|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
OP
|
$345.45
|
|
|
Service Code
|
NDC 68084085901
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.18 |
| Max. Negotiated Rate |
$345.45 |
| Rate for Payer: Aetna Commercial |
$310.90
|
| Rate for Payer: Aetna Medicare |
$172.72
|
| Rate for Payer: ASR ASR |
$335.09
|
| Rate for Payer: ASR Commercial |
$335.09
|
| Rate for Payer: BCBS Complete |
$138.18
|
| Rate for Payer: BCBS Trust/PPO |
$282.89
|
| Rate for Payer: BCN Commercial |
$267.83
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$324.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.36
|
| Rate for Payer: Healthscope Commercial |
$345.45
|
| Rate for Payer: Healthscope Whirlpool |
$335.09
|
| Rate for Payer: Mclaren Commercial |
$310.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.63
|
| Rate for Payer: Nomi Health Commercial |
$283.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$302.68
|
| Rate for Payer: Priority Health Narrow Network |
$242.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$304.00
|
|
|
LEVETIRACETAM 250 MG TABLET
|
Facility
|
OP
|
$291.40
|
|
|
Service Code
|
NDC 00904712361
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.56 |
| Max. Negotiated Rate |
$291.40 |
| Rate for Payer: Aetna Commercial |
$262.26
|
| Rate for Payer: Aetna Medicare |
$145.70
|
| Rate for Payer: ASR ASR |
$282.66
|
| Rate for Payer: ASR Commercial |
$282.66
|
| Rate for Payer: BCBS Complete |
$116.56
|
| Rate for Payer: BCBS Trust/PPO |
$238.63
|
| Rate for Payer: BCN Commercial |
$225.92
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cofinity Commercial |
$273.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.12
|
| Rate for Payer: Healthscope Commercial |
$291.40
|
| Rate for Payer: Healthscope Whirlpool |
$282.66
|
| Rate for Payer: Mclaren Commercial |
$262.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.69
|
| Rate for Payer: Nomi Health Commercial |
$238.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.32
|
| Rate for Payer: Priority Health Narrow Network |
$204.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.43
|
|
|
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 |
$6.21 |
| Max. Negotiated Rate |
$15.53 |
| Rate for Payer: Aetna Commercial |
$13.98
|
| Rate for Payer: Aetna Medicare |
$7.76
|
| Rate for Payer: ASR ASR |
$15.06
|
| Rate for Payer: ASR Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.21
|
| Rate for Payer: BCBS Trust/PPO |
$12.72
|
| Rate for Payer: BCN Commercial |
$12.04
|
| 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 |
$15.53
|
| Rate for Payer: Healthscope Whirlpool |
$15.06
|
| 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: Priority Health Cigna Priority Health |
$10.09
|
| Rate for Payer: 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 |
$13.67
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$12.41
|
|
|
Service Code
|
NDC 00904726592
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$12.41 |
| Rate for Payer: Aetna Commercial |
$11.17
|
| Rate for Payer: Aetna Medicare |
$6.21
|
| Rate for Payer: ASR ASR |
$12.04
|
| Rate for Payer: ASR Commercial |
$12.04
|
| Rate for Payer: BCBS Complete |
$4.96
|
| Rate for Payer: BCBS Trust/PPO |
$10.16
|
| Rate for Payer: BCN Commercial |
$9.62
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Cofinity Commercial |
$11.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.93
|
| Rate for Payer: Healthscope Commercial |
$12.41
|
| Rate for Payer: Healthscope Whirlpool |
$12.04
|
| Rate for Payer: Mclaren Commercial |
$11.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.55
|
| Rate for Payer: Nomi Health Commercial |
$10.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.87
|
| Rate for Payer: Priority Health Narrow Network |
$8.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.92
|
|
|
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 |
$10.09 |
| Max. Negotiated Rate |
$15.53 |
| Rate for Payer: Aetna Commercial |
$13.98
|
| Rate for Payer: ASR ASR |
$15.06
|
| Rate for Payer: ASR Commercial |
$15.06
|
| Rate for Payer: BCBS Trust/PPO |
$12.66
|
| Rate for Payer: BCN Commercial |
