|
DILTIAZEM 30 MG TABLET
|
Facility
|
OP
|
$4.29
|
|
|
Service Code
|
NDC 60687071711
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$3.86
|
| Rate for Payer: Aetna Medicare |
$1.59
|
| Rate for Payer: ASR ASR |
$4.16
|
| Rate for Payer: BCBS Complete |
$1.71
|
| Rate for Payer: BCBS Trust/PPO |
$3.53
|
| Rate for Payer: BCN Commercial |
$3.53
|
| Rate for Payer: Cash Price |
$3.43
|
| Rate for Payer: Cofinity Commercial |
$4.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.43
|
| Rate for Payer: Healthscope Commercial |
$4.16
|
| Rate for Payer: Healthscope Whirlpool |
$4.29
|
| Rate for Payer: Mclaren Commercial |
$3.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.64
|
| Rate for Payer: Nomi Health Commercial |
$3.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.75
|
| Rate for Payer: Priority Health Narrow Network |
$3.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.77
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
OP
|
$428.45
|
|
|
Service Code
|
NDC 60687071701
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.53 |
| Max. Negotiated Rate |
$428.45 |
| Rate for Payer: Aetna Commercial |
$385.61
|
| Rate for Payer: Aetna Medicare |
$158.53
|
| Rate for Payer: ASR ASR |
$415.60
|
| Rate for Payer: BCBS Complete |
$171.38
|
| Rate for Payer: BCBS Trust/PPO |
$353.26
|
| Rate for Payer: BCN Commercial |
$353.26
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Commercial |
$402.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Healthscope Commercial |
$415.60
|
| Rate for Payer: Healthscope Whirlpool |
$428.45
|
| Rate for Payer: Mclaren Commercial |
$385.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$342.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: Nomi Health Commercial |
$351.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$375.41
|
| Rate for Payer: Priority Health Narrow Network |
$300.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$377.04
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$373.65
|
|
|
Service Code
|
NDC 51079074520
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.24 |
| Max. Negotiated Rate |
$373.65 |
| Rate for Payer: Aetna Commercial |
$336.29
|
| Rate for Payer: ASR ASR |
$362.44
|
| Rate for Payer: BCBS Trust/PPO |
$306.84
|
| Rate for Payer: BCN Commercial |
$306.84
|
| 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 |
$362.44
|
| Rate for Payer: Healthscope Whirlpool |
$373.65
|
| Rate for Payer: Mclaren Commercial |
$336.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.60
|
| Rate for Payer: Nomi Health Commercial |
$306.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.81
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$326.65
|
|
|
Service Code
|
NDC 93031801
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$244.99 |
| Max. Negotiated Rate |
$326.65 |
| Rate for Payer: Aetna Commercial |
$293.99
|
| Rate for Payer: ASR ASR |
$316.85
|
| Rate for Payer: BCBS Trust/PPO |
$268.24
|
| Rate for Payer: BCN Commercial |
$268.24
|
| 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 |
$316.85
|
| Rate for Payer: Healthscope Whirlpool |
$326.65
|
| Rate for Payer: Mclaren Commercial |
$293.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Nomi Health Commercial |
$267.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.45
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$3.74
|
|
|
Service Code
|
NDC 51079074501
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: ASR ASR |
$3.62
|
| Rate for Payer: BCBS Trust/PPO |
$3.07
|
| Rate for Payer: BCN Commercial |
$3.07
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.62
|
| Rate for Payer: Healthscope Whirlpool |
$3.74
|
| Rate for Payer: Mclaren Commercial |
$3.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.18
|
| Rate for Payer: Nomi Health Commercial |
$3.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.29
