|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$116.79
|
|
|
Service Code
|
NDC 00093202631
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.91 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna Commercial |
$99.27
|
| Rate for Payer: BCBS Trust/PPO |
$95.34
|
| Rate for Payer: BCN Commercial |
$90.26
|
| Rate for Payer: Cash Price |
$93.43
|
| Rate for Payer: Cofinity Commercial |
$100.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.43
|
| Rate for Payer: Healthscope Commercial |
$105.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.27
|
| Rate for Payer: Nomi Health Commercial |
$95.77
|
| Rate for Payer: PHP Commercial |
$99.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.91
|
| Rate for Payer: Priority Health HMO/PPO |
$101.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.78
|
| Rate for Payer: UHC Core |
$97.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.59
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$19.08
|
|
|
Service Code
|
NDC 09900000333
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$17.17 |
| Rate for Payer: Aetna Commercial |
$16.22
|
| Rate for Payer: Aetna Medicare |
$4.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.96
|
| Rate for Payer: BCBS Complete |
$7.63
|
| Rate for Payer: BCBS MAPPO |
$4.77
|
| Rate for Payer: BCBS Trust/PPO |
$15.69
|
| Rate for Payer: BCN Commercial |
$14.83
|
| Rate for Payer: BCN Medicare Advantage |
$4.77
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: Cofinity Commercial |
$16.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.77
|
| Rate for Payer: Healthscope Commercial |
$17.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.22
|
| Rate for Payer: Nomi Health Commercial |
$15.65
|
| Rate for Payer: PACE Senior Care Partners |
$4.53
|
| Rate for Payer: PACE SWMI |
$4.77
|
| Rate for Payer: PHP Commercial |
$16.22
|
| Rate for Payer: PHP Medicare Advantage |
$4.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.40
|
| Rate for Payer: Priority Health HMO/PPO |
$16.60
|
| Rate for Payer: Priority Health Medicare |
$4.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.78
|
| Rate for Payer: Railroad Medicare Medicare |
$4.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.79
|
| Rate for Payer: UHC Core |
$15.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.77
|
| Rate for Payer: UHC Exchange |
$4.77
|
| Rate for Payer: UHC Medicare Advantage |
$4.77
|
| Rate for Payer: VA VA |
$4.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.31
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 50268009811
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna Commercial |
$2.65
|
| Rate for Payer: BCBS Trust/PPO |
$2.55
|
| Rate for Payer: BCN Commercial |
$2.41
|
| 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: PHP Commercial |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.03
|
| Rate for Payer: Priority Health HMO/PPO |
$2.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.09
|
| 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
|
OP
|
$51.62
|
|
|
Service Code
|
NDC 50111078751
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.26 |
| 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 |
$20.65
|
| Rate for Payer: BCBS MAPPO |
$12.90
|
| Rate for Payer: BCBS Trust/PPO |
$42.44
|
| Rate for Payer: BCN Commercial |
$40.13
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.88
|
| Rate for Payer: Nomi Health Commercial |
$42.33
|
| 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 Cigna Priority Health |
$33.55
|
| Rate for Payer: Priority Health HMO/PPO |
$44.91
|
| Rate for Payer: Priority Health Medicare |
$13.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.59
|
| 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 Dual Complete DSNP |
$12.90
|
| Rate for Payer: UHC Exchange |
$12.90
|
| Rate for Payer: UHC Medicare Advantage |
$12.90
|
| Rate for Payer: VA VA |
$12.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.72
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$775.20
|
|
|
Service Code
|
NDC 60687028201
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$503.88 |
| Max. Negotiated Rate |
$697.68 |
| Rate for Payer: Aetna Commercial |
$658.92
|
| Rate for Payer: BCBS Trust/PPO |
$632.80
|
| Rate for Payer: BCN Commercial |
$599.07
|
| Rate for Payer: Cash Price |
$620.16
|
| Rate for Payer: Cofinity Commercial |
