|
ATENOLOL 50 MG TABLET
|
Facility
IP
|
$199.75
|
|
|
Service Code
|
NDC 51079-684-20
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.89 |
| Max. Negotiated Rate |
$179.78 |
| Rate for Payer: Aetna American Axle |
$129.84
|
| Rate for Payer: Aetna Commercial |
$169.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.84
|
| Rate for Payer: Cash Price |
$159.80
|
| Rate for Payer: Cofinity Commercial |
$139.82
|
| Rate for Payer: Cofinity Commercial |
$171.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.80
|
| Rate for Payer: Healthscope Commercial |
$179.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.79
|
| Rate for Payer: PHP Commercial |
$169.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.82
|
| Rate for Payer: Priority Health SBD |
$125.84
|
| Rate for Payer: UMR Bronson Commercial |
$87.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.81
|
|
|
ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$47,620.59
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
179035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20,953.06 |
| Max. Negotiated Rate |
$42,858.53 |
| Rate for Payer: Aetna American Axle |
$30,953.38
|
| Rate for Payer: Aetna Commercial |
$40,477.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,953.38
|
| Rate for Payer: Cash Price |
$38,096.47
|
| Rate for Payer: Cofinity Commercial |
$33,334.41
|
| Rate for Payer: Cofinity Commercial |
$40,953.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38,096.47
|
| Rate for Payer: Healthscope Commercial |
$42,858.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33,334.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35,715.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40,477.50
|
| Rate for Payer: PHP Commercial |
$40,477.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33,334.41
|
| Rate for Payer: Priority Health SBD |
$30,000.97
|
| Rate for Payer: UMR Bronson Commercial |
$20,953.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35,715.44
|
|
|
ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION
|
Facility
OP
|
$47,620.59
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
179035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$42,858.53 |
| Rate for Payer: Aetna American Axle |
$30,953.38
|
| Rate for Payer: Aetna Commercial |
$40,477.50
|
| Rate for Payer: Aetna Medicare |
$88.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,953.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.26
|
| Rate for Payer: BCBS Complete |
$48.83
|
| Rate for Payer: BCBS MAPPO |
$85.01
|
| Rate for Payer: BCBS Trust/PPO |
$274.70
|
| Rate for Payer: BCN Medicare Advantage |
$85.01
|
| Rate for Payer: Cash Price |
$38,096.47
|
| Rate for Payer: Cash Price |
$38,096.47
|
| Rate for Payer: Cofinity Commercial |
$33,334.41
|
| Rate for Payer: Cofinity Commercial |
$40,953.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38,096.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.01
|
| Rate for Payer: Healthscope Commercial |
$42,858.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33,334.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35,715.44
|
| Rate for Payer: Mclaren Medicaid |
$46.50
|
| Rate for Payer: Mclaren Medicare |
$85.01
|
| Rate for Payer: Meridian Medicaid |
$48.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$89.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40,477.50
|
| Rate for Payer: PACE Medicare |
$80.76
|
| Rate for Payer: PACE SWMI |
$85.01
|
| Rate for Payer: PHP Commercial |
$40,477.50
|
| Rate for Payer: PHP Medicare Advantage |
$85.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33,334.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$242.64
|
| Rate for Payer: Priority Health Medicare |
$85.01
|
| Rate for Payer: Priority Health Narrow Network |
$194.11
|
| Rate for Payer: Priority Health SBD |
$30,000.97
|
| Rate for Payer: Railroad Medicare Medicare |
$85.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.01
|
| Rate for Payer: UHC Medicare Advantage |
$87.56
|
| Rate for Payer: UMR Bronson Commercial |
$17,619.62
|
| Rate for Payer: VA VA |
$85.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35,715.44
|
|
|
ATHEROSCLEROSIS WITH MCC
|
Facility
IP
|
