|
AZACITIDINE 100 MG/10 ML SOLN
|
Facility
|
IP
|
$2,627.73
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
168892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,156.20 |
| Max. Negotiated Rate |
$2,364.96 |
| Rate for Payer: Aetna American Axle |
$1,708.02
|
| Rate for Payer: Aetna American Axle |
$152.18
|
| Rate for Payer: Aetna American Axle |
$297.55
|
| Rate for Payer: Aetna American Axle |
$143.16
|
| Rate for Payer: Aetna Commercial |
$389.10
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna Commercial |
$187.21
|
| Rate for Payer: Aetna Commercial |
$199.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.16
|
| Rate for Payer: Cash Price |
$176.20
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cash Price |
$187.30
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cofinity Advantage |
$163.89
|
| Rate for Payer: Cofinity Advantage |
$154.18
|
| Rate for Payer: Cofinity Advantage |
$1,839.41
|
| Rate for Payer: Cofinity Advantage |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Cofinity Commercial |
$189.41
|
| Rate for Payer: Cofinity Commercial |
$201.35
|
| 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 |
$176.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.30
|
| Rate for Payer: Healthscope Commercial |
$210.72
|
| Rate for Payer: Healthscope Commercial |
$411.99
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Healthscope Commercial |
$198.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,839.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.60
|
| 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 |
$165.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,970.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.19
|
| Rate for Payer: PHP Commercial |
$187.21
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$199.01
|
| Rate for Payer: PHP Commercial |
$389.10
|
| Rate for Payer: Priority Health SBD |
$288.40
|
| Rate for Payer: Priority Health SBD |
$138.76
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
| Rate for Payer: Priority Health SBD |
$147.50
|
| Rate for Payer: UMR Bronson Commercial |
$103.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,156.20
|
| Rate for Payer: UMR Bronson Commercial |
$96.91
|
| Rate for Payer: UMR Bronson Commercial |
$201.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,970.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.33
|
|
|
AZACITIDINE 100 MG/10 ML SOLN
|
Facility
|
OP
|
$457.77
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
168892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$411.99 |
| Rate for Payer: Aetna American Axle |
$297.55
|
| Rate for Payer: Aetna American Axle |
$143.16
|
| Rate for Payer: Aetna American Axle |
$152.18
|
| Rate for Payer: Aetna American Axle |
$1,708.02
|
| Rate for Payer: Aetna Commercial |
$389.10
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna Commercial |
$187.21
|
| Rate for Payer: Aetna Commercial |
$199.01
|
| Rate for Payer: Aetna Medicare |
$1,313.87
|
| Rate for Payer: Aetna Medicare |
$117.06
|
| Rate for Payer: Aetna Medicare |
$228.88
|
| Rate for Payer: Aetna Medicare |
$110.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.16
|
| 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 |
$88.10
|
| Rate for Payer: BCBS Complete |
$93.65
|
| Rate for Payer: BCBS Complete |
$1,051.09
|
| Rate for Payer: BCBS Complete |
$183.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.46
|
| Rate for Payer: BCBS Trust/PPO |
$1.46
|
| Rate for Payer: BCBS Trust/PPO |
$1.46
|
| Rate for Payer: BCBS Trust/PPO |
$1.46
|
| Rate for Payer: BCN Commercial |
$1.46
|
| Rate for Payer: BCN Commercial |
$1.46
|
| Rate for Payer: BCN Commercial |
$1.46
|
| Rate for Payer: BCN Commercial |
$1.46
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cash Price |
$176.20
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$187.30
|
| Rate for Payer: Cash Price |
$187.30
|
| Rate for Payer: Cash Price |
$176.20
|
| Rate for Payer: Cofinity Advantage |
$320.44
|
| Rate for Payer: Cofinity Advantage |
$1,839.41
|
| Rate for Payer: Cofinity Advantage |
$163.89
|
| Rate for Payer: Cofinity Advantage |
$154.18
|
| Rate for Payer: Cofinity Commercial |
$201.35
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Cofinity Commercial |
$393.68
|
| Rate for Payer: Cofinity Commercial |
$189.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.20
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Healthscope Commercial |
$198.22
|
| Rate for Payer: Healthscope Commercial |
$210.72
|
| Rate for Payer: Healthscope Commercial |
$411.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.18
|
| 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 |
