|
ATENOLOL 25 MG TABLET
|
Facility
|
OP
|
$340.75
|
|
|
Service Code
|
NDC 00904718761
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.08 |
| Max. Negotiated Rate |
$306.68 |
| Rate for Payer: Aetna American Axle |
$221.49
|
| Rate for Payer: Aetna Commercial |
$289.64
|
| Rate for Payer: Aetna Medicare |
$170.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.49
|
| Rate for Payer: BCBS Complete |
$136.30
|
| Rate for Payer: Cash Price |
$272.60
|
| Rate for Payer: Cofinity Commercial |
$238.52
|
| Rate for Payer: Cofinity Commercial |
$293.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.60
|
| Rate for Payer: Healthscope Commercial |
$306.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.64
|
| Rate for Payer: PHP Commercial |
$289.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.49
|
| Rate for Payer: Priority Health SBD |
$214.67
|
| Rate for Payer: UMR Bronson Commercial |
$126.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.56
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
NDC 51079075901
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Aetna American Axle |
$2.80
|
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.80
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: Cofinity Commercial |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.45
|
| Rate for Payer: Healthscope Commercial |
$3.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.66
|
| Rate for Payer: PHP Commercial |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health SBD |
$2.72
|
| Rate for Payer: UMR Bronson Commercial |
$1.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.23
|
|
|
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 Commercial |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$64.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.64
|
| 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: Multiplan/Beech St/PHCS Commercial |
$63.92
|
| Rate for Payer: PHP Commercial |
$63.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.88
|
| Rate for Payer: Priority Health SBD |
$47.38
|
| Rate for Payer: UMR Bronson Commercial |
$27.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.40
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
IP
|
$430.05
|
|
|
Service Code
|
NDC 51079075920
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.22 |
| Max. Negotiated Rate |
$387.04 |
| Rate for Payer: Aetna American Axle |
$279.53
|
| Rate for Payer: Aetna Commercial |
$365.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.53
|
| Rate for Payer: Cash Price |
$344.04
|
| Rate for Payer: Cofinity Commercial |
$301.04
|
| Rate for Payer: Cofinity Commercial |
$369.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.04
|
| Rate for Payer: Healthscope Commercial |
$387.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.54
|
| Rate for Payer: PHP Commercial |
$365.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.53
|
| Rate for Payer: Priority Health SBD |
$270.93
|
| Rate for Payer: UMR Bronson Commercial |
$189.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.54
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
IP
|
$340.75
|
|
|
Service Code
|
NDC 00904718761
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.93 |
| Max. Negotiated Rate |
$306.68 |
| Rate for Payer: Aetna American Axle |
$221.49
|
| Rate for Payer: Aetna Commercial |
$289.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.49
|
| Rate for Payer: Cash Price |
$272.60
|
| Rate for Payer: Cofinity Commercial |
$238.52
|
| Rate for Payer: Cofinity Commercial |
$293.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.60
|
| Rate for Payer: Healthscope Commercial |
$306.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.64
|
| Rate for Payer: PHP Commercial |
$289.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.49
|
| Rate for Payer: Priority Health SBD |
$214.67
|
| Rate for Payer: UMR Bronson Commercial |
$149.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.56
|
|
|
ATENOLOL 25 MG TABLET
|
Facility
|
OP
|
$430.05
|
|
|
Service Code
|
NDC 51079075920
|
| Hospital Charge Code |
717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.12 |
| Max. Negotiated Rate |
$387.04 |
| Rate for Payer: Aetna American Axle |
$279.53
|
| Rate for Payer: Aetna Commercial |
$365.54
|
| Rate for Payer: Aetna Medicare |
$215.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.53
|
| Rate for Payer: BCBS Complete |
$172.02
|
| Rate for Payer: Cash Price |
$344.04
|
| Rate for Payer: Cofinity Commercial |
$301.04
|
| Rate for Payer: Cofinity Commercial |
$369.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.04
|
| Rate for Payer: Healthscope Commercial |
$387.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.54
|