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.47
|
|
|
Service Code
|
HCPCS J1163
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$23.47 |
| Rate for Payer: Aetna Commercial |
$21.13
|
| Rate for Payer: Aetna Commercial |
$17.38
|
| Rate for Payer: Aetna Commercial |
$15.85
|
| Rate for Payer: Aetna Commercial |
$24.11
|
| Rate for Payer: Aetna Commercial |
$25.90
|
| Rate for Payer: Aetna Commercial |
$40.65
|
| Rate for Payer: Aetna Commercial |
$13.39
|
| Rate for Payer: Aetna Medicare |
$7.15
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Aetna Medicare |
$10.65
|
| Rate for Payer: Aetna Medicare |
$9.91
|
| Rate for Payer: Aetna Medicare |
$16.71
|
| Rate for Payer: Aetna Medicare |
$8.69
|
| Rate for Payer: Aetna Medicare |
$6.52
|
| Rate for Payer: ASR ASR |
$22.77
|
| Rate for Payer: ASR ASR |
$17.08
|
| Rate for Payer: ASR ASR |
$14.43
|
| Rate for Payer: ASR ASR |
$18.73
|
| Rate for Payer: ASR ASR |
$27.92
|
| Rate for Payer: ASR ASR |
$43.81
|
| Rate for Payer: ASR ASR |
$25.98
|
| Rate for Payer: BCBS Complete |
$5.95
|
| Rate for Payer: BCBS Complete |
$11.51
|
| Rate for Payer: BCBS Complete |
$18.07
|
| Rate for Payer: BCBS Complete |
$10.72
|
| Rate for Payer: BCBS Complete |
$7.04
|
| Rate for Payer: BCBS Complete |
$7.73
|
| Rate for Payer: BCBS Complete |
$9.39
|
| Rate for Payer: BCBS Trust/PPO |
$22.09
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$15.92
|
| Rate for Payer: BCBS Trust/PPO |
$12.26
|
| Rate for Payer: BCBS Trust/PPO |
$14.52
|
| Rate for Payer: BCBS Trust/PPO |
$37.24
|
| Rate for Payer: BCBS Trust/PPO |
$23.73
|
| Rate for Payer: BCN Commercial |
$23.73
|
| Rate for Payer: BCN Commercial |
$22.09
|
| Rate for Payer: BCN Commercial |
$14.52
|
| Rate for Payer: BCN Commercial |
$12.26
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Commercial |
$15.92
|
| Rate for Payer: BCN Commercial |
$37.24
|
| Rate for Payer: Cash Price |
$14.09
|
| Rate for Payer: Cash Price |
$14.09
|
| Rate for Payer: Cash Price |
$36.13
|
| Rate for Payer: Cash Price |
$21.43
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Cash Price |
$15.45
|
| Rate for Payer: Cash Price |
$21.43
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cash Price |
$18.78
|
| Rate for Payer: Cash Price |
$36.13
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cash Price |
$18.78
|
| Rate for Payer: Cash Price |
$15.45
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Cofinity Commercial |
$22.07
|
| Rate for Payer: Cofinity Commercial |
$16.56
|
| Rate for Payer: Cofinity Commercial |
$18.16
|
| Rate for Payer: Cofinity Commercial |
$13.98
|
| Rate for Payer: Cofinity Commercial |
$25.18
|
| Rate for Payer: Cofinity Commercial |
$27.06
|
| Rate for Payer: Cofinity Commercial |
$42.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Healthscope Commercial |
$27.92
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Healthscope Commercial |
$17.08
|
| Rate for Payer: Healthscope Commercial |
$14.43
|
| Rate for Payer: Healthscope Commercial |
$43.81
|
| Rate for Payer: Healthscope Commercial |
$25.98
|
| Rate for Payer: Healthscope Commercial |
$22.77
|
| Rate for Payer: Healthscope Whirlpool |
$28.78
|
| Rate for Payer: Healthscope Whirlpool |
$23.47
|
| Rate for Payer: Healthscope Whirlpool |
$17.61
|
| Rate for Payer: Healthscope Whirlpool |
$45.17
|
| Rate for Payer: Healthscope Whirlpool |
$14.87
|
| Rate for Payer: Healthscope Whirlpool |
$26.79
|
| Rate for Payer: Healthscope Whirlpool |
$19.31
|
| Rate for Payer: Mclaren Commercial |
$13.39
|
| Rate for Payer: Mclaren Commercial |
$17.38
|
| Rate for Payer: Mclaren Commercial |
$15.85
|
| Rate for Payer: Mclaren Commercial |
$24.11
|
| Rate for Payer: Mclaren Commercial |
$21.13
|
| Rate for Payer: Mclaren Commercial |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$40.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: Nomi Health Commercial |
