|
PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION [32855]
|
Facility
|
OP
|
$11.23
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$609.57 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$488.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$488.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$609.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$609.57
|
| Rate for Payer: Blue Shield of California Commercial |
$27.07
|
| Rate for Payer: Blue Shield of California Commercial |
$27.07
|
| Rate for Payer: Blue Shield of California EPN |
$24.61
|
| Rate for Payer: Blue Shield of California EPN |
$24.61
|
| 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: Central Health Plan Commercial |
$8.98
|
| Rate for Payer: Central Health Plan Commercial |
$10.14
|
| 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: Dignity Health Commercial/Exchange |
$10.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.07
|
| Rate for Payer: EPIC Health Plan Senior |
$4.49
|
| Rate for Payer: EPIC Health Plan Senior |
$5.07
|
| Rate for Payer: Galaxy Health WC |
$10.77
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Global Benefits Group Commercial |
$7.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.87
|
| Rate for Payer: Multiplan Commercial |
$9.50
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: Networks By Design Commercial |
$6.33
|
| Rate for Payer: Networks By Design Commercial |
$5.62
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
| Rate for Payer: Prime Health Services Commercial |
$10.77
|
| Rate for Payer: Riverside University Health System MISP |
$5.07
|
| Rate for Payer: Riverside University Health System MISP |
$4.49
|
| 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 |
$6.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.76
|
| Rate for Payer: United Healthcare All Other HMO |
$4.63
|
| Rate for Payer: United Healthcare All Other HMO |
$4.10
|
| Rate for Payer: United Healthcare HMO Rider |
$4.01
|
| Rate for Payer: United Healthcare HMO Rider |
$4.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.55
|
| 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
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$76,330.36
|
|
|
Service Code
|
MSDRG 406
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$76,330.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76,330.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49,306.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69,030.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$67,487.15
|
| Rate for Payer: EPIC Health Plan Senior |
$44,991.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,901.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57,261.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54,807.74
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$40,901.30
|
| Rate for Payer: Prime Health Services Medicare |
$43,355.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$143,978.09
|
|
|
Service Code
|
MSDRG 405
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$143,978.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$143,978.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93,003.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130,208.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$125,979.13
|
| Rate for Payer: EPIC Health Plan Senior |
$83,986.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76,350.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106,891.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$102,310.33
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$76,350.99
|
| Rate for Payer: Prime Health Services Medicare |
$80,932.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$58,417.65
|
|
|
Service Code
|
MSDRG 407
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$58,417.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58,417.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37,735.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52,830.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$51,998.81
|
| Rate for Payer: EPIC Health Plan Senior |
$34,665.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,514.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44,120.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42,229.34
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$31,514.43
|
| Rate for Payer: Prime Health Services Medicare |
$33,405.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$164,784.16
|
|
|
Service Code
|
MSDRG 010
|
| Min. Negotiated Rate |
$52,191.37 |
| Max. Negotiated Rate |
$164,784.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$129,300.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80,796.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52,191.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73,069.76
|
| Rate for Payer: Blue Shield of California Transplant |
$95,000.00
|
| Rate for Payer: CareMore Health Medicare Advantage |
$99,869.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$164,784.16
|
| Rate for Payer: EPIC Health Plan Senior |
$109,856.11
|
| Rate for Payer: Health Plan of Nevada (Sierra) Transplant |
$70,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$77,857.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$99,869.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$139,816.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$133,824.71
|
| Rate for Payer: OptumHealth Care Solutions (URN) Commercial |
$137,042.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$99,869.19
|
| Rate for Payer: Prime Health Services Medicare |
$105,861.34
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$127,157.82
|
|
|
Service Code
|
APR-DRG 0062
|
| Min. Negotiated Rate |
$80,310.20 |
| Max. Negotiated Rate |
$127,157.82 |
| Rate for Payer: Adventist Health Medi-Cal |
$80,310.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$95,702.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127,157.82
