|
LINEZOLID 600 MG TABLET
|
Facility
|
IP
|
$147.17
|
|
|
Service Code
|
NDC 67877-419-20
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.76 |
| Max. Negotiated Rate |
$132.45 |
| Rate for Payer: Aetna Commercial |
$125.09
|
| Rate for Payer: BCBS Trust/PPO |
$113.73
|
| Rate for Payer: BCN Commercial |
$113.73
|
| Rate for Payer: Cash Price |
$117.74
|
| Rate for Payer: Cofinity Commercial |
$126.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.74
|
| Rate for Payer: Healthscope Commercial |
$132.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.09
|
| Rate for Payer: PHP Commercial |
$125.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.51
|
| Rate for Payer: UHC Core |
$122.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.38
|
|
|
LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$138.32
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
112020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.36 |
| Max. Negotiated Rate |
$124.49 |
| Rate for Payer: Aetna Commercial |
$117.57
|
| Rate for Payer: BCBS Trust/PPO |
$106.89
|
| Rate for Payer: BCN Commercial |
$106.89
|
| Rate for Payer: Cash Price |
$110.66
|
| Rate for Payer: Cofinity Commercial |
$118.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.66
|
| Rate for Payer: Healthscope Commercial |
$124.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.57
|
| Rate for Payer: PHP Commercial |
$117.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.72
|
| Rate for Payer: UHC Core |
$115.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.74
|
|
|
LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL
|
Facility
|
IP
|
$2,832.72
|
|
|
Service Code
|
NDC 0032-1224-01
|
| Hospital Charge Code |
98036
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,727.68 |
| Max. Negotiated Rate |
$2,549.45 |
| Rate for Payer: Aetna Commercial |
$2,407.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.13
|
| Rate for Payer: BCN Commercial |
$2,189.13
|
| Rate for Payer: Cash Price |
$2,266.18
|
| 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: Lakeland Regional Health Systems Commercial |
$2,124.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,407.81
|
| Rate for Payer: PHP Commercial |
$2,407.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,982.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,464.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,727.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,492.79
|
| Rate for Payer: UHC Core |
$2,365.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,124.54
|
|
|
LIPASE-PROTEASE-AMYLASE 3,000-9,500-15,000 UNIT CAPSULE, DELAYED REL
|
Facility
|
IP
|
$548.36
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
153195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$334.44 |
| Max. Negotiated Rate |
$493.52 |
| Rate for Payer: Aetna Commercial |
$466.11
|
| Rate for Payer: BCBS Trust/PPO |
$423.77
|
| Rate for Payer: BCN Commercial |
$423.77
|
| Rate for Payer: Cash Price |
$438.69
|
| Rate for Payer: Cofinity Commercial |
$471.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.69
|
| Rate for Payer: Healthscope Commercial |
$493.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$466.11
|
| Rate for Payer: PHP Commercial |
$466.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$477.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$334.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$482.56
|
| Rate for Payer: UHC Core |
$457.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.27
|
|
|
LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL
|
Facility
|
IP
|
$927.36
|
|
|
Service Code
|
NDC 0032-1206-01
|
| Hospital Charge Code |
98034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$834.62 |
| Rate for Payer: Aetna Commercial |
$788.26
|
| Rate for Payer: BCBS Trust/PPO |
$716.66
|
| Rate for Payer: BCN Commercial |
$716.66
|
| Rate for Payer: Cash Price |
$741.89
|
| Rate for Payer: Cofinity Commercial |
$797.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.89
|
| Rate for Payer: Healthscope Commercial |
$834.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$788.26
|
| Rate for Payer: PHP Commercial |
$788.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$649.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$806.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$565.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$816.08
|
| Rate for Payer: UHC Core |
$774.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.52
|
|
|
LISINOPRIL 10 MG TABLET
|
Facility
|
IP
|
$129.25
|
|
|
Service Code
|
NDC 63739-349-10
|
| Hospital Charge Code |
10449
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.83 |
| Max. Negotiated Rate |
$116.32 |
| Rate for Payer: Aetna Commercial |
$109.86
|
| Rate for Payer: BCBS Trust/PPO |
$99.88
|
| Rate for Payer: BCN Commercial |
$99.88
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cofinity Commercial |
$111.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.40
|
| Rate for Payer: Healthscope Commercial |
$116.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.86
|
| Rate for Payer: PHP Commercial |
$109.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.74
|
| Rate for Payer: UHC Core |
$107.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.94
|
|
|
LISINOPRIL 10 MG TABLET
|
Facility
|
IP
|
$108.10
|
|
|
Service Code
|
NDC 0904-6798-61
|
| Hospital Charge Code |
10449
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.93 |
| Max. Negotiated Rate |
$97.29 |
| Rate for Payer: Aetna Commercial |
$91.88
|
| Rate for Payer: BCBS Trust/PPO |
$83.54
|
| Rate for Payer: BCN Commercial |
$83.54
|
| Rate for Payer: Cash Price |
$86.48
|
| Rate for Payer: Cofinity Commercial |
$92.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.48
|
| Rate for Payer: Healthscope Commercial |
$97.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.88
|
| Rate for Payer: PHP Commercial |
$91.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.13
|
| Rate for Payer: UHC Core |
$90.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.08
|
|
|
LISINOPRIL 20 MG TABLET
|
Facility
|
IP
|
$143.35
