|
ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES
|
Facility
|
IP
|
$36,968.45
|
|
|
Service Code
|
APR-DRG 7574
|
| Min. Negotiated Rate |
$23,348.50 |
| Max. Negotiated Rate |
$36,968.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$23,348.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27,823.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36,968.45
|
|
|
ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES
|
Facility
|
IP
|
$10,657.08
|
|
|
Service Code
|
APR-DRG 7572
|
| Min. Negotiated Rate |
$6,730.79 |
| Max. Negotiated Rate |
$10,657.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,730.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,020.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,657.08
|
|
|
ORITAVANCIN 1,200 MG INTRAVENOUS SOLUTION [231752]
|
Facility
|
OP
|
$6,993.44
|
|
|
Service Code
|
HCPCS J2406
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.41 |
| Max. Negotiated Rate |
$6,294.10 |
| Rate for Payer: Adventist Health Commercial |
$1,398.69
|
| Rate for Payer: Adventist Health Medi-Cal |
$47.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$265.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.53
|
| Rate for Payer: Blue Shield of California Commercial |
$58.71
|
| Rate for Payer: Blue Shield of California EPN |
$53.37
|
| Rate for Payer: Cash Price |
$3,147.05
|
| Rate for Payer: Cash Price |
$3,147.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,594.75
|
| Rate for Payer: Cigna of CA HMO |
$4,895.41
|
| Rate for Payer: Cigna of CA PPO |
$4,895.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,895.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.23
|
| Rate for Payer: EPIC Health Plan Senior |
$52.15
|
| Rate for Payer: Galaxy Health WC |
$5,944.42
|
| Rate for Payer: Global Benefits Group Commercial |
$4,196.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,294.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$77.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,440.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,398.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$63.53
|
| Rate for Payer: Multiplan Commercial |
$5,245.08
|
| Rate for Payer: Networks By Design Commercial |
$3,496.72
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$47.41
|
| Rate for Payer: Prime Health Services Commercial |
$5,944.42
|
| Rate for Payer: Prime Health Services Medicare |
$50.25
|
| Rate for Payer: Riverside University Health System MISP |
$52.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,196.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,196.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,624.64
|
| Rate for Payer: United Healthcare All Other HMO |
$2,554.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2,499.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,290.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$47.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.15
|
| Rate for Payer: Vantage Medical Group Senior |
$52.15
|
|
|
ORITAVANCIN 1,200 MG INTRAVENOUS SOLUTION [231752]
|
Facility
|
IP
|
$6,993.44
|
|
|
Service Code
|
HCPCS J2406
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,398.69 |
| Max. Negotiated Rate |
$6,294.10 |
| Rate for Payer: Adventist Health Commercial |
$1,398.69
|
| Rate for Payer: Blue Shield of California Commercial |
$5,608.74
|
| Rate for Payer: Blue Shield of California EPN |
$3,524.69
|
| Rate for Payer: Cash Price |
$3,147.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,594.75
|
| Rate for Payer: Cigna of CA HMO |
$4,895.41
|
| Rate for Payer: Cigna of CA PPO |
$4,895.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,895.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,797.38
|
| Rate for Payer: EPIC Health Plan Senior |
$2,797.38
|
| Rate for Payer: Galaxy Health WC |
$5,944.42
|
| Rate for Payer: Global Benefits Group Commercial |
$4,196.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,294.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,440.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,126.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,398.69
|
| Rate for Payer: Multiplan Commercial |
$5,245.08
|
| Rate for Payer: Networks By Design Commercial |
$3,496.72
|
| Rate for Payer: Prime Health Services Commercial |
$5,944.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,624.64
|
| Rate for Payer: United Healthcare All Other HMO |
$2,554.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2,499.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,290.35
|
|
|
ORITAVANCIN 400 MG INTRAVENOUS SOLUTION [207378]
|
Facility
|
OP
|
$1,434.76
|
|
|
Service Code
|
HCPCS J2407
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.73 |
| Max. Negotiated Rate |
$1,291.28 |
| Rate for Payer: Adventist Health Commercial |
$286.95
|
| Rate for Payer: Adventist Health Medi-Cal |
$29.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.71
|
| Rate for Payer: Blue Shield of California Commercial |
$38.30
|
| Rate for Payer: Blue Shield of California EPN |
$34.82
|
| Rate for Payer: Cash Price |
$645.64
|
| Rate for Payer: Cash Price |
$645.64
|
| Rate for Payer: Central Health Plan Commercial |
$1,147.81
|
| Rate for Payer: Cigna of CA HMO |
$1,004.33
|
| Rate for Payer: Cigna of CA PPO |
$1,004.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,004.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.05
|
| Rate for Payer: EPIC Health Plan Senior |
$32.70
|
| Rate for Payer: Galaxy Health WC |
