|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$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 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.46
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
21063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$14.81 |
| Rate for Payer: Aetna Commercial |
$13.99
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Commercial |
$12.62
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$17.09
|
| Rate for Payer: Aetna Commercial |
$22.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.00
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$13.17
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cofinity Advantage |
$18.31
|
| Rate for Payer: Cofinity Advantage |
$14.07
|
| Rate for Payer: Cofinity Advantage |
$14.53
|
| Rate for Payer: Cofinity Advantage |
$12.23
|
| Rate for Payer: Cofinity Advantage |
$11.52
|
| Rate for Payer: Cofinity Advantage |
$10.39
|
| Rate for Payer: Cofinity Advantage |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$12.77
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Cofinity Commercial |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Cofinity Commercial |
$22.50
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.17
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$18.68
|
| Rate for Payer: Healthscope Commercial |
$13.37
|
| Rate for Payer: Healthscope Commercial |
$14.81
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Healthscope Commercial |
$18.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.07
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$17.09
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$22.24
|
| Rate for Payer: PHP Commercial |
$12.62
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: PHP Commercial |
$13.99
|
| Rate for Payer: Priority Health SBD |
$19.35
|
| Rate for Payer: Priority Health SBD |
$16.48
|
| Rate for Payer: Priority Health SBD |
$12.66
|
| Rate for Payer: Priority Health SBD |
$9.36
|
| Rate for Payer: Priority Health SBD |
$10.37
|
| Rate for Payer: Priority Health SBD |
$13.08
|
| Rate for Payer: Priority Health SBD |
$11.01
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.10
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
21063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$18.09 |
| Rate for Payer: Aetna Commercial |
$17.09
|
| Rate for Payer: Aetna Commercial |
$22.24
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$13.99
|
| Rate for Payer: Aetna Commercial |
$12.62
|
| Rate for Payer: Aetna Medicare |
$8.23
|
| Rate for Payer: Aetna Medicare |
$13.08
|
| Rate for Payer: Aetna Medicare |
$10.38
|
| Rate for Payer: Aetna Medicare |
$10.05
|
| Rate for Payer: Aetna Medicare |
$15.36
|
| Rate for Payer: Aetna Medicare |
$8.73
|
| Rate for Payer: Aetna Medicare |
$7.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.49
|
| Rate for Payer: BCBS Complete |
$8.04
|
| Rate for Payer: BCBS Complete |
$6.99
|
| Rate for Payer: BCBS Complete |
$12.28
|
| Rate for Payer: BCBS Complete |
$8.30
|
| Rate for Payer: BCBS Complete |
$5.94
|
| Rate for Payer: BCBS Complete |
$6.58
|
| Rate for Payer: BCBS Complete |
$10.46
|
| Rate for Payer: BCBS Trust/PPO |
$5.12
|
| Rate for Payer: BCBS Trust/PPO |
$5.12
|
| Rate for Payer: BCBS Trust/PPO |
$5.12
|
| Rate for Payer: BCBS Trust/PPO |
$5.12
|
| Rate for Payer: BCBS Trust/PPO |
$5.12
|
| Rate for Payer: BCBS Trust/PPO |
$5.12
|
| Rate for Payer: BCBS Trust/PPO |
$5.12
|
| Rate for Payer: BCN Commercial |
$5.12
|
| Rate for Payer: BCN Commercial |
$5.12
|
| Rate for Payer: BCN Commercial |
$5.12
|
| Rate for Payer: BCN Commercial |
$5.12
|
| Rate for Payer: BCN Commercial |
$5.12
|
| Rate for Payer: BCN Commercial |
$5.12
|
| Rate for Payer: BCN Commercial |
$5.12
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cash Price |
$13.17
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$13.17
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cofinity Advantage |
$11.52
|
| Rate for Payer: Cofinity Advantage |
$14.07
|
| Rate for Payer: Cofinity Advantage |
$12.23
|
| Rate for Payer: Cofinity Advantage |
$10.39
|
| Rate for Payer: Cofinity Advantage |
