|
PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$38.14
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
32589
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.26 |
| Max. Negotiated Rate |
$38.14 |
| Rate for Payer: Aetna Commercial |
$34.33
|
| Rate for Payer: Aetna Commercial |
$53.59
|
| Rate for Payer: Aetna Medicare |
$19.07
|
| Rate for Payer: Aetna Medicare |
$29.77
|
| Rate for Payer: ASR ASR |
$37.00
|
| Rate for Payer: ASR ASR |
$57.75
|
| Rate for Payer: ASR Commercial |
$37.00
|
| Rate for Payer: ASR Commercial |
$57.75
|
| Rate for Payer: BCBS Complete |
$23.82
|
| Rate for Payer: BCBS Complete |
$15.26
|
| Rate for Payer: BCBS Trust/PPO |
$48.76
|
| Rate for Payer: BCBS Trust/PPO |
$31.23
|
| Rate for Payer: BCN Commercial |
$29.57
|
| Rate for Payer: BCN Commercial |
$46.16
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cash Price |
$47.63
|
| Rate for Payer: Cofinity Commercial |
$55.97
|
| Rate for Payer: Cofinity Commercial |
$35.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.51
|
| Rate for Payer: Healthscope Commercial |
$38.14
|
| Rate for Payer: Healthscope Commercial |
$59.54
|
| Rate for Payer: Healthscope Whirlpool |
$37.00
|
| Rate for Payer: Healthscope Whirlpool |
$57.75
|
| Rate for Payer: Mclaren Commercial |
$34.33
|
| Rate for Payer: Mclaren Commercial |
$53.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.61
|
| Rate for Payer: Nomi Health Commercial |
$31.27
|
| Rate for Payer: Nomi Health Commercial |
$48.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.17
|
| Rate for Payer: Priority Health Narrow Network |
$26.74
|
| Rate for Payer: Priority Health Narrow Network |
$41.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.40
|
|
|
PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$59.54
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
32589
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$59.54 |
| Rate for Payer: Aetna Commercial |
$53.59
|
| Rate for Payer: Aetna Commercial |
$34.33
|
| Rate for Payer: ASR ASR |
$37.00
|
| Rate for Payer: ASR ASR |
$57.75
|
| Rate for Payer: ASR Commercial |
$37.00
|
| Rate for Payer: ASR Commercial |
$57.75
|
| Rate for Payer: BCBS Trust/PPO |
$31.08
|
| Rate for Payer: BCBS Trust/PPO |
$48.52
|
| Rate for Payer: BCN Commercial |
$29.57
|
| Rate for Payer: BCN Commercial |
$46.16
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cash Price |
$47.63
|
| Rate for Payer: Cofinity Commercial |
$55.97
|
| Rate for Payer: Cofinity Commercial |
$35.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.51
|
| Rate for Payer: Healthscope Commercial |
$38.14
|
| Rate for Payer: Healthscope Commercial |
$59.54
|
| Rate for Payer: Healthscope Whirlpool |
$37.00
|
| Rate for Payer: Healthscope Whirlpool |
$57.75
|
| Rate for Payer: Mclaren Commercial |
$34.33
|
| Rate for Payer: Mclaren Commercial |
$53.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.42
|
| Rate for Payer: Nomi Health Commercial |
$48.82
|
| Rate for Payer: Nomi Health Commercial |
$31.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.56
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$2.19
|
|
|
Service Code
|
NDC 50268058511
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna Commercial |
$1.97
|
| Rate for Payer: Aetna Medicare |
$1.09
|
| Rate for Payer: ASR ASR |
$2.12
|
| Rate for Payer: ASR Commercial |
$2.12
|
| Rate for Payer: BCBS Complete |
$0.88
|
| Rate for Payer: BCBS Trust/PPO |
$1.79
|
| Rate for Payer: BCN Commercial |
$1.70
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cofinity Commercial |
$2.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.75
|
| Rate for Payer: Healthscope Commercial |
$2.19
|
| Rate for Payer: Healthscope Whirlpool |
$2.12
|
| Rate for Payer: Mclaren Commercial |
$1.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.86
|
| Rate for Payer: Nomi Health Commercial |
$1.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.92
|
| Rate for Payer: Priority Health Narrow Network |
$1.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.93
|
|
|
