|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$4,180.26
|
|
|
Service Code
|
NDC 00071015540
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,839.31 |
| Max. Negotiated Rate |
$3,762.23 |
| Rate for Payer: Aetna American Axle |
$2,717.17
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2,926.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,135.20
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,839.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,135.20
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$334.17
|
|
|
Service Code
|
NDC 60505257809
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.64 |
| Max. Negotiated Rate |
$300.75 |
| Rate for Payer: Aetna American Axle |
$217.21
|
| Rate for Payer: Aetna Commercial |
$284.04
|
| Rate for Payer: Aetna Medicare |
$167.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.21
|
| Rate for Payer: BCBS Complete |
$133.67
|
| Rate for Payer: Cash Price |
$267.34
|
| Rate for Payer: Cofinity Commercial |
$233.92
|
| Rate for Payer: Cofinity Commercial |
$287.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.34
|
| Rate for Payer: Healthscope Commercial |
$300.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$284.04
|
| Rate for Payer: PHP Commercial |
$284.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.21
|
| Rate for Payer: Priority Health SBD |
$210.53
|
| Rate for Payer: UMR Bronson Commercial |
$123.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.63
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$241.11
|
|
|
Service Code
|
NDC 63304082790
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.09 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Aetna American Axle |
$156.72
|
| Rate for Payer: Aetna Commercial |
$204.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.72
|
| Rate for Payer: Cash Price |
$192.89
|
| Rate for Payer: Cofinity Commercial |
$168.78
|
| Rate for Payer: Cofinity Commercial |
$207.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.89
|
| Rate for Payer: Healthscope Commercial |
$217.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.94
|
| Rate for Payer: PHP Commercial |
$204.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.72
|
| Rate for Payer: Priority Health SBD |
$151.90
|
| Rate for Payer: UMR Bronson Commercial |
$106.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.83
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$451.20
|
|
|
Service Code
|
NDC 68084009701
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.94 |
| Max. Negotiated Rate |
$406.08 |
| Rate for Payer: Aetna American Axle |
$293.28
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$315.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.40
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$166.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.40
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$411.25
|
|
|
Service Code
|
NDC 00904629061
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.16 |
| Max. Negotiated Rate |
$370.12 |
| Rate for Payer: Aetna American Axle |
$267.31
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$287.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.44
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$152.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.44
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$411.25
|
|
|
Service Code
|
NDC 00904629061
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.95 |
| Max. Negotiated Rate |
$370.12 |
| Rate for Payer: Aetna American Axle |
$267.31
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$287.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.44
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$180.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.44
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$2.23
|
|
|
Service Code
|
NDC 51079020801
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Aetna American Axle |
$1.45
|
| Rate for Payer: Aetna Commercial |
$1.90
|
| Rate for Payer: Aetna Medicare |
$1.11
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.67
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$0.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.67
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$334.17
|
|
|
Service Code
|
NDC 60505257809
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.03 |
| Max. Negotiated Rate |
$300.75 |
| Rate for Payer: Aetna American Axle |
$217.21
|
| Rate for Payer: Aetna Commercial |
$284.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.21
|
| Rate for Payer: Cash Price |
$267.34
|
| Rate for Payer: Cofinity Commercial |
$233.92
|
| Rate for Payer: Cofinity Commercial |
$287.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.34
|
| Rate for Payer: Healthscope Commercial |
$300.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$284.04
|
| Rate for Payer: PHP Commercial |
$284.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.21
|
| Rate for Payer: Priority Health SBD |
$210.53
|
| Rate for Payer: UMR Bronson Commercial |
$147.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.63
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$251.69
|
|
|
Service Code
|
NDC 69097094405
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.13 |
| Max. Negotiated Rate |
$226.52 |
| Rate for Payer: Aetna American Axle |
$163.60
|
| Rate for Payer: Aetna Commercial |
$213.94
|
| Rate for Payer: Aetna Medicare |
$125.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.60
|
| Rate for Payer: BCBS Complete |
$100.68
|
| Rate for Payer: Cash Price |
$201.35
|
| Rate for Payer: Cofinity Commercial |
$176.18
|
| Rate for Payer: Cofinity Commercial |
$216.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.35
|
| Rate for Payer: Healthscope Commercial |
$226.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.94
|
| Rate for Payer: PHP Commercial |
