|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
|
IP
|
$6,135.50
|
|
|
Service Code
|
APR-DRG 5172
|
| Min. Negotiated Rate |
$5,843.33 |
| Max. Negotiated Rate |
$6,135.50 |
| Rate for Payer: BCBS Complete |
$6,135.50
|
| Rate for Payer: Mclaren Medicaid |
$5,843.33
|
| Rate for Payer: Meridian Medicaid |
$6,135.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,843.33
|
| Rate for Payer: UHC Medicaid |
$5,843.33
|
| Rate for Payer: UHCCP Medicaid |
$5,843.33
|
|
|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
|
IP
|
$4,939.22
|
|
|
Service Code
|
APR-DRG 5171
|
| Min. Negotiated Rate |
$4,704.01 |
| Max. Negotiated Rate |
$4,939.22 |
| Rate for Payer: BCBS Complete |
$4,939.22
|
| Rate for Payer: Mclaren Medicaid |
$4,704.01
|
| Rate for Payer: Meridian Medicaid |
$4,939.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,704.01
|
| Rate for Payer: UHC Medicaid |
$4,704.01
|
| Rate for Payer: UHCCP Medicaid |
$4,704.01
|
|
|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
|
IP
|
$13,818.02
|
|
|
Service Code
|
APR-DRG 5174
|
| Min. Negotiated Rate |
$13,160.02 |
| Max. Negotiated Rate |
$13,818.02 |
| Rate for Payer: BCBS Complete |
$13,818.02
|
| Rate for Payer: Mclaren Medicaid |
$13,160.02
|
| Rate for Payer: Meridian Medicaid |
$13,818.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,160.02
|
| Rate for Payer: UHC Medicaid |
$13,160.02
|
| Rate for Payer: UHCCP Medicaid |
$13,160.02
|
|
|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
|
IP
|
$9,680.71
|
|
|
Service Code
|
APR-DRG 5173
|
| Min. Negotiated Rate |
$9,219.73 |
| Max. Negotiated Rate |
$9,680.71 |
| Rate for Payer: BCBS Complete |
$9,680.71
|
| Rate for Payer: Mclaren Medicaid |
$9,219.73
|
| Rate for Payer: Meridian Medicaid |
$9,680.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,219.73
|
| Rate for Payer: UHC Medicaid |
$9,219.73
|
| Rate for Payer: UHCCP Medicaid |
$9,219.73
|
|
|
DILTIAZEM 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$39.77
|
|
|
Service Code
|
HCPCS J1163
|
| Hospital Charge Code |
22156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$35.79 |
| Rate for Payer: Aetna Commercial |
$33.80
|
| Rate for Payer: BCBS Trust/PPO |
$32.85
|
| Rate for Payer: BCN Commercial |
$32.85
|
| Rate for Payer: Cash Price |
$31.82
|
| Rate for Payer: Cofinity Commercial |
$34.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.82
|
| Rate for Payer: Healthscope Commercial |
$35.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.80
|
| Rate for Payer: Nomi Health Commercial |
$32.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.83
|
| Rate for Payer: PHP Commercial |
$33.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$34.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.00
|
| Rate for Payer: UHC Core |
$33.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.83
|
|
|
DILTIAZEM 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$39.77
|
|
|
Service Code
|
HCPCS J1163
|
| Hospital Charge Code |
22156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$35.79 |
| Rate for Payer: Aetna Commercial |
$33.80
|
| Rate for Payer: Aetna Medicare |
$10.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.43
|
| Rate for Payer: BCBS Complete |
$7.36
|
| Rate for Payer: BCBS MAPPO |
$9.94
|
| Rate for Payer: BCBS Trust/PPO |
$32.69
|
| Rate for Payer: BCN Commercial |
$32.69
|
| Rate for Payer: BCN Medicare Advantage |
$9.94
|
| Rate for Payer: Cash Price |
$31.82
|
| Rate for Payer: Cofinity Commercial |
$34.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.94
|
| Rate for Payer: Healthscope Commercial |
$35.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.83
|
| Rate for Payer: Mclaren Medicaid |
$7.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.44
|
| Rate for Payer: Meridian Medicaid |
$7.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.80
|
| Rate for Payer: Nomi Health Commercial |
$32.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.83
|
| Rate for Payer: PACE Senior Care Partners |
$9.45
|
| Rate for Payer: PACE SWMI |
$9.94
|
| Rate for Payer: PHP Commercial |
$33.80
|
| Rate for Payer: PHP Medicare Advantage |
$9.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$34.60
|
| Rate for Payer: Priority Health Medicare |
$10.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.68
|
| Rate for Payer: Railroad Medicare Medicare |
$9.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.00
|
| Rate for Payer: UHC Core |
$33.21
|
| Rate for Payer: UHC Exchange |
$9.94
|
| Rate for Payer: UHC Medicaid |
