|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$126.83
|
|
|
Service Code
|
NDC 50268058515
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.90 |
| Max. Negotiated Rate |
$114.15 |
| Rate for Payer: Aetna Commercial |
$107.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.44
|
| Rate for Payer: Cash Price |
$101.46
|
| Rate for Payer: Cofinity Advantage |
$88.78
|
| Rate for Payer: Cofinity Commercial |
$109.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.46
|
| Rate for Payer: Healthscope Commercial |
$114.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.12
|
| Rate for Payer: PHP Commercial |
$107.81
|
| Rate for Payer: Priority Health SBD |
$79.90
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$197.60
|
|
|
Service Code
|
NDC 60687058501
|
| 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 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: 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
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$126.83
|
|
|
Service Code
|
NDC 50268058515
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.84 |
| Max. Negotiated Rate |
$114.15 |
| Rate for Payer: Aetna Commercial |
$107.81
|
| Rate for Payer: Aetna Medicare |
$63.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.44
|
| Rate for Payer: BCBS Complete |
$50.73
|
| Rate for Payer: Cash Price |
$101.46
|
| Rate for Payer: Cofinity Advantage |
$88.78
|
| Rate for Payer: Cofinity Commercial |
$109.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.46
|
| Rate for Payer: Healthscope Commercial |
$114.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.12
|
| Rate for Payer: PHP Commercial |
$107.81
|
| Rate for Payer: Priority Health SBD |
$79.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.44
|
| Rate for Payer: UHC Core |
$66.08
|
| Rate for Payer: UHC Exchange |
$49.84
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$215.65
|
|
|
Service Code
|
NDC 68084064301
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.86 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| 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: 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
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$2.54
|
|
|
Service Code
|
NDC 50268058511
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: Aetna Medicare |
$1.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.65
|
| Rate for Payer: BCBS Complete |
$1.02
|
| 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: MI Amish Medical Board Commercial |
$2.03
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.65
|
| Rate for Payer: UHC Core |
$1.32
|
| Rate for Payer: UHC Exchange |
$1.00
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.54
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$14.89 |
| Rate for Payer: Aetna Commercial |
$14.06
|
| Rate for Payer: Aetna Commercial |
$12.72
|
| Rate for Payer: Aetna Commercial |
$17.84
|
| Rate for Payer: Aetna Commercial |
$17.85
|
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Commercial |
$11.12
|
| Rate for Payer: Aetna Medicare |
$10.35
|
| Rate for Payer: Aetna Medicare |
$8.44
|
| Rate for Payer: Aetna Medicare |
$6.54
|
| Rate for Payer: Aetna Medicare |
$7.49
|
| Rate for Payer: Aetna Medicare |
$8.27
|
| Rate for Payer: Aetna Medicare |
$13.18
|
| Rate for Payer: Aetna Medicare |
$11.23
|
| Rate for Payer: Aetna Medicare |
$10.50
|
| Rate for Payer: Aetna Medicare |
$10.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.50
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS Complete |
$5.99
|
| Rate for Payer: BCBS Complete |
$10.54
|
| Rate for Payer: BCBS Complete |
$8.99
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS Complete |
$5.23
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: BCBS Trust/PPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$11.47
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cash Price |
$13.23
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cash Price |
$13.23
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cofinity Advantage |
$18.45
|
| Rate for Payer: Cofinity Advantage |
$14.49
|
| Rate for Payer: Cofinity Advantage |
$11.58
|
| Rate for Payer: Cofinity Advantage |
$10.48
|
| Rate for Payer: Cofinity Advantage |