$30,205.06
|
|
|
Service Code
|
MS-DRG 302
|
| Min. Negotiated Rate |
$8,694.01 |
| Max. Negotiated Rate |
$30,205.06 |
| Rate for Payer: Aetna Medicare |
$9,517.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,439.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,439.49
|
| Rate for Payer: BCBS MAPPO |
$9,151.59
|
| Rate for Payer: BCBS Trust/PPO |
$30,205.06
|
| Rate for Payer: BCN Medicare Advantage |
$9,151.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,151.59
|
| Rate for Payer: Mclaren Medicare |
$9,151.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,609.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,524.33
|
| Rate for Payer: PACE Medicare |
$8,694.01
|
| Rate for Payer: PACE SWMI |
$9,151.59
|
| Rate for Payer: PHP Medicare Advantage |
$9,151.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,087.70
|
| Rate for Payer: Priority Health Medicare |
$9,151.59
|
| Rate for Payer: Priority Health Narrow Network |
$12,870.16
|
| Rate for Payer: Railroad Medicare Medicare |
$9,151.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,101.26
|
| Rate for Payer: UHC Core |
$14,022.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,151.59
|
| Rate for Payer: UHC Exchange |
$11,148.22
|
| Rate for Payer: UHC Medicare Advantage |
$9,426.14
|
| Rate for Payer: VA VA |
$9,151.59
|
|
|
ATHEROSCLEROSIS WITHOUT MCC
|
Facility
IP
|
$13,881.26
|
|
|
Service Code
|
MS-DRG 303
|
| Min. Negotiated Rate |
$5,304.51 |
| Max. Negotiated Rate |
$13,881.26 |
| Rate for Payer: Aetna Medicare |
$5,807.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,979.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,979.61
|
| Rate for Payer: BCBS MAPPO |
$5,583.69
|
| Rate for Payer: BCBS Trust/PPO |
$13,881.26
|
| Rate for Payer: BCN Medicare Advantage |
$5,583.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,583.69
|
| Rate for Payer: Mclaren Medicare |
$5,583.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,862.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,421.24
|
| Rate for Payer: PACE Medicare |
$5,304.51
|
| Rate for Payer: PACE SWMI |
$5,583.69
|
| Rate for Payer: PHP Medicare Advantage |
$5,583.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,443.68
|
| Rate for Payer: Priority Health Medicare |
$5,583.69
|
| Rate for Payer: Priority Health Narrow Network |
$7,554.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5,583.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,038.66
|
| Rate for Payer: UHC Core |
$8,231.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,583.69
|
| Rate for Payer: UHC Exchange |
$6,544.15
|
| Rate for Payer: UHC Medicare Advantage |
$5,751.20
|
| Rate for Payer: VA VA |
$5,583.69
|
|
|
ATOMOXETINE 10 MG CAPSULE
|
Facility
IP
|
$1,213.45
|
|
|
Service Code
|
NDC 0002-3227-30
|
| Hospital Charge Code |
34444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$533.92 |
| Max. Negotiated Rate |
$1,092.10 |
| Rate for Payer: Aetna American Axle |
$788.74
|
| Rate for Payer: Aetna Commercial |
$1,031.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.74
|
| Rate for Payer: Cash Price |
$970.76
|
| Rate for Payer: Cofinity Commercial |
$1,043.57
|
| Rate for Payer: Cofinity Commercial |
$849.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.76
|
| Rate for Payer: Healthscope Commercial |
$1,092.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$849.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$910.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,031.43
|
| Rate for Payer: PHP Commercial |
$1,031.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$849.42
|
| Rate for Payer: Priority Health SBD |
$764.47
|
| Rate for Payer: UMR Bronson Commercial |
$533.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$910.09
|
|
|
ATOMOXETINE 10 MG CAPSULE
|
Facility
IP
|
$309.96
|
|
|
Service Code
|
NDC 68462-265-30
|
| Hospital Charge Code |
34444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.38 |
| Max. Negotiated Rate |
$278.96 |
| Rate for Payer: Aetna American Axle |
$201.47
|
| Rate for Payer: Aetna Commercial |
$263.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.47
|
| Rate for Payer: Cash Price |
$247.97
|
| Rate for Payer: Cofinity Commercial |
$216.97
