|
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 |
$58.83 |
| 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 |
$58.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.64
|
|
|
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 |
$58.83
|
| 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 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 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
|
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
|
|
|
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
|
$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
|
IP
|
$90.50
|
|
|
Service Code
|
NDC 00641601410
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.83 |
| 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 |
$58.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.64
|
|
|
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 |
$3.15
|
| 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
|
$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 |
$3.15
|
| 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
|
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 |
$218.59
|
| 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
|
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
|
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 |
$218.59 |
| 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 |
$218.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.94
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.04
|
|
|
Service Code
|
NDC 60687020611
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna Commercial |
$2.74
|
| Rate for Payer: ASR ASR |
$2.95
|
| Rate for Payer: ASR Commercial |
$2.95
|
| Rate for Payer: BCBS Trust/PPO |
$2.48
|
| 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: UHC All Payor (Choice/PPO) + Core |
$2.68
|
|
|
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
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
NDC 60687020601
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.60 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Aetna Commercial |
$273.60
|
| Rate for Payer: Aetna Medicare |
$152.00
|
| Rate for Payer: ASR ASR |
$294.88
|
| Rate for Payer: ASR Commercial |
$294.88
|
| Rate for Payer: BCBS Complete |
$121.60
|
| Rate for Payer: BCBS Trust/PPO |
$248.95
|
| Rate for Payer: BCN Commercial |
$235.69
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cofinity Commercial |
$285.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.20
|
| Rate for Payer: Healthscope Commercial |
$304.00
|
| Rate for Payer: Healthscope Whirlpool |
$294.88
|
| Rate for Payer: Mclaren Commercial |
$273.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.40
|
| Rate for Payer: Nomi Health Commercial |
$249.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$266.36
|
| Rate for Payer: Priority Health Narrow Network |
$213.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$267.52
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
NDC 60687020601
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.60 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Aetna Commercial |
$273.60
|
| Rate for Payer: ASR ASR |
$294.88
|
| Rate for Payer: ASR Commercial |
$294.88
|
| Rate for Payer: BCBS Trust/PPO |
$247.73
|
| Rate for Payer: BCN Commercial |
$235.69
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cofinity Commercial |
$285.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.20
|
| Rate for Payer: Healthscope Commercial |
$304.00
|
| Rate for Payer: Healthscope Whirlpool |
$294.88
|
| Rate for Payer: Mclaren Commercial |
$273.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.40
|
| Rate for Payer: Nomi Health Commercial |
$249.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$267.52
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$273.60
|
|
|
Service Code
|
NDC 00904721861
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.84 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna Commercial |
$246.24
|
| Rate for Payer: ASR ASR |
$265.39
|
| Rate for Payer: ASR Commercial |
$265.39
|
| Rate for Payer: BCBS Trust/PPO |
$222.96
|
| 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: UHC All Payor (Choice/PPO) + Core |
$240.77
|
|
|
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 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$253.92
|
|
|
Service Code
|
NDC 60687021701
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.05 |
| Max. Negotiated Rate |
$253.92 |
| Rate for Payer: Aetna Commercial |
$228.53
|
| Rate for Payer: ASR ASR |
$246.30
|
| Rate for Payer: ASR Commercial |
$246.30
|
| Rate for Payer: BCBS Trust/PPO |
$206.92
|
| Rate for Payer: BCN Commercial |
$196.86
|
| Rate for Payer: Cash Price |
$203.14
|
| Rate for Payer: Cofinity Commercial |
$238.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.14
|
| Rate for Payer: Healthscope Commercial |
$253.92
|
| Rate for Payer: Healthscope Whirlpool |
$246.30
|
| Rate for Payer: Mclaren Commercial |
$228.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.83
|
| Rate for Payer: Nomi Health Commercial |
$208.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.45
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$253.92
|
|
|
Service Code
|
NDC 60687021701
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.57 |
| Max. Negotiated Rate |
$253.92 |
| Rate for Payer: Aetna Commercial |
$228.53
|
| Rate for Payer: Aetna Medicare |
$126.96
|
| Rate for Payer: ASR ASR |
$246.30
|
| Rate for Payer: ASR Commercial |
$246.30
|
| Rate for Payer: BCBS Complete |
$101.57
|
| Rate for Payer: BCBS Trust/PPO |
$207.94
|
| Rate for Payer: BCN Commercial |
$196.86
|
| Rate for Payer: Cash Price |
$203.14
|
| Rate for Payer: Cofinity Commercial |
$238.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.14
|
| Rate for Payer: Healthscope Commercial |
$253.92
|
| Rate for Payer: Healthscope Whirlpool |
$246.30
|
| Rate for Payer: Mclaren Commercial |
$228.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.83
|
| Rate for Payer: Nomi Health Commercial |
$208.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.48
|
| Rate for Payer: Priority Health Narrow Network |
$178.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.45
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$424.65
|
|
|
Service Code
|
NDC 63739001610
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$276.02 |
| Max. Negotiated Rate |
$424.65 |
| Rate for Payer: Aetna Commercial |
$382.19
|
| Rate for Payer: ASR ASR |
$411.91
|
| Rate for Payer: ASR Commercial |
$411.91
|
| Rate for Payer: BCBS Trust/PPO |
$346.05
|
| Rate for Payer: BCN Commercial |
$329.23
|
| Rate for Payer: Cash Price |
$339.72
|
| Rate for Payer: Cofinity Commercial |
$399.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.72
|
| Rate for Payer: Healthscope Commercial |
$424.65
|
| Rate for Payer: Healthscope Whirlpool |
$411.91
|
| Rate for Payer: Mclaren Commercial |
$382.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.95
|
| Rate for Payer: Nomi Health Commercial |
$348.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.69
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$2.54
|
|
|
Service Code
|
NDC 60687021711
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: ASR ASR |
$2.46
|
| Rate for Payer: ASR Commercial |
$2.46
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCN Commercial |
$1.97
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Healthscope Commercial |
$2.54
|
| Rate for Payer: Healthscope Whirlpool |
$2.46
|
| Rate for Payer: Mclaren Commercial |
$2.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: Nomi Health Commercial |
$2.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.24
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$2.54
|
|
|
Service Code
|
NDC 60687021711
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: Aetna Medicare |
$1.27
|
| Rate for Payer: ASR ASR |
$2.46
|
| Rate for Payer: ASR Commercial |
$2.46
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$2.08
|
| Rate for Payer: BCN Commercial |
$1.97
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Healthscope Commercial |
$2.54
|
| Rate for Payer: Healthscope Whirlpool |
$2.46
|
| Rate for Payer: Mclaren Commercial |
$2.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: Nomi Health Commercial |
$2.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.23
|
| Rate for Payer: Priority Health Narrow Network |
$1.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.24
|
|
