Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 9513: MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$12,011.26

Service Code	APR-DRG 9513
Hospital Charge Code	APRDRG 9513
Min. Negotiated Rate	$11,439.30
Max. Negotiated Rate	$12,011.26
Rate for Payer: BCBS Complete	$12,011.26
Rate for Payer: Mclaren Medicaid	$11,439.30
Rate for Payer: Meridian Medicaid	$12,011.26
Rate for Payer: PHP Medicaid	$11,439.30
Rate for Payer: Priority Health Choice Medicaid	$11,439.30

INPATIENT APRDRG 9514: MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$21,068.13

Service Code	APR-DRG 9514
Hospital Charge Code	APRDRG 9514
Min. Negotiated Rate	$20,064.89
Max. Negotiated Rate	$21,068.13
Rate for Payer: BCBS Complete	$21,068.13
Rate for Payer: Mclaren Medicaid	$20,064.89
Rate for Payer: Meridian Medicaid	$21,068.13
Rate for Payer: PHP Medicaid	$20,064.89
Rate for Payer: Priority Health Choice Medicaid	$20,064.89

INPATIENT APRDRG 9521: NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$5,837.60

Service Code	APR-DRG 9521
Hospital Charge Code	APRDRG 9521
Min. Negotiated Rate	$5,559.62
Max. Negotiated Rate	$5,837.60
Rate for Payer: BCBS Complete	$5,837.60
Rate for Payer: Mclaren Medicaid	$5,559.62
Rate for Payer: Meridian Medicaid	$5,837.60
Rate for Payer: PHP Medicaid	$5,559.62
Rate for Payer: Priority Health Choice Medicaid	$5,559.62

INPATIENT APRDRG 9522: NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$7,514.86

Service Code	APR-DRG 9522
Hospital Charge Code	APRDRG 9522
Min. Negotiated Rate	$7,157.01
Max. Negotiated Rate	$7,514.86
Rate for Payer: BCBS Complete	$7,514.86
Rate for Payer: Mclaren Medicaid	$7,157.01
Rate for Payer: Meridian Medicaid	$7,514.86
Rate for Payer: PHP Medicaid	$7,157.01
Rate for Payer: Priority Health Choice Medicaid	$7,157.01

INPATIENT APRDRG 9523: NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$10,119.88

Service Code	APR-DRG 9523
Hospital Charge Code	APRDRG 9523
Min. Negotiated Rate	$9,637.98
Max. Negotiated Rate	$10,119.88
Rate for Payer: BCBS Complete	$10,119.88
Rate for Payer: Mclaren Medicaid	$9,637.98
Rate for Payer: Meridian Medicaid	$10,119.88
Rate for Payer: PHP Medicaid	$9,637.98
Rate for Payer: Priority Health Choice Medicaid	$9,637.98

INPATIENT APRDRG 9524: NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$20,289.96

Service Code	APR-DRG 9524
Hospital Charge Code	APRDRG 9524
Min. Negotiated Rate	$19,323.77
Max. Negotiated Rate	$20,289.96
Rate for Payer: BCBS Complete	$20,289.96
Rate for Payer: Mclaren Medicaid	$19,323.77
Rate for Payer: Meridian Medicaid	$20,289.96
Rate for Payer: PHP Medicaid	$19,323.77
Rate for Payer: Priority Health Choice Medicaid	$19,323.77

INPT/ED TELECONSULT30

Professional

Both

$197.00

Service Code	HCPCS G0425
Min. Negotiated Rate	$58.58
Max. Negotiated Rate	$491.32
Rate for Payer: Aetna Commercial	$122.86
Rate for Payer: Aetna Medicare	$91.69
Rate for Payer: BCBS Complete	$61.51
Rate for Payer: BCBS MAPPO	$91.69
Rate for Payer: BCBS Trust/PPO	$491.32
Rate for Payer: BCN Commercial	$134.38
Rate for Payer: BCN Medicare Advantage	$91.69
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cofinity Commercial	$132.03
Rate for Payer: Cofinity Commercial	$122.86
Rate for Payer: Health Alliance Plan Medicare Advantage	$91.69
Rate for Payer: Healthscope Commercial	$110.03
Rate for Payer: Healthscope Whirlpool	$110.03
Rate for Payer: Meridian Medicaid	$61.51
Rate for Payer: Meridian Wellcare - Medicare Advantage	$96.27
Rate for Payer: PACE SWMI	$91.69
Rate for Payer: PHP Medicare Advantage	$91.69
Rate for Payer: Priority Health Choice Medicaid	$58.58
Rate for Payer: Priority Health Cigna Priority Health	$137.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$117.79
Rate for Payer: Priority Health Medicare	$91.69
Rate for Payer: Priority Health Narrow Network	$117.79
Rate for Payer: UHC Medicare Advantage	$94.44

