|
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
|
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 |
$6.97
|
| 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 |
$7.29
|
| 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 |
$6.97
|
| 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
|
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
|
OP
|
$775.20
|
|
|
Service Code
|
NDC 60687028201
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$310.08 |
| Max. Negotiated Rate |
$775.20 |
| Rate for Payer: Aetna Commercial |
$697.68
|
| Rate for Payer: Aetna Medicare |
$387.60
|
| Rate for Payer: ASR ASR |
$751.94
|
| Rate for Payer: ASR Commercial |
$751.94
|
| Rate for Payer: BCBS Complete |
$310.08
|
| Rate for Payer: BCBS Trust/PPO |
$634.81
|
| 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: 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
|
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
|
$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
|
$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 |
$2.83
|
| 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
|
$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
|
OP
|
$385.54
|
|
|
Service Code
|
NDC 59762306003
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.22 |
| Max. Negotiated Rate |
$385.54 |
| Rate for Payer: Aetna Commercial |
$346.99
|
| Rate for Payer: Aetna Medicare |
$192.77
|
| Rate for Payer: ASR ASR |
$373.97
|
| Rate for Payer: ASR Commercial |
$373.97
|
| Rate for Payer: BCBS Complete |
$154.22
|
| Rate for Payer: BCBS Trust/PPO |
$315.72
|
| 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: 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
|
$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
|
$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
|
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
|
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
|
$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
|
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
|
$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
|
$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
|
|
|
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 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$30.71
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
21063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$30.71 |
| Rate for Payer: Aetna Commercial |
$27.64
|
| Rate for Payer: Aetna Commercial |
$18.09
|
| Rate for Payer: Aetna Commercial |
$18.68
|
| Rate for Payer: Aetna Commercial |
$24.27
|
| Rate for Payer: Aetna Commercial |
$22.64
|
| Rate for Payer: Aetna Commercial |
$15.71
|
| Rate for Payer: Aetna Commercial |
$25.12
|
| Rate for Payer: Aetna Medicare |
$15.36
|
| Rate for Payer: Aetna Medicare |
$10.05
|
| Rate for Payer: Aetna Medicare |
$13.96
|
| Rate for Payer: Aetna Medicare |
$8.73
|
| Rate for Payer: Aetna Medicare |
$13.48
|
| Rate for Payer: Aetna Medicare |
$10.38
|
| Rate for Payer: Aetna Medicare |
$12.58
|
| Rate for Payer: ASR ASR |
$20.14
|
| Rate for Payer: ASR ASR |
$27.07
|
| Rate for Payer: ASR ASR |
$29.79
|
| Rate for Payer: ASR ASR |
$26.16
|
| Rate for Payer: ASR ASR |
$19.50
|
| Rate for Payer: ASR ASR |
$24.41
|
| Rate for Payer: ASR ASR |
$16.94
|
| Rate for Payer: ASR Commercial |
$20.14
|
| Rate for Payer: ASR Commercial |
$16.94
|
| Rate for Payer: ASR Commercial |
$26.16
|
| Rate for Payer: ASR Commercial |
$29.79
|
| Rate for Payer: ASR Commercial |
$27.07
|
| Rate for Payer: ASR Commercial |
$19.50
|
| Rate for Payer: ASR Commercial |
$24.41
|
| Rate for Payer: BCBS Complete |
$10.06
|
| Rate for Payer: BCBS Complete |
$6.98
|
| Rate for Payer: BCBS Complete |
$10.79
|
| Rate for Payer: BCBS Complete |
$8.30
|
| Rate for Payer: BCBS Complete |
$8.04
|
| Rate for Payer: BCBS Complete |
$12.28
|
| Rate for Payer: BCBS Complete |
$11.16
|
| Rate for Payer: BCBS Trust/PPO |
$22.86
|
| Rate for Payer: BCBS Trust/PPO |
$20.60
|
| Rate for Payer: BCBS Trust/PPO |
$14.30
|
| Rate for Payer: BCBS Trust/PPO |
$16.46
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCBS Trust/PPO |
$22.09
|
| Rate for Payer: BCBS Trust/PPO |
$25.15
|
| Rate for Payer: BCN Commercial |
$21.64
|
| Rate for Payer: BCN Commercial |
$20.91
|
| Rate for Payer: BCN Commercial |
$23.81
|
| Rate for Payer: BCN Commercial |
$19.51
|
| Rate for Payer: BCN Commercial |
$15.58
|
| Rate for Payer: BCN Commercial |
$13.54
|
| Rate for Payer: BCN Commercial |
$16.10
|
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Cash Price |
$20.13
|
| Rate for Payer: Cash Price |
$22.33
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cofinity Commercial |
$28.87
|
| Rate for Payer: Cofinity Commercial |
