|
LISINOPRIL 20 MG TABLET
|
Facility
|
OP
|
$2.52
|
|
|
Service Code
|
NDC 60687033311
|
| Hospital Charge Code |
4526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Aetna Commercial |
$2.14
|
| Rate for Payer: Aetna Medicare |
$0.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.79
|
| Rate for Payer: BCBS Complete |
$0.47
|
| Rate for Payer: BCBS MAPPO |
$0.63
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: BCN Medicare Advantage |
$0.63
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.63
|
| Rate for Payer: Healthscope Commercial |
$2.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.89
|
| Rate for Payer: Mclaren Medicaid |
$0.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.66
|
| Rate for Payer: Meridian Medicaid |
$0.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.14
|
| Rate for Payer: Nomi Health Commercial |
$2.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.89
|
| Rate for Payer: PACE Senior Care Partners |
$0.60
|
| Rate for Payer: PACE SWMI |
$0.63
|
| Rate for Payer: PHP Commercial |
$2.14
|
| Rate for Payer: PHP Medicare Advantage |
$0.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.19
|
| Rate for Payer: Priority Health Medicare |
$0.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.75
|
| Rate for Payer: Railroad Medicare Medicare |
$0.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.22
|
| Rate for Payer: UHC Core |
$2.10
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UHC Medicaid |
$0.44
|
| Rate for Payer: UHC Medicare Advantage |
$0.63
|
| Rate for Payer: UHCCP Medicaid |
$0.44
|
| Rate for Payer: VA VA |
$0.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.89
|
|
|
LISINOPRIL 20 MG TABLET
|
Facility
|
OP
|
$251.45
|
|
|
Service Code
|
NDC 60687033301
|
| Hospital Charge Code |
4526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.33 |
| Max. Negotiated Rate |
$226.31 |
| Rate for Payer: Aetna Commercial |
$213.73
|
| Rate for Payer: Aetna Medicare |
$65.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.58
|
| Rate for Payer: BCBS Complete |
$46.54
|
| Rate for Payer: BCBS MAPPO |
$62.86
|
| Rate for Payer: BCBS Trust/PPO |
$206.72
|
| Rate for Payer: BCN Commercial |
$206.72
|
| Rate for Payer: BCN Medicare Advantage |
$62.86
|
| Rate for Payer: Cash Price |
$201.16
|
| Rate for Payer: Cofinity Commercial |
$216.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.86
|
| Rate for Payer: Healthscope Commercial |
$226.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.59
|
| Rate for Payer: Mclaren Medicaid |
$44.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.01
|
| Rate for Payer: Meridian Medicaid |
$46.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$69.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: Nomi Health Commercial |
$206.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.59
|
| Rate for Payer: PACE Senior Care Partners |
$59.72
|
| Rate for Payer: PACE SWMI |
$62.86
|
| Rate for Payer: PHP Commercial |
$213.73
|
| Rate for Payer: PHP Medicare Advantage |
$62.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$218.76
|
| Rate for Payer: Priority Health Medicare |
$63.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.01
|
| Rate for Payer: Railroad Medicare Medicare |
$62.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.28
|
| Rate for Payer: UHC Core |
$209.96
|
| Rate for Payer: UHC Exchange |
$62.86
|
| Rate for Payer: UHC Medicaid |
$44.33
|
| Rate for Payer: UHC Medicare Advantage |
$62.86
|
| Rate for Payer: UHCCP Medicaid |
$44.33
|
| Rate for Payer: VA VA |
$62.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.59
|
|
|
LISINOPRIL 20 MG TABLET
|
Facility
|
IP
|
$2.52
|
|
|
Service Code
|
NDC 60687033311
|
| Hospital Charge Code |
4526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Aetna Commercial |
$2.14
|
| Rate for Payer: BCBS Trust/PPO |
$2.08
|
| Rate for Payer: BCN Commercial |
$2.08
|
| Rate for Payer: Cash Price |
$2.02
|
| 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: Lakeland Regional Health Systems Commercial |
$1.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.14
|
| Rate for Payer: Nomi Health Commercial |
$2.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.89
|
| Rate for Payer: PHP Commercial |
$2.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.22
|
| Rate for Payer: UHC Core |
$2.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.89
|
|
|
LISINOPRIL 20 MG TABLET
|
Facility
|
IP
|
$251.45
|
|
|
Service Code
|
NDC 60687033301
|
| Hospital Charge Code |
4526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.01 |
| Max. Negotiated Rate |
$226.31 |
| Rate for Payer: Aetna Commercial |
$213.73
|
| Rate for Payer: BCBS Trust/PPO |
