|
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
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.70
|
|
|
Service Code
|
NDC 60687019511
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Aetna Commercial |
$3.15
|
| Rate for Payer: Aetna Medicare |
$0.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.16
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: BCBS MAPPO |
$0.93
|
| Rate for Payer: BCBS Trust/PPO |
$3.04
|
| Rate for Payer: BCN Commercial |
$2.88
|
| Rate for Payer: BCN Medicare Advantage |
$0.93
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cofinity Commercial |
$3.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.93
|
| Rate for Payer: Healthscope Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.15
|
| Rate for Payer: Nomi Health Commercial |
$3.03
|
| Rate for Payer: PACE Senior Care Partners |
$0.88
|
| Rate for Payer: PACE SWMI |
$0.93
|
| Rate for Payer: PHP Commercial |
$3.15
|
| Rate for Payer: PHP Medicare Advantage |
$0.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| Rate for Payer: Priority Health HMO/PPO |
$3.22
|
| Rate for Payer: Priority Health Medicare |
$0.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.48
|
| Rate for Payer: Railroad Medicare Medicare |
$0.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.26
|
| Rate for Payer: UHC Core |
$3.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.93
|
| Rate for Payer: UHC Exchange |
$0.93
|
| Rate for Payer: UHC Medicare Advantage |
$0.93
|
| Rate for Payer: VA VA |
$0.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.70
|
|
|
Service Code
|
NDC 60687019511
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Aetna Commercial |
$3.15
|
| Rate for Payer: BCBS Trust/PPO |
$3.02
|
| Rate for Payer: BCN Commercial |
$2.86
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cofinity Commercial |
$3.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.96
|
| Rate for Payer: Healthscope Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.15
|
| Rate for Payer: Nomi Health Commercial |
$3.03
|
| Rate for Payer: PHP Commercial |
$3.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| Rate for Payer: Priority Health HMO/PPO |
$3.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.26
|
| Rate for Payer: UHC Core |
$3.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$369.55
|
|
|
Service Code
|
NDC 60687019501
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$240.21 |
| Max. Negotiated Rate |
$332.60 |
| Rate for Payer: Aetna Commercial |
$314.12
|
| Rate for Payer: BCBS Trust/PPO |
$301.66
|
| Rate for Payer: BCN Commercial |
$285.59
|
| Rate for Payer: Cash Price |
$295.64
|
| Rate for Payer: Cofinity Commercial |
$317.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.64
|
| Rate for Payer: Healthscope Commercial |
$332.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.12
|
| Rate for Payer: Nomi Health Commercial |
$303.03
|
| Rate for Payer: PHP Commercial |
$314.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.21
|
| Rate for Payer: Priority Health HMO/PPO |
$321.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$325.20
|
| Rate for Payer: UHC Core |
$308.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.16
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$369.55
|
|
|
Service Code
|
NDC 60687019501
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.77 |
| Max. Negotiated Rate |
$332.60 |
| Rate for Payer: Aetna Commercial |
$314.12
|
| Rate for Payer: Aetna Medicare |
$96.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$115.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$115.48
|
| Rate for Payer: BCBS Complete |
$147.82
|
| Rate for Payer: BCBS MAPPO |
$92.39
|
| Rate for Payer: BCBS Trust/PPO |
$303.81
|
| Rate for Payer: BCN Commercial |
$287.33
|
| Rate for Payer: BCN Medicare Advantage |
$92.39
|
| Rate for Payer: Cash Price |
$295.64
|
| Rate for Payer: Cofinity Commercial |
$317.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.39
|
| Rate for Payer: Healthscope Commercial |
$332.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.12
|
| Rate for Payer: Nomi Health Commercial |
$303.03
|
| Rate for Payer: PACE Senior Care Partners |
$87.77
|
| Rate for Payer: PACE SWMI |
$92.39
|
| Rate for Payer: PHP Commercial |
$314.12
|
| Rate for Payer: PHP Medicare Advantage |
$92.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.21
|
| Rate for Payer: Priority Health HMO/PPO |
$321.51
|
| Rate for Payer: Priority Health Medicare |
$93.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.60
|
| Rate for Payer: Railroad Medicare Medicare |
$92.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$325.20
|
| Rate for Payer: UHC Core |
$308.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.39
|
| Rate for Payer: UHC Exchange |
$92.39
|
| Rate for Payer: UHC Medicare Advantage |
$92.39
|
