|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$222.30
|
|
|
Service Code
|
NDC 63739056410
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna Commercial |
$188.96
|
| Rate for Payer: Aetna Medicare |
$111.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.50
|
| Rate for Payer: BCBS Complete |
$88.92
|
| 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: MI Amish Medical Board Commercial |
$177.84
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.50
|
| Rate for Payer: UHC Core |
$115.82
|
| Rate for Payer: UHC Exchange |
$87.36
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$2.13
|
|
|
Service Code
|
NDC 51079005101
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Aetna Commercial |
$1.81
|
| Rate for Payer: Aetna Medicare |
$1.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.38
|
| Rate for Payer: BCBS Complete |
$0.85
|
| 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: MI Amish Medical Board Commercial |
$1.70
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.38
|
| Rate for Payer: UHC Core |
$1.11
|
| Rate for Payer: UHC Exchange |
$0.84
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 50268063915
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.56 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.03
|
| 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: 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
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$212.80
|
|
|
Service Code
|
NDC 35573042880
|
| 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
|
$191.53
|
|
|
Service Code
|
NDC 60687073665
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.27 |
| Max. Negotiated Rate |
$172.38 |
| Rate for Payer: Aetna Commercial |
$162.80
|
| Rate for Payer: Aetna Medicare |
$95.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.49
|
| Rate for Payer: BCBS Complete |
$76.61
|
| Rate for Payer: Cash Price |
$153.22
|
| Rate for Payer: Cofinity Advantage |
$134.07
|
| Rate for Payer: Cofinity Commercial |
$164.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.22
|
| Rate for Payer: Healthscope Commercial |
$172.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.65
|
| Rate for Payer: PHP Commercial |
$162.80
|
| Rate for Payer: Priority Health SBD |
$120.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.49
|
| Rate for Payer: UHC Core |
$99.79
|
| Rate for Payer: UHC Exchange |
$75.27
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$3.81
|
|
|
Service Code
|
NDC 60687073611
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.43 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: Aetna Medicare |
$1.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.48
|
| Rate for Payer: BCBS Complete |
$1.52
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: Cofinity Advantage |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$3.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.05
|
| Rate for Payer: Healthscope Commercial |
$3.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.86
|
| Rate for Payer: PHP Commercial |
$3.24
|
| Rate for Payer: Priority Health SBD |
$2.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.48
|
| Rate for Payer: UHC Core |
$1.99
|
| Rate for Payer: UHC Exchange |
$1.50
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$4,617.38
|
|
|
Service Code
|
NDC 00008084181
|
| Hospital Charge Code |
26225
|
|
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 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$4,617.38
|
|
|
Service Code
|
NDC 00008084181
|
| Hospital Charge Code |
26225
|
|
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 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$191.53
|
|
|
Service Code
|
NDC 60687073665
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.66 |
| Max. Negotiated Rate |
$172.38 |
| Rate for Payer: Aetna Commercial |
$162.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.49
|
| Rate for Payer: Cash Price |
$153.22
|
| Rate for Payer: Cofinity Advantage |
$134.07
|
| Rate for Payer: Cofinity Commercial |
$164.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.22
|
| Rate for Payer: Healthscope Commercial |
$172.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.65
|
| Rate for Payer: PHP Commercial |
$162.80
|
| Rate for Payer: Priority Health SBD |
$120.66
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 68084081311
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.60
|
| 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: 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
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$3.81
|
|
|
Service Code
|
NDC 60687073611
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$3.43 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.48
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: Cofinity Advantage |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$3.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.05
|
| Rate for Payer: Healthscope Commercial |
$3.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.86
|
| Rate for Payer: PHP Commercial |
$3.24
|
| Rate for Payer: Priority Health SBD |
$2.40
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$2.13
|
|
|
Service Code
|
NDC 35573042851
|
| 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
|
OP
|
$193.80
|
|
|
Service Code
|
NDC 00904647461
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.16 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna Medicare |
$96.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: BCBS Complete |
$77.52
|
| 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: MI Amish Medical Board Commercial |
$155.04
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.97
