|
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 |
$1.12 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna American Axle |
$1.65
|
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.65
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cofinity Advantage |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Healthscope Commercial |
$2.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.91
|
| Rate for Payer: PHP Commercial |
$2.16
|
| Rate for Payer: Priority Health SBD |
$1.60
|
| Rate for Payer: UMR Bronson Commercial |
$1.12
|
| 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 |
$46.93 |
| Max. Negotiated Rate |
$114.15 |
| Rate for Payer: Aetna American Axle |
$82.44
|
| Rate for Payer: Aetna Commercial |
$107.81
|
| Rate for Payer: Aetna Medicare |
$63.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.44
|
| Rate for Payer: BCBS Complete |
$50.73
|
| Rate for Payer: Cash Price |
$101.46
|
| Rate for Payer: Cofinity Advantage |
$88.78
|
| Rate for Payer: Cofinity Commercial |
$109.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.46
|
| Rate for Payer: Healthscope Commercial |
$114.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.12
|
| Rate for Payer: PHP Commercial |
$107.81
|
| Rate for Payer: Priority Health SBD |
$79.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.44
|
| Rate for Payer: UHC Core |
$66.08
|
| Rate for Payer: UHC Exchange |
$49.84
|
| Rate for Payer: UMR Bronson Commercial |
$46.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.12
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.22
|
|
|
Service Code
|
HCPCS J2471
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$16.40 |
| Rate for Payer: Aetna American Axle |
$11.84
|
| Rate for Payer: Aetna Commercial |
$15.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.84
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cofinity Advantage |
$12.75
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$12.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.66
|
| Rate for Payer: PHP Commercial |
$15.49
|
| Rate for Payer: Priority Health SBD |
$11.48
|
| Rate for Payer: UMR Bronson Commercial |
$8.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.66
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.22
|
|
|
Service Code
|
HCPCS J2471
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$16.40 |
| Rate for Payer: Aetna American Axle |
$11.84
|
| Rate for Payer: Aetna Commercial |
$15.49
|
| Rate for Payer: Aetna Medicare |
$9.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.84
|
| Rate for Payer: BCBS Complete |
$7.29
|
| Rate for Payer: BCBS Trust/PPO |
$11.30
|
| Rate for Payer: BCN Commercial |
$11.30
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cofinity Advantage |
$12.75
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$12.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.66
|
| Rate for Payer: PHP Commercial |
$15.49
|
| Rate for Payer: Priority Health SBD |
$11.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.24
|
| Rate for Payer: UHC Core |
$6.24
|
| Rate for Payer: UHC Exchange |
$6.24
|
| Rate for Payer: UMR Bronson Commercial |
$6.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.66
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15.77
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$14.83 |
| Rate for Payer: Aetna American Axle |
$10.25
|
| Rate for Payer: Aetna American Axle |
$13.65
|
| Rate for Payer: Aetna American Axle |
$14.61
|
| Rate for Payer: Aetna American Axle |
$9.73
|
| Rate for Payer: Aetna American Axle |
$15.85
|
| Rate for Payer: Aetna American Axle |
$13.64
|
| Rate for Payer: Aetna Commercial |
$20.73
|
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Commercial |
$17.84
|
| Rate for Payer: Aetna Commercial |
$12.72
|
| Rate for Payer: Aetna Commercial |
$17.85
|
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna Medicare |
$7.49
|
| Rate for Payer: Aetna Medicare |
$7.88
|
| Rate for Payer: Aetna Medicare |
$10.49
|
| Rate for Payer: Aetna Medicare |
$12.20
|
| Rate for Payer: Aetna Medicare |
$11.23
|
| Rate for Payer: Aetna Medicare |
$10.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.65
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS Complete |
$6.31
|
| Rate for Payer: BCBS Complete |
$5.99
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS Complete |
$8.99
|
| Rate for Payer: BCBS Complete |
$9.76
|
| Rate for Payer: BCBS Trust/PPO |
$14.83
|
| Rate for Payer: BCBS Trust/PPO |
$14.83
|
| Rate for Payer: BCBS Trust/PPO |
$14.83
|
| Rate for Payer: BCBS Trust/PPO |
$14.83
|
| Rate for Payer: BCBS Trust/PPO |
$14.83
|
| Rate for Payer: BCBS Trust/PPO |
