Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$48.63

Service Code	NDC 00641601301
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$19.45
Max. Negotiated Rate	$43.77
Rate for Payer: Aetna Commercial	$41.34
Rate for Payer: Aetna Medicare	$24.32
Rate for Payer: Aetna New Business (MI Preferred)	$31.61
Rate for Payer: BCBS Complete	$19.45
Rate for Payer: Cash Price	$38.90
Rate for Payer: Cofinity Commercial	$34.04
Rate for Payer: Cofinity Commercial	$41.82
Rate for Payer: Cofinity Medicare Advantage	$34.04
Rate for Payer: Encore Health Key Benefits Commercial	$38.90
Rate for Payer: Healthscope Commercial	$43.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.34
Rate for Payer: PHP Commercial	$41.34
Rate for Payer: Priority Health Cigna Priority Health	$31.61
Rate for Payer: Priority Health SBD	$30.64

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$88.75

Service Code	NDC 00641601410
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$55.91
Max. Negotiated Rate	$79.88
Rate for Payer: Aetna Commercial	$75.44
Rate for Payer: Aetna New Business (MI Preferred)	$57.69
Rate for Payer: Cash Price	$71.00
Rate for Payer: Cofinity Commercial	$62.12
Rate for Payer: Cofinity Commercial	$76.33
Rate for Payer: Cofinity Medicare Advantage	$62.12
Rate for Payer: Encore Health Key Benefits Commercial	$71.00
Rate for Payer: Healthscope Commercial	$79.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$75.44
Rate for Payer: PHP Commercial	$75.44
Rate for Payer: Priority Health Cigna Priority Health	$57.69
Rate for Payer: Priority Health SBD	$55.91

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$48.63

Service Code	NDC 00641921710
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$19.45
Max. Negotiated Rate	$43.77
Rate for Payer: Aetna Commercial	$41.34
Rate for Payer: Aetna Medicare	$24.32
Rate for Payer: Aetna New Business (MI Preferred)	$31.61
Rate for Payer: BCBS Complete	$19.45
Rate for Payer: Cash Price	$38.90
Rate for Payer: Cofinity Commercial	$34.04
Rate for Payer: Cofinity Commercial	$41.82
Rate for Payer: Cofinity Medicare Advantage	$34.04
Rate for Payer: Encore Health Key Benefits Commercial	$38.90
Rate for Payer: Healthscope Commercial	$43.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.34
Rate for Payer: PHP Commercial	$41.34
Rate for Payer: Priority Health Cigna Priority Health	$31.61
Rate for Payer: Priority Health SBD	$30.64

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$48.63

Service Code	NDC 00641601310
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$30.64
Max. Negotiated Rate	$43.77
Rate for Payer: Aetna Commercial	$41.34
Rate for Payer: Aetna New Business (MI Preferred)	$31.61
Rate for Payer: Cash Price	$38.90
Rate for Payer: Cofinity Commercial	$34.04
Rate for Payer: Cofinity Commercial	$41.82
Rate for Payer: Cofinity Medicare Advantage	$34.04
Rate for Payer: Encore Health Key Benefits Commercial	$38.90
Rate for Payer: Healthscope Commercial	$43.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.34
Rate for Payer: PHP Commercial	$41.34
Rate for Payer: Priority Health Cigna Priority Health	$31.61
Rate for Payer: Priority Health SBD	$30.64

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$48.63

Service Code	NDC 00641921701
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$30.64
Max. Negotiated Rate	$43.77
Rate for Payer: Aetna Commercial	$41.34
Rate for Payer: Aetna New Business (MI Preferred)	$31.61
Rate for Payer: Cash Price	$38.90
Rate for Payer: Cofinity Commercial	$34.04
Rate for Payer: Cofinity Commercial	$41.82
Rate for Payer: Cofinity Medicare Advantage	$34.04
Rate for Payer: Encore Health Key Benefits Commercial	$38.90
Rate for Payer: Healthscope Commercial	$43.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.34
Rate for Payer: PHP Commercial	$41.34
Rate for Payer: Priority Health Cigna Priority Health	$31.61
Rate for Payer: Priority Health SBD	$30.64

