|
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 |
$125.62
|
| Rate for Payer: ASR Commercial |
$125.62
|
| 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 |
$125.62
|
| 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: 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
|
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 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 |
$90.40
|
| 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
|
$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 |
$90.40
|
| 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
|
IP
|
$150.50
|
|
|
Service Code
|
NDC 00904600861
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.82 |
| Max. Negotiated Rate |
$150.50 |
| Rate for Payer: Aetna Commercial |
$135.45
|
| Rate for Payer: ASR ASR |
$145.98
|
| Rate for Payer: ASR Commercial |
$145.98
|
| 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 |
$145.98
|
| 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 |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.44
|
|
|
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 |
$145.98
|
| Rate for Payer: ASR Commercial |
$145.98
|
| 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 |
$145.98
|
| 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 |
$97.82
|
| 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 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
|
$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
|
$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 2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$18.24
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
10467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$18.24 |
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Aetna Commercial |
$25.62
|
| Rate for Payer: Aetna Commercial |
$148.36
|
| Rate for Payer: Aetna Commercial |
$29.29
|
| Rate for Payer: Aetna Commercial |
$19.04
|
| Rate for Payer: Aetna Medicare |
$10.58
|
| Rate for Payer: Aetna Medicare |
$82.42
|
| Rate for Payer: Aetna Medicare |
$9.12
|
| Rate for Payer: Aetna Medicare |
$14.24
|
| Rate for Payer: Aetna Medicare |
$16.27
|
| 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 ASR |
$20.53
|
| Rate for Payer: ASR ASR |
$31.56
|
| Rate for Payer: ASR Commercial |
$159.89
|
| Rate for Payer: ASR Commercial |
$17.69
|
| Rate for Payer: ASR Commercial |
$31.56
|
| Rate for Payer: ASR Commercial |
$27.62
|
| Rate for Payer: ASR Commercial |
$20.53
|
| Rate for Payer: BCBS Complete |
$13.02
|
| Rate for Payer: BCBS Complete |
$65.94
|
| 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 Trust/PPO |
$23.31
|
| Rate for Payer: BCBS Trust/PPO |
$17.33
|
| Rate for Payer: BCBS Trust/PPO |
$134.99
|
| Rate for Payer: BCBS Trust/PPO |
$14.94
|
| Rate for Payer: BCBS Trust/PPO |
$26.65
|
| Rate for Payer: BCN Commercial |
$22.07
|
| Rate for Payer: BCN Commercial |
$127.80
|
| Rate for Payer: BCN Commercial |
$14.14
|
| Rate for Payer: BCN Commercial |
$16.41
|
| Rate for Payer: BCN Commercial |
$25.23
|
| 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 |
$131.87
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cash Price |
$131.87
|
| Rate for Payer: Cash Price |
$26.03
|
| Rate for Payer: Cash Price |
$14.59
|
| Rate for Payer: Cofinity Commercial |
$17.15
|
| Rate for Payer: Cofinity Commercial |
$26.76
|
| Rate for Payer: Cofinity Commercial |
$30.59
|
| Rate for Payer: Cofinity Commercial |
$154.95
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.93
|
| Rate for Payer: Healthscope Commercial |
$28.47
|
| Rate for Payer: Healthscope Commercial |
$21.16
|
| Rate for Payer: Healthscope Commercial |
$18.24
|
| Rate for Payer: Healthscope Commercial |
$32.54
|
| Rate for Payer: Healthscope Commercial |
$164.84
|
| Rate for Payer: Healthscope Whirlpool |
$31.56
|
| Rate for Payer: Healthscope Whirlpool |
$17.69
|
| Rate for Payer: Healthscope Whirlpool |
$159.89
|
| Rate for Payer: Healthscope Whirlpool |
$27.62
|
| Rate for Payer: Healthscope Whirlpool |
$20.53
|
| Rate for Payer: Mclaren Commercial |
$25.62
|
| Rate for Payer: Mclaren Commercial |
$148.36
|
| Rate for Payer: Mclaren Commercial |
$16.42
|
| Rate for Payer: Mclaren Commercial |
$19.04
|
| Rate for Payer: Mclaren Commercial |
$29.29
|
| 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 |
$15.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.99
|