$18.31
|
| Rate for Payer: Cofinity Advantage |
$21.50
|
| Rate for Payer: Cofinity Advantage |
$14.53
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Cofinity Commercial |
$12.77
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$22.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.61
|
| Rate for Payer: Healthscope Commercial |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$13.37
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Healthscope Commercial |
$14.81
|
| Rate for Payer: Healthscope Commercial |
$18.68
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$18.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.62
|
| Rate for Payer: PHP Commercial |
$12.62
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: PHP Commercial |
$17.09
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$22.24
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$13.99
|
| Rate for Payer: Priority Health SBD |
$16.48
|
| Rate for Payer: Priority Health SBD |
$9.36
|
| Rate for Payer: Priority Health SBD |
$19.35
|
| Rate for Payer: Priority Health SBD |
$13.08
|
| Rate for Payer: Priority Health SBD |
$12.66
|
| Rate for Payer: Priority Health SBD |
$10.37
|
| Rate for Payer: Priority Health SBD |
$11.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.37
|
| Rate for Payer: UHC Core |
$3.37
|
| Rate for Payer: UHC Core |
$3.37
|
| Rate for Payer: UHC Core |
$3.37
|
| Rate for Payer: UHC Core |
$3.37
|
| Rate for Payer: UHC Core |
$3.37
|
| Rate for Payer: UHC Core |
$3.37
|
| Rate for Payer: UHC Core |
$3.37
|
| Rate for Payer: UHC Exchange |
$3.37
|
| Rate for Payer: UHC Exchange |
$3.37
|
| Rate for Payer: UHC Exchange |
$3.37
|
| Rate for Payer: UHC Exchange |
$3.37
|
| Rate for Payer: UHC Exchange |
$3.37
|
| Rate for Payer: UHC Exchange |
$3.37
|
| Rate for Payer: UHC Exchange |
$3.37
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$498.06
|
|
|
Service Code
|
NDC 68180016106
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$313.78 |
| Max. Negotiated Rate |
$448.25 |
| Rate for Payer: Aetna Commercial |
$423.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.74
|
| Rate for Payer: Cash Price |
$398.45
|
| Rate for Payer: Cofinity Advantage |
$348.64
|
| Rate for Payer: Cofinity Commercial |
$428.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.45
|
| Rate for Payer: Healthscope Commercial |
$448.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.55
|
| Rate for Payer: PHP Commercial |
$423.35
|
| Rate for Payer: Priority Health SBD |
$313.78
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$247.76
|
|
|
Service Code
|
NDC 00904735104
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.09 |
| Max. Negotiated Rate |
$222.98 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.04
|
| Rate for Payer: Cash Price |
$198.21
|
| Rate for Payer: Cofinity Advantage |
$173.43
|
| Rate for Payer: Cofinity Commercial |
$213.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.21
|
| Rate for Payer: Healthscope Commercial |
$222.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.82
|
| Rate for Payer: PHP Commercial |
$210.60
|
| Rate for Payer: Priority Health SBD |
$156.09
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$10.30
|
|
|
Service Code
|
NDC 60687027111
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$9.27 |
| Rate for Payer: Aetna Commercial |
$8.76
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.70
|
| Rate for Payer: BCBS Complete |
$4.12
|
| Rate for Payer: Cash Price |
$8.24
|
| Rate for Payer: Cofinity Advantage |
$7.21
|
| Rate for Payer: Cofinity Commercial |
$8.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.24
|
| Rate for Payer: Healthscope Commercial |
$9.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.72
|
| Rate for Payer: PHP Commercial |
$8.76
|
| Rate for Payer: Priority Health SBD |
$6.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.70
|
| Rate for Payer: UHC Core |
$5.37
|
| Rate for Payer: UHC Exchange |
$4.05
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$8.35
|
|
|
Service Code
|
NDC 50268009911
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$7.51 |
