|
DIGOXIN 125 MCG (0.125 MG) ORAL TAB
|
Facility
|
IP
|
$5.22
|
|
|
Service Code
|
NDC 00904592161
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$4.86 |
| Rate for Payer: Aetna Commercial |
$4.51
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Cigna All Commercial |
$4.51
|
| Rate for Payer: CORVEL All Commercial |
$4.86
|
| Rate for Payer: Coventry All Commercial |
$4.60
|
| Rate for Payer: Encore All Commercial |
$4.81
|
| Rate for Payer: Frontpath All Commercial |
$4.80
|
| Rate for Payer: Humana ChoiceCare |
$4.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.70
|
| Rate for Payer: PHCS All Commercial |
$3.92
|
| Rate for Payer: PHP All Commercial |
$3.96
|
| Rate for Payer: Sagamore Health Network All Products |
$4.03
|
| Rate for Payer: Signature Care EPO |
$4.33
|
| Rate for Payer: Signature Care PPO |
$4.60
|
| Rate for Payer: United Healthcare Commercial |
$4.11
|
|
|
DIGOXIN 250 MCG (0.25 MG) ORAL TAB
|
Facility
|
OP
|
$6.57
|
|
|
Service Code
|
NDC 00904592261
|
| Hospital Charge Code |
2445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$6.11 |
| Rate for Payer: Aetna Commercial |
$5.55
|
| Rate for Payer: Aetna Medicare |
$2.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.31
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Centivo All Commercial |
$3.58
|
| Rate for Payer: Cigna All Commercial |
$5.67
|
| Rate for Payer: CORVEL All Commercial |
$6.11
|
| Rate for Payer: Coventry All Commercial |
$5.78
|
| Rate for Payer: Encore All Commercial |
$6.05
|
| Rate for Payer: Frontpath All Commercial |
$6.05
|
| Rate for Payer: Humana ChoiceCare |
$5.68
|
| Rate for Payer: Humana Medicare |
$2.10
|
| Rate for Payer: Lucent All Commercial |
$3.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.92
|
| Rate for Payer: PHCS All Commercial |
$4.93
|
| Rate for Payer: PHP All Commercial |
$4.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.56
|
| Rate for Payer: Sagamore Health Network All Products |
$5.07
|
| Rate for Payer: Signature Care EPO |
$5.46
|
| Rate for Payer: Signature Care PPO |
$5.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.59
|
| Rate for Payer: United Healthcare Commercial |
$5.18
|
| Rate for Payer: United Healthcare Medicare |
$2.10
|
|
|
DIGOXIN 250 MCG (0.25 MG) ORAL TAB
|
Facility
|
IP
|
$6.57
|
|
|
Service Code
|
NDC 00904592261
|
| Hospital Charge Code |
2445
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$6.11 |
| Rate for Payer: Aetna Commercial |
$5.68
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cigna All Commercial |
$5.67
|
| Rate for Payer: CORVEL All Commercial |
$6.11
|
| Rate for Payer: Coventry All Commercial |
$5.78
|
| Rate for Payer: Encore All Commercial |
$6.05
|
| Rate for Payer: Frontpath All Commercial |
$6.05
|
| Rate for Payer: Humana ChoiceCare |
$5.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.92
|
| Rate for Payer: PHCS All Commercial |
$4.93
|
| Rate for Payer: PHP All Commercial |
$4.98
|
| Rate for Payer: Sagamore Health Network All Products |
$5.07
|
| Rate for Payer: Signature Care EPO |
$5.46
|
| Rate for Payer: Signature Care PPO |
$5.78
|
| Rate for Payer: United Healthcare Commercial |
$5.18
|
|
|
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN
|
Facility
|
OP
|
$36.02
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
110919
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$33.50 |
| Rate for Payer: Aetna Commercial |
$30.40
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$20.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.68
|
| Rate for Payer: Cash Price |
$21.61
|
| Rate for Payer: Centivo All Commercial |
$19.60
|
| Rate for Payer: Cigna All Commercial |
$31.09
|
| Rate for Payer: CORVEL All Commercial |
$33.50
|
| Rate for Payer: Coventry All Commercial |
$31.70
|
| Rate for Payer: Encore All Commercial |
$33.16
|
| Rate for Payer: Frontpath All Commercial |
$33.14
|
| Rate for Payer: Humana ChoiceCare |
$31.11
|
| Rate for Payer: Humana Medicare |
$11.53
|
| Rate for Payer: Lucent All Commercial |
$19.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.42
|
| Rate for Payer: PHCS All Commercial |
