|
LISDEXAMFETAMINE 10 MG CAPSULE
|
Facility
|
OP
|
$3,966.93
|
|
|
Service Code
|
NDC 59417010110
|
| Hospital Charge Code |
173697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,467.76 |
| Max. Negotiated Rate |
$3,570.24 |
| Rate for Payer: Aetna American Axle |
$2,578.50
|
| Rate for Payer: Aetna Commercial |
$3,371.89
|
| Rate for Payer: Aetna Medicare |
$1,983.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,578.50
|
| Rate for Payer: BCBS Complete |
$1,586.77
|
| Rate for Payer: Cash Price |
$3,173.54
|
| Rate for Payer: Cofinity Commercial |
$2,776.85
|
| Rate for Payer: Cofinity Commercial |
$3,411.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,776.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,173.54
|
| Rate for Payer: Healthscope Commercial |
$3,570.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,776.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,975.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,371.89
|
| Rate for Payer: PHP Commercial |
$3,371.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,578.50
|
| Rate for Payer: Priority Health SBD |
$2,499.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,467.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,975.20
|
|
|
LISDEXAMFETAMINE 10 MG CAPSULE
|
Facility
|
OP
|
$1,201.90
|
|
|
Service Code
|
NDC 00527466137
|
| Hospital Charge Code |
173697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$444.70 |
| Max. Negotiated Rate |
$1,081.71 |
| Rate for Payer: Aetna American Axle |
$781.24
|
| Rate for Payer: Aetna Commercial |
$1,021.62
|
| Rate for Payer: Aetna Medicare |
$600.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$781.24
|
| Rate for Payer: BCBS Complete |
$480.76
|
| Rate for Payer: Cash Price |
$961.52
|
| Rate for Payer: Cofinity Commercial |
$1,033.63
|
| Rate for Payer: Cofinity Commercial |
$841.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$841.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$961.52
|
| Rate for Payer: Healthscope Commercial |
$1,081.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$841.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$901.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,021.62
|
| Rate for Payer: PHP Commercial |
$1,021.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$781.24
|
| Rate for Payer: Priority Health SBD |
$757.20
|
| Rate for Payer: UMR Bronson Commercial |
$444.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$901.42
|
|
|
LISDEXAMFETAMINE 10 MG CAPSULE
|
Facility
|
IP
|
$480.90
|
|
|
Service Code
|
NDC 43547060210
|
| Hospital Charge Code |
173697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.60 |
| Max. Negotiated Rate |
$432.81 |
| Rate for Payer: Aetna American Axle |
$312.58
|
| Rate for Payer: Aetna Commercial |
$408.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.58
|
| Rate for Payer: Cash Price |
$384.72
|
| Rate for Payer: Cofinity Commercial |
$336.63
|
| Rate for Payer: Cofinity Commercial |
$413.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$336.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.72
|
| Rate for Payer: Healthscope Commercial |
$432.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$336.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$360.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.76
|
| Rate for Payer: PHP Commercial |
$408.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.58
|
| Rate for Payer: Priority Health SBD |
$302.97
|
| Rate for Payer: UMR Bronson Commercial |
$211.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$360.68
|
|
|
LISDEXAMFETAMINE 10 MG CAPSULE
|
Facility
|
IP
|
$3,966.93
|
|
|
Service Code
|
NDC 59417010110
|
| Hospital Charge Code |
173697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,745.45 |
| Max. Negotiated Rate |
$3,570.24 |
| Rate for Payer: Aetna American Axle |
$2,578.50
|
| Rate for Payer: Aetna Commercial |
$3,371.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,578.50
|
| Rate for Payer: Cash Price |
$3,173.54
|
| Rate for Payer: Cofinity Commercial |
$2,776.85
|
| Rate for Payer: Cofinity Commercial |
$3,411.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,776.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,173.54
|
| Rate for Payer: Healthscope Commercial |
$3,570.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,776.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,975.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,371.89
|
| Rate for Payer: PHP Commercial |
$3,371.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,578.50
|
| Rate for Payer: Priority Health SBD |
