Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 9511: MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$6,890.73

Service Code	APR-DRG 9511
Hospital Charge Code	APRDRG 9511
Min. Negotiated Rate	$6,562.60
Max. Negotiated Rate	$6,890.73
Rate for Payer: BCBS Complete	$6,890.73
Rate for Payer: Mclaren Medicaid	$6,562.60
Rate for Payer: Meridian Medicaid	$6,890.73
Rate for Payer: Priority Health Choice Medicaid	$6,562.60

INPATIENT APRDRG 9512: MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$8,337.10

Service Code	APR-DRG 9512
Hospital Charge Code	APRDRG 9512
Min. Negotiated Rate	$7,940.10
Max. Negotiated Rate	$8,337.10
Rate for Payer: BCBS Complete	$8,337.10
Rate for Payer: Mclaren Medicaid	$7,940.10
Rate for Payer: Meridian Medicaid	$8,337.10
Rate for Payer: Priority Health Choice Medicaid	$7,940.10

INPATIENT APRDRG 9513: MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$11,693.69

Service Code	APR-DRG 9513
Hospital Charge Code	APRDRG 9513
Min. Negotiated Rate	$11,136.85
Max. Negotiated Rate	$11,693.69
Rate for Payer: BCBS Complete	$11,693.69
Rate for Payer: Mclaren Medicaid	$11,136.85
Rate for Payer: Meridian Medicaid	$11,693.69
Rate for Payer: Priority Health Choice Medicaid	$11,136.85

INPATIENT APRDRG 9514: MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$20,511.10

Service Code	APR-DRG 9514
Hospital Charge Code	APRDRG 9514
Min. Negotiated Rate	$19,534.38
Max. Negotiated Rate	$20,511.10
Rate for Payer: BCBS Complete	$20,511.10
Rate for Payer: Mclaren Medicaid	$19,534.38
Rate for Payer: Meridian Medicaid	$20,511.10
Rate for Payer: Priority Health Choice Medicaid	$19,534.38

INPATIENT APRDRG 9521: NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$5,683.26

Service Code	APR-DRG 9521
Hospital Charge Code	APRDRG 9521
Min. Negotiated Rate	$5,412.63
Max. Negotiated Rate	$5,683.26
Rate for Payer: BCBS Complete	$5,683.26
Rate for Payer: Mclaren Medicaid	$5,412.63
Rate for Payer: Meridian Medicaid	$5,683.26
Rate for Payer: Priority Health Choice Medicaid	$5,412.63

INPATIENT APRDRG 9522: NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$7,316.17

Service Code	APR-DRG 9522
Hospital Charge Code	APRDRG 9522
Min. Negotiated Rate	$6,967.78
Max. Negotiated Rate	$7,316.17
Rate for Payer: BCBS Complete	$7,316.17
Rate for Payer: Mclaren Medicaid	$6,967.78
Rate for Payer: Meridian Medicaid	$7,316.17
Rate for Payer: Priority Health Choice Medicaid	$6,967.78

INPATIENT APRDRG 9523: NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$9,852.31

Service Code	APR-DRG 9523
Hospital Charge Code	APRDRG 9523
Min. Negotiated Rate	$9,383.15
Max. Negotiated Rate	$9,852.31
Rate for Payer: BCBS Complete	$9,852.31
Rate for Payer: Mclaren Medicaid	$9,383.15
Rate for Payer: Meridian Medicaid	$9,852.31
Rate for Payer: Priority Health Choice Medicaid	$9,383.15

INPATIENT APRDRG 9524: NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$19,753.49

Service Code	APR-DRG 9524
Hospital Charge Code	APRDRG 9524
Min. Negotiated Rate	$18,812.85
Max. Negotiated Rate	$19,753.49
Rate for Payer: BCBS Complete	$19,753.49
Rate for Payer: Mclaren Medicaid	$18,812.85
Rate for Payer: Meridian Medicaid	$19,753.49
Rate for Payer: Priority Health Choice Medicaid	$18,812.85