$165.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$366.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,102.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,970.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.33
|
| Rate for Payer: PHP Commercial |
$187.21
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$389.10
|
| Rate for Payer: PHP Commercial |
$199.01
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
| Rate for Payer: Priority Health SBD |
$138.76
|
| Rate for Payer: Priority Health SBD |
$147.50
|
| Rate for Payer: Priority Health SBD |
$288.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UMR Bronson Commercial |
$169.37
|
| Rate for Payer: UMR Bronson Commercial |
$81.49
|
| Rate for Payer: UMR Bronson Commercial |
$86.63
|
| Rate for Payer: UMR Bronson Commercial |
$972.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,970.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.33
|
|
|
AZACITIDINE 100 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$311.19
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
78420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$280.07 |
| Rate for Payer: Aetna American Axle |
$202.27
|
| Rate for Payer: Aetna American Axle |
$161.28
|
| Rate for Payer: Aetna American Axle |
$166.24
|
| Rate for Payer: Aetna American Axle |
$167.38
|
| Rate for Payer: Aetna American Axle |
$152.18
|
| Rate for Payer: Aetna American Axle |
$281.50
|
| Rate for Payer: Aetna American Axle |
$198.35
|
| Rate for Payer: Aetna American Axle |
$1,708.02
|
| Rate for Payer: Aetna American Axle |
$157.62
|
| Rate for Payer: Aetna American Axle |
$278.83
|
| Rate for Payer: Aetna American Axle |
$297.55
|
| Rate for Payer: Aetna American Axle |
$143.16
|
| Rate for Payer: Aetna Commercial |
$206.12
|
| Rate for Payer: Aetna Commercial |
$210.91
|
| Rate for Payer: Aetna Commercial |
$199.01
|
| Rate for Payer: Aetna Commercial |
$264.51
|
| Rate for Payer: Aetna Commercial |
$368.11
|
| Rate for Payer: Aetna Commercial |
$259.38
|
| Rate for Payer: Aetna Commercial |
$217.39
|
| Rate for Payer: Aetna Commercial |
$187.21
|
| Rate for Payer: Aetna Commercial |
$218.88
|
| Rate for Payer: Aetna Commercial |
$364.62
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna Commercial |
$389.10
|
| Rate for Payer: Aetna Medicare |
$155.59
|
| Rate for Payer: Aetna Medicare |
$117.06
|
| Rate for Payer: Aetna Medicare |
$214.49
|
| Rate for Payer: Aetna Medicare |
$110.12
|
| Rate for Payer: Aetna Medicare |
$121.25
|
| Rate for Payer: Aetna Medicare |
$128.75
|
| Rate for Payer: Aetna Medicare |
$1,313.87
|
| Rate for Payer: Aetna Medicare |
$124.06
|
| Rate for Payer: Aetna Medicare |
$228.88
|
| Rate for Payer: Aetna Medicare |
$152.57
|
| Rate for Payer: Aetna Medicare |
$127.88
|
| Rate for Payer: Aetna Medicare |
$216.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: BCBS Complete |
$173.23
|
| Rate for Payer: BCBS Complete |
$102.30
|
| Rate for Payer: BCBS Complete |
$88.10
|
| Rate for Payer: BCBS Complete |
$93.65
|
| Rate for Payer: BCBS Complete |
$97.00
|
| Rate for Payer: BCBS Complete |
$183.11
|
| Rate for Payer: BCBS Complete |
$171.59
|
| Rate for Payer: BCBS Complete |
$124.48
|
| Rate for Payer: BCBS Complete |
$122.06
|
| Rate for Payer: BCBS Complete |
$1,051.09
|
| Rate for Payer: BCBS Complete |
$99.25
|
| Rate for Payer: BCBS Complete |
$103.00
|
| Rate for Payer: BCBS Trust/PPO |
$1.46
|
| Rate for Payer: BCBS Trust/PPO |
$1.46
|
| Rate for Payer: BCBS Trust/PPO |
$1.46
|
| Rate for Payer: BCBS Trust/PPO |
$1.46
|
| Rate for Payer: BCBS Trust/PPO |
$1.46
|
| Rate for Payer: BCBS Trust/PPO |
$1.46
|
| Rate for Payer: BCBS Trust/PPO |
$1.46
|
| Rate for Payer: BCBS Trust/PPO |
$1.46
|
| Rate for Payer: BCBS Trust/PPO |
$1.46
|
| Rate for Payer: BCBS Trust/PPO |
$1.46
|
| Rate for Payer: BCBS Trust/PPO |
$1.46
|
| Rate for Payer: BCBS Trust/PPO |
$1.46
|
| Rate for Payer: BCN Commercial |
$1.46
|
| Rate for Payer: BCN Commercial |
$1.46
|
| Rate for Payer: BCN Commercial |
$1.46
|
| Rate for Payer: BCN Commercial |
$1.46
|
| Rate for Payer: BCN Commercial |
$1.46
|
| Rate for Payer: BCN Commercial |
$1.46
|
| Rate for Payer: BCN Commercial |
$1.46
|
| Rate for Payer: BCN Commercial |
$1.46
|
| Rate for Payer: BCN Commercial |
$1.46
|
| Rate for Payer: BCN Commercial |
$1.46
|
| Rate for Payer: BCN Commercial |
$1.46
|
| Rate for Payer: BCN Commercial |
$1.46
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cash Price |
$244.12
|
| Rate for Payer: Cash Price |
$198.50
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cash Price |
$176.20
|
| Rate for Payer: Cash Price |
$176.20
|
| Rate for Payer: Cash Price |
$343.18
|
| Rate for Payer: Cash Price |
