|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$10.71
|
|
|
Service Code
|
NDC 00904743535
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$9.64 |
| Rate for Payer: Aetna Commercial |
$9.10
|
| Rate for Payer: Aetna Medicare |
$2.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.35
|
| Rate for Payer: BCBS Complete |
$1.98
|
| Rate for Payer: BCBS MAPPO |
$2.68
|
| Rate for Payer: BCBS Trust/PPO |
$8.80
|
| Rate for Payer: BCN Commercial |
$8.80
|
| Rate for Payer: BCN Medicare Advantage |
$2.68
|
| Rate for Payer: Cash Price |
$8.57
|
| Rate for Payer: Cofinity Commercial |
$9.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.68
|
| Rate for Payer: Healthscope Commercial |
$9.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.03
|
| Rate for Payer: Mclaren Medicaid |
$1.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.81
|
| Rate for Payer: Meridian Medicaid |
$1.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.10
|
| Rate for Payer: Nomi Health Commercial |
$8.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.03
|
| Rate for Payer: PACE Senior Care Partners |
$2.54
|
| Rate for Payer: PACE SWMI |
$2.68
|
| Rate for Payer: PHP Commercial |
$9.10
|
| Rate for Payer: PHP Medicare Advantage |
$2.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.32
|
| Rate for Payer: Priority Health Medicare |
$2.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.45
|
| Rate for Payer: Railroad Medicare Medicare |
$2.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.42
|
| Rate for Payer: UHC Core |
$8.94
|
| Rate for Payer: UHC Exchange |
$2.68
|
| Rate for Payer: UHC Medicaid |
$1.89
|
| Rate for Payer: UHC Medicare Advantage |
$2.68
|
| Rate for Payer: UHCCP Medicaid |
$1.89
|
| Rate for Payer: VA VA |
$2.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.03
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$10.26
|
|
|
Service Code
|
NDC 70000000101
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$9.23 |
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Aetna Medicare |
$2.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.21
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS MAPPO |
$2.56
|
| Rate for Payer: BCBS Trust/PPO |
$8.43
|
| Rate for Payer: BCN Commercial |
$8.43
|
| Rate for Payer: BCN Medicare Advantage |
$2.56
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.56
|
| Rate for Payer: Healthscope Commercial |
$9.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.70
|
| Rate for Payer: Mclaren Medicaid |
$1.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.69
|
| Rate for Payer: Meridian Medicaid |
$1.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.72
|
| Rate for Payer: Nomi Health Commercial |
$8.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.70
|
| Rate for Payer: PACE Senior Care Partners |
$2.44
|
| Rate for Payer: PACE SWMI |
$2.56
|
| Rate for Payer: PHP Commercial |
$8.72
|
| Rate for Payer: PHP Medicare Advantage |
$2.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.93
|
| Rate for Payer: Priority Health Medicare |
$2.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.14
|
| Rate for Payer: Railroad Medicare Medicare |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.03
|
| Rate for Payer: UHC Core |
$8.57
|
| Rate for Payer: UHC Exchange |
$2.56
|
| Rate for Payer: UHC Medicaid |
$1.81
|
| Rate for Payer: UHC Medicare Advantage |
$2.56
|
| Rate for Payer: UHCCP Medicaid |
$1.81
|
| Rate for Payer: VA VA |
$2.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.70
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$13.23
|
|
|
Service Code
|
NDC 45802041059
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: BCBS Trust/PPO |
$10.93
|
| Rate for Payer: BCN Commercial |
$10.93
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: Nomi Health Commercial |
$10.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.92
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.64
|
| Rate for Payer: UHC Core |
$11.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$5.22
|
|
|
Service Code
|
NDC 00904571130
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: Aetna Commercial |
$4.44
|
| Rate for Payer: BCBS Trust/PPO |
$4.31
|
| Rate for Payer: BCN Commercial |
$4.31
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Cofinity Commercial |
$4.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.18
|
| Rate for Payer: Healthscope Commercial |
$4.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.44
|
| Rate for Payer: Nomi Health Commercial |
$4.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.92
|
| Rate for Payer: PHP Commercial |
$4.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.59