$14.69
|
| Rate for Payer: Cofinity Advantage |
$11.82
|
| Rate for Payer: Cofinity Advantage |
$9.16
|
| Rate for Payer: Cofinity Advantage |
$15.73
|
| Rate for Payer: Cofinity Advantage |
$14.70
|
| Rate for Payer: Cofinity Commercial |
$12.87
|
| Rate for Payer: Cofinity Commercial |
$11.25
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$14.22
|
| Rate for Payer: Cofinity Commercial |
$18.05
|
| Rate for Payer: Cofinity Commercial |
$14.52
|
| Rate for Payer: Cofinity Commercial |
$22.66
|
| Rate for Payer: Cofinity Commercial |
$18.06
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.08
|
| Rate for Payer: Healthscope Commercial |
$11.77
|
| Rate for Payer: Healthscope Commercial |
$23.71
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$15.19
|
| Rate for Payer: Healthscope Commercial |
$13.47
|
| Rate for Payer: Healthscope Commercial |
$14.89
|
| Rate for Payer: Healthscope Commercial |
$18.90
|
| Rate for Payer: Healthscope Commercial |
$18.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.53
|
| Rate for Payer: PHP Commercial |
$11.12
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: PHP Commercial |
$12.72
|
| Rate for Payer: PHP Commercial |
$14.35
|
| Rate for Payer: PHP Commercial |
$17.85
|
| Rate for Payer: PHP Commercial |
$17.84
|
| Rate for Payer: PHP Commercial |
$14.06
|
| Rate for Payer: PHP Commercial |
$22.40
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: Priority Health SBD |
$14.16
|
| Rate for Payer: Priority Health SBD |
$13.23
|
| Rate for Payer: Priority Health SBD |
$13.04
|
| Rate for Payer: Priority Health SBD |
$8.24
|
| Rate for Payer: Priority Health SBD |
$9.43
|
| Rate for Payer: Priority Health SBD |
$10.42
|
| Rate for Payer: Priority Health SBD |
$13.22
|
| Rate for Payer: Priority Health SBD |
$16.60
|
| Rate for Payer: Priority Health SBD |
$10.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC Core |
$14.34
|
| Rate for Payer: UHC Core |
$14.34
|
| Rate for Payer: UHC Core |
$14.34
|
| Rate for Payer: UHC Core |
$14.34
|
| Rate for Payer: UHC Core |
$14.34
|
| Rate for Payer: UHC Core |
$14.34
|
| Rate for Payer: UHC Core |
$14.34
|
| Rate for Payer: UHC Core |
$14.34
|
| Rate for Payer: UHC Core |
$14.34
|
| Rate for Payer: UHC Exchange |
$14.34
|
| Rate for Payer: UHC Exchange |
$14.34
|
| Rate for Payer: UHC Exchange |
$14.34
|
| Rate for Payer: UHC Exchange |
$14.34
|
| Rate for Payer: UHC Exchange |
$14.34
|
| Rate for Payer: UHC Exchange |
$14.34
|
| Rate for Payer: UHC Exchange |
$14.34
|
| Rate for Payer: UHC Exchange |
$14.34
|
| Rate for Payer: UHC Exchange |
$14.34
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.27
|
|
|
Service Code
|
HCPCS J2471
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$17.34 |
| Rate for Payer: BCN Commercial |
$8.74
|
| Rate for Payer: Aetna Commercial |
$16.38
|
| Rate for Payer: Aetna Commercial |
$15.49
|
| Rate for Payer: Aetna Medicare |
$9.63
|
| Rate for Payer: Aetna Medicare |
$9.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.53
|
| Rate for Payer: BCBS Complete |
$7.71
|
| Rate for Payer: BCBS Complete |
$7.29
|
| Rate for Payer: BCBS Trust/PPO |
$8.74
|
| Rate for Payer: BCBS Trust/PPO |
$8.74
|
| Rate for Payer: BCN Commercial |
$8.74
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cash Price |
$15.42
|
| Rate for Payer: Cash Price |
$15.42
|
| Rate for Payer: Cofinity Advantage |
$12.75
|
| Rate for Payer: Cofinity Advantage |
$13.49
|
| Rate for Payer: Cofinity Commercial |
$16.57
|
| Rate for Payer: Cofinity Commercial |
$15.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.58
|
| Rate for Payer: Healthscope Commercial |
$16.40
|
| Rate for Payer: Healthscope Commercial |
$17.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.45
|
| Rate for Payer: PHP Commercial |
$16.38
|
| Rate for Payer: PHP Commercial |
$15.49
|
| Rate for Payer: Priority Health SBD |
$11.48
|
| Rate for Payer: Priority Health SBD |
$12.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.24
|
| Rate for Payer: UHC Core |
$6.24
|
| Rate for Payer: UHC Core |
$6.24
|
| Rate for Payer: UHC Exchange |
$6.24
|
| Rate for Payer: UHC Exchange |
$6.24
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.54
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$14.89 |
