|
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 Commercial |
$3,402.17
|
| Rate for Payer: Cofinity Commercial |
$4,179.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,402.17
|
| 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: PHP Commercial |
$4,131.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,159.16
|
| Rate for Payer: Priority Health SBD |
$3,061.95
|
| Rate for Payer: UMR Bronson Commercial |
$1,798.29
|
| 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
|
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 Commercial |
$3,402.17
|
| Rate for Payer: Cofinity Commercial |
$4,179.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,402.17
|
| 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: PHP Commercial |
$4,131.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,159.16
|
| 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 SUBCUTANEOUS BASAL PUMP - HUMAN (HUMULIN R)
|
Facility
|
OP
|
$60.35
|
|
|
Service Code
|
NDC 00002821501
|
| Hospital Charge Code |
180910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$54.31 |
| Rate for Payer: Aetna American Axle |
$39.23
|
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Medicare |
$30.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.23
|
| Rate for Payer: BCBS Complete |
$24.14
|
| Rate for Payer: Cash Price |
$48.28
|
| Rate for Payer: Cofinity Commercial |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$51.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.28
|
| Rate for Payer: Healthscope Commercial |
$54.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.30
|
| Rate for Payer: PHP Commercial |
$51.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.23
|
| Rate for Payer: Priority Health SBD |
$38.02
|
| Rate for Payer: UMR Bronson Commercial |
$22.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.26
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - HUMAN (HUMULIN R)
|
Facility
|
IP
|
$60.35
|
|
|
Service Code
|
NDC 00002821501
|
| Hospital Charge Code |
180910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$54.31 |
| Rate for Payer: Aetna American Axle |
$39.23
|
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.23
|
| Rate for Payer: Cash Price |
$48.28
|
| Rate for Payer: Cofinity Commercial |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$51.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.28
|
| Rate for Payer: Healthscope Commercial |
$54.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.30
|
| Rate for Payer: PHP Commercial |
$51.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.23
|
| Rate for Payer: Priority Health SBD |
$38.02
|
| Rate for Payer: UMR Bronson Commercial |
$26.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.26
|
|
|
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 |
$107.39 |
| 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: Cash Price |
$232.18
|
| Rate for Payer: Cofinity Commercial |
$203.16
|
| Rate for Payer: Cofinity Commercial |
$249.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.16
|
| 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: PHP Commercial |
$246.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.65
|
| Rate for Payer: Priority Health SBD |
$182.84
|
| 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 Commercial |
$203.16
|
| Rate for Payer: Cofinity Commercial |
$249.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.16
|
| 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: PHP Commercial |
$246.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.65
|
| 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 Commercial |
$124.06
|
| Rate for Payer: Cofinity Commercial |
$152.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.06
|
| 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: PHP Commercial |
$150.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.20
|
| Rate for Payer: Priority Health SBD |
$111.65
|
| 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 Commercial |
$124.06
|
| Rate for Payer: Cofinity Commercial |
$152.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.06
|
| 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: PHP Commercial |
$150.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.20
|
| 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
|
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 Commercial |
$3,545.92
|
| Rate for Payer: Cofinity Commercial |
$4,356.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,545.92
|
| 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: PHP Commercial |
