Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

REVISION OF PERI-IMPLANT CAPSULE, BREAST, INCLUDING CAPSULOTOMY, CAPSULORRHAPHY, AND/OR PARTIAL CAPSULECTOMY

Facility

$10,512.58

Service Code	CPT 19370
Hospital Revenue Code	360
Min. Negotiated Rate	$2,001.76
Max. Negotiated Rate	$10,512.58
Rate for Payer: Aetna Medicare	$3,884.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,668.27
Rate for Payer: Amish Plain Church Group Commercial	$4,668.27
Rate for Payer: BCBS Complete	$2,101.84
Rate for Payer: BCBS MAPPO	$3,734.62
Rate for Payer: BCN Medicare Advantage	$3,734.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,734.62
Rate for Payer: Mclaren Medicaid	$2,001.76
Rate for Payer: Mclaren Medicare	$3,734.62
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,921.35
Rate for Payer: Meridian Medicaid	$2,101.84
Rate for Payer: MI Amish Medical Board Commercial	$4,294.81
Rate for Payer: PACE Medicare	$3,547.89
Rate for Payer: PACE SWMI	$3,734.62
Rate for Payer: PHP Medicare Advantage	$3,734.62
Rate for Payer: Priority Health Choice Medicaid	$2,001.76
Rate for Payer: Priority Health Medicare	$3,734.62
Rate for Payer: Railroad Medicare Medicare	$3,734.62
Rate for Payer: UHC All Payor (Choice/PPO)	$10,512.58
Rate for Payer: UHC Dual Complete DSNP	$3,734.62
Rate for Payer: UHC Medicare Advantage	$3,734.62
Rate for Payer: UHCCP Medicaid	$2,102.59
Rate for Payer: VA VA	$3,734.62

REVISION OF RECONSTRUCTED BREAST (EG, SIGNIFICANT REMOVAL OF TISSUE, RE-ADVANCEMENT AND/OR RE-INSET OF FLAPS IN AUTOLOGOUS RECONSTRUCTION OR SIGNIFICANT CAPSULAR REVISION COMBINED WITH SOFT TISSUE EXCISION IN IMPLANT-BASED RECONSTRUCTION)

Facility

$17,903.47

Service Code	CPT 19380
Hospital Revenue Code	360
Min. Negotiated Rate	$3,409.09
Max. Negotiated Rate	$17,903.47
Rate for Payer: Aetna Medicare	$6,614.66
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,950.31
Rate for Payer: Amish Plain Church Group Commercial	$7,950.31
Rate for Payer: BCBS Complete	$3,579.55
Rate for Payer: BCBS MAPPO	$6,360.25
Rate for Payer: BCN Medicare Advantage	$6,360.25
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,360.25
Rate for Payer: Mclaren Medicaid	$3,409.09
Rate for Payer: Mclaren Medicare	$6,360.25
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,678.26
Rate for Payer: Meridian Medicaid	$3,579.55
Rate for Payer: MI Amish Medical Board Commercial	$7,314.29
Rate for Payer: PACE Medicare	$6,042.24
Rate for Payer: PACE SWMI	$6,360.25
Rate for Payer: PHP Medicare Advantage	$6,360.25
Rate for Payer: Priority Health Choice Medicaid	$3,409.09
Rate for Payer: Priority Health Medicare	$6,360.25
Rate for Payer: Railroad Medicare Medicare	$6,360.25
Rate for Payer: UHC All Payor (Choice/PPO)	$17,903.47
Rate for Payer: UHC Dual Complete DSNP	$6,360.25
Rate for Payer: UHC Medicare Advantage	$6,360.25
Rate for Payer: UHCCP Medicaid	$3,580.82
Rate for Payer: VA VA	$6,360.25

