|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET [204693]
|
Facility
|
OP
|
$23.99
|
|
|
Service Code
|
NDC 0310-6210-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.39 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.73
|
| Rate for Payer: Cash Price |
$13.19
|
| Rate for Payer: Cigna of CA HMO |
$16.79
|
| Rate for Payer: Cigna of CA PPO |
$16.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.39
|
| Rate for Payer: Global Benefits Group Commercial |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.79
|
| Rate for Payer: Multiplan Commercial |
$19.19
|
| Rate for Payer: Networks By Design Commercial |
$15.59
|
| Rate for Payer: Prime Health Services Commercial |
$20.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.99
|
| Rate for Payer: United Healthcare All Other HMO |
$11.99
|
| Rate for Payer: United Healthcare HMO Rider |
$11.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Vantage Medical Group Senior |
$20.39
|
|
|
DAPSONE 100 MG TABLET [2131]
|
Facility
|
OP
|
$1.45
|
|
|
Service Code
|
NDC 70954-136-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.89
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$1.16
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.73
|
| Rate for Payer: United Healthcare All Other HMO |
$0.73
|
| Rate for Payer: United Healthcare HMO Rider |
$0.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1.23
|
|
|
DAPSONE 100 MG TABLET [2131]
|
Facility
|
IP
|
$1.86
|
|
|
Service Code
|
NDC 64980-566-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Senior |
$0.74
|
| Rate for Payer: Galaxy Health WC |
$1.58
|
| Rate for Payer: Cigna of CA HMO |
$1.30
|
| Rate for Payer: Cigna of CA PPO |
$1.30
|
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.90
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: Networks By Design Commercial |
$1.21
|
| Rate for Payer: Prime Health Services Commercial |
$1.58
|
|
|
DAPSONE 100 MG TABLET [2131]
|
Facility
|
OP
|
$1.86
|
|
|
Service Code
|
NDC 64980-566-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.14
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$1.30
|
| Rate for Payer: Cigna of CA PPO |
$1.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Senior |
$0.74
|
| Rate for Payer: Galaxy Health WC |
$1.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: Networks By Design Commercial |
$1.21
|
| Rate for Payer: Prime Health Services Commercial |
$1.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.93
|
| Rate for Payer: United Healthcare All Other HMO |
$0.93
|
| Rate for Payer: United Healthcare HMO Rider |
$0.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.58
|
| Rate for Payer: Vantage Medical Group Senior |
$1.58
|
|
|
DAPSONE 100 MG TABLET [2131]
|
Facility
|
IP
|
$1.45
|
|
|
Service Code
|
NDC 70954-136-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.16
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.23
|
|
|
DAPSONE 25 MG TABLET [2132]
|
Facility
|
IP
|
$2.74
|
|
|
Service Code
|
NDC 49938-102-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Adventist Health Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.33
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cigna of CA HMO |
$1.92
|
| Rate for Payer: Cigna of CA PPO |
$1.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.10
|
| Rate for Payer: EPIC Health Plan Senior |
$1.10
|
| Rate for Payer: Galaxy Health WC |
$2.33
|
| Rate for Payer: Global Benefits Group Commercial |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.19
|
| Rate for Payer: Networks By Design Commercial |
$1.78
|
| Rate for Payer: Prime Health Services Commercial |
$2.33
|
|
|
DAPSONE 25 MG TABLET [2132]
|
Facility
|
OP
|
$2.74
|
|
|
Service Code
|
NDC 49938-102-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Adventist Health Commercial |
$0.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.68
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cigna of CA HMO |
$1.92
|
| Rate for Payer: Cigna of CA PPO |
$1.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.10
|
| Rate for Payer: EPIC Health Plan Senior |
$1.10
|
| Rate for Payer: Galaxy Health WC |
$2.33
|
| Rate for Payer: Global Benefits Group Commercial |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$2.19
|
| Rate for Payer: Networks By Design Commercial |
$1.78
|
| Rate for Payer: Prime Health Services Commercial |
$2.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1.37
|
| Rate for Payer: United Healthcare HMO Rider |
$1.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.33
|
| Rate for Payer: Vantage Medical Group Senior |
$2.33
|
|
|
DAPSONE ORAL SUSPENSION COMPOUND 2 MG/ML [4080263]
|
Facility
|
IP
|
$2.37
|
|
|
Service Code
|
NDC 9994-0802-63
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1.75
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cigna of CA HMO |
$1.66
|
| Rate for Payer: Cigna of CA PPO |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: EPIC Health Plan Senior |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$2.01
