|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$2.16
|
|
|
Service Code
|
NDC 60687062711
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: BCBS Trust/PPO |
$1.78
|
| Rate for Payer: BCN Commercial |
$1.78
|
| 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 Commercial |
$1.84
|
| Rate for Payer: Nomi Health Commercial |
$1.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.62
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.50
|
| 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 0.5 MG TABLET
|
Facility
|
IP
|
$215.25
|
|
|
Service Code
|
NDC 60687062701
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.81 |
| Max. Negotiated Rate |
$193.72 |
| Rate for Payer: Aetna Commercial |
$182.96
|
| Rate for Payer: BCBS Trust/PPO |
$177.77
|
| Rate for Payer: BCN Commercial |
$177.77
|
| 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 Commercial |
$182.96
|
| Rate for Payer: Nomi Health Commercial |
$176.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.44
|
| Rate for Payer: PHP Commercial |
$182.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$187.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.81
|
| 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
|
OP
|
$2.16
|
|
|
Service Code
|
NDC 60687062711
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna Medicare |
$0.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.68
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.54
|
| Rate for Payer: BCBS Trust/PPO |
$1.78
|
| Rate for Payer: BCN Commercial |
$1.78
|
| Rate for Payer: BCN Medicare Advantage |
$0.54
|
| 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: Health Alliance Plan Medicare Advantage |
$0.54
|
| Rate for Payer: Healthscope Commercial |
$1.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.62
|
| Rate for Payer: Mclaren Medicaid |
$0.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.57
|
| Rate for Payer: Meridian Medicaid |
$0.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Nomi Health Commercial |
$1.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.62
|
| Rate for Payer: PACE Senior Care Partners |
$0.51
|
| Rate for Payer: PACE SWMI |
$0.54
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: PHP Medicare Advantage |
$0.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.88
|
| Rate for Payer: Priority Health Medicare |
$0.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.50
|
| Rate for Payer: Railroad Medicare Medicare |
$0.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.90
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Exchange |
$0.54
|
| Rate for Payer: UHC Medicaid |
$0.38
|
| Rate for Payer: UHC Medicare Advantage |
$0.54
|
| Rate for Payer: UHCCP Medicaid |
$0.38
|
| Rate for Payer: VA VA |
$0.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.62
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$87.50
|
|
|
Service Code
|
NDC 69315090401
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.90 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Aetna Commercial |
$74.38
|
| Rate for Payer: BCBS Trust/PPO |
$72.27
|
| Rate for Payer: BCN Commercial |
$72.27
|
| 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: Healthscope Commercial |
$78.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.62
|
| 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: PHP Commercial |
$74.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.00
|
| Rate for Payer: UHC Core |
$73.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.62
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$150.50
|
|
|
Service Code
|
NDC 00904600861
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.53 |
| Max. Negotiated Rate |
$135.45 |
| Rate for Payer: Aetna Commercial |
$127.92
|
| Rate for Payer: Aetna Medicare |
$39.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.03
|
| Rate for Payer: BCBS Complete |
$27.86
|
| Rate for Payer: BCBS MAPPO |
$37.62
|
| Rate for Payer: BCBS Trust/PPO |
$123.73
|
| Rate for Payer: BCN Commercial |
$123.73
|
| Rate for Payer: BCN Medicare Advantage |
$37.62
|
| 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: Health Alliance Plan Medicare Advantage |
$37.62
|
| Rate for Payer: Healthscope Commercial |
$135.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.88
|
| Rate for Payer: Mclaren Medicaid |
$26.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.51
|
| Rate for Payer: Meridian Medicaid |
$27.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.92
|
| Rate for Payer: Nomi Health Commercial |
$123.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.88
|
| Rate for Payer: PACE Senior Care Partners |
$35.74
|
| Rate for Payer: PACE SWMI |
$37.62
|
| Rate for Payer: PHP Commercial |
$127.92
|
| Rate for Payer: PHP Medicare Advantage |
