|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$8.23
|
|
|
Service Code
|
NDC 09900001117
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$7.41 |
| Rate for Payer: Aetna Commercial |
$7.00
|
| Rate for Payer: Aetna Medicare |
$4.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.35
|
| Rate for Payer: BCBS Complete |
$3.29
|
| Rate for Payer: Cash Price |
$6.58
|
| Rate for Payer: Cofinity Advantage |
$5.76
|
| Rate for Payer: Cofinity Commercial |
$7.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.58
|
| Rate for Payer: Healthscope Commercial |
$7.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.17
|
| Rate for Payer: PHP Commercial |
$7.00
|
| Rate for Payer: Priority Health SBD |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.35
|
| Rate for Payer: UHC Core |
$4.29
|
| Rate for Payer: UHC Exchange |
$3.23
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$77.55
|
|
|
Service Code
|
NDC 00781604146
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Aetna Medicare |
$38.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.41
|
| Rate for Payer: BCBS Complete |
$31.02
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Advantage |
$54.28
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Healthscope Commercial |
$69.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.16
|
| Rate for Payer: PHP Commercial |
$65.92
|
| Rate for Payer: Priority Health SBD |
$48.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.41
|
| Rate for Payer: UHC Core |
$40.40
|
| Rate for Payer: UHC Exchange |
$30.48
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$82.25
|
|
|
Service Code
|
NDC 00093415573
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$74.03 |
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna Medicare |
$41.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.46
|
| Rate for Payer: BCBS Complete |
$32.90
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Advantage |
$57.58
|
| Rate for Payer: Cofinity Commercial |
$70.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$74.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.69
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health SBD |
$51.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.46
|
| Rate for Payer: UHC Core |
$42.85
|
| Rate for Payer: UHC Exchange |
$32.32
|
|
|
AMOXICILLIN 250 MG CAPSULE
|
Facility
|
OP
|
$166.85
|
|
|
Service Code
|
NDC 00781202001
|
| Hospital Charge Code |
450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.57 |
| Max. Negotiated Rate |
$150.16 |
| Rate for Payer: Aetna Commercial |
$141.82
|
| Rate for Payer: Aetna Medicare |
$83.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.45
|
| Rate for Payer: BCBS Complete |
$66.74
|
| Rate for Payer: Cash Price |
$133.48
|
| Rate for Payer: Cofinity Advantage |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$143.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.48
|
| Rate for Payer: Healthscope Commercial |
$150.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$133.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.14
|
| Rate for Payer: PHP Commercial |
$141.82
|
| Rate for Payer: Priority Health SBD |
$105.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.45
|
| Rate for Payer: UHC Core |
$86.93
|
| Rate for Payer: UHC Exchange |
$65.57
|
|
|
AMOXICILLIN 250 MG CAPSULE
|
Facility
|
IP
|
$166.85
|
|
|
Service Code
|
NDC 00781202001
|
| Hospital Charge Code |
450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.12 |
| Max. Negotiated Rate |
$150.16 |
| Rate for Payer: Aetna Commercial |
$141.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.45
|
| Rate for Payer: Cash Price |
$133.48
|
| Rate for Payer: Cofinity Advantage |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$143.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.48
|
| Rate for Payer: Healthscope Commercial |
$150.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.14
|
| Rate for Payer: PHP Commercial |
$141.82
|
| Rate for Payer: Priority Health SBD |
$105.12
|
|
|
AMOXICILLIN 500 MG CAPSULE
|
Facility
|
OP
|
$106.93
|
|
|
Service Code
|
NDC 00093310953
|
| Hospital Charge Code |
451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.02 |
| Max. Negotiated Rate |
$96.24 |
| Rate for Payer: Aetna Commercial |
$90.89
|
| Rate for Payer: Aetna Medicare |
$53.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.50
|
| Rate for Payer: BCBS Complete |
$42.77
|
| Rate for Payer: Cash Price |
$85.54
|
| Rate for Payer: Cofinity Advantage |
$74.85
|
| Rate for Payer: Cofinity Commercial |
$91.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.54
|
| Rate for Payer: Healthscope Commercial |
$96.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.20
|
| Rate for Payer: PHP Commercial |
$90.89
|
| Rate for Payer: Priority Health SBD |
$67.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.50
|
| Rate for Payer: UHC Core |
$55.71
|
| Rate for Payer: UHC Exchange |
$42.02
|
|
|
AMOXICILLIN 500 MG CAPSULE
|
Facility
|
OP
|
$392.16
|
|
|
Service Code
