|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$3.82
|
|
|
Service Code
|
NDC 51079011801
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: ASR ASR |
$3.71
|
| Rate for Payer: ASR Commercial |
$3.71
|
| Rate for Payer: BCBS Trust/PPO |
$3.11
|
| Rate for Payer: BCN Commercial |
$2.96
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: Healthscope Whirlpool |
$3.71
|
| Rate for Payer: Mclaren Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Nomi Health Commercial |
$3.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.36
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 00591079401
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.12 |
| Max. Negotiated Rate |
$437.10 |
| Rate for Payer: Aetna Commercial |
$393.39
|
| Rate for Payer: ASR ASR |
$423.99
|
| Rate for Payer: ASR Commercial |
$423.99
|
| Rate for Payer: BCBS Trust/PPO |
$356.19
|
| Rate for Payer: BCN Commercial |
$338.88
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$410.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$437.10
|
| Rate for Payer: Healthscope Whirlpool |
$423.99
|
| Rate for Payer: Mclaren Commercial |
$393.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Nomi Health Commercial |
$358.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.65
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$3.82
|
|
|
Service Code
|
NDC 51079011801
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Aetna Medicare |
$1.91
|
| Rate for Payer: ASR ASR |
$3.71
|
| Rate for Payer: ASR Commercial |
$3.71
|
| Rate for Payer: BCBS Complete |
$1.53
|
| Rate for Payer: BCBS Trust/PPO |
$3.13
|
| Rate for Payer: BCN Commercial |
$2.96
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: Healthscope Whirlpool |
$3.71
|
| Rate for Payer: Mclaren Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Nomi Health Commercial |
$3.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.35
|
| Rate for Payer: Priority Health Narrow Network |
$2.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.36
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 00591079401
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.84 |
| Max. Negotiated Rate |
$437.10 |
| Rate for Payer: Aetna Commercial |
$393.39
|
| Rate for Payer: Aetna Medicare |
$218.55
|
| Rate for Payer: ASR ASR |
$423.99
|
| Rate for Payer: ASR Commercial |
$423.99
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: BCBS Trust/PPO |
$357.94
|
| Rate for Payer: BCN Commercial |
$338.88
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$410.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$437.10
|
| Rate for Payer: Healthscope Whirlpool |
$423.99
|
| Rate for Payer: Mclaren Commercial |
$393.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Nomi Health Commercial |
$358.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.99
|
| Rate for Payer: Priority Health Narrow Network |
$306.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.65
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$398.05
|
|
|
Service Code
|
NDC 00904698761
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.22 |
| Max. Negotiated Rate |
$398.05 |
| Rate for Payer: Aetna Commercial |
$358.24
|
| Rate for Payer: Aetna Medicare |
$199.02
|
| Rate for Payer: ASR ASR |
$386.11
|
| Rate for Payer: ASR Commercial |
$386.11
|
| Rate for Payer: BCBS Complete |
$159.22
|
| Rate for Payer: BCBS Trust/PPO |
$325.96
|
| Rate for Payer: BCN Commercial |
$308.61
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Commercial |
$374.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$398.05
|
| Rate for Payer: Healthscope Whirlpool |
$386.11
|
| Rate for Payer: Mclaren Commercial |
$358.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: Nomi Health Commercial |
$326.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$348.77
|
| Rate for Payer: Priority Health Narrow Network |
$279.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$350.28
|
|
|
DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$32.48