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 |
$87.98 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna Commercial |
$197.96
|
| Rate for Payer: Aetna Medicare |
$109.98
|
| Rate for Payer: ASR ASR |
$213.36
|
| Rate for Payer: ASR Commercial |
$213.36
|
| Rate for Payer: BCBS Complete |
$87.98
|
| Rate for Payer: BCBS Trust/PPO |
$180.13
|
| 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 Commercial |
$186.97
|
| Rate for Payer: Nomi Health Commercial |
$180.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.73
|
| Rate for Payer: Priority Health Narrow Network |
$154.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.56
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$109.72
|
|
|
Service Code
|
NDC 50268058515
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.32 |
| Max. Negotiated Rate |
$109.72 |
| Rate for Payer: Aetna Commercial |
$98.75
|
| Rate for Payer: ASR ASR |
$106.43
|
| Rate for Payer: ASR Commercial |
$106.43
|
| Rate for Payer: BCBS Trust/PPO |
$89.41
|
| Rate for Payer: BCN Commercial |
$85.07
|
| Rate for Payer: Cash Price |
$87.78
|
| Rate for Payer: Cofinity Commercial |
$103.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.78
|
| Rate for Payer: Healthscope Commercial |
$109.72
|
| Rate for Payer: Healthscope Whirlpool |
$106.43
|
| Rate for Payer: Mclaren Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.26
|
| Rate for Payer: Nomi Health Commercial |
$89.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.55
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$2.19
|
|
|
Service Code
|
NDC 50268058511
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna Commercial |
$1.97
|
| Rate for Payer: ASR ASR |
$2.12
|
| Rate for Payer: ASR Commercial |
$2.12
|
| Rate for Payer: BCBS Trust/PPO |
$1.78
|
| Rate for Payer: BCN Commercial |
$1.70
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cofinity Commercial |
$2.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.75
|
| Rate for Payer: Healthscope Commercial |
$2.19
|
| Rate for Payer: Healthscope Whirlpool |
$2.12
|
| Rate for Payer: Mclaren Commercial |
$1.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.86
|
| Rate for Payer: Nomi Health Commercial |
$1.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.93
|
|
|
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 |
$142.97 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna Commercial |
$197.96
|
| Rate for Payer: ASR ASR |
$213.36
|
| Rate for Payer: ASR Commercial |
$213.36
|
| Rate for Payer: BCBS Trust/PPO |
$179.25
|
| 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 Commercial |
$186.97
|
| Rate for Payer: Nomi Health Commercial |
$180.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.56
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$109.72
|
|
|
Service Code
|
NDC 50268058515
|
| Hospital Charge Code |
26224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.89 |
| Max. Negotiated Rate |
$109.72 |
| Rate for Payer: Aetna Commercial |
$98.75
|
| Rate for Payer: Aetna Medicare |
$54.86
|
| Rate for Payer: ASR ASR |
$106.43
|
| Rate for Payer: ASR Commercial |
$106.43
|
| Rate for Payer: BCBS Complete |
$43.89
|
| Rate for Payer: BCBS Trust/PPO |
$89.85
|
| Rate for Payer: BCN Commercial |
$85.07
|
| Rate for Payer: Cash Price |
$87.78
|
| Rate for Payer: Cofinity Commercial |
$103.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.78
|
| Rate for Payer: Healthscope Commercial |
$109.72
|
| Rate for Payer: Healthscope Whirlpool |
$106.43
|
| Rate for Payer: Mclaren Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.26
|
| Rate for Payer: Nomi Health Commercial |
$89.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.14
|
| Rate for Payer: Priority Health Narrow Network |
$76.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.55
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.27
|
|
|
Service Code
|
HCPCS J2471
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$19.27 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: ASR ASR |
$18.69
|
| Rate for Payer: ASR Commercial |