$27.02
|
| Rate for Payer: PHP All Commercial |
$27.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.05
|
| Rate for Payer: Sagamore Health Network All Products |
$27.81
|
| Rate for Payer: Signature Care EPO |
$29.90
|
| Rate for Payer: Signature Care PPO |
$31.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30.62
|
| Rate for Payer: United Healthcare Commercial |
$28.39
|
| Rate for Payer: United Healthcare Medicare |
$11.53
|
|
|
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN
|
Facility
|
IP
|
$36.02
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
110919
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.02 |
| Max. Negotiated Rate |
$33.50 |
| Rate for Payer: Aetna Commercial |
$31.12
|
| Rate for Payer: Cash Price |
$21.61
|
| Rate for Payer: Cigna All Commercial |
$31.09
|
| Rate for Payer: CORVEL All Commercial |
$33.50
|
| Rate for Payer: Coventry All Commercial |
$31.70
|
| Rate for Payer: Encore All Commercial |
$33.16
|
| Rate for Payer: Frontpath All Commercial |
$33.14
|
| Rate for Payer: Humana ChoiceCare |
$31.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.42
|
| Rate for Payer: PHCS All Commercial |
$27.02
|
| Rate for Payer: PHP All Commercial |
$27.32
|
| Rate for Payer: Sagamore Health Network All Products |
$27.81
|
| Rate for Payer: Signature Care EPO |
$29.90
|
| Rate for Payer: Signature Care PPO |
$31.70
|
| Rate for Payer: United Healthcare Commercial |
$28.39
|
|
|
DIGOXIN IMMUNE FAB 40 MG IV SOLR
|
Facility
|
OP
|
$16,320.96
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
31432
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,059.50 |
| Max. Negotiated Rate |
$15,178.49 |
| Rate for Payer: Aetna Commercial |
$13,774.89
|
| Rate for Payer: Aetna Medicare |
$5,222.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,059.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,373.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,202.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,006.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,744.98
|
| Rate for Payer: Cash Price |
$9,792.57
|
| Rate for Payer: Centivo All Commercial |
$8,878.60
|
| Rate for Payer: Cigna All Commercial |
$14,084.98
|
| Rate for Payer: CORVEL All Commercial |
$15,178.49
|
| Rate for Payer: Coventry All Commercial |
$14,362.44
|
| Rate for Payer: Encore All Commercial |
$15,023.44
|
| Rate for Payer: Frontpath All Commercial |
$15,015.28
|
| Rate for Payer: Humana ChoiceCare |
$14,096.41
|
| Rate for Payer: Humana Medicare |
$5,222.71
|
| Rate for Payer: Lucent All Commercial |
$8,878.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,688.86
|
| Rate for Payer: PHCS All Commercial |
$12,240.72
|
| Rate for Payer: PHP All Commercial |
$12,377.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,365.17
|
| Rate for Payer: Sagamore Health Network All Products |
$12,599.78
|
| Rate for Payer: Signature Care EPO |
$13,546.39
|
| Rate for Payer: Signature Care PPO |
$14,362.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,872.81
|
| Rate for Payer: United Healthcare Commercial |
$12,860.91
|
| Rate for Payer: United Healthcare Medicare |
$5,222.71
|
|
|
DIGOXIN IMMUNE FAB 40 MG IV SOLR
|
Facility
|
IP
|
$16,320.96
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
31432
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12,240.72 |
| Max. Negotiated Rate |
$15,178.49 |
| Rate for Payer: Aetna Commercial |
$14,101.31
|
| Rate for Payer: Cash Price |
$9,792.57
|
| Rate for Payer: Cigna All Commercial |
$14,084.98
|
| Rate for Payer: CORVEL All Commercial |
$15,178.49
|
| Rate for Payer: Coventry All Commercial |
$14,362.44
|
| Rate for Payer: Encore All Commercial |
$15,023.44
|
| Rate for Payer: Frontpath All Commercial |
$15,015.28
|
| Rate for Payer: Humana ChoiceCare |
$14,096.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,688.86
|
| Rate for Payer: PHCS All Commercial |
$12,240.72
|
| Rate for Payer: PHP All Commercial |
$12,377.81
|
| Rate for Payer: Sagamore Health Network All Products |
$12,599.78
|
| Rate for Payer: Signature Care EPO |
$13,546.39
|
