Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LINEZOLID 600 MG TABLET

Facility

$275.40

Service Code	NDC 00904655304
Hospital Charge Code	28224
Hospital Revenue Code	637
Min. Negotiated Rate	$110.16
Max. Negotiated Rate	$247.86
Rate for Payer: Aetna Commercial	$234.09
Rate for Payer: Aetna Medicare	$137.70
Rate for Payer: Aetna New Business (MI Preferred)	$179.01
Rate for Payer: BCBS Complete	$110.16
Rate for Payer: Cash Price	$220.32
Rate for Payer: Cofinity Commercial	$192.78
Rate for Payer: Cofinity Commercial	$236.84
Rate for Payer: Cofinity Medicare Advantage	$192.78
Rate for Payer: Encore Health Key Benefits Commercial	$220.32
Rate for Payer: Healthscope Commercial	$247.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$234.09
Rate for Payer: PHP Commercial	$234.09
Rate for Payer: Priority Health Cigna Priority Health	$179.01
Rate for Payer: Priority Health SBD	$173.50

LINEZOLID 600 MG TABLET

Facility

$118.03

Service Code	NDC 72606000111
Hospital Charge Code	28224
Hospital Revenue Code	637
Min. Negotiated Rate	$74.36
Max. Negotiated Rate	$106.23
Rate for Payer: Aetna Commercial	$100.33
Rate for Payer: Aetna New Business (MI Preferred)	$76.72
Rate for Payer: Cash Price	$94.42
Rate for Payer: Cofinity Commercial	$101.51
Rate for Payer: Cofinity Commercial	$82.62
Rate for Payer: Cofinity Medicare Advantage	$82.62
Rate for Payer: Encore Health Key Benefits Commercial	$94.42
Rate for Payer: Healthscope Commercial	$106.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$100.33
Rate for Payer: PHP Commercial	$100.33
Rate for Payer: Priority Health Cigna Priority Health	$76.72
Rate for Payer: Priority Health SBD	$74.36

LINEZOLID 600 MG TABLET

Facility

$118.03

Service Code	NDC 72606000111
Hospital Charge Code	28224
Hospital Revenue Code	637
Min. Negotiated Rate	$47.21
Max. Negotiated Rate	$106.23
Rate for Payer: Aetna Commercial	$100.33
Rate for Payer: Aetna Medicare	$59.02
Rate for Payer: Aetna New Business (MI Preferred)	$76.72
Rate for Payer: BCBS Complete	$47.21
Rate for Payer: Cash Price	$94.42
Rate for Payer: Cofinity Commercial	$101.51
Rate for Payer: Cofinity Commercial	$82.62
Rate for Payer: Cofinity Medicare Advantage	$82.62
Rate for Payer: Encore Health Key Benefits Commercial	$94.42
Rate for Payer: Healthscope Commercial	$106.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$100.33
Rate for Payer: PHP Commercial	$100.33
Rate for Payer: Priority Health Cigna Priority Health	$76.72
Rate for Payer: Priority Health SBD	$74.36

LINEZOLID 600 MG TABLET

Facility

$275.40

Service Code	NDC 00904655304
Hospital Charge Code	28224
Hospital Revenue Code	637
Min. Negotiated Rate	$173.50
Max. Negotiated Rate	$247.86
Rate for Payer: Aetna Commercial	$234.09
Rate for Payer: Aetna New Business (MI Preferred)	$179.01
Rate for Payer: Cash Price	$220.32
Rate for Payer: Cofinity Commercial	$192.78
Rate for Payer: Cofinity Commercial	$236.84
Rate for Payer: Cofinity Medicare Advantage	$192.78
Rate for Payer: Encore Health Key Benefits Commercial	$220.32
Rate for Payer: Healthscope Commercial	$247.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$234.09
Rate for Payer: PHP Commercial	$234.09
Rate for Payer: Priority Health Cigna Priority Health	$179.01
Rate for Payer: Priority Health SBD	$173.50

LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK

Facility

$139.20

Service Code	HCPCS J2020
Hospital Charge Code	112020
Hospital Revenue Code	636
Min. Negotiated Rate	$87.70
Max. Negotiated Rate	$125.28
Rate for Payer: Aetna Commercial	$118.32
Rate for Payer: Aetna Commercial	$65.55
Rate for Payer: Aetna New Business (MI Preferred)	$90.48
Rate for Payer: Aetna New Business (MI Preferred)	$50.13
Rate for Payer: Cash Price	$111.36
Rate for Payer: Cash Price	$61.70
Rate for Payer: Cofinity Commercial	$119.71
Rate for Payer: Cofinity Commercial	$53.98
Rate for Payer: Cofinity Commercial	$66.32
Rate for Payer: Cofinity Commercial	$97.44
Rate for Payer: Cofinity Medicare Advantage	$53.98
Rate for Payer: Cofinity Medicare Advantage	$97.44
Rate for Payer: Encore Health Key Benefits Commercial	$111.36
Rate for Payer: Encore Health Key Benefits Commercial	$61.70
Rate for Payer: Healthscope Commercial	$125.28
Rate for Payer: Healthscope Commercial	$69.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$118.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.55
Rate for Payer: PHP Commercial	$118.32
Rate for Payer: PHP Commercial	$65.55
Rate for Payer: Priority Health Cigna Priority Health	$50.13
Rate for Payer: Priority Health Cigna Priority Health	$90.48
Rate for Payer: Priority Health SBD	$48.59
Rate for Payer: Priority Health SBD	$87.70

LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK

Facility

$77.12

Service Code	HCPCS J2020
Hospital Charge Code	112020
Hospital Revenue Code	636
Min. Negotiated Rate	$30.85
Max. Negotiated Rate	$69.41
Rate for Payer: Aetna Commercial	$65.55
Rate for Payer: Aetna Commercial	$118.32
Rate for Payer: Aetna Medicare	$69.60
Rate for Payer: Aetna Medicare	$38.56
Rate for Payer: Aetna New Business (MI Preferred)	$50.13
Rate for Payer: Aetna New Business (MI Preferred)	$90.48
Rate for Payer: BCBS Complete	$30.85
Rate for Payer: BCBS Complete	$55.68
Rate for Payer: Cash Price	$61.70
Rate for Payer: Cash Price	$111.36
Rate for Payer: Cofinity Commercial	$66.32
Rate for Payer: Cofinity Commercial	$119.71
Rate for Payer: Cofinity Commercial	$97.44
Rate for Payer: Cofinity Commercial	$53.98
Rate for Payer: Cofinity Medicare Advantage	$97.44
Rate for Payer: Cofinity Medicare Advantage	$53.98
Rate for Payer: Encore Health Key Benefits Commercial	$111.36
Rate for Payer: Encore Health Key Benefits Commercial	$61.70
Rate for Payer: Healthscope Commercial	$69.41
Rate for Payer: Healthscope Commercial	$125.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$118.32
Rate for Payer: PHP Commercial	$65.55
Rate for Payer: PHP Commercial	$118.32
Rate for Payer: Priority Health Cigna Priority Health	$90.48
Rate for Payer: Priority Health Cigna Priority Health	$50.13
Rate for Payer: Priority Health SBD	$87.70
Rate for Payer: Priority Health SBD	$48.59

LIOTHYRONINE 25 MCG TABLET

Facility

$620.64

Service Code	NDC 51862032101
Hospital Charge Code	4504
Hospital Revenue Code	637
Min. Negotiated Rate	$248.26
Max. Negotiated Rate	$558.58
Rate for Payer: Aetna Commercial	$527.54
Rate for Payer: Aetna Medicare	$310.32
Rate for Payer: Aetna New Business (MI Preferred)	$403.42
Rate for Payer: BCBS Complete	$248.26
Rate for Payer: Cash Price	$496.51
Rate for Payer: Cofinity Commercial	$434.45
Rate for Payer: Cofinity Commercial	$533.75
Rate for Payer: Cofinity Medicare Advantage	$434.45
Rate for Payer: Encore Health Key Benefits Commercial	$496.51
Rate for Payer: Healthscope Commercial	$558.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$527.54
Rate for Payer: PHP Commercial	$527.54
Rate for Payer: Priority Health Cigna Priority Health	$403.42
Rate for Payer: Priority Health SBD	$391.00

