Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LIPASE-PROTEASE-AMYLASE (PORK)6,000-19,000-30,000 UNIT CAPSULE,DEL REL

Facility

$933.12

Service Code	NDC 00032120601
Hospital Charge Code	98034
Hospital Revenue Code	637
Min. Negotiated Rate	$587.87
Max. Negotiated Rate	$839.81
Rate for Payer: Aetna Commercial	$793.15
Rate for Payer: Aetna New Business (MI Preferred)	$606.53
Rate for Payer: Cash Price	$746.50
Rate for Payer: Cofinity Advantage	$653.18
Rate for Payer: Cofinity Commercial	$802.48
Rate for Payer: Encore Health Key Benefits Commercial	$746.50
Rate for Payer: Healthscope Commercial	$839.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$793.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$699.84
Rate for Payer: PHP Commercial	$793.15
Rate for Payer: Priority Health SBD	$587.87

LIPASE-PROTEASE-AMYLASE (PORK)6,000-19,000-30,000 UNIT CAPSULE,DEL REL

Facility

$757.76

Service Code	NDC 00032004670
Hospital Charge Code	98034
Hospital Revenue Code	637
Min. Negotiated Rate	$477.39
Max. Negotiated Rate	$681.98
Rate for Payer: Aetna Commercial	$644.10
Rate for Payer: Aetna New Business (MI Preferred)	$492.54
Rate for Payer: Cash Price	$606.21
Rate for Payer: Cofinity Advantage	$530.43
Rate for Payer: Cofinity Commercial	$651.67
Rate for Payer: Encore Health Key Benefits Commercial	$606.21
Rate for Payer: Healthscope Commercial	$681.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$644.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$568.32
Rate for Payer: PHP Commercial	$644.10
Rate for Payer: Priority Health SBD	$477.39

LIPASE-PROTEASE-AMYLASE (PORK)6,000-19,000-30,000 UNIT CAPSULE,DEL REL

Facility

$757.76

Service Code	NDC 00032004670
Hospital Charge Code	98034
Hospital Revenue Code	637
Min. Negotiated Rate	$297.80
Max. Negotiated Rate	$681.98
Rate for Payer: Aetna Commercial	$644.10
Rate for Payer: Aetna Medicare	$378.88
Rate for Payer: Aetna New Business (MI Preferred)	$492.54
Rate for Payer: BCBS Complete	$303.10
Rate for Payer: Cash Price	$606.21
Rate for Payer: Cofinity Advantage	$530.43
Rate for Payer: Cofinity Commercial	$651.67
Rate for Payer: Encore Health Key Benefits Commercial	$606.21
Rate for Payer: Healthscope Commercial	$681.98
Rate for Payer: MI Amish Medical Board Commercial	$606.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$644.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$568.32
Rate for Payer: PHP Commercial	$644.10
Rate for Payer: Priority Health SBD	$477.39
Rate for Payer: UHC All Payor (Choice/PPO)	$492.54
Rate for Payer: UHC Core	$394.79
Rate for Payer: UHC Exchange	$297.80

LIPASE-PROTEASE-AMYLASE (PORK)6,000-19,000-30,000 UNIT CAPSULE,DEL REL

Facility

$933.12

Service Code	NDC 00032120601
Hospital Charge Code	98034
Hospital Revenue Code	637
Min. Negotiated Rate	$366.72
Max. Negotiated Rate	$839.81
Rate for Payer: Aetna Commercial	$793.15
Rate for Payer: Aetna Medicare	$466.56
Rate for Payer: Aetna New Business (MI Preferred)	$606.53
Rate for Payer: BCBS Complete	$373.25
Rate for Payer: Cash Price	$746.50
Rate for Payer: Cofinity Advantage	$653.18
Rate for Payer: Cofinity Commercial	$802.48
Rate for Payer: Encore Health Key Benefits Commercial	$746.50
Rate for Payer: Healthscope Commercial	$839.81
Rate for Payer: MI Amish Medical Board Commercial	$746.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$793.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$699.84
Rate for Payer: PHP Commercial	$793.15
Rate for Payer: Priority Health SBD	$587.87
Rate for Payer: UHC All Payor (Choice/PPO)	$606.53
Rate for Payer: UHC Core	$486.16
Rate for Payer: UHC Exchange	$366.72

