Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GREATER OCCIPITAL NERVE

Facility

$219.58

Service Code	CPT 64405
Hospital Revenue Code	360
Min. Negotiated Rate	$209.11
Max. Negotiated Rate	$219.58
Rate for Payer: BCBS Complete	$219.58
Rate for Payer: Mclaren Medicaid	$209.11
Rate for Payer: Meridian Medicaid	$219.58
Rate for Payer: Priority Health Choice Medicaid	$209.11
Rate for Payer: UHCCP Medicaid	$209.11

INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; INTERCOSTAL NERVE, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$662.24

Service Code	CPT 64421
Hospital Revenue Code	360
Min. Negotiated Rate	$630.67
Max. Negotiated Rate	$662.24
Rate for Payer: BCBS Complete	$662.24
Rate for Payer: Mclaren Medicaid	$630.67
Rate for Payer: Meridian Medicaid	$662.24
Rate for Payer: Priority Health Choice Medicaid	$630.67
Rate for Payer: UHCCP Medicaid	$630.67

INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; INTERCOSTAL NERVE, SINGLE LEVEL

Facility

$515.13

Service Code	CPT 64420
Hospital Revenue Code	360
Min. Negotiated Rate	$490.57
Max. Negotiated Rate	$515.13
Rate for Payer: BCBS Complete	$515.13
Rate for Payer: Mclaren Medicaid	$490.57
Rate for Payer: Meridian Medicaid	$515.13
Rate for Payer: Priority Health Choice Medicaid	$490.57
Rate for Payer: UHCCP Medicaid	$490.57

INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; NERVES INNERVATING THE SACROILIAC JOINT, WITH IMAGE GUIDANCE (IE, FLUOROSCOPY OR COMPUTED TOMOGRAPHY)

Facility

$515.13

Service Code	CPT 64451
Hospital Revenue Code	360
Min. Negotiated Rate	$490.57
Max. Negotiated Rate	$515.13
Rate for Payer: BCBS Complete	$515.13
Rate for Payer: Mclaren Medicaid	$490.57
Rate for Payer: Meridian Medicaid	$515.13
Rate for Payer: Priority Health Choice Medicaid	$490.57
Rate for Payer: UHCCP Medicaid	$490.57

INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; OTHER PERIPHERAL NERVE OR BRANCH

Facility

$515.13

Service Code	CPT 64450
Hospital Revenue Code	360
Min. Negotiated Rate	$490.57
Max. Negotiated Rate	$515.13
Rate for Payer: BCBS Complete	$515.13
Rate for Payer: Mclaren Medicaid	$490.57
Rate for Payer: Meridian Medicaid	$515.13
Rate for Payer: Priority Health Choice Medicaid	$490.57
Rate for Payer: UHCCP Medicaid	$490.57

INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SINGLE LEVEL

Facility

$662.24

Service Code	CPT 64490
Hospital Revenue Code	360
Min. Negotiated Rate	$630.67
Max. Negotiated Rate	$662.24
Rate for Payer: BCBS Complete	$662.24
Rate for Payer: Mclaren Medicaid	$630.67
Rate for Payer: Meridian Medicaid	$662.24
Rate for Payer: Priority Health Choice Medicaid	$630.67
Rate for Payer: UHCCP Medicaid	$630.67

INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SINGLE LEVEL

Facility

$662.24

Service Code	CPT 64493
Hospital Revenue Code	360
Min. Negotiated Rate	$630.67
Max. Negotiated Rate	$662.24
Rate for Payer: BCBS Complete	$662.24
Rate for Payer: Mclaren Medicaid	$630.67
Rate for Payer: Meridian Medicaid	$662.24
Rate for Payer: Priority Health Choice Medicaid	$630.67
Rate for Payer: UHCCP Medicaid	$630.67

INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, INTERLAMINAR EPIDURAL OR SUBARACHNOID, LUMBAR OR SACRAL (CAUDAL); WITH IMAGING GUIDANCE (IE, FLUOROSCOPY OR CT)

Facility

$515.13

Service Code	CPT 62323
Hospital Revenue Code	360
Min. Negotiated Rate	$490.57
Max. Negotiated Rate	$515.13
Rate for Payer: BCBS Complete	$515.13
Rate for Payer: Mclaren Medicaid	$490.57
Rate for Payer: Meridian Medicaid	$515.13
Rate for Payer: Priority Health Choice Medicaid	$490.57
Rate for Payer: UHCCP Medicaid	$490.57

