|
Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach
|
Facility
|
OP
|
$9,590.00
|
|
|
Service Code
|
CPT 54520
|
| Min. Negotiated Rate |
$481.00 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Media |
$4,355.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,143.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,143.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,056.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7,056.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,355.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
Orchiopexy, inguinal or scrotal approach
|
Facility
|
OP
|
$12,491.00
|
|
|
Service Code
|
CPT 54640
|
| Min. Negotiated Rate |
$848.84 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Media |
$4,322.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,835.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,322.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,089.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,089.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,002.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7,002.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$848.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,322.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,792.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
ORGANIC MENTAL HEALTH DISTURBANCES
|
Facility
|
IP
|
$33,555.63
|
|
|
Service Code
|
APR-DRG 7574
|
| Min. Negotiated Rate |
$25,740.70 |
| Max. Negotiated Rate |
$33,555.63 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25,740.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33,555.63
|
|
|
ORGANIC MENTAL HEALTH DISTURBANCES
|
Facility
|
IP
|
$14,540.60
|
|
|
Service Code
|
APR-DRG 7573
|
| Min. Negotiated Rate |
$11,154.17 |
| Max. Negotiated Rate |
$14,540.60 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,154.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,540.60
|
|
|
ORGANIC MENTAL HEALTH DISTURBANCES
|
Facility
|
IP
|
$7,028.21
|
|
|
Service Code
|
APR-DRG 7571
|
| Min. Negotiated Rate |
$5,391.38 |
| Max. Negotiated Rate |
$7,028.21 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,391.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,028.21
|
|
|
ORGANIC MENTAL HEALTH DISTURBANCES
|
Facility
|
IP
|
$9,523.48
|
|
|
Service Code
|
APR-DRG 7572
|
| Min. Negotiated Rate |
$7,305.51 |
| Max. Negotiated Rate |
$9,523.48 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,305.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,523.48
|
|
|
ORITAVANCIN 1,200 MG INTRAVENOUS SOLUTION [231752]
|
Facility
|
IP
|
$6,036.62
|
|
|
Service Code
|
CPT J2406
|
| Hospital Charge Code |
ERX231752
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,448.79 |
| Max. Negotiated Rate |
$5,131.13 |
| Rate for Payer: Blue Shield of California Commercial |
$4,298.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,090.75
|
| Rate for Payer: Cash Price |
$2,716.48
|
| Rate for Payer: Cigna of CA HMO |
$4,225.63
|
| Rate for Payer: Cigna of CA PPO |
$4,225.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,414.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,414.65
|
| Rate for Payer: Galaxy Health WC |
$5,131.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3,621.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,026.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,299.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,448.79
|
| Rate for Payer: Multiplan Commercial |
$4,829.30
|
| Rate for Payer: Networks By Design Commercial |
$3,018.31
|
| Rate for Payer: Prime Health Services Commercial |
$5,131.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,279.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2,226.31
|
| Rate for Payer: United Healthcare HMO Rider |
$2,178.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,992.08
|
|
|
ORITAVANCIN 1,200 MG INTRAVENOUS SOLUTION [231752]
|
Facility
|
OP
|
$6,036.62
|
|
|
Service Code
|
CPT J2406
|
| Hospital Charge Code |
ERX231752
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.92 |
| Max. Negotiated Rate |
$5,131.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$257.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.76
|
| Rate for Payer: Blue Distinction Transplant |
$3,621.97
|
| Rate for Payer: Blue Shield of California Commercial |
$4,448.99
|
| Rate for Payer: Blue Shield of California EPN |
$3,525.39
|
| Rate for Payer: Cash Price |
$2,716.48
|
| Rate for Payer: Cash Price |
$2,716.48
|
| Rate for Payer: Cigna of CA HMO |
$4,225.63
|
| Rate for Payer: Cigna of CA PPO |
$4,225.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.15
|
| Rate for Payer: Dignity Health Media |
$45.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$40.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$5,131.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3,621.97
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,527.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$67.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$66.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$66.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,026.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,448.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54.83
|
| Rate for Payer: Multiplan Commercial |
$4,829.30
|
| Rate for Payer: Networks By Design Commercial |
$3,018.31
|
| Rate for Payer: Prime Health Services Commercial |
