|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.70
|
|
|
Service Code
|
NDC 60687019511
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Aetna American Axle |
$2.40
|
| Rate for Payer: Aetna Commercial |
$3.15
|
| Rate for Payer: Aetna Medicare |
$1.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cofinity Commercial |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$3.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.96
|
| Rate for Payer: Healthscope Commercial |
$3.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.15
|
| Rate for Payer: PHP Commercial |
$3.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| Rate for Payer: Priority Health SBD |
$2.33
|
| Rate for Payer: UMR Bronson Commercial |
$1.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$336.30
|
|
|
Service Code
|
NDC 00904721761
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.97 |
| Max. Negotiated Rate |
$302.67 |
| Rate for Payer: Aetna American Axle |
$218.59
|
| Rate for Payer: Aetna Commercial |
$285.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.59
|
| Rate for Payer: Cash Price |
$269.04
|
| Rate for Payer: Cofinity Commercial |
$235.41
|
| Rate for Payer: Cofinity Commercial |
$289.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.04
|
| Rate for Payer: Healthscope Commercial |
$302.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.86
|
| Rate for Payer: PHP Commercial |
$285.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.59
|
| Rate for Payer: Priority Health SBD |
$211.87
|
| Rate for Payer: UMR Bronson Commercial |
$147.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.22
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.04
|
|
|
Service Code
|
NDC 60687020611
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Aetna American Axle |
$1.98
|
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna Medicare |
$1.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.98
|
| Rate for Payer: BCBS Complete |
$1.22
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cofinity Commercial |
$2.13
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.43
|
| Rate for Payer: Healthscope Commercial |
$2.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.98
|
| Rate for Payer: Priority Health SBD |
$1.92
|
| Rate for Payer: UMR Bronson Commercial |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.28
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$273.60
|
|
|
Service Code
|
NDC 00904721861
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.38 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna American Axle |
$177.84
|
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.84
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cofinity Commercial |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.84
|
| Rate for Payer: Priority Health SBD |
$172.37
|
| Rate for Payer: UMR Bronson Commercial |
$120.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.20
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$273.60
|
|
|
Service Code
|
NDC 00904721861
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.23 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna American Axle |
$177.84
|
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna Medicare |
$136.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.84
|
| Rate for Payer: BCBS Complete |
$109.44
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cofinity Commercial |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.84
|
| Rate for Payer: Priority Health SBD |
$172.37
|
| Rate for Payer: UMR Bronson Commercial |
$101.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.20
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
NDC 60687020601
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.76 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna American Axle |
$197.60
|
| Rate for Payer: Aetna Commercial |
$258.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.60
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cofinity Commercial |
$212.80
|
| Rate for Payer: Cofinity Commercial |
$261.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.20
|
| Rate for Payer: Healthscope Commercial |
$273.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.40
|
| Rate for Payer: PHP Commercial |
$258.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.60
|
| Rate for Payer: Priority Health SBD |
$191.52
|
| Rate for Payer: UMR Bronson Commercial |
$133.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.00
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.04
|
|
|
Service Code
|
NDC 60687020611
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Aetna American Axle |
$1.98
|
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.98
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cofinity Commercial |
$2.13
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.43
|
| Rate for Payer: Healthscope Commercial |
$2.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.98
|
| Rate for Payer: Priority Health SBD |
$1.92
|
| Rate for Payer: UMR Bronson Commercial |
$1.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.28
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
NDC 60687020601
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna American Axle |