$37.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$130.94
|
| Rate for Payer: Priority Health Medicare |
$38.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.75
|
| Rate for Payer: Railroad Medicare Medicare |
$37.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.44
|
| Rate for Payer: UHC Core |
$125.67
|
| Rate for Payer: UHC Exchange |
$37.62
|
| Rate for Payer: UHC Medicaid |
$26.53
|
| Rate for Payer: UHC Medicare Advantage |
$37.62
|
| Rate for Payer: UHCCP Medicaid |
$26.53
|
| Rate for Payer: VA VA |
$37.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.88
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
NDC 60687063801
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.26 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Aetna Commercial |
$184.45
|
| Rate for Payer: Aetna Medicare |
$56.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.81
|
| Rate for Payer: BCBS Complete |
$40.17
|
| Rate for Payer: BCBS MAPPO |
$54.25
|
| Rate for Payer: BCBS Trust/PPO |
$178.40
|
| Rate for Payer: BCN Commercial |
$178.40
|
| Rate for Payer: BCN Medicare Advantage |
$54.25
|
| 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: Health Alliance Plan Medicare Advantage |
$54.25
|
| Rate for Payer: Healthscope Commercial |
$195.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.75
|
| Rate for Payer: Mclaren Medicaid |
$38.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.96
|
| Rate for Payer: Meridian Medicaid |
$40.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.45
|
| Rate for Payer: Nomi Health Commercial |
$177.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.75
|
| Rate for Payer: PACE Senior Care Partners |
$51.54
|
| Rate for Payer: PACE SWMI |
$54.25
|
| Rate for Payer: PHP Commercial |
$184.45
|
| Rate for Payer: PHP Medicare Advantage |
$54.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$188.79
|
| Rate for Payer: Priority Health Medicare |
$54.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.03
|
| Rate for Payer: Railroad Medicare Medicare |
$54.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.96
|
| Rate for Payer: UHC Core |
$181.19
|
| Rate for Payer: UHC Exchange |
$54.25
|
| Rate for Payer: UHC Medicaid |
$38.26
|
| Rate for Payer: UHC Medicare Advantage |
$54.25
|
| Rate for Payer: UHCCP Medicaid |
$38.26
|
| Rate for Payer: VA VA |
$54.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.75
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$2.17
|
|
|
Service Code
|
NDC 60687063811
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna Medicare |
$0.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.68
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.54
|
| Rate for Payer: BCBS Trust/PPO |
$1.78
|
| Rate for Payer: BCN Commercial |
$1.78
|
| Rate for Payer: BCN Medicare Advantage |
$0.54
|
| 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: Health Alliance Plan Medicare Advantage |
$0.54
|
| Rate for Payer: Healthscope Commercial |
$1.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.63
|
| Rate for Payer: Mclaren Medicaid |
$0.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.57
|
| Rate for Payer: Meridian Medicaid |
$0.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Nomi Health Commercial |
$1.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.63
|
| Rate for Payer: PACE Senior Care Partners |
$0.52
|
| Rate for Payer: PACE SWMI |
$0.54
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: PHP Medicare Advantage |
$0.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.89
|
| Rate for Payer: Priority Health Medicare |
$0.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.51
|
| Rate for Payer: Railroad Medicare Medicare |
$0.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.91
|
| Rate for Payer: UHC Core |
$1.81
|
| Rate for Payer: UHC Exchange |
$0.54
|
| Rate for Payer: UHC Medicaid |
$0.38
|
| Rate for Payer: UHC Medicare Advantage |
$0.54
|
| Rate for Payer: UHCCP Medicaid |
$0.38
|
| Rate for Payer: VA VA |
$0.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.63
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
NDC 60687063801
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.03 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Aetna Commercial |
$184.45
|
| Rate for Payer: BCBS Trust/PPO |
$179.22
|
| Rate for Payer: BCN Commercial |
$179.22
|
| 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 Commercial |
$184.45
|
| Rate for Payer: Nomi Health Commercial |
$177.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.75
|
| Rate for Payer: PHP Commercial |
$184.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$188.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.96
|
| Rate for Payer: UHC Core |