| 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: Nomi Health Commercial |
$23.35
|
| Rate for Payer: Nomi Health Commercial |
$17.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.62
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.06
|
| 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 |
$28.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.62
|
|
|
LORAZEPAM 2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$18.24
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
10467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.86 |
| Max. Negotiated Rate |
$18.24 |
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Aetna Commercial |
$25.62
|
| Rate for Payer: Aetna Commercial |
$29.29
|
| Rate for Payer: Aetna Commercial |
$19.04
|
| Rate for Payer: Aetna Commercial |
$148.36
|
| Rate for Payer: ASR ASR |
$31.56
|
| Rate for Payer: ASR ASR |
$27.62
|
| Rate for Payer: ASR ASR |
$20.53
|
| Rate for Payer: ASR ASR |
$17.69
|
| Rate for Payer: ASR ASR |
$159.89
|
| Rate for Payer: ASR Commercial |
$20.53
|
| Rate for Payer: ASR Commercial |
$31.56
|
| Rate for Payer: ASR Commercial |
$27.62
|
| Rate for Payer: ASR Commercial |
$17.69
|
| Rate for Payer: ASR Commercial |
$159.89
|
| Rate for Payer: BCBS Trust/PPO |
$26.52
|
| Rate for Payer: BCBS Trust/PPO |
$134.33
|
| Rate for Payer: BCBS Trust/PPO |
$14.86
|
| Rate for Payer: BCBS Trust/PPO |
$23.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.24
|
| Rate for Payer: BCN Commercial |
$14.14
|
| Rate for Payer: BCN Commercial |
$25.23
|
| Rate for Payer: BCN Commercial |
$127.80
|
| Rate for Payer: BCN Commercial |
$16.41
|
| Rate for Payer: BCN Commercial |
$22.07
|
| 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 |
$26.03
|
| Rate for Payer: Cash Price |
$131.87
|
| Rate for Payer: Cofinity Commercial |
$17.15
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Commercial |
$154.95
|
| Rate for Payer: Cofinity Commercial |
$26.76
|
| Rate for Payer: Cofinity Commercial |
$30.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.59
|
| Rate for Payer: Healthscope Commercial |
$21.16
|
| Rate for Payer: Healthscope Commercial |
$28.47
|
| Rate for Payer: Healthscope Commercial |
$18.24
|
| Rate for Payer: Healthscope Commercial |
$164.84
|
| Rate for Payer: Healthscope Commercial |
$32.54
|
| Rate for Payer: Healthscope Whirlpool |
$31.56
|
| Rate for Payer: Healthscope Whirlpool |
$159.89
|
| Rate for Payer: Healthscope Whirlpool |
$20.53
|
| Rate for Payer: Healthscope Whirlpool |
$17.69
|
| Rate for Payer: Healthscope Whirlpool |
$27.62
|
| Rate for Payer: Mclaren Commercial |
$16.42
|
| Rate for Payer: Mclaren Commercial |
$19.04
|
| Rate for Payer: Mclaren Commercial |
$148.36
|
| Rate for Payer: Mclaren Commercial |
$25.62
|
| Rate for Payer: Mclaren Commercial |
$29.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.99
|
| 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: Nomi Health Commercial |
$23.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.06
|
| 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 |
$28.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.05
|
|
|
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 |
$11.61 |
| Max. Negotiated Rate |
$17.86 |
| Rate for Payer: Aetna Commercial |
$16.07
|
| Rate for Payer: ASR ASR |
$17.32
|
| Rate for Payer: ASR Commercial |
$17.32
|
| Rate for Payer: BCBS Trust/PPO |
$14.55
|
| Rate for Payer: BCN Commercial |
$13.85
|
| 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 |
$17.86
|
| Rate for Payer: Healthscope Whirlpool |
$17.32
|
| Rate for Payer: Mclaren Commercial |
$16.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.18
|
| Rate for Payer: Nomi Health Commercial |
$14.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.72
|
|
|
LORAZEPAM 2 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$17.86
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
112180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$17.86 |
| Rate for Payer: Aetna Commercial |
$16.07
|
| Rate for Payer: Aetna Medicare |
$8.93
|
| Rate for Payer: ASR ASR |
$17.32
|
| Rate for Payer: ASR Commercial |
$17.32
|
| Rate for Payer: BCBS Complete |
$7.14
|
| Rate for Payer: BCBS Trust/PPO |
$14.63
|
| Rate for Payer: BCN Commercial |
$13.85
|
| Rate for Payer: Cash Price |
$14.29
|
| 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 |
$17.86
|
| Rate for Payer: Healthscope Whirlpool |