|
NDC 60687078701
|
| Hospital Charge Code |
451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.12 |
| Max. Negotiated Rate |
$352.94 |
| Rate for Payer: Aetna Commercial |
$333.34
|
| Rate for Payer: Aetna Medicare |
$196.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.90
|
| Rate for Payer: BCBS Complete |
$156.86
|
| Rate for Payer: Cash Price |
$313.73
|
| Rate for Payer: Cofinity Advantage |
$274.51
|
| Rate for Payer: Cofinity Commercial |
$337.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.73
|
| Rate for Payer: Healthscope Commercial |
$352.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$313.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.12
|
| Rate for Payer: PHP Commercial |
$333.34
|
| Rate for Payer: Priority Health SBD |
$247.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.90
|
| Rate for Payer: UHC Core |
$204.32
|
| Rate for Payer: UHC Exchange |
$154.12
|
|
|
AMOXICILLIN 500 MG CAPSULE
|
Facility
|
IP
|
$3.93
|
|
|
Service Code
|
NDC 60687078711
|
| Hospital Charge Code |
451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$3.54 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.55
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cofinity Advantage |
$2.75
|
| Rate for Payer: Cofinity Commercial |
$3.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.14
|
| Rate for Payer: Healthscope Commercial |
$3.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.95
|
| Rate for Payer: PHP Commercial |
$3.34
|
| Rate for Payer: Priority Health SBD |
$2.48
|
|
|
AMOXICILLIN 500 MG CAPSULE
|
Facility
|
IP
|
$284.35
|
|
|
Service Code
|
NDC 00781261301
|
| Hospital Charge Code |
451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.14 |
| Max. Negotiated Rate |
$255.91 |
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.83
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Advantage |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$255.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.26
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: Priority Health SBD |
$179.14
|
|
|
AMOXICILLIN 500 MG CAPSULE
|
Facility
|
IP
|
$106.93
|
|
|
Service Code
|
NDC 00093310953
|
| Hospital Charge Code |
451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.37 |
| Max. Negotiated Rate |
$96.24 |
| Rate for Payer: Aetna Commercial |
$90.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.50
|
| Rate for Payer: Cash Price |
$85.54
|
| Rate for Payer: Cofinity Advantage |
$74.85
|
| Rate for Payer: Cofinity Commercial |
$91.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.54
|
| Rate for Payer: Healthscope Commercial |
$96.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.20
|
| Rate for Payer: PHP Commercial |
$90.89
|
| Rate for Payer: Priority Health SBD |
$67.37
|
|
|
AMOXICILLIN 500 MG CAPSULE
|
Facility
|
OP
|
$284.35
|
|
|
Service Code
|
NDC 00781261301
|
| Hospital Charge Code |
451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.75 |
| Max. Negotiated Rate |
$255.91 |
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: Aetna Medicare |
$142.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.83
|
| Rate for Payer: BCBS Complete |
$113.74
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Advantage |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$255.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.26
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: Priority Health SBD |
$179.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.83
|
| Rate for Payer: UHC Core |
$148.15
|
| Rate for Payer: UHC Exchange |
$111.75
|
|
|
AMOXICILLIN 500 MG CAPSULE
|
Facility
|
OP
|
$3.93
|
|
|
Service Code
|
NDC 60687078711
|
| Hospital Charge Code |
451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.54 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Aetna Medicare |
$1.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.55
|
| Rate for Payer: BCBS Complete |
$1.57
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cofinity Advantage |
$2.75
|
| Rate for Payer: Cofinity Commercial |
$3.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.14
|
| Rate for Payer: Healthscope Commercial |
$3.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.95
|
| Rate for Payer: PHP Commercial |
$3.34
|
| Rate for Payer: Priority Health SBD |
$2.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.55
|
| Rate for Payer: UHC Core |
$2.05
|
| Rate for Payer: UHC Exchange |
$1.54
|
|
|
AMOXICILLIN 500 MG CAPSULE
|
Facility
|
IP
|
$392.16
|
|
|
Service Code
|
NDC 60687078701
|
| Hospital Charge Code |
451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$247.06 |
| Max. Negotiated Rate |
$352.94 |
| Rate for Payer: Aetna Commercial |
$333.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.90
|
| Rate for Payer: Cash Price |
$313.73
|
| Rate for Payer: Cofinity Advantage |
$274.51
|
| Rate for Payer: Cofinity Commercial |
$337.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.73
|
| Rate for Payer: Healthscope Commercial |
$352.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.12
