|
DARATUMUMAB-HYALURONIDASE-FIHJ (DARZALEX FASPRO) 1800 MG/30000 UNIT SQ INJECTION [40820601]
|
Facility
|
OP
|
$845.75
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.64 |
| Max. Negotiated Rate |
$761.17 |
| Rate for Payer: Adventist Health Commercial |
$169.15
|
| Rate for Payer: Adventist Health Medi-Cal |
$54.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$513.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.64
|
| Rate for Payer: Blue Shield of California Commercial |
$73.50
|
| Rate for Payer: Blue Shield of California EPN |
$66.82
|
| Rate for Payer: Cash Price |
$465.16
|
| Rate for Payer: Cash Price |
$465.16
|
| Rate for Payer: Central Health Plan Commercial |
$676.60
|
| Rate for Payer: Cigna of CA HMO |
$592.02
|
| Rate for Payer: Cigna of CA PPO |
$592.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.67
|
| Rate for Payer: Galaxy Health WC |
$718.89
|
| Rate for Payer: Global Benefits Group Commercial |
$507.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$761.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$89.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$54.67
|
| Rate for Payer: InnovAge PACE Commercial |
$82.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.25
|
| Rate for Payer: Multiplan Commercial |
$634.31
|
| Rate for Payer: Networks By Design Commercial |
$422.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$54.67
|
| Rate for Payer: Prime Health Services Commercial |
$718.89
|
| Rate for Payer: Prime Health Services Medicare |
$57.95
|
| Rate for Payer: Riverside University Health System MISP |
$60.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$507.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$507.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$317.41
|
| Rate for Payer: United Healthcare All Other HMO |
$308.95
|
| Rate for Payer: United Healthcare HMO Rider |
$302.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$54.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.13
|
| Rate for Payer: Vantage Medical Group Senior |
$60.13
|
|
|
DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE [108041]
|
Facility
|
IP
|
$552.86
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.57 |
| Max. Negotiated Rate |
$497.57 |
| Rate for Payer: Adventist Health Commercial |
$110.57
|
| Rate for Payer: Blue Shield of California Commercial |
$427.36
|
| Rate for Payer: Blue Shield of California EPN |
$278.64
|
| Rate for Payer: Cash Price |
$304.07
|
| Rate for Payer: Central Health Plan Commercial |
$442.29
|
| 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 Senior |
$221.14
|
| Rate for Payer: Galaxy Health WC |
$469.93
|
| Rate for Payer: Global Benefits Group Commercial |
$331.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$497.57
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$342.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.57
|
| Rate for Payer: Multiplan Commercial |
$414.64
|
| Rate for Payer: Networks By Design Commercial |
$276.43
|
| Rate for Payer: Prime Health Services Commercial |
$469.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$207.49
|
| Rate for Payer: United Healthcare All Other HMO |
$201.96
|
| Rate for Payer: United Healthcare HMO Rider |
$197.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$181.06
|
|
|
DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE [108041]
|
Facility
|
OP
|
$552.86
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$497.57 |
| Rate for Payer: Adventist Health Commercial |
$110.57
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$335.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.22
|
| Rate for Payer: Blue Shield of California Commercial |
$10.22
|
| Rate for Payer: Blue Shield of California EPN |
$9.29
|
| Rate for Payer: Cash Price |
$304.07
|
| Rate for Payer: Cash Price |
$304.07
|
| Rate for Payer: Central Health Plan Commercial |
$442.29
|
| 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 |
$3.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$3.00
|
| Rate for Payer: Galaxy Health WC |
$469.93
|
| Rate for Payer: Global Benefits Group Commercial |
$331.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$497.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.00
|
| Rate for Payer: InnovAge PACE Commercial |
$4.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$414.64
|
| Rate for Payer: Networks By Design Commercial |
$276.43
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.00
|
| Rate for Payer: Prime Health Services Commercial |
$469.93
|
| Rate for Payer: Prime Health Services Medicare |
$3.17
|
| Rate for Payer: Riverside University Health System MISP |
$3.29
|
| 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 |
