|
ATROPINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$30.96
|
|
|
Service Code
|
HCPCS J0462
|
| Hospital Charge Code |
195981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$30.96 |
| Rate for Payer: Aetna Commercial |
$27.86
|
| Rate for Payer: Aetna Medicare |
$11.45
|
| Rate for Payer: ASR ASR |
$30.03
|
| Rate for Payer: BCBS Complete |
$12.38
|
| Rate for Payer: BCBS Trust/PPO |
$25.53
|
| Rate for Payer: BCN Commercial |
$25.53
|
| Rate for Payer: Cash Price |
$24.77
|
| Rate for Payer: Cash Price |
$24.77
|
| Rate for Payer: Cofinity Commercial |
$29.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.77
|
| Rate for Payer: Healthscope Commercial |
$30.03
|
| Rate for Payer: Healthscope Whirlpool |
$30.96
|
| Rate for Payer: Mclaren Commercial |
$27.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.32
|
| Rate for Payer: Nomi Health Commercial |
$25.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.14
|
| Rate for Payer: Priority Health Narrow Network |
$0.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.24
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$57,472.61
|
|
|
Service Code
|
APR-DRG 0084
|
| Min. Negotiated Rate |
$51,962.11 |
| Max. Negotiated Rate |
$57,472.61 |
| Rate for Payer: BCBS Complete |
$57,472.61
|
| Rate for Payer: Mclaren Medicaid |
$54,735.82
|
| Rate for Payer: Meridian Medicaid |
$57,472.61
|
| Rate for Payer: PHP Medicaid |
$51,962.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$54,735.82
|
| Rate for Payer: UHC Medicaid |
$54,735.82
|
| Rate for Payer: UHCCP Medicaid |
$54,735.82
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$23,517.86
|
|
|
Service Code
|
APR-DRG 0082
|
| Min. Negotiated Rate |
$21,262.96 |
| Max. Negotiated Rate |
$23,517.86 |
| Rate for Payer: BCBS Complete |
$23,517.86
|
| Rate for Payer: Mclaren Medicaid |
$22,397.96
|
| Rate for Payer: Meridian Medicaid |
$23,517.86
|
| Rate for Payer: PHP Medicaid |
$21,262.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,397.96
|
| Rate for Payer: UHC Medicaid |
$22,397.96
|
| Rate for Payer: UHCCP Medicaid |
$22,397.96
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$34,810.32
|
|
|
Service Code
|
APR-DRG 0083
|
| Min. Negotiated Rate |
$31,472.69 |
| Max. Negotiated Rate |
$34,810.32 |
| Rate for Payer: BCBS Complete |
$34,810.32
|
| Rate for Payer: Mclaren Medicaid |
$33,152.68
|
| Rate for Payer: Meridian Medicaid |
$34,810.32
|
| Rate for Payer: PHP Medicaid |
$31,472.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$33,152.68
|
| Rate for Payer: UHC Medicaid |
$33,152.68
|
| Rate for Payer: UHCCP Medicaid |
$33,152.68
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$19,463.98
|
|
|
Service Code
|
APR-DRG 0081
|
| Min. Negotiated Rate |
$17,597.77 |
| Max. Negotiated Rate |
$19,463.98 |
| Rate for Payer: BCBS Complete |
$19,463.98
|
| Rate for Payer: Mclaren Medicaid |
$18,537.12
|
| Rate for Payer: Meridian Medicaid |
$19,463.98
|
| Rate for Payer: PHP Medicaid |
$17,597.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$18,537.12
|
| Rate for Payer: UHC Medicaid |
$18,537.12
|
| Rate for Payer: UHCCP Medicaid |
$18,537.12
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC
|
Facility
|
IP
|
$81,466.96
|
|
|
Service Code
|
MSDRG 016
|
| Min. Negotiated Rate |
$42,232.90 |
| Max. Negotiated Rate |
$81,466.96 |
| Rate for Payer: Aetna Medicare |
$44,455.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55,569.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55,569.60
|
| Rate for Payer: BCBS MAPPO |
$44,455.68
|
| Rate for Payer: BCN Medicare Advantage |
$44,455.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44,455.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$44,455.68
|
| Rate for Payer: Mclaren Medicare |
$44,455.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46,678.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51,124.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$48,901.25
|
| Rate for Payer: PACE Medicare |
$42,232.90
|
| Rate for Payer: PACE SWMI |
$44,455.68
|
| Rate for Payer: PHP Commercial |
$48,901.25
|
| Rate for Payer: PHP Medicare Advantage |
$44,455.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$81,466.96
|
| Rate for Payer: Priority Health Medicare |
$44,455.68
|
| Rate for Payer: Priority Health Narrow Network |
$65,173.57