|
| Rate for Payer: UHC Core |
$4.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.92
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$9.32
|
|
|
Service Code
|
NDC 00904742730
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$8.39 |
| Rate for Payer: Aetna Commercial |
$7.92
|
| Rate for Payer: Aetna Medicare |
$2.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.91
|
| Rate for Payer: BCBS Complete |
$1.73
|
| Rate for Payer: BCBS MAPPO |
$2.33
|
| Rate for Payer: BCBS Trust/PPO |
$7.66
|
| Rate for Payer: BCN Commercial |
$7.66
|
| Rate for Payer: BCN Medicare Advantage |
$2.33
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.33
|
| Rate for Payer: Healthscope Commercial |
$8.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.99
|
| Rate for Payer: Mclaren Medicaid |
$1.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.45
|
| Rate for Payer: Meridian Medicaid |
$1.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.92
|
| Rate for Payer: Nomi Health Commercial |
$7.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.99
|
| Rate for Payer: PACE Senior Care Partners |
$2.21
|
| Rate for Payer: PACE SWMI |
$2.33
|
| Rate for Payer: PHP Commercial |
$7.92
|
| Rate for Payer: PHP Medicare Advantage |
$2.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.11
|
| Rate for Payer: Priority Health Medicare |
$2.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.49
|
| Rate for Payer: Railroad Medicare Medicare |
$2.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.20
|
| Rate for Payer: UHC Core |
$7.78
|
| Rate for Payer: UHC Exchange |
$2.33
|
| Rate for Payer: UHC Medicaid |
$1.64
|
| Rate for Payer: UHC Medicare Advantage |
$2.33
|
| Rate for Payer: UHCCP Medicaid |
$1.64
|
| Rate for Payer: VA VA |
$2.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.99
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$5.22
|
|
|
Service Code
|
NDC 00904571130
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: Aetna Commercial |
$4.44
|
| Rate for Payer: Aetna Medicare |
$1.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.63
|
| Rate for Payer: BCBS Complete |
$0.97
|
| Rate for Payer: BCBS MAPPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$4.29
|
| Rate for Payer: BCN Commercial |
$4.29
|
| Rate for Payer: BCN Medicare Advantage |
$1.30
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Cofinity Commercial |
$4.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.30
|
| Rate for Payer: Healthscope Commercial |
$4.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.92
|
| Rate for Payer: Mclaren Medicaid |
$0.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.37
|
| Rate for Payer: Meridian Medicaid |
$0.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.44
|
| Rate for Payer: Nomi Health Commercial |
$4.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.92
|
| Rate for Payer: PACE Senior Care Partners |
$1.24
|
| Rate for Payer: PACE SWMI |
$1.30
|
| Rate for Payer: PHP Commercial |
$4.44
|
| Rate for Payer: PHP Medicare Advantage |
$1.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.54
|
| Rate for Payer: Priority Health Medicare |
$1.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.63
|
| Rate for Payer: Railroad Medicare Medicare |
$1.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.59
|
| Rate for Payer: UHC Core |
$4.36
|
| Rate for Payer: UHC Exchange |
$1.30
|
| Rate for Payer: UHC Medicaid |
$0.92
|
| Rate for Payer: UHC Medicare Advantage |
$1.30
|
| Rate for Payer: UHCCP Medicaid |
$0.92
|
| Rate for Payer: VA VA |
$1.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.92
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$9.45
|
|
|
Service Code
|
NDC 00904676130
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$8.51 |
| Rate for Payer: Aetna Commercial |
$8.03
|
| Rate for Payer: Aetna Medicare |
$2.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.95
|
| Rate for Payer: BCBS Complete |
$1.75
|
| Rate for Payer: BCBS MAPPO |
$2.36
|
| Rate for Payer: BCBS Trust/PPO |
$7.77
|
| Rate for Payer: BCN Commercial |
$7.77
|
| Rate for Payer: BCN Medicare Advantage |
$2.36
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$8.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.36
|
| Rate for Payer: Healthscope Commercial |
$8.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.09
|
| Rate for Payer: Mclaren Medicaid |
$1.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.48
|
| Rate for Payer: Meridian Medicaid |
$1.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.03
|
| Rate for Payer: Nomi Health Commercial |
$7.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.09
