Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

DIGESTIVE MALIGNANCY WITHOUT CC/MCC

Facility

$11,534.86

Service Code	MS-DRG 376
Min. Negotiated Rate	$8,766.50
Max. Negotiated Rate	$11,534.86
Rate for Payer: Aetna Medicare	$9,227.89
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,534.86
Rate for Payer: Amish Plain Church Group Commercial	$11,534.86
Rate for Payer: BCBS MAPPO	$9,227.89
Rate for Payer: BCN Medicare Advantage	$9,227.89
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,227.89
Rate for Payer: Humana Choice PPO Medicare	$9,227.89
Rate for Payer: Mclaren Medicare	$9,227.89
Rate for Payer: Meridian Wellcare - Medicare Advantage	$9,689.28
Rate for Payer: MI Amish Medical Board Commercial	$10,612.07
Rate for Payer: PACE Medicare	$8,766.50
Rate for Payer: PACE SWMI	$9,227.89
Rate for Payer: PHP Commercial	$10,150.68
Rate for Payer: PHP Medicare Advantage	$9,227.89
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11,445.58
Rate for Payer: Priority Health Medicare	$9,227.89
Rate for Payer: Priority Health Narrow Network	$9,156.46
Rate for Payer: Railroad Medicare Medicare	$9,227.89
Rate for Payer: UHC Medicare Advantage	$9,504.73
Rate for Payer: VA VA	$9,227.89

DIGOXIN 125 MCG (0.125 MG) TABLET

Facility

$403.20

Service Code	NDC 0904-5921-61
Hospital Charge Code	2444
Hospital Revenue Code	637
Min. Negotiated Rate	$282.24
Max. Negotiated Rate	$403.20
Rate for Payer: Aetna Commercial	$362.88
Rate for Payer: ASR ASR	$391.10
Rate for Payer: BCBS Trust/PPO	$312.60
Rate for Payer: BCN Commercial	$312.60
Rate for Payer: Cash Price	$322.56
Rate for Payer: Cofinity Commercial	$379.01
Rate for Payer: Encore Health Key Benefits Commercial	$322.56
Rate for Payer: Healthscope Commercial	$403.20
Rate for Payer: Healthscope Whirlpool	$391.10
Rate for Payer: Mclaren Commercial	$362.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$342.72
Rate for Payer: Priority Health Cigna Priority Health	$282.24
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$354.82

DIGOXIN 125 MCG (0.125 MG) TABLET

Facility

$601.92

Service Code	NDC 42292-003-20
Hospital Charge Code	2444
Hospital Revenue Code	637
Min. Negotiated Rate	$421.34
Max. Negotiated Rate	$601.92
Rate for Payer: Aetna Commercial	$541.73
Rate for Payer: ASR ASR	$583.86
Rate for Payer: BCBS Trust/PPO	$466.67
Rate for Payer: BCN Commercial	$466.67
Rate for Payer: Cash Price	$481.54
Rate for Payer: Cofinity Commercial	$565.80
Rate for Payer: Encore Health Key Benefits Commercial	$481.54
Rate for Payer: Healthscope Commercial	$601.92
Rate for Payer: Healthscope Whirlpool	$583.86
Rate for Payer: Mclaren Commercial	$541.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$511.63
Rate for Payer: Priority Health Cigna Priority Health	$421.34
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$529.69

DIGOXIN 125 MCG (0.125 MG) TABLET

Facility

$6.02

Service Code	NDC 42292-003-01
Hospital Charge Code	2444
Hospital Revenue Code	637
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$6.02
Rate for Payer: Aetna Commercial	$5.42
Rate for Payer: ASR ASR	$5.84
Rate for Payer: BCBS Trust/PPO	$4.67
Rate for Payer: BCN Commercial	$4.67
Rate for Payer: Cash Price	$4.82
Rate for Payer: Cofinity Commercial	$5.66
Rate for Payer: Encore Health Key Benefits Commercial	$4.82
Rate for Payer: Healthscope Commercial	$6.02
Rate for Payer: Healthscope Whirlpool	$5.84
Rate for Payer: Mclaren Commercial	$5.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5.12
Rate for Payer: Priority Health Cigna Priority Health	$4.21
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5.30