INPT/ED TELECONSULT30

Professional

Both

$197.00

Service Code	HCPCS G0425
Min. Negotiated Rate	$58.58
Max. Negotiated Rate	$491.32
Rate for Payer: Aetna Commercial	$122.86
Rate for Payer: Aetna Medicare	$95.36
Rate for Payer: BCBS Complete	$61.51
Rate for Payer: BCBS MAPPO	$91.69
Rate for Payer: BCBS Trust/PPO	$491.32
Rate for Payer: BCN Commercial	$134.38
Rate for Payer: BCN Medicare Advantage	$91.69
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cofinity Commercial	$132.03
Rate for Payer: Cofinity Commercial	$122.86
Rate for Payer: Health Alliance Plan Medicare Advantage	$91.69
Rate for Payer: Mclaren Medicaid	$58.58
Rate for Payer: Meridian Medicaid	$61.51
Rate for Payer: Meridian Wellcare - Medicare Advantage	$96.27
Rate for Payer: PACE SWMI	$91.69
Rate for Payer: PHP Medicare Advantage	$91.69
Rate for Payer: Priority Health Choice Medicaid	$58.58
Rate for Payer: Priority Health Cigna Priority Health	$137.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$117.79
Rate for Payer: Priority Health Medicare	$91.69
Rate for Payer: Priority Health Narrow/Tiered Network	$117.79
Rate for Payer: UHC All Payor (Choice/PPO)	$91.69
Rate for Payer: UHC Dual Complete DSNP	$91.69
Rate for Payer: UHC Medicare Advantage	$94.44

INPT/ED TELECONSULT50

Professional

Both

$267.00

Service Code	HCPCS G0426
Min. Negotiated Rate	$82.86
Max. Negotiated Rate	$562.64
Rate for Payer: Aetna Commercial	$171.87
Rate for Payer: Aetna Medicare	$133.39
Rate for Payer: BCBS Complete	$87.00
Rate for Payer: BCBS MAPPO	$128.26
Rate for Payer: BCBS Trust/PPO	$562.64
Rate for Payer: BCN Commercial	$188.63
Rate for Payer: BCN Medicare Advantage	$128.26
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cofinity Commercial	$171.87
Rate for Payer: Cofinity Commercial	$184.69
Rate for Payer: Health Alliance Plan Medicare Advantage	$128.26
Rate for Payer: Mclaren Medicaid	$82.86
Rate for Payer: Meridian Medicaid	$87.00
Rate for Payer: Meridian Wellcare - Medicare Advantage	$134.67
Rate for Payer: PACE SWMI	$128.26
Rate for Payer: PHP Medicare Advantage	$128.26
Rate for Payer: Priority Health Choice Medicaid	$82.86
Rate for Payer: Priority Health Cigna Priority Health	$186.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$165.33
Rate for Payer: Priority Health Medicare	$128.26
Rate for Payer: Priority Health Narrow/Tiered Network	$165.33
Rate for Payer: UHC All Payor (Choice/PPO)	$128.26
Rate for Payer: UHC Dual Complete DSNP	$128.26
Rate for Payer: UHC Medicare Advantage	$132.11

INPT/ED TELECONSULT70

Professional

Both

$396.00

Service Code	HCPCS G0427
Min. Negotiated Rate	$117.15
Max. Negotiated Rate	$348.68
Rate for Payer: Aetna Commercial	$244.66
Rate for Payer: Aetna Medicare	$189.88
Rate for Payer: BCBS Complete	$123.01
Rate for Payer: BCBS MAPPO	$182.58
Rate for Payer: BCBS Trust/PPO	$348.68
Rate for Payer: BCN Commercial	$268.29
Rate for Payer: BCN Medicare Advantage	$182.58
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cofinity Commercial	$244.66
Rate for Payer: Cofinity Commercial	$262.92
Rate for Payer: Health Alliance Plan Medicare Advantage	$182.58
Rate for Payer: Mclaren Medicaid	$117.15
Rate for Payer: Meridian Medicaid	$123.01
Rate for Payer: Meridian Wellcare - Medicare Advantage	$191.71
Rate for Payer: PACE SWMI	$182.58
Rate for Payer: PHP Medicare Advantage	$182.58
Rate for Payer: Priority Health Choice Medicaid	$117.15
Rate for Payer: Priority Health Cigna Priority Health	$277.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$235.15
Rate for Payer: Priority Health Medicare	$182.58
Rate for Payer: Priority Health Narrow/Tiered Network	$235.15
Rate for Payer: UHC All Payor (Choice/PPO)	$182.58
Rate for Payer: UHC Dual Complete DSNP	$182.58
Rate for Payer: UHC Medicare Advantage	$188.06