$14.83
|
| Rate for Payer: BCN Commercial |
$14.83
|
| Rate for Payer: BCN Commercial |
$14.83
|
| Rate for Payer: BCN Commercial |
$14.83
|
| Rate for Payer: BCN Commercial |
$14.83
|
| Rate for Payer: BCN Commercial |
$14.83
|
| Rate for Payer: BCN Commercial |
$14.83
|
| Rate for Payer: Cash Price |
$19.51
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$19.51
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Advantage |
$14.70
|
| Rate for Payer: Cofinity Advantage |
$14.69
|
| Rate for Payer: Cofinity Advantage |
$17.07
|
| Rate for Payer: Cofinity Advantage |
$10.48
|
| Rate for Payer: Cofinity Advantage |
$11.04
|
| Rate for Payer: Cofinity Advantage |
$15.73
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Cofinity Commercial |
$12.87
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Cofinity Commercial |
$18.05
|
| Rate for Payer: Cofinity Commercial |
$18.06
|
| Rate for Payer: Cofinity Commercial |
$20.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$13.47
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Healthscope Commercial |
$18.89
|
| Rate for Payer: Healthscope Commercial |
$18.90
|
| Rate for Payer: Healthscope Commercial |
$21.95
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.74
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: PHP Commercial |
$17.84
|
| Rate for Payer: PHP Commercial |
$17.85
|
| Rate for Payer: PHP Commercial |
$12.72
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: PHP Commercial |
$20.73
|
| Rate for Payer: Priority Health SBD |
$13.23
|
| Rate for Payer: Priority Health SBD |
$9.43
|
| Rate for Payer: Priority Health SBD |
$9.94
|
| Rate for Payer: Priority Health SBD |
$15.37
|
| Rate for Payer: Priority Health SBD |
$13.22
|
| Rate for Payer: Priority Health SBD |
$14.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC Core |
$14.34
|
| Rate for Payer: UHC Core |
$14.34
|
| Rate for Payer: UHC Core |
$14.34
|
| Rate for Payer: UHC Core |
$14.34
|
| Rate for Payer: UHC Core |
$14.34
|
| Rate for Payer: UHC Core |
$14.34
|
| Rate for Payer: UHC Exchange |
$14.34
|
| Rate for Payer: UHC Exchange |
$14.34
|
| Rate for Payer: UHC Exchange |
$14.34
|
| Rate for Payer: UHC Exchange |
$14.34
|
| Rate for Payer: UHC Exchange |
$14.34
|
| Rate for Payer: UHC Exchange |
$14.34
|
| Rate for Payer: UMR Bronson Commercial |
$7.77
|
| Rate for Payer: UMR Bronson Commercial |
$8.31
|
| Rate for Payer: UMR Bronson Commercial |
$5.83
|
| Rate for Payer: UMR Bronson Commercial |
$5.54
|
| Rate for Payer: UMR Bronson Commercial |
$9.02
|
| Rate for Payer: UMR Bronson Commercial |
$7.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.75
|
| 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 |
$11.83
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.39
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$21.95 |
| Rate for Payer: Aetna American Axle |
$15.85
|
| Rate for Payer: Aetna American Axle |
$14.61
|
| Rate for Payer: Aetna American Axle |
$13.65
|
| Rate for Payer: Aetna American Axle |
$9.73
|
| Rate for Payer: Aetna American Axle |
$13.64
|
| Rate for Payer: Aetna American Axle |
$10.25
|
| Rate for Payer: Aetna Commercial |
$20.73
|
| Rate for Payer: Aetna Commercial |
$17.84
|
| Rate for Payer: Aetna Commercial |
$17.85
|
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Commercial |
$12.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.73
|
| Rate for Payer: Cash Price |
$19.51
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cofinity Advantage |
$14.70
|
| Rate for Payer: Cofinity Advantage |
$11.04
|
| Rate for Payer: Cofinity Advantage |
$10.48
|
| Rate for Payer: Cofinity Advantage |
$15.73
|
| Rate for Payer: Cofinity Advantage |
$14.69
|
| Rate for Payer: Cofinity Advantage |
$17.07
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Cofinity Commercial |
$18.06
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Cofinity Commercial |
$12.87
|
| Rate for Payer: Cofinity Commercial |
$18.05
|
| Rate for Payer: Cofinity Commercial |
$20.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.51
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Healthscope Commercial |
$13.47
|
| Rate for Payer: Healthscope Commercial |
$18.90
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Healthscope Commercial |
$18.89
|
| Rate for Payer: Healthscope Commercial |
$21.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.74
|
| Rate for Payer: PHP Commercial |
$17.84
|
| Rate for Payer: PHP Commercial |
$20.73
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: PHP Commercial |
$17.85
|
| Rate for Payer: PHP Commercial |
$12.72
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: Priority Health SBD |
