|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$129.38
|
|
|
Service Code
|
NDC 0641-9219-10
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$56.93 |
| Max. Negotiated Rate |
$116.44 |
| Rate for Payer: Aetna American Axle |
$84.10
|
| Rate for Payer: Aetna Commercial |
$109.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.10
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cofinity Commercial |
$111.27
|
| Rate for Payer: Cofinity Commercial |
$90.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.50
|
| Rate for Payer: Healthscope Commercial |
$116.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.97
|
| Rate for Payer: PHP Commercial |
$109.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.57
|
| Rate for Payer: Priority Health SBD |
$81.51
|
| Rate for Payer: UMR Bronson Commercial |
$56.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.04
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$129.38
|
|
|
Service Code
|
NDC 0641-9219-01
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$56.93 |
| Max. Negotiated Rate |
$116.44 |
| Rate for Payer: Aetna American Axle |
$84.10
|
| Rate for Payer: Aetna Commercial |
$109.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.10
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cofinity Commercial |
$111.27
|
| Rate for Payer: Cofinity Commercial |
$90.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.50
|
| Rate for Payer: Healthscope Commercial |
$116.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.97
|
| Rate for Payer: PHP Commercial |
$109.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.57
|
| Rate for Payer: Priority Health SBD |
$81.51
|
| Rate for Payer: UMR Bronson Commercial |
$56.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.04
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$239.38
|
|
|
Service Code
|
NDC 55150-427-10
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$105.33 |
| Max. Negotiated Rate |
$215.44 |
| Rate for Payer: Aetna American Axle |
$155.60
|
| Rate for Payer: Aetna Commercial |
$203.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.60
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cofinity Commercial |
$167.57
|
| Rate for Payer: Cofinity Commercial |
$205.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.50
|
| Rate for Payer: Healthscope Commercial |
$215.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$203.47
|
| Rate for Payer: PHP Commercial |
$203.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.57
|
| Rate for Payer: Priority Health SBD |
$150.81
|
| Rate for Payer: UMR Bronson Commercial |
$105.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.54
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$88.75
|
|
|
Service Code
|
NDC 0641-6014-10
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.05 |
| Max. Negotiated Rate |
$79.88 |
| Rate for Payer: Aetna American Axle |
$57.69
|
| Rate for Payer: Aetna Commercial |
$75.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.69
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cofinity Commercial |
$62.12
|
| Rate for Payer: Cofinity Commercial |
$76.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.00
|
| Rate for Payer: Healthscope Commercial |
$79.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.44
|
| Rate for Payer: PHP Commercial |
$75.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.12
|
| Rate for Payer: Priority Health SBD |
$55.91
|
| Rate for Payer: UMR Bronson Commercial |
$39.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.56
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$65.25
|
|
|
Service Code
|
NDC 17478-937-05
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.71 |
| Max. Negotiated Rate |
$58.72 |
| Rate for Payer: Aetna American Axle |
$42.41
|
| Rate for Payer: Aetna Commercial |
$55.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.41
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cofinity Commercial |
$45.68
|
| Rate for Payer: Cofinity Commercial |
$56.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.20
|
| Rate for Payer: Healthscope Commercial |
$58.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.46
|
| Rate for Payer: PHP Commercial |
$55.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.68
|
| Rate for Payer: Priority Health SBD |
$41.11
|
| Rate for Payer: UMR Bronson Commercial |
$28.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.94
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$90.50
|
|
|
Service Code
|
NDC 70860-301-10
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.82 |
| Max. Negotiated Rate |
$81.45 |
| Rate for Payer: Aetna American Axle |
$58.82
|
| Rate for Payer: Aetna Commercial |
$76.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.82
|
| Rate for Payer: Cash Price |
$72.40
|
| Rate for Payer: Cofinity Commercial |
$63.35
|
| Rate for Payer: Cofinity Commercial |
$77.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.40
|
| Rate for Payer: Healthscope Commercial |
$81.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.92
|
| Rate for Payer: PHP Commercial |
$76.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.35
|
| Rate for Payer: Priority Health SBD |
$57.02
|
| Rate for Payer: UMR Bronson Commercial |
$39.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.88
