|
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 |
$2.25 |
| Max. Negotiated Rate |
$10.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.82
|
| 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 Exchange |
$5.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.63
|
| Rate for Payer: BCBS Transplant Transplant |
$6.74
|
| Rate for Payer: Blue Shield of California Commercial |
$7.06
|
| Rate for Payer: Blue Shield of California EPN |
$5.49
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Central Health Plan Commercial |
$8.98
|
| 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: 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 Management Network EPO/PPO |
$10.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.42
|
| Rate for Payer: IEHP medi-cal |
$3.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| 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: Riverside University Health MISP |
$4.49
|
| 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 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 |
$2.25 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$8.42
|
| Rate for Payer: Blue Shield of California EPN |
$6.00
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Central Health Plan Commercial |
$8.98
|
| 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: Health Management Network EPO/PPO |
$10.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$1.91 |
| Max. Negotiated Rate |
$8.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.80
|
| 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 Exchange |
$4.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.64
|
| Rate for Payer: BCBS Transplant Transplant |
$5.73
|
| Rate for Payer: Blue Shield of California Commercial |
$6.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.67
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Central Health Plan Commercial |
$7.64
|
| 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: 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 Management Network EPO/PPO |
$8.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.16
|
| Rate for Payer: IEHP medi-cal |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$7.16
|
| 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: Riverside University Health MISP |
$3.82
|
| 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 Medi-Cal |
$8.12
|
| Rate for Payer: Vantage Medical Group Senior |
$8.12
|
|
|
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 |
$0.62 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.89
|
| 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 Exchange |
$1.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.84
|
| Rate for Payer: BCBS Transplant Transplant |
$1.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California EPN |
$1.53
|
| 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: 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 Management Network EPO/PPO |
$2.81
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.34
|
| Rate for Payer: IEHP medi-cal |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.08
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.87
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$2.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2.65
|
|
|
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 |
$0.62 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.34
|
| Rate for Payer: Blue Shield of California EPN |
$1.67
|
| Rate for Payer: Cash Price |
$1.40
|
| 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: 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: Health Management Network EPO/PPO |
$2.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.08
|
| 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
IP
|
$9.55
|
|
|
Service Code
|
NDC 69238-1264-1
|
| Hospital Charge Code |
1712606
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$7.16
|
| Rate for Payer: Blue Shield of California EPN |
$5.10
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Central Health Plan Commercial |
$7.64
|
| 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: Health Management Network EPO/PPO |
$8.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$7.16
|
| Rate for Payer: Networks By Design Commercial |
$6.21
|
| Rate for Payer: Prime Health Services Commercial |
$8.12
|
|
|
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 |
$3.34 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.15
|
| 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 Exchange |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.88
|
| Rate for Payer: BCBS Transplant Transplant |
$10.03
|
| Rate for Payer: Blue Shield of California Commercial |
$10.52
|
| Rate for Payer: Blue Shield of California EPN |
$8.18
|
| 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: 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 Management Network EPO/PPO |
$15.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.54
|
| Rate for Payer: IEHP medi-cal |
$5.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.15
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.03
|
| Rate for Payer: Riverside University Health 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 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 |
$3.34 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$12.54
|
| Rate for Payer: Blue Shield of California EPN |
$8.93
|
| Rate for Payer: Cash Price |
$7.52
|
| 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: 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: Health Management Network EPO/PPO |
$15.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.15
|
| 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 0004-0822-05
|
| Hospital Charge Code |
1715279
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California EPN |
$1.62
|
| Rate for Payer: Cash Price |
$1.37
|
| 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: 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: Health Management Network EPO/PPO |
$2.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.03
|
| 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
OP
|
$3.04
|
|
|
Service Code
|
NDC 0004-0822-05
|
| Hospital Charge Code |
1715279
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.85
|
| 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 Exchange |
$1.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.80
|
| Rate for Payer: BCBS Transplant Transplant |
$1.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1.91
|
| Rate for Payer: Blue Shield of California EPN |
$1.49
|
| 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: Dignity Health Commercial/Exchange |
$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 Management Network EPO/PPO |
$2.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.28
|
| Rate for Payer: IEHP medi-cal |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.03
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.82
|
| Rate for Payer: Riverside University Health MISP |
$1.22
|
| 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 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 |
