|
LIOTHYRONINE 5 MCG TABLET
|
Facility
|
OP
|
$245.28
|
|
|
Service Code
|
NDC 62756058988
|
| Hospital Charge Code |
10443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.11 |
| Max. Negotiated Rate |
$245.28 |
| Rate for Payer: Aetna Commercial |
$220.75
|
| Rate for Payer: Aetna Medicare |
$122.64
|
| Rate for Payer: ASR ASR |
$237.92
|
| Rate for Payer: ASR Commercial |
$237.92
|
| Rate for Payer: BCBS Complete |
$98.11
|
| Rate for Payer: BCBS Trust/PPO |
$200.86
|
| Rate for Payer: BCN Commercial |
$190.17
|
| Rate for Payer: Cash Price |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$230.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.22
|
| Rate for Payer: Healthscope Commercial |
$245.28
|
| Rate for Payer: Healthscope Whirlpool |
$237.92
|
| Rate for Payer: Mclaren Commercial |
$220.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.49
|
| Rate for Payer: Nomi Health Commercial |
$201.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.91
|
| Rate for Payer: Priority Health Narrow Network |
$171.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.85
|
|
|
LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL
|
Facility
|
OP
|
$2,832.72
|
|
|
Service Code
|
NDC 00032122401
|
| Hospital Charge Code |
98036
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,133.09 |
| Max. Negotiated Rate |
$2,832.72 |
| Rate for Payer: Aetna Commercial |
$2,549.45
|
| Rate for Payer: Aetna Medicare |
$1,416.36
|
| Rate for Payer: ASR ASR |
$2,747.74
|
| Rate for Payer: ASR Commercial |
$2,747.74
|
| Rate for Payer: BCBS Complete |
$1,133.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,319.71
|
| Rate for Payer: BCN Commercial |
$2,196.21
|
| Rate for Payer: Cash Price |
$2,266.18
|
| Rate for Payer: Cofinity Commercial |
$2,662.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,266.18
|
| Rate for Payer: Healthscope Commercial |
$2,832.72
|
| Rate for Payer: Healthscope Whirlpool |
$2,747.74
|
| Rate for Payer: Mclaren Commercial |
$2,549.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,407.81
|
| Rate for Payer: Nomi Health Commercial |
$2,322.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,841.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,482.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,985.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,492.79
|
|
|
LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL
|
Facility
|
IP
|
$2,832.72
|
|
|
Service Code
|
NDC 00032122401
|
| Hospital Charge Code |
98036
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,841.27 |
| Max. Negotiated Rate |
$2,832.72 |
| Rate for Payer: Aetna Commercial |
$2,549.45
|
| Rate for Payer: ASR ASR |
$2,747.74
|
| Rate for Payer: ASR Commercial |
$2,747.74
|
| Rate for Payer: BCBS Trust/PPO |
$2,308.38
|
| Rate for Payer: BCN Commercial |
$2,196.21
|
| Rate for Payer: Cash Price |
$2,266.18
|
| Rate for Payer: Cofinity Commercial |
$2,662.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,266.18
|
| Rate for Payer: Healthscope Commercial |
$2,832.72
|
| Rate for Payer: Healthscope Whirlpool |
$2,747.74
|
| Rate for Payer: Mclaren Commercial |
$2,549.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,407.81
|
| Rate for Payer: Nomi Health Commercial |
$2,322.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,841.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,492.79
|
|
|
LISINOPRIL 20 MG TABLET
|
Facility
|
OP
|
$148.05
|
|
|
Service Code
|
NDC 00904679961
|
| Hospital Charge Code |
4526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.22 |
| Max. Negotiated Rate |
$148.05 |
| Rate for Payer: Aetna Commercial |
$133.25
|
| Rate for Payer: Aetna Medicare |
$74.03
|
| Rate for Payer: ASR ASR |
$143.61
|
| Rate for Payer: ASR Commercial |
$143.61
|
| Rate for Payer: BCBS Complete |
$59.22
|
| Rate for Payer: BCBS Trust/PPO |
$121.24
|
| Rate for Payer: BCN Commercial |
$114.78
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$139.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$148.05
|
| Rate for Payer: Healthscope Whirlpool |
$143.61
|
| Rate for Payer: Mclaren Commercial |
$133.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: Nomi Health Commercial |
$121.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.72
|
| Rate for Payer: Priority Health Narrow Network |
$103.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.28
|
|
|
LISINOPRIL 20 MG TABLET
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
