|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$2.33
|
|
|
Service Code
|
NDC 51079024601
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna Medicare |
$0.86
|
| Rate for Payer: ASR ASR |
$2.26
|
| Rate for Payer: BCBS Complete |
$0.93
|
| Rate for Payer: BCBS Trust/PPO |
$1.92
|
| Rate for Payer: BCN Commercial |
$1.92
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Healthscope Commercial |
$2.26
|
| Rate for Payer: Healthscope Whirlpool |
$2.33
|
| Rate for Payer: Mclaren Commercial |
$2.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.98
|
| Rate for Payer: Nomi Health Commercial |
$1.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.04
|
| Rate for Payer: Priority Health Narrow Network |
$1.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.05
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$232.75
|
|
|
Service Code
|
NDC 51079024620
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.12 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna Commercial |
$209.47
|
| Rate for Payer: Aetna Medicare |
$86.12
|
| Rate for Payer: ASR ASR |
$225.77
|
| Rate for Payer: BCBS Complete |
$93.10
|
| Rate for Payer: BCBS Trust/PPO |
$191.90
|
| Rate for Payer: BCN Commercial |
$191.90
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$225.77
|
| Rate for Payer: Healthscope Whirlpool |
$232.75
|
| Rate for Payer: Mclaren Commercial |
$209.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$203.94
|
| Rate for Payer: Priority Health Narrow Network |
$163.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$204.82
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$211.85
|
|
|
Service Code
|
NDC 904685261
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.89 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Aetna Commercial |
$190.66
|
| Rate for Payer: ASR ASR |
$205.49
|
| Rate for Payer: BCBS Trust/PPO |
$173.97
|
| Rate for Payer: BCN Commercial |
$173.97
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Cofinity Commercial |
$199.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.48
|
| Rate for Payer: Healthscope Commercial |
$205.49
|
| Rate for Payer: Healthscope Whirlpool |
$211.85
|
| Rate for Payer: Mclaren Commercial |
$190.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: Nomi Health Commercial |
$173.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.43
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$2.33
|
|
|
Service Code
|
NDC 51079024601
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: ASR ASR |
$2.26
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Healthscope Commercial |
$2.26
|
| Rate for Payer: Healthscope Whirlpool |
$2.33
|
| Rate for Payer: Mclaren Commercial |
$2.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.98
|
| Rate for Payer: Nomi Health Commercial |
$1.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.05
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$232.75
|
|
|
Service Code
|
NDC 68084024801
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.12 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna Commercial |
$209.47
|
| Rate for Payer: Aetna Medicare |
$86.12
|
| Rate for Payer: ASR ASR |
$225.77
|
| Rate for Payer: BCBS Complete |
$93.10
|
| Rate for Payer: BCBS Trust/PPO |
$191.90
|
| Rate for Payer: BCN Commercial |
$191.90
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$225.77
|
| Rate for Payer: Healthscope Whirlpool |
$232.75
|
| Rate for Payer: Mclaren Commercial |
$209.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$203.94
|
| Rate for Payer: Priority Health Narrow Network |
$163.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$204.82
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$232.75
|
|
|
Service Code
|
NDC 68084024811
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.56 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna Commercial |
$209.47
|
| Rate for Payer: ASR ASR |
$225.77
|
| Rate for Payer: BCBS Trust/PPO |
$191.13
|
| Rate for Payer: BCN Commercial |
$191.13
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$225.77
|
| Rate for Payer: Healthscope Whirlpool |
$232.75
|
| Rate for Payer: Mclaren Commercial |
$209.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$204.82
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$232.75
|
|
|
Service Code
|
NDC 51079024620
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.56 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna Commercial |
$209.47
|
| Rate for Payer: ASR ASR |
$225.77
|
| Rate for Payer: BCBS Trust/PPO |
$191.13
|
| Rate for Payer: BCN Commercial |
$191.13
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$225.77
|
| Rate for Payer: Healthscope Whirlpool |
$232.75
|
| Rate for Payer: Mclaren Commercial |
$209.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$204.82
