|
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 |
$2.25 |
| Max. Negotiated Rate |
$10.11 |
| Rate for Payer: Blue Shield of California Commercial |
$8.42
|
| Rate for Payer: Blue Shield of California Commercial |
$9.50
|
| Rate for Payer: Blue Shield of California EPN |
$6.00
|
| Rate for Payer: Blue Shield of California EPN |
$6.77
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Central Health Plan Commercial |
$10.14
|
| Rate for Payer: Central Health Plan Commercial |
$8.98
|
| 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 |
$4.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$10.77
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.11
|
| 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: LLUH Dept of Risk Management WC |
$2.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$9.50
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| 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
|
|
|
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 |
$2.25 |
| Max. Negotiated Rate |
$534.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.97
|
| 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 |
$534.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$534.83
|
| Rate for Payer: BCBS Transplant Transplant |
$7.60
|
| Rate for Payer: BCBS Transplant Transplant |
$6.74
|
| Rate for Payer: Blue Shield of California Commercial |
$24.81
|
| Rate for Payer: Blue Shield of California Commercial |
$24.81
|
| 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 |
$5.05
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Central Health Plan Commercial |
$10.14
|
| Rate for Payer: Central Health Plan Commercial |
$8.98
|
| 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 |
$9.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$10.77
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.42
|
| Rate for Payer: IEHP medi-cal |
$11.67
|
| Rate for Payer: IEHP medi-cal |
$11.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.53
|
| Rate for Payer: Multiplan Commercial |
$9.50
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: Networks By Design Commercial |
$6.34
|
| 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 MISP |
$5.07
|
| Rate for Payer: Riverside University Health 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 |
$6.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.62
|
| Rate for Payer: United Healthcare All Other HMO |
$5.62
|
| Rate for Payer: United Healthcare All Other HMO |
$6.34
|
| Rate for Payer: United Healthcare HMO Rider |
$5.62
|
| Rate for Payer: United Healthcare HMO Rider |
$6.34
|
| 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 Medi-Cal |
$10.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Vantage Medical Group Senior |
$9.55
|
| Rate for Payer: Vantage Medical Group Senior |
$10.77
|
|
|
PANCREAS TRANSPLANT
|
Facility
IP
|
$93,819.08
|
|
|
Service Code
|
APR-DRG 0062
|
| Min. Negotiated Rate |
$78,729.30 |
| Max. Negotiated Rate |
$93,819.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$78,729.30
|
| Rate for Payer: IEHP medi-cal |
$93,819.08
|
|
|
PANCREAS TRANSPLANT
|
Facility
IP
|
$153,700.52
|
|
|
Service Code
|
APR-DRG 0064
|
| Min. Negotiated Rate |
$128,979.46 |
| Max. Negotiated Rate |
$153,700.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$128,979.46
|
| Rate for Payer: IEHP medi-cal |
$153,700.52
|
|
|
PANCREAS TRANSPLANT
|
Facility
IP
|
$73,746.93
|
|
|
Service Code
|
APR-DRG 0061
|
| Min. Negotiated Rate |
$61,885.54 |
| Max. Negotiated Rate |
$73,746.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$61,885.54
|
| Rate for Payer: IEHP medi-cal |
$73,746.93
|
|
|
PANCREAS TRANSPLANT
|
Facility
IP
|
$108,074.34
|
|
|
Service Code
|
APR-DRG 0063
|
| Min. Negotiated Rate |
$90,691.75 |
| Max. Negotiated Rate |
$108,074.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$90,691.75
|
| Rate for Payer: IEHP medi-cal |
$108,074.34
|
|
|
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 |
$0.14 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Central Health Plan Commercial |
$0.55
|
| 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: Health Management Network EPO/PPO |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| 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 |
$0.14 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: BCBS Transplant Transplant |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Central Health Plan Commercial |
$0.55
|
| 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: 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 Management Network EPO/PPO |
$0.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.52
|
| Rate for Payer: IEHP medi-cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.59
|
| Rate for Payer: Riverside University Health MISP |
$0.28
|
| 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 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 |
$75.33 |
| Max. Negotiated Rate |
$339.00 |
| Rate for Payer: Blue Shield of California Commercial |
$282.50
|
| Rate for Payer: Blue Shield of California EPN |
$201.14
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Central Health Plan Commercial |
$301.34
|
| 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: Health Management Network EPO/PPO |
$339.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.33
|
| Rate for Payer: Multiplan Commercial |
$282.50
|
| Rate for Payer: Networks By Design Commercial |
$188.34
|
| Rate for Payer: Prime Health Services Commercial |
$320.17
|
|
|
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 |
$75.33 |
| Max. Negotiated Rate |
$933.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$150.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$933.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$188.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$165.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$165.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$164.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.62
|
| Rate for Payer: BCBS Transplant Transplant |
$226.00
|
| Rate for Payer: Blue Shield of California Commercial |
$169.36
|
| Rate for Payer: Blue Shield of California EPN |
$153.96
|
| Rate for Payer: Caremore Medicare Advantage |
$150.66
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Central Health Plan Commercial |
$301.34
|
| 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: 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 Management Network EPO/PPO |
$339.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$282.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$247.08
|
| Rate for Payer: IEHP medi-cal |
$248.59
|
| Rate for Payer: IEHP Medicare Advantage |
$150.66
|
| Rate for Payer: Innovage PACE Commercial |
$225.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.88
|
| Rate for Payer: Multiplan Commercial |
$282.50
|
| Rate for Payer: Networks By Design Commercial |
$188.34
|
| Rate for Payer: Prime Health Services Commercial |
$320.17
|
| Rate for Payer: Prime Health Services Medicare |
$159.70
|
| Rate for Payer: Riverside University Health MISP |
$165.72
|
| 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 |
$75.33 |
| Max. Negotiated Rate |
