|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [39276]
|
Facility
IP
|
$0.56
|
|
|
Service Code
|
NDC 68001-414-05
|
| Hospital Charge Code |
1711840
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE [39277]
|
Facility
OP
|
$0.59
|
|
|
Service Code
|
NDC 43547-381-03
|
| Hospital Charge Code |
1711841
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: BCBS Transplant Transplant |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.50
|
| Rate for Payer: Dignity Health Media |
$0.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Vantage Medical Group Senior |
$0.50
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE [39277]
|
Facility
IP
|
$0.36
|
|
|
Service Code
|
NDC 68001-415-04
|
| Hospital Charge Code |
1711841
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE [39277]
|
Facility
OP
|
$0.36
|
|
|
Service Code
|
NDC 68001-415-04
|
| Hospital Charge Code |
1711841
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: BCBS Transplant Transplant |
$0.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Media |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE [39277]
|
Facility
IP
|
$0.40
|
|
|
Service Code
|
NDC 57237-019-30
|
| Hospital Charge Code |
1711841
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE [39277]
|
Facility
OP
|
$0.40
|
|
|
Service Code
|
NDC 57237-019-30
|
| Hospital Charge Code |
1711841
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.24
|
| Rate for Payer: BCBS Transplant Transplant |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.34
|
| Rate for Payer: Dignity Health Media |
$0.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE [39277]
|
Facility
IP
|
$0.59
|
|
|
Service Code
|
NDC 43547-381-03
|
| Hospital Charge Code |
1711841
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.50
|
|
|
DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION [217071]
|
Facility
OP
|
$473.79
|
|
|
Service Code
|
NDC 0310-4500-12
|
| Hospital Charge Code |
NDG217071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.71 |
| Max. Negotiated Rate |
$402.72 |
| Rate for Payer: EPIC Health Plan Commercial |
$189.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$310.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$402.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$260.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$260.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$282.28
|
| Rate for Payer: BCBS Transplant Transplant |
$284.27
|
| Rate for Payer: Blue Shield of California Commercial |
$349.18
|
| Rate for Payer: Blue Shield of California EPN |
$276.69
|
| Rate for Payer: Cash Price |
$213.21
|
| Rate for Payer: Cash Price |
$213.21
|
| Rate for Payer: Cigna of CA HMO |
$331.65
|
| Rate for Payer: Cigna of CA PPO |
$331.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$402.72
|
| Rate for Payer: Dignity Health Media |
$402.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$402.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$189.52
|
| Rate for Payer: Galaxy Health WC |
$402.72
|
| Rate for Payer: Global Benefits Group Commercial |
$284.27
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$355.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$316.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.71
|
| Rate for Payer: Multiplan Commercial |
$379.03
|
| Rate for Payer: Networks By Design Commercial |
$236.90
|
| Rate for Payer: Prime Health Services Commercial |
$402.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$284.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$284.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$236.90
|
| Rate for Payer: United Healthcare All Other HMO |
$236.90
|
| Rate for Payer: United Healthcare HMO Rider |
$236.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$236.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$402.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$402.72
|
| Rate for Payer: Vantage Medical Group Senior |
$402.72
|
|
|
DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION [217071]
|
Facility
OP
|
$473.79
|
|
|
Service Code
|
NDC 0310-4611-50
|
| Hospital Charge Code |
NDG217071A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.71 |
| Max. Negotiated Rate |
$402.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$310.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$402.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$260.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$260.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$282.28