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$48.63
|
|
|
Service Code
|
NDC 0641-6013-10
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$43.77 |
| Rate for Payer: Aetna American Axle |
$31.61
|
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.61
|
| Rate for Payer: Cash Price |
$38.90
|
| Rate for Payer: Cofinity Commercial |
$34.04
|
| Rate for Payer: Cofinity Commercial |
$41.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.90
|
| Rate for Payer: Healthscope Commercial |
$43.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.34
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.04
|
| Rate for Payer: Priority Health SBD |
$30.64
|
| Rate for Payer: UMR Bronson Commercial |
$21.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.47
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
IP
|
$595.20
|
|
|
Service Code
|
NDC 68682-007-10
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$261.89 |
| Max. Negotiated Rate |
$535.68 |
| Rate for Payer: Aetna American Axle |
$386.88
|
| Rate for Payer: Aetna Commercial |
$505.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.88
|
| Rate for Payer: Cash Price |
$476.16
|
| Rate for Payer: Cofinity Commercial |
$416.64
|
| Rate for Payer: Cofinity Commercial |
$511.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.16
|
| Rate for Payer: Healthscope Commercial |
$535.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$416.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$505.92
|
| Rate for Payer: PHP Commercial |
$505.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.64
|
| Rate for Payer: Priority Health SBD |
$374.98
|
| Rate for Payer: UMR Bronson Commercial |
$261.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.40
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
IP
|
$394.80
|
|
|
Service Code
|
NDC 63739-080-10
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.71 |
| Max. Negotiated Rate |
$355.32 |
| Rate for Payer: Aetna American Axle |
$256.62
|
| Rate for Payer: Aetna Commercial |
$335.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.62
|
| Rate for Payer: Cash Price |
$315.84
|
| Rate for Payer: Cofinity Commercial |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$339.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.84
|
| Rate for Payer: Healthscope Commercial |
$355.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$296.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$335.58
|
| Rate for Payer: PHP Commercial |
$335.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.36
|
| Rate for Payer: Priority Health SBD |
$248.72
|
| Rate for Payer: UMR Bronson Commercial |
$173.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$296.10
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
IP
|
$208.05
|
|
|
Service Code
|
NDC 0093-0319-01
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.54 |
| Max. Negotiated Rate |
$187.24 |
| Rate for Payer: Aetna American Axle |
$135.23
|
| Rate for Payer: Aetna Commercial |
$176.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.23
|
| Rate for Payer: Cash Price |
$166.44
|
| Rate for Payer: Cofinity Commercial |
$145.64
|
| Rate for Payer: Cofinity Commercial |
$178.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.44
|
| Rate for Payer: Healthscope Commercial |
$187.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.84
|
| Rate for Payer: PHP Commercial |
$176.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.64
|
| Rate for Payer: Priority Health SBD |
$131.07
|
| Rate for Payer: UMR Bronson Commercial |
$91.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.04
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
IP
|
$200.45
|
|
|
Service Code
|
NDC 51079-746-20
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$180.40 |
| Rate for Payer: Aetna American Axle |
$130.29
|
| Rate for Payer: Aetna Commercial |
$170.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.29
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$140.32
|
| Rate for Payer: Cofinity Commercial |
$172.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$180.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.38
|
| Rate for Payer: PHP Commercial |
$170.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.32
|
| Rate for Payer: Priority Health SBD |
$126.28
|
| Rate for Payer: UMR Bronson Commercial |
$88.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.34
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
IP
|
$2.01
|
|
|
Service Code
|
NDC 51079-746-01
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna American Axle |
$1.31
|
| Rate for Payer: Aetna Commercial |
$1.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.31
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cofinity Commercial |
$1.41
|
| Rate for Payer: Cofinity Commercial |
$1.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.61
|
| Rate for Payer: Healthscope Commercial |
$1.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.71
|
| Rate for Payer: PHP Commercial |
$1.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.41
|
| Rate for Payer: Priority Health SBD |
$1.27
|
| Rate for Payer: UMR Bronson Commercial |
$0.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.51
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4.29
|
|
|
Service Code
|
NDC 60687-195-11
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Aetna American Axle |
