|
LORAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
NDC 69315090501
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.27 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna Commercial |
$113.05
|
| Rate for Payer: Aetna Medicare |
$66.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.45
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Advantage |
$93.10
|
| Rate for Payer: Cofinity Commercial |
$114.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.40
|
| Rate for Payer: Healthscope Commercial |
$119.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.75
|
| Rate for Payer: PHP Commercial |
$113.05
|
| Rate for Payer: Priority Health SBD |
$83.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.45
|
| Rate for Payer: UHC Core |
$69.29
|
| Rate for Payer: UHC Exchange |
$52.27
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$150.50
|
|
|
Service Code
|
NDC 00904600861
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.81 |
| Max. Negotiated Rate |
$135.45 |
| Rate for Payer: Aetna Commercial |
$127.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.83
|
| Rate for Payer: Cash Price |
$120.40
|
| Rate for Payer: Cofinity Advantage |
$105.35
|
| Rate for Payer: Cofinity Commercial |
$129.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.40
|
| Rate for Payer: Healthscope Commercial |
$135.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.88
|
| Rate for Payer: PHP Commercial |
$127.92
|
| Rate for Payer: Priority Health SBD |
$94.81
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$411.25
|
|
|
Service Code
|
NDC 69315090505
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.09 |
| Max. Negotiated Rate |
$370.12 |
| Rate for Payer: Aetna Commercial |
$349.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.31
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cofinity Advantage |
$287.88
|
| Rate for Payer: Cofinity Commercial |
$353.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.00
|
| Rate for Payer: Healthscope Commercial |
$370.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$308.44
|
| Rate for Payer: PHP Commercial |
$349.56
|
| Rate for Payer: Priority Health SBD |
$259.09
|
|
|
LORAZEPAM 2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$14.84
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
10467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$13.36 |
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Aetna Commercial |
$137.28
|
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Medicare |
$7.42
|
| Rate for Payer: Aetna Medicare |
$80.75
|
| Rate for Payer: Aetna Medicare |
$8.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.62
|
| Rate for Payer: BCBS Complete |
$7.15
|
| Rate for Payer: BCBS Complete |
$5.94
|
| Rate for Payer: BCBS Complete |
$64.60
|
| Rate for Payer: BCBS Trust/PPO |
$3.52
|
| Rate for Payer: BCBS Trust/PPO |
$3.52
|
| Rate for Payer: BCBS Trust/PPO |
$3.52
|
| Rate for Payer: BCN Commercial |
$3.52
|
| Rate for Payer: BCN Commercial |
$3.52
|
| Rate for Payer: BCN Commercial |
$3.52
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cash Price |
$129.21
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cash Price |
$129.21
|
| Rate for Payer: Cofinity Advantage |
$113.06
|
| Rate for Payer: Cofinity Advantage |
$10.39
|
| Rate for Payer: Cofinity Advantage |
$12.52
|
| Rate for Payer: Cofinity Commercial |
$12.76
|
| Rate for Payer: Cofinity Commercial |
$138.90
|
| Rate for Payer: Cofinity Commercial |
$15.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.87
|
| Rate for Payer: Healthscope Commercial |
$16.09
|
| Rate for Payer: Healthscope Commercial |
$145.36
|
| Rate for Payer: Healthscope Commercial |
$13.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.41
|
| Rate for Payer: PHP Commercial |
$12.61
|
| Rate for Payer: PHP Commercial |
$137.28
|
| Rate for Payer: PHP Commercial |
$15.20
|
| Rate for Payer: Priority Health SBD |
$9.35
|
| Rate for Payer: Priority Health SBD |
$11.26
|
| Rate for Payer: Priority Health SBD |
$101.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.33
|
| Rate for Payer: UHC Core |
$2.33
|
| Rate for Payer: UHC Core |
$2.33
|
| Rate for Payer: UHC Core |
$2.33
|
| Rate for Payer: UHC Exchange |
$2.33
|
| Rate for Payer: UHC Exchange |
$2.33
|
| Rate for Payer: UHC Exchange |
$2.33
|
|
|
LORAZEPAM 2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$161.51
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
10467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.75 |
| Max. Negotiated Rate |
$145.36 |
| Rate for Payer: Aetna Commercial |
$137.28
|
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.65
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cash Price |
$129.21
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cofinity Advantage |
$113.06
|
| Rate for Payer: Cofinity Advantage |
$10.39
|
| Rate for Payer: Cofinity Advantage |
$12.52
|
| Rate for Payer: Cofinity Commercial |
$15.38
|
| Rate for Payer: Cofinity Commercial |
$12.76
|
| Rate for Payer: Cofinity Commercial |
$138.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.30
|
| Rate for Payer: Healthscope Commercial |
$13.36
|
| Rate for Payer: Healthscope Commercial |
