|
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 |
$3.18 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Aetna Medicare |
$4.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.64
|
| Rate for Payer: BCBS Complete |
$3.34
|
| Rate for Payer: BCBS MAPPO |
$4.51
|
| Rate for Payer: BCBS Trust/PPO |
$14.85
|
| Rate for Payer: BCN Commercial |
$14.85
|
| Rate for Payer: BCN Medicare Advantage |
$4.51
|
| Rate for Payer: Cash Price |
$14.45
|
| Rate for Payer: Cofinity Commercial |
$15.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.51
|
| Rate for Payer: Healthscope Commercial |
$16.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.54
|
| Rate for Payer: Mclaren Medicaid |
$3.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.74
|
| Rate for Payer: Meridian Medicaid |
$3.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.35
|
| Rate for Payer: Nomi Health Commercial |
$14.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.54
|
| Rate for Payer: PACE Senior Care Partners |
$4.29
|
| Rate for Payer: PACE SWMI |
$4.51
|
| Rate for Payer: PHP Commercial |
$15.35
|
| Rate for Payer: PHP Medicare Advantage |
$4.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.71
|
| Rate for Payer: Priority Health Medicare |
$4.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.57
|
| Rate for Payer: Railroad Medicare Medicare |
$4.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.89
|
| Rate for Payer: UHC Core |
$15.08
|
| Rate for Payer: UHC Exchange |
$4.51
|
| Rate for Payer: UHC Medicaid |
$3.18
|
| Rate for Payer: UHC Medicare Advantage |
$4.51
|
| Rate for Payer: UHCCP Medicaid |
$3.18
|
| Rate for Payer: VA VA |
$4.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.54
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.54
|
|
|
Service Code
|
NDC 00143931110
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$17.59 |
| Rate for Payer: Aetna Commercial |
$16.61
|
| Rate for Payer: Aetna Medicare |
$5.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.11
|
| Rate for Payer: BCBS Complete |
$3.62
|
| Rate for Payer: BCBS MAPPO |
$4.88
|
| Rate for Payer: BCBS Trust/PPO |
$16.06
|
| Rate for Payer: BCN Commercial |
$16.06
|
| Rate for Payer: BCN Medicare Advantage |
$4.88
|
| Rate for Payer: Cash Price |
$15.63
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.88
|
| Rate for Payer: Healthscope Commercial |
$17.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.65
|
| Rate for Payer: Mclaren Medicaid |
$3.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.13
|
| Rate for Payer: Meridian Medicaid |
$3.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.61
|
| Rate for Payer: Nomi Health Commercial |
$16.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.65
|
| Rate for Payer: PACE Senior Care Partners |
$4.64
|
| Rate for Payer: PACE SWMI |
$4.88
|
| Rate for Payer: PHP Commercial |
$16.61
|
| Rate for Payer: PHP Medicare Advantage |
$4.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.00
|
| Rate for Payer: Priority Health Medicare |
$4.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.60
|
| Rate for Payer: Railroad Medicare Medicare |
$4.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.20
|
| Rate for Payer: UHC Core |
$16.32
|
| Rate for Payer: UHC Exchange |
$4.88
|
| Rate for Payer: UHC Medicaid |
$3.44
|
| Rate for Payer: UHC Medicare Advantage |
$4.88
|
| Rate for Payer: UHCCP Medicaid |
$3.44
|
| Rate for Payer: VA VA |
$4.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.65
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.05
|
|
|
Service Code
|
NDC 65219044720
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$23.45 |
| Rate for Payer: Aetna Commercial |
$22.14
|
| Rate for Payer: Aetna Medicare |
$6.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.14
|
| Rate for Payer: BCBS Complete |
$4.82
|
| Rate for Payer: BCBS MAPPO |
$6.51
|
| Rate for Payer: BCBS Trust/PPO |
$21.42
|
| Rate for Payer: BCN Commercial |
$21.42
|
| Rate for Payer: BCN Medicare Advantage |
$6.51
|
| Rate for Payer: Cash Price |
$20.84
|
| Rate for Payer: Cofinity Commercial |
$22.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.51
|
| Rate for Payer: Healthscope Commercial |
$23.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.54
|
| Rate for Payer: Mclaren Medicaid |
$4.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.84
|
| Rate for Payer: Meridian Medicaid |
