Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

AZITHROMYCIN 250 MG TABLET

Facility

$157.92

Service Code	NDC 00904735006
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$99.49
Max. Negotiated Rate	$142.13
Rate for Payer: Aetna Commercial	$134.23
Rate for Payer: Aetna New Business (MI Preferred)	$102.65
Rate for Payer: Cash Price	$126.34
Rate for Payer: Cofinity Advantage	$110.54
Rate for Payer: Cofinity Commercial	$135.81
Rate for Payer: Encore Health Key Benefits Commercial	$126.34
Rate for Payer: Healthscope Commercial	$142.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.44
Rate for Payer: PHP Commercial	$134.23
Rate for Payer: Priority Health SBD	$99.49

AZITHROMYCIN 250 MG TABLET

Facility

$409.92

Service Code	NDC 00904670861
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$258.25
Max. Negotiated Rate	$368.93
Rate for Payer: Aetna Commercial	$348.43
Rate for Payer: Aetna New Business (MI Preferred)	$266.45
Rate for Payer: Cash Price	$327.94
Rate for Payer: Cofinity Advantage	$286.94
Rate for Payer: Cofinity Commercial	$352.53
Rate for Payer: Encore Health Key Benefits Commercial	$327.94
Rate for Payer: Healthscope Commercial	$368.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$348.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$307.44
Rate for Payer: PHP Commercial	$348.43
Rate for Payer: Priority Health SBD	$258.25

AZITHROMYCIN 250 MG TABLET

Facility

$223.67

Service Code	NDC 00781808931
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$140.91
Max. Negotiated Rate	$201.30
Rate for Payer: Aetna Commercial	$190.12
Rate for Payer: Aetna New Business (MI Preferred)	$145.39
Rate for Payer: Cash Price	$178.94
Rate for Payer: Cofinity Advantage	$156.57
Rate for Payer: Cofinity Commercial	$192.36
Rate for Payer: Encore Health Key Benefits Commercial	$178.94
Rate for Payer: Healthscope Commercial	$201.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$190.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$167.75
Rate for Payer: PHP Commercial	$190.12
Rate for Payer: Priority Health SBD	$140.91

AZITHROMYCIN 250 MG TABLET

Facility

$419.04

Service Code	NDC 00904735061
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$164.68
Max. Negotiated Rate	$377.14
Rate for Payer: Aetna Commercial	$356.18
Rate for Payer: Aetna Medicare	$209.52
Rate for Payer: Aetna New Business (MI Preferred)	$272.38
Rate for Payer: BCBS Complete	$167.62
Rate for Payer: Cash Price	$335.23
Rate for Payer: Cofinity Advantage	$293.33
Rate for Payer: Cofinity Commercial	$360.37
Rate for Payer: Encore Health Key Benefits Commercial	$335.23
Rate for Payer: Healthscope Commercial	$377.14
Rate for Payer: MI Amish Medical Board Commercial	$335.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$356.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$314.28
Rate for Payer: PHP Commercial	$356.18
Rate for Payer: Priority Health SBD	$264.00
Rate for Payer: UHC All Payor (Choice/PPO)	$272.38
Rate for Payer: UHC Core	$218.32
Rate for Payer: UHC Exchange	$164.68

AZITHROMYCIN 250 MG TABLET

Facility

$384.80

Service Code	NDC 59762306003
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$151.23
Max. Negotiated Rate	$346.32
Rate for Payer: Aetna Commercial	$327.08
Rate for Payer: Aetna Medicare	$192.40
Rate for Payer: Aetna New Business (MI Preferred)	$250.12
Rate for Payer: BCBS Complete	$153.92
Rate for Payer: Cash Price	$307.84
Rate for Payer: Cofinity Advantage	$269.36
Rate for Payer: Cofinity Commercial	$330.93
Rate for Payer: Encore Health Key Benefits Commercial	$307.84
Rate for Payer: Healthscope Commercial	$346.32
Rate for Payer: MI Amish Medical Board Commercial	$307.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$327.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$288.60
Rate for Payer: PHP Commercial	$327.08
Rate for Payer: Priority Health SBD	$242.42
Rate for Payer: UHC All Payor (Choice/PPO)	$250.12
Rate for Payer: UHC Core	$200.48
Rate for Payer: UHC Exchange	$151.23

