|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$173.76
|
|
|
Service Code
|
NDC 50268007415
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.29 |
| Max. Negotiated Rate |
$173.76 |
| Rate for Payer: Aetna Commercial |
$156.38
|
| Rate for Payer: Aetna Medicare |
$64.29
|
| Rate for Payer: ASR ASR |
$168.55
|
| Rate for Payer: BCBS Complete |
$69.50
|
| Rate for Payer: BCBS Trust/PPO |
$143.27
|
| Rate for Payer: BCN Commercial |
$143.27
|
| Rate for Payer: Cash Price |
$139.01
|
| Rate for Payer: Cofinity Commercial |
$163.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.01
|
| Rate for Payer: Healthscope Commercial |
$168.55
|
| Rate for Payer: Healthscope Whirlpool |
$173.76
|
| Rate for Payer: Mclaren Commercial |
$156.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.70
|
| Rate for Payer: Nomi Health Commercial |
$142.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$152.25
|
| Rate for Payer: Priority Health Narrow Network |
$121.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.91
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
NDC 60687074265
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.50 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Aetna Commercial |
$156.60
|
| Rate for Payer: ASR ASR |
$168.78
|
| Rate for Payer: BCBS Trust/PPO |
$142.89
|
| Rate for Payer: BCN Commercial |
$142.89
|
| 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: 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: UHC All Payor (Choice/PPO) + Core |
$153.12
|
|
|
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
|
OP
|
$775.20
|
|
|
Service Code
|
NDC 60687028201
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$286.82 |
| Max. Negotiated Rate |
$775.20 |
| Rate for Payer: Aetna Commercial |
$697.68
|
| Rate for Payer: Aetna Medicare |
$286.82
|
| Rate for Payer: ASR ASR |
$751.94
|
| Rate for Payer: BCBS Complete |
$310.08
|
| Rate for Payer: BCBS Trust/PPO |
$639.15
|
| Rate for Payer: BCN Commercial |
$639.15
|
| Rate for Payer: Cash Price |
$620.16
|
| Rate for Payer: Cofinity Commercial |
$728.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.16
|
| Rate for Payer: Healthscope Commercial |
$751.94
|
| Rate for Payer: Healthscope Whirlpool |
$775.20
|
| Rate for Payer: Mclaren Commercial |
$697.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$620.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$658.92
|
| Rate for Payer: Nomi Health Commercial |
$635.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$581.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$679.23
|
| Rate for Payer: Priority Health Narrow Network |
$543.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$682.18
|
|
|
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
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$44.73
|
|
|
Service Code
|
NDC 781808926
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.55 |
| Max. Negotiated Rate |
$44.73 |
| Rate for Payer: Aetna Commercial |
$40.26
|
| Rate for Payer: Aetna Medicare |
$16.55
|
| Rate for Payer: ASR ASR |
$43.39
|
| Rate for Payer: BCBS Complete |
$17.89
|
| Rate for Payer: BCBS Trust/PPO |
$36.88
|
| Rate for Payer: BCN Commercial |
$36.88
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$42.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$43.39
|
| Rate for Payer: Healthscope Whirlpool |
$44.73
|
| Rate for Payer: Mclaren Commercial |
$40.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.02
|
| Rate for Payer: Nomi Health Commercial |
$36.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$39.20
|
| Rate for Payer: Priority Health Narrow Network |
$31.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.37
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$385.54
|
|
|
Service Code
|
NDC 59762306003
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.65 |
| Max. Negotiated Rate |
$385.54 |
| Rate for Payer: Aetna Commercial |
