|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$246.24
|
|
|
Service Code
|
NDC 60687022901
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.35 |
| Max. Negotiated Rate |
$221.62 |
| Rate for Payer: Aetna American Axle |
$160.06
|
| Rate for Payer: Aetna Commercial |
$209.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.06
|
| Rate for Payer: Cash Price |
$196.99
|
| Rate for Payer: Cofinity Commercial |
$172.37
|
| Rate for Payer: Cofinity Commercial |
$211.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.99
|
| Rate for Payer: Healthscope Commercial |
$221.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.30
|
| Rate for Payer: PHP Commercial |
$209.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.06
|
| Rate for Payer: Priority Health SBD |
$155.13
|
| Rate for Payer: UMR Bronson Commercial |
$108.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.68
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$330.72
|
|
|
Service Code
|
NDC 51079069020
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.52 |
| Max. Negotiated Rate |
$297.65 |
| Rate for Payer: Aetna American Axle |
$214.97
|
| Rate for Payer: Aetna Commercial |
$281.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.97
|
| Rate for Payer: Cash Price |
$264.58
|
| Rate for Payer: Cofinity Commercial |
$231.50
|
| Rate for Payer: Cofinity Commercial |
$284.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.58
|
| Rate for Payer: Healthscope Commercial |
$297.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.11
|
| Rate for Payer: PHP Commercial |
$281.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.97
|
| Rate for Payer: Priority Health SBD |
$208.35
|
| Rate for Payer: UMR Bronson Commercial |
$145.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.04
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$330.72
|
|
|
Service Code
|
NDC 51079069020
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.37 |
| Max. Negotiated Rate |
$297.65 |
| Rate for Payer: Aetna American Axle |
$214.97
|
| Rate for Payer: Aetna Commercial |
$281.11
|
| Rate for Payer: Aetna Medicare |
$165.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.97
|
| Rate for Payer: BCBS Complete |
$132.29
|
| Rate for Payer: Cash Price |
$264.58
|
| Rate for Payer: Cofinity Commercial |
$231.50
|
| Rate for Payer: Cofinity Commercial |
$284.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.58
|
| Rate for Payer: Healthscope Commercial |
$297.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.11
|
| Rate for Payer: PHP Commercial |
$281.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.97
|
| Rate for Payer: Priority Health SBD |
$208.35
|
| Rate for Payer: UMR Bronson Commercial |
$122.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.04
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$246.24
|
|
|
Service Code
|
NDC 60687022901
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.11 |
| Max. Negotiated Rate |
$221.62 |
| Rate for Payer: Aetna American Axle |
$160.06
|
| Rate for Payer: Aetna Commercial |
$209.30
|
| Rate for Payer: Aetna Medicare |
$123.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.06
|
| Rate for Payer: BCBS Complete |
$98.50
|
| Rate for Payer: Cash Price |
$196.99
|
| Rate for Payer: Cofinity Commercial |
$172.37
|
| Rate for Payer: Cofinity Commercial |
$211.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.99
|
| Rate for Payer: Healthscope Commercial |
$221.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.30
|
| Rate for Payer: PHP Commercial |
$209.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.06
|
| Rate for Payer: Priority Health SBD |
$155.13
|
| Rate for Payer: UMR Bronson Commercial |
$91.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.68
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$2.47
|
|
|
Service Code
|
NDC 60687022911
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna American Axle |
$1.61
|
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna Medicare |
$1.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.61
|
| Rate for Payer: BCBS Complete |
$0.99
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.61
|
| Rate for Payer: Priority Health SBD |
$1.56
|
| Rate for Payer: UMR Bronson Commercial |
$0.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.85
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$3.31
|
|
|
Service Code
|
NDC 51079069001
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$2.98 |
| Rate for Payer: Aetna American Axle |
$2.15
|
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.15
|
| Rate for Payer: Cash Price |
$2.65
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.65
|
| Rate for Payer: Healthscope Commercial |
$2.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.81
|
| Rate for Payer: PHP Commercial |
$2.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.15
|
| Rate for Payer: Priority Health SBD |
$2.09
|
| Rate for Payer: UMR Bronson Commercial |
$1.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.48
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$2.47
|
|
|
Service Code
|
NDC 60687022911
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna American Axle |
$1.61
|
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.61
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.61
|
| Rate for Payer: Priority Health SBD |
$1.56
|
| Rate for Payer: UMR Bronson Commercial |
$1.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.85
|
|
|
LOPINAVIR-RITONAVIR 400 MG-100 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$1,847.04
|
|
|
Service Code
|
NDC 00074395646
|
| Hospital Charge Code |
28929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$812.70 |
| Max. Negotiated Rate |
$1,662.34 |
| Rate for Payer: Aetna American Axle |
$1,200.58
|
| Rate for Payer: Aetna Commercial |
$1,569.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,200.58
|
| Rate for Payer: Cash Price |
$1,477.63
|
| Rate for Payer: Cofinity Commercial |
$1,292.93
|
| Rate for Payer: Cofinity Commercial |
$1,588.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,292.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,477.63
|
| Rate for Payer: Healthscope Commercial |
$1,662.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,292.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,385.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,569.98
|
| Rate for Payer: PHP Commercial |
$1,569.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.58
