|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$231.84
|
|
|
Service Code
|
NDC 50383070530
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.78 |
| Max. Negotiated Rate |
$208.66 |
| Rate for Payer: Aetna American Axle |
$150.70
|
| Rate for Payer: Aetna Commercial |
$197.06
|
| Rate for Payer: Aetna Medicare |
$115.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.70
|
| Rate for Payer: BCBS Complete |
$92.74
|
| Rate for Payer: Cash Price |
$185.47
|
| Rate for Payer: Cofinity Advantage |
$162.29
|
| Rate for Payer: Cofinity Commercial |
$199.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.47
|
| Rate for Payer: Healthscope Commercial |
$208.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$185.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.88
|
| Rate for Payer: PHP Commercial |
$197.06
|
| Rate for Payer: Priority Health SBD |
$146.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.70
|
| Rate for Payer: UHC Core |
$120.79
|
| Rate for Payer: UHC Exchange |
$91.11
|
| Rate for Payer: UMR Bronson Commercial |
$85.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.88
|
|
|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$2.60
|
|
|
Service Code
|
NDC 09900000008
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna American Axle |
$1.69
|
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: Aetna Medicare |
$1.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.69
|
| Rate for Payer: BCBS Complete |
$1.04
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Advantage |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Healthscope Commercial |
$2.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.95
|
| Rate for Payer: PHP Commercial |
$2.21
|
| Rate for Payer: Priority Health SBD |
$1.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.69
|
| Rate for Payer: UHC Core |
$1.35
|
| Rate for Payer: UHC Exchange |
$1.02
|
| Rate for Payer: UMR Bronson Commercial |
$0.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.95
|
|
|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$311.85
|
|
|
Service Code
|
NDC 00054353244
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.38 |
| Max. Negotiated Rate |
$280.67 |
| Rate for Payer: Aetna American Axle |
$202.70
|
| Rate for Payer: Aetna Commercial |
$265.07
|
| Rate for Payer: Aetna Medicare |
$155.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.70
|
| Rate for Payer: BCBS Complete |
$124.74
|
| Rate for Payer: Cash Price |
$249.48
|
| Rate for Payer: Cofinity Advantage |
$218.29
|
| Rate for Payer: Cofinity Commercial |
$268.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.48
|
| Rate for Payer: Healthscope Commercial |
$280.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.89
|
| Rate for Payer: PHP Commercial |
$265.07
|
| Rate for Payer: Priority Health SBD |
$196.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.70
|
| Rate for Payer: UHC Core |
$162.47
|
| Rate for Payer: UHC Exchange |
$122.56
|
| Rate for Payer: UMR Bronson Commercial |
$115.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.89
|
|
|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$311.85
|
|
|
Service Code
|
NDC 00054353244
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.21 |
| Max. Negotiated Rate |
$280.67 |
| Rate for Payer: Aetna American Axle |
$202.70
|
| Rate for Payer: Aetna Commercial |
$265.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.70
|
| Rate for Payer: Cash Price |
$249.48
|
| Rate for Payer: Cofinity Advantage |
$218.29
|
| Rate for Payer: Cofinity Commercial |
$268.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.48
|
| Rate for Payer: Healthscope Commercial |
$280.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.89
|
| Rate for Payer: PHP Commercial |
$265.07
|
| Rate for Payer: Priority Health SBD |
$196.47
|
| Rate for Payer: UMR Bronson Commercial |
$137.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.89
|
|
|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$231.84
|
|
|
Service Code
|
NDC 50383070530
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.01 |
| Max. Negotiated Rate |
$208.66 |
| Rate for Payer: Aetna American Axle |
$150.70
|
| Rate for Payer: Aetna Commercial |
$197.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.70
|
| Rate for Payer: Cash Price |
$185.47
|
| Rate for Payer: Cofinity Advantage |
$162.29
|
| Rate for Payer: Cofinity Commercial |
$199.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.47
|
| Rate for Payer: Healthscope Commercial |
$208.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.88
|
| Rate for Payer: PHP Commercial |
$197.06
|
| Rate for Payer: Priority Health SBD |
$146.06
|
| Rate for Payer: UMR Bronson Commercial |
$102.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.88
|
|
|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$2.60
|
|
|
Service Code
|
NDC 09900000008
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna American Axle |
$1.69
|
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.69
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Advantage |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Healthscope Commercial |
$2.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.95
|
| Rate for Payer: PHP Commercial |
$2.21
|
| Rate for Payer: Priority Health SBD |
$1.64
|
| Rate for Payer: UMR Bronson Commercial |
$1.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.95
|
|
|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$15.93
|
|
|