$7.01
|
| Rate for Payer: UHC Medicare Advantage |
$9.94
|
| Rate for Payer: UHCCP Medicaid |
$7.01
|
| Rate for Payer: VA VA |
$9.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.83
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
OP
|
$4.29
|
|
|
Service Code
|
NDC 60687071711
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: Aetna Medicare |
$1.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.34
|
| Rate for Payer: BCBS Complete |
$0.79
|
| Rate for Payer: BCBS MAPPO |
$1.07
|
| Rate for Payer: BCBS Trust/PPO |
$3.53
|
| Rate for Payer: BCN Commercial |
$3.53
|
| Rate for Payer: BCN Medicare Advantage |
$1.07
|
| Rate for Payer: Cash Price |
$3.43
|
| Rate for Payer: Cofinity Commercial |
$3.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.07
|
| Rate for Payer: Healthscope Commercial |
$3.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.22
|
| Rate for Payer: Mclaren Medicaid |
$0.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.13
|
| Rate for Payer: Meridian Medicaid |
$0.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: Nomi Health Commercial |
$3.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.22
|
| Rate for Payer: PACE Senior Care Partners |
$1.02
|
| Rate for Payer: PACE SWMI |
$1.07
|
| Rate for Payer: PHP Commercial |
$3.65
|
| Rate for Payer: PHP Medicare Advantage |
$1.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.73
|
| Rate for Payer: Priority Health Medicare |
$1.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.99
|
| Rate for Payer: Railroad Medicare Medicare |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.78
|
| Rate for Payer: UHC Core |
$3.58
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UHC Medicaid |
$0.76
|
| Rate for Payer: UHC Medicare Advantage |
$1.07
|
| Rate for Payer: UHCCP Medicaid |
$0.76
|
| Rate for Payer: VA VA |
$1.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.22
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$428.45
|
|
|
Service Code
|
NDC 60687071701
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$298.20 |
| Max. Negotiated Rate |
$385.61 |
| Rate for Payer: Aetna Commercial |
$364.18
|
| Rate for Payer: BCBS Trust/PPO |
$353.86
|
| Rate for Payer: BCN Commercial |
$353.86
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Commercial |
$368.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Healthscope Commercial |
$385.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: Nomi Health Commercial |
$351.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.34
|
| Rate for Payer: PHP Commercial |
$364.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$372.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$298.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.04
|
| Rate for Payer: UHC Core |
$357.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.34
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$4.29
|
|
|
Service Code
|
NDC 60687071711
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: BCBS Trust/PPO |
$3.54
|
| Rate for Payer: BCN Commercial |
$3.54
|
| Rate for Payer: Cash Price |
$3.43
|
| Rate for Payer: Cofinity Commercial |
$3.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.43
|
| Rate for Payer: Healthscope Commercial |
$3.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: Nomi Health Commercial |
$3.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.22
|
| Rate for Payer: PHP Commercial |
$3.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.78
|
| Rate for Payer: UHC Core |
$3.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.22
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
OP
|
$326.65
|
|
|
Service Code
|
NDC 00093031801
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.59 |
| Max. Negotiated Rate |
$293.99 |
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: Aetna Medicare |
$84.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.08
|
| Rate for Payer: BCBS Complete |
$60.46
|
| Rate for Payer: BCBS MAPPO |
$81.66
|
| Rate for Payer: BCBS Trust/PPO |
$268.54
|
| Rate for Payer: BCN Commercial |
$268.54
|
| Rate for Payer: BCN Medicare Advantage |
$81.66
|
| 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: Health Alliance Plan Medicare Advantage |
$81.66
|
| Rate for Payer: Healthscope Commercial |
$293.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: Mclaren Medicaid |
$57.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.75
|
| Rate for Payer: Meridian Medicaid |
