|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR [24470]
|
Facility
IP
|
$0.19
|
|
|
Service Code
|
NDC 65162-371-10
|
| Hospital Charge Code |
1710880
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR [24470]
|
Facility
IP
|
$3.16
|
|
|
Service Code
|
NDC 50268-627-15
|
| Hospital Charge Code |
1710880
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.37
|
| Rate for Payer: Blue Shield of California EPN |
$1.69
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Central Health Plan Commercial |
$2.53
|
| Rate for Payer: Cigna of CA HMO |
$2.21
|
| Rate for Payer: Cigna of CA PPO |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$2.37
|
| Rate for Payer: Networks By Design Commercial |
$2.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.69
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR [24470]
|
Facility
OP
|
$0.19
|
|
|
Service Code
|
NDC 65162-371-10
|
| Hospital Charge Code |
1710880
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: BCBS Transplant Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.14
|
| Rate for Payer: IEHP medi-cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: Riverside University Health MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR [24470]
|
Facility
OP
|
$3.27
|
|
|
Service Code
|
NDC 51079-722-01
|
| Hospital Charge Code |
1710880
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.93
|
| Rate for Payer: BCBS Transplant Transplant |
$1.96
|
| Rate for Payer: Blue Shield of California Commercial |
$2.06
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Central Health Plan Commercial |
$2.62
|
| Rate for Payer: Cigna of CA HMO |
$2.29
|
| Rate for Payer: Cigna of CA PPO |
$2.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.31
|
| Rate for Payer: Galaxy Health WC |
$2.78
|
| Rate for Payer: Global Benefits Group Commercial |
$1.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.94
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.45
|
| Rate for Payer: IEHP medi-cal |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$2.45
|
| Rate for Payer: Networks By Design Commercial |
$2.13
|
| Rate for Payer: Prime Health Services Commercial |
$2.78
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.96
|
| Rate for Payer: Riverside University Health MISP |
$1.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1.64
|
| Rate for Payer: United Healthcare HMO Rider |
$1.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.78
|
| Rate for Payer: Vantage Medical Group Senior |
$2.78
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR [24470]
|
Facility
OP
|
$3.16
|
|
|
Service Code
|
NDC 50268-627-15
|
| Hospital Charge Code |
1710880
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.87
|
| Rate for Payer: BCBS Transplant Transplant |
$1.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1.99
|
| Rate for Payer: Blue Shield of California EPN |
$1.55
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Central Health Plan Commercial |
$2.53
|
| Rate for Payer: Cigna of CA HMO |
$2.21
|
| Rate for Payer: Cigna of CA PPO |
$2.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.37
|
| Rate for Payer: IEHP medi-cal |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$2.37
|
| Rate for Payer: Networks By Design Commercial |
$2.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.69
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.90
|
| Rate for Payer: Riverside University Health MISP |
$1.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2.69
|
|
|
OXYCHLOROSENE SODIUM TOPICAL POWDER FOR SOLUTION [207355]
|
Facility
OP
|
$3.36
|
|
|
Service Code
|
NDC 0327-0001-10
|
| Hospital Charge Code |
1743758
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.99
|
| Rate for Payer: BCBS Transplant Transplant |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Central Health Plan Commercial |
$2.69
|
| Rate for Payer: Cigna of CA HMO |
$2.35
|
| Rate for Payer: Cigna of CA PPO |
$2.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.52
|
| Rate for Payer: IEHP medi-cal |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.02
|
| Rate for Payer: Riverside University Health MISP |
$1.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.86
|
| Rate for Payer: Vantage Medical Group Senior |
$2.86
|
|
|
OXYCHLOROSENE SODIUM TOPICAL POWDER FOR SOLUTION [207355]
|
Facility
IP
|
$3.36
|
|
|
Service Code
|
NDC 0327-0001-10
|
| Hospital Charge Code |
1743758
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.79
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Central Health Plan Commercial |
$2.69
|
| Rate for Payer: Cigna of CA HMO |
$2.35
|
| Rate for Payer: Cigna of CA PPO |
$2.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
|
|
OXYCODONE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [215181]
|
Facility
IP
|
$4.49
|
|
|
Service Code
|
NDC 68094-801-58
|
| Hospital Charge Code |
NDG215181
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.37
|
| Rate for Payer: Blue Shield of California EPN |
$2.40
