|
ATORVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$5,963.29
|
|
|
Service Code
|
NDC 0071-0156-40
|
| 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: 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 Multiplan/Beech St/PHCS |
$5,068.80
|
| Rate for Payer: PHP Commercial |
$5,068.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,174.30
|
| Rate for Payer: Priority Health SBD |
$3,756.87
|
| Rate for Payer: UMR Bronson Commercial |
$2,623.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,472.47
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$209.95
|
|
|
Service Code
|
NDC 68084-098-01
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.38 |
| Max. Negotiated Rate |
$188.96 |
| Rate for Payer: Aetna American Axle |
$136.47
|
| Rate for Payer: Aetna Commercial |
$178.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.47
|
| Rate for Payer: Cash Price |
$167.96
|
| Rate for Payer: Cofinity Commercial |
$146.96
|
| Rate for Payer: Cofinity Commercial |
$180.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.96
|
| Rate for Payer: Healthscope Commercial |
$188.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.46
|
| Rate for Payer: PHP Commercial |
$178.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.96
|
| Rate for Payer: Priority Health SBD |
$132.27
|
| Rate for Payer: UMR Bronson Commercial |
$92.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.46
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$205.20
|
|
|
Service Code
|
NDC 0904-6291-61
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.29 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna American Axle |
$133.38
|
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.38
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$143.64
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$174.42
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.64
|
| Rate for Payer: Priority Health SBD |
$129.28
|
| Rate for Payer: UMR Bronson Commercial |
$90.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.90
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$1,492.25
|
|
|
Service Code
|
NDC 55111-123-05
|
| 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: 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 Multiplan/Beech St/PHCS |
$1,268.41
|
| Rate for Payer: PHP Commercial |
$1,268.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,044.58
|
| 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
|
$6,359.56
|
|
|
Service Code
|
NDC 0071-0157-40
|
| 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: 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 Multiplan/Beech St/PHCS |
$5,405.63
|
| Rate for Payer: PHP Commercial |
$5,405.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,451.69
|
| 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
|
IP
|
$377.15
|
|
|
Service Code
|
NDC 51079-210-20
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.95 |
| Max. Negotiated Rate |
$339.44 |
| Rate for Payer: Aetna American Axle |
$245.15
|
| Rate for Payer: Aetna Commercial |
$320.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.15
|
| Rate for Payer: Cash Price |
$301.72
|
| Rate for Payer: Cofinity Commercial |
$264.00
|
| Rate for Payer: Cofinity Commercial |
$324.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.72
|
| Rate for Payer: Healthscope Commercial |
$339.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$264.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$320.58
|
| Rate for Payer: PHP Commercial |
$320.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.00
|
| Rate for Payer: Priority Health SBD |
$237.60
|
| Rate for Payer: UMR Bronson Commercial |
$165.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.86
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$365.90
|
|
|
Service Code
|
NDC 63304-829-90
|
| 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: 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 Multiplan/Beech St/PHCS |
$311.02
|
| Rate for Payer: PHP Commercial |
$311.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.13
|
| 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 40 MG TABLET
|
Facility
|
IP
|
$296.10
|
|
|
Service Code
|
NDC 62175-892-46
|
| 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: 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 Multiplan/Beech St/PHCS |
$251.68
|
| Rate for Payer: PHP Commercial |
$251.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.27
|
| 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
|
IP
|
$191.52
|
|
|
Service Code
|
NDC 60505-2580-9
|
| 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: 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 Multiplan/Beech St/PHCS |
$162.79
|
| Rate for Payer: PHP Commercial |
$162.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.06
|
| 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
|
$215.65
|
|
|
Service Code
|
NDC 0904-6292-61
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.89 |
| Max. Negotiated Rate |
$194.08 |
| Rate for Payer: Aetna American Axle |
$140.17
|
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.30
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.96