$145.36
|
| Rate for Payer: Healthscope Commercial |
$16.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.13
|
| Rate for Payer: PHP Commercial |
$12.61
|
| Rate for Payer: PHP Commercial |
$15.20
|
| Rate for Payer: PHP Commercial |
$137.28
|
| Rate for Payer: Priority Health SBD |
$11.26
|
| Rate for Payer: Priority Health SBD |
$9.35
|
| Rate for Payer: Priority Health SBD |
$101.75
|
|
|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$311.85
|
|
|
Service Code
|
NDC 00054353244
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.56 |
| Max. Negotiated Rate |
$280.67 |
| Rate for Payer: Aetna Commercial |
$265.07
|
| Rate for Payer: Aetna Medicare |
$155.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.70
|
| Rate for Payer: BCBS Complete |
$124.74
|
| Rate for Payer: Cash Price |
$249.48
|
| Rate for Payer: Cofinity Advantage |
$218.29
|
| Rate for Payer: Cofinity Commercial |
$268.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.48
|
| Rate for Payer: Healthscope Commercial |
$280.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.89
|
| Rate for Payer: PHP Commercial |
$265.07
|
| Rate for Payer: Priority Health SBD |
$196.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.70
|
| Rate for Payer: UHC Core |
$162.47
|
| Rate for Payer: UHC Exchange |
$122.56
|
|
|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$311.85
|
|
|
Service Code
|
NDC 00054353244
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.47 |
| Max. Negotiated Rate |
$280.67 |
| Rate for Payer: Aetna Commercial |
$265.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.70
|
| Rate for Payer: Cash Price |
$249.48
|
| Rate for Payer: Cofinity Advantage |
$218.29
|
| Rate for Payer: Cofinity Commercial |
$268.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.48
|
| Rate for Payer: Healthscope Commercial |
$280.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.89
|
| Rate for Payer: PHP Commercial |
$265.07
|
| Rate for Payer: Priority Health SBD |
$196.47
|
|
|
LOSARTAN 100 MG TABLET
|
Facility
|
OP
|
$49.35
|
|
|
Service Code
|
NDC 65862020330
|
| Hospital Charge Code |
22588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$44.41 |
| Rate for Payer: Aetna Commercial |
$41.95
|
| Rate for Payer: Aetna Medicare |
$24.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.08
|
| Rate for Payer: BCBS Complete |
$19.74
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cofinity Advantage |
$34.55
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.48
|
| Rate for Payer: Healthscope Commercial |
$44.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.01
|
| Rate for Payer: PHP Commercial |
$41.95
|
| Rate for Payer: Priority Health SBD |
$31.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.08
|
| Rate for Payer: UHC Core |
$25.71
|
| Rate for Payer: UHC Exchange |
$19.39
|
|
|
LOSARTAN 100 MG TABLET
|
Facility
|
OP
|
$179.55
|
|
|
Service Code
|
NDC 50268050615
|
| Hospital Charge Code |
22588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.56 |
| Max. Negotiated Rate |
$161.59 |
| Rate for Payer: Aetna Commercial |
$152.62
|
| Rate for Payer: Aetna Medicare |
$89.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.71
|
| Rate for Payer: BCBS Complete |
$71.82
|
| Rate for Payer: Cash Price |
$143.64
|
| Rate for Payer: Cofinity Advantage |
$125.69
|
| Rate for Payer: Cofinity Commercial |
$154.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.64
|
| Rate for Payer: Healthscope Commercial |
$161.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.66
|
| Rate for Payer: PHP Commercial |
$152.62
|
| Rate for Payer: Priority Health SBD |
$113.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.71
|
| Rate for Payer: UHC Core |
$93.55
|
| Rate for Payer: UHC Exchange |
$70.56
|
|
|
LOSARTAN 100 MG TABLET
|
Facility
|
IP
|
$49.35
|
|
|
Service Code
|
NDC 65862020330
|
| Hospital Charge Code |
22588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$44.41 |
| Rate for Payer: Aetna Commercial |
$41.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.08
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cofinity Advantage |
$34.55
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.48
|
| Rate for Payer: Healthscope Commercial |
$44.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.01
|
| Rate for Payer: PHP Commercial |
$41.95
|
| Rate for Payer: Priority Health SBD |
$31.09
|
|
|
LOSARTAN 100 MG TABLET
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
NDC 50268050611
|
| Hospital Charge Code |
22588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Aetna Commercial |
$3.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.34
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cofinity Advantage |
$2.52
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.88
|
| Rate for Payer: Healthscope Commercial |
$3.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.70
|
| Rate for Payer: PHP Commercial |
$3.06
|
| Rate for Payer: Priority Health SBD |
$2.27
|
|
|
LOSARTAN 100 MG TABLET
|
Facility
|
IP
|
$179.55
|
|
|
Service Code
|
NDC 50268050615
|
| Hospital Charge Code |
22588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.12 |
| Max. Negotiated Rate |
$161.59 |
