|
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
|
|
|
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
|
$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
|
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
|
$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
|
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
|
|
|
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
|
$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
|
$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
|
|
|
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
|
$209.00
|
|
|
Service Code
|
NDC 00904685261
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.85 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: ASR ASR |
$202.73
|
| Rate for Payer: ASR Commercial |
$202.73
|
| Rate for Payer: BCBS Trust/PPO |
$170.31
|
| Rate for Payer: BCN Commercial |
$162.04
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$196.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$209.00
|
| Rate for Payer: Healthscope Whirlpool |
$202.73
|
| Rate for Payer: Mclaren Commercial |
$188.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: Nomi Health Commercial |
$171.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.92
|
|
|
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 |
$248.80
|
| Rate for Payer: ASR Commercial |
$248.80
|
| 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 |
$248.80
|
| Rate for Payer: Mclaren Commercial |
$230.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.02
|
| 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
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$229.90
|
|
|
Service Code
|
NDC 68084024801
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.44 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Aetna Commercial |
$206.91
|
| Rate for Payer: ASR ASR |
$223.00
|
| Rate for Payer: ASR Commercial |
$223.00
|
| Rate for Payer: BCBS Trust/PPO |
$187.35
|
| Rate for Payer: BCN Commercial |
$178.24
|
| Rate for Payer: Cash Price |
$183.92
|
| Rate for Payer: Cofinity Commercial |
$216.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.92
|
| Rate for Payer: Healthscope Commercial |
$229.90
|
| Rate for Payer: Healthscope Whirlpool |
$223.00
|
| Rate for Payer: Mclaren Commercial |
$206.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.42
|
| Rate for Payer: Nomi Health Commercial |
$188.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$202.31
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$229.90
|
|
|
Service Code
|
NDC 68084024801
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.96 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Aetna Commercial |
$206.91
|
| Rate for Payer: Aetna Medicare |
$114.95
|
| Rate for Payer: ASR ASR |
$223.00
|
| Rate for Payer: ASR Commercial |
$223.00
|
| Rate for Payer: BCBS Complete |
$91.96
|
| Rate for Payer: BCBS Trust/PPO |
$188.27
|
| Rate for Payer: BCN Commercial |
$178.24
|
| Rate for Payer: Cash Price |
$183.92
|
| Rate for Payer: Cofinity Commercial |
$216.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.92
|
| Rate for Payer: Healthscope Commercial |
$229.90
|
| Rate for Payer: Healthscope Whirlpool |
$223.00
|
| Rate for Payer: Mclaren Commercial |
$206.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.42
|
| Rate for Payer: Nomi Health Commercial |
$188.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.44
|
| Rate for Payer: Priority Health Narrow Network |
$161.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$202.31
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$256.50
|
|
|
Service Code
|
NDC 51079024620
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.60 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna Commercial |
$230.85
|
| Rate for Payer: Aetna Medicare |
$128.25
|
| Rate for Payer: ASR ASR |
$248.80
|
| Rate for Payer: ASR Commercial |
$248.80
|
| Rate for Payer: BCBS Complete |
$102.60
|
| Rate for Payer: BCBS Trust/PPO |
$210.05
|
| 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 |
$248.80
|
| Rate for Payer: Mclaren Commercial |
$230.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.02
|
| Rate for Payer: Nomi Health Commercial |
$210.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.75
|
| Rate for Payer: Priority Health Narrow Network |
$179.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.72
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$229.90
|
|
|
Service Code
|
NDC 68084024811
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.44 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Aetna Commercial |
$206.91
|
| Rate for Payer: ASR ASR |
$223.00
|
| Rate for Payer: ASR Commercial |
$223.00
|
| Rate for Payer: BCBS Trust/PPO |
$187.35
|
| Rate for Payer: BCN Commercial |
$178.24
|
| Rate for Payer: Cash Price |
$183.92
|
| Rate for Payer: Cofinity Commercial |
$216.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.92
|
| Rate for Payer: Healthscope Commercial |
$229.90
|
| Rate for Payer: Healthscope Whirlpool |
$223.00
|
| Rate for Payer: Mclaren Commercial |
$206.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.42
|
| Rate for Payer: Nomi Health Commercial |
$188.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$202.31
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
IP
|
$2.56
|
|
|
Service Code
|
NDC 51079024601
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: ASR ASR |
$2.48
|
| Rate for Payer: ASR Commercial |
$2.48
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| 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: UHC All Payor (Choice/PPO) + Core |
$2.25
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$229.90
|
|
|
Service Code
|
NDC 68084024811
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.96 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Aetna Commercial |
$206.91
|
| Rate for Payer: Aetna Medicare |
$114.95
|
| Rate for Payer: ASR ASR |
$223.00
|
| Rate for Payer: ASR Commercial |
$223.00
|
| Rate for Payer: BCBS Complete |
$91.96
|
| Rate for Payer: BCBS Trust/PPO |
$188.27
|
| Rate for Payer: BCN Commercial |
$178.24
|
| Rate for Payer: Cash Price |
$183.92
|
| Rate for Payer: Cofinity Commercial |
$216.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.92
|
| Rate for Payer: Healthscope Commercial |
$229.90
|
