|
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 |
$86.73 |
| Max. Negotiated Rate |
$115.64 |
| Rate for Payer: Aetna Commercial |
$104.07
|
| Rate for Payer: ASR ASR |
$112.17
|
| Rate for Payer: BCBS Trust/PPO |
$94.96
|
| Rate for Payer: BCN Commercial |
$94.96
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Commercial |
$108.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$112.17
|
| Rate for Payer: Healthscope Whirlpool |
$115.64
|
| Rate for Payer: Mclaren Commercial |
$104.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Nomi Health Commercial |
$94.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.76
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$63.93
|
|
|
Service Code
|
NDC 169633910
|
| Hospital Charge Code |
300796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: Aetna Medicare |
$23.66
|
| Rate for Payer: ASR ASR |
$62.02
|
| Rate for Payer: BCBS Complete |
$25.57
|
| Rate for Payer: BCBS Trust/PPO |
$52.71
|
| Rate for Payer: BCN Commercial |
$52.71
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$62.02
|
| Rate for Payer: Healthscope Whirlpool |
$63.93
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$56.02
|
| Rate for Payer: Priority Health Narrow Network |
$44.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.26
|
|
|
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 |
$42.79 |
| Max. Negotiated Rate |
$115.64 |
| Rate for Payer: Aetna Commercial |
$104.07
|
| Rate for Payer: Aetna Medicare |
$42.79
|
| Rate for Payer: ASR ASR |
$112.17
|
| Rate for Payer: BCBS Complete |
$46.26
|
| Rate for Payer: BCBS Trust/PPO |
$95.34
|
| Rate for Payer: BCN Commercial |
$95.34
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Commercial |
$108.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$112.17
|
| Rate for Payer: Healthscope Whirlpool |
$115.64
|
| Rate for Payer: Mclaren Commercial |
$104.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Nomi Health Commercial |
$94.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$101.32
|
| Rate for Payer: Priority Health Narrow Network |
$81.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.76
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$63.93
|
|
|
Service Code
|
NDC 169633910
|
| Hospital Charge Code |
300796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.95 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: ASR ASR |
$62.02
|
| Rate for Payer: BCBS Trust/PPO |
$52.50
|
| Rate for Payer: BCN Commercial |
$52.50
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$62.02
|
| Rate for Payer: Healthscope Whirlpool |
$63.93
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.26
|
|
|
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 |
$86.73 |
| Max. Negotiated Rate |
$115.64 |
| Rate for Payer: Aetna Commercial |
$104.07
|
| Rate for Payer: ASR ASR |
$112.17
|
| Rate for Payer: BCBS Trust/PPO |
$94.96
|
| Rate for Payer: BCN Commercial |
$94.96
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Commercial |
$108.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$112.17
|
| Rate for Payer: Healthscope Whirlpool |
$115.64
|
| Rate for Payer: Mclaren Commercial |
$104.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Nomi Health Commercial |
$94.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.76
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$115.64
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
300797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.79 |
| Max. Negotiated Rate |
$115.64 |
| Rate for Payer: Aetna Commercial |
$104.07
|
| Rate for Payer: Aetna Medicare |
$42.79
|
| Rate for Payer: ASR ASR |
$112.17
|
| Rate for Payer: BCBS Complete |
$46.26
|
| Rate for Payer: BCBS Trust/PPO |
$95.34
|
| Rate for Payer: BCN Commercial |
$95.34
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Commercial |
$108.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$112.17
|
| Rate for Payer: Healthscope Whirlpool |
$115.64
|
| Rate for Payer: Mclaren Commercial |
$104.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Nomi Health Commercial |
$94.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$101.32
|
| Rate for Payer: Priority Health Narrow Network |
$81.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.76
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
300797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.73 |
| Max. Negotiated Rate |
$115.64 |
| Rate for Payer: Aetna Commercial |
$104.07
|
| Rate for Payer: ASR ASR |
$112.17
|
| Rate for Payer: BCBS Trust/PPO |
$94.96
|
| Rate for Payer: BCN Commercial |
$94.96
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Commercial |
$108.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$112.17