DIGOXIN 250 MCG (0.25 MG) TABLET

Facility

$40.99

Service Code	NDC 0904-5922-61
Hospital Charge Code	2445
Hospital Revenue Code	637
Min. Negotiated Rate	$28.69
Max. Negotiated Rate	$40.99
Rate for Payer: Aetna Commercial	$36.89
Rate for Payer: ASR ASR	$39.76
Rate for Payer: BCBS Trust/PPO	$31.78
Rate for Payer: BCN Commercial	$31.78
Rate for Payer: Cash Price	$32.79
Rate for Payer: Cofinity Commercial	$38.53
Rate for Payer: Encore Health Key Benefits Commercial	$32.79
Rate for Payer: Healthscope Commercial	$40.99
Rate for Payer: Healthscope Whirlpool	$39.76
Rate for Payer: Mclaren Commercial	$36.89
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$34.84
Rate for Payer: Priority Health Cigna Priority Health	$28.69
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$36.07

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

Facility

$21.61

Service Code	HCPCS J1160
Hospital Charge Code	108720
Hospital Revenue Code	636
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$21.61
Rate for Payer: Aetna Commercial	$19.45
Rate for Payer: ASR ASR	$20.96
Rate for Payer: BCBS Trust/PPO	$16.75
Rate for Payer: BCN Commercial	$16.75
Rate for Payer: Cash Price	$17.29
Rate for Payer: Cofinity Commercial	$20.31
Rate for Payer: Encore Health Key Benefits Commercial	$17.29
Rate for Payer: Healthscope Commercial	$21.61
Rate for Payer: Healthscope Whirlpool	$20.96
Rate for Payer: Mclaren Commercial	$19.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.37
Rate for Payer: Priority Health Cigna Priority Health	$15.13
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$19.02

DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION

Facility

$11,120.38

Service Code	HCPCS J1162
Hospital Charge Code	31432
Hospital Revenue Code	636
Min. Negotiated Rate	$7,784.27
Max. Negotiated Rate	$11,120.38
Rate for Payer: Aetna Commercial	$10,008.34
Rate for Payer: ASR ASR	$10,786.77
Rate for Payer: BCBS Trust/PPO	$8,621.63
Rate for Payer: BCN Commercial	$8,621.63
Rate for Payer: Cash Price	$8,896.31
Rate for Payer: Cofinity Commercial	$10,453.16
Rate for Payer: Encore Health Key Benefits Commercial	$8,896.30
Rate for Payer: Healthscope Commercial	$11,120.38
Rate for Payer: Healthscope Whirlpool	$10,786.77
Rate for Payer: Mclaren Commercial	$10,008.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$9,452.32
Rate for Payer: Priority Health Cigna Priority Health	$7,784.27
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$9,785.93

DILTIAZEM 100 MG INTRAVENOUS SOLUTION

Facility

$83.29

Service Code	NDC 0409-4350-13
Hospital Charge Code	22156
Hospital Revenue Code	250
Min. Negotiated Rate	$58.30
Max. Negotiated Rate	$83.29
Rate for Payer: Aetna Commercial	$74.96
Rate for Payer: ASR ASR	$80.79
Rate for Payer: BCBS Trust/PPO	$64.57
Rate for Payer: BCN Commercial	$64.57
Rate for Payer: Cash Price	$66.63
Rate for Payer: Cofinity Commercial	$78.29
Rate for Payer: Encore Health Key Benefits Commercial	$66.63
Rate for Payer: Healthscope Commercial	$83.29
Rate for Payer: Healthscope Whirlpool	$80.79
Rate for Payer: Mclaren Commercial	$74.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$70.80
Rate for Payer: Priority Health Cigna Priority Health	$58.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$73.30

DILTIAZEM 100 MG INTRAVENOUS SOLUTION

Facility

$83.29

Service Code	NDC 0409-4350-03
Hospital Charge Code	22156
Hospital Revenue Code	250
Min. Negotiated Rate	$58.30
Max. Negotiated Rate	$83.29
Rate for Payer: Aetna Commercial	$74.96
Rate for Payer: ASR ASR	$80.79
Rate for Payer: BCBS Trust/PPO	$64.57
Rate for Payer: BCN Commercial	$64.57
Rate for Payer: Cash Price	$66.63
Rate for Payer: Cofinity Commercial	$78.29
Rate for Payer: Encore Health Key Benefits Commercial	$66.63
Rate for Payer: Healthscope Commercial	$83.29
Rate for Payer: Healthscope Whirlpool	$80.79
Rate for Payer: Mclaren Commercial	$74.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$70.80
Rate for Payer: Priority Health Cigna Priority Health	$58.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$73.30

