|
ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH REMOVAL OF LESION
|
Facility
|
OP
|
$9,136.00
|
|
|
Service Code
|
CPT 67412
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,057.84 |
| Max. Negotiated Rate |
$9,136.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,136.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,057.84
|
| Rate for Payer: Heritage Provider Network Senior |
$3,761.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,809.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,363.62
|
| Rate for Payer: TriValley Medical Group Senior |
$3,363.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY
|
Facility
|
IP
|
$25,407.02
|
|
|
Service Code
|
MSDRG 884
|
| Min. Negotiated Rate |
$18,960.46 |
| Max. Negotiated Rate |
$25,407.02 |
| Rate for Payer: EPIC Health Plan Medicare |
$18,960.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18,960.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,804.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25,407.02
|
|
|
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 |
$1,265.81 |
| Max. Negotiated Rate |
$5,245.08 |
| Rate for Payer: Adventist Health Commercial |
$1,398.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,503.78
|
| Rate for Payer: Cash Price |
$3,147.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,216.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,776.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,237.96
|
| Rate for Payer: Heritage Provider Network Senior |
$3,237.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,265.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,748.36
|
| Rate for Payer: Multiplan Commercial |
$5,245.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,526.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,315.53
|
|
|
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 |
$45.36 |
| Max. Negotiated Rate |
$5,245.08 |
| Rate for Payer: Adventist Health Commercial |
$1,398.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,321.95
|
| 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 HMO/PPO |
$98.67
|
| Rate for Payer: Blue Shield of California Commercial |
$45.36
|
| Rate for Payer: Blue Shield of California EPN |
$45.36
|
| Rate for Payer: Cash Price |
$3,147.05
|
| Rate for Payer: Cash Price |
$3,147.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,216.98
|
| 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: EPIC Health Plan Commercial |
$4,475.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$47.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,237.96
|
| Rate for Payer: Heritage Provider Network Senior |
$3,237.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,335.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,265.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,748.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$63.53
|
| Rate for Payer: Multiplan Commercial |
$5,245.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,797.38
|
| Rate for Payer: TriValley Medical Group Senior |
$2,797.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,526.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,315.53
|
| 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 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 |
$259.69 |
| Max. Negotiated Rate |
$1,076.07 |
| Rate for Payer: Adventist Health Commercial |
$286.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$923.99
|
| Rate for Payer: Cash Price |
$645.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$659.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$774.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$664.29
|
| Rate for Payer: Heritage Provider Network Senior |
$664.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$259.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.69
|
| Rate for Payer: Multiplan Commercial |
$1,076.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$518.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$475.05
|
|
|
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 |
$29.60 |
| Max. Negotiated Rate |
$1,076.07 |
| Rate for Payer: Adventist Health Commercial |
$286.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$886.68
|
| 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 HMO/PPO |
$58.61
|
| Rate for Payer: Blue Shield of California Commercial |
$29.60
|
| Rate for Payer: Blue Shield of California EPN |
$29.60
|
| Rate for Payer: Cash Price |
$645.64
|
| Rate for Payer: Cash Price |
$645.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$659.99
|
| 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: EPIC Health Plan Commercial |
$918.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$664.29
|
| Rate for Payer: Heritage Provider Network Senior |
$664.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$684.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$259.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.84
|
| Rate for Payer: Multiplan Commercial |
$1,076.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$573.90
|
| Rate for Payer: TriValley Medical Group Senior |
$573.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$518.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$475.05
|
| 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
|
|
|
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 |
$1.30 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.64
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.33
|
| Rate for Payer: Heritage Provider Network Senior |
$3.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.38
|
|
|
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 |
$1.30 |
| Max. Negotiated Rate |
$39.75 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.45
|
| 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 HMO/PPO |
$39.75
|
| Rate for Payer: Blue Shield of California Commercial |
$14.99
|
| Rate for Payer: Blue Shield of California EPN |
$14.99
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| 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: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.33
|
| Rate for Payer: Heritage Provider Network Senior |
$3.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.88
|
| Rate for Payer: TriValley Medical Group Senior |
$2.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.38
|
| 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
|
$25,274.95
|
|
|
Service Code
|
MSDRG 620
|
| Min. Negotiated Rate |
$12,050.00 |
| Max. Negotiated Rate |
$25,274.95 |
| Rate for Payer: EPIC Health Plan Medicare |
