|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 0169-6339-10
|
| Hospital Charge Code |
300797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna American Axle |
$75.17
|
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Commercial |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.29
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.95
|
| Rate for Payer: Priority Health SBD |
$72.85
|
| Rate for Payer: UMR Bronson Commercial |
$50.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.73
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 0169-6339-10
|
| Hospital Charge Code |
301083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna American Axle |
$75.17
|
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Commercial |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.29
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.95
|
| Rate for Payer: Priority Health SBD |
$72.85
|
| Rate for Payer: UMR Bronson Commercial |
$50.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.73
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 73070-103-10
|
| Hospital Charge Code |
112756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna American Axle |
$75.17
|
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Commercial |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.29
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.95
|
| Rate for Payer: Priority Health SBD |
$72.85
|
| Rate for Payer: UMR Bronson Commercial |
$50.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.73
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 0169-6339-10
|
| Hospital Charge Code |
112756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna American Axle |
$75.17
|
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Cofinity Commercial |
$80.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.29
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.95
|
| Rate for Payer: Priority Health SBD |
$72.85
|
| Rate for Payer: UMR Bronson Commercial |
$50.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.73
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 73070-103-15
|
| Hospital Charge Code |
112756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna American Axle |
$75.17
|
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Commercial |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.29
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.95
|
| Rate for Payer: Priority Health SBD |
$72.85
|
| Rate for Payer: UMR Bronson Commercial |
$50.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.73
|
|
|
INSULIN ASPART U-100 100 UNIT/ML (MDV ADS)
|
Facility
|
OP
|
$248.94
|
|
|
Service Code
|
NDC 73070-100-11
|
| Hospital Charge Code |
300258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.11 |
| Max. Negotiated Rate |
$224.05 |
| Rate for Payer: Aetna American Axle |
$161.81
|
| Rate for Payer: Aetna Commercial |
$211.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.81
|
| Rate for Payer: BCBS Complete |
$99.58
|
| Rate for Payer: Cash Price |
$199.15
|
| Rate for Payer: Cofinity Commercial |
$174.26
|
| Rate for Payer: Cofinity Commercial |
$214.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.15
|
| Rate for Payer: Healthscope Commercial |
$224.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.60
|
| Rate for Payer: PHP Commercial |
$211.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.26
|
| Rate for Payer: Priority Health SBD |
$156.83
|
| Rate for Payer: UMR Bronson Commercial |
$92.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.70
|
|
|
INSULIN ASPART U-100 100 UNIT/ML SUBCUTANEOUS CARTRIDGE
|
Facility
|
IP
|
$92.48
|
|
|
Service Code
|
NDC 0169-3303-12
|
| Hospital Charge Code |
111375
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.69 |
| Max. Negotiated Rate |
$83.23 |
| Rate for Payer: Aetna American Axle |
$60.11
|
| Rate for Payer: Aetna Commercial |
$78.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.11
|
| Rate for Payer: Cash Price |
$73.98
|
| Rate for Payer: Cofinity Commercial |
$64.74
|
| Rate for Payer: Cofinity Commercial |
$79.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.98
|
| Rate for Payer: Healthscope Commercial |
$83.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.61
|
| Rate for Payer: PHP Commercial |
$78.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.74
|
| Rate for Payer: Priority Health SBD |
$58.26
|
| Rate for Payer: UMR Bronson Commercial |
$40.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.36
|
|
|
INSULIN ASPART U-100 100 UNIT/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$248.94
|
|
|
Service Code
|
NDC 0169-7501-11
|
| Hospital Charge Code |
28534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.53 |
| Max. Negotiated Rate |
$224.05 |
| Rate for Payer: Aetna American Axle |
$161.81
|
| Rate for Payer: Aetna Commercial |
$211.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.81
|
