|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$263.57
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
188040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$237.21 |
| Rate for Payer: Aetna Commercial |
$224.03
|
| Rate for Payer: Aetna Commercial |
$110.19
|
| Rate for Payer: Aetna Medicare |
$131.78
|
| Rate for Payer: Aetna Medicare |
$64.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.32
|
| Rate for Payer: BCBS Complete |
$105.43
|
| Rate for Payer: BCBS Complete |
$51.86
|
| Rate for Payer: BCBS Trust/PPO |
$0.86
|
| Rate for Payer: BCBS Trust/PPO |
$0.86
|
| Rate for Payer: BCN Commercial |
$0.86
|
| Rate for Payer: BCN Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$103.71
|
| Rate for Payer: Cash Price |
$103.71
|
| Rate for Payer: Cash Price |
$210.86
|
| Rate for Payer: Cash Price |
$210.86
|
| Rate for Payer: Cofinity Advantage |
$90.75
|
| Rate for Payer: Cofinity Advantage |
$184.50
|
| Rate for Payer: Cofinity Commercial |
$226.67
|
| Rate for Payer: Cofinity Commercial |
$111.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$116.68
|
| Rate for Payer: Healthscope Commercial |
$237.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.68
|
| Rate for Payer: PHP Commercial |
$224.03
|
| Rate for Payer: PHP Commercial |
$110.19
|
| Rate for Payer: Priority Health SBD |
$81.67
|
| Rate for Payer: Priority Health SBD |
$166.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.58
|
| Rate for Payer: UHC Core |
$0.58
|
| Rate for Payer: UHC Core |
$0.58
|
| Rate for Payer: UHC Exchange |
$0.58
|
| Rate for Payer: UHC Exchange |
$0.58
|
|
|
PALONOSETRON 250 MCG + DEXAMETHASONE 10 MG IVPB (PREMIX)
|
Facility
|
OP
|
$298.74
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
301168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$268.87 |
| Rate for Payer: Aetna Commercial |
$253.93
|
| Rate for Payer: Aetna Medicare |
$149.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.18
|
| Rate for Payer: BCBS Complete |
$119.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.86
|
| Rate for Payer: BCN Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$238.99
|
| Rate for Payer: Cash Price |
$238.99
|
| Rate for Payer: Cofinity Advantage |
$209.12
|
| Rate for Payer: Cofinity Commercial |
$256.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.99
|
| Rate for Payer: Healthscope Commercial |
$268.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$238.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.06
|
| Rate for Payer: PHP Commercial |
$253.93
|
| Rate for Payer: Priority Health SBD |
$188.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.58
|
| Rate for Payer: UHC Core |
$0.58
|
| Rate for Payer: UHC Exchange |
$0.58
|
|
|
PALONOSETRON 250 MCG + DEXAMETHASONE 10 MG IVPB (PREMIX)
|
Facility
|
IP
|
$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 Advantage |
$209.12
|
| Rate for Payer: Cofinity Commercial |
$256.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.99
|
| Rate for Payer: Healthscope Commercial |
$268.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.06
|
| Rate for Payer: PHP Commercial |
$253.93
|
| Rate for Payer: Priority Health SBD |
$188.21
|
|
|
PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$38.14
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
32589
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$34.33 |
| Rate for Payer: Aetna Commercial |
$32.42
|
| Rate for Payer: Aetna Commercial |
$50.62
|
| Rate for Payer: Aetna Medicare |
$29.77
|
| Rate for Payer: Aetna Medicare |
$19.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.79
|
| Rate for Payer: BCBS Complete |
$15.26
|
| Rate for Payer: BCBS Complete |
$23.82
|
| Rate for Payer: BCBS Trust/PPO |
$28.32
|
| Rate for Payer: BCBS Trust/PPO |
$28.32
|
| Rate for Payer: BCN Commercial |
$28.32
|
| Rate for Payer: BCN Commercial |
$28.32
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cash Price |
$47.64
|
| Rate for Payer: Cash Price |
$47.64
|
| Rate for Payer: Cofinity Advantage |
$26.70
|
| Rate for Payer: Cofinity Advantage |
$41.69
|
| Rate for Payer: Cofinity Commercial |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$51.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.51
|
| Rate for Payer: Healthscope Commercial |
$34.33
|
| Rate for Payer: Healthscope Commercial |
$53.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.66
|
| Rate for Payer: PHP Commercial |
$50.62
|
| Rate for Payer: PHP Commercial |
$32.42
|
| Rate for Payer: Priority Health SBD |
$24.03
|
| Rate for Payer: Priority Health SBD |
$37.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.79
|
| Rate for Payer: UHC Core |
$19.87
|
| Rate for Payer: UHC Core |
$31.03
|
| Rate for Payer: UHC Exchange |
$14.99
|