$18.69
|
| Rate for Payer: BCBS Trust/PPO |
$15.70
|
| Rate for Payer: BCN Commercial |
$14.94
|
| 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 |
$19.27
|
| Rate for Payer: Healthscope Whirlpool |
$18.69
|
| 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: Priority Health Cigna Priority Health |
$12.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.96
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.64
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$19.64 |
| Rate for Payer: Aetna Commercial |
$17.68
|
| Rate for Payer: Aetna Commercial |
$19.85
|
| Rate for Payer: Aetna Commercial |
$14.89
|
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: Aetna Commercial |
$13.83
|
| Rate for Payer: Aetna Commercial |
$25.18
|
| Rate for Payer: Aetna Commercial |
$15.18
|
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Commercial |
$22.91
|
| Rate for Payer: Aetna Commercial |
$20.82
|
| Rate for Payer: Aetna Medicare |
$11.03
|
| Rate for Payer: Aetna Medicare |
$8.27
|
| Rate for Payer: Aetna Medicare |
$7.68
|
| Rate for Payer: Aetna Medicare |
$10.35
|
| Rate for Payer: Aetna Medicare |
$13.99
|
| Rate for Payer: Aetna Medicare |
$9.21
|
| Rate for Payer: Aetna Medicare |
$9.82
|
| Rate for Payer: Aetna Medicare |
$11.56
|
| Rate for Payer: Aetna Medicare |
$8.44
|
| Rate for Payer: Aetna Medicare |
$12.72
|
| Rate for Payer: Aetna Medicare |
$13.18
|
| Rate for Payer: ASR ASR |
$17.87
|
| Rate for Payer: ASR ASR |
$16.36
|
| Rate for Payer: ASR ASR |
$22.44
|
| Rate for Payer: ASR ASR |
$27.14
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: ASR ASR |
$14.91
|
| Rate for Payer: ASR ASR |
$21.40
|
| Rate for Payer: ASR ASR |
$25.56
|
| Rate for Payer: ASR ASR |
$19.05
|
| Rate for Payer: ASR ASR |
$24.69
|
| Rate for Payer: ASR ASR |
$16.04
|
| Rate for Payer: ASR Commercial |
$20.07
|
| Rate for Payer: ASR Commercial |
$16.04
|
| Rate for Payer: ASR Commercial |
$16.36
|
| Rate for Payer: ASR Commercial |
$17.87
|
| Rate for Payer: ASR Commercial |
$14.91
|
| Rate for Payer: ASR Commercial |
$27.14
|
| Rate for Payer: ASR Commercial |
$25.56
|
| Rate for Payer: ASR Commercial |
$24.69
|
| Rate for Payer: ASR Commercial |
$22.44
|
| Rate for Payer: ASR Commercial |
$19.05
|
| Rate for Payer: ASR Commercial |
$21.40
|
| Rate for Payer: BCBS Complete |
$9.25
|
| Rate for Payer: BCBS Complete |
$10.18
|
| Rate for Payer: BCBS Complete |
$11.19
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS Complete |
$8.82
|
| Rate for Payer: BCBS Complete |
$6.15
|
| Rate for Payer: BCBS Complete |
$10.54
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: BCBS Complete |
$7.86
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS Trust/PPO |
$15.08
|
| Rate for Payer: BCBS Trust/PPO |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.84
|
| Rate for Payer: BCBS Trust/PPO |
$18.94
|
| Rate for Payer: BCBS Trust/PPO |
$13.81
|
| Rate for Payer: BCBS Trust/PPO |
$13.54
|
| Rate for Payer: BCBS Trust/PPO |
$12.59
|
| Rate for Payer: BCBS Trust/PPO |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$16.08
|
| Rate for Payer: BCBS Trust/PPO |
$18.06
|
| Rate for Payer: BCBS Trust/PPO |
$22.91
|
| Rate for Payer: BCN Commercial |
$12.82
|
| Rate for Payer: BCN Commercial |
$17.93
|
| Rate for Payer: BCN Commercial |
$16.04
|
| Rate for Payer: BCN Commercial |
$14.28
|
| Rate for Payer: BCN Commercial |
$21.69
|
| Rate for Payer: BCN Commercial |
$15.23
|
| Rate for Payer: BCN Commercial |
$17.10
|
| Rate for Payer: BCN Commercial |
$19.73
|
| Rate for Payer: BCN Commercial |
$20.43
|
| Rate for Payer: BCN Commercial |
$13.08
|
| Rate for Payer: BCN Commercial |
$11.92
|
| Rate for Payer: Cash Price |
$22.39
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cash Price |
$17.64
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$20.36
|
| Rate for Payer: Cash Price |
$13.23
|
| Rate for Payer: Cofinity Commercial |
$24.77
|
| Rate for Payer: Cofinity Commercial |
$21.74
|
| Rate for Payer: Cofinity Commercial |
$17.31
|
| Rate for Payer: Cofinity Commercial |
