|
LORAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$82.25
|
|
|
Service Code
|
NDC 00093342601
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$74.02 |
| Rate for Payer: Aetna American Axle |
$53.46
|
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna Medicare |
$41.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.46
|
| Rate for Payer: BCBS Complete |
$32.90
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$57.58
|
| Rate for Payer: Cofinity Commercial |
$70.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$74.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.46
|
| Rate for Payer: Priority Health SBD |
$51.82
|
| Rate for Payer: UMR Bronson Commercial |
$30.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.69
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$82.25
|
|
|
Service Code
|
NDC 00093342601
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.19 |
| Max. Negotiated Rate |
$74.02 |
| Rate for Payer: Aetna American Axle |
$53.46
|
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.46
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$57.58
|
| Rate for Payer: Cofinity Commercial |
$70.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$74.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.46
|
| Rate for Payer: Priority Health SBD |
$51.82
|
| Rate for Payer: UMR Bronson Commercial |
$36.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.69
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$96.25
|
|
|
Service Code
|
NDC 00904600860
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.35 |
| Max. Negotiated Rate |
$86.62 |
| Rate for Payer: Aetna American Axle |
$62.56
|
| Rate for Payer: Aetna Commercial |
$81.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.56
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cofinity Commercial |
$67.38
|
| Rate for Payer: Cofinity Commercial |
$82.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.00
|
| Rate for Payer: Healthscope Commercial |
$86.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.81
|
| Rate for Payer: PHP Commercial |
$81.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.56
|
| Rate for Payer: Priority Health SBD |
$60.64
|
| Rate for Payer: UMR Bronson Commercial |
$42.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.19
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$134.75
|
|
|
Service Code
|
NDC 63304077301
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$121.28 |
| Rate for Payer: Aetna American Axle |
$87.59
|
| Rate for Payer: Aetna Commercial |
$114.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.59
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cofinity Commercial |
$115.88
|
| Rate for Payer: Cofinity Commercial |
$94.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.80
|
| Rate for Payer: Healthscope Commercial |
$121.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.54
|
| Rate for Payer: PHP Commercial |
$114.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.59
|
| Rate for Payer: Priority Health SBD |
$84.89
|
| Rate for Payer: UMR Bronson Commercial |
$59.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.06
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$110.25
|
|
|
Service Code
|
NDC 69315090501
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.79 |
| Max. Negotiated Rate |
$99.22 |
| Rate for Payer: Aetna American Axle |
$71.66
|
| Rate for Payer: Aetna Commercial |
$93.71
|
| Rate for Payer: Aetna Medicare |
$55.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.66
|
| Rate for Payer: BCBS Complete |
$44.10
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cofinity Commercial |
$77.18
|
| Rate for Payer: Cofinity Commercial |
$94.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.20
|
| Rate for Payer: Healthscope Commercial |
$99.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.71
|
| Rate for Payer: PHP Commercial |
$93.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.66
|
| Rate for Payer: Priority Health SBD |
$69.46
|
| Rate for Payer: UMR Bronson Commercial |
$40.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.69
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
NDC 60687063801
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.48 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Aetna American Axle |
$141.05
|
| Rate for Payer: Aetna Commercial |
$184.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.05
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cofinity Commercial |
$151.90
|
| Rate for Payer: Cofinity Commercial |
$186.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.60
|
| Rate for Payer: Healthscope Commercial |
$195.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.45
|
| Rate for Payer: PHP Commercial |
$184.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.05
|
| Rate for Payer: Priority Health SBD |
$136.71
|
| Rate for Payer: UMR Bronson Commercial |
$95.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.75
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$96.25
|
|
|
Service Code
|
NDC 00904600860
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.61 |
| Max. Negotiated Rate |
$86.62 |
| Rate for Payer: Aetna American Axle |
$62.56
|
| Rate for Payer: Aetna Commercial |
$81.81
|
| Rate for Payer: Aetna Medicare |
