|
PANCREAS TRANSPLANT
|
Facility
IP
|
$80,555.73
|
|
|
Service Code
|
APR-DRG 0063
|
| Min. Negotiated Rate |
$80,555.73 |
| Max. Negotiated Rate |
$80,555.73 |
| Rate for Payer: IEHP Medi-Cal |
$80,555.73
|
|
|
PANCREAS TRANSPLANT
|
Facility
IP
|
$69,930.25
|
|
|
Service Code
|
APR-DRG 0062
|
| Min. Negotiated Rate |
$69,930.25 |
| Max. Negotiated Rate |
$69,930.25 |
| Rate for Payer: IEHP Medi-Cal |
$69,930.25
|
|
|
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 |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.47
|
| Rate for Payer: Heritage Provider Network Senior |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
|
|
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 |
$0.12 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
| 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 |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.59
|
| Rate for Payer: Dignity Health Senior |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Senior |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| 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 |
$68.18 |
| Max. Negotiated Rate |
$282.50 |
| Rate for Payer: Adventist Health Commercial |
$75.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$258.77
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$173.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.01
|
| Rate for Payer: Heritage Provider Network Senior |
$255.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.17
|
| Rate for Payer: Multiplan Commercial |
$282.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$125.85
|
|
|
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 |
$68.18 |
| Max. Negotiated Rate |
$370.12 |
| Rate for Payer: Adventist Health Commercial |
$75.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$370.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$258.77
|
| 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 HMO/PPO |
$178.13
|
| Rate for Payer: Blue Shield of California Commercial |
$151.16
|
| Rate for Payer: Blue Shield of California EPN |
$151.16
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$173.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.72
|
| Rate for Payer: Dignity Health Senior |
$165.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.07
|
| Rate for Payer: EPIC Health Plan Medicare |
$150.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.40
|
| Rate for Payer: Heritage Provider Network Senior |
$174.40
|
| Rate for Payer: Humana Medicare |
$150.66
|
| Rate for Payer: IEHP Medi-Cal |
$241.99
|
| Rate for Payer: IEHP Medicare Advantage |
$150.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$286.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$189.83
|
| Rate for Payer: Multiplan Commercial |
$282.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$165.72
|
| Rate for Payer: TriValley Medical Group Senior |
$150.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$125.85
|
| 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 |
$68.18 |
| Max. Negotiated Rate |
$370.12 |
| Rate for Payer: Adventist Health Commercial |
$75.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$370.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$258.77
|
| 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 HMO/PPO |
$178.13
|
| Rate for Payer: Blue Shield of California Commercial |
$151.16
|
| Rate for Payer: Blue Shield of California EPN |
$151.16
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$173.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.72
|
| Rate for Payer: Dignity Health Senior |
$165.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.07
|
| Rate for Payer: EPIC Health Plan Medicare |
$150.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.40
|
| Rate for Payer: Heritage Provider Network Senior |
$174.40
|
| Rate for Payer: Humana Medicare |
$150.66
|
| Rate for Payer: IEHP Medi-Cal |
$241.99
|
| Rate for Payer: IEHP Medicare Advantage |
$150.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$286.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$189.83
|
| Rate for Payer: Multiplan Commercial |
$282.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$165.72
|
| Rate for Payer: TriValley Medical Group Senior |
$150.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$125.85
|
| 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 |
$68.18 |
| Max. Negotiated Rate |
$282.50 |
| Rate for Payer: Adventist Health Commercial |
$75.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$258.77
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$173.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.01
|
| Rate for Payer: Heritage Provider Network Senior |
$255.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.17
|
| Rate for Payer: Multiplan Commercial |
$282.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$125.85
|
|
|
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 |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
|
|
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 |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
| 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 |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: Dignity Health Senior |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Senior |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| 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
|
$0.24
|
|
|
Service Code
|
NDC 13668-096-90
|
| Hospital Charge Code |
1712608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Senior |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
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 |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.21
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
|
|
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 |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
|
|
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 |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
|
|
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 |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
|
|
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 |
$0.05 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.21
|
| 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 |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Senior |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| 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 68084-643-11
|
| Hospital Charge Code |
1712608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.21
|
| 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 |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Senior |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| 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
|
$0.13
|
|
|
Service Code
|
NDC 65862-559-90
|
| Hospital Charge Code |
1712608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
| 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 |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: Dignity Health Senior |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Senior |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| 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
|
$0.33
|
|
|
Service Code
|
NDC 50268-636-15
|
| Hospital Charge Code |
1712608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.23
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
|
|
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 |
$0.06 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.23
|
| 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 |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Senior |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| 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
|
$0.13
|
|
|
Service Code
|
NDC 31722-712-90
|
| Hospital Charge Code |
1712608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
| 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 |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: Dignity Health Senior |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Senior |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| 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
|
$0.30
|
|
|
Service Code
|
NDC 68084-643-01
|
| Hospital Charge Code |
1712608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.21
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [26226]
|
Facility
IP
|
$5.86
|
|
|
Service Code
|
CPT C9113
|
| Hospital Charge Code |
1759991
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.40 |
| Rate for Payer: Adventist Health Commercial |
$1.17
|
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.04
|
| Rate for Payer: Cash Price |
$2.65
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.12
|
| Rate for Payer: Heritage Provider Network Senior |
$8.12
|
| Rate for Payer: Heritage Provider Network Senior |
$3.98
|
| Rate for Payer: Heritage Provider Network Senior |
$4.06
|
| Rate for Payer: Heritage Provider Network Senior |
$3.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$4.40
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$4.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.01
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [26226]
|
Facility
OP
|
$5.88
|
|
|
Service Code
|
CPT C9113
|
| Hospital Charge Code |
1759991
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$63.86 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Adventist Health Commercial |
$1.17
|
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.86
|
| Rate for Payer: Blue Shield of California Commercial |
$3.73
|
| Rate for Payer: Blue Shield of California Commercial |
$3.65
|
| Rate for Payer: Blue Shield of California Commercial |
$3.64
|
| Rate for Payer: Blue Shield of California Commercial |
$7.45
|
| Rate for Payer: Blue Shield of California EPN |
$3.52
|
| Rate for Payer: Blue Shield of California EPN |
$7.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.45
|
| Rate for Payer: Blue Shield of California EPN |
$3.44
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.65
|
| Rate for Payer: Cash Price |
$2.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.00
|
| Rate for Payer: Dignity Health Senior |
$10.20
|
| Rate for Payer: Dignity Health Senior |
$4.98
|
| Rate for Payer: Dignity Health Senior |
$5.10
|
| Rate for Payer: Dignity Health Senior |
$5.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.71
|
| Rate for Payer: Heritage Provider Network Senior |
$5.56
|
| Rate for Payer: Heritage Provider Network Senior |
$2.72
|
| Rate for Payer: Heritage Provider Network Senior |
$2.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$4.41
|
| Rate for Payer: Multiplan Commercial |
$4.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.00
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4.98
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]
|
Facility
OP
|
$0.34
|
|
|
Service Code
|
NDC 51079-051-01
|
| Hospital Charge Code |
1712267
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: Dignity Health Senior |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.21
|
| Rate for Payer: Heritage Provider Network Senior |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
