|
ESTRADIOL 1 MG TABLET
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 70954056510
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.43 |
| Max. Negotiated Rate |
$173.90 |
| Rate for Payer: Aetna Commercial |
$156.51
|
| Rate for Payer: ASR ASR |
$168.68
|
| Rate for Payer: BCBS Trust/PPO |
$142.81
|
| Rate for Payer: BCN Commercial |
$142.81
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$163.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$168.68
|
| Rate for Payer: Healthscope Whirlpool |
$173.90
|
| Rate for Payer: Mclaren Commercial |
$156.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Nomi Health Commercial |
$142.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.03
|
|
|
ESTRADIOL 1 MG TABLET
|
Facility
|
OP
|
$271.70
|
|
|
Service Code
|
NDC 555088602
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Aetna Commercial |
$244.53
|
| Rate for Payer: Aetna Medicare |
$100.53
|
| Rate for Payer: ASR ASR |
$263.55
|
| Rate for Payer: BCBS Complete |
$108.68
|
| Rate for Payer: BCBS Trust/PPO |
$224.02
|
| Rate for Payer: BCN Commercial |
$224.02
|
| 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 |
$263.55
|
| Rate for Payer: Healthscope Whirlpool |
$271.70
|
| Rate for Payer: Mclaren Commercial |
$244.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.94
|
| Rate for Payer: Nomi Health Commercial |
$222.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.78
|
| Rate for Payer: Priority Health Cigna 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 555088602
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.78 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Aetna Commercial |
$244.53
|
| Rate for Payer: ASR ASR |
$263.55
|
| Rate for Payer: BCBS Trust/PPO |
$223.12
|
| Rate for Payer: BCN Commercial |
$223.12
|
| 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 |
$263.55
|
| Rate for Payer: Healthscope Whirlpool |
$271.70
|
| 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: Opus (Opus Packaging Group) HMA |
$203.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.10
|
|
|
ESTRADIOL 1 MG TABLET
|
Facility
|
OP
|
$173.90
|
|
|
Service Code
|
NDC 70954056510
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$173.90 |
| Rate for Payer: Aetna Commercial |
$156.51
|
| Rate for Payer: Aetna Medicare |
$64.34
|
| Rate for Payer: ASR ASR |
$168.68
|
| Rate for Payer: BCBS Complete |
$69.56
|
| Rate for Payer: BCBS Trust/PPO |
$143.38
|
| Rate for Payer: BCN Commercial |
$143.38
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$163.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$168.68
|
| Rate for Payer: Healthscope Whirlpool |
$173.90
|
| Rate for Payer: Mclaren Commercial |
$156.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Nomi Health Commercial |
$142.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$152.37
|
| Rate for Payer: Priority Health Narrow Network |
$121.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.03
|
|
|
ETODOLAC 200 MG CAPSULE
|
Facility
|
IP
|
$480.96
|
|
|
Service Code
|
NDC 51672401601
|
| Hospital Charge Code |
9997
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$360.72 |
| Max. Negotiated Rate |
$480.96 |
| Rate for Payer: Aetna Commercial |
$432.86
|
| Rate for Payer: ASR ASR |
$466.53
|
| Rate for Payer: BCBS Trust/PPO |
$394.96
|
| Rate for Payer: BCN Commercial |
$394.96
|
| 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 |
$466.53
|
| Rate for Payer: Healthscope Whirlpool |
$480.96
|
| 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: Opus (Opus Packaging Group) HMA |
$360.72
|
| 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 |
$177.96 |
| Max. Negotiated Rate |
$480.96 |
| Rate for Payer: Aetna Commercial |
$432.86
|
| Rate for Payer: Aetna Medicare |
$177.96
|
| Rate for Payer: ASR ASR |
$466.53
|
| Rate for Payer: BCBS Complete |
$192.38
|
| Rate for Payer: BCBS Trust/PPO |
$396.55
|
| Rate for Payer: BCN Commercial |
$396.55
|
| 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 |
$466.53
|
| Rate for Payer: Healthscope Whirlpool |
$480.96
|
| Rate for Payer: Mclaren Commercial |
$432.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$384.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.82
|
| Rate for Payer: Nomi Health Commercial |
$394.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$360.72
|
| Rate for Payer: Priority Health Cigna 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
|
IP
|
$18.57
|
|
|
Service Code
|
NDC 55150022110
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$18.57 |