|
|
|
Service Code
|
NDC 0904-6799-61
|
| Hospital Charge Code |
4526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.43 |
| Max. Negotiated Rate |
$129.02 |
| Rate for Payer: Aetna Commercial |
$121.85
|
| Rate for Payer: BCBS Trust/PPO |
$110.78
|
| Rate for Payer: BCN Commercial |
$110.78
|
| Rate for Payer: Cash Price |
$114.68
|
| Rate for Payer: Cofinity Commercial |
$123.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.68
|
| Rate for Payer: Healthscope Commercial |
$129.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.51
|
| 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 HMO/PPO/Tiered Network |
$124.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.15
|
| Rate for Payer: UHC Core |
$119.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.51
|
|
|
LISINOPRIL 2.5 MG TABLET
|
Facility
|
IP
|
$127.68
|
|
|
Service Code
|
NDC 68084-765-21
|
| Hospital Charge Code |
13089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.87 |
| Max. Negotiated Rate |
$114.91 |
| Rate for Payer: Aetna Commercial |
$108.53
|
| Rate for Payer: BCBS Trust/PPO |
$98.67
|
| Rate for Payer: BCN Commercial |
$98.67
|
| Rate for Payer: Cash Price |
$102.14
|
| Rate for Payer: Cofinity Commercial |
$109.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.14
|
| Rate for Payer: Healthscope Commercial |
$114.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.53
|
| Rate for Payer: PHP Commercial |
$108.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.36
|
| Rate for Payer: UHC Core |
$106.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.76
|
|
|
LISINOPRIL 2.5 MG TABLET
|
Facility
|
IP
|
$30.55
|
|
|
Service Code
|
NDC 68180-512-01
|
| Hospital Charge Code |
13089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.63 |
| Max. Negotiated Rate |
$27.50 |
| Rate for Payer: Aetna Commercial |
$25.97
|
| Rate for Payer: BCBS Trust/PPO |
$23.61
|
| Rate for Payer: BCN Commercial |
$23.61
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$26.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.44
|
| Rate for Payer: Healthscope Commercial |
$27.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.97
|
| Rate for Payer: PHP Commercial |
$25.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.88
|
| Rate for Payer: UHC Core |
$25.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.91
|
|
|
LISINOPRIL 2.5 MG TABLET
|
Facility
|
IP
|
$121.98
|
|
|
Service Code
|
NDC 68084-765-25
|
| Hospital Charge Code |
13089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$109.78 |
| Rate for Payer: Aetna Commercial |
$103.68
|
| Rate for Payer: BCBS Trust/PPO |
$94.27
|
| Rate for Payer: BCN Commercial |
$94.27
|
| Rate for Payer: Cash Price |
$97.58
|
| Rate for Payer: Cofinity Commercial |
$104.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.58
|
| Rate for Payer: Healthscope Commercial |
$109.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.68
|
| Rate for Payer: PHP Commercial |
$103.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.34
|
| Rate for Payer: UHC Core |
$101.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.48
|
|
|
LISINOPRIL 2.5 MG TABLET
|
Facility
|
IP
|
$4.26
|
|
|
Service Code
|
NDC 68084-765-11
|
| Hospital Charge Code |
13089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: BCBS Trust/PPO |
$3.29
|
| Rate for Payer: BCN Commercial |
$3.29
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cofinity Commercial |
$3.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.41
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.62
|
| Rate for Payer: PHP Commercial |
$3.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.75
|
| Rate for Payer: UHC Core |
$3.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.20
|
|
|
LISINOPRIL 2.5 MG TABLET
|
Facility
|
IP
|
$4.07
|
|
|
Service Code
|
NDC 68084-765-95
|
| Hospital Charge Code |
13089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: BCBS Trust/PPO |
$3.15
|
| Rate for Payer: BCN Commercial |
$3.15
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$3.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$3.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.46
|
| Rate for Payer: PHP Commercial |
$3.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.58
|
| Rate for Payer: UHC Core |
$3.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.05
|
|
|
LISINOPRIL 40 MG TABLET
|
Facility
|
IP
|
$244.40
|
|
|
Service Code
|
NDC 0904-7200-61
|
| Hospital Charge Code |
10450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.06 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna Commercial |
$207.74
|
| Rate for Payer: BCBS Trust/PPO |
$188.87
|
| Rate for Payer: BCN Commercial |
$188.87
|
| Rate for Payer: Cash Price |
$195.52
|
| Rate for Payer: Cofinity Commercial |
$210.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.52
|
| Rate for Payer: Healthscope Commercial |
$219.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.30
|
| 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 HMO/PPO/Tiered Network |
$212.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.07
|
| Rate for Payer: UHC Core |
$204.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.30
|
|
|
LISINOPRIL 40 MG TABLET
|
Facility
|
IP
|
$206.80
|
|
|
Service Code
|
NDC 0904-6800-61
|
| Hospital Charge Code |
10450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.13 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: Aetna Commercial |
$175.78
|
| Rate for Payer: BCBS Trust/PPO |
$159.82
|
| Rate for Payer: BCN Commercial |
$159.82
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cofinity Commercial |
$177.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.44
|
| Rate for Payer: Healthscope Commercial |
$186.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.78
|
| Rate for Payer: PHP Commercial |
$175.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.98
|
| Rate for Payer: UHC Core |
$172.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.10
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
IP
|
$272.60
|
|
|
Service Code
|
NDC 68084-196-01
