|
LITHIUM CARBONATE 150 MG CAPSULE
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 68462022001
|
| Hospital Charge Code |
4528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.88 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna American Axle |
$174.13
|
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.13
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Advantage |
$187.53
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$187.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.93
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health SBD |
$168.78
|
| Rate for Payer: UMR Bronson Commercial |
$117.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.93
|
|
|
LITHIUM CARBONATE 150 MG CAPSULE
|
Facility
|
OP
|
$270.25
|
|
|
Service Code
|
NDC 00054252625
|
| Hospital Charge Code |
4528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.99 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna American Axle |
$175.66
|
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: Aetna Medicare |
$135.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.66
|
| Rate for Payer: BCBS Complete |
$108.10
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Advantage |
$189.18
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$189.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.69
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health SBD |
$170.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.66
|
| Rate for Payer: UHC Core |
$140.80
|
| Rate for Payer: UHC Exchange |
$106.21
|
| Rate for Payer: UMR Bronson Commercial |
$99.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.69
|
|
|
LITHIUM CARBONATE 150 MG CAPSULE
|
Facility
|
OP
|
$267.90
|
|
|
Service Code
|
NDC 68462022001
|
| Hospital Charge Code |
4528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.12 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna American Axle |
$174.13
|
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna Medicare |
$133.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.13
|
| Rate for Payer: BCBS Complete |
$107.16
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Advantage |
$187.53
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$187.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$214.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.93
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health SBD |
$168.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.13
|
| Rate for Payer: UHC Core |
$139.58
|
| Rate for Payer: UHC Exchange |
$105.28
|
| Rate for Payer: UMR Bronson Commercial |
$99.12
|
| 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 |
$118.91 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna American Axle |
$175.66
|
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.66
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Advantage |
$189.18
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$189.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.69
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health SBD |
$170.26
|
| Rate for Payer: UMR Bronson Commercial |
$118.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.69
|
|
|
LITHIUM CARBONATE 300 MG CAPSULE
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
NDC 31722054501
|
| Hospital Charge Code |
4529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna American Axle |
$91.65
|
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna Medicare |
$70.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.65
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Advantage |
$98.70
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$98.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.75
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health SBD |
$88.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.65
|
| Rate for Payer: UHC Core |
$73.46
|
| Rate for Payer: UHC Exchange |
$55.41
|
| Rate for Payer: UMR Bronson Commercial |
$52.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
LITHIUM CARBONATE 300 MG CAPSULE
|
Facility
|
IP
|
$21.09
|
|
|
Service Code
|
NDC 00054852725
|
| Hospital Charge Code |
4529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$18.98 |
| Rate for Payer: Aetna American Axle |
$13.71
|
| Rate for Payer: Aetna Commercial |
$17.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.71
|
| Rate for Payer: Cash Price |
$16.87
|
| Rate for Payer: Cofinity Advantage |
$14.76
|
| Rate for Payer: Cofinity Commercial |
$18.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$18.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.82
|
| Rate for Payer: PHP Commercial |
$17.93
|
| Rate for Payer: Priority Health SBD |
$13.29
|
| Rate for Payer: UMR Bronson Commercial |
$9.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.82
|
|
|
LITHIUM CARBONATE 300 MG CAPSULE
|
Facility
|
IP
|
$192.70
|
|
|
Service Code
|
NDC 68462022101
|
| Hospital Charge Code |
4529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.79 |
| Max. Negotiated Rate |
$173.43 |
| Rate for Payer: Aetna American Axle |
$125.25
|
| Rate for Payer: Aetna Commercial |
$163.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.25
|
| Rate for Payer: Cash Price |
$154.16
|
| Rate for Payer: Cofinity Advantage |
$134.89
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$134.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.53
|
| Rate for Payer: PHP Commercial |
$163.79
|
