|
LOSARTAN 25 MG TABLET
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
NDC 68084034611
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna American Axle |
$2.21
|
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna Medicare |
$1.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: BCBS Complete |
$1.36
|
| 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 |
$1.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
OP
|
$103.55
|
|
|
Service Code
|
NDC 50268050415
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.31 |
| Max. Negotiated Rate |
$93.20 |
| Rate for Payer: Aetna American Axle |
$67.31
|
| Rate for Payer: Aetna Commercial |
$88.02
|
| Rate for Payer: Aetna Medicare |
$51.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.31
|
| Rate for Payer: BCBS Complete |
$41.42
|
| 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 |
$38.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.66
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
OP
|
$57.11
|
|
|
Service Code
|
NDC 65862020290
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.13 |
| Max. Negotiated Rate |
$51.40 |
| Rate for Payer: Aetna American Axle |
$37.12
|
| Rate for Payer: Aetna Commercial |
$48.54
|
| Rate for Payer: Aetna Medicare |
$28.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.12
|
| Rate for Payer: BCBS Complete |
$22.84
|
| Rate for Payer: Cash Price |
$45.69
|
| Rate for Payer: Cofinity Commercial |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$49.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.69
|
| Rate for Payer: Healthscope Commercial |
$51.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.54
|
| Rate for Payer: PHP Commercial |
$48.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.12
|
| Rate for Payer: Priority Health SBD |
$35.98
|
| Rate for Payer: UMR Bronson Commercial |
$21.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.83
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$253.65
|
|
|
Service Code
|
NDC 68084034711
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.61 |
| Max. Negotiated Rate |
$228.28 |
| Rate for Payer: Aetna American Axle |
$164.87
|
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.87
|
| Rate for Payer: Cash Price |
$202.92
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Cofinity Commercial |
$218.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.92
|
| Rate for Payer: Healthscope Commercial |
$228.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.60
|
| Rate for Payer: PHP Commercial |
$215.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.87
|
| Rate for Payer: Priority Health SBD |
$159.80
|
| Rate for Payer: UMR Bronson Commercial |
$111.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.24
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
OP
|
$253.65
|
|
|
Service Code
|
NDC 68084034711
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.85 |
| Max. Negotiated Rate |
$228.28 |
| Rate for Payer: Aetna American Axle |
$164.87
|
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Aetna Medicare |
$126.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.87
|
| Rate for Payer: BCBS Complete |
$101.46
|
| Rate for Payer: Cash Price |
$202.92
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Cofinity Commercial |
$218.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.92
|
| Rate for Payer: Healthscope Commercial |
$228.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.60
|
| Rate for Payer: PHP Commercial |
$215.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.87
|
| Rate for Payer: Priority Health SBD |
$159.80
|
| Rate for Payer: UMR Bronson Commercial |
$93.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.24
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$327.83
|
|
|
Service Code
|
NDC 43547036109
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.25 |
| Max. Negotiated Rate |
$295.05 |
| Rate for Payer: Aetna American Axle |
$213.09
|
| Rate for Payer: Aetna Commercial |
$278.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.09
|
| Rate for Payer: Cash Price |
$262.26
|
| Rate for Payer: Cofinity Commercial |
$229.48
|
| Rate for Payer: Cofinity Commercial |
$281.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.26
|
| Rate for Payer: Healthscope Commercial |
$295.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.66
|
| Rate for Payer: PHP Commercial |
$278.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.09
|
| Rate for Payer: Priority Health SBD |
$206.53
|
| Rate for Payer: UMR Bronson Commercial |
$144.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.87
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$230.85
|
|
|
Service Code
|
NDC 00904704861
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.57 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna American Axle |
$150.05
|
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.05
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$161.60
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$161.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.05
|
| Rate for Payer: Priority Health SBD |
$145.44
|
| Rate for Payer: UMR Bronson Commercial |
$101.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$253.65
|
|
|
Service Code
|
NDC 68084034701
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.61 |
| Max. Negotiated Rate |
$228.28 |
| Rate for Payer: Aetna American Axle |
$164.87
|
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.87
|
| Rate for Payer: Cash Price |
$202.92
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Cofinity Commercial |
$218.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.92
|
| Rate for Payer: Healthscope Commercial |