$4,305.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,292.64
|
| 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 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 Commercial |
$3,545.92
|
| Rate for Payer: Cofinity Commercial |
$4,356.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,545.92
|
| 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: PHP Commercial |
$4,305.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,292.64
|
| Rate for Payer: Priority Health SBD |
$3,191.33
|
| Rate for Payer: UMR Bronson Commercial |
$1,874.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,799.20
|
|
|
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 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 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 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 U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$60.35
|
|
|
Service Code
|
NDC 00002821501
|
| Hospital Charge Code |
10289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$54.31 |
| Rate for Payer: Aetna American Axle |
$39.23
|
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.23
|
| Rate for Payer: Cash Price |
$48.28
|
| Rate for Payer: Cofinity Commercial |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$51.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.28
|
| Rate for Payer: Healthscope Commercial |
$54.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.30
|
| Rate for Payer: PHP Commercial |
$51.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.23
|
| Rate for Payer: Priority Health SBD |
$38.02
|
| Rate for Payer: UMR Bronson Commercial |
$26.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.26
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$60.35
|
|
|
Service Code
|
NDC 00002821501
|
| Hospital Charge Code |
10289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$54.31 |
| Rate for Payer: Aetna American Axle |
$39.23
|
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Medicare |
$30.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.23
|
| Rate for Payer: BCBS Complete |
$24.14
|
| Rate for Payer: Cash Price |
$48.28
|
| Rate for Payer: Cofinity Commercial |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$51.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.28
|
| Rate for Payer: Healthscope Commercial |
$54.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.30
|
| Rate for Payer: PHP Commercial |
$51.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.23
|
| Rate for Payer: Priority Health SBD |
$38.02
|
| Rate for Payer: UMR Bronson Commercial |
$22.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.26
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
OP
|
$60.35
|
|
|
Service Code
|
NDC 00002821501
|
| Hospital Charge Code |
301806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$54.31 |
| Rate for Payer: Aetna American Axle |
$39.23
|
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Medicare |
$30.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.23
|
| Rate for Payer: BCBS Complete |
$24.14
|
| Rate for Payer: Cash Price |
$48.28
|
| Rate for Payer: Cofinity Commercial |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$51.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.28
|
| Rate for Payer: Healthscope Commercial |
$54.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.30
|
| Rate for Payer: PHP Commercial |
$51.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.23
|
| Rate for Payer: Priority Health SBD |
$38.02
|
| Rate for Payer: UMR Bronson Commercial |
$22.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.26
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
IP
|
$60.35
|
|
|
Service Code
|
NDC 00002821501
|
| Hospital Charge Code |
301806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$54.31 |
| Rate for Payer: Aetna American Axle |
$39.23
|
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.23
|
| Rate for Payer: Cash Price |
$48.28
|
| Rate for Payer: Cofinity Commercial |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$51.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.28
|
| Rate for Payer: Healthscope Commercial |
$54.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.30
|
| Rate for Payer: PHP Commercial |
$51.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.23
|
| Rate for Payer: Priority Health SBD |
$38.02
|
| Rate for Payer: UMR Bronson Commercial |
$26.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.26
|
|
|
INTERFERON ALFA-2B 50 MILLION UNIT (1 ML) SOLUTION FOR INJECTION
|
Facility
|
IP
|
$6,726.43
|
|
|
Service Code
|
HCPCS J9214
|
