Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

ISOSORBIDE DINITRATE 10 MG TABLET

Facility

$2.47

Service Code	NDC 68084-082-11
Hospital Charge Code	4064
Hospital Revenue Code	637
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$2.22
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna New Business (MI Preferred)	$1.61
Rate for Payer: Cash Price	$1.98
Rate for Payer: Cofinity Commercial	$1.73
Rate for Payer: Cofinity Commercial	$2.12
Rate for Payer: Healthscope Commercial	$2.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.10
Rate for Payer: PHP Commercial	$2.10
Rate for Payer: Priority Health Cigna Priority Health	$1.73
Rate for Payer: Priority Health SBD	$1.56

ISOSORBIDE DINITRATE 10 MG TABLET

Facility

$415.15

Service Code	NDC 0904-6619-61
Hospital Charge Code	4064
Hospital Revenue Code	637
Min. Negotiated Rate	$261.54
Max. Negotiated Rate	$373.64
Rate for Payer: Aetna Commercial	$352.88
Rate for Payer: Aetna New Business (MI Preferred)	$269.85
Rate for Payer: Cash Price	$332.12
Rate for Payer: Cofinity Commercial	$290.60
Rate for Payer: Cofinity Commercial	$357.03
Rate for Payer: Healthscope Commercial	$373.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$352.88
Rate for Payer: PHP Commercial	$352.88
Rate for Payer: Priority Health Cigna Priority Health	$290.60
Rate for Payer: Priority Health SBD	$261.54

ISOSORBIDE DINITRATE 10 MG TABLET

Facility

$246.72

Service Code	NDC 68084-082-01
Hospital Charge Code	4064
Hospital Revenue Code	637
Min. Negotiated Rate	$155.43
Max. Negotiated Rate	$222.05
Rate for Payer: Aetna Commercial	$209.71
Rate for Payer: Aetna New Business (MI Preferred)	$160.37
Rate for Payer: Cash Price	$197.38
Rate for Payer: Cofinity Commercial	$172.70
Rate for Payer: Cofinity Commercial	$212.18
Rate for Payer: Healthscope Commercial	$222.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$209.71
Rate for Payer: PHP Commercial	$209.71
Rate for Payer: Priority Health Cigna Priority Health	$172.70
Rate for Payer: Priority Health SBD	$155.43

ISOSORBIDE DINITRATE 10 MG TABLET

Facility

$251.04

Service Code	NDC 63739-569-10
Hospital Charge Code	4064
Hospital Revenue Code	637
Min. Negotiated Rate	$158.16
Max. Negotiated Rate	$225.94
Rate for Payer: Aetna Commercial	$213.38
Rate for Payer: Aetna New Business (MI Preferred)	$163.18
Rate for Payer: Cash Price	$200.83
Rate for Payer: Cofinity Commercial	$175.73
Rate for Payer: Cofinity Commercial	$215.89
Rate for Payer: Healthscope Commercial	$225.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$213.38
Rate for Payer: PHP Commercial	$213.38
Rate for Payer: Priority Health Cigna Priority Health	$175.73
Rate for Payer: Priority Health SBD	$158.16

ISOSORBIDE MONONITRATE 20 MG TABLET

Facility

$451.25

Service Code	NDC 62175-107-01
Hospital Charge Code	10357
Hospital Revenue Code	637
Min. Negotiated Rate	$284.29
Max. Negotiated Rate	$406.12
Rate for Payer: Aetna Commercial	$383.56
Rate for Payer: Aetna New Business (MI Preferred)	$293.31
Rate for Payer: Cash Price	$361.00
Rate for Payer: Cofinity Commercial	$315.88
Rate for Payer: Cofinity Commercial	$388.08
Rate for Payer: Healthscope Commercial	$406.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$383.56
Rate for Payer: PHP Commercial	$383.56
Rate for Payer: Priority Health Cigna Priority Health	$315.88
Rate for Payer: Priority Health SBD	$284.29

