|
DILTIAZEM 30 MG TABLET
|
Facility
|
OP
|
$3.67
|
|
|
Service Code
|
NDC 60687071711
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna Commercial |
$3.12
|
| Rate for Payer: Aetna Medicare |
$0.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.15
|
| Rate for Payer: BCBS Complete |
$1.47
|
| Rate for Payer: BCBS MAPPO |
$0.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.02
|
| Rate for Payer: BCN Commercial |
$2.85
|
| Rate for Payer: BCN Medicare Advantage |
$0.92
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.92
|
| Rate for Payer: Healthscope Commercial |
$3.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.12
|
| Rate for Payer: Nomi Health Commercial |
$3.01
|
| Rate for Payer: PACE Senior Care Partners |
$0.87
|
| Rate for Payer: PACE SWMI |
$0.92
|
| Rate for Payer: PHP Commercial |
$3.12
|
| Rate for Payer: PHP Medicare Advantage |
$0.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: Priority Health HMO/PPO |
$3.19
|
| Rate for Payer: Priority Health Medicare |
$0.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.46
|
| Rate for Payer: Railroad Medicare Medicare |
$0.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.23
|
| Rate for Payer: UHC Core |
$3.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.92
|
| Rate for Payer: UHC Exchange |
$0.92
|
| Rate for Payer: UHC Medicare Advantage |
$0.92
|
| Rate for Payer: VA VA |
$0.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.75
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
OP
|
$366.70
|
|
|
Service Code
|
NDC 60687071701
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.09 |
| Max. Negotiated Rate |
$330.03 |
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna Medicare |
$95.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.59
|
| Rate for Payer: BCBS Complete |
$146.68
|
| Rate for Payer: BCBS MAPPO |
$91.67
|
| Rate for Payer: BCBS Trust/PPO |
$301.46
|
| Rate for Payer: BCN Commercial |
$285.11
|
| Rate for Payer: BCN Medicare Advantage |
$91.67
|
| Rate for Payer: Cash Price |
$293.36
|
| Rate for Payer: Cofinity Commercial |
$315.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.67
|
| Rate for Payer: Healthscope Commercial |
$330.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.69
|
| Rate for Payer: Nomi Health Commercial |
$300.69
|
| Rate for Payer: PACE Senior Care Partners |
$87.09
|
| Rate for Payer: PACE SWMI |
$91.67
|
| Rate for Payer: PHP Commercial |
$311.69
|
| Rate for Payer: PHP Medicare Advantage |
$91.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.35
|
| Rate for Payer: Priority Health HMO/PPO |
$319.03
|
| Rate for Payer: Priority Health Medicare |
$92.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.69
|
| Rate for Payer: Railroad Medicare Medicare |
$91.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.70
|
| Rate for Payer: UHC Core |
$306.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.67
|
| Rate for Payer: UHC Exchange |
$91.67
|
| Rate for Payer: UHC Medicare Advantage |
$91.67
|
| Rate for Payer: VA VA |
$91.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.02
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$48.63
|
|
|
Service Code
|
NDC 00641921710
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.61 |
| Max. Negotiated Rate |
$43.77 |
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: BCBS Trust/PPO |
$39.70
|
| Rate for Payer: BCN Commercial |
$37.58
|
| Rate for Payer: Cash Price |
$38.90
|
| Rate for Payer: Cofinity Commercial |
$41.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.90
|
| Rate for Payer: Healthscope Commercial |
$43.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: Nomi Health Commercial |
$39.88
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.61
|
| Rate for Payer: Priority Health HMO/PPO |
$42.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.79
|
| Rate for Payer: UHC Core |
$40.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.47
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$48.63
|
|
|
Service Code
|
NDC 00641921701
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$43.77 |
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: Aetna Medicare |
$12.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.20
|
| Rate for Payer: BCBS Complete |
$19.45
|
| Rate for Payer: BCBS MAPPO |
$12.16
|
| Rate for Payer: BCBS Trust/PPO |
$39.98
|
| Rate for Payer: BCN Commercial |
$37.81
|
| Rate for Payer: BCN Medicare Advantage |
$12.16
|
| Rate for Payer: Cash Price |
$38.90
|
| Rate for Payer: Cofinity Commercial |
$41.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.16
