|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
OP
|
$115.64
|
|
|
Service Code
|
NDC 73070010310
|
| 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) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$115.64
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
300797
|
|
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) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
300797
|
|
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) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$115.64
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
300797
|
|
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) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
300797
|
|
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) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
300797
|
|
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) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
300797
|
|
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) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
301083
|
|
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) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
301083
|
|
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) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
OP
|
$115.64
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
301083
|
|
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) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
301083
|
|
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) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
301083
|
|
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) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
OP
|
$115.64
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
301083
|
|
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) SUBCUTANEOUS PEN
|
Facility
|
OP
|
$115.64
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
112756
|
|
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) SUBCUTANEOUS PEN
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
112756
|
|
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) SUBCUTANEOUS PEN
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
112756
|
|
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) SUBCUTANEOUS PEN
|
Facility
|
OP
|
$115.64
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
112756
|
|
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) SUBCUTANEOUS PEN
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
112756
|
|
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) SUBCUTANEOUS PEN
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
112756
|
|
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 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 |
$39.89 |
| Max. Negotiated Rate |
$56.99 |
| 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 Advantage |
$44.32
|
| Rate for Payer: Cofinity Commercial |
$54.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.66
|
| Rate for Payer: Healthscope Commercial |
$56.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.49
|
| Rate for Payer: PHP Commercial |
$53.82
|
| Rate for Payer: Priority Health SBD |
$39.89
|
|
|
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 |
$1.11 |
| Max. Negotiated Rate |
$56.99 |
| 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 |
$1.11
|
| Rate for Payer: BCN Commercial |
$1.11
|
| Rate for Payer: Cash Price |
$50.66
|
| Rate for Payer: Cash Price |
$50.66
|
| Rate for Payer: Cofinity Advantage |
$44.32
|
| Rate for Payer: Cofinity Commercial |
$54.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.66
|
| Rate for Payer: Healthscope Commercial |
$56.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.49
|
| Rate for Payer: PHP Commercial |
$53.82
|
| Rate for Payer: Priority Health SBD |
$39.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.16
|
| Rate for Payer: UHC Core |
$32.99
|
| Rate for Payer: UHC Exchange |
$24.88
|
|
|
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 |
$175.44 |
| Max. Negotiated Rate |
$250.62 |
| 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 Advantage |
$194.93
|
| Rate for Payer: Cofinity Commercial |
$239.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.78
|
| Rate for Payer: Healthscope Commercial |
$250.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.85
|
| Rate for Payer: PHP Commercial |
$236.70
|
| Rate for Payer: Priority Health SBD |
$175.44
|
|
|
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 |
$1.11 |
| Max. Negotiated Rate |
$250.62 |
| 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 |
$1.11
|
| Rate for Payer: BCN Commercial |
$1.11
|
| Rate for Payer: Cash Price |
$222.78
|
| Rate for Payer: Cash Price |
$222.78
|
| Rate for Payer: Cofinity Advantage |
$194.93
|
| Rate for Payer: Cofinity Commercial |
$239.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.78
|
| Rate for Payer: Healthscope Commercial |
$250.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.85
|
| Rate for Payer: PHP Commercial |
$236.70
|
| Rate for Payer: Priority Health SBD |
$175.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.01
|
| Rate for Payer: UHC Core |
$145.08
|
| Rate for Payer: UHC Exchange |
$109.44
|
|
|
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 |
$65.89 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare |
$83.83
|
| 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 Advantage |
$117.36
|
| Rate for Payer: Cofinity Commercial |
$144.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.12
|
| Rate for Payer: Healthscope Commercial |
$150.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.74
|
| Rate for Payer: PHP Commercial |
$142.50
|
| Rate for Payer: Priority Health SBD |
$105.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.97
|
| Rate for Payer: UHC Core |
$87.35
|
| Rate for Payer: UHC Exchange |
$65.89
|
|
|
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 |
$105.62 |
| Max. Negotiated Rate |
$150.88 |
| 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 Advantage |
$117.36
|
| Rate for Payer: Cofinity Commercial |
$144.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.12
|
| Rate for Payer: Healthscope Commercial |
$150.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.74
|
| Rate for Payer: PHP Commercial |
$142.50
|
| Rate for Payer: Priority Health SBD |
$105.62
|
|