$346.46
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$248.95
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cash Price |
$206.00
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$248.95
|
| Rate for Payer: Cash Price |
$346.46
|
| Rate for Payer: Cash Price |
$206.00
|
| Rate for Payer: Cash Price |
$244.12
|
| Rate for Payer: Cash Price |
$343.18
|
| Rate for Payer: Cash Price |
$198.50
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cash Price |
$187.30
|
| Rate for Payer: Cash Price |
$187.30
|
| Rate for Payer: Cofinity Advantage |
$303.15
|
| Rate for Payer: Cofinity Advantage |
$169.75
|
| Rate for Payer: Cofinity Advantage |
$163.89
|
| Rate for Payer: Cofinity Advantage |
$154.18
|
| Rate for Payer: Cofinity Advantage |
$173.69
|
| Rate for Payer: Cofinity Advantage |
$179.03
|
| Rate for Payer: Cofinity Advantage |
$180.25
|
| Rate for Payer: Cofinity Advantage |
$1,839.41
|
| Rate for Payer: Cofinity Advantage |
$213.60
|
| Rate for Payer: Cofinity Advantage |
$217.83
|
| Rate for Payer: Cofinity Advantage |
$300.28
|
| Rate for Payer: Cofinity Advantage |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$372.44
|
| Rate for Payer: Cofinity Commercial |
$262.43
|
| Rate for Payer: Cofinity Commercial |
$267.62
|
| Rate for Payer: Cofinity Commercial |
$213.39
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Cofinity Commercial |
$393.68
|
| Rate for Payer: Cofinity Commercial |
$189.41
|
| Rate for Payer: Cofinity Commercial |
$201.35
|
| Rate for Payer: Cofinity Commercial |
$208.55
|
| Rate for Payer: Cofinity Commercial |
$219.94
|
| Rate for Payer: Cofinity Commercial |
$221.45
|
| Rate for Payer: Cofinity Commercial |
$368.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.22
|
| Rate for Payer: Healthscope Commercial |
$218.25
|
| Rate for Payer: Healthscope Commercial |
$223.32
|
| Rate for Payer: Healthscope Commercial |
$389.76
|
| Rate for Payer: Healthscope Commercial |
$280.07
|
| Rate for Payer: Healthscope Commercial |
$411.99
|
| Rate for Payer: Healthscope Commercial |
$231.75
|
| Rate for Payer: Healthscope Commercial |
$386.07
|
| Rate for Payer: Healthscope Commercial |
$210.72
|
| Rate for Payer: Healthscope Commercial |
$198.22
|
| Rate for Payer: Healthscope Commercial |
$230.18
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Healthscope Commercial |
$274.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$303.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,839.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.60
|
| 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 |
$165.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$346.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,102.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$343.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$366.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$194.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$206.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,970.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.19
|
| Rate for Payer: PHP Commercial |
$389.10
|
| Rate for Payer: PHP Commercial |
$206.12
|
| Rate for Payer: PHP Commercial |
$210.91
|
| Rate for Payer: PHP Commercial |
$264.51
|
| Rate for Payer: PHP Commercial |
$368.11
|
| Rate for Payer: PHP Commercial |
$187.21
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$199.01
|
| Rate for Payer: PHP Commercial |
$364.62
|
| Rate for Payer: PHP Commercial |
$217.39
|
| Rate for Payer: PHP Commercial |
$218.88
|
| Rate for Payer: PHP Commercial |
$259.38
|
| Rate for Payer: Priority Health SBD |
$192.24
|
| Rate for Payer: Priority Health SBD |
$162.22
|
| Rate for Payer: Priority Health SBD |
$152.78
|
| Rate for Payer: Priority Health SBD |
$272.83
|
| Rate for Payer: Priority Health SBD |
$270.25
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
| Rate for Payer: Priority Health SBD |
$196.05
|
| Rate for Payer: Priority Health SBD |
$288.40
|
| Rate for Payer: Priority Health SBD |
$138.76
|
| Rate for Payer: Priority Health SBD |
$147.50
|
| Rate for Payer: Priority Health SBD |
$156.32
|
| Rate for Payer: Priority Health SBD |
$161.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UMR Bronson Commercial |
$94.63
|
| Rate for Payer: UMR Bronson Commercial |
$89.72
|
| Rate for Payer: UMR Bronson Commercial |
$169.37
|
| Rate for Payer: UMR Bronson Commercial |
$972.26
|
| Rate for Payer: UMR Bronson Commercial |
$86.63
|
| Rate for Payer: UMR Bronson Commercial |
$81.49
|
| Rate for Payer: UMR Bronson Commercial |
$112.91
|
| Rate for Payer: UMR Bronson Commercial |
$115.14
|
| Rate for Payer: UMR Bronson Commercial |
$91.81
|
| Rate for Payer: UMR Bronson Commercial |
