|
REZAFUNGIN 200 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,326.47
|
|
|
Service Code
|
HCPCS J0349
|
| Hospital Charge Code |
204281
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,343.65 |
| Max. Negotiated Rate |
$4,793.82 |
| Rate for Payer: Aetna American Axle |
$3,462.21
|
| Rate for Payer: Aetna Commercial |
$4,527.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,462.21
|
| Rate for Payer: Cash Price |
$4,261.18
|
| Rate for Payer: Cofinity Advantage |
$3,728.53
|
| Rate for Payer: Cofinity Commercial |
$4,580.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,261.18
|
| Rate for Payer: Healthscope Commercial |
$4,793.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,728.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,994.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,527.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,994.85
|
| Rate for Payer: PHP Commercial |
$4,527.50
|
| Rate for Payer: Priority Health SBD |
$3,355.68
|
| Rate for Payer: UMR Bronson Commercial |
$2,343.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,994.85
|
|
|
REZAFUNGIN 200 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,326.47
|
|
|
Service Code
|
HCPCS J0349
|
| Hospital Charge Code |
204281
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$4,793.82 |
| Rate for Payer: Aetna American Axle |
$3,462.21
|
| Rate for Payer: Aetna Commercial |
$4,527.50
|
| Rate for Payer: Aetna Medicare |
$11.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,462.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.49
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS MAPPO |
$10.79
|
| Rate for Payer: BCBS Trust/PPO |
$35.04
|
| Rate for Payer: BCN Commercial |
$35.04
|
| Rate for Payer: BCN Medicare Advantage |
$10.79
|
| Rate for Payer: Cash Price |
$4,261.18
|
| Rate for Payer: Cash Price |
$4,261.18
|
| Rate for Payer: Cofinity Advantage |
$3,728.53
|
| Rate for Payer: Cofinity Commercial |
$4,580.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,261.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.79
|
| Rate for Payer: Healthscope Commercial |
$4,793.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,728.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,994.85
|
| Rate for Payer: Mclaren Medicaid |
$10.79
|
| Rate for Payer: Mclaren Medicare |
$10.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.33
|
| Rate for Payer: Meridian Medicaid |
$11.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,527.50
|
| Rate for Payer: Nomi Health Commercial |
$32.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,994.85
|
| Rate for Payer: PACE Medicare |
$10.25
|
| Rate for Payer: PACE SWMI |
$10.79
|
| Rate for Payer: PHP Commercial |
$4,527.50
|
| Rate for Payer: PHP Medicare Advantage |
$10.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33.50
|
| Rate for Payer: Priority Health Medicare |
$10.79
|
| Rate for Payer: Priority Health SBD |
$3,355.68
|
| Rate for Payer: Priority Health Tiered Network |
$26.80
|
| Rate for Payer: Railroad Medicare Medicare |
$10.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.85
|
| Rate for Payer: UHC Core |
$17.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.79
|
| Rate for Payer: UHC Exchange |
$17.85
|
| Rate for Payer: UHC Medicaid |
$5.64
|
| Rate for Payer: UHCCP Medicaid |
$5.64
|
| Rate for Payer: UMR Bronson Commercial |
$1,970.79
|
| Rate for Payer: VA VA |
$10.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,994.85
|
|
|
RHINOPLASTY, PRIMARY; INCLUDING MAJOR SEPTAL REPAIR
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 30420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$7,524.88
|
| Rate for Payer: BCN Commercial |
$7,524.88
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJECTION SYRINGE
|
Facility
|
OP
|
$267.32
|
|
|
Service Code
|
NDC 44206030001
|
| Hospital Charge Code |
38072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$98.91 |
| Max. Negotiated Rate |
$240.59 |
| Rate for Payer: Aetna American Axle |
$173.76
|
| Rate for Payer: Aetna Commercial |
$227.22
|
| Rate for Payer: Aetna Medicare |
$133.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.76
|
| Rate for Payer: BCBS Complete |
$106.93
|
| Rate for Payer: Cash Price |
$213.86
|
| Rate for Payer: Cofinity Advantage |
$187.12
|
| Rate for Payer: Cofinity Commercial |
$229.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.86
|
| Rate for Payer: Healthscope Commercial |
$240.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$213.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.49
|
| Rate for Payer: PHP Commercial |
