|
ATORVASTATIN 40 MG TABLET
|
Facility
IP
|
$220.40
|
|
|
Service Code
|
NDC 68084-099-01
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.28 |
| Max. Negotiated Rate |
$220.40 |
| Rate for Payer: Aetna Commercial |
$198.36
|
| Rate for Payer: ASR ASR |
$213.79
|
| Rate for Payer: BCBS Trust/PPO |
$170.88
|
| Rate for Payer: BCN Commercial |
$170.88
|
| Rate for Payer: Cash Price |
$176.32
|
| Rate for Payer: Cofinity Commercial |
$207.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.32
|
| Rate for Payer: Healthscope Commercial |
$220.40
|
| Rate for Payer: Healthscope Whirlpool |
$213.79
|
| Rate for Payer: Mclaren Commercial |
$198.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.95
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
IP
|
$377.15
|
|
|
Service Code
|
NDC 51079-210-20
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$377.15 |
| Rate for Payer: Aetna Commercial |
$339.44
|
| Rate for Payer: ASR ASR |
$365.84
|
| Rate for Payer: BCBS Trust/PPO |
$292.40
|
| Rate for Payer: BCN Commercial |
$292.40
|
| Rate for Payer: Cash Price |
$301.72
|
| Rate for Payer: Cofinity Commercial |
$354.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.72
|
| Rate for Payer: Healthscope Commercial |
$377.15
|
| Rate for Payer: Healthscope Whirlpool |
$365.84
|
| Rate for Payer: Mclaren Commercial |
$339.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$320.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$331.89
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
IP
|
$2.20
|
|
|
Service Code
|
NDC 68084-099-11
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: ASR ASR |
$2.13
|
| Rate for Payer: BCBS Trust/PPO |
$1.71
|
| Rate for Payer: BCN Commercial |
$1.71
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cofinity Commercial |
$2.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.76
|
| Rate for Payer: Healthscope Commercial |
$2.20
|
| Rate for Payer: Healthscope Whirlpool |
$2.13
|
| Rate for Payer: Mclaren Commercial |
$1.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.94
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
IP
|
$215.65
|
|
|
Service Code
|
NDC 0904-6292-61
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.96 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Aetna Commercial |
$194.08
|
| Rate for Payer: ASR ASR |
$209.18
|
| Rate for Payer: BCBS Trust/PPO |
$167.19
|
| Rate for Payer: BCN Commercial |
$167.19
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$202.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$215.65
|
| Rate for Payer: Healthscope Whirlpool |
$209.18
|
| Rate for Payer: Mclaren Commercial |
$194.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.77
|
|
|
ATORVASTATIN 40 MG TABLET
|
Facility
IP
|
$3.77
|
|
|
Service Code
|
NDC 51079-210-01
|
| Hospital Charge Code |
19177
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: ASR ASR |
$3.66
|
| Rate for Payer: BCBS Trust/PPO |
$2.92
|
| Rate for Payer: BCN Commercial |
$2.92
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$3.77
|
| Rate for Payer: Healthscope Whirlpool |
$3.66
|
| Rate for Payer: Mclaren Commercial |
$3.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.32
|
|
|
ATROPINE 0.1 MG/ML INJECTION SYRINGE
|
Facility
IP
|
$36.09
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
730
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.26 |
| Max. Negotiated Rate |
$36.09 |
| Rate for Payer: Aetna Commercial |
$32.48
|
| Rate for Payer: Aetna Commercial |
$33.04
|
| Rate for Payer: Aetna Commercial |
$32.60
|
| Rate for Payer: Aetna Commercial |
$35.44
|
| Rate for Payer: ASR ASR |
$35.61
|
| Rate for Payer: ASR ASR |
$38.20
|
| Rate for Payer: ASR ASR |
$35.13
|
| Rate for Payer: ASR ASR |
$35.01
|
| Rate for Payer: BCBS Trust/PPO |
$28.46
|
| Rate for Payer: BCBS Trust/PPO |
$27.98
|
| Rate for Payer: BCBS Trust/PPO |
$30.53
|
| Rate for Payer: BCBS Trust/PPO |
$28.08
|
| Rate for Payer: BCN Commercial |
$27.98
|
| Rate for Payer: BCN Commercial |
$30.53
|
| Rate for Payer: BCN Commercial |
$28.08
|
| Rate for Payer: BCN Commercial |
$28.46
|
| Rate for Payer: Cash Price |
$31.51
|
| Rate for Payer: Cash Price |
$29.37
|
| Rate for Payer: Cash Price |
$28.98
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Cofinity Commercial |
$34.51
|
| Rate for Payer: Cofinity Commercial |
$33.92
|
| Rate for Payer: Cofinity Commercial |
$37.02
|
| Rate for Payer: Cofinity Commercial |