$160.24
|
| Rate for Payer: UMR Bronson Commercial |
$158.72
|
| Rate for Payer: UMR Bronson Commercial |
$95.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,970.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.80
|
|
|
AZACITIDINE 100 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$220.25
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
78420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.91 |
| Max. Negotiated Rate |
$198.22 |
| Rate for Payer: Aetna American Axle |
$143.16
|
| Rate for Payer: Aetna American Axle |
$167.38
|
| Rate for Payer: Aetna American Axle |
$1,708.02
|
| Rate for Payer: Aetna American Axle |
$297.55
|
| Rate for Payer: Aetna American Axle |
$278.83
|
| Rate for Payer: Aetna American Axle |
$202.27
|
| Rate for Payer: Aetna American Axle |
$152.18
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna Commercial |
$199.01
|
| Rate for Payer: Aetna Commercial |
$187.21
|
| Rate for Payer: Aetna Commercial |
$218.88
|
| Rate for Payer: Aetna Commercial |
$389.10
|
| Rate for Payer: Aetna Commercial |
$264.51
|
| Rate for Payer: Aetna Commercial |
$364.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.55
|
| Rate for Payer: Cash Price |
$176.20
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$206.00
|
| Rate for Payer: Cash Price |
$187.30
|
| Rate for Payer: Cash Price |
$248.95
|
| Rate for Payer: Cash Price |
$343.18
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cofinity Advantage |
$300.28
|
| Rate for Payer: Cofinity Advantage |
$154.18
|
| Rate for Payer: Cofinity Advantage |
$163.89
|
| Rate for Payer: Cofinity Advantage |
$1,839.41
|
| Rate for Payer: Cofinity Advantage |
$180.25
|
| Rate for Payer: Cofinity Advantage |
$217.83
|
| Rate for Payer: Cofinity Advantage |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$221.45
|
| Rate for Payer: Cofinity Commercial |
$393.68
|
| Rate for Payer: Cofinity Commercial |
$368.91
|
| Rate for Payer: Cofinity Commercial |
$189.41
|
| Rate for Payer: Cofinity Commercial |
$201.35
|
| Rate for Payer: Cofinity Commercial |
$267.62
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.30
|
| Rate for Payer: Healthscope Commercial |
$411.99
|
| Rate for Payer: Healthscope Commercial |
$198.22
|
| Rate for Payer: Healthscope Commercial |
$386.07
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Healthscope Commercial |
$210.72
|
| Rate for Payer: Healthscope Commercial |
$231.75
|
| Rate for Payer: Healthscope Commercial |
$280.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,839.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,970.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,970.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.60
|
| Rate for Payer: PHP Commercial |
$199.01
|
| Rate for Payer: PHP Commercial |
$364.62
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$389.10
|
| Rate for Payer: PHP Commercial |
$218.88
|
| Rate for Payer: PHP Commercial |
$187.21
|
| Rate for Payer: PHP Commercial |
$264.51
|
| Rate for Payer: Priority Health SBD |
$138.76
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
| Rate for Payer: Priority Health SBD |
$196.05
|
| Rate for Payer: Priority Health SBD |
$270.25
|
| Rate for Payer: Priority Health SBD |
$288.40
|
| Rate for Payer: Priority Health SBD |
$147.50
|
| Rate for Payer: Priority Health SBD |
$162.22
|
| Rate for Payer: UMR Bronson Commercial |
$201.42
|
| Rate for Payer: UMR Bronson Commercial |
$96.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,156.20
|
| Rate for Payer: UMR Bronson Commercial |
$103.02
|
| Rate for Payer: UMR Bronson Commercial |
$136.92
|
| Rate for Payer: UMR Bronson Commercial |
$188.75
|
| Rate for Payer: UMR Bronson Commercial |
$113.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,970.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.33
|
|
|
AZATHIOPRINE 50 MG TABLET
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
9183
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna American Axle |
$2.03
|
| Rate for Payer: Aetna American Axle |
$202.49
|
| Rate for Payer: Aetna American Axle |
$239.82
|
| Rate for Payer: Aetna American Axle |
$143.88
|
| Rate for Payer: Aetna Commercial |
$313.61
|
| Rate for Payer: Aetna Commercial |
$2.65
|
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: Aetna Commercial |
$264.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.88
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cash Price |
$249.22
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Advantage |
$218.06
|
| Rate for Payer: Cofinity Advantage |
$154.94
|
| Rate for Payer: Cofinity Advantage |
$2.18
|
| Rate for Payer: Cofinity Advantage |
$258.26
