Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

ISOSORBIDE DINITRATE 10 MG TABLET

Facility

$143.04

Service Code	NDC 50268044815
Hospital Charge Code	4064
Hospital Revenue Code	637
Min. Negotiated Rate	$57.22
Max. Negotiated Rate	$128.74
Rate for Payer: Aetna Commercial	$121.58
Rate for Payer: Aetna Medicare	$71.52
Rate for Payer: Aetna New Business (MI Preferred)	$92.98
Rate for Payer: BCBS Complete	$57.22
Rate for Payer: Cash Price	$114.43
Rate for Payer: Cofinity Commercial	$100.13
Rate for Payer: Cofinity Commercial	$123.01
Rate for Payer: Cofinity Medicare Advantage	$100.13
Rate for Payer: Encore Health Key Benefits Commercial	$114.43
Rate for Payer: Healthscope Commercial	$128.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$121.58
Rate for Payer: PHP Commercial	$121.58
Rate for Payer: Priority Health Cigna Priority Health	$92.98
Rate for Payer: Priority Health SBD	$90.12

ISOSORBIDE DINITRATE 10 MG TABLET

Facility

$143.04

Service Code	NDC 50268044815
Hospital Charge Code	4064
Hospital Revenue Code	637
Min. Negotiated Rate	$90.12
Max. Negotiated Rate	$128.74
Rate for Payer: Aetna Commercial	$121.58
Rate for Payer: Aetna New Business (MI Preferred)	$92.98
Rate for Payer: Cash Price	$114.43
Rate for Payer: Cofinity Commercial	$100.13
Rate for Payer: Cofinity Commercial	$123.01
Rate for Payer: Cofinity Medicare Advantage	$100.13
Rate for Payer: Encore Health Key Benefits Commercial	$114.43
Rate for Payer: Healthscope Commercial	$128.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$121.58
Rate for Payer: PHP Commercial	$121.58
Rate for Payer: Priority Health Cigna Priority Health	$92.98
Rate for Payer: Priority Health SBD	$90.12

ISOSORBIDE DINITRATE 10 MG TABLET

Facility

$428.45

Service Code	NDC 00904661961
Hospital Charge Code	4064
Hospital Revenue Code	637
Min. Negotiated Rate	$269.92
Max. Negotiated Rate	$385.61
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: Cofinity Medicare Advantage	$299.92
Rate for Payer: Encore Health Key Benefits Commercial	$342.76
Rate for Payer: Healthscope Commercial	$385.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$364.18
Rate for Payer: PHP Commercial	$364.18
Rate for Payer: Priority Health Cigna Priority Health	$278.49
Rate for Payer: Priority Health SBD	$269.92

ISOSORBIDE DINITRATE 10 MG TABLET

Facility

$255.84

Service Code	NDC 68084008201
Hospital Charge Code	4064
Hospital Revenue Code	637
Min. Negotiated Rate	$161.18
Max. Negotiated Rate	$230.26
Rate for Payer: Aetna Commercial	$217.46
Rate for Payer: Aetna New Business (MI Preferred)	$166.30
Rate for Payer: Cash Price	$204.67
Rate for Payer: Cofinity Commercial	$179.09
Rate for Payer: Cofinity Commercial	$220.02
Rate for Payer: Cofinity Medicare Advantage	$179.09
Rate for Payer: Encore Health Key Benefits Commercial	$204.67
Rate for Payer: Healthscope Commercial	$230.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$217.46
Rate for Payer: PHP Commercial	$217.46
Rate for Payer: Priority Health Cigna Priority Health	$166.30
Rate for Payer: Priority Health SBD	$161.18

ISOSORBIDE DINITRATE 10 MG TABLET

Facility

$262.08

Service Code	NDC 63739056910
Hospital Charge Code	4064
Hospital Revenue Code	637
Min. Negotiated Rate	$165.11
Max. Negotiated Rate	$235.87
Rate for Payer: Aetna Commercial	$222.77
Rate for Payer: Aetna New Business (MI Preferred)	$170.35
Rate for Payer: Cash Price	$209.66
Rate for Payer: Cofinity Commercial	$183.46
Rate for Payer: Cofinity Commercial	$225.39
Rate for Payer: Cofinity Medicare Advantage	$183.46
Rate for Payer: Encore Health Key Benefits Commercial	$209.66
Rate for Payer: Healthscope Commercial	$235.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$222.77
Rate for Payer: PHP Commercial	$222.77
Rate for Payer: Priority Health Cigna Priority Health	$170.35
Rate for Payer: Priority Health SBD	$165.11

