|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [5940]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 5374620301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208667]
|
Facility
|
OP
|
$7.57
|
|
|
Service Code
|
NDC 5901141020
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$6.81 |
| Rate for Payer: Adventist Health Commercial |
$1.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4.80
|
| Rate for Payer: Blue Shield of California EPN |
$3.02
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Central Health Plan Commercial |
$6.06
|
| Rate for Payer: Cigna of CA HMO |
$5.30
|
| Rate for Payer: Cigna of CA PPO |
$5.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.03
|
| Rate for Payer: EPIC Health Plan Senior |
$3.03
|
| Rate for Payer: Galaxy Health WC |
$6.43
|
| Rate for Payer: Global Benefits Group Commercial |
$4.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.30
|
| Rate for Payer: Multiplan Commercial |
$5.68
|
| Rate for Payer: Networks By Design Commercial |
$4.92
|
| Rate for Payer: Prime Health Services Commercial |
$6.43
|
| Rate for Payer: Riverside University Health System MISP |
$3.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.79
|
| Rate for Payer: United Healthcare All Other HMO |
$3.79
|
| Rate for Payer: United Healthcare HMO Rider |
$3.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.43
|
| Rate for Payer: Vantage Medical Group Senior |
$6.43
|
|
|
OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208667]
|
Facility
|
IP
|
$7.57
|
|
|
Service Code
|
NDC 5901141020
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$6.81 |
| Rate for Payer: Adventist Health Commercial |
$1.51
|
| Rate for Payer: Blue Shield of California Commercial |
$6.07
|
| Rate for Payer: Blue Shield of California EPN |
$3.82
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Central Health Plan Commercial |
$6.06
|
| Rate for Payer: Cigna of CA HMO |
$5.30
|
| Rate for Payer: Cigna of CA PPO |
$5.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.03
|
| Rate for Payer: EPIC Health Plan Senior |
$3.03
|
| Rate for Payer: Galaxy Health WC |
$6.43
|
| Rate for Payer: Global Benefits Group Commercial |
$4.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.68
|
| Rate for Payer: Networks By Design Commercial |
$4.92
|
| Rate for Payer: Prime Health Services Commercial |
$6.43
|
|
|
OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208669]
|
Facility
|
IP
|
$13.76
|
|
|
Service Code
|
NDC 5901142010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$12.38 |
| Rate for Payer: Adventist Health Commercial |
$2.75
|
| Rate for Payer: Blue Shield of California Commercial |
$11.04
|
| Rate for Payer: Blue Shield of California EPN |
$6.94
|
| Rate for Payer: Cash Price |
$6.19
|
| Rate for Payer: Central Health Plan Commercial |
$11.01
|
| Rate for Payer: Cigna of CA HMO |
$9.63
|
| Rate for Payer: Cigna of CA PPO |
$9.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.50
|
| Rate for Payer: EPIC Health Plan Senior |
$5.50
|
| Rate for Payer: Galaxy Health WC |
$11.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.75
|
| Rate for Payer: Multiplan Commercial |
$10.32
|
| Rate for Payer: Networks By Design Commercial |
$8.94
|
| Rate for Payer: Prime Health Services Commercial |
$11.70
|
|
|
OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208669]
|
Facility
|
IP
|
$14.11
|
|
|
Service Code
|
NDC 5901142020
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$12.70 |
| Rate for Payer: Adventist Health Commercial |
$2.82
|
| Rate for Payer: Blue Shield of California Commercial |
$11.32
|
| Rate for Payer: Blue Shield of California EPN |
$7.11
|
| Rate for Payer: Cash Price |
$6.35
|
| Rate for Payer: Central Health Plan Commercial |
$11.29
|
| Rate for Payer: Cigna of CA HMO |
$9.88
|
| Rate for Payer: Cigna of CA PPO |
$9.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.64
|
| Rate for Payer: EPIC Health Plan Senior |
$5.64
|
| Rate for Payer: Galaxy Health WC |
$11.99
|
| Rate for Payer: Global Benefits Group Commercial |
$8.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Commercial |
$10.58
|
| Rate for Payer: Networks By Design Commercial |
$9.17
|
| Rate for Payer: Prime Health Services Commercial |
$11.99
|
|
|
OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208669]
|
Facility
|
OP
|
$13.76
|
|
|
Service Code
|
NDC 5901142010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$12.38 |
| Rate for Payer: Adventist Health Commercial |
$2.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8.72
|
| Rate for Payer: Blue Shield of California EPN |
$5.49
|
| Rate for Payer: Cash Price |
$6.19
|
| Rate for Payer: Central Health Plan Commercial |
$11.01
|
| Rate for Payer: Cigna of CA HMO |
$9.63
|
| Rate for Payer: Cigna of CA PPO |
$9.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.50
|
| Rate for Payer: EPIC Health Plan Senior |
$5.50
|
| Rate for Payer: Galaxy Health WC |
$11.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.63
|
| Rate for Payer: Multiplan Commercial |
$10.32
|
| Rate for Payer: Networks By Design Commercial |
$8.94
|
| Rate for Payer: Prime Health Services Commercial |
$11.70
|
| Rate for Payer: Riverside University Health System MISP |
