|
INSULIN GLARGINE-AGLR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
IP
|
$63.31
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
203258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.15 |
| Max. Negotiated Rate |
$63.31 |
| Rate for Payer: Aetna Commercial |
$56.98
|
| Rate for Payer: ASR ASR |
$61.41
|
| Rate for Payer: ASR Commercial |
$61.41
|
| Rate for Payer: BCBS Trust/PPO |
$51.59
|
| Rate for Payer: BCN Commercial |
$49.08
|
| Rate for Payer: Cash Price |
$50.65
|
| Rate for Payer: Cofinity Commercial |
$59.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.65
|
| Rate for Payer: Healthscope Commercial |
$63.31
|
| Rate for Payer: Healthscope Whirlpool |
$61.41
|
| Rate for Payer: Mclaren Commercial |
$56.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.81
|
| Rate for Payer: Nomi Health Commercial |
$51.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.71
|
|
|
INSULIN GLARGINE-AGLR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN
|
Facility
|
OP
|
$63.31
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
203258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.32 |
| Max. Negotiated Rate |
$63.31 |
| Rate for Payer: Aetna Commercial |
$56.98
|
| Rate for Payer: Aetna Medicare |
$31.66
|
| Rate for Payer: ASR ASR |
$61.41
|
| Rate for Payer: ASR Commercial |
$61.41
|
| Rate for Payer: BCBS Complete |
$25.32
|
| Rate for Payer: BCBS Trust/PPO |
$51.84
|
| Rate for Payer: BCN Commercial |
$49.08
|
| Rate for Payer: Cash Price |
$50.65
|
| Rate for Payer: Cofinity Commercial |
$59.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.65
|
| Rate for Payer: Healthscope Commercial |
$63.31
|
| Rate for Payer: Healthscope Whirlpool |
$61.41
|
| Rate for Payer: Mclaren Commercial |
$56.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.81
|
| Rate for Payer: Nomi Health Commercial |
$51.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.47
|
| Rate for Payer: Priority Health Narrow Network |
$44.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.71
|
|
|
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 |
$181.00 |
| Max. Negotiated Rate |
$278.46 |
| Rate for Payer: Aetna Commercial |
$250.61
|
| Rate for Payer: ASR ASR |
$270.11
|
| Rate for Payer: ASR Commercial |
$270.11
|
| Rate for Payer: BCBS Trust/PPO |
$226.92
|
| Rate for Payer: BCN Commercial |
$215.89
|
| 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 |
$278.46
|
| Rate for Payer: Healthscope Whirlpool |
$270.11
|
| Rate for Payer: Mclaren Commercial |
$250.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.69
|
| Rate for Payer: Nomi Health Commercial |
$228.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.04
|
|
|
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 |
$111.38 |
| Max. Negotiated Rate |
$278.46 |
| Rate for Payer: Aetna Commercial |
$250.61
|
| Rate for Payer: Aetna Medicare |
$139.23
|
| Rate for Payer: ASR ASR |
$270.11
|
| Rate for Payer: ASR Commercial |
$270.11
|
| Rate for Payer: BCBS Complete |
$111.38
|
| Rate for Payer: BCBS Trust/PPO |
$228.03
|
| Rate for Payer: BCN Commercial |
$215.89
|
| 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 |
$278.46
|
| Rate for Payer: Healthscope Whirlpool |
$270.11
|
| Rate for Payer: Mclaren Commercial |
$250.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.69
|
| Rate for Payer: Nomi Health Commercial |
$228.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.99
|
| Rate for Payer: Priority Health Narrow Network |
$195.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.04
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
OP
|
$167.65
|
|
|
Service Code
|
NDC 00002751001
|
| Hospital Charge Code |
301805
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.06 |
| Max. Negotiated Rate |
$167.65 |
| Rate for Payer: Aetna Commercial |
$150.88
|
| Rate for Payer: Aetna Medicare |
$83.83
|
| Rate for Payer: ASR ASR |
$162.62
|
| Rate for Payer: ASR Commercial |
$162.62
|
| Rate for Payer: BCBS Complete |
$67.06
|
| Rate for Payer: BCBS Trust/PPO |
$137.29
|
| Rate for Payer: BCN Commercial |
$129.98
|
| 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 |
$167.65
|
| Rate for Payer: Healthscope Whirlpool |
$162.62
|
| 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: Priority Health Cigna Priority Health |
