|
DAPSONE 25 MG TABLET [2132]
|
Facility
OP
|
$2.37
|
|
|
Service Code
|
NDC 13925-504-30
|
| Hospital Charge Code |
1711606
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.40
|
| Rate for Payer: BCBS Transplant Transplant |
$1.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1.49
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Central Health Plan Commercial |
$1.90
|
| Rate for Payer: Cigna of CA HMO |
$1.66
|
| Rate for Payer: Cigna of CA PPO |
$1.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$2.01
|
| Rate for Payer: Global Benefits Group Commercial |
$1.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.78
|
| Rate for Payer: IEHP medi-cal |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.78
|
| Rate for Payer: Networks By Design Commercial |
$1.54
|
| Rate for Payer: Prime Health Services Commercial |
$2.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.42
|
| Rate for Payer: Riverside University Health MISP |
$0.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.18
|
| Rate for Payer: United Healthcare All Other HMO |
$1.18
|
| Rate for Payer: United Healthcare HMO Rider |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.01
|
| Rate for Payer: Vantage Medical Group Senior |
$2.01
|
|
|
DAPSONE ORAL SUSPENSION COMPOUND 2 MG/ML [4080263]
|
Facility
OP
|
$2.37
|
|
|
Service Code
|
NDC 9994-0802-63
|
| Hospital Charge Code |
1715000
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.40
|
| Rate for Payer: BCBS Transplant Transplant |
$1.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1.49
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Central Health Plan Commercial |
$1.90
|
| Rate for Payer: Cigna of CA HMO |
$1.66
|
| Rate for Payer: Cigna of CA PPO |
$1.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$2.01
|
| Rate for Payer: Global Benefits Group Commercial |
$1.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.78
|
| Rate for Payer: IEHP medi-cal |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.78
|
| Rate for Payer: Networks By Design Commercial |
$1.54
|
| Rate for Payer: Prime Health Services Commercial |
$2.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.42
|
| Rate for Payer: Riverside University Health MISP |
$0.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.18
|
| Rate for Payer: United Healthcare All Other HMO |
$1.18
|
| Rate for Payer: United Healthcare HMO Rider |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.01
|
| Rate for Payer: Vantage Medical Group Senior |
$2.01
|
|
|
DAPSONE ORAL SUSPENSION COMPOUND 2 MG/ML [4080263]
|
Facility
IP
|
$2.37
|
|
|
Service Code
|
NDC 9994-0802-63
|
| Hospital Charge Code |
1715000
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.78
|
| Rate for Payer: Blue Shield of California EPN |
$1.27
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Central Health Plan Commercial |
$1.90
|
| Rate for Payer: Cigna of CA HMO |
$1.66
|
| Rate for Payer: Cigna of CA PPO |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$2.01
|
| Rate for Payer: Global Benefits Group Commercial |
$1.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.78
|
| Rate for Payer: Networks By Design Commercial |
$1.54
|
| Rate for Payer: Prime Health Services Commercial |
$2.01
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION [36989]
|
Facility
IP
|
$42.00
|
|
|
Service Code
|
CPT J0878
|
| Hospital Charge Code |
1720999
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$90.00
|
| Rate for Payer: Blue Shield of California Commercial |
$31.50
|
| Rate for Payer: Blue Shield of California EPN |
$22.43
|
| Rate for Payer: Blue Shield of California EPN |
$64.08
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$29.40
|
| 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 |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION [36989]
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
CPT J0878
|
| Hospital Charge Code |
1720999
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
| Rate for Payer: BCBS Transplant Transplant |
$72.00
|
| Rate for Payer: BCBS Transplant Transplant |
$25.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$29.40
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$29.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$90.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$31.50
|
| Rate for Payer: IEHP medi-cal |
$0.02
|
| Rate for Payer: IEHP medi-cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Riverside University Health MISP |
$48.00
|
| Rate for Payer: Riverside University Health MISP |
$16.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.00
|
| Rate for Payer: United Healthcare All Other HMO |
$60.00
|
| Rate for Payer: United Healthcare All Other HMO |
$21.00
|
| Rate for Payer: United Healthcare HMO Rider |
$21.00
|
| Rate for Payer: United Healthcare HMO Rider |
$60.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.70
|
| Rate for Payer: Vantage Medical Group Senior |
$35.70
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