AZITHROMYCIN 250 MG TABLET

Facility

$409.92

Service Code	NDC 00904670861
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$161.10
Max. Negotiated Rate	$368.93
Rate for Payer: Aetna Commercial	$348.43
Rate for Payer: Aetna Medicare	$204.96
Rate for Payer: Aetna New Business (MI Preferred)	$266.45
Rate for Payer: BCBS Complete	$163.97
Rate for Payer: Cash Price	$327.94
Rate for Payer: Cofinity Advantage	$286.94
Rate for Payer: Cofinity Commercial	$352.53
Rate for Payer: Encore Health Key Benefits Commercial	$327.94
Rate for Payer: Healthscope Commercial	$368.93
Rate for Payer: MI Amish Medical Board Commercial	$327.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$348.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$307.44
Rate for Payer: PHP Commercial	$348.43
Rate for Payer: Priority Health SBD	$258.25
Rate for Payer: UHC All Payor (Choice/PPO)	$266.45
Rate for Payer: UHC Core	$213.57
Rate for Payer: UHC Exchange	$161.10

AZITHROMYCIN 250 MG TABLET

Facility

$281.96

Service Code	NDC 64679096101
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$110.81
Max. Negotiated Rate	$253.76
Rate for Payer: Aetna Commercial	$239.67
Rate for Payer: Aetna Medicare	$140.98
Rate for Payer: Aetna New Business (MI Preferred)	$183.27
Rate for Payer: BCBS Complete	$112.78
Rate for Payer: Cash Price	$225.57
Rate for Payer: Cofinity Advantage	$197.37
Rate for Payer: Cofinity Commercial	$242.49
Rate for Payer: Encore Health Key Benefits Commercial	$225.57
Rate for Payer: Healthscope Commercial	$253.76
Rate for Payer: MI Amish Medical Board Commercial	$225.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$239.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$211.47
Rate for Payer: PHP Commercial	$239.67
Rate for Payer: Priority Health SBD	$177.63
Rate for Payer: UHC All Payor (Choice/PPO)	$183.27
Rate for Payer: UHC Core	$146.90
Rate for Payer: UHC Exchange	$110.81

AZITHROMYCIN 250 MG TABLET

Facility

$3.12

Service Code	NDC 50268009811
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$2.81
Rate for Payer: Aetna Commercial	$2.65
Rate for Payer: Aetna New Business (MI Preferred)	$2.03
Rate for Payer: Cash Price	$2.50
Rate for Payer: Cofinity Advantage	$2.18
Rate for Payer: Cofinity Commercial	$2.68
Rate for Payer: Encore Health Key Benefits Commercial	$2.50
Rate for Payer: Healthscope Commercial	$2.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.34
Rate for Payer: PHP Commercial	$2.65
Rate for Payer: Priority Health SBD	$1.97

AZITHROMYCIN 250 MG TABLET

Facility

$154.08

Service Code	NDC 00904670806
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$60.55
Max. Negotiated Rate	$138.67
Rate for Payer: Aetna Commercial	$130.97
Rate for Payer: Aetna Medicare	$77.04
Rate for Payer: Aetna New Business (MI Preferred)	$100.15
Rate for Payer: BCBS Complete	$61.63
Rate for Payer: Cash Price	$123.26
Rate for Payer: Cofinity Advantage	$107.86
Rate for Payer: Cofinity Commercial	$132.51
Rate for Payer: Encore Health Key Benefits Commercial	$123.26
Rate for Payer: Healthscope Commercial	$138.67
Rate for Payer: MI Amish Medical Board Commercial	$123.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$130.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$115.56
Rate for Payer: PHP Commercial	$130.97
Rate for Payer: Priority Health SBD	$97.07
Rate for Payer: UHC All Payor (Choice/PPO)	$100.15
Rate for Payer: UHC Core	$80.28
Rate for Payer: UHC Exchange	$60.55

AZITHROMYCIN 250 MG TABLET

Facility

$384.80

Service Code	NDC 59762306003
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$242.42
Max. Negotiated Rate	$346.32
Rate for Payer: Aetna Commercial	$327.08
Rate for Payer: Aetna New Business (MI Preferred)	$250.12
Rate for Payer: Cash Price	$307.84
Rate for Payer: Cofinity Advantage	$269.36
Rate for Payer: Cofinity Commercial	$330.93
Rate for Payer: Encore Health Key Benefits Commercial	$307.84
Rate for Payer: Healthscope Commercial	$346.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$327.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$288.60
Rate for Payer: PHP Commercial	$327.08
Rate for Payer: Priority Health SBD	$242.42

