|
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
|
$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
|
|
|
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 |
$212.42
|
| 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
|
$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 |
$328.32
|
| Rate for Payer: Aetna Commercial |
$429.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.32
|
| 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 |
$429.34
|
| Rate for Payer: PHP Commercial |
$429.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.32
|
| 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
|
$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 |
$328.32
|
| Rate for Payer: Aetna Commercial |
$429.34
|
| Rate for Payer: Aetna Medicare |
$252.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.32
|
| 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 |
$429.34
|
| Rate for Payer: PHP Commercial |
$429.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.32
|
| 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
|
|
|
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 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 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 |
$5,621.26
|
| 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
|
|
|
RIFAXIMIN 550 MG TABLET
|
Facility
|
IP
|
$11,242.53
|
|
|
Service Code
|
NDC 65649030303
|
| 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 65649030302
|
| 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 |
$5,621.26
|
| 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
|
|
|
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
|
|
|
RILPIVIRINE HCL 25 MG TABLET
|
Facility
|
OP
|
$5,351.20
|
|
|
Service Code
|
NDC 59676027801
|
| Hospital Charge Code |
152774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,979.94 |
| Max. Negotiated Rate |
$4,816.08 |
| Rate for Payer: Aetna American Axle |
$3,478.28
|
| Rate for Payer: Aetna Commercial |
$4,548.52
|
| Rate for Payer: Aetna Medicare |
$2,675.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,478.28
|
| Rate for Payer: BCBS Complete |
$2,140.48
|
| Rate for Payer: Cash Price |
$4,280.96
|
| Rate for Payer: Cofinity Commercial |
$3,745.84
|
| Rate for Payer: Cofinity Commercial |
$4,602.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,745.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,280.96
|
| Rate for Payer: Healthscope Commercial |
$4,816.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,745.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,013.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,548.52
|
| Rate for Payer: PHP Commercial |
$4,548.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,478.28
|
| Rate for Payer: Priority Health SBD |
$3,371.26
|
| Rate for Payer: UMR Bronson Commercial |
$1,979.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,013.40
|
|
|
RILPIVIRINE HCL 25 MG TABLET
|
Facility
|
IP
|
$5,351.20
|
|
|
Service Code
|
NDC 59676027801
|
| Hospital Charge Code |
152774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,354.53 |
| Max. Negotiated Rate |
$4,816.08 |
| Rate for Payer: Aetna American Axle |
$3,478.28
|
| Rate for Payer: Aetna Commercial |
$4,548.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,478.28
|
| Rate for Payer: Cash Price |
$4,280.96
|
| Rate for Payer: Cofinity Commercial |
$3,745.84
|
| Rate for Payer: Cofinity Commercial |
$4,602.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,745.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,280.96
|
| Rate for Payer: Healthscope Commercial |
$4,816.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,745.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,013.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,548.52
|
| Rate for Payer: PHP Commercial |
$4,548.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,478.28
|
| Rate for Payer: Priority Health SBD |
$3,371.26
|
| Rate for Payer: UMR Bronson Commercial |
$2,354.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,013.40
|
|
|
RIMANTADINE 100 MG TABLET
|
Facility
|
IP
|
$782.55
|
|
|
Service Code
|
NDC 00115191101
|
| Hospital Charge Code |
15440
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$344.32 |
| Max. Negotiated Rate |
$704.30 |
| Rate for Payer: Aetna American Axle |
$508.66
|
| Rate for Payer: Aetna Commercial |
$665.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$508.66
|
| Rate for Payer: Cash Price |
$626.04
|
| Rate for Payer: Cofinity Commercial |
$547.78
|
| Rate for Payer: Cofinity Commercial |
$672.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$547.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$626.04
|
| Rate for Payer: Healthscope Commercial |
$704.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$547.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$586.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$665.17
|
| Rate for Payer: PHP Commercial |
$665.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$508.66
|
| Rate for Payer: Priority Health SBD |
$493.01
|
| Rate for Payer: UMR Bronson Commercial |
$344.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$586.91
|
|
|
RIMANTADINE 100 MG TABLET
|
Facility
|
OP
|
$782.55
|
|
|
Service Code
|
NDC 00115191101
|
| Hospital Charge Code |
15440
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$289.54 |
| Max. Negotiated Rate |
$704.30 |
| Rate for Payer: Aetna American Axle |
$508.66
|
| Rate for Payer: Aetna Commercial |
$665.17
|
| Rate for Payer: Aetna Medicare |
$391.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$508.66