|
| Rate for Payer: Priority Health SBD |
$1,163.64
|
| Rate for Payer: UMR Bronson Commercial |
$812.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,385.28
|
|
|
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 Commercial |
$1,075.27
|
| Rate for Payer: Cofinity Commercial |
$875.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$875.22
|
| 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: PHP Commercial |
$1,062.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$812.70
|
| 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
|
|
|
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 Commercial |
$1,075.27
|
| Rate for Payer: Cofinity Commercial |
$875.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$875.22
|
| 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: PHP Commercial |
$1,062.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$812.70
|
| Rate for Payer: Priority Health SBD |
$787.70
|
| 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
|
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 Commercial |
$1,292.93
|
| Rate for Payer: Cofinity Commercial |
$1,588.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,292.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,477.63
|
| Rate for Payer: Healthscope Commercial |
$1,662.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,292.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,385.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,569.98
|
| Rate for Payer: PHP Commercial |
$1,569.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.58
|
| Rate for Payer: Priority Health SBD |
$1,163.64
|
| Rate for Payer: UMR Bronson Commercial |
$683.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,385.28
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$256.50
|
|
|
Service Code
|
NDC 51079024620
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.86 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna American Axle |
$166.72
|
| Rate for Payer: Aetna Commercial |
$218.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.72
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cofinity Commercial |
$179.55
|
| Rate for Payer: Cofinity Commercial |
$220.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.20
|
| Rate for Payer: Healthscope Commercial |
$230.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.03
|
| Rate for Payer: PHP Commercial |
$218.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.72
|
| Rate for Payer: Priority Health SBD |
$161.59
|
| Rate for Payer: UMR Bronson Commercial |
$112.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.38
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$229.90
|
|
|
Service Code
|
NDC 68084024811
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.16 |
| Max. Negotiated Rate |
$206.91 |
| Rate for Payer: Aetna American Axle |
$149.44
|
| Rate for Payer: Aetna Commercial |
$195.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.44
|
| Rate for Payer: Cash Price |
$183.92
|
| Rate for Payer: Cofinity Commercial |
$160.93
|
| Rate for Payer: Cofinity Commercial |
$197.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$160.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.92
|
| Rate for Payer: Healthscope Commercial |
$206.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.41
|
| Rate for Payer: PHP Commercial |
$195.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.44
|
| Rate for Payer: Priority Health SBD |
$144.84
|
| Rate for Payer: UMR Bronson Commercial |
$101.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.43
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$256.50
|
|
|
Service Code
|
NDC 51079024620
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.91 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna American Axle |
$166.72
|
| Rate for Payer: Aetna Commercial |
$218.03
|
| Rate for Payer: Aetna Medicare |
$128.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.72
|
| Rate for Payer: BCBS Complete |
$102.60
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cofinity Commercial |
$179.55
|
| Rate for Payer: Cofinity Commercial |
$220.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.20
|
| Rate for Payer: Healthscope Commercial |
$230.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.03
|
| Rate for Payer: PHP Commercial |
$218.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.72
|
| Rate for Payer: Priority Health SBD |
$161.59
|
| Rate for Payer: UMR Bronson Commercial |
$94.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.38
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$4.35
|
|
|
Service Code
|
NDC 50268048911
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Aetna American Axle |
$2.83
|
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Aetna Medicare |
$2.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.83
|
| Rate for Payer: BCBS Complete |
$1.74
|
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Cofinity Commercial |
$3.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.48
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.70
|
| Rate for Payer: PHP Commercial |
$3.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.83
|
| Rate for Payer: Priority Health SBD |
$2.74
|
| Rate for Payer: UMR Bronson Commercial |
$1.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.26
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
NDC 00904685261
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.33 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna American Axle |
$135.85
|
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna Medicare |
$104.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health SBD |
$131.67
|
| Rate for Payer: UMR Bronson Commercial |
$77.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$129.25
|
|
|
Service Code
|
NDC 45802065078
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$116.33 |
| Rate for Payer: Aetna American Axle |
$84.01
|
| Rate for Payer: Aetna Commercial |
$109.86
|
| Rate for Payer: Aetna Medicare |
$64.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.01
|
| Rate for Payer: BCBS Complete |
$51.70
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cofinity Commercial |
$111.16
|
| Rate for Payer: Cofinity Commercial |
$90.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.40
|
| Rate for Payer: Healthscope Commercial |
$116.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.86
|
