|
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
|
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
|
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
|
$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
|
$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 40 MG TABLET
|
Facility
|
IP
|
$3.86
|
|
|
Service Code
|
NDC 51079021001
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$3.47 |
| Rate for Payer: Aetna American Axle |
$2.51
|
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.51
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.09
|
| Rate for Payer: Healthscope Commercial |
$3.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.28
|
| Rate for Payer: PHP Commercial |
$3.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.51
|
| Rate for Payer: Priority Health SBD |
$2.43
|
| Rate for Payer: UMR Bronson Commercial |
$1.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.90
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$385.70
|
|
|
Service Code
|
NDC 51079021020
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.71 |
| Max. Negotiated Rate |
$347.13 |
| Rate for Payer: Aetna American Axle |
$250.70
|
| Rate for Payer: Aetna Commercial |
$327.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.70
|
| Rate for Payer: Cash Price |
$308.56
|
| Rate for Payer: Cofinity Commercial |
$269.99
|
| Rate for Payer: Cofinity Commercial |
$331.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.56
|
| Rate for Payer: Healthscope Commercial |
$347.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.84
|
| Rate for Payer: PHP Commercial |
$327.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.70
|
| Rate for Payer: Priority Health SBD |
$242.99
|
| Rate for Payer: UMR Bronson Commercial |
$169.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.28
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$219.45
|
|
|
Service Code
|
NDC 00904629261
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.56 |
| Max. Negotiated Rate |
$197.50 |
| Rate for Payer: Aetna American Axle |
$142.64
|
| Rate for Payer: Aetna Commercial |
$186.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.64
|
| 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 |
$96.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.59
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$6,359.56
|
|
|
Service Code
|
NDC 00071015740
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,798.21 |
| Max. Negotiated Rate |
$5,723.60 |
| Rate for Payer: Aetna American Axle |
$4,133.71
|
| Rate for Payer: Aetna Commercial |
$5,405.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,133.71
|
| Rate for Payer: Cash Price |
$5,087.65
|
| Rate for Payer: Cofinity Commercial |
$4,451.69
|
| Rate for Payer: Cofinity Commercial |
$5,469.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,451.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,087.65
|
| Rate for Payer: Healthscope Commercial |
$5,723.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,451.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,769.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,405.63
|
| Rate for Payer: PHP Commercial |
$5,405.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,133.71
|
| Rate for Payer: Priority Health SBD |
$4,006.52
|
| Rate for Payer: UMR Bronson Commercial |
$2,798.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,769.67
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$6,359.56
|
|
|
Service Code
|
NDC 00071015740
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,353.04 |
| Max. Negotiated Rate |
$5,723.60 |
| Rate for Payer: Aetna American Axle |
$4,133.71
|
| Rate for Payer: Aetna Commercial |
$5,405.63
|
| Rate for Payer: Aetna Medicare |
$3,179.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,133.71
|
| Rate for Payer: BCBS Complete |
$2,543.82
|
| Rate for Payer: Cash Price |
$5,087.65
|
| Rate for Payer: Cofinity Commercial |
$4,451.69
|
| Rate for Payer: Cofinity Commercial |
$5,469.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,451.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,087.65
|
| Rate for Payer: Healthscope Commercial |
$5,723.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,451.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,769.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,405.63
|
| Rate for Payer: PHP Commercial |
$5,405.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,133.71
|
| Rate for Payer: Priority Health SBD |
$4,006.52
|
| Rate for Payer: UMR Bronson Commercial |
$2,353.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,769.67
|
|
|
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 |
$1,343.02 |
| 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 |
$1,343.02
|
| 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
|
$385.70
|
|
|
Service Code
|
NDC 51079021020
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.71 |
| Max. Negotiated Rate |
$347.13 |
| Rate for Payer: Aetna American Axle |
$250.70
|
| Rate for Payer: Aetna Commercial |
$327.84
|
| Rate for Payer: Aetna Medicare |
$192.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.70
|
| Rate for Payer: BCBS Complete |
$154.28
|
| Rate for Payer: Cash Price |