|
| Rate for Payer: Railroad Medicare Medicare |
$44,455.68
|
| Rate for Payer: UHCCP DNSP |
$44,455.68
|
| Rate for Payer: VA VA |
$44,455.68
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC
|
Facility
|
IP
|
$74,633.28
|
|
|
Service Code
|
MSDRG 017
|
| Min. Negotiated Rate |
$38,830.08 |
| Max. Negotiated Rate |
$74,633.28 |
| Rate for Payer: Aetna Medicare |
$40,873.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51,092.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51,092.21
|
| Rate for Payer: BCBS MAPPO |
$40,873.77
|
| Rate for Payer: BCN Medicare Advantage |
$40,873.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40,873.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$40,873.77
|
| Rate for Payer: Mclaren Medicare |
$40,873.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42,917.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47,004.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$44,961.15
|
| Rate for Payer: PACE Medicare |
$38,830.08
|
| Rate for Payer: PACE SWMI |
$40,873.77
|
| Rate for Payer: PHP Commercial |
$44,961.15
|
| Rate for Payer: PHP Medicare Advantage |
$40,873.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$74,633.28
|
| Rate for Payer: Priority Health Medicare |
$40,873.77
|
| Rate for Payer: Priority Health Narrow Network |
$59,706.63
|
| Rate for Payer: Railroad Medicare Medicare |
$40,873.77
|
| Rate for Payer: UHCCP DNSP |
$40,873.77
|
| Rate for Payer: VA VA |
$40,873.77
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$124.55
|
|
|
Service Code
|
NDC 70710146002
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.41 |
| Max. Negotiated Rate |
$124.55 |
| Rate for Payer: Aetna Commercial |
$112.09
|
| Rate for Payer: ASR ASR |
$120.81
|
| Rate for Payer: BCBS Trust/PPO |
$102.28
|
| Rate for Payer: BCN Commercial |
$102.28
|
| Rate for Payer: Cash Price |
$99.64
|
| Rate for Payer: Cofinity Commercial |
$117.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$120.81
|
| Rate for Payer: Healthscope Whirlpool |
$124.55
|
| Rate for Payer: Mclaren Commercial |
$112.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.86
|
| Rate for Payer: Nomi Health Commercial |
$102.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.60
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$82.37
|
|
|
Service Code
|
NDC 42806015134
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.77 |
| Max. Negotiated Rate |
$82.36 |
| Rate for Payer: Aetna Commercial |
$74.13
|
| Rate for Payer: ASR ASR |
$79.89
|
| Rate for Payer: BCBS Trust/PPO |
$67.64
|
| Rate for Payer: BCN Commercial |
$67.64
|
| Rate for Payer: Cash Price |
$65.89
|
| Rate for Payer: Cofinity Commercial |
$77.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.89
|
| Rate for Payer: Healthscope Commercial |
$79.89
|
| Rate for Payer: Healthscope Whirlpool |
$82.36
|
| Rate for Payer: Mclaren Commercial |
$74.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.01
|
| Rate for Payer: Nomi Health Commercial |
$67.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.48
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$75.67
|
|
|
Service Code
|
NDC 42806015033
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.75 |
| Max. Negotiated Rate |
$75.67 |
| Rate for Payer: Aetna Commercial |
$68.10
|
| Rate for Payer: ASR ASR |
$73.40
|
| Rate for Payer: BCBS Trust/PPO |
$62.14
|
| Rate for Payer: BCN Commercial |
$62.14
|
| Rate for Payer: Cash Price |
$60.53
|
| Rate for Payer: Cofinity Commercial |
$71.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.53
|
| Rate for Payer: Healthscope Commercial |
$73.40
|
| Rate for Payer: Healthscope Whirlpool |
$75.67
|
| Rate for Payer: Mclaren Commercial |
$68.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.32
|
| Rate for Payer: Nomi Health Commercial |
$62.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.59
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$124.55
|
|
|
Service Code
|
NDC 70710146002
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.08 |
| Max. Negotiated Rate |
$124.55 |
| Rate for Payer: Aetna Commercial |
$112.09
|
| Rate for Payer: Aetna Medicare |
$46.08
|
| Rate for Payer: ASR ASR |
$120.81
|
| Rate for Payer: BCBS Complete |
$49.82
|
| Rate for Payer: BCBS Trust/PPO |
$102.69
|
| Rate for Payer: BCN Commercial |
$102.69
|