| Rate for Payer: Healthscope Whirlpool |
$223.00
|
| Rate for Payer: Mclaren Commercial |
$206.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.42
|
| Rate for Payer: Nomi Health Commercial |
$188.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.44
|
| Rate for Payer: Priority Health Narrow Network |
$161.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$202.31
|
|
|
LORATADINE 10 MG TABLET
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
NDC 00904685261
|
| Hospital Charge Code |
10466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: Aetna Medicare |
$104.50
|
| Rate for Payer: ASR ASR |
$202.73
|
| Rate for Payer: ASR Commercial |
$202.73
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: BCBS Trust/PPO |
$171.15
|
| Rate for Payer: BCN Commercial |
$162.04
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$196.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$209.00
|
| Rate for Payer: Healthscope Whirlpool |
$202.73
|
| Rate for Payer: Mclaren Commercial |
$188.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: Nomi Health Commercial |
$171.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.13
|
| Rate for Payer: Priority Health Narrow Network |
$146.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.92
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$129.50
|
|
|
Service Code
|
NDC 00904600761
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.18 |
| Max. Negotiated Rate |
$129.50 |
| Rate for Payer: Aetna Commercial |
$116.55
|
| Rate for Payer: ASR ASR |
$125.62
|
| Rate for Payer: ASR Commercial |
$125.62
|
| Rate for Payer: BCBS Trust/PPO |
$105.53
|
| Rate for Payer: BCN Commercial |
$100.40
|
| 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 |
$129.50
|
| Rate for Payer: Healthscope Whirlpool |
$125.62
|
| 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: Priority Health Cigna Priority Health |
$84.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.96
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$1.98
|
|
|
Service Code
|
NDC 60687040111
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna Commercial |
$1.78
|
| Rate for Payer: ASR ASR |
$1.92
|
| Rate for Payer: ASR Commercial |
$1.92
|
| Rate for Payer: BCBS Trust/PPO |
$1.61
|
| Rate for Payer: BCN Commercial |
$1.54
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.58
|
| Rate for Payer: Healthscope Commercial |
$1.98
|
| Rate for Payer: Healthscope Whirlpool |
$1.92
|
| Rate for Payer: Mclaren Commercial |
$1.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.68
|
| Rate for Payer: Nomi Health Commercial |
$1.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.74
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$271.25
|
|
|
Service Code
|
NDC 69315090405
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.50 |
| Max. Negotiated Rate |
$271.25 |
| Rate for Payer: Aetna Commercial |
$244.12
|
| Rate for Payer: Aetna Medicare |
$135.62
|
| Rate for Payer: ASR ASR |
$263.11
|
| Rate for Payer: ASR Commercial |
$263.11
|
| Rate for Payer: BCBS Complete |
$108.50
|
| Rate for Payer: BCBS Trust/PPO |
$222.13
|
| Rate for Payer: BCN Commercial |
$210.30
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cofinity Commercial |
$254.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.00
|
| Rate for Payer: Healthscope Commercial |
$271.25
|
| Rate for Payer: Healthscope Whirlpool |
$263.11
|
| Rate for Payer: Mclaren Commercial |
$244.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.56
|
| Rate for Payer: Nomi Health Commercial |
$222.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$237.67
|
| Rate for Payer: Priority Health Narrow Network |
$190.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.70
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$197.75
|
|
|
Service Code
|
NDC 60687040101
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$197.75 |
| Rate for Payer: Aetna Commercial |
$177.98
|
| Rate for Payer: ASR ASR |
$191.82
|
| Rate for Payer: ASR Commercial |
$191.82
|
| Rate for Payer: BCBS Trust/PPO |
$161.15
|
| Rate for Payer: BCN Commercial |
$153.32
|
| Rate for Payer: Cash Price |
$158.20
|
| Rate for Payer: Cofinity Commercial |
$185.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.20
|
| Rate for Payer: Healthscope Commercial |
$197.75
|
| Rate for Payer: Healthscope Whirlpool |
$191.82
|
| Rate for Payer: Mclaren Commercial |
$177.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.09
|
| Rate for Payer: Nomi Health Commercial |
$162.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.02
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$271.25
|
|
|
Service Code
|
NDC 69315090405
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.31 |
| Max. Negotiated Rate |
$271.25 |
| Rate for Payer: Aetna Commercial |
$244.12
|
| Rate for Payer: ASR ASR |
$263.11
|
| Rate for Payer: ASR Commercial |
$263.11
|
| Rate for Payer: BCBS Trust/PPO |
$221.04
|
| Rate for Payer: BCN Commercial |
$210.30
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cofinity Commercial |
$254.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.00
|
| Rate for Payer: Healthscope Commercial |
$271.25
|
| Rate for Payer: Healthscope Whirlpool |
$263.11
|
| Rate for Payer: Mclaren Commercial |
$244.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.56
|
| Rate for Payer: Nomi Health Commercial |
$222.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.70
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$1.98
|
|
|
Service Code
|
NDC 60687040111
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna Commercial |
$1.78
|
| Rate for Payer: Aetna Medicare |
$0.99
|
| Rate for Payer: ASR ASR |
$1.92
|
| Rate for Payer: ASR Commercial |
$1.92
|
| Rate for Payer: BCBS Complete |
$0.79
|
| Rate for Payer: BCBS Trust/PPO |
$1.62
|
| Rate for Payer: BCN Commercial |
$1.54
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.58
|
| Rate for Payer: Healthscope Commercial |
$1.98
|
| Rate for Payer: Healthscope Whirlpool |
$1.92
|
| Rate for Payer: Mclaren Commercial |
$1.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.68
|
| Rate for Payer: Nomi Health Commercial |
$1.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.73
|
| Rate for Payer: Priority Health Narrow Network |
$1.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.74
|
|