$12.04
|
| 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 |
$15.53
|
| Rate for Payer: Healthscope Whirlpool |
$15.06
|
| 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: Priority Health Cigna Priority Health |
$10.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.67
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$12.41
|
|
|
Service Code
|
NDC 00904726541
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$12.41 |
| Rate for Payer: Aetna Commercial |
$11.17
|
| Rate for Payer: ASR ASR |
$12.04
|
| Rate for Payer: ASR Commercial |
$12.04
|
| Rate for Payer: BCBS Trust/PPO |
$10.11
|
| Rate for Payer: BCN Commercial |
$9.62
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Cofinity Commercial |
$11.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.93
|
| Rate for Payer: Healthscope Commercial |
$12.41
|
| Rate for Payer: Healthscope Whirlpool |
$12.04
|
| Rate for Payer: Mclaren Commercial |
$11.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.55
|
| Rate for Payer: Nomi Health Commercial |
$10.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.92
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$20.24
|
|
|
Service Code
|
NDC 00904706041
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$20.24 |
| Rate for Payer: Aetna Commercial |
$18.22
|
| Rate for Payer: Aetna Medicare |
$10.12
|
| Rate for Payer: ASR ASR |
$19.63
|
| Rate for Payer: ASR Commercial |
$19.63
|
| Rate for Payer: BCBS Complete |
$8.10
|
| Rate for Payer: BCBS Trust/PPO |
$16.57
|
| Rate for Payer: BCN Commercial |
$15.69
|
| Rate for Payer: Cash Price |
$16.19
|
| Rate for Payer: Cofinity Commercial |
$19.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.19
|
| Rate for Payer: Healthscope Commercial |
$20.24
|
| Rate for Payer: Healthscope Whirlpool |
$19.63
|
| Rate for Payer: Mclaren Commercial |
$18.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.20
|
| Rate for Payer: Nomi Health Commercial |
$16.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.73
|
| Rate for Payer: Priority Health Narrow Network |
$14.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.81
|
|
|
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 |
$6.21 |
| Max. Negotiated Rate |
$15.53 |
| Rate for Payer: Aetna Commercial |
$13.98
|
| Rate for Payer: Aetna Medicare |
$7.76
|
| Rate for Payer: ASR ASR |
$15.06
|
| Rate for Payer: ASR Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.21
|
| Rate for Payer: BCBS Trust/PPO |
$12.72
|
| Rate for Payer: BCN Commercial |
$12.04
|
| 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 |
$15.53
|
| Rate for Payer: Healthscope Whirlpool |
$15.06
|
| 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: Priority Health Cigna Priority Health |
$10.09
|
| Rate for Payer: 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 |
$13.67
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$12.41
|
|
|
Service Code
|
NDC 00904726541
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$12.41 |
| Rate for Payer: Aetna Commercial |
$11.17
|
| Rate for Payer: Aetna Medicare |
$6.21
|
| Rate for Payer: ASR ASR |
$12.04
|
| Rate for Payer: ASR Commercial |
$12.04
|
| Rate for Payer: BCBS Complete |
$4.96
|
| Rate for Payer: BCBS Trust/PPO |
$10.16
|
| Rate for Payer: BCN Commercial |
$9.62
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Cofinity Commercial |
$11.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.93
|
| Rate for Payer: Healthscope Commercial |
$12.41
|
| Rate for Payer: Healthscope Whirlpool |
$12.04
|
| Rate for Payer: Mclaren Commercial |
$11.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.55
|
| Rate for Payer: Nomi Health Commercial |
$10.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.87
|
| Rate for Payer: Priority Health Narrow Network |
$8.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.92
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$13.68
|
|
|
Service Code
|
NDC 00121479950
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.47 |
| Max. Negotiated Rate |
$13.68 |
| Rate for Payer: Aetna Commercial |
$12.31
|
| Rate for Payer: Aetna Medicare |
$6.84
|
| Rate for Payer: ASR ASR |