| Hospital Charge Code |
10304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,959.63 |
| Max. Negotiated Rate |
$6,053.79 |
| Rate for Payer: Aetna American Axle |
$4,372.18
|
| Rate for Payer: Aetna Commercial |
$5,717.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,372.18
|
| Rate for Payer: Cash Price |
$5,381.14
|
| Rate for Payer: Cofinity Commercial |
$4,708.50
|
| Rate for Payer: Cofinity Commercial |
$5,784.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,708.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,381.14
|
| Rate for Payer: Healthscope Commercial |
$6,053.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,708.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,044.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,717.47
|
| Rate for Payer: PHP Commercial |
$5,717.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,372.18
|
| Rate for Payer: Priority Health SBD |
$4,237.65
|
| Rate for Payer: UMR Bronson Commercial |
$2,959.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,044.82
|
|
|
INTERFERON ALFA-2B 50 MILLION UNIT (1 ML) SOLUTION FOR INJECTION
|
Facility
|
OP
|
$6,726.43
|
|
|
Service Code
|
HCPCS J9214
|
| Hospital Charge Code |
10304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,488.78 |
| Max. Negotiated Rate |
$6,053.79 |
| Rate for Payer: Aetna American Axle |
$4,372.18
|
| Rate for Payer: Aetna Commercial |
$5,717.47
|
| Rate for Payer: Aetna Medicare |
$3,363.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,372.18
|
| Rate for Payer: BCBS Complete |
$2,690.57
|
| Rate for Payer: Cash Price |
$5,381.14
|
| Rate for Payer: Cofinity Commercial |
$4,708.50
|
| Rate for Payer: Cofinity Commercial |
$5,784.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,708.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,381.14
|
| Rate for Payer: Healthscope Commercial |
$6,053.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,708.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,044.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,717.47
|
| Rate for Payer: PHP Commercial |
$5,717.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,372.18
|
| Rate for Payer: Priority Health SBD |
$4,237.65
|
| Rate for Payer: UMR Bronson Commercial |
$2,488.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,044.82
|
|
|
INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR FLOOR OF MOUTH; SUBMANDIBULAR SPACE
|
Facility
|
OP
|
$8,903.25
|
|
|
Service Code
|
CPT 41008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,695.31 |
| Max. Negotiated Rate |
$8,903.25 |
| Rate for Payer: Aetna Medicare |
$3,289.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,953.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,953.62
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,162.90
|
| Rate for Payer: Mclaren Medicaid |
$1,695.31
|
| Rate for Payer: Mclaren Medicare |
$3,162.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,321.05
|
| Rate for Payer: Meridian Medicaid |
$1,780.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,637.34
|
| Rate for Payer: PACE Medicare |
$3,004.76
|
| Rate for Payer: PACE SWMI |
$3,162.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,162.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.31
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,903.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,162.90
|
| Rate for Payer: UHC Exchange |
$6,044.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,695.31
|
| Rate for Payer: VA VA |
$3,162.90
|
|
|
INTRAVENOUS INJECTION OF AGENT (EG, FLUORESCEIN) TO TEST VASCULAR FLOW IN FLAP OR GRAFT
|
Facility
|
OP
|
$1,095.50
|
|
|
Service Code
|
CPT 15860
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$208.60 |
| Max. Negotiated Rate |
$1,095.50 |
| Rate for Payer: Aetna Medicare |
$404.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$486.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$486.48
|
| Rate for Payer: BCBS Complete |
$219.03
|
| Rate for Payer: BCBS MAPPO |
$389.18
|
| Rate for Payer: BCN Medicare Advantage |
$389.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.18
|
| Rate for Payer: Mclaren Medicaid |
$208.60
|
| Rate for Payer: Mclaren Medicare |
$389.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$408.64
|
| Rate for Payer: Meridian Medicaid |
$219.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$447.56
|
| Rate for Payer: PACE Medicare |
$369.72
|
| Rate for Payer: PACE SWMI |
$389.18
|
| Rate for Payer: PHP Medicare Advantage |
$389.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.60
|
| Rate for Payer: Priority Health Medicare |
