|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
300797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.49 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: BCBS Trust/PPO |
$95.51
|
| Rate for Payer: BCN Commercial |
$95.51
|
| 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 Commercial |
$98.29
|
| Rate for Payer: Nomi Health Commercial |
$94.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$100.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.49
|
| 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
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
300797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$57.55 |
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna Medicare |
$16.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.98
|
| Rate for Payer: BCBS Complete |
$11.84
|
| Rate for Payer: BCBS MAPPO |
$15.98
|
| Rate for Payer: BCBS Trust/PPO |
$52.57
|
| Rate for Payer: BCN Commercial |
$52.57
|
| Rate for Payer: BCN Medicare Advantage |
$15.98
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.98
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.95
|
| Rate for Payer: Mclaren Medicaid |
$11.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.78
|
| Rate for Payer: Meridian Medicaid |
$11.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: Nomi Health Commercial |
$52.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.95
|
| Rate for Payer: PACE Senior Care Partners |
$15.19
|
| Rate for Payer: PACE SWMI |
$15.98
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: PHP Medicare Advantage |
$15.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.63
|
| Rate for Payer: Priority Health Medicare |
$16.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.50
|
| Rate for Payer: Railroad Medicare Medicare |
$15.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.27
|
| Rate for Payer: UHC Core |
$53.39
|
| Rate for Payer: UHC Exchange |
$15.98
|
| Rate for Payer: UHC Medicaid |
$11.27
|
| Rate for Payer: UHC Medicare Advantage |
$15.98
|
| Rate for Payer: UHCCP Medicaid |
$11.27
|
| Rate for Payer: VA VA |
$15.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.95
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
112756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$57.55 |
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: BCBS Trust/PPO |
$52.81
|
| Rate for Payer: BCN Commercial |
$52.81
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: Nomi Health Commercial |
$52.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.95
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.27
|
| Rate for Payer: UHC Core |
$53.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.95
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
OP
|
$115.64
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
112756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.39 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna Medicare |
$30.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.14
|
| Rate for Payer: BCBS Complete |
$21.40
|
| Rate for Payer: BCBS MAPPO |
$28.91
|
| Rate for Payer: BCBS Trust/PPO |
$95.07
|
| Rate for Payer: BCN Commercial |
$95.07
|
| Rate for Payer: BCN Medicare Advantage |
$28.91
|
| 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: Health Alliance Plan Medicare Advantage |
$28.91
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.73
|
| Rate for Payer: Mclaren Medicaid |
$20.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.36
|
| Rate for Payer: Meridian Medicaid |
$21.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Nomi Health Commercial |
$94.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PACE Senior Care Partners |
$27.46
|
| Rate for Payer: PACE SWMI |
$28.91
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: PHP Medicare Advantage |
$28.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$100.61
|
| Rate for Payer: Priority Health Medicare |
$29.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.49
|
| Rate for Payer: Railroad Medicare Medicare |
$28.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.76
|
| Rate for Payer: UHC Core |
$96.56
|
| Rate for Payer: UHC Exchange |
$28.91
|
| Rate for Payer: UHC Medicaid |
$20.39
|
| Rate for Payer: UHC Medicare Advantage |
$28.91
|
| Rate for Payer: UHCCP Medicaid |
$20.39
|
| Rate for Payer: VA VA |
$28.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.73
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
112756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$57.55 |
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna Medicare |
$16.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.98
|
