|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$339.15
|
|
|
Service Code
|
NDC 60687020601
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.79 |
| Max. Negotiated Rate |
$305.24 |
| Rate for Payer: Aetna Commercial |
$288.28
|
| Rate for Payer: Aetna Medicare |
$88.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.98
|
| Rate for Payer: BCBS Complete |
$62.78
|
| Rate for Payer: BCBS MAPPO |
$84.79
|
| Rate for Payer: BCBS Trust/PPO |
$278.82
|
| Rate for Payer: BCN Commercial |
$278.82
|
| Rate for Payer: BCN Medicare Advantage |
$84.79
|
| Rate for Payer: Cash Price |
$271.32
|
| Rate for Payer: Cofinity Commercial |
$291.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.79
|
| Rate for Payer: Healthscope Commercial |
$305.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.36
|
| Rate for Payer: Mclaren Medicaid |
$59.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.03
|
| Rate for Payer: Meridian Medicaid |
$62.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$93.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.28
|
| Rate for Payer: Nomi Health Commercial |
$278.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.36
|
| Rate for Payer: PACE Senior Care Partners |
$80.55
|
| Rate for Payer: PACE SWMI |
$84.79
|
| Rate for Payer: PHP Commercial |
$288.28
|
| Rate for Payer: PHP Medicare Advantage |
$84.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$295.06
|
| Rate for Payer: Priority Health Medicare |
$85.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.05
|
| Rate for Payer: Railroad Medicare Medicare |
$84.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.45
|
| Rate for Payer: UHC Core |
$283.19
|
| Rate for Payer: UHC Exchange |
$84.79
|
| Rate for Payer: UHC Medicaid |
$59.79
|
| Rate for Payer: UHC Medicare Advantage |
$84.79
|
| Rate for Payer: UHCCP Medicaid |
$59.79
|
| Rate for Payer: VA VA |
$84.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.36
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$339.15
|
|
|
Service Code
|
NDC 60687020601
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.05 |
| Max. Negotiated Rate |
$305.24 |
| Rate for Payer: Aetna Commercial |
$288.28
|
| Rate for Payer: BCBS Trust/PPO |
$280.10
|
| Rate for Payer: BCN Commercial |
$280.10
|
| Rate for Payer: Cash Price |
$271.32
|
| Rate for Payer: Cofinity Commercial |
$291.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.32
|
| Rate for Payer: Healthscope Commercial |
$305.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.28
|
| Rate for Payer: Nomi Health Commercial |
$278.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.36
|
| Rate for Payer: PHP Commercial |
$288.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$295.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.45
|
| Rate for Payer: UHC Core |
$283.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.36
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$307.80
|
|
|
Service Code
|
NDC 00904721861
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.27 |
| Max. Negotiated Rate |
$277.02 |
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: Aetna Medicare |
$80.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.19
|
| Rate for Payer: BCBS Complete |
$56.97
|
| Rate for Payer: BCBS MAPPO |
$76.95
|
| Rate for Payer: BCBS Trust/PPO |
$253.04
|
| Rate for Payer: BCN Commercial |
$253.04
|
| Rate for Payer: BCN Medicare Advantage |
$76.95
|
| 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: Health Alliance Plan Medicare Advantage |
$76.95
|
| Rate for Payer: Healthscope Commercial |
$277.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.85
|
| Rate for Payer: Mclaren Medicaid |
$54.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.80
|
| Rate for Payer: Meridian Medicaid |
$56.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$84.64
|
| 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: PACE Senior Care Partners |
$73.10
|
| Rate for Payer: PACE SWMI |
$76.95
|
| Rate for Payer: PHP Commercial |
$261.63
|
| Rate for Payer: PHP Medicare Advantage |
$76.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$267.79
|
| Rate for Payer: Priority Health Medicare |
$77.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.23
|
| Rate for Payer: Railroad Medicare Medicare |
$76.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.86
|
| Rate for Payer: UHC Core |
$257.01
|
| Rate for Payer: UHC Exchange |
$76.95
|
| Rate for Payer: UHC Medicaid |
$54.27
|
| Rate for Payer: UHC Medicare Advantage |
$76.95
|
| Rate for Payer: UHCCP Medicaid |
$54.27
|
