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NDC 65145017510

levETIRAcetam 1,500 mg/100 mL in sodium chloride(iso-osm) IV piggyback

Reported by 30 hospitals in the network.

Filter by billing methodology

All methodologiesAggregated across all available billing methodologies for this code.Case rateCMS definition: a flat rate for a package of items and services triggered by a diagnosis, treatment, or condition for a designated length of time.Fee scheduleCMS definition: the payer-specific negotiated charge is based on a fee schedule — for example, a Medicare, Medicaid, commercial payer, or workers’ compensation fee schedule.Per diemCMS definition: the per day charge for providing hospital items and services.Percent of billed chargesCMS definition: the payer-specific negotiated charge is based on a percentage of the total billed charges for an item or service, which may vary depending on certain pre-determined criteria being met.OtherCMS definition: used when the standard charge methodology can’t be described by case rate, fee schedule, per diem, or percent of total billed charges.

National pricing summary

Low

$14

Average

$29

Median

$18

High

$351

Hospitals reporting this code

#HospitalLocation
1Baylor Scott & White Medical Center - TempleTemple, TX$5$17$17$27$5
2Baylor Scott & White Medical Center - BrenhamBrenham, TX$4$16$14$27$7
3Baylor Scott & White Medical Center - TaylorTaylor, TX$6$16$15$24$6
4Baylor Scott & White Medical Center - HillcrestWaco, TX$4$17$16$26$4
5Baylor University Medical CenterDallas, TX$5$20$351$7.4k$1.5k
6Baylor Scott & White All Saints Medical Center - Fort WorthFort Worth, TX$5$19$17$26$6
7Baylor Scott & White Medical Center - Round RockRound Rock, TX$6$18$18$27$5
8Baylor Scott & White McLane Children's Medical CenterTemple, TX$5$17$17$26$4
9Baylor Scott & White Medical Center - Lake PointeRowlett, TX$3$19$18$26$5
10Baylor Scott & White Medical Center - PlanoPlano, TX$4$19$18$26$4
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