| Rate for Payer: Aetna Commercial |
$7.10
|
| Rate for Payer: Aetna Medicare |
$4.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.43
|
| Rate for Payer: BCBS Complete |
$3.34
|
| Rate for Payer: Cash Price |
$6.68
|
| Rate for Payer: Cofinity Advantage |
$5.84
|
| Rate for Payer: Cofinity Commercial |
$7.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$7.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.26
|
| Rate for Payer: PHP Commercial |
$7.10
|
| Rate for Payer: Priority Health SBD |
$5.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.43
|
| Rate for Payer: UHC Core |
$4.35
|
| Rate for Payer: UHC Exchange |
$3.28
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$8.35
|
|
|
Service Code
|
NDC 50268009911
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$7.51 |
| Rate for Payer: Aetna Commercial |
$7.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.43
|
| Rate for Payer: Cash Price |
$6.68
|
| Rate for Payer: Cofinity Advantage |
$5.84
|
| Rate for Payer: Cofinity Commercial |
$7.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$7.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.26
|
| Rate for Payer: PHP Commercial |
$7.10
|
| Rate for Payer: Priority Health SBD |
$5.26
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$498.06
|
|
|
Service Code
|
NDC 50111078810
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$313.78 |
| Max. Negotiated Rate |
$448.25 |
| Rate for Payer: Aetna Commercial |
$423.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.74
|
| Rate for Payer: Cash Price |
$398.45
|
| Rate for Payer: Cofinity Advantage |
$348.64
|
| Rate for Payer: Cofinity Commercial |
$428.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.45
|
| Rate for Payer: Healthscope Commercial |
$448.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.55
|
| Rate for Payer: PHP Commercial |
$423.35
|
| Rate for Payer: Priority Health SBD |
$313.78
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$498.06
|
|
|
Service Code
|
NDC 50111078810
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.74 |
| Max. Negotiated Rate |
$448.25 |
| Rate for Payer: Aetna Commercial |
$423.35
|
| Rate for Payer: Aetna Medicare |
$249.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.74
|
| Rate for Payer: BCBS Complete |
$199.22
|
| Rate for Payer: Cash Price |
$398.45
|
| Rate for Payer: Cofinity Advantage |
$348.64
|
| Rate for Payer: Cofinity Commercial |
$428.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.45
|
| Rate for Payer: Healthscope Commercial |
$448.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$398.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.55
|
| Rate for Payer: PHP Commercial |
$423.35
|
| Rate for Payer: Priority Health SBD |
$313.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.74
|
| Rate for Payer: UHC Core |
$259.49
|
| Rate for Payer: UHC Exchange |
$195.74
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$219.32
|
|
|
Service Code
|
NDC 00904690904
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.19 |
| Max. Negotiated Rate |
$197.39 |
| Rate for Payer: Aetna Commercial |
$186.42
|
| Rate for Payer: Aetna Medicare |
$109.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.56
|
| Rate for Payer: BCBS Complete |
$87.73
|
| Rate for Payer: Cash Price |
$175.46
|
| Rate for Payer: Cofinity Advantage |
$153.52
|
| Rate for Payer: Cofinity Commercial |
$188.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.46
|
| Rate for Payer: Healthscope Commercial |
$197.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.49
|
| Rate for Payer: PHP Commercial |
$186.42
|
| Rate for Payer: Priority Health SBD |
$138.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.56
|
| Rate for Payer: UHC Core |
$114.27
|
| Rate for Payer: UHC Exchange |
$86.19
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$498.06
|
|
|
Service Code
|
NDC 68180016106
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.74 |
| Max. Negotiated Rate |
$448.25 |
| Rate for Payer: Aetna Commercial |
$423.35
|
| Rate for Payer: Aetna Medicare |
$249.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.74
|
| Rate for Payer: BCBS Complete |