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$232.75
|
|
|
Service Code
|
NDC 68084024811
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.12 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna Commercial |
$209.47
|
| Rate for Payer: Aetna Medicare |
$86.12
|
| Rate for Payer: ASR ASR |
$225.77
|
| Rate for Payer: BCBS Complete |
$93.10
|
| Rate for Payer: BCBS Trust/PPO |
$191.90
|
| Rate for Payer: BCN Commercial |
$191.90
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$225.77
|
| Rate for Payer: Healthscope Whirlpool |
$232.75
|
| Rate for Payer: Mclaren Commercial |
$209.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$203.94
|
| Rate for Payer: Priority Health Narrow Network |
$163.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$204.82
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$232.75
|
|
|
Service Code
|
NDC 68084024801
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.56 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna Commercial |
$209.47
|
| Rate for Payer: ASR ASR |
$225.77
|
| Rate for Payer: BCBS Trust/PPO |
$191.13
|
| Rate for Payer: BCN Commercial |
$191.13
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$225.77
|
| Rate for Payer: Healthscope Whirlpool |
$232.75
|
| Rate for Payer: Mclaren Commercial |
$209.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$204.82
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$211.85
|
|
|
Service Code
|
NDC 904685261
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Aetna Commercial |
$190.66
|
| Rate for Payer: Aetna Medicare |
$78.38
|
| Rate for Payer: ASR ASR |
$205.49
|
| Rate for Payer: BCBS Complete |
$84.74
|
| Rate for Payer: BCBS Trust/PPO |
$174.67
|
| Rate for Payer: BCN Commercial |
$174.67
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Cofinity Commercial |
$199.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.48
|
| Rate for Payer: Healthscope Commercial |
$205.49
|
| Rate for Payer: Healthscope Whirlpool |
$211.85
|
| Rate for Payer: Mclaren Commercial |
$190.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: Nomi Health Commercial |
$173.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$185.62
|
| Rate for Payer: Priority Health Narrow Network |
$148.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.43
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$129.50
|
|
|
Service Code
|
NDC 904600761
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.91 |
| Max. Negotiated Rate |
$129.50 |
| Rate for Payer: Aetna Commercial |
$116.55
|
| Rate for Payer: Aetna Medicare |
$47.91
|
| Rate for Payer: ASR ASR |
$125.61
|
| Rate for Payer: BCBS Complete |
$51.80
|
| Rate for Payer: BCBS Trust/PPO |
$106.77
|
| Rate for Payer: BCN Commercial |
$106.77
|
| Rate for Payer: Cash Price |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$121.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.60
|
| Rate for Payer: Healthscope Commercial |
$125.61
|
| Rate for Payer: Healthscope Whirlpool |
$129.50
|
| Rate for Payer: Mclaren Commercial |
$116.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.08
|
| Rate for Payer: Nomi Health Commercial |
$106.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$113.47
|
| Rate for Payer: Priority Health Narrow Network |
$90.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.96
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
NDC 69315090405
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$283.50
|
| Rate for Payer: ASR ASR |
$305.55
|
| Rate for Payer: BCBS Trust/PPO |
$258.68
|
| Rate for Payer: BCN Commercial |
$258.68
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$296.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.00
|
| Rate for Payer: Healthscope Commercial |
$305.55
|
| Rate for Payer: Healthscope Whirlpool |
$315.00
|
| Rate for Payer: Mclaren Commercial |
$283.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.75
|
| Rate for Payer: Nomi Health Commercial |
$258.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.20
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$129.50
|
|
|
Service Code
|
NDC 904600761
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.12 |
| Max. Negotiated Rate |
$129.50 |
| Rate for Payer: Aetna Commercial |
$116.55
|
| Rate for Payer: ASR ASR |
$125.61
|
| Rate for Payer: BCBS Trust/PPO |
$106.35
|
| Rate for Payer: BCN Commercial |
$106.35
|
| Rate for Payer: Cash Price |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$121.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.60
|
| Rate for Payer: Healthscope Commercial |
$125.61
|
| Rate for Payer: Healthscope Whirlpool |
$129.50
|
| Rate for Payer: Mclaren Commercial |
$116.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.08
|
| Rate for Payer: Nomi Health Commercial |
$106.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.96
