Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [31864]

Facility

IP

$2.06

Service Code	NDC 68084-710-01
Hospital Charge Code	1730174
Hospital Revenue Code	259
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$1.65
Rate for Payer: Cash Price	$0.93
Rate for Payer: Cigna of CA HMO/PPO	$1.65
Rate for Payer: Health Smart Auto/Commercial	$1.24
Rate for Payer: LLUH Dept of Risk Management WC	$1.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.54

OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [31864]

Facility

IP

$2.06

Service Code	NDC 68084-710-11
Hospital Charge Code	1730174
Hospital Revenue Code	259
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$1.65
Rate for Payer: Cash Price	$0.93
Rate for Payer: Cigna of CA HMO/PPO	$1.65
Rate for Payer: Health Smart Auto/Commercial	$1.24
Rate for Payer: LLUH Dept of Risk Management WC	$1.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.54

OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [31864]

Facility

IP

$2.27

Service Code	NDC 0406-0523-62
Hospital Charge Code	1730174
Hospital Revenue Code	259
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.82
Rate for Payer: Cash Price	$1.02
Rate for Payer: Cigna of CA HMO/PPO	$1.82
Rate for Payer: Health Smart Auto/Commercial	$1.36
Rate for Payer: LLUH Dept of Risk Management WC	$1.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.70

OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [31864]

Facility

OP

$0.59

Service Code	NDC 0406-0523-01
Hospital Charge Code	1730174
Hospital Revenue Code	259
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.35
Rate for Payer: Aetna of CA Government/Medicare	$0.35
Rate for Payer: Cash Price	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.35
Rate for Payer: LLUH Dept of Risk Management WC	$0.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.44

OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [31864]

Facility

IP

$2.16

Service Code	NDC 68308-480-47
Hospital Charge Code	1730174
Hospital Revenue Code	259
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.73
Rate for Payer: Cash Price	$0.97
Rate for Payer: Cigna of CA HMO/PPO	$1.73
Rate for Payer: Health Smart Auto/Commercial	$1.30
Rate for Payer: LLUH Dept of Risk Management WC	$1.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.62

OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [31864]

Facility

OP

$2.27

Service Code	NDC 0406-0523-23
Hospital Charge Code	1730174
Hospital Revenue Code	259
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.36
Rate for Payer: Aetna of CA Government/Medicare	$1.36
Rate for Payer: Cash Price	$1.02
Rate for Payer: Health Smart Auto/Commercial	$1.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.36
Rate for Payer: LLUH Dept of Risk Management WC	$1.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.70

OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [5940]

Facility

OP

$0.34

Service Code	NDC 0904-7093-61
Hospital Charge Code	1730102
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.20
Rate for Payer: Aetna of CA Government/Medicare	$0.20
Rate for Payer: Cash Price	$0.15
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.26

OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [5940]

Facility

IP

$0.22

Service Code	NDC 53746-203-01
Hospital Charge Code	1730102
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.18
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cigna of CA HMO/PPO	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [5940]

Facility

IP

$0.08

Service Code	NDC 42858-102-01
Hospital Charge Code	1730102
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cigna of CA HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.06

OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [5940]

Facility

OP

$0.22

Service Code	NDC 53746-203-01
Hospital Charge Code	1730102
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.13
Rate for Payer: Aetna of CA Government/Medicare	$0.13
Rate for Payer: Cash Price	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [5940]

Facility

IP

$0.34

Service Code	NDC 0904-7093-61
Hospital Charge Code	1730102
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.27
Rate for Payer: Cash Price	$0.15
Rate for Payer: Cigna of CA HMO/PPO	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.26

OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [5940]

Facility

OP

$0.08

Service Code	NDC 42858-102-01
Hospital Charge Code	1730102
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.05
Rate for Payer: Aetna of CA Government/Medicare	$0.05
Rate for Payer: Cash Price	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.06

OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208667]

Facility

IP

$6.03

Service Code	NDC 59011-410-20
Hospital Charge Code	1730114
Hospital Revenue Code	259
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$4.82
Rate for Payer: Cash Price	$2.71
Rate for Payer: Cigna of CA HMO/PPO	$4.82
Rate for Payer: Health Smart Auto/Commercial	$3.62
Rate for Payer: LLUH Dept of Risk Management WC	$3.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.52

OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208667]

Facility

OP

$6.03

Service Code	NDC 59011-410-20
Hospital Charge Code	1730114
Hospital Revenue Code	259
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$4.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.62
Rate for Payer: Aetna of CA Government/Medicare	$3.62
Rate for Payer: Cash Price	$2.71
Rate for Payer: Health Smart Auto/Commercial	$3.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.62
Rate for Payer: LLUH Dept of Risk Management WC	$3.32
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.52

OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208669]

Facility

OP

$11.23

Service Code	NDC 59011-420-20
Hospital Charge Code	1730115
Hospital Revenue Code	259
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$8.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.74
Rate for Payer: Aetna of CA Government/Medicare	$6.74
Rate for Payer: Cash Price	$5.05
Rate for Payer: Health Smart Auto/Commercial	$6.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.74
Rate for Payer: LLUH Dept of Risk Management WC	$6.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.42

OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208669]

Facility

IP

$11.23

Service Code	NDC 59011-420-20
Hospital Charge Code	1730115
Hospital Revenue Code	259
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$8.98
Rate for Payer: Cash Price	$5.05
Rate for Payer: Cigna of CA HMO/PPO	$8.98
Rate for Payer: Health Smart Auto/Commercial	$6.74
Rate for Payer: LLUH Dept of Risk Management WC	$6.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.42

OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208669]

Facility

IP

$9.00

Service Code	NDC 69238-2296-1
Hospital Charge Code	1730115
Hospital Revenue Code	259
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Cash Price	$4.05
Rate for Payer: Cigna of CA HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.75

OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208669]

Facility

OP

$9.00

Service Code	NDC 69238-2296-1
Hospital Charge Code	1730115
Hospital Revenue Code	259
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$6.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.40
Rate for Payer: Aetna of CA Government/Medicare	$5.40
Rate for Payer: Cash Price	$4.05
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.75

OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208671]

Facility

OP

$19.22

Service Code	NDC 59011-440-20
Hospital Charge Code	1731015
Hospital Revenue Code	259
Min. Negotiated Rate	$10.57
Max. Negotiated Rate	$14.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.53
Rate for Payer: Aetna of CA Government/Medicare	$11.53
Rate for Payer: Cash Price	$8.65
Rate for Payer: Health Smart Auto/Commercial	$11.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.53
Rate for Payer: LLUH Dept of Risk Management WC	$10.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.42

OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208671]

Facility

IP

$19.22

Service Code	NDC 59011-440-20
Hospital Charge Code	1731015
Hospital Revenue Code	259
Min. Negotiated Rate	$10.57
Max. Negotiated Rate	$15.38
Rate for Payer: Cash Price	$8.65
Rate for Payer: Cigna of CA HMO/PPO	$15.38
Rate for Payer: Health Smart Auto/Commercial	$11.53
Rate for Payer: LLUH Dept of Risk Management WC	$10.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.42

OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208673]

Facility

IP

$33.56

Service Code	NDC 59011-480-20
Hospital Charge Code	1731012
Hospital Revenue Code	259
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$26.85
Rate for Payer: Cash Price	$15.10
Rate for Payer: Cigna of CA HMO/PPO	$26.85
Rate for Payer: Health Smart Auto/Commercial	$20.14
Rate for Payer: LLUH Dept of Risk Management WC	$18.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$25.17

OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208673]

Facility

OP

$33.56

Service Code	NDC 59011-480-20
Hospital Charge Code	1731012
Hospital Revenue Code	259
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$25.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.14
Rate for Payer: Aetna of CA Government/Medicare	$20.14
Rate for Payer: Cash Price	$15.10
Rate for Payer: Health Smart Auto/Commercial	$20.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.14
Rate for Payer: LLUH Dept of Risk Management WC	$18.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$25.17

OXYMETAZOLINE 0.05 % NASAL MIST [114934]

Facility

OP

$0.53

Service Code	NDC 0363-0308-01
Hospital Charge Code	NDG114934
Hospital Revenue Code	259
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.32
Rate for Payer: Aetna of CA Government/Medicare	$0.32
Rate for Payer: Cash Price	$0.24
Rate for Payer: Health Smart Auto/Commercial	$0.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.32
Rate for Payer: LLUH Dept of Risk Management WC	$0.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.40

OXYMETAZOLINE 0.05 % NASAL MIST [114934]

Facility

IP

$0.48

Service Code	NDC 2390002326
Hospital Charge Code	NDG114934
Hospital Revenue Code	259
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.38
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cigna of CA HMO/PPO	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.36

OXYMETAZOLINE 0.05 % NASAL MIST [114934]

Facility

IP

$0.48

Service Code	NDC 2390002325
Hospital Charge Code	NDG114934
Hospital Revenue Code	259
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.38
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cigna of CA HMO/PPO	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.36

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