$34.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.50
|
| Rate for Payer: Healthscope Commercial |
$36.09
|
| Rate for Payer: Healthscope Commercial |
$36.71
|
| Rate for Payer: Healthscope Commercial |
$39.38
|
| Rate for Payer: Healthscope Commercial |
$36.22
|
| Rate for Payer: Healthscope Whirlpool |
$35.01
|
| Rate for Payer: Healthscope Whirlpool |
$38.20
|
| Rate for Payer: Healthscope Whirlpool |
$35.61
|
| Rate for Payer: Healthscope Whirlpool |
$35.13
|
| Rate for Payer: Mclaren Commercial |
$32.60
|
| Rate for Payer: Mclaren Commercial |
$35.44
|
| Rate for Payer: Mclaren Commercial |
$32.48
|
| Rate for Payer: Mclaren Commercial |
$33.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.87
|
|
|
ATROPINE 0.1 MG/ML SYRINGE (CODE)
|
Facility
IP
|
$36.09
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
163701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.26 |
| Max. Negotiated Rate |
$36.09 |
| Rate for Payer: Aetna Commercial |
$32.48
|
| Rate for Payer: Aetna Commercial |
$33.04
|
| Rate for Payer: ASR ASR |
$35.61
|
| Rate for Payer: ASR ASR |
$35.01
|
| Rate for Payer: BCBS Trust/PPO |
$27.98
|
| Rate for Payer: BCBS Trust/PPO |
$28.46
|
| Rate for Payer: BCN Commercial |
$28.46
|
| Rate for Payer: BCN Commercial |
$27.98
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Cash Price |
$29.37
|
| Rate for Payer: Cofinity Commercial |
$34.51
|
| Rate for Payer: Cofinity Commercial |
$33.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.37
|
| Rate for Payer: Healthscope Commercial |
$36.09
|
| Rate for Payer: Healthscope Commercial |
$36.71
|
| Rate for Payer: Healthscope Whirlpool |
$35.61
|
| Rate for Payer: Healthscope Whirlpool |
$35.01
|
| Rate for Payer: Mclaren Commercial |
$32.48
|
| Rate for Payer: Mclaren Commercial |
$33.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.76
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC
|
Facility
IP
|
$79,312.68
|
|
|
Service Code
|
MS-DRG 016
|
| Min. Negotiated Rate |
$51,278.99 |
| Max. Negotiated Rate |
$79,312.68 |
| Rate for Payer: Aetna Medicare |
$53,977.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67,472.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67,472.35
|
| Rate for Payer: BCBS MAPPO |
$53,977.88
|
| Rate for Payer: BCN Medicare Advantage |
$53,977.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53,977.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$53,977.88
|
| Rate for Payer: Mclaren Medicare |
$53,977.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$56,676.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62,074.56
|
| Rate for Payer: PACE Medicare |
$51,278.99
|
| Rate for Payer: PACE SWMI |
$53,977.88
|
| Rate for Payer: PHP Commercial |
$59,375.67
|
| Rate for Payer: PHP Medicare Advantage |
$53,977.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79,312.68
|
| Rate for Payer: Priority Health Medicare |
$53,977.88
|
| Rate for Payer: Priority Health Narrow Network |
$63,450.14
|
| Rate for Payer: Railroad Medicare Medicare |
$53,977.88
|
| Rate for Payer: UHC Medicare Advantage |
$55,597.22
|
| Rate for Payer: VA VA |
$53,977.88
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC
|
Facility
IP
|
$79,312.68
|
|
|
Service Code
|
MS-DRG 017
|
| Min. Negotiated Rate |
$51,278.99 |
| Max. Negotiated Rate |
$79,312.68 |
| Rate for Payer: Aetna Medicare |
$53,977.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67,472.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67,472.35
|
| Rate for Payer: BCBS MAPPO |
$53,977.88
|
| Rate for Payer: BCN Medicare Advantage |
$53,977.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53,977.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$53,977.88
|
| Rate for Payer: Mclaren Medicare |
$53,977.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$56,676.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62,074.56
|
| Rate for Payer: PACE Medicare |
$51,278.99
|
| Rate for Payer: PACE SWMI |
$53,977.88
|
| Rate for Payer: PHP Commercial |
$59,375.67
|
| Rate for Payer: PHP Medicare Advantage |
$53,977.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79,312.68
|
| Rate for Payer: Priority Health Medicare |
$53,977.88
|
| Rate for Payer: Priority Health Narrow Network |
$63,450.14
|
| Rate for Payer: Railroad Medicare Medicare |
$53,977.88
|
| Rate for Payer: UHC Medicare Advantage |
$55,597.22
|
| Rate for Payer: VA VA |
$53,977.88