| Rate for Payer: VA VA |
$76.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.85
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
NDC 60687020611
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: BCBS Trust/PPO |
$2.81
|
| Rate for Payer: BCN Commercial |
$2.81
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: Nomi Health Commercial |
$2.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.55
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC Core |
$2.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
NDC 60687020611
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna Medicare |
$0.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.06
|
| Rate for Payer: BCBS Complete |
$0.63
|
| Rate for Payer: BCBS MAPPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$2.80
|
| Rate for Payer: BCN Commercial |
$2.80
|
| Rate for Payer: BCN Medicare Advantage |
$0.85
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.85
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: Mclaren Medicaid |
$0.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.89
|
| Rate for Payer: Meridian Medicaid |
$0.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: Nomi Health Commercial |
$2.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.55
|
| Rate for Payer: PACE Senior Care Partners |
$0.81
|
| Rate for Payer: PACE SWMI |
$0.85
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: PHP Medicare Advantage |
$0.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.96
|
| Rate for Payer: Priority Health Medicare |
$0.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.37
|
| Rate for Payer: Railroad Medicare Medicare |
$0.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC Core |
$2.84
|
| Rate for Payer: UHC Exchange |
$0.85
|
| Rate for Payer: UHC Medicaid |
$0.60
|
| Rate for Payer: UHC Medicare Advantage |
$0.85
|
| Rate for Payer: UHCCP Medicaid |
$0.60
|
| Rate for Payer: VA VA |
$0.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
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 |
$295.56 |
| Max. Negotiated Rate |
$382.19 |
| Rate for Payer: Aetna Commercial |
$360.95
|
| Rate for Payer: BCBS Trust/PPO |
$350.72
|
| Rate for Payer: BCN Commercial |
$350.72
|
| 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: Opus (Opus Packaging Group) HMA |
$318.49
|
| Rate for Payer: PHP Commercial |
$360.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$369.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$295.56
|
| 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
|
OP
|
$374.30
|
|
|
Service Code
|
NDC 00904721961
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.99 |
| Max. Negotiated Rate |
$336.87 |
| Rate for Payer: Aetna Commercial |
$318.15
|
| Rate for Payer: Aetna Medicare |
$97.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.97
|
| Rate for Payer: BCBS Complete |
$69.28
|
| Rate for Payer: BCBS MAPPO |
$93.58
|
| Rate for Payer: BCBS Trust/PPO |
$307.71
|
| Rate for Payer: BCN Commercial |
$307.71
|
| Rate for Payer: BCN Medicare Advantage |
$93.58
|
| Rate for Payer: Cash Price |
$299.44
|
| Rate for Payer: Cofinity Commercial |
$321.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.58
|
| Rate for Payer: Healthscope Commercial |
$336.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.73
|
| Rate for Payer: Mclaren Medicaid |
$65.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.25
|
| Rate for Payer: Meridian Medicaid |
$69.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$102.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.15
|
| Rate for Payer: Nomi Health Commercial |
$306.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.73
|
| Rate for Payer: PACE Senior Care Partners |
$88.90
|
| Rate for Payer: PACE SWMI |
$93.58
|
| Rate for Payer: PHP Commercial |
$318.15
|
| Rate for Payer: PHP Medicare Advantage |
$93.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$325.64
|
| Rate for Payer: Priority Health Medicare |
$94.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.51
|
| Rate for Payer: Railroad Medicare Medicare |
$93.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.38
|
| Rate for Payer: UHC Core |
$312.54
|
| Rate for Payer: UHC Exchange |
$93.58
|
| Rate for Payer: UHC Medicaid |
$65.99
|
| Rate for Payer: UHC Medicare Advantage |
$93.58
|
| Rate for Payer: UHCCP Medicaid |
$65.99
|
| Rate for Payer: VA VA |
$93.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.73
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4.13
|
|
|
Service Code
|
NDC 60687021711
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.51