$108.97
|
| Rate for Payer: 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 00002751001
|
| Hospital Charge Code |
301805
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.97 |
| Max. Negotiated Rate |
$167.65 |
| Rate for Payer: Aetna Commercial |
$150.88
|
| Rate for Payer: ASR ASR |
$162.62
|
| Rate for Payer: ASR Commercial |
$162.62
|
| Rate for Payer: BCBS Trust/PPO |
$136.62
|
| Rate for Payer: BCN Commercial |
$129.98
|
| 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 |
$167.65
|
| Rate for Payer: Healthscope Whirlpool |
$162.62
|
| 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: Priority Health Cigna Priority Health |
$108.97
|
| 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
|
OP
|
$66.31
|
|
|
Service Code
|
NDC 00338012612
|
| Hospital Charge Code |
191217
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$66.31 |
| Rate for Payer: Aetna Commercial |
$59.68
|
| Rate for Payer: Aetna Medicare |
$33.16
|
| Rate for Payer: ASR ASR |
$64.32
|
| Rate for Payer: ASR Commercial |
$64.32
|
| Rate for Payer: BCBS Complete |
$26.52
|
| Rate for Payer: BCBS Trust/PPO |
$54.30
|
| Rate for Payer: BCN Commercial |
$51.41
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$62.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.05
|
| Rate for Payer: Healthscope Commercial |
$66.31
|
| Rate for Payer: Healthscope Whirlpool |
$64.32
|
| Rate for Payer: Mclaren Commercial |
$59.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: 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 100 UNIT/100 ML (1 UNIT/ML) IN 0.9 % NACL IV SOLUTION
|
Facility
|
IP
|
$66.31
|
|
|
Service Code
|
NDC 00338012612
|
| Hospital Charge Code |
191217
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$66.31 |
| Rate for Payer: Aetna Commercial |
$59.68
|
| Rate for Payer: ASR ASR |
$64.32
|
| Rate for Payer: ASR Commercial |
$64.32
|
| Rate for Payer: BCBS Trust/PPO |
$54.04
|
| Rate for Payer: BCN Commercial |
$51.41
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$62.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.05
|
| Rate for Payer: Healthscope Commercial |
$66.31
|
| Rate for Payer: Healthscope Whirlpool |
$64.32
|
| Rate for Payer: Mclaren Commercial |
$59.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| 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 00338012612
|
| Hospital Charge Code |
301039
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$66.31 |
| Rate for Payer: Aetna Commercial |
$59.68
|
| Rate for Payer: ASR ASR |
$64.32
|
| Rate for Payer: ASR Commercial |
$64.32
|
| Rate for Payer: BCBS Trust/PPO |
$54.04
|
| Rate for Payer: BCN Commercial |
$51.41
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$62.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.05
|
| Rate for Payer: Healthscope Commercial |
$66.31
|
| Rate for Payer: Healthscope Whirlpool |
$64.32
|
| Rate for Payer: Mclaren Commercial |
$59.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.35
|
|
|
INSULIN REGULAR 1 UNIT/ML IN 0.9 % NACL IV PUSH (CUSTOM)
|
Facility
|
OP
|
$66.31
|
|
|
Service Code
|
NDC 00338012612
|
| Hospital Charge Code |
301039
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$66.31 |
| Rate for Payer: Aetna Commercial |
$59.68
|
| Rate for Payer: Aetna Medicare |
$33.16
|
| Rate for Payer: ASR ASR |
$64.32
|
| Rate for Payer: ASR Commercial |
$64.32
|
| Rate for Payer: BCBS Complete |
$26.52
|
| Rate for Payer: BCBS Trust/PPO |
$54.30
|
| Rate for Payer: BCN Commercial |
$51.41
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$62.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.05
|
| Rate for Payer: Healthscope Commercial |
$66.31
|
| Rate for Payer: Healthscope Whirlpool |
$64.32
|
| Rate for Payer: Mclaren Commercial |
$59.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: 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
|
IP
|
$76.26
|
|
|
Service Code
|
NDC 00002821517
|
| Hospital Charge Code |
164971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.57 |
| Max. Negotiated Rate |
$76.26 |
| Rate for Payer: Aetna Commercial |
$68.63
|
| Rate for Payer: ASR ASR |
$73.97
|
| Rate for Payer: ASR Commercial |
$73.97
|
| Rate for Payer: BCBS Trust/PPO |
$62.14
|
| Rate for Payer: BCN Commercial |
$59.12
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cofinity Commercial |