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Cofinity Commercial |
$267.91
|
| Rate for Payer: Cofinity Commercial |
$317.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.22
|
| Rate for Payer: Healthscope Commercial |
$280.37
|
| Rate for Payer: Healthscope Commercial |
$332.06
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$258.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.01
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: PHP Commercial |
$2.65
|
| Rate for Payer: PHP Commercial |
$264.79
|
| Rate for Payer: PHP Commercial |
$313.61
|
| Rate for Payer: Priority Health SBD |
$232.44
|
| Rate for Payer: Priority Health SBD |
$139.45
|
| Rate for Payer: Priority Health SBD |
$1.97
|
| Rate for Payer: Priority Health SBD |
$196.26
|
| Rate for Payer: UMR Bronson Commercial |
$137.07
|
| Rate for Payer: UMR Bronson Commercial |
$1.37
|
| Rate for Payer: UMR Bronson Commercial |
$97.39
|
| Rate for Payer: UMR Bronson Commercial |
$162.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.71
|
|
|
AZATHIOPRINE 50 MG TABLET
|
Facility
|
OP
|
$368.95
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
9183
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$332.06 |
| Rate for Payer: Aetna American Axle |
$239.82
|
| Rate for Payer: Aetna American Axle |
$202.49
|
| Rate for Payer: Aetna American Axle |
$143.88
|
| Rate for Payer: Aetna American Axle |
$2.03
|
| Rate for Payer: Aetna Commercial |
$313.61
|
| Rate for Payer: Aetna Commercial |
$264.79
|
| Rate for Payer: Aetna Commercial |
$2.65
|
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: Aetna Medicare |
$184.47
|
| Rate for Payer: Aetna Medicare |
$110.67
|
| Rate for Payer: Aetna Medicare |
$155.76
|
| Rate for Payer: Aetna Medicare |
$1.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.88
|
| Rate for Payer: BCBS Complete |
$88.54
|
| Rate for Payer: BCBS Complete |
$124.61
|
| Rate for Payer: BCBS Complete |
$1.25
|
| Rate for Payer: BCBS Complete |
$147.58
|
| Rate for Payer: BCBS Trust/PPO |
$3.18
|
| Rate for Payer: BCBS Trust/PPO |
$3.18
|
| Rate for Payer: BCBS Trust/PPO |
$3.18
|
| Rate for Payer: BCBS Trust/PPO |
$3.18
|
| Rate for Payer: BCN Commercial |
$3.18
|
| Rate for Payer: BCN Commercial |
$3.18
|
| Rate for Payer: BCN Commercial |
$3.18
|
| Rate for Payer: BCN Commercial |
$3.18
|
| Rate for Payer: Cash Price |
$249.22
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cash Price |
$249.22
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cofinity Advantage |
$218.06
|
| Rate for Payer: Cofinity Advantage |
$2.18
|
| Rate for Payer: Cofinity Advantage |
$258.26
|
| Rate for Payer: Cofinity Advantage |
$154.94
|
| Rate for Payer: Cofinity Commercial |
$267.91
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Cofinity Commercial |
$317.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Healthscope Commercial |
$332.06
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Healthscope Commercial |
$280.37
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$258.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$295.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.34
|
| Rate for Payer: PHP Commercial |
$313.61
|
| Rate for Payer: PHP Commercial |
$2.65
|
| Rate for Payer: PHP Commercial |
$264.79
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: Priority Health SBD |
$196.26
|
| Rate for Payer: Priority Health SBD |
$232.44
|
| Rate for Payer: Priority Health SBD |
$1.97
|
| Rate for Payer: Priority Health SBD |
$139.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.03
|
| Rate for Payer: UHC Core |
$1.63
|
| Rate for Payer: UHC Core |
$162.30
|
| Rate for Payer: UHC Core |
$115.32
|
| Rate for Payer: UHC Core |
$192.22
|
| Rate for Payer: UHC Exchange |
$1.23
|
| Rate for Payer: UHC Exchange |
$86.99
|
| Rate for Payer: UHC Exchange |
$122.43
|
| Rate for Payer: UHC Exchange |
$145.00
|
| Rate for Payer: UMR Bronson Commercial |
$136.51
|
| Rate for Payer: UMR Bronson Commercial |
$115.26
|
| Rate for Payer: UMR Bronson Commercial |
$81.90
|
| Rate for Payer: UMR Bronson Commercial |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.71
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$116.79
|
|
|
Service Code
|
NDC 00093202631
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.39 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna American Axle |
$75.91
|
| Rate for Payer: Aetna Commercial |
$99.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.91
|
| Rate for Payer: Cash Price |
$93.43
|
| Rate for Payer: Cofinity Advantage |
$81.75
|
| Rate for Payer: Cofinity Commercial |
$100.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.43
|
| Rate for Payer: Healthscope Commercial |
