|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
|
IP
|
$58.75
|
|
|
Service Code
|
NDC 00536132601
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$52.88 |
| Rate for Payer: Aetna Commercial |
$49.94
|
| Rate for Payer: BCBS Trust/PPO |
$47.96
|
| Rate for Payer: BCN Commercial |
$45.40
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.00
|
| Rate for Payer: Healthscope Commercial |
$52.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.94
|
| Rate for Payer: Nomi Health Commercial |
$48.18
|
| Rate for Payer: PHP Commercial |
$49.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.19
|
| Rate for Payer: Priority Health HMO/PPO |
$51.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.70
|
| Rate for Payer: UHC Core |
$49.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.06
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
|
OP
|
$58.75
|
|
|
Service Code
|
NDC 00536132601
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$52.88 |
| Rate for Payer: Aetna Commercial |
$49.94
|
| Rate for Payer: Aetna Medicare |
$15.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.36
|
| Rate for Payer: BCBS Complete |
$23.50
|
| Rate for Payer: BCBS MAPPO |
$14.69
|
| Rate for Payer: BCBS Trust/PPO |
$48.30
|
| Rate for Payer: BCN Commercial |
$45.68
|
| Rate for Payer: BCN Medicare Advantage |
$14.69
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$52.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.94
|
| Rate for Payer: Nomi Health Commercial |
$48.18
|
| Rate for Payer: PACE Senior Care Partners |
$13.95
|
| Rate for Payer: PACE SWMI |
$14.69
|
| Rate for Payer: PHP Commercial |
$49.94
|
| Rate for Payer: PHP Medicare Advantage |
$14.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.19
|
| Rate for Payer: Priority Health HMO/PPO |
$51.11
|
| Rate for Payer: Priority Health Medicare |
$14.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.36
|
| Rate for Payer: Railroad Medicare Medicare |
$14.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.70
|
| Rate for Payer: UHC Core |
$49.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.69
|
| Rate for Payer: UHC Exchange |
$14.69
|
| Rate for Payer: UHC Medicare Advantage |
$14.69
|
| Rate for Payer: VA VA |
$14.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.06
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
|
IP
|
$44.65
|
|
|
Service Code
|
NDC 00904513559
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.02 |
| Max. Negotiated Rate |
$40.18 |
| Rate for Payer: Aetna Commercial |
$37.95
|
| Rate for Payer: BCBS Trust/PPO |
$36.45
|
| Rate for Payer: BCN Commercial |
$34.51
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cofinity Commercial |
$38.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.72
|
| Rate for Payer: Healthscope Commercial |
$40.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.95
|
| Rate for Payer: Nomi Health Commercial |
$36.61
|
| Rate for Payer: PHP Commercial |
$37.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.02
|
| Rate for Payer: Priority Health HMO/PPO |
$38.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.29
|
| Rate for Payer: UHC Core |
$37.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.49
|
|
|
ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET
|
Facility
|
IP
|
$61.10
|
|
|
Service Code
|
NDC 09629513158
|
| Hospital Charge Code |
9158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.72 |
| Max. Negotiated Rate |
$54.99 |
| Rate for Payer: Aetna Commercial |
$51.94
|
| Rate for Payer: BCBS Trust/PPO |
$49.88
|
| Rate for Payer: BCN Commercial |
$47.22
|
| Rate for Payer: Cash Price |
$48.88
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.88
|
| Rate for Payer: Healthscope Commercial |
$54.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.94
|
| Rate for Payer: Nomi Health Commercial |
$50.10
|
| Rate for Payer: PHP Commercial |
$51.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.72
|
| Rate for Payer: Priority Health HMO/PPO |
$53.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.77
|
| Rate for Payer: UHC Core |
$51.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.82
|
|
|
ATENOLOL 12.5 MG CUSTOM TAB
|
Facility
|
OP
|
$1.39
|
|
|
Service Code
|
NDC 09900000308
|
| Hospital Charge Code |
155119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Aetna Commercial |
$1.18
|
| Rate for Payer: Aetna Medicare |
$0.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.43
|
| Rate for Payer: BCBS Complete |
$0.56
|
| Rate for Payer: BCBS MAPPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$1.14
|
| Rate for Payer: BCN Commercial |
$1.08
|
| Rate for Payer: BCN Medicare Advantage |
$0.35
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cofinity Commercial |
$1.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.35
|
| Rate for Payer: Healthscope Commercial |
$1.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.18
|
| Rate for Payer: Nomi Health Commercial |
$1.14
|
| Rate for Payer: PACE Senior Care Partners |
$0.33
|
| Rate for Payer: PACE SWMI |
$0.35