|
| Rate for Payer: Healthscope Commercial |
$43.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: Nomi Health Commercial |
$39.88
|
| Rate for Payer: PACE Senior Care Partners |
$11.55
|
| Rate for Payer: PACE SWMI |
$12.16
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: PHP Medicare Advantage |
$12.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.61
|
| Rate for Payer: Priority Health HMO/PPO |
$42.31
|
| Rate for Payer: Priority Health Medicare |
$12.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.58
|
| Rate for Payer: Railroad Medicare Medicare |
$12.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.79
|
| Rate for Payer: UHC Core |
$40.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.16
|
| Rate for Payer: UHC Exchange |
$12.16
|
| Rate for Payer: UHC Medicare Advantage |
$12.16
|
| Rate for Payer: VA VA |
$12.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.47
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$48.63
|
|
|
Service Code
|
NDC 00641601301
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.61 |
| Max. Negotiated Rate |
$43.77 |
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: BCBS Trust/PPO |
$39.70
|
| Rate for Payer: BCN Commercial |
$37.58
|
| Rate for Payer: Cash Price |
$38.90
|
| Rate for Payer: Cofinity Commercial |
$41.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.90
|
| Rate for Payer: Healthscope Commercial |
$43.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: Nomi Health Commercial |
$39.88
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.61
|
| Rate for Payer: Priority Health HMO/PPO |
$42.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.79
|
| Rate for Payer: UHC Core |
$40.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.47
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$129.38
|
|
|
Service Code
|
NDC 00641601501
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.10 |
| Max. Negotiated Rate |
$116.44 |
| Rate for Payer: Aetna Commercial |
$109.97
|
| Rate for Payer: BCBS Trust/PPO |
$105.61
|
| Rate for Payer: BCN Commercial |
$99.98
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cofinity Commercial |
$111.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.50
|
| Rate for Payer: Healthscope Commercial |
$116.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.97
|
| Rate for Payer: Nomi Health Commercial |
$106.09
|
| Rate for Payer: PHP Commercial |
$109.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.10
|
| Rate for Payer: Priority Health HMO/PPO |
$112.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.85
|
| Rate for Payer: UHC Core |
$108.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.03
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$253.75
|
|
|
Service Code
|
NDC 17478093726
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$164.94 |
| Max. Negotiated Rate |
$228.38 |
| Rate for Payer: Aetna Commercial |
$215.69
|
| Rate for Payer: BCBS Trust/PPO |
$207.14
|
| Rate for Payer: BCN Commercial |
$196.10
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: Cofinity Commercial |
$218.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.00
|
| Rate for Payer: Healthscope Commercial |
$228.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.69
|
| Rate for Payer: Nomi Health Commercial |
$208.07
|
| Rate for Payer: PHP Commercial |
$215.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.94
|
| Rate for Payer: Priority Health HMO/PPO |
$220.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.30
|
| Rate for Payer: UHC Core |
$211.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.31
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$129.38
|
|
|
Service Code
|
NDC 00641601510
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.10 |
| Max. Negotiated Rate |
$116.44 |
| Rate for Payer: Aetna Commercial |
$109.97
|
| Rate for Payer: BCBS Trust/PPO |
$105.61
|
| Rate for Payer: BCN Commercial |
$99.98
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cofinity Commercial |
$111.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.50
|
| Rate for Payer: Healthscope Commercial |
$116.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.97
|
| Rate for Payer: Nomi Health Commercial |
$106.09
|
| Rate for Payer: PHP Commercial |
$109.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.10
|
| Rate for Payer: Priority Health HMO/PPO |
$112.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.85
|
| Rate for Payer: UHC Core |
$108.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.03
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$48.63
