|
INSULIN REGULAR 1 UNIT/ML IN 0.9 % NACL IV PUSH (CUSTOM)
|
Facility
|
OP
|
$66.31
|
|
|
Service Code
|
NDC 338012612
|
| Hospital Charge Code |
301039
|
|
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 HUMAN 100 UNIT/ML INJECTION (MDV ADS)
|
Facility
|
OP
|
$76.26
|
|
|
Service Code
|
NDC 2821517
|
| Hospital Charge Code |
164971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$76.26 |
| Rate for Payer: Aetna Commercial |
$68.63
|
| Rate for Payer: Aetna Medicare |
$28.21
|
| Rate for Payer: ASR ASR |
$73.97
|
| Rate for Payer: BCBS Complete |
$30.50
|
| Rate for Payer: BCBS Trust/PPO |
$62.87
|
| Rate for Payer: BCN Commercial |
$62.87
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cofinity Commercial |
$71.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.00
|
| Rate for Payer: Healthscope Commercial |
$73.97
|
| Rate for Payer: Healthscope Whirlpool |
$76.26
|
| Rate for Payer: Mclaren Commercial |
$68.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.82
|
| Rate for Payer: Nomi Health Commercial |
$62.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$66.82
|
| Rate for Payer: Priority Health Narrow Network |
$53.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.11
|
|
|
INSULIN REGULAR HUMAN 100 UNIT/ML INJECTION (MDV ADS)
|
Facility
|
IP
|
$76.26
|
|
|
Service Code
|
NDC 2821517
|
| Hospital Charge Code |
164971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.19 |
| Max. Negotiated Rate |
$76.26 |
| Rate for Payer: Aetna Commercial |
$68.63
|
| Rate for Payer: ASR ASR |
$73.97
|
| Rate for Payer: BCBS Trust/PPO |
$62.62
|
| Rate for Payer: BCN Commercial |
$62.62
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cofinity Commercial |
$71.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.00
|
| Rate for Payer: Healthscope Commercial |
$73.97
|
| Rate for Payer: Healthscope Whirlpool |
$76.26
|
| Rate for Payer: Mclaren Commercial |
$68.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.82
|
| Rate for Payer: Nomi Health Commercial |
$62.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.11
|
|
|
INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN
|
Facility
|
IP
|
$938.39
|
|
|
Service Code
|
NDC 2882427
|
| Hospital Charge Code |
178095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$703.79 |
| Max. Negotiated Rate |
$938.39 |
| Rate for Payer: Aetna Commercial |
$844.55
|
| Rate for Payer: ASR ASR |
$910.24
|
| Rate for Payer: BCBS Trust/PPO |
$770.61
|
| Rate for Payer: BCN Commercial |
$770.61
|
| Rate for Payer: Cash Price |
$750.71
|
| Rate for Payer: Cofinity Commercial |
$882.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.71
|
| Rate for Payer: Healthscope Commercial |
$910.24
|
| Rate for Payer: Healthscope Whirlpool |
$938.39
|
| Rate for Payer: Mclaren Commercial |
$844.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$797.63
|
| Rate for Payer: Nomi Health Commercial |
$769.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$703.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$825.79
|
|
|
INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN
|
Facility
|
OP
|
$938.39
|
|
|
Service Code
|
NDC 2882401
|
| Hospital Charge Code |
178095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$347.21 |
| Max. Negotiated Rate |
$938.39 |
| Rate for Payer: Aetna Commercial |
$844.55
|
| Rate for Payer: Aetna Medicare |
$347.21
|
| Rate for Payer: ASR ASR |
$910.24
|
| Rate for Payer: BCBS Complete |
$375.36
|
| Rate for Payer: BCBS Trust/PPO |
$773.71
|
| Rate for Payer: BCN Commercial |
$773.71
|
| Rate for Payer: Cash Price |
$750.71
|
| Rate for Payer: Cofinity Commercial |
$882.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.71
|
| Rate for Payer: Healthscope Commercial |
$910.24
|
| Rate for Payer: Healthscope Whirlpool |
$938.39
|
| Rate for Payer: Mclaren Commercial |
$844.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$750.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$797.63
|
| Rate for Payer: Nomi Health Commercial |
