|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$51.62
|
|
|
Service Code
|
NDC 50111078751
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.93 |
| Max. Negotiated Rate |
$46.46 |
| Rate for Payer: Aetna Commercial |
$43.88
|
| Rate for Payer: BCBS Trust/PPO |
$42.63
|
| Rate for Payer: BCN Commercial |
$42.63
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: Cofinity Commercial |
$44.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.30
|
| Rate for Payer: Healthscope Commercial |
$46.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.88
|
| Rate for Payer: Nomi Health Commercial |
$42.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.72
|
| Rate for Payer: PHP Commercial |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.43
|
| Rate for Payer: UHC Core |
$43.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.72
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$51.62
|
|
|
Service Code
|
NDC 50111078751
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$46.46 |
| Rate for Payer: Aetna Commercial |
$43.88
|
| Rate for Payer: Aetna Medicare |
$13.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.13
|
| Rate for Payer: BCBS Complete |
$9.55
|
| Rate for Payer: BCBS MAPPO |
$12.90
|
| Rate for Payer: BCBS Trust/PPO |
$42.44
|
| Rate for Payer: BCN Commercial |
$42.44
|
| Rate for Payer: BCN Medicare Advantage |
$12.90
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: Cofinity Commercial |
$44.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.90
|
| Rate for Payer: Healthscope Commercial |
$46.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.72
|
| Rate for Payer: Mclaren Medicaid |
$9.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.55
|
| Rate for Payer: Meridian Medicaid |
$9.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.88
|
| Rate for Payer: Nomi Health Commercial |
$42.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.72
|
| Rate for Payer: PACE Senior Care Partners |
$12.26
|
| Rate for Payer: PACE SWMI |
$12.90
|
| Rate for Payer: PHP Commercial |
$43.88
|
| Rate for Payer: PHP Medicare Advantage |
$12.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.91
|
| Rate for Payer: Priority Health Medicare |
$13.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.93
|
| Rate for Payer: Railroad Medicare Medicare |
$12.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.43
|
| Rate for Payer: UHC Core |
$43.10
|
| Rate for Payer: UHC Exchange |
$12.90
|
| Rate for Payer: UHC Medicaid |
$9.10
|
| Rate for Payer: UHC Medicare Advantage |
$12.90
|
| Rate for Payer: UHCCP Medicaid |
$9.10
|
| Rate for Payer: VA VA |
$12.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.72
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$384.80
|
|
|
Service Code
|
NDC 59762306003
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.84 |
| Max. Negotiated Rate |
$346.32 |
| Rate for Payer: Aetna Commercial |
$327.08
|
| Rate for Payer: Aetna Medicare |
$100.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$120.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$120.25
|
| Rate for Payer: BCBS Complete |
$71.23
|
| Rate for Payer: BCBS MAPPO |
$96.20
|
| Rate for Payer: BCBS Trust/PPO |
$316.34
|
| Rate for Payer: BCN Commercial |
$316.34
|
| Rate for Payer: BCN Medicare Advantage |
$96.20
|
| Rate for Payer: Cash Price |
$307.84
|
| Rate for Payer: Cofinity Commercial |
$330.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.20
|
| Rate for Payer: Healthscope Commercial |
$346.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.60
|
| Rate for Payer: Mclaren Medicaid |
$67.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.01
|
| Rate for Payer: Meridian Medicaid |
$71.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$105.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.08
|
| Rate for Payer: Nomi Health Commercial |
$315.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$288.60
|
| Rate for Payer: PACE Senior Care Partners |
$91.39
|
| Rate for Payer: PACE SWMI |
$96.20
|
| Rate for Payer: PHP Commercial |
$327.08
|
| Rate for Payer: PHP Medicare Advantage |
$96.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$334.78
|
| Rate for Payer: Priority Health Medicare |
$97.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$267.82
|
| Rate for Payer: Railroad Medicare Medicare |
$96.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.62
|
| Rate for Payer: UHC Core |
$321.31
|
| Rate for Payer: UHC Exchange |
$96.20
|
| Rate for Payer: UHC Medicaid |
$67.84
|
| Rate for Payer: UHC Medicare Advantage |
$96.20
|
| Rate for Payer: UHCCP Medicaid |
$67.84
|
| Rate for Payer: VA VA |
$96.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.60
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 50268009811
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna Commercial |
$2.65
|
| Rate for Payer: BCBS Trust/PPO |
$2.58
|
| Rate for Payer: BCN Commercial |
$2.58
|
| Rate for Payer: Cash Price |
$2.50
|
| 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: Lakeland Regional Health Systems Commercial |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.65
|
| Rate for Payer: Nomi Health Commercial |
$2.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.34
|
| Rate for Payer: PHP Commercial |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.75
|
| Rate for Payer: UHC Core |
$2.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.34
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$419.04
|
|
|
Service Code
