|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$381.90
|
|
|
Service Code
|
NDC 51079-118-20
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.92 |
| Max. Negotiated Rate |
$343.71 |
| Rate for Payer: Aetna Commercial |
$324.62
|
| Rate for Payer: BCBS Trust/PPO |
$295.13
|
| Rate for Payer: BCN Commercial |
$295.13
|
| Rate for Payer: Cash Price |
$305.52
|
| 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: Lakeland Regional Health Systems Commercial |
$286.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$324.62
|
| Rate for Payer: PHP Commercial |
$324.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$332.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.07
|
| Rate for Payer: UHC Core |
$318.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.42
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$3.96
|
|
|
Service Code
|
NDC 60687-369-11
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: BCBS Trust/PPO |
$3.06
|
| Rate for Payer: BCN Commercial |
$3.06
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.17
|
| Rate for Payer: Healthscope Commercial |
$3.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.37
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC Core |
$3.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.97
|
|
|
DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$277.52
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$169.26 |
| Max. Negotiated Rate |
$249.77 |
| Rate for Payer: Aetna Commercial |
$235.89
|
| Rate for Payer: Aetna Commercial |
$131.63
|
| Rate for Payer: BCBS Trust/PPO |
$119.68
|
| Rate for Payer: BCBS Trust/PPO |
$214.47
|
| Rate for Payer: BCN Commercial |
$119.68
|
| Rate for Payer: BCN Commercial |
$214.47
|
| Rate for Payer: Cash Price |
$123.89
|
| Rate for Payer: Cash Price |
$222.02
|
| Rate for Payer: Cofinity Commercial |
$133.18
|
| Rate for Payer: Cofinity Commercial |
$238.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.89
|
| Rate for Payer: Healthscope Commercial |
$139.37
|
| Rate for Payer: Healthscope Commercial |
$249.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.63
|
| Rate for Payer: PHP Commercial |
$131.63
|
| Rate for Payer: PHP Commercial |
$235.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.28
|
| Rate for Payer: UHC Core |
$129.31
|
| Rate for Payer: UHC Core |
$231.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.14
|
|
|
DICYCLOMINE 20 MG TABLET
|
Facility
|
IP
|
$381.90
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$232.92 |
| Max. Negotiated Rate |
$343.71 |
| Rate for Payer: Aetna Commercial |
$324.62
|
| Rate for Payer: BCBS Trust/PPO |
$295.13
|
| Rate for Payer: BCN Commercial |
$295.13
|
| Rate for Payer: Cash Price |
$305.52
|
| 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: Lakeland Regional Health Systems Commercial |
$286.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$324.62
|
| Rate for Payer: PHP Commercial |
$324.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$332.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.07
|
| Rate for Payer: UHC Core |
$318.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.42
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
IP
|
$3.91
|
|
|
Service Code
|
NDC 68084-366-11
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$3.52 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: BCBS Trust/PPO |
$3.02
|
| Rate for Payer: BCN Commercial |
$3.02
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Cofinity Commercial |
$3.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.13
|
| Rate for Payer: Healthscope Commercial |
$3.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.32
|
| Rate for Payer: PHP Commercial |
$3.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.44
|
| Rate for Payer: UHC Core |
$3.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.93
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
IP
|
$390.72
|
|
|
Service Code
|
NDC 68084-366-01
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.30 |
| Max. Negotiated Rate |
$351.65 |
| Rate for Payer: Aetna Commercial |
$332.11
|
| Rate for Payer: BCBS Trust/PPO |
$301.95
|
| Rate for Payer: BCN Commercial |
$301.95
|
| Rate for Payer: Cash Price |
$312.58
|
| Rate for Payer: Cofinity Commercial |
$336.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.58
|
| Rate for Payer: Healthscope Commercial |
$351.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$293.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$332.11
|
| Rate for Payer: PHP Commercial |
$332.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$339.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.83
|
| Rate for Payer: UHC Core |
$326.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$293.04
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
IP
|
$403.20
|
|
|
Service Code
|
NDC 0904-5921-61
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.91 |
| Max. Negotiated Rate |
$362.88 |
| Rate for Payer: Aetna Commercial |
$342.72
|
| Rate for Payer: BCBS Trust/PPO |
$311.59
|
| Rate for Payer: BCN Commercial |
$311.59
|
| Rate for Payer: Cash Price |
$322.56
|
| Rate for Payer: Cofinity Commercial |
$346.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.56
|
| Rate for Payer: Healthscope Commercial |
$362.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$302.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$342.72
|
| Rate for Payer: PHP Commercial |
$342.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$350.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$354.82
|
| Rate for Payer: UHC Core |
$336.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$302.40
|
|
|
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$21.14
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
108720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$19.03 |
| Rate for Payer: Aetna Commercial |
$17.97
|
| Rate for Payer: BCBS Trust/PPO |
$16.34
|
| Rate for Payer: BCN Commercial |
$16.34
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cofinity Commercial |
$18.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.91
|
| Rate for Payer: Healthscope Commercial |
$19.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.97
