Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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	$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	$3.25
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

$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

$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

ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$3.11

Service Code	NDC 68084059211
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: Cofinity Medicare Advantage	$2.18
Rate for Payer: Encore Health Key Benefits Commercial	$2.49
Rate for Payer: Healthscope Commercial	$2.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.64
Rate for Payer: PHP Commercial	$2.64
Rate for Payer: Priority Health Cigna Priority Health	$2.02
Rate for Payer: Priority Health SBD	$1.96

ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$386.65

Service Code	NDC 68382065101
Hospital Charge Code	24268
Hospital Revenue Code	637
Min. Negotiated Rate	$154.66
Max. Negotiated Rate	$347.99
Rate for Payer: Aetna Commercial	$328.65
Rate for Payer: Aetna Medicare	$193.32
Rate for Payer: Aetna New Business (MI Preferred)	$251.32
Rate for Payer: BCBS Complete	$154.66
Rate for Payer: Cash Price	$309.32
Rate for Payer: Cofinity Commercial	$270.65
Rate for Payer: Cofinity Commercial	$332.52
Rate for Payer: Cofinity Medicare Advantage	$270.65
Rate for Payer: Encore Health Key Benefits Commercial	$309.32
Rate for Payer: Healthscope Commercial	$347.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$328.65
Rate for Payer: PHP Commercial	$328.65
Rate for Payer: Priority Health Cigna Priority Health	$251.32
Rate for Payer: Priority Health SBD	$243.59

ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$294.50

Service Code	NDC 00904645061
Hospital Charge Code	24268
Hospital Revenue Code	637
Min. Negotiated Rate	$185.53
Max. Negotiated Rate	$265.05
Rate for Payer: Aetna Commercial	$250.32
Rate for Payer: Aetna New Business (MI Preferred)	$191.43
Rate for Payer: Cash Price	$235.60
Rate for Payer: Cofinity Commercial	$206.15
Rate for Payer: Cofinity Commercial	$253.27
Rate for Payer: Cofinity Medicare Advantage	$206.15
Rate for Payer: Encore Health Key Benefits Commercial	$235.60
Rate for Payer: Healthscope Commercial	$265.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$250.32
Rate for Payer: PHP Commercial	$250.32
Rate for Payer: Priority Health Cigna Priority Health	$191.43
Rate for Payer: Priority Health SBD	$185.53

ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$386.65

Service Code	NDC 68382065101
Hospital Charge Code	24268
Hospital Revenue Code	637
Min. Negotiated Rate	$243.59
Max. Negotiated Rate	$347.99
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	$270.65
Rate for Payer: Cofinity Commercial	$332.52
Rate for Payer: Cofinity Medicare Advantage	$270.65
Rate for Payer: Encore Health Key Benefits Commercial	$309.32
Rate for Payer: Healthscope Commercial	$347.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$328.65
Rate for Payer: PHP Commercial	$328.65
Rate for Payer: Priority Health Cigna Priority Health	$251.32
Rate for Payer: Priority Health SBD	$243.59

ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$310.56

Service Code	NDC 68084059201
Hospital Charge Code	24268
Hospital Revenue Code	637
Min. Negotiated Rate	$124.22
Max. Negotiated Rate	$279.50
Rate for Payer: Aetna Commercial	$263.98
Rate for Payer: Aetna Medicare	$155.28
Rate for Payer: Aetna New Business (MI Preferred)	$201.86
Rate for Payer: BCBS Complete	$124.22
Rate for Payer: Cash Price	$248.45
Rate for Payer: Cofinity Commercial	$217.39
Rate for Payer: Cofinity Commercial	$267.08
Rate for Payer: Cofinity Medicare Advantage	$217.39
Rate for Payer: Encore Health Key Benefits Commercial	$248.45
Rate for Payer: Healthscope Commercial	$279.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$263.98
Rate for Payer: PHP Commercial	$263.98
Rate for Payer: Priority Health Cigna Priority Health	$201.86
Rate for Payer: Priority Health SBD	$195.65

ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$3.11

Service Code	NDC 68084059211
Hospital Charge Code	24268
Hospital Revenue Code	637
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$2.80
Rate for Payer: Aetna Commercial	$2.64
Rate for Payer: Aetna Medicare	$1.55
Rate for Payer: Aetna New Business (MI Preferred)	$2.02
Rate for Payer: BCBS Complete	$1.24
Rate for Payer: Cash Price	$2.49
Rate for Payer: Cofinity Commercial	$2.18
Rate for Payer: Cofinity Commercial	$2.67
Rate for Payer: Cofinity Medicare Advantage	$2.18
Rate for Payer: Encore Health Key Benefits Commercial	$2.49
Rate for Payer: Healthscope Commercial	$2.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.64
Rate for Payer: PHP Commercial	$2.64
Rate for Payer: Priority Health Cigna Priority Health	$2.02
Rate for Payer: Priority Health SBD	$1.96

ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$294.50

Service Code	NDC 00904645061
Hospital Charge Code	24268
Hospital Revenue Code	637
Min. Negotiated Rate	$117.80
Max. Negotiated Rate	$265.05
Rate for Payer: Aetna Commercial	$250.32
Rate for Payer: Aetna Medicare	$147.25
Rate for Payer: Aetna New Business (MI Preferred)	$191.43
Rate for Payer: BCBS Complete	$117.80
Rate for Payer: Cash Price	$235.60
Rate for Payer: Cofinity Commercial	$206.15
Rate for Payer: Cofinity Commercial	$253.27
Rate for Payer: Cofinity Medicare Advantage	$206.15
Rate for Payer: Encore Health Key Benefits Commercial	$235.60
Rate for Payer: Healthscope Commercial	$265.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$250.32
Rate for Payer: PHP Commercial	$250.32
Rate for Payer: Priority Health Cigna Priority Health	$191.43
Rate for Payer: Priority Health SBD	$185.53

ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$310.56

Service Code	NDC 68084059201
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: Cofinity Medicare Advantage	$217.39
Rate for Payer: Encore Health Key Benefits Commercial	$248.45
Rate for Payer: Healthscope Commercial	$279.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$263.98
Rate for Payer: PHP Commercial	$263.98
Rate for Payer: Priority Health Cigna Priority Health	$201.86
Rate for Payer: Priority Health SBD	$195.65

ISOSOURCE 1.5 BOLUS FEED

Facility

$9.60

Service Code	NDC 43900018181
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: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

ISOSOURCE 1.5 BOLUS FEED

Facility

$9.60

Service Code	NDC 43900018181
Hospital Charge Code	150768
Hospital Revenue Code	637
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna Medicare	$4.80
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: BCBS Complete	$3.84
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

ISOSOURCE 1.5 BOLUS FEED

Facility

$4.75

Service Code	NDC 43900018150
Hospital Charge Code	150768
Hospital Revenue Code	637
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$4.28
Rate for Payer: Aetna Commercial	$4.04
Rate for Payer: Aetna Medicare	$2.38
Rate for Payer: Aetna New Business (MI Preferred)	$3.09
Rate for Payer: BCBS Complete	$1.90
Rate for Payer: Cash Price	$3.80
Rate for Payer: Cofinity Commercial	$3.33
Rate for Payer: Cofinity Commercial	$4.08
Rate for Payer: Cofinity Medicare Advantage	$3.33
Rate for Payer: Encore Health Key Benefits Commercial	$3.80
Rate for Payer: Healthscope Commercial	$4.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.04
Rate for Payer: PHP Commercial	$4.04
Rate for Payer: Priority Health Cigna Priority Health	$3.09
Rate for Payer: Priority Health SBD	$2.99

ISOSOURCE 1.5 BOLUS FEED

Facility

$4.75

Service Code	NDC 43900018150
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	$3.33
Rate for Payer: Cofinity Commercial	$4.08
Rate for Payer: Cofinity Medicare Advantage	$3.33
Rate for Payer: Encore Health Key Benefits Commercial	$3.80
Rate for Payer: Healthscope Commercial	$4.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.04
Rate for Payer: PHP Commercial	$4.04
Rate for Payer: Priority Health Cigna Priority Health	$3.09
Rate for Payer: Priority Health SBD	$2.99

ISOSOURCE 1.5 CONTINUOUS FEED

Facility

$9.60

Service Code	NDC 43900018181
Hospital Charge Code	168943
Hospital Revenue Code	637
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna Medicare	$4.80
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: BCBS Complete	$3.84
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

ISOSOURCE 1.5 CONTINUOUS FEED

Facility

$9.60

Service Code	NDC 43900018181
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: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

ISOSOURCE 1.5 CYCLIC FEED

Facility

$9.60

Service Code	NDC 43900018181
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: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

ISOSOURCE 1.5 CYCLIC FEED

Facility

$9.60

Service Code	NDC 43900018181
Hospital Charge Code	200081
Hospital Revenue Code	637
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna Medicare	$4.80
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: BCBS Complete	$3.84
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

ISOSOURCE 1.5 INTERMITTENT FEED

Facility

$9.60

Service Code	NDC 43900018181
Hospital Charge Code	200080
Hospital Revenue Code	637
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna Medicare	$4.80
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: BCBS Complete	$3.84
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

ISOSOURCE 1.5 INTERMITTENT FEED

Facility

$9.60

Service Code	NDC 43900018181
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: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

ISOSOURCE HN BOLUS FEED

Facility

$9.60

Service Code	NDC 43900018480
Hospital Charge Code	150769
Hospital Revenue Code	637
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna Medicare	$4.80
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: BCBS Complete	$3.84
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

ISOSOURCE HN BOLUS FEED

Facility

$9.60

Service Code	NDC 43900018480
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: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

ISOSOURCE HN CONTINUOUS FEED

Facility

$9.60

Service Code	NDC 43900018480
Hospital Charge Code	168942
Hospital Revenue Code	637
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna Medicare	$4.80
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: BCBS Complete	$3.84
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

Know your out-of-pocket cost for care.

All Charges