|
NDC 00904735061
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$291.65 |
| Max. Negotiated Rate |
$377.14 |
| Rate for Payer: Aetna Commercial |
$356.18
|
| Rate for Payer: BCBS Trust/PPO |
$346.09
|
| Rate for Payer: BCN Commercial |
$346.09
|
| Rate for Payer: Cash Price |
$335.23
|
| 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: Lakeland Regional Health Systems Commercial |
$314.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.18
|
| Rate for Payer: Nomi Health Commercial |
$343.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$314.28
|
| Rate for Payer: PHP Commercial |
$356.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$364.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$291.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$368.76
|
| Rate for Payer: UHC Core |
$349.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$314.28
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$3.12
|
|
|
Service Code
|
NDC 50268009811
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna Commercial |
$2.65
|
| Rate for Payer: Aetna Medicare |
$0.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.98
|
| Rate for Payer: BCBS Complete |
$0.58
|
| Rate for Payer: BCBS MAPPO |
$0.78
|
| Rate for Payer: BCBS Trust/PPO |
$2.56
|
| Rate for Payer: BCN Commercial |
$2.56
|
| Rate for Payer: BCN Medicare Advantage |
$0.78
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.78
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.34
|
| Rate for Payer: Mclaren Medicaid |
$0.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.82
|
| Rate for Payer: Meridian Medicaid |
$0.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.65
|
| Rate for Payer: Nomi Health Commercial |
$2.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.34
|
| Rate for Payer: PACE Senior Care Partners |
$0.74
|
| Rate for Payer: PACE SWMI |
$0.78
|
| Rate for Payer: PHP Commercial |
$2.65
|
| Rate for Payer: PHP Medicare Advantage |
$0.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.71
|
| Rate for Payer: Priority Health Medicare |
$0.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.17
|
| Rate for Payer: Railroad Medicare Medicare |
$0.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.75
|
| Rate for Payer: UHC Core |
$2.61
|
| Rate for Payer: UHC Exchange |
$0.78
|
| Rate for Payer: UHC Medicaid |
$0.55
|
| Rate for Payer: UHC Medicare Advantage |
$0.78
|
| Rate for Payer: UHCCP Medicaid |
$0.55
|
| Rate for Payer: VA VA |
$0.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.34
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$419.04
|
|
|
Service Code
|
NDC 00904735061
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.88 |
| Max. Negotiated Rate |
$377.14 |
| Rate for Payer: Aetna Commercial |
$356.18
|
| Rate for Payer: Aetna Medicare |
$108.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.95
|
| Rate for Payer: BCBS Complete |
$77.56
|
| Rate for Payer: BCBS MAPPO |
$104.76
|
| Rate for Payer: BCBS Trust/PPO |
$344.49
|
| Rate for Payer: BCN Commercial |
$344.49
|
| Rate for Payer: BCN Medicare Advantage |
$104.76
|
| Rate for Payer: Cash Price |
$335.23
|
| Rate for Payer: Cofinity Commercial |
$360.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.76
|
| Rate for Payer: Healthscope Commercial |
$377.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$314.28
|
| Rate for Payer: Mclaren Medicaid |
$73.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.00
|
| Rate for Payer: Meridian Medicaid |
$77.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$115.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.18
|
| Rate for Payer: Nomi Health Commercial |
$343.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$314.28
|
| Rate for Payer: PACE Senior Care Partners |
$99.52
|
| Rate for Payer: PACE SWMI |
$104.76
|
| Rate for Payer: PHP Commercial |
$356.18
|
| Rate for Payer: PHP Medicare Advantage |
$104.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$364.56
|
| Rate for Payer: Priority Health Medicare |
$105.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$291.65
|
| Rate for Payer: Railroad Medicare Medicare |
$104.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$368.76
|
| Rate for Payer: UHC Core |
$349.90
|
| Rate for Payer: UHC Exchange |
$104.76
|
| Rate for Payer: UHC Medicaid |
$73.88
|
| Rate for Payer: UHC Medicare Advantage |
$104.76
|
| Rate for Payer: UHCCP Medicaid |
$73.88
|
| Rate for Payer: VA VA |
$104.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$314.28
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$409.92
|
|
|
Service Code
|
NDC 00904670861
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.27 |
| Max. Negotiated Rate |
$368.93 |
| Rate for Payer: Aetna Commercial |
$348.43
|
| Rate for Payer: Aetna Medicare |
$106.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$128.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$128.10
|
| Rate for Payer: BCBS Complete |
$75.88
|
| Rate for Payer: BCBS MAPPO |
$102.48
|
| Rate for Payer: BCBS Trust/PPO |
$337.00
|
| Rate for Payer: BCN Commercial |
$337.00
|
| Rate for Payer: BCN Medicare Advantage |
$102.48
|
| Rate for Payer: Cash Price |
$327.94
|
| Rate for Payer: Cofinity Commercial |
$352.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.48
|
| Rate for Payer: Healthscope Commercial |
$368.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.44
|
| Rate for Payer: Mclaren Medicaid |
$72.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.60
