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New York rates for HCPCS C9113

Injection, pantoprazole sodium, per vial

Insurance Carrier
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.00 / $5.00 / $5.50
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $5.00 / $5.00
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $597.00 / $74,999.25
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.75 / $12.75 / $12.75
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.75 / $12.75 / $13.96