|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$96.61
|
|
|
Service Code
|
NDC 42806015134
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.80 |
| Max. Negotiated Rate |
$96.61 |
| Rate for Payer: Aetna Commercial |
$86.95
|
| Rate for Payer: ASR ASR |
$93.71
|
| Rate for Payer: ASR Commercial |
$93.71
|
| Rate for Payer: BCBS Trust/PPO |
$78.73
|
| Rate for Payer: BCN Commercial |
$74.90
|
| Rate for Payer: Cash Price |
$77.29
|
| Rate for Payer: Cofinity Commercial |
$90.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.29
|
| Rate for Payer: Healthscope Commercial |
$96.61
|
| Rate for Payer: Healthscope Whirlpool |
$93.71
|
| Rate for Payer: Mclaren Commercial |
$86.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.12
|
| Rate for Payer: Nomi Health Commercial |
$79.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.02
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$96.61
|
|
|
Service Code
|
NDC 42806015134
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.64 |
| Max. Negotiated Rate |
$96.61 |
| Rate for Payer: Aetna Commercial |
$86.95
|
| Rate for Payer: Aetna Medicare |
$48.30
|
| Rate for Payer: ASR ASR |
$93.71
|
| Rate for Payer: ASR Commercial |
$93.71
|
| Rate for Payer: BCBS Complete |
$38.64
|
| Rate for Payer: BCBS Trust/PPO |
$79.11
|
| Rate for Payer: BCN Commercial |
$74.90
|
| Rate for Payer: Cash Price |
$77.29
|
| Rate for Payer: Cofinity Commercial |
$90.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.29
|
| Rate for Payer: Healthscope Commercial |
$96.61
|
| Rate for Payer: Healthscope Whirlpool |
$93.71
|
| Rate for Payer: Mclaren Commercial |
$86.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.12
|
| Rate for Payer: Nomi Health Commercial |
$79.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.65
|
| Rate for Payer: Priority Health Narrow Network |
$67.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.02
|
|
|
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 |
$35.71 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$80.35
|
| Rate for Payer: Aetna Medicare |
$44.64
|
| Rate for Payer: ASR ASR |
$86.60
|
| Rate for Payer: ASR Commercial |
$86.60
|
| Rate for Payer: BCBS Complete |
$35.71
|
| Rate for Payer: BCBS Trust/PPO |
$73.11
|
| Rate for Payer: BCN Commercial |
$69.22
|
| 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 |
$89.28
|
| Rate for Payer: Healthscope Whirlpool |
$86.60
|
| 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: Priority Health Cigna Priority Health |
$58.03
|
| Rate for Payer: 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 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$124.54
|
|
|
Service Code
|
NDC 70710146002
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.95 |
| Max. Negotiated Rate |
$124.54 |
| Rate for Payer: Aetna Commercial |
$112.09
|
| Rate for Payer: ASR ASR |
$120.80
|
| Rate for Payer: ASR Commercial |
$120.80
|
| Rate for Payer: BCBS Trust/PPO |
$101.49
|
| Rate for Payer: BCN Commercial |
$96.56
|
| Rate for Payer: Cash Price |
$99.64
|
| Rate for Payer: Cofinity Commercial |
$117.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.63
|
| Rate for Payer: Healthscope Commercial |
$124.54
|
| Rate for Payer: Healthscope Whirlpool |
$120.80
|
| Rate for Payer: Mclaren Commercial |
$112.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.86
|
| Rate for Payer: Nomi Health Commercial |
$102.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.95
|
| 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 00093202631
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.71 |
| Max. Negotiated Rate |
$116.78 |
| Rate for Payer: Aetna Commercial |
$105.10
|
| Rate for Payer: Aetna Medicare |
$58.39
|
| Rate for Payer: ASR ASR |
$113.28
|
| Rate for Payer: ASR Commercial |
$113.28
|
| Rate for Payer: BCBS Complete |
$46.71
|
| Rate for Payer: BCBS Trust/PPO |
$95.63
|
| Rate for Payer: BCN Commercial |
$90.54
|
| Rate for Payer: Cash Price |
$93.43
|
| Rate for Payer: Cofinity Commercial |
$109.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.42
|
| Rate for Payer: Healthscope Commercial |
$116.78
|
| Rate for Payer: Healthscope Whirlpool |
$113.28
|
| Rate for Payer: Mclaren Commercial |
$105.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.26
|
| Rate for Payer: Nomi Health Commercial |