$17.32
|
| Rate for Payer: Mclaren Commercial |
$16.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.18
|
| Rate for Payer: Nomi Health Commercial |
$14.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.62
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.72
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$230.85
|
|
|
Service Code
|
NDC 00904704861
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.05 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna Commercial |
$207.76
|
| Rate for Payer: ASR ASR |
$223.92
|
| Rate for Payer: ASR Commercial |
$223.92
|
| Rate for Payer: BCBS Trust/PPO |
$188.12
|
| Rate for Payer: BCN Commercial |
$178.98
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$217.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$230.85
|
| Rate for Payer: Healthscope Whirlpool |
$223.92
|
| Rate for Payer: Mclaren Commercial |
$207.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Nomi Health Commercial |
$189.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.15
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
OP
|
$253.65
|
|
|
Service Code
|
NDC 68084034711
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.46 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Aetna Commercial |
$228.28
|
| Rate for Payer: Aetna Medicare |
$126.82
|
| Rate for Payer: ASR ASR |
$246.04
|
| Rate for Payer: ASR Commercial |
$246.04
|
| Rate for Payer: BCBS Complete |
$101.46
|
| Rate for Payer: BCBS Trust/PPO |
$207.71
|
| Rate for Payer: BCN Commercial |
$196.65
|
| Rate for Payer: Cash Price |
$202.92
|
| Rate for Payer: Cofinity Commercial |
$238.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.92
|
| Rate for Payer: Healthscope Commercial |
$253.65
|
| Rate for Payer: Healthscope Whirlpool |
$246.04
|
| Rate for Payer: Mclaren Commercial |
$228.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.60
|
| Rate for Payer: Nomi Health Commercial |
$207.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.25
|
| Rate for Payer: Priority Health Narrow Network |
$177.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.21
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
OP
|
$230.85
|
|
|
Service Code
|
NDC 00904704861
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.34 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna Commercial |
$207.76
|
| Rate for Payer: Aetna Medicare |
$115.42
|
| Rate for Payer: ASR ASR |
$223.92
|
| Rate for Payer: ASR Commercial |
$223.92
|
| Rate for Payer: BCBS Complete |
$92.34
|
| Rate for Payer: BCBS Trust/PPO |
$189.04
|
| Rate for Payer: BCN Commercial |
$178.98
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$217.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$230.85
|
| Rate for Payer: Healthscope Whirlpool |
$223.92
|
| Rate for Payer: Mclaren Commercial |
$207.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Nomi Health Commercial |
$189.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$202.27
|
| Rate for Payer: Priority Health Narrow Network |
$161.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.15
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$253.65
|
|
|
Service Code
|
NDC 68084034711
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.87 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Aetna Commercial |
$228.28
|
| Rate for Payer: ASR ASR |
$246.04
|
| Rate for Payer: ASR Commercial |
$246.04
|
| Rate for Payer: BCBS Trust/PPO |
$206.70
|
| Rate for Payer: BCN Commercial |
$196.65
|
| Rate for Payer: Cash Price |
$202.92
|
| Rate for Payer: Cofinity Commercial |
$238.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.92
|
| Rate for Payer: Healthscope Commercial |
$253.65
|
| Rate for Payer: Healthscope Whirlpool |
$246.04
|
| Rate for Payer: Mclaren Commercial |
$228.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.60
|
| Rate for Payer: Nomi Health Commercial |
$207.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.21
|
|
|
LUSPATERCEPT-AAMT 25 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$10,484.47
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.13 |
| Max. Negotiated Rate |
$10,484.47 |
| Rate for Payer: Aetna Commercial |
$9,436.02
|
| Rate for Payer: Aetna Medicare |
$41.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.60
|
| Rate for Payer: ASR ASR |
$10,169.94
|
| Rate for Payer: ASR Commercial |
$10,169.94
|
| Rate for Payer: BCBS Complete |