INPT/TELE FOLLOW UP 35

Professional

Both

$180.00

Service Code	HCPCS G0408
Min. Negotiated Rate	$66.46
Max. Negotiated Rate	$1,554.26
Rate for Payer: Aetna Commercial	$138.50
Rate for Payer: Aetna Medicare	$107.49
Rate for Payer: BCBS Complete	$69.78
Rate for Payer: BCBS MAPPO	$103.36
Rate for Payer: BCBS Trust/PPO	$1,554.26
Rate for Payer: BCN Commercial	$152.47
Rate for Payer: BCN Medicare Advantage	$103.36
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cofinity Commercial	$148.84
Rate for Payer: Cofinity Commercial	$138.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$103.36
Rate for Payer: Mclaren Medicaid	$66.46
Rate for Payer: Meridian Medicaid	$69.78
Rate for Payer: Meridian Wellcare - Medicare Advantage	$108.53
Rate for Payer: PACE SWMI	$103.36
Rate for Payer: PHP Medicare Advantage	$103.36
Rate for Payer: Priority Health Choice Medicaid	$66.46
Rate for Payer: Priority Health Cigna Priority Health	$126.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$140.14
Rate for Payer: Priority Health Medicare	$103.36
Rate for Payer: Priority Health Narrow/Tiered Network	$140.14
Rate for Payer: UHC All Payor (Choice/PPO)	$103.36
Rate for Payer: UHC Dual Complete DSNP	$103.36
Rate for Payer: UHC Medicare Advantage	$106.46

INSULIN 5 UNIT/5 ML IV PUSH 5 ML

Facility

$20.00

Service Code	NDC 9900-0011-38
Hospital Charge Code	300205
Hospital Revenue Code	637
Min. Negotiated Rate	$12.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$17.00
Rate for Payer: BCBS Trust/PPO	$15.46
Rate for Payer: BCN Commercial	$15.46
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cofinity Commercial	$17.20
Rate for Payer: Encore Health Key Benefits Commercial	$16.00
Rate for Payer: Healthscope Commercial	$18.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$15.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.00
Rate for Payer: PHP Commercial	$17.00
Rate for Payer: Priority Health Cigna Priority Health	$14.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17.40
Rate for Payer: Priority Health Narrow/Tiered Network	$12.20
Rate for Payer: UHC All Payor (Choice/PPO)	$17.60
Rate for Payer: UHC Core	$16.70
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$15.00

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

Facility

$115.64

Service Code	NDC 0169-6339-10
Hospital Charge Code	300798
Hospital Revenue Code	637
Min. Negotiated Rate	$70.53
Max. Negotiated Rate	$104.08
Rate for Payer: Aetna Commercial	$98.29
Rate for Payer: BCBS Trust/PPO	$89.37
Rate for Payer: BCN Commercial	$89.37
Rate for Payer: Cash Price	$92.51
Rate for Payer: Cofinity Commercial	$99.45
Rate for Payer: Encore Health Key Benefits Commercial	$92.51
Rate for Payer: Healthscope Commercial	$104.08
Rate for Payer: Lakeland Regional Health Systems Commercial	$86.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$98.29
Rate for Payer: PHP Commercial	$98.29
Rate for Payer: Priority Health Cigna Priority Health	$80.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$100.61
Rate for Payer: Priority Health Narrow/Tiered Network	$70.53
Rate for Payer: UHC All Payor (Choice/PPO)	$101.76
Rate for Payer: UHC Core	$96.56
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$86.73