$207.49
|
| Rate for Payer: United Healthcare All Other HMO |
$201.96
|
| Rate for Payer: United Healthcare HMO Rider |
$197.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$181.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3.29
|
|
|
DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE [108042]
|
Facility
|
IP
|
$928.80
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$185.76 |
| Max. Negotiated Rate |
$835.92 |
| Rate for Payer: Adventist Health Commercial |
$185.76
|
| Rate for Payer: Blue Shield of California Commercial |
$717.96
|
| Rate for Payer: Blue Shield of California EPN |
$468.12
|
| Rate for Payer: Cash Price |
$510.84
|
| Rate for Payer: Central Health Plan Commercial |
$743.04
|
| 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 Senior |
$371.52
|
| Rate for Payer: Galaxy Health WC |
$789.48
|
| Rate for Payer: Global Benefits Group Commercial |
$557.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$835.92
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$574.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.76
|
| Rate for Payer: Multiplan Commercial |
$696.60
|
| Rate for Payer: Networks By Design Commercial |
$464.40
|
| Rate for Payer: Prime Health Services Commercial |
$789.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$348.58
|
| Rate for Payer: United Healthcare All Other HMO |
$339.29
|
| Rate for Payer: United Healthcare HMO Rider |
$331.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$304.18
|
|
|
DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE [108042]
|
Facility
|
OP
|
$928.80
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$835.92 |
| Rate for Payer: Adventist Health Commercial |
$185.76
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$564.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.22
|
| Rate for Payer: Blue Shield of California Commercial |
$10.22
|
| Rate for Payer: Blue Shield of California EPN |
$9.29
|
| Rate for Payer: Cash Price |
$510.84
|
| Rate for Payer: Cash Price |
$510.84
|
| Rate for Payer: Central Health Plan Commercial |
$743.04
|
| 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 |
$3.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$3.00
|
| Rate for Payer: Galaxy Health WC |
$789.48
|
| Rate for Payer: Global Benefits Group Commercial |
$557.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$835.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.00
|
| Rate for Payer: InnovAge PACE Commercial |
$4.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$619.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$696.60
|
| Rate for Payer: Networks By Design Commercial |
$464.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.00
|
| Rate for Payer: Prime Health Services Commercial |
$789.48
|
| Rate for Payer: Prime Health Services Medicare |
$3.17
|
| Rate for Payer: Riverside University Health System MISP |
$3.29
|
| 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 |
$348.58
|
| Rate for Payer: United Healthcare All Other HMO |
$339.29
|
| Rate for Payer: United Healthcare HMO Rider |
$331.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$304.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3.29
|
|
|
DAROLUTAMIDE 300 MG TABLET [225419]
|
Facility
|
OP
|
$142.54
|
|
|
Service Code
|
NDC 50419-395-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.51 |
| Max. Negotiated Rate |
$128.29 |
| Rate for Payer: Adventist Health Commercial |
$28.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$86.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$121.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.71
|
| Rate for Payer: Blue Shield of California Commercial |
$87.09
|
| Rate for Payer: Blue Shield of California EPN |
$56.87
|
| Rate for Payer: Cash Price |
$78.39
|
| Rate for Payer: Central Health Plan Commercial |
$114.03
|
| Rate for Payer: Cigna of CA HMO |
$99.78
|
| Rate for Payer: Cigna of CA PPO |
$99.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$121.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$121.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$121.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.02
|
| Rate for Payer: EPIC Health Plan Senior |
$57.02
|
| Rate for Payer: Galaxy Health WC |
$121.16
|
| Rate for Payer: Global Benefits Group Commercial |
$85.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$128.29
|
| Rate for Payer: InnovAge PACE Commercial |
$71.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99.78
|
| Rate for Payer: Multiplan Commercial |
$106.91
|
| Rate for Payer: Networks By Design Commercial |
$92.65
|
| Rate for Payer: Prime Health Services Commercial |
$121.16
|
| Rate for Payer: Riverside University Health System MISP |