|
| Rate for Payer: PHP Commercial |
$1.18
|
| Rate for Payer: PHP Medicare Advantage |
$0.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.90
|
| Rate for Payer: Priority Health HMO/PPO |
$1.21
|
| Rate for Payer: Priority Health Medicare |
$0.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.93
|
| Rate for Payer: Railroad Medicare Medicare |
$0.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.22
|
| Rate for Payer: UHC Core |
$1.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.35
|
| Rate for Payer: UHC Exchange |
$0.35
|
| Rate for Payer: UHC Medicare Advantage |
$0.35
|
| Rate for Payer: VA VA |
$0.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.04
|
|
|
ATENOLOL 12.5 MG CUSTOM TAB
|
Facility
|
IP
|
$1.39
|
|
|
Service Code
|
NDC 09900000308
|
| Hospital Charge Code |
155119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Aetna Commercial |
$1.18
|
| Rate for Payer: BCBS Trust/PPO |
$1.13
|
| Rate for Payer: BCN Commercial |
$1.07
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cofinity Commercial |
$1.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.11
|
| Rate for Payer: Healthscope Commercial |
$1.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.18
|
| Rate for Payer: Nomi Health Commercial |
$1.14
|
| Rate for Payer: PHP Commercial |
$1.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.90
|
| Rate for Payer: Priority Health HMO/PPO |
$1.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.22
|
| Rate for Payer: UHC Core |
$1.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.04
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
IP
|
$430.05
|
|
|
Service Code
|
NDC 51079075920
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$279.53 |
| Max. Negotiated Rate |
$387.04 |
| Rate for Payer: Aetna Commercial |
$365.54
|
| Rate for Payer: BCBS Trust/PPO |
$351.05
|
| Rate for Payer: BCN Commercial |
$332.34
|
| Rate for Payer: Cash Price |
$344.04
|
| Rate for Payer: Cofinity Commercial |
$369.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.04
|
| Rate for Payer: Healthscope Commercial |
$387.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.54
|
| Rate for Payer: Nomi Health Commercial |
$352.64
|
| Rate for Payer: PHP Commercial |
$365.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.53
|
| Rate for Payer: Priority Health HMO/PPO |
$374.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$288.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.44
|
| Rate for Payer: UHC Core |
$359.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.54
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
NDC 51079075901
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: BCBS Trust/PPO |
$3.52
|
| Rate for Payer: BCN Commercial |
$3.33
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: Cofinity Commercial |
$3.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.45
|
| Rate for Payer: Healthscope Commercial |
$3.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.66
|
| Rate for Payer: Nomi Health Commercial |
$3.53
|
| Rate for Payer: PHP Commercial |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health HMO/PPO |
$3.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.79
|
| Rate for Payer: UHC Core |
$3.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.23
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
IP
|
$75.20
|
|
|
Service Code
|
NDC 00093078701
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.88 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna Commercial |
$63.92
|
| Rate for Payer: BCBS Trust/PPO |
$61.39
|
| Rate for Payer: BCN Commercial |
$58.11
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cofinity Commercial |
$64.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.16
|
| Rate for Payer: Healthscope Commercial |
$67.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.92
|
| Rate for Payer: Nomi Health Commercial |
$61.66
|
| Rate for Payer: PHP Commercial |
$63.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.88
|
| Rate for Payer: Priority Health HMO/PPO |
$65.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.18
|
| Rate for Payer: UHC Core |
$62.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.40
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
OP
|
$4.31
|
|
|
Service Code
|
NDC 51079075901
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: Aetna Medicare |
$1.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.35
|
| Rate for Payer: BCBS Complete |
$1.72
|
| Rate for Payer: BCBS MAPPO |
$1.08
|
| Rate for Payer: BCBS Trust/PPO |
$3.54
|
| Rate for Payer: BCN Commercial |
$3.35
|
| Rate for Payer: BCN Medicare Advantage |
$1.08
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: Cofinity Commercial |
$3.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.08
|
| Rate for Payer: Healthscope Commercial |
$3.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.66
|
| Rate for Payer: Nomi Health Commercial |
$3.53
|
| Rate for Payer: PACE Senior Care Partners |
$1.02
|
| Rate for Payer: PACE SWMI |
$1.08
|