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.11 |
| Max. Negotiated Rate |
$32.48 |
| Rate for Payer: Aetna Commercial |
$29.23
|
| Rate for Payer: Aetna Commercial |
$64.02
|
| Rate for Payer: Aetna Commercial |
$249.77
|
| Rate for Payer: Aetna Commercial |
$28.73
|
| Rate for Payer: Aetna Commercial |
$156.18
|
| Rate for Payer: Aetna Commercial |
$145.26
|
| Rate for Payer: Aetna Commercial |
$29.80
|
| Rate for Payer: ASR ASR |
$32.12
|
| Rate for Payer: ASR ASR |
$31.51
|
| Rate for Payer: ASR ASR |
$269.19
|
| Rate for Payer: ASR ASR |
$168.32
|
| Rate for Payer: ASR ASR |
$156.56
|
| Rate for Payer: ASR ASR |
$30.96
|
| Rate for Payer: ASR ASR |
$69.00
|
| Rate for Payer: ASR Commercial |
$156.56
|
| Rate for Payer: ASR Commercial |
$168.32
|
| Rate for Payer: ASR Commercial |
$69.00
|
| Rate for Payer: ASR Commercial |
$31.51
|
| Rate for Payer: ASR Commercial |
$269.19
|
| Rate for Payer: ASR Commercial |
$32.12
|
| Rate for Payer: ASR Commercial |
$30.96
|
| Rate for Payer: BCBS Trust/PPO |
$26.01
|
| Rate for Payer: BCBS Trust/PPO |
$131.52
|
| Rate for Payer: BCBS Trust/PPO |
$141.41
|
| Rate for Payer: BCBS Trust/PPO |
$226.15
|
| Rate for Payer: BCBS Trust/PPO |
$26.47
|
| Rate for Payer: BCBS Trust/PPO |
$26.98
|
| Rate for Payer: BCBS Trust/PPO |
$57.96
|
| Rate for Payer: BCN Commercial |
$134.54
|
| Rate for Payer: BCN Commercial |
$25.67
|
| Rate for Payer: BCN Commercial |
$215.16
|
| Rate for Payer: BCN Commercial |
$25.18
|
| Rate for Payer: BCN Commercial |
$55.15
|
| Rate for Payer: BCN Commercial |
$24.75
|
| Rate for Payer: BCN Commercial |
$125.13
|
| Rate for Payer: Cash Price |
$25.53
|
| Rate for Payer: Cash Price |
$56.90
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$138.83
|
| Rate for Payer: Cash Price |
$129.12
|
| Rate for Payer: Cash Price |
$25.99
|
| Rate for Payer: Cash Price |
$222.01
|
| Rate for Payer: Cofinity Commercial |
$30.53
|
| Rate for Payer: Cofinity Commercial |
$163.12
|
| Rate for Payer: Cofinity Commercial |
$260.87
|
| Rate for Payer: Cofinity Commercial |
$31.12
|
| Rate for Payer: Cofinity Commercial |
$66.86
|
| Rate for Payer: Cofinity Commercial |
$30.00
|
| Rate for Payer: Cofinity Commercial |
$151.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.12
|
| Rate for Payer: Healthscope Commercial |
$161.40
|
| Rate for Payer: Healthscope Commercial |
$277.52
|
| Rate for Payer: Healthscope Commercial |
$33.11
|
| Rate for Payer: Healthscope Commercial |
$31.92
|
| Rate for Payer: Healthscope Commercial |
$32.48
|
| Rate for Payer: Healthscope Commercial |
$71.13
|
| Rate for Payer: Healthscope Commercial |
$173.53
|
| Rate for Payer: Healthscope Whirlpool |
$30.96
|
| Rate for Payer: Healthscope Whirlpool |
$69.00
|
| Rate for Payer: Healthscope Whirlpool |
$168.32
|
| Rate for Payer: Healthscope Whirlpool |
$269.19
|
| Rate for Payer: Healthscope Whirlpool |
$31.51
|
| Rate for Payer: Healthscope Whirlpool |
$156.56
|
| Rate for Payer: Healthscope Whirlpool |
$32.12
|
| Rate for Payer: Mclaren Commercial |
$29.23
|
| Rate for Payer: Mclaren Commercial |
$28.73
|
| Rate for Payer: Mclaren Commercial |
$249.77
|
| Rate for Payer: Mclaren Commercial |
$156.18
|
| Rate for Payer: Mclaren Commercial |
$64.02
|
| Rate for Payer: Mclaren Commercial |
$145.26
|
| Rate for Payer: Mclaren Commercial |
$29.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.13
|
| Rate for Payer: Nomi Health Commercial |
$142.29
|
| Rate for Payer: Nomi Health Commercial |
$26.17
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: Nomi Health Commercial |
$26.63
|
| Rate for Payer: Nomi Health Commercial |
$132.35
|
| Rate for Payer: Nomi Health Commercial |
$227.57
|
| Rate for Payer: Nomi Health Commercial |
$58.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.22
|
|
|
DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$71.13
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.67 |
| Max. Negotiated Rate |
$71.13 |