$5,131.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,621.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,621.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,018.31
|
| Rate for Payer: United Healthcare All Other HMO |
$3,018.31
|
| Rate for Payer: United Healthcare HMO Rider |
$3,018.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,018.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.01
|
| Rate for Payer: Vantage Medical Group Senior |
$45.01
|
|
|
ORITAVANCIN 400 MG INTRAVENOUS SOLUTION [207378]
|
Facility
|
IP
|
$1,352.40
|
|
|
Service Code
|
CPT J2407
|
| Hospital Charge Code |
ERX207378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$324.58 |
| Max. Negotiated Rate |
$1,149.54 |
| Rate for Payer: Blue Shield of California Commercial |
$962.91
|
| Rate for Payer: Blue Shield of California EPN |
$692.43
|
| Rate for Payer: Cash Price |
$608.58
|
| Rate for Payer: Cigna of CA HMO |
$946.68
|
| Rate for Payer: Cigna of CA PPO |
$946.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$540.96
|
| Rate for Payer: Galaxy Health WC |
$1,149.54
|
| Rate for Payer: Global Benefits Group Commercial |
$811.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$902.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.58
|
| Rate for Payer: Multiplan Commercial |
$1,081.92
|
| Rate for Payer: Networks By Design Commercial |
$676.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,149.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$510.67
|
| Rate for Payer: United Healthcare All Other HMO |
$498.77
|
| Rate for Payer: United Healthcare HMO Rider |
$487.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$446.29
|
|
|
ORITAVANCIN 400 MG INTRAVENOUS SOLUTION [207378]
|
Facility
|
OP
|
$1,352.40
|
|
|
Service Code
|
CPT J2407
|
| Hospital Charge Code |
ERX207378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$1,149.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$173.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.53
|
| Rate for Payer: Blue Distinction Transplant |
$811.44
|
| Rate for Payer: Blue Shield of California Commercial |
$996.72
|
| Rate for Payer: Blue Shield of California EPN |
$29.87
|
| Rate for Payer: Cash Price |
$608.58
|
| Rate for Payer: Cash Price |
$608.58
|
| Rate for Payer: Cigna of CA HMO |
$946.68
|
| Rate for Payer: Cigna of CA PPO |
$946.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.39
|
| Rate for Payer: Dignity Health Media |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.25
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.60
|
| Rate for Payer: Galaxy Health WC |
$1,149.54
|
| Rate for Payer: Global Benefits Group Commercial |
$811.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,014.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.26
|
| Rate for Payer: Heritage Provider Network Transplant |
$45.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$44.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$44.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$902.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.98
|
| Rate for Payer: Multiplan Commercial |
$1,081.92
|
| Rate for Payer: Networks By Design Commercial |
$676.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,149.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$811.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$811.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.20
|
| Rate for Payer: United Healthcare All Other HMO |
$676.20
|
| Rate for Payer: United Healthcare HMO Rider |
$676.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.35
|
| Rate for Payer: Vantage Medical Group Senior |
$27.60
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION [5886]
|
Facility
|
OP
|
$7.20
|
|
|
Service Code
|
CPT J2360
|
| Hospital Charge Code |
NDG5886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$61.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$61.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.95
|
| Rate for Payer: Blue Distinction Transplant |
$4.32
|
| Rate for Payer: Blue Distinction Transplant |
$5.71
|
| Rate for Payer: Blue Shield of California Commercial |
$5.31
|
| Rate for Payer: Blue Shield of California Commercial |
$7.02
|
| Rate for Payer: Blue Shield of California EPN |
$18.72
|
| Rate for Payer: Blue Shield of California EPN |
$18.72
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$6.66
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$6.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Media |
$8.09
|
| Rate for Payer: Dignity Health Media |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.81
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$8.09
|
| Rate for Payer: Global Benefits Group Commercial |
$5.71
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.14
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$7.62
|
| Rate for Payer: Multiplan Commercial |
$5.76
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$4.76
|
| Rate for Payer: Prime Health Services Commercial |
$8.09
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.76
|
| Rate for Payer: United Healthcare All Other HMO |
$4.76
|
| Rate for Payer: United Healthcare All Other HMO |
$3.60
|
| Rate for Payer: United Healthcare HMO Rider |
$4.76
|
| Rate for Payer: United Healthcare HMO Rider |
$3.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.09
|
| Rate for Payer: Vantage Medical Group Senior |
$8.09
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION [5886]
|
Facility
|
IP
|
$7.20
|
|
|
Service Code
|
CPT J2360
|
| Hospital Charge Code |
NDG5886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$6.12 |