$2,499.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,745.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,975.20
|
|
|
LISDEXAMFETAMINE 30 MG CAPSULE
|
Facility
|
OP
|
$852.23
|
|
|
Service Code
|
NDC 65162002409
|
| Hospital Charge Code |
81474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$315.33 |
| Max. Negotiated Rate |
$767.01 |
| Rate for Payer: Aetna American Axle |
$553.95
|
| Rate for Payer: Aetna Commercial |
$724.40
|
| Rate for Payer: Aetna Medicare |
$426.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.95
|
| Rate for Payer: BCBS Complete |
$340.89
|
| Rate for Payer: Cash Price |
$681.78
|
| Rate for Payer: Cofinity Commercial |
$596.56
|
| Rate for Payer: Cofinity Commercial |
$732.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$596.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$681.78
|
| Rate for Payer: Healthscope Commercial |
$767.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$596.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$639.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$724.40
|
| Rate for Payer: PHP Commercial |
$724.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.95
|
| Rate for Payer: Priority Health SBD |
$536.90
|
| Rate for Payer: UMR Bronson Commercial |
$315.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$639.17
|
|
|
LISDEXAMFETAMINE 30 MG CAPSULE
|
Facility
|
OP
|
$480.90
|
|
|
Service Code
|
NDC 43547060410
|
| Hospital Charge Code |
81474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.93 |
| Max. Negotiated Rate |
$432.81 |
| Rate for Payer: Aetna American Axle |
$312.58
|
| Rate for Payer: Aetna Commercial |
$408.76
|
| Rate for Payer: Aetna Medicare |
$240.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.58
|
| Rate for Payer: BCBS Complete |
$192.36
|
| Rate for Payer: Cash Price |
$384.72
|
| Rate for Payer: Cofinity Commercial |
$336.63
|
| Rate for Payer: Cofinity Commercial |
$413.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$336.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.72
|
| Rate for Payer: Healthscope Commercial |
$432.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$336.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$360.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.76
|
| Rate for Payer: PHP Commercial |
$408.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.58
|
| Rate for Payer: Priority Health SBD |
$302.97
|
| Rate for Payer: UMR Bronson Commercial |
$177.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$360.68
|
|
|
LISDEXAMFETAMINE 30 MG CAPSULE
|
Facility
|
OP
|
$3,966.93
|
|
|
Service Code
|
NDC 59417010310
|
| Hospital Charge Code |
81474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,467.76 |
| Max. Negotiated Rate |
$3,570.24 |
| Rate for Payer: Aetna American Axle |
$2,578.50
|
| Rate for Payer: Aetna Commercial |
$3,371.89
|
| Rate for Payer: Aetna Medicare |
$1,983.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,578.50
|
| Rate for Payer: BCBS Complete |
$1,586.77
|
| Rate for Payer: Cash Price |
$3,173.54
|
| Rate for Payer: Cofinity Commercial |
$2,776.85
|
| Rate for Payer: Cofinity Commercial |
$3,411.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,776.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,173.54
|
| Rate for Payer: Healthscope Commercial |
$3,570.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,776.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,975.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,371.89
|
| Rate for Payer: PHP Commercial |
$3,371.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,578.50
|
| Rate for Payer: Priority Health SBD |
$2,499.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,467.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,975.20
|
|
|
LISDEXAMFETAMINE 30 MG CAPSULE
|
Facility
|
IP
|
$852.23
|
|
|
Service Code
|
NDC 65162002409
|
| Hospital Charge Code |
81474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$374.98 |
| Max. Negotiated Rate |
$767.01 |
| Rate for Payer: Aetna American Axle |
$553.95
|
| Rate for Payer: Aetna Commercial |
$724.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.95
|
| Rate for Payer: Cash Price |
$681.78
|
| Rate for Payer: Cofinity Commercial |
$596.56
|
| Rate for Payer: Cofinity Commercial |
$732.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$596.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$681.78
|
| Rate for Payer: Healthscope Commercial |
$767.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$596.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$639.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$724.40
|
| Rate for Payer: PHP Commercial |
