|
ATENOLOL 50 MG TABLET
|
Facility
|
OP
|
$155.10
|
|
|
Service Code
|
NDC 00378023101
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.04 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna Medicare |
$77.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.82
|
| Rate for Payer: BCBS Complete |
$62.04
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$108.57
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.82
|
| Rate for Payer: Priority Health SBD |
$97.71
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
OP
|
$75.20
|
|
|
Service Code
|
NDC 00093075201
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.08 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna Commercial |
$63.92
|
| Rate for Payer: Aetna Medicare |
$37.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.88
|
| Rate for Payer: BCBS Complete |
$30.08
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cofinity Commercial |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$64.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.16
|
| Rate for Payer: Healthscope Commercial |
$67.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.92
|
| Rate for Payer: PHP Commercial |
$63.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.88
|
| Rate for Payer: Priority Health SBD |
$47.38
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
IP
|
$68.15
|
|
|
Service Code
|
NDC 65862016901
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.93 |
| Max. Negotiated Rate |
$61.34 |
| Rate for Payer: Aetna Commercial |
$57.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.30
|
| Rate for Payer: Cash Price |
$54.52
|
| Rate for Payer: Cofinity Commercial |
$47.70
|
| Rate for Payer: Cofinity Commercial |
$58.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.52
|
| Rate for Payer: Healthscope Commercial |
$61.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.93
|
| Rate for Payer: PHP Commercial |
$57.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.30
|
| Rate for Payer: Priority Health SBD |
$42.93
|
|
|
ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$50,520.68
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
179035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.29 |
| Max. Negotiated Rate |
$45,468.61 |
| Rate for Payer: Aetna Commercial |
$42,942.58
|
| Rate for Payer: Aetna Medicare |
$91.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,838.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$110.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$110.28
|
| Rate for Payer: BCBS Complete |
$49.65
|
| Rate for Payer: BCBS MAPPO |
$88.22
|
| Rate for Payer: BCBS Trust/PPO |
$249.19
|
| Rate for Payer: BCN Commercial |
$249.19
|
| Rate for Payer: BCN Medicare Advantage |
$88.22
|
| Rate for Payer: Cash Price |
$40,416.54
|
| Rate for Payer: Cash Price |
$40,416.54
|
| Rate for Payer: Cofinity Commercial |
$43,447.78
|
| Rate for Payer: Cofinity Commercial |
$35,364.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$35,364.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,416.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.22
|
| Rate for Payer: Healthscope Commercial |
$45,468.61
|
| Rate for Payer: Mclaren Medicaid |
$47.29
|
| Rate for Payer: Mclaren Medicare |
$88.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.63
|
| Rate for Payer: Meridian Medicaid |
$49.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,942.58
|
| Rate for Payer: Nomi Health Commercial |
$264.66
|
| Rate for Payer: PACE Medicare |
$83.81
|
| Rate for Payer: PACE SWMI |
$88.22
|
| Rate for Payer: PHP Commercial |
$42,942.58
|
| Rate for Payer: PHP Medicare Advantage |
$88.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,838.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.21
|
| Rate for Payer: Priority Health Medicare |
$88.22
|
| Rate for Payer: Priority Health Narrow Network |
$198.57
|
| Rate for Payer: Priority Health SBD |
$31,828.03
|
| Rate for Payer: Railroad Medicare Medicare |
$88.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.22
|
| Rate for Payer: UHC Medicare Advantage |
$88.22
|
| Rate for Payer: UHCCP Medicaid |
$49.67
|
| Rate for Payer: VA VA |
$88.22
|
|
|
ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$50,520.68
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
179035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31,828.03 |
| Max. Negotiated Rate |
$45,468.61 |
| Rate for Payer: Aetna Commercial |
$42,942.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,838.44
|
| Rate for Payer: Cash Price |
$40,416.54
|
| Rate for Payer: Cofinity Commercial |
$35,364.48
|
| Rate for Payer: Cofinity Commercial |
$43,447.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$35,364.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,416.54
|
| Rate for Payer: Healthscope Commercial |
$45,468.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,942.58
|
| Rate for Payer: PHP Commercial |
$42,942.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,838.44
|
| Rate for Payer: Priority Health SBD |
$31,828.03
|
|
|
ATEZOLIZUMAB 840 MG/14 ML (60 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$35,364.48
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
189931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.29 |
| Max. Negotiated Rate |
$31,828.03 |
| Rate for Payer: Aetna Commercial |
$30,059.81
|
| Rate for Payer: Aetna Medicare |
$91.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22,986.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$110.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$110.28
|
| Rate for Payer: BCBS Complete |
$49.65
|
| Rate for Payer: BCBS MAPPO |
$88.22
|
| Rate for Payer: BCBS Trust/PPO |
$249.19
|
| Rate for Payer: BCN Commercial |
$249.19
|
| Rate for Payer: BCN Medicare Advantage |
$88.22
|
| Rate for Payer: Cash Price |
$28,291.58
|
| Rate for Payer: Cash Price |
$28,291.58
|
| Rate for Payer: Cofinity Commercial |
$30,413.45
|
| Rate for Payer: Cofinity Commercial |
$24,755.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$24,755.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28,291.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.22
|
| Rate for Payer: Healthscope Commercial |
$31,828.03
|
| Rate for Payer: Mclaren Medicaid |
$47.29
|
| Rate for Payer: Mclaren Medicare |
$88.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.63
|
| Rate for Payer: Meridian Medicaid |
$49.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30,059.81
|
| Rate for Payer: Nomi Health Commercial |
$264.66
|
| Rate for Payer: PACE Medicare |
$83.81
|
| Rate for Payer: PACE SWMI |
$88.22
|
| Rate for Payer: PHP Commercial |
