$21.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.35
|
| Rate for Payer: Healthscope Commercial |
$22.25
|
| Rate for Payer: Healthscope Whirlpool |
$22.94
|
| Rate for Payer: Mclaren Commercial |
$20.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.50
|
| Rate for Payer: Nomi Health Commercial |
$18.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20.10
|
| Rate for Payer: Priority Health Narrow Network |
$16.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.19
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$15.53
|
|
|
Service Code
|
NDC 50268047013
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$15.53 |
| Rate for Payer: Aetna Commercial |
$13.98
|
| Rate for Payer: ASR ASR |
$15.06
|
| Rate for Payer: BCBS Trust/PPO |
$12.75
|
| Rate for Payer: BCN Commercial |
$12.75
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Cofinity Commercial |
$14.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.42
|
| Rate for Payer: Healthscope Commercial |
$15.06
|
| Rate for Payer: Healthscope Whirlpool |
$15.53
|
| Rate for Payer: Mclaren Commercial |
$13.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.20
|
| Rate for Payer: Nomi Health Commercial |
$12.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.66
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$15.53
|
|
|
Service Code
|
NDC 50268047013
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$15.53 |
| Rate for Payer: Aetna Commercial |
$13.98
|
| Rate for Payer: Aetna Medicare |
$5.75
|
| Rate for Payer: ASR ASR |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.21
|
| Rate for Payer: BCBS Trust/PPO |
$12.80
|
| Rate for Payer: BCN Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Cofinity Commercial |
$14.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.42
|
| Rate for Payer: Healthscope Commercial |
$15.06
|
| Rate for Payer: Healthscope Whirlpool |
$15.53
|
| Rate for Payer: Mclaren Commercial |
$13.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.20
|
| Rate for Payer: Nomi Health Commercial |
$12.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.61
|
| Rate for Payer: Priority Health Narrow Network |
$10.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.66
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$13.34
|
|
|
Service Code
|
NDC 904726541
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$13.34 |
| Rate for Payer: Aetna Commercial |
$12.01
|
| Rate for Payer: Aetna Medicare |
$4.94
|
| Rate for Payer: ASR ASR |
$12.94
|
| Rate for Payer: BCBS Complete |
$5.34
|
| Rate for Payer: BCBS Trust/PPO |
$11.00
|
| Rate for Payer: BCN Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$10.68
|
| Rate for Payer: Cofinity Commercial |
$12.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.68
|
| Rate for Payer: Healthscope Commercial |
$12.94
|
| Rate for Payer: Healthscope Whirlpool |
$13.34
|
| Rate for Payer: Mclaren Commercial |
$12.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.34
|
| Rate for Payer: Nomi Health Commercial |
$10.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.69
|
| Rate for Payer: Priority Health Narrow Network |
$9.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.74
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$15.53
|
|
|
Service Code
|
NDC 50268047011
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$15.53 |
| Rate for Payer: Aetna Commercial |
$13.98
|
| Rate for Payer: ASR ASR |
$15.06
|
| Rate for Payer: BCBS Trust/PPO |
$12.75
|
| Rate for Payer: BCN Commercial |
$12.75
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Cofinity Commercial |
$14.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.42
|
| Rate for Payer: Healthscope Commercial |
$15.06
|
| Rate for Payer: Healthscope Whirlpool |
$15.53
|
| Rate for Payer: Mclaren Commercial |
$13.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.20
|
| Rate for Payer: Nomi Health Commercial |
$12.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.66