| Rate for Payer: Aetna Commercial |
$14.06
|
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna Commercial |
$17.84
|
| Rate for Payer: Aetna Commercial |
$12.72
|
| Rate for Payer: Aetna Commercial |
$11.12
|
| Rate for Payer: Aetna Commercial |
$17.85
|
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.75
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cash Price |
$13.23
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Advantage |
$9.16
|
| Rate for Payer: Cofinity Advantage |
$10.48
|
| Rate for Payer: Cofinity Advantage |
$11.82
|
| Rate for Payer: Cofinity Advantage |
$14.70
|
| Rate for Payer: Cofinity Advantage |
$15.73
|
| Rate for Payer: Cofinity Advantage |
$18.45
|
| Rate for Payer: Cofinity Advantage |
$11.58
|
| Rate for Payer: Cofinity Advantage |
$14.49
|
| Rate for Payer: Cofinity Advantage |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$12.87
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$14.52
|
| Rate for Payer: Cofinity Commercial |
$22.66
|
| Rate for Payer: Cofinity Commercial |
$14.22
|
| Rate for Payer: Cofinity Commercial |
$11.25
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Cofinity Commercial |
$18.05
|
| Rate for Payer: Cofinity Commercial |
$18.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.23
|
| Rate for Payer: Healthscope Commercial |
$18.89
|
| Rate for Payer: Healthscope Commercial |
$14.89
|
| Rate for Payer: Healthscope Commercial |
$13.47
|
| Rate for Payer: Healthscope Commercial |
$11.77
|
| Rate for Payer: Healthscope Commercial |
$15.19
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$18.90
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Healthscope Commercial |
$23.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.23
|
| Rate for Payer: PHP Commercial |
$22.40
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: PHP Commercial |
$17.85
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: PHP Commercial |
$17.84
|
| Rate for Payer: PHP Commercial |
$14.35
|
| Rate for Payer: PHP Commercial |
$11.12
|
| Rate for Payer: PHP Commercial |
$14.06
|
| Rate for Payer: PHP Commercial |
$12.72
|
| Rate for Payer: Priority Health SBD |
$10.63
|
| Rate for Payer: Priority Health SBD |
$13.22
|
| Rate for Payer: Priority Health SBD |
$13.04
|
| Rate for Payer: Priority Health SBD |
$14.16
|
| Rate for Payer: Priority Health SBD |
$16.60
|
| Rate for Payer: Priority Health SBD |
$8.24
|
| Rate for Payer: Priority Health SBD |
$9.43
|
| Rate for Payer: Priority Health SBD |
$10.42
|
| Rate for Payer: Priority Health SBD |
$13.23
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.22
|
|
|
Service Code
|
HCPCS J2471
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$16.40 |
| Rate for Payer: Aetna Commercial |
$15.49
|
| Rate for Payer: Aetna Commercial |
$16.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.53
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cash Price |
$15.42
|
| Rate for Payer: Cofinity Advantage |
$12.75
|
| Rate for Payer: Cofinity Advantage |
$13.49
|
| Rate for Payer: Cofinity Commercial |
$15.67
|
| Rate for Payer: Cofinity Commercial |
$16.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.58
|
| Rate for Payer: Healthscope Commercial |
$17.34
|
| Rate for Payer: Healthscope Commercial |
$16.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.45
|
| Rate for Payer: PHP Commercial |
$15.49
|
| Rate for Payer: PHP Commercial |
$16.38
|
| Rate for Payer: Priority Health SBD |
$11.48
|
| Rate for Payer: Priority Health SBD |
$12.14
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION FOR DRIP
|
Facility
|
IP
|
$22.47
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
301183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.16 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Commercial |
$11.12
|
| Rate for Payer: Aetna Commercial |
$17.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.50
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cofinity Advantage |
$15.73
|
| Rate for Payer: Cofinity Advantage |
$9.16
|
| Rate for Payer: Cofinity Advantage |
$18.45
|
| Rate for Payer: Cofinity Advantage |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$22.66
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Cofinity Commercial |
