Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LISINOPRIL 20 MG TABLET

Facility

$251.45

Service Code	NDC 60687033301
Hospital Charge Code	4526
Hospital Revenue Code	637
Min. Negotiated Rate	$98.82
Max. Negotiated Rate	$226.31
Rate for Payer: Aetna Commercial	$213.73
Rate for Payer: Aetna Medicare	$125.72
Rate for Payer: Aetna New Business (MI Preferred)	$163.44
Rate for Payer: BCBS Complete	$100.58
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: MI Amish Medical Board Commercial	$201.16
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
Rate for Payer: UHC All Payor (Choice/PPO)	$163.44
Rate for Payer: UHC Core	$131.01
Rate for Payer: UHC Exchange	$98.82

LISINOPRIL 2.5 MG TABLET

Facility

$139.65

Service Code	NDC 60687065621
Hospital Charge Code	13089
Hospital Revenue Code	637
Min. Negotiated Rate	$54.88
Max. Negotiated Rate	$125.69
Rate for Payer: Aetna Commercial	$118.70
Rate for Payer: Aetna Medicare	$69.83
Rate for Payer: Aetna New Business (MI Preferred)	$90.77
Rate for Payer: BCBS Complete	$55.86
Rate for Payer: Cash Price	$111.72
Rate for Payer: Cofinity Advantage	$97.75
Rate for Payer: Cofinity Commercial	$120.10
Rate for Payer: Encore Health Key Benefits Commercial	$111.72
Rate for Payer: Healthscope Commercial	$125.69
Rate for Payer: MI Amish Medical Board Commercial	$111.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$118.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$104.74
Rate for Payer: PHP Commercial	$118.70
Rate for Payer: Priority Health SBD	$87.98
Rate for Payer: UHC All Payor (Choice/PPO)	$90.77
Rate for Payer: UHC Core	$72.76
Rate for Payer: UHC Exchange	$54.88

LISINOPRIL 2.5 MG TABLET

Facility

$4.66

Service Code	NDC 60687065611
Hospital Charge Code	13089
Hospital Revenue Code	637
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$4.19
Rate for Payer: Aetna Commercial	$3.96
Rate for Payer: Aetna New Business (MI Preferred)	$3.03
Rate for Payer: Cash Price	$3.73
Rate for Payer: Cofinity Advantage	$3.26
Rate for Payer: Cofinity Commercial	$4.01
Rate for Payer: Encore Health Key Benefits Commercial	$3.73
Rate for Payer: Healthscope Commercial	$4.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.50
Rate for Payer: PHP Commercial	$3.96
Rate for Payer: Priority Health SBD	$2.94

LISINOPRIL 2.5 MG TABLET

Facility

$139.65

Service Code	NDC 60687065621
Hospital Charge Code	13089
Hospital Revenue Code	637
Min. Negotiated Rate	$87.98
Max. Negotiated Rate	$125.69
Rate for Payer: Aetna Commercial	$118.70
Rate for Payer: Aetna New Business (MI Preferred)	$90.77
Rate for Payer: Cash Price	$111.72
Rate for Payer: Cofinity Advantage	$97.75
Rate for Payer: Cofinity Commercial	$120.10
Rate for Payer: Encore Health Key Benefits Commercial	$111.72
Rate for Payer: Healthscope Commercial	$125.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$118.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$104.74
Rate for Payer: PHP Commercial	$118.70
Rate for Payer: Priority Health SBD	$87.98

LISINOPRIL 2.5 MG TABLET

Facility

$4.66

Service Code	NDC 60687065611
Hospital Charge Code	13089
Hospital Revenue Code	637
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$4.19
Rate for Payer: Aetna Commercial	$3.96
Rate for Payer: Aetna Medicare	$2.33
Rate for Payer: Aetna New Business (MI Preferred)	$3.03
Rate for Payer: BCBS Complete	$1.86
Rate for Payer: Cash Price	$3.73
Rate for Payer: Cofinity Advantage	$3.26
Rate for Payer: Cofinity Commercial	$4.01
Rate for Payer: Encore Health Key Benefits Commercial	$3.73
Rate for Payer: Healthscope Commercial	$4.19
Rate for Payer: MI Amish Medical Board Commercial	$3.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.50
Rate for Payer: PHP Commercial	$3.96
Rate for Payer: Priority Health SBD	$2.94
Rate for Payer: UHC All Payor (Choice/PPO)	$3.03
Rate for Payer: UHC Core	$2.43
Rate for Payer: UHC Exchange	$1.83