$346.99
|
| Rate for Payer: Aetna Medicare |
$142.65
|
| Rate for Payer: ASR ASR |
$373.97
|
| Rate for Payer: BCBS Complete |
$154.22
|
| Rate for Payer: BCBS Trust/PPO |
$317.88
|
| Rate for Payer: BCN Commercial |
$317.88
|
| 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: MI Amish Medical Board Commercial |
$308.43
|
| 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: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$337.81
|
| Rate for Payer: Priority Health Narrow Network |
$270.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$339.28
|
|
|
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
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 50268009811
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Aetna Commercial |
$2.80
|
| Rate for Payer: ASR ASR |
$3.02
|
| Rate for Payer: BCBS Trust/PPO |
$2.56
|
| Rate for Payer: BCN Commercial |
$2.56
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.49
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Healthscope Whirlpool |
$3.12
|
| Rate for Payer: Mclaren Commercial |
$2.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.65
|
| Rate for Payer: Nomi Health Commercial |
$2.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.74
|
|
|
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
|
$44.73
|
|
|
Service Code
|
NDC 781808926
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.55 |
| Max. Negotiated Rate |
$44.73 |
| Rate for Payer: Aetna Commercial |
$40.26
|
| Rate for Payer: ASR ASR |
$43.39
|
| Rate for Payer: BCBS Trust/PPO |
$36.73
|
| Rate for Payer: BCN Commercial |
$36.73
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$42.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$43.39
|
| Rate for Payer: Healthscope Whirlpool |
$44.73
|
| Rate for Payer: Mclaren Commercial |
$40.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.02
|
| Rate for Payer: Nomi Health Commercial |
$36.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.37
|
|
|
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
|
IP
|
$7.75
|
|
|
Service Code
|
NDC 60687028211
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$7.75 |
| Rate for Payer: Aetna Commercial |
$6.98
|
| Rate for Payer: ASR ASR |
$7.52
|
| Rate for Payer: BCBS Trust/PPO |
$6.37
|
| Rate for Payer: BCN Commercial |
$6.37
|
| 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: 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: UHC All Payor (Choice/PPO) + Core |
$6.82
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$4.61
|
|
|
Service Code
|
NDC 60687074211
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Aetna Commercial |
$4.15
|
| Rate for Payer: ASR ASR |
$4.47
|
| Rate for Payer: BCBS Trust/PPO |
$3.78
|
| Rate for Payer: BCN Commercial |
$3.78
|
| 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: 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: UHC All Payor (Choice/PPO) + Core |
$4.06
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.97
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
21063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.23 |
| Max. Negotiated Rate |
$26.97 |
| Rate for Payer: Aetna Commercial |
$24.27
|
| Rate for Payer: Aetna Commercial |
$27.64
|
| Rate for Payer: Aetna Commercial |
$18.13
|
| Rate for Payer: Aetna Commercial |
$18.68
|
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Commercial |
$14.81
|
| Rate for Payer: Aetna Commercial |
$23.50
|
| Rate for Payer: Aetna Commercial |
$18.09
|
| Rate for Payer: ASR ASR |
$19.50
|
| Rate for Payer: ASR ASR |
$26.16
|
| Rate for Payer: ASR ASR |
$20.13
|
| Rate for Payer: ASR ASR |
$29.79
|
| Rate for Payer: ASR ASR |
$16.94
|
| Rate for Payer: ASR ASR |
$19.54
|
| Rate for Payer: ASR ASR |
$15.96
|
| Rate for Payer: ASR ASR |
$25.32
|
| Rate for Payer: BCBS Trust/PPO |
$13.52
|
| Rate for Payer: BCBS Trust/PPO |
$14.34
|
| Rate for Payer: BCBS Trust/PPO |
$17.05
