|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$27.14
|
|
|
Service Code
|
NDC 4110081123
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$27.14 |
| Rate for Payer: Aetna Commercial |
$24.43
|
| Rate for Payer: ASR ASR |
$26.33
|
| Rate for Payer: BCBS Trust/PPO |
$21.04
|
| Rate for Payer: BCN Commercial |
$21.04
|
| Rate for Payer: Cash Price |
$21.71
|
| Rate for Payer: Cofinity Commercial |
$25.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.71
|
| Rate for Payer: Healthscope Commercial |
$27.14
|
| Rate for Payer: Healthscope Whirlpool |
$26.33
|
| Rate for Payer: Mclaren Commercial |
$24.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.88
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$9.31
|
|
|
Service Code
|
NDC 0904-6761-30
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$9.31 |
| Rate for Payer: Aetna Commercial |
$8.38
|
| Rate for Payer: ASR ASR |
$9.03
|
| Rate for Payer: BCBS Trust/PPO |
$7.22
|
| Rate for Payer: BCN Commercial |
$7.22
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Cofinity Commercial |
$8.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.45
|
| Rate for Payer: Healthscope Commercial |
$9.31
|
| Rate for Payer: Healthscope Whirlpool |
$9.03
|
| Rate for Payer: Mclaren Commercial |
$8.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.19
|
|
|
OXYTOCIN 10 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$24.78
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
5944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$24.78 |
| Rate for Payer: Aetna Commercial |
$22.30
|
| Rate for Payer: Aetna Commercial |
$11.77
|
| Rate for Payer: ASR ASR |
$24.04
|
| Rate for Payer: ASR ASR |
$12.69
|
| Rate for Payer: BCBS Trust/PPO |
$19.21
|
| Rate for Payer: BCBS Trust/PPO |
$10.14
|
| Rate for Payer: BCN Commercial |
$10.14
|
| Rate for Payer: BCN Commercial |
$19.21
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cofinity Commercial |
$12.30
|
| Rate for Payer: Cofinity Commercial |
$23.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.82
|
| Rate for Payer: Healthscope Commercial |
$13.08
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Healthscope Whirlpool |
$24.04
|
| Rate for Payer: Healthscope Whirlpool |
$12.69
|
| Rate for Payer: Mclaren Commercial |
$11.77
|
| Rate for Payer: Mclaren Commercial |
$22.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.51
|
|
|
PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$57.81
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
32589
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.47 |
| Max. Negotiated Rate |
$57.81 |
| Rate for Payer: Aetna Commercial |
$52.03
|
| Rate for Payer: Aetna Commercial |
$34.33
|
| Rate for Payer: ASR ASR |
$37.00
|
| Rate for Payer: ASR ASR |
$56.08
|
| Rate for Payer: BCBS Trust/PPO |
$44.82
|
| Rate for Payer: BCBS Trust/PPO |
$29.57
|
| Rate for Payer: BCN Commercial |
$29.57
|
| Rate for Payer: BCN Commercial |
$44.82
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cash Price |
$46.24
|
| Rate for Payer: Cofinity Commercial |
$35.85
|
| Rate for Payer: Cofinity Commercial |
$54.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.51
|
| Rate for Payer: Healthscope Commercial |
$57.81
|
| Rate for Payer: Healthscope Commercial |
$38.14
|
| Rate for Payer: Healthscope Whirlpool |
$37.00
|
| Rate for Payer: Healthscope Whirlpool |
$56.08
|
| Rate for Payer: Mclaren Commercial |
$52.03
|
| Rate for Payer: Mclaren Commercial |
$34.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.56
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$37,074.22
|
|
|
Service Code
|
MS-DRG 406
|
| Min. Negotiated Rate |
$24,820.47 |
| Max. Negotiated Rate |
$37,074.22 |
| Rate for Payer: Aetna Medicare |
$26,126.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32,658.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32,658.51
|
| Rate for Payer: BCBS MAPPO |
$26,126.81
|
| Rate for Payer: BCN Medicare Advantage |
$26,126.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26,126.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$26,126.81
|
| Rate for Payer: Mclaren Medicare |
$26,126.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27,433.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30,045.83
|
| Rate for Payer: PACE Medicare |
$24,820.47
|
| Rate for Payer: PACE SWMI |
$26,126.81
|
| Rate for Payer: PHP Commercial |
$28,739.49
|
| Rate for Payer: PHP Medicare Advantage |
$26,126.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37,074.22
|
| Rate for Payer: Priority Health Medicare |
$26,126.81
|
| Rate for Payer: Priority Health Narrow Network |
$29,659.38
|
| Rate for Payer: Railroad Medicare Medicare |
$26,126.81
|
| Rate for Payer: UHC Medicare Advantage |
$26,910.61
|
| Rate for Payer: VA VA |
$26,126.81
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$70,686.77
|