$197.60
|
| Rate for Payer: Aetna Commercial |
$258.40
|
| Rate for Payer: Aetna Medicare |
$152.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.60
|
| Rate for Payer: BCBS Complete |
$121.60
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cofinity Commercial |
$212.80
|
| Rate for Payer: Cofinity Commercial |
$261.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.20
|
| Rate for Payer: Healthscope Commercial |
$273.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.40
|
| Rate for Payer: PHP Commercial |
$258.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.60
|
| Rate for Payer: Priority Health SBD |
$191.52
|
| Rate for Payer: UMR Bronson Commercial |
$112.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.00
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$253.92
|
|
|
Service Code
|
NDC 60687021701
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.95 |
| Max. Negotiated Rate |
$228.53 |
| Rate for Payer: Aetna American Axle |
$165.05
|
| Rate for Payer: Aetna Commercial |
$215.83
|
| Rate for Payer: Aetna Medicare |
$126.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.05
|
| Rate for Payer: BCBS Complete |
$101.57
|
| Rate for Payer: Cash Price |
$203.14
|
| Rate for Payer: Cofinity Commercial |
$177.74
|
| Rate for Payer: Cofinity Commercial |
$218.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.14
|
| Rate for Payer: Healthscope Commercial |
$228.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.83
|
| Rate for Payer: PHP Commercial |
$215.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.05
|
| Rate for Payer: Priority Health SBD |
$159.97
|
| Rate for Payer: UMR Bronson Commercial |
$93.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.44
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$544.32
|
|
|
Service Code
|
NDC 10370083109
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.40 |
| Max. Negotiated Rate |
$489.89 |
| Rate for Payer: Aetna American Axle |
$353.81
|
| Rate for Payer: Aetna Commercial |
$462.67
|
| Rate for Payer: Aetna Medicare |
$272.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.81
|
| Rate for Payer: BCBS Complete |
$217.73
|
| Rate for Payer: Cash Price |
$435.46
|
| Rate for Payer: Cofinity Commercial |
$381.02
|
| Rate for Payer: Cofinity Commercial |
$468.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$381.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$435.46
|
| Rate for Payer: Healthscope Commercial |
$489.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$381.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$408.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$462.67
|
| Rate for Payer: PHP Commercial |
$462.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.81
|
| Rate for Payer: Priority Health SBD |
$342.92
|
| Rate for Payer: UMR Bronson Commercial |
$201.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$408.24
|
|
|
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 Commercial |
$297.25
|
| Rate for Payer: Cofinity Commercial |
$365.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.25
|
| 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: PHP Commercial |
$360.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.02
|
| 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
|
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 Commercial |
$297.25
|
| Rate for Payer: Cofinity Commercial |
$365.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.25
|
| 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: PHP Commercial |
$360.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.02
|
| Rate for Payer: Priority Health SBD |
$267.53
|
| 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
|
$2.54
|
|
|
Service Code
|
NDC 60687021711
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna American Axle |
$1.65
|
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.65
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Healthscope Commercial |
$2.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: PHP Commercial |
$2.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.65
|
| Rate for Payer: Priority Health SBD |
$1.60
|
| Rate for Payer: UMR Bronson Commercial |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$2.54
|
|
|
Service Code
|
NDC 60687021711
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna American Axle |
$1.65
|
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: Aetna Medicare |
$1.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.65
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Healthscope Commercial |
$2.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: PHP Commercial |
$2.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.65
|
| Rate for Payer: Priority Health SBD |
$1.60
|
| Rate for Payer: UMR Bronson Commercial |
$0.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$544.32
|
|
|
Service Code
|
NDC 10370083109
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$239.50 |
| Max. Negotiated Rate |
$489.89 |
| Rate for Payer: Aetna American Axle |
$353.81
|
| Rate for Payer: Aetna Commercial |
$462.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.81
|
| Rate for Payer: Cash Price |
$435.46
|
| Rate for Payer: Cofinity Commercial |
