|
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 |
$293.98
|
| 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 |
$293.98
|
| 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
|
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
|
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
|
|
|
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
|
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 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 |
$293.98
|
| 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 |
$293.98
|
| 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
|
IP
|
$366.70
|
|
|
Service Code
|
NDC 60687071701
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.36 |
| 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 |
$311.70
|
| Rate for Payer: Nomi Health Commercial |
$300.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.70
|
|
|
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 |
$336.28
|
| 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 |
$336.28
|
| 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: 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 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$253.75
|
|
|
Service Code
|
NDC 17478093725
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$164.94 |
| Max. Negotiated Rate |
$253.75 |
| Rate for Payer: Aetna Commercial |
$228.38
|
| Rate for Payer: ASR ASR |
$246.14
|
| Rate for Payer: ASR Commercial |
$246.14
|
| Rate for Payer: BCBS Trust/PPO |
$206.78
|
| Rate for Payer: BCN Commercial |
$196.73
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: Cofinity Commercial |
$238.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.00
|
| Rate for Payer: Healthscope Commercial |
$253.75
|
| Rate for Payer: Healthscope Whirlpool |
$246.14
|
| Rate for Payer: Mclaren Commercial |
$228.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.69
|
| Rate for Payer: Nomi Health Commercial |
$208.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.30
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$50.25
|
|
|
Service Code
|
NDC 25021031905
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.10 |
| Max. Negotiated Rate |
$50.25 |
| Rate for Payer: Aetna Commercial |
$45.22
|
| Rate for Payer: Aetna Medicare |
$25.12
|
| Rate for Payer: ASR ASR |
$48.74
|
| Rate for Payer: ASR Commercial |
$48.74
|
| Rate for Payer: BCBS Complete |
$20.10
|
| Rate for Payer: BCBS Trust/PPO |
$41.15
|
| Rate for Payer: BCN Commercial |
$38.96
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cofinity Commercial |
$47.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.20
|
| Rate for Payer: Healthscope Commercial |
$50.25
|
| Rate for Payer: Healthscope Whirlpool |
$48.74
|
| Rate for Payer: Mclaren Commercial |
$45.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.71
|
| Rate for Payer: Nomi Health Commercial |
$41.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.03
|
| Rate for Payer: Priority Health Narrow Network |
$35.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.22
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$49.62
|
|
|
Service Code
|
NDC 00641601310
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.85 |
| Max. Negotiated Rate |
$49.62 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Aetna Medicare |
$24.81
|
| Rate for Payer: ASR ASR |
$48.13
|
| Rate for Payer: ASR Commercial |
$48.13
|
| Rate for Payer: BCBS Complete |
$19.85
|
| Rate for Payer: BCBS Trust/PPO |
$40.63
|
| Rate for Payer: BCN Commercial |
$38.47
|
| Rate for Payer: Cash Price |
$39.70
|
| Rate for Payer: Cofinity Commercial |
$46.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.70
|
| Rate for Payer: Healthscope Commercial |
$49.62
|
| Rate for Payer: Healthscope Whirlpool |
$48.13
|
| Rate for Payer: Mclaren Commercial |
$44.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.18
|
| Rate for Payer: Nomi Health Commercial |
$40.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.48
|
| Rate for Payer: Priority Health Narrow Network |
$34.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.67
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$253.75
|
|
|
Service Code
|
NDC 17478093726
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$164.94 |
| Max. Negotiated Rate |
$253.75 |
| Rate for Payer: Aetna Commercial |
$228.38
|
