|
DAPSONE 25 MG TABLET [2132]
|
Facility
IP
|
$2.74
|
|
|
Service Code
|
NDC 49938-102-30
|
| Hospital Charge Code |
1711606
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.06 |
| Rate for Payer: Adventist Health Commercial |
$0.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.88
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.06
|
|
|
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 |
$0.43 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.63
|
| 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 |
$1.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.01
|
| Rate for Payer: Dignity Health Senior |
$2.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.78
|
| 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 |
$0.43 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.63
|
| 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 |
$1.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.01
|
| Rate for Payer: Dignity Health Senior |
$2.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.78
|
| 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 |
$0.43 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.63
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.60
|
| Rate for Payer: Heritage Provider Network Senior |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.78
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION [36989]
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
CPT J0878
|
| Hospital Charge Code |
1720999
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.43
|
| Rate for Payer: Heritage Provider Network Senior |
$81.24
|
| Rate for Payer: Heritage Provider Network Senior |
$28.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.03
|
|
|
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 |
$0.10 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$31.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.69
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Senior |
$102.00
|
| Rate for Payer: Dignity Health Senior |
$35.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.56
|
| Rate for Payer: Heritage Provider Network Senior |
$55.56
|
| Rate for Payer: Heritage Provider Network Senior |
$19.45
|
| Rate for Payer: IEHP Medi-Cal |
$7.02
|
| Rate for Payer: IEHP Medi-Cal |
$7.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$57.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.09
|
| 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 |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$35.70
|
|
|
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 |
$132.04 |
| Max. Negotiated Rate |
$547.12 |
| Rate for Payer: Adventist Health Commercial |
$145.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$501.16
|
| Rate for Payer: Cash Price |
$328.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$335.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$493.86
|
| Rate for Payer: Heritage Provider Network Senior |
$493.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.37
|
| Rate for Payer: Multiplan Commercial |
$547.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$265.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.72
|
|
|
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 |
$547.12 |
| Rate for Payer: Adventist Health Commercial |
$145.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$96.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$501.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$61.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$53.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$53.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.90
|
| Rate for Payer: Blue Shield of California Commercial |
$49.44
|
| Rate for Payer: Blue Shield of California EPN |
$49.44
|
| Rate for Payer: Cash Price |
$328.27
|
| Rate for Payer: Cash Price |
$328.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$335.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.96
|
| Rate for Payer: Dignity Health Senior |
$53.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$466.87
|
| Rate for Payer: EPIC Health Plan Medicare |
$49.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$337.75
|
| Rate for Payer: Heritage Provider Network Senior |
$337.75
|
| Rate for Payer: Humana Medicare |
$49.05
|
| Rate for Payer: IEHP Medi-Cal |
$83.48
|
| Rate for Payer: IEHP Medicare Advantage |
$49.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.80
|
| Rate for Payer: Multiplan Commercial |
$547.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$53.96
|
| Rate for Payer: TriValley Medical Group Senior |
$49.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$265.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.72
|
| 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 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 |
$29.06 |
| Max. Negotiated Rate |
$136.48 |
| Rate for Payer: Adventist Health Commercial |
$32.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$85.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.30
|
| 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 |
$120.42
|
| Rate for Payer: Blue Shield of California Commercial |
$99.71
|
| Rate for Payer: Blue Shield of California EPN |
$94.25
|
| Rate for Payer: Cash Price |
$72.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$73.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.48
|
| Rate for Payer: Dignity Health Senior |
$136.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.34
|
| Rate for Payer: Heritage Provider Network Senior |
$74.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$77.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.14
|
| Rate for Payer: Multiplan Commercial |
$120.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$58.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$53.64
|
| 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 57894-502-05
|
| Hospital Charge Code |
NDG211862B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$136.48 |
| Rate for Payer: Adventist Health Commercial |
$32.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$85.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.30
|
| 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 |
$120.42
|
| Rate for Payer: Blue Shield of California Commercial |
$99.71
|
| Rate for Payer: Blue Shield of California EPN |
$94.25
|
| Rate for Payer: Cash Price |
$72.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$73.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.48
|
| Rate for Payer: Dignity Health Senior |
$136.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.34
|
| Rate for Payer: Heritage Provider Network Senior |
$74.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$77.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.14
|
| Rate for Payer: Multiplan Commercial |
$120.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$58.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$53.64
|
| 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 57894-502-05
|
| Hospital Charge Code |
