|
MINOXIDIL 10 MG TABLET [5114]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 49884025701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$5.82 |
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.40
|
| Rate for Payer: MDX Hawaii PPO |
$5.82
|
|
|
MINOXIDIL 10 MG TABLET [5114]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 49884025701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$5.82 |
| Rate for Payer: AlohaCare Medicaid |
$3.00
|
| Rate for Payer: AlohaCare Medicare |
$4.56
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Devoted Health Medicare |
$5.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.70
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Humana Medicare |
$4.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.56
|
| Rate for Payer: MDX Hawaii PPO |
$5.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.56
|
| Rate for Payer: University Health Alliance Commercial |
$4.37
|
|
|
MINOXIDIL 2.5 MG TABLET [5115]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 49884025601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
MINOXIDIL 2.5 MG TABLET [5115]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 49884025601
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$2.28
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Devoted Health Medicare |
$2.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$2.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.28
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.28
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
MIRTAZAPINE 15 MG TABLET [17466]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 68084011901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: AlohaCare Medicaid |
$2.00
|
| Rate for Payer: AlohaCare Medicare |
$3.04
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Devoted Health Medicare |
$3.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.80
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Humana Medicare |
$3.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.04
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.04
|
| Rate for Payer: University Health Alliance Commercial |
$2.92
|
|
|
MIRTAZAPINE 15 MG TABLET [17466]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 68084011901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.60
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
|
|
MIRTAZAPINE 15 MG TABLET [17466]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 68084011911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: AlohaCare Medicaid |
$2.00
|
| Rate for Payer: AlohaCare Medicare |
$3.04
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Devoted Health Medicare |
$3.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.80
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Humana Medicare |
$3.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.04
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.04
|
| Rate for Payer: University Health Alliance Commercial |
$2.92
|
|
|
MIRTAZAPINE 15 MG TABLET [17466]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 68084011911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.60
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
|
|
MIRTAZAPINE 30 MG TABLET [17465]
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
NDC 13107000334
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$9.70 |
| Rate for Payer: AlohaCare Medicaid |
$5.00
|
| Rate for Payer: AlohaCare Medicare |
$7.60
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Devoted Health Medicare |
$8.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.50
|
| Rate for Payer: Health Management Network Commercial |
$8.50
|
| Rate for Payer: Humana Medicare |
$7.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.60
|
| Rate for Payer: MDX Hawaii PPO |
$9.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.60
|
| Rate for Payer: University Health Alliance Commercial |
$7.29
|
|
|
MIRTAZAPINE 30 MG TABLET [17465]
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 68084012001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: AlohaCare Medicaid |
$2.50
|
| Rate for Payer: AlohaCare Medicare |
$3.80
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Devoted Health Medicare |
$4.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Humana Medicare |
$3.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.80
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.80
|
| Rate for Payer: University Health Alliance Commercial |
$3.64
|
|
|
MIRTAZAPINE 30 MG TABLET [17465]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 68084012001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.50
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
|
|
MIRTAZAPINE 30 MG TABLET [17465]
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
NDC 13107000334
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$9.70 |
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Health Management Network Commercial |
$8.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.00
|
| Rate for Payer: MDX Hawaii PPO |
$9.70
|
|
|
MIRTAZAPINE 30 MG TABLET [17465]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 68084012011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.50
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
|
|
MIRTAZAPINE 30 MG TABLET [17465]
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 68084012011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: AlohaCare Medicaid |
$2.50
|
| Rate for Payer: AlohaCare Medicare |
$3.80
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Devoted Health Medicare |
$4.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Humana Medicare |
$3.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.80
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.80
|
| Rate for Payer: University Health Alliance Commercial |
$3.64
|
|
|
MIRVETUXIMAB SORAVTANSINE-GYNX 5 MG/ML INTRAVENOUS SOLUTION [188970]
|
Facility
|
OP
|
$12,209.00
|
|
|
Service Code
|
HCPCS J9063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.52 |
| Max. Negotiated Rate |
$11,842.73 |
| Rate for Payer: AlohaCare Medicaid |
$6,104.50
|
| Rate for Payer: AlohaCare Medicaid |
$15,749.00
|
| Rate for Payer: AlohaCare Medicare |
$23,938.48
|
| Rate for Payer: AlohaCare Medicare |
$9,278.84
|
| Rate for Payer: Cash Price |
$18,898.80
|
| Rate for Payer: Cash Price |
$7,325.40
|
| Rate for Payer: Cash Price |
$18,898.80
|
| Rate for Payer: Cash Price |
$7,325.40
|
| Rate for Payer: Devoted Health Medicare |
$10,255.56