$181.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.75
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
NDC 69315090501
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.57 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna Commercial |
$113.05
|
| Rate for Payer: BCBS Trust/PPO |
$109.84
|
| Rate for Payer: BCN Commercial |
$109.84
|
| Rate for Payer: Cash Price |
$106.40
|
| 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: Lakeland Regional Health Systems Commercial |
$99.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.05
|
| Rate for Payer: Nomi Health Commercial |
$109.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.75
|
| Rate for Payer: PHP Commercial |
$113.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$115.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.04
|
| Rate for Payer: UHC Core |
$111.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.75
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$150.50
|
|
|
Service Code
|
NDC 00904600861
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.75 |
| Max. Negotiated Rate |
$135.45 |
| Rate for Payer: Aetna Commercial |
$127.92
|
| Rate for Payer: BCBS Trust/PPO |
$124.30
|
| Rate for Payer: BCN Commercial |
$124.30
|
| 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 Commercial |
$127.92
|
| Rate for Payer: Nomi Health Commercial |
$123.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.88
|
| Rate for Payer: PHP Commercial |
$127.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$130.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.75
|
| 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 1 MG TABLET
|
Facility
|
IP
|
$2.17
|
|
|
Service Code
|
NDC 60687063811
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: BCBS Trust/PPO |
$1.79
|
| Rate for Payer: BCN Commercial |
$1.79
|
| 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 Commercial |
$1.84
|
| Rate for Payer: Nomi Health Commercial |
$1.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.63
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.51
|
| 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
|
OP
|
$133.00
|
|
|
Service Code
|
NDC 69315090501
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.45 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna Commercial |
$113.05
|
| Rate for Payer: Aetna Medicare |
$34.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.56
|
| Rate for Payer: BCBS Complete |
$24.62
|
| Rate for Payer: BCBS MAPPO |
$33.25
|
| Rate for Payer: BCBS Trust/PPO |
$109.34
|
| Rate for Payer: BCN Commercial |
$109.34
|
| Rate for Payer: BCN Medicare Advantage |
$33.25
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$114.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.25
|
| Rate for Payer: Healthscope Commercial |
$119.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.75
|
| Rate for Payer: Mclaren Medicaid |
$23.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.91
|
| Rate for Payer: Meridian Medicaid |
$24.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.05
|
| Rate for Payer: Nomi Health Commercial |
$109.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.75
|
| Rate for Payer: PACE Senior Care Partners |
$31.59
|
| Rate for Payer: PACE SWMI |
$33.25
|
| Rate for Payer: PHP Commercial |
$113.05
|
| Rate for Payer: PHP Medicare Advantage |
$33.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$115.71
|
| Rate for Payer: Priority Health Medicare |
$33.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.57
|
| Rate for Payer: Railroad Medicare Medicare |
$33.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.04
|
| Rate for Payer: UHC Core |
$111.06
|
| Rate for Payer: UHC Exchange |
$33.25
|
| Rate for Payer: UHC Medicaid |
$23.45
|
| Rate for Payer: UHC Medicare Advantage |
$33.25
|
| Rate for Payer: UHCCP Medicaid |
$23.45
|
| Rate for Payer: VA VA |
$33.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.75
|
|
|
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 |
$2.62 |
| Max. Negotiated Rate |
$13.36 |
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Medicare |
$4.65
|
| Rate for Payer: Aetna Medicare |
$3.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.59
|
| Rate for Payer: BCBS Complete |
$2.75
|
| Rate for Payer: BCBS Complete |
$3.31
|
| Rate for Payer: BCBS MAPPO |
$3.71
|
| Rate for Payer: BCBS MAPPO |
$4.47
|
| Rate for Payer: BCBS Trust/PPO |
$12.20
|
| Rate for Payer: BCBS Trust/PPO |
$14.70
|
| Rate for Payer: BCN Commercial |
$14.70
|
| Rate for Payer: BCN Commercial |
$12.20
|
| Rate for Payer: BCN Medicare Advantage |
$4.47
|
| Rate for Payer: BCN Medicare Advantage |
$3.71
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cofinity Commercial |
$12.76
|
| Rate for Payer: Cofinity Commercial |
