Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

ASTHMA

Facility

$2,972.70

Service Code	APR-DRG 1411
Min. Negotiated Rate	$2,687.68
Max. Negotiated Rate	$2,972.70
Rate for Payer: BCBS Complete	$2,972.70
Rate for Payer: Mclaren Medicaid	$2,831.14
Rate for Payer: Meridian Medicaid	$2,972.70
Rate for Payer: PHP Medicaid	$2,687.68
Rate for Payer: Priority Health Choice Medicaid	$2,831.14
Rate for Payer: UHC Medicaid	$2,831.14
Rate for Payer: UHCCP Medicaid	$2,831.14

ATENOLOL 25 MG TABLET

Facility

$3.90

Service Code	NDC 60687060511
Hospital Charge Code	717
Hospital Revenue Code	637
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$3.90
Rate for Payer: Aetna Commercial	$3.51
Rate for Payer: ASR ASR	$3.78
Rate for Payer: BCBS Trust/PPO	$3.20
Rate for Payer: BCN Commercial	$3.20
Rate for Payer: Cash Price	$3.12
Rate for Payer: Cofinity Commercial	$3.67
Rate for Payer: Encore Health Key Benefits Commercial	$3.12
Rate for Payer: Healthscope Commercial	$3.78
Rate for Payer: Healthscope Whirlpool	$3.90
Rate for Payer: Mclaren Commercial	$3.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.32
Rate for Payer: Nomi Health Commercial	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.93
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.43

ATENOLOL 25 MG TABLET

Facility

$3.90

Service Code	NDC 60687060511
Hospital Charge Code	717
Hospital Revenue Code	637
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$3.90
Rate for Payer: Aetna Commercial	$3.51
Rate for Payer: Aetna Medicare	$1.44
Rate for Payer: ASR ASR	$3.78
Rate for Payer: BCBS Complete	$1.56
Rate for Payer: BCBS Trust/PPO	$3.22
Rate for Payer: BCN Commercial	$3.22
Rate for Payer: Cash Price	$3.12
Rate for Payer: Cofinity Commercial	$3.67
Rate for Payer: Encore Health Key Benefits Commercial	$3.12
Rate for Payer: Healthscope Commercial	$3.78
Rate for Payer: Healthscope Whirlpool	$3.90
Rate for Payer: Mclaren Commercial	$3.51
Rate for Payer: MI Amish Medical Board Commercial	$3.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.32
Rate for Payer: Nomi Health Commercial	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.93
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$3.42
Rate for Payer: Priority Health Narrow Network	$2.73
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.43

ATENOLOL 25 MG TABLET

Facility

$4.04

Service Code	NDC 51079075901
Hospital Charge Code	717
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$4.04
Rate for Payer: Aetna Commercial	$3.64
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: ASR ASR	$3.92
Rate for Payer: BCBS Complete	$1.62
Rate for Payer: BCBS Trust/PPO	$3.33
Rate for Payer: BCN Commercial	$3.33
Rate for Payer: Cash Price	$3.23
Rate for Payer: Cofinity Commercial	$3.80
Rate for Payer: Encore Health Key Benefits Commercial	$3.23
Rate for Payer: Healthscope Commercial	$3.92
Rate for Payer: Healthscope Whirlpool	$4.04
Rate for Payer: Mclaren Commercial	$3.64
Rate for Payer: MI Amish Medical Board Commercial	$3.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.44
Rate for Payer: Nomi Health Commercial	$3.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$3.54
Rate for Payer: Priority Health Narrow Network	$2.83
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.56

ATENOLOL 25 MG TABLET

Facility

$4.04

Service Code	NDC 51079075901
Hospital Charge Code	717
Hospital Revenue Code	637
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$4.04
Rate for Payer: Aetna Commercial	$3.64
Rate for Payer: ASR ASR	$3.92
Rate for Payer: BCBS Trust/PPO	$3.32
Rate for Payer: BCN Commercial	$3.32
Rate for Payer: Cash Price	$3.23
Rate for Payer: Cofinity Commercial	$3.80
Rate for Payer: Encore Health Key Benefits Commercial	$3.23
Rate for Payer: Healthscope Commercial	$3.92
Rate for Payer: Healthscope Whirlpool	$4.04
Rate for Payer: Mclaren Commercial	$3.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.44
Rate for Payer: Nomi Health Commercial	$3.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.03
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.56

