|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM
|
Facility
|
OP
|
$544.42
|
|
|
Service Code
|
NDC 47781010444
|
| Hospital Charge Code |
9969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$217.77 |
| Max. Negotiated Rate |
$544.42 |
| Rate for Payer: Aetna Commercial |
$489.98
|
| Rate for Payer: Aetna Medicare |
$272.21
|
| Rate for Payer: ASR ASR |
$528.09
|
| Rate for Payer: ASR Commercial |
$528.09
|
| Rate for Payer: BCBS Complete |
$217.77
|
| Rate for Payer: BCBS Trust/PPO |
$445.83
|
| Rate for Payer: BCN Commercial |
$422.09
|
| Rate for Payer: Cash Price |
$435.54
|
| Rate for Payer: Cofinity Commercial |
$511.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$435.54
|
| Rate for Payer: Healthscope Commercial |
$544.42
|
| Rate for Payer: Healthscope Whirlpool |
$528.09
|
| Rate for Payer: Mclaren Commercial |
$489.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$462.76
|
| Rate for Payer: Nomi Health Commercial |
$446.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$477.02
|
| Rate for Payer: Priority Health Narrow Network |
$381.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$479.09
|
|
|
ESTRADIOL 1 MG TABLET
|
Facility
|
IP
|
$190.35
|
|
|
Service Code
|
NDC 70954056510
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.73 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$171.32
|
| Rate for Payer: ASR ASR |
$184.64
|
| Rate for Payer: ASR Commercial |
$184.64
|
| Rate for Payer: BCBS Trust/PPO |
$155.12
|
| Rate for Payer: BCN Commercial |
$147.58
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$178.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Healthscope Whirlpool |
$184.64
|
| Rate for Payer: Mclaren Commercial |
$171.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Nomi Health Commercial |
$156.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.51
|
|
|
ESTRADIOL 1 MG TABLET
|
Facility
|
OP
|
$271.70
|
|
|
Service Code
|
NDC 00555088602
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.68 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Aetna Commercial |
$244.53
|
| Rate for Payer: Aetna Medicare |
$135.85
|
| Rate for Payer: ASR ASR |
$263.55
|
| Rate for Payer: ASR Commercial |
$263.55
|
| Rate for Payer: BCBS Complete |
$108.68
|
| Rate for Payer: BCBS Trust/PPO |
$222.50
|
| Rate for Payer: BCN Commercial |
$210.65
|
| Rate for Payer: Cash Price |
$217.36
|
| Rate for Payer: Cofinity Commercial |
$255.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.36
|
| Rate for Payer: Healthscope Commercial |
$271.70
|
| Rate for Payer: Healthscope Whirlpool |
$263.55
|
| Rate for Payer: Mclaren Commercial |
$244.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.94
|
| Rate for Payer: Nomi Health Commercial |
$222.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.06
|
| Rate for Payer: Priority Health Narrow Network |
$190.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.10
|
|
|
ESTRADIOL 1 MG TABLET
|
Facility
|
IP
|
$271.70
|
|
|
Service Code
|
NDC 00555088602
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.60 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Aetna Commercial |
$244.53
|
| Rate for Payer: ASR ASR |
$263.55
|
| Rate for Payer: ASR Commercial |
$263.55
|
| Rate for Payer: BCBS Trust/PPO |
$221.41
|
| Rate for Payer: BCN Commercial |
$210.65
|
| Rate for Payer: Cash Price |
$217.36
|
| Rate for Payer: Cofinity Commercial |
$255.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.36
|
| Rate for Payer: Healthscope Commercial |
$271.70
|
| Rate for Payer: Healthscope Whirlpool |
$263.55
|
| Rate for Payer: Mclaren Commercial |
$244.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.94
|
| Rate for Payer: Nomi Health Commercial |
$222.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.10
|
|
|
ESTRADIOL 1 MG TABLET
|
Facility
|
OP
|
$190.35
|
|
|
Service Code
|
NDC 70954056510
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.14 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$171.32
|
| Rate for Payer: Aetna Medicare |
$95.18
|
| Rate for Payer: ASR ASR |
$184.64
|
| Rate for Payer: ASR Commercial |
$184.64
|
| Rate for Payer: BCBS Complete |
$76.14
|
| Rate for Payer: BCBS Trust/PPO |
$155.88
|
| Rate for Payer: BCN Commercial |
$147.58
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$178.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Healthscope Whirlpool |
$184.64
|
| Rate for Payer: Mclaren Commercial |