| Rate for Payer: Aetna Commercial |
$64.02
|
| Rate for Payer: Aetna Commercial |
$249.77
|
| Rate for Payer: Aetna Commercial |
$156.18
|
| Rate for Payer: Aetna Commercial |
$28.73
|
| Rate for Payer: Aetna Commercial |
$29.80
|
| Rate for Payer: Aetna Commercial |
$145.26
|
| Rate for Payer: Aetna Commercial |
$29.23
|
| Rate for Payer: Aetna Medicare |
$138.76
|
| Rate for Payer: Aetna Medicare |
$16.56
|
| Rate for Payer: Aetna Medicare |
$16.24
|
| Rate for Payer: Aetna Medicare |
$35.56
|
| Rate for Payer: Aetna Medicare |
$15.96
|
| Rate for Payer: Aetna Medicare |
$86.76
|
| Rate for Payer: Aetna Medicare |
$80.70
|
| Rate for Payer: ASR ASR |
$32.12
|
| Rate for Payer: ASR ASR |
$30.96
|
| Rate for Payer: ASR ASR |
$269.19
|
| Rate for Payer: ASR ASR |
$156.56
|
| Rate for Payer: ASR ASR |
$168.32
|
| Rate for Payer: ASR ASR |
$69.00
|
| Rate for Payer: ASR ASR |
$31.51
|
| Rate for Payer: ASR Commercial |
$156.56
|
| Rate for Payer: ASR Commercial |
$30.96
|
| Rate for Payer: ASR Commercial |
$168.32
|
| Rate for Payer: ASR Commercial |
$269.19
|
| Rate for Payer: ASR Commercial |
$69.00
|
| Rate for Payer: ASR Commercial |
$32.12
|
| Rate for Payer: ASR Commercial |
$31.51
|
| Rate for Payer: BCBS Complete |
$111.01
|
| Rate for Payer: BCBS Complete |
$69.41
|
| Rate for Payer: BCBS Complete |
$64.56
|
| Rate for Payer: BCBS Complete |
$28.45
|
| Rate for Payer: BCBS Complete |
$13.24
|
| Rate for Payer: BCBS Complete |
$12.99
|
| Rate for Payer: BCBS Complete |
$12.77
|
| Rate for Payer: BCBS Trust/PPO |
$227.26
|
| Rate for Payer: BCBS Trust/PPO |
$132.17
|
| Rate for Payer: BCBS Trust/PPO |
$58.25
|
| Rate for Payer: BCBS Trust/PPO |
$142.10
|
| Rate for Payer: BCBS Trust/PPO |
$27.11
|
| Rate for Payer: BCBS Trust/PPO |
$26.14
|
| Rate for Payer: BCBS Trust/PPO |
$26.60
|
| Rate for Payer: BCN Commercial |
$55.15
|
| Rate for Payer: BCN Commercial |
$134.54
|
| Rate for Payer: BCN Commercial |
$25.18
|
| Rate for Payer: BCN Commercial |
$125.13
|
| Rate for Payer: BCN Commercial |
$215.16
|
| Rate for Payer: BCN Commercial |
$24.75
|
| Rate for Payer: BCN Commercial |
$25.67
|
| Rate for Payer: Cash Price |
$25.53
|
| Rate for Payer: Cash Price |
$222.01
|
| Rate for Payer: Cash Price |
$129.12
|
| Rate for Payer: Cash Price |
$138.83
|
| Rate for Payer: Cash Price |
$138.83
|
| Rate for Payer: Cash Price |
$129.12
|
| Rate for Payer: Cash Price |
$222.01
|
| Rate for Payer: Cash Price |
$25.53
|
| Rate for Payer: Cash Price |
$25.99
|
| Rate for Payer: Cash Price |
$25.99
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$56.90
|
| Rate for Payer: Cash Price |
$56.90
|
| Rate for Payer: Cofinity Commercial |
$163.12
|
| Rate for Payer: Cofinity Commercial |
$66.86
|
| Rate for Payer: Cofinity Commercial |
$260.87
|
| Rate for Payer: Cofinity Commercial |
$31.12
|
| Rate for Payer: Cofinity Commercial |
$151.72
|
| Rate for Payer: Cofinity Commercial |
$30.00
|
| Rate for Payer: Cofinity Commercial |
$30.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.98
|
| Rate for Payer: Healthscope Commercial |
$31.92
|
| Rate for Payer: Healthscope Commercial |
$161.40
|
| Rate for Payer: Healthscope Commercial |
$173.53
|
| Rate for Payer: Healthscope Commercial |
$33.11
|
| Rate for Payer: Healthscope Commercial |
$32.48
|
| Rate for Payer: Healthscope Commercial |
$277.52
|
| Rate for Payer: Healthscope Commercial |
$71.13
|
| Rate for Payer: Healthscope Whirlpool |
$30.96
|
| Rate for Payer: Healthscope Whirlpool |
$269.19
|
| Rate for Payer: Healthscope Whirlpool |
$168.32
|
| Rate for Payer: Healthscope Whirlpool |
$31.51
|
| Rate for Payer: Healthscope Whirlpool |
$32.12
|
| Rate for Payer: Healthscope Whirlpool |
$69.00
|
| Rate for Payer: Healthscope Whirlpool |
$156.56
|
| Rate for Payer: Mclaren Commercial |
$29.80
|
| Rate for Payer: Mclaren Commercial |
$28.73
|
| Rate for Payer: Mclaren Commercial |
$249.77
|
| Rate for Payer: Mclaren Commercial |
$64.02
|
| Rate for Payer: Mclaren Commercial |
