|
ATORVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$219.45
|
|
|
Service Code
|
NDC 00904629261
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$219.45 |
| Rate for Payer: Aetna Commercial |
$197.50
|
| Rate for Payer: Aetna Medicare |
$109.72
|
| Rate for Payer: ASR ASR |
$212.87
|
| Rate for Payer: ASR Commercial |
$212.87
|
| Rate for Payer: BCBS Complete |
$87.78
|
| Rate for Payer: BCBS Trust/PPO |
$179.71
|
| Rate for Payer: BCN Commercial |
$170.14
|
| Rate for Payer: Cash Price |
$175.56
|
| Rate for Payer: Cofinity Commercial |
$206.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.56
|
| Rate for Payer: Healthscope Commercial |
$219.45
|
| Rate for Payer: Healthscope Whirlpool |
$212.87
|
| Rate for Payer: Mclaren Commercial |
$197.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.53
|
| Rate for Payer: Nomi Health Commercial |
$179.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.28
|
| Rate for Payer: Priority Health Narrow Network |
$153.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.12
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$3.86
|
|
|
Service Code
|
NDC 51079021001
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: ASR ASR |
$3.74
|
| Rate for Payer: ASR Commercial |
$3.74
|
| Rate for Payer: BCBS Trust/PPO |
$3.15
|
| Rate for Payer: BCN Commercial |
$2.99
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Cofinity Commercial |
$3.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.09
|
| Rate for Payer: Healthscope Commercial |
$3.86
|
| Rate for Payer: Healthscope Whirlpool |
$3.74
|
| Rate for Payer: Mclaren Commercial |
$3.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.28
|
| Rate for Payer: Nomi Health Commercial |
$3.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.40
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$2.41
|
|
|
Service Code
|
NDC 68084009911
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: ASR ASR |
$2.34
|
| Rate for Payer: ASR Commercial |
$2.34
|
| Rate for Payer: BCBS Trust/PPO |
$1.96
|
| Rate for Payer: BCN Commercial |
$1.87
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cofinity Commercial |
$2.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Healthscope Whirlpool |
$2.34
|
| Rate for Payer: Mclaren Commercial |
$2.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.05
|
| Rate for Payer: Nomi Health Commercial |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.12
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$241.30
|
|
|
Service Code
|
NDC 68084009901
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.84 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Aetna Commercial |
$217.17
|
| Rate for Payer: ASR ASR |
$234.06
|
| Rate for Payer: ASR Commercial |
$234.06
|
| Rate for Payer: BCBS Trust/PPO |
$196.64
|
| Rate for Payer: BCN Commercial |
$187.08
|
| Rate for Payer: Cash Price |
$193.04
|
| Rate for Payer: Cofinity Commercial |
$226.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.04
|
| Rate for Payer: Healthscope Commercial |
$241.30
|
| Rate for Payer: Healthscope Whirlpool |
$234.06
|
| Rate for Payer: Mclaren Commercial |
$217.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.10
|
| Rate for Payer: Nomi Health Commercial |
$197.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.34
|
|
|
ATROPINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$40.41
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.27 |
| Max. Negotiated Rate |
$40.41 |
| Rate for Payer: Aetna Commercial |
$36.37
|
| Rate for Payer: Aetna Commercial |
$32.60
|
| Rate for Payer: Aetna Commercial |
$38.97
|
| Rate for Payer: ASR ASR |
$35.13
|
| Rate for Payer: ASR ASR |
$39.20
|
| Rate for Payer: ASR ASR |
$42.00
|
| Rate for Payer: ASR Commercial |
$39.20
|
| Rate for Payer: ASR Commercial |
$35.13
|
| Rate for Payer: ASR Commercial |
$42.00
|
| Rate for Payer: BCBS Trust/PPO |
$35.29
|
| Rate for Payer: BCBS Trust/PPO |
$29.52
|
| Rate for Payer: BCBS Trust/PPO |
