|
LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$272.65
|
|
|
Service Code
|
NDC 00054002025
|
| Hospital Charge Code |
10455
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.76 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: BCBS Trust/PPO |
$225.18
|
| Rate for Payer: BCN Commercial |
$225.18
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$234.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.12
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.75
|
| Rate for Payer: Nomi Health Commercial |
$223.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.49
|
| Rate for Payer: PHP Commercial |
$231.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$237.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.93
|
| Rate for Payer: UHC Core |
$227.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.49
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$364.25
|
|
|
Service Code
|
NDC 69452027120
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.22 |
| Max. Negotiated Rate |
$327.82 |
| Rate for Payer: Aetna Commercial |
$309.61
|
| Rate for Payer: Aetna Medicare |
$94.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.83
|
| Rate for Payer: BCBS Complete |
$67.42
|
| Rate for Payer: BCBS MAPPO |
$91.06
|
| Rate for Payer: BCBS Trust/PPO |
$299.45
|
| Rate for Payer: BCN Commercial |
$299.45
|
| Rate for Payer: BCN Medicare Advantage |
$91.06
|
| Rate for Payer: Cash Price |
$291.40
|
| Rate for Payer: Cofinity Commercial |
$313.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.06
|
| Rate for Payer: Healthscope Commercial |
$327.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.19
|
| Rate for Payer: Mclaren Medicaid |
$64.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.62
|
| Rate for Payer: Meridian Medicaid |
$67.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$100.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.61
|
| Rate for Payer: Nomi Health Commercial |
$298.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.19
|
| Rate for Payer: PACE Senior Care Partners |
$86.51
|
| Rate for Payer: PACE SWMI |
$91.06
|
| Rate for Payer: PHP Commercial |
$309.61
|
| Rate for Payer: PHP Medicare Advantage |
$91.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$316.90
|
| Rate for Payer: Priority Health Medicare |
$91.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.52
|
| Rate for Payer: Railroad Medicare Medicare |
$91.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.54
|
| Rate for Payer: UHC Core |
$304.15
|
| Rate for Payer: UHC Exchange |
$91.06
|
| Rate for Payer: UHC Medicaid |
$64.22
|
| Rate for Payer: UHC Medicare Advantage |
$91.06
|
| Rate for Payer: UHCCP Medicaid |
$64.22
|
| Rate for Payer: VA VA |
$91.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.19
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$246.24
|
|
|
Service Code
|
NDC 00904747261
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.41 |
| Max. Negotiated Rate |
$221.62 |
| Rate for Payer: Aetna Commercial |
$209.30
|
| Rate for Payer: Aetna Medicare |
$64.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.95
|
| Rate for Payer: BCBS Complete |
$45.58
|
| Rate for Payer: BCBS MAPPO |
$61.56
|
| Rate for Payer: BCBS Trust/PPO |
$202.43
|
| Rate for Payer: BCN Commercial |
$202.43
|
| Rate for Payer: BCN Medicare Advantage |
$61.56
|
| Rate for Payer: Cash Price |
$196.99
|
| Rate for Payer: Cofinity Commercial |
$211.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.56
|
| Rate for Payer: Healthscope Commercial |
$221.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.68
|
| Rate for Payer: Mclaren Medicaid |
$43.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.64
|
| Rate for Payer: Meridian Medicaid |
$45.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$67.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.30
|
| Rate for Payer: Nomi Health Commercial |
$201.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.68
|
| Rate for Payer: PACE Senior Care Partners |
$58.48
|
| Rate for Payer: PACE SWMI |
$61.56
|
| Rate for Payer: PHP Commercial |
$209.30
|
| Rate for Payer: PHP Medicare Advantage |
$61.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$214.23
|
| Rate for Payer: Priority Health Medicare |
$62.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.38
|
| Rate for Payer: Railroad Medicare Medicare |
$61.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.69
|
| Rate for Payer: UHC Core |
$205.61
|