| Rate for Payer: BCBS Complete |
$11.84
|
| Rate for Payer: BCBS MAPPO |
$15.98
|
| Rate for Payer: BCBS Trust/PPO |
$52.57
|
| Rate for Payer: BCN Commercial |
$52.57
|
| Rate for Payer: BCN Medicare Advantage |
$15.98
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.98
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.95
|
| Rate for Payer: Mclaren Medicaid |
$11.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.78
|
| Rate for Payer: Meridian Medicaid |
$11.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: Nomi Health Commercial |
$52.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.95
|
| Rate for Payer: PACE Senior Care Partners |
$15.19
|
| Rate for Payer: PACE SWMI |
$15.98
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: PHP Medicare Advantage |
$15.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.63
|
| Rate for Payer: Priority Health Medicare |
$16.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.50
|
| Rate for Payer: Railroad Medicare Medicare |
$15.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.27
|
| Rate for Payer: UHC Core |
$53.39
|
| Rate for Payer: UHC Exchange |
$15.98
|
| Rate for Payer: UHC Medicaid |
$11.27
|
| Rate for Payer: UHC Medicare Advantage |
$15.98
|
| Rate for Payer: UHCCP Medicaid |
$11.27
|
| Rate for Payer: VA VA |
$15.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.95
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
112756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.49 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: BCBS Trust/PPO |
$95.51
|
| Rate for Payer: BCN Commercial |
$95.51
|
| 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 Commercial |
$98.29
|
| Rate for Payer: Nomi Health Commercial |
$94.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$100.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.49
|
| 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
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
112756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.49 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: BCBS Trust/PPO |
$95.51
|
| Rate for Payer: BCN Commercial |
$95.51
|
| 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 Commercial |
$98.29
|
| Rate for Payer: Nomi Health Commercial |
$94.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$100.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.49
|
| 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
|
OP
|
$115.64
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
112756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.39 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna Medicare |
$30.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.14
|
| Rate for Payer: BCBS Complete |
$21.40
|
| Rate for Payer: BCBS MAPPO |
$28.91
|
| Rate for Payer: BCBS Trust/PPO |
$95.07
|
| Rate for Payer: BCN Commercial |
$95.07
|
| Rate for Payer: BCN Medicare Advantage |
$28.91
|
| 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: Health Alliance Plan Medicare Advantage |
$28.91
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.73
|
| Rate for Payer: Mclaren Medicaid |
$20.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.36
|
| Rate for Payer: Meridian Medicaid |
$21.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Nomi Health Commercial |
$94.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PACE Senior Care Partners |
$27.46
|
| Rate for Payer: PACE SWMI |
$28.91
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: PHP Medicare Advantage |
$28.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$100.61
|
| Rate for Payer: Priority Health Medicare |
$29.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.49
|
| Rate for Payer: Railroad Medicare Medicare |
$28.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.76
|
| Rate for Payer: UHC Core |
$96.56
|
| Rate for Payer: UHC Exchange |
$28.91
|
| Rate for Payer: UHC Medicaid |
$20.39
|
| Rate for Payer: UHC Medicare Advantage |
$28.91
|
| Rate for Payer: UHCCP Medicaid |
$20.39
|
| Rate for Payer: VA VA |
$28.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.73
|
|
|
INSULIN GLARGINE-AGLR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
IP
|
$63.32
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
203258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.07 |
| Max. Negotiated Rate |
$56.99 |
| Rate for Payer: Aetna Commercial |
$53.82
|
| Rate for Payer: BCBS Trust/PPO |
$52.30
|
| Rate for Payer: BCN Commercial |
$52.30
|
| Rate for Payer: Cash Price |
$50.66
|
| Rate for Payer: Cofinity Commercial |
$54.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.66
|
| Rate for Payer: Healthscope Commercial |
