|
INSULIN 5 UNIT/5 ML IV PUSH 5 ML
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
NDC 09900001138
|
| Hospital Charge Code |
300205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Advantage |
$14.00
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.00
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: Priority Health SBD |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.00
|
| Rate for Payer: UHC Core |
$10.42
|
| Rate for Payer: UHC Exchange |
$7.86
|
|
|
INSULIN 5 UNIT/5 ML IV PUSH 5 ML
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
NDC 09900001138
|
| Hospital Charge Code |
300205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Advantage |
$14.00
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.00
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: Priority Health SBD |
$12.60
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Advantage |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health SBD |
$72.85
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Advantage |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health SBD |
$72.85
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$115.64
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna Medicare |
$57.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: BCBS Complete |
$46.26
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Advantage |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health SBD |
$72.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.17
|
| Rate for Payer: UHC Core |
$60.25
|
| Rate for Payer: UHC Exchange |
$45.45
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.28 |
| Max. Negotiated Rate |
$57.55 |
| 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 Advantage |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.95
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health SBD |
$40.28
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$57.55 |
| 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 Advantage |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.95
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health SBD |
$40.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.56
|
| Rate for Payer: UHC Core |
$33.31
|
| Rate for Payer: UHC Exchange |
$25.13
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$115.64
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna Medicare |
$57.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: BCBS Complete |
$46.26
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Advantage |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health SBD |
$72.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.17
|
| Rate for Payer: UHC Core |
$60.25
|
| Rate for Payer: UHC Exchange |
$45.45
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
301084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Advantage |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health SBD |
$72.85
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
OP
|
$115.64
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
301084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna Medicare |
$57.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: BCBS Complete |
$46.26
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Advantage |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health SBD |
$72.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.17
|
| Rate for Payer: UHC Core |
$60.25
|
| Rate for Payer: UHC Exchange |
$45.45
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
OP
|
$115.64
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
301084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna Medicare |
$57.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: BCBS Complete |
$46.26
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Advantage |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health SBD |
$72.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.17
|
| Rate for Payer: UHC Core |
$60.25
|
| Rate for Payer: UHC Exchange |
$45.45
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
301084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Advantage |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health SBD |
$72.85
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
301084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.28 |
| Max. Negotiated Rate |
$57.55 |
| 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 Advantage |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.95
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health SBD |
$40.28
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
301084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$57.55 |
| 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 Advantage |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.95
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health SBD |
$40.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.56
|
| Rate for Payer: UHC Core |
$33.31
|
| Rate for Payer: UHC Exchange |
$25.13
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$115.64
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
300796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna Medicare |
$57.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: BCBS Complete |
$46.26
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Advantage |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health SBD |
$72.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.17
|
| Rate for Payer: UHC Core |
$60.25
|
| Rate for Payer: UHC Exchange |
$45.45
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
300796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Advantage |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health SBD |
$72.85
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
300796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.28 |
| Max. Negotiated Rate |
$57.55 |
| 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 Advantage |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.95
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health SBD |
$40.28
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
300796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$57.55 |
| 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 Advantage |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.95
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health SBD |
$40.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.56
|
| Rate for Payer: UHC Core |
$33.31
|
| Rate for Payer: UHC Exchange |
$25.13
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
300796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Advantage |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health SBD |
$72.85
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$115.64
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
300796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna Medicare |
$57.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: BCBS Complete |
$46.26
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Advantage |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health SBD |
$72.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.17
|
| Rate for Payer: UHC Core |
$60.25
|
| Rate for Payer: UHC Exchange |
$45.45
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
301082
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.28 |
| Max. Negotiated Rate |
$57.55 |
| 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 Advantage |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.95
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health SBD |
$40.28
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
301082
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$57.55 |
| 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 Advantage |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.95
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health SBD |
$40.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.56
|
| Rate for Payer: UHC Core |
$33.31
|
| Rate for Payer: UHC Exchange |
$25.13
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
OP
|
$115.64
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
301082
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna Medicare |
$57.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: BCBS Complete |
$46.26
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Advantage |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health SBD |
$72.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.17
|
| Rate for Payer: UHC Core |
$60.25
|
| Rate for Payer: UHC Exchange |
$45.45
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
301082
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Advantage |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health SBD |
$72.85
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
301082
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Advantage |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health SBD |
$72.85
|
|
