|
INSULIN LISPRO (U-100) 100 UNIT/ML PEDIATRIC CARB BASED CORRECTION HALF-UNIT PEN
|
Facility
|
IP
|
$80.59
|
|
|
Service Code
|
NDC 00002775201
|
| Hospital Charge Code |
301623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.46 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity 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
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML PEDIATRIC CARB BASED CORRECTION HALF-UNIT PEN
|
Facility
|
OP
|
$80.59
|
|
|
Service Code
|
NDC 00002775201
|
| Hospital Charge Code |
301623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna Medicare |
$40.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: BCBS Complete |
$32.24
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity 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 |
$29.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML PEDIATRIC CARB BASED CORRECTION HALF-UNIT PEN
|
Facility
|
OP
|
$80.59
|
|
|
Service Code
|
NDC 00002775205
|
| Hospital Charge Code |
301623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna Medicare |
$40.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: BCBS Complete |
$32.24
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity 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 |
$29.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
IP
|
$167.65
|
|
|
Service Code
|
NDC 00002751001
|
| Hospital Charge Code |
301805
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.77 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna American Axle |
$108.97
|
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.97
|
| Rate for Payer: Cash Price |
$134.12
|
| Rate for Payer: Cofinity Commercial |
$117.36
|
| Rate for Payer: Cofinity Commercial |
$144.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.12
|
| Rate for Payer: Healthscope Commercial |
$150.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.50
|
| Rate for Payer: PHP Commercial |
$142.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.97
|
| Rate for Payer: Priority Health SBD |
$105.62
|
| Rate for Payer: UMR Bronson Commercial |
$73.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.74
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
OP
|
$167.65
|
|
|
Service Code
|
NDC 00002751001
|
| Hospital Charge Code |
301805
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.03 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna American Axle |
$108.97
|
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare |
$83.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.97
|
| Rate for Payer: BCBS Complete |
$67.06
|
| Rate for Payer: Cash Price |
$134.12
|
| Rate for Payer: Cofinity Commercial |
$117.36
|
| Rate for Payer: Cofinity Commercial |
$144.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.12
|
| Rate for Payer: Healthscope Commercial |
$150.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.50
|
| Rate for Payer: PHP Commercial |
$142.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.97
|
| Rate for Payer: Priority Health SBD |
$105.62
|
| Rate for Payer: UMR Bronson Commercial |
$62.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.74
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS HALF-UNIT PEN
|
Facility
|
IP
|
$80.59
|
|
|
Service Code
|
NDC 00002771459
|
| Hospital Charge Code |
184350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.46 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity 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
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS HALF-UNIT PEN
|
Facility
|
OP
|
$80.59
|
|
|
Service Code
|
NDC 00002771459
|
| Hospital Charge Code |
184350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna Medicare |
$40.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: BCBS Complete |
$32.24
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity 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 |
$29.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS HALF-UNIT PEN
|
Facility
|
OP
|
$80.59
|
|
|
Service Code
|
NDC 00002771401
|
| Hospital Charge Code |
184350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna Medicare |
$40.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: BCBS Complete |
$32.24
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity 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 |
$29.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS HALF-UNIT PEN
|
Facility
|
IP
|
$80.59
|
|
|
Service Code
|
NDC 00002771401
|
| Hospital Charge Code |
184350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.46 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity 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
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS HALF-UNIT PEN
|
Facility
|
OP
|
$80.59
|
|
|
Service Code
|
NDC 00002775205
|
| Hospital Charge Code |
184350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna Medicare |
$40.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: BCBS Complete |
$32.24
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity 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 |
$29.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS HALF-UNIT PEN
|
Facility
|
IP
|
$80.59
|
|
|
Service Code
|
NDC 00002775201
|
| Hospital Charge Code |
184350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.46 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity 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
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS HALF-UNIT PEN
|
Facility
|
IP
|
$80.59
|
|
|
Service Code
|
NDC 00002775205
|
