|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
IP
|
$12.30
|
|
|
Service Code
|
NDC 60687-819-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Blue Shield of California Commercial |
$9.08
|
| Rate for Payer: Blue Shield of California EPN |
$5.98
|
| Rate for Payer: Cash Price |
$6.77
|
| Rate for Payer: Cigna of CA HMO |
$8.61
|
| Rate for Payer: Cigna of CA PPO |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Multiplan Commercial |
$9.84
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
OP
|
$86.33
|
|
|
Service Code
|
NDC 59676-566-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$73.38 |
| Rate for Payer: Adventist Health Commercial |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.02
|
| Rate for Payer: Cash Price |
$47.48
|
| Rate for Payer: Cigna of CA HMO |
$60.43
|
| Rate for Payer: Cigna of CA PPO |
$60.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.53
|
| Rate for Payer: EPIC Health Plan Senior |
$34.53
|
| Rate for Payer: Galaxy Health WC |
$73.38
|
| Rate for Payer: Global Benefits Group Commercial |
$51.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.43
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: Networks By Design Commercial |
$56.11
|
| Rate for Payer: Prime Health Services Commercial |
$73.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.16
|
| Rate for Payer: United Healthcare All Other HMO |
$43.16
|
| Rate for Payer: United Healthcare HMO Rider |
$43.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.38
|
| Rate for Payer: Vantage Medical Group Senior |
$73.38
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
IP
|
$86.33
|
|
|
Service Code
|
NDC 59676-566-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$73.38 |
| Rate for Payer: Adventist Health Commercial |
$17.27
|
| Rate for Payer: Blue Shield of California Commercial |
$63.71
|
| Rate for Payer: Blue Shield of California EPN |
$41.96
|
| Rate for Payer: Cash Price |
$47.48
|
| Rate for Payer: Cigna of CA HMO |
$60.43
|
| Rate for Payer: Cigna of CA PPO |
$60.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.53
|
| Rate for Payer: EPIC Health Plan Senior |
$34.53
|
| Rate for Payer: Galaxy Health WC |
$73.38
|
| Rate for Payer: Global Benefits Group Commercial |
$51.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.72
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: Networks By Design Commercial |
$56.11
|
| Rate for Payer: Prime Health Services Commercial |
$73.38
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
IP
|
$3.96
|
|
|
Service Code
|
NDC 68180-346-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.92
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna of CA HMO |
$2.77
|
| Rate for Payer: Cigna of CA PPO |
$2.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: EPIC Health Plan Senior |
$1.58
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.17
|
| Rate for Payer: Networks By Design Commercial |
$2.57
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
OP
|
$3.96
|
|
|
Service Code
|
NDC 68180-346-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.43
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna of CA HMO |
$2.77
|
| Rate for Payer: Cigna of CA PPO |
$2.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: EPIC Health Plan Senior |
$1.58
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.77
|
| Rate for Payer: Multiplan Commercial |
$3.17
|
| Rate for Payer: Networks By Design Commercial |
$2.57
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.98
|
| Rate for Payer: United Healthcare All Other HMO |
$1.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.37
|
| Rate for Payer: Vantage Medical Group Senior |
$3.37
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
OP
|
$12.30
|
|
|
Service Code
|
NDC 60687-819-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.55
|
| Rate for Payer: Cash Price |
$6.77
|
| Rate for Payer: Cigna of CA HMO |
$8.61
|
| Rate for Payer: Cigna of CA PPO |
$8.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$9.84
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.15
|
| Rate for Payer: United Healthcare All Other HMO |
$6.15
|
| Rate for Payer: United Healthcare HMO Rider |
$6.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.46
|
| Rate for Payer: Vantage Medical Group Senior |
$10.46
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
OP
|
$12.30
|
|
|
Service Code
|
NDC 60687-819-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.55
|
| Rate for Payer: Cash Price |
$6.77
|
| Rate for Payer: Cigna of CA HMO |
$8.61
|
| Rate for Payer: Cigna of CA PPO |