ATENOLOL 25 MG TABLET

Facility

$390.10

Service Code	NDC 60687060501
Hospital Charge Code	717
Hospital Revenue Code	637
Min. Negotiated Rate	$144.34
Max. Negotiated Rate	$390.10
Rate for Payer: Aetna Commercial	$351.09
Rate for Payer: Aetna Medicare	$144.34
Rate for Payer: ASR ASR	$378.40
Rate for Payer: BCBS Complete	$156.04
Rate for Payer: BCBS Trust/PPO	$321.64
Rate for Payer: BCN Commercial	$321.64
Rate for Payer: Cash Price	$312.08
Rate for Payer: Cofinity Commercial	$366.69
Rate for Payer: Encore Health Key Benefits Commercial	$312.08
Rate for Payer: Healthscope Commercial	$378.40
Rate for Payer: Healthscope Whirlpool	$390.10
Rate for Payer: Mclaren Commercial	$351.09
Rate for Payer: MI Amish Medical Board Commercial	$312.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$331.58
Rate for Payer: Nomi Health Commercial	$319.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$292.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$341.81
Rate for Payer: Priority Health Narrow Network	$273.46
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$343.29

ATENOLOL 25 MG TABLET

Facility

$354.85

Service Code	NDC 904718761
Hospital Charge Code	717
Hospital Revenue Code	637
Min. Negotiated Rate	$266.14
Max. Negotiated Rate	$354.85
Rate for Payer: Aetna Commercial	$319.37
Rate for Payer: ASR ASR	$344.20
Rate for Payer: BCBS Trust/PPO	$291.40
Rate for Payer: BCN Commercial	$291.40
Rate for Payer: Cash Price	$283.88
Rate for Payer: Cofinity Commercial	$333.56
Rate for Payer: Encore Health Key Benefits Commercial	$283.88
Rate for Payer: Healthscope Commercial	$344.20
Rate for Payer: Healthscope Whirlpool	$354.85
Rate for Payer: Mclaren Commercial	$319.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$301.62
Rate for Payer: Nomi Health Commercial	$290.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$266.14
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$312.27

ATENOLOL 25 MG TABLET

Facility

$354.85

Service Code	NDC 904718761
Hospital Charge Code	717
Hospital Revenue Code	637
Min. Negotiated Rate	$131.29
Max. Negotiated Rate	$354.85
Rate for Payer: Aetna Commercial	$319.37
Rate for Payer: Aetna Medicare	$131.29
Rate for Payer: ASR ASR	$344.20
Rate for Payer: BCBS Complete	$141.94
Rate for Payer: BCBS Trust/PPO	$292.57
Rate for Payer: BCN Commercial	$292.57
Rate for Payer: Cash Price	$283.88
Rate for Payer: Cofinity Commercial	$333.56
Rate for Payer: Encore Health Key Benefits Commercial	$283.88
Rate for Payer: Healthscope Commercial	$344.20
Rate for Payer: Healthscope Whirlpool	$354.85
Rate for Payer: Mclaren Commercial	$319.37
Rate for Payer: MI Amish Medical Board Commercial	$283.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$301.62
Rate for Payer: Nomi Health Commercial	$290.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$266.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$310.92
Rate for Payer: Priority Health Narrow Network	$248.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$312.27

ATENOLOL 25 MG TABLET

Facility

$390.10

Service Code	NDC 60687060501
Hospital Charge Code	717
Hospital Revenue Code	637
Min. Negotiated Rate	$292.57
Max. Negotiated Rate	$390.10
Rate for Payer: Aetna Commercial	$351.09
Rate for Payer: ASR ASR	$378.40
Rate for Payer: BCBS Trust/PPO	$320.35
Rate for Payer: BCN Commercial	$320.35
Rate for Payer: Cash Price	$312.08
Rate for Payer: Cofinity Commercial	$366.69
Rate for Payer: Encore Health Key Benefits Commercial	$312.08
Rate for Payer: Healthscope Commercial	$378.40
Rate for Payer: Healthscope Whirlpool	$390.10
Rate for Payer: Mclaren Commercial	$351.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$331.58
Rate for Payer: Nomi Health Commercial	$319.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$292.57
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$343.29