| Rate for Payer: Cash Price |
$199.15
|
| Rate for Payer: Cofinity Commercial |
$174.26
|
| Rate for Payer: Cofinity Commercial |
$214.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.15
|
| Rate for Payer: Healthscope Commercial |
$224.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.60
|
| Rate for Payer: PHP Commercial |
$211.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.26
|
| Rate for Payer: Priority Health SBD |
$156.83
|
| Rate for Payer: UMR Bronson Commercial |
$109.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.70
|
|
|
INSULIN DETEMIR 100 UNIT/ML SUBCUTANEOUS (HOSPITAL USE BULK)
|
Facility
|
IP
|
$311.77
|
|
|
Service Code
|
NDC 0169-3687-12
|
| Hospital Charge Code |
180051
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.18 |
| Max. Negotiated Rate |
$280.59 |
| Rate for Payer: Aetna American Axle |
$202.65
|
| Rate for Payer: Aetna Commercial |
$265.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.65
|
| Rate for Payer: Cash Price |
$249.42
|
| Rate for Payer: Cofinity Commercial |
$218.24
|
| Rate for Payer: Cofinity Commercial |
$268.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.42
|
| Rate for Payer: Healthscope Commercial |
$280.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$265.00
|
| Rate for Payer: PHP Commercial |
$265.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.24
|
| Rate for Payer: Priority Health SBD |
$196.42
|
| Rate for Payer: UMR Bronson Commercial |
$137.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.83
|
|
|
INSULIN DETEMIR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
IP
|
$111.34
|
|
|
Service Code
|
NDC 0169-6432-55
|
| Hospital Charge Code |
116361
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.99 |
| Max. Negotiated Rate |
$100.21 |
| Rate for Payer: Aetna American Axle |
$72.37
|
| Rate for Payer: Aetna Commercial |
$94.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.37
|
| Rate for Payer: Cash Price |
$89.07
|
| Rate for Payer: Cofinity Commercial |
$77.94
|
| Rate for Payer: Cofinity Commercial |
$95.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.07
|
| Rate for Payer: Healthscope Commercial |
$100.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.64
|
| Rate for Payer: PHP Commercial |
$94.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.94
|
| Rate for Payer: Priority Health SBD |
$70.14
|
| Rate for Payer: UMR Bronson Commercial |
$48.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.50
|
|
|
INSULIN DETEMIR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
IP
|
$111.34
|
|
|
Service Code
|
NDC 0169-6432-10
|
| Hospital Charge Code |
116361
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.99 |
| Max. Negotiated Rate |
$100.21 |
| Rate for Payer: Aetna American Axle |
$72.37
|
| Rate for Payer: Aetna Commercial |
$94.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.37
|
| Rate for Payer: Cash Price |
$89.07
|
| Rate for Payer: Cofinity Commercial |
$77.94
|
| Rate for Payer: Cofinity Commercial |
$95.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.07
|
| Rate for Payer: Healthscope Commercial |
$100.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.64
|
| Rate for Payer: PHP Commercial |
$94.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.94
|
| Rate for Payer: Priority Health SBD |
$70.14
|
| Rate for Payer: UMR Bronson Commercial |
$48.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.50
|
|
|
INSULIN DETEMIR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
IP
|
$97.49
|
|
|
Service Code
|
NDC 0169-6438-90
|
| Hospital Charge Code |
116361
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$87.74 |
| Rate for Payer: Aetna American Axle |
$63.37
|
| Rate for Payer: Aetna Commercial |
$82.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.37
|
| Rate for Payer: Cash Price |
$77.99
|
| Rate for Payer: Cofinity Commercial |
$68.24
|
| Rate for Payer: Cofinity Commercial |
$83.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.99
|
| Rate for Payer: Healthscope Commercial |
$87.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.87
|
| Rate for Payer: PHP Commercial |
$82.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.24
|
| Rate for Payer: Priority Health SBD |
$61.42
|
| Rate for Payer: UMR Bronson Commercial |
$42.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.12
|
|
|
INSULIN DETEMIR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
IP
|
$97.49
|
|
|
Service Code
|
NDC 0169-6438-10
|
| Hospital Charge Code |
116361
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$87.74 |
| Rate for Payer: Aetna American Axle |
$63.37
|
| Rate for Payer: Aetna Commercial |
$82.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.37
|
| Rate for Payer: Cash Price |
$77.99
|
| Rate for Payer: Cofinity Commercial |
$68.24
|
| Rate for Payer: Cofinity Commercial |
$83.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.99
|
| Rate for Payer: Healthscope Commercial |
