|
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 Commercial |
$228.66
|
| Rate for Payer: Cofinity Commercial |
$280.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$228.66
|
| 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: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.32
|
| 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
|
$4.09
|
|
|
Service Code
|
NDC 60687056211
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna American Axle |
$2.66
|
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Aetna Medicare |
$2.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.66
|
| Rate for Payer: BCBS Complete |
$1.64
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.27
|
| Rate for Payer: Healthscope Commercial |
$3.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.48
|
| Rate for Payer: PHP Commercial |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.66
|
| Rate for Payer: Priority Health SBD |
$2.58
|
| Rate for Payer: UMR Bronson Commercial |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.07
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$239.38
|
|
|
Service Code
|
NDC 55150042701
|
| 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: Cofinity Medicare Advantage |
$167.57
|
| 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 |
$179.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.47
|
| Rate for Payer: PHP Commercial |
$203.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.60
|
| 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 |
$179.53
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$253.75
|
|
|
Service Code
|
NDC 17478093725
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$111.65 |
| Max. Negotiated Rate |
$228.38 |
| Rate for Payer: Aetna American Axle |
$164.94
|
| Rate for Payer: Aetna Commercial |
$215.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.94
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: Cofinity Commercial |
$177.62
|
| Rate for Payer: Cofinity Commercial |
$218.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.00
|
| Rate for Payer: Healthscope Commercial |
$228.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.69
|
| Rate for Payer: PHP Commercial |
$215.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.94
|
| Rate for Payer: Priority Health SBD |
$159.86
|
| Rate for Payer: UMR Bronson Commercial |
$111.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.31
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$65.25
|
|
|
Service Code
|
NDC 17478093705
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.71 |
| Max. Negotiated Rate |
$58.73 |
| 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 |
$45.67
|
| Rate for Payer: Cofinity Commercial |
$56.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.20
|
| Rate for Payer: Healthscope Commercial |
$58.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.46
|
| Rate for Payer: PHP Commercial |
$55.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.41
|
| 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
|
OP
|
$88.75
|
|
|
Service Code
|
NDC 00641601401
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.84 |
| Max. Negotiated Rate |
$79.88 |
| Rate for Payer: Aetna American Axle |
$57.69
|
| Rate for Payer: Aetna Commercial |
$75.44
|
| Rate for Payer: Aetna Medicare |
$44.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.69
|
| Rate for Payer: BCBS Complete |
$35.50
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cofinity Commercial |
$62.12
|
| Rate for Payer: Cofinity Commercial |
$76.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.12
|
| 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 Commercial |
$75.44
|
| Rate for Payer: PHP Commercial |
$75.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.69
|
| Rate for Payer: Priority Health SBD |
$55.91
|
| Rate for Payer: UMR Bronson Commercial |
$32.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.56
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$129.38
|
|
|
Service Code
|
NDC 00641601501
|
| 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: Cofinity Medicare Advantage |
$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 |
$97.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.97
|
| Rate for Payer: PHP Commercial |
$109.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.10
|
| 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 |
$97.03
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$59.50
|
|
|
Service Code
|
NDC 17478093710
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.02 |
| Max. Negotiated Rate |
$53.55 |
| Rate for Payer: Aetna American Axle |
$38.67
|
| Rate for Payer: Aetna Commercial |
$50.58
|
| Rate for Payer: Aetna Medicare |
$29.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.67
|
| Rate for Payer: BCBS Complete |
$23.80
|
| Rate for Payer: Cash Price |
$47.60
|
| Rate for Payer: Cofinity Commercial |
$41.65
|
| Rate for Payer: Cofinity Commercial |
$51.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.60
|
| Rate for Payer: Healthscope Commercial |
$53.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.58
|
| Rate for Payer: PHP Commercial |
$50.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.67
|
| Rate for Payer: Priority Health SBD |
$37.48
|
| Rate for Payer: UMR Bronson Commercial |
$22.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.62
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$61.50
|
|
|
Service Code
|
NDC 70860030110
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.06 |
| Max. Negotiated Rate |
$55.35 |
| Rate for Payer: Aetna American Axle |
$39.98
|
| Rate for Payer: Aetna Commercial |
$52.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.98
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cofinity Commercial |
$43.05
|
| Rate for Payer: Cofinity Commercial |
$52.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.20
|
| Rate for Payer: Healthscope Commercial |
$55.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.27
|
| Rate for Payer: PHP Commercial |
$52.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.98
|
| Rate for Payer: Priority Health SBD |
$38.74
|
| Rate for Payer: UMR Bronson Commercial |
$27.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.12
