|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$12.83
|
|
|
Service Code
|
NDC 00904742730
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Aetna Commercial |
$10.91
|
| Rate for Payer: Aetna Medicare |
$3.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.01
|
| Rate for Payer: BCBS Complete |
$5.13
|
| Rate for Payer: BCBS MAPPO |
$3.21
|
| Rate for Payer: BCBS Trust/PPO |
$10.55
|
| Rate for Payer: BCN Commercial |
$9.98
|
| Rate for Payer: BCN Medicare Advantage |
$3.21
|
| Rate for Payer: Cash Price |
$10.26
|
| Rate for Payer: Cofinity Commercial |
$11.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.21
|
| Rate for Payer: Healthscope Commercial |
$11.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.91
|
| Rate for Payer: Nomi Health Commercial |
$10.52
|
| Rate for Payer: PACE Senior Care Partners |
$3.05
|
| Rate for Payer: PACE SWMI |
$3.21
|
| Rate for Payer: PHP Commercial |
$10.91
|
| Rate for Payer: PHP Medicare Advantage |
$3.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.34
|
| Rate for Payer: Priority Health HMO/PPO |
$11.16
|
| Rate for Payer: Priority Health Medicare |
$3.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.60
|
| Rate for Payer: Railroad Medicare Medicare |
$3.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.29
|
| Rate for Payer: UHC Core |
$10.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.21
|
| Rate for Payer: UHC Exchange |
$3.21
|
| Rate for Payer: UHC Medicare Advantage |
$3.21
|
| Rate for Payer: VA VA |
$3.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.62
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$41.06
|
|
|
Service Code
|
NDC 41100081125
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$36.95 |
| Rate for Payer: Aetna Commercial |
$34.90
|
| Rate for Payer: Aetna Medicare |
$10.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.83
|
| Rate for Payer: BCBS Complete |
$16.42
|
| Rate for Payer: BCBS MAPPO |
$10.26
|
| Rate for Payer: BCBS Trust/PPO |
$33.76
|
| Rate for Payer: BCN Commercial |
$31.92
|
| Rate for Payer: BCN Medicare Advantage |
$10.26
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cofinity Commercial |
$35.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.26
|
| Rate for Payer: Healthscope Commercial |
$36.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.90
|
| Rate for Payer: Nomi Health Commercial |
$33.67
|
| Rate for Payer: PACE Senior Care Partners |
$9.75
|
| Rate for Payer: PACE SWMI |
$10.26
|
| Rate for Payer: PHP Commercial |
$34.90
|
| Rate for Payer: PHP Medicare Advantage |
$10.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.69
|
| Rate for Payer: Priority Health HMO/PPO |
$35.72
|
| Rate for Payer: Priority Health Medicare |
$10.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.51
|
| Rate for Payer: Railroad Medicare Medicare |
$10.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.13
|
| Rate for Payer: UHC Core |
$34.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.26
|
| Rate for Payer: UHC Exchange |
$10.26
|
| Rate for Payer: UHC Medicare Advantage |
$10.26
|
| Rate for Payer: VA VA |
$10.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.80
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$11.34
|
|
|
Service Code
|
NDC 00904743535
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$10.21 |
| Rate for Payer: Aetna Commercial |
$9.64
|
| Rate for Payer: Aetna Medicare |
$2.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.54
|
| Rate for Payer: BCBS Complete |
$4.54
|
| Rate for Payer: BCBS MAPPO |
$2.84
|
| Rate for Payer: BCBS Trust/PPO |
$9.32
|
| Rate for Payer: BCN Commercial |
$8.82
|
| Rate for Payer: BCN Medicare Advantage |
$2.84
|
| Rate for Payer: Cash Price |
$9.07
|
| Rate for Payer: Cofinity Commercial |
$9.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.84
|
| Rate for Payer: Healthscope Commercial |
$10.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.64
|
| Rate for Payer: Nomi Health Commercial |
$9.30
|
| Rate for Payer: PACE Senior Care Partners |
$2.69
|
| Rate for Payer: PACE SWMI |
$2.84
|
| Rate for Payer: PHP Commercial |
$9.64
|
| Rate for Payer: PHP Medicare Advantage |
$2.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.37
|
| Rate for Payer: Priority Health HMO/PPO |
$9.87
|
| Rate for Payer: Priority Health Medicare |
$2.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.98