$308.56
|
| Rate for Payer: Cofinity Commercial |
$269.99
|
| Rate for Payer: Cofinity Commercial |
$331.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.56
|
| Rate for Payer: Healthscope Commercial |
$347.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.84
|
| Rate for Payer: PHP Commercial |
$327.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.70
|
| Rate for Payer: Priority Health SBD |
$242.99
|
| Rate for Payer: UMR Bronson Commercial |
$142.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.28
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$365.90
|
|
|
Service Code
|
NDC 63304082990
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.38 |
| Max. Negotiated Rate |
$329.31 |
| Rate for Payer: Aetna American Axle |
$237.84
|
| Rate for Payer: Aetna Commercial |
$311.02
|
| Rate for Payer: Aetna Medicare |
$182.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.84
|
| Rate for Payer: BCBS Complete |
$146.36
|
| Rate for Payer: Cash Price |
$292.72
|
| Rate for Payer: Cofinity Commercial |
$256.13
|
| Rate for Payer: Cofinity Commercial |
$314.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.72
|
| Rate for Payer: Healthscope Commercial |
$329.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.02
|
| Rate for Payer: PHP Commercial |
$311.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.84
|
| Rate for Payer: Priority Health SBD |
$230.52
|
| Rate for Payer: UMR Bronson Commercial |
$135.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.42
|
|
|
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
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$191.52
|
|
|
Service Code
|
NDC 60505258009
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.86 |
| Max. Negotiated Rate |
$172.37 |
| Rate for Payer: Aetna American Axle |
$124.49
|
| Rate for Payer: Aetna Commercial |
$162.79
|
| Rate for Payer: Aetna Medicare |
$95.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.49
|
| Rate for Payer: BCBS Complete |
$76.61
|
| Rate for Payer: Cash Price |
$153.22
|
| Rate for Payer: Cofinity Commercial |
$134.06
|
| Rate for Payer: Cofinity Commercial |
$164.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.22
|
| Rate for Payer: Healthscope Commercial |
$172.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.79
|
| Rate for Payer: PHP Commercial |
$162.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.49
|
| Rate for Payer: Priority Health SBD |
$120.66
|
| Rate for Payer: UMR Bronson Commercial |
$70.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.64
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$1,492.25
|
|
|
Service Code
|
NDC 55111012305
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$656.59 |
| Max. Negotiated Rate |
$1,343.02 |
| Rate for Payer: Aetna American Axle |
$969.96
|
| Rate for Payer: Aetna Commercial |
$1,268.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$969.96
|
| 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 |
$1,343.02
|
| 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 |
$656.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,119.19
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$296.10
|
|
|
Service Code
|
NDC 62175089246
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.28 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna American Axle |
$192.46
|
| Rate for Payer: Aetna Commercial |
$251.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.46
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$207.27
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.68
|
| Rate for Payer: PHP Commercial |
$251.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.46
|
| Rate for Payer: Priority Health SBD |
$186.54
|
| Rate for Payer: UMR Bronson Commercial |
$130.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.08
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$296.10
|
|
|
Service Code
|
NDC 62175089246
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.56 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna American Axle |
$192.46
|
| Rate for Payer: Aetna Commercial |
$251.68
|
| Rate for Payer: Aetna Medicare |
$148.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.46
|
| Rate for Payer: BCBS Complete |
$118.44
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$207.27
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.68
|
| Rate for Payer: PHP Commercial |
$251.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.46
|
| Rate for Payer: Priority Health SBD |
$186.54
|
| Rate for Payer: UMR Bronson Commercial |
$109.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.08
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$3.86
|
|
|
Service Code
|
NDC 51079021001
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$3.47 |
| Rate for Payer: Aetna American Axle |
$2.51
|
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Aetna Medicare |
$1.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.51
|
| Rate for Payer: BCBS Complete |
$1.54
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.09
|
| Rate for Payer: Healthscope Commercial |
$3.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.28
|
| Rate for Payer: PHP Commercial |
$3.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.51
