|
AZACITIDINE 100 MG/10 ML SOLN
|
Facility
OP
|
$2,627.73
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
168892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$2,364.96 |
| Rate for Payer: Aetna American Axle |
$1,708.02
|
| Rate for Payer: Aetna American Axle |
$238.59
|
| Rate for Payer: Aetna American Axle |
$297.55
|
| Rate for Payer: Aetna Commercial |
$389.10
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna Commercial |
$312.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: BCBS Complete |
$146.82
|
| Rate for Payer: BCBS Complete |
$183.11
|
| Rate for Payer: BCBS Complete |
$1,051.09
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: Cash Price |
$293.65
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$293.65
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Cofinity Commercial |
$393.68
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$1,839.41
|
| Rate for Payer: Cofinity Commercial |
$256.94
|
| Rate for Payer: Cofinity Commercial |
$315.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.65
|
| Rate for Payer: Healthscope Commercial |
$330.35
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Healthscope Commercial |
$411.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,839.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,970.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$389.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$312.00
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$389.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,839.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.44
|
| Rate for Payer: Priority Health SBD |
$288.40
|
| Rate for Payer: Priority Health SBD |
$231.25
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
| Rate for Payer: UMR Bronson Commercial |
$972.26
|
| Rate for Payer: UMR Bronson Commercial |
$169.37
|
| Rate for Payer: UMR Bronson Commercial |
$135.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,970.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.30
|
|
|
AZACITIDINE 100 MG/10 ML SOLN
|
Facility
IP
|
$367.06
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
168892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.51 |
| Max. Negotiated Rate |
$330.35 |
| Rate for Payer: Aetna American Axle |
$238.59
|
| Rate for Payer: Aetna American Axle |
$1,708.02
|
| Rate for Payer: Aetna American Axle |
$297.55
|
| Rate for Payer: Aetna Commercial |
$389.10
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna Commercial |
$312.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: Cash Price |
$293.65
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cofinity Commercial |
$1,839.41
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Cofinity Commercial |
$256.94
|
| Rate for Payer: Cofinity Commercial |
$315.67
|
| Rate for Payer: Cofinity Commercial |
$393.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.22
|
| Rate for Payer: Healthscope Commercial |
$411.99
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Healthscope Commercial |
$330.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,839.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,970.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$389.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,233.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.00
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$389.10
|
| Rate for Payer: PHP Commercial |
$312.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,839.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.44
|
| Rate for Payer: Priority Health SBD |
$288.40
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
| Rate for Payer: Priority Health SBD |
$231.25
|
| Rate for Payer: UMR Bronson Commercial |
$161.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,156.20
|
| Rate for Payer: UMR Bronson Commercial |
$201.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,970.80
|
|
|
AZACITIDINE 100 MG SOLUTION FOR INJECTION
|
Facility
OP
|
$286.70
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
78420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$258.03 |
| Rate for Payer: Aetna American Axle |
$186.36
|
| Rate for Payer: Aetna American Axle |
$281.50
|
| Rate for Payer: Aetna American Axle |
$198.35
|
| Rate for Payer: Aetna American Axle |
$216.87
|
| Rate for Payer: Aetna American Axle |
$223.66
|
| Rate for Payer: Aetna American Axle |
$216.40
|
| Rate for Payer: Aetna Commercial |
$282.98
|
| Rate for Payer: Aetna Commercial |
$368.11
|
| Rate for Payer: Aetna Commercial |
$243.70
|
| Rate for Payer: Aetna Commercial |
$259.38
|
| Rate for Payer: Aetna Commercial |
$292.48
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.50
|
| Rate for Payer: BCBS Complete |
$173.23
|
| Rate for Payer: BCBS Complete |
$133.17
|
| Rate for Payer: BCBS Complete |