$227.22
|
| Rate for Payer: Priority Health SBD |
$168.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.76
|
| Rate for Payer: UHC Core |
$139.27
|
| Rate for Payer: UHC Exchange |
$105.06
|
| Rate for Payer: UMR Bronson Commercial |
$98.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.49
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJECTION SYRINGE
|
Facility
|
IP
|
$269.80
|
|
|
Service Code
|
NDC 44206030010
|
| Hospital Charge Code |
38072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$118.71 |
| Max. Negotiated Rate |
$242.82 |
| Rate for Payer: Aetna American Axle |
$175.37
|
| Rate for Payer: Aetna Commercial |
$229.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.37
|
| Rate for Payer: Cash Price |
$215.84
|
| Rate for Payer: Cofinity Advantage |
$188.86
|
| Rate for Payer: Cofinity Commercial |
$232.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.84
|
| Rate for Payer: Healthscope Commercial |
$242.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.35
|
| Rate for Payer: PHP Commercial |
$229.33
|
| Rate for Payer: Priority Health SBD |
$169.97
|
| Rate for Payer: UMR Bronson Commercial |
$118.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.35
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJECTION SYRINGE
|
Facility
|
OP
|
$267.32
|
|
|
Service Code
|
NDC 44206030090
|
| Hospital Charge Code |
38072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$98.91 |
| Max. Negotiated Rate |
$240.59 |
| Rate for Payer: Aetna American Axle |
$173.76
|
| Rate for Payer: Aetna Commercial |
$227.22
|
| Rate for Payer: Aetna Medicare |
$133.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.76
|
| Rate for Payer: BCBS Complete |
$106.93
|
| Rate for Payer: Cash Price |
$213.86
|
| Rate for Payer: Cofinity Advantage |
$187.12
|
| Rate for Payer: Cofinity Commercial |
$229.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.86
|
| Rate for Payer: Healthscope Commercial |
$240.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$213.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.49
|
| Rate for Payer: PHP Commercial |
$227.22
|
| Rate for Payer: Priority Health SBD |
$168.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.76
|
| Rate for Payer: UHC Core |
$139.27
|
| Rate for Payer: UHC Exchange |
$105.06
|
| Rate for Payer: UMR Bronson Commercial |
$98.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.49
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJECTION SYRINGE
|
Facility
|
IP
|
$267.32
|
|
|
Service Code
|
NDC 44206030001
|
| Hospital Charge Code |
38072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$117.62 |
| Max. Negotiated Rate |
$240.59 |
| Rate for Payer: Aetna American Axle |
$173.76
|
| Rate for Payer: Aetna Commercial |
$227.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.76
|
| Rate for Payer: Cash Price |
$213.86
|
| Rate for Payer: Cofinity Advantage |
$187.12
|
| Rate for Payer: Cofinity Commercial |
$229.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.86
|
| Rate for Payer: Healthscope Commercial |
$240.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.49
|
| Rate for Payer: PHP Commercial |
$227.22
|
| Rate for Payer: Priority Health SBD |
$168.41
|
| Rate for Payer: UMR Bronson Commercial |
$117.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.49
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJECTION SYRINGE
|
Facility
|
IP
|
$267.32
|
|
|
Service Code
|
NDC 44206030090
|
| Hospital Charge Code |
38072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$117.62 |
| Max. Negotiated Rate |
$240.59 |
| Rate for Payer: Aetna American Axle |
$173.76
|
| Rate for Payer: Aetna Commercial |
$227.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.76
|
| Rate for Payer: Cash Price |
$213.86
|
| Rate for Payer: Cofinity Advantage |
$187.12
|
| Rate for Payer: Cofinity Commercial |
$229.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.86
|
| Rate for Payer: Healthscope Commercial |
$240.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.49
|
| Rate for Payer: PHP Commercial |
$227.22
|
| Rate for Payer: Priority Health SBD |
$168.41
|
| Rate for Payer: UMR Bronson Commercial |
$117.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.49
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJECTION SYRINGE
|
Facility
|
OP
|
$269.80
|
|
|
Service Code
|
NDC 44206030010
|
| Hospital Charge Code |
38072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$99.83 |
| Max. Negotiated Rate |
$242.82 |
| Rate for Payer: Aetna American Axle |
$175.37
|
| Rate for Payer: Aetna Commercial |
$229.33
|