|
| Rate for Payer: Meridian Medicaid |
$75.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$112.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.43
|
| Rate for Payer: Nomi Health Commercial |
$336.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.44
|
| Rate for Payer: PACE Senior Care Partners |
$97.36
|
| Rate for Payer: PACE SWMI |
$102.48
|
| Rate for Payer: PHP Commercial |
$348.43
|
| Rate for Payer: PHP Medicare Advantage |
$102.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$356.63
|
| Rate for Payer: Priority Health Medicare |
$103.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.30
|
| Rate for Payer: Railroad Medicare Medicare |
$102.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.73
|
| Rate for Payer: UHC Core |
$342.28
|
| Rate for Payer: UHC Exchange |
$102.48
|
| Rate for Payer: UHC Medicaid |
$72.27
|
| Rate for Payer: UHC Medicare Advantage |
$102.48
|
| Rate for Payer: UHCCP Medicaid |
$72.27
|
| Rate for Payer: VA VA |
$102.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.44
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$37.68
|
|
|
Service Code
|
NDC 50111078766
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$33.91 |
| Rate for Payer: Aetna Commercial |
$32.03
|
| Rate for Payer: Aetna Medicare |
$9.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.78
|
| Rate for Payer: BCBS Complete |
$6.97
|
| Rate for Payer: BCBS MAPPO |
$9.42
|
| Rate for Payer: BCBS Trust/PPO |
$30.98
|
| Rate for Payer: BCN Commercial |
$30.98
|
| Rate for Payer: BCN Medicare Advantage |
$9.42
|
| Rate for Payer: Cash Price |
$30.14
|
| Rate for Payer: Cofinity Commercial |
$32.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.42
|
| Rate for Payer: Healthscope Commercial |
$33.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.26
|
| Rate for Payer: Mclaren Medicaid |
$6.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.89
|
| Rate for Payer: Meridian Medicaid |
$6.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.03
|
| Rate for Payer: Nomi Health Commercial |
$30.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.26
|
| Rate for Payer: PACE Senior Care Partners |
$8.95
|
| Rate for Payer: PACE SWMI |
$9.42
|
| Rate for Payer: PHP Commercial |
$32.03
|
| Rate for Payer: PHP Medicare Advantage |
$9.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.78
|
| Rate for Payer: Priority Health Medicare |
$9.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.23
|
| Rate for Payer: Railroad Medicare Medicare |
$9.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.16
|
| Rate for Payer: UHC Core |
$31.46
|
| Rate for Payer: UHC Exchange |
$9.42
|
| Rate for Payer: UHC Medicaid |
$6.64
|
| Rate for Payer: UHC Medicare Advantage |
$9.42
|
| Rate for Payer: UHCCP Medicaid |
$6.64
|
| Rate for Payer: VA VA |
$9.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.26
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$37.68
|
|
|
Service Code
|
NDC 50111078766
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.23 |
| Max. Negotiated Rate |
$33.91 |
| Rate for Payer: Aetna Commercial |
$32.03
|
| Rate for Payer: BCBS Trust/PPO |
$31.12
|
| Rate for Payer: BCN Commercial |
$31.12
|
| Rate for Payer: Cash Price |
$30.14
|
| Rate for Payer: Cofinity Commercial |
$32.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.14
|
| Rate for Payer: Healthscope Commercial |
$33.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.03
|
| Rate for Payer: Nomi Health Commercial |
$30.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.26
|
| Rate for Payer: PHP Commercial |
$32.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.16
|
| Rate for Payer: UHC Core |
$31.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.26
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$384.80
|
|
|
Service Code
|
NDC 59762306003
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$267.82 |
| Max. Negotiated Rate |
$346.32 |
| Rate for Payer: Aetna Commercial |
$327.08
|
| Rate for Payer: BCBS Trust/PPO |
$317.81
|
| Rate for Payer: BCN Commercial |
$317.81
|
| Rate for Payer: Cash Price |
$307.84
|
| 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: Lakeland Regional Health Systems Commercial |
$288.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.08
|
| Rate for Payer: Nomi Health Commercial |
$315.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$288.60
|
| Rate for Payer: PHP Commercial |
$327.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$334.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$267.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.62
|
| Rate for Payer: UHC Core |
$321.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.60
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$30.71
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
21063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.37 |
| Max. Negotiated Rate |
$27.64 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Commercial |
$17.09
|
| Rate for Payer: Aetna Commercial |
$22.19
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$13.99
|
| Rate for Payer: Aetna Commercial |
$22.24
|
| Rate for Payer: BCBS Trust/PPO |
$25.36
|
| Rate for Payer: BCBS Trust/PPO |
$14.43
|
| Rate for Payer: BCBS Trust/PPO |
$21.61
|
| Rate for Payer: BCBS Trust/PPO |
$13.59
|
| Rate for Payer: BCBS Trust/PPO |
$21.56
|
| Rate for Payer: BCBS Trust/PPO |
$16.60
|
| Rate for Payer: BCBS Trust/PPO |
$17.15
|
| Rate for Payer: BCN Commercial |
$16.60
|
