St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OXYCODONE 5 MG/0.25 ML CONC LIQUID (HOSP

Facility

$1.00

Hospital Charge Code	41645425
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 5 MG TAB

Facility

$1.00

Hospital Charge Code	41655315
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 5 MG TAB

Facility

$1.00

Hospital Charge Code	41645315
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 80 MG TAB ER

Facility

$22.45

Hospital Charge Code	41655314
Hospital Revenue Code	250
Min. Negotiated Rate	$7.86
Max. Negotiated Rate	$17.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.22
Rate for Payer: Aetna Government	$11.22
Rate for Payer: Brighton Health Commercial	$16.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.27
Rate for Payer: Group Health Inc Commercial	$11.22
Rate for Payer: Group Health Inc Medicare	$7.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.22
Rate for Payer: Hamaspik Choice Inc Medicare	$11.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.59

OXYCODONE 80 MG TAB ER

Facility

$22.45

Hospital Charge Code	41645314
Hospital Revenue Code	250
Min. Negotiated Rate	$7.86
Max. Negotiated Rate	$17.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.22
Rate for Payer: Aetna Government	$11.22
Rate for Payer: Brighton Health Commercial	$16.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.27
Rate for Payer: Group Health Inc Commercial	$11.22
Rate for Payer: Group Health Inc Medicare	$7.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.22
Rate for Payer: Hamaspik Choice Inc Medicare	$11.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.59

OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS [5940]

Facility

$1.37

Service Code	NDC 00406051223
Hospital Charge Code	00406051223
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.69
Rate for Payer: Aetna Government	$0.69
Rate for Payer: Brighton Health Commercial	$1.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.93
Rate for Payer: Group Health Inc Commercial	$0.69
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.69
Rate for Payer: Hamaspik Choice Inc Medicare	$0.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.89

OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS [5940]

Facility

$1.37

Service Code	NDC 00406051201
Hospital Charge Code	00406051201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.68
Rate for Payer: Aetna Government	$0.68
Rate for Payer: Brighton Health Commercial	$1.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.93
Rate for Payer: Group Health Inc Commercial	$0.68
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68
Rate for Payer: Hamaspik Choice Inc Medicare	$0.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.89

OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS [5940]

Facility

$1.37

Service Code	NDC 00406051262
Hospital Charge Code	00406051262
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.68
Rate for Payer: Aetna Government	$0.68
Rate for Payer: Brighton Health Commercial	$1.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.93
Rate for Payer: Group Health Inc Commercial	$0.68
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68
Rate for Payer: Hamaspik Choice Inc Medicare	$0.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.89

OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS [5940]

Facility

$0.20

Service Code	NDC 42858010201
Hospital Charge Code	42858010201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.13
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.13

OXYCODONE AND METABOLITE

Facility

$49.93

Service Code	HCPCS 80365
Hospital Charge Code	40609840
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$39.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$37.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.95
Rate for Payer: Group Health Inc Commercial	$24.96
Rate for Payer: Group Health Inc Medicare	$17.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.96
Rate for Payer: Hamaspik Choice Inc Medicare	$24.96
Rate for Payer: United Healthcare Commercial	$23.93

OXYCODONE HCL 100 MG/5ML PO CONC [10812]

Facility

$11.34

Service Code	NDC 68308002003
Hospital Charge Code	68308002003
Hospital Revenue Code	250
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$9.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.67
Rate for Payer: Aetna Government	$5.67
Rate for Payer: Brighton Health Commercial	$8.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.71
Rate for Payer: Group Health Inc Commercial	$5.67
Rate for Payer: Group Health Inc Medicare	$3.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.67
Rate for Payer: Hamaspik Choice Inc Medicare	$5.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.37

OXYCODONE HCL 100 MG/5ML PO CONC [10812]

Facility

$7.29

Service Code	NDC 00121082601
Hospital Charge Code	00121082601
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$5.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.65
Rate for Payer: Aetna Government	$3.65
Rate for Payer: Brighton Health Commercial	$5.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.96
Rate for Payer: Group Health Inc Commercial	$3.65
Rate for Payer: Group Health Inc Medicare	$2.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.65
Rate for Payer: Hamaspik Choice Inc Medicare	$3.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.74

OXYCODONE HCL 100 MG/5ML PO CONC [10812]