| Rate for Payer: PHP Commercial |
$365.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.53
|
| Rate for Payer: Priority Health SBD |
$270.93
|
| Rate for Payer: UMR Bronson Commercial |
$159.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.54
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
OP
|
$68.15
|
|
|
Service Code
|
NDC 65862016901
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$61.34 |
| Rate for Payer: Aetna American Axle |
$44.30
|
| Rate for Payer: Aetna Commercial |
$57.93
|
| Rate for Payer: Aetna Medicare |
$34.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.30
|
| Rate for Payer: BCBS Complete |
$27.26
|
| Rate for Payer: Cash Price |
$54.52
|
| Rate for Payer: Cofinity Commercial |
$47.70
|
| Rate for Payer: Cofinity Commercial |
$58.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.52
|
| Rate for Payer: Healthscope Commercial |
$61.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.93
|
| Rate for Payer: PHP Commercial |
$57.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.30
|
| Rate for Payer: Priority Health SBD |
$42.93
|
| Rate for Payer: UMR Bronson Commercial |
$25.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.11
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
IP
|
$211.50
|
|
|
Service Code
|
NDC 51079068420
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna American Axle |
$137.48
|
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.48
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cofinity Commercial |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$181.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.20
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.78
|
| Rate for Payer: PHP Commercial |
$179.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.48
|
| Rate for Payer: Priority Health SBD |
$133.24
|
| Rate for Payer: UMR Bronson Commercial |
$93.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.62
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
IP
|
$2.12
|
|
|
Service Code
|
NDC 51079068401
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna American Axle |
$1.38
|
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.38
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cofinity Commercial |
$1.48
|
| Rate for Payer: Cofinity Commercial |
$1.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.70
|
| Rate for Payer: Healthscope Commercial |
$1.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.80
|
| Rate for Payer: PHP Commercial |
$1.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.38
|
| Rate for Payer: Priority Health SBD |
$1.34
|
| Rate for Payer: UMR Bronson Commercial |
$0.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.59
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
IP
|
$68.15
|
|
|
Service Code
|
NDC 65862016901
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.99 |
| Max. Negotiated Rate |
$61.34 |
| Rate for Payer: Aetna American Axle |
$44.30
|
| Rate for Payer: Aetna Commercial |
$57.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.30
|
| Rate for Payer: Cash Price |
$54.52
|
| Rate for Payer: Cofinity Commercial |
$47.70
|
| Rate for Payer: Cofinity Commercial |
$58.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.52
|
| Rate for Payer: Healthscope Commercial |
$61.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.93
|
| Rate for Payer: PHP Commercial |
$57.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.30
|
| Rate for Payer: Priority Health SBD |
$42.93
|
| Rate for Payer: UMR Bronson Commercial |
$29.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.11
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
OP
|
$211.50
|
|
|
Service Code
|
NDC 51079068420
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna American Axle |
$137.48
|
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: Aetna Medicare |
$105.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.48
|
| Rate for Payer: BCBS Complete |
$84.60
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cofinity Commercial |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$181.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.20
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.78
|
| Rate for Payer: PHP Commercial |
$179.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.48
|
| Rate for Payer: Priority Health SBD |
$133.24
|
| Rate for Payer: UMR Bronson Commercial |
$78.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.62
|
|
|
ATENOLOL 50 MG TABLET
|
Facility
|
OP
|
$2.12
|
|
|
Service Code
|
NDC 51079068401
|
| Hospital Charge Code |
718
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna American Axle |
$1.38
|
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna Medicare |
