|
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
|
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
|
$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
|
$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
|
|
|
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
|
$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
|
$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: 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: 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 |
$22.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.72
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$284.12
|
|
|
Service Code
|
NDC 51224002230
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.01 |
| Max. Negotiated Rate |
$255.71 |
| Rate for Payer: Aetna American Axle |
$184.68
|
| Rate for Payer: Aetna Commercial |
$241.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.68
|
| 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 |
$125.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.09
|
|
|
AZITHROMYCIN 500 MG 250 ML (IV PREMIX)
|
Facility
|
IP
|
$84.92
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
500536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.36 |
| Max. Negotiated Rate |
$76.43 |
| Rate for Payer: Aetna American Axle |
$55.20
|
| Rate for Payer: Aetna Commercial |
$72.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.20
|
| Rate for Payer: Cash Price |
$67.94
|
| Rate for Payer: Cofinity Commercial |
$59.44
|
| Rate for Payer: Cofinity Commercial |
$73.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.94
|
| Rate for Payer: Healthscope Commercial |
$76.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.18
|
| Rate for Payer: PHP Commercial |
$72.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.20
|
| Rate for Payer: Priority Health SBD |
$53.50
|
| Rate for Payer: UMR Bronson Commercial |
$37.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.69
|
|
|
AZITHROMYCIN 500 MG 250 ML (IV PREMIX)
|
Facility
|
OP
|
$84.92
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
500536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$76.43 |
| Rate for Payer: Aetna American Axle |
$55.20
|
| Rate for Payer: Aetna Commercial |
$72.18
|
| Rate for Payer: Aetna Medicare |
$42.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.20
|
| Rate for Payer: BCBS Complete |
$33.97
|
| Rate for Payer: Cash Price |
$67.94
|
| Rate for Payer: Cofinity Commercial |
$59.44
|
| Rate for Payer: Cofinity Commercial |
$73.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.94
|
| Rate for Payer: Healthscope Commercial |
$76.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.18
|
| Rate for Payer: PHP Commercial |
$72.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.20
|
| Rate for Payer: Priority Health SBD |
$53.50
|
| Rate for Payer: UMR Bronson Commercial |
$31.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.69
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.16
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
21063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$23.54 |
| Rate for Payer: Aetna American Axle |
$17.00
|
| Rate for Payer: Aetna American Axle |
$11.36
|
| Rate for Payer: Aetna American Axle |
$13.06
|
| Rate for Payer: Aetna American Axle |
$19.96
|
| Rate for Payer: Aetna American Axle |
$13.49
|
| Rate for Payer: Aetna Commercial |
$22.24
|
| Rate for Payer: Aetna Commercial |
$17.09
|
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.06
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$12.23
|
| Rate for Payer: Cofinity Commercial |
$22.50
|
| Rate for Payer: Cofinity Commercial |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$14.53
|
| Rate for Payer: Cofinity Commercial |
$14.07
|
| Rate for Payer: Cofinity Commercial |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.61
|
| Rate for Payer: Healthscope Commercial |
$18.09
|
| Rate for Payer: Healthscope Commercial |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$18.68
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.07
|
| 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: Multiplan/Beech St/PHCS Commercial |
$17.09
|
| 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 |
$22.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.85
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$22.24
|
| Rate for Payer: PHP Commercial |
$17.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.36
|
| Rate for Payer: Priority Health SBD |
$19.35
|
| Rate for Payer: Priority Health SBD |
$13.08
|
| Rate for Payer: Priority Health SBD |
$12.66
|
| Rate for Payer: Priority Health SBD |
$11.01
|
| Rate for Payer: Priority Health SBD |
$16.48
|
| Rate for Payer: UMR Bronson Commercial |
$7.69
|
| Rate for Payer: UMR Bronson Commercial |
$8.84
|
| Rate for Payer: UMR Bronson Commercial |
$11.51
|
| Rate for Payer: UMR Bronson Commercial |
$13.51
|
| Rate for Payer: UMR Bronson Commercial |
$9.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.62
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.10
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
21063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$18.09 |
| Rate for Payer: Aetna American Axle |
$13.06
|
| Rate for Payer: Aetna American Axle |
$17.00
|
| Rate for Payer: Aetna American Axle |
$19.96
|
| Rate for Payer: Aetna American Axle |
$11.36
|
| Rate for Payer: Aetna American Axle |
$13.49
|
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$22.24
|
| Rate for Payer: Aetna Commercial |
$17.09
|
| Rate for Payer: Aetna Medicare |
$13.08
|
| Rate for Payer: Aetna Medicare |
$10.05
|
| Rate for Payer: Aetna Medicare |
$15.36
|
| Rate for Payer: Aetna Medicare |
$10.38
|
| Rate for Payer: Aetna Medicare |
$8.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.00
|
| Rate for Payer: BCBS Complete |
$12.28
|
| Rate for Payer: BCBS Complete |
$6.99
|
| Rate for Payer: BCBS Complete |
$10.46
|
