Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

ESTRADIOL 1 MG TABLET

Facility

$271.70

Service Code	NDC 00555088602
Hospital Charge Code	9967
Hospital Revenue Code	637
Min. Negotiated Rate	$108.68
Max. Negotiated Rate	$244.53
Rate for Payer: Aetna Commercial	$230.94
Rate for Payer: Aetna Medicare	$135.85
Rate for Payer: Aetna New Business (MI Preferred)	$176.60
Rate for Payer: BCBS Complete	$108.68
Rate for Payer: Cash Price	$217.36
Rate for Payer: Cofinity Commercial	$190.19
Rate for Payer: Cofinity Commercial	$233.66
Rate for Payer: Cofinity Medicare Advantage	$190.19
Rate for Payer: Encore Health Key Benefits Commercial	$217.36
Rate for Payer: Healthscope Commercial	$244.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$230.94
Rate for Payer: PHP Commercial	$230.94
Rate for Payer: Priority Health Cigna Priority Health	$176.60
Rate for Payer: Priority Health SBD	$171.17

ESTRADIOL CYPIONATE 5 MG/ML INTRAMUSCULAR OIL

Facility

$736.49

Service Code	HCPCS J1000
Hospital Charge Code	2929
Hospital Revenue Code	636
Min. Negotiated Rate	$463.99
Max. Negotiated Rate	$662.84
Rate for Payer: Aetna Commercial	$626.02
Rate for Payer: Aetna New Business (MI Preferred)	$478.72
Rate for Payer: Cash Price	$589.19
Rate for Payer: Cofinity Commercial	$515.54
Rate for Payer: Cofinity Commercial	$633.38
Rate for Payer: Cofinity Medicare Advantage	$515.54
Rate for Payer: Encore Health Key Benefits Commercial	$589.19
Rate for Payer: Healthscope Commercial	$662.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$626.02
Rate for Payer: PHP Commercial	$626.02
Rate for Payer: Priority Health Cigna Priority Health	$478.72
Rate for Payer: Priority Health SBD	$463.99

ESTRADIOL CYPIONATE 5 MG/ML INTRAMUSCULAR OIL

Facility

$736.49

Service Code	HCPCS J1000
Hospital Charge Code	2929
Hospital Revenue Code	636
Min. Negotiated Rate	$109.18
Max. Negotiated Rate	$662.84
Rate for Payer: Aetna Commercial	$626.02
Rate for Payer: Aetna Medicare	$368.24
Rate for Payer: Aetna New Business (MI Preferred)	$478.72
Rate for Payer: BCBS Complete	$294.60
Rate for Payer: BCBS Trust/PPO	$109.18
Rate for Payer: BCN Commercial	$109.18
Rate for Payer: Cash Price	$589.19
Rate for Payer: Cash Price	$589.19
Rate for Payer: Cofinity Commercial	$515.54
Rate for Payer: Cofinity Commercial	$633.38
Rate for Payer: Cofinity Medicare Advantage	$515.54
Rate for Payer: Encore Health Key Benefits Commercial	$589.19
Rate for Payer: Healthscope Commercial	$662.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$626.02
Rate for Payer: PHP Commercial	$626.02
Rate for Payer: Priority Health Cigna Priority Health	$478.72
Rate for Payer: Priority Health SBD	$463.99

ESTRADIOL VALERATE 10 MG/ML INTRAMUSCULAR OIL

Facility

$575.88

Service Code	HCPCS J1380
Hospital Charge Code	2930
Hospital Revenue Code	636
Min. Negotiated Rate	$362.80
Max. Negotiated Rate	$518.29
Rate for Payer: Aetna Commercial	$489.50
Rate for Payer: Aetna New Business (MI Preferred)	$374.32
Rate for Payer: Cash Price	$460.70
Rate for Payer: Cofinity Commercial	$403.12
Rate for Payer: Cofinity Commercial	$495.26
Rate for Payer: Cofinity Medicare Advantage	$403.12
Rate for Payer: Encore Health Key Benefits Commercial	$460.70
Rate for Payer: Healthscope Commercial	$518.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$489.50
Rate for Payer: PHP Commercial	$489.50
Rate for Payer: Priority Health Cigna Priority Health	$374.32
Rate for Payer: Priority Health SBD	$362.80