$1.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.38
|
| Rate for Payer: BCBS Complete |
$0.85
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cofinity Commercial |
$1.48
|
| Rate for Payer: Cofinity Commercial |
$1.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.70
|
| Rate for Payer: Healthscope Commercial |
$1.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.80
|
| Rate for Payer: PHP Commercial |
$1.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.38
|
| Rate for Payer: Priority Health SBD |
$1.34
|
| Rate for Payer: UMR Bronson Commercial |
$0.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.59
|
|
|
ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$50,520.68
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
179035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.29 |
| Max. Negotiated Rate |
$45,468.61 |
| Rate for Payer: Aetna American Axle |
$32,838.44
|
| Rate for Payer: Aetna Commercial |
$42,942.58
|
| Rate for Payer: Aetna Medicare |
$91.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,838.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$110.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$110.28
|
| Rate for Payer: BCBS Complete |
$49.65
|
| Rate for Payer: BCBS MAPPO |
$88.22
|
| Rate for Payer: BCBS Trust/PPO |
$237.86
|
| Rate for Payer: BCN Commercial |
$237.86
|
| Rate for Payer: BCN Medicare Advantage |
$88.22
|
| Rate for Payer: Cash Price |
$40,416.54
|
| Rate for Payer: Cash Price |
$40,416.54
|
| Rate for Payer: Cofinity Commercial |
$43,447.78
|
| Rate for Payer: Cofinity Commercial |
$35,364.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$35,364.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,416.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.22
|
| Rate for Payer: Healthscope Commercial |
$45,468.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35,364.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,890.51
|
| Rate for Payer: Mclaren Medicaid |
$47.29
|
| Rate for Payer: Mclaren Medicare |
$88.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.63
|
| Rate for Payer: Meridian Medicaid |
$49.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,942.58
|
| Rate for Payer: Nomi Health Commercial |
$264.66
|
| Rate for Payer: PACE Medicare |
$83.81
|
| Rate for Payer: PACE SWMI |
$88.22
|
| Rate for Payer: PHP Commercial |
$42,942.58
|
| Rate for Payer: PHP Medicare Advantage |
$88.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,838.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.21
|
| Rate for Payer: Priority Health Medicare |
$88.22
|
| Rate for Payer: Priority Health Narrow Network |
$198.57
|
| Rate for Payer: Priority Health SBD |
$31,828.03
|
| Rate for Payer: Railroad Medicare Medicare |
$88.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.22
|
| Rate for Payer: UHC Exchange |
$168.60
|
| Rate for Payer: UHC Medicare Advantage |
$88.22
|
| Rate for Payer: UHCCP Medicaid |
$47.29
|
| Rate for Payer: UMR Bronson Commercial |
$18,692.65
|
| Rate for Payer: VA VA |
$88.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,890.51
|
|
|
ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$50,520.68
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
179035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22,229.10 |
| Max. Negotiated Rate |
$45,468.61 |
| Rate for Payer: Aetna American Axle |
$32,838.44
|
| Rate for Payer: Aetna Commercial |
$42,942.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,838.44
|
| Rate for Payer: Cash Price |
$40,416.54
|
| Rate for Payer: Cofinity Commercial |
$35,364.48
|
| Rate for Payer: Cofinity Commercial |
$43,447.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$35,364.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,416.54
|
| Rate for Payer: Healthscope Commercial |
$45,468.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35,364.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,890.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,942.58
|
| Rate for Payer: PHP Commercial |
$42,942.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,838.44
|
| Rate for Payer: Priority Health SBD |
$31,828.03
|
| Rate for Payer: UMR Bronson Commercial |
$22,229.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,890.51
|
|
|
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 |
$1,092.10 |
| Rate for Payer: Aetna American Axle |
$788.74
|
| Rate for Payer: Aetna Commercial |
$1,031.43
|
| Rate for Payer: Aetna Medicare |
$606.72
|
| 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 Commercial |
$1,043.57
|
| Rate for Payer: Cofinity Commercial |
$849.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$849.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.76
|
| Rate for Payer: Healthscope Commercial |