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$22.94
|
|
|
Service Code
|
NDC 121479905
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.21 |
| Max. Negotiated Rate |
$22.94 |
| Rate for Payer: Aetna Commercial |
$20.65
|
| Rate for Payer: ASR ASR |
$22.25
|
| Rate for Payer: BCBS Trust/PPO |
$18.84
|
| Rate for Payer: BCN Commercial |
$18.84
|
| Rate for Payer: Cash Price |
$18.35
|
| Rate for Payer: Cofinity Commercial |
$21.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.35
|
| Rate for Payer: Healthscope Commercial |
$22.25
|
| Rate for Payer: Healthscope Whirlpool |
$22.94
|
| Rate for Payer: Mclaren Commercial |
$20.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.50
|
| Rate for Payer: Nomi Health Commercial |
$18.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.19
|
|
|
LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.37
|
|
|
Service Code
|
HCPCS J1953
|
| Hospital Charge Code |
77195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$15.37 |
| Rate for Payer: Aetna Commercial |
$13.83
|
| Rate for Payer: Aetna Commercial |
$13.38
|
| Rate for Payer: Aetna Commercial |
$14.36
|
| Rate for Payer: Aetna Commercial |
$16.65
|
| Rate for Payer: Aetna Commercial |
$207.99
|
| Rate for Payer: Aetna Commercial |
$15.99
|
| Rate for Payer: Aetna Commercial |
$18.14
|
| Rate for Payer: ASR ASR |
$17.95
|
| Rate for Payer: ASR ASR |
$15.47
|
| Rate for Payer: ASR ASR |
$224.17
|
| Rate for Payer: ASR ASR |
$14.42
|
| Rate for Payer: ASR ASR |
$14.91
|
| Rate for Payer: ASR ASR |
$17.23
|
| Rate for Payer: ASR ASR |
$19.55
|
| Rate for Payer: BCBS Trust/PPO |
$189.78
|
| Rate for Payer: BCBS Trust/PPO |
$16.55
|
| Rate for Payer: BCBS Trust/PPO |
$15.19
|
| Rate for Payer: BCBS Trust/PPO |
$12.62
|
| Rate for Payer: BCBS Trust/PPO |
$12.21
|
| Rate for Payer: BCBS Trust/PPO |
$14.59
|
| Rate for Payer: BCBS Trust/PPO |
$13.10
|
| Rate for Payer: BCN Commercial |
$16.55
|
| Rate for Payer: BCN Commercial |
$13.10
|
| Rate for Payer: BCN Commercial |
$12.62
|
| Rate for Payer: BCN Commercial |
$14.59
|
| Rate for Payer: BCN Commercial |
$15.19
|
| Rate for Payer: BCN Commercial |
$12.21
|
| Rate for Payer: BCN Commercial |
$189.78
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cash Price |
$12.76
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cash Price |
$184.88
|
| Rate for Payer: Cash Price |
$16.12
|
| Rate for Payer: Cash Price |
$14.21
|
| Rate for Payer: Cofinity Commercial |
$18.95
|
| Rate for Payer: Cofinity Commercial |
$14.45
|
| Rate for Payer: Cofinity Commercial |
$16.70
|
| Rate for Payer: Cofinity Commercial |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$14.99
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Cofinity Commercial |
$217.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.88
|
| Rate for Payer: Healthscope Commercial |
$14.91
|
| Rate for Payer: Healthscope Commercial |
$15.47
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Healthscope Commercial |
$14.42
|
| Rate for Payer: Healthscope Commercial |
$17.95
|
| Rate for Payer: Healthscope Commercial |
$19.55
|
| Rate for Payer: Healthscope Commercial |
$224.17
|
| Rate for Payer: Healthscope Whirlpool |
$18.50
|
| Rate for Payer: Healthscope Whirlpool |
$14.86
|
| Rate for Payer: Healthscope Whirlpool |
$15.37
|
| Rate for Payer: Healthscope Whirlpool |
$20.16
|
| Rate for Payer: Healthscope Whirlpool |
$15.95
|
| Rate for Payer: Healthscope Whirlpool |
$231.10
|
| Rate for Payer: Healthscope Whirlpool |
$17.76
|
| Rate for Payer: Mclaren Commercial |
$13.38
|
| Rate for Payer: Mclaren Commercial |
$15.99
|
| Rate for Payer: Mclaren Commercial |
$13.83
|
| Rate for Payer: Mclaren Commercial |
$16.65
|
| Rate for Payer: Mclaren Commercial |
$18.14
|
| Rate for Payer: Mclaren Commercial |
$14.36
|
| Rate for Payer: Mclaren Commercial |
$207.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.56
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: Nomi Health Commercial |
