|
DILATION OF EXISTING TRACT, PERCUTANEOUS, FOR AN ENDOUROLOGIC PROCEDURE INCLUDING IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, WITH POSTPROCEDURE TUBE PLACEMENT, WHEN PERFORMED;
|
Facility
|
OP
|
$11,358.48
|
|
|
Service Code
|
CPT 50436
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,688.33 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,688.33
|
| Rate for Payer: BCN Commercial |
$1,688.33
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Mclaren Medicaid |
$3,512.31
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: VA VA |
$3,512.31
|
|
|
DILTIAZEM 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$39.77
|
|
|
Service Code
|
HCPCS J1163
|
| Hospital Charge Code |
22156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$35.79 |
| Rate for Payer: Aetna American Axle |
$25.85
|
| Rate for Payer: Aetna Commercial |
$33.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.85
|
| Rate for Payer: Cash Price |
$31.82
|
| Rate for Payer: Cofinity Advantage |
$27.84
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$27.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.83
|
| Rate for Payer: PHP Commercial |
$33.80
|
| Rate for Payer: Priority Health SBD |
$25.06
|
| Rate for Payer: UMR Bronson Commercial |
$17.50
|
| 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 |
$0.05 |
| Max. Negotiated Rate |
$35.79 |
| Rate for Payer: Aetna American Axle |
$25.85
|
| Rate for Payer: Aetna Commercial |
$33.80
|
| Rate for Payer: Aetna Medicare |
$19.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.85
|
| Rate for Payer: BCBS Complete |
$15.91
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$31.82
|
| Rate for Payer: Cash Price |
$31.82
|
| Rate for Payer: Cofinity Advantage |
$27.84
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$27.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.83
|
| Rate for Payer: PHP Commercial |
$33.80
|
| Rate for Payer: Priority Health SBD |
$25.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UMR Bronson Commercial |
$14.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.83
|
|
|
DILTIAZEM 1MG/1 ML INFUSION 125 ML (IV PREMIX)
|
Facility
|
OP
|
$156.25
|
|
|
Service Code
|
NDC 09900000302
|
| Hospital Charge Code |
155072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.81 |
| Max. Negotiated Rate |
$140.62 |
| Rate for Payer: Aetna American Axle |
$101.56
|
| Rate for Payer: Aetna Commercial |
$132.81
|
| Rate for Payer: Aetna Medicare |
$78.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.56
|
| Rate for Payer: BCBS Complete |
$62.50
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cofinity Advantage |
$109.38
|
| Rate for Payer: Cofinity Commercial |
$134.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.00
|
| Rate for Payer: Healthscope Commercial |
$140.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.19
|
| Rate for Payer: PHP Commercial |
$132.81
|
| Rate for Payer: Priority Health SBD |
$98.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.56
|
| Rate for Payer: UHC Core |
$81.41
|
| Rate for Payer: UHC Exchange |
$61.41
|
| Rate for Payer: UMR Bronson Commercial |
$57.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.19
|
|
|
DILTIAZEM 1MG/1 ML INFUSION 125 ML (IV PREMIX)
|
Facility
|
IP
|
$156.25
|
|
|
Service Code
|
NDC 09900000302
|
| Hospital Charge Code |
155072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$140.62 |
| Rate for Payer: Aetna American Axle |
$101.56
|
| Rate for Payer: Aetna Commercial |
$132.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.56
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cofinity Advantage |
$109.38
|
| Rate for Payer: Cofinity Commercial |
$134.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.00
|
| Rate for Payer: Healthscope Commercial |
$140.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.19
|
| Rate for Payer: PHP Commercial |
$132.81
|
| Rate for Payer: Priority Health SBD |
$98.44
|
| Rate for Payer: UMR Bronson Commercial |
$68.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.19
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
OP
|
$131.60
|
|
|
Service Code
|
NDC 50228048101
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna American Axle |
$85.54
|
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna Medicare |
$65.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: BCBS Complete |
$52.64
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Advantage |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.54
|
| Rate for Payer: UHC Core |
$68.56
|
| Rate for Payer: UHC Exchange |
$51.72
|
| Rate for Payer: UMR Bronson Commercial |
$48.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$373.65
