|
AZATHIOPRINE 50 MG TABLET
|
Facility
|
OP
|
$254.60
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
9183
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$229.14 |
| Rate for Payer: Aetna American Axle |
$165.49
|
| Rate for Payer: Aetna American Axle |
$1.73
|
| Rate for Payer: Aetna American Axle |
$172.85
|
| Rate for Payer: Aetna American Axle |
$143.88
|
| Rate for Payer: Aetna American Axle |
$266.76
|
| Rate for Payer: Aetna Commercial |
$216.41
|
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: Aetna Commercial |
$348.84
|
| Rate for Payer: Aetna Commercial |
$226.03
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Medicare |
$132.96
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: Aetna Medicare |
$127.30
|
| Rate for Payer: Aetna Medicare |
$110.68
|
| Rate for Payer: Aetna Medicare |
$205.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.85
|
| Rate for Payer: BCBS Complete |
$101.84
|
| Rate for Payer: BCBS Complete |
$88.54
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS Complete |
$164.16
|
| Rate for Payer: BCBS Complete |
$106.37
|
| Rate for Payer: BCBS Trust/PPO |
$4.34
|
| Rate for Payer: BCBS Trust/PPO |
$4.34
|
| Rate for Payer: BCBS Trust/PPO |
$4.34
|
| Rate for Payer: BCBS Trust/PPO |
$4.34
|
| Rate for Payer: BCBS Trust/PPO |
$4.34
|
| Rate for Payer: BCN Commercial |
$4.34
|
| Rate for Payer: BCN Commercial |
$4.34
|
| Rate for Payer: BCN Commercial |
$4.34
|
| Rate for Payer: BCN Commercial |
$4.34
|
| Rate for Payer: BCN Commercial |
$4.34
|
| Rate for Payer: Cash Price |
$203.68
|
| Rate for Payer: Cash Price |
$212.74
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cash Price |
$203.68
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cash Price |
$212.74
|
| Rate for Payer: Cash Price |
$328.32
|
| Rate for Payer: Cash Price |
$328.32
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Commercial |
$178.22
|
| Rate for Payer: Cofinity Commercial |
$352.94
|
| Rate for Payer: Cofinity Commercial |
$154.94
|
| Rate for Payer: Cofinity Commercial |
$228.69
|
| Rate for Payer: Cofinity Commercial |
$186.14
|
| Rate for Payer: Cofinity Commercial |
$287.28
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$218.96
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Healthscope Commercial |
$229.14
|
| Rate for Payer: Healthscope Commercial |
$239.33
|
| Rate for Payer: Healthscope Commercial |
$369.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: PHP Commercial |
$348.84
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$216.41
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: PHP Commercial |
$226.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.49
|
| Rate for Payer: Priority Health SBD |
$160.40
|
| Rate for Payer: Priority Health SBD |
$258.55
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: Priority Health SBD |
$139.45
|
| Rate for Payer: Priority Health SBD |
$167.53
|
| Rate for Payer: UMR Bronson Commercial |
$81.90
|
| Rate for Payer: UMR Bronson Commercial |
$98.39
|
| Rate for Payer: UMR Bronson Commercial |
$94.20
|
| Rate for Payer: UMR Bronson Commercial |
$0.98
|
| Rate for Payer: UMR Bronson Commercial |
$151.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
|
|
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 |
$51.39 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna American Axle |
$75.91
|
| Rate for Payer: Aetna Commercial |
$99.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.91
|
| Rate for Payer: Cash Price |
$93.43
|
| Rate for Payer: Cofinity Commercial |
$100.44
|
| Rate for Payer: Cofinity Commercial |
$81.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.43
|
| Rate for Payer: Healthscope Commercial |
$105.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.27
|
| Rate for Payer: PHP Commercial |
$99.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.91
|
| Rate for Payer: Priority Health SBD |
$73.58
|
| Rate for Payer: UMR Bronson Commercial |
$51.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.59
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$89.28
|
|
|
Service Code
|
NDC 59762314001
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Aetna American Axle |
$58.03
|
| Rate for Payer: Aetna Commercial |
$75.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.03
|
| Rate for Payer: Cash Price |
$71.42
|
| Rate for Payer: Cofinity Commercial |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$76.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$80.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.89
|
| Rate for Payer: PHP Commercial |
$75.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.03
|
| Rate for Payer: Priority Health SBD |
$56.25
|
| Rate for Payer: UMR Bronson Commercial |
$39.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.96
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$96.62
|
|
|
Service Code
|
NDC 42806015134
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$86.96 |
| Rate for Payer: Aetna American Axle |
$62.80
|
| Rate for Payer: Aetna Commercial |
$82.13
|
| Rate for Payer: Aetna Medicare |