$133.46
|
| Rate for Payer: BCBS Complete |
$114.68
|
| Rate for Payer: BCBS Complete |
$137.64
|
| Rate for Payer: BCBS Complete |
$122.06
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: Cash Price |
$244.12
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$266.34
|
| Rate for Payer: Cash Price |
$244.12
|
| Rate for Payer: Cash Price |
$346.46
|
| Rate for Payer: Cash Price |
$275.28
|
| Rate for Payer: Cash Price |
$229.36
|
| Rate for Payer: Cash Price |
$229.36
|
| Rate for Payer: Cash Price |
$266.34
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$346.46
|
| Rate for Payer: Cash Price |
$275.28
|
| Rate for Payer: Cofinity Commercial |
$295.93
|
| Rate for Payer: Cofinity Commercial |
$213.60
|
| Rate for Payer: Cofinity Commercial |
$303.15
|
| Rate for Payer: Cofinity Commercial |
$372.44
|
| Rate for Payer: Cofinity Commercial |
$233.04
|
| Rate for Payer: Cofinity Commercial |
$286.31
|
| Rate for Payer: Cofinity Commercial |
$246.56
|
| Rate for Payer: Cofinity Commercial |
$200.69
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Cofinity Commercial |
$233.55
|
| Rate for Payer: Cofinity Commercial |
$262.43
|
| Rate for Payer: Cofinity Commercial |
$240.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.46
|
| Rate for Payer: Healthscope Commercial |
$274.64
|
| Rate for Payer: Healthscope Commercial |
$299.63
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Healthscope Commercial |
$389.76
|
| Rate for Payer: Healthscope Commercial |
$258.03
|
| Rate for Payer: Healthscope Commercial |
$309.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$303.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$259.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$368.11
|
| Rate for Payer: PHP Commercial |
$292.48
|
| Rate for Payer: PHP Commercial |
$259.38
|
| Rate for Payer: PHP Commercial |
$368.11
|
| Rate for Payer: PHP Commercial |
$282.98
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: PHP Commercial |
$243.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.15
|
| Rate for Payer: Priority Health SBD |
$210.19
|
| Rate for Payer: Priority Health SBD |
$209.74
|
| Rate for Payer: Priority Health SBD |
$180.62
|
| Rate for Payer: Priority Health SBD |
$192.24
|
| Rate for Payer: Priority Health SBD |
$272.83
|
| Rate for Payer: Priority Health SBD |
$216.78
|
| Rate for Payer: UMR Bronson Commercial |
$123.18
|
| Rate for Payer: UMR Bronson Commercial |
$112.91
|
| Rate for Payer: UMR Bronson Commercial |
$127.32
|
| Rate for Payer: UMR Bronson Commercial |
$123.45
|
| Rate for Payer: UMR Bronson Commercial |
$106.08
|
| Rate for Payer: UMR Bronson Commercial |
$160.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.08
|
|
|
AZACITIDINE 100 MG SOLUTION FOR INJECTION
|
Facility
IP
|
$344.10
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
78420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$151.40 |
| Max. Negotiated Rate |
$309.69 |
| Rate for Payer: Aetna American Axle |
$223.66
|
| Rate for Payer: Aetna American Axle |
$1,708.02
|
| Rate for Payer: Aetna American Axle |
$238.59
|
| Rate for Payer: Aetna American Axle |
$297.55
|
| Rate for Payer: Aetna Commercial |
$312.00
|
| Rate for Payer: Aetna Commercial |
$292.48
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna Commercial |
$389.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.66
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cash Price |
$293.65
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$275.28
|
| Rate for Payer: Cofinity Commercial |
$393.68
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Cofinity Commercial |
$1,839.41
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$240.87
|
| Rate for Payer: Cofinity Commercial |
$315.67
|
| Rate for Payer: Cofinity Commercial |
$256.94
|
| Rate for Payer: Cofinity Commercial |
$295.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.22
|
| Rate for Payer: Healthscope Commercial |
$309.69
|
| Rate for Payer: Healthscope Commercial |
$411.99
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Healthscope Commercial |
$330.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,839.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,970.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,233.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$389.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.00
|
| Rate for Payer: PHP Commercial |
$389.10
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$312.00
|
| Rate for Payer: PHP Commercial |
$292.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,839.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.44
|
| Rate for Payer: Priority Health SBD |
$231.25
|
| Rate for Payer: Priority Health SBD |
$288.40
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