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

Facility

$115.64

Service Code	NDC 0169-6339-10
Hospital Charge Code	300796
Hospital Revenue Code	637
Min. Negotiated Rate	$70.53
Max. Negotiated Rate	$104.08
Rate for Payer: Aetna Commercial	$98.29
Rate for Payer: BCBS Trust/PPO	$89.37
Rate for Payer: BCN Commercial	$89.37
Rate for Payer: Cash Price	$92.51
Rate for Payer: Cofinity Commercial	$99.45
Rate for Payer: Encore Health Key Benefits Commercial	$92.51
Rate for Payer: Healthscope Commercial	$104.08
Rate for Payer: Lakeland Regional Health Systems Commercial	$86.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$98.29
Rate for Payer: PHP Commercial	$98.29
Rate for Payer: Priority Health Cigna Priority Health	$80.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$100.61
Rate for Payer: Priority Health Narrow/Tiered Network	$70.53
Rate for Payer: UHC All Payor (Choice/PPO)	$101.76
Rate for Payer: UHC Core	$96.56
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$86.73

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

Facility

$115.64

Service Code	NDC 0169-6339-10
Hospital Charge Code	300797
Hospital Revenue Code	637
Min. Negotiated Rate	$70.53
Max. Negotiated Rate	$104.08
Rate for Payer: Aetna Commercial	$98.29
Rate for Payer: BCBS Trust/PPO	$89.37
Rate for Payer: BCN Commercial	$89.37
Rate for Payer: Cash Price	$92.51
Rate for Payer: Cofinity Commercial	$99.45
Rate for Payer: Encore Health Key Benefits Commercial	$92.51
Rate for Payer: Healthscope Commercial	$104.08
Rate for Payer: Lakeland Regional Health Systems Commercial	$86.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$98.29
Rate for Payer: PHP Commercial	$98.29
Rate for Payer: Priority Health Cigna Priority Health	$80.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$100.61
Rate for Payer: Priority Health Narrow/Tiered Network	$70.53
Rate for Payer: UHC All Payor (Choice/PPO)	$101.76
Rate for Payer: UHC Core	$96.56
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$86.73

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

Facility

$115.64

Service Code	NDC 73070-103-10
Hospital Charge Code	112756
Hospital Revenue Code	637
Min. Negotiated Rate	$70.53
Max. Negotiated Rate	$104.08
Rate for Payer: Aetna Commercial	$98.29
Rate for Payer: BCBS Trust/PPO	$89.37
Rate for Payer: BCN Commercial	$89.37
Rate for Payer: Cash Price	$92.51
Rate for Payer: Cofinity Commercial	$99.45
Rate for Payer: Encore Health Key Benefits Commercial	$92.51
Rate for Payer: Healthscope Commercial	$104.08
Rate for Payer: Lakeland Regional Health Systems Commercial	$86.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$98.29
Rate for Payer: PHP Commercial	$98.29
Rate for Payer: Priority Health Cigna Priority Health	$80.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$100.61
Rate for Payer: Priority Health Narrow/Tiered Network	$70.53
Rate for Payer: UHC All Payor (Choice/PPO)	$101.76
Rate for Payer: UHC Core	$96.56
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$86.73

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

Facility

$115.64

Service Code	NDC 73070-103-15
Hospital Charge Code	112756
Hospital Revenue Code	637
Min. Negotiated Rate	$70.53
Max. Negotiated Rate	$104.08
Rate for Payer: Aetna Commercial	$98.29
Rate for Payer: BCBS Trust/PPO	$89.37
Rate for Payer: BCN Commercial	$89.37
Rate for Payer: Cash Price	$92.51
Rate for Payer: Cofinity Commercial	$99.45
Rate for Payer: Encore Health Key Benefits Commercial	$92.51
Rate for Payer: Healthscope Commercial	$104.08
Rate for Payer: Lakeland Regional Health Systems Commercial	$86.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$98.29
Rate for Payer: PHP Commercial	$98.29
Rate for Payer: Priority Health Cigna Priority Health	$80.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$100.61
Rate for Payer: Priority Health Narrow/Tiered Network	$70.53
Rate for Payer: UHC All Payor (Choice/PPO)	$101.76
Rate for Payer: UHC Core	$96.56
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$86.73

