|
DASATINIB 70 MG TABLET [76719]
|
Facility
|
IP
|
$404.95
|
|
|
Service Code
|
NDC 0003-0524-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$80.99 |
| Max. Negotiated Rate |
$364.45 |
| Rate for Payer: Adventist Health Commercial |
$80.99
|
| Rate for Payer: Blue Shield of California Commercial |
$313.03
|
| Rate for Payer: Blue Shield of California EPN |
$204.09
|
| Rate for Payer: Cash Price |
$222.72
|
| Rate for Payer: Central Health Plan Commercial |
$323.96
|
| Rate for Payer: Cigna of CA HMO |
$283.46
|
| Rate for Payer: Cigna of CA PPO |
$283.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.98
|
| Rate for Payer: EPIC Health Plan Senior |
$161.98
|
| Rate for Payer: Galaxy Health WC |
$344.21
|
| Rate for Payer: Global Benefits Group Commercial |
$242.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.99
|
| Rate for Payer: Multiplan Commercial |
$303.71
|
| Rate for Payer: Networks By Design Commercial |
$263.22
|
| Rate for Payer: Prime Health Services Commercial |
$344.21
|
|
|
DASATINIB 70 MG TABLET [76719]
|
Facility
|
OP
|
$404.95
|
|
|
Service Code
|
NDC 0003-0524-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$80.99 |
| Max. Negotiated Rate |
$364.45 |
| Rate for Payer: Adventist Health Commercial |
$80.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$245.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.83
|
| Rate for Payer: Blue Shield of California Commercial |
$247.42
|
| Rate for Payer: Blue Shield of California EPN |
$161.58
|
| Rate for Payer: Cash Price |
$222.72
|
| Rate for Payer: Central Health Plan Commercial |
$323.96
|
| Rate for Payer: Cigna of CA HMO |
$283.46
|
| Rate for Payer: Cigna of CA PPO |
$283.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$344.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$344.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.98
|
| Rate for Payer: EPIC Health Plan Senior |
$161.98
|
| Rate for Payer: Galaxy Health WC |
$344.21
|
| Rate for Payer: Global Benefits Group Commercial |
$242.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.45
|
| Rate for Payer: InnovAge PACE Commercial |
$202.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$283.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$283.46
|
| Rate for Payer: Multiplan Commercial |
$303.71
|
| Rate for Payer: Networks By Design Commercial |
$263.22
|
| Rate for Payer: Prime Health Services Commercial |
$344.21
|
| Rate for Payer: Riverside University Health System MISP |
$161.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$242.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$242.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.47
|
| Rate for Payer: United Healthcare All Other HMO |
$202.47
|
| Rate for Payer: United Healthcare HMO Rider |
$202.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$202.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$344.21
|
| Rate for Payer: Vantage Medical Group Senior |
$344.21
|
|
|
DASATINIB 80 MG TABLET [108421]
|
Facility
|
IP
|
$729.85
|
|
|
Service Code
|
NDC 0003-0855-22
|
| 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 80 MG TABLET [108421]
|
Facility
|
OP
|
$729.85
|
|
|
Service Code
|
NDC 0003-0855-22
|
| 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
|
|
|
DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION [22661]
|
Facility
|
OP
|
$39.34
|
|
|
Service Code
|
HCPCS J9150
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$145.21 |
| Rate for Payer: Adventist Health Commercial |
$7.87
|
| Rate for Payer: Adventist Health Commercial |
$7.42
|
| Rate for Payer: Adventist Health Medi-Cal |
$19.76
|
| Rate for Payer: Adventist Health Medi-Cal |
$19.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.56
|
| Rate for Payer: Blue Shield of California Commercial |
$87.16
|
| Rate for Payer: Blue Shield of California Commercial |
$87.16
|
| Rate for Payer: Blue Shield of California EPN |
$79.24
|
| Rate for Payer: Blue Shield of California EPN |
$79.24
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$20.39
|
| Rate for Payer: Cash Price |
$20.39
|
| Rate for Payer: Central Health Plan Commercial |
$31.47
|
| Rate for Payer: Central Health Plan Commercial |
$29.66
|
| Rate for Payer: Cigna of CA HMO |
$25.96
|
| Rate for Payer: Cigna of CA HMO |
$27.54
|
| Rate for Payer: Cigna of CA PPO |
$25.96
|
| Rate for Payer: Cigna of CA PPO |
$27.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.68
|
| Rate for Payer: EPIC Health Plan Senior |
$19.76
|
| Rate for Payer: EPIC Health Plan Senior |
$19.76
|
| Rate for Payer: Galaxy Health WC |
$33.44
|
| Rate for Payer: Galaxy Health WC |
$31.52
|
| Rate for Payer: Global Benefits Group Commercial |
$23.60
|
