|
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
|
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
|
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 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$30.71
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
21063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$30.71 |
| Rate for Payer: Aetna Commercial |
$27.64
|
| Rate for Payer: Aetna Commercial |
$18.68
|
| Rate for Payer: Aetna Commercial |
$18.09
|
| Rate for Payer: Aetna Commercial |
$22.64
|
| Rate for Payer: Aetna Commercial |
$25.12
|
| Rate for Payer: Aetna Commercial |
$15.71
|
| Rate for Payer: Aetna Commercial |
$24.27
|
| Rate for Payer: Aetna Medicare |
$10.38
|
| Rate for Payer: Aetna Medicare |
$13.96
|
| Rate for Payer: Aetna Medicare |
$13.48
|
| Rate for Payer: Aetna Medicare |
$15.36
|
| Rate for Payer: Aetna Medicare |
$12.58
|
| Rate for Payer: Aetna Medicare |
$10.05
|
| Rate for Payer: Aetna Medicare |
$8.73
|
| Rate for Payer: ASR ASR |
$27.07
|
| Rate for Payer: ASR ASR |
$24.41
|
| Rate for Payer: ASR ASR |
$20.14
|
| Rate for Payer: ASR ASR |
$16.94
|
| Rate for Payer: ASR ASR |
$19.50
|
| Rate for Payer: ASR ASR |
$29.79
|
| Rate for Payer: ASR ASR |
$26.16
|
| Rate for Payer: ASR Commercial |
$16.94
|
| Rate for Payer: ASR Commercial |
$24.41
|
| Rate for Payer: ASR Commercial |
$19.50
|
| Rate for Payer: ASR Commercial |
$20.14
|
| Rate for Payer: ASR Commercial |
$29.79
|
| Rate for Payer: ASR Commercial |
$27.07
|
| Rate for Payer: ASR Commercial |
$26.16
|
| Rate for Payer: BCBS Complete |
$8.30
|
| Rate for Payer: BCBS Complete |
$8.04
|
| Rate for Payer: BCBS Complete |
$6.98
|
| Rate for Payer: BCBS Complete |
$12.28
|
| Rate for Payer: BCBS Complete |
$11.16
|
| Rate for Payer: BCBS Complete |
$10.79
|
| Rate for Payer: BCBS Complete |
$10.06
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCBS Trust/PPO |
$14.30
|
| Rate for Payer: BCBS Trust/PPO |
$25.15
|
| Rate for Payer: BCBS Trust/PPO |
$16.46
|
| Rate for Payer: BCBS Trust/PPO |
$22.86
|
| Rate for Payer: BCBS Trust/PPO |
$20.60
|
| Rate for Payer: BCBS Trust/PPO |
$22.09
|
| Rate for Payer: BCN Commercial |
$23.81
|
| Rate for Payer: BCN Commercial |
$15.58
|
| Rate for Payer: BCN Commercial |
$20.91
|
| Rate for Payer: BCN Commercial |
$13.54
|
| Rate for Payer: BCN Commercial |
$16.10
|
| Rate for Payer: BCN Commercial |
$19.51
|
| Rate for Payer: BCN Commercial |
$21.64
|
| Rate for Payer: Cash Price |
$20.13
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$20.13
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$22.33
|
| Rate for Payer: Cash Price |
$22.33
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cofinity Commercial |
$18.89
|
| Rate for Payer: Cofinity Commercial |
$28.87
|
| Rate for Payer: Cofinity Commercial |
$19.51
|
| Rate for Payer: Cofinity Commercial |
$26.24
|
| Rate for Payer: Cofinity Commercial |
$16.41
|
| Rate for Payer: Cofinity Commercial |
$23.65
|
| Rate for Payer: Cofinity Commercial |
$25.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.08
|
| 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 |
$25.16
|
| Rate for Payer: Healthscope Commercial |
$17.46
|
| Rate for Payer: Healthscope Commercial |
$20.10
|
| Rate for Payer: Healthscope Commercial |
$27.91
|
| Rate for Payer: Healthscope Commercial |
$26.97
|
| Rate for Payer: Healthscope Commercial |
$20.76
|
| Rate for Payer: Healthscope Commercial |
$30.71
|
| Rate for Payer: Healthscope Whirlpool |
$24.41
|
| Rate for Payer: Healthscope Whirlpool |
$20.14
|
| Rate for Payer: Healthscope Whirlpool |
$19.50
|
| 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 |
$16.94
|
| Rate for Payer: Mclaren Commercial |
$25.12
|
| Rate for Payer: Mclaren Commercial |
$22.64
|
| Rate for Payer: Mclaren Commercial |
$18.68
|
| Rate for Payer: Mclaren Commercial |
$27.64
|
| Rate for Payer: Mclaren Commercial |
$24.27
|
| Rate for Payer: Mclaren Commercial |
$18.09
|
| Rate for Payer: Mclaren Commercial |
$15.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.72
|
| Rate for Payer: Nomi Health Commercial |
$14.32
|
| 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: Nomi Health Commercial |