$18.05
|
| Rate for Payer: Cofinity Commercial |
$11.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Healthscope Commercial |
$23.71
|
| Rate for Payer: Healthscope Commercial |
$11.77
|
| Rate for Payer: Healthscope Commercial |
$18.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.74
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: PHP Commercial |
$17.84
|
| Rate for Payer: PHP Commercial |
$11.12
|
| Rate for Payer: PHP Commercial |
$22.40
|
| Rate for Payer: Priority Health SBD |
$13.22
|
| Rate for Payer: Priority Health SBD |
$16.60
|
| Rate for Payer: Priority Health SBD |
$14.16
|
| Rate for Payer: Priority Health SBD |
$8.24
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION FOR DRIP
|
Facility
|
OP
|
$20.99
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
301183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$18.89 |
| Rate for Payer: Aetna Commercial |
$17.84
|
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Commercial |
$11.12
|
| Rate for Payer: Aetna Medicare |
$10.49
|
| Rate for Payer: Aetna Medicare |
$13.18
|
| Rate for Payer: Aetna Medicare |
$11.23
|
| Rate for Payer: Aetna Medicare |
$6.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.64
|
| Rate for Payer: BCBS Complete |
$10.54
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS Complete |
$5.23
|
| Rate for Payer: BCBS Complete |
$8.99
|
| Rate for Payer: BCBS Trust/PPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$11.47
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cofinity Advantage |
$18.45
|
| Rate for Payer: Cofinity Advantage |
$9.16
|
| Rate for Payer: Cofinity Advantage |
$15.73
|
| Rate for Payer: Cofinity Advantage |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$11.25
|
| Rate for Payer: Cofinity Commercial |
$22.66
|
| Rate for Payer: Cofinity Commercial |
$18.05
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.79
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Healthscope Commercial |
$11.77
|
| Rate for Payer: Healthscope Commercial |
$23.71
|
| Rate for Payer: Healthscope Commercial |
$18.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.76
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: PHP Commercial |
$17.84
|
| Rate for Payer: PHP Commercial |
$22.40
|
| Rate for Payer: PHP Commercial |
$11.12
|
| Rate for Payer: Priority Health SBD |
$8.24
|
| Rate for Payer: Priority Health SBD |
$14.16
|
| Rate for Payer: Priority Health SBD |
$16.60
|
| Rate for Payer: Priority Health SBD |
$13.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC Core |
$14.34
|
| Rate for Payer: UHC Core |
$14.34
|
| Rate for Payer: UHC Core |
$14.34
|
| Rate for Payer: UHC Core |
$14.34
|
| Rate for Payer: UHC Exchange |
$14.34
|
| Rate for Payer: UHC Exchange |
$14.34
|
| Rate for Payer: UHC Exchange |
$14.34
|
| Rate for Payer: UHC Exchange |
$14.34
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$120.56
|
|
|
Service Code
|
NDC 65862056090
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.38 |
| Max. Negotiated Rate |
$108.50 |
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: Aetna Medicare |
$60.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.36
|
| Rate for Payer: BCBS Complete |
$48.22
|
| Rate for Payer: Cash Price |
$96.45
|
| Rate for Payer: Cofinity Advantage |
$84.39
|
| Rate for Payer: Cofinity Commercial |
$103.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.45
|
| Rate for Payer: Healthscope Commercial |
$108.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.42
|
| Rate for Payer: PHP Commercial |
$102.48
|
| Rate for Payer: Priority Health SBD |
$75.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.36
|
| Rate for Payer: UHC Core |
$62.81
|
| Rate for Payer: UHC Exchange |
$47.38
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$212.80
|
|
|
Service Code
|
NDC 35573042880
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.63 |
| Max. Negotiated Rate |
$191.52 |
| Rate for Payer: Aetna Commercial |
$180.88
|
| Rate for Payer: Aetna Medicare |
$106.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.32
|
| Rate for Payer: BCBS Complete |
$85.12
|
| Rate for Payer: Cash Price |
$170.24
|
| Rate for Payer: Cofinity Advantage |
$148.96
|
| Rate for Payer: Cofinity Commercial |