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$48.63

Service Code	NDC 00641601310
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$19.45
Max. Negotiated Rate	$43.77
Rate for Payer: Aetna Commercial	$41.34
Rate for Payer: Aetna Medicare	$24.32
Rate for Payer: Aetna New Business (MI Preferred)	$31.61
Rate for Payer: BCBS Complete	$19.45
Rate for Payer: Cash Price	$38.90
Rate for Payer: Cofinity Commercial	$34.04
Rate for Payer: Cofinity Commercial	$41.82
Rate for Payer: Cofinity Medicare Advantage	$34.04
Rate for Payer: Encore Health Key Benefits Commercial	$38.90
Rate for Payer: Healthscope Commercial	$43.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.34
Rate for Payer: PHP Commercial	$41.34
Rate for Payer: Priority Health Cigna Priority Health	$31.61
Rate for Payer: Priority Health SBD	$30.64

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$129.38

Service Code	NDC 00641601510
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$81.51
Max. Negotiated Rate	$116.44
Rate for Payer: Aetna Commercial	$109.97
Rate for Payer: Aetna New Business (MI Preferred)	$84.10
Rate for Payer: Cash Price	$103.50
Rate for Payer: Cofinity Commercial	$111.27
Rate for Payer: Cofinity Commercial	$90.57
Rate for Payer: Cofinity Medicare Advantage	$90.57
Rate for Payer: Encore Health Key Benefits Commercial	$103.50
Rate for Payer: Healthscope Commercial	$116.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$109.97
Rate for Payer: PHP Commercial	$109.97
Rate for Payer: Priority Health Cigna Priority Health	$84.10
Rate for Payer: Priority Health SBD	$81.51

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$71.75

Service Code	NDC 55150042501
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$45.20
Max. Negotiated Rate	$64.58
Rate for Payer: Aetna Commercial	$60.99
Rate for Payer: Aetna New Business (MI Preferred)	$46.64
Rate for Payer: Cash Price	$57.40
Rate for Payer: Cofinity Commercial	$50.23
Rate for Payer: Cofinity Commercial	$61.70
Rate for Payer: Cofinity Medicare Advantage	$50.23
Rate for Payer: Encore Health Key Benefits Commercial	$57.40
Rate for Payer: Healthscope Commercial	$64.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.99
Rate for Payer: PHP Commercial	$60.99
Rate for Payer: Priority Health Cigna Priority Health	$46.64
Rate for Payer: Priority Health SBD	$45.20

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$88.75

Service Code	NDC 00641601410
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$35.50
Max. Negotiated Rate	$79.88
Rate for Payer: Aetna Commercial	$75.44
Rate for Payer: Aetna Medicare	$44.38
Rate for Payer: Aetna New Business (MI Preferred)	$57.69
Rate for Payer: BCBS Complete	$35.50
Rate for Payer: Cash Price	$71.00
Rate for Payer: Cofinity Commercial	$62.12
Rate for Payer: Cofinity Commercial	$76.33
Rate for Payer: Cofinity Medicare Advantage	$62.12
Rate for Payer: Encore Health Key Benefits Commercial	$71.00
Rate for Payer: Healthscope Commercial	$79.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$75.44
Rate for Payer: PHP Commercial	$75.44
Rate for Payer: Priority Health Cigna Priority Health	$57.69
Rate for Payer: Priority Health SBD	$55.91

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$59.50

Service Code	NDC 17478093710
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$37.48
Max. Negotiated Rate	$53.55
Rate for Payer: Aetna Commercial	$50.58
Rate for Payer: Aetna New Business (MI Preferred)	$38.67
Rate for Payer: Cash Price	$47.60
Rate for Payer: Cofinity Commercial	$41.65
Rate for Payer: Cofinity Commercial	$51.17
Rate for Payer: Cofinity Medicare Advantage	$41.65
Rate for Payer: Encore Health Key Benefits Commercial	$47.60
Rate for Payer: Healthscope Commercial	$53.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.58
Rate for Payer: PHP Commercial	$50.58
Rate for Payer: Priority Health Cigna Priority Health	$38.67
Rate for Payer: Priority Health SBD	$37.48

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$48.63

Service Code	NDC 00641601301
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$30.64
Max. Negotiated Rate	$43.77
Rate for Payer: Aetna Commercial	$41.34
Rate for Payer: Aetna New Business (MI Preferred)	$31.61
Rate for Payer: Cash Price	$38.90
Rate for Payer: Cofinity Commercial	$34.04
Rate for Payer: Cofinity Commercial	$41.82
Rate for Payer: Cofinity Medicare Advantage	$34.04
Rate for Payer: Encore Health Key Benefits Commercial	$38.90
Rate for Payer: Healthscope Commercial	$43.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.34
Rate for Payer: PHP Commercial	$41.34
Rate for Payer: Priority Health Cigna Priority Health	$31.61
Rate for Payer: Priority Health SBD	$30.64