| Rate for Payer: Global Benefits Group Commercial |
$22.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.76
|
| Rate for Payer: InnovAge PACE Commercial |
$29.64
|
| Rate for Payer: InnovAge PACE Commercial |
$29.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.48
|
| Rate for Payer: Multiplan Commercial |
$27.81
|
| Rate for Payer: Multiplan Commercial |
$29.50
|
| Rate for Payer: Networks By Design Commercial |
$19.67
|
| Rate for Payer: Networks By Design Commercial |
$18.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19.76
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19.76
|
| Rate for Payer: Prime Health Services Commercial |
$33.44
|
| Rate for Payer: Prime Health Services Commercial |
$31.52
|
| Rate for Payer: Prime Health Services Medicare |
$20.95
|
| Rate for Payer: Prime Health Services Medicare |
$20.95
|
| Rate for Payer: Riverside University Health System MISP |
$21.74
|
| Rate for Payer: Riverside University Health System MISP |
$21.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.76
|
| Rate for Payer: United Healthcare All Other HMO |
$13.55
|
| Rate for Payer: United Healthcare All Other HMO |
$14.37
|
| Rate for Payer: United Healthcare HMO Rider |
$13.25
|
| Rate for Payer: United Healthcare HMO Rider |
$14.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.74
|
| Rate for Payer: Vantage Medical Group Senior |
$21.74
|
| Rate for Payer: Vantage Medical Group Senior |
$21.74
|
|
|
DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION [22661]
|
Facility
|
IP
|
$39.34
|
|
|
Service Code
|
HCPCS J9150
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$35.41 |
| Rate for Payer: Adventist Health Commercial |
$7.87
|
| Rate for Payer: Adventist Health Commercial |
$7.42
|
| Rate for Payer: Blue Shield of California Commercial |
$30.41
|
| Rate for Payer: Blue Shield of California Commercial |
$28.66
|
| Rate for Payer: Blue Shield of California EPN |
$18.69
|
| Rate for Payer: Blue Shield of California EPN |
$19.83
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$20.39
|
| Rate for Payer: Central Health Plan Commercial |
$31.47
|
| Rate for Payer: Central Health Plan Commercial |
$29.66
|
| Rate for Payer: Cigna of CA HMO |
$25.96
|
| Rate for Payer: Cigna of CA HMO |
$27.54
|
| Rate for Payer: Cigna of CA PPO |
$25.96
|
| Rate for Payer: Cigna of CA PPO |
$27.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.74
|
| Rate for Payer: EPIC Health Plan Senior |
$14.83
|
| Rate for Payer: EPIC Health Plan Senior |
$15.74
|
| Rate for Payer: Galaxy Health WC |
$31.52
|
| Rate for Payer: Galaxy Health WC |
$33.44
|
| Rate for Payer: Global Benefits Group Commercial |
$23.60
|
| Rate for Payer: Global Benefits Group Commercial |
$22.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.42
|
| Rate for Payer: Multiplan Commercial |
$27.81
|
| Rate for Payer: Multiplan Commercial |
$29.50
|
| Rate for Payer: Networks By Design Commercial |
$18.54
|
| Rate for Payer: Networks By Design Commercial |
$19.67
|
| Rate for Payer: Prime Health Services Commercial |
$33.44
|
| Rate for Payer: Prime Health Services Commercial |
$31.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.76
|
| Rate for Payer: United Healthcare All Other HMO |
$14.37
|
| Rate for Payer: United Healthcare All Other HMO |
$13.55
|
| Rate for Payer: United Healthcare HMO Rider |
$13.25
|
| Rate for Payer: United Healthcare HMO Rider |
$14.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.88
|
|
|
DECITABINE 50 MG INTRAVENOUS SOLUTION [76364]
|
Facility
|
OP
|
$237.60
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$213.84 |
| Rate for Payer: Adventist Health Commercial |
$47.52
|
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$437.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$130.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$396.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$178.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$540.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.78
|
| Rate for Payer: Blue Shield of California Commercial |
$8.33
|
| Rate for Payer: Blue Shield of California Commercial |
$8.33
|
| Rate for Payer: Blue Shield of California Commercial |
$8.33
|
| Rate for Payer: Blue Shield of California EPN |
$7.57
|
| Rate for Payer: Blue Shield of California EPN |
$7.57
|
| Rate for Payer: Blue Shield of California EPN |
$7.57
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$130.68
|
| Rate for Payer: Cash Price |
$130.68
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Central Health Plan Commercial |
$576.00
|
| Rate for Payer: Central Health Plan Commercial |
$190.08
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$504.00
|
| Rate for Payer: Cigna of CA HMO |
