Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PALIPERIDONE ER 6 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$223.67

Service Code	NDC 65162-282-03
Hospital Charge Code	78065
Hospital Revenue Code	637
Min. Negotiated Rate	$140.91
Max. Negotiated Rate	$201.30
Rate for Payer: Aetna Commercial	$190.12
Rate for Payer: Aetna New Business (MI Preferred)	$145.39
Rate for Payer: Cash Price	$178.94
Rate for Payer: Cofinity Commercial	$156.57
Rate for Payer: Cofinity Commercial	$192.36
Rate for Payer: Healthscope Commercial	$201.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$190.12
Rate for Payer: PHP Commercial	$190.12
Rate for Payer: Priority Health Cigna Priority Health	$156.57
Rate for Payer: Priority Health SBD	$140.91

PALIPERIDONE ER 6 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$223.67

Service Code	NDC 43975-351-03
Hospital Charge Code	78065
Hospital Revenue Code	637
Min. Negotiated Rate	$140.91
Max. Negotiated Rate	$201.30
Rate for Payer: Aetna Commercial	$190.12
Rate for Payer: Aetna New Business (MI Preferred)	$145.39
Rate for Payer: Cash Price	$178.94
Rate for Payer: Cofinity Commercial	$156.57
Rate for Payer: Cofinity Commercial	$192.36
Rate for Payer: Healthscope Commercial	$201.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$190.12
Rate for Payer: PHP Commercial	$190.12
Rate for Payer: Priority Health Cigna Priority Health	$156.57
Rate for Payer: Priority Health SBD	$140.91

PALIPERIDONE ER 6 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$1,136.76

Service Code	NDC 10147-0953-3
Hospital Charge Code	78065
Hospital Revenue Code	637
Min. Negotiated Rate	$716.16
Max. Negotiated Rate	$1,023.08
Rate for Payer: Aetna Commercial	$966.25
Rate for Payer: Aetna New Business (MI Preferred)	$738.89
Rate for Payer: Cash Price	$909.41
Rate for Payer: Cofinity Commercial	$795.73
Rate for Payer: Cofinity Commercial	$977.61
Rate for Payer: Healthscope Commercial	$1,023.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$966.25
Rate for Payer: PHP Commercial	$966.25
Rate for Payer: Priority Health Cigna Priority Health	$795.73
Rate for Payer: Priority Health SBD	$716.16

PALIPERIDONE ER 6 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$223.67

Service Code	NDC 68180-525-06
Hospital Charge Code	78065
Hospital Revenue Code	637
Min. Negotiated Rate	$140.91
Max. Negotiated Rate	$201.30
Rate for Payer: Aetna Commercial	$190.12
Rate for Payer: Aetna New Business (MI Preferred)	$145.39
Rate for Payer: Cash Price	$178.94
Rate for Payer: Cofinity Commercial	$156.57
Rate for Payer: Cofinity Commercial	$192.36
Rate for Payer: Healthscope Commercial	$201.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$190.12
Rate for Payer: PHP Commercial	$190.12
Rate for Payer: Priority Health Cigna Priority Health	$156.57
Rate for Payer: Priority Health SBD	$140.91

PALIPERIDONE ER 9 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$5,985.12

Service Code	NDC 0904-6937-61
Hospital Charge Code	78066
Hospital Revenue Code	637
Min. Negotiated Rate	$3,770.63
Max. Negotiated Rate	$5,386.61
Rate for Payer: Aetna Commercial	$5,087.35
Rate for Payer: Aetna New Business (MI Preferred)	$3,890.33
Rate for Payer: Cash Price	$4,788.10
Rate for Payer: Cofinity Commercial	$4,189.58
Rate for Payer: Cofinity Commercial	$5,147.20
Rate for Payer: Healthscope Commercial	$5,386.61
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,087.35
Rate for Payer: PHP Commercial	$5,087.35
Rate for Payer: Priority Health Cigna Priority Health	$4,189.58
Rate for Payer: Priority Health SBD	$3,770.63