| Rate for Payer: BCBS Complete |
$8.30
|
| Rate for Payer: BCBS Complete |
$8.04
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$22.50
|
| Rate for Payer: Cofinity Commercial |
$12.23
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$14.53
|
| Rate for Payer: Cofinity Commercial |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$14.07
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.61
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$18.68
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Healthscope Commercial |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$18.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$22.24
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: PHP Commercial |
$17.09
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.96
|
| 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 Cigna Priority Health |
$13.06
|
| Rate for Payer: Priority Health SBD |
$12.66
|
| Rate for Payer: Priority Health SBD |
$11.01
|
| Rate for Payer: Priority Health SBD |
$13.08
|
| Rate for Payer: Priority Health SBD |
$16.48
|
| Rate for Payer: Priority Health SBD |
$19.35
|
| Rate for Payer: UMR Bronson Commercial |
$11.36
|
| Rate for Payer: UMR Bronson Commercial |
$9.68
|
| Rate for Payer: UMR Bronson Commercial |
$7.44
|
| Rate for Payer: UMR Bronson Commercial |
$6.46
|
| Rate for Payer: UMR Bronson Commercial |
$7.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.57
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION (BMH OSC)
|
Facility
|
IP
|
$30.71
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
169410
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.51 |
| Max. Negotiated Rate |
$27.64 |
| Rate for Payer: Aetna American Axle |
$19.96
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.96
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.96
|
| Rate for Payer: Priority Health SBD |
$19.35
|
| Rate for Payer: UMR Bronson Commercial |
$13.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.03
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION (BMH OSC)
|
Facility
|
OP
|
$30.71
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
169410
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.36 |
| Max. Negotiated Rate |
$27.64 |
| Rate for Payer: Aetna American Axle |
$19.96
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Medicare |
$15.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.96
|
| Rate for Payer: BCBS Complete |
$12.28
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.96
|
| Rate for Payer: Priority Health SBD |
$19.35
|
| Rate for Payer: UMR Bronson Commercial |
$11.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.03
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$136.23
|
|
|
Service Code
|
NDC 62332025230
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.41 |
| Max. Negotiated Rate |
$122.61 |
| Rate for Payer: Aetna American Axle |
$88.55
|
| Rate for Payer: Aetna Commercial |
$115.80
|
| Rate for Payer: Aetna Medicare |
$68.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.55
|
| Rate for Payer: BCBS Complete |
$54.49
|
| Rate for Payer: Cash Price |
$108.98
|
| Rate for Payer: Cofinity Commercial |
$117.16
|
| Rate for Payer: Cofinity Commercial |
$95.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.98
|
| Rate for Payer: Healthscope Commercial |
$122.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.80
|
| Rate for Payer: PHP Commercial |
$115.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.55
|
| Rate for Payer: Priority Health SBD |
$85.82
|
| Rate for Payer: UMR Bronson Commercial |
$50.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.17
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$121.25
|
|
|
Service Code
|
NDC 65862064230
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.35 |
| Max. Negotiated Rate |
$109.12 |
| Rate for Payer: Aetna American Axle |
$78.81
|
| Rate for Payer: Aetna Commercial |
$103.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.81
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cofinity Commercial |
$104.28
|
| Rate for Payer: Cofinity Commercial |
$84.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.00
|
| Rate for Payer: Healthscope Commercial |
$109.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.06
|
| Rate for Payer: PHP Commercial |
$103.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.81
|
| Rate for Payer: Priority Health SBD |
$76.39
|
| Rate for Payer: UMR Bronson Commercial |
$53.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.94
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$19.69
|
|
|
Service Code
|
NDC 69452017272
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.29 |
| Max. Negotiated Rate |
$17.72 |
| Rate for Payer: Aetna American Axle |
$12.80
|
| Rate for Payer: Aetna Commercial |
$16.74
|
| Rate for Payer: Aetna Medicare |
$9.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.80
|
| Rate for Payer: BCBS Complete |
$7.88
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cofinity Commercial |
$13.78
|
| Rate for Payer: Cofinity Commercial |
$16.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.75
|
| Rate for Payer: Healthscope Commercial |
$17.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.74
|
| Rate for Payer: PHP Commercial |
$16.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.80
|
| Rate for Payer: Priority Health SBD |
$12.40
|
| Rate for Payer: UMR Bronson Commercial |
$7.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.77
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$19.69
|
|
|
Service Code
|
NDC 69452017272
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$17.72 |
| Rate for Payer: Aetna American Axle |
$12.80
|
| Rate for Payer: Aetna Commercial |
$16.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.80
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cofinity Commercial |
$13.78
|
| Rate for Payer: Cofinity Commercial |