REVISION OF TOTAL SHOULDER ARTHROPLASTY, INCLUDING ALLOGRAFT WHEN PERFORMED; HUMERAL OR GLENOID COMPONENT

Facility

$35,323.48

Service Code	CPT 23473
Hospital Revenue Code	360
Min. Negotiated Rate	$6,726.13
Max. Negotiated Rate	$35,323.48
Rate for Payer: Aetna Medicare	$13,050.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,685.94
Rate for Payer: Amish Plain Church Group Commercial	$15,685.94
Rate for Payer: BCBS Complete	$7,062.44
Rate for Payer: BCBS MAPPO	$12,548.75
Rate for Payer: BCN Medicare Advantage	$12,548.75
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,548.75
Rate for Payer: Mclaren Medicaid	$6,726.13
Rate for Payer: Mclaren Medicare	$12,548.75
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,176.19
Rate for Payer: Meridian Medicaid	$7,062.44
Rate for Payer: MI Amish Medical Board Commercial	$14,431.06
Rate for Payer: PACE Medicare	$11,921.31
Rate for Payer: PACE SWMI	$12,548.75
Rate for Payer: PHP Medicare Advantage	$12,548.75
Rate for Payer: Priority Health Choice Medicaid	$6,726.13
Rate for Payer: Priority Health Medicare	$12,548.75
Rate for Payer: Railroad Medicare Medicare	$12,548.75
Rate for Payer: UHC All Payor (Choice/PPO)	$35,323.48
Rate for Payer: UHC Dual Complete DSNP	$12,548.75
Rate for Payer: UHC Medicare Advantage	$12,548.75
Rate for Payer: UHCCP Medicaid	$7,064.95
Rate for Payer: VA VA	$12,548.75

REVISION, OPEN, ARTERIOVENOUS FISTULA; WITHOUT THROMBECTOMY, AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE)

Facility

$14,840.35

Service Code	CPT 36832
Hospital Revenue Code	360
Min. Negotiated Rate	$2,825.83
Max. Negotiated Rate	$14,840.35
Rate for Payer: Aetna Medicare	$5,482.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,590.09
Rate for Payer: Amish Plain Church Group Commercial	$6,590.09
Rate for Payer: BCBS Complete	$2,967.12
Rate for Payer: BCBS MAPPO	$5,272.07
Rate for Payer: BCN Medicare Advantage	$5,272.07
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,272.07
Rate for Payer: Mclaren Medicaid	$2,825.83
Rate for Payer: Mclaren Medicare	$5,272.07
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,535.67
Rate for Payer: Meridian Medicaid	$2,967.12
Rate for Payer: MI Amish Medical Board Commercial	$6,062.88
Rate for Payer: PACE Medicare	$5,008.47
Rate for Payer: PACE SWMI	$5,272.07
Rate for Payer: PHP Medicare Advantage	$5,272.07
Rate for Payer: Priority Health Choice Medicaid	$2,825.83
Rate for Payer: Priority Health Medicare	$5,272.07
Rate for Payer: Railroad Medicare Medicare	$5,272.07
Rate for Payer: UHC All Payor (Choice/PPO)	$14,840.35
Rate for Payer: UHC Dual Complete DSNP	$5,272.07
Rate for Payer: UHC Medicare Advantage	$5,272.07
Rate for Payer: UHCCP Medicaid	$2,968.18
Rate for Payer: VA VA	$5,272.07

REVISION, OPEN, ARTERIOVENOUS FISTULA; WITH THROMBECTOMY, AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE)

Facility

$14,840.35

Service Code	CPT 36833
Hospital Revenue Code	360
Min. Negotiated Rate	$2,825.83
Max. Negotiated Rate	$14,840.35
Rate for Payer: Aetna Medicare	$5,482.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,590.09
Rate for Payer: Amish Plain Church Group Commercial	$6,590.09
Rate for Payer: BCBS Complete	$2,967.12
Rate for Payer: BCBS MAPPO	$5,272.07
Rate for Payer: BCN Medicare Advantage	$5,272.07
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,272.07
Rate for Payer: Mclaren Medicaid	$2,825.83
Rate for Payer: Mclaren Medicare	$5,272.07
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,535.67
Rate for Payer: Meridian Medicaid	$2,967.12
Rate for Payer: MI Amish Medical Board Commercial	$6,062.88
Rate for Payer: PACE Medicare	$5,008.47
Rate for Payer: PACE SWMI	$5,272.07
Rate for Payer: PHP Medicare Advantage	$5,272.07
Rate for Payer: Priority Health Choice Medicaid	$2,825.83
Rate for Payer: Priority Health Medicare	$5,272.07
Rate for Payer: Railroad Medicare Medicare	$5,272.07
Rate for Payer: UHC All Payor (Choice/PPO)	$14,840.35
Rate for Payer: UHC Dual Complete DSNP	$5,272.07
Rate for Payer: UHC Medicare Advantage	$5,272.07
Rate for Payer: UHCCP Medicaid	$2,968.18
Rate for Payer: VA VA	$5,272.07