| Rate for Payer: PHP Commercial |
$3.66
|
| Rate for Payer: PHP Medicare Advantage |
$1.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health HMO/PPO |
$3.75
|
| Rate for Payer: Priority Health Medicare |
$1.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.79
|
| Rate for Payer: UHC Core |
$3.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.08
|
| Rate for Payer: UHC Exchange |
$1.08
|
| Rate for Payer: UHC Medicare Advantage |
$1.08
|
| Rate for Payer: VA VA |
$1.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.23
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
OP
|
$430.05
|
|
|
Service Code
|
NDC 51079075920
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.14 |
| Max. Negotiated Rate |
$387.04 |
| Rate for Payer: Aetna Commercial |
$365.54
|
| Rate for Payer: Aetna Medicare |
$111.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.39
|
| Rate for Payer: BCBS Complete |
$172.02
|
| Rate for Payer: BCBS MAPPO |
$107.51
|
| Rate for Payer: BCBS Trust/PPO |
$353.54
|
| Rate for Payer: BCN Commercial |
$334.36
|
| Rate for Payer: BCN Medicare Advantage |
$107.51
|
| Rate for Payer: Cash Price |
$344.04
|
| Rate for Payer: Cofinity Commercial |
$369.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.51
|
| Rate for Payer: Healthscope Commercial |
$387.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.54
|
| Rate for Payer: Nomi Health Commercial |
$352.64
|
| Rate for Payer: PACE Senior Care Partners |
$102.14
|
| Rate for Payer: PACE SWMI |
$107.51
|
| Rate for Payer: PHP Commercial |
$365.54
|
| Rate for Payer: PHP Medicare Advantage |
$107.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.53
|
| Rate for Payer: Priority Health HMO/PPO |
$374.14
|
| Rate for Payer: Priority Health Medicare |
$108.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$288.13
|
| Rate for Payer: Railroad Medicare Medicare |
$107.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.44
|
| Rate for Payer: UHC Core |
$359.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.51
|
| Rate for Payer: UHC Exchange |
$107.51
|
| Rate for Payer: UHC Medicare Advantage |
$107.51
|
| Rate for Payer: VA VA |
$107.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.54
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
OP
|
$75.20
|
|
|
Service Code
|
NDC 00093078701
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.86 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna Commercial |
$63.92
|
| Rate for Payer: Aetna Medicare |
$19.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.50
|
| Rate for Payer: BCBS Complete |
$30.08
|
| Rate for Payer: BCBS MAPPO |
$18.80
|
| Rate for Payer: BCBS Trust/PPO |
$61.82
|
| Rate for Payer: BCN Commercial |
$58.47
|
| Rate for Payer: BCN Medicare Advantage |
$18.80
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cofinity Commercial |
$64.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$67.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.92
|
| Rate for Payer: Nomi Health Commercial |
$61.66
|
| Rate for Payer: PACE Senior Care Partners |
$17.86
|
| Rate for Payer: PACE SWMI |
$18.80
|
| Rate for Payer: PHP Commercial |
$63.92
|
| Rate for Payer: PHP Medicare Advantage |
$18.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.88
|
| Rate for Payer: Priority Health HMO/PPO |
$65.42
|
| Rate for Payer: Priority Health Medicare |
$18.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.38
|
| Rate for Payer: Railroad Medicare Medicare |
$18.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.18
|
| Rate for Payer: UHC Core |
$62.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.80
|
| Rate for Payer: UHC Exchange |
$18.80
|
| Rate for Payer: UHC Medicare Advantage |
$18.80
|
| Rate for Payer: VA VA |
$18.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.40
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
OP
|
$340.75
|
|
|
Service Code
|
NDC 00904718761
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.93 |
| Max. Negotiated Rate |
$306.68 |
| Rate for Payer: Aetna Commercial |
$289.64
|
| Rate for Payer: Aetna Medicare |
$88.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.48
|
| Rate for Payer: BCBS Complete |
$136.30
|
| Rate for Payer: BCBS MAPPO |
$85.19
|
| Rate for Payer: BCBS Trust/PPO |
$280.13
|
| Rate for Payer: BCN Commercial |
$264.93
|
| Rate for Payer: BCN Medicare Advantage |
$85.19
|
| Rate for Payer: Cash Price |
$272.60
|
| Rate for Payer: Cofinity Commercial |
$293.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.19
|
| Rate for Payer: Healthscope Commercial |
$306.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.64
|
| Rate for Payer: Nomi Health Commercial |
$279.42
|
| Rate for Payer: PACE Senior Care Partners |
$80.93
|
| Rate for Payer: PACE SWMI |
$85.19
|
| Rate for Payer: PHP Commercial |
$289.64
|
| Rate for Payer: PHP Medicare Advantage |
$85.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.49
|
| Rate for Payer: Priority Health HMO/PPO |
$296.45
|
| Rate for Payer: Priority Health Medicare |
$86.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.30