| Rate for Payer: Aetna Medicare |
$134.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.37
|
| Rate for Payer: BCBS Complete |
$107.92
|
| Rate for Payer: Cash Price |
$215.84
|
| Rate for Payer: Cofinity Advantage |
$188.86
|
| Rate for Payer: Cofinity Commercial |
$232.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.84
|
| Rate for Payer: Healthscope Commercial |
$242.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$215.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.35
|
| Rate for Payer: PHP Commercial |
$229.33
|
| Rate for Payer: Priority Health SBD |
$169.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.37
|
| Rate for Payer: UHC Core |
$140.57
|
| Rate for Payer: UHC Exchange |
$106.03
|
| Rate for Payer: UMR Bronson Commercial |
$99.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.35
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$287.29
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
11283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.30 |
| Max. Negotiated Rate |
$271.51 |
| Rate for Payer: Aetna American Axle |
$186.74
|
| Rate for Payer: Aetna American Axle |
$157.58
|
| Rate for Payer: Aetna American Axle |
$186.75
|
| Rate for Payer: Aetna Commercial |
$244.20
|
| Rate for Payer: Aetna Commercial |
$244.21
|
| Rate for Payer: Aetna Commercial |
$206.07
|
| Rate for Payer: Aetna Medicare |
$143.65
|
| Rate for Payer: Aetna Medicare |
$121.22
|
| Rate for Payer: Aetna Medicare |
$143.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.75
|
| Rate for Payer: BCBS Complete |
$96.97
|
| Rate for Payer: BCBS Complete |
$114.92
|
| Rate for Payer: BCBS Complete |
$114.92
|
| Rate for Payer: BCBS Trust/PPO |
$271.51
|
| Rate for Payer: BCBS Trust/PPO |
$271.51
|
| Rate for Payer: BCBS Trust/PPO |
$271.51
|
| Rate for Payer: BCN Commercial |
$271.51
|
| Rate for Payer: BCN Commercial |
$271.51
|
| Rate for Payer: BCN Commercial |
$271.51
|
| Rate for Payer: Cash Price |
$193.94
|
| Rate for Payer: Cash Price |
$193.94
|
| Rate for Payer: Cash Price |
$229.85
|
| Rate for Payer: Cash Price |
$229.85
|
| Rate for Payer: Cash Price |
$229.83
|
| Rate for Payer: Cash Price |
$229.83
|
| Rate for Payer: Cofinity Advantage |
$201.12
|
| Rate for Payer: Cofinity Advantage |
$201.10
|
| Rate for Payer: Cofinity Advantage |
$169.70
|
| Rate for Payer: Cofinity Commercial |
$208.49
|
| Rate for Payer: Cofinity Commercial |
$247.07
|
| Rate for Payer: Cofinity Commercial |
$247.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.83
|
| Rate for Payer: Healthscope Commercial |
$218.19
|
| Rate for Payer: Healthscope Commercial |
$258.56
|
| Rate for Payer: Healthscope Commercial |
$258.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.48
|
| Rate for Payer: PHP Commercial |
$244.20
|
| Rate for Payer: PHP Commercial |
$206.07
|
| Rate for Payer: PHP Commercial |
$244.21
|
| Rate for Payer: Priority Health SBD |
$152.73
|
| Rate for Payer: Priority Health SBD |
$181.01
|
| Rate for Payer: Priority Health SBD |
$180.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.87
|
| Rate for Payer: UHC Core |
$132.87
|
| Rate for Payer: UHC Core |
$132.87
|
| Rate for Payer: UHC Core |
$132.87
|
| Rate for Payer: UHC Exchange |
$132.87
|
| Rate for Payer: UHC Exchange |
$132.87
|
| Rate for Payer: UHC Exchange |
$132.87
|
| Rate for Payer: UMR Bronson Commercial |
$106.30
|
| Rate for Payer: UMR Bronson Commercial |
$89.70
|
| Rate for Payer: UMR Bronson Commercial |
$106.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.48
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$242.43
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
11283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.67 |
| Max. Negotiated Rate |
$218.19 |
| Rate for Payer: Aetna American Axle |
$157.58
|
| Rate for Payer: Aetna American Axle |
$186.75
|
| Rate for Payer: Aetna American Axle |
$186.74
|
| Rate for Payer: Aetna Commercial |
$244.20
|
| Rate for Payer: Aetna Commercial |
$206.07
|
| Rate for Payer: Aetna Commercial |
$244.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.74
|
| Rate for Payer: Cash Price |
$229.83
|
| Rate for Payer: Cash Price |
$193.94
|
| Rate for Payer: Cash Price |
$229.85
|
| Rate for Payer: Cofinity Advantage |
$201.12
|
| Rate for Payer: Cofinity Advantage |
$169.70
|
| Rate for Payer: Cofinity Advantage |
$201.10
|
| Rate for Payer: Cofinity Commercial |
$247.09
|
| Rate for Payer: Cofinity Commercial |
$208.49
|
| Rate for Payer: Cofinity Commercial |
$247.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.85
|
| Rate for Payer: Healthscope Commercial |
$258.56
|
