|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17.47
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
21063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Aetna American Axle |
$11.36
|
| Rate for Payer: Aetna American Axle |
$17.00
|
| Rate for Payer: Aetna American Axle |
$13.49
|
| Rate for Payer: Aetna American Axle |
$13.06
|
| Rate for Payer: Aetna American Axle |
$19.96
|
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Commercial |
$17.09
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$22.24
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Medicare |
$15.36
|
| Rate for Payer: Aetna Medicare |
$10.05
|
| Rate for Payer: Aetna Medicare |
$8.73
|
| Rate for Payer: Aetna Medicare |
$10.38
|
| Rate for Payer: Aetna Medicare |
$13.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.96
|
| Rate for Payer: BCBS Complete |
$10.46
|
| Rate for Payer: BCBS Complete |
$6.99
|
| Rate for Payer: BCBS Complete |
$8.04
|
| Rate for Payer: BCBS Complete |
$8.30
|
| Rate for Payer: BCBS Complete |
$12.28
|
| Rate for Payer: BCBS Trust/PPO |
$6.62
|
| Rate for Payer: BCBS Trust/PPO |
$6.62
|
| Rate for Payer: BCBS Trust/PPO |
$6.62
|
| Rate for Payer: BCBS Trust/PPO |
$6.62
|
| Rate for Payer: BCBS Trust/PPO |
$6.62
|
| Rate for Payer: BCN Commercial |
$6.62
|
| Rate for Payer: BCN Commercial |
$6.62
|
| Rate for Payer: BCN Commercial |
$6.62
|
| Rate for Payer: BCN Commercial |
$6.62
|
| Rate for Payer: BCN Commercial |
$6.62
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cofinity Advantage |
$18.31
|
| Rate for Payer: Cofinity Advantage |
$14.07
|
| Rate for Payer: Cofinity Advantage |
$14.53
|
| Rate for Payer: Cofinity Advantage |
$21.50
|
| Rate for Payer: Cofinity Advantage |
$12.23
|
| Rate for Payer: Cofinity Commercial |
$22.50
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.61
|
| Rate for Payer: Healthscope Commercial |
$18.68
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Healthscope Commercial |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$18.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.03
|
| Rate for Payer: PHP Commercial |
$17.09
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$22.24
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: Priority Health SBD |
$13.08
|
| Rate for Payer: Priority Health SBD |
$11.01
|
| Rate for Payer: Priority Health SBD |
$16.48
|
| Rate for Payer: Priority Health SBD |
$19.35
|
| Rate for Payer: Priority Health SBD |
$12.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.37
|
| Rate for Payer: UHC Core |
$3.37
|
| Rate for Payer: UHC Core |
$3.37
|
| Rate for Payer: UHC Core |
$3.37
|
| Rate for Payer: UHC Core |
$3.37
|
| Rate for Payer: UHC Core |
$3.37
|
| Rate for Payer: UHC Exchange |
$3.37
|
| Rate for Payer: UHC Exchange |
$3.37
|
| Rate for Payer: UHC Exchange |
$3.37
|
| Rate for Payer: UHC Exchange |
$3.37
|
| Rate for Payer: UHC Exchange |
$3.37
|
| Rate for Payer: UMR Bronson Commercial |
$6.46
|
| Rate for Payer: UMR Bronson Commercial |
$9.68
|
| Rate for Payer: UMR Bronson Commercial |
$7.68
|
| Rate for Payer: UMR Bronson Commercial |
$11.36
|
| Rate for Payer: UMR Bronson Commercial |
$7.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.10
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$30.71
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
21063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.51 |
| Max. Negotiated Rate |
$27.64 |
| Rate for Payer: Aetna American Axle |
$19.96
|
| Rate for Payer: Aetna American Axle |
$13.49
|
| Rate for Payer: Aetna American Axle |
$11.36
|
| Rate for Payer: Aetna American Axle |
$13.06
|
| Rate for Payer: Aetna American Axle |
$17.00
|
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Commercial |
$17.09
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$22.24
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.00
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cofinity Advantage |
$21.50
|
| Rate for Payer: Cofinity Advantage |
$14.53
|
| Rate for Payer: Cofinity Advantage |
$12.23
|
| Rate for Payer: Cofinity Advantage |
$14.07
|
| Rate for Payer: Cofinity Advantage |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$22.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.98
|
| Rate for Payer: Healthscope Commercial |
$18.09
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Healthscope Commercial |