|
| Rate for Payer: UHC Core |
$9.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.84
|
| Rate for Payer: UHC Exchange |
$2.84
|
| Rate for Payer: UHC Medicare Advantage |
$2.84
|
| Rate for Payer: VA VA |
$2.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.50
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$5.22
|
|
|
Service Code
|
NDC 00904571130
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: Aetna Commercial |
$4.44
|
| Rate for Payer: BCBS Trust/PPO |
$4.26
|
| Rate for Payer: BCN Commercial |
$4.03
|
| 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: PHP Commercial |
$4.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.39
|
| Rate for Payer: Priority Health HMO/PPO |
$4.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.50
|
| 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
|
|
|
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 |
$8.50 |
| Max. Negotiated Rate |
$11.77 |
| Rate for Payer: Aetna Commercial |
$11.12
|
| Rate for Payer: BCBS Trust/PPO |
$10.68
|
| Rate for Payer: BCN Commercial |
$10.11
|
| 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: PHP Commercial |
$11.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.50
|
| Rate for Payer: Priority Health HMO/PPO |
$11.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.76
|
| 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 |
$3.11 |
| 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 |
$5.23
|
| Rate for Payer: BCBS MAPPO |
$3.27
|
| Rate for Payer: BCBS Trust/PPO |
$10.75
|
| Rate for Payer: BCN Commercial |
$10.17
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.12
|
| Rate for Payer: Nomi Health Commercial |
$10.73
|
| 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 Cigna Priority Health |
$8.50
|
| Rate for Payer: Priority Health HMO/PPO |
$11.38
|
| Rate for Payer: Priority Health Medicare |
$3.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.76
|
| 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 Dual Complete DSNP |
$3.27
|
| Rate for Payer: UHC Exchange |
$3.27
|
| Rate for Payer: UHC Medicare Advantage |
$3.27
|
| 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 |
$24.79 |
| Max. Negotiated Rate |
$34.33 |
| Rate for Payer: Aetna Commercial |
$32.42
|
| Rate for Payer: BCBS Trust/PPO |
$31.13
|
| Rate for Payer: BCN Commercial |
$29.47
|
| 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 |
$28.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.42
|
| Rate for Payer: Nomi Health Commercial |
$31.27
|
| Rate for Payer: PHP Commercial |
$32.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.79
|
| Rate for Payer: Priority Health HMO/PPO |
$33.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.55
|
| 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 |
$28.60
|
|
|
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 |
$9.06 |
| 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 |
$15.26
|
| Rate for Payer: BCBS MAPPO |
$9.54
|
| Rate for Payer: BCBS Trust/PPO |
$31.35
|
| Rate for Payer: BCN Commercial |
$29.65
|
| 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 |
$28.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.42
|
| Rate for Payer: Nomi Health Commercial |
$31.27
|
| 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 Cigna Priority Health |
$24.79
|
| Rate for Payer: Priority Health HMO/PPO |
$33.18
|
| Rate for Payer: Priority Health Medicare |
$9.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.55
|
| 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 Dual Complete DSNP |
$9.54
|
| Rate for Payer: UHC Exchange |
$9.54
|
| Rate for Payer: UHC Medicare Advantage |
$9.54
|
| Rate for Payer: VA VA |
$9.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.60
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$2.20
|
|
|
Service Code
|
NDC 50268058511
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Medicare |
$0.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.69
|
| Rate for Payer: BCBS Complete |
$0.88
|
| Rate for Payer: BCBS MAPPO |
$0.55
|
| Rate for Payer: BCBS Trust/PPO |
$1.81
|
| Rate for Payer: BCN Commercial |
$1.71
|
| Rate for Payer: BCN Medicare Advantage |
$0.55
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cofinity Commercial |
$1.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.55
|
| Rate for Payer: Healthscope Commercial |