|
| Rate for Payer: Healthscope Whirlpool |
$115.64
|
| Rate for Payer: Mclaren Commercial |
$104.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Nomi Health Commercial |
$94.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.76
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$63.93
|
|
|
Service Code
|
NDC 169633910
|
| Hospital Charge Code |
300797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: Aetna Medicare |
$23.66
|
| Rate for Payer: ASR ASR |
$62.02
|
| Rate for Payer: BCBS Complete |
$25.57
|
| Rate for Payer: BCBS Trust/PPO |
$52.71
|
| Rate for Payer: BCN Commercial |
$52.71
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$62.02
|
| Rate for Payer: Healthscope Whirlpool |
$63.93
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$56.02
|
| Rate for Payer: Priority Health Narrow Network |
$44.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.26
|
|
|
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 |
$42.79 |
| Max. Negotiated Rate |
$115.64 |
| Rate for Payer: Aetna Commercial |
$104.07
|
| Rate for Payer: Aetna Medicare |
$42.79
|
| Rate for Payer: ASR ASR |
$112.17
|
| Rate for Payer: BCBS Complete |
$46.26
|
| Rate for Payer: BCBS Trust/PPO |
$95.34
|
| Rate for Payer: BCN Commercial |
$95.34
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Commercial |
$108.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$112.17
|
| Rate for Payer: Healthscope Whirlpool |
$115.64
|
| Rate for Payer: Mclaren Commercial |
$104.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Nomi Health Commercial |
$94.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$101.32
|
| Rate for Payer: Priority Health Narrow Network |
$81.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.76
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) MEDIUM DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$63.93
|
|
|
Service Code
|
NDC 169633910
|
| Hospital Charge Code |
300797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.95 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: ASR ASR |
$62.02
|
| Rate for Payer: BCBS Trust/PPO |
$52.50
|
| Rate for Payer: BCN Commercial |
$52.50
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$62.02
|
| Rate for Payer: Healthscope Whirlpool |
$63.93
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.26
|
|
|
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 |
$42.79 |
| Max. Negotiated Rate |
$115.64 |
| Rate for Payer: Aetna Commercial |
$104.07
|
| Rate for Payer: Aetna Medicare |
$42.79
|
| Rate for Payer: ASR ASR |
$112.17
|
| Rate for Payer: BCBS Complete |
$46.26
|
| Rate for Payer: BCBS Trust/PPO |
$95.34
|
| Rate for Payer: BCN Commercial |
$95.34
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Commercial |
$108.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$112.17
|
| Rate for Payer: Healthscope Whirlpool |
$115.64
|
| Rate for Payer: Mclaren Commercial |
$104.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Nomi Health Commercial |
$94.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$101.32
|
| Rate for Payer: Priority Health Narrow Network |
$81.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.76
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
OP
|
$63.93
|
|
|
Service Code
|
NDC 169633910
|
| Hospital Charge Code |
112756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: Aetna Medicare |
$23.66
|
| Rate for Payer: ASR ASR |
$62.02
|
| Rate for Payer: BCBS Complete |
$25.57
|
| Rate for Payer: BCBS Trust/PPO |
$52.71
|
| Rate for Payer: BCN Commercial |
$52.71
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$62.02
|
| Rate for Payer: Healthscope Whirlpool |
$63.93
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$56.02
|
| Rate for Payer: Priority Health Narrow Network |
$44.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.26
|
|
|
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 |
$86.73 |
| Max. Negotiated Rate |
$115.64 |
| Rate for Payer: Aetna Commercial |
$104.07
|
| Rate for Payer: ASR ASR |
$112.17
|
| Rate for Payer: BCBS Trust/PPO |
$94.96
|
| Rate for Payer: BCN Commercial |
$94.96
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Commercial |
$108.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$112.17
|
| Rate for Payer: Healthscope Whirlpool |
$115.64
|
| Rate for Payer: Mclaren Commercial |
$104.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Nomi Health Commercial |
$94.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.76
|
|
|
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 |
$42.79 |
| Max. Negotiated Rate |
$115.64 |
| Rate for Payer: Aetna Commercial |
$104.07
|
| Rate for Payer: Aetna Medicare |
$42.79
|
| Rate for Payer: ASR ASR |