|
| Rate for Payer: PHP Commercial |
$17.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.60
|
| Rate for Payer: UHC Core |
$17.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.86
|
|
|
DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$11,120.39
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
31432
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,782.33 |
| Max. Negotiated Rate |
$10,008.35 |
| Rate for Payer: Aetna Commercial |
$9,452.33
|
| Rate for Payer: BCBS Trust/PPO |
$8,593.84
|
| Rate for Payer: BCN Commercial |
$8,593.84
|
| Rate for Payer: Cash Price |
$8,896.31
|
| Rate for Payer: Cofinity Commercial |
$9,563.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,896.31
|
| Rate for Payer: Healthscope Commercial |
$10,008.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,340.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,452.33
|
| Rate for Payer: PHP Commercial |
$9,452.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,784.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,674.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,782.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,785.94
|
| Rate for Payer: UHC Core |
$9,285.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,340.29
|
|
|
DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$449.33
|
|
|
Service Code
|
HCPCS J1110
|
| Hospital Charge Code |
9859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$274.05 |
| Max. Negotiated Rate |
$404.40 |
| Rate for Payer: Aetna Commercial |
$381.93
|
| Rate for Payer: Aetna Commercial |
$153.55
|
| Rate for Payer: Aetna Commercial |
$170.62
|
| Rate for Payer: BCBS Trust/PPO |
$139.61
|
| Rate for Payer: BCBS Trust/PPO |
$347.24
|
| Rate for Payer: BCBS Trust/PPO |
$155.12
|
| Rate for Payer: BCN Commercial |
$155.12
|
| Rate for Payer: BCN Commercial |
$139.61
|
| Rate for Payer: BCN Commercial |
$347.24
|
| Rate for Payer: Cash Price |
$144.52
|
| Rate for Payer: Cash Price |
$359.46
|
| Rate for Payer: Cash Price |
$160.58
|
| Rate for Payer: Cofinity Commercial |
$172.63
|
| Rate for Payer: Cofinity Commercial |
$386.42
|
| Rate for Payer: Cofinity Commercial |
$155.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.46
|
| Rate for Payer: Healthscope Commercial |
$404.40
|
| Rate for Payer: Healthscope Commercial |
$162.58
|
| Rate for Payer: Healthscope Commercial |
$180.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$381.93
|
| Rate for Payer: PHP Commercial |
$381.93
|
| Rate for Payer: PHP Commercial |
$153.55
|
| Rate for Payer: PHP Commercial |
$170.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.41
|
| Rate for Payer: UHC Core |
$167.61
|
| Rate for Payer: UHC Core |
$375.19
|
| Rate for Payer: UHC Core |
$150.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.00
|
|
|
DILTIAZEM 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$82.05
|
|
|
Service Code
|
NDC 0409-4350-13
|
| Hospital Charge Code |
22156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.04 |
| Max. Negotiated Rate |
$73.84 |
| Rate for Payer: Aetna Commercial |
$69.74
|
| Rate for Payer: BCBS Trust/PPO |
$63.41
|
| Rate for Payer: BCN Commercial |
$63.41
|
| Rate for Payer: Cash Price |
$65.64
|
| Rate for Payer: Cofinity Commercial |
$70.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.64
|
| Rate for Payer: Healthscope Commercial |
$73.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.74
|
| Rate for Payer: PHP Commercial |
$69.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.20
|
| Rate for Payer: UHC Core |
$68.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.54
|
|
|
DILTIAZEM 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$82.05
|
|
|
Service Code
|
NDC 0409-4350-03
|
| Hospital Charge Code |
22156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.04 |
| Max. Negotiated Rate |
$73.84 |
| Rate for Payer: Aetna Commercial |
$69.74
|
| Rate for Payer: BCBS Trust/PPO |
$63.41
|
| Rate for Payer: BCN Commercial |
$63.41
|
| Rate for Payer: Cash Price |
$65.64
|
| Rate for Payer: Cofinity Commercial |
$70.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.64
|
| Rate for Payer: Healthscope Commercial |
$73.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.74
|
| Rate for Payer: PHP Commercial |
$69.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.20
|
| Rate for Payer: UHC Core |
$68.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.54
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$3.48
|
|
|
Service Code
|
NDC 60687-717-11
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: BCBS Trust/PPO |
$2.69
|
| Rate for Payer: BCN Commercial |
$2.69
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$2.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$3.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.96
|
| Rate for Payer: PHP Commercial |
$2.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.06
|
| Rate for Payer: UHC Core |
$2.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.61
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$4.09
|
|
|
Service Code
|
NDC 60687-562-11
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: BCBS Trust/PPO |
$3.16
|
| Rate for Payer: BCN Commercial |
$3.16
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.27
|
| Rate for Payer: Healthscope Commercial |
$3.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.48
|
| Rate for Payer: PHP Commercial |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.60
|
| Rate for Payer: UHC Core |
$3.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.07
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$408.90
|
|
|
Service Code
|
NDC 60687-562-01
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$249.39 |
| Max. Negotiated Rate |
$368.01 |
| Rate for Payer: Aetna Commercial |
$347.56
|
| Rate for Payer: BCBS Trust/PPO |
$316.00
|
| Rate for Payer: BCN Commercial |
$316.00
|
| Rate for Payer: Cash Price |
$327.12
|
| Rate for Payer: Cofinity Commercial |
$351.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.12
|
| Rate for Payer: Healthscope Commercial |
$368.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$347.56
|
| Rate for Payer: PHP Commercial |