| Rate for Payer: BCN Commercial |
$21.61
|
| Rate for Payer: BCN Commercial |
$25.36
|
| Rate for Payer: BCN Commercial |
$21.56
|
| Rate for Payer: BCN Commercial |
$14.43
|
| Rate for Payer: BCN Commercial |
$17.15
|
| Rate for Payer: BCN Commercial |
$13.59
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cash Price |
$13.17
|
| Rate for Payer: Cash Price |
$20.89
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Cofinity Commercial |
$22.45
|
| Rate for Payer: Cofinity Commercial |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Cofinity Commercial |
$22.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.08
|
| 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 |
$20.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$18.09
|
| Rate for Payer: Healthscope Commercial |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$23.50
|
| Rate for Payer: Healthscope Commercial |
$14.81
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Healthscope Commercial |
$18.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.99
|
| 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 |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.09
|
| Rate for Payer: Nomi Health Commercial |
$17.02
|
| Rate for Payer: Nomi Health Commercial |
$13.50
|
| Rate for Payer: Nomi Health Commercial |
$25.18
|
| Rate for Payer: Nomi Health Commercial |
$21.45
|
| Rate for Payer: Nomi Health Commercial |
$21.41
|
| Rate for Payer: Nomi Health Commercial |
$16.48
|
| Rate for Payer: Nomi Health Commercial |
$14.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.07
|
| Rate for Payer: PHP Commercial |
$13.99
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: PHP Commercial |
$17.09
|
| Rate for Payer: PHP Commercial |
$22.19
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$22.24
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.69
|
| Rate for Payer: UHC Core |
$13.74
|
| Rate for Payer: UHC Core |
$21.84
|
| Rate for Payer: UHC Core |
$14.59
|
| Rate for Payer: UHC Core |
$16.78
|
| Rate for Payer: UHC Core |
$21.80
|
| Rate for Payer: UHC Core |
$25.64
|
| Rate for Payer: UHC Core |
$17.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.62
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.76
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
21063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$18.68 |
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$13.99
|
| Rate for Payer: Aetna Commercial |
$17.09
|
| Rate for Payer: Aetna Commercial |
$22.24
|
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Commercial |
$22.19
|
| Rate for Payer: Aetna Medicare |
$4.54
|
| Rate for Payer: Aetna Medicare |
$5.23
|
| Rate for Payer: Aetna Medicare |
$7.98
|
| Rate for Payer: Aetna Medicare |
$5.40
|
| Rate for Payer: Aetna Medicare |
$4.28
|
| Rate for Payer: Aetna Medicare |
$6.80
|
| Rate for Payer: Aetna Medicare |
$6.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.14
|
| Rate for Payer: BCBS Complete |
$5.68
|
| Rate for Payer: BCBS Complete |
$3.05
|
| Rate for Payer: BCBS Complete |
$3.23
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: BCBS Complete |
$4.83
|
| Rate for Payer: BCBS Complete |
$3.72
|
| Rate for Payer: BCBS Complete |
$4.84
|
| Rate for Payer: BCBS MAPPO |
$5.03
|
| Rate for Payer: BCBS MAPPO |
$6.53
|
| Rate for Payer: BCBS MAPPO |
$5.19
|
| Rate for Payer: BCBS MAPPO |
$4.12
|
| Rate for Payer: BCBS MAPPO |
$6.54
|
| Rate for Payer: BCBS MAPPO |
$4.37
|
| Rate for Payer: BCBS MAPPO |
$7.68
|
| Rate for Payer: BCBS Trust/PPO |
$25.25
|
| Rate for Payer: BCBS Trust/PPO |
$21.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.51
|
| Rate for Payer: BCBS Trust/PPO |
$17.07
|
| Rate for Payer: BCBS Trust/PPO |
$13.53
|
| Rate for Payer: BCBS Trust/PPO |
$14.36
|
| Rate for Payer: BCBS Trust/PPO |
$16.52
|
| Rate for Payer: BCN Commercial |
$14.36
|
| Rate for Payer: BCN Commercial |
$13.53
|
| Rate for Payer: BCN Commercial |
$25.25
|
| Rate for Payer: BCN Commercial |
$21.51
|
| Rate for Payer: BCN Commercial |
$21.47
|
| Rate for Payer: BCN Commercial |
$16.52
|
| Rate for Payer: BCN Commercial |
$17.07
|
| Rate for Payer: BCN Medicare Advantage |
$5.19
|
| Rate for Payer: BCN Medicare Advantage |
$4.37
|
| Rate for Payer: BCN Medicare Advantage |
$7.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.03
|
| Rate for Payer: BCN Medicare Advantage |
$4.12
|
| Rate for Payer: BCN Medicare Advantage |
$6.54
|
| Rate for Payer: BCN Medicare Advantage |
$6.53
|
| Rate for Payer: Cash Price |
$20.89
|
| Rate for Payer: Cash Price |
$13.17
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Cofinity Commercial |
$22.45
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$22.50
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
| 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 |
$20.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.53
|
| Rate for Payer: Healthscope Commercial |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Healthscope Commercial |
$23.50
|
| Rate for Payer: Healthscope Commercial |
$18.09
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$14.81
|
| Rate for Payer: Healthscope Commercial |
$18.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.03
|
| Rate for Payer: Mclaren Medicaid |
$4.61
|
| Rate for Payer: Mclaren Medicaid |
$3.08
|
| Rate for Payer: Mclaren Medicaid |
$2.90
|
| Rate for Payer: Mclaren Medicaid |
$3.66
|
| Rate for Payer: Mclaren Medicaid |
$4.60
|
| Rate for Payer: Mclaren Medicaid |
$5.41
|
