|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$211.85
|
|
|
Service Code
|
NDC 0904-6852-61
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.21 |
| Max. Negotiated Rate |
$190.66 |
| Rate for Payer: Aetna Commercial |
$180.07
|
| Rate for Payer: BCBS Trust/PPO |
$163.72
|
| Rate for Payer: BCN Commercial |
$163.72
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Cofinity Commercial |
$182.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.48
|
| Rate for Payer: Healthscope Commercial |
$190.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180.07
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.43
|
| Rate for Payer: UHC Core |
$176.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.89
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$2.41
|
|
|
Service Code
|
NDC 51079-246-01
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Aetna Commercial |
$2.05
|
| Rate for Payer: BCBS Trust/PPO |
$1.86
|
| Rate for Payer: BCN Commercial |
$1.86
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cofinity Commercial |
$2.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$2.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.05
|
| Rate for Payer: PHP Commercial |
$2.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.12
|
| Rate for Payer: UHC Core |
$2.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.81
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$238.45
|
|
|
Service Code
|
NDC 68084-248-11
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.43 |
| Max. Negotiated Rate |
$214.60 |
| Rate for Payer: Aetna Commercial |
$202.68
|
| Rate for Payer: BCBS Trust/PPO |
$184.27
|
| Rate for Payer: BCN Commercial |
$184.27
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$205.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$214.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$202.68
|
| Rate for Payer: PHP Commercial |
$202.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$207.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.84
|
| Rate for Payer: UHC Core |
$199.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.84
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$240.35
|
|
|
Service Code
|
NDC 51079-246-20
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.59 |
| Max. Negotiated Rate |
$216.32 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: BCBS Trust/PPO |
$185.74
|
| Rate for Payer: BCN Commercial |
$185.74
|
| Rate for Payer: Cash Price |
$192.28
|
| Rate for Payer: Cofinity Commercial |
$206.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.28
|
| Rate for Payer: Healthscope Commercial |
$216.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.30
|
| Rate for Payer: PHP Commercial |
$204.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$209.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.51
|
| Rate for Payer: UHC Core |
$200.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.26
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$238.45
|
|
|
Service Code
|
NDC 68084-248-01
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.43 |
| Max. Negotiated Rate |
$214.60 |
| Rate for Payer: Aetna Commercial |
$202.68
|
| Rate for Payer: BCBS Trust/PPO |
$184.27
|
| Rate for Payer: BCN Commercial |
$184.27
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$205.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$214.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$202.68
|
| Rate for Payer: PHP Commercial |
$202.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$207.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.84
|
| Rate for Payer: UHC Core |
$199.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.84
|
|
|
LORAZEPAM 0.25 MG CUSTOM TAB
|
Facility
|
IP
|
$0.46
|
|
|
Service Code
|
NDC 9900-0003-53
|
| Hospital Charge Code |
158587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Aetna Commercial |
$0.39
|
| Rate for Payer: BCBS Trust/PPO |
$0.36
|
| Rate for Payer: BCN Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cofinity Commercial |
$0.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.37
|
| Rate for Payer: Healthscope Commercial |
$0.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.39
|
| Rate for Payer: PHP Commercial |
$0.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.40
|
| Rate for Payer: UHC Core |
$0.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.35
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$71.75
|
|
|
Service Code
|
NDC 69315-904-01
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.76 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Aetna Commercial |
$60.99
|
| Rate for Payer: BCBS Trust/PPO |
$55.45
|
| Rate for Payer: BCN Commercial |
$55.45
|
| Rate for Payer: Cash Price |
$57.40
|
| Rate for Payer: Cofinity Commercial |
$61.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.40
|
| Rate for Payer: Healthscope Commercial |
$64.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.99
|
| Rate for Payer: PHP Commercial |
$60.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.14
|
| Rate for Payer: UHC Core |
$59.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.81
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$215.25
|
|
|
Service Code
|
NDC 60687-627-01
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.28 |
| Max. Negotiated Rate |
$193.72 |
| Rate for Payer: Aetna Commercial |
$182.96
|
| Rate for Payer: BCBS Trust/PPO |
$166.35
|
| Rate for Payer: BCN Commercial |
$166.35
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cofinity Commercial |
$185.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.20
|
| Rate for Payer: Healthscope Commercial |
$193.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$182.96
|
| Rate for Payer: PHP Commercial |
$182.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$187.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.42
|
| Rate for Payer: UHC Core |
$179.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.44
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$129.50
|
|
|
Service Code
|
NDC 0904-6007-61
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.98 |
| Max. Negotiated Rate |
$116.55 |
| Rate for Payer: Aetna Commercial |
