|
LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$270.25
|
|
|
Service Code
|
NDC 00378130001
|
| Hospital Charge Code |
10454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.18 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: Aetna Medicare |
$70.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.45
|
| Rate for Payer: BCBS Complete |
$108.10
|
| Rate for Payer: BCBS MAPPO |
$67.56
|
| Rate for Payer: BCBS Trust/PPO |
$222.17
|
| Rate for Payer: BCN Commercial |
$210.12
|
| Rate for Payer: BCN Medicare Advantage |
$67.56
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$232.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.56
|
| Rate for Payer: Healthscope Commercial |
$243.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.71
|
| Rate for Payer: Nomi Health Commercial |
$221.60
|
| Rate for Payer: PACE Senior Care Partners |
$64.18
|
| Rate for Payer: PACE SWMI |
$67.56
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: PHP Medicare Advantage |
$67.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.66
|
| Rate for Payer: Priority Health HMO/PPO |
$235.12
|
| Rate for Payer: Priority Health Medicare |
$68.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.07
|
| Rate for Payer: Railroad Medicare Medicare |
$67.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.82
|
| Rate for Payer: UHC Core |
$225.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.56
|
| Rate for Payer: UHC Exchange |
$67.56
|
| Rate for Payer: UHC Medicare Advantage |
$67.56
|
| Rate for Payer: VA VA |
$67.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.69
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$246.24
|
|
|
Service Code
|
NDC 60687022901
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.06 |
| Max. Negotiated Rate |
$221.62 |
| Rate for Payer: Aetna Commercial |
$209.30
|
| Rate for Payer: BCBS Trust/PPO |
$201.01
|
| Rate for Payer: BCN Commercial |
$190.29
|
| 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: PHP Commercial |
$209.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.06
|
| Rate for Payer: Priority Health HMO/PPO |
$214.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.98
|
| 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
|
OP
|
$3.31
|
|
|
Service Code
|
NDC 51079069001
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$2.98 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Medicare |
$0.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.03
|
| Rate for Payer: BCBS Complete |
$1.32
|
| Rate for Payer: BCBS MAPPO |
$0.83
|
| Rate for Payer: BCBS Trust/PPO |
$2.72
|
| Rate for Payer: BCN Commercial |
$2.57
|
| Rate for Payer: BCN Medicare Advantage |
$0.83
|
| Rate for Payer: Cash Price |
$2.65
|
| Rate for Payer: Cofinity Commercial |
$2.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.83
|
| Rate for Payer: Healthscope Commercial |
$2.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.81
|
| Rate for Payer: Nomi Health Commercial |
$2.71
|
| Rate for Payer: PACE Senior Care Partners |
$0.79
|
| Rate for Payer: PACE SWMI |
$0.83
|
| Rate for Payer: PHP Commercial |
$2.81
|
| Rate for Payer: PHP Medicare Advantage |
$0.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.15
|
| Rate for Payer: Priority Health HMO/PPO |
$2.88
|
| Rate for Payer: Priority Health Medicare |
$0.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.22
|
| Rate for Payer: Railroad Medicare Medicare |
$0.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.91
|
| Rate for Payer: UHC Core |
$2.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.83
|
| Rate for Payer: UHC Exchange |
$0.83
|
| Rate for Payer: UHC Medicare Advantage |
$0.83
|
| Rate for Payer: VA VA |
$0.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.48
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$3.31
|
|
|
Service Code
|
NDC 51079069001
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$2.98 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: BCBS Trust/PPO |
$2.70
|
| Rate for Payer: BCN Commercial |
$2.56
|
| Rate for Payer: Cash Price |
$2.65
|
| Rate for Payer: Cofinity Commercial |
$2.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.65
|
| Rate for Payer: Healthscope Commercial |
$2.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.81
|
| Rate for Payer: Nomi Health Commercial |
$2.71
|
| Rate for Payer: PHP Commercial |
$2.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.15
|
| Rate for Payer: Priority Health HMO/PPO |
$2.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.91
|
| Rate for Payer: UHC Core |
$2.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.48
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$246.24
|
|
|
Service Code
|
NDC 60687022901
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.48 |