|
| Rate for Payer: PACE Senior Care Partners |
$2.24
|
| Rate for Payer: PACE SWMI |
$2.36
|
| Rate for Payer: PHP Commercial |
$8.03
|
| Rate for Payer: PHP Medicare Advantage |
$2.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.22
|
| Rate for Payer: Priority Health Medicare |
$2.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.58
|
| Rate for Payer: Railroad Medicare Medicare |
$2.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.32
|
| Rate for Payer: UHC Core |
$7.89
|
| Rate for Payer: UHC Exchange |
$2.36
|
| Rate for Payer: UHC Medicaid |
$1.67
|
| Rate for Payer: UHC Medicare Advantage |
$2.36
|
| Rate for Payer: UHCCP Medicaid |
$1.67
|
| Rate for Payer: VA VA |
$2.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.09
|
|
|
OXYTOCIN 10 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$13.08
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
5944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$11.77 |
| Rate for Payer: Aetna Commercial |
$11.12
|
| Rate for Payer: BCBS Trust/PPO |
$10.80
|
| Rate for Payer: BCN Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cofinity Commercial |
$11.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.46
|
| Rate for Payer: Healthscope Commercial |
$11.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.12
|
| Rate for Payer: Nomi Health Commercial |
$10.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.81
|
| Rate for Payer: PHP Commercial |
$11.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.51
|
| Rate for Payer: UHC Core |
$10.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.81
|
|
|
OXYTOCIN 10 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$13.08
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
5944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$11.77 |
| Rate for Payer: Aetna Commercial |
$11.12
|
| Rate for Payer: Aetna Medicare |
$3.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.09
|
| Rate for Payer: BCBS Complete |
$2.42
|
| Rate for Payer: BCBS MAPPO |
$3.27
|
| Rate for Payer: BCBS Trust/PPO |
$10.75
|
| Rate for Payer: BCN Commercial |
$10.75
|
| Rate for Payer: BCN Medicare Advantage |
$3.27
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cofinity Commercial |
$11.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.27
|
| Rate for Payer: Healthscope Commercial |
$11.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.81
|
| Rate for Payer: Mclaren Medicaid |
$2.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.43
|
| Rate for Payer: Meridian Medicaid |
$2.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.12
|
| Rate for Payer: Nomi Health Commercial |
$10.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.81
|
| Rate for Payer: PACE Senior Care Partners |
$3.11
|
| Rate for Payer: PACE SWMI |
$3.27
|
| Rate for Payer: PHP Commercial |
$11.12
|
| Rate for Payer: PHP Medicare Advantage |
$3.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.38
|
| Rate for Payer: Priority Health Medicare |
$3.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.10
|
| Rate for Payer: Railroad Medicare Medicare |
$3.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.51
|
| Rate for Payer: UHC Core |
$10.92
|
| Rate for Payer: UHC Exchange |
$3.27
|
| Rate for Payer: UHC Medicaid |
$2.31
|
| Rate for Payer: UHC Medicare Advantage |
$3.27
|
| Rate for Payer: UHCCP Medicaid |
$2.31
|
| Rate for Payer: VA VA |
$3.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.81
|
|
|
PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$38.14
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
32589
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$34.33 |
| Rate for Payer: Aetna Commercial |
$32.42
|
| Rate for Payer: BCBS Trust/PPO |
$31.50
|
| Rate for Payer: BCN Commercial |
$31.50
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cofinity Commercial |
$32.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.51
|
| Rate for Payer: Healthscope Commercial |
$34.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.42
|
| Rate for Payer: Nomi Health Commercial |
$31.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.61
|
| Rate for Payer: PHP Commercial |
$32.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.56
|
| Rate for Payer: UHC Core |
$31.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.61
|
|
|
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 |
$6.72 |
| Max. Negotiated Rate |
$34.33 |
| Rate for Payer: Aetna Commercial |
$32.42
|
| Rate for Payer: Aetna Medicare |
$9.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.92
|
| Rate for Payer: BCBS Complete |
$7.06
|
| Rate for Payer: BCBS MAPPO |
$9.54
|
