|
DARBEPOETIN ALFA 200 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE [108047]
|
Facility
|
IP
|
$4,644.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$840.56 |
| Max. Negotiated Rate |
$3,483.00 |
| Rate for Payer: Adventist Health Commercial |
$928.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,990.74
|
| Rate for Payer: Cash Price |
$2,089.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,136.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,507.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,150.17
|
| Rate for Payer: Heritage Provider Network Senior |
$2,150.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$840.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.00
|
| Rate for Payer: Multiplan Commercial |
$3,483.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,677.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,537.63
|
|
|
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 Non-Gatekeeper |
$341.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.70
|
| Rate for Payer: Blue Shield of California Commercial |
$7.90
|
| Rate for Payer: Blue Shield of California EPN |
$7.90
|
| Rate for Payer: Cash Price |
$248.79
|
| Rate for Payer: Cash Price |
$248.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$254.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$353.83
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.92
|
| 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) Medicare Advantage |
$2.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$263.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$100.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.91
|
| 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 |
$3.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.21
|
| Rate for Payer: Vantage Medical Group Senior |
$3.21
|
|
|
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: Aetna of CA Non-Gatekeeper |
$356.04
|
| Rate for Payer: Cash Price |
$248.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$254.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.97
|
| Rate for Payer: Heritage Provider Network Senior |
$255.97
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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: Aetna of CA Non-Gatekeeper |
$598.15
|
| Rate for Payer: Cash Price |
$417.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$427.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$501.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$430.03
|
| Rate for Payer: Heritage Provider Network Senior |
$430.03
|
| Rate for Payer: Kaiser Foundation Hospitals 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 Non-Gatekeeper |
$574.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.70
|
| Rate for Payer: Blue Shield of California Commercial |
$7.90
|
| Rate for Payer: Blue Shield of California EPN |
$7.90
|
| Rate for Payer: Cash Price |
$417.96
|
| Rate for Payer: Cash Price |
$417.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$427.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.43
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.92
|
| 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) Medicare Advantage |
$2.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$443.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$168.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.91
|
| 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 |
$3.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.21
|
| Rate for Payer: Vantage Medical Group Senior |
$3.21
|
|
|
DARBEPOETIN ALFA 60 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE [108043]
|
Facility
|
OP
|
$1,857.60
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$1,393.20 |
| Rate for Payer: Adventist Health Commercial |
$371.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,148.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.70
|
| Rate for Payer: Blue Shield of California Commercial |
$7.90
|
| Rate for Payer: Blue Shield of California EPN |
$7.90
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$854.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,188.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$860.07
|
| Rate for Payer: Heritage Provider Network Senior |
$860.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$886.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$336.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.91
|
| Rate for Payer: Multiplan Commercial |
$1,393.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$743.04
|
| Rate for Payer: TriValley Medical Group Senior |
$743.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$671.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$615.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.21
|
| Rate for Payer: Vantage Medical Group Senior |
$3.21
|
|
|
DARBEPOETIN ALFA 60 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE [108043]
|
Facility
|
IP
|
$1,857.60
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$336.23 |
| Max. Negotiated Rate |
$1,393.20 |
| Rate for Payer: Adventist Health Commercial |
$371.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,196.29
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$854.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,003.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$860.07
|
| Rate for Payer: Heritage Provider Network Senior |
$860.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$336.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.40
|
| Rate for Payer: Multiplan Commercial |
$1,393.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$671.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$615.05
|
|
|
DAROLUTAMIDE 300 MG TABLET [225419]
|
Facility
|
OP
|
$151.01
|
|
|
Service Code
|
NDC 5041939501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.33 |
| Max. Negotiated Rate |
$128.36 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$93.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$128.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.54
|
| Rate for Payer: Blue Shield of California Commercial |
$92.12
|
| Rate for Payer: Blue Shield of California EPN |
$73.69
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$98.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$128.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$128.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.48
|
| Rate for Payer: Heritage Provider Network Senior |
$93.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$72.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$105.71
|
| Rate for Payer: Multiplan Commercial |
$113.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$60.40
|
| Rate for Payer: TriValley Medical Group Senior |