| Rate for Payer: VA VA |
$92.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.16
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
NDC 60687020601
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.60 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna Commercial |
$258.40
|
| Rate for Payer: BCBS Trust/PPO |
$248.16
|
| Rate for Payer: BCN Commercial |
$234.93
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cofinity Commercial |
$261.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.20
|
| Rate for Payer: Healthscope Commercial |
$273.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.40
|
| Rate for Payer: Nomi Health Commercial |
$249.28
|
| Rate for Payer: PHP Commercial |
$258.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.60
|
| Rate for Payer: Priority Health HMO/PPO |
$264.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.52
|
| Rate for Payer: UHC Core |
$253.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.00
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.04
|
|
|
Service Code
|
NDC 60687020611
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna Medicare |
$0.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.95
|
| Rate for Payer: BCBS Complete |
$1.22
|
| Rate for Payer: BCBS MAPPO |
$0.76
|
| Rate for Payer: BCBS Trust/PPO |
$2.50
|
| Rate for Payer: BCN Commercial |
$2.36
|
| Rate for Payer: BCN Medicare Advantage |
$0.76
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.76
|
| Rate for Payer: Healthscope Commercial |
$2.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Nomi Health Commercial |
$2.49
|
| Rate for Payer: PACE Senior Care Partners |
$0.72
|
| Rate for Payer: PACE SWMI |
$0.76
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: PHP Medicare Advantage |
$0.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.98
|
| Rate for Payer: Priority Health HMO/PPO |
$2.64
|
| Rate for Payer: Priority Health Medicare |
$0.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.04
|
| Rate for Payer: Railroad Medicare Medicare |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.68
|
| Rate for Payer: UHC Core |
$2.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Medicare Advantage |
$0.76
|
| Rate for Payer: VA VA |
$0.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.28
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
NDC 60687020601
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.20 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna Commercial |
$258.40
|
| Rate for Payer: Aetna Medicare |
$79.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.00
|
| Rate for Payer: BCBS Complete |
$121.60
|
| Rate for Payer: BCBS MAPPO |
$76.00
|
| Rate for Payer: BCBS Trust/PPO |
$249.92
|
| Rate for Payer: BCN Commercial |
$236.36
|
| Rate for Payer: BCN Medicare Advantage |
$76.00
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cofinity Commercial |
$261.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.00
|
| Rate for Payer: Healthscope Commercial |
$273.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.40
|
| Rate for Payer: Nomi Health Commercial |
$249.28
|
| Rate for Payer: PACE Senior Care Partners |
$72.20
|
| Rate for Payer: PACE SWMI |
$76.00
|
| Rate for Payer: PHP Commercial |
$258.40
|
| Rate for Payer: PHP Medicare Advantage |
$76.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.60
|
| Rate for Payer: Priority Health HMO/PPO |
$264.48
|
| Rate for Payer: Priority Health Medicare |
$76.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.68
|
| Rate for Payer: Railroad Medicare Medicare |
$76.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.52
|
| Rate for Payer: UHC Core |
$253.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.00
|
| Rate for Payer: UHC Exchange |
$76.00
|
| Rate for Payer: UHC Medicare Advantage |
$76.00
|
| Rate for Payer: VA VA |
$76.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.00
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.04
|
|
|
Service Code
|
NDC 60687020611
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: BCBS Trust/PPO |
$2.48
|
| Rate for Payer: BCN Commercial |
$2.35
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.43
|
| Rate for Payer: Healthscope Commercial |
$2.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Nomi Health Commercial |
$2.49
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.98
|
| Rate for Payer: Priority Health HMO/PPO |
$2.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.68
|
| Rate for Payer: UHC Core |
$2.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.28
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$273.60
|
|
|
Service Code
|
NDC 00904721861
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.98 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna Medicare |
$71.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.50
|