DARATUMUMAB 1,800 MG-HYALURONIDASE-FIHJ 30,000 UNIT/15 ML SUBCUT SOLN [228045]
|
Facility
OP
|
$729.49
|
|
|
Service Code
|
CPT J9144
|
| Hospital Charge Code |
NDG228045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.05 |
| Max. Negotiated Rate |
$656.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$49.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$61.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$53.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$53.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$83.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.15
|
| Rate for Payer: BCBS Transplant Transplant |
$437.69
|
| Rate for Payer: Blue Shield of California Commercial |
$458.85
|
| Rate for Payer: Blue Shield of California EPN |
$356.72
|
| Rate for Payer: Caremore Medicare Advantage |
$49.05
|
| Rate for Payer: Cash Price |
$328.27
|
| Rate for Payer: Cash Price |
$328.27
|
| Rate for Payer: Central Health Plan Commercial |
$583.59
|
| Rate for Payer: Cigna of CA HMO |
$510.64
|
| Rate for Payer: Cigna of CA PPO |
$510.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$49.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$49.05
|
| Rate for Payer: Galaxy Health WC |
$620.07
|
| Rate for Payer: Global Benefits Group Commercial |
$437.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$656.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$547.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$80.44
|
| Rate for Payer: IEHP medi-cal |
$80.93
|
| Rate for Payer: IEHP Medicare Advantage |
$49.05
|
| Rate for Payer: Innovage PACE Commercial |
$73.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$65.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$65.73
|
| Rate for Payer: Multiplan Commercial |
$547.12
|
| Rate for Payer: Networks By Design Commercial |
$364.74
|
| Rate for Payer: Prime Health Services Commercial |
$620.07
|
| Rate for Payer: Prime Health Services Medicare |
$51.99
|
| Rate for Payer: Riverside University Health MISP |
$53.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$437.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$437.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.74
|
| Rate for Payer: United Healthcare All Other HMO |
$364.74
|
| Rate for Payer: United Healthcare HMO Rider |
$364.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$364.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.96
|
| Rate for Payer: Vantage Medical Group Senior |
$53.96
|
|
|
DARATUMUMAB 1,800 MG-HYALURONIDASE-FIHJ 30,000 UNIT/15 ML SUBCUT SOLN [228045]
|
Facility
IP
|
$729.49
|
|
|
Service Code
|
CPT J9144
|
| Hospital Charge Code |
NDG228045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$145.90 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$547.12
|
| Rate for Payer: Blue Shield of California EPN |
$389.55
|
| Rate for Payer: Cash Price |
$328.27
|
| Rate for Payer: Cash Price |
$328.27
|
| Rate for Payer: Central Health Plan Commercial |
$583.59
|
| Rate for Payer: Cigna of CA HMO |
$510.64
|
| Rate for Payer: Cigna of CA PPO |
$510.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$291.80
|
| Rate for Payer: Galaxy Health WC |
$620.07
|
| Rate for Payer: Global Benefits Group Commercial |
$437.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$656.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.90
|
| Rate for Payer: Multiplan Commercial |
$547.12
|
| Rate for Payer: Networks By Design Commercial |
$364.74
|
| Rate for Payer: Prime Health Services Commercial |
$620.07
|
|
|
DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION [211862]
|
Facility
IP
|
$160.56
|
|
|
Service Code
|
NDC 57894-502-05
|
| Hospital Charge Code |
NDG211862B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.11 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$120.42
|
| Rate for Payer: Blue Shield of California EPN |
$85.74
|
| Rate for Payer: Cash Price |
$72.25
|
| Rate for Payer: Cash Price |
$72.25
|
| Rate for Payer: Central Health Plan Commercial |
$128.45
|
| Rate for Payer: Cigna of CA HMO |
$112.39
|
| Rate for Payer: Cigna of CA PPO |
$112.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.22
|
| Rate for Payer: Galaxy Health WC |
$136.48
|
| Rate for Payer: Global Benefits Group Commercial |
$96.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.11
|
| Rate for Payer: Multiplan Commercial |
$120.42
|
| Rate for Payer: Networks By Design Commercial |
$80.28
|
| Rate for Payer: Prime Health Services Commercial |
$136.48
|
|
|
DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION [211862]
|
Facility
OP
|
$160.56
|
|
|
Service Code
|
NDC 57894-502-05
|
| Hospital Charge Code |
NDG211862B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.11 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$97.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$136.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$88.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$77.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.86
