Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]

Facility

IP

$0.21

Service Code	NDC 68084-813-11
Hospital Charge Code	1712267
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.17
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA HMO/PPO	$0.17
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.16

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]

Facility

IP

$0.34

Service Code	NDC 51079-051-01
Hospital Charge Code	1712267
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.27
Rate for Payer: Cash Price	$0.15
Rate for Payer: Cigna of CA HMO/PPO	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.26

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]

Facility

IP

$0.26

Service Code	NDC 50268-639-15
Hospital Charge Code	1712267
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.21
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna of CA HMO/PPO	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]

Facility

OP

$0.34

Service Code	NDC 51079-051-20
Hospital Charge Code	1712267
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.20
Rate for Payer: Aetna of CA Government/Medicare	$0.20
Rate for Payer: Cash Price	$0.15
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.26

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]

Facility

OP

$0.36

Service Code	NDC 0904-6474-61
Hospital Charge Code	1712267
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.27
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.22
Rate for Payer: Aetna of CA Government/Medicare	$0.22
Rate for Payer: Cash Price	$0.16
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.27

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]

Facility

OP

$0.17

Service Code	NDC 65862-560-90
Hospital Charge Code	1712267
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.10
Rate for Payer: Aetna of CA Government/Medicare	$0.10
Rate for Payer: Cash Price	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.13

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]

Facility

IP

$0.17

Service Code	NDC 65862-560-90
Hospital Charge Code	1712267
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.08
Rate for Payer: Cigna of CA HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.13

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]

Facility

OP

$0.13

Service Code	NDC 31722-713-90
Hospital Charge Code	1712267
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.08
Rate for Payer: Aetna of CA Government/Medicare	$0.08
Rate for Payer: Cash Price	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.10

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]

Facility

IP

$0.13

Service Code	NDC 0378-6689-77
Hospital Charge Code	1712267
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of CA HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.10

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]

Facility

IP

$0.26

Service Code	NDC 50268-639-11
Hospital Charge Code	1712267
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.21
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna of CA HMO/PPO	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]

Facility

OP

$0.17

Service Code	NDC 65862-560-99
Hospital Charge Code	1712267
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.10
Rate for Payer: Aetna of CA Government/Medicare	$0.10
Rate for Payer: Cash Price	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.13

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]

Facility

IP

$0.17

Service Code	NDC 65862-560-99
Hospital Charge Code	1712267
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.08
Rate for Payer: Cigna of CA HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.13

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]

Facility

IP

$0.21

Service Code	NDC 68084-813-09
Hospital Charge Code	1712267
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.17
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA HMO/PPO	$0.17
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.16

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]

Facility

OP

$0.21

Service Code	NDC 68084-813-11
Hospital Charge Code	1712267
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.13
Rate for Payer: Aetna of CA Government/Medicare	$0.13
Rate for Payer: Cash Price	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.16

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]

Facility

OP

$0.26

Service Code	NDC 50268-639-11
Hospital Charge Code	1712267
Hospital Revenue Code	259
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.16
Rate for Payer: Aetna of CA Government/Medicare	$0.16
Rate for Payer: Cash Price	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]

Facility

IP

$0.36

Service Code	NDC 0904-6474-61
Hospital Charge Code	1712267
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.29
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of CA HMO/PPO	$0.29
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.27

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]

Facility

OP

$0.21

Service Code	NDC 68084-813-09
Hospital Charge Code	1712267
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.13
Rate for Payer: Aetna of CA Government/Medicare	$0.13
Rate for Payer: Cash Price	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.16

PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]

Facility

OP

$20.83

Service Code	NDC 0008-0844-02
Hospital Charge Code	ERX89791
Hospital Revenue Code	259
Min. Negotiated Rate	$11.46
Max. Negotiated Rate	$15.62
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.50
Rate for Payer: Aetna of CA Government/Medicare	$12.50
Rate for Payer: Cash Price	$9.37
Rate for Payer: Health Smart Auto/Commercial	$12.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.50
Rate for Payer: LLUH Dept of Risk Management WC	$11.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.62

PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]

Facility

IP

$16.99

Service Code	NDC 62756-071-60
Hospital Charge Code	ERX89791
Hospital Revenue Code	259
Min. Negotiated Rate	$9.34
Max. Negotiated Rate	$13.59
Rate for Payer: Cash Price	$7.65
Rate for Payer: Cigna of CA HMO/PPO	$13.59
Rate for Payer: Health Smart Auto/Commercial	$10.19
Rate for Payer: LLUH Dept of Risk Management WC	$9.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.74

PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]

Facility

IP

$16.99

Service Code	NDC 62756-071-64
Hospital Charge Code	ERX89791
Hospital Revenue Code	259
Min. Negotiated Rate	$9.34
Max. Negotiated Rate	$13.59
Rate for Payer: Cash Price	$7.65
Rate for Payer: Cigna of CA HMO/PPO	$13.59
Rate for Payer: Health Smart Auto/Commercial	$10.19
Rate for Payer: LLUH Dept of Risk Management WC	$9.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.74

PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]

Facility

OP

$16.99

Service Code	NDC 62756-071-60
Hospital Charge Code	ERX89791
Hospital Revenue Code	259
Min. Negotiated Rate	$9.34
Max. Negotiated Rate	$12.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.19
Rate for Payer: Aetna of CA Government/Medicare	$10.19
Rate for Payer: Cash Price	$7.65
Rate for Payer: Health Smart Auto/Commercial	$10.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.19
Rate for Payer: LLUH Dept of Risk Management WC	$9.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.74

PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]

Facility

IP

$20.83

Service Code	NDC 0008-0844-01
Hospital Charge Code	ERX89791
Hospital Revenue Code	259
Min. Negotiated Rate	$11.46
Max. Negotiated Rate	$16.66
Rate for Payer: Cash Price	$9.37
Rate for Payer: Cigna of CA HMO/PPO	$16.66
Rate for Payer: Health Smart Auto/Commercial	$12.50
Rate for Payer: LLUH Dept of Risk Management WC	$11.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.62

PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]

Facility

OP

$20.83

Service Code	NDC 0008-0844-01
Hospital Charge Code	ERX89791
Hospital Revenue Code	259
Min. Negotiated Rate	$11.46
Max. Negotiated Rate	$15.62
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.50
Rate for Payer: Aetna of CA Government/Medicare	$12.50
Rate for Payer: Cash Price	$9.37
Rate for Payer: Health Smart Auto/Commercial	$12.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.50
Rate for Payer: LLUH Dept of Risk Management WC	$11.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.62

PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]

Facility

IP

$20.83

Service Code	NDC 0008-0844-02
Hospital Charge Code	ERX89791
Hospital Revenue Code	259
Min. Negotiated Rate	$11.46
Max. Negotiated Rate	$16.66
Rate for Payer: Cash Price	$9.37
Rate for Payer: Cigna of CA HMO/PPO	$16.66
Rate for Payer: Health Smart Auto/Commercial	$12.50
Rate for Payer: LLUH Dept of Risk Management WC	$11.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.62

PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]

Facility

OP

$16.99

Service Code	NDC 62756-071-64
Hospital Charge Code	ERX89791
Hospital Revenue Code	259
Min. Negotiated Rate	$9.34
Max. Negotiated Rate	$12.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.19
Rate for Payer: Aetna of CA Government/Medicare	$10.19
Rate for Payer: Cash Price	$7.65
Rate for Payer: Health Smart Auto/Commercial	$10.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.19
Rate for Payer: LLUH Dept of Risk Management WC	$9.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.74

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