|
| Rate for Payer: BCBS Complete |
$313.02
|
| Rate for Payer: Cash Price |
$626.04
|
| Rate for Payer: Cofinity Commercial |
$547.78
|
| Rate for Payer: Cofinity Commercial |
$672.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$547.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$626.04
|
| Rate for Payer: Healthscope Commercial |
$704.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$547.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$586.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$665.17
|
| Rate for Payer: PHP Commercial |
$665.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$508.66
|
| Rate for Payer: Priority Health SBD |
$493.01
|
| Rate for Payer: UMR Bronson Commercial |
$289.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$586.91
|
|
|
RINGERS LACTATE INFUSION, UP TO 1000 CC
|
Facility
|
OP
|
$6.51
|
|
|
Service Code
|
CPT J7120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$6.51 |
| Rate for Payer: BCBS Trust/PPO |
$6.51
|
| Rate for Payer: BCN Commercial |
$6.51
|
|
|
RISANKIZUMAB-RZAA 60 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26,969.02
|
|
|
Service Code
|
HCPCS J2327
|
| Hospital Charge Code |
200582
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$24,272.12 |
| Rate for Payer: BCBS Trust/PPO |
$40.65
|
| Rate for Payer: BCN Commercial |
$40.65
|
| Rate for Payer: BCN Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$21,575.22
|
| Rate for Payer: Cash Price |
$21,575.22
|
| Rate for Payer: Cofinity Commercial |
$23,193.36
|
| Rate for Payer: Cofinity Commercial |
$18,878.31
|
| Rate for Payer: Aetna American Axle |
$17,529.86
|
| Rate for Payer: Aetna Commercial |
$22,923.67
|
| Rate for Payer: Aetna Medicare |
$15.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,529.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.85
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS MAPPO |
$15.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,878.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,575.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$24,272.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,878.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,226.76
|
| Rate for Payer: Mclaren Medicaid |
$8.08
|
| Rate for Payer: Mclaren Medicare |
$15.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.83
|
| Rate for Payer: Meridian Medicaid |
$8.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,923.67
|
| Rate for Payer: Nomi Health Commercial |
$45.24
|
| Rate for Payer: PACE Medicare |
$14.33
|
| Rate for Payer: PACE SWMI |
$15.08
|
| Rate for Payer: PHP Commercial |
$22,923.67
|
| Rate for Payer: PHP Medicare Advantage |
$15.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,529.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.11
|
| Rate for Payer: Priority Health Medicare |
$15.08
|
| Rate for Payer: Priority Health Narrow Network |
$33.69
|
| Rate for Payer: Priority Health SBD |
$16,990.48
|
| Rate for Payer: Railroad Medicare Medicare |
$15.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.08
|
| Rate for Payer: UHC Exchange |
$28.82
|
| Rate for Payer: UHC Medicare Advantage |
$15.08
|
| Rate for Payer: UHCCP Medicaid |
$8.08
|
| Rate for Payer: UMR Bronson Commercial |
$9,978.54
|
| Rate for Payer: VA VA |
$15.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,226.76
|
|
|
RISANKIZUMAB-RZAA 60 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26,969.02
|
|
|
Service Code
|
HCPCS J2327
|
| Hospital Charge Code |
200582
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,866.37 |
| Max. Negotiated Rate |
$24,272.12 |
| Rate for Payer: Aetna American Axle |
$17,529.86
|
| Rate for Payer: Aetna Commercial |
$22,923.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,529.86
|
| Rate for Payer: Cash Price |
$21,575.22
|
| Rate for Payer: Cofinity Commercial |
$18,878.31
|
| Rate for Payer: Cofinity Commercial |
$23,193.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,878.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,575.22
|
| Rate for Payer: Healthscope Commercial |
$24,272.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,878.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,226.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,923.67
|
| Rate for Payer: PHP Commercial |
$22,923.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,529.86
|
| Rate for Payer: Priority Health SBD |
$16,990.48
|
| Rate for Payer: UMR Bronson Commercial |
$11,866.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,226.76
|
|
|
RISEDRONATE 150 MG TABLET
|
Facility
|
OP
|
$1,270.88
|
|
|
Service Code
|
NDC 00430047801
|
| Hospital Charge Code |
91538
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$470.23 |
| Max. Negotiated Rate |
$1,143.79 |
| Rate for Payer: Aetna American Axle |
$826.07
|
| Rate for Payer: Aetna Commercial |
$1,080.25
|
| Rate for Payer: Aetna Medicare |
$635.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$826.07
|
| Rate for Payer: BCBS Complete |
$508.35
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cofinity Commercial |
$1,092.96
|
| Rate for Payer: Cofinity Commercial |
$889.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$889.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,016.70
|
| Rate for Payer: Healthscope Commercial |
$1,143.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$889.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$953.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,080.25
|
| Rate for Payer: PHP Commercial |
$1,080.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$826.07
