|
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
|
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
|
$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 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 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 (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/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 |
$8.64 |
| 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: 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 |
$18.93
|
| Rate for Payer: Priority Health Narrow Network |
$15.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.02
|
|
|
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
|
|
|
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 |
$2,770.17 |
| Max. Negotiated Rate |
$11,565.29 |
| Rate for Payer: Aetna Commercial |
$10,408.76
|
| Rate for Payer: Aetna Medicare |
$5,168.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,460.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,460.29
|
| Rate for Payer: ASR ASR |
$11,218.33
|
| Rate for Payer: ASR Commercial |
$11,218.33
|
| Rate for Payer: BCBS Complete |
$2,908.68
|
| Rate for Payer: BCBS MAPPO |
$5,168.23
|
| Rate for Payer: BCBS Trust/PPO |
$9,470.82
|
| Rate for Payer: BCN Commercial |
$8,966.57
|
| Rate for Payer: BCN Medicare Advantage |
$5,168.23
|
| 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 |
$5,168.23
|
| Rate for Payer: Healthscope Commercial |
$11,565.29
|
| Rate for Payer: Healthscope Whirlpool |
$11,218.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,168.23
|
| Rate for Payer: Mclaren Commercial |
$10,408.76
|
| Rate for Payer: Mclaren Medicaid |
$2,770.17
|
| Rate for Payer: Mclaren Medicare |
$5,168.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,426.64
|
| Rate for Payer: Meridian Medicaid |
$2,908.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,943.46
|
| 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 |
$4,909.82
|
| Rate for Payer: PACE SWMI |
$5,168.23
|
| Rate for Payer: PHP Commercial |
$5,685.05
|
| Rate for Payer: PHP Medicaid |
$2,770.17
|
| Rate for Payer: PHP Medicare Advantage |
$5,168.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,770.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,517.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,133.51
|
| Rate for Payer: Priority Health Medicare |
$5,168.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,107.27
|
| Rate for Payer: Railroad Medicare Medicare |
$5,168.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,177.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,168.23
|
| Rate for Payer: UHC Exchange |
$8,010.76
|
| Rate for Payer: UHC Medicare Advantage |
$5,168.23
|
| Rate for Payer: UHCCP DNSP |
$5,168.23
|
| Rate for Payer: UHCCP Medicaid |
$2,770.17
|
| Rate for Payer: VA VA |
$5,168.23
|
|
|
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 |
$41.65
|
| 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
|
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
|
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 |
$41.65
|
| 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
|
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 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 |
$311.69
|
| Rate for Payer: Nomi Health Commercial |
$300.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.35
|
| 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
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
OP
|
$3.74
|
|
|
Service Code
|
NDC 51079074501
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna Medicare |
$1.87
|
| Rate for Payer: ASR ASR |
$3.63
|
| Rate for Payer: ASR Commercial |
$3.63
|
| Rate for Payer: BCBS Complete |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$3.06
|
| Rate for Payer: BCN Commercial |
$2.90
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.74
|
| Rate for Payer: Healthscope Whirlpool |
$3.63
|
| Rate for Payer: Mclaren Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.18
|
| Rate for Payer: Nomi Health Commercial |
$3.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.28
|
| Rate for Payer: Priority Health Narrow Network |
$2.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.29
|
|
|
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 |
$336.29
|
| 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 |
$336.29
|
| 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
|
$326.65
|
|
|
Service Code
|
NDC 00093031801
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.66 |
| Max. Negotiated Rate |
$326.65 |
| Rate for Payer: Aetna Commercial |
$293.99
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: ASR ASR |
$316.85
|
| Rate for Payer: ASR Commercial |
$316.85
|
| Rate for Payer: BCBS Complete |
$130.66
|
| Rate for Payer: BCBS Trust/PPO |
$267.49
|
| Rate for Payer: BCN Commercial |
$253.25
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Commercial |
$307.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$326.65
|
| Rate for Payer: Healthscope Whirlpool |
$316.85
|
| Rate for Payer: Mclaren Commercial |