$95.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.32
|
| Rate for Payer: Priority Health Narrow Network |
$81.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.77
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$124.54
|
|
|
Service Code
|
NDC 70710146002
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.82 |
| Max. Negotiated Rate |
$124.54 |
| Rate for Payer: Aetna Commercial |
$112.09
|
| Rate for Payer: Aetna Medicare |
$62.27
|
| Rate for Payer: ASR ASR |
$120.80
|
| Rate for Payer: ASR Commercial |
$120.80
|
| Rate for Payer: BCBS Complete |
$49.82
|
| Rate for Payer: BCBS Trust/PPO |
$101.99
|
| Rate for Payer: BCN Commercial |
$96.56
|
| Rate for Payer: Cash Price |
$99.64
|
| Rate for Payer: Cofinity Commercial |
$117.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.63
|
| Rate for Payer: Healthscope Commercial |
$124.54
|
| Rate for Payer: Healthscope Whirlpool |
$120.80
|
| Rate for Payer: Mclaren Commercial |
$112.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.86
|
| Rate for Payer: Nomi Health Commercial |
$102.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.12
|
| Rate for Payer: Priority Health Narrow Network |
$87.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.60
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$7.75
|
|
|
Service Code
|
NDC 60687028211
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$7.75 |
| Rate for Payer: Aetna Commercial |
$6.98
|
| Rate for Payer: ASR ASR |
$7.52
|
| Rate for Payer: ASR Commercial |
$7.52
|
| Rate for Payer: BCBS Trust/PPO |
$6.32
|
| Rate for Payer: BCN Commercial |
$6.01
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Cofinity Commercial |
$7.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.20
|
| Rate for Payer: Healthscope Commercial |
$7.75
|
| Rate for Payer: Healthscope Whirlpool |
$7.52
|
| 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: Priority Health Cigna Priority Health |
$5.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.82
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$184.08
|
|
|
Service Code
|
NDC 60687074265
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.65 |
| Max. Negotiated Rate |
$184.08 |
| Rate for Payer: Aetna Commercial |
$165.67
|
| Rate for Payer: ASR ASR |
$178.56
|
| Rate for Payer: ASR Commercial |
$178.56
|
| Rate for Payer: BCBS Trust/PPO |
$150.01
|
| Rate for Payer: BCN Commercial |
$142.72
|
| Rate for Payer: Cash Price |
$147.26
|
| Rate for Payer: Cofinity Commercial |
$173.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.26
|
| Rate for Payer: Healthscope Commercial |
$184.08
|
| Rate for Payer: Healthscope Whirlpool |
$178.56
|
| Rate for Payer: Mclaren Commercial |
$165.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.47
|
| Rate for Payer: Nomi Health Commercial |
$150.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.99
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$22.90
|
|
|
Service Code
|
NDC 00781808926
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$22.90 |
| Rate for Payer: Aetna Commercial |
$20.61
|
| Rate for Payer: ASR ASR |
$22.21
|
| Rate for Payer: ASR Commercial |
$22.21
|
| Rate for Payer: BCBS Trust/PPO |
$18.66
|
| Rate for Payer: BCN Commercial |
$17.75
|
| Rate for Payer: Cash Price |
$18.32
|
| Rate for Payer: Cofinity Commercial |
$21.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.32
|
| Rate for Payer: Healthscope Commercial |
$22.90
|
| Rate for Payer: Healthscope Whirlpool |
$22.21
|
| Rate for Payer: Mclaren Commercial |
$20.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Nomi Health Commercial |
$18.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.15
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$174.24
|
|
|
Service Code
|
NDC 50268007415
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.70 |
| Max. Negotiated Rate |
$174.24 |
| Rate for Payer: Aetna Commercial |
$156.82
|
| Rate for Payer: Aetna Medicare |
$87.12
|
| Rate for Payer: ASR ASR |
$169.01
|
| Rate for Payer: ASR Commercial |
$169.01
|
| Rate for Payer: BCBS Complete |
$69.70
|
| Rate for Payer: BCBS Trust/PPO |
$142.69
|
| Rate for Payer: BCN Commercial |
$135.09
|
| Rate for Payer: Cash Price |
$139.39
|
| Rate for Payer: Cofinity Commercial |
$163.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.39
