|
ATEZOLIZUMAB 840 MG/14 ML (60 MG/ML) INTRAVENOUS SOLUTION
|
Facility
OP
|
$33,334.41
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
189931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$30,000.97 |
| Rate for Payer: Aetna Commercial |
$28,334.25
|
| Rate for Payer: Aetna Medicare |
$88.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21,667.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.26
|
| Rate for Payer: BCBS Complete |
$48.83
|
| Rate for Payer: BCBS MAPPO |
$85.01
|
| Rate for Payer: BCBS Trust/PPO |
$251.66
|
| Rate for Payer: BCN Medicare Advantage |
$85.01
|
| Rate for Payer: Cash Price |
$26,667.53
|
| Rate for Payer: Cash Price |
$26,667.53
|
| Rate for Payer: Cofinity Commercial |
$28,667.59
|
| Rate for Payer: Cofinity Commercial |
$23,334.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.01
|
| Rate for Payer: Healthscope Commercial |
$30,000.97
|
| Rate for Payer: Mclaren Medicaid |
$46.50
|
| Rate for Payer: Mclaren Medicare |
$85.01
|
| Rate for Payer: Meridian Medicaid |
$48.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$89.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28,334.25
|
| Rate for Payer: PACE Medicare |
$80.76
|
| Rate for Payer: PACE SWMI |
$85.01
|
| Rate for Payer: PHP Commercial |
$28,334.25
|
| Rate for Payer: PHP Medicare Advantage |
$85.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23,334.09
|
| Rate for Payer: Priority Health Medicare |
$85.01
|
| Rate for Payer: Priority Health SBD |
$21,000.68
|
| Rate for Payer: Railroad Medicare Medicare |
$85.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.01
|
| Rate for Payer: UHC Medicare Advantage |
$87.56
|
| Rate for Payer: VA VA |
$85.01
|
|
|
ATHEROSCLEROSIS WITH MCC
|
Facility
IP
|
$26,394.72
|
|
|
Service Code
|
MS-DRG 302
|
| Min. Negotiated Rate |
$8,138.33 |
| Max. Negotiated Rate |
$26,394.72 |
| Rate for Payer: Aetna Medicare |
$8,909.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,708.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,708.32
|
| Rate for Payer: BCBS MAPPO |
$8,566.66
|
| Rate for Payer: BCBS Trust/PPO |
$26,394.72
|
| Rate for Payer: BCN Medicare Advantage |
$8,566.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,566.66
|
| Rate for Payer: Mclaren Medicare |
$8,566.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,994.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,851.66
|
| Rate for Payer: PACE Medicare |
$8,138.33
|
| Rate for Payer: PACE SWMI |
$8,566.66
|
| Rate for Payer: PHP Medicare Advantage |
$8,566.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,087.70
|
| Rate for Payer: Priority Health Medicare |
$8,566.66
|
| Rate for Payer: Priority Health Narrow Network |
$12,870.16
|
| Rate for Payer: Railroad Medicare Medicare |
$8,566.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,101.26
|
| Rate for Payer: UHC Core |
$10,493.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,566.66
|
| Rate for Payer: UHC Exchange |
$11,239.03
|
| Rate for Payer: UHC Medicare Advantage |
$8,823.66
|
| Rate for Payer: VA VA |
$8,566.66
|
|
|
ATHEROSCLEROSIS WITHOUT MCC
|
Facility
IP
|
$12,130.15
|
|
|
Service Code
|
MS-DRG 303
|
| Min. Negotiated Rate |
$4,970.63 |
| Max. Negotiated Rate |
$12,130.15 |
| Rate for Payer: Aetna Medicare |
$5,441.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,540.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,540.30
|
| Rate for Payer: BCBS MAPPO |
$5,232.24
|
| Rate for Payer: BCBS Trust/PPO |
$12,130.15
|
| Rate for Payer: BCN Medicare Advantage |
$5,232.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,232.24
|
| Rate for Payer: Mclaren Medicare |
$5,232.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,493.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,017.08
|
| Rate for Payer: PACE Medicare |
$4,970.63
|
| Rate for Payer: PACE SWMI |
$5,232.24
|
| Rate for Payer: PHP Medicare Advantage |
$5,232.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,443.68
|
| Rate for Payer: Priority Health Medicare |
$5,232.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,554.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5,232.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,038.66
|
| Rate for Payer: UHC Core |
$6,159.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,232.24
|
| Rate for Payer: UHC Exchange |
$6,597.45
|
| Rate for Payer: UHC Medicare Advantage |
$5,389.21
|
| Rate for Payer: VA VA |
$5,232.24
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
IP
|
$2.74
|
|
|
Service Code
|
NDC 51079-208-01
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.78
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.33
|
| Rate for Payer: PHP Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.92
|
| Rate for Payer: Priority Health SBD |
$1.73
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
IP
|
$130.15
|
|
|
Service Code
|
NDC 50268-093-15
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.99 |
| Max. Negotiated Rate |
$117.14 |
| Rate for Payer: Aetna Commercial |
$110.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.60
|
| Rate for Payer: Cash Price |
$104.12
|
| Rate for Payer: Cofinity Commercial |
$111.93
|
| Rate for Payer: Cofinity Commercial |
$91.10
|
| Rate for Payer: Healthscope Commercial |
$117.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.63
|
| Rate for Payer: PHP Commercial |
$110.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.10
|
| Rate for Payer: Priority Health SBD |
$81.99
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
IP
|
$2.61
|
|
|
Service Code
|
NDC 50268-093-11
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.70
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$1.83
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Healthscope Commercial |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.22
|
| Rate for Payer: PHP Commercial |
$2.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.83
|
| Rate for Payer: Priority Health SBD |
$1.64
