|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.54
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$16.54 |
| Rate for Payer: Aetna Commercial |
$14.89
|
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Commercial |
$21.95
|
| Rate for Payer: Aetna Commercial |
$17.68
|
| Rate for Payer: Aetna Commercial |
$17.80
|
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna Commercial |
$13.83
|
| Rate for Payer: Aetna Commercial |
$18.88
|
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: Aetna Commercial |
$25.19
|
| Rate for Payer: Aetna Commercial |
$15.18
|
| Rate for Payer: ASR ASR |
$23.66
|
| Rate for Payer: ASR ASR |
$27.15
|
| Rate for Payer: ASR ASR |
$20.35
|
| Rate for Payer: ASR ASR |
$14.91
|
| Rate for Payer: ASR ASR |
$16.37
|
| Rate for Payer: ASR ASR |
$19.18
|
| Rate for Payer: ASR ASR |
$17.87
|
| Rate for Payer: ASR ASR |
$13.08
|
| Rate for Payer: ASR ASR |
$19.05
|
| Rate for Payer: ASR ASR |
$16.04
|
| Rate for Payer: ASR ASR |
$25.56
|
| Rate for Payer: BCBS Trust/PPO |
$16.24
|
| Rate for Payer: BCBS Trust/PPO |
$17.23
|
| Rate for Payer: BCBS Trust/PPO |
$12.62
|
| Rate for Payer: BCBS Trust/PPO |
$16.13
|
| Rate for Payer: BCBS Trust/PPO |
$15.13
|
| Rate for Payer: BCBS Trust/PPO |
$13.58
|
| Rate for Payer: BCBS Trust/PPO |
$13.86
|
| Rate for Payer: BCBS Trust/PPO |
$22.98
|
| Rate for Payer: BCBS Trust/PPO |
$20.03
|
| Rate for Payer: BCBS Trust/PPO |
$11.07
|
| Rate for Payer: BCBS Trust/PPO |
$21.64
|
| Rate for Payer: BCN Commercial |
$15.13
|
| Rate for Payer: BCN Commercial |
$21.64
|
| Rate for Payer: BCN Commercial |
$11.07
|
| Rate for Payer: BCN Commercial |
$13.58
|
| Rate for Payer: BCN Commercial |
$17.23
|
| Rate for Payer: BCN Commercial |
$20.03
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: BCN Commercial |
$16.24
|
| Rate for Payer: BCN Commercial |
$22.98
|
| Rate for Payer: BCN Commercial |
$12.62
|
| Rate for Payer: BCN Commercial |
$13.86
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: Cash Price |
$13.23
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cash Price |
$22.39
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cash Price |
$19.51
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cofinity Commercial |
$15.55
|
| Rate for Payer: Cofinity Commercial |
$14.45
|
| Rate for Payer: Cofinity Commercial |
$26.31
|
| Rate for Payer: Cofinity Commercial |
$15.86
|
| Rate for Payer: Cofinity Commercial |
$18.59
|
| Rate for Payer: Cofinity Commercial |
$19.72
|
| Rate for Payer: Cofinity Commercial |
$17.31
|
| Rate for Payer: Cofinity Commercial |
$12.68
|
| Rate for Payer: Cofinity Commercial |
$24.77
|
| Rate for Payer: Cofinity Commercial |
$22.93
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.39
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Healthscope Commercial |
$23.66
|
| Rate for Payer: Healthscope Commercial |
$20.35
|
| Rate for Payer: Healthscope Commercial |
$27.15
|
| Rate for Payer: Healthscope Commercial |
$14.91
|
| Rate for Payer: Healthscope Commercial |
$16.37
|
| Rate for Payer: Healthscope Commercial |
$13.08
|
| Rate for Payer: Healthscope Commercial |
$16.04
|
| Rate for Payer: Healthscope Commercial |
$17.87
|
| Rate for Payer: Healthscope Commercial |
$19.18
|
| Rate for Payer: Healthscope Commercial |
$25.56
|
| Rate for Payer: Healthscope Whirlpool |
$26.35
|
| Rate for Payer: Healthscope Whirlpool |
$16.87
|
| Rate for Payer: Healthscope Whirlpool |
$15.37
|
| Rate for Payer: Healthscope Whirlpool |
$16.54
|
| Rate for Payer: Healthscope Whirlpool |
$18.42
|
| Rate for Payer: Healthscope Whirlpool |
$13.48
|
| Rate for Payer: Healthscope Whirlpool |
$19.64
|
| Rate for Payer: Healthscope Whirlpool |
$19.78
|
| Rate for Payer: Healthscope Whirlpool |
$20.98
|
| Rate for Payer: Healthscope Whirlpool |
$24.39
|
| Rate for Payer: Healthscope Whirlpool |
$27.98
|
| Rate for Payer: Mclaren Commercial |
$23.71
|
| Rate for Payer: Mclaren Commercial |
$21.95
|
| Rate for Payer: Mclaren Commercial |
