Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LISINOPRIL 20 MG TABLET

Facility

$58.75

Service Code	NDC 68180-981-01
Hospital Charge Code	4526
Hospital Revenue Code	637
Min. Negotiated Rate	$37.01
Max. Negotiated Rate	$52.88
Rate for Payer: Aetna Commercial	$49.94
Rate for Payer: Aetna New Business (MI Preferred)	$38.19
Rate for Payer: Cash Price	$47.00
Rate for Payer: Cofinity Commercial	$41.12
Rate for Payer: Cofinity Commercial	$50.52
Rate for Payer: Healthscope Commercial	$52.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$49.94
Rate for Payer: PHP Commercial	$49.94
Rate for Payer: Priority Health Cigna Priority Health	$41.12
Rate for Payer: Priority Health SBD	$37.01

LISINOPRIL 20 MG TABLET

Facility

$263.20

Service Code	NDC 60687-333-01
Hospital Charge Code	4526
Hospital Revenue Code	637
Min. Negotiated Rate	$165.82
Max. Negotiated Rate	$236.88
Rate for Payer: Aetna Commercial	$223.72
Rate for Payer: Aetna New Business (MI Preferred)	$171.08
Rate for Payer: Cash Price	$210.56
Rate for Payer: Cofinity Commercial	$184.24
Rate for Payer: Cofinity Commercial	$226.35
Rate for Payer: Healthscope Commercial	$236.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$223.72
Rate for Payer: PHP Commercial	$223.72
Rate for Payer: Priority Health Cigna Priority Health	$184.24
Rate for Payer: Priority Health SBD	$165.82

LISINOPRIL 20 MG TABLET

Facility

$2.64

Service Code	NDC 60687-333-11
Hospital Charge Code	4526
Hospital Revenue Code	637
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$2.38
Rate for Payer: Aetna Commercial	$2.24
Rate for Payer: Aetna New Business (MI Preferred)	$1.72
Rate for Payer: Cash Price	$2.11
Rate for Payer: Cofinity Commercial	$1.85
Rate for Payer: Cofinity Commercial	$2.27
Rate for Payer: Healthscope Commercial	$2.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.24
Rate for Payer: PHP Commercial	$2.24
Rate for Payer: Priority Health Cigna Priority Health	$1.85
Rate for Payer: Priority Health SBD	$1.66

LISINOPRIL 20 MG TABLET

Facility

$143.35

Service Code	NDC 0904-6799-61
Hospital Charge Code	4526
Hospital Revenue Code	637
Min. Negotiated Rate	$90.31
Max. Negotiated Rate	$129.02
Rate for Payer: Aetna Commercial	$121.85
Rate for Payer: Aetna New Business (MI Preferred)	$93.18
Rate for Payer: Cash Price	$114.68
Rate for Payer: Cofinity Commercial	$100.34
Rate for Payer: Cofinity Commercial	$123.28
Rate for Payer: Healthscope Commercial	$129.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$121.85
Rate for Payer: PHP Commercial	$121.85
Rate for Payer: Priority Health Cigna Priority Health	$100.34
Rate for Payer: Priority Health SBD	$90.31

LISINOPRIL 2.5 MG TABLET

Facility

$4.28

Service Code	NDC 60687-656-11
Hospital Charge Code	13089
Hospital Revenue Code	637
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$3.64
Rate for Payer: Aetna New Business (MI Preferred)	$2.78
Rate for Payer: Cash Price	$3.42
Rate for Payer: Cofinity Commercial	$3.00
Rate for Payer: Cofinity Commercial	$3.68
Rate for Payer: Healthscope Commercial	$3.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.64
Rate for Payer: PHP Commercial	$3.64
Rate for Payer: Priority Health Cigna Priority Health	$3.00
Rate for Payer: Priority Health SBD	$2.70

