|
PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION [32589]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
CPT J2430
|
| Hospital Charge Code |
NDG32589
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$526.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$526.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$526.08
|
| Rate for Payer: Blue Distinction Transplant |
$1.01
|
| Rate for Payer: Blue Distinction Transplant |
$1.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California Commercial |
$2.39
|
| Rate for Payer: Blue Shield of California EPN |
$22.55
|
| Rate for Payer: Blue Shield of California EPN |
$22.55
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA HMO |
$2.27
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$2.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Media |
$2.75
|
| Rate for Payer: Dignity Health Media |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Galaxy Health WC |
$2.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1.94
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.43
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$0.84
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.75
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1.62
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1.62
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
PAMIDRONATE 30 MG INTRAVENOUS SOLUTION [10845]
|
Facility
|
IP
|
$22.55
|
|
|
Service Code
|
CPT J2430
|
| Hospital Charge Code |
1759468
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$19.17 |
| Rate for Payer: Blue Shield of California Commercial |
$16.06
|
| Rate for Payer: Blue Shield of California EPN |
$11.55
|
| Rate for Payer: Cash Price |
$10.15
|
| Rate for Payer: Cigna of CA HMO |
$15.78
|
| Rate for Payer: Cigna of CA PPO |
$15.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.02
|
| Rate for Payer: Galaxy Health WC |
$19.17
|
| Rate for Payer: Global Benefits Group Commercial |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.41
|
| Rate for Payer: Multiplan Commercial |
$18.04
|
| Rate for Payer: Networks By Design Commercial |
$11.28
|
| Rate for Payer: Prime Health Services Commercial |
$19.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.51
|
| Rate for Payer: United Healthcare All Other HMO |
$8.32
|
| Rate for Payer: United Healthcare HMO Rider |
$8.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.44
|
|
|
PAMIDRONATE 30 MG INTRAVENOUS SOLUTION [10845]
|
Facility
|
OP
|
$22.55
|
|
|
Service Code
|
CPT J2430
|
| Hospital Charge Code |
1759468
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$526.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$526.08
|
| Rate for Payer: Blue Distinction Transplant |
$13.53
|
| Rate for Payer: Blue Shield of California Commercial |
$16.62
|
| Rate for Payer: Blue Shield of California EPN |
$22.55
|
| Rate for Payer: Cash Price |
$10.15
|
| Rate for Payer: Cash Price |
$10.15
|
| Rate for Payer: Cigna of CA HMO |
$15.78
|
| Rate for Payer: Cigna of CA PPO |
$15.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.17
|
| Rate for Payer: Dignity Health Media |
$19.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.02
|
| Rate for Payer: Galaxy Health WC |
$19.17
|
| Rate for Payer: Global Benefits Group Commercial |
$13.53
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.41
|
| Rate for Payer: Multiplan Commercial |
$18.04
|
| Rate for Payer: Networks By Design Commercial |
$11.28
|
| Rate for Payer: Prime Health Services Commercial |
$19.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.28
|
| Rate for Payer: United Healthcare All Other HMO |
$11.28
|
| Rate for Payer: United Healthcare HMO Rider |
$11.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.17
|
| Rate for Payer: Vantage Medical Group Senior |
$19.17
|
|
|
PAMIDRONATE 60 MG/10 ML (6 MG/ML) INTRAVENOUS SOLUTION [33886]
|
Facility
|
IP
|
$4.09
|
|
|
Service Code
|
CPT J2430
|
| Hospital Charge Code |
1755744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Blue Shield of California Commercial |
$2.91
|
| Rate for Payer: Blue Shield of California EPN |
$2.09
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Cigna of CA HMO |
$2.86
|
| Rate for Payer: Cigna of CA PPO |
$2.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.27
|
| Rate for Payer: Networks By Design Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1.51
|
| Rate for Payer: United Healthcare HMO Rider |
$1.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.35
|
|
|
PAMIDRONATE 60 MG/10 ML (6 MG/ML) INTRAVENOUS SOLUTION [33886]
|
Facility
|
OP
|
$4.09
|
|
|
Service Code
|
CPT J2430
|
| Hospital Charge Code |
1755744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$526.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$526.08
|
| Rate for Payer: Blue Distinction Transplant |
$2.45
|
| Rate for Payer: Blue Shield of California Commercial |
$3.01
|
| Rate for Payer: Blue Shield of California EPN |
$22.55
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Cigna of CA HMO |
$2.86
|
| Rate for Payer: Cigna of CA PPO |
$2.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.48
|
| Rate for Payer: Dignity Health Media |
$3.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.45
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.27
|
| Rate for Payer: Networks By Design Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.04
|
| Rate for Payer: United Healthcare All Other HMO |
$2.04
|
| Rate for Payer: United Healthcare HMO Rider |
$2.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.48
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION [32855]
|
Facility
|
OP
|
$11.23
|
|
|
Service Code
|
CPT J2430
|
| Hospital Charge Code |
NDG32855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$526.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$526.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$526.08
|
| Rate for Payer: Blue Distinction Transplant |
$6.74
|
| Rate for Payer: Blue Distinction Transplant |
$7.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8.28
|
| Rate for Payer: Blue Shield of California Commercial |
$9.34
|
| Rate for Payer: Blue Shield of California EPN |
$22.55
|
| Rate for Payer: Blue Shield of California EPN |
$22.55
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cigna of CA HMO |