$769.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$703.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$822.22
|
| Rate for Payer: Priority Health Narrow Network |
$657.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$825.79
|
|
|
INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN
|
Facility
|
IP
|
$938.39
|
|
|
Service Code
|
NDC 2882401
|
| Hospital Charge Code |
178095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$703.79 |
| Max. Negotiated Rate |
$938.39 |
| Rate for Payer: Aetna Commercial |
$844.55
|
| Rate for Payer: ASR ASR |
$910.24
|
| Rate for Payer: BCBS Trust/PPO |
$770.61
|
| Rate for Payer: BCN Commercial |
$770.61
|
| Rate for Payer: Cash Price |
$750.71
|
| Rate for Payer: Cofinity Commercial |
$882.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.71
|
| Rate for Payer: Healthscope Commercial |
$910.24
|
| Rate for Payer: Healthscope Whirlpool |
$938.39
|
| Rate for Payer: Mclaren Commercial |
$844.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$797.63
|
| Rate for Payer: Nomi Health Commercial |
$769.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$703.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$825.79
|
|
|
INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN
|
Facility
|
OP
|
$938.39
|
|
|
Service Code
|
NDC 2882427
|
| Hospital Charge Code |
178095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$347.21 |
| Max. Negotiated Rate |
$938.39 |
| Rate for Payer: Aetna Commercial |
$844.55
|
| Rate for Payer: Aetna Medicare |
$347.21
|
| Rate for Payer: ASR ASR |
$910.24
|
| Rate for Payer: BCBS Complete |
$375.36
|
| Rate for Payer: BCBS Trust/PPO |
$773.71
|
| Rate for Payer: BCN Commercial |
$773.71
|
| Rate for Payer: Cash Price |
$750.71
|
| Rate for Payer: Cofinity Commercial |
$882.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.71
|
| Rate for Payer: Healthscope Commercial |
$910.24
|
| Rate for Payer: Healthscope Whirlpool |
$938.39
|
| Rate for Payer: Mclaren Commercial |
$844.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$750.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$797.63
|
| Rate for Payer: Nomi Health Commercial |
$769.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$703.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$822.22
|
| Rate for Payer: Priority Health Narrow Network |
$657.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$825.79
|
|
|
INSULIN REGULAR HUMAN U-500"CONCENTRATE" 500 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
IP
|
$4,860.23
|
|
|
Service Code
|
NDC 2850101
|
| Hospital Charge Code |
301808
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,645.18 |
| Max. Negotiated Rate |
$4,860.23 |
| Rate for Payer: Aetna Commercial |
$4,374.21
|
| Rate for Payer: ASR ASR |
$4,714.43
|
| Rate for Payer: BCBS Trust/PPO |
$3,991.22
|
| Rate for Payer: BCN Commercial |
$3,991.22
|
| Rate for Payer: Cash Price |
$3,888.19
|
| Rate for Payer: Cofinity Commercial |
$4,568.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,888.19
|
| Rate for Payer: Healthscope Commercial |
$4,714.43
|
| Rate for Payer: Healthscope Whirlpool |
$4,860.23
|
| Rate for Payer: Mclaren Commercial |
$4,374.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,131.20
|
| Rate for Payer: Nomi Health Commercial |
$3,985.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,645.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,277.01
|
|
|
INSULIN REGULAR HUMAN U-500"CONCENTRATE" 500 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
OP
|
$4,860.23
|
|
|
Service Code
|
NDC 2850101
|
| Hospital Charge Code |
301808
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,798.29 |
| Max. Negotiated Rate |
$4,860.23 |
| Rate for Payer: Aetna Commercial |
$4,374.21
|
| Rate for Payer: Aetna Medicare |
$1,798.29
|
| Rate for Payer: ASR ASR |
$4,714.43
|
| Rate for Payer: BCBS Complete |
$1,944.09
|
| Rate for Payer: BCBS Trust/PPO |
$4,007.26
|
| Rate for Payer: BCN Commercial |
$4,007.26
|
| Rate for Payer: Cash Price |