$15.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.71
|
| Rate for Payer: Healthscope Commercial |
$13.36
|
| Rate for Payer: Healthscope Commercial |
$16.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.41
|
| Rate for Payer: Mclaren Medicaid |
$3.15
|
| Rate for Payer: Mclaren Medicaid |
$2.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.90
|
| Rate for Payer: Meridian Medicaid |
$2.75
|
| Rate for Payer: Meridian Medicaid |
$3.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.61
|
| Rate for Payer: Nomi Health Commercial |
$14.66
|
| Rate for Payer: Nomi Health Commercial |
$12.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.41
|
| Rate for Payer: PACE Senior Care Partners |
$4.25
|
| Rate for Payer: PACE Senior Care Partners |
$3.52
|
| Rate for Payer: PACE SWMI |
$4.47
|
| Rate for Payer: PACE SWMI |
$3.71
|
| Rate for Payer: PHP Commercial |
$12.61
|
| Rate for Payer: PHP Commercial |
$15.20
|
| Rate for Payer: PHP Medicare Advantage |
$3.71
|
| Rate for Payer: PHP Medicare Advantage |
$4.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.91
|
| Rate for Payer: Priority Health Medicare |
$4.51
|
| Rate for Payer: Priority Health Medicare |
$3.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: Railroad Medicare Medicare |
$3.71
|
| Rate for Payer: Railroad Medicare Medicare |
$4.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.73
|
| Rate for Payer: UHC Core |
$14.93
|
| Rate for Payer: UHC Core |
$12.39
|
| Rate for Payer: UHC Exchange |
$4.47
|
| Rate for Payer: UHC Exchange |
$3.71
|
| Rate for Payer: UHC Medicaid |
$3.15
|
| Rate for Payer: UHC Medicaid |
$2.62
|
| Rate for Payer: UHC Medicare Advantage |
$3.71
|
| Rate for Payer: UHC Medicare Advantage |
$4.47
|
| Rate for Payer: UHCCP Medicaid |
$2.62
|
| Rate for Payer: UHCCP Medicaid |
$3.15
|
| Rate for Payer: VA VA |
$3.71
|
| Rate for Payer: VA VA |
$4.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.13
|
|
|
LORAZEPAM 2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$14.84
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
10467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$13.36 |
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: BCBS Trust/PPO |
$12.26
|
| Rate for Payer: BCBS Trust/PPO |
$14.77
|
| Rate for Payer: BCN Commercial |
$12.26
|
| Rate for Payer: BCN Commercial |
$14.77
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cofinity Commercial |
$15.38
|
| Rate for Payer: Cofinity Commercial |
$12.76
|
| 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 |
$13.36
|
| Rate for Payer: Healthscope Commercial |
$16.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.20
|
| Rate for Payer: Nomi Health Commercial |
$12.17
|
| Rate for Payer: Nomi Health Commercial |
$14.66
|
| 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 |
$15.20
|
| Rate for Payer: PHP Commercial |
$12.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.73
|
| Rate for Payer: UHC Core |
$12.39
|
| Rate for Payer: UHC Core |
$14.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.41
|
|
|
LORAZEPAM 2 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$17.86
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
112180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$16.07 |
| Rate for Payer: Aetna Commercial |
$15.18
|
| Rate for Payer: BCBS Trust/PPO |
$14.75
|
| Rate for Payer: BCN Commercial |
$14.75
|
| Rate for Payer: Cash Price |
$14.29
|
| Rate for Payer: Cofinity Commercial |
$15.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.29
|
| Rate for Payer: Healthscope Commercial |
$16.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.18
|
| Rate for Payer: Nomi Health Commercial |
$14.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.39
|
| Rate for Payer: PHP Commercial |
$15.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.72
|
| Rate for Payer: UHC Core |
$14.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.39
|
|
|
LORAZEPAM 2 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$17.86
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
112180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$16.07 |
| Rate for Payer: Aetna Commercial |
$15.18
|
| Rate for Payer: Aetna Medicare |
$4.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.58
|
| Rate for Payer: BCBS Complete |
$3.31
|
| Rate for Payer: BCBS MAPPO |
$4.46
|
| Rate for Payer: BCBS Trust/PPO |
$14.68
|
| Rate for Payer: BCN Commercial |
$14.68
|
| Rate for Payer: BCN Medicare Advantage |
$4.46
|
| Rate for Payer: Cash Price |
$14.29
|
| Rate for Payer: Cofinity Commercial |
$15.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$16.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.39
|
| Rate for Payer: Mclaren Medicaid |
$3.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.69
