|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$331.55
|
|
|
Service Code
|
NDC 0093-0311-01
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.88 |
| Max. Negotiated Rate |
$298.40 |
| Rate for Payer: Aetna American Axle |
$215.51
|
| Rate for Payer: Aetna Commercial |
$281.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.51
|
| Rate for Payer: Cash Price |
$265.24
|
| Rate for Payer: Cofinity Commercial |
$232.08
|
| Rate for Payer: Cofinity Commercial |
$285.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.24
|
| Rate for Payer: Healthscope Commercial |
$298.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.82
|
| Rate for Payer: PHP Commercial |
$281.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.08
|
| Rate for Payer: Priority Health SBD |
$208.88
|
| Rate for Payer: UMR Bronson Commercial |
$145.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.66
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
NDC 69452-271-20
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.96 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna American Axle |
$135.85
|
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$146.30
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$146.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.65
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.30
|
| Rate for Payer: Priority Health SBD |
$131.67
|
| Rate for Payer: UMR Bronson Commercial |
$91.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$3.25
|
|
|
Service Code
|
NDC 51079-690-01
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna American Axle |
$2.11
|
| Rate for Payer: Aetna Commercial |
$2.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.11
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.76
|
| Rate for Payer: PHP Commercial |
$2.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.28
|
| Rate for Payer: Priority Health SBD |
$2.05
|
| Rate for Payer: UMR Bronson Commercial |
$1.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.44
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$324.96
|
|
|
Service Code
|
NDC 51079-690-20
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.98 |
| Max. Negotiated Rate |
$292.46 |
| Rate for Payer: Aetna American Axle |
$211.22
|
| Rate for Payer: Aetna Commercial |
$276.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.22
|
| Rate for Payer: Cash Price |
$259.97
|
| Rate for Payer: Cofinity Commercial |
$227.47
|
| Rate for Payer: Cofinity Commercial |
$279.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.97
|
| Rate for Payer: Healthscope Commercial |
$292.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.22
|
| Rate for Payer: PHP Commercial |
$276.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.47
|
| Rate for Payer: Priority Health SBD |
$204.72
|
| Rate for Payer: UMR Bronson Commercial |
$142.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.72
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$242.88
|
|
|
Service Code
|
NDC 60687-229-01
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.87 |
| Max. Negotiated Rate |
$218.59 |
| Rate for Payer: Aetna American Axle |
$157.87
|
| Rate for Payer: Aetna Commercial |
$206.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.87
|
| Rate for Payer: Cash Price |
$194.30
|
| Rate for Payer: Cofinity Commercial |
$170.02
|
| Rate for Payer: Cofinity Commercial |
$208.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.30
|
| Rate for Payer: Healthscope Commercial |
$218.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$206.45
|
| Rate for Payer: PHP Commercial |
$206.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.02
|
| Rate for Payer: Priority Health SBD |
$153.01
|
| Rate for Payer: UMR Bronson Commercial |
$106.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.16
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$2.43
|
|
|
Service Code
|
NDC 60687-229-11
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna American Axle |
$1.58
|
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.58
|
| Rate for Payer: BCBS Complete |
$0.97
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Healthscope Commercial |
$2.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.07
|
| Rate for Payer: PHP Commercial |
$2.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.70
|
| Rate for Payer: Priority Health SBD |
$1.53
|
| Rate for Payer: UMR Bronson Commercial |
$0.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.82
|
|
|
LOPINAVIR-RITONAVIR 400 MG-100 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$1,236.10
|
|
|
Service Code
|
NDC 0527-1947-48
|
| Hospital Charge Code |
28929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$543.88 |
| Max. Negotiated Rate |
$1,112.49 |
| Rate for Payer: Aetna American Axle |
$803.46
|
| Rate for Payer: Aetna Commercial |
$1,050.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.46
|
| Rate for Payer: Cash Price |
$988.88
|
| Rate for Payer: Cofinity Commercial |
$1,063.05
|
| Rate for Payer: Cofinity Commercial |
$865.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$988.88
|
| Rate for Payer: Healthscope Commercial |
$1,112.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$865.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$927.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,050.68
