|
ATENOLOL 25 MG TABLET
|
Facility
|
IP
|
$404.20
|
|
|
Service Code
|
NDC 51079075920
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.85 |
| Max. Negotiated Rate |
$363.78 |
| Rate for Payer: Aetna American Axle |
$262.73
|
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.73
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Advantage |
$282.94
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$282.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.15
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: Priority Health SBD |
$254.65
|
| Rate for Payer: UMR Bronson Commercial |
$177.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
OP
|
$4.05
|
|
|
Service Code
|
NDC 51079075901
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Aetna American Axle |
$2.63
|
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Aetna Medicare |
$2.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.63
|
| Rate for Payer: BCBS Complete |
$1.62
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cofinity Advantage |
$2.83
|
| Rate for Payer: Cofinity Commercial |
$3.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.24
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.04
|
| Rate for Payer: PHP Commercial |
$3.44
|
| Rate for Payer: Priority Health SBD |
$2.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.63
|
| Rate for Payer: UHC Core |
$2.11
|
| Rate for Payer: UHC Exchange |
$1.59
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.04
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
IP
|
$354.85
|
|
|
Service Code
|
NDC 00904718761
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$319.37 |
| Rate for Payer: Aetna American Axle |
$230.65
|
| Rate for Payer: Aetna Commercial |
$301.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.65
|
| Rate for Payer: Cash Price |
$283.88
|
| Rate for Payer: Cofinity Advantage |
$248.40
|
| Rate for Payer: Cofinity Commercial |
$305.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.88
|
| Rate for Payer: Healthscope Commercial |
$319.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.14
|
| Rate for Payer: PHP Commercial |
$301.62
|
| Rate for Payer: Priority Health SBD |
$223.56
|
| Rate for Payer: UMR Bronson Commercial |
$156.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.14
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
OP
|
$404.20
|
|
|
Service Code
|
NDC 51079075920
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.55 |
| Max. Negotiated Rate |
$363.78 |
| Rate for Payer: Aetna American Axle |
$262.73
|
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna Medicare |
$202.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.73
|
| Rate for Payer: BCBS Complete |
$161.68
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Advantage |
$282.94
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$282.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.15
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: Priority Health SBD |
$254.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.73
|
| Rate for Payer: UHC Core |
$210.59
|
| Rate for Payer: UHC Exchange |
$158.85
|
| Rate for Payer: UMR Bronson Commercial |
$149.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
OP
|
$75.20
|
|
|
Service Code
|
NDC 00093078701
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna American Axle |
$48.88
|
| Rate for Payer: Aetna Commercial |
$63.92
|
| Rate for Payer: Aetna Medicare |
$37.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.88
|
| Rate for Payer: BCBS Complete |
$30.08
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cofinity Advantage |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$64.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.16
|
| Rate for Payer: Healthscope Commercial |
$67.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.40
|
| Rate for Payer: PHP Commercial |
$63.92
|
| Rate for Payer: Priority Health SBD |
$47.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.88
|
| Rate for Payer: UHC Core |
$39.18
|
| Rate for Payer: UHC Exchange |
$29.55
|
| Rate for Payer: UMR Bronson Commercial |
$27.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.40
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
IP
|
$70.50
|
|
|
Service Code
|
NDC 65862016901
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.02 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna American Axle |
$45.83
|
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.83
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Advantage |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.88
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health SBD |
$44.41
|
| Rate for Payer: UMR Bronson Commercial |
$31.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
IP
|
$246.75
|
|
|
Service Code
|
NDC 51079068420
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.57 |
| Max. Negotiated Rate |
$222.07 |
| Rate for Payer: Aetna American Axle |