|
| Rate for Payer: PHP Commercial |
$333.34
|
| Rate for Payer: Priority Health SBD |
$247.06
|
|
|
AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
OP
|
$62.70
|
|
|
Service Code
|
NDC 00093227434
|
| Hospital Charge Code |
33227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$56.43 |
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: Aetna Medicare |
$31.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.76
|
| Rate for Payer: BCBS Complete |
$25.08
|
| Rate for Payer: Cash Price |
$50.16
|
| Rate for Payer: Cofinity Advantage |
$43.89
|
| Rate for Payer: Cofinity Commercial |
$53.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.16
|
| Rate for Payer: Healthscope Commercial |
$56.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.02
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: Priority Health SBD |
$39.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.76
|
| Rate for Payer: UHC Core |
$32.67
|
| Rate for Payer: UHC Exchange |
$24.64
|
|
|
AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
IP
|
$62.70
|
|
|
Service Code
|
NDC 00093227434
|
| Hospital Charge Code |
33227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.50 |
| Max. Negotiated Rate |
$56.43 |
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.76
|
| Rate for Payer: Cash Price |
$50.16
|
| Rate for Payer: Cofinity Advantage |
$43.89
|
| Rate for Payer: Cofinity Commercial |
$53.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.16
|
| Rate for Payer: Healthscope Commercial |
$56.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.02
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: Priority Health SBD |
$39.50
|
|
|
AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
OP
|
$5.72
|
|
|
Service Code
|
NDC 60687079211
|
| Hospital Charge Code |
33227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$5.15 |
| Rate for Payer: Aetna Commercial |
$4.86
|
| Rate for Payer: Aetna Medicare |
$2.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.72
|
| Rate for Payer: BCBS Complete |
$2.29
|
| Rate for Payer: Cash Price |
$4.58
|
| Rate for Payer: Cofinity Advantage |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$4.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.58
|
| Rate for Payer: Healthscope Commercial |
$5.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.29
|
| Rate for Payer: PHP Commercial |
$4.86
|
| Rate for Payer: Priority Health SBD |
$3.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.72
|
| Rate for Payer: UHC Core |
$2.98
|
| Rate for Payer: UHC Exchange |
$2.25
|
|
|
AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
IP
|
$571.68
|
|
|
Service Code
|
NDC 60687079201
|
| Hospital Charge Code |
33227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$360.16 |
| Max. Negotiated Rate |
$514.51 |
| Rate for Payer: Aetna Commercial |
$485.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.59
|
| Rate for Payer: Cash Price |
$457.34
|
| Rate for Payer: Cofinity Advantage |
$400.18
|
| Rate for Payer: Cofinity Commercial |
$491.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.34
|
| Rate for Payer: Healthscope Commercial |
$514.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$485.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$428.76
|
| Rate for Payer: PHP Commercial |
$485.93
|
| Rate for Payer: Priority Health SBD |
$360.16
|
|
|
AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
IP
|
$5.72
|
|
|
Service Code
|
NDC 60687079211
|
| Hospital Charge Code |
33227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$5.15 |
| Rate for Payer: Aetna Commercial |
$4.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.72
|
| Rate for Payer: Cash Price |
$4.58
|
| Rate for Payer: Cofinity Advantage |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$4.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.58
|
| Rate for Payer: Healthscope Commercial |
$5.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.29
|
| Rate for Payer: PHP Commercial |
$4.86
|
| Rate for Payer: Priority Health SBD |
$3.60
|
|
|
AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
OP
|
$571.68
|
|
|
Service Code
|
NDC 60687079201
|
| Hospital Charge Code |
33227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.67 |
| Max. Negotiated Rate |
$514.51 |
| Rate for Payer: Aetna Commercial |
$485.93
|
| Rate for Payer: Aetna Medicare |
$285.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.59
|
| Rate for Payer: BCBS Complete |
$228.67
|
| Rate for Payer: Cash Price |
$457.34
|
| Rate for Payer: Cofinity Advantage |
$400.18
|
| Rate for Payer: Cofinity Commercial |
$491.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.34
|
| Rate for Payer: Healthscope Commercial |
$514.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$457.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$485.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$428.76
|
| Rate for Payer: PHP Commercial |
$485.93
|
| Rate for Payer: Priority Health SBD |