$8.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$9.84
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.15
|
| Rate for Payer: United Healthcare All Other HMO |
$6.15
|
| Rate for Payer: United Healthcare HMO Rider |
$6.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.46
|
| Rate for Payer: Vantage Medical Group Senior |
$10.46
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
IP
|
$12.30
|
|
|
Service Code
|
NDC 60687-819-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Blue Shield of California Commercial |
$9.08
|
| Rate for Payer: Blue Shield of California EPN |
$5.98
|
| Rate for Payer: Cash Price |
$6.77
|
| Rate for Payer: Cigna of CA HMO |
$8.61
|
| Rate for Payer: Cigna of CA PPO |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Multiplan Commercial |
$9.84
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
|
|
DASATINIB 100 MG TABLET [92897]
|
Facility
|
IP
|
$729.85
|
|
|
Service Code
|
NDC 0003-0852-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$145.97 |
| Max. Negotiated Rate |
$620.37 |
| Rate for Payer: Adventist Health Commercial |
$145.97
|
| Rate for Payer: Blue Shield of California Commercial |
$538.63
|
| Rate for Payer: Blue Shield of California EPN |
$354.71
|
| Rate for Payer: Cash Price |
$401.42
|
| Rate for Payer: Cigna of CA HMO |
$510.89
|
| Rate for Payer: Cigna of CA PPO |
$510.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.94
|
| Rate for Payer: EPIC Health Plan Senior |
$291.94
|
| Rate for Payer: Galaxy Health WC |
$620.37
|
| Rate for Payer: Global Benefits Group Commercial |
$437.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$451.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.16
|
| Rate for Payer: Multiplan Commercial |
$583.88
|
| Rate for Payer: Networks By Design Commercial |
$474.40
|
| Rate for Payer: Prime Health Services Commercial |
$620.37
|
|
|
DASATINIB 100 MG TABLET [92897]
|
Facility
|
OP
|
$729.85
|
|
|
Service Code
|
NDC 0003-0852-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$145.97 |
| Max. Negotiated Rate |
$620.37 |
| Rate for Payer: Adventist Health Commercial |
$145.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$478.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$620.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$401.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$547.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$448.20
|
| Rate for Payer: Cash Price |
$401.42
|
| Rate for Payer: Cigna of CA HMO |
$510.89
|
| Rate for Payer: Cigna of CA PPO |
$510.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$620.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$620.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$620.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.94
|
| Rate for Payer: EPIC Health Plan Senior |
$291.94
|
| Rate for Payer: Galaxy Health WC |
$620.37
|
| Rate for Payer: Global Benefits Group Commercial |
$437.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$451.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$510.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$510.89
|
| Rate for Payer: Multiplan Commercial |
$583.88
|
| Rate for Payer: Networks By Design Commercial |
$474.40
|
| Rate for Payer: Prime Health Services Commercial |
$620.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$437.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$437.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.93
|
| Rate for Payer: United Healthcare All Other HMO |
$364.93
|
| Rate for Payer: United Healthcare HMO Rider |
$364.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$364.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$620.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$620.37
|
| Rate for Payer: Vantage Medical Group Senior |
$620.37
|
|
|
DASATINIB 140 MG TABLET [108422]
|
Facility
|
IP
|
$729.85
|
|
|
Service Code
|
NDC 0003-0857-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$145.97 |
| Max. Negotiated Rate |
$620.37 |
| Rate for Payer: Adventist Health Commercial |
$145.97
|
| Rate for Payer: Blue Shield of California Commercial |
$538.63
|
| Rate for Payer: Blue Shield of California EPN |
$354.71
|
| Rate for Payer: Cash Price |
$401.42
|
| Rate for Payer: Cigna of CA HMO |
$510.89
|
| Rate for Payer: Cigna of CA PPO |
$510.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.94
|
| Rate for Payer: EPIC Health Plan Senior |
$291.94
|
| Rate for Payer: Galaxy Health WC |
$620.37
|
| Rate for Payer: Global Benefits Group Commercial |