$48.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.56
|
| Rate for Payer: BCBS Complete |
$38.50
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cofinity Commercial |
$67.38
|
| Rate for Payer: Cofinity Commercial |
$82.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.00
|
| Rate for Payer: Healthscope Commercial |
$86.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.81
|
| Rate for Payer: PHP Commercial |
$81.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.56
|
| Rate for Payer: Priority Health SBD |
$60.64
|
| Rate for Payer: UMR Bronson Commercial |
$35.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.19
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
NDC 60687063801
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.29 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Aetna American Axle |
$141.05
|
| Rate for Payer: Aetna Commercial |
$184.45
|
| Rate for Payer: Aetna Medicare |
$108.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.05
|
| Rate for Payer: BCBS Complete |
$86.80
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cofinity Commercial |
$151.90
|
| Rate for Payer: Cofinity Commercial |
$186.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.60
|
| Rate for Payer: Healthscope Commercial |
$195.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.45
|
| Rate for Payer: PHP Commercial |
$184.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.05
|
| Rate for Payer: Priority Health SBD |
$136.71
|
| Rate for Payer: UMR Bronson Commercial |
$80.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.75
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$402.50
|
|
|
Service Code
|
NDC 69315090505
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.92 |
| Max. Negotiated Rate |
$362.25 |
| Rate for Payer: Aetna American Axle |
$261.62
|
| Rate for Payer: Aetna Commercial |
$342.12
|
| Rate for Payer: Aetna Medicare |
$201.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.62
|
| Rate for Payer: BCBS Complete |
$161.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cofinity Commercial |
$281.75
|
| Rate for Payer: Cofinity Commercial |
$346.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$281.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.00
|
| Rate for Payer: Healthscope Commercial |
$362.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.12
|
| Rate for Payer: PHP Commercial |
$342.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.62
|
| Rate for Payer: Priority Health SBD |
$253.58
|
| Rate for Payer: UMR Bronson Commercial |
$148.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.88
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$402.50
|
|
|
Service Code
|
NDC 13107008405
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.92 |
| Max. Negotiated Rate |
$362.25 |
| Rate for Payer: Aetna American Axle |
$261.62
|
| Rate for Payer: Aetna Commercial |
$342.12
|
| Rate for Payer: Aetna Medicare |
$201.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.62
|
| Rate for Payer: BCBS Complete |
$161.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cofinity Commercial |
$281.75
|
| Rate for Payer: Cofinity Commercial |
$346.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$281.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.00
|
| Rate for Payer: Healthscope Commercial |
$362.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.12
|
| Rate for Payer: PHP Commercial |
$342.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.62
|
| Rate for Payer: Priority Health SBD |
$253.58
|
| Rate for Payer: UMR Bronson Commercial |
$148.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.88
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$80.50
|
|
|
Service Code
|
NDC 13107008401
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.78 |
| Max. Negotiated Rate |
$72.45 |
| Rate for Payer: Aetna American Axle |
$52.32
|
| Rate for Payer: Aetna Commercial |
$68.42
|
| Rate for Payer: Aetna Medicare |
$40.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.32
|
| Rate for Payer: BCBS Complete |
$32.20
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: Cofinity Commercial |
$56.35
|
| Rate for Payer: Cofinity Commercial |
$69.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.40
|
| Rate for Payer: Healthscope Commercial |
$72.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.42
|
| Rate for Payer: PHP Commercial |
$68.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.32
|
| Rate for Payer: Priority Health SBD |
$50.72
|
| Rate for Payer: UMR Bronson Commercial |
$29.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.38
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$110.25
|
|
|
Service Code
|
NDC 69315090501
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$99.22 |
| Rate for Payer: Aetna American Axle |
$71.66
|
| Rate for Payer: Aetna Commercial |
$93.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.66
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cofinity Commercial |
$77.18
|
| Rate for Payer: Cofinity Commercial |
$94.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.20
|
| Rate for Payer: Healthscope Commercial |
$99.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.71
|
| Rate for Payer: PHP Commercial |
$93.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.66
