|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$5.50 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.69
|
| Rate for Payer: Blue Shield of California Commercial |
$4.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.67
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Central Health Plan Commercial |
$3.46
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: EPIC Health Plan Senior |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$3.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
| Rate for Payer: Networks By Design Commercial |
$2.16
|
| Rate for Payer: Prime Health Services Commercial |
$3.67
|
| Rate for Payer: Riverside University Health System MISP |
$1.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION. [40836591]
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$9.28
|
| Rate for Payer: Blue Shield of California EPN |
$6.05
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$4.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION. [40836591]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.69
|
| Rate for Payer: Blue Shield of California Commercial |
$4.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.67
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.50
|
| Rate for Payer: InnovAge PACE Commercial |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Riverside University Health System MISP |
$4.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$4.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SYRINGE [222773]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.69
|
| Rate for Payer: Blue Shield of California Commercial |
$4.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.67
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.50
|
| Rate for Payer: InnovAge PACE Commercial |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Riverside University Health System MISP |
$4.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$4.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SYRINGE [222773]
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$9.28
|
| Rate for Payer: Blue Shield of California EPN |
$6.05
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$4.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
|
|
PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION [32589]
|
Facility
|
OP
|
$1.73
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$45.57 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.99
|
| 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 |
$0.95
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: Central Health Plan Commercial |
$2.59
|
| Rate for Payer: Cigna of CA HMO |
$2.27
|
| Rate for Payer: Cigna of CA HMO |
$1.21
|
| Rate for Payer: Cigna of CA PPO |
$2.27
|
| Rate for Payer: Cigna of CA PPO |
$1.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$2.75
|
| Rate for Payer: Galaxy Health WC |
$1.47
|
| Rate for Payer: Global Benefits Group Commercial |
$1.94
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.88
|
| Rate for Payer: InnovAge PACE Commercial |
$0.87
|
| Rate for Payer: InnovAge PACE Commercial |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.21
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$2.43
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Networks By Design Commercial |
$0.87
|
| Rate for Payer: Prime Health Services Commercial |
$2.75
|
| Rate for Payer: Prime Health Services Commercial |
$1.47
|
| Rate for Payer: Riverside University Health System MISP |
$0.69
|
| Rate for Payer: Riverside University Health System MISP |
$1.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$1.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1.47
|
| Rate for Payer: Vantage Medical Group Senior |
$2.75
|
|
|
PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION [32589]
|
Facility
|
IP
|
$3.24
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$2.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$1.63
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Central Health Plan Commercial |
$2.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$1.21
|
| Rate for Payer: Cigna of CA HMO |
$2.27
|
| Rate for Payer: Cigna of CA PPO |
$1.21
|
| Rate for Payer: Cigna of CA PPO |
$2.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$1.47
|
| Rate for Payer: Galaxy Health WC |
$2.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1.94
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$2.43
|
| Rate for Payer: Networks By Design Commercial |
$0.87
|
| 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 |
$1.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$1.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
|
|
PAMIDRONATE 30 MG INTRAVENOUS SOLUTION [10845]
|
Facility
|
OP
|
$22.55
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$45.57 |
| Rate for Payer: Adventist Health Commercial |
$4.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.69
|
| 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 |
$16.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.99
|
| Rate for Payer: Blue Shield of California Commercial |
$27.07
|
| Rate for Payer: Blue Shield of California EPN |
$24.61
|
| Rate for Payer: Cash Price |
$12.40
|
| Rate for Payer: Cash Price |
$12.40
|
| Rate for Payer: Central Health Plan Commercial |
$18.04
|
| Rate for Payer: Cigna of CA HMO |
$15.79
|
| Rate for Payer: Cigna of CA PPO |
$15.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.02
|
| Rate for Payer: EPIC Health Plan Senior |
$9.02
|
| Rate for Payer: Galaxy Health WC |
$19.17
|
| Rate for Payer: Global Benefits Group Commercial |
$13.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.88
|
| Rate for Payer: InnovAge PACE Commercial |
$11.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.79
|
| Rate for Payer: Multiplan Commercial |
$16.91
|
