|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [31864]
|
Facility
|
IP
|
$2.06
|
|
|
Service Code
|
NDC 6808471001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.33
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [31864]
|
Facility
|
IP
|
$0.59
|
|
|
Service Code
|
NDC 0406052301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.38
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.40
|
| Rate for Payer: Heritage Provider Network Senior |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [31864]
|
Facility
|
IP
|
$3.16
|
|
|
Service Code
|
NDC 0406052362
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.37 |
| Rate for Payer: Adventist Health Commercial |
$0.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.04
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.14
|
| Rate for Payer: Heritage Provider Network Senior |
$2.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$2.37
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [31864]
|
Facility
|
OP
|
$3.16
|
|
|
Service Code
|
NDC 0406052323
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Adventist Health Commercial |
$0.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1.93
|
| Rate for Payer: Blue Shield of California EPN |
$1.54
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.96
|
| Rate for Payer: Heritage Provider Network Senior |
$1.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.21
|
| Rate for Payer: Multiplan Commercial |
$2.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.26
|
| Rate for Payer: TriValley Medical Group Senior |
$1.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2.69
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [31864]
|
Facility
|
IP
|
$3.16
|
|
|
Service Code
|
NDC 0406052323
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.37 |
| Rate for Payer: Adventist Health Commercial |
$0.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.04
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.14
|
| Rate for Payer: Heritage Provider Network Senior |
$2.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$2.37
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [31864]
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
NDC 0406052301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Vantage Medical Group Senior |
$0.50
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [31864]
|
Facility
|
OP
|
$2.06
|
|
|
Service Code
|
NDC 6808471001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.82
|
| Rate for Payer: TriValley Medical Group Senior |
$0.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1.75
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [31864]
|
Facility
|
OP
|
$2.06
|
|
|
Service Code
|
NDC 6808471011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.82
|
| Rate for Payer: TriValley Medical Group Senior |
$0.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1.75
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [31864]
|
Facility
|
IP
|
$2.06
|
|
|
Service Code
|
NDC 6808471011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.33
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
|
|
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 |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [5940]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 5374620301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [5940]
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 4285810201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [5940]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
NDC 0904709361
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.37
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Senior |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [5940]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
NDC 0904709361
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Senior |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Senior |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [5940]
|
Facility
|
IP
|
$0.20
|
|
|
Service Code
|
NDC 4285810201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.13
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
|
|
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 |
$1.37 |
| Max. Negotiated Rate |
$6.43 |
| Rate for Payer: Adventist Health Commercial |
$1.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.68
|
| 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 HMO/PPO |
$3.79
|
| Rate for Payer: Blue Shield of California Commercial |
$4.62
|
| Rate for Payer: Blue Shield of California EPN |
$3.69
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.92
|
| 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: EPIC Health Plan Commercial |
$4.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.69
|
| Rate for Payer: Heritage Provider Network Senior |
$4.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.30
|
| Rate for Payer: Multiplan Commercial |
$5.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.03
|
| Rate for Payer: TriValley Medical Group Senior |
$3.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 |
$1.37 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Adventist Health Commercial |
$1.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.88
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.12
|
| Rate for Payer: Heritage Provider Network Senior |
$5.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.89
|
| Rate for Payer: Multiplan Commercial |
$5.68
|
|
|
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 |
$2.55 |
| Max. Negotiated Rate |
$11.99 |
| Rate for Payer: Adventist Health Commercial |
$2.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.72
|
| 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 HMO/PPO |
$7.06
|
| Rate for Payer: Blue Shield of California Commercial |
$8.61
|
| Rate for Payer: Blue Shield of California EPN |
$6.89
|
| Rate for Payer: Cash Price |
$6.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.17
|
| 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: EPIC Health Plan Commercial |
$9.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.73
|
| Rate for Payer: Heritage Provider Network Senior |
$8.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.88
|
| Rate for Payer: Multiplan Commercial |
$10.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.64
|
| Rate for Payer: TriValley Medical Group Senior |
$5.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 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 |
$2.49 |
| Max. Negotiated Rate |
$10.32 |
| Rate for Payer: Adventist Health Commercial |
$2.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.86
|
| Rate for Payer: Cash Price |
$6.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.32
|
| Rate for Payer: Heritage Provider Network Senior |
$9.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.44
|
| Rate for Payer: Multiplan Commercial |
$10.32
|
|
|
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 |
$2.49 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Adventist Health Commercial |
$2.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.50
|
| 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 HMO/PPO |
$6.88
|
| Rate for Payer: Blue Shield of California Commercial |
$8.39
|
| Rate for Payer: Blue Shield of California EPN |
$6.71
|
| Rate for Payer: Cash Price |
$6.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.94
|
| 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: EPIC Health Plan Commercial |
$8.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.52
|
| Rate for Payer: Heritage Provider Network Senior |
$8.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.63
|
| Rate for Payer: Multiplan Commercial |
$10.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.50
|
| Rate for Payer: TriValley Medical Group Senior |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
IP
|
$14.11
|
|
|
Service Code
|
NDC 5901142020
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$10.58 |
| Rate for Payer: Adventist Health Commercial |
$2.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.09
|
| Rate for Payer: Cash Price |
$6.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.55
|
| Rate for Payer: Heritage Provider Network Senior |
$9.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.53
|
| Rate for Payer: Multiplan Commercial |
$10.58
|
|
|
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 |
$4.37 |
| Max. Negotiated Rate |
$18.12 |
| Rate for Payer: Adventist Health Commercial |
$4.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.56
|
| Rate for Payer: Cash Price |
$10.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.36
|
| Rate for Payer: Heritage Provider Network Senior |
$16.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.04
|
| Rate for Payer: Multiplan Commercial |
$18.12
|
|
|
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 |
$4.37 |
| Max. Negotiated Rate |
$20.54 |
| Rate for Payer: Adventist Health Commercial |
$4.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.93
|
| 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 HMO/PPO |
$12.08
|
| Rate for Payer: Blue Shield of California Commercial |
$14.74
|
| Rate for Payer: Blue Shield of California EPN |
$11.79
|
| Rate for Payer: Cash Price |
$10.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.70
|
| 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: EPIC Health Plan Commercial |
$15.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.96
|
| Rate for Payer: Heritage Provider Network Senior |
$14.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.91
|
| Rate for Payer: Multiplan Commercial |
$18.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.66
|
| Rate for Payer: TriValley Medical Group Senior |
$9.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 |
$7.63 |
| Max. Negotiated Rate |
$31.63 |
| Rate for Payer: Adventist Health Commercial |
$8.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.16
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.55
|
| Rate for Payer: Heritage Provider Network Senior |
$28.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.54
|
| Rate for Payer: Multiplan Commercial |
$31.63
|
|
|
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 |
$7.63 |
| Max. Negotiated Rate |
$35.84 |
| Rate for Payer: Adventist Health Commercial |
$8.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.06
|
| 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 HMO/PPO |
$21.09
|
| Rate for Payer: Blue Shield of California Commercial |
$25.72
|
| Rate for Payer: Blue Shield of California EPN |
$20.58
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.41
|
| 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: EPIC Health Plan Commercial |
$26.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.10
|
| Rate for Payer: Heritage Provider Network Senior |
$26.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.52
|
| Rate for Payer: Multiplan Commercial |
$31.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.87
|
| Rate for Payer: TriValley Medical Group Senior |
$16.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
|