| Rate for Payer: BCBS Complete |
$109.44
|
| Rate for Payer: BCBS MAPPO |
$68.40
|
| Rate for Payer: BCBS Trust/PPO |
$224.93
|
| Rate for Payer: BCN Commercial |
$212.72
|
| Rate for Payer: BCN Medicare Advantage |
$68.40
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.40
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: Nomi Health Commercial |
$224.35
|
| Rate for Payer: PACE Senior Care Partners |
$64.98
|
| Rate for Payer: PACE SWMI |
$68.40
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: PHP Medicare Advantage |
$68.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.84
|
| Rate for Payer: Priority Health HMO/PPO |
$238.03
|
| Rate for Payer: Priority Health Medicare |
$69.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.31
|
| Rate for Payer: Railroad Medicare Medicare |
$68.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.77
|
| Rate for Payer: UHC Core |
$228.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.40
|
| Rate for Payer: UHC Exchange |
$68.40
|
| Rate for Payer: UHC Medicare Advantage |
$68.40
|
| Rate for Payer: VA VA |
$68.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.20
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$273.60
|
|
|
Service Code
|
NDC 00904721861
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.84 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: BCBS Trust/PPO |
$223.34
|
| Rate for Payer: BCN Commercial |
$211.44
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: Nomi Health Commercial |
$224.35
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.84
|
| Rate for Payer: Priority Health HMO/PPO |
$238.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.77
|
| Rate for Payer: UHC Core |
$228.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.20
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$253.92
|
|
|
Service Code
|
NDC 60687021701
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.31 |
| Max. Negotiated Rate |
$228.53 |
| Rate for Payer: Aetna Commercial |
$215.83
|
| Rate for Payer: Aetna Medicare |
$66.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.35
|
| Rate for Payer: BCBS Complete |
$101.57
|
| Rate for Payer: BCBS MAPPO |
$63.48
|
| Rate for Payer: BCBS Trust/PPO |
$208.75
|
| Rate for Payer: BCN Commercial |
$197.42
|
| Rate for Payer: BCN Medicare Advantage |
$63.48
|
| Rate for Payer: Cash Price |
$203.14
|
| Rate for Payer: Cofinity Commercial |
$218.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.48
|
| Rate for Payer: Healthscope Commercial |
$228.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.83
|
| Rate for Payer: Nomi Health Commercial |
$208.21
|
| Rate for Payer: PACE Senior Care Partners |
$60.31
|
| Rate for Payer: PACE SWMI |
$63.48
|
| Rate for Payer: PHP Commercial |
$215.83
|
| Rate for Payer: PHP Medicare Advantage |
$63.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.05
|
| Rate for Payer: Priority Health HMO/PPO |
$220.91
|
| Rate for Payer: Priority Health Medicare |
$64.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.13
|
| Rate for Payer: Railroad Medicare Medicare |
$63.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.45
|
| Rate for Payer: UHC Core |
$212.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.48
|
| Rate for Payer: UHC Exchange |
$63.48
|
| Rate for Payer: UHC Medicare Advantage |
$63.48
|
| Rate for Payer: VA VA |
$63.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.44
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$2.54
|
|
|
Service Code
|
NDC 60687021711
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCN Commercial |
$1.96
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Healthscope Commercial |
$2.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: Nomi Health Commercial |
$2.08
|
| Rate for Payer: PHP Commercial |
$2.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.65
|
| Rate for Payer: Priority Health HMO/PPO |
$2.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.24
|
| Rate for Payer: UHC Core |
$2.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
NDC 00904721961
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.22 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna Medicare |
$88.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.88
|
| Rate for Payer: BCBS Complete |
$136.80
|
| Rate for Payer: BCBS MAPPO |
$85.50
|
| Rate for Payer: BCBS Trust/PPO |
$281.16
|
| Rate for Payer: BCN Commercial |
$265.90
|
| Rate for Payer: BCN Medicare Advantage |
$85.50
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Commercial |
$294.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.50
|
| Rate for Payer: Healthscope Commercial |
$307.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.70
|
| Rate for Payer: Nomi Health Commercial |
$280.44
|
| Rate for Payer: PACE Senior Care Partners |
$81.22
|
| Rate for Payer: PACE SWMI |
$85.50
|