LISINOPRIL 40 MG TABLET

Facility

$265.55

Service Code	NDC 00904720061
Hospital Charge Code	10450
Hospital Revenue Code	637
Min. Negotiated Rate	$104.36
Max. Negotiated Rate	$239.00
Rate for Payer: Aetna Commercial	$225.72
Rate for Payer: Aetna Medicare	$132.78
Rate for Payer: Aetna New Business (MI Preferred)	$172.61
Rate for Payer: BCBS Complete	$106.22
Rate for Payer: Cash Price	$212.44
Rate for Payer: Cofinity Advantage	$185.88
Rate for Payer: Cofinity Commercial	$228.37
Rate for Payer: Encore Health Key Benefits Commercial	$212.44
Rate for Payer: Healthscope Commercial	$239.00
Rate for Payer: MI Amish Medical Board Commercial	$212.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$225.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$199.16
Rate for Payer: PHP Commercial	$225.72
Rate for Payer: Priority Health SBD	$167.30
Rate for Payer: UHC All Payor (Choice/PPO)	$172.61
Rate for Payer: UHC Core	$138.35
Rate for Payer: UHC Exchange	$104.36

LISINOPRIL 40 MG TABLET

Facility

$213.85

Service Code	NDC 43547035610
Hospital Charge Code	10450
Hospital Revenue Code	637
Min. Negotiated Rate	$84.04
Max. Negotiated Rate	$192.47
Rate for Payer: Aetna Commercial	$181.77
Rate for Payer: Aetna Medicare	$106.92
Rate for Payer: Aetna New Business (MI Preferred)	$139.00
Rate for Payer: BCBS Complete	$85.54
Rate for Payer: Cash Price	$171.08
Rate for Payer: Cofinity Advantage	$149.69
Rate for Payer: Cofinity Commercial	$183.91
Rate for Payer: Encore Health Key Benefits Commercial	$171.08
Rate for Payer: Healthscope Commercial	$192.47
Rate for Payer: MI Amish Medical Board Commercial	$171.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$181.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$160.39
Rate for Payer: PHP Commercial	$181.77
Rate for Payer: Priority Health SBD	$134.73
Rate for Payer: UHC All Payor (Choice/PPO)	$139.00
Rate for Payer: UHC Core	$111.42
Rate for Payer: UHC Exchange	$84.04

LISINOPRIL 40 MG TABLET

Facility

$265.55

Service Code	NDC 00904720061
Hospital Charge Code	10450
Hospital Revenue Code	637
Min. Negotiated Rate	$167.30
Max. Negotiated Rate	$239.00
Rate for Payer: Aetna Commercial	$225.72
Rate for Payer: Aetna New Business (MI Preferred)	$172.61
Rate for Payer: Cash Price	$212.44
Rate for Payer: Cofinity Advantage	$185.88
Rate for Payer: Cofinity Commercial	$228.37
Rate for Payer: Encore Health Key Benefits Commercial	$212.44
Rate for Payer: Healthscope Commercial	$239.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$225.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$199.16
Rate for Payer: PHP Commercial	$225.72
Rate for Payer: Priority Health SBD	$167.30

LISINOPRIL 40 MG TABLET

Facility

$213.85

Service Code	NDC 43547035610
Hospital Charge Code	10450
Hospital Revenue Code	637
Min. Negotiated Rate	$134.73
Max. Negotiated Rate	$192.47
Rate for Payer: Aetna Commercial	$181.77
Rate for Payer: Aetna New Business (MI Preferred)	$139.00
Rate for Payer: Cash Price	$171.08
Rate for Payer: Cofinity Advantage	$149.69
Rate for Payer: Cofinity Commercial	$183.91
Rate for Payer: Encore Health Key Benefits Commercial	$171.08
Rate for Payer: Healthscope Commercial	$192.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$181.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$160.39
Rate for Payer: PHP Commercial	$181.77
Rate for Payer: Priority Health SBD	$134.73

LISINOPRIL 5 MG TABLET

Facility

$272.60

Service Code	NDC 60687066701
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 Advantage	$190.82
Rate for Payer: Cofinity Commercial	$234.44
Rate for Payer: Encore Health Key Benefits Commercial	$218.08
Rate for Payer: Healthscope Commercial	$245.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$231.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$204.45
Rate for Payer: PHP Commercial	$231.71
Rate for Payer: Priority Health SBD	$171.74

