|
INSULIN ASPART U-100 100 UNIT/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$137.64
|
|
|
Service Code
|
NDC 00169750111
|
| Hospital Charge Code |
28534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.56 |
| Max. Negotiated Rate |
$123.88 |
| Rate for Payer: Aetna American Axle |
$89.47
|
| Rate for Payer: Aetna Commercial |
$116.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.47
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity Advantage |
$96.35
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$96.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.23
|
| Rate for Payer: PHP Commercial |
$116.99
|
| Rate for Payer: Priority Health SBD |
$86.71
|
| Rate for Payer: UMR Bronson Commercial |
$60.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.23
|
|
|
INSULIN ASPART U-100 100 UNIT/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$137.64
|
|
|
Service Code
|
NDC 00169750111
|
| Hospital Charge Code |
28534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.93 |
| Max. Negotiated Rate |
$123.88 |
| Rate for Payer: Aetna American Axle |
$89.47
|
| Rate for Payer: Aetna Commercial |
$116.99
|
| Rate for Payer: Aetna Medicare |
$68.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.47
|
| Rate for Payer: BCBS Complete |
$55.06
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity Advantage |
$96.35
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$96.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.23
|
| Rate for Payer: PHP Commercial |
$116.99
|
| Rate for Payer: Priority Health SBD |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.47
|
| Rate for Payer: UHC Core |
$71.71
|
| Rate for Payer: UHC Exchange |
$54.09
|
| Rate for Payer: UMR Bronson Commercial |
$50.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.23
|
|
|
INSULIN GLARGINE-AGLR (U-100) 100 UNIT/ML (3 ML) PEN CUSTOM PEDIATRIC
|
Facility
|
OP
|
$63.32
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
301779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$56.99 |
| Rate for Payer: Aetna American Axle |
$41.16
|
| Rate for Payer: Aetna Commercial |
$53.82
|
| Rate for Payer: Aetna Medicare |
$31.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.16
|
| Rate for Payer: BCBS Complete |
$25.33
|
| Rate for Payer: BCBS Trust/PPO |
$1.43
|
| Rate for Payer: BCN Commercial |
$1.43
|
| Rate for Payer: Cash Price |
$50.66
|
| Rate for Payer: Cash Price |
$50.66
|
| Rate for Payer: Cofinity Advantage |
$44.32
|
| Rate for Payer: Cofinity Commercial |
$54.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.66
|
| Rate for Payer: Healthscope Commercial |
$56.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.49
|
| Rate for Payer: PHP Commercial |
$53.82
|
| Rate for Payer: Priority Health SBD |
$39.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.16
|
| Rate for Payer: UHC Core |
$32.99
|
| Rate for Payer: UHC Exchange |
$24.88
|
| Rate for Payer: UMR Bronson Commercial |
$23.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.49
|
|
|
INSULIN GLARGINE-AGLR (U-100) 100 UNIT/ML (3 ML) PEN CUSTOM PEDIATRIC
|
Facility
|
IP
|
$63.32
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
301779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$56.99 |
| Rate for Payer: Aetna American Axle |
$41.16
|
| Rate for Payer: Aetna Commercial |
$53.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.16
|
| Rate for Payer: Cash Price |
$50.66
|
| Rate for Payer: Cofinity Advantage |
$44.32
|
| Rate for Payer: Cofinity Commercial |
$54.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.66
|
| Rate for Payer: Healthscope Commercial |
$56.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.49
|
| Rate for Payer: PHP Commercial |
$53.82
|
| Rate for Payer: Priority Health SBD |
$39.89
|
| Rate for Payer: UMR Bronson Commercial |
$27.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.49
|
|
|
INSULIN GLARGINE-AGLR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
IP
|
$63.32
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
203258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$56.99 |
| Rate for Payer: Aetna American Axle |
$41.16
|
| Rate for Payer: Aetna Commercial |
$53.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.16
|
| Rate for Payer: Cash Price |
$50.66
|
| Rate for Payer: Cofinity Advantage |
$44.32
|
| Rate for Payer: Cofinity Commercial |
$54.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.66
|
| Rate for Payer: Healthscope Commercial |
$56.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.49
|
| Rate for Payer: PHP Commercial |
$53.82
|
| Rate for Payer: Priority Health SBD |
$39.89
|
| Rate for Payer: UMR Bronson Commercial |
$27.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.49
|
|
|
INSULIN GLARGINE-AGLR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