$26.30
|
| Rate for Payer: Cofinity Commercial |
$15.55
|
| Rate for Payer: Cofinity Commercial |
$23.92
|
| Rate for Payer: Cofinity Commercial |
$14.45
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Cofinity Commercial |
$20.74
|
| Rate for Payer: Cofinity Commercial |
$15.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| 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 |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.38
|
| Rate for Payer: Healthscope Commercial |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$19.64
|
| Rate for Payer: Healthscope Commercial |
$23.13
|
| Rate for Payer: Healthscope Commercial |
$22.06
|
| Rate for Payer: Healthscope Commercial |
$20.69
|
| Rate for Payer: Healthscope Commercial |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$15.37
|
| Rate for Payer: Healthscope Commercial |
$18.42
|
| Rate for Payer: Healthscope Commercial |
$16.54
|
| Rate for Payer: Healthscope Commercial |
$26.35
|
| Rate for Payer: Healthscope Commercial |
$27.98
|
| Rate for Payer: Healthscope Whirlpool |
$27.14
|
| Rate for Payer: Healthscope Whirlpool |
$25.56
|
| Rate for Payer: Healthscope Whirlpool |
$14.91
|
| Rate for Payer: Healthscope Whirlpool |
$16.04
|
| Rate for Payer: Healthscope Whirlpool |
$16.36
|
| Rate for Payer: Healthscope Whirlpool |
$22.44
|
| Rate for Payer: Healthscope Whirlpool |
$24.69
|
| Rate for Payer: Healthscope Whirlpool |
$19.05
|
| Rate for Payer: Healthscope Whirlpool |
$21.40
|
| Rate for Payer: Healthscope Whirlpool |
$20.07
|
| Rate for Payer: Healthscope Whirlpool |
$17.87
|
| Rate for Payer: Mclaren Commercial |
$22.91
|
| Rate for Payer: Mclaren Commercial |
$17.68
|
| Rate for Payer: Mclaren Commercial |
$19.85
|
| Rate for Payer: Mclaren Commercial |
$25.18
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: Mclaren Commercial |
$16.58
|
| Rate for Payer: Mclaren Commercial |
$20.82
|
| Rate for Payer: Mclaren Commercial |
$13.83
|
| Rate for Payer: Mclaren Commercial |
$14.89
|
| Rate for Payer: Mclaren Commercial |
$15.18
|
| Rate for Payer: Mclaren Commercial |
$23.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.75
|
| Rate for Payer: Nomi Health Commercial |
$20.87
|
| Rate for Payer: Nomi Health Commercial |
$13.83
|
| Rate for Payer: Nomi Health Commercial |
$18.97
|
| Rate for Payer: Nomi Health Commercial |
$16.10
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$12.60
|
| Rate for Payer: Nomi Health Commercial |
$22.94
|
| Rate for Payer: Nomi Health Commercial |
$21.61
|
| Rate for Payer: Nomi Health Commercial |
$13.56
|
| Rate for Payer: Nomi Health Commercial |
$15.10
|
| Rate for Payer: Nomi Health Commercial |
$18.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.14
|
| Rate for Payer: Priority Health Narrow Network |
$16.21
|
| Rate for Payer: Priority Health Narrow Network |
$11.83
|
| Rate for Payer: Priority Health Narrow Network |
$10.77
|
| Rate for Payer: Priority Health Narrow Network |
$15.46
|
| Rate for Payer: Priority Health Narrow Network |
$18.47
|
| Rate for Payer: Priority Health Narrow Network |
$19.61
|
| Rate for Payer: Priority Health Narrow Network |
$13.77
|
| Rate for Payer: Priority Health Narrow Network |
$11.59
|
| Rate for Payer: Priority Health Narrow Network |
$12.91
|
| Rate for Payer: Priority Health Narrow Network |
$14.50
|
| Rate for Payer: Priority Health Narrow Network |
$17.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.64
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$19.64 |
| Rate for Payer: Aetna Commercial |
$17.68
|
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: Aetna Commercial |
$14.89
|
| Rate for Payer: Aetna Commercial |
$13.83
|
| Rate for Payer: Aetna Commercial |
$15.18
|
| Rate for Payer: Aetna Commercial |
$19.85
|
| Rate for Payer: Aetna Commercial |
$20.82
|
| Rate for Payer: Aetna Commercial |
$22.91
|
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Commercial |
$25.18
|
| Rate for Payer: ASR ASR |
$17.87
|
| Rate for Payer: ASR ASR |
$27.14
|
| Rate for Payer: ASR ASR |
$16.36
|