$56.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.82
|
| Rate for Payer: Nomi Health Commercial |
$51.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.49
|
| Rate for Payer: PHP Commercial |
$53.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.72
|
| Rate for Payer: UHC Core |
$52.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.49
|
|
|
INSULIN GLARGINE-AGLR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
OP
|
$63.32
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
203258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$56.99 |
| Rate for Payer: Aetna Commercial |
$53.82
|
| Rate for Payer: Aetna Medicare |
$16.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.79
|
| Rate for Payer: BCBS Complete |
$11.72
|
| Rate for Payer: BCBS MAPPO |
$15.83
|
| Rate for Payer: BCBS Trust/PPO |
$52.06
|
| Rate for Payer: BCN Commercial |
$52.06
|
| Rate for Payer: BCN Medicare Advantage |
$15.83
|
| Rate for Payer: Cash Price |
$50.66
|
| Rate for Payer: Cofinity Commercial |
$54.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.83
|
| Rate for Payer: Healthscope Commercial |
$56.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.49
|
| Rate for Payer: Mclaren Medicaid |
$11.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.62
|
| Rate for Payer: Meridian Medicaid |
$11.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.82
|
| Rate for Payer: Nomi Health Commercial |
$51.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.49
|
| Rate for Payer: PACE Senior Care Partners |
$15.04
|
| Rate for Payer: PACE SWMI |
$15.83
|
| Rate for Payer: PHP Commercial |
$53.82
|
| Rate for Payer: PHP Medicare Advantage |
$15.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.09
|
| Rate for Payer: Priority Health Medicare |
$15.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.07
|
| Rate for Payer: Railroad Medicare Medicare |
$15.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.72
|
| Rate for Payer: UHC Core |
$52.87
|
| Rate for Payer: UHC Exchange |
$15.83
|
| Rate for Payer: UHC Medicaid |
$11.16
|
| Rate for Payer: UHC Medicare Advantage |
$15.83
|
| Rate for Payer: UHCCP Medicaid |
$11.16
|
| Rate for Payer: VA VA |
$15.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.49
|
|
|
INSULIN GLULISINE (U-100) 100 UNIT/MLÂ SQ FOR INSULIN PUMP REFILL
|
Facility
|
IP
|
$278.47
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
301807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.82 |
| Max. Negotiated Rate |
$250.62 |
| Rate for Payer: Aetna Commercial |
$236.70
|
| Rate for Payer: BCBS Trust/PPO |
$229.99
|
| Rate for Payer: BCN Commercial |
$229.99
|
| Rate for Payer: Cash Price |
$222.78
|
| Rate for Payer: Cofinity Commercial |
$239.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.78
|
| Rate for Payer: Healthscope Commercial |
$250.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.70
|
| Rate for Payer: Nomi Health Commercial |
$228.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.85
|
| Rate for Payer: PHP Commercial |
$236.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$242.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.05
|
| Rate for Payer: UHC Core |
$232.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.85
|
|
|
INSULIN GLULISINE (U-100) 100 UNIT/MLÂ SQ FOR INSULIN PUMP REFILL
|
Facility
|
OP
|
$278.47
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
301807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.09 |
| Max. Negotiated Rate |
$250.62 |
| Rate for Payer: Aetna Commercial |
$236.70
|
| Rate for Payer: Aetna Medicare |
$72.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.02
|
| Rate for Payer: BCBS Complete |
$51.54
|
| Rate for Payer: BCBS MAPPO |
$69.62
|
| Rate for Payer: BCBS Trust/PPO |
$228.93
|
| Rate for Payer: BCN Commercial |
$228.93
|
| Rate for Payer: BCN Medicare Advantage |
$69.62
|
| Rate for Payer: Cash Price |
$222.78
|
| Rate for Payer: Cofinity Commercial |
$239.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.62
|
| Rate for Payer: Healthscope Commercial |
$250.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.85
|
| Rate for Payer: Mclaren Medicaid |
$49.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.10
|
| Rate for Payer: Meridian Medicaid |
$51.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$76.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.70
|
| Rate for Payer: Nomi Health Commercial |
$228.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.85
|
| Rate for Payer: PACE Senior Care Partners |
$66.14
|
| Rate for Payer: PACE SWMI |
$69.62
|
| Rate for Payer: PHP Commercial |
$236.70
|
| Rate for Payer: PHP Medicare Advantage |
