Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

loratadine 10 mg Tab [HMC]

Facility

$5.86

Service Code	NDC 00904685261
Hospital Charge Code	3809701
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$5.57
Rate for Payer: Aetna Commercial	$5.27
Rate for Payer: Humana Medicare Advantage	$2.46
Rate for Payer: UnitedHealthcare Commercial	$5.57
Rate for Payer: UnitedHealthcare Medicaid	$2.34
Rate for Payer: WPPA Medicare Advantage	$3.52

loratadine 10 mg Tab [HMC]

Facility

$7.09

Service Code	NDC 50268048915
Hospital Charge Code	3809701
Hospital Revenue Code	250
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$6.74
Rate for Payer: Aetna Commercial	$6.38
Rate for Payer: Humana Medicare Advantage	$2.98
Rate for Payer: UnitedHealthcare Commercial	$6.74
Rate for Payer: UnitedHealthcare Medicaid	$2.84
Rate for Payer: WPPA Medicare Advantage	$4.25

loratadine 10 mg Tab [HMC]

Facility

$7.09

Service Code	NDC 50268048915
Hospital Charge Code	3809701
Hospital Revenue Code	250
Min. Negotiated Rate	$6.38
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.38
Rate for Payer: UnitedHealthcare Commercial	$6.74
Rate for Payer: WPPA Medicare Advantage	$1,200.00

loratadine 10 mg Tab [HMC]

Facility

$5.86

Service Code	NDC 00904685261
Hospital Charge Code	3809701
Hospital Revenue Code	250
Min. Negotiated Rate	$5.27
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.27
Rate for Payer: UnitedHealthcare Commercial	$5.57
Rate for Payer: WPPA Medicare Advantage	$1,200.00

loratadine 10 mg Tab [HMC]

Facility

$7.11

Service Code	NDC 68084024801
Hospital Charge Code	3809701
Hospital Revenue Code	250
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.40
Rate for Payer: UnitedHealthcare Commercial	$6.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

loratadine 10 mg Tab [HMC]

Facility

$7.11

Service Code	NDC 68084024801
Hospital Charge Code	3809701
Hospital Revenue Code	250
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$6.75
Rate for Payer: Aetna Commercial	$6.40
Rate for Payer: Humana Medicare Advantage	$2.99
Rate for Payer: UnitedHealthcare Commercial	$6.75
Rate for Payer: UnitedHealthcare Medicaid	$2.84
Rate for Payer: WPPA Medicare Advantage	$4.27

loratadine 10 mg Tab [HMC]

Facility

$5.90

Service Code	NDC 45802065065
Hospital Charge Code	3809701
Hospital Revenue Code	250
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$5.61
Rate for Payer: Aetna Commercial	$5.31
Rate for Payer: Humana Medicare Advantage	$2.48
Rate for Payer: UnitedHealthcare Commercial	$5.61
Rate for Payer: UnitedHealthcare Medicaid	$2.36
Rate for Payer: WPPA Medicare Advantage	$3.54

loratadine 5 mg/5 mL Syr [HMC]

Facility

$1.03

Service Code	NDC 51672213108
Hospital Charge Code	3800230
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.93
Rate for Payer: Humana Medicare Advantage	$0.43
Rate for Payer: UnitedHealthcare Commercial	$0.98
Rate for Payer: UnitedHealthcare Medicaid	$0.41
Rate for Payer: WPPA Medicare Advantage	$0.62

loratadine 5 mg/5 mL Syr [HMC]

Facility

$1.03

Service Code	NDC 51672213108
Hospital Charge Code	3800230
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$0.93
Rate for Payer: UnitedHealthcare Commercial	$0.98
Rate for Payer: WPPA Medicare Advantage	$1,200.00

loratadine 5 mg/5 mL Syr [HMC]

Facility

$0.89

Service Code	NDC 54838055840
Hospital Charge Code	3800230
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$0.80
Rate for Payer: UnitedHealthcare Commercial	$0.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

loratadine 5 mg/5 mL Syr [HMC]