$3,888.19
|
| Rate for Payer: Cofinity Commercial |
$4,568.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,888.19
|
| Rate for Payer: Healthscope Commercial |
$4,714.43
|
| Rate for Payer: Healthscope Whirlpool |
$4,860.23
|
| Rate for Payer: Mclaren Commercial |
$4,374.21
|
| 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: Nomi Health Commercial |
$3,985.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,645.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,258.54
|
| Rate for Payer: Priority Health Narrow Network |
$3,407.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,277.01
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - HUMAN (HUMULIN R)
|
Facility
|
IP
|
$141.16
|
|
|
Service Code
|
NDC 169183311
|
| Hospital Charge Code |
180910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.87 |
| Max. Negotiated Rate |
$141.16 |
| Rate for Payer: Aetna Commercial |
$127.04
|
| Rate for Payer: ASR ASR |
$136.92
|
| Rate for Payer: BCBS Trust/PPO |
$115.92
|
| Rate for Payer: BCN Commercial |
$115.92
|
| Rate for Payer: Cash Price |
$112.92
|
| Rate for Payer: Cofinity Commercial |
$132.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.92
|
| Rate for Payer: Healthscope Commercial |
$136.92
|
| Rate for Payer: Healthscope Whirlpool |
$141.16
|
| Rate for Payer: Mclaren Commercial |
$127.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.98
|
| Rate for Payer: Nomi Health Commercial |
$115.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.22
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - HUMAN (HUMULIN R)
|
Facility
|
OP
|
$141.16
|
|
|
Service Code
|
NDC 169183311
|
| Hospital Charge Code |
180910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.23 |
| Max. Negotiated Rate |
$141.16 |
| Rate for Payer: Aetna Commercial |
$127.04
|
| Rate for Payer: Aetna Medicare |
$52.23
|
| Rate for Payer: ASR ASR |
$136.92
|
| Rate for Payer: BCBS Complete |
$56.46
|
| Rate for Payer: BCBS Trust/PPO |
$116.38
|
| Rate for Payer: BCN Commercial |
$116.38
|
| Rate for Payer: Cash Price |
$112.92
|
| Rate for Payer: Cofinity Commercial |
$132.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.92
|
| Rate for Payer: Healthscope Commercial |
$136.92
|
| Rate for Payer: Healthscope Whirlpool |
$141.16
|
| Rate for Payer: Mclaren Commercial |
$127.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.98
|
| Rate for Payer: Nomi Health Commercial |
$115.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$123.68
|
| Rate for Payer: Priority Health Narrow Network |
$98.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.22
|
|
|
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 |
$217.67 |
| Max. Negotiated Rate |
$290.23 |
| Rate for Payer: Aetna Commercial |
$261.21
|
| Rate for Payer: ASR ASR |
$281.52
|
| Rate for Payer: BCBS Trust/PPO |
$238.34
|
| Rate for Payer: BCN Commercial |
$238.34
|
| Rate for Payer: Cash Price |
$232.18
|
| Rate for Payer: Cofinity Commercial |
$272.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.18
|
| Rate for Payer: Healthscope Commercial |
$281.52
|
| Rate for Payer: Healthscope Whirlpool |
$290.23
|
| Rate for Payer: Mclaren Commercial |
$261.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.69
|
| Rate for Payer: Nomi Health Commercial |
$237.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.40
|
|
|
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 |
$0.18 |
| Max. Negotiated Rate |
$290.23 |
| Rate for Payer: Aetna Commercial |
$261.21
|
| Rate for Payer: Aetna Medicare |
$107.38
|
| Rate for Payer: ASR ASR |
$281.52
|
| Rate for Payer: BCBS Complete |
$116.09
|
| Rate for Payer: BCBS Trust/PPO |
$239.29
|
| Rate for Payer: BCN Commercial |
$239.29
|
| Rate for Payer: Cash Price |
$232.18
|
| Rate for Payer: Cash Price |
$232.18
|
| Rate for Payer: Cofinity Commercial |
$272.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.18
|
| Rate for Payer: Healthscope Commercial |
$281.52
|
| Rate for Payer: Healthscope Whirlpool |