$228.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.60
|
| Rate for Payer: PHP Commercial |
$215.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.87
|
| Rate for Payer: Priority Health SBD |
$159.80
|
| Rate for Payer: UMR Bronson Commercial |
$111.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.24
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$57.11
|
|
|
Service Code
|
NDC 65862020290
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$51.40 |
| Rate for Payer: Aetna American Axle |
$37.12
|
| Rate for Payer: Aetna Commercial |
$48.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.12
|
| Rate for Payer: Cash Price |
$45.69
|
| Rate for Payer: Cofinity Commercial |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$49.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.69
|
| Rate for Payer: Healthscope Commercial |
$51.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.54
|
| Rate for Payer: PHP Commercial |
$48.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.12
|
| Rate for Payer: Priority Health SBD |
$35.98
|
| Rate for Payer: UMR Bronson Commercial |
$25.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.83
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
OP
|
$327.83
|
|
|
Service Code
|
NDC 43547036109
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.30 |
| Max. Negotiated Rate |
$295.05 |
| Rate for Payer: Aetna American Axle |
$213.09
|
| Rate for Payer: Aetna Commercial |
$278.66
|
| Rate for Payer: Aetna Medicare |
$163.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.09
|
| Rate for Payer: BCBS Complete |
$131.13
|
| Rate for Payer: Cash Price |
$262.26
|
| Rate for Payer: Cofinity Commercial |
$229.48
|
| Rate for Payer: Cofinity Commercial |
$281.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.26
|
| Rate for Payer: Healthscope Commercial |
$295.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.66
|
| Rate for Payer: PHP Commercial |
$278.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.09
|
| Rate for Payer: Priority Health SBD |
$206.53
|
| Rate for Payer: UMR Bronson Commercial |
$121.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.87
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
OP
|
$253.65
|
|
|
Service Code
|
NDC 68084034701
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.85 |
| Max. Negotiated Rate |
$228.28 |
| Rate for Payer: Aetna American Axle |
$164.87
|
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Aetna Medicare |
$126.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.87
|
| Rate for Payer: BCBS Complete |
$101.46
|
| Rate for Payer: Cash Price |
$202.92
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Cofinity Commercial |
$218.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.92
|
| Rate for Payer: Healthscope Commercial |
$228.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.60
|
| Rate for Payer: PHP Commercial |
$215.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.87
|
| Rate for Payer: Priority Health SBD |
$159.80
|
| Rate for Payer: UMR Bronson Commercial |
$93.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.24
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
OP
|
$230.85
|
|
|
Service Code
|
NDC 00904704861
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna American Axle |
$150.05
|
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: Aetna Medicare |
$115.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.05
|
| Rate for Payer: BCBS Complete |
$92.34
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$161.60
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$161.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.05
|
| Rate for Payer: Priority Health SBD |
$145.44
|
| Rate for Payer: UMR Bronson Commercial |
$85.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
LOXAPINE SUCCINATE 10 MG CAPSULE
|
Facility
|
OP
|
$321.12
|
|
|
Service Code
|
NDC 00591037001
|
| Hospital Charge Code |
4599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.81 |
| Max. Negotiated Rate |
$289.01 |
| Rate for Payer: Aetna American Axle |
$208.73
|
| Rate for Payer: Aetna Commercial |
$272.95
|
| Rate for Payer: Aetna Medicare |
$160.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.73
|
| Rate for Payer: BCBS Complete |
$128.45
|
| Rate for Payer: Cash Price |
$256.90
|
| Rate for Payer: Cofinity Commercial |
$224.78
|
| Rate for Payer: Cofinity Commercial |
$276.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.90
|
| Rate for Payer: Healthscope Commercial |
$289.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.95
|
| Rate for Payer: PHP Commercial |
$272.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.73
|
| Rate for Payer: Priority Health SBD |
$202.31
|
| Rate for Payer: UMR Bronson Commercial |
$118.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.84
|
|
|
LOXAPINE SUCCINATE 10 MG CAPSULE
|
Facility
|
IP
|
$321.12
|
|
|
Service Code
|
NDC 00591037001
|
| Hospital Charge Code |
4599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.29 |
| Max. Negotiated Rate |
$289.01 |
| Rate for Payer: Aetna American Axle |
$208.73
|
| Rate for Payer: Aetna Commercial |
$272.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.73
|
| Rate for Payer: Cash Price |
$256.90
|
| Rate for Payer: Cofinity Commercial |
$224.78
|
| Rate for Payer: Cofinity Commercial |
$276.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.90
|
| Rate for Payer: Healthscope Commercial |
$289.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.95
|
| Rate for Payer: PHP Commercial |
$272.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.73
|
| Rate for Payer: Priority Health SBD |
$202.31
|
| Rate for Payer: UMR Bronson Commercial |