$207.67
|
| Rate for Payer: BCN Commercial |
$207.67
|
| Rate for Payer: Cash Price |
$201.16
|
| 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: Lakeland Regional Health Systems Commercial |
$188.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: Nomi Health Commercial |
$206.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.59
|
| Rate for Payer: PHP Commercial |
$213.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$218.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.28
|
| Rate for Payer: UHC Core |
$209.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.59
|
|
|
LISINOPRIL 2.5 MG TABLET
|
Facility
|
IP
|
$139.65
|
|
|
Service Code
|
NDC 60687065621
|
| Hospital Charge Code |
13089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$125.69 |
| Rate for Payer: Aetna Commercial |
$118.70
|
| Rate for Payer: BCBS Trust/PPO |
$115.34
|
| Rate for Payer: BCN Commercial |
$115.34
|
| Rate for Payer: Cash Price |
$111.72
|
| 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: Lakeland Regional Health Systems Commercial |
$104.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.70
|
| Rate for Payer: Nomi Health Commercial |
$114.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.74
|
| Rate for Payer: PHP Commercial |
$118.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$121.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.89
|
| Rate for Payer: UHC Core |
$116.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.74
|
|
|
LISINOPRIL 2.5 MG TABLET
|
Facility
|
OP
|
$35.25
|
|
|
Service Code
|
NDC 68180051201
|
| Hospital Charge Code |
13089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.21 |
| Max. Negotiated Rate |
$31.73 |
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: Aetna Medicare |
$9.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.02
|
| Rate for Payer: BCBS Complete |
$6.52
|
| Rate for Payer: BCBS MAPPO |
$8.81
|
| Rate for Payer: BCBS Trust/PPO |
$28.98
|
| Rate for Payer: BCN Commercial |
$28.98
|
| Rate for Payer: BCN Medicare Advantage |
$8.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.81
|
| Rate for Payer: Healthscope Commercial |
$31.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.44
|
| Rate for Payer: Mclaren Medicaid |
$6.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.25
|
| Rate for Payer: Meridian Medicaid |
$6.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.96
|
| Rate for Payer: Nomi Health Commercial |
$28.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.44
|
| Rate for Payer: PACE Senior Care Partners |
$8.37
|
| Rate for Payer: PACE SWMI |
$8.81
|
| Rate for Payer: PHP Commercial |
$29.96
|
| Rate for Payer: PHP Medicare Advantage |
$8.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.67
|
| Rate for Payer: Priority Health Medicare |
$8.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.53
|
| Rate for Payer: Railroad Medicare Medicare |
$8.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.02
|
| Rate for Payer: UHC Core |
$29.43
|
| Rate for Payer: UHC Exchange |
$8.81
|
| Rate for Payer: UHC Medicaid |
$6.21
|
| Rate for Payer: UHC Medicare Advantage |
$8.81
|
| Rate for Payer: UHCCP Medicaid |
$6.21
|
| Rate for Payer: VA VA |
$8.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.44
|
|
|
LISINOPRIL 2.5 MG TABLET
|
Facility
|
IP
|
$4.66
|
|
|
Service Code
|
NDC 60687065611
|
| Hospital Charge Code |
13089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: BCBS Trust/PPO |
$3.85
|
| Rate for Payer: BCN Commercial |
$3.85
|
| Rate for Payer: Cash Price |
$3.73
|
| 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: Lakeland Regional Health Systems Commercial |
$3.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.96
|
| Rate for Payer: Nomi Health Commercial |
$3.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.50
|
| Rate for Payer: PHP Commercial |
$3.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.10
|
| Rate for Payer: UHC Core |
$3.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.50
|
|
|
LISINOPRIL 2.5 MG TABLET
|
Facility
|
OP
|
$139.65
|
|
|
Service Code
|
NDC 60687065621
|
| Hospital Charge Code |
13089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.62 |
| Max. Negotiated Rate |
$125.69 |
| Rate for Payer: Aetna Commercial |
$118.70
|
| Rate for Payer: Aetna Medicare |
$36.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.64
|
| Rate for Payer: BCBS Complete |
$25.85
|
| Rate for Payer: BCBS MAPPO |
$34.91
|
| Rate for Payer: BCBS Trust/PPO |
$114.81
|
| Rate for Payer: BCN Commercial |
$114.81
|
| Rate for Payer: BCN Medicare Advantage |
$34.91
|
| Rate for Payer: Cash Price |
$111.72
|
| Rate for Payer: Cofinity Commercial |