LIPASE-PROTEASE-AMYLAS(PORK)24,000-76,000-120,000 UNIT CAPSULE,DEL REL

Facility

$2,832.72

Service Code	NDC 00032122401
Hospital Charge Code	98036
Hospital Revenue Code	637
Min. Negotiated Rate	$1,113.26
Max. Negotiated Rate	$2,549.45
Rate for Payer: Aetna Commercial	$2,407.81
Rate for Payer: Aetna Medicare	$1,416.36
Rate for Payer: Aetna New Business (MI Preferred)	$1,841.27
Rate for Payer: BCBS Complete	$1,133.09
Rate for Payer: Cash Price	$2,266.18
Rate for Payer: Cofinity Advantage	$1,982.90
Rate for Payer: Cofinity Commercial	$2,436.14
Rate for Payer: Encore Health Key Benefits Commercial	$2,266.18
Rate for Payer: Healthscope Commercial	$2,549.45
Rate for Payer: MI Amish Medical Board Commercial	$2,266.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,407.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,124.54
Rate for Payer: PHP Commercial	$2,407.81
Rate for Payer: Priority Health SBD	$1,784.61
Rate for Payer: UHC All Payor (Choice/PPO)	$1,841.27
Rate for Payer: UHC Core	$1,475.85
Rate for Payer: UHC Exchange	$1,113.26

LIPASE-PROTEASE-AMYLAS(PORK)24,000-76,000-120,000 UNIT CAPSULE,DEL REL

Facility

$3,002.55

Service Code	NDC 00032263601
Hospital Charge Code	98036
Hospital Revenue Code	637
Min. Negotiated Rate	$1,180.00
Max. Negotiated Rate	$2,702.30
Rate for Payer: Aetna Commercial	$2,552.17
Rate for Payer: Aetna Medicare	$1,501.28
Rate for Payer: Aetna New Business (MI Preferred)	$1,951.66
Rate for Payer: BCBS Complete	$1,201.02
Rate for Payer: Cash Price	$2,402.04
Rate for Payer: Cofinity Advantage	$2,101.78
Rate for Payer: Cofinity Commercial	$2,582.19
Rate for Payer: Encore Health Key Benefits Commercial	$2,402.04
Rate for Payer: Healthscope Commercial	$2,702.30
Rate for Payer: MI Amish Medical Board Commercial	$2,402.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,552.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,251.91
Rate for Payer: PHP Commercial	$2,552.17
Rate for Payer: Priority Health SBD	$1,891.61
Rate for Payer: UHC All Payor (Choice/PPO)	$1,951.66
Rate for Payer: UHC Core	$1,564.33
Rate for Payer: UHC Exchange	$1,180.00

LIPASE-PROTEASE-AMYLAS(PORK)24,000-76,000-120,000 UNIT CAPSULE,DEL REL

Facility

$3,002.55

Service Code	NDC 00032263601
Hospital Charge Code	98036
Hospital Revenue Code	637
Min. Negotiated Rate	$1,891.61
Max. Negotiated Rate	$2,702.30
Rate for Payer: Aetna Commercial	$2,552.17
Rate for Payer: Aetna New Business (MI Preferred)	$1,951.66
Rate for Payer: Cash Price	$2,402.04
Rate for Payer: Cofinity Advantage	$2,101.78
Rate for Payer: Cofinity Commercial	$2,582.19
Rate for Payer: Encore Health Key Benefits Commercial	$2,402.04
Rate for Payer: Healthscope Commercial	$2,702.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,552.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,251.91
Rate for Payer: PHP Commercial	$2,552.17
Rate for Payer: Priority Health SBD	$1,891.61

