Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION

Facility

$141.16

Service Code	NDC 00169183411
Hospital Charge Code	10284
Hospital Revenue Code	637
Min. Negotiated Rate	$88.93
Max. Negotiated Rate	$127.04
Rate for Payer: Aetna Commercial	$119.99
Rate for Payer: Aetna New Business (MI Preferred)	$91.75
Rate for Payer: Cash Price	$112.93
Rate for Payer: Cofinity Commercial	$121.40
Rate for Payer: Cofinity Commercial	$98.81
Rate for Payer: Cofinity Medicare Advantage	$98.81
Rate for Payer: Encore Health Key Benefits Commercial	$112.93
Rate for Payer: Healthscope Commercial	$127.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.99
Rate for Payer: PHP Commercial	$119.99
Rate for Payer: Priority Health Cigna Priority Health	$91.75
Rate for Payer: Priority Health SBD	$88.93

INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION

Facility

$141.16

Service Code	NDC 00169183411
Hospital Charge Code	10284
Hospital Revenue Code	637
Min. Negotiated Rate	$56.46
Max. Negotiated Rate	$127.04
Rate for Payer: Aetna Commercial	$119.99
Rate for Payer: Aetna Medicare	$70.58
Rate for Payer: Aetna New Business (MI Preferred)	$91.75
Rate for Payer: BCBS Complete	$56.46
Rate for Payer: Cash Price	$112.93
Rate for Payer: Cofinity Commercial	$121.40
Rate for Payer: Cofinity Commercial	$98.81
Rate for Payer: Cofinity Medicare Advantage	$98.81
Rate for Payer: Encore Health Key Benefits Commercial	$112.93
Rate for Payer: Healthscope Commercial	$127.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.99
Rate for Payer: PHP Commercial	$119.99
Rate for Payer: Priority Health Cigna Priority Health	$91.75
Rate for Payer: Priority Health SBD	$88.93

INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION

Facility

$60.35

Service Code	NDC 00002831501
Hospital Charge Code	10284
Hospital Revenue Code	637
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$54.31
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna New Business (MI Preferred)	$39.23
Rate for Payer: Cash Price	$48.28
Rate for Payer: Cofinity Commercial	$42.24
Rate for Payer: Cofinity Commercial	$51.90
Rate for Payer: Cofinity Medicare Advantage	$42.24
Rate for Payer: Encore Health Key Benefits Commercial	$48.28
Rate for Payer: Healthscope Commercial	$54.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.30
Rate for Payer: PHP Commercial	$51.30
Rate for Payer: Priority Health Cigna Priority Health	$39.23
Rate for Payer: Priority Health SBD	$38.02

INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION

Facility

$60.35

Service Code	NDC 00002831501
Hospital Charge Code	10284
Hospital Revenue Code	637
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$54.31
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare	$30.18
Rate for Payer: Aetna New Business (MI Preferred)	$39.23
Rate for Payer: BCBS Complete	$24.14
Rate for Payer: Cash Price	$48.28
Rate for Payer: Cofinity Commercial	$42.24
Rate for Payer: Cofinity Commercial	$51.90
Rate for Payer: Cofinity Medicare Advantage	$42.24
Rate for Payer: Encore Health Key Benefits Commercial	$48.28
Rate for Payer: Healthscope Commercial	$54.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.30
Rate for Payer: PHP Commercial	$51.30
Rate for Payer: Priority Health Cigna Priority Health	$39.23
Rate for Payer: Priority Health SBD	$38.02

INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN

Facility

$938.40

Service Code	NDC 00002882427
Hospital Charge Code	178095
Hospital Revenue Code	637
Min. Negotiated Rate	$375.36
Max. Negotiated Rate	$844.56
Rate for Payer: Aetna Commercial	$797.64
Rate for Payer: Aetna Medicare	$469.20
Rate for Payer: Aetna New Business (MI Preferred)	$609.96
Rate for Payer: BCBS Complete	$375.36
Rate for Payer: Cash Price	$750.72
Rate for Payer: Cofinity Commercial	$656.88
Rate for Payer: Cofinity Commercial	$807.02
Rate for Payer: Cofinity Medicare Advantage	$656.88
Rate for Payer: Encore Health Key Benefits Commercial	$750.72
Rate for Payer: Healthscope Commercial	$844.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$797.64
Rate for Payer: PHP Commercial	$797.64
Rate for Payer: Priority Health Cigna Priority Health	$609.96
Rate for Payer: Priority Health SBD	$591.19

INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN

Facility

$938.40

Service Code	NDC 00002882427
Hospital Charge Code	178095
Hospital Revenue Code	637
Min. Negotiated Rate	$591.19
Max. Negotiated Rate	$844.56
Rate for Payer: Aetna Commercial	$797.64
Rate for Payer: Aetna New Business (MI Preferred)	$609.96
Rate for Payer: Cash Price	$750.72
Rate for Payer: Cofinity Commercial	$656.88
Rate for Payer: Cofinity Commercial	$807.02
Rate for Payer: Cofinity Medicare Advantage	$656.88
Rate for Payer: Encore Health Key Benefits Commercial	$750.72
Rate for Payer: Healthscope Commercial	$844.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$797.64
Rate for Payer: PHP Commercial	$797.64
Rate for Payer: Priority Health Cigna Priority Health	$609.96
Rate for Payer: Priority Health SBD	$591.19

INSULIN REGULAR HUMAN U-500"CONCENTRATE" 500 UNIT/ML SQ FOR INSULIN PUMP REFILL

Facility

$4,860.24

Service Code	NDC 00002850101
Hospital Charge Code	301808
Hospital Revenue Code	637
Min. Negotiated Rate	$3,061.95
Max. Negotiated Rate	$4,374.22
Rate for Payer: Aetna Commercial	$4,131.20
Rate for Payer: Aetna New Business (MI Preferred)	$3,159.16
Rate for Payer: Cash Price	$3,888.19
Rate for Payer: Cofinity Commercial	$3,402.17
Rate for Payer: Cofinity Commercial	$4,179.81
Rate for Payer: Cofinity Medicare Advantage	$3,402.17
Rate for Payer: Encore Health Key Benefits Commercial	$3,888.19
Rate for Payer: Healthscope Commercial	$4,374.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,131.20
Rate for Payer: PHP Commercial	$4,131.20
Rate for Payer: Priority Health Cigna Priority Health	$3,159.16
Rate for Payer: Priority Health SBD	$3,061.95

INSULIN REGULAR HUMAN U-500"CONCENTRATE" 500 UNIT/ML SQ FOR INSULIN PUMP REFILL

Facility

$4,860.24

Service Code	NDC 00002850101
Hospital Charge Code	301808
Hospital Revenue Code	637
Min. Negotiated Rate	$1,944.10
Max. Negotiated Rate	$4,374.22
Rate for Payer: Aetna Commercial	$4,131.20
Rate for Payer: Aetna Medicare	$2,430.12
Rate for Payer: Aetna New Business (MI Preferred)	$3,159.16
Rate for Payer: BCBS Complete	$1,944.10
Rate for Payer: Cash Price	$3,888.19
Rate for Payer: Cofinity Commercial	$3,402.17
Rate for Payer: Cofinity Commercial	$4,179.81
Rate for Payer: Cofinity Medicare Advantage	$3,402.17
Rate for Payer: Encore Health Key Benefits Commercial	$3,888.19
Rate for Payer: Healthscope Commercial	$4,374.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,131.20
Rate for Payer: PHP Commercial	$4,131.20
Rate for Payer: Priority Health Cigna Priority Health	$3,159.16
Rate for Payer: Priority Health SBD	$3,061.95

INSULIN SUBCUTANEOUS BASAL PUMP - HUMAN (HUMULIN R)