| Rate for Payer: Cash Price |
$99.64
|
| Rate for Payer: Cofinity Commercial |
$117.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$120.81
|
| Rate for Payer: Healthscope Whirlpool |
$124.55
|
| Rate for Payer: Mclaren Commercial |
$112.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.86
|
| Rate for Payer: Nomi Health Commercial |
$102.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$109.13
|
| Rate for Payer: Priority Health Narrow Network |
$87.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.60
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$116.78
|
|
|
Service Code
|
NDC 93202631
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.21 |
| Max. Negotiated Rate |
$116.78 |
| Rate for Payer: Aetna Commercial |
$105.11
|
| Rate for Payer: Aetna Medicare |
$43.21
|
| Rate for Payer: ASR ASR |
$113.28
|
| Rate for Payer: BCBS Complete |
$46.71
|
| Rate for Payer: BCBS Trust/PPO |
$96.29
|
| Rate for Payer: BCN Commercial |
$96.29
|
| Rate for Payer: Cash Price |
$93.43
|
| Rate for Payer: Cofinity Commercial |
$109.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.43
|
| Rate for Payer: Healthscope Commercial |
$113.28
|
| Rate for Payer: Healthscope Whirlpool |
$116.78
|
| Rate for Payer: Mclaren Commercial |
$105.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.27
|
| Rate for Payer: Nomi Health Commercial |
$95.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$102.33
|
| Rate for Payer: Priority Health Narrow Network |
$81.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.77
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$89.28
|
|
|
Service Code
|
NDC 59762314001
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.96 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$80.35
|
| Rate for Payer: ASR ASR |
$86.60
|
| Rate for Payer: BCBS Trust/PPO |
$73.32
|
| Rate for Payer: BCN Commercial |
$73.32
|
| Rate for Payer: Cash Price |
$71.42
|
| Rate for Payer: Cofinity Commercial |
$83.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$86.60
|
| Rate for Payer: Healthscope Whirlpool |
$89.28
|
| Rate for Payer: Mclaren Commercial |
$80.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.89
|
| Rate for Payer: Nomi Health Commercial |
$73.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.57
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$82.37
|
|
|
Service Code
|
NDC 42806015134
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$82.36 |
| Rate for Payer: Aetna Commercial |
$74.13
|
| Rate for Payer: Aetna Medicare |
$30.48
|
| Rate for Payer: ASR ASR |
$79.89
|
| Rate for Payer: BCBS Complete |
$32.95
|
| Rate for Payer: BCBS Trust/PPO |
$67.91
|
| Rate for Payer: BCN Commercial |
$67.91
|
| Rate for Payer: Cash Price |
$65.89
|
| Rate for Payer: Cofinity Commercial |
$77.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.89
|
| Rate for Payer: Healthscope Commercial |
$79.89
|
| Rate for Payer: Healthscope Whirlpool |
$82.36
|
| Rate for Payer: Mclaren Commercial |
$74.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.01
|
| Rate for Payer: Nomi Health Commercial |
$67.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$72.17
|
| Rate for Payer: Priority Health Narrow Network |
$57.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.48
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$116.78
|
|
|
Service Code
|
NDC 93202631
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.59 |
| Max. Negotiated Rate |
$116.78 |
| Rate for Payer: Aetna Commercial |
$105.11
|
| Rate for Payer: ASR ASR |
$113.28
|
| Rate for Payer: BCBS Trust/PPO |
$95.90
|
| Rate for Payer: BCN Commercial |
$95.90
|
| Rate for Payer: Cash Price |
$93.43
|
| Rate for Payer: Cofinity Commercial |
$109.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.43
|
| Rate for Payer: Healthscope Commercial |
$113.28
|
| Rate for Payer: Healthscope Whirlpool |
$116.78
|
| Rate for Payer: Mclaren Commercial |
$105.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.27
|
| Rate for Payer: Nomi Health Commercial |
$95.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.77
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$75.67
|
|
|
Service Code
|
NDC 42806015033
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$75.67 |
| Rate for Payer: Aetna Commercial |
$68.10
|
| Rate for Payer: Aetna Medicare |