| Rate for Payer: UHC Exchange |
$61.56
|
| Rate for Payer: UHC Medicaid |
$43.41
|
| Rate for Payer: UHC Medicare Advantage |
$61.56
|
| Rate for Payer: UHCCP Medicaid |
$43.41
|
| Rate for Payer: VA VA |
$61.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.68
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$3.11
|
|
|
Service Code
|
NDC 51079069001
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna Commercial |
$2.64
|
| Rate for Payer: Aetna Medicare |
$0.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.97
|
| Rate for Payer: BCBS Complete |
$0.58
|
| Rate for Payer: BCBS MAPPO |
$0.78
|
| Rate for Payer: BCBS Trust/PPO |
$2.56
|
| Rate for Payer: BCN Commercial |
$2.56
|
| Rate for Payer: BCN Medicare Advantage |
$0.78
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.78
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.33
|
| Rate for Payer: Mclaren Medicaid |
$0.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.82
|
| Rate for Payer: Meridian Medicaid |
$0.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.64
|
| Rate for Payer: Nomi Health Commercial |
$2.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.33
|
| Rate for Payer: PACE Senior Care Partners |
$0.74
|
| Rate for Payer: PACE SWMI |
$0.78
|
| Rate for Payer: PHP Commercial |
$2.64
|
| Rate for Payer: PHP Medicare Advantage |
$0.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.71
|
| Rate for Payer: Priority Health Medicare |
$0.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.16
|
| Rate for Payer: Railroad Medicare Medicare |
$0.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.74
|
| Rate for Payer: UHC Core |
$2.60
|
| Rate for Payer: UHC Exchange |
$0.78
|
| Rate for Payer: UHC Medicaid |
$0.55
|
| Rate for Payer: UHC Medicare Advantage |
$0.78
|
| Rate for Payer: UHCCP Medicaid |
$0.55
|
| Rate for Payer: VA VA |
$0.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.33
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$3.22
|
|
|
Service Code
|
NDC 60687022911
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: Aetna Commercial |
$2.74
|
| Rate for Payer: Aetna Medicare |
$0.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.01
|
| Rate for Payer: BCBS Complete |
$0.60
|
| Rate for Payer: BCBS MAPPO |
$0.81
|
| Rate for Payer: BCBS Trust/PPO |
$2.65
|
| Rate for Payer: BCN Commercial |
$2.65
|
| Rate for Payer: BCN Medicare Advantage |
$0.81
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$2.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.81
|
| Rate for Payer: Healthscope Commercial |
$2.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.42
|
| Rate for Payer: Mclaren Medicaid |
$0.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.85
|
| Rate for Payer: Meridian Medicaid |
$0.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.74
|
| Rate for Payer: Nomi Health Commercial |
$2.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.42
|
| Rate for Payer: PACE Senior Care Partners |
$0.76
|
| Rate for Payer: PACE SWMI |
$0.81
|
| Rate for Payer: PHP Commercial |
$2.74
|
| Rate for Payer: PHP Medicare Advantage |
$0.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.80
|
| Rate for Payer: Priority Health Medicare |
$0.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.24
|
| Rate for Payer: Railroad Medicare Medicare |
$0.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.83
|
| Rate for Payer: UHC Core |
$2.69
|
| Rate for Payer: UHC Exchange |
$0.81
|
| Rate for Payer: UHC Medicaid |
$0.57
|
| Rate for Payer: UHC Medicare Advantage |
$0.81
|
| Rate for Payer: UHCCP Medicaid |
$0.57
|
| Rate for Payer: VA VA |
$0.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.42
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$364.25
|
|
|
Service Code
|
NDC 69452027120
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.52 |
| Max. Negotiated Rate |
$327.82 |
| Rate for Payer: Aetna Commercial |
$309.61
|
| Rate for Payer: BCBS Trust/PPO |
$300.83
|
| Rate for Payer: BCN Commercial |
$300.83
|
| Rate for Payer: Cash Price |
$291.40
|
| Rate for Payer: Cofinity Commercial |
$313.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.40
|
| Rate for Payer: Healthscope Commercial |
$327.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.61
|
| Rate for Payer: Nomi Health Commercial |
$298.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.19
|
| Rate for Payer: PHP Commercial |
$309.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$316.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.54