$171.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Nomi Health Commercial |
$156.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.78
|
| Rate for Payer: Priority Health Narrow Network |
$133.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.51
|
|
|
ETODOLAC 200 MG CAPSULE
|
Facility
|
IP
|
$480.96
|
|
|
Service Code
|
NDC 51672401601
|
| Hospital Charge Code |
9997
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$312.62 |
| Max. Negotiated Rate |
$480.96 |
| Rate for Payer: Aetna Commercial |
$432.86
|
| Rate for Payer: ASR ASR |
$466.53
|
| Rate for Payer: ASR Commercial |
$466.53
|
| Rate for Payer: BCBS Trust/PPO |
$391.93
|
| Rate for Payer: BCN Commercial |
$372.89
|
| Rate for Payer: Cash Price |
$384.77
|
| Rate for Payer: Cofinity Commercial |
$452.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.77
|
| Rate for Payer: Healthscope Commercial |
$480.96
|
| Rate for Payer: Healthscope Whirlpool |
$466.53
|
| Rate for Payer: Mclaren Commercial |
$432.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.82
|
| Rate for Payer: Nomi Health Commercial |
$394.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.24
|
|
|
ETODOLAC 200 MG CAPSULE
|
Facility
|
OP
|
$480.96
|
|
|
Service Code
|
NDC 51672401601
|
| Hospital Charge Code |
9997
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.38 |
| Max. Negotiated Rate |
$480.96 |
| Rate for Payer: Aetna Commercial |
$432.86
|
| Rate for Payer: Aetna Medicare |
$240.48
|
| Rate for Payer: ASR ASR |
$466.53
|
| Rate for Payer: ASR Commercial |
$466.53
|
| Rate for Payer: BCBS Complete |
$192.38
|
| Rate for Payer: BCBS Trust/PPO |
$393.86
|
| Rate for Payer: BCN Commercial |
$372.89
|
| Rate for Payer: Cash Price |
$384.77
|
| Rate for Payer: Cofinity Commercial |
$452.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.77
|
| Rate for Payer: Healthscope Commercial |
$480.96
|
| Rate for Payer: Healthscope Whirlpool |
$466.53
|
| Rate for Payer: Mclaren Commercial |
$432.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.82
|
| Rate for Payer: Nomi Health Commercial |
$394.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$421.42
|
| Rate for Payer: Priority Health Narrow Network |
$337.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.24
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.23
|
|
|
Service Code
|
NDC 00143931010
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: Aetna Medicare |
$12.62
|
| Rate for Payer: ASR ASR |
$24.47
|
| Rate for Payer: ASR Commercial |
$24.47
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS Trust/PPO |
$20.66
|
| Rate for Payer: BCN Commercial |
$19.56
|
| Rate for Payer: Cash Price |
$20.18
|
| Rate for Payer: Cofinity Commercial |
$23.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.18
|
| Rate for Payer: Healthscope Commercial |
$25.23
|
| Rate for Payer: Healthscope Whirlpool |
$24.47
|
| Rate for Payer: Mclaren Commercial |
$22.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Nomi Health Commercial |
$20.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.11
|
| Rate for Payer: Priority Health Narrow Network |
$17.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.20
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.23
|
|
|
Service Code
|
NDC 00143931001
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: Aetna Medicare |
$12.62
|
| Rate for Payer: ASR ASR |
$24.47
|
| Rate for Payer: ASR Commercial |
$24.47
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS Trust/PPO |
$20.66
|
| Rate for Payer: BCN Commercial |
$19.56
|
| Rate for Payer: Cash Price |
$20.18
|
| Rate for Payer: Cofinity Commercial |
$23.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.18
|
| Rate for Payer: Healthscope Commercial |
$25.23
|
| Rate for Payer: Healthscope Whirlpool |
$24.47
|
| Rate for Payer: Mclaren Commercial |
$22.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Nomi Health Commercial |
$20.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.11
|
| Rate for Payer: Priority Health Narrow Network |
$17.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.20
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17.24
|
|
|
Service Code
|
NDC 72266014610
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$17.24 |
| Rate for Payer: Aetna Commercial |
$15.52
|
| Rate for Payer: Aetna Medicare |
$8.62
|
| Rate for Payer: ASR ASR |
$16.72
|
| Rate for Payer: ASR Commercial |
$16.72
|
| Rate for Payer: BCBS Complete |