| Rate for Payer: ASR ASR |
$19.05
|
| Rate for Payer: ASR ASR |
$21.40
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: ASR ASR |
$25.56
|
| Rate for Payer: ASR ASR |
$22.44
|
| Rate for Payer: ASR ASR |
$16.04
|
| Rate for Payer: ASR ASR |
$14.91
|
| Rate for Payer: ASR ASR |
$24.69
|
| Rate for Payer: ASR Commercial |
$16.36
|
| Rate for Payer: ASR Commercial |
$17.87
|
| Rate for Payer: ASR Commercial |
$16.04
|
| Rate for Payer: ASR Commercial |
$14.91
|
| Rate for Payer: ASR Commercial |
$21.40
|
| Rate for Payer: ASR Commercial |
$22.44
|
| Rate for Payer: ASR Commercial |
$25.56
|
| Rate for Payer: ASR Commercial |
$24.69
|
| Rate for Payer: ASR Commercial |
$27.14
|
| Rate for Payer: ASR Commercial |
$20.07
|
| Rate for Payer: ASR Commercial |
$19.05
|
| Rate for Payer: BCBS Trust/PPO |
$20.74
|
| Rate for Payer: BCBS Trust/PPO |
$18.85
|
| Rate for Payer: BCBS Trust/PPO |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$12.53
|
| Rate for Payer: BCBS Trust/PPO |
$13.48
|
| Rate for Payer: BCBS Trust/PPO |
$15.01
|
| Rate for Payer: BCBS Trust/PPO |
$13.75
|
| Rate for Payer: BCBS Trust/PPO |
$22.80
|
| Rate for Payer: BCBS Trust/PPO |
$21.47
|
| Rate for Payer: BCBS Trust/PPO |
$16.86
|
| Rate for Payer: BCBS Trust/PPO |
$17.98
|
| Rate for Payer: BCN Commercial |
$15.23
|
| Rate for Payer: BCN Commercial |
$16.04
|
| Rate for Payer: BCN Commercial |
$14.28
|
| Rate for Payer: BCN Commercial |
$11.92
|
| Rate for Payer: BCN Commercial |
$19.73
|
| Rate for Payer: BCN Commercial |
$12.82
|
| Rate for Payer: BCN Commercial |
$13.08
|
| Rate for Payer: BCN Commercial |
$17.10
|
| Rate for Payer: BCN Commercial |
$20.43
|
| Rate for Payer: BCN Commercial |
$21.69
|
| Rate for Payer: BCN Commercial |
$17.93
|
| Rate for Payer: Cash Price |
$22.39
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cash Price |
$17.64
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cash Price |
$20.36
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cash Price |
$13.23
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cofinity Commercial |
$21.74
|
| Rate for Payer: Cofinity Commercial |
$26.30
|
| Rate for Payer: Cofinity Commercial |
$15.55
|
| Rate for Payer: Cofinity Commercial |
$24.77
|
| Rate for Payer: Cofinity Commercial |
$20.74
|
| Rate for Payer: Cofinity Commercial |
$17.31
|
| Rate for Payer: Cofinity Commercial |
$14.45
|
| Rate for Payer: Cofinity Commercial |
$15.86
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Cofinity Commercial |
$23.92
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.36
|
| Rate for Payer: Healthscope Commercial |
$23.13
|
| Rate for Payer: Healthscope Commercial |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$20.69
|
| Rate for Payer: Healthscope Commercial |
$26.35
|
| Rate for Payer: Healthscope Commercial |
$19.64
|
| Rate for Payer: Healthscope Commercial |
$22.06
|
| Rate for Payer: Healthscope Commercial |
$27.98
|
| Rate for Payer: Healthscope Commercial |
$15.37
|
| Rate for Payer: Healthscope Commercial |
$16.54
|
| Rate for Payer: Healthscope Commercial |
$18.42
|
| Rate for Payer: Healthscope Whirlpool |
$25.56
|
| Rate for Payer: Healthscope Whirlpool |
$14.91
|
| Rate for Payer: Healthscope Whirlpool |
$16.36
|
| Rate for Payer: Healthscope Whirlpool |
$16.04
|
| Rate for Payer: Healthscope Whirlpool |
$17.87
|
| Rate for Payer: Healthscope Whirlpool |
$19.05
|
| Rate for Payer: Healthscope Whirlpool |
$20.07
|
| Rate for Payer: Healthscope Whirlpool |
$21.40
|
| Rate for Payer: Healthscope Whirlpool |
$22.44
|
| Rate for Payer: Healthscope Whirlpool |
$24.69
|
| Rate for Payer: Healthscope Whirlpool |
$27.14
|
| Rate for Payer: Mclaren Commercial |
$25.18
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: Mclaren Commercial |
$17.68
|
| Rate for Payer: Mclaren Commercial |
$14.89
|
| Rate for Payer: Mclaren Commercial |
$15.18
|
| Rate for Payer: Mclaren Commercial |
$20.82
|
| Rate for Payer: Mclaren Commercial |
$19.85
|
| Rate for Payer: Mclaren Commercial |
$13.83
|
| Rate for Payer: Mclaren Commercial |
$16.58
