|
DAROLUTAMIDE 300 MG TABLET [225419]
|
Facility
|
IP
|
$151.01
|
|
|
Service Code
|
NDC 5041939501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$128.36 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Blue Shield of California Commercial |
$116.13
|
| Rate for Payer: Blue Shield of California Commercial |
$76.56
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cigna of CA HMO |
$105.71
|
| Rate for Payer: Cigna of CA PPO |
$105.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Senior |
$60.40
|
| Rate for Payer: Galaxy Health WC |
$128.36
|
| Rate for Payer: Global Benefits Group Commercial |
$90.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.24
|
| Rate for Payer: Multiplan Commercial |
$120.81
|
| Rate for Payer: Networks By Design Commercial |
$98.16
|
| Rate for Payer: Prime Health Services Commercial |
$128.36
|
|
|
DAROLUTAMIDE 300 MG TABLET [225419]
|
Facility
|
OP
|
$151.01
|
|
|
Service Code
|
NDC 5041939501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$128.36 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$128.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.90
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cigna of CA HMO |
$105.71
|
| Rate for Payer: Cigna of CA PPO |
$105.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$128.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$128.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Senior |
$60.40
|
| Rate for Payer: Galaxy Health WC |
$128.36
|
| Rate for Payer: Global Benefits Group Commercial |
$90.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.71
|
| Rate for Payer: Multiplan Commercial |
$120.81
|
| Rate for Payer: Networks By Design Commercial |
$98.16
|
| Rate for Payer: Prime Health Services Commercial |
$128.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.50
|
| Rate for Payer: United Healthcare All Other HMO |
$75.50
|
| Rate for Payer: United Healthcare HMO Rider |
$75.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$128.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.36
|
| Rate for Payer: Vantage Medical Group Senior |
$128.36
|
|
|
DARUNAVIR 600 MG TABLET [92851]
|
Facility
|
IP
|
$43.16
|
|
|
Service Code
|
NDC 5967656201
|
| 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 |
$21.88
|
| Rate for Payer: Blue Shield of California Commercial |
$33.19
|
| Rate for Payer: Cash Price |
$19.42
|
| Rate for Payer: Cigna of CA HMO |
$30.21
|
| Rate for Payer: Cigna of CA PPO |
$30.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$27.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.46
|
| 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 600 MG TABLET [92851]
|
Facility
|
OP
|
$43.16
|
|
|
Service Code
|
NDC 5967656201
|
| 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 |
$27.70
|
| Rate for Payer: Cash Price |
$19.42
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$27.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.46
|
| 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 800 MG-COBICISTAT 150 MG TABLET [208697]
|
Facility
|
IP
|
$98.67
|
|
|
Service Code
|
NDC 5967657530
|
| 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 |
$50.03
|
| Rate for Payer: Blue Shield of California Commercial |
$75.88
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna of CA HMO |
$69.07
|
| Rate for Payer: Cigna of CA PPO |
$69.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$62.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.22
|
| 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
|
|
|
DARUNAVIR 800 MG-COBICISTAT 150 MG TABLET [208697]
|
Facility
|
OP
|
$98.67
|
|
|
Service Code
|
NDC 5967657530
|
| 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 |
$63.32
|
| Rate for Payer: Cash Price |
$44.40
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$62.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.22
|
| 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 TABLET [199468]
|
Facility
|
OP
|
$12.30
|
|
|
Service Code
|
NDC 6068781921
|
| 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 |
$7.89
|
| Rate for Payer: Cash Price |
$5.54
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$7.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.26
|
| 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 6068781911
|
| 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 |
$7.89
|
| Rate for Payer: Cash Price |
$5.54
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$7.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.26
|
| 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 6068781921
|
| 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 |
$6.24
|
| Rate for Payer: Blue Shield of California Commercial |
$9.46
|
| Rate for Payer: Cash Price |
$5.54
|
| Rate for Payer: Cigna of CA HMO |
$8.61
|
| Rate for Payer: Cigna of CA PPO |
$8.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$7.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.26
|
| 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
|
IP
|
$86.33
|
|
|
Service Code
|
NDC 5967656630
|
| 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 |
$43.77
|
| Rate for Payer: Blue Shield of California Commercial |
$66.39
|
| Rate for Payer: Cash Price |
$38.85
|
| Rate for Payer: Cigna of CA HMO |
$60.43
|
| Rate for Payer: Cigna of CA PPO |
$60.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$54.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.93
|
| 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
|
OP
|
$3.96
|
|
|
Service Code
|
NDC 6818034606
|
| 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 |
$2.54
|
| Rate for Payer: Cash Price |
$1.78
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.34
|
| 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
|
$86.33
|
|
|
Service Code
|
NDC 5967656630
|
| 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 |
$55.40
|
| Rate for Payer: Cash Price |
$38.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$54.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.93
|
| 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
|
$3.96
|
|
|
Service Code
|
NDC 6818034606
|
| 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 |
$2.01
|
| Rate for Payer: Blue Shield of California Commercial |
$3.05
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cigna of CA HMO |
$2.77
|
| Rate for Payer: Cigna of CA PPO |
$2.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.34
|
| 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
|
IP
|
$12.30
|
|
|
Service Code
|
NDC 6068781911
|
| 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 |
$6.24
|
| Rate for Payer: Blue Shield of California Commercial |
$9.46
|
| Rate for Payer: Cash Price |
$5.54
|
| Rate for Payer: Cigna of CA HMO |
$8.61
|
| Rate for Payer: Cigna of CA PPO |
$8.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$7.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.26
|
| 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