$14.16
|
| Rate for Payer: Priority Health SBD |
$9.94
|
| Rate for Payer: Priority Health SBD |
$9.43
|
| Rate for Payer: Priority Health SBD |
$13.22
|
| Rate for Payer: Priority Health SBD |
$13.23
|
| Rate for Payer: Priority Health SBD |
$15.37
|
| Rate for Payer: UMR Bronson Commercial |
$9.89
|
| Rate for Payer: UMR Bronson Commercial |
$9.24
|
| Rate for Payer: UMR Bronson Commercial |
$9.24
|
| Rate for Payer: UMR Bronson Commercial |
$6.94
|
| Rate for Payer: UMR Bronson Commercial |
$10.73
|
| Rate for Payer: UMR Bronson Commercial |
$6.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.74
|
|
|
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 |
$9.89 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Aetna American Axle |
$14.61
|
| Rate for Payer: Aetna American Axle |
$15.85
|
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Commercial |
$20.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.85
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cash Price |
$19.51
|
| Rate for Payer: Cofinity Advantage |
$17.07
|
| Rate for Payer: Cofinity Advantage |
$15.73
|
| Rate for Payer: Cofinity Commercial |
$20.98
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.51
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Healthscope Commercial |
$21.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.29
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: PHP Commercial |
$20.73
|
| Rate for Payer: Priority Health SBD |
$15.37
|
| Rate for Payer: Priority Health SBD |
$14.16
|
| Rate for Payer: UMR Bronson Commercial |
$9.89
|
| Rate for Payer: UMR Bronson Commercial |
$10.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.29
|
|
|
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 |
$8.31 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Aetna American Axle |
$14.61
|
| Rate for Payer: Aetna American Axle |
$15.85
|
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Commercial |
$20.73
|
| Rate for Payer: Aetna Medicare |
$11.23
|
| Rate for Payer: Aetna Medicare |
$12.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.85
|
| Rate for Payer: BCBS Complete |
$9.76
|
| Rate for Payer: BCBS Complete |
$8.99
|
| Rate for Payer: BCBS Trust/PPO |
$14.83
|
| Rate for Payer: BCBS Trust/PPO |
$14.83
|
| Rate for Payer: BCN Commercial |
$14.83
|
| Rate for Payer: BCN Commercial |
$14.83
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cash Price |
$19.51
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cash Price |
$19.51
|
| Rate for Payer: Cofinity Advantage |
$15.73
|
| Rate for Payer: Cofinity Advantage |
$17.07
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Cofinity Commercial |
$20.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.51
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Healthscope Commercial |
$21.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.85
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: PHP Commercial |
$20.73
|
| Rate for Payer: Priority Health SBD |
$14.16
|
| Rate for Payer: Priority Health SBD |
$15.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.34
|
| Rate for Payer: UHC Core |
$14.34
|
| Rate for Payer: UHC Core |
$14.34
|
| Rate for Payer: UHC Exchange |
$14.34
|
| Rate for Payer: UHC Exchange |
$14.34
|
| Rate for Payer: UMR Bronson Commercial |
$8.31
|
| Rate for Payer: UMR Bronson Commercial |
$9.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.29
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$193.80
|
|
|
Service Code
|
NDC 00904647461
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.27 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna American Axle |
$125.97
|
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Advantage |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.04
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.35
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health SBD |
$122.09
|
| Rate for Payer: UMR Bronson Commercial |
$85.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.35
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$217.85
|
|
|
Service Code
|
NDC 13668042990
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna American Axle |
$141.60
|
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna Medicare |
$108.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.60
|
| Rate for Payer: BCBS Complete |
$87.14
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Advantage |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.39
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health SBD |
$137.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.60
|
| Rate for Payer: UHC Core |
