|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$2.57
|
|
|
Service Code
|
NDC 51079024601
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCN Commercial |
$1.99
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Nomi Health Commercial |
$2.11
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.67
|
| Rate for Payer: Priority Health HMO/PPO |
$2.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.26
|
| Rate for Payer: UHC Core |
$2.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.93
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$229.90
|
|
|
Service Code
|
NDC 68084024811
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$206.91 |
| Rate for Payer: Aetna Commercial |
$195.42
|
| Rate for Payer: Aetna Medicare |
$59.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.84
|
| Rate for Payer: BCBS Complete |
$91.96
|
| Rate for Payer: BCBS MAPPO |
$57.48
|
| Rate for Payer: BCBS Trust/PPO |
$189.00
|
| Rate for Payer: BCN Commercial |
$178.75
|
| Rate for Payer: BCN Medicare Advantage |
$57.48
|
| Rate for Payer: Cash Price |
$183.92
|
| Rate for Payer: Cofinity Commercial |
$197.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.48
|
| Rate for Payer: Healthscope Commercial |
$206.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.42
|
| Rate for Payer: Nomi Health Commercial |
$188.52
|
| Rate for Payer: PACE Senior Care Partners |
$54.60
|
| Rate for Payer: PACE SWMI |
$57.48
|
| Rate for Payer: PHP Commercial |
$195.42
|
| Rate for Payer: PHP Medicare Advantage |
$57.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.44
|
| Rate for Payer: Priority Health HMO/PPO |
$200.01
|
| Rate for Payer: Priority Health Medicare |
$58.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.03
|
| Rate for Payer: Railroad Medicare Medicare |
$57.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.31
|
| Rate for Payer: UHC Core |
$191.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.48
|
| Rate for Payer: UHC Exchange |
$57.48
|
| Rate for Payer: UHC Medicare Advantage |
$57.48
|
| Rate for Payer: VA VA |
$57.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.42
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$229.90
|
|
|
Service Code
|
NDC 68084024801
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$206.91 |
| Rate for Payer: Aetna Commercial |
$195.42
|
| Rate for Payer: Aetna Medicare |
$59.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.84
|
| Rate for Payer: BCBS Complete |
$91.96
|
| Rate for Payer: BCBS MAPPO |
$57.48
|
| Rate for Payer: BCBS Trust/PPO |
$189.00
|
| Rate for Payer: BCN Commercial |
$178.75
|
| Rate for Payer: BCN Medicare Advantage |
$57.48
|
| Rate for Payer: Cash Price |
$183.92
|
| Rate for Payer: Cofinity Commercial |
$197.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.48
|
| Rate for Payer: Healthscope Commercial |
$206.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.42
|
| Rate for Payer: Nomi Health Commercial |
$188.52
|
| Rate for Payer: PACE Senior Care Partners |
$54.60
|
| Rate for Payer: PACE SWMI |
$57.48
|
| Rate for Payer: PHP Commercial |
$195.42
|
| Rate for Payer: PHP Medicare Advantage |
$57.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.44
|
| Rate for Payer: Priority Health HMO/PPO |
$200.01
|
| Rate for Payer: Priority Health Medicare |
$58.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.03
|
| Rate for Payer: Railroad Medicare Medicare |
$57.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.31
|
| Rate for Payer: UHC Core |
$191.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.48
|
| Rate for Payer: UHC Exchange |
$57.48
|
| Rate for Payer: UHC Medicare Advantage |
$57.48
|
| Rate for Payer: VA VA |
$57.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.42
|
|
|
LORAZEPAM 0.25 MG CUSTOM TAB
|
Facility
|
OP
|
$0.46
|
|
|
Service Code
|
NDC 09900000353
|
| Hospital Charge Code |
158587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Aetna Commercial |
$0.39
|
| Rate for Payer: Aetna Medicare |
$0.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.14
|
| Rate for Payer: BCBS Complete |
$0.18
|
| Rate for Payer: BCBS MAPPO |
$0.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.38
|
| Rate for Payer: BCN Commercial |
$0.36
|
| Rate for Payer: BCN Medicare Advantage |
$0.12
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cofinity Commercial |
$0.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.12
|
| Rate for Payer: Healthscope Commercial |
$0.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.39
|
