|
INSULIN SUBCUTANEOUS BASAL PUMP - HUMAN (HUMULIN R)
|
Facility
|
OP
|
$19.46
|
|
|
Service Code
|
NDC 00002821517
|
| Hospital Charge Code |
180910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$17.51 |
| Rate for Payer: Aetna Commercial |
$16.54
|
| Rate for Payer: Aetna Medicare |
$5.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.08
|
| Rate for Payer: BCBS Complete |
$3.60
|
| Rate for Payer: BCBS MAPPO |
$4.87
|
| Rate for Payer: BCBS Trust/PPO |
$16.00
|
| Rate for Payer: BCN Commercial |
$16.00
|
| Rate for Payer: BCN Medicare Advantage |
$4.87
|
| 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: Health Alliance Plan Medicare Advantage |
$4.87
|
| Rate for Payer: Healthscope Commercial |
$17.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.60
|
| Rate for Payer: Mclaren Medicaid |
$3.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.11
|
| Rate for Payer: Meridian Medicaid |
$3.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.35
|
| 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: PACE Senior Care Partners |
$4.62
|
| Rate for Payer: PACE SWMI |
$4.87
|
| Rate for Payer: PHP Commercial |
$16.54
|
| Rate for Payer: PHP Medicare Advantage |
$4.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.93
|
| Rate for Payer: Priority Health Medicare |
$4.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.54
|
| Rate for Payer: Railroad Medicare Medicare |
$4.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.12
|
| Rate for Payer: UHC Core |
$16.25
|
| Rate for Payer: UHC Exchange |
$4.87
|
| Rate for Payer: UHC Medicaid |
$3.43
|
| Rate for Payer: UHC Medicare Advantage |
$4.87
|
| Rate for Payer: UHCCP Medicaid |
$3.43
|
| Rate for Payer: VA VA |
$4.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.60
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - INSULIN GLULISINE (APIDRA)
|
Facility
|
IP
|
$290.23
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
180908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$261.21 |
| Rate for Payer: Aetna Commercial |
$246.70
|
| Rate for Payer: BCBS Trust/PPO |
$239.70
|
| Rate for Payer: BCN Commercial |
$239.70
|
| Rate for Payer: Cash Price |
$232.18
|
| Rate for Payer: Cofinity Commercial |
$249.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.18
|
| Rate for Payer: Healthscope Commercial |
$261.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.70
|
| Rate for Payer: Nomi Health Commercial |
$237.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.67
|
| Rate for Payer: PHP Commercial |
$246.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$252.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.40
|
| Rate for Payer: UHC Core |
$242.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.67
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - INSULIN GLULISINE (APIDRA)
|
Facility
|
OP
|
$290.23
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
180908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.17 |
| Max. Negotiated Rate |
$261.21 |
| Rate for Payer: Aetna Commercial |
$246.70
|
| Rate for Payer: Aetna Medicare |
$75.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.70
|
| Rate for Payer: BCBS Complete |
$53.72
|
| Rate for Payer: BCBS MAPPO |
$72.56
|
| Rate for Payer: BCBS Trust/PPO |
$238.60
|
| Rate for Payer: BCN Commercial |
$238.60
|
| Rate for Payer: BCN Medicare Advantage |
$72.56
|
| Rate for Payer: Cash Price |
$232.18
|
| Rate for Payer: Cofinity Commercial |
$249.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.56
|
| Rate for Payer: Healthscope Commercial |
$261.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.67
|
| Rate for Payer: Mclaren Medicaid |
$51.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.19
|
| Rate for Payer: Meridian Medicaid |
$53.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.70
|
| Rate for Payer: Nomi Health Commercial |
$237.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.67
|
| Rate for Payer: PACE Senior Care Partners |
$68.93
|
| Rate for Payer: PACE SWMI |
$72.56
|
| Rate for Payer: PHP Commercial |
$246.70
|
