|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$2.60
|
|
|
Service Code
|
NDC 09900000008
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna American Axle |
$1.69
|
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: Aetna Medicare |
$1.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.69
|
| Rate for Payer: BCBS Complete |
$1.04
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Healthscope Commercial |
$2.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.21
|
| Rate for Payer: PHP Commercial |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.69
|
| Rate for Payer: Priority Health SBD |
$1.64
|
| Rate for Payer: UMR Bronson Commercial |
$0.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.95
|
|
|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$311.33
|
|
|
Service Code
|
NDC 00054353244
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.19 |
| Max. Negotiated Rate |
$280.20 |
| Rate for Payer: Aetna American Axle |
$202.36
|
| Rate for Payer: Aetna Commercial |
$264.63
|
| Rate for Payer: Aetna Medicare |
$155.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.36
|
| Rate for Payer: BCBS Complete |
$124.53
|
| Rate for Payer: Cash Price |
$249.06
|
| Rate for Payer: Cofinity Commercial |
$217.93
|
| Rate for Payer: Cofinity Commercial |
$267.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$217.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.06
|
| Rate for Payer: Healthscope Commercial |
$280.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.63
|
| Rate for Payer: PHP Commercial |
$264.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.36
|
| Rate for Payer: Priority Health SBD |
$196.14
|
| Rate for Payer: UMR Bronson Commercial |
$115.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.50
|
|
|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$311.33
|
|
|
Service Code
|
NDC 00054353244
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.99 |
| Max. Negotiated Rate |
$280.20 |
| Rate for Payer: Aetna American Axle |
$202.36
|
| Rate for Payer: Aetna Commercial |
$264.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.36
|
| Rate for Payer: Cash Price |
$249.06
|
| Rate for Payer: Cofinity Commercial |
$217.93
|
| Rate for Payer: Cofinity Commercial |
$267.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$217.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.06
|
| Rate for Payer: Healthscope Commercial |
$280.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.63
|
| Rate for Payer: PHP Commercial |
$264.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.36
|
| Rate for Payer: Priority Health SBD |
$196.14
|
| Rate for Payer: UMR Bronson Commercial |
$136.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.50
|
|
|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$5.19
|
|
|
Service Code
|
NDC 09900000007
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna American Axle |
$3.37
|
| Rate for Payer: Aetna Commercial |
$4.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.37
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cofinity Commercial |
$3.63
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.15
|
| Rate for Payer: Healthscope Commercial |
$4.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.41
|
| Rate for Payer: PHP Commercial |
$4.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.37
|
| Rate for Payer: Priority Health SBD |
$3.27
|
| Rate for Payer: UMR Bronson Commercial |
$2.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.89
|
|
|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$244.65
|
|
|
Service Code
|
NDC 00121077001
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.52 |
| Max. Negotiated Rate |
$220.18 |
| Rate for Payer: Aetna American Axle |
$159.02
|
| Rate for Payer: Aetna Commercial |
$207.95
|
| Rate for Payer: Aetna Medicare |
$122.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.02
|
| Rate for Payer: BCBS Complete |
$97.86
|
| 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 |
$90.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.49
|
|
|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$5.19
|
|
|
Service Code
|
NDC 09900000007
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna American Axle |
$3.37
|
| Rate for Payer: Aetna Commercial |
$4.41
|
| Rate for Payer: Aetna Medicare |
$2.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.37
|
| Rate for Payer: BCBS Complete |
$2.08
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cofinity Commercial |
$3.63
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.15
|
| Rate for Payer: Healthscope Commercial |
$4.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.41
|
| Rate for Payer: PHP Commercial |
$4.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.37
|
| Rate for Payer: Priority Health SBD |
$3.27
|
| Rate for Payer: UMR Bronson Commercial |
$1.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.89
|
|
|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$15.93
|
|
|
Service Code