LIOTHYRONINE 25 MCG TABLET

Facility

$620.64

Service Code	NDC 51862032101
Hospital Charge Code	4504
Hospital Revenue Code	637
Min. Negotiated Rate	$391.00
Max. Negotiated Rate	$558.58
Rate for Payer: Aetna Commercial	$527.54
Rate for Payer: Aetna New Business (MI Preferred)	$403.42
Rate for Payer: Cash Price	$496.51
Rate for Payer: Cofinity Commercial	$434.45
Rate for Payer: Cofinity Commercial	$533.75
Rate for Payer: Cofinity Medicare Advantage	$434.45
Rate for Payer: Encore Health Key Benefits Commercial	$496.51
Rate for Payer: Healthscope Commercial	$558.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$527.54
Rate for Payer: PHP Commercial	$527.54
Rate for Payer: Priority Health Cigna Priority Health	$403.42
Rate for Payer: Priority Health SBD	$391.00

LIOTHYRONINE 5 MCG TABLET

Facility

$472.32

Service Code	NDC 51862032001
Hospital Charge Code	10443
Hospital Revenue Code	637
Min. Negotiated Rate	$188.93
Max. Negotiated Rate	$425.09
Rate for Payer: Aetna Commercial	$401.47
Rate for Payer: Aetna Medicare	$236.16
Rate for Payer: Aetna New Business (MI Preferred)	$307.01
Rate for Payer: BCBS Complete	$188.93
Rate for Payer: Cash Price	$377.86
Rate for Payer: Cofinity Commercial	$330.62
Rate for Payer: Cofinity Commercial	$406.20
Rate for Payer: Cofinity Medicare Advantage	$330.62
Rate for Payer: Encore Health Key Benefits Commercial	$377.86
Rate for Payer: Healthscope Commercial	$425.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$401.47
Rate for Payer: PHP Commercial	$401.47
Rate for Payer: Priority Health Cigna Priority Health	$307.01
Rate for Payer: Priority Health SBD	$297.56

LIOTHYRONINE 5 MCG TABLET

Facility

$472.32

Service Code	NDC 51862032001
Hospital Charge Code	10443
Hospital Revenue Code	637
Min. Negotiated Rate	$297.56
Max. Negotiated Rate	$425.09
Rate for Payer: Aetna Commercial	$401.47
Rate for Payer: Aetna New Business (MI Preferred)	$307.01
Rate for Payer: Cash Price	$377.86
Rate for Payer: Cofinity Commercial	$330.62
Rate for Payer: Cofinity Commercial	$406.20
Rate for Payer: Cofinity Medicare Advantage	$330.62
Rate for Payer: Encore Health Key Benefits Commercial	$377.86
Rate for Payer: Healthscope Commercial	$425.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$401.47
Rate for Payer: PHP Commercial	$401.47
Rate for Payer: Priority Health Cigna Priority Health	$307.01
Rate for Payer: Priority Health SBD	$297.56

LIOTHYRONINE 5 MCG TABLET

Facility

$356.25

Service Code	NDC 60793011501
Hospital Charge Code	10443
Hospital Revenue Code	637
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$320.62
Rate for Payer: Aetna Commercial	$302.81
Rate for Payer: Aetna Medicare	$178.12
Rate for Payer: Aetna New Business (MI Preferred)	$231.56
Rate for Payer: BCBS Complete	$142.50
Rate for Payer: Cash Price	$285.00
Rate for Payer: Cofinity Commercial	$249.38
Rate for Payer: Cofinity Commercial	$306.38
Rate for Payer: Cofinity Medicare Advantage	$249.38
Rate for Payer: Encore Health Key Benefits Commercial	$285.00
Rate for Payer: Healthscope Commercial	$320.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$302.81
Rate for Payer: PHP Commercial	$302.81
Rate for Payer: Priority Health Cigna Priority Health	$231.56
Rate for Payer: Priority Health SBD	$224.44

