|
ATOMOXETINE 60 MG CAPSULE
|
Facility
|
OP
|
$1,318.49
|
|
|
Service Code
|
NDC 00002323930
|
| Hospital Charge Code |
34448
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$487.84 |
| 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 Medicare |
$659.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$857.02
|
| Rate for Payer: BCBS Complete |
$527.40
|
| Rate for Payer: Cash Price |
$1,054.79
|
| Rate for Payer: Cofinity Advantage |
$922.94
|
| Rate for Payer: Cofinity Commercial |
$1,133.90
|
| 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: MI Amish Medical Board Commercial |
$1,054.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,120.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$988.87
|
| Rate for Payer: PHP Commercial |
$1,120.72
|
| Rate for Payer: Priority Health SBD |
$830.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$857.02
|
| Rate for Payer: UHC Core |
$686.93
|
| Rate for Payer: UHC Exchange |
$518.17
|
| Rate for Payer: UMR Bronson Commercial |
$487.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$988.87
|
|
|
ATOMOXETINE 60 MG CAPSULE
|
Facility
|
IP
|
$1,318.49
|
|
|
Service Code
|
NDC 00002323930
|
| 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 Advantage |
$922.94
|
| Rate for Payer: Cofinity Commercial |
$1,133.90
|
| 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 Commercial |
$1,120.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$988.87
|
| Rate for Payer: PHP Commercial |
$1,120.72
|
| 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
|
|
|
ATOMOXETINE 60 MG CAPSULE
|
Facility
|
OP
|
$437.58
|
|
|
Service Code
|
NDC 60505283403
|
| Hospital Charge Code |
34448
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.90 |
| Max. Negotiated Rate |
$393.82 |
| Rate for Payer: Aetna American Axle |
$284.43
|
| Rate for Payer: Aetna Commercial |
$371.94
|
| Rate for Payer: Aetna Medicare |
$218.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.43
|
| Rate for Payer: BCBS Complete |
$175.03
|
| Rate for Payer: Cash Price |
$350.06
|
| Rate for Payer: Cofinity Advantage |
$306.31
|
| Rate for Payer: Cofinity Commercial |
$376.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.06
|
| Rate for Payer: Healthscope Commercial |
$393.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$306.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$328.19
|
| Rate for Payer: PHP Commercial |
$371.94
|
| Rate for Payer: Priority Health SBD |
$275.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.43
|
| Rate for Payer: UHC Core |
$227.98
|
| Rate for Payer: UHC Exchange |
$171.97
|
| Rate for Payer: UMR Bronson Commercial |
$161.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.19
|
|
|
ATOMOXETINE 60 MG CAPSULE
|
Facility
|
IP
|
$13.27
|
|
|
Service Code
|
NDC 50268005911
|
| Hospital Charge Code |
34448
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna American Axle |
$8.63
|
| Rate for Payer: Aetna Commercial |
$11.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.63
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cofinity Advantage |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.95
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: Priority Health SBD |
$8.36
|
| Rate for Payer: UMR Bronson Commercial |
$5.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.95
|
|
|
ATOMOXETINE 60 MG CAPSULE
|
Facility
|
IP
|
$437.58
|
|
|
Service Code
|
NDC 60505283403
|
| Hospital Charge Code |
34448
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.54 |
| Max. Negotiated Rate |
$393.82 |
| Rate for Payer: Aetna American Axle |
$284.43
|
| Rate for Payer: Aetna Commercial |
$371.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.43
|
| Rate for Payer: Cash Price |
$350.06
|
| Rate for Payer: Cofinity Advantage |
$306.31
|
| Rate for Payer: Cofinity Commercial |
$376.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.06
|
| Rate for Payer: Healthscope Commercial |
$393.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$306.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$328.19
|
| Rate for Payer: PHP Commercial |
$371.94
|
| Rate for Payer: Priority Health SBD |
$275.68
|
| Rate for Payer: UMR Bronson Commercial |
$192.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.19
|
|
|
ATOMOXETINE 60 MG CAPSULE
|
Facility
|
OP
|
$13.27
|
|
|
Service Code
|
NDC 50268005911
|
| Hospital Charge Code |
34448
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna American Axle |
$8.63
|
| Rate for Payer: Aetna Commercial |
$11.28
|
| Rate for Payer: Aetna Medicare |
$6.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.63
|
| Rate for Payer: BCBS Complete |
$5.31
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cofinity Advantage |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.95
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: Priority Health SBD |
$8.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.63
|
| Rate for Payer: UHC Core |
$6.91
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UMR Bronson Commercial |
$4.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.95
|
|
|
ATOMOXETINE 60 MG CAPSULE
|
Facility
|
OP
|
$397.92
|
|
|
Service Code
|
NDC 50268005913
|
| Hospital Charge Code |
34448