| Rate for Payer: ASR ASR |
$246.14
|
| Rate for Payer: ASR Commercial |
$246.14
|
| Rate for Payer: BCBS Trust/PPO |
$206.78
|
| Rate for Payer: BCN Commercial |
$196.73
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: Cofinity Commercial |
$238.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.00
|
| Rate for Payer: Healthscope Commercial |
$253.75
|
| Rate for Payer: Healthscope Whirlpool |
$246.14
|
| Rate for Payer: Mclaren Commercial |
$228.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.69
|
| Rate for Payer: Nomi Health Commercial |
$208.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.30
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$253.75
|
|
|
Service Code
|
NDC 17478093726
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$101.50 |
| Max. Negotiated Rate |
$253.75 |
| Rate for Payer: Aetna Commercial |
$228.38
|
| Rate for Payer: Aetna Medicare |
$126.88
|
| Rate for Payer: ASR ASR |
$246.14
|
| Rate for Payer: ASR Commercial |
$246.14
|
| Rate for Payer: BCBS Complete |
$101.50
|
| Rate for Payer: BCBS Trust/PPO |
$207.80
|
| Rate for Payer: BCN Commercial |
$196.73
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: Cofinity Commercial |
$238.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.00
|
| Rate for Payer: Healthscope Commercial |
$253.75
|
| Rate for Payer: Healthscope Whirlpool |
$246.14
|
| Rate for Payer: Mclaren Commercial |
$228.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.69
|
| Rate for Payer: Nomi Health Commercial |
$208.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.34
|
| Rate for Payer: Priority Health Narrow Network |
$177.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.30
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$49.62
|
|
|
Service Code
|
NDC 00641601301
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.85 |
| Max. Negotiated Rate |
$49.62 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Aetna Medicare |
$24.81
|
| Rate for Payer: ASR ASR |
$48.13
|
| Rate for Payer: ASR Commercial |
$48.13
|
| Rate for Payer: BCBS Complete |
$19.85
|
| Rate for Payer: BCBS Trust/PPO |
$40.63
|
| Rate for Payer: BCN Commercial |
$38.47
|
| Rate for Payer: Cash Price |
$39.70
|
| Rate for Payer: Cofinity Commercial |
$46.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.70
|
| Rate for Payer: Healthscope Commercial |
$49.62
|
| Rate for Payer: Healthscope Whirlpool |
$48.13
|
| Rate for Payer: Mclaren Commercial |
$44.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.18
|
| Rate for Payer: Nomi Health Commercial |
$40.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.48
|
| Rate for Payer: Priority Health Narrow Network |
$34.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.67
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$65.25
|
|
|
Service Code
|
NDC 17478093705
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Aetna Commercial |
$58.72
|
| Rate for Payer: Aetna Medicare |
$32.62
|
| Rate for Payer: ASR ASR |
$63.29
|
| Rate for Payer: ASR Commercial |
$63.29
|
| Rate for Payer: BCBS Complete |
$26.10
|
| Rate for Payer: BCBS Trust/PPO |
$53.43
|
| Rate for Payer: BCN Commercial |
$50.59
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cofinity Commercial |
$61.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.20
|
| Rate for Payer: Healthscope Commercial |
$65.25
|
| Rate for Payer: Healthscope Whirlpool |
$63.29
|
| Rate for Payer: Mclaren Commercial |
$58.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.46
|
| Rate for Payer: Nomi Health Commercial |
$53.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.17
|
| Rate for Payer: Priority Health Narrow Network |
$45.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.42
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$253.75
|
|
|
Service Code
|
NDC 17478093725
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$101.50 |
| Max. Negotiated Rate |
$253.75 |
| Rate for Payer: Aetna Commercial |
$228.38
|
| Rate for Payer: Aetna Medicare |
$126.88
|
| Rate for Payer: ASR ASR |
$246.14
|
| Rate for Payer: ASR Commercial |
$246.14
|
| Rate for Payer: BCBS Complete |
$101.50
|
| Rate for Payer: BCBS Trust/PPO |
$207.80
|
| Rate for Payer: BCN Commercial |
$196.73
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: Cofinity Commercial |
$238.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.00
