|
DABIGATRAN ETEXILATE 75 MG CAPSULE [106490]
|
Facility
|
OP
|
$3.97
|
|
|
Service Code
|
NDC 0597035556
|
| 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 Non-Gatekeeper |
$2.45
|
| 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 |
$2.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.99
|
| Rate for Payer: Blue Shield of California Commercial |
$2.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.94
|
| Rate for Payer: Cash Price |
$1.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.46
|
| Rate for Payer: Heritage Provider Network Senior |
$2.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.78
|
| Rate for Payer: Multiplan Commercial |
$2.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.59
|
| Rate for Payer: TriValley Medical Group Senior |
$1.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.99
|
| 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
|
|
|
DABIGATRAN ETEXILATE 75 MG CAPSULE [106490]
|
Facility
|
OP
|
$14.37
|
|
|
Service Code
|
NDC 6068774411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$12.21 |
| Rate for Payer: Adventist Health Commercial |
$2.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.19
|
| Rate for Payer: Blue Shield of California Commercial |
$8.77
|
| Rate for Payer: Blue Shield of California EPN |
$7.01
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.90
|
| Rate for Payer: Heritage Provider Network Senior |
$8.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.06
|
| Rate for Payer: Multiplan Commercial |
$10.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.75
|
| Rate for Payer: TriValley Medical Group Senior |
$5.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.21
|
| Rate for Payer: Vantage Medical Group Senior |
$12.21
|
|
|
DABIGATRAN ETEXILATE 75 MG CAPSULE [106490]
|
Facility
|
IP
|
$3.97
|
|
|
Service Code
|
NDC 0597035556
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$2.98 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.56
|
| Rate for Payer: Cash Price |
$1.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.69
|
| Rate for Payer: Heritage Provider Network Senior |
$2.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.99
|
| Rate for Payer: Multiplan Commercial |
$2.98
|
|
|
DABIGATRAN ETEXILATE 75 MG CAPSULE [106490]
|
Facility
|
IP
|
$14.37
|
|
|
Service Code
|
NDC 6068774411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$10.78 |
| Rate for Payer: Adventist Health Commercial |
$2.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.25
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.73
|
| Rate for Payer: Heritage Provider Network Senior |
$9.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.59
|
| Rate for Payer: Multiplan Commercial |
$10.78
|
|
|
DABRAFENIB 10 MG TABLET FOR ORAL SUSPENSION [237957]
|
Facility
|
IP
|
$26.12
|
|
|
Service Code
|
NDC 0078115421
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$19.59 |
| Rate for Payer: Adventist Health Commercial |
$5.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.82
|
| Rate for Payer: Cash Price |
$11.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.68
|
| Rate for Payer: Heritage Provider Network Senior |
$17.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$19.59
|
|
|
DABRAFENIB 10 MG TABLET FOR ORAL SUSPENSION [237957]
|
Facility
|
OP
|
$26.12
|
|
|
Service Code
|
NDC 0078115421
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$22.20 |
| Rate for Payer: Adventist Health Commercial |
$5.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.07
|
| Rate for Payer: Blue Shield of California Commercial |
$15.93
|
| Rate for Payer: Blue Shield of California EPN |
$12.75
|
| Rate for Payer: Cash Price |
$11.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.17
|
| Rate for Payer: Heritage Provider Network Senior |
$16.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.28
|
| Rate for Payer: Multiplan Commercial |
$19.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.45
|
| Rate for Payer: TriValley Medical Group Senior |
$10.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.20
|
| Rate for Payer: Vantage Medical Group Senior |
$22.20
|
|
|
DABRAFENIB 50 MG CAPSULE [202199]
|
Facility
|
OP
|
$130.62
|
|
|
Service Code
|
NDC 0078068266
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$111.03 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$80.72
|
| Rate for Payer: Adventist Health Commercial |
$26.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.34
|
| Rate for Payer: Blue Shield of California Commercial |
$79.68
|
| Rate for Payer: Blue Shield of California EPN |
$63.74
|
| Rate for Payer: Cash Price |
$58.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$111.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$111.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$80.85
|
| Rate for Payer: Heritage Provider Network Senior |
$80.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$62.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$91.43
|
| Rate for Payer: Multiplan Commercial |
$97.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$52.25
|
| Rate for Payer: TriValley Medical Group Senior |
$52.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$65.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$65.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$111.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$111.03
|
| Rate for Payer: Vantage Medical Group Senior |
$111.03
|
|
|
DABRAFENIB 50 MG CAPSULE [202199]
|
Facility
|
IP
|
$130.62
|
|
|
Service Code
|
NDC 0078068266
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: Adventist Health Commercial |
$26.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$84.12
|
| Rate for Payer: Cash Price |
$58.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.43
|
| Rate for Payer: Heritage Provider Network Senior |
$88.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.66
|
| Rate for Payer: Multiplan Commercial |
$97.97
|
|
|
DABRAFENIB 75 MG CAPSULE [202200]
|
Facility
|
IP
|
$168.34
|
|
|
Service Code
|
NDC 0078068166