| Rate for Payer: UHC Exchange |
$23.40
|
|
|
PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$59.55
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
32589
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.52 |
| Max. Negotiated Rate |
$53.59 |
| Rate for Payer: Aetna Commercial |
$50.62
|
| Rate for Payer: Aetna Commercial |
$32.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.71
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cash Price |
$47.64
|
| Rate for Payer: Cofinity Advantage |
$26.70
|
| Rate for Payer: Cofinity Advantage |
$41.69
|
| Rate for Payer: Cofinity Commercial |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$51.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.51
|
| Rate for Payer: Healthscope Commercial |
$53.59
|
| Rate for Payer: Healthscope Commercial |
$34.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.66
|
| Rate for Payer: PHP Commercial |
$32.42
|
| Rate for Payer: PHP Commercial |
$50.62
|
| Rate for Payer: Priority Health SBD |
$24.03
|
| Rate for Payer: Priority Health SBD |
$37.52
|
|
|
PAMIDRONATE 30 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$64.05
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
10845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.63 |
| Max. Negotiated Rate |
$57.65 |
| Rate for Payer: Aetna Commercial |
$54.44
|
| Rate for Payer: Aetna Medicare |
$32.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.63
|
| Rate for Payer: BCBS Complete |
$25.62
|
| Rate for Payer: BCBS Trust/PPO |
$28.32
|
| Rate for Payer: BCN Commercial |
$28.32
|
| Rate for Payer: Cash Price |
$51.24
|
| Rate for Payer: Cash Price |
$51.24
|
| Rate for Payer: Cofinity Advantage |
$44.84
|
| Rate for Payer: Cofinity Commercial |
$55.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.24
|
| Rate for Payer: Healthscope Commercial |
$57.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.04
|
| Rate for Payer: PHP Commercial |
$54.44
|
| Rate for Payer: Priority Health SBD |
$40.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.63
|
| Rate for Payer: UHC Core |
$18.63
|
| Rate for Payer: UHC Exchange |
$18.63
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$63,311.62
|
|
|
Service Code
|
MSDRG 406
|
| Min. Negotiated Rate |
$21,842.80 |
| Max. Negotiated Rate |
$63,311.62 |
| Rate for Payer: Aetna Medicare |
$23,912.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28,740.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28,740.53
|
| Rate for Payer: BCBS MAPPO |
$22,992.42
|
| Rate for Payer: BCBS Trust/PPO |
$63,311.62
|
| Rate for Payer: BCN Commercial |
$63,311.62
|
| Rate for Payer: BCN Medicare Advantage |
$22,992.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,992.42
|
| Rate for Payer: Mclaren Medicare |
$22,992.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24,142.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,441.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$25,291.66
|
| Rate for Payer: Nomi Health Commercial |
$37,412.58
|
| Rate for Payer: PACE Medicare |
$21,842.80
|
| Rate for Payer: PACE SWMI |
$22,992.42
|
| Rate for Payer: PHP Medicare Advantage |
$22,992.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$46,757.43
|
| Rate for Payer: Priority Health Medicare |
$22,992.42
|
| Rate for Payer: Priority Health Tiered Network |
$37,405.94
|
| Rate for Payer: Railroad Medicare Medicare |
$22,992.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47,273.26
|
| Rate for Payer: UHC Core |
$39,550.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22,992.42
|
| Rate for Payer: UHC Exchange |
$32,299.53
|
| Rate for Payer: VA VA |
$22,992.42
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$89,169.15
|
|
|
Service Code
|
MSDRG 405
|
| Min. Negotiated Rate |
$40,713.46 |
| Max. Negotiated Rate |
$89,169.15 |
| Rate for Payer: Aetna Medicare |
$44,570.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53,570.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53,570.34
|
| Rate for Payer: BCBS MAPPO |
$42,856.27
|
| Rate for Payer: BCBS Trust/PPO |
$88,206.03
|
| Rate for Payer: BCN Commercial |
$88,206.03
|
| Rate for Payer: BCN Medicare Advantage |
$42,856.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42,856.27
|
| Rate for Payer: Mclaren Medicare |
$42,856.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44,999.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49,284.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$47,141.90
|
| Rate for Payer: Nomi Health Commercial |
$70,569.45
|
| Rate for Payer: PACE Medicare |
$40,713.46
|
| Rate for Payer: PACE SWMI |
$42,856.27
|
| Rate for Payer: PHP Medicare Advantage |
$42,856.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$88,196.17
|
| Rate for Payer: Priority Health Medicare |