$437.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$451.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.16
|
| Rate for Payer: Multiplan Commercial |
$583.88
|
| Rate for Payer: Networks By Design Commercial |
$474.40
|
| Rate for Payer: Prime Health Services Commercial |
$620.37
|
|
|
DASATINIB 140 MG TABLET [108422]
|
Facility
|
OP
|
$729.85
|
|
|
Service Code
|
NDC 0003-0857-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$145.97 |
| Max. Negotiated Rate |
$620.37 |
| Rate for Payer: Cigna of CA PPO |
$510.89
|
| Rate for Payer: Cigna of CA HMO |
$510.89
|
| Rate for Payer: Adventist Health Commercial |
$145.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$478.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$620.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$401.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$547.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$448.20
|
| Rate for Payer: Cash Price |
$401.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$620.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$620.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$620.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.94
|
| Rate for Payer: EPIC Health Plan Senior |
$291.94
|
| Rate for Payer: Galaxy Health WC |
$620.37
|
| Rate for Payer: Global Benefits Group Commercial |
$437.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$451.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$510.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$510.89
|
| Rate for Payer: Multiplan Commercial |
$583.88
|
| Rate for Payer: Networks By Design Commercial |
$474.40
|
| Rate for Payer: Prime Health Services Commercial |
$620.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$437.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$437.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.93
|
| Rate for Payer: United Healthcare All Other HMO |
$364.93
|
| Rate for Payer: United Healthcare HMO Rider |
$364.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$364.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$620.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$620.37
|
| Rate for Payer: Vantage Medical Group Senior |
$620.37
|
|
|
DASATINIB 20 MG TABLET [76717]
|
Facility
|
IP
|
$202.48
|
|
|
Service Code
|
NDC 0003-0527-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$172.11 |
| Rate for Payer: Adventist Health Commercial |
$40.50
|
| Rate for Payer: Blue Shield of California Commercial |
$149.43
|
| Rate for Payer: Blue Shield of California EPN |
$98.41
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cigna of CA HMO |
$141.74
|
| Rate for Payer: Cigna of CA PPO |
$141.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.99
|
| Rate for Payer: EPIC Health Plan Senior |
$80.99
|
| Rate for Payer: Galaxy Health WC |
$172.11
|
| Rate for Payer: Global Benefits Group Commercial |
$121.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$135.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.60
|
| Rate for Payer: Multiplan Commercial |
$161.98
|
| Rate for Payer: Networks By Design Commercial |
$131.61
|
| Rate for Payer: Prime Health Services Commercial |
$172.11
|
|
|
DASATINIB 20 MG TABLET [76717]
|
Facility
|
OP
|
$202.48
|
|
|
Service Code
|
NDC 0003-0527-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$172.11 |
| Rate for Payer: Adventist Health Commercial |
$40.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$172.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$111.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$151.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.34
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cigna of CA HMO |
$141.74
|
| Rate for Payer: Cigna of CA PPO |
$141.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$172.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$172.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$172.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.99
|
| Rate for Payer: EPIC Health Plan Senior |
$80.99
|
| Rate for Payer: Galaxy Health WC |
$172.11
|
| Rate for Payer: Global Benefits Group Commercial |
$121.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$135.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$141.74
|
| Rate for Payer: Multiplan Commercial |
$161.98
|
| Rate for Payer: Networks By Design Commercial |
$131.61
|
| Rate for Payer: Prime Health Services Commercial |
$172.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.24
|
| Rate for Payer: United Healthcare All Other HMO |
$101.24
|
| Rate for Payer: United Healthcare HMO Rider |