$14.44
|
| Rate for Payer: Nomi Health Commercial |
$15.84
|
| Rate for Payer: Nomi Health Commercial |
$37.04
|
| Rate for Payer: Nomi Health Commercial |
$19.25
|
| Rate for Payer: Nomi Health Commercial |
$12.20
|
| Rate for Payer: Nomi Health Commercial |
$23.60
|
| Rate for Payer: Nomi Health Commercial |
$21.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.09
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17.61
|
|
|
Service Code
|
HCPCS J1163
|
| Hospital Charge Code |
9869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$17.61 |
| Rate for Payer: Aetna Commercial |
$15.85
|
| Rate for Payer: Aetna Commercial |
$13.39
|
| Rate for Payer: Aetna Commercial |
$17.38
|
| Rate for Payer: Aetna Commercial |
$24.11
|
| Rate for Payer: Aetna Commercial |
$40.65
|
| Rate for Payer: Aetna Commercial |
$21.13
|
| Rate for Payer: Aetna Commercial |
$25.90
|
| Rate for Payer: ASR ASR |
$25.98
|
| Rate for Payer: ASR ASR |
$18.73
|
| Rate for Payer: ASR ASR |
$43.81
|
| Rate for Payer: ASR ASR |
$14.43
|
| Rate for Payer: ASR ASR |
$17.08
|
| Rate for Payer: ASR ASR |
$22.77
|
| Rate for Payer: ASR ASR |
$27.92
|
| Rate for Payer: BCBS Trust/PPO |
$37.09
|
| Rate for Payer: BCBS Trust/PPO |
$23.64
|
| Rate for Payer: BCBS Trust/PPO |
$22.00
|
| Rate for Payer: BCBS Trust/PPO |
$14.46
|
| Rate for Payer: BCBS Trust/PPO |
$12.21
|
| Rate for Payer: BCBS Trust/PPO |
$19.28
|
| Rate for Payer: BCBS Trust/PPO |
$15.86
|
| Rate for Payer: BCN Commercial |
$23.64
|
| Rate for Payer: BCN Commercial |
$15.86
|
| Rate for Payer: BCN Commercial |
$14.46
|
| Rate for Payer: BCN Commercial |
$19.28
|
| Rate for Payer: BCN Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$12.21
|
| Rate for Payer: BCN Commercial |
$37.09
|
| Rate for Payer: Cash Price |
$14.09
|
| Rate for Payer: Cash Price |
$21.43
|
| Rate for Payer: Cash Price |
$15.45
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Cash Price |
$36.13
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cash Price |
$18.78
|
| Rate for Payer: Cofinity Commercial |
$27.06
|
| Rate for Payer: Cofinity Commercial |
$16.56
|
| Rate for Payer: Cofinity Commercial |
$22.07
|
| Rate for Payer: Cofinity Commercial |
$25.18
|
| Rate for Payer: Cofinity Commercial |
$18.16
|
| Rate for Payer: Cofinity Commercial |
$13.98
|
| Rate for Payer: Cofinity Commercial |
$42.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.13
|
| Rate for Payer: Healthscope Commercial |
$17.08
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Healthscope Commercial |
$22.77
|
| Rate for Payer: Healthscope Commercial |
$14.43
|
| Rate for Payer: Healthscope Commercial |
$25.98
|
| Rate for Payer: Healthscope Commercial |
$27.92
|
| Rate for Payer: Healthscope Commercial |
$43.81
|
| Rate for Payer: Healthscope Whirlpool |
$26.79
|
| Rate for Payer: Healthscope Whirlpool |
$14.87
|
| Rate for Payer: Healthscope Whirlpool |
$17.61
|
| Rate for Payer: Healthscope Whirlpool |
$28.78
|
| Rate for Payer: Healthscope Whirlpool |
$19.31
|
| Rate for Payer: Healthscope Whirlpool |
$45.17
|
| Rate for Payer: Healthscope Whirlpool |
$23.47
|
| Rate for Payer: Mclaren Commercial |
$13.39
|
| Rate for Payer: Mclaren Commercial |
$21.13
|
| Rate for Payer: Mclaren Commercial |
$15.85
|
| Rate for Payer: Mclaren Commercial |
$24.11
|
| Rate for Payer: Mclaren Commercial |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$17.38
|
| Rate for Payer: Mclaren Commercial |
$40.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.42
|
| Rate for Payer: Nomi Health Commercial |
$12.20
|
| Rate for Payer: Nomi Health Commercial |
$21.97
|
| Rate for Payer: Nomi Health Commercial |
$15.84
|
| Rate for Payer: Nomi Health Commercial |
$23.60
|
| Rate for Payer: Nomi Health Commercial |
$37.04
|
| Rate for Payer: Nomi Health Commercial |
$14.44
|
| Rate for Payer: Nomi Health Commercial |
$19.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.57
