|
LOPINAVIR-RITONAVIR 400 MG-100 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$1,847.04
|
|
|
Service Code
|
NDC 00074395646
|
| Hospital Charge Code |
28929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$683.40 |
| 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 Medicare |
$923.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,200.58
|
| Rate for Payer: BCBS Complete |
$738.82
|
| 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: MI Amish Medical Board Commercial |
$1,477.63
|
| 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: UHC All Payor (Choice/PPO) |
$1,200.58
|
| Rate for Payer: UHC Core |
$962.31
|
| Rate for Payer: UHC Exchange |
$725.89
|
| Rate for Payer: UMR Bronson Commercial |
$683.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,385.28
|
|
|
LOPINAVIR-RITONAVIR 400 MG-100 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$1,250.31
|
|
|
Service Code
|
NDC 00527194748
|
| Hospital Charge Code |
28929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$462.61 |
| Max. Negotiated Rate |
$1,125.28 |
| Rate for Payer: Aetna American Axle |
$812.70
|
| Rate for Payer: Aetna Commercial |
$1,062.76
|
| Rate for Payer: Aetna Medicare |
$625.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$812.70
|
| Rate for Payer: BCBS Complete |
$500.12
|
| Rate for Payer: Cash Price |
$1,000.25
|
| Rate for Payer: Cofinity Advantage |
$875.22
|
| Rate for Payer: Cofinity Commercial |
$1,075.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,000.25
|
| Rate for Payer: Healthscope Commercial |
$1,125.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$875.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$937.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,000.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,062.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$937.73
|
| Rate for Payer: PHP Commercial |
$1,062.76
|
| Rate for Payer: Priority Health SBD |
$787.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$812.70
|
| Rate for Payer: UHC Core |
$651.41
|
| Rate for Payer: UHC Exchange |
$491.37
|
| Rate for Payer: UMR Bronson Commercial |
$462.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$937.73
|
|
|
LOPINAVIR-RITONAVIR 400 MG-100 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$1,250.31
|
|
|
Service Code
|
NDC 00527194748
|
| Hospital Charge Code |
28929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$550.14 |
| Max. Negotiated Rate |
$1,125.28 |
| Rate for Payer: Aetna American Axle |
$812.70
|
| Rate for Payer: Aetna Commercial |
$1,062.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$812.70
|
| Rate for Payer: Cash Price |
$1,000.25
|
| Rate for Payer: Cofinity Advantage |
$875.22
|
| Rate for Payer: Cofinity Commercial |
$1,075.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,000.25
|
| Rate for Payer: Healthscope Commercial |
$1,125.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$875.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$937.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,062.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$937.73
|
| Rate for Payer: PHP Commercial |
$1,062.76
|
| Rate for Payer: Priority Health SBD |
$787.70
|
| Rate for Payer: UMR Bronson Commercial |
$550.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$937.73
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$2.33
|
|
|
Service Code
|
NDC 51079024601
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna American Axle |
$1.51
|
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.51
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Advantage |
$1.63
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Healthscope Commercial |
$2.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.75
|
| Rate for Payer: PHP Commercial |
$1.98
|
| Rate for Payer: Priority Health SBD |
$1.47
|
| Rate for Payer: UMR Bronson Commercial |
$1.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.75
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$232.75
|
|
|
Service Code
|
NDC 68084024801
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.12 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Aetna American Axle |
$151.29
|
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: Aetna Medicare |
$116.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.29
|
| Rate for Payer: BCBS Complete |
$93.10
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Advantage |
$162.93
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$209.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: Priority Health SBD |
$146.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.29
|
| Rate for Payer: UHC Core |
$121.26
|
| Rate for Payer: UHC Exchange |
$91.47
|
| Rate for Payer: UMR Bronson Commercial |
$86.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$159.13
|
|
|
Service Code
|
NDC 50268048915
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.88 |
| Max. Negotiated Rate |
$143.22 |
| Rate for Payer: Aetna American Axle |
$103.43
|
| Rate for Payer: Aetna Commercial |
$135.26
|
| Rate for Payer: Aetna Medicare |
$79.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.43
|
| Rate for Payer: BCBS Complete |
$63.65
|
| Rate for Payer: Cash Price |
$127.30
|
| Rate for Payer: Cofinity Advantage |
$111.39
|
| Rate for Payer: Cofinity Commercial |
$136.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.30
|
| Rate for Payer: Healthscope Commercial |
$143.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.35
|
| Rate for Payer: PHP Commercial |
$135.26
|
| Rate for Payer: Priority Health SBD |
$100.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.43
|
| Rate for Payer: UHC Core |
$82.91
|
| Rate for Payer: UHC Exchange |
$62.54
|
| Rate for Payer: UMR Bronson Commercial |
$58.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.35
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$211.85
|
|
|
Service Code
|
NDC 00904685261
|
| 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 Medicare |
$105.92
|
| 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 Advantage |
$148.29
|
| 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 |
$148.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.89
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: Priority Health SBD |
$133.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.70
|
| Rate for Payer: UHC Core |
$110.37
|