$160.39
|
| Rate for Payer: Aetna Commercial |
$209.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.39
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Advantage |
$172.72
|
| Rate for Payer: Cofinity Commercial |
$212.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$222.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.06
|
| Rate for Payer: PHP Commercial |
$209.74
|
| Rate for Payer: Priority Health SBD |
$155.45
|
| Rate for Payer: UMR Bronson Commercial |
$108.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.06
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
OP
|
$70.50
|
|
|
Service Code
|
NDC 65862016901
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.09 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna American Axle |
$45.83
|
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna Medicare |
$35.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.83
|
| Rate for Payer: BCBS Complete |
$28.20
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Advantage |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.88
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health SBD |
$44.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.83
|
| Rate for Payer: UHC Core |
$36.73
|
| Rate for Payer: UHC Exchange |
$27.71
|
| Rate for Payer: UMR Bronson Commercial |
$26.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
IP
|
$2.47
|
|
|
Service Code
|
NDC 51079068401
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna American Axle |
$1.61
|
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.61
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Advantage |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.85
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: Priority Health SBD |
$1.56
|
| Rate for Payer: UMR Bronson Commercial |
$1.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.85
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
OP
|
$2.47
|
|
|
Service Code
|
NDC 51079068401
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna American Axle |
$1.61
|
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna Medicare |
$1.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.61
|
| Rate for Payer: BCBS Complete |
$0.99
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Advantage |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.85
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: Priority Health SBD |
$1.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.61
|
| Rate for Payer: UHC Core |
$1.29
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UMR Bronson Commercial |
$0.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.85
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
OP
|
$246.75
|
|
|
Service Code
|
NDC 51079068420
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.30 |
| Max. Negotiated Rate |
$222.07 |
| Rate for Payer: Aetna American Axle |
$160.39
|
| Rate for Payer: Aetna Commercial |
$209.74
|
| Rate for Payer: Aetna Medicare |
$123.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.39
|
| Rate for Payer: BCBS Complete |
$98.70
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Advantage |
$172.72
|
| Rate for Payer: Cofinity Commercial |
$212.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$222.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.06
|
| Rate for Payer: PHP Commercial |
$209.74
|
| Rate for Payer: Priority Health SBD |
$155.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.39
|
| Rate for Payer: UHC Core |
$128.56
|
| Rate for Payer: UHC Exchange |
$96.97
|
| Rate for Payer: UMR Bronson Commercial |
$91.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.06
|
|
|
ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$53,597.31
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
179035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23,582.82 |
| Max. Negotiated Rate |
$48,237.58 |
| Rate for Payer: Aetna American Axle |
$34,838.25
|
| Rate for Payer: Aetna Commercial |
$45,557.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34,838.25
|
| Rate for Payer: Cash Price |
$42,877.85
|
| Rate for Payer: Cofinity Advantage |
$37,518.12
|
| Rate for Payer: Cofinity Commercial |
$46,093.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42,877.85
|
| Rate for Payer: Healthscope Commercial |
$48,237.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37,518.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40,197.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45,557.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40,197.98
|
| Rate for Payer: PHP Commercial |
$45,557.71
|
| Rate for Payer: Priority Health SBD |
$33,766.31
|
| Rate for Payer: UMR Bronson Commercial |
$23,582.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40,197.98
|
|
|
ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$53,597.31
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