| Rate for Payer: Signature Care PPO |
$14,362.44
|
| Rate for Payer: United Healthcare Commercial |
$12,860.91
|
|
|
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN
|
Facility
|
IP
|
$370.13
|
|
|
Service Code
|
HCPCS J1110
|
| Hospital Charge Code |
9859
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$277.60 |
| Max. Negotiated Rate |
$344.22 |
| Rate for Payer: Aetna Commercial |
$319.79
|
| Rate for Payer: Aetna Commercial |
$311.04
|
| Rate for Payer: Cash Price |
$222.08
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna All Commercial |
$319.42
|
| Rate for Payer: Cigna All Commercial |
$310.68
|
| Rate for Payer: CORVEL All Commercial |
$334.80
|
| Rate for Payer: CORVEL All Commercial |
$344.22
|
| Rate for Payer: Coventry All Commercial |
$316.80
|
| Rate for Payer: Coventry All Commercial |
$325.71
|
| Rate for Payer: Encore All Commercial |
$340.70
|
| Rate for Payer: Encore All Commercial |
$331.38
|
| Rate for Payer: Frontpath All Commercial |
$331.20
|
| Rate for Payer: Frontpath All Commercial |
$340.52
|
| Rate for Payer: Humana ChoiceCare |
$319.68
|
| Rate for Payer: Humana ChoiceCare |
$310.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$333.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$324.00
|
| Rate for Payer: PHCS All Commercial |
$270.00
|
| Rate for Payer: PHCS All Commercial |
$277.60
|
| Rate for Payer: PHP All Commercial |
$273.02
|
| Rate for Payer: PHP All Commercial |
$280.71
|
| Rate for Payer: Sagamore Health Network All Products |
$277.92
|
| Rate for Payer: Sagamore Health Network All Products |
$285.74
|
| Rate for Payer: Signature Care EPO |
$298.80
|
| Rate for Payer: Signature Care EPO |
$307.21
|
| Rate for Payer: Signature Care PPO |
$325.71
|
| Rate for Payer: Signature Care PPO |
$316.80
|
| Rate for Payer: United Healthcare Commercial |
$283.68
|
| Rate for Payer: United Healthcare Commercial |
$291.66
|
|
|
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN
|
Facility
|
OP
|
$370.13
|
|
|
Service Code
|
HCPCS J1110
|
| Hospital Charge Code |
9859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.62 |
| Max. Negotiated Rate |
$344.22 |
| Rate for Payer: Aetna Commercial |
$312.39
|
| Rate for Payer: Aetna Commercial |
$303.84
|
| Rate for Payer: Aetna Medicare |
$118.44
|
| Rate for Payer: Aetna Medicare |
$115.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$69.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$69.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$114.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$111.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$206.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$212.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$231.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$225.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$69.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$69.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$136.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$132.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$130.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$126.72
|
| Rate for Payer: Cash Price |
$222.08
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$222.08
|
| Rate for Payer: Centivo All Commercial |
$195.84
|
| Rate for Payer: Centivo All Commercial |
$201.35
|
| Rate for Payer: Cigna All Commercial |
$319.42
|
| Rate for Payer: Cigna All Commercial |
$310.68
|
| Rate for Payer: CORVEL All Commercial |
$344.22
|
| Rate for Payer: CORVEL All Commercial |
$334.80
|
| Rate for Payer: Coventry All Commercial |
$325.71
|
| Rate for Payer: Coventry All Commercial |
$316.80
|
| Rate for Payer: Encore All Commercial |
$340.70
|
| Rate for Payer: Encore All Commercial |
$331.38
|
| Rate for Payer: Frontpath All Commercial |
$331.20
|
| Rate for Payer: Frontpath All Commercial |
$340.52
|
| Rate for Payer: Humana ChoiceCare |
$319.68
|
| Rate for Payer: Humana ChoiceCare |
$310.93
|
| Rate for Payer: Humana Medicare |
$115.20
|
| Rate for Payer: Humana Medicare |
$118.44
|
| Rate for Payer: Lucent All Commercial |
$201.35