$29.23
|
| Rate for Payer: Mclaren Commercial |
$156.18
|
| Rate for Payer: Mclaren Commercial |
$145.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Nomi Health Commercial |
$132.35
|
| Rate for Payer: Nomi Health Commercial |
$26.17
|
| Rate for Payer: Nomi Health Commercial |
$227.57
|
| Rate for Payer: Nomi Health Commercial |
$142.29
|
| Rate for Payer: Nomi Health Commercial |
$26.63
|
| Rate for Payer: Nomi Health Commercial |
$58.33
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.34
|
| Rate for Payer: Priority Health Narrow Network |
$10.67
|
| Rate for Payer: Priority Health Narrow Network |
$10.67
|
| Rate for Payer: Priority Health Narrow Network |
$10.67
|
| Rate for Payer: Priority Health Narrow Network |
$10.67
|
| Rate for Payer: Priority Health Narrow Network |
$10.67
|
| Rate for Payer: Priority Health Narrow Network |
$10.67
|
| Rate for Payer: Priority Health Narrow Network |
$10.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.71
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
IP
|
$6.02
|
|
|
Service Code
|
NDC 42292000301
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Aetna Commercial |
$5.42
|
| Rate for Payer: ASR ASR |
$5.84
|
| Rate for Payer: ASR Commercial |
$5.84
|
| Rate for Payer: BCBS Trust/PPO |
$4.91
|
| Rate for Payer: BCN Commercial |
$4.67
|
| Rate for Payer: Cash Price |
$4.82
|
| Rate for Payer: Cofinity Commercial |
$5.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.82
|
| Rate for Payer: Healthscope Commercial |
$6.02
|
| Rate for Payer: Healthscope Whirlpool |
$5.84
|
| Rate for Payer: Mclaren Commercial |
$5.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.12
|
| Rate for Payer: Nomi Health Commercial |
$4.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.30
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
OP
|
$601.92
|
|
|
Service Code
|
NDC 42292000320
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$240.77 |
| Max. Negotiated Rate |
$601.92 |
| Rate for Payer: Aetna Commercial |
$541.73
|
| Rate for Payer: Aetna Medicare |
$300.96
|
| Rate for Payer: ASR ASR |
$583.86
|
| Rate for Payer: ASR Commercial |
$583.86
|
| Rate for Payer: BCBS Complete |
$240.77
|
| Rate for Payer: BCBS Trust/PPO |
$492.91
|
| Rate for Payer: BCN Commercial |
$466.67
|
| Rate for Payer: Cash Price |
$481.54
|
| Rate for Payer: Cofinity Commercial |
$565.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.54
|
| Rate for Payer: Healthscope Commercial |
$601.92
|
| Rate for Payer: Healthscope Whirlpool |
$583.86
|
| Rate for Payer: Mclaren Commercial |
$541.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$511.63
|
| Rate for Payer: Nomi Health Commercial |
$493.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$527.40
|
| Rate for Payer: Priority Health Narrow Network |
$421.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$529.69
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
IP
|
$601.92
|
|
|
Service Code
|
NDC 42292000320
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$391.25 |
| Max. Negotiated Rate |
$601.92 |
| Rate for Payer: Aetna Commercial |
$541.73
|
| Rate for Payer: ASR ASR |
$583.86
|
| Rate for Payer: ASR Commercial |
$583.86
|
| Rate for Payer: BCBS Trust/PPO |
$490.50
|
| Rate for Payer: BCN Commercial |
$466.67
|
| Rate for Payer: Cash Price |
$481.54
|
| Rate for Payer: Cofinity Commercial |
$565.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.54
|
| Rate for Payer: Healthscope Commercial |
$601.92
|
| Rate for Payer: Healthscope Whirlpool |
$583.86
|
| Rate for Payer: Mclaren Commercial |
$541.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$511.63
|
| Rate for Payer: Nomi Health Commercial |
$493.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$529.69
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
OP
|
$6.02
|
|
|
Service Code
|
NDC 42292000301
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Aetna Commercial |
$5.42
|
| Rate for Payer: Aetna Medicare |
$3.01
|