$25.18
|
| Rate for Payer: Nomi Health Commercial |
$22.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.35
|
| 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 |
$13.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.30
|
| Rate for Payer: Priority Health Narrow Network |
$1.84
|
| Rate for Payer: Priority Health Narrow Network |
$1.84
|
| Rate for Payer: Priority Health Narrow Network |
$1.84
|
| Rate for Payer: Priority Health Narrow Network |
$1.84
|
| Rate for Payer: Priority Health Narrow Network |
$1.84
|
| Rate for Payer: Priority Health Narrow Network |
$1.84
|
| Rate for Payer: Priority Health Narrow Network |
$1.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.73
|
| 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 |
$22.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.69
|
|
|
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 |
$17.08
|
| 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
|
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
|
|
|
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 |
$7.52
|
| 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 |
$7.52
|
| 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
|
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 |
$7.52
|
| Rate for Payer: Aetna Medicare |
$4.18
|
| 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 |
$7.52
|
| 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
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$123.02
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.96 |
| Max. Negotiated Rate |
$123.02 |
| Rate for Payer: Aetna Commercial |
$110.72
|
| Rate for Payer: Aetna Commercial |
$92.08
|
| Rate for Payer: Aetna Commercial |
$82.24
|
| Rate for Payer: ASR ASR |
$99.24
|
| Rate for Payer: ASR ASR |
$119.33
|
| Rate for Payer: ASR ASR |
$88.64
|
| Rate for Payer: ASR Commercial |
$119.33
|
| Rate for Payer: ASR Commercial |
$99.24
|
| Rate for Payer: ASR Commercial |
$88.64
|
| Rate for Payer: BCBS Trust/PPO |
$74.47
|
| Rate for Payer: BCBS Trust/PPO |
$83.37
|
| Rate for Payer: BCBS Trust/PPO |
$100.25
|
| Rate for Payer: BCN Commercial |
$79.32
|
| Rate for Payer: BCN Commercial |
$70.85
|
| Rate for Payer: BCN Commercial |
$95.38
|
| Rate for Payer: Cash Price |
$98.41
|
| Rate for Payer: Cash Price |
$81.84
|
| Rate for Payer: Cash Price |
$73.10
|
| Rate for Payer: Cofinity Commercial |
$85.90
|
| Rate for Payer: Cofinity Commercial |
$96.17
|
| Rate for Payer: Cofinity Commercial |
$115.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.10
|
| Rate for Payer: Healthscope Commercial |
$102.31
|
| Rate for Payer: Healthscope Commercial |
$123.02
|
| Rate for Payer: Healthscope Commercial |
$91.38
|
| Rate for Payer: Healthscope Whirlpool |
$119.33
|
| Rate for Payer: Healthscope Whirlpool |
$99.24
|
| Rate for Payer: Healthscope Whirlpool |
$88.64
|
| Rate for Payer: Mclaren Commercial |
$110.72
|
| Rate for Payer: Mclaren Commercial |
$92.08
|
| Rate for Payer: Mclaren Commercial |
$82.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.96
|
| Rate for Payer: Nomi Health Commercial |
$100.88
|
| Rate for Payer: Nomi Health Commercial |
$83.89
|
| Rate for Payer: Nomi Health Commercial |
$74.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.03
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$102.31
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$102.31 |
| Rate for Payer: Aetna Commercial |
$92.08
|
| Rate for Payer: Aetna Commercial |
$82.24
|
| Rate for Payer: Aetna Commercial |
$110.72
|
| Rate for Payer: Aetna Medicare |
$45.69
|
| Rate for Payer: Aetna Medicare |
$51.16
|
| Rate for Payer: Aetna Medicare |
$61.51
|
| Rate for Payer: ASR ASR |
$119.33
|
| Rate for Payer: ASR ASR |
$99.24
|
| Rate for Payer: ASR ASR |
$88.64
|
| Rate for Payer: ASR Commercial |
$119.33
|
| Rate for Payer: ASR Commercial |
$99.24
|
| Rate for Payer: ASR Commercial |
$88.64
|
| Rate for Payer: BCBS Complete |
$40.92
|
| Rate for Payer: BCBS Complete |
$49.21
|
| Rate for Payer: BCBS Complete |
$36.55
|
| Rate for Payer: BCBS Trust/PPO |
$74.83
|
| Rate for Payer: BCBS Trust/PPO |
$83.78
|