|
| Rate for Payer: Lucent All Commercial |
$195.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$333.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$324.00
|
| Rate for Payer: Managed Health Services Medicaid |
$69.62
|
| Rate for Payer: Managed Health Services Medicaid |
$69.62
|
| Rate for Payer: MDWise Medicaid |
$69.62
|
| Rate for Payer: MDWise Medicaid |
$69.62
|
| Rate for Payer: PHCS All Commercial |
$270.00
|
| Rate for Payer: PHCS All Commercial |
$277.60
|
| Rate for Payer: PHP All Commercial |
$280.71
|
| Rate for Payer: PHP All Commercial |
$273.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$140.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.35
|
| Rate for Payer: Sagamore Health Network All Products |
$277.92
|
| Rate for Payer: Sagamore Health Network All Products |
$285.74
|
| Rate for Payer: Signature Care EPO |
$307.21
|
| Rate for Payer: Signature Care EPO |
$298.80
|
| Rate for Payer: Signature Care PPO |
$316.80
|
| Rate for Payer: Signature Care PPO |
$325.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$314.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$306.00
|
| Rate for Payer: United Healthcare Commercial |
$283.68
|
| Rate for Payer: United Healthcare Commercial |
$291.66
|
| Rate for Payer: United Healthcare Medicare |
$115.20
|
| Rate for Payer: United Healthcare Medicare |
$118.44
|
|
|
DILTIAZEM HCL 120 MG ORAL CP24
|
Facility
|
IP
|
$2.84
|
|
|
Service Code
|
NDC 60687019511
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$2.64 |
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cigna All Commercial |
$2.45
|
| Rate for Payer: CORVEL All Commercial |
$2.64
|
| Rate for Payer: Coventry All Commercial |
$2.50
|
| Rate for Payer: Encore All Commercial |
$2.62
|
| Rate for Payer: Frontpath All Commercial |
$2.61
|
| Rate for Payer: Humana ChoiceCare |
$2.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.56
|
| Rate for Payer: PHCS All Commercial |
$2.13
|
| Rate for Payer: PHP All Commercial |
$2.16
|
| Rate for Payer: Sagamore Health Network All Products |
$2.19
|
| Rate for Payer: Signature Care EPO |
$2.36
|
| Rate for Payer: Signature Care PPO |
$2.50
|
| Rate for Payer: United Healthcare Commercial |
$2.24
|
|
|
DILTIAZEM HCL 120 MG ORAL CP24
|
Facility
|
OP
|
$2.84
|
|
|
Service Code
|
NDC 60687019511
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$2.64 |
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Aetna Medicare |
$0.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.00
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Centivo All Commercial |
$1.55
|
| Rate for Payer: Cigna All Commercial |
$2.45
|
| Rate for Payer: CORVEL All Commercial |
$2.64
|
| Rate for Payer: Coventry All Commercial |
$2.50
|
| Rate for Payer: Encore All Commercial |
$2.62
|
| Rate for Payer: Frontpath All Commercial |
$2.61
|
| Rate for Payer: Humana ChoiceCare |
$2.45
|
| Rate for Payer: Humana Medicare |
$0.91
|
| Rate for Payer: Lucent All Commercial |
$1.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.56
|
| Rate for Payer: PHCS All Commercial |
$2.13
|
| Rate for Payer: PHP All Commercial |
$2.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.11
|
| Rate for Payer: Sagamore Health Network All Products |
$2.19
|
| Rate for Payer: Signature Care EPO |
$2.36
|
| Rate for Payer: Signature Care PPO |
$2.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.42
|
| Rate for Payer: United Healthcare Commercial |
$2.24
|
| Rate for Payer: United Healthcare Medicare |
$0.91
|
|
|
DILTIAZEM HCL 120 MG ORAL CP24
|
Facility
|
OP
|
$2.84
|
|
|
Service Code
|
NDC 60687019501
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$2.64 |
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Aetna Medicare |
$0.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.00
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Centivo All Commercial |
$1.55
|
| Rate for Payer: Cigna All Commercial |
$2.45
|
| Rate for Payer: CORVEL All Commercial |
$2.64
|
| Rate for Payer: Coventry All Commercial |
$2.50
|
| Rate for Payer: Encore All Commercial |
$2.62
|