NDC 00904679961
|
| Hospital Charge Code |
4526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.23 |
| Max. Negotiated Rate |
$148.05 |
| Rate for Payer: Aetna Commercial |
$133.25
|
| Rate for Payer: ASR ASR |
$143.61
|
| Rate for Payer: ASR Commercial |
$143.61
|
| Rate for Payer: BCBS Trust/PPO |
$120.65
|
| Rate for Payer: BCN Commercial |
$114.78
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$139.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$148.05
|
| Rate for Payer: Healthscope Whirlpool |
$143.61
|
| Rate for Payer: Mclaren Commercial |
$133.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: Nomi Health Commercial |
$121.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.28
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
OP
|
$3.71
|
|
|
Service Code
|
NDC 68084019611
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Aetna Medicare |
$1.85
|
| Rate for Payer: ASR ASR |
$3.60
|
| Rate for Payer: ASR Commercial |
$3.60
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: BCBS Trust/PPO |
$3.04
|
| Rate for Payer: BCN Commercial |
$2.88
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cofinity Commercial |
$3.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$3.71
|
| Rate for Payer: Healthscope Whirlpool |
$3.60
|
| Rate for Payer: Mclaren Commercial |
$3.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.15
|
| Rate for Payer: Nomi Health Commercial |
$3.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.25
|
| Rate for Payer: Priority Health Narrow Network |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.26
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
IP
|
$3.71
|
|
|
Service Code
|
NDC 68084019611
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: ASR ASR |
$3.60
|
| Rate for Payer: ASR Commercial |
$3.60
|
| Rate for Payer: BCBS Trust/PPO |
$3.02
|
| Rate for Payer: BCN Commercial |
$2.88
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cofinity Commercial |
$3.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$3.71
|
| Rate for Payer: Healthscope Whirlpool |
$3.60
|
| Rate for Payer: Mclaren Commercial |
$3.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.15
|
| Rate for Payer: Nomi Health Commercial |
$3.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.26
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
IP
|
$371.30
|
|
|
Service Code
|
NDC 68084019601
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.34 |
| Max. Negotiated Rate |
$371.30 |
| Rate for Payer: Aetna Commercial |
$334.17
|
| Rate for Payer: ASR ASR |
$360.16
|
| Rate for Payer: ASR Commercial |
$360.16
|
| Rate for Payer: BCBS Trust/PPO |
$302.57
|
| Rate for Payer: BCN Commercial |
$287.87
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Commercial |
$349.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Healthscope Commercial |
$371.30
|
| Rate for Payer: Healthscope Whirlpool |
$360.16
|
| Rate for Payer: Mclaren Commercial |
$334.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.61
|
| Rate for Payer: Nomi Health Commercial |
$304.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$326.74
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
OP
|
$371.30
|
|
|
Service Code
|
NDC 68084019601
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.52 |
| Max. Negotiated Rate |
$371.30 |
| Rate for Payer: Aetna Commercial |
$334.17
|
| Rate for Payer: Aetna Medicare |
$185.65
|
| Rate for Payer: ASR ASR |
$360.16
|
| Rate for Payer: ASR Commercial |
$360.16
|
| Rate for Payer: BCBS Complete |
$148.52
|
| Rate for Payer: BCBS Trust/PPO |
$304.06
|
| Rate for Payer: BCN Commercial |
$287.87
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Commercial |
$349.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Healthscope Commercial |
$371.30
|
| Rate for Payer: Healthscope Whirlpool |
$360.16
|
| Rate for Payer: Mclaren Commercial |
$334.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.61
|
| Rate for Payer: Nomi Health Commercial |
$304.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$325.33
|
| Rate for Payer: Priority Health Narrow Network |
$260.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$326.74
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
IP
|
$37.60
|
|
|
Service Code
|
NDC 68180051301
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$37.60 |
| Rate for Payer: Aetna Commercial |
$33.84
|
| Rate for Payer: ASR ASR |
$36.47
|
| Rate for Payer: ASR Commercial |
$36.47