| Rate for Payer: Mclaren Medicaid |
$3.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.45
|
| Rate for Payer: Meridian Medicaid |
$3.23
|
| Rate for Payer: Meridian Medicaid |
$3.05
|
| Rate for Payer: Meridian Medicaid |
$3.72
|
| Rate for Payer: Meridian Medicaid |
$3.84
|
| Rate for Payer: Meridian Medicaid |
$4.83
|
| Rate for Payer: Meridian Medicaid |
$4.84
|
| Rate for Payer: Meridian Medicaid |
$5.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| 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 |
$13.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.24
|
| Rate for Payer: Nomi Health Commercial |
$16.48
|
| Rate for Payer: Nomi Health Commercial |
$21.41
|
| Rate for Payer: Nomi Health Commercial |
$17.02
|
| Rate for Payer: Nomi Health Commercial |
$14.33
|
| Rate for Payer: Nomi Health Commercial |
$13.50
|
| Rate for Payer: Nomi Health Commercial |
$21.45
|
| Rate for Payer: Nomi Health Commercial |
$25.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.07
|
| 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 |
$12.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.62
|
| Rate for Payer: PACE Senior Care Partners |
$6.20
|
| Rate for Payer: PACE Senior Care Partners |
$4.15
|
| Rate for Payer: PACE Senior Care Partners |
$3.91
|
| Rate for Payer: PACE Senior Care Partners |
$6.21
|
| Rate for Payer: PACE Senior Care Partners |
$4.77
|
| Rate for Payer: PACE Senior Care Partners |
$7.29
|
| Rate for Payer: PACE Senior Care Partners |
$4.93
|
| Rate for Payer: PACE SWMI |
$5.03
|
| Rate for Payer: PACE SWMI |
$6.54
|
| Rate for Payer: PACE SWMI |
$6.53
|
| Rate for Payer: PACE SWMI |
$4.37
|
| Rate for Payer: PACE SWMI |
$5.19
|
| Rate for Payer: PACE SWMI |
$7.68
|
| Rate for Payer: PACE SWMI |
$4.12
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$17.09
|
| Rate for Payer: PHP Commercial |
$22.19
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: PHP Commercial |
$22.24
|
| Rate for Payer: PHP Commercial |
$13.99
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: PHP Medicare Advantage |
$4.37
|
| Rate for Payer: PHP Medicare Advantage |
$6.53
|
| Rate for Payer: PHP Medicare Advantage |
$4.12
|
| Rate for Payer: PHP Medicare Advantage |
$5.03
|
| Rate for Payer: PHP Medicare Advantage |
$5.19
|
| Rate for Payer: PHP Medicare Advantage |
$6.54
|
| Rate for Payer: PHP Medicare Advantage |
$7.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.06
|
| Rate for Payer: Priority Health Medicare |
$6.61
|
| Rate for Payer: Priority Health Medicare |
$7.75
|
| Rate for Payer: Priority Health Medicare |
$6.59
|
| Rate for Payer: Priority Health Medicare |
$5.08
|
| Rate for Payer: Priority Health Medicare |
$4.41
|
| Rate for Payer: Priority Health Medicare |
$5.24
|
| Rate for Payer: Priority Health Medicare |
$4.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.53
|
| Rate for Payer: Railroad Medicare Medicare |
$7.68
|
| Rate for Payer: Railroad Medicare Medicare |
$4.12
|
| Rate for Payer: Railroad Medicare Medicare |
$6.54
|
| Rate for Payer: Railroad Medicare Medicare |
$4.37
|
| Rate for Payer: Railroad Medicare Medicare |
$5.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.48
|
| Rate for Payer: UHC Core |
$17.33
|
| Rate for Payer: UHC Core |
$13.74
|
| Rate for Payer: UHC Core |
$16.78
|
| Rate for Payer: UHC Core |
$21.84
|
| Rate for Payer: UHC Core |
$25.64
|
| Rate for Payer: UHC Core |
$14.59
|
| Rate for Payer: UHC Core |
$21.80
|
| Rate for Payer: UHC Exchange |
$4.37
|
| Rate for Payer: UHC Exchange |
$6.53
|
| Rate for Payer: UHC Exchange |
$4.12
|
| Rate for Payer: UHC Exchange |
$6.54
|
| Rate for Payer: UHC Exchange |
$5.19
|
| Rate for Payer: UHC Exchange |
$5.03
|
| Rate for Payer: UHC Exchange |
$7.68
|
| Rate for Payer: UHC Medicaid |
$5.41
|
| Rate for Payer: UHC Medicaid |
$4.61
|
| Rate for Payer: UHC Medicaid |
$3.54
|
| Rate for Payer: UHC Medicaid |
$2.90
|
| Rate for Payer: UHC Medicaid |
$3.08
|
| Rate for Payer: UHC Medicaid |
$4.60
|
| Rate for Payer: UHC Medicaid |
$3.66
|
| Rate for Payer: UHC Medicare Advantage |
$4.37
|
| Rate for Payer: UHC Medicare Advantage |
$7.68
|
| Rate for Payer: UHC Medicare Advantage |
$4.12
|
| Rate for Payer: UHC Medicare Advantage |
$5.19
|
| Rate for Payer: UHC Medicare Advantage |
$6.54
|
| Rate for Payer: UHC Medicare Advantage |
$6.53
|
| Rate for Payer: UHC Medicare Advantage |
$5.03
|
| Rate for Payer: UHCCP Medicaid |
$2.90
|
| Rate for Payer: UHCCP Medicaid |
$5.41
|
| Rate for Payer: UHCCP Medicaid |
$3.08
|
| Rate for Payer: UHCCP Medicaid |
$3.66
|
| Rate for Payer: UHCCP Medicaid |
$4.60
|
| Rate for Payer: UHCCP Medicaid |
$4.61
|
| Rate for Payer: UHCCP Medicaid |
$3.54
|
| Rate for Payer: VA VA |
$4.12
|
| Rate for Payer: VA VA |
$6.54
|
| Rate for Payer: VA VA |
$5.03
|
| Rate for Payer: VA VA |
$6.53
|
| Rate for Payer: VA VA |
$7.68
|
| Rate for Payer: VA VA |
$4.37
|
| Rate for Payer: VA VA |
$5.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.57
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$102.31
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.04 |
| Max. Negotiated Rate |
$92.08 |
| Rate for Payer: Aetna Commercial |
$86.96
|
| Rate for Payer: Aetna Commercial |
$77.64
|
| Rate for Payer: Aetna Medicare |
$23.75
|
| Rate for Payer: Aetna Medicare |
$26.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.54
|
| Rate for Payer: BCBS Complete |
$18.94
|
| Rate for Payer: BCBS Complete |
$16.91
|
| Rate for Payer: BCBS MAPPO |
$25.58
|
| Rate for Payer: BCBS MAPPO |
