|
DILTIAZEM 30 MG TABLET
|
Facility
|
OP
|
$326.65
|
|
|
Service Code
|
NDC 00093031801
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.37 |
| Max. Negotiated Rate |
$293.99 |
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.32
|
| Rate for Payer: BCBS Complete |
$130.66
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Advantage |
$228.66
|
| Rate for Payer: Cofinity Commercial |
$280.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$293.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$261.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.99
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health SBD |
$205.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.32
|
| Rate for Payer: UHC Core |
$170.18
|
| Rate for Payer: UHC Exchange |
$128.37
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$373.65
|
|
|
Service Code
|
NDC 51079074520
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$235.40 |
| Max. Negotiated Rate |
$336.29 |
| Rate for Payer: Aetna Commercial |
$317.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.87
|
| Rate for Payer: Cash Price |
$298.92
|
| Rate for Payer: Cofinity Advantage |
$261.56
|
| Rate for Payer: Cofinity Commercial |
$321.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.92
|
| Rate for Payer: Healthscope Commercial |
$336.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.24
|
| Rate for Payer: PHP Commercial |
$317.60
|
| Rate for Payer: Priority Health SBD |
$235.40
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$4.29
|
|
|
Service Code
|
NDC 60687071711
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.79
|
| Rate for Payer: Cash Price |
$3.43
|
| Rate for Payer: Cofinity Advantage |
$3.00
|
| Rate for Payer: Cofinity Commercial |
$3.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.43
|
| Rate for Payer: Healthscope Commercial |
$3.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.22
|
| Rate for Payer: PHP Commercial |
$3.65
|
| Rate for Payer: Priority Health SBD |
$2.70
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.27
|
|
|
Service Code
|
HCPCS J1163
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$23.64 |
| Rate for Payer: Aetna Commercial |
$22.33
|
| Rate for Payer: Aetna Commercial |
$23.98
|
| Rate for Payer: Aetna Commercial |
$38.39
|
| Rate for Payer: Aetna Commercial |
$19.58
|
| Rate for Payer: Aetna Commercial |
$22.37
|
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Medicare |
$10.62
|
| Rate for Payer: Aetna Medicare |
$14.11
|
| Rate for Payer: Aetna Medicare |
$13.16
|
| Rate for Payer: Aetna Medicare |
$13.13
|
| Rate for Payer: Aetna Medicare |
$22.59
|
| Rate for Payer: Aetna Medicare |
$11.52
|
| Rate for Payer: Aetna Medicare |
$8.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.11
|
| Rate for Payer: BCBS Complete |
$10.51
|
| Rate for Payer: BCBS Complete |
$9.21
|
| Rate for Payer: BCBS Complete |
$18.07
|
| Rate for Payer: BCBS Complete |
$10.53
|
| Rate for Payer: BCBS Complete |
$7.05
|
| Rate for Payer: BCBS Complete |
$8.50
|
| Rate for Payer: BCBS Complete |
$11.28
|
| Rate for Payer: BCBS Trust/PPO |
$0.07
|
| Rate for Payer: BCBS Trust/PPO |
$0.07
|
| Rate for Payer: BCBS Trust/PPO |
$0.07
|
| Rate for Payer: BCBS Trust/PPO |
$0.07
|
| Rate for Payer: BCBS Trust/PPO |
$0.07
|
| Rate for Payer: BCBS Trust/PPO |
$0.07
|
| Rate for Payer: BCBS Trust/PPO |
$0.07
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$21.02
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cash Price |
$18.42
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cash Price |
$18.42
|
| Rate for Payer: Cash Price |
$21.02
|
| Rate for Payer: Cash Price |
$21.06
|
| Rate for Payer: Cash Price |
$21.06
|
| Rate for Payer: Cash Price |
$22.57
|
| Rate for Payer: Cash Price |
$22.57
|
| Rate for Payer: Cash Price |
$36.14
|
| Rate for Payer: Cash Price |
$36.14
|
| Rate for Payer: Cofinity Advantage |
$14.87
|
| Rate for Payer: Cofinity Advantage |
$18.39
|
| Rate for Payer: Cofinity Advantage |
$16.12
|
| Rate for Payer: Cofinity Advantage |
$12.33
|
| Rate for Payer: Cofinity Advantage |
$19.75
|
| Rate for Payer: Cofinity Advantage |
$31.62
|
| Rate for Payer: Cofinity Advantage |
$18.42
|
| Rate for Payer: Cofinity Commercial |
$22.64
|
| Rate for Payer: Cofinity Commercial |
$22.59
|
| Rate for Payer: Cofinity Commercial |
$38.85
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Cofinity Commercial |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$19.81
|
| Rate for Payer: Cofinity Commercial |
$24.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Commercial |
$15.86
|
| Rate for Payer: Healthscope Commercial |
$40.65
|
| Rate for Payer: Healthscope Commercial |