$16.58
|
| Rate for Payer: Mclaren Commercial |
$14.89
|
| Rate for Payer: Mclaren Commercial |
$12.14
|
| Rate for Payer: Mclaren Commercial |
$17.80
|
| Rate for Payer: Mclaren Commercial |
$17.68
|
| Rate for Payer: Mclaren Commercial |
$13.83
|
| Rate for Payer: Mclaren Commercial |
$18.88
|
| Rate for Payer: Mclaren Commercial |
$25.19
|
| Rate for Payer: Mclaren Commercial |
$15.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.79
|
| Rate for Payer: Nomi Health Commercial |
$13.84
|
| Rate for Payer: Nomi Health Commercial |
$12.60
|
| Rate for Payer: Nomi Health Commercial |
$13.56
|
| Rate for Payer: Nomi Health Commercial |
$16.10
|
| Rate for Payer: Nomi Health Commercial |
$22.95
|
| Rate for Payer: Nomi Health Commercial |
$21.60
|
| Rate for Payer: Nomi Health Commercial |
$15.10
|
| Rate for Payer: Nomi Health Commercial |
$17.21
|
| Rate for Payer: Nomi Health Commercial |
$16.22
|
| Rate for Payer: Nomi Health Commercial |
$20.00
|
| Rate for Payer: Nomi Health Commercial |
$11.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.85
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.27
|
|
|
Service Code
|
HCPCS J2471
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$19.27 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: ASR ASR |
$18.69
|
| Rate for Payer: BCBS Trust/PPO |
$15.82
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: Cash Price |
$15.42
|
| Rate for Payer: Cofinity Commercial |
$18.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.42
|
| Rate for Payer: Healthscope Commercial |
$18.69
|
| Rate for Payer: Healthscope Whirlpool |
$19.27
|
| Rate for Payer: Mclaren Commercial |
$17.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.38
|
| Rate for Payer: Nomi Health Commercial |
$15.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.96
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.54
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$16.54 |
| Rate for Payer: Aetna Commercial |
$14.89
|
| Rate for Payer: Aetna Commercial |
$17.80
|
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: Aetna Commercial |
$17.68
|
| Rate for Payer: Aetna Commercial |
$21.95
|
| Rate for Payer: Aetna Commercial |
$18.88
|
| Rate for Payer: Aetna Commercial |
$25.19
|
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Commercial |
$15.18
|
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna Commercial |
$13.83
|
| Rate for Payer: Aetna Medicare |
$9.75
|
| Rate for Payer: Aetna Medicare |
$9.02
|
| Rate for Payer: Aetna Medicare |
$6.12
|
| Rate for Payer: Aetna Medicare |
$5.69
|
| Rate for Payer: Aetna Medicare |
$4.99
|
| Rate for Payer: Aetna Medicare |
$6.82
|
| Rate for Payer: Aetna Medicare |
$7.27
|
| Rate for Payer: Aetna Medicare |
$7.32
|
| Rate for Payer: Aetna Medicare |
$10.35
|
| Rate for Payer: Aetna Medicare |
$7.76
|
| Rate for Payer: Aetna Medicare |
$6.24
|
| Rate for Payer: ASR ASR |
$16.04
|
| Rate for Payer: ASR ASR |
$27.15
|
| Rate for Payer: ASR ASR |
$13.08
|
| Rate for Payer: ASR ASR |
$23.66
|
| Rate for Payer: ASR ASR |
$14.91
|
| Rate for Payer: ASR ASR |
$19.18
|
| Rate for Payer: ASR ASR |
$25.56
|
| Rate for Payer: ASR ASR |
$16.37
|
| Rate for Payer: ASR ASR |
$20.35
|
| Rate for Payer: ASR ASR |
$19.05
|
| Rate for Payer: ASR ASR |
$17.87
|
| Rate for Payer: BCBS Complete |
$7.86
|
| Rate for Payer: BCBS Complete |
$8.39
|
| Rate for Payer: BCBS Complete |
$7.91
|
| Rate for Payer: BCBS Complete |
$6.15
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: BCBS Complete |
$11.19
|
| Rate for Payer: BCBS Complete |
$10.54
|
| Rate for Payer: BCBS Complete |
$9.76
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: BCBS Complete |
$5.39
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS Trust/PPO |
$15.19
|
| Rate for Payer: BCBS Trust/PPO |
$13.64
|
| Rate for Payer: BCBS Trust/PPO |
$11.12
|
| Rate for Payer: BCBS Trust/PPO |
$12.67
|
| Rate for Payer: BCBS Trust/PPO |
$23.07
|
| Rate for Payer: BCBS Trust/PPO |
$21.72
|