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$239.38
|
|
|
Service Code
|
NDC 55150042710
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$88.57 |
| Max. Negotiated Rate |
$215.44 |
| Rate for Payer: Aetna American Axle |
$155.60
|
| Rate for Payer: Aetna Commercial |
$203.47
|
| Rate for Payer: Aetna Medicare |
$119.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.60
|
| Rate for Payer: BCBS Complete |
$95.75
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cofinity Commercial |
$167.57
|
| Rate for Payer: Cofinity Commercial |
$205.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.57
|
| 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 |
$179.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.47
|
| Rate for Payer: PHP Commercial |
$203.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.60
|
| Rate for Payer: Priority Health SBD |
$150.81
|
| Rate for Payer: UMR Bronson Commercial |
$88.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.53
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$239.38
|
|
|
Service Code
|
NDC 55150042710
|
| 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: Cofinity Medicare Advantage |
$167.57
|
| 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 |
$179.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.47
|
| Rate for Payer: PHP Commercial |
$203.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.60
|
| 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 |
$179.53
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$61.50
|
|
|
Service Code
|
NDC 70860030142
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$55.35 |
| Rate for Payer: Aetna American Axle |
$39.98
|
| Rate for Payer: Aetna Commercial |
$52.27
|
| Rate for Payer: Aetna Medicare |
$30.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.98
|
| Rate for Payer: BCBS Complete |
$24.60
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cofinity Commercial |
$43.05
|
| Rate for Payer: Cofinity Commercial |
$52.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.20
|
| Rate for Payer: Healthscope Commercial |
$55.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.27
|
| Rate for Payer: PHP Commercial |
$52.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.98
|
| Rate for Payer: Priority Health SBD |
$38.74
|
| Rate for Payer: UMR Bronson Commercial |
$22.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.12
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$129.38
|
|
|
Service Code
|
NDC 00641921910
|
| 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: Cofinity Medicare Advantage |
$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 |
$97.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.97
|
| Rate for Payer: PHP Commercial |
$109.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.10
|
| 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 |
$97.03
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$129.38
|
|
|
Service Code
|
NDC 00641921901
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.87 |
| Max. Negotiated Rate |
$116.44 |
| Rate for Payer: Aetna American Axle |
$84.10
|
| Rate for Payer: Aetna Commercial |
$109.97
|
| Rate for Payer: Aetna Medicare |
$64.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.10
|
| Rate for Payer: BCBS Complete |
$51.75
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cofinity Commercial |
$111.27
|
| Rate for Payer: Cofinity Commercial |
$90.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 |
$97.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.97
|
| Rate for Payer: PHP Commercial |
$109.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.10
|
| Rate for Payer: Priority Health SBD |
$81.51
|
| Rate for Payer: UMR Bronson Commercial |
$47.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.03
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$129.38
|
|
|
Service Code
|
NDC 00641921901
|
| 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: Cofinity Medicare Advantage |
$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 |
$97.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.97
|
| Rate for Payer: PHP Commercial |
$109.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.10
|
| 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 |
$97.03
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$129.38
|
|
|
Service Code
|
NDC 00641601510
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.87 |
| Max. Negotiated Rate |
$116.44 |
| Rate for Payer: Aetna American Axle |
$84.10
|
| Rate for Payer: Aetna Commercial |
$109.97
|
| Rate for Payer: Aetna Medicare |
$64.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.10
|
| Rate for Payer: BCBS Complete |
$51.75
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cofinity Commercial |
$111.27
|
| Rate for Payer: Cofinity Commercial |
$90.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 |
$97.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.97
|
| Rate for Payer: PHP Commercial |
$109.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.10
|
| Rate for Payer: Priority Health SBD |
$81.51
|
| Rate for Payer: UMR Bronson Commercial |
$47.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.03
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$129.38
|
|
|
Service Code
|
NDC 00641601510
|
| 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: Cofinity Medicare Advantage |
$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 |
$97.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.97
|
| Rate for Payer: PHP Commercial |
$109.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.10
|
| 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 |
$97.03
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$59.50
|
|
|
Service Code
|
NDC 17478093710
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.18 |
| Max. Negotiated Rate |
$53.55 |
| Rate for Payer: Aetna American Axle |
$38.67
|
| Rate for Payer: Aetna Commercial |
$50.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.67
|
| Rate for Payer: Cash Price |
$47.60
|
| Rate for Payer: Cofinity Commercial |
$41.65
|
| Rate for Payer: Cofinity Commercial |
$51.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.60
|
| Rate for Payer: Healthscope Commercial |
