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  4. /NDC 62756051340

NDC 62756051340

levETIRAcetam 500 mg/5 mL intravenous solution at Baylor Scott & White All Saints Medical Center - Fort Worth

Fort Worth, TX

Pricing by billing methodology

Price type

All methodologies

$124

Aggregated across all available billing methodologies for this code.

Case rate

Not reported

Reflects a negotiated flat case rate paid per episode of care, rather than itemized charges.

Fee schedule

$0

Reflects negotiated fee schedule rates with commercial payers.

Per diem

Not reported

Reflects a negotiated per diem rate paid per day of care.

Percent of billed charges

$124

Reflects a negotiated percentage of total billed charges.

Other

Not reported

Reflects a payer-specific billing methodology not covered by the standard categories.

Last updated: Jun 29, 2026

Compare to other hospitals

See levETIRAcetam 500 mg/5 mL intravenous solution pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.

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