|
ATOMOXETINE 40 MG CAPSULE
|
Facility
|
IP
|
$232.42
|
|
|
Service Code
|
NDC 68462026830
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.26 |
| Max. Negotiated Rate |
$209.18 |
| Rate for Payer: Aetna American Axle |
$151.07
|
| Rate for Payer: Aetna Commercial |
$197.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.07
|
| 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 |
$102.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.31
|
|
|
ATOMOXETINE 40 MG CAPSULE
|
Facility
|
IP
|
$1,478.30
|
|
|
Service Code
|
NDC 00002322930
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$650.45 |
| Max. Negotiated Rate |
$1,330.47 |
| Rate for Payer: Aetna American Axle |
$960.89
|
| Rate for Payer: Aetna Commercial |
$1,256.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.89
|
| Rate for Payer: Cash Price |
$1,182.64
|
| Rate for Payer: Cofinity Commercial |
$1,034.81
|
| Rate for Payer: Cofinity Commercial |
$1,271.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,034.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,182.64
|
| Rate for Payer: Healthscope Commercial |
$1,330.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,034.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,108.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,256.56
|
| Rate for Payer: PHP Commercial |
$1,256.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$960.89
|
| Rate for Payer: Priority Health SBD |
$931.33
|
| Rate for Payer: UMR Bronson Commercial |
$650.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,108.72
|
|
|
ATOMOXETINE 40 MG CAPSULE
|
Facility
|
OP
|
$1,478.30
|
|
|
Service Code
|
NDC 00002322930
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$546.97 |
| Max. Negotiated Rate |
$1,330.47 |
| Rate for Payer: Aetna American Axle |
$960.89
|
| Rate for Payer: Aetna Commercial |
$1,256.56
|
| Rate for Payer: Aetna Medicare |
$739.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.89
|
| Rate for Payer: BCBS Complete |
$591.32
|
| Rate for Payer: Cash Price |
$1,182.64
|
| Rate for Payer: Cofinity Commercial |
$1,034.81
|
| Rate for Payer: Cofinity Commercial |
$1,271.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,034.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,182.64
|
| Rate for Payer: Healthscope Commercial |
$1,330.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,034.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,108.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,256.56
|
| Rate for Payer: PHP Commercial |
$1,256.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$960.89
|
| Rate for Payer: Priority Health SBD |
$931.33
|
| Rate for Payer: UMR Bronson Commercial |
$546.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,108.72
|
|
|
ATOMOXETINE 40 MG CAPSULE
|
Facility
|
IP
|
$408.37
|
|
|
Service Code
|
NDC 50268005813
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.68 |
| Max. Negotiated Rate |
$367.53 |
| Rate for Payer: Aetna American Axle |
$265.44
|
| Rate for Payer: Aetna Commercial |
$347.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.44
|
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: Cofinity Commercial |
$285.86
|
| Rate for Payer: Cofinity Commercial |
$351.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$285.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.70
|
| Rate for Payer: Healthscope Commercial |
$367.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.11
|
| Rate for Payer: PHP Commercial |
$347.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.44
|
| Rate for Payer: Priority Health SBD |
$257.27
|
| Rate for Payer: UMR Bronson Commercial |
$179.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.28
|
|
|
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
|
|
|
ATOMOXETINE 40 MG CAPSULE
|
Facility
|
IP
|
$415.14
|
|
|
Service Code
|
NDC 00093354556
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.66 |
| Max. Negotiated Rate |
$373.63 |
| Rate for Payer: Aetna American Axle |
$269.84
|
| Rate for Payer: Aetna Commercial |
$352.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.84
|
| Rate for Payer: Cash Price |
$332.11
|
| Rate for Payer: Cofinity Commercial |
$290.60
|
| Rate for Payer: Cofinity Commercial |
$357.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$290.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.11
|
| Rate for Payer: Healthscope Commercial |
$373.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.87
|
| Rate for Payer: PHP Commercial |
$352.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.84
|
| Rate for Payer: Priority Health SBD |
$261.54
|
| Rate for Payer: UMR Bronson Commercial |
$182.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.36
|
|
|
ATOMOXETINE 40 MG CAPSULE
|
Facility
|
OP
|
$415.14
|
|
|
Service Code
|
NDC 00093354556
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.60 |
| Max. Negotiated Rate |
$373.63 |
| Rate for Payer: Aetna American Axle |
$269.84
|
| Rate for Payer: Aetna Commercial |
$352.87
|
| Rate for Payer: Aetna Medicare |
$207.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.84
|
| Rate for Payer: BCBS Complete |
$166.06
|
| Rate for Payer: Cash Price |
$332.11
|
| Rate for Payer: Cofinity Commercial |
$290.60
|
| Rate for Payer: Cofinity Commercial |
$357.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$290.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.11
|
| Rate for Payer: Healthscope Commercial |
$373.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.87
|
| Rate for Payer: PHP Commercial |
$352.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.84
|
| Rate for Payer: Priority Health SBD |
$261.54
|
| Rate for Payer: UMR Bronson Commercial |
$153.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.36
|
|
|
ATOMOXETINE 40 MG CAPSULE
|
Facility
|
IP
|
$415.14
|
|
|
Service Code
|
NDC 60505283303
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.66 |
| Max. Negotiated Rate |
$373.63 |
| Rate for Payer: Aetna American Axle |
$269.84
|
| Rate for Payer: Aetna Commercial |
$352.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.84
|
| Rate for Payer: Cash Price |
