|
AMOXICILLIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$66.98
|
|
|
Service Code
|
NDC 143988815
|
| Hospital Charge Code |
453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.23 |
| Max. Negotiated Rate |
$66.97 |
| Rate for Payer: Aetna Commercial |
$60.28
|
| Rate for Payer: ASR ASR |
$64.97
|
| Rate for Payer: BCBS Trust/PPO |
$55.00
|
| Rate for Payer: BCN Commercial |
$55.00
|
| Rate for Payer: Cash Price |
$53.58
|
| Rate for Payer: Cofinity Commercial |
$62.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.58
|
| Rate for Payer: Healthscope Commercial |
$64.97
|
| Rate for Payer: Healthscope Whirlpool |
$66.97
|
| Rate for Payer: Mclaren Commercial |
$60.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.93
|
| Rate for Payer: Nomi Health Commercial |
$54.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.94
|
|
|
AMOXICILLIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$81.08
|
|
|
Service Code
|
NDC 781603955
|
| Hospital Charge Code |
453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$81.08 |
| Rate for Payer: Aetna Commercial |
$72.97
|
| Rate for Payer: Aetna Medicare |
$30.00
|
| Rate for Payer: ASR ASR |
$78.64
|
| Rate for Payer: BCBS Complete |
$32.43
|
| Rate for Payer: BCBS Trust/PPO |
$66.85
|
| Rate for Payer: BCN Commercial |
$66.85
|
| Rate for Payer: Cash Price |
$64.86
|
| Rate for Payer: Cofinity Commercial |
$76.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.86
|
| Rate for Payer: Healthscope Commercial |
$78.64
|
| Rate for Payer: Healthscope Whirlpool |
$81.08
|
| Rate for Payer: Mclaren Commercial |
$72.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.91
|
| Rate for Payer: Nomi Health Commercial |
$66.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$71.04
|
| Rate for Payer: Priority Health Narrow Network |
$56.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.35
|
|
|
AMOXICILLIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$51.70
|
|
|
Service Code
|
NDC 143988801
|
| Hospital Charge Code |
453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.77 |
| Max. Negotiated Rate |
$51.70 |
| Rate for Payer: Aetna Commercial |
$46.53
|
| Rate for Payer: ASR ASR |
$50.15
|
| Rate for Payer: BCBS Trust/PPO |
$42.46
|
| Rate for Payer: BCN Commercial |
$42.46
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cofinity Commercial |
$48.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.36
|
| Rate for Payer: Healthscope Commercial |
$50.15
|
| Rate for Payer: Healthscope Whirlpool |
$51.70
|
| Rate for Payer: Mclaren Commercial |
$46.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.95
|
| Rate for Payer: Nomi Health Commercial |
$42.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.50
|
|
|
AMOXICILLIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
NDC 781603958
|
| Hospital Charge Code |
453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.39 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna Commercial |
$42.30
|
| Rate for Payer: Aetna Medicare |
$17.39
|
| Rate for Payer: ASR ASR |
$45.59
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS Trust/PPO |
$38.75
|
| Rate for Payer: BCN Commercial |
$38.75
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$44.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$45.59
|
| Rate for Payer: Healthscope Whirlpool |
$47.00
|
| Rate for Payer: Mclaren Commercial |
$42.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.95
|
| Rate for Payer: Nomi Health Commercial |
$38.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$41.18
|
| Rate for Payer: Priority Health Narrow Network |
$32.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.36
|
|
|
AMOXICILLIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
NDC 781603958
|
| Hospital Charge Code |
453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.25 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna Commercial |
$42.30
|
| Rate for Payer: ASR ASR |
$45.59
|
| Rate for Payer: BCBS Trust/PPO |
$38.60
|
| Rate for Payer: BCN Commercial |
$38.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$44.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$45.59
|
| Rate for Payer: Healthscope Whirlpool |
$47.00
|
| Rate for Payer: Mclaren Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.95
|
| Rate for Payer: Nomi Health Commercial |
$38.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.36
|
|
|
AMOXICILLIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$51.70
|
|
|
Service Code
|
NDC 143988801
|
| Hospital Charge Code |
453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$51.70 |
| Rate for Payer: Aetna Commercial |
$46.53
|
| Rate for Payer: Aetna Medicare |
$19.13
|
| Rate for Payer: ASR ASR |
$50.15
|
| Rate for Payer: BCBS Complete |
$20.68
|
| Rate for Payer: BCBS Trust/PPO |
$42.63
|
| Rate for Payer: BCN Commercial |
$42.63
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cofinity Commercial |
$48.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.36
|
| Rate for Payer: Healthscope Commercial |
$50.15
|
| Rate for Payer: Healthscope Whirlpool |
$51.70
|
| Rate for Payer: Mclaren Commercial |
$46.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.95
|
| Rate for Payer: Nomi Health Commercial |
$42.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$45.30
|
| Rate for Payer: Priority Health Narrow Network |
$36.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.50
|
|
|
AMOXICILLIN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$81.08
|
|
|
Service Code
|
NDC 781603955
|
| Hospital Charge Code |
453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.81 |
| Max. Negotiated Rate |
$81.08 |
| Rate for Payer: Aetna Commercial |
$72.97
|
| Rate for Payer: ASR ASR |
$78.64
|
| Rate for Payer: BCBS Trust/PPO |
$66.58
|
| Rate for Payer: BCN Commercial |
$66.58
|
| Rate for Payer: Cash Price |
$64.86
|
| Rate for Payer: Cofinity Commercial |
$76.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.86
|
| Rate for Payer: Healthscope Commercial |
$78.64
|
| Rate for Payer: Healthscope Whirlpool |
$81.08
|
| Rate for Payer: Mclaren Commercial |
$72.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.91
|
| Rate for Payer: Nomi Health Commercial |
$66.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.35
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$77.55
|
|
|
Service Code
|
NDC 65862070701
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.16 |
| Max. Negotiated Rate |
$77.55 |
| Rate for Payer: Aetna Commercial |
$69.80
|
| Rate for Payer: ASR ASR |
$75.22
|
| Rate for Payer: BCBS Trust/PPO |
$63.68
|
| Rate for Payer: BCN Commercial |
$63.68
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Commercial |
$72.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Healthscope Commercial |
$75.22
|
| Rate for Payer: Healthscope Whirlpool |
$77.55
|
| Rate for Payer: Mclaren Commercial |
$69.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: Nomi Health Commercial |
$63.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.24
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$82.25
|
|
|
Service Code
|
NDC 93415573
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$82.25 |
| Rate for Payer: Aetna Commercial |
$74.03
|
| Rate for Payer: Aetna Medicare |
$30.43
|
| Rate for Payer: ASR ASR |
$79.78
|
| Rate for Payer: BCBS Complete |
$32.90
|
| Rate for Payer: BCBS Trust/PPO |
$67.82
|
| Rate for Payer: BCN Commercial |
$67.82
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$77.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$79.78
|
| Rate for Payer: Healthscope Whirlpool |
$82.25
|
| Rate for Payer: Mclaren Commercial |
$74.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Nomi Health Commercial |
$67.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$72.07
|
| Rate for Payer: Priority Health Narrow Network |
$57.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.38
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$67.68
|
|
|
Service Code
|
NDC 65862070780
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.04 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna Commercial |
$60.91
|
| Rate for Payer: Aetna Medicare |
$25.04
|
| Rate for Payer: ASR ASR |
$65.65
|
| Rate for Payer: BCBS Complete |
$27.07
|
| Rate for Payer: BCBS Trust/PPO |
$55.80
|
| Rate for Payer: BCN Commercial |
$55.80
|
| Rate for Payer: Cash Price |
$54.14
|
| Rate for Payer: Cofinity Commercial |
$63.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.14
|
| Rate for Payer: Healthscope Commercial |
$65.65
|
| Rate for Payer: Healthscope Whirlpool |
$67.68
|
| Rate for Payer: Mclaren Commercial |
$60.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.53
|
| Rate for Payer: Nomi Health Commercial |
$55.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$59.30
|