| Rate for Payer: BCBS Trust/PPO |
$31.35
|
| Rate for Payer: BCN Commercial |
$31.35
|
| Rate for Payer: BCN Medicare Advantage |
$9.54
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cofinity Commercial |
$32.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.54
|
| Rate for Payer: Healthscope Commercial |
$34.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.61
|
| Rate for Payer: Mclaren Medicaid |
$6.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.01
|
| Rate for Payer: Meridian Medicaid |
$7.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.42
|
| Rate for Payer: Nomi Health Commercial |
$31.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.61
|
| Rate for Payer: PACE Senior Care Partners |
$9.06
|
| Rate for Payer: PACE SWMI |
$9.54
|
| Rate for Payer: PHP Commercial |
$32.42
|
| Rate for Payer: PHP Medicare Advantage |
$9.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.18
|
| Rate for Payer: Priority Health Medicare |
$9.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.55
|
| Rate for Payer: Railroad Medicare Medicare |
$9.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.56
|
| Rate for Payer: UHC Core |
$31.85
|
| Rate for Payer: UHC Exchange |
$9.54
|
| Rate for Payer: UHC Medicaid |
$6.72
|
| Rate for Payer: UHC Medicare Advantage |
$9.54
|
| Rate for Payer: UHCCP Medicaid |
$6.72
|
| Rate for Payer: VA VA |
$9.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.61
|
|
|
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 |
$38.02 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna Medicare |
$56.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.39
|
| Rate for Payer: BCBS Complete |
$39.92
|
| Rate for Payer: BCBS MAPPO |
$53.91
|
| Rate for Payer: BCBS Trust/PPO |
$177.29
|
| Rate for Payer: BCN Commercial |
$177.29
|
| Rate for Payer: BCN Medicare Advantage |
$53.91
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.91
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Mclaren Medicaid |
$38.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.61
|
| Rate for Payer: Meridian Medicaid |
$39.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Nomi Health Commercial |
$176.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.74
|
| Rate for Payer: PACE Senior Care Partners |
$51.22
|
| Rate for Payer: PACE SWMI |
$53.91
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: PHP Medicare Advantage |
$53.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$187.62
|
| Rate for Payer: Priority Health Medicare |
$54.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.09
|
| Rate for Payer: Railroad Medicare Medicare |
$53.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.77
|
| Rate for Payer: UHC Core |
$180.07
|
| Rate for Payer: UHC Exchange |
$53.91
|
| Rate for Payer: UHC Medicaid |
$38.02
|
| Rate for Payer: UHC Medicare Advantage |
$53.91
|
| Rate for Payer: UHCCP Medicaid |
$38.02
|
| Rate for Payer: VA VA |
$53.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
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 |
$0.38 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna Medicare |
$0.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.68
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.54
|
| Rate for Payer: BCBS Trust/PPO |
$1.78
|
| Rate for Payer: BCN Commercial |
$1.78
|
| Rate for Payer: BCN Medicare Advantage |
$0.54
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.54
|
| Rate for Payer: Healthscope Commercial |
$1.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.62
|
| Rate for Payer: Mclaren Medicaid |
$0.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.57
|
| Rate for Payer: Meridian Medicaid |
$0.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Nomi Health Commercial |
$1.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.62
|
| Rate for Payer: PACE Senior Care Partners |
$0.51
|
| Rate for Payer: PACE SWMI |
$0.54
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: PHP Medicare Advantage |
$0.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.88
|
| Rate for Payer: Priority Health Medicare |
$0.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.50
|
| Rate for Payer: Railroad Medicare Medicare |
$0.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.90
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Exchange |
$0.54
|
| Rate for Payer: UHC Medicaid |
$0.38
|
| Rate for Payer: UHC Medicare Advantage |
$0.54
|
| Rate for Payer: UHCCP Medicaid |
$0.38
|
| Rate for Payer: VA VA |
$0.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.62
|
|
|
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 |
$88.27 |
| Max. Negotiated Rate |
$114.15 |
