|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$347.70
|
|
|
Service Code
|
NDC 00904721761
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.65 |
| Max. Negotiated Rate |
$312.93 |
| Rate for Payer: Aetna American Axle |
$226.00
|
| Rate for Payer: Aetna Commercial |
$295.55
|
| Rate for Payer: Aetna Medicare |
$173.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.00
|
| Rate for Payer: BCBS Complete |
$139.08
|
| Rate for Payer: Cash Price |
$278.16
|
| Rate for Payer: Cofinity Advantage |
$243.39
|
| Rate for Payer: Cofinity Commercial |
$299.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.16
|
| Rate for Payer: Healthscope Commercial |
$312.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$243.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$278.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.77
|
| Rate for Payer: PHP Commercial |
$295.55
|
| Rate for Payer: Priority Health SBD |
$219.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.00
|
| Rate for Payer: UHC Core |
$181.15
|
| Rate for Payer: UHC Exchange |
$136.65
|
| Rate for Payer: UMR Bronson Commercial |
$128.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.77
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$311.04
|
|
|
Service Code
|
NDC 10370082909
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.08 |
| Max. Negotiated Rate |
$279.94 |
| Rate for Payer: Aetna American Axle |
$202.18
|
| Rate for Payer: Aetna Commercial |
$264.38
|
| Rate for Payer: Aetna Medicare |
$155.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.18
|
| Rate for Payer: BCBS Complete |
$124.42
|
| Rate for Payer: Cash Price |
$248.83
|
| Rate for Payer: Cofinity Advantage |
$217.73
|
| Rate for Payer: Cofinity Commercial |
$267.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.83
|
| Rate for Payer: Healthscope Commercial |
$279.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.28
|
| Rate for Payer: PHP Commercial |
$264.38
|
| Rate for Payer: Priority Health SBD |
$195.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.18
|
| Rate for Payer: UHC Core |
$162.05
|
| Rate for Payer: UHC Exchange |
$122.24
|
| Rate for Payer: UMR Bronson Commercial |
$115.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.28
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$381.90
|
|
|
Service Code
|
NDC 60687019501
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.30 |
| Max. Negotiated Rate |
$343.71 |
| Rate for Payer: Aetna American Axle |
$248.24
|
| Rate for Payer: Aetna Commercial |
$324.62
|
| Rate for Payer: Aetna Medicare |
$190.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.24
|
| Rate for Payer: BCBS Complete |
$152.76
|
| 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: MI Amish Medical Board Commercial |
$305.52
|
| 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: UHC All Payor (Choice/PPO) |
$248.24
|
| Rate for Payer: UHC Core |
$198.97
|
| Rate for Payer: UHC Exchange |
$150.09
|
| Rate for Payer: UMR Bronson Commercial |
$141.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.43
|
|
|
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
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$311.04
|
|
|
Service Code
|
NDC 10370082909
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.86 |
| Max. Negotiated Rate |
$279.94 |
| Rate for Payer: Aetna American Axle |
$202.18
|
| Rate for Payer: Aetna Commercial |
$264.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.18
|
| Rate for Payer: Cash Price |
$248.83
|
| Rate for Payer: Cofinity Advantage |
$217.73
|
| Rate for Payer: Cofinity Commercial |
$267.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.83
|
| Rate for Payer: Healthscope Commercial |
$279.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.28
|
| Rate for Payer: PHP Commercial |
$264.38
|
| Rate for Payer: Priority Health SBD |
$195.96
|
| Rate for Payer: UMR Bronson Commercial |
$136.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.28
|
|
|
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 |
$1.50 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna American Axle |
$2.21
|
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Advantage |
$2.38
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.55
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
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 |
$125.49 |
| Max. Negotiated Rate |
$305.24 |
| Rate for Payer: Aetna American Axle |
$220.45
|
| Rate for Payer: Aetna Commercial |
$288.28
|
| Rate for Payer: Aetna Medicare |
$169.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.45
|
| Rate for Payer: BCBS Complete |
$135.66
|
| Rate for Payer: Cash Price |
$271.32
|
| Rate for Payer: Cofinity Advantage |
$237.41
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$237.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.36
|
| Rate for Payer: PHP Commercial |
$288.28
|
| Rate for Payer: Priority Health SBD |
$213.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.45
|
| Rate for Payer: UHC Core |
$176.70
|
| Rate for Payer: UHC Exchange |
$133.29
|
| Rate for Payer: UMR Bronson Commercial |
$125.49
|
