Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM OB

Facility

$63.94

Service Code	NDC 73070010310
Hospital Charge Code	301083
Hospital Revenue Code	637
Min. Negotiated Rate	$40.28
Max. Negotiated Rate	$57.55
Rate for Payer: Aetna Commercial	$54.35
Rate for Payer: Aetna New Business (MI Preferred)	$41.56
Rate for Payer: Cash Price	$51.15
Rate for Payer: Cofinity Commercial	$44.76
Rate for Payer: Cofinity Commercial	$54.99
Rate for Payer: Cofinity Medicare Advantage	$44.76
Rate for Payer: Encore Health Key Benefits Commercial	$51.15
Rate for Payer: Healthscope Commercial	$57.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.35
Rate for Payer: PHP Commercial	$54.35
Rate for Payer: Priority Health Cigna Priority Health	$41.56
Rate for Payer: Priority Health SBD	$40.28

INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM OB

Facility

$63.94

Service Code	NDC 73070010315
Hospital Charge Code	301083
Hospital Revenue Code	637
Min. Negotiated Rate	$40.28
Max. Negotiated Rate	$57.55
Rate for Payer: Aetna Commercial	$54.35
Rate for Payer: Aetna New Business (MI Preferred)	$41.56
Rate for Payer: Cash Price	$51.15
Rate for Payer: Cofinity Commercial	$44.76
Rate for Payer: Cofinity Commercial	$54.99
Rate for Payer: Cofinity Medicare Advantage	$44.76
Rate for Payer: Encore Health Key Benefits Commercial	$51.15
Rate for Payer: Healthscope Commercial	$57.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.35
Rate for Payer: PHP Commercial	$54.35
Rate for Payer: Priority Health Cigna Priority Health	$41.56
Rate for Payer: Priority Health SBD	$40.28

INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM OB

Facility

$63.94

Service Code	NDC 73070010310
Hospital Charge Code	301083
Hospital Revenue Code	637
Min. Negotiated Rate	$25.58
Max. Negotiated Rate	$57.55
Rate for Payer: Aetna Commercial	$54.35
Rate for Payer: Aetna Medicare	$31.97
Rate for Payer: Aetna New Business (MI Preferred)	$41.56
Rate for Payer: BCBS Complete	$25.58
Rate for Payer: Cash Price	$51.15
Rate for Payer: Cofinity Commercial	$44.76
Rate for Payer: Cofinity Commercial	$54.99
Rate for Payer: Cofinity Medicare Advantage	$44.76
Rate for Payer: Encore Health Key Benefits Commercial	$51.15
Rate for Payer: Healthscope Commercial	$57.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.35
Rate for Payer: PHP Commercial	$54.35
Rate for Payer: Priority Health Cigna Priority Health	$41.56
Rate for Payer: Priority Health SBD	$40.28

INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN

Facility

$63.94

Service Code	NDC 73070010310
Hospital Charge Code	112756
Hospital Revenue Code	637
Min. Negotiated Rate	$40.28
Max. Negotiated Rate	$57.55
Rate for Payer: Aetna Commercial	$54.35
Rate for Payer: Aetna New Business (MI Preferred)	$41.56
Rate for Payer: Cash Price	$51.15
Rate for Payer: Cofinity Commercial	$44.76
Rate for Payer: Cofinity Commercial	$54.99
Rate for Payer: Cofinity Medicare Advantage	$44.76
Rate for Payer: Encore Health Key Benefits Commercial	$51.15
Rate for Payer: Healthscope Commercial	$57.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.35
Rate for Payer: PHP Commercial	$54.35
Rate for Payer: Priority Health Cigna Priority Health	$41.56
Rate for Payer: Priority Health SBD	$40.28

INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN

Facility

$63.94

Service Code	NDC 00169633910
Hospital Charge Code	112756
Hospital Revenue Code	637
Min. Negotiated Rate	$25.58
Max. Negotiated Rate	$57.55
Rate for Payer: Aetna Commercial	$54.35
Rate for Payer: Aetna Medicare	$31.97
Rate for Payer: Aetna New Business (MI Preferred)	$41.56
Rate for Payer: BCBS Complete	$25.58
Rate for Payer: Cash Price	$51.15
Rate for Payer: Cofinity Commercial	$44.76
Rate for Payer: Cofinity Commercial	$54.99
Rate for Payer: Cofinity Medicare Advantage	$44.76
Rate for Payer: Encore Health Key Benefits Commercial	$51.15
Rate for Payer: Healthscope Commercial	$57.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.35
Rate for Payer: PHP Commercial	$54.35
Rate for Payer: Priority Health Cigna Priority Health	$41.56
Rate for Payer: Priority Health SBD	$40.28

INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN

Facility

$63.94

Service Code	NDC 00169633910
Hospital Charge Code	112756
Hospital Revenue Code	637
Min. Negotiated Rate	$40.28
Max. Negotiated Rate	$57.55
Rate for Payer: Aetna Commercial	$54.35
Rate for Payer: Aetna New Business (MI Preferred)	$41.56
Rate for Payer: Cash Price	$51.15
Rate for Payer: Cofinity Commercial	$44.76
Rate for Payer: Cofinity Commercial	$54.99
Rate for Payer: Cofinity Medicare Advantage	$44.76
Rate for Payer: Encore Health Key Benefits Commercial	$51.15
Rate for Payer: Healthscope Commercial	$57.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.35
Rate for Payer: PHP Commercial	$54.35
Rate for Payer: Priority Health Cigna Priority Health	$41.56
Rate for Payer: Priority Health SBD	$40.28

INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN

Facility

$63.94

Service Code	NDC 73070010310
Hospital Charge Code	112756
Hospital Revenue Code	637
Min. Negotiated Rate	$25.58
Max. Negotiated Rate	$57.55
Rate for Payer: Aetna Commercial	$54.35
Rate for Payer: Aetna Medicare	$31.97
Rate for Payer: Aetna New Business (MI Preferred)	$41.56
Rate for Payer: BCBS Complete	$25.58
Rate for Payer: Cash Price	$51.15
Rate for Payer: Cofinity Commercial	$44.76
Rate for Payer: Cofinity Commercial	$54.99
Rate for Payer: Cofinity Medicare Advantage	$44.76
Rate for Payer: Encore Health Key Benefits Commercial	$51.15
Rate for Payer: Healthscope Commercial	$57.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.35
Rate for Payer: PHP Commercial	$54.35
Rate for Payer: Priority Health Cigna Priority Health	$41.56
Rate for Payer: Priority Health SBD	$40.28

INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN

Facility

$63.94

Service Code	NDC 73070010315
Hospital Charge Code	112756
Hospital Revenue Code	637
Min. Negotiated Rate	$40.28
Max. Negotiated Rate	$57.55
Rate for Payer: Aetna Commercial	$54.35
Rate for Payer: Aetna New Business (MI Preferred)	$41.56
Rate for Payer: Cash Price	$51.15
Rate for Payer: Cofinity Commercial	$44.76
Rate for Payer: Cofinity Commercial	$54.99
Rate for Payer: Cofinity Medicare Advantage	$44.76
Rate for Payer: Encore Health Key Benefits Commercial	$51.15
Rate for Payer: Healthscope Commercial	$57.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.35
Rate for Payer: PHP Commercial	$54.35
Rate for Payer: Priority Health Cigna Priority Health	$41.56
Rate for Payer: Priority Health SBD	$40.28

INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN

Facility

$63.94

Service Code	NDC 73070010315
Hospital Charge Code	112756
Hospital Revenue Code	637
Min. Negotiated Rate	$25.58
Max. Negotiated Rate	$57.55
Rate for Payer: Aetna Commercial	$54.35
Rate for Payer: Aetna Medicare	$31.97
Rate for Payer: Aetna New Business (MI Preferred)	$41.56
Rate for Payer: BCBS Complete	$25.58
Rate for Payer: Cash Price	$51.15
Rate for Payer: Cofinity Commercial	$44.76
Rate for Payer: Cofinity Commercial	$54.99
Rate for Payer: Cofinity Medicare Advantage	$44.76
Rate for Payer: Encore Health Key Benefits Commercial	$51.15
Rate for Payer: Healthscope Commercial	$57.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.35
Rate for Payer: PHP Commercial	$54.35
Rate for Payer: Priority Health Cigna Priority Health	$41.56
Rate for Payer: Priority Health SBD	$40.28

