|
DARBEPOETIN ALFA 60 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE [108043]
|
Facility
|
IP
|
$1,857.60
|
|
|
Service Code
|
CPT J0881
|
| Hospital Charge Code |
1720971
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$445.82 |
| Max. Negotiated Rate |
$1,578.96 |
| Rate for Payer: Blue Shield of California Commercial |
$1,322.61
|
| Rate for Payer: Blue Shield of California EPN |
$951.09
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Cigna of CA HMO |
$1,300.32
|
| Rate for Payer: Cigna of CA PPO |
$1,300.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$743.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$743.04
|
| Rate for Payer: Galaxy Health WC |
$1,578.96
|
| Rate for Payer: Global Benefits Group Commercial |
$1,114.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,239.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$707.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$445.82
|
| Rate for Payer: Multiplan Commercial |
$1,486.08
|
| Rate for Payer: Networks By Design Commercial |
$928.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,578.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.43
|
| Rate for Payer: United Healthcare All Other HMO |
$685.08
|
| Rate for Payer: United Healthcare HMO Rider |
$670.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$613.01
|
|
|
DARBEPOETIN ALFA 60 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE [108043]
|
Facility
|
OP
|
$1,857.60
|
|
|
Service Code
|
CPT J0881
|
| Hospital Charge Code |
1720971
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$1,578.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.17
|
| Rate for Payer: Blue Distinction Transplant |
$1,114.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1,369.05
|
| Rate for Payer: Blue Shield of California EPN |
$9.29
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Cigna of CA HMO |
$1,300.32
|
| Rate for Payer: Cigna of CA PPO |
$1,300.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.40
|
| Rate for Payer: Dignity Health Media |
$2.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.93
|
| Rate for Payer: Galaxy Health WC |
$1,578.96
|
| Rate for Payer: Global Benefits Group Commercial |
$1,114.56
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,393.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.81
|
| Rate for Payer: Heritage Provider Network Transplant |
$4.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$4.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,239.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$445.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.93
|
| Rate for Payer: Multiplan Commercial |
$1,486.08
|
| Rate for Payer: Networks By Design Commercial |
$928.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,578.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,114.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,114.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$928.80
|
| Rate for Payer: United Healthcare All Other HMO |
$928.80
|
| Rate for Payer: United Healthcare HMO Rider |
$928.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$928.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2.93
|
|
|
DAROLUTAMIDE 300 MG TABLET [225419]
|
Facility
|
IP
|
$128.66
|
|
|
Service Code
|
NDC 50419-395-01
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.88 |
| Max. Negotiated Rate |
$109.36 |
| Rate for Payer: Blue Shield of California Commercial |
$91.61
|
| Rate for Payer: Blue Shield of California EPN |
$65.87
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna of CA HMO |
$90.06
|
| Rate for Payer: Cigna of CA PPO |
$90.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.46
|
| Rate for Payer: Galaxy Health WC |
$109.36
|
| Rate for Payer: Global Benefits Group Commercial |
$77.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.88
|
| Rate for Payer: Multiplan Commercial |
$102.93
|
| Rate for Payer: Networks By Design Commercial |
$83.63
|
| Rate for Payer: Prime Health Services Commercial |
$109.36
|
|
|
DAROLUTAMIDE 300 MG TABLET [225419]
|
Facility
|
OP
|
$128.66
|
|
|
Service Code
|
NDC 50419-395-01
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.88 |
| Max. Negotiated Rate |
$109.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$84.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.66
|
| Rate for Payer: Blue Distinction Transplant |
$77.20
|
| Rate for Payer: Blue Shield of California Commercial |
$94.82
|
| Rate for Payer: Blue Shield of California EPN |
$75.14
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna of CA HMO |
$90.06
|
| Rate for Payer: Cigna of CA PPO |
$90.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.36
|
| Rate for Payer: Dignity Health Media |
$109.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.46
|
| Rate for Payer: Galaxy Health WC |
$109.36
|