$60.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$89.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Nomi Health Commercial |
$267.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.99
|
| Rate for Payer: PACE Senior Care Partners |
$77.58
|
| Rate for Payer: PACE SWMI |
$81.66
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: PHP Medicare Advantage |
$81.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$284.19
|
| Rate for Payer: Priority Health Medicare |
$82.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.35
|
| Rate for Payer: Railroad Medicare Medicare |
$81.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.45
|
| Rate for Payer: UHC Core |
$272.75
|
| Rate for Payer: UHC Exchange |
$81.66
|
| Rate for Payer: UHC Medicaid |
$57.59
|
| Rate for Payer: UHC Medicare Advantage |
$81.66
|
| Rate for Payer: UHCCP Medicaid |
$57.59
|
| Rate for Payer: VA VA |
$81.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$326.65
|
|
|
Service Code
|
NDC 00093031801
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$227.35 |
| Max. Negotiated Rate |
$293.99 |
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: BCBS Trust/PPO |
$269.78
|
| Rate for Payer: BCN Commercial |
$269.78
|
| 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 |
$293.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Nomi Health Commercial |
$267.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.99
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$284.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.35
|
| 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
|
OP
|
$428.45
|
|
|
Service Code
|
NDC 60687071701
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.54 |
| Max. Negotiated Rate |
$385.61 |
| Rate for Payer: Aetna Commercial |
$364.18
|
| Rate for Payer: Aetna Medicare |
$111.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$133.89
|
| Rate for Payer: BCBS Complete |
$79.31
|
| Rate for Payer: BCBS MAPPO |
$107.11
|
| Rate for Payer: BCBS Trust/PPO |
$352.23
|
| Rate for Payer: BCN Commercial |
$352.23
|
| Rate for Payer: BCN Medicare Advantage |
$107.11
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Commercial |
$368.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.11
|
| Rate for Payer: Healthscope Commercial |
$385.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.34
|
| Rate for Payer: Mclaren Medicaid |
$75.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.47
|
| Rate for Payer: Meridian Medicaid |
$79.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$117.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: Nomi Health Commercial |
$351.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.34
|
| Rate for Payer: PACE Senior Care Partners |
$101.76
|
| Rate for Payer: PACE SWMI |
$107.11
|
| Rate for Payer: PHP Commercial |
$364.18
|
| Rate for Payer: PHP Medicare Advantage |
$107.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$372.75
|
| Rate for Payer: Priority Health Medicare |
$108.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$298.20
|
| Rate for Payer: Railroad Medicare Medicare |
$107.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.04
|
| Rate for Payer: UHC Core |
$357.76
|
| Rate for Payer: UHC Exchange |
$107.11
|
| Rate for Payer: UHC Medicaid |
$75.54
|
| Rate for Payer: UHC Medicare Advantage |
$107.11
|
| Rate for Payer: UHCCP Medicaid |
$75.54
|
| Rate for Payer: VA VA |
$107.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.34
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$45.17
|
|
|
Service Code
|
HCPCS J1163
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$40.65 |
| Rate for Payer: Aetna Commercial |
$38.39
|
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Aetna Commercial |
$23.98
|
| Rate for Payer: Aetna Commercial |
$22.37
|
| Rate for Payer: Aetna Commercial |
$19.58
|
| Rate for Payer: Aetna Medicare |
$6.88
|
| Rate for Payer: Aetna Medicare |
$5.99
|
| Rate for Payer: Aetna Medicare |
$5.02
|
| Rate for Payer: Aetna Medicare |
$11.74
|
| Rate for Payer: Aetna Medicare |
$6.84
|
| Rate for Payer: Aetna Medicare |
$7.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.27
|
| Rate for Payer: BCBS Complete |
$4.87
|
| Rate for Payer: BCBS Complete |
$5.22
|
| Rate for Payer: BCBS Complete |
$4.26
|
| Rate for Payer: BCBS Complete |
$3.58
|
| Rate for Payer: BCBS Complete |
$8.36
|
| Rate for Payer: BCBS Complete |
$4.90
|
| Rate for Payer: BCBS MAPPO |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.29
|
| Rate for Payer: BCBS MAPPO |
$7.05
|
| Rate for Payer: BCBS MAPPO |