$101.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$172.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$172.11
|
| Rate for Payer: Vantage Medical Group Senior |
$172.11
|
|
|
DASATINIB 70 MG TABLET [76719]
|
Facility
|
IP
|
$404.95
|
|
|
Service Code
|
NDC 0003-0524-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$80.99 |
| Max. Negotiated Rate |
$344.21 |
| Rate for Payer: Adventist Health Commercial |
$80.99
|
| Rate for Payer: Blue Shield of California Commercial |
$298.85
|
| Rate for Payer: Blue Shield of California EPN |
$196.81
|
| Rate for Payer: Cash Price |
$222.72
|
| Rate for Payer: Cigna of CA HMO |
$283.46
|
| Rate for Payer: Cigna of CA PPO |
$283.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.98
|
| Rate for Payer: EPIC Health Plan Senior |
$161.98
|
| Rate for Payer: Galaxy Health WC |
$344.21
|
| Rate for Payer: Global Benefits Group Commercial |
$242.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.19
|
| Rate for Payer: Multiplan Commercial |
$323.96
|
| Rate for Payer: Networks By Design Commercial |
$263.22
|
| Rate for Payer: Prime Health Services Commercial |
$344.21
|
|
|
DASATINIB 70 MG TABLET [76719]
|
Facility
|
OP
|
$404.95
|
|
|
Service Code
|
NDC 0003-0524-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$80.99 |
| Max. Negotiated Rate |
$344.21 |
| Rate for Payer: Adventist Health Commercial |
$80.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$265.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.68
|
| Rate for Payer: Cash Price |
$222.72
|
| Rate for Payer: Cigna of CA HMO |
$283.46
|
| Rate for Payer: Cigna of CA PPO |
$283.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$344.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$344.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.98
|
| Rate for Payer: EPIC Health Plan Senior |
$161.98
|
| Rate for Payer: Galaxy Health WC |
$344.21
|
| Rate for Payer: Global Benefits Group Commercial |
$242.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$283.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$283.46
|
| Rate for Payer: Multiplan Commercial |
$323.96
|
| Rate for Payer: Networks By Design Commercial |
$263.22
|
| Rate for Payer: Prime Health Services Commercial |
$344.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$242.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$242.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.47
|
| Rate for Payer: United Healthcare All Other HMO |
$202.47
|
| Rate for Payer: United Healthcare HMO Rider |
$202.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$202.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$344.21
|
| Rate for Payer: Vantage Medical Group Senior |
$344.21
|
|
|
DASATINIB 80 MG TABLET [108421]
|
Facility
|
IP
|
$729.85
|
|
|
Service Code
|
NDC 0003-0855-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$145.97 |
| Max. Negotiated Rate |
$620.37 |
| Rate for Payer: Adventist Health Commercial |
$145.97
|
| Rate for Payer: Blue Shield of California Commercial |
$538.63
|
| Rate for Payer: Blue Shield of California EPN |
$354.71
|
| Rate for Payer: Cash Price |
$401.42
|
| Rate for Payer: Cigna of CA HMO |
$510.89
|
| Rate for Payer: Cigna of CA PPO |
$510.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.94
|
| Rate for Payer: EPIC Health Plan Senior |
$291.94
|
| Rate for Payer: Galaxy Health WC |
$620.37
|
| Rate for Payer: Global Benefits Group Commercial |
$437.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$451.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.16
|
| Rate for Payer: Multiplan Commercial |
$583.88
|
| Rate for Payer: Networks By Design Commercial |
$474.40
|
| Rate for Payer: Prime Health Services Commercial |
$620.37
|
|
|
DASATINIB 80 MG TABLET [108421]
|
Facility
|
OP
|
$729.85
|
|
|
Service Code
|
NDC 0003-0855-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$145.97 |
| Max. Negotiated Rate |
$620.37 |
| Rate for Payer: Adventist Health Commercial |
$145.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$478.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$620.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$401.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$547.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$448.20
|
| Rate for Payer: Cash Price |
$401.42
|
| Rate for Payer: Cigna of CA HMO |
$510.89
|
| Rate for Payer: Cigna of CA PPO |
$510.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$620.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$620.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$620.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.94