$113.50
|
| Rate for Payer: UHC Exchange |
$85.62
|
| Rate for Payer: UMR Bronson Commercial |
$80.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.39
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$120.56
|
|
|
Service Code
|
NDC 65862056090
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.61 |
| Max. Negotiated Rate |
$108.50 |
| Rate for Payer: Aetna American Axle |
$78.36
|
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: Aetna Medicare |
$60.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.36
|
| Rate for Payer: BCBS Complete |
$48.22
|
| Rate for Payer: Cash Price |
$96.45
|
| Rate for Payer: Cofinity Advantage |
$84.39
|
| Rate for Payer: Cofinity Commercial |
$103.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.45
|
| Rate for Payer: Healthscope Commercial |
$108.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.42
|
| Rate for Payer: PHP Commercial |
$102.48
|
| Rate for Payer: Priority Health SBD |
$75.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.36
|
| Rate for Payer: UHC Core |
$62.81
|
| Rate for Payer: UHC Exchange |
$47.38
|
| Rate for Payer: UMR Bronson Commercial |
$44.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.42
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$276.36
|
|
|
Service Code
|
NDC 00904687045
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.60 |
| Max. Negotiated Rate |
$248.72 |
| Rate for Payer: Aetna American Axle |
$179.63
|
| Rate for Payer: Aetna Commercial |
$234.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.63
|
| Rate for Payer: Cash Price |
$221.09
|
| Rate for Payer: Cofinity Advantage |
$193.45
|
| Rate for Payer: Cofinity Commercial |
$237.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.09
|
| Rate for Payer: Healthscope Commercial |
$248.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.27
|
| Rate for Payer: PHP Commercial |
$234.91
|
| Rate for Payer: Priority Health SBD |
$174.11
|
| Rate for Payer: UMR Bronson Commercial |
$121.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.27
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$120.56
|
|
|
Service Code
|
NDC 65862056090
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.05 |
| Max. Negotiated Rate |
$108.50 |
| Rate for Payer: Aetna American Axle |
$78.36
|
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.36
|
| Rate for Payer: Cash Price |
$96.45
|
| Rate for Payer: Cofinity Advantage |
$84.39
|
| Rate for Payer: Cofinity Commercial |
$103.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.45
|
| Rate for Payer: Healthscope Commercial |
$108.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.42
|
| Rate for Payer: PHP Commercial |
$102.48
|
| Rate for Payer: Priority Health SBD |
$75.95
|
| Rate for Payer: UMR Bronson Commercial |
$53.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.42
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$276.36
|
|
|
Service Code
|
NDC 00904687045
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.25 |
| Max. Negotiated Rate |
$248.72 |
| Rate for Payer: Aetna American Axle |
$179.63
|
| Rate for Payer: Aetna Commercial |
$234.91
|
| Rate for Payer: Aetna Medicare |
$138.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.63
|
| Rate for Payer: BCBS Complete |
$110.54
|
| Rate for Payer: Cash Price |
$221.09
|
| Rate for Payer: Cofinity Advantage |
$193.45
|
| Rate for Payer: Cofinity Commercial |
$237.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.09
|
| Rate for Payer: Healthscope Commercial |
$248.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.27
|
| Rate for Payer: PHP Commercial |
$234.91
|
| Rate for Payer: Priority Health SBD |
$174.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.63
|
| Rate for Payer: UHC Core |
$143.98
|
| Rate for Payer: UHC Exchange |
$108.61
|
| Rate for Payer: UMR Bronson Commercial |
$102.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.27
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$217.85
|
|
|
Service Code
|
NDC 13668042990
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna American Axle |
$141.60
|
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.60
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Advantage |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.39
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health SBD |
$137.25
|
| Rate for Payer: UMR Bronson Commercial |
$95.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.39
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$193.80
|
|
|
Service Code
|
NDC 00904647461
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.71 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna American Axle |