$724.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.95
|
| Rate for Payer: Priority Health SBD |
$536.90
|
| Rate for Payer: UMR Bronson Commercial |
$374.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$639.17
|
|
|
LISDEXAMFETAMINE 30 MG CAPSULE
|
Facility
|
IP
|
$480.90
|
|
|
Service Code
|
NDC 43547060410
|
| Hospital Charge Code |
81474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.60 |
| Max. Negotiated Rate |
$432.81 |
| Rate for Payer: Aetna American Axle |
$312.58
|
| Rate for Payer: Aetna Commercial |
$408.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.58
|
| Rate for Payer: Cash Price |
$384.72
|
| Rate for Payer: Cofinity Commercial |
$336.63
|
| Rate for Payer: Cofinity Commercial |
$413.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$336.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.72
|
| Rate for Payer: Healthscope Commercial |
$432.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$336.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$360.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.76
|
| Rate for Payer: PHP Commercial |
$408.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.58
|
| Rate for Payer: Priority Health SBD |
$302.97
|
| Rate for Payer: UMR Bronson Commercial |
$211.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$360.68
|
|
|
LISDEXAMFETAMINE 30 MG CAPSULE
|
Facility
|
IP
|
$3,966.93
|
|
|
Service Code
|
NDC 59417010310
|
| Hospital Charge Code |
81474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,745.45 |
| Max. Negotiated Rate |
$3,570.24 |
| Rate for Payer: Aetna American Axle |
$2,578.50
|
| Rate for Payer: Aetna Commercial |
$3,371.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,578.50
|
| Rate for Payer: Cash Price |
$3,173.54
|
| Rate for Payer: Cofinity Commercial |
$2,776.85
|
| Rate for Payer: Cofinity Commercial |
$3,411.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,776.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,173.54
|
| Rate for Payer: Healthscope Commercial |
$3,570.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,776.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,975.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,371.89
|
| Rate for Payer: PHP Commercial |
$3,371.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,578.50
|
| Rate for Payer: Priority Health SBD |
$2,499.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,745.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,975.20
|
|
|
LISINOPRIL 10 MG TABLET
|
Facility
|
OP
|
$44.65
|
|
|
Service Code
|
NDC 68180098001
|
| Hospital Charge Code |
10449
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.52 |
| Max. Negotiated Rate |
$40.18 |
| Rate for Payer: Aetna American Axle |
$29.02
|
| Rate for Payer: Aetna Commercial |
$37.95
|
| Rate for Payer: Aetna Medicare |
$22.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.02
|
| Rate for Payer: BCBS Complete |
$17.86
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cofinity Commercial |
$31.26
|
| Rate for Payer: Cofinity Commercial |
$38.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.72
|
| Rate for Payer: Healthscope Commercial |
$40.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.95
|
| Rate for Payer: PHP Commercial |
$37.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.02
|
| Rate for Payer: Priority Health SBD |
$28.13
|
| Rate for Payer: UMR Bronson Commercial |
$16.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.49
|
|
|
LISINOPRIL 10 MG TABLET
|
Facility
|
IP
|
$44.65
|
|
|
Service Code
|
NDC 68180098001
|
| Hospital Charge Code |
10449
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.65 |
| Max. Negotiated Rate |
$40.18 |
| Rate for Payer: Aetna American Axle |
$29.02
|
| Rate for Payer: Aetna Commercial |
$37.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.02
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cofinity Commercial |
$31.26
|
| Rate for Payer: Cofinity Commercial |
$38.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.72
|
| Rate for Payer: Healthscope Commercial |
$40.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.95
|
| Rate for Payer: PHP Commercial |
$37.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.02
|
| Rate for Payer: Priority Health SBD |
$28.13
|
| Rate for Payer: UMR Bronson Commercial |
$19.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.49
|
|
|
LISINOPRIL 10 MG TABLET
|
Facility
|
IP
|
$110.45
|
|
|
Service Code
|
NDC 00904679861
|
| Hospital Charge Code |
10449
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$99.40 |
| Rate for Payer: Aetna American Axle |
$71.79
|