$30,059.81
|
| Rate for Payer: PHP Medicare Advantage |
$88.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22,986.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.21
|
| Rate for Payer: Priority Health Medicare |
$88.22
|
| Rate for Payer: Priority Health Narrow Network |
$198.57
|
| Rate for Payer: Priority Health SBD |
$22,279.62
|
| Rate for Payer: Railroad Medicare Medicare |
$88.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.22
|
| Rate for Payer: UHC Medicare Advantage |
$88.22
|
| Rate for Payer: UHCCP Medicaid |
$49.67
|
| Rate for Payer: VA VA |
$88.22
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$4,180.26
|
|
|
Service Code
|
NDC 00071015540
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,672.10 |
| Max. Negotiated Rate |
$3,762.23 |
| Rate for Payer: Aetna Commercial |
$3,553.22
|
| Rate for Payer: Aetna Medicare |
$2,090.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,717.17
|
| Rate for Payer: BCBS Complete |
$1,672.10
|
| 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: Cofinity Medicare Advantage |
$2,926.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,344.21
|
| Rate for Payer: Healthscope Commercial |
$3,762.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,553.22
|
| Rate for Payer: PHP Commercial |
$3,553.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,717.17
|
| Rate for Payer: Priority Health SBD |
$2,633.56
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
NDC 50268009315
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Aetna Commercial |
$199.75
|
| Rate for Payer: Aetna Medicare |
$117.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.75
|
| Rate for Payer: BCBS Complete |
$94.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$164.50
|
| Rate for Payer: Cofinity Commercial |
$202.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.00
|
| Rate for Payer: Healthscope Commercial |
$211.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.75
|
| Rate for Payer: PHP Commercial |
$199.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.75
|
| Rate for Payer: Priority Health SBD |
$148.05
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
NDC 50268009315
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.05 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Aetna Commercial |
$199.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.75
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$164.50
|
| Rate for Payer: Cofinity Commercial |
$202.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.00
|
| Rate for Payer: Healthscope Commercial |
$211.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.75
|
| Rate for Payer: PHP Commercial |
$199.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.75
|
| Rate for Payer: Priority Health SBD |
$148.05
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$411.25
|
|
|
Service Code
|
NDC 00904629061
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$370.12 |
| Rate for Payer: Aetna Commercial |
$349.56
|
| Rate for Payer: Aetna Medicare |
$205.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.31
|
| Rate for Payer: BCBS Complete |
$164.50
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$287.88
|
| Rate for Payer: Cofinity Commercial |
$353.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.00
|
| Rate for Payer: Healthscope Commercial |
$370.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.56
|
| Rate for Payer: PHP Commercial |
$349.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.31
|
| Rate for Payer: Priority Health SBD |
$259.09
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$411.25
|
|
|
Service Code
|
NDC 00904629061
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.09 |
| Max. Negotiated Rate |
$370.12 |
| Rate for Payer: Aetna Commercial |
$349.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.31
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$287.88
|
| Rate for Payer: Cofinity Commercial |
$353.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.00
|
| Rate for Payer: Healthscope Commercial |
$370.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.56
|
| Rate for Payer: PHP Commercial |
$349.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.31
|
| Rate for Payer: Priority Health SBD |
$259.09
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$4.70
|
|
|
Service Code
|
NDC 50268009311
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$4.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.06
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Cofinity Commercial |
$4.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.76
|
| Rate for Payer: Healthscope Commercial |
$4.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.00
|
| Rate for Payer: PHP Commercial |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.06
|
| Rate for Payer: Priority Health SBD |
$2.96
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$4,180.26
|
|
|
Service Code
|
NDC 00071015540
|
| 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: Cofinity Medicare Advantage |
$2,926.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,344.21
|
| Rate for Payer: Healthscope Commercial |
$3,762.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,553.22
|
| Rate for Payer: PHP Commercial |
$3,553.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,717.17
|
| Rate for Payer: Priority Health SBD |
$2,633.56
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$4.52
|
|
|
Service Code
|
NDC 68084009711
|
| Hospital Charge Code |
19176
|
|
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: Cofinity Medicare Advantage |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.62
|
| Rate for Payer: Healthscope Commercial |
$4.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.84
|
| Rate for Payer: PHP Commercial |
$3.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.94
|
| Rate for Payer: Priority Health SBD |
$2.85
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$4.52
|
|
|
Service Code
|
NDC 68084009711
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna Commercial |
$3.84
|
| Rate for Payer: Aetna Medicare |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.94
|
| Rate for Payer: BCBS Complete |
$1.81
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Cofinity Commercial |
$3.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.62
|
| Rate for Payer: Healthscope Commercial |
$4.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.84
|
| Rate for Payer: PHP Commercial |
$3.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.94
|
| Rate for Payer: Priority Health SBD |
$2.85