| Rate for Payer: Frontpath All Commercial |
$2.61
|
| Rate for Payer: Humana ChoiceCare |
$2.45
|
| Rate for Payer: Humana Medicare |
$0.91
|
| Rate for Payer: Lucent All Commercial |
$1.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.56
|
| Rate for Payer: PHCS All Commercial |
$2.13
|
| Rate for Payer: PHP All Commercial |
$2.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.11
|
| Rate for Payer: Sagamore Health Network All Products |
$2.19
|
| Rate for Payer: Signature Care EPO |
$2.36
|
| Rate for Payer: Signature Care PPO |
$2.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.42
|
| Rate for Payer: United Healthcare Commercial |
$2.24
|
| Rate for Payer: United Healthcare Medicare |
$0.91
|
|
|
DILTIAZEM HCL 120 MG ORAL CP24
|
Facility
|
IP
|
$2.84
|
|
|
Service Code
|
NDC 60687019501
|
| Hospital Charge Code |
27480
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$2.64 |
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cigna All Commercial |
$2.45
|
| Rate for Payer: CORVEL All Commercial |
$2.64
|
| Rate for Payer: Coventry All Commercial |
$2.50
|
| Rate for Payer: Encore All Commercial |
$2.62
|
| Rate for Payer: Frontpath All Commercial |
$2.61
|
| Rate for Payer: Humana ChoiceCare |
$2.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.56
|
| Rate for Payer: PHCS All Commercial |
$2.13
|
| Rate for Payer: PHP All Commercial |
$2.16
|
| Rate for Payer: Sagamore Health Network All Products |
$2.19
|
| Rate for Payer: Signature Care EPO |
$2.36
|
| Rate for Payer: Signature Care PPO |
$2.50
|
| Rate for Payer: United Healthcare Commercial |
$2.24
|
|
|
DILTIAZEM HCL 180 MG ORAL CP24
|
Facility
|
OP
|
$2.42
|
|
|
Service Code
|
NDC 60687020601
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna Commercial |
$2.04
|
| Rate for Payer: Aetna Medicare |
$0.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.85
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Centivo All Commercial |
$1.32
|
| Rate for Payer: Cigna All Commercial |
$2.09
|
| Rate for Payer: CORVEL All Commercial |
$2.25
|
| Rate for Payer: Coventry All Commercial |
$2.13
|
| Rate for Payer: Encore All Commercial |
$2.23
|
| Rate for Payer: Frontpath All Commercial |
$2.23
|
| Rate for Payer: Humana ChoiceCare |
$2.09
|
| Rate for Payer: Humana Medicare |
$0.78
|
| Rate for Payer: Lucent All Commercial |
$1.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.18
|
| Rate for Payer: PHCS All Commercial |
$1.82
|
| Rate for Payer: PHP All Commercial |
$1.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.94
|
| Rate for Payer: Sagamore Health Network All Products |
$1.87
|
| Rate for Payer: Signature Care EPO |
$2.01
|
| Rate for Payer: Signature Care PPO |
$2.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.06
|
| Rate for Payer: United Healthcare Commercial |
$1.91
|
| Rate for Payer: United Healthcare Medicare |
$0.78
|
|
|
DILTIAZEM HCL 180 MG ORAL CP24
|
Facility
|
IP
|
$2.42
|
|
|
Service Code
|
NDC 60687020601
|
| Hospital Charge Code |
29272
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cigna All Commercial |
$2.09
|
| Rate for Payer: CORVEL All Commercial |
$2.25
|
| Rate for Payer: Coventry All Commercial |
$2.13
|
| Rate for Payer: Encore All Commercial |
$2.23
|
| Rate for Payer: Frontpath All Commercial |
$2.23
|
| Rate for Payer: Humana ChoiceCare |
$2.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.18
|
| Rate for Payer: PHCS All Commercial |
$1.82
|
| Rate for Payer: PHP All Commercial |
$1.84
|
| Rate for Payer: Sagamore Health Network All Products |
$1.87
|
| Rate for Payer: Signature Care EPO |
$2.01
|
| Rate for Payer: Signature Care PPO |
$2.13
|
| Rate for Payer: United Healthcare Commercial |
$1.91
|
|
|
DILTIAZEM HCL 30 MG ORAL TAB
|
Facility
|
IP
|
$2.91
|
|
|
Service Code
|
NDC 60687071711
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$2.71 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna All Commercial |
$2.51
|
| Rate for Payer: CORVEL All Commercial |
$2.71
|
| Rate for Payer: Coventry All Commercial |
$2.56
|
| Rate for Payer: Encore All Commercial |
$2.68
|
| Rate for Payer: Frontpath All Commercial |
