Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$47.75

Service Code	NDC 0409-1171-01
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$30.08
Max. Negotiated Rate	$42.98
Rate for Payer: Aetna Commercial	$40.59
Rate for Payer: Aetna New Business (MI Preferred)	$31.04
Rate for Payer: Cash Price	$38.20
Rate for Payer: Cofinity Commercial	$33.42
Rate for Payer: Cofinity Commercial	$41.06
Rate for Payer: Healthscope Commercial	$42.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$40.59
Rate for Payer: PHP Commercial	$40.59
Rate for Payer: Priority Health Cigna Priority Health	$33.42
Rate for Payer: Priority Health SBD	$30.08

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$59.50

Service Code	NDC 17478-937-10
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)	$38.68
Rate for Payer: Cash Price	$47.60
Rate for Payer: Cofinity Commercial	$41.65
Rate for Payer: Cofinity Commercial	$51.17
Rate for Payer: Healthscope Commercial	$53.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$50.58
Rate for Payer: PHP Commercial	$50.58
Rate for Payer: Priority Health Cigna Priority Health	$41.65
Rate for Payer: Priority Health SBD	$37.48

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$253.75

Service Code	NDC 17478-937-25
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: Healthscope Commercial	$228.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$215.69
Rate for Payer: PHP Commercial	$215.69
Rate for Payer: Priority Health Cigna Priority Health	$177.62
Rate for Payer: Priority Health SBD	$159.86

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$71.75

Service Code	NDC 55150-425-01
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	$50.22
Rate for Payer: Cofinity Commercial	$61.70
Rate for Payer: Healthscope Commercial	$64.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$60.99
Rate for Payer: PHP Commercial	$60.99
Rate for Payer: Priority Health Cigna Priority Health	$50.22
Rate for Payer: Priority Health SBD	$45.20

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$48.63

Service Code	NDC 0641-6013-10
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: Healthscope Commercial	$43.77
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$41.34
Rate for Payer: PHP Commercial	$41.34
Rate for Payer: Priority Health Cigna Priority Health	$34.04
Rate for Payer: Priority Health SBD	$30.64

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$48.63

Service Code	NDC 0641-9217-01
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: Healthscope Commercial	$43.77
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$41.34
Rate for Payer: PHP Commercial	$41.34
Rate for Payer: Priority Health Cigna Priority Health	$34.04
Rate for Payer: Priority Health SBD	$30.64

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$48.63

Service Code	NDC 0641-9217-10
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: Healthscope Commercial	$43.77
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$41.34
Rate for Payer: PHP Commercial	$41.34
Rate for Payer: Priority Health Cigna Priority Health	$34.04
Rate for Payer: Priority Health SBD	$30.64

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$129.38

Service Code	NDC 0641-6015-10
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: Healthscope Commercial	$116.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$109.97
Rate for Payer: PHP Commercial	$109.97
Rate for Payer: Priority Health Cigna Priority Health	$90.57
Rate for Payer: Priority Health SBD	$81.51

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$88.75

Service Code	NDC 0641-6014-10
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	$76.32
Rate for Payer: Healthscope Commercial	$79.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$75.44
Rate for Payer: PHP Commercial	$75.44
Rate for Payer: Priority Health Cigna Priority Health	$62.12
Rate for Payer: Priority Health SBD	$55.91

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$48.63

Service Code	NDC 0641-6013-01
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: Healthscope Commercial	$43.77
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$41.34
Rate for Payer: PHP Commercial	$41.34
Rate for Payer: Priority Health Cigna Priority Health	$34.04
Rate for Payer: Priority Health SBD	$30.64

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$57.25

Service Code	NDC 0409-1171-02
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$36.07
Max. Negotiated Rate	$51.52
Rate for Payer: Aetna Commercial	$48.66
Rate for Payer: Aetna New Business (MI Preferred)	$37.21
Rate for Payer: Cash Price	$45.80
Rate for Payer: Cofinity Commercial	$40.08
Rate for Payer: Cofinity Commercial	$49.24
Rate for Payer: Healthscope Commercial	$51.52
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$48.66
Rate for Payer: PHP Commercial	$48.66
Rate for Payer: Priority Health Cigna Priority Health	$40.08
Rate for Payer: Priority Health SBD	$36.07