|
| Rate for Payer: Cofinity Commercial |
$266.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.97
|
| Rate for Payer: Healthscope Commercial |
$278.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.47
|
| Rate for Payer: PHP Commercial |
$263.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.97
|
| Rate for Payer: Priority Health SBD |
$195.27
|
| Rate for Payer: UMR Bronson Commercial |
$136.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.47
|
|
|
ATOMOXETINE 18 MG CAPSULE
|
Facility
IP
|
$1,213.45
|
|
|
Service Code
|
NDC 0002-3238-30
|
| Hospital Charge Code |
34445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$533.92 |
| Max. Negotiated Rate |
$1,092.10 |
| Rate for Payer: Aetna American Axle |
$788.74
|
| Rate for Payer: Aetna Commercial |
$1,031.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.74
|
| Rate for Payer: Cash Price |
$970.76
|
| Rate for Payer: Cofinity Commercial |
$1,043.57
|
| Rate for Payer: Cofinity Commercial |
$849.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.76
|
| Rate for Payer: Healthscope Commercial |
$1,092.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$849.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$910.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,031.43
|
| Rate for Payer: PHP Commercial |
$1,031.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$849.42
|
| Rate for Payer: Priority Health SBD |
$764.47
|
| Rate for Payer: UMR Bronson Commercial |
$533.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$910.09
|
|
|
ATOMOXETINE 25 MG CAPSULE
|
Facility
IP
|
$10.22
|
|
|
Service Code
|
NDC 60687-567-11
|
| Hospital Charge Code |
34446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna American Axle |
$6.64
|
| Rate for Payer: Aetna Commercial |
$8.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.64
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cofinity Commercial |
$7.15
|
| Rate for Payer: Cofinity Commercial |
$8.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.18
|
| Rate for Payer: Healthscope Commercial |
$9.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.69
|
| Rate for Payer: PHP Commercial |
$8.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: Priority Health SBD |
$6.44
|
| Rate for Payer: UMR Bronson Commercial |
$4.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.66
|
|
|
ATOMOXETINE 25 MG CAPSULE
|
Facility
IP
|
$306.48
|
|
|
Service Code
|
NDC 60687-567-21
|
| Hospital Charge Code |
34446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.85 |
| Max. Negotiated Rate |
$275.83 |
| Rate for Payer: Aetna American Axle |
$199.21
|
| Rate for Payer: Aetna Commercial |
$260.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.21
|
| Rate for Payer: Cash Price |
$245.18
|
| Rate for Payer: Cofinity Commercial |
$214.54
|
| Rate for Payer: Cofinity Commercial |
$263.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.18
|
| Rate for Payer: Healthscope Commercial |
$275.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.51
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.54
|
| Rate for Payer: Priority Health SBD |
$193.08
|
| Rate for Payer: UMR Bronson Commercial |
$134.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.86
|
|
|
ATOMOXETINE 25 MG CAPSULE
|
Facility
IP
|
$1,360.53
|
|
|
Service Code
|
NDC 0002-3228-30
|
| Hospital Charge Code |
34446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$598.63 |
| Max. Negotiated Rate |
$1,224.48 |
| Rate for Payer: Aetna American Axle |
$884.34
|
| Rate for Payer: Aetna Commercial |
$1,156.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$884.34
|
| Rate for Payer: Cash Price |
$1,088.42
|
| Rate for Payer: Cofinity Commercial |
$1,170.06
|
| Rate for Payer: Cofinity Commercial |
$952.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,088.42
|
| Rate for Payer: Healthscope Commercial |
$1,224.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$952.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,020.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,156.45
|
| Rate for Payer: PHP Commercial |
$1,156.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$952.37
|
| Rate for Payer: Priority Health SBD |
$857.13
|