$71.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.01
|
| Rate for Payer: Healthscope Commercial |
$76.26
|
| Rate for Payer: Healthscope Whirlpool |
$73.97
|
| 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: Priority Health Cigna Priority Health |
$49.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.11
|
|
|
INSULIN REGULAR HUMAN 100 UNIT/ML INJECTION (MDV ADS)
|
Facility
|
OP
|
$76.26
|
|
|
Service Code
|
NDC 00002821517
|
| Hospital Charge Code |
164971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$76.26 |
| Rate for Payer: Aetna Commercial |
$68.63
|
| Rate for Payer: Aetna Medicare |
$38.13
|
| Rate for Payer: ASR ASR |
$73.97
|
| Rate for Payer: ASR Commercial |
$73.97
|
| Rate for Payer: BCBS Complete |
$30.50
|
| Rate for Payer: BCBS Trust/PPO |
$62.45
|
| Rate for Payer: BCN Commercial |
$59.12
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cofinity Commercial |
$71.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.01
|
| Rate for Payer: Healthscope Commercial |
$76.26
|
| Rate for Payer: Healthscope Whirlpool |
$73.97
|
| 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: Priority Health Cigna Priority Health |
$49.57
|
| Rate for Payer: 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 U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN
|
Facility
|
IP
|
$938.39
|
|
|
Service Code
|
NDC 00002882401
|
| Hospital Charge Code |
178095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$609.95 |
| Max. Negotiated Rate |
$938.39 |
| Rate for Payer: Aetna Commercial |
$844.55
|
| Rate for Payer: ASR ASR |
$910.24
|
| Rate for Payer: ASR Commercial |
$910.24
|
| Rate for Payer: BCBS Trust/PPO |
$764.69
|
| Rate for Payer: BCN Commercial |
$727.53
|
| 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 |
$938.39
|
| Rate for Payer: Healthscope Whirlpool |
$910.24
|
| 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: Priority Health Cigna Priority Health |
$609.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$825.78
|
|
|
INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN
|
Facility
|
OP
|
$938.39
|
|
|
Service Code
|
NDC 00002882427
|
| Hospital Charge Code |
178095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$375.36 |
| Max. Negotiated Rate |
$938.39 |
| Rate for Payer: Aetna Commercial |
$844.55
|
| Rate for Payer: Aetna Medicare |
$469.19
|
| Rate for Payer: ASR ASR |
$910.24
|
| Rate for Payer: ASR Commercial |
$910.24
|
| Rate for Payer: BCBS Complete |
$375.36
|
| Rate for Payer: BCBS Trust/PPO |
$768.45
|
| Rate for Payer: BCN Commercial |
$727.53
|
| 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 |
$938.39
|
| Rate for Payer: Healthscope Whirlpool |
$910.24
|
| 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: Priority Health Cigna Priority Health |
$609.95
|
| Rate for Payer: 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 |
$825.78
|
|
|
INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN
|
Facility
|
IP
|
$938.39
|
|
|
Service Code
|
NDC 00002882427
|
| Hospital Charge Code |
178095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$609.95 |
| Max. Negotiated Rate |
$938.39 |
| Rate for Payer: Aetna Commercial |
$844.55
|
| Rate for Payer: ASR ASR |
$910.24
|
| Rate for Payer: ASR Commercial |
$910.24
|
| Rate for Payer: BCBS Trust/PPO |
$764.69
|
| Rate for Payer: BCN Commercial |
$727.53
|
| 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 |
$938.39
|
| Rate for Payer: Healthscope Whirlpool |
$910.24
|
| 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: Priority Health Cigna Priority Health |
$609.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$825.78
|
|
|
INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN
|
Facility
|
OP
|
$938.39
|
|
|
Service Code
|
NDC 00002882401
|
| Hospital Charge Code |
178095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$375.36 |
| Max. Negotiated Rate |
$938.39 |
| Rate for Payer: Aetna Commercial |
$844.55
|
| Rate for Payer: Aetna Medicare |
$469.19
|
| Rate for Payer: ASR ASR |
$910.24
|
| Rate for Payer: ASR Commercial |
$910.24
|
| Rate for Payer: BCBS Complete |
$375.36
|
| Rate for Payer: BCBS Trust/PPO |
$768.45
|
| Rate for Payer: BCN Commercial |
$727.53
|
| 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 |