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

Facility

$115.64

Service Code	NDC 0169-6339-10
Hospital Charge Code	112756
Hospital Revenue Code	637
Min. Negotiated Rate	$70.53
Max. Negotiated Rate	$104.08
Rate for Payer: Aetna Commercial	$98.29
Rate for Payer: BCBS Trust/PPO	$89.37
Rate for Payer: BCN Commercial	$89.37
Rate for Payer: Cash Price	$92.51
Rate for Payer: Cofinity Commercial	$99.45
Rate for Payer: Encore Health Key Benefits Commercial	$92.51
Rate for Payer: Healthscope Commercial	$104.08
Rate for Payer: Lakeland Regional Health Systems Commercial	$86.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$98.29
Rate for Payer: PHP Commercial	$98.29
Rate for Payer: Priority Health Cigna Priority Health	$80.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$100.61
Rate for Payer: Priority Health Narrow/Tiered Network	$70.53
Rate for Payer: UHC All Payor (Choice/PPO)	$101.76
Rate for Payer: UHC Core	$96.56
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$86.73

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

Facility

$111.34

Service Code	NDC 0169-6432-10
Hospital Charge Code	116361
Hospital Revenue Code	637
Min. Negotiated Rate	$67.91
Max. Negotiated Rate	$100.21
Rate for Payer: Aetna Commercial	$94.64
Rate for Payer: BCBS Trust/PPO	$86.04
Rate for Payer: BCN Commercial	$86.04
Rate for Payer: Cash Price	$89.07
Rate for Payer: Cofinity Commercial	$95.75
Rate for Payer: Encore Health Key Benefits Commercial	$89.07
Rate for Payer: Healthscope Commercial	$100.21
Rate for Payer: Lakeland Regional Health Systems Commercial	$83.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$94.64
Rate for Payer: PHP Commercial	$94.64
Rate for Payer: Priority Health Cigna Priority Health	$77.94
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$96.87
Rate for Payer: Priority Health Narrow/Tiered Network	$67.91
Rate for Payer: UHC All Payor (Choice/PPO)	$97.98
Rate for Payer: UHC Core	$92.97
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$83.50

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

Facility

$97.49

Service Code	NDC 0169-6438-10
Hospital Charge Code	116361
Hospital Revenue Code	637
Min. Negotiated Rate	$59.46
Max. Negotiated Rate	$87.74
Rate for Payer: Aetna Commercial	$82.87
Rate for Payer: BCBS Trust/PPO	$75.34
Rate for Payer: BCN Commercial	$75.34
Rate for Payer: Cash Price	$77.99
Rate for Payer: Cofinity Commercial	$83.84
Rate for Payer: Encore Health Key Benefits Commercial	$77.99
Rate for Payer: Healthscope Commercial	$87.74
Rate for Payer: Lakeland Regional Health Systems Commercial	$73.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$82.87
Rate for Payer: PHP Commercial	$82.87
Rate for Payer: Priority Health Cigna Priority Health	$68.24
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$84.82
Rate for Payer: Priority Health Narrow/Tiered Network	$59.46
Rate for Payer: UHC All Payor (Choice/PPO)	$85.79
Rate for Payer: UHC Core	$81.40
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$73.12

