|
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 |
$78.25 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna American Axle |
$137.47
|
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: Aetna Medicare |
$105.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.47
|
| 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 |
$137.47
|
| Rate for Payer: Priority Health SBD |
$133.25
|
| Rate for Payer: UMR Bronson Commercial |
$78.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.62
|
|
|
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 |
$137.47
|
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.47
|
| 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 |
$137.47
|
| Rate for Payer: Priority Health SBD |
$133.25
|
| 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
|
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 |
$48.96 |
| 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 |
$94.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,838.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.17
|
| Rate for Payer: BCBS Complete |
$51.41
|
| Rate for Payer: BCBS MAPPO |
$91.34
|
| Rate for Payer: BCN Medicare Advantage |
$91.34
|
| 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 |
$91.34
|
| 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 |
$48.96
|
| Rate for Payer: Mclaren Medicare |
$91.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.91
|
| Rate for Payer: Meridian Medicaid |
$51.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,942.58
|
| Rate for Payer: PACE Medicare |
$86.77
|
| Rate for Payer: PACE SWMI |
$91.34
|
| Rate for Payer: PHP Commercial |
$42,942.58
|
| Rate for Payer: PHP Medicare Advantage |
$91.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,838.44
|
| Rate for Payer: Priority Health Medicare |
$91.34
|
| Rate for Payer: Priority Health SBD |
$31,828.03
|
| Rate for Payer: Railroad Medicare Medicare |
$91.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.34
|
| Rate for Payer: UHC Exchange |
$174.56
|
| Rate for Payer: UHC Medicare Advantage |
$91.34
|
| Rate for Payer: UHCCP Medicaid |
$48.96
|
| Rate for Payer: UMR Bronson Commercial |
$18,692.65
|
| Rate for Payer: VA VA |
$91.34
|
| 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
|
$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
|
$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 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 Commercial |
$1,043.57
|
| Rate for Payer: Cofinity Commercial |
$849.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$849.41
|
| 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: 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
|
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 Commercial |
$1,043.57
|
| Rate for Payer: Cofinity Commercial |
$849.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$849.41
|
| 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: 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
|
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
|
$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 Commercial |
$1,043.57
|
| Rate for Payer: Cofinity Commercial |
$849.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$849.41
|
| 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: 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 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 Commercial |
$1,043.57
|
| Rate for Payer: Cofinity Commercial |
$849.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$849.41
|
| 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: 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
|
$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 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
|
$271.51
|
|
|
Service Code
|
NDC 60687056721
|
| Hospital Charge Code |
34446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.46 |
| Max. Negotiated Rate |
$244.36 |
| Rate for Payer: Aetna American Axle |
$176.48
|
| Rate for Payer: Aetna Commercial |
$230.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.48
|
| Rate for Payer: Cash Price |
$217.21
|
| Rate for Payer: Cofinity Commercial |
$190.06
|
| Rate for Payer: Cofinity Commercial |
$233.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.21
|
| Rate for Payer: Healthscope Commercial |
$244.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.78
|
| Rate for Payer: PHP Commercial |
$230.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.48
|
| Rate for Payer: Priority Health SBD |
$171.05
|
| Rate for Payer: UMR Bronson Commercial |
$119.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.63
|
|
|
ATOMOXETINE 25 MG CAPSULE
|
Facility
|
OP
|
$271.51
|
|
|
Service Code
|
NDC 60687056721
|
| Hospital Charge Code |
34446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$244.36 |
| Rate for Payer: Aetna American Axle |
$176.48
|
| Rate for Payer: Aetna Commercial |
$230.78
|
| Rate for Payer: Aetna Medicare |
$135.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.48
|
| Rate for Payer: BCBS Complete |