| Rate for Payer: ASR ASR |
$5.84
|
| Rate for Payer: ASR Commercial |
$5.84
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: BCBS Trust/PPO |
$4.93
|
| Rate for Payer: BCN Commercial |
$4.67
|
| Rate for Payer: Cash Price |
$4.82
|
| Rate for Payer: Cofinity Commercial |
$5.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.82
|
| Rate for Payer: Healthscope Commercial |
$6.02
|
| Rate for Payer: Healthscope Whirlpool |
$5.84
|
| Rate for Payer: Mclaren Commercial |
$5.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.12
|
| Rate for Payer: Nomi Health Commercial |
$4.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.27
|
| Rate for Payer: Priority Health Narrow Network |
$4.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.30
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
IP
|
$426.72
|
|
|
Service Code
|
NDC 00904592161
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$426.72 |
| Rate for Payer: Aetna Commercial |
$384.05
|
| Rate for Payer: ASR ASR |
$413.92
|
| Rate for Payer: ASR Commercial |
$413.92
|
| Rate for Payer: BCBS Trust/PPO |
$347.73
|
| Rate for Payer: BCN Commercial |
$330.84
|
| Rate for Payer: Cash Price |
$341.38
|
| Rate for Payer: Cofinity Commercial |
$401.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.38
|
| Rate for Payer: Healthscope Commercial |
$426.72
|
| Rate for Payer: Healthscope Whirlpool |
$413.92
|
| Rate for Payer: Mclaren Commercial |
$384.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.71
|
| Rate for Payer: Nomi Health Commercial |
$349.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$375.51
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
OP
|
$426.72
|
|
|
Service Code
|
NDC 00904592161
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.69 |
| Max. Negotiated Rate |
$426.72 |
| Rate for Payer: Aetna Commercial |
$384.05
|
| Rate for Payer: Aetna Medicare |
$213.36
|
| Rate for Payer: ASR ASR |
$413.92
|
| Rate for Payer: ASR Commercial |
$413.92
|
| Rate for Payer: BCBS Complete |
$170.69
|
| Rate for Payer: BCBS Trust/PPO |
$349.44
|
| Rate for Payer: BCN Commercial |
$330.84
|
| Rate for Payer: Cash Price |
$341.38
|
| Rate for Payer: Cofinity Commercial |
$401.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.38
|
| Rate for Payer: Healthscope Commercial |
$426.72
|
| Rate for Payer: Healthscope Whirlpool |
$413.92
|
| Rate for Payer: Mclaren Commercial |
$384.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.71
|
| Rate for Payer: Nomi Health Commercial |
$349.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$373.89
|
| Rate for Payer: Priority Health Narrow Network |
$299.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$375.51
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET
|
Facility
|
OP
|
$43.97
|
|
|
Service Code
|
NDC 00904592261
|
| Hospital Charge Code |
2445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.59 |
| Max. Negotiated Rate |
$43.97 |
| Rate for Payer: Aetna Commercial |
$39.57
|
| Rate for Payer: Aetna Medicare |
$21.98
|
| Rate for Payer: ASR ASR |
$42.65
|
| Rate for Payer: ASR Commercial |
$42.65
|
| Rate for Payer: BCBS Complete |
$17.59
|
| Rate for Payer: BCBS Trust/PPO |
$36.01
|
| Rate for Payer: BCN Commercial |
$34.09
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Cofinity Commercial |
$41.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.18
|
| Rate for Payer: Healthscope Commercial |
$43.97
|
| Rate for Payer: Healthscope Whirlpool |
$42.65
|
| Rate for Payer: Mclaren Commercial |
$39.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.37
|
| Rate for Payer: Nomi Health Commercial |
$36.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.53
|
| Rate for Payer: Priority Health Narrow Network |
$30.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.69
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET
|
Facility
|
IP
|
$43.97
|
|
|
Service Code
|
NDC 00904592261
|
| Hospital Charge Code |
2445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.58 |