| Hospital Charge Code |
184350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.46 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity 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
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS HALF-UNIT PEN
|
Facility
|
OP
|
$80.59
|
|
|
Service Code
|
NDC 00002775201
|
| Hospital Charge Code |
184350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$72.53 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.50
|
| Rate for Payer: Aetna Medicare |
$40.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: BCBS Complete |
$32.24
|
| Rate for Payer: Cash Price |
$64.47
|
| Rate for Payer: Cofinity 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 |
$29.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$167.65
|
|
|
Service Code
|
NDC 00002751001
|
| Hospital Charge Code |
17405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.03 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna American Axle |
$108.97
|
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare |
$83.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.97
|
| Rate for Payer: BCBS Complete |
$67.06
|
| Rate for Payer: Cash Price |
$134.12
|
| Rate for Payer: Cofinity Commercial |
$117.36
|
| Rate for Payer: Cofinity Commercial |
$144.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.12
|
| Rate for Payer: Healthscope Commercial |
$150.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.50
|
| Rate for Payer: PHP Commercial |
$142.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.97
|
| Rate for Payer: Priority Health SBD |
$105.62
|
| Rate for Payer: UMR Bronson Commercial |
$62.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.74
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$167.65
|
|
|
Service Code
|
NDC 00002751001
|
| Hospital Charge Code |
17405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.77 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna American Axle |
$108.97
|
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.97
|
| Rate for Payer: Cash Price |
$134.12
|
| Rate for Payer: Cofinity Commercial |
$117.36
|
| Rate for Payer: Cofinity Commercial |
$144.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.12
|
| Rate for Payer: Healthscope Commercial |
$150.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.50
|
| Rate for Payer: PHP Commercial |
$142.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.97
|
| Rate for Payer: Priority Health SBD |
$105.62
|
| Rate for Payer: UMR Bronson Commercial |
$73.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.74
|
|
|
INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION
|
Facility
|
OP
|
$141.16
|
|
|
Service Code
|
NDC 00169183411
|
| Hospital Charge Code |
10284
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.23 |
| Max. Negotiated Rate |
$127.04 |
| Rate for Payer: Aetna American Axle |
$91.75
|
| Rate for Payer: Aetna Commercial |
$119.99
|
| Rate for Payer: Aetna Medicare |
$70.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.75
|
| Rate for Payer: BCBS Complete |
$56.46
|
| Rate for Payer: Cash Price |
$112.93
|
| Rate for Payer: Cofinity Commercial |
$121.40
|
| Rate for Payer: Cofinity Commercial |
$98.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.93
|
| Rate for Payer: Healthscope Commercial |
$127.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.99
|
| Rate for Payer: PHP Commercial |
$119.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.75
|
| Rate for Payer: Priority Health SBD |
$88.93
|
| Rate for Payer: UMR Bronson Commercial |
$52.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.87
|
|
|
INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION
|
Facility
|
IP
|
$141.16
|
|
|
Service Code
|
NDC 00169183411
|
| Hospital Charge Code |
10284
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.11 |
| Max. Negotiated Rate |
$127.04 |
| Rate for Payer: Aetna American Axle |
$91.75
|
| Rate for Payer: Aetna Commercial |
$119.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.75
|
| Rate for Payer: Cash Price |
$112.93
|
| Rate for Payer: Cofinity Commercial |
$121.40
|
| Rate for Payer: Cofinity Commercial |
$98.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.93
|
| Rate for Payer: Healthscope Commercial |
$127.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.99
|
| Rate for Payer: PHP Commercial |
$119.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.75
|
| Rate for Payer: Priority Health SBD |
$88.93
|
| Rate for Payer: UMR Bronson Commercial |
$62.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.87
|
|
|
INSULIN REGULAR 1 UNIT/ML IN 0.9 % NACL IV PUSH (CUSTOM)
|
Facility
|
OP
|
$66.31
|
|
|
Service Code
|
NDC 00338012612
|
| Hospital Charge Code |
301039
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.53 |
| Max. Negotiated Rate |
$59.68 |
| Rate for Payer: Aetna American Axle |
$43.10
|
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna Medicare |
$33.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.10
|
| Rate for Payer: BCBS Complete |
$26.52
|
| Rate for Payer: Cash Price |
$53.05
|
| Rate for Payer: Cofinity Commercial |
$46.42
|
| Rate for Payer: Cofinity Commercial |
$57.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.05
|
| Rate for Payer: Healthscope Commercial |
$59.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: Priority Health SBD |
$41.78
|
| Rate for Payer: UMR Bronson Commercial |
$24.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.73
|
|
|
INSULIN REGULAR 1 UNIT/ML IN 0.9 % NACL IV PUSH (CUSTOM)
|
Facility
|
IP
|
$66.31
|
|
|
