|
ETHYL CHLORIDE 100 % TOPICAL SPRAY
|
Facility
|
OP
|
$216.63
|
|
|
Service Code
|
NDC 00386000102
|
| Hospital Charge Code |
2951
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.14 |
| Max. Negotiated Rate |
$194.97 |
| Rate for Payer: Aetna Commercial |
$184.14
|
| Rate for Payer: Aetna Medicare |
$108.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.81
|
| Rate for Payer: BCBS Complete |
$86.65
|
| Rate for Payer: Cash Price |
$173.30
|
| Rate for Payer: Cofinity Advantage |
$151.64
|
| Rate for Payer: Cofinity Commercial |
$186.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.30
|
| Rate for Payer: Healthscope Commercial |
$194.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.47
|
| Rate for Payer: PHP Commercial |
$184.14
|
| Rate for Payer: Priority Health SBD |
$136.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.81
|
| Rate for Payer: UHC Core |
$112.86
|
| Rate for Payer: UHC Exchange |
$85.14
|
|
|
ETHYL CHLORIDE 100 % TOPICAL SPRAY
|
Facility
|
IP
|
$216.63
|
|
|
Service Code
|
NDC 00386000102
|
| Hospital Charge Code |
2951
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.48 |
| Max. Negotiated Rate |
$194.97 |
| Rate for Payer: Aetna Commercial |
$184.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.81
|
| Rate for Payer: Cash Price |
$173.30
|
| Rate for Payer: Cofinity Advantage |
$151.64
|
| Rate for Payer: Cofinity Commercial |
$186.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.30
|
| Rate for Payer: Healthscope Commercial |
$194.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.47
|
| Rate for Payer: PHP Commercial |
$184.14
|
| Rate for Payer: Priority Health SBD |
$136.48
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.92
|
|
|
Service Code
|
NDC 00409669501
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.44 |
| Max. Negotiated Rate |
$20.63 |
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.90
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Cofinity Advantage |
$16.04
|
| Rate for Payer: Cofinity Commercial |
$19.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.34
|
| Rate for Payer: Healthscope Commercial |
$20.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.19
|
| Rate for Payer: PHP Commercial |
$19.48
|
| Rate for Payer: Priority Health SBD |
$14.44
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.65
|
|
|
Service Code
|
NDC 00143950601
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$22.18 |
| Rate for Payer: Aetna Commercial |
$20.95
|
| Rate for Payer: Aetna Medicare |
$12.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.02
|
| Rate for Payer: BCBS Complete |
$9.86
|
| Rate for Payer: Cash Price |
$19.72
|
| Rate for Payer: Cofinity Advantage |
$17.25
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.72
|
| Rate for Payer: Healthscope Commercial |
$22.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.49
|
| Rate for Payer: PHP Commercial |
$20.95
|
| Rate for Payer: Priority Health SBD |
$15.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.02
|
| Rate for Payer: UHC Core |
$12.84
|
| Rate for Payer: UHC Exchange |
$9.69
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$22.92
|
|
|
Service Code
|
NDC 00409669501
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$20.63 |
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: Aetna Medicare |
$11.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.90
|
| Rate for Payer: BCBS Complete |
$9.17
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Cofinity Advantage |
$16.04
|
| Rate for Payer: Cofinity Commercial |
$19.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.34
|
| Rate for Payer: Healthscope Commercial |
$20.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.19
|
| Rate for Payer: PHP Commercial |
$19.48
|
| Rate for Payer: Priority Health SBD |
$14.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.90
|
| Rate for Payer: UHC Core |
$11.94
|
| Rate for Payer: UHC Exchange |
$9.01
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.65
|
|
|
Service Code
|
NDC 00143931010
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$22.18 |
| Rate for Payer: Aetna Commercial |
$20.95
|
| Rate for Payer: Aetna Medicare |
$12.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.02
