|
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
|
$23.19
|
|
|
Service Code
|
NDC 65862064169
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$20.87 |
| Rate for Payer: Aetna American Axle |
$15.07
|
| Rate for Payer: Aetna Commercial |
$19.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.07
|
| Rate for Payer: Cash Price |
$18.55
|
| Rate for Payer: Cofinity Advantage |
$16.23
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.55
|
| Rate for Payer: Healthscope Commercial |
$20.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.39
|
| Rate for Payer: PHP Commercial |
$19.71
|
| Rate for Payer: Priority Health SBD |
$14.61
|
| Rate for Payer: UMR Bronson Commercial |
$10.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.39
|
|
|
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
|
IP
|
$284.12
|
|
|
Service Code
|
NDC 51224002230
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.01 |
| Max. Negotiated Rate |
$255.71 |
| Rate for Payer: Aetna American Axle |
$184.68
|
| Rate for Payer: Aetna Commercial |
$241.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.68
|
| Rate for Payer: Cash Price |
$227.30
|
| Rate for Payer: Cofinity Advantage |
$198.88
|
| Rate for Payer: Cofinity Commercial |
$244.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.30
|
| Rate for Payer: Healthscope Commercial |
$255.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.09
|
| Rate for Payer: PHP Commercial |
$241.50
|
| Rate for Payer: Priority Health SBD |
$179.00
|
| Rate for Payer: UMR Bronson Commercial |
$125.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.09
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$51.62
|
|
|
Service Code
|
NDC 50111078751
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$46.46 |
| Rate for Payer: Aetna American Axle |
$33.55
|
| Rate for Payer: Aetna Commercial |
$43.88
|
| Rate for Payer: Aetna Medicare |
$25.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.55
|
| Rate for Payer: BCBS Complete |
$20.65
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$41.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.72
|
| Rate for Payer: PHP Commercial |
$43.88
|
| Rate for Payer: Priority Health SBD |
$32.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.55
|
| Rate for Payer: UHC Core |
$26.89
|
| Rate for Payer: UHC Exchange |
$20.29
|
| Rate for Payer: UMR Bronson Commercial |
$19.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.72
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$775.20
|
|
|
Service Code
|
NDC 60687028201
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$286.82 |
| Max. Negotiated Rate |
$697.68 |
| Rate for Payer: Aetna American Axle |
$503.88
|
| Rate for Payer: Aetna Commercial |
$658.92
|
| Rate for Payer: Aetna Medicare |
$387.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.88
|
| Rate for Payer: BCBS Complete |
$310.08
|
| 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: MI Amish Medical Board Commercial |
$620.16
|
| 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: UHC All Payor (Choice/PPO) |
$503.88
|
| Rate for Payer: UHC Core |
$403.88
|
| Rate for Payer: UHC Exchange |
$304.65
|
| Rate for Payer: UMR Bronson Commercial |
$286.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.40
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$284.55
|
|
|
Service Code
|
NDC 50111078710
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.28 |
| Max. Negotiated Rate |
$256.10 |
| Rate for Payer: Aetna American Axle |
$184.96
|
| Rate for Payer: Aetna Commercial |
$241.87
|
| Rate for Payer: Aetna Medicare |
$142.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.96
|
| Rate for Payer: BCBS Complete |
$113.82
|
| 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: MI Amish Medical Board Commercial |
$227.64
|
| 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: UHC All Payor (Choice/PPO) |
$184.96
|
| Rate for Payer: UHC Core |
$148.25
|
| Rate for Payer: UHC Exchange |
$111.83
|
| Rate for Payer: UMR Bronson Commercial |
$105.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.41
|
|
|
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
|
$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
|
$44.74
|
|
|
Service Code
|
NDC 00781808926
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.55 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna American Axle |
$29.08
|
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: Aetna Medicare |
$22.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.08
|
| Rate for Payer: BCBS Complete |
$17.90
|
| 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: MI Amish Medical Board Commercial |
$35.79
|
| 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: UHC All Payor (Choice/PPO) |
$29.08
|
| Rate for Payer: UHC Core |
$23.31
|
| Rate for Payer: UHC Exchange |
$17.58
|
| Rate for Payer: UMR Bronson Commercial |
$16.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.55