$57.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.27
|
| Rate for Payer: United Healthcare All Other HMO |
$71.27
|
| Rate for Payer: United Healthcare HMO Rider |
$71.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$121.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$121.16
|
| Rate for Payer: Vantage Medical Group Senior |
$121.16
|
|
|
DAROLUTAMIDE 300 MG TABLET [225419]
|
Facility
|
IP
|
$142.54
|
|
|
Service Code
|
NDC 50419-395-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.51 |
| Max. Negotiated Rate |
$128.29 |
| Rate for Payer: Adventist Health Commercial |
$28.51
|
| Rate for Payer: Blue Shield of California Commercial |
$110.18
|
| Rate for Payer: Blue Shield of California EPN |
$71.84
|
| Rate for Payer: Cash Price |
$78.39
|
| Rate for Payer: Central Health Plan Commercial |
$114.03
|
| Rate for Payer: Cigna of CA HMO |
$99.78
|
| Rate for Payer: Cigna of CA PPO |
$99.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.02
|
| Rate for Payer: EPIC Health Plan Senior |
$57.02
|
| Rate for Payer: Galaxy Health WC |
$121.16
|
| Rate for Payer: Global Benefits Group Commercial |
$85.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$128.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.51
|
| Rate for Payer: Multiplan Commercial |
$106.91
|
| Rate for Payer: Networks By Design Commercial |
$92.65
|
| Rate for Payer: Prime Health Services Commercial |
$121.16
|
|
|
DARUNAVIR 600 MG TABLET [92851]
|
Facility
|
OP
|
$43.16
|
|
|
Service Code
|
NDC 59676-562-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$38.84 |
| Rate for Payer: Adventist Health Commercial |
$8.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.35
|
| Rate for Payer: Blue Shield of California Commercial |
$26.37
|
| Rate for Payer: Blue Shield of California EPN |
$17.22
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Central Health Plan Commercial |
$34.53
|
| Rate for Payer: Cigna of CA HMO |
$30.21
|
| Rate for Payer: Cigna of CA PPO |
$30.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.26
|
| Rate for Payer: EPIC Health Plan Senior |
$17.26
|
| Rate for Payer: Galaxy Health WC |
$36.69
|
| Rate for Payer: Global Benefits Group Commercial |
$25.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.84
|
| Rate for Payer: InnovAge PACE Commercial |
$21.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.21
|
| Rate for Payer: Multiplan Commercial |
$32.37
|
| Rate for Payer: Networks By Design Commercial |
$28.05
|
| Rate for Payer: Prime Health Services Commercial |
$36.69
|
| Rate for Payer: Riverside University Health System MISP |
$17.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.58
|
| Rate for Payer: United Healthcare All Other HMO |
$21.58
|
| Rate for Payer: United Healthcare HMO Rider |
$21.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.69
|
| Rate for Payer: Vantage Medical Group Senior |
$36.69
|
|
|
DARUNAVIR 600 MG TABLET [92851]
|
Facility
|
IP
|
$43.16
|
|
|
Service Code
|
NDC 59676-562-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$38.84 |
| Rate for Payer: Adventist Health Commercial |
$8.63
|
| Rate for Payer: Blue Shield of California Commercial |
$33.36
|
| Rate for Payer: Blue Shield of California EPN |
$21.75
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Central Health Plan Commercial |
$34.53
|
| Rate for Payer: Cigna of CA HMO |
$30.21
|
| Rate for Payer: Cigna of CA PPO |
$30.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.26
|
| Rate for Payer: EPIC Health Plan Senior |
$17.26
|
| Rate for Payer: Galaxy Health WC |
$36.69
|
| Rate for Payer: Global Benefits Group Commercial |
$25.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.63
|
| Rate for Payer: Multiplan Commercial |
$32.37
|
| Rate for Payer: Networks By Design Commercial |
$28.05
|
| Rate for Payer: Prime Health Services Commercial |
$36.69
|
|
|
DARUNAVIR 800 MG-COBICISTAT 150 MG TABLET [208697]
|
Facility
|
OP
|
$98.67
|
|
|
Service Code
|
NDC 59676-575-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$88.80 |
| Rate for Payer: Adventist Health Commercial |
$19.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.95
|
| Rate for Payer: Blue Shield of California Commercial |
$60.29
|
| Rate for Payer: Blue Shield of California EPN |
$39.37
|
| Rate for Payer: Cash Price |
$54.27
|
| Rate for Payer: Central Health Plan Commercial |
$78.94
|
| Rate for Payer: Cigna of CA HMO |
$69.07
|
| Rate for Payer: Cigna of CA PPO |
$69.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$83.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.47
|
| Rate for Payer: EPIC Health Plan Senior |
$39.47
|
| Rate for Payer: Galaxy Health WC |
$83.87
|
| Rate for Payer: Global Benefits Group Commercial |
