|
INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,818.98
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
181037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$1,818.98 |
| Rate for Payer: Aetna Commercial |
$1,637.08
|
| Rate for Payer: Aetna Medicare |
$19.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.99
|
| Rate for Payer: ASR ASR |
$1,764.41
|
| Rate for Payer: ASR Commercial |
$1,764.41
|
| Rate for Payer: BCBS Complete |
$11.25
|
| Rate for Payer: BCBS MAPPO |
$19.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,489.56
|
| Rate for Payer: BCN Commercial |
$1,410.26
|
| Rate for Payer: BCN Medicare Advantage |
$19.99
|
| Rate for Payer: Cash Price |
$1,455.18
|
| Rate for Payer: Cash Price |
$1,455.18
|
| Rate for Payer: Cofinity Commercial |
$1,709.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,455.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.99
|
| Rate for Payer: Healthscope Commercial |
$1,818.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,764.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.99
|
| Rate for Payer: Mclaren Commercial |
$1,637.08
|
| Rate for Payer: Mclaren Medicaid |
$10.71
|
| Rate for Payer: Mclaren Medicare |
$19.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.99
|
| Rate for Payer: Meridian Medicaid |
$11.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,546.13
|
| Rate for Payer: Nomi Health Commercial |
$1,491.56
|
| Rate for Payer: PACE Medicare |
$18.99
|
| Rate for Payer: PACE SWMI |
$19.99
|
| Rate for Payer: PHP Commercial |
$21.99
|
| Rate for Payer: PHP Medicaid |
$10.71
|
| Rate for Payer: PHP Medicare Advantage |
$19.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,182.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,593.79
|
| Rate for Payer: Priority Health Medicare |
$19.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,275.10
|
| Rate for Payer: Railroad Medicare Medicare |
$19.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,600.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.99
|
| Rate for Payer: UHC Exchange |
$30.98
|
| Rate for Payer: UHC Medicare Advantage |
$19.99
|
| Rate for Payer: UHCCP DNSP |
$19.99
|
| Rate for Payer: UHCCP Medicaid |
$10.71
|
| Rate for Payer: VA VA |
$19.99
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$63.93
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.57 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: Aetna Medicare |
$31.96
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Complete |
$25.57
|
| Rate for Payer: BCBS Trust/PPO |
$52.35
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.02
|
| Rate for Payer: Priority Health Narrow Network |
$44.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.26
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$63.93
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.57 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: Aetna Medicare |
$31.96
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Complete |
$25.57
|
| Rate for Payer: BCBS Trust/PPO |
$52.35
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.02
|
| Rate for Payer: Priority Health Narrow Network |
$44.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.26
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$63.93
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.57 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: Aetna Medicare |
$31.96
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Complete |
$25.57
|
| Rate for Payer: BCBS Trust/PPO |
$52.35
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.02
|
| Rate for Payer: Priority Health Narrow Network |
$44.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.26
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$63.93
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Trust/PPO |
$52.10
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.26
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$63.93
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Trust/PPO |
$52.10
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.26
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$63.93
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Trust/PPO |
$52.10
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| 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
|
$63.93
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
300796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.57 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: Aetna Medicare |
$31.96
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Complete |
$25.57
|
| Rate for Payer: BCBS Trust/PPO |
$52.35
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.02
|
| Rate for Payer: Priority Health Narrow Network |
$44.81
|
| 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
|
IP
|
$63.93
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
300796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Trust/PPO |
$52.10
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| 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
|
IP
|
$63.93
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
300796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Trust/PPO |
$52.10
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| 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
|
IP
|
$63.93
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
300796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Trust/PPO |
$52.10
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| 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
|
$63.93
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
300796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.57 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: Aetna Medicare |
$31.96
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Complete |
$25.57
|
| Rate for Payer: BCBS Trust/PPO |
$52.35
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.02
|
| Rate for Payer: Priority Health Narrow Network |
$44.81
|
| 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
|
$63.93
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
300796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.57 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: Aetna Medicare |
$31.96
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Complete |
$25.57
|
| Rate for Payer: BCBS Trust/PPO |
$52.35
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.02
|
| Rate for Payer: Priority Health Narrow Network |
$44.81
|
| 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
|
$63.93
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
300797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.57 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: Aetna Medicare |
$31.96
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Complete |
$25.57
|
| Rate for Payer: BCBS Trust/PPO |
$52.35
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.02
|
| Rate for Payer: Priority Health Narrow Network |
$44.81
|
| 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
|
$63.93
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
300797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Trust/PPO |
$52.10
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| 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
|
$63.93
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
300797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.57 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: Aetna Medicare |
$31.96
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Complete |
$25.57
|
| Rate for Payer: BCBS Trust/PPO |
$52.35
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.02
|
| Rate for Payer: Priority Health Narrow Network |
$44.81
|
| 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
|
$63.93
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
300797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Trust/PPO |
$52.10
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| 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
|
$63.93
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
300797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Trust/PPO |
$52.10
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| 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
|
$63.93
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
300797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.57 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: Aetna Medicare |
$31.96
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Complete |
$25.57
|
| Rate for Payer: BCBS Trust/PPO |
$52.35
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.02
|
| Rate for Payer: Priority Health Narrow Network |
$44.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.26
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
OP
|
$63.93
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
112756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.57 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: Aetna Medicare |
$31.96
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Complete |
$25.57
|
| Rate for Payer: BCBS Trust/PPO |
$52.35
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.02
|
| Rate for Payer: Priority Health Narrow Network |
$44.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.26
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
OP
|
$63.93
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
112756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.57 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: Aetna Medicare |
$31.96
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Complete |
$25.57
|
| Rate for Payer: BCBS Trust/PPO |
$52.35
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.02
|
| Rate for Payer: Priority Health Narrow Network |
$44.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.26
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
IP
|
$63.93
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
112756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Trust/PPO |
$52.10
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.26
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
IP
|
$63.93
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
112756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Trust/PPO |
$52.10
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.26
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
OP
|
$63.93
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
112756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.57 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: Aetna Medicare |
$31.96
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Complete |
$25.57
|
| Rate for Payer: BCBS Trust/PPO |
$52.35
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.02
|
| Rate for Payer: Priority Health Narrow Network |
$44.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.26
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
IP
|
$63.93
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
112756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$63.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: ASR ASR |
$62.01
|
| Rate for Payer: ASR Commercial |
$62.01
|
| Rate for Payer: BCBS Trust/PPO |
$52.10
|
| Rate for Payer: BCN Commercial |
$49.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$60.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$63.93
|
| Rate for Payer: Healthscope Whirlpool |
$62.01
|
| Rate for Payer: Mclaren Commercial |
$57.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.34
|
| Rate for Payer: Nomi Health Commercial |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.26
|
|
