|
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 (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
|
$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
|
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 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$28.57
|
|
|
Service Code
|
HCPCS J1953
|
| Hospital Charge Code |
77195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$28.57 |
| Rate for Payer: Aetna Commercial |
$25.71
|
| Rate for Payer: Aetna Commercial |
$16.32
|
| Rate for Payer: Aetna Commercial |
$14.36
|
| Rate for Payer: Aetna Commercial |
$18.55
|
| Rate for Payer: Aetna Commercial |
$202.72
|
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Commercial |
$19.84
|
| Rate for Payer: Aetna Medicare |
$9.06
|
| Rate for Payer: Aetna Medicare |
$112.62
|
| Rate for Payer: Aetna Medicare |
$11.02
|
| Rate for Payer: Aetna Medicare |
$14.28
|
| Rate for Payer: Aetna Medicare |
$10.30
|
| Rate for Payer: Aetna Medicare |
$7.98
|
| Rate for Payer: Aetna Medicare |
$7.43
|
| Rate for Payer: ASR ASR |
$218.49
|
| Rate for Payer: ASR ASR |
$19.99
|
| Rate for Payer: ASR ASR |
$17.59
|
| Rate for Payer: ASR ASR |
$14.41
|
| Rate for Payer: ASR ASR |
$15.47
|
| Rate for Payer: ASR ASR |
$27.71
|
| Rate for Payer: ASR ASR |
$21.38
|
| Rate for Payer: ASR Commercial |
$14.41
|
| Rate for Payer: ASR Commercial |
$19.99
|
| Rate for Payer: ASR Commercial |
$15.47
|
| Rate for Payer: ASR Commercial |
$17.59
|
| Rate for Payer: ASR Commercial |
$27.71
|
| Rate for Payer: ASR Commercial |
$218.49
|
| Rate for Payer: ASR Commercial |
$21.38
|
| Rate for Payer: BCBS Complete |
$7.25
|
| Rate for Payer: BCBS Complete |
$6.38
|
| Rate for Payer: BCBS Complete |
$5.94
|
| Rate for Payer: BCBS Complete |
$11.43
|
| Rate for Payer: BCBS Complete |
$90.10
|
| Rate for Payer: BCBS Complete |
$8.82
|
| Rate for Payer: BCBS Complete |
$8.24
|
| Rate for Payer: BCBS Trust/PPO |
$14.85
|
| Rate for Payer: BCBS Trust/PPO |
$12.17
|
| Rate for Payer: BCBS Trust/PPO |
$23.40
|
| Rate for Payer: BCBS Trust/PPO |
$13.06
|
| Rate for Payer: BCBS Trust/PPO |
$184.46
|
| Rate for Payer: BCBS Trust/PPO |
$16.88
|
| Rate for Payer: BCBS Trust/PPO |
$18.05
|
| Rate for Payer: BCN Commercial |
$22.15
|
| Rate for Payer: BCN Commercial |
$12.37
|
| Rate for Payer: BCN Commercial |
$17.09
|
| Rate for Payer: BCN Commercial |
$11.52
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Commercial |
$15.98
|
| Rate for Payer: BCN Commercial |
$174.64
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cash Price |
$12.76
|
| Rate for Payer: Cash Price |
$12.76
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cash Price |
$17.63
|
| Rate for Payer: Cash Price |
$17.63
|
| Rate for Payer: Cash Price |
$180.20
|
| Rate for Payer: Cash Price |
$180.20
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$14.99
|
| Rate for Payer: Cofinity Commercial |
$26.86
|
| Rate for Payer: Cofinity Commercial |
$17.04
|
| Rate for Payer: Cofinity Commercial |
$211.74
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Cofinity Commercial |
$19.37
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.76
|
| 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 |
$20.61
|
| Rate for Payer: Healthscope Commercial |
$14.86
|
| Rate for Payer: Healthscope Commercial |
$15.95
|
| Rate for Payer: Healthscope Commercial |
$225.25
|
| Rate for Payer: Healthscope Commercial |
$22.04
|
| Rate for Payer: Healthscope Commercial |
$18.13
|
| Rate for Payer: Healthscope Commercial |
$28.57
|
| Rate for Payer: Healthscope Whirlpool |
$19.99
|
| Rate for Payer: Healthscope Whirlpool |
$17.59
|
| Rate for Payer: Healthscope Whirlpool |
$15.47
|
| 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 |
$14.41
|
| Rate for Payer: Mclaren Commercial |
$202.72
|
| Rate for Payer: Mclaren Commercial |
$18.55
|
| Rate for Payer: Mclaren Commercial |
$16.32
|
| Rate for Payer: Mclaren Commercial |
$25.71
|
| Rate for Payer: Mclaren Commercial |
$19.84
|
| Rate for Payer: Mclaren Commercial |
$14.36
|
| Rate for Payer: Mclaren Commercial |
$13.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.46