ISOSORBIDE MONONITRATE 20 MG TABLET

Facility

$321.95

Service Code	NDC 0228-2620-11
Hospital Charge Code	10357
Hospital Revenue Code	637
Min. Negotiated Rate	$202.83
Max. Negotiated Rate	$289.76
Rate for Payer: Aetna Commercial	$273.66
Rate for Payer: Aetna New Business (MI Preferred)	$209.27
Rate for Payer: Cash Price	$257.56
Rate for Payer: Cofinity Commercial	$225.36
Rate for Payer: Cofinity Commercial	$276.88
Rate for Payer: Healthscope Commercial	$289.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$273.66
Rate for Payer: PHP Commercial	$273.66
Rate for Payer: Priority Health Cigna Priority Health	$225.36
Rate for Payer: Priority Health SBD	$202.83

ISOSORBIDE MONONITRATE ER 120 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$311.76

Service Code	NDC 50268-453-15
Hospital Charge Code	27278
Hospital Revenue Code	637
Min. Negotiated Rate	$196.41
Max. Negotiated Rate	$280.58
Rate for Payer: Aetna Commercial	$265.00
Rate for Payer: Aetna New Business (MI Preferred)	$202.64
Rate for Payer: Cash Price	$249.41
Rate for Payer: Cofinity Commercial	$218.23
Rate for Payer: Cofinity Commercial	$268.11
Rate for Payer: Healthscope Commercial	$280.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$265.00
Rate for Payer: PHP Commercial	$265.00
Rate for Payer: Priority Health Cigna Priority Health	$218.23
Rate for Payer: Priority Health SBD	$196.41

ISOSORBIDE MONONITRATE ER 120 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$6.24

Service Code	NDC 50268-453-11
Hospital Charge Code	27278
Hospital Revenue Code	637
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$5.30
Rate for Payer: Aetna New Business (MI Preferred)	$4.06
Rate for Payer: Cash Price	$4.99
Rate for Payer: Cofinity Commercial	$4.37
Rate for Payer: Cofinity Commercial	$5.37
Rate for Payer: Healthscope Commercial	$5.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5.30
Rate for Payer: PHP Commercial	$5.30
Rate for Payer: Priority Health Cigna Priority Health	$4.37
Rate for Payer: Priority Health SBD	$3.93

ISOSORBIDE MONONITRATE ER 120 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$267.90

Service Code	NDC 23155-628-01
Hospital Charge Code	27278
Hospital Revenue Code	637
Min. Negotiated Rate	$168.78
Max. Negotiated Rate	$241.11
Rate for Payer: Aetna Commercial	$227.72
Rate for Payer: Aetna New Business (MI Preferred)	$174.14
Rate for Payer: Cash Price	$214.32
Rate for Payer: Cofinity Commercial	$187.53
Rate for Payer: Cofinity Commercial	$230.39
Rate for Payer: Healthscope Commercial	$241.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$227.72
Rate for Payer: PHP Commercial	$227.72
Rate for Payer: Priority Health Cigna Priority Health	$187.53
Rate for Payer: Priority Health SBD	$168.78

ISOSORBIDE MONONITRATE ER 120 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$269.80

Service Code	NDC 62175-129-37
Hospital Charge Code	27278
Hospital Revenue Code	637
Min. Negotiated Rate	$169.97
Max. Negotiated Rate	$242.82
Rate for Payer: Aetna Commercial	$229.33
Rate for Payer: Aetna New Business (MI Preferred)	$175.37
Rate for Payer: Cash Price	$215.84
Rate for Payer: Cofinity Commercial	$188.86
Rate for Payer: Cofinity Commercial	$232.03
Rate for Payer: Healthscope Commercial	$242.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$229.33
Rate for Payer: PHP Commercial	$229.33
Rate for Payer: Priority Health Cigna Priority Health	$188.86
Rate for Payer: Priority Health SBD	$169.97

ISOSORBIDE MONONITRATE ER 120 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$272.64