AZITHROMYCIN 250 MG TABLET

Facility

$3.48

Service Code	NDC 50268007411
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$3.13
Rate for Payer: Aetna Commercial	$2.96
Rate for Payer: Aetna Medicare	$1.74
Rate for Payer: Aetna New Business (MI Preferred)	$2.26
Rate for Payer: BCBS Complete	$1.39
Rate for Payer: Cash Price	$2.78
Rate for Payer: Cofinity Advantage	$2.44
Rate for Payer: Cofinity Commercial	$2.99
Rate for Payer: Encore Health Key Benefits Commercial	$2.78
Rate for Payer: Healthscope Commercial	$3.13
Rate for Payer: MI Amish Medical Board Commercial	$2.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.61
Rate for Payer: PHP Commercial	$2.96
Rate for Payer: Priority Health SBD	$2.19
Rate for Payer: UHC All Payor (Choice/PPO)	$2.26
Rate for Payer: UHC Core	$1.81
Rate for Payer: UHC Exchange	$1.37

AZITHROMYCIN 250 MG TABLET

Facility

$7.76

Service Code	NDC 60687028211
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$4.89
Max. Negotiated Rate	$6.98
Rate for Payer: Aetna Commercial	$6.60
Rate for Payer: Aetna New Business (MI Preferred)	$5.04
Rate for Payer: Cash Price	$6.21
Rate for Payer: Cofinity Advantage	$5.43
Rate for Payer: Cofinity Commercial	$6.67
Rate for Payer: Encore Health Key Benefits Commercial	$6.21
Rate for Payer: Healthscope Commercial	$6.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.82
Rate for Payer: PHP Commercial	$6.60
Rate for Payer: Priority Health SBD	$4.89

AZITHROMYCIN 250 MG TABLET

Facility

$3.48

Service Code	NDC 50268007411
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$3.13
Rate for Payer: Aetna Commercial	$2.96
Rate for Payer: Aetna New Business (MI Preferred)	$2.26
Rate for Payer: Cash Price	$2.78
Rate for Payer: Cofinity Advantage	$2.44
Rate for Payer: Cofinity Commercial	$2.99
Rate for Payer: Encore Health Key Benefits Commercial	$2.78
Rate for Payer: Healthscope Commercial	$3.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.61
Rate for Payer: PHP Commercial	$2.96
Rate for Payer: Priority Health SBD	$2.19

AZITHROMYCIN 250 MG TABLET

Facility

$173.76

Service Code	NDC 50268007415
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$109.47
Max. Negotiated Rate	$156.38
Rate for Payer: Aetna Commercial	$147.70
Rate for Payer: Aetna New Business (MI Preferred)	$112.94
Rate for Payer: Cash Price	$139.01
Rate for Payer: Cofinity Advantage	$121.63
Rate for Payer: Cofinity Commercial	$149.43
Rate for Payer: Encore Health Key Benefits Commercial	$139.01
Rate for Payer: Healthscope Commercial	$156.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$147.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$130.32
Rate for Payer: PHP Commercial	$147.70
Rate for Payer: Priority Health SBD	$109.47

AZITHROMYCIN 250 MG TABLET

Facility

$157.92

Service Code	NDC 00904735006
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$62.06
Max. Negotiated Rate	$142.13
Rate for Payer: Aetna Commercial	$134.23
Rate for Payer: Aetna Medicare	$78.96
Rate for Payer: Aetna New Business (MI Preferred)	$102.65
Rate for Payer: BCBS Complete	$63.17
Rate for Payer: Cash Price	$126.34
Rate for Payer: Cofinity Advantage	$110.54
Rate for Payer: Cofinity Commercial	$135.81
Rate for Payer: Encore Health Key Benefits Commercial	$126.34
Rate for Payer: Healthscope Commercial	$142.13
Rate for Payer: MI Amish Medical Board Commercial	$126.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.44
Rate for Payer: PHP Commercial	$134.23
Rate for Payer: Priority Health SBD	$99.49
Rate for Payer: UHC All Payor (Choice/PPO)	$102.65
Rate for Payer: UHC Core	$82.28
Rate for Payer: UHC Exchange	$62.06

