|
INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 1 OR 2 MUSCLE(S)
|
Facility
|
OP
|
$224.11
|
|
|
Service Code
|
CPT 20552
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$213.42 |
| Max. Negotiated Rate |
$224.11 |
| Rate for Payer: BCBS Complete |
$224.11
|
| Rate for Payer: Mclaren Medicaid |
$213.42
|
| Rate for Payer: Meridian Medicaid |
$224.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.42
|
| Rate for Payer: UHCCP Medicaid |
$213.42
|
|
|
INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 3 OR MORE MUSCLES
|
Facility
|
OP
|
$224.11
|
|
|
Service Code
|
CPT 20553
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$213.42 |
| Max. Negotiated Rate |
$224.11 |
| Rate for Payer: BCBS Complete |
$224.11
|
| Rate for Payer: Mclaren Medicaid |
$213.42
|
| Rate for Payer: Meridian Medicaid |
$224.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.42
|
| Rate for Payer: UHCCP Medicaid |
$213.42
|
|
|
INJECTION(S); SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$224.11
|
|
|
Service Code
|
CPT 20551
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$213.42 |
| Max. Negotiated Rate |
$224.11 |
| Rate for Payer: BCBS Complete |
$224.11
|
| Rate for Payer: Mclaren Medicaid |
$213.42
|
| Rate for Payer: Meridian Medicaid |
$224.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.42
|
| Rate for Payer: UHCCP Medicaid |
$213.42
|
|
|
INSULIN 5 UNIT/5 ML IV PUSH 5 ML
|
Facility
|
IP
|
$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
|
OP
|
$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
|
OP
|
$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 |
$47.95
|
| 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 |
$47.95
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$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 |
$47.95
|
| 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 |
$47.95
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$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 |
$47.95
|
| 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 |
$47.95
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$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 |
$47.95
|
| 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 |
$47.95
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$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 |
$47.95
|
| 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 |
$47.95
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$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 |
$47.95
|
| 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 |
$47.95
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 73070010310
|
| 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 |
$47.95
|
| 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 |
$47.95
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$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 |
$47.95
|
| 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 |
$47.95
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$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 |
$47.95
|
| 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 |
$47.95
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$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 |
$47.95
|
| 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 |
$47.95
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$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 |
$47.95
|
| 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 |
$47.95
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$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 |
$47.95
|
| 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 |
$47.95
|
|
|
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 |
$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 |
$47.95
|
| 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 |
$47.95
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
300797
|
|
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 |
$47.95
|
| 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 |
$47.95
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
300797
|
|
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 |
$47.95
|
| 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 |
$47.95
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
300797
|
|
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 |
$47.95
|
| 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 |
$47.95
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
300797
|
|
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 |
$47.95
|
| 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 |
$47.95
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
300797
|
|
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 |
$47.95
|
| 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 |
$47.95
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
112756
|
|
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 |
$47.95
|
| 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 |
$47.95
|
|
|
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 |
$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 |
$47.95
|
| 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 |
$47.95
|
|