Facility

$0.89

Service Code	NDC 54838055840
Hospital Charge Code	3800230
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.85
Rate for Payer: Aetna Commercial	$0.80
Rate for Payer: Humana Medicare Advantage	$0.37
Rate for Payer: UnitedHealthcare Commercial	$0.85
Rate for Payer: UnitedHealthcare Medicaid	$0.36
Rate for Payer: WPPA Medicare Advantage	$0.53

LORazepam 0.5 mg Tab [HMC]

Facility

$7.72

Service Code	NDC 60687082001
Hospital Charge Code	3805024
Hospital Revenue Code	250
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$7.33
Rate for Payer: Aetna Commercial	$6.95
Rate for Payer: Humana Medicare Advantage	$3.24
Rate for Payer: UnitedHealthcare Commercial	$7.33
Rate for Payer: UnitedHealthcare Medicaid	$3.09
Rate for Payer: WPPA Medicare Advantage	$4.63

LORazepam 0.5 mg Tab [HMC]

Facility

$6.93

Service Code	NDC 69315090401
Hospital Charge Code	3805024
Hospital Revenue Code	250
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.24
Rate for Payer: UnitedHealthcare Commercial	$6.58
Rate for Payer: WPPA Medicare Advantage	$1,200.00

LORazepam 0.5 mg Tab [HMC]

Facility

$5.29

Service Code	NDC 00904600761
Hospital Charge Code	3805024
Hospital Revenue Code	250
Min. Negotiated Rate	$4.76
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$4.76
Rate for Payer: UnitedHealthcare Commercial	$5.03
Rate for Payer: WPPA Medicare Advantage	$1,200.00

LORazepam 0.5 mg Tab [HMC]

Facility

$6.93

Service Code	NDC 00591024001
Hospital Charge Code	3805024
Hospital Revenue Code	250
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.24
Rate for Payer: UnitedHealthcare Commercial	$6.58
Rate for Payer: WPPA Medicare Advantage	$1,200.00

LORazepam 0.5 mg Tab [HMC]

Facility

$5.29

Service Code	NDC 00904600761
Hospital Charge Code	3805024
Hospital Revenue Code	250
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$5.03
Rate for Payer: Aetna Commercial	$4.76
Rate for Payer: Humana Medicare Advantage	$2.22
Rate for Payer: UnitedHealthcare Commercial	$5.03
Rate for Payer: UnitedHealthcare Medicaid	$2.12
Rate for Payer: WPPA Medicare Advantage	$3.17

LORazepam 0.5 mg Tab [HMC]

Facility

$6.93

Service Code	NDC 69315090401
Hospital Charge Code	3805024
Hospital Revenue Code	250
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$6.58
Rate for Payer: Aetna Commercial	$6.24
Rate for Payer: Humana Medicare Advantage	$2.91
Rate for Payer: UnitedHealthcare Commercial	$6.58
Rate for Payer: UnitedHealthcare Medicaid	$2.77
Rate for Payer: WPPA Medicare Advantage	$4.16

LORazepam 0.5 mg Tab [HMC]

Facility

$7.72

Service Code	NDC 60687082001
Hospital Charge Code	3805024
Hospital Revenue Code	250
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.95
Rate for Payer: UnitedHealthcare Commercial	$7.33
Rate for Payer: WPPA Medicare Advantage	$1,200.00

LORazepam 0.5 mg Tab [HMC]

Facility

$6.93

Service Code	NDC 00591024001
Hospital Charge Code	3805024
Hospital Revenue Code	250
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$6.58
Rate for Payer: Aetna Commercial	$6.24
Rate for Payer: Humana Medicare Advantage	$2.91
Rate for Payer: UnitedHealthcare Commercial	$6.58
Rate for Payer: UnitedHealthcare Medicaid	$2.77
Rate for Payer: WPPA Medicare Advantage	$4.16

LORazepam 2 mg/mL Inj Sol [HMC]