$166.32
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$504.00
|
| Rate for Payer: Cigna of CA PPO |
$166.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$201.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$612.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$201.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$612.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$95.04
|
| Rate for Payer: EPIC Health Plan Senior |
$288.00
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$201.96
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Global Benefits Group Commercial |
$142.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$648.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$213.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.76
|
| Rate for Payer: InnovAge PACE Commercial |
$360.00
|
| Rate for Payer: InnovAge PACE Commercial |
$118.80
|
| Rate for Payer: InnovAge PACE Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$480.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$445.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$504.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$166.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$166.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$504.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$178.20
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$360.00
|
| Rate for Payer: Networks By Design Commercial |
$118.80
|
| Rate for Payer: Prime Health Services Commercial |
$201.96
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Riverside University Health System MISP |
$288.00
|
| Rate for Payer: Riverside University Health System MISP |
$95.04
|
| Rate for Payer: Riverside University Health System MISP |
$48.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$142.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$432.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$142.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$432.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare All Other HMO |
$86.80
|
| Rate for Payer: United Healthcare All Other HMO |
$263.02
|
| Rate for Payer: United Healthcare HMO Rider |
$84.92
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare HMO Rider |
$257.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$612.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$201.96
|
| Rate for Payer: Vantage Medical Group Senior |
$201.96
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$612.00
|
|
|
DECITABINE 50 MG INTRAVENOUS SOLUTION [76364]
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Adventist Health Commercial |
$47.52
|
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Blue Shield of California Commercial |
$556.56
|
| Rate for Payer: Blue Shield of California Commercial |
$183.66
|
| Rate for Payer: Blue Shield of California Commercial |
$92.76
|
| Rate for Payer: Blue Shield of California EPN |
$60.48
|
| Rate for Payer: Blue Shield of California EPN |
$362.88
|
| Rate for Payer: Blue Shield of California EPN |
$119.75
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$130.68
|
| Rate for Payer: Central Health Plan Commercial |
$190.08
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Central Health Plan Commercial |
$576.00
|
| Rate for Payer: Cigna of CA HMO |
$504.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$166.32
|
| Rate for Payer: Cigna of CA PPO |
$504.00
|
| Rate for Payer: Cigna of CA PPO |
$166.32
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$95.04
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$288.00
|
| Rate for Payer: Galaxy Health WC |
$201.96
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Global Benefits Group Commercial |
$142.56
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$648.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$213.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$480.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$445.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Multiplan Commercial |
$178.20
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$360.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$118.80
|
| Rate for Payer: Prime Health Services Commercial |
$201.96
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.17
|
| Rate for Payer: United Healthcare All Other HMO |
$86.80
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare All Other HMO |
$263.02
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare HMO Rider |
$84.92
|
| Rate for Payer: United Healthcare HMO Rider |
$257.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
|
|
DEFERASIROX 180 MG TABLET [206427]
|
Facility
|
OP
|
$132.38
|
|
|
Service Code
|
