|
LONG CHAIN TRIGLYCERIDES 7.5 GRAM-67.5 KCAL/15 ML ORAL EMULSION
|
Facility
|
IP
|
$17.09
|
|
|
Service Code
|
NDC 41679008702
|
| Hospital Charge Code |
173669
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$15.38 |
| Rate for Payer: Aetna American Axle |
$11.11
|
| Rate for Payer: Aetna Commercial |
$14.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.11
|
| Rate for Payer: Cash Price |
$13.67
|
| Rate for Payer: Cofinity Advantage |
$11.96
|
| Rate for Payer: Cofinity Commercial |
$14.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.67
|
| Rate for Payer: Healthscope Commercial |
$15.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.82
|
| Rate for Payer: PHP Commercial |
$14.53
|
| Rate for Payer: Priority Health SBD |
$10.77
|
| Rate for Payer: UMR Bronson Commercial |
$7.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.82
|
|
|
LONG CHAIN TRIGLYCERIDES 7.5 GRAM-67.5 KCAL/15 ML ORAL EMULSION
|
Facility
|
OP
|
$17.09
|
|
|
Service Code
|
NDC 41679008743
|
| Hospital Charge Code |
173669
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$15.38 |
| Rate for Payer: Aetna American Axle |
$11.11
|
| Rate for Payer: Aetna Commercial |
$14.53
|
| Rate for Payer: Aetna Medicare |
$8.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.11
|
| Rate for Payer: BCBS Complete |
$6.84
|
| Rate for Payer: Cash Price |
$13.67
|
| Rate for Payer: Cofinity Advantage |
$11.96
|
| Rate for Payer: Cofinity Commercial |
$14.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.67
|
| Rate for Payer: Healthscope Commercial |
$15.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.82
|
| Rate for Payer: PHP Commercial |
$14.53
|
| Rate for Payer: Priority Health SBD |
$10.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.11
|
| Rate for Payer: UHC Core |
$8.90
|
| Rate for Payer: UHC Exchange |
$6.72
|
| Rate for Payer: UMR Bronson Commercial |
$6.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.82
|
|
|
LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID
|
Facility
|
OP
|
$13.50
|
|
|
Service Code
|
NDC 70000041801
|
| Hospital Charge Code |
42219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Aetna American Axle |
$8.78
|
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: Aetna Medicare |
$6.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.78
|
| Rate for Payer: BCBS Complete |
$5.40
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Advantage |
$9.45
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$12.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.12
|
| Rate for Payer: PHP Commercial |
$11.47
|
| Rate for Payer: Priority Health SBD |
$8.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.78
|
| Rate for Payer: UHC Core |
$7.03
|
| Rate for Payer: UHC Exchange |
$5.31
|
| Rate for Payer: UMR Bronson Commercial |
$5.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
|
|
LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID
|
Facility
|
IP
|
$23.52
|
|
|
Service Code
|
NDC 00450013404
|
| Hospital Charge Code |
42219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$21.17 |
| Rate for Payer: Aetna American Axle |
$15.29
|
| Rate for Payer: Aetna Commercial |
$19.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.29
|
| Rate for Payer: Cash Price |
$18.82
|
| Rate for Payer: Cofinity Advantage |
$16.46
|
| Rate for Payer: Cofinity Commercial |
$20.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.82
|
| Rate for Payer: Healthscope Commercial |
$21.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.64
|
| Rate for Payer: PHP Commercial |
$19.99
|
| Rate for Payer: Priority Health SBD |
$14.82
|
| Rate for Payer: UMR Bronson Commercial |
$10.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.64
|
|
|
LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID
|
Facility
|
OP
|
$23.52
|
|
|
Service Code
|
NDC 00450013444
|
| Hospital Charge Code |
42219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$21.17 |
| Rate for Payer: Aetna American Axle |
$15.29
|
| Rate for Payer: Aetna Commercial |
$19.99
|
| Rate for Payer: Aetna Medicare |
$11.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.29
|
| Rate for Payer: BCBS Complete |
$9.41
|
| Rate for Payer: Cash Price |
$18.82
|
| Rate for Payer: Cofinity Advantage |
$16.46
|
| Rate for Payer: Cofinity Commercial |
$20.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.82
|
| Rate for Payer: Healthscope Commercial |
$21.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.64