$42,856.27
|
| Rate for Payer: Priority Health Tiered Network |
$70,556.92
|
| Rate for Payer: Railroad Medicare Medicare |
$42,856.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89,169.15
|
| Rate for Payer: UHC Core |
$74,601.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42,856.27
|
| Rate for Payer: UHC Exchange |
$60,924.96
|
| Rate for Payer: VA VA |
$42,856.27
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$42,045.45
|
|
|
Service Code
|
MSDRG 407
|
| Min. Negotiated Rate |
$16,845.94 |
| Max. Negotiated Rate |
$42,045.45 |
| Rate for Payer: Aetna Medicare |
$18,441.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,165.71
|
| Rate for Payer: BCBS MAPPO |
$17,732.57
|
| Rate for Payer: BCBS Trust/PPO |
$42,045.45
|
| Rate for Payer: BCN Commercial |
$42,045.45
|
| Rate for Payer: BCN Medicare Advantage |
$17,732.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,732.57
|
| Rate for Payer: Mclaren Medicare |
$17,732.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,619.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,392.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,505.83
|
| Rate for Payer: Nomi Health Commercial |
$28,632.84
|
| Rate for Payer: PACE Medicare |
$16,845.94
|
| Rate for Payer: PACE SWMI |
$17,732.57
|
| Rate for Payer: PHP Medicare Advantage |
$17,732.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35,784.70
|
| Rate for Payer: Priority Health Medicare |
$17,732.57
|
| Rate for Payer: Priority Health Tiered Network |
$28,627.76
|
| Rate for Payer: Railroad Medicare Medicare |
$17,732.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36,179.48
|
| Rate for Payer: UHC Core |
$30,268.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,732.57
|
| Rate for Payer: UHC Exchange |
$24,719.69
|
| Rate for Payer: VA VA |
$17,732.57
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$115,687.64
|
|
|
Service Code
|
MSDRG 010
|
| Min. Negotiated Rate |
$39,601.71 |
| Max. Negotiated Rate |
$115,687.64 |
| Rate for Payer: Aetna Medicare |
$58,275.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70,043.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70,043.07
|
| Rate for Payer: BCBS MAPPO |
$56,034.46
|
| Rate for Payer: BCBS Trust/PPO |
$83,042.22
|
| Rate for Payer: BCN Commercial |
$83,042.22
|
| Rate for Payer: BCN Medicare Advantage |
$56,034.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56,034.46
|
| Rate for Payer: Mclaren Medicare |
$56,034.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58,836.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64,439.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$61,637.91
|
| Rate for Payer: Nomi Health Commercial |
$39,601.71
|
| Rate for Payer: PACE Medicare |
$53,232.74
|
| Rate for Payer: PACE SWMI |
$56,034.46
|
| Rate for Payer: PHP Medicare Advantage |
$56,034.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$115,687.64
|
| Rate for Payer: Priority Health Medicare |
$56,034.46
|
| Rate for Payer: Priority Health Tiered Network |
$92,550.10
|
| Rate for Payer: Railroad Medicare Medicare |
$56,034.46
|
| Rate for Payer: VA VA |
$56,034.46
|
|
|
PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$8,326.67
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
77484
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,245.80 |
| Max. Negotiated Rate |
$7,494.00 |
| Rate for Payer: Aetna Commercial |
$7,077.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,412.34
|
| Rate for Payer: Cash Price |
$6,661.34
|
| Rate for Payer: Cofinity Advantage |
$5,828.67
|
| Rate for Payer: Cofinity Commercial |
$7,160.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,661.34
|
| Rate for Payer: Healthscope Commercial |
$7,494.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,077.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,245.00
|
| Rate for Payer: PHP Commercial |
$7,077.67
|
| Rate for Payer: Priority Health SBD |
$5,245.80
|
|
|
PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$8,326.67
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
77484
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.21 |
| Max. Negotiated Rate |
$7,494.00 |
| Rate for Payer: Aetna Commercial |
$7,077.67
|
| Rate for Payer: Aetna Medicare |
$181.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,412.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.99
|
| Rate for Payer: BCBS Complete |
$95.77
|
| Rate for Payer: BCBS MAPPO |
$174.39
|
| Rate for Payer: BCBS Trust/PPO |
$427.65
|
| Rate for Payer: BCN Commercial |
$427.65
|
| Rate for Payer: BCN Medicare Advantage |
$174.39
|
| Rate for Payer: Cash Price |
$6,661.34
|
| Rate for Payer: Cash Price |
$6,661.34
|
| Rate for Payer: Cofinity Advantage |
$5,828.67
|
