|
DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION [211862]
|
Facility
IP
|
$160.56
|
|
|
Service Code
|
NDC 57894-502-20
|
| Hospital Charge Code |
NDG211862
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.53 |
| Max. Negotiated Rate |
$136.48 |
| Rate for Payer: Blue Shield of California Commercial |
$114.32
|
| Rate for Payer: Blue Shield of California EPN |
$82.21
|
| Rate for Payer: Cash Price |
$72.25
|
| Rate for Payer: Cigna of CA HMO |
$112.39
|
| Rate for Payer: Cigna of CA PPO |
$112.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.22
|
| Rate for Payer: Galaxy Health WC |
$136.48
|
| Rate for Payer: Global Benefits Group Commercial |
$96.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.53
|
| Rate for Payer: Multiplan Commercial |
$128.45
|
| Rate for Payer: Networks By Design Commercial |
$80.28
|
| Rate for Payer: Prime Health Services Commercial |
$136.48
|
|
|
DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION [211862]
|
Facility
OP
|
$160.56
|
|
|
Service Code
|
NDC 57894-502-05
|
| Hospital Charge Code |
NDG211862B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.53 |
| Max. Negotiated Rate |
$136.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$105.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$136.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$88.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.66
|
| Rate for Payer: BCBS Transplant Transplant |
$96.34
|
| Rate for Payer: Blue Shield of California Commercial |
$118.33
|
| Rate for Payer: Blue Shield of California EPN |
$93.77
|
| Rate for Payer: Cash Price |
$72.25
|
| Rate for Payer: Cash Price |
$72.25
|
| Rate for Payer: Cigna of CA HMO |
$112.39
|
| Rate for Payer: Cigna of CA PPO |
$112.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.48
|
| Rate for Payer: Dignity Health Media |
$136.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.22
|
| Rate for Payer: Galaxy Health WC |
$136.48
|
| Rate for Payer: Global Benefits Group Commercial |
$96.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$120.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.53
|
| Rate for Payer: Multiplan Commercial |
$128.45
|
| Rate for Payer: Networks By Design Commercial |
$80.28
|
| Rate for Payer: Prime Health Services Commercial |
$136.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.28
|
| Rate for Payer: United Healthcare All Other HMO |
$80.28
|
| Rate for Payer: United Healthcare HMO Rider |
$80.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$136.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.48
|
| Rate for Payer: Vantage Medical Group Senior |
$136.48
|
|
|
DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION [211862]
|
Facility
OP
|
$160.56
|
|
|
Service Code
|
NDC 57894-502-20
|
| Hospital Charge Code |
NDG211862
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.53 |
| Max. Negotiated Rate |
$136.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$105.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$136.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$88.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.66
|
| Rate for Payer: BCBS Transplant Transplant |
$96.34
|
| Rate for Payer: Blue Shield of California Commercial |
$118.33
|
| Rate for Payer: Blue Shield of California EPN |
$93.77
|
| Rate for Payer: Cash Price |
$72.25
|
| Rate for Payer: Cash Price |
$72.25
|
| Rate for Payer: Cigna of CA HMO |
$112.39
|
| Rate for Payer: Cigna of CA PPO |
$112.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.48
|
| Rate for Payer: Dignity Health Media |
$136.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.22
|
| Rate for Payer: Galaxy Health WC |
$136.48
|
| Rate for Payer: Global Benefits Group Commercial |
$96.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$120.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.53
|
| Rate for Payer: Multiplan Commercial |
$128.45
|
| Rate for Payer: Networks By Design Commercial |
$80.28
|
| Rate for Payer: Prime Health Services Commercial |
$136.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.28
|
| Rate for Payer: United Healthcare All Other HMO |
$80.28
|
| Rate for Payer: United Healthcare HMO Rider |
$80.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$136.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.48
|
| Rate for Payer: Vantage Medical Group Senior |
$136.48
|
|
|
DARATUMUMAB-HYALURONIDASE-FIHJ (DARZALEX FASPRO) 1800 MG/30000 UNIT SQ INJECTION [40820601]
|
Facility
OP
|
$729.49
|
|
|
Service Code
|
CPT J9144
|
| Hospital Charge Code |
NDG228045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.05 |
| Max. Negotiated Rate |
$620.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$96.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$61.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$53.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$53.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.66
|
| Rate for Payer: BCBS Transplant Transplant |
$437.69
|
| Rate for Payer: Blue Shield of California Commercial |
$537.63
|
| Rate for Payer: Blue Shield of California EPN |
$426.02
|
| Rate for Payer: Cash Price |
$328.27
|
| Rate for Payer: Cash Price |
$328.27
|
| Rate for Payer: Cigna of CA HMO |
$510.64
|
| Rate for Payer: Cigna of CA PPO |
$510.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.31
|
| Rate for Payer: Dignity Health Media |
$53.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$49.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$49.05
|
| Rate for Payer: Galaxy Health WC |
$620.07
|
| Rate for Payer: Global Benefits Group Commercial |
$437.69
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$547.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$80.44
|
| Rate for Payer: Heritage Provider Network Transplant |
$80.44
|
| Rate for Payer: IEHP Medi-Cal |
$79.46
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$79.46
|
| Rate for Payer: IEHP Medicare Advantage |
$49.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$65.73
|
| Rate for Payer: Multiplan Commercial |
$583.59
|
| Rate for Payer: Networks By Design Commercial |
$364.74
|
| Rate for Payer: Prime Health Services Commercial |
$620.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$437.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$437.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.74
|
| Rate for Payer: United Healthcare All Other HMO |