$23.23
|
| Rate for Payer: BCBS MAPPO |
$41.28
|
| Rate for Payer: BCBS Trust/PPO |
$8,585.73
|
| Rate for Payer: BCN Commercial |
$8,128.61
|
| Rate for Payer: BCN Medicare Advantage |
$41.28
|
| Rate for Payer: Cash Price |
$8,387.58
|
| Rate for Payer: Cash Price |
$8,387.58
|
| Rate for Payer: Cofinity Commercial |
$9,855.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,387.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.28
|
| Rate for Payer: Healthscope Commercial |
$10,484.47
|
| Rate for Payer: Healthscope Whirlpool |
$10,169.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$41.28
|
| Rate for Payer: Mclaren Commercial |
$9,436.02
|
| Rate for Payer: Mclaren Medicaid |
$22.13
|
| Rate for Payer: Mclaren Medicare |
$41.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.34
|
| Rate for Payer: Meridian Medicaid |
$23.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,911.80
|
| Rate for Payer: Nomi Health Commercial |
$8,597.27
|
| Rate for Payer: PACE Medicare |
$39.22
|
| Rate for Payer: PACE SWMI |
$41.28
|
| Rate for Payer: PHP Commercial |
$45.41
|
| Rate for Payer: PHP Medicaid |
$22.13
|
| Rate for Payer: PHP Medicare Advantage |
$41.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,814.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.80
|
| Rate for Payer: Priority Health Medicare |
$41.28
|
| Rate for Payer: Priority Health Narrow Network |
$34.24
|
| Rate for Payer: Railroad Medicare Medicare |
$41.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,226.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.28
|
| Rate for Payer: UHC Exchange |
$63.98
|
| Rate for Payer: UHC Medicare Advantage |
$41.28
|
| Rate for Payer: UHCCP DNSP |
$41.28
|
| Rate for Payer: UHCCP Medicaid |
$22.13
|
| Rate for Payer: VA VA |
$41.28
|
|
|
LUSPATERCEPT-AAMT 25 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$10,484.47
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,814.91 |
| Max. Negotiated Rate |
$10,484.47 |
| Rate for Payer: Aetna Commercial |
$9,436.02
|
| Rate for Payer: ASR ASR |
$10,169.94
|
| Rate for Payer: ASR Commercial |
$10,169.94
|
| Rate for Payer: BCBS Trust/PPO |
$8,543.79
|
| Rate for Payer: BCN Commercial |
$8,128.61
|
| Rate for Payer: Cash Price |
$8,387.58
|
| Rate for Payer: Cofinity Commercial |
$9,855.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,387.58
|
| Rate for Payer: Healthscope Commercial |
$10,484.47
|
| Rate for Payer: Healthscope Whirlpool |
$10,169.94
|
| Rate for Payer: Mclaren Commercial |
$9,436.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,911.80
|
| Rate for Payer: Nomi Health Commercial |
$8,597.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,814.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,226.33
|
|
|
LUSPATERCEPT-AAMT 75 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$31,453.29
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.13 |
| Max. Negotiated Rate |
$31,453.29 |
| Rate for Payer: Aetna Commercial |
$28,307.96
|
| Rate for Payer: Aetna Medicare |
$41.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.60
|
| Rate for Payer: ASR ASR |
$30,509.69
|
| Rate for Payer: ASR Commercial |
$30,509.69
|
| Rate for Payer: BCBS Complete |
$23.23
|
| Rate for Payer: BCBS MAPPO |
$41.28
|
| Rate for Payer: BCBS Trust/PPO |
$25,757.10
|
| Rate for Payer: BCN Commercial |
$24,385.74
|
| Rate for Payer: BCN Medicare Advantage |
$41.28
|
| Rate for Payer: Cash Price |
$25,162.63
|
| Rate for Payer: Cash Price |
$25,162.63
|
| Rate for Payer: Cofinity Commercial |
$29,566.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25,162.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.28
|
| Rate for Payer: Healthscope Commercial |
$31,453.29
|
| Rate for Payer: Healthscope Whirlpool |
$30,509.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$41.28
|
| Rate for Payer: Mclaren Commercial |
$28,307.96
|
| Rate for Payer: Mclaren Medicaid |
$22.13
|
| Rate for Payer: Mclaren Medicare |
$41.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.34
|
| Rate for Payer: Meridian Medicaid |
$23.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,735.30
|
| Rate for Payer: Nomi Health Commercial |
$25,791.70
|
| Rate for Payer: PACE Medicare |
$39.22
|
| Rate for Payer: PACE SWMI |
$41.28
|
| Rate for Payer: PHP Commercial |
$45.41
|
| Rate for Payer: PHP Medicaid |
$22.13
|
| Rate for Payer: PHP Medicare Advantage |