PALIPERIDONE ER 9 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$326.90

Service Code	NDC 65162-283-03
Hospital Charge Code	78066
Hospital Revenue Code	637
Min. Negotiated Rate	$205.95
Max. Negotiated Rate	$294.21
Rate for Payer: Aetna Commercial	$277.86
Rate for Payer: Aetna New Business (MI Preferred)	$212.48
Rate for Payer: Cash Price	$261.52
Rate for Payer: Cofinity Commercial	$228.83
Rate for Payer: Cofinity Commercial	$281.13
Rate for Payer: Healthscope Commercial	$294.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$277.86
Rate for Payer: PHP Commercial	$277.86
Rate for Payer: Priority Health Cigna Priority Health	$228.83
Rate for Payer: Priority Health SBD	$205.95

PALIPERIDONE ER 9 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$272.74

Service Code	NDC 47335-767-83
Hospital Charge Code	78066
Hospital Revenue Code	637
Min. Negotiated Rate	$171.83
Max. Negotiated Rate	$245.47
Rate for Payer: Aetna Commercial	$231.83
Rate for Payer: Aetna New Business (MI Preferred)	$177.28
Rate for Payer: Cash Price	$218.19
Rate for Payer: Cofinity Commercial	$234.56
Rate for Payer: Cofinity Commercial	$190.92
Rate for Payer: Healthscope Commercial	$245.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$231.83
Rate for Payer: PHP Commercial	$231.83
Rate for Payer: Priority Health Cigna Priority Health	$190.92
Rate for Payer: Priority Health SBD	$171.83

PALIPERIDONE ER 9 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$1,705.08

Service Code	NDC 10147-0954-3
Hospital Charge Code	78066
Hospital Revenue Code	637
Min. Negotiated Rate	$1,074.20
Max. Negotiated Rate	$1,534.57
Rate for Payer: Aetna Commercial	$1,449.32
Rate for Payer: Aetna New Business (MI Preferred)	$1,108.30
Rate for Payer: Cash Price	$1,364.06
Rate for Payer: Cofinity Commercial	$1,193.56
Rate for Payer: Cofinity Commercial	$1,466.37
Rate for Payer: Healthscope Commercial	$1,534.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,449.32
Rate for Payer: PHP Commercial	$1,449.32
Rate for Payer: Priority Health Cigna Priority Health	$1,193.56
Rate for Payer: Priority Health SBD	$1,074.20

PALIPERIDONE ER 9 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$6,188.99

Service Code	NDC 10147-0954-1
Hospital Charge Code	78066
Hospital Revenue Code	637
Min. Negotiated Rate	$3,899.06
Max. Negotiated Rate	$5,570.09
Rate for Payer: Aetna Commercial	$5,260.64
Rate for Payer: Aetna New Business (MI Preferred)	$4,022.84
Rate for Payer: Cash Price	$4,951.19
Rate for Payer: Cofinity Commercial	$4,332.29
Rate for Payer: Cofinity Commercial	$5,322.53
Rate for Payer: Healthscope Commercial	$5,570.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,260.64
Rate for Payer: PHP Commercial	$5,260.64
Rate for Payer: Priority Health Cigna Priority Health	$4,332.29
Rate for Payer: Priority Health SBD	$3,899.06

PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SYRINGE

Facility

$129.64

Service Code	HCPCS J2469
Hospital Charge Code	188040
Hospital Revenue Code	636
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$116.68
Rate for Payer: Aetna Commercial	$110.19
Rate for Payer: Aetna New Business (MI Preferred)	$84.27
Rate for Payer: BCBS Complete	$51.86
Rate for Payer: BCBS Trust/PPO	$2.50
Rate for Payer: Cash Price	$103.71
Rate for Payer: Cash Price	$103.71
Rate for Payer: Cofinity Commercial	$111.49
Rate for Payer: Cofinity Commercial	$90.75
Rate for Payer: Healthscope Commercial	$116.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$110.19
Rate for Payer: PHP Commercial	$110.19
Rate for Payer: Priority Health Cigna Priority Health	$90.75
Rate for Payer: Priority Health SBD	$81.67

PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SYRINGE

Facility

$129.64

Service Code	HCPCS J2469
Hospital Charge Code	188040
Hospital Revenue Code	636
Min. Negotiated Rate	$81.67
Max. Negotiated Rate	$116.68
Rate for Payer: Aetna Commercial	$110.19
Rate for Payer: Aetna Commercial	$207.40
Rate for Payer: Aetna New Business (MI Preferred)	$84.27
Rate for Payer: Aetna New Business (MI Preferred)	$158.60
Rate for Payer: Cash Price	$103.71
Rate for Payer: Cash Price	$195.20
Rate for Payer: Cofinity Commercial	$90.75
Rate for Payer: Cofinity Commercial	$209.84
Rate for Payer: Cofinity Commercial	$170.80
Rate for Payer: Cofinity Commercial	$111.49
Rate for Payer: Healthscope Commercial	$116.68
Rate for Payer: Healthscope Commercial	$219.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$110.19
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$207.40
Rate for Payer: PHP Commercial	$110.19
Rate for Payer: PHP Commercial	$207.40
Rate for Payer: Priority Health Cigna Priority Health	$170.80
Rate for Payer: Priority Health Cigna Priority Health	$90.75
Rate for Payer: Priority Health SBD	$81.67
Rate for Payer: Priority Health SBD	$153.72

PALONOSETRON 250 MCG + DEXAMETHASONE 10 MG IVPB

Facility

$298.74

Service Code	HCPCS J2469
Hospital Charge Code	301168
Hospital Revenue Code	636
Min. Negotiated Rate	$188.21
Max. Negotiated Rate	$268.87
Rate for Payer: Aetna Commercial	$253.93
Rate for Payer: Aetna New Business (MI Preferred)	$194.18
Rate for Payer: Cash Price	$238.99
Rate for Payer: Cofinity Commercial	$209.12
Rate for Payer: Cofinity Commercial	$256.92
Rate for Payer: Healthscope Commercial	$268.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$253.93
Rate for Payer: PHP Commercial	$253.93
Rate for Payer: Priority Health Cigna Priority Health	$209.12
Rate for Payer: Priority Health SBD	$188.21

PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION

Facility

$38.14

Service Code	HCPCS J2430
Hospital Charge Code	32589
Hospital Revenue Code	250
Min. Negotiated Rate	$24.03
Max. Negotiated Rate	$34.33
Rate for Payer: Aetna Commercial	$32.42
Rate for Payer: Aetna Commercial	$49.14
Rate for Payer: Aetna New Business (MI Preferred)	$24.79
Rate for Payer: Aetna New Business (MI Preferred)	$37.58
Rate for Payer: Cash Price	$46.25
Rate for Payer: Cash Price	$30.51
Rate for Payer: Cofinity Commercial	$49.72
Rate for Payer: Cofinity Commercial	$40.47
Rate for Payer: Cofinity Commercial	$32.80
Rate for Payer: Cofinity Commercial	$26.70
Rate for Payer: Healthscope Commercial	$52.03
Rate for Payer: Healthscope Commercial	$34.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$32.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$49.14
Rate for Payer: PHP Commercial	$49.14
Rate for Payer: PHP Commercial	$32.42
Rate for Payer: Priority Health Cigna Priority Health	$26.70
Rate for Payer: Priority Health Cigna Priority Health	$40.47
Rate for Payer: Priority Health SBD	$36.42
Rate for Payer: Priority Health SBD	$24.03

PAMIDRONATE 30 MG INTRAVENOUS SOLUTION

Facility

$64.05

Service Code	HCPCS J2430
Hospital Charge Code	10845
Hospital Revenue Code	636
Min. Negotiated Rate	$25.62
Max. Negotiated Rate	$57.64
Rate for Payer: Aetna Commercial	$54.44
Rate for Payer: Aetna New Business (MI Preferred)	$41.63
Rate for Payer: BCBS Complete	$25.62
Rate for Payer: BCBS Trust/PPO	$26.27
Rate for Payer: Cash Price	$51.24
Rate for Payer: Cash Price	$51.24
Rate for Payer: Cofinity Commercial	$44.84
Rate for Payer: Cofinity Commercial	$55.08
Rate for Payer: Healthscope Commercial	$57.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$54.44
Rate for Payer: PHP Commercial	$54.44
Rate for Payer: Priority Health Cigna Priority Health	$44.84
Rate for Payer: Priority Health SBD	$40.35

PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC

Facility

$59,392.51

Service Code	MS-DRG 406
Min. Negotiated Rate	$20,222.82
Max. Negotiated Rate	$59,392.51
Rate for Payer: Aetna Medicare	$22,138.67
Rate for Payer: Allen County Amish Medical Aid Commercial	$26,608.98
Rate for Payer: Amish Plain Church Group Commercial	$26,608.98
Rate for Payer: BCBS MAPPO	$21,287.18
Rate for Payer: BCBS Trust/PPO	$59,392.51
Rate for Payer: BCN Medicare Advantage	$21,287.18
Rate for Payer: Health Alliance Plan Medicare Advantage	$21,287.18
Rate for Payer: Mclaren Medicare	$21,287.18
Rate for Payer: Meridian Wellcare - Medicare Advantage	$22,351.54
Rate for Payer: MI Amish Medical Board Commercial	$24,480.26
Rate for Payer: PACE Medicare	$20,222.82
Rate for Payer: PACE SWMI	$21,287.18
Rate for Payer: PHP Medicare Advantage	$21,287.18
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$41,433.96
Rate for Payer: Priority Health Medicare	$21,287.18
Rate for Payer: Priority Health Narrow Network	$33,147.17
Rate for Payer: Railroad Medicare Medicare	$21,287.18
Rate for Payer: UHC All Payor (Choice/PPO)	$44,044.40
Rate for Payer: UHC Core	$27,026.06
Rate for Payer: UHC Dual Complete DSNP	$21,287.18
Rate for Payer: UHC Exchange	$28,946.19
Rate for Payer: UHC Medicare Advantage	$21,925.80
Rate for Payer: VA VA	$21,287.18

PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC

Facility

$83,976.32

Service Code	MS-DRG 405
Min. Negotiated Rate	$38,133.04
Max. Negotiated Rate	$83,976.32
Rate for Payer: Aetna Medicare	$41,745.64
Rate for Payer: Allen County Amish Medical Aid Commercial	$50,175.05
Rate for Payer: Amish Plain Church Group Commercial	$50,175.05
Rate for Payer: BCBS MAPPO	$40,140.04
Rate for Payer: BCBS Trust/PPO	$83,389.30
Rate for Payer: BCN Medicare Advantage	$40,140.04
Rate for Payer: Health Alliance Plan Medicare Advantage	$40,140.04
Rate for Payer: Mclaren Medicare	$40,140.04
Rate for Payer: Meridian Wellcare - Medicare Advantage	$42,147.04
Rate for Payer: MI Amish Medical Board Commercial	$46,161.05
Rate for Payer: PACE Medicare	$38,133.04
Rate for Payer: PACE SWMI	$40,140.04
Rate for Payer: PHP Medicare Advantage	$40,140.04
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$78,999.18
Rate for Payer: Priority Health Medicare	$40,140.04
Rate for Payer: Priority Health Narrow Network	$63,199.34
Rate for Payer: Railroad Medicare Medicare	$40,140.04
Rate for Payer: UHC All Payor (Choice/PPO)	$83,976.32
Rate for Payer: UHC Core	$51,528.67
Rate for Payer: UHC Dual Complete DSNP	$40,140.04
Rate for Payer: UHC Exchange	$55,189.63
Rate for Payer: UHC Medicare Advantage	$41,344.24
Rate for Payer: VA VA	$40,140.04

PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC

Facility

$39,442.76

Service Code	MS-DRG 407
Min. Negotiated Rate	$15,184.60
Max. Negotiated Rate	$39,442.76
Rate for Payer: Aetna Medicare	$16,623.14
Rate for Payer: Allen County Amish Medical Aid Commercial	$19,979.74
Rate for Payer: Amish Plain Church Group Commercial	$19,979.74
Rate for Payer: BCBS MAPPO	$15,983.79
Rate for Payer: BCBS Trust/PPO	$39,442.76
Rate for Payer: BCN Medicare Advantage	$15,983.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$15,983.79
Rate for Payer: Mclaren Medicare	$15,983.79
Rate for Payer: Meridian Wellcare - Medicare Advantage	$16,782.98
Rate for Payer: MI Amish Medical Board Commercial	$18,381.36
Rate for Payer: PACE Medicare	$15,184.60
Rate for Payer: PACE SWMI	$15,983.79
Rate for Payer: PHP Medicare Advantage	$15,983.79
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$30,866.68
Rate for Payer: Priority Health Medicare	$15,983.79
Rate for Payer: Priority Health Narrow Network	$24,693.34
Rate for Payer: Railroad Medicare Medicare	$15,983.79
Rate for Payer: UHC All Payor (Choice/PPO)	$32,811.35
Rate for Payer: UHC Core	$20,133.36
Rate for Payer: UHC Dual Complete DSNP	$15,983.79
Rate for Payer: UHC Exchange	$21,563.78
Rate for Payer: UHC Medicare Advantage	$16,463.30
Rate for Payer: VA VA	$15,983.79