|
| Rate for Payer: Mclaren Commercial |
$23.71
|
| Rate for Payer: Mclaren Commercial |
$22.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.78
|
| Rate for Payer: Nomi Health Commercial |
$15.10
|
| Rate for Payer: Nomi Health Commercial |
$13.83
|
| Rate for Payer: Nomi Health Commercial |
$18.97
|
| Rate for Payer: Nomi Health Commercial |
$18.09
|
| Rate for Payer: Nomi Health Commercial |
$21.61
|
| Rate for Payer: Nomi Health Commercial |
$20.87
|
| Rate for Payer: Nomi Health Commercial |
$13.56
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$22.94
|
| Rate for Payer: Nomi Health Commercial |
$16.10
|
| Rate for Payer: Nomi Health Commercial |
$12.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.41
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.27
|
|
|
Service Code
|
HCPCS J2471
|
| Hospital Charge Code |
26226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$19.27 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$9.63
|
| Rate for Payer: ASR ASR |
$18.69
|
| Rate for Payer: ASR Commercial |
$18.69
|
| Rate for Payer: BCBS Complete |
$7.71
|
| Rate for Payer: BCBS Trust/PPO |
$15.78
|
| Rate for Payer: BCN Commercial |
$14.94
|
| 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 |
$19.27
|
| Rate for Payer: Healthscope Whirlpool |
$18.69
|
| 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: Priority Health Cigna Priority Health |
$12.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.88
|
| Rate for Payer: Priority Health Narrow Network |
$13.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.96
|
|
|
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 |
$12.77 |
| Max. Negotiated Rate |
$19.64 |
| Rate for Payer: Aetna Commercial |
$17.68
|
| Rate for Payer: ASR ASR |
$19.05
|
| Rate for Payer: ASR Commercial |
$19.05
|
| Rate for Payer: BCBS Trust/PPO |
$16.00
|
| Rate for Payer: BCN Commercial |
$15.23
|
| 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 |
$19.64
|
| Rate for Payer: Healthscope Whirlpool |
$19.05
|
| 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: Priority Health Cigna Priority Health |
$12.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.28
|
|
|
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 |
$7.86 |
| Max. Negotiated Rate |
$19.64 |
| Rate for Payer: Aetna Commercial |
$17.68
|
| Rate for Payer: Aetna Medicare |
$9.82
|
| Rate for Payer: ASR ASR |
$19.05
|
| Rate for Payer: ASR Commercial |
$19.05
|
| Rate for Payer: BCBS Complete |
$7.86
|
| Rate for Payer: BCBS Trust/PPO |
$16.08
|
| Rate for Payer: BCN Commercial |
$15.23
|
| 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 |
$19.64
|
| Rate for Payer: Healthscope Whirlpool |
$19.05
|
| 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: Priority Health Cigna Priority Health |
$12.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.21
|
| Rate for Payer: Priority Health Narrow Network |
$13.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.28
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$270.72
|
|
|
Service Code
|
NDC 00904687045
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.97 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna Commercial |
$243.65
|
| Rate for Payer: ASR ASR |
$262.60
|
| Rate for Payer: ASR Commercial |
$262.60
|
| Rate for Payer: BCBS Trust/PPO |
$220.61
|
| Rate for Payer: BCN Commercial |
$209.89
|
| Rate for Payer: Cash Price |
$216.58
|
| Rate for Payer: Cofinity Commercial |
$254.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.58
|
| Rate for Payer: Healthscope Commercial |
$270.72
|
| Rate for Payer: Healthscope Whirlpool |
$262.60
|
| Rate for Payer: Mclaren Commercial |
$243.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.11
|
| Rate for Payer: Nomi Health Commercial |
$221.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.23
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$446.50
|
|
|
Service Code
|
NDC 66993006880
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.60 |
| Max. Negotiated Rate |
$446.50 |
| Rate for Payer: Aetna Commercial |
$401.85