$112.17
|
| Rate for Payer: BCBS Complete |
$46.26
|
| Rate for Payer: BCBS Trust/PPO |
$95.34
|
| Rate for Payer: BCN Commercial |
$95.34
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Commercial |
$108.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$112.17
|
| Rate for Payer: Healthscope Whirlpool |
$115.64
|
| Rate for Payer: Mclaren Commercial |
$104.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Nomi Health Commercial |
$94.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$101.32
|
| Rate for Payer: Priority Health Narrow Network |
$81.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.76
|
|
|
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 |
$86.73 |
| Max. Negotiated Rate |
$115.64 |
| Rate for Payer: Aetna Commercial |
$104.07
|
| Rate for Payer: ASR ASR |
$112.17
|
| Rate for Payer: BCBS Trust/PPO |
$94.96
|
| Rate for Payer: BCN Commercial |
$94.96
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Commercial |
$108.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$112.17
|
| Rate for Payer: Healthscope Whirlpool |
$115.64
|
| Rate for Payer: Mclaren Commercial |
$104.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Nomi Health Commercial |
$94.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.76
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
IP
|
$63.93
|
|
|
Service Code
|
NDC 169633910
|
| Hospital Charge Code |
112756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.95 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: ASR ASR |
$62.02
|
| Rate for Payer: BCBS Trust/PPO |
$52.50
|
| Rate for Payer: BCN Commercial |
$52.50
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$62.02
|
| Rate for Payer: Healthscope Whirlpool |
$63.93
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.26
|
|
|
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 |
$47.49 |
| Max. Negotiated Rate |
$63.31 |
| Rate for Payer: Aetna Commercial |
$56.98
|
| Rate for Payer: ASR ASR |
$61.42
|
| Rate for Payer: BCBS Trust/PPO |
$51.99
|
| Rate for Payer: BCN Commercial |
$51.99
|
| Rate for Payer: Cash Price |
$50.65
|
| Rate for Payer: Cofinity Commercial |
$59.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.65
|
| Rate for Payer: Healthscope Commercial |
$61.42
|
| Rate for Payer: Healthscope Whirlpool |
$63.31
|
| Rate for Payer: Mclaren Commercial |
$56.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.82
|
| Rate for Payer: Nomi Health Commercial |
$51.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.72
|
|
|
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 |
$0.18 |
| Max. Negotiated Rate |
$63.31 |
| Rate for Payer: Aetna Commercial |
$56.98
|
| Rate for Payer: Aetna Medicare |
$23.43
|
| Rate for Payer: ASR ASR |
$61.42
|
| Rate for Payer: BCBS Complete |
$25.33
|
| Rate for Payer: BCBS Trust/PPO |
$52.20
|
| Rate for Payer: BCN Commercial |
$52.20
|
| Rate for Payer: Cash Price |
$50.65
|
| Rate for Payer: Cash Price |
$50.65
|
| Rate for Payer: Cofinity Commercial |
$59.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.65
|
| Rate for Payer: Healthscope Commercial |
$61.42
|
| Rate for Payer: Healthscope Whirlpool |
$63.31
|
| Rate for Payer: Mclaren Commercial |
$56.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.82
|
| Rate for Payer: Nomi Health Commercial |
$51.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.23
|
| Rate for Payer: Priority Health Narrow Network |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.72
|
|
|
INSULIN GLULISINE (U-100) 100 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
IP
|
$278.46
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
301807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$278.46 |
| Rate for Payer: Aetna Commercial |
$250.62
|
| Rate for Payer: ASR ASR |
$270.11
|
| Rate for Payer: BCBS Trust/PPO |
$228.67
|
| Rate for Payer: BCN Commercial |
$228.67
|
| Rate for Payer: Cash Price |
$222.77
|
| Rate for Payer: Cofinity Commercial |
$261.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.77
|
| Rate for Payer: Healthscope Commercial |
$270.11
|
| Rate for Payer: Healthscope Whirlpool |
$278.46
|
| Rate for Payer: Mclaren Commercial |
$250.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.69
|
| Rate for Payer: Nomi Health Commercial |
$228.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.05
|
|
|
INSULIN GLULISINE (U-100) 100 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
OP
|
$278.46
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
301807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$278.46 |
| Rate for Payer: Aetna Commercial |
$250.62
|
| Rate for Payer: Aetna Medicare |
$103.03
|
| Rate for Payer: ASR ASR |
$270.11
|
| Rate for Payer: BCBS Complete |