| Rate for Payer: Aetna Commercial |
$16.72
|
| Rate for Payer: ASR ASR |
$18.02
|
| Rate for Payer: BCBS Trust/PPO |
$15.25
|
| Rate for Payer: BCN Commercial |
$15.25
|
| 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 |
$18.02
|
| Rate for Payer: Healthscope Whirlpool |
$18.57
|
| Rate for Payer: Mclaren Commercial |
$16.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.79
|
| Rate for Payer: Nomi Health Commercial |
$15.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.35
|
|
|
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 |
$6.82 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: Aetna Medicare |
$6.82
|
| Rate for Payer: ASR ASR |
$17.87
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: BCBS Trust/PPO |
$15.19
|
| Rate for Payer: BCN Commercial |
$15.19
|
| 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 |
$17.87
|
| Rate for Payer: Healthscope Whirlpool |
$18.43
|
| Rate for Payer: Mclaren Commercial |
$16.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.66
|
| Rate for Payer: Nomi Health Commercial |
$15.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.14
|
| Rate for Payer: Priority Health Narrow Network |
$12.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.21
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.23
|
|
|
Service Code
|
NDC 143931010
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.92 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: ASR ASR |
$24.47
|
| Rate for Payer: BCBS Trust/PPO |
$20.72
|
| Rate for Payer: BCN Commercial |
$20.72
|
| 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 |
$24.47
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| 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: Opus (Opus Packaging Group) HMA |
$18.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.20
|
|
|
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 |
$12.93 |
| Max. Negotiated Rate |
$17.24 |
| Rate for Payer: Aetna Commercial |
$15.52
|
| Rate for Payer: ASR ASR |
$16.72
|
| Rate for Payer: BCBS Trust/PPO |
$14.16
|
| Rate for Payer: BCN Commercial |
$14.16
|
| 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 |
$16.72
|
| Rate for Payer: Healthscope Whirlpool |
$17.24
|
| Rate for Payer: Mclaren Commercial |
$15.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.66
|
| Rate for Payer: Nomi Health Commercial |
$14.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.17
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.23
|
|
|
Service Code
|
NDC 143931010
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: Aetna Medicare |
$9.34
|
| Rate for Payer: ASR ASR |
$24.47
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS Trust/PPO |
$20.80
|
| Rate for Payer: BCN Commercial |
$20.80
|
| 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 |
$24.47
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$22.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Nomi Health Commercial |
$20.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.92
|
| Rate for Payer: Priority Health Cigna 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
|
$26.20
|
|
|
Service Code
|
NDC 55150022220
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$26.20 |
| Rate for Payer: Aetna Commercial |
$23.58
|
| Rate for Payer: Aetna Medicare |
$9.69
|
| Rate for Payer: ASR ASR |
$25.41
|
| Rate for Payer: BCBS Complete |
$10.48
|
| Rate for Payer: BCBS Trust/PPO |
$21.60
|
| Rate for Payer: BCN Commercial |
$21.60
|
| Rate for Payer: Cash Price |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.96
|
| Rate for Payer: Healthscope Commercial |
$25.41
|
| Rate for Payer: Healthscope Whirlpool |
$26.20
|
| Rate for Payer: Mclaren Commercial |
$23.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.27
|
| Rate for Payer: Nomi Health Commercial |
$21.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.95
|
| Rate for Payer: Priority Health Narrow Network |
$18.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.05
|
|
|
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 |
$6.38 |
| Max. Negotiated Rate |
$17.24 |
| Rate for Payer: Aetna Commercial |
$15.52
|
| Rate for Payer: Aetna Medicare |
$6.38
|
| Rate for Payer: ASR ASR |
$16.72
|
| Rate for Payer: BCBS Complete |
$6.90
|
| Rate for Payer: BCBS Trust/PPO |
$14.22
|
| Rate for Payer: BCN Commercial |
$14.22
|
| 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 |
$16.72
|
| Rate for Payer: Healthscope Whirlpool |
$17.24
|
| Rate for Payer: Mclaren Commercial |
$15.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.66