$22.84
|
| Rate for Payer: BCBS Trust/PPO |
$84.11
|
| Rate for Payer: BCBS Trust/PPO |
$75.09
|
| Rate for Payer: BCN Commercial |
$75.09
|
| Rate for Payer: BCN Commercial |
$84.11
|
| Rate for Payer: BCN Medicare Advantage |
$22.84
|
| Rate for Payer: BCN Medicare Advantage |
$25.58
|
| Rate for Payer: Cash Price |
$81.85
|
| Rate for Payer: Cash Price |
$73.07
|
| Rate for Payer: Cofinity Commercial |
$87.99
|
| Rate for Payer: Cofinity Commercial |
$78.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.58
|
| Rate for Payer: Healthscope Commercial |
$92.08
|
| Rate for Payer: Healthscope Commercial |
$82.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.50
|
| Rate for Payer: Mclaren Medicaid |
$16.10
|
| Rate for Payer: Mclaren Medicaid |
$18.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.86
|
| Rate for Payer: Meridian Medicaid |
$18.94
|
| Rate for Payer: Meridian Medicaid |
$16.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.96
|
| Rate for Payer: Nomi Health Commercial |
$74.90
|
| Rate for Payer: Nomi Health Commercial |
$83.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.50
|
| Rate for Payer: PACE Senior Care Partners |
$21.69
|
| Rate for Payer: PACE Senior Care Partners |
$24.30
|
| Rate for Payer: PACE SWMI |
$22.84
|
| Rate for Payer: PACE SWMI |
$25.58
|
| Rate for Payer: PHP Commercial |
$86.96
|
| Rate for Payer: PHP Commercial |
$77.64
|
| Rate for Payer: PHP Medicare Advantage |
$25.58
|
| Rate for Payer: PHP Medicare Advantage |
$22.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$89.01
|
| Rate for Payer: Priority Health Medicare |
$23.06
|
| Rate for Payer: Priority Health Medicare |
$25.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.57
|
| Rate for Payer: Railroad Medicare Medicare |
$25.58
|
| Rate for Payer: Railroad Medicare Medicare |
$22.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.38
|
| Rate for Payer: UHC Core |
$76.27
|
| Rate for Payer: UHC Core |
$85.43
|
| Rate for Payer: UHC Exchange |
$22.84
|
| Rate for Payer: UHC Exchange |
$25.58
|
| Rate for Payer: UHC Medicaid |
$16.10
|
| Rate for Payer: UHC Medicaid |
$18.04
|
| Rate for Payer: UHC Medicare Advantage |
$25.58
|
| Rate for Payer: UHC Medicare Advantage |
$22.84
|
| Rate for Payer: UHCCP Medicaid |
$18.04
|
| Rate for Payer: UHCCP Medicaid |
$16.10
|
| Rate for Payer: VA VA |
$25.58
|
| Rate for Payer: VA VA |
$22.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.73
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$102.31
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.21 |
| Max. Negotiated Rate |
$92.08 |
| Rate for Payer: Aetna Commercial |
$86.96
|
| Rate for Payer: Aetna Commercial |
$77.64
|
| Rate for Payer: BCBS Trust/PPO |
$84.50
|
| Rate for Payer: BCBS Trust/PPO |
$75.44
|
| Rate for Payer: BCN Commercial |
$84.50
|
| Rate for Payer: BCN Commercial |
$75.44
|
| Rate for Payer: Cash Price |
$81.85
|
| Rate for Payer: Cash Price |
$73.07
|
| Rate for Payer: Cofinity Commercial |
$78.55
|
| Rate for Payer: Cofinity Commercial |
$87.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.85
|
| Rate for Payer: Healthscope Commercial |
$92.08
|
| Rate for Payer: Healthscope Commercial |
$82.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.64
|
| Rate for Payer: Nomi Health Commercial |
$83.89
|
| Rate for Payer: Nomi Health Commercial |
$74.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.50
|
| Rate for Payer: PHP Commercial |
$77.64
|
| Rate for Payer: PHP Commercial |
$86.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$89.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.38
|
| Rate for Payer: UHC Core |
$85.43
|
| Rate for Payer: UHC Core |
$76.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.50
|
|
|
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 |
$63.57 |
| Max. Negotiated Rate |
$82.21 |
| Rate for Payer: Aetna Commercial |
$77.64
|
| Rate for Payer: BCBS Trust/PPO |
$75.44
|
| Rate for Payer: BCN Commercial |
$75.44
|
| Rate for Payer: Cash Price |
$73.07
|
| 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: Lakeland Regional Health Systems Commercial |
$68.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.64
|
| Rate for Payer: Nomi Health Commercial |
$74.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.50
|
| Rate for Payer: PHP Commercial |
$77.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.38
|
| Rate for Payer: UHC Core |
$76.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.50
|
|
|
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 |
$16.10 |
| Max. Negotiated Rate |
$82.21 |
| Rate for Payer: Aetna Commercial |
$77.64
|
| Rate for Payer: Aetna Medicare |
$23.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.54
|
| Rate for Payer: BCBS Complete |
$16.91
|
| Rate for Payer: BCBS MAPPO |
$22.84
|
| Rate for Payer: BCBS Trust/PPO |
$75.09
|
| Rate for Payer: BCN Commercial |
$75.09
|
| Rate for Payer: BCN Medicare Advantage |
$22.84
|
| Rate for Payer: Cash Price |
$73.07
|
| Rate for Payer: Cofinity Commercial |
$78.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.84
|
| Rate for Payer: Healthscope Commercial |
$82.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.50
|
| Rate for Payer: Mclaren Medicaid |
$16.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.98
|
| Rate for Payer: Meridian Medicaid |
$16.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.64
|
| Rate for Payer: Nomi Health Commercial |
$74.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.50