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.47 |
| Max. Negotiated Rate |
$126.25 |
| Rate for Payer: Adventist Health Commercial |
$33.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$108.41
|
| Rate for Payer: Cash Price |
$75.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.97
|
| Rate for Payer: Heritage Provider Network Senior |
$113.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.09
|
| Rate for Payer: Multiplan Commercial |
$126.25
|
|
|
DABRAFENIB 75 MG CAPSULE [202200]
|
Facility
|
OP
|
$168.34
|
|
|
Service Code
|
NDC 0078068166
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.47 |
| Max. Negotiated Rate |
$143.09 |
| Rate for Payer: Adventist Health Commercial |
$33.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$104.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$143.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.20
|
| Rate for Payer: Blue Shield of California Commercial |
$102.69
|
| Rate for Payer: Blue Shield of California EPN |
$82.15
|
| Rate for Payer: Cash Price |
$75.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$143.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.20
|
| Rate for Payer: Heritage Provider Network Senior |
$104.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$80.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$117.84
|
| Rate for Payer: Multiplan Commercial |
$126.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.34
|
| Rate for Payer: TriValley Medical Group Senior |
$67.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$84.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$84.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$143.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.09
|
| Rate for Payer: Vantage Medical Group Senior |
$143.09
|
|
|
DACARBAZINE 100 MG INTRAVENOUS SOLUTION [2090]
|
Facility
|
OP
|
$14.87
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$31.11 |
| Rate for Payer: Adventist Health Commercial |
$2.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.11
|
| Rate for Payer: Blue Shield of California Commercial |
$6.12
|
| Rate for Payer: Blue Shield of California EPN |
$6.12
|
| Rate for Payer: Cash Price |
$6.69
|
| Rate for Payer: Cash Price |
$6.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.88
|
| Rate for Payer: Heritage Provider Network Senior |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.41
|
| Rate for Payer: Multiplan Commercial |
$11.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.95
|
| Rate for Payer: TriValley Medical Group Senior |
$5.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.64
|
| Rate for Payer: Vantage Medical Group Senior |
$12.64
|
|
|
DACARBAZINE 100 MG INTRAVENOUS SOLUTION [2090]
|
Facility
|
IP
|
$14.87
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$11.15 |
| Rate for Payer: Adventist Health Commercial |
$2.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.58
|
| Rate for Payer: Cash Price |
$6.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.88
|
| Rate for Payer: Heritage Provider Network Senior |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$11.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.92
|
|
|
DACARBAZINE 200 MG INTRAVENOUS SOLUTION [2091]
|
Facility
|
IP
|
$14.40
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.27
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.67
|
| Rate for Payer: Heritage Provider Network Senior |
$6.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$10.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.77
|
|
|
DACARBAZINE 200 MG INTRAVENOUS SOLUTION [2091]
|
Facility
|
OP
|
$14.40
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$31.11 |
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.11
|
| Rate for Payer: Blue Shield of California Commercial |
$6.12
|
| Rate for Payer: Blue Shield of California EPN |
$6.12
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.67
|
| Rate for Payer: Heritage Provider Network Senior |
$6.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.76
|
| Rate for Payer: TriValley Medical Group Senior |
$5.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.24
|
| Rate for Payer: Vantage Medical Group Senior |
$12.24
|
|
|
DACOMITINIB 15 MG TABLET [222938]
|
Facility
|
IP
|
$693.42
|
|
|
Service Code
|
NDC 0069019730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$125.51 |
| Max. Negotiated Rate |
$520.07 |
| Rate for Payer: Adventist Health Commercial |
$138.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$446.56
|
| Rate for Payer: Cash Price |
$312.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$374.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$469.45
|
| Rate for Payer: Heritage Provider Network Senior |
$469.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.35
|
| Rate for Payer: Multiplan Commercial |
$520.07
|
|
|
DACOMITINIB 15 MG TABLET [222938]
|
Facility
|
OP
|
$693.42
|
|
|
Service Code
|
NDC 0069019730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$125.51 |
| Max. Negotiated Rate |
$589.41 |
| Rate for Payer: Adventist Health Commercial |
$138.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$428.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$589.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$381.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$520.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$346.85
|
| Rate for Payer: Blue Shield of California Commercial |
$422.99
|
| Rate for Payer: Blue Shield of California EPN |
$338.39
|
| Rate for Payer: Cash Price |
$312.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$450.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$589.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$589.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$589.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$443.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.23
|
| Rate for Payer: Heritage Provider Network Senior |
$429.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$330.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$485.39