$110.08
|
| Rate for Payer: BCBS Trust/PPO |
$100.08
|
| Rate for Payer: BCN Commercial |
$100.08
|
| Rate for Payer: Cash Price |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$111.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.60
|
| Rate for Payer: Healthscope Commercial |
$116.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.08
|
| Rate for Payer: PHP Commercial |
$110.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.96
|
| Rate for Payer: UHC Core |
$108.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.12
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$2.16
|
|
|
Service Code
|
NDC 60687-627-11
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: BCBS Trust/PPO |
$1.67
|
| Rate for Payer: BCN Commercial |
$1.67
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$1.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.84
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.90
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.62
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$113.75
|
|
|
Service Code
|
NDC 51079-386-20
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.38 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$96.69
|
| Rate for Payer: BCBS Trust/PPO |
$87.91
|
| Rate for Payer: BCN Commercial |
$87.91
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cofinity Commercial |
$97.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.00
|
| Rate for Payer: Healthscope Commercial |
$102.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.69
|
| Rate for Payer: PHP Commercial |
$96.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.10
|
| Rate for Payer: UHC Core |
$94.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.31
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$2.17
|
|
|
Service Code
|
NDC 60687-638-11
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: BCBS Trust/PPO |
$1.68
|
| Rate for Payer: BCN Commercial |
$1.68
|
| Rate for Payer: Cash Price |
$1.74
|
| Rate for Payer: Cofinity Commercial |
$1.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.74
|
| Rate for Payer: Healthscope Commercial |
$1.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.84
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.91
|
| Rate for Payer: UHC Core |
$1.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.63
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
NDC 60687-638-01
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.35 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Aetna Commercial |
$184.45
|
| Rate for Payer: BCBS Trust/PPO |
$167.70
|
| Rate for Payer: BCN Commercial |
$167.70
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cofinity Commercial |
$186.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.60
|
| Rate for Payer: Healthscope Commercial |
$195.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$184.45
|
| Rate for Payer: PHP Commercial |
$184.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$188.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.96
|
| Rate for Payer: UHC Core |
$181.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.75
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$78.75
|
|
|
Service Code
|
NDC 69315-905-01
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.03 |
| Max. Negotiated Rate |
$70.88 |
| Rate for Payer: Aetna Commercial |
$66.94
|
| Rate for Payer: BCBS Trust/PPO |
$60.86
|
| Rate for Payer: BCN Commercial |
$60.86
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cofinity Commercial |
$67.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.00
|
| Rate for Payer: Healthscope Commercial |
$70.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.94
|
| Rate for Payer: PHP Commercial |
$66.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.30
|
| Rate for Payer: UHC Core |
$65.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.06
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$150.50
|
|
|
Service Code
|
NDC 0904-6008-61
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.79 |
| Max. Negotiated Rate |
$135.45 |
| Rate for Payer: Aetna Commercial |
$127.92
|
| Rate for Payer: BCBS Trust/PPO |
$116.31
|
| Rate for Payer: BCN Commercial |
$116.31
|
| Rate for Payer: Cash Price |
$120.40
|
| 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: Lakeland Regional Health Systems Commercial |
$112.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.92
|
| Rate for Payer: PHP Commercial |
$127.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.44
|
| Rate for Payer: UHC Core |
$125.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.88
|
|
|
LORAZEPAM 2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$17.88
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
10467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$16.09 |
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Commercial |
$26.42
|
| Rate for Payer: BCBS Trust/PPO |
$24.02
|
| Rate for Payer: BCBS Trust/PPO |
$13.82
|
| Rate for Payer: BCN Commercial |
$13.82
|
| Rate for Payer: BCN Commercial |
$24.02
|
| Rate for Payer: Cash Price |
$24.86
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cofinity Commercial |
$15.38
|
| Rate for Payer: Cofinity Commercial |
$26.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.30
|
| Rate for Payer: Healthscope Commercial |
$16.09
|
| Rate for Payer: Healthscope Commercial |
$27.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.42
|
| Rate for Payer: PHP Commercial |
$15.20
|
| Rate for Payer: PHP Commercial |
$26.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.73
|
| Rate for Payer: UHC Core |
$14.93
|
| Rate for Payer: UHC Core |
$25.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.31
|
|
|
LORAZEPAM 2 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$16.54
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
112180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$14.89 |
| Rate for Payer: Aetna Commercial |
$14.06
|
| Rate for Payer: BCBS Trust/PPO |
$12.78
|
| Rate for Payer: BCN Commercial |
$12.78
|
| Rate for Payer: Cash Price |
$13.23
|
| Rate for Payer: Cofinity Commercial |
$14.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.23
|