|
| Rate for Payer: Priority Health SBD |
$135.86
|
| Rate for Payer: UMR Bronson Commercial |
$94.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$3.78
|
|
|
Service Code
|
NDC 51079-210-01
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Aetna American Axle |
$2.46
|
| Rate for Payer: Aetna Commercial |
$3.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.46
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$2.65
|
| Rate for Payer: Cofinity Commercial |
$3.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$3.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.21
|
| Rate for Payer: PHP Commercial |
$3.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.65
|
| Rate for Payer: Priority Health SBD |
$2.38
|
| Rate for Payer: UMR Bronson Commercial |
$1.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.84
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
|
IP
|
$3.90
|
|
|
Service Code
|
NDC 51079-211-01
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna American Axle |
$2.54
|
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.54
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$3.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.12
|
| Rate for Payer: Healthscope Commercial |
$3.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.32
|
| Rate for Payer: PHP Commercial |
$3.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.73
|
| Rate for Payer: Priority Health SBD |
$2.46
|
| Rate for Payer: UMR Bronson Commercial |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.92
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
|
IP
|
$116.85
|
|
|
Service Code
|
NDC 51079-211-03
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.41 |
| Max. Negotiated Rate |
$105.16 |
| Rate for Payer: Aetna American Axle |
$75.95
|
| Rate for Payer: Aetna Commercial |
$99.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.95
|
| Rate for Payer: Cash Price |
$93.48
|
| Rate for Payer: Cofinity Commercial |
$100.49
|
| Rate for Payer: Cofinity Commercial |
$81.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.48
|
| Rate for Payer: Healthscope Commercial |
$105.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.32
|
| Rate for Payer: PHP Commercial |
$99.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.80
|
| Rate for Payer: Priority Health SBD |
$73.62
|
| Rate for Payer: UMR Bronson Commercial |
$51.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.64
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
|
IP
|
$4.05
|
|
|
Service Code
|
NDC 68084-590-95
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$3.64 |
| Rate for Payer: Aetna American Axle |
$2.63
|
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.63
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cofinity Commercial |
$2.84
|
| Rate for Payer: Cofinity Commercial |
$3.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.24
|
| Rate for Payer: Healthscope Commercial |
$3.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.44
|
| Rate for Payer: PHP Commercial |
$3.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.84
|
| Rate for Payer: Priority Health SBD |
$2.55
|
| Rate for Payer: UMR Bronson Commercial |
$1.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.04
|
|
|
ATORVASTATIN 80 MG TABLET
|
Facility
|
IP
|
$121.41
|
|
|
Service Code
|
NDC 68084-590-25
|
| Hospital Charge Code |
28645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.42 |
| Max. Negotiated Rate |
$109.27 |
| Rate for Payer: Aetna American Axle |
$78.92
|
| Rate for Payer: Aetna Commercial |
$103.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.92
|
| Rate for Payer: Cash Price |
$97.13
|
| Rate for Payer: Cofinity Commercial |
$104.41
|
| Rate for Payer: Cofinity Commercial |
$84.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.13
|
| Rate for Payer: Healthscope Commercial |
$109.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.20
|
| Rate for Payer: PHP Commercial |
$103.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.99
|
| Rate for Payer: Priority Health SBD |
$76.49
|
| Rate for Payer: UMR Bronson Commercial |
$53.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.06
|
|
|
ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$5,181.82
|
|
|
Service Code
|
NDC 0173-0665-18
|
| 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: 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 Multiplan/Beech St/PHCS |
$4,404.55
|
| Rate for Payer: PHP Commercial |
$4,404.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,627.27
|
| 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
|
$1,197.51
|
|
|
Service Code
|
NDC 31722-629-21
|
| Hospital Charge Code |
14953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$526.90 |
| Max. Negotiated Rate |
$1,077.76 |
| Rate for Payer: Aetna American Axle |
$778.38
|
| Rate for Payer: Aetna Commercial |
$1,017.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$778.38
|
| Rate for Payer: Cash Price |
$958.01
|
| Rate for Payer: Cofinity Commercial |
$1,029.86
|
| Rate for Payer: Cofinity Commercial |
$838.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$958.01
|
| Rate for Payer: Healthscope Commercial |