$87.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.87
|
| Rate for Payer: PHP Commercial |
$82.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.24
|
| Rate for Payer: Priority Health SBD |
$61.42
|
| Rate for Payer: UMR Bronson Commercial |
$42.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.12
|
|
|
INSULIN DETEMIR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$111.34
|
|
|
Service Code
|
NDC 0169-6432-10
|
| Hospital Charge Code |
301467
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.99 |
| Max. Negotiated Rate |
$100.21 |
| Rate for Payer: Aetna American Axle |
$72.37
|
| Rate for Payer: Aetna Commercial |
$94.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.37
|
| Rate for Payer: Cash Price |
$89.07
|
| Rate for Payer: Cofinity Commercial |
$77.94
|
| Rate for Payer: Cofinity Commercial |
$95.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.07
|
| Rate for Payer: Healthscope Commercial |
$100.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.64
|
| Rate for Payer: PHP Commercial |
$94.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.94
|
| Rate for Payer: Priority Health SBD |
$70.14
|
| Rate for Payer: UMR Bronson Commercial |
$48.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.50
|
|
|
INSULIN DETEMIR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$111.34
|
|
|
Service Code
|
NDC 0169-6432-55
|
| Hospital Charge Code |
301467
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.99 |
| Max. Negotiated Rate |
$100.21 |
| Rate for Payer: Aetna American Axle |
$72.37
|
| Rate for Payer: Aetna Commercial |
$94.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.37
|
| Rate for Payer: Cash Price |
$89.07
|
| Rate for Payer: Cofinity Commercial |
$77.94
|
| Rate for Payer: Cofinity Commercial |
$95.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.07
|
| Rate for Payer: Healthscope Commercial |
$100.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.64
|
| Rate for Payer: PHP Commercial |
$94.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.94
|
| Rate for Payer: Priority Health SBD |
$70.14
|
| Rate for Payer: UMR Bronson Commercial |
$48.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.50
|
|
|
INSULIN DETEMIR (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$311.77
|
|
|
Service Code
|
NDC 0169-3687-12
|
| Hospital Charge Code |
70261
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.18 |
| Max. Negotiated Rate |
$280.59 |
| Rate for Payer: Aetna American Axle |
$202.65
|
| Rate for Payer: Aetna Commercial |
$265.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.65
|
| Rate for Payer: Cash Price |
$249.42
|
| Rate for Payer: Cofinity Commercial |
$218.24
|
| Rate for Payer: Cofinity Commercial |
$268.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.42
|
| Rate for Payer: Healthscope Commercial |
$280.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$265.00
|
| Rate for Payer: PHP Commercial |
$265.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.24
|
| Rate for Payer: Priority Health SBD |
$196.42
|
| Rate for Payer: UMR Bronson Commercial |
$137.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.83
|
|
|
INSULIN GLARGINE 100 UNIT/ML SUB-Q (HOSPITAL USE BULK)
|
Facility
|
IP
|
$211.05
|
|
|
Service Code
|
NDC 0088-2220-33
|
| Hospital Charge Code |
166384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.86 |
| Max. Negotiated Rate |
$189.94 |
| Rate for Payer: Aetna American Axle |
$137.18
|
| Rate for Payer: Aetna Commercial |
$179.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.18
|
| Rate for Payer: Cash Price |
$168.84
|
| Rate for Payer: Cofinity Commercial |
$147.74
|
| Rate for Payer: Cofinity Commercial |
$181.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.84
|
| Rate for Payer: Healthscope Commercial |
$189.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.39
|
| Rate for Payer: PHP Commercial |
$179.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.74
|
| Rate for Payer: Priority Health SBD |
$132.96
|
| Rate for Payer: UMR Bronson Commercial |
$92.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.29
|
|
|
INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$211.05
|
|
|
Service Code
|
NDC 0088-2220-33
|
| Hospital Charge Code |
28282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.86 |
| Max. Negotiated Rate |
$189.94 |
| Rate for Payer: Aetna American Axle |
$137.18
|
| Rate for Payer: Aetna Commercial |
$179.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.18
|
| Rate for Payer: Cash Price |
$168.84
|
| Rate for Payer: Cofinity Commercial |
$147.74
|
| Rate for Payer: Cofinity Commercial |
$181.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.84
|
| Rate for Payer: Healthscope Commercial |
$189.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.39
|
| Rate for Payer: PHP Commercial |
$179.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.74
|
| Rate for Payer: Priority Health SBD |
$132.96