|
| Rate for Payer: Priority Health SBD |
$69.46
|
| Rate for Payer: UMR Bronson Commercial |
$48.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.69
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$402.50
|
|
|
Service Code
|
NDC 69315090505
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.10 |
| Max. Negotiated Rate |
$362.25 |
| Rate for Payer: Aetna American Axle |
$261.62
|
| Rate for Payer: Aetna Commercial |
$342.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.62
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cofinity Commercial |
$281.75
|
| Rate for Payer: Cofinity Commercial |
$346.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$281.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.00
|
| Rate for Payer: Healthscope Commercial |
$362.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.12
|
| Rate for Payer: PHP Commercial |
$342.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.62
|
| Rate for Payer: Priority Health SBD |
$253.58
|
| Rate for Payer: UMR Bronson Commercial |
$177.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.88
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$134.75
|
|
|
Service Code
|
NDC 63304077301
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.86 |
| Max. Negotiated Rate |
$121.28 |
| Rate for Payer: Aetna American Axle |
$87.59
|
| Rate for Payer: Aetna Commercial |
$114.54
|
| Rate for Payer: Aetna Medicare |
$67.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.59
|
| Rate for Payer: BCBS Complete |
$53.90
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cofinity Commercial |
$115.88
|
| Rate for Payer: Cofinity Commercial |
$94.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.80
|
| Rate for Payer: Healthscope Commercial |
$121.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.54
|
| Rate for Payer: PHP Commercial |
$114.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.59
|
| Rate for Payer: Priority Health SBD |
$84.89
|
| Rate for Payer: UMR Bronson Commercial |
$49.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.06
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$2.17
|
|
|
Service Code
|
NDC 60687063811
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna American Axle |
$1.41
|
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.41
|
| Rate for Payer: Cash Price |
$1.74
|
| Rate for Payer: Cofinity Commercial |
$1.52
|
| Rate for Payer: Cofinity Commercial |
$1.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.74
|
| Rate for Payer: Healthscope Commercial |
$1.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.41
|
| Rate for Payer: Priority Health SBD |
$1.37
|
| Rate for Payer: UMR Bronson Commercial |
$0.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.63
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$402.50
|
|
|
Service Code
|
NDC 13107008405
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.10 |
| Max. Negotiated Rate |
$362.25 |
| Rate for Payer: Aetna American Axle |
$261.62
|
| Rate for Payer: Aetna Commercial |
$342.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.62
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cofinity Commercial |
$281.75
|
| Rate for Payer: Cofinity Commercial |
$346.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$281.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.00
|
| Rate for Payer: Healthscope Commercial |
$362.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.12
|
| Rate for Payer: PHP Commercial |
$342.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.62
|
| Rate for Payer: Priority Health SBD |
$253.58
|
| Rate for Payer: UMR Bronson Commercial |
$177.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.88
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$80.50
|
|
|
Service Code
|
NDC 13107008401
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.42 |
| Max. Negotiated Rate |
$72.45 |
| Rate for Payer: Aetna American Axle |
$52.32
|
| Rate for Payer: Aetna Commercial |
$68.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.32
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: Cofinity Commercial |
$56.35
|
| Rate for Payer: Cofinity Commercial |
$69.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.40
|
| Rate for Payer: Healthscope Commercial |
$72.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.42
|
| Rate for Payer: PHP Commercial |
$68.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.32
|
| Rate for Payer: Priority Health SBD |
$50.72
|
| Rate for Payer: UMR Bronson Commercial |
$35.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.38
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$2.17
|
|
|
Service Code
|
NDC 60687063811
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna American Axle |
$1.41
|
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna Medicare |
$1.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.41
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: Cash Price |
$1.74
|
| Rate for Payer: Cofinity Commercial |
$1.52
|
| Rate for Payer: Cofinity Commercial |
$1.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.74
|
| Rate for Payer: Healthscope Commercial |
$1.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.41
|
| Rate for Payer: Priority Health SBD |
$1.37
|