$120.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.91
|
| Rate for Payer: Healthscope Commercial |
$125.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.74
|
| Rate for Payer: Mclaren Medicaid |
$24.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.66
|
| Rate for Payer: Meridian Medicaid |
$25.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.70
|
| Rate for Payer: Nomi Health Commercial |
$114.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.74
|
| Rate for Payer: PACE Senior Care Partners |
$33.17
|
| Rate for Payer: PACE SWMI |
$34.91
|
| Rate for Payer: PHP Commercial |
$118.70
|
| Rate for Payer: PHP Medicare Advantage |
$34.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$121.50
|
| Rate for Payer: Priority Health Medicare |
$35.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.20
|
| Rate for Payer: Railroad Medicare Medicare |
$34.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.89
|
| Rate for Payer: UHC Core |
$116.61
|
| Rate for Payer: UHC Exchange |
$34.91
|
| Rate for Payer: UHC Medicaid |
$24.62
|
| Rate for Payer: UHC Medicare Advantage |
$34.91
|
| Rate for Payer: UHCCP Medicaid |
$24.62
|
| Rate for Payer: VA VA |
$34.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.74
|
|
|
LISINOPRIL 2.5 MG TABLET
|
Facility
|
IP
|
$35.25
|
|
|
Service Code
|
NDC 68180051201
|
| Hospital Charge Code |
13089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.53 |
| Max. Negotiated Rate |
$31.73 |
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: BCBS Trust/PPO |
$29.11
|
| Rate for Payer: BCN Commercial |
$29.11
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.20
|
| Rate for Payer: Healthscope Commercial |
$31.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.96
|
| Rate for Payer: Nomi Health Commercial |
$28.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.44
|
| Rate for Payer: PHP Commercial |
$29.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.02
|
| Rate for Payer: UHC Core |
$29.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.44
|
|
|
LISINOPRIL 2.5 MG TABLET
|
Facility
|
OP
|
$4.66
|
|
|
Service Code
|
NDC 60687065611
|
| Hospital Charge Code |
13089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: Aetna Medicare |
$1.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.46
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS MAPPO |
$1.17
|
| Rate for Payer: BCBS Trust/PPO |
$3.83
|
| Rate for Payer: BCN Commercial |
$3.83
|
| Rate for Payer: BCN Medicare Advantage |
$1.17
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cofinity Commercial |
$4.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.17
|
| Rate for Payer: Healthscope Commercial |
$4.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.50
|
| Rate for Payer: Mclaren Medicaid |
$0.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.22
|
| Rate for Payer: Meridian Medicaid |
$0.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.96
|
| Rate for Payer: Nomi Health Commercial |
$3.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.50
|
| Rate for Payer: PACE Senior Care Partners |
$1.11
|
| Rate for Payer: PACE SWMI |
$1.17
|
| Rate for Payer: PHP Commercial |
$3.96
|
| Rate for Payer: PHP Medicare Advantage |
$1.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.05
|
| Rate for Payer: Priority Health Medicare |
$1.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.24
|
| Rate for Payer: Railroad Medicare Medicare |
$1.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.10
|
| Rate for Payer: UHC Core |
$3.89
|
| Rate for Payer: UHC Exchange |
$1.17
|
| Rate for Payer: UHC Medicaid |
$0.82
|
| Rate for Payer: UHC Medicare Advantage |
$1.17
|
| Rate for Payer: UHCCP Medicaid |
$0.82
|
| Rate for Payer: VA VA |
$1.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.50
|
|
|
LISINOPRIL 40 MG TABLET
|
Facility
|
OP
|
$265.55
|
|
|
Service Code
|
NDC 00904720061
|
| Hospital Charge Code |
10450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.82 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna Commercial |
$225.72
|
| Rate for Payer: Aetna Medicare |
$69.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.98
|
| Rate for Payer: BCBS Complete |
$49.15
|
| Rate for Payer: BCBS MAPPO |
$66.39
|
| Rate for Payer: BCBS Trust/PPO |
$218.31
|
| Rate for Payer: BCN Commercial |
$218.31
|
| Rate for Payer: BCN Medicare Advantage |
$66.39
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cofinity Commercial |
$228.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.39
|
| Rate for Payer: Healthscope Commercial |
$239.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.16
|
| Rate for Payer: Mclaren Medicaid |
$46.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.71