|
|
|
Service Code
|
NDC 00641601310
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.61 |
| Max. Negotiated Rate |
$43.77 |
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: BCBS Trust/PPO |
$39.70
|
| Rate for Payer: BCN Commercial |
$37.58
|
| Rate for Payer: Cash Price |
$38.90
|
| Rate for Payer: Cofinity Commercial |
$41.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.90
|
| Rate for Payer: Healthscope Commercial |
$43.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: Nomi Health Commercial |
$39.88
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.61
|
| Rate for Payer: Priority Health HMO/PPO |
$42.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.79
|
| Rate for Payer: UHC Core |
$40.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.47
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$253.75
|
|
|
Service Code
|
NDC 17478093726
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$228.38 |
| Rate for Payer: Aetna Commercial |
$215.69
|
| Rate for Payer: Aetna Medicare |
$65.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.30
|
| Rate for Payer: BCBS Complete |
$101.50
|
| Rate for Payer: BCBS MAPPO |
$63.44
|
| Rate for Payer: BCBS Trust/PPO |
$208.61
|
| Rate for Payer: BCN Commercial |
$197.29
|
| Rate for Payer: BCN Medicare Advantage |
$63.44
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: Cofinity Commercial |
$218.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.44
|
| Rate for Payer: Healthscope Commercial |
$228.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.69
|
| Rate for Payer: Nomi Health Commercial |
$208.07
|
| Rate for Payer: PACE Senior Care Partners |
$60.27
|
| Rate for Payer: PACE SWMI |
$63.44
|
| Rate for Payer: PHP Commercial |
$215.69
|
| Rate for Payer: PHP Medicare Advantage |
$63.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.94
|
| Rate for Payer: Priority Health HMO/PPO |
$220.76
|
| Rate for Payer: Priority Health Medicare |
$64.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.01
|
| Rate for Payer: Railroad Medicare Medicare |
$63.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.30
|
| Rate for Payer: UHC Core |
$211.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.44
|
| Rate for Payer: UHC Exchange |
$63.44
|
| Rate for Payer: UHC Medicare Advantage |
$63.44
|
| Rate for Payer: VA VA |
$63.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.31
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$45.63
|
|
|
Service Code
|
NDC 70860030141
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$41.07 |
| Rate for Payer: Aetna Commercial |
$38.79
|
| Rate for Payer: Aetna Medicare |
$11.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.26
|
| Rate for Payer: BCBS Complete |
$18.25
|
| Rate for Payer: BCBS MAPPO |
$11.41
|
| Rate for Payer: BCBS Trust/PPO |
$37.51
|
| Rate for Payer: BCN Commercial |
$35.48
|
| Rate for Payer: BCN Medicare Advantage |
$11.41
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cofinity Commercial |
$39.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.41
|
| Rate for Payer: Healthscope Commercial |
$41.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.79
|
| Rate for Payer: Nomi Health Commercial |
$37.42
|
| Rate for Payer: PACE Senior Care Partners |
$10.84
|
| Rate for Payer: PACE SWMI |
$11.41
|
| Rate for Payer: PHP Commercial |
$38.79
|
| Rate for Payer: PHP Medicare Advantage |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.66
|
| Rate for Payer: Priority Health HMO/PPO |
$39.70
|
| Rate for Payer: Priority Health Medicare |
$11.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.57
|
| Rate for Payer: Railroad Medicare Medicare |
$11.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.15
|
| Rate for Payer: UHC Core |
$38.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.41
|
| Rate for Payer: UHC Exchange |
$11.41
|
| Rate for Payer: UHC Medicare Advantage |
$11.41
|
| Rate for Payer: VA VA |
$11.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.22
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$45.63
|
|
|
Service Code
|
NDC 70860030141
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.66 |
| Max. Negotiated Rate |
$41.07 |
| Rate for Payer: Aetna Commercial |
$38.79
|
| Rate for Payer: BCBS Trust/PPO |
$37.25
|
| Rate for Payer: BCN Commercial |
$35.26
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cofinity Commercial |
$39.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.50
|
| Rate for Payer: Healthscope Commercial |
$41.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.79
|
| Rate for Payer: Nomi Health Commercial |