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| 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: Nomi Health Commercial |
$23.43
|
| Rate for Payer: Nomi Health Commercial |
$184.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.40
|
| 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 |
$11.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.05
|
| Rate for Payer: Priority Health Narrow Network |
$0.04
|
| Rate for Payer: Priority Health Narrow Network |
$0.04
|
| Rate for Payer: Priority Health Narrow Network |
$0.04
|
| Rate for Payer: Priority Health Narrow Network |
$0.04
|
| Rate for Payer: Priority Health Narrow Network |
$0.04
|
| Rate for Payer: Priority Health Narrow Network |
$0.04
|
| Rate for Payer: Priority Health Narrow Network |
$0.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.40
|
| 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 |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.04
|
|
|
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 |
$184.70
|
| 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 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
|
$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
|
$317.25
|
|
|
Service Code
|
NDC 00904712461
|
| Hospital Charge Code |
26817
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.21 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Aetna Commercial |
$285.52
|
| Rate for Payer: ASR ASR |
$307.73
|
| Rate for Payer: ASR Commercial |
$307.73
|
| Rate for Payer: BCBS Trust/PPO |
$258.53
|
| Rate for Payer: BCN Commercial |
$245.96
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cofinity Commercial |
$298.22
|
| 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: UHC All Payor (Choice/PPO) + Core |
$279.18
|
|
|
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 |
$298.22
|
| 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
|
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
|
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
|
|
|
LEVOFLOXACIN 250 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
HCPCS J1956
|
| Hospital Charge Code |
112929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: ASR ASR |
$14.36
|
| Rate for Payer: ASR Commercial |
$14.36
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: BCBS Trust/PPO |
$12.12
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$14.80
|
| Rate for Payer: Healthscope Whirlpool |
$14.36
|
| Rate for Payer: Mclaren Commercial |
$13.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Nomi Health Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.02
|
|
|
LEVOFLOXACIN 250 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
HCPCS J1956
|
| Hospital Charge Code |
112929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: ASR ASR |
$14.36
|
| Rate for Payer: ASR Commercial |
$14.36
|
| Rate for Payer: BCBS Trust/PPO |
$12.06
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$14.80
|
| Rate for Payer: Healthscope Whirlpool |
$14.36
|
| Rate for Payer: Mclaren Commercial |
$13.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Nomi Health Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.02
|
|
|
LEVOFLOXACIN 250 MG TABLET
|
Facility
|
OP
|
$418.30
|
|
|
Service Code
|
NDC 00904635161
|
| Hospital Charge Code |
18918
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.32 |
| Max. Negotiated Rate |
$418.30 |
| Rate for Payer: Aetna Commercial |
$376.47
|
| Rate for Payer: Aetna Medicare |
$209.15
|
| Rate for Payer: ASR ASR |
$405.75
|
| Rate for Payer: ASR Commercial |
$405.75
|
| Rate for Payer: BCBS Complete |
$167.32
|
| Rate for Payer: BCBS Trust/PPO |
$342.55
|
| Rate for Payer: BCN Commercial |
$324.31
|
| Rate for Payer: Cash Price |
$334.64
|
| Rate for Payer: Cofinity Commercial |
$393.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.64
|
| Rate for Payer: Healthscope Commercial |
$418.30
|
| Rate for Payer: Healthscope Whirlpool |
$405.75
|
| Rate for Payer: Mclaren Commercial |
$376.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.56
|
| Rate for Payer: Nomi Health Commercial |
$343.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$366.51
|
| Rate for Payer: Priority Health Narrow Network |
$293.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$368.10