$25.35
|
| Rate for Payer: Cofinity Commercial |
$26.24
|
| Rate for Payer: Cofinity Commercial |
$16.41
|
| Rate for Payer: Cofinity Commercial |
$18.89
|
| Rate for Payer: Cofinity Commercial |
$23.65
|
| Rate for Payer: Cofinity Commercial |
$19.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.13
|
| 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 |
$22.33
|
| 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 |
$21.58
|
| Rate for Payer: Healthscope Commercial |
$17.46
|
| Rate for Payer: Healthscope Commercial |
$30.71
|
| Rate for Payer: Healthscope Commercial |
$27.91
|
| Rate for Payer: Healthscope Commercial |
$25.16
|
| Rate for Payer: Healthscope Commercial |
$20.10
|
| Rate for Payer: Healthscope Commercial |
$26.97
|
| Rate for Payer: Healthscope Commercial |
$20.76
|
| Rate for Payer: Healthscope Whirlpool |
$20.14
|
| Rate for Payer: Healthscope Whirlpool |
$16.94
|
| Rate for Payer: Healthscope Whirlpool |
$24.41
|
| Rate for Payer: Healthscope Whirlpool |
$26.16
|
| Rate for Payer: Healthscope Whirlpool |
$27.07
|
| Rate for Payer: Healthscope Whirlpool |
$29.79
|
| Rate for Payer: Healthscope Whirlpool |
$19.50
|
| Rate for Payer: Mclaren Commercial |
$18.68
|
| Rate for Payer: Mclaren Commercial |
$24.27
|
| Rate for Payer: Mclaren Commercial |
$25.12
|
| Rate for Payer: Mclaren Commercial |
$27.64
|
| Rate for Payer: Mclaren Commercial |
$22.64
|
| Rate for Payer: Mclaren Commercial |
$15.71
|
| Rate for Payer: Mclaren Commercial |
$18.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: Nomi Health Commercial |
$17.02
|
| Rate for Payer: Nomi Health Commercial |
$22.89
|
| Rate for Payer: Nomi Health Commercial |
$22.12
|
| Rate for Payer: Nomi Health Commercial |
$25.18
|
| Rate for Payer: Nomi Health Commercial |
$16.48
|
| Rate for Payer: Nomi Health Commercial |
$14.32
|
| Rate for Payer: Nomi Health Commercial |
$20.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.61
|
| Rate for Payer: Priority Health Narrow Network |
$14.09
|
| Rate for Payer: Priority Health Narrow Network |
$17.64
|
| Rate for Payer: Priority Health Narrow Network |
$14.55
|
| Rate for Payer: Priority Health Narrow Network |
$12.24
|
| Rate for Payer: Priority Health Narrow Network |
$19.56
|
| Rate for Payer: Priority Health Narrow Network |
$18.91
|
| Rate for Payer: Priority Health Narrow Network |
$21.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.36
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.10
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
21063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$20.10 |
| Rate for Payer: Aetna Commercial |
$18.09
|
| Rate for Payer: Aetna Commercial |
$22.64
|
| Rate for Payer: Aetna Commercial |
$18.68
|
| Rate for Payer: Aetna Commercial |
$24.27
|
| Rate for Payer: Aetna Commercial |
$27.64
|
| Rate for Payer: Aetna Commercial |
$15.71
|
| Rate for Payer: Aetna Commercial |
$25.12
|
| Rate for Payer: ASR ASR |
$24.41
|
| Rate for Payer: ASR ASR |
$20.14
|
| Rate for Payer: ASR ASR |
$29.79
|
| Rate for Payer: ASR ASR |
$26.16
|
| Rate for Payer: ASR ASR |
$19.50
|
| Rate for Payer: ASR ASR |
$16.94
|
| Rate for Payer: ASR ASR |
$27.07
|
| Rate for Payer: ASR Commercial |
$29.79
|
| Rate for Payer: ASR Commercial |
$27.07
|
| Rate for Payer: ASR Commercial |
$20.14
|
| Rate for Payer: ASR Commercial |
$26.16
|
| Rate for Payer: ASR Commercial |
$24.41
|
| Rate for Payer: ASR Commercial |
$19.50
|
| Rate for Payer: ASR Commercial |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$22.74
|
| Rate for Payer: BCBS Trust/PPO |
$21.98
|
| Rate for Payer: BCBS Trust/PPO |
$14.23
|
| Rate for Payer: BCBS Trust/PPO |
$16.38
|
| Rate for Payer: BCBS Trust/PPO |
$20.50
|
| Rate for Payer: BCBS Trust/PPO |
$16.92
|
| Rate for Payer: BCBS Trust/PPO |
$25.03
|
| Rate for Payer: BCN Commercial |
$16.10
|
| Rate for Payer: BCN Commercial |
$23.81
|
| Rate for Payer: BCN Commercial |
$20.91
|
| Rate for Payer: BCN Commercial |
$13.54
|
| Rate for Payer: BCN Commercial |
$15.58
|
| Rate for Payer: BCN Commercial |
$21.64
|
| Rate for Payer: BCN Commercial |
$19.51
|
| Rate for Payer: Cash Price |
$22.33
|
| Rate for Payer: Cash Price |
$20.13
|
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cofinity Commercial |
$25.35
|
| Rate for Payer: Cofinity Commercial |
$19.51
|
| Rate for Payer: Cofinity Commercial |
$16.41
|
| Rate for Payer: Cofinity Commercial |
$23.65
|
| Rate for Payer: Cofinity Commercial |
$18.89
|
| Rate for Payer: Cofinity Commercial |
$26.24
|
| Rate for Payer: Cofinity Commercial |
$28.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| 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 |