$5.76
|
| Rate for Payer: BCBS MAPPO |
$4.83
|
| Rate for Payer: BCBS MAPPO |
$6.58
|
| Rate for Payer: BCBS Trust/PPO |
$15.88
|
| Rate for Payer: BCBS Trust/PPO |
$23.19
|
| Rate for Payer: BCBS Trust/PPO |
$18.93
|
| Rate for Payer: BCBS Trust/PPO |
$21.64
|
| Rate for Payer: BCBS Trust/PPO |
$21.76
|
| Rate for Payer: BCBS Trust/PPO |
$37.13
|
| Rate for Payer: BCN Commercial |
$21.64
|
| Rate for Payer: BCN Commercial |
$21.76
|
| Rate for Payer: BCN Commercial |
$15.88
|
| Rate for Payer: BCN Commercial |
$18.93
|
| Rate for Payer: BCN Commercial |
$23.19
|
| Rate for Payer: BCN Commercial |
$37.13
|
| Rate for Payer: BCN Medicare Advantage |
$7.05
|
| Rate for Payer: BCN Medicare Advantage |
$11.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.58
|
| Rate for Payer: BCN Medicare Advantage |
$4.83
|
| Rate for Payer: BCN Medicare Advantage |
$6.62
|
| Rate for Payer: BCN Medicare Advantage |
$5.76
|
| Rate for Payer: Cash Price |
$21.18
|
| Rate for Payer: Cash Price |
$15.46
|
| Rate for Payer: Cash Price |
$18.42
|
| Rate for Payer: Cash Price |
$36.14
|
| Rate for Payer: Cash Price |
$22.57
|
| Rate for Payer: Cash Price |
$21.06
|
| Rate for Payer: Cofinity Commercial |
$22.76
|
| Rate for Payer: Cofinity Commercial |
$22.64
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$19.81
|
| Rate for Payer: Cofinity Commercial |
$38.85
|
| Rate for Payer: Cofinity Commercial |
$24.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.76
|
| Rate for Payer: Healthscope Commercial |
$23.82
|
| Rate for Payer: Healthscope Commercial |
$40.65
|
| Rate for Payer: Healthscope Commercial |
$23.69
|
| Rate for Payer: Healthscope Commercial |
$20.73
|
| Rate for Payer: Healthscope Commercial |
$17.39
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.74
|
| Rate for Payer: Mclaren Medicaid |
$4.06
|
| Rate for Payer: Mclaren Medicaid |
$3.41
|
| Rate for Payer: Mclaren Medicaid |
$4.64
|
| Rate for Payer: Mclaren Medicaid |
$4.67
|
| Rate for Payer: Mclaren Medicaid |
$4.97
|
| Rate for Payer: Mclaren Medicaid |
$7.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.91
|
| Rate for Payer: Meridian Medicaid |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$8.36
|
| Rate for Payer: Meridian Medicaid |
$4.26
|
| Rate for Payer: Meridian Medicaid |
$3.58
|
| Rate for Payer: Meridian Medicaid |
$4.87
|
| Rate for Payer: Meridian Medicaid |
$4.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.39
|
| Rate for Payer: Nomi Health Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$21.71
|
| Rate for Payer: Nomi Health Commercial |
$15.84
|
| Rate for Payer: Nomi Health Commercial |
$23.13
|
| Rate for Payer: Nomi Health Commercial |
$37.04
|
| Rate for Payer: Nomi Health Commercial |
$18.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.27
|
| Rate for Payer: PACE Senior Care Partners |
$6.25
|
| Rate for Payer: PACE Senior Care Partners |
$5.47
|
| Rate for Payer: PACE Senior Care Partners |
$6.29
|
| Rate for Payer: PACE Senior Care Partners |
$6.70
|
| Rate for Payer: PACE Senior Care Partners |
$4.59
|
| Rate for Payer: PACE Senior Care Partners |
$10.73
|
| Rate for Payer: PACE SWMI |
$5.76
|
| Rate for Payer: PACE SWMI |
$6.62
|
| Rate for Payer: PACE SWMI |
$11.29
|
| Rate for Payer: PACE SWMI |
$4.83
|
| Rate for Payer: PACE SWMI |
$7.05
|
| Rate for Payer: PACE SWMI |
$6.58
|
| Rate for Payer: PHP Commercial |
$22.37
|
| Rate for Payer: PHP Commercial |
$19.58
|
| Rate for Payer: PHP Commercial |
$22.50
|
| Rate for Payer: PHP Commercial |
$23.98
|
| Rate for Payer: PHP Commercial |
$38.39
|
| Rate for Payer: PHP Commercial |
$16.42
|
| Rate for Payer: PHP Medicare Advantage |
$11.29
|
| Rate for Payer: PHP Medicare Advantage |
$5.76
|
| Rate for Payer: PHP Medicare Advantage |
$7.05
|
| Rate for Payer: PHP Medicare Advantage |
$4.83
|
| Rate for Payer: PHP Medicare Advantage |
$6.62
|
| Rate for Payer: PHP Medicare Advantage |
$6.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$39.30
|
| Rate for Payer: Priority Health Medicare |
$4.88
|
| Rate for Payer: Priority Health Medicare |
$11.41
|
| Rate for Payer: Priority Health Medicare |
$5.82
|
| Rate for Payer: Priority Health Medicare |
$6.68
|
| Rate for Payer: Priority Health Medicare |
$6.65
|
| Rate for Payer: Priority Health Medicare |
$7.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.42
|
| Rate for Payer: Railroad Medicare Medicare |
$4.83
|
| Rate for Payer: Railroad Medicare Medicare |
$7.05
|
| Rate for Payer: Railroad Medicare Medicare |
$6.62
|