|
| Rate for Payer: UHC Core |
$304.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.19
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$246.24
|
|
|
Service Code
|
NDC 00904747261
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.38 |
| Max. Negotiated Rate |
$221.62 |
| Rate for Payer: Aetna Commercial |
$209.30
|
| Rate for Payer: BCBS Trust/PPO |
$203.37
|
| Rate for Payer: BCN Commercial |
$203.37
|
| Rate for Payer: Cash Price |
$196.99
|
| Rate for Payer: Cofinity Commercial |
$211.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.99
|
| Rate for Payer: Healthscope Commercial |
$221.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.30
|
| Rate for Payer: Nomi Health Commercial |
$201.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.68
|
| Rate for Payer: PHP Commercial |
$209.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$214.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.69
|
| Rate for Payer: UHC Core |
$205.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.68
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$3.11
|
|
|
Service Code
|
NDC 51079069001
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna Commercial |
$2.64
|
| Rate for Payer: BCBS Trust/PPO |
$2.57
|
| Rate for Payer: BCN Commercial |
$2.57
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.49
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.64
|
| Rate for Payer: Nomi Health Commercial |
$2.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.33
|
| Rate for Payer: PHP Commercial |
$2.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.74
|
| Rate for Payer: UHC Core |
$2.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.33
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$321.12
|
|
|
Service Code
|
NDC 60687022901
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.50 |
| Max. Negotiated Rate |
$289.01 |
| Rate for Payer: Aetna Commercial |
$272.95
|
| Rate for Payer: BCBS Trust/PPO |
$265.21
|
| Rate for Payer: BCN Commercial |
$265.21
|
| Rate for Payer: Cash Price |
$256.90
|
| Rate for Payer: Cofinity Commercial |
$276.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.90
|
| Rate for Payer: Healthscope Commercial |
$289.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.95
|
| Rate for Payer: Nomi Health Commercial |
$263.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.84
|
| Rate for Payer: PHP Commercial |
$272.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$279.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$223.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$282.59
|
| Rate for Payer: UHC Core |
$268.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.84
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$3.22
|
|
|
Service Code
|
NDC 60687022911
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: Aetna Commercial |
$2.74
|
| Rate for Payer: BCBS Trust/PPO |
$2.66
|
| Rate for Payer: BCN Commercial |
$2.66
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$2.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.58
|
| Rate for Payer: Healthscope Commercial |
$2.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.74
|
| Rate for Payer: Nomi Health Commercial |
$2.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.42
|
| Rate for Payer: PHP Commercial |
$2.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.83
|
| Rate for Payer: UHC Core |
$2.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.42
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$321.12
|
|
|
Service Code
|
NDC 60687022901
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.61 |
| Max. Negotiated Rate |
$289.01 |
| Rate for Payer: Aetna Commercial |
$272.95
|
| Rate for Payer: Aetna Medicare |
$83.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.35
|
| Rate for Payer: BCBS Complete |
$59.44
|
| Rate for Payer: BCBS MAPPO |
$80.28
|
| Rate for Payer: BCBS Trust/PPO |
$263.99
|
| Rate for Payer: BCN Commercial |
$263.99
|
| Rate for Payer: BCN Medicare Advantage |
$80.28
|
| Rate for Payer: Cash Price |
$256.90
|
| Rate for Payer: Cofinity Commercial |
$276.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.28
|
| Rate for Payer: Healthscope Commercial |
$289.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.84
|
| Rate for Payer: Mclaren Medicaid |
$56.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.29
|
| Rate for Payer: Meridian Medicaid |
$59.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.95