ATENOLOL 50 MG TABLET

Facility

$2.47

Service Code	NDC 51079068401
Hospital Charge Code	718
Hospital Revenue Code	637
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$2.47
Rate for Payer: Aetna Commercial	$2.22
Rate for Payer: ASR ASR	$2.39
Rate for Payer: BCBS Trust/PPO	$2.03
Rate for Payer: BCN Commercial	$2.03
Rate for Payer: Cash Price	$1.97
Rate for Payer: Cofinity Commercial	$2.32
Rate for Payer: Encore Health Key Benefits Commercial	$1.97
Rate for Payer: Healthscope Commercial	$2.39
Rate for Payer: Healthscope Whirlpool	$2.47
Rate for Payer: Mclaren Commercial	$2.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.10
Rate for Payer: Nomi Health Commercial	$2.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.85
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2.17

ATENOLOL 50 MG TABLET

Facility

$2.47

Service Code	NDC 51079068401
Hospital Charge Code	718
Hospital Revenue Code	637
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$2.47
Rate for Payer: Aetna Commercial	$2.22
Rate for Payer: Aetna Medicare	$0.91
Rate for Payer: ASR ASR	$2.39
Rate for Payer: BCBS Complete	$0.99
Rate for Payer: BCBS Trust/PPO	$2.03
Rate for Payer: BCN Commercial	$2.03
Rate for Payer: Cash Price	$1.97
Rate for Payer: Cofinity Commercial	$2.32
Rate for Payer: Encore Health Key Benefits Commercial	$1.97
Rate for Payer: Healthscope Commercial	$2.39
Rate for Payer: Healthscope Whirlpool	$2.47
Rate for Payer: Mclaren Commercial	$2.22
Rate for Payer: MI Amish Medical Board Commercial	$1.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.10
Rate for Payer: Nomi Health Commercial	$2.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$2.16
Rate for Payer: Priority Health Narrow Network	$1.73
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2.17

ATHEROSCLEROSIS WITH MCC

Facility

$16,439.85

Service Code	MSDRG 302
Min. Negotiated Rate	$9,852.89
Max. Negotiated Rate	$16,439.85
Rate for Payer: Aetna Medicare	$10,371.46
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,964.33
Rate for Payer: Amish Plain Church Group Commercial	$12,964.33
Rate for Payer: BCBS MAPPO	$10,371.46
Rate for Payer: BCN Medicare Advantage	$10,371.46
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,371.46
Rate for Payer: Humana Choice PPO Medicare	$10,371.46
Rate for Payer: Mclaren Medicare	$10,371.46
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,890.03
Rate for Payer: MI Amish Medical Board Commercial	$11,927.18
Rate for Payer: Molina Medicare/Medicaid	$11,408.61
Rate for Payer: PACE Medicare	$9,852.89
Rate for Payer: PACE SWMI	$10,371.46
Rate for Payer: PHP Commercial	$11,408.61
Rate for Payer: PHP Medicare Advantage	$10,371.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$16,439.85
Rate for Payer: Priority Health Medicare	$10,371.46
Rate for Payer: Priority Health Narrow Network	$13,151.88
Rate for Payer: Railroad Medicare Medicare	$10,371.46
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,371.46
Rate for Payer: UHC Exchange	$16,075.76
Rate for Payer: UHCCP DNSP	$10,371.46
Rate for Payer: VA VA	$10,371.46

ATHEROSCLEROSIS WITHOUT MCC

Facility

$10,233.63

Service Code	MSDRG 303
Min. Negotiated Rate	$6,272.22
Max. Negotiated Rate	$10,233.63
Rate for Payer: Aetna Medicare	$6,602.34
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,252.92
Rate for Payer: Amish Plain Church Group Commercial	$8,252.92
Rate for Payer: BCBS MAPPO	$6,602.34
Rate for Payer: BCN Medicare Advantage	$6,602.34
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,602.34
Rate for Payer: Humana Choice PPO Medicare	$6,602.34
Rate for Payer: Mclaren Medicare	$6,602.34
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,932.46
Rate for Payer: MI Amish Medical Board Commercial	$7,592.69
Rate for Payer: Molina Medicare/Medicaid	$7,262.57
Rate for Payer: PACE Medicare	$6,272.22
Rate for Payer: PACE SWMI	$6,602.34
Rate for Payer: PHP Commercial	$7,262.57
Rate for Payer: PHP Medicare Advantage	$6,602.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$9,248.96
Rate for Payer: Priority Health Medicare	$6,602.34
Rate for Payer: Priority Health Narrow Network	$7,399.17
Rate for Payer: Railroad Medicare Medicare	$6,602.34
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,602.34
Rate for Payer: UHC Exchange	$10,233.63
Rate for Payer: UHCCP DNSP	$6,602.34
Rate for Payer: VA VA	$6,602.34