|
| Rate for Payer: BCBS Transplant Transplant |
$96.34
|
| Rate for Payer: Blue Shield of California Commercial |
$100.99
|
| Rate for Payer: Blue Shield of California EPN |
$78.51
|
| Rate for Payer: Cash Price |
$72.25
|
| Rate for Payer: Cash Price |
$72.25
|
| Rate for Payer: Central Health Plan Commercial |
$128.45
|
| Rate for Payer: Cigna of CA HMO |
$112.39
|
| Rate for Payer: Cigna of CA PPO |
$112.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.22
|
| Rate for Payer: Galaxy Health WC |
$136.48
|
| Rate for Payer: Global Benefits Group Commercial |
$96.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$120.42
|
| Rate for Payer: IEHP medi-cal |
$56.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.11
|
| Rate for Payer: Multiplan Commercial |
$120.42
|
| Rate for Payer: Networks By Design Commercial |
$80.28
|
| Rate for Payer: Prime Health Services Commercial |
$136.48
|
| Rate for Payer: Riverside University Health MISP |
$64.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.28
|
| Rate for Payer: United Healthcare All Other HMO |
$80.28
|
| Rate for Payer: United Healthcare HMO Rider |
$80.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.48
|
| Rate for Payer: Vantage Medical Group Senior |
$136.48
|
|
|
DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION [211862]
|
Facility
OP
|
$160.56
|
|
|
Service Code
|
NDC 57894-502-20
|
| Hospital Charge Code |
NDG211862
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.11 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$97.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$136.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$88.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$77.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.86
|
| Rate for Payer: BCBS Transplant Transplant |
$96.34
|
| Rate for Payer: Blue Shield of California Commercial |
$100.99
|
| Rate for Payer: Blue Shield of California EPN |
$78.51
|
| Rate for Payer: Cash Price |
$72.25
|
| Rate for Payer: Cash Price |
$72.25
|
| Rate for Payer: Central Health Plan Commercial |
$128.45
|
| Rate for Payer: Cigna of CA HMO |
$112.39
|
| Rate for Payer: Cigna of CA PPO |
$112.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.22
|
| Rate for Payer: Galaxy Health WC |
$136.48
|
| Rate for Payer: Global Benefits Group Commercial |
$96.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$120.42
|
| Rate for Payer: IEHP medi-cal |
$56.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.11
|
| Rate for Payer: Multiplan Commercial |
$120.42
|
| Rate for Payer: Networks By Design Commercial |
$80.28
|
| Rate for Payer: Prime Health Services Commercial |
$136.48
|
| Rate for Payer: Riverside University Health MISP |
$64.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.28
|
| Rate for Payer: United Healthcare All Other HMO |
$80.28
|
| Rate for Payer: United Healthcare HMO Rider |
$80.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.48
|
| Rate for Payer: Vantage Medical Group Senior |
$136.48
|
|
|
DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION [211862]
|
Facility
IP
|
$160.56
|
|
|
Service Code
|
NDC 57894-502-20
|
| Hospital Charge Code |
NDG211862
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.11 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$120.42
|
| Rate for Payer: Blue Shield of California EPN |
$85.74
|
| Rate for Payer: Cash Price |
$72.25
|
| Rate for Payer: Cash Price |
$72.25
|
| Rate for Payer: Central Health Plan Commercial |
$128.45
|
| Rate for Payer: Cigna of CA HMO |
$112.39
|
| Rate for Payer: Cigna of CA PPO |
$112.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.22
|
| Rate for Payer: Galaxy Health WC |
$136.48
|
| Rate for Payer: Global Benefits Group Commercial |
$96.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.11
|
| Rate for Payer: Multiplan Commercial |
$120.42
|
| Rate for Payer: Networks By Design Commercial |
$80.28
|
| Rate for Payer: Prime Health Services Commercial |
$136.48
|
|
|
DARATUMUMAB-HYALURONIDASE-FIHJ (DARZALEX FASPRO) 1800 MG/30000 UNIT SQ INJECTION [40820601]
|
Facility
IP
|
$729.49
|
|
|
Service Code
|
CPT J9144
|
| Hospital Charge Code |
NDG228045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$145.90 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$547.12
|
| Rate for Payer: Blue Shield of California EPN |
$389.55
|
| Rate for Payer: Cash Price |
$328.27
|
| Rate for Payer: Cash Price |
$328.27
|
| Rate for Payer: Central Health Plan Commercial |
$583.59
|
| Rate for Payer: Cigna of CA HMO |
$510.64
|
| Rate for Payer: Cigna of CA PPO |
$510.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$291.80
|
| Rate for Payer: Galaxy Health WC |
$620.07
|
| Rate for Payer: Global Benefits Group Commercial |
$437.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$656.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.90
|
| Rate for Payer: Multiplan Commercial |
$547.12
|
| Rate for Payer: Networks By Design Commercial |
