|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]
|
Facility
IP
|
$6.28
|
|
|
Service Code
|
NDC 9999-9994-05
|
| Hospital Charge Code |
1715201
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$4.71 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.31
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.25
|
| Rate for Payer: Heritage Provider Network Senior |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.57
|
| Rate for Payer: Multiplan Commercial |
$4.71
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]
|
Facility
IP
|
$6.28
|
|
|
Service Code
|
NDC 42799-217-01
|
| Hospital Charge Code |
NDG99405
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$4.71 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.31
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.25
|
| Rate for Payer: Heritage Provider Network Senior |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.57
|
| Rate for Payer: Multiplan Commercial |
$4.71
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]
|
Facility
OP
|
$6.28
|
|
|
Service Code
|
NDC 42799-217-01
|
| Hospital Charge Code |
NDG99405
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.71
|
| Rate for Payer: Blue Shield of California Commercial |
$3.90
|
| Rate for Payer: Blue Shield of California EPN |
$3.69
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.34
|
| Rate for Payer: Dignity Health Senior |
$5.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.89
|
| Rate for Payer: Heritage Provider Network Senior |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.57
|
| Rate for Payer: Multiplan Commercial |
$4.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.34
|
| Rate for Payer: Vantage Medical Group Senior |
$5.34
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
IP
|
$7,981.06
|
|
|
Service Code
|
APR-DRG 0731
|
| Min. Negotiated Rate |
$7,981.06 |
| Max. Negotiated Rate |
$7,981.06 |
| Rate for Payer: IEHP Medi-Cal |
$7,981.06
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
IP
|
$15,853.67
|
|
|
Service Code
|
APR-DRG 0733
|
| Min. Negotiated Rate |
$15,853.67 |
| Max. Negotiated Rate |
$15,853.67 |
| Rate for Payer: IEHP Medi-Cal |
$15,853.67
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
IP
|
$30,580.11
|
|
|
Service Code
|
APR-DRG 0734
|
| Min. Negotiated Rate |
$30,580.11 |
| Max. Negotiated Rate |
$30,580.11 |
| Rate for Payer: IEHP Medi-Cal |
$30,580.11
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
IP
|
$10,131.03
|
|
|
Service Code
|
APR-DRG 0732
|
| Min. Negotiated Rate |
$10,131.03 |
| Max. Negotiated Rate |
$10,131.03 |
| Rate for Payer: IEHP Medi-Cal |
$10,131.03
|
|
|
Orbitotomy without bone flap (frontal or transconjunctival approach); for exploration, with or without biopsy
|
Facility
OP
|
$9,178.50
|
|
|
Service Code
|
CPT 67400
|
| Min. Negotiated Rate |
$789.30 |
| Max. Negotiated Rate |
$9,178.50 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,246.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,313.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,830.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,246.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,313.87
|
| Rate for Payer: Dignity Health Senior |
$4,830.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,830.79
|
| Rate for Payer: Humana Medicare |
$4,830.79
|
| Rate for Payer: IEHP Medi-Cal |
$789.30
|
| Rate for Payer: IEHP Medicare Advantage |
$4,830.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,178.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,700.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,086.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,086.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,313.87
|
| Rate for Payer: TriValley Medical Group Senior |
$4,830.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,246.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,313.87
|
| Rate for Payer: Vantage Medical Group Senior |
$4,830.79
|
|
|
Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of foreign body
|
Facility
OP
|
$8,054.00
|
|
|
Service Code
|
CPT 67413
|
| Min. Negotiated Rate |
$139.96 |
| Max. Negotiated Rate |
$8,054.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: Dignity Health Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,919.67
|
| Rate for Payer: Humana Medicare |
$2,919.67
|
| Rate for Payer: IEHP Medi-Cal |
$139.96
|
| Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,547.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,445.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,678.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,211.64
|
| Rate for Payer: TriValley Medical Group Senior |
$2,919.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of lesion
|
Facility
OP
|
$8,054.00
|
|
|
Service Code
|
CPT 67412
|
| Min. Negotiated Rate |
$827.63 |
| Max. Negotiated Rate |
$8,054.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: Dignity Health Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,919.67
|
| Rate for Payer: Humana Medicare |
$2,919.67
|
| Rate for Payer: IEHP Medi-Cal |
$827.63
|
| Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,547.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,445.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,678.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,211.64
|
| Rate for Payer: TriValley Medical Group Senior |
$2,919.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
Orchiectomy, radical, for tumor; inguinal approach
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 54530