| Rate for Payer: Aetna Commercial |
$107.81
|
| Rate for Payer: BCBS Trust/PPO |
$104.75
|
| Rate for Payer: BCN Commercial |
$104.75
|
| Rate for Payer: Cash Price |
$101.46
|
| 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: Lakeland Regional Health Systems Commercial |
$95.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.81
|
| Rate for Payer: Nomi Health Commercial |
$104.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.12
|
| Rate for Payer: PHP Commercial |
$107.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$110.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.61
|
| Rate for Payer: UHC Core |
$105.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.12
|
|
|
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 |
$1.50 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: BCBS Trust/PPO |
$1.78
|
| Rate for Payer: BCN Commercial |
$1.78
|
| Rate for Payer: Cash Price |
$1.73
|
| 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: Lakeland Regional Health Systems Commercial |
$1.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Nomi Health Commercial |
$1.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.62
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.90
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.62
|
|
|
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 |
$1.77 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: Cash Price |
$2.03
|
| 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: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: Nomi Health Commercial |
$2.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.91
|
| Rate for Payer: PHP Commercial |
$2.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.24
|
| Rate for Payer: UHC Core |
$2.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
|
|
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 |
$150.09 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: BCBS Trust/PPO |
$178.11
|
| Rate for Payer: BCN Commercial |
$178.11
|
| Rate for Payer: Cash Price |
$172.52
|
| 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: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Nomi Health Commercial |
$176.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.74
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$187.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.77
|
| Rate for Payer: UHC Core |
$180.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
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 |
$0.45 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: Aetna Medicare |
$0.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.79
|
| Rate for Payer: BCBS Complete |
$0.47
|
| Rate for Payer: BCBS MAPPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: BCN Medicare Advantage |
$0.64
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.64
|
| Rate for Payer: Healthscope Commercial |
$2.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Mclaren Medicaid |
$0.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.67
|
| Rate for Payer: Meridian Medicaid |
$0.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: Nomi Health Commercial |
$2.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.91
|
| Rate for Payer: PACE Senior Care Partners |
$0.60
|
| Rate for Payer: PACE SWMI |
$0.64
|
| Rate for Payer: PHP Commercial |
$2.16
|
| Rate for Payer: PHP Medicare Advantage |
$0.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.21
|
| Rate for Payer: Priority Health Medicare |
$0.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.77
|
| Rate for Payer: Railroad Medicare Medicare |
$0.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.24
|
| Rate for Payer: UHC Core |
$2.12
|
| Rate for Payer: UHC Exchange |
$0.64
|
| Rate for Payer: UHC Medicaid |
$0.45
|
| Rate for Payer: UHC Medicare Advantage |
$0.64
|
| Rate for Payer: UHCCP Medicaid |
$0.45
|
| Rate for Payer: VA VA |
$0.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
|
|
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 |
$22.36 |
| Max. Negotiated Rate |
$114.15 |
| Rate for Payer: Aetna Commercial |
$107.81
|
| Rate for Payer: Aetna Medicare |
$32.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.63
|
| Rate for Payer: BCBS Complete |
$23.48
|
| Rate for Payer: BCBS MAPPO |
$31.71
|
| Rate for Payer: BCBS Trust/PPO |
$104.27
|
| Rate for Payer: BCN Commercial |
$104.27
|
| Rate for Payer: BCN Medicare Advantage |
$31.71
|
| Rate for Payer: Cash Price |
$101.46
|
| Rate for Payer: Cofinity Commercial |
$109.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.71
|
| Rate for Payer: Healthscope Commercial |
$114.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.12