| Rate for Payer: Railroad Medicare Medicare |
$5.76
|
| Rate for Payer: Railroad Medicare Medicare |
$6.58
|
| Rate for Payer: Railroad Medicare Medicare |
$11.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.00
|
| Rate for Payer: UHC Core |
$21.98
|
| Rate for Payer: UHC Core |
$23.56
|
| Rate for Payer: UHC Core |
$22.10
|
| Rate for Payer: UHC Core |
$37.72
|
| Rate for Payer: UHC Core |
$16.13
|
| Rate for Payer: UHC Core |
$19.23
|
| Rate for Payer: UHC Exchange |
$5.76
|
| Rate for Payer: UHC Exchange |
$4.83
|
| Rate for Payer: UHC Exchange |
$6.62
|
| Rate for Payer: UHC Exchange |
$6.58
|
| Rate for Payer: UHC Exchange |
$7.05
|
| Rate for Payer: UHC Exchange |
$11.29
|
| Rate for Payer: UHC Medicaid |
$4.97
|
| Rate for Payer: UHC Medicaid |
$4.67
|
| Rate for Payer: UHC Medicaid |
$4.06
|
| Rate for Payer: UHC Medicaid |
$4.64
|
| Rate for Payer: UHC Medicaid |
$3.41
|
| Rate for Payer: UHC Medicaid |
$7.96
|
| Rate for Payer: UHC Medicare Advantage |
$5.76
|
| Rate for Payer: UHC Medicare Advantage |
$7.05
|
| Rate for Payer: UHC Medicare Advantage |
$6.62
|
| Rate for Payer: UHC Medicare Advantage |
$6.58
|
| Rate for Payer: UHC Medicare Advantage |
$4.83
|
| Rate for Payer: UHC Medicare Advantage |
$11.29
|
| Rate for Payer: UHCCP Medicaid |
$4.97
|
| Rate for Payer: UHCCP Medicaid |
$4.67
|
| Rate for Payer: UHCCP Medicaid |
$4.64
|
| Rate for Payer: UHCCP Medicaid |
$4.06
|
| Rate for Payer: UHCCP Medicaid |
$3.41
|
| Rate for Payer: UHCCP Medicaid |
$7.96
|
| Rate for Payer: VA VA |
$6.58
|
| Rate for Payer: VA VA |
$5.76
|
| Rate for Payer: VA VA |
$7.05
|
| Rate for Payer: VA VA |
$6.62
|
| Rate for Payer: VA VA |
$4.83
|
| Rate for Payer: VA VA |
$11.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.74
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$45.17
|
|
|
Service Code
|
HCPCS J1163
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.44 |
| Max. Negotiated Rate |
$40.65 |
| Rate for Payer: Aetna Commercial |
$38.39
|
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Aetna Commercial |
$22.37
|
| Rate for Payer: Aetna Commercial |
$19.58
|
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Commercial |
$23.98
|
| Rate for Payer: BCBS Trust/PPO |
$37.31
|
| Rate for Payer: BCBS Trust/PPO |
$21.86
|
| Rate for Payer: BCBS Trust/PPO |
$23.30
|
| Rate for Payer: BCBS Trust/PPO |
$19.02
|
| Rate for Payer: BCBS Trust/PPO |
$15.96
|
| Rate for Payer: BCBS Trust/PPO |
$21.74
|
| Rate for Payer: BCN Commercial |
$23.30
|
| Rate for Payer: BCN Commercial |
$21.86
|
| Rate for Payer: BCN Commercial |
$15.96
|
| Rate for Payer: BCN Commercial |
$21.74
|
| Rate for Payer: BCN Commercial |
$37.31
|
| Rate for Payer: BCN Commercial |
$19.02
|
| Rate for Payer: Cash Price |
$36.14
|
| Rate for Payer: Cash Price |
$18.42
|
| Rate for Payer: Cash Price |
$21.06
|
| Rate for Payer: Cash Price |
$21.18
|
| Rate for Payer: Cash Price |
$15.46
|
| Rate for Payer: Cash Price |
$22.57
|
| Rate for Payer: Cofinity Commercial |
$24.26
|
| Rate for Payer: Cofinity Commercial |
$19.81
|
| Rate for Payer: Cofinity Commercial |
$22.64
|
| Rate for Payer: Cofinity Commercial |
$22.76
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$38.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.14
|
| Rate for Payer: Healthscope Commercial |
$17.39
|
| Rate for Payer: Healthscope Commercial |
$20.73
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Commercial |
$40.65
|
| Rate for Payer: Healthscope Commercial |
$23.82
|
| Rate for Payer: Healthscope Commercial |
$23.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.37
|
| Rate for Payer: Nomi Health Commercial |
$23.13
|
| Rate for Payer: Nomi Health Commercial |
$15.84
|
| Rate for Payer: Nomi Health Commercial |
$18.88
|
| Rate for Payer: Nomi Health Commercial |
$21.71
|
| Rate for Payer: Nomi Health Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$37.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.85
|
| Rate for Payer: PHP Commercial |
$23.98
|
| Rate for Payer: PHP Commercial |
$38.39
|
| Rate for Payer: PHP Commercial |
$22.50
|
| Rate for Payer: PHP Commercial |
$16.42
|
| Rate for Payer: PHP Commercial |
$19.58
|
| Rate for Payer: PHP Commercial |
$22.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$39.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.75
|
| Rate for Payer: UHC Core |
$37.72
|
| Rate for Payer: UHC Core |
$19.23
|
| Rate for Payer: UHC Core |
$21.98
|
| Rate for Payer: UHC Core |
$23.56
|
| Rate for Payer: UHC Core |
$22.10
|
| Rate for Payer: UHC Core |
