|
OSELTAMIVIR 30 MG CAPSULE [88704]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
NDC 64380-797-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.99
|
| 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: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Senior |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.89
|
| Rate for Payer: Heritage Provider Network Senior |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.58
|
| Rate for Payer: TriValley Medical Group Senior |
$0.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 30 MG CAPSULE [88704]
|
Facility
|
OP
|
$3.12
|
|
|
Service Code
|
NDC 68180-675-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.14
|
| 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: Blue Shield of California Commercial |
$1.90
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$1.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.65
|
| Rate for Payer: Dignity Health Senior |
$2.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.93
|
| Rate for Payer: Heritage Provider Network Senior |
$1.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$2.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.25
|
| Rate for Payer: TriValley Medical Group Senior |
$1.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 64380-797-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Senior |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
|
|
OSELTAMIVIR 30 MG CAPSULE [88704]
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 31722-630-31
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Cash Price |
$1.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$2.34
|
|
|
OSELTAMIVIR 45 MG CAPSULE [88705]
|
Facility
|
IP
|
$16.72
|
|
|
Service Code
|
NDC 0004-0801-85
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$12.54 |
| Rate for Payer: Adventist Health Commercial |
$3.34
|
| Rate for Payer: Cash Price |
$9.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.32
|
| Rate for Payer: Heritage Provider Network Senior |
$11.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.18
|
| Rate for Payer: Multiplan Commercial |
$12.54
|
|
|
OSELTAMIVIR 45 MG CAPSULE [88705]
|
Facility
|
OP
|
$16.72
|
|
|
Service Code
|
NDC 0004-0801-85
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$14.21 |
| Rate for Payer: Adventist Health Commercial |
$3.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.49
|
| 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: Blue Shield of California Commercial |
$10.20
|
| Rate for Payer: Blue Shield of California EPN |
$8.16
|
| Rate for Payer: Cash Price |
$9.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.21
|
| Rate for Payer: Dignity Health Senior |
$14.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.35
|
| Rate for Payer: Heritage Provider Network Senior |
$10.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.70
|
| Rate for Payer: Multiplan Commercial |
$12.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.69
|
| Rate for Payer: TriValley Medical Group Senior |
$6.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 6 MG/ML ORAL SUSPENSION [187854]
|
Facility
|
OP
|
$3.04
|
|
|
Service Code
|
NDC 0004-0822-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Adventist Health Commercial |
$0.61
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.48
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.58
|
| Rate for Payer: Dignity Health Senior |
$2.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.13
|
| Rate for Payer: Multiplan Commercial |
$2.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.22
|
| Rate for Payer: TriValley Medical Group Senior |
$1.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
$3.04
|
|
|
Service Code
|
NDC 0004-0822-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.28 |
| Rate for Payer: Adventist Health Commercial |
$0.61
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.06
|
| Rate for Payer: Heritage Provider Network Senior |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.28
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [187854]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 68180-678-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [187854]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 68180-678-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Senior |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Senior |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
OSELTAMIVIR 75 MG CAPSULE [26546]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 33342-258-66
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.03
|
| Rate for Payer: Heritage Provider Network Senior |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.25
|
|
|
OSELTAMIVIR 75 MG CAPSULE [26546]
|
Facility
|
OP
|
$2.22
|
|
|
Service Code
|
NDC 64380-799-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.89 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1.35
|
| Rate for Payer: Blue Shield of California EPN |
$1.08
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.89
|
| Rate for Payer: Dignity Health Senior |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.55
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.89
|
| Rate for Payer: TriValley Medical Group Senior |
$0.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: Vantage Medical Group Senior |
$1.89
|
|
|
OSELTAMIVIR 75 MG CAPSULE [26546]