$1,077.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$838.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$898.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,017.88
|
| Rate for Payer: PHP Commercial |
$1,017.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$838.26
|
| Rate for Payer: Priority Health SBD |
$754.43
|
| Rate for Payer: UMR Bronson Commercial |
$526.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$898.13
|
|
|
ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$112.95
|
|
|
Service Code
|
NDC 0173-0547-00
|
| Hospital Charge Code |
14953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$101.66 |
| Rate for Payer: Aetna American Axle |
$73.42
|
| Rate for Payer: Aetna Commercial |
$96.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.42
|
| Rate for Payer: Cash Price |
$90.36
|
| Rate for Payer: Cofinity Commercial |
$79.06
|
| Rate for Payer: Cofinity Commercial |
$97.14
|
| 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 Multiplan/Beech St/PHCS |
$96.01
|
| Rate for Payer: PHP Commercial |
$96.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.06
|
| Rate for Payer: Priority Health SBD |
$71.16
|
| Rate for Payer: UMR Bronson Commercial |
$49.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.71
|
|
|
ATROPINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$36.23
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$32.61 |
| Rate for Payer: Aetna American Axle |
$23.55
|
| Rate for Payer: Aetna American Axle |
$25.43
|
| Rate for Payer: Aetna American Axle |
$23.49
|
| Rate for Payer: Aetna American Axle |
$42.29
|
| Rate for Payer: Aetna American Axle |
$19.47
|
| Rate for Payer: Aetna American Axle |
$23.29
|
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Aetna Commercial |
$25.46
|
| Rate for Payer: Aetna Commercial |
$55.30
|
| Rate for Payer: Aetna Commercial |
$33.25
|
| Rate for Payer: Aetna Commercial |
$30.72
|
| Rate for Payer: Aetna Commercial |
$30.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.29
|
| Rate for Payer: Cash Price |
$28.91
|
| Rate for Payer: Cash Price |
$52.05
|
| Rate for Payer: Cash Price |
$28.66
|
| Rate for Payer: Cash Price |
$28.98
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cash Price |
$31.30
|
| Rate for Payer: Cofinity Commercial |
$31.16
|
| Rate for Payer: Cofinity Commercial |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$25.76
|
| Rate for Payer: Cofinity Commercial |
$25.08
|
| Rate for Payer: Cofinity Commercial |
$30.81
|
| Rate for Payer: Cofinity Commercial |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$31.08
|
| Rate for Payer: Cofinity Commercial |
$25.36
|
| Rate for Payer: Cofinity Commercial |
$27.38
|
| Rate for Payer: Cofinity Commercial |
$33.64
|
| Rate for Payer: Cofinity Commercial |
$45.54
|
| Rate for Payer: Cofinity Commercial |
$55.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.05
|
| Rate for Payer: Healthscope Commercial |
$32.53
|
| Rate for Payer: Healthscope Commercial |
$32.61
|
| Rate for Payer: Healthscope Commercial |
$26.96
|
| Rate for Payer: Healthscope Commercial |
$58.55
|
| Rate for Payer: Healthscope Commercial |
$35.21
|
| Rate for Payer: Healthscope Commercial |
$32.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.72
|
| Rate for Payer: PHP Commercial |
$25.46
|
| Rate for Payer: PHP Commercial |
$30.72
|
| Rate for Payer: PHP Commercial |
$55.30
|
| Rate for Payer: PHP Commercial |
$33.25
|
| Rate for Payer: PHP Commercial |
$30.46
|
| Rate for Payer: PHP Commercial |
$30.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.30
|
| Rate for Payer: Priority Health SBD |
$22.77
|
| Rate for Payer: Priority Health SBD |
$22.57
|
| Rate for Payer: Priority Health SBD |
$40.99
|
| Rate for Payer: Priority Health SBD |
$22.82
|
| Rate for Payer: Priority Health SBD |
$18.87
|
| Rate for Payer: Priority Health SBD |
$24.65
|
| Rate for Payer: UMR Bronson Commercial |
$15.90
|
| Rate for Payer: UMR Bronson Commercial |
$13.18
|
| Rate for Payer: UMR Bronson Commercial |
$15.94
|
| Rate for Payer: UMR Bronson Commercial |
$17.21
|
| Rate for Payer: UMR Bronson Commercial |
$15.77
|
| Rate for Payer: UMR Bronson Commercial |
$28.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.87
|
|
|
ATROPINE 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
IP
|
$36.14
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
163701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.90 |
| Max. Negotiated Rate |
$32.53 |
| Rate for Payer: Aetna American Axle |
$23.49
|
| Rate for Payer: Aetna American Axle |
$42.29
|
| Rate for Payer: Aetna American Axle |
$19.47
|
| Rate for Payer: Aetna Commercial |
$25.46
|
| Rate for Payer: Aetna Commercial |
$55.30
|
| Rate for Payer: Aetna Commercial |
$30.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.47
|
| Rate for Payer: Cash Price |
$52.05
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cash Price |
$28.91
|
| Rate for Payer: Cofinity Commercial |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$25.76
|
| Rate for Payer: Cofinity Commercial |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$31.08
|
| Rate for Payer: Cofinity Commercial |
$55.95
|