|
| Rate for Payer: Aetna Medicare |
$223.25
|
| Rate for Payer: ASR ASR |
$433.11
|
| Rate for Payer: ASR Commercial |
$433.11
|
| Rate for Payer: BCBS Complete |
$178.60
|
| Rate for Payer: BCBS Trust/PPO |
$365.64
|
| Rate for Payer: BCN Commercial |
$346.17
|
| Rate for Payer: Cash Price |
$357.20
|
| Rate for Payer: Cofinity Commercial |
$419.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.20
|
| Rate for Payer: Healthscope Commercial |
$446.50
|
| Rate for Payer: Healthscope Whirlpool |
$433.11
|
| Rate for Payer: Mclaren Commercial |
$401.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.52
|
| Rate for Payer: Nomi Health Commercial |
$366.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.22
|
| Rate for Payer: Priority Health Narrow Network |
$313.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$392.92
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$4.46
|
|
|
Service Code
|
NDC 66993006851
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$4.01
|
| Rate for Payer: ASR ASR |
$4.33
|
| Rate for Payer: ASR Commercial |
$4.33
|
| Rate for Payer: BCBS Trust/PPO |
$3.63
|
| Rate for Payer: BCN Commercial |
$3.46
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cofinity Commercial |
$4.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.57
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Healthscope Whirlpool |
$4.33
|
| Rate for Payer: Mclaren Commercial |
$4.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.79
|
| Rate for Payer: Nomi Health Commercial |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.92
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$3.08
|
|
|
Service Code
|
NDC 50268063911
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.08 |
| Rate for Payer: Aetna Commercial |
$2.77
|
| Rate for Payer: ASR ASR |
$2.99
|
| Rate for Payer: ASR Commercial |
$2.99
|
| Rate for Payer: BCBS Trust/PPO |
$2.51
|
| Rate for Payer: BCN Commercial |
$2.39
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$3.08
|
| Rate for Payer: Healthscope Whirlpool |
$2.99
|
| Rate for Payer: Mclaren Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.62
|
| Rate for Payer: Nomi Health Commercial |
$2.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.71
|
|
|
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 |
$80.18 |
| Max. Negotiated Rate |
$200.45 |
| Rate for Payer: Aetna Commercial |
$180.41
|
| Rate for Payer: Aetna Medicare |
$100.22
|
| Rate for Payer: ASR ASR |
$194.44
|
| Rate for Payer: ASR Commercial |
$194.44
|
| Rate for Payer: BCBS Complete |
$80.18
|
| Rate for Payer: BCBS Trust/PPO |
$164.15
|
| Rate for Payer: BCN Commercial |
$155.41
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$188.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$200.45
|
| Rate for Payer: Healthscope Whirlpool |
$194.44
|
| Rate for Payer: Mclaren Commercial |
$180.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: Nomi Health Commercial |
$164.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.63
|
| Rate for Payer: Priority Health Narrow Network |
$140.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.40
|
|
|
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 |
$130.29 |
| Max. Negotiated Rate |
$200.45 |
| Rate for Payer: Aetna Commercial |
$180.41
|
| Rate for Payer: ASR ASR |
$194.44
|
| Rate for Payer: ASR Commercial |
$194.44
|
| Rate for Payer: BCBS Trust/PPO |
$163.35
|
| Rate for Payer: BCN Commercial |
$155.41
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$188.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$200.45
|
| Rate for Payer: Healthscope Whirlpool |
$194.44
|
| Rate for Payer: Mclaren Commercial |
$180.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: Nomi Health Commercial |
$164.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.40
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$153.93
|
|
|
Service Code
|
NDC 50268063915
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.05 |
| Max. Negotiated Rate |
$153.93 |
| Rate for Payer: Aetna Commercial |
$138.54
|
| Rate for Payer: ASR ASR |