| Rate for Payer: Cofinity Commercial |
$7,160.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,661.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.39
|
| Rate for Payer: Healthscope Commercial |
$7,494.00
|
| Rate for Payer: Mclaren Medicaid |
$91.21
|
| Rate for Payer: Mclaren Medicare |
$174.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.11
|
| Rate for Payer: Meridian Medicaid |
$183.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$191.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,077.67
|
| Rate for Payer: Nomi Health Commercial |
$523.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,245.00
|
| Rate for Payer: PACE Medicare |
$165.67
|
| Rate for Payer: PACE SWMI |
$174.39
|
| Rate for Payer: PHP Commercial |
$7,077.67
|
| Rate for Payer: PHP Medicare Advantage |
$174.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$545.73
|
| Rate for Payer: Priority Health Medicare |
$174.39
|
| Rate for Payer: Priority Health SBD |
$5,245.80
|
| Rate for Payer: Priority Health Tiered Network |
$436.58
|
| Rate for Payer: Railroad Medicare Medicare |
$174.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.56
|
| Rate for Payer: UHC Core |
$286.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.39
|
| Rate for Payer: UHC Exchange |
$286.56
|
| Rate for Payer: UHC Medicaid |
$91.21
|
| Rate for Payer: UHCCP Medicaid |
$91.21
|
| Rate for Payer: VA VA |
$174.39
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$4,617.38
|
|
|
Service Code
|
NDC 00008084381
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,908.95 |
| Max. Negotiated Rate |
$4,155.64 |
| Rate for Payer: Aetna Commercial |
$3,924.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,001.30
|
| Rate for Payer: Cash Price |
$3,693.90
|
| Rate for Payer: Cofinity Advantage |
$3,232.17
|
| Rate for Payer: Cofinity Commercial |
$3,970.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,693.90
|
| Rate for Payer: Healthscope Commercial |
$4,155.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,924.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,463.03
|
| Rate for Payer: PHP Commercial |
$3,924.77
|
| Rate for Payer: Priority Health SBD |
$2,908.95
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
NDC 60687072501
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.14 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna Medicare |
$104.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Advantage |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$167.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.75
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health SBD |
$131.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.85
|
| Rate for Payer: UHC Core |
$108.89
|
| Rate for Payer: UHC Exchange |
$82.14
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$2.09
|
|
|
Service Code
|
NDC 60687072511
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna Commercial |
$1.78
|
| Rate for Payer: Aetna Medicare |
$1.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.36
|
| Rate for Payer: BCBS Complete |
$0.84
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Cofinity Advantage |
$1.46
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.67
|
| Rate for Payer: Healthscope Commercial |
$1.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.57
|
| Rate for Payer: PHP Commercial |
$1.78
|
| Rate for Payer: Priority Health SBD |
$1.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.36
|
| Rate for Payer: UHC Core |
$1.09
|
| Rate for Payer: UHC Exchange |
$0.82
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$215.65
|
|
|
Service Code
|
NDC 68084064301
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.75 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna Medicare |
$107.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: BCBS Complete |
$86.26
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Advantage |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.74
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health SBD |
$135.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.17
|
| Rate for Payer: UHC Core |
$112.35
|
| Rate for Payer: UHC Exchange |
$84.75
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
NDC 60687072501
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Advantage |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.75
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health SBD |
$131.67
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$2.09
|
|
|
Service Code
|
NDC 60687072511
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna Commercial |
$1.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.36
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Cofinity Advantage |
$1.46