NDG211862B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$120.42 |
| Rate for Payer: Adventist Health Commercial |
$32.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.30
|
| Rate for Payer: Cash Price |
$72.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$73.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.70
|
| Rate for Payer: Heritage Provider Network Senior |
$108.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.14
|
| Rate for Payer: Multiplan Commercial |
$120.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$58.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$53.64
|
|
|
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 |
$29.06 |
| Max. Negotiated Rate |
$120.42 |
| Rate for Payer: Adventist Health Commercial |
$32.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.30
|
| Rate for Payer: Cash Price |
$72.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$73.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.70
|
| Rate for Payer: Heritage Provider Network Senior |
$108.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.14
|
| Rate for Payer: Multiplan Commercial |
$120.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$58.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$53.64
|
|
|
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 |
$132.04 |
| Max. Negotiated Rate |
$547.12 |
| Rate for Payer: Adventist Health Commercial |
$145.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$501.16
|
| Rate for Payer: Cash Price |
$328.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$335.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$493.86
|
| Rate for Payer: Heritage Provider Network Senior |
$493.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.37
|
| Rate for Payer: Multiplan Commercial |
$547.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$265.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.72
|
|
|
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 |
$547.12 |
| Rate for Payer: Adventist Health Commercial |
$145.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$96.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$501.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$61.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$53.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$53.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.90
|
| Rate for Payer: Blue Shield of California Commercial |
$49.44
|
| Rate for Payer: Blue Shield of California EPN |
$49.44
|
| Rate for Payer: Cash Price |
$328.27
|
| Rate for Payer: Cash Price |
$328.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$335.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.96
|
| Rate for Payer: Dignity Health Senior |
$53.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$466.87
|
| Rate for Payer: EPIC Health Plan Medicare |
$49.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$337.75
|
| Rate for Payer: Heritage Provider Network Senior |
$337.75
|
| Rate for Payer: Humana Medicare |
$49.05
|
| Rate for Payer: IEHP Medi-Cal |
$83.48
|
| Rate for Payer: IEHP Medicare Advantage |
$49.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.80
|
| Rate for Payer: Multiplan Commercial |
$547.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$53.96
|
| Rate for Payer: TriValley Medical Group Senior |
$49.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$265.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.72
|
| 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 |
$336.23 |
| Max. Negotiated Rate |
$1,393.20 |
| Rate for Payer: Adventist Health Commercial |
$371.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,276.17
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$854.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,003.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,257.60
|
| Rate for Payer: Heritage Provider Network Senior |
$1,257.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.40
|
| Rate for Payer: Multiplan Commercial |
$1,393.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$677.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$620.62
|
|
|
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 |
$1,393.20 |
| Rate for Payer: Adventist Health Commercial |
$371.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,276.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.33
|
| Rate for Payer: Blue Shield of California Commercial |
$7.90
|
| Rate for Payer: Blue Shield of California EPN |
$7.90
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$854.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.22
|
| Rate for Payer: Dignity Health Senior |
$3.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,188.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$860.07
|
| Rate for Payer: Heritage Provider Network Senior |
$860.07
|
| Rate for Payer: Humana Medicare |
$2.93
|
| Rate for Payer: IEHP Medi-Cal |
$11.53
|
| Rate for Payer: IEHP Medicare Advantage |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.69
|
| Rate for Payer: Multiplan Commercial |
$1,393.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.22
|
| Rate for Payer: TriValley Medical Group Senior |
$2.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$677.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$620.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2.93
|
|
|
DARBEPOETIN ALFA 150 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE [108046]
|
Facility
OP
|
$4,644.00
|
|
|
Service Code
|
CPT J0881
|
| Hospital Charge Code |
1720973
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$3,483.00 |
| Rate for Payer: Adventist Health Commercial |
$928.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,190.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.33
|
| Rate for Payer: Blue Shield of California Commercial |
$7.90
|
| Rate for Payer: Blue Shield of California EPN |
$7.90
|
| Rate for Payer: Cash Price |
$2,089.80
|
| Rate for Payer: Cash Price |
$2,089.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,136.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.22
|
| Rate for Payer: Dignity Health Senior |
$3.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,972.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,150.17
|
| Rate for Payer: Heritage Provider Network Senior |
$2,150.17
|
| Rate for Payer: Humana Medicare |
$2.93
|
| Rate for Payer: IEHP Medi-Cal |
$11.53
|
| Rate for Payer: IEHP Medicare Advantage |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$840.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.69
|
| Rate for Payer: Multiplan Commercial |
$3,483.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.22
|
| Rate for Payer: TriValley Medical Group Senior |
$2.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,693.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,551.56
|
| 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 |
$840.56 |
| Max. Negotiated Rate |
$3,483.00 |
| Rate for Payer: Adventist Health Commercial |
$928.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,190.43