$37.42
|
| Rate for Payer: PHP Commercial |
$38.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.66
|
| Rate for Payer: Priority Health HMO/PPO |
$39.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.15
|
| Rate for Payer: UHC Core |
$38.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.22
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$45.63
|
|
|
Service Code
|
NDC 70860030105
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$41.07 |
| Rate for Payer: Aetna Commercial |
$38.79
|
| Rate for Payer: Aetna Medicare |
$11.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.26
|
| Rate for Payer: BCBS Complete |
$18.25
|
| Rate for Payer: BCBS MAPPO |
$11.41
|
| Rate for Payer: BCBS Trust/PPO |
$37.51
|
| Rate for Payer: BCN Commercial |
$35.48
|
| Rate for Payer: BCN Medicare Advantage |
$11.41
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cofinity Commercial |
$39.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.41
|
| Rate for Payer: Healthscope Commercial |
$41.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.79
|
| Rate for Payer: Nomi Health Commercial |
$37.42
|
| Rate for Payer: PACE Senior Care Partners |
$10.84
|
| Rate for Payer: PACE SWMI |
$11.41
|
| Rate for Payer: PHP Commercial |
$38.79
|
| Rate for Payer: PHP Medicare Advantage |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.66
|
| Rate for Payer: Priority Health HMO/PPO |
$39.70
|
| Rate for Payer: Priority Health Medicare |
$11.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.57
|
| Rate for Payer: Railroad Medicare Medicare |
$11.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.15
|
| Rate for Payer: UHC Core |
$38.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.41
|
| Rate for Payer: UHC Exchange |
$11.41
|
| Rate for Payer: UHC Medicare Advantage |
$11.41
|
| Rate for Payer: VA VA |
$11.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.22
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$65.25
|
|
|
Service Code
|
NDC 17478093705
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$58.73 |
| Rate for Payer: Aetna Commercial |
$55.46
|
| Rate for Payer: Aetna Medicare |
$16.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.39
|
| Rate for Payer: BCBS Complete |
$26.10
|
| Rate for Payer: BCBS MAPPO |
$16.31
|
| Rate for Payer: BCBS Trust/PPO |
$53.64
|
| Rate for Payer: BCN Commercial |
$50.73
|
| Rate for Payer: BCN Medicare Advantage |
$16.31
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cofinity Commercial |
$56.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.31
|
| Rate for Payer: Healthscope Commercial |
$58.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.46
|
| Rate for Payer: Nomi Health Commercial |
$53.51
|
| Rate for Payer: PACE Senior Care Partners |
$15.50
|
| Rate for Payer: PACE SWMI |
$16.31
|
| Rate for Payer: PHP Commercial |
$55.46
|
| Rate for Payer: PHP Medicare Advantage |
$16.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.41
|
| Rate for Payer: Priority Health HMO/PPO |
$56.77
|
| Rate for Payer: Priority Health Medicare |
$16.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.72
|
| Rate for Payer: Railroad Medicare Medicare |
$16.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.42
|
| Rate for Payer: UHC Core |
$54.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.31
|
| Rate for Payer: UHC Exchange |
$16.31
|
| Rate for Payer: UHC Medicare Advantage |
$16.31
|
| Rate for Payer: VA VA |
$16.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.94
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$48.63
|
|
|
Service Code
|
NDC 00641601310
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$43.77 |
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: Aetna Medicare |
$12.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.20
|
| Rate for Payer: BCBS Complete |
$19.45
|
| Rate for Payer: BCBS MAPPO |
$12.16
|
| Rate for Payer: BCBS Trust/PPO |
$39.98
|
| Rate for Payer: BCN Commercial |
$37.81
|
| Rate for Payer: BCN Medicare Advantage |
$12.16
|
| Rate for Payer: Cash Price |
$38.90
|
| Rate for Payer: Cofinity Commercial |
$41.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.16
|
| Rate for Payer: Healthscope Commercial |
$43.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: Nomi Health Commercial |
$39.88
|
| Rate for Payer: PACE Senior Care Partners |
$11.55
|
| Rate for Payer: PACE SWMI |
$12.16
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: PHP Medicare Advantage |
$12.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.61
|
| Rate for Payer: Priority Health HMO/PPO |
