Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

DIGOXIN 125 MCG (0.125 MG) TABLET

Facility

$475.20

Service Code	NDC 60687085801
Hospital Charge Code	2444
Hospital Revenue Code	637
Min. Negotiated Rate	$299.38
Max. Negotiated Rate	$427.68
Rate for Payer: Aetna Commercial	$403.92
Rate for Payer: Aetna New Business (MI Preferred)	$308.88
Rate for Payer: Cash Price	$380.16
Rate for Payer: Cofinity Advantage	$332.64
Rate for Payer: Cofinity Commercial	$408.67
Rate for Payer: Encore Health Key Benefits Commercial	$380.16
Rate for Payer: Healthscope Commercial	$427.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$403.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$356.40
Rate for Payer: PHP Commercial	$403.92
Rate for Payer: Priority Health SBD	$299.38

DIGOXIN 125 MCG (0.125 MG) TABLET

Facility

$432.00

Service Code	NDC 00904592161
Hospital Charge Code	2444
Hospital Revenue Code	637
Min. Negotiated Rate	$272.16
Max. Negotiated Rate	$388.80
Rate for Payer: Aetna Commercial	$367.20
Rate for Payer: Aetna New Business (MI Preferred)	$280.80
Rate for Payer: Cash Price	$345.60
Rate for Payer: Cofinity Advantage	$302.40
Rate for Payer: Cofinity Commercial	$371.52
Rate for Payer: Encore Health Key Benefits Commercial	$345.60
Rate for Payer: Healthscope Commercial	$388.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$367.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$324.00
Rate for Payer: PHP Commercial	$367.20
Rate for Payer: Priority Health SBD	$272.16

DIGOXIN 125 MCG (0.125 MG) TABLET

Facility

$475.20

Service Code	NDC 60687085801
Hospital Charge Code	2444
Hospital Revenue Code	637
Min. Negotiated Rate	$186.75
Max. Negotiated Rate	$427.68
Rate for Payer: Aetna Commercial	$403.92
Rate for Payer: Aetna Medicare	$237.60
Rate for Payer: Aetna New Business (MI Preferred)	$308.88
Rate for Payer: BCBS Complete	$190.08
Rate for Payer: Cash Price	$380.16
Rate for Payer: Cofinity Advantage	$332.64
Rate for Payer: Cofinity Commercial	$408.67
Rate for Payer: Encore Health Key Benefits Commercial	$380.16
Rate for Payer: Healthscope Commercial	$427.68
Rate for Payer: MI Amish Medical Board Commercial	$380.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$403.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$356.40
Rate for Payer: PHP Commercial	$403.92
Rate for Payer: Priority Health SBD	$299.38
Rate for Payer: UHC All Payor (Choice/PPO)	$308.88
Rate for Payer: UHC Core	$247.58
Rate for Payer: UHC Exchange	$186.75

DIGOXIN 125 MCG (0.125 MG) TABLET

Facility

$4.76

Service Code	NDC 60687085811
Hospital Charge Code	2444
Hospital Revenue Code	637
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$4.28
Rate for Payer: Aetna Commercial	$4.05
Rate for Payer: Aetna Medicare	$2.38
Rate for Payer: Aetna New Business (MI Preferred)	$3.09
Rate for Payer: BCBS Complete	$1.90
Rate for Payer: Cash Price	$3.81
Rate for Payer: Cofinity Advantage	$3.33
Rate for Payer: Cofinity Commercial	$4.09
Rate for Payer: Encore Health Key Benefits Commercial	$3.81
Rate for Payer: Healthscope Commercial	$4.28
Rate for Payer: MI Amish Medical Board Commercial	$3.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.57
Rate for Payer: PHP Commercial	$4.05
Rate for Payer: Priority Health SBD	$3.00
Rate for Payer: UHC All Payor (Choice/PPO)	$3.09
Rate for Payer: UHC Core	$2.48
Rate for Payer: UHC Exchange	$1.87

DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION

Facility

$21.14

Service Code	HCPCS J1160
Hospital Charge Code	108720
Hospital Revenue Code	636
Min. Negotiated Rate	$8.46
Max. Negotiated Rate	$24.01
Rate for Payer: Aetna Commercial	$17.97
Rate for Payer: Aetna Medicare	$10.57
Rate for Payer: Aetna New Business (MI Preferred)	$13.74
Rate for Payer: BCBS Complete	$8.46
Rate for Payer: BCBS Trust/PPO	$24.01
Rate for Payer: BCN Commercial	$24.01
Rate for Payer: Cash Price	$16.91
Rate for Payer: Cash Price	$16.91
Rate for Payer: Cofinity Advantage	$14.80
Rate for Payer: Cofinity Commercial	$18.18
Rate for Payer: Encore Health Key Benefits Commercial	$16.91
Rate for Payer: Healthscope Commercial	$19.03
Rate for Payer: MI Amish Medical Board Commercial	$16.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.86
Rate for Payer: PHP Commercial	$17.97
Rate for Payer: Priority Health SBD	$13.32
Rate for Payer: UHC All Payor (Choice/PPO)	$15.79
Rate for Payer: UHC Core	$15.79
Rate for Payer: UHC Exchange	$15.79

DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION

Facility

$21.14

Service Code	HCPCS J1160
Hospital Charge Code	108720
Hospital Revenue Code	636
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$19.03
Rate for Payer: Aetna Commercial	$17.97
Rate for Payer: Aetna New Business (MI Preferred)	$13.74
Rate for Payer: Cash Price	$16.91
Rate for Payer: Cofinity Advantage	$14.80
Rate for Payer: Cofinity Commercial	$18.18
Rate for Payer: Encore Health Key Benefits Commercial	$16.91
Rate for Payer: Healthscope Commercial	$19.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.86
Rate for Payer: PHP Commercial	$17.97
Rate for Payer: Priority Health SBD	$13.32

DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION

Facility

$12,027.14

Service Code	HCPCS J1162
Hospital Charge Code	31432
Hospital Revenue Code	636
Min. Negotiated Rate	$7,577.10
Max. Negotiated Rate	$10,824.43
Rate for Payer: Aetna Commercial	$10,223.07
Rate for Payer: Aetna New Business (MI Preferred)	$7,817.64
Rate for Payer: Cash Price	$9,621.71
Rate for Payer: Cofinity Advantage	$8,419.00
Rate for Payer: Cofinity Commercial	$10,343.34
Rate for Payer: Encore Health Key Benefits Commercial	$9,621.71
Rate for Payer: Healthscope Commercial	$10,824.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10,223.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$9,020.35
Rate for Payer: PHP Commercial	$10,223.07
Rate for Payer: Priority Health SBD	$7,577.10

DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION

Facility

$12,027.14

Service Code	HCPCS J1162
Hospital Charge Code	31432
Hospital Revenue Code	636
Min. Negotiated Rate	$2,702.34
Max. Negotiated Rate	$16,300.43
Rate for Payer: Aetna Commercial	$10,223.07
Rate for Payer: Aetna Medicare	$5,373.67
Rate for Payer: Aetna New Business (MI Preferred)	$7,817.64
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,458.74
Rate for Payer: Amish Plain Church Group Commercial	$6,458.74
Rate for Payer: BCBS Complete	$2,837.71
Rate for Payer: BCBS MAPPO	$5,166.99
Rate for Payer: BCBS Trust/PPO	$12,963.26
Rate for Payer: BCN Commercial	$12,963.26
Rate for Payer: BCN Medicare Advantage	$5,166.99
Rate for Payer: Cash Price	$9,621.71
Rate for Payer: Cash Price	$9,621.71
Rate for Payer: Cofinity Advantage	$8,419.00
Rate for Payer: Cofinity Commercial	$10,343.34
Rate for Payer: Encore Health Key Benefits Commercial	$9,621.71
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,166.99
Rate for Payer: Healthscope Commercial	$10,824.43
Rate for Payer: Mclaren Medicaid	$2,702.34
Rate for Payer: Mclaren Medicare	$5,166.99
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,425.34
Rate for Payer: Meridian Medicaid	$5,425.34
Rate for Payer: MI Amish Medical Board Commercial	$5,942.04
Rate for Payer: Molina Medicare/Medicaid	$5,683.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10,223.07
Rate for Payer: Nomi Health Commercial	$15,500.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$9,020.35
Rate for Payer: PACE Medicare	$4,908.64
Rate for Payer: PACE SWMI	$5,166.99
Rate for Payer: PHP Commercial	$10,223.07
Rate for Payer: PHP Medicare Advantage	$5,166.99
Rate for Payer: Priority Health Choice Medicaid	$2,702.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$16,300.43
Rate for Payer: Priority Health Medicare	$5,166.99
Rate for Payer: Priority Health SBD	$7,577.10
Rate for Payer: Priority Health Tiered Network	$13,040.34
Rate for Payer: Railroad Medicare Medicare	$5,166.99
Rate for Payer: UHC All Payor (Choice/PPO)	$8,525.53
Rate for Payer: UHC Core	$8,525.53
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$5,166.99
Rate for Payer: UHC Exchange	$8,525.53
Rate for Payer: UHC Medicaid	$2,702.34
Rate for Payer: UHCCP Medicaid	$2,702.34
Rate for Payer: VA VA	$5,166.99