LIOTHYRONINE 5 MCG TABLET

Facility

$356.25

Service Code	NDC 60793011501
Hospital Charge Code	10443
Hospital Revenue Code	637
Min. Negotiated Rate	$224.44
Max. Negotiated Rate	$320.62
Rate for Payer: Aetna Commercial	$302.81
Rate for Payer: Aetna New Business (MI Preferred)	$231.56
Rate for Payer: Cash Price	$285.00
Rate for Payer: Cofinity Commercial	$249.38
Rate for Payer: Cofinity Commercial	$306.38
Rate for Payer: Cofinity Medicare Advantage	$249.38
Rate for Payer: Encore Health Key Benefits Commercial	$285.00
Rate for Payer: Healthscope Commercial	$320.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$302.81
Rate for Payer: PHP Commercial	$302.81
Rate for Payer: Priority Health Cigna Priority Health	$231.56
Rate for Payer: Priority Health SBD	$224.44

LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED 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 Commercial	$1,982.90
Rate for Payer: Cofinity Commercial	$2,436.14
Rate for Payer: Cofinity Medicare Advantage	$1,982.90
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: PHP Commercial	$2,407.81
Rate for Payer: Priority Health Cigna Priority Health	$1,841.27
Rate for Payer: Priority Health SBD	$1,784.61

LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL

Facility

$2,832.72

Service Code	NDC 00032122401
Hospital Charge Code	98036
Hospital Revenue Code	637
Min. Negotiated Rate	$1,133.09
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 Commercial	$1,982.90
Rate for Payer: Cofinity Commercial	$2,436.14
Rate for Payer: Cofinity Medicare Advantage	$1,982.90
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: PHP Commercial	$2,407.81
Rate for Payer: Priority Health Cigna Priority Health	$1,841.27
Rate for Payer: Priority Health SBD	$1,784.61

LIPASE-PROTEASE-AMYLASE 36,000-114,000-180,000 UNIT CAPSULE,DELAY REL

Facility

$4,443.33

Service Code	NDC 00032301613
Hospital Charge Code	166135
Hospital Revenue Code	637
Min. Negotiated Rate	$2,799.30
Max. Negotiated Rate	$3,999.00
Rate for Payer: Aetna Commercial	$3,776.83
Rate for Payer: Aetna New Business (MI Preferred)	$2,888.16
Rate for Payer: Cash Price	$3,554.66
Rate for Payer: Cofinity Commercial	$3,110.33
Rate for Payer: Cofinity Commercial	$3,821.26
Rate for Payer: Cofinity Medicare Advantage	$3,110.33
Rate for Payer: Encore Health Key Benefits Commercial	$3,554.66
Rate for Payer: Healthscope Commercial	$3,999.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,776.83
Rate for Payer: PHP Commercial	$3,776.83
Rate for Payer: Priority Health Cigna Priority Health	$2,888.16
Rate for Payer: Priority Health SBD	$2,799.30

LIPASE-PROTEASE-AMYLASE 36,000-114,000-180,000 UNIT CAPSULE,DELAY REL

Facility

$4,443.33

Service Code	NDC 00032301613
Hospital Charge Code	166135
Hospital Revenue Code	637
Min. Negotiated Rate	$1,777.33
Max. Negotiated Rate	$3,999.00
Rate for Payer: Aetna Commercial	$3,776.83
Rate for Payer: Aetna Medicare	$2,221.66
Rate for Payer: Aetna New Business (MI Preferred)	$2,888.16
Rate for Payer: BCBS Complete	$1,777.33
Rate for Payer: Cash Price	$3,554.66
Rate for Payer: Cofinity Commercial	$3,110.33
Rate for Payer: Cofinity Commercial	$3,821.26
Rate for Payer: Cofinity Medicare Advantage	$3,110.33
Rate for Payer: Encore Health Key Benefits Commercial	$3,554.66
Rate for Payer: Healthscope Commercial	$3,999.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,776.83
Rate for Payer: PHP Commercial	$3,776.83
Rate for Payer: Priority Health Cigna Priority Health	$2,888.16
Rate for Payer: Priority Health SBD	$2,799.30

LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED 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 Commercial	$653.18
Rate for Payer: Cofinity Commercial	$802.48
Rate for Payer: Cofinity Medicare Advantage	$653.18
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: PHP Commercial	$793.15
Rate for Payer: Priority Health Cigna Priority Health	$606.53
Rate for Payer: Priority Health SBD	$587.87

LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL

Facility

$933.12

Service Code	NDC 00032120601
Hospital Charge Code	98034
Hospital Revenue Code	637
Min. Negotiated Rate	$373.25
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 Commercial	$653.18
Rate for Payer: Cofinity Commercial	$802.48
Rate for Payer: Cofinity Medicare Advantage	$653.18
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: PHP Commercial	$793.15
Rate for Payer: Priority Health Cigna Priority Health	$606.53
Rate for Payer: Priority Health SBD	$587.87

LISINOPRIL 10 MG TABLET

Facility

$44.65

Service Code	NDC 68180098001
Hospital Charge Code	10449
Hospital Revenue Code	637
Min. Negotiated Rate	$17.86
Max. Negotiated Rate	$40.19
Rate for Payer: Aetna Commercial	$37.95
Rate for Payer: Aetna Medicare	$22.32
Rate for Payer: Aetna New Business (MI Preferred)	$29.02
Rate for Payer: BCBS Complete	$17.86
Rate for Payer: Cash Price	$35.72
Rate for Payer: Cofinity Commercial	$31.25
Rate for Payer: Cofinity Commercial	$38.40
Rate for Payer: Cofinity Medicare Advantage	$31.25
Rate for Payer: Encore Health Key Benefits Commercial	$35.72
Rate for Payer: Healthscope Commercial	$40.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.95
Rate for Payer: PHP Commercial	$37.95
Rate for Payer: Priority Health Cigna Priority Health	$29.02
Rate for Payer: Priority Health SBD	$28.13

LISINOPRIL 10 MG TABLET

Facility

$110.45

Service Code	NDC 00904679861
Hospital Charge Code	10449
Hospital Revenue Code	637
Min. Negotiated Rate	$69.58
Max. Negotiated Rate	$99.41
Rate for Payer: Aetna Commercial	$93.88
Rate for Payer: Aetna New Business (MI Preferred)	$71.79
Rate for Payer: Cash Price	$88.36
Rate for Payer: Cofinity Commercial	$77.31
Rate for Payer: Cofinity Commercial	$94.99
Rate for Payer: Cofinity Medicare Advantage	$77.31
Rate for Payer: Encore Health Key Benefits Commercial	$88.36
Rate for Payer: Healthscope Commercial	$99.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$93.88
Rate for Payer: PHP Commercial	$93.88
Rate for Payer: Priority Health Cigna Priority Health	$71.79
Rate for Payer: Priority Health SBD	$69.58

LISINOPRIL 10 MG TABLET

Facility

$249.10

Service Code	NDC 60687032501
Hospital Charge Code	10449
Hospital Revenue Code	637
Min. Negotiated Rate	$156.93
Max. Negotiated Rate	$224.19
Rate for Payer: Aetna Commercial	$211.74
Rate for Payer: Aetna New Business (MI Preferred)	$161.91
Rate for Payer: Cash Price	$199.28
Rate for Payer: Cofinity Commercial	$174.37
Rate for Payer: Cofinity Commercial	$214.23
Rate for Payer: Cofinity Medicare Advantage	$174.37
Rate for Payer: Encore Health Key Benefits Commercial	$199.28
Rate for Payer: Healthscope Commercial	$224.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$211.74
Rate for Payer: PHP Commercial	$211.74
Rate for Payer: Priority Health Cigna Priority Health	$161.91
Rate for Payer: Priority Health SBD	$156.93