|
| Rate for Payer: PACE Senior Care Partners |
$21.69
|
| Rate for Payer: PACE SWMI |
$22.84
|
| Rate for Payer: PHP Commercial |
$77.64
|
| Rate for Payer: PHP Medicare Advantage |
$22.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.47
|
| Rate for Payer: Priority Health Medicare |
$23.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.57
|
| Rate for Payer: Railroad Medicare Medicare |
$22.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.38
|
| Rate for Payer: UHC Core |
$76.27
|
| Rate for Payer: UHC Exchange |
$22.84
|
| Rate for Payer: UHC Medicaid |
$16.10
|
| Rate for Payer: UHC Medicare Advantage |
$22.84
|
| Rate for Payer: UHCCP Medicaid |
$16.10
|
| Rate for Payer: VA VA |
$22.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.50
|
|
|
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 |
$32.89 |
| Max. Negotiated Rate |
$167.88 |
| Rate for Payer: Aetna Commercial |
$158.55
|
| Rate for Payer: Aetna Commercial |
$177.54
|
| Rate for Payer: Aetna Medicare |
$54.31
|
| Rate for Payer: Aetna Medicare |
$48.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.27
|
| Rate for Payer: BCBS Complete |
$34.53
|
| Rate for Payer: BCBS Complete |
$38.66
|
| Rate for Payer: BCBS MAPPO |
$46.63
|
| Rate for Payer: BCBS MAPPO |
$52.22
|
| Rate for Payer: BCBS Trust/PPO |
$153.35
|
| Rate for Payer: BCBS Trust/PPO |
$171.71
|
| Rate for Payer: BCN Commercial |
$171.71
|
| Rate for Payer: BCN Commercial |
$153.35
|
| Rate for Payer: BCN Medicare Advantage |
$52.22
|
| Rate for Payer: BCN Medicare Advantage |
$46.63
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cofinity Commercial |
$160.42
|
| 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: Health Alliance Plan Medicare Advantage |
$52.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.63
|
| Rate for Payer: Healthscope Commercial |
$167.88
|
| Rate for Payer: Healthscope Commercial |
$187.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.65
|
| Rate for Payer: Mclaren Medicaid |
$36.82
|
| Rate for Payer: Mclaren Medicaid |
$32.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.96
|
| Rate for Payer: Meridian Medicaid |
$34.53
|
| Rate for Payer: Meridian Medicaid |
$38.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.55
|
| Rate for Payer: Nomi Health Commercial |
$171.27
|
| Rate for Payer: Nomi Health Commercial |
$152.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.65
|
| Rate for Payer: PACE Senior Care Partners |
$49.61
|
| Rate for Payer: PACE Senior Care Partners |
$44.30
|
| Rate for Payer: PACE SWMI |
$52.22
|
| Rate for Payer: PACE SWMI |
$46.63
|
| Rate for Payer: PHP Commercial |
$158.55
|
| Rate for Payer: PHP Commercial |
$177.54
|
| Rate for Payer: PHP Medicare Advantage |
$46.63
|
| Rate for Payer: PHP Medicare Advantage |
$52.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$181.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$162.28
|
| Rate for Payer: Priority Health Medicare |
$52.74
|
| Rate for Payer: Priority Health Medicare |
$47.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.37
|
| Rate for Payer: Railroad Medicare Medicare |
$46.63
|
| Rate for Payer: Railroad Medicare Medicare |
$52.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.81
|
| Rate for Payer: UHC Core |
$174.41
|
| Rate for Payer: UHC Core |
$155.75
|
| Rate for Payer: UHC Exchange |
$52.22
|
| Rate for Payer: UHC Exchange |
$46.63
|
| Rate for Payer: UHC Medicaid |
$36.82
|
| Rate for Payer: UHC Medicaid |
$32.89
|
| Rate for Payer: UHC Medicare Advantage |
$46.63
|
| Rate for Payer: UHC Medicare Advantage |
$52.22
|
| Rate for Payer: UHCCP Medicaid |
$32.89
|
| Rate for Payer: UHCCP Medicaid |
$36.82
|
| Rate for Payer: VA VA |
$46.63
|
| Rate for Payer: VA VA |
$52.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.90
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$186.53
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.82 |
| Max. Negotiated Rate |
$167.88 |
| Rate for Payer: Aetna Commercial |
$158.55
|
| Rate for Payer: Aetna Commercial |
$177.54
|
| Rate for Payer: BCBS Trust/PPO |
$154.06
|
| Rate for Payer: BCBS Trust/PPO |
$172.51
|
| Rate for Payer: BCN Commercial |
$154.06
|
| Rate for Payer: BCN Commercial |
$172.51
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cofinity Commercial |
$179.63
|
| Rate for Payer: Cofinity Commercial |
$160.42
|
| 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 |
$167.88
|
| Rate for Payer: Healthscope Commercial |
$187.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.54
|
| Rate for Payer: Nomi Health Commercial |
$152.95
|
| Rate for Payer: Nomi Health Commercial |
$171.27
|
| 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 |
$177.54
|
| Rate for Payer: PHP Commercial |
$158.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$181.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$162.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.81
|
| Rate for Payer: UHC Core |
$155.75
|
| Rate for Payer: UHC Core |
$174.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.65
|
|
|
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 |
$32.89 |
| Max. Negotiated Rate |
$167.88 |
| Rate for Payer: Aetna Commercial |
$158.55
|
| Rate for Payer: Aetna Medicare |
$48.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.29
|
| Rate for Payer: BCBS Complete |
$34.53
|
| Rate for Payer: BCBS MAPPO |
$46.63
|
| Rate for Payer: BCBS Trust/PPO |
$153.35
|
| Rate for Payer: BCN Commercial |
$153.35
|