Service Code	NDC 68382-652-01
Hospital Charge Code	27278
Hospital Revenue Code	637
Min. Negotiated Rate	$171.76
Max. Negotiated Rate	$245.38
Rate for Payer: Aetna Commercial	$231.74
Rate for Payer: Aetna New Business (MI Preferred)	$177.22
Rate for Payer: Cash Price	$218.11
Rate for Payer: Cofinity Commercial	$190.85
Rate for Payer: Cofinity Commercial	$234.47
Rate for Payer: Healthscope Commercial	$245.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$231.74
Rate for Payer: PHP Commercial	$231.74
Rate for Payer: Priority Health Cigna Priority Health	$190.85
Rate for Payer: Priority Health SBD	$171.76

ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$464.55

Service Code	NDC 68084-591-01
Hospital Charge Code	24521
Hospital Revenue Code	637
Min. Negotiated Rate	$292.67
Max. Negotiated Rate	$418.10
Rate for Payer: Aetna Commercial	$394.87
Rate for Payer: Aetna New Business (MI Preferred)	$301.96
Rate for Payer: Cash Price	$371.64
Rate for Payer: Cofinity Commercial	$325.18
Rate for Payer: Cofinity Commercial	$399.51
Rate for Payer: Healthscope Commercial	$418.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$394.87
Rate for Payer: PHP Commercial	$394.87
Rate for Payer: Priority Health Cigna Priority Health	$325.18
Rate for Payer: Priority Health SBD	$292.67

ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$4.65

Service Code	NDC 68084-591-11
Hospital Charge Code	24521
Hospital Revenue Code	637
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$4.18
Rate for Payer: Aetna Commercial	$3.95
Rate for Payer: Aetna New Business (MI Preferred)	$3.02
Rate for Payer: Cash Price	$3.72
Rate for Payer: Cofinity Commercial	$3.26
Rate for Payer: Cofinity Commercial	$4.00
Rate for Payer: Healthscope Commercial	$4.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.95
Rate for Payer: PHP Commercial	$3.95
Rate for Payer: Priority Health Cigna Priority Health	$3.26
Rate for Payer: Priority Health SBD	$2.93

ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$366.70

Service Code	NDC 68382-650-01
Hospital Charge Code	24521
Hospital Revenue Code	637
Min. Negotiated Rate	$231.02
Max. Negotiated Rate	$330.03
Rate for Payer: Aetna Commercial	$311.70
Rate for Payer: Aetna New Business (MI Preferred)	$238.36
Rate for Payer: Cash Price	$293.36
Rate for Payer: Cofinity Commercial	$256.69
Rate for Payer: Cofinity Commercial	$315.36
Rate for Payer: Healthscope Commercial	$330.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$311.70
Rate for Payer: PHP Commercial	$311.70
Rate for Payer: Priority Health Cigna Priority Health	$256.69
Rate for Payer: Priority Health SBD	$231.02

ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$243.20

Service Code	NDC 0904-6449-61
Hospital Charge Code	24521
Hospital Revenue Code	637
Min. Negotiated Rate	$153.22
Max. Negotiated Rate	$218.88
Rate for Payer: Aetna Commercial	$206.72
Rate for Payer: Aetna New Business (MI Preferred)	$158.08
Rate for Payer: Cash Price	$194.56
Rate for Payer: Cofinity Commercial	$170.24
Rate for Payer: Cofinity Commercial	$209.15
Rate for Payer: Healthscope Commercial	$218.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$206.72
Rate for Payer: PHP Commercial	$206.72
Rate for Payer: Priority Health Cigna Priority Health	$170.24
Rate for Payer: Priority Health SBD	$153.22

ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$310.56

Service Code	NDC 68084-592-01
Hospital Charge Code	24268
Hospital Revenue Code	637
Min. Negotiated Rate	$195.65
Max. Negotiated Rate	$279.50
Rate for Payer: Aetna Commercial	$263.98
Rate for Payer: Aetna New Business (MI Preferred)	$201.86
Rate for Payer: Cash Price	$248.45
Rate for Payer: Cofinity Commercial	$217.39
Rate for Payer: Cofinity Commercial	$267.08
Rate for Payer: Healthscope Commercial	$279.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$263.98
Rate for Payer: PHP Commercial	$263.98
Rate for Payer: Priority Health Cigna Priority Health	$217.39
Rate for Payer: Priority Health SBD	$195.65

ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$3.11

Service Code	NDC 68084-592-11
Hospital Charge Code	24268
Hospital Revenue Code	637
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$2.80
Rate for Payer: Aetna Commercial	$2.64
Rate for Payer: Aetna New Business (MI Preferred)	$2.02
Rate for Payer: Cash Price	$2.49
Rate for Payer: Cofinity Commercial	$2.18
Rate for Payer: Cofinity Commercial	$2.67
Rate for Payer: Healthscope Commercial	$2.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.64
Rate for Payer: PHP Commercial	$2.64
Rate for Payer: Priority Health Cigna Priority Health	$2.18
Rate for Payer: Priority Health SBD	$1.96

ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$386.65

Service Code	NDC 68382-651-01
Hospital Charge Code	24268
Hospital Revenue Code	637
Min. Negotiated Rate	$243.59
Max. Negotiated Rate	$347.98
Rate for Payer: Aetna Commercial	$328.65
Rate for Payer: Aetna New Business (MI Preferred)	$251.32
Rate for Payer: Cash Price	$309.32
Rate for Payer: Cofinity Commercial	$270.66
Rate for Payer: Cofinity Commercial	$332.52
Rate for Payer: Healthscope Commercial	$347.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$328.65
Rate for Payer: PHP Commercial	$328.65
Rate for Payer: Priority Health Cigna Priority Health	$270.66
Rate for Payer: Priority Health SBD	$243.59

ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$289.75

Service Code	NDC 0904-6450-61
Hospital Charge Code	24268
Hospital Revenue Code	637
Min. Negotiated Rate	$182.54
Max. Negotiated Rate	$260.78
Rate for Payer: Aetna Commercial	$246.29
Rate for Payer: Aetna New Business (MI Preferred)	$188.34
Rate for Payer: Cash Price	$231.80
Rate for Payer: Cofinity Commercial	$202.82
Rate for Payer: Cofinity Commercial	$249.18
Rate for Payer: Healthscope Commercial	$260.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$246.29
Rate for Payer: PHP Commercial	$246.29
Rate for Payer: Priority Health Cigna Priority Health	$202.82
Rate for Payer: Priority Health SBD	$182.54

ISOSOURCE 1.5 BOLUS FEED

Facility

$9.60

Service Code	NDC 4390018181
Hospital Charge Code	150768
Hospital Revenue Code	637
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.72
Rate for Payer: Priority Health SBD	$6.05

ISOSOURCE 1.5 BOLUS FEED

Facility

$4.75

Service Code	NDC 4390018150
Hospital Charge Code	150768
Hospital Revenue Code	637
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$4.28
Rate for Payer: Aetna Commercial	$4.04
Rate for Payer: Aetna New Business (MI Preferred)	$3.09
Rate for Payer: Cash Price	$3.80
Rate for Payer: Cofinity Commercial	$3.32
Rate for Payer: Cofinity Commercial	$4.08
Rate for Payer: Healthscope Commercial	$4.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4.04
Rate for Payer: PHP Commercial	$4.04
Rate for Payer: Priority Health Cigna Priority Health	$3.32
Rate for Payer: Priority Health SBD	$2.99

ISOSOURCE 1.5 CONTINUOUS FEED

Facility

$9.60

Service Code	NDC 4390018181
Hospital Charge Code	168943
Hospital Revenue Code	637
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.72
Rate for Payer: Priority Health SBD	$6.05

ISOSOURCE 1.5 CYCLIC FEED

Facility

$9.60

Service Code	NDC 4390018181
Hospital Charge Code	200081
Hospital Revenue Code	637
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.72
Rate for Payer: Priority Health SBD	$6.05

ISOSOURCE 1.5 INTERMITTENT FEED

Facility

$9.60

Service Code	NDC 4390018181
Hospital Charge Code	200080
Hospital Revenue Code	637
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.72
Rate for Payer: Priority Health SBD	$6.05

ISOSOURCE HN BOLUS FEED

Facility

$9.60

Service Code	NDC 4390018480
Hospital Charge Code	150769
Hospital Revenue Code	637
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.72
Rate for Payer: Priority Health SBD	$6.05

Know your out-of-pocket cost for care.

All Charges