$666.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.16
|
| Rate for Payer: Healthscope Commercial |
$697.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$581.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$658.92
|
| Rate for Payer: Nomi Health Commercial |
$635.66
|
| Rate for Payer: PHP Commercial |
$658.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.88
|
| Rate for Payer: Priority Health HMO/PPO |
$674.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$519.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$682.18
|
| Rate for Payer: UHC Core |
$647.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.40
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$3.12
|
|
|
Service Code
|
NDC 50268009811
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.74 |
| 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 |
$1.25
|
| Rate for Payer: BCBS MAPPO |
$0.78
|
| Rate for Payer: BCBS Trust/PPO |
$2.56
|
| Rate for Payer: BCN Commercial |
$2.43
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.65
|
| Rate for Payer: Nomi Health Commercial |
$2.56
|
| 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 Cigna Priority Health |
$2.03
|
| Rate for Payer: Priority Health HMO/PPO |
$2.71
|
| Rate for Payer: Priority Health Medicare |
$0.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.09
|
| 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 Dual Complete DSNP |
$0.78
|
| Rate for Payer: UHC Exchange |
$0.78
|
| Rate for Payer: UHC Medicare Advantage |
$0.78
|
| Rate for Payer: VA VA |
$0.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.34
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$37.68
|
|
|
Service Code
|
NDC 50111078766
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.95 |
| 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 |
$15.07
|
| Rate for Payer: BCBS MAPPO |
$9.42
|
| Rate for Payer: BCBS Trust/PPO |
$30.98
|
| Rate for Payer: BCN Commercial |
$29.30
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.03
|
| Rate for Payer: Nomi Health Commercial |
$30.90
|
| 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 Cigna Priority Health |
$24.49
|
| Rate for Payer: Priority Health HMO/PPO |
$32.78
|
| Rate for Payer: Priority Health Medicare |
$9.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.25
|
| 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 Dual Complete DSNP |
$9.42
|
| Rate for Payer: UHC Exchange |
$9.42
|
| Rate for Payer: UHC Medicare Advantage |
$9.42
|
| Rate for Payer: VA VA |
$9.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.26
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$409.92
|
|
|
Service Code
|
NDC 00904670861
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.45 |
| Max. Negotiated Rate |
$368.93 |
| Rate for Payer: Aetna Commercial |
$348.43
|
| Rate for Payer: BCBS Trust/PPO |
$334.62
|
| Rate for Payer: BCN Commercial |
$316.79
|
| 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: Healthscope Commercial |
$368.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.43
|
| Rate for Payer: Nomi Health Commercial |
$336.13
|
| Rate for Payer: PHP Commercial |
$348.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.45
|
| Rate for Payer: Priority Health HMO/PPO |
$356.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.73
|
| Rate for Payer: UHC Core |
$342.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.44
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$7.76
|
|
|
Service Code
|
NDC 60687028211
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$6.98 |
| Rate for Payer: Aetna Commercial |
$6.60
|
| Rate for Payer: BCBS Trust/PPO |
$6.33
|
| Rate for Payer: BCN Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: Cofinity Commercial |
$6.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.21
|
| Rate for Payer: Healthscope Commercial |
$6.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.60
|
| Rate for Payer: Nomi Health Commercial |
$6.36
|
| Rate for Payer: PHP Commercial |
$6.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.04
|
| Rate for Payer: Priority Health HMO/PPO |
$6.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.83
|
| Rate for Payer: UHC Core |
$6.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.82
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$409.92
|
|
|
Service Code
|
NDC 00904670861
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.36 |
