|
RHO(D) IMMUNE GLOBULIN-MALTOSE 1,500 UNIT (300 MCG)/1.3 ML INJECT.SOLN
|
Facility
|
OP
|
$1,327.24
|
|
|
Service Code
|
HCPCS J2792
|
| Hospital Charge Code |
70575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.61 |
| Max. Negotiated Rate |
$1,194.52 |
| Rate for Payer: Aetna American Axle |
$862.71
|
| Rate for Payer: Aetna American Axle |
$888.58
|
| Rate for Payer: Aetna Commercial |
$1,161.98
|
| Rate for Payer: Aetna Commercial |
$1,128.15
|
| Rate for Payer: Aetna Medicare |
$34.17
|
| Rate for Payer: Aetna Medicare |
$34.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$862.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$888.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.08
|
| Rate for Payer: BCBS Complete |
$18.49
|
| Rate for Payer: BCBS Complete |
$18.49
|
| Rate for Payer: BCBS MAPPO |
$32.86
|
| Rate for Payer: BCBS MAPPO |
$32.86
|
| Rate for Payer: BCBS Trust/PPO |
$94.29
|
| Rate for Payer: BCBS Trust/PPO |
$94.29
|
| Rate for Payer: BCN Commercial |
$94.29
|
| Rate for Payer: BCN Commercial |
$94.29
|
| Rate for Payer: BCN Medicare Advantage |
$32.86
|
| Rate for Payer: BCN Medicare Advantage |
$32.86
|
| Rate for Payer: Cash Price |
$1,093.63
|
| Rate for Payer: Cash Price |
$1,061.79
|
| Rate for Payer: Cash Price |
$1,093.63
|
| Rate for Payer: Cash Price |
$1,061.79
|
| Rate for Payer: Cofinity Commercial |
$1,175.65
|
| Rate for Payer: Cofinity Commercial |
$1,141.43
|
| Rate for Payer: Cofinity Commercial |
$929.07
|
| Rate for Payer: Cofinity Commercial |
$956.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$929.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$956.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,093.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.86
|
| Rate for Payer: Healthscope Commercial |
$1,194.52
|
| Rate for Payer: Healthscope Commercial |
$1,230.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$956.93
|
| 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 |
$1,025.28
|
| Rate for Payer: Mclaren Medicaid |
$17.61
|
| Rate for Payer: Mclaren Medicaid |
$17.61
|
| Rate for Payer: Mclaren Medicare |
$32.86
|
| Rate for Payer: Mclaren Medicare |
$32.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.50
|
| Rate for Payer: Meridian Medicaid |
$18.49
|
| Rate for Payer: Meridian Medicaid |
$18.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,128.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,161.98
|
| Rate for Payer: Nomi Health Commercial |
$98.58
|
| Rate for Payer: Nomi Health Commercial |
$98.58
|
| Rate for Payer: PACE Medicare |
$31.22
|
| Rate for Payer: PACE Medicare |
$31.22
|
| Rate for Payer: PACE SWMI |
$32.86
|
| Rate for Payer: PACE SWMI |
$32.86
|
| Rate for Payer: PHP Commercial |
$1,128.15
|
| Rate for Payer: PHP Commercial |
$1,161.98
|
| Rate for Payer: PHP Medicare Advantage |
$32.86
|
| Rate for Payer: PHP Medicare Advantage |
$32.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$888.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.83
|
| Rate for Payer: Priority Health Medicare |
$32.86
|
| Rate for Payer: Priority Health Medicare |
$32.86
|
| Rate for Payer: Priority Health Narrow Network |
$79.06
|
| Rate for Payer: Priority Health Narrow Network |
$79.06
|
| Rate for Payer: Priority Health SBD |
$836.16
|
| Rate for Payer: Priority Health SBD |
$861.24
|
| Rate for Payer: Railroad Medicare Medicare |
$32.86
|
| Rate for Payer: Railroad Medicare Medicare |
$32.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.86
|
| Rate for Payer: UHC Exchange |
$62.80
|
| Rate for Payer: UHC Exchange |
$62.80
|
| Rate for Payer: UHC Medicare Advantage |
$32.86
|
| Rate for Payer: UHC Medicare Advantage |
$32.86
|
| Rate for Payer: UHCCP Medicaid |
$17.61
|
| Rate for Payer: UHCCP Medicaid |
$17.61
|
| Rate for Payer: UMR Bronson Commercial |
$491.08
|
| Rate for Payer: UMR Bronson Commercial |
$505.80
|
| Rate for Payer: VA VA |
$32.86
|
| Rate for Payer: VA VA |
$32.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$995.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,025.28
|
|
|
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 |
$888.58
|
| Rate for Payer: Aetna Commercial |
$1,128.15
|
| Rate for Payer: Aetna Commercial |
$1,161.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$862.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$888.58
|
| Rate for Payer: Cash Price |
$1,061.79
|
| Rate for Payer: Cash Price |
$1,093.63
|
| Rate for Payer: Cofinity Commercial |
$956.93
|
| Rate for Payer: Cofinity Commercial |
$1,175.65
|
| Rate for Payer: Cofinity Commercial |
$1,141.43
|
| Rate for Payer: Cofinity Commercial |
$929.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$929.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$956.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,093.63
|
| Rate for Payer: Healthscope Commercial |
$1,194.52
|
| Rate for Payer: Healthscope Commercial |
$1,230.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$929.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$956.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$995.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,025.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,161.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,128.15
|
| Rate for Payer: PHP Commercial |
$1,161.98
|
| Rate for Payer: PHP Commercial |
$1,128.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$888.58
|
| Rate for Payer: Priority Health SBD |
$836.16
|
| Rate for Payer: Priority Health SBD |
$861.24
|
| Rate for Payer: UMR Bronson Commercial |
$583.99
|
| Rate for Payer: UMR Bronson Commercial |
$601.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$995.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,025.28
|
|
|
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 Commercial |
$3,189.21
|
| Rate for Payer: Cofinity Commercial |
$3,918.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,189.21
|
| 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: PHP Commercial |
$3,872.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,961.41
|
| 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 |
$17.61 |
| 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 |