|
| Rate for Payer: BCBS Trust/PPO |
$3.41
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Commercial |
$3.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.30
|
| Rate for Payer: Healthscope Commercial |
$3.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.51
|
| Rate for Payer: Nomi Health Commercial |
$3.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.10
|
| Rate for Payer: PHP Commercial |
$3.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.63
|
| Rate for Payer: UHC Core |
$3.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.10
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$412.30
|
|
|
Service Code
|
NDC 60687021701
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$286.96 |
| Max. Negotiated Rate |
$371.07 |
| Rate for Payer: Aetna Commercial |
$350.45
|
| Rate for Payer: BCBS Trust/PPO |
$340.52
|
| Rate for Payer: BCN Commercial |
$340.52
|
| Rate for Payer: Cash Price |
$329.84
|
| Rate for Payer: Cofinity Commercial |
$354.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.84
|
| Rate for Payer: Healthscope Commercial |
$371.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.45
|
| Rate for Payer: Nomi Health Commercial |
$338.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.23
|
| Rate for Payer: PHP Commercial |
$350.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$358.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$286.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$362.82
|
| Rate for Payer: UHC Core |
$344.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.23
|
|
|
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 |
$74.87 |
| 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 |
$78.60
|
| Rate for Payer: BCBS MAPPO |
$106.16
|
| Rate for Payer: BCBS Trust/PPO |
$349.10
|
| Rate for Payer: BCN Commercial |
$349.10
|
| 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: Mclaren Medicaid |
$74.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.47
|
| Rate for Payer: Meridian Medicaid |
$78.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$116.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.95
|
| Rate for Payer: Nomi Health Commercial |
$348.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.49
|
| 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 Choice Medicaid |
$74.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$369.45
|
| Rate for Payer: Priority Health Medicare |
$107.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$295.56
|
| 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 Exchange |
$106.16
|
| Rate for Payer: UHC Medicaid |
$74.87
|
| Rate for Payer: UHC Medicare Advantage |
$106.16
|
| Rate for Payer: UHCCP Medicaid |
$74.87
|
| 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
|
$4.13
|
|
|
Service Code
|
NDC 60687021711
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.51
|
| Rate for Payer: Aetna Medicare |
$1.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.29
|
| Rate for Payer: BCBS Complete |
$0.76
|
| Rate for Payer: BCBS MAPPO |
$1.03
|
| Rate for Payer: BCBS Trust/PPO |
$3.40
|
| Rate for Payer: BCN Commercial |
$3.40
|
| Rate for Payer: BCN Medicare Advantage |
$1.03
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Commercial |
$3.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.03
|
| Rate for Payer: Healthscope Commercial |
$3.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.10
|
| Rate for Payer: Mclaren Medicaid |
$0.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.08
|
| Rate for Payer: Meridian Medicaid |
$0.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.51
|
| Rate for Payer: Nomi Health Commercial |
$3.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.10
|
| Rate for Payer: PACE Senior Care Partners |
$0.98
|
| Rate for Payer: PACE SWMI |
$1.03
|
| Rate for Payer: PHP Commercial |
$3.51
|
| Rate for Payer: PHP Medicare Advantage |
$1.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.59
|
| Rate for Payer: Priority Health Medicare |
$1.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.63
|
| Rate for Payer: UHC Core |
$3.45
|
| Rate for Payer: UHC Exchange |
$1.03
|
| Rate for Payer: UHC Medicaid |
$0.73
|
| Rate for Payer: UHC Medicare Advantage |
$1.03
|
| Rate for Payer: UHCCP Medicaid |
$0.73
|
| Rate for Payer: VA VA |
$1.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.10
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$412.30
|
|
|
Service Code
|
NDC 60687021701
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.69 |
| Max. Negotiated Rate |
$371.07 |