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
NDC 69315090405
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.55 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$283.50
|
| Rate for Payer: Aetna Medicare |
$116.55
|
| Rate for Payer: ASR ASR |
$305.55
|
| Rate for Payer: BCBS Complete |
$126.00
|
| Rate for Payer: BCBS Trust/PPO |
$259.72
|
| Rate for Payer: BCN Commercial |
$259.72
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$296.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.00
|
| Rate for Payer: Healthscope Commercial |
$305.55
|
| Rate for Payer: Healthscope Whirlpool |
$315.00
|
| Rate for Payer: Mclaren Commercial |
$283.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.75
|
| Rate for Payer: Nomi Health Commercial |
$258.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$276.00
|
| Rate for Payer: Priority Health Narrow Network |
$220.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.20
|
|
|
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 |
$217.00 |
| Rate for Payer: Aetna Commercial |
$195.30
|
| Rate for Payer: Aetna Medicare |
$80.29
|
| Rate for Payer: ASR ASR |
$210.49
|
| Rate for Payer: BCBS Complete |
$86.80
|
| Rate for Payer: BCBS Trust/PPO |
$178.92
|
| Rate for Payer: BCN Commercial |
$178.92
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cofinity Commercial |
$203.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.60
|
| Rate for Payer: Healthscope Commercial |
$210.49
|
| Rate for Payer: Healthscope Whirlpool |
$217.00
|
| Rate for Payer: Mclaren Commercial |
$195.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.45
|
| Rate for Payer: Nomi Health Commercial |
$177.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$190.14
|
| Rate for Payer: Priority Health Narrow Network |
$152.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.96
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$150.50
|
|
|
Service Code
|
NDC 904600861
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.69 |
| Max. Negotiated Rate |
$150.50 |
| Rate for Payer: Aetna Commercial |
$135.45
|
| Rate for Payer: Aetna Medicare |
$55.69
|
| Rate for Payer: ASR ASR |
$145.99
|
| Rate for Payer: BCBS Complete |
$60.20
|
| Rate for Payer: BCBS Trust/PPO |
$124.09
|
| Rate for Payer: BCN Commercial |
$124.09
|
| Rate for Payer: Cash Price |
$120.40
|
| Rate for Payer: Cofinity Commercial |
$141.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.40
|
| Rate for Payer: Healthscope Commercial |
$145.99
|
| Rate for Payer: Healthscope Whirlpool |
$150.50
|
| Rate for Payer: Mclaren Commercial |
$135.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.92
|
| Rate for Payer: Nomi Health Commercial |
$123.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$131.87
|
| Rate for Payer: Priority Health Narrow Network |
$105.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.44
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$150.50
|
|
|
Service Code
|
NDC 904600861
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.88 |
| Max. Negotiated Rate |
$150.50 |
| Rate for Payer: Aetna Commercial |
$135.45
|
| Rate for Payer: ASR ASR |
$145.99
|
| Rate for Payer: BCBS Trust/PPO |
$123.59
|
| Rate for Payer: BCN Commercial |
$123.59
|
| Rate for Payer: Cash Price |
$120.40
|
| Rate for Payer: Cofinity Commercial |
$141.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.40
|
| Rate for Payer: Healthscope Commercial |
$145.99
|
| Rate for Payer: Healthscope Whirlpool |
$150.50
|
| Rate for Payer: Mclaren Commercial |
$135.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.92
|
| Rate for Payer: Nomi Health Commercial |
$123.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.44
|
|
|
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 |
$2.17 |
| Rate for Payer: Aetna Commercial |
$1.95
|
| Rate for Payer: Aetna Medicare |
$0.80
|
| Rate for Payer: ASR ASR |
$2.10
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS Trust/PPO |
$1.79
|
| Rate for Payer: BCN Commercial |
$1.79
|
| Rate for Payer: Cash Price |
$1.74
|
| Rate for Payer: Cofinity Commercial |
$2.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.74
|
| Rate for Payer: Healthscope Commercial |
$2.10
|
| Rate for Payer: Healthscope Whirlpool |
$2.17
|
| Rate for Payer: Mclaren Commercial |
$1.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Nomi Health Commercial |
$1.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.90
|
| Rate for Payer: Priority Health Narrow Network |
$1.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.91
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
NDC 69315090501
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.21 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Medicare |
$49.21
|
| Rate for Payer: ASR ASR |
$129.01
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: BCBS Trust/PPO |