| Rate for Payer: BCBS Trust/PPO |
$100.74
|
| Rate for Payer: BCN Commercial |
$95.38
|
| Rate for Payer: BCN Commercial |
$70.85
|
| Rate for Payer: BCN Commercial |
$79.32
|
| Rate for Payer: Cash Price |
$81.84
|
| Rate for Payer: Cash Price |
$81.84
|
| Rate for Payer: Cash Price |
$98.41
|
| Rate for Payer: Cash Price |
$98.41
|
| Rate for Payer: Cash Price |
$73.10
|
| Rate for Payer: Cash Price |
$73.10
|
| Rate for Payer: Cofinity Commercial |
$85.90
|
| Rate for Payer: Cofinity Commercial |
$96.17
|
| Rate for Payer: Cofinity Commercial |
$115.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.42
|
| Rate for Payer: Healthscope Commercial |
$91.38
|
| Rate for Payer: Healthscope Commercial |
$123.02
|
| Rate for Payer: Healthscope Commercial |
$102.31
|
| Rate for Payer: Healthscope Whirlpool |
$88.64
|
| Rate for Payer: Healthscope Whirlpool |
$119.33
|
| Rate for Payer: Healthscope Whirlpool |
$99.24
|
| Rate for Payer: Mclaren Commercial |
$110.72
|
| Rate for Payer: Mclaren Commercial |
$82.24
|
| Rate for Payer: Mclaren Commercial |
$92.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.96
|
| Rate for Payer: Nomi Health Commercial |
$83.89
|
| Rate for Payer: Nomi Health Commercial |
$74.93
|
| Rate for Payer: Nomi Health Commercial |
$100.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.57
|
| Rate for Payer: Priority Health Narrow Network |
$2.06
|
| Rate for Payer: Priority Health Narrow Network |
$2.06
|
| Rate for Payer: Priority Health Narrow Network |
$2.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.41
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS CUSTOM
|
Facility
|
OP
|
$102.31
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$102.31 |
| Rate for Payer: Aetna Commercial |
$92.08
|
| Rate for Payer: Aetna Medicare |
$51.16
|
| Rate for Payer: ASR ASR |
$99.24
|
| Rate for Payer: ASR Commercial |
$99.24
|
| Rate for Payer: BCBS Complete |
$40.92
|
| Rate for Payer: BCBS Trust/PPO |
$83.78
|
| Rate for Payer: BCN Commercial |
$79.32
|
| Rate for Payer: Cash Price |
$81.84
|
| Rate for Payer: Cash Price |
$81.84
|
| Rate for Payer: Cofinity Commercial |
$96.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.85
|
| Rate for Payer: Healthscope Commercial |
$102.31
|
| Rate for Payer: Healthscope Whirlpool |
$99.24
|
| Rate for Payer: Mclaren Commercial |
$92.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.96
|
| Rate for Payer: Nomi Health Commercial |
$83.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.57
|
| Rate for Payer: Priority Health Narrow Network |
$2.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.03
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS CUSTOM
|
Facility
|
IP
|
$102.31
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$102.31 |
| Rate for Payer: Aetna Commercial |
$92.08
|
| Rate for Payer: ASR ASR |
$99.24
|
| Rate for Payer: ASR Commercial |
$99.24
|
| Rate for Payer: BCBS Trust/PPO |
$83.37
|
| Rate for Payer: BCN Commercial |
$79.32
|
| Rate for Payer: Cash Price |
$81.84
|
| Rate for Payer: Cofinity Commercial |
$96.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.85
|
| Rate for Payer: Healthscope Commercial |
$102.31
|
| Rate for Payer: Healthscope Whirlpool |
$99.24
|
| Rate for Payer: Mclaren Commercial |
$92.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.96
|
| Rate for Payer: Nomi Health Commercial |
$83.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.03
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$196.28
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$127.58 |
| Max. Negotiated Rate |
$196.28 |
| Rate for Payer: Aetna Commercial |
$176.65
|
| Rate for Payer: Aetna Commercial |
$167.90
|
| Rate for Payer: Aetna Commercial |
$187.98
|
| Rate for Payer: ASR ASR |
$180.96
|
| Rate for Payer: ASR ASR |
$190.39
|
| Rate for Payer: ASR ASR |
$202.60
|
| Rate for Payer: ASR Commercial |
$190.39
|
| Rate for Payer: ASR Commercial |
$180.96
|
| Rate for Payer: ASR Commercial |
$202.60
|
| Rate for Payer: BCBS Trust/PPO |
$170.21
|
| Rate for Payer: BCBS Trust/PPO |
$152.03
|
| Rate for Payer: BCBS Trust/PPO |
$159.95
|
| Rate for Payer: BCN Commercial |