|
| Rate for Payer: Meridian Medicaid |
$3.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.18
|
| Rate for Payer: Nomi Health Commercial |
$14.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.39
|
| Rate for Payer: PACE Senior Care Partners |
$4.24
|
| Rate for Payer: PACE SWMI |
$4.46
|
| Rate for Payer: PHP Commercial |
$15.18
|
| Rate for Payer: PHP Medicare Advantage |
$4.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.54
|
| Rate for Payer: Priority Health Medicare |
$4.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.43
|
| Rate for Payer: Railroad Medicare Medicare |
$4.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.72
|
| Rate for Payer: UHC Core |
$14.91
|
| Rate for Payer: UHC Exchange |
$4.46
|
| Rate for Payer: UHC Medicaid |
$3.15
|
| Rate for Payer: UHC Medicare Advantage |
$4.46
|
| Rate for Payer: UHCCP Medicaid |
$3.15
|
| Rate for Payer: VA VA |
$4.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.39
|
|
|
LOSARTAN 100 MG TABLET
|
Facility
|
IP
|
$470.25
|
|
|
Service Code
|
NDC 68084034801
|
| Hospital Charge Code |
22588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$327.29 |
| Max. Negotiated Rate |
$423.23 |
| Rate for Payer: Aetna Commercial |
$399.71
|
| Rate for Payer: BCBS Trust/PPO |
$388.38
|
| Rate for Payer: BCN Commercial |
$388.38
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cofinity Commercial |
$404.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.20
|
| Rate for Payer: Healthscope Commercial |
$423.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.71
|
| Rate for Payer: Nomi Health Commercial |
$385.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.69
|
| Rate for Payer: PHP Commercial |
$399.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$409.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$327.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$413.82
|
| Rate for Payer: UHC Core |
$392.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.69
|
|
|
LOSARTAN 100 MG TABLET
|
Facility
|
OP
|
$470.25
|
|
|
Service Code
|
NDC 68084034801
|
| Hospital Charge Code |
22588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.91 |
| Max. Negotiated Rate |
$423.23 |
| Rate for Payer: Aetna Commercial |
$399.71
|
| Rate for Payer: Aetna Medicare |
$122.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.95
|
| Rate for Payer: BCBS Complete |
$87.04
|
| Rate for Payer: BCBS MAPPO |
$117.56
|
| Rate for Payer: BCBS Trust/PPO |
$386.59
|
| Rate for Payer: BCN Commercial |
$386.59
|
| Rate for Payer: BCN Medicare Advantage |
$117.56
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cofinity Commercial |
$404.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.56
|
| Rate for Payer: Healthscope Commercial |
$423.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.69
|
| Rate for Payer: Mclaren Medicaid |
$82.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.44
|
| Rate for Payer: Meridian Medicaid |
$87.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$129.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.71
|
| Rate for Payer: Nomi Health Commercial |
$385.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.69
|
| Rate for Payer: PACE Senior Care Partners |
$111.68
|
| Rate for Payer: PACE SWMI |
$117.56
|
| Rate for Payer: PHP Commercial |
$399.71
|
| Rate for Payer: PHP Medicare Advantage |
$117.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$409.12
|
| Rate for Payer: Priority Health Medicare |
$118.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$327.29
|
| Rate for Payer: Railroad Medicare Medicare |
$117.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$413.82
|
| Rate for Payer: UHC Core |
$392.66
|
| Rate for Payer: UHC Exchange |
$117.56
|
| Rate for Payer: UHC Medicaid |
$82.91
|
| Rate for Payer: UHC Medicare Advantage |
$117.56
|
| Rate for Payer: UHCCP Medicaid |
$82.91
|
| Rate for Payer: VA VA |
$117.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.69
|
|
|
LOSARTAN 100 MG TABLET
|
Facility
|
OP
|
$427.50
|
|
|
Service Code
|
NDC 00904704961
|
| Hospital Charge Code |
22588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.37 |
| Max. Negotiated Rate |
$384.75 |
| Rate for Payer: Aetna Commercial |
$363.38
|
| Rate for Payer: Aetna Medicare |
$111.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$133.59
|
| Rate for Payer: BCBS Complete |
$79.13
|
| Rate for Payer: BCBS MAPPO |
$106.88
|
| Rate for Payer: BCBS Trust/PPO |
$351.45
|
| Rate for Payer: BCN Commercial |
$351.45
|
| Rate for Payer: BCN Medicare Advantage |
$106.88
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cofinity Commercial |
$367.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.88
|
| Rate for Payer: Healthscope Commercial |