|
| Rate for Payer: Healthscope Commercial |
$174.24
|
| Rate for Payer: Healthscope Whirlpool |
$169.01
|
| Rate for Payer: Mclaren Commercial |
$156.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.10
|
| Rate for Payer: Nomi Health Commercial |
$142.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.67
|
| Rate for Payer: Priority Health Narrow Network |
$122.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.33
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 50268009811
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: ASR ASR |
$3.03
|
| Rate for Payer: ASR Commercial |
$3.03
|
| Rate for Payer: BCBS Trust/PPO |
$2.54
|
| Rate for Payer: BCN Commercial |
$2.42
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$3.12
|
| Rate for Payer: Healthscope Whirlpool |
$3.03
|
| Rate for Payer: Mclaren Commercial |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.65
|
| Rate for Payer: Nomi Health Commercial |
$2.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.75
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$184.08
|
|
|
Service Code
|
NDC 60687074265
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.63 |
| Max. Negotiated Rate |
$184.08 |
| Rate for Payer: Aetna Commercial |
$165.67
|
| Rate for Payer: Aetna Medicare |
$92.04
|
| Rate for Payer: ASR ASR |
$178.56
|
| Rate for Payer: ASR Commercial |
$178.56
|
| Rate for Payer: BCBS Complete |
$73.63
|
| Rate for Payer: BCBS Trust/PPO |
$150.74
|
| Rate for Payer: BCN Commercial |
$142.72
|
| Rate for Payer: Cash Price |
$147.26
|
| Rate for Payer: Cofinity Commercial |
$173.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.26
|
| Rate for Payer: Healthscope Commercial |
$184.08
|
| Rate for Payer: Healthscope Whirlpool |
$178.56
|
| Rate for Payer: Mclaren Commercial |
$165.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.47
|
| Rate for Payer: Nomi Health Commercial |
$150.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$161.29
|
| Rate for Payer: Priority Health Narrow Network |
$129.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.99
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$154.08
|
|
|
Service Code
|
NDC 00904670806
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.15 |
| Max. Negotiated Rate |
$154.08 |
| Rate for Payer: Aetna Commercial |
$138.67
|
| Rate for Payer: ASR ASR |
$149.46
|
| Rate for Payer: ASR Commercial |
$149.46
|
| Rate for Payer: BCBS Trust/PPO |
$125.56
|
| Rate for Payer: BCN Commercial |
$119.46
|
| 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 |
$154.08
|
| Rate for Payer: Healthscope Whirlpool |
$149.46
|
| 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: Priority Health Cigna Priority Health |
$100.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.59
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$5.65
|
|
|
Service Code
|
NDC 60687074211
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$5.65 |
| Rate for Payer: Aetna Commercial |
$5.08
|
| Rate for Payer: ASR ASR |
$5.48
|
| Rate for Payer: ASR Commercial |
$5.48
|
| Rate for Payer: BCBS Trust/PPO |
$4.60
|
| Rate for Payer: BCN Commercial |
$4.38
|
| Rate for Payer: Cash Price |
$4.52
|
| Rate for Payer: Cofinity Commercial |
$5.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.52
|
| Rate for Payer: Healthscope Commercial |
$5.65
|
| Rate for Payer: Healthscope Whirlpool |
$5.48
|
| Rate for Payer: Mclaren Commercial |
$5.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.80
|
| Rate for Payer: Nomi Health Commercial |
$4.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.97
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$22.90
|
|
|
Service Code
|
NDC 00781808926
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$22.90 |
| Rate for Payer: Aetna Commercial |
$20.61
|
| Rate for Payer: Aetna Medicare |
$11.45
|
| Rate for Payer: ASR ASR |
$22.21
|
| Rate for Payer: ASR Commercial |
$22.21
|
| Rate for Payer: BCBS Complete |
$9.16
|
| Rate for Payer: BCBS Trust/PPO |
$18.75
|
| Rate for Payer: BCN Commercial |
$17.75
|
| Rate for Payer: Cash Price |
$18.32
|
| Rate for Payer: Cofinity Commercial |
$21.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.32
|
| Rate for Payer: Healthscope Commercial |
$22.90
|
| Rate for Payer: Healthscope Whirlpool |
$22.21
|