| Rate for Payer: UHC Exchange |
$83.26
|
| Rate for Payer: UMR Bronson Commercial |
$78.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.89
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$232.75
|
|
|
Service Code
|
NDC 51079024620
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.41 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Aetna American Axle |
$151.29
|
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.29
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Advantage |
$162.93
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$209.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: Priority Health SBD |
$146.63
|
| Rate for Payer: UMR Bronson Commercial |
$102.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$211.85
|
|
|
Service Code
|
NDC 00904685261
|
| 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 Advantage |
$148.29
|
| 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 |
$148.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.89
|
| Rate for Payer: PHP Commercial |
$180.07
|
| 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
|
IP
|
$232.75
|
|
|
Service Code
|
NDC 68084024801
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.41 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Aetna American Axle |
$151.29
|
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.29
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Advantage |
$162.93
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$209.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: Priority Health SBD |
$146.63
|
| Rate for Payer: UMR Bronson Commercial |
$102.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$211.85
|
|
|
Service Code
|
NDC 904685261
|
| 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 Medicare |
$105.92
|
| 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 Advantage |
$148.29
|
| 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 |
$148.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.89
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: Priority Health SBD |
$133.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.70
|
| Rate for Payer: UHC Core |
$110.37
|
| Rate for Payer: UHC Exchange |
$83.26
|
| 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
|
$232.75
|
|
|
Service Code
|
NDC 68084024811
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.12 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Aetna American Axle |
$151.29
|
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: Aetna Medicare |
$116.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.29
|
| Rate for Payer: BCBS Complete |
$93.10
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Advantage |
$162.93
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$209.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: Priority Health SBD |
$146.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.29
|
| Rate for Payer: UHC Core |
$121.26
|
| Rate for Payer: UHC Exchange |
$91.47
|
| Rate for Payer: UMR Bronson Commercial |
$86.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$2.33
|
|
|
Service Code
|
NDC 51079024601
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna American Axle |
$1.51
|
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Aetna Medicare |
$1.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.51
|
| Rate for Payer: BCBS Complete |
$0.93
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Advantage |
$1.63
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Healthscope Commercial |
$2.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.75
|
| Rate for Payer: PHP Commercial |
$1.98
|
| Rate for Payer: Priority Health SBD |
$1.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.51
|
| Rate for Payer: UHC Core |
$1.21
|
| Rate for Payer: UHC Exchange |
$0.92
|
| Rate for Payer: UMR Bronson Commercial |
$0.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.75
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$211.85
|
|
|
Service Code
|
NDC 00904751161
|
| 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 Advantage |
$148.29
|
| 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 |
$148.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.89
|
| Rate for Payer: PHP Commercial |
$180.07
|
| 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
|
IP
|
$232.75
|
|
|
Service Code
|
NDC 68084024811
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.41 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Aetna American Axle |
$151.29
|
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.29
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Advantage |
$162.93
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$209.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: Priority Health SBD |
$146.63
|
| Rate for Payer: UMR Bronson Commercial |
$102.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$232.75
|
|
|
Service Code
|
NDC 51079024620
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.12 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Aetna American Axle |
$151.29
|
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: Aetna Medicare |
$116.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.29
|
| Rate for Payer: BCBS Complete |
$93.10
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Advantage |
$162.93
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$209.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: Priority Health SBD |
$146.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.29
|
| Rate for Payer: UHC Core |
$121.26
|
| Rate for Payer: UHC Exchange |
$91.47
|
| Rate for Payer: UMR Bronson Commercial |
$86.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$3.19
|
|
|
Service Code
|
NDC 50268048911
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna American Axle |
$2.07
|
| Rate for Payer: Aetna Commercial |
$2.71
|
| Rate for Payer: Aetna Medicare |
$1.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.07
|
| Rate for Payer: BCBS Complete |
$1.28
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cofinity Advantage |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.55
|
| Rate for Payer: Healthscope Commercial |
$2.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.39
|
| Rate for Payer: PHP Commercial |
$2.71
|
| Rate for Payer: Priority Health SBD |
$2.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.07
|
| Rate for Payer: UHC Core |