| Rate for Payer: Healthscope Commercial |
$258.58
|
| Rate for Payer: Healthscope Commercial |
$218.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.48
|
| Rate for Payer: PHP Commercial |
$244.20
|
| Rate for Payer: PHP Commercial |
$206.07
|
| Rate for Payer: PHP Commercial |
$244.21
|
| Rate for Payer: Priority Health SBD |
$152.73
|
| Rate for Payer: Priority Health SBD |
$180.99
|
| Rate for Payer: Priority Health SBD |
$181.01
|
| Rate for Payer: UMR Bronson Commercial |
$106.67
|
| Rate for Payer: UMR Bronson Commercial |
$126.42
|
| Rate for Payer: UMR Bronson Commercial |
$126.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.48
|
|
|
RHO(D) IMMUNE GLOBULIN-MALTOSE 15,000 UNIT (3,000 MCG)/13 ML INJ. SOLN
|
Facility
|
OP
|
$10,781.83
|
|
|
Service Code
|
HCPCS J2792
|
| Hospital Charge Code |
70576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$9,703.65 |
| Rate for Payer: Aetna American Axle |
$7,008.19
|
| Rate for Payer: Aetna Commercial |
$9,164.56
|
| Rate for Payer: Aetna Medicare |
$35.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,008.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.83
|
| Rate for Payer: BCBS Complete |
$18.82
|
| Rate for Payer: BCBS MAPPO |
$34.26
|
| Rate for Payer: BCBS Trust/PPO |
$41.37
|
| Rate for Payer: BCN Commercial |
$41.37
|
| Rate for Payer: BCN Medicare Advantage |
$34.26
|
| Rate for Payer: Cash Price |
$8,625.46
|
| Rate for Payer: Cash Price |
$8,625.46
|
| Rate for Payer: Cofinity Advantage |
$7,547.28
|
| Rate for Payer: Cofinity Commercial |
$9,272.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,625.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.26
|
| Rate for Payer: Healthscope Commercial |
$9,703.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,547.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,086.37
|
| Rate for Payer: Mclaren Medicaid |
$34.26
|
| Rate for Payer: Mclaren Medicare |
$34.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.97
|
| Rate for Payer: Meridian Medicaid |
$35.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,164.56
|
| Rate for Payer: Nomi Health Commercial |
$102.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,086.37
|
| Rate for Payer: PACE Medicare |
$32.55
|
| Rate for Payer: PACE SWMI |
$34.26
|
| Rate for Payer: PHP Commercial |
$9,164.56
|
| Rate for Payer: PHP Medicare Advantage |
$34.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$80.30
|
| Rate for Payer: Priority Health Medicare |
$34.26
|
| Rate for Payer: Priority Health SBD |
$6,792.55
|
| Rate for Payer: Priority Health Tiered Network |
$64.24
|
| Rate for Payer: Railroad Medicare Medicare |
$34.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.95
|
| Rate for Payer: UHC Core |
$55.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$34.26
|
| Rate for Payer: UHC Exchange |
$55.95
|
| Rate for Payer: UHC Medicaid |
$17.92
|
| Rate for Payer: UHCCP Medicaid |
$17.92
|
| Rate for Payer: UMR Bronson Commercial |
$3,989.28
|
| Rate for Payer: VA VA |
$34.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,086.37
|
|
|
RHO(D) IMMUNE GLOBULIN-MALTOSE 15,000 UNIT (3,000 MCG)/13 ML INJ. SOLN
|
Facility
|
IP
|
$10,781.83
|
|
|
Service Code
|
HCPCS J2792
|
| Hospital Charge Code |
70576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,744.01 |
| Max. Negotiated Rate |
$9,703.65 |
| Rate for Payer: Aetna American Axle |
$7,008.19
|
| Rate for Payer: Aetna Commercial |
$9,164.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,008.19
|
| Rate for Payer: Cash Price |
$8,625.46
|
| Rate for Payer: Cofinity Advantage |
$7,547.28
|
| Rate for Payer: Cofinity Commercial |
$9,272.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,625.46
|
| Rate for Payer: Healthscope Commercial |
$9,703.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,547.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,086.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,164.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,086.37
|
| Rate for Payer: PHP Commercial |
$9,164.56
|
| Rate for Payer: Priority Health SBD |
$6,792.55
|
| Rate for Payer: UMR Bronson Commercial |
$4,744.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,086.37
|
|
|
RHO(D) IMMUNE GLOBULIN-MALTOSE 1,500 UNIT (300 MCG)/1.3 ML INJECT.SOLN
|
Facility
|
OP
|
$1,414.82
|
|
|
Service Code
|
HCPCS J2792
|
| Hospital Charge Code |
70575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$1,273.34 |
| Rate for Payer: Aetna American Axle |
$919.63
|
| Rate for Payer: Aetna American Axle |
$862.71
|
| Rate for Payer: Aetna Commercial |
$1,128.15
|