$2.68
|
| Rate for Payer: Humana ChoiceCare |
$2.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.62
|
| Rate for Payer: PHCS All Commercial |
$2.18
|
| Rate for Payer: PHP All Commercial |
$2.21
|
| Rate for Payer: Sagamore Health Network All Products |
$2.25
|
| Rate for Payer: Signature Care EPO |
$2.42
|
| Rate for Payer: Signature Care PPO |
$2.56
|
| Rate for Payer: United Healthcare Commercial |
$2.29
|
|
|
DILTIAZEM HCL 30 MG ORAL TAB
|
Facility
|
OP
|
$2.91
|
|
|
Service Code
|
NDC 60687071701
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$2.71 |
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna Medicare |
$0.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.03
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Centivo All Commercial |
$1.58
|
| Rate for Payer: Cigna All Commercial |
$2.51
|
| Rate for Payer: CORVEL All Commercial |
$2.71
|
| Rate for Payer: Coventry All Commercial |
$2.56
|
| Rate for Payer: Encore All Commercial |
$2.68
|
| Rate for Payer: Frontpath All Commercial |
$2.68
|
| Rate for Payer: Humana ChoiceCare |
$2.52
|
| Rate for Payer: Humana Medicare |
$0.93
|
| Rate for Payer: Lucent All Commercial |
$1.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.62
|
| Rate for Payer: PHCS All Commercial |
$2.18
|
| Rate for Payer: PHP All Commercial |
$2.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.14
|
| Rate for Payer: Sagamore Health Network All Products |
$2.25
|
| Rate for Payer: Signature Care EPO |
$2.42
|
| Rate for Payer: Signature Care PPO |
$2.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.48
|
| Rate for Payer: United Healthcare Commercial |
$2.29
|
| Rate for Payer: United Healthcare Medicare |
$0.93
|
|
|
DILTIAZEM HCL 30 MG ORAL TAB
|
Facility
|
IP
|
$2.91
|
|
|
Service Code
|
NDC 60687071701
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$2.71 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna All Commercial |
$2.51
|
| Rate for Payer: CORVEL All Commercial |
$2.71
|
| Rate for Payer: Coventry All Commercial |
$2.56
|
| Rate for Payer: Encore All Commercial |
$2.68
|
| Rate for Payer: Frontpath All Commercial |
$2.68
|
| Rate for Payer: Humana ChoiceCare |
$2.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.62
|
| Rate for Payer: PHCS All Commercial |
$2.18
|
| Rate for Payer: PHP All Commercial |
$2.21
|
| Rate for Payer: Sagamore Health Network All Products |
$2.25
|
| Rate for Payer: Signature Care EPO |
$2.42
|
| Rate for Payer: Signature Care PPO |
$2.56
|
| Rate for Payer: United Healthcare Commercial |
$2.29
|
|
|
DILTIAZEM HCL 30 MG ORAL TAB
|
Facility
|
OP
|
$2.91
|
|
|
Service Code
|
NDC 60687071711
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$2.71 |
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna Medicare |
$0.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.03
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Centivo All Commercial |
$1.58
|
| Rate for Payer: Cigna All Commercial |
$2.51
|
| Rate for Payer: CORVEL All Commercial |
$2.71
|
| Rate for Payer: Coventry All Commercial |
$2.56
|
| Rate for Payer: Encore All Commercial |
$2.68
|
| Rate for Payer: Frontpath All Commercial |
$2.68
|
| Rate for Payer: Humana ChoiceCare |
$2.52
|
| Rate for Payer: Humana Medicare |
$0.93
|
| Rate for Payer: Lucent All Commercial |
$1.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.62
|
| Rate for Payer: PHCS All Commercial |
$2.18
|
| Rate for Payer: PHP All Commercial |
$2.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.14
|
| Rate for Payer: Sagamore Health Network All Products |
$2.25
|
| Rate for Payer: Signature Care EPO |
$2.42
|
| Rate for Payer: Signature Care PPO |
$2.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.48
|
| Rate for Payer: United Healthcare Commercial |
$2.29
|
| Rate for Payer: United Healthcare Medicare |
$0.93
|
|
|
DILTIAZEM HCL 5 MG/ML IV SOLN
|
Facility
|
IP
|
$56.70
|
|
|
Service Code
|
HCPCS J1163
|
| Hospital Charge Code |
97253
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.52 |
| Max. Negotiated Rate |
$52.73 |
| Rate for Payer: Aetna Commercial |