$6.90
|
| Rate for Payer: BCBS Trust/PPO |
$14.12
|
| Rate for Payer: BCN Commercial |
$13.37
|
| Rate for Payer: Cash Price |
$13.79
|
| Rate for Payer: Cofinity Commercial |
$16.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.79
|
| Rate for Payer: Healthscope Commercial |
$17.24
|
| Rate for Payer: Healthscope Whirlpool |
$16.72
|
| Rate for Payer: Mclaren Commercial |
$15.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.65
|
| Rate for Payer: Nomi Health Commercial |
$14.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.11
|
| Rate for Payer: Priority Health Narrow Network |
$12.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.17
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.83
|
|
|
Service Code
|
NDC 00143931110
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$19.83 |
| Rate for Payer: Aetna Commercial |
$17.85
|
| Rate for Payer: ASR ASR |
$19.24
|
| Rate for Payer: ASR Commercial |
$19.24
|
| Rate for Payer: BCBS Trust/PPO |
$16.16
|
| Rate for Payer: BCN Commercial |
$15.37
|
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Cofinity Commercial |
$18.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.86
|
| Rate for Payer: Healthscope Commercial |
$19.83
|
| Rate for Payer: Healthscope Whirlpool |
$19.24
|
| Rate for Payer: Mclaren Commercial |
$17.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.86
|
| Rate for Payer: Nomi Health Commercial |
$16.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.45
|
|
|
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 |
$14.90 |
| Max. Negotiated Rate |
$22.92 |
| Rate for Payer: Aetna Commercial |
$20.63
|
| Rate for Payer: ASR ASR |
$22.23
|
| Rate for Payer: ASR Commercial |
$22.23
|
| Rate for Payer: BCBS Trust/PPO |
$18.68
|
| Rate for Payer: BCN Commercial |
$17.77
|
| Rate for Payer: Cash Price |
$18.33
|
| Rate for Payer: Cofinity Commercial |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.34
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: Healthscope Whirlpool |
$22.23
|
| Rate for Payer: Mclaren Commercial |
$20.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.48
|
| Rate for Payer: Nomi Health Commercial |
$18.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.17
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.43
|
|
|
Service Code
|
NDC 65219044510
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Aetna Commercial |
$16.59
|
| Rate for Payer: ASR ASR |
$17.88
|
| Rate for Payer: ASR Commercial |
$17.88
|
| Rate for Payer: BCBS Trust/PPO |
$15.02
|
| Rate for Payer: BCN Commercial |
$14.29
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$17.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$18.43
|
| Rate for Payer: Healthscope Whirlpool |
$17.88
|
| Rate for Payer: Mclaren Commercial |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Nomi Health Commercial |
$15.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.22
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.57
|
|
|
Service Code
|
NDC 55150022110
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$18.57 |
| Rate for Payer: Aetna Commercial |
$16.71
|
| Rate for Payer: Aetna Medicare |
$9.28
|
| Rate for Payer: ASR ASR |
$18.01
|
| Rate for Payer: ASR Commercial |
$18.01
|
| Rate for Payer: BCBS Complete |
$7.43
|
| Rate for Payer: BCBS Trust/PPO |
$15.21
|
| Rate for Payer: BCN Commercial |
$14.40
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.86
|
| Rate for Payer: Healthscope Commercial |
$18.57
|
| Rate for Payer: Healthscope Whirlpool |
$18.01
|
| Rate for Payer: Mclaren Commercial |
$16.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.78
|
| Rate for Payer: Nomi Health Commercial |
$15.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.27
|
| Rate for Payer: Priority Health Narrow Network |
$13.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.34
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.20
|
|
|
Service Code
|
NDC 55150022220
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$26.20 |
| Rate for Payer: Aetna Commercial |
$23.58
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: ASR ASR |
$25.41
|
| Rate for Payer: ASR Commercial |
$25.41
|
| Rate for Payer: BCBS Complete |
$10.48
|
| Rate for Payer: BCBS Trust/PPO |
$21.46
|
| Rate for Payer: BCN Commercial |
$20.31
|
| Rate for Payer: Cash Price |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$24.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.96
