|
LORATADINE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$101.52
|
|
|
Service Code
|
NDC 51672207308
|
| Hospital Charge Code |
76472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.56 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna American Axle |
$65.99
|
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna Medicare |
$50.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: BCBS Complete |
$40.61
|
| 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: MI Amish Medical Board Commercial |
$81.22
|
| 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: UHC All Payor (Choice/PPO) |
$65.99
|
| Rate for Payer: UHC Core |
$52.89
|
| Rate for Payer: UHC Exchange |
$39.90
|
| Rate for Payer: UMR Bronson Commercial |
$37.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.14
|
|
|
LORATADINE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$118.44
|
|
|
Service Code
|
NDC 54838055840
|
| Hospital Charge Code |
76472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.82 |
| Max. Negotiated Rate |
$106.60 |
| Rate for Payer: Aetna American Axle |
$76.99
|
| Rate for Payer: Aetna Commercial |
$100.67
|
| Rate for Payer: Aetna Medicare |
$59.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.99
|
| Rate for Payer: BCBS Complete |
$47.38
|
| 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: MI Amish Medical Board Commercial |
$94.75
|
| 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: UHC All Payor (Choice/PPO) |
$76.99
|
| Rate for Payer: UHC Core |
$61.71
|
| Rate for Payer: UHC Exchange |
$46.55
|
| Rate for Payer: UMR Bronson Commercial |
$43.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.83
|
|
|
LORATADINE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$107.16
|
|
|
Service Code
|
NDC 00904676720
|
| Hospital Charge Code |
76472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.15 |
| Max. Negotiated Rate |
$96.44 |
| Rate for Payer: Aetna American Axle |
$69.65
|
| Rate for Payer: Aetna Commercial |
$91.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.65
|
| Rate for Payer: Cash Price |
$85.73
|
| Rate for Payer: Cofinity Advantage |
$75.01
|
| Rate for Payer: Cofinity Commercial |
$92.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.73
|
| Rate for Payer: Healthscope Commercial |
$96.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.37
|
| Rate for Payer: PHP Commercial |
$91.09
|
| Rate for Payer: Priority Health SBD |
$67.51
|
| Rate for Payer: UMR Bronson Commercial |
$47.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.37
|
|
|
LORATADINE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$107.16
|
|
|
Service Code
|
NDC 00904676720
|
| Hospital Charge Code |
76472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.65 |
| Max. Negotiated Rate |
$96.44 |
| Rate for Payer: Aetna American Axle |
$69.65
|
| Rate for Payer: Aetna Commercial |
$91.09
|
| Rate for Payer: Aetna Medicare |
$53.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.65
|
| Rate for Payer: BCBS Complete |
$42.86
|
| Rate for Payer: Cash Price |
$85.73
|
| Rate for Payer: Cofinity Advantage |
$75.01
|
| Rate for Payer: Cofinity Commercial |
$92.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.73
|
| Rate for Payer: Healthscope Commercial |
$96.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.37
|
| Rate for Payer: PHP Commercial |
$91.09
|
| Rate for Payer: Priority Health SBD |
$67.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.65
|
| Rate for Payer: UHC Core |
$55.83
|
| Rate for Payer: UHC Exchange |
$42.11
|
| Rate for Payer: UMR Bronson Commercial |
$39.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.37
|
|
|
LORATADINE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$78.96
|
|
|
Service Code
|
NDC 51672209208
|
| 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 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: 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: UMR Bronson Commercial |
$34.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.22
|
|
|
LORATADINE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$122.02
|
|
|
Service Code
|
NDC 96295012925
|
| Hospital Charge Code |
76472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.15 |
| Max. Negotiated Rate |
$109.82 |
| Rate for Payer: Aetna American Axle |
$79.31
|
| Rate for Payer: Aetna Commercial |
$103.72
|
| Rate for Payer: Aetna Medicare |
$61.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.31
|
| Rate for Payer: BCBS Complete |
$48.81
|
| Rate for Payer: Cash Price |
$97.62
|
| Rate for Payer: Cofinity Advantage |
$85.41
|
| Rate for Payer: Cofinity Commercial |
$104.94
|
| 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: MI Amish Medical Board Commercial |
$97.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.52
|
| Rate for Payer: PHP Commercial |
$103.72
|
| Rate for Payer: Priority Health SBD |
$76.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.31
|
| Rate for Payer: UHC Core |
$63.57
|
| Rate for Payer: UHC Exchange |
$47.95
|
| Rate for Payer: UMR Bronson Commercial |
$45.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.52
|
|
|
LORATADINE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$122.02
|
|
|
Service Code
|
NDC 96295012925
|
| 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 Advantage |
$85.41
|
| Rate for Payer: Cofinity Commercial |
$104.94
|
| 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 Commercial |
$103.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.52
|
| Rate for Payer: PHP Commercial |
$103.72
|
| 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
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$0.74
|
|
|
Service Code
|
NDC 9900002063