$933.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$150.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$933.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$188.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$165.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$165.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$164.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.62
|
| Rate for Payer: BCBS Transplant Transplant |
$226.00
|
| Rate for Payer: Blue Shield of California Commercial |
$169.36
|
| Rate for Payer: Blue Shield of California EPN |
$153.96
|
| Rate for Payer: Caremore Medicare Advantage |
$150.66
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Central Health Plan Commercial |
$301.34
|
| 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: 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 Management Network EPO/PPO |
$339.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$282.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$247.08
|
| Rate for Payer: IEHP medi-cal |
$248.59
|
| Rate for Payer: IEHP Medicare Advantage |
$150.66
|
| Rate for Payer: Innovage PACE Commercial |
$225.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.88
|
| Rate for Payer: Multiplan Commercial |
$282.50
|
| Rate for Payer: Networks By Design Commercial |
$188.34
|
| Rate for Payer: Prime Health Services Commercial |
$320.17
|
| Rate for Payer: Prime Health Services Medicare |
$159.70
|
| Rate for Payer: Riverside University Health MISP |
$165.72
|
| 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 |
$75.33 |
| Max. Negotiated Rate |
$339.00 |
| Rate for Payer: Blue Shield of California Commercial |
$282.50
|
| Rate for Payer: Blue Shield of California EPN |
$201.14
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Central Health Plan Commercial |
$301.34
|
| 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: Health Management Network EPO/PPO |
$339.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.33
|
| Rate for Payer: Multiplan Commercial |
$282.50
|
| Rate for Payer: Networks By Design Commercial |
$188.34
|
| Rate for Payer: Prime Health Services Commercial |
$320.17
|
|
|
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 |
$0.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.07
|
| 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: BCBS Transplant Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| 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: 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 Management Network EPO/PPO |
$0.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.10
|
| Rate for Payer: IEHP medi-cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: Riverside University Health 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 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 65862-559-90
|
| Hospital Charge Code |
1712608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$0.09
|
| 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
|
$0.33
|
|
|
Service Code
|
NDC 50268-636-15
|
| Hospital Charge Code |
1712608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| 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: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| 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
IP
|
$0.13
|
|
|
Service Code
|
NDC 31722-712-90
|
| Hospital Charge Code |
1712608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$0.09
|
| 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 68084-643-11
|
| Hospital Charge Code |
1712608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| 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: 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: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| 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
|
$0.30
|
|
|
Service Code
|
NDC 68084-643-01
|
| Hospital Charge Code |
1712608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: BCBS Transplant Transplant |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| 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: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.23
|
| Rate for Payer: IEHP medi-cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$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 |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.19
|
| 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: Health Management Network EPO/PPO |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| 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
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 |
$0.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.07
|
| 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: BCBS Transplant Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| 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: 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 Management Network EPO/PPO |
$0.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.10
|
| Rate for Payer: IEHP medi-cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: Riverside University Health 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 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 |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: BCBS Transplant Transplant |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| 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: 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 Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.25
|
| Rate for Payer: IEHP medi-cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: Riverside University Health MISP |
$0.13
|
| 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 Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]
|
Facility
OP
|
$0.30
|
|
|
Service Code
|
NDC 68084-643-11
|
| Hospital Charge Code |
1712608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: BCBS Transplant Transplant |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| 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: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.23
|
| Rate for Payer: IEHP medi-cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: Riverside University Health 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 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 0378-6688-77
|
| Hospital Charge Code |
1712608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$0.09
|
| 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 68084-643-01
|
| Hospital Charge Code |
1712608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| 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: 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: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| 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 65862-559-90
|
| Hospital Charge Code |
1712608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.07
|
| 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: BCBS Transplant Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| 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: 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 Management Network EPO/PPO |
$0.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.10
|
| Rate for Payer: IEHP medi-cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$0.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.11
|
|