|
| Rate for Payer: Priority Health SBD |
$2.43
|
| Rate for Payer: UMR Bronson Commercial |
$1.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.90
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$191.52
|
|
|
Service Code
|
NDC 60505258009
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.27 |
| Max. Negotiated Rate |
$172.37 |
| Rate for Payer: Aetna American Axle |
$124.49
|
| Rate for Payer: Aetna Commercial |
$162.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.49
|
| Rate for Payer: Cash Price |
$153.22
|
| Rate for Payer: Cofinity Commercial |
$134.06
|
| Rate for Payer: Cofinity Commercial |
$164.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.22
|
| Rate for Payer: Healthscope Commercial |
$172.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.79
|
| Rate for Payer: PHP Commercial |
$162.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.49
|
| Rate for Payer: Priority Health SBD |
$120.66
|
| Rate for Payer: UMR Bronson Commercial |
$84.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.64
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$365.90
|
|
|
Service Code
|
NDC 63304082990
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$329.31 |
| Rate for Payer: Aetna American Axle |
$237.84
|
| Rate for Payer: Aetna Commercial |
$311.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.84
|
| Rate for Payer: Cash Price |
$292.72
|
| Rate for Payer: Cofinity Commercial |
$256.13
|
| Rate for Payer: Cofinity Commercial |
$314.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.72
|
| Rate for Payer: Healthscope Commercial |
$329.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.02
|
| Rate for Payer: PHP Commercial |
$311.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.84
|
| Rate for Payer: Priority Health SBD |
$230.52
|
| Rate for Payer: UMR Bronson Commercial |
$161.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.42
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
|
IP
|
$129.11
|
|
|
Service Code
|
NDC 68084059025
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.81 |
| Max. Negotiated Rate |
$116.20 |
| Rate for Payer: Aetna American Axle |
$83.92
|
| Rate for Payer: Aetna Commercial |
$109.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.92
|
| Rate for Payer: Cash Price |
$103.29
|
| Rate for Payer: Cofinity Commercial |
$111.03
|
| Rate for Payer: Cofinity Commercial |
$90.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.29
|
| Rate for Payer: Healthscope Commercial |
$116.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.74
|
| Rate for Payer: PHP Commercial |
$109.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.92
|
| Rate for Payer: Priority Health SBD |
$81.34
|
| Rate for Payer: UMR Bronson Commercial |
$56.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.83
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
NDC 68084059095
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Aetna American Axle |
$2.80
|
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.80
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: Cofinity Commercial |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.45
|
| Rate for Payer: Healthscope Commercial |
$3.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.66
|
| Rate for Payer: PHP Commercial |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health SBD |
$2.72
|
| Rate for Payer: UMR Bronson Commercial |
$1.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.23
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
|
OP
|
$129.11
|
|
|
Service Code
|
NDC 68084059025
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.77 |
| Max. Negotiated Rate |
$116.20 |
| Rate for Payer: Aetna American Axle |
$83.92
|
| Rate for Payer: Aetna Commercial |
$109.74
|
| Rate for Payer: Aetna Medicare |
$64.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.92
|
| Rate for Payer: BCBS Complete |
$51.64
|
| Rate for Payer: Cash Price |
$103.29
|
| Rate for Payer: Cofinity Commercial |
$111.03
|
| Rate for Payer: Cofinity Commercial |
$90.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.29
|
| Rate for Payer: Healthscope Commercial |
$116.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.74
|
| Rate for Payer: PHP Commercial |
$109.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.92
|
| Rate for Payer: Priority Health SBD |
$81.34
|
| Rate for Payer: UMR Bronson Commercial |
$47.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.83
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 51079021101
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Aetna American Axle |
$2.73
|
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Aetna Medicare |
$2.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.73
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$3.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.36
|
| Rate for Payer: Healthscope Commercial |
$3.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.57
|
| Rate for Payer: PHP Commercial |
$3.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.73
|
| Rate for Payer: Priority Health SBD |
$2.65
|
| Rate for Payer: UMR Bronson Commercial |
$1.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.15
|
|
