|
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
|
|
|
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
|
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 |
$195.41
|
| 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
|
$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
|
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 |
$195.41
|
| 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
|
|
|
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 |
$248.81
|
| Rate for Payer: ASR Commercial |
$248.81
|
| 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 |
$248.81
|
| 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: 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
|
|
|
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 |
$254.97
|
| 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 |
$222.43
|
| 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
|
OP
|
$197.75
|
|
|
Service Code
|
NDC 60687040101
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$197.75 |
| Rate for Payer: Aetna Commercial |
$177.97
|
| Rate for Payer: Aetna Medicare |
$98.88
|
| Rate for Payer: ASR ASR |
$191.82
|
| Rate for Payer: ASR Commercial |
$191.82
|
| Rate for Payer: BCBS Complete |
$79.10
|
| Rate for Payer: BCBS Trust/PPO |
$161.94
|
| 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 |
$177.97
|
| 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: Priority Health HMO/PPO/Tiered Network |
$173.27
|
| Rate for Payer: Priority Health Narrow Network |
$138.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.02
|
|
|
LORAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$129.50
|
|
|
Service Code
|
NDC 00904600761
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$129.50 |
| Rate for Payer: Aetna Commercial |
$116.55
|
| Rate for Payer: Aetna Medicare |
$64.75
|
| Rate for Payer: ASR ASR |
$125.61
|
| Rate for Payer: ASR Commercial |
$125.61
|
| Rate for Payer: BCBS Complete |
$51.80
|
| Rate for Payer: BCBS Trust/PPO |
$106.05
|
| 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 |
$125.61
|
| 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 |
$84.17
|
| Rate for Payer: 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
|
$129.50
|
|
|
Service Code
|
NDC 00904600761
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.17 |
| Max. Negotiated Rate |
$129.50 |
| Rate for Payer: Aetna Commercial |
$116.55
|
| Rate for Payer: ASR ASR |
$125.61
|
| Rate for Payer: ASR Commercial |
$125.61
|
| 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 |
$125.61
|
| 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 |
$84.17
|
| 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
|
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 |
$177.97
|
| 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 |
$177.97
|
| 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 |
$254.97
|
| 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 |
$222.43
|
| 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
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$110.25
|
|
|
Service Code
|
NDC 69315090501
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.66 |
| Max. Negotiated Rate |
$110.25 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: ASR ASR |
$106.94
|
| Rate for Payer: ASR Commercial |
$106.94
|
| Rate for Payer: BCBS Trust/PPO |
$89.84
|
| Rate for Payer: BCN Commercial |
$85.48
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cofinity Commercial |
$103.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.20
|
| Rate for Payer: Healthscope Commercial |
$110.25
|
| Rate for Payer: Healthscope Whirlpool |
$106.94
|
| Rate for Payer: Mclaren Commercial |
$99.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.71
|
| Rate for Payer: Nomi Health Commercial |
$90.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.02
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$2.17
|
|
|
Service Code
|
NDC 60687063811
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Aetna Commercial |
$1.95
|
| Rate for Payer: Aetna Medicare |
$1.08
|
| Rate for Payer: ASR ASR |
$2.10
|
| Rate for Payer: ASR Commercial |
$2.10
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS Trust/PPO |