$364.74
|
| Rate for Payer: Prime Health Services Commercial |
$620.07
|
|
|
DARATUMUMAB-HYALURONIDASE-FIHJ (DARZALEX FASPRO) 1800 MG/30000 UNIT SQ INJECTION [40820601]
|
Facility
OP
|
$729.49
|
|
|
Service Code
|
CPT J9144
|
| Hospital Charge Code |
NDG228045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.05 |
| Max. Negotiated Rate |
$656.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$49.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$61.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$53.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$53.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$83.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.15
|
| Rate for Payer: BCBS Transplant Transplant |
$437.69
|
| Rate for Payer: Blue Shield of California Commercial |
$458.85
|
| Rate for Payer: Blue Shield of California EPN |
$356.72
|
| Rate for Payer: Caremore Medicare Advantage |
$49.05
|
| Rate for Payer: Cash Price |
$328.27
|
| Rate for Payer: Cash Price |
$328.27
|
| Rate for Payer: Central Health Plan Commercial |
$583.59
|
| Rate for Payer: Cigna of CA HMO |
$510.64
|
| Rate for Payer: Cigna of CA PPO |
$510.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$49.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$49.05
|
| Rate for Payer: Galaxy Health WC |
$620.07
|
| Rate for Payer: Global Benefits Group Commercial |
$437.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$656.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$547.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$80.44
|
| Rate for Payer: IEHP medi-cal |
$80.93
|
| Rate for Payer: IEHP Medicare Advantage |
$49.05
|
| Rate for Payer: Innovage PACE Commercial |
$73.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$65.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$65.73
|
| Rate for Payer: Multiplan Commercial |
$547.12
|
| Rate for Payer: Networks By Design Commercial |
$364.74
|
| Rate for Payer: Prime Health Services Commercial |
$620.07
|
| Rate for Payer: Prime Health Services Medicare |
$51.99
|
| Rate for Payer: Riverside University Health MISP |
$53.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$437.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$437.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.74
|
| Rate for Payer: United Healthcare All Other HMO |
$364.74
|
| Rate for Payer: United Healthcare HMO Rider |
$364.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$364.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.96
|
| Rate for Payer: Vantage Medical Group Senior |
$53.96
|
|
|
DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE [108044]
|
Facility
IP
|
$1,857.60
|
|
|
Service Code
|
CPT J0881
|
| Hospital Charge Code |
1720972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$371.52 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,393.20
|
| Rate for Payer: Blue Shield of California EPN |
$991.96
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Central Health Plan Commercial |
$1,486.08
|
| Rate for Payer: Cigna of CA HMO |
$1,300.32
|
| Rate for Payer: Cigna of CA PPO |
$1,300.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$743.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$743.04
|
| Rate for Payer: Galaxy Health WC |
$1,578.96
|
| Rate for Payer: Global Benefits Group Commercial |
$1,114.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,671.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,239.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.52
|
| Rate for Payer: Multiplan Commercial |
$1,393.20
|
| Rate for Payer: Networks By Design Commercial |
$928.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,578.96
|
|
|
DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE [108044]
|
Facility
OP
|
$1,857.60
|
|
|
Service Code
|
CPT J0881
|
| Hospital Charge Code |
1720972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$1,671.84 |
| Rate for Payer: Adventist Health Medi-Cal |
$2.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$57.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.20
|
| Rate for Payer: BCBS Transplant Transplant |
$1,114.56
|
| Rate for Payer: Blue Shield of California Commercial |
$10.22
|
| Rate for Payer: Blue Shield of California EPN |
$9.29
|
| Rate for Payer: Caremore Medicare Advantage |
$2.93
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Central Health Plan Commercial |
$1,486.08
|
| Rate for Payer: Cigna of CA HMO |
$1,300.32
|
| Rate for Payer: Cigna of CA PPO |
$1,300.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.93
|
| Rate for Payer: Galaxy Health WC |
$1,578.96
|
| Rate for Payer: Global Benefits Group Commercial |
$1,114.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,671.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,393.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.81
|
| Rate for Payer: IEHP medi-cal |
$4.83
|
| Rate for Payer: IEHP Medicare Advantage |
$2.93
|
