|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$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 Commercial |
$104.41
|
| Rate for Payer: Cofinity Commercial |
$84.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.99
|
| 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: PHP Commercial |
$103.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.92
|
| Rate for Payer: Priority Health SBD |
$76.49
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$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 Commercial |
$286.94
|
| Rate for Payer: Cofinity Commercial |
$352.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$286.94
|
| 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: PHP Commercial |
$348.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.45
|
| Rate for Payer: Priority Health SBD |
$258.25
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$154.08
|
|
|
Service Code
|
NDC 00904670806
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.07 |
| Max. Negotiated Rate |
$138.67 |
| Rate for Payer: Aetna Commercial |
$130.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.15
|
| Rate for Payer: Cash Price |
$123.26
|
| Rate for Payer: Cofinity Commercial |
$107.86
|
| Rate for Payer: Cofinity Commercial |
$132.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.26
|
| Rate for Payer: Healthscope Commercial |
$138.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.97
|
| Rate for Payer: PHP Commercial |
$130.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.15
|
| Rate for Payer: Priority Health SBD |
$97.07
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$140.51
|
|
|
Service Code
|
NDC 00781808931
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.20 |
| Max. Negotiated Rate |
$126.46 |
| Rate for Payer: Aetna Commercial |
$119.43
|
| Rate for Payer: Aetna Medicare |
$70.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.33
|
| Rate for Payer: BCBS Complete |
$56.20
|
| Rate for Payer: Cash Price |
$112.41
|
| Rate for Payer: Cofinity Commercial |
$120.84
|
| Rate for Payer: Cofinity Commercial |
$98.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.41
|
| Rate for Payer: Healthscope Commercial |
$126.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.43
|
| Rate for Payer: PHP Commercial |
$119.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.33
|
| Rate for Payer: Priority Health SBD |
$88.52
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$174.24
|
|
|
Service Code
|
NDC 50268007415
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.70 |
| Max. Negotiated Rate |
$156.82 |
| Rate for Payer: Aetna Commercial |
$148.10
|
| Rate for Payer: Aetna Medicare |
$87.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.26
|
| Rate for Payer: BCBS Complete |
$69.70
|
| Rate for Payer: Cash Price |
$139.39
|
| Rate for Payer: Cofinity Commercial |
$121.97
|
| Rate for Payer: Cofinity Commercial |
$149.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.39
|
| Rate for Payer: Healthscope Commercial |
$156.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.10
|
| Rate for Payer: PHP Commercial |
$148.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.26
|
| Rate for Payer: Priority Health SBD |
$109.77
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$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 Commercial |
$5.43
|
| Rate for Payer: Cofinity Commercial |
$6.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.43
|
| 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: PHP Commercial |
$6.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.04
|
| Rate for Payer: Priority Health SBD |
$4.89
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$513.60
|
|
|
Service Code
|
NDC 00904735061
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.44 |
| Max. Negotiated Rate |
$462.24 |
| Rate for Payer: Aetna Commercial |
$436.56
|
| Rate for Payer: Aetna Medicare |
$256.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.84
|
| Rate for Payer: BCBS Complete |
$205.44
|
| Rate for Payer: Cash Price |
$410.88
|
| Rate for Payer: Cofinity Commercial |
$359.52
|
| Rate for Payer: Cofinity Commercial |
$441.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$359.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$410.88
|
| Rate for Payer: Healthscope Commercial |
$462.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.56
|
| Rate for Payer: PHP Commercial |
$436.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.84
|
| Rate for Payer: Priority Health SBD |
$323.57
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.76
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
21063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$18.68 |
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$17.08
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Commercial |
$12.72
|
| Rate for Payer: Aetna Commercial |
$23.73
|
| Rate for Payer: Aetna Commercial |
$22.24
|
| Rate for Payer: Aetna Medicare |
$13.08
|
| Rate for Payer: Aetna Medicare |
$10.05
|
| Rate for Payer: Aetna Medicare |
$7.48
|
| Rate for Payer: Aetna Medicare |
$10.38
|
| Rate for Payer: Aetna Medicare |
$8.74
|
| Rate for Payer: Aetna Medicare |
$15.36
|
| Rate for Payer: Aetna Medicare |
$13.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.96
|
| Rate for Payer: BCBS Complete |
$6.99
|
| Rate for Payer: BCBS Complete |
$5.99
|
| Rate for Payer: BCBS Complete |
$10.46
|
| Rate for Payer: BCBS Complete |
$11.17
|
| Rate for Payer: BCBS Complete |
$12.28
|
| Rate for Payer: BCBS Complete |
$8.04
|
| Rate for Payer: BCBS Complete |
$8.30
|
| Rate for Payer: BCBS Trust/PPO |
$5.79
|
| Rate for Payer: BCBS Trust/PPO |
$5.79
|
| Rate for Payer: BCBS Trust/PPO |
$5.79
|
| Rate for Payer: BCBS Trust/PPO |
$5.79
|
| Rate for Payer: BCBS Trust/PPO |
$5.79
|
| Rate for Payer: BCBS Trust/PPO |
$5.79
|