INPT/ED TELECONSULT50

Professional

Both

$267.00

Service Code	HCPCS G0426
Min. Negotiated Rate	$82.86
Max. Negotiated Rate	$562.64
Rate for Payer: Aetna Commercial	$171.87
Rate for Payer: Aetna Medicare	$128.26
Rate for Payer: BCBS Complete	$87.00
Rate for Payer: BCBS MAPPO	$128.26
Rate for Payer: BCBS Trust/PPO	$562.64
Rate for Payer: BCN Commercial	$188.63
Rate for Payer: BCN Medicare Advantage	$128.26
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cofinity Commercial	$171.87
Rate for Payer: Cofinity Commercial	$184.69
Rate for Payer: Health Alliance Plan Medicare Advantage	$128.26
Rate for Payer: Healthscope Commercial	$153.91
Rate for Payer: Healthscope Whirlpool	$153.91
Rate for Payer: Meridian Medicaid	$87.00
Rate for Payer: Meridian Wellcare - Medicare Advantage	$134.67
Rate for Payer: PACE SWMI	$128.26
Rate for Payer: PHP Medicare Advantage	$128.26
Rate for Payer: Priority Health Choice Medicaid	$82.86
Rate for Payer: Priority Health Cigna Priority Health	$186.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$165.33
Rate for Payer: Priority Health Medicare	$128.26
Rate for Payer: Priority Health Narrow Network	$165.33
Rate for Payer: UHC Medicare Advantage	$132.11

INPT/ED TELECONSULT70

Professional

Both

$396.00

Service Code	HCPCS G0427
Min. Negotiated Rate	$117.15
Max. Negotiated Rate	$348.68
Rate for Payer: Aetna Commercial	$244.66
Rate for Payer: Aetna Medicare	$182.58
Rate for Payer: BCBS Complete	$123.01
Rate for Payer: BCBS MAPPO	$182.58
Rate for Payer: BCBS Trust/PPO	$348.68
Rate for Payer: BCN Commercial	$268.29
Rate for Payer: BCN Medicare Advantage	$182.58
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cofinity Commercial	$262.92
Rate for Payer: Cofinity Commercial	$244.66
Rate for Payer: Health Alliance Plan Medicare Advantage	$182.58
Rate for Payer: Healthscope Commercial	$219.10
Rate for Payer: Healthscope Whirlpool	$219.10
Rate for Payer: Meridian Medicaid	$123.01
Rate for Payer: Meridian Wellcare - Medicare Advantage	$191.71
Rate for Payer: PACE SWMI	$182.58
Rate for Payer: PHP Medicare Advantage	$182.58
Rate for Payer: Priority Health Choice Medicaid	$117.15
Rate for Payer: Priority Health Cigna Priority Health	$277.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$235.15
Rate for Payer: Priority Health Medicare	$182.58
Rate for Payer: Priority Health Narrow Network	$235.15
Rate for Payer: UHC Medicare Advantage	$188.06

INPT/TELE FOLLOW UP 35

Professional

Both

$180.00

Service Code	HCPCS G0408
Min. Negotiated Rate	$66.46
Max. Negotiated Rate	$1,554.26
Rate for Payer: Aetna Commercial	$138.50
Rate for Payer: Aetna Medicare	$103.36
Rate for Payer: BCBS Complete	$69.78
Rate for Payer: BCBS MAPPO	$103.36
Rate for Payer: BCBS Trust/PPO	$1,554.26
Rate for Payer: BCN Commercial	$152.47
Rate for Payer: BCN Medicare Advantage	$103.36
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cofinity Commercial	$148.84
Rate for Payer: Cofinity Commercial	$138.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$103.36
Rate for Payer: Healthscope Commercial	$124.03
Rate for Payer: Healthscope Whirlpool	$124.03
Rate for Payer: Meridian Medicaid	$69.78
Rate for Payer: Meridian Wellcare - Medicare Advantage	$108.53
Rate for Payer: PACE SWMI	$103.36
Rate for Payer: PHP Medicare Advantage	$103.36
Rate for Payer: Priority Health Choice Medicaid	$66.46
Rate for Payer: Priority Health Cigna Priority Health	$126.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$140.14
Rate for Payer: Priority Health Medicare	$103.36
Rate for Payer: Priority Health Narrow Network	$140.14
Rate for Payer: UHC Medicare Advantage	$106.46

INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM

Facility

$115.64

Service Code	NDC 0169-6339-10
Hospital Charge Code	300798
Hospital Revenue Code	637
Min. Negotiated Rate	$80.95
Max. Negotiated Rate	$115.64
Rate for Payer: Aetna Commercial	$104.08
Rate for Payer: ASR ASR	$112.17
Rate for Payer: BCBS Trust/PPO	$89.66
Rate for Payer: BCN Commercial	$89.66
Rate for Payer: Cash Price	$92.51
Rate for Payer: Cofinity Commercial	$108.70
Rate for Payer: Encore Health Key Benefits Commercial	$92.51
Rate for Payer: Healthscope Commercial	$115.64
Rate for Payer: Healthscope Whirlpool	$112.17
Rate for Payer: Mclaren Commercial	$104.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$98.29
Rate for Payer: Priority Health Cigna Priority Health	$80.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$101.76

INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM

Facility

$115.64

Service Code	NDC 0169-6339-10
Hospital Charge Code	300796
Hospital Revenue Code	637
Min. Negotiated Rate	$80.95
Max. Negotiated Rate	$115.64
Rate for Payer: Aetna Commercial	$104.08
Rate for Payer: ASR ASR	$112.17
Rate for Payer: BCBS Trust/PPO	$89.66
Rate for Payer: BCN Commercial	$89.66
Rate for Payer: Cash Price	$92.51
Rate for Payer: Cofinity Commercial	$108.70
Rate for Payer: Encore Health Key Benefits Commercial	$92.51
Rate for Payer: Healthscope Commercial	$115.64
Rate for Payer: Healthscope Whirlpool	$112.17
Rate for Payer: Mclaren Commercial	$104.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$98.29
Rate for Payer: Priority Health Cigna Priority Health	$80.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$101.76

INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM

Facility

$115.64

Service Code	NDC 0169-6339-10
Hospital Charge Code	300797
Hospital Revenue Code	637
Min. Negotiated Rate	$80.95
Max. Negotiated Rate	$115.64
Rate for Payer: Aetna Commercial	$104.08
Rate for Payer: ASR ASR	$112.17
Rate for Payer: BCBS Trust/PPO	$89.66
Rate for Payer: BCN Commercial	$89.66
Rate for Payer: Cash Price	$92.51
Rate for Payer: Cofinity Commercial	$108.70
Rate for Payer: Encore Health Key Benefits Commercial	$92.51
Rate for Payer: Healthscope Commercial	$115.64
Rate for Payer: Healthscope Whirlpool	$112.17
Rate for Payer: Mclaren Commercial	$104.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$98.29
Rate for Payer: Priority Health Cigna Priority Health	$80.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$101.76

INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN

Facility

$115.64

Service Code	NDC 0169-6339-10
Hospital Charge Code	112756
Hospital Revenue Code	637
Min. Negotiated Rate	$80.95
Max. Negotiated Rate	$115.64
Rate for Payer: Aetna Commercial	$104.08
Rate for Payer: ASR ASR	$112.17
Rate for Payer: BCBS Trust/PPO	$89.66
Rate for Payer: BCN Commercial	$89.66
Rate for Payer: Cash Price	$92.51
Rate for Payer: Cofinity Commercial	$108.70
Rate for Payer: Encore Health Key Benefits Commercial	$92.51
Rate for Payer: Healthscope Commercial	$115.64
Rate for Payer: Healthscope Whirlpool	$112.17
Rate for Payer: Mclaren Commercial	$104.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$98.29
Rate for Payer: Priority Health Cigna Priority Health	$80.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$101.76

INSULIN DETEMIR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN

Facility

$97.48

Service Code	NDC 0169-6438-90
Hospital Charge Code	116361
Hospital Revenue Code	637
Min. Negotiated Rate	$68.24
Max. Negotiated Rate	$97.48
Rate for Payer: Aetna Commercial	$87.73
Rate for Payer: ASR ASR	$94.56
Rate for Payer: BCBS Trust/PPO	$75.58
Rate for Payer: BCN Commercial	$75.58
Rate for Payer: Cash Price	$77.98
Rate for Payer: Cofinity Commercial	$91.63
Rate for Payer: Encore Health Key Benefits Commercial	$77.98
Rate for Payer: Healthscope Commercial	$97.48
Rate for Payer: Healthscope Whirlpool	$94.56
Rate for Payer: Mclaren Commercial	$87.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$82.86
Rate for Payer: Priority Health Cigna Priority Health	$68.24
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$85.78

