|
LITHIUM CARBONATE 300 MG CAPSULE
|
Facility
|
IP
|
$25.94
|
|
|
Service Code
|
NDC 00054852725
|
| Hospital Charge Code |
4529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$23.35 |
| Rate for Payer: Aetna American Axle |
$16.86
|
| Rate for Payer: Aetna Commercial |
$22.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.86
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$18.16
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$23.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.05
|
| Rate for Payer: PHP Commercial |
$22.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.86
|
| Rate for Payer: Priority Health SBD |
$16.34
|
| Rate for Payer: UMR Bronson Commercial |
$11.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.46
|
|
|
LITHIUM CARBONATE 300 MG CAPSULE
|
Facility
|
OP
|
$25.94
|
|
|
Service Code
|
NDC 00054852725
|
| Hospital Charge Code |
4529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$23.35 |
| Rate for Payer: Aetna American Axle |
$16.86
|
| Rate for Payer: Aetna Commercial |
$22.05
|
| Rate for Payer: Aetna Medicare |
$12.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.86
|
| Rate for Payer: BCBS Complete |
$10.38
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$18.16
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$23.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.05
|
| Rate for Payer: PHP Commercial |
$22.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.86
|
| Rate for Payer: Priority Health SBD |
$16.34
|
| Rate for Payer: UMR Bronson Commercial |
$9.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.46
|
|
|
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 Commercial |
$136.32
|
| Rate for Payer: Cofinity Commercial |
$167.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.32
|
| 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: PHP Commercial |
$165.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.59
|
| Rate for Payer: Priority Health SBD |
$122.69
|
| Rate for Payer: UMR Bronson Commercial |
$72.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.06
|
|
|
LITHIUM CARBONATE 300 MG CAPSULE
|
Facility
|
IP
|
$206.80
|
|
|
Service Code
|
NDC 68462022101
|
| Hospital Charge Code |
4529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.99 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: Aetna American Axle |
$134.42
|
| Rate for Payer: Aetna Commercial |
$175.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.42
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cofinity Commercial |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$177.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.44
|
| Rate for Payer: Healthscope Commercial |
$186.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.78
|
| Rate for Payer: PHP Commercial |
$175.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.42
|
| Rate for Payer: Priority Health SBD |
$130.28
|
| Rate for Payer: UMR Bronson Commercial |
$90.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.10
|
|
|
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 Commercial |
$189.18
|
| Rate for Payer: Cofinity Commercial |
$232.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.18
|
| 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: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.66
|
| 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
|
OP
|
$455.90
|
|
|
Service Code
|
NDC 00054002125
|
| Hospital Charge Code |
10454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$410.31 |
| Rate for Payer: Aetna American Axle |
$296.34
|
| Rate for Payer: Aetna Commercial |
$387.52
|
| Rate for Payer: Aetna Medicare |
$227.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.34
|
| Rate for Payer: BCBS Complete |
$182.36
|
| Rate for Payer: Cash Price |
$364.72
|
| Rate for Payer: Cofinity Commercial |
$319.13
|
| Rate for Payer: Cofinity Commercial |
$392.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$319.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.72
|
| Rate for Payer: Healthscope Commercial |
$410.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$319.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$341.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$387.52
|
| Rate for Payer: PHP Commercial |
$387.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.34
|
| Rate for Payer: Priority Health SBD |
$287.22
|
| Rate for Payer: UMR Bronson Commercial |
$168.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$341.92
|
|
|
LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$3.23
|
|
|
Service Code
|
NDC 68084064011
|
| Hospital Charge Code |
10454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Aetna American Axle |
$2.10
|
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: Aetna Medicare |
$1.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.10
|
| Rate for Payer: BCBS Complete |
$1.29
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$2.26
|
| Rate for Payer: Cofinity Commercial |
$2.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.58
|
| Rate for Payer: Healthscope Commercial |
$2.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.10
|
| Rate for Payer: Priority Health SBD |
$2.03
|
| Rate for Payer: UMR Bronson Commercial |
$1.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.42
|
|
|
LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$455.90
|
|
|
Service Code
|
NDC 00054002125
|
| Hospital Charge Code |
10454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$410.31 |
| Rate for Payer: Aetna American Axle |
$296.34
|
| Rate for Payer: Aetna Commercial |
$387.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.34
|
| Rate for Payer: Cash Price |
$364.72
|
| Rate for Payer: Cofinity Commercial |
$319.13
|
| Rate for Payer: Cofinity Commercial |
$392.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$319.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.72
|
| Rate for Payer: Healthscope Commercial |