ISOSORBIDE MONONITRATE 20 MG TABLET

Facility

$392.45

Service Code	NDC 00228262011
Hospital Charge Code	10357
Hospital Revenue Code	637
Min. Negotiated Rate	$156.98
Max. Negotiated Rate	$353.20
Rate for Payer: Aetna Commercial	$333.58
Rate for Payer: Aetna Medicare	$196.22
Rate for Payer: Aetna New Business (MI Preferred)	$255.09
Rate for Payer: BCBS Complete	$156.98
Rate for Payer: Cash Price	$313.96
Rate for Payer: Cofinity Commercial	$274.71
Rate for Payer: Cofinity Commercial	$337.51
Rate for Payer: Cofinity Medicare Advantage	$274.71
Rate for Payer: Encore Health Key Benefits Commercial	$313.96
Rate for Payer: Healthscope Commercial	$353.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$333.58
Rate for Payer: PHP Commercial	$333.58
Rate for Payer: Priority Health Cigna Priority Health	$255.09
Rate for Payer: Priority Health SBD	$247.24

ISOSORBIDE MONONITRATE 20 MG TABLET

Facility

$451.25

Service Code	NDC 62175010701
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	$388.07
Rate for Payer: Cofinity Medicare Advantage	$315.88
Rate for Payer: Encore Health Key Benefits Commercial	$361.00
Rate for Payer: Healthscope Commercial	$406.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$383.56
Rate for Payer: PHP Commercial	$383.56
Rate for Payer: Priority Health Cigna Priority Health	$293.31
Rate for Payer: Priority Health SBD	$284.29

ISOSORBIDE MONONITRATE 20 MG TABLET

Facility

$451.25

Service Code	NDC 62175010701
Hospital Charge Code	10357
Hospital Revenue Code	637
Min. Negotiated Rate	$180.50
Max. Negotiated Rate	$406.12
Rate for Payer: Aetna Commercial	$383.56
Rate for Payer: Aetna Medicare	$225.62
Rate for Payer: Aetna New Business (MI Preferred)	$293.31
Rate for Payer: BCBS Complete	$180.50
Rate for Payer: Cash Price	$361.00
Rate for Payer: Cofinity Commercial	$315.88
Rate for Payer: Cofinity Commercial	$388.07
Rate for Payer: Cofinity Medicare Advantage	$315.88
Rate for Payer: Encore Health Key Benefits Commercial	$361.00
Rate for Payer: Healthscope Commercial	$406.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$383.56
Rate for Payer: PHP Commercial	$383.56
Rate for Payer: Priority Health Cigna Priority Health	$293.31
Rate for Payer: Priority Health SBD	$284.29

ISOSORBIDE MONONITRATE 20 MG TABLET

Facility

$392.45

Service Code	NDC 00228262011
Hospital Charge Code	10357
Hospital Revenue Code	637
Min. Negotiated Rate	$247.24
Max. Negotiated Rate	$353.20
Rate for Payer: Aetna Commercial	$333.58
Rate for Payer: Aetna New Business (MI Preferred)	$255.09
Rate for Payer: Cash Price	$313.96
Rate for Payer: Cofinity Commercial	$274.71
Rate for Payer: Cofinity Commercial	$337.51
Rate for Payer: Cofinity Medicare Advantage	$274.71
Rate for Payer: Encore Health Key Benefits Commercial	$313.96
Rate for Payer: Healthscope Commercial	$353.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$333.58
Rate for Payer: PHP Commercial	$333.58
Rate for Payer: Priority Health Cigna Priority Health	$255.09
Rate for Payer: Priority Health SBD	$247.24

ISOSORBIDE MONONITRATE ER 120 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$272.64

Service Code	NDC 68382065201
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: Cofinity Medicare Advantage	$190.85
Rate for Payer: Encore Health Key Benefits Commercial	$218.11
Rate for Payer: Healthscope Commercial	$245.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$231.74
Rate for Payer: PHP Commercial	$231.74
Rate for Payer: Priority Health Cigna Priority Health	$177.22
Rate for Payer: Priority Health SBD	$171.76

