|
INSULIN ASPART U-100 100 UNIT/ML (MDV ADS)
|
Facility
|
OP
|
$137.64
|
|
|
Service Code
|
NDC 73070010011
|
| Hospital Charge Code |
300258
|
|
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 PEDIATRIC CARB BASED CORRECTION PEN
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
301554
|
|
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 PEDIATRIC CARB BASED CORRECTION PEN
|
Facility
|
OP
|
$64.98
|
|
|
Service Code
|
NDC 00169210125
|
| Hospital Charge Code |
301554
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.04 |
| Max. Negotiated Rate |
$58.48 |
| Rate for Payer: Aetna American Axle |
$42.24
|
| Rate for Payer: Aetna Commercial |
$55.23
|
| Rate for Payer: Aetna Medicare |
$32.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.24
|
| Rate for Payer: BCBS Complete |
$25.99
|
| Rate for Payer: Cash Price |
$51.98
|
| Rate for Payer: Cofinity Commercial |
$45.49
|
| Rate for Payer: Cofinity Commercial |
$55.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.98
|
| Rate for Payer: Healthscope Commercial |
$58.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.23
|
| Rate for Payer: PHP Commercial |
$55.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.24
|
| Rate for Payer: Priority Health SBD |
$40.94
|
| Rate for Payer: UMR Bronson Commercial |
$24.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.74
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML PEDIATRIC CARB BASED CORRECTION PEN
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
301554
|
|
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 PEDIATRIC CARB BASED CORRECTION PEN
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
301554
|
|
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 PEDIATRIC CARB BASED CORRECTION PEN
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
301554
|
|
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 PEDIATRIC CARB BASED CORRECTION PEN
|
Facility
|
IP
|
$64.98
|
|
|
Service Code
|
NDC 00169210125
|
| Hospital Charge Code |
301554
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.59 |
| Max. Negotiated Rate |
$58.48 |
| Rate for Payer: Aetna American Axle |
$42.24
|
| Rate for Payer: Aetna Commercial |
$55.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.24
|
| Rate for Payer: Cash Price |
$51.98
|
| Rate for Payer: Cofinity Commercial |
$45.49
|
| Rate for Payer: Cofinity Commercial |
$55.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.98
|
| Rate for Payer: Healthscope Commercial |
$58.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.23
|
| Rate for Payer: PHP Commercial |
$55.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.24
|
| Rate for Payer: Priority Health SBD |
$40.94
|
| Rate for Payer: UMR Bronson Commercial |
$28.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.74
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML PEDIATRIC CARB BASED CORRECTION PEN
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
301554
|
|
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 PEDIATRIC CARB BASED CORRECTION PEN
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
301554
|
|
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 SQ FOR INSULIN PUMP REFILL
|
Facility
|
OP
|
$137.64
|
|
|
Service Code
|
NDC 00169750111
|
| Hospital Charge Code |
301794
|
|
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 SQ FOR INSULIN PUMP REFILL
|
Facility
|
IP
|
$137.64
|
|
|
Service Code
|
NDC 00169750111
|
| Hospital Charge Code |
301794
|
|
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 U-100 100 UNIT/ML SUBCUTANEOUS CARTRIDGE
|
Facility
|
IP
|
$76.14
|
|
|
Service Code
|
NDC 00169330312
|
| Hospital Charge Code |
111375
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$68.53 |
| Rate for Payer: Aetna American Axle |
$49.49
|
| Rate for Payer: Aetna Commercial |
$64.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.49
|
| Rate for Payer: Cash Price |
$60.91
|
| Rate for Payer: Cofinity Commercial |
$53.30
|
| Rate for Payer: Cofinity Commercial |
$65.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.91
|
| Rate for Payer: Healthscope Commercial |
$68.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.72
|
| Rate for Payer: PHP Commercial |
$64.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.49
|
| Rate for Payer: Priority Health SBD |
$47.97
|
| Rate for Payer: UMR Bronson Commercial |
$33.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.10
|
|
|
INSULIN ASPART U-100 100 UNIT/ML SUBCUTANEOUS CARTRIDGE
|
Facility
|
OP
|
$76.14
|
|
|
Service Code
|
NDC 00169330312
|
| Hospital Charge Code |
111375
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.17 |
| Max. Negotiated Rate |
$68.53 |
| Rate for Payer: Aetna American Axle |
$49.49
|
| Rate for Payer: Aetna Commercial |
$64.72
|
| Rate for Payer: Aetna Medicare |
$38.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.49
|
| Rate for Payer: BCBS Complete |
$30.46
|
| Rate for Payer: Cash Price |
$60.91
|
| Rate for Payer: Cofinity Commercial |