$199.22
|
| Rate for Payer: Cash Price |
$398.45
|
| Rate for Payer: Cofinity Advantage |
$348.64
|
| Rate for Payer: Cofinity Commercial |
$428.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.45
|
| Rate for Payer: Healthscope Commercial |
$448.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$398.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.55
|
| Rate for Payer: PHP Commercial |
$423.35
|
| Rate for Payer: Priority Health SBD |
$313.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.74
|
| Rate for Payer: UHC Core |
$259.49
|
| Rate for Payer: UHC Exchange |
$195.74
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$308.81
|
|
|
Service Code
|
NDC 60687027121
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.55 |
| Max. Negotiated Rate |
$277.93 |
| Rate for Payer: Aetna Commercial |
$262.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.73
|
| Rate for Payer: Cash Price |
$247.05
|
| Rate for Payer: Cofinity Advantage |
$216.17
|
| Rate for Payer: Cofinity Commercial |
$265.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.05
|
| Rate for Payer: Healthscope Commercial |
$277.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.61
|
| Rate for Payer: PHP Commercial |
$262.49
|
| Rate for Payer: Priority Health SBD |
$194.55
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$308.81
|
|
|
Service Code
|
NDC 60687027121
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.36 |
| Max. Negotiated Rate |
$277.93 |
| Rate for Payer: Aetna Commercial |
$262.49
|
| Rate for Payer: Aetna Medicare |
$154.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.73
|
| Rate for Payer: BCBS Complete |
$123.52
|
| Rate for Payer: Cash Price |
$247.05
|
| Rate for Payer: Cofinity Advantage |
$216.17
|
| Rate for Payer: Cofinity Commercial |
$265.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.05
|
| Rate for Payer: Healthscope Commercial |
$277.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.61
|
| Rate for Payer: PHP Commercial |
$262.49
|
| Rate for Payer: Priority Health SBD |
$194.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.73
|
| Rate for Payer: UHC Core |
$160.89
|
| Rate for Payer: UHC Exchange |
$121.36
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$219.32
|
|
|
Service Code
|
NDC 00904690904
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.17 |
| Max. Negotiated Rate |
$197.39 |
| Rate for Payer: Aetna Commercial |
$186.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.56
|
| Rate for Payer: Cash Price |
$175.46
|
| Rate for Payer: Cofinity Advantage |
$153.52
|
| Rate for Payer: Cofinity Commercial |
$188.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.46
|
| Rate for Payer: Healthscope Commercial |
$197.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.49
|
| Rate for Payer: PHP Commercial |
$186.42
|
| Rate for Payer: Priority Health SBD |
$138.17
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$247.76
|
|
|
Service Code
|
NDC 00904735104
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.37 |
| Max. Negotiated Rate |
$222.98 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Medicare |
$123.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.04
|
| Rate for Payer: BCBS Complete |
$99.10
|
| Rate for Payer: Cash Price |
$198.21
|
| Rate for Payer: Cofinity Advantage |
$173.43
|
| Rate for Payer: Cofinity Commercial |
$213.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.21
|
| Rate for Payer: Healthscope Commercial |
$222.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.82
|
| Rate for Payer: PHP Commercial |
$210.60
|
| Rate for Payer: Priority Health SBD |
$156.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.04
|
| Rate for Payer: UHC Core |
$129.08
|
| Rate for Payer: UHC Exchange |
$97.37
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$10.30
|
|
|
Service Code
|
NDC 60687027111
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$9.27 |
| Rate for Payer: Aetna Commercial |
$8.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.70
|
| Rate for Payer: Cash Price |
$8.24
|
| Rate for Payer: Cofinity Advantage |
$7.21
|
| Rate for Payer: Cofinity Commercial |