|
|
|
Service Code
|
NDC 51079074520
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.41 |
| Max. Negotiated Rate |
$336.29 |
| Rate for Payer: Aetna American Axle |
$242.87
|
| Rate for Payer: Aetna Commercial |
$317.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.87
|
| Rate for Payer: Cash Price |
$298.92
|
| Rate for Payer: Cofinity Advantage |
$261.56
|
| Rate for Payer: Cofinity Commercial |
$321.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.92
|
| Rate for Payer: Healthscope Commercial |
$336.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.24
|
| Rate for Payer: PHP Commercial |
$317.60
|
| Rate for Payer: Priority Health SBD |
$235.40
|
| Rate for Payer: UMR Bronson Commercial |
$164.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.24
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$326.65
|
|
|
Service Code
|
NDC 00378002301
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.73 |
| Max. Negotiated Rate |
$293.99 |
| Rate for Payer: Aetna American Axle |
$212.32
|
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.32
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Advantage |
$228.66
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$228.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.99
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health SBD |
$205.79
|
| Rate for Payer: UMR Bronson Commercial |
$143.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
OP
|
$3.74
|
|
|
Service Code
|
NDC 51079074501
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna American Axle |
$2.43
|
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: Aetna Medicare |
$1.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.43
|
| Rate for Payer: BCBS Complete |
$1.50
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Advantage |
$2.62
|
| Rate for Payer: Cofinity Commercial |
$3.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.81
|
| Rate for Payer: PHP Commercial |
$3.18
|
| Rate for Payer: Priority Health SBD |
$2.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.43
|
| Rate for Payer: UHC Core |
$1.95
|
| Rate for Payer: UHC Exchange |
$1.47
|
| Rate for Payer: UMR Bronson Commercial |
$1.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.81
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$3.74
|
|
|
Service Code
|
NDC 51079074501
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna American Axle |
$2.43
|
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.43
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Advantage |
$2.62
|
| Rate for Payer: Cofinity Commercial |
$3.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.81
|
| Rate for Payer: PHP Commercial |
$3.18
|
| Rate for Payer: Priority Health SBD |
$2.36
|
| Rate for Payer: UMR Bronson Commercial |
$1.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.81
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
OP
|
$326.65
|
|
|
Service Code
|
NDC 00093031801
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.86 |
| Max. Negotiated Rate |
$293.99 |
| Rate for Payer: Aetna American Axle |
$212.32
|
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.32
|
| Rate for Payer: BCBS Complete |
$130.66
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Advantage |
$228.66
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$228.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$261.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.99
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health SBD |
$205.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.32
|
| Rate for Payer: UHC Core |
$170.18
|
| Rate for Payer: UHC Exchange |
$128.37
|
| Rate for Payer: UMR Bronson Commercial |
$120.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
OP
|
$326.65
|
|
|
Service Code
|
NDC 00378002301
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.86 |
| Max. Negotiated Rate |
$293.99 |
| Rate for Payer: Aetna American Axle |
$212.32
|
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.32
|
| Rate for Payer: BCBS Complete |
$130.66
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Advantage |
$228.66
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$228.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$261.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.99
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health SBD |
$205.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.32
|
| Rate for Payer: UHC Core |
$170.18
|
| Rate for Payer: UHC Exchange |
$128.37
|
| Rate for Payer: UMR Bronson Commercial |
$120.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
OP
|
$373.65
|
|
|
Service Code
|
NDC 51079074520