ISOSORBIDE MONONITRATE ER 120 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$229.90

Service Code	NDC 59651054101
Hospital Charge Code	27278
Hospital Revenue Code	637
Min. Negotiated Rate	$91.96
Max. Negotiated Rate	$206.91
Rate for Payer: Aetna Commercial	$195.41
Rate for Payer: Aetna Medicare	$114.95
Rate for Payer: Aetna New Business (MI Preferred)	$149.44
Rate for Payer: BCBS Complete	$91.96
Rate for Payer: Cash Price	$183.92
Rate for Payer: Cofinity Commercial	$160.93
Rate for Payer: Cofinity Commercial	$197.71
Rate for Payer: Cofinity Medicare Advantage	$160.93
Rate for Payer: Encore Health Key Benefits Commercial	$183.92
Rate for Payer: Healthscope Commercial	$206.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$195.41
Rate for Payer: PHP Commercial	$195.41
Rate for Payer: Priority Health Cigna Priority Health	$149.44
Rate for Payer: Priority Health SBD	$144.84

ISOSORBIDE MONONITRATE ER 120 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$311.76

Service Code	NDC 50268045315
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: Cofinity Medicare Advantage	$218.23
Rate for Payer: Encore Health Key Benefits Commercial	$249.41
Rate for Payer: Healthscope Commercial	$280.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$265.00
Rate for Payer: PHP Commercial	$265.00
Rate for Payer: Priority Health Cigna Priority Health	$202.64
Rate for Payer: Priority Health SBD	$196.41

ISOSORBIDE MONONITRATE ER 120 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$271.20

Service Code	NDC 23155062801
Hospital Charge Code	27278
Hospital Revenue Code	637
Min. Negotiated Rate	$170.86
Max. Negotiated Rate	$244.08
Rate for Payer: Aetna Commercial	$230.52
Rate for Payer: Aetna New Business (MI Preferred)	$176.28
Rate for Payer: Cash Price	$216.96
Rate for Payer: Cofinity Commercial	$189.84
Rate for Payer: Cofinity Commercial	$233.23
Rate for Payer: Cofinity Medicare Advantage	$189.84
Rate for Payer: Encore Health Key Benefits Commercial	$216.96
Rate for Payer: Healthscope Commercial	$244.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$230.52
Rate for Payer: PHP Commercial	$230.52
Rate for Payer: Priority Health Cigna Priority Health	$176.28
Rate for Payer: Priority Health SBD	$170.86

ISOSORBIDE MONONITRATE ER 120 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$269.80

Service Code	NDC 62175012937
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: Cofinity Medicare Advantage	$188.86
Rate for Payer: Encore Health Key Benefits Commercial	$215.84
Rate for Payer: Healthscope Commercial	$242.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$229.33
Rate for Payer: PHP Commercial	$229.33
Rate for Payer: Priority Health Cigna Priority Health	$175.37
Rate for Payer: Priority Health SBD	$169.97

ISOSORBIDE MONONITRATE ER 120 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$271.20

Service Code	NDC 23155062801
Hospital Charge Code	27278
Hospital Revenue Code	637
Min. Negotiated Rate	$108.48
Max. Negotiated Rate	$244.08
Rate for Payer: Aetna Commercial	$230.52
Rate for Payer: Aetna Medicare	$135.60
Rate for Payer: Aetna New Business (MI Preferred)	$176.28
Rate for Payer: BCBS Complete	$108.48
Rate for Payer: Cash Price	$216.96
Rate for Payer: Cofinity Commercial	$189.84
Rate for Payer: Cofinity Commercial	$233.23
Rate for Payer: Cofinity Medicare Advantage	$189.84
Rate for Payer: Encore Health Key Benefits Commercial	$216.96
Rate for Payer: Healthscope Commercial	$244.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$230.52
Rate for Payer: PHP Commercial	$230.52
Rate for Payer: Priority Health Cigna Priority Health	$176.28
Rate for Payer: Priority Health SBD	$170.86

ISOSORBIDE MONONITRATE ER 120 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$272.64