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$381.90
|
|
|
Service Code
|
NDC 60687019501
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$286.43 |
| Max. Negotiated Rate |
$381.90 |
| Rate for Payer: Aetna Commercial |
$343.71
|
| Rate for Payer: ASR ASR |
$370.44
|
| Rate for Payer: BCBS Trust/PPO |
$313.62
|
| Rate for Payer: BCN Commercial |
$313.62
|
| Rate for Payer: Cash Price |
$305.52
|
| Rate for Payer: Cofinity Commercial |
$358.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.52
|
| Rate for Payer: Healthscope Commercial |
$370.44
|
| Rate for Payer: Healthscope Whirlpool |
$381.90
|
| Rate for Payer: Mclaren Commercial |
$343.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.62
|
| Rate for Payer: Nomi Health Commercial |
$313.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$286.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$336.07
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$381.90
|
|
|
Service Code
|
NDC 60687019501
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.30 |
| Max. Negotiated Rate |
$381.90 |
| Rate for Payer: Aetna Commercial |
$343.71
|
| Rate for Payer: Aetna Medicare |
$141.30
|
| Rate for Payer: ASR ASR |
$370.44
|
| Rate for Payer: BCBS Complete |
$152.76
|
| Rate for Payer: BCBS Trust/PPO |
$314.88
|
| Rate for Payer: BCN Commercial |
$314.88
|
| Rate for Payer: Cash Price |
$305.52
|
| Rate for Payer: Cofinity Commercial |
$358.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.52
|
| Rate for Payer: Healthscope Commercial |
$370.44
|
| Rate for Payer: Healthscope Whirlpool |
$381.90
|
| Rate for Payer: Mclaren Commercial |
$343.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$305.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.62
|
| Rate for Payer: Nomi Health Commercial |
$313.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$286.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$334.62
|
| Rate for Payer: Priority Health Narrow Network |
$267.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$336.07
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.82
|
|
|
Service Code
|
NDC 60687019511
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Aetna Medicare |
$1.41
|
| Rate for Payer: ASR ASR |
$3.70
|
| Rate for Payer: BCBS Complete |
$1.53
|
| Rate for Payer: BCBS Trust/PPO |
$3.15
|
| Rate for Payer: BCN Commercial |
$3.15
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$3.70
|
| Rate for Payer: Healthscope Whirlpool |
$3.82
|
| Rate for Payer: Mclaren Commercial |
$3.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Nomi Health Commercial |
$3.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.35
|
| Rate for Payer: Priority Health Narrow Network |
$2.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.36
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$347.70
|
|
|
Service Code
|
NDC 904721761
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.77 |
| Max. Negotiated Rate |
$347.70 |
| Rate for Payer: Aetna Commercial |
$312.93
|
| Rate for Payer: ASR ASR |
$337.27
|
| Rate for Payer: BCBS Trust/PPO |
$285.53
|
| Rate for Payer: BCN Commercial |
$285.53
|
| Rate for Payer: Cash Price |
$278.16
|
| Rate for Payer: Cofinity Commercial |
$326.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.16
|
| Rate for Payer: Healthscope Commercial |
$337.27
|
| Rate for Payer: Healthscope Whirlpool |
$347.70
|
| Rate for Payer: Mclaren Commercial |
$312.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.55
|
| Rate for Payer: Nomi Health Commercial |
$285.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$305.98
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.82
|
|
|
Service Code
|
NDC 60687019511
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: ASR ASR |
$3.70
|
| Rate for Payer: BCBS Trust/PPO |
$3.14
|
| Rate for Payer: BCN Commercial |
$3.14