| Rate for Payer: BCBS Trust/PPO |
$5.79
|
| Rate for Payer: BCN Commercial |
$5.79
|
| Rate for Payer: BCN Commercial |
$5.79
|
| Rate for Payer: BCN Commercial |
$5.79
|
| Rate for Payer: BCN Commercial |
$5.79
|
| Rate for Payer: BCN Commercial |
$5.79
|
| Rate for Payer: BCN Commercial |
$5.79
|
| Rate for Payer: BCN Commercial |
$5.79
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cash Price |
$16.08
|
| 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 |
$11.98
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$22.34
|
| Rate for Payer: Cash Price |
$22.34
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$10.48
|
| Rate for Payer: Cofinity Commercial |
$12.87
|
| Rate for Payer: Cofinity Commercial |
$12.23
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$14.07
|
| Rate for Payer: Cofinity Commercial |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$14.53
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$22.50
|
| Rate for Payer: Cofinity Commercial |
$24.01
|
| Rate for Payer: Cofinity Commercial |
$19.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.98
|
| Rate for Payer: Healthscope Commercial |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$18.09
|
| Rate for Payer: Healthscope Commercial |
$18.68
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$25.13
|
| Rate for Payer: Healthscope Commercial |
$13.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.08
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: PHP Commercial |
$23.73
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$22.24
|
| Rate for Payer: PHP Commercial |
$17.08
|
| Rate for Payer: PHP Commercial |
$12.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.73
|
| Rate for Payer: Priority Health SBD |
$16.48
|
| Rate for Payer: Priority Health SBD |
$17.59
|
| Rate for Payer: Priority Health SBD |
$13.08
|
| Rate for Payer: Priority Health SBD |
$12.66
|
| Rate for Payer: Priority Health SBD |
$9.43
|
| Rate for Payer: Priority Health SBD |
$11.01
|
| Rate for Payer: Priority Health SBD |
$19.35
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17.47
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
21063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Commercial |
$23.73
|
| Rate for Payer: Aetna Commercial |
$22.24
|
| Rate for Payer: Aetna Commercial |
$12.72
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$17.08
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.06
|
| 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) |
$18.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.49
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$22.34
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cofinity Commercial |
$19.54
|
| Rate for Payer: Cofinity Commercial |
$10.48
|
| Rate for Payer: Cofinity Commercial |
$12.87
|
| Rate for Payer: Cofinity Commercial |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$12.23
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$14.07
|
| Rate for Payer: Cofinity Commercial |
$14.53
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$22.50
|
| Rate for Payer: Cofinity Commercial |
$24.01
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.34
|
| 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 |
$11.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.98
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$25.13
|
| Rate for Payer: Healthscope Commercial |
$18.68
|
| Rate for Payer: Healthscope Commercial |
$18.09
|
| Rate for Payer: Healthscope Commercial |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$13.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.08
|
| Rate for Payer: PHP Commercial |
$23.73
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$17.08
|
| Rate for Payer: PHP Commercial |
$22.24
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$12.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.73
|
| Rate for Payer: Priority Health SBD |
$16.48
|
| Rate for Payer: Priority Health SBD |
$13.08
|
| Rate for Payer: Priority Health SBD |
$11.01
|
| Rate for Payer: Priority Health SBD |
$12.66
|
| Rate for Payer: Priority Health SBD |
$17.59
|
| Rate for Payer: Priority Health SBD |
$9.43
|
| Rate for Payer: Priority Health SBD |
$19.35
|
|
|
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 |
$7.52 |
| 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 Commercial |
$5.84
|
| Rate for Payer: Cofinity Commercial |
$7.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$7.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.10
|
| Rate for Payer: PHP Commercial |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.43
|
| Rate for Payer: Priority Health SBD |
$5.26
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$8.35
|
|
|
Service Code
|
NDC 50268009911
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Aetna Commercial |
$7.10
|
| Rate for Payer: Aetna Medicare |
$4.18
|
| 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 Commercial |
$5.84
|
| Rate for Payer: Cofinity Commercial |
$7.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$7.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.10
|
| Rate for Payer: PHP Commercial |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.43
|
| Rate for Payer: Priority Health SBD |
$5.26
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$10.30
|
|
|
Service Code
|
NDC 60687027111
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.12 |
| 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 Commercial |
$7.21
|
| Rate for Payer: Cofinity Commercial |
$8.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.21
|
| 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: PHP Commercial |
$8.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.70
|
| Rate for Payer: Priority Health SBD |
$6.49
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$498.06
|
|
|
Service Code
|
