|
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 |
$188.65 |
| Max. Negotiated Rate |
$261.21 |
| Rate for Payer: Aetna Commercial |
$246.70
|
| Rate for Payer: BCBS Trust/PPO |
$236.91
|
| Rate for Payer: BCN Commercial |
$224.29
|
| 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: PHP Commercial |
$246.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.65
|
| Rate for Payer: Priority Health HMO/PPO |
$252.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$194.45
|
| 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 - LISPRO (HUMALOG)
|
Facility
|
OP
|
$46.55
|
|
|
Service Code
|
NDC 00002751017
|
| Hospital Charge Code |
180914
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.06 |
| 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 |
$18.62
|
| Rate for Payer: BCBS MAPPO |
$11.64
|
| Rate for Payer: BCBS Trust/PPO |
$38.27
|
| Rate for Payer: BCN Commercial |
$36.19
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.57
|
| Rate for Payer: Nomi Health Commercial |
$38.17
|
| 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 Cigna Priority Health |
$30.26
|
| Rate for Payer: Priority Health HMO/PPO |
$40.50
|
| Rate for Payer: Priority Health Medicare |
$11.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.19
|
| 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 Dual Complete DSNP |
$11.64
|
| Rate for Payer: UHC Exchange |
$11.64
|
| Rate for Payer: UHC Medicare Advantage |
$11.64
|
| 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 |
$30.26 |
| Max. Negotiated Rate |
$41.90 |
| Rate for Payer: Aetna Commercial |
$39.57
|
| Rate for Payer: BCBS Trust/PPO |
$38.00
|
| Rate for Payer: BCN Commercial |
$35.97
|
| 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: PHP Commercial |
$39.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.26
|
| Rate for Payer: Priority Health HMO/PPO |
$40.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.19
|
| 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 |
$1,203.08 |
| 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 |
$2,026.24
|
| Rate for Payer: BCBS MAPPO |
$1,266.40
|
| Rate for Payer: BCBS Trust/PPO |
$4,164.43
|
| Rate for Payer: BCN Commercial |
$3,938.50
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,329.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,456.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,305.76
|
| Rate for Payer: Nomi Health Commercial |
$4,153.79
|
| 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 Cigna Priority Health |
$3,292.64
|
| Rate for Payer: Priority Health HMO/PPO |
$4,407.07
|
| Rate for Payer: Priority Health Medicare |
$1,279.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,393.95
|
| 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 Dual Complete DSNP |
$1,266.40
|
| Rate for Payer: UHC Exchange |
$1,266.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,266.40
|
| 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 |
$3,292.64 |
| Max. Negotiated Rate |
$4,559.04 |
| Rate for Payer: Aetna Commercial |
$4,305.76
|
| Rate for Payer: BCBS Trust/PPO |
$4,135.05
|
| Rate for Payer: BCN Commercial |
$3,914.70
|
| 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: PHP Commercial |
$4,305.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,292.64
|
| Rate for Payer: Priority Health HMO/PPO |
$4,407.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,393.95
|
| 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 |
$33.53 |
| 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 |
$56.46
|
| Rate for Payer: BCBS MAPPO |
$35.29
|
| Rate for Payer: BCBS Trust/PPO |
$116.05
|
| Rate for Payer: BCN Commercial |
$109.75
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.99
|
| Rate for Payer: Nomi Health Commercial |
$115.75
|
| 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 Cigna Priority Health |
$91.75
|
| Rate for Payer: Priority Health HMO/PPO |
$122.81
|
| Rate for Payer: Priority Health Medicare |
$35.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.58
|
| 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 Dual Complete DSNP |
$35.29
|
| Rate for Payer: UHC Exchange |
$35.29
|
| Rate for Payer: UHC Medicare Advantage |
$35.29
|
| 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 |
$91.75 |
| Max. Negotiated Rate |
$127.04 |
| Rate for Payer: Aetna Commercial |
$119.99
|
| Rate for Payer: BCBS Trust/PPO |
$115.23
|
| Rate for Payer: BCN Commercial |
$109.09
|
| 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: PHP Commercial |
$119.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.75
|
| Rate for Payer: Priority Health HMO/PPO |
$122.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.58
|
| 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
|
IP
|
$137.64
|
|
|
Service Code
|
NDC 00169750111
|
| Hospital Charge Code |
180912
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.47 |
| Max. Negotiated Rate |
$123.88 |
| Rate for Payer: Aetna Commercial |
$116.99
|
| Rate for Payer: BCBS Trust/PPO |
$112.36
|
| Rate for Payer: BCN Commercial |
$106.37
|
| 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: PHP Commercial |