$347.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$355.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.83
|
| Rate for Payer: UHC Core |
$341.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.68
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$326.65
|
|
|
Service Code
|
NDC 0093-0318-01
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.22 |
| Max. Negotiated Rate |
$293.98 |
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: BCBS Trust/PPO |
$252.44
|
| Rate for Payer: BCN Commercial |
$252.44
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Commercial |
$280.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$293.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.65
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$284.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.45
|
| Rate for Payer: UHC Core |
$272.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$347.70
|
|
|
Service Code
|
NDC 60687-717-01
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.06 |
| Max. Negotiated Rate |
$312.93 |
| Rate for Payer: Aetna Commercial |
$295.54
|
| Rate for Payer: BCBS Trust/PPO |
$268.70
|
| Rate for Payer: BCN Commercial |
$268.70
|
| Rate for Payer: Cash Price |
$278.16
|
| 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: Lakeland Regional Health Systems Commercial |
$260.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$295.54
|
| Rate for Payer: PHP Commercial |
$295.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$302.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$212.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.98
|
| Rate for Payer: UHC Core |
$290.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.78
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$307.85
|
|
|
Service Code
|
NDC 63739-079-10
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.76 |
| Max. Negotiated Rate |
$277.06 |
| Rate for Payer: Aetna Commercial |
$261.67
|
| Rate for Payer: BCBS Trust/PPO |
$237.91
|
| Rate for Payer: BCN Commercial |
$237.91
|
| Rate for Payer: Cash Price |
$246.28
|
| Rate for Payer: Cofinity Commercial |
$264.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.28
|
| Rate for Payer: Healthscope Commercial |
$277.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$261.67
|
| Rate for Payer: PHP Commercial |
$261.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$267.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.91
|
| Rate for Payer: UHC Core |
$257.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.89
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$129.38
|
|
|
Service Code
|
NDC 0641-6015-01
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.91 |
| Max. Negotiated Rate |
$116.44 |
| Rate for Payer: Aetna Commercial |
$109.97
|
| Rate for Payer: BCBS Trust/PPO |
$99.98
|
| 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 |
$97.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.97
|
| Rate for Payer: PHP Commercial |
$109.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.91
|
| 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 |
$97.04
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$48.63
|
|
|
Service Code
|
NDC 0641-9217-10
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.66 |
| Max. Negotiated Rate |
$43.77 |
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: BCBS Trust/PPO |
$37.58
|
| 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 Multiplan/Beech St/PHCS |
$41.34
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.66
|
| 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
|
$48.63
|
|
|
Service Code
|
NDC 0641-6013-01
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.66 |
| Max. Negotiated Rate |
$43.77 |
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: BCBS Trust/PPO |
$37.58
|
| 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 Multiplan/Beech St/PHCS |
$41.34
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.66
|
| 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
|
$253.75
|
|
|
Service Code
|
NDC 17478-937-26
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$154.76 |
| Max. Negotiated Rate |
$228.38 |
| Rate for Payer: Aetna Commercial |
$215.69
|
| Rate for Payer: BCBS Trust/PPO |
$196.10
|
| 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 Multiplan/Beech St/PHCS |
$215.69
|
| Rate for Payer: PHP Commercial |
$215.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$220.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.76
|
| 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
|
$253.75
|
|
|
Service Code
|
NDC 17478-937-25
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$154.76 |
| Max. Negotiated Rate |
$228.38 |
| Rate for Payer: Aetna Commercial |
$215.69
|
| Rate for Payer: BCBS Trust/PPO |
$196.10
|
| 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 Multiplan/Beech St/PHCS |
$215.69
|
| Rate for Payer: PHP Commercial |
$215.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$220.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.76
|
| 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
|
$48.63
|
|
|
Service Code
|
NDC 0641-6013-10
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.66 |
| Max. Negotiated Rate |
$43.77 |
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: BCBS Trust/PPO |
$37.58
|
| 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 Multiplan/Beech St/PHCS |
$41.34
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.66
|
| 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
|
$71.00
|
|
|
Service Code
|
NDC 70860-301-05
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.30 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna Commercial |
$60.35
|
| Rate for Payer: BCBS Trust/PPO |
$54.87
|
| Rate for Payer: BCN Commercial |
$54.87
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$61.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.80
|
| Rate for Payer: Healthscope Commercial |
$63.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.35
|
| Rate for Payer: PHP Commercial |
$60.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.48
|
| Rate for Payer: UHC Core |
$59.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.25
|
|