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$19.68
|
|
|
Service Code
|
NDC 65862064163
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Aetna American Axle |
$12.79
|
| Rate for Payer: Aetna Commercial |
$16.73
|
| Rate for Payer: Aetna Medicare |
$9.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.79
|
| Rate for Payer: BCBS Complete |
$7.87
|
| Rate for Payer: Cash Price |
$15.74
|
| Rate for Payer: Cofinity 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: MI Amish Medical Board Commercial |
$15.74
|
| 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: UHC All Payor (Choice/PPO) |
$12.79
|
| Rate for Payer: UHC Core |
$10.25
|
| Rate for Payer: UHC Exchange |
$7.73
|
| Rate for Payer: UMR Bronson Commercial |
$7.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.76
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$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
|
$19.68
|
|
|
Service Code
|
NDC 69452017173
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Aetna American Axle |
$12.79
|
| Rate for Payer: Aetna Commercial |
$16.73
|
| Rate for Payer: Aetna Medicare |
$9.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.79
|
| Rate for Payer: BCBS Complete |
$7.87
|
| Rate for Payer: Cash Price |
$15.74
|
| Rate for Payer: Cofinity 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: MI Amish Medical Board Commercial |
$15.74
|
| 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: UHC All Payor (Choice/PPO) |
$12.79
|
| Rate for Payer: UHC Core |
$10.25
|
| Rate for Payer: UHC Exchange |
$7.73
|
| Rate for Payer: UMR Bronson Commercial |
$7.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.76
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$223.67
|
|
|
Service Code
|
NDC 00781808931
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.76 |
| Max. Negotiated Rate |
$201.30 |
| Rate for Payer: Aetna American Axle |
$145.39
|
| Rate for Payer: Aetna Commercial |
$190.12
|
| Rate for Payer: Aetna Medicare |
$111.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.39
|
| Rate for Payer: BCBS Complete |
$89.47
|
| Rate for Payer: Cash Price |
$178.94
|
| Rate for Payer: Cofinity Advantage |
$156.57
|
| Rate for Payer: Cofinity Commercial |
$192.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.94
|
| Rate for Payer: Healthscope Commercial |
$201.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$178.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.75
|
| Rate for Payer: PHP Commercial |
$190.12
|
| Rate for Payer: Priority Health SBD |
$140.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.39
|
| Rate for Payer: UHC Core |
$116.53
|
| Rate for Payer: UHC Exchange |
$87.90
|
| Rate for Payer: UMR Bronson Commercial |
$82.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.75
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$7.76
|
|
|
Service Code
|
NDC 60687028211
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$6.98 |
| Rate for Payer: Aetna American Axle |
$5.04
|
| Rate for Payer: Aetna Commercial |
$6.60
|
| Rate for Payer: Aetna Medicare |
$3.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.04
|
| Rate for Payer: BCBS Complete |
$3.10
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: Cofinity 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: MI Amish Medical Board Commercial |
$6.21
|
| 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: UHC All Payor (Choice/PPO) |
$5.04
|
| Rate for Payer: UHC Core |
$4.04
|
| Rate for Payer: UHC Exchange |
$3.05
|
| Rate for Payer: UMR Bronson Commercial |
$2.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.82
|
|
|
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
|
$51.62
|
|
|
Service Code
|
NDC 50111078751
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.71 |
| Max. Negotiated Rate |
$46.46 |
| Rate for Payer: Aetna American Axle |
$33.55
|
| Rate for Payer: Aetna Commercial |
$43.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.55
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: Cofinity Advantage |
$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 Commercial |
$43.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.72
|
| Rate for Payer: PHP Commercial |
$43.88
|
| 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
|
OP
|
$384.80
|
|
|
Service Code
|
NDC 59762306003
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.38 |
| Max. Negotiated Rate |
$346.32 |
| Rate for Payer: Aetna American Axle |
$250.12
|
| Rate for Payer: Aetna Commercial |
$327.08
|
| Rate for Payer: Aetna Medicare |
$192.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.12
|
| Rate for Payer: BCBS Complete |
$153.92
|
| Rate for Payer: Cash Price |
$307.84
|
| Rate for Payer: Cofinity 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: MI Amish Medical Board Commercial |
$307.84
|
| 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: UHC All Payor (Choice/PPO) |