| 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 |
$113.89 |
| Max. Negotiated Rate |
$277.02 |
| Rate for Payer: Aetna American Axle |
$200.07
|
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: Aetna Medicare |
$153.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.07
|
| Rate for Payer: BCBS Complete |
$123.12
|
| Rate for Payer: Cash Price |
$246.24
|
| Rate for Payer: Cofinity Advantage |
$215.46
|
| Rate for Payer: Cofinity Commercial |
$264.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.24
|
| Rate for Payer: Healthscope Commercial |
$277.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.85
|
| Rate for Payer: PHP Commercial |
$261.63
|
| Rate for Payer: Priority Health SBD |
$193.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.07
|
| Rate for Payer: UHC Core |
$160.36
|
| Rate for Payer: UHC Exchange |
$120.97
|
| Rate for Payer: UMR Bronson Commercial |
$113.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.85
|
|
|
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 |
$1.26 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna American Axle |
$2.21
|
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna Medicare |
$1.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Advantage |
$2.38
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.55
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.21
|
| Rate for Payer: UHC Core |
$1.77
|
| Rate for Payer: UHC Exchange |
$1.34
|
| Rate for Payer: UMR Bronson Commercial |
$1.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$307.80
|
|
|
Service Code
|
NDC 00904721861
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.43 |
| Max. Negotiated Rate |
$277.02 |
| Rate for Payer: Aetna American Axle |
$200.07
|
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.07
|
| Rate for Payer: Cash Price |
$246.24
|
| Rate for Payer: Cofinity Advantage |
$215.46
|
| Rate for Payer: Cofinity Commercial |
$264.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.24
|
| Rate for Payer: Healthscope Commercial |
$277.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.85
|
| Rate for Payer: PHP Commercial |
$261.63
|
| Rate for Payer: Priority Health SBD |
$193.91
|
| Rate for Payer: UMR Bronson Commercial |
$135.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.85
|
|
|
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 |
$149.23 |
| Max. Negotiated Rate |
$305.24 |
| Rate for Payer: Aetna American Axle |
$220.45
|
| Rate for Payer: Aetna Commercial |
$288.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.45
|
| Rate for Payer: Cash Price |
$271.32
|
| Rate for Payer: Cofinity Advantage |
$237.41
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$237.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.36
|
| Rate for Payer: PHP Commercial |
$288.28
|
| Rate for Payer: Priority Health SBD |
$213.66
|
| Rate for Payer: UMR Bronson Commercial |
$149.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.36
|
|
|
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 |
$186.85 |
| Max. Negotiated Rate |
$382.19 |
| 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 Advantage |
$297.25
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$297.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.49
|
| Rate for Payer: PHP Commercial |
$360.95
|
| 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
|
$412.30
|
|
|
Service Code
|
NDC 60687021701
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.41 |
| Max. Negotiated Rate |
$371.07 |
| Rate for Payer: Aetna American Axle |
$268.00
|
| Rate for Payer: Aetna Commercial |
$350.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.00
|
| Rate for Payer: Cash Price |
$329.84
|
| Rate for Payer: Cofinity Advantage |
$288.61
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$288.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.23
|
| Rate for Payer: PHP Commercial |
$350.45
|
| Rate for Payer: Priority Health SBD |
$259.75
|
| Rate for Payer: UMR Bronson Commercial |
$181.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.23
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$533.09
|
|
|
Service Code
|
NDC 10370083109
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.56 |
| Max. Negotiated Rate |
$479.78 |
| Rate for Payer: Aetna American Axle |
$346.51
|
| Rate for Payer: Aetna Commercial |
$453.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.51
|
| Rate for Payer: Cash Price |
$426.47
|
| Rate for Payer: Cofinity Advantage |
$373.16
|
| Rate for Payer: Cofinity Commercial |
$458.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$426.47
|
| Rate for Payer: Healthscope Commercial |
$479.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$373.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$399.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$453.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$399.82
|
| Rate for Payer: PHP Commercial |
$453.13
|
| Rate for Payer: Priority Health SBD |
$335.85
|
| Rate for Payer: UMR Bronson Commercial |
$234.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$399.82
|
|
|
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 |
$157.12 |