INJECTION(S), PLATELET RICH PLASMA, ANY SITE, INCLUDING IMAGE GUIDANCE, HARVESTING AND PREPARATION WHEN PERFORMED

Facility

$296.82

Service Code	CPT 0232T
Hospital Revenue Code	360
Min. Negotiated Rate	$282.67
Max. Negotiated Rate	$296.82
Rate for Payer: BCBS Complete	$296.82
Rate for Payer: Mclaren Medicaid	$282.67
Rate for Payer: Meridian Medicaid	$296.82
Rate for Payer: Priority Health Choice Medicaid	$282.67
Rate for Payer: UHCCP Medicaid	$282.67

INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 1 OR 2 MUSCLE(S)

Facility

$219.58

Service Code	CPT 20552
Hospital Revenue Code	360
Min. Negotiated Rate	$209.11
Max. Negotiated Rate	$219.58
Rate for Payer: BCBS Complete	$219.58
Rate for Payer: Mclaren Medicaid	$209.11
Rate for Payer: Meridian Medicaid	$219.58
Rate for Payer: Priority Health Choice Medicaid	$209.11
Rate for Payer: UHCCP Medicaid	$209.11

INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 3 OR MORE MUSCLES

Facility

$219.58

Service Code	CPT 20553
Hospital Revenue Code	360
Min. Negotiated Rate	$209.11
Max. Negotiated Rate	$219.58
Rate for Payer: BCBS Complete	$219.58
Rate for Payer: Mclaren Medicaid	$209.11
Rate for Payer: Meridian Medicaid	$219.58
Rate for Payer: Priority Health Choice Medicaid	$209.11
Rate for Payer: UHCCP Medicaid	$209.11

INJECTION(S); SINGLE TENDON ORIGIN/INSERTION

Facility

$219.58

Service Code	CPT 20551
Hospital Revenue Code	360
Min. Negotiated Rate	$209.11
Max. Negotiated Rate	$219.58
Rate for Payer: BCBS Complete	$219.58
Rate for Payer: Mclaren Medicaid	$209.11
Rate for Payer: Meridian Medicaid	$219.58
Rate for Payer: Priority Health Choice Medicaid	$209.11
Rate for Payer: UHCCP Medicaid	$209.11

INSULIN 5 UNIT/5 ML IV PUSH 5 ML

Facility

$20.00

Service Code	NDC 09900001138
Hospital Charge Code	300205
Hospital Revenue Code	637
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$17.00
Rate for Payer: BCBS Trust/PPO	$16.33
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 Commercial	$17.00
Rate for Payer: Nomi Health Commercial	$16.40
Rate for Payer: PHP Commercial	$17.00
Rate for Payer: Priority Health Cigna Priority Health	$13.00
Rate for Payer: Priority Health HMO/PPO	$17.40
Rate for Payer: Priority Health Narrow/Tiered Network	$13.40
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 5 UNIT/5 ML IV PUSH 5 ML

Facility

$20.00

Service Code	NDC 09900001138
Hospital Charge Code	300205
Hospital Revenue Code	637
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$17.00
Rate for Payer: Aetna Medicare	$5.20
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.25
Rate for Payer: Amish Plain Church Group Commercial	$6.25
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: BCBS MAPPO	$5.00
Rate for Payer: BCBS Trust/PPO	$16.44
Rate for Payer: BCN Commercial	$15.55
Rate for Payer: BCN Medicare Advantage	$5.00
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: Health Alliance Plan Medicare Advantage	$5.00
Rate for Payer: Healthscope Commercial	$18.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$15.00
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5.25
Rate for Payer: MI Amish Medical Board Commercial	$5.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.00
Rate for Payer: Nomi Health Commercial	$16.40
Rate for Payer: PACE Senior Care Partners	$4.75
Rate for Payer: PACE SWMI	$5.00
Rate for Payer: PHP Commercial	$17.00
Rate for Payer: PHP Medicare Advantage	$5.00
Rate for Payer: Priority Health Cigna Priority Health	$13.00
Rate for Payer: Priority Health HMO/PPO	$17.40
Rate for Payer: Priority Health Medicare	$5.05
Rate for Payer: Priority Health Narrow/Tiered Network	$13.40
Rate for Payer: Railroad Medicare Medicare	$5.00
Rate for Payer: UHC All Payor (Choice/PPO)	$17.60
Rate for Payer: UHC Core	$16.70
Rate for Payer: UHC Dual Complete DSNP	$5.00
Rate for Payer: UHC Exchange	$5.00
Rate for Payer: UHC Medicare Advantage	$5.00
Rate for Payer: VA VA	$5.00
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