|
| Rate for Payer: BCBS Trust/PPO |
$30.64
|
| Rate for Payer: BCN Commercial |
$29.15
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cofinity Commercial |
$35.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.08
|
| Rate for Payer: Healthscope Commercial |
$37.60
|
| Rate for Payer: Healthscope Whirlpool |
$36.47
|
| Rate for Payer: Mclaren Commercial |
$33.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.96
|
| Rate for Payer: Nomi Health Commercial |
$30.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.09
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
NDC 00904679761
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: Aetna Medicare |
$70.50
|
| Rate for Payer: ASR ASR |
$136.77
|
| Rate for Payer: ASR Commercial |
$136.77
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: BCBS Trust/PPO |
$115.46
|
| Rate for Payer: BCN Commercial |
$109.32
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$132.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$141.00
|
| Rate for Payer: Healthscope Whirlpool |
$136.77
|
| Rate for Payer: Mclaren Commercial |
$126.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.54
|
| Rate for Payer: Priority Health Narrow Network |
$98.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.08
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
NDC 00904679761
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.65 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: ASR ASR |
$136.77
|
| Rate for Payer: ASR Commercial |
$136.77
|
| Rate for Payer: BCBS Trust/PPO |
$114.90
|
| Rate for Payer: BCN Commercial |
$109.32
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$132.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$141.00
|
| Rate for Payer: Healthscope Whirlpool |
$136.77
|
| Rate for Payer: Mclaren Commercial |
$126.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.08
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
OP
|
$37.60
|
|
|
Service Code
|
NDC 68180051301
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$37.60 |
| Rate for Payer: Aetna Commercial |
$33.84
|
| Rate for Payer: Aetna Medicare |
$18.80
|
| Rate for Payer: ASR ASR |
$36.47
|
| Rate for Payer: ASR Commercial |
$36.47
|
| Rate for Payer: BCBS Complete |
$15.04
|
| Rate for Payer: BCBS Trust/PPO |
$30.79
|
| Rate for Payer: BCN Commercial |
$29.15
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cofinity Commercial |
$35.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.08
|
| Rate for Payer: Healthscope Commercial |
$37.60
|
| Rate for Payer: Healthscope Whirlpool |
$36.47
|
| Rate for Payer: Mclaren Commercial |
$33.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.96
|
| Rate for Payer: Nomi Health Commercial |
$30.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.95
|
| Rate for Payer: Priority Health Narrow Network |
$26.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.09
|
|
|
LITHIUM CARBONATE 300 MG CAPSULE
|
Facility
|
OP
|
$25.93
|
|
|
Service Code
|
NDC 00054852725
|
| Hospital Charge Code |
4529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$25.93 |
| Rate for Payer: Aetna Commercial |
$23.34
|
| Rate for Payer: Aetna Medicare |
$12.96
|
| Rate for Payer: ASR ASR |
$25.15
|
| Rate for Payer: ASR Commercial |
$25.15
|
| Rate for Payer: BCBS Complete |
$10.37
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCN Commercial |
$20.10
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$24.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.74
|
| Rate for Payer: Healthscope Commercial |
$25.93
|
| Rate for Payer: Healthscope Whirlpool |
$25.15
|
| Rate for Payer: Mclaren Commercial |
$23.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.04
|
| Rate for Payer: Nomi Health Commercial |
$21.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.72
|
| Rate for Payer: Priority Health Narrow Network |
$18.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.82
|
|
|
LITHIUM CARBONATE 300 MG CAPSULE
|
Facility
|
IP
|
$25.93
|
|
|
Service Code
|
NDC 00054852725
|
| Hospital Charge Code |
4529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.85 |
| Max. Negotiated Rate |
$25.93 |
| Rate for Payer: Aetna Commercial |
$23.34
|
| Rate for Payer: ASR ASR |
$25.15
|
| Rate for Payer: ASR Commercial |
$25.15
|
| Rate for Payer: BCBS Trust/PPO |
$21.13
|
| Rate for Payer: BCN Commercial |
$20.10
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$24.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.74