LISINOPRIL 10 MG TABLET

Facility

$249.10

Service Code	NDC 60687032501
Hospital Charge Code	10449
Hospital Revenue Code	637
Min. Negotiated Rate	$99.64
Max. Negotiated Rate	$224.19
Rate for Payer: Aetna Commercial	$211.74
Rate for Payer: Aetna Medicare	$124.55
Rate for Payer: Aetna New Business (MI Preferred)	$161.91
Rate for Payer: BCBS Complete	$99.64
Rate for Payer: Cash Price	$199.28
Rate for Payer: Cofinity Commercial	$174.37
Rate for Payer: Cofinity Commercial	$214.23
Rate for Payer: Cofinity Medicare Advantage	$174.37
Rate for Payer: Encore Health Key Benefits Commercial	$199.28
Rate for Payer: Healthscope Commercial	$224.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$211.74
Rate for Payer: PHP Commercial	$211.74
Rate for Payer: Priority Health Cigna Priority Health	$161.91
Rate for Payer: Priority Health SBD	$156.93

LISINOPRIL 10 MG TABLET

Facility

$110.45

Service Code	NDC 00904679861
Hospital Charge Code	10449
Hospital Revenue Code	637
Min. Negotiated Rate	$44.18
Max. Negotiated Rate	$99.41
Rate for Payer: Aetna Commercial	$93.88
Rate for Payer: Aetna Medicare	$55.23
Rate for Payer: Aetna New Business (MI Preferred)	$71.79
Rate for Payer: BCBS Complete	$44.18
Rate for Payer: Cash Price	$88.36
Rate for Payer: Cofinity Commercial	$77.31
Rate for Payer: Cofinity Commercial	$94.99
Rate for Payer: Cofinity Medicare Advantage	$77.31
Rate for Payer: Encore Health Key Benefits Commercial	$88.36
Rate for Payer: Healthscope Commercial	$99.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$93.88
Rate for Payer: PHP Commercial	$93.88
Rate for Payer: Priority Health Cigna Priority Health	$71.79
Rate for Payer: Priority Health SBD	$69.58

LISINOPRIL 10 MG TABLET

Facility

$2.50

Service Code	NDC 60687032511
Hospital Charge Code	10449
Hospital Revenue Code	637
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$2.12
Rate for Payer: Aetna New Business (MI Preferred)	$1.62
Rate for Payer: Cash Price	$2.00
Rate for Payer: Cofinity Commercial	$1.75
Rate for Payer: Cofinity Commercial	$2.15
Rate for Payer: Cofinity Medicare Advantage	$1.75
Rate for Payer: Encore Health Key Benefits Commercial	$2.00
Rate for Payer: Healthscope Commercial	$2.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.12
Rate for Payer: PHP Commercial	$2.12
Rate for Payer: Priority Health Cigna Priority Health	$1.62
Rate for Payer: Priority Health SBD	$1.57

LISINOPRIL 10 MG TABLET

Facility

$44.65

Service Code	NDC 68180098001
Hospital Charge Code	10449
Hospital Revenue Code	637
Min. Negotiated Rate	$28.13
Max. Negotiated Rate	$40.19
Rate for Payer: Aetna Commercial	$37.95
Rate for Payer: Aetna New Business (MI Preferred)	$29.02
Rate for Payer: Cash Price	$35.72
Rate for Payer: Cofinity Commercial	$31.25
Rate for Payer: Cofinity Commercial	$38.40
Rate for Payer: Cofinity Medicare Advantage	$31.25
Rate for Payer: Encore Health Key Benefits Commercial	$35.72
Rate for Payer: Healthscope Commercial	$40.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.95
Rate for Payer: PHP Commercial	$37.95
Rate for Payer: Priority Health Cigna Priority Health	$29.02
Rate for Payer: Priority Health SBD	$28.13

Know your out-of-pocket cost for care.

All Charges