$63.94

Service Code	NDC 73070010315
Hospital Charge Code	300798
Hospital Revenue Code	637
Min. Negotiated Rate	$15.19
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	$25.58
Rate for Payer: BCBS MAPPO	$15.98
Rate for Payer: BCBS Trust/PPO	$52.57
Rate for Payer: BCN Commercial	$49.71
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	$47.96
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$16.78
Rate for Payer: MI Amish Medical Board Commercial	$18.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.35
Rate for Payer: Nomi Health Commercial	$52.43
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 Cigna Priority Health	$41.56
Rate for Payer: Priority Health HMO/PPO	$55.63
Rate for Payer: Priority Health Medicare	$16.14
Rate for Payer: Priority Health Narrow/Tiered Network	$42.84
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 Dual Complete DSNP	$15.98
Rate for Payer: UHC Exchange	$15.98
Rate for Payer: UHC Medicare Advantage	$15.98
Rate for Payer: VA VA	$15.98
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$47.96

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

Facility

$63.94

Service Code	NDC 73070010310
Hospital Charge Code	300798
Hospital Revenue Code	637
Min. Negotiated Rate	$41.56
Max. Negotiated Rate	$57.55
Rate for Payer: Aetna Commercial	$54.35
Rate for Payer: BCBS Trust/PPO	$52.19
Rate for Payer: BCN Commercial	$49.41
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	$47.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.35
Rate for Payer: Nomi Health Commercial	$52.43
Rate for Payer: PHP Commercial	$54.35
Rate for Payer: Priority Health Cigna Priority Health	$41.56
Rate for Payer: Priority Health HMO/PPO	$55.63
Rate for Payer: Priority Health Narrow/Tiered Network	$42.84
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	$47.96

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

Facility

$63.94

Service Code	NDC 73070010315
Hospital Charge Code	300798
Hospital Revenue Code	637
Min. Negotiated Rate	$41.56
Max. Negotiated Rate	$57.55
Rate for Payer: Aetna Commercial	$54.35
Rate for Payer: BCBS Trust/PPO	$52.19
Rate for Payer: BCN Commercial	$49.41
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	$47.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.35
Rate for Payer: Nomi Health Commercial	$52.43
Rate for Payer: PHP Commercial	$54.35
Rate for Payer: Priority Health Cigna Priority Health	$41.56
Rate for Payer: Priority Health HMO/PPO	$55.63
Rate for Payer: Priority Health Narrow/Tiered Network	$42.84
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	$47.96

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

Facility

$63.94

Service Code	NDC 00169633910
Hospital Charge Code	300798
Hospital Revenue Code	637
Min. Negotiated Rate	$15.19
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	$25.58
Rate for Payer: BCBS MAPPO	$15.98
Rate for Payer: BCBS Trust/PPO	$52.57
Rate for Payer: BCN Commercial	$49.71
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	$47.96
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$16.78
Rate for Payer: MI Amish Medical Board Commercial	$18.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.35
Rate for Payer: Nomi Health Commercial	$52.43
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 Cigna Priority Health	$41.56
Rate for Payer: Priority Health HMO/PPO	$55.63
Rate for Payer: Priority Health Medicare	$16.14
Rate for Payer: Priority Health Narrow/Tiered Network	$42.84
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 Dual Complete DSNP	$15.98
Rate for Payer: UHC Exchange	$15.98
Rate for Payer: UHC Medicare Advantage	$15.98
Rate for Payer: VA VA	$15.98
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$47.96

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

Facility

$63.94

Service Code	NDC 73070010310
Hospital Charge Code	300798
Hospital Revenue Code	637
Min. Negotiated Rate	$15.19
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	$25.58
Rate for Payer: BCBS MAPPO	$15.98
Rate for Payer: BCBS Trust/PPO	$52.57
Rate for Payer: BCN Commercial	$49.71
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	$47.96
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$16.78
Rate for Payer: MI Amish Medical Board Commercial	$18.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.35
Rate for Payer: Nomi Health Commercial	$52.43
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 Cigna Priority Health	$41.56
Rate for Payer: Priority Health HMO/PPO	$55.63
Rate for Payer: Priority Health Medicare	$16.14
Rate for Payer: Priority Health Narrow/Tiered Network	$42.84
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 Dual Complete DSNP	$15.98
Rate for Payer: UHC Exchange	$15.98
Rate for Payer: UHC Medicare Advantage	$15.98
Rate for Payer: VA VA	$15.98
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$47.96

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

Facility

$63.94

Service Code	NDC 00169633910
Hospital Charge Code	300798
Hospital Revenue Code	637
Min. Negotiated Rate	$41.56
Max. Negotiated Rate	$57.55
Rate for Payer: Aetna Commercial	$54.35
Rate for Payer: BCBS Trust/PPO	$52.19
Rate for Payer: BCN Commercial	$49.41
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	$47.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.35
Rate for Payer: Nomi Health Commercial	$52.43
Rate for Payer: PHP Commercial	$54.35
Rate for Payer: Priority Health Cigna Priority Health	$41.56
Rate for Payer: Priority Health HMO/PPO	$55.63
Rate for Payer: Priority Health Narrow/Tiered Network	$42.84
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	$47.96

