|
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
|
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
|
$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
|
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 |
$311.01
|
| 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 |
$274.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.01
|
| Rate for Payer: PHP Commercial |
$311.01
|
| 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 |
$274.43
|
|
|
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
|
$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
|
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
|
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
|
$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 |
$192.47
|
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.47
|
| 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 |
$222.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: PHP Commercial |
$251.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.47
|
| 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 |
$222.07
|
|
|
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 |
$1,343.03 |
| 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 |
$1,343.03
|
| 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 |
$656.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,119.19
|
|
|
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
|
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 |
$250.71
|
| Rate for Payer: Aetna Commercial |
$327.85
|
| Rate for Payer: Aetna Medicare |
$192.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.71
|
| 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 |
$289.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.85
|
| Rate for Payer: PHP Commercial |
$327.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.71
|
| 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 |
$289.27
|
|
|
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 |
$192.47
|
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: Aetna Medicare |
$148.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.47
|
| 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 |
$222.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: PHP Commercial |
$251.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.47
|
| 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 |
$222.07
|
|
|
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 |
$311.01
|
| 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 |
$274.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.01
|
| Rate for Payer: PHP Commercial |
$311.01
|
| 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 |
$274.43
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 51079021101
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Aetna American Axle |
$2.73
|
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.73
|
| 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 |
$1.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.15
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
|
OP
|
$125.97
|
|
|
Service Code
|
NDC 51079021103
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.61 |
| Max. Negotiated Rate |
$113.37 |
| Rate for Payer: Aetna American Axle |
$81.88
|
| Rate for Payer: Aetna Commercial |
$107.07
|
| Rate for Payer: Aetna Medicare |
$62.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.88
|
| Rate for Payer: BCBS Complete |
$50.39
|
| Rate for Payer: Cash Price |
$100.78
|
| Rate for Payer: Cofinity Commercial |
$108.33
|
| Rate for Payer: Cofinity Commercial |
$88.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.78
|
| Rate for Payer: Healthscope Commercial |
$113.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.07
|
| Rate for Payer: PHP Commercial |
$107.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.88
|
| Rate for Payer: Priority Health SBD |
$79.36
|
| Rate for Payer: UMR Bronson Commercial |
$46.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.48
|
|
|
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
|
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
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
|
IP
|
$125.97
|
|
|
Service Code
|
NDC 51079021103
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.43 |
| Max. Negotiated Rate |
$113.37 |
| Rate for Payer: Aetna American Axle |
$81.88
|
| Rate for Payer: Aetna Commercial |
$107.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.88
|
| Rate for Payer: Cash Price |
$100.78
|
| Rate for Payer: Cofinity Commercial |
$108.33
|
| Rate for Payer: Cofinity Commercial |
$88.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.78
|
| Rate for Payer: Healthscope Commercial |
$113.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.07
|
| Rate for Payer: PHP Commercial |
$107.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.88
|
| Rate for Payer: Priority Health SBD |
$79.36
|
| Rate for Payer: UMR Bronson Commercial |
$55.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.48
|
|
|
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
|
$4.31
|
|
|
Service Code
|
NDC 68084059095
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Aetna American Axle |
$2.80
|
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: Aetna Medicare |
$2.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.80
|
| Rate for Payer: BCBS Complete |
$1.72
|
| 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 |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.23
|
|
|
ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$5,181.82
|
|
|
Service Code
|
NDC 00173066518
|
| Hospital Charge Code |
14953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,280.00 |
| Max. Negotiated Rate |
$4,663.64 |
| Rate for Payer: Aetna American Axle |
$3,368.18
|
| Rate for Payer: Aetna Commercial |
$4,404.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,368.18
|
| Rate for Payer: Cash Price |
$4,145.46
|
| Rate for Payer: Cofinity Commercial |
$3,627.27
|
| Rate for Payer: Cofinity Commercial |
$4,456.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,627.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,145.46
|
| Rate for Payer: Healthscope Commercial |
$4,663.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,627.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,886.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,404.55
|
| Rate for Payer: PHP Commercial |
$4,404.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,368.18
|
| Rate for Payer: Priority Health SBD |
$3,264.55
|
| Rate for Payer: UMR Bronson Commercial |
$2,280.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,886.36
|
|
|
ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,220.69
|
|
|
Service Code
|
NDC 31722062921
|
| Hospital Charge Code |
14953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$537.10 |
| Max. Negotiated Rate |
$1,098.62 |
| Rate for Payer: Aetna American Axle |
$793.45
|
| Rate for Payer: Aetna Commercial |
$1,037.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$793.45
|
| Rate for Payer: Cash Price |
$976.55
|
| Rate for Payer: Cofinity Commercial |
$1,049.79
|
| Rate for Payer: Cofinity Commercial |
$854.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$854.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$976.55
|
| Rate for Payer: Healthscope Commercial |
$1,098.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$854.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$915.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,037.59
|
| Rate for Payer: PHP Commercial |
$1,037.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.45
|
| Rate for Payer: Priority Health SBD |
$769.03
|
| Rate for Payer: UMR Bronson Commercial |
$537.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$915.52
|
|
|
ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$112.95
|
|
|
Service Code
|
NDC 00173054700
|
| Hospital Charge Code |
14953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.79 |
| Max. Negotiated Rate |
$101.66 |
| Rate for Payer: Aetna American Axle |
$73.42
|
| Rate for Payer: Aetna Commercial |
$96.01
|
| Rate for Payer: Aetna Medicare |
$56.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.42
|
| Rate for Payer: BCBS Complete |
$45.18
|
| Rate for Payer: Cash Price |
$90.36
|
| Rate for Payer: Cofinity Commercial |
$79.06
|
| Rate for Payer: Cofinity Commercial |
$97.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.36
|
| Rate for Payer: Healthscope Commercial |
$101.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.01
|
| Rate for Payer: PHP Commercial |
$96.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.42
|
| Rate for Payer: Priority Health SBD |
$71.16
|
| Rate for Payer: UMR Bronson Commercial |
$41.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.71
|
|