| Rate for Payer: Aetna Commercial |
$1,202.60
|
| Rate for Payer: Aetna Medicare |
$35.63
|
| Rate for Payer: Aetna Medicare |
$35.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$862.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$919.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.83
|
| Rate for Payer: BCBS Complete |
$18.82
|
| Rate for Payer: BCBS Complete |
$18.82
|
| Rate for Payer: BCBS MAPPO |
$34.26
|
| Rate for Payer: BCBS MAPPO |
$34.26
|
| Rate for Payer: BCBS Trust/PPO |
$41.37
|
| Rate for Payer: BCBS Trust/PPO |
$41.37
|
| Rate for Payer: BCN Commercial |
$41.37
|
| Rate for Payer: BCN Commercial |
$41.37
|
| Rate for Payer: BCN Medicare Advantage |
$34.26
|
| Rate for Payer: BCN Medicare Advantage |
$34.26
|
| Rate for Payer: Cash Price |
$1,061.79
|
| Rate for Payer: Cash Price |
$1,131.86
|
| Rate for Payer: Cash Price |
$1,131.86
|
| Rate for Payer: Cash Price |
$1,061.79
|
| Rate for Payer: Cofinity Advantage |
$990.37
|
| Rate for Payer: Cofinity Advantage |
$929.07
|
| Rate for Payer: Cofinity Commercial |
$1,141.43
|
| Rate for Payer: Cofinity Commercial |
$1,216.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,131.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.26
|
| Rate for Payer: Healthscope Commercial |
$1,194.52
|
| Rate for Payer: Healthscope Commercial |
$1,273.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$990.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$929.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$995.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,061.12
|
| Rate for Payer: Mclaren Medicaid |
$34.26
|
| Rate for Payer: Mclaren Medicaid |
$34.26
|
| Rate for Payer: Mclaren Medicare |
$34.26
|
| Rate for Payer: Mclaren Medicare |
$34.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.97
|
| Rate for Payer: Meridian Medicaid |
$35.97
|
| Rate for Payer: Meridian Medicaid |
$35.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,128.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,202.60
|
| Rate for Payer: Nomi Health Commercial |
$102.78
|
| Rate for Payer: Nomi Health Commercial |
$102.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,061.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$995.43
|
| Rate for Payer: PACE Medicare |
$32.55
|
| Rate for Payer: PACE Medicare |
$32.55
|
| Rate for Payer: PACE SWMI |
$34.26
|
| Rate for Payer: PACE SWMI |
$34.26
|
| Rate for Payer: PHP Commercial |
$1,128.15
|
| Rate for Payer: PHP Commercial |
$1,202.60
|
| Rate for Payer: PHP Medicare Advantage |
$34.26
|
| Rate for Payer: PHP Medicare Advantage |
$34.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$80.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$80.30
|
| Rate for Payer: Priority Health Medicare |
$34.26
|
| Rate for Payer: Priority Health Medicare |
$34.26
|
| Rate for Payer: Priority Health SBD |
$836.16
|
| Rate for Payer: Priority Health SBD |
$891.34
|
| Rate for Payer: Priority Health Tiered Network |
$64.24
|
| Rate for Payer: Priority Health Tiered Network |
$64.24
|
| Rate for Payer: Railroad Medicare Medicare |
$34.26
|
| Rate for Payer: Railroad Medicare Medicare |
$34.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.95
|
| Rate for Payer: UHC Core |
$55.95
|
| Rate for Payer: UHC Core |
$55.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$34.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$34.26
|
| Rate for Payer: UHC Exchange |
$55.95
|
| Rate for Payer: UHC Exchange |
$55.95
|
| Rate for Payer: UHC Medicaid |
$17.92
|
| Rate for Payer: UHC Medicaid |
$17.92
|
| Rate for Payer: UHCCP Medicaid |
$17.92
|
| Rate for Payer: UHCCP Medicaid |
$17.92
|
| Rate for Payer: UMR Bronson Commercial |
$491.08
|
| Rate for Payer: UMR Bronson Commercial |
$523.48
|
| Rate for Payer: VA VA |
$34.26
|
| Rate for Payer: VA VA |
$34.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,061.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$995.43
|
|
|
RHO(D) IMMUNE GLOBULIN-MALTOSE 1,500 UNIT (300 MCG)/1.3 ML INJECT.SOLN
|
Facility
|
IP
|
$1,327.24
|
|
|
Service Code
|
HCPCS J2792
|
| Hospital Charge Code |
70575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$583.99 |
| Max. Negotiated Rate |
$1,194.52 |
| Rate for Payer: Aetna American Axle |
$862.71
|
| Rate for Payer: Aetna American Axle |
$919.63
|
| Rate for Payer: Aetna Commercial |
$1,128.15
|
| Rate for Payer: Aetna Commercial |
$1,202.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$862.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$919.63
|
| Rate for Payer: Cash Price |
$1,061.79
|
| Rate for Payer: Cash Price |
$1,131.86
|