|
| Rate for Payer: Meridian Medicaid |
$49.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$73.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.72
|
| Rate for Payer: Nomi Health Commercial |
$217.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.16
|
| Rate for Payer: PACE Senior Care Partners |
$63.07
|
| Rate for Payer: PACE SWMI |
$66.39
|
| Rate for Payer: PHP Commercial |
$225.72
|
| Rate for Payer: PHP Medicare Advantage |
$66.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$231.03
|
| Rate for Payer: Priority Health Medicare |
$67.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.82
|
| Rate for Payer: Railroad Medicare Medicare |
$66.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.68
|
| Rate for Payer: UHC Core |
$221.73
|
| Rate for Payer: UHC Exchange |
$66.39
|
| Rate for Payer: UHC Medicaid |
$46.82
|
| Rate for Payer: UHC Medicare Advantage |
$66.39
|
| Rate for Payer: UHCCP Medicaid |
$46.82
|
| Rate for Payer: VA VA |
$66.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.16
|
|
|
LISINOPRIL 40 MG TABLET
|
Facility
|
IP
|
$265.55
|
|
|
Service Code
|
NDC 00904720061
|
| Hospital Charge Code |
10450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.82 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna Commercial |
$225.72
|
| Rate for Payer: BCBS Trust/PPO |
$219.32
|
| Rate for Payer: BCN Commercial |
$219.32
|
| Rate for Payer: Cash Price |
$212.44
|
| 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: Lakeland Regional Health Systems Commercial |
$199.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.72
|
| Rate for Payer: Nomi Health Commercial |
$217.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.16
|
| Rate for Payer: PHP Commercial |
$225.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$231.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.68
|
| Rate for Payer: UHC Core |
$221.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.16
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
OP
|
$272.60
|
|
|
Service Code
|
NDC 60687066701
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.06 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: Aetna Medicare |
$70.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.19
|
| Rate for Payer: BCBS Complete |
$50.46
|
| Rate for Payer: BCBS MAPPO |
$68.15
|
| Rate for Payer: BCBS Trust/PPO |
$224.10
|
| Rate for Payer: BCN Commercial |
$224.10
|
| Rate for Payer: BCN Medicare Advantage |
$68.15
|
| 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: Health Alliance Plan Medicare Advantage |
$68.15
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.45
|
| Rate for Payer: Mclaren Medicaid |
$48.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.56
|
| Rate for Payer: Meridian Medicaid |
$50.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$74.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.71
|
| Rate for Payer: Nomi Health Commercial |
$223.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.45
|
| Rate for Payer: PACE Senior Care Partners |
$64.74
|
| Rate for Payer: PACE SWMI |
$68.15
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: PHP Medicare Advantage |
$68.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$237.16
|
| Rate for Payer: Priority Health Medicare |
$68.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.73
|
| Rate for Payer: Railroad Medicare Medicare |
$68.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.89
|
| Rate for Payer: UHC Core |
$227.62
|
| Rate for Payer: UHC Exchange |
$68.15
|
| Rate for Payer: UHC Medicaid |
$48.06
|
| Rate for Payer: UHC Medicare Advantage |
$68.15
|
| Rate for Payer: UHCCP Medicaid |
$48.06
|
| Rate for Payer: VA VA |
$68.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
OP
|
$2.73
|
|
|
Service Code
|
NDC 60687066711
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: Aetna Medicare |
$0.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.85
|
| Rate for Payer: BCBS Complete |
$0.51
|
| Rate for Payer: BCBS MAPPO |
$0.68
|
| Rate for Payer: BCBS Trust/PPO |
$2.24
|
| Rate for Payer: BCN Commercial |
$2.24
|
| Rate for Payer: BCN Medicare Advantage |
$0.68
|
| 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: Health Alliance Plan Medicare Advantage |
$0.68
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.05
|
| Rate for Payer: Mclaren Medicaid |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.72
|
| Rate for Payer: Meridian Medicaid |
$0.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.32
|
| Rate for Payer: Nomi Health Commercial |
$2.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.05
|
| Rate for Payer: PACE Senior Care Partners |
