|
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 Commercial |
$7,686.86
|
| Rate for Payer: Cofinity Commercial |
$9,443.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,686.86
|
| 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: PHP Commercial |
$9,334.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,137.80
|
| 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
|
|
|
RIFAMPIN 150 MG CAPSULE
|
Facility
|
IP
|
$110.60
|
|
|
Service Code
|
NDC 68180065806
|
| Hospital Charge Code |
11292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.66 |
| Max. Negotiated Rate |
$99.54 |
| Rate for Payer: Aetna American Axle |
$71.89
|
| Rate for Payer: Aetna Commercial |
$94.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.89
|
| Rate for Payer: Cash Price |
$88.48
|
| Rate for Payer: Cofinity Commercial |
$77.42
|
| Rate for Payer: Cofinity Commercial |
$95.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.48
|
| Rate for Payer: Healthscope Commercial |
$99.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.01
|
| Rate for Payer: PHP Commercial |
$94.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.89
|
| Rate for Payer: Priority Health SBD |
$69.68
|
| Rate for Payer: UMR Bronson Commercial |
$48.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.95
|
|
|
RIFAMPIN 150 MG CAPSULE
|
Facility
|
OP
|
$267.40
|
|
|
Service Code
|
NDC 00185080130
|
| Hospital Charge Code |
11292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.94 |
| Max. Negotiated Rate |
$240.66 |
| Rate for Payer: Aetna American Axle |
$173.81
|
| Rate for Payer: Aetna Commercial |
$227.29
|
| Rate for Payer: Aetna Medicare |
$133.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.81
|
| Rate for Payer: BCBS Complete |
$106.96
|
| Rate for Payer: Cash Price |
$213.92
|
| Rate for Payer: Cofinity Commercial |
$187.18
|
| Rate for Payer: Cofinity Commercial |
$229.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.92
|
| Rate for Payer: Healthscope Commercial |
$240.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.29
|
| Rate for Payer: PHP Commercial |
$227.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.81
|
| Rate for Payer: Priority Health SBD |
$168.46
|
| Rate for Payer: UMR Bronson Commercial |
$98.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.55
|
|
|
RIFAMPIN 150 MG CAPSULE
|
Facility
|
OP
|
$110.60
|
|
|
Service Code
|
NDC 68180065806
|
| Hospital Charge Code |
11292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.92 |
| Max. Negotiated Rate |
$99.54 |
| Rate for Payer: Aetna American Axle |
$71.89
|
| Rate for Payer: Aetna Commercial |
$94.01
|
| Rate for Payer: Aetna Medicare |
$55.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.89
|
| Rate for Payer: BCBS Complete |
$44.24
|
| Rate for Payer: Cash Price |
$88.48
|
| Rate for Payer: Cofinity Commercial |
$77.42
|
| Rate for Payer: Cofinity Commercial |
$95.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.48
|
| Rate for Payer: Healthscope Commercial |
$99.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.01
|
| Rate for Payer: PHP Commercial |
$94.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.89
|
| Rate for Payer: Priority Health SBD |
$69.68
|
| Rate for Payer: UMR Bronson Commercial |
$40.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.95
|
|
|
RIFAMPIN 150 MG CAPSULE
|
Facility
|
IP
|
$267.40
|
|
|
Service Code
|
NDC 00185080130
|
| Hospital Charge Code |
11292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.66 |
| Max. Negotiated Rate |
$240.66 |
| Rate for Payer: Aetna American Axle |
$173.81
|
| Rate for Payer: Aetna Commercial |
$227.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.81
|
| Rate for Payer: Cash Price |
$213.92
|
| Rate for Payer: Cofinity Commercial |
$187.18
|
| Rate for Payer: Cofinity Commercial |
$229.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.92
|
| Rate for Payer: Healthscope Commercial |
$240.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.29
|
| Rate for Payer: PHP Commercial |
$227.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.81
|
| Rate for Payer: Priority Health SBD |
$168.46
|
| Rate for Payer: UMR Bronson Commercial |
$117.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.55
|
|
|
RIFAMPIN 300 MG CAPSULE
|
Facility
|
OP
|
$187.20
|
|
|
Service Code
|
NDC 68180065907
|
| Hospital Charge Code |
11293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.26 |
| Max. Negotiated Rate |
$168.48 |
| Rate for Payer: Aetna American Axle |
$121.68
|
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: Aetna Medicare |
$93.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.68
|
| Rate for Payer: BCBS Complete |
$74.88
|
| Rate for Payer: Cash Price |
$149.76
|
| Rate for Payer: Cofinity Commercial |
$131.04
|
| Rate for Payer: Cofinity Commercial |
