|
INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION
|
Facility
|
OP
|
$141.16
|
|
|
Service Code
|
NDC 00169183411
|
| Hospital Charge Code |
10284
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.23 |
| Max. Negotiated Rate |
$127.04 |
| Rate for Payer: Aetna American Axle |
$91.75
|
| Rate for Payer: Aetna Commercial |
$119.99
|
| Rate for Payer: Aetna Medicare |
$70.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.75
|
| Rate for Payer: BCBS Complete |
$56.46
|
| Rate for Payer: Cash Price |
$112.93
|
| Rate for Payer: Cofinity Advantage |
$98.81
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$98.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.87
|
| Rate for Payer: PHP Commercial |
$119.99
|
| Rate for Payer: Priority Health SBD |
$88.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.75
|
| Rate for Payer: UHC Core |
$73.54
|
| Rate for Payer: UHC Exchange |
$55.48
|
| Rate for Payer: UMR Bronson Commercial |
$52.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.87
|
|
|
INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION
|
Facility
|
IP
|
$141.16
|
|
|
Service Code
|
NDC 00169183411
|
| Hospital Charge Code |
10284
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.11 |
| Max. Negotiated Rate |
$127.04 |
| Rate for Payer: Aetna American Axle |
$91.75
|
| Rate for Payer: Aetna Commercial |
$119.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.75
|
| Rate for Payer: Cash Price |
$112.93
|
| Rate for Payer: Cofinity Advantage |
$98.81
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$98.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.87
|
| Rate for Payer: PHP Commercial |
$119.99
|
| Rate for Payer: Priority Health SBD |
$88.93
|
| Rate for Payer: UMR Bronson Commercial |
$62.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.87
|
|
|
INSULIN REGULAR 1 UNIT/ML IN 0.9 % NACL IV PUSH (CUSTOM)
|
Facility
|
OP
|
$66.31
|
|
|
Service Code
|
NDC 00338012612
|
| Hospital Charge Code |
301039
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.53 |
| Max. Negotiated Rate |
$59.68 |
| Rate for Payer: Aetna American Axle |
$43.10
|
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna Medicare |
$33.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.10
|
| Rate for Payer: BCBS Complete |
$26.52
|
| Rate for Payer: Cash Price |
$53.05
|
| Rate for Payer: Cofinity Advantage |
$46.42
|
| Rate for Payer: Cofinity Commercial |
$57.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.05
|
| Rate for Payer: Healthscope Commercial |
$59.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.73
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: Priority Health SBD |
$41.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.10
|
| Rate for Payer: UHC Core |
$34.55
|
| Rate for Payer: UHC Exchange |
$26.06
|
| Rate for Payer: UMR Bronson Commercial |
$24.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.73
|
|
|
INSULIN REGULAR 1 UNIT/ML IN 0.9 % NACL IV PUSH (CUSTOM)
|
Facility
|
IP
|
$66.31
|
|
|
Service Code
|
NDC 00338012612
|
| Hospital Charge Code |
301039
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$59.68 |
| Rate for Payer: Aetna American Axle |
$43.10
|
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.10
|
| Rate for Payer: Cash Price |
$53.05
|
| Rate for Payer: Cofinity Advantage |
$46.42
|
| Rate for Payer: Cofinity Commercial |
$57.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.05
|
| Rate for Payer: Healthscope Commercial |
$59.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.73
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: Priority Health SBD |
$41.78
|
| Rate for Payer: UMR Bronson Commercial |
$29.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.73
|
|
|
INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN
|
Facility
|
OP
|
$938.40
|
|
|
Service Code
|
NDC 00002882401
|
| Hospital Charge Code |
178095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$347.21 |
| Max. Negotiated Rate |
$844.56 |
| Rate for Payer: Aetna American Axle |
$609.96
|
| Rate for Payer: Aetna Commercial |
$797.64
|
| Rate for Payer: Aetna Medicare |
$469.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.96
|
| Rate for Payer: BCBS Complete |
$375.36
|
| Rate for Payer: Cash Price |
$750.72
|
| Rate for Payer: Cofinity Advantage |
$656.88
|
| Rate for Payer: Cofinity Commercial |
$807.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.72
|
| Rate for Payer: Healthscope Commercial |
$844.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$656.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$703.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$750.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$797.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$703.80