|
|
Service Code
|
MS-DRG 405
|
| Min. Negotiated Rate |
$45,875.64 |
| Max. Negotiated Rate |
$70,686.77 |
| Rate for Payer: Aetna Medicare |
$48,290.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60,362.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60,362.69
|
| Rate for Payer: BCBS MAPPO |
$48,290.15
|
| Rate for Payer: BCN Medicare Advantage |
$48,290.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48,290.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$48,290.15
|
| Rate for Payer: Mclaren Medicare |
$48,290.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50,704.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55,533.67
|
| Rate for Payer: PACE Medicare |
$45,875.64
|
| Rate for Payer: PACE SWMI |
$48,290.15
|
| Rate for Payer: PHP Commercial |
$53,119.16
|
| Rate for Payer: PHP Medicare Advantage |
$48,290.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70,686.77
|
| Rate for Payer: Priority Health Medicare |
$48,290.15
|
| Rate for Payer: Priority Health Narrow Network |
$56,549.42
|
| Rate for Payer: Railroad Medicare Medicare |
$48,290.15
|
| Rate for Payer: UHC Medicare Advantage |
$49,738.85
|
| Rate for Payer: VA VA |
$48,290.15
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$27,618.84
|
|
|
Service Code
|
MS-DRG 407
|
| Min. Negotiated Rate |
$18,897.54 |
| Max. Negotiated Rate |
$27,618.84 |
| Rate for Payer: Aetna Medicare |
$19,892.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,865.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,865.19
|
| Rate for Payer: BCBS MAPPO |
$19,892.15
|
| Rate for Payer: BCN Medicare Advantage |
$19,892.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,892.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$19,892.15
|
| Rate for Payer: Mclaren Medicare |
$19,892.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,886.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,875.97
|
| Rate for Payer: PACE Medicare |
$18,897.54
|
| Rate for Payer: PACE SWMI |
$19,892.15
|
| Rate for Payer: PHP Commercial |
$21,881.36
|
| Rate for Payer: PHP Medicare Advantage |
$19,892.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,618.84
|
| Rate for Payer: Priority Health Medicare |
$19,892.15
|
| Rate for Payer: Priority Health Narrow Network |
$22,095.07
|
| Rate for Payer: Railroad Medicare Medicare |
$19,892.15
|
| Rate for Payer: UHC Medicare Advantage |
$20,488.91
|
| Rate for Payer: VA VA |
$19,892.15
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$61,806.62
|
|
|
Service Code
|
MS-DRG 010
|
| Min. Negotiated Rate |
$40,313.05 |
| Max. Negotiated Rate |
$61,806.62 |
| Rate for Payer: Aetna Medicare |
$42,434.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53,043.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53,043.49
|
| Rate for Payer: BCBS MAPPO |
$42,434.79
|
| Rate for Payer: BCN Medicare Advantage |
$42,434.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42,434.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$42,434.79
|
| Rate for Payer: Mclaren Medicare |
$42,434.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44,556.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48,800.01
|
| Rate for Payer: PACE Medicare |
$40,313.05
|
| Rate for Payer: PACE SWMI |
$42,434.79
|
| Rate for Payer: PHP Commercial |
$46,678.27
|
| Rate for Payer: PHP Medicare Advantage |
$42,434.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61,806.62
|
| Rate for Payer: Priority Health Medicare |
$42,434.79
|
| Rate for Payer: Priority Health Narrow Network |
$49,445.30
|
| Rate for Payer: Railroad Medicare Medicare |
$42,434.79
|
| Rate for Payer: UHC Medicare Advantage |
$43,707.83
|
| Rate for Payer: VA VA |
$42,434.79
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$107.35
|
|
|
Service Code
|
NDC 50268-585-15
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.14 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Aetna Commercial |
$96.62
|
| Rate for Payer: ASR ASR |
$104.13
|
| Rate for Payer: BCBS Trust/PPO |
$83.23
|
| Rate for Payer: BCN Commercial |
$83.23
|
| Rate for Payer: Cash Price |
$85.88
|
| Rate for Payer: Cofinity Commercial |
$100.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.88
|
| Rate for Payer: Healthscope Commercial |
$107.35
|
| Rate for Payer: Healthscope Whirlpool |
$104.13
|
| Rate for Payer: Mclaren Commercial |
$96.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.47
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$219.96
|
|
|
Service Code
|
NDC 0378-6688-77
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.97 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna Commercial |
$197.96
|
| Rate for Payer: ASR ASR |
$213.36
|
| Rate for Payer: BCBS Trust/PPO |
$170.53
|
| Rate for Payer: BCN Commercial |
$170.53
|
| Rate for Payer: Cash Price |
$175.97
|
| Rate for Payer: Cofinity Commercial |