$4.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.14
|
| Rate for Payer: Nomi Health Commercial |
$21.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.54
|
| Rate for Payer: PACE Senior Care Partners |
$6.19
|
| Rate for Payer: PACE SWMI |
$6.51
|
| Rate for Payer: PHP Commercial |
$22.14
|
| Rate for Payer: PHP Medicare Advantage |
$6.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.66
|
| Rate for Payer: Priority Health Medicare |
$6.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.13
|
| Rate for Payer: Railroad Medicare Medicare |
$6.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.92
|
| Rate for Payer: UHC Core |
$21.75
|
| Rate for Payer: UHC Exchange |
$6.51
|
| Rate for Payer: UHC Medicaid |
$4.59
|
| Rate for Payer: UHC Medicare Advantage |
$6.51
|
| Rate for Payer: UHCCP Medicaid |
$4.59
|
| Rate for Payer: VA VA |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.54
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.54
|
|
|
Service Code
|
NDC 72266014710
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$19.39 |
| Rate for Payer: Aetna Commercial |
$18.31
|
| Rate for Payer: Aetna Medicare |
$5.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.73
|
| Rate for Payer: BCBS Complete |
$3.99
|
| Rate for Payer: BCBS MAPPO |
$5.38
|
| Rate for Payer: BCBS Trust/PPO |
$17.71
|
| Rate for Payer: BCN Commercial |
$17.71
|
| Rate for Payer: BCN Medicare Advantage |
$5.38
|
| Rate for Payer: Cash Price |
$17.23
|
| Rate for Payer: Cofinity Commercial |
$18.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.38
|
| Rate for Payer: Healthscope Commercial |
$19.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.16
|
| Rate for Payer: Mclaren Medicaid |
$3.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.65
|
| Rate for Payer: Meridian Medicaid |
$3.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.31
|
| Rate for Payer: Nomi Health Commercial |
$17.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.12
|
| Rate for Payer: PACE SWMI |
$5.38
|
| Rate for Payer: PHP Commercial |
$18.31
|
| Rate for Payer: PHP Medicare Advantage |
$5.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.74
|
| Rate for Payer: Priority Health Medicare |
$5.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.99
|
| Rate for Payer: Railroad Medicare Medicare |
$5.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.96
|
| Rate for Payer: UHC Core |
$17.99
|
| Rate for Payer: UHC Exchange |
$5.38
|
| Rate for Payer: UHC Medicaid |
$3.80
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: UHCCP Medicaid |
$3.80
|
| Rate for Payer: VA VA |
$5.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.16
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.05
|
|
|
Service Code
|
NDC 65219044702
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$23.45 |
| Rate for Payer: Aetna Commercial |
$22.14
|
| Rate for Payer: Aetna Medicare |
$6.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.14
|
| Rate for Payer: BCBS Complete |
$4.82
|
| Rate for Payer: BCBS MAPPO |
$6.51
|
| Rate for Payer: BCBS Trust/PPO |
$21.42
|
| Rate for Payer: BCN Commercial |
$21.42
|
| Rate for Payer: BCN Medicare Advantage |
$6.51
|
| Rate for Payer: Cash Price |
$20.84
|
| Rate for Payer: Cofinity Commercial |
$22.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.51
|
| Rate for Payer: Healthscope Commercial |
$23.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.54
|
| Rate for Payer: Mclaren Medicaid |
$4.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.84
|
| Rate for Payer: Meridian Medicaid |
$4.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.14
|
| Rate for Payer: Nomi Health Commercial |
$21.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.54
|
| Rate for Payer: PACE Senior Care Partners |
$6.19
|
| Rate for Payer: PACE SWMI |
$6.51
|
| Rate for Payer: PHP Commercial |
$22.14
|
| Rate for Payer: PHP Medicare Advantage |
$6.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.66
|
| Rate for Payer: Priority Health Medicare |
$6.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.13
|
| Rate for Payer: Railroad Medicare Medicare |
$6.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.92
|
| Rate for Payer: UHC Core |
$21.75
|
| Rate for Payer: UHC Exchange |
$6.51
|
| Rate for Payer: UHC Medicaid |
$4.59
|
| Rate for Payer: UHC Medicare Advantage |
$6.51
|
| Rate for Payer: UHCCP Medicaid |
$4.59
|
| Rate for Payer: VA VA |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.54