| Rate for Payer: Priority Health Narrow Network |
$47.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.56
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$56.40
|
|
|
Service Code
|
NDC 143988980
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.87 |
| Max. Negotiated Rate |
$56.40 |
| Rate for Payer: Aetna Commercial |
$50.76
|
| Rate for Payer: Aetna Medicare |
$20.87
|
| Rate for Payer: ASR ASR |
$54.71
|
| Rate for Payer: BCBS Complete |
$22.56
|
| Rate for Payer: BCBS Trust/PPO |
$46.50
|
| Rate for Payer: BCN Commercial |
$46.50
|
| Rate for Payer: Cash Price |
$45.12
|
| Rate for Payer: Cofinity Commercial |
$53.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.12
|
| Rate for Payer: Healthscope Commercial |
$54.71
|
| Rate for Payer: Healthscope Whirlpool |
$56.40
|
| Rate for Payer: Mclaren Commercial |
$50.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.94
|
| Rate for Payer: Nomi Health Commercial |
$46.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$49.42
|
| Rate for Payer: Priority Health Narrow Network |
$39.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.63
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$77.55
|
|
|
Service Code
|
NDC 781604146
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.69 |
| Max. Negotiated Rate |
$77.55 |
| Rate for Payer: Aetna Commercial |
$69.80
|
| Rate for Payer: Aetna Medicare |
$28.69
|
| Rate for Payer: ASR ASR |
$75.22
|
| Rate for Payer: BCBS Complete |
$31.02
|
| Rate for Payer: BCBS Trust/PPO |
$63.94
|
| Rate for Payer: BCN Commercial |
$63.94
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Commercial |
$72.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Healthscope Commercial |
$75.22
|
| Rate for Payer: Healthscope Whirlpool |
$77.55
|
| Rate for Payer: Mclaren Commercial |
$69.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: Nomi Health Commercial |
$63.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$67.95
|
| Rate for Payer: Priority Health Narrow Network |
$54.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.24
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1.29
|
|
|
Service Code
|
NDC 9900000421
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Aetna Commercial |
$1.16
|
| Rate for Payer: ASR ASR |
$1.25
|
| Rate for Payer: BCBS Trust/PPO |
$1.06
|
| Rate for Payer: BCN Commercial |
$1.06
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Cofinity Commercial |
$1.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.03
|
| Rate for Payer: Healthscope Commercial |
$1.25
|
| Rate for Payer: Healthscope Whirlpool |
$1.29
|
| Rate for Payer: Mclaren Commercial |
$1.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.10
|
| Rate for Payer: Nomi Health Commercial |
$1.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.14
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$1.29
|
|
|
Service Code
|
NDC 9900000421
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Aetna Commercial |
$1.16
|
| Rate for Payer: Aetna Medicare |
$0.48
|
| Rate for Payer: ASR ASR |
$1.25
|
| Rate for Payer: BCBS Complete |
$0.52
|
| Rate for Payer: BCBS Trust/PPO |
$1.07
|
| Rate for Payer: BCN Commercial |
$1.07
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Cofinity Commercial |
$1.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.03
|
| Rate for Payer: Healthscope Commercial |
$1.25
|
| Rate for Payer: Healthscope Whirlpool |
$1.29
|
| Rate for Payer: Mclaren Commercial |
$1.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.10
|
| Rate for Payer: Nomi Health Commercial |
$1.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.13
|
| Rate for Payer: Priority Health Narrow Network |
$0.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.14
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$69.56
|
|
|
Service Code
|
NDC 781604158
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.74 |
| Max. Negotiated Rate |
$69.56 |
| Rate for Payer: Aetna Commercial |
$62.60
|
| Rate for Payer: Aetna Medicare |
$25.74
|
| Rate for Payer: ASR ASR |
$67.47
|
| Rate for Payer: BCBS Complete |
$27.82
|
| Rate for Payer: BCBS Trust/PPO |
$57.35
|
| Rate for Payer: BCN Commercial |
$57.35
|
| Rate for Payer: Cash Price |
$55.65
|
| Rate for Payer: Cofinity Commercial |
$65.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.65
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Healthscope Whirlpool |
$69.56
|