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Central Health Plan Commercial |
$3.59
|
| Rate for Payer: Cigna of CA HMO |
$3.14
|
| Rate for Payer: Cigna of CA PPO |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: Galaxy Health WC |
$3.82
|
| Rate for Payer: Global Benefits Group Commercial |
$2.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$3.37
|
| Rate for Payer: Networks By Design Commercial |
$2.92
|
| Rate for Payer: Prime Health Services Commercial |
$3.82
|
|
|
OXYCODONE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [215181]
|
Facility
OP
|
$4.49
|
|
|
Service Code
|
NDC 68094-801-01
|
| Hospital Charge Code |
NDG215181
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.65
|
| Rate for Payer: BCBS Transplant Transplant |
$2.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.82
|
| Rate for Payer: Blue Shield of California EPN |
$2.20
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Central Health Plan Commercial |
$3.59
|
| Rate for Payer: Cigna of CA HMO |
$3.14
|
| Rate for Payer: Cigna of CA PPO |
$3.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.80
|
| Rate for Payer: Galaxy Health WC |
$3.82
|
| Rate for Payer: Global Benefits Group Commercial |
$2.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.37
|
| Rate for Payer: IEHP medi-cal |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$3.37
|
| Rate for Payer: Networks By Design Commercial |
$2.92
|
| Rate for Payer: Prime Health Services Commercial |
$3.82
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.69
|
| Rate for Payer: Riverside University Health MISP |
$1.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.24
|
| Rate for Payer: United Healthcare All Other HMO |
$2.24
|
| Rate for Payer: United Healthcare HMO Rider |
$2.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.82
|
| Rate for Payer: Vantage Medical Group Senior |
$3.82
|
|
|
OXYCODONE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [215181]
|
Facility
OP
|
$4.49
|
|
|
Service Code
|
NDC 68094-801-58
|
| Hospital Charge Code |
NDG215181
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.65
|
| Rate for Payer: BCBS Transplant Transplant |
$2.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.82
|
| Rate for Payer: Blue Shield of California EPN |
$2.20
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Central Health Plan Commercial |
$3.59
|
| Rate for Payer: Cigna of CA HMO |
$3.14
|
| Rate for Payer: Cigna of CA PPO |
$3.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.80
|
| Rate for Payer: Galaxy Health WC |
$3.82
|
| Rate for Payer: Global Benefits Group Commercial |
$2.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.37
|
| Rate for Payer: IEHP medi-cal |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$3.37
|
| Rate for Payer: Networks By Design Commercial |
$2.92
|
| Rate for Payer: Prime Health Services Commercial |
$3.82
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.69
|
| Rate for Payer: Riverside University Health MISP |
$1.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.24
|
| Rate for Payer: United Healthcare All Other HMO |
$2.24
|
| Rate for Payer: United Healthcare HMO Rider |
$2.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.82
|
| Rate for Payer: Vantage Medical Group Senior |
$3.82
|
|
|
OXYCODONE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [215181]
|
Facility
IP
|
$4.49
|
|
|
Service Code
|
NDC 68094-801-01
|
| Hospital Charge Code |
NDG215181
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.37
|
| Rate for Payer: Blue Shield of California EPN |
$2.40
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Central Health Plan Commercial |
$3.59
|
| Rate for Payer: Cigna of CA HMO |
$3.14
|
| Rate for Payer: Cigna of CA PPO |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: Galaxy Health WC |
$3.82
|
| Rate for Payer: Global Benefits Group Commercial |
$2.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$3.37
|
| Rate for Payer: Networks By Design Commercial |
$2.92
|
| Rate for Payer: Prime Health Services Commercial |
$3.82
|
|
|
OXYCODONE 10 MG TABLET [87795]
|
Facility
IP
|
$0.15
|
|
|
Service Code
|
NDC 42858-002-01
|
| Hospital Charge Code |
ERX87795
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
|
|
OXYCODONE 10 MG TABLET [87795]
|
Facility
OP
|
$0.17
|
|
|
Service Code
|
NDC 10702-056-01
|
| Hospital Charge Code |
ERX87795
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: BCBS Transplant Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| 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 |
$0.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.13
|
| Rate for Payer: IEHP medi-cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: Riverside University Health MISP |
$0.07
|
| 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 |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
OXYCODONE 10 MG TABLET [87795]
|
Facility
OP
|
$0.15
|
|
|
Service Code
|
NDC 42858-002-01
|
| Hospital Charge Code |
ERX87795