| Rate for Payer: UMR Bronson Commercial |
$598.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,020.40
|
|
|
ATOMOXETINE 40 MG CAPSULE
|
Facility
IP
|
$13.17
|
|
|
Service Code
|
NDC 50268-058-11
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$11.85 |
| Rate for Payer: Aetna American Axle |
$8.56
|
| Rate for Payer: Aetna Commercial |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.56
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: Cofinity Commercial |
$11.33
|
| Rate for Payer: Cofinity Commercial |
$9.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.54
|
| Rate for Payer: Healthscope Commercial |
$11.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.19
|
| Rate for Payer: PHP Commercial |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.22
|
| Rate for Payer: Priority Health SBD |
$8.30
|
| Rate for Payer: UMR Bronson Commercial |
$5.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.88
|
|
|
ATOMOXETINE 40 MG CAPSULE
|
Facility
IP
|
$360.87
|
|
|
Service Code
|
NDC 0904-6908-04
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.78 |
| Max. Negotiated Rate |
$324.78 |
| Rate for Payer: Aetna American Axle |
$234.57
|
| Rate for Payer: Aetna Commercial |
$306.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.57
|
| Rate for Payer: Cash Price |
$288.70
|
| Rate for Payer: Cofinity Commercial |
$252.61
|
| Rate for Payer: Cofinity Commercial |
$310.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.70
|
| Rate for Payer: Healthscope Commercial |
$324.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$306.74
|
| Rate for Payer: PHP Commercial |
$306.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.61
|
| Rate for Payer: Priority Health SBD |
$227.35
|
| Rate for Payer: UMR Bronson Commercial |
$158.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.65
|
|
|
ATOMOXETINE 40 MG CAPSULE
|
Facility
IP
|
$281.24
|
|
|
Service Code
|
NDC 31722-717-30
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$253.12 |
| Rate for Payer: Aetna American Axle |
$182.81
|
| Rate for Payer: Aetna Commercial |
$239.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.81
|
| Rate for Payer: Cash Price |
$224.99
|
| Rate for Payer: Cofinity Commercial |
$196.87
|
| Rate for Payer: Cofinity Commercial |
$241.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.99
|
| Rate for Payer: Healthscope Commercial |
$253.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.05
|
| Rate for Payer: PHP Commercial |
$239.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.87
|
| Rate for Payer: Priority Health SBD |
$177.18
|
| Rate for Payer: UMR Bronson Commercial |
$123.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.93
|
|
|
ATOMOXETINE 40 MG CAPSULE
|
Facility
IP
|
$415.14
|
|
|
Service Code
|
NDC 0093-3545-56
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.66 |
| Max. Negotiated Rate |
$373.63 |
| Rate for Payer: Aetna American Axle |
$269.84
|
| Rate for Payer: Aetna Commercial |
$352.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.84
|
| Rate for Payer: Cash Price |
$332.11
|
| Rate for Payer: Cofinity Commercial |
$290.60
|
| Rate for Payer: Cofinity Commercial |
$357.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.11
|
| Rate for Payer: Healthscope Commercial |
$373.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$352.87
|
| Rate for Payer: PHP Commercial |
$352.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.60
|
| Rate for Payer: Priority Health SBD |
$261.54
|
| Rate for Payer: UMR Bronson Commercial |
$182.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.36
|
|
|
ATOMOXETINE 40 MG CAPSULE
|
Facility
IP
|
$232.42
|
|
|
Service Code
|
NDC 68462-268-30
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.26 |
| Max. Negotiated Rate |
$209.18 |
| Rate for Payer: Aetna American Axle |
$151.07
|
| Rate for Payer: Aetna Commercial |
$197.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.07
|
| Rate for Payer: Cash Price |
$185.94
|
| Rate for Payer: Cofinity Commercial |
$162.69
|
| Rate for Payer: Cofinity Commercial |
$199.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.94
|
| Rate for Payer: Healthscope Commercial |
$209.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$197.56