|
| Rate for Payer: Nomi Health Commercial |
$263.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.84
|
| Rate for Payer: PACE Senior Care Partners |
$76.27
|
| Rate for Payer: PACE SWMI |
$80.28
|
| Rate for Payer: PHP Commercial |
$272.95
|
| Rate for Payer: PHP Medicare Advantage |
$80.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$279.37
|
| Rate for Payer: Priority Health Medicare |
$81.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$223.50
|
| Rate for Payer: Railroad Medicare Medicare |
$80.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$282.59
|
| Rate for Payer: UHC Core |
$268.14
|
| Rate for Payer: UHC Exchange |
$80.28
|
| Rate for Payer: UHC Medicaid |
$56.61
|
| Rate for Payer: UHC Medicare Advantage |
$80.28
|
| Rate for Payer: UHCCP Medicaid |
$56.61
|
| Rate for Payer: VA VA |
$80.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.84
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$232.75
|
|
|
Service Code
|
NDC 51079024620
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.99 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: BCBS Trust/PPO |
$192.23
|
| Rate for Payer: BCN Commercial |
$192.23
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$209.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$202.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.82
|
| Rate for Payer: UHC Core |
$194.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$232.75
|
|
|
Service Code
|
NDC 68084024801
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.99 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: BCBS Trust/PPO |
$192.23
|
| Rate for Payer: BCN Commercial |
$192.23
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$209.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$202.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.82
|
| Rate for Payer: UHC Core |
$194.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$211.85
|
|
|
Service Code
|
NDC 00904685261
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.45 |
| Max. Negotiated Rate |
$190.66 |
| Rate for Payer: Aetna Commercial |
$180.07
|
| Rate for Payer: BCBS Trust/PPO |
$174.97
|
| Rate for Payer: BCN Commercial |
$174.97
|
| 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 Commercial |
$180.07
|
| Rate for Payer: Nomi Health Commercial |
$173.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.89
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$184.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.45
|
| 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
|
OP
|
$2.33
|
|
|
Service Code
|
NDC 51079024601
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Aetna Medicare |
$0.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.73
|
| Rate for Payer: BCBS Complete |
$0.43
|
| Rate for Payer: BCBS MAPPO |
$0.58
|
| Rate for Payer: BCBS Trust/PPO |
$1.92
|
| Rate for Payer: BCN Commercial |
$1.92
|
| Rate for Payer: BCN Medicare Advantage |
$0.58
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.58
|
| Rate for Payer: Healthscope Commercial |
$2.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.75
|
| Rate for Payer: Mclaren Medicaid |
$0.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.61
|
| Rate for Payer: Meridian Medicaid |
$0.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.98
|
| Rate for Payer: Nomi Health Commercial |
$1.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.75
|
| Rate for Payer: PACE Senior Care Partners |
$0.55
|
| Rate for Payer: PACE SWMI |
$0.58
|
| Rate for Payer: PHP Commercial |
$1.98
|
| Rate for Payer: PHP Medicare Advantage |
$0.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.03
|
| Rate for Payer: Priority Health Medicare |
$0.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.62
|
| Rate for Payer: Railroad Medicare Medicare |
$0.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.05
|
| Rate for Payer: UHC Core |
$1.95
|
| Rate for Payer: UHC Exchange |
$0.58
|
| Rate for Payer: UHC Medicaid |
$0.41
|
| Rate for Payer: UHC Medicare Advantage |
$0.58
|
| Rate for Payer: UHCCP Medicaid |
$0.41
|
| Rate for Payer: VA VA |
$0.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.75
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$2.33
|
|
|
Service Code
|
NDC 51079024601
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: BCBS Trust/PPO |
$1.92
|
| Rate for Payer: BCN Commercial |
$1.92
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Healthscope Commercial |