|
| Rate for Payer: EPIC Health Plan Senior |
$291.94
|
| Rate for Payer: Galaxy Health WC |
$620.37
|
| Rate for Payer: Global Benefits Group Commercial |
$437.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$451.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$510.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$510.89
|
| Rate for Payer: Multiplan Commercial |
$583.88
|
| Rate for Payer: Networks By Design Commercial |
$474.40
|
| Rate for Payer: Prime Health Services Commercial |
$620.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$437.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$437.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.93
|
| Rate for Payer: United Healthcare All Other HMO |
$364.93
|
| Rate for Payer: United Healthcare HMO Rider |
$364.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$364.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$620.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$620.37
|
| Rate for Payer: Vantage Medical Group Senior |
$620.37
|
|
|
DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION [22661]
|
Facility
|
IP
|
$39.34
|
|
|
Service Code
|
HCPCS J9150
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$33.44 |
| Rate for Payer: Adventist Health Commercial |
$7.87
|
| Rate for Payer: Adventist Health Commercial |
$7.42
|
| Rate for Payer: Blue Shield of California Commercial |
$29.03
|
| Rate for Payer: Blue Shield of California Commercial |
$27.37
|
| Rate for Payer: Blue Shield of California EPN |
$18.02
|
| Rate for Payer: Blue Shield of California EPN |
$19.12
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$20.39
|
| Rate for Payer: Cigna of CA HMO |
$27.54
|
| Rate for Payer: Cigna of CA HMO |
$25.96
|
| Rate for Payer: Cigna of CA PPO |
$25.96
|
| Rate for Payer: Cigna of CA PPO |
$27.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.74
|
| Rate for Payer: EPIC Health Plan Senior |
$14.83
|
| Rate for Payer: EPIC Health Plan Senior |
$15.74
|
| Rate for Payer: Galaxy Health WC |
$31.52
|
| Rate for Payer: Galaxy Health WC |
$33.44
|
| Rate for Payer: Global Benefits Group Commercial |
$22.25
|
| Rate for Payer: Global Benefits Group Commercial |
$23.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.44
|
| Rate for Payer: Multiplan Commercial |
$29.66
|
| Rate for Payer: Multiplan Commercial |
$31.47
|
| Rate for Payer: Networks By Design Commercial |
$19.67
|
| Rate for Payer: Networks By Design Commercial |
$18.54
|
| Rate for Payer: Prime Health Services Commercial |
$33.44
|
| Rate for Payer: Prime Health Services Commercial |
$31.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.76
|
| Rate for Payer: United Healthcare All Other HMO |
$14.37
|
| Rate for Payer: United Healthcare All Other HMO |
$13.55
|
| Rate for Payer: United Healthcare HMO Rider |
$13.25
|
| Rate for Payer: United Healthcare HMO Rider |
$14.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.88
|
|
|
DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION [22661]
|
Facility
|
OP
|
$37.08
|
|
|
Service Code
|
HCPCS J9150
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$179.38 |
| Rate for Payer: Adventist Health Commercial |
$7.42
|
| Rate for Payer: Adventist Health Commercial |
$7.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.38
|
| Rate for Payer: Blue Shield of California Commercial |
$79.24
|
| Rate for Payer: Blue Shield of California Commercial |
$79.24
|
| Rate for Payer: Blue Shield of California EPN |
$79.24
|
| Rate for Payer: Blue Shield of California EPN |
$79.24
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$20.39
|
| Rate for Payer: Cash Price |
$20.39
|
| Rate for Payer: Cigna of CA HMO |
$27.54
|
| Rate for Payer: Cigna of CA HMO |
$25.96
|
| Rate for Payer: Cigna of CA PPO |
$25.96
|
| Rate for Payer: Cigna of CA PPO |
$27.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.68
|
| Rate for Payer: EPIC Health Plan Senior |
$19.76
|
| Rate for Payer: EPIC Health Plan Senior |
$19.76
|
| Rate for Payer: Galaxy Health WC |
$31.52
|
| Rate for Payer: Galaxy Health WC |
$33.44
|
| Rate for Payer: Global Benefits Group Commercial |
$23.60
|
| Rate for Payer: Global Benefits Group Commercial |
$22.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.48
|
| Rate for Payer: Multiplan Commercial |
$29.66
|
| Rate for Payer: Multiplan Commercial |
$31.47
|
| Rate for Payer: Networks By Design Commercial |
$19.67
|
| Rate for Payer: Networks By Design Commercial |
$18.54
|
| Rate for Payer: Prime Health Services Commercial |
$31.52
|
| Rate for Payer: Prime Health Services Commercial |