$160.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.76
|
| Rate for Payer: Healthscope Commercial |
$168.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.12
|
| Rate for Payer: PHP Commercial |
$159.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.68
|
| Rate for Payer: Priority Health SBD |
$117.94
|
| Rate for Payer: UMR Bronson Commercial |
$69.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.40
|
|
|
RIFAMPIN 300 MG CAPSULE
|
Facility
|
IP
|
$8.31
|
|
|
Service Code
|
NDC 60687058611
|
| Hospital Charge Code |
11293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$7.48 |
| Rate for Payer: Aetna American Axle |
$5.40
|
| Rate for Payer: Aetna Commercial |
$7.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.40
|
| Rate for Payer: Cash Price |
$6.65
|
| Rate for Payer: Cofinity Commercial |
$5.82
|
| Rate for Payer: Cofinity Commercial |
$7.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.65
|
| Rate for Payer: Healthscope Commercial |
$7.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.06
|
| Rate for Payer: PHP Commercial |
$7.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.40
|
| Rate for Payer: Priority Health SBD |
$5.24
|
| Rate for Payer: UMR Bronson Commercial |
$3.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.23
|
|
|
RIFAMPIN 300 MG CAPSULE
|
Facility
|
OP
|
$830.40
|
|
|
Service Code
|
NDC 60687058601
|
| Hospital Charge Code |
11293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$307.25 |
| Max. Negotiated Rate |
$747.36 |
| Rate for Payer: Aetna American Axle |
$539.76
|
| Rate for Payer: Aetna Commercial |
$705.84
|
| Rate for Payer: Aetna Medicare |
$415.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$539.76
|
| Rate for Payer: BCBS Complete |
$332.16
|
| Rate for Payer: Cash Price |
$664.32
|
| Rate for Payer: Cofinity Commercial |
$581.28
|
| Rate for Payer: Cofinity Commercial |
$714.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$581.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$664.32
|
| Rate for Payer: Healthscope Commercial |
$747.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$581.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$622.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$705.84
|
| Rate for Payer: PHP Commercial |
$705.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$539.76
|
| Rate for Payer: Priority Health SBD |
$523.15
|
| Rate for Payer: UMR Bronson Commercial |
$307.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$622.80
|
|
|
RIFAMPIN 300 MG CAPSULE
|
Facility
|
OP
|
$8.31
|
|
|
Service Code
|
NDC 60687058611
|
| Hospital Charge Code |
11293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$7.48 |
| Rate for Payer: Aetna American Axle |
$5.40
|
| Rate for Payer: Aetna Commercial |
$7.06
|
| Rate for Payer: Aetna Medicare |
$4.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.40
|
| Rate for Payer: BCBS Complete |
$3.32
|
| Rate for Payer: Cash Price |
$6.65
|
| Rate for Payer: Cofinity Commercial |
$5.82
|
| Rate for Payer: Cofinity Commercial |
$7.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.65
|
| Rate for Payer: Healthscope Commercial |
$7.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.06
|
| Rate for Payer: PHP Commercial |
$7.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.40
|
| Rate for Payer: Priority Health SBD |
$5.24
|
| Rate for Payer: UMR Bronson Commercial |
$3.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.23
|
|
|
RIFAMPIN 300 MG CAPSULE
|
Facility
|
IP
|
$830.40
|
|
|
Service Code
|
NDC 60687058601
|
| Hospital Charge Code |
11293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$365.38 |
| Max. Negotiated Rate |
$747.36 |
| Rate for Payer: Aetna American Axle |
$539.76
|
| Rate for Payer: Aetna Commercial |
$705.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$539.76
|
| Rate for Payer: Cash Price |
$664.32
|
| Rate for Payer: Cofinity Commercial |
$581.28
|
| Rate for Payer: Cofinity Commercial |
$714.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$581.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$664.32
|
| Rate for Payer: Healthscope Commercial |
$747.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$581.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$622.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$705.84
|
| Rate for Payer: PHP Commercial |
$705.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$539.76
|
| Rate for Payer: Priority Health SBD |
$523.15
|
| Rate for Payer: UMR Bronson Commercial |
$365.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$622.80
|
|
|
RIFAMPIN 300 MG CAPSULE
|
Facility
|
OP
|
$98.93
|
|
|
Service Code
|
NDC 68180065906
|
| Hospital Charge Code |
11293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$89.04 |
| Rate for Payer: Aetna American Axle |
$64.30
|
