|
INSERTION OR REPLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, REQUIRING POCKET CREATION AND CONNECTION BETWEEN ELECTRODE ARRAY AND PULSE GENERATOR OR RECEIVER
|
Facility
|
OP
|
$93,841.38
|
|
|
Service Code
|
CPT 63685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$331.30 |
| Max. Negotiated Rate |
$93,841.38 |
| Rate for Payer: Aetna Medicare |
$31,051.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37,321.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37,321.76
|
| Rate for Payer: BCBS Complete |
$16,803.75
|
| Rate for Payer: BCBS MAPPO |
$29,857.41
|
| Rate for Payer: BCBS Trust/PPO |
$33,546.20
|
| Rate for Payer: BCN Commercial |
$33,546.20
|
| Rate for Payer: BCN Medicare Advantage |
$29,857.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29,857.41
|
| Rate for Payer: Mclaren Medicaid |
$16,003.57
|
| Rate for Payer: Mclaren Medicare |
$29,857.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31,350.28
|
| Rate for Payer: Meridian Medicaid |
$16,803.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34,336.02
|
| Rate for Payer: Nomi Health Commercial |
$62,700.56
|
| Rate for Payer: PACE Medicare |
$28,364.54
|
| Rate for Payer: PACE SWMI |
$29,857.41
|
| Rate for Payer: PHP Medicare Advantage |
$29,857.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,003.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93,841.38
|
| Rate for Payer: Priority Health Medicare |
$29,857.41
|
| Rate for Payer: Priority Health Narrow Network |
$75,073.10
|
| Rate for Payer: Railroad Medicare Medicare |
$29,857.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$364.43
|
| Rate for Payer: UHC Core |
$30,600.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$29,857.41
|
| Rate for Payer: UHC Exchange |
$331.30
|
| Rate for Payer: UHC Medicare Advantage |
$29,857.41
|
| Rate for Payer: UHCCP Medicaid |
$16,003.57
|
| Rate for Payer: VA VA |
$29,857.41
|
|
|
INSERTION OR REPLACEMENT OF TEMPORARY TRANSVENOUS SINGLE CHAMBER CARDIAC ELECTRODE OR PACEMAKER CATHETER (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$25,485.33
|
|
|
Service Code
|
CPT 33210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.09 |
| Max. Negotiated Rate |
$25,485.33 |
| Rate for Payer: Aetna Medicare |
$8,432.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,135.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,135.80
|
| Rate for Payer: BCBS Complete |
$4,563.54
|
| Rate for Payer: BCBS MAPPO |
$8,108.64
|
| Rate for Payer: BCBS Trust/PPO |
$7,506.92
|
| Rate for Payer: BCN Commercial |
$7,506.92
|
| Rate for Payer: BCN Medicare Advantage |
$8,108.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,108.64
|
| Rate for Payer: Mclaren Medicaid |
$4,346.23
|
| Rate for Payer: Mclaren Medicare |
$8,108.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,514.07
|
| Rate for Payer: Meridian Medicaid |
$4,563.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,324.94
|
| Rate for Payer: Nomi Health Commercial |
$17,028.14
|
| Rate for Payer: PACE Medicare |
$7,703.21
|
| Rate for Payer: PACE SWMI |
$8,108.64
|
| Rate for Payer: PHP Medicare Advantage |
$8,108.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,346.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,485.33
|
| Rate for Payer: Priority Health Medicare |
$8,108.64
|
| Rate for Payer: Priority Health Narrow Network |
$20,388.26
|
| Rate for Payer: Railroad Medicare Medicare |
$8,108.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.60
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,108.64
|
| Rate for Payer: UHC Exchange |
$155.09
|
| Rate for Payer: UHC Medicare Advantage |
$8,108.64
|
| Rate for Payer: UHCCP Medicaid |
$4,346.23
|
| Rate for Payer: VA VA |
$8,108.64
|
|
|
INSULIN 1 UNIT/ ML INFUSION 100 ML (IV PREMIX)
|
Facility
|
OP
|
$77.40
|
|
|
Service Code
|
NDC 09900001834
|
| Hospital Charge Code |
300906
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.64 |
| Max. Negotiated Rate |
$69.66 |
| Rate for Payer: Aetna American Axle |
$50.31
|
| Rate for Payer: Aetna Commercial |
$65.79
|
| Rate for Payer: Aetna Medicare |
$38.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.31
|
| Rate for Payer: BCBS Complete |
$30.96
|
| Rate for Payer: Cash Price |
$61.92
|
| Rate for Payer: Cofinity Commercial |
$54.18
|
| Rate for Payer: Cofinity Commercial |
$66.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.92
|
| Rate for Payer: Healthscope Commercial |
$69.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.79
|
| Rate for Payer: PHP Commercial |
$65.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.31
|
| Rate for Payer: Priority Health SBD |
$48.76
|
| Rate for Payer: UMR Bronson Commercial |
$28.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.05
|
|
|
INSULIN 1 UNIT/ ML INFUSION 100 ML (IV PREMIX)
|
Facility
|
IP
|
$77.40
|
|
|
Service Code
|
NDC 09900001834
|
| Hospital Charge Code |
300906
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$69.66 |
| Rate for Payer: Aetna American Axle |
$50.31
|
| Rate for Payer: Aetna Commercial |
$65.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.31
|
| Rate for Payer: Cash Price |
$61.92
|
| Rate for Payer: Cofinity Commercial |
$54.18
|
| Rate for Payer: Cofinity Commercial |
$66.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.92
|
| Rate for Payer: Healthscope Commercial |
$69.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.79
|
| Rate for Payer: PHP Commercial |
$65.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.31
|
| Rate for Payer: Priority Health SBD |
$48.76
|
| Rate for Payer: UMR Bronson Commercial |
$34.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.05
|
|
|
INSULIN 5 UNIT/5 ML IV PUSH 5 ML
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
NDC 09900001138
|
| Hospital Charge Code |
300205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna American Axle |
$13.00
|
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$14.00
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.00
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health SBD |
$12.60
|
| Rate for Payer: UMR Bronson Commercial |
$8.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.00
|
|
|
INSULIN 5 UNIT/5 ML IV PUSH 5 ML
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
NDC 09900001138
|
| Hospital Charge Code |
300205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$14.00
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.00
|
| Rate for Payer: Aetna American Axle |
$13.00
|
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.00
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health SBD |
$12.60
|
| Rate for Payer: UMR Bronson Commercial |
$7.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.00
|
|
|
INSULIN ASPART 100 UNIT/ML CUSTOM SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$137.64
|
|
|
Service Code
|
NDC 00169750111
|
| Hospital Charge Code |
180447
|
|
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 Commercial |
$118.37
|
| Rate for Payer: Cofinity Commercial |
$96.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.35
|
| 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: PHP Commercial |
$116.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.47
|
| 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 100 UNIT/ML CUSTOM SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$137.64
|
|
|
Service Code
|
NDC 00169750111