OP
|
$63.32
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
203258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$56.99 |
| Rate for Payer: Aetna American Axle |
$41.16
|
| Rate for Payer: Aetna Commercial |
$53.82
|
| Rate for Payer: Aetna Medicare |
$31.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.16
|
| Rate for Payer: BCBS Complete |
$25.33
|
| Rate for Payer: BCBS Trust/PPO |
$1.43
|
| Rate for Payer: BCN Commercial |
$1.43
|
| Rate for Payer: Cash Price |
$50.66
|
| Rate for Payer: Cash Price |
$50.66
|
| Rate for Payer: Cofinity Advantage |
$44.32
|
| Rate for Payer: Cofinity Commercial |
$54.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.66
|
| Rate for Payer: Healthscope Commercial |
$56.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.49
|
| Rate for Payer: PHP Commercial |
$53.82
|
| Rate for Payer: Priority Health SBD |
$39.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.16
|
| Rate for Payer: UHC Core |
$32.99
|
| Rate for Payer: UHC Exchange |
$24.88
|
| Rate for Payer: UMR Bronson Commercial |
$23.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.49
|
|
|
INSULIN GLULISINE (U-100) 100 UNIT/MLÂ SQ FOR INSULIN PUMP REFILL
|
Facility
|
IP
|
$278.47
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
301807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.53 |
| Max. Negotiated Rate |
$250.62 |
| Rate for Payer: Aetna American Axle |
$181.01
|
| Rate for Payer: Aetna Commercial |
$236.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.01
|
| Rate for Payer: Cash Price |
$222.78
|
| Rate for Payer: Cofinity Advantage |
$194.93
|
| Rate for Payer: Cofinity Commercial |
$239.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.78
|
| Rate for Payer: Healthscope Commercial |
$250.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.85
|
| Rate for Payer: PHP Commercial |
$236.70
|
| Rate for Payer: Priority Health SBD |
$175.44
|
| Rate for Payer: UMR Bronson Commercial |
$122.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.85
|
|
|
INSULIN GLULISINE (U-100) 100 UNIT/MLÂ SQ FOR INSULIN PUMP REFILL
|
Facility
|
OP
|
$278.47
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
301807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$250.62 |
| Rate for Payer: Aetna American Axle |
$181.01
|
| Rate for Payer: Aetna Commercial |
$236.70
|
| Rate for Payer: Aetna Medicare |
$139.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.01
|
| Rate for Payer: BCBS Complete |
$111.39
|
| Rate for Payer: BCBS Trust/PPO |
$1.43
|
| Rate for Payer: BCN Commercial |
$1.43
|
| Rate for Payer: Cash Price |
$222.78
|
| Rate for Payer: Cash Price |
$222.78
|
| Rate for Payer: Cofinity Advantage |
$194.93
|
| Rate for Payer: Cofinity Commercial |
$239.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.78
|
| Rate for Payer: Healthscope Commercial |
$250.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.85
|
| Rate for Payer: PHP Commercial |
$236.70
|
| Rate for Payer: Priority Health SBD |
$175.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.01
|
| Rate for Payer: UHC Core |
$145.08
|
| Rate for Payer: UHC Exchange |
$109.44
|
| Rate for Payer: UMR Bronson Commercial |
$103.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.85
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML PEDIATRIC CARB BASED CORRECTION HALF-UNIT PEN
|
Facility
|
IP
|
$80.59
|
|
|
Service Code
|
NDC 00002775201
|
| Hospital Charge Code |
301623
|
|
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 Advantage |
$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 Commercial |
$68.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.44
|
| Rate for Payer: PHP Commercial |
$68.50
|
| 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 PEDIATRIC CARB BASED CORRECTION HALF-UNIT PEN
|
Facility
|
IP
|
$80.59
|
|
|
Service Code
|
NDC 00002775205
|
| Hospital Charge Code |
301623
|
|
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 Advantage |
$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 Commercial |
$68.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.44
|
| Rate for Payer: PHP Commercial |
$68.50
|
| 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 PEDIATRIC CARB BASED CORRECTION HALF-UNIT PEN
|
Facility
|
OP
|
$80.59
|
|
|
Service Code
|
NDC 00002775205
|
| Hospital Charge Code |
301623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna Medicare |
$40.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: BCBS Complete |
$32.24
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$64.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.44
|
| Rate for Payer: PHP Commercial |
$68.50
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.38
|
| Rate for Payer: UHC Core |
$41.99
|
| Rate for Payer: UHC Exchange |
$31.67