$2.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.98
|
| Rate for Payer: Nomi Health Commercial |
$1.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.75
|
| Rate for Payer: PHP Commercial |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.05
|
| Rate for Payer: UHC Core |
$1.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.75
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$232.75
|
|
|
Service Code
|
NDC 68084024801
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.03 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: Aetna Medicare |
$60.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.73
|
| Rate for Payer: BCBS Complete |
$43.08
|
| Rate for Payer: BCBS MAPPO |
$58.19
|
| Rate for Payer: BCBS Trust/PPO |
$191.34
|
| Rate for Payer: BCN Commercial |
$191.34
|
| Rate for Payer: BCN Medicare Advantage |
$58.19
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.19
|
| Rate for Payer: Healthscope Commercial |
$209.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Mclaren Medicaid |
$41.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.10
|
| Rate for Payer: Meridian Medicaid |
$43.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: PACE Senior Care Partners |
$55.28
|
| Rate for Payer: PACE SWMI |
$58.19
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: PHP Medicare Advantage |
$58.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$202.49
|
| Rate for Payer: Priority Health Medicare |
$58.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.99
|
| Rate for Payer: Railroad Medicare Medicare |
$58.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.82
|
| Rate for Payer: UHC Core |
$194.35
|
| Rate for Payer: UHC Exchange |
$58.19
|
| Rate for Payer: UHC Medicaid |
$41.03
|
| Rate for Payer: UHC Medicare Advantage |
$58.19
|
| Rate for Payer: UHCCP Medicaid |
$41.03
|
| Rate for Payer: VA VA |
$58.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$211.85
|
|
|
Service Code
|
NDC 00904685261
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.35 |
| Max. Negotiated Rate |
$190.66 |
| Rate for Payer: Aetna Commercial |
$180.07
|
| Rate for Payer: Aetna Medicare |
$55.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.20
|
| Rate for Payer: BCBS Complete |
$39.21
|
| Rate for Payer: BCBS MAPPO |
$52.96
|
| Rate for Payer: BCBS Trust/PPO |
$174.16
|
| Rate for Payer: BCN Commercial |
$174.16
|
| Rate for Payer: BCN Medicare Advantage |
$52.96
|
| 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: Health Alliance Plan Medicare Advantage |
$52.96
|
| Rate for Payer: Healthscope Commercial |
$190.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: Mclaren Medicaid |
$37.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.61
|
| Rate for Payer: Meridian Medicaid |
$39.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: Nomi Health Commercial |
$173.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.89
|
| Rate for Payer: PACE Senior Care Partners |
$50.31
|
| Rate for Payer: PACE SWMI |
$52.96
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: PHP Medicare Advantage |
$52.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$184.31
|
| Rate for Payer: Priority Health Medicare |
$53.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.45
|
| Rate for Payer: Railroad Medicare Medicare |
$52.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.43
|
| Rate for Payer: UHC Core |
$176.89
|
| Rate for Payer: UHC Exchange |
$52.96
|
| Rate for Payer: UHC Medicaid |
$37.35
|
| Rate for Payer: UHC Medicare Advantage |
$52.96
|
| Rate for Payer: UHCCP Medicaid |
$37.35
|
| Rate for Payer: VA VA |
$52.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.89
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$232.75
|
|
|
Service Code
|
NDC 68084024811
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.99 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: BCBS Trust/PPO |
$192.23
|
| Rate for Payer: BCN Commercial |
$192.23
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$209.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$202.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.82
|
| Rate for Payer: UHC Core |
$194.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$232.75
|
|
|
Service Code
|
NDC 68084024811
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.03 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: Aetna Medicare |
$60.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.73
|
| Rate for Payer: BCBS Complete |