|
| Rate for Payer: PHP Commercial |
$797.64
|
| Rate for Payer: Priority Health SBD |
$591.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$609.96
|
| Rate for Payer: UHC Core |
$488.91
|
| Rate for Payer: UHC Exchange |
$368.79
|
| Rate for Payer: UMR Bronson Commercial |
$347.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$703.80
|
|
|
INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN
|
Facility
|
IP
|
$938.40
|
|
|
Service Code
|
NDC 00002882401
|
| Hospital Charge Code |
178095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$412.90 |
| Max. Negotiated Rate |
$844.56 |
| Rate for Payer: Aetna American Axle |
$609.96
|
| Rate for Payer: Aetna Commercial |
$797.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.96
|
| Rate for Payer: Cash Price |
$750.72
|
| Rate for Payer: Cofinity Advantage |
$656.88
|
| Rate for Payer: Cofinity Commercial |
$807.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.72
|
| Rate for Payer: Healthscope Commercial |
$844.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$656.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$703.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$797.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$703.80
|
| Rate for Payer: PHP Commercial |
$797.64
|
| Rate for Payer: Priority Health SBD |
$591.19
|
| Rate for Payer: UMR Bronson Commercial |
$412.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$703.80
|
|
|
INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN
|
Facility
|
IP
|
$938.40
|
|
|
Service Code
|
NDC 00002882427
|
| Hospital Charge Code |
178095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$412.90 |
| Max. Negotiated Rate |
$844.56 |
| Rate for Payer: Aetna American Axle |
$609.96
|
| Rate for Payer: Aetna Commercial |
$797.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.96
|
| Rate for Payer: Cash Price |
$750.72
|
| Rate for Payer: Cofinity Advantage |
$656.88
|
| Rate for Payer: Cofinity Commercial |
$807.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.72
|
| Rate for Payer: Healthscope Commercial |
$844.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$656.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$703.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$797.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$703.80
|
| Rate for Payer: PHP Commercial |
$797.64
|
| Rate for Payer: Priority Health SBD |
$591.19
|
| Rate for Payer: UMR Bronson Commercial |
$412.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$703.80
|
|
|
INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN
|
Facility
|
OP
|
$938.40
|
|
|
Service Code
|
NDC 00002882427
|
| Hospital Charge Code |
178095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$347.21 |
| Max. Negotiated Rate |
$844.56 |
| Rate for Payer: Aetna American Axle |
$609.96
|
| Rate for Payer: Aetna Commercial |
$797.64
|
| Rate for Payer: Aetna Medicare |
$469.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.96
|
| Rate for Payer: BCBS Complete |
$375.36
|
| Rate for Payer: Cash Price |
$750.72
|
| Rate for Payer: Cofinity Advantage |
$656.88
|
| Rate for Payer: Cofinity Commercial |
$807.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.72
|
| Rate for Payer: Healthscope Commercial |
$844.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$656.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$703.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$750.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$797.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$703.80
|
| Rate for Payer: PHP Commercial |
$797.64
|
| Rate for Payer: Priority Health SBD |
$591.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$609.96
|
| Rate for Payer: UHC Core |
$488.91
|
| Rate for Payer: UHC Exchange |
$368.79
|
| Rate for Payer: UMR Bronson Commercial |
$347.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$703.80
|
|
|
INSULIN REGULAR HUMAN U-500"CONCENTRATE" 500 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
IP
|
$4,860.24
|
|
|
Service Code
|
NDC 00002850101
|
| Hospital Charge Code |
301808
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,138.51 |
| Max. Negotiated Rate |
$4,374.22 |
| Rate for Payer: Aetna American Axle |
$3,159.16
|
| Rate for Payer: Aetna Commercial |
$4,131.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,159.16
|
| Rate for Payer: Cash Price |
$3,888.19
|
| Rate for Payer: Cofinity Advantage |
$3,402.17
|
| Rate for Payer: Cofinity Commercial |
$4,179.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,888.19
|
| Rate for Payer: Healthscope Commercial |
