|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION [36989]
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
901700025
|
|
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 |
$7.20
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.67
|
| 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 |
$16.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$39.73
|
|
|
DARATUMUMAB 1,800 MG-HYALURONIDASE-FIHJ 30,000 UNIT/15 ML SUBCUT SOLN [228045]
|
Facility
|
IP
|
$845.75
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$153.08 |
| Max. Negotiated Rate |
$634.31 |
| Rate for Payer: Adventist Health Commercial |
$169.15
|
| Rate for Payer: Cash Price |
$465.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$389.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$391.58
|
| Rate for Payer: Heritage Provider Network Senior |
$391.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.44
|
| Rate for Payer: Multiplan Commercial |
$634.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$305.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$280.03
|
|
|
DARATUMUMAB 1,800 MG-HYALURONIDASE-FIHJ 30,000 UNIT/15 ML SUBCUT SOLN [228045]
|
Facility
|
OP
|
$845.75
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.99 |
| Max. Negotiated Rate |
$634.31 |
| Rate for Payer: Adventist Health Commercial |
$169.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$452.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$581.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.12
|
| Rate for Payer: Blue Shield of California Commercial |
$56.80
|
| Rate for Payer: Blue Shield of California EPN |
$56.80
|
| Rate for Payer: Cash Price |
$465.16
|
| Rate for Payer: Cash Price |
$465.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$389.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.13
|
| Rate for Payer: Dignity Health Senior |
$60.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$54.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$391.58
|
| Rate for Payer: Heritage Provider Network Senior |
$391.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$54.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$403.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.88
|
| Rate for Payer: Multiplan Commercial |
$634.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$338.30
|
| Rate for Payer: TriValley Medical Group Senior |
$338.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$305.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$280.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.13
|
| Rate for Payer: Vantage Medical Group Senior |
$60.13
|
|
|
DARATUMUMAB-HYALURONIDASE-FIHJ (DARZALEX FASPRO) 1800 MG/30000 UNIT SQ INJECTION [40820601]
|
Facility
|
IP
|
$845.75
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$153.08 |
| Max. Negotiated Rate |
$634.31 |
| Rate for Payer: Adventist Health Commercial |
$169.15
|
| Rate for Payer: Cash Price |
$465.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$389.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$391.58
|
| Rate for Payer: Heritage Provider Network Senior |
$391.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.44
|
| Rate for Payer: Multiplan Commercial |
$634.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$305.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$280.03
|
|
|
DARATUMUMAB-HYALURONIDASE-FIHJ (DARZALEX FASPRO) 1800 MG/30000 UNIT SQ INJECTION [40820601]
|
Facility
|
OP
|
$845.75
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.99 |
| Max. Negotiated Rate |
$634.31 |
| Rate for Payer: Adventist Health Commercial |
$169.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$452.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$581.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.12
|
| Rate for Payer: Blue Shield of California Commercial |
$56.80
|
| Rate for Payer: Blue Shield of California EPN |
$56.80
|
| Rate for Payer: Cash Price |
$465.16
|
| Rate for Payer: Cash Price |
$465.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$389.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.13
|
| Rate for Payer: Dignity Health Senior |
$60.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$54.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$391.58
|
| Rate for Payer: Heritage Provider Network Senior |
$391.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$54.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$403.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.88
|
| Rate for Payer: Multiplan Commercial |
$634.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$338.30
|
| Rate for Payer: TriValley Medical Group Senior |
$338.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$305.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$280.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.13
|
| Rate for Payer: Vantage Medical Group Senior |
$60.13
|
|
|
DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE [108041]
|
Facility
|
IP
|
$552.86
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.07 |
| Max. Negotiated Rate |
$414.64 |
| Rate for Payer: Adventist Health Commercial |
$110.57
|
| Rate for Payer: Cash Price |
$304.07
|
| 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 |
$255.97
|
| Rate for Payer: Heritage Provider Network Senior |
$255.97
|
| 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 |
$199.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$183.05
|
|
|
DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE [108041]
|
Facility
|
OP
|
$552.86
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$414.64 |
| Rate for Payer: Adventist Health Commercial |
$110.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$295.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$379.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.05
|
| 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 |
$304.07
|
| Rate for Payer: Cash Price |
$304.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$254.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.29
|
| Rate for Payer: Dignity Health Senior |
$3.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$353.83
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.97
|
| Rate for Payer: Heritage Provider Network Senior |
$255.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$263.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.77
|
| Rate for Payer: Multiplan Commercial |
$414.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$221.14
|
| Rate for Payer: TriValley Medical Group Senior |
$221.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$199.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$183.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3.29
|
|
|
DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE [108042]
|
Facility
|
IP
|
$928.80
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.11 |
| Max. Negotiated Rate |
$696.60 |