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.23 |
| Max. Negotiated Rate |
$358.13 |
| Rate for Payer: Aetna American Axle |
$258.65
|
| Rate for Payer: Aetna Commercial |
$338.23
|
| Rate for Payer: Aetna Medicare |
$198.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.65
|
| Rate for Payer: BCBS Complete |
$159.17
|
| Rate for Payer: Cash Price |
$318.34
|
| Rate for Payer: Cofinity Advantage |
$278.54
|
| Rate for Payer: Cofinity Commercial |
$342.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.34
|
| Rate for Payer: Healthscope Commercial |
$358.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$318.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.44
|
| Rate for Payer: PHP Commercial |
$338.23
|
| Rate for Payer: Priority Health SBD |
$250.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.65
|
| Rate for Payer: UHC Core |
$207.32
|
| Rate for Payer: UHC Exchange |
$156.38
|
| Rate for Payer: UMR Bronson Commercial |
$147.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.44
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$334.17
|
|
|
Service Code
|
NDC 60505257809
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.64 |
| Max. Negotiated Rate |
$300.75 |
| Rate for Payer: Aetna American Axle |
$217.21
|
| Rate for Payer: Aetna Commercial |
$284.04
|
| Rate for Payer: Aetna Medicare |
$167.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.21
|
| Rate for Payer: BCBS Complete |
$133.67
|
| Rate for Payer: Cash Price |
$267.34
|
| Rate for Payer: Cofinity Advantage |
$233.92
|
| Rate for Payer: Cofinity Commercial |
$287.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.34
|
| Rate for Payer: Healthscope Commercial |
$300.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$267.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$284.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.63
|
| Rate for Payer: PHP Commercial |
$284.04
|
| Rate for Payer: Priority Health SBD |
$210.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.21
|
| Rate for Payer: UHC Core |
$174.10
|
| Rate for Payer: UHC Exchange |
$131.33
|
| Rate for Payer: UMR Bronson Commercial |
$123.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.63
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$195.70
|
|
|
Service Code
|
NDC 00904629061
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.41 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna American Axle |
$127.20
|
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna Medicare |
$97.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.20
|
| Rate for Payer: BCBS Complete |
$78.28
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Advantage |
$136.99
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.78
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health SBD |
$123.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.20
|
| Rate for Payer: UHC Core |
$101.96
|
| Rate for Payer: UHC Exchange |
$76.91
|
| Rate for Payer: UMR Bronson Commercial |
$72.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.78
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$2.16
|
|
|
Service Code
|
NDC 68084009711
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna American Axle |
$1.40
|
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.40
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Advantage |
$1.51
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$1.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.62
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health SBD |
$1.36
|
| Rate for Payer: UMR Bronson Commercial |
$0.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.62
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$2.16
|
|
|
Service Code
|
NDC 68084009711
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna American Axle |
$1.40
|
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna Medicare |
$1.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.40
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Advantage |
$1.51
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$1.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.62
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health SBD |
$1.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.40
|
| Rate for Payer: UHC Core |
$1.13
|
| Rate for Payer: UHC Exchange |
$0.85
|
| Rate for Payer: UMR Bronson Commercial |
$0.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.62
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$215.65
|
|
|
Service Code
|
NDC 51079020820
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.89 |
| Max. Negotiated Rate |
$194.09 |
| 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 Advantage |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| 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 Commercial |
$183.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.74
|
| Rate for Payer: PHP Commercial |
$183.30
|
| 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 10 MG TABLET
|
Facility
|
IP
|
$2.16
|
|
|
Service Code
|
NDC 51079020801
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna American Axle |
$1.40
|
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.40
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Advantage |