$183.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.24
|
| Rate for Payer: Healthscope Commercial |
$191.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$170.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.60
|
| Rate for Payer: PHP Commercial |
$180.88
|
| Rate for Payer: Priority Health SBD |
$134.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.32
|
| Rate for Payer: UHC Core |
$110.87
|
| Rate for Payer: UHC Exchange |
$83.63
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$3.48
|
|
|
Service Code
|
NDC 50268063911
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Aetna Medicare |
$1.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.26
|
| Rate for Payer: BCBS Complete |
$1.39
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cofinity Advantage |
$2.44
|
| Rate for Payer: Cofinity Commercial |
$2.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$3.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.61
|
| Rate for Payer: PHP Commercial |
$2.96
|
| Rate for Payer: Priority Health SBD |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.26
|
| Rate for Payer: UHC Core |
$1.81
|
| Rate for Payer: UHC Exchange |
$1.37
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$173.90
|
|
|
Service Code
|
NDC 50268063915
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: Aetna Medicare |
$86.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.03
|
| Rate for Payer: BCBS Complete |
$69.56
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Advantage |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope 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: Opus (Opus Packaging Group) HMA |
$130.43
|
| Rate for Payer: PHP Commercial |
$147.81
|
| Rate for Payer: Priority Health SBD |
$109.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.03
|
| Rate for Payer: UHC Core |
$90.60
|
| Rate for Payer: UHC Exchange |
$68.34
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 68084081311
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.60
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Advantage |
$2.80
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.20
|
| Rate for Payer: Healthscope Commercial |
$3.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.00
|
| Rate for Payer: PHP Commercial |
$3.40
|
| Rate for Payer: Priority Health SBD |
$2.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.60
|
| Rate for Payer: UHC Core |
$2.08
|
| Rate for Payer: UHC Exchange |
$1.57
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$3.48
|
|
|
Service Code
|
NDC 50268063911
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.26
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cofinity Advantage |
$2.44
|
| Rate for Payer: Cofinity Commercial |
$2.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$3.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.61
|
| Rate for Payer: PHP Commercial |
$2.96
|
| Rate for Payer: Priority Health SBD |
$2.19
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$272.84
|
|
|
Service Code
|
NDC 62175061746
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.23 |
| Max. Negotiated Rate |
$245.56 |
| Rate for Payer: Aetna Commercial |
$231.91
|
| Rate for Payer: Aetna Medicare |
$136.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.35
|
| Rate for Payer: BCBS Complete |
$109.14
|
| Rate for Payer: Cash Price |
$218.27
|
| Rate for Payer: Cofinity Advantage |
$190.99
|
| Rate for Payer: Cofinity Commercial |
$234.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.27
|
| Rate for Payer: Healthscope Commercial |
$245.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.63
|
| Rate for Payer: PHP Commercial |
$231.91
|
| Rate for Payer: Priority Health SBD |
$171.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.35
|
| Rate for Payer: UHC Core |
$142.15
|
| Rate for Payer: UHC Exchange |
$107.23
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$319.60
|
|
|
Service Code
|
NDC 68084081309
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.35 |
| Max. Negotiated Rate |
$287.64 |
| Rate for Payer: Aetna Commercial |
$271.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.74
|
| Rate for Payer: Cash Price |
$255.68
|
| Rate for Payer: Cofinity Advantage |
$223.72