$18.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.03
|
| Rate for Payer: PHP Commercial |
$17.09
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: PHP Commercial |
$22.24
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: Priority Health SBD |
$11.01
|
| Rate for Payer: Priority Health SBD |
$12.66
|
| Rate for Payer: Priority Health SBD |
$16.48
|
| Rate for Payer: Priority Health SBD |
$13.08
|
| Rate for Payer: Priority Health SBD |
$19.35
|
| Rate for Payer: UMR Bronson Commercial |
$9.13
|
| Rate for Payer: UMR Bronson Commercial |
$13.51
|
| Rate for Payer: UMR Bronson Commercial |
$11.51
|
| Rate for Payer: UMR Bronson Commercial |
$7.69
|
| Rate for Payer: UMR Bronson Commercial |
$8.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.62
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION (BMH OSC)
|
Facility
|
OP
|
$30.71
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
169410
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$27.64 |
| Rate for Payer: Aetna American Axle |
$19.96
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Medicare |
$15.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.96
|
| Rate for Payer: BCBS Complete |
$12.28
|
| Rate for Payer: BCBS Trust/PPO |
$6.62
|
| Rate for Payer: BCN Commercial |
$6.62
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cofinity Advantage |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.03
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: Priority Health SBD |
$19.35
|
| 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 |
$11.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.03
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION (BMH OSC)
|
Facility
|
IP
|
$30.71
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
169410
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.51 |
| Max. Negotiated Rate |
$27.64 |
| Rate for Payer: Aetna American Axle |
$19.96
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.96
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cofinity Advantage |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.03
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: Priority Health SBD |
$19.35
|
| Rate for Payer: UMR Bronson Commercial |
$13.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.03
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$19.73
|
|
|
Service Code
|
NDC 69452017260
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna Commercial |
$16.77
|
| Rate for Payer: Aetna Medicare |
$9.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Advantage |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$16.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.80
|
| Rate for Payer: PHP Commercial |
$16.77
|
| Rate for Payer: Priority Health SBD |
$12.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.82
|
| Rate for Payer: UHC Core |
$10.28
|
| Rate for Payer: UHC Exchange |
$7.75
|
| Rate for Payer: UMR Bronson Commercial |
$7.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.80
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$498.06
|
|
|
Service Code
|
NDC 50111078810
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.15 |
| Max. Negotiated Rate |
$448.25 |
| Rate for Payer: Aetna American Axle |
$323.74
|
| Rate for Payer: Aetna Commercial |
$423.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.74
|
| Rate for Payer: Cash Price |
$398.45
|
| Rate for Payer: Cofinity Advantage |
$348.64
|
| Rate for Payer: Cofinity Commercial |
$428.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.45
|
| Rate for Payer: Healthscope Commercial |
$448.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$348.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.55
|
| Rate for Payer: PHP Commercial |
$423.35
|
| Rate for Payer: Priority Health SBD |
$313.78
|
| Rate for Payer: UMR Bronson Commercial |
$219.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.55
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$9.57
|
|
|
Service Code
|
NDC 60687075311
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna American Axle |
$6.22
|
| Rate for Payer: Aetna Commercial |
$8.13
|
| Rate for Payer: Aetna Medicare |
$4.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.22
|
| Rate for Payer: BCBS Complete |
$3.83
|
| Rate for Payer: Cash Price |
$7.66
|
| Rate for Payer: Cofinity Advantage |
$6.70
|
| Rate for Payer: Cofinity Commercial |
$8.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.66