$290.23
|
| Rate for Payer: Mclaren Commercial |
$261.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.69
|
| Rate for Payer: Nomi Health Commercial |
$237.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.67
|
| 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 |
$255.40
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - LISPRO (HUMALOG)
|
Facility
|
IP
|
$177.23
|
|
|
Service Code
|
NDC 2751001
|
| Hospital Charge Code |
180914
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.92 |
| Max. Negotiated Rate |
$177.23 |
| Rate for Payer: Aetna Commercial |
$159.51
|
| Rate for Payer: ASR ASR |
$171.91
|
| Rate for Payer: BCBS Trust/PPO |
$145.54
|
| Rate for Payer: BCN Commercial |
$145.54
|
| Rate for Payer: Cash Price |
$141.78
|
| Rate for Payer: Cofinity Commercial |
$166.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.78
|
| Rate for Payer: Healthscope Commercial |
$171.91
|
| Rate for Payer: Healthscope Whirlpool |
$177.23
|
| Rate for Payer: Mclaren Commercial |
$159.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.65
|
| Rate for Payer: Nomi Health Commercial |
$145.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.96
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - LISPRO (HUMALOG)
|
Facility
|
OP
|
$177.23
|
|
|
Service Code
|
NDC 2751001
|
| Hospital Charge Code |
180914
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.58 |
| Max. Negotiated Rate |
$177.23 |
| Rate for Payer: Aetna Commercial |
$159.51
|
| Rate for Payer: Aetna Medicare |
$65.58
|
| Rate for Payer: ASR ASR |
$171.91
|
| Rate for Payer: BCBS Complete |
$70.89
|
| Rate for Payer: BCBS Trust/PPO |
$146.13
|
| Rate for Payer: BCN Commercial |
$146.13
|
| Rate for Payer: Cash Price |
$141.78
|
| Rate for Payer: Cofinity Commercial |
$166.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.78
|
| Rate for Payer: Healthscope Commercial |
$171.91
|
| Rate for Payer: Healthscope Whirlpool |
$177.23
|
| Rate for Payer: Mclaren Commercial |
$159.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.65
|
| Rate for Payer: Nomi Health Commercial |
$145.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$155.29
|
| Rate for Payer: Priority Health Narrow Network |
$124.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.96
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - REGULAR HUMAN (U-500)
|
Facility
|
OP
|
$5,065.60
|
|
|
Service Code
|
NDC 2850101
|
| Hospital Charge Code |
180916
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,874.27 |
| Max. Negotiated Rate |
$5,065.60 |
| Rate for Payer: Aetna Commercial |
$4,559.04
|
| Rate for Payer: Aetna Medicare |
$1,874.27
|
| Rate for Payer: ASR ASR |
$4,913.63
|
| Rate for Payer: BCBS Complete |
$2,026.24
|
| Rate for Payer: BCBS Trust/PPO |
$4,176.58
|
| Rate for Payer: BCN Commercial |
$4,176.58
|
| Rate for Payer: Cash Price |
$4,052.48
|
| Rate for Payer: Cofinity Commercial |
$4,761.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,052.48
|
| Rate for Payer: Healthscope Commercial |
$4,913.63
|
| Rate for Payer: Healthscope Whirlpool |
$5,065.60
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$4,153.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,799.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,438.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,550.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,457.72
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - REGULAR HUMAN (U-500)
|
Facility
|
IP
|
$5,065.60
|
|
|
Service Code
|
NDC 2850101
|
| Hospital Charge Code |
180916
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,799.20 |
| Max. Negotiated Rate |
$5,065.60 |
| Rate for Payer: Aetna Commercial |
$4,559.04
|
| Rate for Payer: ASR ASR |
$4,913.63
|
| Rate for Payer: BCBS Trust/PPO |
$4,159.87
|
| Rate for Payer: BCN Commercial |
$4,159.87
|
| Rate for Payer: Cash Price |
$4,052.48
|
| Rate for Payer: Cofinity Commercial |
$4,761.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,052.48
|
| Rate for Payer: Healthscope Commercial |