$389.18
|
| Rate for Payer: Railroad Medicare Medicare |
$389.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,095.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.18
|
| Rate for Payer: UHC Exchange |
$743.76
|
| Rate for Payer: UHC Medicare Advantage |
$389.18
|
| Rate for Payer: UHCCP Medicaid |
$208.60
|
| Rate for Payer: VA VA |
$389.18
|
|
|
INTRODUCTION OF NEEDLE(S) AND/OR CATHETER(S), DIALYSIS CIRCUIT, WITH DIAGNOSTIC ANGIOGRAPHY OF THE DIALYSIS CIRCUIT, INCLUDING ALL DIRECT PUNCTURE(S) AND CATHETER PLACEMENT(S), INJECTION(S) OF CONTRAST, ALL NECESSARY IMAGING FROM THE ARTERIAL ANASTOMOSIS AND ADJACENT ARTERY THROUGH ENTIRE VENOUS OUTFLOW INCLUDING THE INFERIOR OR SUPERIOR VENA CAVA, FLUOROSCOPIC GUIDANCE, RADIOLOGICAL SUPERVISION AND INTERPRETATION AND IMAGE DOCUMENTATION AND REPORT;
|
Facility
|
OP
|
$4,264.69
|
|
|
Service Code
|
CPT 36901
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$812.06 |
| Max. Negotiated Rate |
$4,264.69 |
| Rate for Payer: Aetna Medicare |
$1,575.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,893.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,893.80
|
| Rate for Payer: BCBS Complete |
$852.66
|
| Rate for Payer: BCBS MAPPO |
$1,515.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,515.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,515.04
|
| Rate for Payer: Mclaren Medicaid |
$812.06
|
| Rate for Payer: Mclaren Medicare |
$1,515.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,590.79
|
| Rate for Payer: Meridian Medicaid |
$852.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,742.30
|
| Rate for Payer: PACE Medicare |
$1,439.29
|
| Rate for Payer: PACE SWMI |
$1,515.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,515.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$812.06
|
| Rate for Payer: Priority Health Medicare |
$1,515.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1,515.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,264.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,515.04
|
| Rate for Payer: UHC Exchange |
$2,895.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,515.04
|
| Rate for Payer: UHCCP Medicaid |
$812.06
|
| Rate for Payer: VA VA |
$1,515.04
|
|
|
INTRODUCTION OF NEEDLE(S) AND/OR CATHETER(S), DIALYSIS CIRCUIT, WITH DIAGNOSTIC ANGIOGRAPHY OF THE DIALYSIS CIRCUIT, INCLUDING ALL DIRECT PUNCTURE(S) AND CATHETER PLACEMENT(S), INJECTION(S) OF CONTRAST, ALL NECESSARY IMAGING FROM THE ARTERIAL ANASTOMOSIS AND ADJACENT ARTERY THROUGH ENTIRE VENOUS OUTFLOW INCLUDING THE INFERIOR OR SUPERIOR VENA CAVA, FLUOROSCOPIC GUIDANCE, RADIOLOGICAL SUPERVISION AND INTERPRETATION AND IMAGE DOCUMENTATION AND REPORT; WITH TRANSCATHETER PLACEMENT OF INTRAVASCULAR STENT(S), PERIPHERAL DIALYSIS SEGMENT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE STENTING, AND ALL ANGIOPLASTY WITHIN THE PERIPHERAL DIALYSIS SEGMENT
|
Facility
|
OP
|
$31,133.44
|
|
|
Service Code
|
CPT 36903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,928.28 |
| Max. Negotiated Rate |
$31,133.44 |
| Rate for Payer: Aetna Medicare |
$11,502.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,825.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,825.29
|
| Rate for Payer: BCBS Complete |
$6,224.70
|
| Rate for Payer: BCBS MAPPO |
$11,060.23
|
| Rate for Payer: BCN Medicare Advantage |
$11,060.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,060.23
|
| Rate for Payer: Mclaren Medicaid |
$5,928.28
|
| Rate for Payer: Mclaren Medicare |
$11,060.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,613.24
|
| Rate for Payer: Meridian Medicaid |
$6,224.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,719.26
|
| Rate for Payer: PACE Medicare |
$10,507.22
|
| Rate for Payer: PACE SWMI |
$11,060.23
|
| Rate for Payer: PHP Medicare Advantage |
$11,060.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,928.28
|
| Rate for Payer: Priority Health Medicare |
$11,060.23
|
| Rate for Payer: Railroad Medicare Medicare |
$11,060.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,133.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,060.23
|
| Rate for Payer: UHC Exchange |
$21,137.21
|
| Rate for Payer: UHC Medicare Advantage |
$11,060.23
|
| Rate for Payer: UHCCP Medicaid |
$5,928.28
|
| Rate for Payer: VA VA |
$11,060.23
|
|
|