| 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 |
$163.97
|
| Rate for Payer: BCBS MAPPO |
$102.48
|
| Rate for Payer: BCBS Trust/PPO |
$337.00
|
| Rate for Payer: BCN Commercial |
$318.71
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.43
|
| Rate for Payer: Nomi Health Commercial |
$336.13
|
| 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 Cigna Priority Health |
$266.45
|
| Rate for Payer: Priority Health HMO/PPO |
$356.63
|
| Rate for Payer: Priority Health Medicare |
$103.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.65
|
| 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 Dual Complete DSNP |
$102.48
|
| Rate for Payer: UHC Exchange |
$102.48
|
| Rate for Payer: UHC Medicare Advantage |
$102.48
|
| Rate for Payer: VA VA |
$102.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.44
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$384.80
|
|
|
Service Code
|
NDC 59762306003
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.39 |
| 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 |
$153.92
|
| Rate for Payer: BCBS MAPPO |
$96.20
|
| Rate for Payer: BCBS Trust/PPO |
$316.34
|
| Rate for Payer: BCN Commercial |
$299.18
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.08
|
| Rate for Payer: Nomi Health Commercial |
$315.54
|
| 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 Cigna Priority Health |
$250.12
|
| Rate for Payer: Priority Health HMO/PPO |
$334.78
|
| Rate for Payer: Priority Health Medicare |
$97.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.82
|
| 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 Dual Complete DSNP |
$96.20
|
| Rate for Payer: UHC Exchange |
$96.20
|
| Rate for Payer: UHC Medicare Advantage |
$96.20
|
| Rate for Payer: VA VA |
$96.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.60
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$37.68
|
|
|
Service Code
|
NDC 50111078766
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.49 |
| Max. Negotiated Rate |
$33.91 |
| Rate for Payer: Aetna Commercial |
$32.03
|
| Rate for Payer: BCBS Trust/PPO |
$30.76
|
| Rate for Payer: BCN Commercial |
$29.12
|
| 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: PHP Commercial |
$32.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.49
|
| Rate for Payer: Priority Health HMO/PPO |
$32.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.25
|
| 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
|
OP
|
$775.20
|
|
|
Service Code
|
NDC 60687028201
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.11 |
| Max. Negotiated Rate |
$697.68 |
| Rate for Payer: Aetna Commercial |
$658.92
|
| Rate for Payer: Aetna Medicare |
$201.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.25
|
| Rate for Payer: BCBS Complete |
$310.08
|
| Rate for Payer: BCBS MAPPO |
$193.80
|
| Rate for Payer: BCBS Trust/PPO |
$637.29
|
| Rate for Payer: BCN Commercial |
$602.72
|
| Rate for Payer: BCN Medicare Advantage |
$193.80
|
| Rate for Payer: Cash Price |
$620.16
|
| Rate for Payer: Cofinity Commercial |
$666.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.80
|
| Rate for Payer: Healthscope Commercial |
$697.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$581.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$658.92
|
| Rate for Payer: Nomi Health Commercial |
$635.66
|
| Rate for Payer: PACE Senior Care Partners |
$184.11
|
| Rate for Payer: PACE SWMI |
$193.80
|
| Rate for Payer: PHP Commercial |
$658.92
|
| Rate for Payer: PHP Medicare Advantage |
$193.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.88
|
| Rate for Payer: Priority Health HMO/PPO |
$674.42
|
| Rate for Payer: Priority Health Medicare |
$195.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$519.38
|
| Rate for Payer: Railroad Medicare Medicare |
$193.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$682.18
|
| Rate for Payer: UHC Core |
$647.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.80
|
| Rate for Payer: UHC Exchange |
$193.80
|
| Rate for Payer: UHC Medicare Advantage |
$193.80
|
| Rate for Payer: VA VA |
$193.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.40
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$513.60
|
|
|
Service Code
|
NDC 00904735061
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$333.84 |
| Max. Negotiated Rate |
$462.24 |
| Rate for Payer: Aetna Commercial |
$436.56
|
| Rate for Payer: BCBS Trust/PPO |
$419.25
|