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
NDC 69238-1266-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Adventist Health Commercial |
$2.08
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.04
|
| Rate for Payer: Heritage Provider Network Senior |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$7.80
|
|
|
OSELTAMIVIR 75 MG CAPSULE [26546]
|
Facility
|
OP
|
$10.40
|
|
|
Service Code
|
NDC 69238-1266-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$8.84 |
| Rate for Payer: Adventist Health Commercial |
$2.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Blue Shield of California EPN |
$5.08
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.84
|
| Rate for Payer: Dignity Health Senior |
$8.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.44
|
| Rate for Payer: Heritage Provider Network Senior |
$6.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.28
|
| Rate for Payer: Multiplan Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.16
|
| Rate for Payer: TriValley Medical Group Senior |
$4.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.84
|
| Rate for Payer: Vantage Medical Group Senior |
$8.84
|
|
|
OSELTAMIVIR 75 MG CAPSULE [26546]
|
Facility
|
IP
|
$2.22
|
|
|
Service Code
|
NDC 64380-799-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
|
|
OSELTAMIVIR 75 MG CAPSULE [26546]
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 31722-632-31
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Cash Price |
$1.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$2.34
|
|
|
OSELTAMIVIR 75 MG CAPSULE [26546]
|
Facility
|
OP
|
$18.23
|
|
|
Service Code
|
NDC 0004-0800-85
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$15.50 |
| Rate for Payer: Adventist Health Commercial |
$3.65
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.67
|
| Rate for Payer: Blue Shield of California Commercial |
$11.12
|
| Rate for Payer: Blue Shield of California EPN |
$8.90
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.50
|
| Rate for Payer: Dignity Health Senior |
$15.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.28
|
| Rate for Payer: Heritage Provider Network Senior |
$11.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.76
|
| Rate for Payer: Multiplan Commercial |
$13.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.29
|
| Rate for Payer: TriValley Medical Group Senior |
$7.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
OP
|
$2.22
|
|
|
Service Code
|
NDC 72205-044-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.89 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1.35
|
| Rate for Payer: Blue Shield of California EPN |
$1.08
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.89
|
| Rate for Payer: Dignity Health Senior |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.55
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.89
|
| Rate for Payer: TriValley Medical Group Senior |
$0.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: Vantage Medical Group Senior |
$1.89
|
|
|
OSELTAMIVIR 75 MG CAPSULE [26546]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 33342-258-66
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1.83
|
| Rate for Payer: Blue Shield of California EPN |
$1.46
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.55
|
| Rate for Payer: Dignity Health Senior |
$2.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.86
|
| Rate for Payer: Heritage Provider Network Senior |
$1.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$2.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2.55
|
|
|
OSELTAMIVIR 75 MG CAPSULE [26546]
|
Facility
|
IP
|
$18.23
|
|
|
Service Code
|
NDC 0004-0800-85
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$13.67 |
| Rate for Payer: Adventist Health Commercial |
$3.65
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.34
|
| Rate for Payer: Heritage Provider Network Senior |
$12.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Multiplan Commercial |
$13.67
|
|
|
OSELTAMIVIR 75 MG CAPSULE [26546]
|
Facility
|
OP
|
$3.12
|
|
|
Service Code
|
NDC 31722-632-31
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.14
|
| 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: Blue Shield of California Commercial |
$1.90
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$1.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.65
|
| Rate for Payer: Dignity Health Senior |
$2.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.93
|
| Rate for Payer: Heritage Provider Network Senior |
$1.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$2.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.25
|
| Rate for Payer: TriValley Medical Group Senior |
$1.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
IP
|
$2.22
|
|
|
Service Code
|
NDC 72205-044-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
|
|
OSTOMY ADHESIVE PASTE [115464]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 6845510690
|
| Hospital Charge Code |
901700016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
|
|
OSTOMY ADHESIVE PASTE [115464]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 6845510690
|
| Hospital Charge Code |
901700016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
OSTOMY SUPPLIES POWDER [110541]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 6845510826
|
| Hospital Charge Code |
901700016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