|
| Rate for Payer: Mclaren Medicaid |
$22.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.29
|
| Rate for Payer: Meridian Medicaid |
$23.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.81
|
| Rate for Payer: Nomi Health Commercial |
$104.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.12
|
| Rate for Payer: PACE Senior Care Partners |
$30.12
|
| Rate for Payer: PACE SWMI |
$31.71
|
| Rate for Payer: PHP Commercial |
$107.81
|
| Rate for Payer: PHP Medicare Advantage |
$31.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$110.34
|
| Rate for Payer: Priority Health Medicare |
$32.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.27
|
| Rate for Payer: Railroad Medicare Medicare |
$31.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.61
|
| Rate for Payer: UHC Core |
$105.90
|
| Rate for Payer: UHC Exchange |
$31.71
|
| Rate for Payer: UHC Medicaid |
$22.36
|
| Rate for Payer: UHC Medicare Advantage |
$31.71
|
| Rate for Payer: UHCCP Medicaid |
$22.36
|
| Rate for Payer: VA VA |
$31.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.12
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.35
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$23.71 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Commercial |
$12.72
|
| Rate for Payer: Aetna Commercial |
$17.84
|
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Commercial |
$11.12
|
| Rate for Payer: BCBS Trust/PPO |
$18.56
|
| Rate for Payer: BCBS Trust/PPO |
$21.76
|
| Rate for Payer: BCBS Trust/PPO |
$17.34
|
| Rate for Payer: BCBS Trust/PPO |
$12.36
|
| Rate for Payer: BCBS Trust/PPO |
$10.80
|
| Rate for Payer: BCN Commercial |
$18.56
|
| Rate for Payer: BCN Commercial |
$17.34
|
| Rate for Payer: BCN Commercial |
$10.80
|
| Rate for Payer: BCN Commercial |
$12.36
|
| Rate for Payer: BCN Commercial |
$21.76
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$22.66
|
| 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 |
$12.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.08
|
| Rate for Payer: Healthscope Commercial |
$13.47
|
| Rate for Payer: Healthscope Commercial |
$18.89
|
| Rate for Payer: Healthscope Commercial |
$11.77
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Healthscope Commercial |
$23.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: Nomi Health Commercial |
$10.73
|
| Rate for Payer: Nomi Health Commercial |
$12.28
|
| Rate for Payer: Nomi Health Commercial |
$17.21
|
| Rate for Payer: Nomi Health Commercial |
$18.43
|
| Rate for Payer: Nomi Health Commercial |
$21.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.74
|
| 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 |
$19.76
|
| Rate for Payer: PHP Commercial |
$12.72
|
| Rate for Payer: PHP Commercial |
$17.84
|
| Rate for Payer: PHP Commercial |
$22.40
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: PHP Commercial |
$11.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.77
|
| Rate for Payer: UHC Core |
$10.92
|
| Rate for Payer: UHC Core |
$12.50
|
| Rate for Payer: UHC Core |
$18.76
|
| Rate for Payer: UHC Core |
$22.00
|
| Rate for Payer: UHC Core |
$17.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.85
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.22
|
|
|
Service Code
|
HCPCS J2471
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$16.40 |
| Rate for Payer: Aetna Commercial |
$15.49
|
| Rate for Payer: Aetna Medicare |
$4.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.69
|
| Rate for Payer: BCBS Complete |
$3.37
|
| Rate for Payer: BCBS MAPPO |
$4.55
|
| Rate for Payer: BCBS Trust/PPO |
$14.98
|
| Rate for Payer: BCN Commercial |
$14.98
|
| Rate for Payer: BCN Medicare Advantage |
$4.55
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cofinity Commercial |
$15.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.55
|
| Rate for Payer: Healthscope Commercial |
$16.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.66
|
| Rate for Payer: Mclaren Medicaid |
$3.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.78
|
| Rate for Payer: Meridian Medicaid |
$3.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.49
|
| Rate for Payer: Nomi Health Commercial |
$14.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.66
|
| Rate for Payer: PACE Senior Care Partners |
$4.33
|
| Rate for Payer: PACE SWMI |
$4.55
|
| Rate for Payer: PHP Commercial |
$15.49
|
| Rate for Payer: PHP Medicare Advantage |
$4.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.85
|
| Rate for Payer: Priority Health Medicare |
$4.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.68
|
| Rate for Payer: Railroad Medicare Medicare |
$4.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.03