ATOMOXETINE 18 MG CAPSULE

Facility

$144.27

Service Code	NDC 64980037403
Hospital Charge Code	34445
Hospital Revenue Code	637
Min. Negotiated Rate	$108.20
Max. Negotiated Rate	$144.27
Rate for Payer: Aetna Commercial	$129.84
Rate for Payer: ASR ASR	$139.94
Rate for Payer: BCBS Trust/PPO	$118.47
Rate for Payer: BCN Commercial	$118.47
Rate for Payer: Cash Price	$115.42
Rate for Payer: Cofinity Commercial	$135.61
Rate for Payer: Encore Health Key Benefits Commercial	$115.42
Rate for Payer: Healthscope Commercial	$139.94
Rate for Payer: Healthscope Whirlpool	$144.27
Rate for Payer: Mclaren Commercial	$129.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$122.63
Rate for Payer: Nomi Health Commercial	$118.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$108.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$126.96

ATOMOXETINE 18 MG CAPSULE

Facility

$144.27

Service Code	NDC 64980037403
Hospital Charge Code	34445
Hospital Revenue Code	637
Min. Negotiated Rate	$53.38
Max. Negotiated Rate	$144.27
Rate for Payer: Aetna Commercial	$129.84
Rate for Payer: Aetna Medicare	$53.38
Rate for Payer: ASR ASR	$139.94
Rate for Payer: BCBS Complete	$57.71
Rate for Payer: BCBS Trust/PPO	$118.95
Rate for Payer: BCN Commercial	$118.95
Rate for Payer: Cash Price	$115.42
Rate for Payer: Cofinity Commercial	$135.61
Rate for Payer: Encore Health Key Benefits Commercial	$115.42
Rate for Payer: Healthscope Commercial	$139.94
Rate for Payer: Healthscope Whirlpool	$144.27
Rate for Payer: Mclaren Commercial	$129.84
Rate for Payer: MI Amish Medical Board Commercial	$115.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$122.63
Rate for Payer: Nomi Health Commercial	$118.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$108.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$126.41
Rate for Payer: Priority Health Narrow Network	$101.13
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$126.96

ATOMOXETINE 40 MG CAPSULE

Facility

$145.58

Service Code	NDC 64980037603
Hospital Charge Code	34447
Hospital Revenue Code	637
Min. Negotiated Rate	$53.87
Max. Negotiated Rate	$145.58
Rate for Payer: Aetna Commercial	$131.03
Rate for Payer: Aetna Medicare	$53.87
Rate for Payer: ASR ASR	$141.22
Rate for Payer: BCBS Complete	$58.23
Rate for Payer: BCBS Trust/PPO	$120.03
Rate for Payer: BCN Commercial	$120.03
Rate for Payer: Cash Price	$116.47
Rate for Payer: Cofinity Commercial	$136.85
Rate for Payer: Encore Health Key Benefits Commercial	$116.47
Rate for Payer: Healthscope Commercial	$141.22
Rate for Payer: Healthscope Whirlpool	$145.58
Rate for Payer: Mclaren Commercial	$131.03
Rate for Payer: MI Amish Medical Board Commercial	$116.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$123.75
Rate for Payer: Nomi Health Commercial	$119.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$109.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$127.56
Rate for Payer: Priority Health Narrow Network	$102.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$128.11

ATOMOXETINE 40 MG CAPSULE

Facility

$145.58

Service Code	NDC 64980037603
Hospital Charge Code	34447
Hospital Revenue Code	637
Min. Negotiated Rate	$109.19
Max. Negotiated Rate	$145.58
Rate for Payer: Aetna Commercial	$131.03
Rate for Payer: ASR ASR	$141.22
Rate for Payer: BCBS Trust/PPO	$119.55
Rate for Payer: BCN Commercial	$119.55
Rate for Payer: Cash Price	$116.47
Rate for Payer: Cofinity Commercial	$136.85
Rate for Payer: Encore Health Key Benefits Commercial	$116.47
Rate for Payer: Healthscope Commercial	$141.22
Rate for Payer: Healthscope Whirlpool	$145.58
Rate for Payer: Mclaren Commercial	$131.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$123.75
Rate for Payer: Nomi Health Commercial	$119.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$109.19
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$128.11

