|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN
|
Facility
|
IP
|
$80.59
|
|
|
Service Code
|
NDC 00002822201
|
| Hospital Charge Code |
111377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.77 |
| Max. Negotiated Rate |
$72.53 |
| 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 Advantage |
$56.41
|
| Rate for Payer: Cofinity Commercial |
$69.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.47
|
| Rate for Payer: Healthscope Commercial |
$72.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.44
|
| Rate for Payer: PHP Commercial |
$68.50
|
| Rate for Payer: Priority Health SBD |
$50.77
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN
|
Facility
|
IP
|
$80.59
|
|
|
Service Code
|
NDC 00002822259
|
| Hospital Charge Code |
111377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.77 |
| Max. Negotiated Rate |
$72.53 |
| 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 Advantage |
$56.41
|
| Rate for Payer: Cofinity Commercial |
$69.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.47
|
| Rate for Payer: Healthscope Commercial |
$72.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.44
|
| Rate for Payer: PHP Commercial |
$68.50
|
| Rate for Payer: Priority Health SBD |
$50.77
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN
|
Facility
|
IP
|
$80.59
|
|
|
Service Code
|
NDC 00002879959
|
| Hospital Charge Code |
111377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.77 |
| Max. Negotiated Rate |
$72.53 |
| 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 Advantage |
$56.41
|
| Rate for Payer: Cofinity Commercial |
$69.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.47
|
| Rate for Payer: Healthscope Commercial |
$72.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.44
|
| Rate for Payer: PHP Commercial |
$68.50
|
| Rate for Payer: Priority Health SBD |
$50.77
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN
|
Facility
|
OP
|
$80.59
|
|
|
Service Code
|
NDC 00002822259
|
| Hospital Charge Code |
111377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.67 |
| Max. Negotiated Rate |
$72.53 |
| 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 Advantage |
$56.41
|
| Rate for Payer: Cofinity Commercial |
$69.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.47
|
| Rate for Payer: Healthscope Commercial |
$72.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.44
|
| Rate for Payer: PHP Commercial |
$68.50
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.38
|
| Rate for Payer: UHC Core |
$41.99
|
| Rate for Payer: UHC Exchange |
$31.67
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN
|
Facility
|
OP
|
$80.59
|
|
|
Service Code
|
NDC 00002879959
|
| Hospital Charge Code |
111377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.67 |
| Max. Negotiated Rate |
$72.53 |
| 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 Advantage |
$56.41
|
| Rate for Payer: Cofinity Commercial |
$69.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.47
|
| Rate for Payer: Healthscope Commercial |
$72.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.44
|
| Rate for Payer: PHP Commercial |
$68.50
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.38
|
| Rate for Payer: UHC Core |
$41.99
|
| Rate for Payer: UHC Exchange |
$31.67
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN
|
Facility
|
OP
|
$80.59
|
|
|
Service Code
|
NDC 00002822201
|
| Hospital Charge Code |
111377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.67 |
| Max. Negotiated Rate |
$72.53 |
| 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 Advantage |
$56.41
|
| Rate for Payer: Cofinity Commercial |
$69.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.47
|
| Rate for Payer: Healthscope Commercial |
$72.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.44
|
| Rate for Payer: PHP Commercial |
$68.50
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.38
|
| Rate for Payer: UHC Core |
$41.99
|
| Rate for Payer: UHC Exchange |
$31.67
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN
|
Facility
|
IP
|
$80.59
|
|
|
Service Code
|
NDC 00002879901
|
| Hospital Charge Code |
111377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.77 |
| Max. Negotiated Rate |
$72.53 |
| 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 Advantage |
$56.41
|
| Rate for Payer: Cofinity Commercial |
$69.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.47
|
| Rate for Payer: Healthscope Commercial |
$72.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.44
|
| Rate for Payer: PHP Commercial |
$68.50
|
| Rate for Payer: Priority Health SBD |
$50.77
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN
|
Facility