|
| Min. Negotiated Rate |
$526.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: Dignity Health Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,322.62
|
| Rate for Payer: Humana Medicare |
$4,322.62
|
| Rate for Payer: IEHP Medi-Cal |
$526.19
|
| Rate for Payer: IEHP Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,212.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,100.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,446.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,754.88
|
| Rate for Payer: TriValley Medical Group Senior |
$4,322.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 54520
|
| Min. Negotiated Rate |
$394.93 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: Dignity Health Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,355.72
|
| Rate for Payer: Humana Medicare |
$4,355.72
|
| Rate for Payer: IEHP Medi-Cal |
$394.93
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,275.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,139.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,488.21
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,791.29
|
| Rate for Payer: TriValley Medical Group Senior |
$4,355.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
Orchiopexy, inguinal or scrotal approach
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 54640
|
| Min. Negotiated Rate |
$696.95 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: Dignity Health Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,322.62
|
| Rate for Payer: Humana Medicare |
$4,322.62
|
| Rate for Payer: IEHP Medi-Cal |
$696.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,212.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,100.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,446.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,754.88
|
| Rate for Payer: TriValley Medical Group Senior |
$4,322.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
ORGANIC MENTAL HEALTH DISTURBANCES
|
Facility
IP
|
$8,157.15
|
|
|
Service Code
|
APR-DRG 7573
|
| Min. Negotiated Rate |
$8,157.15 |
| Max. Negotiated Rate |
$8,157.15 |
| Rate for Payer: IEHP Medi-Cal |
$8,157.15
|
|
|
ORGANIC MENTAL HEALTH DISTURBANCES
|
Facility
IP
|
$18,824.43
|
|
|
Service Code
|
APR-DRG 7574
|
| Min. Negotiated Rate |
$18,824.43 |
| Max. Negotiated Rate |
$18,824.43 |
| Rate for Payer: IEHP Medi-Cal |
$18,824.43
|
|
|
ORGANIC MENTAL HEALTH DISTURBANCES
|
Facility
IP
|
$3,942.78
|
|
|
Service Code
|
APR-DRG 7571
|
| Min. Negotiated Rate |
$3,942.78 |
| Max. Negotiated Rate |
$3,942.78 |
| Rate for Payer: IEHP Medi-Cal |
$3,942.78
|
|
|
ORGANIC MENTAL HEALTH DISTURBANCES
|
Facility
IP
|
$5,342.59
|
|
|
Service Code
|
APR-DRG 7572
|
| Min. Negotiated Rate |
$5,342.59 |
| Max. Negotiated Rate |
$5,342.59 |
| Rate for Payer: IEHP Medi-Cal |
$5,342.59
|
|
|
ORITAVANCIN 1,200 MG INTRAVENOUS SOLUTION [231752]
|
Facility
IP
|
$6,036.62
|
|
|
Service Code
|
CPT J2406
|
| Hospital Charge Code |
ERX231752
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,092.63 |
| Max. Negotiated Rate |
$4,527.46 |
| Rate for Payer: Adventist Health Commercial |
$1,207.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,147.16
|
| Rate for Payer: Cash Price |
$2,716.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,776.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,259.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,086.79
|
| Rate for Payer: Heritage Provider Network Senior |
$4,086.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,092.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,509.16
|
| Rate for Payer: Multiplan Commercial |
$4,527.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,200.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,016.83
|
|
|
ORITAVANCIN 1,200 MG INTRAVENOUS SOLUTION [231752]
|
Facility
OP
|
$6,036.62
|
|
|
Service Code
|
CPT J2406
|
| Hospital Charge Code |
ERX231752
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.92 |
| Max. Negotiated Rate |
$4,527.46 |
| Rate for Payer: Adventist Health Commercial |
$1,207.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$100.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,147.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$51.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$45.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.99
|
| Rate for Payer: Blue Shield of California Commercial |
$42.76
|
| Rate for Payer: Blue Shield of California EPN |
$42.76
|
| Rate for Payer: Cash Price |
$2,716.48
|
| Rate for Payer: Cash Price |
$2,716.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,776.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.01
|
| Rate for Payer: Dignity Health Senior |
$45.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,863.44
|
| Rate for Payer: EPIC Health Plan Medicare |
$40.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,794.96
|
| Rate for Payer: Heritage Provider Network Senior |
$2,794.96
|
| Rate for Payer: Humana Medicare |
$40.92
|
| Rate for Payer: IEHP Medi-Cal |
$70.79
|
| Rate for Payer: IEHP Medicare Advantage |
$40.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$77.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,092.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,509.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.56
|
| Rate for Payer: Multiplan Commercial |
$4,527.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$45.01
|
| Rate for Payer: TriValley Medical Group Senior |