$18,861.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18,861.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12,050.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,691.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25,274.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22,991.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19,290.00
|
|
|
O.R. PROCEDURES FOR OBESITY WITH MCC
|
Facility
|
IP
|
$45,038.97
|
|
|
Service Code
|
MSDRG 619
|
| Min. Negotiated Rate |
$12,050.00 |
| Max. Negotiated Rate |
$45,038.97 |
| Rate for Payer: EPIC Health Plan Medicare |
$33,611.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,611.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12,050.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38,652.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45,038.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22,991.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19,290.00
|
|
|
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC
|
Facility
|
IP
|
$23,863.78
|
|
|
Service Code
|
MSDRG 621
|
| Min. Negotiated Rate |
$12,050.00 |
| Max. Negotiated Rate |
$23,863.78 |
| Rate for Payer: EPIC Health Plan Medicare |
$17,808.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17,808.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12,050.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,480.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23,863.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22,991.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19,290.00
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC
|
Facility
|
IP
|
$36,585.81
|
|
|
Service Code
|
MSDRG 940
|
| Min. Negotiated Rate |
$27,302.84 |
| Max. Negotiated Rate |
$36,585.81 |
| Rate for Payer: EPIC Health Plan Medicare |
$27,302.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,302.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,398.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36,585.81
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC
|
Facility
|
IP
|
$56,418.92
|
|
|
Service Code
|
MSDRG 939
|
| Min. Negotiated Rate |
$42,103.67 |
| Max. Negotiated Rate |
$56,418.92 |
| Rate for Payer: EPIC Health Plan Medicare |
$42,103.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42,103.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48,419.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$56,418.92
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC
|
Facility
|
IP
|
$31,837.88
|
|
|
Service Code
|
MSDRG 941
|
| Min. Negotiated Rate |
$23,759.61 |
| Max. Negotiated Rate |
$31,837.88 |
| Rate for Payer: EPIC Health Plan Medicare |
$23,759.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,759.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,323.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,837.88
|
|
|
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS
|
Facility
|
IP
|
$60,048.94
|
|
|
Service Code
|
MSDRG 876
|
| Min. Negotiated Rate |
$44,812.64 |
| Max. Negotiated Rate |
$60,048.94 |
| Rate for Payer: EPIC Health Plan Medicare |
$44,812.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$44,812.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51,534.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$60,048.94
|
|
|
OSELTAMIVIR 30 MG CAPSULE [88704]
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
NDC 6438079701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.93
|
| Rate for Payer: Cash Price |
$0.65
|
| 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 Foundation Hospitals 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
|
OP
|
$1.44
|
|
|
Service Code
|
NDC 6438079701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.89
|
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| 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 HMO/PPO |
$0.72
|
| 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 |
$0.65
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 6818067511
|
| 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: Aetna of CA Non-Gatekeeper |
$2.01
|
| Rate for Payer: Cash Price |
$1.40
|
| 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 Foundation Hospitals Medi-Cal |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$2.34
|
|
|
OSELTAMIVIR 30 MG CAPSULE [88704]
|
Facility
|
OP
|
$3.12
|
|
|
Service Code
|
NDC 6818067511
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.93
|
| 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 HMO/PPO |
$1.56
|
| 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 |
$1.40
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$1.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
OP
|
$1.98
|
|
|
Service Code
|
NDC 3172263031
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.22
|
| 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 HMO/PPO |
$0.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.97
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.29
|
| 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: EPIC Health Plan Commercial |
$1.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.39
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.79
|
| Rate for Payer: TriValley Medical Group Senior |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
IP
|
$1.98
|
|
|
Service Code
|
NDC 3172263031
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.28
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
|
|
OSELTAMIVIR 45 MG CAPSULE [88705]
|
Facility
|
IP
|
$16.72
|
|
|
Service Code
|
NDC 0004080185
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$12.54 |
| Rate for Payer: Adventist Health Commercial |
$3.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.77
|
| Rate for Payer: Cash Price |
$7.52
|
| 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 Foundation Hospitals 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 0004080185
|
| 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 Non-Gatekeeper |
$10.33
|
| 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 HMO/PPO |
$8.36
|
| 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 |
$7.52
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$7.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 0004082205
|
| 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 Non-Gatekeeper |
$1.88
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| 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 |
$1.37
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$1.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 0004082205
|
| 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: Aetna of CA Non-Gatekeeper |
$1.96
|
| Rate for Payer: Cash Price |
$1.37
|
| 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 Foundation Hospitals Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.28
|
|