|
| Rate for Payer: PHP Commercial |
$1,050.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$865.27
|
| Rate for Payer: Priority Health SBD |
$778.74
|
| Rate for Payer: UMR Bronson Commercial |
$543.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$927.08
|
|
|
LOPINAVIR-RITONAVIR 400 MG-100 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$1,847.04
|
|
|
Service Code
|
NDC 0074-3956-46
|
| Hospital Charge Code |
28929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$812.70 |
| Max. Negotiated Rate |
$1,662.34 |
| Rate for Payer: Aetna American Axle |
$1,200.58
|
| Rate for Payer: Aetna Commercial |
$1,569.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,200.58
|
| Rate for Payer: Cash Price |
$1,477.63
|
| Rate for Payer: Cofinity Commercial |
$1,292.93
|
| Rate for Payer: Cofinity Commercial |
$1,588.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,477.63
|
| Rate for Payer: Healthscope Commercial |
$1,662.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,292.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,385.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,569.98
|
| Rate for Payer: PHP Commercial |
$1,569.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,292.93
|
| Rate for Payer: Priority Health SBD |
$1,163.64
|
| Rate for Payer: UMR Bronson Commercial |
$812.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,385.28
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$240.35
|
|
|
Service Code
|
NDC 51079-246-20
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.75 |
| Max. Negotiated Rate |
$216.32 |
| Rate for Payer: Aetna American Axle |
$156.23
|
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.23
|
| Rate for Payer: Cash Price |
$192.28
|
| Rate for Payer: Cofinity Commercial |
$168.24
|
| Rate for Payer: Cofinity Commercial |
$206.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.28
|
| Rate for Payer: Healthscope Commercial |
$216.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.30
|
| Rate for Payer: PHP Commercial |
$204.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.24
|
| Rate for Payer: Priority Health SBD |
$151.42
|
| Rate for Payer: UMR Bronson Commercial |
$105.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.26
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$2.41
|
|
|
Service Code
|
NDC 51079-246-01
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Aetna American Axle |
$1.57
|
| Rate for Payer: Aetna Commercial |
$2.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.57
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cofinity Commercial |
$1.69
|
| Rate for Payer: Cofinity Commercial |
$2.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$2.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.05
|
| Rate for Payer: PHP Commercial |
$2.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.69
|
| Rate for Payer: Priority Health SBD |
$1.52
|
| Rate for Payer: UMR Bronson Commercial |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.81
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$2.41
|
|
|
Service Code
|
NDC 51079-246-01
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Aetna American Axle |
$1.57
|
| Rate for Payer: Aetna Commercial |
$2.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.57
|
| Rate for Payer: BCBS Complete |
$0.96
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cofinity Commercial |
$1.69
|
| Rate for Payer: Cofinity Commercial |
$2.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$2.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.05
|
| Rate for Payer: PHP Commercial |
$2.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.69
|
| Rate for Payer: Priority Health SBD |
$1.52
|
| Rate for Payer: UMR Bronson Commercial |
$0.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.81
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$129.25
|
|
|
Service Code
|
NDC 45802-650-78
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$116.32 |
| Rate for Payer: Aetna American Axle |
$84.01
|
| Rate for Payer: Aetna Commercial |
$109.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.01
|
| Rate for Payer: BCBS Complete |
$51.70
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cofinity Commercial |
$111.16
|
| Rate for Payer: Cofinity Commercial |
$90.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.40
|
| Rate for Payer: Healthscope Commercial |
$116.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.86
|
| Rate for Payer: PHP Commercial |
$109.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.48
|
| Rate for Payer: Priority Health SBD |
$81.43
|
| Rate for Payer: UMR Bronson Commercial |
$47.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.94
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$240.35
|
|
|
Service Code
|
NDC 51079-246-20
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.93 |
| Max. Negotiated Rate |
$216.32 |
| Rate for Payer: Aetna American Axle |
$156.23
|
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.23
|
| Rate for Payer: BCBS Complete |
$96.14
|
| Rate for Payer: Cash Price |
$192.28
|
| Rate for Payer: Cofinity Commercial |
$168.24
|
| Rate for Payer: Cofinity Commercial |
$206.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.28
|
| Rate for Payer: Healthscope Commercial |
