|
LISINOPRIL 2.5 MG TABLET
|
Facility
|
IP
|
$127.68
|
|
|
Service Code
|
NDC 68084076521
|
| Hospital Charge Code |
13089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.99 |
| Max. Negotiated Rate |
$114.91 |
| Rate for Payer: Aetna Commercial |
$108.53
|
| Rate for Payer: BCBS Trust/PPO |
$104.23
|
| 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 Commercial |
$108.53
|
| Rate for Payer: Nomi Health Commercial |
$104.70
|
| Rate for Payer: PHP Commercial |
$108.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.99
|
| Rate for Payer: Priority Health HMO/PPO |
$111.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.55
|
| 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
|
$4.26
|
|
|
Service Code
|
NDC 68084076511
|
| Hospital Charge Code |
13089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: BCBS Trust/PPO |
$3.48
|
| 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 |
$3.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.62
|
| Rate for Payer: Nomi Health Commercial |
$3.49
|
| Rate for Payer: PHP Commercial |
$3.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.77
|
| Rate for Payer: Priority Health HMO/PPO |
$3.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.85
|
| 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 |
$3.19
|
|
|
LISINOPRIL 2.5 MG TABLET
|
Facility
|
IP
|
$131.96
|
|
|
Service Code
|
NDC 60687065621
|
| Hospital Charge Code |
13089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.77 |
| Max. Negotiated Rate |
$118.76 |
| Rate for Payer: Aetna Commercial |
$112.17
|
| Rate for Payer: BCBS Trust/PPO |
$107.72
|
| Rate for Payer: BCN Commercial |
$101.98
|
| Rate for Payer: Cash Price |
$105.57
|
| Rate for Payer: Cofinity Commercial |
$113.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.57
|
| Rate for Payer: Healthscope Commercial |
$118.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.17
|
| Rate for Payer: Nomi Health Commercial |
$108.21
|
| Rate for Payer: PHP Commercial |
$112.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.77
|
| Rate for Payer: Priority Health HMO/PPO |
$114.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.12
|
| Rate for Payer: UHC Core |
$110.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.97
|
|
|
LISINOPRIL 2.5 MG TABLET
|
Facility
|
OP
|
$4.26
|
|
|
Service Code
|
NDC 68084076511
|
| Hospital Charge Code |
13089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: Aetna Medicare |
$1.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.33
|
| Rate for Payer: BCBS Complete |
$1.70
|
| Rate for Payer: BCBS MAPPO |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$3.50
|
| Rate for Payer: BCN Commercial |
$3.31
|
| Rate for Payer: BCN Medicare Advantage |
$1.06
|
| 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: Health Alliance Plan Medicare Advantage |
$1.06
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.62
|
| Rate for Payer: Nomi Health Commercial |
$3.49
|
| Rate for Payer: PACE Senior Care Partners |
$1.01
|
| Rate for Payer: PACE SWMI |
$1.06
|
| Rate for Payer: PHP Commercial |
$3.62
|
| Rate for Payer: PHP Medicare Advantage |
$1.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.77
|
| Rate for Payer: Priority Health HMO/PPO |
$3.71
|
| Rate for Payer: Priority Health Medicare |
$1.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.75
|
| Rate for Payer: UHC Core |
$3.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.06
|
| Rate for Payer: UHC Exchange |
$1.06
|
| Rate for Payer: UHC Medicare Advantage |
$1.06
|
| Rate for Payer: VA VA |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.19
|
|
|
LISINOPRIL 2.5 MG TABLET
|
Facility
|
OP
|
$131.96
|
|
|
Service Code
|
NDC 60687065621
|
| Hospital Charge Code |
13089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.34 |
| Max. Negotiated Rate |
$118.76 |
| Rate for Payer: Aetna Commercial |
$112.17
|
| Rate for Payer: Aetna Medicare |
$34.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.24
|
| Rate for Payer: BCBS Complete |
$52.78
|
| Rate for Payer: BCBS MAPPO |
$32.99
|
| Rate for Payer: BCBS Trust/PPO |
$108.48
|
| Rate for Payer: BCN Commercial |
$102.60
|
| Rate for Payer: BCN Medicare Advantage |
$32.99
|
| Rate for Payer: Cash Price |
$105.57
|
| Rate for Payer: Cofinity Commercial |
$113.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.99
|
| Rate for Payer: Healthscope Commercial |
$118.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.17
|
| Rate for Payer: Nomi Health Commercial |
$108.21
|
| Rate for Payer: PACE Senior Care Partners |
$31.34
|
| Rate for Payer: PACE SWMI |
$32.99
|
| Rate for Payer: PHP Commercial |
$112.17
|
| Rate for Payer: PHP Medicare Advantage |
$32.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.77
|
| Rate for Payer: Priority Health HMO/PPO |
$114.81
|
| Rate for Payer: Priority Health Medicare |
$33.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.41
|
| Rate for Payer: Railroad Medicare Medicare |
$32.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.12