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.25 |
| Max. Negotiated Rate |
$336.29 |
| Rate for Payer: Aetna American Axle |
$242.87
|
| Rate for Payer: Aetna Commercial |
$317.60
|
| Rate for Payer: Aetna Medicare |
$186.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.87
|
| Rate for Payer: BCBS Complete |
$149.46
|
| Rate for Payer: Cash Price |
$298.92
|
| Rate for Payer: Cofinity Advantage |
$261.56
|
| Rate for Payer: Cofinity Commercial |
$321.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.92
|
| Rate for Payer: Healthscope Commercial |
$336.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$298.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.24
|
| Rate for Payer: PHP Commercial |
$317.60
|
| Rate for Payer: Priority Health SBD |
$235.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.87
|
| Rate for Payer: UHC Core |
$194.67
|
| Rate for Payer: UHC Exchange |
$146.84
|
| Rate for Payer: UMR Bronson Commercial |
$138.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.24
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$131.60
|
|
|
Service Code
|
NDC 50228048101
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.90 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna American Axle |
$85.54
|
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Advantage |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UMR Bronson Commercial |
$57.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$326.65
|
|
|
Service Code
|
NDC 00093031801
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.73 |
| Max. Negotiated Rate |
$293.99 |
| Rate for Payer: Aetna American Axle |
$212.32
|
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.32
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Advantage |
$228.66
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$228.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.99
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health SBD |
$205.79
|
| Rate for Payer: UMR Bronson Commercial |
$143.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.27
|
|
|
Service Code
|
HCPCS J1163
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$23.64 |
| Rate for Payer: Aetna American Axle |
$17.08
|
| Rate for Payer: Aetna American Axle |
$14.97
|
| Rate for Payer: Aetna American Axle |
$11.84
|
| Rate for Payer: Aetna American Axle |
$12.56
|
| Rate for Payer: Aetna American Axle |
$13.81
|
| Rate for Payer: Aetna American Axle |
$11.45
|
| Rate for Payer: Aetna American Axle |
$29.36
|
| Rate for Payer: Aetna American Axle |
$27.70
|
| Rate for Payer: Aetna American Axle |
$21.91
|
| Rate for Payer: Aetna American Axle |
$18.34
|
| Rate for Payer: Aetna Commercial |
$23.98
|
| Rate for Payer: Aetna Commercial |
$19.58
|
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Aetna Commercial |
$38.39
|
| Rate for Payer: Aetna Commercial |
$22.33
|
| Rate for Payer: Aetna Commercial |
$36.22
|
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.56
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cash Price |
$18.42
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cash Price |
$36.14
|
| Rate for Payer: Cash Price |
$22.57
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cash Price |
$15.46
|
| Rate for Payer: Cash Price |
$34.09
|
| Rate for Payer: Cash Price |
$21.02
|
| Rate for Payer: Cash Price |
$26.97
|
| Rate for Payer: Cofinity Advantage |
$12.33
|
| Rate for Payer: Cofinity Advantage |
$12.75
|
| Rate for Payer: Cofinity Advantage |
$14.87
|
| Rate for Payer: Cofinity Advantage |
$13.52
|
| Rate for Payer: Cofinity Advantage |
$16.12
|
| Rate for Payer: Cofinity Advantage |
$18.39
|
| Rate for Payer: Cofinity Advantage |
$19.75
|
| Rate for Payer: Cofinity Advantage |
$23.60
|
| Rate for Payer: Cofinity Advantage |
$29.83
|
| Rate for Payer: Cofinity Advantage |
$31.62
|
| Rate for Payer: Cofinity Commercial |
$19.81
|
| Rate for Payer: Cofinity Commercial |
$24.26
|
| Rate for Payer: Cofinity Commercial |
$36.64
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$22.59
|
| Rate for Payer: Cofinity Commercial |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$38.85
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Cofinity Commercial |
$28.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.02
|
| Rate for Payer: Healthscope Commercial |
$38.35
|
| Rate for Payer: Healthscope Commercial |
$20.73
|
| Rate for Payer: Healthscope Commercial |
$23.64
|
| Rate for Payer: Healthscope Commercial |
$15.86
|
| Rate for Payer: Healthscope Commercial |
$19.12
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$17.39
|
| Rate for Payer: Healthscope Commercial |
$40.65
|
| Rate for Payer: Healthscope Commercial |
$30.34