$19.12
|
| Rate for Payer: Healthscope Commercial |
$23.69
|
| Rate for Payer: Healthscope Commercial |
$20.73
|
| Rate for Payer: Healthscope Commercial |
$23.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.16
|
| Rate for Payer: PHP Commercial |
$14.98
|
| Rate for Payer: PHP Commercial |
$19.58
|
| Rate for Payer: PHP Commercial |
$22.33
|
| Rate for Payer: PHP Commercial |
$22.37
|
| Rate for Payer: PHP Commercial |
$23.98
|
| Rate for Payer: PHP Commercial |
$38.39
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health SBD |
$17.77
|
| Rate for Payer: Priority Health SBD |
$11.10
|
| Rate for Payer: Priority Health SBD |
$28.46
|
| Rate for Payer: Priority Health SBD |
$16.58
|
| Rate for Payer: Priority Health SBD |
$16.55
|
| Rate for Payer: Priority Health SBD |
$13.38
|
| Rate for Payer: Priority Health SBD |
$14.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.32
|
|
|
Service Code
|
HCPCS J1163
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.58 |
| Max. Negotiated Rate |
$23.69 |
| Rate for Payer: Aetna Commercial |
$22.37
|
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Commercial |
$38.39
|
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Commercial |
$19.58
|
| Rate for Payer: Aetna Commercial |
$23.98
|
| Rate for Payer: Aetna Commercial |
$22.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.08
|
| Rate for Payer: Cash Price |
$21.02
|
| Rate for Payer: Cash Price |
$36.14
|
| Rate for Payer: Cash Price |
$21.06
|
| Rate for Payer: Cash Price |
$18.42
|
| Rate for Payer: Cash Price |
$22.57
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cofinity Advantage |
$18.39
|
| Rate for Payer: Cofinity Advantage |
$19.75
|
| Rate for Payer: Cofinity Advantage |
$31.62
|
| Rate for Payer: Cofinity Advantage |
$14.87
|
| Rate for Payer: Cofinity Advantage |
$18.42
|
| Rate for Payer: Cofinity Advantage |
$16.12
|
| Rate for Payer: Cofinity Advantage |
$12.33
|
| Rate for Payer: Cofinity Commercial |
$38.85
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Cofinity Commercial |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$19.81
|
| Rate for Payer: Cofinity Commercial |
$24.26
|
| Rate for Payer: Cofinity Commercial |
$22.59
|
| Rate for Payer: Cofinity Commercial |
$22.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Healthscope Commercial |
$19.12
|
| Rate for Payer: Healthscope Commercial |
$15.86
|
| Rate for Payer: Healthscope Commercial |
$23.69
|
| Rate for Payer: Healthscope Commercial |
$23.64
|
| Rate for Payer: Healthscope Commercial |
$20.73
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Commercial |
$40.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.16
|
| Rate for Payer: PHP Commercial |
$22.37
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: PHP Commercial |
$23.98
|
| Rate for Payer: PHP Commercial |
$22.33
|
| Rate for Payer: PHP Commercial |
$38.39
|
| Rate for Payer: PHP Commercial |
$14.98
|
| Rate for Payer: PHP Commercial |
$19.58
|
| Rate for Payer: Priority Health SBD |
$16.58
|
| Rate for Payer: Priority Health SBD |
$13.38
|
| Rate for Payer: Priority Health SBD |
$17.77
|
| Rate for Payer: Priority Health SBD |
$14.51
|
| Rate for Payer: Priority Health SBD |
$28.46
|
| Rate for Payer: Priority Health SBD |
$16.55
|
| Rate for Payer: Priority Health SBD |
$11.10
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
OP
|
$178.60
|
|
|
Service Code
|
NDC 50228048201
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.19 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$151.81
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.09
|
| Rate for Payer: BCBS Complete |
$71.44
|
| Rate for Payer: Cash Price |
$142.88
|
| Rate for Payer: Cofinity Advantage |
$125.02
|
| Rate for Payer: Cofinity Commercial |
$153.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.88
|
| Rate for Payer: Healthscope Commercial |
$160.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.95
|
| Rate for Payer: PHP Commercial |
$151.81
|
| Rate for Payer: Priority Health SBD |
$112.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.09
|
| Rate for Payer: UHC Core |
$93.05
|
| Rate for Payer: UHC Exchange |
$70.19
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
IP
|
$178.60
|
|
|
Service Code
|
NDC 50228048201
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$151.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.09
|
| Rate for Payer: Cash Price |
$142.88
|
| Rate for Payer: Cofinity Advantage |
$125.02
|
| Rate for Payer: Cofinity Commercial |
$153.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.88
|
| Rate for Payer: Healthscope Commercial |
$160.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.95