$410.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$319.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$341.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$387.52
|
| Rate for Payer: PHP Commercial |
$387.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.34
|
| Rate for Payer: Priority Health SBD |
$287.22
|
| Rate for Payer: UMR Bronson Commercial |
$200.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$341.92
|
|
|
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 Commercial |
$189.18
|
| Rate for Payer: Cofinity Commercial |
$232.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.18
|
| 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: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.66
|
| Rate for Payer: Priority Health SBD |
$170.26
|
| 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
|
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 |
$1.56
|
| 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 Commercial |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.18
|
| 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: PHP Commercial |
$2.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.02
|
| Rate for Payer: Priority Health SBD |
$1.96
|
| 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
|
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 Commercial |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.18
|
| 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: PHP Commercial |
$2.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.02
|
| 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
|
$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 Commercial |
$217.46
|
| Rate for Payer: Cofinity Commercial |
$267.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$217.46
|
| 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: PHP Commercial |
$264.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.92
|
| Rate for Payer: Priority Health SBD |
$195.71
|
| 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
|
$322.05
|
|
|
Service Code
|
NDC 68084064001
|
| Hospital Charge Code |
10454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.70 |
| Max. Negotiated Rate |
$289.84 |
| Rate for Payer: Aetna American Axle |
$209.33
|
| Rate for Payer: Aetna Commercial |
$273.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.33
|
| Rate for Payer: Cash Price |
$257.64
|
| Rate for Payer: Cofinity Commercial |
$225.44
|
| Rate for Payer: Cofinity Commercial |
$276.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$225.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.64
|
| Rate for Payer: Healthscope Commercial |
$289.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.74
|
| Rate for Payer: PHP Commercial |
$273.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.33
|
| Rate for Payer: Priority Health SBD |
$202.89
|
| Rate for Payer: UMR Bronson Commercial |
$141.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.54
|
|
|
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 Commercial |
$217.46
|
| Rate for Payer: Cofinity Commercial |
$267.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$217.46
|
| 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: PHP Commercial |
$264.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.92
|
| 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
|
$322.05
|
|
|
Service Code
|
NDC 68084064001
|
| Hospital Charge Code |
10454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.16 |
| Max. Negotiated Rate |
$289.84 |
| Rate for Payer: Aetna American Axle |
$209.33
|
| Rate for Payer: Aetna Commercial |
$273.74
|
| Rate for Payer: Aetna Medicare |
$161.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.33
|
| Rate for Payer: BCBS Complete |
$128.82
|
| Rate for Payer: Cash Price |
$257.64
|
| Rate for Payer: Cofinity Commercial |
$225.44
|
| Rate for Payer: Cofinity Commercial |
$276.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$225.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.64
|
| Rate for Payer: Healthscope Commercial |
$289.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.74
|
| Rate for Payer: PHP Commercial |
$273.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.33
|
| Rate for Payer: Priority Health SBD |
$202.89
|
| Rate for Payer: UMR Bronson Commercial |
$119.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.54
|
|
|
LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$3.23
|
|
|
Service Code
|
NDC 68084064011
|
| Hospital Charge Code |
10454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Aetna American Axle |
$2.10
|
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.10
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$2.26
|
| Rate for Payer: Cofinity Commercial |
$2.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.58
|
| Rate for Payer: Healthscope Commercial |
$2.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.10
|
| Rate for Payer: Priority Health SBD |
$2.03
|
| Rate for Payer: UMR Bronson Commercial |
$1.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.42
|
|
|
LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$3.73
|
|
|
Service Code
|
NDC 51079014201
|
| Hospital Charge Code |
10455
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Aetna American Axle |
$2.42
|
| Rate for Payer: Aetna Commercial |
$3.17
|
| Rate for Payer: Aetna Medicare |
$1.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.42
|
| Rate for Payer: BCBS Complete |
$1.49
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.17
|
| Rate for Payer: PHP Commercial |
$3.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: Priority Health SBD |
$2.35
|
| Rate for Payer: UMR Bronson Commercial |
$1.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.80
|
|
|
LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$3.73
|
|
|
Service Code
|
NDC 51079014201
|
| Hospital Charge Code |
10455
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Aetna American Axle |
$2.42
|
| Rate for Payer: Aetna Commercial |