LISINOPRIL 5 MG TABLET

Facility

$39.95

Service Code	NDC 68180051301
Hospital Charge Code	10451
Hospital Revenue Code	637
Min. Negotiated Rate	$25.17
Max. Negotiated Rate	$35.95
Rate for Payer: Aetna Commercial	$33.96
Rate for Payer: Aetna New Business (MI Preferred)	$25.97
Rate for Payer: Cash Price	$31.96
Rate for Payer: Cofinity Advantage	$27.96
Rate for Payer: Cofinity Commercial	$34.36
Rate for Payer: Encore Health Key Benefits Commercial	$31.96
Rate for Payer: Healthscope Commercial	$35.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$29.96
Rate for Payer: PHP Commercial	$33.96
Rate for Payer: Priority Health SBD	$25.17

LISINOPRIL 5 MG TABLET

Facility

$39.95

Service Code	NDC 68180051301
Hospital Charge Code	10451
Hospital Revenue Code	637
Min. Negotiated Rate	$15.70
Max. Negotiated Rate	$35.95
Rate for Payer: Aetna Commercial	$33.96
Rate for Payer: Aetna Medicare	$19.98
Rate for Payer: Aetna New Business (MI Preferred)	$25.97
Rate for Payer: BCBS Complete	$15.98
Rate for Payer: Cash Price	$31.96
Rate for Payer: Cofinity Advantage	$27.96
Rate for Payer: Cofinity Commercial	$34.36
Rate for Payer: Encore Health Key Benefits Commercial	$31.96
Rate for Payer: Healthscope Commercial	$35.95
Rate for Payer: MI Amish Medical Board Commercial	$31.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$29.96
Rate for Payer: PHP Commercial	$33.96
Rate for Payer: Priority Health SBD	$25.17
Rate for Payer: UHC All Payor (Choice/PPO)	$25.97
Rate for Payer: UHC Core	$20.81
Rate for Payer: UHC Exchange	$15.70

LISINOPRIL 5 MG TABLET

Facility

$176.25

Service Code	NDC 00904679761
Hospital Charge Code	10451
Hospital Revenue Code	637
Min. Negotiated Rate	$69.27
Max. Negotiated Rate	$158.62
Rate for Payer: Aetna Commercial	$149.81
Rate for Payer: Aetna Medicare	$88.12
Rate for Payer: Aetna New Business (MI Preferred)	$114.56
Rate for Payer: BCBS Complete	$70.50
Rate for Payer: Cash Price	$141.00
Rate for Payer: Cofinity Advantage	$123.38
Rate for Payer: Cofinity Commercial	$151.57
Rate for Payer: Encore Health Key Benefits Commercial	$141.00
Rate for Payer: Healthscope Commercial	$158.62
Rate for Payer: MI Amish Medical Board Commercial	$141.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$149.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$132.19
Rate for Payer: PHP Commercial	$149.81
Rate for Payer: Priority Health SBD	$111.04
Rate for Payer: UHC All Payor (Choice/PPO)	$114.56
Rate for Payer: UHC Core	$91.83
Rate for Payer: UHC Exchange	$69.27

LISINOPRIL 5 MG TABLET

Facility

$176.25

Service Code	NDC 00904679761
Hospital Charge Code	10451
Hospital Revenue Code	637
Min. Negotiated Rate	$111.04
Max. Negotiated Rate	$158.62
Rate for Payer: Aetna Commercial	$149.81
Rate for Payer: Aetna New Business (MI Preferred)	$114.56
Rate for Payer: Cash Price	$141.00
Rate for Payer: Cofinity Advantage	$123.38
Rate for Payer: Cofinity Commercial	$151.57
Rate for Payer: Encore Health Key Benefits Commercial	$141.00
Rate for Payer: Healthscope Commercial	$158.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$149.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$132.19
Rate for Payer: PHP Commercial	$149.81
Rate for Payer: Priority Health SBD	$111.04

LISINOPRIL 5 MG TABLET

Facility

$2.73

Service Code	NDC 60687066711
Hospital Charge Code	10451
Hospital Revenue Code	637
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$2.46
Rate for Payer: Aetna Commercial	$2.32
Rate for Payer: Aetna Medicare	$1.36
Rate for Payer: Aetna New Business (MI Preferred)	$1.77
Rate for Payer: BCBS Complete	$1.09
Rate for Payer: Cash Price	$2.18
Rate for Payer: Cofinity Advantage	$1.91
Rate for Payer: Cofinity Commercial	$2.35
Rate for Payer: Encore Health Key Benefits Commercial	$2.18
Rate for Payer: Healthscope Commercial	$2.46
Rate for Payer: MI Amish Medical Board Commercial	$2.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.05
Rate for Payer: PHP Commercial	$2.32
Rate for Payer: Priority Health SBD	$1.72
Rate for Payer: UHC All Payor (Choice/PPO)	$1.77
Rate for Payer: UHC Core	$1.42
Rate for Payer: UHC Exchange	$1.07