|
| Rate for Payer: PHP Commercial |
$151.81
|
| Rate for Payer: Priority Health SBD |
$112.52
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
OP
|
$582.72
|
|
|
Service Code
|
NDC 68682000710
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.01 |
| Max. Negotiated Rate |
$524.45 |
| Rate for Payer: Aetna Commercial |
$495.31
|
| Rate for Payer: Aetna Medicare |
$291.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.77
|
| Rate for Payer: BCBS Complete |
$233.09
|
| Rate for Payer: Cash Price |
$466.18
|
| Rate for Payer: Cofinity Advantage |
$407.90
|
| Rate for Payer: Cofinity Commercial |
$501.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.18
|
| Rate for Payer: Healthscope Commercial |
$524.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$466.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$437.04
|
| Rate for Payer: PHP Commercial |
$495.31
|
| Rate for Payer: Priority Health SBD |
$367.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.77
|
| Rate for Payer: UHC Core |
$303.60
|
| Rate for Payer: UHC Exchange |
$229.01
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
OP
|
$208.05
|
|
|
Service Code
|
NDC 00093031901
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.76 |
| Max. Negotiated Rate |
$187.25 |
| Rate for Payer: Aetna Commercial |
$176.84
|
| Rate for Payer: Aetna Medicare |
$104.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.23
|
| Rate for Payer: BCBS Complete |
$83.22
|
| Rate for Payer: Cash Price |
$166.44
|
| Rate for Payer: Cofinity Advantage |
$145.63
|
| Rate for Payer: Cofinity Commercial |
$178.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.44
|
| Rate for Payer: Healthscope Commercial |
$187.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.04
|
| Rate for Payer: PHP Commercial |
$176.84
|
| Rate for Payer: Priority Health SBD |
$131.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.23
|
| Rate for Payer: UHC Core |
$108.39
|
| Rate for Payer: UHC Exchange |
$81.76
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
OP
|
$240.48
|
|
|
Service Code
|
NDC 60687072801
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.51 |
| Max. Negotiated Rate |
$216.43 |
| Rate for Payer: Aetna Commercial |
$204.41
|
| Rate for Payer: Aetna Medicare |
$120.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.31
|
| Rate for Payer: BCBS Complete |
$96.19
|
| Rate for Payer: Cash Price |
$192.38
|
| Rate for Payer: Cofinity Advantage |
$168.34
|
| Rate for Payer: Cofinity Commercial |
$206.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.38
|
| Rate for Payer: Healthscope Commercial |
$216.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.36
|
| Rate for Payer: PHP Commercial |
$204.41
|
| Rate for Payer: Priority Health SBD |
$151.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.31
|
| Rate for Payer: UHC Core |
$125.29
|
| Rate for Payer: UHC Exchange |
$94.51
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
IP
|
$240.48
|
|
|
Service Code
|
NDC 60687072801
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.50 |
| Max. Negotiated Rate |
$216.43 |
| Rate for Payer: Aetna Commercial |
$204.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.31
|
| Rate for Payer: Cash Price |
$192.38
|
| Rate for Payer: Cofinity Advantage |
$168.34
|
| Rate for Payer: Cofinity Commercial |
$206.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.38
|
| Rate for Payer: Healthscope Commercial |
$216.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.36
|
| Rate for Payer: PHP Commercial |
$204.41
|
| Rate for Payer: Priority Health SBD |
$151.50
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
IP
|
$582.72
|
|
|
Service Code
|
NDC 68682000710
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$367.11 |
| Max. Negotiated Rate |
$524.45 |
| Rate for Payer: Aetna Commercial |
$495.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.77
|
| Rate for Payer: Cash Price |
$466.18
|
| Rate for Payer: Cofinity Advantage |
$407.90
|
| Rate for Payer: Cofinity Commercial |
$501.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.18
|
| Rate for Payer: Healthscope Commercial |
$524.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$437.04
|
| Rate for Payer: PHP Commercial |
$495.31
|
| Rate for Payer: Priority Health SBD |
$367.11
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
IP
|
$208.05
|
|
|
Service Code
|
NDC 00093031901
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.07 |
| Max. Negotiated Rate |
$187.25 |
| Rate for Payer: Aetna Commercial |
$176.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.23
|
| Rate for Payer: Cash Price |
$166.44
|
| Rate for Payer: Cofinity Advantage |