| Rate for Payer: Networks By Design Commercial |
$11.28
|
| Rate for Payer: Prime Health Services Commercial |
$19.17
|
| Rate for Payer: Riverside University Health System MISP |
$9.02
|
| 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 |
$8.46
|
| Rate for Payer: United Healthcare All Other HMO |
$8.24
|
| Rate for Payer: United Healthcare HMO Rider |
$8.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.39
|
| 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 30 MG INTRAVENOUS SOLUTION [10845]
|
Facility
|
IP
|
$22.55
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$20.30 |
| Rate for Payer: Adventist Health Commercial |
$4.51
|
| Rate for Payer: Blue Shield of California Commercial |
$17.43
|
| Rate for Payer: Blue Shield of California EPN |
$11.37
|
| Rate for Payer: Cash Price |
$12.40
|
| Rate for Payer: Central Health Plan Commercial |
$18.04
|
| Rate for Payer: Cigna of CA HMO |
$15.79
|
| Rate for Payer: Cigna of CA PPO |
$15.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.02
|
| Rate for Payer: EPIC Health Plan Senior |
$9.02
|
| Rate for Payer: Galaxy Health WC |
$19.17
|
| Rate for Payer: Global Benefits Group Commercial |
$13.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.30
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$13.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.51
|
| Rate for Payer: Multiplan Commercial |
$16.91
|
| 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 |
$8.46
|
| Rate for Payer: United Healthcare All Other HMO |
$8.24
|
| Rate for Payer: United Healthcare HMO Rider |
$8.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.39
|
|
|
PAMIDRONATE 60 MG/10 ML (6 MG/ML) INTRAVENOUS SOLUTION [33886]
|
Facility
|
OP
|
$5.45
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$45.57 |
| Rate for Payer: Adventist Health Commercial |
$1.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.99
|
| Rate for Payer: Blue Shield of California Commercial |
$27.07
|
| Rate for Payer: Blue Shield of California EPN |
$24.61
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Central Health Plan Commercial |
$4.36
|
| Rate for Payer: Cigna of CA HMO |
$3.81
|
| Rate for Payer: Cigna of CA PPO |
$3.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.18
|
| Rate for Payer: EPIC Health Plan Senior |
$2.18
|
| Rate for Payer: Galaxy Health WC |
$4.63
|
| Rate for Payer: Global Benefits Group Commercial |
$3.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.88
|
| Rate for Payer: InnovAge PACE Commercial |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.81
|
| Rate for Payer: Multiplan Commercial |
$4.09
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$4.63
|
| Rate for Payer: Riverside University Health System MISP |
$2.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Other HMO |
$1.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4.63
|
|
|
PAMIDRONATE 60 MG/10 ML (6 MG/ML) INTRAVENOUS SOLUTION [33886]
|
Facility
|
IP
|
$5.45
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.91 |
| Rate for Payer: Adventist Health Commercial |
$1.09
|
| Rate for Payer: Blue Shield of California Commercial |
$4.21
|
| Rate for Payer: Blue Shield of California EPN |
$2.75
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Central Health Plan Commercial |
$4.36
|
| Rate for Payer: Cigna of CA HMO |
$3.81
|
| Rate for Payer: Cigna of CA PPO |
$3.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.18
|
| Rate for Payer: EPIC Health Plan Senior |
$2.18
|
| Rate for Payer: Galaxy Health WC |
$4.63
|
| Rate for Payer: Global Benefits Group Commercial |
$3.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.09
|
| Rate for Payer: Multiplan Commercial |
$4.09
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$4.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Other HMO |
$1.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.78
|
|
|
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 |
$45.57 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.82
|
| 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 |
$6.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.99
|
| 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 |
$6.17
|
| Rate for Payer: Cash Price |
$6.17
|
| Rate for Payer: Cash Price |
$6.97
|
| Rate for Payer: Cash Price |
$6.97
|
| 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 |
$8.87
|
| Rate for Payer: Cigna of CA HMO |
$7.86
|
| 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 |
$9.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$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 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 |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$13.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.88
|
| Rate for Payer: InnovAge PACE Commercial |
$5.62
|
| Rate for Payer: InnovAge PACE Commercial |
$6.33
|
| 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: Kaiser Permanente of CA Medi-Cal |
$23.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.95
|
| 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: Molina Healthcare of CA Medi-Cal |
$7.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.86
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$9.50
|
| 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 |
$10.77
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
| Rate for Payer: Riverside University Health System MISP |
$4.49
|
| Rate for Payer: Riverside University Health System MISP |
$5.07
|
| 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 |
$4.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Other HMO |
$4.10
|
| Rate for Payer: United Healthcare All Other HMO |
$4.63
|
| 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 |
$3.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.15
|
| 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 |
