|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$137.48
|
|
|
Service Code
|
NDC 65862055990
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.49 |
| Max. Negotiated Rate |
$123.73 |
| Rate for Payer: Aetna American Axle |
$89.36
|
| Rate for Payer: Aetna Commercial |
$116.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.36
|
| Rate for Payer: Cash Price |
$109.98
|
| Rate for Payer: Cofinity Commercial |
$118.23
|
| Rate for Payer: Cofinity Commercial |
$96.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.98
|
| Rate for Payer: Healthscope Commercial |
$123.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.86
|
| Rate for Payer: PHP Commercial |
$116.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.36
|
| Rate for Payer: Priority Health SBD |
$86.61
|
| Rate for Payer: UMR Bronson Commercial |
$60.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.11
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$1.98
|
|
|
Service Code
|
NDC 60687058511
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna American Axle |
$1.29
|
| Rate for Payer: Aetna Commercial |
$1.68
|
| Rate for Payer: Aetna Medicare |
$0.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.29
|
| Rate for Payer: BCBS Complete |
$0.79
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cofinity Commercial |
$1.39
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.58
|
| Rate for Payer: Healthscope Commercial |
$1.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.68
|
| Rate for Payer: PHP Commercial |
$1.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.29
|
| Rate for Payer: Priority Health SBD |
$1.25
|
| Rate for Payer: UMR Bronson Commercial |
$0.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.48
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$219.96
|
|
|
Service Code
|
NDC 00378668877
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.78 |
| Max. Negotiated Rate |
$197.96 |
| Rate for Payer: Cofinity Commercial |
$153.97
|
| Rate for Payer: Cofinity Commercial |
$189.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.97
|
| Rate for Payer: Aetna American Axle |
$142.97
|
| Rate for Payer: Aetna Commercial |
$186.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.97
|
| Rate for Payer: Cash Price |
$175.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.97
|
| Rate for Payer: Healthscope Commercial |
$197.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.97
|
| Rate for Payer: PHP Commercial |
$186.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.97
|
| Rate for Payer: Priority Health SBD |
$138.57
|
| Rate for Payer: UMR Bronson Commercial |
$96.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.97
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$219.96
|
|
|
Service Code
|
NDC 00378668877
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.39 |
| Max. Negotiated Rate |
$197.96 |
| Rate for Payer: Aetna American Axle |
$142.97
|
| Rate for Payer: Aetna Commercial |
$186.97
|
| Rate for Payer: Aetna Medicare |
$109.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.97
|
| Rate for Payer: BCBS Complete |
$87.98
|
| Rate for Payer: Cash Price |
$175.97
|
| Rate for Payer: Cofinity Commercial |
$153.97
|
| Rate for Payer: Cofinity Commercial |
$189.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.97
|
| Rate for Payer: Healthscope Commercial |
$197.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.97
|
| Rate for Payer: PHP Commercial |
$186.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.97
|
| Rate for Payer: Priority Health SBD |
$138.57
|
| Rate for Payer: UMR Bronson Commercial |
$81.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.97
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$224.19
|
|
|
Service Code
|
NDC 65162063609
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.64 |
| Max. Negotiated Rate |
$201.77 |
| Rate for Payer: Aetna American Axle |
$145.72
|
| Rate for Payer: Aetna Commercial |
$190.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.72
|
| Rate for Payer: Cash Price |
$179.35
|
| Rate for Payer: Cofinity Commercial |
$156.93
|
| Rate for Payer: Cofinity Commercial |
$192.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.35
|
| Rate for Payer: Healthscope Commercial |
$201.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.56
|
| Rate for Payer: PHP Commercial |
$190.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.72
|
| Rate for Payer: Priority Health SBD |
$141.24
|
| Rate for Payer: UMR Bronson Commercial |
$98.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.14
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$1.98
|
|
|
Service Code
|
NDC 60687058511
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna American Axle |
$1.29
|
| Rate for Payer: Aetna Commercial |
$1.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.29
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cofinity Commercial |
$1.39
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.58