$1,219.55
|
| Rate for Payer: Global Benefits Group Commercial |
$860.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,291.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$911.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.84
|
| Rate for Payer: Multiplan Commercial |
$1,076.07
|
| Rate for Payer: Networks By Design Commercial |
$717.38
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$29.73
|
| Rate for Payer: Prime Health Services Commercial |
$1,219.55
|
| Rate for Payer: Prime Health Services Medicare |
$31.51
|
| Rate for Payer: Riverside University Health System MISP |
$32.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$860.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$860.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$538.47
|
| Rate for Payer: United Healthcare All Other HMO |
$524.12
|
| Rate for Payer: United Healthcare HMO Rider |
$512.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$469.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.70
|
| Rate for Payer: Vantage Medical Group Senior |
$32.70
|
|
|
ORITAVANCIN 400 MG INTRAVENOUS SOLUTION [207378]
|
Facility
|
IP
|
$1,434.76
|
|
|
Service Code
|
HCPCS J2407
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$286.95 |
| Max. Negotiated Rate |
$1,291.28 |
| Rate for Payer: Adventist Health Commercial |
$286.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,150.68
|
| Rate for Payer: Blue Shield of California EPN |
$723.12
|
| Rate for Payer: Cash Price |
$645.64
|
| Rate for Payer: Central Health Plan Commercial |
$1,147.81
|
| Rate for Payer: Cigna of CA HMO |
$1,004.33
|
| Rate for Payer: Cigna of CA PPO |
$1,004.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,004.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$573.90
|
| Rate for Payer: EPIC Health Plan Senior |
$573.90
|
| Rate for Payer: Galaxy Health WC |
$1,219.55
|
| Rate for Payer: Global Benefits Group Commercial |
$860.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,291.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$911.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$846.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.95
|
| Rate for Payer: Multiplan Commercial |
$1,076.07
|
| Rate for Payer: Networks By Design Commercial |
$717.38
|
| Rate for Payer: Prime Health Services Commercial |
$1,219.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$538.47
|
| Rate for Payer: United Healthcare All Other HMO |
$524.12
|
| Rate for Payer: United Healthcare HMO Rider |
$512.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$469.88
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION [5886]
|
Facility
|
IP
|
$7.20
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$6.48 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Blue Shield of California Commercial |
$5.77
|
| Rate for Payer: Blue Shield of California EPN |
$3.63
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Central Health Plan Commercial |
$5.76
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2.63
|
| Rate for Payer: United Healthcare HMO Rider |
$2.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.36
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION [5886]
|
Facility
|
OP
|
$7.20
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$76.39 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.39
|
| 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 Medicare Advantage/Dual Product |
$5.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.50
|
| Rate for Payer: Blue Shield of California Commercial |
$19.40
|
| Rate for Payer: Blue Shield of California EPN |
$17.64
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Central Health Plan Commercial |
$5.76
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Riverside University Health System MISP |
$2.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2.63
|
| Rate for Payer: United Healthcare HMO Rider |
$2.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
|
|
O.R. PROCEDURES FOR OBESITY WITH CC
|
Facility
|
IP
|
$42,118.30
|
|
|
Service Code
|
MSDRG 620
|
| Min. Negotiated Rate |
$12,166.00 |
| Max. Negotiated Rate |
$42,118.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42,118.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27,206.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38,090.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,905.48
|
| Rate for Payer: EPIC Health Plan Senior |
$25,270.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,973.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32,162.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30,783.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,973.02
|
| Rate for Payer: Prime Health Services Medicare |
$24,351.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$28,919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,919.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28,283.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25,912.00
|
|
|
O.R. PROCEDURES FOR OBESITY WITH MCC
|
Facility
|
IP
|
$75,993.48
|
|
|
Service Code
|
MSDRG 619
|
| Min. Negotiated Rate |
$12,166.00 |
| Max. Negotiated Rate |
$75,993.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$75,993.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49,088.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68,725.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$67,195.84
|
| Rate for Payer: EPIC Health Plan Senior |