|
| Rate for Payer: BCBS Trust/PPO |
$25.22
|
| Rate for Payer: BCBS Trust/PPO |
$22.15
|
| Rate for Payer: BCBS Trust/PPO |
$21.44
|
| Rate for Payer: BCBS Trust/PPO |
$16.51
|
| Rate for Payer: BCBS Trust/PPO |
$16.54
|
| Rate for Payer: BCN Commercial |
$14.34
|
| Rate for Payer: BCN Commercial |
$16.51
|
| Rate for Payer: BCN Commercial |
$25.22
|
| Rate for Payer: BCN Commercial |
$16.54
|
| Rate for Payer: BCN Commercial |
$17.05
|
| Rate for Payer: BCN Commercial |
$13.52
|
| Rate for Payer: BCN Commercial |
$21.44
|
| Rate for Payer: BCN Commercial |
$22.15
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$13.17
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cash Price |
$16.11
|
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Cash Price |
$20.89
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cofinity Commercial |
$24.54
|
| Rate for Payer: Cofinity Commercial |
$18.89
|
| Rate for Payer: Cofinity Commercial |
$15.47
|
| Rate for Payer: Cofinity Commercial |
$18.93
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Cofinity Commercial |
$28.87
|
| Rate for Payer: Cofinity Commercial |
$19.51
|
| Rate for Payer: Cofinity Commercial |
$25.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.08
|
| Rate for Payer: Healthscope Commercial |
$20.13
|
| Rate for Payer: Healthscope Commercial |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$19.50
|
| Rate for Payer: Healthscope Commercial |
$29.79
|
| Rate for Payer: Healthscope Commercial |
$26.16
|
| Rate for Payer: Healthscope Commercial |
$25.32
|
| Rate for Payer: Healthscope Commercial |
$15.96
|
| Rate for Payer: Healthscope Commercial |
$19.54
|
| Rate for Payer: Healthscope Whirlpool |
$20.10
|
| Rate for Payer: Healthscope Whirlpool |
$20.14
|
| Rate for Payer: Healthscope Whirlpool |
$17.46
|
| Rate for Payer: Healthscope Whirlpool |
$20.76
|
| Rate for Payer: Healthscope Whirlpool |
$16.46
|
| Rate for Payer: Healthscope Whirlpool |
$26.11
|
| Rate for Payer: Healthscope Whirlpool |
$26.97
|
| Rate for Payer: Healthscope Whirlpool |
$30.71
|
| Rate for Payer: Mclaren Commercial |
$18.68
|
| Rate for Payer: Mclaren Commercial |
$27.64
|
| Rate for Payer: Mclaren Commercial |
$14.81
|
| Rate for Payer: Mclaren Commercial |
$15.72
|
| Rate for Payer: Mclaren Commercial |
$18.13
|
| Rate for Payer: Mclaren Commercial |
$24.27
|
| Rate for Payer: Mclaren Commercial |
$18.09
|
| Rate for Payer: Mclaren Commercial |
$23.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: Nomi Health Commercial |
$17.02
|
| Rate for Payer: Nomi Health Commercial |
$25.18
|
| Rate for Payer: Nomi Health Commercial |
$21.41
|
| Rate for Payer: Nomi Health Commercial |
$13.50
|
| Rate for Payer: Nomi Health Commercial |
$16.52
|
| Rate for Payer: Nomi Health Commercial |
$14.32
|
| Rate for Payer: Nomi Health Commercial |
$16.48
|
| Rate for Payer: Nomi Health Commercial |
$22.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.98
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.76
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
21063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$20.76 |
| Rate for Payer: Aetna Commercial |
$18.68
|
| Rate for Payer: Aetna Commercial |
$23.50
|
| Rate for Payer: Aetna Commercial |
$14.81
|
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Commercial |
$27.64
|
| Rate for Payer: Aetna Commercial |
$24.27
|
| Rate for Payer: Aetna Commercial |
$18.09
|
| Rate for Payer: Aetna Commercial |
$18.13
|
| Rate for Payer: Aetna Medicare |
$7.45
|
| Rate for Payer: Aetna Medicare |
$7.68
|
| Rate for Payer: Aetna Medicare |
$6.46
|
| Rate for Payer: Aetna Medicare |
$9.66
|
| Rate for Payer: Aetna Medicare |
$9.98
|
| Rate for Payer: Aetna Medicare |
$11.36
|
| Rate for Payer: Aetna Medicare |
$7.44
|
| Rate for Payer: Aetna Medicare |
$6.09
|
| Rate for Payer: ASR ASR |
$20.13
|
| Rate for Payer: ASR ASR |
$19.54
|
| Rate for Payer: ASR ASR |