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Aetna American Axle |
$0.48
|
| Rate for Payer: Aetna Commercial |
$0.63
|
| Rate for Payer: Aetna Medicare |
$0.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.48
|
| Rate for Payer: BCBS Complete |
$0.30
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cofinity Advantage |
$0.52
|
| Rate for Payer: Cofinity Commercial |
$0.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.59
|
| Rate for Payer: Healthscope Commercial |
$0.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.56
|
| Rate for Payer: PHP Commercial |
$0.63
|
| Rate for Payer: Priority Health SBD |
$0.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.48
|
| Rate for Payer: UHC Core |
$0.39
|
| Rate for Payer: UHC Exchange |
$0.29
|
| Rate for Payer: UMR Bronson Commercial |
$0.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.56
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$96.25
|
|
|
Service Code
|
NDC 00904600760
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.35 |
| Max. Negotiated Rate |
$86.62 |
| Rate for Payer: Aetna American Axle |
$62.56
|
| Rate for Payer: Aetna Commercial |
$81.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.56
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cofinity Advantage |
$67.38
|
| Rate for Payer: Cofinity Commercial |
$82.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.00
|
| Rate for Payer: Healthscope Commercial |
$86.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.19
|
| Rate for Payer: PHP Commercial |
$81.81
|
| Rate for Payer: Priority Health SBD |
$60.64
|
| Rate for Payer: UMR Bronson Commercial |
$42.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.19
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$122.50
|
|
|
Service Code
|
NDC 63304077201
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.33 |
| Max. Negotiated Rate |
$110.25 |
| Rate for Payer: Aetna American Axle |
$79.62
|
| Rate for Payer: Aetna Commercial |
$104.12
|
| Rate for Payer: Aetna Medicare |
$61.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.62
|
| Rate for Payer: BCBS Complete |
$49.00
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cofinity Advantage |
$85.75
|
| Rate for Payer: Cofinity Commercial |
$105.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.00
|
| Rate for Payer: Healthscope Commercial |
$110.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.88
|
| Rate for Payer: PHP Commercial |
$104.12
|
| Rate for Payer: Priority Health SBD |
$77.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.62
|
| Rate for Payer: UHC Core |
$63.82
|
| Rate for Payer: UHC Exchange |
$48.14
|
| Rate for Payer: UMR Bronson Commercial |
$45.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.88
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$129.50
|
|
|
Service Code
|
NDC 904600761
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.91 |
| Max. Negotiated Rate |
$116.55 |
| Rate for Payer: Aetna American Axle |
$84.17
|
| Rate for Payer: Aetna Commercial |
$110.08
|
| Rate for Payer: Aetna Medicare |
$64.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.17
|
| Rate for Payer: BCBS Complete |
$51.80
|
| Rate for Payer: Cash Price |
$103.60
|
| Rate for Payer: Cofinity Advantage |
$90.65
|
| Rate for Payer: Cofinity Commercial |
$111.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.60
|
| Rate for Payer: Healthscope Commercial |
$116.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.12
|
| Rate for Payer: PHP Commercial |
$110.08
|
| Rate for Payer: Priority Health SBD |
$81.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.17
|
| Rate for Payer: UHC Core |
$67.47
|
| Rate for Payer: UHC Exchange |
$50.89
|
| Rate for Payer: UMR Bronson Commercial |
$47.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.12
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$129.50
|
|
|
Service Code
|
NDC 00904600761
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.91 |
| Max. Negotiated Rate |
$116.55 |
| Rate for Payer: Aetna American Axle |
$84.17
|
| Rate for Payer: Aetna Commercial |
$110.08
|
| Rate for Payer: Aetna Medicare |
$64.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.17
|
| Rate for Payer: BCBS Complete |
$51.80
|
| Rate for Payer: Cash Price |
$103.60
|
| Rate for Payer: Cofinity Advantage |
$90.65
|
| Rate for Payer: Cofinity Commercial |
$111.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.60
|
| Rate for Payer: Healthscope Commercial |
$116.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.12
|
| Rate for Payer: PHP Commercial |
$110.08
|
| Rate for Payer: Priority Health SBD |
$81.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.17
|
| Rate for Payer: UHC Core |
$67.47
|
| Rate for Payer: UHC Exchange |
$50.89
|
| Rate for Payer: UMR Bronson Commercial |
$47.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.12
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
NDC 69315090405
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.55 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna American Axle |
$204.75
|
| Rate for Payer: Aetna Commercial |
$267.75
|
| Rate for Payer: Aetna Medicare |
$157.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.75
|
| Rate for Payer: BCBS Complete |
$126.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cofinity Advantage |
$220.50
|
| Rate for Payer: Cofinity Commercial |
$270.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.00
|
| Rate for Payer: Healthscope Commercial |
$283.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
| Rate for Payer: PHP Commercial |
$267.75
|
| Rate for Payer: Priority Health SBD |
$198.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.75
|
| Rate for Payer: UHC Core |
$164.12
|