| Rate for Payer: Cofinity Advantage |
$990.37
|
| Rate for Payer: Cofinity Advantage |
$929.07
|
| Rate for Payer: Cofinity Commercial |
$1,216.75
|
| Rate for Payer: Cofinity Commercial |
$1,141.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,131.86
|
| Rate for Payer: Healthscope Commercial |
$1,194.52
|
| Rate for Payer: Healthscope Commercial |
$1,273.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$990.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$929.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$995.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,061.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,128.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,202.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$995.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,061.12
|
| Rate for Payer: PHP Commercial |
$1,128.15
|
| Rate for Payer: PHP Commercial |
$1,202.60
|
| Rate for Payer: Priority Health SBD |
$891.34
|
| Rate for Payer: Priority Health SBD |
$836.16
|
| Rate for Payer: UMR Bronson Commercial |
$583.99
|
| Rate for Payer: UMR Bronson Commercial |
$622.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$995.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,061.12
|
|
|
RHO(D) IMMUNE GLOBULIN-MALTOSE 5,000 UNIT (1,000 MCG)/4.4 ML INJ. SOLN
|
Facility
|
IP
|
$4,556.01
|
|
|
Service Code
|
HCPCS J2792
|
| Hospital Charge Code |
70574
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,004.64 |
| Max. Negotiated Rate |
$4,100.41 |
| Rate for Payer: Aetna American Axle |
$2,961.41
|
| Rate for Payer: Aetna Commercial |
$3,872.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,961.41
|
| Rate for Payer: Cash Price |
$3,644.81
|
| Rate for Payer: Cofinity Advantage |
$3,189.21
|
| Rate for Payer: Cofinity Commercial |
$3,918.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,644.81
|
| Rate for Payer: Healthscope Commercial |
$4,100.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,189.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,417.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,872.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,417.01
|
| Rate for Payer: PHP Commercial |
$3,872.61
|
| Rate for Payer: Priority Health SBD |
$2,870.29
|
| Rate for Payer: UMR Bronson Commercial |
$2,004.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,417.01
|
|
|
RHO(D) IMMUNE GLOBULIN-MALTOSE 5,000 UNIT (1,000 MCG)/4.4 ML INJ. SOLN
|
Facility
|
OP
|
$4,556.01
|
|
|
Service Code
|
HCPCS J2792
|
| Hospital Charge Code |
70574
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$4,100.41 |
| Rate for Payer: Aetna American Axle |
$2,961.41
|
| Rate for Payer: Aetna Commercial |
$3,872.61
|
| Rate for Payer: Aetna Medicare |
$35.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,961.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.83
|
| Rate for Payer: BCBS Complete |
$18.82
|
| Rate for Payer: BCBS MAPPO |
$34.26
|
| Rate for Payer: BCBS Trust/PPO |
$41.37
|
| Rate for Payer: BCN Commercial |
$41.37
|
| Rate for Payer: BCN Medicare Advantage |
$34.26
|
| Rate for Payer: Cash Price |
$3,644.81
|
| Rate for Payer: Cash Price |
$3,644.81
|
| Rate for Payer: Cofinity Advantage |
$3,189.21
|
| Rate for Payer: Cofinity Commercial |
$3,918.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,644.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.26
|
| Rate for Payer: Healthscope Commercial |
$4,100.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,189.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,417.01
|
| Rate for Payer: Mclaren Medicaid |
$34.26
|
| Rate for Payer: Mclaren Medicare |
$34.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.97
|
| Rate for Payer: Meridian Medicaid |
$35.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,872.61
|
| Rate for Payer: Nomi Health Commercial |
$102.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,417.01
|
| Rate for Payer: PACE Medicare |
$32.55
|
| Rate for Payer: PACE SWMI |
$34.26
|
| Rate for Payer: PHP Commercial |
$3,872.61
|
| Rate for Payer: PHP Medicare Advantage |
$34.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$80.30
|
| Rate for Payer: Priority Health Medicare |
$34.26
|
| Rate for Payer: Priority Health SBD |
$2,870.29
|
| Rate for Payer: Priority Health Tiered Network |
$64.24
|
| Rate for Payer: Railroad Medicare Medicare |
$34.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.95
|
| Rate for Payer: UHC Core |
$55.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$34.26
|
| Rate for Payer: UHC Exchange |
$55.95
|
| Rate for Payer: UHC Medicaid |
$17.92