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$102,610.89
|
|
|
Service Code
|
APR-DRG 0061
|
| Min. Negotiated Rate |
$64,806.88 |
| Max. Negotiated Rate |
$102,610.89 |
| Rate for Payer: Adventist Health Medi-Cal |
$64,806.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$77,228.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102,610.89
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$176,688.77
|
|
|
Service Code
|
APR-DRG 0064
|
| Min. Negotiated Rate |
$111,592.91 |
| Max. Negotiated Rate |
$176,688.77 |
| Rate for Payer: Adventist Health Medi-Cal |
$111,592.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$132,981.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$176,688.77
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$150,375.40
|
|
|
Service Code
|
APR-DRG 0063
|
| Min. Negotiated Rate |
$94,973.94 |
| Max. Negotiated Rate |
$150,375.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$94,973.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113,177.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150,375.40
|
|
|
PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION [108055]
|
Facility
|
OP
|
$456.54
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.31 |
| Max. Negotiated Rate |
$1,022.02 |
| Rate for Payer: Adventist Health Commercial |
$91.31
|
| Rate for Payer: Adventist Health Medi-Cal |
$182.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,022.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$273.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$200.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$182.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$164.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.86
|
| Rate for Payer: Blue Shield of California Commercial |
$227.75
|
| Rate for Payer: Blue Shield of California EPN |
$207.05
|
| Rate for Payer: Cash Price |
$205.44
|
| Rate for Payer: Cash Price |
$205.44
|
| Rate for Payer: Central Health Plan Commercial |
$365.23
|
| Rate for Payer: Cigna of CA HMO |
$319.58
|
| Rate for Payer: Cigna of CA PPO |
$319.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$200.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$319.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.61
|
| Rate for Payer: EPIC Health Plan Senior |
$200.41
|
| Rate for Payer: Galaxy Health WC |
$388.06
|
| Rate for Payer: Global Benefits Group Commercial |
$273.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$410.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$298.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$182.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$182.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$289.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$329.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$255.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$244.13
|
| Rate for Payer: Multiplan Commercial |
$342.40
|
| Rate for Payer: Networks By Design Commercial |
$228.27
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$182.19
|
| Rate for Payer: Prime Health Services Commercial |
$388.06
|
| Rate for Payer: Prime Health Services Medicare |
$193.12
|
| Rate for Payer: Riverside University Health System MISP |
$200.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$273.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.34
|
| Rate for Payer: United Healthcare All Other HMO |
$166.77
|
| Rate for Payer: United Healthcare HMO Rider |
$163.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$149.52
|
| Rate for Payer: Upland Medical Group Pediatric |
$182.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$200.41
|
| Rate for Payer: Vantage Medical Group Senior |
$200.41
|
|
|
PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION [108055]
|
Facility
|
IP
|
$456.54
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.31 |
| Max. Negotiated Rate |
$410.89 |
| Rate for Payer: Adventist Health Commercial |
$91.31
|
| Rate for Payer: Blue Shield of California Commercial |
$366.15
|
| Rate for Payer: Blue Shield of California EPN |
$230.10
|
| Rate for Payer: Cash Price |
$205.44
|
| Rate for Payer: Central Health Plan Commercial |
$365.23
|
| Rate for Payer: Cigna of CA HMO |
$319.58
|
| Rate for Payer: Cigna of CA PPO |
$319.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$319.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.62
|
| Rate for Payer: EPIC Health Plan Senior |
$182.62
|
| Rate for Payer: Galaxy Health WC |
$388.06
|
| Rate for Payer: Global Benefits Group Commercial |
$273.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$410.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$289.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$269.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.31
|
| Rate for Payer: Multiplan Commercial |
$342.40
|
| Rate for Payer: Networks By Design Commercial |
$228.27
|
| Rate for Payer: Prime Health Services Commercial |
$388.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.34
|
| Rate for Payer: United Healthcare All Other HMO |
$166.77
|
| Rate for Payer: United Healthcare HMO Rider |
$163.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$149.52
|
|
|
PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION [108057]
|
Facility
|
IP
|
$456.54
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.31 |
| Max. Negotiated Rate |
$410.89 |
| Rate for Payer: Adventist Health Commercial |
$91.31
|
| Rate for Payer: Blue Shield of California Commercial |
$366.15
|
| Rate for Payer: Blue Shield of California EPN |
$230.10
|
| Rate for Payer: Cash Price |
$205.44
|
| Rate for Payer: Central Health Plan Commercial |
$365.23
|
| Rate for Payer: Cigna of CA HMO |
$319.58
|
| Rate for Payer: Cigna of CA PPO |
$319.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$319.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.62
|
| Rate for Payer: EPIC Health Plan Senior |
$182.62
|
| Rate for Payer: Galaxy Health WC |
$388.06
|
| Rate for Payer: Global Benefits Group Commercial |