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$253.75

Service Code	NDC 17478093725
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$101.50
Max. Negotiated Rate	$228.38
Rate for Payer: Aetna Commercial	$215.69
Rate for Payer: Aetna Medicare	$126.88
Rate for Payer: Aetna New Business (MI Preferred)	$164.94
Rate for Payer: BCBS Complete	$101.50
Rate for Payer: Cash Price	$203.00
Rate for Payer: Cofinity Commercial	$177.62
Rate for Payer: Cofinity Commercial	$218.22
Rate for Payer: Cofinity Medicare Advantage	$177.62
Rate for Payer: Encore Health Key Benefits Commercial	$203.00
Rate for Payer: Healthscope Commercial	$228.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$215.69
Rate for Payer: PHP Commercial	$215.69
Rate for Payer: Priority Health Cigna Priority Health	$164.94
Rate for Payer: Priority Health SBD	$159.86

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$48.63

Service Code	NDC 00641921701
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$19.45
Max. Negotiated Rate	$43.77
Rate for Payer: Aetna Commercial	$41.34
Rate for Payer: Aetna Medicare	$24.32
Rate for Payer: Aetna New Business (MI Preferred)	$31.61
Rate for Payer: BCBS Complete	$19.45
Rate for Payer: Cash Price	$38.90
Rate for Payer: Cofinity Commercial	$34.04
Rate for Payer: Cofinity Commercial	$41.82
Rate for Payer: Cofinity Medicare Advantage	$34.04
Rate for Payer: Encore Health Key Benefits Commercial	$38.90
Rate for Payer: Healthscope Commercial	$43.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.34
Rate for Payer: PHP Commercial	$41.34
Rate for Payer: Priority Health Cigna Priority Health	$31.61
Rate for Payer: Priority Health SBD	$30.64

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$71.75

Service Code	NDC 55150042510
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$64.58
Rate for Payer: Aetna Commercial	$60.99
Rate for Payer: Aetna Medicare	$35.88
Rate for Payer: Aetna New Business (MI Preferred)	$46.64
Rate for Payer: BCBS Complete	$28.70
Rate for Payer: Cash Price	$57.40
Rate for Payer: Cofinity Commercial	$50.23
Rate for Payer: Cofinity Commercial	$61.70
Rate for Payer: Cofinity Medicare Advantage	$50.23
Rate for Payer: Encore Health Key Benefits Commercial	$57.40
Rate for Payer: Healthscope Commercial	$64.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.99
Rate for Payer: PHP Commercial	$60.99
Rate for Payer: Priority Health Cigna Priority Health	$46.64
Rate for Payer: Priority Health SBD	$45.20

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$71.75

Service Code	NDC 55150042510
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$45.20
Max. Negotiated Rate	$64.58
Rate for Payer: Aetna Commercial	$60.99
Rate for Payer: Aetna New Business (MI Preferred)	$46.64
Rate for Payer: Cash Price	$57.40
Rate for Payer: Cofinity Commercial	$50.23
Rate for Payer: Cofinity Commercial	$61.70
Rate for Payer: Cofinity Medicare Advantage	$50.23
Rate for Payer: Encore Health Key Benefits Commercial	$57.40
Rate for Payer: Healthscope Commercial	$64.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.99
Rate for Payer: PHP Commercial	$60.99
Rate for Payer: Priority Health Cigna Priority Health	$46.64
Rate for Payer: Priority Health SBD	$45.20

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$59.50

Service Code	NDC 17478093710
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$53.55
Rate for Payer: Aetna Commercial	$50.58
Rate for Payer: Aetna Medicare	$29.75
Rate for Payer: Aetna New Business (MI Preferred)	$38.67
Rate for Payer: BCBS Complete	$23.80
Rate for Payer: Cash Price	$47.60
Rate for Payer: Cofinity Commercial	$41.65
Rate for Payer: Cofinity Commercial	$51.17
Rate for Payer: Cofinity Medicare Advantage	$41.65
Rate for Payer: Encore Health Key Benefits Commercial	$47.60
Rate for Payer: Healthscope Commercial	$53.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.58
Rate for Payer: PHP Commercial	$50.58
Rate for Payer: Priority Health Cigna Priority Health	$38.67
Rate for Payer: Priority Health SBD	$37.48