| Rate for Payer: Blue Shield of California Commercial |
$5.13
|
| Rate for Payer: Blue Shield of California Commercial |
$6.78
|
| Rate for Payer: Blue Shield of California EPN |
$3.69
|
| Rate for Payer: Blue Shield of California EPN |
$4.87
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$6.66
|
| Rate for Payer: Cigna of CA PPO |
$6.66
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.81
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$8.09
|
| Rate for Payer: Global Benefits Group Commercial |
$5.71
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Multiplan Commercial |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$7.62
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$4.76
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Prime Health Services Commercial |
$8.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2.66
|
| Rate for Payer: United Healthcare All Other HMO |
$3.51
|
| Rate for Payer: United Healthcare HMO Rider |
$2.60
|
| Rate for Payer: United Healthcare HMO Rider |
$3.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.14
|
|
|
OSELTAMIVIR 30 MG CAPSULE [88704]
|
Facility
|
OP
|
$11.23
|
|
|
Service Code
|
NDC 47781-468-13
|
| Hospital Charge Code |
1712606
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.69
|
| Rate for Payer: Blue Distinction Transplant |
$6.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8.28
|
| Rate for Payer: Blue Shield of California EPN |
$6.56
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cigna of CA HMO |
$7.86
|
| Rate for Payer: Cigna of CA PPO |
$7.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.55
|
| Rate for Payer: Dignity Health Media |
$9.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.62
|
| Rate for Payer: United Healthcare All Other HMO |
$5.62
|
| Rate for Payer: United Healthcare HMO Rider |
$5.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Vantage Medical Group Senior |
$9.55
|
|
|
OSELTAMIVIR 30 MG CAPSULE [88704]
|
Facility
|
OP
|
$9.55
|
|
|
Service Code
|
NDC 69238-1264-1
|
| Hospital Charge Code |
1712606
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$8.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.69
|
| Rate for Payer: Blue Distinction Transplant |
$5.73
|
| Rate for Payer: Blue Shield of California Commercial |
$7.04
|
| Rate for Payer: Blue Shield of California EPN |
$5.58
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cigna of CA HMO |
$6.68
|
| Rate for Payer: Cigna of CA PPO |
$6.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.12
|
| Rate for Payer: Dignity Health Media |
$8.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.82
|
| Rate for Payer: Galaxy Health WC |
$8.12
|
| Rate for Payer: Global Benefits Group Commercial |
$5.73
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.29
|
| Rate for Payer: Multiplan Commercial |
$7.64
|
| Rate for Payer: Networks By Design Commercial |
$6.21
|
| Rate for Payer: Prime Health Services Commercial |
$8.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.78
|
| Rate for Payer: United Healthcare All Other HMO |
$4.78
|
| Rate for Payer: United Healthcare HMO Rider |
$4.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.12
|
| Rate for Payer: Vantage Medical Group Senior |
$8.12
|
|
|
OSELTAMIVIR 30 MG CAPSULE [88704]
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 68180-675-11
|
| Hospital Charge Code |
1712606
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Blue Shield of California Commercial |
$2.22
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cigna of CA HMO |
$2.18
|
| Rate for Payer: Cigna of CA PPO |
$2.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.25
|
| Rate for Payer: Galaxy Health WC |
$2.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Networks By Design Commercial |
$2.03
|
| Rate for Payer: Prime Health Services Commercial |
$2.65
|
|
|
OSELTAMIVIR 30 MG CAPSULE [88704]
|
Facility
|
OP
|
$3.12
|
|
|
Service Code
|
NDC 68180-675-11
|
| Hospital Charge Code |
1712606
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.86
|
| Rate for Payer: Blue Distinction Transplant |
$1.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2.30
|
| Rate for Payer: Blue Shield of California EPN |
$1.82
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cigna of CA HMO |
$2.18
|
| Rate for Payer: Cigna of CA PPO |
$2.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.65
|
| Rate for Payer: Dignity Health Media |
$2.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.25
|
| Rate for Payer: Galaxy Health WC |
$2.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1.87
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Networks By Design Commercial |
$2.03
|
| Rate for Payer: Prime Health Services Commercial |
$2.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1.56
|
| Rate for Payer: United Healthcare HMO Rider |
$1.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2.65
|
|
|
OSELTAMIVIR 30 MG CAPSULE [88704]
|
Facility
|
IP
|
$9.55
|
|
|
Service Code
|
NDC 69238-1264-1
|
| Hospital Charge Code |
1712606
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$8.12 |
| Rate for Payer: Blue Shield of California Commercial |
$6.80
|
| Rate for Payer: Blue Shield of California EPN |
$4.89
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cigna of CA HMO |
$6.68
|
| Rate for Payer: Cigna of CA PPO |
$6.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.82
|
| Rate for Payer: Galaxy Health WC |
$8.12
|
| Rate for Payer: Global Benefits Group Commercial |