| Rate for Payer: Aetna Commercial |
$152.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.71
|
| Rate for Payer: Cash Price |
$143.64
|
| Rate for Payer: Cofinity Advantage |
$125.69
|
| Rate for Payer: Cofinity Commercial |
$154.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.64
|
| Rate for Payer: Healthscope Commercial |
$161.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.66
|
| Rate for Payer: PHP Commercial |
$152.62
|
| Rate for Payer: Priority Health SBD |
$113.12
|
|
|
LOSARTAN 100 MG TABLET
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
NDC 50268050611
|
| Hospital Charge Code |
22588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Aetna Commercial |
$3.06
|
| Rate for Payer: Aetna Medicare |
$1.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.34
|
| Rate for Payer: BCBS Complete |
$1.44
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cofinity Advantage |
$2.52
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.88
|
| Rate for Payer: Healthscope Commercial |
$3.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.70
|
| Rate for Payer: PHP Commercial |
$3.06
|
| Rate for Payer: Priority Health SBD |
$2.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.34
|
| Rate for Payer: UHC Core |
$1.88
|
| Rate for Payer: UHC Exchange |
$1.41
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
OP
|
$3.41
|
|
|
Service Code
|
NDC 68084034611
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: Aetna Medicare |
$1.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.22
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cofinity Advantage |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.73
|
| Rate for Payer: Healthscope Commercial |
$3.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.56
|
| Rate for Payer: PHP Commercial |
$2.90
|
| Rate for Payer: Priority Health SBD |
$2.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.22
|
| Rate for Payer: UHC Core |
$1.78
|
| Rate for Payer: UHC Exchange |
$1.34
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
OP
|
$340.10
|
|
|
Service Code
|
NDC 68084034601
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.66 |
| Max. Negotiated Rate |
$306.09 |
| Rate for Payer: Aetna Commercial |
$289.08
|
| Rate for Payer: Aetna Medicare |
$170.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.06
|
| Rate for Payer: BCBS Complete |
$136.04
|
| Rate for Payer: Cash Price |
$272.08
|
| Rate for Payer: Cofinity Advantage |
$238.07
|
| Rate for Payer: Cofinity Commercial |
$292.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.08
|
| Rate for Payer: Healthscope Commercial |
$306.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.07
|
| Rate for Payer: PHP Commercial |
$289.08
|
| Rate for Payer: Priority Health SBD |
$214.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.06
|
| Rate for Payer: UHC Core |
$177.19
|
| Rate for Payer: UHC Exchange |
$133.66
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$340.10
|
|
|
Service Code
|
NDC 68084034601
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.26 |
| Max. Negotiated Rate |
$306.09 |
| Rate for Payer: Aetna Commercial |
$289.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.06
|
| Rate for Payer: Cash Price |
$272.08
|
| Rate for Payer: Cofinity Advantage |
$238.07
|
| Rate for Payer: Cofinity Commercial |
$292.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.08
|
| Rate for Payer: Healthscope Commercial |
$306.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.07
|
| Rate for Payer: PHP Commercial |
$289.08
|
| Rate for Payer: Priority Health SBD |
$214.26
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$3.41
|
|
|
Service Code
|
NDC 68084034611
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.22
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cofinity Advantage |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.73
|
| Rate for Payer: Healthscope Commercial |
$3.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.56
|
| Rate for Payer: PHP Commercial |
$2.90
|
| Rate for Payer: Priority Health SBD |
$2.15
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$293.55
|
|
|
Service Code
|
NDC 63739068610
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.94 |
| Max. Negotiated Rate |
$264.19 |
| Rate for Payer: Aetna Commercial |
$249.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.81
|
| Rate for Payer: Cash Price |
$234.84
|
| Rate for Payer: Cofinity Advantage |
$205.49
|
| Rate for Payer: Cofinity Commercial |
$252.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.84
|
| Rate for Payer: Healthscope Commercial |
$264.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.16
|
| Rate for Payer: PHP Commercial |
$249.52
|
| Rate for Payer: Priority Health SBD |
$184.94
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$67.68
|
|
|
Service Code
|
NDC 65862020290
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.64 |
| Max. Negotiated Rate |
$60.91 |
| Rate for Payer: Aetna Commercial |
$57.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.99
|
| Rate for Payer: Cash Price |
$54.14
|
| Rate for Payer: Cofinity Advantage |
$47.38
|
| Rate for Payer: Cofinity Commercial |
$58.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.14