$13.27
|
| Rate for Payer: ASR Commercial |
$13.27
|
| Rate for Payer: BCBS Complete |
$5.47
|
| Rate for Payer: BCBS Trust/PPO |
$11.20
|
| Rate for Payer: BCN Commercial |
$10.61
|
| Rate for Payer: Cash Price |
$10.94
|
| Rate for Payer: Cofinity Commercial |
$12.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.94
|
| Rate for Payer: Healthscope Commercial |
$13.68
|
| Rate for Payer: Healthscope Whirlpool |
$13.27
|
| Rate for Payer: Mclaren Commercial |
$12.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.63
|
| Rate for Payer: Nomi Health Commercial |
$11.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.99
|
| Rate for Payer: Priority Health Narrow Network |
$9.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.04
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$13.68
|
|
|
Service Code
|
NDC 00121479950
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$13.68 |
| Rate for Payer: Aetna Commercial |
$12.31
|
| Rate for Payer: ASR ASR |
$13.27
|
| Rate for Payer: ASR Commercial |
$13.27
|
| Rate for Payer: BCBS Trust/PPO |
$11.15
|
| Rate for Payer: BCN Commercial |
$10.61
|
| Rate for Payer: Cash Price |
$10.94
|
| Rate for Payer: Cofinity Commercial |
$12.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.94
|
| Rate for Payer: Healthscope Commercial |
$13.68
|
| Rate for Payer: Healthscope Whirlpool |
$13.27
|
| Rate for Payer: Mclaren Commercial |
$12.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.63
|
| Rate for Payer: Nomi Health Commercial |
$11.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.04
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$20.24
|
|
|
Service Code
|
NDC 00904706041
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$20.24 |
| Rate for Payer: Aetna Commercial |
$18.22
|
| Rate for Payer: ASR ASR |
$19.63
|
| Rate for Payer: ASR Commercial |
$19.63
|
| Rate for Payer: BCBS Trust/PPO |
$16.49
|
| Rate for Payer: BCN Commercial |
$15.69
|
| Rate for Payer: Cash Price |
$16.19
|
| Rate for Payer: Cofinity Commercial |
$19.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.19
|
| Rate for Payer: Healthscope Commercial |
$20.24
|
| Rate for Payer: Healthscope Whirlpool |
$19.63
|
| Rate for Payer: Mclaren Commercial |
$18.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.20
|
| Rate for Payer: Nomi Health Commercial |
$16.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.81
|
|
|
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 |
$10.09 |
| Max. Negotiated Rate |
$15.53 |
| Rate for Payer: Aetna Commercial |
$13.98
|
| Rate for Payer: ASR ASR |
$15.06
|
| Rate for Payer: ASR Commercial |
$15.06
|
| Rate for Payer: BCBS Trust/PPO |
$12.66
|
| Rate for Payer: BCN Commercial |
$12.04
|
| 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 |
$15.53
|
| Rate for Payer: Healthscope Whirlpool |
$15.06
|
| 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: Priority Health Cigna Priority Health |
$10.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.67
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$12.02
|
|
|
Service Code
|
NDC 00904706093
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$12.02 |
| Rate for Payer: Aetna Commercial |
$10.82
|
| Rate for Payer: ASR ASR |
$11.66
|
| Rate for Payer: ASR Commercial |
$11.66
|
| Rate for Payer: BCBS Trust/PPO |
$9.80
|
| Rate for Payer: BCN Commercial |
$9.32
|
| Rate for Payer: Cash Price |
$9.62
|
| Rate for Payer: Cofinity Commercial |
$11.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.62
|
| Rate for Payer: Healthscope Commercial |
$12.02
|
| Rate for Payer: Healthscope Whirlpool |
$11.66
|
| Rate for Payer: Mclaren Commercial |
$10.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.22
|
| Rate for Payer: Nomi Health Commercial |
$9.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.58
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$12.02
|
|
|
Service Code
|
NDC 00904706093
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$12.02 |
| Rate for Payer: Aetna Commercial |
$10.82
|
| Rate for Payer: Aetna Medicare |
$6.01
|
| Rate for Payer: ASR ASR |
$11.66
|
| Rate for Payer: ASR Commercial |
$11.66
|