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.35
|
|
|
Service Code
|
NDC 00409669502
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$23.71 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$6.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.23
|
| Rate for Payer: BCBS Complete |
$4.88
|
| Rate for Payer: BCBS MAPPO |
$6.59
|
| Rate for Payer: BCBS Trust/PPO |
$21.66
|
| Rate for Payer: BCN Commercial |
$21.66
|
| Rate for Payer: BCN Medicare Advantage |
$6.59
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cofinity Commercial |
$22.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.59
|
| Rate for Payer: Healthscope Commercial |
$23.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.76
|
| Rate for Payer: Mclaren Medicaid |
$4.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.92
|
| Rate for Payer: Meridian Medicaid |
$4.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.40
|
| Rate for Payer: Nomi Health Commercial |
$21.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.76
|
| Rate for Payer: PACE Senior Care Partners |
$6.26
|
| Rate for Payer: PACE SWMI |
$6.59
|
| Rate for Payer: PHP Commercial |
$22.40
|
| Rate for Payer: PHP Medicare Advantage |
$6.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.92
|
| Rate for Payer: Priority Health Medicare |
$6.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.34
|
| Rate for Payer: Railroad Medicare Medicare |
$6.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.19
|
| Rate for Payer: UHC Core |
$22.00
|
| Rate for Payer: UHC Exchange |
$6.59
|
| Rate for Payer: UHC Medicaid |
$4.65
|
| Rate for Payer: UHC Medicare Advantage |
$6.59
|
| Rate for Payer: UHCCP Medicaid |
$4.65
|
| Rate for Payer: VA VA |
$6.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.76
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.66
|
|
|
Service Code
|
NDC 67457090300
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$22.19 |
| Rate for Payer: Aetna Commercial |
$20.96
|
| Rate for Payer: BCBS Trust/PPO |
$20.37
|
| Rate for Payer: BCN Commercial |
$20.37
|
| Rate for Payer: Cash Price |
$19.73
|
| Rate for Payer: Cofinity Commercial |
$21.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.73
|
| Rate for Payer: Healthscope Commercial |
$22.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.96
|
| Rate for Payer: Nomi Health Commercial |
$20.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.50
|
| Rate for Payer: PHP Commercial |
$20.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.70
|
| Rate for Payer: UHC Core |
$20.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.50
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.54
|
|
|
Service Code
|
NDC 72266014701
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$19.39 |
| Rate for Payer: Aetna Commercial |
$18.31
|
| Rate for Payer: BCBS Trust/PPO |
$17.79
|
| Rate for Payer: BCN Commercial |
$17.79
|
| Rate for Payer: Cash Price |
$17.23
|
| Rate for Payer: Cofinity Commercial |
$18.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.23
|
| Rate for Payer: Healthscope Commercial |
$19.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.31
|
| Rate for Payer: Nomi Health Commercial |
$17.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.16
|
| Rate for Payer: PHP Commercial |
$18.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.96
|
| Rate for Payer: UHC Core |
$17.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.16
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.54
|
|
|
Service Code
|
NDC 00143931110
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$17.59 |
| Rate for Payer: Aetna Commercial |
$16.61
|
| Rate for Payer: BCBS Trust/PPO |
$16.14
|
| Rate for Payer: BCN Commercial |
$16.14
|
| Rate for Payer: Cash Price |
$15.63
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.63
|
| Rate for Payer: Healthscope Commercial |
$17.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.61
|
| Rate for Payer: Nomi Health Commercial |
$16.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.65
|
| Rate for Payer: PHP Commercial |
$16.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.20
|
| Rate for Payer: UHC Core |
$16.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.65
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.54
|
|
|
Service Code
|
NDC 00143931101
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$17.59 |