|
| Rate for Payer: Healthscope Commercial |
$1.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.68
|
| Rate for Payer: PHP Commercial |
$1.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.29
|
| Rate for Payer: Priority Health SBD |
$1.25
|
| Rate for Payer: UMR Bronson Commercial |
$0.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.48
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$224.19
|
|
|
Service Code
|
NDC 65162063609
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.95 |
| Max. Negotiated Rate |
$201.77 |
| Rate for Payer: Aetna American Axle |
$145.72
|
| Rate for Payer: Aetna Commercial |
$190.56
|
| Rate for Payer: Aetna Medicare |
$112.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.72
|
| Rate for Payer: BCBS Complete |
$89.68
|
| Rate for Payer: Cash Price |
$179.35
|
| Rate for Payer: Cofinity Commercial |
$156.93
|
| Rate for Payer: Cofinity Commercial |
$192.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.35
|
| Rate for Payer: Healthscope Commercial |
$201.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.56
|
| Rate for Payer: PHP Commercial |
$190.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.72
|
| Rate for Payer: Priority Health SBD |
$141.24
|
| Rate for Payer: UMR Bronson Commercial |
$82.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.14
|
|
|
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 |
$0.97 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna American Axle |
$1.43
|
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.43
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cofinity Commercial |
$1.54
|
| Rate for Payer: Cofinity Commercial |
$1.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.76
|
| Rate for Payer: Healthscope Commercial |
$1.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.87
|
| Rate for Payer: PHP Commercial |
$1.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.43
|
| Rate for Payer: Priority Health SBD |
$1.39
|
| Rate for Payer: UMR Bronson Commercial |
$0.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.65
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.37
|
|
|
Service Code
|
HCPCS J2471
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$23.73 |
| Rate for Payer: Aetna American Axle |
$17.14
|
| Rate for Payer: Aetna Commercial |
$22.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.14
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Cofinity Commercial |
$22.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.10
|
| Rate for Payer: Healthscope Commercial |
$23.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.41
|
| Rate for Payer: PHP Commercial |
$22.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.14
|
| Rate for Payer: Priority Health SBD |
$16.61
|
| Rate for Payer: UMR Bronson Commercial |
$11.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.78
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.37
|
|
|
Service Code
|
HCPCS J2471
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$23.73 |
| Rate for Payer: Aetna American Axle |
$17.14
|
| Rate for Payer: Aetna Commercial |
$22.41
|
| Rate for Payer: Aetna Medicare |
$13.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.14
|
| Rate for Payer: BCBS Complete |
$10.55
|
| Rate for Payer: BCBS Trust/PPO |
$12.54
|
| Rate for Payer: BCN Commercial |
$12.54
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Cofinity Commercial |
$22.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.10
|
| Rate for Payer: Healthscope Commercial |
$23.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.41
|
| Rate for Payer: PHP Commercial |
$22.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.14
|
| Rate for Payer: Priority Health SBD |
$16.61
|
| Rate for Payer: UMR Bronson Commercial |
$9.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.78
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.45
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$22.90 |
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: PHP Commercial |
$21.63
|
| Rate for Payer: Aetna American Axle |
$16.54
|
| Rate for Payer: Aetna American Axle |
$10.25
|
| Rate for Payer: Aetna American Axle |
$9.73
|
| Rate for Payer: Aetna American Axle |
$13.46
|
| Rate for Payer: Aetna American Axle |
$13.65
|
| Rate for Payer: Aetna American Axle |
$14.61
|
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna Commercial |
$12.72
|
| Rate for Payer: Aetna Commercial |
$21.63
|
| Rate for Payer: Aetna Commercial |
$17.85
|
| Rate for Payer: Aetna Medicare |
$12.72
|
| Rate for Payer: Aetna Medicare |
$10.50
|
| Rate for Payer: Aetna Medicare |
$7.88
|
| Rate for Payer: Aetna Medicare |
$11.24
|
| Rate for Payer: Aetna Medicare |
$10.35
|
| Rate for Payer: Aetna Medicare |
$7.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.61
|
| Rate for Payer: BCBS Complete |
$8.99
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS Complete |
$5.99