REVISION OR REMOVAL OF IMPLANTED SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, WITH DETACHABLE CONNECTION TO ELECTRODE ARRAY

Facility

$9,441.17

Service Code	CPT 63688
Hospital Revenue Code	360
Min. Negotiated Rate	$1,797.74
Max. Negotiated Rate	$9,441.17
Rate for Payer: Aetna Medicare	$3,488.16
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,192.50
Rate for Payer: Amish Plain Church Group Commercial	$4,192.50
Rate for Payer: BCBS Complete	$1,887.63
Rate for Payer: BCBS MAPPO	$3,354.00
Rate for Payer: BCN Medicare Advantage	$3,354.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,354.00
Rate for Payer: Mclaren Medicaid	$1,797.74
Rate for Payer: Mclaren Medicare	$3,354.00
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,521.70
Rate for Payer: Meridian Medicaid	$1,887.63
Rate for Payer: MI Amish Medical Board Commercial	$3,857.10
Rate for Payer: PACE Medicare	$3,186.30
Rate for Payer: PACE SWMI	$3,354.00
Rate for Payer: PHP Medicare Advantage	$3,354.00
Rate for Payer: Priority Health Choice Medicaid	$1,797.74
Rate for Payer: Priority Health Medicare	$3,354.00
Rate for Payer: Railroad Medicare Medicare	$3,354.00
Rate for Payer: UHC All Payor (Choice/PPO)	$9,441.17
Rate for Payer: UHC Dual Complete DSNP	$3,354.00
Rate for Payer: UHC Medicare Advantage	$3,354.00
Rate for Payer: UHCCP Medicaid	$1,888.30
Rate for Payer: VA VA	$3,354.00

REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR ELECTRODE ARRAY

Facility

$9,441.17

Service Code	CPT 64585
Hospital Revenue Code	360
Min. Negotiated Rate	$1,797.74
Max. Negotiated Rate	$9,441.17
Rate for Payer: Aetna Medicare	$3,488.16
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,192.50
Rate for Payer: Amish Plain Church Group Commercial	$4,192.50
Rate for Payer: BCBS Complete	$1,887.63
Rate for Payer: BCBS MAPPO	$3,354.00
Rate for Payer: BCN Medicare Advantage	$3,354.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,354.00
Rate for Payer: Mclaren Medicaid	$1,797.74
Rate for Payer: Mclaren Medicare	$3,354.00
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,521.70
Rate for Payer: Meridian Medicaid	$1,887.63
Rate for Payer: MI Amish Medical Board Commercial	$3,857.10
Rate for Payer: PACE Medicare	$3,186.30
Rate for Payer: PACE SWMI	$3,354.00
Rate for Payer: PHP Medicare Advantage	$3,354.00
Rate for Payer: Priority Health Choice Medicaid	$1,797.74
Rate for Payer: Priority Health Medicare	$3,354.00
Rate for Payer: Railroad Medicare Medicare	$3,354.00
Rate for Payer: UHC All Payor (Choice/PPO)	$9,441.17
Rate for Payer: UHC Dual Complete DSNP	$3,354.00
Rate for Payer: UHC Medicare Advantage	$3,354.00
Rate for Payer: UHCCP Medicaid	$1,888.30
Rate for Payer: VA VA	$3,354.00

REVISION OR REMOVAL OF PERIPHERAL, SACRAL, OR GASTRIC NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, WITH DETACHABLE CONNECTION TO ELECTRODE ARRAY