$145.63
|
| Rate for Payer: Cofinity Commercial |
$178.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.44
|
| Rate for Payer: Healthscope Commercial |
$187.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.04
|
| Rate for Payer: PHP Commercial |
$176.84
|
| Rate for Payer: Priority Health SBD |
$131.07
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
OP
|
$2.41
|
|
|
Service Code
|
NDC 60687072811
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Aetna Commercial |
$2.05
|
| Rate for Payer: Aetna Medicare |
$1.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.57
|
| Rate for Payer: BCBS Complete |
$0.96
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cofinity Advantage |
$1.69
|
| Rate for Payer: Cofinity Commercial |
$2.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$2.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.81
|
| Rate for Payer: PHP Commercial |
$2.05
|
| Rate for Payer: Priority Health SBD |
$1.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.57
|
| Rate for Payer: UHC Core |
$1.26
|
| Rate for Payer: UHC Exchange |
$0.95
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
IP
|
$2.41
|
|
|
Service Code
|
NDC 60687072811
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Aetna Commercial |
$2.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.57
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cofinity Advantage |
$1.69
|
| Rate for Payer: Cofinity Commercial |
$2.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$2.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.81
|
| Rate for Payer: PHP Commercial |
$2.05
|
| Rate for Payer: Priority Health SBD |
$1.52
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$311.04
|
|
|
Service Code
|
NDC 10370082909
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.96 |
| Max. Negotiated Rate |
$279.94 |
| Rate for Payer: Aetna Commercial |
$264.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.18
|
| Rate for Payer: Cash Price |
$248.83
|
| Rate for Payer: Cofinity Advantage |
$217.73
|
| Rate for Payer: Cofinity Commercial |
$267.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.83
|
| Rate for Payer: Healthscope Commercial |
$279.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.28
|
| Rate for Payer: PHP Commercial |
$264.38
|
| Rate for Payer: Priority Health SBD |
$195.96
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$381.90
|
|
|
Service Code
|
NDC 60687019501
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$240.60 |
| Max. Negotiated Rate |
$343.71 |
| Rate for Payer: Aetna Commercial |
$324.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.24
|
| Rate for Payer: Cash Price |
$305.52
|
| Rate for Payer: Cofinity Advantage |
$267.33
|
| Rate for Payer: Cofinity Commercial |
$328.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.52
|
| Rate for Payer: Healthscope Commercial |
$343.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$286.43
|
| Rate for Payer: PHP Commercial |
$324.62
|
| Rate for Payer: Priority Health SBD |
$240.60
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$389.88
|
|
|
Service Code
|
NDC 68382059516
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.62 |
| Max. Negotiated Rate |
$350.89 |
| Rate for Payer: Aetna Commercial |
$331.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.42
|
| Rate for Payer: Cash Price |
$311.90
|
| Rate for Payer: Cofinity Advantage |
$272.92
|
| Rate for Payer: Cofinity Commercial |
$335.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.90
|
| Rate for Payer: Healthscope Commercial |
$350.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.41
|
| Rate for Payer: PHP Commercial |
$331.40
|
| Rate for Payer: Priority Health SBD |
$245.62
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.82
|
|
|
Service Code
|
NDC 60687019511
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.44 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Aetna Medicare |
$1.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.48
|
| Rate for Payer: BCBS Complete |
$1.53
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Advantage |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$3.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.87
|
| Rate for Payer: PHP Commercial |
$3.25
|
| Rate for Payer: Priority Health SBD |
$2.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.48
|
| Rate for Payer: UHC Core |
$1.99
|
| Rate for Payer: UHC Exchange |
$1.50
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$347.70
|
|
|
Service Code
|
NDC 00904721761
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.65 |
| Max. Negotiated Rate |
$312.93 |
| Rate for Payer: Aetna Commercial |
$295.55
|