$69.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$242.27
|
| Rate for Payer: Priority Health Medicare |
$70.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.82
|
| Rate for Payer: Railroad Medicare Medicare |
$69.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.05
|
| Rate for Payer: UHC Core |
$232.52
|
| Rate for Payer: UHC Exchange |
$69.62
|
| Rate for Payer: UHC Medicaid |
$49.09
|
| Rate for Payer: UHC Medicare Advantage |
$69.62
|
| Rate for Payer: UHCCP Medicaid |
$49.09
|
| Rate for Payer: VA VA |
$69.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.85
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/MLÂ SQ FOR INSULIN PUMP REFILL
|
Facility
|
IP
|
$167.65
|
|
|
Service Code
|
NDC 00002751001
|
| Hospital Charge Code |
301805
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.68 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: BCBS Trust/PPO |
$138.46
|
| Rate for Payer: BCN Commercial |
$138.46
|
| Rate for Payer: Cash Price |
$134.12
|
| Rate for Payer: Cofinity Commercial |
$144.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.12
|
| Rate for Payer: Healthscope Commercial |
$150.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.50
|
| Rate for Payer: Nomi Health Commercial |
$137.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.74
|
| Rate for Payer: PHP Commercial |
$142.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$145.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.53
|
| Rate for Payer: UHC Core |
$139.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.74
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/MLÂ SQ FOR INSULIN PUMP REFILL
|
Facility
|
OP
|
$167.65
|
|
|
Service Code
|
NDC 00002751001
|
| Hospital Charge Code |
301805
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare |
$43.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.39
|
| Rate for Payer: BCBS Complete |
$31.03
|
| Rate for Payer: BCBS MAPPO |
$41.91
|
| Rate for Payer: BCBS Trust/PPO |
$137.83
|
| Rate for Payer: BCN Commercial |
$137.83
|
| Rate for Payer: BCN Medicare Advantage |
$41.91
|
| Rate for Payer: Cash Price |
$134.12
|
| Rate for Payer: Cofinity Commercial |
$144.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.91
|
| Rate for Payer: Healthscope Commercial |
$150.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.74
|
| Rate for Payer: Mclaren Medicaid |
$29.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.01
|
| Rate for Payer: Meridian Medicaid |
$31.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.50
|
| Rate for Payer: Nomi Health Commercial |
$137.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.74
|
| Rate for Payer: PACE Senior Care Partners |
$39.82
|
| Rate for Payer: PACE SWMI |
$41.91
|
| Rate for Payer: PHP Commercial |
$142.50
|
| Rate for Payer: PHP Medicare Advantage |
$41.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$145.86
|
| Rate for Payer: Priority Health Medicare |
$42.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.68
|
| Rate for Payer: Railroad Medicare Medicare |
$41.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.53
|
| Rate for Payer: UHC Core |
$139.99
|
| Rate for Payer: UHC Exchange |
$41.91
|
| Rate for Payer: UHC Medicaid |
$29.56
|
| Rate for Payer: UHC Medicare Advantage |
$41.91
|
| Rate for Payer: UHCCP Medicaid |
$29.56
|
| Rate for Payer: VA VA |
$41.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.74
|
|
|
INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION
|
Facility
|
OP
|
$141.16
|
|
|
Service Code
|
NDC 00169183411
|
| Hospital Charge Code |
10284
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.89 |
| Max. Negotiated Rate |
$127.04 |
| Rate for Payer: Aetna Commercial |
$119.99
|
| Rate for Payer: Aetna Medicare |
$36.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.11
|
| Rate for Payer: BCBS Complete |
$26.13
|
| Rate for Payer: BCBS MAPPO |
$35.29
|
| Rate for Payer: BCBS Trust/PPO |
$116.05
|
| Rate for Payer: BCN Commercial |
$116.05
|
| Rate for Payer: BCN Medicare Advantage |
$35.29
|
| Rate for Payer: Cash Price |
$112.93
|
| Rate for Payer: Cofinity Commercial |
$121.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.29
|
| Rate for Payer: Healthscope Commercial |
$127.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.87
|
| Rate for Payer: Mclaren Medicaid |
$24.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.05
|
| Rate for Payer: Meridian Medicaid |
$26.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.99
|
| Rate for Payer: Nomi Health Commercial |
$115.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.87
|
| Rate for Payer: PACE Senior Care Partners |
$33.53
|
| Rate for Payer: PACE SWMI |
$35.29