$16.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.75
|
| Rate for Payer: Healthscope Commercial |
$17.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.74
|
| Rate for Payer: PHP Commercial |
$16.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.80
|
| 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 |
$14.77
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$19.73
|
|
|
Service Code
|
NDC 69452017260
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna Commercial |
$16.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$16.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.77
|
| Rate for Payer: PHP Commercial |
$16.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.82
|
| Rate for Payer: Priority Health SBD |
$12.43
|
| Rate for Payer: UMR Bronson Commercial |
$8.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.80
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$29.05
|
|
|
Service Code
|
NDC 50111078867
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$26.14 |
| Rate for Payer: Aetna American Axle |
$18.88
|
| Rate for Payer: Aetna Commercial |
$24.69
|
| Rate for Payer: Aetna Medicare |
$14.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.88
|
| Rate for Payer: BCBS Complete |
$11.62
|
| Rate for Payer: Cash Price |
$23.24
|
| Rate for Payer: Cofinity Commercial |
$20.34
|
| Rate for Payer: Cofinity Commercial |
$24.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.24
|
| Rate for Payer: Healthscope Commercial |
$26.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.69
|
| Rate for Payer: PHP Commercial |
$24.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.88
|
| Rate for Payer: Priority Health SBD |
$18.30
|
| Rate for Payer: UMR Bronson Commercial |
$10.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.79
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$19.73
|
|
|
Service Code
|
NDC 69452017260
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna Commercial |
$16.77
|
| Rate for Payer: Aetna Medicare |
$9.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$16.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.77
|
| Rate for Payer: PHP Commercial |
$16.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.82
|
| Rate for Payer: Priority Health SBD |
$12.43
|
| Rate for Payer: UMR Bronson Commercial |
$7.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.80
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$306.48
|
|
|
Service Code
|
NDC 60687075321
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$275.83 |
| Rate for Payer: Aetna American Axle |
$199.21
|
| Rate for Payer: Aetna Commercial |
$260.51
|
| Rate for Payer: Aetna Medicare |
$153.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.21
|
| Rate for Payer: BCBS Complete |
$122.59
|
| Rate for Payer: Cash Price |
$245.18
|
| Rate for Payer: Cofinity Commercial |
$214.54
|
| Rate for Payer: Cofinity Commercial |
$263.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.18
|
| Rate for Payer: Healthscope Commercial |
$275.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.51
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.21
|
| Rate for Payer: Priority Health SBD |
$193.08
|
| Rate for Payer: UMR Bronson Commercial |
$113.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.86
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$306.48
|
|
|
Service Code
|
NDC 60687075321
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.85 |
| Max. Negotiated Rate |
$275.83 |
| Rate for Payer: Aetna American Axle |
$199.21
|
| Rate for Payer: Aetna Commercial |
$260.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.21
|
| Rate for Payer: Cash Price |
$245.18
|
| Rate for Payer: Cofinity Commercial |
$214.54
|
| Rate for Payer: Cofinity Commercial |
$263.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.18
|
| Rate for Payer: Healthscope Commercial |
$275.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.51
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.21
|
| Rate for Payer: Priority Health SBD |
$193.08
|
| Rate for Payer: UMR Bronson Commercial |
$134.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.86
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$10.22
|
|
|
Service Code
|
NDC 60687075311
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna American Axle |
$6.64
|
| Rate for Payer: Aetna Commercial |
$8.69
|
| Rate for Payer: Aetna Medicare |
$5.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.64
|
| Rate for Payer: BCBS Complete |
$4.09
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cofinity Commercial |
$7.15
|
| Rate for Payer: Cofinity Commercial |
$8.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.18
|
| Rate for Payer: Healthscope Commercial |
$9.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.69
|
| Rate for Payer: PHP Commercial |
$8.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.64
|
| Rate for Payer: Priority Health SBD |
$6.44
|
| Rate for Payer: UMR Bronson Commercial |
$3.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.67
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$136.23
|
|
|
Service Code
|
NDC 62332025230
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.94 |
| Max. Negotiated Rate |
$122.61 |
| Rate for Payer: Aetna American Axle |
$88.55
|
| Rate for Payer: Aetna Commercial |
$115.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.55
|
| Rate for Payer: Cash Price |
$108.98
|
| Rate for Payer: Cofinity Commercial |
$117.16
|
| Rate for Payer: Cofinity Commercial |
$95.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.98
|
| Rate for Payer: Healthscope Commercial |
$122.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.80
|
| Rate for Payer: PHP Commercial |
$115.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.55
|
| Rate for Payer: Priority Health SBD |
$85.82
|
| Rate for Payer: UMR Bronson Commercial |
$59.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.17
|
|