| Rate for Payer: PHP Medicare Advantage |
$72.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$252.50
|
| Rate for Payer: Priority Health Medicare |
$73.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.00
|
| Rate for Payer: Railroad Medicare Medicare |
$72.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.40
|
| Rate for Payer: UHC Core |
$242.34
|
| Rate for Payer: UHC Exchange |
$72.56
|
| Rate for Payer: UHC Medicaid |
$51.17
|
| Rate for Payer: UHC Medicare Advantage |
$72.56
|
| Rate for Payer: UHCCP Medicaid |
$51.17
|
| Rate for Payer: VA VA |
$72.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.67
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - LISPRO (HUMALOG)
|
Facility
|
OP
|
$46.55
|
|
|
Service Code
|
NDC 00002751017
|
| Hospital Charge Code |
180914
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$41.90 |
| Rate for Payer: Aetna Commercial |
$39.57
|
| Rate for Payer: Aetna Medicare |
$12.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.55
|
| Rate for Payer: BCBS Complete |
$8.62
|
| Rate for Payer: BCBS MAPPO |
$11.64
|
| Rate for Payer: BCBS Trust/PPO |
$38.27
|
| Rate for Payer: BCN Commercial |
$38.27
|
| Rate for Payer: BCN Medicare Advantage |
$11.64
|
| Rate for Payer: Cash Price |
$37.24
|
| Rate for Payer: Cofinity Commercial |
$40.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.64
|
| Rate for Payer: Healthscope Commercial |
$41.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.91
|
| Rate for Payer: Mclaren Medicaid |
$8.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.22
|
| Rate for Payer: Meridian Medicaid |
$8.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.57
|
| Rate for Payer: Nomi Health Commercial |
$38.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.91
|
| Rate for Payer: PACE Senior Care Partners |
$11.06
|
| Rate for Payer: PACE SWMI |
$11.64
|
| Rate for Payer: PHP Commercial |
$39.57
|
| Rate for Payer: PHP Medicare Advantage |
$11.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.50
|
| Rate for Payer: Priority Health Medicare |
$11.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.40
|
| Rate for Payer: Railroad Medicare Medicare |
$11.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.96
|
| Rate for Payer: UHC Core |
$38.87
|
| Rate for Payer: UHC Exchange |
$11.64
|
| Rate for Payer: UHC Medicaid |
$8.21
|
| Rate for Payer: UHC Medicare Advantage |
$11.64
|
| Rate for Payer: UHCCP Medicaid |
$8.21
|
| Rate for Payer: VA VA |
$11.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.91
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - LISPRO (HUMALOG)
|
Facility
|
IP
|
$46.55
|
|
|
Service Code
|
NDC 00002751017
|
| Hospital Charge Code |
180914
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$41.90 |
| Rate for Payer: Aetna Commercial |
$39.57
|
| Rate for Payer: BCBS Trust/PPO |
$38.45
|
| Rate for Payer: BCN Commercial |
$38.45
|
| Rate for Payer: Cash Price |
$37.24
|
| Rate for Payer: Cofinity Commercial |
$40.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.24
|
| Rate for Payer: Healthscope Commercial |
$41.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.57
|
| Rate for Payer: Nomi Health Commercial |
$38.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.91
|
| Rate for Payer: PHP Commercial |
$39.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.96
|
| Rate for Payer: UHC Core |
$38.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.91
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - REGULAR HUMAN (U-500)
|
Facility
|
OP
|
$5,065.60
|
|
|
Service Code
|
NDC 00002850101
|
| Hospital Charge Code |
180916
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$893.07 |
| Max. Negotiated Rate |
$4,559.04 |
| Rate for Payer: Aetna Commercial |
$4,305.76
|
| Rate for Payer: Aetna Medicare |
$1,317.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,583.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,583.00
|
| Rate for Payer: BCBS Complete |
$937.64
|
| Rate for Payer: BCBS MAPPO |
$1,266.40
|
| Rate for Payer: BCBS Trust/PPO |
$4,164.43
|
| Rate for Payer: BCN Commercial |
