|
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
|
$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
|
$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
|
|
|
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 65862-641-63
|
| 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
|
$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
|
$284.55
|
|
|
Service Code
|
NDC 68180-160-06
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.20 |
| Max. Negotiated Rate |
$256.10 |
| Rate for Payer: Aetna American Axle |
$184.96
|
| Rate for Payer: Aetna Commercial |
$241.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.96
|
| Rate for Payer: Cash Price |
$227.64
|
| Rate for Payer: Cofinity Commercial |
$199.18
|
| Rate for Payer: Cofinity Commercial |
$244.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.64
|
| Rate for Payer: Healthscope Commercial |
$256.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$241.87
|
| Rate for Payer: PHP Commercial |
$241.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.18
|
| Rate for Payer: Priority Health SBD |
$179.27
|
| Rate for Payer: UMR Bronson Commercial |
$125.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.41
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$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
|
$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
|
$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
|
$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
|
$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
|
$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
|
$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
|
$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
|
$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
|
$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 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: 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 Multiplan/Beech St/PHCS |
$72.18
|
| Rate for Payer: PHP Commercial |
$72.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.44
|
| 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 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.76
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
21063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$18.68 |
| Rate for Payer: Aetna American Axle |
$13.49
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.49
|
| Rate for Payer: BCBS Complete |
$8.30
|
| Rate for Payer: BCBS Trust/PPO |
$8.37
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cofinity Commercial |
$14.53
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.61
|
| Rate for Payer: Healthscope Commercial |
$18.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.65
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.53
|
| Rate for Payer: Priority Health SBD |
$13.08
|
| Rate for Payer: UMR Bronson Commercial |
$7.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.57
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17.47
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
21063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$15.72 |
| 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 |
$17.00
|
| Rate for Payer: Aetna American Axle |
$13.49
|
| Rate for Payer: Aetna American Axle |
$12.61
|
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$16.49
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$17.08
|
| Rate for Payer: Aetna Commercial |
$22.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.96
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$15.52
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cofinity Commercial |
$13.58
|
| Rate for Payer: Cofinity Commercial |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$12.23
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| 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 |
$22.50
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$16.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.08
|
| Rate for Payer: Healthscope Commercial |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$17.46
|
| Rate for Payer: Healthscope Commercial |
$18.09
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$18.68
|
| Rate for Payer: 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 |
$18.31
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.85
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$22.24
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$17.08
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: PHP Commercial |
$16.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.50
|
| 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 |
$19.35
|
| Rate for Payer: Priority Health SBD |
$12.22
|
| Rate for Payer: Priority Health SBD |
$16.48
|
| Rate for Payer: UMR Bronson Commercial |
$8.54
|
| Rate for Payer: UMR Bronson Commercial |
$9.13
|
| 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 |
$7.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.55
|
| 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: 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 Multiplan/Beech St/PHCS |
$26.10
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.50
|
| 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 TABLET
|
Facility
|
IP
|
$498.06
|
|
|
Service Code
|
NDC 50111-788-10
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.15 |
| Max. Negotiated Rate |
$448.25 |
| Rate for Payer: Aetna American Axle |
$323.74
|
| Rate for Payer: Aetna Commercial |
$423.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.74
|
| Rate for Payer: Cash Price |
$398.45
|
| Rate for Payer: Cofinity Commercial |
$348.64
|
| Rate for Payer: Cofinity Commercial |
$428.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.45
|
| Rate for Payer: Healthscope Commercial |
$448.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$348.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$423.35
|
| Rate for Payer: PHP Commercial |
$423.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.64
|
| Rate for Payer: Priority Health SBD |
$313.78
|
| Rate for Payer: UMR Bronson Commercial |
$219.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.54
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$250.42
|
|
|
Service Code
|
NDC 50268-099-13
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.18 |
| Max. Negotiated Rate |
$225.38 |
| Rate for Payer: Aetna American Axle |
$162.77
|
| Rate for Payer: Aetna Commercial |
$212.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.77
|
| Rate for Payer: Cash Price |
$200.34
|
| Rate for Payer: Cofinity Commercial |
$175.29
|
| Rate for Payer: Cofinity Commercial |
$215.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.34
|
| Rate for Payer: Healthscope Commercial |
$225.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.86
|
| Rate for Payer: PHP Commercial |
$212.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.29
|
| Rate for Payer: Priority Health SBD |
$157.76
|
| Rate for Payer: UMR Bronson Commercial |
$110.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.82
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$8.35
|
|
|
Service Code
|
NDC 50268-099-11
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Aetna American Axle |
$5.43
|
| Rate for Payer: Aetna Commercial |
$7.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.43
|
| Rate for Payer: Cash Price |
$6.68
|
| Rate for Payer: Cofinity Commercial |
$5.84
|
| Rate for Payer: Cofinity Commercial |
$7.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$7.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.10
|
| Rate for Payer: PHP Commercial |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.84
|
| Rate for Payer: Priority Health SBD |
$5.26
|
| Rate for Payer: UMR Bronson Commercial |
$3.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.26
|
|