| Rate for Payer: Mclaren Commercial |
$20.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Nomi Health Commercial |
$18.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.06
|
| Rate for Payer: Priority Health Narrow Network |
$16.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.15
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$158.40
|
|
|
Service Code
|
NDC 00904735006
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$142.56
|
| Rate for Payer: Aetna Medicare |
$79.20
|
| Rate for Payer: ASR ASR |
$153.65
|
| Rate for Payer: ASR Commercial |
$153.65
|
| Rate for Payer: BCBS Complete |
$63.36
|
| Rate for Payer: BCBS Trust/PPO |
$129.71
|
| Rate for Payer: BCN Commercial |
$122.81
|
| Rate for Payer: Cash Price |
$126.72
|
| Rate for Payer: Cofinity Commercial |
$148.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.72
|
| Rate for Payer: Healthscope Commercial |
$158.40
|
| Rate for Payer: Healthscope Whirlpool |
$153.65
|
| Rate for Payer: Mclaren Commercial |
$142.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.64
|
| Rate for Payer: Nomi Health Commercial |
$129.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.79
|
| Rate for Payer: Priority Health Narrow Network |
$111.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.39
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$385.54
|
|
|
Service Code
|
NDC 59762306003
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.60 |
| Max. Negotiated Rate |
$385.54 |
| Rate for Payer: Aetna Commercial |
$346.99
|
| Rate for Payer: ASR ASR |
$373.97
|
| Rate for Payer: ASR Commercial |
$373.97
|
| Rate for Payer: BCBS Trust/PPO |
$314.18
|
| Rate for Payer: BCN Commercial |
$298.91
|
| 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 |
$385.54
|
| Rate for Payer: Healthscope Whirlpool |
$373.97
|
| 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: Priority Health Cigna Priority Health |
$250.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$339.28
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$3.48
|
|
|
Service Code
|
NDC 50268007411
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna Commercial |
$3.13
|
| Rate for Payer: Aetna Medicare |
$1.74
|
| Rate for Payer: ASR ASR |
$3.38
|
| Rate for Payer: ASR Commercial |
$3.38
|
| Rate for Payer: BCBS Complete |
$1.39
|
| Rate for Payer: BCBS Trust/PPO |
$2.85
|
| Rate for Payer: BCN Commercial |
$2.70
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$3.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$3.48
|
| Rate for Payer: Healthscope Whirlpool |
$3.38
|
| Rate for Payer: Mclaren Commercial |
$3.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.96
|
| Rate for Payer: Nomi Health Commercial |
$2.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.26
|
| Rate for Payer: 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
|
IP
|
$3.48
|
|
|
Service Code
|
NDC 50268007411
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna Commercial |
$3.13
|
| Rate for Payer: ASR ASR |
$3.38
|
| Rate for Payer: ASR Commercial |
$3.38
|
| Rate for Payer: BCBS Trust/PPO |
$2.84
|
| Rate for Payer: BCN Commercial |
$2.70
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$3.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$3.48
|
| Rate for Payer: Healthscope Whirlpool |
$3.38
|
| Rate for Payer: Mclaren Commercial |
$3.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.96
|
| Rate for Payer: Nomi Health Commercial |
$2.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.06
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$775.20
|
|
|
Service Code
|
NDC 60687028201
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$503.88 |
| Max. Negotiated Rate |
$775.20 |
| Rate for Payer: Aetna Commercial |
$697.68
|
| Rate for Payer: ASR ASR |
$751.94
|
| Rate for Payer: ASR Commercial |
$751.94
|
| Rate for Payer: BCBS Trust/PPO |
$631.71
|
| Rate for Payer: BCN Commercial |
$601.01
|
| 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 |
$775.20
|
| Rate for Payer: Healthscope Whirlpool |
$751.94
|
| Rate for Payer: Mclaren Commercial |
$697.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$658.92
|
| Rate for Payer: Nomi Health Commercial |
$635.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$682.18
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$5.65