| Rate for Payer: Priority Health SBD |
$121.40
|
| Rate for Payer: UMR Bronson Commercial |
$84.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.53
|
|
|
LITHIUM CARBONATE 300 MG CAPSULE
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
NDC 31722054501
|
| Hospital Charge Code |
4529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.04 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna American Axle |
$91.65
|
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.65
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Advantage |
$98.70
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$98.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.75
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health SBD |
$88.83
|
| Rate for Payer: UMR Bronson Commercial |
$62.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
LITHIUM CARBONATE 300 MG CAPSULE
|
Facility
|
OP
|
$21.09
|
|
|
Service Code
|
NDC 00054852725
|
| Hospital Charge Code |
4529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$18.98 |
| Rate for Payer: Aetna American Axle |
$13.71
|
| Rate for Payer: Aetna Commercial |
$17.93
|
| Rate for Payer: Aetna Medicare |
$10.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.71
|
| Rate for Payer: BCBS Complete |
$8.44
|
| Rate for Payer: Cash Price |
$16.87
|
| Rate for Payer: Cofinity Advantage |
$14.76
|
| Rate for Payer: Cofinity Commercial |
$18.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$18.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.82
|
| Rate for Payer: PHP Commercial |
$17.93
|
| Rate for Payer: Priority Health SBD |
$13.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.71
|
| Rate for Payer: UHC Core |
$10.99
|
| Rate for Payer: UHC Exchange |
$8.29
|
| Rate for Payer: UMR Bronson Commercial |
$7.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.82
|
|
|
LITHIUM CARBONATE 300 MG CAPSULE
|
Facility
|
IP
|
$194.75
|
|
|
Service Code
|
NDC 00054252725
|
| Hospital Charge Code |
4529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.69 |
| Max. Negotiated Rate |
$175.28 |
| Rate for Payer: Aetna American Axle |
$126.59
|
| Rate for Payer: Aetna Commercial |
$165.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.59
|
| Rate for Payer: Cash Price |
$155.80
|
| Rate for Payer: Cofinity Advantage |
$136.32
|
| Rate for Payer: Cofinity Commercial |
$167.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.80
|
| Rate for Payer: Healthscope Commercial |
$175.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.06
|
| Rate for Payer: PHP Commercial |
$165.54
|
| Rate for Payer: Priority Health SBD |
$122.69
|
| Rate for Payer: UMR Bronson Commercial |
$85.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.06
|
|
|
LITHIUM CARBONATE 300 MG CAPSULE
|
Facility
|
OP
|
$192.70
|
|
|
Service Code
|
NDC 68462022101
|
| Hospital Charge Code |
4529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.30 |
| Max. Negotiated Rate |
$173.43 |
| Rate for Payer: Aetna American Axle |
$125.25
|
| Rate for Payer: Aetna Commercial |
$163.79
|
| Rate for Payer: Aetna Medicare |
$96.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.25
|
| Rate for Payer: BCBS Complete |
$77.08
|
| Rate for Payer: Cash Price |
$154.16
|
| Rate for Payer: Cofinity Advantage |
$134.89
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$134.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.53
|
| Rate for Payer: PHP Commercial |
$163.79
|
| Rate for Payer: Priority Health SBD |
$121.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.25
|
| Rate for Payer: UHC Core |
$100.40
|
| Rate for Payer: UHC Exchange |
$75.73
|
| Rate for Payer: UMR Bronson Commercial |
$71.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.53
|
|
|
LITHIUM CARBONATE 300 MG CAPSULE
|
Facility
|
OP
|
$194.75
|
|
|
Service Code
|
NDC 00054252725
|
| Hospital Charge Code |
4529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.06 |
| Max. Negotiated Rate |
$175.28 |
| Rate for Payer: Aetna American Axle |
$126.59
|
| Rate for Payer: Aetna Commercial |
$165.54
|
| Rate for Payer: Aetna Medicare |
$97.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.59
|
| Rate for Payer: BCBS Complete |
$77.90
|
| Rate for Payer: Cash Price |
$155.80
|
| Rate for Payer: Cofinity Advantage |
$136.32
|
| Rate for Payer: Cofinity Commercial |
$167.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.80
|
| Rate for Payer: Healthscope Commercial |
$175.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.06
|
| Rate for Payer: PHP Commercial |
$165.54
|
| Rate for Payer: Priority Health SBD |
$122.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.59
|
| Rate for Payer: UHC Core |
$101.46
|
| Rate for Payer: UHC Exchange |
$76.54
|
| Rate for Payer: UMR Bronson Commercial |
$72.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.06
|
|
|
LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$386.65
|
|
|
Service Code
|
NDC 68084064001
|
| Hospital Charge Code |
10454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.13 |
| Max. Negotiated Rate |
$347.99 |
| Rate for Payer: Aetna American Axle |
$251.32
|
| Rate for Payer: Aetna Commercial |
$328.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.32
|
| Rate for Payer: Cash Price |
$309.32
|
| Rate for Payer: Cofinity Advantage |
$270.65
|
| Rate for Payer: Cofinity Commercial |
$332.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.32
|
| Rate for Payer: Healthscope Commercial |