ESTRADIOL VALERATE 10 MG/ML INTRAMUSCULAR OIL

Facility

$575.88

Service Code	HCPCS J1380
Hospital Charge Code	2930
Hospital Revenue Code	636
Min. Negotiated Rate	$21.18
Max. Negotiated Rate	$518.29
Rate for Payer: Aetna Commercial	$489.50
Rate for Payer: Aetna Medicare	$287.94
Rate for Payer: Aetna New Business (MI Preferred)	$374.32
Rate for Payer: BCBS Complete	$230.35
Rate for Payer: BCBS Trust/PPO	$21.18
Rate for Payer: BCN Commercial	$21.18
Rate for Payer: Cash Price	$460.70
Rate for Payer: Cash Price	$460.70
Rate for Payer: Cofinity Commercial	$403.12
Rate for Payer: Cofinity Commercial	$495.26
Rate for Payer: Cofinity Medicare Advantage	$403.12
Rate for Payer: Encore Health Key Benefits Commercial	$460.70
Rate for Payer: Healthscope Commercial	$518.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$489.50
Rate for Payer: PHP Commercial	$489.50
Rate for Payer: Priority Health Cigna Priority Health	$374.32
Rate for Payer: Priority Health SBD	$362.80

ETHAMBUTOL 400 MG TABLET

Facility

$404.64

Service Code	NDC 68084028011
Hospital Charge Code	9983
Hospital Revenue Code	637
Min. Negotiated Rate	$161.86
Max. Negotiated Rate	$364.18
Rate for Payer: Aetna Commercial	$343.94
Rate for Payer: Aetna Medicare	$202.32
Rate for Payer: Aetna New Business (MI Preferred)	$263.02
Rate for Payer: BCBS Complete	$161.86
Rate for Payer: Cash Price	$323.71
Rate for Payer: Cofinity Commercial	$283.25
Rate for Payer: Cofinity Commercial	$347.99
Rate for Payer: Cofinity Medicare Advantage	$283.25
Rate for Payer: Encore Health Key Benefits Commercial	$323.71
Rate for Payer: Healthscope Commercial	$364.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$343.94
Rate for Payer: PHP Commercial	$343.94
Rate for Payer: Priority Health Cigna Priority Health	$263.02
Rate for Payer: Priority Health SBD	$254.92

ETHAMBUTOL 400 MG TABLET

Facility

$350.40

Service Code	NDC 68850001202
Hospital Charge Code	9983
Hospital Revenue Code	637
Min. Negotiated Rate	$220.75
Max. Negotiated Rate	$315.36
Rate for Payer: Aetna Commercial	$297.84
Rate for Payer: Aetna New Business (MI Preferred)	$227.76
Rate for Payer: Cash Price	$280.32
Rate for Payer: Cofinity Commercial	$245.28
Rate for Payer: Cofinity Commercial	$301.34
Rate for Payer: Cofinity Medicare Advantage	$245.28
Rate for Payer: Encore Health Key Benefits Commercial	$280.32
Rate for Payer: Healthscope Commercial	$315.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$297.84
Rate for Payer: PHP Commercial	$297.84
Rate for Payer: Priority Health Cigna Priority Health	$227.76
Rate for Payer: Priority Health SBD	$220.75