Service Code	NDC 68382065201
Hospital Charge Code	27278
Hospital Revenue Code	637
Min. Negotiated Rate	$109.06
Max. Negotiated Rate	$245.38
Rate for Payer: Aetna Commercial	$231.74
Rate for Payer: Aetna Medicare	$136.32
Rate for Payer: Aetna New Business (MI Preferred)	$177.22
Rate for Payer: BCBS Complete	$109.06
Rate for Payer: Cash Price	$218.11
Rate for Payer: Cofinity Commercial	$190.85
Rate for Payer: Cofinity Commercial	$234.47
Rate for Payer: Cofinity Medicare Advantage	$190.85
Rate for Payer: Encore Health Key Benefits Commercial	$218.11
Rate for Payer: Healthscope Commercial	$245.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$231.74
Rate for Payer: PHP Commercial	$231.74
Rate for Payer: Priority Health Cigna Priority Health	$177.22
Rate for Payer: Priority Health SBD	$171.76

ISOSORBIDE MONONITRATE ER 120 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$311.76

Service Code	NDC 50268045315
Hospital Charge Code	27278
Hospital Revenue Code	637
Min. Negotiated Rate	$124.70
Max. Negotiated Rate	$280.58
Rate for Payer: Aetna Commercial	$265.00
Rate for Payer: Aetna Medicare	$155.88
Rate for Payer: Aetna New Business (MI Preferred)	$202.64
Rate for Payer: BCBS Complete	$124.70
Rate for Payer: Cash Price	$249.41
Rate for Payer: Cofinity Commercial	$218.23
Rate for Payer: Cofinity Commercial	$268.11
Rate for Payer: Cofinity Medicare Advantage	$218.23
Rate for Payer: Encore Health Key Benefits Commercial	$249.41
Rate for Payer: Healthscope Commercial	$280.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$265.00
Rate for Payer: PHP Commercial	$265.00
Rate for Payer: Priority Health Cigna Priority Health	$202.64
Rate for Payer: Priority Health SBD	$196.41

ISOSORBIDE MONONITRATE ER 120 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$269.80

Service Code	NDC 62175012937
Hospital Charge Code	27278
Hospital Revenue Code	637
Min. Negotiated Rate	$107.92
Max. Negotiated Rate	$242.82
Rate for Payer: Aetna Commercial	$229.33
Rate for Payer: Aetna Medicare	$134.90
Rate for Payer: Aetna New Business (MI Preferred)	$175.37
Rate for Payer: BCBS Complete	$107.92
Rate for Payer: Cash Price	$215.84
Rate for Payer: Cofinity Commercial	$188.86
Rate for Payer: Cofinity Commercial	$232.03
Rate for Payer: Cofinity Medicare Advantage	$188.86
Rate for Payer: Encore Health Key Benefits Commercial	$215.84
Rate for Payer: Healthscope Commercial	$242.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$229.33
Rate for Payer: PHP Commercial	$229.33
Rate for Payer: Priority Health Cigna Priority Health	$175.37
Rate for Payer: Priority Health SBD	$169.97

ISOSORBIDE MONONITRATE ER 120 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$229.90

Service Code	NDC 59651054101
Hospital Charge Code	27278
Hospital Revenue Code	637
Min. Negotiated Rate	$144.84
Max. Negotiated Rate	$206.91
Rate for Payer: Aetna Commercial	$195.41
Rate for Payer: Aetna New Business (MI Preferred)	$149.44
Rate for Payer: Cash Price	$183.92
Rate for Payer: Cofinity Commercial	$160.93
Rate for Payer: Cofinity Commercial	$197.71
Rate for Payer: Cofinity Medicare Advantage	$160.93
Rate for Payer: Encore Health Key Benefits Commercial	$183.92
Rate for Payer: Healthscope Commercial	$206.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$195.41
Rate for Payer: PHP Commercial	$195.41
Rate for Payer: Priority Health Cigna Priority Health	$149.44
Rate for Payer: Priority Health SBD	$144.84

ISOSORBIDE MONONITRATE ER 120 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$6.24

Service Code	NDC 50268045311
Hospital Charge Code	27278
Hospital Revenue Code	637
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$5.30
Rate for Payer: Aetna Medicare	$3.12
Rate for Payer: Aetna New Business (MI Preferred)	$4.06
Rate for Payer: BCBS Complete	$2.50
Rate for Payer: Cash Price	$4.99
Rate for Payer: Cofinity Commercial	$4.37
Rate for Payer: Cofinity Commercial	$5.37
Rate for Payer: Cofinity Medicare Advantage	$4.37
Rate for Payer: Encore Health Key Benefits Commercial	$4.99
Rate for Payer: Healthscope Commercial	$5.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.30
Rate for Payer: PHP Commercial	$5.30
Rate for Payer: Priority Health Cigna Priority Health	$4.06
Rate for Payer: Priority Health SBD	$3.93