$43.08
|
| Rate for Payer: BCBS MAPPO |
$58.19
|
| Rate for Payer: BCBS Trust/PPO |
$191.34
|
| Rate for Payer: BCN Commercial |
$191.34
|
| Rate for Payer: BCN Medicare Advantage |
$58.19
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.19
|
| Rate for Payer: Healthscope Commercial |
$209.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Mclaren Medicaid |
$41.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.10
|
| Rate for Payer: Meridian Medicaid |
$43.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: PACE Senior Care Partners |
$55.28
|
| Rate for Payer: PACE SWMI |
$58.19
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: PHP Medicare Advantage |
$58.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$202.49
|
| Rate for Payer: Priority Health Medicare |
$58.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.99
|
| Rate for Payer: Railroad Medicare Medicare |
$58.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.82
|
| Rate for Payer: UHC Core |
$194.35
|
| Rate for Payer: UHC Exchange |
$58.19
|
| Rate for Payer: UHC Medicaid |
$41.03
|
| Rate for Payer: UHC Medicare Advantage |
$58.19
|
| Rate for Payer: UHCCP Medicaid |
$41.03
|
| Rate for Payer: VA VA |
$58.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$232.75
|
|
|
Service Code
|
NDC 51079024620
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.03 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: Aetna Medicare |
$60.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.73
|
| Rate for Payer: BCBS Complete |
$43.08
|
| Rate for Payer: BCBS MAPPO |
$58.19
|
| Rate for Payer: BCBS Trust/PPO |
$191.34
|
| Rate for Payer: BCN Commercial |
$191.34
|
| Rate for Payer: BCN Medicare Advantage |
$58.19
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.19
|
| Rate for Payer: Healthscope Commercial |
$209.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Mclaren Medicaid |
$41.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.10
|
| Rate for Payer: Meridian Medicaid |
$43.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: PACE Senior Care Partners |
$55.28
|
| Rate for Payer: PACE SWMI |
$58.19
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: PHP Medicare Advantage |
$58.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$202.49
|
| Rate for Payer: Priority Health Medicare |
$58.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.99
|
| Rate for Payer: Railroad Medicare Medicare |
$58.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.82
|
| Rate for Payer: UHC Core |
$194.35
|
| Rate for Payer: UHC Exchange |
$58.19
|
| Rate for Payer: UHC Medicaid |
$41.03
|
| Rate for Payer: UHC Medicare Advantage |
$58.19
|
| Rate for Payer: UHCCP Medicaid |
$41.03
|
| Rate for Payer: VA VA |
$58.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$215.25
|
|
|
Service Code
|
NDC 60687062701
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.95 |
| Max. Negotiated Rate |
$193.72 |
| Rate for Payer: Aetna Commercial |
$182.96
|
| Rate for Payer: Aetna Medicare |
$55.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.27
|
| Rate for Payer: BCBS Complete |
$39.84
|
| Rate for Payer: BCBS MAPPO |
$53.81
|
| Rate for Payer: BCBS Trust/PPO |
$176.96
|
| Rate for Payer: BCN Commercial |
$176.96
|
| Rate for Payer: BCN Medicare Advantage |
$53.81
|
| 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: Health Alliance Plan Medicare Advantage |
$53.81
|
| Rate for Payer: Healthscope Commercial |
$193.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.44
|
| Rate for Payer: Mclaren Medicaid |
$37.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.50
|
| Rate for Payer: Meridian Medicaid |
$39.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.96
|
| Rate for Payer: Nomi Health Commercial |
$176.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.44
|
| Rate for Payer: PACE Senior Care Partners |
$51.12
|
| Rate for Payer: PACE SWMI |
$53.81
|
| Rate for Payer: PHP Commercial |
$182.96
|
| Rate for Payer: PHP Medicare Advantage |
$53.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$187.27
|
| Rate for Payer: Priority Health Medicare |
$54.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.81
|
| Rate for Payer: Railroad Medicare Medicare |
$53.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.42
|
| Rate for Payer: UHC Core |
$179.73
|
| Rate for Payer: UHC Exchange |
$53.81
|
| Rate for Payer: UHC Medicaid |
$37.95
|
| Rate for Payer: UHC Medicare Advantage |