LIPASE-PROTEASE-AMYLAS(PORK)24,000-76,000-120,000 UNIT CAPSULE,DEL REL

Facility

$2,832.72

Service Code	NDC 00032122401
Hospital Charge Code	98036
Hospital Revenue Code	637
Min. Negotiated Rate	$1,784.61
Max. Negotiated Rate	$2,549.45
Rate for Payer: Aetna Commercial	$2,407.81
Rate for Payer: Aetna New Business (MI Preferred)	$1,841.27
Rate for Payer: Cash Price	$2,266.18
Rate for Payer: Cofinity Advantage	$1,982.90
Rate for Payer: Cofinity Commercial	$2,436.14
Rate for Payer: Encore Health Key Benefits Commercial	$2,266.18
Rate for Payer: Healthscope Commercial	$2,549.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,407.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,124.54
Rate for Payer: PHP Commercial	$2,407.81
Rate for Payer: Priority Health SBD	$1,784.61

LISDEXAMFETAMINE 30 MG CAPSULE

Facility

$3,966.93

Service Code	NDC 59417010310
Hospital Charge Code	81474
Hospital Revenue Code	637
Min. Negotiated Rate	$1,559.00
Max. Negotiated Rate	$3,570.24
Rate for Payer: Aetna Commercial	$3,371.89
Rate for Payer: Aetna Medicare	$1,983.46
Rate for Payer: Aetna New Business (MI Preferred)	$2,578.50
Rate for Payer: BCBS Complete	$1,586.77
Rate for Payer: Cash Price	$3,173.54
Rate for Payer: Cofinity Advantage	$2,776.85
Rate for Payer: Cofinity Commercial	$3,411.56
Rate for Payer: Encore Health Key Benefits Commercial	$3,173.54
Rate for Payer: Healthscope Commercial	$3,570.24
Rate for Payer: MI Amish Medical Board Commercial	$3,173.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,371.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,975.20
Rate for Payer: PHP Commercial	$3,371.89
Rate for Payer: Priority Health SBD	$2,499.17
Rate for Payer: UHC All Payor (Choice/PPO)	$2,578.50
Rate for Payer: UHC Core	$2,066.77
Rate for Payer: UHC Exchange	$1,559.00

LISDEXAMFETAMINE 30 MG CAPSULE

Facility

$3,966.93

Service Code	NDC 59417010310
Hospital Charge Code	81474
Hospital Revenue Code	637
Min. Negotiated Rate	$2,499.17
Max. Negotiated Rate	$3,570.24
Rate for Payer: Aetna Commercial	$3,371.89
Rate for Payer: Aetna New Business (MI Preferred)	$2,578.50
Rate for Payer: Cash Price	$3,173.54
Rate for Payer: Cofinity Advantage	$2,776.85
Rate for Payer: Cofinity Commercial	$3,411.56
Rate for Payer: Encore Health Key Benefits Commercial	$3,173.54
Rate for Payer: Healthscope Commercial	$3,570.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,371.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,975.20
Rate for Payer: PHP Commercial	$3,371.89
Rate for Payer: Priority Health SBD	$2,499.17

LISINOPRIL 10 MG TABLET

Facility

$2.33

Service Code	NDC 60687032511
Hospital Charge Code	10449
Hospital Revenue Code	637
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$2.10
Rate for Payer: Aetna Commercial	$1.98
Rate for Payer: Aetna Medicare	$1.17
Rate for Payer: Aetna New Business (MI Preferred)	$1.51
Rate for Payer: BCBS Complete	$0.93
Rate for Payer: Cash Price	$1.86
Rate for Payer: Cofinity Advantage	$1.63
Rate for Payer: Cofinity Commercial	$2.00
Rate for Payer: Encore Health Key Benefits Commercial	$1.86
Rate for Payer: Healthscope Commercial	$2.10
Rate for Payer: MI Amish Medical Board Commercial	$1.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.75
Rate for Payer: PHP Commercial	$1.98
Rate for Payer: Priority Health SBD	$1.47
Rate for Payer: UHC All Payor (Choice/PPO)	$1.51
Rate for Payer: UHC Core	$1.21
Rate for Payer: UHC Exchange	$0.92

LISINOPRIL 10 MG TABLET

Facility

$2.33

Service Code	NDC 60687032511
Hospital Charge Code	10449
Hospital Revenue Code	637
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$2.10
Rate for Payer: Aetna Commercial	$1.98
Rate for Payer: Aetna New Business (MI Preferred)	$1.51
Rate for Payer: Cash Price	$1.86
Rate for Payer: Cofinity Advantage	$1.63
Rate for Payer: Cofinity Commercial	$2.00
Rate for Payer: Encore Health Key Benefits Commercial	$1.86
Rate for Payer: Healthscope Commercial	$2.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.75
Rate for Payer: PHP Commercial	$1.98
Rate for Payer: Priority Health SBD	$1.47