$3.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.42
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.17
|
| Rate for Payer: PHP Commercial |
$3.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: Priority Health SBD |
$2.35
|
| Rate for Payer: UMR Bronson Commercial |
$1.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.80
|
|
|
LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$372.40
|
|
|
Service Code
|
NDC 51079014220
|
| Hospital Charge Code |
10455
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.79 |
| Max. Negotiated Rate |
$335.16 |
| Rate for Payer: Aetna American Axle |
$242.06
|
| Rate for Payer: Aetna Commercial |
$316.54
|
| Rate for Payer: Aetna Medicare |
$186.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.06
|
| Rate for Payer: BCBS Complete |
$148.96
|
| Rate for Payer: Cash Price |
$297.92
|
| Rate for Payer: Cofinity Commercial |
$260.68
|
| Rate for Payer: Cofinity Commercial |
$320.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.92
|
| Rate for Payer: Healthscope Commercial |
$335.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.54
|
| Rate for Payer: PHP Commercial |
$316.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.06
|
| Rate for Payer: Priority Health SBD |
$234.61
|
| Rate for Payer: UMR Bronson Commercial |
$137.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.30
|
|
|
LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$2.56
|
|
|
Service Code
|
NDC 68084065511
|
| Hospital Charge Code |
10455
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna American Axle |
$1.66
|
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.66
|
| Rate for Payer: Priority Health SBD |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$0.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.92
|
|
|
LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$372.40
|
|
|
Service Code
|
NDC 51079014220
|
| Hospital Charge Code |
10455
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.86 |
| Max. Negotiated Rate |
$335.16 |
| Rate for Payer: Aetna American Axle |
$242.06
|
| Rate for Payer: Aetna Commercial |
$316.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.06
|
| Rate for Payer: Cash Price |
$297.92
|
| Rate for Payer: Cofinity Commercial |
$260.68
|
| Rate for Payer: Cofinity Commercial |
$320.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.92
|
| Rate for Payer: Healthscope Commercial |
$335.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.54
|
| Rate for Payer: PHP Commercial |
$316.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.06
|
| Rate for Payer: Priority Health SBD |
$234.61
|
| Rate for Payer: UMR Bronson Commercial |
$163.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.30
|
|
|
LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$269.80
|
|
|
Service Code
|
NDC 00054002025
|
| Hospital Charge Code |
10455
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.71 |
| Max. Negotiated Rate |
$242.82 |
| Rate for Payer: Aetna American Axle |
$175.37
|
| Rate for Payer: Aetna Commercial |
$229.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.37
|
| Rate for Payer: Cash Price |
$215.84
|
| Rate for Payer: Cofinity Commercial |
$188.86
|
| Rate for Payer: Cofinity Commercial |
$232.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.84
|
| Rate for Payer: Healthscope Commercial |
$242.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.33
|
| Rate for Payer: PHP Commercial |
$229.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.37
|
| Rate for Payer: Priority Health SBD |
$169.97
|
| Rate for Payer: UMR Bronson Commercial |
$118.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.35
|
|
|
LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$269.80
|
|
|
Service Code
|
NDC 00378145001
|
| Hospital Charge Code |
10455
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.71 |
| Max. Negotiated Rate |
$242.82 |
| Rate for Payer: Aetna American Axle |
$175.37
|
| Rate for Payer: Aetna Commercial |
$229.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.37
|
| Rate for Payer: Cash Price |
$215.84
|
| Rate for Payer: Cofinity Commercial |
$188.86
|
| Rate for Payer: Cofinity Commercial |
$232.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.84
|
| Rate for Payer: Healthscope Commercial |
$242.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.33
|
| Rate for Payer: PHP Commercial |
$229.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.37
|
| Rate for Payer: Priority Health SBD |
$169.97
|
| Rate for Payer: UMR Bronson Commercial |
$118.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.35
|
|
|
LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.56
|
|
|
Service Code
|
NDC 68084065511
|
| Hospital Charge Code |
10455
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna American Axle |
$1.66
|
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.66
|
| Rate for Payer: Priority Health SBD |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$1.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.92
|
|
|
LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$255.84
|
|
|
Service Code
|
NDC 68084065501
|
| Hospital Charge Code |
10455
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.57 |
| Max. Negotiated Rate |
$230.26 |
| Rate for Payer: Aetna American Axle |
$166.30
|
| Rate for Payer: Aetna Commercial |
$217.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.30
|
| Rate for Payer: Cash Price |
$204.67
|
| Rate for Payer: Cofinity Commercial |
$179.09
|
| Rate for Payer: Cofinity Commercial |
$220.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.67
|
| Rate for Payer: Healthscope Commercial |
$230.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.46
|
| Rate for Payer: PHP Commercial |
$217.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.30
|
| Rate for Payer: Priority Health SBD |
$161.18
|
| Rate for Payer: UMR Bronson Commercial |
$112.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.88
|
|