$40.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,200.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,016.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.01
|
| Rate for Payer: Vantage Medical Group Senior |
$45.01
|
|
|
ORITAVANCIN 400 MG INTRAVENOUS SOLUTION [207378]
|
Facility
OP
|
$1,352.40
|
|
|
Service Code
|
CPT J2407
|
| Hospital Charge Code |
ERX207378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$1,014.30 |
| Rate for Payer: Adventist Health Commercial |
$270.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$929.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$30.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.67
|
| Rate for Payer: Blue Shield of California Commercial |
$27.91
|
| Rate for Payer: Blue Shield of California EPN |
$27.91
|
| Rate for Payer: Cash Price |
$608.58
|
| Rate for Payer: Cash Price |
$608.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$622.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.35
|
| Rate for Payer: Dignity Health Senior |
$30.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$865.54
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$626.16
|
| Rate for Payer: Heritage Provider Network Senior |
$626.16
|
| Rate for Payer: Humana Medicare |
$27.60
|
| Rate for Payer: IEHP Medi-Cal |
$50.01
|
| Rate for Payer: IEHP Medicare Advantage |
$27.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$52.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.77
|
| Rate for Payer: Multiplan Commercial |
$1,014.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$30.35
|
| Rate for Payer: TriValley Medical Group Senior |
$27.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$493.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$451.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.35
|
| Rate for Payer: Vantage Medical Group Senior |
$27.60
|
|
|
ORITAVANCIN 400 MG INTRAVENOUS SOLUTION [207378]
|
Facility
IP
|
$1,352.40
|
|
|
Service Code
|
CPT J2407
|
| Hospital Charge Code |
ERX207378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$244.78 |
| Max. Negotiated Rate |
$1,014.30 |
| Rate for Payer: Adventist Health Commercial |
$270.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$929.10
|
| Rate for Payer: Cash Price |
$608.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$622.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$730.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$915.57
|
| Rate for Payer: Heritage Provider Network Senior |
$915.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.10
|
| Rate for Payer: Multiplan Commercial |
$1,014.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$493.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$451.84
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION [5886]
|
Facility
IP
|
$9.52
|
|
|
Service Code
|
CPT J2360
|
| Hospital Charge Code |
NDG5886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Adventist Health Commercial |
$1.90
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.54
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.87
|
| Rate for Payer: Heritage Provider Network Senior |
$4.87
|
| Rate for Payer: Heritage Provider Network Senior |
$6.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$7.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.41
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION [5886]
|
Facility
OP
|
$7.20
|
|
|
Service Code
|
CPT J2360
|
| Hospital Charge Code |
NDG5886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$35.04 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$1.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.04
|
| Rate for Payer: Blue Shield of California Commercial |
$15.91
|
| Rate for Payer: Blue Shield of California Commercial |
$15.91
|
| Rate for Payer: Blue Shield of California EPN |
$15.91
|
| Rate for Payer: Blue Shield of California EPN |
$15.91
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.09
|
| Rate for Payer: Dignity Health Senior |
$6.12
|
| Rate for Payer: Dignity Health Senior |
$8.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.33
|
| Rate for Payer: Heritage Provider Network Senior |
$3.33
|
| Rate for Payer: Heritage Provider Network Senior |
$4.41
|
| Rate for Payer: IEHP Medi-Cal |
$22.11
|
| Rate for Payer: IEHP Medi-Cal |
$22.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$7.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.09
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$8.09
|
|
|
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 |
$2.03 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.72
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.60
|
| Rate for Payer: Heritage Provider Network Senior |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
|
|
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 |
$1.73 |
| Max. Negotiated Rate |
$8.12 |
| Rate for Payer: Adventist Health Commercial |
$1.91
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.56
|
| 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 |
$7.16
|
| Rate for Payer: Blue Shield of California Commercial |
$5.93
|
| Rate for Payer: Blue Shield of California EPN |
$5.61
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.12
|
| Rate for Payer: Dignity Health Senior |
$8.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.91
|
| Rate for Payer: Heritage Provider Network Senior |
$5.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.39
|
| Rate for Payer: Multiplan Commercial |
$7.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.12
|
| Rate for Payer: Vantage Medical Group Senior |
$8.12
|
|
