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Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

OXCARBAZEPINE 150 MG TABLET [27049]

Facility

IP

$0.36

Service Code	NDC 62756-183-88
Hospital Charge Code	1710905
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.29
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of CA HMO/PPO	$0.29
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.27

OXCARBAZEPINE 150 MG TABLET [27049]

Facility

IP

$0.65

Service Code	NDC 68084-845-01
Hospital Charge Code	1710905
Hospital Revenue Code	259
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.52
Rate for Payer: Cash Price	$0.29
Rate for Payer: Cigna of CA HMO/PPO	$0.52
Rate for Payer: Health Smart Auto/Commercial	$0.39
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.49

OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION [30479]

Facility

IP

$0.79

Service Code	NDC 0781-6270-43
Hospital Charge Code	1715990
Hospital Revenue Code	259
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.63
Rate for Payer: Cash Price	$0.36
Rate for Payer: Cigna of CA HMO/PPO	$0.63
Rate for Payer: Health Smart Auto/Commercial	$0.47
Rate for Payer: LLUH Dept of Risk Management WC	$0.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.59

OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION [30479]

Facility

OP

$0.79

Service Code	NDC 65162-649-78
Hospital Charge Code	1715990
Hospital Revenue Code	259
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.47
Rate for Payer: Aetna of CA Government/Medicare	$0.47
Rate for Payer: Cash Price	$0.36
Rate for Payer: Health Smart Auto/Commercial	$0.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.47
Rate for Payer: LLUH Dept of Risk Management WC	$0.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.59

OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION [30479]

Facility

IP

$0.79

Service Code	NDC 65162-649-78
Hospital Charge Code	1715990
Hospital Revenue Code	259
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.63
Rate for Payer: Cash Price	$0.36
Rate for Payer: Cigna of CA HMO/PPO	$0.63
Rate for Payer: Health Smart Auto/Commercial	$0.47
Rate for Payer: LLUH Dept of Risk Management WC	$0.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.59

OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION [30479]

Facility

OP

$0.79

Service Code	NDC 0781-6270-43
Hospital Charge Code	1715990
Hospital Revenue Code	259
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.47
Rate for Payer: Aetna of CA Government/Medicare	$0.47
Rate for Payer: Cash Price	$0.36
Rate for Payer: Health Smart Auto/Commercial	$0.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.47
Rate for Payer: LLUH Dept of Risk Management WC	$0.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.59

OXCARBAZEPINE 300 MG TABLET [21061]

Facility

OP

$0.66

Service Code	NDC 62756-184-88
Hospital Charge Code	1711831
Hospital Revenue Code	259
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.40
Rate for Payer: Aetna of CA Government/Medicare	$0.40
Rate for Payer: Cash Price	$0.30
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

OXCARBAZEPINE 300 MG TABLET [21061]

Facility

IP

$1.06

Service Code	NDC 68084-853-11
Hospital Charge Code	1711831
Hospital Revenue Code	259
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.85
Rate for Payer: Cash Price	$0.48
Rate for Payer: Cigna of CA HMO/PPO	$0.85
Rate for Payer: Health Smart Auto/Commercial	$0.64
Rate for Payer: LLUH Dept of Risk Management WC	$0.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.80

OXCARBAZEPINE 300 MG TABLET [21061]

Facility

IP

$0.93

Service Code	NDC 51991-293-01
Hospital Charge Code	1711831
Hospital Revenue Code	259
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.74
Rate for Payer: Cash Price	$0.42
Rate for Payer: Cigna of CA HMO/PPO	$0.74
Rate for Payer: Health Smart Auto/Commercial	$0.56
Rate for Payer: LLUH Dept of Risk Management WC	$0.51
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.70

OXCARBAZEPINE 300 MG TABLET [21061]

Facility

OP

$0.93

Service Code	NDC 51991-293-01
Hospital Charge Code	1711831
Hospital Revenue Code	259
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.56
Rate for Payer: Aetna of CA Government/Medicare	$0.56
Rate for Payer: Cash Price	$0.42
Rate for Payer: Health Smart Auto/Commercial	$0.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.56
Rate for Payer: LLUH Dept of Risk Management WC	$0.51
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.70

OXCARBAZEPINE 300 MG TABLET [21061]

Facility

IP

$0.66

Service Code	NDC 62756-184-88
Hospital Charge Code	1711831
Hospital Revenue Code	259
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.53
Rate for Payer: Cash Price	$0.30
Rate for Payer: Cigna of CA HMO/PPO	$0.53
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

OXCARBAZEPINE 300 MG TABLET [21061]

Facility

OP

$0.66

Service Code	NDC 68462-138-01
Hospital Charge Code	1711831
Hospital Revenue Code	259
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.40
Rate for Payer: Aetna of CA Government/Medicare	$0.40
Rate for Payer: Cash Price	$0.30
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

OXCARBAZEPINE 300 MG TABLET [21061]