NDC 0078-0655-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.48 |
| Max. Negotiated Rate |
$119.14 |
| Rate for Payer: Adventist Health Commercial |
$26.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$64.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.75
|
| Rate for Payer: Blue Shield of California Commercial |
$80.88
|
| Rate for Payer: Blue Shield of California EPN |
$52.82
|
| Rate for Payer: Cash Price |
$72.81
|
| Rate for Payer: Central Health Plan Commercial |
$105.90
|
| Rate for Payer: Cigna of CA HMO |
$92.67
|
| Rate for Payer: Cigna of CA PPO |
$92.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.95
|
| Rate for Payer: EPIC Health Plan Senior |
$52.95
|
| Rate for Payer: Galaxy Health WC |
$112.52
|
| Rate for Payer: Global Benefits Group Commercial |
$79.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.14
|
| Rate for Payer: InnovAge PACE Commercial |
$66.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.67
|
| Rate for Payer: Multiplan Commercial |
$99.28
|
| Rate for Payer: Networks By Design Commercial |
$86.05
|
| Rate for Payer: Prime Health Services Commercial |
$112.52
|
| Rate for Payer: Riverside University Health System MISP |
$52.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.19
|
| Rate for Payer: United Healthcare All Other HMO |
$66.19
|
| Rate for Payer: United Healthcare HMO Rider |
$66.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.52
|
| Rate for Payer: Vantage Medical Group Senior |
$112.52
|
|
|
DEFERASIROX 180 MG TABLET [206427]
|
Facility
|
IP
|
$132.38
|
|
|
Service Code
|
NDC 0078-0655-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.48 |
| Max. Negotiated Rate |
$119.14 |
| Rate for Payer: Adventist Health Commercial |
$26.48
|
| Rate for Payer: Blue Shield of California Commercial |
$102.33
|
| Rate for Payer: Blue Shield of California EPN |
$66.72
|
| Rate for Payer: Cash Price |
$72.81
|
| Rate for Payer: Central Health Plan Commercial |
$105.90
|
| Rate for Payer: Cigna of CA HMO |
$92.67
|
| Rate for Payer: Cigna of CA PPO |
$92.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.95
|
| Rate for Payer: EPIC Health Plan Senior |
$52.95
|
| Rate for Payer: Galaxy Health WC |
$112.52
|
| Rate for Payer: Global Benefits Group Commercial |
$79.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.48
|
| Rate for Payer: Multiplan Commercial |
$99.28
|
| Rate for Payer: Networks By Design Commercial |
$86.05
|
| Rate for Payer: Prime Health Services Commercial |
$112.52
|
|
|
DEFERASIROX 250 MG DISPERSIBLE TABLET [43416]
|
Facility
|
OP
|
$123.47
|
|
|
Service Code
|
NDC 0078-0469-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$24.69 |
| Max. Negotiated Rate |
$111.12 |
| Rate for Payer: Adventist Health Commercial |
$24.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$104.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.51
|
| Rate for Payer: Blue Shield of California Commercial |
$75.44
|
| Rate for Payer: Blue Shield of California EPN |
$49.26
|
| Rate for Payer: Cash Price |
$67.91
|
| Rate for Payer: Central Health Plan Commercial |
$98.78
|
| Rate for Payer: Cigna of CA HMO |
$86.43
|
| Rate for Payer: Cigna of CA PPO |
$86.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$104.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$104.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$104.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.39
|
| Rate for Payer: EPIC Health Plan Senior |
$49.39
|
| Rate for Payer: Galaxy Health WC |
$104.95
|
| Rate for Payer: Global Benefits Group Commercial |
$74.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.12
|
| Rate for Payer: InnovAge PACE Commercial |
$61.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$86.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.43
|
| Rate for Payer: Multiplan Commercial |
$92.60
|
| Rate for Payer: Networks By Design Commercial |
$80.26
|
| Rate for Payer: Prime Health Services Commercial |
$104.95
|
| Rate for Payer: Riverside University Health System MISP |
$49.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.73
|
| Rate for Payer: United Healthcare All Other HMO |
$61.73
|
| Rate for Payer: United Healthcare HMO Rider |
$61.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$104.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$104.95
|
| Rate for Payer: Vantage Medical Group Senior |
$104.95
|
|
|
DEFERASIROX 250 MG DISPERSIBLE TABLET [43416]
|
Facility
|
IP
|
$123.47
|
|
|
Service Code
|
NDC 0078-0469-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$24.69 |
| Max. Negotiated Rate |
$111.12 |
| Rate for Payer: Adventist Health Commercial |
$24.69
|
| Rate for Payer: Blue Shield of California Commercial |
$95.44
|