|
| Rate for Payer: BCBS Complete |
$9.86
|
| Rate for Payer: Cash Price |
$19.72
|
| Rate for Payer: Cofinity Advantage |
$17.25
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.72
|
| Rate for Payer: Healthscope Commercial |
$22.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.49
|
| Rate for Payer: PHP Commercial |
$20.95
|
| Rate for Payer: Priority Health SBD |
$15.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.02
|
| Rate for Payer: UHC Core |
$12.84
|
| Rate for Payer: UHC Exchange |
$9.69
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$66.44
|
|
|
Service Code
|
NDC 00409806201
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.11 |
| Max. Negotiated Rate |
$59.80 |
| Rate for Payer: Aetna Commercial |
$56.47
|
| Rate for Payer: Aetna Medicare |
$33.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.19
|
| Rate for Payer: BCBS Complete |
$26.58
|
| Rate for Payer: Cash Price |
$53.15
|
| Rate for Payer: Cofinity Advantage |
$46.51
|
| Rate for Payer: Cofinity Commercial |
$57.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.15
|
| Rate for Payer: Healthscope Commercial |
$59.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.83
|
| Rate for Payer: PHP Commercial |
$56.47
|
| Rate for Payer: Priority Health SBD |
$41.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.19
|
| Rate for Payer: UHC Core |
$34.62
|
| Rate for Payer: UHC Exchange |
$26.11
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.61
|
|
|
Service Code
|
NDC 67457090200
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$18.55 |
| Rate for Payer: Aetna Commercial |
$17.52
|
| Rate for Payer: Aetna Medicare |
$10.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.40
|
| Rate for Payer: BCBS Complete |
$8.24
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cofinity Advantage |
$14.43
|
| Rate for Payer: Cofinity Commercial |
$17.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.49
|
| Rate for Payer: Healthscope Commercial |
$18.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.46
|
| Rate for Payer: PHP Commercial |
$17.52
|
| Rate for Payer: Priority Health SBD |
$12.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.40
|
| Rate for Payer: UHC Core |
$10.74
|
| Rate for Payer: UHC Exchange |
$8.10
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.61
|
|
|
Service Code
|
NDC 67457090200
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.98 |
| Max. Negotiated Rate |
$18.55 |
| Rate for Payer: Aetna Commercial |
$17.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.40
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cofinity Advantage |
$14.43
|
| Rate for Payer: Cofinity Commercial |
$17.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.49
|
| Rate for Payer: Healthscope Commercial |
$18.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.46
|
| Rate for Payer: PHP Commercial |
$17.52
|
| Rate for Payer: Priority Health SBD |
$12.98
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.06
|
|
|
Service Code
|
NDC 55150022110
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Aetna Medicare |
$9.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.74
|
| Rate for Payer: BCBS Complete |
$7.22
|
| Rate for Payer: Cash Price |
$14.45
|
| Rate for Payer: Cofinity Advantage |
$12.64
|
| Rate for Payer: Cofinity Commercial |
$15.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.45
|
| Rate for Payer: Healthscope Commercial |
$16.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.54
|
| Rate for Payer: PHP Commercial |
$15.35
|
| Rate for Payer: Priority Health SBD |
$11.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.74
|
| Rate for Payer: UHC Core |
$9.41
|
| Rate for Payer: UHC Exchange |
$7.10
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.65
|
|
|
Service Code
|
NDC 00143931001
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$22.18 |
| Rate for Payer: Aetna Commercial |
$20.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.02
|
| Rate for Payer: Cash Price |
$19.72
|
| Rate for Payer: Cofinity Advantage |
$17.25
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.72
|
| Rate for Payer: Healthscope Commercial |
$22.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.49