|
| Rate for Payer: PHP Commercial |
$19.99
|
| Rate for Payer: Priority Health SBD |
$14.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.29
|
| Rate for Payer: UHC Core |
$12.25
|
| Rate for Payer: UHC Exchange |
$9.24
|
| Rate for Payer: UMR Bronson Commercial |
$8.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.64
|
|
|
LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID
|
Facility
|
IP
|
$23.52
|
|
|
Service Code
|
NDC 00450013444
|
| Hospital Charge Code |
42219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$21.17 |
| Rate for Payer: Aetna American Axle |
$15.29
|
| Rate for Payer: Aetna Commercial |
$19.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.29
|
| Rate for Payer: Cash Price |
$18.82
|
| Rate for Payer: Cofinity Advantage |
$16.46
|
| Rate for Payer: Cofinity Commercial |
$20.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.82
|
| Rate for Payer: Healthscope Commercial |
$21.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.64
|
| Rate for Payer: PHP Commercial |
$19.99
|
| Rate for Payer: Priority Health SBD |
$14.82
|
| Rate for Payer: UMR Bronson Commercial |
$10.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.64
|
|
|
LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID
|
Facility
|
OP
|
$16.74
|
|
|
Service Code
|
NDC 00904683620
|
| Hospital Charge Code |
42219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$15.07 |
| Rate for Payer: Aetna American Axle |
$10.88
|
| Rate for Payer: Aetna Commercial |
$14.23
|
| Rate for Payer: Aetna Medicare |
$8.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.88
|
| Rate for Payer: BCBS Complete |
$6.70
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cofinity Advantage |
$11.72
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.39
|
| Rate for Payer: Healthscope Commercial |
$15.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.55
|
| Rate for Payer: PHP Commercial |
$14.23
|
| Rate for Payer: Priority Health SBD |
$10.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.88
|
| Rate for Payer: UHC Core |
$8.72
|
| Rate for Payer: UHC Exchange |
$6.58
|
| Rate for Payer: UMR Bronson Commercial |
$6.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.55
|
|
|
LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID
|
Facility
|
OP
|
$13.50
|
|
|
Service Code
|
NDC 96295013558
|
| Hospital Charge Code |
42219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Aetna American Axle |
$8.78
|
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: Aetna Medicare |
$6.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.78
|
| Rate for Payer: BCBS Complete |
$5.40
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Advantage |
$9.45
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$12.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.12
|
| Rate for Payer: PHP Commercial |
$11.47
|
| Rate for Payer: Priority Health SBD |
$8.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.78
|
| Rate for Payer: UHC Core |
$7.03
|
| Rate for Payer: UHC Exchange |
$5.31
|
| Rate for Payer: UMR Bronson Commercial |
$5.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
|
|
LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID
|
Facility
|
OP
|
$23.52
|
|
|
Service Code
|
NDC 00450013404
|
| Hospital Charge Code |
42219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$21.17 |
| Rate for Payer: Aetna American Axle |
$15.29
|
| Rate for Payer: Aetna Commercial |
$19.99
|
| Rate for Payer: Aetna Medicare |
$11.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.29
|
| Rate for Payer: BCBS Complete |
$9.41
|
| Rate for Payer: Cash Price |
$18.82
|
| Rate for Payer: Cofinity Advantage |
$16.46
|
| Rate for Payer: Cofinity Commercial |
$20.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.82
|
| Rate for Payer: Healthscope Commercial |
$21.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.64
|
| Rate for Payer: PHP Commercial |
$19.99
|
| Rate for Payer: Priority Health SBD |
$14.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.29
|
| Rate for Payer: UHC Core |
$12.25
|
| Rate for Payer: UHC Exchange |
$9.24
|
| Rate for Payer: UMR Bronson Commercial |
$8.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.64
|
|
|
LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID
|
Facility
|
IP
|
$16.74
|
|
|
Service Code
|
NDC 00904683620
|
| Hospital Charge Code |
42219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$15.07 |
| Rate for Payer: Aetna American Axle |