|
| Rate for Payer: Railroad Medicare Medicare |
$85.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.86
|
| Rate for Payer: UHC Core |
$284.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.19
|
| Rate for Payer: UHC Exchange |
$85.19
|
| Rate for Payer: UHC Medicare Advantage |
$85.19
|
| Rate for Payer: VA VA |
$85.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.56
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
IP
|
$340.75
|
|
|
Service Code
|
NDC 00904718761
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.49 |
| Max. Negotiated Rate |
$306.68 |
| Rate for Payer: Aetna Commercial |
$289.64
|
| Rate for Payer: BCBS Trust/PPO |
$278.15
|
| Rate for Payer: BCN Commercial |
$263.33
|
| Rate for Payer: Cash Price |
$272.60
|
| Rate for Payer: Cofinity Commercial |
$293.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.60
|
| Rate for Payer: Healthscope Commercial |
$306.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.64
|
| Rate for Payer: Nomi Health Commercial |
$279.42
|
| Rate for Payer: PHP Commercial |
$289.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.49
|
| Rate for Payer: Priority Health HMO/PPO |
$296.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.86
|
| Rate for Payer: UHC Core |
$284.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.56
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
OP
|
$2.12
|
|
|
Service Code
|
NDC 51079068401
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna Medicare |
$0.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.66
|
| Rate for Payer: BCBS Complete |
$0.85
|
| Rate for Payer: BCBS MAPPO |
$0.53
|
| Rate for Payer: BCBS Trust/PPO |
$1.74
|
| Rate for Payer: BCN Commercial |
$1.65
|
| Rate for Payer: BCN Medicare Advantage |
$0.53
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cofinity Commercial |
$1.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.53
|
| Rate for Payer: Healthscope Commercial |
$1.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.80
|
| Rate for Payer: Nomi Health Commercial |
$1.74
|
| Rate for Payer: PACE Senior Care Partners |
$0.50
|
| Rate for Payer: PACE SWMI |
$0.53
|
| Rate for Payer: PHP Commercial |
$1.80
|
| Rate for Payer: PHP Medicare Advantage |
$0.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.38
|
| Rate for Payer: Priority Health HMO/PPO |
$1.84
|
| Rate for Payer: Priority Health Medicare |
$0.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.42
|
| Rate for Payer: Railroad Medicare Medicare |
$0.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.87
|
| Rate for Payer: UHC Core |
$1.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.53
|
| Rate for Payer: UHC Exchange |
$0.53
|
| Rate for Payer: UHC Medicare Advantage |
$0.53
|
| Rate for Payer: VA VA |
$0.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.59
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
OP
|
$728.50
|
|
|
Service Code
|
NDC 00093075210
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.02 |
| Max. Negotiated Rate |
$655.65 |
| Rate for Payer: Aetna Commercial |
$619.22
|
| Rate for Payer: Aetna Medicare |
$189.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$227.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$227.66
|
| Rate for Payer: BCBS Complete |
$291.40
|
| Rate for Payer: BCBS MAPPO |
$182.12
|
| Rate for Payer: BCBS Trust/PPO |
$598.90
|
| Rate for Payer: BCN Commercial |
$566.41
|
| Rate for Payer: BCN Medicare Advantage |
$182.12
|
| Rate for Payer: Cash Price |
$582.80
|
| Rate for Payer: Cofinity Commercial |
$626.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.12
|
| Rate for Payer: Healthscope Commercial |
$655.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$546.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.22
|
| Rate for Payer: Nomi Health Commercial |
$597.37
|
| Rate for Payer: PACE Senior Care Partners |
$173.02
|
| Rate for Payer: PACE SWMI |
$182.12
|
| Rate for Payer: PHP Commercial |
$619.22
|
| Rate for Payer: PHP Medicare Advantage |
$182.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.52
|
| Rate for Payer: Priority Health HMO/PPO |
$633.80
|
| Rate for Payer: Priority Health Medicare |
$183.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$488.10
|
| Rate for Payer: Railroad Medicare Medicare |
$182.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$641.08
|
| Rate for Payer: UHC Core |
$608.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.12
|
| Rate for Payer: UHC Exchange |
$182.12
|
| Rate for Payer: UHC Medicare Advantage |
$182.12
|
| Rate for Payer: VA VA |
$182.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$546.38
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
IP
|
$2.12
|
|
|
Service Code
|
NDC 51079068401
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: BCBS Trust/PPO |
$1.73
|
| Rate for Payer: BCN Commercial |
$1.64
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cofinity Commercial |
$1.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.70
|
| Rate for Payer: Healthscope Commercial |