$16.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.49
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
IP
|
$178.60
|
|
|
Service Code
|
NDC 50228048201
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.31 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$151.81
|
| Rate for Payer: BCBS Trust/PPO |
$147.51
|
| Rate for Payer: BCN Commercial |
$147.51
|
| Rate for Payer: Cash Price |
$142.88
|
| Rate for Payer: Cofinity Commercial |
$153.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.88
|
| Rate for Payer: Healthscope Commercial |
$160.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.81
|
| Rate for Payer: Nomi Health Commercial |
$146.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.95
|
| Rate for Payer: PHP Commercial |
$151.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$155.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.17
|
| Rate for Payer: UHC Core |
$149.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.95
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
OP
|
$208.05
|
|
|
Service Code
|
NDC 00093031901
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.68 |
| 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 |
$38.51
|
| Rate for Payer: BCBS MAPPO |
$52.01
|
| Rate for Payer: BCBS Trust/PPO |
$171.04
|
| Rate for Payer: BCN Commercial |
$171.04
|
| 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: Mclaren Medicaid |
$36.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.61
|
| Rate for Payer: Meridian Medicaid |
$38.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.84
|
| Rate for Payer: Nomi Health Commercial |
$170.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.04
|
| 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 Choice Medicaid |
$36.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$181.00
|
| Rate for Payer: Priority Health Medicare |
$52.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.80
|
| 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 Exchange |
$52.01
|
| Rate for Payer: UHC Medicaid |
$36.68
|
| Rate for Payer: UHC Medicare Advantage |
$52.01
|
| Rate for Payer: UHCCP Medicaid |
$36.68
|
| Rate for Payer: VA VA |
$52.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.04
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
OP
|
$178.60
|
|
|
Service Code
|
NDC 50228048201
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.49 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$151.81
|
| Rate for Payer: Aetna Medicare |
$46.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.81
|
| Rate for Payer: BCBS Complete |
$33.06
|
| Rate for Payer: BCBS MAPPO |
$44.65
|
| Rate for Payer: BCBS Trust/PPO |
$146.83
|
| Rate for Payer: BCN Commercial |
$146.83
|
| Rate for Payer: BCN Medicare Advantage |
$44.65
|
| Rate for Payer: Cash Price |
$142.88
|
| Rate for Payer: Cofinity Commercial |
$153.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.65
|
| Rate for Payer: Healthscope Commercial |
$160.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.95
|
| Rate for Payer: Mclaren Medicaid |
$31.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.88
|
| Rate for Payer: Meridian Medicaid |
$33.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.81
|
| Rate for Payer: Nomi Health Commercial |
$146.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.95
|
| Rate for Payer: PACE Senior Care Partners |
$42.42
|
| Rate for Payer: PACE SWMI |
$44.65
|
| Rate for Payer: PHP Commercial |
$151.81
|
| Rate for Payer: PHP Medicare Advantage |
$44.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$155.38
|
| Rate for Payer: Priority Health Medicare |
$45.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.31
|
| Rate for Payer: Railroad Medicare Medicare |
$44.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.17
|
| Rate for Payer: UHC Core |
$149.13
|
| Rate for Payer: UHC Exchange |
$44.65
|
| Rate for Payer: UHC Medicaid |
$31.49
|
| Rate for Payer: UHC Medicare Advantage |
$44.65
|
| Rate for Payer: UHCCP Medicaid |
$31.49
|
| Rate for Payer: VA VA |
$44.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.95
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
IP
|
$208.05
|
|
|
Service Code
|
NDC 00093031901
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.80 |
| Max. Negotiated Rate |
$187.25 |
| Rate for Payer: Aetna Commercial |
$176.84
|
| Rate for Payer: BCBS Trust/PPO |
$171.83
|
| Rate for Payer: BCN Commercial |
$171.83
|
| 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: Healthscope Commercial |