$16.94
|
| Rate for Payer: ASR ASR |
$15.96
|
| Rate for Payer: ASR ASR |
$19.50
|
| Rate for Payer: ASR ASR |
$29.79
|
| Rate for Payer: ASR ASR |
$26.16
|
| Rate for Payer: ASR ASR |
$25.32
|
| Rate for Payer: BCBS Complete |
$8.04
|
| Rate for Payer: BCBS Complete |
$8.06
|
| Rate for Payer: BCBS Complete |
$8.30
|
| Rate for Payer: BCBS Complete |
$10.79
|
| Rate for Payer: BCBS Complete |
$12.28
|
| Rate for Payer: BCBS Complete |
$6.99
|
| Rate for Payer: BCBS Complete |
$10.44
|
| Rate for Payer: BCBS Complete |
$6.58
|
| Rate for Payer: BCBS Trust/PPO |
$14.40
|
| Rate for Payer: BCBS Trust/PPO |
$13.57
|
| Rate for Payer: BCBS Trust/PPO |
$16.57
|
| Rate for Payer: BCBS Trust/PPO |
$25.32
|
| Rate for Payer: BCBS Trust/PPO |
$22.24
|
| Rate for Payer: BCBS Trust/PPO |
$17.11
|
| Rate for Payer: BCBS Trust/PPO |
$21.53
|
| Rate for Payer: BCBS Trust/PPO |
$16.61
|
| Rate for Payer: BCN Commercial |
$13.57
|
| Rate for Payer: BCN Commercial |
$17.11
|
| Rate for Payer: BCN Commercial |
$25.32
|
| Rate for Payer: BCN Commercial |
$16.57
|
| Rate for Payer: BCN Commercial |
$16.61
|
| Rate for Payer: BCN Commercial |
$14.40
|
| Rate for Payer: BCN Commercial |
$22.24
|
| Rate for Payer: BCN Commercial |
$21.53
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cash Price |
$13.17
|
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Cash Price |
$13.17
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cash Price |
$16.11
|
| Rate for Payer: Cash Price |
$16.11
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$20.89
|
| Rate for Payer: Cash Price |
$20.89
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cofinity Commercial |
$18.89
|
| Rate for Payer: Cofinity Commercial |
$18.93
|
| Rate for Payer: Cofinity Commercial |
$24.54
|
| Rate for Payer: Cofinity Commercial |
$28.87
|
| Rate for Payer: Cofinity Commercial |
$25.35
|
| Rate for Payer: Cofinity Commercial |
$19.51
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Cofinity Commercial |
$15.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.61
|
| Rate for Payer: Healthscope Commercial |
$19.54
|
| Rate for Payer: Healthscope Commercial |
$29.79
|
| Rate for Payer: Healthscope Commercial |
$26.16
|
| Rate for Payer: Healthscope Commercial |
$19.50
|
| Rate for Payer: Healthscope Commercial |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$15.96
|
| Rate for Payer: Healthscope Commercial |
$25.32
|
| Rate for Payer: Healthscope Commercial |
$20.13
|
| Rate for Payer: Healthscope Whirlpool |
$16.46
|
| Rate for Payer: Healthscope Whirlpool |
$30.71
|
| Rate for Payer: Healthscope Whirlpool |
$20.14
|
| Rate for Payer: Healthscope Whirlpool |
$20.76
|
| Rate for Payer: Healthscope Whirlpool |
$26.11
|
| Rate for Payer: Healthscope Whirlpool |
$17.46
|
| Rate for Payer: Healthscope Whirlpool |
$26.97
|
| Rate for Payer: Healthscope Whirlpool |
$20.10
|
| Rate for Payer: Mclaren Commercial |
$18.09
|
| Rate for Payer: Mclaren Commercial |
$18.13
|
| Rate for Payer: Mclaren Commercial |
$23.50
|
| Rate for Payer: Mclaren Commercial |
$24.27
|
| Rate for Payer: Mclaren Commercial |
$14.81
|
| Rate for Payer: Mclaren Commercial |
$15.72
|
| Rate for Payer: Mclaren Commercial |
$18.68
|
| Rate for Payer: Mclaren Commercial |
$27.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.99
|
| Rate for Payer: Nomi Health Commercial |
$13.50
|
| Rate for Payer: Nomi Health Commercial |
$25.18
|
| Rate for Payer: Nomi Health Commercial |
$16.48
|
| Rate for Payer: Nomi Health Commercial |
$16.52
|
| Rate for Payer: Nomi Health Commercial |
$14.32
|
| Rate for Payer: Nomi Health Commercial |
$21.41
|
| Rate for Payer: Nomi Health Commercial |
$22.12
|
| Rate for Payer: Nomi Health Commercial |
$17.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.12
|
| Rate for Payer: Priority Health Narrow Network |
$1.70
|
| Rate for Payer: Priority Health Narrow Network |
$1.70