$4,913.63
|
| Rate for Payer: Healthscope Whirlpool |
$5,065.60
|
| Rate for Payer: Mclaren Commercial |
$4,559.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,305.76
|
| Rate for Payer: Nomi Health Commercial |
$4,153.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,799.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,457.72
|
|
|
INSULIN SUBCUTANEOUS BOLUS PUMP - HUMAN (HUMULIN R)
|
Facility
|
IP
|
$141.16
|
|
|
Service Code
|
NDC 169183311
|
| Hospital Charge Code |
180911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.87 |
| Max. Negotiated Rate |
$141.16 |
| Rate for Payer: Aetna Commercial |
$127.04
|
| Rate for Payer: ASR ASR |
$136.92
|
| Rate for Payer: BCBS Trust/PPO |
$115.92
|
| Rate for Payer: BCN Commercial |
$115.92
|
| Rate for Payer: Cash Price |
$112.92
|
| Rate for Payer: Cofinity Commercial |
$132.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.92
|
| Rate for Payer: Healthscope Commercial |
$136.92
|
| Rate for Payer: Healthscope Whirlpool |
$141.16
|
| Rate for Payer: Mclaren Commercial |
$127.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.98
|
| Rate for Payer: Nomi Health Commercial |
$115.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.22
|
|
|
INSULIN SUBCUTANEOUS BOLUS PUMP - HUMAN (HUMULIN R)
|
Facility
|
OP
|
$141.16
|
|
|
Service Code
|
NDC 169183311
|
| Hospital Charge Code |
180911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.23 |
| Max. Negotiated Rate |
$141.16 |
| Rate for Payer: Aetna Commercial |
$127.04
|
| Rate for Payer: Aetna Medicare |
$52.23
|
| Rate for Payer: ASR ASR |
$136.92
|
| Rate for Payer: BCBS Complete |
$56.46
|
| Rate for Payer: BCBS Trust/PPO |
$116.38
|
| Rate for Payer: BCN Commercial |
$116.38
|
| Rate for Payer: Cash Price |
$112.92
|
| Rate for Payer: Cofinity Commercial |
$132.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.92
|
| Rate for Payer: Healthscope Commercial |
$136.92
|
| Rate for Payer: Healthscope Whirlpool |
$141.16
|
| Rate for Payer: Mclaren Commercial |
$127.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.98
|
| Rate for Payer: Nomi Health Commercial |
$115.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$123.68
|
| Rate for Payer: Priority Health Narrow Network |
$98.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.22
|
|
|
INSULIN SUBCUTANEOUS CONTINUOUS BASAL PUMP - ASPARTATE (NOVOLOG)
|
Facility
|
OP
|
$137.64
|
|
|
Service Code
|
NDC 169750111
|
| Hospital Charge Code |
180912
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.93 |
| Max. Negotiated Rate |
$137.64 |
| Rate for Payer: Aetna Commercial |
$123.88
|
| Rate for Payer: Aetna Medicare |
$50.93
|
| Rate for Payer: ASR ASR |
$133.51
|
| Rate for Payer: BCBS Complete |
$55.06
|
| Rate for Payer: BCBS Trust/PPO |
$113.48
|
| Rate for Payer: BCN Commercial |
$113.48
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity Commercial |
$129.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.11
|
| Rate for Payer: Healthscope Commercial |
$133.51
|
| Rate for Payer: Healthscope Whirlpool |
$137.64
|
| Rate for Payer: Mclaren Commercial |
$123.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.99
|
| Rate for Payer: Nomi Health Commercial |
$112.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$120.60
|
| Rate for Payer: Priority Health Narrow Network |
$96.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.12
|
|
|
INSULIN SUBCUTANEOUS CONTINUOUS BASAL PUMP - ASPARTATE (NOVOLOG)
|
Facility
|
IP
|
$137.64
|
|
|
Service Code
|
NDC 169750111
|
| Hospital Charge Code |
180912
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.23 |
| Max. Negotiated Rate |
$137.64 |
| Rate for Payer: Aetna Commercial |
$123.88
|
| Rate for Payer: ASR ASR |
$133.51
|
| Rate for Payer: BCBS Trust/PPO |
$113.03
|
| Rate for Payer: BCN Commercial |
$113.03
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity Commercial |
$129.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.11
|
| Rate for Payer: Healthscope Commercial |