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.33
|
| 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 |
$13.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.22
|
| 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: Opus (Opus Packaging Group) HMA |
$13.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.93
|
| Rate for Payer: PHP Commercial |
$38.39
|
| Rate for Payer: PHP Commercial |
$22.33
|
| Rate for Payer: PHP Commercial |
$15.48
|
| Rate for Payer: PHP Commercial |
$23.98
|
| Rate for Payer: PHP Commercial |
$19.58
|
| Rate for Payer: PHP Commercial |
$28.65
|
| Rate for Payer: PHP Commercial |
$36.22
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: PHP Commercial |
$14.98
|
| Rate for Payer: PHP Commercial |
$16.42
|
| Rate for Payer: Priority Health SBD |
$17.77
|
| Rate for Payer: Priority Health SBD |
$26.84
|
| Rate for Payer: Priority Health SBD |
$28.46
|
| Rate for Payer: Priority Health SBD |
$12.17
|
| Rate for Payer: Priority Health SBD |
$21.24
|
| Rate for Payer: Priority Health SBD |
$11.10
|
| Rate for Payer: Priority Health SBD |
$11.47
|
| Rate for Payer: Priority Health SBD |
$14.51
|
| Rate for Payer: Priority Health SBD |
$16.55
|
| Rate for Payer: Priority Health SBD |
$13.38
|
| Rate for Payer: UMR Bronson Commercial |
$8.01
|
| Rate for Payer: UMR Bronson Commercial |
$19.87
|
| Rate for Payer: UMR Bronson Commercial |
$8.50
|
| Rate for Payer: UMR Bronson Commercial |
$7.75
|
| Rate for Payer: UMR Bronson Commercial |
$10.13
|
| Rate for Payer: UMR Bronson Commercial |
$18.75
|
| Rate for Payer: UMR Bronson Commercial |
$9.35
|
| Rate for Payer: UMR Bronson Commercial |
$11.56
|
| Rate for Payer: UMR Bronson Commercial |
$12.41
|
| Rate for Payer: UMR Bronson Commercial |
$14.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.96
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.27
|
|
|
Service Code
|
HCPCS J1163
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$23.64 |
| Rate for Payer: Aetna American Axle |
$17.08
|
| Rate for Payer: Aetna American Axle |
$11.84
|
| Rate for Payer: Aetna American Axle |
$13.81
|
| Rate for Payer: Aetna American Axle |
$27.70
|
| Rate for Payer: Aetna American Axle |
$29.36
|
| Rate for Payer: Aetna American Axle |
$21.91
|
| Rate for Payer: Aetna American Axle |
$18.34
|
| Rate for Payer: Aetna American Axle |
$14.97
|
| Rate for Payer: Aetna American Axle |
$12.56
|
| Rate for Payer: Aetna American Axle |
$11.45
|
| Rate for Payer: Aetna Commercial |
$23.98
|
| Rate for Payer: Aetna Commercial |
$22.33
|
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Commercial |
$36.22
|
| Rate for Payer: Aetna Commercial |
$38.39
|
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: Aetna Commercial |
$19.58
|
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Aetna Medicare |
$22.59
|
| Rate for Payer: Aetna Medicare |
$16.86
|
| Rate for Payer: Aetna Medicare |
$9.11
|
| Rate for Payer: Aetna Medicare |
$8.81
|
| Rate for Payer: Aetna Medicare |
$9.66
|
| Rate for Payer: Aetna Medicare |
$11.52
|
| Rate for Payer: Aetna Medicare |
$10.62
|
| Rate for Payer: Aetna Medicare |
$13.13
|
| Rate for Payer: Aetna Medicare |
$14.11
|
| Rate for Payer: Aetna Medicare |
$21.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.91
|
| Rate for Payer: BCBS Complete |
$11.28
|
| Rate for Payer: BCBS Complete |
$9.21
|
| Rate for Payer: BCBS Complete |
$13.48
|
| Rate for Payer: BCBS Complete |
$10.51
|
| Rate for Payer: BCBS Complete |
$7.73
|
| Rate for Payer: BCBS Complete |
$18.07
|
| Rate for Payer: BCBS Complete |
$17.04
|
| Rate for Payer: BCBS Complete |
$7.28
|
| Rate for Payer: BCBS Complete |
$7.05
|
| Rate for Payer: BCBS Complete |
$8.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$26.97
|
| Rate for Payer: Cash Price |
$22.57
|
| Rate for Payer: Cash Price |
$34.09
|
| Rate for Payer: Cash Price |
$36.14
|
| Rate for Payer: Cash Price |
$36.14
|
| Rate for Payer: Cash Price |
$22.57
|
| Rate for Payer: Cash Price |
$21.02
|
| Rate for Payer: Cash Price |
$18.42
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cash Price |
$15.46
|
| Rate for Payer: Cash Price |
$15.46
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cash Price |
$21.02
|
| Rate for Payer: Cash Price |
$18.42
|
| Rate for Payer: Cash Price |
$26.97
|
| Rate for Payer: Cash Price |
$34.09
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cofinity Advantage |
$12.33
|
| Rate for Payer: Cofinity Advantage |
$12.75
|
| Rate for Payer: Cofinity Advantage |
$13.52
|
| Rate for Payer: Cofinity Advantage |
$23.60
|
| Rate for Payer: Cofinity Advantage |
$31.62
|
| Rate for Payer: Cofinity Advantage |
$19.75
|
| Rate for Payer: Cofinity Advantage |