|
| Rate for Payer: PHP Commercial |
$119.99
|
| Rate for Payer: PHP Medicare Advantage |
$35.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$122.81
|
| Rate for Payer: Priority Health Medicare |
$35.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.25
|
| Rate for Payer: Railroad Medicare Medicare |
$35.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.22
|
| Rate for Payer: UHC Core |
$117.87
|
| Rate for Payer: UHC Exchange |
$35.29
|
| Rate for Payer: UHC Medicaid |
$24.89
|
| Rate for Payer: UHC Medicare Advantage |
$35.29
|
| Rate for Payer: UHCCP Medicaid |
$24.89
|
| Rate for Payer: VA VA |
$35.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.87
|
|
|
INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION
|
Facility
|
IP
|
$141.16
|
|
|
Service Code
|
NDC 00169183411
|
| Hospital Charge Code |
10284
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.25 |
| Max. Negotiated Rate |
$127.04 |
| Rate for Payer: Aetna Commercial |
$119.99
|
| Rate for Payer: BCBS Trust/PPO |
$116.58
|
| Rate for Payer: BCN Commercial |
$116.58
|
| Rate for Payer: Cash Price |
$112.93
|
| Rate for Payer: Cofinity Commercial |
$121.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.93
|
| Rate for Payer: Healthscope Commercial |
$127.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.99
|
| Rate for Payer: Nomi Health Commercial |
$115.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.87
|
| Rate for Payer: PHP Commercial |
$119.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$122.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.22
|
| Rate for Payer: UHC Core |
$117.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.87
|
|
|
INSULIN REGULAR 100 UNIT/100 ML (1 UNIT/ML) IN 0.9 % NACL IV SOLUTION
|
Facility
|
OP
|
$66.31
|
|
|
Service Code
|
NDC 00338012612
|
| Hospital Charge Code |
191217
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.69 |
| Max. Negotiated Rate |
$59.68 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna Medicare |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.72
|
| Rate for Payer: BCBS Complete |
$12.27
|
| Rate for Payer: BCBS MAPPO |
$16.58
|
| Rate for Payer: BCBS Trust/PPO |
$54.51
|
| Rate for Payer: BCN Commercial |
$54.51
|
| Rate for Payer: BCN Medicare Advantage |
$16.58
|
| Rate for Payer: Cash Price |
$53.05
|
| Rate for Payer: Cofinity Commercial |
$57.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$59.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.73
|
| Rate for Payer: Mclaren Medicaid |
$11.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.41
|
| Rate for Payer: Meridian Medicaid |
$12.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.73
|
| Rate for Payer: PACE Senior Care Partners |
$15.75
|
| Rate for Payer: PACE SWMI |
$16.58
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: PHP Medicare Advantage |
$16.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$57.69
|
| Rate for Payer: Priority Health Medicare |
$16.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.15
|
| Rate for Payer: Railroad Medicare Medicare |
$16.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.35
|
| Rate for Payer: UHC Core |
$55.37
|
| Rate for Payer: UHC Exchange |
$16.58
|
| Rate for Payer: UHC Medicaid |
$11.69
|
| Rate for Payer: UHC Medicare Advantage |
$16.58
|
| Rate for Payer: UHCCP Medicaid |
$11.69
|
| Rate for Payer: VA VA |
$16.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.73
|
|
|
INSULIN REGULAR 100 UNIT/100 ML (1 UNIT/ML) IN 0.9 % NACL IV SOLUTION
|
Facility
|
IP
|
$66.31
|
|
|
Service Code
|
NDC 00338012612
|
| Hospital Charge Code |
191217
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$59.68 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: BCBS Trust/PPO |
$54.77
|
| Rate for Payer: BCN Commercial |
$54.77
|
| Rate for Payer: Cash Price |
$53.05
|
| Rate for Payer: Cofinity Commercial |
$57.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.05
|
| Rate for Payer: Healthscope Commercial |
$59.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.73
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$57.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.35
|
| Rate for Payer: UHC Core |
$55.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.73
|
|
|
INSULIN REGULAR 1 UNIT/ML IN 0.9 % NACL IV PUSH (CUSTOM)
|
Facility
|
OP
|
$66.31
|
|
|
Service Code
|
NDC 00338012612
|
| Hospital Charge Code |
301039
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.69 |
| Max. Negotiated Rate |
$59.68 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna Medicare |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.72
|
| Rate for Payer: BCBS Complete |
$12.27
|