|
| Rate for Payer: Cash Price |
$2,089.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,136.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,507.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,143.99
|
| Rate for Payer: Heritage Provider Network Senior |
$3,143.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$840.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.00
|
| Rate for Payer: Multiplan Commercial |
$3,483.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,693.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,551.56
|
|
|
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 |
$414.64 |
| Rate for Payer: Adventist Health Commercial |
$110.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$379.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.33
|
| Rate for Payer: Blue Shield of California Commercial |
$7.90
|
| Rate for Payer: Blue Shield of California EPN |
$7.90
|
| Rate for Payer: Cash Price |
$248.79
|
| Rate for Payer: Cash Price |
$248.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$254.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.22
|
| Rate for Payer: Dignity Health Senior |
$3.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$353.83
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.97
|
| Rate for Payer: Heritage Provider Network Senior |
$255.97
|
| Rate for Payer: Humana Medicare |
$2.93
|
| Rate for Payer: IEHP Medi-Cal |
$11.53
|
| Rate for Payer: IEHP Medicare Advantage |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.69
|
| Rate for Payer: Multiplan Commercial |
$414.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.22
|
| Rate for Payer: TriValley Medical Group Senior |
$2.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$201.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$184.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2.93
|
|
|
DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE [108041]
|
Facility
IP
|
$552.86
|
|
|
Service Code
|
CPT J0881
|
| Hospital Charge Code |
1720969
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.07 |
| Max. Negotiated Rate |
$414.64 |
| Rate for Payer: Adventist Health Commercial |
$110.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$379.81
|
| Rate for Payer: Cash Price |
$248.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$254.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$374.29
|
| Rate for Payer: Heritage Provider Network Senior |
$374.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.22
|
| Rate for Payer: Multiplan Commercial |
$414.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$201.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$184.71
|
|
|
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 |
$168.11 |
| Max. Negotiated Rate |
$696.60 |
| Rate for Payer: Adventist Health Commercial |
$185.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$638.09
|
| Rate for Payer: Cash Price |
$417.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$427.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$501.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$628.80
|
| Rate for Payer: Heritage Provider Network Senior |
$628.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.20
|
| Rate for Payer: Multiplan Commercial |
$696.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$338.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$310.31
|
|
|
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 |
$696.60 |
| Rate for Payer: Adventist Health Commercial |
$185.76
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$638.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.33
|
| Rate for Payer: Blue Shield of California Commercial |
$7.90
|
| Rate for Payer: Blue Shield of California EPN |
$7.90
|
| Rate for Payer: Cash Price |
$417.96
|
| Rate for Payer: Cash Price |
$417.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$427.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.22
|
| Rate for Payer: Dignity Health Senior |
$3.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.43
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$430.03
|
| Rate for Payer: Heritage Provider Network Senior |
$430.03
|
| Rate for Payer: Humana Medicare |
$2.93
|
| Rate for Payer: IEHP Medi-Cal |
$11.53
|
| Rate for Payer: IEHP Medicare Advantage |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.69
|
| Rate for Payer: Multiplan Commercial |
$696.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.22
|
| Rate for Payer: TriValley Medical Group Senior |
$2.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$338.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$310.31
|
| 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 |
$1,393.20 |
| Rate for Payer: Adventist Health Commercial |
$371.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,276.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.33
|
| Rate for Payer: Blue Shield of California Commercial |
$7.90
|
| Rate for Payer: Blue Shield of California EPN |
$7.90
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$854.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.22
|
| Rate for Payer: Dignity Health Senior |
$3.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,188.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$860.07
|
| Rate for Payer: Heritage Provider Network Senior |
$860.07
|
| Rate for Payer: Humana Medicare |
$2.93
|
| Rate for Payer: IEHP Medi-Cal |
$11.53
|
| Rate for Payer: IEHP Medicare Advantage |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.69
|
| Rate for Payer: Multiplan Commercial |
$1,393.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.22
|
| Rate for Payer: TriValley Medical Group Senior |
$2.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$677.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$620.62
|
| 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 |
$336.23 |
| Max. Negotiated Rate |
$1,393.20 |
| Rate for Payer: Adventist Health Commercial |
$371.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,276.17
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$854.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,003.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,257.60
|
| Rate for Payer: Heritage Provider Network Senior |
$1,257.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.40
|
| Rate for Payer: Multiplan Commercial |
$1,393.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$677.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$620.62
|
|
|
DAROLUTAMIDE 300 MG TABLET [225419]
|
Facility
IP
|
$128.66
|
|
|
Service Code
|
NDC 50419-395-01
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.29 |
| Max. Negotiated Rate |
$96.50 |
| Rate for Payer: Adventist Health Commercial |
$25.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.39
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.10
|
| Rate for Payer: Heritage Provider Network Senior |
$87.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.16
|
| Rate for Payer: Multiplan Commercial |
$96.50
|
|