| Rate for Payer: Blue Shield of California EPN |
$62.23
|
| Rate for Payer: Cash Price |
$67.91
|
| Rate for Payer: Central Health Plan Commercial |
$98.78
|
| Rate for Payer: Cigna of CA HMO |
$86.43
|
| Rate for Payer: Cigna of CA PPO |
$86.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.39
|
| Rate for Payer: EPIC Health Plan Senior |
$49.39
|
| Rate for Payer: Galaxy Health WC |
$104.95
|
| Rate for Payer: Global Benefits Group Commercial |
$74.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.69
|
| Rate for Payer: Multiplan Commercial |
$92.60
|
| Rate for Payer: Networks By Design Commercial |
$80.26
|
| Rate for Payer: Prime Health Services Commercial |
$104.95
|
|
|
DEFERASIROX 360 MG TABLET [206428]
|
Facility
|
OP
|
$264.76
|
|
|
Service Code
|
NDC 0078-0656-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$52.95 |
| Max. Negotiated Rate |
$238.28 |
| Rate for Payer: Adventist Health Commercial |
$52.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$160.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.49
|
| Rate for Payer: Blue Shield of California Commercial |
$161.77
|
| Rate for Payer: Blue Shield of California EPN |
$105.64
|
| Rate for Payer: Cash Price |
$145.62
|
| Rate for Payer: Central Health Plan Commercial |
$211.81
|
| Rate for Payer: Cigna of CA HMO |
$185.33
|
| Rate for Payer: Cigna of CA PPO |
$185.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.90
|
| Rate for Payer: EPIC Health Plan Senior |
$105.90
|
| Rate for Payer: Galaxy Health WC |
$225.05
|
| Rate for Payer: Global Benefits Group Commercial |
$158.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.28
|
| Rate for Payer: InnovAge PACE Commercial |
$132.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.33
|
| Rate for Payer: Multiplan Commercial |
$198.57
|
| Rate for Payer: Networks By Design Commercial |
$172.09
|
| Rate for Payer: Prime Health Services Commercial |
$225.05
|
| Rate for Payer: Riverside University Health System MISP |
$105.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.38
|
| Rate for Payer: United Healthcare All Other HMO |
$132.38
|
| Rate for Payer: United Healthcare HMO Rider |
$132.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.05
|
| Rate for Payer: Vantage Medical Group Senior |
$225.05
|
|
|
DEFERASIROX 360 MG TABLET [206428]
|
Facility
|
IP
|
$264.76
|
|
|
Service Code
|
NDC 0078-0656-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$52.95 |
| Max. Negotiated Rate |
$238.28 |
| Rate for Payer: Adventist Health Commercial |
$52.95
|
| Rate for Payer: Blue Shield of California Commercial |
$204.66
|
| Rate for Payer: Blue Shield of California EPN |
$133.44
|
| Rate for Payer: Cash Price |
$145.62
|
| Rate for Payer: Central Health Plan Commercial |
$211.81
|
| Rate for Payer: Cigna of CA HMO |
$185.33
|
| Rate for Payer: Cigna of CA PPO |
$185.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.90
|
| Rate for Payer: EPIC Health Plan Senior |
$105.90
|
| Rate for Payer: Galaxy Health WC |
$225.05
|
| Rate for Payer: Global Benefits Group Commercial |
$158.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.95
|
| Rate for Payer: Multiplan Commercial |
$198.57
|
| Rate for Payer: Networks By Design Commercial |
$172.09
|
| Rate for Payer: Prime Health Services Commercial |
$225.05
|
|
|
DEFERASIROX 500 MG DISPERSIBLE TABLET [43417]
|
Facility
|
OP
|
$246.93
|
|
|
Service Code
|
NDC 0078-0470-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$49.39 |
| Max. Negotiated Rate |
$222.24 |
| Rate for Payer: Adventist Health Commercial |
$49.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.02
|
| Rate for Payer: Blue Shield of California Commercial |
$150.87
|
| Rate for Payer: Blue Shield of California EPN |
$98.53
|
| Rate for Payer: Cash Price |
$135.81
|
| Rate for Payer: Central Health Plan Commercial |
$197.54
|
| Rate for Payer: Cigna of CA HMO |
$172.85
|
| Rate for Payer: Cigna of CA PPO |
$172.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.77
|
| Rate for Payer: EPIC Health Plan Senior |
$98.77
|
| Rate for Payer: Galaxy Health WC |
$209.89
|
| Rate for Payer: Global Benefits Group Commercial |
$148.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$222.24
|
| Rate for Payer: InnovAge PACE Commercial |
$123.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$172.85
|
| Rate for Payer: Multiplan Commercial |
$185.20
|
| Rate for Payer: Networks By Design Commercial |
$160.50
|
| Rate for Payer: Prime Health Services Commercial |
$209.89
|
| Rate for Payer: Riverside University Health System MISP |
$98.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.47
|
| Rate for Payer: United Healthcare All Other HMO |
$123.47
|
