St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OXCARBAZEPINE (TRILEPTAL),S

Facility

$33.13

Service Code	HCPCS 80183
Hospital Charge Code	40609813
Hospital Revenue Code	301
Min. Negotiated Rate	$9.28
Max. Negotiated Rate	$26.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.25
Rate for Payer: Aetna Government	$13.25
Rate for Payer: Affinity Essential Plan 1&2	$9.28
Rate for Payer: Affinity Essential Plan 3&4	$9.28
Rate for Payer: Affinity Medicaid/CHP/HARP	$9.28
Rate for Payer: Brighton Health Commercial	$24.85
Rate for Payer: Cash Price	$13.25
Rate for Payer: Cash Price	$13.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$13.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.53
Rate for Payer: Elderplan Medicare Advantage	$13.25
Rate for Payer: EmblemHealth Commercial	$13.25
Rate for Payer: Fidelis Essential Plan Aliesa	$11.26
Rate for Payer: Fidelis Essential Plan QHP	$11.79
Rate for Payer: Fidelis Medicare Advantage	$13.25
Rate for Payer: Fidelis Qualified Health Plan	$11.79
Rate for Payer: Group Health Inc Commercial	$13.25
Rate for Payer: Group Health Inc Medicare	$13.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.56
Rate for Payer: Hamaspik Choice Inc Medicare	$13.25
Rate for Payer: Healthfirst Medicare Advantage	$13.25
Rate for Payer: Healthfirst QHP	$13.25
Rate for Payer: Humana Medicare	$13.52
Rate for Payer: Senior Whole Health Medicare Advantage	$13.25
Rate for Payer: United Healthcare Commercial	$16.28
Rate for Payer: United Healthcare Medicare Advantage	$13.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.60
Rate for Payer: Wellcare Medicare	$11.92

OXINIUM FEM HD 12/14 36MM

Facility

$4,920.00

Service Code	HCPCS C1776
Hospital Charge Code	64902866
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,166.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,706.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,952.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,460.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,829.00
Rate for Payer: EmblemHealth Commercial	$2,460.00
Rate for Payer: Fidelis Medicare Advantage	$5,166.00
Rate for Payer: Group Health Inc Commercial	$2,460.00
Rate for Payer: Group Health Inc Medicare	$1,722.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,460.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,460.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,198.00

OXINIUM FEM HD 12/14 36MM

Facility

$4,920.00

Service Code	HCPCS C1776
Hospital Charge Code	64902866
Hospital Revenue Code	278
Min. Negotiated Rate	$2,460.00
Max. Negotiated Rate	$2,460.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,460.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,460.00

OXINIUM FEM HD 12/14 36MM M4

Facility

$4,920.00

Service Code	HCPCS C1776
Hospital Charge Code	64905218
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,166.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,706.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,952.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,460.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,829.00
Rate for Payer: EmblemHealth Commercial	$2,460.00
Rate for Payer: Fidelis Medicare Advantage	$5,166.00
Rate for Payer: Group Health Inc Commercial	$2,460.00
Rate for Payer: Group Health Inc Medicare	$1,722.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,460.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,460.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,198.00

OXINIUM FEM HD 12/14 36MM M4

Facility

$4,920.00

Service Code	HCPCS C1776
Hospital Charge Code	64905218
Hospital Revenue Code	278
Min. Negotiated Rate	$2,460.00
Max. Negotiated Rate	$2,460.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,460.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,460.00

OXISENSOR 11 D-25 ADT FINGER SNSR

Facility

$797.05

Hospital Charge Code	64902729
Hospital Revenue Code	270
Min. Negotiated Rate	$278.97
Max. Negotiated Rate	$637.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$438.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.52
Rate for Payer: Aetna Government	$398.52
Rate for Payer: Brighton Health Commercial	$597.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$637.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$541.99
Rate for Payer: Group Health Inc Commercial	$398.52
Rate for Payer: Group Health Inc Medicare	$278.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$398.52
Rate for Payer: Hamaspik Choice Inc Medicare	$398.52

OXYBUTYNIN 1 MG/ ML SYRUP

Facility

$0.03

Hospital Charge Code	41655571
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

OXYBUTYNIN 1 MG/ ML SYRUP

Facility

$0.03

Hospital Charge Code	41645571
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

OXYBUTYNIN 5 MG TAB

Facility

$1.00

Hospital Charge Code	41640665
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

OXYBUTYNIN 5 MG TAB

Facility

$1.00

Hospital Charge Code	41650665
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

OXYBUTYNIN CHLORIDE 5 MG/5ML PO SOLN [187942]

Facility

$0.11

Service Code	NDC 54838051080
Hospital Charge Code	54838051080
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

OXYBUTYNIN CHLORIDE 5 MG PO TABS [5938]

Facility

$0.66

Service Code	NDC 00832003801
Hospital Charge Code	00832003801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.45
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.43

OXYBUTYNIN CHLORIDE 5 MG PO TABS [5938]