| Rate for Payer: Mclaren Commercial |
$62.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.13
|
| Rate for Payer: Nomi Health Commercial |
$57.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$60.95
|
| Rate for Payer: Priority Health Narrow Network |
$48.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.21
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$77.55
|
|
|
Service Code
|
NDC 65862070701
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.69 |
| Max. Negotiated Rate |
$77.55 |
| Rate for Payer: Aetna Commercial |
$69.80
|
| Rate for Payer: Aetna Medicare |
$28.69
|
| Rate for Payer: ASR ASR |
$75.22
|
| Rate for Payer: BCBS Complete |
$31.02
|
| Rate for Payer: BCBS Trust/PPO |
$63.94
|
| Rate for Payer: BCN Commercial |
$63.94
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Commercial |
$72.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Healthscope Commercial |
$75.22
|
| Rate for Payer: Healthscope Whirlpool |
$77.55
|
| Rate for Payer: Mclaren Commercial |
$69.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: Nomi Health Commercial |
$63.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$67.95
|
| Rate for Payer: Priority Health Narrow Network |
$54.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.24
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$77.55
|
|
|
Service Code
|
NDC 781604146
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.16 |
| Max. Negotiated Rate |
$77.55 |
| Rate for Payer: Aetna Commercial |
$69.80
|
| Rate for Payer: ASR ASR |
$75.22
|
| Rate for Payer: BCBS Trust/PPO |
$63.68
|
| Rate for Payer: BCN Commercial |
$63.68
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Commercial |
$72.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Healthscope Commercial |
$75.22
|
| Rate for Payer: Healthscope Whirlpool |
$77.55
|
| Rate for Payer: Mclaren Commercial |
$69.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: Nomi Health Commercial |
$63.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.24
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$69.56
|
|
|
Service Code
|
NDC 781604158
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$69.56 |
| Rate for Payer: Aetna Commercial |
$62.60
|
| Rate for Payer: ASR ASR |
$67.47
|
| Rate for Payer: BCBS Trust/PPO |
$57.12
|
| Rate for Payer: BCN Commercial |
$57.12
|
| Rate for Payer: Cash Price |
$55.65
|
| Rate for Payer: Cofinity Commercial |
$65.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.65
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Healthscope Whirlpool |
$69.56
|
| Rate for Payer: Mclaren Commercial |
$62.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.13
|
| Rate for Payer: Nomi Health Commercial |
$57.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.21
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$82.25
|
|
|
Service Code
|
NDC 93415573
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.69 |
| Max. Negotiated Rate |
$82.25 |
| Rate for Payer: Aetna Commercial |
$74.03
|
| Rate for Payer: ASR ASR |
$79.78
|
| Rate for Payer: BCBS Trust/PPO |
$67.54
|
| Rate for Payer: BCN Commercial |
$67.54
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$77.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$79.78
|
| Rate for Payer: Healthscope Whirlpool |
$82.25
|
| Rate for Payer: Mclaren Commercial |
$74.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Nomi Health Commercial |
$67.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.38
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$56.40
|
|
|
Service Code
|
NDC 143988980
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$56.40 |
| Rate for Payer: Aetna Commercial |
$50.76
|
| Rate for Payer: ASR ASR |
$54.71
|
| Rate for Payer: BCBS Trust/PPO |
$46.32
|
| Rate for Payer: BCN Commercial |
$46.32
|
| Rate for Payer: Cash Price |
$45.12
|
| Rate for Payer: Cofinity Commercial |
$53.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.12
|
| Rate for Payer: Healthscope Commercial |
$54.71
|
| Rate for Payer: Healthscope Whirlpool |
$56.40
|
| Rate for Payer: Mclaren Commercial |
$50.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.94
|
| Rate for Payer: Nomi Health Commercial |
$46.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.63
|
|
|
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$67.68
|
|
|
Service Code
|
NDC 65862070780
|
| Hospital Charge Code |