$149.31
|
| Rate for Payer: ASR Commercial |
$149.31
|
| Rate for Payer: BCBS Trust/PPO |
$125.44
|
| Rate for Payer: BCN Commercial |
$119.34
|
| Rate for Payer: Cash Price |
$123.14
|
| Rate for Payer: Cofinity Commercial |
$144.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.14
|
| Rate for Payer: Healthscope Commercial |
$153.93
|
| Rate for Payer: Healthscope Whirlpool |
$149.31
|
| Rate for Payer: Mclaren Commercial |
$138.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.84
|
| Rate for Payer: Nomi Health Commercial |
$126.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.46
|
|
|
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 |
$108.29 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna Commercial |
$243.65
|
| Rate for Payer: Aetna Medicare |
$135.36
|
| Rate for Payer: ASR ASR |
$262.60
|
| Rate for Payer: ASR Commercial |
$262.60
|
| Rate for Payer: BCBS Complete |
$108.29
|
| Rate for Payer: BCBS Trust/PPO |
$221.69
|
| Rate for Payer: BCN Commercial |
$209.89
|
| Rate for Payer: Cash Price |
$216.58
|
| Rate for Payer: Cofinity Commercial |
$254.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.58
|
| Rate for Payer: Healthscope Commercial |
$270.72
|
| Rate for Payer: Healthscope Whirlpool |
$262.60
|
| Rate for Payer: Mclaren Commercial |
$243.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.11
|
| Rate for Payer: Nomi Health Commercial |
$221.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$237.20
|
| Rate for Payer: Priority Health Narrow Network |
$189.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.23
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$3.08
|
|
|
Service Code
|
NDC 50268063911
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$3.08 |
| Rate for Payer: Aetna Commercial |
$2.77
|
| Rate for Payer: Aetna Medicare |
$1.54
|
| Rate for Payer: ASR ASR |
$2.99
|
| Rate for Payer: ASR Commercial |
$2.99
|
| Rate for Payer: BCBS Complete |
$1.23
|
| Rate for Payer: BCBS Trust/PPO |
$2.52
|
| Rate for Payer: BCN Commercial |
$2.39
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$3.08
|
| Rate for Payer: Healthscope Whirlpool |
$2.99
|
| Rate for Payer: Mclaren Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.62
|
| Rate for Payer: Nomi Health Commercial |
$2.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.70
|
| Rate for Payer: Priority Health Narrow Network |
$2.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.71
|
|
|
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 |
$88.92 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$200.07
|
| Rate for Payer: Aetna Medicare |
$111.15
|
| Rate for Payer: ASR ASR |
$215.63
|
| Rate for Payer: ASR Commercial |
$215.63
|
| Rate for Payer: BCBS Complete |
$88.92
|
| Rate for Payer: BCBS Trust/PPO |
$182.04
|
| Rate for Payer: BCN Commercial |
$172.35
|
| 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 |
$222.30
|
| Rate for Payer: Healthscope Whirlpool |
$215.63
|
| 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: Priority Health Cigna Priority Health |
$144.50
|
| Rate for Payer: 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
|
OP
|
$4.46
|
|
|
Service Code
|
NDC 66993006851
|
| Hospital Charge Code |
26225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$4.01
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: ASR ASR |
$4.33
|
| Rate for Payer: ASR Commercial |
$4.33
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: BCBS Trust/PPO |
$3.65
|
| Rate for Payer: BCN Commercial |
$3.46
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cofinity Commercial |
$4.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.57
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Healthscope Whirlpool |
$4.33
|
| Rate for Payer: Mclaren Commercial |
$4.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.79
|
| Rate for Payer: Nomi Health Commercial |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.91
|
| Rate for Payer: Priority Health Narrow Network |
$3.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.92
|
|