$216.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.30
|
| Rate for Payer: PHP Commercial |
$204.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.24
|
| Rate for Payer: Priority Health SBD |
$151.42
|
| Rate for Payer: UMR Bronson Commercial |
$88.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.26
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$211.85
|
|
|
Service Code
|
NDC 0904-6852-61
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$190.66 |
| Rate for Payer: Aetna American Axle |
$137.70
|
| Rate for Payer: Aetna Commercial |
$180.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.70
|
| Rate for Payer: BCBS Complete |
$84.74
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Cofinity Commercial |
$148.30
|
| Rate for Payer: Cofinity Commercial |
$182.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.48
|
| Rate for Payer: Healthscope Commercial |
$190.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180.07
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.30
|
| Rate for Payer: Priority Health SBD |
$133.47
|
| Rate for Payer: UMR Bronson Commercial |
$78.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.89
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$211.50
|
|
|
Service Code
|
NDC 50268-489-15
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna American Axle |
$137.48
|
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.48
|
| Rate for Payer: BCBS Complete |
$84.60
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cofinity Commercial |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$181.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.20
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.78
|
| Rate for Payer: PHP Commercial |
$179.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.05
|
| Rate for Payer: Priority Health SBD |
$133.24
|
| Rate for Payer: UMR Bronson Commercial |
$78.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.62
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$238.45
|
|
|
Service Code
|
NDC 68084-248-11
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.92 |
| Max. Negotiated Rate |
$214.60 |
| Rate for Payer: Aetna American Axle |
$154.99
|
| Rate for Payer: Aetna Commercial |
$202.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.99
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$166.92
|
| Rate for Payer: Cofinity Commercial |
$205.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$214.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$202.68
|
| Rate for Payer: PHP Commercial |
$202.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.92
|
| Rate for Payer: Priority Health SBD |
$150.22
|
| Rate for Payer: UMR Bronson Commercial |
$104.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.84
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$238.45
|
|
|
Service Code
|
NDC 68084-248-01
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.92 |
| Max. Negotiated Rate |
$214.60 |
| Rate for Payer: Aetna American Axle |
$154.99
|
| Rate for Payer: Aetna Commercial |
$202.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.99
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$166.92
|
| Rate for Payer: Cofinity Commercial |
$205.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$214.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$202.68
|
| Rate for Payer: PHP Commercial |
$202.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.92
|
| Rate for Payer: Priority Health SBD |
$150.22
|
| Rate for Payer: UMR Bronson Commercial |
$104.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.84
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$211.85
|
|
|
Service Code
|
NDC 0904-6852-61
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.21 |
| Max. Negotiated Rate |
$190.66 |
| Rate for Payer: Aetna American Axle |
$137.70
|
| Rate for Payer: Aetna Commercial |
$180.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.70
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Cofinity Commercial |
$148.30
|
| Rate for Payer: Cofinity Commercial |
$182.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.48
|
| Rate for Payer: Healthscope Commercial |
$190.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180.07
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.30
|
| Rate for Payer: Priority Health SBD |
$133.47
|
| Rate for Payer: UMR Bronson Commercial |
$93.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.89
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$4.23
|
|
|
Service Code
|
NDC 50268-489-11
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna American Axle |
$2.75
|
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.75
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Commercial |
$2.96
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.38
|
| Rate for Payer: Healthscope Commercial |
$3.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.60
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.96
|
| Rate for Payer: Priority Health SBD |
$2.66
|
| Rate for Payer: UMR Bronson Commercial |
$1.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.17
|
|
|
LORATADINE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$122.02
|
|
|
Service Code
|
NDC 9629512925
|
| Hospital Charge Code |
76472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.69 |