$2.79
|
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.79
|
| Rate for Payer: Cash Price |
$3.43
|
| Rate for Payer: Cofinity Commercial |
$3.00
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$3.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.65
|
| Rate for Payer: PHP Commercial |
$3.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.00
|
| Rate for Payer: Priority Health SBD |
$2.70
|
| Rate for Payer: UMR Bronson Commercial |
$1.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.22
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$329.65
|
|
|
Service Code
|
NDC 0904-7217-61
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.05 |
| Max. Negotiated Rate |
$296.68 |
| Rate for Payer: Aetna American Axle |
$214.27
|
| Rate for Payer: Aetna Commercial |
$280.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.27
|
| Rate for Payer: Cash Price |
$263.72
|
| Rate for Payer: Cofinity Commercial |
$230.76
|
| Rate for Payer: Cofinity Commercial |
$283.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.72
|
| Rate for Payer: Healthscope Commercial |
$296.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.20
|
| Rate for Payer: PHP Commercial |
$280.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.76
|
| Rate for Payer: Priority Health SBD |
$207.68
|
| Rate for Payer: UMR Bronson Commercial |
$145.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.24
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$317.96
|
|
|
Service Code
|
NDC 10370-829-09
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.90 |
| Max. Negotiated Rate |
$286.16 |
| Rate for Payer: Aetna American Axle |
$206.67
|
| Rate for Payer: Aetna Commercial |
$270.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.67
|
| Rate for Payer: Cash Price |
$254.37
|
| Rate for Payer: Cofinity Commercial |
$222.57
|
| Rate for Payer: Cofinity Commercial |
$273.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.37
|
| Rate for Payer: Healthscope Commercial |
$286.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$270.27
|
| Rate for Payer: PHP Commercial |
$270.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.57
|
| Rate for Payer: Priority Health SBD |
$200.31
|
| Rate for Payer: UMR Bronson Commercial |
$139.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.47
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$428.45
|
|
|
Service Code
|
NDC 60687-195-01
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.52 |
| Max. Negotiated Rate |
$385.60 |
| Rate for Payer: Aetna American Axle |
$278.49
|
| Rate for Payer: Aetna Commercial |
$364.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.49
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Commercial |
$299.92
|
| Rate for Payer: Cofinity Commercial |
$368.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Healthscope Commercial |
$385.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.18
|
| Rate for Payer: PHP Commercial |
$364.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.92
|
| Rate for Payer: Priority Health SBD |
$269.92
|
| Rate for Payer: UMR Bronson Commercial |
$188.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.34
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$200.45
|
|
|
Service Code
|
NDC 63739-015-10
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$180.40 |
| Rate for Payer: Aetna American Axle |
$130.29
|
| Rate for Payer: Aetna Commercial |
$170.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.29
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$140.32
|
| Rate for Payer: Cofinity Commercial |
$172.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$180.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.38
|
| Rate for Payer: PHP Commercial |
$170.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.32
|
| Rate for Payer: Priority Health SBD |
$126.28
|
| Rate for Payer: UMR Bronson Commercial |
$88.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.34
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$305.90
|
|
|
Service Code
|
NDC 60687-206-01
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.60 |
| Max. Negotiated Rate |
$275.31 |
| Rate for Payer: Aetna American Axle |
$198.84
|
| Rate for Payer: Aetna Commercial |
$260.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.84
|
| Rate for Payer: Cash Price |
$244.72
|
| Rate for Payer: Cofinity Commercial |
$214.13
|
| Rate for Payer: Cofinity Commercial |
$263.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.72
|
| Rate for Payer: Healthscope Commercial |
$275.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.02
|
| Rate for Payer: PHP Commercial |
$260.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.13
|
| Rate for Payer: Priority Health SBD |
$192.72
|
| Rate for Payer: UMR Bronson Commercial |
$134.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.42
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.06
|
|
|
Service Code
|
NDC 60687-206-11
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna American Axle |
$1.99
|
| Rate for Payer: Aetna Commercial |
$2.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.99
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cofinity Commercial |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.45
|
| Rate for Payer: Healthscope Commercial |