$332.11
|
| Rate for Payer: Cofinity Commercial |
$290.60
|
| Rate for Payer: Cofinity Commercial |
$357.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$290.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.11
|
| Rate for Payer: Healthscope Commercial |
$373.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.87
|
| Rate for Payer: PHP Commercial |
$352.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.84
|
| Rate for Payer: Priority Health SBD |
$261.54
|
| Rate for Payer: UMR Bronson Commercial |
$182.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.36
|
|
|
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
|
$144.00
|
|
|
Service Code
|
NDC 64980037603
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna American Axle |
$93.60
|
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Aetna Medicare |
$72.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.60
|
| Rate for Payer: BCBS Complete |
$57.60
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$123.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.20
|
| Rate for Payer: Healthscope Commercial |
$129.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.40
|
| Rate for Payer: PHP Commercial |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.60
|
| Rate for Payer: Priority Health SBD |
$90.72
|
| Rate for Payer: UMR Bronson Commercial |
$53.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.00
|
|
|
ATOMOXETINE 40 MG CAPSULE
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
NDC 64980037603
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna American Axle |
$93.60
|
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.60
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$123.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.20
|
| Rate for Payer: Healthscope Commercial |
$129.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.40
|
| Rate for Payer: PHP Commercial |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.60
|
| Rate for Payer: Priority Health SBD |
$90.72
|
| Rate for Payer: UMR Bronson Commercial |
$63.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.00
|
|
|
ATOMOXETINE 40 MG CAPSULE
|
Facility
|
IP
|
$254.88
|
|
|
Service Code
|
NDC 31722071730
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.15 |
| Max. Negotiated Rate |
$229.39 |
| Rate for Payer: Aetna American Axle |
$165.67
|
| Rate for Payer: Aetna Commercial |
$216.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.67
|
| Rate for Payer: Cash Price |
$203.90
|
| Rate for Payer: Cofinity Commercial |
$178.42
|
| Rate for Payer: Cofinity Commercial |
$219.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.90
|
| Rate for Payer: Healthscope Commercial |
$229.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.65
|
| Rate for Payer: PHP Commercial |
$216.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.67
|
| Rate for Payer: Priority Health SBD |
$160.57
|
| Rate for Payer: UMR Bronson Commercial |
$112.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.16
|
|
|
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
|
$415.14
|
|
|
Service Code
|
NDC 60505283303
|
| Hospital Charge Code |
34447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.60 |
| Max. Negotiated Rate |
$373.63 |
| Rate for Payer: Aetna American Axle |
$269.84
|
| Rate for Payer: Aetna Commercial |
$352.87
|
| Rate for Payer: Aetna Medicare |
$207.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.84
|
| Rate for Payer: BCBS Complete |
$166.06
|
| Rate for Payer: Cash Price |
$332.11
|
| Rate for Payer: Cofinity Commercial |
$290.60
|
| Rate for Payer: Cofinity Commercial |
$357.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$290.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.11
|
| Rate for Payer: Healthscope Commercial |
$373.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.87
|
| Rate for Payer: PHP Commercial |
$352.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.84
|
| Rate for Payer: Priority Health SBD |
$261.54
|
| Rate for Payer: UMR Bronson Commercial |
$153.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.36
|
|
|
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 Commercial |
$1,133.90
|
| Rate for Payer: Cofinity Commercial |
$922.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$922.94
|
| 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: PHP Commercial |
$1,120.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$857.02
|
| 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
|
IP
|
$381.54
|
|
|
Service Code
|
NDC 50268005913
|
| Hospital Charge Code |
34448
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.88 |
| Max. Negotiated Rate |
$343.39 |
| Rate for Payer: Aetna American Axle |
$248.00
|
| Rate for Payer: Aetna Commercial |
$324.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.00
|
| Rate for Payer: Cash Price |
$305.23
|
| Rate for Payer: Cofinity Commercial |
$267.08
|
| Rate for Payer: Cofinity Commercial |
$328.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$267.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.23
|
| Rate for Payer: Healthscope Commercial |
$343.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$267.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.31
|
| Rate for Payer: PHP Commercial |
$324.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.00
|
| Rate for Payer: Priority Health SBD |
$240.37
|
| Rate for Payer: UMR Bronson Commercial |
$167.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.15
|
|
|
ATOMOXETINE 60 MG CAPSULE
|
Facility
|
OP
|
$12.72
|
|
|
Service Code
|
NDC 50268005911
|
| Hospital Charge Code |
34448
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$11.45 |
| Rate for Payer: Aetna American Axle |
$8.27
|
| Rate for Payer: Aetna Commercial |
$10.81
|
| Rate for Payer: Aetna Medicare |
$6.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.27
|
| Rate for Payer: BCBS Complete |
$5.09
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cofinity Commercial |
$10.94
|
| Rate for Payer: Cofinity Commercial |
$8.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$11.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.81