| Rate for Payer: Nomi Health Commercial |
$0.38
|
| Rate for Payer: PACE Senior Care Partners |
$0.11
|
| Rate for Payer: PACE SWMI |
$0.12
|
| Rate for Payer: PHP Commercial |
$0.39
|
| Rate for Payer: PHP Medicare Advantage |
$0.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.30
|
| Rate for Payer: Priority Health HMO/PPO |
$0.40
|
| Rate for Payer: Priority Health Medicare |
$0.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.31
|
| Rate for Payer: Railroad Medicare Medicare |
$0.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.40
|
| Rate for Payer: UHC Core |
$0.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.12
|
| Rate for Payer: UHC Medicare Advantage |
$0.12
|
| Rate for Payer: VA VA |
$0.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.35
|
|
|
LORAZEPAM 0.25 MG CUSTOM TAB
|
Facility
|
IP
|
$0.46
|
|
|
Service Code
|
NDC 09900000353
|
| Hospital Charge Code |
158587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Aetna Commercial |
$0.39
|
| Rate for Payer: BCBS Trust/PPO |
$0.38
|
| Rate for Payer: BCN Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cofinity Commercial |
$0.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.37
|
| Rate for Payer: Healthscope Commercial |
$0.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.39
|
| Rate for Payer: Nomi Health Commercial |
$0.38
|
| Rate for Payer: PHP Commercial |
$0.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.30
|
| Rate for Payer: Priority Health HMO/PPO |
$0.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.40
|
| Rate for Payer: UHC Core |
$0.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.35
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$215.25
|
|
|
Service Code
|
NDC 60687062701
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$193.72 |
| Rate for Payer: Aetna Commercial |
$182.96
|
| Rate for Payer: Aetna Medicare |
$55.96
|
| 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 |
$86.10
|
| Rate for Payer: BCBS MAPPO |
$53.81
|
| Rate for Payer: BCBS Trust/PPO |
$176.96
|
| Rate for Payer: BCN Commercial |
$167.36
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.96
|
| Rate for Payer: Nomi Health Commercial |
$176.50
|
| 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 Cigna Priority Health |
$139.91
|
| Rate for Payer: Priority Health HMO/PPO |
$187.27
|
| Rate for Payer: Priority Health Medicare |
$54.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.22
|
| 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 Dual Complete DSNP |
$53.81
|
| Rate for Payer: UHC Exchange |
$53.81
|
| Rate for Payer: UHC Medicare Advantage |
$53.81
|
| 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
|
$2.16
|
|
|
Service Code
|
NDC 60687062711
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: BCBS Trust/PPO |
$1.76
|
| Rate for Payer: BCN Commercial |
$1.67
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$1.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Nomi Health Commercial |
$1.77
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.45
|
| 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 |
$139.91 |
| Max. Negotiated Rate |
$193.72 |
| Rate for Payer: Aetna Commercial |
$182.96
|
| Rate for Payer: BCBS Trust/PPO |
$175.71
|
| Rate for Payer: BCN Commercial |
$166.35
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cofinity Commercial |
$185.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.20
|
| Rate for Payer: Healthscope Commercial |
$193.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.96
|
| Rate for Payer: Nomi Health Commercial |
$176.50
|
| Rate for Payer: PHP Commercial |
$182.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.91
|
| Rate for Payer: Priority Health HMO/PPO |
$187.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.22
|
| 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
|
$73.50
|
|
|
Service Code
|
NDC 69315090401
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.46 |
| Max. Negotiated Rate |
$66.15 |
| Rate for Payer: Aetna Commercial |
$62.48
|
| Rate for Payer: Aetna Medicare |
$19.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.97
|
| Rate for Payer: BCBS Complete |
$29.40
|
| Rate for Payer: BCBS MAPPO |
$18.38
|
| Rate for Payer: BCBS Trust/PPO |
$60.42
|
| Rate for Payer: BCN Commercial |
$57.15
|
| Rate for Payer: BCN Medicare Advantage |
$18.38
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cofinity Commercial |
$63.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.38
|
| Rate for Payer: Healthscope Commercial |
$66.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.48