LISINOPRIL 5 MG TABLET

Facility

$2.73

Service Code	NDC 60687066711
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 Advantage	$1.91
Rate for Payer: Cofinity Commercial	$2.35
Rate for Payer: Encore Health Key Benefits Commercial	$2.18
Rate for Payer: Healthscope Commercial	$2.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.05
Rate for Payer: PHP Commercial	$2.32
Rate for Payer: Priority Health SBD	$1.72

LISINOPRIL 5 MG TABLET

Facility

$272.60

Service Code	NDC 60687066701
Hospital Charge Code	10451
Hospital Revenue Code	637
Min. Negotiated Rate	$107.13
Max. Negotiated Rate	$245.34
Rate for Payer: Aetna Commercial	$231.71
Rate for Payer: Aetna Medicare	$136.30
Rate for Payer: Aetna New Business (MI Preferred)	$177.19
Rate for Payer: BCBS Complete	$109.04
Rate for Payer: Cash Price	$218.08
Rate for Payer: Cofinity Advantage	$190.82
Rate for Payer: Cofinity Commercial	$234.44
Rate for Payer: Encore Health Key Benefits Commercial	$218.08
Rate for Payer: Healthscope Commercial	$245.34
Rate for Payer: MI Amish Medical Board Commercial	$218.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$231.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$204.45
Rate for Payer: PHP Commercial	$231.71
Rate for Payer: Priority Health SBD	$171.74
Rate for Payer: UHC All Payor (Choice/PPO)	$177.19
Rate for Payer: UHC Core	$142.02
Rate for Payer: UHC Exchange	$107.13

LITHIUM CARBONATE 150 MG CAPSULE

Facility

$378.35

Service Code	NDC 00054852625
Hospital Charge Code	4528
Hospital Revenue Code	637
Min. Negotiated Rate	$238.36
Max. Negotiated Rate	$340.51
Rate for Payer: Aetna Commercial	$321.60
Rate for Payer: Aetna New Business (MI Preferred)	$245.93
Rate for Payer: Cash Price	$302.68
Rate for Payer: Cofinity Advantage	$264.85
Rate for Payer: Cofinity Commercial	$325.38
Rate for Payer: Encore Health Key Benefits Commercial	$302.68
Rate for Payer: Healthscope Commercial	$340.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$321.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$283.76
Rate for Payer: PHP Commercial	$321.60
Rate for Payer: Priority Health SBD	$238.36

LITHIUM CARBONATE 150 MG CAPSULE

Facility

$378.35

Service Code	NDC 00054852625
Hospital Charge Code	4528
Hospital Revenue Code	637
Min. Negotiated Rate	$148.69
Max. Negotiated Rate	$340.51
Rate for Payer: Aetna Commercial	$321.60
Rate for Payer: Aetna Medicare	$189.18
Rate for Payer: Aetna New Business (MI Preferred)	$245.93
Rate for Payer: BCBS Complete	$151.34
Rate for Payer: Cash Price	$302.68
Rate for Payer: Cofinity Advantage	$264.85
Rate for Payer: Cofinity Commercial	$325.38
Rate for Payer: Encore Health Key Benefits Commercial	$302.68
Rate for Payer: Healthscope Commercial	$340.51
Rate for Payer: MI Amish Medical Board Commercial	$302.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$321.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$283.76
Rate for Payer: PHP Commercial	$321.60
Rate for Payer: Priority Health SBD	$238.36
Rate for Payer: UHC All Payor (Choice/PPO)	$245.93
Rate for Payer: UHC Core	$197.12
Rate for Payer: UHC Exchange	$148.69

LITHIUM CARBONATE 300 MG CAPSULE

Facility

$21.09

Service Code	NDC 00054852725
Hospital Charge Code	4529
Hospital Revenue Code	637
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$18.98
Rate for Payer: Aetna Commercial	$17.93
Rate for Payer: Aetna New Business (MI Preferred)	$13.71
Rate for Payer: Cash Price	$16.87
Rate for Payer: Cofinity Advantage	$14.76
Rate for Payer: Cofinity Commercial	$18.14
Rate for Payer: Encore Health Key Benefits Commercial	$16.87
Rate for Payer: Healthscope Commercial	$18.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.82
Rate for Payer: PHP Commercial	$17.93
Rate for Payer: Priority Health SBD	$13.29