$13.08
|
| Rate for Payer: Nomi Health Commercial |
$16.53
|
| Rate for Payer: Nomi Health Commercial |
$189.51
|
| Rate for Payer: Nomi Health Commercial |
$12.60
|
| Rate for Payer: Nomi Health Commercial |
$14.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.28
|
|
|
LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17.76
|
|
|
Service Code
|
HCPCS J1953
|
| Hospital Charge Code |
77195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Aetna Commercial |
$15.99
|
| Rate for Payer: Aetna Commercial |
$14.36
|
| Rate for Payer: Aetna Commercial |
$13.83
|
| Rate for Payer: Aetna Commercial |
$16.65
|
| Rate for Payer: Aetna Commercial |
$18.14
|
| Rate for Payer: Aetna Commercial |
$207.99
|
| Rate for Payer: Aetna Commercial |
$13.38
|
| Rate for Payer: Aetna Medicare |
$5.90
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Aetna Medicare |
$7.46
|
| Rate for Payer: Aetna Medicare |
$6.84
|
| Rate for Payer: Aetna Medicare |
$85.51
|
| Rate for Payer: Aetna Medicare |
$6.57
|
| Rate for Payer: Aetna Medicare |
$5.69
|
| Rate for Payer: ASR ASR |
$17.23
|
| Rate for Payer: ASR ASR |
$14.91
|
| Rate for Payer: ASR ASR |
$14.42
|
| Rate for Payer: ASR ASR |
$15.47
|
| Rate for Payer: ASR ASR |
$19.55
|
| Rate for Payer: ASR ASR |
$224.17
|
| Rate for Payer: ASR ASR |
$17.95
|
| Rate for Payer: BCBS Complete |
$5.95
|
| Rate for Payer: BCBS Complete |
$8.06
|
| Rate for Payer: BCBS Complete |
$92.44
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: BCBS Complete |
$6.15
|
| Rate for Payer: BCBS Complete |
$6.38
|
| Rate for Payer: BCBS Complete |
$7.11
|
| Rate for Payer: BCBS Trust/PPO |
$15.25
|
| Rate for Payer: BCBS Trust/PPO |
$14.65
|
| Rate for Payer: BCBS Trust/PPO |
$13.15
|
| Rate for Payer: BCBS Trust/PPO |
$12.25
|
| Rate for Payer: BCBS Trust/PPO |
$12.67
|
| Rate for Payer: BCBS Trust/PPO |
$190.55
|
| Rate for Payer: BCBS Trust/PPO |
$16.62
|
| Rate for Payer: BCN Commercial |
$16.62
|
| Rate for Payer: BCN Commercial |
$15.25
|
| Rate for Payer: BCN Commercial |
$12.67
|
| Rate for Payer: BCN Commercial |
$12.25
|
| Rate for Payer: BCN Commercial |
$14.65
|
| Rate for Payer: BCN Commercial |
$13.15
|
| Rate for Payer: BCN Commercial |
$190.55
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$184.88
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cash Price |
$12.76
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cash Price |
$16.12
|
| Rate for Payer: Cash Price |
$14.21
|
| Rate for Payer: Cash Price |
$184.88
|
| Rate for Payer: Cash Price |
$16.12
|
| Rate for Payer: Cash Price |
$14.21
|
| Rate for Payer: Cash Price |
$12.76
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$16.70
|
| Rate for Payer: Cofinity Commercial |
$14.45
|
| Rate for Payer: Cofinity Commercial |
$14.99
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Cofinity Commercial |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$18.95
|
| Rate for Payer: Cofinity Commercial |
$217.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.12
|
| Rate for Payer: Healthscope Commercial |
$19.55
|
| Rate for Payer: Healthscope Commercial |
$15.47
|
| Rate for Payer: Healthscope Commercial |
$14.91
|
| Rate for Payer: Healthscope Commercial |
$14.42
|
| Rate for Payer: Healthscope Commercial |
$224.17
|
| Rate for Payer: Healthscope Commercial |
$17.95
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Healthscope Whirlpool |
$20.16
|
| Rate for Payer: Healthscope Whirlpool |
$17.76
|
| Rate for Payer: Healthscope Whirlpool |
$15.37
|
| Rate for Payer: Healthscope Whirlpool |
$231.10
|
| Rate for Payer: Healthscope Whirlpool |
$14.86
|
| Rate for Payer: Healthscope Whirlpool |
$18.50
|
| Rate for Payer: Healthscope Whirlpool |
$15.95
|
| Rate for Payer: Mclaren Commercial |
$13.38
|
| Rate for Payer: Mclaren Commercial |
$14.36
|
| Rate for Payer: Mclaren Commercial |
$13.83
|
| Rate for Payer: Mclaren Commercial |
$16.65
|