| Rate for Payer: Healthscope Commercial |
$14.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.06
|
| Rate for Payer: PHP Commercial |
$14.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.56
|
| Rate for Payer: UHC Core |
$13.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.40
|
|
|
LOSARTAN 100 MG TABLET
|
Facility
|
IP
|
$377.15
|
|
|
Service Code
|
NDC 0904-7049-61
|
| Hospital Charge Code |
22588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$230.02 |
| Max. Negotiated Rate |
$339.44 |
| Rate for Payer: Aetna Commercial |
$320.58
|
| Rate for Payer: BCBS Trust/PPO |
$291.46
|
| Rate for Payer: BCN Commercial |
$291.46
|
| Rate for Payer: Cash Price |
$301.72
|
| Rate for Payer: Cofinity Commercial |
$324.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.72
|
| Rate for Payer: Healthscope Commercial |
$339.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$320.58
|
| Rate for Payer: PHP Commercial |
$320.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$328.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$230.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$331.89
|
| Rate for Payer: UHC Core |
$314.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.86
|
|
|
LOSARTAN 100 MG TABLET
|
Facility
|
IP
|
$387.60
|
|
|
Service Code
|
NDC 68084-348-01
|
| Hospital Charge Code |
22588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.40 |
| Max. Negotiated Rate |
$348.84 |
| Rate for Payer: Aetna Commercial |
$329.46
|
| Rate for Payer: BCBS Trust/PPO |
$299.54
|
| Rate for Payer: BCN Commercial |
$299.54
|
| Rate for Payer: Cash Price |
$310.08
|
| Rate for Payer: Cofinity Commercial |
$333.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.08
|
| Rate for Payer: Healthscope Commercial |
$348.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$329.46
|
| Rate for Payer: PHP Commercial |
$329.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$337.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.09
|
| Rate for Payer: UHC Core |
$323.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.70
|
|
|
LOSARTAN 100 MG TABLET
|
Facility
|
IP
|
$387.60
|
|
|
Service Code
|
NDC 68084-348-11
|
| Hospital Charge Code |
22588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.40 |
| Max. Negotiated Rate |
$348.84 |
| Rate for Payer: Aetna Commercial |
$329.46
|
| Rate for Payer: BCBS Trust/PPO |
$299.54
|
| Rate for Payer: BCN Commercial |
$299.54
|
| Rate for Payer: Cash Price |
$310.08
|
| Rate for Payer: Cofinity Commercial |
$333.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.08
|
| Rate for Payer: Healthscope Commercial |
$348.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$329.46
|
| Rate for Payer: PHP Commercial |
$329.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$337.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.09
|
| Rate for Payer: UHC Core |
$323.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.70
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$304.95
|
|
|
Service Code
|
NDC 68084-346-01
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.99 |
| Max. Negotiated Rate |
$274.46 |
| Rate for Payer: Aetna Commercial |
$259.21
|
| Rate for Payer: BCBS Trust/PPO |
$235.67
|
| Rate for Payer: BCN Commercial |
$235.67
|
| Rate for Payer: Cash Price |
$243.96
|
| Rate for Payer: Cofinity Commercial |
$262.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.96
|
| Rate for Payer: Healthscope Commercial |
$274.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$259.21
|
| Rate for Payer: PHP Commercial |
$259.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$185.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.36
|
| Rate for Payer: UHC Core |
$254.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.71
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$3.05
|
|
|
Service Code
|
NDC 68084-346-11
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Aetna Commercial |
$2.59
|
| Rate for Payer: BCBS Trust/PPO |
$2.36
|
| Rate for Payer: BCN Commercial |
$2.36
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cofinity Commercial |
$2.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.44
|
| Rate for Payer: Healthscope Commercial |
$2.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.59
|
| Rate for Payer: PHP Commercial |
$2.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.68
|
| Rate for Payer: UHC Core |
$2.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.29
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$300.20
|
|
|
Service Code
|
NDC 0904-7047-61
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.09 |
| Max. Negotiated Rate |
$270.18 |
| Rate for Payer: Aetna Commercial |
$255.17
|
| Rate for Payer: BCBS Trust/PPO |
$231.99
|
| Rate for Payer: BCN Commercial |
$231.99
|
| Rate for Payer: Cash Price |
$240.16
|
| Rate for Payer: Cofinity Commercial |
$258.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.16
|
| Rate for Payer: Healthscope Commercial |
$270.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.17
|
| Rate for Payer: PHP Commercial |
$255.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.18
|
| Rate for Payer: UHC Core |
$250.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.15
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$225.15
|
|
|
Service Code
|
NDC 0904-7048-61
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.32 |
| Max. Negotiated Rate |
$202.64 |
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: BCBS Trust/PPO |
$174.00
|
| Rate for Payer: BCN Commercial |
$174.00
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.38
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.13
|
| Rate for Payer: UHC Core |
$188.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$225.15
|
|
|
Service Code
|
NDC 68084-347-11
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.32 |
| Max. Negotiated Rate |
$202.64 |
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: BCBS Trust/PPO |
$174.00
|
| Rate for Payer: BCN Commercial |
$174.00
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.38
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.13
|
| Rate for Payer: UHC Core |
$188.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