| Max. Negotiated Rate |
$382.19 |
| Rate for Payer: Aetna American Axle |
$276.02
|
| Rate for Payer: Aetna Commercial |
$360.95
|
| Rate for Payer: Aetna Medicare |
$212.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.02
|
| Rate for Payer: BCBS Complete |
$169.86
|
| Rate for Payer: Cash Price |
$339.72
|
| Rate for Payer: Cofinity Advantage |
$297.25
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$297.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$339.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.49
|
| Rate for Payer: PHP Commercial |
$360.95
|
| Rate for Payer: Priority Health SBD |
$267.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.02
|
| Rate for Payer: UHC Core |
$221.24
|
| Rate for Payer: UHC Exchange |
$166.89
|
| Rate for Payer: UMR Bronson Commercial |
$157.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.49
|
|
|
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 |
$1.82 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna American Axle |
$2.68
|
| Rate for Payer: Aetna Commercial |
$3.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.68
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Advantage |
$2.89
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.10
|
| Rate for Payer: PHP Commercial |
$3.51
|
| Rate for Payer: Priority Health SBD |
$2.60
|
| Rate for Payer: UMR Bronson Commercial |
$1.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.10
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$533.09
|
|
|
Service Code
|
NDC 10370083109
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.24 |
| Max. Negotiated Rate |
$479.78 |
| Rate for Payer: Aetna American Axle |
$346.51
|
| Rate for Payer: Aetna Commercial |
$453.13
|
| Rate for Payer: Aetna Medicare |
$266.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.51
|
| Rate for Payer: BCBS Complete |
$213.24
|
| Rate for Payer: Cash Price |
$426.47
|
| Rate for Payer: Cofinity Advantage |
$373.16
|
| Rate for Payer: Cofinity Commercial |
$458.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$426.47
|
| Rate for Payer: Healthscope Commercial |
$479.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$373.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$399.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$426.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$453.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$399.82
|
| Rate for Payer: PHP Commercial |
$453.13
|
| Rate for Payer: Priority Health SBD |
$335.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.51
|
| Rate for Payer: UHC Core |
$277.74
|
| Rate for Payer: UHC Exchange |
$209.50
|
| Rate for Payer: UMR Bronson Commercial |
$197.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$399.82
|
|
|
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 |
$1.53 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna American Axle |
$2.68
|
| Rate for Payer: Aetna Commercial |
$3.51
|
| Rate for Payer: Aetna Medicare |
$2.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.68
|
| Rate for Payer: BCBS Complete |
$1.65
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Advantage |
$2.89
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.10
|
| Rate for Payer: PHP Commercial |
$3.51
|
| Rate for Payer: Priority Health SBD |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.68
|
| Rate for Payer: UHC Core |
$2.15
|
| Rate for Payer: UHC Exchange |
$1.62
|
| Rate for Payer: UMR Bronson Commercial |
$1.53
|
| 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 |
$152.55 |
| Max. Negotiated Rate |
$371.07 |
| Rate for Payer: Aetna American Axle |
$268.00
|
| Rate for Payer: Aetna Commercial |
$350.45
|
| Rate for Payer: Aetna Medicare |
$206.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.00
|
| Rate for Payer: BCBS Complete |
$164.92
|
| Rate for Payer: Cash Price |
$329.84
|
| Rate for Payer: Cofinity Advantage |
$288.61
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$288.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$329.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.23
|
| Rate for Payer: PHP Commercial |
$350.45
|
| Rate for Payer: Priority Health SBD |
$259.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.00
|
| Rate for Payer: UHC Core |
$214.81
|
| Rate for Payer: UHC Exchange |
$162.03
|
| Rate for Payer: UMR Bronson Commercial |
$152.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.23
|
|
|
DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$7.31
|
|
|
Service Code
|
NDC 60687022811
|
| Hospital Charge Code |
29276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$6.58 |
| Rate for Payer: Aetna American Axle |
$4.75
|
| Rate for Payer: Aetna Commercial |
$6.21
|
| Rate for Payer: Aetna Medicare |
$3.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.75
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cofinity Advantage |
$5.12
|
| Rate for Payer: Cofinity Commercial |
$6.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.85
|
| Rate for Payer: Healthscope Commercial |
$6.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.48
|
| Rate for Payer: PHP Commercial |
$6.21
|