$48.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.80
|
| Rate for Payer: BCBS Complete |
$38.65
|
| Rate for Payer: Cash Price |
$77.30
|
| Rate for Payer: Cofinity Commercial |
$67.63
|
| Rate for Payer: Cofinity Commercial |
$83.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.30
|
| Rate for Payer: Healthscope Commercial |
$86.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.13
|
| Rate for Payer: PHP Commercial |
$82.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.80
|
| Rate for Payer: Priority Health SBD |
$60.87
|
| Rate for Payer: UMR Bronson Commercial |
$35.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.46
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$116.79
|
|
|
Service Code
|
NDC 00093202631
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.21 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna American Axle |
$75.91
|
| Rate for Payer: Aetna Commercial |
$99.27
|
| Rate for Payer: Aetna Medicare |
$58.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.91
|
| Rate for Payer: BCBS Complete |
$46.72
|
| Rate for Payer: Cash Price |
$93.43
|
| Rate for Payer: Cofinity Commercial |
$100.44
|
| Rate for Payer: Cofinity Commercial |
$81.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.43
|
| Rate for Payer: Healthscope Commercial |
$105.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.27
|
| Rate for Payer: PHP Commercial |
$99.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.91
|
| Rate for Payer: Priority Health SBD |
$73.58
|
| Rate for Payer: UMR Bronson Commercial |
$43.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.59
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$89.28
|
|
|
Service Code
|
NDC 59762314001
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.03 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Aetna American Axle |
$58.03
|
| Rate for Payer: Aetna Commercial |
$75.89
|
| Rate for Payer: Aetna Medicare |
$44.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.03
|
| Rate for Payer: BCBS Complete |
$35.71
|
| Rate for Payer: Cash Price |
$71.42
|
| Rate for Payer: Cofinity Commercial |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$76.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$80.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.89
|
| Rate for Payer: PHP Commercial |
$75.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.03
|
| Rate for Payer: Priority Health SBD |
$56.25
|
| Rate for Payer: UMR Bronson Commercial |
$33.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.96
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$96.62
|
|
|
Service Code
|
NDC 42806015134
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$86.96 |
| Rate for Payer: Aetna American Axle |
$62.80
|
| Rate for Payer: Aetna Commercial |
$82.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.80
|
| Rate for Payer: Cash Price |
$77.30
|
| Rate for Payer: Cofinity Commercial |
$67.63
|
| Rate for Payer: Cofinity Commercial |
$83.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.30
|
| Rate for Payer: Healthscope Commercial |
$86.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.13
|
| Rate for Payer: PHP Commercial |
$82.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.80
|
| Rate for Payer: Priority Health SBD |
$60.87
|
| Rate for Payer: UMR Bronson Commercial |
$42.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.46
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$384.80
|
|
|
Service Code
|
NDC 59762306003
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.38 |
| Max. Negotiated Rate |
$346.32 |
| Rate for Payer: Aetna American Axle |
$250.12
|
| Rate for Payer: Aetna Commercial |
$327.08
|
| Rate for Payer: Aetna Medicare |
$192.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.12
|
| Rate for Payer: BCBS Complete |
$153.92
|
| Rate for Payer: Cash Price |
$307.84
|
| Rate for Payer: Cofinity Commercial |
$269.36
|
| Rate for Payer: Cofinity Commercial |
$330.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.84
|
| Rate for Payer: Healthscope Commercial |
$346.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.08
|
| Rate for Payer: PHP Commercial |
$327.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.12
|
| Rate for Payer: Priority Health SBD |
$242.42
|
| Rate for Payer: UMR Bronson Commercial |
$142.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.60
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$37.68
|
|
|
Service Code
|
NDC 50111078766
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$33.91 |
| Rate for Payer: Aetna American Axle |
$24.49
|
| Rate for Payer: Aetna Commercial |
$32.03
|
| Rate for Payer: Aetna Medicare |
$18.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.49
|
| Rate for Payer: BCBS Complete |
$15.07
|
| Rate for Payer: Cash Price |
$30.14
|
| Rate for Payer: Cofinity Commercial |
$26.38
|
| Rate for Payer: Cofinity Commercial |
$32.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.14
|
| Rate for Payer: Healthscope Commercial |
$33.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.03
|
| Rate for Payer: PHP Commercial |