DILTIAZEM 30 MG TABLET

Facility

$3.74

Service Code	NDC 51079-745-01
Hospital Charge Code	2475
Hospital Revenue Code	637
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$3.74
Rate for Payer: Aetna Commercial	$3.37
Rate for Payer: ASR ASR	$3.63
Rate for Payer: BCBS Trust/PPO	$2.90
Rate for Payer: BCN Commercial	$2.90
Rate for Payer: Cash Price	$2.99
Rate for Payer: Cofinity Commercial	$3.52
Rate for Payer: Encore Health Key Benefits Commercial	$2.99
Rate for Payer: Healthscope Commercial	$3.74
Rate for Payer: Healthscope Whirlpool	$3.63
Rate for Payer: Mclaren Commercial	$3.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.18
Rate for Payer: Priority Health Cigna Priority Health	$2.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.29

DILTIAZEM 30 MG TABLET

Facility

$324.30

Service Code	NDC 63739-079-10
Hospital Charge Code	2475
Hospital Revenue Code	637
Min. Negotiated Rate	$227.01
Max. Negotiated Rate	$324.30
Rate for Payer: Aetna Commercial	$291.87
Rate for Payer: ASR ASR	$314.57
Rate for Payer: BCBS Trust/PPO	$251.43
Rate for Payer: BCN Commercial	$251.43
Rate for Payer: Cash Price	$259.44
Rate for Payer: Cofinity Commercial	$304.84
Rate for Payer: Encore Health Key Benefits Commercial	$259.44
Rate for Payer: Healthscope Commercial	$324.30
Rate for Payer: Healthscope Whirlpool	$314.57
Rate for Payer: Mclaren Commercial	$291.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$275.66
Rate for Payer: Priority Health Cigna Priority Health	$227.01
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$285.38

DILTIAZEM 30 MG TABLET

Facility

$326.65

Service Code	NDC 0093-0318-01
Hospital Charge Code	2475
Hospital Revenue Code	637
Min. Negotiated Rate	$228.66
Max. Negotiated Rate	$326.65
Rate for Payer: Aetna Commercial	$293.98
Rate for Payer: ASR ASR	$316.85
Rate for Payer: BCBS Trust/PPO	$253.25
Rate for Payer: BCN Commercial	$253.25
Rate for Payer: Cash Price	$261.32
Rate for Payer: Cofinity Commercial	$307.05
Rate for Payer: Encore Health Key Benefits Commercial	$261.32
Rate for Payer: Healthscope Commercial	$326.65
Rate for Payer: Healthscope Whirlpool	$316.85
Rate for Payer: Mclaren Commercial	$293.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$277.65
Rate for Payer: Priority Health Cigna Priority Health	$228.66
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$287.45

DILTIAZEM 30 MG TABLET

Facility

$373.65

Service Code	NDC 51079-745-20
Hospital Charge Code	2475
Hospital Revenue Code	637
Min. Negotiated Rate	$261.56
Max. Negotiated Rate	$373.65
Rate for Payer: Aetna Commercial	$336.28
Rate for Payer: ASR ASR	$362.44
Rate for Payer: BCBS Trust/PPO	$289.69
Rate for Payer: BCN Commercial	$289.69
Rate for Payer: Cash Price	$298.92
Rate for Payer: Cofinity Commercial	$351.23
Rate for Payer: Encore Health Key Benefits Commercial	$298.92
Rate for Payer: Healthscope Commercial	$373.65
Rate for Payer: Healthscope Whirlpool	$362.44
Rate for Payer: Mclaren Commercial	$336.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$317.60
Rate for Payer: Priority Health Cigna Priority Health	$261.56
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$328.81

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$131.88

Service Code	NDC 0641-9219-01
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$92.32
Max. Negotiated Rate	$131.88
Rate for Payer: Aetna Commercial	$118.69
Rate for Payer: ASR ASR	$127.92
Rate for Payer: BCBS Trust/PPO	$102.25
Rate for Payer: BCN Commercial	$102.25
Rate for Payer: Cash Price	$105.50
Rate for Payer: Cofinity Commercial	$123.97
Rate for Payer: Encore Health Key Benefits Commercial	$105.50
Rate for Payer: Healthscope Commercial	$131.88
Rate for Payer: Healthscope Whirlpool	$127.92
Rate for Payer: Mclaren Commercial	$118.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$112.10
Rate for Payer: Priority Health Cigna Priority Health	$92.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$116.05