|
| Rate for Payer: PHP Commercial |
$197.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.69
|
| Rate for Payer: Priority Health SBD |
$146.42
|
| Rate for Payer: UMR Bronson Commercial |
$102.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.32
|
|
|
ATOMOXETINE 40 MG CAPSULE
|
Facility
IP
|
$394.83
|
|
|
Service Code
|
NDC 50268-058-13
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.73 |
| Max. Negotiated Rate |
$355.35 |
| Rate for Payer: Aetna American Axle |
$256.64
|
| Rate for Payer: Aetna Commercial |
$335.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.64
|
| Rate for Payer: Cash Price |
$315.86
|
| Rate for Payer: Cofinity Commercial |
$276.38
|
| Rate for Payer: Cofinity Commercial |
$339.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.86
|
| Rate for Payer: Healthscope Commercial |
$355.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$296.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$335.61
|
| Rate for Payer: PHP Commercial |
$335.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.38
|
| Rate for Payer: Priority Health SBD |
$248.74
|
| Rate for Payer: UMR Bronson Commercial |
$173.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$296.12
|
|
|
ATOMOXETINE 40 MG CAPSULE
|
Facility
IP
|
$1,478.30
|
|
|
Service Code
|
NDC 0002-3229-30
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$650.45 |
| Max. Negotiated Rate |
$1,330.47 |
| Rate for Payer: Aetna American Axle |
$960.90
|
| Rate for Payer: Aetna Commercial |
$1,256.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.90
|
| Rate for Payer: Cash Price |
$1,182.64
|
| Rate for Payer: Cofinity Commercial |
$1,034.81
|
| Rate for Payer: Cofinity Commercial |
$1,271.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,182.64
|
| Rate for Payer: Healthscope Commercial |
$1,330.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,034.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,108.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,256.56
|
| Rate for Payer: PHP Commercial |
$1,256.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,034.81
|
| Rate for Payer: Priority Health SBD |
$931.33
|
| Rate for Payer: UMR Bronson Commercial |
$650.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,108.72
|
|
|
ATOMOXETINE 40 MG CAPSULE
|
Facility
IP
|
$415.14
|
|
|
Service Code
|
NDC 60505-2833-3
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.66 |
| Max. Negotiated Rate |
$373.63 |
| Rate for Payer: Aetna American Axle |
$269.84
|
| Rate for Payer: Aetna Commercial |
$352.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.84
|
| Rate for Payer: Cash Price |
$332.11
|
| Rate for Payer: Cofinity Commercial |
$290.60
|
| Rate for Payer: Cofinity Commercial |
$357.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.11
|
| Rate for Payer: Healthscope Commercial |
$373.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$352.87
|
| Rate for Payer: PHP Commercial |
$352.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.60
|
| Rate for Payer: Priority Health SBD |
$261.54
|
| Rate for Payer: UMR Bronson Commercial |
$182.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.36
|
|
|
ATOMOXETINE 40 MG CAPSULE
|
Facility
IP
|
$141.99
|
|
|
Service Code
|
NDC 64980-376-03
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.48 |
| Max. Negotiated Rate |
$127.79 |
| Rate for Payer: Aetna American Axle |
$92.29
|
| Rate for Payer: Aetna Commercial |
$120.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.29
|
| Rate for Payer: Cash Price |
$113.59
|
| Rate for Payer: Cofinity Commercial |
$122.11
|
| Rate for Payer: Cofinity Commercial |
$99.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.59
|
| Rate for Payer: Healthscope Commercial |
$127.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$120.69
|
| Rate for Payer: PHP Commercial |
$120.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.39
|
| Rate for Payer: Priority Health SBD |
$89.45
|
| Rate for Payer: UMR Bronson Commercial |
$62.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.49
|
|
|
ATOMOXETINE 60 MG CAPSULE
|
Facility
IP
|
$12.57
|
|
|
Service Code
|
NDC 50268-059-11
|
| Hospital Charge Code |
34448
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$11.31 |