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.79
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Commercial |
$77.32
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$99.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.79
|
| Rate for Payer: Priority Health SBD |
$69.58
|
| Rate for Payer: UMR Bronson Commercial |
$48.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.84
|
|
|
LISINOPRIL 10 MG TABLET
|
Facility
|
IP
|
$2.50
|
|
|
Service Code
|
NDC 60687032511
|
| Hospital Charge Code |
10449
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna American Axle |
$1.62
|
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.62
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cofinity Commercial |
$1.75
|
| Rate for Payer: Cofinity Commercial |
$2.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.00
|
| Rate for Payer: Healthscope Commercial |
$2.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.12
|
| Rate for Payer: PHP Commercial |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.62
|
| Rate for Payer: Priority Health SBD |
$1.58
|
| Rate for Payer: UMR Bronson Commercial |
$1.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.88
|
|
|
LISINOPRIL 10 MG TABLET
|
Facility
|
OP
|
$2.50
|
|
|
Service Code
|
NDC 60687032511
|
| Hospital Charge Code |
10449
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna American Axle |
$1.62
|
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: Aetna Medicare |
$1.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.62
|
| Rate for Payer: BCBS Complete |
$1.00
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cofinity Commercial |
$1.75
|
| Rate for Payer: Cofinity Commercial |
$2.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.00
|
| Rate for Payer: Healthscope Commercial |
$2.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.12
|
| Rate for Payer: PHP Commercial |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.62
|
| Rate for Payer: Priority Health SBD |
$1.58
|
| Rate for Payer: UMR Bronson Commercial |
$0.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.88
|
|
|
LISINOPRIL 10 MG TABLET
|
Facility
|
OP
|
$249.10
|
|
|
Service Code
|
NDC 60687032501
|
| Hospital Charge Code |
10449
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.17 |
| Max. Negotiated Rate |
$224.19 |
| Rate for Payer: Aetna American Axle |
$161.92
|
| Rate for Payer: Aetna Commercial |
$211.74
|
| Rate for Payer: Aetna Medicare |
$124.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.92
|
| Rate for Payer: BCBS Complete |
$99.64
|
| Rate for Payer: Cash Price |
$199.28
|
| Rate for Payer: Cofinity Commercial |
$174.37
|
| Rate for Payer: Cofinity Commercial |
$214.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$224.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.74
|
| Rate for Payer: PHP Commercial |
$211.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.92
|
| Rate for Payer: Priority Health SBD |
$156.93
|
| Rate for Payer: UMR Bronson Commercial |
$92.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.82
|
|
|
LISINOPRIL 10 MG TABLET
|
Facility
|
OP
|
$110.45
|
|
|
Service Code
|
NDC 00904679861
|
| Hospital Charge Code |
10449
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.87 |
| Max. Negotiated Rate |
$99.40 |
| Rate for Payer: Aetna American Axle |
$71.79
|
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: Aetna Medicare |
$55.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.79
|
| Rate for Payer: BCBS Complete |
$44.18
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Commercial |
$77.32
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$99.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.79
|
| Rate for Payer: Priority Health SBD |
$69.58
|
| Rate for Payer: UMR Bronson Commercial |
$40.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.84
|
|
|
LISINOPRIL 10 MG TABLET
|
Facility
|
IP
|
$249.10
|
|
|
Service Code
|
NDC 60687032501
|
| Hospital Charge Code |
10449
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.60 |
| Max. Negotiated Rate |
$224.19 |
| Rate for Payer: Aetna American Axle |
$161.92
|
| Rate for Payer: Aetna Commercial |
$211.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.92
|
| Rate for Payer: Cash Price |
$199.28
|
| Rate for Payer: Cofinity Commercial |
$174.37
|
| Rate for Payer: Cofinity Commercial |
$214.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$224.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.74
|
| Rate for Payer: PHP Commercial |
$211.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.92
|
| Rate for Payer: Priority Health SBD |
$156.93
|
| Rate for Payer: UMR Bronson Commercial |