$42.31
|
| Rate for Payer: Priority Health Medicare |
$12.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.58
|
| Rate for Payer: Railroad Medicare Medicare |
$12.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.79
|
| Rate for Payer: UHC Core |
$40.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.16
|
| Rate for Payer: UHC Exchange |
$12.16
|
| Rate for Payer: UHC Medicare Advantage |
$12.16
|
| Rate for Payer: VA VA |
$12.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.47
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$129.38
|
|
|
Service Code
|
NDC 00641601501
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.73 |
| Max. Negotiated Rate |
$116.44 |
| Rate for Payer: Aetna Commercial |
$109.97
|
| Rate for Payer: Aetna Medicare |
$33.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.43
|
| Rate for Payer: BCBS Complete |
$51.75
|
| Rate for Payer: BCBS MAPPO |
$32.34
|
| Rate for Payer: BCBS Trust/PPO |
$106.36
|
| Rate for Payer: BCN Commercial |
$100.59
|
| Rate for Payer: BCN Medicare Advantage |
$32.34
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cofinity Commercial |
$111.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.34
|
| Rate for Payer: Healthscope Commercial |
$116.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.97
|
| Rate for Payer: Nomi Health Commercial |
$106.09
|
| Rate for Payer: PACE Senior Care Partners |
$30.73
|
| Rate for Payer: PACE SWMI |
$32.34
|
| Rate for Payer: PHP Commercial |
$109.97
|
| Rate for Payer: PHP Medicare Advantage |
$32.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.10
|
| Rate for Payer: Priority Health HMO/PPO |
$112.56
|
| Rate for Payer: Priority Health Medicare |
$32.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.68
|
| Rate for Payer: Railroad Medicare Medicare |
$32.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.85
|
| Rate for Payer: UHC Core |
$108.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.34
|
| Rate for Payer: UHC Exchange |
$32.34
|
| Rate for Payer: UHC Medicare Advantage |
$32.34
|
| Rate for Payer: VA VA |
$32.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.03
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$253.75
|
|
|
Service Code
|
NDC 17478093725
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$164.94 |
| Max. Negotiated Rate |
$228.38 |
| Rate for Payer: Aetna Commercial |
$215.69
|
| Rate for Payer: BCBS Trust/PPO |
$207.14
|
| Rate for Payer: BCN Commercial |
$196.10
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: Cofinity Commercial |
$218.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.00
|
| Rate for Payer: Healthscope Commercial |
$228.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.69
|
| Rate for Payer: Nomi Health Commercial |
$208.07
|
| Rate for Payer: PHP Commercial |
$215.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.94
|
| Rate for Payer: Priority Health HMO/PPO |
$220.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.30
|
| Rate for Payer: UHC Core |
$211.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.31
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$48.63
|
|
|
Service Code
|
NDC 00641921710
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$43.77 |
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: Aetna Medicare |
$12.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.20
|
| Rate for Payer: BCBS Complete |
$19.45
|
| Rate for Payer: BCBS MAPPO |
$12.16
|
| Rate for Payer: BCBS Trust/PPO |
$39.98
|
| Rate for Payer: BCN Commercial |
$37.81
|
| Rate for Payer: BCN Medicare Advantage |
$12.16
|
| Rate for Payer: Cash Price |
$38.90
|
| Rate for Payer: Cofinity Commercial |
$41.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.16
|
| Rate for Payer: Healthscope Commercial |
$43.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: Nomi Health Commercial |
$39.88
|
| Rate for Payer: PACE Senior Care Partners |
$11.55
|
| Rate for Payer: PACE SWMI |
$12.16
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: PHP Medicare Advantage |
$12.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.61
|
| Rate for Payer: Priority Health HMO/PPO |
$42.31
|
| Rate for Payer: Priority Health Medicare |
$12.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.58
|
| Rate for Payer: Railroad Medicare Medicare |
$12.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.79
|
| Rate for Payer: UHC Core |
$40.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.16
|
| Rate for Payer: UHC Exchange |
$12.16
|
| Rate for Payer: UHC Medicare Advantage |
$12.16
|
| Rate for Payer: VA VA |