$1.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.87
|
| Rate for Payer: Nomi Health Commercial |
$1.80
|
| Rate for Payer: PACE Senior Care Partners |
$0.52
|
| Rate for Payer: PACE SWMI |
$0.55
|
| Rate for Payer: PHP Commercial |
$1.87
|
| Rate for Payer: PHP Medicare Advantage |
$0.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.43
|
| Rate for Payer: Priority Health HMO/PPO |
$1.91
|
| Rate for Payer: Priority Health Medicare |
$0.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.47
|
| Rate for Payer: Railroad Medicare Medicare |
$0.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.94
|
| Rate for Payer: UHC Core |
$1.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.55
|
| Rate for Payer: UHC Exchange |
$0.55
|
| Rate for Payer: UHC Medicare Advantage |
$0.55
|
| Rate for Payer: VA VA |
$0.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.65
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$2.20
|
|
|
Service Code
|
NDC 50268058511
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: BCBS Trust/PPO |
$1.80
|
| Rate for Payer: BCN Commercial |
$1.70
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cofinity Commercial |
$1.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.76
|
| Rate for Payer: Healthscope Commercial |
$1.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.87
|
| Rate for Payer: Nomi Health Commercial |
$1.80
|
| Rate for Payer: PHP Commercial |
$1.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.43
|
| Rate for Payer: Priority Health HMO/PPO |
$1.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.94
|
| Rate for Payer: UHC Core |
$1.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.65
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$109.73
|
|
|
Service Code
|
NDC 50268058515
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.06 |
| Max. Negotiated Rate |
$98.76 |
| Rate for Payer: Aetna Commercial |
$93.27
|
| Rate for Payer: Aetna Medicare |
$28.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.29
|
| Rate for Payer: BCBS Complete |
$43.89
|
| Rate for Payer: BCBS MAPPO |
$27.43
|
| Rate for Payer: BCBS Trust/PPO |
$90.21
|
| Rate for Payer: BCN Commercial |
$85.32
|
| Rate for Payer: BCN Medicare Advantage |
$27.43
|
| Rate for Payer: Cash Price |
$87.78
|
| Rate for Payer: Cofinity Commercial |
$94.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.43
|
| Rate for Payer: Healthscope Commercial |
$98.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.27
|
| Rate for Payer: Nomi Health Commercial |
$89.98
|
| Rate for Payer: PACE Senior Care Partners |
$26.06
|
| Rate for Payer: PACE SWMI |
$27.43
|
| Rate for Payer: PHP Commercial |
$93.27
|
| Rate for Payer: PHP Medicare Advantage |
$27.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.32
|
| Rate for Payer: Priority Health HMO/PPO |
$95.47
|
| Rate for Payer: Priority Health Medicare |
$27.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.52
|
| Rate for Payer: Railroad Medicare Medicare |
$27.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.56
|
| Rate for Payer: UHC Core |
$91.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.43
|
| Rate for Payer: UHC Exchange |
$27.43
|
| Rate for Payer: UHC Medicare Advantage |
$27.43
|
| Rate for Payer: VA VA |
$27.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.30
|
|
|
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 |
$0.51 |
| 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 |
$0.86
|
| Rate for Payer: BCBS MAPPO |
$0.54
|
| Rate for Payer: BCBS Trust/PPO |
$1.78
|
| Rate for Payer: BCN Commercial |
$1.68
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Nomi Health Commercial |
$1.77
|
| 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 Cigna Priority Health |
$1.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1.88
|
| Rate for Payer: Priority Health Medicare |
$0.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.45
|
| 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 Dual Complete DSNP |
$0.54
|
| Rate for Payer: UHC Exchange |
$0.54
|
| Rate for Payer: UHC Medicare Advantage |
$0.54
|
| 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
|
$2.16
|
|
|
Service Code
|
NDC 68084064311
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: BCBS Trust/PPO |
$1.76
|
| Rate for Payer: BCN Commercial |
$1.67
|