$5.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.29
|
| Rate for Payer: Multiplan Commercial |
$7.64
|
| Rate for Payer: Networks By Design Commercial |
$6.21
|
| Rate for Payer: Prime Health Services Commercial |
$8.12
|
|
|
OSELTAMIVIR 30 MG CAPSULE [88704]
|
Facility
|
IP
|
$11.23
|
|
|
Service Code
|
NDC 47781-468-13
|
| Hospital Charge Code |
1712606
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Blue Shield of California Commercial |
$8.00
|
| Rate for Payer: Blue Shield of California EPN |
$5.75
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cigna of CA HMO |
$7.86
|
| Rate for Payer: Cigna of CA PPO |
$7.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
|
|
OSELTAMIVIR 45 MG CAPSULE [88705]
|
Facility
|
OP
|
$16.72
|
|
|
Service Code
|
NDC 0004-0801-85
|
| Hospital Charge Code |
ERX88705
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$14.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.96
|
| Rate for Payer: Blue Distinction Transplant |
$10.03
|
| Rate for Payer: Blue Shield of California Commercial |
$12.32
|
| Rate for Payer: Blue Shield of California EPN |
$9.76
|
| Rate for Payer: Cash Price |
$7.52
|
| Rate for Payer: Cigna of CA HMO |
$11.70
|
| Rate for Payer: Cigna of CA PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.21
|
| Rate for Payer: Dignity Health Media |
$14.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.69
|
| Rate for Payer: Galaxy Health WC |
$14.21
|
| Rate for Payer: Global Benefits Group Commercial |
$10.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$13.38
|
| Rate for Payer: Networks By Design Commercial |
$10.87
|
| Rate for Payer: Prime Health Services Commercial |
$14.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.36
|
| Rate for Payer: United Healthcare All Other HMO |
$8.36
|
| Rate for Payer: United Healthcare HMO Rider |
$8.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.21
|
| Rate for Payer: Vantage Medical Group Senior |
$14.21
|
|
|
OSELTAMIVIR 45 MG CAPSULE [88705]
|
Facility
|
IP
|
$16.72
|
|
|
Service Code
|
NDC 0004-0801-85
|
| Hospital Charge Code |
ERX88705
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$14.21 |
| Rate for Payer: Blue Shield of California Commercial |
$11.90
|
| Rate for Payer: Blue Shield of California EPN |
$8.56
|
| Rate for Payer: Cash Price |
$7.52
|
| Rate for Payer: Cigna of CA HMO |
$11.70
|
| Rate for Payer: Cigna of CA PPO |
$11.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.69
|
| Rate for Payer: Galaxy Health WC |
$14.21
|
| Rate for Payer: Global Benefits Group Commercial |
$10.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$13.38
|
| Rate for Payer: Networks By Design Commercial |
$10.87
|
| Rate for Payer: Prime Health Services Commercial |
$14.21
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [187854]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 68180-678-01
|
| Hospital Charge Code |
1715279
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [187854]
|
Facility
|
IP
|
$3.04
|
|
|
Service Code
|
NDC 0004-0822-05
|
| Hospital Charge Code |
1715279
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Blue Shield of California Commercial |
$2.16
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cigna of CA HMO |
$2.13
|
| Rate for Payer: Cigna of CA PPO |
$2.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.22
|
| Rate for Payer: Galaxy Health WC |
$2.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.43
|
| Rate for Payer: Networks By Design Commercial |
$1.98
|
| Rate for Payer: Prime Health Services Commercial |
$2.58
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [187854]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 68180-678-01
|
| Hospital Charge Code |
1715279
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: Blue Distinction Transplant |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Media |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [187854]
|
Facility
|
OP
|
$3.04
|
|
|
Service Code
|
NDC 0004-0822-05
|
| Hospital Charge Code |
1715279
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.81
|
| Rate for Payer: Blue Distinction Transplant |
$1.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cigna of CA HMO |
$2.13
|
| Rate for Payer: Cigna of CA PPO |
$2.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.58
|
| Rate for Payer: Dignity Health Media |
$2.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.22
|
| Rate for Payer: Galaxy Health WC |
$2.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.43
|
| Rate for Payer: Networks By Design Commercial |
$1.98
|
| Rate for Payer: Prime Health Services Commercial |
$2.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.52
|
| Rate for Payer: United Healthcare All Other HMO |
$1.52
|
| Rate for Payer: United Healthcare HMO Rider |
$1.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.58
|
| Rate for Payer: Vantage Medical Group Senior |
$2.58
|
|
|
OSELTAMIVIR 75 MG CAPSULE [26546]
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 31722-632-31
|
| Hospital Charge Code |
1712299
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Blue Shield of California Commercial |
$2.22
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cigna of CA HMO |
$2.18
|
| Rate for Payer: Cigna of CA PPO |
$2.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.25
|
| Rate for Payer: Galaxy Health WC |
$2.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Networks By Design Commercial |
$2.03
|
| Rate for Payer: Prime Health Services Commercial |
$2.65
|
|