$59.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.80
|
| Rate for Payer: InnovAge PACE Commercial |
$49.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.07
|
| Rate for Payer: Multiplan Commercial |
$74.00
|
| Rate for Payer: Networks By Design Commercial |
$64.14
|
| Rate for Payer: Prime Health Services Commercial |
$83.87
|
| Rate for Payer: Riverside University Health System MISP |
$39.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.34
|
| Rate for Payer: United Healthcare All Other HMO |
$49.34
|
| Rate for Payer: United Healthcare HMO Rider |
$49.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$83.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.87
|
| Rate for Payer: Vantage Medical Group Senior |
$83.87
|
|
|
DARUNAVIR 800 MG-COBICISTAT 150 MG TABLET [208697]
|
Facility
|
IP
|
$98.67
|
|
|
Service Code
|
NDC 59676-575-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$88.80 |
| Rate for Payer: Adventist Health Commercial |
$19.73
|
| Rate for Payer: Blue Shield of California Commercial |
$76.27
|
| Rate for Payer: Blue Shield of California EPN |
$49.73
|
| Rate for Payer: Cash Price |
$54.27
|
| Rate for Payer: Central Health Plan Commercial |
$78.94
|
| Rate for Payer: Cigna of CA HMO |
$69.07
|
| Rate for Payer: Cigna of CA PPO |
$69.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.47
|
| Rate for Payer: EPIC Health Plan Senior |
$39.47
|
| Rate for Payer: Galaxy Health WC |
$83.87
|
| Rate for Payer: Global Benefits Group Commercial |
$59.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.73
|
| Rate for Payer: Multiplan Commercial |
$74.00
|
| Rate for Payer: Networks By Design Commercial |
$64.14
|
| Rate for Payer: Prime Health Services Commercial |
$83.87
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
IP
|
$12.30
|
|
|
Service Code
|
NDC 60687-819-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$11.07 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Blue Shield of California Commercial |
$9.51
|
| Rate for Payer: Blue Shield of California EPN |
$6.20
|
| Rate for Payer: Cash Price |
$6.77
|
| Rate for Payer: Central Health Plan Commercial |
$9.84
|
| Rate for Payer: Cigna of CA HMO |
$8.61
|
| Rate for Payer: Cigna of CA PPO |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
OP
|
$86.33
|
|
|
Service Code
|
NDC 59676-566-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$77.70 |
| Rate for Payer: Adventist Health Commercial |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.70
|
| Rate for Payer: Blue Shield of California Commercial |
$52.75
|
| Rate for Payer: Blue Shield of California EPN |
$34.45
|
| Rate for Payer: Cash Price |
$47.48
|
| Rate for Payer: Central Health Plan Commercial |
$69.06
|
| Rate for Payer: Cigna of CA HMO |
$60.43
|
| Rate for Payer: Cigna of CA PPO |
$60.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.53
|
| Rate for Payer: EPIC Health Plan Senior |
$34.53
|
| Rate for Payer: Galaxy Health WC |
$73.38
|
| Rate for Payer: Global Benefits Group Commercial |
$51.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.70
|
| Rate for Payer: InnovAge PACE Commercial |
$43.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.43
|
| Rate for Payer: Multiplan Commercial |
$64.75
|
| Rate for Payer: Networks By Design Commercial |
$56.11
|
| Rate for Payer: Prime Health Services Commercial |
$73.38
|
| Rate for Payer: Riverside University Health System MISP |
$34.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.16
|
| Rate for Payer: United Healthcare All Other HMO |
$43.16
|
| Rate for Payer: United Healthcare HMO Rider |
$43.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.38
|
| Rate for Payer: Vantage Medical Group Senior |
$73.38
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
OP
|
$12.30
|
|
|
Service Code
|
NDC 60687-819-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$11.07 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.22
|
| Rate for Payer: Blue Shield of California Commercial |
$7.52
|
| Rate for Payer: Blue Shield of California EPN |
$4.91
|
| Rate for Payer: Cash Price |
$6.77
|
| Rate for Payer: Central Health Plan Commercial |
$9.84
|
| Rate for Payer: Cigna of CA HMO |
$8.61
|
| Rate for Payer: Cigna of CA PPO |
$8.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.07
|
| Rate for Payer: InnovAge PACE Commercial |
$6.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
| Rate for Payer: Riverside University Health System MISP |
$4.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.15
|
| Rate for Payer: United Healthcare All Other HMO |
$6.15
|
| Rate for Payer: United Healthcare HMO Rider |
$6.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.46
|
| Rate for Payer: Vantage Medical Group Senior |