|
| Rate for Payer: Healthscope Commercial |
$253.75
|
| Rate for Payer: Healthscope Whirlpool |
$246.14
|
| Rate for Payer: Mclaren Commercial |
$228.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.69
|
| Rate for Payer: Nomi Health Commercial |
$208.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.34
|
| Rate for Payer: Priority Health Narrow Network |
$177.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.30
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$90.50
|
|
|
Service Code
|
NDC 00641601401
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.82 |
| Max. Negotiated Rate |
$90.50 |
| Rate for Payer: Aetna Commercial |
$81.45
|
| Rate for Payer: ASR ASR |
$87.78
|
| Rate for Payer: ASR Commercial |
$87.78
|
| Rate for Payer: BCBS Trust/PPO |
$73.75
|
| Rate for Payer: BCN Commercial |
$70.16
|
| Rate for Payer: Cash Price |
$72.40
|
| Rate for Payer: Cofinity Commercial |
$85.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.40
|
| Rate for Payer: Healthscope Commercial |
$90.50
|
| Rate for Payer: Healthscope Whirlpool |
$87.78
|
| Rate for Payer: Mclaren Commercial |
$81.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.92
|
| Rate for Payer: Nomi Health Commercial |
$74.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.64
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$131.88
|
|
|
Service Code
|
NDC 00641921910
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$85.72 |
| Max. Negotiated Rate |
$131.88 |
| Rate for Payer: Aetna Commercial |
$118.69
|
| Rate for Payer: ASR ASR |
$127.92
|
| Rate for Payer: ASR Commercial |
$127.92
|
| Rate for Payer: BCBS Trust/PPO |
$107.47
|
| Rate for Payer: BCN Commercial |
$102.25
|
| Rate for Payer: Cash Price |
$105.50
|
| Rate for Payer: Cofinity Commercial |
$123.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.50
|
| Rate for Payer: Healthscope Commercial |
$131.88
|
| Rate for Payer: Healthscope Whirlpool |
$127.92
|
| Rate for Payer: Mclaren Commercial |
$118.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.10
|
| Rate for Payer: Nomi Health Commercial |
$108.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.05
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$90.50
|
|
|
Service Code
|
NDC 00641921801
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.82 |
| Max. Negotiated Rate |
$90.50 |
| Rate for Payer: Aetna Commercial |
$81.45
|
| Rate for Payer: ASR ASR |
$87.78
|
| Rate for Payer: ASR Commercial |
$87.78
|
| Rate for Payer: BCBS Trust/PPO |
$73.75
|
| Rate for Payer: BCN Commercial |
$70.16
|
| Rate for Payer: Cash Price |
$72.40
|
| Rate for Payer: Cofinity Commercial |
$85.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.40
|
| Rate for Payer: Healthscope Commercial |
$90.50
|
| Rate for Payer: Healthscope Whirlpool |
$87.78
|
| Rate for Payer: Mclaren Commercial |
$81.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.92
|
| Rate for Payer: Nomi Health Commercial |
$74.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.64
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$131.88
|
|
|
Service Code
|
NDC 00641601501
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.75 |
| Max. Negotiated Rate |
$131.88 |
| Rate for Payer: Aetna Commercial |
$118.69
|
| Rate for Payer: Aetna Medicare |
$65.94
|
| Rate for Payer: ASR ASR |
$127.92
|
| Rate for Payer: ASR Commercial |
$127.92
|
| Rate for Payer: BCBS Complete |
$52.75
|
| Rate for Payer: BCBS Trust/PPO |
$108.00
|
| Rate for Payer: BCN Commercial |
$102.25
|
| Rate for Payer: Cash Price |
$105.50
|
| Rate for Payer: Cofinity Commercial |
$123.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.50
|
| Rate for Payer: Healthscope Commercial |
$131.88
|
| Rate for Payer: Healthscope Whirlpool |
$127.92
|
| Rate for Payer: Mclaren Commercial |
$118.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.10
|
| Rate for Payer: Nomi Health Commercial |
$108.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.55
|
| Rate for Payer: Priority Health Narrow Network |
$92.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.05
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$49.62
|
|
|
Service Code
|
NDC 00641601310
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$49.62 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: ASR ASR |
$48.13
|