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$253.75

Service Code	NDC 17478093725
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$159.86
Max. Negotiated Rate	$228.38
Rate for Payer: Aetna Commercial	$215.69
Rate for Payer: Aetna New Business (MI Preferred)	$164.94
Rate for Payer: Cash Price	$203.00
Rate for Payer: Cofinity Commercial	$177.62
Rate for Payer: Cofinity Commercial	$218.22
Rate for Payer: Cofinity Medicare Advantage	$177.62
Rate for Payer: Encore Health Key Benefits Commercial	$203.00
Rate for Payer: Healthscope Commercial	$228.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$215.69
Rate for Payer: PHP Commercial	$215.69
Rate for Payer: Priority Health Cigna Priority Health	$164.94
Rate for Payer: Priority Health SBD	$159.86

DILTIAZEM 60 MG TABLET

Facility

$152.75

Service Code	NDC 50228048201
Hospital Charge Code	2476
Hospital Revenue Code	637
Min. Negotiated Rate	$61.10
Max. Negotiated Rate	$137.47
Rate for Payer: Aetna Commercial	$129.84
Rate for Payer: Aetna Medicare	$76.38
Rate for Payer: Aetna New Business (MI Preferred)	$99.29
Rate for Payer: BCBS Complete	$61.10
Rate for Payer: Cash Price	$122.20
Rate for Payer: Cofinity Commercial	$106.92
Rate for Payer: Cofinity Commercial	$131.37
Rate for Payer: Cofinity Medicare Advantage	$106.92
Rate for Payer: Encore Health Key Benefits Commercial	$122.20
Rate for Payer: Healthscope Commercial	$137.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$129.84
Rate for Payer: PHP Commercial	$129.84
Rate for Payer: Priority Health Cigna Priority Health	$99.29
Rate for Payer: Priority Health SBD	$96.23

DILTIAZEM 60 MG TABLET

Facility

$2.15

Service Code	NDC 60687057311
Hospital Charge Code	2476
Hospital Revenue Code	637
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.94
Rate for Payer: Aetna Commercial	$1.83
Rate for Payer: Aetna Medicare	$1.07
Rate for Payer: Aetna New Business (MI Preferred)	$1.40
Rate for Payer: BCBS Complete	$0.86
Rate for Payer: Cash Price	$1.72
Rate for Payer: Cofinity Commercial	$1.50
Rate for Payer: Cofinity Commercial	$1.85
Rate for Payer: Cofinity Medicare Advantage	$1.50
Rate for Payer: Encore Health Key Benefits Commercial	$1.72
Rate for Payer: Healthscope Commercial	$1.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.83
Rate for Payer: PHP Commercial	$1.83
Rate for Payer: Priority Health Cigna Priority Health	$1.40
Rate for Payer: Priority Health SBD	$1.35

DILTIAZEM 60 MG TABLET

Facility

$4.41

Service Code	NDC 60687072811
Hospital Charge Code	2476
Hospital Revenue Code	637
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$3.97
Rate for Payer: Aetna Commercial	$3.75
Rate for Payer: Aetna Medicare	$2.21
Rate for Payer: Aetna New Business (MI Preferred)	$2.87
Rate for Payer: BCBS Complete	$1.76
Rate for Payer: Cash Price	$3.53
Rate for Payer: Cofinity Commercial	$3.09
Rate for Payer: Cofinity Commercial	$3.79
Rate for Payer: Cofinity Medicare Advantage	$3.09
Rate for Payer: Encore Health Key Benefits Commercial	$3.53
Rate for Payer: Healthscope Commercial	$3.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.75
Rate for Payer: PHP Commercial	$3.75
Rate for Payer: Priority Health Cigna Priority Health	$2.87
Rate for Payer: Priority Health SBD	$2.78