$109.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.82
|
|
|
LISINOPRIL 20 MG TABLET
|
Facility
|
OP
|
$148.05
|
|
|
Service Code
|
NDC 00591040801
|
| Hospital Charge Code |
4526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$133.24 |
| Rate for Payer: Aetna American Axle |
$96.23
|
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna Medicare |
$74.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: BCBS Complete |
$59.22
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.23
|
| Rate for Payer: Priority Health SBD |
$93.27
|
| Rate for Payer: UMR Bronson Commercial |
$54.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
LISINOPRIL 20 MG TABLET
|
Facility
|
OP
|
$267.90
|
|
|
Service Code
|
NDC 60687033301
|
| Hospital Charge Code |
4526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.12 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna American Axle |
$174.14
|
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna Medicare |
$133.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.14
|
| Rate for Payer: BCBS Complete |
$107.16
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$187.53
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.53
|
| 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 |
$200.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.14
|
| Rate for Payer: Priority Health SBD |
$168.78
|
| Rate for Payer: UMR Bronson Commercial |
$99.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.92
|
|
|
LISINOPRIL 20 MG TABLET
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 60687033311
|
| Hospital Charge Code |
4526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna American Axle |
$1.74
|
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.74
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: UMR Bronson Commercial |
$1.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
LISINOPRIL 20 MG TABLET
|
Facility
|
OP
|
$2.68
|
|
|
Service Code
|
NDC 60687033311
|
| Hospital Charge Code |
4526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna American Axle |
$1.74
|
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Medicare |
$1.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.74
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: UMR Bronson Commercial |
$0.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
LISINOPRIL 20 MG TABLET
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
NDC 00591040801
|
| Hospital Charge Code |
4526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.14 |
| Max. Negotiated Rate |
$133.24 |
| Rate for Payer: Aetna American Axle |
$96.23
|
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.23
|
| Rate for Payer: Priority Health SBD |
$93.27
|
| Rate for Payer: UMR Bronson Commercial |
$65.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
LISINOPRIL 20 MG TABLET
|
Facility
|
OP
|
$143.35
|
|
|
Service Code
|
NDC 43547035410
|
| Hospital Charge Code |
4526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$129.02 |
| Rate for Payer: Aetna American Axle |
$93.18
|
| Rate for Payer: Aetna Commercial |
$121.85
|
| Rate for Payer: Aetna Medicare |
$71.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.18
|
| Rate for Payer: BCBS Complete |
$57.34
|
| Rate for Payer: Cash Price |
$114.68
|
| Rate for Payer: Cofinity Commercial |
$100.34
|
| Rate for Payer: Cofinity Commercial |
$123.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.68
|
| Rate for Payer: Healthscope Commercial |
$129.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.85
|
| Rate for Payer: PHP Commercial |
$121.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.18
|
| Rate for Payer: Priority Health SBD |
$90.31
|
| Rate for Payer: UMR Bronson Commercial |
$53.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.51
|
|
|
LISINOPRIL 20 MG TABLET
|
Facility
|
IP
|
$61.10
|
|
|
Service Code
|
NDC 68180098101
|
| Hospital Charge Code |
4526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$54.99 |
| Rate for Payer: Aetna American Axle |
$39.72
|
| Rate for Payer: Aetna Commercial |
$51.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.72
|
| Rate for Payer: Cash Price |
$48.88
|
| Rate for Payer: Cofinity Commercial |
$42.77
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.88
|
| Rate for Payer: Healthscope Commercial |
$54.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.94
|
| Rate for Payer: PHP Commercial |
$51.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.72
|
| Rate for Payer: Priority Health SBD |
$38.49
|
| Rate for Payer: UMR Bronson Commercial |
$26.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.82
|
|