|
| Rate for Payer: Nomi Health Commercial |
$60.27
|
| Rate for Payer: PACE Senior Care Partners |
$17.46
|
| Rate for Payer: PACE SWMI |
$18.38
|
| Rate for Payer: PHP Commercial |
$62.48
|
| Rate for Payer: PHP Medicare Advantage |
$18.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.78
|
| Rate for Payer: Priority Health HMO/PPO |
$63.94
|
| Rate for Payer: Priority Health Medicare |
$18.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.24
|
| Rate for Payer: Railroad Medicare Medicare |
$18.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.68
|
| Rate for Payer: UHC Core |
$61.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.38
|
| Rate for Payer: UHC Exchange |
$18.38
|
| Rate for Payer: UHC Medicare Advantage |
$18.38
|
| Rate for Payer: VA VA |
$18.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.12
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$2.16
|
|
|
Service Code
|
NDC 60687062711
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.51 |
| 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 |
$0.86
|
| Rate for Payer: BCBS MAPPO |
$0.54
|
| Rate for Payer: BCBS Trust/PPO |
$1.78
|
| Rate for Payer: BCN Commercial |
$1.68
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Nomi Health Commercial |
$1.77
|
| 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 Cigna Priority Health |
$1.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1.88
|
| Rate for Payer: Priority Health Medicare |
$0.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.45
|
| 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 Dual Complete DSNP |
$0.54
|
| Rate for Payer: UHC Exchange |
$0.54
|
| Rate for Payer: UHC Medicare Advantage |
$0.54
|
| Rate for Payer: VA VA |
$0.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.62
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$129.50
|
|
|
Service Code
|
NDC 00904600761
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.76 |
| 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 |
$51.80
|
| Rate for Payer: BCBS MAPPO |
$32.38
|
| Rate for Payer: BCBS Trust/PPO |
$106.46
|
| Rate for Payer: BCN Commercial |
$100.69
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.08
|
| Rate for Payer: Nomi Health Commercial |
$106.19
|
| 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 Cigna Priority Health |
$84.18
|
| Rate for Payer: Priority Health HMO/PPO |
$112.66
|
| Rate for Payer: Priority Health Medicare |
$32.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.76
|
| 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 Dual Complete DSNP |
$32.38
|
| Rate for Payer: UHC Exchange |
$32.38
|
| Rate for Payer: UHC Medicare Advantage |
$32.38
|
| Rate for Payer: VA VA |
$32.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.12
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$73.50
|
|
|
Service Code
|
NDC 69315090401
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.78 |
| Max. Negotiated Rate |
$66.15 |
| Rate for Payer: Aetna Commercial |
$62.48
|
| Rate for Payer: BCBS Trust/PPO |
$60.00
|
| Rate for Payer: BCN Commercial |
$56.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cofinity Commercial |
$63.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.80
|
| Rate for Payer: Healthscope Commercial |
$66.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.48
|
| Rate for Payer: Nomi Health Commercial |
$60.27
|
| Rate for Payer: PHP Commercial |
$62.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.78
|
| Rate for Payer: Priority Health HMO/PPO |
$63.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.68
|
| Rate for Payer: UHC Core |
$61.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.12
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$129.50
|
|
|
Service Code
|
NDC 00904600761
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.18 |
| Max. Negotiated Rate |
$116.55 |
| Rate for Payer: Aetna Commercial |
$110.08
|
| Rate for Payer: BCBS Trust/PPO |
$105.71
|
| Rate for Payer: BCN Commercial |
$100.08
|
| Rate for Payer: Cash Price |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$111.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.60
|
| Rate for Payer: Healthscope Commercial |
$116.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.08
|
| Rate for Payer: Nomi Health Commercial |
$106.19
|
| Rate for Payer: PHP Commercial |
$110.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.18
|
| Rate for Payer: Priority Health HMO/PPO |
$112.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.76
|