| Max. Negotiated Rate |
$43.97 |
| Rate for Payer: Aetna Commercial |
$39.57
|
| Rate for Payer: ASR ASR |
$42.65
|
| Rate for Payer: ASR Commercial |
$42.65
|
| Rate for Payer: BCBS Trust/PPO |
$35.83
|
| Rate for Payer: BCN Commercial |
$34.09
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Cofinity Commercial |
$41.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.18
|
| Rate for Payer: Healthscope Commercial |
$43.97
|
| Rate for Payer: Healthscope Whirlpool |
$42.65
|
| Rate for Payer: Mclaren Commercial |
$39.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.37
|
| Rate for Payer: Nomi Health Commercial |
$36.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.69
|
|
|
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$21.61
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
108720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$21.61 |
| Rate for Payer: Aetna Commercial |
$19.45
|
| Rate for Payer: ASR ASR |
$20.96
|
| Rate for Payer: ASR Commercial |
$20.96
|
| Rate for Payer: BCBS Trust/PPO |
$17.61
|
| Rate for Payer: BCN Commercial |
$16.75
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$20.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$21.61
|
| Rate for Payer: Healthscope Whirlpool |
$20.96
|
| Rate for Payer: Mclaren Commercial |
$19.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Nomi Health Commercial |
$17.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.02
|
|
|
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$21.61
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
108720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$21.61 |
| Rate for Payer: Aetna Commercial |
$19.45
|
| Rate for Payer: Aetna Medicare |
$10.80
|
| Rate for Payer: ASR ASR |
$20.96
|
| Rate for Payer: ASR Commercial |
$20.96
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: BCBS Trust/PPO |
$17.70
|
| Rate for Payer: BCN Commercial |
$16.75
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$20.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$21.61
|
| Rate for Payer: Healthscope Whirlpool |
$20.96
|
| Rate for Payer: Mclaren Commercial |
$19.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Nomi Health Commercial |
$17.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.06
|
| Rate for Payer: Priority Health Narrow Network |
$4.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.02
|
|
|
DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$11,565.29
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
31432
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,717.51 |
| Max. Negotiated Rate |
$11,565.29 |
| Rate for Payer: Aetna Commercial |
$10,408.76
|
| Rate for Payer: Aetna Medicare |
$5,069.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,337.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,337.48
|
| Rate for Payer: ASR ASR |
$11,218.33
|
| Rate for Payer: ASR Commercial |
$11,218.33
|
| Rate for Payer: BCBS Complete |
$2,853.38
|
| Rate for Payer: BCBS MAPPO |
$5,069.98
|
| Rate for Payer: BCBS Trust/PPO |
$9,470.82
|
| Rate for Payer: BCN Commercial |
$8,966.57
|
| Rate for Payer: BCN Medicare Advantage |
$5,069.98
|
| Rate for Payer: Cash Price |
$9,252.24
|
| Rate for Payer: Cash Price |
$9,252.24
|
| Rate for Payer: Cofinity Commercial |
$10,871.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,252.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,069.98
|
| Rate for Payer: Healthscope Commercial |
$11,565.29
|
| Rate for Payer: Healthscope Whirlpool |
$11,218.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,069.98
|
| Rate for Payer: Mclaren Commercial |
$10,408.76
|
| Rate for Payer: Mclaren Medicaid |
$2,717.51
|
| Rate for Payer: Mclaren Medicare |
$5,069.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,323.48
|
| Rate for Payer: Meridian Medicaid |
$2,853.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,830.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,830.50
|