| Rate for Payer: Priority Health SBD |
$4.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.75
|
| Rate for Payer: UHC Core |
$3.81
|
| Rate for Payer: UHC Exchange |
$2.87
|
| Rate for Payer: UMR Bronson Commercial |
$2.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.48
|
|
|
DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$663.84
|
|
|
Service Code
|
NDC 00904722061
|
| Hospital Charge Code |
29276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$292.09 |
| Max. Negotiated Rate |
$597.46 |
| Rate for Payer: Aetna American Axle |
$431.50
|
| Rate for Payer: Aetna Commercial |
$564.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$431.50
|
| Rate for Payer: Cash Price |
$531.07
|
| Rate for Payer: Cofinity Advantage |
$464.69
|
| Rate for Payer: Cofinity Commercial |
$570.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$531.07
|
| Rate for Payer: Healthscope Commercial |
$597.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$464.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$497.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$564.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$497.88
|
| Rate for Payer: PHP Commercial |
$564.26
|
| Rate for Payer: Priority Health SBD |
$418.22
|
| Rate for Payer: UMR Bronson Commercial |
$292.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$497.88
|
|
|
DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$730.08
|
|
|
Service Code
|
NDC 60687022801
|
| Hospital Charge Code |
29276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$321.24 |
| Max. Negotiated Rate |
$657.07 |
| Rate for Payer: Aetna American Axle |
$474.55
|
| Rate for Payer: Aetna Commercial |
$620.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.55
|
| Rate for Payer: Cash Price |
$584.06
|
| Rate for Payer: Cofinity Advantage |
$511.06
|
| Rate for Payer: Cofinity Commercial |
$627.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$584.06
|
| Rate for Payer: Healthscope Commercial |
$657.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$511.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$547.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$620.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$547.56
|
| Rate for Payer: PHP Commercial |
$620.57
|
| Rate for Payer: Priority Health SBD |
$459.95
|
| Rate for Payer: UMR Bronson Commercial |
$321.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$547.56
|
|
|
DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$663.84
|
|
|
Service Code
|
NDC 00904722061
|
| Hospital Charge Code |
29276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.62 |
| Max. Negotiated Rate |
$597.46 |
| Rate for Payer: Aetna American Axle |
$431.50
|
| Rate for Payer: Aetna Commercial |
$564.26
|
| Rate for Payer: Aetna Medicare |
$331.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$431.50
|
| Rate for Payer: BCBS Complete |
$265.54
|
| Rate for Payer: Cash Price |
$531.07
|
| Rate for Payer: Cofinity Advantage |
$464.69
|
| Rate for Payer: Cofinity Commercial |
$570.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$531.07
|
| Rate for Payer: Healthscope Commercial |
$597.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$464.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$497.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$531.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$564.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$497.88
|
| Rate for Payer: PHP Commercial |
$564.26
|
| Rate for Payer: Priority Health SBD |
$418.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.50
|
| Rate for Payer: UHC Core |
$345.86
|
| Rate for Payer: UHC Exchange |
$260.89
|
| Rate for Payer: UMR Bronson Commercial |
$245.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$497.88
|
|
|
DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$730.08
|
|
|
Service Code
|
NDC 60687022801
|
| Hospital Charge Code |
29276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.13 |
| Max. Negotiated Rate |
$657.07 |
| Rate for Payer: Aetna American Axle |
$474.55
|
| Rate for Payer: Aetna Commercial |
$620.57
|
| Rate for Payer: Aetna Medicare |
$365.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.55
|
| Rate for Payer: BCBS Complete |
$292.03
|
| Rate for Payer: Cash Price |
$584.06
|
| Rate for Payer: Cofinity Advantage |
$511.06
|
| Rate for Payer: Cofinity Commercial |
$627.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$584.06
|
| Rate for Payer: Healthscope Commercial |
$657.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$511.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$547.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$584.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$620.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$547.56
|
| Rate for Payer: PHP Commercial |
$620.57
|
| Rate for Payer: Priority Health SBD |
$459.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$474.55
|
| Rate for Payer: UHC Core |
$380.37
|
| Rate for Payer: UHC Exchange |
$286.92
|
| Rate for Payer: UMR Bronson Commercial |
$270.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$547.56
|
|