$5.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.88
|
| Rate for Payer: United Healthcare All Other HMO |
$6.88
|
| Rate for Payer: United Healthcare HMO Rider |
$6.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.70
|
| Rate for Payer: Vantage Medical Group Senior |
$11.70
|
|
|
OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208669]
|
Facility
|
OP
|
$14.11
|
|
|
Service Code
|
NDC 5901142020
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$12.70 |
| Rate for Payer: Adventist Health Commercial |
$2.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.21
|
| Rate for Payer: Blue Shield of California Commercial |
$8.95
|
| Rate for Payer: Blue Shield of California EPN |
$5.63
|
| Rate for Payer: Cash Price |
$6.35
|
| Rate for Payer: Central Health Plan Commercial |
$11.29
|
| Rate for Payer: Cigna of CA HMO |
$9.88
|
| Rate for Payer: Cigna of CA PPO |
$9.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.64
|
| Rate for Payer: EPIC Health Plan Senior |
$5.64
|
| Rate for Payer: Galaxy Health WC |
$11.99
|
| Rate for Payer: Global Benefits Group Commercial |
$8.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.88
|
| Rate for Payer: Multiplan Commercial |
$10.58
|
| Rate for Payer: Networks By Design Commercial |
$9.17
|
| Rate for Payer: Prime Health Services Commercial |
$11.99
|
| Rate for Payer: Riverside University Health System MISP |
$5.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.05
|
| Rate for Payer: United Healthcare All Other HMO |
$7.05
|
| Rate for Payer: United Healthcare HMO Rider |
$7.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.99
|
| Rate for Payer: Vantage Medical Group Senior |
$11.99
|
|
|
OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208671]
|
Facility
|
IP
|
$24.16
|
|
|
Service Code
|
NDC 5901144020
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Adventist Health Commercial |
$4.83
|
| Rate for Payer: Blue Shield of California Commercial |
$19.38
|
| Rate for Payer: Blue Shield of California EPN |
$12.18
|
| Rate for Payer: Cash Price |
$10.87
|
| Rate for Payer: Central Health Plan Commercial |
$19.33
|
| Rate for Payer: Cigna of CA HMO |
$16.91
|
| Rate for Payer: Cigna of CA PPO |
$16.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.66
|
| Rate for Payer: EPIC Health Plan Senior |
$9.66
|
| Rate for Payer: Galaxy Health WC |
$20.54
|
| Rate for Payer: Global Benefits Group Commercial |
$14.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.83
|
| Rate for Payer: Multiplan Commercial |
$18.12
|
| Rate for Payer: Networks By Design Commercial |
$15.70
|
| Rate for Payer: Prime Health Services Commercial |
$20.54
|
|
|
OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208671]
|
Facility
|
OP
|
$24.16
|
|
|
Service Code
|
NDC 5901144020
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Adventist Health Commercial |
$4.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.05
|
| Rate for Payer: Blue Shield of California Commercial |
$15.32
|
| Rate for Payer: Blue Shield of California EPN |
$9.64
|
| Rate for Payer: Cash Price |
$10.87
|
| Rate for Payer: Central Health Plan Commercial |
$19.33
|
| Rate for Payer: Cigna of CA HMO |
$16.91
|
| Rate for Payer: Cigna of CA PPO |
$16.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.66
|
| Rate for Payer: EPIC Health Plan Senior |
$9.66
|
| Rate for Payer: Galaxy Health WC |
$20.54
|
| Rate for Payer: Global Benefits Group Commercial |
$14.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.91
|
| Rate for Payer: Multiplan Commercial |
$18.12
|
| Rate for Payer: Networks By Design Commercial |
$15.70
|
| Rate for Payer: Prime Health Services Commercial |
$20.54
|
| Rate for Payer: Riverside University Health System MISP |
$9.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.08
|
| Rate for Payer: United Healthcare All Other HMO |
$12.08
|
| Rate for Payer: United Healthcare HMO Rider |
$12.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.54
|
| Rate for Payer: Vantage Medical Group Senior |
$20.54
|
|
|
OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208673]
|
Facility
|
IP
|
$42.17
|
|
|
Service Code
|
NDC 5901148020
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.43 |
| Max. Negotiated Rate |
$37.95 |
| Rate for Payer: Adventist Health Commercial |
$8.43
|
| Rate for Payer: Blue Shield of California Commercial |
$33.82
|
| Rate for Payer: Blue Shield of California EPN |
$21.25
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Central Health Plan Commercial |
$33.74
|
| Rate for Payer: Cigna of CA HMO |
$29.52
|
| Rate for Payer: Cigna of CA PPO |
$29.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.87
|
| Rate for Payer: EPIC Health Plan Senior |
$16.87
|
| Rate for Payer: Galaxy Health WC |
$35.84
|
| Rate for Payer: Global Benefits Group Commercial |
$25.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.43
|
| Rate for Payer: Multiplan Commercial |
$31.63
|
| Rate for Payer: Networks By Design Commercial |
$27.41
|
| Rate for Payer: Prime Health Services Commercial |
$35.84
|
|
|
OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208673]
|
Facility
|
OP
|
$42.17
|
|
|
Service Code
|
NDC 5901148020