|
| Rate for Payer: Global Benefits Group Commercial |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$1.90
|
| Rate for Payer: Networks By Design Commercial |
$1.54
|
| Rate for Payer: Prime Health Services Commercial |
$2.01
|
|
|
DAPSONE ORAL SUSPENSION COMPOUND 2 MG/ML [4080263]
|
Facility
|
OP
|
$2.37
|
|
|
Service Code
|
NDC 9994-0802-63
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.46
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cigna of CA HMO |
$1.66
|
| Rate for Payer: Cigna of CA PPO |
$1.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: EPIC Health Plan Senior |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$2.01
|
| Rate for Payer: Global Benefits Group Commercial |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$1.90
|
| Rate for Payer: Networks By Design Commercial |
$1.54
|
| Rate for Payer: Prime Health Services Commercial |
$2.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.01
|
| Rate for Payer: Vantage Medical Group Senior |
$2.01
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION [36989]
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna of CA HMO |
$25.20
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.51
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare All Other HMO |
$13.15
|
| Rate for Payer: United Healthcare HMO Rider |
$12.87
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION [36989]
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Blue Shield of California Commercial |
$26.57
|
| Rate for Payer: Blue Shield of California Commercial |
$88.56
|
| Rate for Payer: Blue Shield of California EPN |
$58.32
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna of CA HMO |
$25.20
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.51
|
| Rate for Payer: United Healthcare All Other HMO |
$13.15
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare HMO Rider |
$12.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.79
|
|
|
DARATUMUMAB 1,800 MG-HYALURONIDASE-FIHJ 30,000 UNIT/15 ML SUBCUT SOLN [228045]
|
Facility
|
IP
|
$845.75
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$169.15 |
| Max. Negotiated Rate |
$718.89 |
| Rate for Payer: Adventist Health Commercial |
$169.15
|
| Rate for Payer: Blue Shield of California Commercial |
$624.16
|
| Rate for Payer: Blue Shield of California EPN |
$411.03
|
| Rate for Payer: Cash Price |
$465.16
|
| Rate for Payer: Cigna of CA HMO |
$592.02
|
| Rate for Payer: Cigna of CA PPO |
$592.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.30
|
| Rate for Payer: EPIC Health Plan Senior |
$338.30
|
| Rate for Payer: Galaxy Health WC |
$718.89
|
| Rate for Payer: Global Benefits Group Commercial |
$507.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$523.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.98
|
| Rate for Payer: Multiplan Commercial |
$676.60
|
| Rate for Payer: Networks By Design Commercial |
$422.88
|
| Rate for Payer: Prime Health Services Commercial |
$718.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$317.41
|
| Rate for Payer: United Healthcare All Other HMO |
$308.95
|
| Rate for Payer: United Healthcare HMO Rider |
$302.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.98
|
|
|
DARATUMUMAB 1,800 MG-HYALURONIDASE-FIHJ 30,000 UNIT/15 ML SUBCUT SOLN [228045]
|
Facility
|
OP
|
$845.75
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.99 |
| Max. Negotiated Rate |
$718.89 |
| Rate for Payer: Adventist Health Commercial |
$169.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$554.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.55
|
| Rate for Payer: Blue Shield of California Commercial |
$66.82
|
| Rate for Payer: Blue Shield of California EPN |
$66.82
|
| Rate for Payer: Cash Price |
$465.16
|
| Rate for Payer: Cash Price |
$465.16
|
| Rate for Payer: Cigna of CA HMO |
$592.02
|
| Rate for Payer: Cigna of CA PPO |
$592.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.67
|
| Rate for Payer: Galaxy Health WC |
$718.89
|
| Rate for Payer: Global Benefits Group Commercial |
$507.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$54.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.26
|
| Rate for Payer: Multiplan Commercial |
$676.60
|
| Rate for Payer: Networks By Design Commercial |
$422.88
|
| Rate for Payer: Prime Health Services Commercial |
$718.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$507.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$507.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$317.41
|
| Rate for Payer: United Healthcare All Other HMO |
$308.95
|
| Rate for Payer: United Healthcare HMO Rider |
$302.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$54.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.14
|
| Rate for Payer: Vantage Medical Group Senior |
$60.14
|
|
|
DARATUMUMAB-HYALURONIDASE-FIHJ (DARZALEX FASPRO) 1800 MG/30000 UNIT SQ INJECTION [40820601]
|
Facility
|
OP
|
$845.75