| 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 |
$98.50
|
| Rate for Payer: BCBS MAPPO |
$61.56
|
| Rate for Payer: BCBS Trust/PPO |
$202.43
|
| Rate for Payer: BCN Commercial |
$191.45
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.30
|
| Rate for Payer: Nomi Health Commercial |
$201.92
|
| 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 Cigna Priority Health |
$160.06
|
| Rate for Payer: Priority Health HMO/PPO |
$214.23
|
| Rate for Payer: Priority Health Medicare |
$62.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.98
|
| 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 Dual Complete DSNP |
$61.56
|
| Rate for Payer: UHC Exchange |
$61.56
|
| Rate for Payer: UHC Medicare Advantage |
$61.56
|
| Rate for Payer: VA VA |
$61.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.68
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$2.47
|
|
|
Service Code
|
NDC 60687022911
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.02
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: Nomi Health Commercial |
$2.03
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.61
|
| Rate for Payer: Priority Health HMO/PPO |
$2.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.17
|
| Rate for Payer: UHC Core |
$2.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.85
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$247.95
|
|
|
Service Code
|
NDC 69452027120
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.17 |
| Max. Negotiated Rate |
$223.16 |
| Rate for Payer: Aetna Commercial |
$210.76
|
| Rate for Payer: BCBS Trust/PPO |
$202.40
|
| Rate for Payer: BCN Commercial |
$191.62
|
| Rate for Payer: Cash Price |
$198.36
|
| Rate for Payer: Cofinity Commercial |
$213.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.36
|
| Rate for Payer: Healthscope Commercial |
$223.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.76
|
| Rate for Payer: Nomi Health Commercial |
$203.32
|
| Rate for Payer: PHP Commercial |
$210.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.17
|
| Rate for Payer: Priority Health HMO/PPO |
$215.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.20
|
| Rate for Payer: UHC Core |
$207.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.96
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$2.47
|
|
|
Service Code
|
NDC 60687022911
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna Medicare |
$0.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.77
|
| Rate for Payer: BCBS Complete |
$0.99
|
| Rate for Payer: BCBS MAPPO |
$0.62
|
| Rate for Payer: BCBS Trust/PPO |
$2.03
|
| Rate for Payer: BCN Commercial |
$1.92
|
| Rate for Payer: BCN Medicare Advantage |
$0.62
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.62
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: Nomi Health Commercial |
$2.03
|
| Rate for Payer: PACE Senior Care Partners |
$0.59
|
| Rate for Payer: PACE SWMI |
$0.62
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: PHP Medicare Advantage |
$0.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.61
|
| Rate for Payer: Priority Health HMO/PPO |
$2.15
|
| Rate for Payer: Priority Health Medicare |
$0.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.65
|
| Rate for Payer: Railroad Medicare Medicare |
$0.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.17
|
| Rate for Payer: UHC Core |
$2.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.62
|
| Rate for Payer: UHC Exchange |
$0.62
|
| Rate for Payer: UHC Medicare Advantage |
$0.62
|
| Rate for Payer: VA VA |
$0.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.85
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$247.95
|
|
|
Service Code
|
NDC 69452027120
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.89 |
| Max. Negotiated Rate |
$223.16 |
| Rate for Payer: Aetna Commercial |
$210.76
|
| Rate for Payer: Aetna Medicare |
$64.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.48
|
| Rate for Payer: BCBS Complete |
$99.18
|
| Rate for Payer: BCBS MAPPO |
$61.99
|
| Rate for Payer: BCBS Trust/PPO |
$203.84
|
| Rate for Payer: BCN Commercial |
$192.78
|
| Rate for Payer: BCN Medicare Advantage |
$61.99
|
| Rate for Payer: Cash Price |
$198.36
|
| Rate for Payer: Cofinity Commercial |
$213.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.99
|
| Rate for Payer: Healthscope Commercial |
$223.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.76
|
| Rate for Payer: Nomi Health Commercial |
$203.32
|
| Rate for Payer: PACE Senior Care Partners |
$58.89
|
| Rate for Payer: PACE SWMI |
$61.99
|
| Rate for Payer: PHP Commercial |
$210.76
|
| Rate for Payer: PHP Medicare Advantage |
$61.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.17
|
| Rate for Payer: Priority Health HMO/PPO |
$215.72
|