ATORVASTATIN 10 MG TABLET

Facility

$1.92

Service Code	NDC 50268009311
Hospital Charge Code	19176
Hospital Revenue Code	637
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$1.92
Rate for Payer: Aetna Commercial	$1.73
Rate for Payer: ASR ASR	$1.86
Rate for Payer: BCBS Trust/PPO	$1.58
Rate for Payer: BCN Commercial	$1.58
Rate for Payer: Cash Price	$1.54
Rate for Payer: Cofinity Commercial	$1.80
Rate for Payer: Encore Health Key Benefits Commercial	$1.54
Rate for Payer: Healthscope Commercial	$1.86
Rate for Payer: Healthscope Whirlpool	$1.92
Rate for Payer: Mclaren Commercial	$1.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.63
Rate for Payer: Nomi Health Commercial	$1.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.44
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1.69

ATORVASTATIN 10 MG TABLET

Facility

$195.70

Service Code	NDC 904629061
Hospital Charge Code	19176
Hospital Revenue Code	637
Min. Negotiated Rate	$146.78
Max. Negotiated Rate	$195.70
Rate for Payer: Aetna Commercial	$176.13
Rate for Payer: ASR ASR	$189.83
Rate for Payer: BCBS Trust/PPO	$160.71
Rate for Payer: BCN Commercial	$160.71
Rate for Payer: Cash Price	$156.56
Rate for Payer: Cofinity Commercial	$183.96
Rate for Payer: Encore Health Key Benefits Commercial	$156.56
Rate for Payer: Healthscope Commercial	$189.83
Rate for Payer: Healthscope Whirlpool	$195.70
Rate for Payer: Mclaren Commercial	$176.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$166.34
Rate for Payer: Nomi Health Commercial	$160.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$146.78
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$172.22

ATORVASTATIN 10 MG TABLET

Facility

$95.95

Service Code	NDC 50268009315
Hospital Charge Code	19176
Hospital Revenue Code	637
Min. Negotiated Rate	$35.50
Max. Negotiated Rate	$95.95
Rate for Payer: Aetna Commercial	$86.36
Rate for Payer: Aetna Medicare	$35.50
Rate for Payer: ASR ASR	$93.07
Rate for Payer: BCBS Complete	$38.38
Rate for Payer: BCBS Trust/PPO	$79.11
Rate for Payer: BCN Commercial	$79.11
Rate for Payer: Cash Price	$76.76
Rate for Payer: Cofinity Commercial	$90.19
Rate for Payer: Encore Health Key Benefits Commercial	$76.76
Rate for Payer: Healthscope Commercial	$93.07
Rate for Payer: Healthscope Whirlpool	$95.95
Rate for Payer: Mclaren Commercial	$86.36
Rate for Payer: MI Amish Medical Board Commercial	$76.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.56
Rate for Payer: Nomi Health Commercial	$78.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$71.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$84.07
Rate for Payer: Priority Health Narrow Network	$67.26
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$84.44

ATORVASTATIN 10 MG TABLET

Facility

$2.16

Service Code	NDC 51079020801
Hospital Charge Code	19176
Hospital Revenue Code	637
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$2.16
Rate for Payer: Aetna Commercial	$1.94
Rate for Payer: ASR ASR	$2.09
Rate for Payer: BCBS Trust/PPO	$1.77
Rate for Payer: BCN Commercial	$1.77
Rate for Payer: Cash Price	$1.73
Rate for Payer: Cofinity Commercial	$2.03
Rate for Payer: Encore Health Key Benefits Commercial	$1.73
Rate for Payer: Healthscope Commercial	$2.09
Rate for Payer: Healthscope Whirlpool	$2.16
Rate for Payer: Mclaren Commercial	$1.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.83
Rate for Payer: Nomi Health Commercial	$1.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1.90