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$3.70
|
| Rate for Payer: Healthscope Whirlpool |
$3.82
|
| Rate for Payer: Mclaren Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Nomi Health Commercial |
$3.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.36
|
|
|
DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$347.70
|
|
|
Service Code
|
NDC 904721761
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.65 |
| Max. Negotiated Rate |
$347.70 |
| Rate for Payer: Aetna Commercial |
$312.93
|
| Rate for Payer: Aetna Medicare |
$128.65
|
| Rate for Payer: ASR ASR |
$337.27
|
| Rate for Payer: BCBS Complete |
$139.08
|
| Rate for Payer: BCBS Trust/PPO |
$286.68
|
| Rate for Payer: BCN Commercial |
$286.68
|
| Rate for Payer: Cash Price |
$278.16
|
| Rate for Payer: Cofinity Commercial |
$326.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.16
|
| Rate for Payer: Healthscope Commercial |
$337.27
|
| Rate for Payer: Healthscope Whirlpool |
$347.70
|
| Rate for Payer: Mclaren Commercial |
$312.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$278.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.55
|
| Rate for Payer: Nomi Health Commercial |
$285.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$304.65
|
| Rate for Payer: Priority Health Narrow Network |
$243.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$305.98
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.39
|
|
|
Service Code
|
NDC 60687020611
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Aetna Commercial |
$3.05
|
| Rate for Payer: ASR ASR |
$3.29
|
| Rate for Payer: BCBS Trust/PPO |
$2.79
|
| Rate for Payer: BCN Commercial |
$2.79
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$3.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.71
|
| Rate for Payer: Healthscope Commercial |
$3.29
|
| Rate for Payer: Healthscope Whirlpool |
$3.39
|
| Rate for Payer: Mclaren Commercial |
$3.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.88
|
| Rate for Payer: Nomi Health Commercial |
$2.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.98
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.39
|
|
|
Service Code
|
NDC 60687020611
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Aetna Commercial |
$3.05
|
| Rate for Payer: Aetna Medicare |
$1.26
|
| Rate for Payer: ASR ASR |
$3.29
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: BCBS Trust/PPO |
$2.80
|
| Rate for Payer: BCN Commercial |
$2.80
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$3.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.71
|
| Rate for Payer: Healthscope Commercial |
$3.29
|
| Rate for Payer: Healthscope Whirlpool |
$3.39
|
| Rate for Payer: Mclaren Commercial |
$3.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.88
|
| Rate for Payer: Nomi Health Commercial |
$2.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.97
|
| Rate for Payer: Priority Health Narrow Network |
$2.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.98
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$339.15
|
|
|
Service Code
|
NDC 60687020601
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.49 |
| Max. Negotiated Rate |
$339.15 |
| Rate for Payer: Aetna Commercial |
$305.24
|
| Rate for Payer: Aetna Medicare |
$125.49
|
| Rate for Payer: ASR ASR |
$328.98
|
| Rate for Payer: BCBS Complete |
$135.66
|
| Rate for Payer: BCBS Trust/PPO |
$279.63
|
| Rate for Payer: BCN Commercial |
$279.63
|
| Rate for Payer: Cash Price |
$271.32
|
| Rate for Payer: Cofinity Commercial |
$318.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.32
|
| Rate for Payer: Healthscope Commercial |
$328.98
|
| Rate for Payer: Healthscope Whirlpool |
$339.15
|
| Rate for Payer: Mclaren Commercial |
$305.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.28
|
| Rate for Payer: Nomi Health Commercial |
$278.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$297.16
