|
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 |
$199.19
|
| Rate for Payer: Cofinity Commercial |
$244.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$199.19
|
| 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 |
$199.19
|
| 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
|
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
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$593.85
|
|
|
Service Code
|
NDC 00069406189
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.72 |
| Max. Negotiated Rate |
$534.47 |
| Rate for Payer: Aetna American Axle |
$386.00
|
| Rate for Payer: Aetna Commercial |
$504.77
|
| Rate for Payer: Aetna Medicare |
$296.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.00
|
| Rate for Payer: BCBS Complete |
$237.54
|
| Rate for Payer: Cash Price |
$475.08
|
| Rate for Payer: Cofinity Commercial |
$415.69
|
| Rate for Payer: Cofinity Commercial |
$510.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$415.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.08
|
| Rate for Payer: Healthscope Commercial |
$534.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$415.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$445.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$504.77
|
| Rate for Payer: PHP Commercial |
$504.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.00
|
| Rate for Payer: Priority Health SBD |
$374.13
|
| Rate for Payer: UMR Bronson Commercial |
$219.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$445.39
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$224.11
|
|
|
Service Code
|
NDC 50111078710
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.92 |
| Max. Negotiated Rate |
$201.70 |
| Rate for Payer: Aetna American Axle |
$145.67
|
| Rate for Payer: Aetna Commercial |
$190.49
|
| Rate for Payer: Aetna Medicare |
$112.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.67
|
| Rate for Payer: BCBS Complete |
$89.64
|
| Rate for Payer: Cash Price |
$179.29
|
| Rate for Payer: Cofinity Commercial |
$156.88
|
| Rate for Payer: Cofinity Commercial |
$192.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.29
|
| Rate for Payer: Healthscope Commercial |
$201.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.49
|
| Rate for Payer: PHP Commercial |
$190.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.67
|
| Rate for Payer: Priority Health SBD |
$141.19
|
| Rate for Payer: UMR Bronson Commercial |
$82.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.08
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$7.76
|
|
|
Service Code
|
NDC 60687028211
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$6.98 |
| Rate for Payer: Aetna American Axle |
$5.04
|
| Rate for Payer: Aetna Commercial |
$6.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.04
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: Cofinity Commercial |
$5.43
|
| Rate for Payer: Cofinity Commercial |
$6.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.21
|
| Rate for Payer: Healthscope Commercial |
$6.98
|
| Rate for Payer: 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 |
$3.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.82
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$19.68
|
|
|
Service Code
|
NDC 69452017173
|
| 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
|
$19.68
|
|
|
Service Code
|
NDC 65862064163
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Aetna American Axle |
$12.79
|
| Rate for Payer: Aetna Commercial |
$16.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.79
|
| 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 |
$8.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.76
|
|
|
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
|
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
|
IP
|
$224.11
|
|
|
Service Code
|
NDC 50111078710
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.61 |
| Max. Negotiated Rate |
$201.70 |
| Rate for Payer: Aetna American Axle |
$145.67
|
| Rate for Payer: Aetna Commercial |
$190.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.67
|
| Rate for Payer: Cash Price |
$179.29
|
| Rate for Payer: Cofinity Commercial |
$156.88
|
| Rate for Payer: Cofinity Commercial |
$192.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.29
|
| Rate for Payer: Healthscope Commercial |
$201.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.49
|
| Rate for Payer: PHP Commercial |
$190.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.67
|
| Rate for Payer: Priority Health SBD |
$141.19
|
| Rate for Payer: UMR Bronson Commercial |
$98.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.08
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$593.85
|
|
|
Service Code
|
NDC 00069406189
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$261.29 |
| Max. Negotiated Rate |
$534.47 |
| Rate for Payer: Aetna American Axle |
$386.00
|
| Rate for Payer: Aetna Commercial |
$504.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.00
|
| Rate for Payer: Cash Price |
$475.08
|
| Rate for Payer: Cofinity Commercial |
$415.69
|
| Rate for Payer: Cofinity Commercial |
$510.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$415.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.08
|
| Rate for Payer: Healthscope Commercial |
$534.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$415.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$445.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$504.77
|
| Rate for Payer: PHP Commercial |
$504.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.00
|
| Rate for Payer: Priority Health SBD |
$374.13
|
| Rate for Payer: UMR Bronson Commercial |
$261.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$445.39
|
|
|
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
|
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
|
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
|
OP
|
$22.90
|
|
|
Service Code
|
NDC 00781808926
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$20.61 |
| Rate for Payer: Aetna American Axle |
$14.88
|
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna Medicare |
$11.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: BCBS Complete |
$9.16
|
| Rate for Payer: Cash Price |
$18.32
|
| Rate for Payer: Cofinity Commercial |
$16.03
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.32
|
| Rate for Payer: Healthscope Commercial |
$20.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: Priority Health SBD |
$14.43
|
| Rate for Payer: UMR Bronson Commercial |
$8.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.18
|
|
|
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
|
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
|
$22.90
|
|
|
Service Code
|
NDC 00781808926
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$20.61 |
| Rate for Payer: Aetna American Axle |
$14.88
|
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: Cash Price |
$18.32
|
| Rate for Payer: Cofinity Commercial |
$16.03
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.32
|
| Rate for Payer: Healthscope Commercial |
$20.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: Priority Health SBD |
$14.43
|
| Rate for Payer: UMR Bronson Commercial |
$10.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.18
|
|
|
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: 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: Cofinity Commercial |
$3.96
|
| Rate for Payer: Cofinity Commercial |
$4.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.96
|
| 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
|
OP
|
$564.96
|
|
|
Service Code
|
NDC 60687074201
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.04 |
| Max. Negotiated Rate |
$508.46 |
| Rate for Payer: Aetna American Axle |
$367.22
|
| Rate for Payer: Aetna Commercial |
$480.22
|
| Rate for Payer: Aetna Medicare |
$282.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.22
|
| Rate for Payer: BCBS Complete |
$225.98
|
| 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 |
$209.04
|
| 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
|
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
|
OP
|
$51.62
|
|
|
Service Code
|
NDC 50111078751
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$46.46 |
| Rate for Payer: Aetna American Axle |
$33.55
|
| Rate for Payer: Aetna Commercial |
$43.88
|
| Rate for Payer: Aetna Medicare |
$25.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.55
|
| Rate for Payer: BCBS Complete |
$20.65
|
| Rate for Payer: Cash Price |
$41.30
|
| 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: 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 |
$19.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.72
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$19.68
|
|
|
Service Code
|
NDC 65862064169
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Aetna American Axle |
$12.79
|
| Rate for Payer: Aetna Commercial |
$16.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.79
|
| 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 |
$8.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.76
|
|