$4,164.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,266.40
|
| Rate for Payer: Cash Price |
$4,052.48
|
| Rate for Payer: Cofinity Commercial |
$4,356.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,052.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,266.40
|
| Rate for Payer: Healthscope Commercial |
$4,559.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,799.20
|
| Rate for Payer: Mclaren Medicaid |
$893.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,329.72
|
| Rate for Payer: Meridian Medicaid |
$937.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,456.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,393.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,305.76
|
| Rate for Payer: Nomi Health Commercial |
$4,153.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,799.20
|
| Rate for Payer: PACE Senior Care Partners |
$1,203.08
|
| Rate for Payer: PACE SWMI |
$1,266.40
|
| Rate for Payer: PHP Commercial |
$4,305.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,266.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$893.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,407.07
|
| Rate for Payer: Priority Health Medicare |
$1,279.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,525.66
|
| Rate for Payer: Railroad Medicare Medicare |
$1,266.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,457.73
|
| Rate for Payer: UHC Core |
$4,229.78
|
| Rate for Payer: UHC Exchange |
$1,266.40
|
| Rate for Payer: UHC Medicaid |
$893.07
|
| Rate for Payer: UHC Medicare Advantage |
$1,266.40
|
| Rate for Payer: UHCCP Medicaid |
$893.07
|
| Rate for Payer: VA VA |
$1,266.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,799.20
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - REGULAR HUMAN (U-500)
|
Facility
|
IP
|
$5,065.60
|
|
|
Service Code
|
NDC 00002850101
|
| Hospital Charge Code |
180916
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,525.66 |
| Max. Negotiated Rate |
$4,559.04 |
| Rate for Payer: Aetna Commercial |
$4,305.76
|
| Rate for Payer: BCBS Trust/PPO |
$4,183.68
|
| Rate for Payer: BCN Commercial |
$4,183.68
|
| Rate for Payer: Cash Price |
$4,052.48
|
| Rate for Payer: Cofinity Commercial |
$4,356.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,052.48
|
| Rate for Payer: Healthscope Commercial |
$4,559.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,799.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,305.76
|
| Rate for Payer: Nomi Health Commercial |
$4,153.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,799.20
|
| Rate for Payer: PHP Commercial |
$4,305.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,407.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,525.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,457.73
|
| Rate for Payer: UHC Core |
$4,229.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,799.20
|
|
|
INSULIN SUBCUTANEOUS BOLUS PUMP - HUMAN (HUMULIN R)
|
Facility
|
OP
|
$141.16
|
|
|
Service Code
|
NDC 00169183311
|
| Hospital Charge Code |
180911
|
|
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 SUBCUTANEOUS BOLUS PUMP - HUMAN (HUMULIN R)
|
Facility
|
IP
|
$141.16
|
|
|
Service Code
|
NDC 00169183311
|
| Hospital Charge Code |
180911
|
|
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 CONTINUOUS BASAL PUMP - ASPARTATE (NOVOLOG)
|
Facility
|
OP
|
$137.64
|
|
|
Service Code
|
NDC 00169750111
|
| Hospital Charge Code |
180912
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.27 |
| Max. Negotiated Rate |
$123.88 |
| Rate for Payer: Aetna Commercial |
$116.99
|
| Rate for Payer: Aetna Medicare |
$35.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.01
|
| Rate for Payer: BCBS Complete |
$25.48
|
| Rate for Payer: BCBS MAPPO |
$34.41
|
| Rate for Payer: BCBS Trust/PPO |
$113.15
|
| Rate for Payer: BCN Commercial |
$113.15
|
| Rate for Payer: BCN Medicare Advantage |
$34.41
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity Commercial |
$118.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.41
|
| Rate for Payer: Healthscope Commercial |
$123.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.23