$133.51
|
| Rate for Payer: Healthscope Whirlpool |
$137.64
|
| Rate for Payer: Mclaren Commercial |
$123.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.99
|
| Rate for Payer: Nomi Health Commercial |
$112.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.12
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$81.55
|
|
|
Service Code
|
NDC 2821501
|
| Hospital Charge Code |
10289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.17 |
| Max. Negotiated Rate |
$81.55 |
| Rate for Payer: Aetna Commercial |
$73.39
|
| Rate for Payer: Aetna Medicare |
$30.17
|
| Rate for Payer: ASR ASR |
$79.10
|
| Rate for Payer: BCBS Complete |
$32.62
|
| Rate for Payer: BCBS Trust/PPO |
$67.24
|
| Rate for Payer: BCN Commercial |
$67.24
|
| Rate for Payer: Cash Price |
$65.24
|
| Rate for Payer: Cofinity Commercial |
$76.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.24
|
| Rate for Payer: Healthscope Commercial |
$79.10
|
| Rate for Payer: Healthscope Whirlpool |
$81.55
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$66.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$71.45
|
| Rate for Payer: Priority Health Narrow Network |
$57.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.76
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$81.55
|
|
|
Service Code
|
NDC 2821501
|
| Hospital Charge Code |
10289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.16 |
| Max. Negotiated Rate |
$81.55 |
| Rate for Payer: Aetna Commercial |
$73.39
|
| Rate for Payer: ASR ASR |
$79.10
|
| Rate for Payer: BCBS Trust/PPO |
$66.97
|
| Rate for Payer: BCN Commercial |
$66.97
|
| Rate for Payer: Cash Price |
$65.24
|
| Rate for Payer: Cofinity Commercial |
$76.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.24
|
| Rate for Payer: Healthscope Commercial |
$79.10
|
| Rate for Payer: Healthscope Whirlpool |
$81.55
|
| Rate for Payer: Mclaren Commercial |
$73.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.32
|
| Rate for Payer: Nomi Health Commercial |
$66.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.76
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
OP
|
$141.16
|
|
|
Service Code
|
NDC 169183311
|
| Hospital Charge Code |
301806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.23 |
| Max. Negotiated Rate |
$141.16 |
| Rate for Payer: Aetna Commercial |
$127.04
|
| Rate for Payer: Aetna Medicare |
$52.23
|
| Rate for Payer: ASR ASR |
$136.92
|
| Rate for Payer: BCBS Complete |
$56.46
|
| Rate for Payer: BCBS Trust/PPO |
$116.38
|
| Rate for Payer: BCN Commercial |
$116.38
|
| Rate for Payer: Cash Price |
$112.92
|
| Rate for Payer: Cofinity Commercial |
$132.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.92
|
| Rate for Payer: Healthscope Commercial |
$136.92
|
| Rate for Payer: Healthscope Whirlpool |
$141.16
|
| Rate for Payer: Mclaren Commercial |
$127.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.98
|
| Rate for Payer: Nomi Health Commercial |
$115.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$123.68
|
| Rate for Payer: Priority Health Narrow Network |
$98.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.22
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
IP
|
$141.16
|
|
|
Service Code
|
NDC 169183311
|
| Hospital Charge Code |
301806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.87 |
| Max. Negotiated Rate |
$141.16 |
| Rate for Payer: Aetna Commercial |
$127.04
|
| Rate for Payer: ASR ASR |
$136.92
|
| Rate for Payer: BCBS Trust/PPO |
$115.92
|
| Rate for Payer: BCN Commercial |
$115.92
|
| Rate for Payer: Cash Price |
$112.92
|
| Rate for Payer: Cofinity Commercial |
$132.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.92
|
| Rate for Payer: Healthscope Commercial |
$136.92
|
| Rate for Payer: Healthscope Whirlpool |
$141.16
|
| Rate for Payer: Mclaren Commercial |
$127.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.98
|
| Rate for Payer: Nomi Health Commercial |
$115.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.22
|
|