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.43 |
| Max. Negotiated Rate |
$37.95 |
| Rate for Payer: Adventist Health Commercial |
$8.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.53
|
| Rate for Payer: Blue Shield of California Commercial |
$26.74
|
| Rate for Payer: Blue Shield of California EPN |
$16.83
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Central Health Plan Commercial |
$33.74
|
| Rate for Payer: Cigna of CA HMO |
$29.52
|
| Rate for Payer: Cigna of CA PPO |
$29.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.87
|
| Rate for Payer: EPIC Health Plan Senior |
$16.87
|
| Rate for Payer: Galaxy Health WC |
$35.84
|
| Rate for Payer: Global Benefits Group Commercial |
$25.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.52
|
| Rate for Payer: Multiplan Commercial |
$31.63
|
| Rate for Payer: Networks By Design Commercial |
$27.41
|
| Rate for Payer: Prime Health Services Commercial |
$35.84
|
| Rate for Payer: Riverside University Health System MISP |
$16.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.09
|
| Rate for Payer: United Healthcare All Other HMO |
$21.09
|
| Rate for Payer: United Healthcare HMO Rider |
$21.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.84
|
| Rate for Payer: Vantage Medical Group Senior |
$35.84
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST [114934]
|
Facility
|
IP
|
$0.48
|
|
|
Service Code
|
NDC 2390002325
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST [114934]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 4612279235
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST [114934]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 4612279235
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST [114934]
|
Facility
|
IP
|
$0.45
|
|
|
Service Code
|
NDC 1152311591
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.38
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST [114934]
|
Facility
|
OP
|
$0.45
|
|
|
Service Code
|
NDC 1152311591
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.38
|
| Rate for Payer: Riverside University Health System MISP |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Vantage Medical Group Senior |
$0.38
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST [114934]
|
Facility
|
OP
|
$0.53
|
|
|
Service Code
|
NDC 0363030801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.42
|
| Rate for Payer: Cigna of CA HMO |
$0.37
|
| Rate for Payer: Cigna of CA PPO |
$0.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: EPIC Health Plan Senior |
$0.21
|
| Rate for Payer: Galaxy Health WC |
$0.45
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$0.40
|
| Rate for Payer: Networks By Design Commercial |
$0.34
|
| Rate for Payer: Prime Health Services Commercial |
$0.45
|
| Rate for Payer: Riverside University Health System MISP |
$0.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Vantage Medical Group Senior |
$0.45
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST [114934]
|
Facility
|
OP
|
$0.48
|
|
|
Service Code
|
NDC 2390002325
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Riverside University Health System MISP |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST [114934]
|
Facility
|
IP
|
$0.53
|
|
|
Service Code
|
NDC 0363030801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.42
|
| Rate for Payer: Cigna of CA HMO |
$0.37
|
| Rate for Payer: Cigna of CA PPO |
$0.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: EPIC Health Plan Senior |
$0.21
|
| Rate for Payer: Galaxy Health WC |
$0.45
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.40
|
| Rate for Payer: Networks By Design Commercial |
$0.34
|
| Rate for Payer: Prime Health Services Commercial |
$0.45
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
NDC 1152311676
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Riverside University Health System MISP |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]
|
Facility
|
OP
|
$0.51
|
|
|
Service Code
|
NDC 4110081127
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Central Health Plan Commercial |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
| Rate for Payer: Riverside University Health System MISP |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO |
$0.26
|
| Rate for Payer: United Healthcare HMO Rider |
$0.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Vantage Medical Group Senior |
$0.43
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
NDC 5002443100
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.27
|
| Rate for Payer: Riverside University Health System MISP |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Vantage Medical Group Senior |
$0.27
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
NDC 1152311676
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]
|
Facility
|
IP
|
$0.40
|
|
|
Service Code
|
NDC 1152341121
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 0904743535
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| 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: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Riverside University Health System MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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
|
|