DILTIAZEM 60 MG TABLET

Facility

$595.20

Service Code	NDC 68682000710
Hospital Charge Code	2476
Hospital Revenue Code	637
Min. Negotiated Rate	$374.98
Max. Negotiated Rate	$535.68
Rate for Payer: Aetna Commercial	$505.92
Rate for Payer: Aetna New Business (MI Preferred)	$386.88
Rate for Payer: Cash Price	$476.16
Rate for Payer: Cofinity Commercial	$416.64
Rate for Payer: Cofinity Commercial	$511.87
Rate for Payer: Cofinity Medicare Advantage	$416.64
Rate for Payer: Encore Health Key Benefits Commercial	$476.16
Rate for Payer: Healthscope Commercial	$535.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$505.92
Rate for Payer: PHP Commercial	$505.92
Rate for Payer: Priority Health Cigna Priority Health	$386.88
Rate for Payer: Priority Health SBD	$374.98

DILTIAZEM 60 MG TABLET

Facility

$152.75

Service Code	NDC 50228048201
Hospital Charge Code	2476
Hospital Revenue Code	637
Min. Negotiated Rate	$96.23
Max. Negotiated Rate	$137.47
Rate for Payer: Aetna Commercial	$129.84
Rate for Payer: Aetna New Business (MI Preferred)	$99.29
Rate for Payer: Cash Price	$122.20
Rate for Payer: Cofinity Commercial	$106.92
Rate for Payer: Cofinity Commercial	$131.37
Rate for Payer: Cofinity Medicare Advantage	$106.92
Rate for Payer: Encore Health Key Benefits Commercial	$122.20
Rate for Payer: Healthscope Commercial	$137.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$129.84
Rate for Payer: PHP Commercial	$129.84
Rate for Payer: Priority Health Cigna Priority Health	$99.29
Rate for Payer: Priority Health SBD	$96.23

DILTIAZEM 60 MG TABLET

Facility

$595.20

Service Code	NDC 68682000710
Hospital Charge Code	2476
Hospital Revenue Code	637
Min. Negotiated Rate	$238.08
Max. Negotiated Rate	$535.68
Rate for Payer: Aetna Commercial	$505.92
Rate for Payer: Aetna Medicare	$297.60
Rate for Payer: Aetna New Business (MI Preferred)	$386.88
Rate for Payer: BCBS Complete	$238.08
Rate for Payer: Cash Price	$476.16
Rate for Payer: Cofinity Commercial	$416.64
Rate for Payer: Cofinity Commercial	$511.87
Rate for Payer: Cofinity Medicare Advantage	$416.64
Rate for Payer: Encore Health Key Benefits Commercial	$476.16
Rate for Payer: Healthscope Commercial	$535.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$505.92
Rate for Payer: PHP Commercial	$505.92
Rate for Payer: Priority Health Cigna Priority Health	$386.88
Rate for Payer: Priority Health SBD	$374.98

DILTIAZEM 60 MG TABLET

Facility

$2.15

Service Code	NDC 60687057311
Hospital Charge Code	2476
Hospital Revenue Code	637
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.94
Rate for Payer: Aetna Commercial	$1.83
Rate for Payer: Aetna New Business (MI Preferred)	$1.40
Rate for Payer: Cash Price	$1.72
Rate for Payer: Cofinity Commercial	$1.50
Rate for Payer: Cofinity Commercial	$1.85
Rate for Payer: Cofinity Medicare Advantage	$1.50
Rate for Payer: Encore Health Key Benefits Commercial	$1.72
Rate for Payer: Healthscope Commercial	$1.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.83
Rate for Payer: PHP Commercial	$1.83
Rate for Payer: Priority Health Cigna Priority Health	$1.40
Rate for Payer: Priority Health SBD	$1.35

DILTIAZEM 60 MG TABLET

Facility

$208.05

Service Code	NDC 00093031901
Hospital Charge Code	2476
Hospital Revenue Code	637
Min. Negotiated Rate	$131.07
Max. Negotiated Rate	$187.25
Rate for Payer: Aetna Commercial	$176.84
Rate for Payer: Aetna New Business (MI Preferred)	$135.23
Rate for Payer: Cash Price	$166.44
Rate for Payer: Cofinity Commercial	$145.63
Rate for Payer: Cofinity Commercial	$178.92
Rate for Payer: Cofinity Medicare Advantage	$145.63
Rate for Payer: Encore Health Key Benefits Commercial	$166.44
Rate for Payer: Healthscope Commercial	$187.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$176.84
Rate for Payer: PHP Commercial	$176.84
Rate for Payer: Priority Health Cigna Priority Health	$135.23
Rate for Payer: Priority Health SBD	$131.07

Know your out-of-pocket cost for care.

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