AZITHROMYCIN 250 MG TABLET

Facility

$281.96

Service Code	NDC 64679096101
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$177.63
Max. Negotiated Rate	$253.76
Rate for Payer: Aetna Commercial	$239.67
Rate for Payer: Aetna New Business (MI Preferred)	$183.27
Rate for Payer: Cash Price	$225.57
Rate for Payer: Cofinity Advantage	$197.37
Rate for Payer: Cofinity Commercial	$242.49
Rate for Payer: Encore Health Key Benefits Commercial	$225.57
Rate for Payer: Healthscope Commercial	$253.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$239.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$211.47
Rate for Payer: PHP Commercial	$239.67
Rate for Payer: Priority Health SBD	$177.63

AZITHROMYCIN 250 MG TABLET

Facility

$59.85

Service Code	NDC 59762219807
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$37.71
Max. Negotiated Rate	$53.87
Rate for Payer: Aetna Commercial	$50.87
Rate for Payer: Aetna New Business (MI Preferred)	$38.90
Rate for Payer: Cash Price	$47.88
Rate for Payer: Cofinity Advantage	$41.90
Rate for Payer: Cofinity Commercial	$51.47
Rate for Payer: Encore Health Key Benefits Commercial	$47.88
Rate for Payer: Healthscope Commercial	$53.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$44.89
Rate for Payer: PHP Commercial	$50.87
Rate for Payer: Priority Health SBD	$37.71

AZITHROMYCIN 250 MG TABLET

Facility

$775.20

Service Code	NDC 60687028201
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$304.65
Max. Negotiated Rate	$697.68
Rate for Payer: Aetna Commercial	$658.92
Rate for Payer: Aetna Medicare	$387.60
Rate for Payer: Aetna New Business (MI Preferred)	$503.88
Rate for Payer: BCBS Complete	$310.08
Rate for Payer: Cash Price	$620.16
Rate for Payer: Cofinity Advantage	$542.64
Rate for Payer: Cofinity Commercial	$666.67
Rate for Payer: Encore Health Key Benefits Commercial	$620.16
Rate for Payer: Healthscope Commercial	$697.68
Rate for Payer: MI Amish Medical Board Commercial	$620.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$658.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$581.40
Rate for Payer: PHP Commercial	$658.92
Rate for Payer: Priority Health SBD	$488.38
Rate for Payer: UHC All Payor (Choice/PPO)	$503.88
Rate for Payer: UHC Core	$403.88
Rate for Payer: UHC Exchange	$304.65

AZITHROMYCIN 250 MG TABLET

Facility

$7.76

Service Code	NDC 60687028211
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$6.98
Rate for Payer: Aetna Commercial	$6.60
Rate for Payer: Aetna Medicare	$3.88
Rate for Payer: Aetna New Business (MI Preferred)	$5.04
Rate for Payer: BCBS Complete	$3.10
Rate for Payer: Cash Price	$6.21
Rate for Payer: Cofinity Advantage	$5.43
Rate for Payer: Cofinity Commercial	$6.67
Rate for Payer: Encore Health Key Benefits Commercial	$6.21
Rate for Payer: Healthscope Commercial	$6.98
Rate for Payer: MI Amish Medical Board Commercial	$6.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.82
Rate for Payer: PHP Commercial	$6.60
Rate for Payer: Priority Health SBD	$4.89
Rate for Payer: UHC All Payor (Choice/PPO)	$5.04
Rate for Payer: UHC Core	$4.04
Rate for Payer: UHC Exchange	$3.05

AZITHROMYCIN 250 MG TABLET

Facility

$59.85

Service Code	NDC 59762219807
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$23.52
Max. Negotiated Rate	$53.87
Rate for Payer: Aetna Commercial	$50.87
Rate for Payer: Aetna Medicare	$29.93
Rate for Payer: Aetna New Business (MI Preferred)	$38.90
Rate for Payer: BCBS Complete	$23.94
Rate for Payer: Cash Price	$47.88
Rate for Payer: Cofinity Advantage	$41.90
Rate for Payer: Cofinity Commercial	$51.47
Rate for Payer: Encore Health Key Benefits Commercial	$47.88
Rate for Payer: Healthscope Commercial	$53.87
Rate for Payer: MI Amish Medical Board Commercial	$47.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$44.89
Rate for Payer: PHP Commercial	$50.87
Rate for Payer: Priority Health SBD	$37.71
Rate for Payer: UHC All Payor (Choice/PPO)	$38.90
Rate for Payer: UHC Core	$31.18
Rate for Payer: UHC Exchange	$23.52