| Rate for Payer: Nomi Health Commercial |
$9,483.54
|
| Rate for Payer: PACE Medicare |
$4,816.48
|
| Rate for Payer: PACE SWMI |
$5,069.98
|
| Rate for Payer: PHP Commercial |
$5,576.98
|
| Rate for Payer: PHP Medicaid |
$2,717.51
|
| Rate for Payer: PHP Medicare Advantage |
$5,069.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,717.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,517.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,156.07
|
| Rate for Payer: Priority Health Medicare |
$5,069.98
|
| Rate for Payer: Priority Health Narrow Network |
$4,124.86
|
| Rate for Payer: Railroad Medicare Medicare |
$5,069.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,177.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,069.98
|
| Rate for Payer: UHC Exchange |
$7,858.47
|
| Rate for Payer: UHC Medicare Advantage |
$5,069.98
|
| Rate for Payer: UHCCP DNSP |
$5,069.98
|
| Rate for Payer: UHCCP Medicaid |
$2,717.51
|
| Rate for Payer: VA VA |
$5,069.98
|
|
|
DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$11,565.29
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
31432
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,517.44 |
| Max. Negotiated Rate |
$11,565.29 |
| Rate for Payer: Aetna Commercial |
$10,408.76
|
| Rate for Payer: ASR ASR |
$11,218.33
|
| Rate for Payer: ASR Commercial |
$11,218.33
|
| Rate for Payer: BCBS Trust/PPO |
$9,424.55
|
| Rate for Payer: BCN Commercial |
$8,966.57
|
| Rate for Payer: Cash Price |
$9,252.24
|
| Rate for Payer: Cofinity Commercial |
$10,871.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,252.23
|
| Rate for Payer: Healthscope Commercial |
$11,565.29
|
| Rate for Payer: Healthscope Whirlpool |
$11,218.33
|
| Rate for Payer: Mclaren Commercial |
$10,408.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,830.50
|
| Rate for Payer: Nomi Health Commercial |
$9,483.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,517.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,177.46
|
|
|
DILTIAZEM 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$83.29
|
|
|
Service Code
|
NDC 00409435003
|
| Hospital Charge Code |
22156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.14 |
| Max. Negotiated Rate |
$83.29 |
| Rate for Payer: Aetna Commercial |
$74.96
|
| Rate for Payer: ASR ASR |
$80.79
|
| Rate for Payer: ASR Commercial |
$80.79
|
| Rate for Payer: BCBS Trust/PPO |
$67.87
|
| Rate for Payer: BCN Commercial |
$64.57
|
| Rate for Payer: Cash Price |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$78.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.63
|
| Rate for Payer: Healthscope Commercial |
$83.29
|
| Rate for Payer: Healthscope Whirlpool |
$80.79
|
| Rate for Payer: Mclaren Commercial |
$74.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.80
|
| Rate for Payer: Nomi Health Commercial |
$68.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.30
|
|
|
DILTIAZEM 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$83.29
|
|
|
Service Code
|
NDC 00409435013
|
| Hospital Charge Code |
22156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.14 |
| Max. Negotiated Rate |
$83.29 |
| Rate for Payer: Aetna Commercial |
$74.96
|
| Rate for Payer: ASR ASR |
$80.79
|
| Rate for Payer: ASR Commercial |
$80.79
|
| Rate for Payer: BCBS Trust/PPO |
$67.87
|
| Rate for Payer: BCN Commercial |
$64.57
|
| Rate for Payer: Cash Price |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$78.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.63
|
| Rate for Payer: Healthscope Commercial |
$83.29
|
| Rate for Payer: Healthscope Whirlpool |
$80.79
|
| Rate for Payer: Mclaren Commercial |
$74.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.80
|
| Rate for Payer: Nomi Health Commercial |
$68.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.30
|
|
|
DILTIAZEM 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$83.29
|
|
|
Service Code
|
NDC 00409435013
|
| Hospital Charge Code |
22156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.32 |