$1.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.80
|
| Rate for Payer: Nomi Health Commercial |
$1.74
|
| Rate for Payer: PHP Commercial |
$1.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.38
|
| Rate for Payer: Priority Health HMO/PPO |
$1.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.87
|
| Rate for Payer: UHC Core |
$1.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.59
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
IP
|
$728.50
|
|
|
Service Code
|
NDC 00093075210
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$473.52 |
| Max. Negotiated Rate |
$655.65 |
| Rate for Payer: Aetna Commercial |
$619.22
|
| Rate for Payer: BCBS Trust/PPO |
$594.67
|
| Rate for Payer: BCN Commercial |
$562.98
|
| Rate for Payer: Cash Price |
$582.80
|
| Rate for Payer: Cofinity Commercial |
$626.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.80
|
| Rate for Payer: Healthscope Commercial |
$655.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$546.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.22
|
| Rate for Payer: Nomi Health Commercial |
$597.37
|
| Rate for Payer: PHP Commercial |
$619.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.52
|
| Rate for Payer: Priority Health HMO/PPO |
$633.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$488.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$641.08
|
| Rate for Payer: UHC Core |
$608.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$546.38
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$2.23
|
|
|
Service Code
|
NDC 51079020801
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Aetna Commercial |
$1.90
|
| Rate for Payer: Aetna Medicare |
$0.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.70
|
| Rate for Payer: BCBS Complete |
$0.89
|
| Rate for Payer: BCBS MAPPO |
$0.56
|
| Rate for Payer: BCBS Trust/PPO |
$1.83
|
| Rate for Payer: BCN Commercial |
$1.73
|
| Rate for Payer: BCN Medicare Advantage |
$0.56
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$1.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.56
|
| Rate for Payer: Healthscope Commercial |
$2.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.90
|
| Rate for Payer: Nomi Health Commercial |
$1.83
|
| Rate for Payer: PACE Senior Care Partners |
$0.53
|
| Rate for Payer: PACE SWMI |
$0.56
|
| Rate for Payer: PHP Commercial |
$1.90
|
| Rate for Payer: PHP Medicare Advantage |
$0.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1.94
|
| Rate for Payer: Priority Health Medicare |
$0.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.49
|
| Rate for Payer: Railroad Medicare Medicare |
$0.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC Core |
$1.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.56
|
| Rate for Payer: UHC Exchange |
$0.56
|
| Rate for Payer: UHC Medicare Advantage |
$0.56
|
| Rate for Payer: VA VA |
$0.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.67
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$411.25
|
|
|
Service Code
|
NDC 00904629061
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$267.31 |
| Max. Negotiated Rate |
$370.12 |
| Rate for Payer: Aetna Commercial |
$349.56
|
| Rate for Payer: BCBS Trust/PPO |
$335.70
|
| Rate for Payer: BCN Commercial |
$317.81
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$353.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.00
|
| Rate for Payer: Healthscope Commercial |
$370.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.56
|
| Rate for Payer: Nomi Health Commercial |
$337.22
|
| Rate for Payer: PHP Commercial |
$349.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.31
|
| Rate for Payer: Priority Health HMO/PPO |
$357.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$275.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$361.90
|
| Rate for Payer: UHC Core |
$343.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.44
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$222.30
|
|
|
Service Code
|
NDC 51079020820
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.50 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna Commercial |
$188.96
|
| Rate for Payer: BCBS Trust/PPO |
$181.46
|
| Rate for Payer: BCN Commercial |
$171.79
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Healthscope Commercial |
$200.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: Nomi Health Commercial |
$182.29
|
| Rate for Payer: PHP Commercial |
$188.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.50
|
| Rate for Payer: Priority Health HMO/PPO |
$193.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.62
|
| Rate for Payer: UHC Core |
$185.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.72
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$222.30
|
|
|
Service Code
|
NDC 51079020820
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna Commercial |
$188.96
|
| Rate for Payer: Aetna Medicare |
$57.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.47
|
| Rate for Payer: BCBS Complete |
$88.92
|
| Rate for Payer: BCBS MAPPO |