Facility

IP

$0.66

Service Code	NDC 68462-138-01
Hospital Charge Code	1711831
Hospital Revenue Code	259
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.53
Rate for Payer: Cash Price	$0.30
Rate for Payer: Cigna of CA HMO/PPO	$0.53
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

OXCARBAZEPINE 300 MG TABLET [21061]

Facility

OP

$1.06

Service Code	NDC 68084-853-11
Hospital Charge Code	1711831
Hospital Revenue Code	259
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.64
Rate for Payer: Aetna of CA Government/Medicare	$0.64
Rate for Payer: Cash Price	$0.48
Rate for Payer: Health Smart Auto/Commercial	$0.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.64
Rate for Payer: LLUH Dept of Risk Management WC	$0.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.80

OXCARBAZEPINE 75 MG 1/2 TAB [192290]

Facility

OP

$0.51

Service Code	NDC 9999-1922-90
Hospital Charge Code	1712504
Hospital Revenue Code	259
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.31
Rate for Payer: Aetna of CA Government/Medicare	$0.31
Rate for Payer: Cash Price	$0.23
Rate for Payer: Health Smart Auto/Commercial	$0.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.31
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.38

OXCARBAZEPINE 75 MG 1/2 TAB [192290]

Facility

IP

$0.51

Service Code	NDC 9999-1922-90
Hospital Charge Code	1712504
Hospital Revenue Code	259
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.41
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna of CA HMO/PPO	$0.41
Rate for Payer: Health Smart Auto/Commercial	$0.31
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.38

OXYBUTYNIN 3.9 MG/24 HOUR TRANSDERMAL 4 DAY PATCH [203474]

Facility

OP

$3.30

Service Code	NDC 11523-4322-4
Hospital Charge Code	ERX203474
Hospital Revenue Code	259
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$2.48
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.98
Rate for Payer: Aetna of CA Government/Medicare	$1.98
Rate for Payer: Cash Price	$1.49
Rate for Payer: Health Smart Auto/Commercial	$1.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.98
Rate for Payer: LLUH Dept of Risk Management WC	$1.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.48

OXYBUTYNIN 3.9 MG/24 HOUR TRANSDERMAL 4 DAY PATCH [203474]

Facility

OP

$1.73

Service Code	NDC 11523-4322-2
Hospital Charge Code	ERX203474
Hospital Revenue Code	259
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$1.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.04
Rate for Payer: Aetna of CA Government/Medicare	$1.04
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Smart Auto/Commercial	$1.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.30

OXYBUTYNIN 3.9 MG/24 HOUR TRANSDERMAL 4 DAY PATCH [203474]

Facility

IP

$3.30

Service Code	NDC 11523-4322-4
Hospital Charge Code	ERX203474
Hospital Revenue Code	259
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$2.64
Rate for Payer: Cash Price	$1.49
Rate for Payer: Cigna of CA HMO/PPO	$2.64
Rate for Payer: Health Smart Auto/Commercial	$1.98
Rate for Payer: LLUH Dept of Risk Management WC	$1.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.48

OXYBUTYNIN 3.9 MG/24 HOUR TRANSDERMAL 4 DAY PATCH [203474]

Facility

IP

$1.73

Service Code	NDC 11523-4322-2
Hospital Charge Code	ERX203474
Hospital Revenue Code	259
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$1.38
Rate for Payer: Cash Price	$0.78
Rate for Payer: Cigna of CA HMO/PPO	$1.38
Rate for Payer: Health Smart Auto/Commercial	$1.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.30

OXYBUTYNIN CHLORIDE 5 MG/5 ML ORAL SYRUP [10810]

Facility

IP

$0.04

Service Code	NDC 54838-510-80
Hospital Charge Code	1715478
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA HMO/PPO	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.03

OXYBUTYNIN CHLORIDE 5 MG/5 ML ORAL SYRUP [10810]

Facility

OP

$0.04

Service Code	NDC 54838-510-80
Hospital Charge Code	1715478
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.03

OXYBUTYNIN CHLORIDE 5 MG TABLET [5938]

Facility

IP

$0.15

Service Code	NDC 0832-0038-00
Hospital Charge Code	1710316
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.12
Rate for Payer: Cash Price	$0.07
Rate for Payer: Cigna of CA HMO/PPO	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

OXYBUTYNIN CHLORIDE 5 MG TABLET [5938]

Facility

OP

$0.12

Service Code	NDC 69315-182-01
Hospital Charge Code	1710316
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.07
Rate for Payer: Aetna of CA Government/Medicare	$0.07
Rate for Payer: Cash Price	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.09

OXYBUTYNIN CHLORIDE 5 MG TABLET [5938]

Facility

OP

$0.15

Service Code	NDC 0832-0038-00
Hospital Charge Code	1710316
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.09
Rate for Payer: Aetna of CA Government/Medicare	$0.09
Rate for Payer: Cash Price	$0.07
Rate for Payer: Health Smart Auto/Commercial	$0.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

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