$144.64
|
| Rate for Payer: BCN Commercial |
$161.94
|
| Rate for Payer: BCN Commercial |
$152.18
|
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cofinity Commercial |
$196.34
|
| Rate for Payer: Cofinity Commercial |
$175.37
|
| Rate for Payer: Cofinity Commercial |
$184.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.10
|
| Rate for Payer: Healthscope Commercial |
$186.56
|
| Rate for Payer: Healthscope Commercial |
$196.28
|
| Rate for Payer: Healthscope Commercial |
$208.87
|
| Rate for Payer: Healthscope Whirlpool |
$190.39
|
| Rate for Payer: Healthscope Whirlpool |
$180.96
|
| Rate for Payer: Healthscope Whirlpool |
$202.60
|
| Rate for Payer: Mclaren Commercial |
$176.65
|
| Rate for Payer: Mclaren Commercial |
$167.90
|
| Rate for Payer: Mclaren Commercial |
$187.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.58
|
| Rate for Payer: Nomi Health Commercial |
$160.95
|
| Rate for Payer: Nomi Health Commercial |
$152.98
|
| Rate for Payer: Nomi Health Commercial |
$171.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$172.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.17
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$186.56
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$186.56 |
| Rate for Payer: Aetna Commercial |
$167.90
|
| Rate for Payer: Aetna Commercial |
$187.98
|
| Rate for Payer: Aetna Commercial |
$176.65
|
| Rate for Payer: Aetna Medicare |
$104.44
|
| Rate for Payer: Aetna Medicare |
$93.28
|
| Rate for Payer: Aetna Medicare |
$98.14
|
| Rate for Payer: ASR ASR |
$190.39
|
| Rate for Payer: ASR ASR |
$180.96
|
| Rate for Payer: ASR ASR |
$202.60
|
| Rate for Payer: ASR Commercial |
$190.39
|
| Rate for Payer: ASR Commercial |
$180.96
|
| Rate for Payer: ASR Commercial |
$202.60
|
| Rate for Payer: BCBS Complete |
$74.62
|
| Rate for Payer: BCBS Complete |
$78.51
|
| Rate for Payer: BCBS Complete |
$83.55
|
| Rate for Payer: BCBS Trust/PPO |
$171.04
|
| Rate for Payer: BCBS Trust/PPO |
$152.77
|
| Rate for Payer: BCBS Trust/PPO |
$160.73
|
| Rate for Payer: BCN Commercial |
$152.18
|
| Rate for Payer: BCN Commercial |
$161.94
|
| Rate for Payer: BCN Commercial |
$144.64
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cofinity Commercial |
$196.34
|
| Rate for Payer: Cofinity Commercial |
$175.37
|
| Rate for Payer: Cofinity Commercial |
$184.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.02
|
| Rate for Payer: Healthscope Commercial |
$208.87
|
| Rate for Payer: Healthscope Commercial |
$196.28
|
| Rate for Payer: Healthscope Commercial |
$186.56
|
| Rate for Payer: Healthscope Whirlpool |
$202.60
|
| Rate for Payer: Healthscope Whirlpool |
$190.39
|
| Rate for Payer: Healthscope Whirlpool |
$180.96
|
| Rate for Payer: Mclaren Commercial |
$176.65
|
| Rate for Payer: Mclaren Commercial |
$187.98
|
| Rate for Payer: Mclaren Commercial |
$167.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.58
|
| Rate for Payer: Nomi Health Commercial |
$152.98
|
| Rate for Payer: Nomi Health Commercial |
$171.27
|
| Rate for Payer: Nomi Health Commercial |
$160.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.57
|
| Rate for Payer: Priority Health Narrow Network |
$2.06
|
| Rate for Payer: Priority Health Narrow Network |
$2.06
|
| Rate for Payer: Priority Health Narrow Network |
$2.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$172.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.81
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$208.87
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$208.87 |
| Rate for Payer: Aetna Commercial |
$187.98
|
| Rate for Payer: Aetna Medicare |
$104.44
|
| Rate for Payer: ASR ASR |
$202.60
|
| Rate for Payer: ASR Commercial |
$202.60
|
| Rate for Payer: BCBS Complete |
$83.55
|
| Rate for Payer: BCBS Trust/PPO |
$171.04
|
| Rate for Payer: BCN Commercial |
$161.94
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cofinity Commercial |
$196.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.10
|
| Rate for Payer: Healthscope Commercial |
$208.87
|
| Rate for Payer: Healthscope Whirlpool |
$202.60
|
| Rate for Payer: Mclaren Commercial |