|
| Rate for Payer: Priority Health SBD |
$800.65
|
| Rate for Payer: UMR Bronson Commercial |
$470.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$953.16
|
|
|
RISEDRONATE 150 MG TABLET
|
Facility
|
IP
|
$1,270.88
|
|
|
Service Code
|
NDC 00430047801
|
| Hospital Charge Code |
91538
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$559.19 |
| Max. Negotiated Rate |
$1,143.79 |
| Rate for Payer: Cofinity Medicare Advantage |
$889.62
|
| Rate for Payer: Aetna American Axle |
$826.07
|
| Rate for Payer: Aetna Commercial |
$1,080.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$826.07
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cofinity Commercial |
$1,092.96
|
| Rate for Payer: Cofinity Commercial |
$889.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,016.70
|
| Rate for Payer: Healthscope Commercial |
$1,143.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$889.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$953.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,080.25
|
| Rate for Payer: PHP Commercial |
$1,080.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$826.07
|
| Rate for Payer: Priority Health SBD |
$800.65
|
| Rate for Payer: UMR Bronson Commercial |
$559.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$953.16
|
|
|
RISEDRONATE 35 MG TABLET
|
Facility
|
IP
|
$3,526.70
|
|
|
Service Code
|
NDC 00430047207
|
| Hospital Charge Code |
32895
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$3,174.03 |
| Rate for Payer: Aetna American Axle |
$2,292.36
|
| Rate for Payer: Aetna Commercial |
$2,997.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,292.36
|
| Rate for Payer: Cash Price |
$2,821.36
|
| Rate for Payer: Cofinity Commercial |
$2,468.69
|
| Rate for Payer: Cofinity Commercial |
$3,032.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,468.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,821.36
|
| Rate for Payer: Healthscope Commercial |
$3,174.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,468.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,645.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,997.70
|
| Rate for Payer: PHP Commercial |
$2,997.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,292.36
|
| Rate for Payer: Priority Health SBD |
$2,221.82
|
| Rate for Payer: UMR Bronson Commercial |
$1,551.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,645.02
|
|
|
RISEDRONATE 35 MG TABLET
|
Facility
|
OP
|
$3,526.70
|
|
|
Service Code
|
NDC 00430047207
|
| Hospital Charge Code |
32895
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,304.88 |
| Max. Negotiated Rate |
$3,174.03 |
| Rate for Payer: Aetna American Axle |
$2,292.36
|
| Rate for Payer: Aetna Commercial |
$2,997.70
|
| Rate for Payer: Aetna Medicare |
$1,763.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,292.36
|
| Rate for Payer: BCBS Complete |
$1,410.68
|
| Rate for Payer: Cash Price |
$2,821.36
|
| Rate for Payer: Cofinity Commercial |
$2,468.69
|
| Rate for Payer: Cofinity Commercial |
$3,032.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,468.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,821.36
|
| Rate for Payer: Healthscope Commercial |
$3,174.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,468.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,645.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,997.70
|
| Rate for Payer: PHP Commercial |
$2,997.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,292.36
|
| Rate for Payer: Priority Health SBD |
$2,221.82
|
| Rate for Payer: UMR Bronson Commercial |
$1,304.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,645.02
|
|
|
RISEDRONATE 5 MG TABLET
|
Facility
|
OP
|
$257.97
|
|
|
Service Code
|
NDC 33342010707
|
| Hospital Charge Code |
27112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.45 |
| Max. Negotiated Rate |
$232.17 |
| Rate for Payer: Aetna American Axle |
$167.68
|
| Rate for Payer: Aetna Commercial |
$219.27
|
| Rate for Payer: Aetna Medicare |
$128.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.68
|
| Rate for Payer: BCBS Complete |
$103.19
|
| Rate for Payer: Cash Price |
$206.38
|
| Rate for Payer: Cofinity Commercial |
$180.58
|
| Rate for Payer: Cofinity Commercial |
$221.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.38
|
| Rate for Payer: Healthscope Commercial |
$232.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.27
|
| Rate for Payer: PHP Commercial |
$219.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.68
|
| Rate for Payer: Priority Health SBD |
$162.52
|
| Rate for Payer: UMR Bronson Commercial |
$95.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.48
|
|
|
RISEDRONATE 5 MG TABLET
|
Facility
|
IP
|
$257.97
|
|
|
Service Code
|
NDC 33342010707
|
| Hospital Charge Code |
27112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.51 |
| Max. Negotiated Rate |
$232.17 |
| Rate for Payer: Aetna American Axle |
$167.68
|
| Rate for Payer: Aetna Commercial |
$219.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.68
|
| Rate for Payer: Cash Price |
$206.38
|
| Rate for Payer: Cofinity Commercial |
$180.58
|
| Rate for Payer: Cofinity Commercial |
$221.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.38
|
| Rate for Payer: Healthscope Commercial |
$232.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.27
|
| Rate for Payer: PHP Commercial |
$219.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.68
|
| Rate for Payer: Priority Health SBD |
$162.52
|
| Rate for Payer: UMR Bronson Commercial |
$113.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.48
|
|