$250.12
|
| Rate for Payer: UHC Core |
$200.48
|
| Rate for Payer: UHC Exchange |
$151.23
|
| Rate for Payer: UMR Bronson Commercial |
$142.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.60
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$384.80
|
|
|
Service Code
|
NDC 59762306003
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.31 |
| Max. Negotiated Rate |
$346.32 |
| Rate for Payer: Aetna American Axle |
$250.12
|
| Rate for Payer: Aetna Commercial |
$327.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.12
|
| Rate for Payer: Cash Price |
$307.84
|
| Rate for Payer: Cofinity 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
|
OP
|
$284.12
|
|
|
Service Code
|
NDC 51224002230
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.12 |
| Max. Negotiated Rate |
$255.71 |
| Rate for Payer: Aetna American Axle |
$184.68
|
| Rate for Payer: Aetna Commercial |
$241.50
|
| Rate for Payer: Aetna Medicare |
$142.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.68
|
| Rate for Payer: BCBS Complete |
$113.65
|
| Rate for Payer: Cash Price |
$227.30
|
| Rate for Payer: Cofinity Advantage |
$198.88
|
| Rate for Payer: Cofinity Commercial |
$244.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.30
|
| Rate for Payer: Healthscope Commercial |
$255.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.09
|
| Rate for Payer: PHP Commercial |
$241.50
|
| Rate for Payer: Priority Health SBD |
$179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.68
|
| Rate for Payer: UHC Core |
$148.03
|
| Rate for Payer: UHC Exchange |
$111.66
|
| Rate for Payer: UMR Bronson Commercial |
$105.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.09
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$460.80
|
|
|
Service Code
|
NDC 60687074201
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.50 |
| Max. Negotiated Rate |
$414.72 |
| Rate for Payer: Aetna American Axle |
$299.52
|
| Rate for Payer: Aetna Commercial |
$391.68
|
| Rate for Payer: Aetna Medicare |
$230.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.52
|
| Rate for Payer: BCBS Complete |
$184.32
|
| 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: MI Amish Medical Board Commercial |
$368.64
|
| 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: UHC All Payor (Choice/PPO) |
$299.52
|
| Rate for Payer: UHC Core |
$240.08
|
| Rate for Payer: UHC Exchange |
$181.09
|
| Rate for Payer: UMR Bronson Commercial |
$170.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$345.60
|
|
|
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
|
OP
|
$174.00
|
|
|
Service Code
|
NDC 60687074265
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.38 |
| Max. Negotiated Rate |
$156.60 |
| Rate for Payer: Aetna American Axle |
$113.10
|
| Rate for Payer: Aetna Commercial |
$147.90
|
| Rate for Payer: Aetna Medicare |
$87.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.10
|
| Rate for Payer: BCBS Complete |
$69.60
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cofinity Advantage |
$121.80
|
| Rate for Payer: Cofinity Commercial |
$149.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.20
|
| Rate for Payer: Healthscope Commercial |
$156.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.50
|
| Rate for Payer: PHP Commercial |
$147.90
|
| Rate for Payer: Priority Health SBD |
$109.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.10
|
| Rate for Payer: UHC Core |
$90.65
|
| Rate for Payer: UHC Exchange |
$68.38
|
| Rate for Payer: UMR Bronson Commercial |
$64.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.50
|
|
|
AZITHROMYCIN 500 MG 250 ML (IV PREMIX)
|
Facility
|
OP
|
$84.92
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
500536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$76.43 |
| Rate for Payer: Aetna American Axle |
$55.20
|
| Rate for Payer: Aetna Commercial |
$72.18
|
| Rate for Payer: Aetna Medicare |
$42.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.20
|
| Rate for Payer: BCBS Complete |
$33.97
|
| Rate for Payer: BCBS Trust/PPO |
$6.62
|
| Rate for Payer: BCN Commercial |
$6.62
|
| Rate for Payer: Cash Price |
$67.94
|
| Rate for Payer: Cash Price |
$67.94
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$67.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.69
|
| Rate for Payer: PHP Commercial |
$72.18
|
| Rate for Payer: Priority Health SBD |
$53.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.37
|
| Rate for Payer: UHC Core |
$3.37
|
| Rate for Payer: UHC Exchange |
$3.37
|
| Rate for Payer: UMR Bronson Commercial |
$31.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.69
|
|
|
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 Advantage |
$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 Commercial |
$72.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.69
|
| Rate for Payer: PHP Commercial |
$72.18
|
| 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
|
|