$22.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Healthscope Commercial |
$26.97
|
| Rate for Payer: Healthscope Commercial |
$30.71
|
| Rate for Payer: Healthscope Commercial |
$20.76
|
| Rate for Payer: Healthscope Commercial |
$25.16
|
| Rate for Payer: Healthscope Commercial |
$27.91
|
| Rate for Payer: Healthscope Commercial |
$20.10
|
| Rate for Payer: Healthscope Commercial |
$17.46
|
| Rate for Payer: Healthscope Whirlpool |
$27.07
|
| Rate for Payer: Healthscope Whirlpool |
$26.16
|
| Rate for Payer: Healthscope Whirlpool |
$24.41
|
| Rate for Payer: Healthscope Whirlpool |
$19.50
|
| Rate for Payer: Healthscope Whirlpool |
$20.14
|
| Rate for Payer: Healthscope Whirlpool |
$16.94
|
| Rate for Payer: Healthscope Whirlpool |
$29.79
|
| Rate for Payer: Mclaren Commercial |
$24.27
|
| Rate for Payer: Mclaren Commercial |
$27.64
|
| Rate for Payer: Mclaren Commercial |
$15.71
|
| Rate for Payer: Mclaren Commercial |
$25.12
|
| Rate for Payer: Mclaren Commercial |
$18.68
|
| Rate for Payer: Mclaren Commercial |
$18.09
|
| Rate for Payer: Mclaren Commercial |
$22.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.72
|
| Rate for Payer: Nomi Health Commercial |
$14.32
|
| Rate for Payer: Nomi Health Commercial |
$22.89
|
| Rate for Payer: Nomi Health Commercial |
$25.18
|
| Rate for Payer: Nomi Health Commercial |
$20.63
|
| Rate for Payer: Nomi Health Commercial |
$17.02
|
| Rate for Payer: Nomi Health Commercial |
$16.48
|
| Rate for Payer: Nomi Health Commercial |
$22.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.02
|
| 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 |
$24.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.27
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$8.35
|
|
|
Service Code
|
NDC 50268009911
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: Aetna Commercial |
$7.51
|
| Rate for Payer: Aetna Medicare |
$4.17
|
| Rate for Payer: ASR ASR |
$8.10
|
| Rate for Payer: ASR Commercial |
$8.10
|
| Rate for Payer: BCBS Complete |
$3.34
|
| Rate for Payer: BCBS Trust/PPO |
$6.84
|
| Rate for Payer: BCN Commercial |
$6.47
|
| 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 |
$8.35
|
| Rate for Payer: Healthscope Whirlpool |
$8.10
|
| 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: Priority Health Cigna Priority Health |
$5.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.32
|
| 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
|
$8.35
|
|
|
Service Code
|
NDC 50268009911
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: Aetna Commercial |
$7.51
|
| Rate for Payer: ASR ASR |
$8.10
|
| Rate for Payer: ASR Commercial |
$8.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.80
|
| Rate for Payer: BCN Commercial |
$6.47
|
| 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 |
$8.35
|
| Rate for Payer: Healthscope Whirlpool |
$8.10
|
| 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: Priority Health Cigna Priority Health |
$5.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.35
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
|
OP
|
$498.06
|
|
|
Service Code
|
NDC 50111078810
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.22 |
| Max. Negotiated Rate |
$498.06 |
| Rate for Payer: Aetna Commercial |
$448.25
|
| Rate for Payer: Aetna Medicare |
$249.03
|
| Rate for Payer: ASR ASR |
$483.12
|
| Rate for Payer: ASR Commercial |
$483.12
|
| Rate for Payer: BCBS Complete |
$199.22
|
| Rate for Payer: BCBS Trust/PPO |
$407.86
|
| Rate for Payer: BCN Commercial |
$386.15
|
| Rate for Payer: Cash Price |
$398.45
|
| Rate for Payer: Cofinity Commercial |
$468.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.45
|
| Rate for Payer: Healthscope Commercial |
$498.06
|
| Rate for Payer: Healthscope Whirlpool |
$483.12
|
| 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: Priority Health Cigna Priority Health |
$323.74
|
| Rate for Payer: 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
|
$498.06
|
|
|
Service Code
|
NDC 50111078810
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$323.74 |
| Max. Negotiated Rate |
$498.06 |
| Rate for Payer: Aetna Commercial |
$448.25
|
| Rate for Payer: ASR ASR |
$483.12
|
| Rate for Payer: ASR Commercial |
$483.12
|
| Rate for Payer: BCBS Trust/PPO |
$405.87
|
| Rate for Payer: BCN Commercial |
$386.15
|
| Rate for Payer: Cash Price |
$398.45
|
| Rate for Payer: Cofinity Commercial |
$468.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.45
|
| Rate for Payer: Healthscope Commercial |
$498.06
|
| Rate for Payer: Healthscope Whirlpool |
$483.12
|
| 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: Priority Health Cigna Priority Health |
$323.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$438.29
|
|