$213.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.60
|
| Rate for Payer: Priority Health SBD |
$158.56
|
| Rate for Payer: UMR Bronson Commercial |
$93.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.77
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$2.23
|
|
|
Service Code
|
NDC 51079020801
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Aetna American Axle |
$1.45
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.67
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$0.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.67
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$4.52
|
|
|
Service Code
|
NDC 68084009711
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna American Axle |
$2.94
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$3.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.39
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.39
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$222.30
|
|
|
Service Code
|
NDC 51079020820
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.81 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna American Axle |
$144.50
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$155.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.72
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$97.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.72
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$4.52
|
|
|
Service Code
|
NDC 68084009711
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna American Axle |
$2.94
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$3.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.39
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.39
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$4,180.26
|
|
|
Service Code
|
NDC 00071015540
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,546.70 |
| Max. Negotiated Rate |
$3,762.23 |
| Rate for Payer: Aetna American Axle |
$2,717.17
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2,926.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,135.20
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,546.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,135.20
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$251.69
|
|
|
Service Code
|
NDC 69097094405
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.74 |
| Max. Negotiated Rate |
$226.52 |
| Rate for Payer: Aetna American Axle |
$163.60
|
| Rate for Payer: Aetna Commercial |
$213.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.60
|
| Rate for Payer: Cash Price |
$201.35
|
| Rate for Payer: Cofinity Commercial |
$176.18
|
| Rate for Payer: Cofinity Commercial |
$216.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.35
|
| Rate for Payer: Healthscope Commercial |
$226.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.94
|
| Rate for Payer: PHP Commercial |
$213.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.60
|
| Rate for Payer: Priority Health SBD |
$158.56
|
| Rate for Payer: UMR Bronson Commercial |
$110.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.77
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$5,963.29
|
|
|
Service Code
|
NDC 00071015640
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,623.85 |
| Max. Negotiated Rate |
$5,366.96 |
| Rate for Payer: Aetna American Axle |
$3,876.14
|
| Rate for Payer: Aetna Commercial |
$5,068.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,876.14
|
| Rate for Payer: Cash Price |
$4,770.63
|
| Rate for Payer: Cofinity Commercial |
$4,174.30
|
| Rate for Payer: Cofinity Commercial |
$5,128.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,174.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,770.63
|
| Rate for Payer: Healthscope Commercial |
$5,366.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,174.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,472.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,068.80
|
| Rate for Payer: PHP Commercial |
$5,068.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,876.14
|
| Rate for Payer: Priority Health SBD |
$3,756.87
|
| Rate for Payer: UMR Bronson Commercial |
$2,623.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,472.47
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$229.90
|
|
|
Service Code
|
NDC 68084009801
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.16 |
| Max. Negotiated Rate |
$206.91 |
| Rate for Payer: Aetna American Axle |
$149.44
|
| Rate for Payer: Aetna Commercial |
$195.41
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$160.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.41
|
| Rate for Payer: PHP Commercial |
$195.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.44
|
| Rate for Payer: Priority Health SBD |
$144.84
|
| Rate for Payer: UMR Bronson Commercial |
$101.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.43
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
NDC 00904629161
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.33 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna American Axle |
$135.85
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$146.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.75
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$77.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
NDC 00904629161
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.96 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna American Axle |
$135.85
|
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$146.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.75
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$91.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$313.02
|
|
|
Service Code
|
NDC 63304082890
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.82 |
| Max. Negotiated Rate |
$281.72 |
| Rate for Payer: Aetna American Axle |
$203.46
|
| Rate for Payer: Aetna Commercial |