$9.55
|
| Rate for Payer: Vantage Medical Group Senior |
$10.77
|
|
|
PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION [32855]
|
Facility
|
IP
|
$12.67
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Blue Shield of California Commercial |
$9.79
|
| Rate for Payer: Blue Shield of California Commercial |
$8.68
|
| Rate for Payer: Blue Shield of California EPN |
$5.66
|
| Rate for Payer: Blue Shield of California EPN |
$6.39
|
| Rate for Payer: Cash Price |
$6.97
|
| Rate for Payer: Cash Price |
$6.17
|
| 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: 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 |
$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 Management Network EPO/PPO |
$10.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.40
|
| 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: Kaiser Permanente of CA Medi-Cal |
$4.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.84
|
| 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 |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$9.50
|
| Rate for Payer: Networks By Design Commercial |
$5.62
|
| Rate for Payer: Networks By Design Commercial |
$6.33
|
| Rate for Payer: Prime Health Services Commercial |
$10.77
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
| 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 |
$3.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.15
|
|
|
PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION [108055]
|
Facility
|
IP
|
$434.80
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.96 |
| Max. Negotiated Rate |
$391.32 |
| Rate for Payer: Adventist Health Commercial |
$86.96
|
| Rate for Payer: Blue Shield of California Commercial |
$336.10
|
| Rate for Payer: Blue Shield of California EPN |
$219.14
|
| Rate for Payer: Cash Price |
$239.14
|
| Rate for Payer: Central Health Plan Commercial |
$347.84
|
| Rate for Payer: Cigna of CA HMO |
$304.36
|
| Rate for Payer: Cigna of CA PPO |
$304.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.92
|
| Rate for Payer: EPIC Health Plan Senior |
$173.92
|
| Rate for Payer: Galaxy Health WC |
$369.58
|
| Rate for Payer: Global Benefits Group Commercial |
$260.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$391.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$269.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.96
|
| Rate for Payer: Multiplan Commercial |
$326.10
|
| Rate for Payer: Networks By Design Commercial |
$217.40
|
| Rate for Payer: Prime Health Services Commercial |
$369.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$163.18
|
| Rate for Payer: United Healthcare All Other HMO |
$158.83
|
| Rate for Payer: United Healthcare HMO Rider |
$155.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.40
|
|
|
PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION [108055]
|
Facility
|
OP
|
$434.80
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.96 |
| Max. Negotiated Rate |
$398.39 |
| Rate for Payer: Adventist Health Commercial |
$86.96
|
| Rate for Payer: Adventist Health Medi-Cal |
$172.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$264.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$258.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$189.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$398.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.27
|
| 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 |
$239.14
|
| Rate for Payer: Cash Price |
$239.14
|
| Rate for Payer: Central Health Plan Commercial |
$347.84
|
| Rate for Payer: Cigna of CA HMO |
$304.36
|
| Rate for Payer: Cigna of CA PPO |
$304.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$189.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$189.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.94
|
| Rate for Payer: EPIC Health Plan Senior |
$172.55
|
| Rate for Payer: Galaxy Health WC |
$369.58
|
| Rate for Payer: Global Benefits Group Commercial |
$260.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$391.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$282.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$164.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$172.55
|
| Rate for Payer: InnovAge PACE Commercial |
$258.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$231.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$231.22
|
| Rate for Payer: Multiplan Commercial |
$326.10
|
| Rate for Payer: Networks By Design Commercial |
$217.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$172.55
|
| Rate for Payer: Prime Health Services Commercial |
$369.58
|
| Rate for Payer: Prime Health Services Medicare |
$182.90
|
| Rate for Payer: Riverside University Health System MISP |
$189.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$260.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$260.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$163.18
|
| Rate for Payer: United Healthcare All Other HMO |
$158.83
|
| Rate for Payer: United Healthcare HMO Rider |
$155.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$172.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$189.80
|
| Rate for Payer: Vantage Medical Group Senior |
$189.80
|
|
|
PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION [108057]
|
Facility
|
IP
|
$434.80
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.96 |
| Max. Negotiated Rate |
$391.32 |
| Rate for Payer: Adventist Health Commercial |
$86.96
|
| Rate for Payer: Blue Shield of California Commercial |
$336.10
|
| Rate for Payer: Blue Shield of California EPN |
$219.14
|
| Rate for Payer: Cash Price |
$239.14
|
| Rate for Payer: Central Health Plan Commercial |
$347.84
|
| Rate for Payer: Cigna of CA HMO |
$304.36
|
| Rate for Payer: Cigna of CA PPO |
$304.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.92
|