$34.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,961.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.08
|
| Rate for Payer: BCBS Complete |
$18.49
|
| Rate for Payer: BCBS MAPPO |
$32.86
|
| Rate for Payer: BCBS Trust/PPO |
$94.29
|
| Rate for Payer: BCN Commercial |
$94.29
|
| Rate for Payer: BCN Medicare Advantage |
$32.86
|
| Rate for Payer: Cash Price |
$3,644.81
|
| Rate for Payer: Cash Price |
$3,644.81
|
| Rate for Payer: Cofinity Commercial |
$3,918.17
|
| Rate for Payer: Cofinity Commercial |
$3,189.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,189.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,644.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.86
|
| 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 |
$17.61
|
| Rate for Payer: Mclaren Medicare |
$32.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.50
|
| Rate for Payer: Meridian Medicaid |
$18.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,872.61
|
| Rate for Payer: Nomi Health Commercial |
$98.58
|
| Rate for Payer: PACE Medicare |
$31.22
|
| Rate for Payer: PACE SWMI |
$32.86
|
| Rate for Payer: PHP Commercial |
$3,872.61
|
| Rate for Payer: PHP Medicare Advantage |
$32.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,961.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.83
|
| Rate for Payer: Priority Health Medicare |
$32.86
|
| Rate for Payer: Priority Health Narrow Network |
$79.06
|
| Rate for Payer: Priority Health SBD |
$2,870.29
|
| Rate for Payer: Railroad Medicare Medicare |
$32.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.86
|
| Rate for Payer: UHC Exchange |
$62.80
|
| Rate for Payer: UHC Medicare Advantage |
$32.86
|
| Rate for Payer: UHCCP Medicaid |
$17.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,685.72
|
| Rate for Payer: VA VA |
$32.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,417.01
|
|
|
RHYTIDECTOMY; SUPERFICIAL MUSCULOAPONEUROTIC SYSTEM (SMAS) FLAP
|
Facility
|
OP
|
$11,273.70
|
|
|
Service Code
|
CPT 15829
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,922.61 |
| Max. Negotiated Rate |
$11,273.70 |
| Rate for Payer: Aetna Medicare |
$3,730.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,483.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,483.69
|
| Rate for Payer: BCBS Complete |
$2,018.74
|
| Rate for Payer: BCBS MAPPO |
$3,586.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,108.09
|
| Rate for Payer: BCN Commercial |
$2,108.09
|
| Rate for Payer: BCN Medicare Advantage |
$3,586.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,586.95
|
| Rate for Payer: Mclaren Medicaid |
$1,922.61
|
| Rate for Payer: Mclaren Medicare |
$3,586.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,766.30
|
| Rate for Payer: Meridian Medicaid |
$2,018.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,124.99
|
| Rate for Payer: Nomi Health Commercial |
$7,532.60
|
| Rate for Payer: PACE Medicare |
$3,407.60
|
| Rate for Payer: PACE SWMI |
$3,586.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,586.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,922.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,273.70
|
| Rate for Payer: Priority Health Medicare |
$3,586.95
|
| Rate for Payer: Priority Health Narrow Network |
$9,018.96
|
| Rate for Payer: Railroad Medicare Medicare |
$3,586.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,096.91
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,586.95
|
| Rate for Payer: UHC Exchange |
$6,855.02
|
| Rate for Payer: UHC Medicare Advantage |
$3,586.95
|
| Rate for Payer: UHCCP Medicaid |
$1,922.61
|
| Rate for Payer: VA VA |
$3,586.95
|
|
|
RIFABUTIN 150 MG CAPSULE
|
Facility
|
OP
|
$4,052.98
|
|
|
Service Code
|
NDC 59762135001
|
| Hospital Charge Code |
11290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,499.60 |
| Max. Negotiated Rate |
$3,647.68 |
| Rate for Payer: Aetna American Axle |
$2,634.44
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2,837.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,039.74
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,499.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,039.74
|
|
|
RIFABUTIN 150 MG CAPSULE
|
Facility
|
IP
|
$4,052.98
|
|
|
Service Code
|
NDC 59762135001
|
| Hospital Charge Code |
11290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,783.31 |
| Max. Negotiated Rate |
$3,647.68 |
| Rate for Payer: Aetna American Axle |
$2,634.44
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2,837.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,039.74
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,783.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,039.74
|
|
|
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 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: 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: 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
|
| 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
|
$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 |
$5,490.62
|
| 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 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 |
$4,063.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,235.92
|
|
|
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 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: 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: 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
|
| 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 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
|
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 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 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
|
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 |
$49.46
|
| 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
|
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
|
$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
|
$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 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
|
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
|
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
|
$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
|
|