|
| Rate for Payer: Healthscope Commercial |
$8.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.18
|
| Rate for Payer: PHP Commercial |
$8.13
|
| Rate for Payer: Priority Health SBD |
$6.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.22
|
| Rate for Payer: UHC Core |
$4.99
|
| Rate for Payer: UHC Exchange |
$3.76
|
| Rate for Payer: UMR Bronson Commercial |
$3.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.18
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$140.79
|
|
|
Service Code
|
NDC 62332025230
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.95 |
| Max. Negotiated Rate |
$126.71 |
| Rate for Payer: Aetna American Axle |
$91.51
|
| Rate for Payer: Aetna Commercial |
$119.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.51
|
| Rate for Payer: Cash Price |
$112.63
|
| Rate for Payer: Cofinity Advantage |
$98.55
|
| Rate for Payer: Cofinity Commercial |
$121.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.63
|
| Rate for Payer: Healthscope Commercial |
$126.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.59
|
| Rate for Payer: PHP Commercial |
$119.67
|
| Rate for Payer: Priority Health SBD |
$88.70
|
| Rate for Payer: UMR Bronson Commercial |
$61.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.59
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$19.69
|
|
|
Service Code
|
NDC 69452017272
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.29 |
| Max. Negotiated Rate |
$17.72 |
| Rate for Payer: Aetna American Axle |
$12.80
|
| Rate for Payer: Aetna Commercial |
$16.74
|
| Rate for Payer: Aetna Medicare |
$9.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.80
|
| Rate for Payer: BCBS Complete |
$7.88
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cofinity Advantage |
$13.78
|
| Rate for Payer: Cofinity Commercial |
$16.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.75
|
| Rate for Payer: Healthscope Commercial |
$17.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.77
|
| Rate for Payer: PHP Commercial |
$16.74
|
| Rate for Payer: Priority Health SBD |
$12.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.80
|
| Rate for Payer: UHC Core |
$10.26
|
| Rate for Payer: UHC Exchange |
$7.74
|
| Rate for Payer: UMR Bronson Commercial |
$7.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.77
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$19.69
|
|
|
Service Code
|
NDC 69452017272
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$17.72 |
| Rate for Payer: Aetna American Axle |
$12.80
|
| Rate for Payer: Aetna Commercial |
$16.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.80
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cofinity Advantage |
$13.78
|
| Rate for Payer: Cofinity Commercial |
$16.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.75
|
| Rate for Payer: Healthscope Commercial |
$17.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.77
|
| Rate for Payer: PHP Commercial |
$16.74
|
| Rate for Payer: Priority Health SBD |
$12.40
|
| Rate for Payer: UMR Bronson Commercial |
$8.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.77
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$19.73
|
|
|
Service Code
|
NDC 69452017260
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna Commercial |
$16.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Advantage |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$16.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.80
|
| Rate for Payer: PHP Commercial |
$16.77
|
| Rate for Payer: Priority Health SBD |
$12.43
|
| Rate for Payer: UMR Bronson Commercial |
$8.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.80
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$8.35
|
|
|
Service Code
|
NDC 50268009911
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$7.51 |
| Rate for Payer: Aetna American Axle |
$5.43
|
| Rate for Payer: Aetna Commercial |
$7.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.43
|
| Rate for Payer: Cash Price |
$6.68
|
| Rate for Payer: Cofinity Advantage |
$5.84
|
| Rate for Payer: Cofinity Commercial |
$7.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$7.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.26
|
| Rate for Payer: PHP Commercial |
$7.10
|
| Rate for Payer: Priority Health SBD |
$5.26
|
| Rate for Payer: UMR Bronson Commercial |
$3.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.26