| Rate for Payer: United Healthcare HMO Rider |
$123.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$209.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.89
|
| Rate for Payer: Vantage Medical Group Senior |
$209.89
|
|
|
DEFERASIROX 500 MG DISPERSIBLE TABLET [43417]
|
Facility
|
IP
|
$246.93
|
|
|
Service Code
|
NDC 0078-0470-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$49.39 |
| Max. Negotiated Rate |
$222.24 |
| Rate for Payer: Adventist Health Commercial |
$49.39
|
| Rate for Payer: Blue Shield of California Commercial |
$190.88
|
| Rate for Payer: Blue Shield of California EPN |
$124.45
|
| Rate for Payer: Cash Price |
$135.81
|
| Rate for Payer: Central Health Plan Commercial |
$197.54
|
| Rate for Payer: Cigna of CA HMO |
$172.85
|
| Rate for Payer: Cigna of CA PPO |
$172.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.77
|
| Rate for Payer: EPIC Health Plan Senior |
$98.77
|
| Rate for Payer: Galaxy Health WC |
$209.89
|
| Rate for Payer: Global Benefits Group Commercial |
$148.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$222.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.39
|
| Rate for Payer: Multiplan Commercial |
$185.20
|
| Rate for Payer: Networks By Design Commercial |
$160.50
|
| Rate for Payer: Prime Health Services Commercial |
$209.89
|
|
|
DEFERASIROX 90 MG TABLET [206426]
|
Facility
|
OP
|
$66.19
|
|
|
Service Code
|
NDC 0078-0654-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$59.57 |
| Rate for Payer: Adventist Health Commercial |
$13.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.87
|
| Rate for Payer: Blue Shield of California Commercial |
$40.44
|
| Rate for Payer: Blue Shield of California EPN |
$26.41
|
| Rate for Payer: Cash Price |
$36.41
|
| Rate for Payer: Central Health Plan Commercial |
$52.95
|
| Rate for Payer: Cigna of CA HMO |
$46.33
|
| Rate for Payer: Cigna of CA PPO |
$46.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.48
|
| Rate for Payer: EPIC Health Plan Senior |
$26.48
|
| Rate for Payer: Galaxy Health WC |
$56.26
|
| Rate for Payer: Global Benefits Group Commercial |
$39.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.57
|
| Rate for Payer: InnovAge PACE Commercial |
$33.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.33
|
| Rate for Payer: Multiplan Commercial |
$49.64
|
| Rate for Payer: Networks By Design Commercial |
$43.02
|
| Rate for Payer: Prime Health Services Commercial |
$56.26
|
| Rate for Payer: Riverside University Health System MISP |
$26.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.09
|
| Rate for Payer: United Healthcare All Other HMO |
$33.09
|
| Rate for Payer: United Healthcare HMO Rider |
$33.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.26
|
| Rate for Payer: Vantage Medical Group Senior |
$56.26
|
|
|
DEFERASIROX 90 MG TABLET [206426]
|
Facility
|
IP
|
$66.19
|
|
|
Service Code
|
NDC 0078-0654-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$59.57 |
| Rate for Payer: Adventist Health Commercial |
$13.24
|
| Rate for Payer: Blue Shield of California Commercial |
$51.16
|
| Rate for Payer: Blue Shield of California EPN |
$33.36
|
| Rate for Payer: Cash Price |
$36.41
|
| Rate for Payer: Central Health Plan Commercial |
$52.95
|
| Rate for Payer: Cigna of CA HMO |
$46.33
|
| Rate for Payer: Cigna of CA PPO |
$46.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.48
|
| Rate for Payer: EPIC Health Plan Senior |
$26.48
|
| Rate for Payer: Galaxy Health WC |
$56.26
|
| Rate for Payer: Global Benefits Group Commercial |
$39.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.24
|
| Rate for Payer: Multiplan Commercial |
$49.64
|
| Rate for Payer: Networks By Design Commercial |
$43.02
|
| Rate for Payer: Prime Health Services Commercial |
$56.26
|
|
|
DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION [9722]
|
Facility
|
OP
|
$49.44
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$44.50 |
| Rate for Payer: Adventist Health Commercial |
$9.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.08
|
| Rate for Payer: Blue Shield of California Commercial |
$14.92
|
| Rate for Payer: Blue Shield of California EPN |
$13.56
|
| Rate for Payer: Cash Price |
$27.19
|
| Rate for Payer: Cash Price |
$27.19
|
| Rate for Payer: Central Health Plan Commercial |
$39.55
|
| Rate for Payer: Cigna of CA HMO |
$34.61
|
| Rate for Payer: Cigna of CA PPO |
$34.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.78
|
| Rate for Payer: EPIC Health Plan Senior |
$19.78
|
| Rate for Payer: Galaxy Health WC |
$42.02
|
| Rate for Payer: Global Benefits Group Commercial |
$29.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.21
|
| Rate for Payer: InnovAge PACE Commercial |
$24.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.61