| Rate for Payer: Global Benefits Group Commercial |
$77.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$96.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.88
|
| Rate for Payer: Multiplan Commercial |
$102.93
|
| Rate for Payer: Networks By Design Commercial |
$83.63
|
| Rate for Payer: Prime Health Services Commercial |
$109.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.33
|
| Rate for Payer: United Healthcare All Other HMO |
$64.33
|
| Rate for Payer: United Healthcare HMO Rider |
$64.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.36
|
| Rate for Payer: Vantage Medical Group Senior |
$109.36
|
|
|
DARUNAVIR 600 MG TABLET [92851]
|
Facility
|
OP
|
$41.91
|
|
|
Service Code
|
NDC 59676-562-01
|
| Hospital Charge Code |
1712433
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$35.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.97
|
| Rate for Payer: Blue Distinction Transplant |
$25.15
|
| Rate for Payer: Blue Shield of California Commercial |
$30.89
|
| Rate for Payer: Blue Shield of California EPN |
$24.48
|
| Rate for Payer: Cash Price |
$18.86
|
| Rate for Payer: Cigna of CA HMO |
$29.34
|
| Rate for Payer: Cigna of CA PPO |
$29.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.62
|
| Rate for Payer: Dignity Health Media |
$35.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.76
|
| Rate for Payer: Galaxy Health WC |
$35.62
|
| Rate for Payer: Global Benefits Group Commercial |
$25.15
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$31.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.06
|
| Rate for Payer: Multiplan Commercial |
$33.53
|
| Rate for Payer: Networks By Design Commercial |
$27.24
|
| Rate for Payer: Prime Health Services Commercial |
$35.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.96
|
| Rate for Payer: United Healthcare All Other HMO |
$20.96
|
| Rate for Payer: United Healthcare HMO Rider |
$20.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.62
|
| Rate for Payer: Vantage Medical Group Senior |
$35.62
|
|
|
DARUNAVIR 600 MG TABLET [92851]
|
Facility
|
IP
|
$41.91
|
|
|
Service Code
|
NDC 59676-562-01
|
| Hospital Charge Code |
1712433
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$35.62 |
| Rate for Payer: Blue Shield of California Commercial |
$29.84
|
| Rate for Payer: Blue Shield of California EPN |
$21.46
|
| Rate for Payer: Cash Price |
$18.86
|
| Rate for Payer: Cigna of CA HMO |
$29.34
|
| Rate for Payer: Cigna of CA PPO |
$29.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.76
|
| Rate for Payer: Galaxy Health WC |
$35.62
|
| Rate for Payer: Global Benefits Group Commercial |
$25.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.06
|
| Rate for Payer: Multiplan Commercial |
$33.53
|
| Rate for Payer: Networks By Design Commercial |
$27.24
|
| Rate for Payer: Prime Health Services Commercial |
$35.62
|
|
|
DARUNAVIR 800 MG-COBICISTAT 150 MG TABLET [208697]
|
Facility
|
OP
|
$95.80
|
|
|
Service Code
|
NDC 59676-575-30
|
| Hospital Charge Code |
ERX208697
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.99 |
| Max. Negotiated Rate |
$81.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.08
|
| Rate for Payer: Blue Distinction Transplant |
$57.48
|
| Rate for Payer: Blue Shield of California Commercial |
$70.60
|
| Rate for Payer: Blue Shield of California EPN |
$55.95
|
| Rate for Payer: Cash Price |
$43.11
|
| Rate for Payer: Cigna of CA HMO |
$67.06
|
| Rate for Payer: Cigna of CA PPO |
$67.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.43
|
| Rate for Payer: Dignity Health Media |
$81.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.32
|
| Rate for Payer: Galaxy Health WC |
$81.43
|
| Rate for Payer: Global Benefits Group Commercial |
$57.48
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$71.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.99
|
| Rate for Payer: Multiplan Commercial |
$76.64
|
| Rate for Payer: Networks By Design Commercial |
$62.27
|
| Rate for Payer: Prime Health Services Commercial |
$81.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.90
|
| Rate for Payer: United Healthcare All Other HMO |
$47.90
|
| Rate for Payer: United Healthcare HMO Rider |
$47.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.43
|
| Rate for Payer: Vantage Medical Group Senior |
$81.43
|
|
|
DARUNAVIR 800 MG-COBICISTAT 150 MG TABLET [208697]
|
Facility
|
IP
|
$95.80
|
|
|
Service Code
|
NDC 59676-575-30
|
| Hospital Charge Code |
ERX208697
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.99 |
| Max. Negotiated Rate |
$81.43 |
| Rate for Payer: Blue Shield of California Commercial |
$68.21
|
| Rate for Payer: Blue Shield of California EPN |
$49.05
|
| Rate for Payer: Cash Price |
$43.11
|
| Rate for Payer: Cigna of CA HMO |
$67.06
|
| Rate for Payer: Cigna of CA PPO |
$67.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.32
|
| Rate for Payer: Galaxy Health WC |