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$29.05
|
|
|
Service Code
|
NDC 50111078867
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$26.14 |
| Rate for Payer: Aetna American Axle |
$18.88
|
| Rate for Payer: Aetna Commercial |
$24.69
|
| Rate for Payer: Aetna Medicare |
$14.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.88
|
| Rate for Payer: BCBS Complete |
$11.62
|
| Rate for Payer: Cash Price |
$23.24
|
| Rate for Payer: Cofinity Advantage |
$20.34
|
| Rate for Payer: Cofinity Commercial |
$24.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.24
|
| Rate for Payer: Healthscope Commercial |
$26.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.79
|
| Rate for Payer: PHP Commercial |
$24.69
|
| Rate for Payer: Priority Health SBD |
$18.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.88
|
| Rate for Payer: UHC Core |
$15.14
|
| Rate for Payer: UHC Exchange |
$11.42
|
| Rate for Payer: UMR Bronson Commercial |
$10.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.79
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$170.64
|
|
|
Service Code
|
NDC 65862064230
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.08 |
| Max. Negotiated Rate |
$153.58 |
| Rate for Payer: Aetna American Axle |
$110.92
|
| Rate for Payer: Aetna Commercial |
$145.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.92
|
| Rate for Payer: Cash Price |
$136.51
|
| Rate for Payer: Cofinity Advantage |
$119.45
|
| Rate for Payer: Cofinity Commercial |
$146.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.51
|
| Rate for Payer: Healthscope Commercial |
$153.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$119.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.98
|
| Rate for Payer: PHP Commercial |
$145.04
|
| Rate for Payer: Priority Health SBD |
$107.50
|
| Rate for Payer: UMR Bronson Commercial |
$75.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.98
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$9.57
|
|
|
Service Code
|
NDC 60687075311
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna American Axle |
$6.22
|
| Rate for Payer: Aetna Commercial |
$8.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.22
|
| Rate for Payer: Cash Price |
$7.66
|
| Rate for Payer: Cofinity Advantage |
$6.70
|
| Rate for Payer: Cofinity Commercial |
$8.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.66
|
| Rate for Payer: Healthscope Commercial |
$8.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.18
|
| Rate for Payer: PHP Commercial |
$8.13
|
| Rate for Payer: Priority Health SBD |
$6.03
|
| Rate for Payer: UMR Bronson Commercial |
$4.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.18
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$286.94
|
|
|
Service Code
|
NDC 60687075321
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.17 |
| Max. Negotiated Rate |
$258.25 |
| Rate for Payer: Aetna American Axle |
$186.51
|
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Medicare |
$143.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.51
|
| Rate for Payer: BCBS Complete |
$114.78
|
| Rate for Payer: Cash Price |
$229.55
|
| Rate for Payer: Cofinity Advantage |
$200.86
|
| Rate for Payer: Cofinity Commercial |
$246.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.55
|
| Rate for Payer: Healthscope Commercial |
$258.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.21
|
| Rate for Payer: PHP Commercial |
$243.90
|
| Rate for Payer: Priority Health SBD |
$180.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.51
|
| Rate for Payer: UHC Core |
$149.50
|
| Rate for Payer: UHC Exchange |
$112.77
|
| Rate for Payer: UMR Bronson Commercial |
$106.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.21
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$170.64
|
|
|
Service Code
|
NDC 65862064230
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.14 |
| Max. Negotiated Rate |
$153.58 |
| Rate for Payer: Aetna American Axle |
$110.92
|
| Rate for Payer: Aetna Commercial |
$145.04
|
| Rate for Payer: Aetna Medicare |
$85.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.92
|
| Rate for Payer: BCBS Complete |
$68.26
|
| Rate for Payer: Cash Price |
$136.51
|
| Rate for Payer: Cofinity Advantage |
$119.45
|
| Rate for Payer: Cofinity Commercial |
$146.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.51
|
| Rate for Payer: Healthscope Commercial |