| Rate for Payer: Priority Health SBD |
$216.78
|
| Rate for Payer: UMR Bronson Commercial |
$201.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,156.20
|
| Rate for Payer: UMR Bronson Commercial |
$161.51
|
| Rate for Payer: UMR Bronson Commercial |
$151.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,970.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.33
|
|
|
AZATHIOPRINE 50 MG TABLET
|
Facility
IP
|
$221.35
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
9183
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$97.39 |
| Max. Negotiated Rate |
$199.22 |
| Rate for Payer: Aetna American Axle |
$143.88
|
| Rate for Payer: Aetna American Axle |
$160.55
|
| Rate for Payer: Aetna American Axle |
$266.76
|
| Rate for Payer: Aetna American Axle |
$1.66
|
| Rate for Payer: Aetna American Axle |
$165.98
|
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: Aetna Commercial |
$348.84
|
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Commercial |
$217.06
|
| Rate for Payer: Aetna Commercial |
$209.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.55
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cash Price |
$328.32
|
| Rate for Payer: Cash Price |
$204.29
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Cofinity Commercial |
$154.94
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Cofinity Commercial |
$352.94
|
| Rate for Payer: Cofinity Commercial |
$287.28
|
| Rate for Payer: Cofinity Commercial |
$172.90
|
| Rate for Payer: Cofinity Commercial |
$212.42
|
| Rate for Payer: Cofinity Commercial |
$178.75
|
| Rate for Payer: Cofinity Commercial |
$219.61
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.29
|
| Rate for Payer: Healthscope Commercial |
$222.30
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Healthscope Commercial |
$369.36
|
| Rate for Payer: Healthscope Commercial |
$229.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$188.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$348.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.95
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: PHP Commercial |
$209.95
|
| Rate for Payer: PHP Commercial |
$348.84
|
| Rate for Payer: PHP Commercial |
$217.06
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.90
|
| Rate for Payer: Priority Health SBD |
$258.55
|
| Rate for Payer: Priority Health SBD |
$1.61
|
| Rate for Payer: Priority Health SBD |
$139.45
|
| Rate for Payer: Priority Health SBD |
$160.88
|
| Rate for Payer: Priority Health SBD |
$155.61
|
| Rate for Payer: UMR Bronson Commercial |
$112.36
|
| Rate for Payer: UMR Bronson Commercial |
$108.68
|
| Rate for Payer: UMR Bronson Commercial |
$1.13
|
| Rate for Payer: UMR Bronson Commercial |
$97.39
|
| Rate for Payer: UMR Bronson Commercial |
$180.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.80
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$116.79
|
|
|
Service Code
|
NDC 0093-2026-31
|
| 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: 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 Multiplan/Beech St/PHCS |
$99.27
|
| Rate for Payer: PHP Commercial |
$99.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.75
|
| 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 59762-3140-1
|
| 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: 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 Multiplan/Beech St/PHCS |
$75.89
|
| Rate for Payer: PHP Commercial |
$75.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.50
|
| 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 250 MG TABLET
|
Facility
IP
|
$231.12
|
|
|
Service Code
|
NDC 50268-098-15
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.69 |
| Max. Negotiated Rate |
$208.01 |
| Rate for Payer: Aetna American Axle |
$150.23
|
| Rate for Payer: Aetna Commercial |
$196.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.23
|
| Rate for Payer: Cash Price |
$184.90
|
| Rate for Payer: Cofinity Commercial |
$161.78
|
| Rate for Payer: Cofinity Commercial |
$198.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.90
|
| Rate for Payer: Healthscope Commercial |
$208.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$196.45
|
| Rate for Payer: PHP Commercial |
$196.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.78
|
| Rate for Payer: Priority Health SBD |
$145.61
|
| Rate for Payer: UMR Bronson Commercial |
$101.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.34
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$7.76
|
|
|
Service Code
|
NDC 60687-282-11
|
| 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: 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 Multiplan/Beech St/PHCS |
$6.60
|
| Rate for Payer: PHP Commercial |
$6.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.43
|
| 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