$32.93
|
| Rate for Payer: BCN Commercial |
$28.08
|
| Rate for Payer: BCN Commercial |
$33.57
|
| Rate for Payer: BCN Commercial |
$31.33
|
| Rate for Payer: Cash Price |
$32.32
|
| Rate for Payer: Cash Price |
$28.98
|
| Rate for Payer: Cash Price |
$34.64
|
| Rate for Payer: Cofinity Commercial |
$40.70
|
| Rate for Payer: Cofinity Commercial |
$34.05
|
| Rate for Payer: Cofinity Commercial |
$37.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.64
|
| Rate for Payer: Healthscope Commercial |
$36.22
|
| Rate for Payer: Healthscope Commercial |
$40.41
|
| Rate for Payer: Healthscope Commercial |
$43.30
|
| Rate for Payer: Healthscope Whirlpool |
$39.20
|
| Rate for Payer: Healthscope Whirlpool |
$35.13
|
| Rate for Payer: Healthscope Whirlpool |
$42.00
|
| Rate for Payer: Mclaren Commercial |
$36.37
|
| Rate for Payer: Mclaren Commercial |
$32.60
|
| Rate for Payer: Mclaren Commercial |
$38.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.79
|
| Rate for Payer: Nomi Health Commercial |
$33.14
|
| Rate for Payer: Nomi Health Commercial |
$29.70
|
| Rate for Payer: Nomi Health Commercial |
$35.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.87
|
|
|
ATROPINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$36.22
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.49 |
| Max. Negotiated Rate |
$36.22 |
| Rate for Payer: Aetna Commercial |
$32.60
|
| Rate for Payer: Aetna Commercial |
$36.37
|
| Rate for Payer: Aetna Commercial |
$38.97
|
| Rate for Payer: Aetna Medicare |
$20.20
|
| Rate for Payer: Aetna Medicare |
$21.65
|
| Rate for Payer: Aetna Medicare |
$18.11
|
| Rate for Payer: ASR ASR |
$39.20
|
| Rate for Payer: ASR ASR |
$35.13
|
| Rate for Payer: ASR ASR |
$42.00
|
| Rate for Payer: ASR Commercial |
$42.00
|
| Rate for Payer: ASR Commercial |
$39.20
|
| Rate for Payer: ASR Commercial |
$35.13
|
| Rate for Payer: BCBS Complete |
$14.49
|
| Rate for Payer: BCBS Complete |
$16.16
|
| Rate for Payer: BCBS Complete |
$17.32
|
| Rate for Payer: BCBS Trust/PPO |
$29.66
|
| Rate for Payer: BCBS Trust/PPO |
$33.09
|
| Rate for Payer: BCBS Trust/PPO |
$35.46
|
| Rate for Payer: BCN Commercial |
$33.57
|
| Rate for Payer: BCN Commercial |
$28.08
|
| Rate for Payer: BCN Commercial |
$31.33
|
| Rate for Payer: Cash Price |
$32.32
|
| Rate for Payer: Cash Price |
$28.98
|
| Rate for Payer: Cash Price |
$34.64
|
| Rate for Payer: Cofinity Commercial |
$40.70
|
| Rate for Payer: Cofinity Commercial |
$34.05
|
| Rate for Payer: Cofinity Commercial |
$37.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.64
|
| Rate for Payer: Healthscope Commercial |
$36.22
|
| Rate for Payer: Healthscope Commercial |
$40.41
|
| Rate for Payer: Healthscope Commercial |
$43.30
|
| Rate for Payer: Healthscope Whirlpool |
$39.20
|
| Rate for Payer: Healthscope Whirlpool |
$35.13
|
| Rate for Payer: Healthscope Whirlpool |
$42.00
|
| Rate for Payer: Mclaren Commercial |
$32.60
|
| Rate for Payer: Mclaren Commercial |
$36.37
|
| Rate for Payer: Mclaren Commercial |
$38.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.80
|
| Rate for Payer: Nomi Health Commercial |
$29.70
|
| Rate for Payer: Nomi Health Commercial |
$33.14
|
| Rate for Payer: Nomi Health Commercial |
$35.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.94
|
| Rate for Payer: Priority Health Narrow Network |
$30.35
|
| Rate for Payer: Priority Health Narrow Network |
$25.39
|
| Rate for Payer: Priority Health Narrow Network |
$28.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.10
|
|
|
ATROPINE 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
OP
|
$40.41
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
163701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.16 |
| Max. Negotiated Rate |
$40.41 |
| Rate for Payer: Aetna Commercial |
$36.37
|
| Rate for Payer: Aetna Medicare |
$20.20
|
| Rate for Payer: ASR ASR |
$39.20
|
| Rate for Payer: ASR Commercial |
$39.20
|
| Rate for Payer: BCBS Complete |
$16.16
|