|
| Rate for Payer: UHCCP Medicaid |
$17.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,685.72
|
| Rate for Payer: VA VA |
$34.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,417.01
|
|
|
RIFABUTIN 150 MG CAPSULE
|
Facility
|
OP
|
$10,981.23
|
|
|
Service Code
|
NDC 00013530117
|
| Hospital Charge Code |
11290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,063.06 |
| Max. Negotiated Rate |
$9,883.11 |
| Rate for Payer: Aetna American Axle |
$7,137.80
|
| Rate for Payer: Aetna Commercial |
$9,334.05
|
| Rate for Payer: Aetna Medicare |
$5,490.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,137.80
|
| Rate for Payer: BCBS Complete |
$4,392.49
|
| Rate for Payer: Cash Price |
$8,784.98
|
| Rate for Payer: Cofinity Advantage |
$7,686.86
|
| Rate for Payer: Cofinity Commercial |
$9,443.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,784.98
|
| Rate for Payer: Healthscope Commercial |
$9,883.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,686.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,235.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,784.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,334.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,235.92
|
| Rate for Payer: PHP Commercial |
$9,334.05
|
| Rate for Payer: Priority Health SBD |
$6,918.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,137.80
|
| Rate for Payer: UHC Core |
$5,721.22
|
| Rate for Payer: UHC Exchange |
$4,315.62
|
| Rate for Payer: UMR Bronson Commercial |
$4,063.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,235.92
|
|
|
RIFABUTIN 150 MG CAPSULE
|
Facility
|
IP
|
$4,334.18
|
|
|
Service Code
|
NDC 70954004110
|
| Hospital Charge Code |
11290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,907.04 |
| Max. Negotiated Rate |
$3,900.76 |
| Rate for Payer: Aetna American Axle |
$2,817.22
|
| 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 Advantage |
$3,033.93
|
| Rate for Payer: Cofinity Commercial |
$3,727.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,467.34
|
| Rate for Payer: Healthscope Commercial |
$3,900.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,033.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,250.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,684.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,250.64
|
| Rate for Payer: PHP Commercial |
$3,684.05
|
| Rate for Payer: Priority Health SBD |
$2,730.53
|
| Rate for Payer: UMR Bronson Commercial |
$1,907.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,250.64
|
|
|
RIFABUTIN 150 MG CAPSULE
|
Facility
|
OP
|
$4,334.18
|
|
|
Service Code
|
NDC 70954004110
|
| Hospital Charge Code |
11290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,603.65 |
| Max. Negotiated Rate |
$3,900.76 |
| Rate for Payer: Aetna American Axle |
$2,817.22
|
| 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 Advantage |
$3,033.93
|
| Rate for Payer: Cofinity Commercial |
$3,727.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,467.34
|
| Rate for Payer: Healthscope Commercial |
$3,900.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,033.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,250.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,467.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,684.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,250.64
|
| Rate for Payer: PHP Commercial |
$3,684.05
|
| Rate for Payer: Priority Health SBD |
$2,730.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,817.22
|
| Rate for Payer: UHC Core |
$2,258.11
|
| Rate for Payer: UHC Exchange |
$1,703.33
|
| Rate for Payer: UMR Bronson Commercial |
$1,603.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,250.64
|
|
|
RIFABUTIN 150 MG CAPSULE
|
Facility
|
IP
|
$10,981.23
|
|
|
Service Code
|
NDC 00013530117
|
| Hospital Charge Code |
11290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,831.74 |
| Max. Negotiated Rate |
$9,883.11 |
| Rate for Payer: Aetna American Axle |
$7,137.80
|
| Rate for Payer: Aetna Commercial |
$9,334.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,137.80
|
| Rate for Payer: Cash Price |
$8,784.98
|
| Rate for Payer: Cofinity Advantage |
$7,686.86
|
| Rate for Payer: Cofinity Commercial |
$9,443.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,784.98
|
| Rate for Payer: Healthscope Commercial |
$9,883.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,686.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,235.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,334.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,235.92
|
| Rate for Payer: PHP Commercial |