| 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: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.45
|
| 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
|
OP
|
$215.65
|
|
|
Service Code
|
NDC 68084064301
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.22 |
| Max. Negotiated Rate |
$194.08 |
| 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 |
$86.26
|
| Rate for Payer: BCBS MAPPO |
$53.91
|
| Rate for Payer: BCBS Trust/PPO |
$177.29
|
| Rate for Payer: BCN Commercial |
$167.67
|
| 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 |
$194.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Nomi Health Commercial |
$176.83
|
| 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 Cigna Priority Health |
$140.17
|
| Rate for Payer: Priority Health HMO/PPO |
$187.62
|
| Rate for Payer: Priority Health Medicare |
$54.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.49
|
| 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 Dual Complete DSNP |
$53.91
|
| Rate for Payer: UHC Exchange |
$53.91
|
| Rate for Payer: UHC Medicare Advantage |
$53.91
|
| 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
|
IP
|
$215.65
|
|
|
Service Code
|
NDC 68084064301
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.17 |
| Max. Negotiated Rate |
$194.08 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: BCBS Trust/PPO |
$176.04
|
| Rate for Payer: BCN Commercial |
$166.65
|
| 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 |
$194.08
|
| 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: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.17
|
| Rate for Payer: Priority Health HMO/PPO |
$187.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.49
|
| 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
|
IP
|
$109.73
|
|
|
Service Code
|
NDC 50268058515
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.32 |
| Max. Negotiated Rate |
$98.76 |
| Rate for Payer: Aetna Commercial |
$93.27
|
| Rate for Payer: BCBS Trust/PPO |
$89.57
|
| Rate for Payer: BCN Commercial |
$84.80
|
| Rate for Payer: Cash Price |
$87.78
|
| Rate for Payer: Cofinity Commercial |
$94.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.78
|
| Rate for Payer: Healthscope Commercial |
$98.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.27
|
| Rate for Payer: Nomi Health Commercial |
$89.98
|
| Rate for Payer: PHP Commercial |
$93.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.32
|
| Rate for Payer: Priority Health HMO/PPO |
$95.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.56
|
| Rate for Payer: UHC Core |
$91.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.30
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.37
|
|
|
Service Code
|
HCPCS J2471
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$23.73 |
| Rate for Payer: Aetna Commercial |
$22.41
|
| Rate for Payer: BCBS Trust/PPO |
$21.53
|
| Rate for Payer: BCN Commercial |
$20.38
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cofinity Commercial |
$22.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.10
|
| Rate for Payer: Healthscope Commercial |
$23.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.41
|
| Rate for Payer: Nomi Health Commercial |
$21.62
|
| Rate for Payer: PHP Commercial |
$22.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.14
|
| Rate for Payer: Priority Health HMO/PPO |
$22.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.21
|
| Rate for Payer: UHC Core |
$22.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.78
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.70
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna Commercial |
$18.18
|
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Commercial |
$12.72
|
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.56
|
| Rate for Payer: Aetna Medicare |
$3.89
|
| Rate for Payer: Aetna Medicare |
$5.38
|
| Rate for Payer: Aetna Medicare |
$5.84
|
| Rate for Payer: Aetna Medicare |
$6.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.68
|
| 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 |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.02
|
| Rate for Payer: BCBS Complete |
$8.99
|
| Rate for Payer: BCBS Complete |
$5.99
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS Complete |
$8.56
|
| Rate for Payer: BCBS Complete |
$10.54
|
| Rate for Payer: BCBS MAPPO |
$5.35
|
| Rate for Payer: BCBS MAPPO |
$3.74