|
| Rate for Payer: BCBS Transplant Transplant |
$284.27
|
| Rate for Payer: Blue Shield of California Commercial |
$349.18
|
| Rate for Payer: Blue Shield of California EPN |
$276.69
|
| Rate for Payer: Cash Price |
$213.21
|
| Rate for Payer: Cash Price |
$213.21
|
| Rate for Payer: Cigna of CA HMO |
$331.65
|
| Rate for Payer: Cigna of CA PPO |
$331.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$402.72
|
| Rate for Payer: Dignity Health Media |
$402.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$402.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$189.52
|
| Rate for Payer: Galaxy Health WC |
$402.72
|
| Rate for Payer: Global Benefits Group Commercial |
$284.27
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$355.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$316.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.71
|
| Rate for Payer: Multiplan Commercial |
$379.03
|
| Rate for Payer: Networks By Design Commercial |
$236.90
|
| Rate for Payer: Prime Health Services Commercial |
$402.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$284.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$284.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$236.90
|
| Rate for Payer: United Healthcare All Other HMO |
$236.90
|
| Rate for Payer: United Healthcare HMO Rider |
$236.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$236.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$402.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$402.72
|
| Rate for Payer: Vantage Medical Group Senior |
$402.72
|
|
|
DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION [217071]
|
Facility
IP
|
$473.79
|
|
|
Service Code
|
NDC 0310-4611-50
|
| Hospital Charge Code |
NDG217071A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.71 |
| Max. Negotiated Rate |
$402.72 |
| Rate for Payer: Blue Shield of California Commercial |
$337.34
|
| Rate for Payer: Blue Shield of California EPN |
$242.58
|
| Rate for Payer: Cash Price |
$213.21
|
| Rate for Payer: Cigna of CA HMO |
$331.65
|
| Rate for Payer: Cigna of CA PPO |
$331.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$189.52
|
| Rate for Payer: Galaxy Health WC |
$402.72
|
| Rate for Payer: Global Benefits Group Commercial |
$284.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$316.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.71
|
| Rate for Payer: Multiplan Commercial |
$379.03
|
| Rate for Payer: Networks By Design Commercial |
$236.90
|
| Rate for Payer: Prime Health Services Commercial |
$402.72
|
|
|
DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION [217071]
|
Facility
IP
|
$473.79
|
|
|
Service Code
|
NDC 0310-4500-12
|
| Hospital Charge Code |
NDG217071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.71 |
| Max. Negotiated Rate |
$402.72 |
| Rate for Payer: Blue Shield of California Commercial |
$337.34
|
| Rate for Payer: Blue Shield of California EPN |
$242.58
|
| Rate for Payer: Cash Price |
$213.21
|
| Rate for Payer: Cigna of CA HMO |
$331.65
|
| Rate for Payer: Cigna of CA PPO |
$331.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$189.52
|
| Rate for Payer: Galaxy Health WC |
$402.72
|
| Rate for Payer: Global Benefits Group Commercial |
$284.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$316.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.71
|
| Rate for Payer: Multiplan Commercial |
$379.03
|
| Rate for Payer: Networks By Design Commercial |
$236.90
|
| Rate for Payer: Prime Health Services Commercial |
$402.72
|
|
|
DUTASTERIDE 0.5 MG CAPSULE [34089]
|
Facility
OP
|
$11.00
|
|
|
Service Code
|
NDC 0173-0712-15
|
| Hospital Charge Code |
1710969
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$9.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.55
|
| Rate for Payer: BCBS Transplant Transplant |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8.11
|
| Rate for Payer: Blue Shield of California EPN |
$6.42
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO |
$7.70
|
| Rate for Payer: Cigna of CA PPO |
$7.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.35
|
| Rate for Payer: Dignity Health Media |
$9.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
|
|
DUTASTERIDE 0.5 MG CAPSULE [34089]
|
Facility
IP
|
$11.00
|
|
|
Service Code
|