| Max. Negotiated Rate |
$83.29 |
| Rate for Payer: Aetna Commercial |
$74.96
|
| Rate for Payer: Aetna Medicare |
$41.64
|
| Rate for Payer: ASR ASR |
$80.79
|
| Rate for Payer: ASR Commercial |
$80.79
|
| Rate for Payer: BCBS Complete |
$33.32
|
| Rate for Payer: BCBS Trust/PPO |
$68.21
|
| Rate for Payer: BCN Commercial |
$64.57
|
| Rate for Payer: Cash Price |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$78.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.63
|
| Rate for Payer: Healthscope Commercial |
$83.29
|
| Rate for Payer: Healthscope Whirlpool |
$80.79
|
| Rate for Payer: Mclaren Commercial |
$74.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.80
|
| Rate for Payer: Nomi Health Commercial |
$68.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.98
|
| Rate for Payer: Priority Health Narrow Network |
$58.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.30
|
|
|
DILTIAZEM 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$83.29
|
|
|
Service Code
|
NDC 00409435003
|
| Hospital Charge Code |
22156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.32 |
| Max. Negotiated Rate |
$83.29 |
| Rate for Payer: Aetna Commercial |
$74.96
|
| Rate for Payer: Aetna Medicare |
$41.64
|
| Rate for Payer: ASR ASR |
$80.79
|
| Rate for Payer: ASR Commercial |
$80.79
|
| Rate for Payer: BCBS Complete |
$33.32
|
| Rate for Payer: BCBS Trust/PPO |
$68.21
|
| Rate for Payer: BCN Commercial |
$64.57
|
| Rate for Payer: Cash Price |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$78.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.63
|
| Rate for Payer: Healthscope Commercial |
$83.29
|
| Rate for Payer: Healthscope Whirlpool |
$80.79
|
| Rate for Payer: Mclaren Commercial |
$74.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.80
|
| Rate for Payer: Nomi Health Commercial |
$68.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.98
|
| Rate for Payer: Priority Health Narrow Network |
$58.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.30
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$373.65
|
|
|
Service Code
|
NDC 51079074520
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$242.87 |
| Max. Negotiated Rate |
$373.65 |
| Rate for Payer: Aetna Commercial |
$336.28
|
| Rate for Payer: ASR ASR |
$362.44
|
| Rate for Payer: ASR Commercial |
$362.44
|
| Rate for Payer: BCBS Trust/PPO |
$304.49
|
| Rate for Payer: BCN Commercial |
$289.69
|
| Rate for Payer: Cash Price |
$298.92
|
| Rate for Payer: Cofinity Commercial |
$351.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.92
|
| Rate for Payer: Healthscope Commercial |
$373.65
|
| Rate for Payer: Healthscope Whirlpool |
$362.44
|
| Rate for Payer: Mclaren Commercial |
$336.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.60
|
| Rate for Payer: Nomi Health Commercial |
$306.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.81
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
OP
|
$366.70
|
|
|
Service Code
|
NDC 60687071701
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.68 |
| Max. Negotiated Rate |
$366.70 |
| Rate for Payer: Aetna Commercial |
$330.03
|
| Rate for Payer: Aetna Medicare |
$183.35
|
| Rate for Payer: ASR ASR |
$355.70
|
| Rate for Payer: ASR Commercial |
$355.70
|
| Rate for Payer: BCBS Complete |
$146.68
|
| Rate for Payer: BCBS Trust/PPO |
$300.29
|
| Rate for Payer: BCN Commercial |
$284.30
|
| Rate for Payer: Cash Price |
$293.36
|
| Rate for Payer: Cofinity Commercial |
$344.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.36
|
| Rate for Payer: Healthscope Commercial |
$366.70
|
| Rate for Payer: Healthscope Whirlpool |
$355.70
|
| Rate for Payer: Mclaren Commercial |
$330.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.70
|
| Rate for Payer: Nomi Health Commercial |
$300.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$321.30
|
| Rate for Payer: Priority Health Narrow Network |
$257.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.70
|
|