$187.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.84
|
| Rate for Payer: Nomi Health Commercial |
$170.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.04
|
| Rate for Payer: PHP Commercial |
$176.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$181.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.08
|
| Rate for Payer: UHC Core |
$173.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.04
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$381.90
|
|
|
Service Code
|
NDC 60687019501
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$265.80 |
| Max. Negotiated Rate |
$343.71 |
| Rate for Payer: Aetna Commercial |
$324.62
|
| Rate for Payer: BCBS Trust/PPO |
$315.41
|
| Rate for Payer: BCN Commercial |
$315.41
|
| 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 |
$286.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.62
|
| Rate for Payer: Nomi Health Commercial |
$313.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$286.43
|
| Rate for Payer: PHP Commercial |
$324.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$332.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.80
|
| 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 |
$286.43
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$347.70
|
|
|
Service Code
|
NDC 00904721761
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.30 |
| Max. Negotiated Rate |
$312.93 |
| Rate for Payer: Aetna Commercial |
$295.55
|
| Rate for Payer: Aetna Medicare |
$90.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.66
|
| Rate for Payer: BCBS Complete |
$64.36
|
| Rate for Payer: BCBS MAPPO |
$86.92
|
| Rate for Payer: BCBS Trust/PPO |
$285.84
|
| Rate for Payer: BCN Commercial |
$285.84
|
| Rate for Payer: BCN Medicare Advantage |
$86.92
|
| 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: Health Alliance Plan Medicare Advantage |
$86.92
|
| Rate for Payer: Healthscope Commercial |
$312.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.77
|
| Rate for Payer: Mclaren Medicaid |
$61.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.27
|
| Rate for Payer: Meridian Medicaid |
$64.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.55
|
| Rate for Payer: Nomi Health Commercial |
$285.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.77
|
| Rate for Payer: PACE Senior Care Partners |
$82.58
|
| Rate for Payer: PACE SWMI |
$86.92
|
| Rate for Payer: PHP Commercial |
$295.55
|
| Rate for Payer: PHP Medicare Advantage |
$86.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$302.50
|
| Rate for Payer: Priority Health Medicare |
$87.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$242.00
|
| Rate for Payer: Railroad Medicare Medicare |
$86.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.98
|
| Rate for Payer: UHC Core |
$290.33
|
| Rate for Payer: UHC Exchange |
$86.92
|
| Rate for Payer: UHC Medicaid |
$61.30
|
| Rate for Payer: UHC Medicare Advantage |
$86.92
|
| Rate for Payer: UHCCP Medicaid |
$61.30
|
| Rate for Payer: VA VA |
$86.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.77
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$381.90
|
|
|
Service Code
|
NDC 60687019501
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.33 |
| Max. Negotiated Rate |
$343.71 |
| Rate for Payer: Aetna Commercial |
$324.62
|
| Rate for Payer: Aetna Medicare |
$99.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.34
|
| Rate for Payer: BCBS Complete |
$70.69
|
| Rate for Payer: BCBS MAPPO |
$95.47
|
| Rate for Payer: BCBS Trust/PPO |
$313.96
|
| Rate for Payer: BCN Commercial |
$313.96
|
| Rate for Payer: BCN Medicare Advantage |
$95.47
|
| 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: Health Alliance Plan Medicare Advantage |
$95.47
|
| Rate for Payer: Healthscope Commercial |
$343.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.43
|
| Rate for Payer: Mclaren Medicaid |
$67.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.25
|
| Rate for Payer: Meridian Medicaid |
$70.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$105.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.62
|
| Rate for Payer: Nomi Health Commercial |
$313.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$286.43
|
| Rate for Payer: PACE Senior Care Partners |
$90.70
|
| Rate for Payer: PACE SWMI |
$95.47
|
| Rate for Payer: PHP Commercial |
$324.62
|
| Rate for Payer: PHP Medicare Advantage |
$95.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$332.25
|
| Rate for Payer: Priority Health Medicare |