| Rate for Payer: Adventist Health Commercial |
$185.76
|
| Rate for Payer: Cash Price |
$510.84
|
| 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 |
$430.03
|
| Rate for Payer: Heritage Provider Network Senior |
$430.03
|
| 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 |
$335.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$307.53
|
|
|
DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE [108042]
|
Facility
|
OP
|
$928.80
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$696.60 |
| Rate for Payer: Adventist Health Commercial |
$185.76
|
| Rate for Payer: Aetna of CA Gatekeeper |
$496.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$638.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.05
|
| 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 |
$510.84
|
| Rate for Payer: Cash Price |
$510.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$427.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.29
|
| Rate for Payer: Dignity Health Senior |
$3.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.43
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$430.03
|
| Rate for Payer: Heritage Provider Network Senior |
$430.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$443.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.77
|
| Rate for Payer: Multiplan Commercial |
$696.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$371.52
|
| Rate for Payer: TriValley Medical Group Senior |
$371.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$335.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$307.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3.29
|
|
|
DAROLUTAMIDE 300 MG TABLET [225419]
|
Facility
|
OP
|
$142.54
|
|
|
Service Code
|
NDC 50419-395-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$121.16 |
| Rate for Payer: Adventist Health Commercial |
$28.51
|
| Rate for Payer: Aetna of CA Gatekeeper |
$76.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$97.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$121.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.91
|
| Rate for Payer: Blue Shield of California Commercial |
$86.95
|
| Rate for Payer: Blue Shield of California EPN |
$69.56
|
| Rate for Payer: Cash Price |
$78.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$92.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$121.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$121.16
|
| Rate for Payer: Dignity Health Senior |
$121.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.23
|
| Rate for Payer: Heritage Provider Network Senior |
$88.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$67.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99.78
|
| Rate for Payer: Multiplan Commercial |
$106.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$57.02
|
| Rate for Payer: TriValley Medical Group Senior |
$57.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$121.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$121.16
|
| Rate for Payer: Vantage Medical Group Senior |
$121.16
|
|
|
DAROLUTAMIDE 300 MG TABLET [225419]
|
Facility
|
IP
|
$142.54
|
|
|
Service Code
|
NDC 50419-395-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$106.91 |
| Rate for Payer: Adventist Health Commercial |
$28.51
|
| Rate for Payer: Cash Price |
$78.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.50
|
| Rate for Payer: Heritage Provider Network Senior |
$96.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.63
|
| Rate for Payer: Multiplan Commercial |
$106.91
|
|
|
DARUNAVIR 600 MG TABLET [92851]
|
Facility
|
OP
|
$43.16
|
|
|
Service Code
|
NDC 59676-562-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$36.69 |
| Rate for Payer: Adventist Health Commercial |
$8.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.37
|
| Rate for Payer: Blue Shield of California Commercial |
$26.33
|
| Rate for Payer: Blue Shield of California EPN |
$21.06
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.69
|
| Rate for Payer: Dignity Health Senior |
$36.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.72
|
| Rate for Payer: Heritage Provider Network Senior |
$26.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.21
|
| Rate for Payer: Multiplan Commercial |
$32.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.26
|
| Rate for Payer: TriValley Medical Group Senior |
$17.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.69
|
| Rate for Payer: Vantage Medical Group Senior |
$36.69
|
|
|
DARUNAVIR 600 MG TABLET [92851]
|
Facility
|
IP
|
$43.16
|
|
|
Service Code
|
NDC 59676-562-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$32.37 |
| Rate for Payer: Adventist Health Commercial |
$8.63
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.22
|
| Rate for Payer: Heritage Provider Network Senior |
$29.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.79
|
| Rate for Payer: Multiplan Commercial |
$32.37
|
|
|
DARUNAVIR 800 MG-COBICISTAT 150 MG TABLET [208697]
|
Facility
|
IP
|
$98.67
|
|
|
Service Code
|
NDC 59676-575-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.86 |
| Max. Negotiated Rate |
$74.00 |
| Rate for Payer: Adventist Health Commercial |
$19.73
|
| Rate for Payer: Cash Price |
$54.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.80
|
| Rate for Payer: Heritage Provider Network Senior |
$66.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.67
|
| Rate for Payer: Multiplan Commercial |
$74.00
|
|
|
DARUNAVIR 800 MG-COBICISTAT 150 MG TABLET [208697]
|
Facility
|
OP
|
$98.67
|
|
|
Service Code
|
NDC 59676-575-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.86 |
| Max. Negotiated Rate |
$83.87 |
| Rate for Payer: Adventist Health Commercial |
$19.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.00
|
| Rate for Payer: Blue Shield of California Commercial |
$60.19
|
| Rate for Payer: Blue Shield of California EPN |
$48.15
|
| Rate for Payer: Cash Price |
$54.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.87
|
| Rate for Payer: Dignity Health Senior |
$83.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.08
|
| Rate for Payer: Heritage Provider Network Senior |
$61.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.07
|
| Rate for Payer: Multiplan Commercial |
$74.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$39.47
|
| Rate for Payer: TriValley Medical Group Senior |
$39.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$49.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$49.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$83.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.87
|
| Rate for Payer: Vantage Medical Group Senior |
$83.87
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
OP
|
$86.33
|
|
|
Service Code
|
NDC 59676-566-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$73.38 |
| Rate for Payer: Adventist Health Commercial |
$17.27
|
| Rate for Payer: Aetna of CA Gatekeeper |