|
OP
|
$80.59
|
|
|
Service Code
|
NDC 00002879901
|
| Hospital Charge Code |
111377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.67 |
| Max. Negotiated Rate |
$72.53 |
| 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 Advantage |
$56.41
|
| Rate for Payer: Cofinity Commercial |
$69.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.47
|
| Rate for Payer: Healthscope Commercial |
$72.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.44
|
| Rate for Payer: PHP Commercial |
$68.50
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.38
|
| Rate for Payer: UHC Core |
$41.99
|
| Rate for Payer: UHC Exchange |
$31.67
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$44.03
|
|
|
Service Code
|
NDC 00002751017
|
| Hospital Charge Code |
17405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.30 |
| Max. Negotiated Rate |
$39.63 |
| Rate for Payer: Aetna Commercial |
$37.43
|
| Rate for Payer: Aetna Medicare |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.62
|
| Rate for Payer: BCBS Complete |
$17.61
|
| Rate for Payer: Cash Price |
$35.22
|
| Rate for Payer: Cofinity Advantage |
$30.82
|
| Rate for Payer: Cofinity Commercial |
$37.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.22
|
| Rate for Payer: Healthscope Commercial |
$39.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.02
|
| Rate for Payer: PHP Commercial |
$37.43
|
| Rate for Payer: Priority Health SBD |
$27.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.62
|
| Rate for Payer: UHC Core |
$22.94
|
| Rate for Payer: UHC Exchange |
$17.30
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$44.03
|
|
|
Service Code
|
NDC 00002751017
|
| Hospital Charge Code |
17405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.74 |
| Max. Negotiated Rate |
$39.63 |
| Rate for Payer: Aetna Commercial |
$37.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.62
|
| Rate for Payer: Cash Price |
$35.22
|
| Rate for Payer: Cofinity Advantage |
$30.82
|
| Rate for Payer: Cofinity Commercial |
$37.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.22
|
| Rate for Payer: Healthscope Commercial |
$39.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.02
|
| Rate for Payer: PHP Commercial |
$37.43
|
| Rate for Payer: Priority Health SBD |
$27.74
|
|
|
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 |
$55.48 |
| Max. Negotiated Rate |
$127.04 |
| 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 Advantage |
$98.81
|
| Rate for Payer: Cofinity Commercial |
$121.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.93
|
| Rate for Payer: Healthscope Commercial |
$127.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.87
|
| Rate for Payer: PHP Commercial |
$119.99
|
| Rate for Payer: Priority Health SBD |
$88.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.75
|
| Rate for Payer: UHC Core |
$73.54
|
| Rate for Payer: UHC Exchange |
$55.48
|
|
|
INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION
|
Facility
|
IP
|
$81.55
|
|
|
Service Code
|
NDC 00002831501
|
| Hospital Charge Code |
10284
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.38 |
| Max. Negotiated Rate |
$73.39 |
| Rate for Payer: Aetna Commercial |
$69.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.01
|
| Rate for Payer: Cash Price |
$65.24
|
| Rate for Payer: Cofinity Advantage |
$57.09
|
| Rate for Payer: Cofinity Commercial |
$70.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.24
|
| Rate for Payer: Healthscope Commercial |
$73.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.16
|
| Rate for Payer: PHP Commercial |
$69.32
|
| Rate for Payer: Priority Health SBD |
$51.38
|
|
|
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 |
$88.93 |
| Max. Negotiated Rate |
$127.04 |
| 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 Advantage |
$98.81
|
| Rate for Payer: Cofinity Commercial |
$121.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.93
|
| Rate for Payer: Healthscope Commercial |
$127.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.87
|
| Rate for Payer: PHP Commercial |
$119.99
|
| Rate for Payer: Priority Health SBD |
$88.93
|
|
|
INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION
|
Facility
|
OP
|
$81.55
|
|
|
Service Code
|
NDC 00002831501
|
| Hospital Charge Code |
10284
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.05 |
| Max. Negotiated Rate |
$73.39 |
| Rate for Payer: Aetna Commercial |
$69.32
|
| Rate for Payer: Aetna Medicare |
$40.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.01
|
| Rate for Payer: BCBS Complete |
$32.62
|
| Rate for Payer: Cash Price |
$65.24
|
| Rate for Payer: Cofinity Advantage |
$57.09
|