$44,797.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,724.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57,014.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54,571.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$40,724.75
|
| Rate for Payer: Prime Health Services Medicare |
$43,168.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$28,919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,919.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28,283.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25,912.00
|
|
|
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC
|
Facility
|
IP
|
$39,699.58
|
|
|
Service Code
|
MSDRG 621
|
| Min. Negotiated Rate |
$12,166.00 |
| Max. Negotiated Rate |
$39,699.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,699.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25,644.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35,902.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,814.09
|
| Rate for Payer: EPIC Health Plan Senior |
$23,876.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,705.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,387.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29,085.38
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21,705.51
|
| Rate for Payer: Prime Health Services Medicare |
$23,007.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$28,919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,919.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28,283.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25,912.00
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC
|
Facility
|
IP
|
$61,504.87
|
|
|
Service Code
|
MSDRG 940
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$61,504.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$61,504.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39,729.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55,622.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$54,668.18
|
| Rate for Payer: EPIC Health Plan Senior |
$36,445.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,132.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46,385.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$44,397.19
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$33,132.23
|
| Rate for Payer: Prime Health Services Medicare |
$35,120.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC
|
Facility
|
IP
|
$95,498.49
|
|
|
Service Code
|
MSDRG 939
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$95,498.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$95,498.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61,688.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86,365.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$84,060.97
|
| Rate for Payer: EPIC Health Plan Senior |
$56,040.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50,946.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71,324.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68,267.69
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$50,946.04
|
| Rate for Payer: Prime Health Services Medicare |
$54,002.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC
|
Facility
|
IP
|
$53,367.04
|
|
|
Service Code
|
MSDRG 941
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$53,367.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53,367.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34,472.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48,263.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$47,631.75
|
| Rate for Payer: EPIC Health Plan Senior |
$31,754.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,867.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40,414.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38,682.76
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$28,867.73
|
| Rate for Payer: Prime Health Services Medicare |
$30,599.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS
|
Facility
|
IP
|
$101,720.30
|
|
|
Service Code
|
MSDRG 876
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$101,720.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$101,720.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65,707.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91,992.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$89,440.69
|
| Rate for Payer: EPIC Health Plan Senior |
$59,627.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$54,206.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75,889.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$72,636.68
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$54,206.48
|
| Rate for Payer: Prime Health Services Medicare |
$57,458.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
OSELTAMIVIR 30 MG CAPSULE [88704]
|
Facility
|
IP
|
$1.98
|
|
|
Service Code
|
NDC 3172263031
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.59
|
| Rate for Payer: Blue Shield of California EPN |
$1.00
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Central Health Plan Commercial |
$1.58
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Senior |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: Networks By Design Commercial |
$1.29
|
| Rate for Payer: Prime Health Services Commercial |
$1.68
|
|
|
OSELTAMIVIR 30 MG CAPSULE [88704]
|
Facility
|
OP
|
$1.98
|
|
|
Service Code
|
NDC 3172263031
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.79
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Central Health Plan Commercial |