| Rate for Payer: PHP Commercial |
$290.70
|
| Rate for Payer: PHP Medicare Advantage |
$85.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.30
|
| Rate for Payer: Priority Health HMO/PPO |
$297.54
|
| Rate for Payer: Priority Health Medicare |
$86.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$229.14
|
| Rate for Payer: Railroad Medicare Medicare |
$85.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.96
|
| Rate for Payer: UHC Core |
$285.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.50
|
| Rate for Payer: UHC Exchange |
$85.50
|
| Rate for Payer: UHC Medicare Advantage |
$85.50
|
| Rate for Payer: VA VA |
$85.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.50
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$424.65
|
|
|
Service Code
|
NDC 63739001610
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$276.02 |
| Max. Negotiated Rate |
$382.19 |
| Rate for Payer: Aetna Commercial |
$360.95
|
| Rate for Payer: BCBS Trust/PPO |
$346.64
|
| Rate for Payer: BCN Commercial |
$328.17
|
| Rate for Payer: Cash Price |
$339.72
|
| Rate for Payer: Cofinity Commercial |
$365.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.72
|
| Rate for Payer: Healthscope Commercial |
$382.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.95
|
| Rate for Payer: Nomi Health Commercial |
$348.21
|
| Rate for Payer: PHP Commercial |
$360.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.02
|
| Rate for Payer: Priority Health HMO/PPO |
$369.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$284.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.69
|
| Rate for Payer: UHC Core |
$354.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.49
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$253.92
|
|
|
Service Code
|
NDC 60687021701
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.05 |
| Max. Negotiated Rate |
$228.53 |
| Rate for Payer: Aetna Commercial |
$215.83
|
| Rate for Payer: BCBS Trust/PPO |
$207.27
|
| Rate for Payer: BCN Commercial |
$196.23
|
| Rate for Payer: Cash Price |
$203.14
|
| Rate for Payer: Cofinity Commercial |
$218.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.14
|
| Rate for Payer: Healthscope Commercial |
$228.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.83
|
| Rate for Payer: Nomi Health Commercial |
$208.21
|
| Rate for Payer: PHP Commercial |
$215.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.05
|
| Rate for Payer: Priority Health HMO/PPO |
$220.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.45
|
| Rate for Payer: UHC Core |
$212.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.44
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$424.65
|
|
|
Service Code
|
NDC 63739001610
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.85 |
| Max. Negotiated Rate |
$382.19 |
| Rate for Payer: Aetna Commercial |
$360.95
|
| Rate for Payer: Aetna Medicare |
$110.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$132.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$132.70
|
| Rate for Payer: BCBS Complete |
$169.86
|
| Rate for Payer: BCBS MAPPO |
$106.16
|
| Rate for Payer: BCBS Trust/PPO |
$349.10
|
| Rate for Payer: BCN Commercial |
$330.17
|
| Rate for Payer: BCN Medicare Advantage |
$106.16
|
| Rate for Payer: Cash Price |
$339.72
|
| Rate for Payer: Cofinity Commercial |
$365.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.16
|
| Rate for Payer: Healthscope Commercial |
$382.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.95
|
| Rate for Payer: Nomi Health Commercial |
$348.21
|
| Rate for Payer: PACE Senior Care Partners |
$100.85
|
| Rate for Payer: PACE SWMI |
$106.16
|
| Rate for Payer: PHP Commercial |
$360.95
|
| Rate for Payer: PHP Medicare Advantage |
$106.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.02
|
| Rate for Payer: Priority Health HMO/PPO |
$369.45
|
| Rate for Payer: Priority Health Medicare |
$107.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$284.52
|
| Rate for Payer: Railroad Medicare Medicare |
$106.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.69
|
| Rate for Payer: UHC Core |
$354.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.16
|
| Rate for Payer: UHC Exchange |
$106.16
|
| Rate for Payer: UHC Medicare Advantage |
$106.16
|
| Rate for Payer: VA VA |
$106.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.49
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$2.54
|
|
|
Service Code
|
NDC 60687021711
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: Aetna Medicare |
$0.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.79
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: BCBS MAPPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$1.97
|
| Rate for Payer: BCN Medicare Advantage |
$0.64
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.64
|
| Rate for Payer: Healthscope Commercial |