Service Code
|
NDC 09900000697
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$14.34 |
| Rate for Payer: Aetna American Axle |
$10.35
|
| Rate for Payer: Aetna Commercial |
$13.54
|
| Rate for Payer: Aetna Medicare |
$7.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.35
|
| Rate for Payer: BCBS Complete |
$6.37
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Advantage |
$11.15
|
| Rate for Payer: Cofinity Commercial |
$13.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$14.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.95
|
| Rate for Payer: PHP Commercial |
$13.54
|
| Rate for Payer: Priority Health SBD |
$10.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.35
|
| Rate for Payer: UHC Core |
$8.30
|
| Rate for Payer: UHC Exchange |
$6.26
|
| Rate for Payer: UMR Bronson Commercial |
$5.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.95
|
|
|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$5.20
|
|
|
Service Code
|
NDC 09900000007
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna American Axle |
$3.38
|
| Rate for Payer: Aetna Commercial |
$4.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.38
|
| Rate for Payer: Cash Price |
$4.16
|
| Rate for Payer: Cofinity Advantage |
$3.64
|
| Rate for Payer: Cofinity Commercial |
$4.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.16
|
| Rate for Payer: Healthscope Commercial |
$4.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.90
|
| Rate for Payer: PHP Commercial |
$4.42
|
| Rate for Payer: Priority Health SBD |
$3.28
|
| Rate for Payer: UMR Bronson Commercial |
$2.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.90
|
|
|
LORAZEPAM (BULK) 100 % POWDER
|
Facility
|
OP
|
$122.61
|
|
|
Service Code
|
NDC 38779092703
|
| Hospital Charge Code |
26060
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$110.35 |
| Rate for Payer: Aetna American Axle |
$79.70
|
| Rate for Payer: Aetna Commercial |
$104.22
|
| Rate for Payer: Aetna Medicare |
$61.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.70
|
| Rate for Payer: BCBS Complete |
$49.04
|
| Rate for Payer: Cash Price |
$98.09
|
| Rate for Payer: Cofinity Advantage |
$85.83
|
| Rate for Payer: Cofinity Commercial |
$105.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.09
|
| Rate for Payer: Healthscope Commercial |
$110.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.96
|
| Rate for Payer: PHP Commercial |
$104.22
|
| Rate for Payer: Priority Health SBD |
$77.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.70
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: UHC Exchange |
$48.19
|
| Rate for Payer: UMR Bronson Commercial |
$45.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.96
|
|
|
LORAZEPAM (BULK) 100 % POWDER
|
Facility
|
IP
|
$122.61
|
|
|
Service Code
|
NDC 38779092703
|
| Hospital Charge Code |
26060
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.95 |
| Max. Negotiated Rate |
$110.35 |
| Rate for Payer: Aetna American Axle |
$79.70
|
| Rate for Payer: Aetna Commercial |
$104.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.70
|
| Rate for Payer: Cash Price |
$98.09
|
| Rate for Payer: Cofinity Advantage |
$85.83
|
| Rate for Payer: Cofinity Commercial |
$105.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.09
|
| Rate for Payer: Healthscope Commercial |
$110.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.96
|
| Rate for Payer: PHP Commercial |
$104.22
|
| Rate for Payer: Priority Health SBD |
$77.24
|
| Rate for Payer: UMR Bronson Commercial |
$53.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.96
|
|
|
LORAZEPAM IV 0.5 MG/ML INJECTION (NICU)
|
Facility
|
OP
|
$30.90
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
500547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$27.81 |
| Rate for Payer: Aetna American Axle |
$20.09
|
| Rate for Payer: Aetna Commercial |
$26.27
|
| Rate for Payer: Aetna Medicare |
$15.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.09
|
| Rate for Payer: BCBS Complete |
$12.36
|
| Rate for Payer: BCBS Trust/PPO |
$4.55
|
| Rate for Payer: BCN Commercial |
$4.55
|
| Rate for Payer: Cash Price |
$24.72
|
| Rate for Payer: Cash Price |
$24.72
|
| Rate for Payer: Cofinity Advantage |
$21.63
|
| Rate for Payer: Cofinity Commercial |
$26.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.72
|
| Rate for Payer: Healthscope Commercial |
$27.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.18
|
| Rate for Payer: PHP Commercial |
$26.27
|
| Rate for Payer: Priority Health SBD |
$19.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.33
|
| Rate for Payer: UHC Core |
$2.33
|
| Rate for Payer: UHC Exchange |
$2.33
|
| Rate for Payer: UMR Bronson Commercial |
$11.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.18
|
|
|
LORAZEPAM IV 0.5 MG/ML INJECTION (NICU)
|
Facility
|
IP
|
$30.90
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
500547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$27.81 |
| Rate for Payer: Aetna American Axle |
$20.09
|
| Rate for Payer: Aetna Commercial |
$26.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.09
|
| Rate for Payer: Cash Price |
$24.72
|
| Rate for Payer: Cofinity Advantage |
$21.63
|
| Rate for Payer: Cofinity Commercial |
$26.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.72
|
| Rate for Payer: Healthscope Commercial |
$27.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.18
|
| Rate for Payer: PHP Commercial |
$26.27
|
| Rate for Payer: Priority Health SBD |
$19.47
|