|
| Rate for Payer: Nomi Health Commercial |
$14.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.93
|
| Rate for Payer: Priority Health Cigna 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
|
$17.24
|
|
|
Service Code
|
NDC 72266014601
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$17.24 |
| Rate for Payer: Aetna Commercial |
$15.52
|
| Rate for Payer: Aetna Medicare |
$6.38
|
| Rate for Payer: ASR ASR |
$16.72
|
| Rate for Payer: BCBS Complete |
$6.90
|
| Rate for Payer: BCBS Trust/PPO |
$14.22
|
| Rate for Payer: BCN Commercial |
$14.22
|
| 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 |
$16.72
|
| Rate for Payer: Healthscope Whirlpool |
$17.24
|
| Rate for Payer: Mclaren Commercial |
$15.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.66
|
| Rate for Payer: Nomi Health Commercial |
$14.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.93
|
| Rate for Payer: Priority Health Cigna 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
|
$26.20
|
|
|
Service Code
|
NDC 55150022220
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.65 |
| Max. Negotiated Rate |
$26.20 |
| Rate for Payer: Aetna Commercial |
$23.58
|
| Rate for Payer: ASR ASR |
$25.41
|
| Rate for Payer: BCBS Trust/PPO |
$21.51
|
| Rate for Payer: BCN Commercial |
$21.51
|
| Rate for Payer: Cash Price |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.96
|
| Rate for Payer: Healthscope Commercial |
$25.41
|
| Rate for Payer: Healthscope Whirlpool |
$26.20
|
| 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: Opus (Opus Packaging Group) HMA |
$19.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.05
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.23
|
|
|
Service Code
|
NDC 143950601
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.92 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: ASR ASR |
$24.47
|
| Rate for Payer: BCBS Trust/PPO |
$20.72
|
| Rate for Payer: BCN Commercial |
$20.72
|
| 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 |
$24.47
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| 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: Opus (Opus Packaging Group) HMA |
$18.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.20
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.23
|
|
|
Service Code
|
NDC 143950610
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: Aetna Medicare |
$9.34
|
| Rate for Payer: ASR ASR |
$24.47
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS Trust/PPO |
$20.80
|
| Rate for Payer: BCN Commercial |
$20.80
|
| 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 |
$24.47
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$22.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Nomi Health Commercial |
$20.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.92
|
| Rate for Payer: Priority Health Cigna 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
|
$22.92
|
|
|
Service Code
|
NDC 409669501
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$22.92 |
| Rate for Payer: Aetna Commercial |
$20.63
|
| Rate for Payer: Aetna Medicare |
$8.48
|
| Rate for Payer: ASR ASR |
$22.23
|
| Rate for Payer: BCBS Complete |
$9.17
|
| Rate for Payer: BCBS Trust/PPO |
$18.90
|
| Rate for Payer: BCN Commercial |
$18.90
|
| Rate for Payer: Cash Price |
$18.33
|
| Rate for Payer: Cofinity Commercial |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.33
|
| Rate for Payer: Healthscope Commercial |
$22.23
|
| Rate for Payer: Healthscope Whirlpool |
$22.92
|
| Rate for Payer: Mclaren Commercial |
$20.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.48
|
| Rate for Payer: Nomi Health Commercial |
$18.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.19
|
| Rate for Payer: Priority Health Cigna 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 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.83
|
|
|
Service Code
|
NDC 143931101
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$19.83 |
| Rate for Payer: Aetna Commercial |
$17.85
|
| Rate for Payer: Aetna Medicare |
$7.34
|
| Rate for Payer: ASR ASR |
$19.24
|
| Rate for Payer: BCBS Complete |
$7.93
|
| Rate for Payer: BCBS Trust/PPO |
$16.35
|
| Rate for Payer: BCN Commercial |
$16.35
|
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Cofinity Commercial |
$18.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.87
|
| Rate for Payer: Healthscope Commercial |
$19.24
|
| Rate for Payer: Healthscope Whirlpool |
$19.83
|
| Rate for Payer: Mclaren Commercial |
