|
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 |
$195.42
|
| 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 |
$172.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.42
|
| Rate for Payer: PHP Commercial |
$195.42
|
| 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 |
$172.42
|
|
|
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 Commercial |
$104.94
|
| Rate for Payer: Cofinity Commercial |
$85.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.41
|
| 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: PHP Commercial |
$103.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.31
|
| 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
|
|
|
LORATADINE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$81.78
|
|
|
Service Code
|
NDC 51672213108
|
| Hospital Charge Code |
76472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.26 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna American Axle |
$53.16
|
| Rate for Payer: Aetna Commercial |
$69.51
|
| Rate for Payer: Aetna Medicare |
$40.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.16
|
| Rate for Payer: BCBS Complete |
$32.71
|
| 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 |
$30.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.34
|
|
|
LORATADINE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$107.16
|
|
|
Service Code
|
NDC 51672207308
|
| 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 Commercial |
$75.01
|
| Rate for Payer: Cofinity Commercial |
$92.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.01
|
| 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: PHP Commercial |
$91.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.65
|
| 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
|
$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 Commercial |
$104.94
|
| Rate for Payer: Cofinity Commercial |
$85.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.41
|
| 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: PHP Commercial |
$103.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.31
|
| Rate for Payer: Priority Health SBD |
$76.87
|
| 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
|
OP
|
$78.96
|
|
|
Service Code
|
NDC 51672209208
|
| Hospital Charge Code |
76472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.22 |
| Max. Negotiated Rate |
$71.06 |
| Rate for Payer: Aetna American Axle |
$51.32
|
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna Medicare |
$39.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.32
|
| Rate for Payer: BCBS Complete |
$31.58
|
| Rate for Payer: Cash Price |
$63.17
|
| Rate for Payer: Cofinity Commercial |
$55.27
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.27
|
| 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: PHP Commercial |
$67.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.32
|
| Rate for Payer: Priority Health SBD |
$49.74
|
| Rate for Payer: UMR Bronson Commercial |
$29.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.22
|
|
|
LORATADINE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$107.16
|
|
|
Service Code
|
NDC 51672207308
|
| 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 Commercial |
$75.01
|
| Rate for Payer: Cofinity Commercial |
$92.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.01
|
| 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: PHP Commercial |
$91.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.65
|
| Rate for Payer: Priority Health SBD |
$67.51
|
| 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
|
OP
|
$112.80
|
|
|
Service Code
|
NDC 00904676720
|
| Hospital Charge Code |
76472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.74 |
| Max. Negotiated Rate |
$101.52 |
| Rate for Payer: Aetna American Axle |
$73.32
|
| Rate for Payer: Aetna Commercial |
$95.88
|
| Rate for Payer: Aetna Medicare |
$56.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.32
|
| Rate for Payer: BCBS Complete |
$45.12
|
| Rate for Payer: Cash Price |
$90.24
|
| Rate for Payer: Cofinity Commercial |
$78.96
|
| Rate for Payer: Cofinity Commercial |
$97.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.24
|
| Rate for Payer: Healthscope Commercial |
$101.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.88
|
| Rate for Payer: PHP Commercial |
$95.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.32
|
| Rate for Payer: Priority Health SBD |
$71.06
|
| Rate for Payer: UMR Bronson Commercial |
$41.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.60
|
|
|
LORATADINE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$118.44
|
|
|
Service Code
|
NDC 54838055840
|
| Hospital Charge Code |
76472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.11 |
| Max. Negotiated Rate |
$106.60 |
| Rate for Payer: Aetna American Axle |
$76.99
|
| Rate for Payer: Aetna Commercial |
$100.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.99
|
| Rate for Payer: Cash Price |
$94.75
|
| Rate for Payer: Cofinity Commercial |
$101.86
|
| Rate for Payer: Cofinity Commercial |
$82.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.75
|
| Rate for Payer: Healthscope Commercial |
$106.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.67
|
| Rate for Payer: PHP Commercial |
$100.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.99
|
| Rate for Payer: Priority Health SBD |
$74.62
|
| Rate for Payer: UMR Bronson Commercial |
$52.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.83
|
|
|
LORATADINE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$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
|
|
|