|
|
|
LEVOFLOXACIN 250 MG TABLET
|
Facility
|
IP
|
$418.30
|
|
|
Service Code
|
NDC 00904635161
|
| Hospital Charge Code |
18918
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.90 |
| Max. Negotiated Rate |
$418.30 |
| Rate for Payer: Aetna Commercial |
$376.47
|
| Rate for Payer: ASR ASR |
$405.75
|
| Rate for Payer: ASR Commercial |
$405.75
|
| Rate for Payer: BCBS Trust/PPO |
$340.87
|
| Rate for Payer: BCN Commercial |
$324.31
|
| Rate for Payer: Cash Price |
$334.64
|
| Rate for Payer: Cofinity Commercial |
$393.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.64
|
| Rate for Payer: Healthscope Commercial |
$418.30
|
| Rate for Payer: Healthscope Whirlpool |
$405.75
|
| Rate for Payer: Mclaren Commercial |
$376.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.56
|
| Rate for Payer: Nomi Health Commercial |
$343.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$368.10
|
|
|
LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$18.80
|
|
|
Service Code
|
HCPCS J1956
|
| Hospital Charge Code |
18924
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$18.80 |
| Rate for Payer: Aetna Commercial |
$16.92
|
| Rate for Payer: Aetna Commercial |
$6.84
|
| Rate for Payer: Aetna Commercial |
$42.12
|
| Rate for Payer: Aetna Medicare |
$3.80
|
| Rate for Payer: Aetna Medicare |
$9.40
|
| Rate for Payer: Aetna Medicare |
$23.40
|
| Rate for Payer: ASR ASR |
$45.40
|
| Rate for Payer: ASR ASR |
$18.24
|
| Rate for Payer: ASR ASR |
$7.37
|
| Rate for Payer: ASR Commercial |
$45.40
|
| Rate for Payer: ASR Commercial |
$18.24
|
| Rate for Payer: ASR Commercial |
$7.37
|
| Rate for Payer: BCBS Complete |
$7.52
|
| Rate for Payer: BCBS Complete |
$18.72
|
| Rate for Payer: BCBS Complete |
$3.04
|
| Rate for Payer: BCBS Trust/PPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$15.40
|
| Rate for Payer: BCBS Trust/PPO |
$38.32
|
| Rate for Payer: BCN Commercial |
$36.28
|
| Rate for Payer: BCN Commercial |
$5.89
|
| Rate for Payer: BCN Commercial |
$14.58
|
| Rate for Payer: Cash Price |
$15.04
|
| Rate for Payer: Cash Price |
$15.04
|
| Rate for Payer: Cash Price |
$37.44
|
| Rate for Payer: Cash Price |
$37.44
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Cofinity Commercial |
$17.67
|
| Rate for Payer: Cofinity Commercial |
$43.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.44
|
| Rate for Payer: Healthscope Commercial |
$7.60
|
| Rate for Payer: Healthscope Commercial |
$46.80
|
| Rate for Payer: Healthscope Commercial |
$18.80
|
| Rate for Payer: Healthscope Whirlpool |
$7.37
|
| Rate for Payer: Healthscope Whirlpool |
$45.40
|
| Rate for Payer: Healthscope Whirlpool |
$18.24
|
| Rate for Payer: Mclaren Commercial |
$42.12
|
| Rate for Payer: Mclaren Commercial |
$6.84
|
| Rate for Payer: Mclaren Commercial |
$16.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.98
|
| Rate for Payer: Nomi Health Commercial |
$15.42
|
| Rate for Payer: Nomi Health Commercial |
$6.23
|
| Rate for Payer: Nomi Health Commercial |
$38.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.85
|
| Rate for Payer: Priority Health Narrow Network |
$0.85
|
| Rate for Payer: Priority Health Narrow Network |
$0.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.69
|
|
|
LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$46.80
|
|
|
Service Code
|
HCPCS J1956
|
| Hospital Charge Code |
18924
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.42 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna Commercial |
$42.12
|
| Rate for Payer: Aetna Commercial |
$16.92
|
| Rate for Payer: Aetna Commercial |
$6.84
|
| Rate for Payer: ASR ASR |
$18.24
|
| Rate for Payer: ASR ASR |
$45.40
|
| Rate for Payer: ASR ASR |
$7.37
|
| Rate for Payer: ASR Commercial |
$45.40
|
| Rate for Payer: ASR Commercial |
$18.24
|
| Rate for Payer: ASR Commercial |
$7.37
|
| Rate for Payer: BCBS Trust/PPO |
$6.19
|
| Rate for Payer: BCBS Trust/PPO |
$15.32
|
| Rate for Payer: BCBS Trust/PPO |
$38.14
|
| Rate for Payer: BCN Commercial |
$14.58
|
| Rate for Payer: BCN Commercial |
$5.89
|
| Rate for Payer: BCN Commercial |
$36.28
|
| Rate for Payer: Cash Price |
$37.44
|
| Rate for Payer: Cash Price |