$81.43
|
| Rate for Payer: Global Benefits Group Commercial |
$57.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.99
|
| Rate for Payer: Multiplan Commercial |
$76.64
|
| Rate for Payer: Networks By Design Commercial |
$62.27
|
| Rate for Payer: Prime Health Services Commercial |
$81.43
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
IP
|
$83.81
|
|
|
Service Code
|
NDC 59676-566-30
|
| Hospital Charge Code |
1712557
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.11 |
| Max. Negotiated Rate |
$71.24 |
| Rate for Payer: Blue Shield of California Commercial |
$59.67
|
| Rate for Payer: Blue Shield of California EPN |
$42.91
|
| Rate for Payer: Cash Price |
$37.71
|
| Rate for Payer: Cigna of CA HMO |
$58.67
|
| Rate for Payer: Cigna of CA PPO |
$58.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.52
|
| Rate for Payer: Galaxy Health WC |
$71.24
|
| Rate for Payer: Global Benefits Group Commercial |
$50.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.11
|
| Rate for Payer: Multiplan Commercial |
$67.05
|
| Rate for Payer: Networks By Design Commercial |
$54.48
|
| Rate for Payer: Prime Health Services Commercial |
$71.24
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
OP
|
$83.81
|
|
|
Service Code
|
NDC 59676-566-30
|
| Hospital Charge Code |
1712557
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.11 |
| Max. Negotiated Rate |
$71.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$54.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.93
|
| Rate for Payer: Blue Distinction Transplant |
$50.29
|
| Rate for Payer: Blue Shield of California Commercial |
$61.77
|
| Rate for Payer: Blue Shield of California EPN |
$48.95
|
| Rate for Payer: Cash Price |
$37.71
|
| Rate for Payer: Cigna of CA HMO |
$58.67
|
| Rate for Payer: Cigna of CA PPO |
$58.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.24
|
| Rate for Payer: Dignity Health Media |
$71.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$33.52
|
| Rate for Payer: Galaxy Health WC |
$71.24
|
| Rate for Payer: Global Benefits Group Commercial |
$50.29
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$62.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.11
|
| Rate for Payer: Multiplan Commercial |
$67.05
|
| Rate for Payer: Networks By Design Commercial |
$54.48
|
| Rate for Payer: Prime Health Services Commercial |
$71.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.90
|
| Rate for Payer: United Healthcare All Other HMO |
$41.90
|
| Rate for Payer: United Healthcare HMO Rider |
$41.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.24
|
| Rate for Payer: Vantage Medical Group Senior |
$71.24
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
IP
|
$72.41
|
|
|
Service Code
|
NDC 68180-346-06
|
| Hospital Charge Code |
1712557
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$61.55 |
| Rate for Payer: Blue Shield of California Commercial |
$51.56
|
| Rate for Payer: Blue Shield of California EPN |
$37.07
|
| Rate for Payer: Cash Price |
$32.58
|
| Rate for Payer: Cigna of CA HMO |
$50.69
|
| Rate for Payer: Cigna of CA PPO |
$50.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.96
|
| Rate for Payer: Galaxy Health WC |
$61.55
|
| Rate for Payer: Global Benefits Group Commercial |
$43.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.38
|
| Rate for Payer: Multiplan Commercial |
$57.93
|
| Rate for Payer: Networks By Design Commercial |
$47.07
|
| Rate for Payer: Prime Health Services Commercial |
$61.55
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
OP
|
$72.41
|
|
|
Service Code
|
NDC 68180-346-06
|
| Hospital Charge Code |
1712557
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$61.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.14
|
| Rate for Payer: Blue Distinction Transplant |
$43.45
|
| Rate for Payer: Blue Shield of California Commercial |
$53.37
|
| Rate for Payer: Blue Shield of California EPN |
$42.29
|
| Rate for Payer: Cash Price |
$32.58
|
| Rate for Payer: Cigna of CA HMO |
$50.69
|
| Rate for Payer: Cigna of CA PPO |
$50.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.55
|
| Rate for Payer: Dignity Health Media |
$61.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.96
|
| Rate for Payer: Galaxy Health WC |
$61.55
|
| Rate for Payer: Global Benefits Group Commercial |
$43.45
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$54.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.38
|
| Rate for Payer: Multiplan Commercial |
$57.93
|
| Rate for Payer: Networks By Design Commercial |
$47.07
|
| Rate for Payer: Prime Health Services Commercial |
$61.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.20
|
| Rate for Payer: United Healthcare All Other HMO |
$36.20
|
| Rate for Payer: United Healthcare HMO Rider |
$36.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.55
|