| Rate for Payer: Cofinity Commercial |
$70.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.24
|
| Rate for Payer: Healthscope Commercial |
$73.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.16
|
| Rate for Payer: PHP Commercial |
$69.32
|
| Rate for Payer: Priority Health SBD |
$51.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.01
|
| Rate for Payer: UHC Core |
$42.49
|
| Rate for Payer: UHC Exchange |
$32.05
|
|
|
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 |
$368.79 |
| Max. Negotiated Rate |
$844.56 |
| 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 Advantage |
$656.88
|
| Rate for Payer: Cofinity Commercial |
$807.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.72
|
| Rate for Payer: Healthscope Commercial |
$844.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$750.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$797.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$703.80
|
| Rate for Payer: PHP Commercial |
$797.64
|
| Rate for Payer: Priority Health SBD |
$591.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$609.96
|
| Rate for Payer: UHC Core |
$488.91
|
| Rate for Payer: UHC Exchange |
$368.79
|
|
|
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 |
$591.19 |
| Max. Negotiated Rate |
$844.56 |
| 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 Advantage |
$656.88
|
| Rate for Payer: Cofinity Commercial |
$807.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.72
|
| Rate for Payer: Healthscope Commercial |
$844.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$797.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$703.80
|
| Rate for Payer: PHP Commercial |
$797.64
|
| Rate for Payer: Priority Health SBD |
$591.19
|
|
|
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 |
$1,910.07 |
| Max. Negotiated Rate |
$4,374.22 |
| 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 Advantage |
$3,402.17
|
| Rate for Payer: Cofinity Commercial |
$4,179.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,888.19
|
| Rate for Payer: Healthscope Commercial |
$4,374.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,888.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,645.18
|
| Rate for Payer: PHP Commercial |
$4,131.20
|
| Rate for Payer: Priority Health SBD |
$3,061.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,159.16
|
| Rate for Payer: UHC Core |
$2,532.19
|
| Rate for Payer: UHC Exchange |
$1,910.07
|
|
|
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 |
$3,061.95 |
| Max. Negotiated Rate |
$4,374.22 |
| 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 Advantage |
$3,402.17
|
| Rate for Payer: Cofinity Commercial |
$4,179.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,888.19
|
| Rate for Payer: Healthscope Commercial |
$4,374.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,645.18
|
| Rate for Payer: PHP Commercial |
$4,131.20
|
| Rate for Payer: Priority Health SBD |
$3,061.95
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - HUMAN (HUMULIN R)
|
Facility
|
IP
|
$81.55
|
|
|
Service Code
|
NDC 00002821501
|
| Hospital Charge Code |
180910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.38 |
| Max. Negotiated Rate |
$73.39 |
| Rate for Payer: Aetna Commercial |
$69.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.01
|
| Rate for Payer: Cash Price |
$65.24
|
| Rate for Payer: Cofinity Advantage |
$57.09
|
| Rate for Payer: Cofinity Commercial |
$70.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.24
|
| Rate for Payer: Healthscope Commercial |
$73.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.16
|
| Rate for Payer: PHP Commercial |
$69.32
|
| Rate for Payer: Priority Health SBD |
$51.38
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - HUMAN (HUMULIN R)
|
Facility
|
OP
|
$81.55
|
|
|
Service Code
|
NDC 00002821501
|
| Hospital Charge Code |
180910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.05 |
| Max. Negotiated Rate |
$73.39 |
| Rate for Payer: Aetna Commercial |
$69.32
|
| Rate for Payer: Aetna Medicare |
$40.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.01
|
| Rate for Payer: BCBS Complete |
$32.62
|
| Rate for Payer: Cash Price |
$65.24
|
| Rate for Payer: Cofinity Advantage |
$57.09
|
| Rate for Payer: Cofinity Commercial |
$70.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.24
|
| Rate for Payer: Healthscope Commercial |
$73.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.16
|
| Rate for Payer: PHP Commercial |
$69.32
|
| Rate for Payer: Priority Health SBD |
$51.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.01
|
| Rate for Payer: UHC Core |
$42.49
|
| Rate for Payer: UHC Exchange |
$32.05