$55.58
|
| Rate for Payer: BCBS Trust/PPO |
$182.75
|
| Rate for Payer: BCN Commercial |
$172.84
|
| Rate for Payer: BCN Medicare Advantage |
$55.58
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.58
|
| Rate for Payer: Healthscope Commercial |
$200.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: Nomi Health Commercial |
$182.29
|
| Rate for Payer: PACE Senior Care Partners |
$52.80
|
| Rate for Payer: PACE SWMI |
$55.58
|
| Rate for Payer: PHP Commercial |
$188.96
|
| Rate for Payer: PHP Medicare Advantage |
$55.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.50
|
| Rate for Payer: Priority Health HMO/PPO |
$193.40
|
| Rate for Payer: Priority Health Medicare |
$56.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.94
|
| Rate for Payer: Railroad Medicare Medicare |
$55.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.62
|
| Rate for Payer: UHC Core |
$185.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.58
|
| Rate for Payer: UHC Exchange |
$55.58
|
| Rate for Payer: UHC Medicare Advantage |
$55.58
|
| Rate for Payer: VA VA |
$55.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.72
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$2.23
|
|
|
Service Code
|
NDC 51079020801
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Aetna Commercial |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$1.82
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$1.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.78
|
| Rate for Payer: Healthscope Commercial |
$2.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.90
|
| Rate for Payer: Nomi Health Commercial |
$1.83
|
| Rate for Payer: PHP Commercial |
$1.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC Core |
$1.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.67
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$411.25
|
|
|
Service Code
|
NDC 00904629061
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.67 |
| Max. Negotiated Rate |
$370.12 |
| Rate for Payer: Aetna Commercial |
$349.56
|
| Rate for Payer: Aetna Medicare |
$106.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$128.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$128.52
|
| Rate for Payer: BCBS Complete |
$164.50
|
| Rate for Payer: BCBS MAPPO |
$102.81
|
| Rate for Payer: BCBS Trust/PPO |
$338.09
|
| Rate for Payer: BCN Commercial |
$319.75
|
| Rate for Payer: BCN Medicare Advantage |
$102.81
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$353.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.81
|
| Rate for Payer: Healthscope Commercial |
$370.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.56
|
| Rate for Payer: Nomi Health Commercial |
$337.22
|
| Rate for Payer: PACE Senior Care Partners |
$97.67
|
| Rate for Payer: PACE SWMI |
$102.81
|
| Rate for Payer: PHP Commercial |
$349.56
|
| Rate for Payer: PHP Medicare Advantage |
$102.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.31
|
| Rate for Payer: Priority Health HMO/PPO |
$357.79
|
| Rate for Payer: Priority Health Medicare |
$103.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$275.54
|
| Rate for Payer: Railroad Medicare Medicare |
$102.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$361.90
|
| Rate for Payer: UHC Core |
$343.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.81
|
| Rate for Payer: UHC Exchange |
$102.81
|
| Rate for Payer: UHC Medicare Advantage |
$102.81
|
| Rate for Payer: VA VA |
$102.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.44
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$2.30
|
|
|
Service Code
|
NDC 68084009811
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Aetna Commercial |
$1.96
|
| Rate for Payer: Aetna Medicare |
$0.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.72
|
| Rate for Payer: BCBS Complete |
$0.92
|
| Rate for Payer: BCBS MAPPO |
$0.58
|
| Rate for Payer: BCBS Trust/PPO |
$1.89
|
| Rate for Payer: BCN Commercial |
$1.79
|
| Rate for Payer: BCN Medicare Advantage |
$0.58
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Cofinity Commercial |
$1.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.58
|
| Rate for Payer: Healthscope Commercial |
$2.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.96
|
| Rate for Payer: Nomi Health Commercial |
$1.89
|
| Rate for Payer: PACE Senior Care Partners |
$0.55
|
| Rate for Payer: PACE SWMI |
$0.58
|
| Rate for Payer: PHP Commercial |
$1.96
|
| Rate for Payer: PHP Medicare Advantage |
$0.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.50
|
| Rate for Payer: Priority Health HMO/PPO |
$2.00
|
| Rate for Payer: Priority Health Medicare |
$0.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.54
|
| Rate for Payer: Railroad Medicare Medicare |
$0.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.02
|
| Rate for Payer: UHC Core |
$1.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.58
|
| Rate for Payer: UHC Exchange |
$0.58
|
| Rate for Payer: UHC Medicare Advantage |
$0.58
|
| Rate for Payer: VA VA |
$0.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.72
|
|