$0.12 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| 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: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| 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
OP
|
$0.60
|
|
|
Service Code
|
NDC 68180-678-01
|
| Hospital Charge Code |
1715279
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| 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 Exchange |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: BCBS Transplant Transplant |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| 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: 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 Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.45
|
| Rate for Payer: IEHP medi-cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| 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: Riverside University Health MISP |
$0.24
|
| 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 Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
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 |
$3.65 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$13.67
|
| Rate for Payer: Blue Shield of California EPN |
$9.73
|
| Rate for Payer: Cash Price |
$8.20
|
| Rate for Payer: Cash Price |
$8.20
|
| Rate for Payer: Central Health Plan Commercial |
$14.58
|
| 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: Health Management Network EPO/PPO |
$16.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.65
|
| Rate for Payer: Multiplan Commercial |
$13.67
|
| Rate for Payer: Networks By Design Commercial |
$11.85
|
| Rate for Payer: Prime Health Services Commercial |
$15.50
|
|
|
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 |
$2.08 |
| Max. Negotiated Rate |
$9.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.32
|
| 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 Exchange |
$5.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.15
|
| Rate for Payer: BCBS Transplant Transplant |
$6.25
|
| Rate for Payer: Blue Shield of California Commercial |
$6.55
|
| Rate for Payer: Blue Shield of California EPN |
$5.09
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Central Health Plan Commercial |
$8.33
|
| 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: 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 Management Network EPO/PPO |
$9.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.81
|
| Rate for Payer: IEHP medi-cal |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.08
|
| Rate for Payer: Multiplan Commercial |
$7.81
|
| 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: Riverside University Health MISP |
$4.16
|
| 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 Medi-Cal |
$8.85
|
| Rate for Payer: Vantage Medical Group Senior |
$8.85
|
|
|
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 |
$2.08 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$7.81
|
| Rate for Payer: Blue Shield of California EPN |
$5.56
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Central Health Plan Commercial |
$8.33
|
| 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: Health Management Network EPO/PPO |
$9.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.08
|
| Rate for Payer: Multiplan Commercial |
$7.81
|
| Rate for Payer: Networks By Design Commercial |
$6.77
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$3.65 |
| Max. Negotiated Rate |
$16.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.07
|
| 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 Exchange |
$8.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.77
|
| Rate for Payer: BCBS Transplant Transplant |
$10.94
|
| Rate for Payer: Blue Shield of California Commercial |
$11.47
|
| Rate for Payer: Blue Shield of California EPN |
$8.91
|
| Rate for Payer: Cash Price |
$8.20
|
| Rate for Payer: Central Health Plan Commercial |
$14.58
|
| 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: 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 Management Network EPO/PPO |
$16.41
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.67
|
| Rate for Payer: IEHP medi-cal |
$6.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.65
|
| Rate for Payer: Multiplan Commercial |
$13.67
|
| 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: Riverside University Health MISP |
$7.29
|
| 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 Medi-Cal |
$15.50
|
| Rate for Payer: Vantage Medical Group Senior |
$15.50
|
|
|
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 |
$0.62 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.89
|
| 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 Exchange |
$1.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.84
|
| Rate for Payer: BCBS Transplant Transplant |
$1.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California EPN |
$1.53
|
| 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: 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 Management Network EPO/PPO |
$2.81
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.34
|
| Rate for Payer: IEHP medi-cal |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.08
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.87
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$2.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2.65
|
|
|
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 |
$0.62 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.34
|
| Rate for Payer: Blue Shield of California EPN |
$1.67
|
| Rate for Payer: Cash Price |
$1.40
|
| 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: 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: Health Management Network EPO/PPO |
$2.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.08
|
| 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
|
|
|
Ostectomy, calcaneus;
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 28118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,044.21 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$6,672.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 3444
|
| Min. Negotiated Rate |
$19,301.22 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,301.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$23,000.62
|
|
|
OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 3441
|
| Min. Negotiated Rate |
$6,605.11 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,605.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$7,871.09
|
|
|
OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 3442
|
| Min. Negotiated Rate |
$8,380.44 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,380.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$9,986.69
|
|
|
OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 3443
|
| Min. Negotiated Rate |
$12,020.70 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,020.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$14,324.67
|
|
|
OSTEOMYELITIS WITH CC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 540
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
OSTEOMYELITIS WITH MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 539
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