|
| Rate for Payer: UHC Core |
$100.97
|
| Rate for Payer: UHC Exchange |
$76.16
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$120.56
|
|
|
Service Code
|
NDC 65862056090
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.95 |
| Max. Negotiated Rate |
$108.50 |
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.36
|
| 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: 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
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$180.41
|
|
|
Service Code
|
NDC 55111033390
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.66 |
| Max. Negotiated Rate |
$162.37 |
| Rate for Payer: Aetna Commercial |
$153.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.27
|
| Rate for Payer: Cash Price |
$144.33
|
| Rate for Payer: Cofinity Advantage |
$126.29
|
| Rate for Payer: Cofinity Commercial |
$155.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.33
|
| Rate for Payer: Healthscope Commercial |
$162.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.31
|
| Rate for Payer: PHP Commercial |
$153.35
|
| Rate for Payer: Priority Health SBD |
$113.66
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$1,104.50
|
|
|
Service Code
|
NDC 65862056099
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$695.84 |
| Max. Negotiated Rate |
$994.05 |
| Rate for Payer: Aetna Commercial |
$938.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$717.92
|
| Rate for Payer: Cash Price |
$883.60
|
| Rate for Payer: Cofinity Advantage |
$773.15
|
| Rate for Payer: Cofinity Commercial |
$949.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$883.60
|
| Rate for Payer: Healthscope Commercial |
$994.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$938.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$828.38
|
| Rate for Payer: PHP Commercial |
$938.83
|
| Rate for Payer: Priority Health SBD |
$695.84
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$319.60
|
|
|
Service Code
|
NDC 68084081309
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.60 |
| Max. Negotiated Rate |
$287.64 |
| Rate for Payer: Aetna Commercial |
$271.66
|
| Rate for Payer: Aetna Medicare |
$159.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.74
|
| Rate for Payer: BCBS Complete |
$127.84
|
| 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: MI Amish Medical Board Commercial |
$255.68
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.74
|
| Rate for Payer: UHC Core |
$166.51
|
| Rate for Payer: UHC Exchange |
$125.60
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$1,104.50
|
|
|
Service Code
|
NDC 65862056099
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$434.07 |
| Max. Negotiated Rate |
$994.05 |
| Rate for Payer: Aetna Commercial |
$938.83
|
| Rate for Payer: Aetna Medicare |
$552.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$717.92
|
| Rate for Payer: BCBS Complete |
$441.80
|
| Rate for Payer: Cash Price |
$883.60
|
| Rate for Payer: Cofinity Advantage |
$773.15
|
| Rate for Payer: Cofinity Commercial |
$949.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$883.60
|
| Rate for Payer: Healthscope Commercial |
$994.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$883.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$938.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$828.38
|
| Rate for Payer: PHP Commercial |
$938.83
|
| Rate for Payer: Priority Health SBD |
$695.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$717.92
|
| Rate for Payer: UHC Core |
$575.44
|
| Rate for Payer: UHC Exchange |
$434.07
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$2.13
|
|
|
Service Code
|
NDC 35573042851
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Aetna Commercial |
$1.81
|
| Rate for Payer: Aetna Medicare |
$1.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.38
|
| Rate for Payer: BCBS Complete |
$0.85
|
| 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: MI Amish Medical Board Commercial |
$1.70
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.38
|
| Rate for Payer: UHC Core |
$1.11
|
| Rate for Payer: UHC Exchange |
$0.84
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$180.41
|
|
|
Service Code
|
NDC 55111033390
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.90 |
| Max. Negotiated Rate |
$162.37 |
| Rate for Payer: Aetna Commercial |
$153.35
|
| Rate for Payer: Aetna Medicare |
$90.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.27
|
| Rate for Payer: BCBS Complete |
$72.16
|
| Rate for Payer: Cash Price |
$144.33
|
| Rate for Payer: Cofinity Advantage |
$126.29
|
| Rate for Payer: Cofinity Commercial |
$155.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.33
|
| Rate for Payer: Healthscope Commercial |
$162.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.31
|
| Rate for Payer: PHP Commercial |
$153.35
|
| Rate for Payer: Priority Health SBD |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.27
|
| Rate for Payer: UHC Core |
$93.99
|
| Rate for Payer: UHC Exchange |
$70.90
|
|
|
PAPAVERINE 30 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$70.36
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
6030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.33 |
| Max. Negotiated Rate |
$63.32 |
| Rate for Payer: Aetna Commercial |
$59.81
|
| Rate for Payer: Aetna Commercial |
$58.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.71
|
| Rate for Payer: Cash Price |
$56.29
|
| Rate for Payer: Cash Price |
$55.02
|
| Rate for Payer: Cofinity Advantage |
$48.15
|
| Rate for Payer: Cofinity Advantage |
$49.25
|
| Rate for Payer: Cofinity Commercial |
$59.15
|
| Rate for Payer: Cofinity Commercial |
$60.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.02