$32.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.49
|
| Rate for Payer: Priority Health SBD |
$23.74
|
| Rate for Payer: UMR Bronson Commercial |
$13.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.26
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$284.12
|
|
|
Service Code
|
NDC 51224002230
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.12 |
| Max. Negotiated Rate |
$255.71 |
| Rate for Payer: Aetna American Axle |
$184.68
|
| Rate for Payer: Aetna Commercial |
$241.50
|
| Rate for Payer: Aetna Medicare |
$142.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.68
|
| Rate for Payer: BCBS Complete |
$113.65
|
| Rate for Payer: Cash Price |
$227.30
|
| Rate for Payer: Cofinity Commercial |
$198.88
|
| Rate for Payer: Cofinity Commercial |
$244.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$198.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.30
|
| Rate for Payer: Healthscope Commercial |
$255.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.50
|
| Rate for Payer: PHP Commercial |
$241.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.68
|
| Rate for Payer: Priority Health SBD |
$179.00
|
| Rate for Payer: UMR Bronson Commercial |
$105.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.09
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$19.68
|
|
|
Service Code
|
NDC 65862064163
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Aetna American Axle |
$12.79
|
| Rate for Payer: Aetna Commercial |
$16.73
|
| Rate for Payer: Aetna Medicare |
$9.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.79
|
| Rate for Payer: BCBS Complete |
$7.87
|
| Rate for Payer: Cash Price |
$15.74
|
| Rate for Payer: Cofinity Commercial |
$13.78
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.74
|
| Rate for Payer: Healthscope Commercial |
$17.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.73
|
| Rate for Payer: PHP Commercial |
$16.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.79
|
| Rate for Payer: Priority Health SBD |
$12.40
|
| Rate for Payer: UMR Bronson Commercial |
$7.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.76
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$5.65
|
|
|
Service Code
|
NDC 60687074211
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$5.08 |
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Cofinity Commercial |
$4.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.96
|
| Rate for Payer: Aetna American Axle |
$3.67
|
| Rate for Payer: Aetna Commercial |
$4.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.67
|
| Rate for Payer: Cash Price |
$4.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.52
|
| Rate for Payer: Healthscope Commercial |
$5.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.80
|
| Rate for Payer: PHP Commercial |
$4.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.67
|
| Rate for Payer: Priority Health SBD |
$3.56
|
| Rate for Payer: UMR Bronson Commercial |
$2.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.24
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$284.55
|
|
|
Service Code
|
NDC 68180016006
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.20 |
| Max. Negotiated Rate |
$256.10 |
| Rate for Payer: Aetna American Axle |
$184.96
|
| Rate for Payer: Aetna Commercial |
$241.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.96
|
| Rate for Payer: Cash Price |
$227.64
|
| Rate for Payer: Cofinity Commercial |
$199.18
|
| Rate for Payer: Cofinity Commercial |
$244.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$199.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.64
|
| Rate for Payer: Healthscope Commercial |
$256.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.87
|
| Rate for Payer: PHP Commercial |
$241.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.96
|
| Rate for Payer: Priority Health SBD |
$179.27
|
| Rate for Payer: UMR Bronson Commercial |
$125.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.41
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$564.96
|
|
|
Service Code
|
NDC 60687074201
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.58 |
| Max. Negotiated Rate |
$508.46 |
| Rate for Payer: Aetna American Axle |
$367.22
|
| Rate for Payer: Aetna Commercial |
$480.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.22
|
| Rate for Payer: Cash Price |
$451.97
|
| Rate for Payer: Cofinity Commercial |
$395.47
|
| Rate for Payer: Cofinity Commercial |
$485.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$395.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$451.97
|
| Rate for Payer: Healthscope Commercial |
$508.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$395.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$480.22
|
| Rate for Payer: PHP Commercial |
$480.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.22
|
| Rate for Payer: Priority Health SBD |
$355.92
|
| Rate for Payer: UMR Bronson Commercial |
$248.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.72
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$37.68
|
|
|
Service Code
|
NDC 50111078766