Facility

$60.35

Service Code	NDC 00002821501
Hospital Charge Code	180910
Hospital Revenue Code	637
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$54.31
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna New Business (MI Preferred)	$39.23
Rate for Payer: Cash Price	$48.28
Rate for Payer: Cofinity Commercial	$42.24
Rate for Payer: Cofinity Commercial	$51.90
Rate for Payer: Cofinity Medicare Advantage	$42.24
Rate for Payer: Encore Health Key Benefits Commercial	$48.28
Rate for Payer: Healthscope Commercial	$54.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.30
Rate for Payer: PHP Commercial	$51.30
Rate for Payer: Priority Health Cigna Priority Health	$39.23
Rate for Payer: Priority Health SBD	$38.02

INSULIN SUBCUTANEOUS BASAL PUMP - HUMAN (HUMULIN R)

Facility

$60.35

Service Code	NDC 00002821501
Hospital Charge Code	180910
Hospital Revenue Code	637
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$54.31
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare	$30.18
Rate for Payer: Aetna New Business (MI Preferred)	$39.23
Rate for Payer: BCBS Complete	$24.14
Rate for Payer: Cash Price	$48.28
Rate for Payer: Cofinity Commercial	$42.24
Rate for Payer: Cofinity Commercial	$51.90
Rate for Payer: Cofinity Medicare Advantage	$42.24
Rate for Payer: Encore Health Key Benefits Commercial	$48.28
Rate for Payer: Healthscope Commercial	$54.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.30
Rate for Payer: PHP Commercial	$51.30
Rate for Payer: Priority Health Cigna Priority Health	$39.23
Rate for Payer: Priority Health SBD	$38.02

INSULIN SUBCUTANEOUS BASAL PUMP - INSULIN GLULISINE (APIDRA)

Facility

$290.23

Service Code	HCPCS J1815
Hospital Charge Code	180908
Hospital Revenue Code	637
Min. Negotiated Rate	$182.84
Max. Negotiated Rate	$261.21
Rate for Payer: Aetna Commercial	$246.70
Rate for Payer: Aetna New Business (MI Preferred)	$188.65
Rate for Payer: Cash Price	$232.18
Rate for Payer: Cofinity Commercial	$203.16
Rate for Payer: Cofinity Commercial	$249.60
Rate for Payer: Cofinity Medicare Advantage	$203.16
Rate for Payer: Encore Health Key Benefits Commercial	$232.18
Rate for Payer: Healthscope Commercial	$261.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$246.70
Rate for Payer: PHP Commercial	$246.70
Rate for Payer: Priority Health Cigna Priority Health	$188.65
Rate for Payer: Priority Health SBD	$182.84

INSULIN SUBCUTANEOUS BASAL PUMP - INSULIN GLULISINE (APIDRA)

Facility

$290.23

Service Code	HCPCS J1815
Hospital Charge Code	180908
Hospital Revenue Code	637
Min. Negotiated Rate	$116.09
Max. Negotiated Rate	$261.21
Rate for Payer: Aetna Commercial	$246.70
Rate for Payer: Aetna Medicare	$145.12
Rate for Payer: Aetna New Business (MI Preferred)	$188.65
Rate for Payer: BCBS Complete	$116.09
Rate for Payer: Cash Price	$232.18
Rate for Payer: Cofinity Commercial	$203.16
Rate for Payer: Cofinity Commercial	$249.60
Rate for Payer: Cofinity Medicare Advantage	$203.16
Rate for Payer: Encore Health Key Benefits Commercial	$232.18
Rate for Payer: Healthscope Commercial	$261.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$246.70
Rate for Payer: PHP Commercial	$246.70
Rate for Payer: Priority Health Cigna Priority Health	$188.65
Rate for Payer: Priority Health SBD	$182.84

INSULIN SUBCUTANEOUS BASAL PUMP - LISPRO (HUMALOG)

Facility

$46.55

Service Code	NDC 00002751017
Hospital Charge Code	180914
Hospital Revenue Code	637
Min. Negotiated Rate	$29.33
Max. Negotiated Rate	$41.90
Rate for Payer: Aetna Commercial	$39.57
Rate for Payer: Aetna New Business (MI Preferred)	$30.26
Rate for Payer: Cash Price	$37.24
Rate for Payer: Cofinity Commercial	$32.59
Rate for Payer: Cofinity Commercial	$40.03
Rate for Payer: Cofinity Medicare Advantage	$32.59
Rate for Payer: Encore Health Key Benefits Commercial	$37.24
Rate for Payer: Healthscope Commercial	$41.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.57
Rate for Payer: PHP Commercial	$39.57
Rate for Payer: Priority Health Cigna Priority Health	$30.26
Rate for Payer: Priority Health SBD	$29.33