| Rate for Payer: Aetna Commercial |
$16.61
|
| Rate for Payer: Aetna Medicare |
$5.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.11
|
| Rate for Payer: BCBS Complete |
$3.62
|
| Rate for Payer: BCBS MAPPO |
$4.88
|
| Rate for Payer: BCBS Trust/PPO |
$16.06
|
| Rate for Payer: BCN Commercial |
$16.06
|
| Rate for Payer: BCN Medicare Advantage |
$4.88
|
| Rate for Payer: Cash Price |
$15.63
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.88
|
| Rate for Payer: Healthscope Commercial |
$17.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.65
|
| Rate for Payer: Mclaren Medicaid |
$3.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.13
|
| Rate for Payer: Meridian Medicaid |
$3.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.61
|
| Rate for Payer: Nomi Health Commercial |
$16.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.65
|
| Rate for Payer: PACE Senior Care Partners |
$4.64
|
| Rate for Payer: PACE SWMI |
$4.88
|
| Rate for Payer: PHP Commercial |
$16.61
|
| Rate for Payer: PHP Medicare Advantage |
$4.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.00
|
| Rate for Payer: Priority Health Medicare |
$4.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.60
|
| Rate for Payer: Railroad Medicare Medicare |
$4.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.20
|
| Rate for Payer: UHC Core |
$16.32
|
| Rate for Payer: UHC Exchange |
$4.88
|
| Rate for Payer: UHC Medicaid |
$3.44
|
| Rate for Payer: UHC Medicare Advantage |
$4.88
|
| Rate for Payer: UHCCP Medicaid |
$3.44
|
| Rate for Payer: VA VA |
$4.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.65
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.31
|
|
|
Service Code
|
NDC 55150022220
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$22.78 |
| Rate for Payer: Aetna Commercial |
$21.51
|
| Rate for Payer: Aetna Medicare |
$6.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.91
|
| Rate for Payer: BCBS Complete |
$4.68
|
| Rate for Payer: BCBS MAPPO |
$6.33
|
| Rate for Payer: BCBS Trust/PPO |
$20.81
|
| Rate for Payer: BCN Commercial |
$20.81
|
| Rate for Payer: BCN Medicare Advantage |
$6.33
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$21.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.33
|
| Rate for Payer: Healthscope Commercial |
$22.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Mclaren Medicaid |
$4.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.64
|
| Rate for Payer: Meridian Medicaid |
$4.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.51
|
| Rate for Payer: Nomi Health Commercial |
$20.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.98
|
| Rate for Payer: PACE Senior Care Partners |
$6.01
|
| Rate for Payer: PACE SWMI |
$6.33
|
| Rate for Payer: PHP Commercial |
$21.51
|
| Rate for Payer: PHP Medicare Advantage |
$6.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.02
|
| Rate for Payer: Priority Health Medicare |
$6.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.62
|
| Rate for Payer: Railroad Medicare Medicare |
$6.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.27
|
| Rate for Payer: UHC Core |
$21.13
|
| Rate for Payer: UHC Exchange |
$6.33
|
| Rate for Payer: UHC Medicaid |
$4.46
|
| Rate for Payer: UHC Medicare Advantage |
$6.33
|
| Rate for Payer: UHCCP Medicaid |
$4.46
|
| Rate for Payer: VA VA |
$6.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
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 |
$12.57 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: BCBS Trust/PPO |
$14.92
|
| Rate for Payer: BCN Commercial |
$14.92
|
| Rate for Payer: Cash Price |
$14.45
|
| 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: Lakeland Regional Health Systems Commercial |
$13.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.35
|
| Rate for Payer: Nomi Health Commercial |
$14.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.54
|
| Rate for Payer: PHP Commercial |
$15.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.89
|
| Rate for Payer: UHC Core |
$15.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.54
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.66
|
|
|
Service Code
|
NDC 67457090320
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$22.19 |
| Rate for Payer: Aetna Commercial |
$20.96
|
| Rate for Payer: BCBS Trust/PPO |
$20.37
|
| Rate for Payer: BCN Commercial |
$20.37
|
| Rate for Payer: Cash Price |
$19.73
|
| Rate for Payer: Cofinity Commercial |