$1,092.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$849.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$910.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,031.43
|
| Rate for Payer: PHP Commercial |
$1,031.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.74
|
| Rate for Payer: Priority Health SBD |
$764.47
|
| Rate for Payer: UMR Bronson Commercial |
$448.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$910.09
|
|
|
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 Commercial |
$216.97
|
| Rate for Payer: Cofinity Commercial |
$266.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.97
|
| 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: PHP Commercial |
$263.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.47
|
| Rate for Payer: Priority Health SBD |
$195.27
|
| Rate for Payer: UMR Bronson Commercial |
$114.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.47
|
|
|
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 |
$1,092.10 |
| Rate for Payer: Aetna American Axle |
$788.74
|
| Rate for Payer: Aetna Commercial |
$1,031.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.74
|
| Rate for Payer: Cash Price |
$970.76
|
| Rate for Payer: Cofinity Commercial |
$1,043.57
|
| Rate for Payer: Cofinity Commercial |
$849.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$849.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.76
|
| Rate for Payer: Healthscope Commercial |
$1,092.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$849.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$910.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,031.43
|
| Rate for Payer: PHP Commercial |
$1,031.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.74
|
| Rate for Payer: Priority Health SBD |
$764.47
|
| Rate for Payer: UMR Bronson Commercial |
$533.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$910.09
|
|
|
ATOMOXETINE 10 MG CAPSULE
|
Facility
|
IP
|
$309.96
|
|
|
Service Code
|
NDC 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 Commercial |
$216.97
|
| Rate for Payer: Cofinity Commercial |
$266.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.97
|
| 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: PHP Commercial |
$263.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.47
|
| 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 18 MG CAPSULE
|
Facility
|
OP
|
$150.78
|
|
|
Service Code
|
NDC 64980037403
|
| Hospital Charge Code |
34445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.79 |
| Max. Negotiated Rate |
$135.70 |
| Rate for Payer: Aetna American Axle |
$98.01
|
| Rate for Payer: Aetna Commercial |
$128.16
|
| Rate for Payer: Aetna Medicare |
$75.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.01
|
| Rate for Payer: BCBS Complete |
$60.31
|
| Rate for Payer: Cash Price |
$120.62
|
| Rate for Payer: Cofinity Commercial |
$105.55
|
| Rate for Payer: Cofinity Commercial |
$129.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.62
|
| Rate for Payer: Healthscope Commercial |
$135.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.16
|
| Rate for Payer: PHP Commercial |
$128.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.01
|
| Rate for Payer: Priority Health SBD |
$94.99
|
| Rate for Payer: UMR Bronson Commercial |
$55.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.08
|
|
|
ATOMOXETINE 18 MG CAPSULE
|
Facility
|
IP
|
$150.78
|
|
|
Service Code
|
NDC 64980037403
|
| Hospital Charge Code |
34445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.34 |
| Max. Negotiated Rate |
$135.70 |
| Rate for Payer: Aetna American Axle |
$98.01
|
| Rate for Payer: Aetna Commercial |
$128.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.01
|
| Rate for Payer: Cash Price |
$120.62
|
| Rate for Payer: Cofinity Commercial |
$105.55
|
| Rate for Payer: Cofinity Commercial |
$129.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.62
|
| Rate for Payer: Healthscope Commercial |
$135.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.16
|
| Rate for Payer: PHP Commercial |
$128.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.01
|
| Rate for Payer: Priority Health SBD |
$94.99
|
| Rate for Payer: UMR Bronson Commercial |
$66.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.08
|
|
|
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 |
$1,092.10 |
| Rate for Payer: Aetna American Axle |
$788.74
|
| Rate for Payer: Aetna Commercial |
$1,031.43
|
| Rate for Payer: Aetna Medicare |
$606.72
|
| 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 Commercial |
$1,043.57
|
| Rate for Payer: Cofinity Commercial |
$849.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$849.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.76
|