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: IEHP medi-cal |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: BCBS Transplant Transplant |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.12
|
| 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 |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.09
|
| Rate for Payer: Riverside University Health MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.09
|
| 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 Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
OXYCODONE 10 MG TABLET [87795]
|
Facility
IP
|
$0.17
|
|
|
Service Code
|
NDC 99702-056-01
|
| Hospital Charge Code |
ERX87795
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| 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 |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
OXYCODONE 10 MG TABLET [87795]
|
Facility
IP
|
$0.17
|
|
|
Service Code
|
NDC 10702-056-01
|
| Hospital Charge Code |
ERX87795
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| 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 |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
OXYCODONE 10 MG TABLET [87795]
|
Facility
OP
|
$0.17
|
|
|
Service Code
|
NDC 99702-056-01
|
| Hospital Charge Code |
ERX87795
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: BCBS Transplant Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| 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 |
$0.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.13
|
| Rate for Payer: IEHP medi-cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: Riverside University Health MISP |
$0.07
|
| 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 |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
OXYCODONE 20 MG/ML ORAL CONCENTRATE [10812]
|
Facility
IP
|
$5.60
|
|
|
Service Code
|
NDC 71930-023-30
|
| Hospital Charge Code |
NDG10812
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.20
|
| Rate for Payer: Blue Shield of California EPN |
$2.99
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Central Health Plan Commercial |
$4.48
|
| Rate for Payer: Cigna of CA HMO |
$3.92
|
| Rate for Payer: Cigna of CA PPO |
$3.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.76
|
| Rate for Payer: Global Benefits Group Commercial |
$3.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$3.64
|
| Rate for Payer: Prime Health Services Commercial |
$4.76
|
|
|
OXYCODONE 20 MG/ML ORAL CONCENTRATE [10812]
|
Facility
IP
|
$7.04
|
|
|
Service Code
|
NDC 9999-9108-12
|
| Hospital Charge Code |
1734050
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$5.28
|
| Rate for Payer: Blue Shield of California EPN |
$3.76
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Central Health Plan Commercial |
$5.63
|
| Rate for Payer: Cigna of CA HMO |
$4.93
|
| Rate for Payer: Cigna of CA PPO |
$4.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.82
|
| Rate for Payer: Galaxy Health WC |
$5.98
|
| Rate for Payer: Global Benefits Group Commercial |
$4.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.41
|
| Rate for Payer: Multiplan Commercial |
$5.28
|
| Rate for Payer: Networks By Design Commercial |
$4.58
|
| Rate for Payer: Prime Health Services Commercial |
$5.98
|
|
|
OXYCODONE 20 MG/ML ORAL CONCENTRATE [10812]
|
Facility
OP
|
$5.60
|
|
|
Service Code
|
NDC 71930-023-30
|
| Hospital Charge Code |
NDG10812
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.31
|
| Rate for Payer: BCBS Transplant Transplant |
$3.36
|
| Rate for Payer: Blue Shield of California Commercial |
$3.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.74
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Central Health Plan Commercial |
$4.48
|
| Rate for Payer: Cigna of CA HMO |
$3.92
|
| Rate for Payer: Cigna of CA PPO |
$3.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.76
|
| Rate for Payer: Global Benefits Group Commercial |
$3.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.20
|
| Rate for Payer: IEHP medi-cal |
$1.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$3.64
|
| Rate for Payer: Prime Health Services Commercial |
$4.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.36
|
| Rate for Payer: Riverside University Health MISP |
$2.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2.80
|
| Rate for Payer: United Healthcare HMO Rider |
$2.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
OXYCODONE 20 MG/ML ORAL CONCENTRATE [10812]
|
Facility
OP
|
$7.04
|
|
|
Service Code
|
NDC 9999-9108-12
|
| Hospital Charge Code |
1734050
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.16
|
| Rate for Payer: BCBS Transplant Transplant |
$4.22
|
| Rate for Payer: Blue Shield of California Commercial |
$4.43
|
| Rate for Payer: Blue Shield of California EPN |
$3.44
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Central Health Plan Commercial |
$5.63
|
| Rate for Payer: Cigna of CA HMO |
$4.93
|
| Rate for Payer: Cigna of CA PPO |
$4.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.82
|
| Rate for Payer: Galaxy Health WC |
$5.98
|