$7.86
|
| Rate for Payer: Cigna of CA HMO |
$8.87
|
| Rate for Payer: Cigna of CA PPO |
$7.86
|
| Rate for Payer: Cigna of CA PPO |
$8.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.55
|
| Rate for Payer: Dignity Health Media |
$10.77
|
| Rate for Payer: Dignity Health Media |
$9.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.07
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Galaxy Health WC |
$10.77
|
| Rate for Payer: Global Benefits Group Commercial |
$7.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$10.14
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$5.62
|
| Rate for Payer: Networks By Design Commercial |
$6.34
|
| Rate for Payer: Prime Health Services Commercial |
$10.77
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.34
|
| Rate for Payer: United Healthcare All Other HMO |
$6.34
|
| Rate for Payer: United Healthcare All Other HMO |
$5.62
|
| Rate for Payer: United Healthcare HMO Rider |
$6.34
|
| Rate for Payer: United Healthcare HMO Rider |
$5.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.77
|
| Rate for Payer: Vantage Medical Group Senior |
$10.77
|
| Rate for Payer: Vantage Medical Group Senior |
$9.55
|
|
|
PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION [32855]
|
Facility
|
IP
|
$11.23
|
|
|
Service Code
|
CPT J2430
|
| Hospital Charge Code |
NDG32855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Blue Shield of California Commercial |
$8.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.02
|
| Rate for Payer: Blue Shield of California EPN |
$5.75
|
| Rate for Payer: Blue Shield of California EPN |
$6.49
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna of CA HMO |
$7.86
|
| Rate for Payer: Cigna of CA HMO |
$8.87
|
| Rate for Payer: Cigna of CA PPO |
$8.87
|
| Rate for Payer: Cigna of CA PPO |
$7.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.07
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Galaxy Health WC |
$10.77
|
| Rate for Payer: Global Benefits Group Commercial |
$7.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Multiplan Commercial |
$10.14
|
| Rate for Payer: Networks By Design Commercial |
$5.62
|
| Rate for Payer: Networks By Design Commercial |
$6.34
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
| Rate for Payer: Prime Health Services Commercial |
$10.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.78
|
| Rate for Payer: United Healthcare All Other HMO |
$4.14
|
| Rate for Payer: United Healthcare All Other HMO |
$4.67
|
| Rate for Payer: United Healthcare HMO Rider |
$4.05
|
| Rate for Payer: United Healthcare HMO Rider |
$4.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.18
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$124,654.72
|
|
|
Service Code
|
APR-DRG 0062
|
| Min. Negotiated Rate |
$65,607.75 |
| Max. Negotiated Rate |
$124,654.72 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95,623.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$65,607.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124,654.72
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$204,217.47
|
|
|
Service Code
|
APR-DRG 0064
|
| Min. Negotiated Rate |
$107,482.88 |
| Max. Negotiated Rate |
$204,217.47 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$156,656.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$107,482.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204,217.47
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$143,595.27
|
|
|
Service Code
|
APR-DRG 0063
|
| Min. Negotiated Rate |
$75,576.46 |
| Max. Negotiated Rate |
$143,595.27 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110,152.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$75,576.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143,595.27
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$97,985.43
|
|
|
Service Code
|
APR-DRG 0061
|
| Min. Negotiated Rate |
$51,571.28 |
| Max. Negotiated Rate |
$97,985.43 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$75,165.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$51,571.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97,985.43
|
|
|
PANCURONIUM 1 MG/ML INTRAVENOUS SOLUTION [6013]
|
Facility
|
IP
|
$0.69
|
|
|
Service Code
|
NDC 0409-4646-01
|
| Hospital Charge Code |
1720288
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.59
|
|
|
PANCURONIUM 1 MG/ML INTRAVENOUS SOLUTION [6013]
|
Facility
|
OP
|
$0.69
|
|
|
Service Code
|
NDC 0409-4646-01
|
| Hospital Charge Code |
1720288
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: Blue Distinction Transplant |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of CA HMO |
$0.44
|
| Rate for Payer: Cigna of CA PPO |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.59
|
| Rate for Payer: Dignity Health Media |
$0.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO |
$0.35
|
| Rate for Payer: United Healthcare HMO Rider |
$0.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Vantage Medical Group Senior |
$0.59
|
|
|
PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION [108055]
|
Facility
|
IP
|
$376.67
|
|
|
Service Code
|
CPT J9303
|
| Hospital Charge Code |
1755745
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$320.17 |
| Rate for Payer: Blue Shield of California Commercial |
$268.19
|
| Rate for Payer: Blue Shield of California EPN |
$192.86
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna of CA HMO |
$263.67
|
| Rate for Payer: Cigna of CA PPO |
$263.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$150.67
|
| Rate for Payer: Galaxy Health WC |
$320.17
|
| Rate for Payer: Global Benefits Group Commercial |
$226.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.40
|
| Rate for Payer: Multiplan Commercial |
$301.34
|
| Rate for Payer: Networks By Design Commercial |
$188.34
|
| Rate for Payer: Prime Health Services Commercial |
$320.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$142.23
|
| Rate for Payer: United Healthcare All Other HMO |
$138.92
|
| Rate for Payer: United Healthcare HMO Rider |
$135.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$124.30
|
|
|
PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION [108055]
|
Facility
|
OP
|
$376.67
|
|
|
Service Code
|
CPT J9303
|
| Hospital Charge Code |
1755745