$12.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.47
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$65.25
|
|
|
Service Code
|
NDC 17478093705
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.41 |
| Max. Negotiated Rate |
$58.73 |
| Rate for Payer: Aetna Commercial |
$55.46
|
| Rate for Payer: BCBS Trust/PPO |
$53.26
|
| Rate for Payer: BCN Commercial |
$50.43
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cofinity Commercial |
$56.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.20
|
| Rate for Payer: Healthscope Commercial |
$58.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.46
|
| Rate for Payer: Nomi Health Commercial |
$53.51
|
| Rate for Payer: PHP Commercial |
$55.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.41
|
| Rate for Payer: Priority Health HMO/PPO |
$56.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.42
|
| Rate for Payer: UHC Core |
$54.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.94
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$129.38
|
|
|
Service Code
|
NDC 00641601510
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.73 |
| Max. Negotiated Rate |
$116.44 |
| Rate for Payer: Aetna Commercial |
$109.97
|
| Rate for Payer: Aetna Medicare |
$33.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.43
|
| Rate for Payer: BCBS Complete |
$51.75
|
| Rate for Payer: BCBS MAPPO |
$32.34
|
| Rate for Payer: BCBS Trust/PPO |
$106.36
|
| Rate for Payer: BCN Commercial |
$100.59
|
| Rate for Payer: BCN Medicare Advantage |
$32.34
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cofinity Commercial |
$111.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.34
|
| Rate for Payer: Healthscope Commercial |
$116.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.97
|
| Rate for Payer: Nomi Health Commercial |
$106.09
|
| Rate for Payer: PACE Senior Care Partners |
$30.73
|
| Rate for Payer: PACE SWMI |
$32.34
|
| Rate for Payer: PHP Commercial |
$109.97
|
| Rate for Payer: PHP Medicare Advantage |
$32.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.10
|
| Rate for Payer: Priority Health HMO/PPO |
$112.56
|
| Rate for Payer: Priority Health Medicare |
$32.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.68
|
| Rate for Payer: Railroad Medicare Medicare |
$32.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.85
|
| Rate for Payer: UHC Core |
$108.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.34
|
| Rate for Payer: UHC Exchange |
$32.34
|
| Rate for Payer: UHC Medicare Advantage |
$32.34
|
| Rate for Payer: VA VA |
$32.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.03
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$253.75
|
|
|
Service Code
|
NDC 17478093725
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$228.38 |
| Rate for Payer: Aetna Commercial |
$215.69
|
| Rate for Payer: Aetna Medicare |
$65.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.30
|
| Rate for Payer: BCBS Complete |
$101.50
|
| Rate for Payer: BCBS MAPPO |
$63.44
|
| Rate for Payer: BCBS Trust/PPO |
$208.61
|
| Rate for Payer: BCN Commercial |
$197.29
|
| Rate for Payer: BCN Medicare Advantage |
$63.44
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: Cofinity Commercial |
$218.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.44
|
| Rate for Payer: Healthscope Commercial |
$228.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.69
|
| Rate for Payer: Nomi Health Commercial |
$208.07
|
| Rate for Payer: PACE Senior Care Partners |
$60.27
|
| Rate for Payer: PACE SWMI |
$63.44
|
| Rate for Payer: PHP Commercial |
$215.69
|
| Rate for Payer: PHP Medicare Advantage |
$63.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.94
|
| Rate for Payer: Priority Health HMO/PPO |
$220.76
|
| Rate for Payer: Priority Health Medicare |
$64.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.01
|
| Rate for Payer: Railroad Medicare Medicare |
$63.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.30
|
| Rate for Payer: UHC Core |
$211.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.44
|
| Rate for Payer: UHC Exchange |
$63.44
|
| Rate for Payer: UHC Medicare Advantage |
$63.44
|
| Rate for Payer: VA VA |
$63.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.31
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$48.63
|
|
|
Service Code
|
NDC 00641921701
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.61 |
| Max. Negotiated Rate |
$43.77 |
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: BCBS Trust/PPO |
$39.70
|
| Rate for Payer: BCN Commercial |
$37.58
|
| Rate for Payer: Cash Price |
$38.90
|