INSULIN DETEMIR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN

Facility

$111.33

Service Code	NDC 0169-6432-55
Hospital Charge Code	116361
Hospital Revenue Code	637
Min. Negotiated Rate	$77.93
Max. Negotiated Rate	$111.33
Rate for Payer: Aetna Commercial	$100.20
Rate for Payer: ASR ASR	$107.99
Rate for Payer: BCBS Trust/PPO	$86.31
Rate for Payer: BCN Commercial	$86.31
Rate for Payer: Cash Price	$89.07
Rate for Payer: Cofinity Commercial	$104.65
Rate for Payer: Encore Health Key Benefits Commercial	$89.06
Rate for Payer: Healthscope Commercial	$111.33
Rate for Payer: Healthscope Whirlpool	$107.99
Rate for Payer: Mclaren Commercial	$100.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$94.63
Rate for Payer: Priority Health Cigna Priority Health	$77.93
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$97.97

INSULIN DETEMIR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN

Facility

$97.48

Service Code	NDC 0169-6438-10
Hospital Charge Code	116361
Hospital Revenue Code	637
Min. Negotiated Rate	$68.24
Max. Negotiated Rate	$97.48
Rate for Payer: Aetna Commercial	$87.73
Rate for Payer: ASR ASR	$94.56
Rate for Payer: BCBS Trust/PPO	$75.58
Rate for Payer: BCN Commercial	$75.58
Rate for Payer: Cash Price	$77.98
Rate for Payer: Cofinity Commercial	$91.63
Rate for Payer: Encore Health Key Benefits Commercial	$77.98
Rate for Payer: Healthscope Commercial	$97.48
Rate for Payer: Healthscope Whirlpool	$94.56
Rate for Payer: Mclaren Commercial	$87.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$82.86
Rate for Payer: Priority Health Cigna Priority Health	$68.24
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$85.78

INSULIN DETEMIR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN

Facility

$111.33

Service Code	NDC 0169-6432-10
Hospital Charge Code	116361
Hospital Revenue Code	637
Min. Negotiated Rate	$77.93
Max. Negotiated Rate	$111.33
Rate for Payer: Aetna Commercial	$100.20
Rate for Payer: ASR ASR	$107.99
Rate for Payer: BCBS Trust/PPO	$86.31
Rate for Payer: BCN Commercial	$86.31
Rate for Payer: Cash Price	$89.07
Rate for Payer: Cofinity Commercial	$104.65
Rate for Payer: Encore Health Key Benefits Commercial	$89.06
Rate for Payer: Healthscope Commercial	$111.33
Rate for Payer: Healthscope Whirlpool	$107.99
Rate for Payer: Mclaren Commercial	$100.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$94.63
Rate for Payer: Priority Health Cigna Priority Health	$77.93
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$97.97

INSULIN GLARGINE (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN

Facility

$352.03

Service Code	HCPCS J1815
Hospital Charge Code	117377
Hospital Revenue Code	636
Min. Negotiated Rate	$246.42
Max. Negotiated Rate	$352.03
Rate for Payer: Aetna Commercial	$316.83
Rate for Payer: ASR ASR	$341.47
Rate for Payer: BCBS Trust/PPO	$272.93
Rate for Payer: BCN Commercial	$272.93
Rate for Payer: Cash Price	$281.62
Rate for Payer: Cofinity Commercial	$330.91
Rate for Payer: Encore Health Key Benefits Commercial	$281.62
Rate for Payer: Healthscope Commercial	$352.03
Rate for Payer: Healthscope Whirlpool	$341.47
Rate for Payer: Mclaren Commercial	$316.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$299.23
Rate for Payer: Priority Health Cigna Priority Health	$246.42
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$309.79

INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN

Facility

$80.58

Service Code	NDC 0002-8799-59
Hospital Charge Code	111377
Hospital Revenue Code	637
Min. Negotiated Rate	$56.41
Max. Negotiated Rate	$80.58
Rate for Payer: Aetna Commercial	$72.52
Rate for Payer: ASR ASR	$78.16
Rate for Payer: BCBS Trust/PPO	$62.47
Rate for Payer: BCN Commercial	$62.47
Rate for Payer: Cash Price	$64.46
Rate for Payer: Cofinity Commercial	$75.75
Rate for Payer: Encore Health Key Benefits Commercial	$64.46
Rate for Payer: Healthscope Commercial	$80.58
Rate for Payer: Healthscope Whirlpool	$78.16
Rate for Payer: Mclaren Commercial	$72.52
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$68.49
Rate for Payer: Priority Health Cigna Priority Health	$56.41
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$70.91

INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN

Facility

$80.58

Service Code	NDC 0002-8799-01
Hospital Charge Code	111377
Hospital Revenue Code	637
Min. Negotiated Rate	$56.41
Max. Negotiated Rate	$80.58
Rate for Payer: Aetna Commercial	$72.52
Rate for Payer: ASR ASR	$78.16
Rate for Payer: BCBS Trust/PPO	$62.47
Rate for Payer: BCN Commercial	$62.47
Rate for Payer: Cash Price	$64.46
Rate for Payer: Cofinity Commercial	$75.75
Rate for Payer: Encore Health Key Benefits Commercial	$64.46
Rate for Payer: Healthscope Commercial	$80.58
Rate for Payer: Healthscope Whirlpool	$78.16
Rate for Payer: Mclaren Commercial	$72.52
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$68.49
Rate for Payer: Priority Health Cigna Priority Health	$56.41
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$70.91

INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN

Facility

$46.05

Service Code	HCPCS J1815
Hospital Charge Code	112517
Hospital Revenue Code	636
Min. Negotiated Rate	$32.24
Max. Negotiated Rate	$46.05
Rate for Payer: Aetna Commercial	$41.44
Rate for Payer: ASR ASR	$44.67
Rate for Payer: BCBS Trust/PPO	$35.70
Rate for Payer: BCN Commercial	$35.70
Rate for Payer: Cash Price	$36.84
Rate for Payer: Cofinity Commercial	$43.29
Rate for Payer: Encore Health Key Benefits Commercial	$36.84
Rate for Payer: Healthscope Commercial	$46.05
Rate for Payer: Healthscope Whirlpool	$44.67
Rate for Payer: Mclaren Commercial	$41.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$39.14
Rate for Payer: Priority Health Cigna Priority Health	$32.24
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$40.52

INSULIN REGULAR 100 UNIT/100 ML (1 UNIT/ML) IN 0.9 % NACL IV SOLUTION

Facility

$70.31

Service Code	NDC 0338-0126-12
Hospital Charge Code	191217
Hospital Revenue Code	250
Min. Negotiated Rate	$49.22
Max. Negotiated Rate	$70.31
Rate for Payer: Aetna Commercial	$63.28
Rate for Payer: ASR ASR	$68.20
Rate for Payer: BCBS Trust/PPO	$54.51
Rate for Payer: BCN Commercial	$54.51
Rate for Payer: Cash Price	$56.25
Rate for Payer: Cofinity Commercial	$66.09
Rate for Payer: Encore Health Key Benefits Commercial	$56.25
Rate for Payer: Healthscope Commercial	$70.31
Rate for Payer: Healthscope Whirlpool	$68.20
Rate for Payer: Mclaren Commercial	$63.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.76
Rate for Payer: Priority Health Cigna Priority Health	$49.22
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.87

INSULIN REGULAR 1 UNIT/ML IN 0.9 % NACL IV PUSH (CUSTOM)

Facility

$70.31

Service Code	NDC 0338-0126-12
Hospital Charge Code	301039
Hospital Revenue Code	250
Min. Negotiated Rate	$49.22
Max. Negotiated Rate	$70.31
Rate for Payer: Aetna Commercial	$63.28
Rate for Payer: ASR ASR	$68.20
Rate for Payer: BCBS Trust/PPO	$54.51
Rate for Payer: BCN Commercial	$54.51
Rate for Payer: Cash Price	$56.25
Rate for Payer: Cofinity Commercial	$66.09
Rate for Payer: Encore Health Key Benefits Commercial	$56.25
Rate for Payer: Healthscope Commercial	$70.31
Rate for Payer: Healthscope Whirlpool	$68.20
Rate for Payer: Mclaren Commercial	$63.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.76
Rate for Payer: Priority Health Cigna Priority Health	$49.22
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.87

INSULIN REGULAR HUMAN 100 UNIT/ML INJECTION (MDV ADS)

Facility

$76.26

Service Code	NDC 0002-8215-17
Hospital Charge Code	164971
Hospital Revenue Code	637
Min. Negotiated Rate	$53.38
Max. Negotiated Rate	$76.26
Rate for Payer: Aetna Commercial	$68.63
Rate for Payer: ASR ASR	$73.97
Rate for Payer: BCBS Trust/PPO	$59.12
Rate for Payer: BCN Commercial	$59.12
Rate for Payer: Cash Price	$61.00
Rate for Payer: Cofinity Commercial	$71.68
Rate for Payer: Encore Health Key Benefits Commercial	$61.01
Rate for Payer: Healthscope Commercial	$76.26
Rate for Payer: Healthscope Whirlpool	$73.97
Rate for Payer: Mclaren Commercial	$68.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$64.82
Rate for Payer: Priority Health Cigna Priority Health	$53.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$67.11

Know your out-of-pocket cost for care.

All Charges