$1.51
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$1.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.62
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health SBD |
$1.36
|
| Rate for Payer: UMR Bronson Commercial |
$0.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.62
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$241.11
|
|
|
Service Code
|
NDC 63304082790
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.21 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Aetna American Axle |
$156.72
|
| Rate for Payer: Aetna Commercial |
$204.94
|
| Rate for Payer: Aetna Medicare |
$120.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.72
|
| Rate for Payer: BCBS Complete |
$96.44
|
| Rate for Payer: Cash Price |
$192.89
|
| Rate for Payer: Cofinity Advantage |
$168.78
|
| Rate for Payer: Cofinity Commercial |
$207.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.89
|
| Rate for Payer: Healthscope Commercial |
$217.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.83
|
| Rate for Payer: PHP Commercial |
$204.94
|
| Rate for Payer: Priority Health SBD |
$151.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.72
|
| Rate for Payer: UHC Core |
$125.62
|
| Rate for Payer: UHC Exchange |
$94.76
|
| Rate for Payer: UMR Bronson Commercial |
$89.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.83
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$334.17
|
|
|
Service Code
|
NDC 60505257809
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.03 |
| Max. Negotiated Rate |
$300.75 |
| Rate for Payer: Aetna American Axle |
$217.21
|
| Rate for Payer: Aetna Commercial |
$284.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.21
|
| Rate for Payer: Cash Price |
$267.34
|
| Rate for Payer: Cofinity Advantage |
$233.92
|
| Rate for Payer: Cofinity Commercial |
$287.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.34
|
| Rate for Payer: Healthscope Commercial |
$300.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$284.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.63
|
| Rate for Payer: PHP Commercial |
$284.04
|
| Rate for Payer: Priority Health SBD |
$210.53
|
| Rate for Payer: UMR Bronson Commercial |
$147.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.63
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$251.69
|
|
|
Service Code
|
NDC 69097094405
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.74 |
| Max. Negotiated Rate |
$226.52 |
| Rate for Payer: Aetna American Axle |
$163.60
|
| Rate for Payer: Aetna Commercial |
$213.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.60
|
| Rate for Payer: Cash Price |
$201.35
|
| Rate for Payer: Cofinity Advantage |
$176.18
|
| Rate for Payer: Cofinity Commercial |
$216.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.35
|
| Rate for Payer: Healthscope Commercial |
$226.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.77
|
| Rate for Payer: PHP Commercial |
$213.94
|
| Rate for Payer: Priority Health SBD |
$158.56
|
| Rate for Payer: UMR Bronson Commercial |
$110.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.77
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$2.16
|
|
|
Service Code
|
NDC 51079020801
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna American Axle |
$1.40
|
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna Medicare |
$1.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.40
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Advantage |
$1.51
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$1.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.62
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health SBD |
$1.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.40
|
| Rate for Payer: UHC Core |
$1.13
|
| Rate for Payer: UHC Exchange |
$0.85
|
| Rate for Payer: UMR Bronson Commercial |
$0.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.62
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$215.65
|
|
|
Service Code
|
NDC 68084009701
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.79 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna American Axle |
$140.17
|
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna Medicare |
$107.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: BCBS Complete |
$86.26
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Advantage |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.74
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health SBD |
$135.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.17
|
| Rate for Payer: UHC Core |
$112.35
|
| Rate for Payer: UHC Exchange |
$84.75
|
| Rate for Payer: UMR Bronson Commercial |
$79.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$251.69
|
|
|
Service Code
|
NDC 69097094405
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.13 |
| Max. Negotiated Rate |
$226.52 |
| Rate for Payer: Aetna American Axle |
$163.60
|
| Rate for Payer: Aetna Commercial |
$213.94
|
| Rate for Payer: Aetna Medicare |
$125.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.60
|
| Rate for Payer: BCBS Complete |
$100.68
|
| Rate for Payer: Cash Price |
$201.35
|
| Rate for Payer: Cofinity Advantage |
$176.18
|
| Rate for Payer: Cofinity Commercial |