| Rate for Payer: BCN Commercial |
$396.91
|
| Rate for Payer: Cash Price |
$410.88
|
| Rate for Payer: Cofinity Commercial |
$441.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$410.88
|
| Rate for Payer: Healthscope Commercial |
$462.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$385.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.56
|
| Rate for Payer: Nomi Health Commercial |
$421.15
|
| Rate for Payer: PHP Commercial |
$436.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.84
|
| Rate for Payer: Priority Health HMO/PPO |
$446.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$451.97
|
| Rate for Payer: UHC Core |
$428.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$385.20
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$384.80
|
|
|
Service Code
|
NDC 59762306003
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.12 |
| Max. Negotiated Rate |
$346.32 |
| Rate for Payer: Aetna Commercial |
$327.08
|
| Rate for Payer: BCBS Trust/PPO |
$314.11
|
| Rate for Payer: BCN Commercial |
$297.37
|
| 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: PHP Commercial |
$327.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.12
|
| Rate for Payer: Priority Health HMO/PPO |
$334.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.82
|
| 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 250 MG TABLET
|
Facility
|
OP
|
$513.60
|
|
|
Service Code
|
NDC 00904735061
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.98 |
| Max. Negotiated Rate |
$462.24 |
| Rate for Payer: Aetna Commercial |
$436.56
|
| Rate for Payer: Aetna Medicare |
$133.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.50
|
| Rate for Payer: BCBS Complete |
$205.44
|
| Rate for Payer: BCBS MAPPO |
$128.40
|
| Rate for Payer: BCBS Trust/PPO |
$422.23
|
| Rate for Payer: BCN Commercial |
$399.32
|
| Rate for Payer: BCN Medicare Advantage |
$128.40
|
| Rate for Payer: Cash Price |
$410.88
|
| Rate for Payer: Cofinity Commercial |
$441.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$410.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.40
|
| Rate for Payer: Healthscope Commercial |
$462.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$385.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.56
|
| Rate for Payer: Nomi Health Commercial |
$421.15
|
| Rate for Payer: PACE Senior Care Partners |
$121.98
|
| Rate for Payer: PACE SWMI |
$128.40
|
| Rate for Payer: PHP Commercial |
$436.56
|
| Rate for Payer: PHP Medicare Advantage |
$128.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.84
|
| Rate for Payer: Priority Health HMO/PPO |
$446.83
|
| Rate for Payer: Priority Health Medicare |
$129.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.11
|
| Rate for Payer: Railroad Medicare Medicare |
$128.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$451.97
|
| Rate for Payer: UHC Core |
$428.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.40
|
| Rate for Payer: UHC Exchange |
$128.40
|
| Rate for Payer: UHC Medicare Advantage |
$128.40
|
| Rate for Payer: VA VA |
$128.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$385.20
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$7.76
|
|
|
Service Code
|
NDC 60687028211
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$6.98 |
| Rate for Payer: Aetna Commercial |
$6.60
|
| Rate for Payer: Aetna Medicare |
$2.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.42
|
| Rate for Payer: BCBS Complete |
$3.10
|
| Rate for Payer: BCBS MAPPO |
$1.94
|
| Rate for Payer: BCBS Trust/PPO |
$6.38
|
| Rate for Payer: BCN Commercial |
$6.03
|
| Rate for Payer: BCN Medicare Advantage |
$1.94
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: Cofinity Commercial |
$6.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.94
|
| Rate for Payer: Healthscope Commercial |
$6.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.60
|
| Rate for Payer: Nomi Health Commercial |
$6.36
|
| Rate for Payer: PACE Senior Care Partners |
$1.84
|
| Rate for Payer: PACE SWMI |
$1.94
|
| Rate for Payer: PHP Commercial |
$6.60
|
| Rate for Payer: PHP Medicare Advantage |
$1.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.04
|
| Rate for Payer: Priority Health HMO/PPO |
$6.75
|
| Rate for Payer: Priority Health Medicare |
$1.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.83
|
| Rate for Payer: UHC Core |
$6.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.94