| Rate for Payer: Priority Health Medicare |
$62.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.13
|
| Rate for Payer: Railroad Medicare Medicare |
$61.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.20
|
| Rate for Payer: UHC Core |
$207.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.99
|
| Rate for Payer: UHC Exchange |
$61.99
|
| Rate for Payer: UHC Medicare Advantage |
$61.99
|
| Rate for Payer: VA VA |
$61.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.96
|
|
|
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
|
IP
|
$209.00
|
|
|
Service Code
|
NDC 00904685261
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.85 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: BCBS Trust/PPO |
$170.61
|
| Rate for Payer: BCN Commercial |
$161.52
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: Nomi Health Commercial |
$171.38
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health HMO/PPO |
$181.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$140.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.92
|
| Rate for Payer: UHC Core |
$174.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
|
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 |
$195.41
|
| 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 |
$172.43
|
| 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 |
$195.41
|
| 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 |
$195.41
|
| 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 |
$172.43
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$229.90
|
|
|
Service Code
|
NDC 68084024811
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.44 |
| Max. Negotiated Rate |
$206.91 |
| Rate for Payer: Aetna Commercial |
$195.41
|
| Rate for Payer: BCBS Trust/PPO |
$187.67
|
| Rate for Payer: BCN Commercial |
$177.67
|
| 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: Healthscope Commercial |
$206.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.41
|
| Rate for Payer: Nomi Health Commercial |
$188.52
|
| Rate for Payer: PHP Commercial |
$195.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.44
|
| Rate for Payer: Priority Health HMO/PPO |
$200.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.31
|
| Rate for Payer: UHC Core |
$191.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.43
|
|
|
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 |
$195.41
|
| 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 |
$172.43
|
| 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 |
$195.41
|
| 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 |
$195.41
|
| 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 |
$172.43
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$229.90
|
|
|
Service Code
|
NDC 68084024801
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.44 |
| Max. Negotiated Rate |
$206.91 |
| Rate for Payer: Aetna Commercial |
$195.41
|
| Rate for Payer: BCBS Trust/PPO |
$187.67
|
| Rate for Payer: BCN Commercial |
$177.67
|
| 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: Healthscope Commercial |
$206.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.41
|
| Rate for Payer: Nomi Health Commercial |
$188.52
|
| Rate for Payer: PHP Commercial |
$195.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.44
|
| Rate for Payer: Priority Health HMO/PPO |
$200.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.31
|
| Rate for Payer: UHC Core |
$191.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.43
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
NDC 00904685261
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.64 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna Medicare |
$54.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.31
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: BCBS MAPPO |
$52.25
|
| Rate for Payer: BCBS Trust/PPO |
$171.82
|
| Rate for Payer: BCN Commercial |
$162.50
|
| Rate for Payer: BCN Medicare Advantage |
$52.25
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.25
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: Nomi Health Commercial |
$171.38
|
| Rate for Payer: PACE Senior Care Partners |
$49.64
|
| Rate for Payer: PACE SWMI |
$52.25
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: PHP Medicare Advantage |
$52.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health HMO/PPO |
$181.83
|
| Rate for Payer: Priority Health Medicare |
$52.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$140.03
|
| Rate for Payer: Railroad Medicare Medicare |
$52.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.92
|
| Rate for Payer: UHC Core |
$174.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.25
|
| Rate for Payer: UHC Exchange |
$52.25
|
| Rate for Payer: UHC Medicare Advantage |
$52.25
|
| Rate for Payer: VA VA |