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.99 |
| Max. Negotiated Rate |
$718.89 |
| Rate for Payer: United Healthcare HMO Rider |
$302.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$54.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.14
|
| Rate for Payer: Vantage Medical Group Senior |
$60.14
|
| Rate for Payer: Adventist Health Commercial |
$169.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$554.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.55
|
| Rate for Payer: Blue Shield of California Commercial |
$66.82
|
| Rate for Payer: Blue Shield of California EPN |
$66.82
|
| Rate for Payer: Cash Price |
$465.16
|
| Rate for Payer: Cash Price |
$465.16
|
| Rate for Payer: Cigna of CA HMO |
$592.02
|
| Rate for Payer: Cigna of CA PPO |
$592.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.67
|
| Rate for Payer: Galaxy Health WC |
$718.89
|
| Rate for Payer: Global Benefits Group Commercial |
$507.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$54.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.26
|
| Rate for Payer: Multiplan Commercial |
$676.60
|
| Rate for Payer: Networks By Design Commercial |
$422.88
|
| Rate for Payer: Prime Health Services Commercial |
$718.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$507.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$507.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$317.41
|
| Rate for Payer: United Healthcare All Other HMO |
$308.95
|
|
|
DARATUMUMAB-HYALURONIDASE-FIHJ (DARZALEX FASPRO) 1800 MG/30000 UNIT SQ INJECTION [40820601]
|
Facility
|
IP
|
$845.75
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$169.15 |
| Max. Negotiated Rate |
$718.89 |
| Rate for Payer: Adventist Health Commercial |
$169.15
|
| Rate for Payer: Blue Shield of California Commercial |
$624.16
|
| Rate for Payer: Blue Shield of California EPN |
$411.03
|
| Rate for Payer: Cash Price |
$465.16
|
| Rate for Payer: Cigna of CA HMO |
$592.02
|
| Rate for Payer: Cigna of CA PPO |
$592.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.30
|
| Rate for Payer: EPIC Health Plan Senior |
$338.30
|
| Rate for Payer: Galaxy Health WC |
$718.89
|
| Rate for Payer: Global Benefits Group Commercial |
$507.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$523.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.98
|
| Rate for Payer: Multiplan Commercial |
$676.60
|
| Rate for Payer: Networks By Design Commercial |
$422.88
|
| Rate for Payer: Prime Health Services Commercial |
$718.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$317.41
|
| Rate for Payer: United Healthcare All Other HMO |
$308.95
|
| Rate for Payer: United Healthcare HMO Rider |
$302.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.98
|
|
|
DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE [108041]
|
Facility
|
OP
|
$552.86
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$469.93 |
| Rate for Payer: Adventist Health Commercial |
$110.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$362.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.03
|
| Rate for Payer: Blue Shield of California Commercial |
$9.29
|
| Rate for Payer: Blue Shield of California EPN |
$9.29
|
| Rate for Payer: Cash Price |
$304.07
|
| Rate for Payer: Cash Price |
$304.07
|
| Rate for Payer: Cigna of CA HMO |
$387.00
|
| Rate for Payer: Cigna of CA PPO |
$387.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.05
|
| Rate for Payer: EPIC Health Plan Senior |
$3.00
|
| Rate for Payer: Galaxy Health WC |
$469.93
|
| Rate for Payer: Global Benefits Group Commercial |
$331.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.02
|
| Rate for Payer: Multiplan Commercial |
$442.29
|
| Rate for Payer: Networks By Design Commercial |
$276.43
|
| Rate for Payer: Prime Health Services Commercial |
$469.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$331.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$331.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$207.49
|
| Rate for Payer: United Healthcare All Other HMO |
$201.96
|
| Rate for Payer: United Healthcare HMO Rider |
$197.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$181.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3.30
|
|
|
DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE [108041]
|
Facility
|
IP
|
$552.86
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.57 |
| Max. Negotiated Rate |
$469.93 |
| Rate for Payer: Adventist Health Commercial |
$110.57
|
| Rate for Payer: Blue Shield of California Commercial |
$408.01
|
| Rate for Payer: Blue Shield of California EPN |
$268.69
|
| Rate for Payer: Cash Price |
$304.07
|
| Rate for Payer: Cigna of CA HMO |
$387.00
|
| Rate for Payer: Cigna of CA PPO |
$387.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.14
|
| Rate for Payer: EPIC Health Plan Senior |
$221.14
|
| Rate for Payer: Galaxy Health WC |
$469.93
|
| Rate for Payer: Global Benefits Group Commercial |
$331.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$342.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.69