| Rate for Payer: Vantage Medical Group Senior |
$61.55
|
|
|
DASATINIB 100 MG TABLET [92897]
|
Facility
|
IP
|
$688.54
|
|
|
Service Code
|
NDC 0003-0852-22
|
| Hospital Charge Code |
1712498
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$165.25 |
| Max. Negotiated Rate |
$585.26 |
| Rate for Payer: Blue Shield of California Commercial |
$490.24
|
| Rate for Payer: Blue Shield of California EPN |
$352.53
|
| Rate for Payer: Cash Price |
$309.84
|
| Rate for Payer: Cigna of CA HMO |
$481.98
|
| Rate for Payer: Cigna of CA PPO |
$481.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.42
|
| Rate for Payer: Galaxy Health WC |
$585.26
|
| Rate for Payer: Global Benefits Group Commercial |
$413.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$459.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.25
|
| Rate for Payer: Multiplan Commercial |
$550.83
|
| Rate for Payer: Networks By Design Commercial |
$447.55
|
| Rate for Payer: Prime Health Services Commercial |
$585.26
|
|
|
DASATINIB 100 MG TABLET [92897]
|
Facility
|
OP
|
$688.54
|
|
|
Service Code
|
NDC 0003-0852-22
|
| Hospital Charge Code |
1712498
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$165.25 |
| Max. Negotiated Rate |
$585.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$451.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$585.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$410.23
|
| Rate for Payer: Blue Distinction Transplant |
$413.12
|
| Rate for Payer: Blue Shield of California Commercial |
$507.45
|
| Rate for Payer: Blue Shield of California EPN |
$402.11
|
| Rate for Payer: Cash Price |
$309.84
|
| Rate for Payer: Cigna of CA HMO |
$481.98
|
| Rate for Payer: Cigna of CA PPO |
$481.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$585.26
|
| Rate for Payer: Dignity Health Media |
$585.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$585.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$275.42
|
| Rate for Payer: Galaxy Health WC |
$585.26
|
| Rate for Payer: Global Benefits Group Commercial |
$413.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$516.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$459.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.25
|
| Rate for Payer: Multiplan Commercial |
$550.83
|
| Rate for Payer: Networks By Design Commercial |
$447.55
|
| Rate for Payer: Prime Health Services Commercial |
$585.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$413.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$413.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$344.27
|
| Rate for Payer: United Healthcare All Other HMO |
$344.27
|
| Rate for Payer: United Healthcare HMO Rider |
$344.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$344.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$585.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$585.26
|
| Rate for Payer: Vantage Medical Group Senior |
$585.26
|
|
|
DASATINIB 140 MG TABLET [108422]
|
Facility
|
IP
|
$688.54
|
|
|
Service Code
|
NDC 0003-0857-22
|
| Hospital Charge Code |
1712499
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$165.25 |
| Max. Negotiated Rate |
$585.26 |
| Rate for Payer: Blue Shield of California Commercial |
$490.24
|
| Rate for Payer: Blue Shield of California EPN |
$352.53
|
| Rate for Payer: Cash Price |
$309.84
|
| Rate for Payer: Cigna of CA HMO |
$481.98
|
| Rate for Payer: Cigna of CA PPO |
$481.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.42
|
| Rate for Payer: Galaxy Health WC |
$585.26
|
| Rate for Payer: Global Benefits Group Commercial |
$413.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$459.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.25
|
| Rate for Payer: Multiplan Commercial |
$550.83
|
| Rate for Payer: Networks By Design Commercial |
$447.55
|
| Rate for Payer: Prime Health Services Commercial |
$585.26
|
|
|
DASATINIB 140 MG TABLET [108422]
|
Facility
|
OP
|
$688.54
|
|
|
Service Code
|
NDC 0003-0857-22
|
| Hospital Charge Code |
1712499
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$165.25 |
| Max. Negotiated Rate |
$585.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$451.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$585.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$410.23
|
| Rate for Payer: Blue Distinction Transplant |
$413.12
|
| Rate for Payer: Blue Shield of California Commercial |
$507.45
|
| Rate for Payer: Blue Shield of California EPN |
$402.11
|
| Rate for Payer: Cash Price |
$309.84
|
| Rate for Payer: Cigna of CA HMO |
$481.98
|
| Rate for Payer: Cigna of CA PPO |
$481.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$585.26
|
| Rate for Payer: Dignity Health Media |
$585.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$585.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$275.42
|
| Rate for Payer: Galaxy Health WC |
$585.26
|