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS Complete |
$6.31
|
| Rate for Payer: BCBS Complete |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$13.73
|
| Rate for Payer: BCN Commercial |
$13.73
|
| Rate for Payer: BCN Commercial |
$13.73
|
| Rate for Payer: BCN Commercial |
$13.73
|
| Rate for Payer: BCN Commercial |
$13.73
|
| Rate for Payer: BCN Commercial |
$13.73
|
| Rate for Payer: BCN Commercial |
$13.73
|
| Rate for Payer: Cash Price |
$20.36
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cash Price |
$20.36
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$12.87
|
| Rate for Payer: Cofinity Commercial |
$10.48
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Cofinity Commercial |
$15.73
|
| Rate for Payer: Cofinity Commercial |
$18.06
|
| Rate for Payer: Cofinity Commercial |
$14.70
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$21.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.36
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Healthscope Commercial |
$22.90
|
| Rate for Payer: Healthscope Commercial |
$18.90
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Healthscope Commercial |
$13.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.83
|
| 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 |
$15.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.85
|
| Rate for Payer: PHP Commercial |
$17.60
|
| Rate for Payer: PHP Commercial |
$17.85
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: PHP Commercial |
$12.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.25
|
| Rate for Payer: Priority Health SBD |
$14.16
|
| Rate for Payer: Priority Health SBD |
$9.94
|
| Rate for Payer: Priority Health SBD |
$13.04
|
| Rate for Payer: Priority Health SBD |
$13.23
|
| Rate for Payer: Priority Health SBD |
$9.43
|
| Rate for Payer: Priority Health SBD |
$16.03
|
| Rate for Payer: UMR Bronson Commercial |
$8.31
|
| Rate for Payer: UMR Bronson Commercial |
$9.42
|
| Rate for Payer: UMR Bronson Commercial |
$7.66
|
| Rate for Payer: UMR Bronson Commercial |
$5.54
|
| Rate for Payer: UMR Bronson Commercial |
$5.83
|
| Rate for Payer: UMR Bronson Commercial |
$7.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.75
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14.97
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$13.47 |
| Rate for Payer: Cofinity Commercial |
$12.87
|
| Rate for Payer: Cofinity Commercial |
$21.89
|
| Rate for Payer: Cofinity Commercial |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$15.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.49
|
| Rate for Payer: Aetna American Axle |
$9.73
|
| Rate for Payer: Aetna American Axle |
$14.61
|
| Rate for Payer: Aetna American Axle |
$13.65
|
| Rate for Payer: Aetna American Axle |
$10.25
|
| Rate for Payer: Aetna American Axle |
$13.46
|
| Rate for Payer: Aetna American Axle |
$16.54
|
| Rate for Payer: Aetna Commercial |
$12.72
|
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna Commercial |
$17.85
|
| Rate for Payer: Aetna Commercial |
$21.63
|
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.61
|
| 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 |
$16.56
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$20.36
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Cofinity Commercial |
$10.48
|
| Rate for Payer: Cofinity Commercial |
$18.06
|
| Rate for Payer: Cofinity Commercial |
$14.70
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.36
|
| Rate for Payer: Healthscope Commercial |
$18.90
|
| Rate for Payer: Healthscope Commercial |
$22.90
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$13.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.83
|
| 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 |
$15.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.60
|
| Rate for Payer: PHP Commercial |
$12.72
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: PHP Commercial |
$17.85
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: PHP Commercial |
$17.60
|
| Rate for Payer: PHP Commercial |
$21.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.54
|
| Rate for Payer: Priority Health SBD |
$14.16
|
| 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 |
$13.04
|
| Rate for Payer: Priority Health SBD |
$16.03
|
| Rate for Payer: UMR Bronson Commercial |
$11.20
|
| Rate for Payer: UMR Bronson Commercial |
$6.94
|
| Rate for Payer: UMR Bronson Commercial |
$9.11
|
| Rate for Payer: UMR Bronson Commercial |
$9.89
|
| Rate for Payer: UMR Bronson Commercial |
$9.24
|
| 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 |
$15.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.23
|
|
|
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 |
$16.54
|
| Rate for Payer: Aetna Commercial |
$21.63
|
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Medicare |
$11.24
|
| Rate for Payer: Aetna Medicare |
$12.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.54
|
| Rate for Payer: BCBS Complete |