ETHAMBUTOL 400 MG TABLET

Facility

$350.40

Service Code	NDC 68850001201
Hospital Charge Code	9983
Hospital Revenue Code	637
Min. Negotiated Rate	$220.75
Max. Negotiated Rate	$315.36
Rate for Payer: Aetna Commercial	$297.84
Rate for Payer: Aetna New Business (MI Preferred)	$227.76
Rate for Payer: Cash Price	$280.32
Rate for Payer: Cofinity Commercial	$245.28
Rate for Payer: Cofinity Commercial	$301.34
Rate for Payer: Cofinity Medicare Advantage	$245.28
Rate for Payer: Encore Health Key Benefits Commercial	$280.32
Rate for Payer: Healthscope Commercial	$315.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$297.84
Rate for Payer: PHP Commercial	$297.84
Rate for Payer: Priority Health Cigna Priority Health	$227.76
Rate for Payer: Priority Health SBD	$220.75

ETHAMBUTOL 400 MG TABLET

Facility

$350.40

Service Code	NDC 68850001201
Hospital Charge Code	9983
Hospital Revenue Code	637
Min. Negotiated Rate	$140.16
Max. Negotiated Rate	$315.36
Rate for Payer: Aetna Commercial	$297.84
Rate for Payer: Aetna Medicare	$175.20
Rate for Payer: Aetna New Business (MI Preferred)	$227.76
Rate for Payer: BCBS Complete	$140.16
Rate for Payer: Cash Price	$280.32
Rate for Payer: Cofinity Commercial	$245.28
Rate for Payer: Cofinity Commercial	$301.34
Rate for Payer: Cofinity Medicare Advantage	$245.28
Rate for Payer: Encore Health Key Benefits Commercial	$280.32
Rate for Payer: Healthscope Commercial	$315.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$297.84
Rate for Payer: PHP Commercial	$297.84
Rate for Payer: Priority Health Cigna Priority Health	$227.76
Rate for Payer: Priority Health SBD	$220.75

ETHAMBUTOL 400 MG TABLET

Facility

$350.40

Service Code	NDC 68850001202
Hospital Charge Code	9983
Hospital Revenue Code	637
Min. Negotiated Rate	$140.16
Max. Negotiated Rate	$315.36
Rate for Payer: Aetna Commercial	$297.84
Rate for Payer: Aetna Medicare	$175.20
Rate for Payer: Aetna New Business (MI Preferred)	$227.76
Rate for Payer: BCBS Complete	$140.16
Rate for Payer: Cash Price	$280.32
Rate for Payer: Cofinity Commercial	$245.28
Rate for Payer: Cofinity Commercial	$301.34
Rate for Payer: Cofinity Medicare Advantage	$245.28
Rate for Payer: Encore Health Key Benefits Commercial	$280.32
Rate for Payer: Healthscope Commercial	$315.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$297.84
Rate for Payer: PHP Commercial	$297.84
Rate for Payer: Priority Health Cigna Priority Health	$227.76
Rate for Payer: Priority Health SBD	$220.75

ETHAMBUTOL 400 MG TABLET

Facility

$404.64

Service Code	NDC 68084028011
Hospital Charge Code	9983
Hospital Revenue Code	637
Min. Negotiated Rate	$254.92
Max. Negotiated Rate	$364.18
Rate for Payer: Aetna Commercial	$343.94
Rate for Payer: Aetna New Business (MI Preferred)	$263.02
Rate for Payer: Cash Price	$323.71
Rate for Payer: Cofinity Commercial	$283.25
Rate for Payer: Cofinity Commercial	$347.99
Rate for Payer: Cofinity Medicare Advantage	$283.25
Rate for Payer: Encore Health Key Benefits Commercial	$323.71
Rate for Payer: Healthscope Commercial	$364.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$343.94
Rate for Payer: PHP Commercial	$343.94
Rate for Payer: Priority Health Cigna Priority Health	$263.02
Rate for Payer: Priority Health SBD	$254.92