$206.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.97
|
| Rate for Payer: Healthscope Commercial |
$219.96
|
| Rate for Payer: Healthscope Whirlpool |
$213.36
|
| Rate for Payer: Mclaren Commercial |
$197.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.56
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$2.15
|
|
|
Service Code
|
NDC 50268-585-11
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.15 |
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: ASR ASR |
$2.09
|
| Rate for Payer: BCBS Trust/PPO |
$1.67
|
| Rate for Payer: BCN Commercial |
$1.67
|
| Rate for Payer: Cash Price |
$1.72
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.72
|
| Rate for Payer: Healthscope Commercial |
$2.15
|
| Rate for Payer: Healthscope Whirlpool |
$2.09
|
| Rate for Payer: Mclaren Commercial |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.89
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$2.45
|
|
|
Service Code
|
NDC 50268-636-11
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: ASR ASR |
$2.38
|
| Rate for Payer: BCBS Trust/PPO |
$1.90
|
| Rate for Payer: BCN Commercial |
$1.90
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.96
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Healthscope Whirlpool |
$2.38
|
| Rate for Payer: Mclaren Commercial |
$2.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.16
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$122.55
|
|
|
Service Code
|
NDC 50268-636-15
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.78 |
| Max. Negotiated Rate |
$122.55 |
| Rate for Payer: Aetna Commercial |
$110.30
|
| Rate for Payer: ASR ASR |
$118.87
|
| Rate for Payer: BCBS Trust/PPO |
$95.01
|
| Rate for Payer: BCN Commercial |
$95.01
|
| Rate for Payer: Cash Price |
$98.04
|
| Rate for Payer: Cofinity Commercial |
$115.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.04
|
| Rate for Payer: Healthscope Commercial |
$122.55
|
| Rate for Payer: Healthscope Whirlpool |
$118.87
|
| Rate for Payer: Mclaren Commercial |
$110.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.84
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.42
|
|
|
Service Code
|
NDC 0781-3232-95
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.59 |
| Max. Negotiated Rate |
$19.42 |
| Rate for Payer: Aetna Commercial |
$17.48
|
| Rate for Payer: ASR ASR |
$18.84
|
| Rate for Payer: BCBS Trust/PPO |
$15.06
|
| Rate for Payer: BCN Commercial |
$15.06
|
| Rate for Payer: Cash Price |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.54
|
| Rate for Payer: Healthscope Commercial |
$19.42
|
| Rate for Payer: Healthscope Whirlpool |
$18.84
|
| Rate for Payer: Mclaren Commercial |
$17.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.09
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.06
|
|
|
Service Code
|
NDC 55150-202-00
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$22.06 |
| Rate for Payer: Aetna Commercial |
$19.85
|
| Rate for Payer: ASR ASR |
$21.40
|
| Rate for Payer: BCBS Trust/PPO |
$17.10
|
| Rate for Payer: BCN Commercial |
$17.10
|
| Rate for Payer: Cash Price |
$17.64
|
| Rate for Payer: Cofinity Commercial |
$20.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.65
|
| Rate for Payer: Healthscope Commercial |
$22.06
|
| Rate for Payer: Healthscope Whirlpool |
$21.40
|
| Rate for Payer: Mclaren Commercial |
$19.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.41
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.30
|
|
|
Service Code
|
NDC 65219-433-15
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.41 |
| Max. Negotiated Rate |
$26.30 |
| Rate for Payer: Aetna Commercial |
$23.67
|
| Rate for Payer: ASR ASR |
$25.51
|
| Rate for Payer: BCBS Trust/PPO |
$20.39
|
| Rate for Payer: BCN Commercial |
$20.39
|
| Rate for Payer: Cash Price |
$21.04
|
| Rate for Payer: Cofinity Commercial |
$24.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.04
|
| Rate for Payer: Healthscope Commercial |
$26.30
|
| Rate for Payer: Healthscope Whirlpool |
$25.51
|
| Rate for Payer: Mclaren Commercial |
$23.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.14
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.09
|
|
|
Service Code
|
NDC 67850-150-25
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$15.09 |
| Rate for Payer: Aetna Commercial |
$13.58
|
| Rate for Payer: ASR ASR |
$14.64
|
| Rate for Payer: BCBS Trust/PPO |
$11.70
|
| Rate for Payer: BCN Commercial |
$11.70
|
| Rate for Payer: Cash Price |
$12.07
|
| Rate for Payer: Cofinity Commercial |
$14.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.07
|
| Rate for Payer: Healthscope Commercial |
$15.09
|
| Rate for Payer: Healthscope Whirlpool |
$14.64
|
| Rate for Payer: Mclaren Commercial |
$13.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.28
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.30
|
|
|
Service Code