$1.66
|
| Rate for Payer: UHC Exchange |
$1.25
|
| Rate for Payer: UMR Bronson Commercial |
$1.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.39
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$211.85
|
|
|
Service Code
|
NDC 00904751161
|
| 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 Medicare |
$105.92
|
| 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 Advantage |
$148.29
|
| 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 |
$148.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.89
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: Priority Health SBD |
$133.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.70
|
| Rate for Payer: UHC Core |
$110.37
|
| Rate for Payer: UHC Exchange |
$83.26
|
| 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
|
$126.90
|
|
|
Service Code
|
NDC 45802065078
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$114.21 |
| Rate for Payer: Aetna American Axle |
$82.48
|
| Rate for Payer: Aetna Commercial |
$107.86
|
| Rate for Payer: Aetna Medicare |
$63.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.48
|
| Rate for Payer: BCBS Complete |
$50.76
|
| Rate for Payer: Cash Price |
$101.52
|
| Rate for Payer: Cofinity Advantage |
$88.83
|
| Rate for Payer: Cofinity Commercial |
$109.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.52
|
| Rate for Payer: Healthscope Commercial |
$114.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.17
|
| Rate for Payer: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health SBD |
$79.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.48
|
| Rate for Payer: UHC Core |
$66.11
|
| Rate for Payer: UHC Exchange |
$49.87
|
| Rate for Payer: UMR Bronson Commercial |
$46.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.17
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$211.85
|
|
|
Service Code
|
NDC 904751161
|
| 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 Medicare |
$105.92
|
| 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 Advantage |
$148.29
|
| 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 |
$148.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.89
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: Priority Health SBD |
$133.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.70
|
| Rate for Payer: UHC Core |
$110.37
|
| Rate for Payer: UHC Exchange |
$83.26
|
| Rate for Payer: UMR Bronson Commercial |
$78.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.89
|
|
|
LORATADINE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$78.96
|
|
|
Service Code
|
NDC 51672209208
|
| Hospital Charge Code |
76472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.22 |
| Max. Negotiated Rate |
$71.06 |
| Rate for Payer: Aetna American Axle |
$51.32
|
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna Medicare |
$39.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.32
|
| Rate for Payer: BCBS Complete |
$31.58
|
| Rate for Payer: Cash Price |
$63.17
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$63.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.22
|
| Rate for Payer: PHP Commercial |
$67.12
|
| Rate for Payer: Priority Health SBD |
$49.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.32
|
| Rate for Payer: UHC Core |
$41.14
|
| Rate for Payer: UHC Exchange |
$31.03
|
| Rate for Payer: UMR Bronson Commercial |
$29.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.22
|
|
|
LORATADINE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$87.42
|
|
|
Service Code
|
NDC 51672213108
|
| Hospital Charge Code |
76472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.35 |
| Max. Negotiated Rate |
$78.68 |
| Rate for Payer: Aetna American Axle |
$56.82
|
| Rate for Payer: Aetna Commercial |
$74.31
|
| Rate for Payer: Aetna Medicare |
$43.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.82
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: Cash Price |
$69.94
|
| Rate for Payer: Cofinity Advantage |
$61.19
|
| Rate for Payer: Cofinity Commercial |
$75.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.94
|
| Rate for Payer: Healthscope Commercial |
$78.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.56
|
| Rate for Payer: PHP Commercial |
$74.31
|
| Rate for Payer: Priority Health SBD |
$55.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.82
|
| Rate for Payer: UHC Core |
$45.55
|
| Rate for Payer: UHC Exchange |
$34.36
|
| Rate for Payer: UMR Bronson Commercial |
$32.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.56
|
|
|
LORATADINE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$87.42
|
|
|
Service Code
|
NDC 51672213108
|
| Hospital Charge Code |
76472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.46 |
| Max. Negotiated Rate |
$78.68 |
| Rate for Payer: Aetna American Axle |
$56.82
|
| Rate for Payer: Aetna Commercial |
$74.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.82
|
| Rate for Payer: Cash Price |
$69.94
|
| Rate for Payer: Cofinity Advantage |
$61.19
|
| Rate for Payer: Cofinity Commercial |
$75.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.94
|
| Rate for Payer: Healthscope Commercial |
$78.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.56
|
| Rate for Payer: PHP Commercial |
$74.31
|
| Rate for Payer: Priority Health SBD |
$55.07
|
| Rate for Payer: UMR Bronson Commercial |
$38.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.56
|
|
|
LORATADINE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$118.44
|
|
|
Service Code
|
NDC 54838055840
|
| 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 Advantage |
$82.91
|
| Rate for Payer: Cofinity Commercial |
$101.86
|
| 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 Commercial |
$100.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.83
|
| Rate for Payer: PHP Commercial |
$100.67
|
| 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
|
$101.52
|
|
|
Service Code
|
NDC 51672207308
|
| Hospital Charge Code |
76472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.67 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna American Axle |
$65.99
|
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Advantage |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.14
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health SBD |
$63.96
|
| Rate for Payer: UMR Bronson Commercial |
$44.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.14
|
|