Facility

$0.76

Service Code	NDC 00603497521
Hospital Charge Code	00603497521
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.38
Rate for Payer: Aetna Government	$0.38
Rate for Payer: Brighton Health Commercial	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.52
Rate for Payer: Group Health Inc Commercial	$0.38
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38
Rate for Payer: Hamaspik Choice Inc Medicare	$0.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.49

OXYBUTYNIN CHLORIDE 5 MG PO TABS [5938]

Facility

$0.76

Service Code	NDC 00832003800
Hospital Charge Code	00832003800
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.38
Rate for Payer: Aetna Government	$0.38
Rate for Payer: Brighton Health Commercial	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.52
Rate for Payer: Group Health Inc Commercial	$0.38
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38
Rate for Payer: Hamaspik Choice Inc Medicare	$0.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.49

OXYCODONE 10MG/0.5ML (CONCEN)

Facility

$3.53

Hospital Charge Code	41658415
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$2.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.76
Rate for Payer: Aetna Government	$1.76
Rate for Payer: Brighton Health Commercial	$2.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.40
Rate for Payer: Group Health Inc Commercial	$1.76
Rate for Payer: Group Health Inc Medicare	$1.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.76
Rate for Payer: Hamaspik Choice Inc Medicare	$1.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.29

OXYCODONE 10MG/0.5ML (CONCEN)

Facility

$3.53

Hospital Charge Code	41648415
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$2.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.76
Rate for Payer: Aetna Government	$1.76
Rate for Payer: Brighton Health Commercial	$2.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.40
Rate for Payer: Group Health Inc Commercial	$1.76
Rate for Payer: Group Health Inc Medicare	$1.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.76
Rate for Payer: Hamaspik Choice Inc Medicare	$1.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.29

OXYCODONE 10 MG TAB

Facility

$1.00

Hospital Charge Code	41655316
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

OXYCODONE 10 MG TAB

Facility

$1.00

Hospital Charge Code	41645316
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

OXYCODONE 10 MG TAB ER

Facility

$3.53

Hospital Charge Code	41645501
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$2.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.76
Rate for Payer: Aetna Government	$1.76
Rate for Payer: Brighton Health Commercial	$2.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.40
Rate for Payer: Group Health Inc Commercial	$1.76
Rate for Payer: Group Health Inc Medicare	$1.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.76
Rate for Payer: Hamaspik Choice Inc Medicare	$1.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.29

OXYCODONE 10 MG TAB ER

Facility

$3.53

Hospital Charge Code	41655501
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$2.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.76
Rate for Payer: Aetna Government	$1.76
Rate for Payer: Brighton Health Commercial	$2.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.40
Rate for Payer: Group Health Inc Commercial	$1.76
Rate for Payer: Group Health Inc Medicare	$1.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.76
Rate for Payer: Hamaspik Choice Inc Medicare	$1.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.29

OXYCODONE 20 MG/ML CONC LIQUID (HOSPICE)

Facility

$5.32

Hospital Charge Code	41645326
Hospital Revenue Code	250
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$4.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.66
Rate for Payer: Aetna Government	$2.66
Rate for Payer: Brighton Health Commercial	$3.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.62
Rate for Payer: Group Health Inc Commercial	$2.66
Rate for Payer: Group Health Inc Medicare	$1.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.66
Rate for Payer: Hamaspik Choice Inc Medicare	$2.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.46

OXYCODONE 20 MG/ML CONC LIQUID (HOSPICE)

Facility

$5.32

Hospital Charge Code	41655326
Hospital Revenue Code	250
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$4.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.66
Rate for Payer: Aetna Government	$2.66
Rate for Payer: Brighton Health Commercial	$3.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.62
Rate for Payer: Group Health Inc Commercial	$2.66
Rate for Payer: Group Health Inc Medicare	$1.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.66
Rate for Payer: Hamaspik Choice Inc Medicare	$2.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.46

OXYCODONE 40 MG TAB ER

Facility

$11.93

Hospital Charge Code	41645313
Hospital Revenue Code	250
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$9.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.96
Rate for Payer: Aetna Government	$5.96
Rate for Payer: Brighton Health Commercial	$8.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.11
Rate for Payer: Group Health Inc Commercial	$5.96
Rate for Payer: Group Health Inc Medicare	$4.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.96
Rate for Payer: Hamaspik Choice Inc Medicare	$5.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.75

OXYCODONE 40 MG TAB ER

Facility

$11.93

Hospital Charge Code	41655313
Hospital Revenue Code	250
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$9.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.96
Rate for Payer: Aetna Government	$5.96
Rate for Payer: Brighton Health Commercial	$8.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.11
Rate for Payer: Group Health Inc Commercial	$5.96
Rate for Payer: Group Health Inc Medicare	$4.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.96
Rate for Payer: Hamaspik Choice Inc Medicare	$5.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.75

OXYCODONE 5 MG/0.25 ML CONC LIQUID (HOSP

Facility

$1.00

Hospital Charge Code	41655425
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

Know your out-of-pocket cost for care.

All Charges