| Rate for Payer: BCBS MAPPO |
$16.58
|
| Rate for Payer: BCBS Trust/PPO |
$54.51
|
| Rate for Payer: BCN Commercial |
$54.51
|
| Rate for Payer: BCN Medicare Advantage |
$16.58
|
| Rate for Payer: Cash Price |
$53.05
|
| Rate for Payer: Cofinity Commercial |
$57.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$59.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.73
|
| Rate for Payer: Mclaren Medicaid |
$11.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.41
|
| Rate for Payer: Meridian Medicaid |
$12.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.73
|
| Rate for Payer: PACE Senior Care Partners |
$15.75
|
| Rate for Payer: PACE SWMI |
$16.58
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: PHP Medicare Advantage |
$16.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$57.69
|
| Rate for Payer: Priority Health Medicare |
$16.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.15
|
| Rate for Payer: Railroad Medicare Medicare |
$16.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.35
|
| Rate for Payer: UHC Core |
$55.37
|
| Rate for Payer: UHC Exchange |
$16.58
|
| Rate for Payer: UHC Medicaid |
$11.69
|
| Rate for Payer: UHC Medicare Advantage |
$16.58
|
| Rate for Payer: UHCCP Medicaid |
$11.69
|
| Rate for Payer: VA VA |
$16.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.73
|
|
|
INSULIN REGULAR 1 UNIT/ML IN 0.9 % NACL IV PUSH (CUSTOM)
|
Facility
|
IP
|
$66.31
|
|
|
Service Code
|
NDC 00338012612
|
| Hospital Charge Code |
301039
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$59.68 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: BCBS Trust/PPO |
$54.77
|
| Rate for Payer: BCN Commercial |
$54.77
|
| Rate for Payer: Cash Price |
$53.05
|
| Rate for Payer: Cofinity Commercial |
$57.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.05
|
| Rate for Payer: Healthscope Commercial |
$59.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.73
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$57.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.35
|
| Rate for Payer: UHC Core |
$55.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.73
|
|
|
INSULIN REGULAR HUMAN U-500"CONCENTRATE" 500 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
OP
|
$4,860.24
|
|
|
Service Code
|
NDC 00002850101
|
| Hospital Charge Code |
301808
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$856.86 |
| Max. Negotiated Rate |
$4,374.22 |
| Rate for Payer: Aetna Commercial |
$4,131.20
|
| Rate for Payer: Aetna Medicare |
$1,263.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,518.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,518.83
|
| Rate for Payer: BCBS Complete |
$899.63
|
| Rate for Payer: BCBS MAPPO |
$1,215.06
|
| Rate for Payer: BCBS Trust/PPO |
$3,995.60
|
| Rate for Payer: BCN Commercial |
$3,995.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,215.06
|
| Rate for Payer: Cash Price |
$3,888.19
|
| Rate for Payer: Cofinity Commercial |
$4,179.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,888.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,215.06
|
| Rate for Payer: Healthscope Commercial |
$4,374.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,645.18
|
| Rate for Payer: Mclaren Medicaid |
$856.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,275.81
|
| Rate for Payer: Meridian Medicaid |
$899.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,397.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,336.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,131.20
|
| Rate for Payer: Nomi Health Commercial |
$3,985.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,645.18
|
| Rate for Payer: PACE Senior Care Partners |
$1,154.31
|
| Rate for Payer: PACE SWMI |
$1,215.06
|
| Rate for Payer: PHP Commercial |
$4,131.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,215.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$856.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,228.41
|
| Rate for Payer: Priority Health Medicare |
$1,227.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,382.73
|
| Rate for Payer: Railroad Medicare Medicare |
$1,215.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,277.01
|
| Rate for Payer: UHC Core |
$4,058.30
|
| Rate for Payer: UHC Exchange |
$1,215.06
|
| Rate for Payer: UHC Medicaid |
$856.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,215.06
|
| Rate for Payer: UHCCP Medicaid |
$856.86
|
| Rate for Payer: VA VA |
$1,215.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,645.18
|
|
|
INSULIN REGULAR HUMAN U-500"CONCENTRATE" 500 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
IP
|
$4,860.24
|
|
|
Service Code
|
NDC 00002850101
|
| Hospital Charge Code |