Facility

$9,441.17

Service Code	CPT 64595
Hospital Revenue Code	360
Min. Negotiated Rate	$1,797.74
Max. Negotiated Rate	$9,441.17
Rate for Payer: Aetna Medicare	$3,488.16
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,192.50
Rate for Payer: Amish Plain Church Group Commercial	$4,192.50
Rate for Payer: BCBS Complete	$1,887.63
Rate for Payer: BCBS MAPPO	$3,354.00
Rate for Payer: BCN Medicare Advantage	$3,354.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,354.00
Rate for Payer: Mclaren Medicaid	$1,797.74
Rate for Payer: Mclaren Medicare	$3,354.00
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,521.70
Rate for Payer: Meridian Medicaid	$1,887.63
Rate for Payer: MI Amish Medical Board Commercial	$3,857.10
Rate for Payer: PACE Medicare	$3,186.30
Rate for Payer: PACE SWMI	$3,354.00
Rate for Payer: PHP Medicare Advantage	$3,354.00
Rate for Payer: Priority Health Choice Medicaid	$1,797.74
Rate for Payer: Priority Health Medicare	$3,354.00
Rate for Payer: Railroad Medicare Medicare	$3,354.00
Rate for Payer: UHC All Payor (Choice/PPO)	$9,441.17
Rate for Payer: UHC Dual Complete DSNP	$3,354.00
Rate for Payer: UHC Medicare Advantage	$3,354.00
Rate for Payer: UHCCP Medicaid	$1,888.30
Rate for Payer: VA VA	$3,354.00

REVISION OR REPLACEMENT OF HYPOGLOSSAL NERVE NEUROSTIMULATOR ARRAY AND DISTAL RESPIRATORY SENSOR ELECTRODE OR ELECTRODE ARRAY, INCLUDING CONNECTION TO EXISTING PULSE GENERATOR

Facility

$34,234.93

Service Code	CPT 64583
Hospital Revenue Code	360
Min. Negotiated Rate	$6,518.85
Max. Negotiated Rate	$34,234.93
Rate for Payer: Aetna Medicare	$12,648.52
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,202.55
Rate for Payer: Amish Plain Church Group Commercial	$15,202.55
Rate for Payer: BCBS Complete	$6,844.80
Rate for Payer: BCBS MAPPO	$12,162.04
Rate for Payer: BCN Medicare Advantage	$12,162.04
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,162.04
Rate for Payer: Mclaren Medicaid	$6,518.85
Rate for Payer: Mclaren Medicare	$12,162.04
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$12,770.14
Rate for Payer: Meridian Medicaid	$6,844.80
Rate for Payer: MI Amish Medical Board Commercial	$13,986.35
Rate for Payer: PACE Medicare	$11,553.94
Rate for Payer: PACE SWMI	$12,162.04
Rate for Payer: PHP Medicare Advantage	$12,162.04
Rate for Payer: Priority Health Choice Medicaid	$6,518.85
Rate for Payer: Priority Health Medicare	$12,162.04
Rate for Payer: Railroad Medicare Medicare	$12,162.04
Rate for Payer: UHC All Payor (Choice/PPO)	$34,234.93
Rate for Payer: UHC Dual Complete DSNP	$12,162.04
Rate for Payer: UHC Medicare Advantage	$12,162.04
Rate for Payer: UHCCP Medicaid	$6,847.23
Rate for Payer: VA VA	$12,162.04

REZAFUNGIN 200 MG INTRAVENOUS SOLUTION

Facility

$6,224.00

Service Code	HCPCS J0349
Hospital Charge Code	204281
Hospital Revenue Code	636
Min. Negotiated Rate	$3,921.12
Max. Negotiated Rate	$5,601.60
Rate for Payer: Aetna Commercial	$5,290.40
Rate for Payer: Aetna New Business (MI Preferred)	$4,045.60
Rate for Payer: Cash Price	$4,979.20
Rate for Payer: Cofinity Commercial	$4,356.80
Rate for Payer: Cofinity Commercial	$5,352.64
Rate for Payer: Cofinity Medicare Advantage	$4,356.80
Rate for Payer: Encore Health Key Benefits Commercial	$4,979.20
Rate for Payer: Healthscope Commercial	$5,601.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,290.40
Rate for Payer: PHP Commercial	$5,290.40
Rate for Payer: Priority Health Cigna Priority Health	$4,045.60
Rate for Payer: Priority Health SBD	$3,921.12