| Max. Negotiated Rate |
$109.82 |
| Rate for Payer: Aetna American Axle |
$79.31
|
| Rate for Payer: Aetna Commercial |
$103.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.31
|
| Rate for Payer: Cash Price |
$97.62
|
| Rate for Payer: Cofinity Commercial |
$104.94
|
| Rate for Payer: Cofinity Commercial |
$85.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.62
|
| Rate for Payer: Healthscope Commercial |
$109.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.72
|
| Rate for Payer: PHP Commercial |
$103.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.41
|
| Rate for Payer: Priority Health SBD |
$76.87
|
| Rate for Payer: UMR Bronson Commercial |
$53.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.52
|
|
|
LORATADINE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$118.44
|
|
|
Service Code
|
NDC 54838-558-40
|
| Hospital Charge Code |
76472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.11 |
| Max. Negotiated Rate |
$106.60 |
| Rate for Payer: Aetna American Axle |
$76.99
|
| Rate for Payer: Aetna Commercial |
$100.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.99
|
| Rate for Payer: Cash Price |
$94.75
|
| Rate for Payer: Cofinity Commercial |
$101.86
|
| Rate for Payer: Cofinity Commercial |
$82.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.75
|
| Rate for Payer: Healthscope Commercial |
$106.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.67
|
| Rate for Payer: PHP Commercial |
$100.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.91
|
| Rate for Payer: Priority Health SBD |
$74.62
|
| Rate for Payer: UMR Bronson Commercial |
$52.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.83
|
|
|
LORATADINE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$112.80
|
|
|
Service Code
|
NDC 0904-6767-20
|
| Hospital Charge Code |
76472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.63 |
| Max. Negotiated Rate |
$101.52 |
| Rate for Payer: Aetna American Axle |
$73.32
|
| Rate for Payer: Aetna Commercial |
$95.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.32
|
| Rate for Payer: Cash Price |
$90.24
|
| Rate for Payer: Cofinity Commercial |
$78.96
|
| Rate for Payer: Cofinity Commercial |
$97.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.24
|
| Rate for Payer: Healthscope Commercial |
$101.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.88
|
| Rate for Payer: PHP Commercial |
$95.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.96
|
| Rate for Payer: Priority Health SBD |
$71.06
|
| Rate for Payer: UMR Bronson Commercial |
$49.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.60
|
|
|
LORATADINE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$78.96
|
|
|
Service Code
|
NDC 51672-2092-8
|
| Hospital Charge Code |
76472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.74 |
| Max. Negotiated Rate |
$71.06 |
| Rate for Payer: Aetna American Axle |
$51.32
|
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.32
|
| Rate for Payer: Cash Price |
$63.17
|
| Rate for Payer: Cofinity Commercial |
$55.27
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.17
|
| Rate for Payer: Healthscope Commercial |
$71.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.12
|
| Rate for Payer: PHP Commercial |
$67.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.27
|
| Rate for Payer: Priority Health SBD |
$49.74
|
| Rate for Payer: UMR Bronson Commercial |
$34.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.22
|
|
|
LORATADINE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$81.78
|
|
|
Service Code
|
NDC 51672-2131-8
|
| Hospital Charge Code |
76472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.98 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna American Axle |
$53.16
|
| Rate for Payer: Aetna Commercial |
$69.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.16
|
| Rate for Payer: Cash Price |
$65.42
|
| Rate for Payer: Cofinity Commercial |
$57.25
|
| Rate for Payer: Cofinity Commercial |
$70.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.42
|
| Rate for Payer: Healthscope Commercial |
$73.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.51
|
| Rate for Payer: PHP Commercial |
$69.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.25
|
| Rate for Payer: Priority Health SBD |
$51.52
|
| Rate for Payer: UMR Bronson Commercial |
$35.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.34
|
|
|
LORATADINE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$138.18
|
|
|
Service Code
|
NDC 51672-2073-8
|
| Hospital Charge Code |
76472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$124.36 |
| Rate for Payer: Aetna American Axle |
$89.82
|
| Rate for Payer: Aetna Commercial |
$117.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.82
|
| Rate for Payer: Cash Price |
$110.54
|
| Rate for Payer: Cofinity Commercial |
$118.83
|
| Rate for Payer: Cofinity Commercial |
$96.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.54
|
| Rate for Payer: Healthscope Commercial |
$124.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.45
|
| Rate for Payer: PHP Commercial |
$117.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.73
|
| Rate for Payer: Priority Health SBD |
$87.05
|
| Rate for Payer: UMR Bronson Commercial |
$60.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.64
|
|