$21.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.73
|
| Rate for Payer: Healthscope Commercial |
$22.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.96
|
| Rate for Payer: Nomi Health Commercial |
$20.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.50
|
| Rate for Payer: PHP Commercial |
$20.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.70
|
| Rate for Payer: UHC Core |
$20.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.50
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.35
|
|
|
Service Code
|
NDC 00409669502
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$23.71 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: BCBS Trust/PPO |
$21.76
|
| Rate for Payer: BCN Commercial |
$21.76
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cofinity Commercial |
$22.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.08
|
| Rate for Payer: Healthscope Commercial |
$23.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.40
|
| Rate for Payer: Nomi Health Commercial |
$21.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.76
|
| Rate for Payer: PHP Commercial |
$22.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.19
|
| Rate for Payer: UHC Core |
$22.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.76
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.54
|
|
|
Service Code
|
NDC 72266014710
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$19.39 |
| Rate for Payer: Aetna Commercial |
$18.31
|
| Rate for Payer: BCBS Trust/PPO |
$17.79
|
| Rate for Payer: BCN Commercial |
$17.79
|
| Rate for Payer: Cash Price |
$17.23
|
| Rate for Payer: Cofinity Commercial |
$18.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.23
|
| Rate for Payer: Healthscope Commercial |
$19.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.31
|
| Rate for Payer: Nomi Health Commercial |
$17.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.16
|
| Rate for Payer: PHP Commercial |
$18.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.96
|
| Rate for Payer: UHC Core |
$17.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.16
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.54
|
|
|
Service Code
|
NDC 00143950710
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$17.59 |
| Rate for Payer: Aetna Commercial |
$16.61
|
| Rate for Payer: BCBS Trust/PPO |
$16.14
|
| Rate for Payer: BCN Commercial |
$16.14
|
| Rate for Payer: Cash Price |
$15.63
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.63
|
| Rate for Payer: Healthscope Commercial |
$17.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.61
|
| Rate for Payer: Nomi Health Commercial |
$16.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.65
|
| Rate for Payer: PHP Commercial |
$16.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.20
|
| Rate for Payer: UHC Core |
$16.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.65
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.31
|
|
|
Service Code
|
NDC 55150022220
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$22.78 |
| Rate for Payer: Aetna Commercial |
$21.51
|
| Rate for Payer: BCBS Trust/PPO |
$20.90
|
| Rate for Payer: BCN Commercial |
$20.90
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$21.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.25
|
| Rate for Payer: Healthscope Commercial |
$22.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.51
|
| Rate for Payer: Nomi Health Commercial |
$20.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.98
|
| Rate for Payer: PHP Commercial |
$21.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.27
|
| Rate for Payer: UHC Core |
$21.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.54
|
|
|
Service Code
|
NDC 00143950710
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$17.59 |
| Rate for Payer: Aetna Commercial |
$16.61
|
| Rate for Payer: Aetna Medicare |
$5.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.11
|
| Rate for Payer: BCBS Complete |
$3.62
|
| Rate for Payer: BCBS MAPPO |
$4.88
|
| Rate for Payer: BCBS Trust/PPO |
$16.06
|
| Rate for Payer: BCN Commercial |
$16.06
|
| Rate for Payer: BCN Medicare Advantage |
$4.88
|
| Rate for Payer: Cash Price |
$15.63
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.88
|
| Rate for Payer: Healthscope Commercial |
$17.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.65
|
| Rate for Payer: Mclaren Medicaid |