$17.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.86
|
| Rate for Payer: Nomi Health Commercial |
$16.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.87
|
| Rate for Payer: Priority Health Cigna 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 143931001
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: Aetna Medicare |
$9.34
|
| Rate for Payer: ASR ASR |
$24.47
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS Trust/PPO |
$20.80
|
| Rate for Payer: BCN Commercial |
$20.80
|
| 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 |
$24.47
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$22.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Nomi Health Commercial |
$20.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.92
|
| Rate for Payer: Priority Health Cigna 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
|
$17.24
|
|
|
Service Code
|
NDC 72266014610
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.93 |
| Max. Negotiated Rate |
$17.24 |
| Rate for Payer: Aetna Commercial |
$15.52
|
| Rate for Payer: ASR ASR |
$16.72
|
| Rate for Payer: BCBS Trust/PPO |
$14.16
|
| Rate for Payer: BCN Commercial |
$14.16
|
| 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 |
$16.72
|
| Rate for Payer: Healthscope Whirlpool |
$17.24
|
| Rate for Payer: Mclaren Commercial |
$15.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.66
|
| Rate for Payer: Nomi Health Commercial |
$14.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.17
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.83
|
|
|
Service Code
|
NDC 143931101
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.87 |
| Max. Negotiated Rate |
$19.83 |
| Rate for Payer: Aetna Commercial |
$17.85
|
| Rate for Payer: ASR ASR |
$19.24
|
| Rate for Payer: BCBS Trust/PPO |
$16.29
|
| Rate for Payer: BCN Commercial |
$16.29
|
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Cofinity Commercial |
$18.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.87
|
| Rate for Payer: Healthscope Commercial |
$19.24
|
| Rate for Payer: Healthscope Whirlpool |
$19.83
|
| 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: Opus (Opus Packaging Group) HMA |
$14.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.45
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.23
|
|
|
Service Code
|
NDC 143950601
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: Aetna Medicare |
$9.34
|
| Rate for Payer: ASR ASR |
$24.47
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS Trust/PPO |
$20.80
|
| Rate for Payer: BCN Commercial |
$20.80
|
| 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 |
$24.47
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$22.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Nomi Health Commercial |
$20.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.92
|
| Rate for Payer: Priority Health Cigna 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 |
$6.82 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: Aetna Medicare |
$6.82
|
| Rate for Payer: ASR ASR |
$17.87
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: BCBS Trust/PPO |
$15.19
|
| Rate for Payer: BCN Commercial |
$15.19
|
| 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 |
$17.87
|
| Rate for Payer: Healthscope Whirlpool |
$18.43
|
| Rate for Payer: Mclaren Commercial |
$16.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.66
|
| Rate for Payer: Nomi Health Commercial |
$15.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.14
|
| Rate for Payer: Priority Health Narrow Network |
$12.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.21
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.83
|
|
|
Service Code
|
NDC 143931110
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$19.83 |
| Rate for Payer: Aetna Commercial |
$17.85
|
| Rate for Payer: Aetna Medicare |
$7.34
|
| Rate for Payer: ASR ASR |
$19.24
|
| Rate for Payer: BCBS Complete |
$7.93
|
| Rate for Payer: BCBS Trust/PPO |
$16.35
|
| Rate for Payer: BCN Commercial |
$16.35
|
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Cofinity Commercial |
$18.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.87
|
| Rate for Payer: Healthscope Commercial |
$19.24
|
| Rate for Payer: Healthscope Whirlpool |
$19.83
|
| Rate for Payer: Mclaren Commercial |
$17.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.86
|
| Rate for Payer: Nomi Health Commercial |
$16.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.87
|
| Rate for Payer: Priority Health Cigna 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
|
|