$384.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.62
|
| Rate for Payer: Mclaren Medicaid |
$75.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.22
|
| Rate for Payer: Meridian Medicaid |
$79.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$117.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.38
|
| Rate for Payer: Nomi Health Commercial |
$350.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$320.62
|
| Rate for Payer: PACE Senior Care Partners |
$101.53
|
| Rate for Payer: PACE SWMI |
$106.88
|
| Rate for Payer: PHP Commercial |
$363.38
|
| Rate for Payer: PHP Medicare Advantage |
$106.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$371.93
|
| Rate for Payer: Priority Health Medicare |
$107.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$297.54
|
| Rate for Payer: Railroad Medicare Medicare |
$106.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$376.20
|
| Rate for Payer: UHC Core |
$356.96
|
| Rate for Payer: UHC Exchange |
$106.88
|
| Rate for Payer: UHC Medicaid |
$75.37
|
| Rate for Payer: UHC Medicare Advantage |
$106.88
|
| Rate for Payer: UHCCP Medicaid |
$75.37
|
| Rate for Payer: VA VA |
$106.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.62
|
|
|
LOSARTAN 100 MG TABLET
|
Facility
|
IP
|
$427.50
|
|
|
Service Code
|
NDC 00904704961
|
| Hospital Charge Code |
22588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.54 |
| Max. Negotiated Rate |
$384.75 |
| Rate for Payer: Aetna Commercial |
$363.38
|
| Rate for Payer: BCBS Trust/PPO |
$353.07
|
| Rate for Payer: BCN Commercial |
$353.07
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cofinity Commercial |
$367.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.00
|
| Rate for Payer: Healthscope Commercial |
$384.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.38
|
| Rate for Payer: Nomi Health Commercial |
$350.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$320.62
|
| Rate for Payer: PHP Commercial |
$363.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$371.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$297.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$376.20
|
| Rate for Payer: UHC Core |
$356.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.62
|
|
|
LOSARTAN 100 MG TABLET
|
Facility
|
OP
|
$470.25
|
|
|
Service Code
|
NDC 68084034811
|
| Hospital Charge Code |
22588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.91 |
| Max. Negotiated Rate |
$423.23 |
| Rate for Payer: Aetna Commercial |
$399.71
|
| Rate for Payer: Aetna Medicare |
$122.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.95
|
| Rate for Payer: BCBS Complete |
$87.04
|
| Rate for Payer: BCBS MAPPO |
$117.56
|
| Rate for Payer: BCBS Trust/PPO |
$386.59
|
| Rate for Payer: BCN Commercial |
$386.59
|
| Rate for Payer: BCN Medicare Advantage |
$117.56
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cofinity Commercial |
$404.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.56
|
| Rate for Payer: Healthscope Commercial |
$423.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.69
|
| Rate for Payer: Mclaren Medicaid |
$82.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.44
|
| Rate for Payer: Meridian Medicaid |
$87.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$129.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.71
|
| Rate for Payer: Nomi Health Commercial |
$385.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.69
|
| Rate for Payer: PACE Senior Care Partners |
$111.68
|
| Rate for Payer: PACE SWMI |
$117.56
|
| Rate for Payer: PHP Commercial |
$399.71
|
| Rate for Payer: PHP Medicare Advantage |
$117.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$409.12
|
| Rate for Payer: Priority Health Medicare |
$118.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$327.29
|
| Rate for Payer: Railroad Medicare Medicare |
$117.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$413.82
|
| Rate for Payer: UHC Core |
$392.66
|
| Rate for Payer: UHC Exchange |
$117.56
|
| Rate for Payer: UHC Medicaid |
$82.91
|
| Rate for Payer: UHC Medicare Advantage |
$117.56
|
| Rate for Payer: UHCCP Medicaid |
$82.91
|
| Rate for Payer: VA VA |
$117.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.69
|
|
|
LOSARTAN 100 MG TABLET
|
Facility
|
IP
|
$470.25
|
|
|
Service Code
|
NDC 68084034811
|
| Hospital Charge Code |
22588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$327.29 |
| Max. Negotiated Rate |
$423.23 |
| Rate for Payer: Aetna Commercial |
$399.71
|
| Rate for Payer: BCBS Trust/PPO |
$388.38
|
| Rate for Payer: BCN Commercial |
$388.38
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cofinity Commercial |
$404.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.20
|
| Rate for Payer: Healthscope Commercial |
$423.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.71