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 Commercial |
$55.27
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.27
|
| 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: PHP Commercial |
$67.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.32
|
| 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
|
$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 Commercial |
$101.86
|
| Rate for Payer: Cofinity Commercial |
$82.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.75
|
| Rate for Payer: Healthscope Commercial |
$106.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.67
|
| Rate for Payer: PHP Commercial |
$100.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.99
|
| Rate for Payer: Priority Health SBD |
$74.62
|
| 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
|
$112.80
|
|
|
Service Code
|
NDC 00904676720
|
| Hospital Charge Code |
76472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.63 |
| Max. Negotiated Rate |
$101.52 |
| Rate for Payer: Aetna American Axle |
$73.32
|
| Rate for Payer: Aetna Commercial |
$95.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.32
|
| Rate for Payer: Cash Price |
$90.24
|
| Rate for Payer: Cofinity Commercial |
$78.96
|
| Rate for Payer: Cofinity Commercial |
$97.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.24
|
| Rate for Payer: Healthscope Commercial |
$101.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.88
|
| Rate for Payer: PHP Commercial |
$95.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.32
|
| Rate for Payer: Priority Health SBD |
$71.06
|
| Rate for Payer: UMR Bronson Commercial |
$49.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.60
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$73.50
|
|
|
Service Code
|
NDC 69315090401
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$66.15 |
| Rate for Payer: Aetna American Axle |
$47.78
|
| Rate for Payer: Aetna Commercial |
$62.48
|
| Rate for Payer: Aetna Medicare |
$36.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.78
|
| Rate for Payer: BCBS Complete |
$29.40
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cofinity Commercial |
$51.45
|
| Rate for Payer: Cofinity Commercial |
$63.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.45
|
| 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: Multiplan/Beech St/PHCS Commercial |
$62.48
|
| Rate for Payer: PHP Commercial |
$62.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.78
|
| Rate for Payer: Priority Health SBD |
$46.30
|
| 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
|
OP
|
$1.98
|
|
|
Service Code
|
NDC 60687040111
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna American Axle |
$1.29
|
| Rate for Payer: Aetna Commercial |
$1.68
|
| Rate for Payer: Aetna Medicare |
$0.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.29
|
| Rate for Payer: BCBS Complete |
$0.79
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cofinity Commercial |
$1.39
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.58
|
| Rate for Payer: Healthscope Commercial |
$1.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.68
|
| Rate for Payer: PHP Commercial |
$1.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.29
|
| Rate for Payer: Priority Health SBD |
$1.25
|
| Rate for Payer: UMR Bronson Commercial |
$0.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.48
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$129.50
|
|
|
Service Code
|
NDC 00904600761
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.92 |
| Max. Negotiated Rate |
$116.55 |
| Rate for Payer: Aetna American Axle |
$84.18
|
| Rate for Payer: Aetna Commercial |
$110.08
|
| Rate for Payer: Aetna Medicare |
$64.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.18
|
| Rate for Payer: BCBS Complete |
$51.80
|
| Rate for Payer: Cash Price |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$111.37
|
| Rate for Payer: Cofinity Commercial |
$90.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.65
|
| 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: PHP Commercial |
$110.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.18
|
| Rate for Payer: Priority Health SBD |
$81.58
|
| Rate for Payer: UMR Bronson Commercial |
$47.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.12
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$122.50
|
|
|
Service Code
|
NDC 63304077201
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.32 |
| 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 Commercial |
$105.35
|
| Rate for Payer: Cofinity Commercial |
$85.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.75
|
| 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: PHP Commercial |
$104.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.62
|
| Rate for Payer: Priority Health SBD |
$77.18
|
| Rate for Payer: UMR Bronson Commercial |
$45.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.88
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$73.50
|
|
|
Service Code
|
NDC 69315090401
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.34 |
| Max. Negotiated Rate |
$66.15 |
| Rate for Payer: Aetna American Axle |
$47.78
|
| Rate for Payer: Aetna Commercial |
$62.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.78
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cofinity Commercial |
$51.45
|
| Rate for Payer: Cofinity Commercial |
$63.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.45
|
| 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: Multiplan/Beech St/PHCS Commercial |
$62.48
|
| Rate for Payer: PHP Commercial |
$62.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.78