$53.30
|
| Rate for Payer: Cofinity Commercial |
$65.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.91
|
| Rate for Payer: Healthscope Commercial |
$68.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.72
|
| Rate for Payer: PHP Commercial |
$64.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.49
|
| Rate for Payer: Priority Health SBD |
$47.97
|
| Rate for Payer: UMR Bronson Commercial |
$28.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.10
|
|
|
INSULIN ASPART U-100 100 UNIT/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$137.64
|
|
|
Service Code
|
NDC 73070010011
|
| Hospital Charge Code |
28534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.93 |
| Max. Negotiated Rate |
$123.88 |
| Rate for Payer: Aetna American Axle |
$89.47
|
| Rate for Payer: Aetna Commercial |
$116.99
|
| Rate for Payer: Aetna Medicare |
$68.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.47
|
| Rate for Payer: BCBS Complete |
$55.06
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity 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 SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$137.64
|
|
|
Service Code
|
NDC 73070010011
|
| Hospital Charge Code |
28534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.56 |
| Max. Negotiated Rate |
$123.88 |
| Rate for Payer: Aetna American Axle |
$89.47
|
| Rate for Payer: Aetna Commercial |
$116.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.47
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity 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 U-100 100 UNIT/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$137.64
|
|
|
Service Code
|
NDC 00169750111
|
| Hospital Charge Code |
28534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.56 |
| Max. Negotiated Rate |
$123.88 |
| Rate for Payer: Aetna American Axle |
$89.47
|
| Rate for Payer: Aetna Commercial |
$116.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.47
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity 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 U-100 100 UNIT/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$137.64
|
|
|
Service Code
|
NDC 00169750111
|
| Hospital Charge Code |
28534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.93 |
| Max. Negotiated Rate |
$123.88 |
| Rate for Payer: Aetna American Axle |
$89.47
|
| Rate for Payer: Aetna Commercial |
$116.99
|
| Rate for Payer: Aetna Medicare |
$68.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.47
|
| Rate for Payer: BCBS Complete |
$55.06
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity 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 GLARGINE-AGLR (U-100) 100 UNIT/ML (3 ML) PEN CUSTOM PEDIATRIC
|
Facility
|
OP
|
$63.32
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
301779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$56.99 |
| Rate for Payer: Aetna American Axle |
$41.16
|
| Rate for Payer: Aetna Commercial |
$53.82
|
| Rate for Payer: Aetna Medicare |
$31.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.16
|
| Rate for Payer: BCBS Complete |
$25.33
|
| Rate for Payer: BCBS Trust/PPO |
$1.46
|
| Rate for Payer: BCN Commercial |
$1.46
|
| Rate for Payer: Cash Price |
$50.66
|
| Rate for Payer: Cash Price |
$50.66
|
| Rate for Payer: Cofinity Commercial |
$44.32
|
| Rate for Payer: Cofinity Commercial |
$54.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.66
|
| Rate for Payer: Healthscope Commercial |
$56.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.82
|
| Rate for Payer: PHP Commercial |
$53.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.16
|
| Rate for Payer: Priority Health SBD |
$39.89
|
| Rate for Payer: UMR Bronson Commercial |
$23.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.49
|
|
|
INSULIN GLARGINE-AGLR (U-100) 100 UNIT/ML (3 ML) PEN CUSTOM PEDIATRIC
|
Facility
|
IP
|
$63.32
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
301779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$56.99 |
| Rate for Payer: Aetna American Axle |
$41.16
|
| Rate for Payer: Aetna Commercial |
$53.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.16
|
| Rate for Payer: Cash Price |
$50.66
|
| Rate for Payer: Cofinity Commercial |
$44.32
|
| Rate for Payer: Cofinity Commercial |
$54.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.66
|
| Rate for Payer: Healthscope Commercial |
$56.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.82
|
| Rate for Payer: PHP Commercial |
$53.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.16
|
| Rate for Payer: Priority Health SBD |
$39.89
|
| Rate for Payer: UMR Bronson Commercial |
$27.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.49
|
|
|
INSULIN GLARGINE-AGLR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
IP
|
$63.32
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
203258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$56.99 |
| Rate for Payer: Cofinity Commercial |
$54.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.32