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

Facility

$80.59

Service Code	NDC 0002-8222-59
Hospital Charge Code	111377
Hospital Revenue Code	637
Min. Negotiated Rate	$49.15
Max. Negotiated Rate	$72.53
Rate for Payer: Aetna Commercial	$68.50
Rate for Payer: BCBS Trust/PPO	$62.28
Rate for Payer: BCN Commercial	$62.28
Rate for Payer: Cash Price	$64.47
Rate for Payer: Cofinity Commercial	$69.31
Rate for Payer: Encore Health Key Benefits Commercial	$64.47
Rate for Payer: Healthscope Commercial	$72.53
Rate for Payer: Lakeland Regional Health Systems Commercial	$60.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$68.50
Rate for Payer: PHP Commercial	$68.50
Rate for Payer: Priority Health Cigna Priority Health	$56.41
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$70.11
Rate for Payer: Priority Health Narrow/Tiered Network	$49.15
Rate for Payer: UHC All Payor (Choice/PPO)	$70.92
Rate for Payer: UHC Core	$67.29
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$60.44

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

Facility

$80.59

Service Code	NDC 0002-8222-01
Hospital Charge Code	111377
Hospital Revenue Code	637
Min. Negotiated Rate	$49.15
Max. Negotiated Rate	$72.53
Rate for Payer: Aetna Commercial	$68.50
Rate for Payer: BCBS Trust/PPO	$62.28
Rate for Payer: BCN Commercial	$62.28
Rate for Payer: Cash Price	$64.47
Rate for Payer: Cofinity Commercial	$69.31
Rate for Payer: Encore Health Key Benefits Commercial	$64.47
Rate for Payer: Healthscope Commercial	$72.53
Rate for Payer: Lakeland Regional Health Systems Commercial	$60.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$68.50
Rate for Payer: PHP Commercial	$68.50
Rate for Payer: Priority Health Cigna Priority Health	$56.41
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$70.11
Rate for Payer: Priority Health Narrow/Tiered Network	$49.15
Rate for Payer: UHC All Payor (Choice/PPO)	$70.92
Rate for Payer: UHC Core	$67.29
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$60.44

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

Facility

$56.95

Service Code	NDC 0169-1834-11
Hospital Charge Code	10284
Hospital Revenue Code	637
Min. Negotiated Rate	$34.73
Max. Negotiated Rate	$51.26
Rate for Payer: Aetna Commercial	$48.41
Rate for Payer: BCBS Trust/PPO	$44.01
Rate for Payer: BCN Commercial	$44.01
Rate for Payer: Cash Price	$45.56
Rate for Payer: Cofinity Commercial	$48.98
Rate for Payer: Encore Health Key Benefits Commercial	$45.56
Rate for Payer: Healthscope Commercial	$51.26
Rate for Payer: Lakeland Regional Health Systems Commercial	$42.71
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$48.41
Rate for Payer: PHP Commercial	$48.41
Rate for Payer: Priority Health Cigna Priority Health	$39.86
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$49.55
Rate for Payer: Priority Health Narrow/Tiered Network	$34.73
Rate for Payer: UHC All Payor (Choice/PPO)	$50.12
Rate for Payer: UHC Core	$47.55
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$42.71

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

Facility

$19.46

Service Code	NDC 0002-8315-17
Hospital Charge Code	10284
Hospital Revenue Code	637
Min. Negotiated Rate	$11.87
Max. Negotiated Rate	$17.51
Rate for Payer: Aetna Commercial	$16.54
Rate for Payer: BCBS Trust/PPO	$15.04
Rate for Payer: BCN Commercial	$15.04
Rate for Payer: Cash Price	$15.57
Rate for Payer: Cofinity Commercial	$16.74
Rate for Payer: Encore Health Key Benefits Commercial	$15.57
Rate for Payer: Healthscope Commercial	$17.51
Rate for Payer: Lakeland Regional Health Systems Commercial	$14.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.54
Rate for Payer: PHP Commercial	$16.54
Rate for Payer: Priority Health Cigna Priority Health	$13.62
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16.93
Rate for Payer: Priority Health Narrow/Tiered Network	$11.87
Rate for Payer: UHC All Payor (Choice/PPO)	$17.12
Rate for Payer: UHC Core	$16.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$14.60

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