| Rate for Payer: Aetna Commercial |
$84.09
|
| Rate for Payer: Aetna Medicare |
$49.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.30
|
| Rate for Payer: BCBS Complete |
$39.57
|
| Rate for Payer: Cash Price |
$79.14
|
| Rate for Payer: Cofinity Commercial |
$69.25
|
| Rate for Payer: Cofinity Commercial |
$85.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.14
|
| Rate for Payer: Healthscope Commercial |
$89.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.09
|
| Rate for Payer: PHP Commercial |
$84.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.30
|
| Rate for Payer: Priority Health SBD |
$62.33
|
| Rate for Payer: UMR Bronson Commercial |
$36.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.20
|
|
|
RIFAMPIN 300 MG CAPSULE
|
Facility
|
IP
|
$187.20
|
|
|
Service Code
|
NDC 68180065907
|
| Hospital Charge Code |
11293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.37 |
| Max. Negotiated Rate |
$168.48 |
| Rate for Payer: Aetna American Axle |
$121.68
|
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.68
|
| Rate for Payer: Cash Price |
$149.76
|
| Rate for Payer: Cofinity Commercial |
$131.04
|
| Rate for Payer: Cofinity Commercial |
$160.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.76
|
| Rate for Payer: Healthscope Commercial |
$168.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.12
|
| Rate for Payer: PHP Commercial |
$159.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.68
|
| Rate for Payer: Priority Health SBD |
$117.94
|
| Rate for Payer: UMR Bronson Commercial |
$82.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.40
|
|
|
RIFAMPIN 300 MG CAPSULE
|
Facility
|
IP
|
$266.40
|
|
|
Service Code
|
NDC 00904528261
|
| Hospital Charge Code |
11293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.22 |
| Max. Negotiated Rate |
$239.76 |
| Rate for Payer: Aetna American Axle |
$173.16
|
| Rate for Payer: Aetna Commercial |
$226.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.16
|
| Rate for Payer: Cash Price |
$213.12
|
| Rate for Payer: Cofinity Commercial |
$186.48
|
| Rate for Payer: Cofinity Commercial |
$229.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.12
|
| Rate for Payer: Healthscope Commercial |
$239.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.44
|
| Rate for Payer: PHP Commercial |
$226.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.16
|
| Rate for Payer: Priority Health SBD |
$167.83
|
| Rate for Payer: UMR Bronson Commercial |
$117.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.80
|
|
|
RIFAMPIN 300 MG CAPSULE
|
Facility
|
OP
|
$266.40
|
|
|
Service Code
|
NDC 00904528261
|
| Hospital Charge Code |
11293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.57 |
| Max. Negotiated Rate |
$239.76 |
| Rate for Payer: Aetna American Axle |
$173.16
|
| Rate for Payer: Aetna Commercial |
$226.44
|
| Rate for Payer: Aetna Medicare |
$133.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.16
|
| Rate for Payer: BCBS Complete |
$106.56
|
| Rate for Payer: Cash Price |
$213.12
|
| Rate for Payer: Cofinity Commercial |
$186.48
|
| Rate for Payer: Cofinity Commercial |
$229.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.12
|
| Rate for Payer: Healthscope Commercial |
$239.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.44
|
| Rate for Payer: PHP Commercial |
$226.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.16
|
| Rate for Payer: Priority Health SBD |
$167.83
|
| Rate for Payer: UMR Bronson Commercial |
$98.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.80
|
|
|
RIFAMPIN 300 MG CAPSULE
|
Facility
|
IP
|
$98.93
|
|
|
Service Code
|
NDC 68180065906
|
| Hospital Charge Code |
11293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.53 |
| Max. Negotiated Rate |
$89.04 |
| Rate for Payer: Aetna American Axle |
$64.30
|
| Rate for Payer: Aetna Commercial |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.30
|
| Rate for Payer: Cash Price |
$79.14
|
| Rate for Payer: Cofinity Commercial |
$69.25
|
| Rate for Payer: Cofinity Commercial |
$85.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.14
|
| Rate for Payer: Healthscope Commercial |
$89.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.09
|
| Rate for Payer: PHP Commercial |
$84.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.30
|
| Rate for Payer: Priority Health SBD |
$62.33
|
| Rate for Payer: UMR Bronson Commercial |
$43.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.20
|
|
|
RIFAMPIN 600 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$505.10
|
|
|
Service Code
|
NDC 63323035120
|
| Hospital Charge Code |
11291
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$186.89 |
| Max. Negotiated Rate |
$454.59 |
| Rate for Payer: Aetna American Axle |
$328.31
|
| Rate for Payer: Aetna Commercial |
$429.33
|
