INSULIN INF PUMP ASPART SBH DRUG
|
Facility
|
IP
|
$7.73
|
|
Service Code
|
HCPCS J1817
|
Hospital Charge Code |
41648195
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$3.86 |
Max. Negotiated Rate |
$3.86 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.86
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3.86
|
|
INSULIN INF PUMP FLULISINE SBH
|
Facility
|
OP
|
$6.25
|
|
Service Code
|
HCPCS J1817
|
Hospital Charge Code |
41658197
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$2.19 |
Max. Negotiated Rate |
$11.14 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.44
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.14
|
Rate for Payer: Aetna Government |
$11.14
|
Rate for Payer: Brighton Health Commercial |
$3.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.12
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.59
|
Rate for Payer: Group Health Inc Commercial |
$3.12
|
Rate for Payer: Group Health Inc Medicare |
$2.19
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.12
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3.12
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.01
|
Rate for Payer: SOMOS Essential |
$8.01
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.06
|
|
INSULIN INF PUMP FLULISINE SBH
|
Facility
|
IP
|
$6.25
|
|
Service Code
|
HCPCS J1817
|
Hospital Charge Code |
41658197
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$3.12 |
Max. Negotiated Rate |
$3.12 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.12
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3.12
|
|
INSULIN INF PUMP GLULISINE SBH
|
Facility
|
IP
|
$6.25
|
|
Service Code
|
HCPCS J1817
|
Hospital Charge Code |
41648197
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$3.12 |
Max. Negotiated Rate |
$3.12 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.12
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3.12
|
|
INSULIN INF PUMP GLULISINE SBH
|
Facility
|
OP
|
$6.25
|
|
Service Code
|
HCPCS J1817
|
Hospital Charge Code |
41648197
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$2.19 |
Max. Negotiated Rate |
$11.14 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.44
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.14
|
Rate for Payer: Aetna Government |
$11.14
|
Rate for Payer: Brighton Health Commercial |
$3.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.12
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.59
|
Rate for Payer: Group Health Inc Commercial |
$3.12
|
Rate for Payer: Group Health Inc Medicare |
$2.19
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.12
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3.12
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.01
|
Rate for Payer: SOMOS Essential |
$8.01
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.06
|
|
INSULIN INF PUMP HUMULIN SBH DRUG
|
Facility
|
OP
|
$1.23
|
|
Service Code
|
HCPCS J1817
|
Hospital Charge Code |
41648199
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.43 |
Max. Negotiated Rate |
$11.14 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.68
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.14
|
Rate for Payer: Aetna Government |
$11.14
|
Rate for Payer: Brighton Health Commercial |
$0.74
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.62
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.71
|
Rate for Payer: Group Health Inc Commercial |
$0.62
|
Rate for Payer: Group Health Inc Medicare |
$0.43
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.62
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.01
|
Rate for Payer: SOMOS Essential |
$8.01
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.80
|
|
INSULIN INF PUMP HUMULIN SBH DRUG
|
Facility
|
IP
|
$1.23
|
|
Service Code
|
HCPCS J1817
|
Hospital Charge Code |
41648199
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.62 |
Max. Negotiated Rate |
$0.62 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.62
|
|
INSULIN INF PUMP HUMULIN SBH DRUG
|
Facility
|
IP
|
$1.23
|
|
Service Code
|
HCPCS J1817
|
Hospital Charge Code |
41658199
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.62 |
Max. Negotiated Rate |
$0.62 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.62
|
|
INSULIN INF PUMP HUMULIN SBH DRUG
|
Facility
|
OP
|
$1.23
|
|
Service Code
|
HCPCS J1817
|
Hospital Charge Code |
41658199
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.43 |
Max. Negotiated Rate |
$11.14 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.68
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.14
|
Rate for Payer: Aetna Government |
$11.14
|
Rate for Payer: Brighton Health Commercial |
$0.74
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.62
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.71
|
Rate for Payer: Group Health Inc Commercial |
$0.62
|