|
| Rate for Payer: Mclaren Medicaid |
$24.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.13
|
| Rate for Payer: Meridian Medicaid |
$25.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.99
|
| Rate for Payer: Nomi Health Commercial |
$112.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.23
|
| Rate for Payer: PACE Senior Care Partners |
$32.69
|
| Rate for Payer: PACE SWMI |
$34.41
|
| Rate for Payer: PHP Commercial |
$116.99
|
| Rate for Payer: PHP Medicare Advantage |
$34.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$119.75
|
| Rate for Payer: Priority Health Medicare |
$34.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.80
|
| Rate for Payer: Railroad Medicare Medicare |
$34.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.12
|
| Rate for Payer: UHC Core |
$114.93
|
| Rate for Payer: UHC Exchange |
$34.41
|
| Rate for Payer: UHC Medicaid |
$24.27
|
| Rate for Payer: UHC Medicare Advantage |
$34.41
|
| Rate for Payer: UHCCP Medicaid |
$24.27
|
| Rate for Payer: VA VA |
$34.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.23
|
|
|
INSULIN SUBCUTANEOUS CONTINUOUS BASAL PUMP - ASPARTATE (NOVOLOG)
|
Facility
|
IP
|
$137.64
|
|
|
Service Code
|
NDC 00169750111
|
| Hospital Charge Code |
180912
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$123.88 |
| Rate for Payer: Aetna Commercial |
$116.99
|
| Rate for Payer: BCBS Trust/PPO |
$113.68
|
| Rate for Payer: BCN Commercial |
$113.68
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity Commercial |
$118.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.11
|
| Rate for Payer: Healthscope Commercial |
$123.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.99
|
| Rate for Payer: Nomi Health Commercial |
$112.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.23
|
| Rate for Payer: PHP Commercial |
$116.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$119.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.12
|
| Rate for Payer: UHC Core |
$114.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.23
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
IP
|
$141.16
|
|
|
Service Code
|
NDC 00169183311
|
| Hospital Charge Code |
301806
|
|
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 U-100 REGULAR HUMAN 100 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
OP
|
$141.16
|
|
|
Service Code
|
NDC 00169183311
|
| Hospital Charge Code |
301806
|
|
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
|
|
|
INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE
|
Facility
|
IP
|
$10,502.60
|
|
|
Service Code
|
APR-DRG 8174
|
| Min. Negotiated Rate |
$10,002.48 |
| Max. Negotiated Rate |
$10,502.60 |
| Rate for Payer: BCBS Complete |
$10,502.60
|
| Rate for Payer: Mclaren Medicaid |
$10,002.48
|
| Rate for Payer: Meridian Medicaid |
$10,502.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,002.48
|
| Rate for Payer: UHC Medicaid |
$10,002.48
|
| Rate for Payer: UHCCP Medicaid |
$10,002.48
|
|
|
INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE
|
Facility
|
IP
|
$6,148.65
|
|
|
Service Code
|
APR-DRG 8173
|
| Min. Negotiated Rate |
$5,855.85 |
| Max. Negotiated Rate |
$6,148.65 |
| Rate for Payer: BCBS Complete |
$6,148.65
|
| Rate for Payer: Mclaren Medicaid |
$5,855.85
|
| Rate for Payer: Meridian Medicaid |
$6,148.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,855.85
|
| Rate for Payer: UHC Medicaid |
$5,855.85
|
| Rate for Payer: UHCCP Medicaid |
$5,855.85
|
|
|
INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE
|
Facility
|
IP
|
$3,420.59
|
|
|
Service Code
|
APR-DRG 8172
|
| Min. Negotiated Rate |
$3,257.70 |
| Max. Negotiated Rate |
$3,420.59 |
| Rate for Payer: BCBS Complete |
$3,420.59
|
| Rate for Payer: Mclaren Medicaid |
$3,257.70
|
| Rate for Payer: Meridian Medicaid |
$3,420.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,257.70
|
| Rate for Payer: UHC Medicaid |
$3,257.70
|
| Rate for Payer: UHCCP Medicaid |
$3,257.70
|
|
|
INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE
|
Facility
|
IP
|
$2,367.33
|
|
|
Service Code
|
APR-DRG 8171
|
| Min. Negotiated Rate |