| 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 1 MG TABLET
|
Facility
|
OP
|
$2.17
|
|
|
Service Code
|
NDC 60687063811
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.52 |
| 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 |
$0.87
|
| Rate for Payer: BCBS MAPPO |
$0.54
|
| Rate for Payer: BCBS Trust/PPO |
$1.78
|
| Rate for Payer: BCN Commercial |
$1.69
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Nomi Health Commercial |
$1.78
|
| 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 Cigna Priority Health |
$1.41
|
| Rate for Payer: Priority Health HMO/PPO |
$1.89
|
| Rate for Payer: Priority Health Medicare |
$0.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.45
|
| 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 Dual Complete DSNP |
$0.54
|
| Rate for Payer: UHC Exchange |
$0.54
|
| Rate for Payer: UHC Medicare Advantage |
$0.54
|
| 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 |
$141.05 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Aetna Commercial |
$184.45
|
| Rate for Payer: BCBS Trust/PPO |
$177.14
|
| Rate for Payer: BCN Commercial |
$167.70
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cofinity Commercial |
$186.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.60
|
| Rate for Payer: Healthscope Commercial |
$195.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.45
|
| Rate for Payer: Nomi Health Commercial |
$177.94
|
| Rate for Payer: PHP Commercial |
$184.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.05
|
| Rate for Payer: Priority Health HMO/PPO |
$188.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.96
|
| Rate for Payer: UHC Core |
$181.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.75
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$150.50
|
|
|
Service Code
|
NDC 00904600861
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.82 |
| Max. Negotiated Rate |
$135.45 |
| Rate for Payer: Aetna Commercial |
$127.92
|
| Rate for Payer: BCBS Trust/PPO |
$122.85
|
| Rate for Payer: BCN Commercial |
$116.31
|
| Rate for Payer: Cash Price |
$120.40
|
| Rate for Payer: Cofinity Commercial |
$129.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.40
|
| Rate for Payer: Healthscope Commercial |
$135.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.92
|
| Rate for Payer: Nomi Health Commercial |
$123.41
|
| Rate for Payer: PHP Commercial |
$127.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.82
|
| Rate for Payer: Priority Health HMO/PPO |
$130.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.84
|
| 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
|
OP
|
$217.00
|
|
|
Service Code
|
NDC 60687063801
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.54 |
| 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 |
$86.80
|
| Rate for Payer: BCBS MAPPO |
$54.25
|
| Rate for Payer: BCBS Trust/PPO |
$178.40
|
| Rate for Payer: BCN Commercial |
$168.72
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.45
|
| Rate for Payer: Nomi Health Commercial |
$177.94
|
| 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 Cigna Priority Health |
$141.05
|
| Rate for Payer: Priority Health HMO/PPO |
$188.79
|
| Rate for Payer: Priority Health Medicare |
$54.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.39
|
| Rate for Payer: Railroad Medicare Medicare |
$54.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.96
|
| Rate for Payer: UHC Core |
$181.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.25
|
| Rate for Payer: UHC Exchange |
$54.25
|
| Rate for Payer: UHC Medicare Advantage |
$54.25
|
| Rate for Payer: VA VA |
$54.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.75
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$2.17
|
|
|
Service Code
|
NDC 60687063811
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: BCBS Trust/PPO |
$1.77
|
| Rate for Payer: BCN Commercial |
$1.68
|
| Rate for Payer: Cash Price |
$1.74
|
| Rate for Payer: Cofinity Commercial |
$1.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.74
|
| Rate for Payer: Healthscope Commercial |
$1.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Nomi Health Commercial |
$1.78
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.41
|
| Rate for Payer: Priority Health HMO/PPO |
$1.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.45
|
| 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
|
$110.25
|
|
|
Service Code
|
NDC 69315090501
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.18 |
| Max. Negotiated Rate |
$99.22 |
| Rate for Payer: Aetna Commercial |
$93.71