|
| Rate for Payer: Healthscope Commercial |
$60.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.76
|
| Rate for Payer: PHP Commercial |
$57.53
|
| Rate for Payer: Priority Health SBD |
$42.64
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$99.41
|
|
|
Service Code
|
NDC 68180037709
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.63 |
| Max. Negotiated Rate |
$89.47 |
| Rate for Payer: Aetna Commercial |
$84.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.62
|
| Rate for Payer: Cash Price |
$79.53
|
| Rate for Payer: Cofinity Advantage |
$69.59
|
| Rate for Payer: Cofinity Commercial |
$85.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.53
|
| Rate for Payer: Healthscope Commercial |
$89.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.56
|
| Rate for Payer: PHP Commercial |
$84.50
|
| Rate for Payer: Priority Health SBD |
$62.63
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
OP
|
$259.35
|
|
|
Service Code
|
NDC 68084034701
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$233.41 |
| Rate for Payer: Aetna Commercial |
$220.45
|
| Rate for Payer: Aetna Medicare |
$129.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.58
|
| Rate for Payer: BCBS Complete |
$103.74
|
| Rate for Payer: Cash Price |
$207.48
|
| Rate for Payer: Cofinity Advantage |
$181.54
|
| Rate for Payer: Cofinity Commercial |
$223.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.48
|
| Rate for Payer: Healthscope Commercial |
$233.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.51
|
| Rate for Payer: PHP Commercial |
$220.45
|
| Rate for Payer: Priority Health SBD |
$163.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.58
|
| Rate for Payer: UHC Core |
$135.12
|
| Rate for Payer: UHC Exchange |
$101.92
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
OP
|
$259.35
|
|
|
Service Code
|
NDC 68084034711
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$233.41 |
| Rate for Payer: Aetna Commercial |
$220.45
|
| Rate for Payer: Aetna Medicare |
$129.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.58
|
| Rate for Payer: BCBS Complete |
$103.74
|
| Rate for Payer: Cash Price |
$207.48
|
| Rate for Payer: Cofinity Advantage |
$181.54
|
| Rate for Payer: Cofinity Commercial |
$223.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.48
|
| Rate for Payer: Healthscope Commercial |
$233.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.51
|
| Rate for Payer: PHP Commercial |
$220.45
|
| Rate for Payer: Priority Health SBD |
$163.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.58
|
| Rate for Payer: UHC Core |
$135.12
|
| Rate for Payer: UHC Exchange |
$101.92
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
OP
|
$293.55
|
|
|
Service Code
|
NDC 63739068610
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.37 |
| Max. Negotiated Rate |
$264.19 |
| Rate for Payer: Aetna Commercial |
$249.52
|
| Rate for Payer: Aetna Medicare |
$146.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.81
|
| Rate for Payer: BCBS Complete |
$117.42
|
| Rate for Payer: Cash Price |
$234.84
|
| Rate for Payer: Cofinity Advantage |
$205.49
|
| Rate for Payer: Cofinity Commercial |
$252.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.84
|
| Rate for Payer: Healthscope Commercial |
$264.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$234.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.16
|
| Rate for Payer: PHP Commercial |
$249.52
|
| Rate for Payer: Priority Health SBD |
$184.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.81
|
| Rate for Payer: UHC Core |
$152.94
|
| Rate for Payer: UHC Exchange |
$115.37
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
OP
|
$99.41
|
|
|
Service Code
|
NDC 68180037709
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.07 |
| Max. Negotiated Rate |
$89.47 |
| Rate for Payer: Aetna Commercial |
$84.50
|
| Rate for Payer: Aetna Medicare |
$49.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.62
|
| Rate for Payer: BCBS Complete |
$39.76
|
| Rate for Payer: Cash Price |
$79.53
|
| Rate for Payer: Cofinity Advantage |
$69.59
|
| Rate for Payer: Cofinity Commercial |
$85.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.53
|
| Rate for Payer: Healthscope Commercial |
$89.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.56
|
| Rate for Payer: PHP Commercial |
$84.50
|
| Rate for Payer: Priority Health SBD |
$62.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.62
|
| Rate for Payer: UHC Core |
$51.79
|
| Rate for Payer: UHC Exchange |
$39.07
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$259.35
|
|
|
Service Code
|
NDC 68084034711
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.39 |
| Max. Negotiated Rate |
$233.41 |
| Rate for Payer: Aetna Commercial |
$220.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.58
|
| Rate for Payer: Cash Price |
$207.48
|
| Rate for Payer: Cofinity Advantage |
$181.54
|
| Rate for Payer: Cofinity Commercial |
$223.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.48
|
| Rate for Payer: Healthscope Commercial |
$233.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.51
|
| Rate for Payer: PHP Commercial |
$220.45
|
| Rate for Payer: Priority Health SBD |
$163.39
|
|