|
| Hospital Charge Code |
180447
|
|
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 Commercial |
$118.37
|
| Rate for Payer: Cofinity Commercial |
$96.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.35
|
| 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: PHP Commercial |
$116.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.47
|
| Rate for Payer: Priority Health SBD |
$86.71
|
| Rate for Payer: UMR Bronson Commercial |
$50.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.23
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.13 |
| Max. Negotiated Rate |
$57.55 |
| Rate for Payer: Aetna American Axle |
$41.56
|
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
| Rate for Payer: UMR Bronson Commercial |
$28.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.96
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$57.55 |
| Rate for Payer: Aetna American Axle |
$41.56
|
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna Medicare |
$31.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.56
|
| Rate for Payer: BCBS Complete |
$25.58
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
| Rate for Payer: UMR Bronson Commercial |
$23.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.96
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.13 |
| Max. Negotiated Rate |
$57.55 |
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Aetna American Axle |
$41.56
|
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
| Rate for Payer: UMR Bronson Commercial |
$28.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.96
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.13 |
| Max. Negotiated Rate |
$57.55 |
| Rate for Payer: Aetna American Axle |
$41.56
|
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
| Rate for Payer: UMR Bronson Commercial |
$28.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.96
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$57.55 |
| Rate for Payer: Aetna American Axle |
$41.56
|
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna Medicare |
$31.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.56
|
| Rate for Payer: BCBS Complete |
$25.58
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
| Rate for Payer: UMR Bronson Commercial |
$23.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.96
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$57.55 |
| Rate for Payer: Aetna American Axle |
$41.56
|
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna Medicare |
$31.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.56
|
| Rate for Payer: BCBS Complete |
$25.58
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
| Rate for Payer: UMR Bronson Commercial |
$23.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.96
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
301084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$57.55 |
| Rate for Payer: Aetna American Axle |
$41.56
|
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna Medicare |
$31.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.56
|
| Rate for Payer: BCBS Complete |
$25.58
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
| Rate for Payer: UMR Bronson Commercial |
$23.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.96
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
301084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.13 |
| Max. Negotiated Rate |
$57.55 |
| Rate for Payer: Aetna American Axle |
$41.56
|
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
| Rate for Payer: UMR Bronson Commercial |
$28.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.96
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
301084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$57.55 |
| Rate for Payer: Aetna American Axle |
$41.56
|
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna Medicare |
$31.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.56
|
| Rate for Payer: BCBS Complete |
$25.58
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
| Rate for Payer: UMR Bronson Commercial |
$23.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.96
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
301084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$57.55 |
| Rate for Payer: Aetna American Axle |
$41.56
|
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna Medicare |
$31.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.56
|
| Rate for Payer: BCBS Complete |
$25.58
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
| Rate for Payer: UMR Bronson Commercial |
$23.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.96
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
301084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.13 |
| Max. Negotiated Rate |
$57.55 |
| Rate for Payer: Aetna American Axle |
$41.56
|
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
| Rate for Payer: UMR Bronson Commercial |
$28.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.96
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
301084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.13 |
| Max. Negotiated Rate |
$57.55 |
| Rate for Payer: Aetna American Axle |
$41.56
|
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
| Rate for Payer: UMR Bronson Commercial |
$28.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.96
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
300796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.13 |
| Max. Negotiated Rate |
$57.55 |
| Rate for Payer: Aetna American Axle |
$41.56
|
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
| Rate for Payer: UMR Bronson Commercial |
$28.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.96
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
300796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$57.55 |
| Rate for Payer: Aetna Medicare |
$31.97
|
| Rate for Payer: Aetna American Axle |
$41.56
|
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.56
|
| Rate for Payer: BCBS Complete |
$25.58
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
| Rate for Payer: UMR Bronson Commercial |
$23.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.96
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
300796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$57.55 |
| Rate for Payer: Aetna American Axle |
$41.56
|
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna Medicare |
$31.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.56
|
| Rate for Payer: BCBS Complete |
$25.58
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
| Rate for Payer: UMR Bronson Commercial |
$23.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.96
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
300796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.13 |
| Max. Negotiated Rate |
$57.55 |
| Rate for Payer: Aetna American Axle |
$41.56
|
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
| Rate for Payer: UMR Bronson Commercial |
$28.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.96
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
300796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.13 |
| Max. Negotiated Rate |
$57.55 |
| Rate for Payer: Aetna American Axle |
$41.56
|
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
| Rate for Payer: UMR Bronson Commercial |
$28.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.96
|
|