|
|
|
Service Code
|
NDC 60687074211
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$5.65 |
| Rate for Payer: Aetna Commercial |
$5.08
|
| Rate for Payer: Aetna Medicare |
$2.82
|
| Rate for Payer: ASR ASR |
$5.48
|
| Rate for Payer: ASR Commercial |
$5.48
|
| Rate for Payer: BCBS Complete |
$2.26
|
| Rate for Payer: BCBS Trust/PPO |
$4.63
|
| Rate for Payer: BCN Commercial |
$4.38
|
| Rate for Payer: Cash Price |
$4.52
|
| Rate for Payer: Cofinity Commercial |
$5.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.52
|
| Rate for Payer: Healthscope Commercial |
$5.65
|
| Rate for Payer: Healthscope Whirlpool |
$5.48
|
| Rate for Payer: Mclaren Commercial |
$5.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.80
|
| Rate for Payer: Nomi Health Commercial |
$4.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.95
|
| Rate for Payer: Priority Health Narrow Network |
$3.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.97
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$174.24
|
|
|
Service Code
|
NDC 50268007415
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.26 |
| Max. Negotiated Rate |
$174.24 |
| Rate for Payer: Aetna Commercial |
$156.82
|
| Rate for Payer: ASR ASR |
$169.01
|
| Rate for Payer: ASR Commercial |
$169.01
|
| Rate for Payer: BCBS Trust/PPO |
$141.99
|
| Rate for Payer: BCN Commercial |
$135.09
|
| Rate for Payer: Cash Price |
$139.39
|
| Rate for Payer: Cofinity Commercial |
$163.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.39
|
| Rate for Payer: Healthscope Commercial |
$174.24
|
| Rate for Payer: Healthscope Whirlpool |
$169.01
|
| Rate for Payer: Mclaren Commercial |
$156.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.10
|
| Rate for Payer: Nomi Health Commercial |
$142.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.33
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
OP
|
$7.75
|
|
|
Service Code
|
NDC 60687028211
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$7.75 |
| Rate for Payer: Aetna Commercial |
$6.98
|
| Rate for Payer: Aetna Medicare |
$3.88
|
| Rate for Payer: ASR ASR |
$7.52
|
| Rate for Payer: ASR Commercial |
$7.52
|
| Rate for Payer: BCBS Complete |
$3.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.35
|
| Rate for Payer: BCN Commercial |
$6.01
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Cofinity Commercial |
$7.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.20
|
| Rate for Payer: Healthscope Commercial |
$7.75
|
| Rate for Payer: Healthscope Whirlpool |
$7.52
|
| 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: Priority Health Cigna Priority Health |
$5.04
|
| Rate for Payer: 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
|
OP
|
$3.12
|
|
|
Service Code
|
NDC 50268009811
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Medicare |
$1.56
|
| Rate for Payer: ASR ASR |
$3.03
|
| Rate for Payer: ASR Commercial |
$3.03
|
| Rate for Payer: BCBS Complete |
$1.25
|
| Rate for Payer: BCBS Trust/PPO |
$2.55
|
| Rate for Payer: BCN Commercial |
$2.42
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$3.12
|
| Rate for Payer: Healthscope Whirlpool |
$3.03
|
| Rate for Payer: Mclaren Commercial |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.65
|
| Rate for Payer: Nomi Health Commercial |
$2.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.73
|
| Rate for Payer: Priority Health Narrow Network |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.75
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$158.40
|
|
|
Service Code
|
NDC 00904735006
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.96 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$142.56
|
| Rate for Payer: ASR ASR |
$153.65
|
| Rate for Payer: ASR Commercial |
$153.65
|
| Rate for Payer: BCBS Trust/PPO |
$129.08
|
| Rate for Payer: BCN Commercial |
$122.81
|
| Rate for Payer: Cash Price |
$126.72
|
| Rate for Payer: Cofinity Commercial |
$148.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.72
|
| Rate for Payer: Healthscope Commercial |
$158.40
|
| Rate for Payer: Healthscope Whirlpool |
$153.65
|
| Rate for Payer: Mclaren Commercial |
$142.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.64
|
| Rate for Payer: Nomi Health Commercial |
$129.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.39
|
|