$96.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.80
|
| Rate for Payer: Railroad Medicare Medicare |
$95.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.07
|
| Rate for Payer: UHC Core |
$318.89
|
| Rate for Payer: UHC Exchange |
$95.47
|
| Rate for Payer: UHC Medicaid |
$67.33
|
| Rate for Payer: UHC Medicare Advantage |
$95.47
|
| Rate for Payer: UHCCP Medicaid |
$67.33
|
| Rate for Payer: VA VA |
$95.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.43
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.82
|
|
|
Service Code
|
NDC 60687019511
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.44 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Aetna Medicare |
$0.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.19
|
| Rate for Payer: BCBS Complete |
$0.71
|
| Rate for Payer: BCBS MAPPO |
$0.96
|
| Rate for Payer: BCBS Trust/PPO |
$3.14
|
| Rate for Payer: BCN Commercial |
$3.14
|
| Rate for Payer: BCN Medicare Advantage |
$0.96
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.96
|
| Rate for Payer: Healthscope Commercial |
$3.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.87
|
| Rate for Payer: Mclaren Medicaid |
$0.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.00
|
| Rate for Payer: Meridian Medicaid |
$0.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Nomi Health Commercial |
$3.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.87
|
| Rate for Payer: PACE Senior Care Partners |
$0.91
|
| Rate for Payer: PACE SWMI |
$0.96
|
| Rate for Payer: PHP Commercial |
$3.25
|
| Rate for Payer: PHP Medicare Advantage |
$0.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.32
|
| Rate for Payer: Priority Health Medicare |
$0.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.66
|
| Rate for Payer: Railroad Medicare Medicare |
$0.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.36
|
| Rate for Payer: UHC Core |
$3.19
|
| Rate for Payer: UHC Exchange |
$0.96
|
| Rate for Payer: UHC Medicaid |
$0.67
|
| Rate for Payer: UHC Medicare Advantage |
$0.96
|
| Rate for Payer: UHCCP Medicaid |
$0.67
|
| Rate for Payer: VA VA |
$0.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.87
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.82
|
|
|
Service Code
|
NDC 60687019511
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$3.44 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: BCBS Trust/PPO |
$3.15
|
| Rate for Payer: BCN Commercial |
$3.15
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$3.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Nomi Health Commercial |
$3.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.87
|
| Rate for Payer: PHP Commercial |
$3.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.36
|
| Rate for Payer: UHC Core |
$3.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.87
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$347.70
|
|
|
Service Code
|
NDC 00904721761
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$242.00 |
| Max. Negotiated Rate |
$312.93 |
| Rate for Payer: Aetna Commercial |
$295.55
|
| Rate for Payer: BCBS Trust/PPO |
$287.17
|
| Rate for Payer: BCN Commercial |
$287.17
|
| 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 |
$260.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.55
|
| Rate for Payer: Nomi Health Commercial |
$285.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.77
|
| Rate for Payer: PHP Commercial |
$295.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$302.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$242.00
|
| 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 |
$260.77
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$307.80
|
|
|
Service Code
|
NDC 00904721861
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.23 |
| Max. Negotiated Rate |
$277.02 |
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: BCBS Trust/PPO |
$254.21
|
| Rate for Payer: BCN Commercial |
$254.21
|
| Rate for Payer: Cash Price |
$246.24
|
| Rate for Payer: Cofinity Commercial |
$264.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.24
|
| Rate for Payer: Healthscope Commercial |
$277.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.63
|
| Rate for Payer: Nomi Health Commercial |
$252.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.85
|
| Rate for Payer: PHP Commercial |
$261.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$267.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.86
|
| Rate for Payer: UHC Core |
$257.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.85
|
|