$266.07
|
| Rate for Payer: Aetna Medicare |
$156.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.46
|
| Rate for Payer: BCBS Complete |
$125.21
|
| Rate for Payer: Cash Price |
$250.42
|
| Rate for Payer: Cofinity Commercial |
$219.11
|
| Rate for Payer: Cofinity Commercial |
$269.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$219.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.42
|
| Rate for Payer: Healthscope Commercial |
$281.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.07
|
| Rate for Payer: PHP Commercial |
$266.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.46
|
| Rate for Payer: Priority Health SBD |
$197.20
|
| Rate for Payer: UMR Bronson Commercial |
$115.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.76
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$5,963.29
|
|
|
Service Code
|
NDC 00071015640
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,206.42 |
| Max. Negotiated Rate |
$5,366.96 |
| Rate for Payer: Aetna American Axle |
$3,876.14
|
| Rate for Payer: Aetna Commercial |
$5,068.80
|
| Rate for Payer: Aetna Medicare |
$2,981.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,876.14
|
| Rate for Payer: BCBS Complete |
$2,385.32
|
| Rate for Payer: Cash Price |
$4,770.63
|
| Rate for Payer: Cofinity Commercial |
$4,174.30
|
| Rate for Payer: Cofinity Commercial |
$5,128.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,174.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,770.63
|
| Rate for Payer: Healthscope Commercial |
$5,366.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,174.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,472.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,068.80
|
| Rate for Payer: PHP Commercial |
$5,068.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,876.14
|
| Rate for Payer: Priority Health SBD |
$3,756.87
|
| Rate for Payer: UMR Bronson Commercial |
$2,206.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,472.47
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$313.02
|
|
|
Service Code
|
NDC 63304082890
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.73 |
| Max. Negotiated Rate |
$281.72 |
| Rate for Payer: Aetna American Axle |
$203.46
|
| Rate for Payer: Aetna Commercial |
$266.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.46
|
| Rate for Payer: Cash Price |
$250.42
|
| Rate for Payer: Cofinity Commercial |
$219.11
|
| Rate for Payer: Cofinity Commercial |
$269.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$219.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.42
|
| Rate for Payer: Healthscope Commercial |
$281.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.07
|
| Rate for Payer: PHP Commercial |
$266.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.46
|
| Rate for Payer: Priority Health SBD |
$197.20
|
| Rate for Payer: UMR Bronson Commercial |
$137.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.76
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$229.90
|
|
|
Service Code
|
NDC 68084009801
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.06 |
| Max. Negotiated Rate |
$206.91 |
| Rate for Payer: Aetna American Axle |
$149.44
|
| Rate for Payer: Aetna Commercial |
$195.41
|
| Rate for Payer: Aetna Medicare |
$114.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.44
|
| Rate for Payer: BCBS Complete |
$91.96
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$160.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.41
|
| Rate for Payer: PHP Commercial |
$195.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.44
|
| Rate for Payer: Priority Health SBD |
$144.84
|
| Rate for Payer: UMR Bronson Commercial |
$85.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.43
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$1,492.25
|
|
|
Service Code
|
NDC 55111012305
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$552.13 |
| Max. Negotiated Rate |
$1,343.03 |
| Rate for Payer: Aetna American Axle |
$969.96
|
| Rate for Payer: Aetna Commercial |
$1,268.41
|
| Rate for Payer: Aetna Medicare |
$746.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$969.96
|
| Rate for Payer: BCBS Complete |
$596.90
|
| Rate for Payer: Cash Price |
$1,193.80
|
| Rate for Payer: Cofinity Commercial |
$1,044.58
|
| Rate for Payer: Cofinity Commercial |
$1,283.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,044.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,193.80
|
| Rate for Payer: Healthscope Commercial |
$1,343.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,044.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,119.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,268.41
|
| Rate for Payer: PHP Commercial |
$1,268.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$969.96
|
| Rate for Payer: Priority Health SBD |
$940.12
|
| Rate for Payer: UMR Bronson Commercial |
$552.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,119.19
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$219.45
|
|
|
Service Code
|
NDC 00904629261
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$197.50 |
| Rate for Payer: Aetna American Axle |
$142.64
|
| Rate for Payer: Aetna Commercial |
$186.53
|
| Rate for Payer: Aetna Medicare |
$109.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.64
|
| Rate for Payer: BCBS Complete |
$87.78
|
| Rate for Payer: Cash Price |
$175.56
|
| Rate for Payer: Cofinity Commercial |
$153.62
|
| Rate for Payer: Cofinity Commercial |
$188.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.56
|
| Rate for Payer: Healthscope Commercial |
$197.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.53
|
| Rate for Payer: PHP Commercial |
$186.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.64
|
| Rate for Payer: Priority Health SBD |
$138.25
|
| Rate for Payer: UMR Bronson Commercial |
$81.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.59
|
|