| Rate for Payer: Aetna Medicare |
$252.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.31
|
| Rate for Payer: BCBS Complete |
$202.04
|
| Rate for Payer: Cash Price |
$404.08
|
| Rate for Payer: Cofinity Commercial |
$353.57
|
| Rate for Payer: Cofinity Commercial |
$434.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$353.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.08
|
| Rate for Payer: Healthscope Commercial |
$454.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$353.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.33
|
| Rate for Payer: PHP Commercial |
$429.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.31
|
| Rate for Payer: Priority Health SBD |
$318.21
|
| Rate for Payer: UMR Bronson Commercial |
$186.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.82
|
|
|
RIFAMPIN 600 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$424.83
|
|
|
Service Code
|
NDC 67457044560
|
| Hospital Charge Code |
11291
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$186.93 |
| Max. Negotiated Rate |
$382.35 |
| Rate for Payer: Aetna American Axle |
$276.14
|
| Rate for Payer: Aetna Commercial |
$361.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.14
|
| Rate for Payer: Cash Price |
$339.86
|
| Rate for Payer: Cofinity Commercial |
$297.38
|
| Rate for Payer: Cofinity Commercial |
$365.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.86
|
| Rate for Payer: Healthscope Commercial |
$382.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.11
|
| Rate for Payer: PHP Commercial |
$361.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.14
|
| Rate for Payer: Priority Health SBD |
$267.64
|
| Rate for Payer: UMR Bronson Commercial |
$186.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.62
|
|
|
RIFAMPIN 600 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$505.10
|
|
|
Service Code
|
NDC 63323035120
|
| Hospital Charge Code |
11291
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$222.24 |
| Max. Negotiated Rate |
$454.59 |
| Rate for Payer: Aetna American Axle |
$328.31
|
| Rate for Payer: Aetna Commercial |
$429.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.31
|
| Rate for Payer: Cash Price |
$404.08
|
| Rate for Payer: Cofinity Commercial |
$353.57
|
| Rate for Payer: Cofinity Commercial |
$434.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$353.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.08
|
| Rate for Payer: Healthscope Commercial |
$454.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$353.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.33
|
| Rate for Payer: PHP Commercial |
$429.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.31
|
| Rate for Payer: Priority Health SBD |
$318.21
|
| Rate for Payer: UMR Bronson Commercial |
$222.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.82
|
|
|
RIFAMPIN 600 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$589.52
|
|
|
Service Code
|
NDC 00068059701
|
| Hospital Charge Code |
11291
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$218.12 |
| Max. Negotiated Rate |
$530.57 |
| Rate for Payer: Aetna American Axle |
$383.19
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$412.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$442.14
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$218.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.14
|
|
|
RIFAMPIN 600 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$424.83
|
|
|
Service Code
|
NDC 67457044560
|
| Hospital Charge Code |
11291
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$157.19 |
| Max. Negotiated Rate |
$382.35 |
| Rate for Payer: Aetna American Axle |
$276.14
|
| Rate for Payer: Aetna Commercial |
$361.11
|
| Rate for Payer: Aetna Medicare |
$212.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.14
|
| Rate for Payer: BCBS Complete |
$169.93
|
| Rate for Payer: Cash Price |
$339.86
|
| Rate for Payer: Cofinity Commercial |
$297.38
|
| Rate for Payer: Cofinity Commercial |
$365.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.86
|
| Rate for Payer: Healthscope Commercial |
$382.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.11
|
| Rate for Payer: PHP Commercial |
$361.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.14
|
| Rate for Payer: Priority Health SBD |
$267.64
|
| Rate for Payer: UMR Bronson Commercial |
$157.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.62
|
|
|
RIFAMPIN 600 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$589.52
|
|
|
Service Code
|
NDC 00068059701
|
| Hospital Charge Code |
11291
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$259.39 |
| Max. Negotiated Rate |
$530.57 |
| Rate for Payer: Aetna American Axle |
$383.19
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$412.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$442.14