$15.04
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Cofinity Commercial |
$17.67
|
| Rate for Payer: Cofinity Commercial |
$43.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.08
|
| Rate for Payer: Healthscope Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$46.80
|
| Rate for Payer: Healthscope Commercial |
$7.60
|
| Rate for Payer: Healthscope Whirlpool |
$45.40
|
| Rate for Payer: Healthscope Whirlpool |
$18.24
|
| Rate for Payer: Healthscope Whirlpool |
$7.37
|
| Rate for Payer: Mclaren Commercial |
$42.12
|
| Rate for Payer: Mclaren Commercial |
$16.92
|
| Rate for Payer: Mclaren Commercial |
$6.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.98
|
| Rate for Payer: Nomi Health Commercial |
$38.38
|
| Rate for Payer: Nomi Health Commercial |
$15.42
|
| Rate for Payer: Nomi Health Commercial |
$6.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.54
|
|
|
LEVOFLOXACIN 500 MG TABLET
|
Facility
|
OP
|
$458.85
|
|
|
Service Code
|
NDC 68084048211
|
| Hospital Charge Code |
18919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.54 |
| Max. Negotiated Rate |
$458.85 |
| Rate for Payer: Aetna Commercial |
$412.96
|
| Rate for Payer: Aetna Medicare |
$229.42
|
| Rate for Payer: ASR ASR |
$445.08
|
| Rate for Payer: ASR Commercial |
$445.08
|
| Rate for Payer: BCBS Complete |
$183.54
|
| Rate for Payer: BCBS Trust/PPO |
$375.75
|
| Rate for Payer: BCN Commercial |
$355.75
|
| Rate for Payer: Cash Price |
$367.08
|
| Rate for Payer: Cofinity Commercial |
$431.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.08
|
| Rate for Payer: Healthscope Commercial |
$458.85
|
| Rate for Payer: Healthscope Whirlpool |
$445.08
|
| Rate for Payer: Mclaren Commercial |
$412.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.02
|
| Rate for Payer: Nomi Health Commercial |
$376.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$402.04
|
| Rate for Payer: Priority Health Narrow Network |
$321.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.79
|
|
|
LEVOFLOXACIN 500 MG TABLET
|
Facility
|
OP
|
$213.75
|
|
|
Service Code
|
NDC 00904635261
|
| Hospital Charge Code |
18919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna Commercial |
$192.38
|
| Rate for Payer: Aetna Medicare |
$106.88
|
| Rate for Payer: ASR ASR |
$207.34
|
| Rate for Payer: ASR Commercial |
$207.34
|
| Rate for Payer: BCBS Complete |
$85.50
|
| Rate for Payer: BCBS Trust/PPO |
$175.04
|
| Rate for Payer: BCN Commercial |
$165.72
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cofinity Commercial |
$200.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.00
|
| Rate for Payer: Healthscope Commercial |
$213.75
|
| Rate for Payer: Healthscope Whirlpool |
$207.34
|
| Rate for Payer: Mclaren Commercial |
$192.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.69
|
| Rate for Payer: Nomi Health Commercial |
$175.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$187.29
|
| Rate for Payer: Priority Health Narrow Network |
$149.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.10
|
|
|
LEVOFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$213.75
|
|
|
Service Code
|
NDC 00904635261
|
| Hospital Charge Code |
18919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.94 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna Commercial |
$192.38
|
| Rate for Payer: ASR ASR |
$207.34
|
| Rate for Payer: ASR Commercial |
$207.34
|
| Rate for Payer: BCBS Trust/PPO |
$174.18
|
| Rate for Payer: BCN Commercial |
$165.72
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cofinity Commercial |
$200.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.00
|
| Rate for Payer: Healthscope Commercial |
$213.75
|
| Rate for Payer: Healthscope Whirlpool |
$207.34
|
| Rate for Payer: Mclaren Commercial |
$192.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.69
|
| Rate for Payer: Nomi Health Commercial |
$175.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.10
|
|
|
LEVOFLOXACIN 500 MG TABLET
|
Facility
|
OP
|
$458.85
|
|
|
Service Code
|
NDC 68084048201
|
| Hospital Charge Code |
18919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.54 |
| Max. Negotiated Rate |
$458.85 |
| Rate for Payer: Aetna Commercial |