$10.88
|
| Rate for Payer: Aetna Commercial |
$14.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.88
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cofinity Advantage |
$11.72
|
| Rate for Payer: Cofinity Commercial |
$14.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.39
|
| Rate for Payer: Healthscope Commercial |
$15.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.55
|
| Rate for Payer: PHP Commercial |
$14.23
|
| Rate for Payer: Priority Health SBD |
$10.55
|
| Rate for Payer: UMR Bronson Commercial |
$7.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.55
|
|
|
LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID
|
Facility
|
IP
|
$13.50
|
|
|
Service Code
|
NDC 70000041801
|
| Hospital Charge Code |
42219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Aetna American Axle |
$8.78
|
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.78
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Advantage |
$9.45
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$12.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.12
|
| Rate for Payer: PHP Commercial |
$11.47
|
| Rate for Payer: Priority Health SBD |
$8.51
|
| Rate for Payer: UMR Bronson Commercial |
$5.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
|
|
LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID
|
Facility
|
IP
|
$13.50
|
|
|
Service Code
|
NDC 96295013558
|
| Hospital Charge Code |
42219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Aetna American Axle |
$8.78
|
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.78
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Advantage |
$9.45
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$12.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.12
|
| Rate for Payer: PHP Commercial |
$11.47
|
| Rate for Payer: Priority Health SBD |
$8.51
|
| Rate for Payer: UMR Bronson Commercial |
$5.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$364.25
|
|
|
Service Code
|
NDC 69452027120
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.77 |
| Max. Negotiated Rate |
$327.82 |
| Rate for Payer: Aetna American Axle |
$236.76
|
| Rate for Payer: Aetna Commercial |
$309.61
|
| Rate for Payer: Aetna Medicare |
$182.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.76
|
| Rate for Payer: BCBS Complete |
$145.70
|
| Rate for Payer: Cash Price |
$291.40
|
| Rate for Payer: Cofinity Advantage |
$254.97
|
| Rate for Payer: Cofinity Commercial |
$313.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.40
|
| Rate for Payer: Healthscope Commercial |
$327.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$291.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.19
|
| Rate for Payer: PHP Commercial |
$309.61
|
| Rate for Payer: Priority Health SBD |
$229.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.76
|
| Rate for Payer: UHC Core |
$189.77
|
| Rate for Payer: UHC Exchange |
$143.15
|
| Rate for Payer: UMR Bronson Commercial |
$134.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.19
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$3.11
|
|
|
Service Code
|
NDC 51079069001
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna American Axle |
$2.02
|
| Rate for Payer: Aetna Commercial |
$2.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.02
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cofinity Advantage |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.49
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.33
|
| Rate for Payer: PHP Commercial |
$2.64
|
| Rate for Payer: Priority Health SBD |
$1.96
|
| Rate for Payer: UMR Bronson Commercial |
$1.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.33
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$3.22
|
|
|
Service Code
|
NDC 60687022911
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: Aetna American Axle |
$2.09
|
| Rate for Payer: Aetna Commercial |
$2.74
|
| Rate for Payer: Aetna Medicare |
$1.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.09
|
| Rate for Payer: BCBS Complete |
$1.29
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cofinity Advantage |
$2.25
|
| Rate for Payer: Cofinity Commercial |
$2.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.58
|
| Rate for Payer: Healthscope Commercial |
$2.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.42
|
| Rate for Payer: PHP Commercial |
$2.74
|
| Rate for Payer: Priority Health SBD |
$2.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.09
|