| Rate for Payer: Cofinity Commercial |
$45.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.05
|
| Rate for Payer: Healthscope Commercial |
$58.55
|
| Rate for Payer: Healthscope Commercial |
$26.96
|
| Rate for Payer: Healthscope Commercial |
$32.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.46
|
| Rate for Payer: PHP Commercial |
$55.30
|
| Rate for Payer: PHP Commercial |
$30.72
|
| Rate for Payer: PHP Commercial |
$25.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.54
|
| Rate for Payer: Priority Health SBD |
$22.77
|
| Rate for Payer: Priority Health SBD |
$40.99
|
| Rate for Payer: Priority Health SBD |
$18.87
|
| Rate for Payer: UMR Bronson Commercial |
$15.90
|
| Rate for Payer: UMR Bronson Commercial |
$13.18
|
| Rate for Payer: UMR Bronson Commercial |
$28.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.46
|
|
|
ATROPINE 0.4 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$35.25
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.51 |
| Max. Negotiated Rate |
$31.72 |
| Rate for Payer: Aetna American Axle |
$22.91
|
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.91
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$24.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.20
|
| Rate for Payer: Healthscope Commercial |
$31.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.96
|
| Rate for Payer: PHP Commercial |
$29.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.68
|
| Rate for Payer: Priority Health SBD |
$22.21
|
| Rate for Payer: UMR Bronson Commercial |
$15.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.44
|
|
|
ATROPINE 0.4 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$123.18
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$110.86 |
| Rate for Payer: Aetna American Axle |
$80.07
|
| Rate for Payer: Aetna Commercial |
$104.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.07
|
| Rate for Payer: BCBS Complete |
$49.27
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: Cash Price |
$98.54
|
| Rate for Payer: Cash Price |
$98.54
|
| Rate for Payer: Cofinity Commercial |
$86.23
|
| Rate for Payer: Cofinity Commercial |
$105.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.54
|
| Rate for Payer: Healthscope Commercial |
$110.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.70
|
| Rate for Payer: PHP Commercial |
$104.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.23
|
| Rate for Payer: Priority Health SBD |
$77.60
|
| Rate for Payer: UMR Bronson Commercial |
$45.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.38
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
IP
|
$102.45
|
|
|
Service Code
|
NDC 60219-1748-2
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.08 |
| Max. Negotiated Rate |
$92.20 |
| Rate for Payer: Aetna American Axle |
$66.59
|
| Rate for Payer: Aetna Commercial |
$87.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.59
|
| Rate for Payer: Cash Price |
$81.96
|
| Rate for Payer: Cofinity Commercial |
$71.72
|
| Rate for Payer: Cofinity Commercial |
$88.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.96
|
| Rate for Payer: Healthscope Commercial |
$92.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.08
|
| Rate for Payer: PHP Commercial |
$87.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.72
|
| Rate for Payer: Priority Health SBD |
$64.54
|
| Rate for Payer: UMR Bronson Commercial |
$45.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.84
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
IP
|
$97.65
|
|
|
Service Code
|
NDC 17478-215-02
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.97 |
| Max. Negotiated Rate |
$87.88 |
| Rate for Payer: Aetna American Axle |
$63.47
|
| Rate for Payer: Aetna Commercial |
$83.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.47
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cofinity Commercial |
$68.36
|
| Rate for Payer: Cofinity Commercial |
$83.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$87.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.00
|
| Rate for Payer: PHP Commercial |
$83.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.36
|
| Rate for Payer: Priority Health SBD |
$61.52
|
| Rate for Payer: UMR Bronson Commercial |
$42.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.24
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
IP
|
$120.72
|
|
|
Service Code
|
NDC 60219-1749-3
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.12 |
| Max. Negotiated Rate |
$108.65 |
| Rate for Payer: Aetna American Axle |
$78.47
|
| Rate for Payer: Aetna Commercial |
$102.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.47
|
| Rate for Payer: Cash Price |
$96.58
|
| Rate for Payer: Cofinity Commercial |
$103.82
|
| Rate for Payer: Cofinity Commercial |
$84.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.58
|
| Rate for Payer: Healthscope Commercial |
$108.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.61
|
| Rate for Payer: PHP Commercial |
$102.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.50
|
| Rate for Payer: Priority Health SBD |
$76.05
|
| Rate for Payer: UMR Bronson Commercial |
$53.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.54
|
|