| Rate for Payer: ASR Commercial |
$48.13
|
| Rate for Payer: BCBS Trust/PPO |
$40.44
|
| Rate for Payer: BCN Commercial |
$38.47
|
| Rate for Payer: Cash Price |
$39.70
|
| Rate for Payer: Cofinity Commercial |
$46.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.70
|
| Rate for Payer: Healthscope Commercial |
$49.62
|
| Rate for Payer: Healthscope Whirlpool |
$48.13
|
| Rate for Payer: Mclaren Commercial |
$44.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.18
|
| Rate for Payer: Nomi Health Commercial |
$40.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.67
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$90.50
|
|
|
Service Code
|
NDC 00641921801
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$90.50 |
| Rate for Payer: Aetna Commercial |
$81.45
|
| Rate for Payer: Aetna Medicare |
$45.25
|
| Rate for Payer: ASR ASR |
$87.78
|
| Rate for Payer: ASR Commercial |
$87.78
|
| Rate for Payer: BCBS Complete |
$36.20
|
| Rate for Payer: BCBS Trust/PPO |
$74.11
|
| Rate for Payer: BCN Commercial |
$70.16
|
| Rate for Payer: Cash Price |
$72.40
|
| Rate for Payer: Cofinity Commercial |
$85.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.40
|
| Rate for Payer: Healthscope Commercial |
$90.50
|
| Rate for Payer: Healthscope Whirlpool |
$87.78
|
| Rate for Payer: Mclaren Commercial |
$81.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.92
|
| Rate for Payer: Nomi Health Commercial |
$74.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.30
|
| Rate for Payer: Priority Health Narrow Network |
$63.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.64
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$131.88
|
|
|
Service Code
|
NDC 00641921901
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$85.72 |
| Max. Negotiated Rate |
$131.88 |
| Rate for Payer: Aetna Commercial |
$118.69
|
| Rate for Payer: ASR ASR |
$127.92
|
| Rate for Payer: ASR Commercial |
$127.92
|
| Rate for Payer: BCBS Trust/PPO |
$107.47
|
| Rate for Payer: BCN Commercial |
$102.25
|
| Rate for Payer: Cash Price |
$105.50
|
| Rate for Payer: Cofinity Commercial |
$123.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.50
|
| Rate for Payer: Healthscope Commercial |
$131.88
|
| Rate for Payer: Healthscope Whirlpool |
$127.92
|
| Rate for Payer: Mclaren Commercial |
$118.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.10
|
| Rate for Payer: Nomi Health Commercial |
$108.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.05
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$90.50
|
|
|
Service Code
|
NDC 00641601410
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$90.50 |
| Rate for Payer: Aetna Commercial |
$81.45
|
| Rate for Payer: Aetna Medicare |
$45.25
|
| Rate for Payer: ASR ASR |
$87.78
|
| Rate for Payer: ASR Commercial |
$87.78
|
| Rate for Payer: BCBS Complete |
$36.20
|
| Rate for Payer: BCBS Trust/PPO |
$74.11
|
| Rate for Payer: BCN Commercial |
$70.16
|
| Rate for Payer: Cash Price |
$72.40
|
| Rate for Payer: Cofinity Commercial |
$85.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.40
|
| Rate for Payer: Healthscope Commercial |
$90.50
|
| Rate for Payer: Healthscope Whirlpool |
$87.78
|
| Rate for Payer: Mclaren Commercial |
$81.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.92
|
| Rate for Payer: Nomi Health Commercial |
$74.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.30
|
| Rate for Payer: Priority Health Narrow Network |
$63.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.64
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$90.50
|
|
|
Service Code
|
NDC 00641601410
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.82 |
| Max. Negotiated Rate |
$90.50 |
| Rate for Payer: Aetna Commercial |
$81.45
|
| Rate for Payer: ASR ASR |
$87.78
|
| Rate for Payer: ASR Commercial |
$87.78
|
| Rate for Payer: BCBS Trust/PPO |
$73.75
|
| Rate for Payer: BCN Commercial |
$70.16
|
| Rate for Payer: Cash Price |
$72.40
|
| Rate for Payer: Cofinity Commercial |
$85.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.40
|
| Rate for Payer: Healthscope Commercial |
$90.50
|
| Rate for Payer: Healthscope Whirlpool |
$87.78
|
| Rate for Payer: Mclaren Commercial |
$81.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.92
|
| Rate for Payer: Nomi Health Commercial |
$74.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.64
|
|