|
| Rate for Payer: Multiplan Commercial |
$520.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$277.37
|
| Rate for Payer: TriValley Medical Group Senior |
$277.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$346.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$346.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$589.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$589.41
|
| Rate for Payer: Vantage Medical Group Senior |
$589.41
|
|
|
DACOMITINIB 30 MG TABLET [222939]
|
Facility
|
OP
|
$693.42
|
|
|
Service Code
|
NDC 0069119830
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$125.51 |
| Max. Negotiated Rate |
$589.41 |
| Rate for Payer: Adventist Health Commercial |
$138.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$428.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$589.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$381.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$520.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$346.85
|
| Rate for Payer: Blue Shield of California Commercial |
$422.99
|
| Rate for Payer: Blue Shield of California EPN |
$338.39
|
| Rate for Payer: Cash Price |
$312.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$450.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$589.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$589.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$589.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$443.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.23
|
| Rate for Payer: Heritage Provider Network Senior |
$429.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$330.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$485.39
|
| Rate for Payer: Multiplan Commercial |
$520.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$277.37
|
| Rate for Payer: TriValley Medical Group Senior |
$277.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$346.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$346.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$589.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$589.41
|
| Rate for Payer: Vantage Medical Group Senior |
$589.41
|
|
|
DACOMITINIB 30 MG TABLET [222939]
|
Facility
|
IP
|
$693.42
|
|
|
Service Code
|
NDC 0069119830
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$125.51 |
| Max. Negotiated Rate |
$520.07 |
| Rate for Payer: Adventist Health Commercial |
$138.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$446.56
|
| Rate for Payer: Cash Price |
$312.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$374.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$469.45
|
| Rate for Payer: Heritage Provider Network Senior |
$469.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.35
|
| Rate for Payer: Multiplan Commercial |
$520.07
|
|
|
DACOMITINIB 45 MG TABLET [222940]
|
Facility
|
IP
|
$693.42
|
|
|
Service Code
|
NDC 0069229930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$125.51 |
| Max. Negotiated Rate |
$520.07 |
| Rate for Payer: Adventist Health Commercial |
$138.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$446.56
|
| Rate for Payer: Cash Price |
$312.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$374.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$469.45
|
| Rate for Payer: Heritage Provider Network Senior |
$469.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.35
|
| Rate for Payer: Multiplan Commercial |
$520.07
|
|
|
DACOMITINIB 45 MG TABLET [222940]
|
Facility
|
OP
|
$693.42
|
|
|
Service Code
|
NDC 0069229930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$125.51 |
| Max. Negotiated Rate |
$589.41 |
| Rate for Payer: Adventist Health Commercial |
$138.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$428.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$589.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$381.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$520.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$346.85
|
| Rate for Payer: Blue Shield of California Commercial |
$422.99
|
| Rate for Payer: Blue Shield of California EPN |
$338.39
|
| Rate for Payer: Cash Price |
$312.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$450.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$589.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$589.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$589.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$443.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.23
|
| Rate for Payer: Heritage Provider Network Senior |
$429.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$330.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$485.39
|
| Rate for Payer: Multiplan Commercial |
$520.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$277.37
|
| Rate for Payer: TriValley Medical Group Senior |
$277.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$346.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$346.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$589.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$589.41
|
| Rate for Payer: Vantage Medical Group Senior |
$589.41
|
|
|
DACTINOMYCIN 0.5 MG INTRAVENOUS SOLUTION [28912]
|
Facility
|
IP
|
$885.00
|
|
|
Service Code
|
HCPCS J9120
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.19 |
| Max. Negotiated Rate |
$663.75 |
| Rate for Payer: Adventist Health Commercial |
$177.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$569.94
|
| Rate for Payer: Cash Price |
$398.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$407.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$477.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$409.75
|
| Rate for Payer: Heritage Provider Network Senior |
$409.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.25
|
| Rate for Payer: Multiplan Commercial |
$663.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$319.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$293.02
|
|
|
DACTINOMYCIN 0.5 MG INTRAVENOUS SOLUTION [28912]
|
Facility
|
OP
|