$4,374.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,402.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,645.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,645.18
|
| Rate for Payer: PHP Commercial |
$4,131.20
|
| Rate for Payer: Priority Health SBD |
$3,061.95
|
| Rate for Payer: UMR Bronson Commercial |
$2,138.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,645.18
|
|
|
INSULIN REGULAR HUMAN U-500"CONCENTRATE" 500 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
OP
|
$4,860.24
|
|
|
Service Code
|
NDC 00002850101
|
| Hospital Charge Code |
301808
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,798.29 |
| Max. Negotiated Rate |
$4,374.22 |
| Rate for Payer: Aetna American Axle |
$3,159.16
|
| Rate for Payer: Aetna Commercial |
$4,131.20
|
| Rate for Payer: Aetna Medicare |
$2,430.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,159.16
|
| Rate for Payer: BCBS Complete |
$1,944.10
|
| Rate for Payer: Cash Price |
$3,888.19
|
| Rate for Payer: Cofinity Advantage |
$3,402.17
|
| Rate for Payer: Cofinity Commercial |
$4,179.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,888.19
|
| Rate for Payer: Healthscope Commercial |
$4,374.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,402.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,645.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,888.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,645.18
|
| Rate for Payer: PHP Commercial |
$4,131.20
|
| Rate for Payer: Priority Health SBD |
$3,061.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,159.16
|
| Rate for Payer: UHC Core |
$2,532.19
|
| Rate for Payer: UHC Exchange |
$1,910.07
|
| Rate for Payer: UMR Bronson Commercial |
$1,798.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,645.18
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - HUMAN (HUMULIN R)
|
Facility
|
OP
|
$81.55
|
|
|
Service Code
|
NDC 00002821501
|
| Hospital Charge Code |
180910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.17 |
| Max. Negotiated Rate |
$73.39 |
| Rate for Payer: Aetna American Axle |
$53.01
|
| Rate for Payer: Aetna Commercial |
$69.32
|
| Rate for Payer: Aetna Medicare |
$40.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.01
|
| Rate for Payer: BCBS Complete |
$32.62
|
| Rate for Payer: Cash Price |
$65.24
|
| Rate for Payer: Cofinity Advantage |
$57.09
|
| Rate for Payer: Cofinity Commercial |
$70.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.24
|
| Rate for Payer: Healthscope Commercial |
$73.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.16
|
| Rate for Payer: PHP Commercial |
$69.32
|
| Rate for Payer: Priority Health SBD |
$51.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.01
|
| Rate for Payer: UHC Core |
$42.49
|
| Rate for Payer: UHC Exchange |
$32.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.16
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - HUMAN (HUMULIN R)
|
Facility
|
IP
|
$81.55
|
|
|
Service Code
|
NDC 00002821501
|
| Hospital Charge Code |
180910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.88 |
| Max. Negotiated Rate |
$73.39 |
| Rate for Payer: Aetna American Axle |
$53.01
|
| Rate for Payer: Aetna Commercial |
$69.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.01
|
| Rate for Payer: Cash Price |
$65.24
|
| Rate for Payer: Cofinity Advantage |
$57.09
|
| Rate for Payer: Cofinity Commercial |
$70.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.24
|
| Rate for Payer: Healthscope Commercial |
$73.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.16
|
| Rate for Payer: PHP Commercial |
$69.32
|
| Rate for Payer: Priority Health SBD |
$51.38
|
| Rate for Payer: UMR Bronson Commercial |
$35.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.16
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - INSULIN GLULISINE (APIDRA)
|
Facility
|
OP
|
$290.23
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
180908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$261.21 |
| Rate for Payer: Aetna American Axle |
$188.65
|
| Rate for Payer: Aetna Commercial |
$246.70
|
| Rate for Payer: Aetna Medicare |
$145.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.65
|
| Rate for Payer: BCBS Complete |
$116.09
|
| Rate for Payer: BCBS Trust/PPO |
$1.43
|
| Rate for Payer: BCN Commercial |
$1.43
|
| Rate for Payer: Cash Price |
$232.18
|
| Rate for Payer: Cash Price |
$232.18
|
| Rate for Payer: Cofinity Advantage |
$203.16
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$203.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.67
|
| Rate for Payer: PHP Commercial |
$246.70
|
| Rate for Payer: Priority Health SBD |
$182.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.65