$10.46
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
IP
|
$12.30
|
|
|
Service Code
|
NDC 60687-819-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$11.07 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Blue Shield of California Commercial |
$9.51
|
| Rate for Payer: Blue Shield of California EPN |
$6.20
|
| Rate for Payer: Cash Price |
$6.77
|
| Rate for Payer: Central Health Plan Commercial |
$9.84
|
| Rate for Payer: Cigna of CA HMO |
$8.61
|
| Rate for Payer: Cigna of CA PPO |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
OP
|
$12.30
|
|
|
Service Code
|
NDC 60687-819-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$11.07 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.22
|
| Rate for Payer: Blue Shield of California Commercial |
$7.52
|
| Rate for Payer: Blue Shield of California EPN |
$4.91
|
| Rate for Payer: Cash Price |
$6.77
|
| Rate for Payer: Central Health Plan Commercial |
$9.84
|
| Rate for Payer: Cigna of CA HMO |
$8.61
|
| Rate for Payer: Cigna of CA PPO |
$8.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.07
|
| Rate for Payer: InnovAge PACE Commercial |
$6.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
| Rate for Payer: Riverside University Health System MISP |
$4.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.15
|
| Rate for Payer: United Healthcare All Other HMO |
$6.15
|
| Rate for Payer: United Healthcare HMO Rider |
$6.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.46
|
| Rate for Payer: Vantage Medical Group Senior |
$10.46
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
OP
|
$3.96
|
|
|
Service Code
|
NDC 68180-346-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.33
|
| Rate for Payer: Blue Shield of California Commercial |
$2.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.58
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Central Health Plan Commercial |
$3.17
|
| Rate for Payer: Cigna of CA HMO |
$2.77
|
| Rate for Payer: Cigna of CA PPO |
$2.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: EPIC Health Plan Senior |
$1.58
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.56
|
| Rate for Payer: InnovAge PACE Commercial |
$1.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.77
|
| Rate for Payer: Multiplan Commercial |
$2.97
|
| Rate for Payer: Networks By Design Commercial |
$2.57
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
| Rate for Payer: Riverside University Health System MISP |
$1.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.98
|
| Rate for Payer: United Healthcare All Other HMO |
$1.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.37
|
| Rate for Payer: Vantage Medical Group Senior |
$3.37
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
IP
|
$3.96
|
|
|
Service Code
|
NDC 68180-346-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$3.06
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Central Health Plan Commercial |
$3.17
|
| Rate for Payer: Cigna of CA HMO |
$2.77
|
| Rate for Payer: Cigna of CA PPO |
$2.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: EPIC Health Plan Senior |
$1.58
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$2.97
|
| Rate for Payer: Networks By Design Commercial |
$2.57
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
IP
|
$86.33
|
|
|
Service Code
|
NDC 59676-566-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$77.70 |
| Rate for Payer: Adventist Health Commercial |
$17.27
|
| Rate for Payer: Blue Shield of California Commercial |
$66.73
|
| Rate for Payer: Blue Shield of California EPN |
$43.51
|
| Rate for Payer: Cash Price |
$47.48
|
| Rate for Payer: Central Health Plan Commercial |
$69.06
|
| Rate for Payer: Cigna of CA HMO |
$60.43
|
| Rate for Payer: Cigna of CA PPO |
$60.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.53
|
| Rate for Payer: EPIC Health Plan Senior |
$34.53
|
| Rate for Payer: Galaxy Health WC |
$73.38
|
| Rate for Payer: Global Benefits Group Commercial |
$51.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$64.75
|
| Rate for Payer: Networks By Design Commercial |
$56.11
|
| Rate for Payer: Prime Health Services Commercial |
$73.38
|
|
|
DASATINIB 100 MG TABLET [92897]
|
Facility
|
IP
|
$729.85
|
|
|
Service Code
|
NDC 0003-0852-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$145.97 |
| Max. Negotiated Rate |
$656.87 |
| Rate for Payer: Adventist Health Commercial |
$145.97
|
| Rate for Payer: Blue Shield of California Commercial |
$564.17
|
| Rate for Payer: Blue Shield of California EPN |
$367.84
|
| Rate for Payer: Cash Price |
$401.42
|
| Rate for Payer: Central Health Plan Commercial |
$583.88
|
| Rate for Payer: Cigna of CA HMO |
$510.89
|
| Rate for Payer: Cigna of CA PPO |