|
| Rate for Payer: PHP Commercial |
$20.95
|
| Rate for Payer: Priority Health SBD |
$15.53
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.65
|
|
|
Service Code
|
NDC 00143931001
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$22.18 |
| Rate for Payer: Aetna Commercial |
$20.95
|
| Rate for Payer: Aetna Medicare |
$12.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.02
|
| Rate for Payer: BCBS Complete |
$9.86
|
| Rate for Payer: Cash Price |
$19.72
|
| Rate for Payer: Cofinity Advantage |
$17.25
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.72
|
| Rate for Payer: Healthscope Commercial |
$22.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.49
|
| Rate for Payer: PHP Commercial |
$20.95
|
| Rate for Payer: Priority Health SBD |
$15.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.02
|
| Rate for Payer: UHC Core |
$12.84
|
| Rate for Payer: UHC Exchange |
$9.69
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$66.44
|
|
|
Service Code
|
NDC 00409806201
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$59.80 |
| Rate for Payer: Aetna Commercial |
$56.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.19
|
| Rate for Payer: Cash Price |
$53.15
|
| Rate for Payer: Cofinity Advantage |
$46.51
|
| Rate for Payer: Cofinity Commercial |
$57.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.15
|
| Rate for Payer: Healthscope Commercial |
$59.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.83
|
| Rate for Payer: PHP Commercial |
$56.47
|
| Rate for Payer: Priority Health SBD |
$41.86
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.61
|
|
|
Service Code
|
NDC 67457090210
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.98 |
| Max. Negotiated Rate |
$18.55 |
| Rate for Payer: Aetna Commercial |
$17.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.40
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cofinity Advantage |
$14.43
|
| Rate for Payer: Cofinity Commercial |
$17.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.49
|
| Rate for Payer: Healthscope Commercial |
$18.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.46
|
| Rate for Payer: PHP Commercial |
$17.52
|
| Rate for Payer: Priority Health SBD |
$12.98
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.06
|
|
|
Service Code
|
NDC 55150022110
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.74
|
| Rate for Payer: Cash Price |
$14.45
|
| Rate for Payer: Cofinity Advantage |
$12.64
|
| Rate for Payer: Cofinity Commercial |
$15.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.45
|
| Rate for Payer: Healthscope Commercial |
$16.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.54
|
| Rate for Payer: PHP Commercial |
$15.35
|
| Rate for Payer: Priority Health SBD |
$11.38
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.61
|
|
|
Service Code
|
NDC 67457090210
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$18.55 |
| Rate for Payer: Aetna Commercial |
$17.52
|
| Rate for Payer: Aetna Medicare |
$10.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.40
|
| Rate for Payer: BCBS Complete |
$8.24
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cofinity Advantage |
$14.43
|
| Rate for Payer: Cofinity Commercial |
$17.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.49
|
| Rate for Payer: Healthscope Commercial |
$18.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.46
|
| Rate for Payer: PHP Commercial |
$17.52
|
| Rate for Payer: Priority Health SBD |
$12.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.40
|
| Rate for Payer: UHC Core |
$10.74
|
| Rate for Payer: UHC Exchange |
$8.10
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.65
|
|
|
Service Code
|
NDC 00143950610
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$22.18 |
| Rate for Payer: Aetna Commercial |
$20.95
|
| Rate for Payer: Aetna Medicare |
$12.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.02
|
| Rate for Payer: BCBS Complete |
$9.86
|
| Rate for Payer: Cash Price |
$19.72
|
| Rate for Payer: Cofinity Advantage |
$17.25
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.72
|
| Rate for Payer: Healthscope Commercial |
$22.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.49