| Rate for Payer: BCBS Trust/PPO |
$20.11
|
| Rate for Payer: BCBS Trust/PPO |
$17.30
|
| Rate for Payer: BCBS Trust/PPO |
$16.31
|
| Rate for Payer: BCBS Trust/PPO |
$13.91
|
| Rate for Payer: BCBS Trust/PPO |
$16.19
|
| Rate for Payer: BCN Commercial |
$16.19
|
| Rate for Payer: BCN Commercial |
$15.19
|
| Rate for Payer: BCN Commercial |
$16.31
|
| Rate for Payer: BCN Commercial |
$13.91
|
| Rate for Payer: BCN Commercial |
$13.64
|
| Rate for Payer: BCN Commercial |
$12.67
|
| Rate for Payer: BCN Commercial |
$11.12
|
| Rate for Payer: BCN Commercial |
$20.11
|
| Rate for Payer: BCN Commercial |
$23.07
|
| Rate for Payer: BCN Commercial |
$21.72
|
| Rate for Payer: BCN Commercial |
$17.30
|
| Rate for Payer: Cash Price |
$13.23
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cash Price |
$13.23
|
| Rate for Payer: Cash Price |
$19.51
|
| Rate for Payer: Cash Price |
$19.51
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cash Price |
$22.39
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cash Price |
$22.39
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cofinity Commercial |
$14.45
|
| Rate for Payer: Cofinity Commercial |
$15.55
|
| Rate for Payer: Cofinity Commercial |
$12.68
|
| Rate for Payer: Cofinity Commercial |
$15.86
|
| Rate for Payer: Cofinity Commercial |
$17.31
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Cofinity Commercial |
$18.59
|
| Rate for Payer: Cofinity Commercial |
$19.72
|
| Rate for Payer: Cofinity Commercial |
$22.93
|
| Rate for Payer: Cofinity Commercial |
$24.77
|
| Rate for Payer: Cofinity Commercial |
$26.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Healthscope Commercial |
$19.18
|
| Rate for Payer: Healthscope Commercial |
$20.35
|
| Rate for Payer: Healthscope Commercial |
$13.08
|
| Rate for Payer: Healthscope Commercial |
$14.91
|
| Rate for Payer: Healthscope Commercial |
$16.04
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Healthscope Commercial |
$25.56
|
| Rate for Payer: Healthscope Commercial |
$17.87
|
| Rate for Payer: Healthscope Commercial |
$16.37
|
| Rate for Payer: Healthscope Commercial |
$27.15
|
| Rate for Payer: Healthscope Commercial |
$23.66
|
| Rate for Payer: Healthscope Whirlpool |
$15.37
|
| Rate for Payer: Healthscope Whirlpool |
$18.42
|
| Rate for Payer: Healthscope Whirlpool |
$16.87
|
| Rate for Payer: Healthscope Whirlpool |
$19.64
|
| Rate for Payer: Healthscope Whirlpool |
$26.35
|
| Rate for Payer: Healthscope Whirlpool |
$27.98
|
| Rate for Payer: Healthscope Whirlpool |
$19.78
|
| Rate for Payer: Healthscope Whirlpool |
$16.54
|
| Rate for Payer: Healthscope Whirlpool |
$20.98
|
| Rate for Payer: Healthscope Whirlpool |
$24.39
|
| Rate for Payer: Healthscope Whirlpool |
$13.48
|
| Rate for Payer: Mclaren Commercial |
$21.95
|
| Rate for Payer: Mclaren Commercial |
$13.83
|
| Rate for Payer: Mclaren Commercial |
$15.18
|
| Rate for Payer: Mclaren Commercial |
$17.80
|
| Rate for Payer: Mclaren Commercial |
$18.88
|
| Rate for Payer: Mclaren Commercial |
$17.68
|
| Rate for Payer: Mclaren Commercial |
$12.14
|
| Rate for Payer: Mclaren Commercial |
$23.71
|
| Rate for Payer: Mclaren Commercial |
$16.58
|
| Rate for Payer: Mclaren Commercial |
$14.89
|
| Rate for Payer: Mclaren Commercial |
$25.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.66
|
| Rate for Payer: Nomi Health Commercial |
$13.56
|
| Rate for Payer: Nomi Health Commercial |
$12.60
|
| Rate for Payer: Nomi Health Commercial |
$11.06
|
| Rate for Payer: Nomi Health Commercial |
$21.60
|
| Rate for Payer: Nomi Health Commercial |
$22.95
|
| Rate for Payer: Nomi Health Commercial |
$17.21
|
| Rate for Payer: Nomi Health Commercial |
$16.22
|
| Rate for Payer: Nomi Health Commercial |
$13.84
|
| Rate for Payer: Nomi Health Commercial |
$15.10
|
| Rate for Payer: Nomi Health Commercial |
$16.10
|
| Rate for Payer: Nomi Health Commercial |
$20.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.93
|
| Rate for Payer: Priority Health Narrow Network |
$1.54
|