$1.58
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Senior |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.39
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: Networks By Design Commercial |
$1.29
|
| Rate for Payer: Prime Health Services Commercial |
$1.68
|
| Rate for Payer: Riverside University Health System MISP |
$0.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Other HMO |
$0.99
|
| Rate for Payer: United Healthcare HMO Rider |
$0.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.68
|
| Rate for Payer: Vantage Medical Group Senior |
$1.68
|
|
|
OSELTAMIVIR 30 MG CAPSULE [88704]
|
Facility
|
OP
|
$3.12
|
|
|
Service Code
|
NDC 6818067511
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.89
|
| 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 |
$2.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1.98
|
| Rate for Payer: Blue Shield of California EPN |
$1.24
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Central Health Plan Commercial |
$2.50
|
| 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 Medi-Cal |
$2.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.25
|
| Rate for Payer: EPIC Health Plan Senior |
$1.25
|
| Rate for Payer: Galaxy Health WC |
$2.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$2.34
|
| Rate for Payer: Networks By Design Commercial |
$2.03
|
| Rate for Payer: Prime Health Services Commercial |
$2.65
|
| Rate for Payer: Riverside University Health System MISP |
$1.25
|
| 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
|
$1.44
|
|
|
Service Code
|
NDC 6438079701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.73
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$1.15
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
OSELTAMIVIR 30 MG CAPSULE [88704]
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 6818067511
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$2.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.57
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Central Health Plan Commercial |
$2.50
|
| Rate for Payer: Cigna of CA HMO |
$2.18
|
| Rate for Payer: Cigna of CA PPO |
$2.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.25
|
| Rate for Payer: EPIC Health Plan Senior |
$1.25
|
| Rate for Payer: Galaxy Health WC |
$2.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$2.34
|
| 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
|
$1.44
|
|
|
Service Code
|
NDC 6438079701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$1.15
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Riverside University Health System MISP |
$0.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
OSELTAMIVIR 45 MG CAPSULE [88705]
|
Facility
|
OP
|
$16.72
|
|
|
Service Code
|
NDC 0004080185
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Adventist Health Commercial |
$3.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.15
|
| 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 |
$12.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.73
|
| Rate for Payer: Blue Shield of California Commercial |
$10.60
|
| Rate for Payer: Blue Shield of California EPN |
$6.67
|
| Rate for Payer: Cash Price |
$7.52
|
| Rate for Payer: Central Health Plan Commercial |
$13.38
|
| 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 Medi-Cal |
$14.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.69
|
| Rate for Payer: EPIC Health Plan Senior |
$6.69
|
| Rate for Payer: Galaxy Health WC |
$14.21
|
| Rate for Payer: Global Benefits Group Commercial |
$10.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.70
|
| Rate for Payer: Multiplan Commercial |
$12.54
|
| Rate for Payer: Networks By Design Commercial |
$10.87
|
| Rate for Payer: Prime Health Services Commercial |
$14.21
|
| Rate for Payer: Riverside University Health System MISP |
$6.69
|
| 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 0004080185
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Adventist Health Commercial |
$3.34
|
| Rate for Payer: Blue Shield of California Commercial |
$13.41
|
| Rate for Payer: Blue Shield of California EPN |
$8.43
|
| Rate for Payer: Cash Price |
$7.52
|
| Rate for Payer: Central Health Plan Commercial |
$13.38
|
| Rate for Payer: Cigna of CA HMO |
$11.70
|
| Rate for Payer: Cigna of CA PPO |
$11.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.69
|
| Rate for Payer: EPIC Health Plan Senior |
$6.69
|
| Rate for Payer: Galaxy Health WC |
$14.21
|
| Rate for Payer: Global Benefits Group Commercial |
$10.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.34
|
| Rate for Payer: Multiplan Commercial |
$12.54
|
| 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
|
$3.04
|
|
|
Service Code
|
NDC 0004082205
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Adventist Health Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California Commercial |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$1.53
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Central Health Plan Commercial |
$2.43
|
| Rate for Payer: Cigna of CA HMO |
$2.13
|
| Rate for Payer: Cigna of CA PPO |
$2.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.22
|
| Rate for Payer: EPIC Health Plan Senior |
$1.22
|
| Rate for Payer: Galaxy Health WC |
$2.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$2.28
|
| 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
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 6818067801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