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.26 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: BCBS Trust/PPO |
$210.67
|
| Rate for Payer: BCN Commercial |
$210.67
|
| Rate for Payer: Cash Price |
$218.08
|
| 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: Lakeland Regional Health Systems Commercial |
$204.45
|
| 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 HMO/PPO/Tiered Network |
$237.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.89
|
| Rate for Payer: UHC Core |
$227.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
IP
|
$2.73
|
|
|
Service Code
|
NDC 68084-196-11
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: BCBS Trust/PPO |
$2.11
|
| Rate for Payer: BCN Commercial |
$2.11
|
| Rate for Payer: Cash Price |
$2.18
|
| 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: Lakeland Regional Health Systems Commercial |
$2.05
|
| 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 HMO/PPO/Tiered Network |
$2.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.40
|
| Rate for Payer: UHC Core |
$2.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.05
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
NDC 0904-6797-61
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: BCBS Trust/PPO |
$108.96
|
| Rate for Payer: BCN Commercial |
$108.96
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| 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 HMO/PPO/Tiered Network |
$122.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.08
|
| Rate for Payer: UHC Core |
$117.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
LITHIUM CARBONATE 150 MG CAPSULE
|
Facility
|
IP
|
$244.40
|
|
|
Service Code
|
NDC 68462-220-01
|
| Hospital Charge Code |
4528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.06 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna Commercial |
$207.74
|
| Rate for Payer: BCBS Trust/PPO |
$188.87
|
| Rate for Payer: BCN Commercial |
$188.87
|
| Rate for Payer: Cash Price |
$195.52
|
| Rate for Payer: Cofinity Commercial |
$210.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.52
|
| Rate for Payer: Healthscope Commercial |
$219.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.30
|
| 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 HMO/PPO/Tiered Network |
$212.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.07
|
| Rate for Payer: UHC Core |
$204.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.30
|
|
|
LITHIUM CARBONATE 150 MG CAPSULE
|
Facility
|
IP
|
$192.70
|
|
|
Service Code
|
NDC 0054-2526-25
|
| Hospital Charge Code |
4528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.53 |
| Max. Negotiated Rate |
$173.43 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: BCBS Trust/PPO |
$148.92
|
| Rate for Payer: BCN Commercial |
$148.92
|
| Rate for Payer: Cash Price |
$154.16
|
| Rate for Payer: Cofinity Commercial |
$165.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.16
|
| Rate for Payer: Healthscope Commercial |
$173.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.80
|
| Rate for Payer: PHP Commercial |
$163.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.58
|
| Rate for Payer: UHC Core |
$160.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.52
|
|
|
LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$270.25
|
|
|
Service Code
|
NDC 0378-1300-01
|
| Hospital Charge Code |
10454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.83 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: BCBS Trust/PPO |
$208.85
|
| Rate for Payer: BCN Commercial |
$208.85
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$232.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Healthscope Commercial |
$243.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.71
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.82
|
| Rate for Payer: UHC Core |
$225.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.69
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$2.43
|
|
|
Service Code
|
NDC 60687-229-11
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: BCBS Trust/PPO |
$1.88
|
| Rate for Payer: BCN Commercial |
$1.88
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Healthscope Commercial |
$2.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.07
|
| Rate for Payer: PHP Commercial |
$2.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.14
|
| Rate for Payer: UHC Core |
$2.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.82
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$242.88
|
|
|
Service Code
|
NDC 60687-229-01
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.13 |
| Max. Negotiated Rate |
$218.59 |
| Rate for Payer: Aetna Commercial |
$206.45
|
| Rate for Payer: BCBS Trust/PPO |
$187.70
|
| Rate for Payer: BCN Commercial |
$187.70
|
| Rate for Payer: Cash Price |
$194.30
|
| Rate for Payer: Cofinity Commercial |
$208.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.30
|
| Rate for Payer: Healthscope Commercial |
$218.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$206.45
|
| Rate for Payer: PHP Commercial |
$206.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$211.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.73
|
| Rate for Payer: UHC Core |
$202.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.16
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$3.25
|
|
|
Service Code
|
NDC 51079-690-01
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna Commercial |
$2.76
|
| Rate for Payer: BCBS Trust/PPO |
$2.51
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.76
|
| Rate for Payer: PHP Commercial |
$2.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.86
|
| Rate for Payer: UHC Core |
$2.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.44
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
NDC 69452-271-20
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.47 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: BCBS Trust/PPO |
$161.52
|
| Rate for Payer: BCN Commercial |
$161.52
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.65
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.92
|
| Rate for Payer: UHC Core |
$174.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