|
| Rate for Payer: UHC Core |
$110.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.99
|
| Rate for Payer: UHC Exchange |
$32.99
|
| Rate for Payer: UHC Medicare Advantage |
$32.99
|
| Rate for Payer: VA VA |
$32.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.97
|
|
|
LISINOPRIL 2.5 MG TABLET
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 60687065611
|
| Hospital Charge Code |
13089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: BCBS Trust/PPO |
$3.59
|
| Rate for Payer: BCN Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$3.52
|
| Rate for Payer: Cofinity Commercial |
$3.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.52
|
| Rate for Payer: Healthscope Commercial |
$3.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.74
|
| Rate for Payer: Nomi Health Commercial |
$3.61
|
| Rate for Payer: PHP Commercial |
$3.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.86
|
| Rate for Payer: Priority Health HMO/PPO |
$3.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.87
|
| Rate for Payer: UHC Core |
$3.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.30
|
|
|
LISINOPRIL 40 MG TABLET
|
Facility
|
IP
|
$206.80
|
|
|
Service Code
|
NDC 00904680061
|
| Hospital Charge Code |
10450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: Aetna Commercial |
$175.78
|
| Rate for Payer: BCBS Trust/PPO |
$168.81
|
| 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 Commercial |
$175.78
|
| Rate for Payer: Nomi Health Commercial |
$169.58
|
| Rate for Payer: PHP Commercial |
$175.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.42
|
| Rate for Payer: Priority Health HMO/PPO |
$179.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.56
|
| 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 40 MG TABLET
|
Facility
|
OP
|
$251.45
|
|
|
Service Code
|
NDC 00904720061
|
| Hospital Charge Code |
10450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.72 |
| 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 |
$100.58
|
| Rate for Payer: BCBS MAPPO |
$62.86
|
| Rate for Payer: BCBS Trust/PPO |
$206.72
|
| Rate for Payer: BCN Commercial |
$195.50
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: Nomi Health Commercial |
$206.19
|
| 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 Cigna Priority Health |
$163.44
|
| Rate for Payer: Priority Health HMO/PPO |
$218.76
|
| Rate for Payer: Priority Health Medicare |
$63.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.47
|
| 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 Dual Complete DSNP |
$62.86
|
| Rate for Payer: UHC Exchange |
$62.86
|
| Rate for Payer: UHC Medicare Advantage |
$62.86
|
| Rate for Payer: VA VA |
$62.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.59
|
|
|
LISINOPRIL 40 MG TABLET
|
Facility
|
IP
|
$251.45
|
|
|
Service Code
|
NDC 00904720061
|
| Hospital Charge Code |
10450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.44 |
| Max. Negotiated Rate |
$226.31 |
| Rate for Payer: Aetna Commercial |
$213.73
|
| Rate for Payer: BCBS Trust/PPO |
$205.26
|
| Rate for Payer: BCN Commercial |
$194.32
|
| 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: PHP Commercial |
$213.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.44
|
| Rate for Payer: Priority Health HMO/PPO |
$218.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.47
|
| 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 40 MG TABLET
|
Facility
|
OP
|
$206.80
|
|
|
Service Code
|
NDC 00904680061
|
| Hospital Charge Code |
10450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.12 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: Aetna Commercial |
$175.78
|
| Rate for Payer: Aetna Medicare |
$53.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.62
|
| Rate for Payer: BCBS Complete |
$82.72
|
| Rate for Payer: BCBS MAPPO |
$51.70
|
| Rate for Payer: BCBS Trust/PPO |
$170.01
|
| Rate for Payer: BCN Commercial |
$160.79
|
| Rate for Payer: BCN Medicare Advantage |
$51.70
|
| 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: Health Alliance Plan Medicare Advantage |
$51.70
|
| Rate for Payer: Healthscope Commercial |
$186.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.78
|
| Rate for Payer: Nomi Health Commercial |
$169.58
|
| Rate for Payer: PACE Senior Care Partners |
$49.12
|
| Rate for Payer: PACE SWMI |
$51.70
|
| Rate for Payer: PHP Commercial |
$175.78
|
| Rate for Payer: PHP Medicare Advantage |
$51.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.42
|
| Rate for Payer: Priority Health HMO/PPO |
$179.92
|
| Rate for Payer: Priority Health Medicare |
$52.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.56
|
| Rate for Payer: Railroad Medicare Medicare |
$51.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.98
|
| Rate for Payer: UHC Core |
$172.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.70
|
| Rate for Payer: UHC Exchange |
$51.70
|
| Rate for Payer: UHC Medicare Advantage |
$51.70
|
| Rate for Payer: VA VA |
$51.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.10