| Rate for Payer: Priority Health Narrow Network |
$1.54
|
| Rate for Payer: Priority Health Narrow Network |
$1.54
|
| Rate for Payer: Priority Health Narrow Network |
$1.54
|
| Rate for Payer: Priority Health Narrow Network |
$1.54
|
| Rate for Payer: Priority Health Narrow Network |
$1.54
|
| Rate for Payer: Priority Health Narrow Network |
$1.54
|
| Rate for Payer: Priority Health Narrow Network |
$1.54
|
| Rate for Payer: Priority Health Narrow Network |
$1.54
|
| Rate for Payer: Priority Health Narrow Network |
$1.54
|
| Rate for Payer: Priority Health Narrow Network |
$1.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.85
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION FOR DRIP
|
Facility
|
OP
|
$19.64
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
301183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$19.64 |
| Rate for Payer: Aetna Commercial |
$17.68
|
| Rate for Payer: Aetna Medicare |
$7.27
|
| Rate for Payer: ASR ASR |
$19.05
|
| Rate for Payer: BCBS Complete |
$7.86
|
| Rate for Payer: BCBS Trust/PPO |
$16.19
|
| Rate for Payer: BCN Commercial |
$16.19
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.71
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Healthscope Whirlpool |
$19.64
|
| Rate for Payer: Mclaren Commercial |
$17.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.69
|
| Rate for Payer: Nomi Health Commercial |
$16.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.93
|
| Rate for Payer: Priority Health Narrow Network |
$1.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.28
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION FOR DRIP
|
Facility
|
IP
|
$19.64
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
301183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$19.64 |
| Rate for Payer: Aetna Commercial |
$17.68
|
| Rate for Payer: ASR ASR |
$19.05
|
| Rate for Payer: BCBS Trust/PPO |
$16.13
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.71
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Healthscope Whirlpool |
$19.64
|
| Rate for Payer: Mclaren Commercial |
$17.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.69
|
| Rate for Payer: Nomi Health Commercial |
$16.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.28
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$222.30
|
|
|
Service Code
|
NDC 63739056410
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.72 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$200.07
|
| Rate for Payer: ASR ASR |
$215.63
|
| Rate for Payer: BCBS Trust/PPO |
$182.55
|
| Rate for Payer: BCN Commercial |
$182.55
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Commercial |
$208.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Healthscope Commercial |
$215.63
|
| Rate for Payer: Healthscope Whirlpool |
$222.30
|
| Rate for Payer: Mclaren Commercial |
$200.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: Nomi Health Commercial |
$182.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.62
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 50268063915
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.43 |
| Max. Negotiated Rate |
$173.90 |
| Rate for Payer: Aetna Commercial |
$156.51
|
| Rate for Payer: ASR ASR |
$168.68
|
| Rate for Payer: BCBS Trust/PPO |
$142.81
|
| Rate for Payer: BCN Commercial |
$142.81
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$163.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$168.68
|
| Rate for Payer: Healthscope Whirlpool |
$173.90
|
| Rate for Payer: Mclaren Commercial |
$156.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Nomi Health Commercial |
$142.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.03
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$4,617.38
|
|
|
Service Code
|
NDC 8084181
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,708.43 |
| Max. Negotiated Rate |
$4,617.38 |
| Rate for Payer: Aetna Commercial |
$4,155.64
|
| Rate for Payer: Aetna Medicare |
$1,708.43
|
| Rate for Payer: ASR ASR |