| Rate for Payer: UMR Bronson Commercial |
$0.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.63
|
|
|
LORAZEPAM 2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$8.63
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
10467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Aetna American Axle |
$5.61
|
| Rate for Payer: Aetna American Axle |
$11.62
|
| Rate for Payer: Aetna American Axle |
$104.98
|
| Rate for Payer: Aetna American Axle |
$12.75
|
| Rate for Payer: Aetna American Axle |
$18.51
|
| Rate for Payer: Aetna American Axle |
$21.16
|
| Rate for Payer: Aetna Commercial |
$16.67
|
| Rate for Payer: Aetna Commercial |
$27.67
|
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Commercial |
$137.28
|
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna Commercial |
$24.21
|
| Rate for Payer: Aetna Medicare |
$4.32
|
| Rate for Payer: Aetna Medicare |
$14.24
|
| Rate for Payer: Aetna Medicare |
$8.94
|
| Rate for Payer: Aetna Medicare |
$16.28
|
| Rate for Payer: Aetna Medicare |
$9.80
|
| Rate for Payer: Aetna Medicare |
$80.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.16
|
| Rate for Payer: BCBS Complete |
$13.02
|
| Rate for Payer: BCBS Complete |
$11.39
|
| Rate for Payer: BCBS Complete |
$64.60
|
| Rate for Payer: BCBS Complete |
$7.84
|
| Rate for Payer: BCBS Complete |
$7.15
|
| Rate for Payer: BCBS Complete |
$3.45
|
| Rate for Payer: BCBS Trust/PPO |
$3.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.92
|
| Rate for Payer: BCN Commercial |
$3.92
|
| Rate for Payer: BCN Commercial |
$3.92
|
| Rate for Payer: BCN Commercial |
$3.92
|
| Rate for Payer: BCN Commercial |
$3.92
|
| Rate for Payer: BCN Commercial |
$3.92
|
| Rate for Payer: BCN Commercial |
$3.92
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$15.69
|
| Rate for Payer: Cash Price |
$26.04
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cash Price |
$129.21
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cash Price |
$15.69
|
| Rate for Payer: Cash Price |
$26.04
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cash Price |
$129.21
|
| Rate for Payer: Cofinity Commercial |
$13.73
|
| Rate for Payer: Cofinity Commercial |
$6.04
|
| Rate for Payer: Cofinity Commercial |
$12.52
|
| Rate for Payer: Cofinity Commercial |
$138.90
|
| Rate for Payer: Cofinity Commercial |
$113.06
|
| Rate for Payer: Cofinity Commercial |
$15.38
|
| Rate for Payer: Cofinity Commercial |
$27.99
|
| Rate for Payer: Cofinity Commercial |
$22.78
|
| Rate for Payer: Cofinity Commercial |
$24.49
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Cofinity Commercial |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$7.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.90
|
| Rate for Payer: Healthscope Commercial |
$29.30
|
| Rate for Payer: Healthscope Commercial |
$7.77
|
| Rate for Payer: Healthscope Commercial |
$25.63
|
| Rate for Payer: Healthscope Commercial |
$17.65
|
| Rate for Payer: Healthscope Commercial |
$16.09
|
| Rate for Payer: Healthscope Commercial |
$145.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.21
|
| Rate for Payer: PHP Commercial |
$16.67
|
| Rate for Payer: PHP Commercial |
$24.21
|
| Rate for Payer: PHP Commercial |
$15.20
|
| Rate for Payer: PHP Commercial |
$137.28
|
| Rate for Payer: PHP Commercial |
$27.67
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.62
|
| Rate for Payer: Priority Health SBD |
$20.51
|
| Rate for Payer: Priority Health SBD |
$11.26
|
| Rate for Payer: Priority Health SBD |
$12.35
|
| Rate for Payer: Priority Health SBD |
$17.94
|
| Rate for Payer: Priority Health SBD |
$101.75
|
| Rate for Payer: Priority Health SBD |
$5.44
|
| Rate for Payer: UMR Bronson Commercial |
$12.04
|
| Rate for Payer: UMR Bronson Commercial |
$3.19
|
| Rate for Payer: UMR Bronson Commercial |
$7.26
|
| Rate for Payer: UMR Bronson Commercial |
$59.76
|
| Rate for Payer: UMR Bronson Commercial |
$6.62
|
| Rate for Payer: UMR Bronson Commercial |
$10.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.36
|
|
|
LORAZEPAM 2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$32.55
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
10467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$29.30 |
| Rate for Payer: Aetna American Axle |
$21.16
|
| Rate for Payer: Aetna American Axle |
$104.98
|
| Rate for Payer: Aetna American Axle |
$5.61
|
| Rate for Payer: Aetna American Axle |
$12.75
|
| Rate for Payer: Aetna American Axle |
$11.62
|
| Rate for Payer: Aetna American Axle |
$18.51
|
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Commercial |
$27.67
|
| Rate for Payer: Aetna Commercial |
$16.67
|
| Rate for Payer: Aetna Commercial |
$137.28
|
| Rate for Payer: Aetna Commercial |
$24.21
|
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.16
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cash Price |
$15.69
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cash Price |
$129.21
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$26.04
|
| Rate for Payer: Cofinity Commercial |
$27.99
|
| Rate for Payer: Cofinity Commercial |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$13.73
|
| Rate for Payer: Cofinity Commercial |
$15.38
|
| Rate for Payer: Cofinity Commercial |
$12.52
|
| Rate for Payer: Cofinity Commercial |
$22.78
|
| Rate for Payer: Cofinity Commercial |