|
OP
|
$729.85
|
|
|
Service Code
|
NDC 0003085222
|
| 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 |
$468.34
|
| Rate for Payer: Cash Price |
$328.43
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$463.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$264.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$430.61
|
| 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 100 MG TABLET [92897]
|
Facility
|
IP
|
$729.85
|
|
|
Service Code
|
NDC 0003085222
|
| 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 |
$370.03
|
| Rate for Payer: Blue Shield of California Commercial |
$561.25
|
| Rate for Payer: Cash Price |
$328.43
|
| Rate for Payer: Cigna of CA HMO |
$510.89
|
| Rate for Payer: Cigna of CA PPO |
$510.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$463.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$430.61
|
| 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
|
IP
|
$729.85
|
|
|
Service Code
|
NDC 0003085722
|
| 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 |
$370.03
|
| Rate for Payer: Blue Shield of California Commercial |
$561.25
|
| Rate for Payer: Cash Price |
$328.43
|
| Rate for Payer: Cigna of CA HMO |
$510.89
|
| Rate for Payer: Cigna of CA PPO |
$510.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$463.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$430.61
|
| 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 0003085722
|
| 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 |
$468.34
|
| Rate for Payer: Cash Price |
$328.43
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$463.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$264.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$430.61
|
| 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
|
OP
|
$202.48
|
|
|
Service Code
|
NDC 0003052711
|
| 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 |
$129.93
|
| Rate for Payer: Cash Price |
$91.12
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$128.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$73.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$119.46
|
| 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 20 MG TABLET [76717]
|
Facility
|
IP
|
$202.48
|
|
|
Service Code
|
NDC 0003052711
|
| 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 |
$102.66
|
| Rate for Payer: Blue Shield of California Commercial |
$155.71
|
| Rate for Payer: Cash Price |
$91.12
|
| Rate for Payer: Cigna of CA HMO |
$141.74
|
| Rate for Payer: Cigna of CA PPO |
$141.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$128.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$119.46
|
| 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 70 MG TABLET [76719]
|
Facility
|
IP
|
$404.95
|
|
|
Service Code
|
NDC 0003052411
|
| 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 |
$205.31
|
| Rate for Payer: Blue Shield of California Commercial |
$311.41
|
| Rate for Payer: Cash Price |
$182.23
|
| Rate for Payer: Cigna of CA HMO |
$283.46
|
| Rate for Payer: Cigna of CA PPO |
$283.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$257.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.92
|
| 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 0003052411
|
| 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 |
$259.86
|
| Rate for Payer: Cash Price |
$182.23
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$257.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$147.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.92
|
| 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
|
OP
|
$729.85
|
|
|
Service Code
|
NDC 0003085522
|
| 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 |
$468.34
|
| Rate for Payer: Cash Price |
$328.43
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$463.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$264.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$430.61
|
| 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 80 MG TABLET [108421]
|
Facility
|
IP
|
$729.85
|
|
|
Service Code
|
NDC 0003085522
|
| 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 |
$370.03
|
| Rate for Payer: Blue Shield of California Commercial |
$561.25
|
| Rate for Payer: Cash Price |
$328.43
|
| Rate for Payer: Cigna of CA HMO |
$510.89
|
| Rate for Payer: Cigna of CA PPO |
$510.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$463.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$430.61
|
| 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
|
|
|
DAUNORUBICIN 44 MG AND CYTARABINE 100 MG IN LIPOSOME IV SOLUTION [219514]
|
Facility
|
OP
|
$13,764.00
|
|
|
Service Code
|
HCPCS J9153
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$272.89 |
| Max. Negotiated Rate |
$11,699.40 |
| Rate for Payer: Galaxy Health WC |
$11,699.40
|
| Rate for Payer: Adventist Health Commercial |
$2,752.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$490.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$409.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$272.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$463.49
|
| Rate for Payer: Blue Shield of California Commercial |
$285.14
|
| Rate for Payer: Cash Price |
$6,193.80
|
| Rate for Payer: Cash Price |
$6,193.80
|
| Rate for Payer: Cigna of CA HMO |
$9,634.80
|
| Rate for Payer: Cigna of CA PPO |
$9,634.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$341.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$300.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,634.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.27
|
| Rate for Payer: EPIC Health Plan Senior |
$300.18
|
| Rate for Payer: Global Benefits Group Commercial |
$8,258.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$447.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$272.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$272.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,740.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$494.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$382.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,303.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$343.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$365.67
|
| Rate for Payer: Multiplan Commercial |
$11,011.20
|
| Rate for Payer: Networks By Design Commercial |
$6,882.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,699.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,258.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,258.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,165.63
|
| Rate for Payer: United Healthcare All Other HMO |
$5,027.99
|
| Rate for Payer: United Healthcare HMO Rider |
$4,919.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,507.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$272.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$341.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.18
|
| Rate for Payer: Vantage Medical Group Senior |
$300.18
|
|