$18.39
|
| Rate for Payer: Cofinity Advantage |
$29.83
|
| Rate for Payer: Cofinity Advantage |
$14.87
|
| Rate for Payer: Cofinity Advantage |
$16.12
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Cofinity Commercial |
$19.81
|
| Rate for Payer: Cofinity Commercial |
$22.59
|
| Rate for Payer: Cofinity Commercial |
$24.26
|
| Rate for Payer: Cofinity Commercial |
$28.99
|
| Rate for Payer: Cofinity Commercial |
$36.64
|
| Rate for Payer: Cofinity Commercial |
$38.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.10
|
| 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 |
$36.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$17.39
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Commercial |
$20.73
|
| Rate for Payer: Healthscope Commercial |
$40.65
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$19.12
|
| Rate for Payer: Healthscope Commercial |
$15.86
|
| Rate for Payer: Healthscope Commercial |
$23.64
|
| Rate for Payer: Healthscope Commercial |
$38.35
|
| Rate for Payer: Healthscope Commercial |
$30.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.39
|
| 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 |
$23.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.27
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: PHP Commercial |
$38.39
|
| Rate for Payer: PHP Commercial |
$36.22
|
| Rate for Payer: PHP Commercial |
$19.58
|
| Rate for Payer: PHP Commercial |
$28.65
|
| Rate for Payer: PHP Commercial |
$15.48
|
| Rate for Payer: PHP Commercial |
$14.98
|
| Rate for Payer: PHP Commercial |
$22.33
|
| Rate for Payer: PHP Commercial |
$23.98
|
| Rate for Payer: PHP Commercial |
$16.42
|
| Rate for Payer: Priority Health SBD |
$16.55
|
| Rate for Payer: Priority Health SBD |
$12.17
|
| Rate for Payer: Priority Health SBD |
$13.38
|
| Rate for Payer: Priority Health SBD |
$21.24
|
| Rate for Payer: Priority Health SBD |
$17.77
|
| Rate for Payer: Priority Health SBD |
$28.46
|
| Rate for Payer: Priority Health SBD |
$26.84
|
| Rate for Payer: Priority Health SBD |
$11.10
|
| Rate for Payer: Priority Health SBD |
$11.47
|
| Rate for Payer: Priority Health SBD |
$14.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UMR Bronson Commercial |
$6.52
|
| Rate for Payer: UMR Bronson Commercial |
$8.52
|
| Rate for Payer: UMR Bronson Commercial |
$10.44
|
| Rate for Payer: UMR Bronson Commercial |
$12.47
|
| Rate for Payer: UMR Bronson Commercial |
$6.74
|
| Rate for Payer: UMR Bronson Commercial |
$7.86
|
| Rate for Payer: UMR Bronson Commercial |
$7.15
|
| Rate for Payer: UMR Bronson Commercial |
$16.71
|
| Rate for Payer: UMR Bronson Commercial |
$9.72
|
| Rate for Payer: UMR Bronson Commercial |
$15.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.27
|
| 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 |
$13.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.93
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
IP
|
$208.05
|
|
|
Service Code
|
NDC 00093031901
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.54 |
| Max. Negotiated Rate |
$187.25 |
| 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 Advantage |
$145.63
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$145.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.04
|
| Rate for Payer: PHP Commercial |
$176.84
|
| 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
|
OP
|
$178.60
|
|
|
Service Code
|
NDC 50228048201
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.08 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna American Axle |
$116.09
|
| Rate for Payer: Aetna Commercial |
$151.81
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.09
|
| Rate for Payer: BCBS Complete |
$71.44
|
| Rate for Payer: Cash Price |
$142.88
|
| Rate for Payer: Cofinity Advantage |
$125.02
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$125.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.95
|
| Rate for Payer: PHP Commercial |
$151.81
|
| Rate for Payer: Priority Health SBD |
$112.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.09
|
| Rate for Payer: UHC Core |
$93.05
|
| Rate for Payer: UHC Exchange |
$70.19
|
| Rate for Payer: UMR Bronson Commercial |
$66.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.95
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
IP
|
$178.60
|
|
|
Service Code
|
NDC 50228048201
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.58 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna American Axle |
$116.09
|
| Rate for Payer: Aetna Commercial |
$151.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.09
|
| Rate for Payer: Cash Price |
$142.88
|
| Rate for Payer: Cofinity Advantage |
$125.02