| Rate for Payer: Aetna American Axle |
$8.17
|
| Rate for Payer: Aetna Commercial |
$10.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.17
|
| Rate for Payer: Cash Price |
$10.06
|
| Rate for Payer: Cofinity Commercial |
$10.81
|
| Rate for Payer: Cofinity Commercial |
$8.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.06
|
| Rate for Payer: Healthscope Commercial |
$11.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.68
|
| Rate for Payer: PHP Commercial |
$10.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.80
|
| Rate for Payer: Priority Health SBD |
$7.92
|
| Rate for Payer: UMR Bronson Commercial |
$5.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.43
|
|
|
ATOMOXETINE 60 MG CAPSULE
|
Facility
IP
|
$376.86
|
|
|
Service Code
|
NDC 50268-059-13
|
| Hospital Charge Code |
34448
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.82 |
| Max. Negotiated Rate |
$339.17 |
| Rate for Payer: Aetna American Axle |
$244.96
|
| Rate for Payer: Aetna Commercial |
$320.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.96
|
| Rate for Payer: Cash Price |
$301.49
|
| Rate for Payer: Cofinity Commercial |
$263.80
|
| Rate for Payer: Cofinity Commercial |
$324.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.49
|
| Rate for Payer: Healthscope Commercial |
$339.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$320.33
|
| Rate for Payer: PHP Commercial |
$320.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.80
|
| Rate for Payer: Priority Health SBD |
$237.42
|
| Rate for Payer: UMR Bronson Commercial |
$165.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.64
|
|
|
ATOMOXETINE 60 MG CAPSULE
|
Facility
IP
|
$1,318.49
|
|
|
Service Code
|
NDC 0002-3239-30
|
| Hospital Charge Code |
34448
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$580.14 |
| Max. Negotiated Rate |
$1,186.64 |
| Rate for Payer: Aetna American Axle |
$857.02
|
| Rate for Payer: Aetna Commercial |
$1,120.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$857.02
|
| Rate for Payer: Cash Price |
$1,054.79
|
| Rate for Payer: Cofinity Commercial |
$1,133.90
|
| Rate for Payer: Cofinity Commercial |
$922.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,054.79
|
| Rate for Payer: Healthscope Commercial |
$1,186.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$922.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$988.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,120.72
|
| Rate for Payer: PHP Commercial |
$1,120.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$922.94
|
| Rate for Payer: Priority Health SBD |
$830.65
|
| Rate for Payer: UMR Bronson Commercial |
$580.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$988.87
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
IP
|
$2.74
|
|
|
Service Code
|
NDC 51079-208-01
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna American Axle |
$1.78
|
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.78
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.33
|
| Rate for Payer: PHP Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.92
|
| Rate for Payer: Priority Health SBD |
$1.73
|
| Rate for Payer: UMR Bronson Commercial |
$1.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.06
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
IP
|
$406.55
|
|
|
Service Code
|
NDC 0904-6290-61
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.88 |
| Max. Negotiated Rate |
$365.90 |
| Rate for Payer: Aetna American Axle |
$264.26
|
| Rate for Payer: Aetna Commercial |
$345.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.26
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cofinity Commercial |
$284.58
|
| Rate for Payer: Cofinity Commercial |
$349.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.24
|
| Rate for Payer: Healthscope Commercial |
$365.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$284.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.57
|
| Rate for Payer: PHP Commercial |
$345.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.58
|
| Rate for Payer: Priority Health SBD |
$256.13
|
| Rate for Payer: UMR Bronson Commercial |
$178.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.91
|
|