$105.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.59
|
| Rate for Payer: PHP Commercial |
$99.27
|
| Rate for Payer: Priority Health SBD |
$73.58
|
| Rate for Payer: UMR Bronson Commercial |
$51.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.59
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$89.28
|
|
|
Service Code
|
NDC 59762314001
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Aetna American Axle |
$58.03
|
| Rate for Payer: Aetna Commercial |
$75.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.03
|
| Rate for Payer: Cash Price |
$71.42
|
| Rate for Payer: Cofinity Advantage |
$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 Commercial |
$75.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.96
|
| Rate for Payer: PHP Commercial |
$75.89
|
| Rate for Payer: Priority Health SBD |
$56.25
|
| Rate for Payer: UMR Bronson Commercial |
$39.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.96
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$82.37
|
|
|
Service Code
|
NDC 42806015134
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$74.13 |
| Rate for Payer: Aetna American Axle |
$53.54
|
| Rate for Payer: Aetna Commercial |
$70.01
|
| Rate for Payer: Aetna Medicare |
$41.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.54
|
| Rate for Payer: BCBS Complete |
$32.95
|
| Rate for Payer: Cash Price |
$65.90
|
| Rate for Payer: Cofinity Advantage |
$57.66
|
| Rate for Payer: Cofinity Commercial |
$70.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.90
|
| Rate for Payer: Healthscope Commercial |
$74.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.78
|
| Rate for Payer: PHP Commercial |
$70.01
|
| Rate for Payer: Priority Health SBD |
$51.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.54
|
| Rate for Payer: UHC Core |
$42.91
|
| Rate for Payer: UHC Exchange |
$32.37
|
| Rate for Payer: UMR Bronson Commercial |
$30.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.78
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$116.79
|
|
|
Service Code
|
NDC 00093202631
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.21 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna American Axle |
$75.91
|
| Rate for Payer: Aetna Commercial |
$99.27
|
| Rate for Payer: Aetna Medicare |
$58.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.91
|
| Rate for Payer: BCBS Complete |
$46.72
|
| Rate for Payer: Cash Price |
$93.43
|
| Rate for Payer: Cofinity Advantage |
$81.75
|
| Rate for Payer: Cofinity Commercial |
$100.44
|
| 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: MI Amish Medical Board Commercial |
$93.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.59
|
| Rate for Payer: PHP Commercial |
$99.27
|
| Rate for Payer: Priority Health SBD |
$73.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.91
|
| Rate for Payer: UHC Core |
$60.85
|
| Rate for Payer: UHC Exchange |
$45.90
|
| Rate for Payer: UMR Bronson Commercial |
$43.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.59
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$82.37
|
|
|
Service Code
|
NDC 42806015134
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.24 |
| Max. Negotiated Rate |
$74.13 |
| Rate for Payer: Aetna American Axle |
$53.54
|
| Rate for Payer: Aetna Commercial |
$70.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.54
|
| Rate for Payer: Cash Price |
$65.90
|
| Rate for Payer: Cofinity Advantage |
$57.66
|
| Rate for Payer: Cofinity Commercial |
$70.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.90
|
| Rate for Payer: Healthscope Commercial |
$74.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.78
|
| Rate for Payer: PHP Commercial |
$70.01
|
| Rate for Payer: Priority Health SBD |
$51.89
|
| Rate for Payer: UMR Bronson Commercial |
$36.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.78
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$89.28
|
|
|
Service Code
|
NDC 59762314001
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.03 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Aetna American Axle |
$58.03
|
| Rate for Payer: Aetna Commercial |
$75.89
|
| Rate for Payer: Aetna Medicare |
$44.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.03
|
| Rate for Payer: BCBS Complete |
$35.71
|
| Rate for Payer: Cash Price |
$71.42
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$71.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.96
|
| Rate for Payer: PHP Commercial |
$75.89
|
| Rate for Payer: Priority Health SBD |
$56.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.03
|
| Rate for Payer: UHC Core |
$46.51
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UMR Bronson Commercial |