$360.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$371.59
|
| Rate for Payer: UHC Core |
$297.85
|
| Rate for Payer: UHC Exchange |
$224.67
|
|
|
AMOXICILLIN 600 MG-POTASSIUM CLAVULANATE 42.9 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$149.82
|
|
|
Service Code
|
NDC 65862053575
|
| Hospital Charge Code |
31177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.39 |
| Max. Negotiated Rate |
$134.84 |
| Rate for Payer: Aetna Commercial |
$127.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.38
|
| Rate for Payer: Cash Price |
$119.86
|
| Rate for Payer: Cofinity Advantage |
$104.87
|
| Rate for Payer: Cofinity Commercial |
$128.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.86
|
| Rate for Payer: Healthscope Commercial |
$134.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.36
|
| Rate for Payer: PHP Commercial |
$127.35
|
| Rate for Payer: Priority Health SBD |
$94.39
|
|
|
AMOXICILLIN 600 MG-POTASSIUM CLAVULANATE 42.9 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$149.82
|
|
|
Service Code
|
NDC 65862053575
|
| Hospital Charge Code |
31177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.88 |
| Max. Negotiated Rate |
$134.84 |
| Rate for Payer: Aetna Commercial |
$127.35
|
| Rate for Payer: Aetna Medicare |
$74.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.38
|
| Rate for Payer: BCBS Complete |
$59.93
|
| Rate for Payer: Cash Price |
$119.86
|
| Rate for Payer: Cofinity Advantage |
$104.87
|
| Rate for Payer: Cofinity Commercial |
$128.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.86
|
| Rate for Payer: Healthscope Commercial |
$134.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.36
|
| Rate for Payer: PHP Commercial |
$127.35
|
| Rate for Payer: Priority Health SBD |
$94.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.38
|
| Rate for Payer: UHC Core |
$78.06
|
| Rate for Payer: UHC Exchange |
$58.88
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
OP
|
$64.03
|
|
|
Service Code
|
NDC 65862050320
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$57.63 |
| Rate for Payer: Aetna Commercial |
$54.43
|
| Rate for Payer: Aetna Medicare |
$32.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.62
|
| Rate for Payer: BCBS Complete |
$25.61
|
| Rate for Payer: Cash Price |
$51.22
|
| Rate for Payer: Cofinity Advantage |
$44.82
|
| Rate for Payer: Cofinity Commercial |
$55.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.22
|
| Rate for Payer: Healthscope Commercial |
$57.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.02
|
| Rate for Payer: PHP Commercial |
$54.43
|
| Rate for Payer: Priority Health SBD |
$40.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.62
|
| Rate for Payer: UHC Core |
$33.36
|
| Rate for Payer: UHC Exchange |
$25.16
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
IP
|
$53.57
|
|
|
Service Code
|
NDC 42571016242
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$48.21 |
| Rate for Payer: Aetna Commercial |
$45.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.82
|
| Rate for Payer: Cash Price |
$42.86
|
| Rate for Payer: Cofinity Advantage |
$37.50
|
| Rate for Payer: Cofinity Commercial |
$46.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.86
|
| Rate for Payer: Healthscope Commercial |
$48.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.18
|
| Rate for Payer: PHP Commercial |
$45.53
|
| Rate for Payer: Priority Health SBD |
$33.75
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
IP
|
$101.86
|
|
|
Service Code
|
NDC 66685100100
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.17 |
| Max. Negotiated Rate |
$91.67 |
| Rate for Payer: Aetna Commercial |
$86.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.21
|
| Rate for Payer: Cash Price |
$81.49
|
| Rate for Payer: Cofinity Advantage |
$71.30
|
| Rate for Payer: Cofinity Commercial |
$87.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.49
|
| Rate for Payer: Healthscope Commercial |
$91.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.39
|
| Rate for Payer: PHP Commercial |
$86.58
|
| Rate for Payer: Priority Health SBD |
$64.17
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET
|
Facility
|
OP
|
$101.86
|
|
|
Service Code
|
NDC 66685100100
|
| Hospital Charge Code |
33228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.03 |
| Max. Negotiated Rate |
$91.67 |
| Rate for Payer: Aetna Commercial |
$86.58
|
| Rate for Payer: Aetna Medicare |
$50.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.21
|
| Rate for Payer: BCBS Complete |
$40.74
|
| Rate for Payer: Cash Price |
$81.49
|
| Rate for Payer: Cofinity Advantage |
$71.30
|
| Rate for Payer: Cofinity Commercial |
$87.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.49
|
| Rate for Payer: Healthscope Commercial |
$91.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.39
|
| Rate for Payer: PHP Commercial |
$86.58
|
| Rate for Payer: Priority Health SBD |
$64.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.21
|
| Rate for Payer: UHC Core |
$53.07
|
| Rate for Payer: UHC Exchange |
$40.03
|
|