$381.02
|
| Rate for Payer: Cofinity Commercial |
$468.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$381.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$435.46
|
| Rate for Payer: Healthscope Commercial |
$489.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$381.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$408.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$462.67
|
| Rate for Payer: PHP Commercial |
$462.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.81
|
| Rate for Payer: Priority Health SBD |
$342.92
|
| Rate for Payer: UMR Bronson Commercial |
$239.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$408.24
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$253.92
|
|
|
Service Code
|
NDC 60687021701
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.72 |
| Max. Negotiated Rate |
$228.53 |
| Rate for Payer: Aetna American Axle |
$165.05
|
| Rate for Payer: Aetna Commercial |
$215.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.05
|
| Rate for Payer: Cash Price |
$203.14
|
| Rate for Payer: Cofinity Commercial |
$177.74
|
| Rate for Payer: Cofinity Commercial |
$218.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.14
|
| Rate for Payer: Healthscope Commercial |
$228.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.83
|
| Rate for Payer: PHP Commercial |
$215.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.05
|
| Rate for Payer: Priority Health SBD |
$159.97
|
| Rate for Payer: UMR Bronson Commercial |
$111.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.44
|
|
|
DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$7.22
|
|
|
Service Code
|
NDC 60687022811
|
| Hospital Charge Code |
29276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna American Axle |
$4.69
|
| Rate for Payer: Aetna Commercial |
$6.14
|
| Rate for Payer: Aetna Medicare |
$3.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.69
|
| Rate for Payer: BCBS Complete |
$2.89
|
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: Cofinity Commercial |
$5.05
|
| Rate for Payer: Cofinity Commercial |
$6.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.78
|
| Rate for Payer: Healthscope Commercial |
$6.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.14
|
| Rate for Payer: PHP Commercial |
$6.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.69
|
| Rate for Payer: Priority Health SBD |
$4.55
|
| Rate for Payer: UMR Bronson Commercial |
$2.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.42
|
|
|
DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$650.88
|
|
|
Service Code
|
NDC 00904722061
|
| Hospital Charge Code |
29276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$240.83 |
| Max. Negotiated Rate |
$585.79 |
| Rate for Payer: Aetna American Axle |
$423.07
|
| Rate for Payer: Aetna Commercial |
$553.25
|
| Rate for Payer: Aetna Medicare |
$325.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.07
|
| Rate for Payer: BCBS Complete |
$260.35
|
| Rate for Payer: Cash Price |
$520.70
|
| Rate for Payer: Cofinity Commercial |
$455.62
|
| Rate for Payer: Cofinity Commercial |
$559.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$455.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.70
|
| Rate for Payer: Healthscope Commercial |
$585.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$455.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.25
|
| Rate for Payer: PHP Commercial |
$553.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.07
|
| Rate for Payer: Priority Health SBD |
$410.05
|
| Rate for Payer: UMR Bronson Commercial |
$240.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.16
|
|
|
DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$7.22
|
|
|
Service Code
|
NDC 60687022811
|
| Hospital Charge Code |
29276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna American Axle |
$4.69
|
| Rate for Payer: Aetna Commercial |
$6.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.69
|
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: Cofinity Commercial |
$5.05
|
| Rate for Payer: Cofinity Commercial |
$6.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.78
|
| Rate for Payer: Healthscope Commercial |
$6.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.14
|
| Rate for Payer: PHP Commercial |
$6.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.69
|
| Rate for Payer: Priority Health SBD |
$4.55
|
| Rate for Payer: UMR Bronson Commercial |
$3.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.42
|
|
|
DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$721.44
|
|
|
Service Code
|
NDC 60687022801
|
| Hospital Charge Code |
29276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$317.43 |
| Max. Negotiated Rate |
$649.30 |
| Rate for Payer: Aetna American Axle |
$468.94
|
| Rate for Payer: Aetna Commercial |
$613.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.94
|
| Rate for Payer: Cash Price |
$577.15
|
| Rate for Payer: Cofinity Commercial |
$505.01
|
| Rate for Payer: Cofinity Commercial |
$620.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$505.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$577.15
|
| Rate for Payer: Healthscope Commercial |