$187.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.54
|
| Rate for Payer: Nomi Health Commercial |
$171.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.57
|
| Rate for Payer: Priority Health Narrow Network |
$2.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.81
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$208.87
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$135.77 |
| Max. Negotiated Rate |
$208.87 |
| Rate for Payer: Aetna Commercial |
$187.98
|
| Rate for Payer: ASR ASR |
$202.60
|
| Rate for Payer: ASR Commercial |
$202.60
|
| Rate for Payer: BCBS Trust/PPO |
$170.21
|
| Rate for Payer: BCN Commercial |
$161.94
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cofinity Commercial |
$196.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.10
|
| Rate for Payer: Healthscope Commercial |
$208.87
|
| Rate for Payer: Healthscope Whirlpool |
$202.60
|
| Rate for Payer: Mclaren Commercial |
$187.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.54
|
| Rate for Payer: Nomi Health Commercial |
$171.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.81
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$9.90
|
|
|
Service Code
|
NDC 16784011631
|
| Hospital Charge Code |
850
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$8.91
|
| Rate for Payer: ASR ASR |
$9.60
|
| Rate for Payer: ASR Commercial |
$9.60
|
| Rate for Payer: BCBS Trust/PPO |
$8.07
|
| Rate for Payer: BCN Commercial |
$7.68
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Healthscope Whirlpool |
$9.60
|
| Rate for Payer: Mclaren Commercial |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.42
|
| Rate for Payer: Nomi Health Commercial |
$8.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.71
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$9.90
|
|
|
Service Code
|
NDC 16784011631
|
| Hospital Charge Code |
850
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$8.91
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: ASR ASR |
$9.60
|
| Rate for Payer: ASR Commercial |
$9.60
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS Trust/PPO |
$8.11
|
| Rate for Payer: BCN Commercial |
$7.68
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Healthscope Whirlpool |
$9.60
|
| Rate for Payer: Mclaren Commercial |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.42
|
| Rate for Payer: Nomi Health Commercial |
$8.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.67
|
| Rate for Payer: Priority Health Narrow Network |
$6.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.71
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$10.22
|
|
|
Service Code
|
NDC 16784011731
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$10.22 |
| Rate for Payer: Aetna Commercial |
$9.20
|
| Rate for Payer: Aetna Medicare |
$5.11
|
| Rate for Payer: ASR ASR |
$9.91
|
| Rate for Payer: ASR Commercial |
$9.91
|
| Rate for Payer: BCBS Complete |
$4.09
|
| Rate for Payer: BCBS Trust/PPO |
$8.37
|
| Rate for Payer: BCN Commercial |
$7.92
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cofinity Commercial |
$9.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.18
|
| Rate for Payer: Healthscope Commercial |
$10.22
|
| Rate for Payer: Healthscope Whirlpool |
$9.91
|
| Rate for Payer: Mclaren Commercial |
$9.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.69
|
| Rate for Payer: Nomi Health Commercial |
$8.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.95
|
| Rate for Payer: Priority Health Narrow Network |
$7.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.99
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$10.22
|
|
|
Service Code
|
NDC 16784011731
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$10.22 |
| Rate for Payer: Aetna Commercial |
$9.20
|
| Rate for Payer: ASR ASR |
$9.91
|
| Rate for Payer: ASR Commercial |
$9.91
|
| Rate for Payer: BCBS Trust/PPO |
$8.33
|
| Rate for Payer: BCN Commercial |
$7.92
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cofinity Commercial |
$9.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.18
|
| Rate for Payer: Healthscope Commercial |
$10.22
|
| Rate for Payer: Healthscope Whirlpool |
$9.91
|