|
| Rate for Payer: PHP Commercial |
$20.95
|
| Rate for Payer: Priority Health SBD |
$15.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.02
|
| Rate for Payer: UHC Core |
$12.84
|
| Rate for Payer: UHC Exchange |
$9.69
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.65
|
|
|
Service Code
|
NDC 00143931010
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$22.18 |
| Rate for Payer: Aetna Commercial |
$20.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.02
|
| Rate for Payer: Cash Price |
$19.72
|
| Rate for Payer: Cofinity Advantage |
$17.25
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.72
|
| Rate for Payer: Healthscope Commercial |
$22.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.49
|
| Rate for Payer: PHP Commercial |
$20.95
|
| Rate for Payer: Priority Health SBD |
$15.53
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.65
|
|
|
Service Code
|
NDC 00143950610
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$22.18 |
| Rate for Payer: Aetna Commercial |
$20.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.02
|
| Rate for Payer: Cash Price |
$19.72
|
| Rate for Payer: Cofinity Advantage |
$17.25
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.72
|
| Rate for Payer: Healthscope Commercial |
$22.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.49
|
| Rate for Payer: PHP Commercial |
$20.95
|
| Rate for Payer: Priority Health SBD |
$15.53
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.65
|
|
|
Service Code
|
NDC 00143950601
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$22.18 |
| Rate for Payer: Aetna Commercial |
$20.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.02
|
| Rate for Payer: Cash Price |
$19.72
|
| Rate for Payer: Cofinity Advantage |
$17.25
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.72
|
| Rate for Payer: Healthscope Commercial |
$22.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.49
|
| Rate for Payer: PHP Commercial |
$20.95
|
| Rate for Payer: Priority Health SBD |
$15.53
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
IP
|
$22.92
|
|
|
Service Code
|
NDC 00409669501
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.44 |
| Max. Negotiated Rate |
$20.63 |
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.90
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Cofinity Advantage |
$16.04
|
| Rate for Payer: Cofinity Commercial |
$19.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.34
|
| Rate for Payer: Healthscope Commercial |
$20.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.19
|
| Rate for Payer: PHP Commercial |
$19.48
|
| Rate for Payer: Priority Health SBD |
$14.44
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
OP
|
$22.92
|
|
|
Service Code
|
NDC 00409669501
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$20.63 |
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: Aetna Medicare |
$11.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.90
|
| Rate for Payer: BCBS Complete |
$9.17
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Cofinity Advantage |
$16.04
|
| Rate for Payer: Cofinity Commercial |
$19.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.34
|
| Rate for Payer: Healthscope Commercial |
$20.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.19
|
| Rate for Payer: PHP Commercial |
$19.48
|
| Rate for Payer: Priority Health SBD |
$14.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.90
|
| Rate for Payer: UHC Core |
$11.94
|
| Rate for Payer: UHC Exchange |
$9.01
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$344.66
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
10000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$310.19 |
| Rate for Payer: Aetna Commercial |
$292.96
|
| Rate for Payer: Aetna Commercial |
$528.76
|
| Rate for Payer: Aetna Commercial |
$316.70
|
| Rate for Payer: Aetna Commercial |
$239.16
|
| Rate for Payer: Aetna Medicare |
$172.33
|
| Rate for Payer: Aetna Medicare |
$311.04
|
| Rate for Payer: Aetna Medicare |
$186.29
|
| Rate for Payer: Aetna Medicare |
$140.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.03
|
| Rate for Payer: BCBS Complete |
$248.83
|
| Rate for Payer: BCBS Complete |
$137.86
|
| Rate for Payer: BCBS Complete |