$510.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.94
|
| Rate for Payer: EPIC Health Plan Senior |
$291.94
|
| Rate for Payer: Galaxy Health WC |
$620.37
|
| Rate for Payer: Global Benefits Group Commercial |
$437.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$656.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$451.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.97
|
| Rate for Payer: Multiplan Commercial |
$547.39
|
| Rate for Payer: Networks By Design Commercial |
$474.40
|
| Rate for Payer: Prime Health Services Commercial |
$620.37
|
|
|
DASATINIB 100 MG TABLET [92897]
|
Facility
|
OP
|
$729.85
|
|
|
Service Code
|
NDC 0003-0852-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$145.97 |
| Max. Negotiated Rate |
$656.87 |
| Rate for Payer: Adventist Health Commercial |
$145.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$443.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$620.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$401.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$547.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$353.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$428.64
|
| Rate for Payer: Blue Shield of California Commercial |
$445.94
|
| Rate for Payer: Blue Shield of California EPN |
$291.21
|
| Rate for Payer: Cash Price |
$401.42
|
| Rate for Payer: Central Health Plan Commercial |
$583.88
|
| Rate for Payer: Cigna of CA HMO |
$510.89
|
| Rate for Payer: Cigna of CA PPO |
$510.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$620.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$620.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$620.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.94
|
| Rate for Payer: EPIC Health Plan Senior |
$291.94
|
| Rate for Payer: Galaxy Health WC |
$620.37
|
| Rate for Payer: Global Benefits Group Commercial |
$437.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$656.87
|
| Rate for Payer: InnovAge PACE Commercial |
$364.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$451.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$510.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$510.89
|
| Rate for Payer: Multiplan Commercial |
$547.39
|
| Rate for Payer: Networks By Design Commercial |
$474.40
|
| Rate for Payer: Prime Health Services Commercial |
$620.37
|
| Rate for Payer: Riverside University Health System MISP |
$291.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$437.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$437.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.93
|
| Rate for Payer: United Healthcare All Other HMO |
$364.93
|
| Rate for Payer: United Healthcare HMO Rider |
$364.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$364.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$620.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$620.37
|
| Rate for Payer: Vantage Medical Group Senior |
$620.37
|
|
|
DASATINIB 140 MG TABLET [108422]
|
Facility
|
OP
|
$729.85
|
|
|
Service Code
|
NDC 0003-0857-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$145.97 |
| Max. Negotiated Rate |
$656.87 |
| Rate for Payer: Adventist Health Commercial |
$145.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$443.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$620.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$401.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$547.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$353.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$428.64
|
| Rate for Payer: Blue Shield of California Commercial |
$445.94
|
| Rate for Payer: Blue Shield of California EPN |
$291.21
|
| Rate for Payer: Cash Price |
$401.42
|
| Rate for Payer: Central Health Plan Commercial |
$583.88
|
| Rate for Payer: Cigna of CA HMO |
$510.89
|
| Rate for Payer: Cigna of CA PPO |
$510.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$620.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$620.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$620.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.94
|
| Rate for Payer: EPIC Health Plan Senior |
$291.94
|
| Rate for Payer: Galaxy Health WC |
$620.37
|
| Rate for Payer: Global Benefits Group Commercial |
$437.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$656.87
|
| Rate for Payer: InnovAge PACE Commercial |
$364.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$451.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$510.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$510.89
|
| Rate for Payer: Multiplan Commercial |
$547.39
|
| Rate for Payer: Networks By Design Commercial |
$474.40
|
| Rate for Payer: Prime Health Services Commercial |
$620.37
|