$885.00
|
|
|
Service Code
|
HCPCS J9120
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.54 |
| Max. Negotiated Rate |
$752.25 |
| Rate for Payer: Adventist Health Commercial |
$177.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$546.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$461.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$338.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.54
|
| Rate for Payer: Blue Shield of California Commercial |
$752.25
|
| Rate for Payer: Blue Shield of California EPN |
$752.25
|
| Rate for Payer: Cash Price |
$398.25
|
| Rate for Payer: Cash Price |
$398.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$407.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$384.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$338.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$338.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$566.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$409.75
|
| Rate for Payer: Heritage Provider Network Senior |
$409.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$422.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$353.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.93
|
| Rate for Payer: Multiplan Commercial |
$663.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$354.00
|
| Rate for Payer: TriValley Medical Group Senior |
$354.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$319.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$293.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$384.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$338.15
|
| Rate for Payer: Vantage Medical Group Senior |
$338.15
|
|
|
DALBAVANCIN 500 MG INTRAVENOUS SOLUTION [206124]
|
Facility
|
OP
|
$2,134.96
|
|
|
Service Code
|
HCPCS J0875
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.29 |
| Max. Negotiated Rate |
$1,601.22 |
| Rate for Payer: Adventist Health Commercial |
$426.99
|
| Rate for Payer: Adventist Health Commercial |
$384.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,187.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,319.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.14
|
| Rate for Payer: Blue Shield of California Commercial |
$18.15
|
| Rate for Payer: Blue Shield of California Commercial |
$18.15
|
| Rate for Payer: Blue Shield of California EPN |
$18.15
|
| Rate for Payer: Blue Shield of California EPN |
$18.15
|
| Rate for Payer: Cash Price |
$960.73
|
| Rate for Payer: Cash Price |
$960.73
|
| Rate for Payer: Cash Price |
$864.66
|
| Rate for Payer: Cash Price |
$864.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$982.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$883.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,366.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,229.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.29
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$988.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$889.64
|
| Rate for Payer: Heritage Provider Network Senior |
$988.49
|
| Rate for Payer: Heritage Provider Network Senior |
$889.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,018.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$916.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$347.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$386.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.13
|
| Rate for Payer: Multiplan Commercial |
$1,601.22
|
| Rate for Payer: Multiplan Commercial |
$1,441.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$768.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$853.98
|
| Rate for Payer: TriValley Medical Group Senior |
$768.58
|
| Rate for Payer: TriValley Medical Group Senior |
$853.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$771.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$694.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$706.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$636.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.42
|
| Rate for Payer: Vantage Medical Group Senior |
$12.42
|
| Rate for Payer: Vantage Medical Group Senior |
$12.42
|
|
|
DALBAVANCIN 500 MG INTRAVENOUS SOLUTION [206124]
|
Facility
|
IP
|
$1,921.46
|
|
|
Service Code
|
HCPCS J0875
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$347.78 |
| Max. Negotiated Rate |
$1,441.10 |
| Rate for Payer: Adventist Health Commercial |
$384.29
|
| Rate for Payer: Adventist Health Commercial |
$426.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,374.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,237.42
|
| Rate for Payer: Cash Price |
$960.73
|
| Rate for Payer: Cash Price |
$864.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$883.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$982.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,037.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$889.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$988.49
|
| Rate for Payer: Heritage Provider Network Senior |
$988.49
|
| Rate for Payer: Heritage Provider Network Senior |
$889.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$386.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$347.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.74
|
| Rate for Payer: Multiplan Commercial |
$1,601.22
|
| Rate for Payer: Multiplan Commercial |
$1,441.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$694.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$771.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$706.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$636.20
|
|
|
DANAZOL 200 MG CAPSULE [2120]
|
Facility
|
IP
|
$7.61
|
|
|
Service Code
|
NDC 0527136901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$5.71 |
| Rate for Payer: Adventist Health Commercial |
$1.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.90
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.15
|
| Rate for Payer: Heritage Provider Network Senior |
$5.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: Multiplan Commercial |
$5.71
|
|