179035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.16 |
| Max. Negotiated Rate |
$48,237.58 |
| Rate for Payer: Aetna American Axle |
$34,838.25
|
| Rate for Payer: Aetna Commercial |
$45,557.71
|
| Rate for Payer: Aetna Medicare |
$97.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34,838.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.50
|
| Rate for Payer: BCBS Complete |
$51.62
|
| Rate for Payer: BCBS MAPPO |
$94.00
|
| Rate for Payer: BCBS Trust/PPO |
$304.51
|
| Rate for Payer: BCN Commercial |
$304.51
|
| Rate for Payer: BCN Medicare Advantage |
$94.00
|
| Rate for Payer: Cash Price |
$42,877.85
|
| Rate for Payer: Cash Price |
$42,877.85
|
| Rate for Payer: Cofinity Advantage |
$37,518.12
|
| Rate for Payer: Cofinity Commercial |
$46,093.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42,877.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.00
|
| Rate for Payer: Healthscope Commercial |
$48,237.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37,518.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40,197.98
|
| Rate for Payer: Mclaren Medicaid |
$94.00
|
| Rate for Payer: Mclaren Medicare |
$94.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.70
|
| Rate for Payer: Meridian Medicaid |
$98.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$103.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45,557.71
|
| Rate for Payer: Nomi Health Commercial |
$282.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40,197.98
|
| Rate for Payer: PACE Medicare |
$89.30
|
| Rate for Payer: PACE SWMI |
$94.00
|
| Rate for Payer: PHP Commercial |
$45,557.71
|
| Rate for Payer: PHP Medicare Advantage |
$94.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$288.09
|
| Rate for Payer: Priority Health Medicare |
$94.00
|
| Rate for Payer: Priority Health SBD |
$33,766.31
|
| Rate for Payer: Priority Health Tiered Network |
$230.47
|
| Rate for Payer: Railroad Medicare Medicare |
$94.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.95
|
| Rate for Payer: UHC Core |
$154.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$94.00
|
| Rate for Payer: UHC Exchange |
$154.95
|
| Rate for Payer: UHC Medicaid |
$49.16
|
| Rate for Payer: UHCCP Medicaid |
$49.16
|
| Rate for Payer: UMR Bronson Commercial |
$19,831.00
|
| Rate for Payer: VA VA |
$94.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40,197.98
|
|
|
ATHEROSCLEROSIS WITH MCC
|
Facility
|
IP
|
$32,996.10
|
|
|
Service Code
|
MSDRG 302
|
| Min. Negotiated Rate |
$10,069.77 |
| Max. Negotiated Rate |
$32,996.10 |
| Rate for Payer: Aetna Medicare |
$11,023.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,249.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,249.70
|
| Rate for Payer: BCBS MAPPO |
$10,599.76
|
| Rate for Payer: BCBS Trust/PPO |
$32,996.10
|
| Rate for Payer: BCN Commercial |
$32,996.10
|
| Rate for Payer: BCN Medicare Advantage |
$10,599.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,599.76
|
| Rate for Payer: Mclaren Medicare |
$10,599.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,129.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,189.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,659.74
|
| Rate for Payer: Nomi Health Commercial |
$15,436.14
|
| Rate for Payer: PACE Medicare |
$10,069.77
|
| Rate for Payer: PACE SWMI |
$10,599.76
|
| Rate for Payer: PHP Medicare Advantage |
$10,599.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,291.75
|
| Rate for Payer: Priority Health Medicare |
$10,599.76
|
| Rate for Payer: Priority Health Tiered Network |
$15,433.40
|
| Rate for Payer: Railroad Medicare Medicare |
$10,599.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,504.58
|
| Rate for Payer: UHC Core |
$16,318.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,599.76
|
| Rate for Payer: UHC Exchange |
$13,326.53
|
| Rate for Payer: VA VA |
$10,599.76
|
|
|
ATHEROSCLEROSIS WITHOUT MCC
|
Facility
|
IP
|
$15,163.93
|
|
|
Service Code
|
MSDRG 303
|
| Min. Negotiated Rate |
$5,911.59 |
| Max. Negotiated Rate |
$15,163.93 |
| Rate for Payer: Aetna Medicare |
$6,471.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,778.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,778.41
|
| Rate for Payer: BCBS MAPPO |
$6,222.73
|
| Rate for Payer: BCBS Trust/PPO |
$15,163.93
|
| Rate for Payer: BCN Commercial |
$15,163.93
|
| Rate for Payer: BCN Medicare Advantage |
$6,222.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,222.73
|
| Rate for Payer: Mclaren Medicare |
$6,222.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,533.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,156.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,845.00
|
| Rate for Payer: Nomi Health Commercial |
$8,684.28
|
| Rate for Payer: PACE Medicare |
$5,911.59
|
| Rate for Payer: PACE SWMI |
$6,222.73
|
| Rate for Payer: PHP Medicare Advantage |
$6,222.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,853.42
|
| Rate for Payer: Priority Health Medicare |