$347.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.99
|
| Rate for Payer: PHP Commercial |
$328.65
|
| Rate for Payer: Priority Health SBD |
$243.59
|
| Rate for Payer: UMR Bronson Commercial |
$170.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.99
|
|
|
LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$465.30
|
|
|
Service Code
|
NDC 00054002125
|
| Hospital Charge Code |
10454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.73 |
| Max. Negotiated Rate |
$418.77 |
| Rate for Payer: Aetna American Axle |
$302.44
|
| Rate for Payer: Aetna Commercial |
$395.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.44
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cofinity Advantage |
$325.71
|
| Rate for Payer: Cofinity Commercial |
$400.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.24
|
| Rate for Payer: Healthscope Commercial |
$418.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.98
|
| Rate for Payer: PHP Commercial |
$395.50
|
| Rate for Payer: Priority Health SBD |
$293.14
|
| Rate for Payer: UMR Bronson Commercial |
$204.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.98
|
|
|
LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$386.65
|
|
|
Service Code
|
NDC 68084064001
|
| Hospital Charge Code |
10454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.06 |
| Max. Negotiated Rate |
$347.99 |
| Rate for Payer: Aetna American Axle |
$251.32
|
| Rate for Payer: Aetna Commercial |
$328.65
|
| Rate for Payer: Aetna Medicare |
$193.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.32
|
| Rate for Payer: BCBS Complete |
$154.66
|
| Rate for Payer: Cash Price |
$309.32
|
| Rate for Payer: Cofinity Advantage |
$270.65
|
| Rate for Payer: Cofinity Commercial |
$332.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.32
|
| Rate for Payer: Healthscope Commercial |
$347.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$309.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.99
|
| Rate for Payer: PHP Commercial |
$328.65
|
| Rate for Payer: Priority Health SBD |
$243.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.32
|
| Rate for Payer: UHC Core |
$201.44
|
| Rate for Payer: UHC Exchange |
$151.95
|
| Rate for Payer: UMR Bronson Commercial |
$143.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.99
|
|
|
LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$3.87
|
|
|
Service Code
|
NDC 68084064011
|
| Hospital Charge Code |
10454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna American Axle |
$2.52
|
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: Aetna Medicare |
$1.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.52
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Advantage |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.90
|
| Rate for Payer: PHP Commercial |
$3.29
|
| Rate for Payer: Priority Health SBD |
$2.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.52
|
| Rate for Payer: UHC Core |
$2.02
|
| Rate for Payer: UHC Exchange |
$1.52
|
| Rate for Payer: UMR Bronson Commercial |
$1.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.90
|
|
|
LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$3.11
|
|
|
Service Code
|
NDC 51079018001
|
| Hospital Charge Code |
10454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna American Axle |
$2.02
|
| Rate for Payer: Aetna Commercial |
$2.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.02
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cofinity Advantage |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.49
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.33
|
| Rate for Payer: PHP Commercial |
$2.64
|
| Rate for Payer: Priority Health SBD |
$1.96
|
| Rate for Payer: UMR Bronson Commercial |
$1.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.33
|
|
|
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 |
$99.99 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna American Axle |
$175.66
|
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: Aetna Medicare |
$135.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.66
|
| Rate for Payer: BCBS Complete |
$108.10
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Advantage |
$189.18
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$189.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.69
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health SBD |
$170.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.66
|
| Rate for Payer: UHC Core |
$140.80
|
| Rate for Payer: UHC Exchange |
$106.21
|
| Rate for Payer: UMR Bronson Commercial |
$99.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.69
|
|
|
LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$3.87
|
|
|
Service Code
|
NDC 68084064011
|
| Hospital Charge Code |
10454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna American Axle |
$2.52
|
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.52
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Advantage |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.90
|
| Rate for Payer: PHP Commercial |
$3.29
|
| Rate for Payer: Priority Health SBD |
$2.44
|
| Rate for Payer: UMR Bronson Commercial |
$1.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.90
|
|
|
LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$3.11
|
|
|
Service Code
|
NDC 51079018001
|
| Hospital Charge Code |
10454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna American Axle |
$2.02
|
| Rate for Payer: Aetna Commercial |