DIGOXIN IV NEONATE 10 MCG/ML INJECTION

Facility

$323.12

Service Code	HCPCS J1160
Hospital Charge Code	163536
Hospital Revenue Code	636
Min. Negotiated Rate	$203.57
Max. Negotiated Rate	$290.81
Rate for Payer: Aetna Commercial	$274.65
Rate for Payer: Aetna New Business (MI Preferred)	$210.03
Rate for Payer: Cash Price	$258.50
Rate for Payer: Cofinity Advantage	$226.18
Rate for Payer: Cofinity Commercial	$277.88
Rate for Payer: Encore Health Key Benefits Commercial	$258.50
Rate for Payer: Healthscope Commercial	$290.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$274.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$242.34
Rate for Payer: PHP Commercial	$274.65
Rate for Payer: Priority Health SBD	$203.57

DIGOXIN IV NEONATE 10 MCG/ML INJECTION

Facility

$323.12

Service Code	HCPCS J1160
Hospital Charge Code	163536
Hospital Revenue Code	636
Min. Negotiated Rate	$15.79
Max. Negotiated Rate	$290.81
Rate for Payer: Aetna Commercial	$274.65
Rate for Payer: Aetna Medicare	$161.56
Rate for Payer: Aetna New Business (MI Preferred)	$210.03
Rate for Payer: BCBS Complete	$129.25
Rate for Payer: BCBS Trust/PPO	$24.01
Rate for Payer: BCN Commercial	$24.01
Rate for Payer: Cash Price	$258.50
Rate for Payer: Cash Price	$258.50
Rate for Payer: Cofinity Advantage	$226.18
Rate for Payer: Cofinity Commercial	$277.88
Rate for Payer: Encore Health Key Benefits Commercial	$258.50
Rate for Payer: Healthscope Commercial	$290.81
Rate for Payer: MI Amish Medical Board Commercial	$258.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$274.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$242.34
Rate for Payer: PHP Commercial	$274.65
Rate for Payer: Priority Health SBD	$203.57
Rate for Payer: UHC All Payor (Choice/PPO)	$15.79
Rate for Payer: UHC Core	$15.79
Rate for Payer: UHC Exchange	$15.79

DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL)

Facility

$10,430.93

Service Code	CPT 58120
Hospital Revenue Code	360
Min. Negotiated Rate	$1,686.93
Max. Negotiated Rate	$10,430.93
Rate for Payer: Aetna Medicare	$3,354.51
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,031.86
Rate for Payer: Amish Plain Church Group Commercial	$4,031.86
Rate for Payer: BCBS Complete	$1,771.44
Rate for Payer: BCBS MAPPO	$3,225.49
Rate for Payer: BCBS Trust/PPO	$1,798.71
Rate for Payer: BCN Commercial	$1,798.71
Rate for Payer: BCN Medicare Advantage	$3,225.49
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,225.49
Rate for Payer: Mclaren Medicaid	$1,686.93
Rate for Payer: Mclaren Medicare	$3,225.49
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,386.76
Rate for Payer: Meridian Medicaid	$3,386.76
Rate for Payer: MI Amish Medical Board Commercial	$3,709.31
Rate for Payer: Molina Medicare/Medicaid	$3,548.04
Rate for Payer: Nomi Health Commercial	$9,676.47
Rate for Payer: PACE Medicare	$3,064.22
Rate for Payer: PACE SWMI	$3,225.49
Rate for Payer: PHP Medicare Advantage	$3,225.49
Rate for Payer: Priority Health Choice Medicaid	$1,686.93
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$10,430.93
Rate for Payer: Priority Health Medicare	$3,225.49
Rate for Payer: Priority Health Tiered Network	$8,344.74
Rate for Payer: Railroad Medicare Medicare	$3,225.49
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$3,225.49
Rate for Payer: UHC Medicaid	$1,686.93
Rate for Payer: UHCCP Medicaid	$1,686.93
Rate for Payer: VA VA	$3,225.49

DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$5,385.01

Service Code	APR-DRG 5171
Min. Negotiated Rate	$5,128.58
Max. Negotiated Rate	$5,385.01
Rate for Payer: BCBS Complete	$5,385.01
Rate for Payer: Mclaren Medicaid	$5,128.58
Rate for Payer: Meridian Medicaid	$5,385.01
Rate for Payer: Priority Health Choice Medicaid	$5,128.58
Rate for Payer: UHC Medicaid	$5,128.58
Rate for Payer: UHCCP Medicaid	$5,128.58

DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$15,065.18

Service Code	APR-DRG 5174
Min. Negotiated Rate	$14,347.79
Max. Negotiated Rate	$15,065.18
Rate for Payer: BCBS Complete	$15,065.18
Rate for Payer: Mclaren Medicaid	$14,347.79
Rate for Payer: Meridian Medicaid	$15,065.18
Rate for Payer: Priority Health Choice Medicaid	$14,347.79
Rate for Payer: UHC Medicaid	$14,347.79
Rate for Payer: UHCCP Medicaid	$14,347.79

DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$6,689.26

Service Code	APR-DRG 5172
Min. Negotiated Rate	$6,370.73
Max. Negotiated Rate	$6,689.26
Rate for Payer: BCBS Complete	$6,689.26
Rate for Payer: Mclaren Medicaid	$6,370.73
Rate for Payer: Meridian Medicaid	$6,689.26
Rate for Payer: Priority Health Choice Medicaid	$6,370.73
Rate for Payer: UHC Medicaid	$6,370.73
Rate for Payer: UHCCP Medicaid	$6,370.73

DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$10,554.45

Service Code	APR-DRG 5173
Min. Negotiated Rate	$10,051.86
Max. Negotiated Rate	$10,554.45
Rate for Payer: BCBS Complete	$10,554.45
Rate for Payer: Mclaren Medicaid	$10,051.86
Rate for Payer: Meridian Medicaid	$10,554.45
Rate for Payer: Priority Health Choice Medicaid	$10,051.86
Rate for Payer: UHC Medicaid	$10,051.86
Rate for Payer: UHCCP Medicaid	$10,051.86

DILATION OF ANAL SPHINCTER (SEPARATE PROCEDURE) UNDER ANESTHESIA OTHER THAN LOCAL

Facility

$3,855.91

Service Code	CPT 45905
Hospital Revenue Code	360
Min. Negotiated Rate	$623.59
Max. Negotiated Rate	$3,855.91
Rate for Payer: Aetna Medicare	$1,240.03
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,490.42
Rate for Payer: Amish Plain Church Group Commercial	$1,490.42
Rate for Payer: BCBS Complete	$654.83
Rate for Payer: BCBS MAPPO	$1,192.34
Rate for Payer: BCBS Trust/PPO	$797.37
Rate for Payer: BCN Commercial	$797.37
Rate for Payer: BCN Medicare Advantage	$1,192.34
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,192.34
Rate for Payer: Mclaren Medicaid	$623.59
Rate for Payer: Mclaren Medicare	$1,192.34
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,251.96
Rate for Payer: Meridian Medicaid	$1,251.96
Rate for Payer: MI Amish Medical Board Commercial	$1,371.19
Rate for Payer: Molina Medicare/Medicaid	$1,311.57
Rate for Payer: Nomi Health Commercial	$3,577.02
Rate for Payer: PACE Medicare	$1,132.72
Rate for Payer: PACE SWMI	$1,192.34
Rate for Payer: PHP Medicare Advantage	$1,192.34
Rate for Payer: Priority Health Choice Medicaid	$623.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$3,855.91
Rate for Payer: Priority Health Medicare	$1,192.34
Rate for Payer: Priority Health Tiered Network	$3,084.73
Rate for Payer: Railroad Medicare Medicare	$1,192.34
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$1,192.34
Rate for Payer: UHC Medicaid	$623.59
Rate for Payer: UHCCP Medicaid	$623.59
Rate for Payer: VA VA	$1,192.34