|
| Rate for Payer: Priority Health Narrow Network |
$1.70
|
| Rate for Payer: Priority Health Narrow Network |
$1.70
|
| Rate for Payer: Priority Health Narrow Network |
$1.70
|
| Rate for Payer: Priority Health Narrow Network |
$1.70
|
| Rate for Payer: Priority Health Narrow Network |
$1.70
|
| Rate for Payer: Priority Health Narrow Network |
$1.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.98
|
|
|
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 |
$8.35 |
| Rate for Payer: Aetna Commercial |
$7.51
|
| Rate for Payer: Aetna Medicare |
$3.09
|
| Rate for Payer: ASR ASR |
$8.10
|
| Rate for Payer: BCBS Complete |
$3.34
|
| Rate for Payer: BCBS Trust/PPO |
$6.88
|
| Rate for Payer: BCN Commercial |
$6.88
|
| Rate for Payer: Cash Price |
$6.68
|
| Rate for Payer: Cofinity Commercial |
$7.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$8.10
|
| Rate for Payer: Healthscope Whirlpool |
$8.35
|
| Rate for Payer: Mclaren Commercial |
$7.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.10
|
| Rate for Payer: Nomi Health Commercial |
$6.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.31
|
| Rate for Payer: Priority Health Narrow Network |
$5.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.35
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$498.06
|
|
|
Service Code
|
NDC 50111078810
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$373.54 |
| Max. Negotiated Rate |
$498.06 |
| Rate for Payer: Aetna Commercial |
$448.25
|
| Rate for Payer: ASR ASR |
$483.12
|
| Rate for Payer: BCBS Trust/PPO |
$409.00
|
| Rate for Payer: BCN Commercial |
$409.00
|
| Rate for Payer: Cash Price |
$398.45
|
| Rate for Payer: Cofinity Commercial |
$468.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.45
|
| Rate for Payer: Healthscope Commercial |
$483.12
|
| Rate for Payer: Healthscope Whirlpool |
$498.06
|
| Rate for Payer: Mclaren Commercial |
$448.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.35
|
| Rate for Payer: Nomi Health Commercial |
$408.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$438.29
|
|
|
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 |
$498.06 |
| Rate for Payer: Aetna Commercial |
$448.25
|
| Rate for Payer: Aetna Medicare |
$184.28
|
| Rate for Payer: ASR ASR |
$483.12
|
| Rate for Payer: BCBS Complete |
$199.22
|
| Rate for Payer: BCBS Trust/PPO |
$410.65
|
| Rate for Payer: BCN Commercial |
$410.65
|
| Rate for Payer: Cash Price |
$398.45
|
| Rate for Payer: Cofinity Commercial |
$468.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.45
|
| Rate for Payer: Healthscope Commercial |
$483.12
|
| Rate for Payer: Healthscope Whirlpool |
$498.06
|
| Rate for Payer: Mclaren Commercial |
$448.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$398.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.35
|
| Rate for Payer: Nomi Health Commercial |
$408.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$436.40
|
| Rate for Payer: Priority Health Narrow Network |
$349.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$438.29
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$8.35
|
|
|
Service Code
|
NDC 50268009911
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: Aetna Commercial |
$7.51
|
| Rate for Payer: ASR ASR |
$8.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.86
|
| Rate for Payer: BCN Commercial |
$6.86
|
| Rate for Payer: Cash Price |
$6.68
|
| Rate for Payer: Cofinity Commercial |
$7.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$8.10
|
| Rate for Payer: Healthscope Whirlpool |
$8.35
|
| Rate for Payer: Mclaren Commercial |
$7.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.10
|
| Rate for Payer: Nomi Health Commercial |
$6.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.35
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$102.31
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$102.31 |
| Rate for Payer: Aetna Commercial |