REZAFUNGIN 200 MG INTRAVENOUS SOLUTION

Facility

$6,224.00

Service Code	HCPCS J0349
Hospital Charge Code	204281
Hospital Revenue Code	636
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5,601.60
Rate for Payer: Aetna Commercial	$5,290.40
Rate for Payer: Aetna Medicare	$11.06
Rate for Payer: Aetna New Business (MI Preferred)	$4,045.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$13.29
Rate for Payer: Amish Plain Church Group Commercial	$13.29
Rate for Payer: BCBS Complete	$5.98
Rate for Payer: BCBS MAPPO	$10.63
Rate for Payer: BCN Medicare Advantage	$10.63
Rate for Payer: Cash Price	$4,979.20
Rate for Payer: Cash Price	$4,979.20
Rate for Payer: Cofinity Commercial	$5,352.64
Rate for Payer: Cofinity Commercial	$4,356.80
Rate for Payer: Cofinity Medicare Advantage	$4,356.80
Rate for Payer: Encore Health Key Benefits Commercial	$4,979.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$10.63
Rate for Payer: Healthscope Commercial	$5,601.60
Rate for Payer: Mclaren Medicaid	$5.70
Rate for Payer: Mclaren Medicare	$10.63
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11.16
Rate for Payer: Meridian Medicaid	$5.98
Rate for Payer: MI Amish Medical Board Commercial	$12.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,290.40
Rate for Payer: PACE Medicare	$10.10
Rate for Payer: PACE SWMI	$10.63
Rate for Payer: PHP Commercial	$5,290.40
Rate for Payer: PHP Medicare Advantage	$10.63
Rate for Payer: Priority Health Choice Medicaid	$5.70
Rate for Payer: Priority Health Cigna Priority Health	$4,045.60
Rate for Payer: Priority Health Medicare	$10.63
Rate for Payer: Priority Health SBD	$3,921.12
Rate for Payer: Railroad Medicare Medicare	$10.63
Rate for Payer: UHC All Payor (Choice/PPO)	$29.92
Rate for Payer: UHC Dual Complete DSNP	$10.63
Rate for Payer: UHC Medicare Advantage	$10.63
Rate for Payer: UHCCP Medicaid	$5.98
Rate for Payer: VA VA	$10.63

RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) INTRAMUSCULAR SYRINGE

Facility

$287.29

Service Code	HCPCS J2790
Hospital Charge Code	11283
Hospital Revenue Code	636
Min. Negotiated Rate	$180.99
Max. Negotiated Rate	$258.56
Rate for Payer: Aetna Commercial	$244.20
Rate for Payer: Aetna New Business (MI Preferred)	$186.74
Rate for Payer: Cash Price	$229.83
Rate for Payer: Cofinity Commercial	$201.10
Rate for Payer: Cofinity Commercial	$247.07
Rate for Payer: Cofinity Medicare Advantage	$201.10
Rate for Payer: Encore Health Key Benefits Commercial	$229.83
Rate for Payer: Healthscope Commercial	$258.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$244.20
Rate for Payer: PHP Commercial	$244.20
Rate for Payer: Priority Health Cigna Priority Health	$186.74
Rate for Payer: Priority Health SBD	$180.99

RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) INTRAMUSCULAR SYRINGE

Facility

$287.29

Service Code	HCPCS J2790
Hospital Charge Code	11283
Hospital Revenue Code	636
Min. Negotiated Rate	$114.92
Max. Negotiated Rate	$258.56
Rate for Payer: Aetna Commercial	$244.20
Rate for Payer: Aetna Medicare	$143.65
Rate for Payer: Aetna New Business (MI Preferred)	$186.74
Rate for Payer: BCBS Complete	$114.92
Rate for Payer: Cash Price	$229.83
Rate for Payer: Cofinity Commercial	$201.10
Rate for Payer: Cofinity Commercial	$247.07
Rate for Payer: Cofinity Medicare Advantage	$201.10
Rate for Payer: Encore Health Key Benefits Commercial	$229.83
Rate for Payer: Healthscope Commercial	$258.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$244.20
Rate for Payer: PHP Commercial	$244.20
Rate for Payer: Priority Health Cigna Priority Health	$186.74
Rate for Payer: Priority Health SBD	$180.99