$6,222.73
|
| Rate for Payer: Priority Health Tiered Network |
$8,682.74
|
| Rate for Payer: Railroad Medicare Medicare |
$6,222.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,973.16
|
| Rate for Payer: UHC Core |
$9,180.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,222.73
|
| Rate for Payer: UHC Exchange |
$7,497.43
|
| Rate for Payer: VA VA |
$6,222.73
|
|
|
ATOMOXETINE 10 MG CAPSULE
|
Facility
|
IP
|
$1,213.45
|
|
|
Service Code
|
NDC 00002322730
|
| Hospital Charge Code |
34444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$533.92 |
| Max. Negotiated Rate |
$1,092.11 |
| 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 Advantage |
$849.41
|
| Rate for Payer: Cofinity Commercial |
$1,043.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.76
|
| Rate for Payer: Healthscope Commercial |
$1,092.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$849.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$910.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,031.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$910.09
|
| Rate for Payer: PHP Commercial |
$1,031.43
|
| 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
|
OP
|
$190.68
|
|
|
Service Code
|
NDC 64380047201
|
| Hospital Charge Code |
34444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.55 |
| Max. Negotiated Rate |
$171.61 |
| Rate for Payer: Aetna American Axle |
$123.94
|
| Rate for Payer: Aetna Commercial |
$162.08
|
| Rate for Payer: Aetna Medicare |
$95.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.94
|
| Rate for Payer: BCBS Complete |
$76.27
|
| Rate for Payer: Cash Price |
$152.54
|
| Rate for Payer: Cofinity Advantage |
$133.48
|
| Rate for Payer: Cofinity Commercial |
$163.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.54
|
| Rate for Payer: Healthscope Commercial |
$171.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.01
|
| Rate for Payer: PHP Commercial |
$162.08
|
| Rate for Payer: Priority Health SBD |
$120.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.94
|
| Rate for Payer: UHC Core |
$99.34
|
| Rate for Payer: UHC Exchange |
$74.94
|
| Rate for Payer: UMR Bronson Commercial |
$70.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.01
|
|
|
ATOMOXETINE 10 MG CAPSULE
|
Facility
|
OP
|
$1,213.45
|
|
|
Service Code
|
NDC 00002322730
|
| Hospital Charge Code |
34444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$448.98 |
| Max. Negotiated Rate |
$1,092.11 |
| Rate for Payer: Aetna American Axle |
$788.74
|
| Rate for Payer: Aetna Commercial |
$1,031.43
|
| Rate for Payer: Aetna Medicare |
$606.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.74
|
| Rate for Payer: BCBS Complete |
$485.38
|
| Rate for Payer: Cash Price |
$970.76
|
| Rate for Payer: Cofinity Advantage |
$849.41
|
| Rate for Payer: Cofinity Commercial |
$1,043.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.76
|
| Rate for Payer: Healthscope Commercial |
$1,092.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$849.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$910.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$970.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,031.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$910.09
|
| Rate for Payer: PHP Commercial |
$1,031.43
|
| Rate for Payer: Priority Health SBD |
$764.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$788.74
|
| Rate for Payer: UHC Core |
$632.21
|
| Rate for Payer: UHC Exchange |
$476.89
|
| Rate for Payer: UMR Bronson Commercial |
$448.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$910.09
|
|
|
ATOMOXETINE 10 MG CAPSULE
|
Facility
|
IP
|
$190.68
|
|
|
Service Code
|
NDC 64380047201
|
| Hospital Charge Code |
34444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.90 |
| Max. Negotiated Rate |
$171.61 |
| Rate for Payer: Aetna American Axle |
$123.94
|
| Rate for Payer: Aetna Commercial |
$162.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.94
|
| Rate for Payer: Cash Price |
$152.54
|
| Rate for Payer: Cofinity Advantage |
$133.48
|
| Rate for Payer: Cofinity Commercial |
$163.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.54
|
| Rate for Payer: Healthscope Commercial |
$171.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.01
|
| Rate for Payer: PHP Commercial |
$162.08
|
| Rate for Payer: Priority Health SBD |
$120.13
|
| Rate for Payer: UMR Bronson Commercial |
$83.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.01
|
|
|
ATOMOXETINE 10 MG CAPSULE
|
Facility
|
IP
|
$309.96
|
|
|
Service Code
|
NDC 68462026530
|
| 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 Advantage |
$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 Commercial |
$263.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.47
|
| Rate for Payer: PHP Commercial |
$263.47
|
| 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 10 MG CAPSULE
|
Facility
|
OP
|
$309.96
|
|
|
Service Code
|
NDC 68462026530
|