ETHANOLAMINE OLEATE 5 % INTRAVENOUS SOLUTION

Facility

$1,429.68

Service Code	HCPCS J1430
Hospital Charge Code	9984
Hospital Revenue Code	636
Min. Negotiated Rate	$263.52
Max. Negotiated Rate	$1,474.95
Rate for Payer: Aetna Commercial	$1,215.23
Rate for Payer: Aetna Medicare	$511.32
Rate for Payer: Aetna New Business (MI Preferred)	$929.29
Rate for Payer: Allen County Amish Medical Aid Commercial	$614.56
Rate for Payer: Amish Plain Church Group Commercial	$614.56
Rate for Payer: BCBS Complete	$276.70
Rate for Payer: BCBS MAPPO	$491.65
Rate for Payer: BCBS Trust/PPO	$1,388.91
Rate for Payer: BCN Commercial	$1,388.91
Rate for Payer: BCN Medicare Advantage	$491.65
Rate for Payer: Cash Price	$1,143.74
Rate for Payer: Cash Price	$1,143.74
Rate for Payer: Cofinity Commercial	$1,229.52
Rate for Payer: Cofinity Commercial	$1,000.78
Rate for Payer: Cofinity Medicare Advantage	$1,000.78
Rate for Payer: Encore Health Key Benefits Commercial	$1,143.74
Rate for Payer: Health Alliance Plan Medicare Advantage	$491.65
Rate for Payer: Healthscope Commercial	$1,286.71
Rate for Payer: Mclaren Medicaid	$263.52
Rate for Payer: Mclaren Medicare	$491.65
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$516.23
Rate for Payer: Meridian Medicaid	$276.70
Rate for Payer: MI Amish Medical Board Commercial	$565.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,215.23
Rate for Payer: Nomi Health Commercial	$1,474.95
Rate for Payer: PACE Medicare	$467.07
Rate for Payer: PACE SWMI	$491.65
Rate for Payer: PHP Commercial	$1,215.23
Rate for Payer: PHP Medicare Advantage	$491.65
Rate for Payer: Priority Health Choice Medicaid	$263.52
Rate for Payer: Priority Health Cigna Priority Health	$929.29
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,415.08
Rate for Payer: Priority Health Medicare	$491.65
Rate for Payer: Priority Health Narrow Network	$1,132.06
Rate for Payer: Priority Health SBD	$900.70
Rate for Payer: Railroad Medicare Medicare	$491.65
Rate for Payer: UHC All Payor (Choice/PPO)	$1,383.95
Rate for Payer: UHC Dual Complete DSNP	$491.65
Rate for Payer: UHC Medicare Advantage	$491.65
Rate for Payer: UHCCP Medicaid	$276.80
Rate for Payer: VA VA	$491.65

ETHANOLAMINE OLEATE 5 % INTRAVENOUS SOLUTION

Facility

$1,429.68

Service Code	HCPCS J1430
Hospital Charge Code	9984
Hospital Revenue Code	636
Min. Negotiated Rate	$900.70
Max. Negotiated Rate	$1,286.71
Rate for Payer: Aetna Commercial	$1,215.23
Rate for Payer: Aetna New Business (MI Preferred)	$929.29
Rate for Payer: Cash Price	$1,143.74
Rate for Payer: Cofinity Commercial	$1,000.78
Rate for Payer: Cofinity Commercial	$1,229.52
Rate for Payer: Cofinity Medicare Advantage	$1,000.78
Rate for Payer: Encore Health Key Benefits Commercial	$1,143.74
Rate for Payer: Healthscope Commercial	$1,286.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,215.23
Rate for Payer: PHP Commercial	$1,215.23
Rate for Payer: Priority Health Cigna Priority Health	$929.29
Rate for Payer: Priority Health SBD	$900.70

ETHOSUXIMIDE 250 MG CAPSULE

Facility

$316.35

Service Code	NDC 64380087806
Hospital Charge Code	9989
Hospital Revenue Code	637
Min. Negotiated Rate	$126.54
Max. Negotiated Rate	$284.72
Rate for Payer: Aetna Commercial	$268.90
Rate for Payer: Aetna Medicare	$158.18
Rate for Payer: Aetna New Business (MI Preferred)	$205.63
Rate for Payer: BCBS Complete	$126.54
Rate for Payer: Cash Price	$253.08
Rate for Payer: Cofinity Commercial	$221.44
Rate for Payer: Cofinity Commercial	$272.06
Rate for Payer: Cofinity Medicare Advantage	$221.44
Rate for Payer: Encore Health Key Benefits Commercial	$253.08
Rate for Payer: Healthscope Commercial	$284.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$268.90
Rate for Payer: PHP Commercial	$268.90
Rate for Payer: Priority Health Cigna Priority Health	$205.63
Rate for Payer: Priority Health SBD	$199.30

