Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

DILTIAZEM 60 MG TABLET

Facility

$440.80

Service Code	NDC 60687072801
Hospital Charge Code	2476
Hospital Revenue Code	637
Min. Negotiated Rate	$277.70
Max. Negotiated Rate	$396.72
Rate for Payer: Aetna Commercial	$374.68
Rate for Payer: Aetna New Business (MI Preferred)	$286.52
Rate for Payer: Cash Price	$352.64
Rate for Payer: Cofinity Commercial	$308.56
Rate for Payer: Cofinity Commercial	$379.09
Rate for Payer: Cofinity Medicare Advantage	$308.56
Rate for Payer: Encore Health Key Benefits Commercial	$352.64
Rate for Payer: Healthscope Commercial	$396.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$374.68
Rate for Payer: PHP Commercial	$374.68
Rate for Payer: Priority Health Cigna Priority Health	$286.52
Rate for Payer: Priority Health SBD	$277.70

DILTIAZEM 60 MG TABLET

Facility

$4.41

Service Code	NDC 60687072811
Hospital Charge Code	2476
Hospital Revenue Code	637
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$3.97
Rate for Payer: Aetna Commercial	$3.75
Rate for Payer: Aetna New Business (MI Preferred)	$2.87
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	$137.48
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	$131.36
Rate for Payer: Cofinity Medicare Advantage	$106.92
Rate for Payer: Encore Health Key Benefits Commercial	$122.20
Rate for Payer: Healthscope Commercial	$137.48
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

$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	$2.20
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

$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

$440.80

Service Code	NDC 60687072801
Hospital Charge Code	2476
Hospital Revenue Code	637
Min. Negotiated Rate	$176.32
Max. Negotiated Rate	$396.72
Rate for Payer: Aetna Commercial	$374.68
Rate for Payer: Aetna Medicare	$220.40
Rate for Payer: Aetna New Business (MI Preferred)	$286.52
Rate for Payer: BCBS Complete	$176.32
Rate for Payer: Cash Price	$352.64
Rate for Payer: Cofinity Commercial	$308.56
Rate for Payer: Cofinity Commercial	$379.09
Rate for Payer: Cofinity Medicare Advantage	$308.56
Rate for Payer: Encore Health Key Benefits Commercial	$352.64
Rate for Payer: Healthscope Commercial	$396.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$374.68
Rate for Payer: PHP Commercial	$374.68
Rate for Payer: Priority Health Cigna Priority Health	$286.52
Rate for Payer: Priority Health SBD	$277.70

DILTIAZEM 60 MG TABLET

Facility

$208.05

Service Code	NDC 00093031901
Hospital Charge Code	2476
Hospital Revenue Code	637
Min. Negotiated Rate	$83.22
Max. Negotiated Rate	$187.24
Rate for Payer: Aetna Commercial	$176.84
Rate for Payer: Aetna Medicare	$104.02
Rate for Payer: Aetna New Business (MI Preferred)	$135.23
Rate for Payer: BCBS Complete	$83.22
Rate for Payer: Cash Price	$166.44
Rate for Payer: Cofinity Commercial	$145.64
Rate for Payer: Cofinity Commercial	$178.92
Rate for Payer: Cofinity Medicare Advantage	$145.64
Rate for Payer: Encore Health Key Benefits Commercial	$166.44
Rate for Payer: Healthscope Commercial	$187.24
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

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	$0.86
Max. Negotiated Rate	$1.94
Rate for Payer: Aetna Commercial	$1.83
Rate for Payer: Aetna Medicare	$1.08
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

$208.05

Service Code	NDC 00093031901
Hospital Charge Code	2476
Hospital Revenue Code	637
Min. Negotiated Rate	$131.07
Max. Negotiated Rate	$187.24
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	$145.64
Rate for Payer: Cofinity Commercial	$178.92
Rate for Payer: Cofinity Medicare Advantage	$145.64
Rate for Payer: Encore Health Key Benefits Commercial	$166.44
Rate for Payer: Healthscope Commercial	$187.24
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

DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$336.30

Service Code	NDC 00904721761
Hospital Charge Code	27480
Hospital Revenue Code	637
Min. Negotiated Rate	$211.87
Max. Negotiated Rate	$302.67
Rate for Payer: Aetna Commercial	$285.86
Rate for Payer: Aetna New Business (MI Preferred)	$218.60
Rate for Payer: Cash Price	$269.04
Rate for Payer: Cofinity Commercial	$235.41
Rate for Payer: Cofinity Commercial	$289.22
Rate for Payer: Cofinity Medicare Advantage	$235.41
Rate for Payer: Encore Health Key Benefits Commercial	$269.04
Rate for Payer: Healthscope Commercial	$302.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$285.86
Rate for Payer: PHP Commercial	$285.86
Rate for Payer: Priority Health Cigna Priority Health	$218.60
Rate for Payer: Priority Health SBD	$211.87

DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$317.96

Service Code	NDC 10370082909
Hospital Charge Code	27480
Hospital Revenue Code	637
Min. Negotiated Rate	$127.18
Max. Negotiated Rate	$286.16
Rate for Payer: Aetna Commercial	$270.27
Rate for Payer: Aetna Medicare	$158.98
Rate for Payer: Aetna New Business (MI Preferred)	$206.67
Rate for Payer: BCBS Complete	$127.18
Rate for Payer: Cash Price	$254.37
Rate for Payer: Cofinity Commercial	$222.57
Rate for Payer: Cofinity Commercial	$273.45
Rate for Payer: Cofinity Medicare Advantage	$222.57
Rate for Payer: Encore Health Key Benefits Commercial	$254.37
Rate for Payer: Healthscope Commercial	$286.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$270.27
Rate for Payer: PHP Commercial	$270.27
Rate for Payer: Priority Health Cigna Priority Health	$206.67
Rate for Payer: Priority Health SBD	$200.31

DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$369.55

Service Code	NDC 60687019501
Hospital Charge Code	27480
Hospital Revenue Code	637
Min. Negotiated Rate	$147.82
Max. Negotiated Rate	$332.60
Rate for Payer: Aetna Commercial	$314.12
Rate for Payer: Aetna Medicare	$184.78
Rate for Payer: Aetna New Business (MI Preferred)	$240.21
Rate for Payer: BCBS Complete	$147.82
Rate for Payer: Cash Price	$295.64
Rate for Payer: Cofinity Commercial	$258.68
Rate for Payer: Cofinity Commercial	$317.81
Rate for Payer: Cofinity Medicare Advantage	$258.68
Rate for Payer: Encore Health Key Benefits Commercial	$295.64
Rate for Payer: Healthscope Commercial	$332.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$314.12
Rate for Payer: PHP Commercial	$314.12
Rate for Payer: Priority Health Cigna Priority Health	$240.21
Rate for Payer: Priority Health SBD	$232.82

DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$389.88

Service Code	NDC 68382059516
Hospital Charge Code	27480
Hospital Revenue Code	637
Min. Negotiated Rate	$245.62
Max. Negotiated Rate	$350.89
Rate for Payer: Aetna Commercial	$331.40
Rate for Payer: Aetna New Business (MI Preferred)	$253.42
Rate for Payer: Cash Price	$311.90
Rate for Payer: Cofinity Commercial	$272.92
Rate for Payer: Cofinity Commercial	$335.30
Rate for Payer: Cofinity Medicare Advantage	$272.92
Rate for Payer: Encore Health Key Benefits Commercial	$311.90
Rate for Payer: Healthscope Commercial	$350.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$331.40
Rate for Payer: PHP Commercial	$331.40
Rate for Payer: Priority Health Cigna Priority Health	$253.42
Rate for Payer: Priority Health SBD	$245.62

DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$336.30

Service Code	NDC 00904721761
Hospital Charge Code	27480
Hospital Revenue Code	637
Min. Negotiated Rate	$134.52
Max. Negotiated Rate	$302.67
Rate for Payer: Aetna Commercial	$285.86
Rate for Payer: Aetna Medicare	$168.15
Rate for Payer: Aetna New Business (MI Preferred)	$218.60
Rate for Payer: BCBS Complete	$134.52
Rate for Payer: Cash Price	$269.04
Rate for Payer: Cofinity Commercial	$235.41
Rate for Payer: Cofinity Commercial	$289.22
Rate for Payer: Cofinity Medicare Advantage	$235.41
Rate for Payer: Encore Health Key Benefits Commercial	$269.04
Rate for Payer: Healthscope Commercial	$302.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$285.86
Rate for Payer: PHP Commercial	$285.86
Rate for Payer: Priority Health Cigna Priority Health	$218.60
Rate for Payer: Priority Health SBD	$211.87

DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$3.70

Service Code	NDC 60687019511
Hospital Charge Code	27480
Hospital Revenue Code	637
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$3.33
Rate for Payer: Aetna Commercial	$3.14
Rate for Payer: Aetna New Business (MI Preferred)	$2.40
Rate for Payer: Cash Price	$2.96
Rate for Payer: Cofinity Commercial	$2.59
Rate for Payer: Cofinity Commercial	$3.18
Rate for Payer: Cofinity Medicare Advantage	$2.59
Rate for Payer: Encore Health Key Benefits Commercial	$2.96
Rate for Payer: Healthscope Commercial	$3.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.14
Rate for Payer: PHP Commercial	$3.14
Rate for Payer: Priority Health Cigna Priority Health	$2.40
Rate for Payer: Priority Health SBD	$2.33

DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$3.70

Service Code	NDC 60687019511
Hospital Charge Code	27480
Hospital Revenue Code	637
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$3.33
Rate for Payer: Aetna Commercial	$3.14
Rate for Payer: Aetna Medicare	$1.85
Rate for Payer: Aetna New Business (MI Preferred)	$2.40
Rate for Payer: BCBS Complete	$1.48
Rate for Payer: Cash Price	$2.96
Rate for Payer: Cofinity Commercial	$2.59
Rate for Payer: Cofinity Commercial	$3.18
Rate for Payer: Cofinity Medicare Advantage	$2.59
Rate for Payer: Encore Health Key Benefits Commercial	$2.96
Rate for Payer: Healthscope Commercial	$3.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.14
Rate for Payer: PHP Commercial	$3.14
Rate for Payer: Priority Health Cigna Priority Health	$2.40
Rate for Payer: Priority Health SBD	$2.33

DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$369.55

Service Code	NDC 60687019501
Hospital Charge Code	27480
Hospital Revenue Code	637
Min. Negotiated Rate	$232.82
Max. Negotiated Rate	$332.60
Rate for Payer: Aetna Commercial	$314.12
Rate for Payer: Aetna New Business (MI Preferred)	$240.21
Rate for Payer: Cash Price	$295.64
Rate for Payer: Cofinity Commercial	$258.68
Rate for Payer: Cofinity Commercial	$317.81
Rate for Payer: Cofinity Medicare Advantage	$258.68
Rate for Payer: Encore Health Key Benefits Commercial	$295.64
Rate for Payer: Healthscope Commercial	$332.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$314.12
Rate for Payer: PHP Commercial	$314.12
Rate for Payer: Priority Health Cigna Priority Health	$240.21
Rate for Payer: Priority Health SBD	$232.82

DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$389.88

Service Code	NDC 68382059516
Hospital Charge Code	27480
Hospital Revenue Code	637
Min. Negotiated Rate	$155.95
Max. Negotiated Rate	$350.89
Rate for Payer: Aetna Commercial	$331.40
Rate for Payer: Aetna Medicare	$194.94
Rate for Payer: Aetna New Business (MI Preferred)	$253.42
Rate for Payer: BCBS Complete	$155.95
Rate for Payer: Cash Price	$311.90
Rate for Payer: Cofinity Commercial	$272.92
Rate for Payer: Cofinity Commercial	$335.30
Rate for Payer: Cofinity Medicare Advantage	$272.92
Rate for Payer: Encore Health Key Benefits Commercial	$311.90
Rate for Payer: Healthscope Commercial	$350.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$331.40
Rate for Payer: PHP Commercial	$331.40
Rate for Payer: Priority Health Cigna Priority Health	$253.42
Rate for Payer: Priority Health SBD	$245.62

DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$317.96

Service Code	NDC 10370082909
Hospital Charge Code	27480
Hospital Revenue Code	637
Min. Negotiated Rate	$200.31
Max. Negotiated Rate	$286.16
Rate for Payer: Aetna Commercial	$270.27
Rate for Payer: Aetna New Business (MI Preferred)	$206.67
Rate for Payer: Cash Price	$254.37
Rate for Payer: Cofinity Commercial	$222.57
Rate for Payer: Cofinity Commercial	$273.45
Rate for Payer: Cofinity Medicare Advantage	$222.57
Rate for Payer: Encore Health Key Benefits Commercial	$254.37
Rate for Payer: Healthscope Commercial	$286.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$270.27
Rate for Payer: PHP Commercial	$270.27
Rate for Payer: Priority Health Cigna Priority Health	$206.67
Rate for Payer: Priority Health SBD	$200.31

DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$172.71

Service Code	NDC 50742024990
Hospital Charge Code	29272
Hospital Revenue Code	637
Min. Negotiated Rate	$69.08
Max. Negotiated Rate	$155.44
Rate for Payer: Aetna Commercial	$146.80
Rate for Payer: Aetna Medicare	$86.36
Rate for Payer: Aetna New Business (MI Preferred)	$112.26
Rate for Payer: BCBS Complete	$69.08
Rate for Payer: Cash Price	$138.17
Rate for Payer: Cofinity Commercial	$120.90
Rate for Payer: Cofinity Commercial	$148.53
Rate for Payer: Cofinity Medicare Advantage	$120.90
Rate for Payer: Encore Health Key Benefits Commercial	$138.17
Rate for Payer: Healthscope Commercial	$155.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$146.80
Rate for Payer: PHP Commercial	$146.80
Rate for Payer: Priority Health Cigna Priority Health	$112.26
Rate for Payer: Priority Health SBD	$108.81

DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$3.04

Service Code	NDC 60687020611
Hospital Charge Code	29272
Hospital Revenue Code	637
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$2.74
Rate for Payer: Aetna Commercial	$2.58
Rate for Payer: Aetna Medicare	$1.52
Rate for Payer: Aetna New Business (MI Preferred)	$1.98
Rate for Payer: BCBS Complete	$1.22
Rate for Payer: Cash Price	$2.43
Rate for Payer: Cofinity Commercial	$2.13
Rate for Payer: Cofinity Commercial	$2.61
Rate for Payer: Cofinity Medicare Advantage	$2.13
Rate for Payer: Encore Health Key Benefits Commercial	$2.43
Rate for Payer: Healthscope Commercial	$2.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.58
Rate for Payer: PHP Commercial	$2.58
Rate for Payer: Priority Health Cigna Priority Health	$1.98
Rate for Payer: Priority Health SBD	$1.92

DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$304.00

Service Code	NDC 60687020601
Hospital Charge Code	29272
Hospital Revenue Code	637
Min. Negotiated Rate	$191.52
Max. Negotiated Rate	$273.60
Rate for Payer: Aetna Commercial	$258.40
Rate for Payer: Aetna New Business (MI Preferred)	$197.60
Rate for Payer: Cash Price	$243.20
Rate for Payer: Cofinity Commercial	$212.80
Rate for Payer: Cofinity Commercial	$261.44
Rate for Payer: Cofinity Medicare Advantage	$212.80
Rate for Payer: Encore Health Key Benefits Commercial	$243.20
Rate for Payer: Healthscope Commercial	$273.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$258.40
Rate for Payer: PHP Commercial	$258.40
Rate for Payer: Priority Health Cigna Priority Health	$197.60
Rate for Payer: Priority Health SBD	$191.52

DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$304.00

Service Code	NDC 60687020601
Hospital Charge Code	29272
Hospital Revenue Code	637
Min. Negotiated Rate	$121.60
Max. Negotiated Rate	$273.60
Rate for Payer: Aetna Commercial	$258.40
Rate for Payer: Aetna Medicare	$152.00
Rate for Payer: Aetna New Business (MI Preferred)	$197.60
Rate for Payer: BCBS Complete	$121.60
Rate for Payer: Cash Price	$243.20
Rate for Payer: Cofinity Commercial	$212.80
Rate for Payer: Cofinity Commercial	$261.44
Rate for Payer: Cofinity Medicare Advantage	$212.80
Rate for Payer: Encore Health Key Benefits Commercial	$243.20
Rate for Payer: Healthscope Commercial	$273.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$258.40
Rate for Payer: PHP Commercial	$258.40
Rate for Payer: Priority Health Cigna Priority Health	$197.60
Rate for Payer: Priority Health SBD	$191.52

Know your out-of-pocket cost for care.

All Charges