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS MAPPO |
$5.62
|
| Rate for Payer: BCBS MAPPO |
$6.59
|
| Rate for Payer: BCBS Trust/PPO |
$12.31
|
| Rate for Payer: BCBS Trust/PPO |
$17.02
|
| Rate for Payer: BCBS Trust/PPO |
$17.58
|
| Rate for Payer: BCBS Trust/PPO |
$21.66
|
| Rate for Payer: BCBS Trust/PPO |
$18.47
|
| Rate for Payer: BCN Commercial |
$20.49
|
| Rate for Payer: BCN Commercial |
$11.64
|
| Rate for Payer: BCN Commercial |
$16.09
|
| Rate for Payer: BCN Commercial |
$16.63
|
| Rate for Payer: BCN Commercial |
$17.47
|
| Rate for Payer: BCN Medicare Advantage |
$6.59
|
| Rate for Payer: BCN Medicare Advantage |
$5.62
|
| Rate for Payer: BCN Medicare Advantage |
$3.74
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.35
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cash Price |
$17.11
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cofinity Commercial |
$22.66
|
| Rate for Payer: Cofinity Commercial |
$12.87
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Cofinity Commercial |
$18.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.08
|
| 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 |
$17.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.74
|
| 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 |
$5.35
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$13.47
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Healthscope Commercial |
$19.25
|
| Rate for Payer: Healthscope Commercial |
$23.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.04
|
| 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 |
$5.61
|
| 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 |
$5.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.60
|
| 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 |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$18.43
|
| Rate for Payer: Nomi Health Commercial |
$17.54
|
| Rate for Payer: Nomi Health Commercial |
$21.61
|
| Rate for Payer: Nomi Health Commercial |
$12.28
|
| Rate for Payer: PACE Senior Care Partners |
$3.56
|
| Rate for Payer: PACE Senior Care Partners |
$5.34
|
| Rate for Payer: PACE Senior Care Partners |
$4.92
|
| Rate for Payer: PACE Senior Care Partners |
$5.08
|
| Rate for Payer: PACE Senior Care Partners |
$6.26
|
| Rate for Payer: PACE SWMI |
$3.74
|
| Rate for Payer: PACE SWMI |
$5.62
|
| Rate for Payer: PACE SWMI |
$5.35
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PACE SWMI |
$6.59
|
| Rate for Payer: PHP Commercial |
$22.40
|
| Rate for Payer: PHP Commercial |
$18.18
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: PHP Commercial |
$17.60
|
| Rate for Payer: PHP Commercial |
$12.72
|
| Rate for Payer: PHP Medicare Advantage |
$5.35
|
| Rate for Payer: PHP Medicare Advantage |
$5.62
|
| Rate for Payer: PHP Medicare Advantage |
$6.59
|
| Rate for Payer: PHP Medicare Advantage |
$3.74
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.73
|
| Rate for Payer: Priority Health HMO/PPO |
$13.02
|
| Rate for Payer: Priority Health HMO/PPO |
$18.61
|
| Rate for Payer: Priority Health HMO/PPO |
$22.92
|
| Rate for Payer: Priority Health HMO/PPO |
$19.55
|
| Rate for Payer: Priority Health HMO/PPO |
$18.01
|
| Rate for Payer: Priority Health Medicare |
$6.65
|
| Rate for Payer: Priority Health Medicare |
$5.40
|
| Rate for Payer: Priority Health Medicare |
$5.23
|
| Rate for Payer: Priority Health Medicare |
$5.67
|
| Rate for Payer: Priority Health Medicare |
$3.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.65
|
| Rate for Payer: Railroad Medicare Medicare |
$5.62
|
| Rate for Payer: Railroad Medicare Medicare |
$5.35
|
| Rate for Payer: Railroad Medicare Medicare |
$3.74
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.82
|
| Rate for Payer: UHC Core |
$17.28
|
| Rate for Payer: UHC Core |
$22.00
|
| Rate for Payer: UHC Core |
$17.86
|
| Rate for Payer: UHC Core |
$18.76
|
| Rate for Payer: UHC Core |
$12.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.35
|
| Rate for Payer: UHC Exchange |
$5.35
|
| Rate for Payer: UHC Exchange |
$6.59
|
| Rate for Payer: UHC Exchange |
$3.74
|
| Rate for Payer: UHC Exchange |
$5.62
|
| Rate for Payer: UHC Exchange |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$6.59
|
| Rate for Payer: UHC Medicare Advantage |
$5.35
|
| Rate for Payer: UHC Medicare Advantage |
$3.74
|
| Rate for Payer: UHC Medicare Advantage |
$5.62
|