| Rate for Payer: BCBS Complete |
$4.81
|
| Rate for Payer: BCBS Trust/PPO |
$9.84
|
| Rate for Payer: BCN Commercial |
$9.32
|
| Rate for Payer: Cash Price |
$9.62
|
| Rate for Payer: Cofinity Commercial |
$11.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.62
|
| Rate for Payer: Healthscope Commercial |
$12.02
|
| Rate for Payer: Healthscope Whirlpool |
$11.66
|
| Rate for Payer: Mclaren Commercial |
$10.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.22
|
| Rate for Payer: Nomi Health Commercial |
$9.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.53
|
| Rate for Payer: Priority Health Narrow Network |
$8.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.58
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$12.38
|
|
|
Service Code
|
NDC 00121479905
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$12.38 |
| Rate for Payer: Aetna Commercial |
$11.14
|
| Rate for Payer: ASR ASR |
$12.01
|
| Rate for Payer: ASR Commercial |
$12.01
|
| Rate for Payer: BCBS Trust/PPO |
$10.09
|
| Rate for Payer: BCN Commercial |
$9.60
|
| Rate for Payer: Cash Price |
$9.91
|
| Rate for Payer: Cofinity Commercial |
$11.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.90
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Healthscope Whirlpool |
$12.01
|
| Rate for Payer: Mclaren Commercial |
$11.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.52
|
| Rate for Payer: Nomi Health Commercial |
$10.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.89
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$12.38
|
|
|
Service Code
|
NDC 00121479905
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$12.38 |
| Rate for Payer: Aetna Commercial |
$11.14
|
| Rate for Payer: Aetna Medicare |
$6.19
|
| Rate for Payer: ASR ASR |
$12.01
|
| Rate for Payer: ASR Commercial |
$12.01
|
| Rate for Payer: BCBS Complete |
$4.95
|
| Rate for Payer: BCBS Trust/PPO |
$10.14
|
| Rate for Payer: BCN Commercial |
$9.60
|
| Rate for Payer: Cash Price |
$9.91
|
| Rate for Payer: Cofinity Commercial |
$11.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.90
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Healthscope Whirlpool |
$12.01
|
| Rate for Payer: Mclaren Commercial |
$11.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.52
|
| Rate for Payer: Nomi Health Commercial |
$10.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.85
|
| Rate for Payer: Priority Health Narrow Network |
$8.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.89
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$12.41
|
|
|
Service Code
|
NDC 00904726592
|
| Hospital Charge Code |
118734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$12.41 |
| Rate for Payer: Aetna Commercial |
$11.17
|
| Rate for Payer: ASR ASR |
$12.04
|
| Rate for Payer: ASR Commercial |
$12.04
|
| Rate for Payer: BCBS Trust/PPO |
$10.11
|
| Rate for Payer: BCN Commercial |
$9.62
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Cofinity Commercial |
$11.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.93
|
| Rate for Payer: Healthscope Commercial |
$12.41
|
| Rate for Payer: Healthscope Whirlpool |
$12.04
|
| Rate for Payer: Mclaren Commercial |
$11.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.55
|
| Rate for Payer: Nomi Health Commercial |
$10.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.92
|
|
|
LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.95
|
|
|
Service Code
|
HCPCS J1953
|
| Hospital Charge Code |
77195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna Commercial |
$14.36
|
| Rate for Payer: Aetna Commercial |
$18.55
|
| Rate for Payer: Aetna Commercial |
$16.32
|
| Rate for Payer: Aetna Commercial |
$19.84
|
| Rate for Payer: Aetna Commercial |
$25.71
|
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Commercial |
$202.72
|
| Rate for Payer: ASR ASR |
$19.99
|
| Rate for Payer: ASR ASR |
$17.59
|
| Rate for Payer: ASR ASR |
$27.71
|
| Rate for Payer: ASR ASR |
$21.38
|
| Rate for Payer: ASR ASR |
$15.47
|
| Rate for Payer: ASR ASR |
$14.41
|
| Rate for Payer: ASR ASR |
$218.49
|
| Rate for Payer: ASR Commercial |
$27.71
|
| Rate for Payer: ASR Commercial |