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$259.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.14
|
|
|
RIFAXIMIN 200 MG TABLET
|
Facility
|
IP
|
$1,093.24
|
|
|
Service Code
|
NDC 65649030103
|
| Hospital Charge Code |
39063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$481.03 |
| Max. Negotiated Rate |
$983.92 |
| Rate for Payer: Aetna American Axle |
$710.61
|
| Rate for Payer: Aetna Commercial |
$929.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.61
|
| Rate for Payer: Cash Price |
$874.59
|
| Rate for Payer: Cofinity Commercial |
$765.27
|
| Rate for Payer: Cofinity Commercial |
$940.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$765.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$874.59
|
| Rate for Payer: Healthscope Commercial |
$983.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$765.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$819.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$929.25
|
| Rate for Payer: PHP Commercial |
$929.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.61
|
| Rate for Payer: Priority Health SBD |
$688.74
|
| Rate for Payer: UMR Bronson Commercial |
$481.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$819.93
|
|
|
RIFAXIMIN 200 MG TABLET
|
Facility
|
OP
|
$1,093.24
|
|
|
Service Code
|
NDC 65649030103
|
| Hospital Charge Code |
39063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$404.50 |
| Max. Negotiated Rate |
$983.92 |
| Rate for Payer: Aetna American Axle |
$710.61
|
| Rate for Payer: Aetna Commercial |
$929.25
|
| Rate for Payer: Aetna Medicare |
$546.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.61
|
| Rate for Payer: BCBS Complete |
$437.30
|
| Rate for Payer: Cash Price |
$874.59
|
| Rate for Payer: Cofinity Commercial |
$765.27
|
| Rate for Payer: Cofinity Commercial |
$940.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$765.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$874.59
|
| Rate for Payer: Healthscope Commercial |
$983.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$765.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$819.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$929.25
|
| Rate for Payer: PHP Commercial |
$929.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.61
|
| Rate for Payer: Priority Health SBD |
$688.74
|
| Rate for Payer: UMR Bronson Commercial |
$404.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$819.93
|
|
|
RIFAXIMIN 550 MG TABLET
|
Facility
|
IP
|
$11,242.53
|
|
|
Service Code
|
NDC 65649030302
|
| Hospital Charge Code |
104604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,946.71 |
| Max. Negotiated Rate |
$10,118.28 |
| Rate for Payer: Aetna American Axle |
$7,307.64
|
| Rate for Payer: Aetna Commercial |
$9,556.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,307.64
|
| Rate for Payer: Cash Price |
$8,994.02
|
| Rate for Payer: Cofinity Commercial |
$7,869.77
|
| Rate for Payer: Cofinity Commercial |
$9,668.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,869.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,994.02
|
| Rate for Payer: Healthscope Commercial |
$10,118.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,869.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,431.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,556.15
|
| Rate for Payer: PHP Commercial |
$9,556.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,307.64
|
| Rate for Payer: Priority Health SBD |
$7,082.79
|
| Rate for Payer: UMR Bronson Commercial |
$4,946.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,431.90
|
|
|
RIFAXIMIN 550 MG TABLET
|
Facility
|
OP
|
$11,242.53
|
|
|
Service Code
|
NDC 65649030303
|
| Hospital Charge Code |
104604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,159.74 |
| Max. Negotiated Rate |
$10,118.28 |
| Rate for Payer: Aetna American Axle |
$7,307.64
|
| Rate for Payer: Aetna Commercial |
$9,556.15
|
| Rate for Payer: Aetna Medicare |
$5,621.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,307.64
|
| Rate for Payer: BCBS Complete |
$4,497.01
|
| Rate for Payer: Cash Price |
$8,994.02
|
| Rate for Payer: Cofinity Commercial |
$7,869.77
|
| Rate for Payer: Cofinity Commercial |
$9,668.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,869.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,994.02
|
| Rate for Payer: Healthscope Commercial |
$10,118.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,869.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,431.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,556.15
|
| Rate for Payer: PHP Commercial |
$9,556.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,307.64
|
| Rate for Payer: Priority Health SBD |
$7,082.79
|
| Rate for Payer: UMR Bronson Commercial |
$4,159.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,431.90
|
|