$125.97
|
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna Medicare |
$96.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: BCBS Complete |
$77.52
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Advantage |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.04
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.35
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health SBD |
$122.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.97
|
| Rate for Payer: UHC Core |
$100.97
|
| Rate for Payer: UHC Exchange |
$76.16
|
| Rate for Payer: UMR Bronson Commercial |
$71.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.35
|
|
|
PAPAVERINE 30MG/ML 2 ML IN 30ML NS IRRIGATION
|
Facility
|
IP
|
$73.16
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
500528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.19 |
| Max. Negotiated Rate |
$65.84 |
| Rate for Payer: Aetna American Axle |
$47.55
|
| Rate for Payer: Aetna Commercial |
$62.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.55
|
| Rate for Payer: Cash Price |
$58.53
|
| Rate for Payer: Cofinity Advantage |
$51.21
|
| Rate for Payer: Cofinity Commercial |
$62.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.53
|
| Rate for Payer: Healthscope Commercial |
$65.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.87
|
| Rate for Payer: PHP Commercial |
$62.19
|
| Rate for Payer: Priority Health SBD |
$46.09
|
| Rate for Payer: UMR Bronson Commercial |
$32.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.87
|
|
|
PAPAVERINE 30MG/ML 2 ML IN 30ML NS IRRIGATION
|
Facility
|
OP
|
$73.16
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
500528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.07 |
| Max. Negotiated Rate |
$106.97 |
| Rate for Payer: Aetna American Axle |
$47.55
|
| Rate for Payer: Aetna Commercial |
$62.19
|
| Rate for Payer: Aetna Medicare |
$36.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.55
|
| Rate for Payer: BCBS Complete |
$29.26
|
| Rate for Payer: BCBS Trust/PPO |
$106.97
|
| Rate for Payer: BCN Commercial |
$106.97
|
| Rate for Payer: Cash Price |
$58.53
|
| Rate for Payer: Cash Price |
$58.53
|
| Rate for Payer: Cofinity Advantage |
$51.21
|
| Rate for Payer: Cofinity Commercial |
$62.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.53
|
| Rate for Payer: Healthscope Commercial |
$65.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.87
|
| Rate for Payer: PHP Commercial |
$62.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$39.75
|
| Rate for Payer: Priority Health SBD |
$46.09
|
| Rate for Payer: Priority Health Tiered Network |
$31.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.80
|
| Rate for Payer: UHC Core |
$75.80
|
| Rate for Payer: UHC Exchange |
$75.80
|
| Rate for Payer: UMR Bronson Commercial |
$27.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.87
|
|
|
PAPAVERINE 30 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$68.78
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
6030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.26 |
| Max. Negotiated Rate |
$61.90 |
| Rate for Payer: Aetna American Axle |
$44.71
|
| Rate for Payer: Aetna Commercial |
$58.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.71
|
| Rate for Payer: Cash Price |
$55.02
|
| Rate for Payer: Cofinity Advantage |
$48.15
|
| Rate for Payer: Cofinity Commercial |
$59.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.02
|
| Rate for Payer: Healthscope Commercial |
$61.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.59
|
| Rate for Payer: PHP Commercial |
$58.46
|
| Rate for Payer: Priority Health SBD |
$43.33
|
| Rate for Payer: UMR Bronson Commercial |
$30.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.59
|
|
|
PAPAVERINE 30 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$68.78
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
6030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$106.97 |
| Rate for Payer: Aetna American Axle |
$44.71
|
| Rate for Payer: Aetna Commercial |
$58.46
|
| Rate for Payer: Aetna Medicare |
$34.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.71
|
| Rate for Payer: BCBS Complete |
$27.51
|
| Rate for Payer: BCBS Trust/PPO |
$106.97
|
| Rate for Payer: BCN Commercial |
$106.97
|
| Rate for Payer: Cash Price |
$55.02
|
| Rate for Payer: Cash Price |
$55.02
|
| Rate for Payer: Cofinity Advantage |
$48.15
|
| Rate for Payer: Cofinity Commercial |
$59.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.02
|
| Rate for Payer: Healthscope Commercial |
$61.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.59
|
| Rate for Payer: PHP Commercial |