|
| Rate for Payer: Aetna American Axle |
$41.16
|
| Rate for Payer: Aetna Commercial |
$53.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.16
|
| Rate for Payer: Cash Price |
$50.66
|
| Rate for Payer: Cofinity Commercial |
$44.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.66
|
| Rate for Payer: Healthscope Commercial |
$56.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.82
|
| Rate for Payer: PHP Commercial |
$53.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.16
|
| Rate for Payer: Priority Health SBD |
$39.89
|
| Rate for Payer: UMR Bronson Commercial |
$27.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.49
|
|
|
INSULIN GLARGINE-AGLR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
OP
|
$63.32
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
203258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$56.99 |
| Rate for Payer: Aetna American Axle |
$41.16
|
| Rate for Payer: Aetna Commercial |
$53.82
|
| Rate for Payer: Aetna Medicare |
$31.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.16
|
| Rate for Payer: BCBS Complete |
$25.33
|
| Rate for Payer: BCBS Trust/PPO |
$1.46
|
| Rate for Payer: BCN Commercial |
$1.46
|
| Rate for Payer: Cash Price |
$50.66
|
| Rate for Payer: Cash Price |
$50.66
|
| Rate for Payer: Cofinity Commercial |
$44.32
|
| Rate for Payer: Cofinity Commercial |
$54.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.66
|
| Rate for Payer: Healthscope Commercial |
$56.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.82
|
| Rate for Payer: PHP Commercial |
$53.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.16
|
| Rate for Payer: Priority Health SBD |
$39.89
|
| Rate for Payer: UMR Bronson Commercial |
$23.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.49
|
|
|
INSULIN GLARGINE-AGLR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN TO GO
|
Facility
|
OP
|
$1.46
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
301777
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: BCBS Trust/PPO |
$1.46
|
| Rate for Payer: BCN Commercial |
$1.46
|
|
|
INSULIN GLULISINE (U-100) 100 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
IP
|
$278.47
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
301807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.53 |
| Max. Negotiated Rate |
$250.62 |
| Rate for Payer: Aetna American Axle |
$181.01
|
| Rate for Payer: Aetna Commercial |
$236.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.01
|
| Rate for Payer: Cash Price |
$222.78
|
| Rate for Payer: Cofinity Commercial |
$194.93
|
| Rate for Payer: Cofinity Commercial |
$239.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.78
|
| Rate for Payer: Healthscope Commercial |
$250.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.70
|
| Rate for Payer: PHP Commercial |
$236.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.01
|
| Rate for Payer: Priority Health SBD |
$175.44
|
| Rate for Payer: UMR Bronson Commercial |
$122.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.85
|
|
|
INSULIN GLULISINE (U-100) 100 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
OP
|
$278.47
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
301807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$250.62 |
| Rate for Payer: Aetna American Axle |
$181.01
|
| Rate for Payer: Aetna Commercial |
$236.70
|
| Rate for Payer: Aetna Medicare |
$139.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.01
|
| Rate for Payer: BCBS Complete |
$111.39
|
| Rate for Payer: BCBS Trust/PPO |
$1.46
|
| Rate for Payer: BCN Commercial |
$1.46
|
| Rate for Payer: Cash Price |
$222.78
|
| Rate for Payer: Cash Price |
$222.78
|
| Rate for Payer: Cofinity Commercial |
$194.93
|
| Rate for Payer: Cofinity Commercial |
$239.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.78
|
| Rate for Payer: Healthscope Commercial |
$250.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.70
|
| Rate for Payer: PHP Commercial |
$236.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.01
|
| Rate for Payer: Priority Health SBD |
$175.44
|
| Rate for Payer: UMR Bronson Commercial |
$103.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.85
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML PEDIATRIC CARB BASED CORRECTION HALF-UNIT PEN
|
Facility
|
IP
|
$80.59
|
|
|
Service Code
|
NDC 00002775205
|
| Hospital Charge Code |
301623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.46 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity Commercial |
$56.41
|
| Rate for Payer: Cofinity Commercial |
$69.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.47
|
| Rate for Payer: Healthscope Commercial |
$72.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.50
|
| Rate for Payer: PHP Commercial |
$68.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.38
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: UMR Bronson Commercial |
$35.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