|
| Rate for Payer: UMR Bronson Commercial |
$29.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML PEDIATRIC CARB BASED CORRECTION HALF-UNIT PEN
|
Facility
|
OP
|
$80.59
|
|
|
Service Code
|
NDC 00002775201
|
| Hospital Charge Code |
301623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna Medicare |
$40.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: BCBS Complete |
$32.24
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$64.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.44
|
| Rate for Payer: PHP Commercial |
$68.50
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.38
|
| Rate for Payer: UHC Core |
$41.99
|
| Rate for Payer: UHC Exchange |
$31.67
|
| Rate for Payer: UMR Bronson Commercial |
$29.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/MLÂ SQ FOR INSULIN PUMP REFILL
|
Facility
|
IP
|
$167.65
|
|
|
Service Code
|
NDC 00002751001
|
| Hospital Charge Code |
301805
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.77 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna American Axle |
$108.97
|
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.97
|
| Rate for Payer: Cash Price |
$134.12
|
| Rate for Payer: Cofinity Advantage |
$117.36
|
| Rate for Payer: Cofinity Commercial |
$144.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.12
|
| Rate for Payer: Healthscope Commercial |
$150.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.74
|
| Rate for Payer: PHP Commercial |
$142.50
|
| Rate for Payer: Priority Health SBD |
$105.62
|
| Rate for Payer: UMR Bronson Commercial |
$73.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.74
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/MLÂ SQ FOR INSULIN PUMP REFILL
|
Facility
|
OP
|
$167.65
|
|
|
Service Code
|
NDC 00002751001
|
| Hospital Charge Code |
301805
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.03 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna American Axle |
$108.97
|
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare |
$83.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.97
|
| Rate for Payer: BCBS Complete |
$67.06
|
| Rate for Payer: Cash Price |
$134.12
|
| Rate for Payer: Cofinity Advantage |
$117.36
|
| Rate for Payer: Cofinity Commercial |
$144.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.12
|
| Rate for Payer: Healthscope Commercial |
$150.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.74
|
| Rate for Payer: PHP Commercial |
$142.50
|
| Rate for Payer: Priority Health SBD |
$105.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.97
|
| Rate for Payer: UHC Core |
$87.35
|
| Rate for Payer: UHC Exchange |
$65.89
|
| Rate for Payer: UMR Bronson Commercial |
$62.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.74
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS HALF-UNIT PEN
|
Facility
|
IP
|
$80.59
|
|
|
Service Code
|
NDC 00002771401
|
| 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 Advantage |
$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 Commercial |
$68.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.44
|
| Rate for Payer: PHP Commercial |
$68.50
|
| 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 00002775205
|
| 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 Advantage |
$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 Commercial |
$68.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.44
|
| Rate for Payer: PHP Commercial |
$68.50
|
| 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
|
OP
|
$80.59
|
|
|
Service Code
|
NDC 00002771459
|
| Hospital Charge Code |
184350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna Medicare |
$40.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: BCBS Complete |
$32.24
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$64.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.44
|
| Rate for Payer: PHP Commercial |
$68.50
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.38
|
| Rate for Payer: UHC Core |
$41.99
|
| Rate for Payer: UHC Exchange |
$31.67
|
| Rate for Payer: UMR Bronson Commercial |
$29.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS HALF-UNIT PEN
|
Facility
|
OP
|
$80.59
|
|
|
Service Code
|
NDC 00002771401
|
| Hospital Charge Code |
184350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna Medicare |
$40.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: BCBS Complete |
$32.24
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$64.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.44
|
| Rate for Payer: PHP Commercial |
$68.50
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.38
|
| Rate for Payer: UHC Core |
$41.99
|
| Rate for Payer: UHC Exchange |
$31.67
|
| Rate for Payer: UMR Bronson Commercial |
$29.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS HALF-UNIT PEN
|
Facility
|