$218.49
|
| Rate for Payer: ASR Commercial |
$17.59
|
| Rate for Payer: ASR Commercial |
$21.38
|
| Rate for Payer: ASR Commercial |
$19.99
|
| Rate for Payer: ASR Commercial |
$15.47
|
| Rate for Payer: ASR Commercial |
$14.41
|
| Rate for Payer: BCBS Trust/PPO |
$183.56
|
| Rate for Payer: BCBS Trust/PPO |
$17.96
|
| Rate for Payer: BCBS Trust/PPO |
$12.11
|
| Rate for Payer: BCBS Trust/PPO |
$13.00
|
| Rate for Payer: BCBS Trust/PPO |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$14.77
|
| Rate for Payer: BCBS Trust/PPO |
$23.28
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Commercial |
$22.15
|
| Rate for Payer: BCN Commercial |
$17.09
|
| Rate for Payer: BCN Commercial |
$11.52
|
| Rate for Payer: BCN Commercial |
$12.37
|
| Rate for Payer: BCN Commercial |
$174.64
|
| Rate for Payer: BCN Commercial |
$15.98
|
| Rate for Payer: Cash Price |
$180.20
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$17.63
|
| Rate for Payer: Cash Price |
$12.76
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$17.04
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Cofinity Commercial |
$19.37
|
| Rate for Payer: Cofinity Commercial |
$14.99
|
| Rate for Payer: Cofinity Commercial |
$211.74
|
| Rate for Payer: Cofinity Commercial |
$26.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.76
|
| 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 |
$14.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.63
|
| Rate for Payer: Healthscope Commercial |
$22.04
|
| Rate for Payer: Healthscope Commercial |
$28.57
|
| Rate for Payer: Healthscope Commercial |
$18.13
|
| Rate for Payer: Healthscope Commercial |
$20.61
|
| Rate for Payer: Healthscope Commercial |
$225.25
|
| Rate for Payer: Healthscope Commercial |
$15.95
|
| Rate for Payer: Healthscope Commercial |
$14.86
|
| Rate for Payer: Healthscope Whirlpool |
$218.49
|
| Rate for Payer: Healthscope Whirlpool |
$21.38
|
| Rate for Payer: Healthscope Whirlpool |
$19.99
|
| Rate for Payer: Healthscope Whirlpool |
$15.47
|
| Rate for Payer: Healthscope Whirlpool |
$17.59
|
| Rate for Payer: Healthscope Whirlpool |
$14.41
|
| Rate for Payer: Healthscope Whirlpool |
$27.71
|
| Rate for Payer: Mclaren Commercial |
$19.84
|
| Rate for Payer: Mclaren Commercial |
$25.71
|
| Rate for Payer: Mclaren Commercial |
$13.37
|
| Rate for Payer: Mclaren Commercial |
$202.72
|
| Rate for Payer: Mclaren Commercial |
$16.32
|
| Rate for Payer: Mclaren Commercial |
$14.36
|
| Rate for Payer: Mclaren Commercial |
$18.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.73
|
| 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 |
$13.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.46
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| Rate for Payer: Nomi Health Commercial |
$184.71
|
| Rate for Payer: Nomi Health Commercial |
$23.43
|
| Rate for Payer: Nomi Health Commercial |
$16.90
|
| Rate for Payer: Nomi Health Commercial |
$14.87
|
| Rate for Payer: Nomi Health Commercial |
$13.08
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.33
|
| 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 |
$9.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.95
|
|
|
LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$28.57
|
|
|
Service Code
|
HCPCS J1953
|
| Hospital Charge Code |
77195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$28.57 |
| Rate for Payer: Aetna Commercial |
$25.71
|
| Rate for Payer: Aetna Commercial |
$14.36
|
| Rate for Payer: Aetna Commercial |
$16.32
|
| Rate for Payer: Aetna Commercial |
$19.84
|
| Rate for Payer: Aetna Commercial |
$18.55
|
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Commercial |
$202.72
|
| Rate for Payer: Aetna Medicare |
$14.29
|
| Rate for Payer: Aetna Medicare |
$7.97
|
| Rate for Payer: Aetna Medicare |
$112.62
|
| Rate for Payer: Aetna Medicare |
$7.43
|
| Rate for Payer: Aetna Medicare |
$11.02
|
| Rate for Payer: Aetna Medicare |
$9.06
|
| Rate for Payer: Aetna Medicare |
$10.30
|
| Rate for Payer: ASR ASR |
$17.59
|
| Rate for Payer: ASR ASR |
$218.49
|
| Rate for Payer: ASR ASR |
$27.71
|
| Rate for Payer: ASR ASR |
$21.38
|
| Rate for Payer: ASR ASR |