|
| Rate for Payer: Nomi Health Commercial |
$385.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.69
|
| Rate for Payer: PHP Commercial |
$399.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$409.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$327.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$413.82
|
| Rate for Payer: UHC Core |
$392.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.69
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
OP
|
$3.41
|
|
|
Service Code
|
NDC 68084034611
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: Aetna Medicare |
$0.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.07
|
| Rate for Payer: BCBS Complete |
$0.63
|
| Rate for Payer: BCBS MAPPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$2.80
|
| Rate for Payer: BCN Commercial |
$2.80
|
| Rate for Payer: BCN Medicare Advantage |
$0.85
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.85
|
| Rate for Payer: Healthscope Commercial |
$3.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.56
|
| Rate for Payer: Mclaren Medicaid |
$0.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.90
|
| Rate for Payer: Meridian Medicaid |
$0.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.90
|
| Rate for Payer: Nomi Health Commercial |
$2.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.56
|
| Rate for Payer: PACE Senior Care Partners |
$0.81
|
| Rate for Payer: PACE SWMI |
$0.85
|
| Rate for Payer: PHP Commercial |
$2.90
|
| Rate for Payer: PHP Medicare Advantage |
$0.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.97
|
| Rate for Payer: Priority Health Medicare |
$0.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.37
|
| Rate for Payer: Railroad Medicare Medicare |
$0.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.00
|
| Rate for Payer: UHC Core |
$2.85
|
| Rate for Payer: UHC Exchange |
$0.85
|
| Rate for Payer: UHC Medicaid |
$0.60
|
| Rate for Payer: UHC Medicare Advantage |
$0.85
|
| Rate for Payer: UHCCP Medicaid |
$0.60
|
| Rate for Payer: VA VA |
$0.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.56
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$3.41
|
|
|
Service Code
|
NDC 68084034611
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: BCBS Trust/PPO |
$2.82
|
| Rate for Payer: BCN Commercial |
$2.82
|
| Rate for Payer: Cash Price |
$2.73
|
| 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: Lakeland Regional Health Systems Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.90
|
| Rate for Payer: Nomi Health Commercial |
$2.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.56
|
| Rate for Payer: PHP Commercial |
$2.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.00
|
| Rate for Payer: UHC Core |
$2.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.56
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
OP
|
$308.75
|
|
|
Service Code
|
NDC 00904704761
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.43 |
| Max. Negotiated Rate |
$277.88 |
| Rate for Payer: Aetna Commercial |
$262.44
|
| Rate for Payer: Aetna Medicare |
$80.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.48
|
| Rate for Payer: BCBS Complete |
$57.15
|
| Rate for Payer: BCBS MAPPO |
$77.19
|
| Rate for Payer: BCBS Trust/PPO |
$253.82
|
| Rate for Payer: BCN Commercial |
$253.82
|
| Rate for Payer: BCN Medicare Advantage |
$77.19
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cofinity Commercial |
$265.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.19
|
| Rate for Payer: Healthscope Commercial |
$277.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.56
|
| Rate for Payer: Mclaren Medicaid |
$54.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.05
|
| Rate for Payer: Meridian Medicaid |
$57.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$84.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.44
|
| Rate for Payer: Nomi Health Commercial |
$253.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.56
|
| Rate for Payer: PACE Senior Care Partners |
$73.33
|
| Rate for Payer: PACE SWMI |
$77.19
|
| Rate for Payer: PHP Commercial |
$262.44
|
| Rate for Payer: PHP Medicare Advantage |
$77.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$268.61
|
| Rate for Payer: Priority Health Medicare |
$77.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.89
|
| Rate for Payer: Railroad Medicare Medicare |
$77.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.70
|
| Rate for Payer: UHC Core |
$257.81
|
| Rate for Payer: UHC Exchange |
$77.19
|
| Rate for Payer: UHC Medicaid |
$54.43
|
| Rate for Payer: UHC Medicare Advantage |
$77.19
|
| Rate for Payer: UHCCP Medicaid |
$54.43
|
| Rate for Payer: VA VA |
$77.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.56
|
|