$938.39
|
| Rate for Payer: Healthscope Whirlpool |
$910.24
|
| 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: Priority Health Cigna Priority Health |
$609.95
|
| Rate for Payer: 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 |
$825.78
|
|
|
INSULIN REGULAR HUMAN U-500"CONCENTRATE" 500 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
IP
|
$4,860.23
|
|
|
Service Code
|
NDC 00002850101
|
| Hospital Charge Code |
301808
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,159.15 |
| Max. Negotiated Rate |
$4,860.23 |
| Rate for Payer: Aetna Commercial |
$4,374.21
|
| Rate for Payer: ASR ASR |
$4,714.42
|
| Rate for Payer: ASR Commercial |
$4,714.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,960.60
|
| Rate for Payer: BCN Commercial |
$3,768.14
|
| Rate for Payer: Cash Price |
$3,888.19
|
| Rate for Payer: Cofinity Commercial |
$4,568.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,888.18
|
| Rate for Payer: Healthscope Commercial |
$4,860.23
|
| Rate for Payer: Healthscope Whirlpool |
$4,714.42
|
| 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: Priority Health Cigna Priority Health |
$3,159.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,277.00
|
|
|
INSULIN REGULAR HUMAN U-500"CONCENTRATE" 500 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
OP
|
$4,860.23
|
|
|
Service Code
|
NDC 00002850101
|
| Hospital Charge Code |
301808
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,944.09 |
| Max. Negotiated Rate |
$4,860.23 |
| Rate for Payer: Aetna Commercial |
$4,374.21
|
| Rate for Payer: Aetna Medicare |
$2,430.11
|
| Rate for Payer: ASR ASR |
$4,714.42
|
| Rate for Payer: ASR Commercial |
$4,714.42
|
| Rate for Payer: BCBS Complete |
$1,944.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,980.04
|
| Rate for Payer: BCN Commercial |
$3,768.14
|
| Rate for Payer: Cash Price |
$3,888.19
|
| Rate for Payer: Cofinity Commercial |
$4,568.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,888.18
|
| Rate for Payer: Healthscope Commercial |
$4,860.23
|
| Rate for Payer: Healthscope Whirlpool |
$4,714.42
|
| 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: Priority Health Cigna Priority Health |
$3,159.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,258.53
|
| Rate for Payer: Priority Health Narrow Network |
$3,407.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,277.00
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - HUMAN (HUMULIN R)
|
Facility
|
OP
|
$141.16
|
|
|
Service Code
|
NDC 00169183311
|
| Hospital Charge Code |
180910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.46 |
| Max. Negotiated Rate |
$141.16 |
| Rate for Payer: Aetna Commercial |
$127.04
|
| Rate for Payer: Aetna Medicare |
$70.58
|
| Rate for Payer: ASR ASR |
$136.93
|
| Rate for Payer: ASR Commercial |
$136.93
|
| Rate for Payer: BCBS Complete |
$56.46
|
| Rate for Payer: BCBS Trust/PPO |
$115.60
|
| Rate for Payer: BCN Commercial |
$109.44
|
| Rate for Payer: Cash Price |
$112.92
|
| Rate for Payer: Cofinity Commercial |
$132.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.93
|
| Rate for Payer: Healthscope Commercial |
$141.16
|
| Rate for Payer: Healthscope Whirlpool |
$136.93
|
| Rate for Payer: Mclaren Commercial |
$127.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.99
|
| Rate for Payer: Nomi Health Commercial |
$115.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.75
|
| Rate for Payer: 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 - HUMAN (HUMULIN R)
|
Facility
|
IP
|
$141.16
|
|
|
Service Code
|
NDC 00169183311
|
| Hospital Charge Code |
180910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.75 |
| Max. Negotiated Rate |
$141.16 |
| Rate for Payer: Aetna Commercial |
$127.04
|
| Rate for Payer: ASR ASR |
$136.93
|
| Rate for Payer: ASR Commercial |
$136.93
|
| Rate for Payer: BCBS Trust/PPO |
$115.03
|
| Rate for Payer: BCN Commercial |
$109.44
|
| Rate for Payer: Cash Price |
$112.92
|
| Rate for Payer: Cofinity Commercial |
$132.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.93
|
| Rate for Payer: Healthscope Commercial |
$141.16
|
| Rate for Payer: Healthscope Whirlpool |
$136.93
|
| Rate for Payer: Mclaren Commercial |
$127.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.99
|
| Rate for Payer: Nomi Health Commercial |