LISINOPRIL 10 MG TABLET

Facility

$47.00

Service Code	NDC 68180098001
Hospital Charge Code	10449
Hospital Revenue Code	637
Min. Negotiated Rate	$29.61
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna Commercial	$39.95
Rate for Payer: Aetna New Business (MI Preferred)	$30.55
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cofinity Advantage	$32.90
Rate for Payer: Cofinity Commercial	$40.42
Rate for Payer: Encore Health Key Benefits Commercial	$37.60
Rate for Payer: Healthscope Commercial	$42.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$35.25
Rate for Payer: PHP Commercial	$39.95
Rate for Payer: Priority Health SBD	$29.61

LISINOPRIL 10 MG TABLET

Facility

$112.80

Service Code	NDC 00904679861
Hospital Charge Code	10449
Hospital Revenue Code	637
Min. Negotiated Rate	$44.33
Max. Negotiated Rate	$101.52
Rate for Payer: Aetna Commercial	$95.88
Rate for Payer: Aetna Medicare	$56.40
Rate for Payer: Aetna New Business (MI Preferred)	$73.32
Rate for Payer: BCBS Complete	$45.12
Rate for Payer: Cash Price	$90.24
Rate for Payer: Cofinity Advantage	$78.96
Rate for Payer: Cofinity Commercial	$97.01
Rate for Payer: Encore Health Key Benefits Commercial	$90.24
Rate for Payer: Healthscope Commercial	$101.52
Rate for Payer: MI Amish Medical Board Commercial	$90.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$95.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$84.60
Rate for Payer: PHP Commercial	$95.88
Rate for Payer: Priority Health SBD	$71.06
Rate for Payer: UHC All Payor (Choice/PPO)	$73.32
Rate for Payer: UHC Core	$58.77
Rate for Payer: UHC Exchange	$44.33

LISINOPRIL 10 MG TABLET

Facility

$232.65

Service Code	NDC 60687032501
Hospital Charge Code	10449
Hospital Revenue Code	637
Min. Negotiated Rate	$146.57
Max. Negotiated Rate	$209.38
Rate for Payer: Aetna Commercial	$197.75
Rate for Payer: Aetna New Business (MI Preferred)	$151.22
Rate for Payer: Cash Price	$186.12
Rate for Payer: Cofinity Advantage	$162.85
Rate for Payer: Cofinity Commercial	$200.08
Rate for Payer: Encore Health Key Benefits Commercial	$186.12
Rate for Payer: Healthscope Commercial	$209.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$197.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$174.49
Rate for Payer: PHP Commercial	$197.75
Rate for Payer: Priority Health SBD	$146.57

LISINOPRIL 10 MG TABLET

Facility

$47.00

Service Code	NDC 68180098001
Hospital Charge Code	10449
Hospital Revenue Code	637
Min. Negotiated Rate	$18.47
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna Commercial	$39.95
Rate for Payer: Aetna Medicare	$23.50
Rate for Payer: Aetna New Business (MI Preferred)	$30.55
Rate for Payer: BCBS Complete	$18.80
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cofinity Advantage	$32.90
Rate for Payer: Cofinity Commercial	$40.42
Rate for Payer: Encore Health Key Benefits Commercial	$37.60
Rate for Payer: Healthscope Commercial	$42.30
Rate for Payer: MI Amish Medical Board Commercial	$37.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$35.25
Rate for Payer: PHP Commercial	$39.95
Rate for Payer: Priority Health SBD	$29.61
Rate for Payer: UHC All Payor (Choice/PPO)	$30.55
Rate for Payer: UHC Core	$24.49
Rate for Payer: UHC Exchange	$18.47