$28.00
|
| Rate for Payer: ASR ASR |
$73.40
|
| Rate for Payer: BCBS Complete |
$30.27
|
| Rate for Payer: BCBS Trust/PPO |
$62.39
|
| Rate for Payer: BCN Commercial |
$62.39
|
| Rate for Payer: Cash Price |
$60.53
|
| Rate for Payer: Cofinity Commercial |
$71.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.53
|
| Rate for Payer: Healthscope Commercial |
$73.40
|
| Rate for Payer: Healthscope Whirlpool |
$75.67
|
| Rate for Payer: Mclaren Commercial |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.32
|
| Rate for Payer: Nomi Health Commercial |
$62.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$66.30
|
| Rate for Payer: Priority Health Narrow Network |
$53.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.59
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$89.28
|
|
|
Service Code
|
NDC 59762314001
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.03 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$80.35
|
| Rate for Payer: Aetna Medicare |
$33.03
|
| Rate for Payer: ASR ASR |
$86.60
|
| Rate for Payer: BCBS Complete |
$35.71
|
| Rate for Payer: BCBS Trust/PPO |
$73.61
|
| Rate for Payer: BCN Commercial |
$73.61
|
| Rate for Payer: Cash Price |
$71.42
|
| Rate for Payer: Cofinity Commercial |
$83.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$86.60
|
| Rate for Payer: Healthscope Whirlpool |
$89.28
|
| Rate for Payer: Mclaren Commercial |
$80.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.89
|
| Rate for Payer: Nomi Health Commercial |
$73.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$78.23
|
| Rate for Payer: Priority Health Narrow Network |
$62.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.57
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$154.08
|
|
|
Service Code
|
NDC 904670806
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.01 |
| Max. Negotiated Rate |
$154.08 |
| Rate for Payer: Aetna Commercial |
$138.67
|
| Rate for Payer: Aetna Medicare |
$57.01
|
| Rate for Payer: ASR ASR |
$149.46
|
| Rate for Payer: BCBS Complete |
$61.63
|
| Rate for Payer: BCBS Trust/PPO |
$127.04
|
| Rate for Payer: BCN Commercial |
$127.04
|
| Rate for Payer: Cash Price |
$123.26
|
| Rate for Payer: Cofinity Commercial |
$144.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.26
|
| Rate for Payer: Healthscope Commercial |
$149.46
|
| Rate for Payer: Healthscope Whirlpool |
$154.08
|
| Rate for Payer: Mclaren Commercial |
$138.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.97
|
| Rate for Payer: Nomi Health Commercial |
$126.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$135.00
|
| Rate for Payer: Priority Health Narrow Network |
$108.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.59
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$385.54
|
|
|
Service Code
|
NDC 59762306003
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$289.15 |
| Max. Negotiated Rate |
$385.54 |
| Rate for Payer: Aetna Commercial |
$346.99
|
| Rate for Payer: ASR ASR |
$373.97
|
| Rate for Payer: BCBS Trust/PPO |
$316.61
|
| Rate for Payer: BCN Commercial |
$316.61
|
| Rate for Payer: Cash Price |
$308.43
|
| Rate for Payer: Cofinity Commercial |
$362.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.43
|
| Rate for Payer: Healthscope Commercial |
$373.97
|
| Rate for Payer: Healthscope Whirlpool |
$385.54
|
| Rate for Payer: Mclaren Commercial |
$346.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.71
|
| Rate for Payer: Nomi Health Commercial |
$316.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$339.28
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$154.08
|
|
|
Service Code
|
NDC 904670806
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.56 |
| Max. Negotiated Rate |
$154.08 |
| Rate for Payer: Aetna Commercial |
$138.67
|
| Rate for Payer: ASR ASR |
$149.46
|
| Rate for Payer: BCBS Trust/PPO |
$126.53
|
| Rate for Payer: BCN Commercial |
$126.53
|
| Rate for Payer: Cash Price |
$123.26
|
| Rate for Payer: Cofinity Commercial |
$144.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.26
|
| Rate for Payer: Healthscope Commercial |
$149.46
|
| Rate for Payer: Healthscope Whirlpool |
$154.08
|
| Rate for Payer: Mclaren Commercial |
$138.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.97
|
| Rate for Payer: Nomi Health Commercial |