| Rate for Payer: Aetna Commercial |
$350.45
|
| Rate for Payer: Aetna Medicare |
$107.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$128.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$128.84
|
| Rate for Payer: BCBS Complete |
$76.32
|
| Rate for Payer: BCBS MAPPO |
$103.08
|
| Rate for Payer: BCBS Trust/PPO |
$338.95
|
| Rate for Payer: BCN Commercial |
$338.95
|
| Rate for Payer: BCN Medicare Advantage |
$103.08
|
| Rate for Payer: Cash Price |
$329.84
|
| Rate for Payer: Cofinity Commercial |
$354.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.08
|
| Rate for Payer: Healthscope Commercial |
$371.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.23
|
| Rate for Payer: Mclaren Medicaid |
$72.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.23
|
| Rate for Payer: Meridian Medicaid |
$76.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$113.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.45
|
| Rate for Payer: Nomi Health Commercial |
$338.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.23
|
| Rate for Payer: PACE Senior Care Partners |
$97.92
|
| Rate for Payer: PACE SWMI |
$103.08
|
| Rate for Payer: PHP Commercial |
$350.45
|
| Rate for Payer: PHP Medicare Advantage |
$103.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$358.70
|
| Rate for Payer: Priority Health Medicare |
$104.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$286.96
|
| Rate for Payer: Railroad Medicare Medicare |
$103.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$362.82
|
| Rate for Payer: UHC Core |
$344.27
|
| Rate for Payer: UHC Exchange |
$103.08
|
| Rate for Payer: UHC Medicaid |
$72.69
|
| Rate for Payer: UHC Medicare Advantage |
$103.08
|
| Rate for Payer: UHCCP Medicaid |
$72.69
|
| Rate for Payer: VA VA |
$103.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.23
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$374.30
|
|
|
Service Code
|
NDC 00904721961
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.51 |
| Max. Negotiated Rate |
$336.87 |
| Rate for Payer: Aetna Commercial |
$318.15
|
| Rate for Payer: BCBS Trust/PPO |
$309.13
|
| Rate for Payer: BCN Commercial |
$309.13
|
| Rate for Payer: Cash Price |
$299.44
|
| Rate for Payer: Cofinity Commercial |
$321.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.44
|
| Rate for Payer: Healthscope Commercial |
$336.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.15
|
| Rate for Payer: Nomi Health Commercial |
$306.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.73
|
| Rate for Payer: PHP Commercial |
$318.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$325.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.38
|
| Rate for Payer: UHC Core |
$312.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.73
|
|
|
DILTIAZEM ER (XR/XT) 180 MG CAPSULE,EXTENDED RELEASE 24 HR, CONTROLLED
|
Facility
|
IP
|
$261.60
|
|
|
Service Code
|
NDC 60505001506
|
| Hospital Charge Code |
29347
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.07 |
| Max. Negotiated Rate |
$235.44 |
| Rate for Payer: Aetna Commercial |
$222.36
|
| Rate for Payer: BCBS Trust/PPO |
$216.06
|
| Rate for Payer: BCN Commercial |
$216.06
|
| Rate for Payer: Cash Price |
$209.28
|
| Rate for Payer: Cofinity Commercial |
$224.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.28
|
| Rate for Payer: Healthscope Commercial |
$235.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.36
|
| Rate for Payer: Nomi Health Commercial |
$214.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.20
|
| Rate for Payer: PHP Commercial |
$222.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$227.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.21
|
| Rate for Payer: UHC Core |
$218.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.20
|
|
|
DILTIAZEM ER (XR/XT) 180 MG CAPSULE,EXTENDED RELEASE 24 HR, CONTROLLED
|
Facility
|
OP
|
$261.60
|
|
|
Service Code
|
NDC 60505001506
|
| Hospital Charge Code |
29347
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.12 |
| Max. Negotiated Rate |
$235.44 |
| Rate for Payer: Aetna Commercial |
$222.36
|
| Rate for Payer: Aetna Medicare |
$68.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.75
|
| Rate for Payer: BCBS Complete |
$48.42
|
| Rate for Payer: BCBS MAPPO |
$65.40
|
| Rate for Payer: BCBS Trust/PPO |
$215.06
|
| Rate for Payer: BCN Commercial |
$215.06
|
| Rate for Payer: BCN Medicare Advantage |
$65.40
|
| Rate for Payer: Cash Price |
$209.28
|
| Rate for Payer: Cofinity Commercial |
$224.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.40
|
| Rate for Payer: Healthscope Commercial |