$115.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.22
|
|
|
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 |
$116.09 |
| Max. Negotiated Rate |
$290.23 |
| Rate for Payer: Aetna Commercial |
$261.21
|
| Rate for Payer: Aetna Medicare |
$145.12
|
| Rate for Payer: ASR ASR |
$281.52
|
| Rate for Payer: ASR Commercial |
$281.52
|
| Rate for Payer: BCBS Complete |
$116.09
|
| Rate for Payer: BCBS Trust/PPO |
$237.67
|
| Rate for Payer: BCN Commercial |
$225.02
|
| Rate for Payer: Cash Price |
$232.18
|
| Rate for Payer: Cofinity Commercial |
$272.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.18
|
| Rate for Payer: Healthscope Commercial |
$290.23
|
| Rate for Payer: Healthscope Whirlpool |
$281.52
|
| Rate for Payer: Mclaren Commercial |
$261.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.70
|
| Rate for Payer: Nomi Health Commercial |
$237.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$254.30
|
| Rate for Payer: Priority Health Narrow Network |
$203.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.40
|
|
|
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 |
$188.65 |
| Max. Negotiated Rate |
$290.23 |
| Rate for Payer: Aetna Commercial |
$261.21
|
| Rate for Payer: ASR ASR |
$281.52
|
| Rate for Payer: ASR Commercial |
$281.52
|
| Rate for Payer: BCBS Trust/PPO |
$236.51
|
| Rate for Payer: BCN Commercial |
$225.02
|
| Rate for Payer: Cash Price |
$232.18
|
| Rate for Payer: Cofinity Commercial |
$272.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.18
|
| Rate for Payer: Healthscope Commercial |
$290.23
|
| Rate for Payer: Healthscope Whirlpool |
$281.52
|
| Rate for Payer: Mclaren Commercial |
$261.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.70
|
| Rate for Payer: Nomi Health Commercial |
$237.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.40
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - LISPRO (HUMALOG)
|
Facility
|
OP
|
$177.23
|
|
|
Service Code
|
NDC 00002751001
|
| Hospital Charge Code |
180914
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.89 |
| Max. Negotiated Rate |
$177.23 |
| Rate for Payer: Aetna Commercial |
$159.51
|
| Rate for Payer: Aetna Medicare |
$88.61
|
| Rate for Payer: ASR ASR |
$171.91
|
| Rate for Payer: ASR Commercial |
$171.91
|
| Rate for Payer: BCBS Complete |
$70.89
|
| Rate for Payer: BCBS Trust/PPO |
$145.13
|
| Rate for Payer: BCN Commercial |
$137.41
|
| 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 |
$177.23
|
| Rate for Payer: Healthscope Whirlpool |
$171.91
|
| 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: Priority Health Cigna Priority Health |
$115.20
|
| Rate for Payer: 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 - LISPRO (HUMALOG)
|
Facility
|
IP
|
$177.23
|
|
|
Service Code
|
NDC 00002751001
|
| Hospital Charge Code |
180914
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.20 |
| Max. Negotiated Rate |
$177.23 |
| Rate for Payer: Aetna Commercial |
$159.51
|
| Rate for Payer: ASR ASR |
$171.91
|
| Rate for Payer: ASR Commercial |
$171.91
|
| Rate for Payer: BCBS Trust/PPO |
$144.42
|
| Rate for Payer: BCN Commercial |
$137.41
|
| 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 |
$177.23
|
| Rate for Payer: Healthscope Whirlpool |
$171.91
|
| 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: Priority Health Cigna Priority Health |
$115.20
|
| 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 00002850101
|
| Hospital Charge Code |
180916
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,026.24 |
| Max. Negotiated Rate |
$5,065.60 |
| Rate for Payer: Aetna Commercial |
$4,559.04
|
| Rate for Payer: Aetna Medicare |
$2,532.80
|
| Rate for Payer: ASR ASR |
$4,913.63
|
| Rate for Payer: ASR Commercial |
$4,913.63
|
| Rate for Payer: BCBS Complete |
$2,026.24
|
| Rate for Payer: BCBS Trust/PPO |
$4,148.22
|
| Rate for Payer: BCN Commercial |
$3,927.36
|
| 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 |
$5,065.60
|
| Rate for Payer: Healthscope Whirlpool |
$4,913.63
|
| 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: Priority Health Cigna Priority Health |
$3,292.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,438.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,550.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,457.73
|
|