$141.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.84
|
|
|
LOXAPINE SUCCINATE 25 MG CAPSULE
|
Facility
|
OP
|
$488.16
|
|
|
Service Code
|
NDC 00591037101
|
| Hospital Charge Code |
4600
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.62 |
| Max. Negotiated Rate |
$439.34 |
| Rate for Payer: Aetna American Axle |
$317.30
|
| Rate for Payer: Aetna Commercial |
$414.94
|
| Rate for Payer: Aetna Medicare |
$244.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.30
|
| Rate for Payer: BCBS Complete |
$195.26
|
| Rate for Payer: Cash Price |
$390.53
|
| Rate for Payer: Cofinity Commercial |
$341.71
|
| Rate for Payer: Cofinity Commercial |
$419.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$341.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.53
|
| Rate for Payer: Healthscope Commercial |
$439.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$341.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$414.94
|
| Rate for Payer: PHP Commercial |
$414.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.30
|
| Rate for Payer: Priority Health SBD |
$307.54
|
| Rate for Payer: UMR Bronson Commercial |
$180.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.12
|
|
|
LOXAPINE SUCCINATE 25 MG CAPSULE
|
Facility
|
IP
|
$488.16
|
|
|
Service Code
|
NDC 00591037101
|
| Hospital Charge Code |
4600
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.79 |
| Max. Negotiated Rate |
$439.34 |
| Rate for Payer: Aetna American Axle |
$317.30
|
| Rate for Payer: Aetna Commercial |
$414.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.30
|
| Rate for Payer: Cash Price |
$390.53
|
| Rate for Payer: Cofinity Commercial |
$341.71
|
| Rate for Payer: Cofinity Commercial |
$419.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$341.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.53
|
| Rate for Payer: Healthscope Commercial |
$439.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$341.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$414.94
|
| Rate for Payer: PHP Commercial |
$414.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.30
|
| Rate for Payer: Priority Health SBD |
$307.54
|
| Rate for Payer: UMR Bronson Commercial |
$214.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.12
|
|
|
LOXAPINE SUCCINATE 25 MG CAPSULE
|
Facility
|
IP
|
$426.55
|
|
|
Service Code
|
NDC 00527139601
|
| Hospital Charge Code |
4600
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.68 |
| Max. Negotiated Rate |
$383.90 |
| Rate for Payer: Aetna American Axle |
$277.26
|
| Rate for Payer: Aetna Commercial |
$362.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.26
|
| Rate for Payer: Cash Price |
$341.24
|
| Rate for Payer: Cofinity Commercial |
$298.58
|
| Rate for Payer: Cofinity Commercial |
$366.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$298.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.24
|
| Rate for Payer: Healthscope Commercial |
$383.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.57
|
| Rate for Payer: PHP Commercial |
$362.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.26
|
| Rate for Payer: Priority Health SBD |
$268.73
|
| Rate for Payer: UMR Bronson Commercial |
$187.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.91
|
|
|
LOXAPINE SUCCINATE 25 MG CAPSULE
|
Facility
|
IP
|
$486.24
|
|
|
Service Code
|
NDC 00378702501
|
| Hospital Charge Code |
4600
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.95 |
| Max. Negotiated Rate |
$437.62 |
| Rate for Payer: Aetna American Axle |
$316.06
|
| Rate for Payer: Aetna Commercial |
$413.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.06
|
| Rate for Payer: Cash Price |
$388.99
|
| Rate for Payer: Cofinity Commercial |
$340.37
|
| Rate for Payer: Cofinity Commercial |
$418.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$340.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.99
|
| Rate for Payer: Healthscope Commercial |
$437.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$340.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.30
|
| Rate for Payer: PHP Commercial |
$413.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.06
|
| Rate for Payer: Priority Health SBD |
$306.33
|
| Rate for Payer: UMR Bronson Commercial |
$213.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.68
|
|
|
LOXAPINE SUCCINATE 25 MG CAPSULE
|
Facility
|
OP
|
$486.24
|
|
|
Service Code
|
NDC 00378702501
|
| Hospital Charge Code |
4600
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.91 |
| Max. Negotiated Rate |
$437.62 |
| Rate for Payer: Aetna American Axle |
$316.06
|
| Rate for Payer: Aetna Commercial |
$413.30
|
| Rate for Payer: Aetna Medicare |
$243.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.06
|
| Rate for Payer: BCBS Complete |
$194.50
|
| Rate for Payer: Cash Price |
$388.99
|
| Rate for Payer: Cofinity Commercial |
$340.37
|
| Rate for Payer: Cofinity Commercial |
$418.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$340.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.99
|
| Rate for Payer: Healthscope Commercial |
$437.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$340.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.30
|
| Rate for Payer: PHP Commercial |
$413.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.06
|
| Rate for Payer: Priority Health SBD |
$306.33
|
| Rate for Payer: UMR Bronson Commercial |
$179.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.68
|
|
|
LOXAPINE SUCCINATE 25 MG CAPSULE
|
Facility
|
OP
|
$426.55
|
|
|
Service Code
|
NDC 00527139601
|
| Hospital Charge Code |
4600
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.82 |
| Max. Negotiated Rate |
$383.90 |