ATORVASTATIN 10 MG TABLET

Facility

$215.65

Service Code	NDC 68084009701
Hospital Charge Code	19176
Hospital Revenue Code	637
Min. Negotiated Rate	$79.79
Max. Negotiated Rate	$215.65
Rate for Payer: Aetna Commercial	$194.09
Rate for Payer: Aetna Medicare	$79.79
Rate for Payer: ASR ASR	$209.18
Rate for Payer: BCBS Complete	$86.26
Rate for Payer: BCBS Trust/PPO	$177.80
Rate for Payer: BCN Commercial	$177.80
Rate for Payer: Cash Price	$172.52
Rate for Payer: Cofinity Commercial	$202.71
Rate for Payer: Encore Health Key Benefits Commercial	$172.52
Rate for Payer: Healthscope Commercial	$209.18
Rate for Payer: Healthscope Whirlpool	$215.65
Rate for Payer: Mclaren Commercial	$194.09
Rate for Payer: MI Amish Medical Board Commercial	$172.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$183.30
Rate for Payer: Nomi Health Commercial	$176.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$161.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$188.95
Rate for Payer: Priority Health Narrow Network	$151.17
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$189.77

ATORVASTATIN 10 MG TABLET

Facility

$2.16

Service Code	NDC 68084009711
Hospital Charge Code	19176
Hospital Revenue Code	637
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$2.16
Rate for Payer: Aetna Commercial	$1.94
Rate for Payer: Aetna Medicare	$0.80
Rate for Payer: ASR ASR	$2.09
Rate for Payer: BCBS Complete	$0.86
Rate for Payer: BCBS Trust/PPO	$1.78
Rate for Payer: BCN Commercial	$1.78
Rate for Payer: Cash Price	$1.73
Rate for Payer: Cofinity Commercial	$2.03
Rate for Payer: Encore Health Key Benefits Commercial	$1.73
Rate for Payer: Healthscope Commercial	$2.09
Rate for Payer: Healthscope Whirlpool	$2.16
Rate for Payer: Mclaren Commercial	$1.94
Rate for Payer: MI Amish Medical Board Commercial	$1.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.83
Rate for Payer: Nomi Health Commercial	$1.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$1.89
Rate for Payer: Priority Health Narrow Network	$1.51
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1.90

ATORVASTATIN 10 MG TABLET

Facility

$2.16

Service Code	NDC 51079020801
Hospital Charge Code	19176
Hospital Revenue Code	637
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$2.16
Rate for Payer: Aetna Commercial	$1.94
Rate for Payer: Aetna Medicare	$0.80
Rate for Payer: ASR ASR	$2.09
Rate for Payer: BCBS Complete	$0.86
Rate for Payer: BCBS Trust/PPO	$1.78
Rate for Payer: BCN Commercial	$1.78
Rate for Payer: Cash Price	$1.73
Rate for Payer: Cofinity Commercial	$2.03
Rate for Payer: Encore Health Key Benefits Commercial	$1.73
Rate for Payer: Healthscope Commercial	$2.09
Rate for Payer: Healthscope Whirlpool	$2.16
Rate for Payer: Mclaren Commercial	$1.94
Rate for Payer: MI Amish Medical Board Commercial	$1.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.83
Rate for Payer: Nomi Health Commercial	$1.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$1.89
Rate for Payer: Priority Health Narrow Network	$1.51
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1.90

ATORVASTATIN 10 MG TABLET

Facility

$95.95

Service Code	NDC 50268009315
Hospital Charge Code	19176
Hospital Revenue Code	637
Min. Negotiated Rate	$71.96
Max. Negotiated Rate	$95.95
Rate for Payer: Aetna Commercial	$86.36
Rate for Payer: ASR ASR	$93.07
Rate for Payer: BCBS Trust/PPO	$78.79
Rate for Payer: BCN Commercial	$78.79
Rate for Payer: Cash Price	$76.76
Rate for Payer: Cofinity Commercial	$90.19
Rate for Payer: Encore Health Key Benefits Commercial	$76.76
Rate for Payer: Healthscope Commercial	$93.07
Rate for Payer: Healthscope Whirlpool	$95.95
Rate for Payer: Mclaren Commercial	$86.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.56
Rate for Payer: Nomi Health Commercial	$78.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$71.96
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$84.44

Know your out-of-pocket cost for care.

All Charges