LISINOPRIL 10 MG TABLET

Facility

$112.80

Service Code	NDC 00904679861
Hospital Charge Code	10449
Hospital Revenue Code	637
Min. Negotiated Rate	$71.06
Max. Negotiated Rate	$101.52
Rate for Payer: Aetna Commercial	$95.88
Rate for Payer: Aetna New Business (MI Preferred)	$73.32
Rate for Payer: Cash Price	$90.24
Rate for Payer: Cofinity Advantage	$78.96
Rate for Payer: Cofinity Commercial	$97.01
Rate for Payer: Encore Health Key Benefits Commercial	$90.24
Rate for Payer: Healthscope Commercial	$101.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$95.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$84.60
Rate for Payer: PHP Commercial	$95.88
Rate for Payer: Priority Health SBD	$71.06

LISINOPRIL 10 MG TABLET

Facility

$232.65

Service Code	NDC 60687032501
Hospital Charge Code	10449
Hospital Revenue Code	637
Min. Negotiated Rate	$91.43
Max. Negotiated Rate	$209.38
Rate for Payer: Aetna Commercial	$197.75
Rate for Payer: Aetna Medicare	$116.33
Rate for Payer: Aetna New Business (MI Preferred)	$151.22
Rate for Payer: BCBS Complete	$93.06
Rate for Payer: Cash Price	$186.12
Rate for Payer: Cofinity Advantage	$162.85
Rate for Payer: Cofinity Commercial	$200.08
Rate for Payer: Encore Health Key Benefits Commercial	$186.12
Rate for Payer: Healthscope Commercial	$209.38
Rate for Payer: MI Amish Medical Board Commercial	$186.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$197.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$174.49
Rate for Payer: PHP Commercial	$197.75
Rate for Payer: Priority Health SBD	$146.57
Rate for Payer: UHC All Payor (Choice/PPO)	$151.22
Rate for Payer: UHC Core	$121.21
Rate for Payer: UHC Exchange	$91.43

LISINOPRIL 20 MG TABLET

Facility

$148.05

Service Code	NDC 00904679961
Hospital Charge Code	4526
Hospital Revenue Code	637
Min. Negotiated Rate	$58.18
Max. Negotiated Rate	$133.25
Rate for Payer: Aetna Commercial	$125.84
Rate for Payer: Aetna Medicare	$74.03
Rate for Payer: Aetna New Business (MI Preferred)	$96.23
Rate for Payer: BCBS Complete	$59.22
Rate for Payer: Cash Price	$118.44
Rate for Payer: Cofinity Advantage	$103.64
Rate for Payer: Cofinity Commercial	$127.32
Rate for Payer: Encore Health Key Benefits Commercial	$118.44
Rate for Payer: Healthscope Commercial	$133.25
Rate for Payer: MI Amish Medical Board Commercial	$118.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$125.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$111.04
Rate for Payer: PHP Commercial	$125.84
Rate for Payer: Priority Health SBD	$93.27
Rate for Payer: UHC All Payor (Choice/PPO)	$96.23
Rate for Payer: UHC Core	$77.13
Rate for Payer: UHC Exchange	$58.18

LISINOPRIL 20 MG TABLET

Facility

$70.50

Service Code	NDC 68180098101
Hospital Charge Code	4526
Hospital Revenue Code	637
Min. Negotiated Rate	$27.71
Max. Negotiated Rate	$63.45
Rate for Payer: Aetna Commercial	$59.92
Rate for Payer: Aetna Medicare	$35.25
Rate for Payer: Aetna New Business (MI Preferred)	$45.83
Rate for Payer: BCBS Complete	$28.20
Rate for Payer: Cash Price	$56.40
Rate for Payer: Cofinity Advantage	$49.35
Rate for Payer: Cofinity Commercial	$60.63
Rate for Payer: Encore Health Key Benefits Commercial	$56.40
Rate for Payer: Healthscope Commercial	$63.45
Rate for Payer: MI Amish Medical Board Commercial	$56.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$52.88
Rate for Payer: PHP Commercial	$59.92
Rate for Payer: Priority Health SBD	$44.41
Rate for Payer: UHC All Payor (Choice/PPO)	$45.83
Rate for Payer: UHC Core	$36.73
Rate for Payer: UHC Exchange	$27.71