|
| Rate for Payer: Priority Health Narrow Network |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.45
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$307.80
|
|
|
Service Code
|
NDC 904721861
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$230.85 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna Commercial |
$277.02
|
| Rate for Payer: ASR ASR |
$298.57
|
| Rate for Payer: BCBS Trust/PPO |
$252.77
|
| Rate for Payer: BCN Commercial |
$252.77
|
| Rate for Payer: Cash Price |
$246.24
|
| Rate for Payer: Cofinity Commercial |
$289.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.24
|
| Rate for Payer: Healthscope Commercial |
$298.57
|
| Rate for Payer: Healthscope Whirlpool |
$307.80
|
| Rate for Payer: Mclaren Commercial |
$277.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.63
|
| Rate for Payer: Nomi Health Commercial |
$252.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$270.86
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$307.80
|
|
|
Service Code
|
NDC 904721861
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.89 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna Commercial |
$277.02
|
| Rate for Payer: Aetna Medicare |
$113.89
|
| Rate for Payer: ASR ASR |
$298.57
|
| Rate for Payer: BCBS Complete |
$123.12
|
| Rate for Payer: BCBS Trust/PPO |
$253.78
|
| Rate for Payer: BCN Commercial |
$253.78
|
| Rate for Payer: Cash Price |
$246.24
|
| Rate for Payer: Cofinity Commercial |
$289.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.24
|
| Rate for Payer: Healthscope Commercial |
$298.57
|
| Rate for Payer: Healthscope Whirlpool |
$307.80
|
| Rate for Payer: Mclaren Commercial |
$277.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.63
|
| Rate for Payer: Nomi Health Commercial |
$252.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$269.69
|
| Rate for Payer: Priority Health Narrow Network |
$215.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$270.86
|
|
|
DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$339.15
|
|
|
Service Code
|
NDC 60687020601
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$254.36 |
| Max. Negotiated Rate |
$339.15 |
| Rate for Payer: Aetna Commercial |
$305.24
|
| Rate for Payer: ASR ASR |
$328.98
|
| Rate for Payer: BCBS Trust/PPO |
$278.51
|
| Rate for Payer: BCN Commercial |
$278.51
|
| Rate for Payer: Cash Price |
$271.32
|
| Rate for Payer: Cofinity Commercial |
$318.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.32
|
| Rate for Payer: Healthscope Commercial |
$328.98
|
| Rate for Payer: Healthscope Whirlpool |
$339.15
|
| Rate for Payer: Mclaren Commercial |
$305.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.28
|
| Rate for Payer: Nomi Health Commercial |
$278.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.45
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4.12
|
|
|
Service Code
|
NDC 60687021711
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Aetna Medicare |
$1.53
|
| Rate for Payer: ASR ASR |
$4.00
|
| Rate for Payer: BCBS Complete |
$1.65
|
| Rate for Payer: BCBS Trust/PPO |
$3.40
|
| Rate for Payer: BCN Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Commercial |
$3.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.30
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Healthscope Whirlpool |
$4.12
|
| Rate for Payer: Mclaren Commercial |
$3.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.50
|
| Rate for Payer: Nomi Health Commercial |
$3.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.61
|
| Rate for Payer: Priority Health Narrow Network |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.63
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$412.30
|
|
|
Service Code
|
NDC 60687021701
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$309.23 |
| Max. Negotiated Rate |
$412.30 |
| Rate for Payer: Aetna Commercial |
$371.07
|