IP
|
$51.62
|
|
|
Service Code
|
NDC 50111-787-51
|
| 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: 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 Multiplan/Beech St/PHCS |
$43.88
|
| Rate for Payer: PHP Commercial |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.13
|
| 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
|
$184.56
|
|
|
Service Code
|
NDC 60687-742-65
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.21 |
| Max. Negotiated Rate |
$166.10 |
| Rate for Payer: Aetna American Axle |
$119.96
|
| Rate for Payer: Aetna Commercial |
$156.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.96
|
| Rate for Payer: Cash Price |
$147.65
|
| Rate for Payer: Cofinity Commercial |
$129.19
|
| Rate for Payer: Cofinity Commercial |
$158.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.65
|
| Rate for Payer: Healthscope Commercial |
$166.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.88
|
| Rate for Payer: PHP Commercial |
$156.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.19
|
| Rate for Payer: Priority Health SBD |
$116.27
|
| Rate for Payer: UMR Bronson Commercial |
$81.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.42
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$19.68
|
|
|
Service Code
|
NDC 65862-641-69
|
| 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: 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 Multiplan/Beech St/PHCS |
$16.73
|
| Rate for Payer: PHP Commercial |
$16.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.78
|
| 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
|
$154.08
|
|
|
Service Code
|
NDC 0904-6708-06
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$138.67 |
| Rate for Payer: Aetna American Axle |
$100.15
|
| Rate for Payer: Aetna Commercial |
$130.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.15
|
| Rate for Payer: Cash Price |
$123.26
|
| Rate for Payer: Cofinity Commercial |
$107.86
|
| Rate for Payer: Cofinity Commercial |
$132.51
|
| 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 Multiplan/Beech St/PHCS |
$130.97
|
| Rate for Payer: PHP Commercial |
$130.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.86
|
| Rate for Payer: Priority Health SBD |
$97.07
|
| Rate for Payer: UMR Bronson Commercial |
$67.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.56
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$22.41
|
|
|
Service Code
|
NDC 0781-8089-26
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$20.17 |
| Rate for Payer: Aetna American Axle |
$14.57
|
| Rate for Payer: Aetna Commercial |
$19.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.57
|
| Rate for Payer: Cash Price |
$17.93
|
| Rate for Payer: Cofinity Commercial |
$15.69
|
| Rate for Payer: Cofinity Commercial |
$19.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$20.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.05
|
| Rate for Payer: PHP Commercial |
$19.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.69
|
| Rate for Payer: Priority Health SBD |
$14.12
|
| Rate for Payer: UMR Bronson Commercial |
$9.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.81
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$593.85
|
|
|
Service Code
|
NDC 0069-4061-89
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$261.29 |
| Max. Negotiated Rate |
$534.46 |
| 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 |
$415.70
|
| Rate for Payer: Cofinity Commercial |
$510.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.08
|
| Rate for Payer: Healthscope Commercial |
$534.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$415.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$445.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$504.77
|
| Rate for Payer: PHP Commercial |
$504.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$415.70
|
| 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
|
$40.50
|
|
|
Service Code
|
NDC 50111-787-66
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna American Axle |
$26.32
|
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Commercial |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.42
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.35
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| Rate for Payer: UMR Bronson Commercial |
$17.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$384.80
|
|
|
Service Code
|
NDC 59762-3060-3
|
| 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: 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 Multiplan/Beech St/PHCS |
$327.08
|
| Rate for Payer: PHP Commercial |
$327.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.36
|
| 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
|
$222.45
|
|
|
Service Code
|
NDC 51224-022-30