Rate for Payer: Group Health Inc Medicare |
$0.43
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.62
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.01
|
Rate for Payer: SOMOS Essential |
$8.01
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.80
|
|
INSULIN INF PUMP LISPRO SBH DRUG
|
Facility
|
IP
|
$4.61
|
|
Service Code
|
HCPCS J1817
|
Hospital Charge Code |
41648201
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$2.30 |
Max. Negotiated Rate |
$2.30 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2.30
|
|
INSULIN INF PUMP LISPRO SBH DRUG
|
Facility
|
OP
|
$4.61
|
|
Service Code
|
HCPCS J1817
|
Hospital Charge Code |
41648201
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.61 |
Max. Negotiated Rate |
$11.14 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.54
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.14
|
Rate for Payer: Aetna Government |
$11.14
|
Rate for Payer: Brighton Health Commercial |
$2.77
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.65
|
Rate for Payer: Group Health Inc Commercial |
$2.30
|
Rate for Payer: Group Health Inc Medicare |
$1.61
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2.30
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.01
|
Rate for Payer: SOMOS Essential |
$8.01
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.00
|
|
INSULIN INF PUMP LISPRO SBH DRUG
|
Facility
|
OP
|
$4.61
|
|
Service Code
|
HCPCS J1817
|
Hospital Charge Code |
41658201
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.61 |
Max. Negotiated Rate |
$11.14 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.54
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.14
|
Rate for Payer: Aetna Government |
$11.14
|
Rate for Payer: Brighton Health Commercial |
$2.77
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.65
|
Rate for Payer: Group Health Inc Commercial |
$2.30
|
Rate for Payer: Group Health Inc Medicare |
$1.61
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2.30
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.01
|
Rate for Payer: SOMOS Essential |
$8.01
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.00
|
|
INSULIN INF PUMP LISPRO SBH DRUG
|
Facility
|
IP
|
$4.61
|
|
Service Code
|
HCPCS J1817
|
Hospital Charge Code |
41658201
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$2.30 |
Max. Negotiated Rate |
$2.30 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2.30
|
|
INSULIN INF PUMP NOVOLIN SBH DRUG
|
Facility
|
IP
|
$2.36
|
|
Service Code
|
HCPCS J1817
|
Hospital Charge Code |
41648203
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.18 |
Max. Negotiated Rate |
$1.18 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.18
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.18
|
|
INSULIN INF PUMP NOVOLIN SBH DRUG
|
Facility
|
OP
|
$2.36
|
|
Service Code
|
HCPCS J1817
|
Hospital Charge Code |
41648203
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.83 |
Max. Negotiated Rate |
$11.14 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.30
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.14
|
Rate for Payer: Aetna Government |
$11.14
|
Rate for Payer: Brighton Health Commercial |
$1.42
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.18
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
Rate for Payer: Group Health Inc Commercial |
$1.18
|
Rate for Payer: Group Health Inc Medicare |
$0.83
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.18
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.18
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.01
|
Rate for Payer: SOMOS Essential |
$8.01
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.53
|
|
INSULIN INF PUMP NOVOLIN SBH DURG
|
Facility
|
IP
|
$2.36
|
|
Service Code
|
HCPCS J1817
|
Hospital Charge Code |
41658203
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.18 |
Max. Negotiated Rate |
$1.18 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.18
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.18
|
|
INSULIN INF PUMP NOVOLIN SBH DURG
|
Facility
|
OP
|
$2.36
|
|
Service Code
|
HCPCS J1817
|
Hospital Charge Code |
41658203
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.83 |
Max. Negotiated Rate |
$11.14 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.30
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.14
|
Rate for Payer: Aetna Government |
$11.14
|
Rate for Payer: Brighton Health Commercial |
$1.42
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.18
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
Rate for Payer: Group Health Inc Commercial |
$1.18
|
Rate for Payer: Group Health Inc Medicare |
$0.83
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.18
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.18
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.01
|
Rate for Payer: SOMOS Essential |
$8.01