LISINOPRIL 20 MG TABLET

Facility

$2.52

Service Code	NDC 60687033311
Hospital Charge Code	4526
Hospital Revenue Code	637
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$2.27
Rate for Payer: Aetna Commercial	$2.14
Rate for Payer: Aetna Medicare	$1.26
Rate for Payer: Aetna New Business (MI Preferred)	$1.64
Rate for Payer: BCBS Complete	$1.01
Rate for Payer: Cash Price	$2.02
Rate for Payer: Cofinity Advantage	$1.76
Rate for Payer: Cofinity Commercial	$2.17
Rate for Payer: Encore Health Key Benefits Commercial	$2.02
Rate for Payer: Healthscope Commercial	$2.27
Rate for Payer: MI Amish Medical Board Commercial	$2.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.89
Rate for Payer: PHP Commercial	$2.14
Rate for Payer: Priority Health SBD	$1.59
Rate for Payer: UHC All Payor (Choice/PPO)	$1.64
Rate for Payer: UHC Core	$1.31
Rate for Payer: UHC Exchange	$0.99

LISINOPRIL 20 MG TABLET

Facility

$251.45

Service Code	NDC 60687033301
Hospital Charge Code	4526
Hospital Revenue Code	637
Min. Negotiated Rate	$158.41
Max. Negotiated Rate	$226.31
Rate for Payer: Aetna Commercial	$213.73
Rate for Payer: Aetna New Business (MI Preferred)	$163.44
Rate for Payer: Cash Price	$201.16
Rate for Payer: Cofinity Advantage	$176.01
Rate for Payer: Cofinity Commercial	$216.25
Rate for Payer: Encore Health Key Benefits Commercial	$201.16
Rate for Payer: Healthscope Commercial	$226.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$213.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$188.59
Rate for Payer: PHP Commercial	$213.73
Rate for Payer: Priority Health SBD	$158.41

LISINOPRIL 20 MG TABLET

Facility

$2.52

Service Code	NDC 60687033311
Hospital Charge Code	4526
Hospital Revenue Code	637
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$2.27
Rate for Payer: Aetna Commercial	$2.14
Rate for Payer: Aetna New Business (MI Preferred)	$1.64
Rate for Payer: Cash Price	$2.02
Rate for Payer: Cofinity Advantage	$1.76
Rate for Payer: Cofinity Commercial	$2.17
Rate for Payer: Encore Health Key Benefits Commercial	$2.02
Rate for Payer: Healthscope Commercial	$2.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.89
Rate for Payer: PHP Commercial	$2.14
Rate for Payer: Priority Health SBD	$1.59

LISINOPRIL 20 MG TABLET

Facility

$70.50

Service Code	NDC 68180098101
Hospital Charge Code	4526
Hospital Revenue Code	637
Min. Negotiated Rate	$44.41
Max. Negotiated Rate	$63.45
Rate for Payer: Aetna Commercial	$59.92
Rate for Payer: Aetna New Business (MI Preferred)	$45.83
Rate for Payer: Cash Price	$56.40
Rate for Payer: Cofinity Advantage	$49.35
Rate for Payer: Cofinity Commercial	$60.63
Rate for Payer: Encore Health Key Benefits Commercial	$56.40
Rate for Payer: Healthscope Commercial	$63.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$52.88
Rate for Payer: PHP Commercial	$59.92
Rate for Payer: Priority Health SBD	$44.41

LISINOPRIL 20 MG TABLET

Facility

$148.05

Service Code	NDC 00904679961
Hospital Charge Code	4526
Hospital Revenue Code	637
Min. Negotiated Rate	$93.27
Max. Negotiated Rate	$133.25
Rate for Payer: Aetna Commercial	$125.84
Rate for Payer: Aetna New Business (MI Preferred)	$96.23
Rate for Payer: Cash Price	$118.44
Rate for Payer: Cofinity Advantage	$103.64
Rate for Payer: Cofinity Commercial	$127.32
Rate for Payer: Encore Health Key Benefits Commercial	$118.44
Rate for Payer: Healthscope Commercial	$133.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$125.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$111.04
Rate for Payer: PHP Commercial	$125.84
Rate for Payer: Priority Health SBD	$93.27

Know your out-of-pocket cost for care.

All Charges