|
| Rate for Payer: Devoted Health Medicare |
$26,458.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$69.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$69.52
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$88.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$88.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23,938.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9,278.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$69.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$69.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11,598.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29,923.10
|
| Rate for Payer: Health Management Network Commercial |
$26,773.30
|
| Rate for Payer: Health Management Network Commercial |
$10,377.65
|
| Rate for Payer: Humana Medicare |
$9,278.84
|
| Rate for Payer: Humana Medicare |
$23,938.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$10,988.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$28,348.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16,063.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6,226.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$9,278.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$23,938.48
|
| Rate for Payer: MDX Hawaii PPO |
$11,842.73
|
| Rate for Payer: MDX Hawaii PPO |
$30,553.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23,938.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9,278.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$9,278.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$23,938.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18,898.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7,325.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$9,278.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$23,938.48
|
| Rate for Payer: University Health Alliance Commercial |
$8,899.14
|
| Rate for Payer: University Health Alliance Commercial |
$22,958.89
|
|
|
MIRVETUXIMAB SORAVTANSINE-GYNX 5 MG/ML INTRAVENOUS SOLUTION [188970]
|
Facility
|
IP
|
$12,209.00
|
|
|
Service Code
|
HCPCS J9063
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10,377.65 |
| Max. Negotiated Rate |
$11,842.73 |
| Rate for Payer: Cash Price |
$7,325.40
|
| Rate for Payer: Cash Price |
$18,898.80
|
| Rate for Payer: Health Management Network Commercial |
$10,377.65
|
| Rate for Payer: Health Management Network Commercial |
$26,773.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$10,988.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$28,348.20
|
| Rate for Payer: MDX Hawaii PPO |
$30,553.06
|
| Rate for Payer: MDX Hawaii PPO |
$11,842.73
|
|
|
MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC
|
Facility
|
IP
|
$20,217.81
|
|
|
Service Code
|
MSDRG 640
|
| Min. Negotiated Rate |
$20,217.81 |
| Max. Negotiated Rate |
$20,217.81 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20,217.81
|
|
|
MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC
|
Facility
|
IP
|
$15,738.13
|
|
|
Service Code
|
MSDRG 641
|
| Min. Negotiated Rate |
$15,738.13 |
| Max. Negotiated Rate |
$15,738.13 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15,738.13
|
|
|
MISOPROSTOL 100 MCG TABLET [10628]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 59762500701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$2.28
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Devoted Health Medicare |
$2.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$2.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.28
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.28
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
MISOPROSTOL 100 MCG TABLET [10628]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 59762500701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
MISOPROSTOL 200 MCG TABLET [10629]
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
NDC 60687074611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$9.70 |
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Health Management Network Commercial |
$8.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.00
|
| Rate for Payer: MDX Hawaii PPO |
$9.70
|
|
|
MISOPROSTOL 200 MCG TABLET [10629]
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
NDC 60687074611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$9.70 |
| Rate for Payer: AlohaCare Medicaid |
$5.00
|
| Rate for Payer: AlohaCare Medicare |
$7.60
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Devoted Health Medicare |
$8.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.50
|
| Rate for Payer: Health Management Network Commercial |
$8.50
|
| Rate for Payer: Humana Medicare |
$7.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.60
|
| Rate for Payer: MDX Hawaii PPO |
$9.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.60
|
| Rate for Payer: University Health Alliance Commercial |
$7.29
|
|
|
MISOPROSTOL 200 MCG TABLET [10629]
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
NDC 60687074601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$9.70 |
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Health Management Network Commercial |
$8.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.00
|
| Rate for Payer: MDX Hawaii PPO |
$9.70
|
|
|
MISOPROSTOL 200 MCG TABLET [10629]
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
NDC 60687074601
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$9.70 |
| Rate for Payer: AlohaCare Medicaid |
$5.00
|
| Rate for Payer: AlohaCare Medicare |
$7.60
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Devoted Health Medicare |
$8.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.50
|
| Rate for Payer: Health Management Network Commercial |
$8.50
|
| Rate for Payer: Humana Medicare |
$7.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.60
|
| Rate for Payer: MDX Hawaii PPO |
$9.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.60
|
| Rate for Payer: University Health Alliance Commercial |
$7.29
|
|
|
MISOPROSTOL 25 MCG QUARTER TABLET [400620]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 09999701554
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: AlohaCare Medicaid |
$0.50
|
| Rate for Payer: AlohaCare Medicare |
$0.76
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Devoted Health Medicare |
$0.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Humana Medicare |
$0.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.76
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.76
|
| Rate for Payer: University Health Alliance Commercial |
$0.73
|
|