$10.18
|
| Rate for Payer: BCBS Complete |
$8.99
|
| Rate for Payer: BCBS Trust/PPO |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$13.73
|
| Rate for Payer: BCN Commercial |
$13.73
|
| Rate for Payer: BCN Commercial |
$13.73
|
| Rate for Payer: Cash Price |
$20.36
|
| Rate for Payer: Cash Price |
$20.36
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$21.89
|
| Rate for Payer: Cofinity Commercial |
$15.73
|
| Rate for Payer: Cofinity Commercial |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$22.90
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.63
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: PHP Commercial |
$21.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.54
|
| Rate for Payer: Priority Health SBD |
$16.03
|
| Rate for Payer: Priority Health SBD |
$14.16
|
| Rate for Payer: UMR Bronson Commercial |
$8.31
|
| Rate for Payer: UMR Bronson Commercial |
$9.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.09
|
| 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 |
$9.89 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Aetna American Axle |
$14.61
|
| Rate for Payer: Aetna American Axle |
$16.54
|
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Commercial |
$21.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.54
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cash Price |
$20.36
|
| Rate for Payer: Cofinity Commercial |
$21.89
|
| Rate for Payer: Cofinity Commercial |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$15.73
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.36
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Healthscope Commercial |
$22.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: PHP Commercial |
$21.63
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.54
|
| Rate for Payer: Priority Health SBD |
$14.16
|
| Rate for Payer: Priority Health SBD |
$16.03
|
| Rate for Payer: UMR Bronson Commercial |
$9.89
|
| Rate for Payer: UMR Bronson Commercial |
$11.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.09
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$234.77
|
|
|
Service Code
|
NDC 13668042990
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.86 |
| Max. Negotiated Rate |
$211.29 |
| Rate for Payer: Aetna American Axle |
$152.60
|
| Rate for Payer: Aetna Commercial |
$199.55
|
| Rate for Payer: Aetna Medicare |
$117.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.60
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: Cash Price |
$187.82
|
| Rate for Payer: Cofinity Commercial |
$164.34
|
| Rate for Payer: Cofinity Commercial |
$201.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.82
|
| Rate for Payer: Healthscope Commercial |
$211.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.55
|
| Rate for Payer: PHP Commercial |
$199.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.60
|
| Rate for Payer: Priority Health SBD |
$147.91
|
| Rate for Payer: UMR Bronson Commercial |
$86.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.08
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$270.72
|
|
|
Service Code
|
NDC 00904687045
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.17 |
| Max. Negotiated Rate |
$243.65 |
| Rate for Payer: Aetna American Axle |
$175.97
|
| Rate for Payer: Aetna Commercial |
$230.11
|
| Rate for Payer: Aetna Medicare |
$135.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.97
|
| Rate for Payer: BCBS Complete |
$108.29
|
| Rate for Payer: Cash Price |
$216.58
|
| Rate for Payer: Cofinity Commercial |
$189.50
|
| Rate for Payer: Cofinity Commercial |
$232.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.58
|
| Rate for Payer: Healthscope Commercial |
$243.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.11
|
| Rate for Payer: PHP Commercial |
$230.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.97
|
| Rate for Payer: Priority Health SBD |
$170.55
|
| Rate for Payer: UMR Bronson Commercial |
$100.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.04
|
|
|
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 Commercial |
$103.68
|
| Rate for Payer: Cofinity Commercial |
$84.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.39
|
| 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: PHP Commercial |
$102.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.36
|
| Rate for Payer: Priority Health SBD |
$75.95
|
| 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
|
OP
|
$200.45
|
|
|
Service Code
|
NDC 00904647461
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.17 |
| Max. Negotiated Rate |
$180.40 |
| Rate for Payer: Aetna American Axle |
$130.29
|
| Rate for Payer: Aetna Commercial |
$170.38
|
| Rate for Payer: Aetna Medicare |
$100.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.29
|
| Rate for Payer: BCBS Complete |
$80.18
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$140.32
|
| Rate for Payer: Cofinity Commercial |