$15.47
|
| Rate for Payer: ASR ASR |
$19.99
|
| Rate for Payer: ASR ASR |
$14.41
|
| Rate for Payer: ASR Commercial |
$17.59
|
| Rate for Payer: ASR Commercial |
$14.41
|
| Rate for Payer: ASR Commercial |
$21.38
|
| Rate for Payer: ASR Commercial |
$27.71
|
| Rate for Payer: ASR Commercial |
$218.49
|
| Rate for Payer: ASR Commercial |
$15.47
|
| Rate for Payer: ASR Commercial |
$19.99
|
| Rate for Payer: BCBS Complete |
$8.24
|
| Rate for Payer: BCBS Complete |
$5.94
|
| Rate for Payer: BCBS Complete |
$8.82
|
| Rate for Payer: BCBS Complete |
$7.25
|
| Rate for Payer: BCBS Complete |
$6.38
|
| Rate for Payer: BCBS Complete |
$11.43
|
| Rate for Payer: BCBS Complete |
$90.10
|
| Rate for Payer: BCBS Trust/PPO |
$184.46
|
| Rate for Payer: BCBS Trust/PPO |
$16.88
|
| Rate for Payer: BCBS Trust/PPO |
$12.17
|
| Rate for Payer: BCBS Trust/PPO |
$13.06
|
| Rate for Payer: BCBS Trust/PPO |
$14.85
|
| Rate for Payer: BCBS Trust/PPO |
$18.05
|
| Rate for Payer: BCBS Trust/PPO |
$23.40
|
| Rate for Payer: BCN Commercial |
$174.64
|
| Rate for Payer: BCN Commercial |
$17.09
|
| Rate for Payer: BCN Commercial |
$22.15
|
| Rate for Payer: BCN Commercial |
$15.98
|
| Rate for Payer: BCN Commercial |
$12.37
|
| Rate for Payer: BCN Commercial |
$11.52
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cash Price |
$180.20
|
| Rate for Payer: Cash Price |
$17.63
|
| Rate for Payer: Cash Price |
$12.76
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$26.86
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$211.74
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Cofinity Commercial |
$14.99
|
| Rate for Payer: Cofinity Commercial |
$19.37
|
| Rate for Payer: Cofinity Commercial |
$17.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.63
|
| Rate for Payer: Healthscope Commercial |
$14.86
|
| Rate for Payer: Healthscope Commercial |
$28.57
|
| Rate for Payer: Healthscope Commercial |
$225.25
|
| Rate for Payer: Healthscope Commercial |
$20.61
|
| Rate for Payer: Healthscope Commercial |
$15.95
|
| Rate for Payer: Healthscope Commercial |
$22.04
|
| Rate for Payer: Healthscope Commercial |
$18.13
|
| Rate for Payer: Healthscope Whirlpool |
$17.59
|
| Rate for Payer: Healthscope Whirlpool |
$14.41
|
| Rate for Payer: Healthscope Whirlpool |
$19.99
|
| Rate for Payer: Healthscope Whirlpool |
$21.38
|
| Rate for Payer: Healthscope Whirlpool |
$218.49
|
| Rate for Payer: Healthscope Whirlpool |
$27.71
|
| Rate for Payer: Healthscope Whirlpool |
$15.47
|
| Rate for Payer: Mclaren Commercial |
$16.32
|
| Rate for Payer: Mclaren Commercial |
$19.84
|
| Rate for Payer: Mclaren Commercial |
$202.72
|
| Rate for Payer: Mclaren Commercial |
$25.71
|
| Rate for Payer: Mclaren Commercial |
$18.55
|
| Rate for Payer: Mclaren Commercial |
$13.37
|
| Rate for Payer: Mclaren Commercial |
$14.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.28
|
| Rate for Payer: Nomi Health Commercial |
$14.87
|
| Rate for Payer: Nomi Health Commercial |
$184.71
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Nomi Health Commercial |
$23.43
|
| Rate for Payer: Nomi Health Commercial |
$13.08
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| Rate for Payer: Nomi Health Commercial |
$16.90
|
| 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 |
$14.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.98
|
| Rate for Payer: Priority Health Narrow Network |
$11.18
|
| Rate for Payer: Priority Health Narrow Network |
$14.45
|
| Rate for Payer: Priority Health Narrow Network |
$12.71
|
| Rate for Payer: Priority Health Narrow Network |
$10.42
|
| Rate for Payer: Priority Health Narrow Network |
$157.90
|
| Rate for Payer: Priority Health Narrow Network |
$15.45
|
| Rate for Payer: Priority Health Narrow Network |
$20.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.08
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
OP
|
$317.25
|
|
|
Service Code
|
NDC 00904712461
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.90 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Aetna Commercial |
$285.52
|
| Rate for Payer: Aetna Medicare |
$158.62
|
| Rate for Payer: ASR ASR |
$307.73
|