301808
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,382.73 |
| Max. Negotiated Rate |
$4,374.22 |
| Rate for Payer: Aetna Commercial |
$4,131.20
|
| Rate for Payer: BCBS Trust/PPO |
$4,014.07
|
| Rate for Payer: BCN Commercial |
$4,014.07
|
| Rate for Payer: Cash Price |
$3,888.19
|
| Rate for Payer: Cofinity Commercial |
$4,179.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,888.19
|
| Rate for Payer: Healthscope Commercial |
$4,374.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,645.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,131.20
|
| Rate for Payer: Nomi Health Commercial |
$3,985.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,645.18
|
| Rate for Payer: PHP Commercial |
$4,131.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,228.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,382.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,277.01
|
| Rate for Payer: UHC Core |
$4,058.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,645.18
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - HUMAN (HUMULIN R)
|
Facility
|
IP
|
$19.46
|
|
|
Service Code
|
NDC 00002821517
|
| Hospital Charge Code |
180910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$17.51 |
| Rate for Payer: Aetna Commercial |
$16.54
|
| Rate for Payer: BCBS Trust/PPO |
$16.07
|
| Rate for Payer: BCN Commercial |
$16.07
|
| 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 Commercial |
$16.54
|
| Rate for Payer: Nomi Health Commercial |
$15.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.60
|
| Rate for Payer: PHP Commercial |
$16.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.54
|
| 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
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - HUMAN (HUMULIN R)
|
Facility
|
IP
|
$141.16
|
|
|
Service Code
|
NDC 00169183311
|
| Hospital Charge Code |
180910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.25 |
| Max. Negotiated Rate |
$127.04 |
| Rate for Payer: Aetna Commercial |
$119.99
|
| Rate for Payer: BCBS Trust/PPO |
$116.58
|
| Rate for Payer: BCN Commercial |
$116.58
|
| Rate for Payer: Cash Price |
$112.93
|
| Rate for Payer: Cofinity Commercial |
$121.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.93
|
| Rate for Payer: Healthscope Commercial |
$127.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.99
|
| Rate for Payer: Nomi Health Commercial |
$115.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.87
|
| Rate for Payer: PHP Commercial |
$119.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$122.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.22
|
| Rate for Payer: UHC Core |
$117.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.87
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - HUMAN (HUMULIN R)
|
Facility
|
OP
|
$141.16
|
|
|
Service Code
|
NDC 00169183311
|
| Hospital Charge Code |
180910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.89 |
| Max. Negotiated Rate |
$127.04 |
| Rate for Payer: Aetna Commercial |
$119.99
|
| Rate for Payer: Aetna Medicare |
$36.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.11
|
| Rate for Payer: BCBS Complete |
$26.13
|
| Rate for Payer: BCBS MAPPO |
$35.29
|
| Rate for Payer: BCBS Trust/PPO |
$116.05
|
| Rate for Payer: BCN Commercial |
$116.05
|
| Rate for Payer: BCN Medicare Advantage |
$35.29
|
| Rate for Payer: Cash Price |
$112.93
|
| Rate for Payer: Cofinity Commercial |
$121.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.29
|
| Rate for Payer: Healthscope Commercial |
$127.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.87
|
| Rate for Payer: Mclaren Medicaid |
$24.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.05
|
| Rate for Payer: Meridian Medicaid |
$26.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.99
|
| Rate for Payer: Nomi Health Commercial |
$115.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.87
|
| Rate for Payer: PACE Senior Care Partners |
$33.53
|
| Rate for Payer: PACE SWMI |
$35.29
|
| Rate for Payer: PHP Commercial |
$119.99
|
| Rate for Payer: PHP Medicare Advantage |
$35.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$122.81
|
| Rate for Payer: Priority Health Medicare |
$35.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.25
|
| Rate for Payer: Railroad Medicare Medicare |
$35.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.22
|
| Rate for Payer: UHC Core |
$117.87
|
| Rate for Payer: UHC Exchange |
$35.29
|
| Rate for Payer: UHC Medicaid |
$24.89
|
| Rate for Payer: UHC Medicare Advantage |
$35.29
|
| Rate for Payer: UHCCP Medicaid |
$24.89
|
| Rate for Payer: VA VA |
$35.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.87
|
|