|
| Rate for Payer: Aetna Medicare |
$28.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.45
|
| Rate for Payer: BCBS Complete |
$44.10
|
| Rate for Payer: BCBS MAPPO |
$27.56
|
| Rate for Payer: BCBS Trust/PPO |
$90.64
|
| Rate for Payer: BCN Commercial |
$85.72
|
| Rate for Payer: BCN Medicare Advantage |
$27.56
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cofinity Commercial |
$94.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.56
|
| Rate for Payer: Healthscope Commercial |
$99.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.71
|
| Rate for Payer: Nomi Health Commercial |
$90.40
|
| Rate for Payer: PACE Senior Care Partners |
$26.18
|
| Rate for Payer: PACE SWMI |
$27.56
|
| Rate for Payer: PHP Commercial |
$93.71
|
| Rate for Payer: PHP Medicare Advantage |
$27.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.66
|
| Rate for Payer: Priority Health HMO/PPO |
$95.92
|
| Rate for Payer: Priority Health Medicare |
$27.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.87
|
| Rate for Payer: Railroad Medicare Medicare |
$27.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.02
|
| Rate for Payer: UHC Core |
$92.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.56
|
| Rate for Payer: UHC Exchange |
$27.56
|
| Rate for Payer: UHC Medicare Advantage |
$27.56
|
| Rate for Payer: VA VA |
$27.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.69
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$150.50
|
|
|
Service Code
|
NDC 00904600861
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.74 |
| 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 |
$60.20
|
| Rate for Payer: BCBS MAPPO |
$37.62
|
| Rate for Payer: BCBS Trust/PPO |
$123.73
|
| Rate for Payer: BCN Commercial |
$117.01
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.92
|
| Rate for Payer: Nomi Health Commercial |
$123.41
|
| 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 Cigna Priority Health |
$97.82
|
| Rate for Payer: Priority Health HMO/PPO |
$130.94
|
| Rate for Payer: Priority Health Medicare |
$38.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.84
|
| 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 Dual Complete DSNP |
$37.62
|
| Rate for Payer: UHC Exchange |
$37.62
|
| Rate for Payer: UHC Medicare Advantage |
$37.62
|
| Rate for Payer: VA VA |
$37.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.88
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$110.25
|
|
|
Service Code
|
NDC 69315090501
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.66 |
| Max. Negotiated Rate |
$99.22 |
| Rate for Payer: Aetna Commercial |
$93.71
|
| Rate for Payer: BCBS Trust/PPO |
$90.00
|
| Rate for Payer: BCN Commercial |
$85.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cofinity Commercial |
$94.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.20
|
| Rate for Payer: Healthscope Commercial |
$99.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.71
|
| Rate for Payer: Nomi Health Commercial |
$90.40
|
| Rate for Payer: PHP Commercial |
$93.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.66
|
| Rate for Payer: Priority Health HMO/PPO |
$95.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.02
|
| Rate for Payer: UHC Core |
$92.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.69
|
|
|
LORAZEPAM 2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$17.88
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
10467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.62 |
| Max. Negotiated Rate |
$16.09 |
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Commercial |
$27.67
|
| Rate for Payer: BCBS Trust/PPO |
$14.60
|
| Rate for Payer: BCBS Trust/PPO |
$26.57
|
| Rate for Payer: BCN Commercial |
$13.82
|
| Rate for Payer: BCN Commercial |
$25.15
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cash Price |
$26.04
|
| Rate for Payer: Cofinity Commercial |
$27.99
|
| Rate for Payer: Cofinity Commercial |
$15.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.30
|
| Rate for Payer: Healthscope Commercial |
$16.09
|
| Rate for Payer: Healthscope Commercial |
$29.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.67
|
| Rate for Payer: Nomi Health Commercial |
$14.66
|
| Rate for Payer: Nomi Health Commercial |
$26.69
|
| Rate for Payer: PHP Commercial |
$15.20
|
| Rate for Payer: PHP Commercial |
$27.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.62
|
| Rate for Payer: Priority Health HMO/PPO |
$28.32
|
| Rate for Payer: Priority Health HMO/PPO |
$15.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.64