$4,478.86
|
| Rate for Payer: BCBS Complete |
$1,846.95
|
| Rate for Payer: BCBS Trust/PPO |
$3,807.03
|
| Rate for Payer: BCN Commercial |
$3,807.03
|
| Rate for Payer: Cash Price |
$3,693.90
|
| Rate for Payer: Cofinity Commercial |
$4,340.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,693.90
|
| Rate for Payer: Healthscope Commercial |
$4,478.86
|
| Rate for Payer: Healthscope Whirlpool |
$4,617.38
|
| Rate for Payer: Mclaren Commercial |
$4,155.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,693.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,924.77
|
| Rate for Payer: Nomi Health Commercial |
$3,786.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,463.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,045.75
|
| Rate for Payer: Priority Health Narrow Network |
$3,236.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,063.29
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$2.13
|
|
|
Service Code
|
NDC 51079005101
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$2.13 |
| Rate for Payer: Aetna Commercial |
$1.92
|
| Rate for Payer: ASR ASR |
$2.06
|
| Rate for Payer: BCBS Trust/PPO |
$1.75
|
| Rate for Payer: BCN Commercial |
$1.75
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.70
|
| Rate for Payer: Healthscope Commercial |
$2.06
|
| Rate for Payer: Healthscope Whirlpool |
$2.13
|
| Rate for Payer: Mclaren Commercial |
$1.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.81
|
| Rate for Payer: Nomi Health Commercial |
$1.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.87
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$3.48
|
|
|
Service Code
|
NDC 50268063911
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna Commercial |
$3.13
|
| Rate for Payer: Aetna Medicare |
$1.29
|
| Rate for Payer: ASR ASR |
$3.37
|
| Rate for Payer: BCBS Complete |
$1.39
|
| Rate for Payer: BCBS Trust/PPO |
$2.87
|
| Rate for Payer: BCN Commercial |
$2.87
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$3.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$3.37
|
| Rate for Payer: Healthscope Whirlpool |
$3.48
|
| Rate for Payer: Mclaren Commercial |
$3.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.96
|
| Rate for Payer: Nomi Health Commercial |
$2.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.05
|
| Rate for Payer: Priority Health Narrow Network |
$2.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.06
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$222.30
|
|
|
Service Code
|
NDC 63739056410
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.25 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$200.07
|
| Rate for Payer: Aetna Medicare |
$82.25
|
| Rate for Payer: ASR ASR |
$215.63
|
| Rate for Payer: BCBS Complete |
$88.92
|
| Rate for Payer: BCBS Trust/PPO |
$183.29
|
| Rate for Payer: BCN Commercial |
$183.29
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Commercial |
$208.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Healthscope Commercial |
$215.63
|
| Rate for Payer: Healthscope Whirlpool |
$222.30
|
| Rate for Payer: Mclaren Commercial |
$200.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: Nomi Health Commercial |
$182.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$194.78
|
| Rate for Payer: Priority Health Narrow Network |
$155.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.62
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$193.80
|
|
|
Service Code
|
NDC 904647461
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.35 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: ASR ASR |
$187.99
|
| Rate for Payer: BCBS Trust/PPO |
$159.15
|
| Rate for Payer: BCN Commercial |
$159.15
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Commercial |
$182.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.04
|
| Rate for Payer: Healthscope Commercial |
$187.99
|
| Rate for Payer: Healthscope Whirlpool |
$193.80
|
| Rate for Payer: Mclaren Commercial |
$174.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.73