| Rate for Payer: VA VA |
$3.74
|
| Rate for Payer: VA VA |
$5.62
|
| Rate for Payer: VA VA |
$5.18
|
| Rate for Payer: VA VA |
$6.59
|
| Rate for Payer: VA VA |
$5.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.85
|
| 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 |
$15.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.04
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.35
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.13 |
| Max. Negotiated Rate |
$23.72 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna Commercial |
$18.18
|
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Commercial |
$12.72
|
| Rate for Payer: BCBS Trust/PPO |
$18.34
|
| Rate for Payer: BCBS Trust/PPO |
$21.51
|
| Rate for Payer: BCBS Trust/PPO |
$17.46
|
| Rate for Payer: BCBS Trust/PPO |
$16.90
|
| Rate for Payer: BCBS Trust/PPO |
$12.22
|
| Rate for Payer: BCN Commercial |
$17.36
|
| Rate for Payer: BCN Commercial |
$16.53
|
| Rate for Payer: BCN Commercial |
$11.57
|
| Rate for Payer: BCN Commercial |
$16.00
|
| Rate for Payer: BCN Commercial |
$20.36
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cash Price |
$17.11
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$22.66
|
| Rate for Payer: Cofinity Commercial |
$12.87
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Cofinity Commercial |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| 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 |
$21.08
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$19.25
|
| Rate for Payer: Healthscope Commercial |
$13.47
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Healthscope Commercial |
$23.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.52
|
| 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 |
$16.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: Nomi Health Commercial |
$12.28
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$17.54
|
| Rate for Payer: Nomi Health Commercial |
$18.43
|
| Rate for Payer: Nomi Health Commercial |
$21.61
|
| Rate for Payer: PHP Commercial |
$18.18
|
| Rate for Payer: PHP Commercial |
$17.60
|
| Rate for Payer: PHP Commercial |
$12.72
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: PHP Commercial |
$22.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.73
|
| Rate for Payer: Priority Health HMO/PPO |
$13.02
|
| Rate for Payer: Priority Health HMO/PPO |
$22.92
|
| Rate for Payer: Priority Health HMO/PPO |
$18.61
|
| Rate for Payer: Priority Health HMO/PPO |
$19.55
|
| Rate for Payer: Priority Health HMO/PPO |
$18.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.77
|
| Rate for Payer: UHC Core |
$12.50
|
| Rate for Payer: UHC Core |
$17.28
|
| Rate for Payer: UHC Core |
$18.76
|
| Rate for Payer: UHC Core |
$22.00
|
| Rate for Payer: UHC Core |
$17.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.52
|
| 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
|
$26.37
|
|
|
Service Code
|
HCPCS J2471
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$23.73 |
| Rate for Payer: Aetna Commercial |
$22.41
|
| Rate for Payer: Aetna Medicare |
$6.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.24
|
| Rate for Payer: BCBS Complete |
$10.55
|
| Rate for Payer: BCBS MAPPO |
$6.59
|
| Rate for Payer: BCBS Trust/PPO |
$21.68
|
| Rate for Payer: BCN Commercial |
$20.50
|
| Rate for Payer: BCN Medicare Advantage |
$6.59
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cofinity Commercial |
$22.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.59
|
| Rate for Payer: Healthscope Commercial |
$23.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.41
|
| Rate for Payer: Nomi Health Commercial |
$21.62
|
| Rate for Payer: PACE Senior Care Partners |
$6.26
|
| Rate for Payer: PACE SWMI |
$6.59
|
| Rate for Payer: PHP Commercial |
$22.41
|
| Rate for Payer: PHP Medicare Advantage |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.14
|
| Rate for Payer: Priority Health HMO/PPO |
$22.94
|
| Rate for Payer: Priority Health Medicare |
$6.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$6.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.21
|
| Rate for Payer: UHC Core |
$22.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.59
|
| Rate for Payer: UHC Exchange |
$6.59
|
| Rate for Payer: UHC Medicare Advantage |
$6.59
|
| Rate for Payer: VA VA |
$6.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.78