$33.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.92
|
| Rate for Payer: United Healthcare All Other HMO |
$13.55
|
| Rate for Payer: United Healthcare All Other HMO |
$14.37
|
| Rate for Payer: United Healthcare HMO Rider |
$13.25
|
| Rate for Payer: United Healthcare HMO Rider |
$14.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.74
|
| Rate for Payer: Vantage Medical Group Senior |
$21.74
|
| Rate for Payer: Vantage Medical Group Senior |
$21.74
|
|
|
DECITABINE 50 MG INTRAVENOUS SOLUTION [76364]
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Galaxy Health WC |
$201.96
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$142.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$480.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$445.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$190.08
|
| Rate for Payer: Multiplan Commercial |
$576.00
|
| Rate for Payer: Networks By Design Commercial |
$118.80
|
| Rate for Payer: Networks By Design Commercial |
$360.00
|
| 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 |
$201.96
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.22
|
| Rate for Payer: United Healthcare All Other HMO |
$263.02
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare All Other HMO |
$86.80
|
| Rate for Payer: United Healthcare HMO Rider |
$84.92
|
| Rate for Payer: United Healthcare HMO Rider |
$257.33
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77.81
|
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$47.52
|
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Blue Shield of California Commercial |
$175.35
|
| Rate for Payer: Blue Shield of California Commercial |
$531.36
|
| Rate for Payer: Blue Shield of California Commercial |
$88.56
|
| Rate for Payer: Blue Shield of California EPN |
$115.47
|
| Rate for Payer: Blue Shield of California EPN |
$58.32
|
| Rate for Payer: Blue Shield of California EPN |
$349.92
|
| Rate for Payer: Cash Price |
$130.68
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna of CA HMO |
$166.32
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$504.00
|
| Rate for Payer: Cigna of CA PPO |
$166.32
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$504.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Senior |
$288.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$95.04
|
|
|
DECITABINE 50 MG INTRAVENOUS SOLUTION [76364]
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Adventist Health Commercial |
$47.52
|
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$155.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$472.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$396.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$130.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$540.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$178.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.24
|
| Rate for Payer: Blue Shield of California Commercial |
$7.57
|
| Rate for Payer: Blue Shield of California Commercial |
$7.57
|
| Rate for Payer: Blue Shield of California Commercial |
$7.57
|
| Rate for Payer: Blue Shield of California EPN |
$7.57
|
| Rate for Payer: Blue Shield of California EPN |
$7.57
|
| Rate for Payer: Blue Shield of California EPN |
$7.57
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$130.68
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$130.68
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna of CA HMO |
$504.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$166.32
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$166.32
|
| Rate for Payer: Cigna of CA PPO |
$504.00
|
| Rate for Payer: Vantage Medical Group Senior |
$612.00
|
| Rate for Payer: Vantage Medical Group Senior |
$201.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$201.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$612.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$612.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$201.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Senior |
$288.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$95.04
|
| Rate for Payer: Galaxy Health WC |
$201.96
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$142.56
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$480.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$445.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$166.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$504.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$504.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$166.32
|
| Rate for Payer: Multiplan Commercial |