$2.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: Nomi Health Commercial |
$2.08
|
| Rate for Payer: PACE Senior Care Partners |
$0.60
|
| Rate for Payer: PACE SWMI |
$0.64
|
| Rate for Payer: PHP Commercial |
$2.16
|
| Rate for Payer: PHP Medicare Advantage |
$0.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.65
|
| Rate for Payer: Priority Health HMO/PPO |
$2.21
|
| Rate for Payer: Priority Health Medicare |
$0.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.70
|
| Rate for Payer: Railroad Medicare Medicare |
$0.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.24
|
| Rate for Payer: UHC Core |
$2.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.64
|
| Rate for Payer: UHC Exchange |
$0.64
|
| Rate for Payer: UHC Medicare Advantage |
$0.64
|
| Rate for Payer: VA VA |
$0.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
NDC 00904721961
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$222.30 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: BCBS Trust/PPO |
$279.17
|
| Rate for Payer: BCN Commercial |
$264.30
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Commercial |
$294.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.60
|
| Rate for Payer: Healthscope Commercial |
$307.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.70
|
| Rate for Payer: Nomi Health Commercial |
$280.44
|
| Rate for Payer: PHP Commercial |
$290.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.30
|
| Rate for Payer: Priority Health HMO/PPO |
$297.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$229.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.96
|
| Rate for Payer: UHC Core |
$285.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.50
|
|
|
DILTIAZEM ER (XR/XT) 180 MG CAPSULE,EXTENDED RELEASE 24 HR, CONTROLLED
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
NDC 60505001506
|
| Hospital Charge Code |
29347
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.05 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Aetna Commercial |
$371.45
|
| Rate for Payer: BCBS Trust/PPO |
$356.72
|
| Rate for Payer: BCN Commercial |
$337.71
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Cofinity Commercial |
$375.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.60
|
| Rate for Payer: Healthscope Commercial |
$393.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.45
|
| Rate for Payer: Nomi Health Commercial |
$358.34
|
| Rate for Payer: PHP Commercial |
$371.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.05
|
| Rate for Payer: Priority Health HMO/PPO |
$380.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$384.56
|
| Rate for Payer: UHC Core |
$364.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.75
|
|
|
DILTIAZEM ER (XR/XT) 180 MG CAPSULE,EXTENDED RELEASE 24 HR, CONTROLLED
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
NDC 60505001506
|
| Hospital Charge Code |
29347
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.79 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Aetna Commercial |
$371.45
|
| Rate for Payer: Aetna Medicare |
$113.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$136.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$136.56
|
| Rate for Payer: BCBS Complete |
$174.80
|
| Rate for Payer: BCBS MAPPO |
$109.25
|
| Rate for Payer: BCBS Trust/PPO |
$359.26
|
| Rate for Payer: BCN Commercial |
$339.77
|
| Rate for Payer: BCN Medicare Advantage |
$109.25
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Cofinity Commercial |
$375.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.25
|
| Rate for Payer: Healthscope Commercial |
$393.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.45
|
| Rate for Payer: Nomi Health Commercial |
$358.34
|
| Rate for Payer: PACE Senior Care Partners |
$103.79
|
| Rate for Payer: PACE SWMI |
$109.25
|
| Rate for Payer: PHP Commercial |
$371.45
|
| Rate for Payer: PHP Medicare Advantage |
$109.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.05
|
| Rate for Payer: Priority Health HMO/PPO |
$380.19
|
| Rate for Payer: Priority Health Medicare |
$110.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.79
|
| Rate for Payer: Railroad Medicare Medicare |
$109.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$384.56
|
| Rate for Payer: UHC Core |
$364.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.25
|
| Rate for Payer: UHC Exchange |
$109.25
|
| Rate for Payer: UHC Medicare Advantage |
$109.25
|
| Rate for Payer: VA VA |
$109.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.75
|
|
|
DIMENHYDRINATE 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$24.01
|
|
|
Service Code
|
HCPCS J1240
|
| Hospital Charge Code |
2483
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.61 |
| Max. Negotiated Rate |
$21.61 |
| Rate for Payer: Aetna Commercial |
$20.41
|
| Rate for Payer: BCBS Trust/PPO |
$19.60
|
| Rate for Payer: BCN Commercial |