| Rate for Payer: Mclaren Commercial |
$15.99
|
| Rate for Payer: Mclaren Commercial |
$18.14
|
| Rate for Payer: Mclaren Commercial |
$207.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.13
|
| Rate for Payer: Nomi Health Commercial |
$12.60
|
| Rate for Payer: Nomi Health Commercial |
$13.08
|
| Rate for Payer: Nomi Health Commercial |
$189.51
|
| Rate for Payer: Nomi Health Commercial |
$14.57
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| Rate for Payer: Nomi Health Commercial |
$16.53
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.04
|
| Rate for Payer: Priority Health Narrow Network |
$0.03
|
| Rate for Payer: Priority Health Narrow Network |
$0.03
|
| Rate for Payer: Priority Health Narrow Network |
$0.03
|
| Rate for Payer: Priority Health Narrow Network |
$0.03
|
| Rate for Payer: Priority Health Narrow Network |
$0.03
|
| Rate for Payer: Priority Health Narrow Network |
$0.03
|
| Rate for Payer: Priority Health Narrow Network |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.08
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
OP
|
$157.92
|
|
|
Service Code
|
NDC 43547022215
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.43 |
| Max. Negotiated Rate |
$157.92 |
| Rate for Payer: Aetna Commercial |
$142.13
|
| Rate for Payer: Aetna Medicare |
$58.43
|
| Rate for Payer: ASR ASR |
$153.18
|
| Rate for Payer: BCBS Complete |
$63.17
|
| Rate for Payer: BCBS Trust/PPO |
$130.21
|
| Rate for Payer: BCN Commercial |
$130.21
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cofinity Commercial |
$148.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.34
|
| Rate for Payer: Healthscope Commercial |
$153.18
|
| Rate for Payer: Healthscope Whirlpool |
$157.92
|
| Rate for Payer: Mclaren Commercial |
$142.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.23
|
| Rate for Payer: Nomi Health Commercial |
$129.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$138.37
|
| Rate for Payer: Priority Health Narrow Network |
$110.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.97
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
OP
|
$390.10
|
|
|
Service Code
|
NDC 904712461
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.34 |
| Max. Negotiated Rate |
$390.10 |
| Rate for Payer: Aetna Commercial |
$351.09
|
| Rate for Payer: Aetna Medicare |
$144.34
|
| Rate for Payer: ASR ASR |
$378.40
|
| Rate for Payer: BCBS Complete |
$156.04
|
| Rate for Payer: BCBS Trust/PPO |
$321.64
|
| Rate for Payer: BCN Commercial |
$321.64
|
| Rate for Payer: Cash Price |
$312.08
|
| Rate for Payer: Cofinity Commercial |
$366.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.08
|
| Rate for Payer: Healthscope Commercial |
$378.40
|
| Rate for Payer: Healthscope Whirlpool |
$390.10
|
| Rate for Payer: Mclaren Commercial |
$351.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$312.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.58
|
| Rate for Payer: Nomi Health Commercial |
$319.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$341.81
|
| Rate for Payer: Priority Health Narrow Network |
$273.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.29
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
IP
|
$157.92
|
|
|
Service Code
|
NDC 43547022215
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.44 |
| Max. Negotiated Rate |
$157.92 |
| Rate for Payer: Aetna Commercial |
$142.13
|
| Rate for Payer: ASR ASR |
$153.18
|
| Rate for Payer: BCBS Trust/PPO |
$129.68
|
| Rate for Payer: BCN Commercial |
$129.68
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cofinity Commercial |
$148.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.34
|
| Rate for Payer: Healthscope Commercial |
$153.18
|
| Rate for Payer: Healthscope Whirlpool |
$157.92
|
| Rate for Payer: Mclaren Commercial |
$142.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.23
|
| Rate for Payer: Nomi Health Commercial |
$129.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.97
|
|