| Rate for Payer: UHC Core |
$1.68
|
| Rate for Payer: UHC Exchange |
$1.27
|
| Rate for Payer: UMR Bronson Commercial |
$1.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.42
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$321.12
|
|
|
Service Code
|
NDC 60687022901
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.29 |
| Max. Negotiated Rate |
$289.01 |
| Rate for Payer: Aetna American Axle |
$208.73
|
| Rate for Payer: Aetna Commercial |
$272.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.73
|
| Rate for Payer: Cash Price |
$256.90
|
| Rate for Payer: Cofinity Advantage |
$224.78
|
| Rate for Payer: Cofinity Commercial |
$276.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.90
|
| Rate for Payer: Healthscope Commercial |
$289.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.84
|
| Rate for Payer: PHP Commercial |
$272.95
|
| Rate for Payer: Priority Health SBD |
$202.31
|
| Rate for Payer: UMR Bronson Commercial |
$141.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.84
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$364.25
|
|
|
Service Code
|
NDC 69452027120
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.27 |
| Max. Negotiated Rate |
$327.82 |
| Rate for Payer: Aetna American Axle |
$236.76
|
| Rate for Payer: Aetna Commercial |
$309.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.76
|
| Rate for Payer: Cash Price |
$291.40
|
| Rate for Payer: Cofinity Advantage |
$254.97
|
| Rate for Payer: Cofinity Commercial |
$313.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.40
|
| Rate for Payer: Healthscope Commercial |
$327.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.19
|
| Rate for Payer: PHP Commercial |
$309.61
|
| Rate for Payer: Priority Health SBD |
$229.48
|
| Rate for Payer: UMR Bronson Commercial |
$160.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.19
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$3.11
|
|
|
Service Code
|
NDC 51079069001
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna American Axle |
$2.02
|
| Rate for Payer: Aetna Commercial |
$2.64
|
| Rate for Payer: Aetna Medicare |
$1.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.02
|
| Rate for Payer: BCBS Complete |
$1.24
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cofinity Advantage |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.49
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.33
|
| Rate for Payer: PHP Commercial |
$2.64
|
| Rate for Payer: Priority Health SBD |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.02
|
| Rate for Payer: UHC Core |
$1.62
|
| Rate for Payer: UHC Exchange |
$1.22
|
| Rate for Payer: UMR Bronson Commercial |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.33
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$310.08
|
|
|
Service Code
|
NDC 51079069020
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.44 |
| Max. Negotiated Rate |
$279.07 |
| Rate for Payer: Aetna American Axle |
$201.55
|
| Rate for Payer: Aetna Commercial |
$263.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.55
|
| Rate for Payer: Cash Price |
$248.06
|
| Rate for Payer: Cofinity Advantage |
$217.06
|
| Rate for Payer: Cofinity Commercial |
$266.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.06
|
| Rate for Payer: Healthscope Commercial |
$279.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.56
|
| Rate for Payer: PHP Commercial |
$263.57
|
| Rate for Payer: Priority Health SBD |
$195.35
|
| Rate for Payer: UMR Bronson Commercial |
$136.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.56
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$310.08
|
|
|
Service Code
|
NDC 51079069020
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.73 |
| Max. Negotiated Rate |
$279.07 |
| Rate for Payer: Aetna American Axle |
$201.55
|
| Rate for Payer: Aetna Commercial |
$263.57
|
| Rate for Payer: Aetna Medicare |
$155.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.55
|
| Rate for Payer: BCBS Complete |
$124.03
|
| Rate for Payer: Cash Price |
$248.06
|
| Rate for Payer: Cofinity Advantage |
$217.06
|
| Rate for Payer: Cofinity Commercial |
$266.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.06
|
| Rate for Payer: Healthscope Commercial |
$279.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.56
|
| Rate for Payer: PHP Commercial |
$263.57
|
| Rate for Payer: Priority Health SBD |
$195.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.55
|
| Rate for Payer: UHC Core |