Facility

$26.41

Service Code	HCPCS J2060
Hospital Charge Code	3800460
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$25.09
Rate for Payer: Aetna Commercial	$23.77
Rate for Payer: Aetna Commercial	$20.48
Rate for Payer: Aetna Commercial	$21.18
Rate for Payer: Aetna Commercial	$21.11
Rate for Payer: Aetna Commercial	$32.88
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.24
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.24
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.24
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.24
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$1.24
Rate for Payer: Humana Medicare Advantage	$9.85
Rate for Payer: Humana Medicare Advantage	$9.56
Rate for Payer: Humana Medicare Advantage	$9.88
Rate for Payer: Humana Medicare Advantage	$11.09
Rate for Payer: Humana Medicare Advantage	$15.34
Rate for Payer: UnitedHealthcare Commercial	$22.29
Rate for Payer: UnitedHealthcare Commercial	$22.35
Rate for Payer: UnitedHealthcare Commercial	$34.70
Rate for Payer: UnitedHealthcare Commercial	$25.09
Rate for Payer: UnitedHealthcare Commercial	$21.62
Rate for Payer: UnitedHealthcare Medicaid	$1.41
Rate for Payer: UnitedHealthcare Medicaid	$1.41
Rate for Payer: UnitedHealthcare Medicaid	$1.41
Rate for Payer: UnitedHealthcare Medicaid	$1.41
Rate for Payer: UnitedHealthcare Medicaid	$1.41
Rate for Payer: WPPA Medicare Advantage	$14.12
Rate for Payer: WPPA Medicare Advantage	$14.08
Rate for Payer: WPPA Medicare Advantage	$13.66
Rate for Payer: WPPA Medicare Advantage	$15.85
Rate for Payer: WPPA Medicare Advantage	$21.92

LORazepam 2 mg/mL Inj Sol [HMC]

Facility

$26.41

Service Code	HCPCS J2060
Hospital Charge Code	3800460
Hospital Revenue Code	250
Min. Negotiated Rate	$23.77
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$23.77
Rate for Payer: Aetna Commercial	$21.18
Rate for Payer: Aetna Commercial	$20.48
Rate for Payer: Aetna Commercial	$32.88
Rate for Payer: Aetna Commercial	$21.11
Rate for Payer: UnitedHealthcare Commercial	$21.62
Rate for Payer: UnitedHealthcare Commercial	$34.70
Rate for Payer: UnitedHealthcare Commercial	$25.09
Rate for Payer: UnitedHealthcare Commercial	$22.29
Rate for Payer: UnitedHealthcare Commercial	$22.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

losartan 50 mg Tab [HMC]

Facility

$7.43

Service Code	NDC 00904704861
Hospital Charge Code	3800980
Hospital Revenue Code	250
Min. Negotiated Rate	$6.69
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.69
Rate for Payer: UnitedHealthcare Commercial	$7.06
Rate for Payer: WPPA Medicare Advantage	$1,200.00

losartan 50 mg Tab [HMC]

Facility

$11.79

Service Code	NDC 65862020299
Hospital Charge Code	3800980
Hospital Revenue Code	250
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$11.20
Rate for Payer: Aetna Commercial	$10.61
Rate for Payer: Humana Medicare Advantage	$4.95
Rate for Payer: UnitedHealthcare Commercial	$11.20
Rate for Payer: UnitedHealthcare Medicaid	$4.72
Rate for Payer: WPPA Medicare Advantage	$7.07

losartan 50 mg Tab [HMC]

Facility

$6.89

Service Code	NDC 50268050515
Hospital Charge Code	3800980
Hospital Revenue Code	250
Min. Negotiated Rate	$6.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.20
Rate for Payer: UnitedHealthcare Commercial	$6.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

losartan 50 mg Tab [HMC]

Facility

$6.89

Service Code	NDC 50268050515
Hospital Charge Code	3800980
Hospital Revenue Code	250
Min. Negotiated Rate	$2.76
Max. Negotiated Rate	$6.55
Rate for Payer: Aetna Commercial	$6.20
Rate for Payer: Humana Medicare Advantage	$2.89
Rate for Payer: UnitedHealthcare Commercial	$6.55
Rate for Payer: UnitedHealthcare Medicaid	$2.76
Rate for Payer: WPPA Medicare Advantage	$4.13

Know your out-of-pocket cost for care.

All Charges