454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.76 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna Commercial |
$60.91
|
| Rate for Payer: ASR ASR |
$65.65
|
| Rate for Payer: BCBS Trust/PPO |
$55.58
|
| Rate for Payer: BCN Commercial |
$55.58
|
| Rate for Payer: Cash Price |
$54.14
|
| Rate for Payer: Cofinity Commercial |
$63.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.14
|
| Rate for Payer: Healthscope Commercial |
$65.65
|
| Rate for Payer: Healthscope Whirlpool |
$67.68
|
| Rate for Payer: Mclaren Commercial |
$60.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.53
|
| Rate for Payer: Nomi Health Commercial |
$55.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.56
|
|
|
AMOXICILLIN 250 MG CAPSULE
|
Facility
|
OP
|
$110.45
|
|
|
Service Code
|
NDC 65862001601
|
| Hospital Charge Code |
450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.87 |
| Max. Negotiated Rate |
$110.45 |
| Rate for Payer: Aetna Commercial |
$99.41
|
| Rate for Payer: Aetna Medicare |
$40.87
|
| Rate for Payer: ASR ASR |
$107.14
|
| Rate for Payer: BCBS Complete |
$44.18
|
| Rate for Payer: BCBS Trust/PPO |
$91.07
|
| Rate for Payer: BCN Commercial |
$91.07
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Commercial |
$103.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$107.14
|
| Rate for Payer: Healthscope Whirlpool |
$110.45
|
| Rate for Payer: Mclaren Commercial |
$99.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Nomi Health Commercial |
$90.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$96.78
|
| Rate for Payer: Priority Health Narrow Network |
$77.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.20
|
|
|
AMOXICILLIN 250 MG CAPSULE
|
Facility
|
IP
|
$110.45
|
|
|
Service Code
|
NDC 65862001601
|
| Hospital Charge Code |
450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$110.45 |
| Rate for Payer: Aetna Commercial |
$99.41
|
| Rate for Payer: ASR ASR |
$107.14
|
| Rate for Payer: BCBS Trust/PPO |
$90.70
|
| Rate for Payer: BCN Commercial |
$90.70
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Commercial |
$103.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$107.14
|
| Rate for Payer: Healthscope Whirlpool |
$110.45
|
| Rate for Payer: Mclaren Commercial |
$99.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Nomi Health Commercial |
$90.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.20
|
|
|
AMOXICILLIN 250 MG CAPSULE
|
Facility
|
OP
|
$775.50
|
|
|
Service Code
|
NDC 781202005
|
| Hospital Charge Code |
450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$286.94 |
| Max. Negotiated Rate |
$775.50 |
| Rate for Payer: Aetna Commercial |
$697.95
|
| Rate for Payer: Aetna Medicare |
$286.94
|
| Rate for Payer: ASR ASR |
$752.24
|
| Rate for Payer: BCBS Complete |
$310.20
|
| Rate for Payer: BCBS Trust/PPO |
$639.40
|
| Rate for Payer: BCN Commercial |
$639.40
|
| Rate for Payer: Cash Price |
$620.40
|
| Rate for Payer: Cofinity Commercial |
$728.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.40
|
| Rate for Payer: Healthscope Commercial |
$752.24
|
| Rate for Payer: Healthscope Whirlpool |
$775.50
|
| Rate for Payer: Mclaren Commercial |
$697.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$620.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$659.17
|
| Rate for Payer: Nomi Health Commercial |
$635.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$581.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$679.49
|
| Rate for Payer: Priority Health Narrow Network |
$543.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$682.44
|
|
|
AMOXICILLIN 250 MG CAPSULE
|
Facility
|
IP
|
$166.85
|
|
|
Service Code
|
NDC 781202001
|
| Hospital Charge Code |
450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.14 |
| Max. Negotiated Rate |
$166.85 |
| Rate for Payer: Aetna Commercial |
$150.16
|
| Rate for Payer: ASR ASR |
$161.84
|
| Rate for Payer: BCBS Trust/PPO |
$137.02
|
| Rate for Payer: BCN Commercial |
$137.02
|
| Rate for Payer: Cash Price |
$133.48
|
| Rate for Payer: Cofinity Commercial |
$156.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.48
|
| Rate for Payer: Healthscope Commercial |
$161.84
|
| Rate for Payer: Healthscope Whirlpool |
$166.85
|
| Rate for Payer: Mclaren Commercial |
$150.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.82
|
| Rate for Payer: Nomi Health Commercial |
$136.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.83
|
|