|
NDC 09900000697
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$14.34 |
| Rate for Payer: Aetna American Axle |
$10.35
|
| Rate for Payer: Aetna Commercial |
$13.54
|
| Rate for Payer: Aetna Medicare |
$7.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.35
|
| Rate for Payer: BCBS Complete |
$6.37
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$11.15
|
| Rate for Payer: Cofinity Commercial |
$13.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$14.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.54
|
| Rate for Payer: PHP Commercial |
$13.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.35
|
| Rate for Payer: Priority Health SBD |
$10.04
|
| Rate for Payer: UMR Bronson Commercial |
$5.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.95
|
|
|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$2.60
|
|
|
Service Code
|
NDC 09900000008
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna American Axle |
$1.69
|
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.69
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Healthscope Commercial |
$2.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.21
|
| Rate for Payer: PHP Commercial |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.69
|
| Rate for Payer: Priority Health SBD |
$1.64
|
| Rate for Payer: UMR Bronson Commercial |
$1.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.95
|
|
|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$15.93
|
|
|
Service Code
|
NDC 09900000697
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$14.34 |
| Rate for Payer: Aetna American Axle |
$10.35
|
| Rate for Payer: Aetna Commercial |
$13.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.35
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$11.15
|
| Rate for Payer: Cofinity Commercial |
$13.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$14.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.54
|
| Rate for Payer: PHP Commercial |
$13.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.35
|
| Rate for Payer: Priority Health SBD |
$10.04
|
| Rate for Payer: UMR Bronson Commercial |
$7.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.95
|
|
|
LORAZEPAM (BULK) 100 % POWDER
|
Facility
|
OP
|
$122.61
|
|
|
Service Code
|
NDC 38779092703
|
| Hospital Charge Code |
26060
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$110.35 |
| Rate for Payer: Aetna Medicare |
$61.30
|
| Rate for Payer: Aetna American Axle |
$79.70
|
| Rate for Payer: Aetna Commercial |
$104.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.70
|
| Rate for Payer: BCBS Complete |
$49.04
|
| Rate for Payer: Cash Price |
$98.09
|
| Rate for Payer: Cofinity Commercial |
$105.44
|
| Rate for Payer: Cofinity Commercial |
$85.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.09
|
| Rate for Payer: Healthscope Commercial |
$110.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.22
|
| Rate for Payer: PHP Commercial |
$104.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.70
|
| Rate for Payer: Priority Health SBD |
$77.24
|
| Rate for Payer: UMR Bronson Commercial |
$45.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.96
|
|
|
LORAZEPAM (BULK) 100 % POWDER
|
Facility
|
IP
|
$122.61
|
|
|
Service Code
|
NDC 38779092703
|
| Hospital Charge Code |
26060
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.95 |
| Max. Negotiated Rate |
$110.35 |
| Rate for Payer: Aetna American Axle |
$79.70
|
| Rate for Payer: Aetna Commercial |
$104.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.70
|
| Rate for Payer: Cash Price |
$98.09
|
| Rate for Payer: Cofinity Commercial |
$105.44
|
| Rate for Payer: Cofinity Commercial |
$85.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.09
|
| Rate for Payer: Healthscope Commercial |
$110.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.22
|
| Rate for Payer: PHP Commercial |
$104.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.70
|
| Rate for Payer: Priority Health SBD |
$77.24
|
| Rate for Payer: UMR Bronson Commercial |
$53.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.96
|
|
|
LORAZEPAM IV 0.5 MG/ML INJECTION (NICU)
|
Facility
|
OP
|
$30.90
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
500547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$27.81 |
| Rate for Payer: Aetna American Axle |
$20.08
|
| Rate for Payer: Aetna Commercial |
$26.26
|
| Rate for Payer: Aetna Medicare |
$15.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.08
|
| Rate for Payer: BCBS Complete |
$12.36
|
| Rate for Payer: BCBS Trust/PPO |
$3.92
|
| Rate for Payer: BCN Commercial |
$3.92
|
| Rate for Payer: Cash Price |
$24.72
|
| Rate for Payer: Cash Price |
$24.72
|
| Rate for Payer: Cofinity Commercial |
$21.63
|
| Rate for Payer: Cofinity Commercial |
$26.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.72
|
| Rate for Payer: Healthscope Commercial |
$27.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.26
|
| Rate for Payer: PHP Commercial |