$60.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$75.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$75.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$128.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.36
|
| Rate for Payer: Vantage Medical Group Senior |
$128.36
|
|
|
DAROLUTAMIDE 300 MG TABLET [225419]
|
Facility
|
IP
|
$151.01
|
|
|
Service Code
|
NDC 5041939501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.33 |
| Max. Negotiated Rate |
$113.26 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$97.25
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.23
|
| Rate for Payer: Heritage Provider Network Senior |
$102.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.75
|
| Rate for Payer: Multiplan Commercial |
$113.26
|
|
|
DARUNAVIR 600 MG TABLET [92851]
|
Facility
|
IP
|
$43.16
|
|
|
Service Code
|
NDC 5967656201
|
| 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: Aetna of CA Non-Gatekeeper |
$27.80
|
| Rate for Payer: Cash Price |
$19.42
|
| 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 Foundation Hospitals Medi-Cal |
$7.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.79
|
| Rate for Payer: Multiplan Commercial |
$32.37
|
|
|
DARUNAVIR 600 MG TABLET [92851]
|
Facility
|
OP
|
$43.16
|
|
|
Service Code
|
NDC 5967656201
|
| 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 Non-Gatekeeper |
$26.67
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$21.59
|
| 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 |
$19.42
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$20.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 800 MG-COBICISTAT 150 MG TABLET [208697]
|
Facility
|
IP
|
$98.67
|
|
|
Service Code
|
NDC 5967657530
|
| 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: Aetna of CA Non-Gatekeeper |
$63.54
|
| Rate for Payer: Cash Price |
$44.40
|
| 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 Foundation Hospitals 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 5967657530
|
| 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 Non-Gatekeeper |
$60.98
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$49.35
|
| 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 |
$44.40
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$47.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 5967656630
|
| 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 Non-Gatekeeper |
$53.35
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$43.18
|
| 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 |
$38.85
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$41.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
OP
|
$12.30
|
|
|
Service Code
|
NDC 6068781921
|
| 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 Non-Gatekeeper |
$7.60
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$6.15
|
| 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 |
$5.54
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$5.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
IP
|
$86.33
|
|
|
Service Code
|
NDC 5967656630
|
| 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: Aetna of CA Non-Gatekeeper |
$55.60
|
| Rate for Payer: Cash Price |
$38.85
|
| 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 Foundation Hospitals 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
|
OP
|
$12.30
|
|
|
Service Code
|
NDC 6068781911
|
| 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 Non-Gatekeeper |
$7.60
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$6.15
|
| 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 |
$5.54
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$5.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
IP
|
$3.96
|
|
|
Service Code
|
NDC 6818034606
|
| 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: Aetna of CA Non-Gatekeeper |
$2.55
|
| Rate for Payer: Cash Price |
$1.78
|
| 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 Foundation Hospitals 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
|
OP
|
$3.96
|
|
|
Service Code
|
NDC 6818034606
|
| 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 |
$2.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.98
|
| 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 |
$1.78
|
| 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 Medicare Advantage |
$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 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 |
$2.77
|
| 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
|
|
|
DARUNAVIR 800 MG TABLET [199468]
|
Facility
|
IP
|
$12.30
|
|
|
Service Code
|
NDC 6068781911
|
| 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: Aetna of CA Non-Gatekeeper |
$7.92
|
| Rate for Payer: Cash Price |
$5.54
|
| 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 Foundation Hospitals 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 6068781921
|
| 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: Aetna of CA Non-Gatekeeper |
$7.92
|
| Rate for Payer: Cash Price |
$5.54
|
| 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 Foundation Hospitals Medi-Cal |
$2.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
|
|
DASATINIB 100 MG TABLET [92897]
|
Facility
|
IP
|
$729.85
|
|
|
Service Code
|
NDC 0003085222
|
| 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: Aetna of CA Non-Gatekeeper |
$470.02
|
| Rate for Payer: Cash Price |
$328.43
|
| 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 Foundation Hospitals Medi-Cal |
$132.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.46
|
| Rate for Payer: Multiplan Commercial |
$547.39
|
|
|
DASATINIB 100 MG TABLET [92897]
|
Facility
|
OP
|
$729.85
|
|
|
Service Code
|
NDC 0003085222
|
| 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 Non-Gatekeeper |
$451.05
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$365.07
|
| 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 |
$328.43
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$348.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 140 MG TABLET [108422]
|
Facility
|
OP
|
$729.85
|
|
|
Service Code
|
NDC 0003085722
|
| 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 Non-Gatekeeper |
$451.05
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$365.07
|
| 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 |
$328.43
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$348.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 140 MG TABLET [108422]
|
Facility
|
IP
|
$729.85
|
|
|
Service Code
|
NDC 0003085722
|
| 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: Aetna of CA Non-Gatekeeper |
$470.02
|
| Rate for Payer: Cash Price |
$328.43
|
| 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 Foundation Hospitals Medi-Cal |
$132.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.46
|
| Rate for Payer: Multiplan Commercial |
$547.39
|
|