PANCREAS TRANSPLANT

Facility

$77,901.75

Service Code	MS-DRG 010
Min. Negotiated Rate	$33,401.32
Max. Negotiated Rate	$77,901.75
Rate for Payer: Aetna Medicare	$36,565.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$43,949.10
Rate for Payer: Amish Plain Church Group Commercial	$43,949.10
Rate for Payer: BCBS MAPPO	$35,159.28
Rate for Payer: BCBS Trust/PPO	$77,901.75
Rate for Payer: BCN Medicare Advantage	$35,159.28
Rate for Payer: Health Alliance Plan Medicare Advantage	$35,159.28
Rate for Payer: Mclaren Medicare	$35,159.28
Rate for Payer: Meridian Wellcare - Medicare Advantage	$36,917.24
Rate for Payer: MI Amish Medical Board Commercial	$40,433.17
Rate for Payer: PACE Medicare	$33,401.32
Rate for Payer: PACE SWMI	$35,159.28
Rate for Payer: PHP Medicare Advantage	$35,159.28
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$69,074.77
Rate for Payer: Priority Health Medicare	$35,159.28
Rate for Payer: Priority Health Narrow Network	$55,259.82
Rate for Payer: Railroad Medicare Medicare	$35,159.28
Rate for Payer: UHC All Payor (Choice/PPO)	$73,426.65
Rate for Payer: UHC Core	$45,055.30
Rate for Payer: UHC Dual Complete DSNP	$35,159.28
Rate for Payer: UHC Exchange	$48,256.34
Rate for Payer: UHC Medicare Advantage	$36,214.06
Rate for Payer: VA VA	$35,159.28

PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION

Facility

$7,213.55

Service Code	HCPCS J9303
Hospital Charge Code	77484
Hospital Revenue Code	636
Min. Negotiated Rate	$82.41
Max. Negotiated Rate	$6,492.20
Rate for Payer: Aetna Commercial	$6,131.52
Rate for Payer: Aetna Medicare	$156.69
Rate for Payer: Aetna New Business (MI Preferred)	$4,688.81
Rate for Payer: Allen County Amish Medical Aid Commercial	$188.32
Rate for Payer: Amish Plain Church Group Commercial	$188.32
Rate for Payer: BCBS Complete	$86.54
Rate for Payer: BCBS MAPPO	$150.66
Rate for Payer: BCBS Trust/PPO	$446.02
Rate for Payer: BCN Medicare Advantage	$150.66
Rate for Payer: Cash Price	$5,770.84
Rate for Payer: Cash Price	$5,770.84
Rate for Payer: Cofinity Commercial	$5,049.48
Rate for Payer: Cofinity Commercial	$6,203.65
Rate for Payer: Health Alliance Plan Medicare Advantage	$150.66
Rate for Payer: Healthscope Commercial	$6,492.20
Rate for Payer: Mclaren Medicaid	$82.41
Rate for Payer: Mclaren Medicare	$150.66
Rate for Payer: Meridian Medicaid	$86.54
Rate for Payer: Meridian Wellcare - Medicare Advantage	$158.19
Rate for Payer: MI Amish Medical Board Commercial	$173.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,131.52
Rate for Payer: PACE Medicare	$143.13
Rate for Payer: PACE SWMI	$150.66
Rate for Payer: PHP Commercial	$6,131.52
Rate for Payer: PHP Medicare Advantage	$150.66
Rate for Payer: Priority Health Choice Medicaid	$82.41
Rate for Payer: Priority Health Cigna Priority Health	$5,049.48
Rate for Payer: Priority Health Medicare	$150.66
Rate for Payer: Priority Health SBD	$4,544.54
Rate for Payer: Railroad Medicare Medicare	$150.66
Rate for Payer: UHC Dual Complete DSNP	$150.66
Rate for Payer: UHC Medicare Advantage	$155.18
Rate for Payer: VA VA	$150.66

PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION

Facility

$7,213.55

Service Code	HCPCS J9303
Hospital Charge Code	77484
Hospital Revenue Code	636
Min. Negotiated Rate	$4,544.54
Max. Negotiated Rate	$6,492.20
Rate for Payer: Aetna Commercial	$6,131.52
Rate for Payer: Aetna New Business (MI Preferred)	$4,688.81
Rate for Payer: Cash Price	$5,770.84
Rate for Payer: Cofinity Commercial	$5,049.48
Rate for Payer: Cofinity Commercial	$6,203.65
Rate for Payer: Healthscope Commercial	$6,492.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,131.52
Rate for Payer: PHP Commercial	$6,131.52
Rate for Payer: Priority Health Cigna Priority Health	$5,049.48
Rate for Payer: Priority Health SBD	$4,544.54

PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE

Facility

$2.16

Service Code	NDC 68084-643-11
Hospital Charge Code	26224
Hospital Revenue Code	637
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$1.94
Rate for Payer: Aetna Commercial	$1.84
Rate for Payer: Aetna New Business (MI Preferred)	$1.40
Rate for Payer: Cash Price	$1.73
Rate for Payer: Cofinity Commercial	$1.51
Rate for Payer: Cofinity Commercial	$1.86
Rate for Payer: Healthscope Commercial	$1.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.84
Rate for Payer: PHP Commercial	$1.84
Rate for Payer: Priority Health Cigna Priority Health	$1.51
Rate for Payer: Priority Health SBD	$1.36

PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE

Facility

$197.60

Service Code	NDC 60687-585-01
Hospital Charge Code	26224
Hospital Revenue Code	637
Min. Negotiated Rate	$124.49
Max. Negotiated Rate	$177.84
Rate for Payer: Aetna Commercial	$167.96
Rate for Payer: Aetna New Business (MI Preferred)	$128.44
Rate for Payer: Cash Price	$158.08
Rate for Payer: Cofinity Commercial	$138.32
Rate for Payer: Cofinity Commercial	$169.94
Rate for Payer: Healthscope Commercial	$177.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$167.96
Rate for Payer: PHP Commercial	$167.96
Rate for Payer: Priority Health Cigna Priority Health	$138.32
Rate for Payer: Priority Health SBD	$124.49

PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE

Facility

$1.98

Service Code	NDC 60687-585-11
Hospital Charge Code	26224
Hospital Revenue Code	637
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.78
Rate for Payer: Aetna Commercial	$1.68
Rate for Payer: Aetna New Business (MI Preferred)	$1.29
Rate for Payer: Cash Price	$1.58
Rate for Payer: Cofinity Commercial	$1.39
Rate for Payer: Cofinity Commercial	$1.70
Rate for Payer: Healthscope Commercial	$1.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.68
Rate for Payer: PHP Commercial	$1.68
Rate for Payer: Priority Health Cigna Priority Health	$1.39
Rate for Payer: Priority Health SBD	$1.25

PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE

Facility

$197.60

Service Code	NDC 60687-725-01
Hospital Charge Code	26224
Hospital Revenue Code	637
Min. Negotiated Rate	$124.49
Max. Negotiated Rate	$177.84
Rate for Payer: Aetna Commercial	$167.96
Rate for Payer: Aetna New Business (MI Preferred)	$128.44
Rate for Payer: Cash Price	$158.08
Rate for Payer: Cofinity Commercial	$169.94
Rate for Payer: Cofinity Commercial	$138.32
Rate for Payer: Healthscope Commercial	$177.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$167.96
Rate for Payer: PHP Commercial	$167.96
Rate for Payer: Priority Health Cigna Priority Health	$138.32
Rate for Payer: Priority Health SBD	$124.49

PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE

Facility

$4,482.85

Service Code	NDC 0008-0843-81
Hospital Charge Code	26224
Hospital Revenue Code	637
Min. Negotiated Rate	$2,824.20
Max. Negotiated Rate	$4,034.56
Rate for Payer: Aetna Commercial	$3,810.42
Rate for Payer: Aetna New Business (MI Preferred)	$2,913.85
Rate for Payer: Cash Price	$3,586.28
Rate for Payer: Cofinity Commercial	$3,138.00
Rate for Payer: Cofinity Commercial	$3,855.25
Rate for Payer: Healthscope Commercial	$4,034.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,810.42
Rate for Payer: PHP Commercial	$3,810.42
Rate for Payer: Priority Health Cigna Priority Health	$3,138.00
Rate for Payer: Priority Health SBD	$2,824.20

Know your out-of-pocket cost for care.

All Charges