|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
301084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.58 |
| 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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 73070010310
|
| 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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
|
|
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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 73070010315
|
| 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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| 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 |
$25.58 |
| 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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| 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 73070010310
|
| Hospital Charge Code |
300796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.58 |
| 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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| 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 73070010315
|
| Hospital Charge Code |
300796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.58 |
| 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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 73070010315
|
| 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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
|
|
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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 73070010310
|
| 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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| 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 73070010315
|
| Hospital Charge Code |
301082
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.58 |
| 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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 73070010310
|
| 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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
|
|
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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| 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 |
$25.58 |
| 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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| 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 73070010310
|
| Hospital Charge Code |
301082
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.58 |
| 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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 73070010315
|
| 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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 73070010310
|
| 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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
300797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.58 |
| 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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 73070010315
|
| 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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
300797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.58 |
| 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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
|
|
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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
|
|
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 |
$25.58 |
| 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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
301083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.58 |
| 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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| 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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
|
|
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 |
$25.58 |
| 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 Commercial |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.76
|
| 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: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.56
|
| Rate for Payer: Priority Health SBD |
$40.28
|
|