| Rate for Payer: Riverside University Health System MISP |
$291.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$437.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$437.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.93
|
| Rate for Payer: United Healthcare All Other HMO |
$364.93
|
| Rate for Payer: United Healthcare HMO Rider |
$364.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$364.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$620.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$620.37
|
| Rate for Payer: Vantage Medical Group Senior |
$620.37
|
|
|
DASATINIB 140 MG TABLET [108422]
|
Facility
|
IP
|
$729.85
|
|
|
Service Code
|
NDC 0003-0857-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$145.97 |
| Max. Negotiated Rate |
$656.87 |
| Rate for Payer: Adventist Health Commercial |
$145.97
|
| Rate for Payer: Blue Shield of California Commercial |
$564.17
|
| Rate for Payer: Blue Shield of California EPN |
$367.84
|
| Rate for Payer: Cash Price |
$401.42
|
| Rate for Payer: Central Health Plan Commercial |
$583.88
|
| Rate for Payer: Cigna of CA HMO |
$510.89
|
| Rate for Payer: Cigna of CA PPO |
$510.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.94
|
| Rate for Payer: EPIC Health Plan Senior |
$291.94
|
| Rate for Payer: Galaxy Health WC |
$620.37
|
| Rate for Payer: Global Benefits Group Commercial |
$437.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$656.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$451.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.97
|
| Rate for Payer: Multiplan Commercial |
$547.39
|
| Rate for Payer: Networks By Design Commercial |
$474.40
|
| Rate for Payer: Prime Health Services Commercial |
$620.37
|
|
|
DASATINIB 20 MG TABLET [76717]
|
Facility
|
OP
|
$202.48
|
|
|
Service Code
|
NDC 0003-0527-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$182.23 |
| Rate for Payer: Adventist Health Commercial |
$40.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$172.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$111.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$151.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.92
|
| Rate for Payer: Blue Shield of California Commercial |
$123.72
|
| Rate for Payer: Blue Shield of California EPN |
$80.79
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Central Health Plan Commercial |
$161.98
|
| Rate for Payer: Cigna of CA HMO |
$141.74
|
| Rate for Payer: Cigna of CA PPO |
$141.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$172.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$172.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$172.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.99
|
| Rate for Payer: EPIC Health Plan Senior |
$80.99
|
| Rate for Payer: Galaxy Health WC |
$172.11
|
| Rate for Payer: Global Benefits Group Commercial |
$121.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$182.23
|
| Rate for Payer: InnovAge PACE Commercial |
$101.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$135.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$141.74
|
| Rate for Payer: Multiplan Commercial |
$151.86
|
| Rate for Payer: Networks By Design Commercial |
$131.61
|
| Rate for Payer: Prime Health Services Commercial |
$172.11
|
| Rate for Payer: Riverside University Health System MISP |
$80.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.24
|
| Rate for Payer: United Healthcare All Other HMO |
$101.24
|
| Rate for Payer: United Healthcare HMO Rider |
$101.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$172.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$172.11
|
| Rate for Payer: Vantage Medical Group Senior |
$172.11
|
|
|
DASATINIB 20 MG TABLET [76717]
|
Facility
|
IP
|
$202.48
|
|
|
Service Code
|
NDC 0003-0527-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$182.23 |
| Rate for Payer: Adventist Health Commercial |
$40.50
|
| Rate for Payer: Blue Shield of California Commercial |
$156.52
|
| Rate for Payer: Blue Shield of California EPN |
$102.05
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Central Health Plan Commercial |
$161.98
|
| Rate for Payer: Cigna of CA HMO |
$141.74
|
| Rate for Payer: Cigna of CA PPO |
$141.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.99
|
| Rate for Payer: EPIC Health Plan Senior |
$80.99
|
| Rate for Payer: Galaxy Health WC |
$172.11
|
| Rate for Payer: Global Benefits Group Commercial |
$121.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$182.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$135.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$151.86
|
| Rate for Payer: Networks By Design Commercial |
$131.61
|
| Rate for Payer: Prime Health Services Commercial |
$172.11
|
|