$18.55
|
| Rate for Payer: Cash Price |
$19.21
|
| Rate for Payer: Cofinity Commercial |
$20.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.21
|
| Rate for Payer: Healthscope Commercial |
$21.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.41
|
| Rate for Payer: Nomi Health Commercial |
$19.69
|
| Rate for Payer: PHP Commercial |
$20.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.61
|
| Rate for Payer: Priority Health HMO/PPO |
$20.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.13
|
| Rate for Payer: UHC Core |
$20.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.01
|
|
|
DIMENHYDRINATE 50 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$24.01
|
|
|
Service Code
|
HCPCS J1240
|
| Hospital Charge Code |
2483
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$21.61 |
| Rate for Payer: Aetna Commercial |
$20.41
|
| Rate for Payer: Aetna Medicare |
$6.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.50
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$6.00
|
| Rate for Payer: BCBS Trust/PPO |
$19.74
|
| Rate for Payer: BCN Commercial |
$18.67
|
| Rate for Payer: BCN Medicare Advantage |
$6.00
|
| Rate for Payer: Cash Price |
$19.21
|
| Rate for Payer: Cofinity Commercial |
$20.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.00
|
| Rate for Payer: Healthscope Commercial |
$21.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.41
|
| Rate for Payer: Nomi Health Commercial |
$19.69
|
| Rate for Payer: PACE Senior Care Partners |
$5.70
|
| Rate for Payer: PACE SWMI |
$6.00
|
| Rate for Payer: PHP Commercial |
$20.41
|
| Rate for Payer: PHP Medicare Advantage |
$6.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.61
|
| Rate for Payer: Priority Health HMO/PPO |
$20.89
|
| Rate for Payer: Priority Health Medicare |
$6.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.09
|
| Rate for Payer: Railroad Medicare Medicare |
$6.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.13
|
| Rate for Payer: UHC Core |
$20.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.00
|
| Rate for Payer: UHC Exchange |
$6.00
|
| Rate for Payer: UHC Medicare Advantage |
$6.00
|
| Rate for Payer: VA VA |
$6.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.01
|
|
|
DIMENHYDRINATE 50 MG TABLET
|
Facility
|
IP
|
$88.20
|
|
|
Service Code
|
NDC 00904205159
|
| Hospital Charge Code |
2485
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.33 |
| Max. Negotiated Rate |
$79.38 |
| Rate for Payer: Aetna Commercial |
$74.97
|
| Rate for Payer: BCBS Trust/PPO |
$72.00
|
| Rate for Payer: BCN Commercial |
$68.16
|
| Rate for Payer: Cash Price |
$70.56
|
| Rate for Payer: Cofinity Commercial |
$75.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.56
|
| Rate for Payer: Healthscope Commercial |
$79.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.97
|
| Rate for Payer: Nomi Health Commercial |
$72.32
|
| Rate for Payer: PHP Commercial |
$74.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.33
|
| Rate for Payer: Priority Health HMO/PPO |
$76.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.62
|
| Rate for Payer: UHC Core |
$73.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.15
|
|
|
DIMENHYDRINATE 50 MG TABLET
|
Facility
|
OP
|
$88.20
|
|
|
Service Code
|
NDC 00904205159
|
| Hospital Charge Code |
2485
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.95 |
| Max. Negotiated Rate |
$79.38 |
| Rate for Payer: Aetna Commercial |
$74.97
|
| Rate for Payer: Aetna Medicare |
$22.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.56
|
| Rate for Payer: BCBS Complete |
$35.28
|
| Rate for Payer: BCBS MAPPO |
$22.05
|
| Rate for Payer: BCBS Trust/PPO |
$72.51
|
| Rate for Payer: BCN Commercial |
$68.58
|
| Rate for Payer: BCN Medicare Advantage |
$22.05
|
| Rate for Payer: Cash Price |
$70.56
|
| Rate for Payer: Cofinity Commercial |
$75.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.05
|
| Rate for Payer: Healthscope Commercial |
$79.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.97
|
| Rate for Payer: Nomi Health Commercial |
$72.32
|
| Rate for Payer: PACE Senior Care Partners |
$20.95
|
| Rate for Payer: PACE SWMI |
$22.05
|
| Rate for Payer: PHP Commercial |
$74.97
|
| Rate for Payer: PHP Medicare Advantage |
$22.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.33
|
| Rate for Payer: Priority Health HMO/PPO |
$76.73
|
| Rate for Payer: Priority Health Medicare |
$22.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.09
|
| Rate for Payer: Railroad Medicare Medicare |
$22.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.62
|
| Rate for Payer: UHC Core |
$73.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.05
|
| Rate for Payer: UHC Exchange |
$22.05
|
| Rate for Payer: UHC Medicare Advantage |
$22.05
|
| Rate for Payer: VA VA |
$22.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.15
|
|