| Rate for Payer: Global Benefits Group Commercial |
$413.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$516.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$459.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.25
|
| Rate for Payer: Multiplan Commercial |
$550.83
|
| Rate for Payer: Networks By Design Commercial |
$447.55
|
| Rate for Payer: Prime Health Services Commercial |
$585.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$413.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$413.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$344.27
|
| Rate for Payer: United Healthcare All Other HMO |
$344.27
|
| Rate for Payer: United Healthcare HMO Rider |
$344.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$344.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$585.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$585.26
|
| Rate for Payer: Vantage Medical Group Senior |
$585.26
|
|
|
DASATINIB 20 MG TABLET [76717]
|
Facility
|
OP
|
$191.01
|
|
|
Service Code
|
NDC 0003-0527-11
|
| Hospital Charge Code |
1711976
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$45.84 |
| Max. Negotiated Rate |
$162.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$125.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$162.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.80
|
| Rate for Payer: Blue Distinction Transplant |
$114.61
|
| Rate for Payer: Blue Shield of California Commercial |
$140.77
|
| Rate for Payer: Blue Shield of California EPN |
$111.55
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cigna of CA HMO |
$133.71
|
| Rate for Payer: Cigna of CA PPO |
$133.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$162.36
|
| Rate for Payer: Dignity Health Media |
$162.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.40
|
| Rate for Payer: Galaxy Health WC |
$162.36
|
| Rate for Payer: Global Benefits Group Commercial |
$114.61
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$143.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.84
|
| Rate for Payer: Multiplan Commercial |
$152.81
|
| Rate for Payer: Networks By Design Commercial |
$124.16
|
| Rate for Payer: Prime Health Services Commercial |
$162.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.50
|
| Rate for Payer: United Healthcare All Other HMO |
$95.50
|
| Rate for Payer: United Healthcare HMO Rider |
$95.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$162.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.36
|
| Rate for Payer: Vantage Medical Group Senior |
$162.36
|
|
|
DASATINIB 20 MG TABLET [76717]
|
Facility
|
IP
|
$191.01
|
|
|
Service Code
|
NDC 0003-0527-11
|
| Hospital Charge Code |
1711976
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$45.84 |
| Max. Negotiated Rate |
$162.36 |
| Rate for Payer: Blue Shield of California Commercial |
$136.00
|
| Rate for Payer: Blue Shield of California EPN |
$97.80
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cigna of CA HMO |
$133.71
|
| Rate for Payer: Cigna of CA PPO |
$133.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.40
|
| Rate for Payer: Galaxy Health WC |
$162.36
|
| Rate for Payer: Global Benefits Group Commercial |
$114.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.84
|
| Rate for Payer: Multiplan Commercial |
$152.81
|
| Rate for Payer: Networks By Design Commercial |
$124.16
|
| Rate for Payer: Prime Health Services Commercial |
$162.36
|
|
|
DASATINIB 70 MG TABLET [76719]
|
Facility
|
OP
|
$382.03
|
|
|
Service Code
|
NDC 0003-0524-11
|
| Hospital Charge Code |
1711974
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$91.69 |
| Max. Negotiated Rate |
$324.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$250.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$324.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$210.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.61
|
| Rate for Payer: Blue Distinction Transplant |
$229.22
|
| Rate for Payer: Blue Shield of California Commercial |
$281.56
|
| Rate for Payer: Blue Shield of California EPN |
$223.11
|
| Rate for Payer: Cash Price |
$171.91
|
| Rate for Payer: Cigna of CA HMO |
$267.42
|
| Rate for Payer: Cigna of CA PPO |
$267.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$324.73
|
| Rate for Payer: Dignity Health Media |
$324.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$152.81
|
| Rate for Payer: Galaxy Health WC |
$324.73
|
| Rate for Payer: Global Benefits Group Commercial |
$229.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$286.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$254.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.69
|
| Rate for Payer: Multiplan Commercial |
$305.62
|
| Rate for Payer: Networks By Design Commercial |
$248.32
|
| Rate for Payer: Prime Health Services Commercial |
$324.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$191.02
|