$2.64
|
| Rate for Payer: Aetna Medicare |
$1.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.02
|
| Rate for Payer: BCBS Complete |
$1.24
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cofinity Advantage |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.49
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.33
|
| Rate for Payer: PHP Commercial |
$2.64
|
| Rate for Payer: Priority Health SBD |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.02
|
| Rate for Payer: UHC Core |
$1.62
|
| Rate for Payer: UHC Exchange |
$1.22
|
| Rate for Payer: UMR Bronson Commercial |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.33
|
|
|
LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$310.65
|
|
|
Service Code
|
NDC 51079018020
|
| Hospital Charge Code |
10454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.94 |
| Max. Negotiated Rate |
$279.58 |
| Rate for Payer: Aetna American Axle |
$201.92
|
| Rate for Payer: Aetna Commercial |
$264.05
|
| Rate for Payer: Aetna Medicare |
$155.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.92
|
| Rate for Payer: BCBS Complete |
$124.26
|
| Rate for Payer: Cash Price |
$248.52
|
| Rate for Payer: Cofinity Advantage |
$217.46
|
| Rate for Payer: Cofinity Commercial |
$267.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.52
|
| Rate for Payer: Healthscope Commercial |
$279.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.99
|
| Rate for Payer: PHP Commercial |
$264.05
|
| Rate for Payer: Priority Health SBD |
$195.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.92
|
| Rate for Payer: UHC Core |
$161.85
|
| Rate for Payer: UHC Exchange |
$122.09
|
| Rate for Payer: UMR Bronson Commercial |
$114.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.99
|
|
|
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 |
$118.91 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna American Axle |
$175.66
|
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.66
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Advantage |
$189.18
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$189.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.69
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health SBD |
$170.26
|
| Rate for Payer: UMR Bronson Commercial |
$118.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.69
|
|
|
LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$310.65
|
|
|
Service Code
|
NDC 51079018020
|
| Hospital Charge Code |
10454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.69 |
| Max. Negotiated Rate |
$279.58 |
| Rate for Payer: Aetna American Axle |
$201.92
|
| Rate for Payer: Aetna Commercial |
$264.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.92
|
| Rate for Payer: Cash Price |
$248.52
|
| Rate for Payer: Cofinity Advantage |
$217.46
|
| Rate for Payer: Cofinity Commercial |
$267.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.52
|
| Rate for Payer: Healthscope Commercial |
$279.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.99
|
| Rate for Payer: PHP Commercial |
$264.05
|
| Rate for Payer: Priority Health SBD |
$195.71
|
| Rate for Payer: UMR Bronson Commercial |
$136.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.99
|
|
|
LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$465.30
|
|
|
Service Code
|
NDC 00054002125
|
| Hospital Charge Code |
10454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.16 |
| Max. Negotiated Rate |
$418.77 |
| Rate for Payer: Aetna American Axle |
$302.44
|
| Rate for Payer: Aetna Commercial |
$395.50
|
| Rate for Payer: Aetna Medicare |
$232.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.44
|
| Rate for Payer: BCBS Complete |
$186.12
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cofinity Advantage |
$325.71
|
| Rate for Payer: Cofinity Commercial |
$400.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.24
|
| Rate for Payer: Healthscope Commercial |
$418.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.98
|
| Rate for Payer: PHP Commercial |
$395.50
|
| Rate for Payer: Priority Health SBD |
$293.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$302.44
|
| Rate for Payer: UHC Core |
$242.42
|
| Rate for Payer: UHC Exchange |
$182.86
|
| Rate for Payer: UMR Bronson Commercial |
$172.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.98
|
|
|
LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$278.40
|
|
|
Service Code
|
NDC 68084065501
|
| Hospital Charge Code |
10455
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.01 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna American Axle |
$180.96
|
| Rate for Payer: Aetna Commercial |
$236.64
|
| Rate for Payer: Aetna Medicare |
$139.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.96
|
| Rate for Payer: BCBS Complete |
$111.36
|
| Rate for Payer: Cash Price |
$222.72
|
| Rate for Payer: Cofinity Advantage |
$194.88
|
| Rate for Payer: Cofinity Commercial |
$239.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.72
|
| Rate for Payer: Healthscope Commercial |
$250.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.80
|
| Rate for Payer: PHP Commercial |
$236.64
|
| Rate for Payer: Priority Health SBD |
$175.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.96
|
| Rate for Payer: UHC Core |
$145.05
|
| Rate for Payer: UHC Exchange |
$109.41
|
| Rate for Payer: UMR Bronson Commercial |
$103.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.80
|
|