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$116.78
|
|
|
Service Code
|
NDC 0093-2026-31
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.75 |
| Max. Negotiated Rate |
$116.78 |
| Rate for Payer: Aetna Commercial |
$105.10
|
| Rate for Payer: ASR ASR |
$113.28
|
| Rate for Payer: BCBS Trust/PPO |
$90.54
|
| 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 Multiplan/Beech St/PHCS |
$99.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.77
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$93.84
|
|
|
Service Code
|
NDC 42806-150-33
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.69 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$84.46
|
| Rate for Payer: ASR ASR |
$91.02
|
| Rate for Payer: BCBS Trust/PPO |
$72.75
|
| Rate for Payer: BCN Commercial |
$72.75
|
| Rate for Payer: Cash Price |
$75.07
|
| Rate for Payer: Cofinity Commercial |
$88.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.07
|
| Rate for Payer: Healthscope Commercial |
$93.84
|
| Rate for Payer: Healthscope Whirlpool |
$91.02
|
| Rate for Payer: Mclaren Commercial |
$84.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.58
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$94.05
|
|
|
Service Code
|
NDC 42806-151-34
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.84 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Aetna Commercial |
$84.64
|
| Rate for Payer: ASR ASR |
$91.23
|
| Rate for Payer: BCBS Trust/PPO |
$72.92
|
| Rate for Payer: BCN Commercial |
$72.92
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Commercial |
$88.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Healthscope Commercial |
$94.05
|
| Rate for Payer: Healthscope Whirlpool |
$91.23
|
| Rate for Payer: Mclaren Commercial |
$84.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.76
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$124.54
|
|
|
Service Code
|
NDC 70710-1460-2
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.18 |
| Max. Negotiated Rate |
$124.54 |
| Rate for Payer: Aetna Commercial |
$112.09
|
| Rate for Payer: ASR ASR |
$120.80
|
| Rate for Payer: BCBS Trust/PPO |
$96.56
|
| 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 Multiplan/Beech St/PHCS |
$105.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.60
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$89.28
|
|
|
Service Code
|
NDC 59762-3140-1
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.50 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$80.35
|
| Rate for Payer: ASR ASR |
$86.60
|
| Rate for Payer: BCBS Trust/PPO |
$69.22
|
| 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 Multiplan/Beech St/PHCS |
$75.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.57
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$5.63
|
|
|
Service Code
|
NDC 60687-742-11
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$5.63 |
| Rate for Payer: Aetna Commercial |
$5.07
|
| Rate for Payer: ASR ASR |
$5.46
|
| Rate for Payer: BCBS Trust/PPO |
$4.36
|
| Rate for Payer: BCN Commercial |
$4.36
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cofinity Commercial |
$5.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$5.63
|
| Rate for Payer: Healthscope Whirlpool |
$5.46
|
| Rate for Payer: Mclaren Commercial |
$5.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.95
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$184.56
|
|
|
Service Code
|
NDC 60687-742-65
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.19 |
| Max. Negotiated Rate |
$184.56 |
| Rate for Payer: Aetna Commercial |
$166.10
|
| Rate for Payer: ASR ASR |
$179.02
|
| Rate for Payer: BCBS Trust/PPO |
$143.09
|
| Rate for Payer: BCN Commercial |
$143.09
|
| Rate for Payer: Cash Price |
$147.65
|
| Rate for Payer: Cofinity Commercial |
$173.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.65
|
| Rate for Payer: Healthscope Commercial |
$184.56
|
| Rate for Payer: Healthscope Whirlpool |
$179.02
|
| Rate for Payer: Mclaren Commercial |
$166.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$162.41
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$7.75
|
|
|
Service Code
|
NDC 60687-282-11
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$7.75 |
| Rate for Payer: Aetna Commercial |
$6.98
|
| Rate for Payer: ASR ASR |
$7.52
|
| Rate for Payer: BCBS Trust/PPO |
$6.01
|
| 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 Multiplan/Beech St/PHCS |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.82