|
|
|
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 |
$5.34 |
| 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 |
$8.99
|
| Rate for Payer: BCBS MAPPO |
$5.62
|
| Rate for Payer: BCBS Trust/PPO |
$18.47
|
| Rate for Payer: BCN Commercial |
$17.47
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: Nomi Health Commercial |
$18.43
|
| 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 Cigna Priority Health |
$14.61
|
| Rate for Payer: Priority Health HMO/PPO |
$19.55
|
| Rate for Payer: Priority Health Medicare |
$5.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.05
|
| 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 Dual Complete DSNP |
$5.62
|
| Rate for Payer: UHC Exchange |
$5.62
|
| Rate for Payer: UHC Medicare Advantage |
$5.62
|
| Rate for Payer: VA VA |
$5.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.85
|
|
|
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 |
$14.61 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: BCBS Trust/PPO |
$18.34
|
| Rate for Payer: BCN Commercial |
$17.36
|
| 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: PHP Commercial |
$19.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.61
|
| Rate for Payer: Priority Health HMO/PPO |
$19.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.05
|
| 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 TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$221.35
|
|
|
Service Code
|
NDC 51079005120
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.88 |
| Max. Negotiated Rate |
$199.22 |
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: BCBS Trust/PPO |
$180.69
|
| Rate for Payer: BCN Commercial |
$171.06
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Nomi Health Commercial |
$181.51
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.88
|
| Rate for Payer: Priority Health HMO/PPO |
$192.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.79
|
| Rate for Payer: UHC Core |
$184.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$270.72
|
|
|
Service Code
|
NDC 00904687045
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.97 |
| Max. Negotiated Rate |
$243.65 |
| Rate for Payer: Aetna Commercial |
$230.11
|
| Rate for Payer: BCBS Trust/PPO |
$220.99
|
| Rate for Payer: BCN Commercial |
$209.21
|
| Rate for Payer: Cash Price |
$216.58
|
| Rate for Payer: Cofinity Commercial |
$232.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.58
|
| Rate for Payer: Healthscope Commercial |
$243.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.11
|
| Rate for Payer: Nomi Health Commercial |
$221.99
|
| Rate for Payer: PHP Commercial |
$230.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.97
|
| Rate for Payer: Priority Health HMO/PPO |
$235.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.23
|
| Rate for Payer: UHC Core |
$226.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.04
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$4.47
|
|
|
Service Code
|
NDC 66993006851
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna Commercial |
$3.80
|
| Rate for Payer: Aetna Medicare |
$1.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.40
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: BCBS MAPPO |
$1.12
|
| Rate for Payer: BCBS Trust/PPO |
$3.67
|
| Rate for Payer: BCN Commercial |
$3.48
|
| Rate for Payer: BCN Medicare Advantage |
$1.12
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.12
|
| Rate for Payer: Healthscope Commercial |
$4.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.80
|
| Rate for Payer: Nomi Health Commercial |
$3.67
|
| Rate for Payer: PACE Senior Care Partners |
$1.06
|
| Rate for Payer: PACE SWMI |
$1.12
|
| Rate for Payer: PHP Commercial |
$3.80
|
| Rate for Payer: PHP Medicare Advantage |
$1.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.91
|
| Rate for Payer: Priority Health HMO/PPO |
$3.89
|
| Rate for Payer: Priority Health Medicare |
$1.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.99
|
| Rate for Payer: Railroad Medicare Medicare |
$1.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.93
|
| Rate for Payer: UHC Core |
$3.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.12
|
| Rate for Payer: UHC Exchange |
$1.12
|
| Rate for Payer: UHC Medicare Advantage |
$1.12
|
| Rate for Payer: VA VA |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.35
|
|