$111.38
|
| Rate for Payer: BCBS Trust/PPO |
$229.59
|
| Rate for Payer: BCN Commercial |
$229.59
|
| Rate for Payer: Cash Price |
$222.77
|
| Rate for Payer: Cash Price |
$222.77
|
| Rate for Payer: Cofinity Commercial |
$261.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.77
|
| Rate for Payer: Healthscope Commercial |
$270.11
|
| Rate for Payer: Healthscope Whirlpool |
$278.46
|
| Rate for Payer: Mclaren Commercial |
$250.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.69
|
| Rate for Payer: Nomi Health Commercial |
$228.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.23
|
| Rate for Payer: Priority Health Narrow Network |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.05
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
OP
|
$167.65
|
|
|
Service Code
|
NDC 2751001
|
| Hospital Charge Code |
301805
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.03 |
| Max. Negotiated Rate |
$167.65 |
| Rate for Payer: Aetna Commercial |
$150.88
|
| Rate for Payer: Aetna Medicare |
$62.03
|
| Rate for Payer: ASR ASR |
$162.62
|
| Rate for Payer: BCBS Complete |
$67.06
|
| Rate for Payer: BCBS Trust/PPO |
$138.23
|
| Rate for Payer: BCN Commercial |
$138.23
|
| Rate for Payer: Cash Price |
$134.12
|
| Rate for Payer: Cofinity Commercial |
$157.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.12
|
| Rate for Payer: Healthscope Commercial |
$162.62
|
| Rate for Payer: Healthscope Whirlpool |
$167.65
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$137.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$146.89
|
| Rate for Payer: Priority Health Narrow Network |
$117.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.53
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
IP
|
$167.65
|
|
|
Service Code
|
NDC 2751001
|
| Hospital Charge Code |
301805
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.74 |
| Max. Negotiated Rate |
$167.65 |
| Rate for Payer: Aetna Commercial |
$150.88
|
| Rate for Payer: ASR ASR |
$162.62
|
| Rate for Payer: BCBS Trust/PPO |
$137.67
|
| Rate for Payer: BCN Commercial |
$137.67
|
| Rate for Payer: Cash Price |
$134.12
|
| Rate for Payer: Cofinity Commercial |
$157.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.12
|
| Rate for Payer: Healthscope Commercial |
$162.62
|
| Rate for Payer: Healthscope Whirlpool |
$167.65
|
| Rate for Payer: Mclaren Commercial |
$150.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.50
|
| Rate for Payer: Nomi Health Commercial |
$137.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.53
|
|
|
INSULIN REGULAR 100 UNIT/100 ML (1 UNIT/ML) IN 0.9 % NACL IV SOLUTION
|
Facility
|
IP
|
$66.31
|
|
|
Service Code
|
NDC 338012612
|
| Hospital Charge Code |
191217
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$66.31 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: ASR ASR |
$64.32
|
| Rate for Payer: BCBS Trust/PPO |
$54.45
|
| Rate for Payer: BCN Commercial |
$54.45
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$62.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$64.32
|
| Rate for Payer: Healthscope Whirlpool |
$66.31
|
| Rate for Payer: Mclaren Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.35
|
|
|
INSULIN REGULAR 100 UNIT/100 ML (1 UNIT/ML) IN 0.9 % NACL IV SOLUTION
|
Facility
|
OP
|
$66.31
|
|
|
Service Code
|
NDC 338012612
|
| Hospital Charge Code |
191217
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.53 |
| Max. Negotiated Rate |
$66.31 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: Aetna Medicare |
$24.53
|
| Rate for Payer: ASR ASR |
$64.32
|
| Rate for Payer: BCBS Complete |
$26.52
|
| Rate for Payer: BCBS Trust/PPO |
$54.67
|
| Rate for Payer: BCN Commercial |
$54.67
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$62.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$64.32
|
| Rate for Payer: Healthscope Whirlpool |
$66.31
|
| Rate for Payer: Mclaren Commercial |
$59.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$58.10
|
| Rate for Payer: Priority Health Narrow Network |
$46.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.35
|
|
|
INSULIN REGULAR 1 UNIT/ML IN 0.9 % NACL IV PUSH (CUSTOM)
|
Facility
|
IP
|
$66.31
|
|
|
Service Code
|
NDC 338012612
|
| Hospital Charge Code |
301039
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$66.31 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: ASR ASR |
$64.32
|
| Rate for Payer: BCBS Trust/PPO |
$54.45
|
| Rate for Payer: BCN Commercial |
$54.45
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$62.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$64.32
|
| Rate for Payer: Healthscope Whirlpool |
$66.31
|
| Rate for Payer: Mclaren Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.35
|
|