$92.08
|
| Rate for Payer: Aetna Commercial |
$110.71
|
| Rate for Payer: Aetna Commercial |
$82.24
|
| Rate for Payer: Aetna Medicare |
$45.52
|
| Rate for Payer: Aetna Medicare |
$37.85
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: ASR ASR |
$88.64
|
| Rate for Payer: ASR ASR |
$99.24
|
| Rate for Payer: ASR ASR |
$119.33
|
| Rate for Payer: BCBS Complete |
$40.92
|
| Rate for Payer: BCBS Complete |
$36.55
|
| Rate for Payer: BCBS Complete |
$49.21
|
| Rate for Payer: BCBS Trust/PPO |
$84.35
|
| Rate for Payer: BCBS Trust/PPO |
$101.43
|
| Rate for Payer: BCBS Trust/PPO |
$75.34
|
| Rate for Payer: BCN Commercial |
$84.35
|
| Rate for Payer: BCN Commercial |
$101.43
|
| Rate for Payer: BCN Commercial |
$75.34
|
| Rate for Payer: Cash Price |
$98.41
|
| Rate for Payer: Cash Price |
$81.84
|
| Rate for Payer: Cash Price |
$98.41
|
| Rate for Payer: Cash Price |
$73.10
|
| Rate for Payer: Cash Price |
$73.10
|
| Rate for Payer: Cash Price |
$81.84
|
| Rate for Payer: Cofinity Commercial |
$115.64
|
| Rate for Payer: Cofinity Commercial |
$96.17
|
| Rate for Payer: Cofinity Commercial |
$85.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.41
|
| Rate for Payer: Healthscope Commercial |
$88.64
|
| Rate for Payer: Healthscope Commercial |
$99.24
|
| Rate for Payer: Healthscope Commercial |
$119.33
|
| Rate for Payer: Healthscope Whirlpool |
$123.02
|
| Rate for Payer: Healthscope Whirlpool |
$102.31
|
| Rate for Payer: Healthscope Whirlpool |
$91.38
|
| Rate for Payer: Mclaren Commercial |
$82.24
|
| Rate for Payer: Mclaren Commercial |
$110.71
|
| Rate for Payer: Mclaren Commercial |
$92.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.96
|
| Rate for Payer: Nomi Health Commercial |
$74.93
|
| Rate for Payer: Nomi Health Commercial |
$83.89
|
| Rate for Payer: Nomi Health Commercial |
$100.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.32
|
| Rate for Payer: Priority Health Narrow Network |
$1.86
|
| Rate for Payer: Priority Health Narrow Network |
$1.86
|
| Rate for Payer: Priority Health Narrow Network |
$1.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.03
|
|
|
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 |
$76.73 |
| Max. Negotiated Rate |
$102.31 |
| Rate for Payer: Aetna Commercial |
$92.08
|
| Rate for Payer: Aetna Commercial |
$82.24
|
| Rate for Payer: Aetna Commercial |
$110.71
|
| Rate for Payer: ASR ASR |
$88.64
|
| Rate for Payer: ASR ASR |
$99.24
|
| Rate for Payer: ASR ASR |
$119.33
|
| Rate for Payer: BCBS Trust/PPO |
$75.04
|
| Rate for Payer: BCBS Trust/PPO |
$84.01
|
| Rate for Payer: BCBS Trust/PPO |
$101.02
|
| Rate for Payer: BCN Commercial |
$101.02
|
| Rate for Payer: BCN Commercial |
$84.01
|
| Rate for Payer: BCN Commercial |
$75.04
|
| Rate for Payer: Cash Price |
$73.10
|
| Rate for Payer: Cash Price |
$81.84
|
| Rate for Payer: Cash Price |
$98.41
|
| Rate for Payer: Cofinity Commercial |
$96.17
|
| Rate for Payer: Cofinity Commercial |
$115.64
|
| Rate for Payer: Cofinity Commercial |
$85.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.41
|
| Rate for Payer: Healthscope Commercial |
$119.33
|
| Rate for Payer: Healthscope Commercial |
$99.24
|
| Rate for Payer: Healthscope Commercial |
$88.64
|
| Rate for Payer: Healthscope Whirlpool |
$123.02
|
| Rate for Payer: Healthscope Whirlpool |
$91.38
|
| Rate for Payer: Healthscope Whirlpool |
$102.31
|
| Rate for Payer: Mclaren Commercial |
$110.71
|
| Rate for Payer: Mclaren Commercial |
$92.08
|
| Rate for Payer: Mclaren Commercial |
$82.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.96
|
| Rate for Payer: Nomi Health Commercial |
$100.87
|
| Rate for Payer: Nomi Health Commercial |
$83.89
|
| Rate for Payer: Nomi Health Commercial |
$74.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.03
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS CUSTOM
|
Facility
|
IP
|
$102.31
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.73 |