| Rate for Payer: ASR ASR |
$399.93
|
| Rate for Payer: BCBS Trust/PPO |
$338.58
|
| Rate for Payer: BCN Commercial |
$338.58
|
| Rate for Payer: Cash Price |
$329.84
|
| Rate for Payer: Cofinity Commercial |
$387.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.84
|
| Rate for Payer: Healthscope Commercial |
$399.93
|
| Rate for Payer: Healthscope Whirlpool |
$412.30
|
| Rate for Payer: Mclaren Commercial |
$371.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.45
|
| Rate for Payer: Nomi Health Commercial |
$338.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$362.82
|
|
|
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 |
$318.49 |
| Max. Negotiated Rate |
$424.65 |
| Rate for Payer: Aetna Commercial |
$382.19
|
| Rate for Payer: ASR ASR |
$411.91
|
| Rate for Payer: BCBS Trust/PPO |
$348.72
|
| Rate for Payer: BCN Commercial |
$348.72
|
| 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 |
$411.91
|
| Rate for Payer: Healthscope Whirlpool |
$424.65
|
| 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: Opus (Opus Packaging Group) HMA |
$318.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.69
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$424.65
|
|
|
Service Code
|
NDC 63739001610
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.12 |
| Max. Negotiated Rate |
$424.65 |
| Rate for Payer: Aetna Commercial |
$382.19
|
| Rate for Payer: Aetna Medicare |
$157.12
|
| Rate for Payer: ASR ASR |
$411.91
|
| Rate for Payer: BCBS Complete |
$169.86
|
| Rate for Payer: BCBS Trust/PPO |
$350.12
|
| Rate for Payer: BCN Commercial |
$350.12
|
| 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 |
$411.91
|
| Rate for Payer: Healthscope Whirlpool |
$424.65
|
| Rate for Payer: Mclaren Commercial |
$382.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$339.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.95
|
| Rate for Payer: Nomi Health Commercial |
$348.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$372.08
|
| Rate for Payer: Priority Health Narrow Network |
$297.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.69
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$412.30
|
|
|
Service Code
|
NDC 60687021701
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.55 |
| Max. Negotiated Rate |
$412.30 |
| Rate for Payer: Aetna Commercial |
$371.07
|
| Rate for Payer: Aetna Medicare |
$152.55
|
| Rate for Payer: ASR ASR |
$399.93
|
| Rate for Payer: BCBS Complete |
$164.92
|
| Rate for Payer: BCBS Trust/PPO |
$339.94
|
| Rate for Payer: BCN Commercial |
$339.94
|
| Rate for Payer: Cash Price |
$329.84
|
| Rate for Payer: Cofinity Commercial |
$387.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.84
|
| Rate for Payer: Healthscope Commercial |
$399.93
|
| Rate for Payer: Healthscope Whirlpool |
$412.30
|
| Rate for Payer: Mclaren Commercial |
$371.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$329.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.45
|
| Rate for Payer: Nomi Health Commercial |
$338.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$361.26
|
| Rate for Payer: Priority Health Narrow Network |
$289.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$362.82
|
|
|
DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4.12
|
|
|
Service Code
|
NDC 60687021711
|
| Hospital Charge Code |
29274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: ASR ASR |
$4.00
|
| Rate for Payer: BCBS Trust/PPO |
$3.39
|
| Rate for Payer: BCN Commercial |
$3.39
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Commercial |
$3.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.30
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Healthscope Whirlpool |
$4.12
|
| Rate for Payer: Mclaren Commercial |
$3.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.50
|
| Rate for Payer: Nomi Health Commercial |
$3.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.63
|
|
