|
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
|
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
|
$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
|
$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
|
$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
|
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
|
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
|
$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
|
$65.25
|
|
|
Service Code
|
NDC 17478093705
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.41 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Aetna Commercial |
$58.72
|
| Rate for Payer: ASR ASR |
$63.29
|
| Rate for Payer: ASR Commercial |
$63.29
|
| Rate for Payer: BCBS Trust/PPO |
$53.17
|
| 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: UHC All Payor (Choice/PPO) + Core |
$57.42
|
|
|
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 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
|
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 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
|
$59.50
|
|
|
Service Code
|
NDC 17478093710
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.68 |
| 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 |
$38.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.36
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$131.88
|
|
|
Service Code
|
NDC 00641601501
|
| 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
|
$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
|
$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 CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.70
|
|
|
Service Code
|
NDC 60687019511
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Aetna Medicare |
$1.85
|
| Rate for Payer: ASR ASR |
$3.59
|
| Rate for Payer: ASR Commercial |
$3.59
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: BCBS Trust/PPO |
$3.03
|
| Rate for Payer: BCN Commercial |
$2.87
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cofinity Commercial |
$3.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.96
|
| Rate for Payer: Healthscope Commercial |
$3.70
|
| Rate for Payer: Healthscope Whirlpool |
$3.59
|
| Rate for Payer: Mclaren Commercial |
$3.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Nomi Health Commercial |
$3.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.24
|
| Rate for Payer: Priority Health Narrow Network |
$2.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.26
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.70
|
|
|
Service Code
|
NDC 60687019511
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: ASR ASR |
$3.59
|
| Rate for Payer: ASR Commercial |
$3.59
|
| Rate for Payer: BCBS Trust/PPO |
$3.02
|
| Rate for Payer: BCN Commercial |
$2.87
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cofinity Commercial |
$3.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.96
|
| Rate for Payer: Healthscope Commercial |
$3.70
|
| Rate for Payer: Healthscope Whirlpool |
$3.59
|
| Rate for Payer: Mclaren Commercial |
$3.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Nomi Health Commercial |
$3.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.26
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$369.55
|
|
|
Service Code
|
NDC 60687019501
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.82 |
| Max. Negotiated Rate |
$369.55 |
| Rate for Payer: Aetna Commercial |
$332.60
|
| Rate for Payer: Aetna Medicare |
$184.78
|
| Rate for Payer: ASR ASR |
$358.46
|
| Rate for Payer: ASR Commercial |
$358.46
|
| Rate for Payer: BCBS Complete |
$147.82
|
| Rate for Payer: BCBS Trust/PPO |
$302.62
|
| Rate for Payer: BCN Commercial |
$286.51
|
| Rate for Payer: Cash Price |
$295.64
|
| Rate for Payer: Cofinity Commercial |
$347.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.64
|
| Rate for Payer: Healthscope Commercial |
$369.55
|
| Rate for Payer: Healthscope Whirlpool |
$358.46
|
| Rate for Payer: Mclaren Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.12
|
| Rate for Payer: Nomi Health Commercial |
$303.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$323.80
|
| Rate for Payer: Priority Health Narrow Network |
$259.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$325.20
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$336.30
|
|
|
Service Code
|
NDC 00904721761
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.52 |
| Max. Negotiated Rate |
$336.30 |
| Rate for Payer: Aetna Commercial |
$302.67
|
| Rate for Payer: Aetna Medicare |
$168.15
|
| Rate for Payer: ASR ASR |
$326.21
|
| Rate for Payer: ASR Commercial |
$326.21
|
| Rate for Payer: BCBS Complete |
$134.52
|
| Rate for Payer: BCBS Trust/PPO |
$275.40
|
| Rate for Payer: BCN Commercial |
$260.73
|
| Rate for Payer: Cash Price |
$269.04
|
| Rate for Payer: Cofinity Commercial |
$316.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.04
|
| Rate for Payer: Healthscope Commercial |
$336.30
|
| Rate for Payer: Healthscope Whirlpool |
$326.21
|
| Rate for Payer: Mclaren Commercial |
$302.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.86
|
| Rate for Payer: Nomi Health Commercial |
$275.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.67
|
| Rate for Payer: Priority Health Narrow Network |
$235.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.94
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$369.55
|
|
|
Service Code
|
NDC 60687019501
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$240.21 |
| Max. Negotiated Rate |
$369.55 |
| Rate for Payer: Aetna Commercial |
$332.60
|
| Rate for Payer: ASR ASR |
$358.46
|
| Rate for Payer: ASR Commercial |
$358.46
|
| Rate for Payer: BCBS Trust/PPO |
$301.15
|
| Rate for Payer: BCN Commercial |
$286.51
|
| Rate for Payer: Cash Price |
$295.64
|
| Rate for Payer: Cofinity Commercial |
$347.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.64
|
| Rate for Payer: Healthscope Commercial |
$369.55
|
| Rate for Payer: Healthscope Whirlpool |
$358.46
|
| Rate for Payer: Mclaren Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.12
|
| Rate for Payer: Nomi Health Commercial |
$303.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$325.20
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$336.30
|
|
|
Service Code
|
NDC 00904721761
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$218.60 |
| Max. Negotiated Rate |
$336.30 |
| Rate for Payer: Aetna Commercial |
$302.67
|
| Rate for Payer: ASR ASR |
$326.21
|
| Rate for Payer: ASR Commercial |
$326.21
|
| Rate for Payer: BCBS Trust/PPO |
$274.05
|
| Rate for Payer: BCN Commercial |
$260.73
|
| Rate for Payer: Cash Price |
$269.04
|
| Rate for Payer: Cofinity Commercial |
$316.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.04
|
| Rate for Payer: Healthscope Commercial |
$336.30
|
| Rate for Payer: Healthscope Whirlpool |
$326.21
|
| Rate for Payer: Mclaren Commercial |
$302.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.86
|
| Rate for Payer: Nomi Health Commercial |
$275.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.94
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$273.60
|
|
|
Service Code
|
NDC 00904721861
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.44 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna Commercial |
$246.24
|
| Rate for Payer: Aetna Medicare |
$136.80
|
| Rate for Payer: ASR ASR |
$265.39
|
| Rate for Payer: ASR Commercial |
$265.39
|
| Rate for Payer: BCBS Complete |
$109.44
|
| Rate for Payer: BCBS Trust/PPO |
$224.05
|
| Rate for Payer: BCN Commercial |
$212.12
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cofinity Commercial |
$257.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
| Rate for Payer: Healthscope Commercial |
$273.60
|
| Rate for Payer: Healthscope Whirlpool |
$265.39
|
| Rate for Payer: Mclaren Commercial |
$246.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: Nomi Health Commercial |
$224.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$239.73
|
| Rate for Payer: Priority Health Narrow Network |
$191.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$240.77
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.04
|
|
|
Service Code
|
NDC 60687020611
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna Commercial |
$2.74
|
| Rate for Payer: Aetna Medicare |
$1.52
|
| Rate for Payer: ASR ASR |
$2.95
|
| Rate for Payer: ASR Commercial |
$2.95
|
| Rate for Payer: BCBS Complete |
$1.22
|
| Rate for Payer: BCBS Trust/PPO |
$2.49
|
| Rate for Payer: BCN Commercial |
$2.36
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.43
|
| Rate for Payer: Healthscope Commercial |
$3.04
|
| Rate for Payer: Healthscope Whirlpool |
$2.95
|
| Rate for Payer: Mclaren Commercial |
$2.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Nomi Health Commercial |
$2.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.66
|
| Rate for Payer: Priority Health Narrow Network |
$2.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.68
|
|