$53.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.58
|
| Rate for Payer: PHP Commercial |
$50.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.67
|
| Rate for Payer: Priority Health SBD |
$37.48
|
| Rate for Payer: UMR Bronson Commercial |
$26.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.62
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$129.38
|
|
|
Service Code
|
NDC 00641601501
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.87 |
| Max. Negotiated Rate |
$116.44 |
| Rate for Payer: Aetna American Axle |
$84.10
|
| Rate for Payer: Aetna Commercial |
$109.97
|
| Rate for Payer: Aetna Medicare |
$64.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.10
|
| Rate for Payer: BCBS Complete |
$51.75
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cofinity Commercial |
$111.27
|
| Rate for Payer: Cofinity Commercial |
$90.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 |
$97.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.97
|
| Rate for Payer: PHP Commercial |
$109.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.10
|
| Rate for Payer: Priority Health SBD |
$81.51
|
| Rate for Payer: UMR Bronson Commercial |
$47.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.03
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$253.75
|
|
|
Service Code
|
NDC 17478093725
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.89 |
| Max. Negotiated Rate |
$228.38 |
| Rate for Payer: Aetna American Axle |
$164.94
|
| Rate for Payer: Aetna Commercial |
$215.69
|
| Rate for Payer: Aetna Medicare |
$126.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.94
|
| Rate for Payer: BCBS Complete |
$101.50
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: Cofinity Commercial |
$177.62
|
| Rate for Payer: Cofinity Commercial |
$218.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.00
|
| Rate for Payer: Healthscope Commercial |
$228.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.69
|
| Rate for Payer: PHP Commercial |
$215.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.94
|
| Rate for Payer: Priority Health SBD |
$159.86
|
| Rate for Payer: UMR Bronson Commercial |
$93.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.31
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$71.75
|
|
|
Service Code
|
NDC 55150042510
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.57 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Aetna American Axle |
$46.64
|
| Rate for Payer: Aetna Commercial |
$60.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.64
|
| Rate for Payer: Cash Price |
$57.40
|
| Rate for Payer: Cofinity Commercial |
$50.23
|
| Rate for Payer: Cofinity Commercial |
$61.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.40
|
| Rate for Payer: Healthscope Commercial |
$64.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.99
|
| Rate for Payer: PHP Commercial |
$60.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.64
|
| Rate for Payer: Priority Health SBD |
$45.20
|
| Rate for Payer: UMR Bronson Commercial |
$31.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.81
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$48.63
|
|
|
Service Code
|
NDC 00641601301
|
| 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: Cofinity Medicare Advantage |
$34.04
|
| 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 Commercial |
$41.34
|
| Rate for Payer: PHP Commercial |
$41.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.61
|
| 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 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$71.75
|
|
|
Service Code
|
NDC 55150042510
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Aetna American Axle |
$46.64
|
| Rate for Payer: Aetna Commercial |
$60.99
|
| Rate for Payer: Aetna Medicare |
$35.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.64
|
| Rate for Payer: BCBS Complete |
$28.70
|
| Rate for Payer: Cash Price |
$57.40
|
| Rate for Payer: Cofinity Commercial |
$50.23
|
| Rate for Payer: Cofinity Commercial |
$61.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.40
|
| Rate for Payer: Healthscope Commercial |
$64.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.99
|
| Rate for Payer: PHP Commercial |
$60.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.64
|
| Rate for Payer: Priority Health SBD |
$45.20
|
| Rate for Payer: UMR Bronson Commercial |
$26.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.81
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$65.25
|
|
|
Service Code
|
NDC 17478093705
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$58.73 |
| Rate for Payer: Aetna American Axle |
$42.41
|
| Rate for Payer: Aetna Commercial |
$55.46
|
| Rate for Payer: Aetna Medicare |
$32.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.41
|
| Rate for Payer: BCBS Complete |
$26.10
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cofinity Commercial |
$45.67
|
| Rate for Payer: Cofinity Commercial |
$56.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.20
|
| Rate for Payer: Healthscope Commercial |
$58.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.46
|
| Rate for Payer: PHP Commercial |
$55.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.41
|
| Rate for Payer: Priority Health SBD |
$41.11
|
| Rate for Payer: UMR Bronson Commercial |
$24.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.94
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$253.75
|
|
|
Service Code
|
NDC 17478093726
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$111.65 |
| Max. Negotiated Rate |
$228.38 |
| Rate for Payer: Aetna American Axle |
$164.94
|
| Rate for Payer: Aetna Commercial |
$215.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.94
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: Cofinity Commercial |
$177.62
|
| Rate for Payer: Cofinity Commercial |
$218.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.00
|
| Rate for Payer: Healthscope Commercial |
$228.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.69
|
| Rate for Payer: PHP Commercial |
$215.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.94
|
| Rate for Payer: Priority Health SBD |
$159.86
|
| Rate for Payer: UMR Bronson Commercial |
$111.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.31
|
|