|
| Rate for Payer: Nomi Health Commercial |
$158.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.54
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$4,617.38
|
|
|
Service Code
|
NDC 8084181
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,463.03 |
| Max. Negotiated Rate |
$4,617.38 |
| Rate for Payer: Aetna Commercial |
$4,155.64
|
| Rate for Payer: ASR ASR |
$4,478.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,791.79
|
| Rate for Payer: BCN Commercial |
$3,791.79
|
| Rate for Payer: Cash Price |
$3,693.90
|
| Rate for Payer: Cofinity Commercial |
$4,340.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,693.90
|
| Rate for Payer: Healthscope Commercial |
$4,478.86
|
| Rate for Payer: Healthscope Whirlpool |
$4,617.38
|
| Rate for Payer: Mclaren Commercial |
$4,155.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,924.77
|
| Rate for Payer: Nomi Health Commercial |
$3,786.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,463.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,063.29
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$276.36
|
|
|
Service Code
|
NDC 904687045
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.27 |
| Max. Negotiated Rate |
$276.36 |
| Rate for Payer: Aetna Commercial |
$248.72
|
| Rate for Payer: ASR ASR |
$268.07
|
| Rate for Payer: BCBS Trust/PPO |
$226.95
|
| Rate for Payer: BCN Commercial |
$226.95
|
| Rate for Payer: Cash Price |
$221.09
|
| Rate for Payer: Cofinity Commercial |
$259.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.09
|
| Rate for Payer: Healthscope Commercial |
$268.07
|
| Rate for Payer: Healthscope Whirlpool |
$276.36
|
| Rate for Payer: Mclaren Commercial |
$248.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.91
|
| Rate for Payer: Nomi Health Commercial |
$226.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.20
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$173.90
|
|
|
Service Code
|
NDC 50268063915
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$173.90 |
| Rate for Payer: Aetna Commercial |
$156.51
|
| Rate for Payer: Aetna Medicare |
$64.34
|
| Rate for Payer: ASR ASR |
$168.68
|
| Rate for Payer: BCBS Complete |
$69.56
|
| Rate for Payer: BCBS Trust/PPO |
$143.38
|
| Rate for Payer: BCN Commercial |
$143.38
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$163.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$168.68
|
| Rate for Payer: Healthscope Whirlpool |
$173.90
|
| Rate for Payer: Mclaren Commercial |
$156.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Nomi Health Commercial |
$142.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$152.37
|
| Rate for Payer: Priority Health Narrow Network |
$121.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.03
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$3.48
|
|
|
Service Code
|
NDC 50268063911
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna Commercial |
$3.13
|
| Rate for Payer: ASR ASR |
$3.37
|
| Rate for Payer: BCBS Trust/PPO |
$2.86
|
| Rate for Payer: BCN Commercial |
$2.86
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$3.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$3.37
|
| Rate for Payer: Healthscope Whirlpool |
$3.48
|
| Rate for Payer: Mclaren Commercial |
$3.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.96
|
| Rate for Payer: Nomi Health Commercial |
$2.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.06
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$2.13
|
|
|
Service Code
|
NDC 51079005101
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$2.13 |
| Rate for Payer: Aetna Commercial |
$1.92
|
| Rate for Payer: Aetna Medicare |
$0.79
|
| Rate for Payer: ASR ASR |
$2.06
|
| Rate for Payer: BCBS Complete |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$1.75
|
| Rate for Payer: BCN Commercial |
$1.75
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.70
|
| Rate for Payer: Healthscope Commercial |
$2.06
|
| Rate for Payer: Healthscope Whirlpool |