LISINOPRIL 2.5 MG TABLET

Facility

$128.25

Service Code	NDC 60687-656-21
Hospital Charge Code	13089
Hospital Revenue Code	637
Min. Negotiated Rate	$80.80
Max. Negotiated Rate	$115.42
Rate for Payer: Aetna Commercial	$109.01
Rate for Payer: Aetna New Business (MI Preferred)	$83.36
Rate for Payer: Cash Price	$102.60
Rate for Payer: Cofinity Commercial	$110.30
Rate for Payer: Cofinity Commercial	$89.78
Rate for Payer: Healthscope Commercial	$115.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$109.01
Rate for Payer: PHP Commercial	$109.01
Rate for Payer: Priority Health Cigna Priority Health	$89.78
Rate for Payer: Priority Health SBD	$80.80

LISINOPRIL 40 MG TABLET

Facility

$357.20

Service Code	NDC 43547-356-10
Hospital Charge Code	10450
Hospital Revenue Code	637
Min. Negotiated Rate	$225.04
Max. Negotiated Rate	$321.48
Rate for Payer: Aetna Commercial	$303.62
Rate for Payer: Aetna New Business (MI Preferred)	$232.18
Rate for Payer: Cash Price	$285.76
Rate for Payer: Cofinity Commercial	$250.04
Rate for Payer: Cofinity Commercial	$307.19
Rate for Payer: Healthscope Commercial	$321.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$303.62
Rate for Payer: PHP Commercial	$303.62
Rate for Payer: Priority Health Cigna Priority Health	$250.04
Rate for Payer: Priority Health SBD	$225.04

LISINOPRIL 40 MG TABLET

Facility

$244.40

Service Code	NDC 0904-7200-61
Hospital Charge Code	10450
Hospital Revenue Code	637
Min. Negotiated Rate	$153.97
Max. Negotiated Rate	$219.96
Rate for Payer: Aetna Commercial	$207.74
Rate for Payer: Aetna New Business (MI Preferred)	$158.86
Rate for Payer: Cash Price	$195.52
Rate for Payer: Cofinity Commercial	$171.08
Rate for Payer: Cofinity Commercial	$210.18
Rate for Payer: Healthscope Commercial	$219.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$207.74
Rate for Payer: PHP Commercial	$207.74
Rate for Payer: Priority Health Cigna Priority Health	$171.08
Rate for Payer: Priority Health SBD	$153.97

LISINOPRIL 40 MG TABLET

Facility

$75.20

Service Code	NDC 68180-517-01
Hospital Charge Code	10450
Hospital Revenue Code	637
Min. Negotiated Rate	$47.38
Max. Negotiated Rate	$67.68
Rate for Payer: Aetna Commercial	$63.92
Rate for Payer: Aetna New Business (MI Preferred)	$48.88
Rate for Payer: Cash Price	$60.16
Rate for Payer: Cofinity Commercial	$52.64
Rate for Payer: Cofinity Commercial	$64.67
Rate for Payer: Healthscope Commercial	$67.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$63.92
Rate for Payer: PHP Commercial	$63.92
Rate for Payer: Priority Health Cigna Priority Health	$52.64
Rate for Payer: Priority Health SBD	$47.38

LISINOPRIL 5 MG TABLET

Facility

$141.00

Service Code	NDC 0904-6797-61
Hospital Charge Code	10451
Hospital Revenue Code	637
Min. Negotiated Rate	$88.83
Max. Negotiated Rate	$126.90
Rate for Payer: Aetna Commercial	$119.85
Rate for Payer: Aetna New Business (MI Preferred)	$91.65
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cofinity Commercial	$121.26
Rate for Payer: Cofinity Commercial	$98.70
Rate for Payer: Healthscope Commercial	$126.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$119.85
Rate for Payer: PHP Commercial	$119.85
Rate for Payer: Priority Health Cigna Priority Health	$98.70
Rate for Payer: Priority Health SBD	$88.83