|
| Rate for Payer: Healthscope Commercial |
$25.93
|
| Rate for Payer: Healthscope Whirlpool |
$25.15
|
| Rate for Payer: Mclaren Commercial |
$23.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.04
|
| Rate for Payer: Nomi Health Commercial |
$21.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.82
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$98.14
|
|
|
Service Code
|
NDC 70000046101
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.79 |
| Max. Negotiated Rate |
$98.14 |
| Rate for Payer: Aetna Commercial |
$88.33
|
| Rate for Payer: ASR ASR |
$95.20
|
| Rate for Payer: ASR Commercial |
$95.20
|
| Rate for Payer: BCBS Trust/PPO |
$79.97
|
| Rate for Payer: BCN Commercial |
$76.09
|
| Rate for Payer: Cash Price |
$78.51
|
| Rate for Payer: Cofinity Commercial |
$92.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.51
|
| Rate for Payer: Healthscope Commercial |
$98.14
|
| Rate for Payer: Healthscope Whirlpool |
$95.20
|
| Rate for Payer: Mclaren Commercial |
$88.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.42
|
| Rate for Payer: Nomi Health Commercial |
$80.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.36
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$246.24
|
|
|
Service Code
|
NDC 60687022901
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.06 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna Commercial |
$221.62
|
| Rate for Payer: ASR ASR |
$238.85
|
| Rate for Payer: ASR Commercial |
$238.85
|
| Rate for Payer: BCBS Trust/PPO |
$200.66
|
| Rate for Payer: BCN Commercial |
$190.91
|
| Rate for Payer: Cash Price |
$196.99
|
| Rate for Payer: Cofinity Commercial |
$231.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.99
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Healthscope Whirlpool |
$238.85
|
| Rate for Payer: Mclaren Commercial |
$221.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.30
|
| Rate for Payer: Nomi Health Commercial |
$201.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.69
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$3.31
|
|
|
Service Code
|
NDC 51079069001
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$3.31 |
| Rate for Payer: Aetna Commercial |
$2.98
|
| Rate for Payer: ASR ASR |
$3.21
|
| Rate for Payer: ASR Commercial |
$3.21
|
| Rate for Payer: BCBS Trust/PPO |
$2.70
|
| Rate for Payer: BCN Commercial |
$2.57
|
| Rate for Payer: Cash Price |
$2.65
|
| Rate for Payer: Cofinity Commercial |
$3.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.65
|
| Rate for Payer: Healthscope Commercial |
$3.31
|
| Rate for Payer: Healthscope Whirlpool |
$3.21
|
| Rate for Payer: Mclaren Commercial |
$2.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.81
|
| Rate for Payer: Nomi Health Commercial |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.91
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$2.46
|
|
|
Service Code
|
NDC 60687022911
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: ASR ASR |
$2.39
|
| Rate for Payer: ASR Commercial |
$2.39
|
| Rate for Payer: BCBS Trust/PPO |
$2.00
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.97
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: Healthscope Whirlpool |
$2.39
|
| Rate for Payer: Mclaren Commercial |
$2.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.09
|
| Rate for Payer: Nomi Health Commercial |
$2.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.16
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$246.24
|
|
|
Service Code
|
NDC 60687022901
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.50 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna Commercial |
$221.62
|
| Rate for Payer: Aetna Medicare |
$123.12
|
| Rate for Payer: ASR ASR |
$238.85
|
| Rate for Payer: ASR Commercial |
$238.85
|
| Rate for Payer: BCBS Complete |
$98.50
|
| Rate for Payer: BCBS Trust/PPO |
$201.65
|
| Rate for Payer: BCN Commercial |
$190.91
|
| Rate for Payer: Cash Price |
$196.99
|
| Rate for Payer: Cofinity Commercial |
$231.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.99
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Healthscope Whirlpool |
$238.85
|
| Rate for Payer: Mclaren Commercial |
$221.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.30
|
| Rate for Payer: Nomi Health Commercial |
$201.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$215.76
|
| Rate for Payer: Priority Health Narrow Network |