$2.13
|
| Rate for Payer: Mclaren Commercial |
$1.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.81
|
| Rate for Payer: Nomi Health Commercial |
$1.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.86
|
| Rate for Payer: Priority Health Narrow Network |
$1.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.87
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$276.36
|
|
|
Service Code
|
NDC 904687045
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.25 |
| Max. Negotiated Rate |
$276.36 |
| Rate for Payer: Aetna Commercial |
$248.72
|
| Rate for Payer: Aetna Medicare |
$102.25
|
| Rate for Payer: ASR ASR |
$268.07
|
| Rate for Payer: BCBS Complete |
$110.54
|
| Rate for Payer: BCBS Trust/PPO |
$227.86
|
| Rate for Payer: BCN Commercial |
$227.86
|
| Rate for Payer: Cash Price |
$221.09
|
| Rate for Payer: Cofinity Commercial |
$259.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.09
|
| Rate for Payer: Healthscope Commercial |
$268.07
|
| Rate for Payer: Healthscope Whirlpool |
$276.36
|
| Rate for Payer: Mclaren Commercial |
$248.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.91
|
| Rate for Payer: Nomi Health Commercial |
$226.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$242.15
|
| Rate for Payer: Priority Health Narrow Network |
$193.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.20
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$193.80
|
|
|
Service Code
|
NDC 904647461
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.71 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: Aetna Medicare |
$71.71
|
| Rate for Payer: ASR ASR |
$187.99
|
| Rate for Payer: BCBS Complete |
$77.52
|
| Rate for Payer: BCBS Trust/PPO |
$159.79
|
| Rate for Payer: BCN Commercial |
$159.79
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Commercial |
$182.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.04
|
| Rate for Payer: Healthscope Commercial |
$187.99
|
| Rate for Payer: Healthscope Whirlpool |
$193.80
|
| Rate for Payer: Mclaren Commercial |
$174.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.73
|
| Rate for Payer: Nomi Health Commercial |
$158.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$169.81
|
| Rate for Payer: Priority Health Narrow Network |
$135.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.54
|
|
|
PAROXETINE 10 MG TABLET
|
Facility
|
OP
|
$297.60
|
|
|
Service Code
|
NDC 68084004401
|
| Hospital Charge Code |
16632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.11 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna Commercial |
$267.84
|
| Rate for Payer: Aetna Medicare |
$110.11
|
| Rate for Payer: ASR ASR |
$288.67
|
| Rate for Payer: BCBS Complete |
$119.04
|
| Rate for Payer: BCBS Trust/PPO |
$245.37
|
| Rate for Payer: BCN Commercial |
$245.37
|
| Rate for Payer: Cash Price |
$238.08
|
| Rate for Payer: Cofinity Commercial |
$279.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.08
|
| Rate for Payer: Healthscope Commercial |
$288.67
|
| Rate for Payer: Healthscope Whirlpool |
$297.60
|
| Rate for Payer: Mclaren Commercial |
$267.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$238.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.96
|
| Rate for Payer: Nomi Health Commercial |
$244.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$260.76
|
| Rate for Payer: Priority Health Narrow Network |
$208.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.89
|
|
|
PAROXETINE 10 MG TABLET
|
Facility
|
OP
|
$74.73
|
|
|
Service Code
|
NDC 378700193
|
| Hospital Charge Code |
16632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.65 |
| Max. Negotiated Rate |
$74.73 |
| Rate for Payer: Aetna Commercial |
$67.26
|
| Rate for Payer: Aetna Medicare |
$27.65
|
| Rate for Payer: ASR ASR |
$72.49
|
| Rate for Payer: BCBS Complete |
$29.89
|
| Rate for Payer: BCBS Trust/PPO |
$61.61
|
| Rate for Payer: BCN Commercial |
$61.61
|
| Rate for Payer: Cash Price |
$59.78
|
| Rate for Payer: Cofinity Commercial |