LISINOPRIL 5 MG TABLET

Facility

$2.73

Service Code	NDC 60687-667-11
Hospital Charge Code	10451
Hospital Revenue Code	637
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$2.46
Rate for Payer: Aetna Commercial	$2.32
Rate for Payer: Aetna New Business (MI Preferred)	$1.77
Rate for Payer: Cash Price	$2.18
Rate for Payer: Cofinity Commercial	$1.91
Rate for Payer: Cofinity Commercial	$2.35
Rate for Payer: Healthscope Commercial	$2.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.32
Rate for Payer: PHP Commercial	$2.32
Rate for Payer: Priority Health Cigna Priority Health	$1.91
Rate for Payer: Priority Health SBD	$1.72

LISINOPRIL 5 MG TABLET

Facility

$37.60

Service Code	NDC 68180-513-01
Hospital Charge Code	10451
Hospital Revenue Code	637
Min. Negotiated Rate	$23.69
Max. Negotiated Rate	$33.84
Rate for Payer: Aetna Commercial	$31.96
Rate for Payer: Aetna New Business (MI Preferred)	$24.44
Rate for Payer: Cash Price	$30.08
Rate for Payer: Cofinity Commercial	$26.32
Rate for Payer: Cofinity Commercial	$32.34
Rate for Payer: Healthscope Commercial	$33.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$31.96
Rate for Payer: PHP Commercial	$31.96
Rate for Payer: Priority Health Cigna Priority Health	$26.32
Rate for Payer: Priority Health SBD	$23.69

LISINOPRIL 5 MG TABLET

Facility

$272.60

Service Code	NDC 60687-667-01
Hospital Charge Code	10451
Hospital Revenue Code	637
Min. Negotiated Rate	$171.74
Max. Negotiated Rate	$245.34
Rate for Payer: Aetna Commercial	$231.71
Rate for Payer: Aetna New Business (MI Preferred)	$177.19
Rate for Payer: Cash Price	$218.08
Rate for Payer: Cofinity Commercial	$190.82
Rate for Payer: Cofinity Commercial	$234.44
Rate for Payer: Healthscope Commercial	$245.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$231.71
Rate for Payer: PHP Commercial	$231.71
Rate for Payer: Priority Health Cigna Priority Health	$190.82
Rate for Payer: Priority Health SBD	$171.74

LITHIUM CARBONATE 150 MG CAPSULE

Facility

$329.00

Service Code	NDC 0054-8526-25
Hospital Charge Code	4528
Hospital Revenue Code	637
Min. Negotiated Rate	$207.27
Max. Negotiated Rate	$296.10
Rate for Payer: Aetna Commercial	$279.65
Rate for Payer: Aetna New Business (MI Preferred)	$213.85
Rate for Payer: Cash Price	$263.20
Rate for Payer: Cofinity Commercial	$230.30
Rate for Payer: Cofinity Commercial	$282.94
Rate for Payer: Healthscope Commercial	$296.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$279.65
Rate for Payer: PHP Commercial	$279.65
Rate for Payer: Priority Health Cigna Priority Health	$230.30
Rate for Payer: Priority Health SBD	$207.27

LITHIUM CARBONATE 300 MG CAPSULE

Facility

$25.94

Service Code	NDC 0054-8527-25
Hospital Charge Code	4529
Hospital Revenue Code	637
Min. Negotiated Rate	$16.34
Max. Negotiated Rate	$23.35
Rate for Payer: Aetna Commercial	$22.05
Rate for Payer: Aetna New Business (MI Preferred)	$16.86
Rate for Payer: Cash Price	$20.75
Rate for Payer: Cofinity Commercial	$18.16
Rate for Payer: Cofinity Commercial	$22.31
Rate for Payer: Healthscope Commercial	$23.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$22.05
Rate for Payer: PHP Commercial	$22.05
Rate for Payer: Priority Health Cigna Priority Health	$18.16
Rate for Payer: Priority Health SBD	$16.34