$0.65
|
| Rate for Payer: PACE SWMI |
$0.68
|
| Rate for Payer: PHP Commercial |
$2.32
|
| Rate for Payer: PHP Medicare Advantage |
$0.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.38
|
| Rate for Payer: Priority Health Medicare |
$0.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.90
|
| Rate for Payer: Railroad Medicare Medicare |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.40
|
| Rate for Payer: UHC Core |
$2.28
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Medicaid |
$0.48
|
| Rate for Payer: UHC Medicare Advantage |
$0.68
|
| Rate for Payer: UHCCP Medicaid |
$0.48
|
| Rate for Payer: VA VA |
$0.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.05
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
IP
|
$272.60
|
|
|
Service Code
|
NDC 60687066701
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.73 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: BCBS Trust/PPO |
$225.14
|
| Rate for Payer: BCN Commercial |
$225.14
|
| 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 Commercial |
$231.71
|
| Rate for Payer: Nomi Health Commercial |
$223.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.45
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$237.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.73
|
| 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 60687066711
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: BCBS Trust/PPO |
$2.25
|
| Rate for Payer: BCN Commercial |
$2.25
|
| 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 Commercial |
$2.32
|
| Rate for Payer: Nomi Health Commercial |
$2.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.05
|
| Rate for Payer: PHP Commercial |
$2.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.90
|
| 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
|
$176.25
|
|
|
Service Code
|
NDC 00904679761
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.67 |
| Max. Negotiated Rate |
$158.62 |
| Rate for Payer: Aetna Commercial |
$149.81
|
| Rate for Payer: BCBS Trust/PPO |
$145.56
|
| Rate for Payer: BCN Commercial |
$145.56
|
| Rate for Payer: Cash Price |
$141.00
|
| 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: Lakeland Regional Health Systems Commercial |
$132.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.81
|
| Rate for Payer: Nomi Health Commercial |
$144.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.19
|
| Rate for Payer: PHP Commercial |
$149.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$153.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.10
|
| Rate for Payer: UHC Core |
$147.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.19
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
OP
|
$176.25
|
|
|
Service Code
|
NDC 00904679761
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.07 |
| Max. Negotiated Rate |
$158.62 |
| Rate for Payer: Aetna Commercial |
$149.81
|
| Rate for Payer: Aetna Medicare |
$45.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.08
|
| Rate for Payer: BCBS Complete |
$32.62
|
| Rate for Payer: BCBS MAPPO |
$44.06
|
| Rate for Payer: BCBS Trust/PPO |
$144.90
|
| Rate for Payer: BCN Commercial |
$144.90
|
| Rate for Payer: BCN Medicare Advantage |
$44.06
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cofinity Commercial |
$151.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.06
|
| Rate for Payer: Healthscope Commercial |
$158.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.19
|
| Rate for Payer: Mclaren Medicaid |
$31.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.27
|
| Rate for Payer: Meridian Medicaid |
$32.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$48.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.81
|
| Rate for Payer: Nomi Health Commercial |
$144.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.19
|
| Rate for Payer: PACE Senior Care Partners |
$41.86
|
| Rate for Payer: PACE SWMI |
$44.06
|
| Rate for Payer: PHP Commercial |
$149.81
|
| Rate for Payer: PHP Medicare Advantage |
$44.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$153.34
|
| Rate for Payer: Priority Health Medicare |
$44.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.67
|
| Rate for Payer: Railroad Medicare Medicare |
$44.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.10
|
| Rate for Payer: UHC Core |
$147.17
|
| Rate for Payer: UHC Exchange |
$44.06
|
| Rate for Payer: UHC Medicaid |
$31.07
|
| Rate for Payer: UHC Medicare Advantage |
$44.06
|
| Rate for Payer: UHCCP Medicaid |
$31.07
|
| Rate for Payer: VA VA |
$44.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.19
|
|
|
LITHIUM CARBONATE 150 MG CAPSULE
|
Facility
|
OP
|
$270.25
|
|
|
Service Code
|
NDC 00054252625
|