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
OP
|
$2.73
|
|
|
Service Code
|
NDC 68084019611
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| 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 |
$1.09
|
| Rate for Payer: BCBS MAPPO |
$0.68
|
| Rate for Payer: BCBS Trust/PPO |
$2.24
|
| Rate for Payer: BCN Commercial |
$2.12
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.32
|
| Rate for Payer: Nomi Health Commercial |
$2.24
|
| 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 Cigna Priority Health |
$1.77
|
| Rate for Payer: Priority Health HMO/PPO |
$2.38
|
| Rate for Payer: Priority Health Medicare |
$0.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.83
|
| 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 Dual Complete DSNP |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Medicare Advantage |
$0.68
|
| Rate for Payer: VA VA |
$0.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.05
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
IP
|
$291.40
|
|
|
Service Code
|
NDC 60687066701
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.41 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna Commercial |
$247.69
|
| Rate for Payer: BCBS Trust/PPO |
$237.87
|
| Rate for Payer: BCN Commercial |
$225.19
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.12
|
| Rate for Payer: Healthscope Commercial |
$262.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.69
|
| Rate for Payer: Nomi Health Commercial |
$238.95
|
| Rate for Payer: PHP Commercial |
$247.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.41
|
| Rate for Payer: Priority Health HMO/PPO |
$253.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.43
|
| Rate for Payer: UHC Core |
$243.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.55
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
NDC 00904679761
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.49 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna Medicare |
$36.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.06
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: BCBS MAPPO |
$35.25
|
| Rate for Payer: BCBS Trust/PPO |
$115.92
|
| Rate for Payer: BCN Commercial |
$109.63
|
| Rate for Payer: BCN Medicare Advantage |
$35.25
|
| 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: Health Alliance Plan Medicare Advantage |
$35.25
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: PACE Senior Care Partners |
$33.49
|
| Rate for Payer: PACE SWMI |
$35.25
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: PHP Medicare Advantage |
$35.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health HMO/PPO |
$122.67
|
| Rate for Payer: Priority Health Medicare |
$35.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.47
|
| Rate for Payer: Railroad Medicare Medicare |
$35.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.08
|
| Rate for Payer: UHC Core |
$117.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.25
|
| Rate for Payer: UHC Exchange |
$35.25
|
| Rate for Payer: UHC Medicare Advantage |
$35.25
|
| Rate for Payer: VA VA |
$35.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
NDC 00904679761
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.65 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: BCBS Trust/PPO |
$115.10
|
| 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 Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health HMO/PPO |
$122.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.08
|
| Rate for Payer: UHC Core |
$117.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
OP
|
$272.60
|
|
|
Service Code
|
NDC 68084019601
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.74 |
| 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 |
$109.04
|
| Rate for Payer: BCBS MAPPO |
$68.15
|
| Rate for Payer: BCBS Trust/PPO |
$224.10
|
| Rate for Payer: BCN Commercial |
$211.95
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.71
|
| Rate for Payer: Nomi Health Commercial |
$223.53
|
| 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 Cigna Priority Health |
$177.19
|
| Rate for Payer: Priority Health HMO/PPO |
$237.16
|
| Rate for Payer: Priority Health Medicare |
$68.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.64
|
| 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 Dual Complete DSNP |
$68.15
|
| Rate for Payer: UHC Exchange |
$68.15
|
| Rate for Payer: UHC Medicare Advantage |
$68.15
|
| Rate for Payer: VA VA |
$68.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
IP
|
$272.60
|
|
|
Service Code
|
NDC 68084019601
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.19 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: BCBS Trust/PPO |
$222.52
|
| 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 Commercial |
$231.71
|
| Rate for Payer: Nomi Health Commercial |
$223.53
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.19
|
| Rate for Payer: Priority Health HMO/PPO |
$237.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.64