$53.81
|
| Rate for Payer: UHCCP Medicaid |
$37.95
|
| Rate for Payer: VA VA |
$53.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.44
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$129.50
|
|
|
Service Code
|
NDC 00904600761
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.13 |
| Max. Negotiated Rate |
$116.55 |
| Rate for Payer: Aetna Commercial |
$110.08
|
| Rate for Payer: BCBS Trust/PPO |
$106.95
|
| Rate for Payer: BCN Commercial |
$106.95
|
| 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 Commercial |
$110.08
|
| Rate for Payer: Nomi Health Commercial |
$106.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.12
|
| Rate for Payer: PHP Commercial |
$110.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$112.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.13
|
| 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
|
OP
|
$87.50
|
|
|
Service Code
|
NDC 69315090401
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Aetna Commercial |
$74.38
|
| Rate for Payer: Aetna Medicare |
$22.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.34
|
| Rate for Payer: BCBS Complete |
$16.20
|
| Rate for Payer: BCBS MAPPO |
$21.88
|
| Rate for Payer: BCBS Trust/PPO |
$71.93
|
| Rate for Payer: BCN Commercial |
$71.93
|
| Rate for Payer: BCN Medicare Advantage |
$21.88
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cofinity Commercial |
$75.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.88
|
| Rate for Payer: Healthscope Commercial |
$78.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.62
|
| Rate for Payer: Mclaren Medicaid |
$15.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.97
|
| Rate for Payer: Meridian Medicaid |
$16.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.38
|
| Rate for Payer: Nomi Health Commercial |
$71.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.62
|
| Rate for Payer: PACE Senior Care Partners |
$20.78
|
| Rate for Payer: PACE SWMI |
$21.88
|
| Rate for Payer: PHP Commercial |
$74.38
|
| Rate for Payer: PHP Medicare Advantage |
$21.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.12
|
| Rate for Payer: Priority Health Medicare |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.90
|
| Rate for Payer: Railroad Medicare Medicare |
$21.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.00
|
| Rate for Payer: UHC Core |
$73.06
|
| Rate for Payer: UHC Exchange |
$21.88
|
| Rate for Payer: UHC Medicaid |
$15.43
|
| Rate for Payer: UHC Medicare Advantage |
$21.88
|
| Rate for Payer: UHCCP Medicaid |
$15.43
|
| Rate for Payer: VA VA |
$21.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.62
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$129.50
|
|
|
Service Code
|
NDC 00904600761
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.83 |
| Max. Negotiated Rate |
$116.55 |
| Rate for Payer: Aetna Commercial |
$110.08
|
| Rate for Payer: Aetna Medicare |
$33.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.47
|
| Rate for Payer: BCBS Complete |
$23.97
|
| Rate for Payer: BCBS MAPPO |
$32.38
|
| Rate for Payer: BCBS Trust/PPO |
$106.46
|
| Rate for Payer: BCN Commercial |
$106.46
|
| Rate for Payer: BCN Medicare Advantage |
$32.38
|
| 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: Health Alliance Plan Medicare Advantage |
$32.38
|
| Rate for Payer: Healthscope Commercial |
$116.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.12
|
| Rate for Payer: Mclaren Medicaid |
$22.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.99
|
| Rate for Payer: Meridian Medicaid |
$23.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.08
|
| Rate for Payer: Nomi Health Commercial |
$106.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.12
|
| Rate for Payer: PACE Senior Care Partners |
$30.76
|
| Rate for Payer: PACE SWMI |
$32.38
|
| Rate for Payer: PHP Commercial |
$110.08
|
| Rate for Payer: PHP Medicare Advantage |
$32.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$112.67
|
| Rate for Payer: Priority Health Medicare |
$32.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.13
|
| Rate for Payer: Railroad Medicare Medicare |
$32.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.96
|
| Rate for Payer: UHC Core |
$108.13
|
| Rate for Payer: UHC Exchange |
$32.38
|
| Rate for Payer: UHC Medicaid |
$22.83
|
| Rate for Payer: UHC Medicare Advantage |
$32.38
|
| Rate for Payer: UHCCP Medicaid |
$22.83
|
| Rate for Payer: VA VA |
$32.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.12
|
|