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.67
|
| Rate for Payer: Healthscope Commercial |
$1.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.57
|
| Rate for Payer: PHP Commercial |
$1.78
|
| Rate for Payer: Priority Health SBD |
$1.32
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$1.98
|
|
|
Service Code
|
NDC 60687058511
|
| 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 Advantage |
$1.39
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.58
|
| Rate for Payer: Healthscope Commercial |
$1.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.49
|
| Rate for Payer: PHP Commercial |
$1.68
|
| Rate for Payer: Priority Health SBD |
$1.25
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$1.98
|
|
|
Service Code
|
NDC 60687058511
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna Commercial |
$1.68
|
| Rate for Payer: Aetna Medicare |
$0.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.29
|
| Rate for Payer: BCBS Complete |
$0.79
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cofinity Advantage |
$1.39
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.58
|
| Rate for Payer: Healthscope Commercial |
$1.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.49
|
| Rate for Payer: PHP Commercial |
$1.68
|
| Rate for Payer: Priority Health SBD |
$1.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC Core |
$1.03
|
| Rate for Payer: UHC Exchange |
$0.78
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$2.16
|
|
|
Service Code
|
NDC 68084064311
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna Medicare |
$1.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.40
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Advantage |
$1.51
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$1.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.62
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health SBD |
$1.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.40
|
| Rate for Payer: UHC Core |
$1.13
|
| Rate for Payer: UHC Exchange |
$0.85
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$197.60
|
|
|
Service Code
|
NDC 60687058501
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.66 |
| Max. Negotiated Rate |
$177.84 |
| Rate for Payer: Aetna Commercial |
$167.96
|
| Rate for Payer: Aetna Medicare |
$98.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.44
|
| Rate for Payer: BCBS Complete |
$79.04
|
| Rate for Payer: Cash Price |
$158.08
|
| Rate for Payer: Cofinity Advantage |
$138.32
|
| Rate for Payer: Cofinity Commercial |
$169.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.08
|
| Rate for Payer: Healthscope Commercial |
$177.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.20
|
| Rate for Payer: PHP Commercial |
$167.96
|
| Rate for Payer: Priority Health SBD |
$124.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.44
|
| Rate for Payer: UHC Core |
$102.95
|
| Rate for Payer: UHC Exchange |
$77.66
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$2.54
|
|
|
Service Code
|
NDC 50268058511
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.65
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cofinity Advantage |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Healthscope Commercial |
$2.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.91
|
| Rate for Payer: PHP Commercial |
$2.16
|
| Rate for Payer: Priority Health SBD |
$1.60
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$4,617.38
|
|
|
Service Code
|
NDC 00008084381
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,814.63 |
| Max. Negotiated Rate |
$4,155.64 |
| Rate for Payer: Aetna Commercial |
$3,924.77
|
| Rate for Payer: Aetna Medicare |
$2,308.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,001.30
|
| Rate for Payer: BCBS Complete |
$1,846.95
|
| Rate for Payer: Cash Price |
$3,693.90
|
| Rate for Payer: Cofinity Advantage |
$3,232.17
|
| Rate for Payer: Cofinity Commercial |
$3,970.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,693.90
|
| Rate for Payer: Healthscope Commercial |
$4,155.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,693.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,924.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,463.03
|
| Rate for Payer: PHP Commercial |
$3,924.77
|
| Rate for Payer: Priority Health SBD |
$2,908.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,001.30
|
| Rate for Payer: UHC Core |
$2,405.65
|
| Rate for Payer: UHC Exchange |
$1,814.63
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$2.16
|
|
|
Service Code
|
NDC 68084064311
|
| 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 Advantage |
$1.51
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.62
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health SBD |
$1.36
|
|