| Rate for Payer: Innovage PACE Commercial |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,239.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.93
|
| Rate for Payer: Multiplan Commercial |
$1,393.20
|
| Rate for Payer: Networks By Design Commercial |
$928.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,578.96
|
| Rate for Payer: Prime Health Services Medicare |
$3.11
|
| Rate for Payer: Riverside University Health MISP |
$3.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,114.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,114.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$928.80
|
| Rate for Payer: United Healthcare All Other HMO |
$928.80
|
| Rate for Payer: United Healthcare HMO Rider |
$928.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$928.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2.93
|
|
|
DARBEPOETIN ALFA 150 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE [108046]
|
Facility
OP
|
$4,644.00
|
|
|
Service Code
|
CPT J0881
|
| Hospital Charge Code |
1720973
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$4,179.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$2.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$57.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.20
|
| Rate for Payer: BCBS Transplant Transplant |
$2,786.40
|
| Rate for Payer: Blue Shield of California Commercial |
$10.22
|
| Rate for Payer: Blue Shield of California EPN |
$9.29
|
| Rate for Payer: Caremore Medicare Advantage |
$2.93
|
| Rate for Payer: Cash Price |
$2,089.80
|
| Rate for Payer: Cash Price |
$2,089.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,715.20
|
| Rate for Payer: Cigna of CA HMO |
$3,250.80
|
| Rate for Payer: Cigna of CA PPO |
$3,250.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.93
|
| Rate for Payer: Galaxy Health WC |
$3,947.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,786.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,179.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,483.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.81
|
| Rate for Payer: IEHP medi-cal |
$4.83
|
| Rate for Payer: IEHP Medicare Advantage |
$2.93
|
| Rate for Payer: Innovage PACE Commercial |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,097.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$928.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.93
|
| Rate for Payer: Multiplan Commercial |
$3,483.00
|
| Rate for Payer: Networks By Design Commercial |
$2,322.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,947.40
|
| Rate for Payer: Prime Health Services Medicare |
$3.11
|
| Rate for Payer: Riverside University Health MISP |
$3.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,786.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,786.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,322.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,322.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,322.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,322.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2.93
|
|
|
DARBEPOETIN ALFA 150 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE [108046]
|
Facility
IP
|
$4,644.00
|
|
|
Service Code
|
CPT J0881
|
| Hospital Charge Code |
1720973
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$928.80 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3,483.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,479.90
|
| Rate for Payer: Cash Price |
$2,089.80
|
| Rate for Payer: Cash Price |
$2,089.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,715.20
|
| Rate for Payer: Cigna of CA HMO |
$3,250.80
|
| Rate for Payer: Cigna of CA PPO |
$3,250.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,857.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,857.60
|
| Rate for Payer: Galaxy Health WC |
$3,947.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,786.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,179.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,097.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$928.80
|
| Rate for Payer: Multiplan Commercial |
$3,483.00
|
| Rate for Payer: Networks By Design Commercial |
$2,322.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,947.40
|
|
|
DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE [108041]
|
Facility
IP
|
$552.86
|
|
|
Service Code
|
CPT J0881
|
| Hospital Charge Code |
1720969
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.57 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$414.64
|
| Rate for Payer: Blue Shield of California EPN |
$295.23
|
| Rate for Payer: Cash Price |
$248.79
|
| Rate for Payer: Cash Price |
$248.79
|
| 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 Transplant |
$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: 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
|
|
|
DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE [108041]
|
Facility
OP
|
$552.86
|
|
|
Service Code
|
CPT J0881
|
| Hospital Charge Code |
1720969
