|
DILATOR WIRE BALLOON CRE 18-20MM
|
Facility
OP
|
$406.00
|
|
| Hospital Charge Code |
40209793
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$142.10 |
| Max. Negotiated Rate |
$324.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$223.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$203.00
|
| Rate for Payer: Aetna Government |
$203.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$324.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$276.08
|
| Rate for Payer: Group Health Inc Commercial |
$203.00
|
| Rate for Payer: Group Health Inc Medicare |
$142.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.00
|
|
|
DILATOR WIRE BALLOON CRE 2
|
Facility
OP
|
$540.00
|
|
| Hospital Charge Code |
40200267
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$297.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$270.00
|
| Rate for Payer: Aetna Government |
$270.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$432.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$367.20
|
| Rate for Payer: Group Health Inc Commercial |
$270.00
|
| Rate for Payer: Group Health Inc Medicare |
$189.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$270.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$270.00
|
|
|
DILATOR WIRE BALLOON CRE 8-10MM
|
Facility
OP
|
$460.00
|
|
| Hospital Charge Code |
40209794
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$253.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$230.00
|
| Rate for Payer: Aetna Government |
$230.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$368.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$312.80
|
| Rate for Payer: Group Health Inc Commercial |
$230.00
|
| Rate for Payer: Group Health Inc Medicare |
$161.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$230.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$230.00
|
|
|
DILATOR WIRE BALLOON CRE -8-9-10
|
Facility
OP
|
$747.50
|
|
| Hospital Charge Code |
64904221
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$261.62 |
| Max. Negotiated Rate |
$598.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$411.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$373.75
|
| Rate for Payer: Aetna Government |
$373.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$598.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$508.30
|
| Rate for Payer: Group Health Inc Commercial |
$373.75
|
| Rate for Payer: Group Health Inc Medicare |
$261.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$373.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$373.75
|
|
|
DILATOR WIRE BLLN CRE 10-11-12MM
|
Facility
OP
|
$460.00
|
|
| Hospital Charge Code |
40209792
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$253.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$230.00
|
| Rate for Payer: Aetna Government |
$230.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$368.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$312.80
|
| Rate for Payer: Group Health Inc Commercial |
$230.00
|
| Rate for Payer: Group Health Inc Medicare |
$161.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$230.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$230.00
|
|
|
DILATR WIRE BALLN CRE 10-12M 240C
|
Facility
OP
|
$747.50
|
|
| Hospital Charge Code |
64903944
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$261.62 |
| Max. Negotiated Rate |
$598.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$411.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$373.75
|
| Rate for Payer: Aetna Government |
$373.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$598.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$508.30
|
| Rate for Payer: Group Health Inc Commercial |
$373.75
|
| Rate for Payer: Group Health Inc Medicare |
$261.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$373.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$373.75
|
|
|
DILATR WIRE BALLN CRE 12-15M 240C
|
Facility
OP
|
$747.50
|
|
| Hospital Charge Code |
64903942
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$261.62 |
| Max. Negotiated Rate |
$598.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$411.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$373.75
|
| Rate for Payer: Aetna Government |
$373.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$598.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$508.30
|
| Rate for Payer: Group Health Inc Commercial |
$373.75
|
| Rate for Payer: Group Health Inc Medicare |
$261.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$373.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$373.75
|
|
|
DIL RETINA EXAM INTERP REV
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 2022F
|
| Hospital Charge Code |
30305435
|
|
Hospital Revenue Code
|
969
|
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
DILTIAZEM 120 MG ERC
|
Facility
OP
|
$0.46
|
|
| Hospital Charge Code |
41643947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.31
|
| Rate for Payer: Group Health Inc Commercial |
$0.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.30
|
|
|
DILTIAZEM 120 MG ERC
|
Facility
OP
|
$0.46
|
|
| Hospital Charge Code |
41653947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.31
|
| Rate for Payer: Group Health Inc Commercial |
$0.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.30
|
|
|
DILTIAZEM 125 MG/25 ML INJ
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
41642473
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
DILTIAZEM 125 MG/25 ML INJ
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
41652473
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
DILTIAZEM 180 MG ERC
|
Facility
OP
|
$0.52
|
|
| Hospital Charge Code |
41644125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.34
|
|
|
DILTIAZEM 180 MG ERC
|
Facility
OP
|
$0.52
|
|
| Hospital Charge Code |
41654125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.34
|
|
|
DILTIAZEM 240 MG ERC
|
Facility
OP
|
$0.77
|
|
| Hospital Charge Code |
41643948
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.39
|
| Rate for Payer: Aetna Government |
$0.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.52
|
| Rate for Payer: Group Health Inc Commercial |
$0.39
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.50
|
|
|
DILTIAZEM 240 MG ERC
|
Facility
OP
|
$0.77
|
|
| Hospital Charge Code |
41653948
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.39
|
| Rate for Payer: Aetna Government |
$0.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.52
|
| Rate for Payer: Group Health Inc Commercial |
$0.39
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.50
|
|
|
DILTIAZEM 25 MG/5 ML INJ
|
Facility
OP
|
$1.09
|
|
| Hospital Charge Code |
41643272
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.55
|
| Rate for Payer: Aetna Government |
$0.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.74
|
| Rate for Payer: Group Health Inc Commercial |
$0.55
|
| Rate for Payer: Group Health Inc Medicare |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.71
|
|
|
DILTIAZEM 25 MG/5 ML INJ
|
Facility
OP
|
$1.09
|
|
| Hospital Charge Code |
41653272
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.55
|
| Rate for Payer: Aetna Government |
$0.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.74
|
| Rate for Payer: Group Health Inc Commercial |
$0.55
|
| Rate for Payer: Group Health Inc Medicare |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.71
|
|
|
DILTIAZEM 30MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41640243
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
DILTIAZEM 30MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41650243
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
DILTIAZEM 50MG/10ML INJ
|
Facility
OP
|
$4.60
|
|
| Hospital Charge Code |
41647011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.30
|
| Rate for Payer: Aetna Government |
$2.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.13
|
| Rate for Payer: Group Health Inc Commercial |
$2.30
|
| Rate for Payer: Group Health Inc Medicare |
$1.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.99
|
|
|
DILTIAZEM 50MG/10ML INJ
|
Facility
IP
|
$4.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41657011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.30
|
|
|
DILTIAZEM 50MG/10ML INJ
|
Facility
OP
|
$4.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41657011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.30
|
| Rate for Payer: Aetna Government |
$2.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.64
|
| Rate for Payer: Group Health Inc Commercial |
$2.30
|
| Rate for Payer: Group Health Inc Medicare |
$1.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.99
|
|
|
DILTIAZEM 60 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41640241
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
DILTIAZEM 60 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41650241
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