$46.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.75
|
| Rate for Payer: Blue Shield of California Commercial |
$52.66
|
| Rate for Payer: Blue Shield of California EPN |
$42.13
|
| Rate for Payer: Cash Price |
$47.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$56.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.38
|
| Rate for Payer: Dignity Health Senior |
$73.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.44
|
| Rate for Payer: Heritage Provider Network Senior |
$53.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.43
|
| Rate for Payer: Multiplan Commercial |
$64.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.53
|
| Rate for Payer: TriValley Medical Group Senior |
$34.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.38
|
| Rate for Payer: Vantage Medical Group Senior |
$73.38
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
IP
|
$86.33
|
|
|
Service Code
|
NDC 59676-566-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$64.75 |
| Rate for Payer: Adventist Health Commercial |
$17.27
|
| Rate for Payer: Cash Price |
$47.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.45
|
| Rate for Payer: Heritage Provider Network Senior |
$58.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.58
|
| Rate for Payer: Multiplan Commercial |
$64.75
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
IP
|
$3.96
|
|
|
Service Code
|
NDC 68180-346-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$2.97 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.68
|
| Rate for Payer: Heritage Provider Network Senior |
$2.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.99
|
| Rate for Payer: Multiplan Commercial |
$2.97
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
IP
|
$12.30
|
|
|
Service Code
|
NDC 60687-819-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$9.22 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Cash Price |
$6.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.33
|
| Rate for Payer: Heritage Provider Network Senior |
$8.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
IP
|
$12.30
|
|
|
Service Code
|
NDC 60687-819-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$9.22 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Cash Price |
$6.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.33
|
| Rate for Payer: Heritage Provider Network Senior |
$8.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
OP
|
$12.30
|
|
|
Service Code
|
NDC 60687-819-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.22
|
| Rate for Payer: Blue Shield of California Commercial |
$7.50
|
| Rate for Payer: Blue Shield of California EPN |
$6.00
|
| Rate for Payer: Cash Price |
$6.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.46
|
| Rate for Payer: Dignity Health Senior |
$10.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.61
|
| Rate for Payer: Heritage Provider Network Senior |
$7.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.92
|
| Rate for Payer: TriValley Medical Group Senior |
$4.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.46
|
| Rate for Payer: Vantage Medical Group Senior |
$10.46
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
OP
|
$12.30
|
|
|
Service Code
|
NDC 60687-819-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.22
|
| Rate for Payer: Blue Shield of California Commercial |
$7.50
|
| Rate for Payer: Blue Shield of California EPN |
$6.00
|
| Rate for Payer: Cash Price |
$6.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.46
|
| Rate for Payer: Dignity Health Senior |
$10.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.61
|
| Rate for Payer: Heritage Provider Network Senior |
$7.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.92
|
| Rate for Payer: TriValley Medical Group Senior |
$4.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.46
|
| Rate for Payer: Vantage Medical Group Senior |
$10.46
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
OP
|
$3.96
|
|
|
Service Code
|
NDC 68180-346-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.93
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.37
|
| Rate for Payer: Dignity Health Senior |
$3.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.45
|
| Rate for Payer: Heritage Provider Network Senior |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.77
|
| Rate for Payer: Multiplan Commercial |
$2.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.58
|
| Rate for Payer: TriValley Medical Group Senior |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.37
|
| Rate for Payer: Vantage Medical Group Senior |
$3.37
|
|
|
DASATINIB 100 MG TABLET [92897]
|
Facility
|
OP
|
$729.85
|
|
|
Service Code
|
NDC 0003-0852-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$132.10 |
| Max. Negotiated Rate |
$620.37 |
| Rate for Payer: Adventist Health Commercial |
$145.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$390.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$501.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$620.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$401.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$547.39
|
| Rate for Payer: Blue Shield of California Commercial |
$445.21
|
| Rate for Payer: Blue Shield of California EPN |
$356.17
|
| Rate for Payer: Cash Price |
$401.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$474.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$620.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$620.37
|
| Rate for Payer: Dignity Health Senior |
$620.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$467.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$451.78
|
| Rate for Payer: Heritage Provider Network Senior |
$451.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$348.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$510.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$510.89
|
| Rate for Payer: Multiplan Commercial |
$547.39
|
| Rate for Payer: TriValley Medical Group Commercial |
$291.94
|
| Rate for Payer: TriValley Medical Group Senior |
$291.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$364.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$364.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$620.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$620.37
|
| Rate for Payer: Vantage Medical Group Senior |
$620.37
|
|
|
DASATINIB 100 MG TABLET [92897]
|
Facility
|
IP
|
$729.85
|
|
|
Service Code
|
NDC 0003-0852-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$132.10 |
| Max. Negotiated Rate |
$547.39 |
| Rate for Payer: Adventist Health Commercial |
$145.97
|
| Rate for Payer: Cash Price |
$401.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$394.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$494.11
|
| Rate for Payer: Heritage Provider Network Senior |
$494.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.46
|
| Rate for Payer: Multiplan Commercial |
$547.39
|
|