NDC 68180016106
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.22 |
| 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 Commercial |
$348.64
|
| Rate for Payer: Cofinity Commercial |
$428.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$348.64
|
| 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: PHP Commercial |
$423.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.74
|
| Rate for Payer: Priority Health SBD |
$313.78
|
|
|
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 Commercial |
$348.64
|
| Rate for Payer: Cofinity Commercial |
$428.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$348.64
|
| 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: PHP Commercial |
$423.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.74
|
| Rate for Payer: Priority Health SBD |
$313.78
|
|
|
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 Commercial |
$7.21
|
| Rate for Payer: Cofinity Commercial |
$8.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.21
|
| 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: PHP Commercial |
$8.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.70
|
| Rate for Payer: Priority Health SBD |
$6.49
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$498.06
|
|
|
Service Code
|
NDC 50111078810
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.22 |
| 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 Commercial |
$348.64
|
| Rate for Payer: Cofinity Commercial |
$428.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$348.64
|
| 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: PHP Commercial |
$423.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.74
|
| Rate for Payer: Priority Health SBD |
$313.78
|
|
|
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 Commercial |
$348.64
|
| Rate for Payer: Cofinity Commercial |
$428.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$348.64
|
| 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: PHP Commercial |
$423.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.74
|
| Rate for Payer: Priority Health SBD |
$313.78
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$308.81
|
|
|
Service Code
|
NDC 60687027121
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.52 |
| Max. Negotiated Rate |
$277.93 |
| Rate for Payer: Aetna Commercial |
$262.49
|
| Rate for Payer: Aetna Medicare |
$154.40
|
| 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 Commercial |
$216.17
|
| Rate for Payer: Cofinity Commercial |
$265.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.17
|
| 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: PHP Commercial |
$262.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.73
|
| Rate for Payer: Priority Health SBD |
$194.55
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$219.32
|
|
|
Service Code
|
NDC 00904690904
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.73 |
| 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 Commercial |
$153.52
|
| Rate for Payer: Cofinity Commercial |
$188.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.52
|
| 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: PHP Commercial |
$186.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.56
|
| Rate for Payer: Priority Health SBD |
$138.17
|
|
|
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 Commercial |
$153.52
|
| Rate for Payer: Cofinity Commercial |
$188.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.52
|
| 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: PHP Commercial |
$186.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.56
|
| Rate for Payer: Priority Health SBD |
$138.17
|
|
|
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 Commercial |
$216.17
|
| Rate for Payer: Cofinity Commercial |
$265.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.17
|
| 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: PHP Commercial |
$262.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.73
|
| Rate for Payer: Priority Health SBD |
$194.55
|
|
|
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 Commercial |
$63.94
|
| Rate for Payer: Cofinity Commercial |
$78.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.94
|
| 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: PHP Commercial |
$77.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.37
|
| 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 |
$5.57 |
| 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 |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: Cash Price |
$73.07
|
| Rate for Payer: Cash Price |
$73.07
|
| Rate for Payer: Cofinity Commercial |
$63.94
|
| Rate for Payer: Cofinity Commercial |
$78.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.94
|
| 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: PHP Commercial |
$77.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.37
|
| Rate for Payer: Priority Health SBD |
$57.54
|
|
|
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 Commercial |
$63.94
|
| Rate for Payer: Cofinity Commercial |
$78.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.94
|
| 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: PHP Commercial |
$77.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.37
|
| Rate for Payer: Priority Health SBD |
$57.54
|
|
|
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 |
$5.57 |
| 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 |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: Cash Price |
$73.07
|
| Rate for Payer: Cash Price |
$73.07
|
| Rate for Payer: Cofinity Commercial |
$63.94
|
| Rate for Payer: Cofinity Commercial |
$78.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.94
|
| 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: PHP Commercial |
$77.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.37
|
| Rate for Payer: Priority Health SBD |
$57.54
|
|