|
| Rate for Payer: UHC Core |
$14.93
|
| Rate for Payer: UHC Core |
$27.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.41
|
|
|
LORAZEPAM 2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$32.55
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
10467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.73 |
| Max. Negotiated Rate |
$29.30 |
| Rate for Payer: Aetna Commercial |
$27.67
|
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Medicare |
$8.46
|
| Rate for Payer: Aetna Medicare |
$4.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.59
|
| Rate for Payer: BCBS Complete |
$7.15
|
| Rate for Payer: BCBS Complete |
$13.02
|
| Rate for Payer: BCBS MAPPO |
$4.47
|
| Rate for Payer: BCBS MAPPO |
$8.14
|
| Rate for Payer: BCBS Trust/PPO |
$26.76
|
| Rate for Payer: BCBS Trust/PPO |
$14.70
|
| Rate for Payer: BCN Commercial |
$25.31
|
| Rate for Payer: BCN Commercial |
$13.90
|
| Rate for Payer: BCN Medicare Advantage |
$8.14
|
| Rate for Payer: BCN Medicare Advantage |
$4.47
|
| Rate for Payer: Cash Price |
$26.04
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cofinity Commercial |
$15.38
|
| Rate for Payer: Cofinity Commercial |
$27.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.14
|
| Rate for Payer: Healthscope Commercial |
$16.09
|
| Rate for Payer: Healthscope Commercial |
$29.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.41
|
| 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 |
$8.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.20
|
| Rate for Payer: Nomi Health Commercial |
$26.69
|
| Rate for Payer: Nomi Health Commercial |
$14.66
|
| Rate for Payer: PACE Senior Care Partners |
$7.73
|
| Rate for Payer: PACE Senior Care Partners |
$4.25
|
| Rate for Payer: PACE SWMI |
$8.14
|
| Rate for Payer: PACE SWMI |
$4.47
|
| Rate for Payer: PHP Commercial |
$27.67
|
| Rate for Payer: PHP Commercial |
$15.20
|
| Rate for Payer: PHP Medicare Advantage |
$4.47
|
| Rate for Payer: PHP Medicare Advantage |
$8.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.62
|
| Rate for Payer: Priority Health HMO/PPO |
$15.56
|
| Rate for Payer: Priority Health HMO/PPO |
$28.32
|
| Rate for Payer: Priority Health Medicare |
$8.22
|
| Rate for Payer: Priority Health Medicare |
$4.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.98
|
| Rate for Payer: Railroad Medicare Medicare |
$4.47
|
| Rate for Payer: Railroad Medicare Medicare |
$8.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.64
|
| Rate for Payer: UHC Core |
$27.18
|
| Rate for Payer: UHC Core |
$14.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.47
|
| Rate for Payer: UHC Exchange |
$4.47
|
| Rate for Payer: UHC Exchange |
$8.14
|
| Rate for Payer: UHC Medicare Advantage |
$4.47
|
| Rate for Payer: UHC Medicare Advantage |
$8.14
|
| Rate for Payer: VA VA |
$4.47
|
| Rate for Payer: VA VA |
$8.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.41
|
| 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 |
$11.61 |
| Max. Negotiated Rate |
$16.07 |
| Rate for Payer: Aetna Commercial |
$15.18
|
| Rate for Payer: BCBS Trust/PPO |
$14.58
|
| Rate for Payer: BCN Commercial |
$13.80
|
| 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 |
$13.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.18
|
| Rate for Payer: Nomi Health Commercial |
$14.65
|
| Rate for Payer: PHP Commercial |
$15.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.61
|
| Rate for Payer: Priority Health HMO/PPO |
$15.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.97
|
| 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 |
$13.40
|
|
|
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 |
$4.24 |
| 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 |
$7.14
|
| Rate for Payer: BCBS MAPPO |
$4.46
|
| Rate for Payer: BCBS Trust/PPO |
$14.68
|
| Rate for Payer: BCN Commercial |
$13.89
|
| 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 |
$13.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.18
|
| Rate for Payer: Nomi Health Commercial |
$14.65
|
| 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 Cigna Priority Health |
$11.61
|
| Rate for Payer: Priority Health HMO/PPO |
$15.54
|
| Rate for Payer: Priority Health Medicare |
$4.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.97
|
| 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 Dual Complete DSNP |
$4.46
|
| Rate for Payer: UHC Exchange |
$4.46
|
| Rate for Payer: UHC Medicare Advantage |
$4.46
|
| Rate for Payer: VA VA |
$4.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.40
|
|