$116.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.47
|
| Rate for Payer: Priority Health HMO/PPO |
$119.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.22
|
| 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 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 |
$32.69 |
| 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 |
$55.06
|
| Rate for Payer: BCBS MAPPO |
$34.41
|
| Rate for Payer: BCBS Trust/PPO |
$113.15
|
| Rate for Payer: BCN Commercial |
$107.02
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.99
|
| Rate for Payer: Nomi Health Commercial |
$112.86
|
| 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 Cigna Priority Health |
$89.47
|
| Rate for Payer: Priority Health HMO/PPO |
$119.75
|
| Rate for Payer: Priority Health Medicare |
$34.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.22
|
| 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 Dual Complete DSNP |
$34.41
|
| Rate for Payer: UHC Exchange |
$34.41
|
| Rate for Payer: UHC Medicare Advantage |
$34.41
|
| Rate for Payer: VA VA |
$34.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.23
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$141.16
|
|
|
Service Code
|
NDC 00169183311
|
| Hospital Charge Code |
10289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.53 |
| 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 |
$56.46
|
| Rate for Payer: BCBS MAPPO |
$35.29
|
| Rate for Payer: BCBS Trust/PPO |
$116.05
|
| Rate for Payer: BCN Commercial |
$109.75
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.99
|
| Rate for Payer: Nomi Health Commercial |
$115.75
|
| 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 Cigna Priority Health |
$91.75
|
| Rate for Payer: Priority Health HMO/PPO |
$122.81
|
| Rate for Payer: Priority Health Medicare |
$35.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.58
|
| 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 Dual Complete DSNP |
$35.29
|
| Rate for Payer: UHC Exchange |
$35.29
|
| Rate for Payer: UHC Medicare Advantage |
$35.29
|
| Rate for Payer: VA VA |
$35.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.87
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$19.46
|
|
|
Service Code
|
NDC 00002821517
|
| Hospital Charge Code |
10289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.62 |
| 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 |
$7.78
|
| Rate for Payer: BCBS MAPPO |
$4.87
|
| Rate for Payer: BCBS Trust/PPO |
$16.00
|
| Rate for Payer: BCN Commercial |
$15.13
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.54
|
| Rate for Payer: Nomi Health Commercial |
$15.96
|
| 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 Cigna Priority Health |
$12.65
|
| Rate for Payer: Priority Health HMO/PPO |
$16.93
|
| Rate for Payer: Priority Health Medicare |
$4.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.04
|
| 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 Dual Complete DSNP |
$4.87
|
| Rate for Payer: UHC Exchange |
$4.87
|
| Rate for Payer: UHC Medicare Advantage |
$4.87
|
| Rate for Payer: VA VA |
$4.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.60
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$19.46
|
|
|
Service Code
|
NDC 00002821517
|
| Hospital Charge Code |
10289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.65 |
| Max. Negotiated Rate |
$17.51 |
| Rate for Payer: Aetna Commercial |
$16.54
|
| Rate for Payer: BCBS Trust/PPO |
$15.89
|
| Rate for Payer: BCN Commercial |
$15.04
|
| Rate for Payer: Cash Price |
$15.57
|
| Rate for Payer: Cofinity Commercial |
$16.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.57
|
| Rate for Payer: Healthscope Commercial |
$17.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.54
|
| Rate for Payer: Nomi Health Commercial |
$15.96
|
| Rate for Payer: PHP Commercial |
$16.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.65
|
| Rate for Payer: Priority Health HMO/PPO |
$16.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.12
|
| Rate for Payer: UHC Core |
$16.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.60
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$141.16
|
|
|
Service Code
|
NDC 00169183311
|
| Hospital Charge Code |
10289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.75 |
| Max. Negotiated Rate |
$127.04 |
| Rate for Payer: Aetna Commercial |
$119.99
|
| Rate for Payer: BCBS Trust/PPO |
$115.23
|
| Rate for Payer: BCN Commercial |
$109.09
|
| 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: PHP Commercial |
$119.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.75
|
| Rate for Payer: Priority Health HMO/PPO |
$122.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.58
|
| 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 |
$33.53 |
| 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 |
$56.46
|
| Rate for Payer: BCBS MAPPO |
$35.29
|
| Rate for Payer: BCBS Trust/PPO |
$116.05
|
| Rate for Payer: BCN Commercial |
$109.75
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.99
|
| Rate for Payer: Nomi Health Commercial |
$115.75
|
| 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 Cigna Priority Health |