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.88 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna American Axle |
$144.59
|
| Rate for Payer: Aetna Commercial |
$189.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.59
|
| Rate for Payer: Cash Price |
$177.96
|
| Rate for Payer: Cofinity Commercial |
$155.72
|
| Rate for Payer: Cofinity Commercial |
$191.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.96
|
| Rate for Payer: Healthscope Commercial |
$200.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$189.08
|
| Rate for Payer: PHP Commercial |
$189.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.72
|
| Rate for Payer: Priority Health SBD |
$140.14
|
| Rate for Payer: UMR Bronson Commercial |
$97.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.84
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$224.11
|
|
|
Service Code
|
NDC 50111-787-10
|
| 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: 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 Multiplan/Beech St/PHCS |
$190.49
|
| Rate for Payer: PHP Commercial |
$190.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.88
|
| 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
|
$775.20
|
|
|
Service Code
|
NDC 60687-282-01
|
| 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: 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 Multiplan/Beech St/PHCS |
$658.92
|
| Rate for Payer: PHP Commercial |
$658.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.64
|
| 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
|
$19.68
|
|
|
Service Code
|
NDC 65862-641-63
|
| 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: 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 Multiplan/Beech St/PHCS |
$16.73
|
| Rate for Payer: PHP Commercial |
$16.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.78
|
| 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
|
$137.66
|
|
|
Service Code
|
NDC 0781-8089-31
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.57 |
| Max. Negotiated Rate |
$123.89 |
| Rate for Payer: Aetna American Axle |
$89.48
|
| Rate for Payer: Aetna Commercial |
$117.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.48
|
| Rate for Payer: Cash Price |
$110.13
|
| Rate for Payer: Cofinity Commercial |
$118.39
|
| Rate for Payer: Cofinity Commercial |
$96.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.13
|
| Rate for Payer: Healthscope Commercial |
$123.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.01
|
| Rate for Payer: PHP Commercial |
$117.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.36
|
| Rate for Payer: Priority Health SBD |
$86.73
|
| Rate for Payer: UMR Bronson Commercial |
$60.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.24
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$5.63
|
|
|
Service Code
|
NDC 60687-742-11
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$5.07 |
| Rate for Payer: Aetna American Axle |
$3.66
|
| Rate for Payer: Aetna Commercial |
$4.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.66
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cofinity Commercial |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$5.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.79
|
| Rate for Payer: PHP Commercial |
$4.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.94
|
| Rate for Payer: Priority Health SBD |
$3.55
|
| Rate for Payer: UMR Bronson Commercial |
$2.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.22
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$19.68
|
|
|
Service Code
|
NDC 69452-171-73
|
| 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: 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 Multiplan/Beech St/PHCS |
$16.73
|
| Rate for Payer: PHP Commercial |
$16.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.78
|
| 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
|
$562.56
|
|
|
Service Code
|
NDC 60687-742-01
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$247.53 |
| Max. Negotiated Rate |
$506.30 |
| Rate for Payer: Aetna American Axle |
$365.66
|
| Rate for Payer: Aetna Commercial |
$478.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.66
|
| Rate for Payer: Cash Price |
$450.05
|
| Rate for Payer: Cofinity Commercial |
$393.79
|
| Rate for Payer: Cofinity Commercial |
$483.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.05
|
| Rate for Payer: Healthscope Commercial |
$506.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$393.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$421.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$478.18
|
| Rate for Payer: PHP Commercial |
$478.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.79
|
| Rate for Payer: Priority Health SBD |
$354.41
|
| Rate for Payer: UMR Bronson Commercial |
$247.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.92
|
|