| Rate for Payer: Aetna American Axle |
$277.26
|
| Rate for Payer: Aetna Commercial |
$362.57
|
| Rate for Payer: Aetna Medicare |
$213.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.26
|
| Rate for Payer: BCBS Complete |
$170.62
|
| Rate for Payer: Cash Price |
$341.24
|
| Rate for Payer: Cofinity Commercial |
$298.58
|
| Rate for Payer: Cofinity Commercial |
$366.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$298.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.24
|
| Rate for Payer: Healthscope Commercial |
$383.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.57
|
| Rate for Payer: PHP Commercial |
$362.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.26
|
| Rate for Payer: Priority Health SBD |
$268.73
|
| Rate for Payer: UMR Bronson Commercial |
$157.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.91
|
|
|
LOXAPINE SUCCINATE 5 MG CAPSULE
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
NDC 00527139401
|
| Hospital Charge Code |
4601
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.69 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Aetna American Axle |
$284.05
|
| Rate for Payer: Aetna Commercial |
$371.45
|
| Rate for Payer: Aetna Medicare |
$218.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.05
|
| Rate for Payer: BCBS Complete |
$174.80
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Cofinity Commercial |
$305.90
|
| Rate for Payer: Cofinity Commercial |
$375.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.60
|
| Rate for Payer: Healthscope Commercial |
$393.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.45
|
| Rate for Payer: PHP Commercial |
$371.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.05
|
| Rate for Payer: Priority Health SBD |
$275.31
|
| Rate for Payer: UMR Bronson Commercial |
$161.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.75
|
|
|
LOXAPINE SUCCINATE 5 MG CAPSULE
|
Facility
|
IP
|
$244.32
|
|
|
Service Code
|
NDC 00591036901
|
| Hospital Charge Code |
4601
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.50 |
| Max. Negotiated Rate |
$219.89 |
| Rate for Payer: Aetna American Axle |
$158.81
|
| Rate for Payer: Aetna Commercial |
$207.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.81
|
| Rate for Payer: Cash Price |
$195.46
|
| Rate for Payer: Cofinity Commercial |
$171.02
|
| Rate for Payer: Cofinity Commercial |
$210.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.46
|
| Rate for Payer: Healthscope Commercial |
$219.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.67
|
| Rate for Payer: PHP Commercial |
$207.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.81
|
| Rate for Payer: Priority Health SBD |
$153.92
|
| Rate for Payer: UMR Bronson Commercial |
$107.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.24
|
|
|
LOXAPINE SUCCINATE 5 MG CAPSULE
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
NDC 00527139401
|
| Hospital Charge Code |
4601
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.28 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Aetna American Axle |
$284.05
|
| Rate for Payer: Aetna Commercial |
$371.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.05
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Cofinity Commercial |
$305.90
|
| Rate for Payer: Cofinity Commercial |
$375.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.60
|
| Rate for Payer: Healthscope Commercial |
$393.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.45
|
| Rate for Payer: PHP Commercial |
$371.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.05
|
| Rate for Payer: Priority Health SBD |
$275.31
|
| Rate for Payer: UMR Bronson Commercial |
$192.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.75
|
|
|
LOXAPINE SUCCINATE 5 MG CAPSULE
|
Facility
|
OP
|
$244.32
|
|
|
Service Code
|
NDC 00591036901
|
| Hospital Charge Code |
4601
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$219.89 |
| Rate for Payer: Aetna American Axle |
$158.81
|
| Rate for Payer: Aetna Commercial |
$207.67
|
| Rate for Payer: Aetna Medicare |
$122.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.81
|
| Rate for Payer: BCBS Complete |
$97.73
|
| Rate for Payer: Cash Price |
$195.46
|
| Rate for Payer: Cofinity Commercial |
$171.02
|
| Rate for Payer: Cofinity Commercial |
$210.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.46
|
| Rate for Payer: Healthscope Commercial |
$219.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.67
|
| Rate for Payer: PHP Commercial |
$207.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.81
|
| Rate for Payer: Priority Health SBD |
$153.92
|
| Rate for Payer: UMR Bronson Commercial |
$90.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.24
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
OP
|
$281.38
|
|
|
Service Code
|
NDC 00254302802
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.11 |
| Max. Negotiated Rate |
$253.24 |
| Rate for Payer: Aetna American Axle |
$182.90
|
| Rate for Payer: Aetna Commercial |
$239.17
|
| Rate for Payer: Aetna Medicare |
$140.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.90
|
| Rate for Payer: BCBS Complete |
$112.55
|
| Rate for Payer: Cash Price |
$225.10
|
| Rate for Payer: Cofinity Commercial |
$196.97
|
| Rate for Payer: Cofinity Commercial |
$241.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.10
|
| Rate for Payer: Healthscope Commercial |
$253.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.17
|
| Rate for Payer: PHP Commercial |
$239.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.90
|
| Rate for Payer: Priority Health SBD |
$177.27
|
| Rate for Payer: UMR Bronson Commercial |
$104.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.04
|
|