$153.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$119.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$136.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.98
|
| Rate for Payer: PHP Commercial |
$145.04
|
| Rate for Payer: Priority Health SBD |
$107.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.92
|
| Rate for Payer: UHC Core |
$88.90
|
| Rate for Payer: UHC Exchange |
$67.06
|
| Rate for Payer: UMR Bronson Commercial |
$63.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.98
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$286.94
|
|
|
Service Code
|
NDC 60687075321
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.25 |
| Max. Negotiated Rate |
$258.25 |
| Rate for Payer: Aetna American Axle |
$186.51
|
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.51
|
| Rate for Payer: Cash Price |
$229.55
|
| Rate for Payer: Cofinity Advantage |
$200.86
|
| Rate for Payer: Cofinity Commercial |
$246.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.55
|
| Rate for Payer: Healthscope Commercial |
$258.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.21
|
| Rate for Payer: PHP Commercial |
$243.90
|
| Rate for Payer: Priority Health SBD |
$180.77
|
| Rate for Payer: UMR Bronson Commercial |
$126.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.21
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$498.06
|
|
|
Service Code
|
NDC 50111078810
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.28 |
| Max. Negotiated Rate |
$448.25 |
| Rate for Payer: Aetna American Axle |
$323.74
|
| Rate for Payer: Aetna Commercial |
$423.35
|
| Rate for Payer: Aetna Medicare |
$249.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.74
|
| Rate for Payer: BCBS Complete |
$199.22
|
| Rate for Payer: Cash Price |
$398.45
|
| Rate for Payer: Cofinity Advantage |
$348.64
|
| Rate for Payer: Cofinity Commercial |
$428.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.45
|
| Rate for Payer: Healthscope Commercial |
$448.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$348.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$398.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.55
|
| Rate for Payer: PHP Commercial |
$423.35
|
| Rate for Payer: Priority Health SBD |
$313.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.74
|
| Rate for Payer: UHC Core |
$259.49
|
| Rate for Payer: UHC Exchange |
$195.74
|
| Rate for Payer: UMR Bronson Commercial |
$184.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.55
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$140.79
|
|
|
Service Code
|
NDC 62332025230
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.09 |
| Max. Negotiated Rate |
$126.71 |
| Rate for Payer: Aetna American Axle |
$91.51
|
| Rate for Payer: Aetna Commercial |
$119.67
|
| Rate for Payer: Aetna Medicare |
$70.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.51
|
| Rate for Payer: BCBS Complete |
$56.32
|
| Rate for Payer: Cash Price |
$112.63
|
| Rate for Payer: Cofinity Advantage |
$98.55
|
| Rate for Payer: Cofinity Commercial |
$121.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.63
|
| Rate for Payer: Healthscope Commercial |
$126.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.59
|
| Rate for Payer: PHP Commercial |
$119.67
|
| Rate for Payer: Priority Health SBD |
$88.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.51
|
| Rate for Payer: UHC Core |
$73.35
|
| Rate for Payer: UHC Exchange |
$55.33
|
| Rate for Payer: UMR Bronson Commercial |
$52.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.59
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$29.05
|
|
|
Service Code
|
NDC 50111078867
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$26.14 |
| Rate for Payer: Aetna American Axle |
$18.88
|
| Rate for Payer: Aetna Commercial |
$24.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.88
|
| Rate for Payer: Cash Price |
$23.24
|
| Rate for Payer: Cofinity Advantage |
$20.34
|
| Rate for Payer: Cofinity Commercial |
$24.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.24
|
| Rate for Payer: Healthscope Commercial |
$26.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.79
|
| Rate for Payer: PHP Commercial |
$24.69
|
| Rate for Payer: Priority Health SBD |
$18.30
|
| Rate for Payer: UMR Bronson Commercial |
$12.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.79
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$8.35
|
|
|
Service Code
|