DILTIAZEM 60 MG TABLET

Facility

$394.80

Service Code	NDC 63739-080-10
Hospital Charge Code	2476
Hospital Revenue Code	637
Min. Negotiated Rate	$248.72
Max. Negotiated Rate	$355.32
Rate for Payer: Aetna Commercial	$335.58
Rate for Payer: Aetna New Business (MI Preferred)	$256.62
Rate for Payer: Cash Price	$315.84
Rate for Payer: Cofinity Commercial	$276.36
Rate for Payer: Cofinity Commercial	$339.53
Rate for Payer: Healthscope Commercial	$355.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$335.58
Rate for Payer: PHP Commercial	$335.58
Rate for Payer: Priority Health Cigna Priority Health	$276.36
Rate for Payer: Priority Health SBD	$248.72

DILTIAZEM 60 MG TABLET

Facility

$595.20

Service Code	NDC 68682-007-10
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: Healthscope Commercial	$535.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$505.92
Rate for Payer: PHP Commercial	$505.92
Rate for Payer: Priority Health Cigna Priority Health	$416.64
Rate for Payer: Priority Health SBD	$374.98

DILTIAZEM 60 MG TABLET

Facility

$2.01

Service Code	NDC 51079-746-01
Hospital Charge Code	2476
Hospital Revenue Code	637
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$1.81
Rate for Payer: Aetna Commercial	$1.71
Rate for Payer: Aetna New Business (MI Preferred)	$1.31
Rate for Payer: Cash Price	$1.61
Rate for Payer: Cofinity Commercial	$1.41
Rate for Payer: Cofinity Commercial	$1.73
Rate for Payer: Healthscope Commercial	$1.81
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.71
Rate for Payer: PHP Commercial	$1.71
Rate for Payer: Priority Health Cigna Priority Health	$1.41
Rate for Payer: Priority Health SBD	$1.27

DILTIAZEM 60 MG TABLET

Facility

$2.15

Service Code	NDC 60687-573-11
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: Healthscope Commercial	$1.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.83
Rate for Payer: PHP Commercial	$1.83
Rate for Payer: Priority Health Cigna Priority Health	$1.50
Rate for Payer: Priority Health SBD	$1.35

DILTIAZEM 60 MG TABLET

Facility

$200.45

Service Code	NDC 51079-746-20
Hospital Charge Code	2476
Hospital Revenue Code	637
Min. Negotiated Rate	$126.28
Max. Negotiated Rate	$180.40
Rate for Payer: Aetna Commercial	$170.38
Rate for Payer: Aetna New Business (MI Preferred)	$130.29
Rate for Payer: Cash Price	$160.36
Rate for Payer: Cofinity Commercial	$140.32
Rate for Payer: Cofinity Commercial	$172.39
Rate for Payer: Healthscope Commercial	$180.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$170.38
Rate for Payer: PHP Commercial	$170.38
Rate for Payer: Priority Health Cigna Priority Health	$140.32
Rate for Payer: Priority Health SBD	$126.28

DILTIAZEM 60 MG TABLET

Facility

$208.05

Service Code	NDC 0093-0319-01
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: Healthscope Commercial	$187.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$176.84
Rate for Payer: PHP Commercial	$176.84
Rate for Payer: Priority Health Cigna Priority Health	$145.64
Rate for Payer: Priority Health SBD	$131.07

DILTIAZEM 60 MG TABLET

Facility

$214.70

Service Code	NDC 60687-573-01
Hospital Charge Code	2476
Hospital Revenue Code	637
Min. Negotiated Rate	$135.26
Max. Negotiated Rate	$193.23
Rate for Payer: Aetna Commercial	$182.50
Rate for Payer: Aetna New Business (MI Preferred)	$139.56
Rate for Payer: Cash Price	$171.76
Rate for Payer: Cofinity Commercial	$150.29
Rate for Payer: Cofinity Commercial	$184.64
Rate for Payer: Healthscope Commercial	$193.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$182.50
Rate for Payer: PHP Commercial	$182.50
Rate for Payer: Priority Health Cigna Priority Health	$150.29
Rate for Payer: Priority Health SBD	$135.26

DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$428.45

Service Code	NDC 60687-195-01
Hospital Charge Code	27480
Hospital Revenue Code	637
Min. Negotiated Rate	$269.92
Max. Negotiated Rate	$385.60
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 Commercial	$299.92
Rate for Payer: Cofinity Commercial	$368.47
Rate for Payer: Healthscope Commercial	$385.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$364.18
Rate for Payer: PHP Commercial	$364.18
Rate for Payer: Priority Health Cigna Priority Health	$299.92
Rate for Payer: Priority Health SBD	$269.92

DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$389.88

Service Code	NDC 68382-595-16
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: Healthscope Commercial	$350.89
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$331.40
Rate for Payer: PHP Commercial	$331.40
Rate for Payer: Priority Health Cigna Priority Health	$272.92
Rate for Payer: Priority Health SBD	$245.62

DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$200.45

Service Code	NDC 63739-014-10
Hospital Charge Code	27480
Hospital Revenue Code	637
Min. Negotiated Rate	$126.28
Max. Negotiated Rate	$180.40
Rate for Payer: Aetna Commercial	$170.38
Rate for Payer: Aetna New Business (MI Preferred)	$130.29
Rate for Payer: Cash Price	$160.36
Rate for Payer: Cofinity Commercial	$140.32
Rate for Payer: Cofinity Commercial	$172.39
Rate for Payer: Healthscope Commercial	$180.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$170.38
Rate for Payer: PHP Commercial	$170.38
Rate for Payer: Priority Health Cigna Priority Health	$140.32
Rate for Payer: Priority Health SBD	$126.28

DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$317.96

Service Code	NDC 10370-829-09
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: Healthscope Commercial	$286.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$270.27
Rate for Payer: PHP Commercial	$270.27
Rate for Payer: Priority Health Cigna Priority Health	$222.57
Rate for Payer: Priority Health SBD	$200.31

DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$4.29

Service Code	NDC 60687-195-11
Hospital Charge Code	27480
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 Commercial	$3.00
Rate for Payer: Cofinity Commercial	$3.69
Rate for Payer: Healthscope Commercial	$3.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.65
Rate for Payer: PHP Commercial	$3.65
Rate for Payer: Priority Health Cigna Priority Health	$3.00
Rate for Payer: Priority Health SBD	$2.70

DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$305.90

Service Code	NDC 60687-206-01
Hospital Charge Code	29272
Hospital Revenue Code	637
Min. Negotiated Rate	$192.72
Max. Negotiated Rate	$275.31
Rate for Payer: Aetna Commercial	$260.02
Rate for Payer: Aetna New Business (MI Preferred)	$198.84
Rate for Payer: Cash Price	$244.72
Rate for Payer: Cofinity Commercial	$214.13
Rate for Payer: Cofinity Commercial	$263.07
Rate for Payer: Healthscope Commercial	$275.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$260.02
Rate for Payer: PHP Commercial	$260.02
Rate for Payer: Priority Health Cigna Priority Health	$214.13
Rate for Payer: Priority Health SBD	$192.72

DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$172.71

Service Code	NDC 50742-249-90
Hospital Charge Code	29272
Hospital Revenue Code	637
Min. Negotiated Rate	$108.81
Max. Negotiated Rate	$155.44
Rate for Payer: Aetna Commercial	$146.80
Rate for Payer: Aetna New Business (MI Preferred)	$112.26
Rate for Payer: Cash Price	$138.17
Rate for Payer: Cofinity Commercial	$120.90
Rate for Payer: Cofinity Commercial	$148.53
Rate for Payer: Healthscope Commercial	$155.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$146.80
Rate for Payer: PHP Commercial	$146.80
Rate for Payer: Priority Health Cigna Priority Health	$120.90
Rate for Payer: Priority Health SBD	$108.81

Know your out-of-pocket cost for care.

All Charges