|
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
|
$18.43
|
|
|
Service Code
|
NDC 65219044510
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Aetna Commercial |
$16.59
|
| Rate for Payer: Aetna Medicare |
$9.21
|
| Rate for Payer: ASR ASR |
$17.88
|
| Rate for Payer: ASR Commercial |
$17.88
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: BCBS Trust/PPO |
$15.09
|
| 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: Priority Health HMO/PPO/Tiered Network |
$16.15
|
| Rate for Payer: Priority Health Narrow Network |
$12.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.22
|
|
|
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
|
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 |
$9.91
|
| 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
|
$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 |
$9.91
|
| 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
|
$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
|
$17.24
|
|
|
Service Code
|
NDC 72266014610
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$17.24 |
| Rate for Payer: Aetna Commercial |
$15.52
|
| Rate for Payer: ASR ASR |
$16.72
|
| Rate for Payer: ASR Commercial |
$16.72
|
| Rate for Payer: BCBS Trust/PPO |
$14.05
|
| 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: UHC All Payor (Choice/PPO) + Core |
$15.17
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17.24
|
|
|
Service Code
|
NDC 72266014601
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$17.24 |
| Rate for Payer: Aetna Commercial |
$15.52
|
| Rate for Payer: ASR ASR |
$16.72
|
| Rate for Payer: ASR Commercial |
$16.72
|
| Rate for Payer: BCBS Trust/PPO |
$14.05
|
| 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: UHC All Payor (Choice/PPO) + Core |
$15.17
|
|
|
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
|
$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
|
$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
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.23
|
|
|
Service Code
|
NDC 00143950601
|
| 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
|
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
|
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
|
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 |
$9.29
|
| 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
|
IP
|
$25.23
|
|
|
Service Code
|
NDC 00143931010
|
| 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
|
$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
|
$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
|
$25.23
|
|
|
Service Code
|
NDC 00143931001
|
| 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
|
$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
|
$18.43
|
|
|
Service Code
|
NDC 65219044501
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Aetna Commercial |
$16.59
|
| Rate for Payer: Aetna Medicare |
$9.21
|
| Rate for Payer: ASR ASR |
$17.88
|
| Rate for Payer: ASR Commercial |
$17.88
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: BCBS Trust/PPO |
$15.09
|
| 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: Priority Health HMO/PPO/Tiered Network |
$16.15
|
| Rate for Payer: Priority Health Narrow Network |
$12.92
|
| 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
|
OP
|
$22.92
|
|
|
Service Code
|
NDC 00409669501
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$22.92 |
| Rate for Payer: Aetna Commercial |
$20.63
|
| Rate for Payer: Aetna Medicare |
$11.46
|
| Rate for Payer: ASR ASR |
$22.23
|
| Rate for Payer: ASR Commercial |
$22.23
|
| Rate for Payer: BCBS Complete |
$9.17
|
| Rate for Payer: BCBS Trust/PPO |
$18.77
|
| 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: Priority Health HMO/PPO/Tiered Network |
$20.08
|
| Rate for Payer: Priority Health Narrow Network |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.17
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
IP
|
$22.92
|
|
|
Service Code
|
NDC 00409669501
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.90 |
| 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
|
|