$26.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.08
|
| Rate for Payer: Priority Health SBD |
$19.47
|
| Rate for Payer: UMR Bronson Commercial |
$11.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.18
|
|
|
LORAZEPAM IV 0.5 MG/ML INJECTION (NICU)
|
Facility
|
IP
|
$30.90
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
500547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$27.81 |
| Rate for Payer: Aetna American Axle |
$20.08
|
| Rate for Payer: Aetna Commercial |
$26.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.08
|
| Rate for Payer: Cash Price |
$24.72
|
| Rate for Payer: Cofinity Commercial |
$21.63
|
| Rate for Payer: Cofinity Commercial |
$26.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.72
|
| Rate for Payer: Healthscope Commercial |
$27.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.26
|
| Rate for Payer: PHP Commercial |
$26.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.08
|
| Rate for Payer: Priority Health SBD |
$19.47
|
| Rate for Payer: UMR Bronson Commercial |
$13.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.18
|
|
|
LOSARTAN 12.5 MG CUSTOM TABLET
|
Facility
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 09900002009
|
| Hospital Charge Code |
301934
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.04 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.58
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna Medicare |
$152.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.58
|
| Rate for Payer: BCBS Complete |
$122.20
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.58
|
| Rate for Payer: Priority Health SBD |
$192.46
|
| Rate for Payer: UMR Bronson Commercial |
$113.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
LOSARTAN 12.5 MG CUSTOM TABLET
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 09900002009
|
| Hospital Charge Code |
301934
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.58
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.58
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.58
|
| Rate for Payer: Priority Health SBD |
$192.46
|
| Rate for Payer: UMR Bronson Commercial |
$134.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$2.08
|
|
|
Service Code
|
NDC 50268050411
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna American Axle |
$1.35
|
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.46
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: Priority Health SBD |
$1.31
|
| Rate for Payer: UMR Bronson Commercial |
$0.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.56
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
OP
|
$339.15
|
|
|
Service Code
|
NDC 68084034601
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.49 |
| Max. Negotiated Rate |
$305.24 |
| Rate for Payer: Aetna American Axle |
$220.45
|
| Rate for Payer: Aetna Commercial |
$288.28
|
| Rate for Payer: Aetna Medicare |
$169.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.45
|
| Rate for Payer: BCBS Complete |
$135.66
|
| Rate for Payer: Cash Price |
$271.32
|
| Rate for Payer: Cofinity Commercial |
$237.40
|
| Rate for Payer: Cofinity Commercial |
$291.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$237.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.32
|
| Rate for Payer: Healthscope Commercial |
$305.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$237.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.28
|
| Rate for Payer: PHP Commercial |
$288.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.45
|
| Rate for Payer: Priority Health SBD |
$213.66
|
| Rate for Payer: UMR Bronson Commercial |
$125.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.36
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$339.15
|
|
|
Service Code
|
NDC 68084034601
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.23 |
| Max. Negotiated Rate |
$305.24 |
| Rate for Payer: Aetna American Axle |
$220.45
|
| Rate for Payer: Aetna Commercial |
$288.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.45
|
| Rate for Payer: Cash Price |
$271.32
|
| Rate for Payer: Cofinity Commercial |
$237.40
|
| Rate for Payer: Cofinity Commercial |
$291.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$237.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.32
|
| Rate for Payer: Healthscope Commercial |
$305.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$237.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.28
|
| Rate for Payer: PHP Commercial |
$288.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.45
|
| Rate for Payer: Priority Health SBD |
$213.66
|
| Rate for Payer: UMR Bronson Commercial |
$149.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.36
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$417.05
|
|
|
Service Code
|
NDC 63739067310
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.50 |
| Max. Negotiated Rate |
$375.34 |
| Rate for Payer: Aetna American Axle |
$271.08
|
| Rate for Payer: Aetna Commercial |
$354.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.08