$8.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.24
|
| Rate for Payer: Healthscope Commercial |
$9.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.72
|
| Rate for Payer: PHP Commercial |
$8.76
|
| Rate for Payer: Priority Health SBD |
$6.49
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$91.34
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.54 |
| Max. Negotiated Rate |
$82.21 |
| Rate for Payer: Aetna Commercial |
$77.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.37
|
| Rate for Payer: Cash Price |
$73.07
|
| Rate for Payer: Cofinity Advantage |
$63.94
|
| Rate for Payer: Cofinity Commercial |
$78.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.07
|
| Rate for Payer: Healthscope Commercial |
$82.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.50
|
| Rate for Payer: PHP Commercial |
$77.64
|
| Rate for Payer: Priority Health SBD |
$57.54
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$91.34
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$82.21 |
| Rate for Payer: Aetna Commercial |
$77.64
|
| Rate for Payer: Aetna Medicare |
$45.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.37
|
| Rate for Payer: BCBS Complete |
$36.54
|
| Rate for Payer: BCBS Trust/PPO |
$5.59
|
| Rate for Payer: BCN Commercial |
$5.59
|
| Rate for Payer: Cash Price |
$73.07
|
| Rate for Payer: Cash Price |
$73.07
|
| Rate for Payer: Cofinity Advantage |
$63.94
|
| Rate for Payer: Cofinity Commercial |
$78.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.07
|
| Rate for Payer: Healthscope Commercial |
$82.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.50
|
| Rate for Payer: PHP Commercial |
$77.64
|
| Rate for Payer: Priority Health SBD |
$57.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.68
|
| Rate for Payer: UHC Core |
$3.68
|
| Rate for Payer: UHC Exchange |
$3.68
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS CUSTOM
|
Facility
|
OP
|
$91.34
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$82.21 |
| Rate for Payer: Aetna Commercial |
$77.64
|
| Rate for Payer: Aetna Medicare |
$45.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.37
|
| Rate for Payer: BCBS Complete |
$36.54
|
| Rate for Payer: BCBS Trust/PPO |
$5.59
|
| Rate for Payer: BCN Commercial |
$5.59
|
| Rate for Payer: Cash Price |
$73.07
|
| Rate for Payer: Cash Price |
$73.07
|
| Rate for Payer: Cofinity Advantage |
$63.94
|
| Rate for Payer: Cofinity Commercial |
$78.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.07
|
| Rate for Payer: Healthscope Commercial |
$82.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.50
|
| Rate for Payer: PHP Commercial |
$77.64
|
| Rate for Payer: Priority Health SBD |
$57.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.68
|
| Rate for Payer: UHC Core |
$3.68
|
| Rate for Payer: UHC Exchange |
$3.68
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS CUSTOM
|
Facility
|
IP
|
$91.34
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.54 |
| Max. Negotiated Rate |
$82.21 |
| Rate for Payer: Aetna Commercial |
$77.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.37
|
| Rate for Payer: Cash Price |
$73.07
|
| Rate for Payer: Cofinity Advantage |
$63.94
|
| Rate for Payer: Cofinity Commercial |
$78.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.07
|
| Rate for Payer: Healthscope Commercial |
$82.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.50
|
| Rate for Payer: PHP Commercial |
$77.64
|
| Rate for Payer: Priority Health SBD |
$57.54
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$186.53
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$167.88 |
| Rate for Payer: Aetna Commercial |
$158.55
|
| Rate for Payer: Aetna Commercial |
$166.84
|
| Rate for Payer: Aetna Commercial |
$177.54
|
| Rate for Payer: Aetna Medicare |
$93.27
|
| Rate for Payer: Aetna Medicare |
$98.14
|
| Rate for Payer: Aetna Medicare |
$104.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.77
|
| Rate for Payer: BCBS Complete |
$83.55
|
| Rate for Payer: BCBS Complete |
$74.61
|
| Rate for Payer: BCBS Complete |
$78.51
|
| Rate for Payer: BCBS Trust/PPO |
$5.59
|
| Rate for Payer: BCBS Trust/PPO |