| Rate for Payer: UHC Exchange |
$123.80
|
| Rate for Payer: UMR Bronson Commercial |
$116.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.25
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$122.50
|
|
|
Service Code
|
NDC 63304077201
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$110.25 |
| Rate for Payer: Aetna American Axle |
$79.62
|
| Rate for Payer: Aetna Commercial |
$104.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.62
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cofinity Advantage |
$85.75
|
| Rate for Payer: Cofinity Commercial |
$105.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.00
|
| Rate for Payer: Healthscope Commercial |
$110.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.88
|
| Rate for Payer: PHP Commercial |
$104.12
|
| Rate for Payer: Priority Health SBD |
$77.17
|
| Rate for Payer: UMR Bronson Commercial |
$53.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.88
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$87.50
|
|
|
Service Code
|
NDC 69315090401
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Aetna American Axle |
$56.88
|
| Rate for Payer: Aetna Commercial |
$74.38
|
| Rate for Payer: Aetna Medicare |
$43.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.88
|
| Rate for Payer: BCBS Complete |
$35.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cofinity Advantage |
$61.25
|
| Rate for Payer: Cofinity Commercial |
$75.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.00
|
| Rate for Payer: Healthscope Commercial |
$78.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.62
|
| Rate for Payer: PHP Commercial |
$74.38
|
| Rate for Payer: Priority Health SBD |
$55.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.88
|
| Rate for Payer: UHC Core |
$45.59
|
| Rate for Payer: UHC Exchange |
$34.39
|
| Rate for Payer: UMR Bronson Commercial |
$32.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.62
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$73.50
|
|
|
Service Code
|
NDC 93342501
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$66.15 |
| Rate for Payer: Aetna American Axle |
$47.77
|
| Rate for Payer: Aetna Commercial |
$62.48
|
| Rate for Payer: Aetna Medicare |
$36.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.77
|
| Rate for Payer: BCBS Complete |
$29.40
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cofinity Advantage |
$51.45
|
| Rate for Payer: Cofinity Commercial |
$63.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.80
|
| Rate for Payer: Healthscope Commercial |
$66.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.12
|
| Rate for Payer: PHP Commercial |
$62.48
|
| Rate for Payer: Priority Health SBD |
$46.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.77
|
| Rate for Payer: UHC Core |
$38.29
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UMR Bronson Commercial |
$27.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.12
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$129.50
|
|
|
Service Code
|
NDC 00904600761
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.98 |
| Max. Negotiated Rate |
$116.55 |
| Rate for Payer: Aetna American Axle |
$84.17
|
| Rate for Payer: Aetna Commercial |
$110.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.17
|
| Rate for Payer: Cash Price |
$103.60
|
| Rate for Payer: Cofinity Advantage |
$90.65
|
| Rate for Payer: Cofinity Commercial |
$111.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.60
|
| Rate for Payer: Healthscope Commercial |
$116.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.12
|
| Rate for Payer: PHP Commercial |
$110.08
|
| Rate for Payer: Priority Health SBD |
$81.58
|
| Rate for Payer: UMR Bronson Commercial |
$56.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.12
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
NDC 69315090405
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna American Axle |
$204.75
|
| Rate for Payer: Aetna Commercial |
$267.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.75
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cofinity Advantage |
$220.50
|
| Rate for Payer: Cofinity Commercial |
$270.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.00
|
| Rate for Payer: Healthscope Commercial |
$283.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
| Rate for Payer: PHP Commercial |
$267.75
|
| Rate for Payer: Priority Health SBD |
$198.45
|
| Rate for Payer: UMR Bronson Commercial |
$138.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.25
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$87.50
|
|
|
Service Code
|
NDC 69315090401
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Aetna American Axle |
$56.88
|
| Rate for Payer: Aetna Commercial |
$74.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.88
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cofinity Advantage |
$61.25
|
| Rate for Payer: Cofinity Commercial |
$75.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.00
|
| Rate for Payer: Healthscope Commercial |
$78.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.62
|
| Rate for Payer: PHP Commercial |
$74.38
|
| Rate for Payer: Priority Health SBD |
$55.12
|
| Rate for Payer: UMR Bronson Commercial |
$38.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.62
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$96.25
|
|
|
Service Code
|
NDC 00904600760
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.61 |
| Max. Negotiated Rate |
$86.62 |
| Rate for Payer: Aetna American Axle |
$62.56
|
| Rate for Payer: Aetna Commercial |
$81.81
|
| Rate for Payer: Aetna Medicare |
$48.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.56
|
| Rate for Payer: BCBS Complete |
$38.50