INSULIN SUBCUTANEOUS BASAL PUMP - LISPRO (HUMALOG)

Facility

$46.55

Service Code	NDC 00002751017
Hospital Charge Code	180914
Hospital Revenue Code	637
Min. Negotiated Rate	$18.62
Max. Negotiated Rate	$41.90
Rate for Payer: Aetna Commercial	$39.57
Rate for Payer: Aetna Medicare	$23.27
Rate for Payer: Aetna New Business (MI Preferred)	$30.26
Rate for Payer: BCBS Complete	$18.62
Rate for Payer: Cash Price	$37.24
Rate for Payer: Cofinity Commercial	$32.59
Rate for Payer: Cofinity Commercial	$40.03
Rate for Payer: Cofinity Medicare Advantage	$32.59
Rate for Payer: Encore Health Key Benefits Commercial	$37.24
Rate for Payer: Healthscope Commercial	$41.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.57
Rate for Payer: PHP Commercial	$39.57
Rate for Payer: Priority Health Cigna Priority Health	$30.26
Rate for Payer: Priority Health SBD	$29.33

INSULIN SUBCUTANEOUS BASAL PUMP - REGULAR HUMAN (U-500)

Facility

$5,065.60

Service Code	NDC 00002850101
Hospital Charge Code	180916
Hospital Revenue Code	637
Min. Negotiated Rate	$3,191.33
Max. Negotiated Rate	$4,559.04
Rate for Payer: Aetna Commercial	$4,305.76
Rate for Payer: Aetna New Business (MI Preferred)	$3,292.64
Rate for Payer: Cash Price	$4,052.48
Rate for Payer: Cofinity Commercial	$3,545.92
Rate for Payer: Cofinity Commercial	$4,356.42
Rate for Payer: Cofinity Medicare Advantage	$3,545.92
Rate for Payer: Encore Health Key Benefits Commercial	$4,052.48
Rate for Payer: Healthscope Commercial	$4,559.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,305.76
Rate for Payer: PHP Commercial	$4,305.76
Rate for Payer: Priority Health Cigna Priority Health	$3,292.64
Rate for Payer: Priority Health SBD	$3,191.33

INSULIN SUBCUTANEOUS BASAL PUMP - REGULAR HUMAN (U-500)

Facility

$5,065.60

Service Code	NDC 00002850101
Hospital Charge Code	180916
Hospital Revenue Code	637
Min. Negotiated Rate	$2,026.24
Max. Negotiated Rate	$4,559.04
Rate for Payer: Aetna Commercial	$4,305.76
Rate for Payer: Aetna Medicare	$2,532.80
Rate for Payer: Aetna New Business (MI Preferred)	$3,292.64
Rate for Payer: BCBS Complete	$2,026.24
Rate for Payer: Cash Price	$4,052.48
Rate for Payer: Cofinity Commercial	$3,545.92
Rate for Payer: Cofinity Commercial	$4,356.42
Rate for Payer: Cofinity Medicare Advantage	$3,545.92
Rate for Payer: Encore Health Key Benefits Commercial	$4,052.48
Rate for Payer: Healthscope Commercial	$4,559.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,305.76
Rate for Payer: PHP Commercial	$4,305.76
Rate for Payer: Priority Health Cigna Priority Health	$3,292.64
Rate for Payer: Priority Health SBD	$3,191.33

INSULIN SUBCUTANEOUS CONTINUOUS BASAL PUMP - ASPARTATE (NOVOLOG)