Facility

$11.10

Service Code	NDC 00406855730
Hospital Charge Code	00406855730
Hospital Revenue Code	250
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$8.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.55
Rate for Payer: Aetna Government	$5.55
Rate for Payer: Brighton Health Commercial	$8.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.55
Rate for Payer: Group Health Inc Commercial	$5.55
Rate for Payer: Group Health Inc Medicare	$3.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.55
Rate for Payer: Hamaspik Choice Inc Medicare	$5.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.21

OXYCODONE HCL 100 MG/5ML PO CONC [10812]

Facility

$4.49

Service Code	NDC 68094080101
Hospital Charge Code	68094080101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$3.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.24
Rate for Payer: Aetna Government	$2.24
Rate for Payer: Brighton Health Commercial	$3.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.05
Rate for Payer: Group Health Inc Commercial	$2.24
Rate for Payer: Group Health Inc Medicare	$1.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.24
Rate for Payer: Hamaspik Choice Inc Medicare	$2.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.92

OXYCODONE HCL 10 MG PO TABS [87795]

Facility

$1.46

Service Code	NDC 00406851062
Hospital Charge Code	00406851062
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$1.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.73
Rate for Payer: Aetna Government	$0.73
Rate for Payer: Brighton Health Commercial	$1.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.99
Rate for Payer: Group Health Inc Commercial	$0.73
Rate for Payer: Group Health Inc Medicare	$0.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.73
Rate for Payer: Hamaspik Choice Inc Medicare	$0.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.95

OXYCODONE HCL 10 MG PO TABS [87795]

Facility

$0.69

Service Code	NDC 68084096811
Hospital Charge Code	68084096811
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.35
Rate for Payer: Aetna Government	$0.35
Rate for Payer: Brighton Health Commercial	$0.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.47
Rate for Payer: Group Health Inc Commercial	$0.35
Rate for Payer: Group Health Inc Medicare	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.45

OXYCODONE HCL 10 MG PO TABS [87795]

Facility

$0.63

Service Code	NDC 65162004810
Hospital Charge Code	65162004810
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.31
Rate for Payer: Aetna Government	$0.31
Rate for Payer: Brighton Health Commercial	$0.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.43
Rate for Payer: Group Health Inc Commercial	$0.31
Rate for Payer: Group Health Inc Medicare	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31
Rate for Payer: Hamaspik Choice Inc Medicare	$0.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.41

OXYCODONE HCL 10 MG PO TABS [87795]

Facility

$0.89

Service Code	NDC 42858000210
Hospital Charge Code	42858000210
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.61
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.58

OXYCODONE HCL 5 MG PO TABS [10814]

Facility

$0.39

Service Code	NDC 00904696661
Hospital Charge Code	00904696661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.26

OXYCODONE HCL 5 MG PO TABS [10814]

Facility

$0.62

Service Code	NDC 42858000110
Hospital Charge Code	42858000110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.31
Rate for Payer: Aetna Government	$0.31
Rate for Payer: Brighton Health Commercial	$0.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.42
Rate for Payer: Group Health Inc Commercial	$0.31
Rate for Payer: Group Health Inc Medicare	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31
Rate for Payer: Hamaspik Choice Inc Medicare	$0.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.40

OXYCODONE HCL 5 MG PO TABS [10814]

Facility

$0.08

Service Code	NDC 42858000101
Hospital Charge Code	42858000101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

OXYCODONE HCL 5 MG PO TABS [10814]

Facility

$0.54

Service Code	NDC 00406055262
Hospital Charge Code	00406055262
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Brighton Health Commercial	$0.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.37
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.35

OXYCODONE HCL 5 MG PO TABS [10814]

Facility

$0.54

Service Code	NDC 00406055223
Hospital Charge Code	00406055223
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Brighton Health Commercial	$0.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.37
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.35

OXYCODONE HCL 5 MG PO TABS [10814]

Facility

$0.54

Service Code	NDC 10702001801
Hospital Charge Code	10702001801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Brighton Health Commercial	$0.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.37
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.35

OXYCODONE HCL ER 10 MG PO T12A [122363]

Facility

$6.57

Service Code	NDC 59011041020
Hospital Charge Code	59011041020
Hospital Revenue Code	250
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$5.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.28
Rate for Payer: Aetna Government	$3.28
Rate for Payer: Brighton Health Commercial	$4.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.47
Rate for Payer: Group Health Inc Commercial	$3.28
Rate for Payer: Group Health Inc Medicare	$2.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.28
Rate for Payer: Hamaspik Choice Inc Medicare	$3.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.27

Know your out-of-pocket cost for care.

All Charges