$172.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.69
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$3.31
|
|
|
Service Code
|
NDC 51079069001
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$3.31 |
| Rate for Payer: Aetna Commercial |
$2.98
|
| Rate for Payer: Aetna Medicare |
$1.66
|
| Rate for Payer: ASR ASR |
$3.21
|
| Rate for Payer: ASR Commercial |
$3.21
|
| Rate for Payer: BCBS Complete |
$1.32
|
| Rate for Payer: BCBS Trust/PPO |
$2.71
|
| Rate for Payer: BCN Commercial |
$2.57
|
| Rate for Payer: Cash Price |
$2.65
|
| Rate for Payer: Cofinity Commercial |
$3.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.65
|
| Rate for Payer: Healthscope Commercial |
$3.31
|
| Rate for Payer: Healthscope Whirlpool |
$3.21
|
| Rate for Payer: Mclaren Commercial |
$2.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.81
|
| Rate for Payer: Nomi Health Commercial |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.90
|
| Rate for Payer: Priority Health Narrow Network |
$2.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.91
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$2.46
|
|
|
Service Code
|
NDC 60687022911
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: Aetna Medicare |
$1.23
|
| Rate for Payer: ASR ASR |
$2.39
|
| Rate for Payer: ASR Commercial |
$2.39
|
| Rate for Payer: BCBS Complete |
$0.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.01
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.97
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: Healthscope Whirlpool |
$2.39
|
| Rate for Payer: Mclaren Commercial |
$2.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.09
|
| Rate for Payer: Nomi Health Commercial |
$2.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.16
|
| Rate for Payer: Priority Health Narrow Network |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.16
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$98.14
|
|
|
Service Code
|
NDC 70000046101
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.26 |
| Max. Negotiated Rate |
$98.14 |
| Rate for Payer: Aetna Commercial |
$88.33
|
| Rate for Payer: Aetna Medicare |
$49.07
|
| Rate for Payer: ASR ASR |
$95.20
|
| Rate for Payer: ASR Commercial |
$95.20
|
| Rate for Payer: BCBS Complete |
$39.26
|
| Rate for Payer: BCBS Trust/PPO |
$80.37
|
| Rate for Payer: BCN Commercial |
$76.09
|
| Rate for Payer: Cash Price |
$78.51
|
| Rate for Payer: Cofinity Commercial |
$92.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.51
|
| Rate for Payer: Healthscope Commercial |
$98.14
|
| Rate for Payer: Healthscope Whirlpool |
$95.20
|
| Rate for Payer: Mclaren Commercial |
$88.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.42
|
| Rate for Payer: Nomi Health Commercial |
$80.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.99
|
| Rate for Payer: Priority Health Narrow Network |
$68.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.36
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$2.56
|
|
|
Service Code
|
NDC 51079024601
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: ASR ASR |
$2.48
|
| Rate for Payer: ASR Commercial |
$2.48
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCN Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cofinity Commercial |
$2.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Healthscope Whirlpool |
$2.48
|
| Rate for Payer: Mclaren Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Nomi Health Commercial |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.24
|
| Rate for Payer: Priority Health Narrow Network |
$1.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.25
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$256.50
|
|
|
Service Code
|
NDC 51079024620
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.72 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna Commercial |
$230.85
|
| Rate for Payer: ASR ASR |
$248.81
|
| Rate for Payer: ASR Commercial |
$248.81
|
| Rate for Payer: BCBS Trust/PPO |
$209.02
|
| Rate for Payer: BCN Commercial |
$198.86
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cofinity Commercial |
$241.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.20
|
| Rate for Payer: Healthscope Commercial |
$256.50
|
| Rate for Payer: Healthscope Whirlpool |
$248.81
|
| Rate for Payer: Mclaren Commercial |
$230.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.03
|
| Rate for Payer: Nomi Health Commercial |
$210.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.72
|
|