INSULIN GLARGINE-AGLR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN

Facility

$63.32

Service Code	HCPCS J1815
Hospital Charge Code	203258
Hospital Revenue Code	637
Min. Negotiated Rate	$25.33
Max. Negotiated Rate	$56.99
Rate for Payer: Aetna Commercial	$53.82
Rate for Payer: Aetna Medicare	$31.66
Rate for Payer: Aetna New Business (MI Preferred)	$41.16
Rate for Payer: BCBS Complete	$25.33
Rate for Payer: Cash Price	$50.66
Rate for Payer: Cofinity Commercial	$44.32
Rate for Payer: Cofinity Commercial	$54.46
Rate for Payer: Cofinity Medicare Advantage	$44.32
Rate for Payer: Encore Health Key Benefits Commercial	$50.66
Rate for Payer: Healthscope Commercial	$56.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.82
Rate for Payer: PHP Commercial	$53.82
Rate for Payer: Priority Health Cigna Priority Health	$41.16
Rate for Payer: Priority Health SBD	$39.89

INSULIN GLARGINE-AGLR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN

Facility

$63.32

Service Code	HCPCS J1815
Hospital Charge Code	203258
Hospital Revenue Code	637
Min. Negotiated Rate	$39.89
Max. Negotiated Rate	$56.99
Rate for Payer: Aetna Commercial	$53.82
Rate for Payer: Aetna New Business (MI Preferred)	$41.16
Rate for Payer: Cash Price	$50.66
Rate for Payer: Cofinity Commercial	$44.32
Rate for Payer: Cofinity Commercial	$54.46
Rate for Payer: Cofinity Medicare Advantage	$44.32
Rate for Payer: Encore Health Key Benefits Commercial	$50.66
Rate for Payer: Healthscope Commercial	$56.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.82
Rate for Payer: PHP Commercial	$53.82
Rate for Payer: Priority Health Cigna Priority Health	$41.16
Rate for Payer: Priority Health SBD	$39.89

INSULIN GLULISINE (U-100) 100 UNIT/ML SQ FOR INSULIN PUMP REFILL

Facility

$278.47

Service Code	HCPCS J1815
Hospital Charge Code	301807
Hospital Revenue Code	637
Min. Negotiated Rate	$175.44
Max. Negotiated Rate	$250.62
Rate for Payer: Aetna Commercial	$236.70
Rate for Payer: Aetna New Business (MI Preferred)	$181.01
Rate for Payer: Cash Price	$222.78
Rate for Payer: Cofinity Commercial	$194.93
Rate for Payer: Cofinity Commercial	$239.48
Rate for Payer: Cofinity Medicare Advantage	$194.93
Rate for Payer: Encore Health Key Benefits Commercial	$222.78
Rate for Payer: Healthscope Commercial	$250.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$236.70
Rate for Payer: PHP Commercial	$236.70
Rate for Payer: Priority Health Cigna Priority Health	$181.01
Rate for Payer: Priority Health SBD	$175.44

INSULIN GLULISINE (U-100) 100 UNIT/ML SQ FOR INSULIN PUMP REFILL

Facility

$278.47

Service Code	HCPCS J1815
Hospital Charge Code	301807
Hospital Revenue Code	637
Min. Negotiated Rate	$111.39
Max. Negotiated Rate	$250.62
Rate for Payer: Aetna Commercial	$236.70
Rate for Payer: Aetna Medicare	$139.24
Rate for Payer: Aetna New Business (MI Preferred)	$181.01
Rate for Payer: BCBS Complete	$111.39
Rate for Payer: Cash Price	$222.78
Rate for Payer: Cofinity Commercial	$194.93
Rate for Payer: Cofinity Commercial	$239.48
Rate for Payer: Cofinity Medicare Advantage	$194.93
Rate for Payer: Encore Health Key Benefits Commercial	$222.78
Rate for Payer: Healthscope Commercial	$250.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$236.70
Rate for Payer: PHP Commercial	$236.70
Rate for Payer: Priority Health Cigna Priority Health	$181.01
Rate for Payer: Priority Health SBD	$175.44