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$231.12
|
|
|
Service Code
|
NDC 50268-098-15
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.78 |
| Max. Negotiated Rate |
$231.12 |
| Rate for Payer: Aetna Commercial |
$208.01
|
| Rate for Payer: ASR ASR |
$224.19
|
| Rate for Payer: BCBS Trust/PPO |
$179.19
|
| Rate for Payer: BCN Commercial |
$179.19
|
| Rate for Payer: Cash Price |
$184.90
|
| Rate for Payer: Cofinity Commercial |
$217.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.90
|
| Rate for Payer: Healthscope Commercial |
$231.12
|
| Rate for Payer: Healthscope Whirlpool |
$224.19
|
| Rate for Payer: Mclaren Commercial |
$208.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$196.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.39
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$155.76
|
|
|
Service Code
|
NDC 50268-074-15
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.03 |
| Max. Negotiated Rate |
$155.76 |
| Rate for Payer: Aetna Commercial |
$140.18
|
| Rate for Payer: ASR ASR |
$151.09
|
| Rate for Payer: BCBS Trust/PPO |
$120.76
|
| Rate for Payer: BCN Commercial |
$120.76
|
| Rate for Payer: Cash Price |
$124.61
|
| Rate for Payer: Cofinity Commercial |
$146.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.61
|
| Rate for Payer: Healthscope Commercial |
$155.76
|
| Rate for Payer: Healthscope Whirlpool |
$151.09
|
| Rate for Payer: Mclaren Commercial |
$140.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.07
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$154.08
|
|
|
Service Code
|
NDC 0904-6708-06
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.86 |
| Max. Negotiated Rate |
$154.08 |
| Rate for Payer: Aetna Commercial |
$138.67
|
| Rate for Payer: ASR ASR |
$149.46
|
| Rate for Payer: BCBS Trust/PPO |
$119.46
|
| 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 Multiplan/Beech St/PHCS |
$130.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.59
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$3.12
|
|
|
Service Code
|
NDC 50268-074-11
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: ASR ASR |
$3.03
|
| Rate for Payer: BCBS Trust/PPO |
$2.42
|
| 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 Multiplan/Beech St/PHCS |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.75
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$3.12
|
|
|
Service Code
|
NDC 50268-098-11
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: ASR ASR |
$3.03
|
| Rate for Payer: BCBS Trust/PPO |
$2.42
|
| 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 Multiplan/Beech St/PHCS |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.75
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$775.20
|
|
|
Service Code
|
NDC 60687-282-01
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$542.64 |
| Max. Negotiated Rate |
$775.20 |
| Rate for Payer: Aetna Commercial |
$697.68
|
| Rate for Payer: ASR ASR |
$751.94
|
| Rate for Payer: BCBS Trust/PPO |
$601.01
|
| 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 Multiplan/Beech St/PHCS |
$658.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$682.18
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$22.41
|
|
|
Service Code
|
NDC 0781-8089-26
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.69 |
| Max. Negotiated Rate |
$22.41 |
| Rate for Payer: Aetna Commercial |
$20.17
|
| Rate for Payer: ASR ASR |
$21.74
|
| Rate for Payer: BCBS Trust/PPO |
$17.37
|
| Rate for Payer: BCN Commercial |
$17.37
|
| Rate for Payer: Cash Price |
$17.93
|
| Rate for Payer: Cofinity Commercial |
$21.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$22.41
|
| Rate for Payer: Healthscope Whirlpool |
$21.74
|
| Rate for Payer: Mclaren Commercial |
$20.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.72
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
IP
|
$385.54
|
|
|
Service Code
|
NDC 59762-3060-3
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$269.88 |
| Max. Negotiated Rate |
$385.54 |
| Rate for Payer: Cofinity Commercial |
$362.41
|
| Rate for Payer: Aetna Commercial |
$346.99
|
| Rate for Payer: ASR ASR |
$373.97
|
| Rate for Payer: BCBS Trust/PPO |
$298.91
|
| Rate for Payer: BCN Commercial |
$298.91
|
| Rate for Payer: Cash Price |
$308.43
|
| 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 Multiplan/Beech St/PHCS |
$327.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$339.28
|
|