| Rate for Payer: BCN Medicare Advantage |
$46.63
|
| Rate for Payer: Cash Price |
$149.22
|
| Rate for Payer: Cofinity Commercial |
$160.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.63
|
| Rate for Payer: Healthscope Commercial |
$167.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.90
|
| Rate for Payer: Mclaren Medicaid |
$32.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.96
|
| Rate for Payer: Meridian Medicaid |
$34.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.55
|
| Rate for Payer: Nomi Health Commercial |
$152.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.90
|
| Rate for Payer: PACE Senior Care Partners |
$44.30
|
| Rate for Payer: PACE SWMI |
$46.63
|
| Rate for Payer: PHP Commercial |
$158.55
|
| Rate for Payer: PHP Medicare Advantage |
$46.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$162.28
|
| Rate for Payer: Priority Health Medicare |
$47.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.82
|
| Rate for Payer: Railroad Medicare Medicare |
$46.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.15
|
| Rate for Payer: UHC Core |
$155.75
|
| Rate for Payer: UHC Exchange |
$46.63
|
| Rate for Payer: UHC Medicaid |
$32.89
|
| Rate for Payer: UHC Medicare Advantage |
$46.63
|
| Rate for Payer: UHCCP Medicaid |
$32.89
|
| Rate for Payer: VA VA |
$46.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.90
|
|
|
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 |
$129.82 |
| Max. Negotiated Rate |
$167.88 |
| Rate for Payer: Aetna Commercial |
$158.55
|
| Rate for Payer: BCBS Trust/PPO |
$154.06
|
| Rate for Payer: BCN Commercial |
$154.06
|
| Rate for Payer: Cash Price |
$149.22
|
| 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: Lakeland Regional Health Systems Commercial |
$139.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.55
|
| Rate for Payer: Nomi Health Commercial |
$152.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.90
|
| Rate for Payer: PHP Commercial |
$158.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$162.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.15
|
| Rate for Payer: UHC Core |
$155.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.90
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$10.46
|
|
|
Service Code
|
NDC 00536126328
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: BCBS Trust/PPO |
$8.64
|
| Rate for Payer: BCN Commercial |
$8.64
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.89
|
| Rate for Payer: Nomi Health Commercial |
$8.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.84
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.20
|
| Rate for Payer: UHC Core |
$8.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.84
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$11.12
|
|
|
Service Code
|
NDC 51672207502
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$10.01 |
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: BCBS Trust/PPO |
$9.18
|
| Rate for Payer: BCN Commercial |
$9.18
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$10.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: Nomi Health Commercial |
$9.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.34
|
| Rate for Payer: PHP Commercial |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.79
|
| Rate for Payer: UHC Core |
$9.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.34
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$15.80
|
|
|
Service Code
|
NDC 14428000944
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: BCBS Trust/PPO |
$13.05
|
| Rate for Payer: BCN Commercial |
$13.05
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.43
|
| Rate for Payer: Nomi Health Commercial |
$12.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.85
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.90
|
| Rate for Payer: UHC Core |
$13.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.85
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$15.80
|
|
|
Service Code
|
NDC 14428000944
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna Medicare |
$4.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.94
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: BCBS MAPPO |
$3.95
|
| Rate for Payer: BCBS Trust/PPO |
$12.99
|
| Rate for Payer: BCN Commercial |
$12.99
|
| Rate for Payer: BCN Medicare Advantage |
$3.95
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.95
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.85
|
| Rate for Payer: Mclaren Medicaid |
$2.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.15
|
| Rate for Payer: Meridian Medicaid |
$2.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.43
|
| Rate for Payer: Nomi Health Commercial |
$12.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.85
|
| Rate for Payer: PACE Senior Care Partners |
$3.75
|
| Rate for Payer: PACE SWMI |
$3.95
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: PHP Medicare Advantage |
$3.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.75
|
| Rate for Payer: Priority Health Medicare |
$3.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.00
|
| Rate for Payer: Railroad Medicare Medicare |
$3.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.90
|
| Rate for Payer: UHC Core |
$13.19
|
| Rate for Payer: UHC Exchange |
$3.95
|
| Rate for Payer: UHC Medicaid |
$2.79
|
| Rate for Payer: UHC Medicare Advantage |
$3.95
|
| Rate for Payer: UHCCP Medicaid |
$2.79
|
| Rate for Payer: VA VA |
$3.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.85
|
|