$235.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.20
|
| Rate for Payer: Mclaren Medicaid |
$46.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.67
|
| Rate for Payer: Meridian Medicaid |
$48.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.36
|
| Rate for Payer: Nomi Health Commercial |
$214.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.20
|
| Rate for Payer: PACE Senior Care Partners |
$62.13
|
| Rate for Payer: PACE SWMI |
$65.40
|
| Rate for Payer: PHP Commercial |
$222.36
|
| Rate for Payer: PHP Medicare Advantage |
$65.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$227.59
|
| Rate for Payer: Priority Health Medicare |
$66.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.07
|
| Rate for Payer: Railroad Medicare Medicare |
$65.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.21
|
| Rate for Payer: UHC Core |
$218.44
|
| Rate for Payer: UHC Exchange |
$65.40
|
| Rate for Payer: UHC Medicaid |
$46.12
|
| Rate for Payer: UHC Medicare Advantage |
$65.40
|
| Rate for Payer: UHCCP Medicaid |
$46.12
|
| Rate for Payer: VA VA |
$65.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.20
|
|
|
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 |
$16.71 |
| Max. Negotiated Rate |
$21.61 |
| Rate for Payer: Aetna Commercial |
$20.41
|
| Rate for Payer: BCBS Trust/PPO |
$19.83
|
| Rate for Payer: BCN Commercial |
$19.83
|
| 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: Opus (Opus Packaging Group) HMA |
$18.01
|
| Rate for Payer: PHP Commercial |
$20.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.71
|
| 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 |
$4.23 |
| 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 |
$4.44
|
| Rate for Payer: BCBS MAPPO |
$6.00
|
| Rate for Payer: BCBS Trust/PPO |
$19.74
|
| Rate for Payer: BCN Commercial |
$19.74
|
| 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: Mclaren Medicaid |
$4.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.30
|
| Rate for Payer: Meridian Medicaid |
$4.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.41
|
| Rate for Payer: Nomi Health Commercial |
$19.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.01
|
| 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 Choice Medicaid |
$4.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.89
|
| Rate for Payer: Priority Health Medicare |
$6.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.71
|
| 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 Exchange |
$6.00
|
| Rate for Payer: UHC Medicaid |
$4.23
|
| Rate for Payer: UHC Medicare Advantage |
$6.00
|
| Rate for Payer: UHCCP Medicaid |
$4.23
|
| Rate for Payer: VA VA |
$6.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.01
|
|
|
DIMENHYDRINATE 50 MG TABLET
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
NDC 00904205159
|
| Hospital Charge Code |
2485
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.88 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.03
|
| Rate for Payer: Aetna Medicare |
$27.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.47
|
| Rate for Payer: BCBS Complete |
$19.82
|
| Rate for Payer: BCBS MAPPO |
$26.77
|
| Rate for Payer: BCBS Trust/PPO |
$88.05
|
| Rate for Payer: BCN Commercial |
$88.05
|
| Rate for Payer: BCN Medicare Advantage |
$26.77
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.77
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.33
|
| Rate for Payer: Mclaren Medicaid |
$18.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.11
|
| Rate for Payer: Meridian Medicaid |
$19.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.03
|
| Rate for Payer: Nomi Health Commercial |
$87.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.33
|
| Rate for Payer: PACE Senior Care Partners |
$25.44
|
| Rate for Payer: PACE SWMI |
$26.77
|
| Rate for Payer: PHP Commercial |
$91.03
|
| Rate for Payer: PHP Medicare Advantage |
$26.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$93.18
|
| Rate for Payer: Priority Health Medicare |
$27.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.54
|
| Rate for Payer: Railroad Medicare Medicare |
$26.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.25
|
| Rate for Payer: UHC Core |
$89.43
|
| Rate for Payer: UHC Exchange |
$26.77
|
| Rate for Payer: UHC Medicaid |
$18.88
|
| Rate for Payer: UHC Medicare Advantage |
$26.77
|
| Rate for Payer: UHCCP Medicaid |
$18.88
|
| Rate for Payer: VA VA |
$26.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.33
|
|
|
DIMENHYDRINATE 50 MG TABLET
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