| Rate for Payer: Global Benefits Group Commercial |
$4.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.28
|
| Rate for Payer: IEHP medi-cal |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.41
|
| Rate for Payer: Multiplan Commercial |
$5.28
|
| Rate for Payer: Networks By Design Commercial |
$4.58
|
| Rate for Payer: Prime Health Services Commercial |
$5.98
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.22
|
| Rate for Payer: Riverside University Health MISP |
$2.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.52
|
| Rate for Payer: United Healthcare All Other HMO |
$3.52
|
| Rate for Payer: United Healthcare HMO Rider |
$3.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.98
|
| Rate for Payer: Vantage Medical Group Senior |
$5.98
|
|
|
OXYCODONE 20 MG/ML ORAL SOLUTION. [4081621]
|
Facility
IP
|
$4.49
|
|
|
Service Code
|
NDC 68094-801-58
|
| Hospital Charge Code |
NDG215181
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.37
|
| Rate for Payer: Blue Shield of California EPN |
$2.40
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Central Health Plan Commercial |
$3.59
|
| Rate for Payer: Cigna of CA HMO |
$3.14
|
| Rate for Payer: Cigna of CA PPO |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: Galaxy Health WC |
$3.82
|
| Rate for Payer: Global Benefits Group Commercial |
$2.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$3.37
|
| Rate for Payer: Networks By Design Commercial |
$2.92
|
| Rate for Payer: Prime Health Services Commercial |
$3.82
|
|
|
OXYCODONE 20 MG/ML ORAL SOLUTION. [4081621]
|
Facility
OP
|
$4.49
|
|
|
Service Code
|
NDC 68094-801-58
|
| Hospital Charge Code |
NDG215181
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.65
|
| Rate for Payer: BCBS Transplant Transplant |
$2.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.82
|
| Rate for Payer: Blue Shield of California EPN |
$2.20
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Central Health Plan Commercial |
$3.59
|
| Rate for Payer: Cigna of CA HMO |
$3.14
|
| Rate for Payer: Cigna of CA PPO |
$3.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.80
|
| Rate for Payer: Galaxy Health WC |
$3.82
|
| Rate for Payer: Global Benefits Group Commercial |
$2.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.37
|
| Rate for Payer: IEHP medi-cal |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$3.37
|
| Rate for Payer: Networks By Design Commercial |
$2.92
|
| Rate for Payer: Prime Health Services Commercial |
$3.82
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.69
|
| Rate for Payer: Riverside University Health MISP |
$1.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.24
|
| Rate for Payer: United Healthcare All Other HMO |
$2.24
|
| Rate for Payer: United Healthcare HMO Rider |
$2.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.82
|
| Rate for Payer: Vantage Medical Group Senior |
$3.82
|
|
|
OXYCODONE 20 MG/ML ORAL SOLUTION. [4081621]
|
Facility
OP
|
$4.49
|
|
|
Service Code
|
NDC 68094-801-01
|
| Hospital Charge Code |
NDG215181
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.65
|
| Rate for Payer: BCBS Transplant Transplant |
$2.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.82
|
| Rate for Payer: Blue Shield of California EPN |
$2.20
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Central Health Plan Commercial |
$3.59
|
| Rate for Payer: Cigna of CA HMO |
$3.14
|
| Rate for Payer: Cigna of CA PPO |
$3.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.80
|
| Rate for Payer: Galaxy Health WC |
$3.82
|
| Rate for Payer: Global Benefits Group Commercial |
$2.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.37
|
| Rate for Payer: IEHP medi-cal |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$3.37
|
| Rate for Payer: Networks By Design Commercial |
$2.92
|
| Rate for Payer: Prime Health Services Commercial |
$3.82
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.69
|
| Rate for Payer: Riverside University Health MISP |
$1.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.24
|
| Rate for Payer: United Healthcare All Other HMO |
$2.24
|
| Rate for Payer: United Healthcare HMO Rider |
$2.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.82
|
| Rate for Payer: Vantage Medical Group Senior |
$3.82
|
|
|
OXYCODONE 20 MG/ML ORAL SOLUTION. [4081621]
|
Facility
IP
|
$4.49
|
|
|
Service Code
|
NDC 68094-801-01
|
| Hospital Charge Code |
NDG215181
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.37
|
| Rate for Payer: Blue Shield of California EPN |
$2.40
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Central Health Plan Commercial |
$3.59
|
| Rate for Payer: Cigna of CA HMO |
$3.14
|
| Rate for Payer: Cigna of CA PPO |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: Galaxy Health WC |
$3.82
|
| Rate for Payer: Global Benefits Group Commercial |
$2.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$3.37
|
| Rate for Payer: Networks By Design Commercial |
$2.92
|
| Rate for Payer: Prime Health Services Commercial |
$3.82
|
|