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - INSULIN GLULISINE (APIDRA)
|
Facility
|
OP
|
$290.23
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
180908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$261.21 |
| Rate for Payer: Aetna Commercial |
$246.70
|
| Rate for Payer: Aetna Medicare |
$145.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.65
|
| Rate for Payer: BCBS Complete |
$116.09
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCN Commercial |
$1.11
|
| Rate for Payer: Cash Price |
$232.18
|
| Rate for Payer: Cash Price |
$232.18
|
| Rate for Payer: Cofinity Advantage |
$203.16
|
| Rate for Payer: Cofinity Commercial |
$249.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.18
|
| Rate for Payer: Healthscope Commercial |
$261.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.67
|
| Rate for Payer: PHP Commercial |
$246.70
|
| Rate for Payer: Priority Health SBD |
$182.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.65
|
| Rate for Payer: UHC Core |
$151.21
|
| Rate for Payer: UHC Exchange |
$114.06
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - INSULIN GLULISINE (APIDRA)
|
Facility
|
IP
|
$290.23
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
180908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.84 |
| Max. Negotiated Rate |
$261.21 |
| Rate for Payer: Aetna Commercial |
$246.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.65
|
| Rate for Payer: Cash Price |
$232.18
|
| Rate for Payer: Cofinity Advantage |
$203.16
|
| Rate for Payer: Cofinity Commercial |
$249.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.18
|
| Rate for Payer: Healthscope Commercial |
$261.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.67
|
| Rate for Payer: PHP Commercial |
$246.70
|
| Rate for Payer: Priority Health SBD |
$182.84
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - LISPRO (HUMALOG)
|
Facility
|
IP
|
$46.55
|
|
|
Service Code
|
NDC 00002751017
|
| Hospital Charge Code |
180914
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.33 |
| Max. Negotiated Rate |
$41.90 |
| Rate for Payer: Aetna Commercial |
$39.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.26
|
| Rate for Payer: Cash Price |
$37.24
|
| Rate for Payer: Cofinity Advantage |
$32.59
|
| Rate for Payer: Cofinity Commercial |
$40.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.24
|
| Rate for Payer: Healthscope Commercial |
$41.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.91
|
| Rate for Payer: PHP Commercial |
$39.57
|
| Rate for Payer: Priority Health SBD |
$29.33
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - LISPRO (HUMALOG)
|
Facility
|
OP
|
$46.55
|
|
|
Service Code
|
NDC 00002751017
|
| Hospital Charge Code |
180914
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$41.90 |
| Rate for Payer: Aetna Commercial |
$39.57
|
| Rate for Payer: Aetna Medicare |
$23.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.26
|
| Rate for Payer: BCBS Complete |
$18.62
|
| Rate for Payer: Cash Price |
$37.24
|
| Rate for Payer: Cofinity Advantage |
$32.59
|
| Rate for Payer: Cofinity Commercial |
$40.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.24
|
| Rate for Payer: Healthscope Commercial |
$41.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.91
|
| Rate for Payer: PHP Commercial |
$39.57
|
| Rate for Payer: Priority Health SBD |
$29.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.26
|
| Rate for Payer: UHC Core |
$24.25
|
| Rate for Payer: UHC Exchange |
$18.29
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - REGULAR HUMAN (U-500)
|
Facility
|
OP
|
$5,065.60
|
|
|
Service Code
|
NDC 00002850101
|
| Hospital Charge Code |
180916
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,990.78 |
| Max. Negotiated Rate |
$4,559.04 |
| Rate for Payer: Aetna Commercial |
$4,305.76
|
| Rate for Payer: Aetna Medicare |
$2,532.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,292.64
|
| Rate for Payer: BCBS Complete |
$2,026.24
|
| Rate for Payer: Cash Price |
$4,052.48
|
| Rate for Payer: Cofinity Advantage |
$3,545.92
|
| Rate for Payer: Cofinity Commercial |
$4,356.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,052.48
|
| Rate for Payer: Healthscope Commercial |
$4,559.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,052.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,305.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,799.20
|
| Rate for Payer: PHP Commercial |
$4,305.76
|
| Rate for Payer: Priority Health SBD |
$3,191.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,292.64
|
| Rate for Payer: UHC Core |
$2,639.18
|
| Rate for Payer: UHC Exchange |
$1,990.78
|
|
