|
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: AlphaCare Medical Group Commercial/Exchange |
$34.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$30.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.53
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$44.70
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$44.70
|
| Rate for Payer: 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
|
|
|
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
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION [5886]
|
Facility
OP
|
$9.52
|
|
|
Service Code
|
CPT J2360
|
| Hospital Charge Code |
NDG5886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.28 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.24
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$5.71
|
| Rate for Payer: BCBS Transplant Transplant |
$4.32
|
| 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 |
$3.24
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Cash Price |
$4.28
|
| 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 |
$6.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: Dignity Health Media |
$6.12
|
| Rate for Payer: Dignity Health Media |
$8.09
|
| 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 |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$8.09
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| 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 Transplant Other |
$5.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.14
|
| 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 |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$7.62
|
| Rate for Payer: Networks By Design Commercial |
$4.76
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| 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 |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$4.76
|
| 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 |
$8.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$8.09
|
|
|
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 |
$4.28
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO |
$6.66
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$6.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$8.09
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.71
|
| 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 |
$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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$8.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.69
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$5.73
|
| 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
|
$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
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: AlphaCare Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.69
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$6.74
|
| 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
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 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: AlphaCare Medical Group Commercial/Exchange |
$2.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.86
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1.87
|
| 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 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: AlphaCare Medical Group Commercial/Exchange |
$14.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.96
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$10.03
|
| 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
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: AlphaCare Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.36
|
| 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
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
|
$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: AlphaCare Medical Group Commercial/Exchange |
$2.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.81
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1.82
|
| 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 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 75 MG CAPSULE [26546]
|
Facility
OP
|
$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: Aetna of CA HMO/PPO |
$2.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.86
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1.87
|
| 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 75 MG CAPSULE [26546]
|
Facility
OP
|
$10.41
|
|
|
Service Code
|
NDC 69238-1266-1
|
| Hospital Charge Code |
1712299
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.20
|
| Rate for Payer: BCBS Transplant Transplant |
$6.25
|
| Rate for Payer: Blue Shield of California Commercial |
$7.67
|
| Rate for Payer: Blue Shield of California EPN |
$6.08
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cigna of CA HMO |
$7.29
|
| Rate for Payer: Cigna of CA PPO |
$7.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.85
|
| Rate for Payer: Dignity Health Media |
$8.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.16
|
| Rate for Payer: Galaxy Health WC |
$8.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$8.33
|
| Rate for Payer: Networks By Design Commercial |
$6.77
|
| Rate for Payer: Prime Health Services Commercial |
$8.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.20
|
| Rate for Payer: United Healthcare All Other HMO |
$5.20
|
| Rate for Payer: United Healthcare HMO Rider |
$5.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.85
|
| Rate for Payer: Vantage Medical Group Senior |
$8.85
|
|
|
OSELTAMIVIR 75 MG CAPSULE [26546]
|
Facility
OP
|
$18.23
|
|
|
Service Code
|
NDC 0004-0800-85
|
| Hospital Charge Code |
1712299
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$15.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.86
|
| Rate for Payer: BCBS Transplant Transplant |
$10.94
|
| Rate for Payer: Blue Shield of California Commercial |
$13.44
|
| Rate for Payer: Blue Shield of California EPN |
$10.65
|
| Rate for Payer: Cash Price |
$8.20
|
| Rate for Payer: Cigna of CA HMO |
$12.76
|
| Rate for Payer: Cigna of CA PPO |
$12.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.50
|
| Rate for Payer: Dignity Health Media |
$15.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.29
|
| Rate for Payer: Galaxy Health WC |
$15.50
|
| Rate for Payer: Global Benefits Group Commercial |
$10.94
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$14.58
|
| Rate for Payer: Networks By Design Commercial |
$11.85
|
| Rate for Payer: Prime Health Services Commercial |
$15.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.12
|
| Rate for Payer: United Healthcare All Other HMO |
$9.12
|
| Rate for Payer: United Healthcare HMO Rider |
$9.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.50
|
| Rate for Payer: Vantage Medical Group Senior |
$15.50
|
|
|
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
|
|
|
OSELTAMIVIR 75 MG CAPSULE [26546]
|
Facility
IP
|
$18.23
|
|
|
Service Code
|
NDC 0004-0800-85
|
| Hospital Charge Code |
1712299
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$15.50 |
| Rate for Payer: Blue Shield of California Commercial |
$12.98
|
| Rate for Payer: Blue Shield of California EPN |
$9.33
|
| Rate for Payer: Cash Price |
$8.20
|
| Rate for Payer: Cigna of CA HMO |
$12.76
|
| Rate for Payer: Cigna of CA PPO |
$12.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.29
|
| Rate for Payer: Galaxy Health WC |
$15.50
|
| Rate for Payer: Global Benefits Group Commercial |
$10.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$14.58
|
| Rate for Payer: Networks By Design Commercial |
$11.85
|
| Rate for Payer: Prime Health Services Commercial |
$15.50
|
|
|
OSELTAMIVIR 75 MG CAPSULE [26546]
|
Facility
IP
|
$10.41
|
|
|
Service Code
|
NDC 69238-1266-1
|
| Hospital Charge Code |
1712299
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Blue Shield of California Commercial |
$7.41
|
| Rate for Payer: Blue Shield of California EPN |
$5.33
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cigna of CA HMO |
$7.29
|
| Rate for Payer: Cigna of CA PPO |
$7.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.16
|
| Rate for Payer: Galaxy Health WC |
$8.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$8.33
|
| Rate for Payer: Networks By Design Commercial |
$6.77
|
| Rate for Payer: Prime Health Services Commercial |
$8.85
|
|
|
OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS
|
Facility
IP
|
$13,269.03
|
|
|
Service Code
|
APR-DRG 3442
|
| Min. Negotiated Rate |
$10,178.74 |
| Max. Negotiated Rate |
$13,269.03 |
| Rate for Payer: IEHP Medi-Cal |
$10,178.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,269.03
|
|
|
OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS
|
Facility
IP
|
$30,560.26
|
|
|
Service Code
|
APR-DRG 3444
|
| Min. Negotiated Rate |
$23,442.94 |
| Max. Negotiated Rate |
$30,560.26 |
| Rate for Payer: IEHP Medi-Cal |
$23,442.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,560.26
|
|
|
OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS
|
Facility
IP
|
$10,458.09
|
|
|
Service Code
|
APR-DRG 3441
|
| Min. Negotiated Rate |
$8,022.46 |
| Max. Negotiated Rate |
$10,458.09 |
| Rate for Payer: IEHP Medi-Cal |
$8,022.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,458.09
|
|