LITHIUM CARBONATE 300 MG CAPSULE

Facility

$21.09

Service Code	NDC 00054852725
Hospital Charge Code	4529
Hospital Revenue Code	637
Min. Negotiated Rate	$8.29
Max. Negotiated Rate	$18.98
Rate for Payer: Aetna Commercial	$17.93
Rate for Payer: Aetna Medicare	$10.54
Rate for Payer: Aetna New Business (MI Preferred)	$13.71
Rate for Payer: BCBS Complete	$8.44
Rate for Payer: Cash Price	$16.87
Rate for Payer: Cofinity Advantage	$14.76
Rate for Payer: Cofinity Commercial	$18.14
Rate for Payer: Encore Health Key Benefits Commercial	$16.87
Rate for Payer: Healthscope Commercial	$18.98
Rate for Payer: MI Amish Medical Board Commercial	$16.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.82
Rate for Payer: PHP Commercial	$17.93
Rate for Payer: Priority Health SBD	$13.29
Rate for Payer: UHC All Payor (Choice/PPO)	$13.71
Rate for Payer: UHC Core	$10.99
Rate for Payer: UHC Exchange	$8.29

LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE

Facility

$3.11

Service Code	NDC 51079018001
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 Advantage	$2.18
Rate for Payer: Cofinity Commercial	$2.67
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: Opus (Opus Packaging Group) HMA	$2.33
Rate for Payer: PHP Commercial	$2.64
Rate for Payer: Priority Health SBD	$1.96

LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE

Facility

$329.00

Service Code	NDC 64980020501
Hospital Charge Code	10454
Hospital Revenue Code	637
Min. Negotiated Rate	$129.30
Max. Negotiated Rate	$296.10
Rate for Payer: Aetna Commercial	$279.65
Rate for Payer: Aetna Medicare	$164.50
Rate for Payer: Aetna New Business (MI Preferred)	$213.85
Rate for Payer: BCBS Complete	$131.60
Rate for Payer: Cash Price	$263.20
Rate for Payer: Cofinity Advantage	$230.30
Rate for Payer: Cofinity Commercial	$282.94
Rate for Payer: Encore Health Key Benefits Commercial	$263.20
Rate for Payer: Healthscope Commercial	$296.10
Rate for Payer: MI Amish Medical Board Commercial	$263.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$279.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$246.75
Rate for Payer: PHP Commercial	$279.65
Rate for Payer: Priority Health SBD	$207.27
Rate for Payer: UHC All Payor (Choice/PPO)	$213.85
Rate for Payer: UHC Core	$171.41
Rate for Payer: UHC Exchange	$129.30

LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE

Facility

$310.65

Service Code	NDC 51079018020
Hospital Charge Code	10454
Hospital Revenue Code	637
Min. Negotiated Rate	$122.09
Max. Negotiated Rate	$279.58
Rate for Payer: Aetna Commercial	$264.05
Rate for Payer: Aetna Medicare	$155.32
Rate for Payer: Aetna New Business (MI Preferred)	$201.92
Rate for Payer: BCBS Complete	$124.26
Rate for Payer: Cash Price	$248.52
Rate for Payer: Cofinity Advantage	$217.46
Rate for Payer: Cofinity Commercial	$267.16
Rate for Payer: Encore Health Key Benefits Commercial	$248.52
Rate for Payer: Healthscope Commercial	$279.58
Rate for Payer: MI Amish Medical Board Commercial	$248.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$264.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$232.99
Rate for Payer: PHP Commercial	$264.05
Rate for Payer: Priority Health SBD	$195.71
Rate for Payer: UHC All Payor (Choice/PPO)	$201.92
Rate for Payer: UHC Core	$161.85
Rate for Payer: UHC Exchange	$122.09

LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE

Facility

$3.11

Service Code	NDC 51079018001
Hospital Charge Code	10454
Hospital Revenue Code	637
Min. Negotiated Rate	$1.22
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 Advantage	$2.18
Rate for Payer: Cofinity Commercial	$2.67
Rate for Payer: Encore Health Key Benefits Commercial	$2.49
Rate for Payer: Healthscope Commercial	$2.80
Rate for Payer: MI Amish Medical Board Commercial	$2.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.33
Rate for Payer: PHP Commercial	$2.64
Rate for Payer: Priority Health SBD	$1.96
Rate for Payer: UHC All Payor (Choice/PPO)	$2.02
Rate for Payer: UHC Core	$1.62
Rate for Payer: UHC Exchange	$1.22

Know your out-of-pocket cost for care.

All Charges