|
| Rate for Payer: UHC Core |
$151.21
|
| Rate for Payer: UHC Exchange |
$114.06
|
| Rate for Payer: UMR Bronson Commercial |
$107.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.67
|
|
|
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 |
$127.70 |
| Max. Negotiated Rate |
$261.21 |
| Rate for Payer: Aetna American Axle |
$188.65
|
| Rate for Payer: Aetna Commercial |
$246.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.65
|
| Rate for Payer: Cash Price |
$232.18
|
| Rate for Payer: Cofinity Advantage |
$203.16
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$203.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.67
|
| Rate for Payer: PHP Commercial |
$246.70
|
| Rate for Payer: Priority Health SBD |
$182.84
|
| Rate for Payer: UMR Bronson Commercial |
$127.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.67
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - LISPRO (HUMALOG)
|
Facility
|
OP
|
$177.23
|
|
|
Service Code
|
NDC 00002751001
|
| Hospital Charge Code |
180914
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.58 |
| Max. Negotiated Rate |
$159.51 |
| Rate for Payer: Aetna American Axle |
$115.20
|
| Rate for Payer: Aetna Commercial |
$150.65
|
| Rate for Payer: Aetna Medicare |
$88.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.20
|
| Rate for Payer: BCBS Complete |
$70.89
|
| Rate for Payer: Cash Price |
$141.78
|
| Rate for Payer: Cofinity Advantage |
$124.06
|
| Rate for Payer: Cofinity Commercial |
$152.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.78
|
| Rate for Payer: Healthscope Commercial |
$159.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.92
|
| Rate for Payer: PHP Commercial |
$150.65
|
| Rate for Payer: Priority Health SBD |
$111.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.20
|
| Rate for Payer: UHC Core |
$92.34
|
| Rate for Payer: UHC Exchange |
$69.65
|
| Rate for Payer: UMR Bronson Commercial |
$65.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.92
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - LISPRO (HUMALOG)
|
Facility
|
IP
|
$177.23
|
|
|
Service Code
|
NDC 00002751001
|
| Hospital Charge Code |
180914
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.98 |
| Max. Negotiated Rate |
$159.51 |
| Rate for Payer: Aetna American Axle |
$115.20
|
| Rate for Payer: Aetna Commercial |
$150.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.20
|
| Rate for Payer: Cash Price |
$141.78
|
| Rate for Payer: Cofinity Advantage |
$124.06
|
| Rate for Payer: Cofinity Commercial |
$152.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.78
|
| Rate for Payer: Healthscope Commercial |
$159.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.92
|
| Rate for Payer: PHP Commercial |
$150.65
|
| Rate for Payer: Priority Health SBD |
$111.65
|
| Rate for Payer: UMR Bronson Commercial |
$77.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.92
|
|
|
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 |
$1,874.27 |
| Max. Negotiated Rate |
$4,559.04 |
| Rate for Payer: Aetna American Axle |
$3,292.64
|
| Rate for Payer: Aetna Commercial |
$4,305.76
|
| Rate for Payer: Aetna Medicare |
$2,532.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,292.64
|
| Rate for Payer: BCBS Complete |
$2,026.24
|
| Rate for Payer: Cash Price |
$4,052.48
|
| Rate for Payer: Cofinity Advantage |
$3,545.92
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$3,545.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,799.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,052.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,305.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,799.20
|
| Rate for Payer: PHP Commercial |
$4,305.76
|
| Rate for Payer: Priority Health SBD |
$3,191.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,292.64
|
| Rate for Payer: UHC Core |
$2,639.18
|
| Rate for Payer: UHC Exchange |
$1,990.78
|
| Rate for Payer: UMR Bronson Commercial |
$1,874.27
|
| 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 |
$2,228.86 |
| Max. Negotiated Rate |
$4,559.04 |
| Rate for Payer: Aetna American Axle |
$3,292.64
|
| Rate for Payer: Aetna Commercial |
$4,305.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,292.64
|
| Rate for Payer: Cash Price |
$4,052.48
|
| Rate for Payer: Cofinity Advantage |
$3,545.92
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$3,545.92
|
| 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: Opus (Opus Packaging Group) HMA |
$3,799.20
|
| Rate for Payer: PHP Commercial |
$4,305.76
|
| Rate for Payer: Priority Health SBD |
$3,191.33
|
| Rate for Payer: UMR Bronson Commercial |
$2,228.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,799.20
|
|
|