|
| Rate for Payer: Cash Price |
$333.64
|
| Rate for Payer: Cofinity Commercial |
$291.94
|
| Rate for Payer: Cofinity Commercial |
$358.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$291.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.64
|
| Rate for Payer: Healthscope Commercial |
$375.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.49
|
| Rate for Payer: PHP Commercial |
$354.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.08
|
| Rate for Payer: Priority Health SBD |
$262.74
|
| Rate for Payer: UMR Bronson Commercial |
$183.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.79
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
NDC 68084034611
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna American Axle |
$2.21
|
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.21
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
OP
|
$63.45
|
|
|
Service Code
|
NDC 65862020190
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$57.10 |
| Rate for Payer: Aetna American Axle |
$41.24
|
| Rate for Payer: Aetna Commercial |
$53.93
|
| Rate for Payer: Aetna Medicare |
$31.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.24
|
| Rate for Payer: BCBS Complete |
$25.38
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cofinity Commercial |
$44.42
|
| Rate for Payer: Cofinity Commercial |
$54.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Healthscope Commercial |
$57.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.93
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.24
|
| Rate for Payer: Priority Health SBD |
$39.97
|
| Rate for Payer: UMR Bronson Commercial |
$23.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.59
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
OP
|
$2.08
|
|
|
Service Code
|
NDC 50268050411
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna American Axle |
$1.35
|
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Aetna Medicare |
$1.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: BCBS Complete |
$0.83
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.46
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: Priority Health SBD |
$1.31
|
| Rate for Payer: UMR Bronson Commercial |
$0.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.56
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$103.55
|
|
|
Service Code
|
NDC 50268050415
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.56 |
| Max. Negotiated Rate |
$93.20 |
| Rate for Payer: Aetna American Axle |
$67.31
|
| Rate for Payer: Aetna Commercial |
$88.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.31
|
| Rate for Payer: Cash Price |
$82.84
|
| Rate for Payer: Cofinity Commercial |
$72.48
|
| Rate for Payer: Cofinity Commercial |
$89.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.84
|
| Rate for Payer: Healthscope Commercial |
$93.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.02
|
| Rate for Payer: PHP Commercial |
$88.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.31
|
| Rate for Payer: Priority Health SBD |
$65.24
|
| Rate for Payer: UMR Bronson Commercial |
$45.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.66
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
OP
|
$417.05
|
|
|
Service Code
|
NDC 63739067310
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$375.34 |
| Rate for Payer: Aetna American Axle |
$271.08
|
| Rate for Payer: Aetna Commercial |
$354.49
|
| Rate for Payer: Aetna Medicare |
$208.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.08
|
| Rate for Payer: BCBS Complete |
$166.82
|
| Rate for Payer: Cash Price |
$333.64
|
| Rate for Payer: Cofinity Commercial |
$291.94
|
| Rate for Payer: Cofinity Commercial |
$358.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$291.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.64
|
| Rate for Payer: Healthscope Commercial |
$375.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.49
|
| Rate for Payer: PHP Commercial |
$354.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.08
|
| Rate for Payer: Priority Health SBD |
$262.74
|
| Rate for Payer: UMR Bronson Commercial |
$154.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.79
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$63.45
|
|
|
Service Code
|
NDC 65862020190
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.92 |
| Max. Negotiated Rate |
$57.10 |
| Rate for Payer: Aetna American Axle |
$41.24
|
| Rate for Payer: Aetna Commercial |
$53.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.24
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cofinity Commercial |
$44.42
|
| Rate for Payer: Cofinity Commercial |
$54.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Healthscope Commercial |
$57.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.93
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.24
|
| Rate for Payer: Priority Health SBD |
$39.97
|
| Rate for Payer: UMR Bronson Commercial |
$27.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.59
|
|