| Rate for Payer: ASR Commercial |
$307.73
|
| Rate for Payer: BCBS Complete |
$126.90
|
| Rate for Payer: BCBS Trust/PPO |
$259.80
|
| Rate for Payer: BCN Commercial |
$245.96
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cofinity Commercial |
$298.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.80
|
| Rate for Payer: Healthscope Commercial |
$317.25
|
| Rate for Payer: Healthscope Whirlpool |
$307.73
|
| Rate for Payer: Mclaren Commercial |
$285.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.66
|
| Rate for Payer: Nomi Health Commercial |
$260.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$277.97
|
| Rate for Payer: Priority Health Narrow Network |
$222.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$279.18
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
OP
|
$238.45
|
|
|
Service Code
|
NDC 68084087001
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.38 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Aetna Commercial |
$214.60
|
| Rate for Payer: Aetna Medicare |
$119.22
|
| Rate for Payer: ASR ASR |
$231.30
|
| Rate for Payer: ASR Commercial |
$231.30
|
| Rate for Payer: BCBS Complete |
$95.38
|
| Rate for Payer: BCBS Trust/PPO |
$195.27
|
| Rate for Payer: BCN Commercial |
$184.87
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$224.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$238.45
|
| Rate for Payer: Healthscope Whirlpool |
$231.30
|
| Rate for Payer: Mclaren Commercial |
$214.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.68
|
| Rate for Payer: Nomi Health Commercial |
$195.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.93
|
| Rate for Payer: Priority Health Narrow Network |
$167.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$209.84
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
IP
|
$238.45
|
|
|
Service Code
|
NDC 68084087001
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.99 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Aetna Commercial |
$214.60
|
| Rate for Payer: ASR ASR |
$231.30
|
| Rate for Payer: ASR Commercial |
$231.30
|
| Rate for Payer: BCBS Trust/PPO |
$194.31
|
| Rate for Payer: BCN Commercial |
$184.87
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$224.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$238.45
|
| Rate for Payer: Healthscope Whirlpool |
$231.30
|
| Rate for Payer: Mclaren Commercial |
$214.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.68
|
| Rate for Payer: Nomi Health Commercial |
$195.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$209.84
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
IP
|
$2.38
|
|
|
Service Code
|
NDC 68084087011
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna Commercial |
$2.14
|
| Rate for Payer: ASR ASR |
$2.31
|
| Rate for Payer: ASR Commercial |
$2.31
|
| Rate for Payer: BCBS Trust/PPO |
$1.94
|
| Rate for Payer: BCN Commercial |
$1.85
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.90
|
| Rate for Payer: Healthscope Commercial |
$2.38
|
| Rate for Payer: Healthscope Whirlpool |
$2.31
|
| Rate for Payer: Mclaren Commercial |
$2.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.02
|
| Rate for Payer: Nomi Health Commercial |
$1.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.09
|
|
|
LEVETIRACETAM 500 MG TABLET
|
Facility
|
OP
|
$2.38
|
|
|
Service Code
|
NDC 68084087011
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna Commercial |
$2.14
|
| Rate for Payer: Aetna Medicare |
$1.19
|
| Rate for Payer: ASR ASR |
$2.31
|
| Rate for Payer: ASR Commercial |
$2.31
|
| Rate for Payer: BCBS Complete |
$0.95
|
| Rate for Payer: BCBS Trust/PPO |
$1.95
|
| Rate for Payer: BCN Commercial |
$1.85
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.90
|
| Rate for Payer: Healthscope Commercial |
$2.38
|
| Rate for Payer: Healthscope Whirlpool |
$2.31
|
| Rate for Payer: Mclaren Commercial |
$2.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.02
|
| Rate for Payer: Nomi Health Commercial |
$1.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.09
|
| Rate for Payer: Priority Health Narrow Network |
$1.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.09
|
|