|
| Rate for Payer: Cofinity Commercial |
$274.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.68
|
| Rate for Payer: Healthscope Commercial |
$287.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$239.70
|
| Rate for Payer: PHP Commercial |
$271.66
|
| Rate for Payer: Priority Health SBD |
$201.35
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$222.30
|
|
|
Service Code
|
NDC 63739056410
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.05 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna Commercial |
$188.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.50
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Advantage |
$155.61
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Healthscope Commercial |
$200.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.72
|
| Rate for Payer: PHP Commercial |
$188.96
|
| Rate for Payer: Priority Health SBD |
$140.05
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$2.13
|
|
|
Service Code
|
NDC 51079005101
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Aetna Commercial |
$1.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.38
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cofinity Advantage |
$1.49
|
| Rate for Payer: Cofinity Commercial |
$1.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.70
|
| Rate for Payer: Healthscope Commercial |
$1.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.60
|
| Rate for Payer: PHP Commercial |
$1.81
|
| Rate for Payer: Priority Health SBD |
$1.34
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$193.80
|
|
|
Service Code
|
NDC 00904647461
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.09 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Advantage |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.04
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.35
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health SBD |
$122.09
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$272.84
|
|
|
Service Code
|
NDC 62175061746
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.89 |
| Max. Negotiated Rate |
$245.56 |
| Rate for Payer: Aetna Commercial |
$231.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.35
|
| Rate for Payer: Cash Price |
$218.27
|
| Rate for Payer: Cofinity Advantage |
$190.99
|
| Rate for Payer: Cofinity Commercial |
$234.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.27
|
| Rate for Payer: Healthscope Commercial |
$245.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.63
|
| Rate for Payer: PHP Commercial |
$231.91
|
| Rate for Payer: Priority Health SBD |
$171.89
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$212.80
|
|
|
Service Code
|
NDC 51079005120
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.06 |
| Max. Negotiated Rate |
$191.52 |
| Rate for Payer: Aetna Commercial |
$180.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.32
|
| Rate for Payer: Cash Price |
$170.24
|
| Rate for Payer: Cofinity Advantage |
$148.96
|
| Rate for Payer: Cofinity Commercial |
$183.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.24
|
| Rate for Payer: Healthscope Commercial |
$191.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.60
|
| Rate for Payer: PHP Commercial |
$180.88
|
| Rate for Payer: Priority Health SBD |
$134.06
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$212.80
|
|
|
Service Code
|
NDC 51079005120
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.63 |
| Max. Negotiated Rate |
$191.52 |
| Rate for Payer: Aetna Commercial |
$180.88
|
| Rate for Payer: Aetna Medicare |
$106.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.32
|
| Rate for Payer: BCBS Complete |
$85.12
|
| Rate for Payer: Cash Price |
$170.24
|
| Rate for Payer: Cofinity Advantage |
$148.96
|
| Rate for Payer: Cofinity Commercial |
$183.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.24
|
| Rate for Payer: Healthscope Commercial |
$191.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$170.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.60
|
| Rate for Payer: PHP Commercial |
$180.88
|
| Rate for Payer: Priority Health SBD |
$134.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.32
|
| Rate for Payer: UHC Core |
$110.87
|
| Rate for Payer: UHC Exchange |
$83.63
|
|