RIBOFLAVIN (VITAMIN B2) 100 MG TABLET

Facility

$162.15

Service Code	NDC 07610003220
Hospital Charge Code	11288
Hospital Revenue Code	637
Min. Negotiated Rate	$102.15
Max. Negotiated Rate	$145.94
Rate for Payer: Aetna Commercial	$137.83
Rate for Payer: Aetna New Business (MI Preferred)	$105.40
Rate for Payer: Cash Price	$129.72
Rate for Payer: Cofinity Commercial	$113.50
Rate for Payer: Cofinity Commercial	$139.45
Rate for Payer: Cofinity Medicare Advantage	$113.50
Rate for Payer: Encore Health Key Benefits Commercial	$129.72
Rate for Payer: Healthscope Commercial	$145.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$137.83
Rate for Payer: PHP Commercial	$137.83
Rate for Payer: Priority Health Cigna Priority Health	$105.40
Rate for Payer: Priority Health SBD	$102.15

RIBOFLAVIN (VITAMIN B2) 100 MG TABLET

Facility

$162.15

Service Code	NDC 07610003220
Hospital Charge Code	11288
Hospital Revenue Code	637
Min. Negotiated Rate	$64.86
Max. Negotiated Rate	$145.94
Rate for Payer: Aetna Commercial	$137.83
Rate for Payer: Aetna Medicare	$81.08
Rate for Payer: Aetna New Business (MI Preferred)	$105.40
Rate for Payer: BCBS Complete	$64.86
Rate for Payer: Cash Price	$129.72
Rate for Payer: Cofinity Commercial	$113.50
Rate for Payer: Cofinity Commercial	$139.45
Rate for Payer: Cofinity Medicare Advantage	$113.50
Rate for Payer: Encore Health Key Benefits Commercial	$129.72
Rate for Payer: Healthscope Commercial	$145.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$137.83
Rate for Payer: PHP Commercial	$137.83
Rate for Payer: Priority Health Cigna Priority Health	$105.40
Rate for Payer: Priority Health SBD	$102.15

RIFABUTIN 150 MG CAPSULE

Facility

$4,052.98

Service Code	NDC 59762135001
Hospital Charge Code	11290
Hospital Revenue Code	637
Min. Negotiated Rate	$2,553.38
Max. Negotiated Rate	$3,647.68
Rate for Payer: Aetna Commercial	$3,445.03
Rate for Payer: Aetna New Business (MI Preferred)	$2,634.44
Rate for Payer: Cash Price	$3,242.38
Rate for Payer: Cofinity Commercial	$2,837.09
Rate for Payer: Cofinity Commercial	$3,485.56
Rate for Payer: Cofinity Medicare Advantage	$2,837.09
Rate for Payer: Encore Health Key Benefits Commercial	$3,242.38
Rate for Payer: Healthscope Commercial	$3,647.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,445.03
Rate for Payer: PHP Commercial	$3,445.03
Rate for Payer: Priority Health Cigna Priority Health	$2,634.44
Rate for Payer: Priority Health SBD	$2,553.38

RIFABUTIN 150 MG CAPSULE

Facility

$4,334.18

Service Code	NDC 70954004110
Hospital Charge Code	11290
Hospital Revenue Code	637
Min. Negotiated Rate	$1,733.67
Max. Negotiated Rate	$3,900.76
Rate for Payer: Aetna Commercial	$3,684.05
Rate for Payer: Aetna Medicare	$2,167.09
Rate for Payer: Aetna New Business (MI Preferred)	$2,817.22
Rate for Payer: BCBS Complete	$1,733.67
Rate for Payer: Cash Price	$3,467.34
Rate for Payer: Cofinity Commercial	$3,033.93
Rate for Payer: Cofinity Commercial	$3,727.39
Rate for Payer: Cofinity Medicare Advantage	$3,033.93
Rate for Payer: Encore Health Key Benefits Commercial	$3,467.34
Rate for Payer: Healthscope Commercial	$3,900.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,684.05
Rate for Payer: PHP Commercial	$3,684.05
Rate for Payer: Priority Health Cigna Priority Health	$2,817.22
Rate for Payer: Priority Health SBD	$2,730.53