| Rate for Payer: UMR Bronson Commercial |
$13.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.18
|
|
|
LOSARTAN 12.5 MG CUSTOM TABLET
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 09900002009
|
| Hospital Charge Code |
301934
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.57
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.57
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Advantage |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health SBD |
$192.47
|
| Rate for Payer: UMR Bronson Commercial |
$134.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
LOSARTAN 12.5 MG CUSTOM TABLET
|
Facility
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 09900002009
|
| Hospital Charge Code |
301934
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.03 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.57
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna Medicare |
$152.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.57
|
| Rate for Payer: BCBS Complete |
$122.20
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Advantage |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health SBD |
$192.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.57
|
| Rate for Payer: UHC Core |
$159.17
|
| Rate for Payer: UHC Exchange |
$120.06
|
| Rate for Payer: UMR Bronson Commercial |
$113.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$63.45
|
|
|
Service Code
|
NDC 65862020190
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.92 |
| Max. Negotiated Rate |
$57.10 |
| Rate for Payer: Aetna American Axle |
$41.24
|
| Rate for Payer: Aetna Commercial |
$53.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.24
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cofinity Advantage |
$44.41
|
| Rate for Payer: Cofinity Commercial |
$54.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Healthscope Commercial |
$57.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: Priority Health SBD |
$39.97
|
| Rate for Payer: UMR Bronson Commercial |
$27.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.59
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$417.05
|
|
|
Service Code
|
NDC 63739067310
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.50 |
| Max. Negotiated Rate |
$375.35 |
| Rate for Payer: Aetna American Axle |
$271.08
|
| Rate for Payer: Aetna Commercial |
$354.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.08
|
| Rate for Payer: Cash Price |
$333.64
|
| Rate for Payer: Cofinity Advantage |
$291.94
|
| Rate for Payer: Cofinity Commercial |
$358.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.64
|
| Rate for Payer: Healthscope Commercial |
$375.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.79
|
| Rate for Payer: PHP Commercial |
$354.49
|
| Rate for Payer: Priority Health SBD |
$262.74
|
| Rate for Payer: UMR Bronson Commercial |
$183.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.79
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
OP
|
$86.72
|
|
|
Service Code
|
NDC 68180037609
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.09 |
| Max. Negotiated Rate |
$78.05 |
| Rate for Payer: Aetna American Axle |
$56.37
|
| Rate for Payer: Aetna Commercial |
$73.71
|
| Rate for Payer: Aetna Medicare |
$43.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.37
|
| Rate for Payer: BCBS Complete |
$34.69
|
| Rate for Payer: Cash Price |
$69.38
|
| Rate for Payer: Cofinity Advantage |
$60.70
|
| Rate for Payer: Cofinity Commercial |
$74.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.38
|
| Rate for Payer: Healthscope Commercial |
$78.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.04
|
| Rate for Payer: PHP Commercial |
$73.71
|
| Rate for Payer: Priority Health SBD |
$54.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.37
|
| Rate for Payer: UHC Core |
$45.18
|
| Rate for Payer: UHC Exchange |
$34.08
|
| Rate for Payer: UMR Bronson Commercial |
$32.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.04
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
OP
|
$63.45
|
|
|
Service Code
|
NDC 65862020190
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$57.10 |
| Rate for Payer: Aetna American Axle |
$41.24
|
| Rate for Payer: Aetna Commercial |
$53.93
|
| Rate for Payer: Aetna Medicare |
$31.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.24
|
| Rate for Payer: BCBS Complete |
$25.38
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cofinity Advantage |
$44.41
|
| Rate for Payer: Cofinity Commercial |
$54.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Healthscope Commercial |
$57.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: Priority Health SBD |
$39.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.24
|
| Rate for Payer: UHC Core |
$33.06
|
| Rate for Payer: UHC Exchange |
$24.94
|
| Rate for Payer: UMR Bronson Commercial |
$23.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.59
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
OP
|
$135.85
|
|
|
Service Code
|
NDC 50268050415
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.26 |
| Max. Negotiated Rate |
$122.27 |
| Rate for Payer: Aetna American Axle |
$88.30
|
| Rate for Payer: Aetna Commercial |
$115.47
|
| Rate for Payer: Aetna Medicare |
$67.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.30
|
| Rate for Payer: BCBS Complete |
$54.34
|
| Rate for Payer: Cash Price |
$108.68
|
| Rate for Payer: Cofinity Advantage |
$95.09
|
| Rate for Payer: Cofinity Commercial |