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cofinity Advantage |
$67.38
|
| Rate for Payer: Cofinity Commercial |
$82.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.00
|
| Rate for Payer: Healthscope Commercial |
$86.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.19
|
| Rate for Payer: PHP Commercial |
$81.81
|
| Rate for Payer: Priority Health SBD |
$60.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.56
|
| Rate for Payer: UHC Core |
$50.15
|
| Rate for Payer: UHC Exchange |
$37.83
|
| Rate for Payer: UMR Bronson Commercial |
$35.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.19
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$531.30
|
|
|
Service Code
|
NDC 60687083101
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.58 |
| Max. Negotiated Rate |
$478.17 |
| Rate for Payer: Aetna American Axle |
$345.35
|
| Rate for Payer: Aetna Commercial |
$451.61
|
| Rate for Payer: Aetna Medicare |
$265.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.35
|
| Rate for Payer: BCBS Complete |
$212.52
|
| Rate for Payer: Cash Price |
$425.04
|
| Rate for Payer: Cofinity Advantage |
$371.91
|
| Rate for Payer: Cofinity Commercial |
$456.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.04
|
| Rate for Payer: Healthscope Commercial |
$478.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$371.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$425.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$398.48
|
| Rate for Payer: PHP Commercial |
$451.61
|
| Rate for Payer: Priority Health SBD |
$334.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.35
|
| Rate for Payer: UHC Core |
$276.81
|
| Rate for Payer: UHC Exchange |
$208.80
|
| Rate for Payer: UMR Bronson Commercial |
$196.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.48
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$82.25
|
|
|
Service Code
|
NDC 00093342601
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$74.03 |
| Rate for Payer: Aetna American Axle |
$53.46
|
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna Medicare |
$41.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.46
|
| Rate for Payer: BCBS Complete |
$32.90
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Advantage |
$57.58
|
| Rate for Payer: Cofinity Commercial |
$70.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$74.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.69
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health SBD |
$51.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.46
|
| Rate for Payer: UHC Core |
$42.85
|
| Rate for Payer: UHC Exchange |
$32.32
|
| Rate for Payer: UMR Bronson Commercial |
$30.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.69
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$80.50
|
|
|
Service Code
|
NDC 13107008401
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.42 |
| Max. Negotiated Rate |
$72.45 |
| Rate for Payer: Aetna American Axle |
$52.33
|
| Rate for Payer: Aetna Commercial |
$68.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.33
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: Cofinity Advantage |
$56.35
|
| Rate for Payer: Cofinity Commercial |
$69.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.40
|
| Rate for Payer: Healthscope Commercial |
$72.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.38
|
| Rate for Payer: PHP Commercial |
$68.42
|
| Rate for Payer: Priority Health SBD |
$50.72
|
| Rate for Payer: UMR Bronson Commercial |
$35.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.38
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$411.25
|
|
|
Service Code
|
NDC 69315090505
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.16 |
| Max. Negotiated Rate |
$370.12 |
| Rate for Payer: Aetna American Axle |
$267.31
|
| Rate for Payer: Aetna Commercial |
$349.56
|
| Rate for Payer: Aetna Medicare |
$205.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.31
|
| Rate for Payer: BCBS Complete |
$164.50
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cofinity Advantage |
$287.88
|
| Rate for Payer: Cofinity Commercial |
$353.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.00
|
| Rate for Payer: Healthscope Commercial |
$370.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$329.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$308.44
|
| Rate for Payer: PHP Commercial |
$349.56
|
| Rate for Payer: Priority Health SBD |
$259.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.31
|
| Rate for Payer: UHC Core |
$214.26
|
| Rate for Payer: UHC Exchange |
$161.62
|
| Rate for Payer: UMR Bronson Commercial |
$152.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.44
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$134.75
|
|
|
Service Code
|
NDC 63304077301
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.86 |
| Max. Negotiated Rate |
$121.28 |
| Rate for Payer: Aetna American Axle |
$87.59
|
| Rate for Payer: Aetna Commercial |
$114.54
|
| Rate for Payer: Aetna Medicare |
$67.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.59
|
| Rate for Payer: BCBS Complete |
$53.90
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cofinity Advantage |
$94.33
|
| Rate for Payer: Cofinity Commercial |
$115.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.80
|
| Rate for Payer: Healthscope Commercial |
$121.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.06
|
| Rate for Payer: PHP Commercial |
$114.54
|
| Rate for Payer: Priority Health SBD |
$84.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.59
|
| Rate for Payer: UHC Core |
$70.20
|
| Rate for Payer: UHC Exchange |
$52.96
|
| Rate for Payer: UMR Bronson Commercial |
$49.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.06
|
|