| Hospital Charge Code |
4528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.65 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: Aetna Medicare |
$70.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.45
|
| Rate for Payer: BCBS Complete |
$50.02
|
| Rate for Payer: BCBS MAPPO |
$67.56
|
| Rate for Payer: BCBS Trust/PPO |
$222.17
|
| Rate for Payer: BCN Commercial |
$222.17
|
| Rate for Payer: BCN Medicare Advantage |
$67.56
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$232.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.56
|
| Rate for Payer: Healthscope Commercial |
$243.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.69
|
| Rate for Payer: Mclaren Medicaid |
$47.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.94
|
| Rate for Payer: Meridian Medicaid |
$50.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$74.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.71
|
| Rate for Payer: Nomi Health Commercial |
$221.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.69
|
| Rate for Payer: PACE Senior Care Partners |
$64.18
|
| Rate for Payer: PACE SWMI |
$67.56
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: PHP Medicare Advantage |
$67.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$235.12
|
| Rate for Payer: Priority Health Medicare |
$68.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.09
|
| Rate for Payer: Railroad Medicare Medicare |
$67.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.82
|
| Rate for Payer: UHC Core |
$225.66
|
| Rate for Payer: UHC Exchange |
$67.56
|
| Rate for Payer: UHC Medicaid |
$47.65
|
| Rate for Payer: UHC Medicare Advantage |
$67.56
|
| Rate for Payer: UHCCP Medicaid |
$47.65
|
| Rate for Payer: VA VA |
$67.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.69
|
|
|
LITHIUM CARBONATE 150 MG CAPSULE
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 68462022001
|
| Hospital Charge Code |
4528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.46 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: BCBS Trust/PPO |
$221.26
|
| Rate for Payer: BCN Commercial |
$221.26
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: Nomi Health Commercial |
$219.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.93
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$233.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.75
|
| Rate for Payer: UHC Core |
$223.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.93
|
|
|
LITHIUM CARBONATE 150 MG CAPSULE
|
Facility
|
OP
|
$267.90
|
|
|
Service Code
|
NDC 68462022001
|
| Hospital Charge Code |
4528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna Medicare |
$69.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.72
|
| Rate for Payer: BCBS Complete |
$49.59
|
| Rate for Payer: BCBS MAPPO |
$66.97
|
| Rate for Payer: BCBS Trust/PPO |
$220.24
|
| Rate for Payer: BCN Commercial |
$220.24
|
| Rate for Payer: BCN Medicare Advantage |
$66.97
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.97
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.93
|
| Rate for Payer: Mclaren Medicaid |
$47.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.32
|
| Rate for Payer: Meridian Medicaid |
$49.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$73.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: Nomi Health Commercial |
$219.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.93
|
| Rate for Payer: PACE Senior Care Partners |
$63.63
|
| Rate for Payer: PACE SWMI |
$66.97
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: PHP Medicare Advantage |
$66.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$233.07
|
| Rate for Payer: Priority Health Medicare |
$67.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.46
|
| Rate for Payer: Railroad Medicare Medicare |
$66.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.75
|
| Rate for Payer: UHC Core |
$223.70
|
| Rate for Payer: UHC Exchange |
$66.97
|
| Rate for Payer: UHC Medicaid |
$47.23
|
| Rate for Payer: UHC Medicare Advantage |
$66.97
|
| Rate for Payer: UHCCP Medicaid |
$47.23
|
| Rate for Payer: VA VA |
$66.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.93
|
|
|
LITHIUM CARBONATE 150 MG CAPSULE
|
Facility
|
IP
|
$270.25
|
|
|
Service Code
|
NDC 00054252625
|
| Hospital Charge Code |
4528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.09 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: BCBS Trust/PPO |
$223.20
|
| Rate for Payer: BCN Commercial |
$223.20
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$232.41
|
| 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 Commercial |
$229.71
|
| Rate for Payer: Nomi Health Commercial |
$221.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.69