|
| Rate for Payer: Healthscope Commercial |
$26.20
|
| Rate for Payer: Healthscope Whirlpool |
$25.41
|
| Rate for Payer: Mclaren Commercial |
$23.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.27
|
| Rate for Payer: Nomi Health Commercial |
$21.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.96
|
| Rate for Payer: Priority Health Narrow Network |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.06
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.83
|
|
|
Service Code
|
NDC 00143931101
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$19.83 |
| Rate for Payer: Aetna Commercial |
$17.85
|
| Rate for Payer: Aetna Medicare |
$9.92
|
| Rate for Payer: ASR ASR |
$19.24
|
| Rate for Payer: ASR Commercial |
$19.24
|
| Rate for Payer: BCBS Complete |
$7.93
|
| Rate for Payer: BCBS Trust/PPO |
$16.24
|
| Rate for Payer: BCN Commercial |
$15.37
|
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Cofinity Commercial |
$18.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.86
|
| Rate for Payer: Healthscope Commercial |
$19.83
|
| Rate for Payer: Healthscope Whirlpool |
$19.24
|
| Rate for Payer: Mclaren Commercial |
$17.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.86
|
| Rate for Payer: Nomi Health Commercial |
$16.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.38
|
| Rate for Payer: Priority Health Narrow Network |
$13.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.45
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.20
|
|
|
Service Code
|
NDC 55150022220
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$26.20 |
| Rate for Payer: Aetna Commercial |
$23.58
|
| Rate for Payer: ASR ASR |
$25.41
|
| Rate for Payer: ASR Commercial |
$25.41
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$20.31
|
| Rate for Payer: Cash Price |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$24.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.96
|
| Rate for Payer: Healthscope Commercial |
$26.20
|
| Rate for Payer: Healthscope Whirlpool |
$25.41
|
| Rate for Payer: Mclaren Commercial |
$23.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.27
|
| Rate for Payer: Nomi Health Commercial |
$21.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.06
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17.24
|
|
|
Service Code
|
NDC 72266014601
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$17.24 |
| Rate for Payer: Aetna Commercial |
$15.52
|
| Rate for Payer: Aetna Medicare |
$8.62
|
| Rate for Payer: ASR ASR |
$16.72
|
| Rate for Payer: ASR Commercial |
$16.72
|
| Rate for Payer: BCBS Complete |
$6.90
|
| Rate for Payer: BCBS Trust/PPO |
$14.12
|
| Rate for Payer: BCN Commercial |
$13.37
|
| Rate for Payer: Cash Price |
$13.79
|
| Rate for Payer: Cofinity Commercial |
$16.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.79
|
| Rate for Payer: Healthscope Commercial |
$17.24
|
| Rate for Payer: Healthscope Whirlpool |
$16.72
|
| Rate for Payer: Mclaren Commercial |
$15.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.65
|
| Rate for Payer: Nomi Health Commercial |
$14.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.11
|
| Rate for Payer: Priority Health Narrow Network |
$12.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.17
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.83
|
|
|
Service Code
|
NDC 00143931101
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$19.83 |
| Rate for Payer: Aetna Commercial |
$17.85
|
| Rate for Payer: ASR ASR |
$19.24
|
| Rate for Payer: ASR Commercial |
$19.24
|
| Rate for Payer: BCBS Trust/PPO |
$16.16
|
| Rate for Payer: BCN Commercial |
$15.37
|
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Cofinity Commercial |
$18.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.86
|
| Rate for Payer: Healthscope Commercial |
$19.83
|
| Rate for Payer: Healthscope Whirlpool |
$19.24
|
| Rate for Payer: Mclaren Commercial |
$17.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.86
|
| Rate for Payer: Nomi Health Commercial |
$16.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.45
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.57
|
|
|
Service Code
|
NDC 55150022110
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$18.57 |
| Rate for Payer: Aetna Commercial |
$16.71
|
| Rate for Payer: ASR ASR |
$18.01
|
| Rate for Payer: ASR Commercial |
$18.01
|
| Rate for Payer: BCBS Trust/PPO |
$15.13
|
| Rate for Payer: BCN Commercial |
$14.40