$126.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.59
|
|
|
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 |
$174.00 |
| Rate for Payer: Aetna Commercial |
$156.60
|
| Rate for Payer: Aetna Medicare |
$64.38
|
| Rate for Payer: ASR ASR |
$168.78
|
| Rate for Payer: BCBS Complete |
$69.60
|
| Rate for Payer: BCBS Trust/PPO |
$143.46
|
| Rate for Payer: BCN Commercial |
$143.46
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cofinity Commercial |
$163.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.20
|
| Rate for Payer: Healthscope Commercial |
$168.78
|
| Rate for Payer: Healthscope Whirlpool |
$174.00
|
| Rate for Payer: Mclaren Commercial |
$156.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.90
|
| Rate for Payer: Nomi Health Commercial |
$142.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$152.46
|
| Rate for Payer: Priority Health Narrow Network |
$121.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.12
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$4.61
|
|
|
Service Code
|
NDC 60687074211
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Aetna Commercial |
$4.15
|
| Rate for Payer: Aetna Medicare |
$1.70
|
| Rate for Payer: ASR ASR |
$4.47
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: BCBS Trust/PPO |
$3.80
|
| Rate for Payer: BCN Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Commercial |
$4.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.47
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Nomi Health Commercial |
$3.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.04
|
| Rate for Payer: Priority Health Narrow Network |
$3.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.06
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$3.48
|
|
|
Service Code
|
NDC 50268007411
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna Commercial |
$3.13
|
| Rate for Payer: Aetna Medicare |
$1.29
|
| Rate for Payer: ASR ASR |
$3.37
|
| Rate for Payer: BCBS Complete |
$1.39
|
| Rate for Payer: BCBS Trust/PPO |
$2.87
|
| Rate for Payer: BCN Commercial |
$2.87
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$3.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$3.37
|
| Rate for Payer: Healthscope Whirlpool |
$3.48
|
| Rate for Payer: Mclaren Commercial |
$3.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.95
|
| Rate for Payer: Nomi Health Commercial |
$2.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.05
|
| Rate for Payer: Priority Health Narrow Network |
$2.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.06
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$7.75
|
|
|
Service Code
|
NDC 60687028211
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$7.75 |
| Rate for Payer: Aetna Commercial |
$6.98
|
| Rate for Payer: Aetna Medicare |
$2.87
|
| Rate for Payer: ASR ASR |
$7.52
|
| Rate for Payer: BCBS Complete |
$3.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.39
|
| Rate for Payer: BCN Commercial |
$6.39
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Cofinity Commercial |
$7.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.20
|
| Rate for Payer: Healthscope Commercial |
$7.52
|
| Rate for Payer: Healthscope Whirlpool |
$7.75
|
| Rate for Payer: Mclaren Commercial |
$6.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.59
|
| Rate for Payer: Nomi Health Commercial |
$6.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.79
|
| Rate for Payer: Priority Health Narrow Network |
$5.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.82
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$157.92
|
|
|
Service Code
|
NDC 904735006
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.44 |
| Max. Negotiated Rate |
$157.92 |
| Rate for Payer: Aetna Commercial |
$142.13
|
| Rate for Payer: ASR ASR |
$153.18
|
| Rate for Payer: BCBS Trust/PPO |
$129.68
|
| Rate for Payer: BCN Commercial |
$129.68
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cofinity Commercial |
$148.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.34
|
| Rate for Payer: Healthscope Commercial |
$153.18
|
| Rate for Payer: Healthscope Whirlpool |
$157.92
|
| Rate for Payer: Mclaren Commercial |
$142.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.23
|
| Rate for Payer: Nomi Health Commercial |
$129.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.97
|
|