|
| Rate for Payer: UMR Bronson Commercial |
$92.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.29
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS HALF-UNIT PEN
|
Facility
|
IP
|
$80.59
|
|
|
Service Code
|
NDC 0002-7714-59
|
| Hospital Charge Code |
184350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.46 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity Commercial |
$56.41
|
| Rate for Payer: Cofinity Commercial |
$69.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.47
|
| Rate for Payer: Healthscope Commercial |
$72.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.50
|
| Rate for Payer: PHP Commercial |
$68.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.41
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: UMR Bronson Commercial |
$35.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS HALF-UNIT PEN
|
Facility
|
IP
|
$80.59
|
|
|
Service Code
|
NDC 0002-7752-05
|
| Hospital Charge Code |
184350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.46 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity Commercial |
$56.41
|
| Rate for Payer: Cofinity Commercial |
$69.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.47
|
| Rate for Payer: Healthscope Commercial |
$72.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.50
|
| Rate for Payer: PHP Commercial |
$68.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.41
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: UMR Bronson Commercial |
$35.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS HALF-UNIT PEN
|
Facility
|
IP
|
$80.59
|
|
|
Service Code
|
NDC 0002-7714-01
|
| Hospital Charge Code |
184350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.46 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity Commercial |
$56.41
|
| Rate for Payer: Cofinity Commercial |
$69.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.47
|
| Rate for Payer: Healthscope Commercial |
$72.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.50
|
| Rate for Payer: PHP Commercial |
$68.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.41
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: UMR Bronson Commercial |
$35.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS HALF-UNIT PEN
|
Facility
|
IP
|
$80.59
|
|
|
Service Code
|
NDC 0002-7752-01
|
| Hospital Charge Code |
184350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.46 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity Commercial |
$56.41
|
| Rate for Payer: Cofinity Commercial |
$69.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.47
|
| Rate for Payer: Healthscope Commercial |
$72.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.50
|
| Rate for Payer: PHP Commercial |
$68.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.41
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: UMR Bronson Commercial |
$35.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN
|
Facility
|
IP
|
$80.59
|
|
|
Service Code
|
NDC 0002-8222-01
|
| Hospital Charge Code |
111377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.46 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity Commercial |
$56.41
|
| Rate for Payer: Cofinity Commercial |
$69.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.47
|
| Rate for Payer: Healthscope Commercial |
$72.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.50
|
| Rate for Payer: PHP Commercial |
$68.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.41
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: UMR Bronson Commercial |
$35.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN
|
Facility
|
IP
|
$80.59
|
|
|
Service Code
|
NDC 0002-8799-59
|
| Hospital Charge Code |
111377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.46 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity Commercial |
$56.41
|
| Rate for Payer: Cofinity Commercial |
$69.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.47
|
| Rate for Payer: Healthscope Commercial |
$72.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.50
|
| Rate for Payer: PHP Commercial |
$68.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.41
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: UMR Bronson Commercial |
$35.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN
|
Facility
|
IP
|
$80.59
|
|
|
Service Code
|
NDC 0002-8222-59
|
| Hospital Charge Code |
111377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.46 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity Commercial |
$56.41
|
| Rate for Payer: Cofinity Commercial |
$69.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.47
|
| Rate for Payer: Healthscope Commercial |
$72.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.50
|
| Rate for Payer: PHP Commercial |
$68.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.41
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: UMR Bronson Commercial |
$35.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