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$90.50

Service Code	NDC 0641-9218-01
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$63.35
Max. Negotiated Rate	$90.50
Rate for Payer: Aetna Commercial	$81.45
Rate for Payer: ASR ASR	$87.78
Rate for Payer: BCBS Trust/PPO	$70.16
Rate for Payer: BCN Commercial	$70.16
Rate for Payer: Cash Price	$72.40
Rate for Payer: Cofinity Commercial	$85.07
Rate for Payer: Encore Health Key Benefits Commercial	$72.40
Rate for Payer: Healthscope Commercial	$90.50
Rate for Payer: Healthscope Whirlpool	$87.78
Rate for Payer: Mclaren Commercial	$81.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$76.92
Rate for Payer: Priority Health Cigna Priority Health	$63.35
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$79.64

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$131.88

Service Code	NDC 0641-9219-10
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$92.32
Max. Negotiated Rate	$131.88
Rate for Payer: Aetna Commercial	$118.69
Rate for Payer: ASR ASR	$127.92
Rate for Payer: BCBS Trust/PPO	$102.25
Rate for Payer: BCN Commercial	$102.25
Rate for Payer: Cash Price	$105.50
Rate for Payer: Cofinity Commercial	$123.97
Rate for Payer: Encore Health Key Benefits Commercial	$105.50
Rate for Payer: Healthscope Commercial	$131.88
Rate for Payer: Healthscope Whirlpool	$127.92
Rate for Payer: Mclaren Commercial	$118.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$112.10
Rate for Payer: Priority Health Cigna Priority Health	$92.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$116.05

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$65.25

Service Code	NDC 17478-937-05
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$45.68
Max. Negotiated Rate	$65.25
Rate for Payer: Aetna Commercial	$58.72
Rate for Payer: ASR ASR	$63.29
Rate for Payer: BCBS Trust/PPO	$50.59
Rate for Payer: BCN Commercial	$50.59
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cofinity Commercial	$61.34
Rate for Payer: Encore Health Key Benefits Commercial	$52.20
Rate for Payer: Healthscope Commercial	$65.25
Rate for Payer: Healthscope Whirlpool	$63.29
Rate for Payer: Mclaren Commercial	$58.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$55.46
Rate for Payer: Priority Health Cigna Priority Health	$45.68
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$57.42

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$253.75

Service Code	NDC 17478-937-26
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$177.62
Max. Negotiated Rate	$253.75
Rate for Payer: Aetna Commercial	$228.38
Rate for Payer: ASR ASR	$246.14
Rate for Payer: BCBS Trust/PPO	$196.73
Rate for Payer: BCN Commercial	$196.73
Rate for Payer: Cash Price	$203.00
Rate for Payer: Cofinity Commercial	$238.52
Rate for Payer: Encore Health Key Benefits Commercial	$203.00
Rate for Payer: Healthscope Commercial	$253.75
Rate for Payer: Healthscope Whirlpool	$246.14
Rate for Payer: Mclaren Commercial	$228.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$215.69
Rate for Payer: Priority Health Cigna Priority Health	$177.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$223.30

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$49.38

Service Code	NDC 0409-1171-01
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$34.57
Max. Negotiated Rate	$49.38
Rate for Payer: Aetna Commercial	$44.44
Rate for Payer: ASR ASR	$47.90
Rate for Payer: BCBS Trust/PPO	$38.28
Rate for Payer: BCN Commercial	$38.28
Rate for Payer: Cash Price	$39.50
Rate for Payer: Cofinity Commercial	$46.42
Rate for Payer: Encore Health Key Benefits Commercial	$39.50
Rate for Payer: Healthscope Commercial	$49.38
Rate for Payer: Healthscope Whirlpool	$47.90
Rate for Payer: Mclaren Commercial	$44.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$41.97
Rate for Payer: Priority Health Cigna Priority Health	$34.57
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$43.45

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$131.88

Service Code	NDC 0641-6015-10
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$92.32
Max. Negotiated Rate	$131.88
Rate for Payer: Aetna Commercial	$118.69
Rate for Payer: ASR ASR	$127.92
Rate for Payer: BCBS Trust/PPO	$102.25
Rate for Payer: BCN Commercial	$102.25
Rate for Payer: Cash Price	$105.50
Rate for Payer: Cofinity Commercial	$123.97
Rate for Payer: Encore Health Key Benefits Commercial	$105.50
Rate for Payer: Healthscope Commercial	$131.88
Rate for Payer: Healthscope Whirlpool	$127.92
Rate for Payer: Mclaren Commercial	$118.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$112.10
Rate for Payer: Priority Health Cigna Priority Health	$92.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$116.05