$3.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.13
|
| Rate for Payer: Meridian Medicaid |
$3.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.61
|
| Rate for Payer: Nomi Health Commercial |
$16.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.65
|
| Rate for Payer: PACE Senior Care Partners |
$4.64
|
| Rate for Payer: PACE SWMI |
$4.88
|
| Rate for Payer: PHP Commercial |
$16.61
|
| Rate for Payer: PHP Medicare Advantage |
$4.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.00
|
| Rate for Payer: Priority Health Medicare |
$4.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.60
|
| Rate for Payer: Railroad Medicare Medicare |
$4.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.20
|
| Rate for Payer: UHC Core |
$16.32
|
| Rate for Payer: UHC Exchange |
$4.88
|
| Rate for Payer: UHC Medicaid |
$3.44
|
| Rate for Payer: UHC Medicare Advantage |
$4.88
|
| Rate for Payer: UHCCP Medicaid |
$3.44
|
| Rate for Payer: VA VA |
$4.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.65
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.54
|
|
|
Service Code
|
NDC 00143931101
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$17.59 |
| Rate for Payer: Aetna Commercial |
$16.61
|
| Rate for Payer: BCBS Trust/PPO |
$16.14
|
| Rate for Payer: BCN Commercial |
$16.14
|
| Rate for Payer: Cash Price |
$15.63
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.63
|
| Rate for Payer: Healthscope Commercial |
$17.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.61
|
| Rate for Payer: Nomi Health Commercial |
$16.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.65
|
| Rate for Payer: PHP Commercial |
$16.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.20
|
| Rate for Payer: UHC Core |
$16.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.65
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.54
|
|
|
Service Code
|
NDC 72266014701
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$19.39 |
| Rate for Payer: Aetna Commercial |
$18.31
|
| Rate for Payer: Aetna Medicare |
$5.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.73
|
| Rate for Payer: BCBS Complete |
$3.99
|
| Rate for Payer: BCBS MAPPO |
$5.38
|
| Rate for Payer: BCBS Trust/PPO |
$17.71
|
| Rate for Payer: BCN Commercial |
$17.71
|
| Rate for Payer: BCN Medicare Advantage |
$5.38
|
| Rate for Payer: Cash Price |
$17.23
|
| Rate for Payer: Cofinity Commercial |
$18.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.38
|
| Rate for Payer: Healthscope Commercial |
$19.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.16
|
| Rate for Payer: Mclaren Medicaid |
$3.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.65
|
| Rate for Payer: Meridian Medicaid |
$3.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.31
|
| Rate for Payer: Nomi Health Commercial |
$17.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.12
|
| Rate for Payer: PACE SWMI |
$5.38
|
| Rate for Payer: PHP Commercial |
$18.31
|
| Rate for Payer: PHP Medicare Advantage |
$5.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.74
|
| Rate for Payer: Priority Health Medicare |
$5.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.99
|
| Rate for Payer: Railroad Medicare Medicare |
$5.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.96
|
| Rate for Payer: UHC Core |
$17.99
|
| Rate for Payer: UHC Exchange |
$5.38
|
| Rate for Payer: UHC Medicaid |
$3.80
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: UHCCP Medicaid |
$3.80
|
| Rate for Payer: VA VA |
$5.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.16
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.66
|
|
|
Service Code
|
NDC 67457090320
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$22.19 |
| Rate for Payer: Aetna Commercial |
$20.96
|
| Rate for Payer: Aetna Medicare |
$6.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.71
|
| Rate for Payer: BCBS Complete |
$4.56
|
| Rate for Payer: BCBS MAPPO |
$6.17
|
| Rate for Payer: BCBS Trust/PPO |
$20.27
|
| Rate for Payer: BCN Commercial |
$20.27
|
| Rate for Payer: BCN Medicare Advantage |
$6.17
|
| Rate for Payer: Cash Price |
$19.73
|
| Rate for Payer: Cofinity Commercial |
$21.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.17
|
| Rate for Payer: Healthscope Commercial |
$22.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.50
|
| Rate for Payer: Mclaren Medicaid |
$4.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.47
|
| Rate for Payer: Meridian Medicaid |