$109.66
|
| Rate for Payer: BCN Commercial |
$109.66
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$125.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.40
|
| Rate for Payer: Healthscope Commercial |
$129.01
|
| Rate for Payer: Healthscope Whirlpool |
$133.00
|
| Rate for Payer: Mclaren Commercial |
$119.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.05
|
| Rate for Payer: Nomi Health Commercial |
$109.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$116.53
|
| Rate for Payer: Priority Health Narrow Network |
$93.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.04
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
NDC 60687063801
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.75 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Aetna Commercial |
$195.30
|
| Rate for Payer: ASR ASR |
$210.49
|
| Rate for Payer: BCBS Trust/PPO |
$178.20
|
| Rate for Payer: BCN Commercial |
$178.20
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cofinity Commercial |
$203.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.60
|
| Rate for Payer: Healthscope Commercial |
$210.49
|
| Rate for Payer: Healthscope Whirlpool |
$217.00
|
| Rate for Payer: Mclaren Commercial |
$195.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.45
|
| Rate for Payer: Nomi Health Commercial |
$177.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.96
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$2.17
|
|
|
Service Code
|
NDC 60687063811
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Aetna Commercial |
$1.95
|
| Rate for Payer: ASR ASR |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$1.78
|
| Rate for Payer: BCN Commercial |
$1.78
|
| Rate for Payer: Cash Price |
$1.74
|
| Rate for Payer: Cofinity Commercial |
$2.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.74
|
| Rate for Payer: Healthscope Commercial |
$2.10
|
| Rate for Payer: Healthscope Whirlpool |
$2.17
|
| Rate for Payer: Mclaren Commercial |
$1.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Nomi Health Commercial |
$1.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.91
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
NDC 69315090501
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: ASR ASR |
$129.01
|
| Rate for Payer: BCBS Trust/PPO |
$109.22
|
| Rate for Payer: BCN Commercial |
$109.22
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$125.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.40
|
| Rate for Payer: Healthscope Commercial |
$129.01
|
| Rate for Payer: Healthscope Whirlpool |
$133.00
|
| Rate for Payer: Mclaren Commercial |
$119.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.05
|
| Rate for Payer: Nomi Health Commercial |
$109.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.04
|
|
|
LORAZEPAM 2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$18.24
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
10467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$18.24 |
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Aetna Commercial |
$25.62
|
| Rate for Payer: Aetna Commercial |
$148.35
|
| Rate for Payer: Aetna Commercial |
$13.36
|
| Rate for Payer: Aetna Commercial |
$19.04
|
| Rate for Payer: Aetna Medicare |
$10.53
|
| Rate for Payer: Aetna Medicare |
$5.49
|
| Rate for Payer: Aetna Medicare |
$7.83
|
| Rate for Payer: Aetna Medicare |
$6.75
|
| Rate for Payer: Aetna Medicare |
$60.99
|
| Rate for Payer: ASR ASR |
$17.69
|
| Rate for Payer: ASR ASR |
$27.62
|
| Rate for Payer: ASR ASR |
$20.53
|
| Rate for Payer: ASR ASR |
$159.89
|
| Rate for Payer: ASR ASR |
$14.39
|
| Rate for Payer: BCBS Complete |
$8.46
|
| Rate for Payer: BCBS Complete |
$5.94
|
| Rate for Payer: BCBS Complete |
$11.39
|
| Rate for Payer: BCBS Complete |
$7.30
|
| Rate for Payer: BCBS Complete |
$65.93
|
| Rate for Payer: BCBS Trust/PPO |
$12.24
|
| Rate for Payer: BCBS Trust/PPO |
$135.91
|
| Rate for Payer: BCBS Trust/PPO |
$17.45
|
| Rate for Payer: BCBS Trust/PPO |
$23.48
|
| Rate for Payer: BCBS Trust/PPO |
$15.04
|
| Rate for Payer: BCN Commercial |
$17.45
|
| Rate for Payer: BCN Commercial |
$135.91
|
| Rate for Payer: BCN Commercial |
$12.24
|
| Rate for Payer: BCN Commercial |
$23.48
|
| Rate for Payer: BCN Commercial |
$15.04
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Cash Price |
$14.59
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cash Price |
$131.87
|
| Rate for Payer: Cash Price |
$131.87
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cash Price |
$14.59
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cofinity Commercial |
$13.95
|
| Rate for Payer: Cofinity Commercial |
$26.76
|
| Rate for Payer: Cofinity Commercial |
$154.94
|
| Rate for Payer: Cofinity Commercial |
$17.15
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.87
|