$364.74
|
| Rate for Payer: United Healthcare HMO Rider |
$364.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$364.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.96
|
| Rate for Payer: Vantage Medical Group Senior |
$53.96
|
|
|
DARATUMUMAB-HYALURONIDASE-FIHJ (DARZALEX FASPRO) 1800 MG/30000 UNIT SQ INJECTION [40820601]
|
Facility
IP
|
$729.49
|
|
|
Service Code
|
CPT J9144
|
| Hospital Charge Code |
NDG228045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$175.08 |
| Max. Negotiated Rate |
$620.07 |
| Rate for Payer: Blue Shield of California Commercial |
$519.40
|
| Rate for Payer: Blue Shield of California EPN |
$373.50
|
| Rate for Payer: Cash Price |
$328.27
|
| Rate for Payer: Cigna of CA HMO |
$510.64
|
| Rate for Payer: Cigna of CA PPO |
$510.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$291.80
|
| Rate for Payer: Galaxy Health WC |
$620.07
|
| Rate for Payer: Global Benefits Group Commercial |
$437.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$277.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.08
|
| Rate for Payer: Multiplan Commercial |
$583.59
|
| Rate for Payer: Networks By Design Commercial |
$364.74
|
| Rate for Payer: Prime Health Services Commercial |
$620.07
|
|
|
DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE [108044]
|
Facility
IP
|
$1,857.60
|
|
|
Service Code
|
CPT J0881
|
| Hospital Charge Code |
1720972
|
|
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
|
|
|
DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE [108044]
|
Facility
OP
|
$1,857.60
|
|
|
Service Code
|
CPT J0881
|
| Hospital Charge Code |
1720972
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.17
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$4.75
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$4.75
|
| Rate for Payer: 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
|
|
|
DARBEPOETIN ALFA 150 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE [108046]
|
Facility
OP
|
$4,644.00
|
|
|
Service Code
|
CPT J0881
|
| Hospital Charge Code |
1720973
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$3,947.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.17
|
| Rate for Payer: BCBS Transplant Transplant |
$2,786.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,422.63
|
| Rate for Payer: Blue Shield of California EPN |
$9.29
|
| Rate for Payer: Cash Price |
$2,089.80
|
| Rate for Payer: Cash Price |
$2,089.80
|
| Rate for Payer: Cigna of CA HMO |
$3,250.80
|
| Rate for Payer: Cigna of CA PPO |
$3,250.80
|
| 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 |
$3,947.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,786.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,483.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.81
|
| Rate for Payer: Heritage Provider Network Transplant |
$4.81
|
| Rate for Payer: IEHP Medi-Cal |
$4.75
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$4.75
|
| Rate for Payer: IEHP Medicare Advantage |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,097.55
|
| 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 |
$1,114.56
|
| 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 |
$3,715.20
|
| Rate for Payer: Networks By Design Commercial |
$2,322.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,947.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,786.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,786.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,322.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,322.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,322.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,322.00
|
| 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
|
|
|
DARBEPOETIN ALFA 150 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE [108046]
|
Facility
IP
|
$4,644.00
|
|
|
Service Code
|
CPT J0881
|
| Hospital Charge Code |
1720973
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,114.56 |
| Max. Negotiated Rate |
$3,947.40 |
| Rate for Payer: Blue Shield of California Commercial |
$3,306.53
|
| Rate for Payer: Blue Shield of California EPN |
$2,377.73
|
| Rate for Payer: Cash Price |
$2,089.80
|
| Rate for Payer: Cigna of CA HMO |
$3,250.80
|
| Rate for Payer: Cigna of CA PPO |
$3,250.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,857.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,857.60
|
| Rate for Payer: Galaxy Health WC |
$3,947.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,786.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,097.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,769.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,114.56
|
| Rate for Payer: Multiplan Commercial |
$3,715.20
|
| Rate for Payer: Networks By Design Commercial |
$2,322.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,947.40
|
|
|
DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE [108041]
|
Facility
OP
|
$552.86
|
|
|
Service Code
|
CPT J0881
|
| Hospital Charge Code |
1720969
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$469.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.17
|
| Rate for Payer: BCBS Transplant Transplant |
$331.72
|
| Rate for Payer: Blue Shield of California Commercial |
$407.46
|
| Rate for Payer: Blue Shield of California EPN |
$9.29
|
| Rate for Payer: Cash Price |
$248.79
|
| Rate for Payer: Cash Price |
$248.79
|
| Rate for Payer: Cigna of CA HMO |
$387.00
|
| Rate for Payer: Cigna of CA PPO |
$387.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$469.93
|
| Rate for Payer: Global Benefits Group Commercial |
$331.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$414.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.81
|
| Rate for Payer: Heritage Provider Network Transplant |
$4.81
|
| Rate for Payer: IEHP Medi-Cal |
$4.75
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$4.75
|
| Rate for Payer: IEHP Medicare Advantage |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.76
|
| 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 |
$132.69
|
| 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 |
$442.29
|
| Rate for Payer: Networks By Design Commercial |
$276.43
|
| Rate for Payer: Prime Health Services Commercial |
$469.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$331.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$331.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$276.43
|
| Rate for Payer: United Healthcare All Other HMO |