INTRODUCTION OF NEEDLE(S) AND/OR CATHETER(S), DIALYSIS CIRCUIT, WITH DIAGNOSTIC ANGIOGRAPHY OF THE DIALYSIS CIRCUIT, INCLUDING ALL DIRECT PUNCTURE(S) AND CATHETER PLACEMENT(S), INJECTION(S) OF CONTRAST, ALL NECESSARY IMAGING FROM THE ARTERIAL ANASTOMOSIS AND ADJACENT ARTERY THROUGH ENTIRE VENOUS OUTFLOW INCLUDING THE INFERIOR OR SUPERIOR VENA CAVA, FLUOROSCOPIC GUIDANCE, RADIOLOGICAL SUPERVISION AND INTERPRETATION AND IMAGE DOCUMENTATION AND REPORT; WITH TRANSLUMINAL BALLOON ANGIOPLASTY, PERIPHERAL DIALYSIS SEGMENT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY
|
Facility
|
OP
|
$15,652.48
|
|
|
Service Code
|
CPT 36902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,980.47 |
| Max. Negotiated Rate |
$15,652.48 |
| Rate for Payer: Aetna Medicare |
$5,783.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,950.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,950.73
|
| Rate for Payer: BCBS Complete |
$3,129.49
|
| Rate for Payer: BCBS MAPPO |
$5,560.58
|
| Rate for Payer: BCN Medicare Advantage |
$5,560.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,560.58
|
| Rate for Payer: Mclaren Medicaid |
$2,980.47
|
| Rate for Payer: Mclaren Medicare |
$5,560.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,838.61
|
| Rate for Payer: Meridian Medicaid |
$3,129.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,394.67
|
| Rate for Payer: PACE Medicare |
$5,282.55
|
| Rate for Payer: PACE SWMI |
$5,560.58
|
| Rate for Payer: PHP Medicare Advantage |
$5,560.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,980.47
|
| Rate for Payer: Priority Health Medicare |
$5,560.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,560.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,652.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,560.58
|
| Rate for Payer: UHC Exchange |
$10,626.82
|
| Rate for Payer: UHC Medicare Advantage |
$5,560.58
|
| Rate for Payer: UHCCP Medicaid |
$2,980.47
|
| Rate for Payer: VA VA |
$5,560.58
|
|
|
INTUBATION, ENDOTRACHEAL, EMERGENCY PROCEDURE
|
Facility
|
OP
|
$637.52
|
|
|
Service Code
|
CPT 31500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$121.39 |
| Max. Negotiated Rate |
$637.52 |
| Rate for Payer: Aetna Medicare |
$235.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$283.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$283.10
|
| Rate for Payer: BCBS Complete |
$127.46
|
| Rate for Payer: BCBS MAPPO |
$226.48
|
| Rate for Payer: BCN Medicare Advantage |
$226.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.48
|
| Rate for Payer: Mclaren Medicaid |
$121.39
|
| Rate for Payer: Mclaren Medicare |
$226.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$237.80
|
| Rate for Payer: Meridian Medicaid |
$127.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$260.45
|
| Rate for Payer: PACE Medicare |
$215.16
|
| Rate for Payer: PACE SWMI |
$226.48
|
| Rate for Payer: PHP Medicare Advantage |
$226.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.39
|
| Rate for Payer: Priority Health Medicare |
$226.48
|
| Rate for Payer: Railroad Medicare Medicare |
$226.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$637.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$226.48
|
| Rate for Payer: UHC Exchange |
$432.83
|
| Rate for Payer: UHC Medicare Advantage |
$226.48
|
| Rate for Payer: UHCCP Medicaid |
$121.39
|
| Rate for Payer: VA VA |
$226.48
|
|
|
INVESTIGATIONAL DAUNORUBICIN 44 MG AND CYTARABINE 100 MG IN LIPOSOME (CPX-351) INJECTION
|
Facility
|
OP
|
$720.87
|
|
|
Service Code
|
HCPCS J9153
|
| Hospital Charge Code |
300818
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$137.26 |
| Max. Negotiated Rate |
$720.87 |
| Rate for Payer: Aetna Medicare |
$266.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$320.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$320.11
|
| Rate for Payer: BCBS Complete |
$144.13
|
| Rate for Payer: BCBS MAPPO |
$256.09
|
| Rate for Payer: BCN Medicare Advantage |
$256.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$256.09
|
| Rate for Payer: Mclaren Medicaid |
$137.26
|
| Rate for Payer: Mclaren Medicare |
$256.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$268.89
|
| Rate for Payer: Meridian Medicaid |
$144.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$294.50
|
| Rate for Payer: PACE Medicare |
$243.29
|
| Rate for Payer: PACE SWMI |
$256.09
|
| Rate for Payer: PHP Medicare Advantage |
$256.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.26
|
| Rate for Payer: Priority Health Medicare |
$256.09
|
| Rate for Payer: Railroad Medicare Medicare |
$256.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$720.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$256.09
|
| Rate for Payer: UHC Exchange |
$489.41
|
| Rate for Payer: UHC Medicare Advantage |
$256.09
|
| Rate for Payer: UHCCP Medicaid |
$137.26
|
| Rate for Payer: VA VA |
$256.09
|
|