| Rate for Payer: BCBS Trust/PPO |
$33.09
|
| Rate for Payer: BCN Commercial |
$31.33
|
| Rate for Payer: Cash Price |
$32.32
|
| Rate for Payer: Cofinity Commercial |
$37.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.33
|
| Rate for Payer: Healthscope Commercial |
$40.41
|
| Rate for Payer: Healthscope Whirlpool |
$39.20
|
| Rate for Payer: Mclaren Commercial |
$36.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.35
|
| Rate for Payer: Nomi Health Commercial |
$33.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.41
|
| Rate for Payer: Priority Health Narrow Network |
$28.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.56
|
|
|
ATROPINE 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
IP
|
$40.41
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
163701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.27 |
| Max. Negotiated Rate |
$40.41 |
| Rate for Payer: Aetna Commercial |
$36.37
|
| Rate for Payer: ASR ASR |
$39.20
|
| Rate for Payer: ASR Commercial |
$39.20
|
| Rate for Payer: BCBS Trust/PPO |
$32.93
|
| Rate for Payer: BCN Commercial |
$31.33
|
| Rate for Payer: Cash Price |
$32.32
|
| Rate for Payer: Cofinity Commercial |
$37.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.33
|
| Rate for Payer: Healthscope Commercial |
$40.41
|
| Rate for Payer: Healthscope Whirlpool |
$39.20
|
| Rate for Payer: Mclaren Commercial |
$36.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.35
|
| Rate for Payer: Nomi Health Commercial |
$33.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.56
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
|
OP
|
$30.96
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$30.96 |
| Rate for Payer: Aetna Commercial |
$27.86
|
| Rate for Payer: Aetna Medicare |
$15.48
|
| Rate for Payer: ASR ASR |
$30.03
|
| Rate for Payer: ASR Commercial |
$30.03
|
| Rate for Payer: BCBS Complete |
$12.38
|
| Rate for Payer: BCBS Trust/PPO |
$25.35
|
| Rate for Payer: BCN Commercial |
$24.00
|
| 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 |
$30.96
|
| Rate for Payer: Healthscope Whirlpool |
$30.03
|
| Rate for Payer: Mclaren Commercial |
$27.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.32
|
| Rate for Payer: Nomi Health Commercial |
$25.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.13
|
| Rate for Payer: Priority Health Narrow Network |
$21.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.24
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
|
IP
|
$30.96
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$30.96 |
| Rate for Payer: Aetna Commercial |
$27.86
|
| Rate for Payer: ASR ASR |
$30.03
|
| Rate for Payer: ASR Commercial |
$30.03
|
| Rate for Payer: BCBS Trust/PPO |
$25.23
|
| Rate for Payer: BCN Commercial |
$24.00
|
| 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 |
$30.96
|
| Rate for Payer: Healthscope Whirlpool |
$30.03
|
| Rate for Payer: Mclaren Commercial |
$27.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.32
|
| Rate for Payer: Nomi Health Commercial |
$25.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.24
|
|
|
ATROPINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$30.96
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
195981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$30.96 |
| Rate for Payer: Aetna Commercial |
$27.86
|
| Rate for Payer: ASR ASR |
$30.03
|
| Rate for Payer: ASR Commercial |
$30.03
|
| Rate for Payer: BCBS Trust/PPO |
$25.23
|
| Rate for Payer: BCN Commercial |
$24.00
|
| 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 |
$30.96
|
| Rate for Payer: Healthscope Whirlpool |
$30.03
|
| Rate for Payer: Mclaren Commercial |
$27.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.32
|
| Rate for Payer: Nomi Health Commercial |
$25.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.24
|
|
|
ATROPINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$30.96
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