|
| Rate for Payer: Healthscope Commercial |
$63.32
|
| Rate for Payer: Healthscope Commercial |
$61.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.77
|
| Rate for Payer: PHP Commercial |
$59.81
|
| Rate for Payer: PHP Commercial |
$58.46
|
| Rate for Payer: Priority Health SBD |
$44.33
|
| Rate for Payer: Priority Health SBD |
$43.33
|
|
|
PAPAVERINE 30 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$70.36
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
6030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.14 |
| Max. Negotiated Rate |
$82.76 |
| Rate for Payer: Aetna Commercial |
$59.81
|
| Rate for Payer: Aetna Commercial |
$58.46
|
| Rate for Payer: Aetna Medicare |
$34.39
|
| Rate for Payer: Aetna Medicare |
$35.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.73
|
| Rate for Payer: BCBS Complete |
$27.51
|
| Rate for Payer: BCBS Complete |
$28.14
|
| Rate for Payer: BCBS Trust/PPO |
$82.76
|
| Rate for Payer: BCBS Trust/PPO |
$82.76
|
| Rate for Payer: BCN Commercial |
$82.76
|
| Rate for Payer: BCN Commercial |
$82.76
|
| Rate for Payer: Cash Price |
$55.02
|
| Rate for Payer: Cash Price |
$55.02
|
| Rate for Payer: Cash Price |
$56.29
|
| Rate for Payer: Cash Price |
$56.29
|
| Rate for Payer: Cofinity Advantage |
$48.15
|
| Rate for Payer: Cofinity Advantage |
$49.25
|
| Rate for Payer: Cofinity Commercial |
$59.15
|
| Rate for Payer: Cofinity Commercial |
$60.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.29
|
| Rate for Payer: Healthscope Commercial |
$61.90
|
| Rate for Payer: Healthscope Commercial |
$63.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.77
|
| Rate for Payer: PHP Commercial |
$58.46
|
| Rate for Payer: PHP Commercial |
$59.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$39.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$39.75
|
| Rate for Payer: Priority Health SBD |
$44.33
|
| Rate for Payer: Priority Health SBD |
$43.33
|
| Rate for Payer: Priority Health Tiered Network |
$31.80
|
| Rate for Payer: Priority Health Tiered Network |
$31.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.80
|
| Rate for Payer: UHC Core |
$75.80
|
| Rate for Payer: UHC Core |
$75.80
|
| Rate for Payer: UHC Exchange |
$75.80
|
| Rate for Payer: UHC Exchange |
$75.80
|
|
|
PARAVAGINAL DEFECT REPAIR (INCLUDING REPAIR OF CYSTOCELE, IF PERFORMED); VAGINAL APPROACH
|
Facility
|
OP
|
$23,894.64
|
|
|
Service Code
|
CPT 57285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,959.70 |
| Max. Negotiated Rate |
$23,894.64 |
| Rate for Payer: Aetna Medicare |
$7,684.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,235.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,235.96
|
| Rate for Payer: BCBS Complete |
$4,057.91
|
| Rate for Payer: BCBS MAPPO |
$7,388.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,959.70
|
| Rate for Payer: BCN Commercial |
$2,959.70
|
| Rate for Payer: BCN Medicare Advantage |
$7,388.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,388.77
|
| Rate for Payer: Mclaren Medicaid |
$3,864.33
|
| Rate for Payer: Mclaren Medicare |
$7,388.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,758.21
|
| Rate for Payer: Meridian Medicaid |
$7,758.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,497.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,127.65
|
| Rate for Payer: Nomi Health Commercial |
$22,166.31
|
| Rate for Payer: PACE Medicare |
$7,019.33
|
| Rate for Payer: PACE SWMI |
$7,388.77
|
| Rate for Payer: PHP Medicare Advantage |
$7,388.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,864.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,894.64
|
| Rate for Payer: Priority Health Medicare |
$7,388.77
|
| Rate for Payer: Priority Health Tiered Network |
$19,115.71
|
| Rate for Payer: Railroad Medicare Medicare |
$7,388.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,388.77
|
| Rate for Payer: UHC Medicaid |
$3,864.33
|
| Rate for Payer: UHCCP Medicaid |
$3,864.33
|
| Rate for Payer: VA VA |
$7,388.77
|
|
|
PARENTERAL AMINO ACID 10 % COMBINATION NO.6 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$43.50
|
|
|
Service Code
|
NDC 00338064406
|
| Hospital Charge Code |
117996
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$39.15 |
| Rate for Payer: Aetna Commercial |
$36.98
|
| Rate for Payer: Aetna Medicare |
$21.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.27
|
| Rate for Payer: BCBS Complete |
$17.40
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cofinity Advantage |
$30.45
|
| Rate for Payer: Cofinity Commercial |
$37.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.80
|
| Rate for Payer: Healthscope Commercial |
$39.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.62
|
| Rate for Payer: PHP Commercial |
$36.98
|
| Rate for Payer: Priority Health SBD |
$27.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.27
|
| Rate for Payer: UHC Core |
$22.66
|
| Rate for Payer: UHC Exchange |
$17.10
|
|
|
PARENTERAL AMINO ACID 10 % COMBINATION NO.6 INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$43.50
|
|
|
Service Code
|
NDC 00338064406
|
| Hospital Charge Code |
117996
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.41 |
| Max. Negotiated Rate |
$39.15 |
| Rate for Payer: Aetna Commercial |
$36.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.27
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cofinity Advantage |
$30.45
|
| Rate for Payer: Cofinity Commercial |
$37.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.80
|
| Rate for Payer: Healthscope Commercial |
$39.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.62
|
| Rate for Payer: PHP Commercial |
$36.98
|
| Rate for Payer: Priority Health SBD |
$27.41
|
|