INSULIN LISPRO (U-100) 100 UNIT/ML SQ FOR INSULIN PUMP REFILL

Facility

$167.65

Service Code	NDC 00002751001
Hospital Charge Code	301805
Hospital Revenue Code	637
Min. Negotiated Rate	$67.06
Max. Negotiated Rate	$150.88
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare	$83.83
Rate for Payer: Aetna New Business (MI Preferred)	$108.97
Rate for Payer: BCBS Complete	$67.06
Rate for Payer: Cash Price	$134.12
Rate for Payer: Cofinity Commercial	$117.36
Rate for Payer: Cofinity Commercial	$144.18
Rate for Payer: Cofinity Medicare Advantage	$117.36
Rate for Payer: Encore Health Key Benefits Commercial	$134.12
Rate for Payer: Healthscope Commercial	$150.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$142.50
Rate for Payer: PHP Commercial	$142.50
Rate for Payer: Priority Health Cigna Priority Health	$108.97
Rate for Payer: Priority Health SBD	$105.62

INSULIN LISPRO (U-100) 100 UNIT/ML SQ FOR INSULIN PUMP REFILL

Facility

$167.65

Service Code	NDC 00002751001
Hospital Charge Code	301805
Hospital Revenue Code	637
Min. Negotiated Rate	$105.62
Max. Negotiated Rate	$150.88
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna New Business (MI Preferred)	$108.97
Rate for Payer: Cash Price	$134.12
Rate for Payer: Cofinity Commercial	$117.36
Rate for Payer: Cofinity Commercial	$144.18
Rate for Payer: Cofinity Medicare Advantage	$117.36
Rate for Payer: Encore Health Key Benefits Commercial	$134.12
Rate for Payer: Healthscope Commercial	$150.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$142.50
Rate for Payer: PHP Commercial	$142.50
Rate for Payer: Priority Health Cigna Priority Health	$108.97
Rate for Payer: Priority Health SBD	$105.62

INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN

Facility

$80.59

Service Code	NDC 00002822201
Hospital Charge Code	111377
Hospital Revenue Code	637
Min. Negotiated Rate	$32.24
Max. Negotiated Rate	$72.53
Rate for Payer: Aetna Commercial	$68.50
Rate for Payer: Aetna Medicare	$40.30
Rate for Payer: Aetna New Business (MI Preferred)	$52.38
Rate for Payer: BCBS Complete	$32.24
Rate for Payer: Cash Price	$64.47
Rate for Payer: Cofinity Commercial	$56.41
Rate for Payer: Cofinity Commercial	$69.31
Rate for Payer: Cofinity Medicare Advantage	$56.41
Rate for Payer: Encore Health Key Benefits Commercial	$64.47
Rate for Payer: Healthscope Commercial	$72.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$68.50
Rate for Payer: PHP Commercial	$68.50
Rate for Payer: Priority Health Cigna Priority Health	$52.38
Rate for Payer: Priority Health SBD	$50.77

INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN

Facility

$80.59

Service Code	NDC 00002822201
Hospital Charge Code	111377
Hospital Revenue Code	637
Min. Negotiated Rate	$50.77
Max. Negotiated Rate	$72.53
Rate for Payer: Aetna Commercial	$68.50
Rate for Payer: Aetna New Business (MI Preferred)	$52.38
Rate for Payer: Cash Price	$64.47
Rate for Payer: Cofinity Commercial	$56.41
Rate for Payer: Cofinity Commercial	$69.31
Rate for Payer: Cofinity Medicare Advantage	$56.41
Rate for Payer: Encore Health Key Benefits Commercial	$64.47
Rate for Payer: Healthscope Commercial	$72.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$68.50
Rate for Payer: PHP Commercial	$68.50
Rate for Payer: Priority Health Cigna Priority Health	$52.38
Rate for Payer: Priority Health SBD	$50.77

INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN

Facility

$80.59

Service Code	NDC 00002879959
Hospital Charge Code	111377
Hospital Revenue Code	637
Min. Negotiated Rate	$32.24
Max. Negotiated Rate	$72.53
Rate for Payer: Aetna Commercial	$68.50
Rate for Payer: Aetna Medicare	$40.30
Rate for Payer: Aetna New Business (MI Preferred)	$52.38
Rate for Payer: BCBS Complete	$32.24
Rate for Payer: Cash Price	$64.47
Rate for Payer: Cofinity Commercial	$56.41
Rate for Payer: Cofinity Commercial	$69.31
Rate for Payer: Cofinity Medicare Advantage	$56.41
Rate for Payer: Encore Health Key Benefits Commercial	$64.47
Rate for Payer: Healthscope Commercial	$72.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$68.50
Rate for Payer: PHP Commercial	$68.50
Rate for Payer: Priority Health Cigna Priority Health	$52.38
Rate for Payer: Priority Health SBD	$50.77

INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN

Facility

$80.59

Service Code	NDC 00002879959
Hospital Charge Code	111377
Hospital Revenue Code	637
Min. Negotiated Rate	$50.77
Max. Negotiated Rate	$72.53
Rate for Payer: Aetna Commercial	$68.50
Rate for Payer: Aetna New Business (MI Preferred)	$52.38
Rate for Payer: Cash Price	$64.47
Rate for Payer: Cofinity Commercial	$56.41
Rate for Payer: Cofinity Commercial	$69.31
Rate for Payer: Cofinity Medicare Advantage	$56.41
Rate for Payer: Encore Health Key Benefits Commercial	$64.47
Rate for Payer: Healthscope Commercial	$72.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$68.50
Rate for Payer: PHP Commercial	$68.50
Rate for Payer: Priority Health Cigna Priority Health	$52.38
Rate for Payer: Priority Health SBD	$50.77

INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN

Facility

$80.59

Service Code	NDC 00002879901
Hospital Charge Code	111377
Hospital Revenue Code	637
Min. Negotiated Rate	$32.24
Max. Negotiated Rate	$72.53
Rate for Payer: Aetna Commercial	$68.50
Rate for Payer: Aetna Medicare	$40.30
Rate for Payer: Aetna New Business (MI Preferred)	$52.38
Rate for Payer: BCBS Complete	$32.24
Rate for Payer: Cash Price	$64.47
Rate for Payer: Cofinity Commercial	$56.41
Rate for Payer: Cofinity Commercial	$69.31
Rate for Payer: Cofinity Medicare Advantage	$56.41
Rate for Payer: Encore Health Key Benefits Commercial	$64.47
Rate for Payer: Healthscope Commercial	$72.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$68.50
Rate for Payer: PHP Commercial	$68.50
Rate for Payer: Priority Health Cigna Priority Health	$52.38
Rate for Payer: Priority Health SBD	$50.77

INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN

Facility

$80.59

Service Code	NDC 00002822259
Hospital Charge Code	111377
Hospital Revenue Code	637
Min. Negotiated Rate	$50.77
Max. Negotiated Rate	$72.53
Rate for Payer: Aetna Commercial	$68.50
Rate for Payer: Aetna New Business (MI Preferred)	$52.38
Rate for Payer: Cash Price	$64.47
Rate for Payer: Cofinity Commercial	$56.41
Rate for Payer: Cofinity Commercial	$69.31
Rate for Payer: Cofinity Medicare Advantage	$56.41
Rate for Payer: Encore Health Key Benefits Commercial	$64.47
Rate for Payer: Healthscope Commercial	$72.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$68.50
Rate for Payer: PHP Commercial	$68.50
Rate for Payer: Priority Health Cigna Priority Health	$52.38
Rate for Payer: Priority Health SBD	$50.77

INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN

Facility

$80.59

Service Code	NDC 00002879901
Hospital Charge Code	111377
Hospital Revenue Code	637
Min. Negotiated Rate	$50.77
Max. Negotiated Rate	$72.53
Rate for Payer: Aetna Commercial	$68.50
Rate for Payer: Aetna New Business (MI Preferred)	$52.38
Rate for Payer: Cash Price	$64.47
Rate for Payer: Cofinity Commercial	$56.41
Rate for Payer: Cofinity Commercial	$69.31
Rate for Payer: Cofinity Medicare Advantage	$56.41
Rate for Payer: Encore Health Key Benefits Commercial	$64.47
Rate for Payer: Healthscope Commercial	$72.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$68.50
Rate for Payer: PHP Commercial	$68.50
Rate for Payer: Priority Health Cigna Priority Health	$52.38
Rate for Payer: Priority Health SBD	$50.77

INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN

Facility

$80.59

Service Code	NDC 00002822259
Hospital Charge Code	111377
Hospital Revenue Code	637
Min. Negotiated Rate	$32.24
Max. Negotiated Rate	$72.53
Rate for Payer: Aetna Commercial	$68.50
Rate for Payer: Aetna Medicare	$40.30
Rate for Payer: Aetna New Business (MI Preferred)	$52.38
Rate for Payer: BCBS Complete	$32.24
Rate for Payer: Cash Price	$64.47
Rate for Payer: Cofinity Commercial	$56.41
Rate for Payer: Cofinity Commercial	$69.31
Rate for Payer: Cofinity Medicare Advantage	$56.41
Rate for Payer: Encore Health Key Benefits Commercial	$64.47
Rate for Payer: Healthscope Commercial	$72.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$68.50
Rate for Payer: PHP Commercial	$68.50
Rate for Payer: Priority Health Cigna Priority Health	$52.38
Rate for Payer: Priority Health SBD	$50.77

INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION

Facility

$44.03

Service Code	NDC 00002751017
Hospital Charge Code	17405
Hospital Revenue Code	637
Min. Negotiated Rate	$27.74
Max. Negotiated Rate	$39.63
Rate for Payer: Aetna Commercial	$37.43
Rate for Payer: Aetna New Business (MI Preferred)	$28.62
Rate for Payer: Cash Price	$35.22
Rate for Payer: Cofinity Commercial	$30.82
Rate for Payer: Cofinity Commercial	$37.87
Rate for Payer: Cofinity Medicare Advantage	$30.82
Rate for Payer: Encore Health Key Benefits Commercial	$35.22
Rate for Payer: Healthscope Commercial	$39.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.43
Rate for Payer: PHP Commercial	$37.43
Rate for Payer: Priority Health Cigna Priority Health	$28.62
Rate for Payer: Priority Health SBD	$27.74

INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION

Facility

$44.03

Service Code	NDC 00002751017
Hospital Charge Code	17405
Hospital Revenue Code	637
Min. Negotiated Rate	$17.61
Max. Negotiated Rate	$39.63
Rate for Payer: Aetna Commercial	$37.43
Rate for Payer: Aetna Medicare	$22.02
Rate for Payer: Aetna New Business (MI Preferred)	$28.62
Rate for Payer: BCBS Complete	$17.61
Rate for Payer: Cash Price	$35.22
Rate for Payer: Cofinity Commercial	$30.82
Rate for Payer: Cofinity Commercial	$37.87
Rate for Payer: Cofinity Medicare Advantage	$30.82
Rate for Payer: Encore Health Key Benefits Commercial	$35.22
Rate for Payer: Healthscope Commercial	$39.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.43
Rate for Payer: PHP Commercial	$37.43
Rate for Payer: Priority Health Cigna Priority Health	$28.62
Rate for Payer: Priority Health SBD	$27.74

Know your out-of-pocket cost for care.

All Charges