|
| Rate for Payer: Priority Health SBD |
$46.30
|
| Rate for Payer: UMR Bronson Commercial |
$32.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.12
|
|
|
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 Commercial |
$105.35
|
| Rate for Payer: Cofinity Commercial |
$85.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.75
|
| 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: PHP Commercial |
$104.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.62
|
| Rate for Payer: Priority Health SBD |
$77.18
|
| 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
|
IP
|
$1.98
|
|
|
Service Code
|
NDC 60687040111
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna American Axle |
$1.29
|
| Rate for Payer: Aetna Commercial |
$1.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.29
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cofinity Commercial |
$1.39
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.58
|
| Rate for Payer: Healthscope Commercial |
$1.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.68
|
| Rate for Payer: PHP Commercial |
$1.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.29
|
| Rate for Payer: Priority Health SBD |
$1.25
|
| Rate for Payer: UMR Bronson Commercial |
$0.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.48
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$271.25
|
|
|
Service Code
|
NDC 69315090405
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.35 |
| Max. Negotiated Rate |
$244.12 |
| Rate for Payer: Aetna American Axle |
$176.31
|
| Rate for Payer: Aetna Commercial |
$230.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.31
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cofinity Commercial |
$189.88
|
| Rate for Payer: Cofinity Commercial |
$233.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.00
|
| Rate for Payer: Healthscope Commercial |
$244.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.56
|
| Rate for Payer: PHP Commercial |
$230.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.31
|
| Rate for Payer: Priority Health SBD |
$170.89
|
| Rate for Payer: UMR Bronson Commercial |
$119.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.44
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$197.75
|
|
|
Service Code
|
NDC 60687040101
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.01 |
| Max. Negotiated Rate |
$177.98 |
| Rate for Payer: Aetna American Axle |
$128.54
|
| Rate for Payer: Aetna Commercial |
$168.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.54
|
| Rate for Payer: Cash Price |
$158.20
|
| Rate for Payer: Cofinity Commercial |
$138.42
|
| Rate for Payer: Cofinity Commercial |
$170.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.20
|
| Rate for Payer: Healthscope Commercial |
$177.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.09
|
| Rate for Payer: PHP Commercial |
$168.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.54
|
| Rate for Payer: Priority Health SBD |
$124.58
|
| Rate for Payer: UMR Bronson Commercial |
$87.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.31
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$197.75
|
|
|
Service Code
|
NDC 60687040101
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.17 |
| Max. Negotiated Rate |
$177.98 |
| Rate for Payer: Aetna American Axle |
$128.54
|
| Rate for Payer: Aetna Commercial |
$168.09
|
| Rate for Payer: Aetna Medicare |
$98.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.54
|
| Rate for Payer: BCBS Complete |
$79.10
|
| Rate for Payer: Cash Price |
$158.20
|
| Rate for Payer: Cofinity Commercial |
$138.42
|
| Rate for Payer: Cofinity Commercial |
$170.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.20
|
| Rate for Payer: Healthscope Commercial |
$177.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.09
|
| Rate for Payer: PHP Commercial |
$168.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.54
|
| Rate for Payer: Priority Health SBD |
$124.58
|
| Rate for Payer: UMR Bronson Commercial |
$73.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.31
|
|
|
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 |
$84.18
|
| Rate for Payer: Aetna Commercial |
$110.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.18
|
| Rate for Payer: Cash Price |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$111.37
|
| Rate for Payer: Cofinity Commercial |
$90.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.65
|
| 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: PHP Commercial |
$110.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.18
|
| 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
|
OP
|
$271.25
|
|
|
Service Code
|
NDC 69315090405
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.36 |
| Max. Negotiated Rate |
$244.12 |
| Rate for Payer: Aetna American Axle |
$176.31
|
| Rate for Payer: Aetna Commercial |
$230.56
|
| Rate for Payer: Aetna Medicare |
$135.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.31
|
| Rate for Payer: BCBS Complete |
$108.50
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cofinity Commercial |
$189.88
|
| Rate for Payer: Cofinity Commercial |
$233.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.00
|
| Rate for Payer: Healthscope Commercial |
$244.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.56
|
| Rate for Payer: PHP Commercial |
$230.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.31
|
| Rate for Payer: Priority Health SBD |
$170.89
|
| Rate for Payer: UMR Bronson Commercial |
$100.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.44
|
|