$293.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Nomi Health Commercial |
$267.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$286.21
|
| Rate for Payer: Priority Health Narrow Network |
$228.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.45
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
OP
|
$373.65
|
|
|
Service Code
|
NDC 51079074520
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.46 |
| Max. Negotiated Rate |
$373.65 |
| Rate for Payer: Aetna Commercial |
$336.29
|
| Rate for Payer: Aetna Medicare |
$186.82
|
| Rate for Payer: ASR ASR |
$362.44
|
| Rate for Payer: ASR Commercial |
$362.44
|
| Rate for Payer: BCBS Complete |
$149.46
|
| Rate for Payer: BCBS Trust/PPO |
$305.98
|
| 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 |
$336.29
|
| 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: Priority Health HMO/PPO/Tiered Network |
$327.39
|
| Rate for Payer: Priority Health Narrow Network |
$261.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.81
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$366.70
|
|
|
Service Code
|
NDC 60687071701
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.35 |
| Max. Negotiated Rate |
$366.70 |
| Rate for Payer: Aetna Commercial |
$330.03
|
| Rate for Payer: ASR ASR |
$355.70
|
| Rate for Payer: ASR Commercial |
$355.70
|
| Rate for Payer: BCBS Trust/PPO |
$298.82
|
| 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 |
$311.69
|
| Rate for Payer: Nomi Health Commercial |
$300.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.70
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$326.65
|
|
|
Service Code
|
NDC 00093031801
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.32 |
| Max. Negotiated Rate |
$326.65 |
| Rate for Payer: Aetna Commercial |
$293.99
|
| Rate for Payer: ASR ASR |
$316.85
|
| Rate for Payer: ASR Commercial |
$316.85
|
| Rate for Payer: BCBS Trust/PPO |
$266.19
|
| Rate for Payer: BCN Commercial |
$253.25
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Commercial |
$307.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$326.65
|
| Rate for Payer: Healthscope Whirlpool |
$316.85
|
| Rate for Payer: Mclaren Commercial |
$293.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Nomi Health Commercial |
$267.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.45
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$3.67
|
|
|
Service Code
|
NDC 60687071711
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: ASR ASR |
$3.56
|
| Rate for Payer: ASR Commercial |
$3.56
|
| Rate for Payer: BCBS Trust/PPO |
$2.99
|
| Rate for Payer: BCN Commercial |
$2.85
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$3.67
|
| Rate for Payer: Healthscope Whirlpool |
$3.56
|
| Rate for Payer: Mclaren Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.12
|
| Rate for Payer: Nomi Health Commercial |
$3.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.23
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
OP
|
$3.67
|
|
|
Service Code
|
NDC 60687071711
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Aetna Medicare |
$1.83
|
| Rate for Payer: ASR ASR |
$3.56
|
| Rate for Payer: ASR Commercial |
$3.56
|
| Rate for Payer: BCBS Complete |
$1.47
|
| Rate for Payer: BCBS Trust/PPO |
$3.01
|
| Rate for Payer: BCN Commercial |
$2.85
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$3.67
|
| Rate for Payer: Healthscope Whirlpool |
$3.56
|
| Rate for Payer: Mclaren Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.12
|
| Rate for Payer: Nomi Health Commercial |
$3.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.22
|
| Rate for Payer: Priority Health Narrow Network |
$2.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.23
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$3.74
|
|
|
Service Code
|
NDC 51079074501
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: ASR ASR |
$3.63
|
| Rate for Payer: ASR Commercial |
$3.63
|
| Rate for Payer: BCBS Trust/PPO |
$3.05
|
| Rate for Payer: BCN Commercial |
$2.90
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.74
|
| Rate for Payer: Healthscope Whirlpool |
$3.63
|
| Rate for Payer: Mclaren Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.18
|
| Rate for Payer: Nomi Health Commercial |
$3.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.29
|
|
|
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 |
$38.67 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: Aetna Commercial |
$53.55
|
| Rate for Payer: ASR ASR |
$57.72
|
| Rate for Payer: ASR Commercial |
$57.72
|
| Rate for Payer: BCBS Trust/PPO |
$48.49
|
| Rate for Payer: BCN Commercial |
$46.13
|
| Rate for Payer: Cash Price |
$47.60
|
| Rate for Payer: Cofinity Commercial |
$55.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.60
|
| Rate for Payer: Healthscope Commercial |
$59.50
|
| Rate for Payer: Healthscope Whirlpool |
$57.72
|
| Rate for Payer: Mclaren Commercial |
$53.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.58
|
| Rate for Payer: Nomi Health Commercial |
$48.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.36
|
|