NDC 00904205159
|
| Hospital Charge Code |
2485
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.54 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.03
|
| Rate for Payer: BCBS Trust/PPO |
$88.45
|
| Rate for Payer: BCN Commercial |
$88.45
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.03
|
| Rate for Payer: Nomi Health Commercial |
$87.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.33
|
| Rate for Payer: PHP Commercial |
$91.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$93.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.25
|
| Rate for Payer: UHC Core |
$89.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.33
|
|
|
DIMENHYDRINATE 50 MG TABLET
|
Facility
|
IP
|
$14.52
|
|
|
Service Code
|
NDC 09629520033
|
| Hospital Charge Code |
2485
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.11 |
| Max. Negotiated Rate |
$13.07 |
| Rate for Payer: Aetna Commercial |
$12.34
|
| Rate for Payer: BCBS Trust/PPO |
$11.99
|
| Rate for Payer: BCN Commercial |
$11.99
|
| Rate for Payer: Cash Price |
$11.62
|
| Rate for Payer: Cofinity Commercial |
$12.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.62
|
| Rate for Payer: Healthscope Commercial |
$13.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.34
|
| Rate for Payer: Nomi Health Commercial |
$11.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.89
|
| Rate for Payer: PHP Commercial |
$12.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.78
|
| Rate for Payer: UHC Core |
$12.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.89
|
|
|
DIMENHYDRINATE 50 MG TABLET
|
Facility
|
OP
|
$14.52
|
|
|
Service Code
|
NDC 09629520033
|
| Hospital Charge Code |
2485
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$13.07 |
| Rate for Payer: Aetna Commercial |
$12.34
|
| Rate for Payer: Aetna Medicare |
$3.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.54
|
| Rate for Payer: BCBS Complete |
$2.69
|
| Rate for Payer: BCBS MAPPO |
$3.63
|
| Rate for Payer: BCBS Trust/PPO |
$11.94
|
| Rate for Payer: BCN Commercial |
$11.94
|
| Rate for Payer: BCN Medicare Advantage |
$3.63
|
| Rate for Payer: Cash Price |
$11.62
|
| Rate for Payer: Cofinity Commercial |
$12.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.63
|
| Rate for Payer: Healthscope Commercial |
$13.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.89
|
| Rate for Payer: Mclaren Medicaid |
$2.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.81
|
| Rate for Payer: Meridian Medicaid |
$2.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.34
|
| Rate for Payer: Nomi Health Commercial |
$11.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.89
|
| Rate for Payer: PACE Senior Care Partners |
$3.45
|
| Rate for Payer: PACE SWMI |
$3.63
|
| Rate for Payer: PHP Commercial |
$12.34
|
| Rate for Payer: PHP Medicare Advantage |
$3.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.63
|
| Rate for Payer: Priority Health Medicare |
$3.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.11
|
| Rate for Payer: Railroad Medicare Medicare |
$3.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.78
|
| Rate for Payer: UHC Core |
$12.12
|
| Rate for Payer: UHC Exchange |
$3.63
|
| Rate for Payer: UHC Medicaid |
$2.56
|
| Rate for Payer: UHC Medicare Advantage |
$3.63
|
| Rate for Payer: UHCCP Medicaid |
$2.56
|
| Rate for Payer: VA VA |
$3.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.89
|
|
|
DIPHENHYD 25 MG-LIDO 200 MG-MAG,AL 400 MG-SIMETH 40 MG/30 ML MOUTHWASH
|
Facility
|
IP
|
$426.37
|
|
|
Service Code
|
NDC 65628005001
|
| Hospital Charge Code |
39984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$296.75 |
| Max. Negotiated Rate |
$383.73 |
| Rate for Payer: Aetna Commercial |
$362.41
|
| Rate for Payer: BCBS Trust/PPO |
$352.14
|
| Rate for Payer: BCN Commercial |
$352.14
|
| Rate for Payer: Cash Price |
$341.10
|
| Rate for Payer: Cofinity Commercial |
$366.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.10
|
| Rate for Payer: Healthscope Commercial |
$383.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.41
|
| Rate for Payer: Nomi Health Commercial |
$349.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.78
|
| Rate for Payer: PHP Commercial |
$362.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$370.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$296.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.21
|
| Rate for Payer: UHC Core |
$356.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.78
|
|
|
DIPHENHYD 25 MG-LIDO 200 MG-MAG,AL 400 MG-SIMETH 40 MG/30 ML MOUTHWASH
|
Facility
|