$33.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.96
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$460.80
|
|
|
Service Code
|
NDC 60687074201
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.75 |
| Max. Negotiated Rate |
$414.72 |
| Rate for Payer: Aetna American Axle |
$299.52
|
| Rate for Payer: Aetna Commercial |
$391.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.52
|
| Rate for Payer: Cash Price |
$368.64
|
| Rate for Payer: Cofinity Advantage |
$322.56
|
| Rate for Payer: Cofinity Commercial |
$396.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.64
|
| Rate for Payer: Healthscope Commercial |
$414.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$322.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$345.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$345.60
|
| Rate for Payer: PHP Commercial |
$391.68
|
| Rate for Payer: Priority Health SBD |
$290.30
|
| Rate for Payer: UMR Bronson Commercial |
$202.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$345.60
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$4.61
|
|
|
Service Code
|
NDC 60687074211
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna American Axle |
$3.00
|
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Aetna Medicare |
$2.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.00
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Advantage |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.46
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: Priority Health SBD |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.00
|
| Rate for Payer: UHC Core |
$2.40
|
| Rate for Payer: UHC Exchange |
$1.81
|
| Rate for Payer: UMR Bronson Commercial |
$1.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$4.61
|
|
|
Service Code
|
NDC 60687074211
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna American Axle |
$3.00
|
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.00
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Advantage |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.46
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: Priority Health SBD |
$2.90
|
| Rate for Payer: UMR Bronson Commercial |
$2.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$154.08
|
|
|
Service Code
|
NDC 00904670806
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.01 |
| Max. Negotiated Rate |
$138.67 |
| Rate for Payer: Aetna American Axle |
$100.15
|
| Rate for Payer: Aetna Commercial |
$130.97
|
| Rate for Payer: Aetna Medicare |
$77.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.15
|
| Rate for Payer: BCBS Complete |
$61.63
|
| Rate for Payer: Cash Price |
$123.26
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$123.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.56
|
| Rate for Payer: PHP Commercial |
$130.97
|
| Rate for Payer: Priority Health SBD |
$97.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.15
|
| Rate for Payer: UHC Core |
$80.28
|
| Rate for Payer: UHC Exchange |
$60.55
|
| Rate for Payer: UMR Bronson Commercial |
$57.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.56
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$7.76
|
|
|
Service Code
|
NDC 60687028211
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$6.98 |
| Rate for Payer: Aetna American Axle |
$5.04
|
| Rate for Payer: Aetna Commercial |
$6.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.04
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: Cofinity Advantage |
$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 Commercial |
$6.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.82
|
| Rate for Payer: PHP Commercial |
$6.60
|
| 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
|
$154.08
|
|
|
Service Code
|
NDC 00904670806
|
| 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 Advantage |
$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 Commercial |
$130.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.56
|
| Rate for Payer: PHP Commercial |
$130.97
|
| 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
|
$44.74
|
|
|
Service Code
|
NDC 00781808926
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.69 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna American Axle |
$29.08
|
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.08
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Advantage |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$38.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$40.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.55
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: Priority Health SBD |
$28.19
|
| Rate for Payer: UMR Bronson Commercial |
$19.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.55