ETHOSUXIMIDE 250 MG CAPSULE

Facility

$535.68

Service Code	NDC 23155053201
Hospital Charge Code	9989
Hospital Revenue Code	637
Min. Negotiated Rate	$337.48
Max. Negotiated Rate	$482.11
Rate for Payer: Aetna Commercial	$455.33
Rate for Payer: Aetna New Business (MI Preferred)	$348.19
Rate for Payer: Cash Price	$428.54
Rate for Payer: Cofinity Commercial	$374.98
Rate for Payer: Cofinity Commercial	$460.68
Rate for Payer: Cofinity Medicare Advantage	$374.98
Rate for Payer: Encore Health Key Benefits Commercial	$428.54
Rate for Payer: Healthscope Commercial	$482.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$455.33
Rate for Payer: PHP Commercial	$455.33
Rate for Payer: Priority Health Cigna Priority Health	$348.19
Rate for Payer: Priority Health SBD	$337.48

ETHOSUXIMIDE 250 MG CAPSULE

Facility

$535.68

Service Code	NDC 61748002501
Hospital Charge Code	9989
Hospital Revenue Code	637
Min. Negotiated Rate	$337.48
Max. Negotiated Rate	$482.11
Rate for Payer: Aetna Commercial	$455.33
Rate for Payer: Aetna New Business (MI Preferred)	$348.19
Rate for Payer: Cash Price	$428.54
Rate for Payer: Cofinity Commercial	$374.98
Rate for Payer: Cofinity Commercial	$460.68
Rate for Payer: Cofinity Medicare Advantage	$374.98
Rate for Payer: Encore Health Key Benefits Commercial	$428.54
Rate for Payer: Healthscope Commercial	$482.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$455.33
Rate for Payer: PHP Commercial	$455.33
Rate for Payer: Priority Health Cigna Priority Health	$348.19
Rate for Payer: Priority Health SBD	$337.48

ETHOSUXIMIDE 250 MG CAPSULE

Facility

$535.68

Service Code	NDC 61748002501
Hospital Charge Code	9989
Hospital Revenue Code	637
Min. Negotiated Rate	$214.27
Max. Negotiated Rate	$482.11
Rate for Payer: Aetna Commercial	$455.33
Rate for Payer: Aetna Medicare	$267.84
Rate for Payer: Aetna New Business (MI Preferred)	$348.19
Rate for Payer: BCBS Complete	$214.27
Rate for Payer: Cash Price	$428.54
Rate for Payer: Cofinity Commercial	$374.98
Rate for Payer: Cofinity Commercial	$460.68
Rate for Payer: Cofinity Medicare Advantage	$374.98
Rate for Payer: Encore Health Key Benefits Commercial	$428.54
Rate for Payer: Healthscope Commercial	$482.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$455.33
Rate for Payer: PHP Commercial	$455.33
Rate for Payer: Priority Health Cigna Priority Health	$348.19
Rate for Payer: Priority Health SBD	$337.48

ETHOSUXIMIDE 250 MG CAPSULE

Facility

$316.35

Service Code	NDC 64380087806
Hospital Charge Code	9989
Hospital Revenue Code	637
Min. Negotiated Rate	$199.30
Max. Negotiated Rate	$284.72
Rate for Payer: Aetna Commercial	$268.90
Rate for Payer: Aetna New Business (MI Preferred)	$205.63
Rate for Payer: Cash Price	$253.08
Rate for Payer: Cofinity Commercial	$221.44
Rate for Payer: Cofinity Commercial	$272.06
Rate for Payer: Cofinity Medicare Advantage	$221.44
Rate for Payer: Encore Health Key Benefits Commercial	$253.08
Rate for Payer: Healthscope Commercial	$284.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$268.90
Rate for Payer: PHP Commercial	$268.90
Rate for Payer: Priority Health Cigna Priority Health	$205.63
Rate for Payer: Priority Health SBD	$199.30