$276.43
|
| Rate for Payer: United Healthcare HMO Rider |
$276.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.43
|
| 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
|
|
|
DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE [108041]
|
Facility
IP
|
$552.86
|
|
|
Service Code
|
CPT J0881
|
| Hospital Charge Code |
1720969
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.69 |
| Max. Negotiated Rate |
$469.93 |
| Rate for Payer: Blue Shield of California Commercial |
$393.64
|
| Rate for Payer: Blue Shield of California EPN |
$283.06
|
| Rate for Payer: Cash Price |
$248.79
|
| Rate for Payer: Cigna of CA HMO |
$387.00
|
| Rate for Payer: Cigna of CA PPO |
$387.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$221.14
|
| Rate for Payer: Galaxy Health WC |
$469.93
|
| Rate for Payer: Global Benefits Group Commercial |
$331.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.69
|
| Rate for Payer: Multiplan Commercial |
$442.29
|
| Rate for Payer: Networks By Design Commercial |
$276.43
|
| Rate for Payer: Prime Health Services Commercial |
$469.93
|
|
|
DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE [108042]
|
Facility
IP
|
$928.80
|
|
|
Service Code
|
CPT J0881
|
| Hospital Charge Code |
1720970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$222.91 |
| Max. Negotiated Rate |
$789.48 |
| Rate for Payer: Blue Shield of California Commercial |
$661.31
|
| Rate for Payer: Blue Shield of California EPN |
$475.55
|
| Rate for Payer: Cash Price |
$417.96
|
| Rate for Payer: Cigna of CA HMO |
$650.16
|
| Rate for Payer: Cigna of CA PPO |
$650.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$371.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$371.52
|
| Rate for Payer: Galaxy Health WC |
$789.48
|
| Rate for Payer: Global Benefits Group Commercial |
$557.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$619.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.91
|
| Rate for Payer: Multiplan Commercial |
$743.04
|
| Rate for Payer: Networks By Design Commercial |
$464.40
|
| Rate for Payer: Prime Health Services Commercial |
$789.48
|
|
|
DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE [108042]
|
Facility
OP
|
$928.80
|
|
|
Service Code
|
CPT J0881
|
| Hospital Charge Code |
1720970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$789.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.17
|
| Rate for Payer: BCBS Transplant Transplant |
$557.28
|
| Rate for Payer: Blue Shield of California Commercial |
$684.53
|
| Rate for Payer: Blue Shield of California EPN |
$9.29
|
| Rate for Payer: Cash Price |
$417.96
|
| Rate for Payer: Cash Price |
$417.96
|
| Rate for Payer: Cigna of CA HMO |
$650.16
|
| Rate for Payer: Cigna of CA PPO |
$650.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$789.48
|
| Rate for Payer: Global Benefits Group Commercial |
$557.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$696.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.81
|
| Rate for Payer: Heritage Provider Network Transplant |
$4.81
|
| Rate for Payer: IEHP Medi-Cal |
$4.75
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$4.75
|
| Rate for Payer: IEHP Medicare Advantage |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$619.51
|
| 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 |
$222.91
|
| 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 |
$743.04
|
| Rate for Payer: Networks By Design Commercial |
$464.40
|
| Rate for Payer: Prime Health Services Commercial |
$789.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$557.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$557.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$464.40
|
| Rate for Payer: United Healthcare All Other HMO |
$464.40
|
| Rate for Payer: United Healthcare HMO Rider |
$464.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$464.40
|
| 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.17
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$4.75
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$4.75
|
| Rate for Payer: 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
|
|
|
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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$109.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$70.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$70.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.66
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$77.20
|
| 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
|
|
|
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
|
|
|
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: Galaxy Health WC |
$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: 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 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: AlphaCare Medical Group Commercial/Exchange |
$35.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.97
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$25.15
|
| 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 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: AlphaCare Medical Group Commercial/Exchange |
$81.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$52.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$52.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.08
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$57.48
|
| 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
|
$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
|
$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: BCBS Transplant Transplant |
$50.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$71.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$46.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$46.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.93
|
| 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$50.29
|
| 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
|
$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
|
$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: AlphaCare Medical Group Commercial/Exchange |
$61.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$39.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$39.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.14
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$43.45
|
| 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
|
|