|
| Rate for Payer: PHP Commercial |
$10.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.27
|
| Rate for Payer: Priority Health SBD |
$8.01
|
| Rate for Payer: UMR Bronson Commercial |
$4.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.54
|
|
|
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 Commercial |
$1,133.90
|
| Rate for Payer: Cofinity Commercial |
$922.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$922.94
|
| 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: PHP Commercial |
$1,120.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$857.02
|
| Rate for Payer: Priority Health SBD |
$830.65
|
| Rate for Payer: UMR Bronson Commercial |
$487.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$988.87
|
|
|
ATOMOXETINE 60 MG CAPSULE
|
Facility
|
OP
|
$381.54
|
|
|
Service Code
|
NDC 50268005913
|
| Hospital Charge Code |
34448
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.17 |
| Max. Negotiated Rate |
$343.39 |
| Rate for Payer: Aetna American Axle |
$248.00
|
| Rate for Payer: Aetna Commercial |
$324.31
|
| Rate for Payer: Aetna Medicare |
$190.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.00
|
| Rate for Payer: BCBS Complete |
$152.62
|
| Rate for Payer: Cash Price |
$305.23
|
| Rate for Payer: Cofinity Commercial |
$267.08
|
| Rate for Payer: Cofinity Commercial |
$328.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$267.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.23
|
| Rate for Payer: Healthscope Commercial |
$343.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$267.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.31
|
| Rate for Payer: PHP Commercial |
$324.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.00
|
| Rate for Payer: Priority Health SBD |
$240.37
|
| Rate for Payer: UMR Bronson Commercial |
$141.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.15
|
|
|
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 Commercial |
$306.31
|
| Rate for Payer: Cofinity Commercial |
$376.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$306.31
|
| 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: PHP Commercial |
$371.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.43
|
| Rate for Payer: Priority Health SBD |
$275.68
|
| 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
|
$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 Commercial |
$306.31
|
| Rate for Payer: Cofinity Commercial |
$376.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$306.31
|
| 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: PHP Commercial |
$371.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.43
|
| 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
|
IP
|
$12.72
|
|
|
Service Code
|
NDC 50268005911
|
| Hospital Charge Code |
34448
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$11.45 |
| Rate for Payer: Aetna American Axle |
$8.27
|
| Rate for Payer: Aetna Commercial |
$10.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.27
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cofinity Commercial |
$10.94
|
| Rate for Payer: Cofinity Commercial |
$8.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$11.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.81
|
| Rate for Payer: PHP Commercial |
$10.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.27
|
| Rate for Payer: Priority Health SBD |
$8.01
|
| Rate for Payer: UMR Bronson Commercial |
$5.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.54
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$4.52
|
|
|
Service Code
|
NDC 68084009711
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna American Axle |
$2.94
|
| Rate for Payer: Aetna Commercial |
$3.84
|
| Rate for Payer: Aetna Medicare |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.94
|
| Rate for Payer: BCBS Complete |
$1.81
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Cofinity Commercial |
$3.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.62
|
| Rate for Payer: Healthscope Commercial |
$4.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.84
|
| Rate for Payer: PHP Commercial |
$3.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.94
|
| Rate for Payer: Priority Health SBD |
$2.85
|
| Rate for Payer: UMR Bronson Commercial |
$1.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.39
|
|
|
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 Commercial |
$168.78
|
| Rate for Payer: Cofinity Commercial |
$207.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.78
|
| 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: PHP Commercial |
$204.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.72
|
| Rate for Payer: Priority Health SBD |
$151.90
|
| Rate for Payer: UMR Bronson Commercial |
$89.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.83
|
|
|
ATORVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$4,180.26
|
|
|
Service Code
|
NDC 00071015540
|
| Hospital Charge Code |
19176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,546.70 |
| Max. Negotiated Rate |
$3,762.23 |
| Rate for Payer: Aetna American Axle |
$2,717.17
|
| Rate for Payer: Aetna Commercial |
$3,553.22
|
| Rate for Payer: Aetna Medicare |
$2,090.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,717.17
|
| Rate for Payer: BCBS Complete |
$1,672.10
|
| Rate for Payer: Cash Price |
$3,344.21
|
| Rate for Payer: Cofinity Commercial |
$2,926.18
|
| Rate for Payer: Cofinity Commercial |
$3,595.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,926.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,344.21
|
| Rate for Payer: Healthscope Commercial |
$3,762.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,926.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,135.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,553.22
|
| Rate for Payer: PHP Commercial |
$3,553.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,717.17
|
| Rate for Payer: Priority Health SBD |
$2,633.56
|
| Rate for Payer: UMR Bronson Commercial |
$1,546.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,135.20
|
|