$1.78
|
| Rate for Payer: BCN Commercial |
$1.68
|
| 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 |
$2.17
|
| Rate for Payer: Healthscope Whirlpool |
$2.10
|
| 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: Priority Health Cigna Priority Health |
$1.41
|
| Rate for Payer: 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
|
$110.25
|
|
|
Service Code
|
NDC 69315090501
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$110.25 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Medicare |
$55.12
|
| Rate for Payer: ASR ASR |
$106.94
|
| Rate for Payer: ASR Commercial |
$106.94
|
| Rate for Payer: BCBS Complete |
$44.10
|
| Rate for Payer: BCBS Trust/PPO |
$90.28
|
| Rate for Payer: BCN Commercial |
$85.48
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cofinity Commercial |
$103.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.20
|
| Rate for Payer: Healthscope Commercial |
$110.25
|
| Rate for Payer: Healthscope Whirlpool |
$106.94
|
| Rate for Payer: Mclaren Commercial |
$99.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.71
|
| Rate for Payer: Nomi Health Commercial |
$90.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.60
|
| Rate for Payer: Priority Health Narrow Network |
$77.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.02
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$2.17
|
|
|
Service Code
|
NDC 60687063811
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Aetna Commercial |
$1.95
|
| Rate for Payer: ASR ASR |
$2.10
|
| Rate for Payer: ASR Commercial |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$1.77
|
| Rate for Payer: BCN Commercial |
$1.68
|
| 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 |
$2.17
|
| Rate for Payer: Healthscope Whirlpool |
$2.10
|
| 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: Priority Health Cigna Priority Health |
$1.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.91
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$150.50
|
|
|
Service Code
|
NDC 00904600861
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.83 |
| Max. Negotiated Rate |
$150.50 |
| Rate for Payer: Aetna Commercial |
$135.45
|
| Rate for Payer: ASR ASR |
$145.99
|
| Rate for Payer: ASR Commercial |
$145.99
|
| Rate for Payer: BCBS Trust/PPO |
$122.64
|
| Rate for Payer: BCN Commercial |
$116.68
|
| 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 |
$150.50
|
| Rate for Payer: Healthscope Whirlpool |
$145.99
|
| 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: Priority Health Cigna Priority Health |
$97.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.44
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
NDC 60687063801
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Aetna Commercial |
$195.30
|
| Rate for Payer: Aetna Medicare |
$108.50
|
| Rate for Payer: ASR ASR |
$210.49
|
| Rate for Payer: ASR Commercial |
$210.49
|
| Rate for Payer: BCBS Complete |
$86.80
|
| Rate for Payer: BCBS Trust/PPO |
$177.70
|
| Rate for Payer: BCN Commercial |
$168.24
|
| 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 |
$217.00
|
| Rate for Payer: Healthscope Whirlpool |
$210.49
|
| 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: Priority Health Cigna Priority Health |
$141.05
|
| Rate for Payer: 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
|
IP
|
$217.00
|
|
|
Service Code
|
NDC 60687063801
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.05 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Aetna Commercial |
$195.30
|
| Rate for Payer: ASR ASR |
$210.49
|
| Rate for Payer: ASR Commercial |
$210.49
|
| Rate for Payer: BCBS Trust/PPO |
$176.83
|
| Rate for Payer: BCN Commercial |
$168.24
|
| 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 |
$217.00
|
| Rate for Payer: Healthscope Whirlpool |
$210.49
|
| 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: Priority Health Cigna Priority Health |
$141.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.96
|
|
|
LORAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$150.50
|
|
|
Service Code
|
NDC 00904600861
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$150.50 |
| Rate for Payer: Aetna Commercial |