$412.96
|
| Rate for Payer: Aetna Medicare |
$229.42
|
| Rate for Payer: ASR ASR |
$445.08
|
| Rate for Payer: ASR Commercial |
$445.08
|
| Rate for Payer: BCBS Complete |
$183.54
|
| Rate for Payer: BCBS Trust/PPO |
$375.75
|
| Rate for Payer: BCN Commercial |
$355.75
|
| Rate for Payer: Cash Price |
$367.08
|
| Rate for Payer: Cofinity Commercial |
$431.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.08
|
| Rate for Payer: Healthscope Commercial |
$458.85
|
| Rate for Payer: Healthscope Whirlpool |
$445.08
|
| Rate for Payer: Mclaren Commercial |
$412.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.02
|
| Rate for Payer: Nomi Health Commercial |
$376.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$402.04
|
| Rate for Payer: Priority Health Narrow Network |
$321.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.79
|
|
|
LEVOFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$458.85
|
|
|
Service Code
|
NDC 68084048211
|
| Hospital Charge Code |
18919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$298.25 |
| Max. Negotiated Rate |
$458.85 |
| Rate for Payer: Aetna Commercial |
$412.96
|
| Rate for Payer: ASR ASR |
$445.08
|
| Rate for Payer: ASR Commercial |
$445.08
|
| Rate for Payer: BCBS Trust/PPO |
$373.92
|
| Rate for Payer: BCN Commercial |
$355.75
|
| Rate for Payer: Cash Price |
$367.08
|
| Rate for Payer: Cofinity Commercial |
$431.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.08
|
| Rate for Payer: Healthscope Commercial |
$458.85
|
| Rate for Payer: Healthscope Whirlpool |
$445.08
|
| Rate for Payer: Mclaren Commercial |
$412.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.02
|
| Rate for Payer: Nomi Health Commercial |
$376.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.79
|
|
|
LEVOFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$458.85
|
|
|
Service Code
|
NDC 68084048201
|
| Hospital Charge Code |
18919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$298.25 |
| Max. Negotiated Rate |
$458.85 |
| Rate for Payer: Aetna Commercial |
$412.96
|
| Rate for Payer: ASR ASR |
$445.08
|
| Rate for Payer: ASR Commercial |
$445.08
|
| Rate for Payer: BCBS Trust/PPO |
$373.92
|
| Rate for Payer: BCN Commercial |
$355.75
|
| Rate for Payer: Cash Price |
$367.08
|
| Rate for Payer: Cofinity Commercial |
$431.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.08
|
| Rate for Payer: Healthscope Commercial |
$458.85
|
| Rate for Payer: Healthscope Whirlpool |
$445.08
|
| Rate for Payer: Mclaren Commercial |
$412.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.02
|
| Rate for Payer: Nomi Health Commercial |
$376.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.79
|
|
|
LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$7.80
|
|
|
Service Code
|
HCPCS J1956
|
| Hospital Charge Code |
112928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Aetna Commercial |
$7.02
|
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Medicare |
$11.10
|
| Rate for Payer: Aetna Medicare |
$3.90
|
| Rate for Payer: ASR ASR |
$7.57
|
| Rate for Payer: ASR ASR |
$21.53
|
| Rate for Payer: ASR Commercial |
$21.53
|
| Rate for Payer: ASR Commercial |
$7.57
|
| Rate for Payer: BCBS Complete |
$3.12
|
| Rate for Payer: BCBS Complete |
$8.88
|
| Rate for Payer: BCBS Trust/PPO |
$6.39
|
| Rate for Payer: BCBS Trust/PPO |
$18.18
|
| Rate for Payer: BCN Commercial |
$17.21
|
| Rate for Payer: BCN Commercial |
$6.05
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cofinity Commercial |
$20.87
|
| Rate for Payer: Cofinity Commercial |
$7.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Healthscope Commercial |
$7.80
|
| Rate for Payer: Healthscope Commercial |
$22.20
|
| Rate for Payer: Healthscope Whirlpool |
$7.57
|
| Rate for Payer: Healthscope Whirlpool |
$21.53
|
| Rate for Payer: Mclaren Commercial |
$19.98
|
| Rate for Payer: Mclaren Commercial |
$7.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Nomi Health Commercial |
$6.40
|
| Rate for Payer: Nomi Health Commercial |
$18.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.85
|
| Rate for Payer: Priority Health Narrow Network |
$0.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.86
|
|