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
IP
|
$427.70
|
|
|
Service Code
|
NDC 68084-097-01
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$269.45 |
| Max. Negotiated Rate |
$384.93 |
| Rate for Payer: Aetna Commercial |
$363.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.00
|
| Rate for Payer: Cash Price |
$342.16
|
| Rate for Payer: Cofinity Commercial |
$299.39
|
| Rate for Payer: Cofinity Commercial |
$367.82
|
| Rate for Payer: Healthscope Commercial |
$384.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$363.54
|
| Rate for Payer: PHP Commercial |
$363.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.39
|
| Rate for Payer: Priority Health SBD |
$269.45
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
IP
|
$4.28
|
|
|
Service Code
|
NDC 68084-097-11
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Aetna Commercial |
$3.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.78
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cofinity Commercial |
$3.00
|
| Rate for Payer: Cofinity Commercial |
$3.68
|
| Rate for Payer: Healthscope Commercial |
$3.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.64
|
| Rate for Payer: PHP Commercial |
$3.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.00
|
| Rate for Payer: Priority Health SBD |
$2.70
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
IP
|
$406.55
|
|
|
Service Code
|
NDC 0904-6290-61
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.13 |
| Max. Negotiated Rate |
$365.90 |
| Rate for Payer: Aetna Commercial |
$345.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.26
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cofinity Commercial |
$284.58
|
| Rate for Payer: Cofinity Commercial |
$349.63
|
| Rate for Payer: Healthscope Commercial |
$365.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.57
|
| Rate for Payer: PHP Commercial |
$345.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.58
|
| Rate for Payer: Priority Health SBD |
$256.13
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
IP
|
$273.60
|
|
|
Service Code
|
NDC 51079-208-20
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.37 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.84
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cofinity Commercial |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.56
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.52
|
| Rate for Payer: Priority Health SBD |
$172.37
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
IP
|
$4,180.26
|
|
|
Service Code
|
NDC 0071-0155-40
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,633.56 |
| Max. Negotiated Rate |
$3,762.23 |
| Rate for Payer: Aetna Commercial |
$3,553.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,717.17
|
| Rate for Payer: Cash Price |
$3,344.21
|
| Rate for Payer: Cofinity Commercial |
$2,926.18
|
| Rate for Payer: Cofinity Commercial |
$3,595.02
|
| Rate for Payer: Healthscope Commercial |
$3,762.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,553.22
|
| Rate for Payer: PHP Commercial |
$3,553.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,926.18
|
| Rate for Payer: Priority Health SBD |
$2,633.56
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
IP
|
$205.20
|
|
|
Service Code
|
NDC 0904-6291-61
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.28 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.38
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$143.64
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$174.42
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.64
|
| Rate for Payer: Priority Health SBD |
$129.28
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
IP
|
$249.85
|
|
|
Service Code
|
NDC 51079-209-20
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.41 |
| Max. Negotiated Rate |
$224.86 |
| Rate for Payer: Aetna Commercial |
$212.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.40
|
| Rate for Payer: Cash Price |
$199.88
|
| Rate for Payer: Cofinity Commercial |
$174.90
|
| Rate for Payer: Cofinity Commercial |
$214.87
|
| Rate for Payer: Healthscope Commercial |
$224.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.37
|
| Rate for Payer: PHP Commercial |
$212.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.90
|
| Rate for Payer: Priority Health SBD |
$157.41
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
IP
|
$2.10
|
|
|
Service Code
|
NDC 68084-098-11
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$1.89 |
| Rate for Payer: Aetna Commercial |
$1.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.36
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Cofinity Commercial |
$1.47
|
| Rate for Payer: Cofinity Commercial |
$1.81
|
| Rate for Payer: Healthscope Commercial |
$1.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.78
|
| Rate for Payer: PHP Commercial |
$1.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.47
|
| Rate for Payer: Priority Health SBD |
$1.32
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
IP
|
$209.95
|
|
|
Service Code
|
NDC 68084-098-01
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.27 |
| Max. Negotiated Rate |
$188.96 |
| Rate for Payer: Aetna Commercial |
$178.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.47
|
| Rate for Payer: Cash Price |
$167.96
|
| Rate for Payer: Cofinity Commercial |
$146.96
|
| Rate for Payer: Cofinity Commercial |
$180.56
|
| Rate for Payer: Healthscope Commercial |
$188.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.46
|
| Rate for Payer: PHP Commercial |
$178.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.96
|
| Rate for Payer: Priority Health SBD |
$132.27
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
IP
|
$2.21
|
|
|
Service Code
|
NDC 68084-099-11
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Aetna Commercial |
$1.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.44
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: Cofinity Commercial |
$1.55
|
| Rate for Payer: Cofinity Commercial |