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 |
$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 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 |
$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 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 |
$62.11 |
| Max. Negotiated Rate |
$127.04 |
| Rate for Payer: Aetna American Axle |
$91.75
|
| Rate for Payer: Aetna Commercial |
$119.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.75
|
| Rate for Payer: Cash Price |
$112.93
|
| Rate for Payer: Cofinity Advantage |
$98.81
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$98.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.87
|
| Rate for Payer: PHP Commercial |
$119.99
|
| Rate for Payer: Priority Health SBD |
$88.93
|
| Rate for Payer: UMR Bronson Commercial |
$62.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.87
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$81.55
|
|
|
Service Code
|
NDC 00002821501
|
| Hospital Charge Code |
10289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.17 |
| Max. Negotiated Rate |
$73.39 |
| Rate for Payer: Aetna American Axle |
$53.01
|
| Rate for Payer: Aetna Commercial |
$69.32
|
| Rate for Payer: Aetna Medicare |
$40.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.01
|
| Rate for Payer: BCBS Complete |
$32.62
|
| Rate for Payer: Cash Price |
$65.24
|
| Rate for Payer: Cofinity Advantage |
$57.09
|
| Rate for Payer: Cofinity Commercial |
$70.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.24
|
| Rate for Payer: Healthscope Commercial |
$73.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.16
|
| Rate for Payer: PHP Commercial |
$69.32
|
| Rate for Payer: Priority Health SBD |
$51.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.01
|
| Rate for Payer: UHC Core |
$42.49
|
| Rate for Payer: UHC Exchange |
$32.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.16
|
|
|
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 |
$52.23 |
| Max. Negotiated Rate |
$127.04 |
| Rate for Payer: Aetna American Axle |
$91.75
|
| Rate for Payer: Aetna Commercial |
$119.99
|
| Rate for Payer: Aetna Medicare |
$70.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.75
|
| Rate for Payer: BCBS Complete |
$56.46
|
| Rate for Payer: Cash Price |
$112.93
|
| Rate for Payer: Cofinity Advantage |
$98.81
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$98.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.87
|
| Rate for Payer: PHP Commercial |
$119.99
|
| Rate for Payer: Priority Health SBD |
$88.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.75
|
| Rate for Payer: UHC Core |
$73.54
|
| Rate for Payer: UHC Exchange |
$55.48
|
| Rate for Payer: UMR Bronson Commercial |
$52.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.87
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$81.55
|
|
|
Service Code
|
NDC 00002821501
|
| Hospital Charge Code |
10289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.88 |
| Max. Negotiated Rate |
$73.39 |
| Rate for Payer: Aetna American Axle |
$53.01
|
| Rate for Payer: Aetna Commercial |
$69.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.01
|
| Rate for Payer: Cash Price |
$65.24
|
| Rate for Payer: Cofinity Advantage |
$57.09
|
| Rate for Payer: Cofinity Commercial |
$70.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.24
|
| Rate for Payer: Healthscope Commercial |
$73.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.16
|
| Rate for Payer: PHP Commercial |
$69.32
|
| Rate for Payer: Priority Health SBD |
$51.38
|
| Rate for Payer: UMR Bronson Commercial |
$35.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.16
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
OP
|
$81.55
|
|
|
Service Code
|
NDC 00002821501
|
| Hospital Charge Code |
301806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.17 |
| Max. Negotiated Rate |
$73.39 |
| Rate for Payer: Aetna American Axle |
$53.01
|
| Rate for Payer: Aetna Commercial |
$69.32
|
| Rate for Payer: Aetna Medicare |
$40.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.01
|
| Rate for Payer: BCBS Complete |
$32.62
|
| Rate for Payer: Cash Price |
$65.24
|
| Rate for Payer: Cofinity Advantage |
$57.09
|
| Rate for Payer: Cofinity Commercial |
$70.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.24
|
| Rate for Payer: Healthscope Commercial |
$73.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.16
|
| Rate for Payer: PHP Commercial |
$69.32
|
| Rate for Payer: Priority Health SBD |
$51.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.01
|
| Rate for Payer: UHC Core |
$42.49
|
| Rate for Payer: UHC Exchange |
$32.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.16
|
|