$108.60
|
| Rate for Payer: Cash Price |
$217.21
|
| Rate for Payer: Cofinity Commercial |
$190.06
|
| Rate for Payer: Cofinity Commercial |
$233.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.21
|
| Rate for Payer: Healthscope Commercial |
$244.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.78
|
| Rate for Payer: PHP Commercial |
$230.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.48
|
| Rate for Payer: Priority Health SBD |
$171.05
|
| Rate for Payer: UMR Bronson Commercial |
$100.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.63
|
|
|
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
|
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 |
$6.79
|
| 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 |
$6.79
|
|
|
ATOMOXETINE 25 MG CAPSULE
|
Facility
|
OP
|
$9.06
|
|
|
Service Code
|
NDC 60687056711
|
| Hospital Charge Code |
34446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$8.15 |
| Rate for Payer: Aetna American Axle |
$5.89
|
| Rate for Payer: Aetna Commercial |
$7.70
|
| Rate for Payer: Aetna Medicare |
$4.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.89
|
| Rate for Payer: BCBS Complete |
$3.62
|
| 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 |
$6.79
|
| 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 |
$3.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.79
|
|
|
ATOMOXETINE 40 MG CAPSULE
|
Facility
|
OP
|
$13.62
|
|
|
Service Code
|
NDC 50268005811
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$12.26 |
| Rate for Payer: Aetna American Axle |
$8.85
|
| Rate for Payer: Aetna Commercial |
$11.58
|
| Rate for Payer: Aetna Medicare |
$6.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.85
|
| Rate for Payer: BCBS Complete |
$5.45
|
| Rate for Payer: Cash Price |
$10.90
|
| Rate for Payer: Cofinity Commercial |
$11.71
|
| Rate for Payer: Cofinity Commercial |
$9.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.90
|
| Rate for Payer: Healthscope Commercial |
$12.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.58
|
| Rate for Payer: PHP Commercial |
$11.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.85
|
| Rate for Payer: Priority Health SBD |
$8.58
|
| Rate for Payer: UMR Bronson Commercial |
$5.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.21
|
|
|
ATOMOXETINE 40 MG CAPSULE
|
Facility
|
IP
|
$371.30
|
|
|
Service Code
|
NDC 00904690804
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.37 |
| Max. Negotiated Rate |
$334.17 |
| Rate for Payer: Aetna American Axle |
$241.34
|
| Rate for Payer: Aetna Commercial |
$315.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.34
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Commercial |
$259.91
|
| Rate for Payer: Cofinity Commercial |
$319.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Healthscope Commercial |
$334.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.61
|
| Rate for Payer: PHP Commercial |
$315.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.34
|
| Rate for Payer: Priority Health SBD |
$233.92
|
| Rate for Payer: UMR Bronson Commercial |
$163.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.48
|
|
|
ATOMOXETINE 40 MG CAPSULE
|
Facility
|
OP
|
$371.30
|
|
|
Service Code
|
NDC 00904690804
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.38 |
| Max. Negotiated Rate |
$334.17 |
| Rate for Payer: Aetna American Axle |
$241.34
|
| Rate for Payer: Aetna Commercial |
$315.61
|
| Rate for Payer: Aetna Medicare |
$185.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.34
|
| Rate for Payer: BCBS Complete |
$148.52
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Commercial |
$259.91
|
| Rate for Payer: Cofinity Commercial |
$319.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Healthscope Commercial |
$334.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.61
|
| Rate for Payer: PHP Commercial |
$315.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.34
|
| Rate for Payer: Priority Health SBD |
$233.92
|
| Rate for Payer: UMR Bronson Commercial |
$137.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.48
|
|
|
ATOMOXETINE 40 MG CAPSULE
|
Facility
|
OP
|
$232.42
|
|
|
Service Code
|
NDC 68462026830
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$209.18 |
| Rate for Payer: Aetna American Axle |
$151.07
|
| Rate for Payer: Aetna Commercial |
$197.56
|
| Rate for Payer: Aetna Medicare |
$116.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.07
|
| Rate for Payer: BCBS Complete |
$92.97
|
| Rate for Payer: Cash Price |
$185.94
|
| Rate for Payer: Cofinity Commercial |
$162.69
|
| Rate for Payer: Cofinity Commercial |
$199.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.94
|
| Rate for Payer: Healthscope Commercial |
$209.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.56
|
| Rate for Payer: PHP Commercial |
$197.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.07
|
| Rate for Payer: Priority Health SBD |
$146.42
|
| Rate for Payer: UMR Bronson Commercial |
$86.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.31
|
|