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

Facility

$63.94

Service Code	NDC 00169633910
Hospital Charge Code	300796
Hospital Revenue Code	637
Min. Negotiated Rate	$41.56
Max. Negotiated Rate	$57.55
Rate for Payer: Aetna Commercial	$54.35
Rate for Payer: BCBS Trust/PPO	$52.19
Rate for Payer: BCN Commercial	$49.41
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	$47.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.35
Rate for Payer: Nomi Health Commercial	$52.43
Rate for Payer: PHP Commercial	$54.35
Rate for Payer: Priority Health Cigna Priority Health	$41.56
Rate for Payer: Priority Health HMO/PPO	$55.63
Rate for Payer: Priority Health Narrow/Tiered Network	$42.84
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	$47.96

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

Facility

$63.94

Service Code	NDC 73070010315
Hospital Charge Code	300796
Hospital Revenue Code	637
Min. Negotiated Rate	$15.19
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	$25.58
Rate for Payer: BCBS MAPPO	$15.98
Rate for Payer: BCBS Trust/PPO	$52.57
Rate for Payer: BCN Commercial	$49.71
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	$47.96
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$16.78
Rate for Payer: MI Amish Medical Board Commercial	$18.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.35
Rate for Payer: Nomi Health Commercial	$52.43
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 Cigna Priority Health	$41.56
Rate for Payer: Priority Health HMO/PPO	$55.63
Rate for Payer: Priority Health Medicare	$16.14
Rate for Payer: Priority Health Narrow/Tiered Network	$42.84
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 Dual Complete DSNP	$15.98
Rate for Payer: UHC Exchange	$15.98
Rate for Payer: UHC Medicare Advantage	$15.98
Rate for Payer: VA VA	$15.98
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$47.96

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

Facility

$63.94

Service Code	NDC 73070010310
Hospital Charge Code	300796
Hospital Revenue Code	637
Min. Negotiated Rate	$15.19
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	$25.58
Rate for Payer: BCBS MAPPO	$15.98
Rate for Payer: BCBS Trust/PPO	$52.57
Rate for Payer: BCN Commercial	$49.71
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	$47.96
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$16.78
Rate for Payer: MI Amish Medical Board Commercial	$18.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.35
Rate for Payer: Nomi Health Commercial	$52.43
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 Cigna Priority Health	$41.56
Rate for Payer: Priority Health HMO/PPO	$55.63
Rate for Payer: Priority Health Medicare	$16.14
Rate for Payer: Priority Health Narrow/Tiered Network	$42.84
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 Dual Complete DSNP	$15.98
Rate for Payer: UHC Exchange	$15.98
Rate for Payer: UHC Medicare Advantage	$15.98
Rate for Payer: VA VA	$15.98
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$47.96

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

Facility

$63.94

Service Code	NDC 00169633910
Hospital Charge Code	300796
Hospital Revenue Code	637
Min. Negotiated Rate	$15.19
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	$25.58
Rate for Payer: BCBS MAPPO	$15.98
Rate for Payer: BCBS Trust/PPO	$52.57
Rate for Payer: BCN Commercial	$49.71
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	$47.96
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$16.78
Rate for Payer: MI Amish Medical Board Commercial	$18.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.35
Rate for Payer: Nomi Health Commercial	$52.43
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 Cigna Priority Health	$41.56
Rate for Payer: Priority Health HMO/PPO	$55.63
Rate for Payer: Priority Health Medicare	$16.14
Rate for Payer: Priority Health Narrow/Tiered Network	$42.84
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 Dual Complete DSNP	$15.98
Rate for Payer: UHC Exchange	$15.98
Rate for Payer: UHC Medicare Advantage	$15.98
Rate for Payer: VA VA	$15.98
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$47.96

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

Facility

$63.94

Service Code	NDC 73070010315
Hospital Charge Code	300796
Hospital Revenue Code	637
Min. Negotiated Rate	$41.56
Max. Negotiated Rate	$57.55
Rate for Payer: Aetna Commercial	$54.35
Rate for Payer: BCBS Trust/PPO	$52.19
Rate for Payer: BCN Commercial	$49.41
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	$47.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.35
Rate for Payer: Nomi Health Commercial	$52.43
Rate for Payer: PHP Commercial	$54.35
Rate for Payer: Priority Health Cigna Priority Health	$41.56
Rate for Payer: Priority Health HMO/PPO	$55.63
Rate for Payer: Priority Health Narrow/Tiered Network	$42.84
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	$47.96

Know your out-of-pocket cost for care.

All Charges