LITHIUM CARBONATE 600 MG CAPSULE

Facility

$228.00

Service Code	NDC 0054-2531-25
Hospital Charge Code	4530
Hospital Revenue Code	637
Min. Negotiated Rate	$143.64
Max. Negotiated Rate	$205.20
Rate for Payer: Aetna Commercial	$193.80
Rate for Payer: Aetna New Business (MI Preferred)	$148.20
Rate for Payer: Cash Price	$182.40
Rate for Payer: Cofinity Commercial	$159.60
Rate for Payer: Cofinity Commercial	$196.08
Rate for Payer: Healthscope Commercial	$205.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$193.80
Rate for Payer: PHP Commercial	$193.80
Rate for Payer: Priority Health Cigna Priority Health	$159.60
Rate for Payer: Priority Health SBD	$143.64

LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE

Facility

$310.65

Service Code	NDC 51079-180-20
Hospital Charge Code	10454
Hospital Revenue Code	637
Min. Negotiated Rate	$195.71
Max. Negotiated Rate	$279.58
Rate for Payer: Aetna Commercial	$264.05
Rate for Payer: Aetna New Business (MI Preferred)	$201.92
Rate for Payer: Cash Price	$248.52
Rate for Payer: Cofinity Commercial	$217.46
Rate for Payer: Cofinity Commercial	$267.16
Rate for Payer: Healthscope Commercial	$279.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$264.05
Rate for Payer: PHP Commercial	$264.05
Rate for Payer: Priority Health Cigna Priority Health	$217.46
Rate for Payer: Priority Health SBD	$195.71

LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE

Facility

$3.11

Service Code	NDC 51079-180-01
Hospital Charge Code	10454
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

LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE

Facility

$3.73

Service Code	NDC 51079-142-01
Hospital Charge Code	10455
Hospital Revenue Code	637
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$3.36
Rate for Payer: Aetna Commercial	$3.17
Rate for Payer: Aetna New Business (MI Preferred)	$2.42
Rate for Payer: Cash Price	$2.98
Rate for Payer: Cofinity Commercial	$2.61
Rate for Payer: Cofinity Commercial	$3.21
Rate for Payer: Healthscope Commercial	$3.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.17
Rate for Payer: PHP Commercial	$3.17
Rate for Payer: Priority Health Cigna Priority Health	$2.61
Rate for Payer: Priority Health SBD	$2.35

LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE

Facility

$239.40

Service Code	NDC 68462-224-01
Hospital Charge Code	10455
Hospital Revenue Code	637
Min. Negotiated Rate	$150.82
Max. Negotiated Rate	$215.46
Rate for Payer: Aetna Commercial	$203.49
Rate for Payer: Aetna New Business (MI Preferred)	$155.61
Rate for Payer: Cash Price	$191.52
Rate for Payer: Cofinity Commercial	$167.58
Rate for Payer: Cofinity Commercial	$205.88
Rate for Payer: Healthscope Commercial	$215.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$203.49
Rate for Payer: PHP Commercial	$203.49
Rate for Payer: Priority Health Cigna Priority Health	$167.58
Rate for Payer: Priority Health SBD	$150.82

LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE

Facility

$289.75

Service Code	NDC 68084-655-01
Hospital Charge Code	10455
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

LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE

Facility

$372.40

Service Code	NDC 51079-142-20
Hospital Charge Code	10455
Hospital Revenue Code	637
Min. Negotiated Rate	$234.61
Max. Negotiated Rate	$335.16
Rate for Payer: Aetna Commercial	$316.54
Rate for Payer: Aetna New Business (MI Preferred)	$242.06
Rate for Payer: Cash Price	$297.92
Rate for Payer: Cofinity Commercial	$260.68
Rate for Payer: Cofinity Commercial	$320.26
Rate for Payer: Healthscope Commercial	$335.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$316.54
Rate for Payer: PHP Commercial	$316.54
Rate for Payer: Priority Health Cigna Priority Health	$260.68
Rate for Payer: Priority Health SBD	$234.61

LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE

Facility

$2.90

Service Code	NDC 68084-655-11
Hospital Charge Code	10455
Hospital Revenue Code	637
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$2.61
Rate for Payer: Aetna Commercial	$2.46
Rate for Payer: Aetna New Business (MI Preferred)	$1.88
Rate for Payer: Cash Price	$2.32
Rate for Payer: Cofinity Commercial	$2.03
Rate for Payer: Cofinity Commercial	$2.49
Rate for Payer: Healthscope Commercial	$2.61
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.46
Rate for Payer: PHP Commercial	$2.46
Rate for Payer: Priority Health Cigna Priority Health	$2.03
Rate for Payer: Priority Health SBD	$1.83

LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND REMOVAL OF FRAGMENTS; COMPLICATED OR LARGE (OVER 2.5 CM)

Facility

$9,573.02

Service Code	CPT 52318
Hospital Revenue Code	360
Min. Negotiated Rate	$456.45
Max. Negotiated Rate	$9,573.02
Rate for Payer: Aetna Medicare	$3,226.04
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,877.45
Rate for Payer: Amish Plain Church Group Commercial	$3,877.45
Rate for Payer: BCBS Complete	$1,781.77
Rate for Payer: BCBS MAPPO	$3,101.96
Rate for Payer: BCBS Trust/PPO	$2,294.53
Rate for Payer: BCN Medicare Advantage	$3,101.96
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,101.96
Rate for Payer: Mclaren Medicaid	$1,696.77
Rate for Payer: Mclaren Medicare	$3,101.96
Rate for Payer: Meridian Medicaid	$1,781.77
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,257.06
Rate for Payer: MI Amish Medical Board Commercial	$3,567.25
Rate for Payer: PACE Medicare	$2,946.86
Rate for Payer: PACE SWMI	$3,101.96
Rate for Payer: PHP Medicare Advantage	$3,101.96
Rate for Payer: Priority Health Choice Medicaid	$1,696.77
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9,573.02
Rate for Payer: Priority Health Medicare	$3,101.96
Rate for Payer: Priority Health Narrow Network	$7,658.42
Rate for Payer: Railroad Medicare Medicare	$3,101.96
Rate for Payer: UHC All Payor (Choice/PPO)	$502.10
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$3,101.96
Rate for Payer: UHC Exchange	$456.45
Rate for Payer: UHC Medicare Advantage	$3,195.02
Rate for Payer: VA VA	$3,101.96

LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND REMOVAL OF FRAGMENTS; SIMPLE OR SMALL (LESS THAN 2.5 CM)

Facility

$9,573.02

Service Code	CPT 52317
Hospital Revenue Code	360
Min. Negotiated Rate	$333.99
Max. Negotiated Rate	$9,573.02
Rate for Payer: Aetna Medicare	$3,226.04
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,877.45
Rate for Payer: Amish Plain Church Group Commercial	$3,877.45
Rate for Payer: BCBS Complete	$1,781.77
Rate for Payer: BCBS MAPPO	$3,101.96
Rate for Payer: BCBS Trust/PPO	$1,861.75
Rate for Payer: BCN Medicare Advantage	$3,101.96
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,101.96
Rate for Payer: Mclaren Medicaid	$1,696.77
Rate for Payer: Mclaren Medicare	$3,101.96
Rate for Payer: Meridian Medicaid	$1,781.77
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,257.06
Rate for Payer: MI Amish Medical Board Commercial	$3,567.25
Rate for Payer: PACE Medicare	$2,946.86
Rate for Payer: PACE SWMI	$3,101.96
Rate for Payer: PHP Medicare Advantage	$3,101.96
Rate for Payer: Priority Health Choice Medicaid	$1,696.77
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9,573.02
Rate for Payer: Priority Health Medicare	$3,101.96
Rate for Payer: Priority Health Narrow Network	$7,658.42
Rate for Payer: Railroad Medicare Medicare	$3,101.96
Rate for Payer: UHC All Payor (Choice/PPO)	$367.39
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$3,101.96
Rate for Payer: UHC Exchange	$333.99
Rate for Payer: UHC Medicare Advantage	$3,195.02
Rate for Payer: VA VA	$3,101.96

Know your out-of-pocket cost for care.

All Charges