OP
|
$426.37
|
|
|
Service Code
|
NDC 65628005001
|
| Hospital Charge Code |
39984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.17 |
| Max. Negotiated Rate |
$383.73 |
| Rate for Payer: Aetna Commercial |
$362.41
|
| Rate for Payer: Aetna Medicare |
$110.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$133.24
|
| Rate for Payer: BCBS Complete |
$78.92
|
| Rate for Payer: BCBS MAPPO |
$106.59
|
| Rate for Payer: BCBS Trust/PPO |
$350.52
|
| Rate for Payer: BCN Commercial |
$350.52
|
| Rate for Payer: BCN Medicare Advantage |
$106.59
|
| Rate for Payer: Cash Price |
$341.10
|
| Rate for Payer: Cofinity Commercial |
$366.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.59
|
| Rate for Payer: Healthscope Commercial |
$383.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.78
|
| Rate for Payer: Mclaren Medicaid |
$75.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.92
|
| Rate for Payer: Meridian Medicaid |
$78.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$117.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.41
|
| Rate for Payer: Nomi Health Commercial |
$349.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.78
|
| Rate for Payer: PACE Senior Care Partners |
$101.26
|
| Rate for Payer: PACE SWMI |
$106.59
|
| Rate for Payer: PHP Commercial |
$362.41
|
| Rate for Payer: PHP Medicare Advantage |
$106.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$370.94
|
| Rate for Payer: Priority Health Medicare |
$107.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$296.75
|
| Rate for Payer: Railroad Medicare Medicare |
$106.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.21
|
| Rate for Payer: UHC Core |
$356.02
|
| Rate for Payer: UHC Exchange |
$106.59
|
| Rate for Payer: UHC Medicaid |
$75.17
|
| Rate for Payer: UHC Medicare Advantage |
$106.59
|
| Rate for Payer: UHCCP Medicaid |
$75.17
|
| Rate for Payer: VA VA |
$106.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.78
|
|
|
DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR
|
Facility
|
IP
|
$15.51
|
|
|
Service Code
|
HCPCS Q0163
|
| Hospital Charge Code |
2511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$13.96 |
| Rate for Payer: Aetna Commercial |
$13.18
|
| Rate for Payer: BCBS Trust/PPO |
$12.81
|
| Rate for Payer: BCN Commercial |
$12.81
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cofinity Commercial |
$13.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.41
|
| Rate for Payer: Healthscope Commercial |
$13.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.18
|
| Rate for Payer: Nomi Health Commercial |
$12.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.63
|
| Rate for Payer: PHP Commercial |
$13.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.65
|
| Rate for Payer: UHC Core |
$12.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.63
|
|
|
DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR
|
Facility
|
OP
|
$15.51
|
|
|
Service Code
|
HCPCS Q0163
|
| Hospital Charge Code |
2511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$13.96 |
| Rate for Payer: Aetna Commercial |
$13.18
|
| Rate for Payer: Aetna Medicare |
$4.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.85
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$3.88
|
| Rate for Payer: BCBS Trust/PPO |
$12.75
|
| Rate for Payer: BCN Commercial |
$12.75
|
| Rate for Payer: BCN Medicare Advantage |
$3.88
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cofinity Commercial |
$13.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.88
|
| Rate for Payer: Healthscope Commercial |
$13.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.63
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.07
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.18
|
| Rate for Payer: Nomi Health Commercial |
$12.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.63
|
| Rate for Payer: PACE Senior Care Partners |
$3.68
|
| Rate for Payer: PACE SWMI |
$3.88
|
| Rate for Payer: PHP Commercial |
$13.18
|
| Rate for Payer: PHP Medicare Advantage |
$3.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.49
|
| Rate for Payer: Priority Health Medicare |
$3.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.79
|
| Rate for Payer: Railroad Medicare Medicare |
$3.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.65
|
| Rate for Payer: UHC Core |
$12.95
|
| Rate for Payer: UHC Exchange |
$3.88
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHC Medicare Advantage |
$3.88
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$3.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.63
|
|