$4.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.96
|
| Rate for Payer: Nomi Health Commercial |
$20.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.50
|
| Rate for Payer: PACE Senior Care Partners |
$5.86
|
| Rate for Payer: PACE SWMI |
$6.17
|
| Rate for Payer: PHP Commercial |
$20.96
|
| Rate for Payer: PHP Medicare Advantage |
$6.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.45
|
| Rate for Payer: Priority Health Medicare |
$6.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.16
|
| Rate for Payer: Railroad Medicare Medicare |
$6.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.70
|
| Rate for Payer: UHC Core |
$20.59
|
| Rate for Payer: UHC Exchange |
$6.17
|
| Rate for Payer: UHC Medicaid |
$4.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.17
|
| Rate for Payer: UHCCP Medicaid |
$4.35
|
| Rate for Payer: VA VA |
$6.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.50
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
OP
|
$26.35
|
|
|
Service Code
|
NDC 00409669502
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$23.71 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$6.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.23
|
| Rate for Payer: BCBS Complete |
$4.88
|
| Rate for Payer: BCBS MAPPO |
$6.59
|
| Rate for Payer: BCBS Trust/PPO |
$21.66
|
| Rate for Payer: BCN Commercial |
$21.66
|
| Rate for Payer: BCN Medicare Advantage |
$6.59
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cofinity Commercial |
$22.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.59
|
| Rate for Payer: Healthscope Commercial |
$23.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.76
|
| Rate for Payer: Mclaren Medicaid |
$4.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.92
|
| Rate for Payer: Meridian Medicaid |
$4.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.40
|
| Rate for Payer: Nomi Health Commercial |
$21.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.76
|
| Rate for Payer: PACE Senior Care Partners |
$6.26
|
| Rate for Payer: PACE SWMI |
$6.59
|
| Rate for Payer: PHP Commercial |
$22.40
|
| Rate for Payer: PHP Medicare Advantage |
$6.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.92
|
| Rate for Payer: Priority Health Medicare |
$6.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.34
|
| Rate for Payer: Railroad Medicare Medicare |
$6.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.19
|
| Rate for Payer: UHC Core |
$22.00
|
| Rate for Payer: UHC Exchange |
$6.59
|
| Rate for Payer: UHC Medicaid |
$4.65
|
| Rate for Payer: UHC Medicare Advantage |
$6.59
|
| Rate for Payer: UHCCP Medicaid |
$4.65
|
| Rate for Payer: VA VA |
$6.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.76
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
IP
|
$26.35
|
|
|
Service Code
|
NDC 00409669502
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$23.71 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: BCBS Trust/PPO |
$21.76
|
| Rate for Payer: BCN Commercial |
$21.76
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cofinity Commercial |
$22.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.08
|
| Rate for Payer: Healthscope Commercial |
$23.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.40
|
| Rate for Payer: Nomi Health Commercial |
$21.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.76
|
| Rate for Payer: PHP Commercial |
$22.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.19
|
| Rate for Payer: UHC Core |
$22.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.76
|
|
|
EXCISION OF CYST, FIBROADENOMA, OR OTHER BENIGN OR MALIGNANT TUMOR, ABERRANT BREAST TISSUE, DUCT LESION, NIPPLE OR AREOLAR LESION (EXCEPT 19300), OPEN, MALE OR FEMALE, 1 OR MORE LESIONS
|
Facility
|
OP
|
$515.37
|
|
|
Service Code
|
CPT 19120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$515.37 |
| Max. Negotiated Rate |
$515.37 |
| Rate for Payer: BCCCP Commercial |
$515.37
|
|
|
EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$12,832.07
|
|
|
Service Code
|
APR-DRG 9112
|
| Min. Negotiated Rate |
$12,221.02 |
| Max. Negotiated Rate |
$12,832.07 |
| Rate for Payer: BCBS Complete |
$12,832.07
|
| Rate for Payer: Mclaren Medicaid |
$12,221.02
|
| Rate for Payer: Meridian Medicaid |
$12,832.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,221.02
|
| Rate for Payer: UHC Medicaid |
$12,221.02
|
| Rate for Payer: UHCCP Medicaid |
$12,221.02
|
|