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.86
|
| Rate for Payer: Healthscope Commercial |
$18.57
|
| Rate for Payer: Healthscope Whirlpool |
$18.01
|
| Rate for Payer: Mclaren Commercial |
$16.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.78
|
| Rate for Payer: Nomi Health Commercial |
$15.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.34
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.43
|
|
|
Service Code
|
NDC 65219044501
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Aetna Commercial |
$16.59
|
| Rate for Payer: ASR ASR |
$17.88
|
| Rate for Payer: ASR Commercial |
$17.88
|
| Rate for Payer: BCBS Trust/PPO |
$15.02
|
| Rate for Payer: BCN Commercial |
$14.29
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$17.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$18.43
|
| Rate for Payer: Healthscope Whirlpool |
$17.88
|
| Rate for Payer: Mclaren Commercial |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Nomi Health Commercial |
$15.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.22
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.23
|
|
|
Service Code
|
NDC 00143950601
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: ASR ASR |
$24.47
|
| Rate for Payer: ASR Commercial |
$24.47
|
| Rate for Payer: BCBS Trust/PPO |
$20.56
|
| Rate for Payer: BCN Commercial |
$19.56
|
| Rate for Payer: Cash Price |
$20.18
|
| Rate for Payer: Cofinity Commercial |
$23.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.18
|
| Rate for Payer: Healthscope Commercial |
$25.23
|
| Rate for Payer: Healthscope Whirlpool |
$24.47
|
| Rate for Payer: Mclaren Commercial |
$22.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Nomi Health Commercial |
$20.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.20
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.23
|
|
|
Service Code
|
NDC 00143950610
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: ASR ASR |
$24.47
|
| Rate for Payer: ASR Commercial |
$24.47
|
| Rate for Payer: BCBS Trust/PPO |
$20.56
|
| Rate for Payer: BCN Commercial |
$19.56
|
| Rate for Payer: Cash Price |
$20.18
|
| Rate for Payer: Cofinity Commercial |
$23.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.18
|
| Rate for Payer: Healthscope Commercial |
$25.23
|
| Rate for Payer: Healthscope Whirlpool |
$24.47
|
| Rate for Payer: Mclaren Commercial |
$22.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Nomi Health Commercial |
$20.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.20
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.83
|
|
|
Service Code
|
NDC 00143931110
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$19.83 |
| Rate for Payer: Aetna Commercial |
$17.85
|
| Rate for Payer: Aetna Medicare |
$9.92
|
| Rate for Payer: ASR ASR |
$19.24
|
| Rate for Payer: ASR Commercial |
$19.24
|
| Rate for Payer: BCBS Complete |
$7.93
|
| Rate for Payer: BCBS Trust/PPO |
$16.24
|
| Rate for Payer: BCN Commercial |
$15.37
|
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Cofinity Commercial |
$18.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.86
|
| Rate for Payer: Healthscope Commercial |
$19.83
|
| Rate for Payer: Healthscope Whirlpool |
$19.24
|
| Rate for Payer: Mclaren Commercial |
$17.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.86
|
| Rate for Payer: Nomi Health Commercial |
$16.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.38
|
| Rate for Payer: Priority Health Narrow Network |
$13.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.45
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.23
|
|
|
Service Code
|
NDC 00143950610
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: Aetna Medicare |
$12.62
|
| Rate for Payer: ASR ASR |
$24.47
|
| Rate for Payer: ASR Commercial |
$24.47
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS Trust/PPO |
$20.66
|
| Rate for Payer: BCN Commercial |
$19.56
|
| Rate for Payer: Cash Price |
$20.18
|
| Rate for Payer: Cofinity Commercial |
$23.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.18
|
| Rate for Payer: Healthscope Commercial |
$25.23
|
| Rate for Payer: Healthscope Whirlpool |
$24.47
|
| Rate for Payer: Mclaren Commercial |
$22.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Nomi Health Commercial |
$20.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.11
|
| Rate for Payer: Priority Health Narrow Network |
$17.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.20
|
|