| Rate for Payer: Cofinity Commercial |
$41.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.90
|
| Rate for Payer: Healthscope Commercial |
$43.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: Nomi Health Commercial |
$39.88
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.61
|
| Rate for Payer: Priority Health HMO/PPO |
$42.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.79
|
| Rate for Payer: UHC Core |
$40.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.47
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$48.63
|
|
|
Service Code
|
NDC 00641601301
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$43.77 |
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: Aetna Medicare |
$12.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.20
|
| Rate for Payer: BCBS Complete |
$19.45
|
| Rate for Payer: BCBS MAPPO |
$12.16
|
| Rate for Payer: BCBS Trust/PPO |
$39.98
|
| Rate for Payer: BCN Commercial |
$37.81
|
| Rate for Payer: BCN Medicare Advantage |
$12.16
|
| Rate for Payer: Cash Price |
$38.90
|
| Rate for Payer: Cofinity Commercial |
$41.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.16
|
| Rate for Payer: Healthscope Commercial |
$43.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: Nomi Health Commercial |
$39.88
|
| Rate for Payer: PACE Senior Care Partners |
$11.55
|
| Rate for Payer: PACE SWMI |
$12.16
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: PHP Medicare Advantage |
$12.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.61
|
| Rate for Payer: Priority Health HMO/PPO |
$42.31
|
| Rate for Payer: Priority Health Medicare |
$12.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.58
|
| Rate for Payer: Railroad Medicare Medicare |
$12.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.79
|
| Rate for Payer: UHC Core |
$40.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.16
|
| Rate for Payer: UHC Exchange |
$12.16
|
| Rate for Payer: UHC Medicare Advantage |
$12.16
|
| Rate for Payer: VA VA |
$12.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.47
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$45.63
|
|
|
Service Code
|
NDC 70860030105
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.66 |
| Max. Negotiated Rate |
$41.07 |
| Rate for Payer: Aetna Commercial |
$38.79
|
| Rate for Payer: BCBS Trust/PPO |
$37.25
|
| Rate for Payer: BCN Commercial |
$35.26
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cofinity Commercial |
$39.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.50
|
| Rate for Payer: Healthscope Commercial |
$41.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.79
|
| Rate for Payer: Nomi Health Commercial |
$37.42
|
| Rate for Payer: PHP Commercial |
$38.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.66
|
| Rate for Payer: Priority Health HMO/PPO |
$39.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.15
|
| Rate for Payer: UHC Core |
$38.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.22
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
OP
|
$208.05
|
|
|
Service Code
|
NDC 00093031901
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$187.25 |
| Rate for Payer: Aetna Commercial |
$176.84
|
| Rate for Payer: Aetna Medicare |
$54.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.02
|
| Rate for Payer: BCBS Complete |
$83.22
|
| Rate for Payer: BCBS MAPPO |
$52.01
|
| Rate for Payer: BCBS Trust/PPO |
$171.04
|
| Rate for Payer: BCN Commercial |
$161.76
|
| Rate for Payer: BCN Medicare Advantage |
$52.01
|
| Rate for Payer: Cash Price |
$166.44
|
| Rate for Payer: Cofinity Commercial |
$178.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.01
|
| Rate for Payer: Healthscope Commercial |
$187.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.84
|
| Rate for Payer: Nomi Health Commercial |
$170.60
|
| Rate for Payer: PACE Senior Care Partners |
$49.41
|
| Rate for Payer: PACE SWMI |
$52.01
|
| Rate for Payer: PHP Commercial |
$176.84
|
| Rate for Payer: PHP Medicare Advantage |
$52.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.23
|
| Rate for Payer: Priority Health HMO/PPO |
$181.00
|
| Rate for Payer: Priority Health Medicare |
$52.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.39
|
| Rate for Payer: Railroad Medicare Medicare |
$52.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.08
|
| Rate for Payer: UHC Core |
$173.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.01
|
| Rate for Payer: UHC Exchange |
$52.01
|
| Rate for Payer: UHC Medicare Advantage |
$52.01
|
| Rate for Payer: VA VA |
$52.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.04
|
|