|
| Rate for Payer: Multiplan Commercial |
$37.08
|
| Rate for Payer: Networks By Design Commercial |
$24.72
|
| Rate for Payer: Prime Health Services Commercial |
$42.02
|
| Rate for Payer: Riverside University Health System MISP |
$19.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.55
|
| Rate for Payer: United Healthcare All Other HMO |
$18.06
|
| Rate for Payer: United Healthcare HMO Rider |
$17.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.02
|
| Rate for Payer: Vantage Medical Group Senior |
$42.02
|
|
|
DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION [9722]
|
Facility
|
IP
|
$49.44
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$44.50 |
| Rate for Payer: Adventist Health Commercial |
$9.89
|
| Rate for Payer: Blue Shield of California Commercial |
$38.22
|
| Rate for Payer: Blue Shield of California EPN |
$24.92
|
| Rate for Payer: Cash Price |
$27.19
|
| Rate for Payer: Central Health Plan Commercial |
$39.55
|
| Rate for Payer: Cigna of CA HMO |
$34.61
|
| Rate for Payer: Cigna of CA PPO |
$34.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.78
|
| Rate for Payer: EPIC Health Plan Senior |
$19.78
|
| Rate for Payer: Galaxy Health WC |
$42.02
|
| Rate for Payer: Global Benefits Group Commercial |
$29.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.89
|
| Rate for Payer: Multiplan Commercial |
$37.08
|
| Rate for Payer: Networks By Design Commercial |
$24.72
|
| Rate for Payer: Prime Health Services Commercial |
$42.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.55
|
| Rate for Payer: United Healthcare All Other HMO |
$18.06
|
| Rate for Payer: United Healthcare HMO Rider |
$17.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.19
|
|
|
DEFEROXAMINE 500 MG SOLN FOR INJ (MIXTURE COMPONENT) [408000012]
|
Facility
|
OP
|
$17.71
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$26.33 |
| Rate for Payer: Adventist Health Commercial |
$3.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.08
|
| Rate for Payer: Blue Shield of California Commercial |
$14.92
|
| Rate for Payer: Blue Shield of California EPN |
$13.56
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Central Health Plan Commercial |
$14.17
|
| Rate for Payer: Cigna of CA HMO |
$12.40
|
| Rate for Payer: Cigna of CA PPO |
$12.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Senior |
$7.08
|
| Rate for Payer: Galaxy Health WC |
$15.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.21
|
| Rate for Payer: InnovAge PACE Commercial |
$8.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.40
|
| Rate for Payer: Multiplan Commercial |
$13.28
|
| Rate for Payer: Networks By Design Commercial |
$8.86
|
| Rate for Payer: Prime Health Services Commercial |
$15.05
|
| Rate for Payer: Riverside University Health System MISP |
$7.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.65
|
| Rate for Payer: United Healthcare All Other HMO |
$6.47
|
| Rate for Payer: United Healthcare HMO Rider |
$6.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
DEFEROXAMINE 500 MG SOLN FOR INJ (MIXTURE COMPONENT) [408000012]
|
Facility
|
IP
|
$17.71
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$15.94 |
| Rate for Payer: Adventist Health Commercial |
$3.54
|
| Rate for Payer: Blue Shield of California Commercial |
$13.69
|
| Rate for Payer: Blue Shield of California EPN |
$8.93
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Central Health Plan Commercial |
$14.17
|
| Rate for Payer: Cigna of CA HMO |
$12.40
|
| Rate for Payer: Cigna of CA PPO |
$12.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Senior |
$7.08
|
| Rate for Payer: Galaxy Health WC |
$15.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Multiplan Commercial |
$13.28
|
| Rate for Payer: Networks By Design Commercial |
$8.86
|
| Rate for Payer: Prime Health Services Commercial |
$15.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.65
|
| Rate for Payer: United Healthcare All Other HMO |
$6.47
|
| Rate for Payer: United Healthcare HMO Rider |
$6.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.80
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION [9723]
|
Facility
|
OP
|
$15.54
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$26.33 |
| Rate for Payer: Adventist Health Commercial |
$3.11
|
| Rate for Payer: Adventist Health Commercial |
$3.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.08
|
| Rate for Payer: Blue Shield of California Commercial |
$14.92
|
| Rate for Payer: Blue Shield of California Commercial |
$14.92
|
| Rate for Payer: Blue Shield of California EPN |
$13.56
|
| Rate for Payer: Blue Shield of California EPN |
$13.56
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Central Health Plan Commercial |