|
| Rate for Payer: UHC Core |
$15.21
|
| Rate for Payer: UHC Exchange |
$4.55
|
| Rate for Payer: UHC Medicaid |
$3.21
|
| Rate for Payer: UHC Medicare Advantage |
$4.55
|
| Rate for Payer: UHCCP Medicaid |
$3.21
|
| Rate for Payer: VA VA |
$4.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.66
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.35
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$23.71 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Commercial |
$12.72
|
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Commercial |
$11.12
|
| Rate for Payer: Aetna Commercial |
$17.84
|
| Rate for Payer: Aetna Medicare |
$3.89
|
| Rate for Payer: Aetna Medicare |
$6.85
|
| Rate for Payer: Aetna Medicare |
$5.46
|
| Rate for Payer: Aetna Medicare |
$3.40
|
| Rate for Payer: Aetna Medicare |
$5.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.02
|
| Rate for Payer: BCBS Complete |
$2.77
|
| Rate for Payer: BCBS Complete |
$2.42
|
| Rate for Payer: BCBS Complete |
$3.89
|
| Rate for Payer: BCBS Complete |
$4.88
|
| Rate for Payer: BCBS Complete |
$4.16
|
| Rate for Payer: BCBS MAPPO |
$6.59
|
| Rate for Payer: BCBS MAPPO |
$3.74
|
| Rate for Payer: BCBS MAPPO |
$3.27
|
| Rate for Payer: BCBS MAPPO |
$5.25
|
| Rate for Payer: BCBS MAPPO |
$5.62
|
| Rate for Payer: BCBS Trust/PPO |
$17.26
|
| Rate for Payer: BCBS Trust/PPO |
$10.75
|
| Rate for Payer: BCBS Trust/PPO |
$12.31
|
| Rate for Payer: BCBS Trust/PPO |
$21.66
|
| Rate for Payer: BCBS Trust/PPO |
$18.47
|
| Rate for Payer: BCN Commercial |
$17.26
|
| Rate for Payer: BCN Commercial |
$12.31
|
| Rate for Payer: BCN Commercial |
$10.75
|
| Rate for Payer: BCN Commercial |
$21.66
|
| Rate for Payer: BCN Commercial |
$18.47
|
| Rate for Payer: BCN Medicare Advantage |
$6.59
|
| Rate for Payer: BCN Medicare Advantage |
$5.62
|
| Rate for Payer: BCN Medicare Advantage |
$5.25
|
| Rate for Payer: BCN Medicare Advantage |
$3.74
|
| Rate for Payer: BCN Medicare Advantage |
$3.27
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Cofinity Commercial |
$18.05
|
| Rate for Payer: Cofinity Commercial |
$22.66
|
| Rate for Payer: Cofinity Commercial |
$11.25
|
| Rate for Payer: Cofinity Commercial |
$12.87
|
| 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 |
$16.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.25
|
| 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 |
$13.47
|
| Rate for Payer: Healthscope Commercial |
$18.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.74
|
| Rate for Payer: Mclaren Medicaid |
$2.64
|
| Rate for Payer: Mclaren Medicaid |
$3.96
|
| Rate for Payer: Mclaren Medicaid |
$3.70
|
| Rate for Payer: Mclaren Medicaid |
$4.65
|
| Rate for Payer: Mclaren Medicaid |
$2.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.51
|
| Rate for Payer: Meridian Medicaid |
$2.77
|
| Rate for Payer: Meridian Medicaid |
$2.42
|
| Rate for Payer: Meridian Medicaid |
$3.89
|
| Rate for Payer: Meridian Medicaid |
$4.16
|
| Rate for Payer: Meridian Medicaid |
$4.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.40
|
| Rate for Payer: Nomi Health Commercial |
$21.61
|
| Rate for Payer: Nomi Health Commercial |
$17.21
|
| Rate for Payer: Nomi Health Commercial |
$18.43
|
| Rate for Payer: Nomi Health Commercial |
$10.73
|
| Rate for Payer: Nomi Health Commercial |
$12.28
|
| 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 |
$15.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.76
|
| Rate for Payer: PACE Senior Care Partners |
$3.11
|
| Rate for Payer: PACE Senior Care Partners |
$3.56
|
| Rate for Payer: PACE Senior Care Partners |
$6.26
|
| Rate for Payer: PACE Senior Care Partners |
$5.34
|
| Rate for Payer: PACE Senior Care Partners |
$4.99
|
| Rate for Payer: PACE SWMI |
$3.27
|
| Rate for Payer: PACE SWMI |
$3.74
|
| Rate for Payer: PACE SWMI |
$5.25
|
| Rate for Payer: PACE SWMI |
$5.62
|
| Rate for Payer: PACE SWMI |
$6.59
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: PHP Commercial |
$11.12
|
| Rate for Payer: PHP Commercial |
$17.84
|
| Rate for Payer: PHP Commercial |
$12.72
|
| Rate for Payer: PHP Commercial |
$22.40
|
| Rate for Payer: PHP Medicare Advantage |
$3.74
|
| Rate for Payer: PHP Medicare Advantage |
$6.59
|
| Rate for Payer: PHP Medicare Advantage |
$3.27
|
| Rate for Payer: PHP Medicare Advantage |
$5.62
|
| Rate for Payer: PHP Medicare Advantage |
$5.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.02
|
| Rate for Payer: Priority Health Medicare |
$3.78
|
| Rate for Payer: Priority Health Medicare |
$6.65
|
| Rate for Payer: Priority Health Medicare |
$3.30
|
| Rate for Payer: Priority Health Medicare |
$5.67
|