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$235.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.09
|
| 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
|
|
|
LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$270.25
|
|
|
Service Code
|
NDC 00378130001
|
| Hospital Charge Code |
10454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.09 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: BCBS Trust/PPO |
$223.20
|
| Rate for Payer: BCN Commercial |
$223.20
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$232.41
|
| 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 Commercial |
$229.71
|
| Rate for Payer: Nomi Health Commercial |
$221.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.69
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$235.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.09
|
| 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
|
|
|
LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$270.25
|
|
|
Service Code
|
NDC 00378130001
|
| Hospital Charge Code |
10454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.65 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: Aetna Medicare |
$70.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.45
|
| Rate for Payer: BCBS Complete |
$50.02
|
| Rate for Payer: BCBS MAPPO |
$67.56
|
| Rate for Payer: BCBS Trust/PPO |
$222.17
|
| Rate for Payer: BCN Commercial |
$222.17
|
| Rate for Payer: BCN Medicare Advantage |
$67.56
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$232.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.56
|
| Rate for Payer: Healthscope Commercial |
$243.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.69
|
| Rate for Payer: Mclaren Medicaid |
$47.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.94
|
| Rate for Payer: Meridian Medicaid |
$50.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$74.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.71
|
| Rate for Payer: Nomi Health Commercial |
$221.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.69
|
| Rate for Payer: PACE Senior Care Partners |
$64.18
|
| Rate for Payer: PACE SWMI |
$67.56
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: PHP Medicare Advantage |
$67.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$235.12
|
| Rate for Payer: Priority Health Medicare |
$68.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.09
|
| Rate for Payer: Railroad Medicare Medicare |
$67.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.82
|
| Rate for Payer: UHC Core |
$225.66
|
| Rate for Payer: UHC Exchange |
$67.56
|
| Rate for Payer: UHC Medicaid |
$47.65
|
| Rate for Payer: UHC Medicare Advantage |
$67.56
|
| Rate for Payer: UHCCP Medicaid |
$47.65
|
| Rate for Payer: VA VA |
$67.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.69
|
|
|
LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$272.65
|
|
|
Service Code
|
NDC 00054002025
|
| Hospital Charge Code |
10455
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.07 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna Medicare |
$70.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.20
|
| Rate for Payer: BCBS Complete |
$50.47
|
| Rate for Payer: BCBS MAPPO |
$68.16
|
| Rate for Payer: BCBS Trust/PPO |
$224.15
|
| Rate for Payer: BCN Commercial |
$224.15
|
| Rate for Payer: BCN Medicare Advantage |
$68.16
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$234.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.16
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.49
|
| Rate for Payer: Mclaren Medicaid |
$48.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.57
|
| Rate for Payer: Meridian Medicaid |
$50.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$74.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.75
|
| Rate for Payer: Nomi Health Commercial |
$223.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.49
|
| Rate for Payer: PACE Senior Care Partners |
$64.75
|
| Rate for Payer: PACE SWMI |
$68.16
|
| Rate for Payer: PHP Commercial |
$231.75
|
| Rate for Payer: PHP Medicare Advantage |
$68.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$237.21
|
| Rate for Payer: Priority Health Medicare |
$68.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.76
|
| Rate for Payer: Railroad Medicare Medicare |
$68.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.93
|
| Rate for Payer: UHC Core |
$227.66
|
| Rate for Payer: UHC Exchange |
$68.16
|
| Rate for Payer: UHC Medicaid |
$48.07
|
| Rate for Payer: UHC Medicare Advantage |
$68.16
|
| Rate for Payer: UHCCP Medicaid |
$48.07
|
| Rate for Payer: VA VA |
$68.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.49
|
|