ISOSORBIDE MONONITRATE ER 120 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$6.24

Service Code	NDC 50268045311
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: Cofinity Medicare Advantage	$4.37
Rate for Payer: Encore Health Key Benefits Commercial	$4.99
Rate for Payer: Healthscope Commercial	$5.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.30
Rate for Payer: PHP Commercial	$5.30
Rate for Payer: Priority Health Cigna Priority Health	$4.06
Rate for Payer: Priority Health SBD	$3.93

ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$464.55

Service Code	NDC 68084059101
Hospital Charge Code	24521
Hospital Revenue Code	637
Min. Negotiated Rate	$185.82
Max. Negotiated Rate	$418.10
Rate for Payer: Aetna Commercial	$394.87
Rate for Payer: Aetna Medicare	$232.28
Rate for Payer: Aetna New Business (MI Preferred)	$301.96
Rate for Payer: BCBS Complete	$185.82
Rate for Payer: Cash Price	$371.64
Rate for Payer: Cofinity Commercial	$325.19
Rate for Payer: Cofinity Commercial	$399.51
Rate for Payer: Cofinity Medicare Advantage	$325.19
Rate for Payer: Encore Health Key Benefits Commercial	$371.64
Rate for Payer: Healthscope Commercial	$418.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$394.87
Rate for Payer: PHP Commercial	$394.87
Rate for Payer: Priority Health Cigna Priority Health	$301.96
Rate for Payer: Priority Health SBD	$292.67

ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$464.55

Service Code	NDC 68084059101
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	$325.19
Rate for Payer: Cofinity Commercial	$399.51
Rate for Payer: Cofinity Medicare Advantage	$325.19
Rate for Payer: Encore Health Key Benefits Commercial	$371.64
Rate for Payer: Healthscope Commercial	$418.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$394.87
Rate for Payer: PHP Commercial	$394.87
Rate for Payer: Priority Health Cigna Priority Health	$301.96
Rate for Payer: Priority Health SBD	$292.67

ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$4.65

Service Code	NDC 68084059111
Hospital Charge Code	24521
Hospital Revenue Code	637
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$4.18
Rate for Payer: Aetna Commercial	$3.95
Rate for Payer: Aetna Medicare	$2.33
Rate for Payer: Aetna New Business (MI Preferred)	$3.02
Rate for Payer: BCBS Complete	$1.86
Rate for Payer: Cash Price	$3.72
Rate for Payer: Cofinity Commercial	$3.25
Rate for Payer: Cofinity Commercial	$4.00
Rate for Payer: Cofinity Medicare Advantage	$3.25
Rate for Payer: Encore Health Key Benefits Commercial	$3.72
Rate for Payer: Healthscope Commercial	$4.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.95
Rate for Payer: PHP Commercial	$3.95
Rate for Payer: Priority Health Cigna Priority Health	$3.02
Rate for Payer: Priority Health SBD	$2.93

ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$248.90

Service Code	NDC 00904644961
Hospital Charge Code	24521
Hospital Revenue Code	637
Min. Negotiated Rate	$99.56
Max. Negotiated Rate	$224.01
Rate for Payer: Aetna Commercial	$211.56
Rate for Payer: Aetna Medicare	$124.45
Rate for Payer: Aetna New Business (MI Preferred)	$161.78
Rate for Payer: BCBS Complete	$99.56
Rate for Payer: Cash Price	$199.12
Rate for Payer: Cofinity Commercial	$174.23
Rate for Payer: Cofinity Commercial	$214.05
Rate for Payer: Cofinity Medicare Advantage	$174.23
Rate for Payer: Encore Health Key Benefits Commercial	$199.12
Rate for Payer: Healthscope Commercial	$224.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$211.56
Rate for Payer: PHP Commercial	$211.56
Rate for Payer: Priority Health Cigna Priority Health	$161.78
Rate for Payer: Priority Health SBD	$156.81

Know your out-of-pocket cost for care.

All Charges