| Rate for Payer: Mclaren Commercial |
$9.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.69
|
| Rate for Payer: Nomi Health Commercial |
$8.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.99
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
IP
|
$341.05
|
|
|
Service Code
|
NDC 00904647561
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.68 |
| Max. Negotiated Rate |
$341.05 |
| Rate for Payer: Aetna Commercial |
$306.94
|
| Rate for Payer: ASR ASR |
$330.82
|
| Rate for Payer: ASR Commercial |
$330.82
|
| Rate for Payer: BCBS Trust/PPO |
$277.92
|
| Rate for Payer: BCN Commercial |
$264.42
|
| Rate for Payer: Cash Price |
$272.84
|
| Rate for Payer: Cofinity Commercial |
$320.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.84
|
| Rate for Payer: Healthscope Commercial |
$341.05
|
| Rate for Payer: Healthscope Whirlpool |
$330.82
|
| Rate for Payer: Mclaren Commercial |
$306.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.89
|
| Rate for Payer: Nomi Health Commercial |
$279.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$300.12
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
OP
|
$341.05
|
|
|
Service Code
|
NDC 00904647561
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.42 |
| Max. Negotiated Rate |
$341.05 |
| Rate for Payer: Aetna Commercial |
$306.94
|
| Rate for Payer: Aetna Medicare |
$170.52
|
| Rate for Payer: ASR ASR |
$330.82
|
| Rate for Payer: ASR Commercial |
$330.82
|
| Rate for Payer: BCBS Complete |
$136.42
|
| Rate for Payer: BCBS Trust/PPO |
$279.29
|
| Rate for Payer: BCN Commercial |
$264.42
|
| Rate for Payer: Cash Price |
$272.84
|
| Rate for Payer: Cofinity Commercial |
$320.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.84
|
| Rate for Payer: Healthscope Commercial |
$341.05
|
| Rate for Payer: Healthscope Whirlpool |
$330.82
|
| Rate for Payer: Mclaren Commercial |
$306.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.89
|
| Rate for Payer: Nomi Health Commercial |
$279.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.83
|
| Rate for Payer: Priority Health Narrow Network |
$239.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$300.12
|
|
|
BARIUM SULFATE 700 MG TABLET
|
Facility
|
IP
|
$340.32
|
|
|
Service Code
|
NDC 10361077831
|
| Hospital Charge Code |
100992
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.21 |
| Max. Negotiated Rate |
$340.32 |
| Rate for Payer: Aetna Commercial |
$306.29
|
| Rate for Payer: ASR ASR |
$330.11
|
| Rate for Payer: ASR Commercial |
$330.11
|
| Rate for Payer: BCBS Trust/PPO |
$277.33
|
| Rate for Payer: BCN Commercial |
$263.85
|
| Rate for Payer: Cash Price |
$272.26
|
| Rate for Payer: Cofinity Commercial |
$319.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.26
|
| Rate for Payer: Healthscope Commercial |
$340.32
|
| Rate for Payer: Healthscope Whirlpool |
$330.11
|
| Rate for Payer: Mclaren Commercial |
$306.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.27
|
| Rate for Payer: Nomi Health Commercial |
$279.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.48
|
|
|
BARIUM SULFATE 700 MG TABLET
|
Facility
|
OP
|
$340.32
|
|
|
Service Code
|
NDC 10361077831
|
| Hospital Charge Code |
100992
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.13 |
| Max. Negotiated Rate |
$340.32 |
| Rate for Payer: Aetna Commercial |
$306.29
|
| Rate for Payer: Aetna Medicare |
$170.16
|
| Rate for Payer: ASR ASR |
$330.11
|
| Rate for Payer: ASR Commercial |
$330.11
|
| Rate for Payer: BCBS Complete |
$136.13
|
| Rate for Payer: BCBS Trust/PPO |
$278.69
|
| Rate for Payer: BCN Commercial |
$263.85
|
| Rate for Payer: Cash Price |
$272.26
|
| Rate for Payer: Cofinity Commercial |
$319.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.26
|
| Rate for Payer: Healthscope Commercial |
$340.32
|
| Rate for Payer: Healthscope Whirlpool |
$330.11
|
| Rate for Payer: Mclaren Commercial |
$306.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.27
|
| Rate for Payer: Nomi Health Commercial |
$279.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.19
|
| Rate for Payer: Priority Health Narrow Network |
$238.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.48
|
|