| Rate for Payer: Priority Health Medicare |
$5.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.10
|
| Rate for Payer: Railroad Medicare Medicare |
$6.59
|
| Rate for Payer: Railroad Medicare Medicare |
$5.62
|
| Rate for Payer: Railroad Medicare Medicare |
$5.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3.27
|
| Rate for Payer: Railroad Medicare Medicare |
$3.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.19
|
| Rate for Payer: UHC Core |
$18.76
|
| Rate for Payer: UHC Core |
$10.92
|
| Rate for Payer: UHC Core |
$22.00
|
| Rate for Payer: UHC Core |
$17.53
|
| Rate for Payer: UHC Core |
$12.50
|
| Rate for Payer: UHC Exchange |
$3.27
|
| Rate for Payer: UHC Exchange |
$5.62
|
| Rate for Payer: UHC Exchange |
$3.74
|
| Rate for Payer: UHC Exchange |
$6.59
|
| Rate for Payer: UHC Exchange |
$5.25
|
| Rate for Payer: UHC Medicaid |
$4.65
|
| Rate for Payer: UHC Medicaid |
$3.96
|
| Rate for Payer: UHC Medicaid |
$2.64
|
| Rate for Payer: UHC Medicaid |
$3.70
|
| Rate for Payer: UHC Medicaid |
$2.31
|
| Rate for Payer: UHC Medicare Advantage |
$5.25
|
| Rate for Payer: UHC Medicare Advantage |
$3.27
|
| Rate for Payer: UHC Medicare Advantage |
$6.59
|
| Rate for Payer: UHC Medicare Advantage |
$3.74
|
| Rate for Payer: UHC Medicare Advantage |
$5.62
|
| Rate for Payer: UHCCP Medicaid |
$3.96
|
| Rate for Payer: UHCCP Medicaid |
$4.65
|
| Rate for Payer: UHCCP Medicaid |
$3.70
|
| Rate for Payer: UHCCP Medicaid |
$2.31
|
| Rate for Payer: UHCCP Medicaid |
$2.64
|
| Rate for Payer: VA VA |
$6.59
|
| Rate for Payer: VA VA |
$3.27
|
| Rate for Payer: VA VA |
$5.62
|
| Rate for Payer: VA VA |
$3.74
|
| Rate for Payer: VA VA |
$5.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.81
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.22
|
|
|
Service Code
|
HCPCS J2471
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$16.40 |
| Rate for Payer: Aetna Commercial |
$15.49
|
| Rate for Payer: BCBS Trust/PPO |
$15.05
|
| Rate for Payer: BCN Commercial |
$15.05
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cofinity Commercial |
$15.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.58
|
| Rate for Payer: Healthscope Commercial |
$16.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.49
|
| Rate for Payer: Nomi Health Commercial |
$14.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.66
|
| Rate for Payer: PHP Commercial |
$15.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.03
|
| Rate for Payer: UHC Core |
$15.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.66
|
|
|
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 |
$15.64 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: BCBS Trust/PPO |
$18.56
|
| Rate for Payer: BCN Commercial |
$18.56
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: Nomi Health Commercial |
$18.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.85
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.77
|
| Rate for Payer: UHC Core |
$18.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.85
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION FOR DRIP
|
Facility
|
OP
|
$22.47
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
301183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Medicare |
$5.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.02
|
| Rate for Payer: BCBS Complete |
$4.16
|
| Rate for Payer: BCBS MAPPO |
$5.62
|
| Rate for Payer: BCBS Trust/PPO |
$18.47
|
| Rate for Payer: BCN Commercial |
$18.47
|
| Rate for Payer: BCN Medicare Advantage |
$5.62
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.62
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.85
|
| Rate for Payer: Mclaren Medicaid |
$3.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.90
|
| Rate for Payer: Meridian Medicaid |
$4.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: Nomi Health Commercial |
$18.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.85
|
| Rate for Payer: PACE Senior Care Partners |
$5.34
|
| Rate for Payer: PACE SWMI |
$5.62
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: PHP Medicare Advantage |
$5.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.55
|
| Rate for Payer: Priority Health Medicare |
$5.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.64
|
| Rate for Payer: Railroad Medicare Medicare |
$5.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.77
|
| Rate for Payer: UHC Core |
$18.76
|
| Rate for Payer: UHC Exchange |
$5.62
|
| Rate for Payer: UHC Medicaid |
$3.96
|
| Rate for Payer: UHC Medicare Advantage |
$5.62
|
| Rate for Payer: UHCCP Medicaid |
$3.96
|
| Rate for Payer: VA VA |
$5.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.85
|
|