|
| 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
|
OP
|
$291.40
|
|
|
Service Code
|
NDC 60687066701
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.21 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna Commercial |
$247.69
|
| Rate for Payer: Aetna Medicare |
$75.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.06
|
| Rate for Payer: BCBS Complete |
$116.56
|
| Rate for Payer: BCBS MAPPO |
$72.85
|
| Rate for Payer: BCBS Trust/PPO |
$239.56
|
| Rate for Payer: BCN Commercial |
$226.56
|
| Rate for Payer: BCN Medicare Advantage |
$72.85
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.85
|
| Rate for Payer: Healthscope Commercial |
$262.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.69
|
| Rate for Payer: Nomi Health Commercial |
$238.95
|
| Rate for Payer: PACE Senior Care Partners |
$69.21
|
| Rate for Payer: PACE SWMI |
$72.85
|
| Rate for Payer: PHP Commercial |
$247.69
|
| Rate for Payer: PHP Medicare Advantage |
$72.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.41
|
| Rate for Payer: Priority Health HMO/PPO |
$253.52
|
| Rate for Payer: Priority Health Medicare |
$73.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.24
|
| Rate for Payer: Railroad Medicare Medicare |
$72.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.43
|
| Rate for Payer: UHC Core |
$243.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.85
|
| Rate for Payer: UHC Exchange |
$72.85
|
| Rate for Payer: UHC Medicare Advantage |
$72.85
|
| Rate for Payer: VA VA |
$72.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.55
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
OP
|
$2.92
|
|
|
Service Code
|
NDC 60687066711
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Aetna Commercial |
$2.48
|
| Rate for Payer: Aetna Medicare |
$0.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.91
|
| Rate for Payer: BCBS Complete |
$1.17
|
| Rate for Payer: BCBS MAPPO |
$0.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.40
|
| Rate for Payer: BCN Commercial |
$2.27
|
| Rate for Payer: BCN Medicare Advantage |
$0.73
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cofinity Commercial |
$2.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.73
|
| Rate for Payer: Healthscope Commercial |
$2.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.48
|
| Rate for Payer: Nomi Health Commercial |
$2.39
|
| Rate for Payer: PACE Senior Care Partners |
$0.69
|
| Rate for Payer: PACE SWMI |
$0.73
|
| Rate for Payer: PHP Commercial |
$2.48
|
| Rate for Payer: PHP Medicare Advantage |
$0.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.90
|
| Rate for Payer: Priority Health HMO/PPO |
$2.54
|
| Rate for Payer: Priority Health Medicare |
$0.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.96
|
| Rate for Payer: Railroad Medicare Medicare |
$0.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.57
|
| Rate for Payer: UHC Core |
$2.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.73
|
| Rate for Payer: UHC Exchange |
$0.73
|
| Rate for Payer: UHC Medicare Advantage |
$0.73
|
| Rate for Payer: VA VA |
$0.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.19
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
IP
|
$2.92
|
|
|
Service Code
|
NDC 60687066711
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Aetna Commercial |
$2.48
|
| Rate for Payer: BCBS Trust/PPO |
$2.38
|
| Rate for Payer: BCN Commercial |
$2.26
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cofinity Commercial |
$2.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.34
|
| Rate for Payer: Healthscope Commercial |
$2.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.48
|
| Rate for Payer: Nomi Health Commercial |
$2.39
|
| Rate for Payer: PHP Commercial |
$2.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.90
|
| Rate for Payer: Priority Health HMO/PPO |
$2.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.57
|
| Rate for Payer: UHC Core |
$2.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.19
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
IP
|
$2.73
|
|
|
Service Code
|
NDC 68084019611
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: BCBS Trust/PPO |
$2.23
|
| 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 Commercial |
$2.32
|
| Rate for Payer: Nomi Health Commercial |
$2.24
|
| Rate for Payer: PHP Commercial |
$2.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| Rate for Payer: Priority Health HMO/PPO |
$2.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.83
|
| 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
|
|
|
LITHIUM CARBONATE 150 MG CAPSULE
|
Facility
|
OP
|
$197.40
|
|
|
Service Code
|
NDC 00054252625
|
| Hospital Charge Code |
4528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$177.66 |
| Rate for Payer: Aetna Commercial |
$167.79
|
| Rate for Payer: Aetna Medicare |
$51.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.69
|
| Rate for Payer: BCBS Complete |
$78.96
|
| Rate for Payer: BCBS MAPPO |
$49.35
|
| Rate for Payer: BCBS Trust/PPO |