NDC 0173-0712-15
|
| Hospital Charge Code |
1710969
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$9.35 |
| Rate for Payer: Blue Shield of California Commercial |
$7.83
|
| Rate for Payer: Blue Shield of California EPN |
$5.63
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO |
$7.70
|
| Rate for Payer: Cigna of CA PPO |
$7.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
|
|
DUTASTERIDE 0.5 MG CAPSULE [34089]
|
Facility
IP
|
$0.38
|
|
|
Service Code
|
NDC 42806-549-30
|
| Hospital Charge Code |
1710969
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
|
|
DUTASTERIDE 0.5 MG CAPSULE [34089]
|
Facility
OP
|
$0.38
|
|
|
Service Code
|
NDC 42806-549-30
|
| Hospital Charge Code |
1710969
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.23
|
| Rate for Payer: BCBS Transplant Transplant |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Media |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Vantage Medical Group Senior |
$0.32
|
|
|
DUTASTERIDE 0.5 MG CAPSULE [34089]
|
Facility
OP
|
$11.00
|
|
|
Service Code
|
NDC 0173-0712-04
|
| Hospital Charge Code |
1710969
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$9.35 |
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.55
|
| Rate for Payer: BCBS Transplant Transplant |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8.11
|
| Rate for Payer: Blue Shield of California EPN |
$6.42
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO |
$7.70
|
| Rate for Payer: Cigna of CA PPO |
$7.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.35
|
| Rate for Payer: Dignity Health Media |
$9.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
|
|
DUTASTERIDE 0.5 MG CAPSULE [34089]
|
Facility
IP
|
$11.00
|
|
|
Service Code
|
NDC 0173-0712-04
|
| Hospital Charge Code |
1710969
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$9.35 |
| Rate for Payer: Blue Shield of California Commercial |
$7.83
|
| Rate for Payer: Blue Shield of California EPN |
$5.63
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO |
$7.70
|
| Rate for Payer: Cigna of CA PPO |
$7.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
|
|
EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES
|
Facility
IP
|
$18,341.12
|
|
|
Service Code
|
APR-DRG 1103
|
| Min. Negotiated Rate |
$14,069.57 |
| Max. Negotiated Rate |
$18,341.12 |
| Rate for Payer: IEHP Medi-Cal |
$14,069.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,341.12
|
|
|
EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES
|
Facility
IP
|
$12,660.73
|
|
|
Service Code
|
APR-DRG 1102
|
| Min. Negotiated Rate |
$9,712.11 |
| Max. Negotiated Rate |
$12,660.73 |
| Rate for Payer: IEHP Medi-Cal |
$9,712.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,660.73
|
|
|
EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES
|
Facility
IP
|
$11,068.16
|
|
|
Service Code
|
APR-DRG 1101
|
| Min. Negotiated Rate |
$8,490.45 |
| Max. Negotiated Rate |
$11,068.16 |
| Rate for Payer: IEHP Medi-Cal |
$8,490.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,068.16
|
|
|
EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES
|
Facility
IP
|
$29,866.84
|
|
|
Service Code
|
APR-DRG 1104
|
| Min. Negotiated Rate |
$22,911.01 |
| Max. Negotiated Rate |
$29,866.84 |
| Rate for Payer: IEHP Medi-Cal |
$22,911.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29,866.84
|
|
|
EATING DISORDERS
|
Facility
IP
|
$20,219.21
|
|
|
Service Code
|
APR-DRG 7593
|
| Min. Negotiated Rate |
$15,510.26 |
| Max. Negotiated Rate |
$20,219.21 |
| Rate for Payer: IEHP Medi-Cal |
$15,510.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20,219.21
|
|
|
EATING DISORDERS
|
Facility
IP
|
$9,339.03
|
|
|
Service Code
|
APR-DRG 7591
|
| Min. Negotiated Rate |
$7,164.02 |
| Max. Negotiated Rate |
$9,339.03 |
| Rate for Payer: IEHP Medi-Cal |
$7,164.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,339.03
|
|
|
EATING DISORDERS
|
Facility
IP
|
$83,529.97
|
|
|
Service Code
|
APR-DRG 7594
|
| Min. Negotiated Rate |
$64,076.28 |
| Max. Negotiated Rate |
$83,529.97 |
| Rate for Payer: IEHP Medi-Cal |
$64,076.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83,529.97
|
|
|
EATING DISORDERS
|
Facility
IP
|
$14,615.08
|
|
|
Service Code
|
APR-DRG 7592
|
| Min. Negotiated Rate |
$11,211.31 |
| Max. Negotiated Rate |
$14,615.08 |
| Rate for Payer: IEHP Medi-Cal |
$11,211.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,615.08
|
|