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$497.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$2.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$57.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.20
|
| Rate for Payer: BCBS Transplant Transplant |
$331.72
|
| Rate for Payer: Blue Shield of California Commercial |
$10.22
|
| Rate for Payer: Blue Shield of California EPN |
$9.29
|
| Rate for Payer: Caremore Medicare Advantage |
$2.93
|
| Rate for Payer: Cash Price |
$248.79
|
| Rate for Payer: Cash Price |
$248.79
|
| 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 |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.93
|
| Rate for Payer: Galaxy Health WC |
$469.93
|
| Rate for Payer: Global Benefits Group Commercial |
$331.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$497.57
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$414.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.81
|
| Rate for Payer: IEHP medi-cal |
$4.83
|
| Rate for Payer: IEHP Medicare Advantage |
$2.93
|
| Rate for Payer: Innovage PACE Commercial |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.93
|
| 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: Prime Health Services Medicare |
$3.11
|
| Rate for Payer: Riverside University Health MISP |
$3.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$331.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$331.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$276.43
|
| Rate for Payer: United Healthcare All Other HMO |
$276.43
|
| Rate for Payer: United Healthcare HMO Rider |
$276.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2.93
|
|
|
DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE [108042]
|
Facility
IP
|
$928.80
|
|
|
Service Code
|
CPT J0881
|
| Hospital Charge Code |
1720970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$185.76 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$696.60
|
| Rate for Payer: Blue Shield of California EPN |
$495.98
|
| Rate for Payer: Cash Price |
$417.96
|
| Rate for Payer: Cash Price |
$417.96
|
| 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 Transplant |
$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: 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
|
|
|
DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE [108042]
|
Facility
OP
|
$928.80
|
|
|
Service Code
|
CPT J0881
|
| Hospital Charge Code |
1720970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$835.92 |
| Rate for Payer: Adventist Health Medi-Cal |
$2.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$57.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.20
|
| Rate for Payer: BCBS Transplant Transplant |
$557.28
|
| Rate for Payer: Blue Shield of California Commercial |
$10.22
|
| Rate for Payer: Blue Shield of California EPN |
$9.29
|
| Rate for Payer: Caremore Medicare Advantage |
$2.93
|
| Rate for Payer: Cash Price |
$417.96
|
| Rate for Payer: Cash Price |
$417.96
|
| 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 |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.93
|
| Rate for Payer: Galaxy Health WC |
$789.48
|
| Rate for Payer: Global Benefits Group Commercial |
$557.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$835.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$696.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.81
|
| Rate for Payer: IEHP medi-cal |
$4.83
|
| Rate for Payer: IEHP Medicare Advantage |
$2.93
|
| Rate for Payer: Innovage PACE Commercial |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$619.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.93
|
| 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: Prime Health Services Medicare |
$3.11
|
| Rate for Payer: Riverside University Health MISP |
$3.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$557.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$557.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$464.40
|
| Rate for Payer: United Healthcare All Other HMO |
$464.40
|
| Rate for Payer: United Healthcare HMO Rider |
$464.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$464.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2.93
|
|
|
DARBEPOETIN ALFA 60 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE [108043]
|
Facility
OP
|
$1,857.60
|
|
|
Service Code
|
CPT J0881
|
| Hospital Charge Code |
1720971
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$1,671.84 |
| Rate for Payer: Adventist Health Medi-Cal |
$2.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$57.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.20
|
| Rate for Payer: BCBS Transplant Transplant |
$1,114.56
|
| Rate for Payer: Blue Shield of California Commercial |
$10.22
|
| Rate for Payer: Blue Shield of California EPN |
$9.29
|
| Rate for Payer: Caremore Medicare Advantage |
$2.93
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Central Health Plan Commercial |
$1,486.08
|
| Rate for Payer: Cigna of CA HMO |
$1,300.32
|
| Rate for Payer: Cigna of CA PPO |