$9,334.05
|
| Rate for Payer: Priority Health SBD |
$6,918.17
|
| Rate for Payer: UMR Bronson Commercial |
$4,831.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,235.92
|
|
|
RIFABUTIN 150 MG CAPSULE
|
Facility
|
IP
|
$3,869.09
|
|
|
Service Code
|
NDC 59762135001
|
| Hospital Charge Code |
11290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,702.40 |
| Max. Negotiated Rate |
$3,482.18 |
| Rate for Payer: Aetna American Axle |
$2,514.91
|
| Rate for Payer: Aetna Commercial |
$3,288.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,514.91
|
| Rate for Payer: Cash Price |
$3,095.27
|
| Rate for Payer: Cofinity Advantage |
$2,708.36
|
| Rate for Payer: Cofinity Commercial |
$3,327.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,095.27
|
| Rate for Payer: Healthscope Commercial |
$3,482.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,708.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,901.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,288.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,901.82
|
| Rate for Payer: PHP Commercial |
$3,288.73
|
| Rate for Payer: Priority Health SBD |
$2,437.53
|
| Rate for Payer: UMR Bronson Commercial |
$1,702.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,901.82
|
|
|
RIFABUTIN 150 MG CAPSULE
|
Facility
|
OP
|
$3,869.09
|
|
|
Service Code
|
NDC 59762135001
|
| Hospital Charge Code |
11290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,431.56 |
| Max. Negotiated Rate |
$3,482.18 |
| Rate for Payer: Aetna American Axle |
$2,514.91
|
| Rate for Payer: Aetna Commercial |
$3,288.73
|
| Rate for Payer: Aetna Medicare |
$1,934.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,514.91
|
| Rate for Payer: BCBS Complete |
$1,547.64
|
| Rate for Payer: Cash Price |
$3,095.27
|
| Rate for Payer: Cofinity Advantage |
$2,708.36
|
| Rate for Payer: Cofinity Commercial |
$3,327.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,095.27
|
| Rate for Payer: Healthscope Commercial |
$3,482.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,708.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,901.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,095.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,288.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,901.82
|
| Rate for Payer: PHP Commercial |
$3,288.73
|
| Rate for Payer: Priority Health SBD |
$2,437.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,514.91
|
| Rate for Payer: UHC Core |
$2,015.80
|
| Rate for Payer: UHC Exchange |
$1,520.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,431.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,901.82
|
|
|
RIFAMPIN 150 MG CAPSULE
|
Facility
|
IP
|
$112.18
|
|
|
Service Code
|
NDC 68180065806
|
| Hospital Charge Code |
11292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.36 |
| Max. Negotiated Rate |
$100.96 |
| Rate for Payer: Aetna American Axle |
$72.92
|
| Rate for Payer: Aetna Commercial |
$95.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.92
|
| Rate for Payer: Cash Price |
$89.74
|
| Rate for Payer: Cofinity Advantage |
$78.53
|
| Rate for Payer: Cofinity Commercial |
$96.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.74
|
| Rate for Payer: Healthscope Commercial |
$100.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.14
|
| Rate for Payer: PHP Commercial |
$95.35
|
| Rate for Payer: Priority Health SBD |
$70.67
|
| Rate for Payer: UMR Bronson Commercial |
$49.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.14
|
|
|
RIFAMPIN 150 MG CAPSULE
|
Facility
|
OP
|
$112.18
|
|
|
Service Code
|
NDC 68180065806
|
| Hospital Charge Code |
11292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.51 |
| Max. Negotiated Rate |
$100.96 |
| Rate for Payer: Aetna American Axle |
$72.92
|
| Rate for Payer: Aetna Commercial |
$95.35
|
| Rate for Payer: Aetna Medicare |
$56.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.92
|
| Rate for Payer: BCBS Complete |
$44.87
|
| Rate for Payer: Cash Price |
$89.74
|
| Rate for Payer: Cofinity Advantage |
$78.53
|
| Rate for Payer: Cofinity Commercial |
$96.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.74
|
| Rate for Payer: Healthscope Commercial |
$100.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.14
|
| Rate for Payer: PHP Commercial |
$95.35
|
| Rate for Payer: Priority Health SBD |
$70.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.92
|
| Rate for Payer: UHC Core |
$58.45
|
| Rate for Payer: UHC Exchange |
$44.09
|
| Rate for Payer: UMR Bronson Commercial |
$41.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.14
|
|