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.58 |
| Max. Negotiated Rate |
$33.91 |
| Rate for Payer: Aetna American Axle |
$24.49
|
| Rate for Payer: Aetna Commercial |
$32.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.49
|
| Rate for Payer: Cash Price |
$30.14
|
| Rate for Payer: Cofinity Commercial |
$26.38
|
| Rate for Payer: Cofinity Commercial |
$32.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.14
|
| Rate for Payer: Healthscope Commercial |
$33.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.03
|
| Rate for Payer: PHP Commercial |
$32.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.49
|
| Rate for Payer: Priority Health SBD |
$23.74
|
| Rate for Payer: UMR Bronson Commercial |
$16.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.26
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$7.76
|
|
|
Service Code
|
NDC 60687028211
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$6.98 |
| Rate for Payer: Aetna American Axle |
$5.04
|
| Rate for Payer: Aetna Commercial |
$6.60
|
| Rate for Payer: Aetna Medicare |
$3.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.04
|
| Rate for Payer: BCBS Complete |
$3.10
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: Cofinity Commercial |
$5.43
|
| Rate for Payer: Cofinity Commercial |
$6.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.21
|
| Rate for Payer: Healthscope Commercial |
$6.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.60
|
| Rate for Payer: PHP Commercial |
$6.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.04
|
| Rate for Payer: Priority Health SBD |
$4.89
|
| Rate for Payer: UMR Bronson Commercial |
$2.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.82
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$154.08
|
|
|
Service Code
|
NDC 00904670806
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.01 |
| Max. Negotiated Rate |
$138.67 |
| Rate for Payer: Aetna American Axle |
$100.15
|
| Rate for Payer: Aetna Commercial |
$130.97
|
| Rate for Payer: Aetna Medicare |
$77.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.15
|
| Rate for Payer: BCBS Complete |
$61.63
|
| Rate for Payer: Cash Price |
$123.26
|
| Rate for Payer: Cofinity Commercial |
$107.86
|
| Rate for Payer: Cofinity Commercial |
$132.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.26
|
| Rate for Payer: Healthscope Commercial |
$138.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.97
|
| Rate for Payer: PHP Commercial |
$130.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.15
|
| Rate for Payer: Priority Health SBD |
$97.07
|
| Rate for Payer: UMR Bronson Commercial |
$57.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.56
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$140.51
|
|
|
Service Code
|
NDC 00781808931
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.99 |
| Max. Negotiated Rate |
$126.46 |
| Rate for Payer: Aetna American Axle |
$91.33
|
| Rate for Payer: Aetna Commercial |
$119.43
|
| Rate for Payer: Aetna Medicare |
$70.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.33
|
| Rate for Payer: BCBS Complete |
$56.20
|
| Rate for Payer: Cash Price |
$112.41
|
| Rate for Payer: Cofinity Commercial |
$120.84
|
| Rate for Payer: Cofinity Commercial |
$98.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.41
|
| Rate for Payer: Healthscope Commercial |
$126.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.43
|
| Rate for Payer: PHP Commercial |
$119.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.33
|
| Rate for Payer: Priority Health SBD |
$88.52
|
| Rate for Payer: UMR Bronson Commercial |
$51.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.38
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$284.55
|
|
|
Service Code
|
NDC 68180016006
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.28 |
| Max. Negotiated Rate |
$256.10 |
| Rate for Payer: Aetna American Axle |
$184.96
|
| Rate for Payer: Aetna Commercial |
$241.87
|
| Rate for Payer: Aetna Medicare |
$142.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.96
|
| Rate for Payer: BCBS Complete |
$113.82
|
| Rate for Payer: Cash Price |
$227.64
|
| Rate for Payer: Cofinity Commercial |
$199.18
|
| Rate for Payer: Cofinity Commercial |
$244.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$199.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.64
|
| Rate for Payer: Healthscope Commercial |
$256.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.87
|
| Rate for Payer: PHP Commercial |
$241.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.96
|
| Rate for Payer: Priority Health SBD |
$179.27
|
| Rate for Payer: UMR Bronson Commercial |
$105.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.41
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$51.62
|
|
|
Service Code
|
NDC 50111078751
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.71 |
| Max. Negotiated Rate |
$46.46 |
| Rate for Payer: Cofinity Commercial |
$36.13
|
| Rate for Payer: Cofinity Commercial |
$44.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.13
|
| Rate for Payer: Aetna American Axle |
$33.55
|