|
| Rate for Payer: UHC Exchange |
$1.94
|
| Rate for Payer: UHC Medicare Advantage |
$1.94
|
| Rate for Payer: VA VA |
$1.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.82
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$51.62
|
|
|
Service Code
|
NDC 50111078751
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.55 |
| Max. Negotiated Rate |
$46.46 |
| Rate for Payer: Aetna Commercial |
$43.88
|
| Rate for Payer: BCBS Trust/PPO |
$42.14
|
| Rate for Payer: BCN Commercial |
$39.89
|
| 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: PHP Commercial |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.55
|
| Rate for Payer: Priority Health HMO/PPO |
$44.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.59
|
| 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 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.16
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
21063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.21 |
| Max. Negotiated Rate |
$23.54 |
| Rate for Payer: Aetna Commercial |
$22.24
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$17.08
|
| Rate for Payer: Aetna Commercial |
$23.73
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna Medicare |
$5.23
|
| Rate for Payer: Aetna Medicare |
$4.54
|
| Rate for Payer: Aetna Medicare |
$6.80
|
| Rate for Payer: Aetna Medicare |
$7.98
|
| Rate for Payer: Aetna Medicare |
$6.54
|
| Rate for Payer: Aetna Medicare |
$7.26
|
| Rate for Payer: Aetna Medicare |
$5.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.18
|
| Rate for Payer: BCBS Complete |
$11.17
|
| Rate for Payer: BCBS Complete |
$6.99
|
| Rate for Payer: BCBS Complete |
$8.04
|
| Rate for Payer: BCBS Complete |
$10.06
|
| Rate for Payer: BCBS Complete |
$10.46
|
| Rate for Payer: BCBS Complete |
$8.30
|
| Rate for Payer: BCBS Complete |
$12.28
|
| Rate for Payer: BCBS MAPPO |
$6.54
|
| Rate for Payer: BCBS MAPPO |
$7.68
|
| Rate for Payer: BCBS MAPPO |
$6.98
|
| Rate for Payer: BCBS MAPPO |
$6.29
|
| Rate for Payer: BCBS MAPPO |
$5.02
|
| Rate for Payer: BCBS MAPPO |
$4.37
|
| Rate for Payer: BCBS MAPPO |
$5.19
|
| Rate for Payer: BCBS Trust/PPO |
$14.36
|
| Rate for Payer: BCBS Trust/PPO |
$16.52
|
| Rate for Payer: BCBS Trust/PPO |
$25.25
|
| Rate for Payer: BCBS Trust/PPO |
$22.95
|
| Rate for Payer: BCBS Trust/PPO |
$17.07
|
| Rate for Payer: BCBS Trust/PPO |
$21.51
|
| Rate for Payer: BCBS Trust/PPO |
$20.68
|
| Rate for Payer: BCN Commercial |
$19.56
|
| Rate for Payer: BCN Commercial |
$13.58
|
| Rate for Payer: BCN Commercial |
$16.14
|
| Rate for Payer: BCN Commercial |
$15.63
|
| Rate for Payer: BCN Commercial |
$21.71
|
| Rate for Payer: BCN Commercial |
$20.34
|
| Rate for Payer: BCN Commercial |
$23.88
|
| Rate for Payer: BCN Medicare Advantage |
$7.68
|
| Rate for Payer: BCN Medicare Advantage |
$6.54
|
| Rate for Payer: BCN Medicare Advantage |
$6.98
|
| Rate for Payer: BCN Medicare Advantage |
$5.19
|
| Rate for Payer: BCN Medicare Advantage |
$4.37
|
| Rate for Payer: BCN Medicare Advantage |
$5.02
|
| Rate for Payer: BCN Medicare Advantage |
$6.29
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$20.13
|
| Rate for Payer: Cash Price |
$22.34
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.64
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$22.50
|
| Rate for Payer: Cofinity Commercial |
$24.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| 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 |
$22.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.29
|
| Rate for Payer: Healthscope Commercial |
$22.64
|
| Rate for Payer: Healthscope Commercial |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$25.13
|
| Rate for Payer: Healthscope Commercial |
$18.09
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$18.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.94
|
| 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 |
$5.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.60
|
| 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 |
$7.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| 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 |
$17.08
|
| Rate for Payer: Nomi Health Commercial |
$22.89
|
| Rate for Payer: Nomi Health Commercial |
$14.33
|
| Rate for Payer: Nomi Health Commercial |
$16.48
|
| Rate for Payer: Nomi Health Commercial |
$25.18
|
| Rate for Payer: Nomi Health Commercial |
$20.63