AZITHROMYCIN 250 MG TABLET

Facility

$775.20

Service Code	NDC 60687028201
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$488.38
Max. Negotiated Rate	$697.68
Rate for Payer: Aetna Commercial	$658.92
Rate for Payer: Aetna New Business (MI Preferred)	$503.88
Rate for Payer: Cash Price	$620.16
Rate for Payer: Cofinity Advantage	$542.64
Rate for Payer: Cofinity Commercial	$666.67
Rate for Payer: Encore Health Key Benefits Commercial	$620.16
Rate for Payer: Healthscope Commercial	$697.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$658.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$581.40
Rate for Payer: PHP Commercial	$658.92
Rate for Payer: Priority Health SBD	$488.38

AZITHROMYCIN 250 MG TABLET

Facility

$121.41

Service Code	NDC 68094090030
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$47.71
Max. Negotiated Rate	$109.27
Rate for Payer: Aetna Commercial	$103.20
Rate for Payer: Aetna Medicare	$60.70
Rate for Payer: Aetna New Business (MI Preferred)	$78.92
Rate for Payer: BCBS Complete	$48.56
Rate for Payer: Cash Price	$97.13
Rate for Payer: Cofinity Advantage	$84.99
Rate for Payer: Cofinity Commercial	$104.41
Rate for Payer: Encore Health Key Benefits Commercial	$97.13
Rate for Payer: Healthscope Commercial	$109.27
Rate for Payer: MI Amish Medical Board Commercial	$97.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$103.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$91.06
Rate for Payer: PHP Commercial	$103.20
Rate for Payer: Priority Health SBD	$76.49
Rate for Payer: UHC All Payor (Choice/PPO)	$78.92
Rate for Payer: UHC Core	$63.25
Rate for Payer: UHC Exchange	$47.71

AZITHROMYCIN 250 MG TABLET

Facility

$593.85

Service Code	NDC 00069406189
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$233.38
Max. Negotiated Rate	$534.47
Rate for Payer: Aetna Commercial	$504.77
Rate for Payer: Aetna Medicare	$296.93
Rate for Payer: Aetna New Business (MI Preferred)	$386.00
Rate for Payer: BCBS Complete	$237.54
Rate for Payer: Cash Price	$475.08
Rate for Payer: Cofinity Advantage	$415.69
Rate for Payer: Cofinity Commercial	$510.71
Rate for Payer: Encore Health Key Benefits Commercial	$475.08
Rate for Payer: Healthscope Commercial	$534.47
Rate for Payer: MI Amish Medical Board Commercial	$475.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$504.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$445.39
Rate for Payer: PHP Commercial	$504.77
Rate for Payer: Priority Health SBD	$374.13
Rate for Payer: UHC All Payor (Choice/PPO)	$386.00
Rate for Payer: UHC Core	$309.40
Rate for Payer: UHC Exchange	$233.38

AZITHROMYCIN 250 MG TABLET

Facility

$121.41

Service Code	NDC 68094090030
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$76.49
Max. Negotiated Rate	$109.27
Rate for Payer: Aetna Commercial	$103.20
Rate for Payer: Aetna New Business (MI Preferred)	$78.92
Rate for Payer: Cash Price	$97.13
Rate for Payer: Cofinity Advantage	$84.99
Rate for Payer: Cofinity Commercial	$104.41
Rate for Payer: Encore Health Key Benefits Commercial	$97.13
Rate for Payer: Healthscope Commercial	$109.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$103.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$91.06
Rate for Payer: PHP Commercial	$103.20
Rate for Payer: Priority Health SBD	$76.49

AZITHROMYCIN 250 MG TABLET

Facility

$3.12

Service Code	NDC 50268009811
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$2.81
Rate for Payer: Aetna Commercial	$2.65
Rate for Payer: Aetna Medicare	$1.56
Rate for Payer: Aetna New Business (MI Preferred)	$2.03
Rate for Payer: BCBS Complete	$1.25
Rate for Payer: Cash Price	$2.50
Rate for Payer: Cofinity Advantage	$2.18
Rate for Payer: Cofinity Commercial	$2.68
Rate for Payer: Encore Health Key Benefits Commercial	$2.50
Rate for Payer: Healthscope Commercial	$2.81
Rate for Payer: MI Amish Medical Board Commercial	$2.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.34
Rate for Payer: PHP Commercial	$2.65
Rate for Payer: Priority Health SBD	$1.97
Rate for Payer: UHC All Payor (Choice/PPO)	$2.03
Rate for Payer: UHC Core	$1.63
Rate for Payer: UHC Exchange	$1.23

Know your out-of-pocket cost for care.

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