$2,254.60 |
| Max. Negotiated Rate |
$2,367.33 |
| Rate for Payer: BCBS Complete |
$2,367.33
|
| Rate for Payer: Mclaren Medicaid |
$2,254.60
|
| Rate for Payer: Meridian Medicaid |
$2,367.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,254.60
|
| Rate for Payer: UHC Medicaid |
$2,254.60
|
| Rate for Payer: UHCCP Medicaid |
$2,254.60
|
|
|
INTERSTITIAL AND ALVEOLAR LUNG DISEASES
|
Facility
|
IP
|
$4,914.50
|
|
|
Service Code
|
APR-DRG 1422
|
| Min. Negotiated Rate |
$4,680.48 |
| Max. Negotiated Rate |
$4,914.50 |
| Rate for Payer: BCBS Complete |
$4,914.50
|
| Rate for Payer: Mclaren Medicaid |
$4,680.48
|
| Rate for Payer: Meridian Medicaid |
$4,914.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,680.48
|
| Rate for Payer: UHC Medicaid |
$4,680.48
|
| Rate for Payer: UHCCP Medicaid |
$4,680.48
|
|
|
INTERSTITIAL AND ALVEOLAR LUNG DISEASES
|
Facility
|
IP
|
$6,959.49
|
|
|
Service Code
|
APR-DRG 1423
|
| Min. Negotiated Rate |
$6,628.09 |
| Max. Negotiated Rate |
$6,959.49 |
| Rate for Payer: BCBS Complete |
$6,959.49
|
| Rate for Payer: Mclaren Medicaid |
$6,628.09
|
| Rate for Payer: Meridian Medicaid |
$6,959.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,628.09
|
| Rate for Payer: UHC Medicaid |
$6,628.09
|
| Rate for Payer: UHCCP Medicaid |
$6,628.09
|
|
|
INTERSTITIAL AND ALVEOLAR LUNG DISEASES
|
Facility
|
IP
|
$3,218.67
|
|
|
Service Code
|
APR-DRG 1421
|
| Min. Negotiated Rate |
$3,065.40 |
| Max. Negotiated Rate |
$3,218.67 |
| Rate for Payer: BCBS Complete |
$3,218.67
|
| Rate for Payer: Mclaren Medicaid |
$3,065.40
|
| Rate for Payer: Meridian Medicaid |
$3,218.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,065.40
|
| Rate for Payer: UHC Medicaid |
$3,065.40
|
| Rate for Payer: UHCCP Medicaid |
$3,065.40
|
|
|
INTERSTITIAL AND ALVEOLAR LUNG DISEASES
|
Facility
|
IP
|
$9,863.71
|
|
|
Service Code
|
APR-DRG 1424
|
| Min. Negotiated Rate |
$9,394.01 |
| Max. Negotiated Rate |
$9,863.71 |
| Rate for Payer: BCBS Complete |
$9,863.71
|
| Rate for Payer: Mclaren Medicaid |
$9,394.01
|
| Rate for Payer: Meridian Medicaid |
$9,863.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,394.01
|
| Rate for Payer: UHC Medicaid |
$9,394.01
|
| Rate for Payer: UHCCP Medicaid |
$9,394.01
|
|
|
INTESTINAL OBSTRUCTION
|
Facility
|
IP
|
$3,651.43
|
|
|
Service Code
|
APR-DRG 2472
|
| Min. Negotiated Rate |
$3,477.56 |
| Max. Negotiated Rate |
$3,651.43 |
| Rate for Payer: BCBS Complete |
$3,651.43
|
| Rate for Payer: Mclaren Medicaid |
$3,477.56
|
| Rate for Payer: Meridian Medicaid |
$3,651.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,477.56
|
| Rate for Payer: UHC Medicaid |
$3,477.56
|
| Rate for Payer: UHCCP Medicaid |
$3,477.56
|
|
|
INTESTINAL OBSTRUCTION
|
Facility
|
IP
|
$2,794.84
|
|
|
Service Code
|
APR-DRG 2471
|
| Min. Negotiated Rate |
$2,661.75 |
| Max. Negotiated Rate |
$2,794.84 |
| Rate for Payer: BCBS Complete |
$2,794.84
|
| Rate for Payer: Mclaren Medicaid |
$2,661.75
|
| Rate for Payer: Meridian Medicaid |
$2,794.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,661.75
|
| Rate for Payer: UHC Medicaid |
$2,661.75
|
| Rate for Payer: UHCCP Medicaid |
$2,661.75
|
|
|
INTESTINAL OBSTRUCTION
|
Facility
|
IP
|
$10,189.73
|
|
|
Service Code
|
APR-DRG 2474
|
| Min. Negotiated Rate |
$9,704.50 |
| Max. Negotiated Rate |
$10,189.73 |
| Rate for Payer: BCBS Complete |
$10,189.73
|
| Rate for Payer: Mclaren Medicaid |
$9,704.50
|
| Rate for Payer: Meridian Medicaid |
$10,189.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,704.50
|
| Rate for Payer: UHC Medicaid |
$9,704.50
|
| Rate for Payer: UHCCP Medicaid |
$9,704.50
|
|
|
INTESTINAL OBSTRUCTION
|
Facility
|
IP
|
$5,323.08
|
|
|
Service Code
|
APR-DRG 2473
|
| Min. Negotiated Rate |
$5,069.60 |
| Max. Negotiated Rate |
$5,323.08 |
| Rate for Payer: BCBS Complete |
$5,323.08
|
| Rate for Payer: Mclaren Medicaid |
$5,069.60
|
| Rate for Payer: Meridian Medicaid |
$5,323.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,069.60
|
| Rate for Payer: UHC Medicaid |
$5,069.60
|
| Rate for Payer: UHCCP Medicaid |
$5,069.60
|
|