$135.45
|
| Rate for Payer: Aetna Medicare |
$75.25
|
| Rate for Payer: ASR ASR |
$145.99
|
| Rate for Payer: ASR Commercial |
$145.99
|
| Rate for Payer: BCBS Complete |
$60.20
|
| Rate for Payer: BCBS Trust/PPO |
$123.24
|
| Rate for Payer: BCN Commercial |
$116.68
|
| 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 |
$150.50
|
| Rate for Payer: Healthscope Whirlpool |
$145.99
|
| 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: Priority Health Cigna Priority Health |
$97.83
|
| Rate for Payer: 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 2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$164.84
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
10467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.94 |
| Max. Negotiated Rate |
$164.84 |
| Rate for Payer: Aetna Commercial |
$148.36
|
| Rate for Payer: Aetna Commercial |
$25.62
|
| Rate for Payer: Aetna Commercial |
$29.29
|
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Aetna Commercial |
$19.04
|
| Rate for Payer: Aetna Medicare |
$9.12
|
| Rate for Payer: Aetna Medicare |
$10.58
|
| Rate for Payer: Aetna Medicare |
$82.42
|
| Rate for Payer: Aetna Medicare |
$16.27
|
| Rate for Payer: Aetna Medicare |
$14.23
|
| Rate for Payer: ASR ASR |
$31.56
|
| Rate for Payer: ASR ASR |
$20.53
|
| Rate for Payer: ASR ASR |
$159.89
|
| Rate for Payer: ASR ASR |
$27.62
|
| Rate for Payer: ASR ASR |
$17.69
|
| Rate for Payer: ASR Commercial |
$31.56
|
| Rate for Payer: ASR Commercial |
$17.69
|
| Rate for Payer: ASR Commercial |
$20.53
|
| Rate for Payer: ASR Commercial |
$27.62
|
| Rate for Payer: ASR Commercial |
$159.89
|
| Rate for Payer: BCBS Complete |
$13.02
|
| Rate for Payer: BCBS Complete |
$7.30
|
| Rate for Payer: BCBS Complete |
$8.46
|
| Rate for Payer: BCBS Complete |
$11.39
|
| Rate for Payer: BCBS Complete |
$65.94
|
| Rate for Payer: BCBS Trust/PPO |
$23.31
|
| Rate for Payer: BCBS Trust/PPO |
$134.99
|
| Rate for Payer: BCBS Trust/PPO |
$14.94
|
| Rate for Payer: BCBS Trust/PPO |
$17.33
|
| Rate for Payer: BCBS Trust/PPO |
$26.65
|
| Rate for Payer: BCN Commercial |
$25.23
|
| Rate for Payer: BCN Commercial |
$22.07
|
| Rate for Payer: BCN Commercial |
$14.14
|
| Rate for Payer: BCN Commercial |
$127.80
|
| Rate for Payer: BCN Commercial |
$16.41
|
| Rate for Payer: Cash Price |
$26.03
|
| Rate for Payer: Cash Price |
$14.59
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Cash Price |
$131.87
|
| Rate for Payer: Cofinity Commercial |
$30.59
|
| Rate for Payer: Cofinity Commercial |
$26.76
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Commercial |
$17.15
|
| Rate for Payer: Cofinity Commercial |
$154.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.78
|
| Rate for Payer: Healthscope Commercial |
$21.16
|
| Rate for Payer: Healthscope Commercial |
$28.47
|
| Rate for Payer: Healthscope Commercial |
$32.54
|
| Rate for Payer: Healthscope Commercial |
$164.84
|
| Rate for Payer: Healthscope Commercial |
$18.24
|
| Rate for Payer: Healthscope Whirlpool |
$27.62
|
| Rate for Payer: Healthscope Whirlpool |
$20.53
|
| Rate for Payer: Healthscope Whirlpool |
$17.69
|
| Rate for Payer: Healthscope Whirlpool |
$159.89
|
| Rate for Payer: Healthscope Whirlpool |
$31.56
|
| Rate for Payer: Mclaren Commercial |
$29.29
|
| Rate for Payer: Mclaren Commercial |
$19.04
|
| Rate for Payer: Mclaren Commercial |
$16.42
|
| Rate for Payer: Mclaren Commercial |
$25.62
|
| Rate for Payer: Mclaren Commercial |
$148.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.66
|
| Rate for Payer: Nomi Health Commercial |
$23.35
|
| Rate for Payer: Nomi Health Commercial |
$17.35
|
| Rate for Payer: Nomi Health Commercial |
$135.17
|
| Rate for Payer: Nomi Health Commercial |
$14.96
|
| Rate for Payer: Nomi Health Commercial |
$26.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.51
|
| Rate for Payer: Priority Health Narrow Network |
$22.81
|
| Rate for Payer: Priority Health Narrow Network |
$19.96
|
| Rate for Payer: Priority Health Narrow Network |
$12.79
|
| Rate for Payer: Priority Health Narrow Network |
$115.55
|
| Rate for Payer: Priority Health Narrow Network |
$14.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.62
|
|