|
| Rate for Payer: Multiplan Commercial |
$442.29
|
| Rate for Payer: Networks By Design Commercial |
$276.43
|
| Rate for Payer: Prime Health Services Commercial |
$469.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$207.49
|
| Rate for Payer: United Healthcare All Other HMO |
$201.96
|
| Rate for Payer: United Healthcare HMO Rider |
$197.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$181.06
|
|
|
DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE [108042]
|
Facility
|
OP
|
$928.80
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$789.48 |
| Rate for Payer: Adventist Health Commercial |
$185.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$609.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.03
|
| Rate for Payer: Blue Shield of California Commercial |
$9.29
|
| Rate for Payer: Blue Shield of California EPN |
$9.29
|
| Rate for Payer: Cash Price |
$510.84
|
| Rate for Payer: Cash Price |
$510.84
|
| Rate for Payer: Cigna of CA HMO |
$650.16
|
| Rate for Payer: Cigna of CA PPO |
$650.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.05
|
| Rate for Payer: EPIC Health Plan Senior |
$3.00
|
| Rate for Payer: Galaxy Health WC |
$789.48
|
| Rate for Payer: Global Benefits Group Commercial |
$557.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$619.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.02
|
| Rate for Payer: Multiplan Commercial |
$743.04
|
| Rate for Payer: Networks By Design Commercial |
$464.40
|
| Rate for Payer: Prime Health Services Commercial |
$789.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$557.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$557.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$348.58
|
| Rate for Payer: United Healthcare All Other HMO |
$339.29
|
| Rate for Payer: United Healthcare HMO Rider |
$331.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$304.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3.30
|
|
|
DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE [108042]
|
Facility
|
IP
|
$928.80
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$185.76 |
| Max. Negotiated Rate |
$789.48 |
| Rate for Payer: Cash Price |
$510.84
|
| Rate for Payer: Cigna of CA HMO |
$650.16
|
| Rate for Payer: Adventist Health Commercial |
$185.76
|
| Rate for Payer: Blue Shield of California Commercial |
$685.45
|
| Rate for Payer: Blue Shield of California EPN |
$451.40
|
| Rate for Payer: Cigna of CA PPO |
$650.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$371.52
|
| Rate for Payer: EPIC Health Plan Senior |
$371.52
|
| Rate for Payer: Galaxy Health WC |
$789.48
|
| Rate for Payer: Global Benefits Group Commercial |
$557.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$619.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$574.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.91
|
| Rate for Payer: Multiplan Commercial |
$743.04
|
| Rate for Payer: Networks By Design Commercial |
$464.40
|
| Rate for Payer: Prime Health Services Commercial |
$789.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$348.58
|
| Rate for Payer: United Healthcare All Other HMO |
$339.29
|
| Rate for Payer: United Healthcare HMO Rider |
$331.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$304.18
|
|
|
DAROLUTAMIDE 300 MG TABLET [225419]
|
Facility
|
IP
|
$142.54
|
|
|
Service Code
|
NDC 50419-395-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.51 |
| Max. Negotiated Rate |
$121.16 |
| Rate for Payer: Adventist Health Commercial |
$28.51
|
| Rate for Payer: Blue Shield of California Commercial |
$105.19
|
| Rate for Payer: Blue Shield of California EPN |
$69.27
|
| Rate for Payer: Cash Price |
$78.39
|
| Rate for Payer: Cigna of CA HMO |
$99.78
|
| Rate for Payer: Cigna of CA PPO |
$99.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.02
|
| Rate for Payer: EPIC Health Plan Senior |
$57.02
|
| Rate for Payer: Galaxy Health WC |
$121.16
|
| Rate for Payer: Global Benefits Group Commercial |
$85.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.21
|
| Rate for Payer: Multiplan Commercial |
$114.03
|
| Rate for Payer: Networks By Design Commercial |
$92.65
|
| Rate for Payer: Prime Health Services Commercial |
$121.16
|
|
|
DAROLUTAMIDE 300 MG TABLET [225419]
|
Facility
|
OP
|
$142.54
|
|
|
Service Code
|
NDC 50419-395-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.51 |
| Max. Negotiated Rate |
$121.16 |
| Rate for Payer: Multiplan Commercial |
$114.03
|
| Rate for Payer: Networks By Design Commercial |
$92.65
|
| Rate for Payer: Adventist Health Commercial |
$28.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$93.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$121.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.53
|
| Rate for Payer: Cash Price |
$78.39
|
| Rate for Payer: Cigna of CA HMO |
$99.78
|
| Rate for Payer: Cigna of CA PPO |