$190.08
|
| Rate for Payer: Multiplan Commercial |
$576.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$360.00
|
| Rate for Payer: Networks By Design Commercial |
$118.80
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$201.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$142.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$432.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$432.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$142.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other HMO |
$263.02
|
| Rate for Payer: United Healthcare All Other HMO |
$86.80
|
| 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 |
$257.33
|
| Rate for Payer: United Healthcare HMO Rider |
$84.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$201.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$612.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
DEFERASIROX 180 MG TABLET [206427]
|
Facility
|
OP
|
$132.38
|
|
|
Service Code
|
NDC 0078-0655-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.48 |
| Max. Negotiated Rate |
$112.52 |
| Rate for Payer: Adventist Health Commercial |
$26.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$86.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.29
|
| Rate for Payer: Cash Price |
$72.81
|
| Rate for Payer: Cigna of CA HMO |
$92.67
|
| Rate for Payer: Cigna of CA PPO |
$92.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.95
|
| Rate for Payer: EPIC Health Plan Senior |
$52.95
|
| Rate for Payer: Galaxy Health WC |
$112.52
|
| Rate for Payer: Global Benefits Group Commercial |
$79.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.67
|
| Rate for Payer: Multiplan Commercial |
$105.90
|
| Rate for Payer: Networks By Design Commercial |
$86.05
|
| Rate for Payer: Prime Health Services Commercial |
$112.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.19
|
| Rate for Payer: United Healthcare All Other HMO |
$66.19
|
| Rate for Payer: United Healthcare HMO Rider |
$66.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.52
|
| Rate for Payer: Vantage Medical Group Senior |
$112.52
|
|
|
DEFERASIROX 180 MG TABLET [206427]
|
Facility
|
IP
|
$132.38
|
|
|
Service Code
|
NDC 0078-0655-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.48 |
| Max. Negotiated Rate |
$112.52 |
| Rate for Payer: Adventist Health Commercial |
$26.48
|
| Rate for Payer: Blue Shield of California Commercial |
$97.70
|
| Rate for Payer: Blue Shield of California EPN |
$64.34
|
| Rate for Payer: Cash Price |
$72.81
|
| Rate for Payer: Cigna of CA HMO |
$92.67
|
| Rate for Payer: Cigna of CA PPO |
$92.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.95
|
| Rate for Payer: EPIC Health Plan Senior |
$52.95
|
| Rate for Payer: Galaxy Health WC |
$112.52
|
| Rate for Payer: Global Benefits Group Commercial |
$79.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.77
|
| Rate for Payer: Multiplan Commercial |
$105.90
|
| Rate for Payer: Networks By Design Commercial |
$86.05
|
| Rate for Payer: Prime Health Services Commercial |
$112.52
|
|
|
DEFERASIROX 250 MG DISPERSIBLE TABLET [43416]
|
Facility
|
OP
|
$123.47
|
|
|
Service Code
|
NDC 0078-0469-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$24.69 |
| Max. Negotiated Rate |
$104.95 |
| Rate for Payer: Adventist Health Commercial |
$24.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$104.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.82
|
| Rate for Payer: Cash Price |
$67.91
|
| Rate for Payer: Cigna of CA HMO |
$86.43
|
| Rate for Payer: Cigna of CA PPO |
$86.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$104.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$104.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$104.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.39
|
| Rate for Payer: EPIC Health Plan Senior |
$49.39
|
| Rate for Payer: Galaxy Health WC |
$104.95
|
| Rate for Payer: Global Benefits Group Commercial |
$74.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$86.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.43
|
| Rate for Payer: Multiplan Commercial |
$98.78
|
| Rate for Payer: Networks By Design Commercial |
$80.26
|
| Rate for Payer: Prime Health Services Commercial |
$104.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.73
|
| Rate for Payer: United Healthcare All Other HMO |
$61.73
|
| Rate for Payer: United Healthcare HMO Rider |
$61.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$104.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$104.95
|
| Rate for Payer: Vantage Medical Group Senior |
$104.95
|
|