$52.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$256.50
|
|
|
Service Code
|
NDC 51079024620
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.92 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna Commercial |
$218.03
|
| Rate for Payer: Aetna Medicare |
$66.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.16
|
| Rate for Payer: BCBS Complete |
$102.60
|
| Rate for Payer: BCBS MAPPO |
$64.12
|
| Rate for Payer: BCBS Trust/PPO |
$210.87
|
| Rate for Payer: BCN Commercial |
$199.43
|
| Rate for Payer: BCN Medicare Advantage |
$64.12
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cofinity Commercial |
$220.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.12
|
| Rate for Payer: Healthscope Commercial |
$230.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.03
|
| Rate for Payer: Nomi Health Commercial |
$210.33
|
| Rate for Payer: PACE Senior Care Partners |
$60.92
|
| Rate for Payer: PACE SWMI |
$64.12
|
| Rate for Payer: PHP Commercial |
$218.03
|
| Rate for Payer: PHP Medicare Advantage |
$64.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.72
|
| Rate for Payer: Priority Health HMO/PPO |
$223.16
|
| Rate for Payer: Priority Health Medicare |
$64.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.85
|
| Rate for Payer: Railroad Medicare Medicare |
$64.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.72
|
| Rate for Payer: UHC Core |
$214.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.12
|
| Rate for Payer: UHC Exchange |
$64.12
|
| Rate for Payer: UHC Medicare Advantage |
$64.12
|
| Rate for Payer: VA VA |
$64.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.38
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$256.50
|
|
|
Service Code
|
NDC 51079024620
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.72 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna Commercial |
$218.03
|
| Rate for Payer: BCBS Trust/PPO |
$209.38
|
| Rate for Payer: BCN Commercial |
$198.22
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cofinity Commercial |
$220.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.20
|
| Rate for Payer: Healthscope Commercial |
$230.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.03
|
| Rate for Payer: Nomi Health Commercial |
$210.33
|
| Rate for Payer: PHP Commercial |
$218.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.72
|
| Rate for Payer: Priority Health HMO/PPO |
$223.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.72
|
| Rate for Payer: UHC Core |
$214.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.38
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$2.57
|
|
|
Service Code
|
NDC 51079024601
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Medicare |
$0.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.80
|
| Rate for Payer: BCBS Complete |
$1.03
|
| Rate for Payer: BCBS MAPPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$2.11
|
| Rate for Payer: BCN Commercial |
$2.00
|
| Rate for Payer: BCN Medicare Advantage |
$0.64
|
| 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: Health Alliance Plan Medicare Advantage |
$0.64
|
| Rate for Payer: Healthscope Commercial |
$2.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Nomi Health Commercial |
$2.11
|
| Rate for Payer: PACE Senior Care Partners |
$0.61
|
| Rate for Payer: PACE SWMI |
$0.64
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: PHP Medicare Advantage |
$0.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.67
|
| Rate for Payer: Priority Health HMO/PPO |
$2.24
|
| Rate for Payer: Priority Health Medicare |
$0.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.72
|
| Rate for Payer: Railroad Medicare Medicare |
$0.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.26
|
| Rate for Payer: UHC Core |
$2.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.64
|
| Rate for Payer: UHC Exchange |
$0.64
|
| Rate for Payer: UHC Medicare Advantage |
$0.64
|
| Rate for Payer: VA VA |
$0.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.93
|
|
|
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
|
$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 |
$47.77
|
| Rate for Payer: Priority Health HMO/PPO |
$63.95
|
| 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
|
$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 |
$55.97
|
| 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 |
$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
|
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 |
$84.17
|
| Rate for Payer: Priority Health HMO/PPO |
$112.67
|
| Rate for Payer: Priority Health Medicare |
$32.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.77
|
| 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
|
$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
|
|