| Rate for Payer: United Healthcare All Other HMO |
$191.02
|
| Rate for Payer: United Healthcare HMO Rider |
$191.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$324.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.73
|
| Rate for Payer: Vantage Medical Group Senior |
$324.73
|
|
|
DASATINIB 70 MG TABLET [76719]
|
Facility
|
IP
|
$382.03
|
|
|
Service Code
|
NDC 0003-0524-11
|
| Hospital Charge Code |
1711974
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$91.69 |
| Max. Negotiated Rate |
$324.73 |
| Rate for Payer: Blue Shield of California Commercial |
$272.01
|
| Rate for Payer: Blue Shield of California EPN |
$195.60
|
| Rate for Payer: Cash Price |
$171.91
|
| Rate for Payer: Cigna of CA HMO |
$267.42
|
| Rate for Payer: Cigna of CA PPO |
$267.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.81
|
| Rate for Payer: Galaxy Health WC |
$324.73
|
| Rate for Payer: Global Benefits Group Commercial |
$229.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$254.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.69
|
| Rate for Payer: Multiplan Commercial |
$305.62
|
| Rate for Payer: Networks By Design Commercial |
$248.32
|
| Rate for Payer: Prime Health Services Commercial |
$324.73
|
|
|
DASATINIB 80 MG TABLET [108421]
|
Facility
|
OP
|
$688.54
|
|
|
Service Code
|
NDC 0003-0855-22
|
| Hospital Charge Code |
1712500
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$165.25 |
| Max. Negotiated Rate |
$585.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$451.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$585.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$410.23
|
| Rate for Payer: Blue Distinction Transplant |
$413.12
|
| Rate for Payer: Blue Shield of California Commercial |
$507.45
|
| Rate for Payer: Blue Shield of California EPN |
$402.11
|
| Rate for Payer: Cash Price |
$309.84
|
| Rate for Payer: Cigna of CA HMO |
$481.98
|
| Rate for Payer: Cigna of CA PPO |
$481.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$585.26
|
| Rate for Payer: Dignity Health Media |
$585.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$585.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$275.42
|
| Rate for Payer: Galaxy Health WC |
$585.26
|
| Rate for Payer: Global Benefits Group Commercial |
$413.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$516.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$459.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.25
|
| Rate for Payer: Multiplan Commercial |
$550.83
|
| Rate for Payer: Networks By Design Commercial |
$447.55
|
| Rate for Payer: Prime Health Services Commercial |
$585.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$413.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$413.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$344.27
|
| Rate for Payer: United Healthcare All Other HMO |
$344.27
|
| Rate for Payer: United Healthcare HMO Rider |
$344.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$344.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$585.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$585.26
|
| Rate for Payer: Vantage Medical Group Senior |
$585.26
|
|
|
DASATINIB 80 MG TABLET [108421]
|
Facility
|
IP
|
$688.54
|
|
|
Service Code
|
NDC 0003-0855-22
|
| Hospital Charge Code |
1712500
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$165.25 |
| Max. Negotiated Rate |
$585.26 |
| Rate for Payer: Blue Shield of California Commercial |
$490.24
|
| Rate for Payer: Blue Shield of California EPN |
$352.53
|
| Rate for Payer: Cash Price |
$309.84
|
| Rate for Payer: Cigna of CA HMO |
$481.98
|
| Rate for Payer: Cigna of CA PPO |
$481.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.42
|
| Rate for Payer: Galaxy Health WC |
$585.26
|
| Rate for Payer: Global Benefits Group Commercial |
$413.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$459.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.25
|
| Rate for Payer: Multiplan Commercial |
$550.83
|
| Rate for Payer: Networks By Design Commercial |
$447.55
|
| Rate for Payer: Prime Health Services Commercial |
$585.26
|
|
|
DAUNORUBICIN 44 MG AND CYTARABINE 100 MG IN LIPOSOME IV SOLUTION [219514]
|
Facility
|
OP
|
$11,772.00
|
|
|
Service Code
|
CPT J9153
|
| Hospital Charge Code |
ERX219514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$230.96 |
| Max. Negotiated Rate |
$10,006.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$456.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$289.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$254.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$254.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$386.69
|
| Rate for Payer: Blue Distinction Transplant |
$7,063.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8,675.96
|
| Rate for Payer: Blue Shield of California EPN |
$230.96
|
| Rate for Payer: Cash Price |
$5,297.40