|
| Rate for Payer: Nomi Health Commercial |
$17.02
|
| Rate for Payer: Nomi Health Commercial |
$21.45
|
| Rate for Payer: PACE Senior Care Partners |
$6.21
|
| Rate for Payer: PACE Senior Care Partners |
$7.29
|
| Rate for Payer: PACE Senior Care Partners |
$5.98
|
| Rate for Payer: PACE Senior Care Partners |
$4.77
|
| Rate for Payer: PACE Senior Care Partners |
$4.15
|
| Rate for Payer: PACE Senior Care Partners |
$4.93
|
| Rate for Payer: PACE Senior Care Partners |
$6.63
|
| Rate for Payer: PACE SWMI |
$6.98
|
| Rate for Payer: PACE SWMI |
$5.19
|
| Rate for Payer: PACE SWMI |
$6.54
|
| Rate for Payer: PACE SWMI |
$4.37
|
| Rate for Payer: PACE SWMI |
$6.29
|
| Rate for Payer: PACE SWMI |
$5.02
|
| Rate for Payer: PACE SWMI |
$7.68
|
| Rate for Payer: PHP Commercial |
$22.24
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$23.73
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: PHP Commercial |
$17.08
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: PHP Medicare Advantage |
$4.37
|
| Rate for Payer: PHP Medicare Advantage |
$6.29
|
| Rate for Payer: PHP Medicare Advantage |
$5.19
|
| Rate for Payer: PHP Medicare Advantage |
$6.54
|
| Rate for Payer: PHP Medicare Advantage |
$6.98
|
| Rate for Payer: PHP Medicare Advantage |
$5.02
|
| Rate for Payer: PHP Medicare Advantage |
$7.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.36
|
| Rate for Payer: Priority Health HMO/PPO |
$17.49
|
| Rate for Payer: Priority Health HMO/PPO |
$21.89
|
| Rate for Payer: Priority Health HMO/PPO |
$22.76
|
| Rate for Payer: Priority Health HMO/PPO |
$24.29
|
| Rate for Payer: Priority Health HMO/PPO |
$18.06
|
| Rate for Payer: Priority Health HMO/PPO |
$26.72
|
| Rate for Payer: Priority Health HMO/PPO |
$15.20
|
| Rate for Payer: Priority Health Medicare |
$5.08
|
| Rate for Payer: Priority Health Medicare |
$6.35
|
| Rate for Payer: Priority Health Medicare |
$5.24
|
| Rate for Payer: Priority Health Medicare |
$4.41
|
| Rate for Payer: Priority Health Medicare |
$6.61
|
| Rate for Payer: Priority Health Medicare |
$7.05
|
| Rate for Payer: Priority Health Medicare |
$7.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.86
|
| Rate for Payer: Railroad Medicare Medicare |
$7.68
|
| Rate for Payer: Railroad Medicare Medicare |
$4.37
|
| Rate for Payer: Railroad Medicare Medicare |
$6.98
|
| Rate for Payer: Railroad Medicare Medicare |
$6.29
|
| Rate for Payer: Railroad Medicare Medicare |
$5.19
|
| Rate for Payer: Railroad Medicare Medicare |
$5.02
|
| Rate for Payer: Railroad Medicare Medicare |
$6.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.37
|
| Rate for Payer: UHC Core |
$16.78
|
| Rate for Payer: UHC Core |
$23.31
|
| Rate for Payer: UHC Core |
$14.59
|
| Rate for Payer: UHC Core |
$21.01
|
| Rate for Payer: UHC Core |
$17.33
|
| Rate for Payer: UHC Core |
$21.84
|
| Rate for Payer: UHC Core |
$25.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.68
|
| Rate for Payer: UHC Exchange |
$6.29
|
| Rate for Payer: UHC Exchange |
$6.98
|
| Rate for Payer: UHC Exchange |
$7.68
|
| Rate for Payer: UHC Exchange |
$5.02
|
| Rate for Payer: UHC Exchange |
$5.19
|
| Rate for Payer: UHC Exchange |
$4.37
|
| Rate for Payer: UHC Exchange |
$6.54
|
| Rate for Payer: UHC Medicare Advantage |
$7.68
|
| Rate for Payer: UHC Medicare Advantage |
$4.37
|
| Rate for Payer: UHC Medicare Advantage |
$5.19
|
| Rate for Payer: UHC Medicare Advantage |
$6.29
|
| Rate for Payer: UHC Medicare Advantage |
$6.54
|
| Rate for Payer: UHC Medicare Advantage |
$6.98
|
| Rate for Payer: UHC Medicare Advantage |
$5.02
|
| Rate for Payer: VA VA |
$5.19
|
| Rate for Payer: VA VA |
$6.29
|
| Rate for Payer: VA VA |
$5.02
|
| Rate for Payer: VA VA |
$7.68
|
| Rate for Payer: VA VA |
$4.37
|
| Rate for Payer: VA VA |
$6.54
|
| Rate for Payer: VA VA |
$6.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.94
|
| 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 |
$19.62
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$30.71
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
21063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.96 |
| Max. Negotiated Rate |
$27.64 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$17.08
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$22.24
|
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Commercial |
$23.73
|
| Rate for Payer: BCBS Trust/PPO |
$25.07
|
| Rate for Payer: BCBS Trust/PPO |