$649.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$505.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$541.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$613.22
|
| Rate for Payer: PHP Commercial |
$613.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.94
|
| Rate for Payer: Priority Health SBD |
$454.51
|
| Rate for Payer: UMR Bronson Commercial |
$317.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$541.08
|
|
|
DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$721.44
|
|
|
Service Code
|
NDC 60687022801
|
| Hospital Charge Code |
29276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.93 |
| Max. Negotiated Rate |
$649.30 |
| Rate for Payer: Aetna American Axle |
$468.94
|
| Rate for Payer: Aetna Commercial |
$613.22
|
| Rate for Payer: Aetna Medicare |
$360.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.94
|
| Rate for Payer: BCBS Complete |
$288.58
|
| Rate for Payer: Cash Price |
$577.15
|
| Rate for Payer: Cofinity Commercial |
$505.01
|
| Rate for Payer: Cofinity Commercial |
$620.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$505.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$577.15
|
| Rate for Payer: Healthscope Commercial |
$649.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$505.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$541.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$613.22
|
| Rate for Payer: PHP Commercial |
$613.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.94
|
| Rate for Payer: Priority Health SBD |
$454.51
|
| Rate for Payer: UMR Bronson Commercial |
$266.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$541.08
|
|
|
DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$650.88
|
|
|
Service Code
|
NDC 00904722061
|
| Hospital Charge Code |
29276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$286.39 |
| Max. Negotiated Rate |
$585.79 |
| Rate for Payer: Aetna American Axle |
$423.07
|
| Rate for Payer: Aetna Commercial |
$553.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.07
|
| Rate for Payer: Cash Price |
$520.70
|
| Rate for Payer: Cofinity Commercial |
$455.62
|
| Rate for Payer: Cofinity Commercial |
$559.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$455.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.70
|
| Rate for Payer: Healthscope Commercial |
$585.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$455.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.25
|
| Rate for Payer: PHP Commercial |
$553.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.07
|
| Rate for Payer: Priority Health SBD |
$410.05
|
| Rate for Payer: UMR Bronson Commercial |
$286.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.16
|
|
|
DILTIAZEM ER 240 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$464.98
|
|
|
Service Code
|
NDC 00187204730
|
| Hospital Charge Code |
35179
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.59 |
| Max. Negotiated Rate |
$418.48 |
| Rate for Payer: Aetna American Axle |
$302.24
|
| Rate for Payer: Aetna Commercial |
$395.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.24
|
| Rate for Payer: Cash Price |
$371.98
|
| Rate for Payer: Cofinity Commercial |
$325.49
|
| Rate for Payer: Cofinity Commercial |
$399.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$325.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.98
|
| Rate for Payer: Healthscope Commercial |
$418.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.23
|
| Rate for Payer: PHP Commercial |
$395.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.24
|
| Rate for Payer: Priority Health SBD |
$292.94
|
| Rate for Payer: UMR Bronson Commercial |
$204.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.74
|
|
|
DILTIAZEM ER 240 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$464.98
|
|
|
Service Code
|
NDC 00187204730
|
| Hospital Charge Code |
35179
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.04 |
| Max. Negotiated Rate |
$418.48 |
| Rate for Payer: Aetna American Axle |
$302.24
|
| Rate for Payer: Aetna Commercial |
$395.23
|
| Rate for Payer: Aetna Medicare |
$232.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.24
|
| Rate for Payer: BCBS Complete |
$185.99
|
| Rate for Payer: Cash Price |
$371.98
|
| Rate for Payer: Cofinity Commercial |
$325.49
|
| Rate for Payer: Cofinity Commercial |
$399.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$325.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.98
|
| Rate for Payer: Healthscope Commercial |
$418.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.23
|
| Rate for Payer: PHP Commercial |
$395.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.24
|
| Rate for Payer: Priority Health SBD |
$292.94
|
| Rate for Payer: UMR Bronson Commercial |
$172.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.74
|
|
|
DILUENT NO.1 FOR LIVE VIRUS VACCINES (STERILE WATER) VIAL
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 00006430901
|
| Hospital Charge Code |
173258
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna American Axle |
$0.01
|
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.02
|
| Rate for Payer: Healthscope Commercial |
$0.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.02
|
| Rate for Payer: PHP Commercial |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.02
|
|