$48.99
|
| Rate for Payer: Aetna Commercial |
$18.42
|
| Rate for Payer: Cash Price |
$12.79
|
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: Cigna All Commercial |
$18.39
|
| Rate for Payer: Cigna All Commercial |
$48.93
|
| Rate for Payer: CORVEL All Commercial |
$19.82
|
| Rate for Payer: CORVEL All Commercial |
$52.73
|
| Rate for Payer: Coventry All Commercial |
$49.90
|
| Rate for Payer: Coventry All Commercial |
$18.76
|
| Rate for Payer: Encore All Commercial |
$52.19
|
| Rate for Payer: Encore All Commercial |
$19.62
|
| Rate for Payer: Frontpath All Commercial |
$19.61
|
| Rate for Payer: Frontpath All Commercial |
$52.16
|
| Rate for Payer: Humana ChoiceCare |
$18.41
|
| Rate for Payer: Humana ChoiceCare |
$48.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.03
|
| Rate for Payer: PHCS All Commercial |
$42.52
|
| Rate for Payer: PHCS All Commercial |
$15.99
|
| Rate for Payer: PHP All Commercial |
$16.17
|
| Rate for Payer: PHP All Commercial |
$43.00
|
| Rate for Payer: Sagamore Health Network All Products |
$43.77
|
| Rate for Payer: Sagamore Health Network All Products |
$16.46
|
| Rate for Payer: Signature Care EPO |
$47.06
|
| Rate for Payer: Signature Care EPO |
$17.69
|
| Rate for Payer: Signature Care PPO |
$18.76
|
| Rate for Payer: Signature Care PPO |
$49.90
|
| Rate for Payer: United Healthcare Commercial |
$16.80
|
| Rate for Payer: United Healthcare Commercial |
$44.68
|
|
|
DILTIAZEM HCL 5 MG/ML IV SOLN
|
Facility
|
OP
|
$56.70
|
|
|
Service Code
|
HCPCS J1163
|
| Hospital Charge Code |
97253
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.58 |
| Max. Negotiated Rate |
$52.73 |
| Rate for Payer: Aetna Commercial |
$47.85
|
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: Aetna Medicare |
$6.82
|
| Rate for Payer: Aetna Medicare |
$18.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$32.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$12.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.96
|
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: Cash Price |
$12.79
|
| Rate for Payer: Centivo All Commercial |
$30.84
|
| Rate for Payer: Centivo All Commercial |
$11.60
|
| Rate for Payer: Cigna All Commercial |
$18.39
|
| Rate for Payer: Cigna All Commercial |
$48.93
|
| Rate for Payer: CORVEL All Commercial |
$19.82
|
| Rate for Payer: CORVEL All Commercial |
$52.73
|
| Rate for Payer: Coventry All Commercial |
$18.76
|
| Rate for Payer: Coventry All Commercial |
$49.90
|
| Rate for Payer: Encore All Commercial |
$19.62
|
| Rate for Payer: Encore All Commercial |
$52.19
|
| Rate for Payer: Frontpath All Commercial |
$52.16
|
| Rate for Payer: Frontpath All Commercial |
$19.61
|
| Rate for Payer: Humana ChoiceCare |
$48.97
|
| Rate for Payer: Humana ChoiceCare |
$18.41
|
| Rate for Payer: Humana Medicare |
$18.14
|
| Rate for Payer: Humana Medicare |
$6.82
|
| Rate for Payer: Lucent All Commercial |
$11.60
|
| Rate for Payer: Lucent All Commercial |
$30.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.18
|
| Rate for Payer: PHCS All Commercial |
$42.52
|
| Rate for Payer: PHCS All Commercial |
$15.99
|
| Rate for Payer: PHP All Commercial |
$16.17
|
| Rate for Payer: PHP All Commercial |
$43.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.11
|
| Rate for Payer: Sagamore Health Network All Products |
$16.46
|
| Rate for Payer: Sagamore Health Network All Products |
$43.77
|
| Rate for Payer: Signature Care EPO |
$47.06
|
| Rate for Payer: Signature Care EPO |
$17.69
|
| Rate for Payer: Signature Care PPO |
$18.76
|
| Rate for Payer: Signature Care PPO |
$49.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.12
|
| Rate for Payer: United Healthcare Commercial |
$16.80
|
| Rate for Payer: United Healthcare Commercial |
$44.68
|
| Rate for Payer: United Healthcare Medicare |
$6.82
|
| Rate for Payer: United Healthcare Medicare |
$18.14
|
|
|
DILTIAZEM HCL 60 MG ORAL TAB
|
Facility
|
OP
|
$1.53
|
|
|
Service Code
|
NDC 00093031901
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Aetna Commercial |
$1.29
|
| Rate for Payer: Aetna Medicare |