$16.41
|
| Rate for Payer: BCBS Trust/PPO |
$22.79
|
| Rate for Payer: BCBS Trust/PPO |
$14.26
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCBS Trust/PPO |
$16.95
|
| Rate for Payer: BCBS Trust/PPO |
$20.54
|
| Rate for Payer: BCN Commercial |
$16.04
|
| Rate for Payer: BCN Commercial |
$21.58
|
| Rate for Payer: BCN Commercial |
$23.73
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: BCN Commercial |
$15.53
|
| Rate for Payer: BCN Commercial |
$19.44
|
| Rate for Payer: BCN Commercial |
$13.50
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$22.34
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cash Price |
$20.13
|
| Rate for Payer: Cofinity Commercial |
$21.64
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$22.50
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Cofinity Commercial |
$24.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.34
|
| 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 |
$16.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Healthscope Commercial |
$18.09
|
| Rate for Payer: Healthscope Commercial |
$18.68
|
| Rate for Payer: Healthscope Commercial |
$25.13
|
| Rate for Payer: Healthscope Commercial |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Healthscope Commercial |
$22.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.65
|
| Rate for Payer: Nomi Health Commercial |
$20.63
|
| Rate for Payer: Nomi Health Commercial |
$14.33
|
| Rate for Payer: Nomi Health Commercial |
$25.18
|
| Rate for Payer: Nomi Health Commercial |
$22.89
|
| Rate for Payer: Nomi Health Commercial |
$21.45
|
| Rate for Payer: Nomi Health Commercial |
$17.02
|
| Rate for Payer: Nomi Health Commercial |
$16.48
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: PHP Commercial |
$22.24
|
| Rate for Payer: PHP Commercial |
$23.73
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$17.08
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.06
|
| 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 |
$19.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.35
|
| Rate for Payer: Priority Health HMO/PPO |
$17.49
|
| Rate for Payer: Priority Health HMO/PPO |
$22.76
|
| Rate for Payer: Priority Health HMO/PPO |
$26.72
|
| Rate for Payer: Priority Health HMO/PPO |
$18.06
|
| Rate for Payer: Priority Health HMO/PPO |
$21.89
|
| Rate for Payer: Priority Health HMO/PPO |
$15.20
|
| Rate for Payer: Priority Health HMO/PPO |
$24.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.27
|
| Rate for Payer: UHC Core |
$14.59
|
| Rate for Payer: UHC Core |
$23.31
|
| Rate for Payer: UHC Core |
$16.78
|
| Rate for Payer: UHC Core |
$17.33
|
| Rate for Payer: UHC Core |
$21.84
|
| Rate for Payer: UHC Core |
$25.64
|
| Rate for Payer: UHC Core |
$21.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.94
|
|
|
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 |
$21.69 |
| Max. Negotiated Rate |
$82.21 |
| Rate for Payer: Aetna Commercial |
$77.64
|
| Rate for Payer: Aetna Commercial |
$86.96
|
| Rate for Payer: Aetna Medicare |
$23.75
|
| Rate for Payer: Aetna Medicare |
$26.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.97
|
| Rate for Payer: BCBS Complete |
$40.92
|
| Rate for Payer: BCBS Complete |
$36.54
|
| Rate for Payer: BCBS MAPPO |
$25.58
|
| Rate for Payer: BCBS MAPPO |
$22.84
|
| Rate for Payer: BCBS Trust/PPO |
$75.09
|
| Rate for Payer: BCBS Trust/PPO |
$84.11
|
| Rate for Payer: BCN Commercial |
$71.02
|
| Rate for Payer: BCN Commercial |
$79.55
|
| Rate for Payer: BCN Medicare Advantage |
$22.84
|
| Rate for Payer: BCN Medicare Advantage |
$25.58
|
| Rate for Payer: Cash Price |
$73.07
|
| Rate for Payer: Cash Price |
$81.85
|
| 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 |
$25.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.84
|
| Rate for Payer: Healthscope Commercial |
$92.08
|
| Rate for Payer: Healthscope Commercial |
$82.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.26
|
| 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: 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 |
$77.64
|
| Rate for Payer: PHP Commercial |
$86.96
|
| Rate for Payer: PHP Medicare Advantage |
$25.58
|
| Rate for Payer: PHP Medicare Advantage |
$22.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health HMO/PPO |
$89.01
|
| Rate for Payer: Priority Health HMO/PPO |
$79.47
|
| Rate for Payer: Priority Health Medicare |
$23.06
|