NDC 50268009911
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$7.51 |
| Rate for Payer: Aetna American Axle |
$5.43
|
| Rate for Payer: Aetna Commercial |
$7.10
|
| Rate for Payer: Aetna Medicare |
$4.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.43
|
| Rate for Payer: BCBS Complete |
$3.34
|
| Rate for Payer: Cash Price |
$6.68
|
| Rate for Payer: Cofinity Advantage |
$5.84
|
| Rate for Payer: Cofinity Commercial |
$7.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$7.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.26
|
| Rate for Payer: PHP Commercial |
$7.10
|
| Rate for Payer: Priority Health SBD |
$5.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.43
|
| Rate for Payer: UHC Core |
$4.35
|
| Rate for Payer: UHC Exchange |
$3.28
|
| Rate for Payer: UMR Bronson Commercial |
$3.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.26
|
|
|
AZTREONAM 1 GM IVPB (INTRA-OP)
|
Facility
|
IP
|
$25.30
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
165983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Aetna American Axle |
$16.45
|
| Rate for Payer: Aetna Commercial |
$21.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.45
|
| Rate for Payer: Cash Price |
$20.24
|
| Rate for Payer: Cofinity Advantage |
$17.71
|
| Rate for Payer: Cofinity Commercial |
$21.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.24
|
| Rate for Payer: Healthscope Commercial |
$22.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.98
|
| Rate for Payer: PHP Commercial |
$21.50
|
| Rate for Payer: Priority Health SBD |
$15.94
|
| Rate for Payer: UMR Bronson Commercial |
$11.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
AZTREONAM 1 GM IVPB (INTRA-OP)
|
Facility
|
OP
|
$25.30
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
165983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Aetna American Axle |
$16.45
|
| Rate for Payer: Aetna Commercial |
$21.50
|
| Rate for Payer: Aetna Medicare |
$12.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.45
|
| Rate for Payer: BCBS Complete |
$10.12
|
| Rate for Payer: BCBS Trust/PPO |
$7.22
|
| Rate for Payer: BCN Commercial |
$7.22
|
| Rate for Payer: Cash Price |
$20.24
|
| Rate for Payer: Cash Price |
$20.24
|
| Rate for Payer: Cofinity Advantage |
$17.71
|
| Rate for Payer: Cofinity Commercial |
$21.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.24
|
| Rate for Payer: Healthscope Commercial |
$22.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.98
|
| Rate for Payer: PHP Commercial |
$21.50
|
| Rate for Payer: Priority Health SBD |
$15.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.68
|
| Rate for Payer: UHC Core |
$3.68
|
| Rate for Payer: UHC Exchange |
$3.68
|
| Rate for Payer: UMR Bronson Commercial |
$9.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$102.31
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.02 |
| Max. Negotiated Rate |
$92.08 |
| Rate for Payer: Aetna American Axle |
$66.50
|
| Rate for Payer: Aetna American Axle |
$59.37
|
| Rate for Payer: Aetna American Axle |
$79.96
|
| Rate for Payer: Aetna Commercial |
$104.57
|
| Rate for Payer: Aetna Commercial |
$86.96
|
| Rate for Payer: Aetna Commercial |
$77.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.96
|
| Rate for Payer: Cash Price |
$98.42
|
| Rate for Payer: Cash Price |
$81.85
|
| Rate for Payer: Cash Price |
$73.07
|
| Rate for Payer: Cofinity Advantage |
$63.94
|
| Rate for Payer: Cofinity Advantage |
$71.62
|
| Rate for Payer: Cofinity Advantage |
$86.11
|
| Rate for Payer: Cofinity Commercial |
$78.55
|
| Rate for Payer: Cofinity Commercial |
$87.99
|
| Rate for Payer: Cofinity Commercial |
$105.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.07
|
| Rate for Payer: Healthscope Commercial |
$110.72
|
| Rate for Payer: Healthscope Commercial |
$82.21
|
| Rate for Payer: Healthscope Commercial |
$92.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.50
|
| Rate for Payer: PHP Commercial |
$104.57
|
| Rate for Payer: PHP Commercial |
$86.96
|
| Rate for Payer: PHP Commercial |
$77.64
|
| Rate for Payer: Priority Health SBD |
$64.46
|
| Rate for Payer: Priority Health SBD |
$77.50
|
| Rate for Payer: Priority Health SBD |
$57.54
|
| Rate for Payer: UMR Bronson Commercial |
$45.02
|
| Rate for Payer: UMR Bronson Commercial |
$40.19
|
| Rate for Payer: UMR Bronson Commercial |
$54.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.50
|
|