$58.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$39.75
|
| Rate for Payer: Priority Health SBD |
$43.33
|
| Rate for Payer: Priority Health Tiered Network |
$31.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.80
|
| Rate for Payer: UHC Core |
$75.80
|
| Rate for Payer: UHC Exchange |
$75.80
|
| Rate for Payer: UMR Bronson Commercial |
$25.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.59
|
|
|
PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH REMOVAL OF AQUEOUS
|
Facility
|
OP
|
$7,436.46
|
|
|
Service Code
|
CPT 65800
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,202.65 |
| Max. Negotiated Rate |
$7,436.46 |
| Rate for Payer: Aetna Medicare |
$2,391.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,874.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,874.40
|
| Rate for Payer: BCBS Complete |
$1,262.90
|
| Rate for Payer: BCBS MAPPO |
$2,299.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,839.59
|
| Rate for Payer: BCN Commercial |
$1,839.59
|
| Rate for Payer: BCN Medicare Advantage |
$2,299.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,299.52
|
| Rate for Payer: Mclaren Medicaid |
$2,299.52
|
| Rate for Payer: Mclaren Medicare |
$2,299.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,414.50
|
| Rate for Payer: Meridian Medicaid |
$2,414.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,644.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,529.47
|
| Rate for Payer: Nomi Health Commercial |
$6,898.56
|
| Rate for Payer: PACE Medicare |
$2,184.54
|
| Rate for Payer: PACE SWMI |
$2,299.52
|
| Rate for Payer: PHP Medicare Advantage |
$2,299.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,202.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7,436.46
|
| Rate for Payer: Priority Health Medicare |
$2,299.52
|
| Rate for Payer: Priority Health Tiered Network |
$5,949.17
|
| Rate for Payer: Railroad Medicare Medicare |
$2,299.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,299.52
|
| Rate for Payer: UHC Medicaid |
$1,202.65
|
| Rate for Payer: UHCCP Medicaid |
$1,202.65
|
| Rate for Payer: VA VA |
$2,299.52
|
|
|
PARATHYROID AUTOTRANSPLANTATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$1,073.07
|
|
|
Service Code
|
CPT 60512
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,073.07 |
| Max. Negotiated Rate |
$1,073.07 |
| Rate for Payer: BCBS Trust/PPO |
$1,073.07
|
| Rate for Payer: BCN Commercial |
$1,073.07
|
|
|
PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID(S);
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 60500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$7,572.19
|
| Rate for Payer: BCN Commercial |
$7,572.19
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID(S); RE-EXPLORATION
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 60502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$4,661.12
|
| Rate for Payer: BCN Commercial |
$4,661.12
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
PARAVAGINAL DEFECT REPAIR (INCLUDING REPAIR OF CYSTOCELE, IF PERFORMED); VAGINAL APPROACH
|
Facility
|
OP
|
$23,894.64
|
|
|
Service Code
|
CPT 57285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,864.33 |
| Max. Negotiated Rate |
$23,894.64 |
| Rate for Payer: Aetna Medicare |
$7,684.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,235.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,235.96
|
| Rate for Payer: BCBS Complete |
$4,057.91
|
| Rate for Payer: BCBS MAPPO |
$7,388.77
|
| Rate for Payer: BCBS Trust/PPO |
$4,864.03
|
| Rate for Payer: BCN Commercial |
$4,864.03
|
| Rate for Payer: BCN Medicare Advantage |
$7,388.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,388.77
|
| Rate for Payer: Mclaren Medicaid |
$7,388.77
|
| Rate for Payer: Mclaren Medicare |
$7,388.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,758.21
|
| Rate for Payer: Meridian Medicaid |
$7,758.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,497.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,127.65
|
| Rate for Payer: Nomi Health Commercial |
$22,166.31
|
| Rate for Payer: PACE Medicare |
$7,019.33
|
| Rate for Payer: PACE SWMI |
$7,388.77
|
| Rate for Payer: PHP Medicare Advantage |
$7,388.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,864.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,894.64
|
| Rate for Payer: Priority Health Medicare |
$7,388.77
|
| Rate for Payer: Priority Health Tiered Network |
$19,115.71
|
| Rate for Payer: Railroad Medicare Medicare |
$7,388.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,388.77
|
| Rate for Payer: UHC Medicaid |
$3,864.33
|
| Rate for Payer: UHCCP Medicaid |
$3,864.33
|
| Rate for Payer: VA VA |
$7,388.77
|
|