$91.75
|
| Rate for Payer: Priority Health HMO/PPO |
$122.81
|
| Rate for Payer: Priority Health Medicare |
$35.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.58
|
| 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 Dual Complete DSNP |
$35.29
|
| Rate for Payer: UHC Exchange |
$35.29
|
| Rate for Payer: UHC Medicare Advantage |
$35.29
|
| Rate for Payer: VA VA |
$35.29
|
| 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
|
IP
|
$141.16
|
|
|
Service Code
|
NDC 00169183311
|
| Hospital Charge Code |
301806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.75 |
| Max. Negotiated Rate |
$127.04 |
| Rate for Payer: Aetna Commercial |
$119.99
|
| Rate for Payer: BCBS Trust/PPO |
$115.23
|
| Rate for Payer: BCN Commercial |
$109.09
|
| 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: PHP Commercial |
$119.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.75
|
| Rate for Payer: Priority Health HMO/PPO |
$122.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.58
|
| 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
|
|
|
IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION
|
Facility
|
OP
|
$116.55
|
|
|
Service Code
|
NDC 48433023015
|
| Hospital Charge Code |
108150
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$104.89 |
| Rate for Payer: Aetna Commercial |
$99.07
|
| Rate for Payer: Aetna Medicare |
$30.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.42
|
| Rate for Payer: BCBS Complete |
$46.62
|
| Rate for Payer: BCBS MAPPO |
$29.14
|
| Rate for Payer: BCBS Trust/PPO |
$95.82
|
| Rate for Payer: BCN Commercial |
$90.62
|
| Rate for Payer: BCN Medicare Advantage |
$29.14
|
| Rate for Payer: Cash Price |
$93.24
|
| Rate for Payer: Cofinity Commercial |
$100.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.14
|
| Rate for Payer: Healthscope Commercial |
$104.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.07
|
| Rate for Payer: Nomi Health Commercial |
$95.57
|
| Rate for Payer: PACE Senior Care Partners |
$27.68
|
| Rate for Payer: PACE SWMI |
$29.14
|
| Rate for Payer: PHP Commercial |
$99.07
|
| Rate for Payer: PHP Medicare Advantage |
$29.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.76
|
| Rate for Payer: Priority Health HMO/PPO |
$101.40
|
| Rate for Payer: Priority Health Medicare |
$29.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.09
|
| Rate for Payer: Railroad Medicare Medicare |
$29.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.56
|
| Rate for Payer: UHC Core |
$97.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.14
|
| Rate for Payer: UHC Exchange |
$29.14
|
| Rate for Payer: UHC Medicare Advantage |
$29.14
|
| Rate for Payer: VA VA |
$29.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.41
|
|
|
IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION
|
Facility
|
IP
|
$116.55
|
|
|
Service Code
|
NDC 48433023015
|
| Hospital Charge Code |
108150
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.76 |
| Max. Negotiated Rate |
$104.89 |
| Rate for Payer: Aetna Commercial |
$99.07
|
| Rate for Payer: BCBS Trust/PPO |
$95.14
|
| Rate for Payer: BCN Commercial |
$90.07
|
| Rate for Payer: Cash Price |
$93.24
|
| Rate for Payer: Cofinity Commercial |
$100.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.24
|
| Rate for Payer: Healthscope Commercial |
$104.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.07
|
| Rate for Payer: Nomi Health Commercial |
$95.57
|
| Rate for Payer: PHP Commercial |
$99.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.76
|
| Rate for Payer: Priority Health HMO/PPO |
$101.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.56
|
| Rate for Payer: UHC Core |
$97.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.41
|
|
|
IPL CHEEKS FIRST
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 00126
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
|
|
IPL CHEST FIRST
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00128
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
|
|
IPL CHEST SECOND
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 00129
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
|
|
IPL FACE FIRST
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 00130
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$149.50 |
| Rate for Payer: Aetna Medicare |
$115.00
|
| Rate for Payer: BCBS Complete |
$92.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.50
|
|
|
IPL FACE, NECK, CHEST FIRST
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 00132
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
|
|
IPL FACE, NECK, CHEST SECOND
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 00133
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
|
|
IPL FACE & NECK FIRST
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00134
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
IPL FACE & NECK SECOND
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 00135
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$116.35 |
| Rate for Payer: Aetna Medicare |
$89.50
|
| Rate for Payer: BCBS Complete |
$71.60
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.35
|
|