|
| Rate for Payer: Cash Price |
$5,297.40
|
| Rate for Payer: Cigna of CA HMO |
$8,240.40
|
| Rate for Payer: Cigna of CA PPO |
$8,240.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$347.65
|
| Rate for Payer: Dignity Health Media |
$231.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$254.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.88
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$231.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$231.76
|
| Rate for Payer: Galaxy Health WC |
$10,006.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,063.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,829.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$380.09
|
| Rate for Payer: Heritage Provider Network Transplant |
$380.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$375.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$375.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$231.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,851.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$448.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$231.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,825.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$292.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$310.56
|
| Rate for Payer: Multiplan Commercial |
$9,417.60
|
| Rate for Payer: Networks By Design Commercial |
$5,886.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,006.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,063.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,063.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,886.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,886.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,886.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,886.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$347.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$254.94
|
| Rate for Payer: Vantage Medical Group Senior |
$231.76
|
|
|
DAUNORUBICIN 44 MG AND CYTARABINE 100 MG IN LIPOSOME IV SOLUTION [219514]
|
Facility
|
IP
|
$11,772.00
|
|
|
Service Code
|
CPT J9153
|
| Hospital Charge Code |
ERX219514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,825.28 |
| Max. Negotiated Rate |
$10,006.20 |
| Rate for Payer: Blue Shield of California Commercial |
$8,381.66
|
| Rate for Payer: Blue Shield of California EPN |
$6,027.26
|
| Rate for Payer: Cash Price |
$5,297.40
|
| Rate for Payer: Cigna of CA HMO |
$8,240.40
|
| Rate for Payer: Cigna of CA PPO |
$8,240.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,708.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,708.80
|
| Rate for Payer: Galaxy Health WC |
$10,006.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,063.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,851.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,485.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,825.28
|
| Rate for Payer: Multiplan Commercial |
$9,417.60
|
| Rate for Payer: Networks By Design Commercial |
$5,886.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,006.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,445.11
|
| Rate for Payer: United Healthcare All Other HMO |
$4,341.51
|
| Rate for Payer: United Healthcare HMO Rider |
$4,247.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,884.76
|
|
|
DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION [22661]
|
Facility
|
OP
|
$39.34
|
|
|
Service Code
|
CPT J9150
|
| Hospital Charge Code |
1755125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$166.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$70.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.34
|
| Rate for Payer: Blue Distinction Transplant |
$23.60
|
| Rate for Payer: Blue Shield of California Commercial |
$28.99
|
| Rate for Payer: Blue Shield of California EPN |
$80.48
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna of CA HMO |
$27.54
|
| Rate for Payer: Cigna of CA PPO |
$27.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.51
|
| Rate for Payer: Dignity Health Media |
$35.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.67
|
| Rate for Payer: Galaxy Health WC |
$33.44
|
| Rate for Payer: Global Benefits Group Commercial |
$23.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$58.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$57.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.80
|
| Rate for Payer: Multiplan Commercial |
$31.47
|
| Rate for Payer: Networks By Design Commercial |
$19.67
|
| Rate for Payer: Prime Health Services Commercial |
$33.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.67
|
| Rate for Payer: United Healthcare All Other HMO |
$19.67
|
| Rate for Payer: United Healthcare HMO Rider |
$19.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.24
|
| Rate for Payer: Vantage Medical Group Senior |
$35.67
|
|