$70.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.78
|
| Rate for Payer: Healthscope Commercial |
$72.49
|
| Rate for Payer: Healthscope Whirlpool |
$74.73
|
| Rate for Payer: Mclaren Commercial |
$67.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.52
|
| Rate for Payer: Nomi Health Commercial |
$61.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.48
|
| Rate for Payer: Priority Health Narrow Network |
$52.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.76
|
|
|
PAROXETINE 10 MG TABLET
|
Facility
|
OP
|
$297.60
|
|
|
Service Code
|
NDC 68084004411
|
| Hospital Charge Code |
16632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.11 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna Commercial |
$267.84
|
| Rate for Payer: Aetna Medicare |
$110.11
|
| Rate for Payer: ASR ASR |
$288.67
|
| Rate for Payer: BCBS Complete |
$119.04
|
| Rate for Payer: BCBS Trust/PPO |
$245.37
|
| Rate for Payer: BCN Commercial |
$245.37
|
| Rate for Payer: Cash Price |
$238.08
|
| Rate for Payer: Cofinity Commercial |
$279.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.08
|
| Rate for Payer: Healthscope Commercial |
$288.67
|
| Rate for Payer: Healthscope Whirlpool |
$297.60
|
| Rate for Payer: Mclaren Commercial |
$267.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$238.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.96
|
| Rate for Payer: Nomi Health Commercial |
$244.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$260.76
|
| Rate for Payer: Priority Health Narrow Network |
$208.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.89
|
|
|
PAROXETINE 10 MG TABLET
|
Facility
|
IP
|
$74.73
|
|
|
Service Code
|
NDC 378700193
|
| Hospital Charge Code |
16632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.05 |
| Max. Negotiated Rate |
$74.73 |
| Rate for Payer: Aetna Commercial |
$67.26
|
| Rate for Payer: ASR ASR |
$72.49
|
| Rate for Payer: BCBS Trust/PPO |
$61.37
|
| Rate for Payer: BCN Commercial |
$61.37
|
| Rate for Payer: Cash Price |
$59.78
|
| Rate for Payer: Cofinity Commercial |
$70.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.78
|
| Rate for Payer: Healthscope Commercial |
$72.49
|
| Rate for Payer: Healthscope Whirlpool |
$74.73
|
| Rate for Payer: Mclaren Commercial |
$67.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.52
|
| Rate for Payer: Nomi Health Commercial |
$61.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.76
|
|
|
PAROXETINE 10 MG TABLET
|
Facility
|
IP
|
$297.60
|
|
|
Service Code
|
NDC 68084004401
|
| Hospital Charge Code |
16632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna Commercial |
$267.84
|
| Rate for Payer: ASR ASR |
$288.67
|
| Rate for Payer: BCBS Trust/PPO |
$244.39
|
| Rate for Payer: BCN Commercial |
$244.39
|
| Rate for Payer: Cash Price |
$238.08
|
| Rate for Payer: Cofinity Commercial |
$279.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.08
|
| Rate for Payer: Healthscope Commercial |
$288.67
|
| Rate for Payer: Healthscope Whirlpool |
$297.60
|
| Rate for Payer: Mclaren Commercial |
$267.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.96
|
| Rate for Payer: Nomi Health Commercial |
$244.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.89
|
|
|
PAROXETINE 10 MG TABLET
|
Facility
|
IP
|
$297.60
|
|
|
Service Code
|
NDC 68084004411
|
| Hospital Charge Code |
16632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna Commercial |
$267.84
|
| Rate for Payer: ASR ASR |
$288.67
|
| Rate for Payer: BCBS Trust/PPO |
$244.39
|
| Rate for Payer: BCN Commercial |
$244.39
|
| Rate for Payer: Cash Price |
$238.08
|
| Rate for Payer: Cofinity Commercial |
$279.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.08
|
| Rate for Payer: Healthscope Commercial |
$288.67
|
| Rate for Payer: Healthscope Whirlpool |
$297.60
|
| Rate for Payer: Mclaren Commercial |
$267.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.96
|
| Rate for Payer: Nomi Health Commercial |
$244.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.89
|
|
