|
DASATINIB 140 MG TABLET [108422]
|
Facility
|
IP
|
$729.85
|
|
|
Service Code
|
NDC 0003-0857-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$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
|
|
|
DASATINIB 140 MG TABLET [108422]
|
Facility
|
OP
|
$729.85
|
|
|
Service Code
|
NDC 0003-0857-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$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 20 MG TABLET [76717]
|
Facility
|
IP
|
$202.48
|
|
|
Service Code
|
NDC 0003-0527-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$36.65 |
| Max. Negotiated Rate |
$151.86 |
| Rate for Payer: Adventist Health Commercial |
$40.50
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$137.08
|
| Rate for Payer: Heritage Provider Network Senior |
$137.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.62
|
| Rate for Payer: Multiplan Commercial |
$151.86
|
|
|
DASATINIB 20 MG TABLET [76717]
|
Facility
|
OP
|
$202.48
|
|
|
Service Code
|
NDC 0003-0527-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$36.65 |
| Max. Negotiated Rate |
$172.11 |
| Rate for Payer: Adventist Health Commercial |
$40.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$108.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$139.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$172.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$111.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$151.86
|
| Rate for Payer: Blue Shield of California Commercial |
$123.51
|
| Rate for Payer: Blue Shield of California EPN |
$98.81
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$131.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$172.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$172.11
|
| Rate for Payer: Dignity Health Senior |
$172.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.34
|
| Rate for Payer: Heritage Provider Network Senior |
$125.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$96.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$141.74
|
| Rate for Payer: Multiplan Commercial |
$151.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$80.99
|
| Rate for Payer: TriValley Medical Group Senior |
$80.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$101.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$101.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$172.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$172.11
|
| Rate for Payer: Vantage Medical Group Senior |
$172.11
|
|
|
DASATINIB 70 MG TABLET [76719]
|
Facility
|
IP
|
$404.95
|
|
|
Service Code
|
NDC 0003-0524-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$73.30 |
| Max. Negotiated Rate |
$303.71 |
| Rate for Payer: Adventist Health Commercial |
$80.99
|
| Rate for Payer: Cash Price |
$222.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$218.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$274.15
|
| Rate for Payer: Heritage Provider Network Senior |
$274.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.24
|
| Rate for Payer: Multiplan Commercial |
$303.71
|
|
|
DASATINIB 70 MG TABLET [76719]
|
Facility
|
OP
|
$404.95
|
|
|
Service Code
|
NDC 0003-0524-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$73.30 |
| Max. Negotiated Rate |
$344.21 |
| Rate for Payer: Adventist Health Commercial |
$80.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$216.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$278.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.71
|
| Rate for Payer: Blue Shield of California Commercial |
$247.02
|
| Rate for Payer: Blue Shield of California EPN |
$197.62
|
| Rate for Payer: Cash Price |
$222.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$263.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$344.21
|
| Rate for Payer: Dignity Health Senior |
$344.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$250.66
|
| Rate for Payer: Heritage Provider Network Senior |
$250.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$193.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$283.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$283.46
|
| Rate for Payer: Multiplan Commercial |
$303.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$161.98
|
| Rate for Payer: TriValley Medical Group Senior |
$161.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$202.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$202.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$344.21
|
| Rate for Payer: Vantage Medical Group Senior |
$344.21
|
|
|
DASATINIB 80 MG TABLET [108421]
|
Facility
|
IP
|
$729.85
|
|
|
Service Code
|
NDC 0003-0855-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$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
|
|
|
DASATINIB 80 MG TABLET [108421]
|
Facility
|
OP
|
$729.85
|
|
|
Service Code
|
NDC 0003-0855-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$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
|
|
|
DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION [22661]
|
Facility
|
OP
|
$37.08
|
|
|
Service Code
|
HCPCS J9150
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$171.02 |
| Rate for Payer: Adventist Health Commercial |
$7.42
|
| Rate for Payer: Adventist Health Commercial |
$7.87
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.02
|
| Rate for Payer: Blue Shield of California Commercial |
$67.35
|
| Rate for Payer: Blue Shield of California Commercial |
$67.35
|
| Rate for Payer: Blue Shield of California EPN |
$67.35
|
| Rate for Payer: Blue Shield of California EPN |
$67.35
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$20.39
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$20.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.74
|
| Rate for Payer: Dignity Health Senior |
$21.74
|
| Rate for Payer: Dignity Health Senior |
$21.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.21
|
| Rate for Payer: Heritage Provider Network Senior |
$17.17
|
| Rate for Payer: Heritage Provider Network Senior |
$18.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.90
|
| Rate for Payer: Multiplan Commercial |
$27.81
|
| Rate for Payer: Multiplan Commercial |
$29.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.83
|
| Rate for Payer: TriValley Medical Group Senior |
$14.83
|
| Rate for Payer: TriValley Medical Group Senior |
$15.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.74
|
| Rate for Payer: Vantage Medical Group Senior |
$21.74
|
| Rate for Payer: Vantage Medical Group Senior |
$21.74
|
|
|
DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION [22661]
|
Facility
|
IP
|
$39.34
|
|
|
Service Code
|
HCPCS J9150
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$29.50 |
| Rate for Payer: Adventist Health Commercial |
$7.87
|
| Rate for Payer: Adventist Health Commercial |
$7.42
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$20.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.21
|
| Rate for Payer: Heritage Provider Network Senior |
$18.21
|
| Rate for Payer: Heritage Provider Network Senior |
$17.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.27
|
| Rate for Payer: Multiplan Commercial |
$27.81
|
| Rate for Payer: Multiplan Commercial |
$29.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.28
|
|
|
DB10B6Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5498
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
DB10BB1
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5499
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
DB11B6Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5500
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
DB11BB1
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5501
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
DB12B6Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5502
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
DB12BB1
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5503
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
DB15B6Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5504
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
DB15BB1
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5505
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
DB16B6Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5506
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
DB16BB1
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5507
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
DB17B6Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5508
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
DB17BB1
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5509
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
DB18B6Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5510
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
DB18BB1
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5511
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
DD10B6Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5512
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