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$49.62

Service Code	NDC 0641-9217-01
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$34.73
Max. Negotiated Rate	$49.62
Rate for Payer: Aetna Commercial	$44.66
Rate for Payer: ASR ASR	$48.13
Rate for Payer: BCBS Trust/PPO	$38.47
Rate for Payer: BCN Commercial	$38.47
Rate for Payer: Cash Price	$39.70
Rate for Payer: Cofinity Commercial	$46.64
Rate for Payer: Encore Health Key Benefits Commercial	$39.70
Rate for Payer: Healthscope Commercial	$49.62
Rate for Payer: Healthscope Whirlpool	$48.13
Rate for Payer: Mclaren Commercial	$44.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$42.18
Rate for Payer: Priority Health Cigna Priority Health	$34.73
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$43.67

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$90.50

Service Code	NDC 0641-6014-10
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$63.35
Max. Negotiated Rate	$90.50
Rate for Payer: Aetna Commercial	$81.45
Rate for Payer: ASR ASR	$87.78
Rate for Payer: BCBS Trust/PPO	$70.16
Rate for Payer: BCN Commercial	$70.16
Rate for Payer: Cash Price	$72.40
Rate for Payer: Cofinity Commercial	$85.07
Rate for Payer: Encore Health Key Benefits Commercial	$72.40
Rate for Payer: Healthscope Commercial	$90.50
Rate for Payer: Healthscope Whirlpool	$87.78
Rate for Payer: Mclaren Commercial	$81.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$76.92
Rate for Payer: Priority Health Cigna Priority Health	$63.35
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$79.64

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	$177.62
Max. Negotiated Rate	$253.75
Rate for Payer: Aetna Commercial	$228.38
Rate for Payer: ASR ASR	$246.14
Rate for Payer: BCBS Trust/PPO	$196.73
Rate for Payer: BCN Commercial	$196.73
Rate for Payer: Cash Price	$203.00
Rate for Payer: Cofinity Commercial	$238.52
Rate for Payer: Encore Health Key Benefits Commercial	$203.00
Rate for Payer: Healthscope Commercial	$253.75
Rate for Payer: Healthscope Whirlpool	$246.14
Rate for Payer: Mclaren Commercial	$228.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$215.69
Rate for Payer: Priority Health Cigna Priority Health	$177.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$223.30

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$49.62

Service Code	NDC 0641-9217-10
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$34.73
Max. Negotiated Rate	$49.62
Rate for Payer: Aetna Commercial	$44.66
Rate for Payer: ASR ASR	$48.13
Rate for Payer: BCBS Trust/PPO	$38.47
Rate for Payer: BCN Commercial	$38.47
Rate for Payer: Cash Price	$39.70
Rate for Payer: Cofinity Commercial	$46.64
Rate for Payer: Encore Health Key Benefits Commercial	$39.70
Rate for Payer: Healthscope Commercial	$49.62
Rate for Payer: Healthscope Whirlpool	$48.13
Rate for Payer: Mclaren Commercial	$44.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$42.18
Rate for Payer: Priority Health Cigna Priority Health	$34.73
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$43.67

DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION

Facility

$74.00

Service Code	NDC 0409-1171-02
Hospital Charge Code	9869
Hospital Revenue Code	250
Min. Negotiated Rate	$51.80
Max. Negotiated Rate	$74.00
Rate for Payer: Aetna Commercial	$66.60
Rate for Payer: ASR ASR	$71.78
Rate for Payer: BCBS Trust/PPO	$57.37
Rate for Payer: BCN Commercial	$57.37
Rate for Payer: Cash Price	$59.20
Rate for Payer: Cofinity Commercial	$69.56
Rate for Payer: Encore Health Key Benefits Commercial	$59.20
Rate for Payer: Healthscope Commercial	$74.00
Rate for Payer: Healthscope Whirlpool	$71.78
Rate for Payer: Mclaren Commercial	$66.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$62.90
Rate for Payer: Priority Health Cigna Priority Health	$51.80
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$65.12

Know your out-of-pocket cost for care.

All Charges