OP
|
$80.59
|
|
|
Service Code
|
NDC 00002775205
|
| Hospital Charge Code |
184350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna Medicare |
$40.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: BCBS Complete |
$32.24
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$64.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.44
|
| Rate for Payer: PHP Commercial |
$68.50
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.38
|
| Rate for Payer: UHC Core |
$41.99
|
| Rate for Payer: UHC Exchange |
$31.67
|
| Rate for Payer: UMR Bronson Commercial |
$29.82
|
| 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 00002771459
|
| 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 Advantage |
$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 Commercial |
$68.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.44
|
| Rate for Payer: PHP Commercial |
$68.50
|
| 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 00002775201
|
| 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 Advantage |
$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 Commercial |
$68.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.44
|
| Rate for Payer: PHP Commercial |
$68.50
|
| 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
|
OP
|
$80.59
|
|
|
Service Code
|
NDC 00002775201
|
| Hospital Charge Code |
184350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna Medicare |
$40.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: BCBS Complete |
$32.24
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$64.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.44
|
| Rate for Payer: PHP Commercial |
$68.50
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.38
|
| Rate for Payer: UHC Core |
$41.99
|
| Rate for Payer: UHC Exchange |
$31.67
|
| Rate for Payer: UMR Bronson Commercial |
$29.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$167.65
|
|
|
Service Code
|
NDC 00002751001
|
| Hospital Charge Code |
17405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.03 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna American Axle |
$108.97
|
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare |
$83.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.97
|
| Rate for Payer: BCBS Complete |
$67.06
|
| Rate for Payer: Cash Price |
$134.12
|
| Rate for Payer: Cofinity Advantage |
$117.36
|
| Rate for Payer: Cofinity Commercial |
$144.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.12
|
| Rate for Payer: Healthscope Commercial |
$150.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.74
|
| Rate for Payer: PHP Commercial |
$142.50
|
| Rate for Payer: Priority Health SBD |
$105.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.97
|
| Rate for Payer: UHC Core |
$87.35
|
| Rate for Payer: UHC Exchange |
$65.89
|
| Rate for Payer: UMR Bronson Commercial |
$62.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.74
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$167.65
|
|
|
Service Code
|
NDC 00002751001
|
| Hospital Charge Code |
17405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.77 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna American Axle |
$108.97
|
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.97
|
| Rate for Payer: Cash Price |
$134.12
|
| Rate for Payer: Cofinity Advantage |
$117.36
|
| Rate for Payer: Cofinity Commercial |
$144.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.12
|
| Rate for Payer: Healthscope Commercial |
$150.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.74
|
| Rate for Payer: PHP Commercial |
$142.50
|
| Rate for Payer: Priority Health SBD |
$105.62
|
| Rate for Payer: UMR Bronson Commercial |
$73.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.74
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$167.65
|
|
|
Service Code
|
NDC 2751001
|
| Hospital Charge Code |
17405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.03 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna American Axle |
$108.97
|
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare |
$83.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.97
|
| Rate for Payer: BCBS Complete |
$67.06
|
| Rate for Payer: Cash Price |
$134.12
|
| Rate for Payer: Cofinity Advantage |
$117.36
|
| Rate for Payer: Cofinity Commercial |
$144.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.12
|
| Rate for Payer: Healthscope Commercial |
$150.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.74
|
| Rate for Payer: PHP Commercial |
$142.50
|
| Rate for Payer: Priority Health SBD |
$105.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.97
|
| Rate for Payer: UHC Core |
$87.35
|
| Rate for Payer: UHC Exchange |
$65.89
|
| Rate for Payer: UMR Bronson Commercial |
$62.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.74
|
|