DILTIAZEM 1MG/1 ML INFUSION 125 ML (IV PREMIX)

Facility

$156.25

Service Code	NDC 09900000302
Hospital Charge Code	155072
Hospital Revenue Code	250
Min. Negotiated Rate	$61.41
Max. Negotiated Rate	$140.62
Rate for Payer: Aetna Commercial	$132.81
Rate for Payer: Aetna Medicare	$78.12
Rate for Payer: Aetna New Business (MI Preferred)	$101.56
Rate for Payer: BCBS Complete	$62.50
Rate for Payer: Cash Price	$125.00
Rate for Payer: Cofinity Advantage	$109.38
Rate for Payer: Cofinity Commercial	$134.38
Rate for Payer: Encore Health Key Benefits Commercial	$125.00
Rate for Payer: Healthscope Commercial	$140.62
Rate for Payer: MI Amish Medical Board Commercial	$125.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$132.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$117.19
Rate for Payer: PHP Commercial	$132.81
Rate for Payer: Priority Health SBD	$98.44
Rate for Payer: UHC All Payor (Choice/PPO)	$101.56
Rate for Payer: UHC Core	$81.41
Rate for Payer: UHC Exchange	$61.41

DILTIAZEM 1MG/1 ML INFUSION 125 ML (IV PREMIX)

Facility

$156.25

Service Code	NDC 09900000302
Hospital Charge Code	155072
Hospital Revenue Code	250
Min. Negotiated Rate	$98.44
Max. Negotiated Rate	$140.62
Rate for Payer: Aetna Commercial	$132.81
Rate for Payer: Aetna New Business (MI Preferred)	$101.56
Rate for Payer: Cash Price	$125.00
Rate for Payer: Cofinity Advantage	$109.38
Rate for Payer: Cofinity Commercial	$134.38
Rate for Payer: Encore Health Key Benefits Commercial	$125.00
Rate for Payer: Healthscope Commercial	$140.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$132.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$117.19
Rate for Payer: PHP Commercial	$132.81
Rate for Payer: Priority Health SBD	$98.44

DILTIAZEM 30 MG TABLET

Facility

$326.65

Service Code	NDC 00093031801
Hospital Charge Code	2475
Hospital Revenue Code	637
Min. Negotiated Rate	$205.79
Max. Negotiated Rate	$293.99
Rate for Payer: Aetna Commercial	$277.65
Rate for Payer: Aetna New Business (MI Preferred)	$212.32
Rate for Payer: Cash Price	$261.32
Rate for Payer: Cofinity Advantage	$228.66
Rate for Payer: Cofinity Commercial	$280.92
Rate for Payer: Encore Health Key Benefits Commercial	$261.32
Rate for Payer: Healthscope Commercial	$293.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$277.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$244.99
Rate for Payer: PHP Commercial	$277.65
Rate for Payer: Priority Health SBD	$205.79

DILTIAZEM 30 MG TABLET

Facility

$428.45

Service Code	NDC 60687071701
Hospital Charge Code	2475
Hospital Revenue Code	637
Min. Negotiated Rate	$168.38
Max. Negotiated Rate	$385.61
Rate for Payer: Aetna Commercial	$364.18
Rate for Payer: Aetna Medicare	$214.22
Rate for Payer: Aetna New Business (MI Preferred)	$278.49
Rate for Payer: BCBS Complete	$171.38
Rate for Payer: Cash Price	$342.76
Rate for Payer: Cofinity Advantage	$299.92
Rate for Payer: Cofinity Commercial	$368.47
Rate for Payer: Encore Health Key Benefits Commercial	$342.76
Rate for Payer: Healthscope 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: Opus (Opus Packaging Group) HMA	$321.34
Rate for Payer: PHP Commercial	$364.18
Rate for Payer: Priority Health SBD	$269.92
Rate for Payer: UHC All Payor (Choice/PPO)	$278.49
Rate for Payer: UHC Core	$223.22
Rate for Payer: UHC Exchange	$168.38