$1,300.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.93
|
| Rate for Payer: Galaxy Health WC |
$1,578.96
|
| Rate for Payer: Global Benefits Group Commercial |
$1,114.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,671.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,393.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.81
|
| Rate for Payer: IEHP medi-cal |
$4.83
|
| Rate for Payer: IEHP Medicare Advantage |
$2.93
|
| Rate for Payer: Innovage PACE Commercial |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,239.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.93
|
| Rate for Payer: Multiplan Commercial |
$1,393.20
|
| Rate for Payer: Networks By Design Commercial |
$928.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,578.96
|
| Rate for Payer: Prime Health Services Medicare |
$3.11
|
| Rate for Payer: Riverside University Health MISP |
$3.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,114.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,114.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$928.80
|
| Rate for Payer: United Healthcare All Other HMO |
$928.80
|
| Rate for Payer: United Healthcare HMO Rider |
$928.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$928.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2.93
|
|
|
DARBEPOETIN ALFA 60 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE [108043]
|
Facility
IP
|
$1,857.60
|
|
|
Service Code
|
CPT J0881
|
| Hospital Charge Code |
1720971
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$371.52 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,393.20
|
| Rate for Payer: Blue Shield of California EPN |
$991.96
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Central Health Plan Commercial |
$1,486.08
|
| Rate for Payer: Cigna of CA HMO |
$1,300.32
|
| Rate for Payer: Cigna of CA PPO |
$1,300.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$743.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$743.04
|
| Rate for Payer: Galaxy Health WC |
$1,578.96
|
| Rate for Payer: Global Benefits Group Commercial |
$1,114.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,671.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,239.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.52
|
| Rate for Payer: Multiplan Commercial |
$1,393.20
|
| Rate for Payer: Networks By Design Commercial |
$928.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,578.96
|
|
|
DAROLUTAMIDE 300 MG TABLET [225419]
|
Facility
IP
|
$128.66
|
|
|
Service Code
|
NDC 50419-395-01
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.73 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$96.50
|
| Rate for Payer: Blue Shield of California EPN |
$68.70
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Central Health Plan Commercial |
$102.93
|
| Rate for Payer: Cigna of CA HMO |
$90.06
|
| Rate for Payer: Cigna of CA PPO |
$90.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.46
|
| Rate for Payer: Galaxy Health WC |
$109.36
|
| Rate for Payer: Global Benefits Group Commercial |
$77.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.73
|
| Rate for Payer: Multiplan Commercial |
$96.50
|
| Rate for Payer: Networks By Design Commercial |
$83.63
|
| Rate for Payer: Prime Health Services Commercial |
$109.36
|
|
|
DAROLUTAMIDE 300 MG TABLET [225419]
|
Facility
OP
|
$128.66
|
|
|
Service Code
|
NDC 50419-395-01
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.73 |
| Max. Negotiated Rate |
$115.79 |
| Rate for Payer: IEHP medi-cal |
$45.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$109.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$70.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$70.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.01
|
| Rate for Payer: BCBS Transplant Transplant |
$77.20
|
| Rate for Payer: Blue Shield of California Commercial |
$80.93
|
| Rate for Payer: Blue Shield of California EPN |
$62.91
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Central Health Plan Commercial |
$102.93
|
| Rate for Payer: Cigna of CA HMO |
$90.06
|
| Rate for Payer: Cigna of CA PPO |
$90.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.46
|
| Rate for Payer: Galaxy Health WC |
$109.36
|
| Rate for Payer: Global Benefits Group Commercial |
$77.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.79
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$96.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.73
|
| Rate for Payer: Multiplan Commercial |
$96.50
|
| Rate for Payer: Networks By Design Commercial |
$83.63
|
| Rate for Payer: Prime Health Services Commercial |
$109.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$77.20
|
| Rate for Payer: Riverside University Health MISP |
$51.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.33
|
| Rate for Payer: United Healthcare All Other HMO |
$64.33
|
| Rate for Payer: United Healthcare HMO Rider |
$64.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.36
|
| Rate for Payer: Vantage Medical Group Senior |
$109.36
|
|