|
NDC 65219-433-01
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.41 |
| Max. Negotiated Rate |
$26.30 |
| Rate for Payer: Aetna Commercial |
$23.67
|
| Rate for Payer: ASR ASR |
$25.51
|
| Rate for Payer: BCBS Trust/PPO |
$20.39
|
| Rate for Payer: BCN Commercial |
$20.39
|
| Rate for Payer: Cash Price |
$21.04
|
| Rate for Payer: Cofinity Commercial |
$24.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.04
|
| Rate for Payer: Healthscope Commercial |
$26.30
|
| Rate for Payer: Healthscope Whirlpool |
$25.51
|
| Rate for Payer: Mclaren Commercial |
$23.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.14
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.16
|
|
|
Service Code
|
NDC 67850-150-00
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.31 |
| Max. Negotiated Rate |
$26.16 |
| Rate for Payer: Aetna Commercial |
$23.54
|
| Rate for Payer: ASR ASR |
$25.38
|
| Rate for Payer: BCBS Trust/PPO |
$20.28
|
| Rate for Payer: BCN Commercial |
$20.28
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cofinity Commercial |
$24.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
| Rate for Payer: Healthscope Commercial |
$26.16
|
| Rate for Payer: Healthscope Whirlpool |
$25.38
|
| Rate for Payer: Mclaren Commercial |
$23.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.02
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.06
|
|
|
Service Code
|
NDC 55150-202-10
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$22.06 |
| Rate for Payer: Aetna Commercial |
$19.85
|
| Rate for Payer: ASR ASR |
$21.40
|
| Rate for Payer: BCBS Trust/PPO |
$17.10
|
| Rate for Payer: BCN Commercial |
$17.10
|
| Rate for Payer: Cash Price |
$17.64
|
| Rate for Payer: Cofinity Commercial |
$20.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.65
|
| Rate for Payer: Healthscope Commercial |
$22.06
|
| Rate for Payer: Healthscope Whirlpool |
$21.40
|
| Rate for Payer: Mclaren Commercial |
$19.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.41
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.42
|
|
|
Service Code
|
NDC 71839-122-10
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$18.42 |
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: ASR ASR |
$17.87
|
| Rate for Payer: BCBS Trust/PPO |
$14.28
|
| Rate for Payer: BCN Commercial |
$14.28
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$17.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$18.42
|
| Rate for Payer: Healthscope Whirlpool |
$17.87
|
| Rate for Payer: Mclaren Commercial |
$16.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.21
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.10
|
|
|
Service Code
|
NDC 0143-9300-01
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$17.19
|
| Rate for Payer: ASR ASR |
$18.53
|
| Rate for Payer: BCBS Trust/PPO |
$14.81
|
| Rate for Payer: BCN Commercial |
$14.81
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$17.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Healthscope Whirlpool |
$18.53
|
| Rate for Payer: Mclaren Commercial |
$17.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.81
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.10
|
|
|
Service Code
|
NDC 0143-9300-10
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$17.19
|
| Rate for Payer: ASR ASR |
$18.53
|
| Rate for Payer: BCBS Trust/PPO |
$14.81
|
| Rate for Payer: BCN Commercial |
$14.81
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$17.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Healthscope Whirlpool |
$18.53
|
| Rate for Payer: Mclaren Commercial |
$17.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.81
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.42
|
|
|
Service Code
|
NDC 71839-122-01
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$18.42 |
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: ASR ASR |
$17.87
|
| Rate for Payer: BCBS Trust/PPO |
$14.28
|
| Rate for Payer: BCN Commercial |
$14.28
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$17.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$18.42
|
| Rate for Payer: Healthscope Whirlpool |
$17.87
|
| Rate for Payer: Mclaren Commercial |
$16.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.21
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.87
|
|
|
Service Code
|
NDC 62756-129-44
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$16.87 |
| Rate for Payer: Aetna Commercial |
$15.18
|
| Rate for Payer: ASR ASR |
$16.36
|
| Rate for Payer: BCBS Trust/PPO |
$13.08
|
| Rate for Payer: BCN Commercial |
$13.08
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cofinity Commercial |
$15.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Healthscope Commercial |
$16.87
|
| Rate for Payer: Healthscope Whirlpool |
$16.36
|
| Rate for Payer: Mclaren Commercial |
$15.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.85
|
|