$161.55
|
| Rate for Payer: UHC Exchange |
$121.86
|
| Rate for Payer: UMR Bronson Commercial |
$114.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.56
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$324.90
|
|
|
Service Code
|
NDC 00093031101
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.21 |
| Max. Negotiated Rate |
$292.41 |
| Rate for Payer: Aetna American Axle |
$211.19
|
| Rate for Payer: Aetna Commercial |
$276.17
|
| Rate for Payer: Aetna Medicare |
$162.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.19
|
| Rate for Payer: BCBS Complete |
$129.96
|
| Rate for Payer: Cash Price |
$259.92
|
| Rate for Payer: Cofinity Advantage |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$279.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.92
|
| Rate for Payer: Healthscope Commercial |
$292.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$259.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.68
|
| Rate for Payer: PHP Commercial |
$276.17
|
| Rate for Payer: Priority Health SBD |
$204.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.19
|
| Rate for Payer: UHC Core |
$169.27
|
| Rate for Payer: UHC Exchange |
$127.69
|
| Rate for Payer: UMR Bronson Commercial |
$120.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.68
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$3.22
|
|
|
Service Code
|
NDC 60687022911
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: Aetna American Axle |
$2.09
|
| Rate for Payer: Aetna Commercial |
$2.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.09
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cofinity Advantage |
$2.25
|
| Rate for Payer: Cofinity Commercial |
$2.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.58
|
| Rate for Payer: Healthscope Commercial |
$2.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.42
|
| Rate for Payer: PHP Commercial |
$2.74
|
| Rate for Payer: Priority Health SBD |
$2.03
|
| Rate for Payer: UMR Bronson Commercial |
$1.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.42
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$321.12
|
|
|
Service Code
|
NDC 60687022901
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.81 |
| Max. Negotiated Rate |
$289.01 |
| Rate for Payer: Aetna American Axle |
$208.73
|
| Rate for Payer: Aetna Commercial |
$272.95
|
| Rate for Payer: Aetna Medicare |
$160.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.73
|
| Rate for Payer: BCBS Complete |
$128.45
|
| Rate for Payer: Cash Price |
$256.90
|
| Rate for Payer: Cofinity Advantage |
$224.78
|
| Rate for Payer: Cofinity Commercial |
$276.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.90
|
| Rate for Payer: Healthscope Commercial |
$289.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$256.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.84
|
| Rate for Payer: PHP Commercial |
$272.95
|
| Rate for Payer: Priority Health SBD |
$202.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.73
|
| Rate for Payer: UHC Core |
$167.30
|
| Rate for Payer: UHC Exchange |
$126.20
|
| Rate for Payer: UMR Bronson Commercial |
$118.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.84
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$324.90
|
|
|
Service Code
|
NDC 00093031101
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.96 |
| Max. Negotiated Rate |
$292.41 |
| Rate for Payer: Aetna American Axle |
$211.19
|
| Rate for Payer: Aetna Commercial |
$276.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.19
|
| Rate for Payer: Cash Price |
$259.92
|
| Rate for Payer: Cofinity Advantage |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$279.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.92
|
| Rate for Payer: Healthscope Commercial |
$292.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.68
|
| Rate for Payer: PHP Commercial |
$276.17
|
| Rate for Payer: Priority Health SBD |
$204.69
|
| Rate for Payer: UMR Bronson Commercial |
$142.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.68
|
|
|
LOPINAVIR-RITONAVIR 400 MG-100 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$1,847.04
|
|
|
Service Code
|
NDC 00074395646
|
| 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 Advantage |
$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 Commercial |
$1,569.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,385.28
|
| Rate for Payer: PHP Commercial |
$1,569.98
|
| 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
|
|