$12.43
|
| Rate for Payer: Central Health Plan Commercial |
$14.17
|
| Rate for Payer: Cigna of CA HMO |
$12.40
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.40
|
| Rate for Payer: Cigna of CA PPO |
$10.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.22
|
| Rate for Payer: EPIC Health Plan Senior |
$6.22
|
| Rate for Payer: EPIC Health Plan Senior |
$7.08
|
| Rate for Payer: Galaxy Health WC |
$15.05
|
| Rate for Payer: Galaxy Health WC |
$13.21
|
| Rate for Payer: Global Benefits Group Commercial |
$10.63
|
| Rate for Payer: Global Benefits Group Commercial |
$9.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.21
|
| Rate for Payer: InnovAge PACE Commercial |
$7.77
|
| Rate for Payer: InnovAge PACE Commercial |
$8.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.88
|
| Rate for Payer: Multiplan Commercial |
$11.65
|
| Rate for Payer: Multiplan Commercial |
$13.28
|
| Rate for Payer: Networks By Design Commercial |
$8.86
|
| Rate for Payer: Networks By Design Commercial |
$7.77
|
| Rate for Payer: Prime Health Services Commercial |
$15.05
|
| Rate for Payer: Prime Health Services Commercial |
$13.21
|
| Rate for Payer: Riverside University Health System MISP |
$6.22
|
| Rate for Payer: Riverside University Health System MISP |
$7.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.83
|
| Rate for Payer: United Healthcare All Other HMO |
$5.68
|
| Rate for Payer: United Healthcare All Other HMO |
$6.47
|
| Rate for Payer: United Healthcare HMO Rider |
$5.55
|
| Rate for Payer: United Healthcare HMO Rider |
$6.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.21
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION [9723]
|
Facility
|
IP
|
$17.71
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$15.94 |
| Rate for Payer: Adventist Health Commercial |
$3.54
|
| Rate for Payer: Adventist Health Commercial |
$3.11
|
| Rate for Payer: Blue Shield of California Commercial |
$13.69
|
| Rate for Payer: Blue Shield of California Commercial |
$12.01
|
| Rate for Payer: Blue Shield of California EPN |
$7.83
|
| Rate for Payer: Blue Shield of California EPN |
$8.93
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Central Health Plan Commercial |
$14.17
|
| Rate for Payer: Central Health Plan Commercial |
$12.43
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA HMO |
$12.40
|
| Rate for Payer: Cigna of CA PPO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Senior |
$6.22
|
| Rate for Payer: EPIC Health Plan Senior |
$7.08
|
| Rate for Payer: Galaxy Health WC |
$13.21
|
| Rate for Payer: Galaxy Health WC |
$15.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10.63
|
| Rate for Payer: Global Benefits Group Commercial |
$9.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$11.65
|
| Rate for Payer: Multiplan Commercial |
$13.28
|
| Rate for Payer: Networks By Design Commercial |
$7.77
|
| Rate for Payer: Networks By Design Commercial |
$8.86
|
| Rate for Payer: Prime Health Services Commercial |
$15.05
|
| Rate for Payer: Prime Health Services Commercial |
$13.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.65
|
| Rate for Payer: United Healthcare All Other HMO |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO |
$5.68
|
| Rate for Payer: United Healthcare HMO Rider |
$5.55
|
| Rate for Payer: United Healthcare HMO Rider |
$6.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.80
|
|
|
DEFIBROTIDE 80 MG/ML INTRAVENOUS SOLUTION [214034]
|
Facility
|
IP
|
$573.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.72 |
| Max. Negotiated Rate |
$516.24 |
| Rate for Payer: Adventist Health Commercial |
$114.72
|
| Rate for Payer: Blue Shield of California Commercial |
$443.39
|
| Rate for Payer: Blue Shield of California EPN |
$289.09
|
| Rate for Payer: Cash Price |
$315.48
|
| Rate for Payer: Central Health Plan Commercial |
$458.88
|
| Rate for Payer: Cigna of CA HMO |
$401.52
|
| Rate for Payer: Cigna of CA PPO |
$401.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.44
|
| Rate for Payer: EPIC Health Plan Senior |
$229.44
|
| Rate for Payer: Galaxy Health WC |
$487.56
|
| Rate for Payer: Global Benefits Group Commercial |
$344.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$516.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.72
|
| Rate for Payer: Multiplan Commercial |
$430.20
|
| Rate for Payer: Networks By Design Commercial |
$286.80
|
| Rate for Payer: Prime Health Services Commercial |
$487.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$215.27
|
| Rate for Payer: United Healthcare All Other HMO |
$209.54
|
| Rate for Payer: United Healthcare HMO Rider |
$205.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$187.85
|
|