$2.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.60
|
| Rate for Payer: PHP Commercial |
$2.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.14
|
| Rate for Payer: Priority Health SBD |
$1.93
|
| Rate for Payer: UMR Bronson Commercial |
$1.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.30
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$424.65
|
|
|
Service Code
|
NDC 63739-016-10
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.85 |
| Max. Negotiated Rate |
$382.18 |
| Rate for Payer: Aetna American Axle |
$276.02
|
| Rate for Payer: Aetna Commercial |
$360.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.02
|
| Rate for Payer: Cash Price |
$339.72
|
| Rate for Payer: Cofinity Commercial |
$297.26
|
| Rate for Payer: Cofinity Commercial |
$365.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.72
|
| Rate for Payer: Healthscope Commercial |
$382.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$360.95
|
| Rate for Payer: PHP Commercial |
$360.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.26
|
| Rate for Payer: Priority Health SBD |
$267.53
|
| Rate for Payer: UMR Bronson Commercial |
$186.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.49
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$544.32
|
|
|
Service Code
|
NDC 10370-831-09
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$239.50 |
| Max. Negotiated Rate |
$489.89 |
| Rate for Payer: Aetna American Axle |
$353.81
|
| Rate for Payer: Aetna Commercial |
$462.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.81
|
| Rate for Payer: Cash Price |
$435.46
|
| Rate for Payer: Cofinity Commercial |
$381.02
|
| Rate for Payer: Cofinity Commercial |
$468.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$435.46
|
| Rate for Payer: Healthscope Commercial |
$489.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$381.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$408.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$462.67
|
| Rate for Payer: PHP Commercial |
$462.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.02
|
| Rate for Payer: Priority Health SBD |
$342.92
|
| Rate for Payer: UMR Bronson Commercial |
$239.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$408.24
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$254.88
|
|
|
Service Code
|
NDC 60687-217-01
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.15 |
| Max. Negotiated Rate |
$229.39 |
| Rate for Payer: Aetna American Axle |
$165.67
|
| Rate for Payer: Aetna Commercial |
$216.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.67
|
| Rate for Payer: Cash Price |
$203.90
|
| Rate for Payer: Cofinity Commercial |
$178.42
|
| Rate for Payer: Cofinity Commercial |
$219.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.90
|
| Rate for Payer: Healthscope Commercial |
$229.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.65
|
| Rate for Payer: PHP Commercial |
$216.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.42
|
| Rate for Payer: Priority Health SBD |
$160.57
|
| Rate for Payer: UMR Bronson Commercial |
$112.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.16
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$2.55
|
|
|
Service Code
|
NDC 60687-217-11
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna American Axle |
$1.66
|
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.04
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health SBD |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
|
|
DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$709.92
|
|
|
Service Code
|
NDC 60687-228-01
|
| Hospital Charge Code |
29276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$312.36 |
| Max. Negotiated Rate |
$638.93 |
| Rate for Payer: Aetna American Axle |
$461.45
|
| Rate for Payer: Aetna Commercial |
$603.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.45
|
| Rate for Payer: Cash Price |
$567.94
|
| Rate for Payer: Cofinity Commercial |
$496.94
|
| Rate for Payer: Cofinity Commercial |
$610.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$567.94
|
| Rate for Payer: Healthscope Commercial |
$638.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$496.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$603.43
|
| Rate for Payer: PHP Commercial |
$603.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$496.94
|
| Rate for Payer: Priority Health SBD |
$447.25
|
| Rate for Payer: UMR Bronson Commercial |
$312.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.44
|
|
|
DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$7.10
|
|
|
Service Code
|
NDC 60687-228-11
|
| Hospital Charge Code |
29276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$6.39 |
| Rate for Payer: Aetna American Axle |
$4.62
|
| Rate for Payer: Aetna Commercial |
$6.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.62
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cofinity Commercial |
$4.97
|
| Rate for Payer: Cofinity Commercial |
$6.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.68
|
| Rate for Payer: Healthscope Commercial |
$6.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.04
|
| Rate for Payer: PHP Commercial |
$6.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.97
|
| Rate for Payer: Priority Health SBD |
$4.47
|
| Rate for Payer: UMR Bronson Commercial |
$3.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.32
|
|