| Rate for Payer: Priority Health Medicare |
$25.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.55
|
| 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 Dual Complete DSNP |
$22.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.58
|
| Rate for Payer: UHC Exchange |
$25.58
|
| Rate for Payer: UHC Exchange |
$22.84
|
| Rate for Payer: UHC Medicare Advantage |
$25.58
|
| Rate for Payer: UHC Medicare Advantage |
$22.84
|
| 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 |
$66.50 |
| 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 |
$83.52
|
| Rate for Payer: BCBS Trust/PPO |
$74.56
|
| Rate for Payer: BCN Commercial |
$79.07
|
| Rate for Payer: BCN Commercial |
$70.59
|
| 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: PHP Commercial |
$86.96
|
| Rate for Payer: PHP Commercial |
$77.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health HMO/PPO |
$79.47
|
| Rate for Payer: Priority Health HMO/PPO |
$89.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.20
|
| 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 |
$59.37 |
| Max. Negotiated Rate |
$82.21 |
| Rate for Payer: Aetna Commercial |
$77.64
|
| Rate for Payer: BCBS Trust/PPO |
$74.56
|
| Rate for Payer: BCN Commercial |
$70.59
|
| 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: PHP Commercial |
$77.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.37
|
| Rate for Payer: Priority Health HMO/PPO |
$79.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.20
|
| 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 |
$21.69 |
| 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 |
$36.54
|
| Rate for Payer: BCBS MAPPO |
$22.84
|
| Rate for Payer: BCBS Trust/PPO |
$75.09
|
| Rate for Payer: BCN Commercial |
$71.02
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.64
|
| Rate for Payer: Nomi Health Commercial |
$74.90
|
| 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 Cigna Priority Health |
$59.37
|
| Rate for Payer: Priority Health HMO/PPO |
$79.47
|
| Rate for Payer: Priority Health Medicare |
$23.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.20
|
| 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 Dual Complete DSNP |
$22.84
|
| Rate for Payer: UHC Exchange |
$22.84
|
| Rate for Payer: UHC Medicare Advantage |
$22.84
|
| 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
|
$208.87
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.61 |
| Max. Negotiated Rate |
$187.98 |
| Rate for Payer: Aetna Commercial |
$177.54
|
| Rate for Payer: Aetna Commercial |
$158.55
|
| Rate for Payer: Aetna Medicare |
$54.31
|
| Rate for Payer: Aetna Medicare |
$48.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.29
|
| Rate for Payer: BCBS Complete |
$74.61
|
| Rate for Payer: BCBS Complete |
$83.55
|
| Rate for Payer: BCBS MAPPO |
$46.63
|
| Rate for Payer: BCBS MAPPO |
$52.22
|
| Rate for Payer: BCBS Trust/PPO |
$171.71
|
| Rate for Payer: BCBS Trust/PPO |
$153.35
|
| Rate for Payer: BCN Commercial |
$162.40
|
| Rate for Payer: BCN Commercial |
$145.03
|
| Rate for Payer: BCN Medicare Advantage |
$52.22
|
| Rate for Payer: BCN Medicare Advantage |
$46.63
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$149.22
|
| 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 |
$46.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$167.88
|
| Rate for Payer: Healthscope Commercial |
$187.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.05
|
| 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: 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 |
$177.54
|
| Rate for Payer: PHP Commercial |
$158.55
|
| Rate for Payer: PHP Medicare Advantage |
$46.63
|
| Rate for Payer: PHP Medicare Advantage |
$52.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.24
|
| Rate for Payer: Priority Health HMO/PPO |
$162.28
|
| Rate for Payer: Priority Health HMO/PPO |
$181.72
|
| Rate for Payer: Priority Health Medicare |
$52.74
|
| Rate for Payer: Priority Health Medicare |
$47.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.98
|
| 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 Dual Complete DSNP |
$52.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.63
|
| Rate for Payer: UHC Exchange |
$46.63
|
| Rate for Payer: UHC Exchange |
$52.22
|
| Rate for Payer: UHC Medicare Advantage |
$46.63
|
| Rate for Payer: UHC Medicare Advantage |
$52.22
|
| 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
|
|