| Rate for Payer: Healthscope Commercial |
$1,092.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$849.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$910.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,031.43
|
| Rate for Payer: PHP Commercial |
$1,031.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.74
|
| Rate for Payer: Priority Health SBD |
$764.47
|
| 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
|
$1,213.45
|
|
|
Service Code
|
NDC 00002323830
|
| Hospital Charge Code |
34445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$533.92 |
| Max. Negotiated Rate |
$1,092.10 |
| Rate for Payer: Aetna American Axle |
$788.74
|
| Rate for Payer: Aetna Commercial |
$1,031.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.74
|
| Rate for Payer: Cash Price |
$970.76
|
| Rate for Payer: Cofinity Commercial |
$1,043.57
|
| Rate for Payer: Cofinity Commercial |
$849.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$849.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.76
|
| Rate for Payer: Healthscope Commercial |
$1,092.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$849.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$910.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,031.43
|
| Rate for Payer: PHP Commercial |
$1,031.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.74
|
| Rate for Payer: Priority Health SBD |
$764.47
|
| Rate for Payer: UMR Bronson Commercial |
$533.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$910.09
|
|
|
ATOMOXETINE 25 MG CAPSULE
|
Facility
|
IP
|
$1,360.53
|
|
|
Service Code
|
NDC 00002322830
|
| Hospital Charge Code |
34446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$598.63 |
| Max. Negotiated Rate |
$1,224.48 |
| Rate for Payer: Aetna American Axle |
$884.34
|
| Rate for Payer: Aetna Commercial |
$1,156.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$884.34
|
| Rate for Payer: Cash Price |
$1,088.42
|
| Rate for Payer: Cofinity Commercial |
$1,170.06
|
| Rate for Payer: Cofinity Commercial |
$952.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$952.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,088.42
|
| Rate for Payer: Healthscope Commercial |
$1,224.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$952.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,020.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,156.45
|
| Rate for Payer: PHP Commercial |
$1,156.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.34
|
| Rate for Payer: Priority Health SBD |
$857.13
|
| Rate for Payer: UMR Bronson Commercial |
$598.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,020.40
|
|
|
ATOMOXETINE 25 MG CAPSULE
|
Facility
|
OP
|
$1,360.53
|
|
|
Service Code
|
NDC 00002322830
|
| Hospital Charge Code |
34446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$503.40 |
| Max. Negotiated Rate |
$1,224.48 |
| Rate for Payer: Aetna American Axle |
$884.34
|
| Rate for Payer: Aetna Commercial |
$1,156.45
|
| Rate for Payer: Aetna Medicare |
$680.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$884.34
|
| Rate for Payer: BCBS Complete |
$544.21
|
| Rate for Payer: Cash Price |
$1,088.42
|
| Rate for Payer: Cofinity Commercial |
$1,170.06
|
| Rate for Payer: Cofinity Commercial |
$952.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$952.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,088.42
|
| Rate for Payer: Healthscope Commercial |
$1,224.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$952.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,020.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,156.45
|
| Rate for Payer: PHP Commercial |
$1,156.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.34
|
| Rate for Payer: Priority Health SBD |
$857.13
|
| Rate for Payer: UMR Bronson Commercial |
$503.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,020.40
|
|
|
ATOMOXETINE 25 MG CAPSULE
|
Facility
|
IP
|
$9.06
|
|
|
Service Code
|
NDC 60687056711
|
| Hospital Charge Code |
34446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$8.15 |
| Rate for Payer: Aetna American Axle |
$5.89
|
| Rate for Payer: Aetna Commercial |
$7.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.89
|
| Rate for Payer: Cash Price |
$7.25
|
| Rate for Payer: Cofinity Commercial |
$6.34
|
| Rate for Payer: Cofinity Commercial |
$7.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.25
|
| Rate for Payer: Healthscope Commercial |
$8.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.70
|
| Rate for Payer: PHP Commercial |
$7.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.89
|
| Rate for Payer: Priority Health SBD |
$5.71
|
| Rate for Payer: UMR Bronson Commercial |
$3.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.80
|
|