| Rate for Payer: Aetna Commercial |
$43.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.55
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.30
|
| Rate for Payer: Healthscope Commercial |
$46.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.88
|
| Rate for Payer: PHP Commercial |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.55
|
| Rate for Payer: Priority Health SBD |
$32.52
|
| Rate for Payer: UMR Bronson Commercial |
$22.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.72
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$140.51
|
|
|
Service Code
|
NDC 00781808931
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.82 |
| Max. Negotiated Rate |
$126.46 |
| Rate for Payer: Aetna American Axle |
$91.33
|
| Rate for Payer: Aetna Commercial |
$119.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.33
|
| Rate for Payer: Cash Price |
$112.41
|
| Rate for Payer: Cofinity Commercial |
$120.84
|
| Rate for Payer: Cofinity Commercial |
$98.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.41
|
| Rate for Payer: Healthscope Commercial |
$126.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.43
|
| Rate for Payer: PHP Commercial |
$119.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.33
|
| Rate for Payer: Priority Health SBD |
$88.52
|
| Rate for Payer: UMR Bronson Commercial |
$61.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.38
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$775.20
|
|
|
Service Code
|
NDC 60687028201
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$341.09 |
| Max. Negotiated Rate |
$697.68 |
| Rate for Payer: Aetna American Axle |
$503.88
|
| Rate for Payer: Aetna Commercial |
$658.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.88
|
| Rate for Payer: Cash Price |
$620.16
|
| Rate for Payer: Cofinity Commercial |
$542.64
|
| Rate for Payer: Cofinity Commercial |
$666.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$542.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.16
|
| Rate for Payer: Healthscope Commercial |
$697.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$542.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$581.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$658.92
|
| Rate for Payer: PHP Commercial |
$658.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.88
|
| Rate for Payer: Priority Health SBD |
$488.38
|
| Rate for Payer: UMR Bronson Commercial |
$341.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.40
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$184.08
|
|
|
Service Code
|
NDC 60687074265
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$165.67 |
| Rate for Payer: Aetna American Axle |
$119.65
|
| Rate for Payer: Aetna Commercial |
$156.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.65
|
| Rate for Payer: Cash Price |
$147.26
|
| Rate for Payer: Cofinity Commercial |
$128.86
|
| Rate for Payer: Cofinity Commercial |
$158.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.26
|
| Rate for Payer: Healthscope Commercial |
$165.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.47
|
| Rate for Payer: PHP Commercial |
$156.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.65
|
| Rate for Payer: Priority Health SBD |
$115.97
|
| Rate for Payer: UMR Bronson Commercial |
$81.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.06
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$384.80
|
|
|
Service Code
|
NDC 59762306003
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.31 |
| Max. Negotiated Rate |
$346.32 |
| Rate for Payer: Aetna American Axle |
$250.12
|
| Rate for Payer: Aetna Commercial |
$327.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.12
|
| Rate for Payer: Cash Price |
$307.84
|
| Rate for Payer: Cofinity Commercial |
$269.36
|
| Rate for Payer: Cofinity Commercial |
$330.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.84
|
| Rate for Payer: Healthscope Commercial |
$346.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.08
|
| Rate for Payer: PHP Commercial |
$327.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.12
|
| Rate for Payer: Priority Health SBD |
$242.42
|
| Rate for Payer: UMR Bronson Commercial |
$169.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.60
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$19.68
|
|
|
Service Code
|
NDC 65862064169
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Aetna American Axle |
$12.79
|
| Rate for Payer: Aetna Commercial |
$16.73
|
| Rate for Payer: Aetna Medicare |
$9.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.79
|
| Rate for Payer: BCBS Complete |
$7.87
|
| Rate for Payer: Cash Price |
$15.74
|
| Rate for Payer: Cofinity Commercial |
$13.78
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.74
|
| Rate for Payer: Healthscope Commercial |
$17.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.73
|
| Rate for Payer: PHP Commercial |
$16.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.79
|
| Rate for Payer: Priority Health SBD |
$12.40
|
| Rate for Payer: UMR Bronson Commercial |
$7.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.76
|
|