$216.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.35
|
| Rate for Payer: Healthscope Commercial |
$226.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.77
|
| Rate for Payer: PHP Commercial |
$213.94
|
| Rate for Payer: Priority Health SBD |
$158.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.60
|
| Rate for Payer: UHC Core |
$131.13
|
| Rate for Payer: UHC Exchange |
$98.91
|
| Rate for Payer: UMR Bronson Commercial |
$93.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.77
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$215.65
|
|
|
Service Code
|
NDC 51079020820
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.79 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna American Axle |
$140.17
|
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna Medicare |
$107.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: BCBS Complete |
$86.26
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Advantage |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.74
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health SBD |
$135.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.17
|
| Rate for Payer: UHC Core |
$112.35
|
| Rate for Payer: UHC Exchange |
$84.75
|
| Rate for Payer: UMR Bronson Commercial |
$79.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$195.70
|
|
|
Service Code
|
NDC 00904629061
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.11 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna American Axle |
$127.20
|
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.20
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Advantage |
$136.99
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.78
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health SBD |
$123.29
|
| Rate for Payer: UMR Bronson Commercial |
$86.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.78
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$215.65
|
|
|
Service Code
|
NDC 68084009701
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.89 |
| Max. Negotiated Rate |
$194.09 |
| 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 Advantage |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| 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 Commercial |
$183.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.74
|
| Rate for Payer: PHP Commercial |
$183.30
|
| 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 10 MG TABLET
|
Facility
|
IP
|
$241.11
|
|
|
Service Code
|
NDC 63304082790
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.09 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Aetna American Axle |
$156.72
|
| Rate for Payer: Aetna Commercial |
$204.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.72
|
| Rate for Payer: Cash Price |
$192.89
|
| Rate for Payer: Cofinity Advantage |
$168.78
|
| Rate for Payer: Cofinity Commercial |
$207.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.89
|
| Rate for Payer: Healthscope Commercial |
$217.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.83
|
| Rate for Payer: PHP Commercial |
$204.94
|
| Rate for Payer: Priority Health SBD |
$151.90
|
| Rate for Payer: UMR Bronson Commercial |
$106.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.83
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$313.02
|
|
|
Service Code
|
NDC 63304082890
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.82 |
| Max. Negotiated Rate |
$281.72 |
| Rate for Payer: Aetna American Axle |
$203.46
|
| Rate for Payer: Aetna Commercial |
$266.07
|
| Rate for Payer: Aetna Medicare |
$156.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.46
|
| Rate for Payer: BCBS Complete |
$125.21
|
| Rate for Payer: Cash Price |
$250.42
|
| Rate for Payer: Cofinity Advantage |
$219.11
|
| Rate for Payer: Cofinity Commercial |
$269.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.42
|
| Rate for Payer: Healthscope Commercial |
$281.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.76
|
| Rate for Payer: PHP Commercial |
$266.07
|
| Rate for Payer: Priority Health SBD |
$197.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.46
|
| Rate for Payer: UHC Core |
$163.08
|
| Rate for Payer: UHC Exchange |
$123.02
|
| Rate for Payer: UMR Bronson Commercial |
$115.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.76
|
|
|
ATORVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$225.15
|
|
|
Service Code
|
NDC 00904629161
|
| Hospital Charge Code |
19178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.31 |
| Max. Negotiated Rate |
$202.63 |
| Rate for Payer: Aetna American Axle |
$146.35
|
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: Aetna Medicare |
$112.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.35
|
| Rate for Payer: BCBS Complete |
$90.06
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Advantage |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$180.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.86
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health SBD |
$141.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.35
|
| Rate for Payer: UHC Core |
$117.30
|
| Rate for Payer: UHC Exchange |
$88.48
|
| Rate for Payer: UMR Bronson Commercial |
$83.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