$0.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.54
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Centivo All Commercial |
$0.83
|
| Rate for Payer: Cigna All Commercial |
$1.32
|
| Rate for Payer: CORVEL All Commercial |
$1.43
|
| Rate for Payer: Coventry All Commercial |
$1.35
|
| Rate for Payer: Encore All Commercial |
$1.41
|
| Rate for Payer: Frontpath All Commercial |
$1.41
|
| Rate for Payer: Humana ChoiceCare |
$1.32
|
| Rate for Payer: Humana Medicare |
$0.49
|
| Rate for Payer: Lucent All Commercial |
$0.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.38
|
| Rate for Payer: PHCS All Commercial |
$1.15
|
| Rate for Payer: PHP All Commercial |
$1.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1.18
|
| Rate for Payer: Signature Care EPO |
$1.27
|
| Rate for Payer: Signature Care PPO |
$1.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.30
|
| Rate for Payer: United Healthcare Commercial |
$1.21
|
| Rate for Payer: United Healthcare Medicare |
$0.49
|
|
|
DILTIAZEM HCL 60 MG ORAL TAB
|
Facility
|
IP
|
$1.53
|
|
|
Service Code
|
NDC 00093031901
|
| Hospital Charge Code |
2476
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Aetna Commercial |
$1.32
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna All Commercial |
$1.32
|
| Rate for Payer: CORVEL All Commercial |
$1.43
|
| Rate for Payer: Coventry All Commercial |
$1.35
|
| Rate for Payer: Encore All Commercial |
$1.41
|
| Rate for Payer: Frontpath All Commercial |
$1.41
|
| Rate for Payer: Humana ChoiceCare |
$1.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.38
|
| Rate for Payer: PHCS All Commercial |
$1.15
|
| Rate for Payer: PHP All Commercial |
$1.16
|
| Rate for Payer: Sagamore Health Network All Products |
$1.18
|
| Rate for Payer: Signature Care EPO |
$1.27
|
| Rate for Payer: Signature Care PPO |
$1.35
|
| Rate for Payer: United Healthcare Commercial |
$1.21
|
|
|
DILTIAZEM HCL IN 0.9% NACL 125 MG/125 ML (1 MG/ML) IV SOLN
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
121619
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna Commercial |
$88.62
|
| Rate for Payer: Aetna Medicare |
$33.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$60.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.96
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Centivo All Commercial |
$57.12
|
| Rate for Payer: Cigna All Commercial |
$90.61
|
| Rate for Payer: CORVEL All Commercial |
$97.65
|
| Rate for Payer: Coventry All Commercial |
$92.40
|
| Rate for Payer: Encore All Commercial |
$96.65
|
| Rate for Payer: Frontpath All Commercial |
$96.60
|
| Rate for Payer: Humana ChoiceCare |
$90.69
|
| Rate for Payer: Humana Medicare |
$33.60
|
| Rate for Payer: Lucent All Commercial |
$57.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.50
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$78.75
|
| Rate for Payer: PHP All Commercial |
$79.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.95
|
| Rate for Payer: Sagamore Health Network All Products |
$81.06
|
| Rate for Payer: Signature Care EPO |
$87.15
|
| Rate for Payer: Signature Care PPO |
$92.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$82.74
|
| Rate for Payer: United Healthcare Medicare |
$33.60
|
|
|
DILTIAZEM HCL IN 0.9% NACL 125 MG/125 ML (1 MG/ML) IV SOLN
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
121619
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna Commercial |
$90.72
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna All Commercial |
$90.61
|
| Rate for Payer: CORVEL All Commercial |
$97.65
|
| Rate for Payer: Coventry All Commercial |
$92.40
|
| Rate for Payer: Encore All Commercial |
$96.65
|
| Rate for Payer: Frontpath All Commercial |
$96.60
|
| Rate for Payer: Humana ChoiceCare |
$90.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.50
|
| Rate for Payer: PHCS All Commercial |
$78.75
|
| Rate for Payer: PHP All Commercial |
$79.63
|
| Rate for Payer: Sagamore Health Network All Products |
$81.06
|
| Rate for Payer: Signature Care EPO |
$87.15
|
| Rate for Payer: Signature Care PPO |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$82.74
|
|