| Rate for Payer: Healthscope Commercial |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$159.89
|
| Rate for Payer: Healthscope Commercial |
$27.62
|
| Rate for Payer: Healthscope Commercial |
$17.69
|
| Rate for Payer: Healthscope Commercial |
$20.53
|
| Rate for Payer: Healthscope Whirlpool |
$18.24
|
| Rate for Payer: Healthscope Whirlpool |
$14.84
|
| Rate for Payer: Healthscope Whirlpool |
$164.84
|
| Rate for Payer: Healthscope Whirlpool |
$28.47
|
| Rate for Payer: Healthscope Whirlpool |
$21.16
|
| Rate for Payer: Mclaren Commercial |
$148.35
|
| Rate for Payer: Mclaren Commercial |
$13.36
|
| Rate for Payer: Mclaren Commercial |
$25.62
|
| Rate for Payer: Mclaren Commercial |
$19.04
|
| Rate for Payer: Mclaren Commercial |
$16.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.50
|
| Rate for Payer: Nomi Health Commercial |
$135.16
|
| Rate for Payer: Nomi Health Commercial |
$12.17
|
| Rate for Payer: Nomi Health Commercial |
$23.35
|
| Rate for Payer: Nomi Health Commercial |
$17.35
|
| Rate for Payer: Nomi Health Commercial |
$14.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.46
|
| Rate for Payer: Priority Health Narrow Network |
$1.17
|
| Rate for Payer: Priority Health Narrow Network |
$1.17
|
| Rate for Payer: Priority Health Narrow Network |
$1.17
|
| Rate for Payer: Priority Health Narrow Network |
$1.17
|
| Rate for Payer: Priority Health Narrow Network |
$1.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.05
|
|
|
LORAZEPAM 2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$28.47
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
10467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.35 |
| Max. Negotiated Rate |
$28.47 |
| Rate for Payer: Aetna Commercial |
$25.62
|
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Aetna Commercial |
$19.04
|
| Rate for Payer: Aetna Commercial |
$148.35
|
| Rate for Payer: Aetna Commercial |
$13.36
|
| Rate for Payer: ASR ASR |
$17.69
|
| Rate for Payer: ASR ASR |
$14.39
|
| Rate for Payer: ASR ASR |
$27.62
|
| Rate for Payer: ASR ASR |
$159.89
|
| Rate for Payer: ASR ASR |
$20.53
|
| Rate for Payer: BCBS Trust/PPO |
$23.38
|
| Rate for Payer: BCBS Trust/PPO |
$135.36
|
| Rate for Payer: BCBS Trust/PPO |
$12.19
|
| Rate for Payer: BCBS Trust/PPO |
$17.38
|
| Rate for Payer: BCBS Trust/PPO |
$14.98
|
| Rate for Payer: BCN Commercial |
$14.98
|
| Rate for Payer: BCN Commercial |
$135.36
|
| Rate for Payer: BCN Commercial |
$17.38
|
| Rate for Payer: BCN Commercial |
$23.38
|
| Rate for Payer: BCN Commercial |
$12.19
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cash Price |
$14.59
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Cash Price |
$131.87
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cofinity Commercial |
$154.94
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Commercial |
$13.95
|
| Rate for Payer: Cofinity Commercial |
$17.15
|
| Rate for Payer: Cofinity Commercial |
$26.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.78
|
| Rate for Payer: Healthscope Commercial |
$17.69
|
| Rate for Payer: Healthscope Commercial |
$159.89
|
| Rate for Payer: Healthscope Commercial |
$20.53
|
| Rate for Payer: Healthscope Commercial |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$27.62
|
| Rate for Payer: Healthscope Whirlpool |
$21.16
|
| Rate for Payer: Healthscope Whirlpool |
$28.47
|
| Rate for Payer: Healthscope Whirlpool |
$14.84
|
| Rate for Payer: Healthscope Whirlpool |
$164.84
|
| Rate for Payer: Healthscope Whirlpool |
$18.24
|
| Rate for Payer: Mclaren Commercial |
$148.35
|
| Rate for Payer: Mclaren Commercial |
$19.04
|
| Rate for Payer: Mclaren Commercial |
$13.36
|
| Rate for Payer: Mclaren Commercial |
$25.62
|
| Rate for Payer: Mclaren Commercial |
$16.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.20
|
| Rate for Payer: Nomi Health Commercial |
$17.35
|
| Rate for Payer: Nomi Health Commercial |
$14.96
|
| Rate for Payer: Nomi Health Commercial |
$135.16
|
| Rate for Payer: Nomi Health Commercial |
$12.17
|
| Rate for Payer: Nomi Health Commercial |
$23.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.06
|
|
|
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 |
$13.39 |
| Max. Negotiated Rate |
$17.86 |
| Rate for Payer: Aetna Commercial |
$16.07
|
| Rate for Payer: ASR ASR |
$17.32
|
| Rate for Payer: BCBS Trust/PPO |
$14.66
|
| Rate for Payer: BCN Commercial |
$14.66
|
| Rate for Payer: Cash Price |
$14.29
|
| Rate for Payer: Cofinity Commercial |
$16.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.29
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Whirlpool |
$17.86
|
| Rate for Payer: Mclaren Commercial |
$16.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.18
|
| Rate for Payer: Nomi Health Commercial |
$14.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.71
|
|