$5.59
|
| Rate for Payer: BCBS Trust/PPO |
$5.59
|
| Rate for Payer: BCN Commercial |
$5.59
|
| Rate for Payer: BCN Commercial |
$5.59
|
| Rate for Payer: BCN Commercial |
$5.59
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Cofinity Advantage |
$137.40
|
| Rate for Payer: Cofinity Advantage |
$130.57
|
| Rate for Payer: Cofinity Advantage |
$146.21
|
| Rate for Payer: Cofinity Commercial |
$160.42
|
| Rate for Payer: Cofinity Commercial |
$168.80
|
| Rate for Payer: Cofinity Commercial |
$179.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.22
|
| Rate for Payer: Healthscope Commercial |
$187.98
|
| Rate for Payer: Healthscope Commercial |
$176.65
|
| Rate for Payer: Healthscope Commercial |
$167.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$167.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.65
|
| Rate for Payer: PHP Commercial |
$158.55
|
| Rate for Payer: PHP Commercial |
$166.84
|
| Rate for Payer: PHP Commercial |
$177.54
|
| Rate for Payer: Priority Health SBD |
$117.51
|
| Rate for Payer: Priority Health SBD |
$131.59
|
| Rate for Payer: Priority Health SBD |
$123.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.68
|
| Rate for Payer: UHC Core |
$3.68
|
| Rate for Payer: UHC Core |
$3.68
|
| Rate for Payer: UHC Core |
$3.68
|
| Rate for Payer: UHC Exchange |
$3.68
|
| Rate for Payer: UHC Exchange |
$3.68
|
| Rate for Payer: UHC Exchange |
$3.68
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$208.87
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$187.98 |
| Rate for Payer: Aetna Commercial |
$177.54
|
| Rate for Payer: Aetna Commercial |
$158.55
|
| Rate for Payer: Aetna Commercial |
$166.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.77
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Cofinity Advantage |
$146.21
|
| Rate for Payer: Cofinity Advantage |
$130.57
|
| Rate for Payer: Cofinity Advantage |
$137.40
|
| Rate for Payer: Cofinity Commercial |
$160.42
|
| Rate for Payer: Cofinity Commercial |
$168.80
|
| Rate for Payer: Cofinity Commercial |
$179.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.02
|
| Rate for Payer: Healthscope Commercial |
$167.88
|
| Rate for Payer: Healthscope Commercial |
$176.65
|
| Rate for Payer: Healthscope Commercial |
$187.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.65
|
| Rate for Payer: PHP Commercial |
$166.84
|
| Rate for Payer: PHP Commercial |
$177.54
|
| Rate for Payer: PHP Commercial |
$158.55
|
| Rate for Payer: Priority Health SBD |
$117.51
|
| Rate for Payer: Priority Health SBD |
$131.59
|
| Rate for Payer: Priority Health SBD |
$123.66
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$186.53
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$167.88 |
| Rate for Payer: Aetna Commercial |
$158.55
|
| Rate for Payer: Aetna Medicare |
$93.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.24
|
| Rate for Payer: BCBS Complete |
$74.61
|
| Rate for Payer: BCBS Trust/PPO |
$5.59
|
| Rate for Payer: BCN Commercial |
$5.59
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cofinity Advantage |
$130.57
|
| Rate for Payer: Cofinity Commercial |
$160.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.22
|
| Rate for Payer: Healthscope Commercial |
$167.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.90
|
| Rate for Payer: PHP Commercial |
$158.55
|
| Rate for Payer: Priority Health SBD |
$117.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.68
|
| Rate for Payer: UHC Core |
$3.68
|
| Rate for Payer: UHC Exchange |
$3.68
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$186.53
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.51 |
| Max. Negotiated Rate |
$167.88 |
| Rate for Payer: Aetna Commercial |
$158.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.24
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cofinity Advantage |
$130.57
|
| Rate for Payer: Cofinity Commercial |
$160.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.22
|
| Rate for Payer: Healthscope Commercial |
$167.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.90
|
| Rate for Payer: PHP Commercial |
$158.55
|
| Rate for Payer: Priority Health SBD |
$117.51
|
|