$1.90
|
| Rate for Payer: Healthscope Commercial |
$1.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.88
|
| Rate for Payer: PHP Commercial |
$1.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.55
|
| Rate for Payer: Priority Health SBD |
$1.39
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
IP
|
$225.60
|
|
|
Service Code
|
NDC 0904-6292-06
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.13 |
| Max. Negotiated Rate |
$203.04 |
| Rate for Payer: Aetna Commercial |
$191.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.64
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Commercial |
$157.92
|
| Rate for Payer: Cofinity Commercial |
$194.02
|
| Rate for Payer: Healthscope Commercial |
$203.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.76
|
| Rate for Payer: PHP Commercial |
$191.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.92
|
| Rate for Payer: Priority Health SBD |
$142.13
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
IP
|
$215.65
|
|
|
Service Code
|
NDC 0904-6292-61
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.86 |
| Max. Negotiated Rate |
$194.08 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Healthscope Commercial |
$194.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.30
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.96
|
| Rate for Payer: Priority Health SBD |
$135.86
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
IP
|
$225.60
|
|
|
Service Code
|
NDC 50268-095-15
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.13 |
| Max. Negotiated Rate |
$203.04 |
| Rate for Payer: Aetna Commercial |
$191.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.64
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Commercial |
$157.92
|
| Rate for Payer: Cofinity Commercial |
$194.02
|
| Rate for Payer: Healthscope Commercial |
$203.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.76
|
| Rate for Payer: PHP Commercial |
$191.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.92
|
| Rate for Payer: Priority Health SBD |
$142.13
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
IP
|
$4.52
|
|
|
Service Code
|
NDC 50268-095-11
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna Commercial |
$3.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.94
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Cofinity Commercial |
$3.89
|
| Rate for Payer: Healthscope Commercial |
$4.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.84
|
| Rate for Payer: PHP Commercial |
$3.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.16
|
| Rate for Payer: Priority Health SBD |
$2.85
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
IP
|
$304.56
|
|
|
Service Code
|
NDC 0378-3952-77
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.87 |
| Max. Negotiated Rate |
$274.10 |
| Rate for Payer: Aetna Commercial |
$258.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.96
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Cofinity Commercial |
$213.19
|
| Rate for Payer: Cofinity Commercial |
$261.92
|
| Rate for Payer: Healthscope Commercial |
$274.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$258.88
|
| Rate for Payer: PHP Commercial |
$258.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.19
|
| Rate for Payer: Priority Health SBD |
$191.87
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
IP
|
$3.78
|
|
|
Service Code
|
NDC 51079-210-01
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Aetna Commercial |
$3.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.46
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$2.65
|
| Rate for Payer: Cofinity Commercial |
$3.25
|
| Rate for Payer: Healthscope Commercial |
$3.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.21
|
| Rate for Payer: PHP Commercial |
$3.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.65
|
| Rate for Payer: Priority Health SBD |
$2.38
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
IP
|
$220.40
|
|
|
Service Code
|
NDC 68084-099-01
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.85 |
| Max. Negotiated Rate |
$198.36 |
| Rate for Payer: Aetna Commercial |
$187.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.26
|
| Rate for Payer: Cash Price |
$176.32
|
| Rate for Payer: Cofinity Commercial |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$189.54
|
| Rate for Payer: Healthscope Commercial |
$198.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.34
|
| Rate for Payer: PHP Commercial |
$187.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.28
|
| Rate for Payer: Priority Health SBD |
$138.85
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
IP
|
$377.15
|
|
|
Service Code
|
NDC 51079-210-20
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.60 |
| Max. Negotiated Rate |
$339.44 |
| Rate for Payer: Aetna Commercial |
$320.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.15
|
| Rate for Payer: Cash Price |
$301.72
|
| Rate for Payer: Cofinity Commercial |
$264.00
|
| Rate for Payer: Cofinity Commercial |
$324.35
|
| Rate for Payer: Healthscope Commercial |
$339.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$320.58
|
| Rate for Payer: PHP Commercial |
$320.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.00
|
| Rate for Payer: Priority Health SBD |
$237.60
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
IP
|
$82.94
|
|
|
Service Code
|
NDC 0904-6293-04
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.25 |
| Max. Negotiated Rate |
$74.65 |
| Rate for Payer: Aetna Commercial |
$70.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.91
|
| Rate for Payer: Cash Price |
$66.35
|
| Rate for Payer: Cofinity Commercial |
$58.06
|
| Rate for Payer: Cofinity Commercial |
$71.33
|
| Rate for Payer: Healthscope Commercial |
$74.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.50
|
| Rate for Payer: PHP Commercial |
$70.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.06
|
| Rate for Payer: Priority Health SBD |
$52.25
|
|