RIFABUTIN 150 MG CAPSULE

Facility

$4,052.98

Service Code	NDC 59762135001
Hospital Charge Code	11290
Hospital Revenue Code	637
Min. Negotiated Rate	$1,621.19
Max. Negotiated Rate	$3,647.68
Rate for Payer: Aetna Commercial	$3,445.03
Rate for Payer: Aetna Medicare	$2,026.49
Rate for Payer: Aetna New Business (MI Preferred)	$2,634.44
Rate for Payer: BCBS Complete	$1,621.19
Rate for Payer: Cash Price	$3,242.38
Rate for Payer: Cofinity Commercial	$2,837.09
Rate for Payer: Cofinity Commercial	$3,485.56
Rate for Payer: Cofinity Medicare Advantage	$2,837.09
Rate for Payer: Encore Health Key Benefits Commercial	$3,242.38
Rate for Payer: Healthscope Commercial	$3,647.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,445.03
Rate for Payer: PHP Commercial	$3,445.03
Rate for Payer: Priority Health Cigna Priority Health	$2,634.44
Rate for Payer: Priority Health SBD	$2,553.38

RIFABUTIN 150 MG CAPSULE

Facility

$4,334.18

Service Code	NDC 70954004110
Hospital Charge Code	11290
Hospital Revenue Code	637
Min. Negotiated Rate	$2,730.53
Max. Negotiated Rate	$3,900.76
Rate for Payer: Aetna Commercial	$3,684.05
Rate for Payer: Aetna New Business (MI Preferred)	$2,817.22
Rate for Payer: Cash Price	$3,467.34
Rate for Payer: Cofinity Commercial	$3,033.93
Rate for Payer: Cofinity Commercial	$3,727.39
Rate for Payer: Cofinity Medicare Advantage	$3,033.93
Rate for Payer: Encore Health Key Benefits Commercial	$3,467.34
Rate for Payer: Healthscope Commercial	$3,900.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,684.05
Rate for Payer: PHP Commercial	$3,684.05
Rate for Payer: Priority Health Cigna Priority Health	$2,817.22
Rate for Payer: Priority Health SBD	$2,730.53

RIFAMPIN 150 MG CAPSULE

Facility

$10.82

Service Code	NDC 60687057511
Hospital Charge Code	11292
Hospital Revenue Code	637
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$9.74
Rate for Payer: Aetna Commercial	$9.20
Rate for Payer: Aetna New Business (MI Preferred)	$7.03
Rate for Payer: Cash Price	$8.66
Rate for Payer: Cofinity Commercial	$7.57
Rate for Payer: Cofinity Commercial	$9.31
Rate for Payer: Cofinity Medicare Advantage	$7.57
Rate for Payer: Encore Health Key Benefits Commercial	$8.66
Rate for Payer: Healthscope Commercial	$9.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.20
Rate for Payer: PHP Commercial	$9.20
Rate for Payer: Priority Health Cigna Priority Health	$7.03
Rate for Payer: Priority Health SBD	$6.82

RIFAMPIN 150 MG CAPSULE

Facility

$324.35

Service Code	NDC 60687057521
Hospital Charge Code	11292
Hospital Revenue Code	637
Min. Negotiated Rate	$129.74
Max. Negotiated Rate	$291.92
Rate for Payer: Aetna Commercial	$275.70
Rate for Payer: Aetna Medicare	$162.18
Rate for Payer: Aetna New Business (MI Preferred)	$210.83
Rate for Payer: BCBS Complete	$129.74
Rate for Payer: Cash Price	$259.48
Rate for Payer: Cofinity Commercial	$227.04
Rate for Payer: Cofinity Commercial	$278.94
Rate for Payer: Cofinity Medicare Advantage	$227.04
Rate for Payer: Encore Health Key Benefits Commercial	$259.48
Rate for Payer: Healthscope Commercial	$291.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$275.70
Rate for Payer: PHP Commercial	$275.70
Rate for Payer: Priority Health Cigna Priority Health	$210.83
Rate for Payer: Priority Health SBD	$204.34