$116.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.68
|
| Rate for Payer: Healthscope Commercial |
$122.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.89
|
| Rate for Payer: PHP Commercial |
$115.47
|
| Rate for Payer: Priority Health SBD |
$85.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.30
|
| Rate for Payer: UHC Core |
$70.78
|
| Rate for Payer: UHC Exchange |
$53.39
|
| Rate for Payer: UMR Bronson Commercial |
$50.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.89
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
OP
|
$417.05
|
|
|
Service Code
|
NDC 63739067310
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$375.35 |
| Rate for Payer: Aetna American Axle |
$271.08
|
| Rate for Payer: Aetna Commercial |
$354.49
|
| Rate for Payer: Aetna Medicare |
$208.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.08
|
| Rate for Payer: BCBS Complete |
$166.82
|
| Rate for Payer: Cash Price |
$333.64
|
| Rate for Payer: Cofinity Advantage |
$291.94
|
| Rate for Payer: Cofinity Commercial |
$358.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.64
|
| Rate for Payer: Healthscope Commercial |
$375.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$333.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.79
|
| Rate for Payer: PHP Commercial |
$354.49
|
| Rate for Payer: Priority Health SBD |
$262.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.08
|
| Rate for Payer: UHC Core |
$217.28
|
| Rate for Payer: UHC Exchange |
$163.90
|
| Rate for Payer: UMR Bronson Commercial |
$154.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.79
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$3.41
|
|
|
Service Code
|
NDC 68084034611
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Aetna American Axle |
$2.22
|
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.22
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cofinity Advantage |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.73
|
| Rate for Payer: Healthscope Commercial |
$3.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.56
|
| Rate for Payer: PHP Commercial |
$2.90
|
| Rate for Payer: Priority Health SBD |
$2.15
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.56
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$340.10
|
|
|
Service Code
|
NDC 68084034601
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.64 |
| Max. Negotiated Rate |
$306.09 |
| Rate for Payer: Aetna American Axle |
$221.06
|
| Rate for Payer: Aetna Commercial |
$289.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.06
|
| Rate for Payer: Cash Price |
$272.08
|
| Rate for Payer: Cofinity Advantage |
$238.07
|
| Rate for Payer: Cofinity Commercial |
$292.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.08
|
| Rate for Payer: Healthscope Commercial |
$306.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.07
|
| Rate for Payer: PHP Commercial |
$289.08
|
| Rate for Payer: Priority Health SBD |
$214.26
|
| Rate for Payer: UMR Bronson Commercial |
$149.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.07
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$86.72
|
|
|
Service Code
|
NDC 68180037609
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.16 |
| Max. Negotiated Rate |
$78.05 |
| Rate for Payer: Aetna American Axle |
$56.37
|
| Rate for Payer: Aetna Commercial |
$73.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.37
|
| Rate for Payer: Cash Price |
$69.38
|
| Rate for Payer: Cofinity Advantage |
$60.70
|
| Rate for Payer: Cofinity Commercial |
$74.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.38
|
| Rate for Payer: Healthscope Commercial |
$78.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.04
|
| Rate for Payer: PHP Commercial |
$73.71
|
| Rate for Payer: Priority Health SBD |
$54.63
|
| Rate for Payer: UMR Bronson Commercial |
$38.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.04
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$135.85
|
|
|
Service Code
|
NDC 50268050415
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.77 |
| Max. Negotiated Rate |
$122.27 |
| Rate for Payer: Aetna American Axle |
$88.30
|
| Rate for Payer: Aetna Commercial |
$115.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.30
|
| Rate for Payer: Cash Price |
$108.68
|
| Rate for Payer: Cofinity Advantage |
$95.09
|
| Rate for Payer: Cofinity Commercial |
$116.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.68
|
| Rate for Payer: Healthscope Commercial |
$122.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.89
|
| Rate for Payer: PHP Commercial |
$115.47
|
| Rate for Payer: Priority Health SBD |
$85.59
|
| Rate for Payer: UMR Bronson Commercial |
$59.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.89
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
OP
|
$2.72
|
|
|
Service Code
|
NDC 50268050411
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna American Axle |
$1.77
|
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna Medicare |
$1.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: BCBS Complete |
$1.09
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Advantage |
$1.90
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.04
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: Priority Health SBD |
$1.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.77
|
| Rate for Payer: UHC Core |
$1.42
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UMR Bronson Commercial |
$1.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