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$125.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.95
|
| Rate for Payer: PHP Commercial |
$151.81
|
| Rate for Payer: Priority Health SBD |
$112.52
|
| Rate for Payer: UMR Bronson Commercial |
$78.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.95
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
IP
|
$582.72
|
|
|
Service Code
|
NDC 68682000710
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.40 |
| Max. Negotiated Rate |
$524.45 |
| Rate for Payer: Aetna American Axle |
$378.77
|
| Rate for Payer: Aetna Commercial |
$495.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.77
|
| Rate for Payer: Cash Price |
$466.18
|
| Rate for Payer: Cofinity Advantage |
$407.90
|
| Rate for Payer: Cofinity Commercial |
$501.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.18
|
| Rate for Payer: Healthscope Commercial |
$524.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$407.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$437.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$437.04
|
| Rate for Payer: PHP Commercial |
$495.31
|
| Rate for Payer: Priority Health SBD |
$367.11
|
| Rate for Payer: UMR Bronson Commercial |
$256.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$437.04
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
OP
|
$208.05
|
|
|
Service Code
|
NDC 00093031901
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.98 |
| Max. Negotiated Rate |
$187.25 |
| Rate for Payer: Aetna American Axle |
$135.23
|
| Rate for Payer: Aetna Commercial |
$176.84
|
| Rate for Payer: Aetna Medicare |
$104.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.23
|
| Rate for Payer: BCBS Complete |
$83.22
|
| Rate for Payer: Cash Price |
$166.44
|
| Rate for Payer: Cofinity Advantage |
$145.63
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$145.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.04
|
| Rate for Payer: PHP Commercial |
$176.84
|
| Rate for Payer: Priority Health SBD |
$131.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.23
|
| Rate for Payer: UHC Core |
$108.39
|
| Rate for Payer: UHC Exchange |
$81.76
|
| Rate for Payer: UMR Bronson Commercial |
$76.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.04
|
|
|
DILTIAZEM 60 MG TABLET
|
Facility
|
OP
|
$582.72
|
|
|
Service Code
|
NDC 68682000710
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$215.61 |
| Max. Negotiated Rate |
$524.45 |
| Rate for Payer: Aetna American Axle |
$378.77
|
| Rate for Payer: Aetna Commercial |
$495.31
|
| Rate for Payer: Aetna Medicare |
$291.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.77
|
| Rate for Payer: BCBS Complete |
$233.09
|
| Rate for Payer: Cash Price |
$466.18
|
| Rate for Payer: Cofinity Advantage |
$407.90
|
| Rate for Payer: Cofinity Commercial |
$501.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.18
|
| Rate for Payer: Healthscope Commercial |
$524.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$407.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$437.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$466.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$437.04
|
| Rate for Payer: PHP Commercial |
$495.31
|
| Rate for Payer: Priority Health SBD |
$367.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.77
|
| Rate for Payer: UHC Core |
$303.60
|
| Rate for Payer: UHC Exchange |
$229.01
|
| Rate for Payer: UMR Bronson Commercial |
$215.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$437.04
|
|
|
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 |
$1.68 |
| Max. Negotiated Rate |
$3.44 |
| Rate for Payer: Aetna American Axle |
$2.48
|
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.48
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Advantage |
$2.67
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.87
|
| Rate for Payer: PHP Commercial |
$3.25
|
| Rate for Payer: Priority Health SBD |
$2.41
|
| Rate for Payer: UMR Bronson Commercial |
$1.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.87
|
|
|
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 |
$168.04 |
| Max. Negotiated Rate |
$343.71 |
| Rate for Payer: Aetna American Axle |
$248.24
|
| Rate for Payer: Aetna Commercial |
$324.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.24
|
| Rate for Payer: Cash Price |
$305.52
|
| Rate for Payer: Cofinity Advantage |
$267.33
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$267.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$286.43
|
| Rate for Payer: PHP Commercial |
$324.62
|
| Rate for Payer: Priority Health SBD |
$240.60
|
| Rate for Payer: UMR Bronson Commercial |
$168.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.43
|
|