RIFAMPIN 150 MG CAPSULE

Facility

$324.35

Service Code	NDC 60687057521
Hospital Charge Code	11292
Hospital Revenue Code	637
Min. Negotiated Rate	$204.34
Max. Negotiated Rate	$291.92
Rate for Payer: Aetna Commercial	$275.70
Rate for Payer: Aetna New Business (MI Preferred)	$210.83
Rate for Payer: Cash Price	$259.48
Rate for Payer: Cofinity Commercial	$227.04
Rate for Payer: Cofinity Commercial	$278.94
Rate for Payer: Cofinity Medicare Advantage	$227.04
Rate for Payer: Encore Health Key Benefits Commercial	$259.48
Rate for Payer: Healthscope Commercial	$291.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$275.70
Rate for Payer: PHP Commercial	$275.70
Rate for Payer: Priority Health Cigna Priority Health	$210.83
Rate for Payer: Priority Health SBD	$204.34

RIFAMPIN 150 MG CAPSULE

Facility

$10.82

Service Code	NDC 60687057511
Hospital Charge Code	11292
Hospital Revenue Code	637
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$9.74
Rate for Payer: Aetna Commercial	$9.20
Rate for Payer: Aetna Medicare	$5.41
Rate for Payer: Aetna New Business (MI Preferred)	$7.03
Rate for Payer: BCBS Complete	$4.33
Rate for Payer: Cash Price	$8.66
Rate for Payer: Cofinity Commercial	$7.57
Rate for Payer: Cofinity Commercial	$9.31
Rate for Payer: Cofinity Medicare Advantage	$7.57
Rate for Payer: Encore Health Key Benefits Commercial	$8.66
Rate for Payer: Healthscope Commercial	$9.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.20
Rate for Payer: PHP Commercial	$9.20
Rate for Payer: Priority Health Cigna Priority Health	$7.03
Rate for Payer: Priority Health SBD	$6.82

RIFAMPIN 600 MG INTRAVENOUS SOLUTION

Facility

$589.52

Service Code	NDC 00068059701
Hospital Charge Code	11291
Hospital Revenue Code	250
Min. Negotiated Rate	$235.81
Max. Negotiated Rate	$530.57
Rate for Payer: Aetna Commercial	$501.09
Rate for Payer: Aetna Medicare	$294.76
Rate for Payer: Aetna New Business (MI Preferred)	$383.19
Rate for Payer: BCBS Complete	$235.81
Rate for Payer: Cash Price	$471.62
Rate for Payer: Cofinity Commercial	$412.66
Rate for Payer: Cofinity Commercial	$506.99
Rate for Payer: Cofinity Medicare Advantage	$412.66
Rate for Payer: Encore Health Key Benefits Commercial	$471.62
Rate for Payer: Healthscope Commercial	$530.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$501.09
Rate for Payer: PHP Commercial	$501.09
Rate for Payer: Priority Health Cigna Priority Health	$383.19
Rate for Payer: Priority Health SBD	$371.40

RIFAMPIN 600 MG INTRAVENOUS SOLUTION

Facility

$589.52

Service Code	NDC 00068059701
Hospital Charge Code	11291
Hospital Revenue Code	250
Min. Negotiated Rate	$371.40
Max. Negotiated Rate	$530.57
Rate for Payer: Aetna Commercial	$501.09
Rate for Payer: Aetna New Business (MI Preferred)	$383.19
Rate for Payer: Cash Price	$471.62
Rate for Payer: Cofinity Commercial	$412.66
Rate for Payer: Cofinity Commercial	$506.99
Rate for Payer: Cofinity Medicare Advantage	$412.66
Rate for Payer: Encore Health Key Benefits Commercial	$471.62
Rate for Payer: Healthscope Commercial	$530.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$501.09
Rate for Payer: PHP Commercial	$501.09
Rate for Payer: Priority Health Cigna Priority Health	$383.19
Rate for Payer: Priority Health SBD	$371.40

Know your out-of-pocket cost for care.

All Charges