| Max. Negotiated Rate |
$102.31 |
| Rate for Payer: Aetna Commercial |
$92.08
|
| Rate for Payer: ASR ASR |
$99.24
|
| Rate for Payer: BCBS Trust/PPO |
$84.01
|
| Rate for Payer: BCN Commercial |
$84.01
|
| Rate for Payer: Cash Price |
$81.84
|
| Rate for Payer: Cofinity Commercial |
$96.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.84
|
| Rate for Payer: Healthscope Commercial |
$99.24
|
| Rate for Payer: Healthscope Whirlpool |
$102.31
|
| Rate for Payer: Mclaren Commercial |
$92.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.96
|
| Rate for Payer: Nomi Health Commercial |
$83.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.03
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS CUSTOM
|
Facility
|
OP
|
$102.31
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$102.31 |
| Rate for Payer: Aetna Commercial |
$92.08
|
| Rate for Payer: Aetna Medicare |
$37.85
|
| Rate for Payer: ASR ASR |
$99.24
|
| Rate for Payer: BCBS Complete |
$40.92
|
| Rate for Payer: BCBS Trust/PPO |
$84.35
|
| Rate for Payer: BCN Commercial |
$84.35
|
| Rate for Payer: Cash Price |
$81.84
|
| Rate for Payer: Cash Price |
$81.84
|
| Rate for Payer: Cofinity Commercial |
$96.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.84
|
| Rate for Payer: Healthscope Commercial |
$99.24
|
| Rate for Payer: Healthscope Whirlpool |
$102.31
|
| Rate for Payer: Mclaren Commercial |
$92.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.96
|
| Rate for Payer: Nomi Health Commercial |
$83.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.32
|
| Rate for Payer: Priority Health Narrow Network |
$1.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.03
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$186.56
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$186.56 |
| Rate for Payer: Aetna Commercial |
$167.91
|
| Rate for Payer: Aetna Commercial |
$176.65
|
| Rate for Payer: Aetna Commercial |
$187.98
|
| Rate for Payer: Aetna Medicare |
$72.62
|
| Rate for Payer: Aetna Medicare |
$69.03
|
| Rate for Payer: Aetna Medicare |
$77.28
|
| Rate for Payer: ASR ASR |
$202.60
|
| Rate for Payer: ASR ASR |
$180.97
|
| Rate for Payer: ASR ASR |
$190.39
|
| Rate for Payer: BCBS Complete |
$74.62
|
| Rate for Payer: BCBS Complete |
$83.55
|
| Rate for Payer: BCBS Complete |
$78.51
|
| Rate for Payer: BCBS Trust/PPO |
$153.82
|
| Rate for Payer: BCBS Trust/PPO |
$161.83
|
| Rate for Payer: BCBS Trust/PPO |
$172.21
|
| Rate for Payer: BCN Commercial |
$153.82
|
| Rate for Payer: BCN Commercial |
$161.83
|
| Rate for Payer: BCN Commercial |
$172.21
|
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Cofinity Commercial |
$184.50
|
| Rate for Payer: Cofinity Commercial |
$175.37
|
| Rate for Payer: Cofinity Commercial |
$196.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.02
|
| Rate for Payer: Healthscope Commercial |
$202.60
|
| Rate for Payer: Healthscope Commercial |
$180.97
|
| Rate for Payer: Healthscope Commercial |
$190.39
|
| Rate for Payer: Healthscope Whirlpool |
$196.28
|
| Rate for Payer: Healthscope Whirlpool |
$186.56
|
| Rate for Payer: Healthscope Whirlpool |
$208.87
|
| Rate for Payer: Mclaren Commercial |
$187.98
|
| Rate for Payer: Mclaren Commercial |
$176.65
|
| Rate for Payer: Mclaren Commercial |
$167.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$167.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.58
|
| Rate for Payer: Nomi Health Commercial |
$171.27
|
| Rate for Payer: Nomi Health Commercial |
$152.98
|
| Rate for Payer: Nomi Health Commercial |
$160.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.32
|
| Rate for Payer: Priority Health Narrow Network |
$1.86
|
| Rate for Payer: Priority Health Narrow Network |
$1.86
|
| Rate for Payer: Priority Health Narrow Network |
$1.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$172.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.17
|
|