$99.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$121.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$121.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$121.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.02
|
| Rate for Payer: EPIC Health Plan Senior |
$57.02
|
| Rate for Payer: Galaxy Health WC |
$121.16
|
| Rate for Payer: Global Benefits Group Commercial |
$85.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99.78
|
| Rate for Payer: Prime Health Services Commercial |
$121.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.27
|
| Rate for Payer: United Healthcare All Other HMO |
$71.27
|
| Rate for Payer: United Healthcare HMO Rider |
$71.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$121.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$121.16
|
| Rate for Payer: Vantage Medical Group Senior |
$121.16
|
|
|
DARUNAVIR 600 MG TABLET [92851]
|
Facility
|
OP
|
$43.16
|
|
|
Service Code
|
NDC 59676-562-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$36.69 |
| Rate for Payer: Adventist Health Commercial |
$8.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.50
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Cigna of CA HMO |
$30.21
|
| Rate for Payer: Cigna of CA PPO |
$30.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.26
|
| Rate for Payer: EPIC Health Plan Senior |
$17.26
|
| Rate for Payer: Galaxy Health WC |
$36.69
|
| Rate for Payer: Global Benefits Group Commercial |
$25.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.21
|
| Rate for Payer: Multiplan Commercial |
$34.53
|
| Rate for Payer: Networks By Design Commercial |
$28.05
|
| Rate for Payer: Prime Health Services Commercial |
$36.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.58
|
| Rate for Payer: United Healthcare All Other HMO |
$21.58
|
| Rate for Payer: United Healthcare HMO Rider |
$21.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.69
|
| Rate for Payer: Vantage Medical Group Senior |
$36.69
|
|
|
DARUNAVIR 600 MG TABLET [92851]
|
Facility
|
IP
|
$43.16
|
|
|
Service Code
|
NDC 59676-562-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$36.69 |
| Rate for Payer: Adventist Health Commercial |
$8.63
|
| Rate for Payer: Blue Shield of California Commercial |
$31.85
|
| Rate for Payer: Blue Shield of California EPN |
$20.98
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Cigna of CA HMO |
$30.21
|
| Rate for Payer: Cigna of CA PPO |
$30.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.26
|
| Rate for Payer: EPIC Health Plan Senior |
$17.26
|
| Rate for Payer: Galaxy Health WC |
$36.69
|
| Rate for Payer: Global Benefits Group Commercial |
$25.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.36
|
| Rate for Payer: Multiplan Commercial |
$34.53
|
| Rate for Payer: Networks By Design Commercial |
$28.05
|
| Rate for Payer: Prime Health Services Commercial |
$36.69
|
|
|
DARUNAVIR 800 MG-COBICISTAT 150 MG TABLET [208697]
|
Facility
|
OP
|
$98.67
|
|
|
Service Code
|
NDC 59676-575-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$83.87 |
| Rate for Payer: Adventist Health Commercial |
$19.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.59
|
| Rate for Payer: Cash Price |
$54.27
|
| Rate for Payer: Cigna of CA HMO |
$69.07
|
| Rate for Payer: Cigna of CA PPO |
$69.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$83.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.47
|
| Rate for Payer: EPIC Health Plan Senior |
$39.47
|
| Rate for Payer: Galaxy Health WC |
$83.87
|
| Rate for Payer: Global Benefits Group Commercial |
$59.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.07
|
| Rate for Payer: Multiplan Commercial |
$78.94
|
| Rate for Payer: Networks By Design Commercial |
$64.14
|
| Rate for Payer: Prime Health Services Commercial |
$83.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.34
|
| Rate for Payer: United Healthcare All Other HMO |
$49.34
|
| Rate for Payer: United Healthcare HMO Rider |
$49.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$83.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.87
|
| Rate for Payer: Vantage Medical Group Senior |
$83.87
|
|
|
DARUNAVIR 800 MG-COBICISTAT 150 MG TABLET [208697]
|
Facility
|
IP
|
$98.67
|
|
|
Service Code
|
NDC 59676-575-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$83.87 |
| Rate for Payer: Adventist Health Commercial |
$19.73
|
| Rate for Payer: Blue Shield of California Commercial |
$72.82
|
| Rate for Payer: Blue Shield of California EPN |
$47.95
|
| Rate for Payer: Cash Price |
$54.27
|
| Rate for Payer: Cigna of CA HMO |
$69.07
|
| Rate for Payer: Cigna of CA PPO |
$69.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.47
|
| Rate for Payer: EPIC Health Plan Senior |
$39.47
|
| Rate for Payer: Galaxy Health WC |
$83.87
|
| Rate for Payer: Global Benefits Group Commercial |
$59.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.68
|
| Rate for Payer: Multiplan Commercial |
$78.94
|
| Rate for Payer: Networks By Design Commercial |
$64.14
|
| Rate for Payer: Prime Health Services Commercial |
$83.87
|
|