Service Code
|
NDC 00338012612
|
| Hospital Charge Code |
301039
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$59.68 |
| Rate for Payer: Aetna American Axle |
$43.10
|
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.10
|
| Rate for Payer: Cash Price |
$53.05
|
| Rate for Payer: Cofinity Commercial |
$46.42
|
| Rate for Payer: Cofinity Commercial |
$57.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.05
|
| Rate for Payer: Healthscope Commercial |
$59.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: Priority Health SBD |
$41.78
|
| Rate for Payer: UMR Bronson Commercial |
$29.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.73
|
|
|
INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN
|
Facility
|
IP
|
$938.40
|
|
|
Service Code
|
NDC 00002882427
|
| Hospital Charge Code |
178095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$412.90 |
| Max. Negotiated Rate |
$844.56 |
| Rate for Payer: Aetna American Axle |
$609.96
|
| Rate for Payer: Aetna Commercial |
$797.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.96
|
| Rate for Payer: Cash Price |
$750.72
|
| Rate for Payer: Cofinity Commercial |
$656.88
|
| Rate for Payer: Cofinity Commercial |
$807.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$656.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.72
|
| Rate for Payer: Healthscope Commercial |
$844.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$656.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$703.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$797.64
|
| Rate for Payer: PHP Commercial |
$797.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.96
|
| Rate for Payer: Priority Health SBD |
$591.19
|
| Rate for Payer: UMR Bronson Commercial |
$412.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$703.80
|
|
|
INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN
|
Facility
|
OP
|
$938.40
|
|
|
Service Code
|
NDC 00002882427
|
| Hospital Charge Code |
178095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$347.21 |
| Max. Negotiated Rate |
$844.56 |
| Rate for Payer: Aetna American Axle |
$609.96
|
| Rate for Payer: Aetna Commercial |
$797.64
|
| Rate for Payer: Aetna Medicare |
$469.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.96
|
| Rate for Payer: BCBS Complete |
$375.36
|
| Rate for Payer: Cash Price |
$750.72
|
| Rate for Payer: Cofinity Commercial |
$656.88
|
| Rate for Payer: Cofinity Commercial |
$807.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$656.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.72
|
| Rate for Payer: Healthscope Commercial |
$844.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$656.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$703.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$797.64
|
| Rate for Payer: PHP Commercial |
$797.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.96
|
| Rate for Payer: Priority Health SBD |
$591.19
|
| Rate for Payer: UMR Bronson Commercial |
$347.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$703.80
|
|
|
INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN
|
Facility
|
IP
|
$938.40
|
|
|
Service Code
|
NDC 00002882401
|
| Hospital Charge Code |
178095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$412.90 |
| Max. Negotiated Rate |
$844.56 |
| Rate for Payer: Aetna American Axle |
$609.96
|
| Rate for Payer: Aetna Commercial |
$797.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.96
|
| Rate for Payer: Cash Price |
$750.72
|
| Rate for Payer: Cofinity Commercial |
$656.88
|
| Rate for Payer: Cofinity Commercial |
$807.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$656.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.72
|
| Rate for Payer: Healthscope Commercial |
$844.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$656.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$703.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$797.64
|
| Rate for Payer: PHP Commercial |
$797.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.96
|
| Rate for Payer: Priority Health SBD |
$591.19
|
| Rate for Payer: UMR Bronson Commercial |
$412.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$703.80
|
|
|
INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN
|
Facility
|
OP
|
$938.40
|
|
|
Service Code
|
NDC 00002882401
|
| Hospital Charge Code |
178095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$347.21 |
| Max. Negotiated Rate |
$844.56 |
| Rate for Payer: Aetna American Axle |
$609.96
|
| Rate for Payer: Aetna Commercial |
$797.64
|
| Rate for Payer: Aetna Medicare |
$469.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.96
|
| Rate for Payer: BCBS Complete |
$375.36
|
| Rate for Payer: Cash Price |
$750.72
|
| Rate for Payer: Cofinity Commercial |
$656.88
|
| Rate for Payer: Cofinity Commercial |
$807.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$656.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.72
|
| Rate for Payer: Healthscope Commercial |
$844.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$656.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$703.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$797.64
|
| Rate for Payer: PHP Commercial |
$797.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.96
|
| Rate for Payer: Priority Health SBD |
$591.19
|
| Rate for Payer: UMR Bronson Commercial |
$347.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$703.80
|
|
|
INSULIN REGULAR HUMAN U-500"CONCENTRATE" 500 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
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
|
|
