|
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
|
$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
|
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 |
$1.84
|
| 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
|
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
|
$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
|
$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
|
$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
|
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 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$49.62
|
|
|
Service Code
|
NDC 00641601301
|
| 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
|
$49.62
|
|
|
Service Code
|
NDC 00641921701
|
| 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
|
$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
|
$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
|
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
|
OP
|
$90.50
|
|
|
Service Code
|
NDC 00641921810
|
| 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
|
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
|
OP
|
$49.62
|
|
|
Service Code
|
NDC 00641921710
|
| 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
|
$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
|
OP
|
$131.88
|
|
|
Service Code
|
NDC 00641921910
|
| 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
|
$131.88
|
|
|
Service Code
|
NDC 00641601510
|
| 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
|
OP
|
$131.88
|
|
|
Service Code
|
NDC 00641921901
|
| 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
|
OP
|
$131.88
|
|
|
Service Code
|
NDC 00641601510
|
| 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 00641921701
|
| 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
|
$59.50
|
|
|
Service Code
|
NDC 17478093710
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: Aetna Commercial |
$53.55
|
| Rate for Payer: Aetna Medicare |
$29.75
|
| Rate for Payer: ASR ASR |
$57.72
|
| Rate for Payer: ASR Commercial |
$57.72
|
| Rate for Payer: BCBS Complete |
$23.80
|
| Rate for Payer: BCBS Trust/PPO |
$48.72
|
| 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 |
$38.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.13
|
| Rate for Payer: Priority Health Narrow Network |
$41.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.36
|
|
|
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
|
|