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$593.85
|
|
|
Service Code
|
NDC 00069406189
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.72 |
| Max. Negotiated Rate |
$534.47 |
| Rate for Payer: Aetna American Axle |
$386.00
|
| Rate for Payer: Aetna Commercial |
$504.77
|
| Rate for Payer: Aetna Medicare |
$296.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.00
|
| Rate for Payer: BCBS Complete |
$237.54
|
| Rate for Payer: Cash Price |
$475.08
|
| Rate for Payer: Cofinity Advantage |
$415.69
|
| Rate for Payer: Cofinity Commercial |
$510.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.08
|
| Rate for Payer: Healthscope Commercial |
$534.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$415.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$445.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$475.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$504.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$445.39
|
| Rate for Payer: PHP Commercial |
$504.77
|
| Rate for Payer: Priority Health SBD |
$374.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.00
|
| Rate for Payer: UHC Core |
$309.40
|
| Rate for Payer: UHC Exchange |
$233.38
|
| Rate for Payer: UMR Bronson Commercial |
$219.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$445.39
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$775.20
|
|
|
Service Code
|
NDC 60687028201
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$341.09 |
| Max. Negotiated Rate |
$697.68 |
| Rate for Payer: Aetna American Axle |
$503.88
|
| Rate for Payer: Aetna Commercial |
$658.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.88
|
| Rate for Payer: Cash Price |
$620.16
|
| Rate for Payer: Cofinity Advantage |
$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 Commercial |
$658.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$581.40
|
| Rate for Payer: PHP Commercial |
$658.92
|
| 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
|
$284.55
|
|
|
Service Code
|
NDC 68180016006
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.20 |
| Max. Negotiated Rate |
$256.10 |
| Rate for Payer: Aetna American Axle |
$184.96
|
| Rate for Payer: Aetna Commercial |
$241.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.96
|
| Rate for Payer: Cash Price |
$227.64
|
| Rate for Payer: Cofinity Advantage |
$199.19
|
| 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 |
$199.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.41
|
| Rate for Payer: PHP Commercial |
$241.87
|
| Rate for Payer: Priority Health SBD |
$179.27
|
| Rate for Payer: UMR Bronson Commercial |
$125.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.41
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$37.68
|
|
|
Service Code
|
NDC 50111078766
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$33.91 |
| Rate for Payer: Aetna American Axle |
$24.49
|
| Rate for Payer: Aetna Commercial |
$32.03
|
| Rate for Payer: Aetna Medicare |
$18.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.49
|
| Rate for Payer: BCBS Complete |
$15.07
|
| Rate for Payer: Cash Price |
$30.14
|
| Rate for Payer: Cofinity Advantage |
$26.38
|
| Rate for Payer: Cofinity Commercial |
$32.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.14
|
| Rate for Payer: Healthscope Commercial |
$33.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.26
|
| Rate for Payer: PHP Commercial |
$32.03
|
| Rate for Payer: Priority Health SBD |
$23.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.49
|
| Rate for Payer: UHC Core |
$19.63
|
| Rate for Payer: UHC Exchange |
$14.81
|
| Rate for Payer: UMR Bronson Commercial |
$13.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.26
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$384.80
|
|
|
Service Code
|
NDC 59762306003
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.31 |
| Max. Negotiated Rate |
$346.32 |
| Rate for Payer: Aetna American Axle |
$250.12
|
| Rate for Payer: Aetna Commercial |
$327.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.12
|
| Rate for Payer: Cash Price |
$307.84
|
| Rate for Payer: Cofinity Advantage |
$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 Commercial |
$327.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$288.60
|
| Rate for Payer: PHP Commercial |
$327.08
|
| 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
|
$19.68
|
|
|
Service Code
|
NDC 69452017173
|
| 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 Advantage |
$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 Commercial |
$16.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.76
|
| Rate for Payer: PHP Commercial |
$16.73
|
| 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
|
|