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.53
|
|
INSULIN LISPRO 100 UNIT/ML IJ SOLN [183768]
|
Facility
|
OP
|
$7.97
|
|
Service Code
|
HCPCS J1815
|
Hospital Charge Code |
00002753301
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.95 |
Max. Negotiated Rate |
$6.37 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.38
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.95
|
Rate for Payer: Aetna Government |
$0.95
|
Rate for Payer: Brighton Health Commercial |
$5.98
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.37
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.42
|
Rate for Payer: Group Health Inc Commercial |
$3.98
|
Rate for Payer: Group Health Inc Medicare |
$2.79
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.98
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3.98
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.18
|
|
INSULIN LISPRO 100 UNIT/ML IJ SOLN [183768]
|
Facility
|
OP
|
$3.00
|
|
Service Code
|
HCPCS J1815
|
Hospital Charge Code |
00002773701
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.95 |
Max. Negotiated Rate |
$2.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.95
|
Rate for Payer: Aetna Government |
$0.95
|
Rate for Payer: Brighton Health Commercial |
$2.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
Rate for Payer: Group Health Inc Commercial |
$1.50
|
Rate for Payer: Group Health Inc Medicare |
$1.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
INSULIN LISPRO 100 UNIT/ML IJ SOLN [183768]
|
Facility
|
OP
|
$7.97
|
|
Service Code
|
HCPCS J1815
|
Hospital Charge Code |
00002751001
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.95 |
Max. Negotiated Rate |
$6.37 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.38
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.95
|
Rate for Payer: Aetna Government |
$0.95
|
Rate for Payer: Brighton Health Commercial |
$5.98
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.37
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.42
|
Rate for Payer: Group Health Inc Commercial |
$3.98
|
Rate for Payer: Group Health Inc Medicare |
$2.79
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.98
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3.98
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.18
|
|
INSULIN LISPRO INJ 3ML-5U
|
Facility
|
IP
|
$0.61
|
|
Service Code
|
HCPCS J1815
|
Hospital Charge Code |
41642189
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.31 |
Max. Negotiated Rate |
$0.31 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.31
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.31
|
|
INSULIN LISPRO INJ 3ML-5U
|
Facility
|
OP
|
$0.61
|
|
Service Code
|
HCPCS J1815
|
Hospital Charge Code |
41642189
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.21 |
Max. Negotiated Rate |
$0.95 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.34
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.95
|
Rate for Payer: Aetna Government |
$0.95
|
Rate for Payer: Brighton Health Commercial |
$0.37
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.31
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
Rate for Payer: Group Health Inc Commercial |
$0.31
|
Rate for Payer: Group Health Inc Medicare |
$0.21
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.31
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.31
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.40
|
|
INSULIN LISPRO INJEC 3ML-5U
|
Facility
|
OP
|
$0.61
|
|
Service Code
|
HCPCS J1815
|
Hospital Charge Code |
41652189
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.21 |
Max. Negotiated Rate |
$0.95 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.34
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.95
|
Rate for Payer: Aetna Government |
$0.95
|
Rate for Payer: Brighton Health Commercial |
$0.37
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.31
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
Rate for Payer: Group Health Inc Commercial |
$0.31
|
Rate for Payer: Group Health Inc Medicare |
$0.21
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.31
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.31
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.40
|
|
INSULIN LISPRO INJEC 3ML-5U
|
Facility
|
IP
|
$0.61
|
|
Service Code
|
HCPCS J1815
|
Hospital Charge Code |
41652189
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.31 |
Max. Negotiated Rate |
$0.31 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.31
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.31
|
|
INSULIN LISPRO INJECTION
|
Facility
|
IP
|
$0.44
|
|
Hospital Charge Code |
41657026
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.22 |
Max. Negotiated Rate |
$0.22 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.22
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.22
|
|