DILTIAZEM 30 MG TABLET

Facility

$4.29

Service Code	NDC 60687071711
Hospital Charge Code	2475
Hospital Revenue Code	637
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$3.86
Rate for Payer: Aetna Commercial	$3.65
Rate for Payer: Aetna New Business (MI Preferred)	$2.79
Rate for Payer: Cash Price	$3.43
Rate for Payer: Cofinity Advantage	$3.00
Rate for Payer: Cofinity Commercial	$3.69
Rate for Payer: Encore Health Key Benefits Commercial	$3.43
Rate for Payer: Healthscope Commercial	$3.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.22
Rate for Payer: PHP Commercial	$3.65
Rate for Payer: Priority Health SBD	$2.70

DILTIAZEM 30 MG TABLET

Facility

$326.65

Service Code	NDC 00093031801
Hospital Charge Code	2475
Hospital Revenue Code	637
Min. Negotiated Rate	$128.37
Max. Negotiated Rate	$293.99
Rate for Payer: Aetna Commercial	$277.65
Rate for Payer: Aetna Medicare	$163.32
Rate for Payer: Aetna New Business (MI Preferred)	$212.32
Rate for Payer: BCBS Complete	$130.66
Rate for Payer: Cash Price	$261.32
Rate for Payer: Cofinity Advantage	$228.66
Rate for Payer: Cofinity Commercial	$280.92
Rate for Payer: Encore Health Key Benefits Commercial	$261.32
Rate for Payer: Healthscope Commercial	$293.99
Rate for Payer: MI Amish Medical Board Commercial	$261.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$277.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$244.99
Rate for Payer: PHP Commercial	$277.65
Rate for Payer: Priority Health SBD	$205.79
Rate for Payer: UHC All Payor (Choice/PPO)	$212.32
Rate for Payer: UHC Core	$170.18
Rate for Payer: UHC Exchange	$128.37

DILTIAZEM 30 MG TABLET

Facility

$4.29

Service Code	NDC 60687071711
Hospital Charge Code	2475
Hospital Revenue Code	637
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$3.86
Rate for Payer: Aetna Commercial	$3.65
Rate for Payer: Aetna Medicare	$2.15
Rate for Payer: Aetna New Business (MI Preferred)	$2.79
Rate for Payer: BCBS Complete	$1.72
Rate for Payer: Cash Price	$3.43
Rate for Payer: Cofinity Advantage	$3.00
Rate for Payer: Cofinity Commercial	$3.69
Rate for Payer: Encore Health Key Benefits Commercial	$3.43
Rate for Payer: Healthscope Commercial	$3.86
Rate for Payer: MI Amish Medical Board Commercial	$3.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.22
Rate for Payer: PHP Commercial	$3.65
Rate for Payer: Priority Health SBD	$2.70
Rate for Payer: UHC All Payor (Choice/PPO)	$2.79
Rate for Payer: UHC Core	$2.24
Rate for Payer: UHC Exchange	$1.69

DILTIAZEM 30 MG TABLET

Facility

$428.45

Service Code	NDC 60687071701
Hospital Charge Code	2475
Hospital Revenue Code	637
Min. Negotiated Rate	$269.92
Max. Negotiated Rate	$385.61
Rate for Payer: Aetna Commercial	$364.18
Rate for Payer: Aetna New Business (MI Preferred)	$278.49
Rate for Payer: Cash Price	$342.76
Rate for Payer: Cofinity Advantage	$299.92
Rate for Payer: Cofinity Commercial	$368.47
Rate for Payer: Encore Health Key Benefits Commercial	$342.76
Rate for Payer: Healthscope Commercial	$385.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$364.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$321.34
Rate for Payer: PHP Commercial	$364.18
Rate for Payer: Priority Health SBD	$269.92

DILTIAZEM 30 MG TABLET

Facility

$3.74

Service Code	NDC 51079074501
Hospital Charge Code	2475
Hospital Revenue Code	637
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$3.37
Rate for Payer: Aetna Commercial	$3.18
Rate for Payer: Aetna New Business (MI Preferred)	$2.43
Rate for Payer: Cash Price	$2.99
Rate for Payer: Cofinity Advantage	$2.62
Rate for Payer: Cofinity Commercial	$3.22
Rate for Payer: Encore Health Key Benefits Commercial	$2.99
Rate for Payer: Healthscope Commercial	$3.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.81
Rate for Payer: PHP Commercial	$3.18
Rate for Payer: Priority Health SBD	$2.36

Know your out-of-pocket cost for care.

All Charges