$112.55
|
| Rate for Payer: BCBS Complete |
$149.04
|
| Rate for Payer: BCBS Trust/PPO |
$2.56
|
| Rate for Payer: BCBS Trust/PPO |
$2.56
|
| Rate for Payer: BCBS Trust/PPO |
$2.56
|
| Rate for Payer: BCBS Trust/PPO |
$2.56
|
| Rate for Payer: BCN Commercial |
$2.56
|
| Rate for Payer: BCN Commercial |
$2.56
|
| Rate for Payer: BCN Commercial |
$2.56
|
| Rate for Payer: BCN Commercial |
$2.56
|
| Rate for Payer: Cash Price |
$275.73
|
| Rate for Payer: Cash Price |
$298.07
|
| Rate for Payer: Cash Price |
$497.66
|
| Rate for Payer: Cash Price |
$298.07
|
| Rate for Payer: Cash Price |
$225.10
|
| Rate for Payer: Cash Price |
$225.10
|
| Rate for Payer: Cash Price |
$497.66
|
| Rate for Payer: Cash Price |
$275.73
|
| Rate for Payer: Cofinity Advantage |
$435.45
|
| Rate for Payer: Cofinity Advantage |
$196.96
|
| Rate for Payer: Cofinity Advantage |
$260.81
|
| Rate for Payer: Cofinity Advantage |
$241.26
|
| Rate for Payer: Cofinity Commercial |
$241.98
|
| Rate for Payer: Cofinity Commercial |
$534.98
|
| Rate for Payer: Cofinity Commercial |
$296.41
|
| Rate for Payer: Cofinity Commercial |
$320.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.73
|
| Rate for Payer: Healthscope Commercial |
$335.33
|
| Rate for Payer: Healthscope Commercial |
$253.23
|
| Rate for Payer: Healthscope Commercial |
$559.86
|
| Rate for Payer: Healthscope Commercial |
$310.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$275.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$298.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$497.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$466.55
|
| Rate for Payer: PHP Commercial |
$316.70
|
| Rate for Payer: PHP Commercial |
$292.96
|
| Rate for Payer: PHP Commercial |
$528.76
|
| Rate for Payer: PHP Commercial |
$239.16
|
| Rate for Payer: Priority Health SBD |
$177.26
|
| Rate for Payer: Priority Health SBD |
$234.73
|
| Rate for Payer: Priority Health SBD |
$391.90
|
| Rate for Payer: Priority Health SBD |
$217.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.72
|
| Rate for Payer: UHC Core |
$1.72
|
| Rate for Payer: UHC Core |
$1.72
|
| Rate for Payer: UHC Core |
$1.72
|
| Rate for Payer: UHC Core |
$1.72
|
| Rate for Payer: UHC Exchange |
$1.72
|
| Rate for Payer: UHC Exchange |
$1.72
|
| Rate for Payer: UHC Exchange |
$1.72
|
| Rate for Payer: UHC Exchange |
$1.72
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$372.59
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
10000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$234.73 |
| Max. Negotiated Rate |
$335.33 |
| Rate for Payer: Aetna Commercial |
$316.70
|
| Rate for Payer: Aetna Commercial |
$292.96
|
| Rate for Payer: Aetna Commercial |
$528.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.03
|
| Rate for Payer: Cash Price |
$497.66
|
| Rate for Payer: Cash Price |
$298.07
|
| Rate for Payer: Cash Price |
$275.73
|
| Rate for Payer: Cofinity Advantage |
$260.81
|
| Rate for Payer: Cofinity Advantage |
$241.26
|
| Rate for Payer: Cofinity Advantage |
$435.45
|
| Rate for Payer: Cofinity Commercial |
$534.98
|
| Rate for Payer: Cofinity Commercial |
$296.41
|
| Rate for Payer: Cofinity Commercial |
$320.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.66
|
| Rate for Payer: Healthscope Commercial |
$310.19
|
| Rate for Payer: Healthscope Commercial |
$335.33
|
| Rate for Payer: Healthscope Commercial |
$559.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$466.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.44
|
| Rate for Payer: PHP Commercial |
$292.96
|
| Rate for Payer: PHP Commercial |
$528.76
|
| Rate for Payer: PHP Commercial |
$316.70
|
| Rate for Payer: Priority Health SBD |
$391.90
|
| Rate for Payer: Priority Health SBD |
$217.14
|
| Rate for Payer: Priority Health SBD |
$234.73
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.5 CM OR LESS
|
Facility
|
OP
|
$5,321.93
|
|
|
Service Code
|
CPT 11420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.68 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,236.38
|
| Rate for Payer: BCN Commercial |
$1,236.38
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Mclaren Medicaid |
$860.68
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