| Rate for Payer: Aetna Medicare |
$173.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.00
|
| Rate for Payer: BCBS Complete |
$139.08
|
| Rate for Payer: Cash Price |
$278.16
|
| Rate for Payer: Cofinity Advantage |
$243.39
|
| Rate for Payer: Cofinity Commercial |
$299.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.16
|
| Rate for Payer: Healthscope Commercial |
$312.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$278.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.77
|
| Rate for Payer: PHP Commercial |
$295.55
|
| Rate for Payer: Priority Health SBD |
$219.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.00
|
| Rate for Payer: UHC Core |
$181.15
|
| Rate for Payer: UHC Exchange |
$136.65
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$381.90
|
|
|
Service Code
|
NDC 60687019501
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.09 |
| Max. Negotiated Rate |
$343.71 |
| Rate for Payer: Aetna Commercial |
$324.62
|
| Rate for Payer: Aetna Medicare |
$190.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.24
|
| Rate for Payer: BCBS Complete |
$152.76
|
| Rate for Payer: Cash Price |
$305.52
|
| Rate for Payer: Cofinity Advantage |
$267.33
|
| Rate for Payer: Cofinity Commercial |
$328.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.52
|
| Rate for Payer: Healthscope Commercial |
$343.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$305.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$286.43
|
| Rate for Payer: PHP Commercial |
$324.62
|
| Rate for Payer: Priority Health SBD |
$240.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.24
|
| Rate for Payer: UHC Core |
$198.97
|
| Rate for Payer: UHC Exchange |
$150.09
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$311.04
|
|
|
Service Code
|
NDC 10370082909
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.24 |
| Max. Negotiated Rate |
$279.94 |
| Rate for Payer: Aetna Commercial |
$264.38
|
| Rate for Payer: Aetna Medicare |
$155.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.18
|
| Rate for Payer: BCBS Complete |
$124.42
|
| Rate for Payer: Cash Price |
$248.83
|
| Rate for Payer: Cofinity Advantage |
$217.73
|
| Rate for Payer: Cofinity Commercial |
$267.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.83
|
| Rate for Payer: Healthscope Commercial |
$279.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.28
|
| Rate for Payer: PHP Commercial |
$264.38
|
| Rate for Payer: Priority Health SBD |
$195.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.18
|
| Rate for Payer: UHC Core |
$162.05
|
| Rate for Payer: UHC Exchange |
$122.24
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$389.88
|
|
|
Service Code
|
NDC 68382059516
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.22 |
| Max. Negotiated Rate |
$350.89 |
| Rate for Payer: Aetna Commercial |
$331.40
|
| Rate for Payer: Aetna Medicare |
$194.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.42
|
| Rate for Payer: BCBS Complete |
$155.95
|
| Rate for Payer: Cash Price |
$311.90
|
| Rate for Payer: Cofinity Advantage |
$272.92
|
| Rate for Payer: Cofinity Commercial |
$335.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.90
|
| Rate for Payer: Healthscope Commercial |
$350.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$311.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.41
|
| Rate for Payer: PHP Commercial |
$331.40
|
| Rate for Payer: Priority Health SBD |
$245.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.42
|
| Rate for Payer: UHC Core |
$203.13
|
| Rate for Payer: UHC Exchange |
$153.22
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$347.70
|
|
|
Service Code
|
NDC 00904721761
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.05 |
| Max. Negotiated Rate |
$312.93 |
| Rate for Payer: Aetna Commercial |
$295.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.00
|
| Rate for Payer: Cash Price |
$278.16
|
| Rate for Payer: Cofinity Advantage |
$243.39
|
| Rate for Payer: Cofinity Commercial |
$299.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.16
|
| Rate for Payer: Healthscope Commercial |
$312.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.77
|
| Rate for Payer: PHP Commercial |
$295.55
|
| Rate for Payer: Priority Health SBD |
$219.05
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.82
|
|
|
Service Code
|
NDC 60687019511
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$3.44 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.48
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Advantage |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.87
|
| Rate for Payer: PHP Commercial |
$3.25
|
| Rate for Payer: Priority Health SBD |
$2.41
|
|