| Hospital Charge Code |
34444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.69 |
| Max. Negotiated Rate |
$278.96 |
| Rate for Payer: Aetna American Axle |
$201.47
|
| Rate for Payer: Aetna Commercial |
$263.47
|
| Rate for Payer: Aetna Medicare |
$154.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.47
|
| Rate for Payer: BCBS Complete |
$123.98
|
| Rate for Payer: Cash Price |
$247.97
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$247.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.47
|
| Rate for Payer: PHP Commercial |
$263.47
|
| Rate for Payer: Priority Health SBD |
$195.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.47
|
| Rate for Payer: UHC Core |
$161.49
|
| Rate for Payer: UHC Exchange |
$121.81
|
| Rate for Payer: UMR Bronson Commercial |
$114.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.47
|
|
|
ATOMOXETINE 18 MG CAPSULE
|
Facility
|
IP
|
$1,213.45
|
|
|
Service Code
|
NDC 00002323830
|
| Hospital Charge Code |
34445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$533.92 |
| Max. Negotiated Rate |
$1,092.11 |
| 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 Advantage |
$849.41
|
| Rate for Payer: Cofinity Commercial |
$1,043.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.76
|
| Rate for Payer: Healthscope Commercial |
$1,092.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$849.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$910.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,031.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$910.09
|
| Rate for Payer: PHP Commercial |
$1,031.43
|
| 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 18 MG CAPSULE
|
Facility
|
OP
|
$144.27
|
|
|
Service Code
|
NDC 64980037403
|
| Hospital Charge Code |
34445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.38 |
| Max. Negotiated Rate |
$129.84 |
| Rate for Payer: Aetna American Axle |
$93.78
|
| Rate for Payer: Aetna Commercial |
$122.63
|
| Rate for Payer: Aetna Medicare |
$72.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.78
|
| Rate for Payer: BCBS Complete |
$57.71
|
| Rate for Payer: Cash Price |
$115.42
|
| Rate for Payer: Cofinity Advantage |
$100.99
|
| Rate for Payer: Cofinity Commercial |
$124.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.42
|
| Rate for Payer: Healthscope Commercial |
$129.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.20
|
| Rate for Payer: PHP Commercial |
$122.63
|
| Rate for Payer: Priority Health SBD |
$90.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.78
|
| Rate for Payer: UHC Core |
$75.16
|
| Rate for Payer: UHC Exchange |
$56.70
|
| Rate for Payer: UMR Bronson Commercial |
$53.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.20
|
|
|
ATOMOXETINE 18 MG CAPSULE
|
Facility
|
OP
|
$1,213.45
|
|
|
Service Code
|
NDC 00002323830
|
| Hospital Charge Code |
34445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$448.98 |
| Max. Negotiated Rate |
$1,092.11 |
| Rate for Payer: Aetna American Axle |
$788.74
|
| Rate for Payer: Aetna Commercial |
$1,031.43
|
| Rate for Payer: Aetna Medicare |
$606.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.74
|
| Rate for Payer: BCBS Complete |
$485.38
|
| Rate for Payer: Cash Price |
$970.76
|
| Rate for Payer: Cofinity Advantage |
$849.41
|
| Rate for Payer: Cofinity Commercial |
$1,043.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.76
|
| Rate for Payer: Healthscope Commercial |
$1,092.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$849.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$910.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$970.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,031.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$910.09
|
| Rate for Payer: PHP Commercial |
$1,031.43
|
| Rate for Payer: Priority Health SBD |
$764.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$788.74
|
| Rate for Payer: UHC Core |
$632.21
|
| Rate for Payer: UHC Exchange |
$476.89
|
| Rate for Payer: UMR Bronson Commercial |
$448.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$910.09
|
|
|
ATOMOXETINE 18 MG CAPSULE
|
Facility
|
IP
|
$144.27
|
|
|
Service Code
|
NDC 64980037403
|
| Hospital Charge Code |
34445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.48 |
| Max. Negotiated Rate |
$129.84 |
| Rate for Payer: Aetna American Axle |
$93.78
|
| Rate for Payer: Aetna Commercial |
$122.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.78
|
| Rate for Payer: Cash Price |
$115.42
|
| Rate for Payer: Cofinity Advantage |
$100.99
|
| Rate for Payer: Cofinity Commercial |
$124.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.42
|
| Rate for Payer: Healthscope Commercial |
$129.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.20
|
| Rate for Payer: PHP Commercial |
$122.63
|
| Rate for Payer: Priority Health SBD |
$90.89
|
| Rate for Payer: UMR Bronson Commercial |
$63.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.20
|
|