$162.28
|
| Rate for Payer: BCN Commercial |
$153.48
|
| Rate for Payer: BCN Medicare Advantage |
$49.35
|
| Rate for Payer: Cash Price |
$157.92
|
| Rate for Payer: Cofinity Commercial |
$169.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.35
|
| Rate for Payer: Healthscope Commercial |
$177.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.79
|
| Rate for Payer: Nomi Health Commercial |
$161.87
|
| Rate for Payer: PACE Senior Care Partners |
$46.88
|
| Rate for Payer: PACE SWMI |
$49.35
|
| Rate for Payer: PHP Commercial |
$167.79
|
| Rate for Payer: PHP Medicare Advantage |
$49.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.31
|
| Rate for Payer: Priority Health HMO/PPO |
$171.74
|
| Rate for Payer: Priority Health Medicare |
$49.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.26
|
| Rate for Payer: Railroad Medicare Medicare |
$49.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.71
|
| Rate for Payer: UHC Core |
$164.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.35
|
| Rate for Payer: UHC Exchange |
$49.35
|
| Rate for Payer: UHC Medicare Advantage |
$49.35
|
| Rate for Payer: VA VA |
$49.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.05
|
|
|
LITHIUM CARBONATE 150 MG CAPSULE
|
Facility
|
OP
|
$244.40
|
|
|
Service Code
|
NDC 68462022001
|
| Hospital Charge Code |
4528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.05 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna Commercial |
$207.74
|
| Rate for Payer: Aetna Medicare |
$63.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.38
|
| Rate for Payer: BCBS Complete |
$97.76
|
| Rate for Payer: BCBS MAPPO |
$61.10
|
| Rate for Payer: BCBS Trust/PPO |
$200.92
|
| Rate for Payer: BCN Commercial |
$190.02
|
| Rate for Payer: BCN Medicare Advantage |
$61.10
|
| 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: Health Alliance Plan Medicare Advantage |
$61.10
|
| Rate for Payer: Healthscope Commercial |
$219.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.74
|
| Rate for Payer: Nomi Health Commercial |
$200.41
|
| Rate for Payer: PACE Senior Care Partners |
$58.05
|
| Rate for Payer: PACE SWMI |
$61.10
|
| Rate for Payer: PHP Commercial |
$207.74
|
| Rate for Payer: PHP Medicare Advantage |
$61.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.86
|
| Rate for Payer: Priority Health HMO/PPO |
$212.63
|
| Rate for Payer: Priority Health Medicare |
$61.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.75
|
| Rate for Payer: Railroad Medicare Medicare |
$61.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.07
|
| Rate for Payer: UHC Core |
$204.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.10
|
| Rate for Payer: UHC Exchange |
$61.10
|
| Rate for Payer: UHC Medicare Advantage |
$61.10
|
| Rate for Payer: VA VA |
$61.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.30
|
|
|
LITHIUM CARBONATE 150 MG CAPSULE
|
Facility
|
IP
|
$197.40
|
|
|
Service Code
|
NDC 00054252625
|
| Hospital Charge Code |
4528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.31 |
| Max. Negotiated Rate |
$177.66 |
| Rate for Payer: Aetna Commercial |
$167.79
|
| Rate for Payer: BCBS Trust/PPO |
$161.14
|
| Rate for Payer: BCN Commercial |
$152.55
|
| Rate for Payer: Cash Price |
$157.92
|
| Rate for Payer: Cofinity Commercial |
$169.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.92
|
| Rate for Payer: Healthscope Commercial |
$177.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.79
|
| Rate for Payer: Nomi Health Commercial |
$161.87
|
| Rate for Payer: PHP Commercial |
$167.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.31
|
| Rate for Payer: Priority Health HMO/PPO |
$171.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.71
|
| Rate for Payer: UHC Core |
$164.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.05
|
|
|
LITHIUM CARBONATE 150 MG CAPSULE
|
Facility
|
IP
|
$244.40
|
|
|
Service Code
|
NDC 68462022001
|
| Hospital Charge Code |
4528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.86 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna Commercial |
$207.74
|
| Rate for Payer: BCBS Trust/PPO |
$199.50
|
| 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 Commercial |
$207.74
|
| Rate for Payer: Nomi Health Commercial |
$200.41
|
| Rate for Payer: PHP Commercial |
$207.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.86
|
| Rate for Payer: Priority Health HMO/PPO |
$212.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.75
|
| 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 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 |
$175.66 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: BCBS Trust/PPO |
$220.61
|
| Rate for Payer: BCN Commercial |
$208.85
|
| 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: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.66
|
| Rate for Payer: Priority Health HMO/PPO |
$235.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.07
|
| 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
|
|