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$947.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$947.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.66
|
| Rate for Payer: Blue Distinction Transplant |
$226.00
|
| Rate for Payer: Blue Shield of California Commercial |
$277.61
|
| Rate for Payer: Blue Shield of California EPN |
$153.96
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna of CA HMO |
$263.67
|
| Rate for Payer: Cigna of CA PPO |
$263.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.99
|
| Rate for Payer: Dignity Health Media |
$150.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$150.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$150.66
|
| Rate for Payer: Galaxy Health WC |
$320.17
|
| Rate for Payer: Global Benefits Group Commercial |
$226.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$282.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$247.08
|
| Rate for Payer: Heritage Provider Network Transplant |
$247.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$244.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$244.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.88
|
| Rate for Payer: Multiplan Commercial |
$301.34
|
| Rate for Payer: Networks By Design Commercial |
$188.34
|
| Rate for Payer: Prime Health Services Commercial |
$320.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.34
|
| Rate for Payer: United Healthcare All Other HMO |
$188.34
|
| Rate for Payer: United Healthcare HMO Rider |
$188.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.72
|
| Rate for Payer: Vantage Medical Group Senior |
$150.66
|
|
|
PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION [108057]
|
Facility
|
OP
|
$376.67
|
|
|
Service Code
|
CPT J9303
|
| Hospital Charge Code |
1755726
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$947.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$947.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.66
|
| Rate for Payer: Blue Distinction Transplant |
$226.00
|
| Rate for Payer: Blue Shield of California Commercial |
$277.61
|
| Rate for Payer: Blue Shield of California EPN |
$153.96
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna of CA HMO |
$263.67
|
| Rate for Payer: Cigna of CA PPO |
$263.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.99
|
| Rate for Payer: Dignity Health Media |
$150.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$150.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$150.66
|
| Rate for Payer: Galaxy Health WC |
$320.17
|
| Rate for Payer: Global Benefits Group Commercial |
$226.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$282.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$247.08
|
| Rate for Payer: Heritage Provider Network Transplant |
$247.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$244.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$244.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.88
|
| Rate for Payer: Multiplan Commercial |
$301.34
|
| Rate for Payer: Networks By Design Commercial |
$188.34
|
| Rate for Payer: Prime Health Services Commercial |
$320.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.34
|
| Rate for Payer: United Healthcare All Other HMO |
$188.34
|
| Rate for Payer: United Healthcare HMO Rider |
$188.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.72
|
| Rate for Payer: Vantage Medical Group Senior |
$150.66
|
|
|
PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION [108057]
|
Facility
|
IP
|
$376.67
|
|
|
Service Code
|
CPT J9303
|
| Hospital Charge Code |
1755726
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$320.17 |
| Rate for Payer: Blue Shield of California Commercial |
$268.19
|
| Rate for Payer: Blue Shield of California EPN |
$192.86
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna of CA HMO |
$263.67
|
| Rate for Payer: Cigna of CA PPO |
$263.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$150.67
|
| Rate for Payer: Galaxy Health WC |
$320.17
|
| Rate for Payer: Global Benefits Group Commercial |
$226.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.40
|
| Rate for Payer: Multiplan Commercial |
$301.34
|
| Rate for Payer: Networks By Design Commercial |
$188.34
|
| Rate for Payer: Prime Health Services Commercial |
$320.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$142.23
|
| Rate for Payer: United Healthcare All Other HMO |
$138.92
|
| Rate for Payer: United Healthcare HMO Rider |
$135.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$124.30
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 68084-643-01
|
| Hospital Charge Code |
1712608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 13668-096-90
|
| Hospital Charge Code |
1712608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]
|
Facility
|
IP
|
$0.33
|
|
|
Service Code
|
NDC 50268-636-15
|
| Hospital Charge Code |
1712608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 0378-6688-77
|
| Hospital Charge Code |
1712608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Distinction Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Media |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.11
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 65862-559-90
|
| Hospital Charge Code |
1712608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Distinction Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Media |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.11
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 31722-712-90
|
| Hospital Charge Code |
1712608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Distinction Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Media |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.11
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]
|
Facility
|
OP
|
$0.33
|
|
|
Service Code
|
NDC 50268-636-15
|
| Hospital Charge Code |
1712608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
| Rate for Payer: Blue Distinction Transplant |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.28
|
| Rate for Payer: Dignity Health Media |
$0.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 13668-096-90
|
| Hospital Charge Code |
1712608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Blue Distinction Transplant |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Media |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