$113.06
|
| Rate for Payer: Cofinity Commercial |
$138.90
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Cofinity Commercial |
$7.42
|
| Rate for Payer: Cofinity Commercial |
$6.04
|
| Rate for Payer: Cofinity Commercial |
$24.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.69
|
| Rate for Payer: Healthscope Commercial |
$16.09
|
| Rate for Payer: Healthscope Commercial |
$25.63
|
| Rate for Payer: Healthscope Commercial |
$145.36
|
| Rate for Payer: Healthscope Commercial |
$17.65
|
| Rate for Payer: Healthscope Commercial |
$29.30
|
| Rate for Payer: Healthscope Commercial |
$7.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.67
|
| Rate for Payer: PHP Commercial |
$27.67
|
| Rate for Payer: PHP Commercial |
$24.21
|
| Rate for Payer: PHP Commercial |
$137.28
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: PHP Commercial |
$16.67
|
| Rate for Payer: PHP Commercial |
$15.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.61
|
| Rate for Payer: Priority Health SBD |
$101.75
|
| Rate for Payer: Priority Health SBD |
$5.44
|
| Rate for Payer: Priority Health SBD |
$17.94
|
| Rate for Payer: Priority Health SBD |
$12.35
|
| Rate for Payer: Priority Health SBD |
$11.26
|
| Rate for Payer: Priority Health SBD |
$20.51
|
| Rate for Payer: UMR Bronson Commercial |
$14.32
|
| Rate for Payer: UMR Bronson Commercial |
$3.80
|
| Rate for Payer: UMR Bronson Commercial |
$7.87
|
| Rate for Payer: UMR Bronson Commercial |
$71.06
|
| Rate for Payer: UMR Bronson Commercial |
$12.53
|
| Rate for Payer: UMR Bronson Commercial |
$8.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.36
|
|
|
LORAZEPAM 2 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$17.86
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
112180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$16.07 |
| Rate for Payer: Aetna American Axle |
$11.61
|
| Rate for Payer: Aetna Commercial |
$15.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.61
|
| Rate for Payer: Cash Price |
$14.29
|
| Rate for Payer: Cofinity Commercial |
$12.50
|
| Rate for Payer: Cofinity Commercial |
$15.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.29
|
| Rate for Payer: Healthscope Commercial |
$16.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.18
|
| Rate for Payer: PHP Commercial |
$15.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.61
|
| Rate for Payer: Priority Health SBD |
$11.25
|
| Rate for Payer: UMR Bronson Commercial |
$7.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.40
|
|
|
LORAZEPAM 2 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$17.86
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
112180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$16.07 |
| Rate for Payer: Aetna American Axle |
$11.61
|
| Rate for Payer: Aetna Commercial |
$15.18
|
| Rate for Payer: Aetna Medicare |
$8.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.61
|
| Rate for Payer: BCBS Complete |
$7.14
|
| Rate for Payer: BCBS Trust/PPO |
$3.92
|
| Rate for Payer: BCN Commercial |
$3.92
|
| Rate for Payer: Cash Price |
$14.29
|
| Rate for Payer: Cash Price |
$14.29
|
| Rate for Payer: Cofinity Commercial |
$12.50
|
| Rate for Payer: Cofinity Commercial |
$15.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.29
|
| Rate for Payer: Healthscope Commercial |
$16.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.18
|
| Rate for Payer: PHP Commercial |
$15.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.61
|
| Rate for Payer: Priority Health SBD |
$11.25
|
| Rate for Payer: UMR Bronson Commercial |
$6.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.40
|
|
|
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 Commercial |
$162.29
|
| Rate for Payer: Cofinity Commercial |
$199.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.29
|
| 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: PHP Commercial |
$197.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.70
|
| 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
|
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 Commercial |
$162.29
|
| Rate for Payer: Cofinity Commercial |
$199.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.29
|
| 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: PHP Commercial |
$197.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.70
|
| Rate for Payer: Priority Health SBD |
$146.06
|
| 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
|
IP
|
$244.65
|
|
|
Service Code
|
NDC 00121077001
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.65 |
| Max. Negotiated Rate |
$220.18 |
| Rate for Payer: Aetna American Axle |
$159.02
|
| Rate for Payer: Aetna Commercial |
$207.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.02
|
| Rate for Payer: Cash Price |
$195.72
|
| Rate for Payer: Cofinity Commercial |
$171.26
|
| Rate for Payer: Cofinity Commercial |
$210.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.72
|
| Rate for Payer: Healthscope Commercial |
$220.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.95
|
| Rate for Payer: PHP Commercial |
$207.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.02
|
| Rate for Payer: Priority Health SBD |
$154.13
|
| Rate for Payer: UMR Bronson Commercial |
$107.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.49
|
|