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$451.20
|
|
|
Service Code
|
NDC 68084009701
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.26 |
| Max. Negotiated Rate |
$406.08 |
| Rate for Payer: Aetna Commercial |
$383.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.28
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Commercial |
$315.84
|
| Rate for Payer: Cofinity Commercial |
$388.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$315.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Healthscope Commercial |
$406.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: PHP Commercial |
$383.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.28
|
| Rate for Payer: Priority Health SBD |
$284.26
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$451.20
|
|
|
Service Code
|
NDC 68084009701
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.48 |
| Max. Negotiated Rate |
$406.08 |
| Rate for Payer: Aetna Commercial |
$383.52
|
| Rate for Payer: Aetna Medicare |
$225.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.28
|
| Rate for Payer: BCBS Complete |
$180.48
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Commercial |
$315.84
|
| Rate for Payer: Cofinity Commercial |
$388.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$315.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Healthscope Commercial |
$406.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: PHP Commercial |
$383.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.28
|
| Rate for Payer: Priority Health SBD |
$284.26
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$4.70
|
|
|
Service Code
|
NDC 50268009311
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$4.00
|
| Rate for Payer: Aetna Medicare |
$2.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.06
|
| Rate for Payer: BCBS Complete |
$1.88
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Cofinity Commercial |
$4.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.76
|
| Rate for Payer: Healthscope Commercial |
$4.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.00
|
| Rate for Payer: PHP Commercial |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.06
|
| Rate for Payer: Priority Health SBD |
$2.96
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$2.23
|
|
|
Service Code
|
NDC 51079020801
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Aetna Commercial |
$1.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.45
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$1.56
|
| Rate for Payer: Cofinity Commercial |
$1.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.78
|
| Rate for Payer: Healthscope Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.90
|
| Rate for Payer: PHP Commercial |
$1.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.45
|
| Rate for Payer: Priority Health SBD |
$1.40
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$222.30
|
|
|
Service Code
|
NDC 51079020820
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.05 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna Commercial |
$188.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.50
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Commercial |
$155.61
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Healthscope Commercial |
$200.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: PHP Commercial |
$188.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.50
|
| Rate for Payer: Priority Health SBD |
$140.05
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$2.23
|
|
|
Service Code
|
NDC 51079020801
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Aetna Commercial |
$1.90
|
| Rate for Payer: Aetna Medicare |
$1.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.45
|
| Rate for Payer: BCBS Complete |
$0.89
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$1.56
|
| Rate for Payer: Cofinity Commercial |
$1.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.78
|
| Rate for Payer: Healthscope Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.90
|
| Rate for Payer: PHP Commercial |
$1.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.45
|
| Rate for Payer: Priority Health SBD |
$1.40
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$222.30
|
|
|
Service Code
|
NDC 51079020820
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.92 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna Commercial |
$188.96
|
| Rate for Payer: Aetna Medicare |
$111.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.50
|
| Rate for Payer: BCBS Complete |
$88.92
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Commercial |
$155.61
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Healthscope Commercial |
$200.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: PHP Commercial |
$188.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.50
|
| Rate for Payer: Priority Health SBD |
$140.05
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$2.30
|
|
|
Service Code
|
NDC 68084009811
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Aetna Commercial |
$1.96
|
| Rate for Payer: Aetna Medicare |
$1.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.50
|
| Rate for Payer: BCBS Complete |
$0.92
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Cofinity Commercial |
$1.61
|
| Rate for Payer: Cofinity Commercial |
$1.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.84
|
| Rate for Payer: Healthscope Commercial |
$2.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.96
|
| Rate for Payer: PHP Commercial |
$1.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.50
|
| Rate for Payer: Priority Health SBD |
$1.45
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
NDC 00904629161
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna Medicare |
$104.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health SBD |
$131.67
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$229.90
|
|
|
Service Code
|
NDC 68084009801
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.84 |
| Max. Negotiated Rate |
$206.91 |
| Rate for Payer: Aetna Commercial |
$195.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.44
|
| Rate for Payer: Cash Price |
$183.92
|
| Rate for Payer: Cofinity Commercial |
$160.93
|
| Rate for Payer: Cofinity Commercial |
$197.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$160.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.92
|
| Rate for Payer: Healthscope Commercial |
$206.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.42
|
| Rate for Payer: PHP Commercial |
$195.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.44
|
| Rate for Payer: Priority Health SBD |
$144.84
|
|