Facility

$137.64

Service Code	NDC 00169750111
Hospital Charge Code	180912
Hospital Revenue Code	637
Min. Negotiated Rate	$55.06
Max. Negotiated Rate	$123.88
Rate for Payer: Aetna Commercial	$116.99
Rate for Payer: Aetna Medicare	$68.82
Rate for Payer: Aetna New Business (MI Preferred)	$89.47
Rate for Payer: BCBS Complete	$55.06
Rate for Payer: Cash Price	$110.11
Rate for Payer: Cofinity Commercial	$118.37
Rate for Payer: Cofinity Commercial	$96.35
Rate for Payer: Cofinity Medicare Advantage	$96.35
Rate for Payer: Encore Health Key Benefits Commercial	$110.11
Rate for Payer: Healthscope Commercial	$123.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$116.99
Rate for Payer: PHP Commercial	$116.99
Rate for Payer: Priority Health Cigna Priority Health	$89.47
Rate for Payer: Priority Health SBD	$86.71

INSULIN SUBCUTANEOUS CONTINUOUS BASAL PUMP - ASPARTATE (NOVOLOG)

Facility

$137.64

Service Code	NDC 00169750111
Hospital Charge Code	180912
Hospital Revenue Code	637
Min. Negotiated Rate	$86.71
Max. Negotiated Rate	$123.88
Rate for Payer: Aetna Commercial	$116.99
Rate for Payer: Aetna New Business (MI Preferred)	$89.47
Rate for Payer: Cash Price	$110.11
Rate for Payer: Cofinity Commercial	$118.37
Rate for Payer: Cofinity Commercial	$96.35
Rate for Payer: Cofinity Medicare Advantage	$96.35
Rate for Payer: Encore Health Key Benefits Commercial	$110.11
Rate for Payer: Healthscope Commercial	$123.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$116.99
Rate for Payer: PHP Commercial	$116.99
Rate for Payer: Priority Health Cigna Priority Health	$89.47
Rate for Payer: Priority Health SBD	$86.71

INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION

Facility

$60.35

Service Code	NDC 09900000758
Hospital Charge Code	10289
Hospital Revenue Code	637
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$54.31
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare	$30.18
Rate for Payer: Aetna New Business (MI Preferred)	$39.23
Rate for Payer: BCBS Complete	$24.14
Rate for Payer: Cash Price	$48.28
Rate for Payer: Cofinity Commercial	$42.24
Rate for Payer: Cofinity Commercial	$51.90
Rate for Payer: Cofinity Medicare Advantage	$42.24
Rate for Payer: Encore Health Key Benefits Commercial	$48.28
Rate for Payer: Healthscope Commercial	$54.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.30
Rate for Payer: PHP Commercial	$51.30
Rate for Payer: Priority Health Cigna Priority Health	$39.23
Rate for Payer: Priority Health SBD	$38.02

INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION

Facility

$60.35

Service Code	NDC 09900000758
Hospital Charge Code	10289
Hospital Revenue Code	637
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$54.31
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna New Business (MI Preferred)	$39.23
Rate for Payer: Cash Price	$48.28
Rate for Payer: Cofinity Commercial	$42.24
Rate for Payer: Cofinity Commercial	$51.90
Rate for Payer: Cofinity Medicare Advantage	$42.24
Rate for Payer: Encore Health Key Benefits Commercial	$48.28
Rate for Payer: Healthscope Commercial	$54.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.30
Rate for Payer: PHP Commercial	$51.30
Rate for Payer: Priority Health Cigna Priority Health	$39.23
Rate for Payer: Priority Health SBD	$38.02

INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION

Facility

$141.16

Service Code	NDC 00169183311
Hospital Charge Code	10289
Hospital Revenue Code	637
Min. Negotiated Rate	$56.46
Max. Negotiated Rate	$127.04
Rate for Payer: Aetna Commercial	$119.99
Rate for Payer: Aetna Medicare	$70.58
Rate for Payer: Aetna New Business (MI Preferred)	$91.75
Rate for Payer: BCBS Complete	$56.46
Rate for Payer: Cash Price	$112.93
Rate for Payer: Cofinity Commercial	$121.40
Rate for Payer: Cofinity Commercial	$98.81
Rate for Payer: Cofinity Medicare Advantage	$98.81
Rate for Payer: Encore Health Key Benefits Commercial	$112.93
Rate for Payer: Healthscope Commercial	$127.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.99
Rate for Payer: PHP Commercial	$119.99
Rate for Payer: Priority Health Cigna Priority Health	$91.75
Rate for Payer: Priority Health SBD	$88.93

INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION

Facility

$141.16

Service Code	NDC 00169183311
Hospital Charge Code	10289
Hospital Revenue Code	637
Min. Negotiated Rate	$88.93
Max. Negotiated Rate	$127.04
Rate for Payer: Aetna Commercial	$119.99
Rate for Payer: Aetna New Business (MI Preferred)	$91.75
Rate for Payer: Cash Price	$112.93
Rate for Payer: Cofinity Commercial	$121.40
Rate for Payer: Cofinity Commercial	$98.81
Rate for Payer: Cofinity Medicare Advantage	$98.81
Rate for Payer: Encore Health Key Benefits Commercial	$112.93
Rate for Payer: Healthscope Commercial	$127.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.99
Rate for Payer: PHP Commercial	$119.99
Rate for Payer: Priority Health Cigna Priority Health	$91.75
Rate for Payer: Priority Health SBD	$88.93

INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION

Facility

$60.35

Service Code	NDC 00002821501
Hospital Charge Code	10289
Hospital Revenue Code	637
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$54.31
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare	$30.18
Rate for Payer: Aetna New Business (MI Preferred)	$39.23
Rate for Payer: BCBS Complete	$24.14
Rate for Payer: Cash Price	$48.28
Rate for Payer: Cofinity Commercial	$42.24
Rate for Payer: Cofinity Commercial	$51.90
Rate for Payer: Cofinity Medicare Advantage	$42.24
Rate for Payer: Encore Health Key Benefits Commercial	$48.28
Rate for Payer: Healthscope Commercial	$54.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.30
Rate for Payer: PHP Commercial	$51.30
Rate for Payer: Priority Health Cigna Priority Health	$39.23
Rate for Payer: Priority Health SBD	$38.02

INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION

Facility

$60.35

Service Code	NDC 00002821501
Hospital Charge Code	10289
Hospital Revenue Code	637
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$54.31
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna New Business (MI Preferred)	$39.23
Rate for Payer: Cash Price	$48.28
Rate for Payer: Cofinity Commercial	$42.24
Rate for Payer: Cofinity Commercial	$51.90
Rate for Payer: Cofinity Medicare Advantage	$42.24
Rate for Payer: Encore Health Key Benefits Commercial	$48.28
Rate for Payer: Healthscope Commercial	$54.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.30
Rate for Payer: PHP Commercial	$51.30
Rate for Payer: Priority Health Cigna Priority Health	$39.23
Rate for Payer: Priority Health SBD	$38.02

INSULIN U-100 REGULAR HUMAN 100 UNIT/ML SQ FOR INSULIN PUMP REFILL

Facility

$141.16

Service Code	NDC 00169183311
Hospital Charge Code	301806
Hospital Revenue Code	637
Min. Negotiated Rate	$56.46
Max. Negotiated Rate	$127.04
Rate for Payer: Aetna Commercial	$119.99
Rate for Payer: Aetna Medicare	$70.58
Rate for Payer: Aetna New Business (MI Preferred)	$91.75
Rate for Payer: BCBS Complete	$56.46
Rate for Payer: Cash Price	$112.93
Rate for Payer: Cofinity Commercial	$121.40
Rate for Payer: Cofinity Commercial	$98.81
Rate for Payer: Cofinity Medicare Advantage	$98.81
Rate for Payer: Encore Health Key Benefits Commercial	$112.93
Rate for Payer: Healthscope Commercial	$127.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.99
Rate for Payer: PHP Commercial	$119.99
Rate for Payer: Priority Health Cigna Priority Health	$91.75
Rate for Payer: Priority Health SBD	$88.93

Know your out-of-pocket cost for care.

All Charges