$172.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$180.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: PHP Commercial |
$170.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.29
|
| Rate for Payer: Priority Health SBD |
$126.28
|
| Rate for Payer: UMR Bronson Commercial |
$74.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.34
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$234.77
|
|
|
Service Code
|
NDC 13668042990
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.30 |
| Max. Negotiated Rate |
$211.29 |
| Rate for Payer: Aetna American Axle |
$152.60
|
| Rate for Payer: Aetna Commercial |
$199.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.60
|
| Rate for Payer: Cash Price |
$187.82
|
| Rate for Payer: Cofinity Commercial |
$164.34
|
| Rate for Payer: Cofinity Commercial |
$201.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.82
|
| Rate for Payer: Healthscope Commercial |
$211.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.55
|
| Rate for Payer: PHP Commercial |
$199.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.60
|
| Rate for Payer: Priority Health SBD |
$147.91
|
| Rate for Payer: UMR Bronson Commercial |
$103.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.08
|
|
|
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 |
$119.12 |
| Max. Negotiated Rate |
$243.65 |
| Rate for Payer: Aetna American Axle |
$175.97
|
| Rate for Payer: Aetna Commercial |
$230.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.97
|
| Rate for Payer: Cash Price |
$216.58
|
| Rate for Payer: Cofinity Commercial |
$189.50
|
| Rate for Payer: Cofinity Commercial |
$232.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.58
|
| Rate for Payer: Healthscope Commercial |
$243.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.11
|
| Rate for Payer: PHP Commercial |
$230.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.97
|
| Rate for Payer: Priority Health SBD |
$170.55
|
| Rate for Payer: UMR Bronson Commercial |
$119.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.04
|
|
|
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 Commercial |
$103.68
|
| Rate for Payer: Cofinity Commercial |
$84.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.39
|
| 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: PHP Commercial |
$102.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.36
|
| 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
|
IP
|
$200.45
|
|
|
Service Code
|
NDC 00904647461
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$180.40 |
| Rate for Payer: Cofinity Commercial |
$140.32
|
| Rate for Payer: Cofinity Commercial |
$172.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.32
|
| Rate for Payer: Aetna American Axle |
$130.29
|
| Rate for Payer: Aetna Commercial |
$170.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.29
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$180.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: PHP Commercial |
$170.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.29
|
| Rate for Payer: Priority Health SBD |
$126.28
|
| Rate for Payer: UMR Bronson Commercial |
$88.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.34
|
|
|
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 Commercial |
$51.21
|
| Rate for Payer: Cofinity Commercial |
$62.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.21
|
| 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: PHP Commercial |
$62.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.55
|
| 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 |
$88.05 |
| 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 |
$88.05
|
| Rate for Payer: BCN Commercial |
$88.05
|
| Rate for Payer: Cash Price |
$58.53
|
| Rate for Payer: Cash Price |
$58.53
|
| Rate for Payer: Cofinity Commercial |
$51.21
|
| Rate for Payer: Cofinity Commercial |
$62.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.21
|
| 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: PHP Commercial |
$62.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.55
|
| Rate for Payer: Priority Health SBD |
$46.09
|
| 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
|
$68.81
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
6030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$61.93 |
| Rate for Payer: Aetna American Axle |
$44.73
|
| Rate for Payer: Aetna Commercial |
$58.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.73
|
| Rate for Payer: Cash Price |
$55.05
|
| Rate for Payer: Cofinity Commercial |
$48.17
|
| Rate for Payer: Cofinity Commercial |
$59.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.05
|
| Rate for Payer: Healthscope Commercial |
$61.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.49
|
| Rate for Payer: PHP Commercial |
$58.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.73
|
| Rate for Payer: Priority Health SBD |
$43.35
|
| Rate for Payer: UMR Bronson Commercial |
$30.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.61
|
|