195981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$30.96 |
| Rate for Payer: Aetna Commercial |
$27.86
|
| Rate for Payer: Aetna Medicare |
$15.48
|
| Rate for Payer: ASR ASR |
$30.03
|
| Rate for Payer: ASR Commercial |
$30.03
|
| Rate for Payer: BCBS Complete |
$12.38
|
| Rate for Payer: BCBS Trust/PPO |
$25.35
|
| Rate for Payer: BCN Commercial |
$24.00
|
| 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 |
$30.96
|
| Rate for Payer: Healthscope Whirlpool |
$30.03
|
| Rate for Payer: Mclaren Commercial |
$27.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.32
|
| Rate for Payer: Nomi Health Commercial |
$25.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.13
|
| Rate for Payer: Priority Health Narrow Network |
$21.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.24
|
|
|
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 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
|
OP
|
$64.58
|
|
|
Service Code
|
NDC 42806015033
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.83 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Aetna Commercial |
$58.12
|
| Rate for Payer: Aetna Medicare |
$32.29
|
| Rate for Payer: ASR ASR |
$62.64
|
| Rate for Payer: ASR Commercial |
$62.64
|
| Rate for Payer: BCBS Complete |
$25.83
|
| Rate for Payer: BCBS Trust/PPO |
$52.88
|
| Rate for Payer: BCN Commercial |
$50.07
|
| Rate for Payer: Cash Price |
$51.67
|
| Rate for Payer: Cofinity Commercial |
$60.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.66
|
| Rate for Payer: Healthscope Commercial |
$64.58
|
| Rate for Payer: Healthscope Whirlpool |
$62.64
|
| Rate for Payer: Mclaren Commercial |
$58.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.89
|
| Rate for Payer: Nomi Health Commercial |
$52.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.58
|
| Rate for Payer: Priority Health Narrow Network |
$45.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.83
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$116.78
|
|
|
Service Code
|
NDC 00093202631
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.91 |
| Max. Negotiated Rate |
$116.78 |
| Rate for Payer: Aetna Commercial |
$105.10
|
| Rate for Payer: ASR ASR |
$113.28
|
| Rate for Payer: ASR Commercial |
$113.28
|
| Rate for Payer: BCBS Trust/PPO |
$95.16
|
| 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: UHC All Payor (Choice/PPO) + Core |
$102.77
|
|
|
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
|
IP
|
$89.28
|
|
|
Service Code
|
NDC 59762314001
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.03 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$80.35
|
| Rate for Payer: ASR ASR |
$86.60
|
| Rate for Payer: ASR Commercial |
$86.60
|
| Rate for Payer: BCBS Trust/PPO |
$72.75
|
| 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: UHC All Payor (Choice/PPO) + Core |
$78.57
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$64.58
|
|
|
Service Code
|
NDC 42806015033
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.98 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Aetna Commercial |
$58.12
|
| Rate for Payer: ASR ASR |
$62.64
|
| Rate for Payer: ASR Commercial |
$62.64
|
| Rate for Payer: BCBS Trust/PPO |
$52.63
|
| Rate for Payer: BCN Commercial |
$50.07
|
| Rate for Payer: Cash Price |
$51.67
|
| Rate for Payer: Cofinity Commercial |
$60.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.66
|
| Rate for Payer: Healthscope Commercial |
$64.58
|
| Rate for Payer: Healthscope Whirlpool |
$62.64
|
| Rate for Payer: Mclaren Commercial |
$58.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.89
|
| Rate for Payer: Nomi Health Commercial |
$52.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.83
|
|
|
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
|
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
|
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 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
|
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
|
|