ETHOSUXIMIDE 250 MG CAPSULE

Facility

$535.68

Service Code	NDC 23155053201
Hospital Charge Code	9989
Hospital Revenue Code	637
Min. Negotiated Rate	$214.27
Max. Negotiated Rate	$482.11
Rate for Payer: Aetna Commercial	$455.33
Rate for Payer: Aetna Medicare	$267.84
Rate for Payer: Aetna New Business (MI Preferred)	$348.19
Rate for Payer: BCBS Complete	$214.27
Rate for Payer: Cash Price	$428.54
Rate for Payer: Cofinity Commercial	$374.98
Rate for Payer: Cofinity Commercial	$460.68
Rate for Payer: Cofinity Medicare Advantage	$374.98
Rate for Payer: Encore Health Key Benefits Commercial	$428.54
Rate for Payer: Healthscope Commercial	$482.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$455.33
Rate for Payer: PHP Commercial	$455.33
Rate for Payer: Priority Health Cigna Priority Health	$348.19
Rate for Payer: Priority Health SBD	$337.48

ETHYL CHLORIDE 100 % TOPICAL SPRAY

Facility

$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 Commercial	$151.64
Rate for Payer: Cofinity Commercial	$186.30
Rate for Payer: Cofinity Medicare Advantage	$151.64
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: PHP Commercial	$184.14
Rate for Payer: Priority Health Cigna Priority Health	$140.81
Rate for Payer: Priority Health SBD	$136.48

ETHYL CHLORIDE 100 % TOPICAL SPRAY

Facility

$216.63

Service Code	NDC 00386000102
Hospital Charge Code	2951
Hospital Revenue Code	637
Min. Negotiated Rate	$86.65
Max. Negotiated Rate	$194.97
Rate for Payer: Aetna Commercial	$184.14
Rate for Payer: Aetna Medicare	$108.32
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 Commercial	$151.64
Rate for Payer: Cofinity Commercial	$186.30
Rate for Payer: Cofinity Medicare Advantage	$151.64
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: PHP Commercial	$184.14
Rate for Payer: Priority Health Cigna Priority Health	$140.81
Rate for Payer: Priority Health SBD	$136.48

ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION

Facility

$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 Commercial	$16.04
Rate for Payer: Cofinity Commercial	$19.71
Rate for Payer: Cofinity Medicare Advantage	$16.04
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: PHP Commercial	$19.48
Rate for Payer: Priority Health Cigna Priority Health	$14.90
Rate for Payer: Priority Health SBD	$14.44

ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION

Facility

$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 Commercial	$12.64
Rate for Payer: Cofinity Commercial	$15.53
Rate for Payer: Cofinity Medicare Advantage	$12.64
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: PHP Commercial	$15.35
Rate for Payer: Priority Health Cigna Priority Health	$11.74
Rate for Payer: Priority Health SBD	$11.38

ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION

Facility

$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 Commercial	$17.26
Rate for Payer: Cofinity Commercial	$21.20
Rate for Payer: Cofinity Medicare Advantage	$17.26
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: PHP Commercial	$20.95
Rate for Payer: Priority Health Cigna Priority Health	$16.02
Rate for Payer: Priority Health SBD	$15.53

ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION

Facility

$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 Commercial	$17.26
Rate for Payer: Cofinity Commercial	$21.20
Rate for Payer: Cofinity Medicare Advantage	$17.26
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: PHP Commercial	$20.95
Rate for Payer: Priority Health Cigna Priority Health	$16.02
Rate for Payer: Priority Health SBD	$15.53

Know your out-of-pocket cost for care.

All Charges