| Rate for Payer: PHP Commercial |
$109.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.01
|
| Rate for Payer: Priority Health SBD |
$81.43
|
| Rate for Payer: UMR Bronson Commercial |
$47.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.94
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
NDC 00904685261
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.96 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna American Axle |
$135.85
|
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health SBD |
$131.67
|
| Rate for Payer: UMR Bronson Commercial |
$91.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$2.57
|
|
|
Service Code
|
NDC 51079024601
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Aetna American Axle |
$1.67
|
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.67
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.67
|
| Rate for Payer: Priority Health SBD |
$1.62
|
| Rate for Payer: UMR Bronson Commercial |
$1.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.93
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$217.38
|
|
|
Service Code
|
NDC 50268048915
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.43 |
| Max. Negotiated Rate |
$195.64 |
| Rate for Payer: Aetna American Axle |
$141.30
|
| Rate for Payer: Aetna Commercial |
$184.77
|
| Rate for Payer: Aetna Medicare |
$108.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.30
|
| Rate for Payer: BCBS Complete |
$86.95
|
| Rate for Payer: Cash Price |
$173.90
|
| Rate for Payer: Cofinity Commercial |
$152.17
|
| Rate for Payer: Cofinity Commercial |
$186.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.90
|
| Rate for Payer: Healthscope Commercial |
$195.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.77
|
| Rate for Payer: PHP Commercial |
$184.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.30
|
| Rate for Payer: Priority Health SBD |
$136.95
|
| Rate for Payer: UMR Bronson Commercial |
$80.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.03
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$229.90
|
|
|
Service Code
|
NDC 68084024801
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.06 |
| Max. Negotiated Rate |
$206.91 |
| Rate for Payer: Aetna American Axle |
$149.44
|
| Rate for Payer: Aetna Commercial |
$195.41
|
| Rate for Payer: Aetna Medicare |
$114.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.44
|
| Rate for Payer: BCBS Complete |
$91.96
|
| Rate for Payer: Cash Price |
$183.92
|
| Rate for Payer: Cofinity Commercial |
$160.93
|
| Rate for Payer: Cofinity Commercial |
$197.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$160.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.92
|
| Rate for Payer: Healthscope Commercial |
$206.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.41
|
| Rate for Payer: PHP Commercial |
$195.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.44
|
| Rate for Payer: Priority Health SBD |
$144.84
|
| Rate for Payer: UMR Bronson Commercial |
$85.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.43
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$229.90
|
|
|
Service Code
|
NDC 68084024801
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.16 |
| Max. Negotiated Rate |
$206.91 |
| Rate for Payer: Aetna American Axle |
$149.44
|
| Rate for Payer: Aetna Commercial |
$195.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.44
|
| Rate for Payer: Cash Price |
$183.92
|
| Rate for Payer: Cofinity Commercial |
$160.93
|
| Rate for Payer: Cofinity Commercial |
$197.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$160.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.92
|
| Rate for Payer: Healthscope Commercial |
$206.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.41
|
| Rate for Payer: PHP Commercial |
$195.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.44
|
| Rate for Payer: Priority Health SBD |
$144.84
|
| Rate for Payer: UMR Bronson Commercial |
$101.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.43
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$229.90
|
|
|
Service Code
|
NDC 68084024811
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.06 |
| Max. Negotiated Rate |
$206.91 |
| Rate for Payer: Aetna American Axle |
$149.44
|
| Rate for Payer: Aetna Commercial |
$195.41
|
| Rate for Payer: Aetna Medicare |
$114.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.44
|
| Rate for Payer: BCBS Complete |
$91.96
|
| Rate for Payer: Cash Price |
$183.92
|
| Rate for Payer: Cofinity Commercial |
$160.93
|
| Rate for Payer: Cofinity Commercial |
$197.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$160.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.92
|
| Rate for Payer: Healthscope Commercial |
$206.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.41
|
| Rate for Payer: PHP Commercial |
$195.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.44
|
| Rate for Payer: Priority Health SBD |
$144.84
|
| Rate for Payer: UMR Bronson Commercial |
$85.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.43
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$2.57
|
|
|
Service Code
|
NDC 51079024601
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Aetna American Axle |
$1.67
|
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.67
|
| Rate for Payer: BCBS Complete |
$1.03
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.67
|
| Rate for Payer: Priority Health SBD |
$1.62
|
| Rate for Payer: UMR Bronson Commercial |
$0.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.93
|
|
|
LORATADINE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$81.78
|
|
|
Service Code
|
NDC 51672213108
|
| Hospital Charge Code |
76472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.98 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna American Axle |
$53.16
|
| Rate for Payer: Aetna Commercial |
$69.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.16
|
| Rate for Payer: Cash Price |
$65.42
|
| Rate for Payer: Cofinity Commercial |
$57.25
|
| Rate for Payer: Cofinity Commercial |
$70.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.42
|
| Rate for Payer: Healthscope Commercial |
$73.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.51
|
| Rate for Payer: PHP Commercial |
$69.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.16
|
| Rate for Payer: Priority Health SBD |
$51.52
|
| Rate for Payer: UMR Bronson Commercial |
$35.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.34
|
|