$273.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$410.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$289.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$269.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.31
|
| Rate for Payer: Multiplan Commercial |
$342.40
|
| Rate for Payer: Networks By Design Commercial |
$228.27
|
| Rate for Payer: Prime Health Services Commercial |
$388.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.34
|
| Rate for Payer: United Healthcare All Other HMO |
$166.77
|
| Rate for Payer: United Healthcare HMO Rider |
$163.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$149.52
|
|
|
PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION [108057]
|
Facility
|
OP
|
$456.54
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.31 |
| Max. Negotiated Rate |
$1,022.02 |
| Rate for Payer: Adventist Health Commercial |
$91.31
|
| Rate for Payer: Adventist Health Medi-Cal |
$182.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,022.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$273.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$200.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$182.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$164.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.86
|
| Rate for Payer: Blue Shield of California Commercial |
$227.75
|
| Rate for Payer: Blue Shield of California EPN |
$207.05
|
| Rate for Payer: Cash Price |
$205.44
|
| Rate for Payer: Cash Price |
$205.44
|
| Rate for Payer: Central Health Plan Commercial |
$365.23
|
| Rate for Payer: Cigna of CA HMO |
$319.58
|
| Rate for Payer: Cigna of CA PPO |
$319.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$200.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$319.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.61
|
| Rate for Payer: EPIC Health Plan Senior |
$200.41
|
| Rate for Payer: Galaxy Health WC |
$388.06
|
| Rate for Payer: Global Benefits Group Commercial |
$273.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$410.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$298.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$182.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$182.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$289.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$329.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$255.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$244.13
|
| Rate for Payer: Multiplan Commercial |
$342.40
|
| Rate for Payer: Networks By Design Commercial |
$228.27
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$182.19
|
| Rate for Payer: Prime Health Services Commercial |
$388.06
|
| Rate for Payer: Prime Health Services Medicare |
$193.12
|
| Rate for Payer: Riverside University Health System MISP |
$200.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$273.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.34
|
| Rate for Payer: United Healthcare All Other HMO |
$166.77
|
| Rate for Payer: United Healthcare HMO Rider |
$163.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$149.52
|
| Rate for Payer: Upland Medical Group Pediatric |
$182.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$200.41
|
| Rate for Payer: Vantage Medical Group Senior |
$200.41
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
NDC 0378668877
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| 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
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 6808464311
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Riverside University Health System MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 6808464311
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| 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
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 0378668877
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| 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 |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| 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 Medi-Cal |
$0.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.09
|
| 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: Riverside University Health System MISP |
$0.05
|
| 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
|
$0.07
|
|
|
Service Code
|
NDC 6586255990
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 6586255990
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 1366809690
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| 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 |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| 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 Medi-Cal |
$0.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.09
|
| 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: Riverside University Health System MISP |
$0.05
|
| 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
|
IP
|
$0.13
|
|
|
Service Code
|
NDC 3172271290
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| 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
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 3172271290
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| 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 |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| 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 Medi-Cal |
$0.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.09
|
| 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: Riverside University Health System MISP |
$0.05
|
| 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
|
$0.30
|
|
|
Service Code
|
NDC 6808464301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Riverside University Health System MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
NDC 1366809690
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| 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
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 6808464301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