$41.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,444.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.80
|
| Rate for Payer: Priority Health Medicare |
$41.28
|
| Rate for Payer: Priority Health Narrow Network |
$34.24
|
| Rate for Payer: Railroad Medicare Medicare |
$41.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27,678.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.28
|
| Rate for Payer: UHC Exchange |
$63.98
|
| Rate for Payer: UHC Medicare Advantage |
$41.28
|
| Rate for Payer: UHCCP DNSP |
$41.28
|
| Rate for Payer: UHCCP Medicaid |
$22.13
|
| Rate for Payer: VA VA |
$41.28
|
|
|
LUSPATERCEPT-AAMT 75 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$31,453.29
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20,444.64 |
| Max. Negotiated Rate |
$31,453.29 |
| Rate for Payer: Aetna Commercial |
$28,307.96
|
| Rate for Payer: ASR ASR |
$30,509.69
|
| Rate for Payer: ASR Commercial |
$30,509.69
|
| Rate for Payer: BCBS Trust/PPO |
$25,631.29
|
| Rate for Payer: BCN Commercial |
$24,385.74
|
| Rate for Payer: Cash Price |
$25,162.63
|
| Rate for Payer: Cofinity Commercial |
$29,566.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25,162.63
|
| Rate for Payer: Healthscope Commercial |
$31,453.29
|
| Rate for Payer: Healthscope Whirlpool |
$30,509.69
|
| Rate for Payer: Mclaren Commercial |
$28,307.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,735.30
|
| Rate for Payer: Nomi Health Commercial |
$25,791.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,444.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27,678.90
|
|
|
LYSINE HCL 500 MG TABLET
|
Facility
|
OP
|
$68.15
|
|
|
Service Code
|
NDC 96295013583
|
| Hospital Charge Code |
119069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.26 |
| Max. Negotiated Rate |
$68.15 |
| Rate for Payer: Aetna Commercial |
$61.34
|
| Rate for Payer: Aetna Medicare |
$34.08
|
| Rate for Payer: ASR ASR |
$66.11
|
| Rate for Payer: ASR Commercial |
$66.11
|
| Rate for Payer: BCBS Complete |
$27.26
|
| Rate for Payer: BCBS Trust/PPO |
$55.81
|
| Rate for Payer: BCN Commercial |
$52.84
|
| Rate for Payer: Cash Price |
$54.52
|
| Rate for Payer: Cofinity Commercial |
$64.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.52
|
| Rate for Payer: Healthscope Commercial |
$68.15
|
| Rate for Payer: Healthscope Whirlpool |
$66.11
|
| Rate for Payer: Mclaren Commercial |
$61.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.93
|
| Rate for Payer: Nomi Health Commercial |
$55.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.71
|
| Rate for Payer: Priority Health Narrow Network |
$47.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.97
|
|
|
LYSINE HCL 500 MG TABLET
|
Facility
|
IP
|
$68.15
|
|
|
Service Code
|
NDC 96295013583
|
| Hospital Charge Code |
119069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.30 |
| Max. Negotiated Rate |
$68.15 |
| Rate for Payer: Aetna Commercial |
$61.34
|
| Rate for Payer: ASR ASR |
$66.11
|
| Rate for Payer: ASR Commercial |
$66.11
|
| Rate for Payer: BCBS Trust/PPO |
$55.54
|
| Rate for Payer: BCN Commercial |
$52.84
|
| Rate for Payer: Cash Price |
$54.52
|
| Rate for Payer: Cofinity Commercial |
$64.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.52
|
| Rate for Payer: Healthscope Commercial |
$68.15
|
| Rate for Payer: Healthscope Whirlpool |
$66.11
|
| Rate for Payer: Mclaren Commercial |
$61.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.93
|
| Rate for Payer: Nomi Health Commercial |
$55.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.97
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
OP
|
$17.32
|
|
|
Service Code
|
NDC 71399788901
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: Aetna Medicare |
$8.66
|
| Rate for Payer: ASR ASR |
$16.80
|
| Rate for Payer: ASR Commercial |
$16.80
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: BCBS Trust/PPO |
$14.18
|
| Rate for Payer: BCN Commercial |
$13.43
|
| Rate for Payer: Cash Price |
$13.85
|
| Rate for Payer: Cofinity Commercial |
$16.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Whirlpool |
$16.80
|
| Rate for Payer: Mclaren Commercial |
$15.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: Nomi Health Commercial |
$14.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.18
|
| Rate for Payer: Priority Health Narrow Network |
$12.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.24
|
|