| Rate for Payer: EPIC Health Plan Senior |
$173.92
|
| Rate for Payer: Galaxy Health WC |
$369.58
|
| Rate for Payer: Global Benefits Group Commercial |
$260.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$391.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$269.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.96
|
| Rate for Payer: Multiplan Commercial |
$326.10
|
| Rate for Payer: Networks By Design Commercial |
$217.40
|
| Rate for Payer: Prime Health Services Commercial |
$369.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$163.18
|
| Rate for Payer: United Healthcare All Other HMO |
$158.83
|
| Rate for Payer: United Healthcare HMO Rider |
$155.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.40
|
|
|
PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION [108057]
|
Facility
|
OP
|
$434.80
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.96 |
| Max. Negotiated Rate |
$398.39 |
| Rate for Payer: Adventist Health Commercial |
$86.96
|
| Rate for Payer: Adventist Health Medi-Cal |
$172.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$264.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$258.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$189.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$398.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.27
|
| 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 |
$239.14
|
| Rate for Payer: Cash Price |
$239.14
|
| Rate for Payer: Central Health Plan Commercial |
$347.84
|
| Rate for Payer: Cigna of CA HMO |
$304.36
|
| Rate for Payer: Cigna of CA PPO |
$304.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$189.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$189.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.94
|
| Rate for Payer: EPIC Health Plan Senior |
$172.55
|
| Rate for Payer: Galaxy Health WC |
$369.58
|
| Rate for Payer: Global Benefits Group Commercial |
$260.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$391.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$282.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$164.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$172.55
|
| Rate for Payer: InnovAge PACE Commercial |
$258.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$231.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$231.22
|
| Rate for Payer: Multiplan Commercial |
$326.10
|
| Rate for Payer: Networks By Design Commercial |
$217.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$172.55
|
| Rate for Payer: Prime Health Services Commercial |
$369.58
|
| Rate for Payer: Prime Health Services Medicare |
$182.90
|
| Rate for Payer: Riverside University Health System MISP |
$189.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$260.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$260.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$163.18
|
| Rate for Payer: United Healthcare All Other HMO |
$158.83
|
| Rate for Payer: United Healthcare HMO Rider |
$155.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$172.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$189.80
|
| Rate for Payer: Vantage Medical Group Senior |
$189.80
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 68084-643-11
|
| 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 |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.16
|
| 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: 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: InnovAge PACE Commercial |
$0.15
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.21
|
| Rate for Payer: Molina Healthcare of CA 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
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 68084-643-01
|
| 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 |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.16
|
| 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: 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: InnovAge PACE Commercial |
$0.15
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.21
|
| Rate for Payer: Molina Healthcare of CA 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 68084-643-11
|
| 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 |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.16
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.19
|
| 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
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 68084-643-01
|
| 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 |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.16
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.19
|
| 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
|
IP
|
$0.13
|
|
|
Service Code
|
NDC 31722-712-90
|
| 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 |
$0.07
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA 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 13668-096-90
|
| 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 |
$0.07
|
| 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: 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: InnovAge PACE Commercial |
$0.07
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.09
|
| Rate for Payer: Molina Healthcare of CA 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
|
$0.07
|
|
|
Service Code
|
NDC 65862-559-90
|
| 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 |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA 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
|
$0.07
|
|
|
Service Code
|
NDC 65862-559-90
|
| 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 |
$0.04
|
| 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: 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: InnovAge PACE Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.05
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
